1040 U.S.

Individual Income Tax Return 2019

Form Department of the Treasury—Internal Revenue Service (99)
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of 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. a
Your first name and middle initial Last name Your social security number
Brady O Applegate 405-45-4979
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
4304 Glenn Ave
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
Covington KY 41015-1642 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and  here a

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

Sebastian O Applregate 029-97-7283 Son

1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . 1 33,059.

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
• Single or Married
filing separately,
c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b 33,059.
household,
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b 33,059.
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 18,350.
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 18,350.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 14,709.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
 Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 1,490.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 1,490.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a 1,461.
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b 1,490.
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 0.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 0.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 0.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17 3,627.
• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a 1,281.
attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b 539.
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 . . . . . a 18e 1,820.
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 5,447.
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 5,447.
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 5,447.
Direct deposit? a b Routing number 0 4 4 1 1 5 0 9 0 a c Type: Checking Savings
See instructions.
a d Account number 0 2 7 1 2 9 4 3 9 1 6
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a 23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 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 a no. a number (PIN) a

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
F

Joint return? factory Manager (see inst.)

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 3rd Party Designee
Preparer Self-employed
Firm’s name a Self-Prepared Phone no.
Use Only
Firm’s address a Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 08/20/20 Intuit.cg.cfp.sp Form 1040 (2019)
SCHEDULE 3 OMB No. 1545-0074
Additional Credits and Payments
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 03
Name(s) shown on Form 1040 or 1040-SR Your social security number
Brady O Applegate 405-45-4979
Part I Nonrefundable Credits
1 Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . . . . . . . 1
2 Credit for child and dependent care expenses. Attach Form 2441 . . . . . . . . . . . . 2
3 Education credits from Form 8863, line 19 . . . . . . . . . . . . . . . . . . . . 3
4 Retirement savings contributions credit. Attach Form 8880 . . . . . . . . . . . . . . 4 29.
5 Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . . . . . . . 5
6 Other credits from Form: a 3800 b 8801 c 6
7 Add lines 1 through 6. Enter here and include on Form 1040 or 1040-SR, line 13b . . . . . . . 7 29.
Part II Other Payments and Refundable Credits
8 2019 estimated tax payments and amount applied from 2018 return . . . . . . . . . . . 8
9 Net premium tax credit. Attach Form 8962 . . . . . . . . . . . . . . . . . . . . 9
10 Amount paid with request for extension to file (see instructions) . . . . . . . . . . . . . 10
11 Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . . . . . . . . 11
12 Credit for federal tax on fuels. Attach Form 4136 . . . . . . . . . . . . . . . . . . 12
13 Credits from Form: a 2439 b Reserved c 8885 d 13
14 Add lines 8 through 13. Enter here and on Form 1040 or 1040-SR, line 18d . . . . . . . . . 14
For Paperwork Reduction Act Notice, see your tax return instructions. REV 08/20/20 Intuit.cg.cfp.sp Schedule 3 (Form 1040 or 1040-SR) 2019
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040 or 1040-SR) 1040 `
Qualifying Child Information
2019
.........
1040-SR
a Complete and attach to Form 1040 or 1040-SR only if you have a
Department of the Treasury qualifying child. EIC Attachment
Internal Revenue Service (99) a Go to www.irs.gov/ScheduleEIC for the latest information. Sequence No. 43
Name(s) shown on return Your social security number
Brady O Applegate 405-45-4979
• See the instructions for Form 1040 or 1040-SR, line 18a, to make sure that (a) you can take the EIC, and (b)
Before you begin: you have a qualifying child.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card.
Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s
social security card is not correct, call the Social Security Administration at 1-800-772-1213.

F
!
CAUTION
• You can't claim the EIC for a child who didn't live with you for more than half of the year.
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.

Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name First name Last name First name Last name First name Last name

If you have more than three qualifying

children, you have to list only three to get
the maximum credit. Sebastian O Applregate
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040 or
1040-SR, line 18a, unless the child was
born and died in 2019. If your child was
born and died in 2019 and did not have an
SSN, enter “Died” on this line and attach a
copy of the child’s birth certificate, death
certificate, or hospital medical records
showing a live birth. 029-97-7283
3 Child’s year of birth
Year 2 0 1 4 Year Year
If born after 2000 and the child is If born after 2000 and the child is If born after 2000 and the child is
younger than you (or your spouse, if younger than you (or your spouse, if younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b;
go to line 5. go to line 5. go to line 5.

4 a Was the child under age 24 at the end of

2019, a student, and younger than you (or Yes. No. Yes. No. Yes. No.
your spouse, if filing jointly)?
Go to Go to line 4b. Go to Go to line 4b. Go to Go to line 4b.
line 5. line 5. line 5.

b Was the child permanently and totally

disabled during any part of 2019? Yes. No. Yes. No. Yes. No.
Go to The child is not a Go to The child is not a Go to The child is not a
line 5. qualifying child. line 5. qualifying child. line 5. qualifying child.

5 Child’s relationship to you

(for example, son, daughter, grandchild,
niece, nephew, eligible foster child, etc.) Son
6 Number of months child lived
with you in the United States
during 2019

• If the child lived with you for more than

half of 2019 but less than 7 months,
enter “7.”
• If the child was born or died in 2019 and 12 months months months
your home was the child’s home for more
than half the time he or she was alive Do not enter more than 12 Do not enter more than 12 Do not enter more than 12
during 2019, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax REV 08/20/20 Intuit.cg.cfp.sp Schedule EIC (Form 1040 or 1040-SR) 2019
BAA
return instructions.
SCHEDULE 8812 OMB No. 1545-0074
Additional Child Tax Credit . . 1040
.......
`
2019
(Form 1040 or 1040-SR) 1040-SR
.........
a
Attach to Form 1040, 1040-SR, or 1040-NR. 1040-NR
Department of the Treasury
a Go to www.irs.gov/Schedule8812 for instructions and the latest 8812 Attachment
Internal Revenue Service (99) information. Sequence No. 47

Name(s) shown on return Your social security number

Brady O Applegate 405-45-4979
Part I All Filers
Caution: If you file Form 2555, stop here; you cannot claim the additional child tax credit.
1 If you are required to use the worksheet in Pub. 972, enter the amount from line 10 of the Child Tax Credit
and Credit for Other Dependents Worksheet in the publication. Otherwise:
1040 and Enter the amount from line 8 of your Child Tax Credit and Credit for Other Dependents
1040-SR filers: Worksheet (see the instructions for Forms 1040 and 1040-SR, line 13a).
1040-NR filers: Enter the amount from line 8 of your Child Tax Credit and Credit for Other Dependents
Worksheet (see the instructions for Form 1040-NR, line 49).
} 1 2,000.

2 Enter the amount from Form 1040, line 13a; Form 1040-SR, line 13a; or Form 1040-NR, line 49 . . . . . 2 1,461.
3 Subtract line 2 from line 1. If zero, stop here; you cannot claim this credit . . . . . . . . . . . . 3 539.
4 Number of qualifying children under 17 with the required social security number: 1 x $1,400.
Enter the result. If zero, stop here; you cannot claim this credit . . . . . . . . . . . . . . . 4 1,400.
TIP: The number of children you use for this line is the same as the number of children you used for line 1 of the
Child Tax Credit and Credit for Other Dependents Worksheet.
5 Enter the smaller of line 3 or line 4 . . . . . . . . . . . . . . . . . . . . . . . 5 539.
6a Earned income (see instructions) . . . . . . . . . . . . . . . . 6a 33,059.
b Nontaxable combat pay (see instructions) . . . . . . 6b
7 Is the amount on line 6a more than $2,500?
No. Leave line 7 blank and enter -0- on line 8.
Yes. Subtract $2,500 from the amount on line 6a. Enter the result . . . . . 7 30,559.
8 Multiply the amount on line 7 by 15% (0.15) and enter the result . . . . . . . . . . . . . . . 8 4,584.
Next. On line 4, is the amount $4,200 or more?
No. If line 8 is zero, stop here; you cannot claim this credit. Otherwise, skip Part II and enter the smaller
of line 5 or line 8 on line 15.
Yes. If line 8 is equal to or more than line 5, skip Part II and enter the amount from line 5 on line 15.
Otherwise, go to line 9.
Part II Certain Filers Who Have Three or More Qualifying Children
9 Withheld social security, Medicare, and Additional Medicare taxes from
Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s amounts
with yours. If your employer withheld or you paid Additional Medicare Tax or tier 1
RRTA taxes, see instructions . . . . . . . . . . . . . . . . . 9

}
10 1040 and Enter the total of the amounts from Schedule 1 (Form 1040 or 1040-SR),
1040-SR filers: line 14, and Schedule 2 (Form 1040 or 1040-SR), line 5, plus any taxes
that you identified using code “UT” and entered on Schedule 2 (Form
1040 or 1040-SR), line 8. 10
1040-NR filers: Enter the total of the amounts from Form 1040-NR, lines 27 and
56, plus any taxes that you identified using code “UT” and
entered on line 60.
11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . 11
12 1040 and Enter the total of the amounts from Form 1040 or 1040-SR, line
1040-SR filers: 18a, and Schedule 3 (Form 1040 or 1040-SR), line 11.
1040-NR filers: Enter the amount from Form 1040-NR, line 67.
} 12
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 13
14 Enter the larger of line 8 or line 13 . . . . . . . . . . . . . . . . . . . . . . . 14
Next, enter the smaller of line 5 or line 14 on line 15.
Part III Additional Child Tax Credit
15 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . . 15 539.
Enter this amount on
Form 1040, line 18b;
Form 1040-SR, line 18b; or
. . 1040
.......
Form 1040-NR, line 64.
1040-SR
.........
1040-NR `

For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 08/20/20 Intuit.cg.cfp.sp Schedule 8812 (Form 1040 or 1040-SR) 2019
Form 8880 Credit for Qualified Retirement Savings Contributions OMB No. 1545-0074

2019
a Attach to Form 1040, 1040-SR, or 1040-NR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form8880 for the latest information. Sequence No. 54
Name(s) shown on return Your social security number
Brady O Applegate 405-45-4979
You cannot take this credit if either of the following applies.

F
!
CAUTION
• The amount on Form 1040 or 1040-SR, line 8b; or Form 1040-NR, line 35, is more than $32,000 ($48,000 if head of household;
$64,000 if married filing jointly).
• The person(s) who made the qualified contribution or elective deferral (a) was born after January 1, 2002; (b) is claimed as a
dependent on someone else’s 2019 tax return; or (c) was a student (see instructions).
(a) You (b) Your spouse
1 Traditional and Roth IRA contributions, and ABLE account contributions by the
designated beneficiary for 2019. Do not include rollover contributions . . . . . 1
2 Elective deferrals to a 401(k) or other qualified employer plan, voluntary employee
contributions, and 501(c)(18)(D) plan contributions for 2019 (see instructions) . . 2 288.
3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . 3 288.
4 Certain distributions received after 2016 and before the due date (including
extensions) of your 2019 tax return (see instructions). If married filing jointly, include
both spouses’ amounts in both columns. See instructions for an exception . . . 4
5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . 5 288.
6 In each column, enter the smaller of line 5 or $2,000 . . . . . . . . . . 6 288.
7 Add the amounts on line 6. If zero, stop; you can’t take this credit . . . . . . . . . . . . 7 288.
8 Enter the amount from Form 1040 or 1040-SR, line 8b;* or Form 1040-NR, line
35 . . . . . . . . . . . . . . . . . . . . . . . . . 8 33,059.
9 Enter the applicable decimal amount from the table below.

If line 8 is— And your filing status is—

Married Head of Single, Married filing
But not
Over— filing jointly household separately, or
over—
Enter on line 9— Qualifying widow(er)
--- $19,250 0.5 0.5 0.5
$19,250 $20,750 0.5 0.5 0.2
$20,750 $28,875 0.5 0.5 0.1 9 x0 .1
$28,875 $31,125 0.5 0.2 0.1
$31,125 $32,000 0.5 0.1 0.1
$32,000 $38,500 0.5 0.1 0.0
$38,500 $41,500 0.2 0.1 0.0
$41,500 $48,000 0.1 0.1 0.0
$48,000 $64,000 0.1 0.0 0.0
$64,000 --- 0.0 0.0 0.0
Note: If line 9 is zero, stop; you can’t take this credit.
10 Multiply line 7 by line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . 10 29.
11 Limitation based on tax liability. Enter the amount from the Credit Limit Worksheet in the instructions 11 1,490.
12 Credit for qualified retirement savings contributions. Enter the smaller of line 10 or line 11 here
and on Schedule 3 (Form 1040 or 1040-SR), line 4; or Form 1040-NR, line 48 . . . . . . . . 12 29.

* See Pub. 590-A for the amount to enter if you claim any exclusion or deduction for foreign earned income, foreign housing, or income from
Puerto Rico or for bona fide residents of American Samoa.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 08/20/20 Intuit.cg.cfp.sp Form 8880 (2019)
 740
1 9 0 0 0 1 1 5 5 5
FORM

KENTUCKY
Commonwealth of Kentucky
Department of Revenue
INDIVIDUAL INCOME TAX RETURN
Residents Only
2019
Check if deceased: ¨ Spouse ¨ Taxpayer For calendar year or other taxable year beginning _________ , 2019, and ending ________ , 20____ .

A. Spouse’s Social Security Number B. Your Social Security Number

405-45-4979
Name—Last, First, Middle Initial (Joint or combined return, give both names and initials.)

Applegate Brady O
Mailing Address (Number and Street including Apartment Number or P.O. Box)

4304 Glenn Ave

City, Town or Post Office State ZIP Code

Covington KY 41015-1642
FILING STATUS (see instructions) Check if applicable: POLITICAL PARTY FUND
1 Single Amended (Enclose Designating $2 will not change your refund or tax due.
2 Married, filing separately on this combined copy of 1040X, if A. Spouse B. Yourself
applicable.)
return. (If both had income.) Democratic (1) (4)
3 Married, filing joint return. Republican (2) (5)
4 Married, filing separate returns. Enter spouse’s No Designation (3) (6)
Social Security number above and full name here.

A. Spouse (Use if B. Yourself

 Filing Status 2 is checked.) (or Joint)
5 Enter amount from federal Form 1040 or 1040-SR, line 8b. (If total of
Columns A and B is $34,248 or less, you may qualify for the
Family Size Tax Credit. See instructions.).......................................................... 5 00 5 33,059. 00

00
6 Additions from Schedule M, line 6..................................................................... 6 6 00
00
7 Add lines 5 and 6................................................................................................. 7 7 33,059. 00
00
8 Subtractions from Schedule M, line 17.............................................................. 8 8 00
00
9 Subtract line 8 from line 7. This is your Kentucky Adjusted Gross Income...... 9 9 33,059. 00

10 Itemizers: Enter itemized deductions from Kentucky Schedule A.

00
Nonitemizers: Enter $2,590 in Columns A and/or B.......................................... 10 10 2,590. 00

00
11 Subtract line 10 from line 9. This is your Taxable Income ............................... 11 11 30,469. 00

12 Tax Computation: Multiply line 11 by 5% (.05) or amount from Schedule J 00

.... 12 12 1,523. 00

13 Enter tax from Form 4972-K ; Schedule RC-R ;

Schedule DS-R  ; Angel Investor Recapture   00

......................................... 13 13 00
00
14 Add lines 12 and 13 and enter total here .......................................................... 14 14 1,523. 00
00
15 Enter amounts from Schedule ITC, Section A, lines 24E and 24F.................... 15 15 00
00
16 Subtract line 15 from line 14. If line 15 is larger than line 14, enter zero........ 16 16 1,523. 00
00
17 Enter personal tax credit amounts from Schedule ITC, Section B ......................... 17 17 00
00
18 Subtract line 17 from line 16. If line 17 is larger than line 16, enter zero........ 18 18 1,523. 00

19 Add tax amount(s) in Columns A and B, line 18 and enter here, continue to page 2.............................................. 19 1,523. 00

1 9 0 0 0 1 4 2 A 7 4 0 (10-19)
Page 1 of 3

1555 REV 05/22/20 Intuit.cg.cfp.sp

FORM 740 (2019) 1 9 0 0 0 2 1 5 5 5 Page 2 of 3

20 Check the box that represents your total family size (see instructions before completing lines 20 and 21)......... 20  1  2  3 4

21 Multiply line 19 by Family Size Tax Credit decimal amount __0.00 0 from
__ __ (__ __ __%) Schedule ITC..................... 21 0. 00

22 Subtract line 21 from line 19......................................................................................................................................... 22 1,523. 00

23 Enter the Education Tuition Tax Credit from Form 8863-K.......................................................................................... 23 00
24 Enter Child and Dependent Care Credit from federal Form 2441, line 11 
x 20% (.20) 24 00

25 Enter Income Gap Tax Credit from Schedule ITC........................................................................................................ 25 0. 00
26 Income Tax Liability. Subtract lines 23 through 25 from line 22. If zero or less, enter
zero..................................... 26 1,523. 00

27 Enter KENTUCKY USE TAX due on Internet, mail order, or other out-of-state purchases (see instructions)...... 27 0. 00

28 Add lines 26 and 27. This is your TOTAL TAX LIABILITY ............................................................................................. 28 1,523. 00

29 For amended return; overpayment, if any, shown on original return.......................................................................  29 00
1,523.
30 Add lines 28 and 29, enter here.................................................................................................................................... 30 00
31 a Enter Kentucky income tax withheld as shown on enclosed

Schedule KW-2................................................................................................. 31a 1,524. 00

b Enter 2019 Kentucky estimated tax payments...............................................  31b 00
c Enter 2019 refundable certified rehabilitation credit ....................................  31c 00
d For amended return; enter amount paid with original return plus
additional payment(s) made after it was filed...............................................  31d 00

32 Add lines 31(a) through 31(d).......................................................................................................................................   32 1,524. 00
33 If line 30 is larger than line 32, subtract line 32 from line 30, enter ADDITIONAL TAX
DUE................................... 33 00
34 a Estimated tax penalty Check if Form 2210-K attached...................... 34a 00
b Interest.............................................................................................................. 34b 00
c Late payment penalty...................................................................................... 34c 00
d Late filing penalty............................................................................................. 34d 00

35 Add lines 34(a) through 34(d). Enter here.................................................................................................................... 35 00

36 If the total of lines 30 and 35 is more than line 32, subtract line 32 from the total of lines 30 and 35.

This is the AMOUNT YOU OWE, continue to page 3............................................................................... OWE 36 00
37 If line 32 is more than line 30, subtract lines 30 and 35 from line 32. This is the AMOUNT YOU OVERPAID,

continue to page 3......................................................................................................................................................... 37 1. 00

1555 REV 05/22/20 Intuit.cg.cfp.sp

1 9 0 0 0 2 4 2 A 7 4 0 (10-19)
FORM 740 (2019) 1 9 0 0 4 0 1 5 5 5 Page 3 of 3

38 FUND CONTRIBUTIONS; see instructions.

a Nature and Wildlife Fund................................................................................. 38a 00

b Child Victims’ Trust Fund.................................................................................. 38b 00
c Veterans’ Program Trust Fund......................................................................... 38c 00
d Breast Cancer Research/Education Trust Fund............................................... 38d 00
e Farms to Food Banks Trust Fund..................................................................... 38e 00
f Local History Trust Fund................................................................................... 38f 00
g Special Olympics Kentucky............................................................................. 38g 00
h Pediatric Cancer Research Trust Fund............................................................. 38h 00
i Rape Crisis Center Trust Fund ........................................................................ 38i 00
j Court Appointed Special AdvocateTrust Fund............................................... 38j 00
k YMCA Youth Association Fund........................................................................ 38k 00

39 Add lines 38(a) through 38(k)........................................................................................................................................ 39 00

40 Amount of line 37 to be CREDITED TO YOUR 2020 ESTIMATED TAX ............................ CREDIT FORWARD
40 00
(Credit forwards not available for amended returns)

00
41 Subtract lines 39 and 40 from line 37. Amount to be REFUNDED TO YOU .................................... REFUND
41 1.

REFUND OPTIONS (Not available for amended returns)

Check here if you would like your refund issued on a Bank of America Prepaid Debit Card

Check here if you would like to receive your Debit Card material in Spanish

I, the undersigned, declare under penalties of perjury that I have examined this return, including all accompanying schedules and statements,
and to the best of my knowledge and belief, it is true, correct and complete. I also understand and agree that our election to file a combined
return under the provisions of Regulation 103 KAR 17:020 will result in refunds being made payable to us jointly and in each of us being jointly
and severally liable for all taxes accruing under this return.

Signature of Taxpayer Driver’s License/State Issued ID No. Date Telephone Number (daytime)

Sign A11154702 (859)445-5543

Here Signature of Spouse Driver’s License/State Issued ID No. Date

Signature of Preparer Date

Self-Prepared
Paid Name of Preparer or Firm ID Number
Preparer
Use
Email Telephone No. May the DOR discuss this return with this preparer?
Yes
No ¨ ¨
Include a complete copy of federal Form 1040, if you Refund
Kentucky Department of Revenue
Enclose received farm, business, or rental income or loss. If not or No
Frankfort, KY 40618-0006
required, check here. Payment
Check Payable: Kentucky State Treasurer
With Kentucky Department of Revenue
Payment E-Pay Options: www.revenue.ky.gov Payment Frankfort, KY 40619-0008
Include: Your Social Security number and “KY Income Tax—2019”
1555 REV 05/22/20 Intuit.cg.cfp.sp

1 9 0 0 4 0 4 2 A 7 4 0 (10-19)
 ITC
SCHEDULE

KENTUCKY INDIVIDUAL
2019
1 9 0 3 4 9 1 5 5 5
TAX CREDIT SCHEDULE
Commonwealth of Kentucky
Department of Revenue  Enclose with Form 740 or 740-NP
Enter name(s) as shown on tax return. Your Social Security Number

Applegate, Brady O 405-45-4979

SECTION A—BUSINESS INCENTIVES AND OTHER TAX CREDITS

A B C D E F
Preapproval Credit Required
Required Name Attachment Spouse Yourself

1 No Nonrefundable Limited Liability Entity Kentucky Limited

Liability Entity Tax Credit
Worksheet/Schedule K-1 00 00

2 Yes Kentucky Small Business Schedule K-1 00 00

3 Yes Skills Training Investment Schedule K-1 00 00

4 Yes Certified Rehabilitation Certification Copies 00 00

5 No Tax Paid to Another State Copy(ies) of Other State(s)
return or Worksheet A 00 00

6 No Unemployment Schedule UTC 00 00

7 Yes Recycling/Composting Equipment Schedule RC 00 00

8 Yes Kentucky Investment Fund KEDFA notification 00 00

9 No Qualified Research Facility Schedule QR 00 00

10 No GED Incentive Form DAEL-31 00 00

11 Yes Voluntary Environmental Remediation Schedule VERB 00 00

12 Yes Biodiesel Schedule BIO 00 00

13 Yes Clean Coal Incentive Schedule CCI 00 00

14 Yes Ethanol Schedule ETH 00 00

15 Yes Cellulosic Ethanol Schedule CELL 00 00

16 No Railroad Maintenance & Improvement Schedule RR-I 00 00

17 Yes Endow Kentucky Schedule ENDOW 00 00

18 Yes New Markets Development Program Form 8874(K)-A 00 00

19 No Food Donation (Carryover only) Schedule FD 00 00

20 No Distilled Spirits Schedule DS 00 00

21 Yes Angel Investor Certification Letter 00 00

22 Yes Film Industry Film Office Certification 00 00

23 No Inventory Schedule INV 00 00

24 Total of Other Tax Credits (add lines 1 through 23). Enter here and on Form 740,
page 1, line 15, Columns A and B, or enter combined totals of Columns E and F
on Form 740-NP, page 1, line 15.................................................................................... 00 00

1 9 0 3 4 9 4 2 A 7 4 0 I T C (10-19) 1555 REV 05/22/20 Intuit.cg.cfp.sp Page 1 of 2

 SCHEDULE ITC
(2019) 1 9 0 3 5 0 1 5 5 5 Page 2 of 2

SECTION B—PERSONAL TAX CREDITS

Taxpayer Spouse
Complete only if filing joint or married,
filing separately on a combined return

Enter your date of birth (MM/DD/YYYY) 07/17/1993 Enter your date of birth (MM/DD/YYYY)
1 If you were 65 on or before 12/31/2019, enter 40....... 1 5 If you were 65 on or before 12/31/2019, enter 40.... 5
2 If you were legally blind on 12/31/2019, enter 40....... 2 6 If you were legally blind on 12/31/2019, enter 40.... 6
3 If you were a member of the Kentucky National 7 If you were a member of the Kentucky National
Guard on 12/31/2019, enter 20..................................... 3 Guard on 12/31/2019, enter 20.................................. 7
4 Allowable Taxpayer Credit—Add lines 1 through 3.... 4 8 Allowable Spouse Credit—Add lines 5 through 7... 8

Assignment of Personal Tax Credits

9 For filing status Single or Married, filing separate returns, enter the amount from line 4 here and in Column B
of Form 740, line 17 or Form 740-NP, line 17 (Not to exceed 100)........................................................................................ 9
10 For filing status Married, filing separately on this combined return, enter the amount from line 4
here and in column B of Form 740, line 17 (Not to exceed 100).......................................................................................... 10
11 For filing status Married, filing separately on this combined return, enter the amount from line 8
here and in column A of Form 740, line 17. (Not to exceed 100).......................................................................................... 11
12 For filing status Married, filing jointly, add line 4 and line 8 and enter here and in Column B of Form 740,
line 17 or Form 740-NP, line 17. (Not to exceed 200)............................................................................................................. 12

SECTION C—FAMILY SIZE TAX CREDIT AND INCOME GAP CREDIT

Enter dependents qualifying for family size credit and income gap credit. See instructions to determine family size and your qualifying
dependents. Your family size will be used to determine your family size tax credit percentage and the amount of your income gap
credit.

Dependent’s Check if qualifying

Dependent’s relationship child for family
First and Last Name Social Security number to you size tax credit

Sebastian Applregate 029-97-7283 Son

Use this Family Size Table to determine the percentage of family size credit and the amount of income gap credit. You will need to
know your family size and your modified gross income (a worksheet is located within the instructions). You will enter the percentage
for the family size tax credit on Form 740 or 740-NP, line 21 and you will enter the income gap credit on Form 740 or 740-NP, line 25.

Family Size: One Two Three Four or More Credit Income Gap Credit
Percentage
If MGI . . . is over is not over is over is not over is over is not over is over is not over is One Two Three
$  ---   $12,490 $  ---   $16,910 $  ---   $21,330 $  ---   $25,750 100%
Tax Year 2019

12,490 12,990 16,910 17,586 21,330 22,183 25,750 26,780 90% $11 $ 7 $ 3
12,990 13,489 17,586 18,263 22,183 23,036 26,780 27,810 80% $20 $13 $ 6
13,489 13,989 18,263 18,939 23,036 23,890 27,810 28,840 70% $29 $18 $ 6
13,989 14,488 18,939 19,616 23,890 24,743 28,840 29,870 60% $37 $22 $ 6
14,488 14,988 19,616 20,292 24,743 25,596 29,870 30,900 50% $45 $24 $ 4
14,988 15,488 20,292 20,968 25,596 26,449 30,900 31,930 40% $51 $26
15,488 15,862 20,968 21,476 26,449 27,089 31,930 32,703 30% $58 $27
15,862 16,237 21,476 21,983 27,089 27,729 32,703 33,475 20% $64 $28
16,237 16,612 21,983 22,490 27,729 28,369 33,475 34,248 10% $69 $28
16,612 ---   22,490 ---   28,369 ---   34,248 ---  0%

Multiply tax from Form 740 or 740-NP, line 19, by the applicable family size tax credit percentage and enter on Form 740 or 740-NP
line 21. This is your Family Size Tax Credit.

1 9 0 3 5 0 4 2 A 7 4 0 I T C (10-19) 1555 REV 05/22/20 Intuit.cg.cfp.sp Page 2 of 2

 KW-2
SCHEDULE

Commonwealth of Kentucky
Department of Revenue
1900101555 KENTUCKY INCOME TAX WITHHELD
 Enclose with Form 740, 740-NP or 740-NP-R
2019
Complete this Schedule KW-2 to determine the total Kentucky income tax withholding to be entered on Kentucky Form 740, 740-NP, or 740-NP-R.
This schedule must be fully completed in order to receive proper credit for Kentucky income tax withheld. Include multiple Schedule KW-2(s)
as needed to report all Kentucky income tax withholdings. Do not send in your W-2, 1099, or W2-G forms; keep them with your tax records.

NAME(S) AS SHOWN ON THE TAX RETURN SPOUSE’S SOCIAL SECURITY NUMBER YOUR SOCIAL SECURITY NUMBER

Applegate, Brady O 405-45-4979

Part I–Form W-2 Enter all W-2s with Kentucky income tax withheld (round to the nearest whole dollar). Do not include other state withholding or local income tax.
A B C D E F
KY Income Tax
Employer’s State KY State Wages Withheld
Employee’s Social Security Number Employer’s Identification Number (EIN) State
I.D. Number (Box 16 of (Box 17 of
(Box 15 of Form W-2) Form W-2) Form W-2)

  1
405-45-4979 34-1441019 KY 121819 33,059. 00 1,524. 00
  2
00 00
  3 00 00
  4 00 00
  5 00 00
  6 00 00

  7 00 00

  8 00 00

  9 00 00

10 00 00

11 TOTAL FROM ALL W-2s

33,059. 00 1,524. 00
Part II–Form 1099 and W-2G Enter all 1099s and W-2Gs with Kentucky income tax withheld (round to the nearest whole dollar).

A B C D E F
Payer’s State KY Income KY Income Tax
Recipient’s Social Security Number Payer’s Identification Number (EIN) State
I.D. Number Amount Withheld

12 00 00

13 00 00

14 00 00

15 00 00

16 00 00
TOTAL FROM ALL 1099s
17 AND W2-Gs 00 00

F
Part III–Totals Enter total Kentucky income tax withheld (round to the nearest whole dollar) from line 18, Column F on your Kentucky Total Kentucky Income
income tax return (Form 740 and 740-NP, line 31(a) or 740-NP-R, line 1). Tax Withheld

18 Enter combined totals from Column F, lines 11 and 17.

1,524. 00

1555
REV 05/22/20 Intuit.cg.cfp.sp
1 9 0 0 1 0 4 2 A 7 4 0 - K W 2 (10-19) Page 1 of 1