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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

1040-SR
Department of the TreasuryInternal Revenue Service
U.S. Tax Return for Seniors 2023 OMB No.1545-0074 IRS Use Only
For the year Jan. 1Dec.31,2023, or other tax year beginning ,2023, ending ,20 See separate instructions.
Your first name and middle initial
Maria Last name
Tallchief Your social security number
466-33-1234
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 P.O. box, see instructions.
1919 Barker Cypress Road
Apt. no.
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 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
77433
Foreign country name Foreign province/state/county Foreign postal code
Filing
Status
Single
Digital
Assets 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.).............................................................
No
Standard Deduction Someone can claim:
None
Age/Blindness You:
Were born before January 2,1959
Spouse:
None
Dependents
If more than four dependents, see instructions and check here (see instructions): (2) Social security
number (3) Relationship
to you (4) if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents
Income
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a Form
W-2, see
instructions. 1a Total amount from Form(s) W-2, box 1(see instructions).......................1a fill in the blank 8da593f8cfea03b_7
23,672
b Household employee wages not reported on Form(s) W-2......................1b
c Tip income not reported on line 1a (see instructions)..........................1c
d Medicaid waiver payments not reported on Form(s) W-2(see instructions)..........1d
e Taxable dependent care benefits from Form 2441, line 26......................1e
f Employer-provided adoption benefits from Form 8839, line 29....................1f
g Wages from Form 8919, line 6.........................................1g
h Other earned income (see instructions)...................................1h
i Nontaxable combat pay election (see instructions)........1i
z Add lines 1a through 1h ..............................................1z fill in the blank 8da593f8cfea03b_8
23,672
Attach Schedule B if required.
2a Tax-exempt interest ...2a b Taxable interest ..........2b
3a Qualified dividends ..3a b Ordinary dividends ........3b
4a IRA distributions ....4a b Taxable amount ..........4b
5a Pensions and annuities 5a b Taxable amount ..........5b
6a Social security benefits 6a b Taxable amount ..........6b
c If you elect to use the lump-sum election method, check here (see instructions).....
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No.71930F Form 1040-SR (2023)
Form 1040-SR (2023) Page 2
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here .....7
8 Additional income from Schedule 1, line 10.................................8
9 Add lines 1z,2b,3b,4b,5b,6b,7, and 8. This is your total income ...............9 fill in the blank 8da593f8cfea03b_9
23,672
10 Adjustments to income from Schedule 1, line 26.............................10
Standard Deduction
See Standard
Deduction Chart
on the last page
of this form. 11 Subtract line 10 from line 9. This is your adjusted gross income ............<

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