File by Mail Instructions for your 2022 Federal Tax Return

Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
Abderrahim Mermache
5189 Cambria Way
Westerville, OH 43081-6646
|
Balance | Your federal tax return (Form 1040) shows you owe a balance due of
Due/ | $2,589.00.
Refund |
| You are paying by check.
|
______________________________________________________________________________________
|
What You | Your tax return - The official return for mailing is included in
Need to | this printout. Remember to sign and date the return.
Mail |
| Your payment - Mail a check or money order for $2,589.00, payable
| to "United States Treasury". Write your Social Security number and
| "2022 Form 1040" on the check. Mail the return and check together.
|
| Attach the first copy or Copy B of Form(s) W-2 to the front of your
| Form 1040.
|
| Mail your return, attachments and payment to:
| Internal Revenue Service
| P.O. Box 802501
| Cincinnati, OH 45280-2501
|
| Deadline: Postmarked by Tuesday, April 18, 2023
|
| Note: Your state return may be due on a different date. Please
| review your state filing instructions.
|
| Don't forget correct postage on the envelope.
|
______________________________________________________________________________________
|
What You | Keep these instructions and a copy of your return for your records.
Need to | You can download or print a copy of your return by logging into your
Keep | TurboTax account.
|
______________________________________________________________________________________
|
2022 | Adjusted Gross Income $ 84,437.00
Federal | Taxable Income $ 71,487.00
Tax | Total Tax $ 11,702.00
Return | Total Payments/Credits $ 9,113.00
Summary | Payment Due $ 2,589.00
| Effective Tax Rate 13.43%
|
______________________________________________________________________________________
|
Estimated | Estimated Payments for 2023 - Do not mail these vouchers with your
Payments to | 2022 income tax return. The estimated vouchers displayed below are
Make for Next | used to prepay your 2023 income taxes that will be filed next year.
Year's Return | If you expect to owe more than $1,000 in 2023, you may incur
| underpayment penalties if you do not make these four estimated tax
| payments. This printout includes your estimated tax vouchers for your
| federal estimated taxes (Form 1040-ES).
|
______________________________________________________________________________________
Page 1 of 2
File by Mail Instructions for your 2022 Federal Tax Return
Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
Abderrahim Mermache
5189 Cambria Way
Westerville, OH 43081-6646
|
Estimated | Mail payments according to the schedule below:
Payments to |
Make for Next| Voucher Number Due Date Amount
Year's Return| 1 04/18/2023 $ 841.00
(Continued) | 2 06/15/2023 $ 841.00
| 3 09/15/2023 $ 841.00
| 4 01/16/2024 $ 841.00
|
| Include a separate check or money order for each payment, payable to
| "United States Treasury". Write your social security number and "Form
| 1040-ES" on each check.
|
| Mail payments to:
| Internal Revenue Service
| P.O. Box 802502
| Cincinnati, OH 45280-2502
|
______________________________________________________________________________________
|
Changed | You can still file electronically. Just go back to TurboTax, select
Your Mind | the File tab, then select the E-file category. We'll walk you
About | through the process. Once you file, we will let you know if your
e-filing? | return is accepted (or rejected) by the Internal Revenue Service.
|
______________________________________________________________________________________

Page 2 of 2
 I Detach Here and Mail With Your Payment I
Calendar Year '
Department of the Treasury
Internal Revenue Service Due 04/18/2023 2023 Form 1040-ES Payment Voucher 1
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2023 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 841.
REV 03/22/23 INTUIT.CG.CFP.SP 1555

111-98-8119
ABDERRAHIM MERMACHE
INTERNAL REVENUE SERVICE
5189 CAMBRIA WAY PO BOX 802502
WESTERVILLE OH 43081-6646 CINCINNATI OH 45280-2502

111988119 VR MERM 30 0 202312 430

 I Detach Here and Mail With Your Payment I
Calendar Year '
Department of the Treasury
Internal Revenue Service Due 06/15/2023 2023 Form 1040-ES Payment Voucher 2
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2023 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 841.
REV 03/22/23 INTUIT.CG.CFP.SP 1555

111-98-8119
ABDERRAHIM MERMACHE
INTERNAL REVENUE SERVICE
5189 CAMBRIA WAY PO BOX 802502
WESTERVILLE OH 43081-6646 CINCINNATI OH 45280-2502

111988119 VR MERM 30 0 202312 430

 I Detach Here and Mail With Your Payment I
Calendar Year '
Department of the Treasury
Internal Revenue Service Due 09/15/2023 2023 Form 1040-ES Payment Voucher 3
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2023 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 841.
REV 03/22/23 INTUIT.CG.CFP.SP 1555

111-98-8119
ABDERRAHIM MERMACHE
INTERNAL REVENUE SERVICE
5189 CAMBRIA WAY PO BOX 802502
WESTERVILLE OH 43081-6646 CINCINNATI OH 45280-2502

111988119 VR MERM 30 0 202312 430

 I Detach Here and Mail With Your Payment I
Calendar Year '
Department of the Treasury
Internal Revenue Service Due 01/16/2024 2023 Form 1040-ES Payment Voucher 4
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2023 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 841.
REV 03/22/23 INTUIT.CG.CFP.SP 1555

111-98-8119
ABDERRAHIM MERMACHE
INTERNAL REVENUE SERVICE
5189 CAMBRIA WAY PO BOX 802502
WESTERVILLE OH 43081-6646 CINCINNATI OH 45280-2502

111988119 VR MERM 30 0 202312 430

Form 1040-V (2022) 2022 Page 2

IF you live in... THEN use this address to send in your payment...

Alabama, Florida, Georgia, Louisiana, Mississippi, North Internal Revenue Service

Carolina, South Carolina, Tennessee, Texas P.O. Box 1214
Charlotte, NC 28201-1214
Arkansas, Connecticut, Delaware, District of Columbia, Illinois,
Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Internal Revenue Service
Minnesota, Missouri, New Hampshire, New Jersey, New York, P.O. Box 931000
Oklahoma, Rhode Island, Vermont, Virginia, West Virginia, Louisville, KY 40293-1000
Wisconsin

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Kansas,

Internal Revenue Service
Michigan, Montana, Nebraska, Nevada, New Mexico, North
P.O. Box 802501
Dakota, Ohio, Oregon, Pennsylvania, South Dakota, Utah,
Cincinnati, OH 45280-2501
Washington, Wyoming

A foreign country, American Samoa, or Puerto Rico (or are

excluding income under Internal Revenue Code section 933), or Internal Revenue Service
use an APO or FPO address, or file Form 2555 or 4563, or are a P.O. Box 1303
dual-status alien or nonpermanent resident of Guam or the U.S. Charlotte, NC 28201-1303
Virgin Islands

TO PAY YOUR TAXES DUE BY CHECK, MAIL THIS FORM TO THE ADDRESS LISTED BELOW.

Form 1040-V 2022

I Detach Here and Mail With Your Payment and Return I
Department of the Treasury
Internal Revenue Service 2022 Form 1040-V Payment Voucher
G Use this voucher when making a payment with Form 1040.
G Do not staple this voucher or your payment to Form 1040.
G Make your check or money order payable to the 'United States Treasury.' Enter the amount
G Write your social security number (SSN) on your check or money order. of your payment. . . . . . . . . G 2,589.
REV 03/22/23 INTUIT.CG. 1555

ABDERRAHIM MERMACHE INTERNAL REVENUE SERVICE

P.O. BOX 802501
5189 CAMBRIA WAY CINCINNATI, OH 45280-2501
WESTERVILLE OH 43081-6646

111988119 VR MERM 30 0 202212 610

 1040 U.S. Individual Income Tax Return 2022
Form Department of the Treasury—Internal Revenue Service

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

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH)
Qualifying surviving
Check only spouse (QSS)
one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s name if the qualifying
person is a child but not your dependent: Karima El Baghdadi
Your first name and middle initial Last name Your social security number
Abderrahim Mermache 111-98-8119
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
5189 Cambria Way Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Westerville OH 430816646 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Digital At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes No
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, 1958 Are blind Spouse: Was born before January 2, 1958 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here . .

Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 84,437.
b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s) c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
W-2 here. Also
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
1099-R if tax
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h 0.
W-2, see
instructions.
i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 84,437.
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
Standard 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Deduction for—
6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
• Single or
Married filing c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
separately,
$12,950 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7
• Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8
jointly or
Qualifying 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 84,437.
surviving spouse,
$25,900
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
• Head of 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 84,437.
household,
$19,400 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12,950.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12,950.
Deduction, 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . .
see instructions.
15 71,487.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2022)
Form 1040 (2022) Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 11,342.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 11,342.
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 11,342.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 360.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 11,702.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 9,113.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 9,113.
26 2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . 26
If you have a
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 9,113.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a
Direct deposit? b Routing number X X X X X X X X X c Type: Checking Savings
See instructions.
d Account number X X X X X X X X X X X X X X X X X
36 Amount of line 34 you want applied to your 2023 estimated tax . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . 37 2,589.
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
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
Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
Joint return? Software Consultant (see inst.)
See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)

Phone no. (347)526-6459 Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name Self-Prepared Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 03/22/23 Intuit.cg.cfp.sp Form 1040 (2022)
SCHEDULE 2 OMB No. 1545-0074
Additional Taxes
(Form 1040)
Department of the Treasury
Attach to Form 1040, 1040-SR, or 1040-NR. 2022
Attachment
Go to www.irs.gov/Form1040 for instructions and the latest information.
Internal Revenue Service Sequence No. 02
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
Abderrahim Mermache 111-98-8119
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . 2
3 Add lines 1 and 2. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . 4
5 Social security and Medicare tax on unreported tip income.
Attach Form 4137 . . . . . . . . . . . . . . . . . . 5
6 Uncollected social security and Medicare tax on wages. Attach
Form 8919 . . . . . . . . . . . . . . . . . . . . . 6
7 Total additional social security and Medicare tax. Add lines 5 and 6 . . . . . . 7
8 Additional tax on IRAs or other tax-favored accounts. Attach Form 5329 if required.
If not required, check here . . . . . . . . . . . . . . . . . . . . . 8 360.
9 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . 9
10 Repayment of first-time homebuyer credit. Attach Form 5405 if required . . . . . 10
11 Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . 11
12 Net investment income tax. Attach Form 8960 . . . . . . . . . . . . . . . 12
13 Uncollected social security and Medicare or RRTA tax on tips or group-term life
insurance from Form W-2, box 12 . . . . . . . . . . . . . . . . . . . . 13
14 Interest on tax due on installment income from the sale of certain residential lots
and timeshares . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Interest on the deferred tax on gain from certain installment sales with a sales price
over $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Recapture of low-income housing credit. Attach Form 8611 . . . . . . . . . . 16
(continued on page 2)
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 2 (Form 1040) 2022
Schedule 2 (Form 1040) 2022 Page 2

Part II Other Taxes (continued)

17 Other additional taxes:
a Recapture of other credits. List type, form number, and amount:
17a
b Recapture of federal mortgage subsidy, if you sold your home
see instructions . . . . . . . . . . . . . . . . . . . 17b
c Additional tax on HSA distributions. Attach Form 8889 . . . . 17c
d Additional tax on an HSA because you didn’t remain an eligible
individual. Attach Form 8889 . . . . . . . . . . . . . . 17d
e Additional tax on Archer MSA distributions. Attach Form 8853 . 17e
f Additional tax on Medicare Advantage MSA distributions. Attach
Form 8853 . . . . . . . . . . . . . . . . . . . . . 17f
g Recapture of a charitable contribution deduction related to a
fractional interest in tangible personal property . . . . . . . 17g
h Income you received from a nonqualified deferred compensation
plan that fails to meet the requirements of section 409A . . . 17h
i Compensation you received from a nonqualified deferred
compensation plan described in section 457A . . . . . . . 17i
j Section 72(m)(5) excess benefits tax . . . . . . . . . . . 17j
k Golden parachute payments . . . . . . . . . . . . . . 17k
l Tax on accumulation distribution of trusts . . . . . . . . . 17l
m Excise tax on insider stock compensation from an expatriated
corporation . . . . . . . . . . . . . . . . . . . . . 17m
n Look-back interest under section 167(g) or 460(b) from Form
8697 or 8866 . . . . . . . . . . . . . . . . . . . . 17n
o Tax on non-effectively connected income for any part of the
year you were a nonresident alien from Form 1040-NR . . . . 17o
p Any interest from Form 8621, line 16f, relating to distributions
from, and dispositions of, stock of a section 1291 fund . . . . 17p
q Any interest from Form 8621, line 24 . . . . . . . . . . . 17q
z Any other taxes. List type and amount:
17z
18 Total additional taxes. Add lines 17a through 17z . . . . . . . . . . . . . . 18
19 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Section 965 net tax liability installment from Form 965-A . . . 20
21 Add lines 4, 7 through 16, and 18. These are your total other taxes. Enter here and
on Form 1040 or 1040-SR, line 23, or Form 1040-NR, line 23b . . . . . . . . . 21 360.
BAA REV 03/22/23 Intuit.cg.cfp.sp Schedule 2 (Form 1040) 2022
SCHEDULE B OMB No. 1545-0074
Interest and Ordinary Dividends
2022
(Form 1040)
Department of the Treasury Go to www.irs.gov/ScheduleB for instructions and the latest information.
Attachment
Internal Revenue Service Attach to Form 1040 or 1040-SR. Sequence No. 08
Name(s) shown on return Your social security number
Abderrahim Mermache 111-98-8119
Amount
Part I 1 List name of payer. If any interest is from a seller-financed mortgage and the
buyer used the property as a personal residence, see the instructions and list this
Interest interest first. Also, show that buyer’s social security number and address:
(See instructions
and the
Instructions for
Form 1040,
line 2b.)
Note: If you
received a
Form 1099-INT, 1
Form 1099-OID,
or substitute
statement from
a brokerage firm,
list the firm’s
name as the
payer and enter
the total interest
shown on that
form.
2 Add the amounts on line 1 . . . . . . . . . . . . . . . . . . . 2
3 Excludable interest on series EE and I U.S. savings bonds issued after 1989.
Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . 3
4 Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b 4
Note: If line 4 is over $1,500, you must complete Part III. Amount
Part II 5 List name of payer:

Ordinary
Dividends
(See instructions
and the
Instructions for
Form 1040,
line 3b.) 5
Note: If you
received a
Form 1099-DIV
or substitute
statement from
a brokerage firm,
list the firm’s
name as the
payer and enter
the ordinary
dividends shown 6 Add the amounts on line 5. Enter the total here and on Form 1040 or 1040-SR, line 3b 6
on that form. Note: If line 6 is over $1,500, you must complete Part III.
Part III You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign
account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
Foreign
Accounts Yes No
and Trusts 7a At any time during 2022, did you have a financial interest in or signature authority over a financial
Caution: If account (such as a bank account, securities account, or brokerage account) located in a foreign
required, failure to country? See instructions . . . . . . . . . . . . . . . . . . . . . . . .
file FinCEN Form
114 may result in If “Yes,” are you required to file FinCEN Form 114, Report of Foreign Bank and Financial
substantial Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114
penalties. and its instructions for filing requirements and exceptions to those requirements . . . . . .
Additionally, you
may be required b If you are required to file FinCEN Form 114, list the name(s) of the foreign country(-ies) where the
to file Form 8938, financial account(s) are located:
Statement of
Specified Foreign
Financial Assets. 8 During 2022, did you receive a distribution from, or were you the grantor of, or transferor to, a
See instructions. foreign trust? If “Yes,” you may have to file Form 3520. See instructions . . . . . . . . .
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 03/22/23 Intuit.cg.cfp.sp Schedule B (Form 1040) 2022
Form 5329 Additional Taxes on Qualified Plans
(Including IRAs) and Other Tax-Favored Accounts
OMB No. 1545-0074

2022
Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. Attachment
Internal Revenue Service Go to www.irs.gov/Form5329 for instructions and the latest information. Sequence No. 29
Name of individual subject to additional tax. If married filing jointly, see instructions. Your social security number
Abderrahim Mermache 111-98-8119
Home address (number and street), or P.O. box if mail is not delivered to your home Apt. no.

Fill in Your Address Only City, town or post office, state, and ZIP code. If you have a foreign address, also complete the spaces
if You Are Filing This below. See instructions.
Form by Itself and Not If this is an amended
With Your Tax Return return, check here
Foreign country name Foreign province/state/county Foreign postal code

If you only owe the additional 10% tax on the full amount of the early distributions, you may be able to report this tax directly on
Schedule 2 (Form 1040), line 8, without filing Form 5329. See instructions.
Part I Additional Tax on Early Distributions. Complete this part if you took a taxable distribution (other than a qualified
disaster distribution) before you reached age 59½ from a qualified retirement plan (including an IRA) or modified
endowment contract (unless you are reporting this tax directly on Schedule 2 (Form 1040)—see above). You may also
have to complete this part to indicate that you qualify for an exception to the additional tax on early distributions or for
certain Roth IRA distributions. See instructions.
1 Early distributions includible in income (see instructions). For Roth IRA distributions, see instructions . 1
2 Early distributions included on line 1 that are not subject to the additional tax (see instructions).
Enter the appropriate exception number from the instructions: . . . . . . . . . . 2
3 Amount subject to additional tax. Subtract line 2 from line 1 . . . . . . . . . . . . . . 3
4 Additional tax. Enter 10% (0.10) of line 3. Include this amount on Schedule 2 (Form 1040), line 8 . . 4
Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have to
include 25% of that amount on line 4 instead of 10%. See instructions.
Part II Additional Tax on Certain Distributions From Education Accounts and ABLE Accounts. Complete this part
if you included an amount in income, on Schedule 1 (Form 1040), line 8z, from a Coverdell education savings account
(ESA) or a qualified tuition program (QTP), or on Schedule 1 (Form 1040), line 8q, from an ABLE account.
5 Distributions included in income from a Coverdell ESA, a QTP, or an ABLE account . . . . . . 5
6 Distributions included on line 5 that are not subject to the additional tax (see instructions) . . . . 6
7 Amount subject to additional tax. Subtract line 6 from line 5 . . . . . . . . . . . . . . 7
8 Additional tax. Enter 10% (0.10) of line 7. Include this amount on Schedule 2 (Form 1040), line 8 . . 8
Part III Additional Tax on Excess Contributions to Traditional IRAs. Complete this part if you contributed more to your
traditional IRAs for 2022 than is allowable or you had an amount on line 17 of your 2021 Form 5329.
9 Enter your excess contributions from line 16 of your 2021 Form 5329. See instructions. If zero, go to line 15 9
10 If your traditional IRA contributions for 2022 are less than your maximum
allowable contribution, see instructions. Otherwise, enter -0- . . . . . . 10
11 2022 traditional IRA distributions included in income (see instructions) . . . 11
12 2022 distributions of prior year excess contributions (see instructions) . . . 12
13 Add lines 10, 11, and 12 . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0- . . . . . . 14
15 Excess contributions for 2022 (see instructions) . . . . . . . . . . . . . . . . . . 15
16 Total excess contributions. Add lines 14 and 15 . . . . . . . . . . . . . . . . . . 16
17 Additional tax. Enter 6% (0.06) of the smaller of line 16 or the value of your traditional IRAs on December
31, 2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2 (Form 1040), line 8 17
Part IV Additional Tax on Excess Contributions to Roth IRAs. Complete this part if you contributed more to your Roth
IRAs for 2022 than is allowable or you had an amount on line 25 of your 2021 Form 5329.
18 Enter your excess contributions from line 24 of your 2021 Form 5329. See instructions. If zero, go to line 23 18 0.
19 If your Roth IRA contributions for 2022 are less than your maximum allowable
contribution, see instructions. Otherwise, enter -0- . . . . . . . . . 19
20 2022 distributions from your Roth IRAs (see instructions) . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . 22
23 Excess contributions for 2022 (see instructions) . . . . . . . . . . . . . . . . . . 23 6,000.
24 Total excess contributions. Add lines 22 and 23 . . . . . . . . . . . . . . . . . . 24 6,000.
25 Additional tax. Enter 6% (0.06) of the smaller of line 24 or the value of your Roth IRAs on December 31,
2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2 (Form 1040), line 8 25 360.
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions. BAA Cat.
REVNo. 13329Q
03/22/23 Intuit.cg.cfp.sp Form 5329 (2022)
Form 5329 (2022) Page 2
Part V Additional Tax on Excess Contributions to Coverdell ESAs. Complete this part if the contributions to your
Coverdell ESAs for 2022 were more than is allowable or you had an amount on line 33 of your 2021 Form 5329.
26 Enter the excess contributions from line 32 of your 2021 Form 5329. See instructions. If zero, go to line 31 26
27 If the contributions to your Coverdell ESAs for 2022 were less than the
maximum allowable contribution, see instructions. Otherwise, enter -0- . . 27
28 2022 distributions from your Coverdell ESAs (see instructions) . . . . . 28
29 Add lines 27 and 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
30 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter -0- . . . . . . 30
31 Excess contributions for 2022 (see instructions) . . . . . . . . . . . . . . . . . . 31
32 Total excess contributions. Add lines 30 and 31 . . . . . . . . . . . . . . . . . . 32
33 Additional tax. Enter 6% (0.06) of the smaller of line 32 or the value of your Coverdell ESAs on
December 31, 2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2
(Form 1040), line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Part VI Additional Tax on Excess Contributions to Archer MSAs. Complete this part if you or your employer contributed
more to your Archer MSAs for 2022 than is allowable or you had an amount on line 41 of your 2021 Form 5329.
34 Enter the excess contributions from line 40 of your 2021 Form 5329. See instructions. If zero, go to line 39 34
35 If the contributions to your Archer MSAs for 2022 are less than the maximum
allowable contribution, see instructions. Otherwise, enter -0- . . . . . . 35
36 2022 distributions from your Archer MSAs from Form 8853, line 8 . . . . 36
37 Add lines 35 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38 Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter -0- . . . . . . 38
39 Excess contributions for 2022 (see instructions) . . . . . . . . . . . . . . . . . . 39
40 Total excess contributions. Add lines 38 and 39 . . . . . . . . . . . . . . . . . . 40
41 Additional tax. Enter 6% (0.06) of the smaller of line 40 or the value of your Archer MSAs on
December 31, 2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2
(Form 1040), line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Part VII Additional Tax on Excess Contributions to Health Savings Accounts (HSAs). Complete this part if you,
someone on your behalf, or your employer contributed more to your HSAs for 2022 than is allowable or you had an
amount on line 49 of your 2021 Form 5329.
42 Enter the excess contributions from line 48 of your 2021 Form 5329. If zero, go to line 47 . . . . 42
43 If the contributions to your HSAs for 2022 are less than the maximum
allowable contribution, see instructions. Otherwise, enter -0- . . . . . . 43
44 2022 distributions from your HSAs from Form 8889, line 16 . . . . . . 44
45 Add lines 43 and 44 . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
46 Prior year excess contributions. Subtract line 45 from line 42. If zero or less, enter -0- . . . . . . 46
47 Excess contributions for 2022 (see instructions) . . . . . . . . . . . . . . . . . . 47
48 Total excess contributions. Add lines 46 and 47 . . . . . . . . . . . . . . . . . . 48
49 Additional tax. Enter 6% (0.06) of the smaller of line 48 or the value of your HSAs on December 31,
2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2 (Form 1040), line 8 49
Part VIII Additional Tax on Excess Contributions to an ABLE Account. Complete this part if contributions to your ABLE
account for 2022 were more than is allowable.
50 Excess contributions for 2022 (see instructions) . . . . . . . . . . . . . . . . . . 50
51 Additional tax. Enter 6% (0.06) of the smaller of line 50 or the value of your ABLE account on
December 31, 2022. Include this amount on Schedule 2 (Form 1040), line 8 . . . . . . . . . 51
Part IX Additional Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs). Complete this part
if you did not receive the minimum required distribution from your qualified retirement plan.
52 Minimum required distribution for 2022 (see instructions) . . . . . . . . . . . . . . . 52
53 Amount actually distributed to you in 2022 . . . . . . . . . . . . . . . . . . . . 53
54 Subtract line 53 from line 52. If zero or less, enter -0- . . . . . . . . . . . . . . . . 54
55 Additional tax. Enter 50% (0.50) of line 54. Include this amount on Schedule 2 (Form 1040), line 8 . 55
Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my knowledge and
Sign Here Only if You belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Are Filing This Form
by Itself and Not With
Your Tax Return Your signature Date
Print/Type preparer’s name Preparer’s signature Date PTIN
Check if
Paid self-employed
Preparer
Firm’s name Firm’s EIN
Use Only
Firm’s address Phone no.
Form 5329 (2022)
REV 03/22/23 Intuit.cg.cfp.sp
File by Mail Instructions for your 2022 Ohio Tax Return
Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.) Do not file these instructions.
Abderrahim Mermache
5189 Cambria Way
Westerville, OH 43081-6646
|
Balance | Your Ohio state tax return (Form IT 1040) shows you are due a refund
Due/ | of $196.00.
Refund |
|
______________________________________________________________________________________
|
What You | Your tax return - The official return for mailing is included in
Need to | this printout. Remember to sign and date the return.
Mail |
| NOTE: Please enclose all employer or provider issued W-2(s), W-2G(s),
| 1099(s) and/or Schedule K-1 form(s), and a copy of all other
| supporting documentation (including worksheets, if applicable) used
| in the preparation of your Ohio IT 1040.
|
| Mail your return and attachments to:
| Ohio Department of Taxation
| P.O. Box 2679
| Columbus, OH 43270-2679
|
| Deadline: Postmarked by April 18, 2023
|
| Don't forget correct postage on the envelope.
|
______________________________________________________________________________________
|
What You | Keep these instructions and a copy of your return for your records.
Need to | You can download or print a copy of your return by logging into your
Keep | TurboTax account.
|
______________________________________________________________________________________
|
2022 | Taxable Income $ 82,537.00
Ohio | Total Tax $ 2,090.00
Tax | Total Payments/Credits $ 2,286.00
Return | Amount to be Refunded $ 196.00
Summary |
|
______________________________________________________________________________________
|
Special | Your printed state tax forms may have special formatting on them,
Formatting | such as bar codes or other symbols. This is to enable fast
| processing. Don't worry, these forms have been approved by your
| taxing authority and are acceptable for printing and mailing.
|
______________________________________________________________________________________
|
Changed | You can still file electronically. Just go back to TurboTax, select
Your Mind | the File tab, then select the E-file category. We'll walk you
About | through the process. Once you file, we will let you know if your
e-filing? | return is accepted (or rejected) by the state taxing agency.
|
______________________________________________________________________________________

Page 1 of 1
 Do not staple or paper clip.
2022 Ohio IT 1040
hio Department of
Taxation
Individual Income Tax Return
Use only black ink/UPPERCASE letters. Use whole dollars only. 22000133
04 17 23 Sequence No. 1

AMENDED RETURN - Check here and include Ohio IT RE. NOL CARRYBACK - Check here and include Schedule IT NOL.

3ULPDU\WD[SD\HU V661 UHTXLUHG  DIf deceased 6SRXVH¶V661 LI¿OLQJMRLQWO\ DIf deceased School district #
111 98 8119 2103
)LUVWQDPH M.I. /DVWQDPH
ABDERRAHIM MERMACHE
6SRXVH V¿UVWQDPH LI¿OLQJMRLQWO\ M.I. /DVWQDPH

$GGUHVVOLQH QXPEHUDQGVWUHHW RU32%R[

5189 CAMBRIA WAY
$GGUHVVOLQH DSDUWPHQWQXPEHUVXLWHQXPEHUHWF

&LW\ 6WDWH ZIP code 2KLRFRXQW\ ¿UVWIRXUOHWWHUV

WESTERVILLE OH 43081 DELA

)RUHLJQFRXQWU\ LIWKHPDLOLQJDGGUHVVLVRXWVLGHWKH86 )RUHLJQSRVWDOFRGH

Residency Status – &KHFNRQO\RQHIRUSULPDU\ Filing Status – &KHFNRQH DVUHSRUWHGRQIHGHUDOLQFRPHWD[UHWXUQ

5HVLGHQW 3DUW\HDU 1RQUHVLGHQW   Single, head of household or qualifying widow(er)
UHVLGHQW ,QGLFDWHVWDWH

&KHFNRQO\RQHIRUVSRXVH LI¿OLQJMRLQWO\ 0DUULHG¿OLQJMRLQWO\

5HVLGHQW 3DUW\HDU 1RQUHVLGHQW   6SRXVH¶V661
UHVLGHQW ,QGLFDWHVWDWH 0DUULHG¿OLQJVHSDUDWHO\

Ohio Nonresident Statement – 6HHLQVWUXFWLRQVIRUUHTXLUHGFULWHULD

3ULPDU\PHHWVWKH¿YHFULWHULDIRULUUHEXWWDEOHSUHVXPSWLRQDVQRQUHVLGHQW )HGHUDOH[WHQVLRQ¿OHUV - check here.

6SRXVHPHHWVWKH¿YHFULWHULDIRULUUHEXWWDEOHSUHVXPSWLRQDVQRQUHVLGHQW ,IVRPHRQHFDQFODLP\RX RU\RXUVSRXVHLI¿OLQJMRLQWO\ DVD

GHSHQGHQWFKHFNKHUH
Do not staple or paper clip.

1. Federal adjusted gross income IHGHUDORU65OLQH 3ODFHDLQWKHER[

LIQHJDWLYH .......................................................................................................................................... ....1. 84437

D$GGLWLRQV±2KLR6FKHGXOHRI$GMXVWPHQWVOLQH include schedule) ....................................................2a.

E'HGXFWLRQV±2KLR6FKHGXOHRI$GMXVWPHQWVOLQH include schedule) .................................................E

 2KLRDGMXVWHGJURVVLQFRPH OLQHSOXVOLQHDPLQXVOLQHE 3ODFHDLQWKHER[LIQHJDWLYH .. .... 84437

 ([HPSWLRQDPRXQW include Schedule of Dependents LIDSSOLFDEOH .........................................................4. 1900

1XPEHURIH[HPSWLRQVLQFOXGLQJ\RXDQG\RXUVSRXVHGHSHQGHQWVLIDSSOLFDEOH 1
 2KLRLQFRPHWD[EDVH OLQHPLQXVOLQHLIQHJDWLYHHQWHU]HUR ...............................................................5. 82537

 7D[DEOHEXVLQHVVLQFRPH±2KLR6FKHGXOH,7%86OLQH include schedule).........................................6.

 7D[DEOHQRQEXVLQHVVLQFRPH OLQHPLQXVOLQHLIQHJDWLYHHQWHU]HUR ...................................................7. 82537

00''<< Code

REV 02/14/23 INTUIT.CG.CFP.SP 2022 IT 1040 – page 1 of 2

 2022 Ohio IT 1040
Individual Income Tax Return
SSN 111 98 8119
22000233 Sequence No. 2

D$PRXQWIURPOLQHRQSDJH ....................................................................................................................7a. 82537

D1RQEXVLQHVVLQFRPHWD[OLDELOLW\RQOLQHD VHHLQVWUXFWLRQVIRUWD[WDEOHV ...........................................................8a. 2090

E%XVLQHVVLQFRPHWD[OLDELOLW\±2KLR6FKHGXOH,7%86OLQH include schedule) ..............................................E

F,QFRPHWD[OLDELOLW\EHIRUHFUHGLWV OLQHDSOXVOLQHE ..........................................................................................8c. 2090

 2KLRQRQUHIXQGDEOHFUHGLWV±2KLR6FKHGXOHRI&UHGLWVOLQH include schedule) .............................................. 0

7D[OLDELOLW\DIWHUQRQUHIXQGDEOHFUHGLWV OLQHFPLQXVOLQHLIQHJDWLYHHQWHU]HUR ............................................10. 2090

,QWHUHVWSHQDOW\RQXQGHUSD\PHQWRIHVWLPDWHGWD[ include Ohio IT/SD 2210) .................................................... 11.

8QSDLGXVHWD[ VHHLQVWUXFWLRQV ............................................................................................................................12.

Total Ohio tax liabilityEHIRUHZLWKKROGLQJRUHVWLPDWHGSD\PHQWV DGGOLQHVDQG ............................... 2090

2KLRLQFRPHWD[ZLWKKHOG±6FKHGXOHRI2KLR:LWKKROGLQJSDUW$OLQH include schedule and
income statements) ..............................................................................................................................................14. 2286
15(VWLPDWHGDQGH[WHQVLRQSD\PHQWV IURP2KLR,7(6DQG,73 DQGFUHGLWFDUU\IRUZDUG
IURPODVW\HDU VUHWXUQ .............................................................................................................................................15.

5HIXQGDEOHFUHGLWV±2KLR6FKHGXOHRI&UHGLWVOLQH include schedule) .........................................................16.

17. Amended return only±DPRXQWSUHYLRXVO\SDLGZLWKRULJLQDODQGRUDPHQGHGUHWXUQ .........................................17.

18. Total Ohio tax payments (add lines 14, 15, 16 and 17) ........................................................................................18. 2286

Amended return only±RYHUSD\PHQWSUHYLRXVO\UHTXHVWHGRQRULJLQDODQGRUDPHQGHGUHWXUQ ..........................

/LQHPLQXVOLQH3ODFHDLQWKHER[LIQHJDWLYH ................................................................................. ......20. 2286

If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.
7D[GXH OLQHPLQXVOLQH ,IOLQHLVQHJDWLYHLJQRUHWKHDQGDGGOLQHWROLQH..............................21.

,QWHUHVWGXHRQODWHSD\PHQWRIWD[ VHHLQVWUXFWLRQV ............................................................................................................22.

TOTAL AMOUNT DUE OLQHSOXVOLQH Include Ohio IT 40P LIRULJLQDOUHWXUQ or
IT 40XP LIDPHQGHGUHWXUQ DQGPDNHFKHFNSD\DEOHWR³2KLR7UHDVXUHURI6WDWH´ ............. AMOUNT DUE 

2YHUSD\PHQW OLQHPLQXVOLQH ......................................................................................................................24. 196

25. Original return only±SRUWLRQRIOLQHFDUULHGIRUZDUGWRQH[W\HDU¶VWD[OLDELOLW\ .................................................25.

26. Original return only±SRUWLRQRIOLQH\RXZLVKWRGRQDWH
a. :LOGOLIH6SHFLHV E0LOLWDU\,QMXU\5HOLHI F2KLR+LVWRU\)XQG

  7RWDO ....26g.
G1DWXUH3UHVHUYHV6FHQLF5LYHUV H%UHDVW&HUYLFDO&DQFHU I:LVKHVIRU6LFN&KLOGUHQ

27. REFUND OLQHPLQXVOLQHVDQGJ .............................................................................YOUR REFUND27. 196

Sign Here (required): ,KDYHUHDGWKLVUHWXUQ8QGHUSHQDOWLHVRISHUMXU\,GHFODUHWKDWWRWKHEHVWRIP\NQRZOHGJH If your refund is $1.00 or less, no refund will be issued.
DQGEHOLHIWKHUHWXUQDQGDOOHQFORVXUHVDUHWUXHFRUUHFWDQGFRPSOHWH If you owe $1.00 or less, no payment is necessary.

3ULPDU\VLJQDWXUH 3KRQHQXPEHU (347)526-6459 NO Payment Included ± Mail to:

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REV 02/14/23 INTUIT.CG.CFP.SP 2022 IT 1040 – page 2 of 2

 2022 Schedule of Ohio
Withholding
Use only black ink/UPPERCASE letters. Use whole dollars only. 22350133
Primary taxpayer’s SSN Sequence No. 11
111 98 8119
/LVW\RXUDQG\RXUVSRXVH¶V LI¿OLQJMRLQWO\ :DQG:*IRUPVonly if they have Ohio withholding. Enter “P” in the “P/S” box if the form is the
SULPDU\WD[SD\HU¶VDQGHQWHU³6´LILWLVWKHVSRXVH¶V,IWKH2KLR,'QXPEHURQDVWDWHPHQWKDVGLJLWVHQWHURQO\WKH¿UVWGLJLWV&RPSOHWHDGGLWLRQDO
copies if necessary. Place state copies of your income statements after the last page of your return.

Part A - Total Withholding

1. Total of all Ohio state tax withheld on pages 1 and 2 as well as any additional pages. Enter here
and on line 14 of your Ohio IT 1040 ..............................................................................................................1. 2286
Part B - W-2s
1. P/S Box b - EIN Box 1 - Wages, tips, other compensation Box 2 - Federal income tax withheld
P 980429806 66823 6434
Box 15 - Employer’s Ohio ID number Box 16 - Ohio wages, tips, etc. Box 17 - Ohio income tax
52650229 66823 2286
2. P/S Box b - EIN Box 1 - Wages, tips, other compensation Box 2 - Federal income tax withheld

Box 15 - Employer’s Ohio ID number Box 16 - Ohio wages, tips, etc. Box 17 - Ohio income tax

3. P/S Box b - EIN Box 1 - Wages, tips, other compensation Box 2 - Federal income tax withheld

Box 15 - Employer’s Ohio ID number Box 16 - Ohio wages, tips, etc. Box 17 - Ohio income tax

4. P/S Box b - EIN Box 1 - Wages, tips, other compensation Box 2 - Federal income tax withheld

Box 15 - Employer’s Ohio ID number Box 16 - Ohio wages, tips, etc. Box 17 - Ohio income tax

5. P/S Box b - EIN Box 1 - Wages, tips, other compensation Box 2 - Federal income tax withheld

Box 15 - Employer’s Ohio ID number Box 16 - Ohio wages, tips, etc. Box 17 - Ohio income tax

6. P/S Box b - EIN Box 1 - Wages, tips, other compensation Box 2 - Federal income tax withheld

Box 15 - Employer’s Ohio ID number Box 16 - Ohio wages, tips, etc. Box 17 - Ohio income tax

7. P/S Box b - EIN Box 1 - Wages, tips, other compensation Box 2 - Federal income tax withheld

Box 15 - Employer’s Ohio ID number Box 16 - Ohio wages, tips, etc. Box 17 - Ohio income tax

2022 Schedule of Withholding – page 1 of 2

REV 02/14/23 INTUIT.CG.CFP.SP
 2022 Schedule of Ohio
Withholding
Primary taxpayer’s SSN
22350233
111 98 8119 Sequence No. 12
Part C - 1099-Rs
1. P/S Payer’s TIN %R[*URVVGLVWULEXWLRQ
Total Box 7 -
distribution Distribution code

Box 15 - Payer’s Ohio number Box 4 - Federal income tax withheld Box 14 - Ohio tax withheld

2. P/S Payer’s TIN %R[*URVVGLVWULEXWLRQ

Total Box 7 -
distribution Distribution code

Box 15 - Payer’s Ohio number Box 4 - Federal income tax withheld Box 14 - Ohio tax withheld

3. P/S Payer’s TIN %R[*URVVGLVWULEXWLRQ

Total Box 7 -
distribution Distribution code

Box 15 - Payer’s Ohio number Box 4 - Federal income tax withheld Box 14 - Ohio tax withheld

4. P/S Payer’s TIN %R[*URVVGLVWULEXWLRQ

Total Box 7 -
distribution Distribution code

Box 15 - Payer’s Ohio number Box 4 - Federal income tax withheld Box 14 - Ohio tax withheld

Part D - W-2Gs
1. P/S Payer’s federal ID number Box 1 - Reportable winnings Box 4 - Federal income tax withheld

Box 13 - Ohio state ID number Box 14 - Ohio state winnings Box 15 - Ohio income tax withheld

2. P/S Payer’s federal ID number Box 1 - Reportable winnings Box 4 - Federal income tax withheld

Box 13 - Ohio state ID number Box 14 - Ohio state winnings Box 15 - Ohio income tax withheld

3. P/S Payer’s federal ID number Box 1 - Reportable winnings Box 4 - Federal income tax withheld

Box 13 - Ohio state ID number Box 14 - Ohio state winnings Box 15 - Ohio income tax withheld

Part E - 1099-NECs
1. P/S Payer’s TIN Box 1 - Nonemployee compensation Box 4 - Federal income tax withheld

Box 6 - Payer’s Ohio number Box 7 - State income Box 5 - Ohio tax withheld

2. P/S Payer’s TIN Box 1 - Nonemployee compensation Box 4 - Federal income tax withheld

Box 6 - Payer’s Ohio number Box 7 - State income Box 5 - Ohio tax withheld

2022 Schedule of Withholding – page 2 of 2

REV 02/14/23 INTUIT.CG.CFP.SP
 1040 U.S. Individual Income Tax Return 2022
Form Department of the Treasury—Internal Revenue Service

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

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH)
Qualifying surviving
Check only spouse (QSS)
one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s name if the qualifying
person is a child but not your dependent: Karima El Baghdadi
Your first name and middle initial Last name Your social security number
Abderrahim Mermache 111-98-8119
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
5189 Cambria Way Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Westerville OH 430816646 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Digital At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes No
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, 1958 Are blind Spouse: Was born before January 2, 1958 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here . .

Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 84,437.
b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s) c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
W-2 here. Also
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
1099-R if tax
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h 0.
W-2, see
instructions.
i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 84,437.
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
Standard 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Deduction for—
6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
• Single or
Married filing c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
separately,
$12,950 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7
• Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8
jointly or
Qualifying 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 84,437.
surviving spouse,
$25,900
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
• Head of 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 84,437.
household,
$19,400 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12,950.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12,950.
Deduction, 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . .
see instructions.
15 71,487.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2022)
Form 1040 (2022) Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 11,342.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 11,342.
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 11,342.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 360.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 11,702.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 9,113.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 9,113.
26 2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . 26
If you have a
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 9,113.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a
Direct deposit? b Routing number X X X X X X X X X c Type: Checking Savings
See instructions.
d Account number X X X X X X X X X X X X X X X X X
36 Amount of line 34 you want applied to your 2023 estimated tax . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . 37 2,589.
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
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
Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
Joint return? Software Consultant (see inst.)
See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)

Phone no. (347)526-6459 Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name Self-Prepared Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 03/22/23 Intuit.cg.cfp.sp Form 1040 (2022)
SCHEDULE 2 OMB No. 1545-0074
Additional Taxes
(Form 1040)
Department of the Treasury
Attach to Form 1040, 1040-SR, or 1040-NR. 2022
Attachment
Go to www.irs.gov/Form1040 for instructions and the latest information.
Internal Revenue Service Sequence No. 02
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
Abderrahim Mermache 111-98-8119
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . 2
3 Add lines 1 and 2. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . 4
5 Social security and Medicare tax on unreported tip income.
Attach Form 4137 . . . . . . . . . . . . . . . . . . 5
6 Uncollected social security and Medicare tax on wages. Attach
Form 8919 . . . . . . . . . . . . . . . . . . . . . 6
7 Total additional social security and Medicare tax. Add lines 5 and 6 . . . . . . 7
8 Additional tax on IRAs or other tax-favored accounts. Attach Form 5329 if required.
If not required, check here . . . . . . . . . . . . . . . . . . . . . 8 360.
9 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . 9
10 Repayment of first-time homebuyer credit. Attach Form 5405 if required . . . . . 10
11 Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . 11
12 Net investment income tax. Attach Form 8960 . . . . . . . . . . . . . . . 12
13 Uncollected social security and Medicare or RRTA tax on tips or group-term life
insurance from Form W-2, box 12 . . . . . . . . . . . . . . . . . . . . 13
14 Interest on tax due on installment income from the sale of certain residential lots
and timeshares . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Interest on the deferred tax on gain from certain installment sales with a sales price
over $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Recapture of low-income housing credit. Attach Form 8611 . . . . . . . . . . 16
(continued on page 2)
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 2 (Form 1040) 2022
Schedule 2 (Form 1040) 2022 Page 2

Part II Other Taxes (continued)

17 Other additional taxes:
a Recapture of other credits. List type, form number, and amount:
17a
b Recapture of federal mortgage subsidy, if you sold your home
see instructions . . . . . . . . . . . . . . . . . . . 17b
c Additional tax on HSA distributions. Attach Form 8889 . . . . 17c
d Additional tax on an HSA because you didn’t remain an eligible
individual. Attach Form 8889 . . . . . . . . . . . . . . 17d
e Additional tax on Archer MSA distributions. Attach Form 8853 . 17e
f Additional tax on Medicare Advantage MSA distributions. Attach
Form 8853 . . . . . . . . . . . . . . . . . . . . . 17f
g Recapture of a charitable contribution deduction related to a
fractional interest in tangible personal property . . . . . . . 17g
h Income you received from a nonqualified deferred compensation
plan that fails to meet the requirements of section 409A . . . 17h
i Compensation you received from a nonqualified deferred
compensation plan described in section 457A . . . . . . . 17i
j Section 72(m)(5) excess benefits tax . . . . . . . . . . . 17j
k Golden parachute payments . . . . . . . . . . . . . . 17k
l Tax on accumulation distribution of trusts . . . . . . . . . 17l
m Excise tax on insider stock compensation from an expatriated
corporation . . . . . . . . . . . . . . . . . . . . . 17m
n Look-back interest under section 167(g) or 460(b) from Form
8697 or 8866 . . . . . . . . . . . . . . . . . . . . 17n
o Tax on non-effectively connected income for any part of the
year you were a nonresident alien from Form 1040-NR . . . . 17o
p Any interest from Form 8621, line 16f, relating to distributions
from, and dispositions of, stock of a section 1291 fund . . . . 17p
q Any interest from Form 8621, line 24 . . . . . . . . . . . 17q
z Any other taxes. List type and amount:
17z
18 Total additional taxes. Add lines 17a through 17z . . . . . . . . . . . . . . 18
19 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Section 965 net tax liability installment from Form 965-A . . . 20
21 Add lines 4, 7 through 16, and 18. These are your total other taxes. Enter here and
on Form 1040 or 1040-SR, line 23, or Form 1040-NR, line 23b . . . . . . . . . 21 360.
BAA REV 03/22/23 Intuit.cg.cfp.sp Schedule 2 (Form 1040) 2022