I Detach Here and Mail With Your Payment I

Calendar Year '

Department of the Treasury
Internal Revenue Service Due 01/15/2021 2020 Form 1040-ES Payment Voucher 4
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the 'United States Treasury.' Write
Amount of estimated tax
your social security number and ' 2020 Form 1040-ES' on your check or money order. Do not you are paying by check
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . G 2,500.
REV 08/20/20 PRO 1555
369-04-2460 378-82-1169
JEFFREY R DIXON INTERNAL REVENUE SERVICE
JENNIFER A DIXON PO BOX 802502
85 STALWART CINCINNATI OH 45280-2502
TROY MI 48098

369042460 HZ DIXO 30 0 202012 430

Form 8879 IRS e-file Signature Authorization
OMB No. 1545-0074

Department of the Treasury

Internal Revenue Service a
a ERO must obtain and retain completed Form 8879.
Go to www.irs.gov/Form8879 for the latest information.
2019

F
Submission Identification Number (SID)
Taxpayer’s name Social security number
JEFFREY R DIXON 369-04-2460
Spouse’s name Spouse’s social security number
JENNIFER A DIXON 378-82-1169
Part I Tax Return Information — Tax Year Ending December 31, 2019 (Whole dollars only)
1 Adjusted gross income (Form 1040 or 1040-SR, line 8b; Form 1040-NR, line 35) . . . . . . . 1 74,281.
2 Total tax (Form 1040 or 1040-SR, line 16; Form 1040-NR, line 61) . . . . . . . . . . . . 2 3,251.
3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040 or 1040-SR, line 17; Form 1040-NR,
line 62a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Refund (Form 1040 or 1040-SR, line 21a; Form 1040-NR, line 73a; Form 1040-SS, Part I, line 13a) . 4
5 Amount you owe (Form 1040 or 1040-SR, line 23; Form 1040-NR, line 75) . . . . . . . . . 3,251. 5
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and
statements for the tax year ending December 31, 2019, and to the best of my knowledge and belief, they are true, correct, and complete. I further
declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider,
transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason
for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize
the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution
account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the
financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial
Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment
cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions
involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues
related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my electronic income tax return
and, if applicable, my Electronic Funds Withdrawal Consent.
Taxpayer’s PIN: check one box only
I authorize Pellegrino Klompstra & Company PC to enter or generate my PIN 4 2 4 6 0 as my
ERO firm name Enter five digits, but
don’t enter all zeros
signature on my tax year 2019 electronically filed income tax return.

I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.

Your signature a Date a

Spouse’s PIN: check one box only

I authorize Pellegrino Klompstra & Company PC to enter or generate my PIN 2 1 1 6 9 as my
ERO firm name Enter five digits, but
don’t enter all zeros
signature on my tax year 2019 electronically filed income tax return.

I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.

Spouse’s signature a Date a

Practitioner PIN Method Returns Only—continue below
Part III Certification and Authentication — Practitioner PIN Method Only

ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. 4 0 5 6 3 8 4 8 0 3 8
Don’t enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the tax year 2019 electronically filed income tax return for the taxpayer(s)
indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345,
Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.

ERO’s signature a Date a

ERO Must Retain This Form — See Instructions
Don’t Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 08/20/20 PRO Form 8879 (2019)
Form 1040-V 2019 Page 2

IF you live in . . . THEN use this address to send in your payment . . .

Alabama, Florida, Louisiana, Mississippi, North Carolina, South Internal Revenue Service
Carolina, Texas P.O. Box 1214
Charlotte, NC 28201-1214
Alaska, California, Hawaii, Washington Internal Revenue Service
P.O. Box 7704
San Francisco, CA 94120-7704
Arizona, Colorado, Idaho, Illinois, Kansas, Michigan, Minnesota, Internal Revenue Service
Montana, Nebraska, Nevada, New Mexico, North Dakota, Ohio, P.O. Box 802501
Oregon, South Dakota, Utah, Wisconsin, Wyoming Cincinnati, OH 45280-2501
Arkansas, Connecticut, District of Columbia, Georgia, Indiana, Internal Revenue Service
Iowa, Kentucky, Maryland, Missouri, New Jersey, Oklahoma, P.O. Box 931000
Rhode Island, Tennessee, Virginia, West Virginia Louisville, KY 40293-1000
Delaware, Maine, Massachusetts, New Hampshire, New York, Internal Revenue Service
Pennsylvania, Vermont P.O. Box 37008
Hartford, CT 06176-7008
A foreign country, American Samoa, or Puerto Rico (or are Internal Revenue Service
excluding income under Internal Revenue Code 933), or use an APO P.O. Box 1303
or FPO address, or file Form 2555 or 4563, or are a dual-status alien Charlotte, NC 28201-1303
or nonpermanent resident of Guam or the U.S. Virgin Islands

MAIL FORM 1040-V TO THE INTERNAL REVENUE SERVICE CENTER AT THE ADDRESS LISTED BELOW.

Form 1040-V 2019

d Detach Here and Mail With Your Payment and Return d

1040-V Payment Voucher

Form

2019
Department of the Treasury a
Internal Revenue Service (99)
Do not staple or attach this voucher to your payment or return.

3 Amount you are paying by check or Dollars Cents

money order. Make your check or
money order payable to “United
States Treasury” 3,251.
REV 08/20/20 PRO 1555
JEFFREY R DIXON
JENNIFER A INTERNAL REVENUE SERVICE
85 STALWART P.O. BOX 802501
TROY MI 48098 CINCINNATI, OH 45280-2501

369042460 HZ DIXO 30 0 201912 610

 1040 U.S. Individual Income Tax Return 2019
Form Department of the Treasury—Internal Revenue Service (99)
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying person is
one box.
a child but not your dependent. a
Your first name and middle initial Last name Your social security number
JEFFREY R DIXON 369-04-2460
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
JENNIFER A DIXON 378-82-1169
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
85 STALWART
jointly, want $3 to go to this fund.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your
TROY MI 48098 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and  here a

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

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

Age/Blindness You: Were born before January 2, 1955 Are blind Spouse: Was born before January 2, 1955 Is blind
Dependents (see instructions): (2) Social security number (3) Relationship to you (4)  if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents

JACQUELINE DIXON 382-33-9439 Daughter

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

2a Tax-exempt interest . . . . 2a b Taxable interest. Attach Sch. B if required 2b 27.
3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b
Standard
Deduction for— 4a IRA distributions . . . . . 4a b Taxable amount . . . . . . 4b
• Single or Married
filing separately,
c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d
$12,200 5a Social security benefits . . . 5a 25,374. b Taxable amount . . . . . . 5b 21,568.
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a 53,110.
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b 74,705.
household, 424.
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b 74,281.
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 24,400.
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10 9,976.
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 34,376.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 39,905.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
 Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 4,403.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 4,403.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a 2,000.
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b 2,000.
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 2,403.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 848.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 3,251.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17

• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a
attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b
nontaxable c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c
combat pay, see
instructions. d Schedule 3, line 14 . . . . . . . . . . . . . . . . . 18d
e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . a 18e
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19
20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20
Refund
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a
Direct deposit? a b Routing number X X X X X X X X X a c Type: Checking Savings
See instructions.
a d Account number X X X X X X X X X X X X X X X X X
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a 23 3,251.
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 24
Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below.
Designee No
(Other than Designee’s Phone Personal identification
paid preparer) name a no. a number (PIN) a

Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
F

Joint return? PLUMBER (see inst.)

See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)
TEACHER
Phone no. Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid 3rd Party Designee
Andrew Pellegrino Andrew Pellegrino 09/14/2020 P00279901
Preparer Phone no. (586)416-1040 Self-employed
Firm’s name a Pellegrino Klompstra & Company PC
Use Only
Firm’s address a 42536 Hayes Road, Suite 800 Clinton Township MI 48038 Firm’s EIN a 46-1626019
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 08/20/20 PRO Form 1040 (2019)
SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01
Name(s) shown on Form 1040 or 1040-SR Your social security number
JEFFREY R & JENNIFER A DIXON 369-04-2460
At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any
virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . 1
2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Date of original divorce or separation agreement (see instructions) a
3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . 3 774.
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . 4
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . 5 52,336.
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income. List type and amount a
8
9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . . . . . 9 53,110.
Part II Adjustments to Income
10 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach
Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . . 12
13 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . 13
14 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . 14 424.
15 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . 15
16 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . 16
17 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . 17
18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . . a
c Date of original divorce or separation agreement (see instructions) a
19 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . 20
21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . 21
22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or
1040-SR, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 424.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 08/20/20 PRO Schedule 1 (Form 1040 or 1040-SR) 2019
SCHEDULE 2 OMB No. 1545-0074
Additional Taxes
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 02
Name(s) shown on Form 1040 or 1040-SR Your social security number
JEFFREY R & JENNIFER A DIXON 369-04-2460
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . 2
3 Add lines 1 and 2. Enter here and include on Form 1040 or 1040-SR, line 12b . . . . . . . . 3
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . 4 848.
5 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . . . . 5
6 Additional tax on IRAs, other qualified retirement plans, and other tax-favored accounts. Attach Form
5329 if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7a Household employment taxes. Attach Schedule H . . . . . . . . . . . . . . . . . 7a
b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required . . . . 7b
8 Taxes from: a Form 8959 b Form 8960
c Instructions; enter code(s) 8
9 Section 965 net tax liability installment from Form 965-A . . . . . . . 9
10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR,
line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 848.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 08/20/20 PRO Schedule 2 (Form 1040 or 1040-SR) 2019
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074

2019
(Form 1040 or 1040-SR) (Sole Proprietorship)
a Go to www.irs.gov/ScheduleC for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
JEFFREY R DIXON 369-04-2460
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
PLUMBING a 2 3 8 2 2 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
A PLUMBING PHD 2 7 1 7 7 4 7 2 1
E Business address (including suite or room no.) a 85 STALWART
City, town or post office, state, and ZIP code TROY, MI 48098
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2019? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . a

I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . a 1 6,000.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 6,000.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 6,000.
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . a 7 6,000.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . . 9 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23
instructions) . . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a
(other than on line 19) . . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . 24b
16 Interest (see instructions): 25 Utilities . . . . . . . . 25
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a
17 Legal and professional services
17 b Reserved for future use . . . 27b
28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 6,000.
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method (see instructions).
Simplified method filers only: enter the total square footage of: (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30
31 Net profit or (loss). Subtract line 30 from line 29.

}
• If a profit, enter on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or Form 1040-NR, line
13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and 31 6,000.
trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.

}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or
Form 1040-NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 32a All investment is at risk.
31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
Schedule C (Form 1040 or 1040-SR) 2019 Page 2
Part III Cost of Goods Sold (see instructions)

33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35

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

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

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

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

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
file Form 4562.

43 When did you place your vehicle in service for business purposes? (month, day, year) a

44 Of the total number of miles you drove your vehicle during 2019, enter the number of miles you used your vehicle for:

a Business b Commuting (see instructions) c Other

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No

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

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26 or line 30.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48

REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074

2019
(Form 1040 or 1040-SR) (Sole Proprietorship)
a Go to www.irs.gov/ScheduleC for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
JENNIFER A DIXON 378-82-1169
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
HAIR STYLIST a 8 1 2 1 1 2
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
JENNIFER DIXON
E Business address (including suite or room no.) a 85 STALWART
City, town or post office, state, and ZIP code TROY, MI 48098
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2019? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . a

I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . a 1
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . a 7
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . . 9 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23
instructions) . . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a
(other than on line 19) . . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . 24b
16 Interest (see instructions): 25 Utilities . . . . . . . . 25
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a 5,226.
17 Legal and professional services
17 b Reserved for future use . . . 27b
28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28 5,226.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 -5,226.
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method (see instructions).
Simplified method filers only: enter the total square footage of: (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30
31 Net profit or (loss). Subtract line 30 from line 29.

}
• If a profit, enter on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or Form 1040-NR, line
13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and 31 -5,226.
trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.

}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or
Form 1040-NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 32a All investment is at risk.
31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
Schedule C (Form 1040 or 1040-SR) 2019 Page 2
Part III Cost of Goods Sold (see instructions)

33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35

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

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

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

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

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
file Form 4562.

43 When did you place your vehicle in service for business purposes? (month, day, year) a

44 Of the total number of miles you drove your vehicle during 2019, enter the number of miles you used your vehicle for:

a Business b Commuting (see instructions) c Other

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No

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

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26 or line 30.

FRANCHISE FEE 5,226.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48 5,226.

REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
Schedule E (Form 1040 or 1040-SR) 2019 Attachment Sequence No. 13 Page 2
Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number
JEFFREY R & JENNIFER A DIXON 369-04-2460
Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
Part II Income or Loss From Partnerships and S Corporations — Note: If you report a loss, receive a distribution, dispose of
stock, or receive a loan repayment from an S corporation, you must check the box in column (e) on line 28 and attach the required basis
computation. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (f) on
line 28 and attach Form 6198 (see instructions).

27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a
passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? If you answered “Yes,”
see instructions before completing this section . . . . . . . . . . . . . . . . . . . Yes No
(b) Enter P for (c) Check if (d) Employer (e) Check if (f) Check if
28 (a) Name partnership; S foreign identification basis computation any amount is
for S corporation partnership number is required not at risk
A A. PLUMBING PHD, INC S 27-1774721
B
C
D
Passive Income and Loss Nonpassive Income and Loss
(g) Passive loss allowed (h) Passive income (i) Nonpassive loss allowed (j) Section 179 expense (k) Nonpassive income
(attach Form 8582 if required) from Schedule K-1 (see Schedule K-1) deduction from Form 4562 from Schedule K-1

A 52,336.
B
C
D
29a Totals 52,336.
b Totals
30 Add columns (h) and (k) of line 29a. . . . . . . . . . . . . . . . . . . . . 30 52,336.
31 Add columns (g), (i), and (j) of line 29b. . . . . . . . . . . . . . . . . . . . 31 ( )
32 Total partnership and S corporation income or (loss). Combine lines 30 and 31 . . . . 32 52,336.
Part III Income or Loss From Estates and Trusts
(b) Employer
33 (a) Name
identification number

A
B
Passive Income and Loss Nonpassive Income and Loss
(c) Passive deduction or loss allowed (d) Passive income (e) Deduction or loss (f) Other income from
(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 Schedule K-1

A
B
34a Totals
b Totals
35 Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . 35
36 Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . 36 ( )
37 Total estate and trust income or (loss). Combine lines 35 and 36 . . . . . . . . . . 37
Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder
(b) Employer identification (c) Excess inclusion from (d) Taxable income (net loss) (e) Income from
38 (a) Name number Schedules Q, line 2c from Schedules Q, line 1b Schedules Q, line 3b
(see instructions)

39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below 39
Part V Summary
40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below . . . . . . 40
41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Schedule 1 (Form 1040 or 1040-SR), line 5, or Form 1040-NR, line 18 a 41 52,336.
42 Reconciliation of farming and fishing income. Enter your gross
farming and fishing income reported on Form 4835, line 7; Schedule K-1
(Form 1065), box 14, code B; Schedule K-1 (Form 1120-S), box 17, code
AC; and Schedule K-1 (Form 1041), box 14, code F (see instructions) . 42
43 Reconciliation for real estate professionals. If you were a real estate professional
(see instructions), enter the net income or (loss) you reported anywhere on Form
1040, Form 1040-SR, or Form 1040-NR from all rental real estate activities in which
you materially participated under the passive activity loss rules . . . . . . 43
REV 08/20/20 PRO Schedule E (Form 1040 or 1040-SR) 2019
SCHEDULE SE OMB No. 1545-0074
(Form 1040 or 1040-SR) Self-Employment Tax
2019
a Go to www.irs.gov/ScheduleSE for instructions and the latest information. Attachment
Department of the Treasury
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, or 1040-NR. Sequence No. 17

Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR) Social security number of person
JEFFREY R DIXON with self-employment income a 369-04-2460
Before you begin: To determine if you must file Schedule SE, see the instructions.

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Note: Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.

Did you receive wages or tips in 2019?

No Yes
d d d
Are you a minister, member of a religious order, or Christian
Yes Was the total of your wages and tips subject to social security Yes
Science practitioner who received IRS approval not to be taxed a or railroad retirement (tier 1) tax plus your net earnings from a
on earnings from these sources, but you owe self-employment
self-employment more than $132,900?
tax on other earnings?

No
No
d d

Are you using one of the optional methods to figure your net Did you receive tips subject to social security or Medicare tax Yes
Yes a
earnings (see instructions)? a that you didn't report to your employer?

No
No d
d
No Did you report any wages on Form 8919, Uncollected Social Yes
Did you receive church employee income (see instructions) Yes ` Security and Medicare Tax on Wages? a
reported on Form W-2 of $108.28 or more? a

No
d d
You may use Short Schedule SE below a You must use Long Schedule SE on page 2

Section A—Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE.

1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
b If you received social security retirement or disability benefits, enter the amount of Conservation
Reserve Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065),
box 20, code AH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b ( )
2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other
than farming). Ministers and members of religious orders, see instructions for types of income to
report on this line. See instructions for other income to report . . . . . . . . . . . . . 2 6,000.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . 3 6,000.
4 Multiply line 3 by 92.35% (0.9235). If less than $400, you don't owe self-employment tax; don't file
this schedule unless you have an amount on line 1b . . . . . . . . . . . . . . . . a 4 5,541.
Note: If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see
instructions.
5 Self-employment tax. If the amount on line 4 is:
• $132,900 or less, multiply line 4 by 15.3% (0.153). Enter the result here and on Schedule 2 (Form
1040 or 1040-SR), line 4, or Form 1040-NR, line 55.
• More than $132,900, multiply line 4 by 2.9% (0.029). Then, add $16,479.60 to the result.
Enter the total here and on Schedule 2 (Form 1040 or 1040-SR), line 4, or Form 1040-NR, line 55 . 5 848.
6 Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (0.50). Enter the result here and on Schedule 1 (Form
1040 or 1040-SR), line 14, or Form 1040-NR, line 27 . . . . . . . . 6 424.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 08/20/20 PRO Schedule SE (Form 1040 or 1040-SR) 2019
Form 8995 Qualified Business Income Deduction OMB No. 1545-0123

Simplified Computation
a Attach
to your tax return.
2019
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form8995 for instructions and the latest information. Sequence No. 55
Name(s) shown on return Your taxpayer identification number
JEFFREY R & JENNIFER A DIXON 369-04-2460

1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)

i PLUMBING 27-1774721 52,336.

ii A PLUMBING PHD 27-1774721 5,576.

iii JENNIFER DIXON 378-82-1169 -5,226.

iv

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

column (c) . . . . . . . . . . . . . . . . . . . . . . 2 52,686.
3 Qualified business net (loss) carryforward from the prior year . . . . . . . 3 ( )
4 Total qualified business income. Combine lines 2 and 3. If zero or less, enter -0- 4 52,686.
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 10,537.
6 Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
(see instructions) . . . . . . . . . . . . . . . . . . . . 6
7 Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
year . . . . . . . . . . . . . . . . . . . . . . . . . 7 ( )
8 Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero
or less, enter -0- . . . . . . . . . . . . . . . . . . . . 8
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . 9
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . 10 10,537.
11 Taxable income before qualified business income deduction . . . . . . 11 49,881.
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . 12 0.
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . 13 49,881.
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 9,976.
15 Qualified business income deduction. Enter the lesser of line 10 or line 14. Also enter this amount on
the applicable line of your return . . . . . . . . . . . . . . . . . . . . . . a 15 9,976.
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . 16 ( 0. )
17 Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 ( 0. )
For Privacy Act and Paperwork Reduction Act Notice, see instructions. REV 08/20/20 PRO Form 8995 (2019)
 8867 Paid Preparer’s Due Diligence Checklist OMB No. 1545-0074

2019
Form Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC), Child Tax Credit (CTC) (including the Additional
Child Tax Credit (ACTC) and Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing Status
Department of the Treasury a To be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS. Attachment
Internal Revenue Service a Go to www.irs.gov/Form8867 for instructions and the latest information. Sequence No. 70
Taxpayer name(s) shown on return Taxpayer identification number
JEFFREY R & JENNIFER A DIXON 369-04-2460
Enter preparer’s name and PTIN
Andrew Pellegrino P00279901
Part I Due Diligence Requirements
Please check the appropriate box for the credit(s) and/or HOH filing status claimed on the return and complete the related Parts I–V
for the benefit(s) claimed (check all that apply). EIC CTC/ACTC/ODC AOTC HOH
1 Did you complete the return based on information for tax year 2019 provided by the taxpayer or Yes No N/A
reasonably obtained by you? . . . . . . . . . . . . . . . . . . . . . . . .
2 If credits are claimed on the return, did you complete the applicable EIC and/or CTC/ACTC/ODC
worksheets found in the Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS instructions, and/or the
AOTC worksheet found in the Form 8863 instructions, or your own worksheet(s) that provides the same
information, and all related forms and schedules for each credit claimed? . . . . . . . . .
3 Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both of
the following.
• Interview the taxpayer, ask questions, and contemporaneously document the taxpayer’s responses to
determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing status.
• Review information to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to compute the amount(s) of any credit(s) . . . . . . . . . . . . . . . .
4 Did any information provided by the taxpayer or a third party for use in preparing the return, or
information reasonably known to you, appear to be incorrect, incomplete, or inconsistent? (If “Yes,”
answer questions 4a and 4b. If “No,” go to question 5.) . . . . . . . . . . . . . . .
a Did you make reasonable inquiries to determine the correct, complete, and consistent information? .
b Did you contemporaneously document your inquiries? (Documentation should include the questions
you asked, whom you asked, when you asked, the information that was provided, and the impact the
information had on your preparation of the return.) . . . . . . . . . . . . . . . . .
5 Did you satisfy the record retention requirement? To meet the record retention requirement, you must
keep a copy of your documentation referenced in 4b, a copy of this Form 8867, a copy of any
applicable worksheet(s), a record of how, when, and from whom the information used to prepare Form
8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by the
taxpayer that you relied on to determine eligibility for the credit(s) and/or HOH filing status or to
compute the amount(s) of the credit(s) . . . . . . . . . . . . . . . . . . . . .
List those documents, if any, that you relied on.

6 Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for the
credit(s) and/or HOH filing status and the amount(s) of any credit(s) claimed on the return if his/her
return is selected for audit? . . . . . . . . . . . . . . . . . . . . . . . . .
7 Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year? . .
(If credits were disallowed or reduced, go to question 7a; if not, go to question 8.)
a Did you complete the required recertification Form 8862? . . . . . . . . . . . . . . .
8 If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and
correct Schedule C (Form 1040 or 1040-SR)? . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see separate instructions. REV 08/20/20 PRO Form 8867 (2019)
Form 8867 (2019) Page 2
Part II Due Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.)
9a Have you determined that the taxpayer is, in fact, eligible to claim the EIC for the number of qualifying Yes No N/A
children claimed, or is eligible to claim the EIC without a qualifying child? (Skip 9b and 9c if the taxpayer
is claiming the EIC and does not have a qualifying child.) . . . . . . . . . . . . . . .
b Did you ask the taxpayer if the child lived with the taxpayer for over half of the year, even if the taxpayer
has supported the child the entire year? . . . . . . . . . . . . . . . . . . . . .
c Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child of
more than one person (tiebreaker rules)? . . . . . . . . . . . . . . . . . . . .
Part III Due Diligence Questions for Returns Claiming CTC/ACTC/ODC (If the return does not claim CTC, ACTC, or ODC, go
to Part IV.)
10 Have you determined that each qualifying person for the CTC/ACTC/ODC is the taxpayer’s dependent who is Yes No N/A
a citizen, national, or resident of the United States? . . . . . . . . . . . . . . . . . .
11 Did you explain to the taxpayer that he/she may not claim the CTC/ACTC if the taxpayer has not lived
with the child for over half of the year, even if the taxpayer has supported the child, unless the child’s
custodial parent has released a claim to exemption for the child? . . . . . . . . . . . .
12 Did you explain to the taxpayer the rules about claiming the CTC/ACTC/ODC for a child of divorced or
separated parents (or parents who live apart), including any requirement to attach a Form 8332 or similar
statement to the return? . . . . . . . . . . . . . . . . . . . . . . . . . .
Part IV Due Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.)
13 Did the taxpayer provide substantiation for the credit, such as a Form 1098-T and/or receipts for the qualified Yes No
tuition and related expenses for the claimed AOTC? . . . . . . . . . . . . . . . . . . . .
Part V Due Diligence Questions for Claiming HOH (If the return does not claim HOH filing status, go to Part VI.)
14 Have you determined that the taxpayer was unmarried or considered unmarried on the last day of the tax year Yes No
and provided more than half of the cost of keeping up a home for the year for a qualifying person? . . . .
Part VI Eligibility Certification
a You will have complied with all due diligence requirements for claiming the applicable credit(s) and/or HOH filing
status on the return of the taxpayer identified above if you:
A. Interview the taxpayer, ask adequate questions, contemporaneously document the taxpayer’s responses on the return or
in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to compute the amount(s) of the credit(s);
B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for any applicable
credit(s) claimed and HOH filing status, if claimed;
C. Submit Form 8867 in the manner required; and
D. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions under
Document Retention.
1. A copy of this Form 8867.
2. The applicable worksheet(s) or your own worksheet(s) for any credit(s) claimed.
3. Copies of any documents provided by the taxpayer on which you relied to determine the taxpayer’s eligibility for the
credit(s) and/or HOH filing status and to compute the amount(s) of the credit(s).
4. A record of how, when, and from whom the information used to prepare this form and the applicable worksheet(s) was
obtained.
5. A record of any additional information you relied upon, including questions you asked and the taxpayer’s responses, to
determine the taxpayer’s eligibility for the credit(s) and/or HOH filing status and to compute the amount(s) of the credit(s).
a Ifyou have not complied with all due diligence requirements, you may have to pay a $530 penalty for each failure to
comply related to a claim of an applicable credit or HOH filing status.
15 Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and Yes No
complete? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
REV 08/20/20 PRO Form 8867 (2019)
Michigan Department of Treasury (Rev. 08-19)
Issued under authority of Public Act 281 of 1967, as amended.

2020 MI-1040ES, Michigan Estimated Income Tax for Individuals

Important Information Payment Due Dates
If you are married and plan to file your annual return as “married You may pay in full with the first estimate voucher due
filing separately,” DO NOT use preprinted vouchers containing April 15, 2020 . You may also pay in equal installments due
the Social Security numbers (SSN) or correspondence on or before April 15, 2020 , June 15, 2020 , September 15,
identification numbers (CID) for both you and your spouse; 2020, and January 15, 2021.
separate vouchers and payments must be submitted for each filer. NOTE: You will not receive reminder notices; save this
set of forms for all of your 2020 payments.
Failure to provide a complete Social Security number on
Form MI-1040ES will result in processing delays. How to Pay Estimated Tax
Who Must File Estimated Tax Payments e-Payments
You may choose to make your estimated income tax
You must make estimated income tax payments if you payments electronically instead of mailing a payment with
expect to owe more than $500 when you file your 2020 the personalized form provided. Paying electronically
MI-1040 return. If you owe more than $500, you may not is easy, fast and secure. Payment options include direct
have to make estimated payments if you expect your 2020 debit (eCheck) from your checking or savings account, or
withholding to be at least: payment by credit or debit card. If you choose to make
• 90 percent of your total 2020 tax (qualified farmers, your payment electronically, you do not need to mail the
fishermen and seafarers use 66 2/3 percent), MI-1040ES form to Treasury. Visit www.michigan.gov/iit
• 100 percent of your 2019 tax, or for more information.
Mail Your Payment
• 1 10 percent of your total 2019 tax if your 2019 adjusted
If you choose to mail your payment, make your check
gross income is more than $150,000 ($75,000 for married payable to “State of Michigan.” Print the last four digits of
filing separately). your SSN and “2020 MI-1040ES” on the check. If paying
Total 2019 tax is the amount on your 2019 MI-1040, line 21 on behalf of another filer, write the filer’s name and the
less the sum of your tax credits on lines 25, 26, 27b, and 28. last four digits of the filer’s SSN on the check. For accurate
Estimated tax payments are not needed if two-thirds of your processing of your payment, do not combine this payment
gross income is from farming, fishing or seafaring and you with any other payments. Send your check with the
meet the qualifications. Estimate filing requirements apply MI-1040ES voucher for that installment. Do not staple your
whether or not you are a Michigan resident. check to the voucher.
Send your voucher and check to:
Do not submit this form for any quarter that you do not
have estimated tax due. Michigan Department of Treasury
P.O. Box 30774
Lansing, MI 48909
DETACH HERE AND MAIL THE RETURN WITH YOUR PAYMENT. DO NOT FOLD OR STAPLE THE RETURN.

2020 MICHIGAN Issued under authority of Public

Act 281 of 1967, as amended.
Due Date for Calendar Year Filers
MI-1040ES Estimated Individual Income Tax Voucher See instructions for filing
guidelines. 01-15-2021
Filer’s Name(s) Filer’s Full Social Security Number Spouse’s Full Social Security Number
JEFFREY R & JENNIFER A DIXON 369-04-2460 378-82-1169
Address (Street, City, State, ZIP Code)
WRITE PAYMENT
85 STALWART AMOUNT HERE $ 1700 .00
TROY MI 48098
MAIL TO: Enclose check payable to “State
Michigan Department of Treasury of Michigan.” Write last four
digits of filer’s SSN and “2020
P.O. Box 30774 MI-1040ES” on the front of your
Lansing, MI 48909 check. Do not fold or staple.

DO NOT WRITE IN THIS SPACE

1555 REV 07/17/20 PRO 68738879 01 2020 378821169 369042460 9

 Instructions for Form MI-1040-V
2019 Michigan Individual Income Tax Payment Voucher
Important Information You can also make your Individual Income Tax payment using
Mail Form MI-1040-V if making your payment after you file direct debit when supported by your e-file software provider.
your MI-1040 return. If you choose to make your payment electronically,
Do not use this voucher to make any other payments to the you do not need to mail the MI-1040-V to Treasury.
State of Michigan. Visit www.michigan.gov/iit for more information.
Do not use this voucher to make estimated income tax Mailing Instructions
payments. Estimated income tax payments should be made
using the MI-1040ES. • Make your check payable to the “State of Michigan.”
Do not use the MI-1040-V to pay tax owed on your City of Print “2019 MI-1040-V” and the last four digits of your
Detroit return. The City of Detroit tax due should be paid Social Security number on the check. If paying on behalf
using the CITY-V. of another filer, write the filer’s name and the last four
digits of the filer’s Social Security number on the check.
Failure to provide a complete Social Security number on
Form MI-1040-V will result in processing delays. • Detach Form MI-1040-V along the dotted line.
Enter on Form MI-1040-V below the tax due as shown on your • Do not attach your payment to Form MI‑1040‑V. Instead,
Individual Income Tax Return (MI-1040), line 33. place both items loose in the envelope and mail to:
Your payment and MI-1040-V are due April 15, 2020. If your Michigan Department of Treasury
payment is late, you will owe interest and penalty in addition P.O. Box 30774
to the tax due. The annual interest rate is 1 percent above Lansing, MI 48909
the current prime rate. Penalty is 5 percent of the tax due for • Do not attach a copy of your return to the MI‑1040‑V.
the first two months, then 5 percent for each month thereafter Attaching a copy of your return will delay the application
until the full payment is received, up to a maximum penalty of payment to your account.
of 25 percent. If you pay late, you may calculate and add
interest and penalty to your payment or Treasury will send • Do not write notes on the MI-1040-V or submit the voucher
you a bill for any additional amount due. Interest rates are without payment.
adjusted on July 1 and January 1. For current interest rates visit • If you mail your payment with your paper filed return, you
www. michigan.gov/taxes. do not need to mail the MI-1040-V to Treasury.
If you do not owe any tax on your MI-1040, do not file this
If you have questions, you may call 517-636-4486. Assistance
form.
is available using TTY through the Michigan Relay Service by
Electronic Payments calling 711.
You may choose to make your individual income tax payment Visit www.michigan.gov/taxes for additional information.
electronically. Paying electronically is easy, fast and secure.
Payment options include direct debit (eCheck) from your
checking or savings account, or payment by credit or debit
card.
Mail this form with payment for your MI-1040 return. Do not file with your paper return.
# Detach here and mail with your payment. Do not fold or staple the voucher.
Michigan Department of Treasury (Rev. 03-19)

2019 MICHIGAN Individual Income Tax Payment Voucher MI-1040-V

Issued under authority of Public Act 281 of 1967, as amended. See instructions for filing guidelines.

Mail Form MI-1040-V with your payment after you file your MI-1040 return.
Do not use this form to make any other payments to the State of Michigan.
REV 07/17/20 PRO

Filer’s Name(s) (First, Middle Initial, Last) and Filer’s Full Social Security Number Spouse’s Full Social Security Number
Home Address (Street, City, State, ZIP Code)
369-04-2460 378-82-1169
WRITE PAYMENT
a $
JEFFREY R DIXON
JENNIFER A DIXON AMOUNT HERE 2108 .00
85 STALWART MAIL TO: Make check payable to “State of Michigan.”
TROY MI 48098 Michigan Department of Treasury Write the last four digits of filer’s Social
P.O. Box 30774 Security number and “2019 MI‑1040‑V”
Lansing, MI 48909 on the check. Do not fold or staple.

DO NOT WRITE IN THIS SPACE

1555 68738879 02 2019 378821169 369042460 0
Michigan Department of Treasury (Rev. 05-19), Page 1 of 2 Issued under authority of Public Act 281 of 1967, as amended.

2019 MICHIGAN Individual Income Tax Return MI-1040 Amended Return

(Include Schedule AMD)
Return is due April 15, 2020. Type or print in blue or black ink.
1. Filer’s First Name M.I. Last Name 2. Filer’s Full Social Security No. (Example: 123-45-6789)
JEFFREY R DIXON
If a Joint Return, Spouse’s First Name M.I. Last Name
369 04 2460
JENNIFER A DIXON 3. Spouse’s Full Social Security No. (Example: 123-45-6789)
Home Address (Number, Street, or P.O. Box)
85 STALWART 378 82 1169
City or Town State ZIP Code 4. School District Code (5 digits – see page 60)
TROY MI 48098 63150
5. STATE CAMPAIGN FUND 6. FARMERS, FISHERMEN, OR SEAFARERS
Check if you (and/or your spouse, if a. Filer
¿OLQJDMRLQWUHWXUQZDQWRI\RXUWD[HV Check this box if 2/3 of your income is from farming,
to go to this fund. This will not increase b. ¿VKLQJRUVHDIDULQJ
Spouse
your tax or reduce your refund.

7. 2019 FILING STATUS. Check one. 8. 2019 RESIDENCY STATUS. Check all that apply.
a. Single * If you check box “c,” complete a. X Resident
line 3 and enter spouse’s full name * If you check box “b” or
b. X 0DUULHG¿OLQJMRLQWO\ below: b. Nonresident * “c,” you must complete
and include Schedule
NR.
c. 0DUULHG¿OLQJVHSDUDWHO\ c. Part-Year Resident *

9. EXEMPTIONS. NOTE: If someone else can claim you as a dependent, check box 9eHQWHURQOLQHDDQGHQWHURQOLQH9e (see instr.).

a. Number of exemptions (see instructions) ............................................................. 9a. 3 x 4,400 9a. 13200 00

b. Number of individuals who qualify for one of the following special exemptions: deaf,
blind, hemiplegic, paraplegic, quadriplegic, or totally and permanently disabled 9b. x  9b. 00
c. 1XPEHURITXDOL¿HGGLVDEOHGYHWHUDQV ................................................................. 9c. x  9c. 00
d. 1XPEHURI&HUWL¿FDWHVRI6WLOOELUWKIURP0'++6VHHLQVWUXFWLRQV ..................... 9d. x  9d. 00

e. Claimed as dependent, see line 9 NOTE above .................................................. 9e. 9e. 00

f. Add lines 9a, 9b, 9c, 9d and 9e. Enter here and on line 15 ............................................................................. 9f. 13200 00

10. Adjusted Gross Income from your U.S. Forms 1040 or 1040NR (see instructions) ................................ 10. 74281 00

11. Additions from Schedule 1, line 9. Include Schedule 1 ............................................................................ 11. 424 00

12. Total. Add lines 10 and 11 .......................................................................................................................... 12. 74705 00

13. Subtractions from Schedule 1, line 28. Include Schedule 1 .................................................................... 13. 21568 00

14. Income subject to tax. Subtract line 13 from line 12. If line 13 is greater than line 12, enter “0” ............ 14. 53137 00

15. Exemption allowance. Enter amount from line 9f or Schedule NR, line 19.............................................. 15. 13200 00

16. Taxable income. Subtract line 15 from line 14. If line 15 is greater than line 14, enter “0” ...................... 16. 39937 00

17. Tax. Multiply line 16 by 4.25% (0.0425) ..................................................................................................... 17. 1697 00

NON-REFUNDABLE CREDITS AMOUNT CREDIT

18. Income Tax Imposed by government units outside Michigan.

Include a copy of the return (see instructions)........................ 18a. 00 18b. 00
19. Michigan Historic Preservation Tax Credit carryforward (see
instructions) ............................................................................ 19a. 00 19b. 00
20. Income Tax. Subtract the sum of lines 18b and 19b from line 17.
If the sum of lines 18b and 19b is greater than line 17, enter “0” ............................................................... 20. 1697 00
REV 07/17/20 PRO
+ 1555 2019 05 01 27 5 Continue on page 2. This form cannot be processed if page 2 is not completed and included.
2019 MI-1040, Page 2 of 2
Filer’s Full Social Security Number 369 04 2460
21. Enter amount of Income Tax from line 20. .................................................................................................. 21. 1697 00
22. Voluntary Contributions from Form 4642, line 10. Include Form 4642...................................................... 22. 00
23. USE TAX. Use tax due on Internet, mail order or other out-of-state purchases from
Worksheet 1 (see instructions) ................................................................................................................... 23. 0 00

24. Total Tax Liability. Add lines 21, 22 and 23 ................................................................................... 24. 1697 00
REFUNDABLE CREDITS AND PAYMENTS

25. Property Tax Credit. Include MI-1040CR or MI-1040CR-2 ..................................................................... 25. 00

26. Farmland Preservation Tax Credit. Include MI-1040CR-5 ..................................................................... 26. 00

FEDERAL MICHIGAN

27. Earned Income Tax Credit. Multiply line 27a by 6% (0.06) and
enter result on line 27b. ........................................................... 27a. 00 27b. 00

28. Michigan Historic Preservation Tax Credit (refundable). Include Form 3581. ........................................... 28. 00

29. Michigan tax withheld from Schedule W, line 6. Include Schedule W (do not submit W-2s) ................. 29. 00

30. Estimated tax, extension payments and 2018 credit forward ..................................................................... 30. 00
31. 2019 AMENDED RETURNS ONLY. Taxpayers completing an original 2019 return should skip to line 32.
Amended returns must include Schedule AMD (see instructions).

If you had a refund and/or credit forward on the original return, check box 31a and enter this amount as a
31a. negative number on line 31c.

If you paid with the original return, check box 31b and enter the amount paid with the original return, plus
31b. DQ\DGGLWLRQDOWD[SDLGDIWHU¿OLQJDVDSRVLWLYHQXPEHURQOLQHF'RQRWLQFOXGHLQWHUHVWRUSHQDOW\ 31c. 00

32. Total refundable credits and payments. Add lines 25, 26, 27b, 28, 29, 30 and 31c ........................ 32. 00
REFUND OR TAX DUE
33. If line 32 is less than line 24, subtract line 32 from line 24. If applicable, see instructions.

Include interest 59 00 and penalty 352 00 ......................... YOU OWE 33. 2108 00

34. Overpayment. If line 32 is greater than line 24, subtract line 24 from line 32 ................................ 34. 00

35. Credit Forward. Amount of line 34 to be credited to your 2020 estimated tax for your 2020 tax return ... 35. 00

36. Subtract line 35 from line 34. ...................................................................................... REFUND 36. 00

DIRECT DEPOSIT a. Routing Transit Number b. Account Number c. Type of Account
'HSRVLW\RXUUHIXQGGLUHFWO\WR\RXU¿QDQFLDO 1. Checking 2. Savings
LQVWLWXWLRQ6HHLQVWUXFWLRQVDQGFRPSOHWHDE
DQGF
Deceased Taxpayer. If Filer and/or Spouse died after December 31, 2018, enter dates below. 3UHSDUHU&HUWL¿FDWLRQ ,GHFODUHXQGHUSHQDOW\RISHUMXU\WKDW
ENTER DATE OF DEATH ONLY. Example: 04-15-2019 (MM-DD-YYYY) WKLVUHWXUQLVEDVHGRQDOOLQIRUPDWLRQRIZKLFK,KDYHDQ\NQRZOHGJH
Preparer’s PTIN, FEIN or SSN
Filer Spouse
P00279901
Preparer’s Name (print or type)
7D[SD\HU&HUWL¿FDWLRQ ,GHFODUHXQGHUSHQDOW\RISHUMXU\WKDWWKHLQIRUPDWLRQLQWKLVUHWXUQ
DQGDWWDFKPHQWVLVWUXHDQGFRPSOHWHWRWKHEHVWRIP\NQRZOHGJH ANDREW PELLEGRINO
Filer’s Signature Date Preparer’s Business Name, Address and Telephone Number
PELLEGRINO KLOMPSTRA & COMPAN
Spouse’s Signature Date

42536 HAYES ROAD SUITE 800

CLINTON TOWNSHIP MI 48038
X By checking this box, I authorize Treasury to discuss my return with my preparer. 586-416-1040

Refund, credit, or zero returns. Mail your return to: Michigan Department of Treasury, Lansing, MI 48956
Pay amount on line 33 (see instructions). Mail your check and return to: Michigan Department of Treasury, Lansing, MI 48929

+ 1555
REV 07/17/20 PRO
2019 05 02 27 3
Michigan Department of Treasury
3423 (Rev. 05-19), Page 1 of 2

2019 MICHIGAN Schedule 1 Additions and Subtractions

Issued under authority of Public Act 281 of 1967, as amended.

Attachment 01
Include with Form MI-1040. Type or print in blue or black ink.
Filer’s First Name M.I. Last Name Filer’s Full Social Security No. (Example: 123-45-6789)

JEFFREY R DIXON 369 04 2460

Additions to Income (all entries must be positive numbers)

1. Gross interest and dividends from obligations issued by states

(other than Michigan) or their political subdivisions...................................................................... 1. 00
2. Deduction for taxes on, or measured by, income including self-employment tax taken on
your federal return (see instructions)............................................................................................ 2. 424 00

3. Gains from Michigan column of MI-1040D and MI-4797............................................................. 3. 00

4. Losses attributable to other states (see instructions).................................................................. 4. 00

5. Net loss from federal column of your Michigan MI-1040D or MI-4797........................................ 5. 00

6. Oil, gas, and nonferrous metallic mineral expenses (Michigan sourced) deducted to arrive at
Adjusted Gross Income (AGI)..................................................................................................... 6. 00

7. Federal Net Operating Loss deduction included in AGI.............................................................. 7. 00

8. Other (see instructions). Describe: ___________________________________________ 8. 00

9. Total additions. Add lines 1 through 8. Enter here and on MI-1040, line 11......................... 9. 424 00

Continue on page 2.
If subtractions do not apply, only submit
page 1 of the Schedule 1 with your
return.

+ 1555 2019 09 01 27 7 REV 07/17/20 PRO

2019 Form 3423, Page 2 of 2

2019 MICHIGAN Schedule 1 Additions and Subtractions

Filer’s First Name M.I. Last Name Filer’s Full Social Security No. (Example: 123-45-6789)

JEFFREY R DIXON 369 04 2460

Subtractions from Income (all entries must be positive numbers)
10. Income from U.S. government bonds and other U.S. obligations included in MI-1040, line 10.
Include U.S. Schedule B if over $5,000........................................................................................ 10. 00
11. Amount included in MI-1040, line 10, from military retirement benefits due to service in the
U.S. Armed Forces or Michigan National Guard, or taxable railroad retirement benefits.............. 11. 00

12. Gains from federal column of Michigan MI-1040D and MI-4797............................................... 12. 00

13. Income attributable to another state. Explain type and source:________________________ 13. 00

14. Taxable Social Security benefits or military pay (not retirement) included on MI-1040, line 10... 14. 21568 00

15. Income earned while a resident of a Renaissance Zone (see instructions)................................. 15. 00
16. Michigan state and local income tax refunds received in 2019 and included
on MI-1040, line 10....................................................................................................................... 16. 00
17. Michigan Education Savings Program, MI 529 Advisor Plan, and Michigan Achieving a Better
Life Experience Program............................................................................................................. 17. 00

18. Michigan Education Trust ........................................................................................................... 18. 00

19. Oil, gas, and nonferrous metallic minerals income (Michigan sourced) included in AGI............. 19. 00
20. Resident Tribal Member income exempted under a State/Tribal tax agreement or
pursuant to Revenue Administrative Bulletin 1988-47................................................................. 20. 00

21. Miscellaneous subtractions (see instructions). Describe:______________________________ 21. 00

Deduction Based on Year of Birth
Complete 22A through 22F if claiming the Michigan Standard Deduction, the retirement benefits deduction or the senior investment income
deduction on lines 23, 24 or 25. Check box(es) 22C and/or 22F only if you or your spouse received retirement benefits from employment with
a governmental agency not covered by the federal Social Security Act (SSA exempt employment). See instructions before continuing.
22. FILER SPOUSE
A. B. C. D. E. F.
Check if filer received Check if spouse received
Year of Birth Age benefits from SSA exempt
Year of Birth Age benefits from SSA exempt
(19xx) (as of 12-31-2019) employment (19xx) (as of 12-31-2019) employment

1969 50 1969 50

23. Michigan Standard Deduction. Complete this line ONLY if the older of you or your spouse
(if married) was born during the period January 1, 1946 through December 31, 1952, and
reached age 67 on or before December 31, 2019. Do not complete lines 24 and 25.............. 23. 00
24. Retirement benefits. Enter amount from line 16, 27, 28 or 29 of Form 4884, Michigan
Pension Schedule. Include Form 4884...................................................................................... 24. 00
25. Dividend/interest/capital gains deduction for taxpayers 74 years and older. Deduction is
limited to $11,771 for single or married filing separately filers and $23,542 for joint filers, less
any deduction for retirement benefits (see instructions)............................................................... 25. 00

Check this box if you are the unremarried surviving spouse claiming a dividend, interest or capital
gains deduction for someone born before 1946 who was at least age 65 at the time of death.

26. Subtotal. Add lines 10 through 25.............................................................................................. 26. 21568 00

27. 2019 Michigan NOL Deduction. Enter amount from line 11 or 12 of Form 5674, Michigan Net
Operating Loss Deduction. Include Form 5674......................................................................... 27. 00

28. Total Subtractions. Add lines 26 and 27. Enter here and on MI-1040, line 13.......................... 28. 21568 00
If additions do not apply, only submit page 2 of the Schedule 1 with your return.
+ 1555 2019 09 02 27 5 REV 07/17/20 PRO
Michigan Department of Treasury (Rev. 11-19), Page 1 of 2 Issued under authority of
Public Act 281 of 1967,
2019 MICHIGAN Underpayment of Estimated Income Tax MI-2210 as amended.
Include with Form MI-1040 or MI-1041. Round all money items to whole dollars. Type or print in blue or black ink.
Year (YYYY) Month-Year (MM-YYYY)

1. For 2019 or taxable year beginning: and ending:

Attachment 12
2. Filer’s Name Shown on Tax Return 3. Identifying Number

JEFFREY R DIXON 369-04-2460

PART 1: ESTIMATED TAX REQUIRED FOR THE YEAR
4. Enter 2018 tax. Subtract the sum of MI-1040 lines 25, 26, 27b, and 28 from line 21 (see instructions).............................. 4. 1403 00
5. Enter 2019 tax. Subtract the sum of MI-1040 lines 25, 26, 27b, and 28 from line 21 (Fiduciaries, see instructions). .......... 5. 1697 00
6. Multiply amount on line 5 by 90% (0.9). ...................................................................................................................... 6. 1527 00
7. Enter the smaller of lines 4 or 6. ................................................................................................................................... 7. 1403 00
8. Check this box if you use the annualized income installment method. If your income varied during the year,
this method may reduce the amount of one or more required installments.

PAYMENT DUE DATES A B C D

NOTE: Complete lines 10 through 21 one column at a time. April 15, 2019 June 17, 2019 Sept. 16, 2019 Jan. 15, 2020

9. Divide the amount on line 7 by four. Enter in each column.

CAUTION: If annualizing, enter amount from Worksheet line 16. 350 351 351 351
10. Estimated tax paid and withheld. (For column A only, enter
amount from line 10 on line 14.)

11. Enter amount, if any, from line 17 of the previous column.

12. Add lines 10 and 11.

13. Add lines 15 and 16 of the previous column and enter the
result here. 350 701 1052
14. Subtract line 13 from line 12. If less than zero, enter “0”
(For column A only, enter the amount from line 10.) 0 0 0
Remaining underpayment from previous period. If amount on
15. line 14 is zero, subtract line 12 from line 13 and enter result here.
Otherwise, go to line 16.
350 701 1052
16. UNDERPAYMENT. If line 9 is greater than or equal to line 14,
subtract line 14 from line 9 and enter the result here. Then go
to line 10 of the next column. Otherwise, go to line 17. 350 351 351 351
17. OVERPAYMENT. If line 14 is greater than line 9, subtract line 9
from line 14 and enter here. Then go to line 10 of next column.

PART 2: FIGURING THE INTEREST

18. Underpayment from line 16.

350 351 351 351
19. a. Rate Period 1: 5.90%. April 15, 2019 - June 30, 2019
Computation starting date for this period: April 15, 2019 June 17, 2019

b. Number of days from date on line 19a to the date line 18

was paid or June 30, 2019, whichever is earlier. If June 30 is
earlier, enter 76 and 13 respectively.

c. 0.0001616 x days on line 19b x underpayment on line 18.

20. a. Rate Period 2: 6.39%. July 1, 2019 - Dec. 31, 2019

Computation starting date for this period: June 30, 2019 June 30, 2019 Sept. 16, 2019

b. Number of days from date on line 20a to the date line 18

was paid or Dec. 31, 2019, whichever is earlier. If Dec. 31 is
earlier, enter 184, 184 and 106 respectively.

c. 0.0001751 x days on line 20b x underpayment on line 18.

Continue on page 2. This form cannot be

+ 1555 2019 53 01 27 4 processed if page 2 is not completed and included.
REV 07/17/20 PRO
2019 MI-2210, Page 2 of 2
Identifying Number 369-04-2460

21. a. Rate Period 3: 6.40%. Jan. 1, 2020 - June 30, 2020

Dec. 31, 2019 Dec. 31, 2019 Dec. 31, 2019 Jan. 15, 2020
Computation starting date for this period:

b. Number of days from date on line 21a to the date line 18

was paid or April 15, 2020, whichever is earlier. If April 15 is
earlier, enter 106, 106, 106 and 91 respectively.

c. 0.0001749 x days on line 21b x underpayment on line 18.

22. TOTAL INTEREST. Add amounts on lines 19c, 20c and 21c in all columns. Enter the total interest here
and on the appropriate line on your MI-1040 or MI-1041 ...................................................................................
SEE STMT 22. 59 00
PART 3: FIGURING THE A B C D
PENALTY April 15, 2019 June 17, 2019 Sept. 16, 2019 Jan. 15, 2020

23. Underpayment (see instructions)......................... 23. 350 00 351 00 351 00 351 00

24. Enter 25% (0.25) or 10% (0.10) (see instructions) 24. 25 % 25 % 25 % 25 %

25. Multiply amount on line 23 by line 24. ................. 25. 88 00 88 00 88 00 88 00

26. TOTAL PENALTY. Add line 25, columns A through D. Enter the total penalty here
and on the appropriate line on your MI-1040 or MI-1041 ................................................................................ 26. 352 00

27. Add lines 22 and 26. This is your total penalty and interest to be added to your tax due. ............................. 27. 411 00
This form computes penalty and interest for estimate vouchers to the date of payment or April 15, 2020, whichever is earlier. Additional penalty and
LQWHUHVWIRUODWH¿OLQJDFFUXHVRQ\RXUDQQXDOUHWXUQIURP$SULOWRWKHGDWHRISD\PHQW
ANNUALIZED INCOME WORKSHEET
Complete one column at a time. Line numbers refer to this Worksheet unless another form is listed.
Estates and trusts: Use the following period ending dates: 2/28/19, 4/30/19, 7/31/19 and 11/30/19.
Do not use the dates in the column headings below.
A B C D
First 3 months First 5 months First 8 months 12 months
1-1 to 3-31-19 1-1 to 5-31-19 1-1 to 8-31-19 1-1 to 12-31-19
1. Enter total income subject to tax (reported on 2019
MI-1040, line 14) that is attributable to each period in the
corresponding column ............................................................. 1.
2. Annualization amounts (Fiduciaries, see instructions) .......... 2. 4 2.4 1.5 1
3. Annualized total income. Multiply line 1 by line 2 .............. 3.
4. Enter total exemption allowance (MI-1040, line 15) .............. 4.
5. Subtract line 4 from line 3 ...................................................... 5.
6. Multiply line 5 by 2019 tax rate 4.25% (0.0425) .................... 6.
7. Enter the sum of your 2019 MI-1040 credits from lines 18b,
19b, 25, 26, 27b, and 28 in each column ............................... 7.
8. Tax after credits. Subtract line 7 from line 6 (if less than zero,
enter “0”) ................................................................................ 8.
(line 8 x 22.5%) (line 8 x 45%) (line 8 x 67.5%) (line 8 x 90%)
9. Multiply line 8 by 22.5% (1st period), 45% (2nd period),
67.5% (3rd period) and 90% (4th period). Enter the results in
each column ........................................................................... 9.
10. Enter combined amounts from line 16 of all previous
columns .................................................................................. 10.
11. Subtract line 10 from line 9 (if less than zero, enter “0”)........ 11.
12. Required quarterly payment. Divide the amount on MI-2210,
line 7, page 1, by four and enter the result in each column ... 12.
13. Enter the amount from line 15 of the previous column .......... 13.
14. Add lines 12 and 13 ............................................................... 14.
15. Subtract line 11 from line 14 (if less than zero, enter “0”) ...... 15.
16. Required installments. Enter the smaller of lines 14 or 11
here and on MI-2210, line 9, page 1....................................... 16.
REV 07/17/20 PRO
+ 1555 2019 53 02 27 2
JEFFREY R & JENNIFER A DIXON 369-04-2460 1

Additional information from your 2019 Michigan Tax Return

Form 2210: Underpayment Penalty

Underpayment Statement Explanation Statement
Line 23
Amount Running # of
Event Date Amount Due Percent Penalty
Paid Balance Days
AMOUNT DUE 04/15/19 350 350 5.90 63 3.56
AMOUNT DUE 06/17/19 351 701 5.90 13 1.47
RATE CHANGE 06/30/19 701 6.39 78 9.57
AMOUNT DUE 09/16/19 351 1052 6.39 106 19.52
RATE CHANGE 12/31/19 1052 6.40 15 2.77
AMOUNT DUE 01/15/20 351 1403 6.40 91 22.39
DATE FILED 04/15/20 1403 6.40
Total 59.28
SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01
Name(s) shown on Form 1040 or 1040-SR Your social security number
JEFFREY R & JENNIFER A DIXON 369-04-2460
At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any
virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . 1
2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Date of original divorce or separation agreement (see instructions) a
3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . 3 774.
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . 4
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . 5 52,336.
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income. List type and amount a
8
9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . . . . . 9 53,110.
Part II Adjustments to Income
10 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach
Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . . 12
13 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . 13
14 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . 14 424.
15 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . 15
16 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . 16
17 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . 17
18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . . a
c Date of original divorce or separation agreement (see instructions) a
19 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . 20
21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . 21
22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or
1040-SR, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 424.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 08/20/20 PRO Schedule 1 (Form 1040 or 1040-SR) 2019
SCHEDULE 2 OMB No. 1545-0074
Additional Taxes
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 02
Name(s) shown on Form 1040 or 1040-SR Your social security number
JEFFREY R & JENNIFER A DIXON 369-04-2460
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . 2
3 Add lines 1 and 2. Enter here and include on Form 1040 or 1040-SR, line 12b . . . . . . . . 3
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . 4 848.
5 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . . . . 5
6 Additional tax on IRAs, other qualified retirement plans, and other tax-favored accounts. Attach Form
5329 if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7a Household employment taxes. Attach Schedule H . . . . . . . . . . . . . . . . . 7a
b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required . . . . 7b
8 Taxes from: a Form 8959 b Form 8960
c Instructions; enter code(s) 8
9 Section 965 net tax liability installment from Form 965-A . . . . . . . 9
10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR,
line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 848.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 08/20/20 PRO Schedule 2 (Form 1040 or 1040-SR) 2019
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074

2019
(Form 1040 or 1040-SR) (Sole Proprietorship)
a Go to www.irs.gov/ScheduleC for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
JEFFREY R DIXON 369-04-2460
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
PLUMBING a 2 3 8 2 2 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
A PLUMBING PHD 2 7 1 7 7 4 7 2 1
E Business address (including suite or room no.) a 85 STALWART
City, town or post office, state, and ZIP code TROY, MI 48098
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2019? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . a

I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . a 1 6,000.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 6,000.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 6,000.
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . a 7 6,000.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . . 9 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23
instructions) . . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a
(other than on line 19) . . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . 24b
16 Interest (see instructions): 25 Utilities . . . . . . . . 25
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a
17 Legal and professional services
17 b Reserved for future use . . . 27b
28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 6,000.
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method (see instructions).
Simplified method filers only: enter the total square footage of: (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30
31 Net profit or (loss). Subtract line 30 from line 29.

}
• If a profit, enter on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or Form 1040-NR, line
13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and 31 6,000.
trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.

}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or
Form 1040-NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 32a All investment is at risk.
31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
Schedule C (Form 1040 or 1040-SR) 2019 Page 2
Part III Cost of Goods Sold (see instructions)

33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35

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

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

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

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

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
file Form 4562.

43 When did you place your vehicle in service for business purposes? (month, day, year) a

44 Of the total number of miles you drove your vehicle during 2019, enter the number of miles you used your vehicle for:

a Business b Commuting (see instructions) c Other

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No

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

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26 or line 30.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48

REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074

2019
(Form 1040 or 1040-SR) (Sole Proprietorship)
a Go to www.irs.gov/ScheduleC for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
JENNIFER A DIXON 378-82-1169
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
HAIR STYLIST a 8 1 2 1 1 2
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
JENNIFER DIXON
E Business address (including suite or room no.) a 85 STALWART
City, town or post office, state, and ZIP code TROY, MI 48098
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2019? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . a

I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . a 1
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . a 7
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . . 9 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23
instructions) . . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a
(other than on line 19) . . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . 24b
16 Interest (see instructions): 25 Utilities . . . . . . . . 25
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a 5,226.
17 Legal and professional services
17 b Reserved for future use . . . 27b
28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28 5,226.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 -5,226.
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method (see instructions).
Simplified method filers only: enter the total square footage of: (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30
31 Net profit or (loss). Subtract line 30 from line 29.

}
• If a profit, enter on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or Form 1040-NR, line
13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and 31 -5,226.
trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.

}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or
Form 1040-NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 32a All investment is at risk.
31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
Schedule C (Form 1040 or 1040-SR) 2019 Page 2
Part III Cost of Goods Sold (see instructions)

33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35

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

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

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

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

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
file Form 4562.

43 When did you place your vehicle in service for business purposes? (month, day, year) a

44 Of the total number of miles you drove your vehicle during 2019, enter the number of miles you used your vehicle for:

a Business b Commuting (see instructions) c Other

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No

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

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26 or line 30.

FRANCHISE FEE 5,226.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48 5,226.

REV 08/20/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
Schedule E (Form 1040 or 1040-SR) 2019 Attachment Sequence No. 13 Page 2
Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number
JEFFREY R & JENNIFER A DIXON 369-04-2460
Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
Part II Income or Loss From Partnerships and S Corporations — Note: If you report a loss, receive a distribution, dispose of
stock, or receive a loan repayment from an S corporation, you must check the box in column (e) on line 28 and attach the required basis
computation. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (f) on
line 28 and attach Form 6198 (see instructions).

27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a
passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? If you answered “Yes,”
see instructions before completing this section . . . . . . . . . . . . . . . . . . . Yes No
(b) Enter P for (c) Check if (d) Employer (e) Check if (f) Check if
28 (a) Name partnership; S foreign identification basis computation any amount is
for S corporation partnership number is required not at risk
A A. PLUMBING PHD, INC S 27-1774721
B
C
D
Passive Income and Loss Nonpassive Income and Loss
(g) Passive loss allowed (h) Passive income (i) Nonpassive loss allowed (j) Section 179 expense (k) Nonpassive income
(attach Form 8582 if required) from Schedule K-1 (see Schedule K-1) deduction from Form 4562 from Schedule K-1

A 52,336.
B
C
D
29a Totals 52,336.
b Totals
30 Add columns (h) and (k) of line 29a. . . . . . . . . . . . . . . . . . . . . 30 52,336.
31 Add columns (g), (i), and (j) of line 29b. . . . . . . . . . . . . . . . . . . . 31 ( )
32 Total partnership and S corporation income or (loss). Combine lines 30 and 31 . . . . 32 52,336.
Part III Income or Loss From Estates and Trusts
(b) Employer
33 (a) Name
identification number

A
B
Passive Income and Loss Nonpassive Income and Loss
(c) Passive deduction or loss allowed (d) Passive income (e) Deduction or loss (f) Other income from
(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 Schedule K-1

A
B
34a Totals
b Totals
35 Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . 35
36 Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . 36 ( )
37 Total estate and trust income or (loss). Combine lines 35 and 36 . . . . . . . . . . 37
Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder
(b) Employer identification (c) Excess inclusion from (d) Taxable income (net loss) (e) Income from
38 (a) Name number Schedules Q, line 2c from Schedules Q, line 1b Schedules Q, line 3b
(see instructions)

39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below 39
Part V Summary
40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below . . . . . . 40
41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Schedule 1 (Form 1040 or 1040-SR), line 5, or Form 1040-NR, line 18 a 41 52,336.
42 Reconciliation of farming and fishing income. Enter your gross
farming and fishing income reported on Form 4835, line 7; Schedule K-1
(Form 1065), box 14, code B; Schedule K-1 (Form 1120-S), box 17, code
AC; and Schedule K-1 (Form 1041), box 14, code F (see instructions) . 42
43 Reconciliation for real estate professionals. If you were a real estate professional
(see instructions), enter the net income or (loss) you reported anywhere on Form
1040, Form 1040-SR, or Form 1040-NR from all rental real estate activities in which
you materially participated under the passive activity loss rules . . . . . . 43
REV 08/20/20 PRO Schedule E (Form 1040 or 1040-SR) 2019