202 1 District of Columbia (DC) Individual Income Tax

D-40

Forms and Instructions

All Individual Income Tax Filers

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MyTax.eDCegov 4 wo Simpler. Faster. Safer.

¢ You may use MyTax.DC.gov to file and pay online for Forms D-40ES (estimated tax) and FR-127 (extension of time to file). ¢ Payments can be made by ACH debit, credit/debit card, check or money order (US dollars).

* Direct deposit, U.S. Bank ReliaCard™ or paper check refund options are available.

INSIDE Contents Chief Financial Officer's Letter 2 New for 2021 Income Tax Returns 3 Reminders 5 Instructions Who must file a DC income tax return? 7 Other forms you may have to file 7 When are your taxes due? 7 Extension of time to file 7 Filing your return 7 Payment options 8 Penalties and interest 8 Direct deposit of refund 13 Refund status inquiry 13

Forms D-40 form and schedules 35-90

Schedule S, Supplemental Information and Dependents Schedule H, Homeowner and Renter Property Tax Credit Schedule U, Additional Miscellaneous Credits and Contributions D-8609, District of Columbia Low-Income Housing Tax Credit Allocation and Certification

D-8609A, Reporting Form for the Allocation, Transfer, Sale or Assignment of Low-Income Housing Tax Credit

D-8609DS, Low-Income Housing Tax Credit Distribution Schedule Schedule |, Additions to and Subtractions from Federal Adjusted Gross Income

Schedule N, DC Non-Custodial Parent EITC Claim

Schedule ELC, Keep Child Care Affordable Tax Credit

Schedule HSR, DC Health Care Shared Responsibility

DC-8379, Injured Spouse Allocation

D-2210, Underpayment of Estimated Income Tax by Individuals D-40P, Payment Voucher

FR-127, Extension of Time to File a DC Income Tax Return

Tax tables and ads Tax tables for taxable income of $100,000 or less 91-100 DC College Savings Plan 101

Need assistance? Back Cover

At the time of printing, all forms and line references were correct. Any language changes will be announced on the DC website, MyTax.DC.gov.

Revised 07/2021

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GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF THE CHIEF FINANCIAL OFFICER

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Fitzroy Lee Acting Chief Financial Officer

Dear Taxpayer:

On behalf of the Office of Tax and Revenue (OTR), Iam pleased to welcome you to the 2022 tax season.

As part of our commitment to better serve District taxpayers, OTR continues to offer many services online at MyTax.DC.gov for individual income, business, and real property taxes. In October, OTR reopened its Walk-In Center and Recorder of Deeds (ROD) office for in-person services. Appointments are preferred, however, walk-in service is available on a first-come, first-serve basis, Monday through Friday, from 9am to 4pm. You can schedule an appointment by visiting OTR’s website at otr.cfo.dc.gov.

In our continuing efforts to keep you abreast of tax changes, I would like to bring to your attention a few updates for this filing season:

e D-40ES, Individual Income Estimated Tax Booklet: OTR will no longer mail the Estimated Payment for Individual Income Tax booklet (D-40ES). Returns and payment may be submitted via MyTax.DC.gov or electronically through a tax professional or software vendor. The form/coupon can also be downloaded from OTR’s

website at otr.cfo.dc.gov under “Forms” and mailed to the address listed in the instructions.

e DC Fillable Forms and Free File: OTR has retired its D-40 fillable form option and will no longer participate in DC Free File.

However, taxpayers can now file their 2021 D-40 form and schedules at no cost at

MyTax.DC. gov.

e Unemployment Insurance Benefits: For taxable years beginning January 1, 2021, unemployment insurance benefits provided by the federal government, District of Columbia, and any other state, are excluded in the

computation of District gross income. To learn more about what’s new this filing season, visit MyTax.DC.gov.

Sincerely,

Aha Lee

Fitzroy Lee

John A. Wilson Building * 1350 Pennsylvania Avenue, NW * Suite 203 * Washington, DC 20004 Phone: (202) 727-2476 * Fax: (202) 727-1643 * www.cfo.dc.gov

New for 2021 Income Tax Returns

¢ Filing Deadline For Tax Year 2021 the filing deadline is April 18, 2022.

* The D-40 form has been revised.

¢ DC Fillable Forms and Free File. OTR has retired its D-40 fillable form option and will no longer participate in DC Free File. The web portal, MyTax.DC.gov offers the ability to file online the D-40/Schedules with certain limitations, to registered taxpayers.

¢ The standard deductions are increasing based on the federal law; beginning January 1, 2021, from:

$12,400 to $12,550 for single and married/registered domestic partner filers filing separately;

$18,650 to $18,800 for head of household filers;

$24,800 to $25,100 for married/registered partners filing jointly and qualifying widow(er) with dependent child(ren) filers; An updated worksheet is available for use by dependent filers.

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¢ Additional Standard Deduction. If born before January 2, 1957, or blind, an additional standard deduction of $1,350 ($1,700 if single or head of household) is allowed — use Schedule S, Calculation G-1. The Schedule S, Calculation G-1 must be submitted with your return. When married filing separately, you may take an additional standard deduction for your spouse/registered domestic partner only if your spouse/ registered domestic partner had no gross income, is not filing a return, and cannot be claimed as a dependent by another taxpayer.

¢ Earned Income Tax Credit (EITC)

o The American Rescue Plan Act of 2021 (ARPA) includes changes to the Earned Income Tax Credit. For taxable years beginning January 1, 2021:

¢ Taxpayers may now be eligible for childless earned income in the case of qualifying children who fail to meet certain identification requirements. See ARPA, § 9622 and IRC § 32, as amended.

¢ The earned income tax credit is now allowed in the case of separated spouses if certain requirements are met. ARPA, § 9622 and IRC § 32(d), as amended.

* The investment income test is increased from $3,650 to $10,000, adjusted for inflation after 2021.

o Temporary Special Rules for 2021 Only

¢ If your earned income in tax year 2021 is less than your earned income in tax year 2019, the earned income credit for tax year 2021 can be determined by substituting your tax year 2019 earned income for your tax year 2021 earned income. In the case of a joint return, the earned income of the taxpayer for taxable year 2019 must be the sum of the earned income of each spouse for such taxable year. ARPA, § 9626.

¢ Inthe case of individuals without qualifying children, the EITC is expanded by decreasing the minimum age of claimants from 25 to age 19, except that it is age 24 for a specified student, or age 18 for a qualified former foster youth or qualified homeless youth. The maximum age of 65 has been eliminated. In addition, there is an increase in the credit and phaseout percentages, and an increase in earned income and phaseout amounts.

¢ Unemployment Insurance o For taxable years beginning January 1, 2021, unemployment insurance benefits provided by the federal government, District of Columbia, and any other state, are excluded in the computation of District gross income.

¢ Schedule HSR - DC Health Care Shared Responsibility o The D-40 filing thresholds have changed, refer to the instructions. o The District Average Bronze Plan Premium Calculation (Worksheet C-1) amounts have been updated.

¢ Schedule H - Homeowner and Renter Property Tax Credit o The real property tax credit is now based on your DC real property tax bill for tax year 2021. Do not include special assessments, interest penalties and services charges. o The maximum property tax credit limit is increased from $1,200 to $1,225 Schedule H federal Adjusted Gross Income (AGI) eligibility threshold for under age 70 increases to $56,200. o Schedule H federal AGI eligibility threshold for age 70 and older increases to $76,700.

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Schedule U - Additional Miscellaneous Credit and Contributions o DC Government Employee first-time home buyer credit is expired o DC Low-Income Housing Tax Credits (LIHTC) are now available to entities/taxpayers investing in qualified projects located in the District. See instructions.

Schedule ELC — Keep Child Care Affordable Tax Credit o The District taxable income thresholds have changed. o The maximum credit amount has been increased to $1,020. o The Child Development Facility License Number (Line 7a) issued by the Office of the State Superintendent of Education (OSSE) is a mandatory field.

D40ES - Individual Income Estimated Tax Booklet. o DC Office of Tax and Revenue (OTR) will no longer mail the D40ES, Estimated Payment for Individual Income Tax booklet. You may file/pay by either a) using the DC web portal, MyTax.DC.gov; b) via MeF; or c) print the coupon from the DC website and mail to the applicable address.

Exclusion of Certain Grants From District Gross Income o The District of Columbia enacted legislation amending D.C. Code § 47-1803.02 to exclude certain grants made by the District from District gross income. See instructions page 9, "Special Filing Circumstances" for guidance on how to report and exclude the amount of these grants from District gross income on your District income tax return for tax year 2021.

Reminders

Verify your Tax Preparer. You are responsible for the submission of your DC Tax Return. Also, if you file electronically, you must receive a copy of your D-40E form for your records in addition to a copy of your DC return.

If you claim a standard deduction on your federal return, you must also claim the standard deduction on your DC return.

DC Earned Income Tax Credit for Childless Workers A DC Earned Income Tax Credit Worksheet for Filers Without A Qualifying Child is included in the Individual Income Tax Forms and Instructions Booklet.

Schedule | — Additions To and Subtractions From Federal Adjusted Gross Income ¢ 2020 Approved DC Opportunity Zone Tax Benefits. Taxpayers may defer the realization of capital gains for investing in an approved District of Columbia Qualified Opportunity Fund. ¢ — Excluded Workers. . During the public health emergency declared in the Mayor's order dated March 11, 2020 and any extensions thereof, the Washington Convention and Sports Authority shall issue, subject to the availability of funds, grants or contracts to nonprofit entities to use to provide cash assistance to District residents who are otherwise excluded from District and federal aid related to COVID-19. . Cash assistance for excluded workers given pursuant to grants awarded by the Washington Convention and Sports Authority in 2021 are non-taxable by the District and thus excluded in the computation of District gross income. If you are a recipient of such assistance, and the amount is included in your federal gross adjusted gross income for federal taxpurposes, use Schedule |, Calculation B, Line 13 to subtract the amount from your federal adjusted gross income for District tax purposes.

D-40P, Payment Voucher is a non-year specific form. The email address has been added to the D-40, it is not mandatory but requested.

DC is collecting sales tax for online purchases. Use the online FR-329, Consumer Use Tax Return to report the sales tax for online purchases on which sales tax was not paid.

State and Local Taxes (SALT). DC does not allow a deduction for state and local income taxes. However, you can deduct your entire state and local real estate taxes. Refer to Calculation D if a part-year resident, or Calculation F if a full-year resident.

1099-G - In January 2020, DC began offering a paperless option for receiving the 1099-G income tax refund statement. You will continue to receive your paper statement unless you choose the paperless option. See instructions.

Statutory Resident/Part-Year Resident instructions have been updated. Some taxpayers who have filed in the past as part-year residents may now be required to file as statutory residents. See instructions.

Schedule HSR - DC Health Care Shared Responsibility. If you and your health care shared responsibility family had full coverage the entire year, do not complete this schedule. Complete the oval on Line 3 of the D40 and enter zero ($0) on Line 25.

Receiving your refund via the U.S. Bank ReliaCard Pre-Acquisition Disclosures

The Consumer Financial Protection Board (CFPB) has published its final Prepaid Account Rule, creating detailed consumer protections for prepaid accounts. For tax year 2020, if you elect to receive a refund using the U.S. Bank ReliaCard™ or use a pre-paid card to make payments, you are required to review and acknowledge the Pre-Acquisition Disclosures (Short and Long Forms) prior to selecting the ReliaCard option as method for receiving a refund or using a pre-paid card when making a payment. Copies of the U.S. Bank ReliaCard Pre-Acquisition Disclosure and the U.S. Bank ReliaCard Fee Schedule can be found on

pages 25-32.

An oval was added to the D-40 form (Line 44) if claiming Injured Spouse Allocation. When claiming this allocation, you must attach Form DC-8379 to your return at the time of filing, otherwise, the offsets may not be recoverable by OTR.

¢ District of Columbia Opportunity Zone Tax Benefits - The Tax Cuts and Jobs Act of 2017 included a provision called ‘Opportunity Zones' which established certain tax benefits for federal taxpayers with capital gains who invest those gains into a Qualified Opportunity Fund (QOF). A QOF is an investment vehicle that files either a partnership or corporation federal income tax return and is organized for the purpose of investing in Qualified Opportunity Zone property. Pursuant to the "Aligning Opportunity Zone Tax Benefits with DC Community Priorities Emergency Act of 2020", the District of Columbia has also acted to establish certain tax benefits for DC taxpayers with capital gains who invest those gains into an approved DC QOF.

The District of Columbia Opportunity Zone Tax Benefits available to a DC taxpayer, if the taxpayer meets certain criteria, are: (1) a deferral of a capital gains tax payment for investing in a QOF; (2) a reduction of capital gains tax liability through a 10% step-up in basis, if invested in a QOF for 5 years prior to December 31, 2026, and an additional 5% step-up in basis, if invested in a QOF for 7 years prior to December 31, 2026; and (3) an abatement of capital gains tax on an investment of capital gains in a QOF for at least 10 years before December 31, 2047.

DC taxpayers seeking the capital gains tax deferral, reduction or abatement at the District level must invest in a QOF that: (1) is a QOF approved by the District of Columbia Government; and (2) has invested at least the value of the taxpayer's investment in the QOF in eligible Qualified Opportunity Zones Businesses (QOZBs) or Qualified Opportunity Zones Business Property (QOZBP) in the District of Columbia.

The District taxpayer investor will need to submit a DC QOF Approval letter issued by the Office of the Deputy Mayor for Planning and Economic Development (DMPED) with their tax returns, along with IRS Forms 8996 and 8997 for the tax year for which the taxpayer is seeking the benefits. The taxpayer must also submit other relating federal forms, if applicable, such as federal forms 8949, 4797, and federal Schedules K-1 and Schedule D, including any other information that OTR may require to administer the benefits.

If you have capital gain deferred on your federal return due to an investment in a Federal Qualified Opportunity Fund, add back the amount of the deferment on Line 8 of Schedule | and attach it to your D-40 return.

If you have capital gain deferred due to an investment in a DC approved DC Qualified Opportunity Fund, subtract the amount of the deferment on Line 15 of Schedule |, provided this amount is also included in Line 8 of Schedule I.

See DC Code §§ 47-1801.04(39A), (39B), (39C), (39D); and 47-1803.03(a)(20). For more information about the Qualified Opportunity Funds approval process and eligible investments, contact DMPED at DCQOF@dc.gov or (202) 727-6365. To apply for DC approved Opportunity Zone Tax Benefits, visit OZMarketplace.dc.gov.

The Office of Tax and Revenue Will No Longer Prepare Individual Income Tax Returns

The Office of Tax and Revenue (OTR) will no longer prepare District of Columbia individual income tax returns at its Walk-In Center located at 1101 4th Street, SW, Washington, DC 20024. OTR recommends the following free tax preparation services available throughout the District of Columbia and online:

¢ VITA - By appointment only.

The Internal Revenue Service (IRS) Volunteer Income Tax Assistance (VITA) program offers free tax preparation to low-moderate income taxpayers. IRS-certified volunteers help eligible taxpayers e-file their federal and District tax returns. During the filing season, taxpayers can locate the VITA site nearest them by visiting http://irs.treasury.gov/freetaxprep/ or call 1-800-906-9887.

¢ — AARP (Tax-Aide Locator) — By appointment only.

The Tax-Aide Program offers free tax help for everyone, with priority assistance to taxpayers who are 60 years of age and older, specializing in questions about pensions, and retirement issues unique to seniors. During the filing season, taxpayers can locate a site nearest them at https://secure.aarp.org/applications/VMISLocator/search TaxAideLocations.action or call 1-888-227-7669.

¢ MyTax.DC.gov — The OTR web portal offers the ability to file online the D-40/Schedules with certain limitations. Should you have additional questions, please call OTR’s Telephone Center at (202) 727-4TAX (4829). * DO NOT STAPLE OR DESTROY THE BARCODE PRINTED AT THE TOP OF THE RETURN.

¢ DO NOT USE THE 2021 RETURN IF YOU ARE FILING FOR A PREVIOUS YEAR. REFER TO THE BOOKLET AND INSTRUCTIONS ON THE DC WEBSITE MYTAX.DC.GOV, ‘FORMS,’ PRIOR YEAR FORMS.

Instructions

Who must file a DC Income tax return?

You must file a 2021 DC Individual Income Tax Return if:

* You were a District of Columbia (DC) resident in 2021 and were required to file a federal income tax return. (A resident is an individual domiciled in DC at any time during the taxable year);

¢ You maintained a place of abode in DC for a total of 183 days or more during 2021 even if your permanent home was outside DC;

¢ You were a part-year resident of DC during 2021 (see instructions for part-year residents, page 17);

* You were a member of the United States (US) armed forces and DC was your legal residence for tax purposes for all or part of 2021.

¢ — If you want to receive a refund of DC taxes withheld or estimated payments made during the year, or if you qualify for and want to receive the following refundable credits:

o DC Earned Income Credit;

o Schedule N, Non-Custodial Parent Earned Income Credit;

o Schedule H, Homeowner and Renter Property Tax Credit; or o Schedule ELC, Keep Child Care Affordable Tax Credit.

Note: If you are the spouse/registered domestic partner of someone

not required to file, such as a nonresident Congressional appointee,

and you meet any of the above requirements, you yourself must file.

You do not need to file a 2021 DC Individual Income tax return if:

¢ You were not required to file a 2021 federal income tax return;

¢ You were not considered a resident of DC during 2021;

¢ You were an elected member of the US government who was not domiciled in DC;

¢ You were an employee on the personal staff of an elected member of the US Congress and you and the elected member were bona fide residents of the same state;

¢ You were a member of the US Executive Branch appointed by the President, subject to US Senate confirmation, whose tenure of office is at the pleasure of the President and you were not domiciled in DC during any part of 2021; or

¢ You were a justice of the US Supreme Court and were not domi- ciled in DC during any part of 2021.

Other forms you may have to file

D-40B Nonresident Request for Refund

If you were not a DC resident and you had DC taxes withheld or you are requesting a refund for erroneous estimated taxes paid, file Form D-40B, Nonresident Request for Refund, along with your W2's or 1099s attached. Military Spouses must include DD FORM 2058, JAN 2018 to honor your request for refund, including your W-2s and/ or 1099s. Schedule K-1's are not a substitute for W2/1099. Failure to provide this information will delay processing your request.

D-40ES Estimated Payment for Individual Income Tax

You must file these vouchers if you are required to file a District of Columbia (DC) income tax return and, you expect to owe $100 or more in taxes. See Worksheet to Estimate DC Tax Payments. You will automatically be assessed interest for any underpayment of DC estimated tax.

Note: Electronic payment required. If the amount of the payment due for a period exceeds $5,000, you must pay electronically. Visit MyTax.DC.gov.

D-41 Fiduciary Income Tax Return Use the D-41 if you are the fiduciary of a DC estate or trust and the gross income for the trust is $100 or more for the year.

FR-329 Consumer Use Tax on Purchases and Rentals

You should file this form electronically via the DC web portal and pay if during the tax year you paid a total of more than $400 for merchandise, services, or rentals subject to DC use tax on which you did not pay sales tax. Visit MyTax.DC.gov for more information.

When are your taxes due?

April 18, 2022 is the deadline for filing your return and paying any taxes due. If the due date falls on a Saturday, Sunday, or legal holiday, the return is timely if filed on the next business day.

Extension of Time to File

FR-127 Extension of Time to File a DC Income Tax Return

An extension of time to file of six months may be granted if a valid extension of time to file is requested. In order to be valid, an FR-127 Extension of Time to File form is due by April 18, 2022. If the due date falls on a Saturday, Sunday, or legal holiday, the request for extension of time is timely if filed on the next business day. The submission of the extension of time to file is subject to the following considerations:

1. If you expect to have a balance due when you file your D-40, you must pay with your timely filed extension. Penalty and interest charges are imposed on any tax found owing and not paid on time with the extension request.

2. If you do not expect to have a balance due when you file your D-40, you would not be required to file a Form FR-127, if you have reasonably estimated your D-40 tax liability and paid the estimated amount of DC income taxes through withholding or estimated tax payment; and

3. If you do not expect to have a balance due and wish to request an extension for your DC income tax return, you should submit a Form FR-127.

Additional extensions

In addition to the 6-month extension, you may receive an additional 6-month extension if you are living or traveling outside the U.S. You must file for the first 6-month extension by the April 18, 2022 deadline before applying for the additional extension of time to file.

Extensions for Members of the US Armed Forces Deployed in a Combat Zone or Contingency Operation.

Deadlines for filing your return, paying your tax, claiming a refund, and taking other actions with OTR is extended for persons in the Armed Forces serving in a Combat Zone or a Contingency Operation. The extension also applies to spouses/registered domestic partners, whether they file jointly or separately on the same return. See IRS Pub. 3, Armed Forces Tax Guide for further information.

Filing your return

This booklet has all the forms and instructions you will need. You are responsible for filing and paying taxes on time whether or not you receive the printed forms.

¢ Modernized e-File (MeF)

MeF offers most DC individual income taxpayers a full federal/ state electronic filing program. There are three ways in which taxpayers can file their federal and District returns together electronically:

1. Through an authorized software provider listed on the IRS website or the OTR website;

2. Through a tax practitioner who is an authorized e-File provider; or

3. Through a commercial online filing service. This allows taxpayers to transmit their DC and federal returns from their PC for a fee.

If you use the e-File options to file your DC return, you also have three options to receive your refund:

1. Direct Deposit; 2. U.S. Bank ReliaCard™; or 3. Paper Check.

Be sure to make a selection on the return for the refund option that you want. If you do not select an option, you will receive a paper check. Please review the information about the refund card at the front of the book. Instructions for direct deposit can be found on page 13.

Electronic Filing Instructions

The instructions in this booklet are specifically for filers of paper returns. When you file electronically, note that the instructions may differ. Follow the "on screen" instructions. If you need further expla- nations, review the instructions in this booklet.

¢ Substitute forms You may file your DC tax return using a computer-prepared or computer-generated substitute form, provided the form is approved in advance by the Office of Tax and Revenue (OTR). The fact that a software package is available for retail purchase does not mean that the substitute form has been approved for use. Call or check with the software developer to determine if their form is a DC OTR approved form.

¢ By mail ¢ — If mailing a return with a payment, send it to: Office of Tax and Revenue PO Box 96169 Washington, DC 20090-6169

¢ — If mailing a refund request return or a no money due return, send it to: Office of Tax and Revenue PO Box 96145 Washington, DC 20090-6145

There are two adhesive mailing labels on the back flap of your return envelope. If you are sending a payment with your return, use the PO Box 96169 mailing label on your return envelope. If you are filing a no money due or a refund request return, use the PO Box 96145 mail label on your return envelope.

Do not include more than one return per envelope.

Payment Options

ACH Debit

ACH debit is available for taxpayers who have signed up for MyTax.DC.gov. There is no fee. Bank account information is stored within their online account. MyTax.DC.gov can store multiple bank accounts across mutiple tax types. Taxpayers give the right to debit the money from their bank account. Ensure you allow 1-3 business days if entering change of banking information.

Direct Debit

Electronic filers have the ability to pay their tax due or estimated pay- ment by direct debit. Enter your banking information, including the routing and account numbers, checking or savings account and the date of withdrawal. The date of withdrawal cannot be greater than thirty (30) days after the due date of the return.

Credit/Debit Card

The taxpayer may pay the amount owed using Visa®, MasterCard®, Discover® or American Express®. You will be charged a fee that is paid directly to the District's credit card service provider. Payment is effec- tive on the day it is charged. Visit MyTax.DC.gov for more information.

Visit the website MyTax.DC.gov for Credit/Debit Card Payment Infor- mation.

Note: International ACH Transaction (IAT). Your payment cannot be drawn on a foreign account. You must pay by money order (US dol- lars) or credit card instead.

Check or money order (US dollars)

Include a check or money order (US dollars), payable to the DC Trea- surer, with your completed return. Write your Taxpayer Identification Number (TIN), daytime telephone number, tax year “2021” and “Form D-40” on your payment. Attach your payment to the Form D-40P voucher provided in this booklet. Do not attach either to your return.

Form D-40P, Payment Voucher - by mail

Use this form when sending a check or money order. Do not staple the voucher to the D-40. If you pay at the same time you file your return, include the D-40P with your D-40 in the return envelope provided. Use the PO Box 96169 mail label from the back flap of the return envelope.

Dishonored Payments

Make sure your check or electronic payment will clear. You will be charged a $65 fee if your check or electronic payment is not honored by your financial institution and returned to OTR.

Penalties and Interest

OTR will charge —

¢ Apenalty of 5% per month if you fail to file a return or pay any tax due on time. It is computed on the unpaid tax for each month, or fraction of a month, that the return is not filed or the tax is not paid. It may not exceed an additional amount equal to 25% of the tax due;

¢ A 20% penalty on the portion of an underpayment of taxes if attributable to negligence. Negligence is a failure to make a reasonable attempt to comply with the law or to exercise ordinary and reasonable care in preparing tax returns without the intent to defraud. One indication of negligence is failure to keep adequate books and records;

¢ — Interest of 10% per year, compounded daily, on a late payment;

¢ A one-time fee to cover internal collection efforts on any unpaid balance. The collection fee assessed is 10% of the tax balance due after 90 days. Payments received by OTR on accounts subject to the collection fee are first applied to the collection fee, then to the penalty, interest and tax owed;

¢ A civil fraud penalty of 75% of the underpayment which is at- tributable to fraud (see DC Code §47-4212).

For Estimated Tax Underpayment Interest, Form D-2210, use D-40 Line 40. The form can also be located at MyTax.DC.gov. File the Form D-2210 with your return.

Criminal Penalties

You will be penalized under the criminal provisions of the DC Code,

Title 47, if you are required to file a return or report, or to perform

any act, and you:

¢ — Fail to file the return or report timely. If convicted, you will be fined not more than $1,000 or imprisoned for not more than 180 days, or both, for each failure or neglect;

¢ — Willfully fail to file the return or report timely. If convicted, you will be fined not more than $1,000 or imprisoned for not more than 180 days, or both;

¢ Willfully attempt to evade or defeat a tax; willfully fail to collect, account for, or pay a tax; or willfully make fraudulent and false statements or fail to provide information. See DC Official Code §47-4101 through 4107.

These penalties are in addition to penalties under DC Code §22-2405 for false statements (and any other applicable penalties).

Enforcement Actions

OTR may use lien, levy, seizure, collection agencies, and liability offset if the taxpayer fails to pay the District within 20 days after receiving a Notice of Tax Due and a demand for payment. Visit MyTax.DC.gov.

Special filing circumstances

Amended return

File an amended DC return if your DC tax liability for a prior open tax year (usually 3 years from date of filing) has changed on the D-40 return for the tax year you are amending. To file an amended return for the current year, complete another 2021 DC Individual Income Tax Return and fill in the "amended return" oval on the form. Attach a list with explanations of the changes covered by your amended return.

If you are filing an amended return for a prior year, attach a copy of the original and any amended returns filed for that tax year. You can download forms from MyTax.DC.gov or call 202-727-4829 to request forms by mail.

If the IRS adjusts your individual federal tax return, you must file an amended DC return within 90 days of receiving a final determination of the federal adjustment. Attach a copy of the adjusted federal return and/or determination letter.

Filing for a deceased taxpayer. Fill in the oval for a deceased tax- payer at the top of the page of the D-40.

If a taxpayer died in 2020 or 2021 before filing a return, a return must be filed for that person. Complete a D-40 on the correct year's tax return and provide the deceased person's information, not your own. Do not adjust the deceased's income, exemptions or deductions to reflect the date of death, unless a D-41 is being filed for the remainder of the year after the date of death. Tax preparers, other than the surviving spouse/registered domestic partner, such as executors, attorneys, or other personal representatives, must attach letters of administration. If a refund is due, all tax preparers must attach a completed Form FR-147, Statement of Persons Claiming Refund Due a Deceased Taxpayer, found on MyTax.DC.gov and a copy of the death certificate. Do not use the federal form to request a DC refund. Refunds will be issued by paper check only.

Joint Returns After Separate Returns

You can change your filing status from a separate return to a joint return by filing an amended return. You generally can change a joint return anytime within three (3) years from the due date of the separate return

or returns. This does not include any extensions. A separate return includes a return filed by you or your spouse/registered domestic partner claiming married filing separately, registered domestic partners filing separately, single, or head of household filing status.

Separate Returns After Joint Return

Once you file a joint return, you cannot choose to file separate returns for that year after the due date of the return. Exception. A personal representative for a decedent can change from a joint return elected by the surviving spouse to a separate return for the decedent. The personal representative has one (1) year from the due date of the return (including extensions) to make this change.

Exclusion of Certain Grants From District Gross Income

The District of Columbia enacted legislation amending D.C.Code § 47-1803.02 to exclude the following grants made by the District from District gross income:

¢ Small business loans awarded and subsequently forgiven under § 7A of the Small Business Act (15 U.S.C. § 636m);

¢ For tax years beginning after December 31, 2020, public health emergency response grants issued pursuant to § 5b of the District of Columbia Public Emergency Act of 1980 (D.C. Official Code § 7-2304.02);

¢ Public health emergency small business grants awarded pursuant to section 2316 of the Small and Certified Business Enterprise Development and Assistance Act of 2005 (D.C. Law 24-9; 68 DCR 6913);

¢ Public health emergency grants authorized pursuant to section 16(m)(1) of the Advisory Neighborhood Commissions Act of 1975, effective March 26, 1976 (D.C. Law 1-58; D.C. Official Code § 1-309.13(m)(1);

¢ Grants awarded by the Mayor under the COVID-19 Hotel Recovery Grant Program of 2021;

¢ The following grants awarded by the Office of the Deputy Mayor for Planning and Economic Development (DMPED);

I|- Grants awardedto Check It Enterprises under § 1-328.4(h) (1)(A);

Il- Small business grants awarded under § 1-328.04(|);

Ill- Grants to DC Center for LQBT Community awarded under § 1-328.04(m);

IV- Large company grants awarded under § 1-328.04(n);

V- Local food access grants awarded under § 1-328.04(0);

VI- Guaranteed income pilot program grants awarded under § 1-328.04(p);

Vil- Grants awarded to Community Development Financial Institutions or Minority Depository Institutions awarded under § 1-328.04(q);

Vill- Equity growth impact grants awarded under § 1-328.04(n);

IX- Great Streets program grants awarded under § 1-328.04(s);

X- Bridge fund recovery and special event support grants awarded under § 1-328.04(t);

Xl- Small and medium business recovery and growth program grants awarded under § 1-328.04(u); and

Xll- Equity impact enterprise commercial property acquisition grants awarded under § 1-328.04(v).

The amount received by businesses and individuals pursuant to

these grants may be subject to federal income tax and included in 9

federal gross income. For Form D-40 Individual Income Tax Return: the amount of the grant should be included in the federal Adjusted Gross Income that is reported on the federal Form 1040 to Line 4 of Form D-40. Therefore, complete and submit Schedule | which is a Schedule for Additions to and Subtractions from federal Adjusted Gross Income. Use Line 13 of Schedule | to report the amount of the grant. The total additions to and subtractions from federal Adjusted Gross Income captured by Schedule | are carried over to Form D-40. Submit the 1099G showing the amount of the grant.

Getting Started

To complete the paper Form D-40, in general you will need:

¢ Acopy of your completed 2021 federal return, as applicable (Form 1040, 1040-SR, 1040-NR, or 1040-NR-EZ) and any additional forms or worksheets related to the return. You can copy many entries directly from federal forms 1040, 1040-SR, 1040-NR or 1040-NR-EZ. Please be careful since the line numbers may differ from the District Form D-40 line numbers;

¢ A copy of your completed state returns if you filed an income tax return with another state;

¢ Your 2021 W-2 and applicable 1099 forms with DC withholding tax or taxable income;

¢ A pen with black ink;

¢ Acalculator.

Not all items will apply. Fill in only those that do. If an amount is zero,

make no entry, leave the line blank.

Do not enter cents. Round to the nearest dollar. $10,500.50 rounds to $10,501 $10,500.49 rounds to $10,500

Examples:

Taxpayer Identification Number(s) (TIN)

You must have a TIN, whether it is a Federal Employer Identification Number (FEIN), Social Security Number (SSN), Individual Taxpayer Identification Number (ITIN) or Preparer Tax Identification Number (PTIN).

¢ An FEIN is a valid number issued by the IRS. To apply for an FEIN, get Form SS-4, Application for Employer Identification Number, or get this form online at www.irs.gov/businesses and click on Employ- er Identification Number (EIN) under Starting a Business. You may also get this form by calling 1-800-TAX-FORM (1-800-829-3676);

¢ An SSN is a valid number issued by the Social Security Administration (SSA) of the United States Government. To apply for an SSN, get Form SS-5, Application for a Social Se- curity Card, from your local SSA office or online at www.ssa. gov. You may also get this form by calling 1-800-772-1213;

¢ An ITIN, Individual Taxpayer Identification Number is a valid number issued by the Internal Revenue Service (IRS). The IRS issues ITINs to individuals who are required to have a U.S. taxpayer identification number but who do not have, and are not eligible to obtain, an SSN from the SSA. ITINs do not serve any purpose other than federal and state tax reporting.

¢ A PTIN, Preparer Tax Identification Number is an identification number issued by the IRS that all paid tax preparers must use on tax returns or claims for refund.

You must wait until you receive either number before you file a DC return. Your return may be rejected if your TIN is missing, incorrect or invalid. You could be subject to a balance due or disallowance of credits if your dependent's or other qualifying person's TINs are missing, incorrect or invalid.

10

Filling out the form To aid us in processing your return please follow these rules.

Do not print outside the boxes.

ROBERTS 8) ELM

Use black ink. Print in CAPITAL letters.

Leave a space between words and between words and numbers.

Write 3s with a rounded top, not a flat top.

Write 7s without a middle bar.

317 BE

-@ <x

Fill in ovals completely.

Do not “W“ or “x” ovals.

Do not enter cents. Round cents to the nearest dollar.

5720400

Note: Your taxpayer identification number is used for tax purposes only.

Personal information

Complete the personal information as instructed using CAPITAL let- ters and black ink. Use one block per letter, including using a space between address fields. Please write clearly, as this can delay process- ing your return.

Wages, tips and salaries

Enter the amount from your federal 1040, 1040-SR, 1040-NR, or 1040-NR-EZ, plus any unemployment compensation received on Line a, Income Information on the D-40, from your withholding statement, W2 or 1099.

DC income tax withheld (paper filers)

Add the DC income tax withheld as shown on your 2021 federal Forms W-2 and applicable Forms 1099. Attach all copies of your Forms W-2 and 1099 that show DC tax withheld to Form D-40 and submit with Form D-40.

Filing Status

More than one filing status may apply to you. Use the one that will give you the lowest tax. Please ensure the oval to the left of the filing status is filled in.

Generally, you will use the same filing status on your DC return as that used on your federal return. However, if you used married filing jointly on your federal return, it may be better for you to file your DC return using either married/registered domestic partners filing separately or married/registered domestic partners filing separately on the same return. lf both have income, figure the tax both ways.

Single

You were unmarried, divorced or legally separated as of December 31, 2021, or were widowed prior to January 1, 2022, and did not remarry before January 1, 2022.

Filing Jointly

You were married or have a registered domestic partner and both spouses/registered domestic partners were DC residents as of December 31, 2021, or your spouse/registered domestic partner died in 2021 and you did not remarry/register in 2021. If legally separated, do not file jointly. If your spouse died during the year, you are consid-

ered married for the whole year for filing status purposes. If you did not remarry before the end of the tax year, you can file a joint return for yourself and your deceased spouse.

lf claiming injured spouse allocation, complete Form DC-8379 and attach it to your D-40 return.

If you are filing a joint return or filing separately on the same return, enter the name and TIN shown first on your previous year return, then enter the name and TIN shown second on your previous year return.

Registered domestic partners

To be considered as a registered domestic partner for DC tax purposes, the parties must be registered with the Vital Records Division of the DC Department of Health. If you have registered your relationship you may either file a joint return or file separately on the same return. You may also file separately using the married filing separately status.

Domestic partners or other similar relationship registered in other jurisdictions. If you have registered your relationship in another jurisdiction, you may file a joint return, or file separately on the same return, or file a separate return using the single status.

¢ — If filing jointly is chosen, enter the total federal adjusted gross income of both registered domestic partners on Line 4 of the Form D-40.

¢ — If you are married or registered domestic partners, you may file either a joint return or file separately on the same return. If filing jointly is chosen, enter the total federal adjusted gross income of both spouses/partners on Line 4, Form D-40.

¢ — If filing separately on the same return is chosen, follow the in- structions under Married or Registered Domestic Partners filing separately on the same return.

Married or registered domestic partner filing separately

If you are married or have a registered domestic partner and both spouses/partners had income, you can use this filing status. Include your spouse/registered domestic partner's name and Taxpayer Identi- fication Number (TIN) in the Personal Information section.

You will each report only your own income, deductions, and credits. You will each report one-half of the income from any securities, bank accounts, real estate, etc., that are registered or titled in both names.

Registered domestic partners who choose to file as married and married individuals must use this filing status if: * You and/or your spouse/registered domestic partner were part-

year residents of DC during different periods of 2021;

¢ You were a DC resident and your spouse/registered domestic partner was one of the following:

— Amember of the US armed forces and not considered a DC resident, but you are required to report income in DC;

— Amember of the US Congress or an employee on the personal staff of a member of Congress who is considered a resident of the member's state of residency;

— An officer of the US Executive Branch whose primary residence was not in DC, who is appointed by the Presi- dent, confirmed by the US Senate and serves at the plea- sure of the President; or

— A justice of the US Supreme Court whose primary resi- dence was not in DC.

Dependent claimed by someone else If you are claimed as a dependent on someone else's return, fill in the ‘dependent claimed by someone else' oval.

Married or registered domestic partner filing separately on the same return

You and your spouse/registered domestic partner must combine your separate amounts using Calculation J on Schedule S so that you will either receive one refund or make one tax payment. You may also claim a credit for child and dependent care expenses. Using this filing status may reduce the amount of tax you owe by allowing each spouse/ registered domestic partner to take advantage of lower tax brackets.

Before completing Calculation J, and the Form D-40, you will need to figure the following for you and your spouse/registered domestic partner:

¢ Each person's federal adjusted gross income;

¢ — Each person's additions to federal income;

¢ Each person's subtractions from federal income; and

¢ Each person's deductions.

NOTE: If you and your spouse/registered domestic partner were part- year residents of DC during different periods of 2021, you cannot file separately on the same return. You must file separate returns.

Injured Spouse Allocation

If either spouse/registered domestic partner has an outstanding liability for prior federal tax, DC income tax, DC unemployment compensation debt, child support, a federal nontax debt, such as a student loan or DC ticket and traffic penalties, the non-liable party may request that his/her portion of the refund, if any, not be offset to satisfy the other spouse’s/registered domestic partner’s debt by requesting “injured spouse” allocation. You must file Form DC-8379 before an offset oc- curs. Once the offset has been applied to a debt, you must contact the agency to which the offset was directed. After an offset has occurred, OTR cannot refund offset amounts. If not filing electronically, fill in the oval on the D-40 form, attach Form DC-8379 (Injured Spouse Allocation) to your return and mail to:

Office of Tax and Revenue PO Box 96145 Washington, DC 20090-6145

Head of Household

You may claim this status if you were unmarried or legally separated as of December 31, 2021, and paid over half of the costs of maintaining a home for a qualifying person, such as a child or parent. Certain individuals who lived apart from the spouse/domestic partner for the last six (6) months of 2021 may also be able to use this filing status. Use the appropriate section of Schedule S to enter the full name, TIN, relationship and Date of Birth (DOB) of the qualifying person whether that person is a dependent or the qualifying non-dependent. Failure to provide a Schedule S can delay processing. All the information must be complete, i.e., name, TIN, relationship and DOB.

Qualifying Widow(er) with Dependent Child

If your spouse/registered domestic partner died in 2021, you can use married filing jointly as your filing status for 2021 if you other- wise qualify to use this status. The year of death is the last year for which you can file jointly with your deceased spouse. You may be eligible to use qualifying widow(er) with dependent child as your filing status for 2 years following the year your spouse/registered domestic partner died. For example, if your spouse/registered domestic partner died in 2019, and you have not remarried, you may be able to use this filing status for 2021.

This filing status entitles you to use joint return tax rates and the high-

est standard deduction amount (if you do not itemize deductions) but it does not entitle you to file a joint return.

11

Eligibility rules. You are eligible to file your 2021 return as a qualifying widow(er) with dependent child if you meet all of the following tests:

¢ You were entitled to file a joint return with your spouse/registered domestic partner for the year your spouse/registered domestic partner died. It does not matter whether you actually filed a joint return.

¢ Your spouse/registered domestic partner died in 2019 or 2020 and you did not remarry by the end of 2021.

¢ You have a child or stepchild whom you can claim as a dependent. This does not include a foster child.

¢ Your child lived in your home all year, except for temporary absences. There are exceptions for a child who was born or died during the year and for a kidnapped child.

¢ You paid more than half the cost of keeping up your home for the year.

Standard Deduction

You are not entitled to the standard deduction if you itemize on your federal return. You are entitled to the itemized deductions excluding the state and local taxes and subject to the DC 5 percent limitation.

District Code §47-1803.03 (c) states "Every individual who claims the standard deduction on his or her federal income tax return shall claim the applicable standard deduction specified in District Code §47-1801.04 (44). Every individual who itemizes the de- ductions on his or her federal income tax return shall itemize the deductions permissible under this chapter. If spouses or registered domestic partners file separate returns, the applicable standard deduc- tion shall not be allowed to either spouse or registered domestic partner if the net income of one of the spouses/registered domestic partners is determined by itemizing deductions." Each spouse/registered domestic partner can claim only his/her own itemized deduction.

Single individuals, and married/registered domestic partners filing separately are allowed a standard deduction amount of $12,550. Head of household filers are allowed a standard deduction of $18,800. Married/registered domestic partners filing jointly, qualifying widow(ers) with dependent children, and married/ registered domestic partners filing separately on the same return are allowed a standard deduction of $25,100.

An additional standard deduction amount of $1,350 ($1,700 if single or head of household) is allowed if you were born before January 2, 1957, or blind. You must attach the Schedule S with a completed Calculation G-1 to claim the additional standard deduction except if you are a dependent filer.

Dependent filers are allowed a standard deduction in an amount based on a formula. Dependent filers should use the worksheet on page 21 to calculate their standard deduction only if someone can claim you, or your spouse/registered domestic partner if filing jointly, as a dependent.

DC Earned Income Tax Credit (EITC) You cannot claim the DC EITC if your filing status is Dependent claimed by someone else.

Qualifying Child for EITC Purposes A qualifying child as defined by the IRS for the EITC is a child who is your son, daughter, stepchild, foster child, brother, sister, stepbrother, stepsister, or a descendant of any of them (for example, your grandchild, niece or nephew) and was: ¢ Atthe end of the filing year, younger than you (or your spouse, if you file a joint return) and younger than 19;

12

¢ Atthe end of the filing year, younger than you (or your spouse, if you file a joint return), younger than 24 and a full-time student; and,

¢ At the end of the filing year, any age and permanently and totally disabled.

In addition, they must have lived with you in the US for more than half of 2021, unless you are claiming the DC EITC as a non-custodial parent (see instructions for Schedule N).

lf your child was married at the end of the year, the child is not a qualifying child unless you can claim the child as a dependent or you have been given the right to claim the child as a dependent in an agreement signed by the child's custodial parent releasing the dependency exemption.

Taxpayers with a Qualifying Child

Taxpayers with a qualifying child who are eligible for and who claim the federal EITC may also claim a DC EITC of 40% of the federal credit. Enter the number of EITC qualifying child(ren), on Line 27a of the D-40.

DC Law also allows the same 40% of federal EITC to those who are not allowed to claim the EITC at the federal level but who meet other DC requirements, such as a non-custodial parent who is a District resident between the ages of 18 and 30, and paying child support under a court order for a minor child. The taxpayer must have paid the child support of at least the amount due for the year through a government sponsored support collection unit and the order must have been in effect for at least one-half of the year. You must file a D-40 form to use this exception. Complete Schedule N, DC Non-Custodial Parent EITC Claim, and attach to the D-40. Also enter the amount to be claimed on the Schedule U, Part 1B, Line 1.

Taxpayers without a Qualifying Child

Taxpayers without a qualifying child must use the DC Earned Income Tax Credit (EITC) Worksheet For Filers Without a Qualifying Child on page 22 to determine the DC EITC. You may need information from the federal instruction booklet concerning the Earned Income Credit to determine your eligibility for the DC Earned Income Tax Credit. If you do not have a qualifying child for the EITC and did not qualify for the federal credit due to your income, you may still qualify for the DC EITC.

Contributions

There are three (3) DC contributions. Contributions will be deducted from the refund due or added to the tax due. You can contribute as much as you would like, however your contribution cannot exceed your amount to be overpaid and the smallest contribution you can make to any one fund is $1.00.

DC Statehood Delegation Fund Enter on Part II Contributions, Line 1 of the Schedule U, and attach to the D-40.

Taxpayer Support for Afterschool Programs for At-Risk Students Enter on Part II Contributions, Line 2 of the Schedule U, and attach to the D-40.

Anacostia River Cleanup and Protection Fund Enter on Part II Contributions, Line 3 of the Schedule U, and attach to the D-40.

Tax tables If your taxable income is $100,000 or less, use the tax tables on pages 91-100 to find the tax on Line 20 of the D-40.

If your taxable income is greater than $100,000, use Calculation | on page 19 to determine your tax.

Tax paid with extensions Report tax paid with extension of time to file on Line 33 of the D-40.

Tax paid with original return Report tax paid with original return if this is an amended return on Line 34 of the D-40.

Refund Options

There are three refund options offered for individual income tax returns. All individual income tax returns require that one of three refund options be selected.

1. Direct deposit of refund

Direct Deposit Facts:

1. It's simple. You don’t have to go to the bank to cash your check. 2. It’s safe. No more lost, stolen or misplaced checks.

3. It’s fast. Your money will be available the morning of the payment.

All new direct deposit requests (taxpayers requesting a direct de- posit for the first time) will receive a paper check.

If you want your refund deposited directly in your bank account, complete the Direct Deposit Information on the D-40. If the routing or account number begins with zeros, include the zeros.

Fill in the bank routing and account number information. You can obtain this information from the lower left portion of your check (see example below).

woot

John Smith veneers:

(oS eae al Sn Yo

Ph. 888-422-6122 \$

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Nar ORDER GF

fom. a a He23LS678% OOOw?22~22" 4008

Check Number DO NOT INCLUDE CHECK NUMBER

ABA Bank Account Number

Routing Number

NOTE: Refer to your own check or financial institution for your num- bers. The routing and account numbers may be in different places on your check.

Your routing number is the left-most number located on your check, identified as the American Banking Association (ABA) routing number. The ABA number identifies your bank uniquely within the direct deposit system. It must be:

¢ Nine (9) digits in length, including zeros;

¢ Acurrent valid bank routing number.

Your account number:

¢ — Is usually just to the right of your ABA routing number includ- ing zeros;

¢ Can be up to 18 digits long; and

* Can be both letters and numbers.

You may want to verify your account and routing numbers with your

financial institution before filling in the information.

Fill in the oval to show the type of bank account. If you want the refund to go to a savings account instead of your checking account, you may need to contact your financial institution for the account and routing number information.

Check the ABA routing number and account number carefully. If your bank account information is incorrect or missing digits, the money can be deposited in someone else's account. Please double check your routing and account number. OTR is not liable for any ABA routing and account numbers reported on the return in error.

If you do not select the checking or savings oval, we will assume the refund will be deposited in your checking account. If the funds are returned to OTR, a paper check will be issued.

In the event of a rejection of direct deposit, refunds will be re-issued on a paper check.

Note: Identity theft and fraud using direct deposit has grown signifi- cantly nationally and locally in recent years. To minimize direct deposit/ identity theft refund fraud, OTR is converting new direct deposit refund requests to paper checks mailed to the taxpayer's address of record. Also see number 3, Paper Check section below for when paper checks will be issued.

Refund direct deposit to a foreign account - International ACH Transaction (IAT)

If you request your refund to be direct deposited to an account outside of the United States, you will receive a paper check.

2. U.S. Bank ReliaCard™

If you want your refund on a ReliaCard, select "ReliaCard" under the Refund Options on the D-40 form. Refunds under $2 or greater than $4,000 do not qualify for the ReliaCard. Non-qualified refunds will receive a paper check if direct deposit is not selected.

To obtain more information, visit https://www.usbankreliacard.com.

3. Paper Check A paper check will be issued if: * no refund option is selected; ¢ the taxpayer selects this option, or direct deposit is not selected or if the taxpayer selects "ReliaCard" and it is beyond the threshold for a ReliaCard; ¢ taxpayer is a first time filer, even if they select direct deposit; ¢ there is a gap between filing i.e., filed in 2018 and 2019, but did not file in 2020; or ¢ the bank account changes from one year to the next; or ¢ the taxpayer requests a refund on behalf of a deceased taxpayer.

Refund status inquiry

To check the status of your refund visit MyTax.DC.gov. You will need to enter your taxpayer identification number (TIN) and the refund amount you requested on your return.

Third Party Designee

If you want to authorize another person to discuss your 2021 tax return

with the OTR, fill-in the oval in the Third Party Designee block on page

3 of the D-40, and enter the designee's name and phone number. If

you want to authorize your paid preparer, enter ‘preparer’ in the ‘third

party designee’ block. If you are filing a joint return, filling in the third

party designee block oval constitutes authorization by both filers.

Filling in the oval also gives the designee authorization to:

¢ — Give OTR any information missing from your return;

¢ Contact OTR for information about processing your return and the status of any refund or payment; and

¢ — Request, receive and/or respond to OTR notices related to your return.

The authorization does not:

13

¢ — Give the designee the right to receive your refund;

¢ Bind you to any additional tax liability related to your return; or ¢ Otherwise represent you before OTR.

This authorization automatically ends on April 15, 2023 (without regard to extensions).

Signature

Sign and date your return. If your filing status is married filing jointly or married filing separately on the same return, both spouses/registered domestic partners must sign. If the return is not signed, it will be sent back to you. If the return was prepared by a paid tax preparer, the tax preparer must also sign the return and provide his or her identification (PTIN) and telephone number. You, the taxpayer(s) is/are responsible for the information prepared and submitted by a paid preparer.

Email address

Enter the email address of the person authorized to discuss your 2021 tax return with OTR. This can be the taxpayer, the third party designee, or the paid preparer if you have filled in the oval authorizing the paid preparer to discuss this return with OTR.

Send in your original return and attachments, if applicable; please keep a copy for your records.

Do not understate your taxes

There may be a penalty if an understatement of the tax required to be shown on your return exceeds the greater of:

¢ 10% of the tax required to be shown on the return; or

* $2,000

The penalty is 20% of the excess of the amount required to be shown on the return over the tax shown on the return.

Using a Paid Preparer

Although you may use a paid preparer, you the taxpayer(s) are respon- sible for the filing and payment of your tax return. Please review the tax return before you allow a paid preparer to issue a return on your behalf.

Preparers must pay a penalty for understating taxes where:

¢ — The refund or amount due is based on unrealistic information; or

¢ The preparer should have been aware of a relevant law or regulation; or

¢ — Relevant facts about the return are not adequately disclosed. Penalties range from $250 to $10,000.

Assembling your D-40 return

¢ Do not staple or otherwise damage the Bar Code located in the upper right hand corner of the form or schedule being attached;

¢ Do not cross out the tax year on the 2021 return. If you are not filing a 2021 Individual Income Tax Return, do not use this booklet. Request a booklet for the specific year you are filing by calling our Forms Center at (202) 727-4829, or visit our Customer Service Administration (CSA) at 1101 4th Street, SW, Washington, DC 20024. You may also visit our website at MyTax.DC.gov for prior year(s) individual income tax booklets/ returns;

¢ Staple check or money order to the D-40P, Payment Voucher;

¢ — Staple Forms W-2 and applicable 1099 to the front of your return;

¢ — Staple any of the other required documents listed on this page in the upper left corner behind the return;

¢ — Send in an original, signed DC return with attachments, if ap- plicable, not a copy. Please fold your return once and use the return envelope provided;

14

[ Staple all supporting forms and . D.49 schedules behind the D-40. [ Staple Forms W-2 and 1099 to the front of Form D-40. Wa, 1099

¢ There are two adhesive mail labels on the back flap of the return envelope. If you are sending a payment by mail with your return, use the PO Box 96169 label on the return envelope. If you are filing a return with no payment due or refund return, use the PO Box 96145 label.

¢ — Copies of the federal return and schedules are not required to be filed with DC and should not be attached unless specified below.

List of other documents for D-40 filers

Staple these behind the D-40 return in file order.

- Schedule S Supplemental Information and Dependents;

- Schedule H, Homeowner and Renter Property Tax Credit;

- Schedule U, Additional Miscellaneous Credits and Contributions;

- D-8609, District of Columbia Low-Income Housing Tax Credit Allocation and Certification;

- D-8609A, Low-Income Housing Tax Credit Allotment;

- D-8609DS, Low-Income Housing Tax Credit Distribution Schedule;

- Schedule I, Additions to and Substractions from Federal Adjusted Gross Income;

- Schedule N, DC Non-Custodial Parent EITC Claim;

- Schedule ELC, Keep Child Care Affordable Tax Credit;

- Schedule HSR, DC Health Care Shared Responsibility;

- DC-8379, Injured Spouse Allocation;

- D-2210, Underpayment of Estimated Income Tax by Individuals;

- D-40P Payment Voucher;

- FR-127, Extension of Time to File a DC Income Tax Return;

- DC Form FR-147, Refund Claim for Deceased Taxpayer, with let- ters of administration and a copy of the death certificate;

- DC Form D-2440, Disability Income Exclusion (and any certification);

- DC Form D-2441, Child and Dependent Care Credit for Part-Year Residents;

- DC Residential Form, Alternative Fuel Vehicle Conversion and Infrastructure Credits.

If any of the above-referenced forms are needed, visit MyTax.DC.gov. Scroll to the "Individuals" section then click on "Current & Prior Year Tax Forms," and select form needed.

You may also contact our Forms Center at (202) 727-4829.

To complete your D-40 return, you will need to do a series of calculations contained in these instructions and copy many of the line items and totals onto your D-40. You may also need to attach DC schedules, or forms to your D-40. Unless instructed otherwise, if you complete any part of any Schedules S, H, U, I, N, ELC, HSR, DC-8379, D-2210, D-40P FR-127, attach it to your return.

DC-8379 Injured Spouse Allocation.

You may be an injured spouse if you file a joint return and all or part of your portion of the overpayment is expected to be, offset to your spouse/ registered domestic partner’s legally enforceable past-due federal tax, state income tax, state unemployment compensation debts, child sup- port, or a federal nontax debt, such as a student loan. You must file the DC-8379 with your return. In order to be eligible for this relief, you

must submit your completed DC-8379 prior to the offset occurring and filed with the return. Once funds have been offset, this relief may be unavailable.

Schedule ELC, Keep Child Care Affordable Tax Credit.

This schedule allows eligible taxpayers to claim an early learning tax credit for an eligible child under the age of 4 as of 9/30/21 and payments made during the taxable year after August 31st if the eligible child meets age requirements for enrollment in Pre-K according to DC Code §38-273.02(a).

Schedule H, Homeowners and Renter Property Tax Credit. This schedule allows eligible residents to claim a property tax credit against their DC income tax liability. The total 2021 federal adjusted gross income (AGI) of your "tax filing unit" cannot exceed $56,200 (under age 70) or $76,700 (age 70 or older). Do not claim this credit for an exempt property owned by a government, a house of worship or a non-profit organization. See Schedule H in this booklet.

Note: File the Schedule H with your D-40 return. If you are not required to file a D-40 because you are below the filing threshold, you may file the Schedule H by itself. It can be filed online via MyTax.DC.gov (if you are not a first time Schedule H filer and registered to use the web portal), or mailed to:

Office of Tax and Revenue 1101 4th St SW, FL4 Washington DC 20024

Schedule HSR, DC Health Care Shared Responsibility.

DC law requires all residents to have health care coverage, have an exemption or pay a tax penalty on their DC tax return. See instructions for Schedule HSR, DC Health Care Shared Responsibility.

Schedule I, Additions to and Subtractions from Federal AGI. This schedule contains two calculations, one for additions and another for subtractions from federal AGI. See Schedule | in this booklet. If you took the 100% federal bonus depreciation and/or the additional Internal Revenue Code (IRC) Section 179 expenses on your federal return, enter the total on Schedule I, Calculation A, Line 3.

If you reported deferred capital gains on your federal return due to an investment in a federal Qualified Opportunity Fund, you must add back the amount of the deferment on Line 8.

If you have deferred capital gains due to an investment in an approved DC Qualified Opportunity Fund, subtract the amount of the deferment on Line 15, provided this amount is also included in Line 8 of Schedule I.

Use Schedule | to exclude District nontaxable grants from District gross income where the amount of the grant is included in federal adjusted gross income. The amount of the grant should be included in the federal Adjusted Gross Income that is reported on the federal Form 1040, to

Line 4 of Form D-40. Use Line 13 of Schedule | to report the amount of the grant if the amount of the grant is included in federal adjusted gross income. The total additions to and subtractions from federal Adjusted Gross Income captured by Schedule | are carried over to Form D-40. Submit the 1099G showing the amount of the grant.

Schedule N, DC Non-Custodial Parent EITC Claim.

Use this schedule to determine whether a non-custodial parent making court-ordered child support payments may claim the DC EITC. See Schedule N in this booklet.

Schedule S, Supplemental Information and Dependents. If claiming dependents, use Schedule S to list each dependent's name, taxpayer identification number (TIN), relationship and date of birth (DOB). If filing head of household/qualifying widow(er) use Schedule S to report dependents or other qualifying non-dependent person.

Calculation G-1 is used to determine the computation of the standard deduction. You must also use Calculation G-1 to claim the additional standard deduction for yourself or your spouse/registered domestic part- ner for being blind and/or age 65 or older, unless you are a dependent claimed by someone else.

Calculation J is used to determine the DC tax amount for married or registered domestic partners filing separately on the same return.

List any TINs (EIN) in the applicable space(s) if there is an amount on D-40, Line 11.

Schedule U, Additional Miscellaneous Credits and Contributions. This schedule lists certain additional non-refundable and refundable credits you may be able to claim. It also lists several contributions funds to which you may wish to contribute. See Schedule U in this booklet.

Non-refundable credits include:

1. Out of State tax credit. The amount DC domiciliary taxpayers may claim as a credit for individual income tax paid to other state(s) if the income taxed by that state is derived from that state and that income is of a kind taxed by DC. The tax paid to a state is the total state tax liability shown on the state tax return. (It is not the state withholding shown on your Form W-2.) The credit is limited to the rate of tax charged in the District. If you are a statutory resident, the state in which you are domiciled gives you a credit for the taxes paid to DC.

Complete Calculation K below, to determine your out of state credit. Enter the credit amount on Schedule U, Part la, Line 2. If you paid tax to more than one state, enter the respective amounts and other state codes in the spaces provided.

No DC credit is allowed for any other tax imposed by a state, including the following:

* Corporate franchise tax;

¢ License tax;

¢ Excise tax;

Calculation K Out-of-state income tax credit

a Amount of income tax paid to other state(s), enter from the other state(s) return(s).

b Income subject to income tax in other states and received while a resident of DC.

c DC adjusted gross income from D-40, Line 16.

d Divide Line b by Line c. (Enter the percent.)

e DC Tax from D-40, Line 20.

f Maximum out-of-state credit. Multiply Line e by Line d.

g Enter the lesser of Line a or Line f. Also enter on Schedule U, Part la Line 2.

+o Qa 090

15

¢ Unincorporated business franchise tax; and * Occupation tax.

2.

16

Alternative Fuel Vehicle Conversion and Infrastructure Credits. See D.C. Code Sections 47-1806.12 and 47-1806.13. A credit up to 50% of the costs for purchase and installation of qualified alternative fuel storage and dispensing or charging equipment per qualified alternative fuel vehicle refueling property or private residence. The credit shall not exceed $1,000 per vehicle charging station for a private residence and $10,000 per qualified alternative fuel vehicle refueling property or vehicle charging station. The cost of the purchase of the land on which the refueling or charging station will be located or the construction or purchase of any structure is not included in the equipment or labor costs. The unused credit can be carried over for two future years.

A credit, not to exceed $19,000 per vehicle, up to the tax liability, for 50% of the cost of equipment and labor per vehicle for vehicle owners who modify their existing petroleum derived gasoline or diesel fuel vehicle into a vehicle capable of operating on one of a list of the listed acceptable operating fuels:

a. At least 85% Ethanol; b. Natural gas;

c. Compressed natural gas; d. Liquefied natural gas;

e. Liquefied petroleum gas;

f. Biodiesel (excluding kerosene);

g. Electricity from a vehicle charging station; or,

h. Hydrogen.

Any unused credit for vehicle conversion cannot be carried forward.

If you are claiming one of these credits, complete the residential form, Alternative Fuel Vehicle Conversion and Infrastructure Credits available online only. Retrieve this form at MyTax.DC.gov, by clicking on 'Forms', ‘Alternative Fuel Vehicle Infrastructure and Conversion Residential Form' under Individual Income Tax Forms; attach it to the DC-40, Schedule U.

If gross income derived from the operation of an alternative fuel dispensing or charging station exceeds $12,000, you must file a DC Form D-30, Unincorporated Franchise Tax Return.

Refundable credits include: a. DC Non-custodial parent EITC. See Schedule N; b. Keep Child Care Affordable Tax Credit. See Schedule ELC.

Contributions include:

1. DC Statehood Delegation Fund;

2. Taxpayer Support for Afterschool Programs For At-Risk Students; and 3. Anacostia River Cleanup and Protection Fund.

(Note: Calculations A and B are on Schedule |)

Calculation C Standard deduction for part-year DC residents

a Your standard deduction. a See instructions, page 12.

b Number of days you lived in DC from D-40, Line 2. b

C_ Divide Line b by the number 365 (366 if leap year). C

d Part-year DC standard deduction. Multiply Line a by Line c, enter here and on D-40, Line 18. d

Calculation D DC Itemized deductions for part-year DC residents.

a Total Itemized Deductions from Form 1040 or 1040-SR, Schedule A, Line 17, or a Form 1040-NR, Schedule A, Line 8.

b Portion of Line a that applies to the time you were a DC resident. b

c Portion of your state and local tax deduction reported on Form 1040 or 1040-SR, iG Schedule A, Line 7, or Form 1040-NR, Schedule A, Line 1b that was paid to DC.

d Subtract Line c from Line b. d

e Portion of your state and local real estate tax deduction from Form 1040 or 1040-SR, e

Schedule A, Line 5b that was paid to DC.

f Portion of your other taxes deduction from Form 1040 or 1040-SR, Schedule A, Line 6 f

that was paid to DC.

g DC itemized deductions. Add Lines d, e, and f. If your District Adjusted Gross Income (AGI) g is equal to or less than $200,000 ($100,000 if married filing separately) stop here and

enter this amount on Line 18 of the D-40.

Note: If your District AGI is greater than $200,000 ($100,000 if married filing separately)

continue below to determine the allowable itemized deductions.

h Enter the sum of Form 1040 or 1040-SR, Schedule A, Lines 4, 9, and 15 allocable to the

time you were a DC resident.

i Subtract amount on Line h from Line g. j Enter the amount of DC adjusted gross income.

k Enter $200,000 (or $100,000 if married filing separately).

| Subtract amount on Line k from Line j. m Multiply amount on Line | by 5%.

n Subtract amount on Line m from amount on Line i (if<O, enter 0). o Add the amounts on Line h and Line n (enter this on Line 18 of the D-40).

- >

os 3

Who is a Resident? You are a resident of DC if:

1. You are an individual domiciled in DC at any time during the tax- able year, or

2. You are an individual who maintains a place of abode within DC for an aggregate of 183 days or more during the taxable year, this is also known as a statutory resident.

Domiciliary

An individual is domiciled in DC if his/her permanent home is in DC. Domicile, once established, is presumed to continue until it is shown to have been changed. To establish a change of domicile, a person must demonstrate (1) physical presence, and (2) an intent to abandon the former domicile and remain [in the new one] for an indefinite period of time. An individual can only have one domicile at a time. An individual domiciled in DC is a full-year resident under DC law and must file a full- year individual income tax return, except, if you establish or abandon your DC domicile during the year, then you are a part-year resident and will file a part-year return.

Statutory Resident

An individual is a DC statutory resident, even though not domiciled in DC, if he/she maintained a place of abode in DC for an aggregate of 183 days or more days during the taxable year. The period of residency does not have to be consecutive days. In determining whether an individual has maintained a place of abode in DC for 183 or more days, temporary absences from the DC residence i.e. vacations, hospitalization, business trips, and the like, shall be considered as periods of District residency. A statutory resident is a full-year resident under DC law and, therefore, must file a tax return reporting his/her entire income for the taxable year. A statutory resident may seek credits for individual income taxes paid to other state(s), while concurrently a resident of DC. However, he/she must provide satisfactory proof of payment, including an individual income tax return filed with the other state(s), in order to be eligible for a credit.

Part-Year Resident

An individual is a part-year resident if he/she moves into or out of DC during the year with the intent to establish or abandon his/her domicile in DC. The calculation of tax liability for a part-year resident is prorated based on the income earned in DC, during the period of residency. An individual filing a part-year return must indicate the pe- riod of residency on Line 2 of Form D-40. All credits, exemptions and deductions must be prorated according to the time of DC residency.

Part-Year Instructions

If you are a part-year resident for the 2021 tax year, fill in the oval on

Line 2 of the D-40, complete the applicable month, day and year in the

"from" and "to" boxes. Divide the number of days lived in DC by 365

(366 if leap year). Use that number (standard rounding to four

decimal places) and multiply by your credit, additions or subtractions

amounts not previously prorated. Complete Calculation C for standard

deduction and Calculation D for DC itemized deductions showing the

type and amount of income received:

¢ During the time you resided in DC;

¢ — During the time you were a nonresident; and

¢ — The total income reported on your federal return as adjusted for DC purposes.

Before completing the D-40, calculate the following:

¢ — Income received when you were a resident of DC, and when you resided outside of DC; and

¢ Allowable expenses paid or incurred when you resided in DC and when you resided outside of DC. The same allocation is required for credits, and other deductions.

If you claimed itemized deductions on your federal income tax return,

include, for DC purposes, only those relating to the time you were a DC

resident. Your federal worksheet will assist you in completing Schedule

| (Calculations A and B) and Calculation D (if applicable). Keep a

copy of your worksheet, a copy of your tax return and all calculations. If you resided in DC for only part of 2021 tax year, allocate your DC income and deductions attributable to the time of your DC residency. Also prorate your standard deduction and credits by dividing the number of days you were a resident of DC by 365 (366 if leap year) and multiplying the result times the standard deduction/credit amount.

Example: *71 days of residency in DC divided by 365 (366 for leap year) equals 0.1945. A taxpayer who is eligible to claim the maxi- mum EITC For Filers Without a Qualifying Child, the credit amount is $1,502. Multiply $1,502 by 0.1945 and the result, $292 is the prorated amount for credit.

March 12 =

January February

31 + 28 + 71 Days*

Standard deduction for part-year DC residents. Adjust your standard deduction to reflect the number of months you were a DC resident. Complete Calculation C on page 16.

Itemized deductions for part-year DC residents. Effective January 1, 2011, DC Official Code §47-1803.03 (b-4) provides that certain DC itemized deductions of DC taxpayers with over $200,000 of DC AGI ($100,000 for a separate return filed by a married individual) will be limited. Reduce the DC itemized deduction amount by 5% of DC AGI in excess of $200,000 ($100,000 for a separate return filed by a married individual). The itemized deductions that are not subject to the 5% limitation are medical and dental expenses, expenses incurred in the production of investment interest and casualty or theft loss deduction.

lf your DC deductions are limited and you were a part-year DC resident, complete Calculation D on page 16.

Credit for child and dependent care expenses for part-year DC residents. Complete the DC Form D-2441 and enter the amount from Line 5 on Line 21 of the D-40. Attach a copy of your DC Form D-2441.

Do not include income tax withheld for other states in the DC tax with- held, Line 31, D-40.

Income Information Section

¢ — Copy Line a through d from the appropriate lines on the federal return. Do not recalculate any amounts or totals.

¢ Not all items will apply to you. Fill in only those that do. If the amount is zero, leave the line blank.

¢ — If you had a loss for Lines b, c, d, 4, 7, 15, or 18, fill in the "Fill in if loss" oval to indicate that the figure entered is a negative one. Do not enter a minus sign or brackets in the boxes.

Line a Wages, salaries, unemployment compensation, and/or tips Enter the amount from your federal 1040, 1040-SR, 1040-NR or 1040-NR-EZ plus any unemployment compensation received.

All unemployment compensation received in 2021 is taxable by the federal government. However, DC has enacted legislation that excludes all unemployment insurance benefits provided by the District, any other state, or the federal government, from District gross income. If any such unemployment insurance benefits are included in your D-40, Line 4 federal adjusted gross income, use Line 13 of the D-40 return to subtract all unemployment insurance benefits from District gross income.

Line b Business income or loss

If you had gross business/self-employment income from DC sources of more than $12,000 from an unincorporated business or business activity, see the instructions for D-30, Unincorporated Franchise Tax Return, to see if you are required to file that return. If you are, do not include the income here, but report it on your D-30 return instead.

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Calculation F DC Itemized deductions for full-year DC residents

a Total itemized deductions from Form 1040 or 1040-SR, Schedule A, Line 17, or Form 1040-NR, a

Schedule A, Line 8.

b Total state and local tax deductions. Enter the amount from your Form 1040 or 1040-SR, Schedule A,

Line 7, or Form 1040-NR, Schedule A, Line 1b. b c Subtract Line b from Line a. € d State and local real estate tax from Form 1040 or 1040-SR, Schedule A, Line 5b. d e Other taxes from Form 1040 or 1040-SR, Schedule A, Line 6. e f DC itemized deductions. Add Lines c, d, and e. If your District Adjusted Gross Income (AGI) f

is equal to or less than $200,000 ($100,000 if married filing separately) stop here and

enter this amount on Line 18 of the D-40 form. Note: If your District AGI is greater than $200,000 ($100,000 if Married filing separately) continue below to determine the allowable itemized deductions g Enter the sum of Form 1040 or 1040-SR, Schedule A, Lines 4, 9 and 15 g h Subtract amount on Line g from Line f. h i Enter the amount of DC adjusted gross income. i j Enter $200,000 ($100,000 if married filing separately). j k Subtract amount on Line j from Line i. k | Multiply amount on Line k by 5%. | m Subtract amount on Line | from amount on Line h (if < O, enter 0). m n Add the amounts on Lines g and m (enter this on Line 18 of the D-40). n

Line c Capital gains or loss

Enter the amount from your 1040, 1040-SR or 1040-NR. The maximum allowable annual capital loss claim is $3000 ($1500 if married or reg- istered domestic partner filing separately).

If you had farm income or loss, enter on Line c the amount on Line 6 of your 1040 or 1040-SR, or Line 19 of your 1040-NR in the amount entered on Line c. Ifa loss, fill in the oval.

For DC tax purposes, upon disposing of an asset not fully depreciated, compute the capital gain/loss reported on your federal return for the year of disposition excluding any bonus depreciation.

Line d Rental real estate, royalties, S corporations, trusts, etc Enter the amount from your 1040, 1040-SR or 1040-NR. If you had gross income, from DC sources, of more than $12,000 from a unincor- porated business or business activity, including rents and royalties, do not include on D-40. You are required to file a D-30 return. File a DC Form D-30, Unincorporated Franchise Tax Return if capital is a material income producing factor. An S Corporation must file a D-20, Corporation Franchise Tax Return.

Computation of DC Gross and Adjusted Gross Income

Line 4 Federal adjusted gross income

Enter the amount from 1040, 1040-SR, 1040-NR, or 1040-NR-EZ.

Include your taxable portion of pension/annuity in your federal adjusted gross income.

NOTE: Any grants and stipends received by certain DC public or charter school teachers under the Housing Support for Teachers Act of 2007 are subject to both federal and DC income tax.

18

Additions to DC Income

Line 5 Franchise Tax Enter any franchise tax deducted on a federal business tax return, from federal Forms 1065 or 1120S.

Line 6 Other additions from DC Schedule | Enter the amount from Line 9 of Calculation A, Schedule |.

Line 7 Add Lines 4, 5 and6 Add federal adjusted gross income, franchise tax deducted and addi- tions to DC income. Fill in oval if loss.

Subtractions from DC Income

Line 8 Income received by a part-year resident during period of nonresidence

For each type of income reported on your federal 1040 or 1040-SR, determine the amount you received when you resided in DC. Subtract that amount from your total income and enter the results on Line 8.

NOTE: Do not include any unemployment insurance benefits as a part of income received during the period of nonresidence on Line 8. Enter the total amount of all unemployment insurance benefits on Line 13, provided this amount is also included on Line 4 of the D-40 return.

Line 9 Taxable refunds, credits or offset of state and local income tax Enter the amount from your 1040, 1040-SR or 1040-NR.

Line 10 Taxable amount of social security and tier 1 railroad retirement Enter the amount from 1040 or 1040-SR.

Calculation I/Tax Rate Schedule If your taxable income from D-40, Line 19 is:

Not over $10,000 Over $10,000 but not over $40,000

4% of the taxable income

$400, plus 6% of the excess over $10,000 Over $40,000 but not over $60,000 $2,200, plus 6.5% of the excess over $40,000 Over $60,000 but not over $350,000 $3,500, plus 8.5% of the excess over $60,000 Over $350,000 but not over $1,000,000 $28,150, plus 8.75% of the excess above $350,000

$85,025, plus 8.95% of the excess above $1,000,000

Over $1,000,000

Line 11 Income reported and taxed this year on a DC franchise or fiduciary return (D-20, D-30 or D-41)

If the income reported on your 1040 or 1040-SR included income reported and taxed on a DC franchise or DC fiduciary return, enter that amount here. Provide the taxpayer identification number (TIN) and your share of the income reported. Refer to Instructions, page 10 regarding TINs. Include the TIN on page 2 of the Schedule S.

Line 12 DC and federal government survivor benefits

If you are an annuitant's survivor and 62 years of age or older as of December 31, 2021, enter the total survivor benefits (do not include Social Security survivor benefits).

Line 13 Unemployment Insurance Benefits

For taxable years beginning after December 31, 2020, unemployment insurance benefits provided by the federal government, District of Columbia, and any other state, are excluded in the computation of District gross income.

Line 14 Other subtractions from DC Schedule |

Line 15 Total subtractions from DC Income Add Lines 8-14.

DC Adjusted Gross Income

Line 16 DC adjusted gross income Line 7 minus Line 15.

DC Taxable Income

Line 17 Deduction type

Indicate which type of deduction (itemized or standard) you are taking by filling in the appropriate oval. You must take the same type of deduction on your DC return as you took on your federal return.

Line 18 DC deduction amount Enter the amount from your federal return.

Standard deduction. Reference page 12 of the Instructions. Part-year DC residents, reference page 17.

Itemized deductions. Do not copy the amount from your federal return. Use Calculation D if you are a part-year DC resident, or Calculation F if you are a full-year or statutory DC resident. DC does not allow a deduc- tion for state and local income taxes. You can deduct your entire state and local real estate taxes.

If your DC AGI is $200,000 or less, complete Calculation F on page 18. DC income taxes paid are not deductible on your DC return. Therefore, reduce your federal itemized deductions amount by those taxes before entering the total on your DC return.

Effective January 1, 2011, DC Official Code §47-1803.03 (b-4) provides that certain DC itemized deductions of DC taxpayers with over $200,000 of DC AGI ($100,000 for a separate return filed by a married individual) will be limited. Reduce the DC itemized deduction amount by 5% of DC AGI in excess of $200,000 ($100,000 for a separate return filed by a married individual). The itemized deductions that are not subject to the 5% limitation are medical and dental expenses, expenses incurred in the production of investment interest and casualty or theft loss deduction.

lf your DC deductions are limited, complete Calculation F on page 18.

Line 19 DC taxable income Subtract Line 18 from Line 16. Enter the result, if a loss, fill in the oval.

Line 20 Tax

If Line 19 is $100,000 or less, use the tax tables on pages 91-100 to determine your tax. If Line 19 is more than $100,000, use Calcula- tion | on this page to determine your tax.

Married or registered domestic partners filing separately on the same return - Before completing Calculation J, the tax computation, on Schedule S, you must determine each person's separate federal AGI, additions to income, subtractions from income, and deductions. You must combine the separate amounts for each person before making entries on Lines 21-35 of the D-40.

DC tax, credits, and payments

The credits claimed on Lines 21 and 22 are non-refundable, which means they can reduce the taxes you owe, but they will not result in a tax refund. The credits you claim on Lines 27d or 27e, 28 and 29 are refundable credits, which means if these credits plus any tax payments are greater than your total tax due, you may receive a refund.

Line 21 Credit for child and dependent care expenses

lf your status is married or registered domestic partner filing separately on the same return, you may claim the credit and divide it between spouses/ registered domestic partners any way you wish.

If you were a full-year or statutory DC resident, to figure your DC credit, multiply by .32, the amount from federal Form 2441, Line 10 or Line 11. Enter the result on Line 21 of the D-40. (Do not use the DC Form D-2441.)

If you were a part-year resident, see the instructions on page 17.

If you were eligible for the Child and Dependent Care Credit but did not claim it for federal purposes, complete the federal Form 2441, multiply the result by .32 and claim the DC credit for child and dependent care expenses.

Generally, married persons must file a joint return to claim the credit. If you claim the credit and your filing status is married filing separately, you are required to show you meet the special requirements listed in the IRS Form 2441 instructions.

Line 22 Non-refundable credits from DC Schedule U This entry is the total of non-refundable amounts from DC Schedule U, Part 1a, Line 7.

Line 23 Total non-refundable credits Add Lines 21 and 22.

Line 24 Subtract Line 23 from Line 20 Subtract Line 23 from Line 20. If Line 20 is less than Line 23, enter zero.

19

Line 25 DC Health Care Shared Responsibility

If you, your spouse/registered domestic partner (If filing jointly or separately on the same return), and anyone you or your spouse/reg- istered domestic partner can claim as a dependent, had qualifying health coverage or an exemption for every month of 2021, enter zero. Otherwise complete Schedule HSR and accompanying worksheets

to determine the amount of your Health Care Shared Responsibility Payment. From Schedule HSR, Part IV, Line 17.

Line 26 Total tax and DC Health Care Shared Responsibility Add Lines 24 and 25.

DC EITC Refer to Instructions, page 12.

Line 27a Qualified EITC children Refer to Instructions, page 12.

Line 27b Enter your earned income amount.

Line 27c Enter your federal earned income credit (for taxpayers with qualifying children only).

Line 27d Multiply federal EIC x .40 and enter result (for taxpayers with qualifying children only).

Line 27e For filers without qualifying children, use the DC Earned Income Tax Credit Worksheet For Filers Without a Qualifying Child to determine your DC EITC and enter result.

Line 28 Property tax credit

If you filed a DC Schedule H, Homeowner and Renter Property Tax Credit, enter the amount from the appropriate Line (3 or 7). See the instructions in this booklet for assistance in completing Schedule H. If you are filing a D-40 and Schedule H by paper, attach Schedule H to your D-40.

Line 29 Refundable credits from DC Schedule U

Complete Schedule U, Part 1b. Attach Schedule U to your D-40. See Schedule N, DC Non-Custodial Parent EITC Claim, to determine if you are eligible to claim this credit. If you complete a Schedule N, attach it to your D-40.

Line 30 Total Refundable Credits Add line 27d or 27e through Line 29.

Line 31 DC income tax withheld Add the amount of DC income tax withheld as shown on your appli- cable 2021 federal Forms W-2 and 1099 that show DC tax withheld.

Line 32 2021 Estimated income tax payments and amount applied from 2020 return

Enter the total of your 2021 DC estimated income tax payments and any amount applied from your 2020 return as a carry forward. If you are filing separate returns and paid estimated income tax payments, you and your spouse/registered domestic partner must divide the payments according to which spouse/registered domestic partner paid them. You cannot arbitrarily allocate the estimated payments between you.

Line 33 Tax paid with extension of time to file lf you filed Form FR-127, Extension of Time to file a DC Income Tax Return, enter the amount you paid with the FR-127.

Line 34 If this is an amended 2021 return, enter payments made with original 2021 D-40 return.

20

Line 35 If this is an amended 2021 return, enter refunds re- quested with original 2021 D-40 return.

Line 36 Total payments and refundable credits

Add Lines 30 through Line 34. Do not include Line 35. Line 37 Tax due

Subtract Line 36 from Line 26.

Line 38 Amount overpaid Subtract Line 26 from Line 36.

Line 39 Amount to be applied to your 2022 estimated tax

Line 40 Underpayment interest Fill in the oval if Form D-2210 is attached.

D-2210:Underpayment of Estimated Income Tax By Individuals You may use this form to calculate your underpayment interest when submitting your D-40 form. If you do, fill in the oval, attach it to your tax return and enter the interest amount on Line 40 of the D-40. If you do not wish to calculate the interest, the Office of Tax and Revenue (OTR) will do it when your return is processed and will notify you of the amount due. You may also complete this form if you believe the interest assessed by OTR for underpayment of estimated income tax is incorrect.

Line 41 Contribution amount from Schedule U, Part II, Line 5 (Cannot exceed refund amount on Line 38) Reference Instructions, page 12.

lf you wish to contribute and you are not due a refund or do not owe additional tax, please enter the total contribution amount on Line 41. Make your payment payable to the DC Treasurer and include it with your return.

Line 42 Total amount due Add Lines 37, 40 and 41. You must pay this amount in full with your return. See page 8 for payment options under Instructions.

Line 43 Net Refund Subtract total of Lines 39, 40 and 41 from Line 38.

Be sure to use the PO Box 96145 mail label from the back flap of the return envelope when mailing your return, requesting a refund.

If you answer yes to the question, "Will this refund go to an account outside the U.S.", you will be issued a paper check in lieu of direct deposit. See page 13 of the Instructions.

Line 44 Injured spouse allocation

Fill in the oval if either spouse is claiming injured spouse alloca- tion, and attach Form DC-8379 (Injured Spouse Allocation). Your DC-8379 must be attached to your return at the time of filing or the offsets cannot be recoverable by OTR.

Electronic 1099-G

In January 2020, the Office of Tax and Revenue (OTR) began offer- ing a paperless option for receiving the Form 1099-G income tax refund statement. If you agree to receive your statement electroni- cally, fill in the oval. We will notify you in January 2022 that your statement is available to be viewed and printed from our web portal if you are a registered user. Otherwise, you will continue to receive your paper statement unless you choose the paperless option.

Standard Deduction Worksheet for Dependent Filers Use this worksheet only if someone can claim you, or your spouse/registered domestic partner if filing jointly, as a dependent. To find out if someone can claim you as a dependent, see IRS Pub. 501.

1. Check if You were born before January 2, 1957 You are blind

Spouse/registered domestic partner was born before January 2, 1957

Spouse/registered domestic partner is blind Total number of boxes checked............. 1. 2. Is your earned income* more than $750? Yes. Add $350 to your earned income. } ERLE WE WL, 00000000000000000000000000000000000000000 2p No. Enter $1,100 3. Enter the amount shown below for your filing status. . Single or married/registered domestic partner filing separately - $12,550 . Married/registered domestic partners filing jointly or filing separately on the same return - $25,100 8 . Head of household - $18,800

4. Standard deduction. a. Enter the smaller of Line 2 or Line 3. If born after January 1, 1957, and not blind, stop here and CHET TTS ERMOUTTE Om [Rent (D440), (LAME 1.77. c00000000000000000000000000000000000000000006aN00N300000000000000000000000d 4a.

b. If born before January 2, 1957, or blind, multiply the number on Line 1 by $1,350 ($1,700 if single or head of household)... -Ab.

Ac.

c. Add Lines 4a and 4b. Enter the total here and on Form D-40, Line 18

* Earned income includes wages, salaries, tips, professional fees, and other compensation received for personal services you performed. It also includes any taxable scholarship of fellowship grant. Generally, your earned income is the total of the amount(s) you reported on Form D-40, Line 4, less any amount representing unemployment compensation received.

Standard Deduction Chart for People who Were Born before January 2, 1957, or Are Blind

Don't use this chart if someone can claim you, or your spouse/registered domestic partner if filing jointly, as a dependent. Instead, use the worksheet above. You were born before January 2, 1957 You are blind Spouse/registered domestic partner was born before January 2, 1957

Spouse/registered domestic partner is blind Enter the total number of boxes Checked..........:ccccesseeessseeesteeeeseeeneeeeneee

If your filing AND the number in THEN your standard | If your filing AND the number in = THEN your standard status is.... the box above is.... deduction is.... status is... the box above is.... deduction is.... 0 $12,550 0 $18,800 Single 1 14,250 Head of 1 20,500 2 15,950 Household 2 22,200 Married/registered (0) $25,100 (0) $12,550 domestic partner 1 26,450 Married filing 1 13,900 filing jointly or filing 2 27,800 separately 2 15,250 separately on the 3 29,150 3* 16,600 same return 4 30,500 4* 17,950 * You can claim an additional standard deduction for Qualifying widow(er) (0) $25,100 your spouse only if your spouse had no income, is not filing 1 26,450 a federal or DC income tax return and cannot be claimed as 2 27,800 a dependent on another person's return.

21

District of Columbia Earned Income Tax Credit (EITC) Worksheet For Filers Without A Qualifying Child

This worksheet is for taxpayers who do not have a qualifying child for the Earned Income Credit. If you have a qualifying child DO NOT USE THIS WORKSHEET.

If your earned income or federal adjusted gross income (fed AGI) is greater than $37,455

YOU CANNOT CLAIM THIS CREDIT

Section A: General Eligibility for the DC Childless Worker EITC.

If you qualified for the federal Earned Income Credit, go directly to Section B, below. If you did not qualify for the federal Earned Income Credit, answer these questions:

22

1.

Were you, or your spouse/registered domestic partner if married filing jointly, or married filing separately on

the same return, at least age 19, or a student up to age 24, or age 18 for a qualified former foster youth, or qualified homeless at the end of 2021? If your spouse died in 2021 or if you are preparing a return for someone who died in 2021, see IRS Pub. 596 before you answer. If YES continue. If NO, STOP, you cannot claim the EITC.

Do you, and your spouse/registered domestic partner (if filing on the same tax return) have a social security number that allows you to work, or is valid for EITC purposes? (See the federal tax return instruction booklet for more information.) If YES, continue.

If you answer YES to any of the following questions, STOP, you are not eligible for the EITC. If you can answer NO to all the questions, go to step 4.

a.

> oa =>

If you are unmarried, can you be claimed as a dependent on someone else’s 2021 tax return, or are you someone else’s qualifying child?

If you are married, and you are not filing with your spouse, can you be claimed as a dependent on someone else’s 2021 tax return, or are you someone else’s qualifying child?

On your federal return are you filing form 2555?

Is your investment income more than $10,000? (Investment income includes: taxable interest, tax-exempt interest, ordinary dividends and capital gains more than $0)

Did you file form 4797 with your federal return?

Did you file Schedule E with your federal return?

Did you have income from the rental of personal property not used in trade or business on your federal return? Did you elect to report child's interest and dividends on your federal return?

Are you a qualifying child of another person for the Earned Income Credit?

4. Were you or your spouse a nonresident alien for any part of 2021? If NO, continue to Line 5. If YES, see the special rule below.

Special Rule for nonresident Aliens: If you are not married, and were a nonresident alien for any part of the year, STOP, you do not qualify for the EITC. If you were married, and both spouses were nonresident aliens for any part of the tax year, STOP, you do not qualify for the EITC. If only one spouse was a nonresident alien for any part of the year, you cannot claim the EITC unless your federal filing status is married filing jointly.

5. If you had income or loss from a passive activity, see IRS Pub. 596 to see if you can claim the EITC.

SECTION B: Calculating Your Earned Income

(For Individuals without federal Schedule SE, Schedule C, and who were not members of the clergy or statutory employees)

If you were self-employed at any time in 2021, or are filing federal Schedule SE because you were a member of the clergy or had church employee income, or are filing federal Schedule C as a statutory employee, DO NOT USE THIS WORKSHEET to figure out your earned income. See special instructions below.

This worksheet is for taxpayers without a qualifying child only. If you claimed the federal EITC on a 1040 ora 1040-SR, DO NOT USE THIS WORKSHEET to figure out your earned income. Report the earned income amount derived from the federal worksheet used to make your federal EITC claim on your 1040 or 1040-SR.

1. Enter the amount of your wages, salaries, tips, etc., (from federal Form 1040 or 1040-SR)...... eee cece cece eens ee eeeneeeeeeeeeeeeeeeeeeeeaaaaaee 1.

2. Enter any amount included on Line 1, that is a taxable scholarship or fellowship grant not reported on a FOr W-2...........ccccceeeeeeeeeeeeeeeeeseneeeeeeeeeeeenees 2.

3. Enter any amount included on Line 1, for work performed while an inmate in a penal institUtion...... 0.0.0... cceceeceececeeeeeeeeeeeeeeeeeeaeeeeeseeeeeeeseeeeeeeaaeeeees 3.

4. Enter any amount included on Line 1 that you received as a pension or annuity from a nonqualified deferred compensation plan or nongovernmental section 457 plan. This amount may be shown in box 11 of Form W-2. If you received such an amount but box 11 is blank, contact your employer for the aMOunt received... eee cece cece eee ee eee ene e teen tere eeeee sees aaaaaanneeeeeeeeeeeeeed 4.

5. Enter any amount included on Line 1, that is a Medicaid waiver

payment you exclude from iNCOME.........6.ccccceeeeeeeeeeeeeeeeaeeeeceeeeeeeeseeeseeeeeeeeeaaeees 5. 6. Add Lines 2, 3, 4, ANd 5D... cccccccecccecceececeeeeeeeceeeesaeceeeecseeeeseeeeeeseeeeneeeaee! 6. 7. Subtract Line 6 from Line Lo... eee cree cette tense eae anette eeeeeeeeeeeeeenaaaaaeees 7.

8. Enter all of your nontaxable combat pay if you elect to include it in CT aa -1e B00) 0 eee 8.

9. Add Lines 7 and 8. This is your earned iNCOME............ccccceeeeeeeeeeeeeeeeaeeeeeeeneeeeees 9.

Special instructions for Members of the Clergy, Statutory employees and those filing Schedule SE, Schedule C. See IRS 1040 instruction, Worksheet B. Use the amount on line 4b as your earned income. (Ignore line 5). Clergy

and Church employees take note of special instructions.

23

SECTION C: Figuring your DC Earned Income Credit

Note: This Earned Income Credit Worksheet is for filers without a qualifying child only. If you are a filer with a qualifying child, DO NOT USE THIS WORKSHEET.

If your earned income or federal adjusted gross income (fed AGI) is greater than $37,455, STOP, you cannot claim this credit.

1. Enter your earned income from Line 9 of the Earned Income worksheet on the previous page, or from Line 4b of Worksheet B from the IRS instructions......... 1.

2. If earned income is less than $9,817, multiply the amount by 0.153, otherwise enter $1502. $1502 is the maximum amount that can be claimed. This is your tentative EITC amount based on your earned income.

Complete the Lines below to determine the actual EITC amount................:::::0eeee 2. 3. Enter your federal adjusted gross income (from Form 1040 or 1040-SR)..........- 3. 4. Enter the higher of Line 1 or Line 3.20.0... ...ccecccececcceeeeeeeeeeeeeeeecaeeeeeeeeeeeeeeeeeeeeaes 4.

5. If Line 4 is less than $19,743, enter the amount from Line 2. This is your actual EITC. If you are a part-year resident, you must prorate the credit attributable to the time of your DC residency. Enter this amount ON Form D-40, LING 276 .... cece cc cc ccccc cece cece ecceeecee cece cess cess eeeeeeeseeeeeeeeseeesaeeeaaeees 5.

6. If Line 4 is between $19,743 and $37,455 subtract $19,743 from the amount on Line 4, enter reSult...........ccccccccecceeeeceeeceeceseeceeeeeeeeseeceseeeeeeeeeeeeneeees 6.

7. Multiply the amount on Line 6 by 0.0848, enter result..............ccccseeeeeeeeeeeeeeeee ee 7.

8. Subtract Line 7 from Line 2, enter result here. If less than zero, enter zero. If you are a part-year resident, you must prorate the credit attributable to the time of your DC residency. This is your actual EITC. Enter this amount on Form D-40, Lin€ 27€...........cccccccccecceeccesee cess ceseeeeeeeeeeneeeee 8.

U.S. Bank ReliaCard® Pre-Acquisition Disclosure Program Name: District of Columbia Personal Income Tax

Monthly fee Per purchase ATM withdrawal Cash reload

$0 $0 $0 in-network N/A $2.00 out-of-network

ATM Balance Inquiry (in-network or out-of-network) $0 or $1.00 Customer Service (automated orlive agent) $0 percall Inactivity (after 90 days with no transactions) $2.00 per month

We charge 4 other types of fees.

No overdraft/credit feature. Your funds are eligible for FDIC insurance.

For general information about prepaid accounts, visit cfpb.gov/prepaid. Find details and conditions for all fees and services inside the card package or call 1-877-528-6408 or visit usbankreliacard.com.

CR-19743526

U.S. Bank ReliaCard® Fee Schedule Program Name: District of Columbia Personal Income Tax

All fees Amount Details Getcash ATM Withdrawal (in-network) $0 This is our fee per withdrawal. “In-network’ refers to the U.S. Bank or MoneyPass” or Allpoint®

ATM networks. Locations can be found at usbank. com/locations or moneypass.com/atm- locator.html or allpointnetwork.com.

ATM Withdrawal $2.00 This is ourfee perwithdrawal. “Out-of-network’ refers to allthe ATMs outside of the U.S. Bank (out-of-network) or MoneyPass or Allpoint ATM networks. You may also be charged a fee by the ATM operator even if you do not complete a transaction.

Teller Cash Withdrawal $0 This is our fee forwhen you withdraw cash off your card from a teller at a bank or credit union that accepts Visa®.

Information

ATM Balance Inquiry (in-network) $0 This is ourfee per inquiry. “In-network’ refers to the U.S. Bank or MoneyPass or Allpoint ATM networks. Locations can be found at usbank. com/locations or moneypass.com/atm-locator.html or_allpointnetwork.com.

ATM Balance Inquiy $1.00 This is ourfee per inquiry. “Out-of-network’ refers to all the ATMs outside of the U.S. Bank or

(out-of-network) MoneyPass or Allpoint ATM networks. You may also be charged a fee by the ATM operator.

Using your card outside the U.S.

International Transaction 3% This is our fee which applies when you use your card for purchases at foreign merchants and for cash withdrawals from foreign ATMs and is a percentage of the transaction dollar amount, after any currency conversion. Some transactions, even if you and/or the merchant or ATM are located} in the United States, are considered foreign transactions under the applicable network rules, and we do not control how these merchants, ATMs and transactions are classified for this purpose.

International ATM Withdrawal $2.00 This is our fee per withdrawal. You may also be charged a fee by the ATM operator even if you do not complete a transaction.

International ATM Balance Inquiry $2.00 This is our fee per inquiry. You may also be charged a fee by the ATM operator. Other Card Replacement $5.00 This is our fee per replacement of a lost card mailed to you with standard delivery (up to 10

business days).

Card Replacement Expedited Delivery} $25.00 | This is ourfee for expedited delivery (up to 3 business days) charged in addition to any Card Replacement fee.

Inactivity $2.00 This is ourfee charged each month after you have not completed a transaction using your card for 90 consecutive days.

Yourfunds are eligible for FDIC insurance. Your funds will be held at U.S. Bank National Association, an FDIC-insured institution, and are insured up to $250,000 by the FDIC in the event U.S. Bank fails. See fdic.qov/deposit/deposits/prepaid.htm! for details.

No overdraft/credit feature. Contact Cardholder Services by calling 1-877-528-6408, by mail at P.O. Box 551617, Jacksonville, FL 32255 or visit usbankreliacard.com.

For general information about prepaid accounts, visit cfob.gov/prepaid. If you have a complaint about a prepaid account, call the Consumer Financal Protection Bureau at 1-855-411-2372 or visit cfob.gov/complaint.

Cr-19743526

The ReliaCard is issued by U.S. Bank National Association pursuantto a license from Visa U.S.A. Inc. ©2021 U.S. Bank. Member FDIC.

CR-19743526

Divulgacion Previa a la Adquisicion de la Tarjeta U.S. Bank ReliaCard® Nombre del Programa: District of Columbia Personal Income Tax

Cargo Por compra Retiros de fondos Recarga de mensual $0 en ATM efectivo

$0 $0 dentro de la red N/A $2.00 fuera de la red

Consulta de Saldo en ATM (dentro o fuerade la red) $0 0 $1.00

Servicio de Atencion al Cliente

(automatizado o representante en vivo) $0 porliamada

Inactividad (después de 90 dias sin transacciones) $2.00 por mes

Cobramos otros 4 tipos de cargos.

Sin prestacion de sobregiro/crédito. Sus fondos son elegibles para el seguro FDIC.

Para obtener informacion general sobre cuentas prepagadas, visite cfpb.gov/prepaid (en inglés). Encuentre detalles y condiciones de todos los cargos y servicios en el paquete de la tarjeta, llamando al 877.528.6408 o visitando usbankreliacard.com (en inglés).

Lista de Cargos de la Tarjeta U.S. Bank ReliaCard® Nombre del Programa: District of Columbia Personal Income Tax

Todos los cargos Monto Detalles

Retiros de efectivo

Retiro de Fondos en ATM $0 Este es nuestro cargo por retiro de fondos. “Dentro de la red” se refiere a las redes de ATMde

(dentro de la red) U.S. Bank, MoneyPass” yAllpoint®. Puede encontrar ubicaciones en usbank.com/locations (en inglés), moneypass.com/atm-locator.html (en inglés) y allpointnetwork.com (en inglés).

Retiro de Fondos en ATM $2.00 Este es nuestro cargo por retiro de fondos. “Fuera de la red” se refiere a todos los ATM que se

(fuera de la red) encuentran fuera de las redes de ATMde U.S. Bank, MoneyPass y Allpoint. El operador del ATM| también puede cobrarle un cargo, incluso sino termina de realizar la transaccion.

Retiro de Efectivo $0 Este es nuestro cargo por realizar un retiro de efectivo desde su tarjeta con la ayuda del

con Personal de Ventanilla personal de ventanilla en un bancoo cooperativa de crédito que acepte Visa®.

Informacion

Consulta de Saldo en ATM $0 Este es nuestro cargo por consulta. “Dentro de la red” se refiere a las redes de ATMde

(dentro de la red) U.S. Bank, MoneyPass y Allpoint. Puede encontrar ubicaciones en usbank.com/locations (en inglés), moneypass.com/atm-locator.html (en inglés) y allpointnetwork.com (en inglés).

Consulta de Saldo en ATM $1.00 Este es nuestro cargo por consulta. “Fuera de la red” se refiere a todos los ATM que se

(fuera de la red) encuentran fuera de las redes de ATMde U.S. Bank, MoneyPass y Allpoint. El operador del ATM|

también puede cobrarle un cargo.

Uso de su tarjeta fuera de los EE. UU.

Transaccion Internacional 3% Este es el cargo que cobramos y que se aplica al uso de su tarjeta para compras en comercios extranjeros y porretiros de efectivo en ATM extranjeros y es un porcentaje del monto en dolares| de la transaccion después de cualquier conversion de moneda. Algunas transacciones, aunque usted y/o el comercio o ATMestén ubicados en los Estados Unidos, se consideran transacciones en el extranjero conforme a las reglas aplicables de la red, y nosotros no tenemos, control sobre como se clasifican estos comercios, ATM y transacciones para este fin.

Retiro de Fondos $2.00 Este es nuestro cargo por retiro de fondos. El operador del ATM también puede cobrarle un en ATM Internacional cargo, incluso sino termina de realizarla transaccion. Consulta de Saldo $2.00 Este es nuestro cargo por consulta. El operador del ATM también puede cobrarle un cargo.

en ATM Internacional

Otros

Reemplazo de Tarjeta $5.00 Este es nuestro cargo por reemplazo de una tarjeta extraviada con servicio de entrega estandar (hasta 10 dias habiles).

Reemplazo de Tarjeta $25.00 | Este es nuestro cargo por entrega expresa (hasta 3 dias habiles), adicional a cualquier cargo por

con Entrega Expresa Reemplazo de Tarjeta.

Inactividad $2.00 Este es nuestro cargo por mes si no ha realizado una transacci6n con su tarjeta durante 90 dias

consecutivos.

Si bien esta comunicacion de U.S. Bank se ofrece en espafiol, las futuras comunicaciones de U.S. Bank y los documentos relacionados con sus acuerdos contractuales, divulgaciones, notificaciones y estados de cuenta, asi como los servicios en Internet y de la banca movil, pueden estar disponibles solamente en inglés. Usted debe poder leer y comprender estos documentos o tener asistencia en su traduccion para poder entender y utilizar este producto o servicio. Los documentos en inglés estan disponibles a peticion suya.

Sus fondos son elegibles para el seguro FDIC. Sus fondos se conservaran en U.S. Bank National Association, unainstitucién asegurada porla FDIC, y estan asegurados porla FDIC hasta $250,000 en caso de queU.S. Bank no lo haga. Consulte fdic.gov/deposit/deposits/prepaid.html (en inglés) para obtener detalles.

Sin prestacion de sobregiro/crédito. Comuniquese con Servicios para Titulares de Tarjetas, llamando al 877.528.6408, por correo a: Cardholder Services P.O. Box 551617, Jacksonville, FL 32255 0 visite usbankreliacard.com (en inglés).

Para obtener informacion general sobre cuentas prepagadas, visite cfpb.gov/prepaid (en inglés). Si tiene alguna queja sobre una cuenta prepagada, llame a la Oficina para la Proteccién Financiera del Consumidor (Consumer Financial Protection Bureau) al 855.4 11.2372, o visite cfpb.gov/complaint (en inglés).

Cr-19743526

La Tarjeta ReliaCard es emitida por U.S. Bank National Association, de conformidad conuna licencia de Visa U.S.A. Inc. ©2021 U.S. Bank. Miembro FDIC.

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Key website resources

DC Official Code www.lexisnexis.com/hottopics/dccode/

DC Regulations www.dcregs.dc.gov/

DC Tax Forms/Publications MyTax.DC.gov

Mailing Address for Returns MyTax.DC.gov

Electronic Funds Transfer (EFT) Guide MyTax.DC.gov

NACHA Guidelines www.nacha.org/

Social Security Administration WWW.SSa.20V/

Internal Revenue Service WWW.irS.ZOV

33

te % Government of the mmm District of Columbia

PYAR D-40 Individual Income Tax Return

Important: Print in CAPITAL letters using black ink.

21 04 0 011 0 0 0 0

A : . Personal information

Your telephone number

Your taxpayer identification number (TIN) and Date of Birth (MMDDYYYY)

Your first name M.I. Last name

Spouse’s/registered domestic partner’s first name M.I. Last name

Home address (number, street and suite/apartment number if applicable)

City

STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK

Email Address

Filing status

1 Fill in only one: Single, Married filing jointly,

Registered domestic partners filing jointly for Lines 5-43. See instructions.

Fill in

Spouse’s/registered domestic partner’s TIN

Married filing separately,

OFFICIAL USE ONLY Vendor ID#0000

and Date of Birth (MMDDYYYY)

if: Filing an amended return. See instructions.

Fill in if Deceased

Fill in if Deceased

State Zip Code +4

Dependent claimed by someone else

Married filing separately on same return Enter combined amounts for Lines 5-43. See instructions.

filing separately on same return Enter combined amounts

Head of household Enter qualifying dependent and/or non-dependent information on Schedule S.

Qualifying widow(er) with dependent child Enter qualifying dependent and/or non-dependent information on Schedule S.

2 Fill in if you are: Part-year resident in DC from

(MMDDYYYY)

3 Did you have qualifying health care coverage for all members of your shared responsibility family for the entire year? Yes If no, or if claiming an exemption, complete Schedule HSR (see instructions).

to See instructions. (MMDDYYYY)

No

STAPLE W-2s AND ANY OTHER WITHHOLDING STATEMENTS HERE ————

Income Information

a Wages, salaries, unemployment compensation and/or tips, a see instructions.

Business income or loss, see instructions. Fill in if loss b

Fill in if loss €

b C Capital gain or loss. d

Rental real estate, royalties, partnerships, etc. Fill in if loss d

Computation of DC Gross and Adjusted Gross Income

4 Federal adjusted gross income. From adjusted gross income lines on federal Forms 1040, 1040-SR, 1040-NR or 1040-NR-EZ.

Revised 07/2021

@ Complete your federal return first - Enter your dependents’ information on DC Schedule S @

Round cents to nearest dollar. If amount is zero, leave line blank; if minus, enter amount and fill in oval.

00 00 00

00

Fill in if loss 4

Enter your TIN

D-40 PAGE 2 r ) 2104 00%1 2 000 0

Additions to DC Income

5 Franchise tax deducted on federal forms, see instructions. 5 00 6 Other additions from DC Schedule |, Calculation A, Line 9. 6 00 7 Add Lines 4, 5 and 6. Fill in if loss 7 00 Subtractions from DC Income

8 Part year residents, enter income received during period of nonresidence, see instructions. 8 00 9 Taxable refunds, credits or offsets of state and local income tax. 9 00 10 Taxable amount of social security and tier 1 railroad retirement 10 00 11. Income reported and taxed this year on a DC franchise or fiduciary return. 11 00 12 DC and federal government survivor benefits, see instructions. 12 00 13 Unemployment Insurance Benefits, see instructions. 13 00 14 Other subtractions from DC Schedule |, Calculation B, Line 16. 14 00 15 Total subtractions from DC income, Lines 8-14. 15 00 16 DC adjusted gross income, Line 7 minus Line 15. Fill in if loss 16 00

17 Deduction type. Take the same type as you took on your federal return. Fill in which type: Standard or Itemized See instructions for amount to enter on Line 17.

18 DC deduction amount. 18 00 19 DC taxable income. Subtract Line 18 from Line 16. Fill in if loss 19 00 20 Tax. If Line 19 is $100,000 or less, use tax tables to find the tax, if more, use Calculation | in instr uctions. 20 00 Fill in if filing separately on same return. Complete Calculation J on Schedule S. 21 Credit for child and dependent care expenses .00 X .32 21 00 From federal Form 2441; if part-year DC resident, from Line 5, DC Form 2441 22 Non-refundable credits from DC Schedule U, Part la, Line 7. Attach Schedule U. 22 00 23 Total non-refundable credits. Add Line 21 and Line 22. 23 00 24 Subtract Line 23 from Line 20. /f less than zero, enter zero. 24 00 25 DC Health Care Shared Responsibility See instructions. if fully covered or fully exempt, enter zero. 25 00 26 Total tax and DC Health Care Shared Responsibility. Add Line 24 and Line 25. 26 00 27 DC Earned Income Tax Credit Fill in if prior year (2019) earned income See instructions. 27a Enter the number of qualified EITC children. 27b Enter earned income amount 27b 00 27c For filers with qualifying children. Enter federal EIC -00 X .40 Enter result > 27d 00 27e For filers without qualifying children. See instructions for special calculations. Enter result> 27e 00 28 Property Tax Credit. From your DC Schedule H; attach a copy. 28 00

DC tax, credit and payments

D-40 PAGE 3 2104 001 3 00 0 0

Enter your TIN

29 Refundable credits from DC Schedule U, Part 1b, Line 3. Attach Schedule U. 29 30 Total refundable credits. Add Line 27d or 27e through Line 29. 30 31 DC income tax withheld shown on Forms W-2 and 1099. Attach these forms. 31 32 2021 estimated income tax payments and amount applied from 2020 return. 32 33 Tax paid with Form FR-127 Extension of Time to File. 33 34 If this is an amended 2021 return, enter payments made with original 2021 D-40 return. 34 35 If this is an amended 2021 return, enter refunds requested with original 2021 D-40 return. 35 36 Total payments and refundable credits. Add Line 30 through Line 34. (Do not include Line 35). 36 37 Tax Due. Subtract Line 36 from Line 26. 37 38 Amount overpaid. Subtract Line 26 from Line 36. 38 39 Amount to be applied to your 2022 estimated tax. 39 40 Underpayment Interest. Fill in the oval and attach Form D-2210. 40 41 Contribution amount from Schedule U, Part II, Line 5. (Cannot exceed amount on Line 38) 41 42 Total Amount Due. Add Lines 37, 40 and 41. 42 43 Net Refund. Subtract total of Lines 39, 40 and 41 from Line 38. 43

Will this refund go to an account outside the U.S.?__ Yes No See instructions. 44 Fillin if either spouse is claiming injured spouse protection. You must attach Form DC-8379.

00 00 00 00 00 00 00 00 00 00 00 00 00

00 00

Refund Options: For information on the tax refund card and program limitations, see instructions or visit our website MyTax.DC.gov.

Mark one refund choice: Direct deposit or Reliacard (See instructions) or Paper check Direct Deposit. To have your refund deposited to your checking or savings account, fill in oval and enter bank routing and account numbers. See instructions. Routing Number Account Number

Fill in if you agree to receive your 1099-G Income Tax refund statement electronically (see instructions).

Third party designee To authorize another person to discuss this return with OTR, fill in here and enter the name and phone number of that person. See instructions.

Designee’s name Phone number

Signature Under penalties of law, | declare that | have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on information available to the preparer. Your signature Date Preparer's signature Date

Spouse's/registered domestic partner's signature if filing jointly or separately on same return Date Preparer’s Tax Identification Number (PTIN) PTIN telephone number

te % Government of the mmm District of Columbia

PYAR D-40 Individual Income Tax Return

Important: Print in CAPITAL letters using black ink.

21 04 0 011 0 0 0 0

A : . Personal information

Your telephone number

Your taxpayer identification number (TIN) and Date of Birth (MMDDYYYY)

Your first name M.I. Last name

Spouse’s/registered domestic partner’s first name M.I. Last name

Home address (number, street and suite/apartment number if applicable)

City

STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK

Email Address

Filing status

1 Fill in only one: Single, Married filing jointly,

Registered domestic partners filing jointly for Lines 5-43. See instructions.

Fill in

Spouse’s/registered domestic partner’s TIN

Married filing separately,

OFFICIAL USE ONLY Vendor ID#0000

and Date of Birth (MMDDYYYY)

if: Filing an amended return. See instructions.

Fill in if Deceased

Fill in if Deceased

State Zip Code +4

Dependent claimed by someone else

Married filing separately on same return Enter combined amounts for Lines 5-43. See instructions.

filing separately on same return Enter combined amounts

Head of household Enter qualifying dependent and/or non-dependent information on Schedule S.

Qualifying widow(er) with dependent child Enter qualifying dependent and/or non-dependent information on Schedule S.

2 Fill in if you are: Part-year resident in DC from

(MMDDYYYY)

3 Did you have qualifying health care coverage for all members of your shared responsibility family for the entire year? Yes If no, or if claiming an exemption, complete Schedule HSR (see instructions).

to See instructions. (MMDDYYYY)

No

STAPLE W-2s AND ANY OTHER WITHHOLDING STATEMENTS HERE ————

Income Information

a Wages, salaries, unemployment compensation and/or tips, a see instructions.

Business income or loss, see instructions. Fill in if loss b

Fill in if loss €

b C Capital gain or loss. d

Rental real estate, royalties, partnerships, etc. Fill in if loss d

Computation of DC Gross and Adjusted Gross Income

4 Federal adjusted gross income. From adjusted gross income lines on federal Forms 1040, 1040-SR, 1040-NR or 1040-NR-EZ.

Revised 07/2021

@ Complete your federal return first - Enter your dependents’ information on DC Schedule S @

Round cents to nearest dollar. If amount is zero, leave line blank; if minus, enter amount and fill in oval.

00 00 00

00

Fill in if loss 4

Enter your TIN

D-40 PAGE 2 r ) 2104 00%1 2 000 0

Additions to DC Income

5 Franchise tax deducted on federal forms, see instructions. 5 00 6 Other additions from DC Schedule |, Calculation A, Line 9. 6 00 7 Add Lines 4, 5 and 6. Fill in if loss 7 00 Subtractions from DC Income

8 Part year residents, enter income received during period of nonresidence, see instructions. 8 00 9 Taxable refunds, credits or offsets of state and local income tax. 9 00 10 Taxable amount of social security and tier 1 railroad retirement 10 00 11. Income reported and taxed this year on a DC franchise or fiduciary return. 11 00 12 DC and federal government survivor benefits, see instructions. 12 00 13 Unemployment Insurance Benefits, see instructions. 13 00 14 Other subtractions from DC Schedule |, Calculation B, Line 16. 14 00 15 Total subtractions from DC income, Lines 8-14. 15 00 16 DC adjusted gross income, Line 7 minus Line 15. Fill in if loss 16 00

17 Deduction type. Take the same type as you took on your federal return. Fill in which type: Standard or Itemized See instructions for amount to enter on Line 17.

18 DC deduction amount. 18 00 19 DC taxable income. Subtract Line 18 from Line 16. Fill in if loss 19 00 20 Tax. If Line 19 is $100,000 or less, use tax tables to find the tax, if more, use Calculation | in instr uctions. 20 00 Fill in if filing separately on same return. Complete Calculation J on Schedule S. 21 Credit for child and dependent care expenses .00 X .32 21 00 From federal Form 2441; if part-year DC resident, from Line 5, DC Form 2441 22 Non-refundable credits from DC Schedule U, Part la, Line 7. Attach Schedule U. 22 00 23 Total non-refundable credits. Add Line 21 and Line 22. 23 00 24 Subtract Line 23 from Line 20. /f less than zero, enter zero. 24 00 25 DC Health Care Shared Responsibility See instructions. if fully covered or fully exempt, enter zero. 25 00 26 Total tax and DC Health Care Shared Responsibility. Add Line 24 and Line 25. 26 00 27 DC Earned Income Tax Credit Fill in if prior year (2019) earned income See instructions. 27a Enter the number of qualified EITC children. 27b Enter earned income amount 27b 00 27c For filers with qualifying children. Enter federal EIC -00 X .40 Enter result > 27d 00 27e For filers without qualifying children. See instructions for special calculations. Enter result> 27e 00 28 Property Tax Credit. From your DC Schedule H; attach a copy. 28 00

DC tax, credit and payments

D-40 PAGE 3 2104 001 3 00 0 0

Enter your TIN

29 Refundable credits from DC Schedule U, Part 1b, Line 3. Attach Schedule U. 29 30 Total refundable credits. Add Line 27d or 27e through Line 29. 30 31 DC income tax withheld shown on Forms W-2 and 1099. Attach these forms. 31 32 2021 estimated income tax payments and amount applied from 2020 return. 32 33 Tax paid with Form FR-127 Extension of Time to File. 33 34 If this is an amended 2021 return, enter payments made with original 2021 D-40 return. 34 35 If this is an amended 2021 return, enter refunds requested with original 2021 D-40 return. 35 36 Total payments and refundable credits. Add Line 30 through Line 34. (Do not include Line 35). 36 37 Tax Due. Subtract Line 36 from Line 26. 37 38 Amount overpaid. Subtract Line 26 from Line 36. 38 39 Amount to be applied to your 2022 estimated tax. 39 40 Underpayment Interest. Fill in the oval and attach Form D-2210. 40 41 Contribution amount from Schedule U, Part II, Line 5. (Cannot exceed amount on Line 38) 41 42 Total Amount Due. Add Lines 37, 40 and 41. 42 43 Net Refund. Subtract total of Lines 39, 40 and 41 from Line 38. 43

Will this refund go to an account outside the U.S.?__ Yes No See instructions. 44 Fillin if either spouse is claiming injured spouse protection. You must attach Form DC-8379.

00 00 00 00 00 00 00 00 00 00 00 00 00

00 00

Refund Options: For information on the tax refund card and program limitations, see instructions or visit our website MyTax.DC.gov.

Mark one refund choice: Direct deposit or Reliacard (See instructions) or Paper check Direct Deposit. To have your refund deposited to your checking or savings account, fill in oval and enter bank routing and account numbers. See instructions. Routing Number Account Number

Fill in if you agree to receive your 1099-G Income Tax refund statement electronically (see instructions).

Third party designee To authorize another person to discuss this return with OTR, fill in here and enter the name and phone number of that person. See instructions.

Designee’s name Phone number

Signature Under penalties of law, | declare that | have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on information available to the preparer. Your signature Date Preparer's signature Date

Spouse's/registered domestic partner's signature if filing jointly or separately on same return Date Preparer’s Tax Identification Number (PTIN) PTIN telephone number

*& & & Government of the

ee tir ercoumes AM SCHEDULE S Supplemental r ) Information and Dependents

Unless instructed otherwise — Od OO es OO OO

If you fill in any part of this schedule, attach it to your D-40. Print in CAPITAL letters using black ink. OFFICIAL USE ONLY

Vendor ID#0000

Enter your last name Enter your TIN

Dependents _/f you have more than 8 dependents, list them on an attachment.

First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) Head of household filers TIN of qualifying non-dependent person Date of Birth of qualifying non-dependent person (MMDDYYYY)

or qualifying widow(er) Do not enter your information

First name of qualifying non-dependent person M.I. Last Name

Revised 07/2021

SCHEDULE S PAGE 2 e Last name and TIN 21°04 002 4 0 0 0 0

Calculation G-1 Computation of Standard Deduction Calculation G-1 must be completed and submitted with the return except for dependent filers

* If you were born before January 2, 1957, you are considered to be age 65 at the end of 2021 a Basic standard deduction amount. See instructions.

b Enter 1 if you are age 65 or over *

c Enter 1 if you are blind

d Enter 1 if married or registered domestic partner filing jointly or filing separately on same return and your spouse or registered domestic partner is 65 or over *

e Enter 1 if married or registered domestic partner filing jointly or filing separately on same return and your spouse or registered domestic partner is blind

f Total number of additions to standard deductions. Add Lines b through e.

g Additional standard deduction amount. Multiply $1,350 ($1,700 if single or head of household.

by number on Line f. See instructions. h_ Total standard deduction. Add Lines a and g, enter here and on D-40, Line 18.

i Total number of dependents

a 00

g 00

Calculation J Tax computation for married or registered domestic partners filing separately on the same DC return.

Enter separate amounts in each column. Combine amounts on Line i. You

a Federal adjusted gross income. Fill in if loss a /f you and your spouse filed a joint federal return, enter each person’s portion of federal adjusted gross income. Registered domestic partners should enter the federal AGI reported on their separate federal returns.

b Total additions to federal adjusted gross income. b Enter each person’s portion of additions entered on D-40, Lines 5 and 6.

c Add Lines a and b. Fill in if loss c

d_ Total subtractions from federal adjusted gross income. d Enter each person’s portion of subtractions entered on D-40, Line 15.

e DC adjusted gross income. Subtract Line d from Line c. Fill in if loss e

f Deduction amount. f

Enter each person’s portion of the amount entered on D-40, Line 18. (You may allocate this amount as you wish.)

g Taxable income. Subtract Line f from Line e.. Fill in if loss g h Tax. /f Line g is $100,000 or less, use tax tables. h If more than $100,000, use Calculation i in instructions.

i Add the amounts on Line h, enter here and on D-40, Line 20. i

00

00

00

00 00 00

00

00 00

Your spouse/registered domestic partner

00

00

00

00 00 00

00

00 00

00 Total tax

List TINs associated with Income reported and taxed on Franchise and Fiduciary Returns for the amount listed on D-40, Line 11.

a b c d e f g h i

Revised 07/2021

*& & & Government of the

ee tir ercoumes AM SCHEDULE S Supplemental r ) Information and Dependents

Unless instructed otherwise — Od OO es OO OO

If you fill in any part of this schedule, attach it to your D-40. Print in CAPITAL letters using black ink. OFFICIAL USE ONLY

Vendor ID#0000

Enter your last name Enter your TIN

Dependents _/f you have more than 8 dependents, list them on an attachment.

First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) First name M.I. Last Name

Taxpayer identification number Relationship Date of Birth (MMDDYYYY) Head of household filers TIN of qualifying non-dependent person Date of Birth of qualifying non-dependent person (MMDDYYYY)

or qualifying widow(er) Do not enter your information

First name of qualifying non-dependent person M.I. Last Name

Revised 07/2021

SCHEDULE S PAGE 2 e Last name and TIN 21°04 002 4 0 0 0 0

Calculation G-1 Computation of Standard Deduction Calculation G-1 must be completed and submitted with the return except for dependent filers

* If you were born before January 2, 1957, you are considered to be age 65 at the end of 2021 a Basic standard deduction amount. See instructions.

b Enter 1 if you are age 65 or over *

c Enter 1 if you are blind

d Enter 1 if married or registered domestic partner filing jointly or filing separately on same return and your spouse or registered domestic partner is 65 or over *

e Enter 1 if married or registered domestic partner filing jointly or filing separately on same return and your spouse or registered domestic partner is blind

f Total number of additions to standard deductions. Add Lines b through e.

g Additional standard deduction amount. Multiply $1,350 ($1,700 if single or head of household.

by number on Line f. See instructions. h_ Total standard deduction. Add Lines a and g, enter here and on D-40, Line 18.

i Total number of dependents

a 00

g 00

Calculation J Tax computation for married or registered domestic partners filing separately on the same DC return.

Enter separate amounts in each column. Combine amounts on Line i. You

a Federal adjusted gross income. Fill in if loss a /f you and your spouse filed a joint federal return, enter each person’s portion of federal adjusted gross income. Registered domestic partners should enter the federal AGI reported on their separate federal returns.

b Total additions to federal adjusted gross income. b Enter each person’s portion of additions entered on D-40, Lines 5 and 6.

c Add Lines a and b. Fill in if loss c

d_ Total subtractions from federal adjusted gross income. d Enter each person’s portion of subtractions entered on D-40, Line 15.

e DC adjusted gross income. Subtract Line d from Line c. Fill in if loss e

f Deduction amount. f

Enter each person’s portion of the amount entered on D-40, Line 18. (You may allocate this amount as you wish.)

g Taxable income. Subtract Line f from Line e.. Fill in if loss g h Tax. /f Line g is $100,000 or less, use tax tables. h If more than $100,000, use Calculation i in instructions.

i Add the amounts on Line h, enter here and on D-40, Line 20. i

00

00

00

00 00 00

00

00 00

Your spouse/registered domestic partner

00

00

00

00 00 00

00

00 00

00 Total tax

List TINs associated with Income reported and taxed on Franchise and Fiduciary Returns for the amount listed on D-40, Line 11.

a b c d e f g h i

Revised 07/2021

Att Government ot tne | PRPSM) SCHEDULE H Homeowner @ mummmm District of Columbia .

and Renter Property Tax Credit Important: Read eligibility requirements before completing. 2199 8011 0000

Print in CAPITAL letters using black ink.

parconalnfonnation OFFICIAL USE ONLY Vendor ID#0000

Your daytime telephone number

Your taxpayer identification number (TIN) and Date of Birth (MMDDYYYY) Spouse’s/registered domestic partner’s TIN and Date of Birth (MMDDYYYY) Your first name M.l. Last name

Spouse’s/registered domestic partner’s first name M.I. Last name

Mailing address (number, street and suite/apartment number if applicable)

City State Zip Code +4

Email Address

Address of DC property (number, street and suite/apartment number if applicable) for which you are claiming the credit if different from above

Type of property for which you are claiming the credit. Fill in only one: House Apartment Rooming house Condominium Cooperative

@ Complete Section A or Section B, whichever applies. @ Do not claim this credit for an exempt property owned by a government,

a house of worship or a non-profit organization. Round cents to nearest dollar

Section A Credit claim based on rent paid Ui enmcmma iS ave) Weerre lis iets

1 Federal adjusted gross income of the tax filing unit (see instructions). /f less than zero, enter zero. 1 00 2 Rent paid by you on the property in 2021 OO x.20=2 00 3 Property tax credit. Use the "Computing Your Property Tax Credit" worksheet. 3 00

4 Landlord’s name

Landlord’s address (number, street and suite/apartment number if applicable) Apartment number

Landlord’s telephone number

City State Zip Code +4 Section B Credit claim based on real property tax owed. Round cents to nearest dollar. If amount is zero, leave line blank. 5 Federal adjusted gross income of the tax filing unit (see instructions). /f less than zero, enter zero. 5 00 6 DC real property tax bill for tax year 2021. Do not include special assessments, interest, 6 00

penalties and service charges.

7 Property tax credit Use the "Computing Your Property Tax Credit" worksheet. 7 00

8 Enter information from your real property tax bill or assessment. If a section is blank on your property tax bill, leave it blank here.

Square number Suffix number Lot number

Revised 07/2021

2199 801 20000

For STANDALONE FILERS only, please complete the following "Refund Options" information _ Will this refund go to an account outside of the U.S.? Yes No Refund Options: For information on the tax refund card and program limitations, see instructions or visit our website ViyTax.DC.gov.

Mark one refund choice: Direct deposit or ReliaCard (See instructions) or Paper check Direct Deposit. To have your refund deposited to your checking or savings account, fill in oval and enter bank routing and account numbers. See instructions. Routing Number Account Number

Signature under penalty of law, | declare that | have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on information available to the preparer.

Your signature Date Preparer's signature Date

Spouse's/domestic partner's signature if filing jointly or separately __ Date Preparers Tax Identification Number (PTIN) PTIN telephone number on same return.

FOR STANDALONE FILERS ONLY - WORKSHEET TO DETERMINE FEDERAL ADJUSTED GROSS INCOME

This Worksheet is for use by standalone filers only. If you are filing a D-40 Return, do not complete this worksheet.

COLUMN A (YOU COLUMN B (SPOUSE/DOMESTIC PARTNER) 1 Wages, salaries, tips, etc. 1$ $ s 2 Taxable interest 2 8 3 Ordinary Dividends 3 = 4 Taxable refunds, credits, or offsets of state and local income taxes 4 5 Alimony received (only if divorce or separation agreement on or before 12/31/18) 5 6 Business Income Fill in if minus 6 Fill in if minus 7 Capital gain Fill in if minus 7 Fill in if minus 8 Other gains Fill in if minus 8 Fill in if minus 9 _ IRA distributions: Taxable amount 9 10 Pensions and annuities: Taxable amount 10 11. Rental real estate, royalties, partnerships, S-Corp., trusts, etc. Fill in if minus 11 Fill in if minus 12 Farm income Fill in if minus 12 Fill in if minus 13 Unemployment compensation 13 14 Social security benefits: Taxable amount 14 15 Other taxable income. Attach separate sheet(s) Fill in if minus 15 Fill in if minus 16 Add Lines 1 through 15 in each column. Fill in if minus 16 Fill in if minus 17 Educator expenses 17 18 Certain business expenses of reservists, performing artists, and fee-basis government officials 18 2 19 Health savings account deduction 19 & 20 Moving expenses for members of the armed forces. Attach fed. Form 3903 20 © 21 Deductible part of self-employment tax 21 a 22 Self-employed SEP SIMPLE, and qualified plans 22 23 Self-employed health insurance deduction 23 24 Penalty on early withdrawal of savings 24 25 Alimony paid (only if divorce or separation agreement on or before 12/31/18) 25 26 IRA deduction 26 27 Student loan interest deduction 27 28 Tuition and fees perfederal Form 8917 28 29 Add Lines 17 through 28 in each column 29 30 Subtract Line 29 from Line 16 Fill in if minus 30 Fill in if minus 31 Total federal adjusted gross income. Add amounts entered on Line 30, Columns A - B

and enter total here on Line 31 and on Section A, Line 1 or Section B, Line 5. If less than zero, enter zero. 31 $

Revised 07/2021

WORKSHEET TO COMPUTE YOUR PROPERTY TAX CREDIT

This credit may not be claimed if you live in a property owned by a government, a house of worship or a nonprofit organization.

The credit equals a percentage of the property taxes paid or accrued or the portion of the rent paid that is equivalent to property taxes (20% of rent paid) in excess of the applicable percentage of the total federal adjusted gross income. The maximum credit amount is $1225.

If you are under age 70 and the

Federal AGI of your tax filing unit is: Percentage -

$0 - $24,999 The amount of property tax that exceeds 3.0% of the adjusted gross income $25,000 - $51,999 The amount of property tax that exceeds 4.0% of the adjusted gross income $52,000 - $56,200 The amount of property tax that exceeds 5.0% of the adjusted gross income

If you are age 70 or older and the

Federal AGI of your tax filing unit Percentage - is: $0 - $76,700 The amount of property tax that exceeds 3.0% of the adjusted gross income of the tax filing unit 1. Enter federal AGI (Line 1, Section A, Schedule H or Line 5, Section B, 1. Schedule H). 2. Enter real property tax bill for 2021 or 20% of rent paid in 2021. 2. (Do not include special assessments, interest, penalties and service charges). 3. 3. Multiply Line 1 by the applicable percentage (.03), (.04) or (.05). 4. 4. Balance (Subtract Line 3 from Line 2). 5. $1,225.00 5. Property Tax Credit Limit. 6. Enter the smaller of Line 4 or Line 5 here on Line 6 and on Line 3 of 6.

Schedule H, Section A for credit based on rent paid, or Line 7 of Schedule H, Section B for credit based on real property tax owed. Round to the nearest whole dollar.

Revised 07/2021

Instructions for Schedule H

Homeowner and Renter Property Tax Credit

Home Defined

The term “home” refers to houses, apartments, rooming houses, condominiums, and cooperatives.

Eligibility You must meet the following requirements to claim this credit:

* You were a District of Columbia (DC) resident from Jan 1. through Dec. 31, 2021;

¢ — Your residence is not part of a public housing dwelling;

¢ You rented or owned and lived in a home, apartment, rooming house, or condominium in DC during all of 2021;

¢ Your 2021 federal adjusted gross income (AGI), was $56,200 or less ($76,700 or less if you are age 70 or older);

¢ You did not rent from a landlord whose property was either exempt from real property taxes or who paid a percentage of rental income to DC instead of paying a real estate tax;

e You must not be claimed as a dependent on someone else’s federal, state, or DC income tax return unless you reached age 65 on or before December 31, 2021.

Additional Information:

¢ A Homeowner and Renter Property Tax Credit cannot be claimed on behalf of a taxpayer who died on or before December 31, 2021.

¢ — Only one claimant per "tax filing unit" can claim the property tax credit.

¢ An individual who is claimed as a dependent on someone else's individual income tax return is eligible to file the claim for his/her tax filing unit only if the individual is 65 years of age or older.

Revised 07/2021

Tax Filing Unit Defined

A tax filing unit is defined as an individual or married couple that would -- were their income above the federal filing threshold

-- file an individual income tax return. A married couple/ registered domestic partners residing in the same household are part of the same tax filing unit whether filing jointly, separately on the same return, or separately on separate returns.

D-40 Filers

If you are required to file a DC individual income tax return (D-40), attach Schedule H to your D-40 return. Use the federal adjusted gross income amount from Line 4 of your D-40 (and the AGI of your spouse/registered domestic partner if filing separately on separate returns). You have three years from the due date to claim the credit. If you have already submitted your tax return for a previous year without the Schedule H form, you may file an amended return to include Schedule H.

Standalone Filers

If you are not required to file a DC individual income tax return because you are below the income tax filing threshold, you can file Schedule H as a standalone return. You may use the "Worksheet To Determine Federal Adjusted Income" on page 2 of Schedule H to calculate the total federal adjusted gross income for yourself, and, if applicable, your spouse or registered domestic partner.

You can now electronically file the standalone Schedule H by accessing the MyTax.DC.gov web portal. For more information, visit MyTax.DC.gov or call e-Services at (202) 759-1946.

When is Schedule H due?

The Schedule H is due by April 18, 2022. You have three years from the due date to claim the credit.

Where to Mail Schedule H

If you are required to file a DC income tax return, attach Schedule H to your DC income tax return. Send it to:

Office of Tax and Revenue PO Box 96145 Washington, DC 20090-6145

If you file Schedule H by mail as a standalone return, send it to:

Office of Tax and Revenue 1101 4th Street, SW, FL 4 Washington, DC 20024

Do | Use Section A or Section B?

If you rent your home, apartment, rooming house, condominium, or cooperative, use Section A.

If you own your home, apartment, rooming house, condominium or cooperative, use Section B.

Section A—Credit claim based on rent paid Line 1 Total federal AGI of the tax filing unit

If you filed a D-40, enter the amount, you and if applicable, your spouse or registered domestic partner reported on Line 4 of your D-40. If you are a standalone filer, you must compute your federal adjusted gross income and enter that amount on Line 1 of Schedule H. For assistance in computing your federal adjusted gross income you may complete the "Worksheet To Determine Federal Adjusted Gross Income".

If the sum of your federal AGI is more than $56,200, ($76,700 if you are age 70 or older) do not claim the property tax credit. You are not eligible.

If you are a standalone filer it is important that you list the name, taxpayer identification number, and date of birth on page 1 of Schedule H of the person whose income is included in the total federal AGI of your tax filing unit.

Line 2 Rent paid on the property in 2021

Enter the total rent you paid for the property during the year and multiply it by .20. If you sublet part of your home to another person, the rent that you received is gross income and must be reported on your D-40, or D-30 if gross rental income is greater than $12,000.

Note: If a claimant rents more than one home in the District in the same calendar year, rent paid by the claimant during the year is determined by dividing the rent paid pursuant to the last rental agreement in force during the year by the number

of months during the year for which this rent was paid and by multiplying the result by 12. Multiply the rent entered by .20.

Line 3 Property tax credit Using the amounts entered on Lines 1 and 3, calculate your

property tax credit amount using the “Computing Your Property Tax Credit Worksheet”.

Revised 07/2021

Section B—Credit claim based on real property tax paid or accrued

Line 5 Total federal AGI of the tax filing unit

If you filed a D-40, enter the amount, you, and if applicable, your spouse or registered domestic partner reported on Line 4 of your D-40. If you are a standalone filer, you must compute your federal adjusted gross income and enter that amount on Line 1 of Schedule H. For assistance in computing your federal adjusted gross income you may complete the "Worksheet To Determine Federal Adjusted Gross Income".

If the sum of your federal AGI is more than $56,200, ($76,700 if you are age 70 or older) do not claim the property tax credit. You are not eligible.

If you are a standalone filer, it is important that you list the name, taxpayer identification number, and date of birth on

page 1 of the person whose income is included in the total

federal AGI of your tax filing unit.

Line 6 DC real property tax bill for tax year 2021

Refer to your real property tax bill. Enter the amount of DC real property tax for tax year 2021 as reflected on the District real estate tax bill ordinarily sent out in September each year. The claim is based upon the amount of real property taxes owed, whether paid or unpaid. Do not include interest, penalties, special assessments or service charges, and do not include taxes paid for earlier tax periods.

If a home is an integral part of a larger unit such as a multi-purpose building or a multi-dwelling building, property taxes accrued shall be that percentage of the total property taxes accrued as the value of the home bears to the total value of the property.

REMINDER: If you rent out part of your residence to another person, the rent you receive is gross income and needs to be reported on your federal and DC tax returns. If gross rental income is greater than $12,000, you will need to file a DC Form D-30.

Line 7 Property tax credit

Using the amounts entered on Lines 8 and 9, calculate your property tax credit amount using the “Worksheet to Compute Your Property Tax Credit”.

xx Government of the

=== District of Columbia MAW SCHEDULE U Additional tT Miscellaneous Credits and Contributions 2104001 70 00 0

Important: Print in CAPITAL letters using black ink. Attach to D-40.

NOTE: Contribution(s) will either decrease a refund or increase the tax owed by the OFFICIAL USE ONLY amount of the contribution(s). Vendor ID#0000 Enter your last name Taxpayer Identification Number (TIN)

Part | Credits a. Non-refundable Credits

1 Enter state income tax credit. List additional states on a separate sheet, attach it to this Schedule. (Enter total of all state tax credits on Line 2 below.)

State (a) 00 () 00 State (c) 00 «@) 00

2 Total of Line 1 state tax credits and any additional tax credits from the attachments. 2 00 3 Enter alternative fuel credits, see instructions. 00

3(a) Alternative fuel infrastructure - private residence. # of stations

3(b) Alternative fuel infrastructure - public use. # of stations Le

3(c) Alternative fuel vehicle conversion. # of vehicles 00 4 Total of Line 3 alternative fuel credits. Add Lines 3(a) - 3(c) only and enter here. 4 00 5 DC Low-Income Housing Tax Credit. See reverse page. D) 00 6 RESERVED 6 00 7 Total your non-refundable credits, enter here and on Form D-40, Line 22. 7 00

b. Refundable Credits 1 DC Non-custodial parent EITC. See Schedule N. 1 00 2 Keep Child Care Affordable Tax Credit. See Schedule ELC. 2 00 3 Total your refundable credits, enter here and on Form D-40, Line 29. 3 00 Part II Contributions (The minimum contribution is $1.00.)

1 DC Statehood Delegation Fund. 1 00 2 Taxpayer Support for Afterschool Programs for At-Risk Students. 2 00 3 Anacostia River Cleanup and Protection Fund. 3 00 4 RESERVED 4 00 5 Total your contributions, enter here and on Form D-40, Line 41. i) 00

If you are not due a refund and do not owe tax, you may still make contributions. Total your contributions and enter on Form D-40, Line 41 If you owe tax, make the payment plus any contributions, payable to the DC Treasurer and mail it with your return.

Attach this schedule to your D-40 Return.

Revised 07/2021

DISTRICT OF COLUMBIA LOW-INCOME HOUSING TAX CREDIT

The federal Low-Income Housing Tax Credit (LIHTC) was established by the Tax Reform Act of 1986 and is a dollar-for- dollar tax credit for federal taxpayers who invest in the construction and rehabilitation of housing for low and moderate- income individuals and families in the United States.

Pursuant to the District of Columbia Low-Income Housing Tax Credit Clarification Amendment Act of 2020, (D.C. Law 23-149, § 7201), the District of Columbia has also acted to establish a low-income housing tax credit for qualified projects located in the District of Columbia. Effective October 1, 2020, a “qualified project” means a rental housing development in the District that receives an allocation of federal low-income housing tax credits under IRC §42(h)(1) or IRC §42(h)(4) after October 1, 2021, and receives an executed extended low-income housing commitment pursuant to IRC §42(h)(6)(B) from the District of Columbia Department of Housing and Community Development (DHCD) dated on or after October 1, 2021.

The District of Columbia low-income housing tax credit (DC LIHTC) can be taken against income tax, franchise tax, and insurance premium tax. The credit can be claimed equally for 10 years and subtracted from the amount of District tax otherwise due for each taxable period. The credit cannot be taken against any tax that is dedicated in whole or in part to the Healthy DC and Health Care Expansion Fund established by DC Code §31-3514.02.

The credit is not refundable, but any amount of the credit that exceeds the tax due for a taxable year can be carried forward to any of the 10 remaining subsequent taxable years. The owner of a qualified project eligible for the District low-income housing tax credit must submit a copy of the eligibility statement issued by the Department of Housing and Community Development with respect to the qualified project at the time of filing the project owner's DC tax return. If the eligibility statement is not attached, no credit will be allowed with respect to such qualified project for that year until the copy is provided to the Office of Tax and Revenue.

All or any portion of District low-income tax credits may be transferred, sold, assigned, or allocated to parties who are eligible pursuant to Chapter 48 of Title 47 of the District of Columbia Official Code. There is no limit on the total number of allocations of all or part of the total credit authorized. Collectively, all transfers, sales, assignments, and allocations are subject to the maximum credit allowable to a particular qualified project. A tax credit earned or purchased by, or transferred or assigned to, a partnership, limited liability company, S corporation, or other pass-through entity may be allocated to the partners, members, or shareholders in accordance with the provisions of any agreement among the partners, members, or shareholders and without regard to the ownership interest of the partners, members, or shareholders in the qualified project. A partner, member, or shareholder to whom a tax credit is allocated may further allocate all or part of the allocated credit or may transfer, sell, or assign the allocated credit. Collectively all transfers, sales, assignments, and allocations are subject to the maximum credit allowable to a particular qualified project.

An owner, transferee, purchaser, assignee, or taxpayer to whom a credit is allocated desiring to make a transfer, sale assignment or allocation must submit to the CFO and the Commissioner of the Department of Insurance, Securities, and Banking (Commissioner) a statement that describes the amount of District low-income housing tax credit for which such transfer, sale, assignment, or allocation of District credit is eligible. The owner, transferor, seller, assignor, or taxpayer must provide to the CFO and the Commissioner appropriate information so that the low-income housing tax credit can be properly allocated.

The District low-income housing tax credit can be recaptured if the owner fails to submit a copy of the eligibility statement issued by the Department with respect to the qualified project at the time of filing the return, or, if under IRC §42, a portion of any federal low-income tax credits taken on a low-income qualified project is required to be recaptured. If a recapture is required, any statement submitted to the CFO as required by DC Code §47-4806(b) must include the proportion of the credit required to be captured, the identity of each transferee subject to recapture, and the amount of credit previously transferred, sold, assigned, or allocated to such transferee, purchaser, assignee, or taxpayer to whom a credit is allocated.

Except for unused credits carried forward and for credits claimed under regulations promulgated by the Department consistent with the special rule set forth in IRC §42, a qualified District of Columbia project is not eligible for any District tax credits for more than 11 taxable years.

Claiming the Credit

The DC Low-Income Housing Tax Credit can only be claimed for buildings allocated a credit after October 1, 2021. To claim the DC Low-Income Housing Tax credit on a District tax return, the owner/transferor/transferee of a project credit must file with the return:

e acopy of the DC LIHTC Eligibility Statement Letter from

DHCD; e properly executed Forms D-8609, D8609A, D8609DS; and e Schedule U.

Failure to attach these documents will result in disallowance of the credit. Do NOT submit a claim for any property for which a Federal Form 8609 has not been issued.

See DC Code §47-4801 through 4812. For more information about the DC low-income housing tax credit approval process and qualified projects, contact DHCD at (202) 442-7200 or visit dhcd.dc.gov.

4% Government of the mem District of Columbia

AWA D-8609 District of Columbia Low-Income Housing Tax Credit Allocation and Certification

Important: Print in CAPITAL letters using black ink.

21 bL 1! HO 1 1 0 0 0 0

OFFICIAL USE ONLY Vendor ID#0000

Part IA. Credit 1. Building Address

This Section to be completed by DHCD

2a. Building Owner Name

b. Building Owner Address

3. Building Owner TIN

4. Federal Building Identification Number DC-

5. Maximum Allowable DC LIHTC Amount*

6. Date of Allocation

7. Date Building Placed in Service

Signature of Authorized DHCD Official

*The amount for each year of the 10-year credit period

Part IB. Owner Certification

Date

Ownership Entity

Under penalties of perjury, | declare that: (1) the above building continues to qualify as a part of a qualified low-income housing development and meets the requirements of Internal Revenue Code Section 42(g) and DC Code §47-4801 and

(2) the qualified basis of the building (check one) ___ has __has not decreased for this tax year. | have examined this form, and to the best of my knowledge and belief, it is true, correct and complete.

Signature

Name (please type or print)

Rev 08/2021

Taxpayer ID Number

Date

21 L 1 HO 1 2 00 0 0

Credit Recipient

Part Il. Credit Recipent Information 1. Taxpayer Entity

2. Taxpayer's Entity TIN

3. Taxpayer's Address

4. Partner isa General Partner ___Limited Partner Limited Liability Company Member 5. Partner type is an __Individual Corporation ___ Partnership

6. Taxpayer's percentage of Federal Low-Income Housing Tax Credit %

7. Taxpayer's percentage of DC Low-Income Housing Tax Credit %

Each partnership or other entity involved in marketing DC Low-Income Housing Tax Credits must attach an assignment letter.

Taxpayer or Shareholder Claiming the Credit

Part III. Instructions:

In the schedule below, each shareholder, partner or member who receives a proportionate share of the DC Low-Income Housing Tax Credit should list the amount claimed/earned each year. Then complete the following lines to arrive at the credit to be claimed on their tax return. This form will be used to show your credits earned and used and will be filed with shareholders’ income tax return or insurance premium tax return.

The letters TIN appear at certain points on this form and mean taxpayer identification number. The NAIC company code is a five-digit code that is assigned to an insurance company by the National Association of Insurance Commissioners (NAIC).

The DC Low-Income Housing Tax Credit can only be claimed for buildings allocated a credit after October 1, 2021. For the purposes of the DC Low-Income Housing Tax Credit, transfers of ownership of the credit do not trigger recapture. However, in case of a transfer, the Chief Financial Officer and/or the Commissioner of Insurance must be notified. Both the transferor, on the return following the trans- fer, and the transferee, on tax returns claiming the credit should check the box indicating transfer be- low. There is a ten year carry forward of unused tax credits.

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ee 2021 D-8609A Reporting Form or ine Mlocatiom signm

Transfer, Sale

Low-Income Housing Tax Credit OFFICIAL USE ONLY Important: Print in CAPITAL letters using black ink. Vendor ID#0000 For calendar year 2021 or taxable year beginning and ending

Select One: ___ 1. You are filing this report as the person/entity ("Transferor') who originally generated the credit. -or-

____ 2. You are filing this report as the person/entity to whom a credit was allotted or transferred, and who is allocating or transferring any portion of such credit to another person/entity. If you selected #2, enter the name and FEIN/SSN/NAIC company code number of the person/entity who allocated or transferred the credit to you.

Name FEIN/SSN/NAIC company code

Name of project Federal Building Identification number

Street address

City State Zip Code + 4 Phone number

Name of project owner Taxpayer Identification number NAIC company code

Street address

City State Zip Code + 4 Phone number

Name of recipient Taxpayer Identification number NAIC company code

Street address

City State Zip Code + 4 Phone number

Name of transferor (if different than project owner) Taxpayer Identification number NAIC company code

Street address

City State Zip Code + 4 Phone number

Taxpayer’s credit share

This statement is issued by the owner/transferor of a project that is eligible to claim the District of Columbia Low-Income Housing Tax Credit (LIHTC) to each recipient to whom the owner/transferor has allocated or has transferred, sold or assigned all or a portion of the LIHTC in accordance with the organizational documents governing the owner/transferor. The recipient should enter the amount of the credit being received from the project on the LIHTC line of the appropriate tax return and file a copy with the return. Retain this statement with your records.

Allotment information

1. Amount of credit allocated... nee teen eeeeee 1. -or- 2. Amount of credit transferred, sold or assigned... cee cece eee eee eeeee 2. Owner/Transferor Taxpayer ID Number Date

@ revog2021

Instructions for D-8609A Reporting Form for the Allocation, Transfer, Sale or Assignment of Low-Income Housing Tax Credit

Use this form to report a transfer, sale, assignment, or allocation of Low-Income Housing Tax Credits.

All or any portion of credits issued in accordance with the provisions of the District of Columbia Low-Income Housing Tax Credit Program may be transferred, sold, or assigned to another taxpayer. There is no limit on the total number of transactions for the transfer, sale or assignment of all or part of the total credit authorized by the Program. Collectively, all transfers, sales, assignments, and allocations, are subject to the maximum credit allowable to a particular qualified project.

A tax credit earned or purchased by, transferred or assigned to, a partnership, limited liability company, S corporation or other pass-through entity may be allocated to the partners, members, or shareholders of that entity in accordance with the provisions of any agreement among the partners, members, or shareholders and without regard to the ownership interest of the partners, members, or shareholders in the qualified project. A partner, member or shareholder to whom a tax credit is allocated may further allocate all or part of the allocated credit or may transfer, sell, or assign the allocated credit. There is no limit on the total number of allocations of all or part of the total credit, however, collectively, all transfers, sales, assignments, and allocations made, are subject to the maximum credit allowable to a particular project.

An owner, transferee, purchaser, assignee, or taxpayer to whom a tax credit is allocated, desiring to make a transfer, sale, assignment, or allocation to another transferee, purchaser, assignee or taxpayer, must submit to the Office of Tax and Revenue, and the Commissioner of the Department of Insurance, Securities, and Banking, Form D-8609A along with other prescribed forms and statements, so that the low-income housing tax credit can be properly allocated.

In the first section of the form, select whether you are filing this report as the person/entity who originally generated the credit, or as the person/entity to whom a credit is allocated or transferred, and who is allocating or transferring any portion of such credit to another person/entity. If you selected #2, enter the name and FEIN/SSN/NAIC company code number of the person/entity who allocated or transferred the credit to you.

Enter the name of the project, address and BIN number. Enter the name, address, telephone number, TIN and NAIC company code (if applicable) of the project owner.

Enter the name, TIN, address, telephone number and NAIC company code (if applicable) of the taxpayer recipient of the credit allocated.

If the transferor of a credit is not the original project owner, enter the name, address, telephone number, TIN, and NAIC company code (if applicable) of the transferor.

Under "Allotment information" report the amount of the credit either (1) allocated, or (2) transfered, sold, or assigned to the recipient.

NOTE: The original project owner must submit a D-8609 with its tax return filed for the first year of the credit

period. Attach a copy of the DC LIHTC Eligibility Statement Letter. Copies of the D-8609 should be provided to all transferees of the credit.

Transferors and recipients must each file a copy of Form D-8609 Part |, properly executed Form D-8609 Part II and Part III, Form D-8609A, and Form D-8609DS, if applicable, with their respective tax returns.

* * %& Government of the 7 r ) SS" District of Columbia 2021 D-8609DS Low-Income Housing Tax Credit 2414bL 1S 01 1 00 0 0

Distribution Schedule OFFICIAL USE ONLY

Important: Print in CAPITAL letters using black ink. Vendor ID#0000

For calendar year 2021 or taxable year beginning and ending Select One: ___ 1. You are filing this report as the person/entity ("Transferor') who originally generated the credit.

-or-

____ 2. You are filing this report as the person/entity to whom a credit was allotted or transferred, and who is allocating or transferring any portion of such credit to another person/entity. If you selected #2, enter the name and FEIN/SSN/NAIC company code number of the person/entity who allocated or transferred the credit to you.

Name FEIN/SSN/NAIC company code

Name of project owner/transferor Taxpayer Identification number NAIC company code

Street address

City State Zip Code + 4 Phone number

Name of project Federal Building Identification number OTR Certificate number

Street address

City State Zip Code + 4 Phone number

Distribution information

1. Maximum Allowable DC LIHTC Amount for this Project:

2. Total Amount of Credit Available to Owner/Transferor for Distribution:

Amount of credit Amount of credit Name of recipient TIN#/NAIC company code allocated transferred, sold or assigned. 3. Total amount of credit allocated. Add additional sheets if necessary. 4. Total amount of credit transferred, sold or assigned. 5. Amount of credit retained by owner/transferor. Owner/Transferor Taxpayer ID Number Date

@ revog2021 e@

Instructions for D-8609DS Low-Income Housing Tax Credit Distribution Schedule

Use this form to report the identity of each transferee, purchaser, assignee, or party to whom a credit is allocated, or transferred, and the amount of credit allocated or transferred to such transferee, purchaser, assignee, or party.

Pursuant to DC Code § 47-4806(b), the owner, transferor, seller, assignor, or taxpayer who is allocating the DC low-income housing tax credit ("transferor") must provide to the Chief Financial Officer and the Commissioner of the Department of Insurance, Securities, and Banking appropriate information so that the low-income housing tax credit can be properly allocated. There is no limit on the total number of transactions for the transfer, sale, or assignment of all or part of the total credit that is authorized, however, collectively, all transfers, sales, assignments, and allocations, are subject to the maximum credit allowable to a particular qualified project.

If under § 42 of the 1986 Internal Revenue Code, as amended and in effect for the taxable year, a portion of any federal low-income housing tax credits taken on a low-income qualified project is required to be recaptured, the District of Columbia low-income housing tax credit authorized with respect to such qualified District of Columbia project shall also be recaptured by the Office of Chief Financial Officer or Commissioner of Insurance Securities and Banking. The District of Columbia recapture amount shall be equal to the amount of the District of Columbia low-income housing tax credits previously claimed times a fraction, the numerator of which shall be the amount of recaptured federal low-income housing tax credits and the denominator of which shall be the amount of federal low-income housing tax credits previously claimed.

If the recapture of District of Columbia low-income housing tax credit is required, any statement submitted to the Chief Financial Officer and the Commissioner must include: (1) the proportion of the District of Columbia credit required to be recaptured; (2) the identity of each transferee, purchaser, assignee, or party to whom a credit is allocated subject to the recapture; and (3) the amount of credit previously allocated to such transferee, purchaser, assignee, or party to whom the credit is allocated.

In the first section of the form, select whether you are filing this report as the person/entity who originally generated the credit, or as the person/entity to whom a credit is allocated or transferred, and who is allocating or transferring any portion of such credit to another person/entity. If you selected #2, enter the name and FEIN/SSN/NAIC company code number of the person/entity who allocated or transferred the credit to you.

Enter the name, TIN, address, telephone number and NAIC company code of the project owner/transferor. Enter the name of the project, address, and BIN Number for the project.

Line 1, enter the yearly maximum allowable DC LIHTC amount for the project.

Line 2, enter the total amount of credit available to the owner/transferor for distribution.

Enter the name, TIN and NAIC company code (if applicable) of each recipient and the amount of credit either (1) allocated, or (2) transferred, sold or assigned. The transferor must issue a Form D-8609A to each credit recipient.

Line 3, enter the total amount of credit allocated to all recipients.

Line 4, enter the total amount of credit transferred, sold or assigned to all recipients.

Line 5, enter the amount of credit retained by the owner/transferor, if any.

Transferors must file this Form D-8609DS with their respective tax returns.

@ EAS Government of the Pedeyal SCHEDULE | Additions Federal Adjusted Gross Income 2104001 8 0 0 0 0

Important: Print in CAPITAL letters using black ink. Attach to your D-40.

Last name Taxpayer Identification Number (TIN)

Calculation A Additions to federal adjusted gross income. Fill in only those that apply.

OFFICIAL USE ONLY Vendor ID#0000

Dollars only, do not enter cents

1 Part-year DC resident — enter the portion of adjustments (from Federal Form 1040, 1 00 1040-SR or 1040-NR) that relate to the time you resided outside DC. For Lines 2 — 7 below include only the amounts related to the time you resided in DC. 2 Income distributions eligible for income averaging on your federal tax return 2 00 (from federal Form 4972). 3 100% federal bonus depreciation and/or extra IRC §179 expenses claimed on fed. return. 3 00 4 Any part of a discrimination award subject to income averaging. 4 00 5 Deductions for S Corporations from Schedule K-I, Form 1120 S. 5) 00 6 Pass through losses from DC unincorporated businesses that exceed the $12,000 threshold (reported as a loss on federal 1040 or 1040-SR return). 6 00 7 Other. See instructions on other side. 7 00 8 Capital gains deferred on federal return due to investment in Qualified Opportunity Fund 8 00 9 Total additions. Add entries on Lines 1-8. Enter the total here and on D-40, Line 6. 9 00 Calculation B Subtractions from federal adjusted gross income. Fill in only those that apply. 1 Taxable interest from US Treasury bonds and other obligations. See instructions on other side. 1 00 2 Disability income exclusion from DC Form D-2440, Line 10. See instructions on other side. 2 00 3 Interest and dividend income of a child from Federal Form 8814*. 3 00 4 Awards, other than front and back pay, received due to unlawful 4 00 employment discrimination. 5 Excess of DC allowable depreciation over federal allowable depreciation. See instructions. 5) 00 6 Amount paid (or carried over) to DC College Savings plan in 2021 (maximum $4,000 per 6 00 person, $8,000 for joint filers if each is an account owner). Part-year residents see instructions. 7a Exclusion of up to $10,000 for DC residents (certified by the Social Security Adm. 7a 00 as disabled) with adjusted annual household income of less than $100,000. See instructions. 7b Annual household adjusted gross income. 7b 00 8 Expenditures by DC teachers for necessary classroom teaching materials, $500 annual limit 8 00 per person. See instructions on other side. 9 Expenditures by DC teachers for certain tuition and fees, $1500 annual limit per person. 9 00 See instructions on other side. 10 Loan repayment awards received by health-care professionals from DC government. 10 00 See instructions on other side. 11 Health-care insurance premiums paid by an employer for an employee’s registered 11 00 domestic partner or same sex spouse. Make no entry if the premium was deducted on your federal return, see instructions on other side. 12 DC Poverty Lawyer Loan Assistance. See instructions on other side. 12 00 13 Other. See instructions on other side. 13 00 14 Military Spouse Residency Relief Act. See instructions on other side. 14 00 15 Capital gains deferred due to DC approved investment in DC Qualified Opportunity Fund 15 00 16 Total subtractions. Add entries on Lines 1-7a and 8-15. Enter the total here and on D-40, Line 14. 16 00 *Note: Since income reported on Federal Form 8814, Parents’ Election to Report Child’s Interest and Dividends, and included in the parents’ federal r ) return income is subtracted above on Line 3 of Calculation B, the child must file a separate DC return reporting this income. r )

Revised 07/2021

SCHEDULE |

Calculation A Instructions Additions to federal adjusted gross income

Line 6 Pass through losses from DC unincorporated businesses that exceed the $12,000 threshold (reported as a loss on federal 1040 or 1040-SR return).

Line 7 Other is for those items not subject to federal tax but subject to DC tax. Please attach a list.

Line 8 If you reported deferred capital gains on your federal return due to an investment in a Qualified Opportunity Fund, you must add back the amount of the deferment here.

Calculation B Instructions Subtractions from federal adjusted gross income

Line 1 Taxable interest from US Treasury bonds and other obliga- tions. This interest is included on your federal Forms 1040 or 1040- SR, Line 2b or 1040-NR, Line 9a. It may be all or part of that amount, or it may be O. Also see your federal Form 1099-INT, Line 3.

Line 2 Disability income exclusion from DC Form D-2440. Enter the amount from Form D-2440, Line 10. Attach a completed D-2440. If disability payments were included in your federal gross income, you may be able to claim an exclusion for them on your DC return.

Line 5 Excess of DC allowable depreciation over federal allowable depreciation. If you claimed the federal bonus depreciation (100%) on your federal return, the DC basis for the depreciated property will be more than the federal basis. Use this line to subtract the excess depreciation from the federal AGI to show the proper DC depreciation allowable.

Line 6 DC College Savings Plan payments. Enter the amount con- tributed to a qualified DC “529” College Savings Plan. You may deduct up to $4,000 annually for contributions you made to all qualified col- lege savings accounts of which you are the owner. If you are married and file a joint or combined separate return, each spouse/registered domestic partner may deduct up to $4,000 for contributions made to all accounts for which that spouse/registered domestic partner is the sole owner. A rollover distribution is not a contribution for purposes of this deduction. Contributions made to one or more accounts in excess of the allowable $4,000 ($8,000 for eligible joint filers) annual deduction may be carried forward as a deduction (subject to the annual limitation) for up to five years. If you were a part-year DC resident during the tax year, you may deduct only the amount contributed when you resided in DC.

Line 7a and 7b Exclusions for DC residents. Income not to exceed $10,000 is excludable in computing DC gross income for persons determined by the Social Security Administration to be totally and permanently disabled and who are receiving: Supplemental Security Income or Social Security Disability; or railroad retirement disability benefits; or federal or DC government disability benefits; and whose annual household adjusted gross income is less than $100,000.

Household income includes income received by all household members in the year, even income excluded from federal adjusted gross income.

Adjusted gross income is that of all persons residing in a household, excluding the adjusted gross income of any person who is a tenant under a written lease for fair market value.

Lines 8 and 9 Expenditures by DC teachers. An individual who:

1) has been approved by the DC public schools; and 2) has been a classroom teacher in a DC public school or public charter school for this entire tax year or the entire prior tax year may deduct: ¢ the amount the teacher paid during the year for basic and neces- sary classroom teaching materials and supplies — up to $500 per person whether filing individually or jointly.

Revised 07/2021

Additions to and Subtractions from Federal Adjusted Gross Income

¢ the tuition and fees paid during the year for postgraduate education, professional development, or state licensing examination and testing for improving teaching credentials or maintaining professional certification - up to $1,500 per person whether filing individually or jointly.

Interaction between DC deductions and similar federal deductions. To prevent a “double deduction” situation — if a DC classroom teacher claims a deduction on his/her federal return for personal expenses, the federal tax deduction claimed reduces the amount that may be claimed for those same expenses on the DC return. For example: a DC classroom teacher who claims $1,500 or more for tuition and fees on the federal return (Form 1040 or 1040-SR) may not take any deduction for these same expenses on the DC return.

Line 10 Loan repayment awards. “Loan repayment awards” of up to $120,000 paid over four years by DC to healthcare professionals to reduce their medical education debt are not taxed by DC. (This program is administered by the DC Department of Health.)

Line 11 Healthcare insurance premiums. Any healthcare insurance premium paid by an employer for an employee’s domestic partner reg- istered with the Vital Records Division of the DC Department of Health (see DC Code §32-701 (3) and 702) or same sex spouse is deduct- ible, unless on your federal return the employee's registered domestic partner or same sex spouse is considered a dependent pursuant to IRC §152 and a deduction from income was taken for the premium on the employee's federal tax return.

Line 12 DC Poverty Lawyer Loan Assistance. Attach a copy of your Form 1099C (Cancellation of Debt) issued by the DC Office of the Attorney General (OAG). Lawyers eligible for this award are those whose legal practice has been certified by the DC OAG as serving the public interest.

Line 13 Other. Other items not subject to DC tax subtracted

from federal adjusted gross income, such as rebates/grants received from the Private Security Camera Systems Program, the Home Composting Incentive Program, the Safe at Home Grant Program, and certain other grants excluded from District gross income. See instructions page 9 and DC Code § 47-1803.02(a)(2)(LL).

Line 14 Military Spouse Residency Relief Act If you have determined that you are required to file a District of Co-lumbia tax return and you are in one of the U.S. military services, one of the following may apply:

(1) If a servicemember’s legal residence for taxes is not in DC but the servicemember and spouse reside in DC due to military orders, the military compensation and the non-military spouse’s compensation should be deducted on Schedule |, Line 14. If this applies to you, a copy of the Department of Defense form providing the servicemember’s legal residence for taxes and a copy of the non-military spouse’s legal residence for taxes driver's license should be kept with your tax records in case it is subsequently needed.

(2) If aservicemember’s legal residence for taxes is in DC and the servicemember and spouse reside in DC in compliance with the ser- vicemember’s military orders, they will file Form D-40 and will report all their income in DC, as either married filing jointly or married filing separately.

Line 15 DC Opportunity Fund Investment

If you have deferred capital gains due to an investment in a DC approved Qualified Opportunity Fund, subtract the amount of deferment here, provided this amount is also included in Calcula- tion A, Line 8 of Schedule |.

2104001 5 0 00 0

Important: Print in CAPITAL letters using black ink. OFFICIAL USE ONLY Attach to Schedule U. File Schedules N and U with your D-40. Vendor ID#0000 First name of non-custodial parent M.I. Last name

Address (number, street and suite/apartment number if applicable) City State Zip Code + 4

Taxpayer Identification Number (TIN) Date of birth (MMDDYYYY)

eee eee eee eeeeeeeee eee eee Even if you are not eligible to claim the Federal Earned Income Credit you may be able to claim the DC Earned Income Tax Credit.

DC Non-Custodial Parent EITC Eligibility - Please complete this checklist to determine your eligibility to file Schedule N. You may claim the DC Non-Custodial Parent EITC only if you can answer “Yes” to the following questions.

YES NO

1 Is your Federal Adjusted Gross Income for 2021 less than: $42,158 ($48,108 married filing jointly) with one qualifying child $47,915 ($53,865 married filing jointly) with two qualifying children $51,464 ($57,414 married filing jointly) with three or more qualifying children 2 Were you a DC resident taxpayer during the year? 3 Were you between the ages of 18 and 30 as of December 31, 2021? 4 Are you a parent of a minor child(ren) with whom you do not reside? 5 Are you under a court order requiring you to make child support payments? 6 Was the child support payment order in effect for at least 183 days in 2021? 7 Did you make child support payment(s) through a government sponsored support collection unit?

8 Did you pay all of the court ordered child support due for 2021 by December 31, 2021?

If you answered “Yes” to the above questions, you may claim the DC Non-Custodial Parent EITC. Complete Schedule N and attach it, and Schedule U, to your D-40.

Revised 07/2021

2021 SCHEDULE N PAGE 2

Last name and TIN

Qualifying Child Information

1.

First Name Child’s name, #1

Child’s name, #2

Child’s name, #3

2104 001 60 0 0 0

M.l. Last Name

If you have more than three qualifying children, you only need to list three to get the maximum credit.

2.

#1 Child’s TIN

#2 #3

#1

. Child’s date of birth

#2 #3

First Name

. Custodian’s name

M.l. Last Name

Number, street and suite/apartment number

. Custodian’s address

City

State Zip Code + 4

. Custodian’s TIN

. Location of the

court that ordered ual

support payments for: #2

#3

. Case or Docket number for: 9

#1

#2

#3

. Name of government agency to which you make payments for:

#1

#2

#3

10.

Address of the government agency for:

#1

#2

#3

11.

Amount of court ordered payment

#1 $ 00 per month

#2 $ 00 per month

#3 $ 00 per month

12.

Date payments were #1 (MMDDYYYY)

ordered to start

#2 (MMDDYYYY) #3 (MMDDYYYY)

IS),

#1

Total payments made during 2021 $ 00

#2 $ 00 $

#3 00

14.

Computation: Using the amount on Line 4 of Form D-40, find the correct Earned Income Credit (EIC) amount from the EIC table in the Federal 1040 tax return booklet. Multiply that amount by .40 to determine the DC Non-Custodial Parent EITC amount to claim on Schedule U, Part 1b, Line 1. If you are a part-year filer, see part-year resident instructions in the D-40 booklet on prorating the credit to be claimed.

Revised 07/2021

na gus Government of the jum District of Columbia

2021

Schedule ELC

Keep Child Care Affordable

Tax Credit

> Complete and attach to Form D-40 only if you have an eligible child.

Name shown on return Your first name

Before you begin:

M.| Last name

OFFICIAL USE ONLY

21 EL CO 010 0 0 0

Vendor ID# 0000

Taxpayer Identification Number (TIN)

oSee the instructions on back of this form to make sure that 1) you can take the Keep Child Care Affordable Tax Credit and 2) you have an eligible

child.

oc Be sure the child’s name on Line 2 and tax identification number (TIN) on Line 3 matches with the eligible child’s social security card. Otherwise, at the time we process your return, we may reduce or disallow your ELC if the name or TIN does not match the social security card. Call the Social Security Administration at 1-800-772-1213

Eligible Child Information

Child 1

Child 2

Child 3

la Is this child a recipient of the District's subsidized child care program?

Yes. STOP, your child is

not eligible for this credit.

[] No. Go to Line 1b.

Yes. STOP, your child is

not eligible for this credit.

No. Go to Line 1b.

Yes. STOP, your child is

not eligible for this credit.

No. Go to Line 1b.

1b Was the child under age 4

[] Yes. Go to Line 2.

Yes. Go to Line 2.

C4 COC Co

Yes. Go to Line 2.

CLI COLI C4

as of 09/30/2021? No. STOP, your child is No. STOP, your child is No. STOP, your child is not eligible for this credit. not eligible for this credit. not eligible for this credit. 2 Child's name First name First name First name Last name Last name Last name 3 Child's taxpayer identification number (MMDDYYYY) (MMDDYYYY) (MMDDYYYY) 4 Child's Date of Birth 5 Child's relationship to you 6 Name of Child Development Facility 7a Child Development Facility License Number 7b Is the child development (] Yes. ] Yes. Yes. facility operated by the federal = government or by a private 7 (] No. (] No. No.

provider on federal property?

8 Child Development Facility taxpayer identification number

9 For payment purposes, was the child under age 3 as of 9/30/2021?

for care from 01/01/2021

Yes. Include payments made ll through 12/31/2021

for care from 01/01/2021

[] Yes. Include payments made through 12/31/2021

Yes. Include payments made for care from 01/01/2021 tI through 12/31/2021

No. Include payments made for care from 01/01/2021 through 8/31/2021

care from 01/01/2021 through 8/31/2021

[ No. Include payments made for

No. Include payments made for care from 01/01/2021 — through 8/31/2021

10 Amount paid. See instructions

.00

-00

.00

11 The maximum credit you can receive for each eligible child is $1,020

1020.00

1020.00

1020.00

12 Enter the lesser of Line 10 or Line 11 for each eligible child here and on Schedule U, Part 1b, Line 2.

-00

00

00

e@ Revised 09/2021

Instructions for Keep Child Care Affordable Tax Credit (Schedule ELC)

You are not eligible to receive this credit if:

1. You do not claim the eligible child as a dependent on your federal or District income tax return for that taxable year;

2. A person other than the taxpayer claimed the eligible child as a dependent on his or her federal and District income tax returns for that taxable year;

3. The child of the taxpayer was eligible for and received subsidized child care services pursuant to Chapter 4, Title 4 of the D.C. Code, during the taxable year;

4. A person other than the taxpayer received a credit under DC Code 47-1806.15 for the same taxable year for the same

eligible child;

5. The payments for child care services for which you seek a tax credit were paid to an entity not licensed by the District to operate a child development facility unless operated by the federal government or by a private provider on federal property; or

6. The taxpayer’s District taxable income for the taxable year exceeds the amounts for taxable year 2021:

a. Single and head of household: $153,400;

b. Married/Registered Domestic Partners Filing Jointly: $153,400;

c. Married/Registered Domestic Partners Filing Separately on the same return: $153,400;

gq, Married/Registered Domestic Partners Filing Separately: $76,700

Definitions

1. “Eligible child” means a dependent, claimed by a

taxpayer who has not reached the age of 4 years by September 30th of the taxable year.

2. “Eligible child care expenses” means payments made

by a taxpayer to a licensed child development facility for child care services of an eligible child during the taxable year but does not include any payments for child care services provided after August 31st of the taxable year of an eligible child who meets the age requirements for enrollment for Pre-K.

3. “Child development facility” means a center, home, or

other structure that provides care and other services,

supervision, and guidance for children, infants, and toddlers on

a regular basis licensed to operate as a childcare development facility in the Distrct unless operated by the federal government or by a private provider on federal property. Child development facility does not include a public or private elementary or secondary school engaged in legally required educational and rel- ated functions or a pre-kindergarten education program licensed pursuant to the Pre-K Act of 2008.

4. Taxpayer Identification Number (TIN) means a valid

federal employer identification number (FEIN) issued by the IRS; or a valid social security number issued by the Social Security Administration.

Eligible Expenses

1. Eligible expenses are limited to the amounts paid to a licensed child development facility for child care services of the eligible child;

2. Child support payments are not qualified expenses even if intended to be used to pay for child care services;

3. Child care expenses that are paid for upfront by a taxpayer but then reimbursed by a state social service agency are not eligible expenses; or

4. Expenses do not include food, lodging, clothing or entertainment even if provided for eligible child.

Line by Line Instructions for Child 1, 2 and 3:

Line 1a: Is the eligible child a recipient of the District’s subsidized child care program? If yes, your child does not qualify for the credit. If no, continue to Line 1b.

Line 1b: The child must be under the age of 4 as of 9/30/21. If under age 4, continue to Line 2. If age 4 or over, your child does not qualify for this credit.

Line 2: Enter your eligible child’s first and last name.

Line 3: Enter your eligible child’s tax identification number. Ensure the name and tax identification number entered matches the eligible child’s social security card.

Line 4: Enter your eligible child’s date of birth in MMDDYYYY format.

Line 5: Enter the eligible child’s relationship to you. Example, son, daughter, grandchild, niece, nephew, eligible foster child.

Line 6: Enter the name of the Child Development Facility. Line 7a: Enter the Child Development Facility License Number.

Line 7b: Check the applicable box.

Line 8: Enter the TIN of the Child Development Facility.

Line 9: Enter the date range of the payments made during the taxable year. This date cannot be a date after August 31st of the taxable year if eligible child meets age requirements for enrollment in Pre-K according to DC Code § 38-273.02(a).

Line 10: Enter the total amount actually paid in 2021 but do

not include any payments for child care services provided after August 31, 2019 of the taxable year if your eligible child meets the age requirement for enrollment in Pre-K according to

DC Code § 38-273.02(a).

Line 11: The maximum credit amount that can be claimed is $1,020.

Line 12: Enter the lesser of Line 10 or Line 11 and enter here and on Schedule U, Part 1B, Line 2.

BRK Government ot tre AUR SCHEDULE HSR @ DC Health Care 2104002 1 0 0 0 0

Shared Responsibility Important: Print in CAPITAL letters using black ink. File with your D-40. OFFICIAL USE ONLY Vendor ID#0000

Personal information Your daytime telephone number

Your taxpayer identification number (TIN) and Date of Birth (MMDDYYYY) Spouse’s/registered domestic partner's TIN and Date of Birth (MMDDYYYY) Your first name M.I. Last name Spouse’s/registered domestic partner’s first name M.I. Last name

Mailing address (number, street and suite/apartment number if applicable)

City State Zip Code +4

PART | Do you have qualifying health coverage? Did you and, if applicable, all members of your health care shared responsibility family have qualifying health coverage for every 1 month in 2021?

Yes. STOP. You do not owe a health care shared responsibility payment and do not need to complete a Schedule HSR. (Enter zero on Line 25 of your D-40)

No. If you answered No, complete Part II.

PART II Do you have an exemption?

2 Can someone else claim you as a dependent on their federal income tax return for 2021? Yes. Proceed to Part IV. See instructions. No.

3 Was your federal adjusted gross income below the applicable filing threshold for your filing status for 2021? See instructions. Yes. Proceed to Part IV. See instructions. No.

4 Was your federal adjusted gross income reported on your D-40, Line 4 for 2021 equal to or less than $28,593 Yes. Proceed to Part IV. See instructions. No.

If you answered Yes to any of questions 2 - 4, enter zero on Line 25 of your D-40. If not, continue by answering questions 5 - 6.

5 Do you affirm under the penalties of perjury that you or any member of your health care shared responsibility family lacked qualifying health coverage in 2021 on the basis of a sincerely held religious belief during the entire taxable year? Yes. You must complete Part III before completing Part IV. No.

6 Are you claiming an exemption (other than a sincerely held religious belief) for at least one month for 2021 for yourself or any member of your health care shared responsibility family? Yes. You must complete Part III before completing Part IV. No.

After answering questions 5 - 6, complete Part IV to determine the amount to enter on Line 25 of your D-40. If you answered yes to question 5 or 6, you must also complete Part III.

r ) Revised 08/2021 e@

2104002 2 0 0 0 0

Enter your last name

Enter your taxpayer identification number (TIN)

PART III What coverage exemptions are you claiming for members of your shared responsibility family and for how many months? See instructions for exemption type(s).

Taxpayer Identification Exemption] Number Name of Individual Number (TIN) Type | of Exempt Months Claimed First name and M.I. 7 Last name First name and M.I. 8 Last name First name and M.I. 9 Last name First name and M.I. 10 Last name First name and M.I. i Last name First name and M.I. 12 Last name reer rere reer reece reece PART IV Complete the applicable worksheets before completing Part IV. ee aren, 13 Enter flat dollar amount (see Worksheet A-1, Line 5 or Worksheet A-2, Line 7)........c:ceeeeseeeeees 13 00 14 Enter the percentage income amount (see Worksheet B-1, Line 4 or Worksheet B-2, Line 14)....... 14 00 15 Enter the larger of Line 13 or Line 14 (If Lines 13 and 14 are the same, enter that number.)......... 15 00

16 Enter the District Average Bronze Plan Premium (see Worksheet C-1, Line 2 or Worksheet C-2, LIME Q)eccccsssseccsssvsssssessesssssseseussassssesusussassssatsusssnsseenusssonssentasissssseniussansseenessssseeeesssean 16 00 17 Enter the smaller of Line 15 or Line 16 here and on D-40, Line 25 17 00

AAX Government of the PZeyall DC Health Care Shared Responsibility Worksheets Important: e@ — KEEP FOR YOUR RECORDS.

DO NOT FILE.

A. Flat Dollar Amount Calculation

Worksheet A-1 (No exemptions claimed)

‘Worksheet A-1 - Complete this worksheet if you are not claiming any exemptions for any month for any member of your health care shared responsibility family. (See instructions for available exemptions and who is included in your health care shared responsibility family.)

Round cents to nearest dollar.

1. Multiply $695 for each member in your health care shared responsibility family who was at least 18 years old /f amount is zero, leave line blank.

as of December 31, 2021. 1. 00 2. Multiply $347.50 for each member in your health care shared responsibility family who was under the age of

18 years old as of December 31, 2021. 2. 00 3. Add Lines 1 and 2. b

3 00

4. Maximum flat dollar amount for 2021. 4. $2,085.00 5. Enter the smaller of Lines 3 or 4 here and on Schedule HSR, Part IV, Line 13. (Proceed to Worksheet B-1) 5. 00

Worksheet A-2 (Exemptions claimed for at least one month for at least one member in your health care shared responsibility family)

Worksheet A-2 - Complete the monthly columns by placing an "X" in each month to represent any member of your health care shared responsibility family that did not have minimum essential coverage or a coverage exemption. If you are claiming an exemption for the entire year for yourself and every member of your shared responsibility family, you do not complete this section. Only complete this worksheet if you are claiming an exemption for any month for any member in your health care shared responsibility family or if you or a member of your family had only partial year minimum essential coverage, even if no other exemption is claimed.

Name Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

la. Total number of X's in a month. If 5 or more, enter 5.

1b. Add the total number reported in Line 1a here and _on Worksheet C-2, Line 1.

2. Total number of X's in a month for members age 18 or older as of December 31, 2021.

3. One-half the number of X's in a month for members under the age of 18 years old as of December 31, 2021.

4. Add Lines 2 and 3 for each month.

5. Multiply Line 4 by $695 for each month. If $2085 or more, enter $2085.

6. Total the amounts for each month on Line 5. $ 00

7. Divide Line 6 by 12.0. This is your flat dollar amount. Enter this amount on Schedule HSR, Part IV, Line 13. (Proceed to Worksheet B-1) $ 00

SAX Government of the aXe ~=DC Health Care Shared Responsibility Worksheets Important: meee District of Columbia KEEP FOR YOUR RECORDS. DO NOT FILE.

B. Percentage Income Calculation

Worksheet B-1

Worksheet B-1 - Complete this worksheet if you completed either Worksheet A-1 or Worksheet A-2. If you completed Worksheet A-2, you must also complete Worksheet B-2.

Round cents to nearest dollar. If amount is zero, leave line blank.

1. Enter your federal adjusted gross income reported on your D-40, Line 4 for 2021. 1. 00 2. Enter the standard deduction amount that corresponds to the filing status that you claimed on your D-40. (See

HSR instructions for amounts). 2. 00 3. Subtract Line 2 from Line 1.

8. .00

4. Multiply Line 3 by 2.5% (0.025). This is your percentage of income amount. Enter this amount on Schedule HSR, Part IV, Line 14 If you completed Worksheet A-1, and proceed to Worksheet C-1. (If you were required to complete Worksheet A-2, you must proceed to Worksheet B-2 to calculate your percentage of income amount. 4 Do not enter this amount on Schedule HSR, Part IV, Line 14. . .00

Worksheet B-2 (Exemptions claimed for at least one month for at least one member in your health care shared responsibility family)

Worksheet B-2 - Complete this worksheet only if you were required to complete Worksheet A-2. Do not complete this worksheet if you completed Worksheet A-1. * If the amount on Line 1a of Worksheet A-2 is zero for any month, leave all columns of this worksheet blank for that month.

For each month, you must determine if the (a) (b) (c)

amount on Line 5 of Worksheet A-2 is less Enter the amount from Enter the amount from Enter the larger of

than the amount on Line 4 of Worksheet B-1. Worksheet A-2, Line 5 Worksheet B-1, Line 4 column (a) or column (b) 1. January .00 2. February -00 3. March -00 4. April -00 5. May -00 6. June -00 7. July .00 8. August -00 9. September -00 10. October 00 11. November .00 12. December .00 13. Add the amounts in column (c) .0O 14. Divide Line 13 by 12.0 Enter this amount on Schedule HSR, Part IV, Line 14. (Proceed to Worksheet C-2.) -00

AK Government of the Paxeval ~DC Health Care Shared Responsibility Worksheets Important: e@ meee District of Columbia KEEP FOR YOUR RECORDS.

DO NOT FILE.

C. District Average Bronze Plan Premium Calculation

Worksheet C-1 (No exemptions claimed)

Worksheet C-1 - Complete this worksheet if you completed Worksheet A-1. If you were required to complete Worksheet A-2, you must complete Worksheet C-2. (See instructions on who is included in your health care shared responsibility family.)

Round cents to nearest dollar. /f amount is zero, leave line blank.

1. Enter the number of members in your health care shared responsibility family.

2. Enter the amount that corresponds to the number of members in your health care shared responsibility family. ¢ 1 person - $3,258 © 2 persons - $6,516 e 3 persons - $9,774 e 4 persons - $13,032 e 5 or more persons - $16,290 Enter this amount on Schedule HSR, Part IV, Line 16. 2. 00

Worksheet C-2 (Exemptions claimed for at least one month for at least one member in your health care shared responsibility family)

Worksheet C-2 - Complete this worksheet only if you were required to complete Worksheet A-2. If you were not required to complete Worksheet A-2, complete Worksheet C-1. Do not complete this worksheet if you completed Worksheet A-1.

(See instructions on who is included in your health care shared responsibility family.)

1. Enter the total number reported on Worksheet A-2, Line 1b.

2. Multiply Line 1 by $272. Enter this amount on Schedule HSR, Part IV, Line 16. 2. 00

INSTRUCTIONS FOR SCHEDULE HSR DC HEALTH CARE SHARED RESPONSIBILITY PAYMENT STOP: If you answered 'yes' to Part I, Line 1. DO NOT complete this

schedule. Mark the oval on Line 3 of the D-40 and enter zero (0) on Line 25 of the D-40

DC law requires all residents to have

health coverage, have an exemption, or pay a tax penalty on their D-40. DC enacted the law in response to the reduction of the federal individual responsibility payment and modeled it after the federal requirement. Beginning in 2020, all District residents must either:

(1) Have qualifying health care coverage (see definition below) for yourself, your spouse/registered domestic partner (if filing jointly or separately on the same return), and anyone you or your married/registered domestic partner claim (or can claim) as a dependent;

(2) Have a coverage exemption for yourself, your spouse/registered domestic partner (if filing jointly or separately on the same return), and anyone you or your married/registered domestic partner claim (or can claim) as a dependent; or

(3) Make a health care shared responsibility payment.

D-40 If you and, if applicable, all members of your shared responsibility family (see definition below) had qualifying health care coverage for every month in 2021, fill-in the oval on Page 1 of your D-40 and enter zero on Line 25 of your D-40. You do not need to complete Schedule HSR or make a shared responsibility payment. If you (and, if applicable, all members of your shared responsibility family) did not have qualifying health care coverage for every month in 2021, you must complete Schedule HSR to calculate your shared responsibility payment and/or to claim an exemption.

Schedule HSR

Part | - Complete Part | of the Schedule HSR. If you answer ‘yes’ to question 1, mark the oval on Line 3 of your D-40 and enter zero on Line 25. If you answer ‘no’ to question 1, you must complete Part II.

Part Il - If you answer ‘yes’ to question 2, 3 or 4, skip Part IIl and continue to complete Part IV. Enter zero on Line 13-17 of Part IV and on Line 25 of the D-40. If you answer ‘no’ to questions 2-4, you must answer questions 5-6 and complete Part Ill.

Part Ill — Complete the name and taxpayer identification number (TIN) for each member of your shared responsibility family, the code for the exemption claimed and the number of exempt months claimed for each exemption type claimed. For a list of exemption codes, see the Exemption Chart.

e If you are claiming one exemption type for the entire year, enter the applicable exemption code and “12” for the number of exempt months claimed for that member.

e If you are claiming an exemption for less than 12 months, enter the applicable exemption code and the total number of months claimed for that exemption type for that member.

e If you are claiming multiple exemption types for one member, list that member more than once and enter exemption code and number of months claimed for each exemption type for that member.

Part IV — Complete Part IV of Schedule HSR to compute your shared responsibility payment. You must complete the worksheets to compute your shared responsibility payment. (If you claimed an exemption for all members of your shared responsibility family for every month of 2021, enter zero on Lines 13-17 of your Schedule HSR.) The worksheets contain the following:

A. Flat Dollar Amount Calculation (Line 13)

1. Complete Worksheet A-1 if no exemptions are claimed by anyone in your shared responsibility family

2. Complete Worksheet A-2 if exemptions are claimed for at least one month for at least one member of your shared responsibility family.

B. Percentage Income Amount Calculation (Line 14)

1. Complete Worksheet B-1. (If you completed Worksheet A- 2, you must also Complete Worksheet B-2.)

2. Complete Worksheet B-2 if you claimed exemptions for at least one month for at least one member of your shared responsibility family.

C. District Average Bronze Plan Premium Calculation (Line 16)

1. Complete Worksheet C-1 if no exemptions were claimed.

2. Complete Worksheet C-2 if you claimed exemptions for at least one month for at least one member in your shared responsibility family.

A. Flat Dollar Amount Calculation Worksheets

e Worksheet A-1

Complete this worksheet if you are not claiming any exemptions for any month for any member of your shared responsibility family.

Follow the line by line directions provided on the form. Enter the amount from Line 5 on Schedule HSR, Part IV, Line 13. Proceed to Worksheet B-1.

e Worksheet A-2

Complete this worksheet only if you are claiming an exemption, including maintaining partial-year minimum essential coverage, for any month for any member of your shared responsibility family.

List the name of each member of your shared responsibility family in the provided row. Then, for each month, mark an X in the appropriate column listed for the member(s) of your shared responsibility family who did not have minimum essential coverage or a coverage exemption. For example, if your dependent “John” had a health care coverage only for the month of January and had no coverage exemptions for the remainder of the year, mark an “X” in each of the month columns February through December on the row associated with John’s name.

Line 1a: For each month, add the total number of “X’s” in the column. The maximum number entered in any month’s column is 5, even if that column includes more than 5 “X’s”. For example, if each of the 6 members of your shared responsibility family did not have health care coverage or a coverage exemption for January, you should enter “5” on Line 1 in

the January column.

Line 1b: After you have completed the step above for each month, add the total calculated for each month together. Enter this sum on the provided space in the “Line 1b” box. For example, if you entered “5” in the January column for Line 1a, “4” in the April column, and “0” in all other columns, enter “9” in the space provided in the “Line 1b” box.

Line 2: Enter the total number of “X's” in each month that correspond to members age 18 or older as of December 31, 2021.

Line 3: Enter one-half the total number

of “X's” in each month that correspond

to members under the age of 18 as of December 31, 2021.

Line 4: Add Lines 2 and 3 for each month.

Line 5: Multiply Line 4 by $695 for each month. If $2,085 or more, enter $2,085.

Line 6: Total the amounts reported in each month’s column on Line 5.

Line 7: Divide the amount reported on Line 6 by 12.0. This is your flat dollar amount. Enter this amount on Schedule HSR, Part IV, Line 13 and proceed to Worksheet B-1.

B. Percentage Interest Calculation Worksheets

Worksheet B-1

Complete this worksheet if you completed either Worksheet A-1 or Worksheet A-2. If you completed Worksheet A-2, you must also complete Worksheet B-2.

Follow the line by line directions provided on the form. The applicable D-40 filing threshold amounts for 2021 are:

o Single (under 65) — $12,550 o Single (65 or older) — $14,250 o Married/Registered domestic partner filing jointly or separately on the same return (both spouses under 65) — $25,100 o Married/Registered domestic partner filing jointly or separately on the same return (one spouse 65 or older) — $26,450 o Married/Registered domestic partner filing jointly or separately on the same return (both spouses 65 or older) — $27,800 Married filing separately (under 65) — $12,550 Married filing separately (65 or older) - $13,900 Head of household (under 65) — $18,800 Head of household (65 or older) — $20,500 Qualifying Widow(er) (under 65) — $25,100 Qualifying Widow(er) (65 or older) — $26,450

NOTE: The IRS does not consider 'blind' as an additional standard deduction.

o 000 00

If you completed Worksheet A-1, enter the amount from Line 4 on Schedule HSR, Part IV, Line 14 and proceed to Worksheet C-1. If you completed Worksheet A-2, proceed to Worksheet B-2 to calculate your percentage of income amount.

Worksheet B-2

Complete this worksheet only if you completed Worksheet A-2 (if you claimed exemptions for at least one month for at least one member of your shared responsibility family).

Line 1-12: For each month enter the amount from Worksheet A-2, Line 5 in column (a) and the amount from Worksheet B-1, Line 4 in column (b). In column (c), enter the larger of column (a) or column (b).

Line 13: Add the amounts reported in column (c) for Lines 1-12.

Line 14: Divide the total on Line 13 by 12.

Enter this amount on Schedule HSR, Part IV, Line 14. Proceed to Worksheet C-2.

77

C. District Average Bronze Plan Premium Calculation Worksheets

Worksheet C-1

Complete this worksheet if you completed Worksheet A-1. Do not complete this worksheet if you completed Worksheet A-2 (if you claimed no exemptions for any member of your shared responsibility family).

Follow the line by line directions provided on the form. Enter the amount from Line 2 on Schedule HSR, Part IV, Line 16.

Worksheet C-2

Complete this worksheet if you completed Worksheet A-2. Do not complete this worksheet if you completed Worksheet A-1 (if you claimed exemptions for at least one month for at least one member of your shared responsibility family).

Follow the line by line directions provided on the form. Enter the amount from Line 2 on Schedule HSR, Part IV, Line 16.

Definitions

e DC resident. For purposes of Schedule HSR, DC resident has the same meaning as “resident” defined in D.C. Official Code § 47-1801.04(42). (Part-year residents should claim an exemption as a nonresident of the District for the month(s) during the tax year that that he or she was not a DC resident.)

For additional information regarding qualifying coverage, contact DC Health Link at www.dchealthlink.com or (855) 532-5465.

e Shared responsibility family. For purposes of Schedule HSR, shared responsibility family includes the following individuals:

o The taxpayer;

o The taxpayer's spouse or registered domestic partner if they file D-40 jointly or separately on the same return; and

o Any dependents that that the taxpayer (or the taxpayer’s spouse registered domestic partner) claimed or could have claimed on their D-40.

e Qualifying health coverage. For purposes of Schedule HSR, qualifying health coverage means:

° Minimum essential coverage as defined by section 5000A of the Internal Revenue Code of 1986 (26 U.S.C. § 5000A) and its implementing regulations, as that section and its implementing regulations were in effect on December 15, 2017;

° The Immigrant Children's Program; and ° Health coverage provided

under a multiple employer welfare arrangement; provided, that the multiple employer welfare arrangement provided coverage in the District on December 15, 2017, or complies with federal law and regulations applicable to multiple employer welfare arrangements that were in place as of December 15, 2017.

Adjusted Gross Income (“AGI”). For purposes of Schedule HSR AGI is the federal AGI reported on Line 4 of your D-40 return. If you are filing a joint return or filing separately on the same return with your spouse or registered domestic partner, use the combined federal AGI reported on Line 4 of your D-40 return. Ifa member of your Shared Responsibility Family (spouse or dependent) filed a separate return, the federal AGI reported by that member on his or her separate return does not need to be added to the federal AGI reported on your D-40 for the purposes of calculating the shared responsibility payment on your return.

Exemptions Chart

Exemption Type

Exemption Code

Affordability—You received an affordability exemption certificate from the Health Benefits Exchange Authority. For information regarding the affordability exemption contact DC Health Link at www.dchealthlink.com or (855) 532-5465.

A

Short coverage gap—You went without coverage for less than 3 consecutive months during the year.

Citizens living abroad and certain noncitizens—You were:

*« AUS. citizen or a resident alien who was physically present in a foreign country or countries for at least 330 full days during any period of 12 consecutive months;

+ AU.S. citizen who was a bona fide resident of a foreign country or countries for an uninterrupted period that includes the entire tax year;

+ A bona fide resident of a U.S. territory;

« A resident alien who was a citizen or national of a foreign country with which the U.S. has an income tax treaty with a nondiscrimination clause, and you were a bona fide resident of a foreign country for an uninterrupted period that includes the entire tax year;

« Not lawfully present in the U.S. and not a U.S. citizen or U.S. national. For more information about who is treated as lawfully present in the U.S. for purposes of this coverage exemption, visit www.HealthCare.gov; or

+ Anonresident alien, including (1) a dual-status alien in the first year of U.S. residency and (2) a nonresident alien or dual-status alien who elects to file a joint return with a U.S. spouse. This exemption doesn't apply if you are a nonresident alien for 2018, but met certain presence requirements and elected to be treated as a resident alien. For more information, see IRS Pub. 519.

Members of a health care sharing ministry—You were a member of a health care sharing ministry.

Members of Indian tribes—You were either a member of a federally recognized Indian tribe including an Alaska Native Claims Settlement Act (ANCSA) Corporation Shareholder (regional or village), or you were otherwise eligible for services through an Indian health care provider or the Indian Health Service.

Incarceration—You were in a jail, prison, or similar penal institution or correctional facility after the disposition of charges.

General hardship— You received a hardship exemption certificate from the Health Benefits Exchange Authority. For information regarding the hardship exemption contact DC Health Link at www.dchealthlink.com or (855) 532-5465.

Member of shared responsibility family born or adopted during the year—The

months before and including the month that an individual was added to your shared

responsibility family by birth or adoption. You should claim this exemption only if you also are claiming another exemption in Part III.

Member of shared responsibility family died during the year—The months after the month that a member of your shared responsibility family died during the year. You should claim this exemption only if you also are claiming another exemption in Part Ill.

Nonresident of the District — You were not a resident of the District of Columbia.

Sincerely Held Religious Belief —You lacked qualifying health coverage on the basis of a sincerely held religious belief during the entire taxable year.

DC Health Alliance — You were enrolled in the DC Health Alliance Program.

79

Low income-— Your federal adjusted gross income reported on your D-40, Line 4 is equal to or below the amounts that correspond to the number of members in your shared responsibility family and the age of the individual for which the exemption is claimed. (If you qualify for this exemption, you may be eligible for Medicaid. Contact DC Health Link at (855) 532-5465 or www.dchealthlink.com or the Department of Health Care Finance at (202) 727-5355 or https://dhcf.dc.gov/service/medicaid or for more information.)

Number of If your AGI is equal to or | If your AGI is equal to or Shared below the following below the following Responsibility amounts, members age _ | amounts, members Family Members: | 21 or older as of under age 21 as of 12/31/2021 are exempt: 12/31/2021 are exempt: 1 $28,593.60 $41,731.20 2 $38,672.40 $56,440.80 3 $48,751.20 $71,150.40 4 $58,830.00 $85,860.00 5 $68,908.80 $100,569.60 6 $78,987.60 $115,279.20 7 $89,066.40 $129,988.80 8 $99,145.20 $144,698.40 For Each Additional Member, add: $10,078.80 $14,709.60

A Religious Sect that is Conscientiously Opposed - If you are a member of a religious sect that is conscientiously opposed to accepting health benefits, including Social Security and Medicare, and need to claim an exemption from the Shared Responsibility Payment.

Maintained Minimum Essential Coverage

kak

ummm Government of the === District of Columbia r ) DC-8379 Injured Spouse Allocation 008 3 79 01 00 0 0

OFFICIAL USE ONLY Vendor ID# 0000

Information About the Tax Return for Which This Form Is Filed

Enter the following information exactly as it is shown on the tax return for which you are filing this form. The spouse’s name and taxpayer identification number shown first on that tax return must also be shown first below.

First name, initial, and last name shown first on the return Taxpayer identification number shown first If Injured Spouse, check here” oO

First name, initial, and last name shown second on the return Taxpayer identification number shown second] If Injured Spouse, check here ~ oO

Mailing address (number, street, and suite/apartment number if applicable)

City State Zip Code +4

Should You File This Form? You must complete this part.

1 Enter the tax year for which you are filing this form. Answer the following questions for that year.

2 Did you (or will you) file a joint return or married/registered domestic partners filing separately on same return?

O Yes. Go to Line 3. CJ No. Stop here. Do not file this form. You are not an injured spouse.

3 Did (or will) DC use the joint overpayment to pay any of the following legally enforceable past-due debt(s) owed only by your spouse? *DC income tax * DC unemployment compensation * Child support *DC tickets and traffic penalties “federal income tax

* federal student loans C1 Yes. Go to Line 4. LJ No. Stop here. Do not file this form. You are not an injured spouse.

4 Are you legally obligated to pay this past-due amount? (1 Yes. Stop here. Do not file this form. You are not an injured spouse.

UJ No.

5 Did you make and report payments, such as DC income tax withholding or estimated tax payments?

UJ Yes. Skip Line 6 and go to Part Il and complete the rest of this form. C1 No. Go to Line 6.

6 Did you have earned income, such as wages, salaries, or self-employment income?

C1 Yes. Go to Part Il and complete the rest of the form. (1 No. Stop here. Do not file this form. You are not an injured spouse.

DC-8379 (Rev.07-2021)

DC-8379, Page 2

Enter your last name

Enter your TIN

008 3790 2 00 0 0

li Allocation Between Spouses of Items on the Tax Return (See the separate DC Form 8379 instructions for Part II).

Allocated Items Fill in | (a) Amount shown | Fillin | (b) Allocated to | Fillin] (c) Allocated to (Column (a) must equal columns (b) + (c)) ifloss| onjointreturn |ifloss|} injured spouse | ifloss| other spouse 7 Federal adjusted gross income $ $ 8 Total additions to federal adjusted gross income $ iS 9 Add Line 7 and Line 8 i$ i$ 10 Total subtractions from federal adjusted gross income $ i$ 11 DC adjusted gross income (subtract Line 10 from Line 9 $ i$ 42 Deduction amount $ i$ 413 DC taxable income. Subtract Line 12 from Line 11 i$ i$ 14 Tax. If Line 20 is $100,000 or more, use Calculation | i$ i$ Total refundable and/or non-refundable 45 credits excluding earned income $ $ 16 DC estimated tax payments i$ i$ 17 DC withholding tax paid i$ i$

lage Signature.

Under penalties of perjury, | declare that | have examined this form and any accompanying schedules or 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.

Keep a copy of| Injured spouse’s signature Date Phone number this form for your records.

. Print/Type preparer’s name Preparer’s signature Date PTIN Paid Check [] if Preparer self-employed

Firm’s name > Firm’s EIN > Use Only Firm’s address > Phone no.

DC-8379 (Rev.07-2021)

Instructions for DC-8379 Injured Spouse Allocation

Purpose of form

DC-8379 is filed by one spouse/registered domestic partner (the injured spouse/registered domestic partner) on a jointly filed tax return when the joint overpayment was (or is expected to be) applied (offset) to a past-due obligation of the other spouse/registered domestic partner. By filing DC-8379, the injured spouse/registered domestic partner may be able to get back his or her share of the joint refund.

Are you an injured spouse?

You may be an injured spouse if you file a joint return and all or part of your portion of the overpayment is expected to be, offset to your spouse’s legally enforceable past- due federal tax, state income tax, state unemployment compensation debts, child support, or a federal nontax debt, such as a student loan.

A Notice of Offset for federal tax debts is issued by the Internal Revenue Service (IRS). All other Notice of Offsets are issued by the DC Office of Tax and Revenue (OTR) on behalf of the affected agency.

Complete Part | to determine if you are an injured spouse/registered domestic partner.

When to file

You must file the DC-8379 with your return. In order to be eligible for this relief. You must submit your completed D-8379 prior to the offset occurring. Once funds have been offset, this relief may be unavailable.

How to file

You can file DC-8379 with your joint tax return. If you file DC-8379 with your joint return, attach it to your return. The processing of DC-8379 may be delayed if the form is incomplete when filed.

Specific Instructions

Part |

Complete Lines 1-6 to determine if you are an injured spouse.

Part Il

Line 7. Enter your federal adjusted gross income.

Line 8. Enter total additions to federal adjusted gross income.

Line 10. Enter total subtractions from federal adjusted gross income.

Lines 11 -— 17. Amounts come from your DC D-40 return.

Part Ill Signature Ensure to sign and date DC-8379.

wa gum Government of the District of Columbia 2021 D-2210 Underpayment of Estimated

mum Office of Tax and Revenue _ Income Tax By Individuals

IMPORTANT: Please read the instructions on the reverse before completing this form.

Your First name, M.I., Last name Taxpayer Identification Number (TIN)

Spouse’s/registered domestic partner's First name, M.I., Last name Spouse’s/ registered domestic partner’s TIN

Daytime telephone number

No underpayment interest is due and this form should not be filed if:

A. Your tax liability on taxable income after deducting your District of Columbia (DC) withholding tax and applicable credits is less than $100, or

B. You made periodic estimated tax payments and had amounts withheld as required and the total is equal to or more than 110% of your last year’s taxes or is at least 90% of your current year’s taxes. Note: You must have been a 12-month DC resident last year in order to use the prior year 110% exception.

Computation of Underpayment Interest

1 2021 DC Tax Liability - Line 24 from your 2021 DC Individual Income Tax Return minus $ Line 30. 2 Multiply the amount on Line 1 by 90% (.90)

3 2020 DC Tax Liability - Line 23 from your 2020 DC Individual Income Tax Return minus the sum of Lines 26d or 26e through Line 28.

4 Multiply Line 3 amount by 110%. 5 Minimum withholding and estimated tax payment required for tax year 2021 (lesser of Line 2 and 4). 6 Multiply Line 5 amount by 25% (.25) for amount required for each periodic payment $

Note: If your income was not evenly divided over 4 periods, see instructions on the reverse of this form on the “Annualized Income” method. Due date of Payments

1st Period 2nd Period 3rd Period Ath Period : . . . 04/15/21 06/15/21 09/15/21 01/15/22 7 Enter Line 6 amount or the annualized income amount in each eh Tiss meh ih period (The 2” period includes the 1° period amount, 3" period includes the 1° and 2" period amounts, the 4'" period includes all period amounts). Check here _ if you are using the “Annualized Income” method. 8 DC withholding and estimated tax paid each period (The 2" period includes the 1% period amount, 3” period includes the 1° and 2"4 period amounts, the 4" period includes all period amounts). 9 Underpayment each period (Line 7 minus Line 8) 10 Underpayment interest factors 0175 0265 .0351 0259 11 Line 9 multiplied by Line 10 12 Underpayment interest — Total of amounts from Line 11. Pay this amount $

(See instructions on reverse)

Make check or money order payable to: DC Treasurer

Revised 09/2021

Instructions for Underpayment of Estimated Income Tax by Individuals

Estimated Tax Interest

DC law requires every individual or couple filing jointly, to pay estimated tax if they:

e receive taxable income which is not subject to DC withholding; or e receive wages with insufficient withholding; or

e the tax on this taxable income is expected to be more than $100. The law states that anyone required to file and pay estimated tax who fails to pay the amount required by the periodic payment due date is subject to interest on the underpayment of estimated income tax.

When is interest assessed for underpayment of estimated

income tax?

Underpayment interest is assessed if your total DC estimated income

tax payments (and withheld amounts) compared to your DC tax liability

do not equal at least the smaller of:

e 90% of the tax due shown on your 2021 DC return; or

e 110% of the tax due shown on your 2020 DC tax return. You must have been a DC resident during all of 2020 to use the 110% exception.

Are there any exceptions to imposition of interest?

You are not subject to interest for underpayment of estimated tax if:

e You had no DC income tax liability for the tax year 2020 and in that year, you lived in DC the entire 12 months;

e The tax due for 2021 minus income tax withheld and/or estimated tax payments is less than $100;

e Your DC estimated tax payments plus any DC income tax withheld equals at least 110% of your 2020 DC income tax liability; or

e Your remaining tax due after totaling all credits, estimated tax payments and withholding, is less than 10% of your total DC tax liability for the year.

When may you use this form?

e You may use this form to calculate your underpayment interest, when submitting your D-40 form. If you do, fill in the oval, attach it to your tax return and enter the underpayment interest amount on Line 40 of the D-40. If you do not wish to calculate the interest, the Office of Tax and Revenue (OTR) will do it when your return is processed and will notify you of the amount due.

e You may also complete this form if you believe the underpayment interest assessed by OTR for an underpayment of estimated income tax is incorrect.

How do you file this form?

Attach this form D-2210 to your return D-40, if you complete it before filing your D-40 return. If you complete this form after filing and/or receiving a notice of an underpayment interest assessment, send it to:

Office of Tax and Revenue

Attn: Customer Service Administration 1101 4th St SW, 2nd Floor Washington DC 20024

Completing this form

Line 1

Enter the amount from your 2021 D-40, Line 24 minus Line 30. Line 2

Multiply the amount on Line 1 by 90% (.90). Your withheld taxes and/or estimated tax payments must be equal to or greater than this amount.

Revised 09/2021

Line 3

Enter the amount from your 2020 D-40, Line 23 minus the sum of Lines 26d or 26e through Line 28.

Line 4

Enter 110% of the amount from Line 3. If your 2020 return was amended or corrected, multiply 110% times the corrected amount. You must have been a DC resident during all of 2020 to use this exception.

Line 5

Enter the lesser of the amounts on Line 2 and Line 4. If you did not file a DC return for 2020, use only the Line 2 amount.

Line 6

Multiply the amount on Line 5 by 25% (.25). This gives you an even distribution of your liability, payable over four periods. Line 7

Enter the amount required from Line 6 under each of the payment columns. For example, if Line 6 is $2000, you would enter $2000 for the 1st period, $4000 for the 2nd period, $6000 for the 3rd period and $8000 for the 4th period.

Annualized Income method: |f your income was different for each period, you may want to determine the percentage for each period (divide the period income by the full year’s income). Multiply Line 5 by each period's percentage and enter the amounts as shown above. Check the “Annualized Income” method box.

Line 8

Enter the amounts withheld and estimated tax payments made for each period. Include the amounts from the previous period in with the 2nd, 3rd and 4th periods. For example, if your withheld and estimated tax payment amount is $1000 in each period, you would enter $1000 in the 1st Period, $2000 in the 2nd Period, $3000 in the 3rd Period and $4000 in the 4th Period.

Line 9 Underpayment each period

For each column, subtract Line 8 from Line 7. If Line 8 exceeds Line 7, you have no underpayment interest. If there is an amount remaining, this is your periodic underpayment amount.

Line 10 Underpayment interest factors These are the underpayment interest factors by period.

Line 11

For each column, multiply the amount on Line 9 by the penalty factor on Line 10. This is your underpayment interest amount by period.

Line 12 Underpayment interest

Add the amounts from each period on Line 11. This is your total underpayment interest for your estimated income tax underpayment.

e If you are filing the D-2210 with your D-40 return, enter the amount of underpayment interest on Line 40, page 3 of the D-40.

e If you are filing the D-2210 separately, pay the amount you owe. Attach payment to Form D-40P Payment Voucher.

Make the check or money order (U.S. dollars) payable to the DC Treasurer and mail the D-2210 and D-40P with payment to:

Office of Tax and Revenue PO Box 96169 Washington DC 20090-6169

D-40P PAYMENT VOUCHER

See instructions on back

Detach at perforation and mail the voucher, with payment attached, to the Office of Tax and Revenue, PO Box 96169, Washington DC 20090-6169.

STAPLE CHECK OR MONEY ORDER HERE

SAX Government of the D-40P Payment Voucher for e — Individual Income Tax Important: Print in CAPITAL letters using black ink.

0004 0P1 100 0 0

Amount of payment eG §) 00 offcial Use Only Vendor ID# 0000 Tax period ending (MMDDYYYY)

1231 To avoid penalties and interest, your payment must be postmarked no later than April 18, 2022. Your first name M.l. Last name Spouse’s/registered domestic partner's first name M.I. Last name Your taxpayer identification number (TIN) Spouse'’s/registered domestic partner's TIN Taxpayer daytime telephone number

Home address (number, street and suite/apartment number if applicable)

City State Zip Code + 4

Revised 08/2021

STAPLE CHECK OR MONEY ORDER HERE

SAX Government of the D-40P Payment Voucher for e — Individual Income Tax Important: Print in CAPITAL letters using black ink.

0004 0 P11 00 0 0

Amount of payment it ey) 00 official Use Only Vendor ID# 0000 Tax period ending (MMDDYYYY) . . . To avoid penalties and interest, your payment must be postmarked no later

Lbe3l than April 18, 2022.

Your first name M.l. Last name

Spouse’s/registered domestic partner's first name M.I. Last name

Your taxpayer identification number (TIN) Spouse'’s/registered domestic partner's TIN Taxpayer daytime telephone number

Home address (number, street and suite/apartment number if applicable)

City State Zip Code + 4

Revised 08/2021

Instructions for D-40P PAYMENT VOUCHER - Please print clearly.

Use the D-40P Payment Voucher to make any payment due on your D-40 return. * Do not use this voucher to make estimated tax payments. ¢ Enter your name, taxpayer identification number (TIN) and address. If you are filing a joint return or filing separately on

the same return, enter the name and TIN shown first on your return, then enter the name and TIN shown second on

your return. ¢ Enter the amount of your payment. ¢ Make check or money order (US dollars) payable to the DC Treasurer. * Make sure your name and address appear on your payment (check or money order). ¢ Enter your TIN, the tax period and - D-40 - on your payment. * To avoid penalties and interest, pay in full by April 18, 2022. * Staple your payment to the D-40P voucher. Do not attach your payment to your D-40 return. ¢ Mail the D-40P with, but not attached to, your D-40 tax return in the envelope provided in this tax booklet. If you do not have the return envelope, make sure to address your envelope to:

Office of Tax and Revenue PO Box 96169 Washington, DC 20090-6169

Dishonored Payments Make sure your check or electronic payment will clear. You will be charged a $65 fee if your check or electronic payment is not honored by your financial institution and returned to OTR.

FR-127 Extension of Time to File a DC Income Tax Return Worksheet

Round cents to the nearest dollar. If the amount is zero, leave Extension of time to file until October 15, 2022 Leave lines blank that do not apply, _‘the line blank.

1 Total estimated income tax liability for 2021. 1 00 2 DC Income tax withheld. 2 00 3 2021 estimated tax payments. 3 00 4 Total payments Add Lines 2 and 3. 4 00 5 Amount due with this request. 8 00

If Line 1 is more than Line 4, subtract Line 4 from Line 1. Pay this amount and send it with the voucher below. See instructions on back.

Payment and mailing Instructions. Make check or money order (do not send cash) payable to: DC Treasurer. Write your taxpayer identification number (TIN) and “2021 FR-127” on your payment. Detach and mail the voucher portion of this form with full payment of any tax due by April 18, 2022 to the Office of Tax and Revenue, PO Box 96018, Washington, DC 20090-6018.

NOTE: You may also file and pay electronically. Visit MyTax.DC.gov

Detach at perforation and mail the voucher, with payment attached, to the Office of Tax and Revenue, PO Box 96018, Washington, DC 20090-6018.

xk + 7 . ee rt counts AWN FR-127 Extension of Time to File e a DC Income Tax Return 2112 70 11 0 00 0

Important: Print in CAPITAL letters using black ink.

Official Use Only Vendor ID# OOOO

00 Fill in if Living or Traveling Outside the U.S. Fill in if Military Combat Zone

Amount of payment (dollars only) $

Your taxpayer identification number (TIN) Spouse’s/registered domestic partner's TIN Your daytime telephone number Your first name M.I. Last name Spouse’s/registered domestic partner’s first name M.l. Last name

Home address (number, street and suite/apartment number if applicable)

City State Zip Code +4

Revised 08/2021

xk . . . ee citorcounnia PAM FR-127 Extension of Time to File e a DC Income Tax Return 2112 70 1 1 0 00 0

Important: Print in CAPITAL letters using black ink.

Official Use Only Vendor ID# O000

00 Fill in if Living or Traveling Outside the U.S. Fill in if Military Combat Zone

Amount of payment (dollars only) $

Your taxpayer identification number (TIN) Spouse’s/registered domestic partner's TIN Your daytime telephone number Your first name M.I. Last name Spouse’s/registered domestic partner’s first name M.I. Last name

Home address (number, street and suite/apartment number if applicable)

City State Zip Code +4

Revised 08/2021

Instructions for Form FR-127 Why file Form FR-127?

Use this form if you cannot file your DC individual income tax return by the April 18, 2022 deadline. By filing this form, you can receive an extension of time to file until October 15, 2022. You must use Form FR-127 to request an extension of time to file a DC individual income tax return.

A filing extension is not an extension of the due date for paying any tax you may owe. Before filing for an extension, estimate the taxes you will owe and pay any part of that amount, not covered by DC withheld tax amounts and/or estimated tax payments. Include your payment with the FR-127 voucher and file it by April 18, 2022.

If filing jointly, or filing separately on the same return, enter the taxpayer identification number (TIN) and name shown first on your D-40 return, then enter the TIN and name shown second on your return.

Additional extension.

In addition to the 6-month extension, you may receive another 6-month extension if you are living or traveling outside the

U.S. You must file the first 6-month extension by the

April 18, 2022 deadline before applying for the additional

extension of time to file by October 15, 2022

Extensions for Members of US Armed Forces Deployed in a Combat Zone or Contingency Operation.

Deadlines for filing your return, paying your tax, claiming a refund, and taking other actions with OTR is extended for persons in the Armed Forces serving in a Combat Zone or Contingency Operation. The extension also applies to spouses/registered domestic partners, whether they file jointly or separately on the same return. See IRS Pub.3, Armed Forces Tax Guide for detailed information. Fill in the ‘if Military Combat Zone' oval.

How to avoid penalties and interest.

You will be charged interest of 10% per year, compounded daily, for any tax not paid on time. Interest is calculated from the due date of the return to the date the tax is paid.

You will be charged a 5% per-month_penalty for failure to file a return or pay any tax due on time. The penalty is calculated on the unpaid tax for each month or part of a month that the return is not filed or the tax is not paid. The maximum penalty is an additional amount due, equal to 25% of the tax due.

Dishonored Payments

Make sure your check or electronic payment will clear. You will be charged a $65 fee if your check or electronic payment is not honored by your financial institution and returned to OTR.

Tax tables for income of $100,000 or less

SOE income

Amount of tax Taxable income

Amount of tax

SSIO0 income

If more than $100,000, use Calculation I instructions on page 19.

Amount of tax e750 income

Amount of tax

$0 - $0 “S28 500 - 2,549 $101 $5,0 000 - 5,049 $201 “375 500 - 7,549 $301 50 - 90 3 2,550 - 2,599 103 5,050 5,099 203 7,550 - 7,599 303 100 - 149 5 2,600 - 2,649 105 5,100 - 5,149 205 7,600 - 7,649 305 150 - 199 7 2,650 - 2,699 107 5,150 - 5,199 207 7,650 - 7,699 307 200 - 249 9 2,700 - 2,749 109 5,200 - 5,249 209 7,700 - 7,749 309 250 - 299 11 2,750 - 2,799 111 5,250 - 5,299 211 7,750 - 7,799 311 300 - 349 13 2,800 - 2,849 113 5,300 - 5,349 213 7,800 - 7,849 313 350 - 399 15 2,850 - 2,899 115 5,350 - 5,399 215 7,850 - 7,899 315 400 - 449 17 2,900 - 2,949 117 5,400 - 5,449 217 7,900 - 7,949 317 450 - 499 19 2,950 - 2,999 119 5,450 - 5,499 219 7,950 - 7,999 319 500 - 549 21 $3,000 - 3,049 $121 5,500 - 5,549 221 $8,000 - 8,049 $321 550 - 599 23 3,050 - 3,099 123 5,550 - 5,599 223 8,050 - 8,099 323 600 - 649 25 3,100 - 3,149 125 5,600 - 5,649 225 8,100 - 8,149 325 650 - 699 27 3,150 - 3,199 127 5,650 - 5,699 227 8,150 - 8,199 327 700 - 749 29 3,200 - 3,249 129 5,700 - 5,749 229 8,200 - 8,249 329 750 - 799 31 3,250 - 3,299 131 5,750 - 5,799 231 8,250 - 8,299 331 800 - 849 0) 3,300 - 3,349 133 5,800 - 5,849 233 8,300 - 8,349 333 850 - 899 5) 3,350 - 3,399 135 5,850 - 5,899 235 8,350 - 8,399 335 900 - 949 37 3,400 - 3,449 137 5,900 - 5,949 237 8,400 - 8,449 337 950 - 999 39 3,450 - 3,499 139 5,950 - 5,999 239 8,450 - 8,499 339 $1,000 - 1,049 $41 3,500 - 3,549 141 $6,000 - 6,049 $241 8,500 - 8,549 341 1,050 - 1,099 43 3,550 - 3,599 143 6,050 - 6,099 243 8,550 - 8,599 343 1,100 - 1,149 45 3,600 - 3,649 145 6,100 - 6,149 245 8,600 - 8,649 345 1,150 - 1,199 47 3,650 - 3,699 147 6,150 - 6,199 247 8,650 - 8,699 347 1,200 - 1,249 49 3,700 - 3,749 149 6,200 - 6,249 249 8,700 - 8,749 349 1,250 - 1,299 51 3,750 - 3,799 151 6,250 - 6,299 251 8,750 - 8,799 351 1,300 - 1,349 53 3,800 - 3,849 153 6,300 - 6,349 253 8,800 - 8,849 353 1,350 - 1,399 55 3,850 - 3,899 155 6,350 - 6,399 255 8,850 - 8,899 355 1,400 - 1,449 57 3,900 - 3,949 157 6,400 - 6,449 257 8,900 - 8,949 357 1,450 - 1,499 59 3,950 - 3,999 159 6,450 - 6,499 259 8,950 - 8,999 359 1,500 - 1,549 61 $4,000 - 4,049 $161 6,500 - 6,549 261 $9,000 - 9,049 $361 1,550 - 1,599 63 4,050 - 4,099 163 6,550 - 6,599 263 9,050 - 9,099 363 1,600 - 1,649 65 4,100 - 4,149 165 6,600 - 6,649 265 9,100 - 9,149 365 1,650 - 1,699 67 4,150 - 4,199 167 6,650 - 6,699 267 9,150 - 9,199 367 1,700 - 1,749 69 4,200 - 4,249 169 6,700 - 6,749 269 9,200 - 9,249 369 1,750 - 1,799 71 4,250 - 4,299 171 6,750 - 6,799 271 9,250 - 9,299 371 1,800 - 1,849 73 4,300 - 4,349 173 6,800 - 6,849 273 9,300 - 9,349 373 1,850 - 1,899 75 4,350 - 4,399 175 6,850 - 6,899 275 9,350 - 9,399 375 1,900 - 1,949 77 4,400 - 4,449 177 6,900 - 6,949 277 9,400 - 9,449 377 1,950 - 1,999 79 4,450 - 4,499 179 6,950 - 6,999 279 9,450 - 9,499 379 $2,000 - 2,049 $81 4,500 - 4,549 181 $7,000 - 7,049 $281 9,500 - 9,549 381 2,050 - 2,099 83 4,550 - 4,599 183 7,050 - 7,099 283 9,550 - 9,599 383 2,100 - 2,149 85 4,600 - 4,649 185 7,100 - 7,149 285 9,600 - 9,649 385 2,150 - 2,199 87 4,650 - 4,699 187 7,150 - 7,199 287 9,650 - 9,699 387 2,200 - 2,249 89 4,700 - 4,749 189 7,200 - 7,249 289 9,700 - 9,749 389 2,250 - 2,299 91 4,750 - 4,799 191 7,250 - 7,299 291 9,750 - 9,799 391 2,300 - 2,349 93 4,800 - 4,849 193 7,300 - 7,349 293 9,800 - 9,849 393 2,350 - 2,399 95 4,850 - 4,899 195 7,350 - 7,399 295 9,850 - 9,899 395 2,400 - 2,449 97 4,900 - 4,949 197 7,400 - 7,449 297 9,900 - 9,949 397 2,450 - 2,499 99 4,950 - 4,999 199 7,450 - 7,499 299 9,950 - 9,999 399

91

Tax tables for Income of $100,000 or less continued

Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax

$10,000 - 10,049 $402 $12,500 - 12,549 $552 $15,000 - 15,049 $702 $17,500 - 17,549 $852 10,050 - 10,099 405 12,550 - 12,599 555 15,050 - 15,099 705 17,550 - 17,599 855 10,100 - 10,149 408 12,600 - 12,649 558 15,100 - 15,149 708 17,600 - 17,649 858 10,150 - 10,199 411 12,650 - 12,699 561 15,150 - 15,199 711 17,650 - 17,699 861 10,200 - 10,249 414 12,700 - 12,749 564 15,200 - 15,249 714 17,700 - 17,749 864 10,250 - 10,299 417 12,750 - 12,799 567 15,250 - 15,299 717 17,750 - 17,799 867 10,300 - 10,349 420 12,800 - 12,849 570 15,300 - 15,349 720 17,800 - 17,849 870 10,350 - 10,399 423 12,850 - 12,899 573 15,350 - 15,399 723 17,850 - 17,899 873 10,400 - 10,449 426 12,900 - 12,949 576 15,400 - 15,449 726 17,900 - 17,949 876 10,450 - 10,499 429 12,950 - 12,999 579 15,450 - 15,499 729 17,950 - 17,999 879 10,500 - 10,549 432 $13,000 - 13,049 $582 15,500 - 15,549 732 $18,000 - 18,049 $882 10,550 - 10,599 435 13,050 - 13,099 585 15,550 - 15,599 735 18,050 - 18,099 885 10,600 - 10,649 438 13,100 - 13,149 588 15,600 - 15,649 738 18,100 - 18,149 888 10,650 - 10,699 441 13,150 - 13,199 591 15,650 - 15,699 741 18,150 - 18,199 891 10,700 - 10,749 444 13,200 - 13,249 594 15,700 - 15,749 744 18,200 - 18,249 894 10,750 - 10,799 447 13,250 - 13,299 597 15,750 - 15,799 TAT 18,250 - 18,299 897 10,800 - 10,849 450 13,300 - 13,349 600 15,800 - 15,849 750 18,300 - 18,349 900 10,850 - 10,899 453 13,350 - 13,399 603 15,850 - 15,899 753 18,350 - 18,399 903 10,900 - 10,949 456 13,400 - 13,449 606 15,900 - 15,949 756 18,400 - 18,449 906 10,950 - 10,999 459 13,450 - 13,499 609 15,950 - 15,999 759 18,450 - 18,499 909 $11,000 - 11,049 $462 13,500 - 13,549 612 $16,000 - 16,049 $762 18,500 - 18,549 912 11,050 - 11,099 465 13,550 - 13,599 615 16,050 - 16,099 765 18,550 - 18,599 915 11,100 - 11,149 468 13,600 - 13,649 618 16,100 - 16,149 768 18,600 - 18,649 918 11,150 - 11,199 471 13,650 - 13,699 621 16,150 - 16,199 771 18,650 - 18,699 921 11,200 - 11,249 474 13,700 - 13,749 624 16,200 - 16,249 774 18,700 - 18,749 924 11,250 - 11,299 477 13,750 - 13,799 627 16,250 - 16,299 777 18,750 - 18,799 927 11,300 - 11,349 480 13,800 - 13,849 630 16,300 - 16,349 780 18,800 - 18,849 930 11,350 - 11,399 483 13,850 - 13,899 633 16,350 - 16,399 783 18,850 - 18,899 933 11,400 - 11,449 486 13,900 - 13,949 636 16,400 - 16,449 786 18,900 - 18,949 936 11,450 - 11,499 489 13,950 - 13,999 639 16,450 - 16,499 789 18,950 - 18,999 939 11,500 - 11,549 492 $14,000 - 14,049 $642 16,500 - 16,549 792 $19,000 - 19,049 $942 11,550 - 11,599 495 14,050 - 14,099 645 16,550 - 16,599 795 19,050 - 19,099 945 11,600 - 11,649 498 14,100 - 14,149 648 16,600 - 16,649 798 19,100 - 19,149 948 11,650 - 11,699 501 14,150 - 14,199 651 16,650 - 16,699 801 19,150 - 19,199 951 11,700 - 11,749 504 14,200 - 14,249 654 16,700 - 16,749 804 19,200 - 19,249 954 11,750 - 11,799 507 14,250 - 14,299 657 16,750 - 16,799 807 19,250 - 19,299 957 11,800 - 11,849 510 14,300 - 14,349 660 16,800 - 16,849 810 19,300 - 19,349 960 11,850 - 11,899 513 14,350 - 14,399 663 16,850 - 16,899 813 19,350 - 19,399 963 11,900 - 11,949 516 14,400 - 14,449 666 16,900 - 16,949 816 19,400 - 19,449 966 11,950 - 11,999 519 14,450 - 14,499 669 16,950 - 16,999 819 19,450 - 19,499 969 $12,000 - 12,049 $522 14,500 - 14,549 672 $17,000 - 17,049 $822 19,500 - 19,549 972 12,050 - 12,099 525 14,550 - 14,599 675 17,050 - 17,099 825 19,550 - 19,599 975 12,100 - 12,149 528 14,600 - 14,649 678 17,100 - 17,149 828 19,600 - 19,649 978 12,150 - 12,199 531 14,650 - 14,699 681 17,150 - 17,199 831 19,650 - 19,699 981 12,200 - 12,249 534 14,700 - 14,749 684 17,200 - 17,249 834 19,700 - 19,749 984 12,250 - 12,299 537 14,750 - 14,799 687 17,250 - 17,299 837 19,750 - 19,799 987 12,300 - 12,349 540 14,800 - 14,849 690 17,300 - 17,349 840 19,800 - 19,849 990 12,350 - 12,399 543 14,850 - 14,899 693 17,350 - 17,399 843 19,850 - 19,899 993 12,400 - 12,449 546 14,900 - 14,949 696 17,400 - 17,449 846 19,900 - 19,949 996 12,450 - 12,499 549 14,950 - 14,999 699 17,450 - 17,499 849 19,950 - 19,999 999

92

Taxable income

Amount of tax Taxable income

$20,000 - 22,499 $22,500 - 24,999 $25,000 - 27,499 $27,500 - 29,999

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax

$20,000 - 20,049 $1,002 20,050 - 20,099 1,005 20,100 - 20,149 1,008 20,150 - 20,199 1,011 20,200 - 20,249 1,014 20,250 - 20,299 1,017 20,300 - 20,349 1,020 20,350 - 20,399 1,023 20,400 - 20,449 1,026 20,450 - 20,499 1,029 20,500 - 20,549 1,032 20,550 - 20,599 1,035 20,600 - 20,649 1,038 20,650 - 20,699 1,041 20,700 - 20,749 1,044 20,750 - 20,799 1,047 20,800 - 20,849 1,050 20,850 - 20,899 1,053 20,900 - 20,949 1,056 20,950 - 20,999 1,059 $21,000 - 21,049 $1,062 21,050 - 21,099 1,065 21,100 - 21,149 1,068 21,150 - 21,199 1,071 21,200 - 21,249 1,074 21,250 - 21,299 1,077 21,300 - 21,349 1,080 21,350 - 21,399 1,083 21,400 - 21,449 1,086 21,450 - 21,499 1,089 21,500 - 21,549 1,092 21,550 - 21,599 1,095 21,600 - 21,649 1,098 21,650 - 21,699 1,101 21,700 - 21,749 1,104 21,750 - 21,799 1,107 21,800 - 21,849 1,110 21,850 - 21,899 1,113 21,900 - 21,949 1,116 21,950 - 21,999 1,119 $22,000 - 22,049 $1,122 22,050 - 22,099 1,125 22,100 - 22,149 1,128 22,150 - 22,199 1,131 22,200 - 22,249 1,134 22,250 - 22,299 1,137 22,300 - 22,349 1,140 22,350 - 22,399 1,143 22,400 - 22,449 1,146 22,450 - 22,499 1,149

$22,500 - 22,549 $1,152 22,550 - 22,599 1,155 22,600 - 22,649 1,158 22,650 - 22,699 1,161 22,700 - 22,749 1,164 22,750 - 22,799 1,167 22,800 - 22,849 1,170 22,850 - 22,899 1,173 22,900 - 22,949 1,176 22,950 - 22,999 1,179 $23,000 - 23,049 $1,182 23,050 - 23,099 1,185 23,100 - 23,149 1,188 23,150 - 23,199 1,191 23,200 - 23,249 1,194 23,250 - 23,299 1,197 23,300 - 23,349 1,200 23,350 - 23,399 1,203 23,400 - 23,449 1,206 23,450 - 23,499 1,209 23,500 - 23,549 1,212 23,550 - 23,599 1,215 23,600 - 23,649 1,218 23,650 - 23,699 1,221 23,700 - 23,749 1,224 23,750 - 23,799 1,227 23,800 - 23,849 1,230 23,850 - 23,899 1,233 23,900 - 23,949 1,236 23,950 - 23,999 1,239 $24,000 - 24,049 $1,242 24,050 - 24,099 1,245 24,100 - 24,149 1,248 24,150 - 24,199 1,251 24,200 - 24,249 1,254 24,250 - 24,299 1,257 24,300 - 24,349 1,260 24,350 - 24,399 1,263 24,400 - 24,449 1,266 24,450 - 24,499 1,269 24,500 - 24,549 1,272 24,550 - 24,599 1,275 24,600 - 24,649 1,278 24,650 - 24,699 1,281 24,700 - 24,749 1,284 24,750 - 24,799 1,287 24,800 - 24,849 1,290 24,850 - 24,899 1,293 24,900 - 24,949 1,296 24,950 - 24,999 1,299

$25,000 - 25,049 $1,302 25,050 - 25,099 1,305 25,100 - 25,149 1,308 25,150 - 25,199 1,311 25,200 - 25,249 1,314 25,250 - 25,299 1,317 25,300 - 25,349 1,320 25,350 - 25,399 1,323 25,400 - 25,449 1,326 25,450 - 25,499 1,329 25,500 - 25,549 1,332 25,550 - 25,599 1,335 25,600 - 25,649 1,338 25,650 - 25,699 1,341 25,700 - 25,749 1,344 25,750 - 25,799 1,347 25,800 - 25,849 1,350 25,850 - 25,899 1,353 25,900 - 25,949 1,356 25,950 - 25,999 1,359 $26,000 - 26,049 $1,362 26,050 - 26,099 1,365 26,100 - 26,149 1,368 26,150 - 26,199 1,371 26,200 - 26,249 1,374 26,250 - 26,299 1,377 26,300 - 26,349 1,380 26,350 - 26,399 1,383 26,400 - 26,449 1,386 26,450 - 26,499 1,389 26,500 - 26,549 1,392 26,550 - 26,599 1,395 26,600 - 26,649 1,398 26,650 - 26,699 1,401 26,700 - 26,749 1,404 26,750 - 26,799 1,407 26,800 - 26,849 1,410 26,850 - 26,899 1,413 26,900 - 26,949 1,416 26,950 - 26,999 1,419 $27,000 - 27,049 $1,422 27,050 - 27,099 1,425 27,100 - 27,149 1,428 27,150 - 27,199 1,431 27,200 - 27,249 1,434 27,250 - 27,299 1,437 27,300 - 27,349 1,440 27,350 - 27,399 1,443 27,400 - 27,449 1,446 27,450 - 27,499 1,449

$27,500 - 27,549 $1,452 27,550 - 27,599 1,455 27,600 - 27,649 1,458 27,650 - 27,699 1,461 27,700 - 27,749 1,464 27,750 - 27,799 1,467 27,800 - 27,849 1,470 27,850 - 27,899 1,473 27,900 - 27,949 1,476 27,950 - 27,999 1,479 $28,000 - 28,049 $1,482 28,050 - 28,099 1,485 28,100 - 28,149 1,488 28,150 - 28,199 1,491 28,200 - 28,249 1,494 28,250 - 28,299 1,497 28,300 - 28,349 1,500 28,350 - 28,399 1,503 28,400 - 28,449 1,506 28,450 - 28,499 1,509 28,500 - 28,549 1,512 28,550 - 28,599 1,515 28,600 - 28,649 1,518 28,650 - 28,699 1,521 28,700 - 28,749 1,524 28,750 - 28,799 1,527 28,800 - 28,849 1,530 28,850 - 28,899 1,533 28,900 - 28,949 1,536 28,950 - 28,999 1,539 $29,000 - 29,049 $1,542 29,050 - 29,099 1,545 29,100 - 29,149 1,548 29,150 - 29,199 1,551 29,200 - 29,249 1,554 29,250 - 29,299 1,557 29,300 - 29,349 1,560 29,350 - 29,399 1,563 29,400 - 29,449 1,566 29,450 - 29,499 1,569 29,500 - 29,549 1,572 29,550 - 29,599 1,575 29,600 - 29,649 1,578 29,650 - 29,699 1,581 29,700 - 29,749 1,584 29,750 - 29,799 1,587 29,800 - 29,849 1,590 29,850 - 29,899 1,593 29,900 - 29,949 1,596 29,950 - 29,999 1,599

93

Tax tables for Income of $100,000 or less continued

Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax

$30,000 - 30,049 $1,602 $32,500 - 32,549 $1,752 $35,000 - 35,049 $1,902 $37,500 - 37,549 $2,052 30,050 - 30,099 1,605 32,550 - 32,599 1,755 35,050 - 35,099 1,905 37,550 - 37,599 2,055 30,100 - 30,149 1,608 32,600 - 32,649 1,758 35,100 - 35,149 1,908 37,600 - 37,649 2,058 30,150 - 30,199 1,611 32,650 - 32,699 1,761 35,150 - 35,199 1,911 37,650 - 37,699 2,061 30,200 - 30,249 1,614 32,700 - 32,749 1,764 35,200 - 35,249 1,914 37,700 - 37,749 2,064 30,250 - 30,299 1,617 32,750 - 32,799 1,767 35,250 - 35,299 1,917 37,750 - 37,799 2,067 30,300 - 30,349 1,620 32,800 - 32,849 1,770 35,300 - 35,349 1,920 37,800 - 37,849 2,070 30,350 - 30,399 1,623 32,850 - 32,899 1,773 35,350 - 35,399 1,923 37,850 - 37,899 2,073 30,400 - 30,449 1,626 32,900 - 32,949 1,776 35,400 - 35,449 1,926 37,900 - 37,949 2,076 30,450 - 30,499 1,629 32,950 - 32,999 1,779 35,450 - 35,499 1,929 37,950 - 37,999 2,079 30,500 - 30,549 1,632 $33,000 - 33,049 $1,782 35,500 - 35,549 1,932 $38,000 - 38,049 $2,082 30,550 - 30,599 1,635 33,050 - 33,099 1,785 35,550 - 35,599 1,935 38,050 - 38,099 2,085 30,600 - 30,649 1,638 33,100 - 33,149 1,788 35,600 - 35,649 1,938 38,100 - 38,149 2,088 30,650 - 30,699 1,641 33,150 - 33,199 1,791 35,650 - 35,699 1,941 38,150 - 38,199 2,091 30,700 - 30,749 1,644 33,200 - 33,249 1,794 35,700 - 35,749 1,944 38,200 - 38,249 2,094 30,750 - 30,799 1,647 33,250 - 33,299 1,797 35,750 - 35,799 1,947 38,250 - 38,299 2,097 30,800 - 30,849 1,650 33,300 - 33,349 1,800 35,800 - 35,849 1,950 38,300 - 38,349 2,100 30,850 - 30,899 1,653 33,350 - 33,399 1,803 35,850 - 35,899 1,953 38,350 - 38,399 2,103 30,900 - 30,949 1,656 33,400 - 33,449 1,806 35,900 - 35,949 1,956 38,400 - 38,449 2,106 30,950 - 30,999 1,659 33,450 - 33,499 1,809 35,950 - 35,999 1,959 38,450 - 38,499 2,109 $31,000 - 31,049 $1,662 33,500 - 33,549 1,812 $36,000 - 36,049 $1,962 38,500 - 38,549 2,112 31,050 - 31,099 1,665 33,550 - 33,599 1,815 36,050 - 36,099 1,965 38,550 - 38,599 2,115 31,100 - 31,149 1,668 33,600 - 33,649 1,818 36,100 - 36,149 1,968 38,600 - 38,649 2,118 31,150 - 31,199 1,671 33,650 - 33,699 1,821 36,150 - 36,199 1,971 38,650 - 38,699 2,121 31,200 - 31,249 1,674 33,700 - 33,749 1,824 36,200 - 36,249 1,974 38,700 - 38,749 2,124 31,250 - 31,299 1,677 33,750 - 33,799 1,827 36,250 - 36,299 1,977 38,750 - 38,799 2,127 31,300 - 31,349 1,680 33,800 - 33,849 1,830 36,300 - 36,349 1,980 38,800 - 38,849 2,130 31,350 - 31,399 1,683 33,850 - 33,899 1,833 36,350 - 36,399 1,983 38,850 - 38,899 2,133 31,400 - 31,449 1,686 33,900 - 33,949 1,836 36,400 - 36,449 1,986 38,900 - 38,949 2,136 31,450 - 31,499 1,689 33,950 - 33,999 1,839 36,450 - 36,499 1,989 38,950 - 38,999 2,139 31,500 - 31,549 1,692 $34,000 - 34,049 $1,842 36,500 - 36,549 1,992 $39,000 - 39,049 $2,142 31,550 - 31,599 1,695 34,050 - 34,099 1,845 36,550 - 36,599 1,995 39,050 - 39,099 2,145 31,600 - 31,649 1,698 34,100 - 34,149 1,848 36,600 - 36,649 1,998 39,100 - 39,149 2,148 31,650 - 31,699 1,701 34,150 - 34,199 1,851 36,650 - 36,699 2,001 39,150 - 39,199 2,151 31,700 - 31,749 1,704 34,200 - 34,249 1,854 36,700 - 36,749 2,004 39,200 - 39,249 2,154 31,750 - 31,799 1,707 34,250 - 34,299 1,857 36,750 - 36,799 2,007 39,250 - 39,299 2,157 31,800 - 31,849 1,710 34,300 - 34,349 1,860 36,800 - 36,849 2,010 39,300 - 39,349 2,160 31,850 - 31,899 1,713 34,350 - 34,399 1,863 36,850 - 36,899 2,013 39,350 - 39,399 2,163 31,900 - 31,949 1,716 34,400 - 34,449 1,866 36,900 - 36,949 2,016 39,400 - 39,449 2,166 31,950 - 31,999 1,719 34,450 - 34,499 1,869 36,950 - 36,999 2,019 39,450 - 39,499 2,169 $32,000 - 32,049 $1,722 34,500 - 34,549 1,872 $37,000 - 37,049 $2,022 39,500 - 39,549 2,172 32,050 - 32,099 1,725 34,550 - 34,599 1,875 37,050 - 37,099 2,025 39,550 - 39,599 2,175 32,100 - 32,149 1,728 34,600 - 34,649 1,878 37,100 - 37,149 2,028 39,600 - 39,649 2,178 32,150 - 32,199 1,731 34,650 - 34,699 1,881 37,150 - 37,199 2,031 39,650 - 39,699 2,181 32,200 - 32,249 1,734 34,700 - 34,749 1,884 37,200 - 37,249 2,034 39,700 - 39,749 2,184 32,250 - 32,299 1,737 34,750 - 34,799 1,887 37,250 - 37,299 2,037 39,750 - 39,799 2,187 32,300 - 32,349 1,740 34,800 - 34,849 1,890 37,300 - 37,349 2,040 39,800 - 39,849 2,190 32,350 - 32,399 1,743 34,850 - 34,899 1,893 37,350 - 37,399 2,043 39,850 - 39,899 2,193 32,400 - 32,449 1,746 34,900 - 34,949 1,896 37,400 - 37,449 2,046 39,900 - 39,949 2,196 32,450 - 32,499 1,749 34,950 - 34,999 1,899 37,450 - 37,499 2,049 39,950 - 39,999 2,199

94

Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax

$40,000 - 40,049 $2,202 $42,500 - 42,549 $2,364 $45,000 - 45,049 $2,527 $47,500 - 47,549 $2,689 40,050 - 40,099 2,205 42,550 - 42,599 2,367 45,050 - 45,099 2,530 47,550 - 47,599 2,692 40,100 - 40,149 2,208 42,600 - 42,649 2,371 45,100 - 45,149 2,533 47,600 - 47,649 2,696 40,150 - 40,199 2,211 42,650 - 42,699 2,374 45,150 - 45,199 2,536 47,650 - 47,699 2,699 40,200 - 40,249 2,215 42,700 - 42,749 2,377 45,200 - 45,249 2,540 47,700 - 47,749 2,702 40,250 - 40,299 2,218 42,750 - 42,799 2,380 45,250 - 45,299 2,543 47,750 - 47,799 2,705 40,300 - 40,349 2,221 42,800 - 42,849 2,384 45,300 - 45,349 2,546 47,800 - 47,849 2,709 40,350 - 40,399 2,224 42,850 - 42,899 2,387 45,350 - 45,399 2,549 47,850 - 47,899 2,712 40,400 - 40,449 2,228 42,900 - 42,949 2,390 45,400 - 45,449 2,553 47,900 - 47,949 2,715 40,450 - 40,499 2,231 42,950 - 42,999 2,393 45,450 - 45,499 2,556 47,950 - 47,999 2,718 40,500 - 40,549 2,234 $43,000 - 43,049 $2,397 45,500 - 45,549 2,559 $48,000 - 48,049 $2,722 40,550 - 40,599 2,237 43,050 - 43,099 2,400 45,550 - 45,599 2,562 48,050 - 48,099 2,725 40,600 - 40,649 2,241 43,100 - 43,149 2,403 45,600 - 45,649 2,566 48,100 - 48,149 2,728 40,650 - 40,699 2,244 43,150 - 43,199 2,406 45,650 - 45,699 2,569 48,150 - 48,199 2,731 40,700 - 40,749 2,247 43,200 - 43,249 2,410 45,700 - 45,749 2,572 48,200 - 48,249 2,735 40,750 - 40,799 2,250 43,250 - 43,299 2,413 45,750 - 45,799 2,575 48,250 - 48,299 2,738 40,800 - 40,849 2,254 43,300 - 43,349 2,416 45,800 - 45,849 2,579 48,300 - 48,349 2,741 40,850 - 40,899 2,257 43,350 - 43,399 2,419 45,850 - 45,899 2,582 48,350 - 48,399 2,744 40,900 - 40,949 2,260 43,400 - 43,449 2,423 45,900 - 45,949 2,585 48,400 - 48,449 2,748 40,950 - 40,999 2,263 43,450 - 43,499 2,426 45,950 - 45,999 $2,588 48,450 - 48,499 2,751 $41,000 - 41,049 $2,267 43,500 - 43,549 2,429 $46,000 - 46,049 $2,592 48,500 - 48,549 2,754 41,050 - 41,099 2,270 43,550 - 43,599 2,432 46,050 - 46,099 2,595 48,550 - 48,599 2,757 41,100 - 41,149 2,273 43,600 - 43,649 2,436 46,100 - 46,149 2,598 48,600 - 48,649 2,761 41,150 - 41,199 2,276 43,650 - 43,699 2,439 46,150 - 46,199 2,601 48,650 - 48,699 2,764 41,200 - 41,249 2,280 43,700 - 43,749 2,442 46,200 - 46,249 2,605 48,700 - 48,749 2,767 41,250 - 41,299 2,283 43,750 - 43,799 2,445 46,250 - 46,299 2,608 48,750 - 48,799 2,770 41,300 - 41,349 2,286 43,800 - 43,849 2,449 46,300 - 46,349 2,611 48,800 - 48,849 2,774 41,350 - 41,399 2,289 43,850 - 43,899 2,452 46,350 - 46,399 2,614 48,850 - 48,899 2,777 41,400 - 41,449 2,293 43,900 - 43,949 2,455 46,400 - 46,449 2,618 48,900 - 48,949 2,780 41,450 - 41,499 2,296 43,950 - 43,999 2,458 46,450 - 46,499 2,621 48,950 - 48,999 $2,783 41,500 - 41,549 2,299 $44,000 - 44,049 $2,462 46,500 - 46,549 2,624 $49,000 - 49,049 $2,787 41,550 - 41,599 2,302 44,050 - 44,099 2,465 46,550 - 46,599 2,627 49,050 - 49,099 2,790 41,600 - 41,649 2,306 44,100 - 44,149 2,468 46,600 - 46,649 2,631 49,100 - 49,149 2,793 41,650 - 41,699 2,309 44,150 - 44,199 2,471 46,650 - 46,699 2,634 49,150 - 49,199 2,796 41,700 - 41,749 2,312 44,200 - 44,249 2,475 46,700 - 46,749 2,637 49,200 - 49,249 2,800 41,750 - 41,799 2,315 44,250 - 44,299 2,478 46,750 - 46,799 2,640 49,250 - 49,299 2,803 41,800 - 41,849 2,319 44,300 - 44,349 2,481 46,800 - 46,849 2,644 49,300 - 49,349 2,806 41,850 - 41,899 2,322 44,350 - 44,399 2,484 46,850 - 46,899 2,647 49,350 - 49,399 2,809 41,900 - 41,949 2,325 44,400 - 44,449 2,488 46,900 - 46,949 2,650 49,400 - 49,449 2,813 41,950 - 41,999 2,328 44,450 - 44,499 2,491 46,950 - 46,999 2,653 49,450 - 49,499 2,816 $42,000 - 42,049 $2,332 44,500 - 44,549 2,494 $47,000 - 47,049 $2,657 49,500 - 49,549 2,819 42,050 - 42,099 2,335 44,550 - 44,599 2,497 47,050 - 47,099 2,660 49,550 - 49,599 2,822 42,100 - 42,149 2,338 44,600 - 44,649 2,501 47,100 - 47,149 2,663 49,600 - 49,649 2,826 42,150 - 42,199 2,341 44,650 - 44,699 2,504 47,150 - 47,199 2,666 49,650 - 49,699 2,829 42,200 - 42,249 2,345 44,700 - 44,749 2,507 47,200 - 47,249 2,670 49,700 - 49,749 2,832 42,250 - 42,299 2,348 44,750 - 44,799 2,510 47,250 - 47,299 2,673 49,750 - 49,799 2,835 42,300 - 42,349 2,351 44,800 - 44,849 2,514 47,300 - 47,349 2,676 49,800 - 49,849 2,839 42,350 - 42,399 2,354 44,850 - 44,899 2,517 47,350 - 47,399 2,679 49,850 - 49,899 2,842 42,400 - 42,449 2,358 44,900 - 44,949 2,520 47,400 - 47,449 2,683 49,900 - 49,949 2,845 42,450 - 42,499 2,361 44,950 - 44,999 2,523 47,450 - 47,499 2,686 49,950 - 49,999 2,848

95

Tax tables for Income of $100,000 or less continued

Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax

$50,000 - 50,049 $2,852 $52,500 - 52,549 $3,014 $55,000 - 55,049 $3,177 $57,500 - 57,549 $3,339 50,050 - 50,099 2,855, 52,550 - 52,599 3,017 55,050 - 55,099 3,180 57,550 - 57,599 3,342 50,100 - 50,149 2,858 52,600 - 52,649 3,021 55,100 - 55,149 3,183 57,600 - 57,649 3,346 50,150 - 50,199 2,861 52,650 - 52,699 3,024 55,150 - 55,199 3,186 57,650 - 57,699 3,349 50,200 - 50,249 2,865 52,700 - 52,749 3,027 55,200 - 55,249 3,190 57,700 - 57,749 3,352 50,250 - 50,299 2,868 52,750 - 52,799 3,030 55,250 - 55,299 3,193 57,750 - 57,799 ro) 50,300 - 50,349 2,871 52,800 - 52,849 3,034 55,300 - 55,349 3,196 57,800 - 57,849 3,359 50,350 - 50,399 2,874 52,850 - 52,899 3,037 55,350 - 55,399 3,199 57,850 - 57,899 3,362 50,400 - 50,449 2,878 52,900 - 52,949 3,040 55,400 - 55,449 3,203 57,900 - 57,949 3,365 50,450 - 50,499 2,881 52,950 - 52,999 3,043 55,450 - 55,499 3,206 57,950 - 57,999 3,368 50,500 - 50,549 2,884 $53,000 - 53,049 $3,047 55,500 - 55,549 3,209 $58,000 - 58,049 $3,372 50,550 - 50,599 2,887 53,050 - 53,099 3,050 55,550 - 55,599 3,212 58,050 - 58,099 roo) 50,600 - 50,649 2,891 53,100 - 53,149 3,053 55,600 - 55,649 3,216 58,100 - 58,149 3,378 50,650 - 50,699 2,894 53,150 - 53,199 3,056 55,650 - 55,699 3,219 58,150 - 58,199 3,381 50,700 - 50,749 2,897 53,200 - 53,249 3,060 55,700 - 55,749 3,222 58,200 - 58,249 3,385 50,750 - 50,799 2,900 53,250 - 53,299 3,063 55,750 - 55,799 3,225 58,250 - 58,299 3,388 50,800 - 50,849 2,904 53,300 - 53,349 3,066 55,800 - 55,849 3,229 58,300 - 58,349 3,391 50,850 - 50,899 2,907 53,350 - 53,399 3,069 55,850 - 55,899 3,232 58,350 - 58,399 3,394 50,900 - 50,949 2,910 53,400 - 53,449 3,073 55,900 - 55,949 3,235 58,400 - 58,449 3,398 50,950 - 50,999 2,913 53,450 - 53,499 3,076 55,950 - 55,999 3,238 58,450 - 58,499 3,401 $51,000 - 51,049 $2,917 53,500 - 53,549 3,079 $56,000 - 56,049 $3,242 58,500 - 58,549 3,404 51,050 - 51,099 2,920 53,550 - 53,599 3,082 56,050 - 56,099 3,245 58,550 - 58,599 3,407 51,100 - 51,149 2,923 53,600 - 53,649 3,086 56,100 - 56,149 3,248 58,600 - 58,649 3,411 51,150 - 51,199 2,926 53,650 - 53,699 3,089 56,150 - 56,199 3,251 58,650 - 58,699 3,414 51,200 - 51,249 2,930 53,700 - 53,749 3,092 56,200 - 56,249 e200) 58,700 - 58,749 3,417 51,250 - 51,299 2,933 53,750 - 53,799 3,095 56,250 - 56,299 3,258 58,750 - 58,799 3,420 51,300 - 51,349 2,936 53,800 - 53,849 3,099 56,300 - 56,349 3,261 58,800 - 58,849 3,424 51,350 - 51,399 2,939 53,850 - 53,899 3,102 56,350 - 56,399 3,264 58,850 - 58,899 3,427 51,400 - 51,449 2,943 53,900 - 53,949 3,105 56,400 - 56,449 3,268 58,900 - 58,949 3,430 51,450 - 51,499 2,946 53,950 - 53,999 3,108 56,450 - 56,499 3,271 58,950 - 58,999 3,433 51,500 - 51,549 2,949 $54,000 - 54,049 $3,112 56,500 - 56,549 3,274 $59,000 - 59,049 $3,437 51,550 - 51,599 2,952 54,050 - 54,099 3,115 56,550 - 56,599 3,277 59,050 - 59,099 3,440 51,600 - 51,649 2,956 54,100 - 54,149 3,118 56,600 - 56,649 3,281 59,100 - 59,149 3,443 51,650 - 51,699 2,959 54,150 - 54,199 3,121 56,650 - 56,699 3,284 59,150 - 59,199 3,446 51,700 - 51,749 2,962 54,200 - 54,249 3,125 56,700 - 56,749 3,287 59,200 - 59,249 3,450 51,750 - 51,799 2,965 54,250 - 54,299 3,128 56,750 - 56,799 3,290 59,250 - 59,299 3,453 51,800 - 51,849 2,969 54,300 - 54,349 3,131 56,800 - 56,849 3,294 59,300 - 59,349 3,456 51,850 - 51,899 2,972 54,350 - 54,399 3,134 56,850 - 56,899 3,297 59,350 - 59,399 3,459 51,900 - 51,949 2,975 54,400 - 54,449 3,138 56,900 - 56,949 3,300 59,400 - 59,449 3,463 51,950 - 51,999 2,978 54,450 - 54,499 3,141 56,950 - 56,999 3,303 59,450 - 59,499 3,466 $52,000 - 52,049 $2,982 54,500 - 54,549 3,144 $57,000 - 57,049 $3,307 59,500 - 59,549 3,469 52,050 - 52,099 2,985 54,550 - 54,599 3,147 57,050 - 57,099 3,310 59,550 - 59,599 3,472 52,100 - 52,149 2,988 54,600 - 54,649 3,151 57,100 - 57,149 3,313 59,600 - 59,649 3,476 52,150 - 52,199 2,991 54,650 - 54,699 3,154 57,150 - 57,199 3,316 59,650 - 59,699 3,479 52,200 - 52,249 2,995 54,700 - 54,749 3,157 57,200 - 57,249 3,320 59,700 - 59,749 3,482 52,250 - 52,299 2,998 54,750 - 54,799 3,160 57,250 - 57,299 3,323 59,750 - 59,799 3,485 52,300 - 52,349 3,001 54,800 - 54,849 3,164 57,300 - 57,349 3,326 59,800 - 59,849 3,489 52,350 - 52,399 3,004 54,850 - 54,899 3,167 57,350 - 57,399 3,329 59,850 - 59,899 3,492 52,400 - 52,449 3,008 54,900 - 54,949 3,170 57,400 - 57,449 3,333 59,900 - 59,949 3,495 52,450 - 52,499 3,011 54,950 - 54,999 3,173 57,450 - 57,499 3,336 59,950 - 59,999 3,498

96

Taxable income

Amount of tax Taxable income

$60,000 - 62,499 $62,500 - 64,999

Amount of tax

Taxable income

$65,000 - 67,499

Amount of tax

$60,000 - 60,049 $3,501 60,050 - 60,099 3,505 60,100 - 60,149 3,510 60,150 - 60,199 3,514 60,200 - 60,249 3,518 60,250 - 60,299 3,522 60,300 - 60,349 3,527 60,350 - 60,399 3,531 60,400 - 60,449 3,535 60,450 - 60,499 3,539 60,500 - 60,549 3,544 60,550 - 60,599 3,548 60,600 - 60,649 3,552 60,650 - 60,699 3,556 60,700 - 60,749 3,561 60,750 - 60,799 3,565 60,800 - 60,849 3,569 60,850 - 60,899 3,573, 60,900 - 60,949 3,578 60,950 - 60,999 3,582 $61,000 - 61,049 $3,586 61,050 - 61,099 3,590 61,100 - 61,149 3,595 61,150 - 61,199 3,599 61,200 - 61,249 3,603 61,250 - 61,299 3,607 61,300 - 61,349 3,612 61,350 - 61,399 3,616 61,400 - 61,449 3,620 61,450 - 61,499 3,624 61,500 - 61,549 3,629 61,550 - 61,599 3,633 61,600 - 61,649 3,637 61,650 - 61,699 3,641 61,700 - 61,749 3,646 61,750 - 61,799 3,650 61,800 - 61,849 3,654 61,850 - 61,899 3,658 61,900 - 61,949 3,663 61,950 - 61,999 3,667 $62,000 - 62,049 $3,671 62,050 - 62,099 3,675 62,100 - 62,149 3,680 62,150 - 62,199 3,684 62,200 - 62,249 3,688 62,250 - 62,299 3,692 62,300 - 62,349 3,697 62,350 - 62,399 3,701 62,400 - 62,449 3,705 62,450 - 62,499 3,709

$62,500 - 62,549 $3,714 62,550 - 62,599 3,718 62,600 - 62,649 3,722 62,650 - 62,699 3,726 62,700 - 62,749 3,731 62,750 - 62,799 3,735 62,800 - 62,849 3,739 62,850 - 62,899 3,743 62,900 - 62,949 3,748 62,950 - 62,999 3,752 $63,000 - 63,049 $3,756 63,050 - 63,099 3,760 63,100 - 63,149 3,765 63,150 - 63,199 3,769 63,200 - 63,249 3,773 63,250 - 63,299 3,777 63,300 - 63,349 3,782 63,350 - 63,399 3,786 63,400 - 63,449 3,790 63,450 - 63,499 3,794 63,500 - 63,549 3,799 63,550 - 63,599 3,803 63,600 - 63,649 3,807 63,650 - 63,699 3,811 63,700 - 63,749 3,816 63,750 - 63,799 3,820 63,800 - 63,849 3,824 63,850 - 63,899 3,828 63,900 - 63,949 3,833 63,950 - 63,999 3,837 $64,000 - 64,049 $3,841 64,050 - 64,099 3,845 64,100 - 64,149 3,850 64,150 - 64,199 3,854 64,200 - 64,249 3,858 64,250 - 64,299 3,862 64,300 - 64,349 3,867 64,350 - 64,399 3,871 64,400 - 64,449 3,875 64,450 - 64,499 3,879 64,500 - 64,549 3,884 64,550 - 64,599 3,888 64,600 - 64,649 3,892 64,650 - 64,699 3,896 64,700 - 64,749 3,901 64,750 - 64,799 3,905 64,800 - 64,849 3,909 64,850 - 64,899 3,913 64,900 - 64,949 3,918 64,950 - 64,999 3,922

$65,000 - 65,049 $3,926 65,050 - 65,099 3,930 65,100 - 65,149 3,935 65,150 - 65,199 3,939 65,200 - 65,249 3,943 65,250 - 65,299 3,947 65,300 - 65,349 3,952 65,350 - 65,399 3,956 65,400 - 65,449 3,960 65,450 - 65,499 3,964 65,500 - 65,549 3,969 65,550 - 65,599 3,973 65,600 - 65,649 3,977 65,650 - 65,699 3,981 65,700 - 65,749 3,986 65,750 - 65,799 3,990 65,800 - 65,849 3,994 65,850 - 65,899 3,998 65,900 - 65,949 4,003 65,950 - 65,999 4,007 $66,000 - 66,049 $4,011 66,050 - 66,099 4,015 66,100 - 66,149 4,020 66,150 - 66,199 4,024 66,200 - 66,249 4,028 66,250 - 66,299 4,032 66,300 - 66,349 4,037 66,350 - 66,399 4,041 66,400 - 66,449 4,045 66,450 - 66,499 4,049 66,500 - 66,549 4,054 66,550 - 66,599 4,058 66,600 - 66,649 4,062 66,650 - 66,699 4,066 66,700 - 66,749 4,071 66,750 - 66,799 4,075 66,800 - 66,849 4,079 66,850 - 66,899 4,083 66,900 - 66,949 4,088 66,950 - 66,999 4,092 $67,000 - 67,049 $4,096 67,050 - 67,099 4,100 67,100 - 67,149 4,105 67,150 - 67,199 4,109 67,200 - 67,249 4,113 67,250 - 67,299 4,117 67,300 - 67,349 4,122 67,350 - 67,399 4,126 67,400 - 67,449 4,130 67,450 - 67,499 4,134

Taxable income

Amount of tax

$67,500 - 69,999

$67,500 - 67,549 $4,139 67,550 - 67,599 4,143 67,600 - 67,649 4,147 67,650 - 67,699 4,151 67,700 - 67,749 4,156 67,750 - 67,799 4,160 67,800 - 67,849 4,164 67,850 - 67,899 4,168 67,900 - 67,949 4,173 67,950 - 67,999 4,177 $68,000 - 68,049 $4,181 68,050 - 68,099 4,185 68,100 - 68,149 4,190 68,150 - 68,199 4,194 68,200 - 68,249 4,198 68,250 - 68,299 4,202 68,300 - 68,349 4,207 68,350 - 68,399 4,211 68,400 - 68,449 4,215 68,450 - 68,499 4,219 68,500 - 68,549 4,224 68,550 - 68,599 4,228 68,600 - 68,649 4,232 68,650 - 68,699 4,236 68,700 - 68,749 4,241 68,750 - 68,799 4,245 68,800 - 68,849 4,249 68,850 - 68,899 4,253 68,900 - 68,949 4,258 68,950 - 68,999 4,262 $69,000 - 69,049 $4,266 69,050 - 69,099 4,270 69,100 - 69,149 4,275 69,150 - 69,199 4,279 69,200 - 69,249 4,283 69,250 - 69,299 4,287 69,300 - 69,349 4,292 69,350 - 69,399 4,296 69,400 - 69,449 4,300 69,450 - 69,499 4,304 69,500 - 69,549 4,309 69,550 - 69,599 4,313 69,600 - 69,649 4,317 69,650 - 69,699 4,321 69,700 - 69,749 4,326 69,750 - 69,799 4,330 69,800 - 69,849 4,334 69,850 - 69,899 4,338 69,900 - 69,949 4,343 69,950 - 69,999 4,347

97

Tax tables for Income of $100,000 or less continued

Taxable income

Amount of tax Taxable income

Amount of tax

Taxable income

Amount of tax Taxable income

Amount of tax

$70,000 - 70,049 $4,351 $72,500 - 72,549 $4,564 $75,000 - 75,049 $4,776 $77,500 - 77,549 $4,989 70,050 - 70,099 4,355 72,550 - 72,599 4,568 75,050 - 75,099 4,780 77,550 - 77,599 4,993 70,100 - 70,149 4,360 72,600 - 72,649 4,572 75,100 - 75,149 4,785 77,600 - 77,649 4,997 70,150 - 70,199 4,364 72,650 - 72,699 4,576 75,150 - 75,199 4,789 77,650 - 77,699 5,001 70,200 - 70,249 4,368 72,700 - 72,749 4,581 75,200 - 75,249 4,793 77,700 - 77,749 5,006 70,250 - 70,299 4,372 72,750 - 72,799 4,585 75,250 - 75,299 4,797 77,750 - 77,799 5,010 70,300 - 70,349 4,377 72,800 - 72,849 4,589 75,300 - 75,349 4,802 77,800 - 77,849 5,014 70,350 - 70,399 4,381 72,850 - 72,899 4,593 75,350 - 75,399 4,806 77,850 - 77,899 5,018 70,400 - 70,449 4,385 72,900 - 72,949 4,598 75,400 - 75,449 4,810 77,900 - 77,949 5,023 70,450 - 70,499 4,389 72,950 - 72,999 4,602 75,450 - 75,499 4,814 77,950 - 77,999 5,027 70,500 - 70,549 4,394 $73,000 - 73,049 $4,606 75,500 - 75,549 4,819 $78,000 - 78,049 $5,031 70,550 - 70,599 4,398 73,050 - 73,099 4,610 75,550 - 75,599 4,823 78,050 - 78,099 5,035 70,600 - 70,649 4,402 73,100 - 73,149 4,615 75,600 - 75,649 4,827 78,100 - 78,149 5,040 70,650 - 70,699 4,406 73,150 - 73,199 4,619 75,650 - 75,699 4,831 78,150 - 78,199 5,044 70,700 - 70,749 4,411 73,200 - 73,249 4,623 75,700 - 75,749 4,836 78,200 - 78,249 5,048 70,750 - 70,799 4,415 73,250 - 73,299 4,627 75,750 - 75,799 4,840 78,250 - 78,299 5,052 70,800 - 70,849 4,419 73,300 - 73,349 4,632 75,800 - 75,849 4,844 78,300 - 78,349 5,057 70,850 - 70,899 4,423 73,350 - 73,399 4,636 75,850 - 75,899 4,848 78,350 - 78,399 5,061 70,900 - 70,949 4,428 73,400 - 73,449 4,640 75,900 - 75,949 4,853 78,400 - 78,449 5,065 70,950 - 70,999 4,432 73,450 - 73,499 4,644 75,950 - 75,999 4,857 78,450 - 78,499 5,069 $71,000 - 71,049 $4,436 73,500 - 73,549 4,649 $76,000 - 76,049 $4,861 78,500 - 78,549 5,074 71,050 - 71,099 4,440 73,550 - 73,599 4,653 76,050 - 76,099 4,865 78,550 - 78,599 5,078 71,100 - 71,149 4,445 73,600 - 73,649 4,657 76,100 - 76,149 4,870 78,600 - 78,649 5,082 71,150 - 71,199 4,449 73,650 - 73,699 4,661 76,150 - 76,199 4,874 78,650 - 78,699 5,086 71,200 - 71,249 4,453 73,700 - 73,749 4,666 76,200 - 76,249 4,878 78,700 - 78,749 5,091 71,250 - 71,299 4,457 73,750 - 73,799 4,670 76,250 - 76,299 4,882 78,750 - 78,799 5,095 71,300 - 71,349 4,462 73,800 - 73,849 4,674 76,300 - 76,349 4,887 78,800 - 78,849 5,099 71,350 - 71,399 4,466 73,850 - 73,899 4,678 76,350 - 76,399 4,891 78,850 - 78,899 5,103 71,400 - 71,449 4,470 73,900 - 73,949 4,683 76,400 - 76,449 4,895 78,900 - 78,949 5,108 71,450 - 71,499 4,474 73,950 - 73,999 4,687 76,450 - 76,499 4,899 78,950 - 78,999 5,112 71,500 - 71,549 4,479 $74,000 - 74,049 $4,691 76,500 - 76,549 4,904 $79,000 - 79,049 $5,116 71,550 - 71,599 4,483 74,050 - 74,099 4,695 76,550 - 76,599 4,908 79,050 - 79,099 5,120 71,600 - 71,649 4,487 74,100 - 74,149 4,700 76,600 - 76,649 4,912 79,100 - 79,149 5,125 71,650 - 71,699 4,491 74,150 - 74,199 4,704 76,650 - 76,699 4,916 79,150 - 79,199 5,129 71,700 - 71,749 4,496 74,200 - 74,249 4,708 76,700 - 76,749 4,921 79,200 - 79,249 5,133 71,750 - 71,799 4,500 74,250 - 74,299 4,712 76,750 - 76,799 4,925 79,250 - 79,299 5,137 71,800 - 71,849 4,504 74,300 - 74,349 4,717 76,800 - 76,849 4,929 79,300 - 79,349 5,142 71,850 - 71,899 4,508 74,350 - 74,399 4,721 76,850 - 76,899 4,933 79,350 - 79,399 5,146 71,900 - 71,949 4,513 74,400 - 74,449 4,725 76,900 - 76,949 4,938 79,400 - 79,449 5,150 71,950 - 71,999 4,517 74,450 - 74,499 4,729 76,950 - 76,999 4,942 79,450 - 79,499 5,154 $72,000 - 72,049 $4,521 74,500 - 74,549 4,734 $77,000 - 77,049 $4,946 79,500 - 79,549 5,159 72,050 - 72,099 4,525 74,550 - 74,599 4,738 77,050 - 77,099 4,950 79,550 - 79,599 5,163 72,100 - 72,149 4,530 74,600 - 74,649 4,742 77,100 - 77,149 4,955 79,600 - 79,649 5,167 72,150 - 72,199 4,534 74,650 - 74,699 4,746 77,150 - 77,199 4,959 79,650 - 79,699 5,171 72,200 - 72,249 4,538 74,700 - 74,749 4,751 77,200 - 77,249 4,963 79,700 - 79,749 5,176 72,250 - 72,299 4,542 74,750 - 74,799 4,755 77,250 - 77,299 4,967 79,750 - 79,799 5,180 72,300 - 72,349 4,547 74,800 - 74,849 4,759 77,300 - 77,349 4,972 79,800 - 79,849 5,184 72,350 - 72,399 4,551 74,850 - 74,899 4,763 77,350 - 77,399 4,976 79,850 - 79,899 5,188 72,400 - 72,449 4,555 74,900 - 74,949 4,768 77,400 - 77,449 4,980 79,900 - 79,949 5,193 72,450 - 72,499 4,559 74,950 - 74,999 4,772 77,450 - 77,499 4,984 79,950 - 79,999 5,197

Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax Taxable income

Amount of tax

$80,000 - 80,049 $5,201 $82,500 - 82,549 $5,414 $85,000 - 85,049 $5,626 $87,500 - 87,549 $5,839 80,050 - 80,099 5,205 82,550 - 82,599 5,418 85,050 - 85,099 5,630 87,550 - 87,599 5,843 80,100 - 80,149 5,210 82,600 - 82,649 5,422 85,100 - 85,149 5,635 87,600 - 87,649 5,847 80,150 - 80,199 5,214 82,650 - 82,699 5,426 85,150 - 85,199 5,639 87,650 - 87,699 5,851 80,200 - 80,249 5,218 82,700 - 82,749 5,431 85,200 - 85,249 5,643 87,700 - 87,749 5,856 80,250 - 80,299 5,222 82,750 - 82,799 5,435 85,250 - 85,299 5,647 87,750 - 87,799 5,860 80,300 - 80,349 5,227 82,800 - 82,849 5,439 85,300 - 85,349 5,652 87,800 - 87,849 5,864 80,350 - 80,399 5,231 82,850 - 82,899 5,443 85,350 - 85,399 5,656 87,850 - 87,899 5,868 80,400 - 80,449 5,235 82,900 - 82,949 5,448 85,400 - 85,449 5,660 87,900 - 87,949 5,873 80,450 - 80,499 5,239 82,950 - 82,999 5,452 85,450 - 85,499 5,664 87,950 - 87,999 5,877 80,500 - 80,549 5,244 $83,000 - 83,049 $5,456 85,500 - 85,549 5,669 $88,000 - 88,049 $5,881 80,550 - 80,599 5,248 83,050 - 83,099 5,460 85,550 - 85,599 5,673 88,050 - 88,099 5,885 80,600 - 80,649 5,252 83,100 - 83,149 5,465 85,600 - 85,649 5,677 88,100 - 88,149 5,890 80,650 - 80,699 5,256 83,150 - 83,199 5,469 85,650 - 85,699 5,681 88,150 - 88,199 5,894 80,700 - 80,749 5,261 83,200 - 83,249 5,473 85,700 - 85,749 5,686 88,200 - 88,249 5,898 80,750 - 80,799 5,265 83,250 - 83,299 5,477 85,750 - 85,799 5,690 88,250 - 88,299 5,902 80,800 - 80,849 5,269 83,300 - 83,349 5,482 85,800 - 85,849 5,694 88,300 - 88,349 5,907 80,850 - 80,899 5,273, 83,350 - 83,399 5,486 85,850 - 85,899 5,698 88,350 - 88,399 5,911 80,900 - 80,949 5,278 83,400 - 83,449 5,490 85,900 - 85,949 5,703 88,400 - 88,449 5,915 80,950 - 80,999 5,282 83,450 - 83,499 5,494 85,950 - 85,999 5,707 88,450 - 88,499 5,919 $81,000 - 81,049 $5,286 83,500 - 83,549 5,499 86,000 - 86,049 $5,711 88,500 - 88,549 5,924 81,050 - 81,099 5,290 83,550 - 83,599 5,503 86,050 - 86,099 5,715 88,550 - 88,599 5,928 81,100 - 81,149 5,295 83,600 - 83,649 5,507 86,100 - 86,149 5,720 88,600 - 88,649 5,932 81,150 - 81,199 5,299 83,650 - 83,699 5,511 86,150 - 86,199 5,724 88,650 - 88,699 5,936 81,200 - 81,249 5,303 83,700 - 83,749 5,516 86,200 - 86,249 5,728 88,700 - 88,749 5,941 81,250 - 81,299 5,307 83,750 - 83,799 5,520 86,250 - 86,299 5,732 88,750 - 88,799 5,945 81,300 - 81,349 5,312 83,800 - 83,849 5,524 86,300 - 86,349 5,737 88,800 - 88,849 5,949 81,350 - 81,399 5,316 83,850 - 83,899 5,528 86,350 - 86,399 5,741 88,850 - 88,899 5,953 81,400 - 81,449 5,320 83,900 - 83,949 5,533 86,400 - 86,449 5,745 88,900 - 88,949 5,958 81,450 - 81,499 5,324 83,950 - 83,999 5,537 86,450 - 86,499 5,749 88,950 - 88,999 5,962 81,500 - 81,549 5,329 $84,000 - 84,049 $5,541 86,500 - 86,549 5,754 $89,000 - 89,049 $5,966 81,550 - 81,599 5,333 84,050 - 84,099 5,545 86,550 - 86,599 5,758 89,050 - 89,099 5,970 81,600 - 81,649 5,337 84,100 - 84,149 5,550 86,600 - 86,649 5,762 89,100 - 89,149 5,975 81,650 - 81,699 5,341 84,150 - 84,199 5,554 86,650 - 86,699 5,766 89,150 - 89,199 5,979 81,700 - 81,749 5,346 84,200 - 84,249 5,558 86,700 - 86,749 5,771 89,200 - 89,249 5,983 81,750 - 81,799 5,350 84,250 - 84,299 5,562 86,750 - 86,799 5,775 89,250 - 89,299 5,987 81,800 - 81,849 5,354 84,300 - 84,349 5,567 86,800 - 86,849 5,779 89,300 - 89,349 5,992 81,850 - 81,899 5,358 84,350 - 84,399 5,571 86,850 - 86,899 5,783 89,350 - 89,399 5,996 81,900 - 81,949 5,363 84,400 - 84,449 5,575 86,900 - 86,949 5,788 89,400 - 89,449 6,000 81,950 - 81,999 5,367 84,450 - 84,499 5,579 86,950 - 86,999 5,792 89,450 - 89,499 6,004 $82,000 - 82,049 $5,371 84,500 - 84,549 5,584 $87,000 - 87,049 $5,796 89,500 - 89,549 6,009 82,050 - 82,099 5,375 84,550 - 84,599 5,588 87,050 - 87,099 5,800 89,550 - 89,599 6,013 82,100 - 82,149 5,380 84,600 - 84,649 5,592 87,100 - 87,149 5,805 89,600 - 89,649 6,017 82,150 - 82,199 5,384 84,650 - 84,699 5,596 87,150 - 87,199 5,809 89,650 - 89,699 6,021 82,200 - 82,249 5,388 84,700 - 84,749 5,601 87,200 - 87,249 5,813 89,700 - 89,749 6,026 82,250 - 82,299 5,392 84,750 - 84,799 5,605 87,250 - 87,299 5,817 89,750 - 89,799 6,030 82,300 - 82,349 5,397 84,800 - 84,849 5,609 87,300 - 87,349 5,822 89,800 - 89,849 6,034 82,350 - 82,399 5,401 84,850 - 84,899 5,613 87,350 - 87,399 5,826 89,850 - 89,899 6,038 82,400 - 82,449 5,405 84,900 - 84,949 5,618 87,400 - 87,449 5,830 89,900 - 89,949 6,043 82,450 - 82,499 5,409 84,950 - 84,999 5,622 87,450 - 87,499 5,834 89,950 - 89,999 6,047

Tax tables for Income of $100,000 or less continued

Taxable income Amount of tax Taxable income ‘Amount of tax Taxable income Amount of tax Taxable income Amount of tax $90,000 - 92,499 $92,500 - 94,999 $95,000 - 97,499 $97,500 - $99,999

$90,000 - 90,049 6,051 $92,500 - 92,549 $6,264 $95,000 - 95,049 $6,476 $97,500 - 97,549 $6,689 90,050 - 90,099 6,055 92,550 - 92,599 6,268 95,050 - 95,099 6,480 97,550 - 97,599 6,693 90,100 - 90,149 6,060 92,600 - 92,649 6,272 95,100 - 95,149 6,485 97,600 - 97,649 6,697 90,150 - 90,199 6,064 92,650 - 92,699 6,276 95,150 - 95,199 6,489 97,650 - 97,699 6,701 90,200 - 90,249 6,068 92,700 - 92,749 6,281 95,200 - 95,249 6,493 97,700 - 97,749 6,706 90,250 - 90,299 6,072 92,750 - 92,799 6,285 95,250 - 95,299 6,497 97,750 - 97,799 6,710 90,300 - 90,349 6,077 92,800 - 92,849 6,289 95,300 - 95,349 6,502 97,800 - 97,849 6,714 90,350 - 90,399 6,081 92,850 - 92,899 6,293 95,350 - 95,399 6,506 97,850 - 97,899 6,718 90,400 - 90,449 6,085 92,900 - 92,949 6,298 95,400 - 95,449 6,510 97,900 - 97,949 6,723 90,450 - 90,499 6,089 92,950 - 92,999 6,302 95,450 - 95,499 6,514 97,950 - 97,999 6,727 90,500 - 90,549 6,094 $93,000 - 93,049 $6,306 95,500 - 95,549 6,519 $98,000 - 98,049 $6,731 90,550 - 90,599 6,098 93,050 - 93,099 6,310 95,550 - 95,599 6,523 98,050 - 98,099 6,735 90,600 - 90,649 6,102 93,100 - 93,149 6,315 95,600 - 95,649 6,527 98,100 - 98,149 6,740 90,650 - 90,699 6,106 93,150 - 93,199 6,319 95,650 - 95,699 6,531 98,150 - 98,199 6,744 90,700 - 90,749 6,111 93,200 - 93,249 6,323 95,700 - 95,749 6,536 98,200 - 98,249 6,748 90,750 - 90,799 6,115 93,250 - 93,299 6,327 95,750 - 95,799 6,540 98,250 - 98,299 6,752 90,800 - 90,849 6,119 93,300 - 93,349 6,332 95,800 - 95,849 6,544 98,300 - 98,349 6,757 90,850 - 90,899 6,123 93,350 - 93,399 6,336 95,850 - 95,899 6,548 98,350 - 98,399 6,761 90,900 - 90,949 6,128 93,400 - 93,449 6,340 95,900 - 95,949 6,553 98,400 - 98,449 6,765 90,950 - 90,999 6,132 93,450 - 93,499 6,344 95,950 - 95,999 $6,557 98,450 - 98,499 6,769 $91,000 - 91,049 $6,136 93,500 - 93,549 6,349 $96,000 - 96,049 $6,561 98,500 - 98,549 6,774 91,050 - 91,099 6,140 93,550 - 93,599 6,353 96,050 - 96,099 6,565 98,550 - 98,599 6,778 91,100 - 91,149 6,145 93,600 - 93,649 6,357 96,100 - 96,149 6,570 98,600 - 98,649 6,782 91,150 - 91,199 6,149 93,650 - 93,699 6,361 96,150 - 96,199 6,574 98,650 - 98,699 6,786 91,200 - 91,249 6,153 93,700 - 93,749 6,366 96,200 - 96,249 6,578 98,700 - 98,749 6,791 91,250 - 91,299 6,157 93,750 - 93,799 6,370 96,250 - 96,299 6,582 98,750 - 98,799 6,795 91,300 - 91,349 6,162 93,800 - 93,849 6,374 96,300 - 96,349 6,587 98,800 - 98,849 6,799 91,350 - 91,399 6,166 93,850 - 93,899 6,378 96,350 - 96,399 6,591 98,850 - 98,899 6,803 91,400 - 91,449 6,170 93,900 - 93,949 6,383 96,400 - 96,449 6,595 98,900 - 98,949 6,808 91,450 - 91,499 6,174 93,950 - 93,999 6,387 96,450 - 96,499 6,599 98,950 - 98,999 6,812 91,500 - 91,549 6,179 $94,000 - 94,049 $6,391 96,500 - 96,549 6,604 $99,000 - 99,049 $6,816 91,550 - 91,599 6,183 94,050 - 94,099 6,395 96,550 - 96,599 6,608 99,050 - 99,099 6,820 91,600 - 91,649 6,187 94,100 - 94,149 6,400 96,600 - 96,649 6,612 99,100 - 99,149 6,825 91,650 - 91,699 6,191 94,150 - 94,199 6,404 96,650 - 96,699 6,616 99,150 - 99,199 6,829 91,700 - 91,749 6,196 94,200 - 94,249 6,408 96,700 - 96,749 6,621 99,200 - 99,249 6,833 91,750 - 91,799 6,200 94,250 - 94,299 6,412 96,750 - 96,799 6,625 99,250 - 99,299 6,837 91,800 - 91,849 6,204 94,300 - 94,349 6,417 96,800 - 96,849 6,629 99,300 - 99,349 6,842 91,850 - 91,899 6,208 94,350 - 94,399 6,421 96,850 - 96,899 6,633 99,350 - 99,399 6,846 91,900 - 91,949 6,213 94,400 - 94,449 6,425 96,900 - 96,949 6,638 99,400 - 99,449 6,850 91,950 - 91,999 6,217 94,450 - 94,499 6,429 96,950 - 96,999 6,642 99,450 - 99,499 6,854 $92,000 - 92,049 $6,221 94,500 - 94,549 6,434 $97,000 - 97,049 $6,646 99,500 - 99,549 6,859 92,050 - 92,099 6,225 94,550 - 94,599 6,438 97,050 - 97,099 6,650 99,550 - 99,599 6,863 92,100 - 92,149 6,230 94,600 - 94,649 6,442 97,100 - 97,149 6,655 99,600 - 99,649 6,867 92,150 - 92,199 6,234 94,650 - 94,699 6,446 97,150 - 97,199 6,659 99,650 - 99,699 6,871 92,200 - 92,249 6,238 94,700 - 94,749 6,451 97,200 - 97,249 6,663 99,700 - 99,749 6,876 92,250 - 92,299 6,242 94,750 - 94,799 6,455 97,250 - 97,299 6,667 99,750 - 99,799 6,880 92,300 - 92,349 6,247 94,800 - 94,849 6,459 97,300 - 97,349 6,672 99,800 - 99,849 6,884 92,350 - 92,399 6,251 94,850 - 94,899 6,463 97,350 - 97,399 6,676 99,850 - 99,899 6,888 92,400 - 92,449 6,255 94,900 - 94,949 6,468 97,400 - 97,449 6,680 99,900 - 99,949 6,893 92,450 - 92,499 6,259 94,950 - 94,999 6,472 97,450 - 97,499 6,684 99,950 - 99,999 6,897 100,000 - $ 6,901

100

aC

DC COLLEGE SAVINGS PLAN

Qualified distributions can be used for:

- Tuition, room & board, books and even computers? - Apprenticeship Programs? - Loan Repayments up to $10,000 lifetime limit?

Special tax deductions for DC residents who contribute to the Plan.

Learn more at dccollegesavings.com/tax or 1.800.987.4859.

‘Earnings on non-qualified withdrawals may be subject to federal income tax and a 10% federal penalty tax, as well as state and local income taxes and recapture of DC tax deductions. Tax and other benefits are contingent on meeting other requirements and certain withdrawals are subject to federal, state, and local taxes.

2 The apprenticeship program must be registered and certified with the Secretary of Labor under the National Apprenticeship Act.

3 Note: if you make an education loan repayment from your Account, you may not also take a federal income tax deduction for any interest included in that education loan repayment.

Before you invest, consider whether your or the beneficiary's home state offers any state tax or other state benefits such as financial aid, scholarship funds, and protection from creditors that that are only available for investments in that state's qualified tuition program.

For more information about The DC College Savings Plan (“The Plan”), call 800.987.4859, or visit dccollegesavings.com to obtain a Program Disclosure Booklet, which includes investment objectives, risks, charges, expenses, and other important information; read and consider it carefully before investing.

The Plan is administered by the District of Columbia Office of the Chief Financial Officer, Office of Finance and Treasury. Ascensus College Savings Recordkeeping Services, LLC, the Program Manager, and its affiliates, have overall responsibility for the day-to-day operations, including recordkeeping and administrative services. Ascensus Investment Advisors, LLC serves as the Investment Manager.

The Plan's Portfolios invest in: (i) exchange-traded funds, (ii) mutual funds and (iii) a funding agreement. Investments in The Plan are municipal securities that will vary with market conditions. Investments are not guaranteed or insured by the Government of the District of Columbia, the District of Columbia College Savings Program Trust, the District of Columbia Chief Financial Officer, the District of Columbia Treasurer, the Trustee for the District of Columbia College Savings Program Trust or any co-fiduciary or instrumentality thereof, the Federal Deposit Insurance Corporation or any instrumentality thereof.

INVESTMENTS ARE NOT FDIC INSURED, MAY LOSE VALUE AND ARE NOT BANK GUARANTEED.

©2020 DC College Savings Plan, Member FINRA. All Rights Reserved. 353855_ES_DC 1020

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