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1 0 4 0 - SR Department of the Treasury Internal Revenue Service U . S . Tax Return for Seniors 2 0 2 3
SR
Department of the TreasuryInternal Revenue Service
US Tax Return for Seniors OMB No IRS Use Only
For the year Jan. Dec or other tax year beginning ending See separate instructions.
Your first name and middle initial
Maria Last name
Tallchief Your social security number
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 PO box, see instructions.
Barker Cypress Road
Apt. no
Presidential Election Campaign
Check here if you, or your spouse if filing jointly, want $ to go to this fund. Checking a box below will not change your tax or refund.
Yes
City, town, or post office. If you have a foreign address, also complete spaces below.
Cypress State
TX ZIP code
Foreign country name Foreign provincestatecounty Foreign postal code
Filing
Status
Single
Digital
Assets At any time during 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 assetSee instructions.
No
Standard Deduction Someone can claim:
None
AgeBlindness You:
Were born before January
Spouse:
None
Dependents
If more than four dependents, see instructions and check here see instructions: Social security
number Relationship
to you if qualifies for see instructions:
First name Last name Child tax credit Credit for other dependents
Income
Attach Forms
W here. Also
attach Forms
WG and
R if tax
was withheld.
If you did not
get a Form
W see
instructions. a Total amount from Forms W box see instructionsa fill in the blank dafcfeab
b Household employee wages not reported on Forms Wb
c Tip income not reported on line a see instructionsc
d Medicaid waiver payments not reported on Forms Wsee instructionsd
e Taxable dependent care benefits from Form line e
f Employerprovided adoption benefits from Form line f
g Wages from Form line g
h Other earned income see instructionsh
i Nontaxable combat pay election see instructionsi
z Add lines a through h z fill in the blank dafcfeab
Attach Schedule B if required.
a Taxexempt interest a b Taxable interest b
a Qualified dividends a b Ordinary dividends b
a IRA distributions a b Taxable amount b
a Pensions and annuities a b Taxable amount b
a Social security benefits a b Taxable amount b
c If you elect to use the lumpsum election method, check here see instructions
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. NoF Form SR
Form SR Page
Capital gain or loss Attach Schedule D if required. If not required, check here
Additional income from Schedule line
Add lines zbbbbb and This is your total income fill in the blank dafcfeab
Adjustments to income from Schedule line
Standard Deduction
See Standard
Deduction Chart
on the last page
of this form. Subtract line from line This is your adjusted gross income
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