1040-SR U.S. Tax Return for Seniors

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Form

1040-SR U.S. Tax Return for Seniors
Department of the Treasury—Internal Revenue Service

(99)

2021

OMB No. 1545-0074

IRS Use Only—Do not write or staple in this space.

Single
Married filing jointly
Married filing separately (MFS)
Head of household (HOH)
Qualifying widow(er) (QW)
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 person is a child but not your dependent ▶

Filing
Status

Check only
one box.
Your first name and middle initial

Last name

Your social security number

Last name

Spouse’s social security number

DRAFT AS OF
August 19, 2021
DO
NOT FILE
{

If joint return, spouse’s first name and middle initial

Home address (number and street). If you have a P.O. box, see instructions.

City, town, or post office. If you have a foreign address, also complete spaces below.
Foreign country name

Apt. no.

State

Foreign province/state/county

Presidential Election Campaign

Check here if you, or your
spouse if filing jointly, want
$3 to go to this fund.
Checking a box below will
Foreign postal code not change your tax or
refund.
You
Spouse

ZIP code

At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any
financial interest in any virtual currency? . . . . . . . . . . . . . . . . . . . . ▶
You as a dependent
Your spouse as a dependent
Standard Someone can claim:
Spouse itemizes on a separate return or you were a dual-status alien
Deduction
Age/Blindness

Dependents

(see instructions): (1) First name

You:
Spouse:

Were born before January 2, 1957
Was born before January 2, 1957
(2) Social security number (3) Relationship to
you

Last name

Yes

No

Are blind
Is blind

(4) ✔ if qualifies for (see instructions):
Child tax credit

Credit for other dependents

If more than four
dependents, see
instructions and
check here ▶

1
Attach
Schedule B
if required.

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

1

.

2a

b Taxable interest

. .

2b

3a Qualified dividends . .

3a

b Ordinary dividends .

3b

4a IRA distributions . . .

4a

b Taxable amount

. .

4b

5a Pensions and annuities

5a

b Taxable amount

. .

5b

6a Social security benefits .

6a

b Taxable amount

. .

6b

2a Tax-exempt interest

7

Capital gain or (loss). Attach Schedule D if required. If not required,
check here . . . . . . . . . . . . . . . . . . . . . . . ▶

7

8

Other income from Schedule 1, line 10 . . . . . . . . . . . . . .

8

9

Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . .

9

▶

10

Adjustments to income from Schedule 1, line 26 . . . . . . . . . .

10

11

Subtract line 10 from line 9. This is your adjusted gross income

11

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

. .

Cat. No. 71930F

▶

Form 1040-SR (2021)

Page 2

Form 1040-SR (2021)

Standard 12a Standard deduction or itemized deductions (from
Deduction
Schedule A) . . . . . . . . . . . . . . . . . 12a
See Standard
Deduction Chart
on the last page
of this form.

b Charitable contributions if you take the standard
deduction (see instructions) . . . . . . . . . . .

12b

DRAFT AS OF
August 19, 2021
DO NOT FILE
c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . .

13

Qualified business income deduction from Form 8995 or Form 8995-A .

13

14

Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . .

14

15

Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- .

15

16

Tax (see instructions). Check if any from:
1

. . . . . . .

16

17

Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . .

17

18

Add lines 16 and 17

. . . . . . . . . . . . . . . . . . . . .

18

19

Nonrefundable 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

23

Other taxes, including self-employment tax, from Schedule 2, line 21 . .

23

24

Add lines 22 and 23. This is your total tax

24

25

Federal income tax withheld from:

Form(s) 8814

2

Form 4972

3

. . . . . . . . . . .

a Form(s) W-2 . . . . . . . . . . . . . . . . .

25a

b Form(s) 1099

. . . . . . . . . . . . . . . .

25b

c Other forms (see instructions) . . . . . . . . . .

25c

▶

d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . .
26
If you have
a qualifying
child, attach
Sch. EIC.

12c

2021 estimated tax payments and amount applied from 2020 return . .

27a Earned income credit (EIC) . . . . . . . . . . .
Check here if you had not reached the age of 19
by December 31, 2021, and satisfy all other
requirements for claiming the EIC. See instructions ▶
b Nontaxable combat pay election .

27b

c Prior year (2019) earned income .

27c

28

25d
26

27a

Refundable child tax credit or additional child tax
credit from Schedule 8812 . . . . . . . . . . .

28

29

American opportunity credit from Form 8863, line 8 .

29

30

Recovery rebate credit. See instructions

30

31

Amount from Schedule 3, line 15 . . . . . . . .
31
Add lines 27a and 28 through 31. These are your total other payments
and refundable credits . . . . . . . . . . . . . . . . . . . ▶

32

Add lines 25d, 26, and 32. These are your total payments . . . . .

33

32
33

Go to www.irs.gov/Form1040SR for instructions and the latest information.

. . . . .

▶

Form 1040-SR (2021)

Page 3

Form 1040-SR (2021)

Refund 34

If line 33 is more than line 24, subtract line 24 from line 33. This is the
amount you overpaid . . . . . . . . . . . . . . . . . . . . .

34

35a Amount of line 34 you want refunded to you. If Form 8888 is attached,
check here . . . . . . . . . . . . . . . . . . . . . . . ▶
35a

DRAFT AS OF
August 19, 2021
DO NOT FILE

Direct deposit? ▶ b
See
instructions.
▶d

36

▶

Estimated tax penalty (see instructions) . . . . .

36

▶

37

38

Do you want to allow another person to discuss this return with the IRS? See
instructions . . . . . . . . . . . . . . . . . . . . . ▶
Phone
no. ▶

Yes. Complete below.

No

Personal identification
▶
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 belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information
of which preparer has any knowledge.
If the IRS sent you an Identity
Date
Your occupation
Your signature
Protection PIN, enter it here
(see inst.)

▲

Paid
Preparer
Use Only

Savings

Account number

Designee’s
name ▶

Joint return?
See instructions.
Keep a copy for
your records.

Checking

Amount you owe. Subtract line 33 from line 24. For details on how to
pay, see instructions . . . . . . . . . . . . . . . . . . . . ▶

38

Sign
Here

c Type:

Amount of line 34 you want applied to your 2022
estimated tax . . . . . . . . . . . . . . . ▶

Amount 37
You Owe
Third Party
Designee

Routing number

Spouse’s signature. If a joint return, both must sign.

Date

Phone no.

Email address

Preparer’s name

Preparer’s signature

Spouse’s occupation

Date

If the IRS sent your spouse an
Identity Protection PIN, enter it here
(see inst.)

Check if:

PTIN

Self-employed
Firm’s name

▶

Firm’s address ▶

Go to www.irs.gov/Form1040SR for instructions and the latest information.

Phone no.
Firm’s EIN

▶

Form 1040-SR (2021)

Page 4

Form 1040-SR (2021)

Standard Deduction Chart*
Add the number of boxes checked in the “Age/Blindness” section of Standard Deduction on page 1 . . . .

IF your filing
status is. . .

AND the number of
boxes checked is. . .

THEN your standard
deduction is. . .

DRAFT AS OF
August 19, 2021
DO NOT FILE
1

$14,250

2

15,950

1

$26,450

2

27,800

3

29,150

4

30,500

Qualifying
widow(er)

1

$26,450

2

27,800

Head of
household

1

$20,500

2

22,200

1

$13,900

2

15,250

3

16,600

4

17,950

Single

▶

Married
filing jointly

Married filing
separately**

* Don’t use this chart if someone can claim you (or your spouse if filing jointly) as a dependent, your spouse itemizes on a
separate return, or you were a dual-status alien. Instead, see instructions.
** You can check the boxes for your spouse if your filing status is married filing separately and your spouse had no
income, isn’t filing a return, and can’t be claimed as a dependent on another person’s return.
Go to www.irs.gov/Form1040SR for instructions and the latest information.

Form 1040-SR (2021)