Sean 2022 Tax Return
Sean 2022 Tax Return
Sean 2022 Tax Return
prepared by,
TaxSlayer.com
QNA
Form 8879 IRS e-file Signature Authorization
(Rev. January 2021) OMB No. 1545-0074
a
ERO must obtain and retain completed Form 8879.
Department of the Treasury
a Go to www.irs.gov/Form8879 for the latest information.
Internal Revenue Service
F
Submission Identification Number (SID)
Taxpayer’s name Social security number
Part I Tax Return Information — Tax Year Ending December 31, 2022 (Enter year you are authorizing.)
Enter whole dollars only on lines 1 through 5.
Note: Form 1040-SS filers use line 4 only. Leave lines 1, 2, 3, and 5 blank.
1 Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -70075
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . . 3 1179
4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . 4 1179
5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 the income tax return (original or amended) I am now authorizing, and to the best of
my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from the income tax
return (original or amended) I am now authorizing. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO)
to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason
for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial
Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for
payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This
authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a
payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2
business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of
taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the
personal identification number (PIN) below is my signature for the income tax return (original or amended) I am now authorizing and, if applicable, my
Electronic Funds Withdrawal Consent.
Taxpayer’s PIN: check one box only
0 0 0 0 0
I authorize to enter or generate my PIN as my
Enter five digits, but
ERO firm name don’t enter all zeros
signature on the income tax return (original or amended) I am now authorizing.
X I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only
if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III
below.
Your signature a Date a
I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only
if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III
below.
I certify that the above numeric entry is my PIN, which is my signature for the electronic individual income tax return (original or amended) I am now
authorized to file for tax year indicated above for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the
requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
Filing Status x Single Married filing jointly Married filing separately (MFS) Head of household (HOH)
Qualifying surviving
Check only spouse (QSS)
one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s name if the qualifying
person is a child but not your dependent:
Your first name and middle initial Last name Your social security number
SEAN L CAHILL 552-97-9592
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
121 HAWTHORNE DRIVE Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
SPENCERPORT NY 14559 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse
Digital At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes X No
Standard Someone can claim: You as a dependent Your spouse as a dependent
Deduction Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness You: Were born before January 2, 1958 Are blind Spouse: Was born before January 2, 1958 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here . .
1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 20560
Income
b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s) c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
W-2 here. Also
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
1099-R if tax
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h
W-2, see
instructions.
i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 20560
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
Standard 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Deduction for—
6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
• Single or
Married filing c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
separately,
$12,950 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7
• Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8 -90635
jointly or
Qualifying 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 -70075
surviving spouse,
$25,900
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
• Head of 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 -70075
household,
$19,400 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12950
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12950
Deduction, 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . 0
see instructions.
15
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2022)
QNA
CAHILL 552-97-9592
Form 1040 (2022) Page 2
Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 0
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 0
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 0
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 1179
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 1179
26 2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . 26
If you have a
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 1179
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 1179
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 1179
Direct deposit? b Routing number c Type: X Checking Savings
See instructions.
d Account number
36 Amount of line 34 you want applied to your 2023 estimated tax . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . 37
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
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
Sign 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
Joint return? (see inst.)
SECURITY GUARD
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.)
QNA
SEAN CAHILL 552-97-9592
Schedule 1 (Form 1040) 2022 Page 2
2022
(Form 1040) (Sole Proprietorship)
Department of the Treasury
Go to www.irs.gov/ScheduleC for instructions and the latest information.
Attachment
Internal Revenue Service Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships must generally file Form 1065. Sequence No. 09
Name of proprietor Link:1000 Social security number (SSN)
SEAN L CAHILL 552-97-9592
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
DELIVERY DRIVER 9 9 9 0 0 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
}
31 Net profit or (loss). Subtract line 30 from line 29.
• If a profit, enter on both Schedule 1 (Form 1040), line 3, and on Schedule SE, line 2. (If you
checked the box on line 1, see instructions.) Estates and trusts, enter on Form 1041, line 3. 31 -90635
• If a loss, you must go to line 32.
}
32 If you have a loss, check the box that describes your investment in this activity. See instructions.
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040), line 3, and on Schedule
SE, line 2. (If you checked the box on line 1, see the line 31 instructions.) Estates and trusts, enter on 32a X All investment is at risk.
Form 1041, line 3. 32b Some investment is not
• If you checked 32b, you must attach Form 6198. Your loss may be limited. at risk.
For Paperwork Reduction Act Notice, see the separate instructions. Schedule C (Form 1040) 2022
QNA
SEAN L CAHILL Link:1000 552-97-9592
Schedule C (Form 1040) 2022 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 X Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No
35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35
39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
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) 01 / 01 /2019
44 Of the total number of miles you drove your vehicle during 2022, enter the number of miles you used your vehicle for:
45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . X Yes No
46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes X No
Simplified Computation
Attach to your tax return.
2022
Department of the Treasury Attachment
Internal Revenue Service Go to www.irs.gov/Form8995 for instructions and the latest information. Sequence No. 55
Name(s) shown on return Your taxpayer identification number
1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)
ii
iii
iv
1 For individuals, subtract your standard deduction or itemized deductions from your adjusted gross
income and enter it here. For estates and trusts, enter taxable income increased by the total of the
charitable deduction, income distribution deduction, and exemption amount (see instructions) . . 1 -83025
2 Nonbusiness capital losses before limitation. Enter as a positive number
(see instructions) . . . . . . . . . . . . . . . . . . . 2
4 If line 2 is more than line 3, enter the difference. Otherwise, enter -0- . . 4
9 If line 6 is more than line 8, enter the difference. Otherwise, enter -0- . . . . . . . . . . 9 12950
10 If line 8 is more than line 6, enter the difference.
Otherwise, enter -0-. But don’t enter more than
line 5 . . . . . . . . . . . . . . 10
19 Enter the loss, if any, from line 21 of your 2022 Schedule D (Form 1040).
(For estates and trusts, enter the loss, if any, from line 20 of Schedule D
(Form 1041).) Enter as a positive number . . . . . . . . . . . 19
20 If line 18 is more than line 19, enter the difference. Otherwise, enter -0- . 20
21 If line 19 is more than line 18, enter the difference. Otherwise, enter -0- . . . . . . . . . 21
23 NOL deduction for losses from other years. Enter as a positive number . . . . . . . . . 23
24 NOL. Combine lines 1, 9, 17, and 21 through 23. If the result is less than zero, enter it here and on
page 1, line 1a. If the result is zero or more, you don’t have an NOL . . . . . . . . . . 24 -70075
Form 1045 (2022)
09-12-1970
RIVERSIDE
Principal Residence
If your address above is the same as your principal/physical residence address at the time of filing, check this box . . . X
If not, enter below your principal/physical residence address at the time of filing.
Street address (number and street) (If foreign address, see instructions.) Apt. no/ste. no.
If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . .
X
2 Married/RDP filing jointly. See instr. 5 Qualifying surviving spouse/RDP. Enter year spouse/RDP died.
See instructions.
3 Married/RDP filing separately. Enter spouse’s/RDP’s SSN or ITIN above and full name here.
6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See instr. . . . . . . ● 6
▶ For line 7, line 8, line 9, and line 10: Multiply the number you enter in the box by the pre-printed dollar amount for that line.
Whole dollars only
7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked
Exemptions
box 2 or 5, enter 2 in the box. If you checked the box on line 6, see instructions. 7 1 X $140 = ● $ 140
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;
if both are visually impaired, enter 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 X $140 = $
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1;
if both are 65 or older, enter 2. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . ●9 X $140 = $
Last Name
Exemptions
SSN. See
instructions. ● ● ●
Dependent’s
relationship
to you
11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32 . . . . . . . . . . . . . 11 $ 140
13 Enter federal adjusted gross income from federal Form 1040 or 1040-SR, line 11 . . . . . . . . 13 -70075 . 00
14 California adjustments – subtractions. Enter the amount from Schedule CA (540),
Part I, line 27, column B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 14 . 00
15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses.
-70075 . 00
Taxable Income
See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 California adjustments – additions. Enter the amount from Schedule CA (540),
Part I, line 27, column C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 16 . 00
{ {
18 Enter the Your California itemized deductions from Schedule CA (540), Part II, line 30; OR
larger of Your California standard deduction shown below for your filing status:
• Single or Married/RDP filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,202
• Married/RDP filing jointly, Head of household, or Qualifying surviving spouse/RDP. $10,404
If Married/RDP filing separately or the box on line 6 is checked, STOP. See instructions ● 18 5202 . 00
19 Subtract line 18 from line 17. This is your taxable income.
If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . 00
33 Subtract line 32 from line 31. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 0 . 00
34 Tax. See instructions. Check the box if from: ● Schedule G-1 ● FTB 5870A . . ● 34 . 00
●
Special Credits
45 To claim more than two credits. See instructions. Attach Schedule P (540). . . . . . . . . . . . . . ● 45 . 00
Special Credits
47 Add line 40 through line 46. These are your total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 60 . 00
48 Subtract line 47 from line 35. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 0 . 00
64 Add line 48, line 61, line 62, and line 63. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . ● 64 0 . 00
●
Use Tax
92 If you and your household had full-year health care coverage, check the box.
●
Penalty
93 Payments balance. If line 78 is more than line 91, subtract line 91 from line 78 . . . . . . . . . . 93 97 . 00
Overpaid Tax/Tax Due
94 Use Tax balance. If line 91 is more than line 78, subtract line 78 from line 91 . . . . . . . . . . . 94 . 00
95 Payments after Individual Shared Responsibility Penalty. If line 93 is more than line 92,
subtract line 92 from line 93. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 97 . 00
96 Individual Shared Responsibility Penalty Balance. If line 92 is more than line 93,
subtract line 93 from line 92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 . 00
97 Overpaid tax. If line 95 is more than line 64, subtract line 64 from line 95. . . . . . . . . . . . . . . 97 97 . 00
100 Tax due. If line 95 is less than line 64, subtract line 95 from line 64 . . . . . . . . . . . . . . . . . . . 100 . 00
Code Amount
Alzheimer’s Disease and Related Dementia Voluntary Tax Contribution Fund . . . . . . . . . . . . . ● 401 . 00
Rare and Endangered Species Preservation Voluntary Tax Contribution Program . . . . . . . . . ● 403 . 00
California Peace Officer Memorial Foundation Voluntary Tax Contribution Fund. . . . . . . . . . . ● 408 . 00
School Supplies for Homeless Children Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . ● 422 . 00
Protect Our Coast and Oceans Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . ● 424 . 00
Prevention of Animal Homelessness and Cruelty Voluntary Tax Contribution Fund . . . . . . . . ● 431 . 00
California Community and Neighborhood Tree Voluntary Tax Contribution Fund . . . . . . . . . . ● 446 . 00
110 Add amounts in code 400 through code 446. This is your total contribution . . . . . . . . . . . . . ● 110 . 00
You Owe
Amount
111 AMOUNT YOU OWE. If you do not have an amount on line 99, add line 94, line 96, line 100, and line 110. See instructions. Do not send cash.
Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001. . . . . ● 111 . 00
Pay Online – Go to ftb.ca.gov/pay for more information.
112 Interest, late return penalties, and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 . 00
Interest and
Penalties
Check the box: ● FTB 5805 attached ● FTB 5805F attached . . . . . . . . . . . ● 113 . 00
114 Total amount due. See instructions. Enclose, but do not staple, any payment . . . . . . . . . . . . 114 . 00
115 REFUND OR NO AMOUNT DUE. Subtract the sum of line 110, line 112, and line 113 from line 99. See instructions.
Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0001. . . . . . . ● 115 97 . 00
Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip.
Refund and Direct Deposit
See instructions. Have you verified the routing and account numbers? Use whole dollars only.
All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:
● Type
● Routing number Checking ● Account number ● 116 Direct deposit amount
. 00
Savings
The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
● Type
● Routing number Checking ● Account number ● 117 Direct deposit amount
. 00
Savings
Voter
Info.
For voter registration information, check the box and go to sos.ca.gov/elections. See instructions . . . . . . . . . . . . . . . .
IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal tax return.
Our privacy notice can be found in annual tax booklets or online. Go to ftb.ca.gov/privacy to learn about our privacy policy statement, or go to ftb.ca.gov/forms and search for 1131
to locate FTB 1131 EN-SP, Franchise Tax Board Privacy Notice on Collection. To request this notice by mail, call 800.338.0505 and enter form code 948 when instructed.
Under penalties of perjury, I declare that I have examined this tax return, including accompanying schedules and statements, and to the best of my knowledge and belief, it
is true, correct, and complete.
Your signature Date Spouse’s/RDP’s signature (if a joint tax return, both must sign)
Your email address. Enter only one email address. Preferred phone number
Here Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
It is unlawful
to forge a
spouse’s/
Firm’s name (or yours, if self-employed) ● PTIN
RDP’s
signature.
Firm’s address ● Firm’s FEIN
Joint tax
return?
See
instructions.
Do you want to allow another person to discuss this tax return with us? See instructions . . . . . . . ● Yes X No
Print Third Party Designee’s Name Telephone Number
1.
20560 4.
1275 8.
Federal income tax withheld Medicare tax withheld Dependent care benefits
2.
1179 6.
298 10.
Social security wages Social security tips Nonqualified plans
3.
20560 7. 11.
12. Codes and amounts
Code Amount Code Amount
12a. 12c.
Code Amount Code Amount
12b. 12d.
Franchise Tax Board Privacy
13. Check the appropriate box for: Statutory employee, Retirement plan, or Third-party sick pay Notice on Collection
Our privacy notice can be found in
Statutory employee Retirement plan Third-party sick pay
annual tax booklets or online. Go to
ftb.ca.gov/privacy to learn about
14. SDI, VPDI, or CA SDI (from federal Form W-2, box 14 or 19) our privacy policy statement, or go
Type Amount 16. State wages, tips, etc. to ftb.ca.gov/forms and search for
1131 to locate FTB 1131 EN-SP,
CASDI 226 20560 Franchise Tax Board Privacy Notice
on Collection - Aviso de Privacidad
del Franchise Tax Board sobre la
15. State and employer’s state ID number
Recaudación. To request this notice
State Employer’s state ID number 17. State income tax
by mail, call 800.338.0505 and enter
CA 18700815 97 form code 948 when instructed.
For Privacy Notice, get FTB 1131 EN-SP. 041 8041224 Schedule W-2 2022
041
Street address (number and street) or PO box Apt. no./ste. no. PMB/private mailbox Daytime telephone number
121 HAWTHORNE DRIVE
City State ZIP code
SPENCERPORT NY 14559
Foreign country name Foreign province/state/county Foreign postal code
For Privacy Notice, get FTB 1131 EN-SP. FTB 8453-OL 2022