User's Manual

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:
Spouse standard deduction: Full-year health care coverage
or exempt (see inst.)
(see inst.)
Social security number Relationship to you if qualifies for (see inst.):
Child tax credit Credit for other dependents
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.
If the IRS sent you an Identity
Protection PIN,
enter it here
Your signature
Date Your occupation
Joint return?
See instructions.
Keep a copy for
your records.
Spouse's occupation
Date
Spouse's signature. If a joint return, must sign.
If the IRS sent you an Identity
Protection PIN,
enter it here
Preparer's name Preparer's signature PTIN Firm's EIN
3rd Party Designee
Phone no. Self-employed
Firm's name
Firm's address
Form (2018)
813921 12-13-18
both
Your social security number
Spouse's social security number
Presidential Election Campaign.
You Spouse
Dependents (2) (3) (4)
(1)
1040
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Form
Single Married filing jointly Married filing separately Head of household Qualifying widow(er)
Your first name and initial
Last name
Your standard deduction: Someone can claim you as a dependent You were born before January 2, 1954 You are blind
If joint return, spouse's first name and initial Last name
Someone can claim your spouse as a dependent Spouse was born before January 2, 1954
Spouse is blind Spouse itemizes on a separate return or you were dual-status alien
Home address (number and street). If you have a P.O. box, see instructions. Apt. no.
City, town or post office, state, and ZIP code. If you have a foreign address, attach Schedule 6. If more than four dependents,
see inst. and here
(see instructions):
First name Last name
Check if:
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|
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LHA
U.S. Individual Income Tax Return
Sign
Here
Paid
Preparer
Use Only
1040
2018
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X
YISROEL GOLDSTEIN 100 88 1947
GITTY GOLDSTEIN 127 60 9060
X
1265 51 ST
BROOKLYN, NY 11219 X
SEE STATEMENT 2
PHOTOGRAPHY
HOMEMAKER
ZACHARIA WAXLER ZACHARIA WAXLER P00502633 11-3360065
ROTH & COMPANY, LLP 732.276.1220
200 CENTRAL AVENUE
LAKEWOOD, NJ 07727