Department of the Treasury - Internal Revenue Service
1040
Form (99)
U.S. Individual Income Tax Return 2019 OMB No. 1545-0074
IRS Use Only - Do not write or staple in this space.
Filing Status Single X 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
KATHERINE
If joint return, spouse's first name and middle initial
CAPITO
Last name
" "
595 38 8943
Spouse's social security number
ARCH A. CAPITO
Home address (number and street). If you have a P.O. box, see instructions. Apt. no.
" "
236 25 8768
Presidential Election Campaign
510 LINDEN ROAD Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). a box below will not change your
CHARLESTON, WV 25314 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and u 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) u if qualifies for (see instructions):
Child tax credit Credit for other dependents
(1) First name Last name
ELIZABETH CAPITO 751-79-7994 DAUGHTER X
ARCH
ARCH A A CAPITO
CAPITO JR JR204-02-3084 SON 204-02-3084
X SON X
1 Wages, salaries, tips, etc. Attach Form(s) W-2••••••••••••••••••••••••• STMT 1 1 204,003.
Taxable interest. Attach Sch.
2a Tax-exempt interest ~~~ 2a b B if required ~~~~~~~~~ 2b
Ordinary dividends. Attach Sch.
Standard 3a Qualified dividends ~~~~ 3a b B if required ~~~~~~~~~ 3b 38.
Deduction for -
Single or Married
4a IRA distributions ~~~~~ 4a b Taxable amount ~~~~~~ 4b
¥ filing separately,
c Pensions and annuities ~~ 4c d Taxable amount ~~~~~~ 4d
$12,200
Married filing
5a Social security benefits ~~ 5a b Taxable amount •••••• 5b
¥ jointly or
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here ~~~~ | 6
Qualifying
widow(er), 7a Other income from Schedule 1, line 9 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7a 220,474.
$24,400
b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income ~~~~~~~~~~~ | 7b 424,515.
¥ Head of
household, 8a Adjustments to income from Schedule 1, line 22 ~~~~~~~~~~~~~~~~~~~~~~ 8a 42,743.
$18,350
b Subtract line 8a from line 7b. This is your adjusted gross income •••••••••••• | 8b 381,772.
¥ Ifany
you checked
46,016.
box under 9 Standard deduction or itemized deductions (from Schedule A) 9
Standard
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A 10
see instructions.
11a Add lines 9 and 10 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 11a 46,016.
b Taxable income. Subtract line 11a from line 8b.
If zero or less, enter -0- •••••••••••••••••••••••••• 11b 335,756.
LHA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
913921 12-19-19
