|   | Your first name and middle initial |   |   |   |   | Last name |   |   |   |   |   |   |   |   |   |   |   |   |   | Your social security number |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | If joint return, spouse’s first name and middle initial | Last name |   |   |   |   |   |   |   |   |   |   |   |   |   | Spouse’s social security number |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | Home address (number and street). If you have a P.O. box, see instructions. |   |   |   |   |   |   |   |   |   | Apt. no. | Presidential Election Campaign | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | Check here if you, or your | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | spouse if filing jointly, want $3 | 
|   | City, town, or post office. If you have a foreign address, also complete spaces below. |   | State |   |   |   |   | ZIP code | 
|   |   |   |   |   |   | to go to this fund. Checking a | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | box below will not change | 
|   | Foreign country name |   |   |   |   |   |   |   |   |   |   | Foreign province/state/county |   |   |   |   | Foreign postal code | your tax or refund. |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | You |   |   | Spouse | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
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|   | At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? |   |   |   |   |   |   | Yes |   |   | No | 
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|   | Standard |   | Someone can claim: |   |   |   | You as a dependent |   |   | Your spouse as a dependent |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
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|   | Deduction |   |   |   |   |   | Spouse itemizes on a separate return or you were a dual-status alien |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
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|   | Age/Blindness You: |   |   | Were born before January 2, 1957 |   |   | Are blind | Spouse: |   |   | Was born before January 2, 1957 |   |   |   |   | Is blind |   |   | 
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|   | Dependents (see instructions): |   |   |   |   |   |   |   |   |   | (2) Social security |   | (3) Relationship | (4) ✔ if qualifies for (see instructions): | 
|   | If more |   |   | (1) First name | Last name |   |   |   |   |   |   |   | number |   |   |   |   |   | to you | Child tax credit |   |   | Credit for other dependents | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | than four |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
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|   | dependents, |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | see instructions |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | and check |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | here ▶ |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
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|   | Attach |   |   | 1 |   |   |   |   | Wages, salaries, tips, etc. Attach Form(s) W-2 | . |   |   | 1 |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   | 2 | a |   |   | Tax-exempt interest . . . | 2a |   |   |   |   |   |   |   |   | b Taxable interest | . . . . |   |   | . |   |   | 2b |   |   |   |   |   |   |   |   |   |   | 
|   | Sch. B if |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   | 3 | a |   |   | Qualified dividends . . . | 3a |   |   |   |   |   |   |   |   | b Ordinary dividends . . . . | . |   |   | 3b |   |   |   |   |   |   |   |   |   |   | 
|   | required. |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   | 4a | IRA distributions . . . . | 4a |   |   |   |   |   |   |   |   | b Taxable amount | . |   |   | 4b |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   | 5a | Pensions and annuities . . | 5a |   |   |   |   |   |   |   |   | b Taxable amount | . |   |   | 5b |   |   |   |   |   |   |   |   |   |   | 
| Standard |   |   | 6a | Social security benefits . . | 6a |   |   |   |   |   |   |   |   | b Taxable amount | . |   |   | 6b |   |   |   |   |   |   |   |   |   |   | 
| Deduction for— | 7 |   |   |   |   | Capital gain or (loss). Attach Schedule D if required. If not required, check here . | . . . ▶ |   |   |   |   | 7 |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| • Single or |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
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| 8 |   |   |   |   | Other income from Schedule 1, line 10 | . |   |   | 8 |   |   |   |   |   |   |   |   |   |   |   | 
|   | Married filing |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | separately, | 9 |   |   |   |   | Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | ▶ |   | 9 |   |   |   |   |   |   |   |   |   |   |   | 
| $12,550 |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| • Married filing | 10 |   |   |   |   | Adjustments to income from Schedule 1, line 26 | . |   |   | 10 |   |   |   |   |   |   |   |   |   |   | 
|   | jointly or | 11 |   |   |   |   | Subtract line 10 from line 9. This is your adjusted gross income | . . . . . . . . . |   |   | ▶ |   | 11 |   |   |   |   |   |   |   |   |   |   | 
|   | Qualifying |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | widow(er), |   |   |   | 12 | a |   |   | Standard deduction or itemized deductions (from Schedule A) | . . | 12a |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| $25,100 |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   | b | Charitable contributions if you take the standard deduction (see instructions) | 12b |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| • Head of |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | household, |   |   |   | c | Add lines 12a and 12b | . |   |   | 12c |   |   |   |   |   |   |   |   |   | 
| $18,800 |   |   |   |   |   |   |   |   |   |   |   | 
| • If you checked | 13 |   |   |   |   | Qualified business income deduction from Form 8995 or Form 8995-A | . |   |   | 13 |   |   |   |   |   |   |   |   |   |   | 
|   | any box under | 14 |   |   |   |   | Add lines 12c and 13 | . . . . . . . . . . . . . . . . . . . . . . |   |   | . |   |   | 14 |   |   |   |   |   |   |   |   |   |   | 
|   | Standard |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | Deduction, | 15 |   |   |   |   | Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- | . |   |   | 15 |   |   |   |   |   |   |   |   |   |   | 
|   | see instructions. |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. |   |   |   |   | Cat. No. 11320B |   |   |   |   |   |   |   |   |   | Form 1040 (2021) |