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 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
Emonee M Wells 159-82-6546
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
425 Dargan St 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
Pittsburgh PA 152241801 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, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes 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, 1957 Are blind Spouse: Was born before January 2, 1957 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 10,118.
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— a
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . 7
• Single or
Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8
separately,
$12,550 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . a 9 10,118.
• Married filing 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
jointly or
11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . a 11 10,118.
Qualifying
widow(er),
$25,100
12a Standard deduction or itemized deductions (from Schedule A) . . 12a 12,550.
• Head of b Charitable contributions if you take the standard deduction (see instructions) 12b
household,
$18,800 c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . 12c 12,550.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . 14 12,550.
Deduction,
see instructions.
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. Form 1040 (2021)
Form 1040 (2021) 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
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 0.
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 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 . . . . . . . . . . . . . . . . a 24 0.
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 138.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 138.
26 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . 26
If you have a
qualifying child, 27a Earned income credit (EIC) . . . . . . . . . . . . . . 27a
attach Sch. EIC.
Check here if you were born after January 1, 1998, and before
January 2, 2004, and you satisfy all the other requirements for
taxpayers who are at least age 18, to claim the EIC. See instructions a
b Nontaxable combat pay election . . . . 27b
c Prior year (2019) earned income . . . . 27c
28 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 1,400.
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits a 32 1,400.
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . a 33 1,538.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 1,538.
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . a 35a 1,538.
Direct deposit? ab Routing number 0 4 1 2 1 5 6 6 3 a c Type: Checking Savings
See instructions. a
d Account number 1 3 3 2 5 0 2 6 8 8 4 7 2
36 Amount of line 34 you want applied to your 2022 estimated tax . . a 36
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . a 37
You Owe 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. 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? Student (see inst.) a

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. (412)872-1627 Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name a Self-Prepared Phone no.
Use Only a a
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 02/02/22 Intuit.cg.cfp.sp Form 1040 (2021)
 2100111323

PA-40 - 2021
Pennsylvania Income Tax Return
ENTER ONE LETTER OR NUMBER IN EACH BOX (06-21)

N Extension. N Amended Return.

159826546
R Residency Status.
WELLS PA Resident/Nonresident/Part-Year Resident
from to
EMONEE M Occupation STUDENT S Single, Married/Filing Jointly,
Married/Filing Separately, Final Return
Occupation
N Deceased

N Taxpayer Date of Death

N Spouse Date of Death

425 DARGAN ST
N Farmers.
PITTSBURGH PA 15224 School District Name PITTSBURGH
________________________

412-872-1627 02745

1a Gross Compensation. Do not include exempt income, such as combat zone pay and 1a 10118
qualifying retirement benefits. See the instructions.

1b Unreimbursed Employee Business Expenses. 1b 0

1c Net Compensation. Subtract Line 1b from Line 1a. 1c 10118

2 Interest Income. Complete PA Schedule A if required. 2 0

3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 3 0
4 Net Income or Loss from the Operation of a Business, Profession or Farm. 4 0

5 Net Gain or Loss from the Sale, Exchange or Disposition of Property. 5 0

6 Net Income or Loss from Rents, Royalties, Patents or Copyrights. 6 0
7 Estate or Trust Income. Complete and submit PA Schedule J. 7 0
8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 8 0
9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c, 9 10118
2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6.

10 Other Deductions. Enter the appropriate code for the type of deduction. N 10 0
See the instructions for additional information.
11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. 11 10118

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EC OFFICIAL USE ONLY FC

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 2100211339
PA-40 - 2021
Social Security Number

159826546 Name(s) EMONEE M WELLS

12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307). 12 311

13 Total PA Tax Withheld. See the instructions. 13 311

14 Credit from your 2020 PA Income Tax return. 14 0

15 2021 Estimated Installment Payments. REV-459B included. N 15 0
16 2021 Extension Payment. 16 0
17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 17 0
18 Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17. 18 0
Tax Forgiveness Credit. Submit PA Schedule SP.
19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19a 00
19b Dependents, Section II, Line 2, PA Schedule SP 19b 00
20 Total Eligibility Income from Section III, Line 11, PA Schedule SP. 20 0
21 Tax Forgiveness Credit from Section IV, Line 16, PA Schedule SP. 21 0

22 Resident Credit. Submit your PA Schedule(s) G-L and/or RK-1. 22 0

23 Total Other Credits. Submit your PA Schedule OC. 23 0
24 TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23. 24 311
25 USE TAX. Due on internet, mail order or out-of-state purchases. See instructions. 25 0
26 TAX DUE. If the total of Line 12 and Line 25 is more than line 24, enter the difference here. 26 0
27 Penalties and Interest. See the instructions. Enter Code: 27 0
If including form REV-1630/REV-1630A, mark the box. N
28 TOTAL PAYMENT DUE. See the instructions. 28 0
29 OVERPAYMENT. If Line 24 is more than the total of Line 12, Line 25 and Line 27, enter 29 0
the difference here.
The total of Lines 30 through 36 must equal Line 29.
30 Refund – Amount of Line 29 you want as a check mailed to you. REFUND 30 0
31 Credit – Amount of Line 29 you want as a credit to your 2022 estimated account. 31 0

32 Refund donation line. Enter the organization code and donation amount. See instructions. 32
33 Refund donation line. Enter the organization code and donation amount. See instructions. 33
34 Refund donation line. Enter the organization code and donation amount. See instructions. 34
35 Refund donation line. Enter the organization code and donation amount. See instructions. 35
36 Refund donation line. Enter the organization code and donation amount. See instructions. 36

Signature(s). Under penalties of perjury, I (we) declare that I (we) have examined this return, including all
accompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete.
Your Signature Spouse’s Signature, if filing jointly

Preparer’s Name and Telephone Number Date E-File Opt Out N

SELF-PREPARED
Firm FEIN
Preparer’s PTIN
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