Estimated Taxes and Form W-4 Worksheet Name: SSN: Choose the Method You Will Use to Pay Your 2019 Federal Income Taxes In By withholding from my paychecks. (You will also need to complete the Additional Information for Form W-4 Worksheet. QuickZoom below.) In By making estimated tax payments. If estimated payments are in addition to withholding, my estimated 2019 withholding will be Overpayment from my 2018 return Amount of my 2018 overpayment to apply to 2019 instead of refunding it Enter Your Filing Status and Other Information for Your 2019 Tax Return Choose your filing status Taxpayer age as of the end of 2019 Spouse age as of the end of 2019 Do you qualify for an additional standard deduction? Taxpayer: Spouse: Check if you must itemize in 2019. (See Tax Help.) Total I ndent of Another Check if you will be the dependent of another person (but not if married filing jointly). Enter Your 2019 Income and Deductions in 2nd column Compensation: Annual wages and salary for taxpayer Medicare wages for taxpayer (W-2 box 5) Annual wages and salary for spouse Medicare wages for spouse (W-2 box 5) Annual net income from self-employment for taxpayer Annual net income from self-employment for spouse Other Tax Information: Note: Include this income in the Other Income section below. Net Investment Income for 3.8% tax Qualified dividends Maximum Capital Gains Rate Tax Information: Net short-term capital gains or losses Net long-term capital gains or losses Net 28%-rate capital gains included in long-term Unrecap'd Sec 1250 gains loci in long-term (see Tax Help) . . Investment income election (see Tax Help) Other Income: Total of your other taxable income and losses (see Tax Help) . . Foreign income or housing exclusions Adjustments: Deductible IRA contributions, alimony, etc Itemized Deductions: Total medical expenses State and local property and income taxes (or sales tax) Deductible foreign income taxes Deductible mortgage interest Cash charitable contributions Other charitable contributions Deductible investment interest expense, casualty or theft losses (see Tax Help) Other itemized deductions Net qualified disaster loss (see Tax Help) 2018 Actual 2019 Expected Other Deduction: Qualified business income deduction (see Tax Help) EFTA01222072 Page 2 Income Tax Calculation for Your 2019 Tax Return Taxable income Income tax Alternative minimum tax (Enter Alt Min tax expected in 2019) Premium tax credit repayment (Enter amt expected for 2019) Total credits (Enter credits expected in 2019) Tax on self-employment income and add.' 0.9% Medicare tax Net investment income tax (3.8%) Other taxes (Enter other taxes expected in 2019) Total federal income tax 2018 Actual 2019 Expected Enter the Tax Payments You've Already Made for Your 2019 Tax Return The federal income tax actually withheld from your paychecks to date Taxpayer Spouse Federal estimated tax payments you've already made Payment number 1 (April 15. 2019) Payment number 2 (June 17. 2019) Payment number 3 (September 16, 2019) 2018 federal overpayment credited to 2019 (from page 1 above) Total taxes paid to date Balance of payments needed or (expected refund) Summary of Taxes to be Paid for 2019 Federal income taxes to be withheld from your paychecks Your 2018 federal overpayment you applied to 2019 Your 2019 federal estimated taxes, based on Estimate of total payments you will need to make for 2019 EFTA01222073