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Tax Year *

1. Tax Year

Filed pursuant to section 301.9100-2

Combat zone

Other (see instructions)

Deceased

Spouse deceased

Deceased date

Spouse deceased date

Coverage year start (optional) ?Select the first day of the coverage period if it differs from the calendar year (combat zone or other special situations).

Coverage year end (optional) ?Select the last day of the coverage period if it differs from the calendar year.

2. Individual Personal Information

Filing status *

Spouse first name, middle initial, and last name ?If you checked the MFS box, enter the name of your spouse

Treat nonresident alien spouse as U.S. resident for the full year? *
Yes No

Your first name and middle initial *

Last name *

Social Security number *

Spouse's SSN (if joint return)

Country *

Home address (number and street) *

Apt / Ste no.

State *

City *

ZIP code *

Foreign province/state/county

Foreign postal code

Check if your main home was in the U.S. for more than half of the tax year (see instructions)

Presidential election campaign

Check if you, or your spouse if filing jointly, want $3 to go to this fund

You

Spouse

Digital assets

At any time during the year, did you receive, sell, exchange, or otherwise dispose of a digital asset? *
Yes No

3. Standard Deduction

Someone can claim you as a dependent

Someone can claim your spouse as a dependent

Spouse itemizes on a separate return or you were a dual-status alien

Born before January 2, 1961 (see instructions)

1a. Wages (Form W-2, box 1) * ?Enter the total amount from Form(s) W-2, box 1. If a joint return, also include your spouse's income from Form(s) W-2, box 1.

1b. Household employee wages not on W-2 ?Enter household employee wages not reported on Form(s) W-2.

1c. Tip income not reported on line 1a

1d. Medicaid waiver payments not reported on Form(s) W-2

1e. Taxable dependent care benefits

1f. Employer-provided adoption benefits

1g. Wages from Form 8919, line 6

1h. Other earned income

1i. Nontaxable combat pay election

1z. Total earned income (1a to 1i)

2a. Tax-exempt interest

2b. Taxable interest ?Enter total taxable interest. Attach Schedule B if required.

3a. Qualified dividends

3b. Ordinary dividends ?Shown in box 1a of Form(s) 1099-DIV.

4a. IRA distributions

4b. Taxable amount (IRA)

5a. Pensions and annuities

5b. Taxable amount (pensions/annuities)

6a. Social security benefits

6b. Taxable amount (social security)

6c. Check if you elect to use lump-sum election method

7. Capital gain or (loss) ?Attach Form 8949 and Schedule D if required.

If Schedule D is not required, check here

8. Other income from Schedule 1, line 10

9. Total income

10. Adjustments to income (Schedule 1, line 26)

11. Adjusted gross income

6. Tax and Payments

Deduction method * ?In most cases, your federal income tax will be less if you take the larger of your itemized deductions or standard deduction.
Standard deduction Itemized deduction

12. Standard deduction (or itemized total) ?In most cases, your federal income tax will be less if you take the larger of your itemized deductions or standard deduction.

13. Qualified business income deduction

14. Total deductions

15. Taxable income

16. Tax ?Include taxes that apply per Form 1040 instructions.

Check if Form 8814 is attached

Check if Form 4972 is attached

Other forms (see instructions)

17. Amount from Schedule 2, line 3

18. Add lines 16 and 17

19. Child tax credit / credit for other dependents

20. Amount from Schedule 3, line 8

21. Add lines 19 and 20

22. Subtract line 21 from line 18

23. Other taxes from Schedule 2, line 21

24. Total tax

7. Refund

25a. Federal income tax withheld (Form W-2) ?Box 2 of Form W-2.

25b. Federal income tax withheld (Form 1099)

25c. Federal income tax withheld (Other forms)

25d. Total federal income tax withheld

26. Estimated tax payments and prior-year applied amount

Former spouse's SSN (if estimated tax payments were made jointly)

27. Earned income credit (EIC)

27b. Clergy filing Schedule SE

27c. Do not want to claim EIC

28. Refundable child tax credit / ACTC

Line 28: Do not want ACTC

29. American opportunity credit

30. Refundable adoption credit

31. Amount from Schedule 3, line 15

32. Total other payments and refundable credits

33. Total payments

34. Overpaid amount

35a. Refund amount you want direct deposited

If Form 8888 is attached, check here

35b. Routing number ?The routing number must be nine digits.

35c. Account type
Checking Savings

35d. Account number ?Up to 17 characters; omit spaces and special symbols except hyphens.

36. Amount applied to next year estimated tax

8. Amount You Owe

If applicable, amount you owe is determined from the tax and payment totals in your generated Form 1040 preview.

Estimated amount you owe

Estimated overpayment (refund basis)

37. Amount you owe

38. Estimated tax penalty

9. Third Party Designee

Allow another person to discuss this return with the IRS?
Yes No

Designee's name

Phone no.

10. Sign Here

Your Signature

Use your mouse or finger to sign above.

Date ?Date you sign this form.

Your occupation

Spouse's occupation

If IRS sent you an Identity Protection PIN, enter it here

If IRS sent your spouse an Identity Protection PIN, enter it here

Phone number

10. Paid Preparer Use Only

Are you a paid preparer?
Yes No

Preparer's name

Preparer's signature

Use your mouse or finger to sign above.

Date

PTIN

Check if self-employed

Firm's name

Firm's EIN

Firm's address

Phone no.

11. Email Information

Email address for delivery *

Alternate email (optional)

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1. Tax Year

2. Individual Personal Information

Presidential election campaign

Digital assets

3. Standard Deduction

4. Dependents

Dependent 1

Dependent 2

Dependent 3

Dependent 4

5. Income