Miguel melendez munoz

Form

U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), or Puerto Rico. For the year Jan. 1–Dec. 31, 2009, Department of the Treasury or other tax year beginning , 2009, and ending , 20 Internal Revenue Service Your first name and initial Last name
Please type or print

1040-SS

U.S. Self-Employment Tax Return (Including the AdditionalChild Tax Credit for Bona Fide Residents of Puerto Rico)
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OMB No. 1545-0090

2009
584-33-3381 584-39-6515

Your social security number Spouse’s social security number

SANDY
If a joint return, spouse’s first name and initial

QUIÑONES
Last name

MARANGELY
Present home address (number, street, and apt. no., or rural route)

MORALES

HC-03 BOX 12424
City, town or post office,commonwealth or territory, and ZIP code

CAROLINA, P.R. 00912-3403

Part I

Total Tax and Credits

1 Filing status. Check the box for your filing status (see page SS-3). Single Married filing jointly. Married filing separately. Enter spouse's social security no. above and full name here. 2 Qualifying children. Complete only if you are a bona fide resident of Puerto Rico and you are claimingthe additional child tax credit (see page SS-5). (a) First name
KENNETH G. KEYSA G. KELVIN G.

Last name
QUIÑONES QUIÑONES QUIÑONES

(b) Child’s social security number
598-48-6073 598-64-8601 598-74-0888

(c) Child’s relationship to you
SON DAUGHTER SON

3 4 5 6 7 8 9 10 11 12 13a

Self-employment tax from Part V, line 12. . . . . . . . . . . . . . . . . . Household employment taxes(see page SS-3). Attach Schedule H (Form 1040) . . . . . Total tax. Add lines 3 and 4 (see page SS-3) . . . . . . . . . . . . . . . . 6 2009 estimated tax payments (see page SS-3) . . . . . . . . 7 Excess social security tax withheld (see page SS-4) . . . . . . 1,674 8 Additional child tax credit from Part II, line 3 . . . . . . . . 9 Health coverage tax credit. Attach Form 8885 . . . . . . . . 10Government retiree credit (see page SS-4) . . . . . . . . . Total payments and credits. Add lines 6 through 10 . . . . . . . . . . . . . If line 11 is more than line 5, subtract line 5 from line 11. This is the amount you overpaid . Amount of line 12 to be refunded to you. If Form 8888 is attached, check here . . . c Type: Checking Savings

. . .

3 4 5

98

. . .

11 12 13a

1,67498

b Routing Number d Account Number 14 15

14 Amount of line 12 to be applied to 2010 estimated tax. . . . Amount you owe. If line 5 is more than line 11, subtract line 11 from line 5. For details on how to pay, see page SS-5 . . . . . . . . . . . . . . . . . . . . . . . .
Do you want to allow another person to discuss this return with the IRS (see page SS-8)?
Designee's name Phone no.15
No

Third Party Designee Sign Here
Joint Return? See pg. SS-3 Keep a copy for your records.

Yes. Complete the following
Personal Identification 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 belief, they are true, correct, and complete. Declaration of preparer (otherthan the taxpayer) is based on all information of which the preparer has any knowledge. Daytime phone number Your signature Date Spouse’s signature. If a joint return, both must sign. Date Date Preparer's SSN or PTIN

Paid Preparer’s Use Only

Preparer’s signature Firm's name (or yours if self-employed), address, and Zip code

Check if self-employed EIN Phone no. Cat. No. 17184B

ForDisclosure, Privacy Act, and Paperwork Reduction Act Notice, see page SS-9.

Form 1040-SS (2009)

Form 1040-SS (2009)

Page

2

Part II Bona Fide Residents of Puerto Rico Claiming Additional Child Tax Credit—See page SS-5.
Caution. You must have three or more qualifying children to claim the additional child tax credit. 1 2 3 Income derived from sources within Puerto Rico . . . . . . . . ....