/n $1040 Department of the Treasury-Internal Revenue Service U.S. Individual Income Tax Return 2023 OMB No. 1545-0074 For the year Jan. 1-Dec. 31, 2023, or other tax year beginning Your first name and middle initial , 2023, ending , 20 Last name If joint return, spouse's first name and middle initial Last name Home address (number and street). If you have a P.O. box, see instructions. City, town, or post office. If you have a foreign address, also complete spaces below. Foreign country name Filing Status Check only one box. IRS Use Only-Do not write or staple in this space. See separate instructions. Your social security number Apt. no. State ZIP code Spouse's social security number Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change Foreign postal code your tax or refund. ☐ You Spouse Foreign province/state/county Head of household (HOH) Qualifying surviving spouse (QSS) Single Married filing jointly (even if only one had income) Married filing separately (MFS) 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: Digital Assets Standard Deduction Age/Blindness You: At any time during 2023, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Someone can claim: You as a dependent ☐ Your spouse as a dependent Yes No Spouse itemizes on a separate return or you were a dual-status alien Were born before January 2, 1959 Are blind Spouse: Dependents (see instructions): (1) First name Last name (2) Social security number Was born before January 2, 1959 (3) Relationship to you Is blind (4) Check the box if qualifies for (see instructions): 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) b Attach Form(s) W-2 here. Also с attach Forms d W-2G and e 1099-R if tax was withheld. f Household employee wages not reported on Form(s) W-2. Tip income not reported on line 1a (see instructions) Medicaid waiver payments not reported on Form(s) W-2 (see instructions) Taxable dependent care benefits from Form 2441, line 26 Employer-provided adoption benefits from Form 8839, line 29 If you did not g Wages from Form 8919, line 6. get a Form h Other earned income (see instructions) W-2, see instructions. Nontaxable combat pay election (see instructions) z Add lines 1a through 1h Attach Sch. B 2a Tax-exempt interest if required. 3a Qualified dividends 4a IRA distributions Standard 5a Pensions and annuities Deduction for- Single or 6a Social security benefits 2a За 4a 5a 6a b Taxable interest b Ordinary dividends b Taxable amount. b Taxable amount. b Taxable amount. 1a 1b 1c 1d 1e 1f 1g 1h 1i 1z 2b 3b 4b 5b 6b Married filing с separately, $13,850 7 • Married filing jointly or 8 If you elect to use the lump-sum election method, check here (see instructions) Capital gain or (loss). Attach Schedule D if required. If not required, check here Additional income from Schedule 1, line 10. ☐ · 7 8 Qualifying 9 surviving spouse, $27,700 10 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income Adjustments to income from Schedule 1, line 26 9 10 Head of household, 11 Subtract line 10 from line 9. This is your adjusted gross income 11 $20,800 12 Standard deduction or itemized deductions (from Schedule A) 12 • If you checked any box under 13 Qualified business income deduction from Form 8995 or Form 8995-A 13 Standard Deduction, 14 Add lines 12 and 13 14 see instructions. 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income 15 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2023) Form 1040 (2023) Page 2 Tax and 16 Credits 17 Tax (see instructions). Check if any from Form(s): 1 8814 2 Amount from Schedule 2, line 3 4972 3 16 18 Add lines 16 and 17 . 19 Child tax credit or credit for other dependents from Schedule 8812 20 Amount from Schedule 3, line 8 21 Add lines 19 and 20 22 Subtract line 21 from line 18. If zero or less, enter -0- 23 Other taxes, including self-employment tax, from Schedule 2, line 21 24 Add lines 22 and 23. This is your total tax 17 18 19 20 21 22 23 24 67 Payments 25 Federal income tax withheld from: a Form(s) W-2 25a b Form(s) 1099 25b с Other forms (see instructions) 25c d Add lines 25a through 25c 26 If you have a 2023 estimated tax payments and amount applied from 2022 return 25d 26 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 33 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits Add lines 25d, 26, and 32. These are your total payments 32 33 Refund 34 35a If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid Amount of line 34 you want refunded to you. If Form 8888 is attached, check here 34 35a Direct deposit? b Routing number c Type: ☐ Checking Savings See instructions. d Account number 36 Amount of line 34 you want applied to your 2024 estimated tax. 36 Amount 37 You Owe 38 Subtract line 33 from line 24. This is the amount you owe. For details on how to pay, go to www.irs.gov/Payments or see instructions Estimated tax penalty (see instructions) 37 38 Third Party Designee Do you want to allow another person to discuss this return with the IRS? See instructions Designee's name Phone no. Yes. Complete below. Personal identification number (PIN) No Sign Here Joint return? See instructions. Keep a copy for your records. 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. Your signature Date Your occupation Spouse's signature. If a joint return, both must sign. Date Spouse's occupation If the IRS sent you an Identity Protection PIN, enter it here (see inst.) If the IRS sent your spouse an Identity Protection PIN, enter it here (see inst.) Phone no. Preparer's name Email address Preparer's signature Paid Preparer Use Only Firm's name Firm's address Go to www.irs.gov/Form 1040 for instructions and the latest information. Date PTIN Check if: Self-employed Phone no. Firm's EIN Form 1040 (2023)