1040 U.S.

Individual Income Tax Return 2021 (99)

Form Department of the Treasury—Internal Revenue Service

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 widow(er) (QW)
Check only If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying
one box.
person is a child but not your dependent a
Your first name and middle initial Last name Your social security number
DAVID GEORGE 391 72 8238
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
N2079 COUNTY ROAD XX 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
BERLIN WI 54923 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

At any time during 2021, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual curr ency? 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, 1956 Are blind Spouse: Was born before January 2, 1956 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4)  if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here a
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . 1
Attach 2a Tax-exempt interest . . . 2a 2b
b Taxable interest . . . . .
Sch. B if
3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
required.
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Standard 6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
Deduction for—
• Single or
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . a 7 0.
Married filing 8 Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . 8 10,300.
separately,
$12,400 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . a 9 10,300.
• Married filing 10 Adjustments to income:
jointly or
Qualifying a From Schedule 1, line 22 . . . . . . . . . . . . . . 10a 728.
widow(er),
$24,800
b Charitable contributions if you take the standard deduction. See instructions 10b 0.
• Head of c Add lines 10a and 10b. These are your total adjustments to income . . . . . . . . a 10c 728.
household,
$18,650 11 Subtract line 10c from line 9. This is your adjusted gross income . . . . . . . . . a 11 9,572.
• If you checked 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12,400.
any box under
Standard 13 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . . . . . . 13
Deduction,
see instructions.
14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12,400.
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . 15 0.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2021)

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Form 1040 (2021) DAVID GEORGE 391-72-8238 Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 0.
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17 0.
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 0.
19 Child tax credit or credit for other dependents . . . . . . . . . . . . . . . . 19
20 Amount from Schedule 3, line 7 . . . . . . . . . . . . . . . . . . . . 20 0.
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21 0.
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 10 . . . . . . . . . 23 1,455.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . a 24 1,455.
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b 7,200.
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 7,200.
• If you have a 26 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . 26
qualifying child, 27
attach Sch. EIC.
Earned income credit (EIC) . . . . . . . . . . . . . . 27 478.
• If you have 28 Additional child tax credit. Attach Schedule 8812 . . . . . . . 28
nontaxable 29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
combat pay,
see instructions. 30 Recovery rebate credit. See instructions . . . . . . . . . . 30 1,800.
31 Amount from Schedule 3, line 13 . . . . . . . . . . . . 31
32 Add lines 27 through 31. These are your total other payments and refundable credits . . . a 32 2,278.
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . a 33 9,478.
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 8,023.
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . a 35a 8,023.
Direct deposit? ab Routing number a c Type: Checking Savings
See instructions. a
d Account number
36 Amount of line 34 you want applied to your 2022 estimated tax . . a 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe now . . . . . . . . . . a 37 0.
You Owe Note: Schedule H and Schedule SE filers, line 37 may not represent all of the taxes you owe for
For details on 2021. See Schedule 3, line 12e, and its instructions for details.
how to pay, see
instructions. 38 Estimated tax penalty (see instructions) . . . . . . . . . a 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . a Yes. Complete below. X No
Designee’s Phone Personal identification
name a no. a number (PIN) a
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
F

Joint return? (see inst.) a

AUTOMOTIVE MECHANICAL & ELECRICAL REPAIR & MAINTENANCE
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.) a
Phone no. Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
SELF-PREPARED
Preparer Firm’s name a Phone no.
Use Only Firm’s address a Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2021)

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SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
(Form 1040)
Department of the Treasury
a Attach to Form 1040, 1040-SR, or 1040-NR. 2021
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, 1040-SR, or 1040-NR Your social security number
DAVID GEORGE 391-72-8238
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 10,300.
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . 4
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 5
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, 1040-SR, or 1040-NR,
line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 10,300.
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 . . . . . . . . . 14 728.
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 deduction. Attach Form 8917 . . . . . . . . . . . . . . . 21
22 Add lines 10 through 21. These are your adjustments to income. Enter here and
on Form 1040, 1040-SR, or 1040-NR, line 10a . . . . . . . . . . . . . . . 22 728.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71479F Schedule 1 (Form 1040) 2021

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SCHEDULE 2 OMB No. 1545-0074
Additional Taxes
(Form 1040)
Department of the Treasury
a Attach to Form 1040, 1040-SR, or 1040-NR. 2021
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, 1040-SR, or 1040-NR Your social security number
DAVID GEORGE 391-72-8238
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 on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . 4 1,455.
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 23, or Form 1040-NR, line 23b . . . . . . . . . . . . 10 1,455.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71478U Schedule 2 (Form 1040) 2021

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SCHEDULE C Profit or Loss From Business OMB No. 1545-0074

2021
(Form 1040) (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)
DAVID GEORGE 391-72-8238
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
AUTOMOTIVE MECHANICAL & ELECRICAL REPAIR & MAINTENANCE a 8 1 1 1 1 8
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)

E Business address (including suite or room no.) a

City, town or post office, state, and ZIP code

F Accounting method: (1) X Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2021? If “No,” see instructions for limit on losses . X Yes No
H If you started or acquired this business during 2021, check here . . . . . . . . . . . . . . . . . a

I Did you make any payments in 2021 that would require you to file Form(s) 1099? See instructions . . . . . . . . Yes X No
J If “Yes,” did you or will you file required Form(s) 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 15,400.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 15,400.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 15,400.
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 15,400.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 600. 18 Office expense (see instructions) 18 500.
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 2,000.
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 2,000.
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 5,100.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 10,300.
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), 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 10,300.
• 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
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. Cat. No. 11334P Schedule C (Form 1040) 2021

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SCHEDULE SE
Self-Employment Tax
OMB No. 1545-0074

2021
(Form 1040)
a Go to www.irs.gov/ScheduleSE for instructions and the latest information.
Department of the Treasury Attachment
Sequence No. 17
a Attach to Form 1040, 1040-SR, or 1040-NR.
Internal Revenue Service (99)
Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR) Social security number of person
DAVID GEORGE with self-employment income a 391-72-8238
Part I Self-Employment Tax
Note: If your only income subject to self-employment tax is church employee income, see instructions for how to report your income
and the definition of church employee income.
A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had
$400 or more of other net earnings from self-employment, check here and continue with Part I . . . . . . . . a
Skip lines 1a and 1b if you use the farm optional method in Part II. See instructions.
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 ( )
Skip line 2 if you use the nonfarm optional method in Part II. See instructions.
2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other than
farming). See instructions for other income to report or if you are a minister or member of a religious order 2 10,300.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . . 3 10,300.
4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . 4a 9,512.
Note: If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions.
b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here . . . . . 4b
c Combine lines 4a and 4b. If less than $400, stop; you don’t owe self-employment tax. Exception: If
less than $400 and you had church employee income, enter -0- and continue . . . . . . . a 4c 9,512.
5a Enter your church employee income from Form W-2. See instructions for
definition of church employee income . . . . . . . . . . . . . 5a
b Multiply line 5a by 92.35% (0.9235). If less than $100, enter -0- . . . . . . . . . . . . . 5b
6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 9,512.
7 Maximum amount of combined wages and self-employment earnings subject to social security tax or
the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2021 . . . . . . . . . . . 7
8a Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2)
and railroad retirement (tier 1) compensation. If $137,700 or more, skip lines
8b through 10, and go to line 11 . . . . . . . . . . . . . . . 8a
b Unreported tips subject to social security tax from Form 4137, line 10 . . . 8b
c Wages subject to social security tax from Form 8919, line 10 . . . . . . 8c
d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . . . . 8d
9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . . . a 9
10 Multiply the smaller of line 6 or line 9 by 12.4% (0.124) . . . . . . . . . . . . . . . . 10 1,179.
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . 11 276.
12 Self-employment tax. Add lines 10 and 11. Enter here and on Schedule 2 (Form 1040), line 4 . . 12 1,455.
13 Deduction for one-half of self-employment tax.
Multiply line 12 by 50% (0.50). Enter here and on Schedule 1 (Form 1040),
line 14 . . . . . . . . . . . . . . . . . . . . . . . . 13 728.
Part II Optional Methods To Figure Net Earnings (see instructions)
Farm Optional Method. You may use this method only if (a) your gross farm income1 wasn’t more than
$8,460, or (b) your net farm profits2 were less than $6,107.
14 Maximum income for optional methods . . . . . . . . . . . . . . . . . . . . . 14
15 Enter the smaller of: two-thirds (2/3) of gross farm income1 (not less than zero) or $5,640. Also, include
this amount on line 4b above . . . . . . . . . . . . . . . . . . . . . . . . 15
Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits3 were less than $6,107
and also less than 72.189% of your gross nonfarm income,4 and (b) you had net earnings from self-employment
of at least $400 in 2 of the prior 3 years. Caution: You may use this method no more than five times.
16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 Enter the smaller of: two-thirds (2/3) of gross nonfarm income4 (not less than zero) or the amount on
line 16. Also, include this amount on line 4b above . . . . . . . . . . . . . . . . . 17
1 3
From Sch. F, line 9; and Sch. K-1 (Form 1065), box 14, code B. From Sch. C, line 31; and Sch. K-1 (Form 1065), box 14, code A.
2 4
From Sch. F, line 34; and Sch. K-1 (Form 1065), box 14, code A—minus the amount From Sch. C, line 7; and Sch. K-1 (Form 1065), box 14, code C.
you would have entered on line 1b had you not used the optional method.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11358Z Schedule SE (Form 1040) 2021

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Schedule SE (Form 1040) 2021 Attachment Sequence No. 17 Page 2
Part III Maximum Deferral of Self-Employment Tax Payments
If line 4c is zero, skip lines 18 through 20, and enter -0- on line 21.
18 Enter the portion of line 3 that can be attributed to March 27, 2021, through December 31, 2021.. 18
19 If line 18 is more than zero, multiply line 18 by 92.35% (0.9235); otherwise, enter the amount from line 18 19
20 Enter the portion of lines 15 and 17 that can be attributed to March 27, 2021, through December 31,
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Combine lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . 21
If line 5b is zero, skip line 22 and enter -0- on line 23.
22 Enter the portion of line 5a that can be attributed to March 27, 2021, through December 31, 2021.. 22
23 Multiply line 22 by 92.35% (0.9235) . . . . . . . . . . . . . . . . . . . . . . 23
24 Add lines 21 and 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
25 Enter the smaller of line 9 or line 24 . . . . . . . . . . . . . . . . . . . . . . 25
26 Multiply line 25 by 6.2% (0.062). Enter here and see the instructions for line 12e of Schedule 3 (Form
1040) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Schedule SE (Form 1040) 2021

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