Title: 2024 Form 8959 Additional Medicare Tax

{--- Your Identity --- }

YourName:
YourSocSec#:

{--- Filing Status ---}

Status { Single, Married/Joint, Head_of_House, Married/Sep, Widow(er) }

{--- Part I   Additional Medicare Tax on Medicare Wages --- }

L1	;{ Medicare wages and tips from Form W-2, box 5. If you
 have more than one Form W-2, enter the total of the amounts
 from box 5}

L2	;{ Unreported tips from Form 4137, line 6}

L3	;{ Wages from Form 8919, line 6}

{--- Part II   Additional Medicare Tax on Self-Employment Income ---}

L8	;{ Self-employment income from Schedule SE (Form 1040),
 Part I, line 6. If you  had a loss, enter -0- (Form 1040-PR
 or 1040-SS filers, see instructions.)}

{--- Part III   Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation --- }

L14	;{ Railroad retirement (RRTA) compensation and tips from
 Form(s) W-2, box 14  (see instructions)}

{--- Part V   Withholding Reconciliation --- }

L19	;{ Medicare tax withheld from Form W-2, box 6. If you have
 more than one Form  W-2, enter the total of the amounts from
 box 6}

L23	;{ Additional Medicare Tax withholding on railroad
 retirement (RRTA)  compensation from Form W-2, box  14 (see
 instructions)}

{--------------------------------------------- }  
