JOSUE PEREZ VELEZ 771-72-2517

2 0 1 9
PERSONAL INFORMATION
TAXPAYER
Social Security Number Birthdate
Age: 32 Deceased
771-72-2517 07/14/1987
First Name Initial
JOSUE
Last Name Suffix
PEREZ VELEZ
Occupation Dependent on Blind Disabled
WOLKER another return? NO NO NO
Home Phone Work Phone Cell Phone
786-334-3764 786-334-3764
EMail
benjirangel87@yahoo.com
Filing Status (1=Single, 2=Married, 3=MFS, 4=HOH, 5=Widow) . . . . . . . . . . . . . . . . (1 )
Check this box if married filing separately and you lived with spouse at any time during the tax year . . . . . . . . ( )
If so, did you live together during the last six months? . . . . . . . . . . . . . . . . . . . . ( )
SPOUSE
Social Security Number Birthdate
Age: Deceased

First Name Initial

Last Name Suffix

Occupation Dependent on Blind Disabled

another return?

Home Phone Work Phone Cell Phone

EMail

ADDRESS
In Care Of

Street Address Apt. #

3810 CORTEZ DR D
City/State/Zip
TAMPA FL 33614
Note(s):

9CLIENT1
 Diagnostics Report

Prepared for:
JOSUE PEREZ VELEZ

3810 CORTEZ DR APT D

TAMPA FL 33614

Work: Home: 786-334-3764

Further Info:

Tax Year 2019

771-72-2517

Diagnostic Information:

Return Printed on 03/31/2020 at 02:03:16 PM

Diagnose Successful - No Errors Found!

9USBDR1
 Consent to Use of Tax Return Information
2019 Tax Year

This form is provided to you by LA FAMILIA MULTISERVICES (Tax Preparer).

Federal law requires this consent form be provided to you. Unless authorized by law, we, as your Tax
Preparer, cannot use your tax return information for purposes other than the preparation and filing of
your tax return without your consent.

You are not required to complete this form to engage our tax return preparation services. If we obtain
your signature on this form by conditioning our tax return preparation services on your consent, your
consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not
specify the duration of your consent, your consent is valid for one year from the date of signature.

If you would like us to use your tax return information to determine your eligibility for the following
product(s), please choose the particular product and check the appropriate box below:

X - Tax Refund - Refund Advance Bank Product

X - Tax Refund - Refund Transfer Bank Product

X - Audit Protection

Printed Name of Taxpayer: Printed Name of Joint Taxpayer:

JOSUE PEREZ VELEZ

Taxpayer Signature: Joint Taxpayer Signature:

Date: Date:

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.
9USCON1
This Page was Printed on: 03/31/20 at 02:03:16 PM
Home Phone:786-334-3764 771-72-2517
Cell Phone:786-334-3764 INVOICE TAX YEAR 2019
Receipt Number: Site ID: Date:
Client Name and Address Office Information PPID:0010RP

3810 CORTEZ DR APT D

TAMPA FL 33614

Description of Services / Charges

Non-Financial Product Related Services / Charges Taxable Amount

1. Itemized Form Billing Charges .................................

2. Hourly Charges Hours @ / Hour
3. Service Bureau Fee / Service Fee................................
4. Document / Electronic Filing Fee ................................
5. Self Prepared Flat Fee .....................................
6. Predefined Charge
7.
8.
9.
10.

1. Software Technology Fee ...................................

2. Transmitter Fee .........................................
3. Electronic Filing Fee* ......................................

Non-Financial Related Subtotal .......

Discounts and Credits

Amount
1. Tax Preparation Discount ...................... %
2. .......
3. .......
4. .......
Discount and Credit Total ....... ( )

@ .......

Non- Financial Related Total .......

Ancillary Products Related Services / Charges

Amount
1. .......
2. .......
3. .......

Ancillary Products Related Subtotal .......

9USIN1
Home Phone:786-334-3764 771-72-2517
Cell Phone:786-334-3764 INVOICE TAX YEAR 2019
Receipt Number: Site ID: Date:
Client Name and Address Office Information PPID:0010RP

3810 CORTEZ DR APT D

TAMPA FL 33614

Description of Services / Charges

Non-Financial Product Related Services / Charges Taxable Amount

1. Itemized Form Billing Charges .................................

2. Hourly Charges Hours @ / Hour
3. Service Bureau Fee / Service Fee................................
4. Document / Electronic Filing Fee ................................
5. Self Prepared Flat Fee .....................................
6. Predefined Charge
7. Transmitter Fee Add-On ....................................
8. Electronic Filing Fee Add-On .................................
9.
10.

1. Software Technology Fee ...................................

2. Transmitter Fee .........................................
3. Electronic Filing Fee* ......................................

Non-Financial Related Subtotal .......

Discounts and Credits

Amount
1. Tax Preparation Discount ...................... %
2. .......
3. .......
4. .......
Discount and Credit Total ....... ( )

@ .......

Non- Financial Related Total .......

Ancillary Products Related Services / Charges

Amount
1. .......
2. .......
3. .......

Ancillary Products Related Subtotal .......

9USIN4
 INVOICE
Client Name and Address Office Information

3810 CORTEZ DR APT D

TAMPA FL 33614

Financial Product Related Services / Charges TAX YEAR 2019

Amount

1. Transmitter Fee ..................................................

2. Electronic Filing Fee* ...............................................
3. Software Technology Fee .............................................
4. Service Bureau Fee / Service Fee .........................................
5. Account-handling Fee Paid to Bank ........................................
6. Document/Electronic Filing Fee
..........................................
7. Finance Charge .................................................
Bank Product Type: Financial Related Total ......
Description of Payment / Credit

Date Received Received From Method Amount

Payment / Credit Total ...... ( )

Invoice Summary

Total of Non- Financial Related Charges .....................................

Prior Year Balance ...............................................
Total Payments Received ............................................ ( )
Sub-Total of Non- Financial Related Charges ..................................
Total of Ancillary Product Related Charges ...................................

Total of Financial Related Charges .......................................

Net Invoice ...................................................
Amount Expected to be Paid by Financial Institution ...............................
Balance Due ..................................................
*Electronic Filing Fees do not apply to New York State returns

Total Itemized Form Billing Amount

9USIN2
 Privacy Statement

In engaging us as your tax preparer, you provide us with information that you entrust to us. Your privacy and
maintaining confidentiality of your personal information are the highest priorities and responsibilities at every staff
level of our firm. Not only is it good business - you expect it and it is required in this day and age of technology.

Why You Are Receiving this Notice

You are receiving this notice because you are a client of PEREZ VELEZ, or you are considering becoming our
client. This notice describes our privacy policy as it pertains to information that you provide to us.

Types of Information We Collect

We collect certain personal information about you - but only when that information is provided by you or is
obtained by us with your authorization. We use the information that you provide to prepare income tax returns
and/or other services to you (at your request), that you engage us to perform.

Examples of sources from which we collect information include:

- interviews and phone calls with you,
- letters and emails from you,
- tax return or financial planning organizers and questionnaires, and
- other documents provided by you on behalf of yourself, your family, or your company/organization.

Confidentiality and Security of Nonpublic Personal Information

Except as otherwise described later in this notice, we restrict access to nonpublic personal information about you
to employees of our firm and other parties who must use that information to provide services to you. Their right to
further disclosure and use the information is limited by the policies of our firm, applicable law, and nondisclosure
agreements where appropriate. We also maintain physical, electronic, and procedural safeguards to guard your
personal information from unauthorized access or alteration.

Parties to Whom We Disclose Information

As a general rule, we do not disclose personal information about our clients or former clients to anyone without
your permission. However, to the extent required by law and applicable regulatory requirements, certain
nonpublic information about you may be disclosed in the following situations:

-To comply with a validly issued and enforceable subpoena or summons.

-To provide workpapers or specific information to assist you in complying with industry-specific federal and
state regulations and requirements.
-In conjunction with a prospective purchase, sale, or merger of all or part of our practice, provided that we
take appropriate precautions (for example, through a written confidentiality agreement) so that the
prospective purchaser or merger partner does not disclose information obtained in the course of the review.
-To provide information to affiliates of the firm and nonaffiliated third parties who perform services or
functions for us in conjunction with our services to you, but only if we have a contractual agreement with
the other party which prohibits them from disclosing or using the information other than for the purposes for
which it was disclosed.

Marketing Our Products and Services

As permitted by applicable law, we may use personal information to provide you with materials about offers,
products, and services that may be of interest to you. You may contact us at any time to opt out of the use of your
personal information for marketing purposes.

In Closing
Thank you for allowing us to serve your tax preparation needs. We value your business and are committed to
protecting your privacy.
March 31, 2020

, -
- -

JOSUE PEREZ VELEZ

3810 CORTEZ DR APT D

TAMPA, FL 33614-0000

Dear Client,

It’s time to gather your tax information and meet with us for your tax appointment.

Your appointment is with at .

Date: Time:

If this date and time is not convenient for you, please call us as soon as possible to schedule
another appointment.

If you have any questions about your return, please feel free to contact our office. Remember
that we are here throughout the year to assist you with all of your financial and tax consulting
needs.

Sincerely,
March 31, 2020
PEREZ VELEZ
9730-9726 2DA AEV NE
MIAMI, FL 33138
786-326-4542

JOSUE PEREZ VELEZ

3810 CORTEZ DR APT D

TAMPA, FL 33614-0000

Dear Client,

Please find enclosed your 2019 Federal individual income tax return. We prepared your return
based on the information provided. Please review the return carefully to ensure that there are
no omissions. You should retain a copy of your return, along with any supporting documents,
for a minimum of three years from the filing date.

Your Federal return was filed electronically. The IRS was instructed to deposit your refund of
$352 directly into your bank account. Most direct deposits are made within three weeks.

As your Electronic Return Originator, we will forward your required supporting documents to
the IRS.

If you have any questions about your return, please feel free to contact our office. Remember
that we are here throughout the year to assist you with all of your financial and tax consulting
needs.

Sincerely,
JOSUE PEREZ VELEZ 771-72-2517
2019 TAX SUMMARY

1. Wages, Salaries and Tips ........ 19. Itemized / Standard Deduction .......... ( 12,200)
2. Interest ................. 20. Qualified Business Income Deduction ...... ( 101)
3. Dividends ................ ... 21. Taxable Income ................. 403
4. Taxable IRA Distributions ........ 22. Tentative Tax .................. 41
5. Taxable Pension Distributions ...... 23. Alternative Minimum Tax .............
6. Social Security Benefits ......... 24. Excess Advance Premium Tax Credit Repayment .
7. Capital Gain / (Loss) ........... 25. Child Tax Credit/Credit for Other Dependents ... ( )
8. State Tax Refund ............ . 26. Other Credits................... ( )
9. Alimony Received ............ 27. Self-Employment Tax............... 1,271
10. Business Income / (Loss)......... 8,993 28. Other Taxes ...................
11. Other Gain / (Loss)............ 29. Total Tax .................... 1,312
12. Rents, Royalties, Part ..........
13. Farm Income / (Loss) .......... Marginal Tax Rate ............... 10.000
14. Unemployment Compensation ...... Effective Tax Rate ............... 10.174
15. Other Income .............. 4,347
16. Total Income .............. 13,340 30. Withholding .......... 1,446
31. Estimated Payments .....
17. Adjustments to Income .......... ( 636) 32. Earned Income Credit ..... 218
18. Adjusted Gross Income ......... 12,704 33. Additional Child Tax Credit ..
34. Other Payments .......
35. Total Payments ........ 1,664

36. Amount Overpaid ............... 352

37. Amount Applied to Your 2020 Estimated Tax ..
38. Refunded to You ............... 352
39. Form 2210 / 2210F Penalty ...........
40. Amount Due ..................

Filing Status: Single

ITEMIZED DEDUCTIONS STANDARD DEDUCTION

Total Medical ................. Filing Status Standard Deduction + Age / Blind

Medical less 7.5% ...............
Single ........... 12,200 1,650
Taxes...................... 289 MFJ/QW.......... 24,400 1,300
Interest ....................
MFS ........... 12,200 1,300
Contributions .................
H of H........... 18,350 1,650
Casualty Loss .................
Other Miscellaneous ..............

TOTAL ITEMIZED DEDUCTIONS ....... 289

State Total Income Total Tax Withholdings Balance Due Refund

Visit the IRS website at http://www.irs.gov to find out about your refund.

9USTS1
 Filing Options Fee Comparison

- IRS DIRECT OPTIONS* - - BANKING OPTIONS FEES WITHHELD -

Federal Filing Options 1. Mail-In ** 2. EFile ** 3. RT ** RT / Advance **
Timeline Check ......... 6 - 8 weeks 3 - 4 weeks 10 - 21 days 10 - 21 days
Timeline Direct Deposit ..... 5 - 7 weeks 10 - 21 days 10 - 21 days 10 - 21 days

Refund Amount ......... 352.00 352.00 352.00 352.00

** Timeline starts from IRS Acceptance

Bank Fees
Refund Administration Federal Fee** NONE NONE 39.95 39.95
Refund Administration State Fee** NONE NONE NONE NONE

Transmitter Fee ......... NONE NONE 48.00 NONE

Electronic Filing Fee....... NONE NONE NONE NONE

Technology Access Fee ..... NONE NONE 25.95 25.95

Office Fees
Tax Preparation Fee ...... NONE NONE 44.00 44.00
Service Bureau Fee ....... NONE NONE 45.00 45.00

Document Preparation Fee NONE NONE NONE NONE

Other Products / Services .... NONE NONE NONE NONE
Total Fees (e) .......... NONE NONE 202.90 202.90
Amount Due Today* (e) ..... NONE NONE NONE NONE
Amount You Receive (e) .... 352.00 352.00 149.10 149.10

Amount of Advance (e) .............................................. NONE

Finance Charge ................................................. NONE
Amount after Advance (e) ............................................. 149.10
Initial below the option selected.
Taxpayer/Spouse Initials ....
"(e)" = Estimate
* All tax preparation and other fees must be paid at the time of filing.
Direct deposit funds availability may be delayed one or more days due to your bank.
**May reduce the cost of the financial product based on Bank Pricing, State RAC and disbursement type of the actual return.

Name of Taxpayer: Name of Spouse:

JOSUE PEREZ VELEZ
Taxpayer's Signature: Spouse's Signature:

Date 03/31/2020 Date

Not an official document

9USFO2
 OMB No. 1545-0074
IRS e-file Signature Authorization
Form 8879 ) ERO must obtain and retain completed Form 8879.
Department of the Treasury
Internal Revenue Service ) Go to www.irs.gov/Form8879 for the latest information.
2019
Submission Identification Number (SID) )
Taxpayer's name Social security number
JOSUE PEREZ VELEZ 771-72-2517
Spouse's name Spouse’s social security number

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 12,704
2 Total tax (Form 1040 or 1040-SR, line 16; Form 1040-NR, line 61) . . . . . . . . . . . . . . 2 1,312
3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040 or 1040-SR, line 17; Form
1040-NR, line 62a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1,446
4 Refund (Form 1040 or 1040-SR, line 21a; Form 1040-NR, line 73a; Form 1040-SS, Part I, line 13a) . 4 352
5 Amount you owe (Form 1040 or 1040-SR, line 23; Form 1040-NR, line 75) . . . . . . . . . . . 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

X I authorize LA FAMILIA MULTISERVICES to enter or generate my PIN 02517
ERO firm name Enter five digits, but
as my signature on my tax year 2019 electronically filed income tax return. don’t enter all zeros

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 ) Date )

Spouse’s PIN: check one box only

I authorize to enter or generate my PIN
ERO firm name Enter five digits, but
as my signature on my tax year 2019 electronically filed income tax return. don’t enter all zeros

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 ) Date )

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. 65614512345
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 ) Date )

ERO Must Retain This Form - See Instructions
Don’t Submit This Form to the IRS Unless Requested To Do So
SPA For Paperwork Reduction Act Notice, see your tax return instructions. 1037 CPTS 9USPA1 Form 8879 (2019)
 Department of the Treasury—Internal Revenue Service (99)
1040 U.S. Individual Income Tax Return 2019 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 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.
Your first name and middle initial Last name Your social security number
JOSUE PEREZ VELEZ 771-72-2517
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
Check here if you, or your spouse if filing
3810 CORTEZ DR APT D 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
TAMPA FL 33614 tax or refund. You Spouse

Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and ! here

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

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
3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b
Standard
Deduction for— 4a IRA distributions . . . . . 4a b Taxable amount . . . . . . 4b
8 Single or Married
c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d
filing separately,
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
8 Married filing
jointly or Qualifying
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . 6
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 13,340
7a
$24,400
8 Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . 7b 13,340
household,
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a 636
8 If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . 8b 12,704
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 12,200
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 101
10
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 12,301
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 403
SPA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. 1037 CPTS 9US011 Form 1040 (2019)
Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 41
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . 12b 41
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . 13b
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 41
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 1,271
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . 16 1,312
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17 1,446
8 If
18 Other payments and refundable credits:
you have a
qualifying child,
attach Sch. EIC.
a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a 218
8 Ifyou 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 . . . . . 18e 218
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . 19 1,664
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 352
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . 21a 352
Direct deposit? b Routing number 063100277 c Type: X Checking Savings
See instructions.
d Account number 898087046600
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . 23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . 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 no. number (PIN)

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
(see inst.)
Joint return? WOLKER
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.)

Phone no. Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid
Preparer ROCIO PEREZ (RTRP) P02348687 3rd Party Designee

Use Only
Firm’s name PEREZ VELEZ Phone no. 786-326-4542 Self-employed
Firm’s address 9730-9726 2DA AEV NE MIAMI FL 33138 Firm’s EIN

SPA Go to www.irs.gov/Form1040 for instructions and the latest information. 1037 CPTS 9US012 Form 1040 (2019)
 US RET 1040
Qualified Business Income Activities
Name(s) Tax Identification Number
JOSUE PEREZ VELEZ 771-72-2517

Trade or Business Name: JEUNESSE LLC

Taxpayer Identification Number: 27-0724014
Business Income........................................... 3,504
Allocated Deduction for One-Half of Self-Employment Tax... (244)
Qualified Business Income....................... 3,260

Trade or Business Name: LYFT

Taxpayer Identification Number: 20-8809830
Business Income........................................... 3,419
Allocated Deduction for One-Half of Self-Employment Tax... (238)
Qualified Business Income....................... 3,181

Trade or Business Name: UBER

Taxpayer Identification Number: 45-2647441
Business Income........................................... 2,200
Allocated Deduction for One-Half of Self-Employment Tax... (153)
Qualified Business Income....................... 2,047

Trade or Business Name: PHARMACEUTICAL RESER

Taxpayer Identification Number: 54-1204111
Business Income........................................... (130)
Qualified Business Income....................... (130)

2019 {) CPTS 8us01k_1 04/03/2019

 US RET 1040
Earned Income Credit Wks
Name(s) Tax Identification Number
JOSUE PEREZ VELEZ 771-72-2517

1. Amount from Form 1040, line 1 ........................ 1. _________

2. Taxable scholarships or fellowship grants, deferred
compensation amounts, prisoner income and Medicaid
......................
waiver payments to care providers 2. _________
3. ..........................
Subtract line 2 from line 1 3. _________
4. Self-employment income .......................... 4. _________
8,357
5a. Earned Income (Excluding combat pay) .................. 5a. _________
8,357
5b. Nontaxable Combat pay ........................................ 5b. _________
6. Earned Income (Including combat pay) ................................ 6. _________
8,357
7. EIC based on lines 5a and 6 ......................... 7a. _________
529 7b. _________
8. Adjusted gross income ............................ 8a. _________
12,704 8b. _________
12,704
9. EIC on lines 8A and 8B if different from 7A & 7B ................ 9a. _________
218 9b. _________
218
Filing status allows credit? Y_
Within Investment Income Limit? Y_
10. Earned income credit ......................................... 10. _________
218
Disqualified Investment Income ($3,600 Limit)
1. Interest (including tax-exempt) ........................ 1. _________
2. Dividends .................................. 2. _________
3. Net rental and royalty income ......................... 3. _________
4. Net capital gain income ............................ 4. _________
5. Net passive income .............................. 5. _________
6. Total disqualified income ........................................ 6. _________

Line 4 Worksheet - Self Employment Income

1. If filing Schedule SE:
a. Amount from Sch SE, Sec A or B, line 3 .................... a. _________
8,993
b. Amount from Sch SE, Section B, line 4b .................... b. _________
c. Add lines 1a and 1b ............................. c. _________
8,993
d. Amount from Schedule 1 (Form 1040), line 14 ................. d. _________
636
e. Subtract line 1d from line 1c ...................................... e. _________
8,357
2. If not required to file Schedule SE:
a. Net farm profit or loss ............................. a. _________
b. Net profit or loss ............................... b. _________
c. Add lines 2a and 2b .......................................... c. _________
3. Statutory employee ........................................... 3. _________
4. Add lines 1e, 2c, and 3 ......................................... 4. _________
8,357

2019 {) CPTS 9us01t1 12/04/2019

SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
Department of the Treasury Attach to Form 1040 or 1040-SR. 2019
Attachment
Internal Revenue Service 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
JOSUE PEREZ VELEZ 771-72-2517
At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any
virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X 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)
3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . 3 8,993
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 PRIVATE TRANSPORT 4,347
8 4,347
9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . . . . . 9 13,340
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 . . . . . . . . . . . . . . 14 636
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 . . . . . . . . . . . . . . . . . . . . .
c Date of original divorce or separation agreement (see instructions)
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 636
SPA For Paperwork Reduction Act Notice, see your tax return instructions. 1037 CPTS 9US0A1 Schedule 1 (Form 1040 or 1040-SR) 2019
 US RET SCH 1
Other Income Wks
Name(s) Tax Identification Number
JOSUE PEREZ VELEZ 771-72-2517

1. Gambling income .................................... _________ 1. _________

2. Child’s Interest ............................................... 2. _________
3. Taxpayer’s other income subject to SE tax ........................ _________ 3. _________
4. Spouse’s other income subject to SE tax ......................... _________ 4. _________
5. Net operating loss deduction .............................. _________ 5. ( _________)
6. Reserved for future use ........................................... 6. _________
7. Housing exclusion and/or Foreign earned income exclusion from
Form 2555 Taxpayer _________ Spouse _________ 7. _________
8. Excess Parsonage or utility allowance .................................... 8. _________
9. Form 8853 Taxable Archer MSA Distributions ................................. 9. _________
10. Form 8853 Taxable LTC Payments ..................................... 10. _________
11. Form 8889 Taxable HSA Distributions .................................... 11. _________
12. Form 8853 Taxable Medicare Advantage MSA Distributions .......................... 12. _________
13. 1099-MISC, K1 1065/1120S Other Income .................................. 13. _________
14. 1099-G ATAA Payments and Taxable Grants ................................. 14. _________
15. Loss on Excess Deferred Distributions .................................... 15. _________
16. QTP and ESA Taxable Distributions ..................................... 16. _________
17. ABLE Account Taxable Distributions ..................................... 17. _________
18. Section 461(l) excess business loss adjustments (from Form 461) ....................... 18. _________
19. Net Section 965(a) inclusion (from Form 965, line 3 minus line 17) ....................... 19. _________
20. Election to not apply NOL deduction (Section 965(n)) ............................. 20. _________
21. Medicaid waiver payments to care provided (Notice 2014-7) .......................... _ 21. ( _________)
22. Other items ................................................. 22. _________
4,347
23. Total .................................................... 23. _________
4,347

Sect. 933, Excluded Puerto Rico Income ................................... _________

2020 {) CPTS 9us0ay1 02/27/2020

SCHEDULE 2 OMB No. 1545-0074
(Form 1040 or 1040-SR)
Additional Taxes
+ Attach to Form 1040 or 1040-SR. 2019
Department of the Treasury Attachment
Internal Revenue Service + 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

JOSUE PEREZ VELEZ 771-72-2517

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 1,271
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 1,271
SPA For Paperwork Reduction Act Notice, see your tax return instructions. 1037 CPTS 9US0B1 Schedule 2 (Form 1040 or 1040-SR) 2019
 OMB No. 1545-0074
SCHEDULE C Profit or Loss From Business
(Form 1040 or 1040-SR) (Sole Proprietorship)
Department of the Treasury j Go to www.irs.gov/ScheduleC for instructions and the latest information. 2019
Attachment
Internal Revenue Service (99) j 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)
JOSUE PEREZ VELEZ 771-72-2517
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
NETWORK MARQUETING j 621610
C Business name. If no separate business name, leave blank. D Employer ID number (EIN), (see instr.)
JEUNESSE LLC 27-0724014
E Business address (including suite or room no.) j 701 INTERNATIONAL PARKWAY
City, town or post office, state, and ZIP code LAKE MARY FL 32746
F Accounting method: (1) X Cash (2) Accrual (3) Other (specify) j
G Did you "materially participate" in the operation of this business during 2019? If "No," see instructions for limit on losses X Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . j X
I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes X No
J If "Yes," did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes X 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 . . . . . . . . j 1 11,635
2 Returns and allowances . . . . . .
. . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . .
. . . . . . . . . . . . . . . . . . . 3 11,635
4 Cost of goods sold (from line 42) . . .
. . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 11,635
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 . . . . . . . . . . . . . . . . . . . . . j 7 11,635
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 1,236
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21 1,263
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 5,632
expense deduction (not
23 Taxes and licenses . . . . .
included in Part III) (see 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 . . . . . j 28 8,131
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 3,504
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.
8 If a profit, enter on both Schedule 1 (Form 1040 or 10404-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 trusts, enter on Form 31 3,504
1041, line 3.
8 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).
8 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 32a All investment is at risk.
line 31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
8 If you checked 32b, you must attach Form 6198. Your loss may be limited.
SPA For Paperwork Reduction Act Notice, see the separate instructions. 1037 CPTS 9US091 Schedule C (Form 1040 or 1040-SR) 2019
 US SCH C
Profit Sharing Plan Contribution Wks
Name(s) Tax Identification Number
JOSUE PEREZ VELEZ 771-72-2517

Profit Sharing Plan Contribution Worksheet

1. Net profit from Schedule C, line 31; Schedule F, line 34; Schedule K-1
(Form 1065), box 14, code A _________
8,993
2. Self-employment tax deduction from Schedule 1 (Form 1040), line 27 _________
636
3. Net earnings from self-employment. Subtract step 2 from step 1 _________
8,357
4. Reduced contribution rate _______ % 020.0000
________ %
5. Multiply step 3 by step 4 _________
1,671
6. Multiply $280,000 by your plan contribution rate (not the reduced rate) _________
70,000
7. Enter the smaller of step 5 or step 6 _________
1,671
8. Contribution dollar limit _________
56,000
9. Enter your allowable elective deferrals (including designated Roth contributions)
made to your self-employed plan during 2019. Do not enter more than $19,000 _________
10. Subtract step 9 from step 8 _________
56,000
11. Subtract step 9 from step 3 _________
8,357
12. Enter one-half of step 11 _________
4,179
13. Enter the smallest of step 7, 10, or 12 _________
1,671
14. Subtract step 13 from step 3 _________
6,686
15. Enter the smaller of step 9 or step 14 _________
16. Subtract step 15 from step 14 _________
6,686
17. Enter your catch-up contributions, if any. Do not enter more than $6,000 _ _________
18. Enter the smaller of step 16 or step 17 _________
19. Add steps 13, 15, and 18. _________
1,671
20. Enter the amount of designated Roth contributions included on lines 9 and 17 _________

21. Subtract step 20 from step 19. This is your maximum deductible contribution. _________
1,671

22. This is your maximum deductible contribution per this Sch C _________
641

2020 {) CPTS 9us09h1 01/16/2020

 OMB No. 1545-0074
SCHEDULE C Profit or Loss From Business
(Form 1040 or 1040-SR) (Sole Proprietorship)
Department of the Treasury j Go to www.irs.gov/ScheduleC for instructions and the latest information. 2019
Attachment
Internal Revenue Service (99) j 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)
JOSUE PEREZ VELEZ 771-72-2517
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
DRIVER LYFT j 485300
C Business name. If no separate business name, leave blank. D Employer ID number (EIN), (see instr.)
LYFT 20-8809830
E Business address (including suite or room no.) j 185 BERRY STREET
City, town or post office, state, and ZIP code SAN FRANCISCO CA 94107
F Accounting method: (1) X Cash (2) Accrual (3) Other (specify) j
G Did you "materially participate" in the operation of this business during 2019? If "No," see instructions for limit on losses X Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . j X
I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes X No
J If "Yes," did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes X 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 . . . . . . . . j 1 17,105
2 Returns and allowances . . . . . .
. . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . .
. . . . . . . . . . . . . . . . . . . 3 17,105
4 Cost of goods sold (from line 42) . . .
. . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 17,105
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 . . . . . . . . . . . . . . . . . . . . . j 7 17,105
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 7,390 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a 654
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) . 22 894
expense deduction (not
23 Taxes and licenses . . . . .
included in Part III) (see 23
instructions) . . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a 741
(other than on line 19) . . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . 24b 948
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 3,059
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 . . . . . j 28 13,686
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 3,419
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.
8 If a profit, enter on both Schedule 1 (Form 1040 or 10404-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 trusts, enter on Form 31 3,419
1041, line 3.
8 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).
8 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 32a All investment is at risk.
line 31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
8 If you checked 32b, you must attach Form 6198. Your loss may be limited.
SPA For Paperwork Reduction Act Notice, see the separate instructions. 1037 CPTS 9US091 Schedule C (Form 1040 or 1040-SR) 2019
 JOSUE PEREZ VELEZ 771-72-2517
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) j 01/01/2019
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 12,741 b Commuting (see instructions) c Other

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

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

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

b If "Yes," is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . X Yes No

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

CAR CLEANING 1,896

INTERNET 1,163

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . 48 3,059

SPA 1037 CPTS 9US092 Schedule C (Form 1040 or 1040-SR) 2019
 US SCH C
Profit Sharing Plan Contribution Wks
Name(s) Tax Identification Number
JOSUE PEREZ VELEZ 771-72-2517

Profit Sharing Plan Contribution Worksheet

1. Net profit from Schedule C, line 31; Schedule F, line 34; Schedule K-1
(Form 1065), box 14, code A _________
8,993
2. Self-employment tax deduction from Schedule 1 (Form 1040), line 27 _________
636
3. Net earnings from self-employment. Subtract step 2 from step 1 _________
8,357
4. Reduced contribution rate _______ % 020.0000
________ %
5. Multiply step 3 by step 4 _________
1,671
6. Multiply $280,000 by your plan contribution rate (not the reduced rate) _________
70,000
7. Enter the smaller of step 5 or step 6 _________
1,671
8. Contribution dollar limit _________
56,000
9. Enter your allowable elective deferrals (including designated Roth contributions)
made to your self-employed plan during 2019. Do not enter more than $19,000 _________
10. Subtract step 9 from step 8 _________
56,000
11. Subtract step 9 from step 3 _________
8,357
12. Enter one-half of step 11 _________
4,179
13. Enter the smallest of step 7, 10, or 12 _________
1,671
14. Subtract step 13 from step 3 _________
6,686
15. Enter the smaller of step 9 or step 14 _________
16. Subtract step 15 from step 14 _________
6,686
17. Enter your catch-up contributions, if any. Do not enter more than $6,000 _ _________
18. Enter the smaller of step 16 or step 17 _________
19. Add steps 13, 15, and 18. _________
1,671
20. Enter the amount of designated Roth contributions included on lines 9 and 17 _________

21. Subtract step 20 from step 19. This is your maximum deductible contribution. _________
1,671

22. This is your maximum deductible contribution per this Sch C _________
626

2020 {) CPTS 9us09h1 01/16/2020

 OMB No. 1545-0074
SCHEDULE C Profit or Loss From Business
(Form 1040 or 1040-SR) (Sole Proprietorship)
Department of the Treasury j Go to www.irs.gov/ScheduleC for instructions and the latest information. 2019
Attachment
Internal Revenue Service (99) j 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)
JOSUE PEREZ VELEZ 771-72-2517
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
DRIVER UBER j 485990
C Business name. If no separate business name, leave blank. D Employer ID number (EIN), (see instr.)
UBER 45-2647441
E Business address (including suite or room no.) j 1455 MARKET ST
City, town or post office, state, and ZIP code SAN FRANCISCO CA 94103
F Accounting method: (1) Cash (2) X Accrual (3) Other (specify) j
G Did you "materially participate" in the operation of this business during 2019? If "No," see instructions for limit on losses X Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . j X
I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes X No
J If "Yes," did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes X 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 . . . . . . . . j 1 22,781
2 Returns and allowances . . . . . .
. . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . .
. . . . . . . . . . . . . . . . . . . 3 22,781
4 Cost of goods sold (from line 42) . . .
. . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 22,781
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 . . . . . . . . . . . . . . . . . . . . . j 7 22,781
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . 8 769 18 Office expense (see instructions) 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . 9 10,709 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a 1,236
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21 913
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 974
expense deduction (not
23 Taxes and licenses . . . . . 730
included in Part III) (see 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 794
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 4,456
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 . . . . . j 28 20,581
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 2,200
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.
8 If a profit, enter on both Schedule 1 (Form 1040 or 10404-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 trusts, enter on Form 31 2,200
1041, line 3.
8 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).
8 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 32a All investment is at risk.
line 31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
8 If you checked 32b, you must attach Form 6198. Your loss may be limited.
SPA For Paperwork Reduction Act Notice, see the separate instructions. 1037 CPTS 9US091 Schedule C (Form 1040 or 1040-SR) 2019
 JOSUE PEREZ VELEZ 771-72-2517
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) j 01/01/2019
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 18,463 b Commuting (see instructions) c Other

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

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

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

b If "Yes," is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . X Yes No

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

CAR CLEANING 1,894

CAR INSURANCE 1,346

CELL PHONE 1,216

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . 48 4,456

SPA 1037 CPTS 9US092 Schedule C (Form 1040 or 1040-SR) 2019
 US SCH C
Profit Sharing Plan Contribution Wks
Name(s) Tax Identification Number
JOSUE PEREZ VELEZ 771-72-2517

Profit Sharing Plan Contribution Worksheet

1. Net profit from Schedule C, line 31; Schedule F, line 34; Schedule K-1
(Form 1065), box 14, code A _________
8,993
2. Self-employment tax deduction from Schedule 1 (Form 1040), line 27 _________
636
3. Net earnings from self-employment. Subtract step 2 from step 1 _________
8,357
4. Reduced contribution rate _______ % 020.0000
________ %
5. Multiply step 3 by step 4 _________
1,671
6. Multiply $280,000 by your plan contribution rate (not the reduced rate) _________
70,000
7. Enter the smaller of step 5 or step 6 _________
1,671
8. Contribution dollar limit _________
56,000
9. Enter your allowable elective deferrals (including designated Roth contributions)
made to your self-employed plan during 2019. Do not enter more than $19,000 _________
10. Subtract step 9 from step 8 _________
56,000
11. Subtract step 9 from step 3 _________
8,357
12. Enter one-half of step 11 _________
4,179
13. Enter the smallest of step 7, 10, or 12 _________
1,671
14. Subtract step 13 from step 3 _________
6,686
15. Enter the smaller of step 9 or step 14 _________
16. Subtract step 15 from step 14 _________
6,686
17. Enter your catch-up contributions, if any. Do not enter more than $6,000 _ _________
18. Enter the smaller of step 16 or step 17 _________
19. Add steps 13, 15, and 18. _________
1,671
20. Enter the amount of designated Roth contributions included on lines 9 and 17 _________

21. Subtract step 20 from step 19. This is your maximum deductible contribution. _________
1,671

22. This is your maximum deductible contribution per this Sch C _________
402

2020 {) CPTS 9us09h1 01/16/2020

 OMB No. 1545-0074
SCHEDULE C Profit or Loss From Business
(Form 1040 or 1040-SR) (Sole Proprietorship)
Department of the Treasury j Go to www.irs.gov/ScheduleC for instructions and the latest information. 2019
Attachment
Internal Revenue Service (99) j 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)
JOSUE PEREZ VELEZ 771-72-2517
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
CLINICAL RESEARCH j 621510
C Business name. If no separate business name, leave blank. D Employer ID number (EIN), (see instr.)
PHARMACEUTICAL RESERCH ASSOC 54-1204111
E Business address (including suite or room no.) j 4130 PARKLAKE AVENUE
City, town or post office, state, and ZIP code RALEIGH NC 27612
F Accounting method: (1) Cash (2) X Accrual (3) Other (specify) j
G Did you "materially participate" in the operation of this business during 2019? If "No," see instructions for limit on losses X Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . j X
I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes X No
J If "Yes," did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes X 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 . . . . . . . . j 1 4,100
2 Returns and allowances . . . . . .
. . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . .
. . . . . . . . . . . . . . . . . . . 3 4,100
4 Cost of goods sold (from line 42) . . .
. . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 4,100
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 . . . . . . . . . . . . . . . . . . . . . j 7 4,100
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) . 22 972
expense deduction (not
23 Taxes and licenses . . . . .
included in Part III) (see 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 886
16 Interest: (see instructions): 25 Utilities . . . . . . . . 25 631
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a 1,741
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 . . . . . j 28 4,230
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 (130)
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.
8 If a profit, enter on both Schedule 1 (Form 1040 or 10404-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 trusts, enter on Form 31 (130)
1041, line 3.
8 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).
8 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 32a X All investment is at risk.
line 31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
8 If you checked 32b, you must attach Form 6198. Your loss may be limited.
SPA For Paperwork Reduction Act Notice, see the separate instructions. 1037 CPTS 9US091 Schedule C (Form 1040 or 1040-SR) 2019
 JOSUE PEREZ VELEZ 771-72-2517
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) j
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.

CELL PHONE 1,741

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . 48 1,741

SPA 1037 CPTS 9US092 Schedule C (Form 1040 or 1040-SR) 2019
 US SCH C
Profit Sharing Plan Contribution Wks
Name(s) Tax Identification Number
JOSUE PEREZ VELEZ 771-72-2517

Profit Sharing Plan Contribution Worksheet

1. Net profit from Schedule C, line 31; Schedule F, line 34; Schedule K-1
(Form 1065), box 14, code A _________
8,993
2. Self-employment tax deduction from Schedule 1 (Form 1040), line 27 _________
636
3. Net earnings from self-employment. Subtract step 2 from step 1 _________
8,357
4. Reduced contribution rate _______ % 020.0000
________ %
5. Multiply step 3 by step 4 _________
1,671
6. Multiply $280,000 by your plan contribution rate (not the reduced rate) _________
70,000
7. Enter the smaller of step 5 or step 6 _________
1,671
8. Contribution dollar limit _________
56,000
9. Enter your allowable elective deferrals (including designated Roth contributions)
made to your self-employed plan during 2019. Do not enter more than $19,000 _________
10. Subtract step 9 from step 8 _________
56,000
11. Subtract step 9 from step 3 _________
8,357
12. Enter one-half of step 11 _________
4,179
13. Enter the smallest of step 7, 10, or 12 _________
1,671
14. Subtract step 13 from step 3 _________
6,686
15. Enter the smaller of step 9 or step 14 _________
16. Subtract step 15 from step 14 _________
6,686
17. Enter your catch-up contributions, if any. Do not enter more than $6,000 _ _________
18. Enter the smaller of step 16 or step 17 _________
19. Add steps 13, 15, and 18. _________
1,671
20. Enter the amount of designated Roth contributions included on lines 9 and 17 _________

21. Subtract step 20 from step 19. This is your maximum deductible contribution. _________
1,671

22. This is your maximum deductible contribution per this Sch C _________

2020 {) CPTS 9us09h1 01/16/2020

SCHEDULE SE OMB No. 1545-0074
(Form 1040 or 1040-SR)
Self-Employment Tax
Department of the Treasury
j Go to www.irs.gov/ScheduleSE for instructions and the latest information. 2019
Attachment
Internal Revenue Service (99) j 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
JOSUE PEREZ VELEZ with self-employment income j 771-72-2517
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

Are you a minister, member of a religious order, or Christian

Science practitioner who received IRS approval not to be taxed Yes Was the total of your wages and tips subject to social security Yes
on earnings from these sources, but you owe self-employment j or railroad retirement (tier 1) tax plus your net earnings from
self-employment more than $132,900?
j
tax on other earnings?

No No

Did you receive tips subject to social security or Medicare tax Yes
Are you using one of the optional methods to figure your net
earnings (see instructions)?
Yes
j that you didn’t report to your employer? j
No
No

Did you report any wages on Form 8919, Uncollected Social

,
Yes
j
No
Did you receive church employee income (see instructions) Yes
reported on Form W-2 of $108.28 or more? j Security and Medicare Tax on Wages?

No

You may use Short Schedule SE below j 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 8,993
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . 3 8,993
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 . . . . . . . . . .j 4 8,305
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 1,271
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 . . . . . . . . . . . . . . . 6 636
SPA For Paperwork Reduction Act Notice, see your tax return instructions. 1037 CPTS 9US171 Schedule SE (Form 1040 or 1040-SR) 2019
 Qualified Business Income Deduction OMB No. 1545-0123
Form 8995 Simplified Computation 2019
Department of the Treasury Attach to your tax return. 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

JOSUE PEREZ VELEZ 771-72-2517
1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)

i JEUNESSE LLC 27-0724014 3,260

ii LYFT 20-8809830 3,181

iii UBER 45-2647441 2,047

iv PHARMACEUTICAL RESERCH AS 54-1204111 (130)

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

column (c) . . . . . . . . . . . . . . . . . . . . . . 2 8,358
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 8,358
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 1,672
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 1,672
11 Taxable income before qualified business income deduction . . . . . . 11 504
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . 12
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . 13 504
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 101
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 . . . . . . . . . . . . . . . . . . . . . . 15 101
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . 16 ( )
17 Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 ( )
SPA For Privacy Act and Paperwork Reduction Act Notice, see instructions. 1037 CPTS 9USQA1 Form 8995 (2019)
 OMB No. 1545-1629
EIC Checklist
Department of the Treasury
j To be completed by preparer and filed with Form 1040, 1040A, or 1040EZ. 2019
Attachment
Internal Revenue Service j Information about Form 8867 and its separate instructions is at www.irs.gov/form8867. Sequence No. 70
Taxpayer name(s) shown on return Taxpayer’s social security number
JOSUE PEREZ VELEZ 771-72-2517
For the definitions of Qualifying Child and Earned Income, see Pub. 596.

Part I All Taxpayers

1 Enter preparer's name and PTIN j ROCIO PEREZ P02348687

2 Is the taxpayer’s filing status married filing separately? . . . . . . . . . . . . . . Yes X No

j If you checked "Yes" on line 2, stop; the taxpayer cannot take the EIC. Otherwise, continue.

3 Does the taxpayer (and the taxpayer’s spouse if filing jointly) have a social security number (SSN)
that allows him or her to work and is valid for EIC purposes? See the instructions before
answering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X Yes No

j If you checked "No" on line 3, stop; the taxpayer cannot take the EIC. Otherwise, continue.

4 Is the taxpayer (or the taxpayer's spouse if filing jointly) filing Form 2555 or 2555-EZ (relating to the
exclusion of foreign earned income)? . . . . . . . . . . . . . . . . . . . . Yes X No

j If you checked "Yes" on line 4, stop; the taxpayer cannot take the EIC. Otherwise, continue.

5a Was the taxpayer (or the taxpayer's spouse) a nonresident alien for any part of 2019? . . . . Yes X No

j If you checked "Yes" on line 5a, go to line 5b. Otherwise, skip line 5b and go to line 6.

b Is the taxpayer’s filing status married filing jointly? . . . . . . . . . . . . . . . . Yes No

j If you checked "Yes" on line 5a and "No" on line 5b, stop; the taxpayer cannot take the EIC.
Otherwise, continue.

6 Is the taxpayer’s investment income more than $3,500? See the instructions before answering. Yes X No

j If you checked "Yes" on line 6, stop; the taxpayer cannot take the EIC. Otherwise, continue.

7 Could the taxpayer be a qualifying child of another person for 2019? If the taxpayer's
filing status is married filing jointly, check "No." Otherwise, see instructions before
answering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No

j If you checked "Yes" on line 7, stop; the taxpayer cannot take the EIC. Otherwise, go to Part II
or Part III, whichever applies.
For Paperwork Reduction Act Notice, see separate instructions. 9USEI1 Form 8867 (2019)
JOSUE PEREZ VELEZ 771-72-2517
Page 2

Part II Taxpayers With a Child

Caution. If there is more than one child, complete lines 8 through 14 for Child 1 Child 2 Child 3
one child before going to the next column.
8 Child’s name . . . . . . . . . . . . . . . . . . . . .
9 Is the child the taxpayer’s son, daughter, stepchild, foster child, brother, sister,
stepbrother, stepsister, half brother, half sister, or a descendant of any of them? Yes No Yes No Yes No
10 Was the child unmarried at the end of 2019?
If the child was married at the end of 2019, see the instructions before
answering . . . . . . . . . . . . . . . . . . . . . Yes No Yes No Yes No
11 Did the child live with the taxpayer in the United States for over half of 2019?
See the instructions before answering . . . . . . . . . . . . Yes No Yes No Yes No
12 Was the child (at the end of 2019)-
8 Under age 19 and younger than the taxpayer (or the taxpayer’s spouse,
if the taxpayer files jointly),
8 Under age 24, a student (defined in the instructions), and younger than
the taxpayer (or the taxpayer’s spouse, if the taxpayer files jointly), or
8 Any age and permanently and totally disabled? . . . . . . . . Yes No Yes No Yes No
If you checked "Yes" on lines 9, 10, 11, and 12, the child is the
taxpayer’s qualifying child; go to line 13a. If you checked "No" on line 9,
10, 11, or 12, the child is not the taxpayer’s qualifying child; see the
instructions for line 12.
13a Do you or the taxpayer know of another person who could check "Yes"
on lines 9, 10, 11, and 12 for the child? (If the only other person is the
taxpayer's spouse, see the instructions before answering.) . . . . Yes No Yes No Yes No
If you checked "No" on line 13a, go to line 14. Otherwise, go to
line 13b.
b Enter the child’s relationship to the other person(s) . . . . . . . .
c Under the tiebreaker rules, is the child treated as the taxpayer’s qualifying Yes No Yes No Yes No
child? See the instructions before answering . . . . . . . . . . Don’t know Don’t know Don’t know

If you checked "Yes" on line 13c, go to line 14. If you checked "No," the
taxpayer cannot take the EIC based on this child and cannot take the EIC for
taxpayers who do not have a qualifying child. If there is more than one child,
see the Note at the bottom of this page. If you checked "Don’t know,"
explain to the taxpayer that, under the tiebreaker rules, the taxpayer’s EIC
and other tax benefits may be disallowed. Then, if the taxpayer wants to take
the EIC based on this child, complete lines 14 and 15. If not, and there are
no other qualifying children, the taxpayer cannot take the EIC, including the
EIC for taxpayers without a qualifying child; do not complete Part III. If there
is more than one child, see the Note at the bottom of this page.
14 Does the qualifying child have an SSN that allows him or her to work and is
valid for EIC purposes? See the instructions before answering . . . . Yes No Yes No Yes No
If you checked "No" on line 14, the taxpayer cannot take the EIC based
on this child and cannot take the EIC available to taxpayers without a
qualifying child. If there is more than one child, see the Note at the bottom
of this page. If you checked "Yes" on line 14, continue.
15 Are the taxpayer’s earned income and adjusted gross income each less
than the limit that applies to the taxpayer for 2019? See instructions . . Yes No

If you checked "No" on line 15, stop; the taxpayer cannot take the
EIC. If you checked "Yes" on line 15, the taxpayer can take the EIC.
Complete Schedule EIC and attach it to the taxpayer’s return. If there are
two or three qualifying children with valid SSNs, list them on Schedule
EIC in the same order as they are listed here. If the taxpayer’s EIC was
reduced or disallowed for a year after 1996, see Pub. 596 to see if Form
8862 must be filed. Go to line 20.

Note. If there is more than one child, complete lines 8 through 14 for the
other child(ren) (but for no more than three qualifying children).

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JOSUE PEREZ VELEZ 771-72-2517
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Part III Taxpayers Without a Qualifying Child

16 Was the taxpayer’s main home, and the main home of the taxpayer’s spouse if filing jointly, in the
United States for more than half the year? (Military personnel on extended active duty outside the
United States are considered to be living in the United States during that duty period.) See the
instructions before answering. X Yes No
If you checked "No" on line 16, stop; the taxpayer cannot take the EIC. Otherwise, continue.

17 Was the taxpayer, or the taxpayer’s spouse if filing jointly, at least age 25 but under age 65 at the
end of 2019? See the instructions before answering . . . . . . . . . . . . . . . . X Yes No
If you checked "No" on line 17, stop; the taxpayer cannot take the EIC. Otherwise, continue.

18 Is the taxpayer eligible to be claimed as a dependent on anyone else’s federal income tax return for
2019? If the taxpayer's filing status is married filing jointly, check "No" . . . . . . . . . . Yes X No
If you checked "Yes" on line 18, stop; the taxpayer cannot take the EIC. Otherwise, continue.

19 Are the taxpayer’s earned income and adjusted gross income each less than the limit that
applies to the taxpayer for 2019? See instructions . . . . . . . . . . . . . . . . X Yes No
If you checked "No" on line 19, stop; the taxpayer cannot take the EIC. If you checked "Yes"
on line 19, the taxpayer can take the EIC. If the taxpayer’s EIC was reduced or disallowed for a
year after 1996, see Pub. 596 to find out if Form 8862 must be filed. Go to line 20.

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 Paid Preparer’s Due Diligence Checklist OMB No. 1545-0074
Form 8867 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 2019
Department of the Treasury To be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS. Attachment
Internal Revenue Service Go to www.irs.gov/Form8867 for instructions and the latest information. Sequence No. 70
Taxpayer name(s) shown on return Taxpayer identification number

JOSUE PEREZ VELEZ 771-72-2517

Enter preparer’s name and PTIN

ROCIO PEREZ P02348687

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 IV for
the benefit(s) claimed (check all that apply). X 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? . . . . . . . . . . . . . . . . . . . . . . . . X
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? . . . . . . . . . . X
3 Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both of
the following.
8 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.
8 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) . . . . . . . . . . . . . . . . X

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.) . . . . . . . . . . . . . . . . X
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
List those documents, if any, that you relied on.
NO QUALIFYING CHILD
NO DISABLED CHILDREN
RECORDS OF GROSS RECEIPTS PROVIDED BY TA

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? . . . . . . . . . . . . . . . . . . . . . . . . . X
7 Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year? . . X
(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)? . . . . . . . . . . . . . . . . . . . X
SPA For Paperwork Reduction Act Notice, see separate instructions. 1037 CPTS 9USEJ1 Form 8867 (2019)
Form 8867 (2019)
JOSUE PEREZ VELEZ 771-72-2517
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.) . . . . . . . . . . . . . . . X
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 Yes No N/A
who is 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
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).
If you 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
SPA 1037 CPTS 9USEJ2 Form 8867 (2019)
JOSUE PEREZ VELEZ 771-72-2517
Line 5 - List of Documents for EIC and CTC/ACTC
A. Which documents below, if any, did you rely on to determine EIC/CTC/ACTC eligibility for the qualifying child(ren)
on the return? Check all that apply. KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If there is no
qualifying child, check box a. If there is no disabled child, check box o.
Residency of Qualifying (Child(ren)

X a No qualifying child j Indian tribal official statement

b School records or statement k Employer statement
c Landlord or property management statement l Other
d Health care provider statement
e Medical records
f Child care provider records
g Placement agency statement
h Social service records or statement m Did not rely on documents, but made notes in file
i Place of worship statement n Did not rely on any documents
Disability of Qualifying Child(ren)
X o No disabled child s Other
p Doctor statement
q Other health care provider statement
r Social services agency or program statement
t Did not rely on documents, but made notes in file
u Did not rely on any documents

B. If a Schedule C is included with this return, which documents or other information, if any, did you rely on to confirm the
existence of the business and to figure the amount of Schedule C income and expenses reported on the return? Check
all that apply. KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If there is no Schedule C, check box a.
Documents or Other Information
a No Schedule C i Reconstruction of income and expenses
b Business license j Other
c Forms 1099
X d Records of gross receipts provided by taxpayer
e Taxpayer summary of income
f Records of expenses provided by taxpayer k Did not rely on documents, but made notes in file
g Taxpayer summary of expenses l Did not reply on any documents
h Bank statements
Line 5 - List of Documents for AOTC
A. Which documents below, if any, did you rely on to determine AOTC eligibility for the qualifying education expenses?
Check all that apply. KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If there is no AOTC, check box a.
Documents or Other Information
X a No American Opportunity Credit f Other
b Form 1098-T from college or university
c Form 1099-Q for distributions
d College or university bursar statement
e Taxpayer summary of expenses g Did not rely on documents, but made notes in file
h Did not rely on any documents
Line 5 - List of Documents for Head of Household
A. Which documents below, if any, did you rely on to determine Head of Household eligibility? Check all that apply.
KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If not filing Head of Household, check box a.
Documents or Other Information
X a Not Head of Household h Other
b Divorce decree
c Separation agreement
d Bank statements
e Property tax bills
i Did not rely on documents, but made notes in file
f Rent statements
j Did not rely on any documents
g Utility bills
8USEJ3