Form

1040 Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

(99)
2017 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2017, or other tax year beginning , 2017, ending , 20 See separate instructions.
Your first name and initial Last name Your social security number

Chad Jackson 438-49-6230

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
and on line 6c are correct.
411 Boso Street
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
Belpre OH 45714 Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign country name Foreign province/state/county Foreign postal code
a box below will not change your tax or
refund. You Spouse

1 Single 4 Head of household (with qualifying person). (See instructions.)

Filing Status
2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, enter this
Check only one 3 Married filing separately. Enter spouse’s SSN above child’s name here. a
box. and full name here. a 5 Qualifying widow(er) (see instructions)

Exemptions 6a
b
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
} Boxes checked
on 6a and 6b
No. of children
1
c Dependents: (2) Dependent’s (3) Dependent’s (4)  if child under age 17 on 6c who:
social security number relationship to you qualifying for child tax credit • lived with you
(1) First name Last name (see instructions) • did not live with
you due to divorce
or separation
If more than four (see instructions)
dependents, see Dependents on 6c
instructions and not entered above
check here a Add numbers on
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . lines above a
1
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
Income
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
Attach Form(s)
9a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
W-2 here. Also
attach Forms b Qualified dividends . . . . . . . . . . . 9b
W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
1099-R if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12 69,530.
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here a 13
If you did not 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14
get a W-2,
see instructions. 15a IRA distributions . 15a b Taxable amount . . . 15b
16a Pensions and annuities 16a b Taxable amount . . . 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18
19 Unemployment compensation . . . . . . . . . . . . . . . . . 19
20a Social security benefits 20a b Taxable amount . . . 20b
21 Other income. List type and amount 21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income a 22 69,530.
23 Educator expenses . . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 . 25
26 Moving expenses. Attach Form 3903 . . . . . . 26
27 Deductible part of self-employment tax. Attach Schedule SE . 27 4,912.
28 Self-employed SEP, SIMPLE, and qualified plans . . 28
29 Self-employed health insurance deduction . . . . 29
30 Penalty on early withdrawal of savings . . . . . . 30
31a Alimony paid b Recipient’s SSN a 31a
32 IRA deduction . . . . . . . . . . . . . 32
33 Student loan interest deduction . . . . . . . . 33
34 Tuition and fees. Attach Form 8917 . . . . . . 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 4,912.
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . a 37 64,618.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 02/22/18 PRO Form 1040 (2017)
Form 1040 (2017) Page 2
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38 64,618.
Tax and
Credits
39a Check
if:
{ You were born before January 2, 1953,
Spouse was born before January 2, 1953,
Blind.
Blind.
} Total boxes
checked a 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here a 39b
Standard 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . 40 6,350.
Deduction 58,268.
for— 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41
• People who 42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions 42 4,050.
check any
box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43 54,218.
39a or 39b or 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44 9,295.
who can be
claimed as a 45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45
dependent,
see 46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . 46
instructions. 47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . a 47 9,295.
• All others:
48 Foreign tax credit. Attach Form 1116 if required . . . . 48
Single or
Married filing 49 Credit for child and dependent care expenses. Attach Form 2441 49
separately,
$6,350 50 Education credits from Form 8863, line 19 . . . . . 50
Married filing 51 Retirement savings contributions credit. Attach Form 8880 51
jointly or
Qualifying 52 Child tax credit. Attach Schedule 8812, if required . . . 52
widow(er), 53 Residential energy credits. Attach Form 5695 . . . . 53
$12,700
Head of 54 Other credits from Form: a 3800 b 8801 c 54
household, 55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . 55
$9,350
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . a 56 9,295.
57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 57 9,824.
Other 58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 58
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 59
Taxes 60a Household employment taxes from Schedule H . . . . . . . . . . . . . . 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . 60b
61 Health care: individual responsibility (see instructions) Full-year coverage . . . . . 61 1,355.
62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62
63 Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . a 63 20,474.
Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . 64
65 2017 estimated tax payments and amount applied from 2016 return 65
If you have a
66a Earned income credit (EIC) . . . . . . .No. . . 66a
qualifying
child, attach b Nontaxable combat pay election 66b
Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 . . . . . 67
68 American opportunity credit from Form 8863, line 8 . . . 68
69 Net premium tax credit. Attach Form 8962 . . . . . . 69
70 Amount paid with request for extension to file . . . . . 70
71 Excess social security and tier 1 RRTA tax withheld 71 . . . .
72 Credit for federal tax on fuels. Attach Form 4136 72 . . . .
73 Credits from Form: a 2439 b Reserved c 8885 d 73
74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . a 74
Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . a 76a
a
b
Routing number X X X X X X X X X a c Type: Checking Savings
Direct deposit?
See a d
Account number X X X X X X X X X X X X X X X X X
instructions.
77 Amount of line 75 you want applied to your 2018 estimated tax a 77
Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78 20,932.
You Owe 79 Estimated tax penalty (see instructions) . . . . . . . 79 458.
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No
Designee’s Phone Personal identification
Designee name a Dan Cross, CPA no. a (812)637-6100 number (PIN) a 27222
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
Sign accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
F

Joint return? See

instructions. Self Employed
Keep a copy for Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
your records. PIN, enter it
here (see inst.)
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
Dan Cross, CPA Dan Cross, CPA 03/27/2020 self-employed P00998191
Preparer
Firm’s name a Dan Cross, CPA Firm’s EIN a46-3078214
Use Only
Firm’s address a 23986 Stateline Rd, Suite 101 Lawrenceburg IN 47025 Phone no. (812)637-6100
Go to www.irs.gov/Form1040 for instructions and the latest information. REV 02/22/18 PRO Form 1040 (2017)
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074
(Form 1040)
Department of the Treasury
a Go
(Sole Proprietorship)
to www.irs.gov/ScheduleC for instructions and the latest information. 2017
Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
Chad Jackson 438-49-6230
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
Distributor of Vacuum Cleaners a 4 5 4 3 9 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
Ches Resolutions
E Business address (including suite or room no.) a 411 Boso Street
City, town or post office, state, and ZIP code Belpre, OH 45714
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2017? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2017, check here . . . . . . . . . . . . . . . . . a

I Did you make any payments in 2017 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If "Yes," did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes 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 . . . . . . . . . a 1 679,273.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 679,273.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4 233,600.
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 445,673.
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 . . . . . . . . . . . . . . . . . . . . . a 7 445,673.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 533. 18 Office expense (see instructions) 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . . 9 61,739. 20 Rent or lease (see instructions):
10 Commissions and fees . 10 254,973. a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 7,250. 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 12,054.
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23 25.
instructions) . . . . . 13 24 Travel, meals, and entertainment:
14 Employee benefit programs a Travel . . . . . . . . . 24a 9,289.
(other than on line 19) . . 14 b Deductible meals and
15 Insurance (other than health) 15 7,279. entertainment (see instructions) . 24b 0.
16 Interest: 25 Utilities . . . . . . . . 25 6,264.
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a 16,737.
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 . . . . . . a 28 376,143.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 69,530.
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.
• If a profit, enter on both Form 1040, line 12 (or Form 1040NR, line 13) and on Schedule SE, line 2.
(If you checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.
} 31 69,530.

}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Form 1040, line 12, (or Form 1040NR, line 13) and
on Schedule SE, line 2. (If you checked the box on line 1, see the line 31 instructions). Estates and 32a All investment is at risk.
trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 11/15/17 PRO Schedule C (Form 1040) 2017
Schedule C (Form 1040) 2017 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 . . . . . . . . . . . . . . 36 233,600.

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 . . . . . . . . . . . . . . . . . . . . . . . . 40 233,600.

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 .
. . . . . 42 233,600.
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) a 01/01/2019

44 Of the total number of miles you drove your vehicle during 2017, enter the number of miles you used your vehicle for:

a Business 105,400 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.

Bank Service Charges 105.

Merchant Service Fees 502.

Employee Provided Meals 4,967.

Recruiting Costs 8,178.

Computer Software 726.

Marketing 69.

Postage and Delivery 327.

Distibutor Fees & Dues (Great Lakes) 1,863.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48 16,737.

REV 11/15/17 PRO Schedule C (Form 1040) 2017
SCHEDULE SE
Self-Employment Tax
OMB No. 1545-0074

2017
(Form 1040)
a Go to www.irs.gov/ScheduleSE for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040 or Form 1040NR. Sequence No. 17
Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) Social security number of person
Chad Jackson with self-employment income a 438-49-6230
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 2017?

No Yes
d d d
Are you a minister, member of a religious order, or Christian
Yes Was the total of your wages and tips subject to social security Yes
Science practitioner who received IRS approval not to be taxed a or railroad retirement (tier 1) tax plus your net earnings from a
on earnings from these sources, but you owe self-employment
self-employment more than $127,200?
tax on other earnings?

No
No
d d

Are you using one of the optional methods to figure your net Did you receive tips subject to social security or Medicare tax Yes
Yes a
earnings (see instructions)? a that you didn't report to your employer?

No
No d
d
No Did you report any wages on Form 8919, Uncollected Social Yes
Did you receive church employee income (see instructions) Yes ` Security and Medicare Tax on Wages? a
reported on Form W-2 of $108.28 or more? a

No
d d
You may use Short Schedule SE below a 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 Z 1b ( )
2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
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 69,530.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . 3 69,530.
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 . . . . . . . . . . . . . a 4 64,211.
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:
• $127,200 or less, multiply line 4 by 15.3% (0.153). Enter the result here and on Form 1040, line
57, or Form 1040NR, line 55
• More than $127,200, multiply line 4 by 2.9% (0.029). Then, add $15,772.80 to the result.
Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 . . . . . . . 5 9,824.
6 Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (0.50). Enter the result here and on Form
1040, line 27, or Form 1040NR, line 27 . . . . . . . . 6 4,912.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 11/14/17 PRO Schedule SE (Form 1040) 2017
Chad Jackson 438-49-6230 1

Additional information from your 2017 Federal Tax Return

Schedule C (Distributor of Vacuum Cleaners): Profit or Loss from Business

Line 25 Itemization Statement
Description Amount
Telephone 5,193.
Gas & Electric 1,071.
Total 6,264.