Total Tax If you have church employee income, see page 2 of the instructions before you begin.

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1 Form 00-SS U.S. Self-Employment Tax Return (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico) Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Department of the Treasury Mariana Islands (CNMI), or Puerto Rico For the year Jan. Dec., 00, Internal Revenue Service or other tax year beginning, 00, and ending, 0. OMB No Your first name and initial Last name Your social security number Please type or print If a joint return, spouse s first name and initial Last name Present home address (number, street, and apt. no., or rural route) City, town or post office, commonwealth or territory, and ZIP code Spouse s social security number Filing status. Check the box for your filing status. See page of the instructions. Single Married filing jointly Married filing separately Part I Total Tax If you have church employee income, see page of the instructions before you begin. A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form, but you had $00 or more of other net earnings from self-employment, check here and continue with Part I Net farm profit or (loss) from Part III, line, and your distributive share from farm partnerships. Note: Skip this line if you use the farm optional method. See page 5 of the instructions Net nonfarm profit or (loss) from Part IV, line, and your distributive share from nonfarm partnerships. Ministers and members of religious orders, see page of the instructions for amounts to report on this line. Note: Skip this line if you use the nonfarm optional method. See page 5 of the instructions Combine lines and a If line is more than zero, multiply line by 9.5% (.95). Otherwise, enter amount from line a b If you elected one or both of the optional methods, enter the total of lines and of Part II here b c Combine lines a and b. If less than $00, you do not owe self-employment tax; go to line (line if Part V is completed). Exception. If less than $00 and you had church employee income, or you owe tax on tips or group-term life insurance, enter -0- and continue c Enter your church employee income from Form(s) W-, W-AS, W-CM, b Multiply line by 9.5% (.95). If less than $00, enter -0-5b Net earnings from self-employment. Add lines c and 5b Maximum amount of combined wages and self-employment earnings subject to social security tax for 00 80, a Total social security wages and tips from Form(s) W-, W-AS, W-CM, 8a b Unreported tips subject to social security tax from Form, line 9. See page 5 8b c Add lines 8a and 8b 8c 9 Subtract line 8c from line. If zero or less, enter -0- here and on line 0 and go to line 9 0 Multiply the smaller of line or line 9 by.% (.) 0 Multiply line by.9% (.09) Self-employment tax. See page 5. Add lines 0 and. Also, include amount (if any) from Part V, line Household employment taxes. Attach Schedule H (Form 00). See page 5 of the instructions Total tax. Add lines and 5 00 estimated tax payments. See page 5 of the instructions 5 Excess social security tax withheld. See page 5 of the instructions Additional child tax credit from Part VII, line 8 Total payments and credits. Add lines 5,, and 8 9 If line 8 is larger than line, enter amount overpaid 9 0 Amount of line 9 to be refunded to you 0 Amount of line 9 to be applied to 00 estimated tax If line is larger than line 8, enter amount you owe. See page of the instructions Part II Optional Methods To Figure Net Earnings See page 5 of the instructions for limitations. Farm Optional Method Maximum income for optional methods,00 00 Enter the smaller of: two-thirds ( ) of gross farm income from Part III, line, and your distributive share from farm partnerships (not less than zero), or $,00. Include this amount on Part I, line b, above. Nonfarm Optional Method Subtract line from line Enter the smaller of: two-thirds ( ) of gross income from Part IV, line 5, and your distributive share from nonfarm partnerships (not less than zero), or the amount on line of this part. Also, include this amount on Part I, line b, above For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 8 of the instructions. Cat. No. 8B Form 00-SS (00)

2 Form 00-SS (00) Page Part III Profit or Loss From Farming Name of proprietor Social security number Section A Farm Income Cash Method Complete Sections A and B (Accrual method taxpayers, complete Sections B and C, and line of Section A.) Do not include sales of livestock held for draft, breeding, sport, or dairy purposes. Sales of livestock and other items you bought for resale Cost or other basis of livestock and other items reported on line Subtract line from line Sales of livestock, produce, grains, and other products you raised Total cooperative distributions (Form(s) 099-PATR) 5b Taxable amount 5b Agricultural program payments received Commodity Credit Corporation loans reported under election (or forfeited) 8 Crop insurance proceeds 8 9 Custom hire (machine work) income 9 0 Other income 0 Gross farm income. Add amounts in the right column for lines through 0. If accrual method taxpayer, enter the amount from Section C, line 9 Section B Farm Expenses Cash and Accrual Method Do not include personal or living expenses (such as taxes, insurance, repairs, etc., on your home) that did not produce farm income. Reduce the amount of your farm expenses by any reimbursements before entering the expenses below. Car and truck expenses Labor hired (attach Form 5) 5 Pension and profit-sharing plans 5 Chemicals Rent or lease: Conservation expenses a Vehicles, machinery, and equipment a 5 Custom hire (machine work) 5 b Other (land, animals, etc.) b Depreciation and section 9 Repairs and maintenance expense deduction not claimed elsewhere (attach 8 Seeds and plants purchased 8 Form 5 if required) Employee benefit programs 9 Storage and warehousing 9 other than on line 5 0 Supplies purchased 0 8 Feed purchased 8 Taxes 9 Fertilizers and lime 9 Utilities 0 Freight and trucking 0 Veterinary, breeding, and medicine Gasoline, fuel, and oil Other expenses (specify): a a Insurance (other than health) b b Interest: c c a Mortgage (paid to banks, etc.) a d d b Other b e e 5 Total expenses. Add lines through e 5 Net farm profit or (loss). Subtract line 5 from line. Enter the result here and on Part I, line, or if this is your spouse s business, Part V, line Form 00-SS (00)

3 Form 00-SS (00) Section C Farm Income Accrual Method Do not include sales of livestock held for draft, breeding, sport, or dairy purposes on any of the lines below. Sales of livestock, produce, grains, and other products during the year Total cooperative distributions (Form(s) 099-PATR) 8a 8b Taxable amount 8b Agricultural program payments received 9 Commodity Credit Corporation loans reported under election (or forfeited) 0 Custom hire (machine work) income 8a 9 0 Other farm income (specify) Add the amounts in the right column for lines through Inventory of livestock, produce, grains, and other products at the beginning of the year 5 Cost of livestock, produce, grains, and other products purchased during the year 5 Add lines and 5 Inventory of livestock, produce, grains, and other products at the end of the year 8 Cost of livestock, produce, grains, and other products sold. Subtract line from line * 8 9 Gross farm income. Subtract line 8 from line. Enter the result here and on Part III, line 9 Page *If you use the unit-livestock-price method or the farm-price method of valuing inventory and the amount on line is larger than the amount on line, subtract line from line. Enter the result on line 8. Add lines and 8. Enter the total on line 9. Part IV Profit or Loss From Business (Sole Proprietorship) Name of proprietor Social security number Section A Income Gross receipts $ Less returns and allowances $ Balance a Inventory at beginning of year a b Purchases less cost of items withdrawn for personal use b c Cost of labor. Do not include any amounts paid to yourself c d Materials and supplies d e Other costs (attach statement) e f Add lines a through e f g Inventory at end of year g h Cost of goods sold. Subtract line g from line f h Gross profit. Subtract line h from line Other income 5 Gross income. Add lines and 5 Section B Expenses Advertising 9 Repairs and maintenance 9 Bad debts from sales or services 0 Supplies (not included in Section A) 0 8 Car and truck expenses Taxes and licenses (attach Form 5) 8 Travel, meals, and entertainment: 9 Commissions and fees 9 a Travel a 0 Depletion 0 b Meals and Depreciation and section 9 entertainment expense deduction (not included in Section A). (Attach c Enter Form 5 if required.) nondeductible Employee benefit programs amount included (other than on line ) on line b Insurance (other than health) d Subtract line c from line b d Interest on business indebtedness Utilities Wages not included on line c 5 Legal and professional services 5 Other expenses (list type and amount): Office expense Pension and profit-sharing plans 8 Rent or lease: a Vehicles, machinery, and equipment 8a b Other business property 8b 5b Total other expenses 5b Total expenses. Add lines through 5b Net profit or (loss). Subtract line from line 5. Enter the result here and on Part I, line, or if this is your spouse s business, Part V, line Form 00-SS (00)

4 Form 00-SS (00) Page Part V Self-Employment Tax (for use by spouse) If you have church employee income see page of the instructions before you begin. Name of person with self-employment income Social security number of person with self-employment income A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form, but you had $00 or more of other net earnings from self-employment, check here and continue with Part V Net farm profit or (loss) from Part III, line, and your distributive share from farm partnerships. Note: Skip this line if you use the farm optional method. See page 5 of the instructions Net nonfarm profit or (loss) from Part IV, line, and your distributive share from nonfarm partnerships. Ministers and members of religious orders, see page of the instructions for amounts to report on this line. Note: Skip this line if you use the nonfarm optional method. See page 5 of the instructions Combine lines and a If line is more than zero, multiply line by 9.5% (.95). Otherwise, enter amount from line a b If you elected one or both of the optional methods, enter the total of lines and of Part VI here b c Combine lines a and b. If less than $00, do not complete the rest of Part V; you do not owe self-employment tax. Exception. If less than $00 and you had church employee income, or you owe tax on tips or group-term life insurance, enter -0- and continue c Enter your church employee income from Form(s) W-, W-AS, W-CM, b Multiply line by 9.5% (.95). If less than $00, enter -0-5b Net earnings from self-employment. Add lines c and 5b Maximum amount of combined wages and self-employment earnings subject to social security tax for 00 80, a Total social security wages and tips from Form(s) W-, W-AS, W-CM, 8a b Unreported tips subject to social security tax from Form, line 9. See page 5 of the instructions 8b c Add lines 8a and 8b 8c 9 Subtract line 8c from line. If zero or less, enter -0- here and on line 0 and go to line 9 0 Multiply the smaller of line or line 9 by.% (.) 0 Multiply line by.9% (.09) Self-employment tax. Add lines 0 and. See page 5 of the instructions Part VI Optional Methods To Figure Net Earnings (for use by spouse) See page 5 of the instructions for limitations. Farm Optional Method Maximum income for optional methods Enter the smaller of: two-thirds ( ) of gross farm income from your separate Part III, line, and your distributive share from farm partnerships (not less than zero), or $,00. Include this amount on Part V, line b, above Nonfarm Optional Method Subtract line from line Enter the smaller of: two-thirds ( ) of gross income from your separate Part IV, line 5, and your distributive share from nonfarm partnerships (not less than zero), or the amount on line of this part. Also, include this amount on Part V, line b, above,00 00 Form 00-SS (00)

5 Form 00-SS (00) Part VII A Bona Fide Residents of Puerto Rico Claiming Additional Child Tax Credit See page of the instructions. If your filing status on page is married filing separately, enter your spouse s name and social security number. Spouse s first name, initial, and last name Qualifying children (if more than five qualifying children, see page of the instructions): (b) Child s (a) First name Last name social security number Spouse s social security number (c) Child s relationship to you Page 5 Total number of qualifying children Income derived from sources within Puerto Rico Adjustments to the income reported on line 5 Subtract line from line 5 Sign Here Withheld social security and Medicare taxes from Forms 99R-/W-PR (attach copy of form(s)) Additional child tax credit. See the worksheet on page of the instructions for the amount to enter here and on Part I, line Do you want to allow another person to discuss this return with the IRS (see page )? Yes. Complete the following. Third Party Designee Joint return? See page. Keep a copy for your records. Paid Preparer s Use Only Designee s name 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 the taxpayer) is based on all information of which the preparer has any knowledge. Your signature Daytime phone number Spouse s signature. If a joint return, both must sign. Preparer s signature Firm s name (or yours if self-employed), address, and ZIP code Phone no. ( ) Personal identification number (PIN) Check if self-employed EIN Phone no. ( ) Preparer s SSN or PTIN ( ) No Form 00-SS (00)

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