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STERLING HEIGHTS, MI 48311 [````
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April 9, 2020

Sparkal Jewell
Pobox 355
Sterling Heights, MI 48311

Dear Sparkal,

Please find enclosed a copy of your tax return(s) for the tax year
ending December 31, 2019.

Form 1040 - Federal Individual Income Tax Return

MI - Michigan Individual Income Tax Return

We prepared your return based on the information you provided us.

Please review the returns carefully to ensure that there are no
omissions or misstatements of material facts.

If you have any questions about your tax return, please contact us.
We appreciate this opportunity to serve you.

Sincerely,

Billy Cunningham
Tax One
4677 Conner
Detroit, MI 48215
 Tax Summary and Instructions for Filing
2019 Federal Individual Income Tax Return

Summary of Federal Information:

Federal adjusted gross income .....$ 6,081.00

Federal taxable income ............$ 0.00
Federal refund ....................$ 577.00
Federal effective tax rate ........ 0.00%

The due date of the Federal Form 1040 is July 15, 2020.

Your return has been electronically filed, and you will receive a
refund of $577.00.

You have selected to have your refund of $577.00 to be direct

deposited into your bank account.
The Routing number is XXXXX0326.
The Account number is XXXXX3132.
Summary of State Information:

MI Form MI-1040

State adjusted gross income ... $ 6,081.00

State taxable income .......... $ 4,581.00
State Refund .................. $ 63.00
State effective tax rate ...... 4.26%

The due date of the MI Form MI-1040 is April 15, 2020.

You have selected to have your refund of $63.00 to be direct

deposited into your bank account.
The Routing number is Xxxxx0326.
The Account number is Xxxxx3132.

Your state return has been electronically filed, and you will
receive
a refund of $ 63.00.
 TAX ONE
4677 CONNER
DETROIT MI 48215
(313) 492-7916

[

]
[SPARKAL L JEWELL ]
[POBOX 355 ] Preparer No.: 1
[STERLING HEIGHTS MI 48311 ] Client No. : XXX-XX-3482
[(586) 453-4245 ] Invoice Date: 04/09/2020
[ ] Invoice No. : 0
’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’
[ ]

INVOICE
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[MI STATE RESIDENT RETURN [
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[ Amount Paid [ $0.00 [
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[ [ Balance Due [ $189.00 [
 TAX YEAR: 2019 PROCESS DATE: 04/09/2020

CLIENT : 363-21-3482 SPARKAL L JEWELL BIRTH DATE : 10/01/1996 Age:23

ADDRESS : POBOX 355 PREPARER : 1

: STERLING HEIGHTS MI 48311

Phone #1: (586) 453-4245 PREPARER FEE :

Phone #2: - ELECTRONIC :
Phone #3: - TOTAL FEES :
STATUS : 1
FED TYPE: Direct Deposit
ST TYPE : Direct Deposit EFFECTIVE RATE: 0.00%
E-MAIL :
_____________________________________________________________________________________
LISTING OF FORMS FOR THIS RETURN
________________________________
FORM 1040
FORM W-2
FORM 8879 (E-FILE SIGNATURE AUTHORIZATION)
MI STATE RESIDENT RETURN

_____________________________________________________________________________________
* QUICK SUMMARY *
__________________________________________________________________________
SUMMARY FEDERAL MI RESIDENT
FILING STATUS 1 1
TOTAL INCOME 6081 6081
TOTAL ADJUSTMENTS 0 0
ADJUSTED GROSS INCOME 6081 6081
DEDUCTIONS 6431 0
EXEMPTIONS 0 1500
TAXABLE INCOME 0 4581
TAX 0 195
CREDITS 0 0
PAYMENTS 577 258
REFUND 577 63
AMOUNT DUE 0 0

__________________________________________________________________________
DIRECT DEPOSIT INFORMATION
RTN: 072000326 ACCOUNT: 325263132 AMOUNT: $577.00

* W-2 INCOME FORMS SUMMARY *

_____________________________________________________________________________________

T/S EMPLOYER
_________________________________________________________________________________
WAGES FED WITH FICA MED TAX STATE WITH ST
 CLIENT : SPARKAL JEWELL 363-21-3482

PREPARER : 1 DATE : 04/09/2020

_____________________________________________________________________________________
* W-2 INCOME FORMS SUMMARY *
_____________________________________________________________________________________

_________________________________________________________________________________
T/S EMPLOYER WAGES FED WITH FICA MED TAX STATE WITH ST
1. T PELOTON INTERACT 6081 577 387 90 258 MI

TOTALS...... 6081 577 387 90 258

Form 8879 IRS e-file Signature Authorization
OMB No. 1545-0074

Department of the Treasury

Internal Revenue Service a
a ERO must obtain and retain completed Form 8879.
Go to www.irs.gov/Form8879 for the latest information.
2019

F
Submission Identification Number (SID)
Taxpayer’s name Social security number

SPARKAL L JEWELL 363-21-3482

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 6081
2 Total tax (Form 1040 or 1040-SR, line 16; Form 1040-NR, line 61) . . . . . . . . . . . . 2
3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040 or 1040-SR, line 17; Form 1040-NR,
line 62a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 577
4 Refund (Form 1040 or 1040-SR, line 21a; Form 1040-NR, line 73a; Form 1040-SS, Part I, line 13a) . 4 577
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 TAX ONE to enter or generate my PIN 1 3 4 8 2 as my
ERO firm name Enter five digits, but
don’t enter all zeros
signature on my tax year 2019 electronically filed income tax return.

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 a Date a 04/09/2020

Spouse’s PIN: check one box only

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

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 a Date a

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. 3 8 8 4 8 5 1 2 5 0 2
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.
TAX ONE
ERO’s signature a BILLY R CUNNINGHAM 04/09/2020 Date a
ERO Must Retain This Form — See Instructions
Don’t Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see your tax return instructions. Form 8879 (2019)
QNA
 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 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. a
Your first name and middle initial Last name Your social security number
SPARKAL L JEWELL 363-21-3482
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
POBOX 355 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
STERLING HEIGHTS, MI 48311 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: X 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 6081

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 6081
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 6081
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 6431
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 6431
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 0
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
QNA
 JEWELL
Form 1040 (2019)
363-21-3482 Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b
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 . . . . . . . . . . . . . . . 17 577
• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a NO
attach Sch. EIC.
• If you 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 . . . . . a 18e
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 577
20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 577
Refund
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 577
Direct deposit? a b Routing number 0 7 2 0 0 0 3 2 6 a c Type: X Checking Savings
See instructions.
a d Account number 3 2 5 2 6 3 1 3 2
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? 04/09/20 STUDENT (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. (586) 453-4245 Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid BILLY R CUNNINGHAM 04/09/20 X 3rd Party Designee
P00542502
Preparer Self-employed
Firm’s name a TAX ONE Phone no. 313-492-7916
Use Only 54-2128037
Firm’s address a 4677 CONNER DETROIT MI 48215 Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2019)
QNA
 JEWELL 363-21-3482
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KRXVHKROG                                                                            E 
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Michigan Department of Treasury
2808 (Rev. 08-19)

20190,&+,*$1,QGLYLGXDO,QFRPH7D['HFODUDWLRQIRUH¿OH0,
Issued under authority of Public Act 284 of 1964, as amended.

127('RQRWVHQG0,WRWKH0LFKLJDQ'HSDUWPHQWRI7UHDVXU\XQOHVVUHTXHVWHGWRGRVR
1. Filer’s First Name M.I. Last Name 2. Filer’s Full Social Security No. (Example: 123-45-6789)
SPARKAL L JEWELL
If a Joint Return, Spouse’s First Name M.I. Last Name 363-21-3482
3. Spouse’s Full Social Security No. (Example: 123-45-6789)
Home Address (Number, Street, or P.O. Box)

POBOX 355
City or Town State ZIP Code

STERLING HEIGHTS MI 48311

3$577$;5(7851,1)250$7,21
The taxpayer should obtain and keep a copy of the return.
)RUP0,Individual Income Tax Return
4. Total federal adjusted gross income from line 10 ......................................................................................... 4. 6081 00
5. Total Michigan income tax from line 20 ........................................................................................................ 5. 195 00
6. Michigan tax withheld from line 29 ............................................................................................................... 6. 258 00
7. Tax due from line 33 ..................................................................................................................................... 7. 00
8. Refund from line 36 ...................................................................................................................................... 8. 63 00
)RUP0,&5Homestead Property Tax Credit Claim
9. Homestead Property Tax Credit from line 44................................................................................................ 9. 00
)RUP0,&5Home Heating Credit Claim
10. Home Heating Credit Claim from line 47 ...................................................................................................... 10. 00
&LW\RI'HWURLW7D[5HWXUQ,QIRUPDWLRQ
11. Adjusted Gross Income or Wages from Form 5118, line 9, Form 5119, line 9,
or Form 5120, line 10 (Column A) ................................................................................................................ 11. 00
12. Tax Due from Form 5118, line 22e, Form 5119, line 24e, or Form 5120, line 41e ....................................... 12. 00
13. Refund from Form 5118, line 25, Form 5119, line 27, or Form 5120, line 44 ............................................... 13. 00

PART 2: DECLARATION AND E-FILE AUTHORIZATION

Under penalties of perjury, I declare that I have examined this return including any accompanying statements and schedules and, to the best of
my knowledge and belief, it is true, correct, and complete. The tax return information in Part 1 agrees with the amounts on the corresponding lines
of my Michigan and/or City of Detroit tax return. I consent to allow my Intermediate Service Provider, transmitter or Electronic Return Originator
(ERO) to send my return to IRS and subsequently by the IRS to the Michigan Department of Treasury and to receive an acknowledgment of
receipt or reason for rejection of the transmission.
Filer’s Signature Date Spouse’s Signature Date

04-09-20
3$57(/(&7521,&5(785125,*,1$725 (52 $1'35(3$5(5'(&/$5$7,21
I declare that the information contained in this electronic tax return is the information furnished to me by the taxpayer. If the taxpayer furnished
me a completed tax return, I declare that the information contained in this electronic tax return is identical to that contained in the return provided
by the taxpayer. If the furnished return was signed by a paid preparer, I declare I have entered the paid preparer’s identifying information in the
appropriate portion of this electronic return. If I am the paid preparer, under the penalties of perjury I declare that I have examined this electronic
return, and to the best of my knowledge and belief, it is true, correct, and complete. This declaration is based on all information of which I have
any knowledge.
ERO or Preparer Signature Date ERO is (check all that apply)

X Preparer Self-Employed
04-09-20
Firm Name (or name of ERO if self-employed) FEIN or PTIN

TAX ONE P00542502

Firm’s Address (Street, City, State, ZIP Code)

4677 CONNER DETROIT MI 48215-

&RPSOHWHWKLVIRUPRQO\LI\RXDUHH¿OLQJD0LFKLJDQRU&LW\RI'HWURLWXQOLQNHG VWDQGDORQH UHWXUQDQG

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1038
Michigan Department of Treasury (Rev. 05-19), Page 1 of 2 Issued under authority of Public Act 281 of 1967, as amended.

2019 MICHIGAN Individual Income Tax Return MI-1040 Amended Return

(Include Schedule AMD)
Return is due April 15, 2020. Type or print in blue or black ink.
1. Filer’s First Name M.I. Last Name 2. Filer’s Full Social Security No. (Example: 123-45-6789)
SPARKAL L JEWELL
If a Joint Return, Spouse’s First Name M.I. Last Name
363-21-3482
3. Spouse’s Full Social Security No. (Example: 123-45-6789)
Home Address (Number, Street, or P.O. Box)
POBOX 355
City or Town State ZIP Code 4. School District Code (5 digits – see page 60)
STERLING HEIGHTS MI 48311 63250
5. STATE CAMPAIGN FUND 6. FARMERS, FISHERMEN, OR SEAFARERS
Check if you (and/or your spouse, if a. Filer
¿OLQJDMRLQWUHWXUQ ZDQWRI\RXUWD[HV Check this box if 2/3 of your income is from farming,
to go to this fund. This will not increase b. ¿VKLQJRUVHDIDULQJ
Spouse
your tax or reduce your refund.

7. 2019 FILING STATUS. Check one. 8. 2019 RESIDENCY STATUS. Check all that apply.
a. X Single * If you check box “c,” complete a. X Resident
line 3 and enter spouse’s full name * If you check box “b” or
b. 0DUULHG¿OLQJMRLQWO\ below: b. Nonresident * “c,” you must complete
and include Schedule
NR.
c. 0DUULHG¿OLQJVHSDUDWHO\ c. Part-Year Resident *

9. EXEMPTIONS. NOTE: If someone else can claim you as a dependent, check box 9eHQWHURQOLQHDDQGHQWHURQOLQH9e (see instr.).

a. Number of exemptions (see instructions) ............................................................. 9a. x 4,400 9a. 00

b. Number of individuals who qualify for one of the following special exemptions: deaf,
blind, hemiplegic, paraplegic, quadriplegic, or totally and permanently disabled 9b. x  9b. 00
c. 1XPEHURITXDOL¿HGGLVDEOHGYHWHUDQV ................................................................. 9c. x  9c. 00
d. 1XPEHURI&HUWL¿FDWHVRI6WLOOELUWKIURP0'++6 VHHLQVWUXFWLRQV ..................... 9d. x  9d. 00

e. Claimed as dependent, see line 9 NOTE above .................................................. 9e. X 9e. 1500 00

f. Add lines 9a, 9b, 9c, 9d and 9e. Enter here and on line 15 ............................................................................. 9f. 1500 00

10. Adjusted Gross Income from your U.S. Forms 1040 or 1040NR (see instructions) ................................ 10. 6081 00

11. Additions from Schedule 1, line 9. Include Schedule 1 ............................................................................ 11. 00

12. Total. Add lines 10 and 11 .......................................................................................................................... 12. 6081 00

13. Subtractions from Schedule 1, line 28. Include Schedule 1 .................................................................... 13. 00

14. Income subject to tax. Subtract line 13 from line 12. If line 13 is greater than line 12, enter “0” ............ 14. 6081 00

15. Exemption allowance. Enter amount from line 9f or Schedule NR, line 19.............................................. 15. 1500 00

16. Taxable income. Subtract line 15 from line 14. If line 15 is greater than line 14, enter “0” ...................... 16. 4581 00

17. Tax. Multiply line 16 by 4.25% (0.0425) ..................................................................................................... 17. 195 00

NON-REFUNDABLE CREDITS AMOUNT CREDIT

18. Income Tax Imposed by government units outside Michigan.

Include a copy of the return (see instructions)........................ 18a. 00 18b. 00
19. Michigan Historic Preservation Tax Credit carryforward (see
instructions) ............................................................................ 19a. 00 19b. 00
20. Income Tax. Subtract the sum of lines 18b and 19b from line 17.
If the sum of lines 18b and 19b is greater than line 17, enter “0” ............................................................... 20. 195 00

+ 1038 2019 05 01 27 1 Continue on page 2. This form cannot be processed if page 2 is not completed and included.
2019 MI-1040, Page 2 of 2
Filer’s Full Social Security Number 363-21-3482
21. Enter amount of Income Tax from line 20. .................................................................................................. 21. 195 00
22. Voluntary Contributions from Form 4642, line 10. Include Form 4642...................................................... 22. 00
23. USE TAX. Use tax due on Internet, mail order or other out-of-state purchases from
Worksheet 1 (see instructions) ................................................................................................................... 23. 00

24. Total Tax Liability. Add lines 21, 22 and 23 ................................................................................... 24. 195 00
REFUNDABLE CREDITS AND PAYMENTS

25. Property Tax Credit. Include MI-1040CR or MI-1040CR-2 ..................................................................... 25. 00

26. Farmland Preservation Tax Credit. Include MI-1040CR-5 ..................................................................... 26. 00

FEDERAL MICHIGAN

27. Earned Income Tax Credit. Multiply line 27a by 6% (0.06) and
enter result on line 27b. ........................................................... 27a. 00 27b. 00

28. Michigan Historic Preservation Tax Credit (refundable). Include Form 3581. ........................................... 28. 00

29. Michigan tax withheld from Schedule W, line 6. Include Schedule W (do not submit W-2s) ................. 29. 258 00

30. Estimated tax, extension payments and 2018 credit forward ..................................................................... 30. 00
31. 2019 AMENDED RETURNS ONLY. Taxpayers completing an original 2019 return should skip to line 32.
Amended returns must include Schedule AMD (see instructions).

If you had a refund and/or credit forward on the original return, check box 31a and enter this amount as a
31a. negative number on line 31c.

If you paid with the original return, check box 31b and enter the amount paid with the original return, plus
31b. DQ\DGGLWLRQDOWD[SDLGDIWHU¿OLQJDVDSRVLWLYHQXPEHURQOLQHF'RQRWLQFOXGHLQWHUHVWRUSHQDOW\ 31c. 00

32. Total refundable credits and payments. Add lines 25, 26, 27b, 28, 29, 30 and 31c ........................ 32. 258 00
REFUND OR TAX DUE
33. If line 32 is less than line 24, subtract line 32 from line 24. If applicable, see instructions.

Include interest 00 and penalty 00 ......................... YOU OWE 33. 00

34. Overpayment. If line 32 is greater than line 24, subtract line 24 from line 32 ................................ 34. 63 00

35. Credit Forward. Amount of line 34 to be credited to your 2020 estimated tax for your 2020 tax return ... 35. 00

36. Subtract line 35 from line 34. ...................................................................................... REFUND 36. 63 00

DIRECT DEPOSIT a. Routing Transit Number b. Account Number c. Type of Account
'HSRVLW\RXUUHIXQGGLUHFWO\WR\RXU¿QDQFLDO
LQVWLWXWLRQ6HHLQVWUXFWLRQVDQGFRPSOHWHDE
1. X Checking 2. Savings
DQGF 072000326 325263132
Deceased Taxpayer. If Filer and/or Spouse died after December 31, 2018, enter dates below. 3UHSDUHU&HUWL¿FDWLRQ ,GHFODUHXQGHUSHQDOW\RISHUMXU\WKDW
ENTER DATE OF DEATH ONLY. Example: 04-15-2019 (MM-DD-YYYY) WKLVUHWXUQLVEDVHGRQDOOLQIRUPDWLRQRIZKLFK,KDYHDQ\NQRZOHGJH
Preparer’s PTIN, FEIN or SSN
Filer Spouse
P00542502
Preparer’s Name (print or type)
7D[SD\HU&HUWL¿FDWLRQ ,GHFODUHXQGHUSHQDOW\RISHUMXU\WKDWWKHLQIRUPDWLRQLQWKLVUHWXUQ
DQGDWWDFKPHQWVLVWUXHDQGFRPSOHWHWRWKHEHVWRIP\NQRZOHGJH BILLY R CUNNINGHAM
Filer’s Signature Date Preparer’s Business Name, Address and Telephone Number
04-09-20 TAX ONE
Spouse’s Signature Date 4677 CONNER
DETROIT MI 48215-
313-492-7916
X By checking this box, I authorize Treasury to discuss my return with my preparer.

Refund, credit, or zero returns. Mail your return to: Michigan Department of Treasury, Lansing, MI 48956
Pay amount on line 33 (see instructions). Mail your check and return to: Michigan Department of Treasury, Lansing, MI 48929

+ 1038 2019 05 02 27 9
Michigan Department of Treasury (Rev. 04-19), Page 1
Schedule W
2019 MICHIGAN Withholding Tax Schedule
Issued under authority of Public Act 281 of 1967, as amended.

Type or print in blue or black ink. Attachment 13

INSTRUCTIONS: If you had Michigan income tax withheld in 2019, you must complete a Withholding Tax Schedule (Schedule W) to claim the
withholding on your Individual Income Tax Return 0,OLQH 5HSRUWPLOLWDU\SD\LQ7DEOHDQGPLOLWDU\UHWLUHPHQWEHQH¿WVDQGWD[DEOH
UDLOURDGUHWLUHPHQWEHQH¿WV(both Tier 1 and Tier 2) in Table 2 even if no Michigan tax was withheld. Include your completed Schedule W with Form
MI-1040. See complete instructions on page 2 of this form. If you need additional space, include another Schedule W.
1. Filer’s First Name M.I. Last Name 2. Filer’s Full Social Security No. (Example: 123-45-6789)

SPARKAL L JEWELL 363-21-3482

If a Joint Return, Spouse’s First Name M.I. Last Name 3. Spouse’s Full Social Security No. (Example: 123-45-6789)

TABLE 1: MICHIGAN TAX WITHHELD OR MILITARY PAY REPORTED ON W-2, W-2G or CORRECTED W-2 FORMS
A B C D E
Enter “X” for: (PSOR\HU¶VLGHQWL¿FDWLRQQXPEHU Box 1 — Wages, tips, Box 17 — Michigan
Filer or Spouse (Example: 38-1234567) Box c — Employer’s name other compensation income tax withheld

X 473533761 PELOTON INTERACT 6081 00 258 00

00 00

00 00

00 00

00 00

Enter Table 1 Subtotal from additional Schedule W forms (if applicable). ...................................................... 00

4. SUBTOTAL. Enter total of Table 1, column E. ............................................................................... 4. 258 00

TABLE 2: MICHIGAN TAX WITHHELD OR MILITARY RETIREMENT BENEFITS AND RAILROAD RETIREMENT
BENEFITS (BOTH TIER 1 AND TIER 2) REPORTED ON 1099 FORMS
A B C D E
Enter “X” for: 3D\HU¶VIHGHUDOLGHQWL¿FDWLRQ Taxable pension distribution, Michigan income
Filer or Spouse number (Example: 38-1234567) Payer’s name misc. income, etc. (see inst.) tax withheld

00 00

00 00

00 00

00 00

00 00

Enter Table 2 Subtotal from additional Schedule W forms (if applicable). ...................................................... 00

5. SUBTOTAL. Enter total of Table 2, column E. ............................................................................... 5. 00

6. TOTAL. Add lines 4 and 5. Enter here and carry to MI-1040, line 29............................................. 6. 258 00

+ 1038 2019 57 01 27 2