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 1040-SR U.S. Tax Return for Seniors 2023
Form Department of the Treasury—Internal Revenue Service
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2023, or other tax year beginning , 2023, ending , 20 See separate instructions.
Your first name and middle initial Last name Your social security number
CHRISTOPHER M COCHRAN 218 68 6047
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
AMY B COCHRAN 157 40 1303
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
6499 BRANDON ST Check here if you, or your
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code spouse if filing jointly, want $3
to go to this fund. Checking a
PALM BEACH GARDENS FL 33418 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Filing Single X Married filing jointly (even if only one had income) Married filing separately (MFS)
Status Head of household (HOH) Qualifying surviving spouse (QSS)
Check only If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s
one box. name if the qualifying person is a child but not your dependent:
Digital At any time during 2023, did you: (a) receive (as a reward, award, or payment for
Assets property or services); or (b) sell, exchange, or otherwise dispose of a digital asset
(or a financial interest in a digital asset)? (See instructions.) . . . . . . . . . Yes X No

Standard Someone can claim: You as a dependent Your spouse as a dependent

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

Age/Blindness
You:
Spouse: {
X Were born before January 2, 1959
Was born before January 2, 1959
Are blind
Is blind
Dependents (2) Social security number (3) Relationship to (4) Check the box if qualifies for (see instructions):
(see instructions): (1) First name Last name you 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) . . . . . . . 1a

Attach
Form(s) W-2 b Household employee wages not reported on Form(s) W-2 . . . . . . 1b
here. Also
attach Forms c Tip income not reported on line 1a (see instructions) . . . . . . . . 1c
W-2G and
1099-R if tax d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) 1d
was
withheld. e Taxable dependent care benefits from Form 2441, line 26 . . . . . . 1e
If you did not
get a Form
f Employer-provided adoption benefits from Form 8839, line 29 . . . . 1f
W-2, see
instructions.
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
Attach 2a Tax-exempt interest . 2a b Taxable interest . . 2b
Schedule B
2,088.
if required. 3a Qualified dividends . . 3a 4,678. b Ordinary dividends . 3b 9,158.
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)

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Form 1040-SR (2023) CHRISTOPHER M COCHRAN & AMY B COCHRAN 218-68-6047 Page 2

7 Capital gain or (loss). Attach Schedule D if required. If not required,

check here . . . . . . . . . . . . . . . . . . . . . . . . 7 9,847.
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 21,093.
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . 10 0.
11 Subtract line 10 from line 9. This is your adjusted gross income . . . 11 21,093.
Standard
Deduction 12 Standard deduction or itemized deductions (from Schedule A) . . . 12 29,200.
See Standard 13 Qualified business income deduction from Form 8995 or Form 8995-A . 13
Deduction Chart
on the last page 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . 14 29,200.
of this form.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your
taxable income . . . . . . . . . . . . . . . . . . . . . . . 15 0.
Tax and 16 Tax (see instructions). Check if any from:
Credits
1 Form(s) 8814 2 Form(s) 4972 3 . . . . . . . 16 0.
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . 17 6.
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . 18 6.
19 Child tax credit or credit for other dependents from Schedule 8812 . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . 21 0.
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . 22 6.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . 23
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . 24 6.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . 25d
26 2023 estimated tax payments and amount applied from 2022 return . . 26
If you have
a qualifying 27 Earned income credit (EIC) . . . . . . . NO. . . . 27
child, 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 Add lines 27, 28, 29, and 31. These are your total other payments and
refundable credits . . . . . . . . . . . . . . . . . . . . . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . 33 0.
Go to www.irs.gov/Form1040SR for instructions and the latest information. Form 1040-SR (2023)

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Form 1040-SR (2023) CHRISTOPHER M COCHRAN & AMY B COCHRAN 218-68-6047 Page 3

Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the
amount you overpaid . . . . . . . . . . . . . . . . . . . . . 34
35a Amount of line 34 you want refunded to you. If Form 8888 is attached,
check here . . . . . . . . . . . . . . . . . . . . . . . . 35a
Direct deposit? b Routing number X X X X X X X X X c Type: Checking Savings
See
instructions. d Account number X X X X X X X X X X X X X X X X X

36 Amount of line 34 you want applied to your 2024

estimated tax . . . . . . . . . . . . . . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions 37 6.
38 Estimated tax penalty (see instructions) . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. X No
Designee’s Phone Personal identification
name no. number (PIN)
Sign 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
Here information of which preparer has any knowledge.
Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
Joint return? RETIRED (see inst.)
See instructions.
Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for
Identity Protection PIN, enter it here
your records. (see inst.)
RETIRED
Phone no. 561-356-3523 Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid
SELF-PREPARED Self-employed
Preparer
Firm’s name Phone no.
Use Only Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040SR for instructions and the latest information. Form 1040-SR (2023)

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SCHEDULE 2 OMB No. 1545-0074
Additional Taxes
(Form 1040)
Department of the Treasury
Attach to Form 1040, 1040-SR, or 1040-NR. 2023
Attachment
Go to www.irs.gov/Form1040 for instructions and the latest information.
Internal Revenue Service Sequence No. 02
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
CHRISTOPHER M COCHRAN & AMY B COCHRAN 218-68-6047
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . 2 6.
3 Add lines 1 and 2. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3 6.
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . 4
5 Social security and Medicare tax on unreported tip income.
Attach Form 4137 . . . . . . . . . . . . . . . . . . 5
6 Uncollected social security and Medicare tax on wages. Attach
Form 8919 . . . . . . . . . . . . . . . . . . . . . 6
7 Total additional social security and Medicare tax. Add lines 5 and 6 . . . . . . 7
8 Additional tax on IRAs or other tax-favored accounts. Attach Form 5329 if required.
If not required, check here . . . . . . . . . . . . . . . . . . . . . 8
9 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . 9
10 Repayment of first-time homebuyer credit. Attach Form 5405 if required . . . . . 10
11 Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . 11
12 Net investment income tax. Attach Form 8960 . . . . . . . . . . . . . . . 12
13 Uncollected social security and Medicare or RRTA tax on tips or group-term life
insurance from Form W-2, box 12 . . . . . . . . . . . . . . . . . . . . 13
14 Interest on tax due on installment income from the sale of certain residential lots
and timeshares . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Interest on the deferred tax on gain from certain installment sales with a sales price
over $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Recapture of low-income housing credit. Attach Form 8611 . . . . . . . . . . 16
(continued on page 2)
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71478U Schedule 2 (Form 1040) 2023

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Schedule 2 (Form 1040) 2023 Page 2

Part II Other Taxes (continued)

17 Other additional taxes:
a Recapture of other credits. List type, form number, and amount:
17a
b Recapture of federal mortgage subsidy, if you sold your home
see instructions . . . . . . . . . . . . . . . . . . . 17b
c Additional tax on HSA distributions. Attach Form 8889 . . . . 17c
d Additional tax on an HSA because you didn’t remain an eligible
individual. Attach Form 8889 . . . . . . . . . . . . . . 17d
e Additional tax on Archer MSA distributions. Attach Form 8853 . 17e
f Additional tax on Medicare Advantage MSA distributions. Attach
Form 8853 . . . . . . . . . . . . . . . . . . . . . 17f
g Recapture of a charitable contribution deduction related to a
fractional interest in tangible personal property . . . . . . . 17g
h Income you received from a nonqualified deferred compensation
plan that fails to meet the requirements of section 409A . . . 17h
i Compensation you received from a nonqualified deferred
compensation plan described in section 457A . . . . . . . 17i
j Section 72(m)(5) excess benefits tax . . . . . . . . . . . 17j
k Golden parachute payments . . . . . . . . . . . . . . 17k
l Tax on accumulation distribution of trusts . . . . . . . . . 17l
m Excise tax on insider stock compensation from an expatriated
corporation . . . . . . . . . . . . . . . . . . . . . 17m
n Look-back interest under section 167(g) or 460(b) from Form
8697 or 8866 . . . . . . . . . . . . . . . . . . . . 17n
o Tax on non-effectively connected income for any part of the
year you were a nonresident alien from Form 1040-NR . . . . 17o
p Any interest from Form 8621, line 16f, relating to distributions
from, and dispositions of, stock of a section 1291 fund . . . . 17p
q Any interest from Form 8621, line 24 . . . . . . . . . . . 17q
z Any other taxes. List type and amount:
17z
18 Total additional taxes. Add lines 17a through 17z . . . . . . . . . . . . . . 18
19 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Section 965 net tax liability installment from Form 965-A . . . 20
21 Add lines 4, 7 through 16, and 18. These are your total other taxes. Enter here and
on Form 1040 or 1040-SR, line 23, or Form 1040-NR, line 23b . . . . . . . . . 21
Schedule 2 (Form 1040) 2023

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SCHEDULE B OMB No. 1545-0074
Interest and Ordinary Dividends
2023
(Form 1040)
Department of the Treasury Attach to Form 1040 or 1040-SR.
Attachment
Internal Revenue Service Go to www.irs.gov/ScheduleB for instructions and the latest information. Sequence No. 08
Name(s) shown on return Your social security number
CHRISTOPHER M COCHRAN & AMY B COCHRAN 218-68-6047
Amount
Part I 1 List name of payer. If any interest is from a seller-financed mortgage and the
buyer used the property as a personal residence, see the instructions and list this
Interest interest first. Also, show that buyer’s social security number and address:
(See instructions CHARLES SCHWAB 1,814.
and the
Instructions for
IRS 274.
Form 1040,
line 2b.)
Note: If you
received a
Form 1099-INT, 1
Form 1099-OID,
or substitute
statement from
a brokerage firm,
list the firm’s
name as the
payer and enter
the total interest
shown on that
form.
2 Add the amounts on line 1 . . . . . . . . . . . . . . . . . . . 2 2,088.
3 Excludable interest on series EE and I U.S. savings bonds issued after 1989.
Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . . 3
4 Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b 4 2,088.
Note: If line 4 is over $1,500, you must complete Part III. Amount
Part II 5 List name of payer:
CHARLES SCHWAB 9,158.
Ordinary
Dividends
(See instructions
and the
Instructions for
Form 1040,
line 3b.) 5
Note: If you
received a
Form 1099-DIV
or substitute
statement from
a brokerage firm,
list the firm’s
name as the
payer and enter
the ordinary
dividends shown 6 Add the amounts on line 5. Enter the total here and on Form 1040 or 1040-SR, line 3b 6 9,158.
on that form. Note: If line 6 is over $1,500, you must complete Part III.
Part III You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign
account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
Foreign
Accounts Yes No
and Trusts 7a At any time during 2023, did you have a financial interest in or signature authority over a financial
Caution: If account (such as a bank account, securities account, or brokerage account) located in a foreign
required, failure to country? See instructions . . . . . . . . . . . . . . . . . . . . . . . . X
file FinCEN Form
114 may result in If “Yes,” are you required to file FinCEN Form 114, Report of Foreign Bank and Financial
substantial Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114
penalties. and its instructions for filing requirements and exceptions to those requirements . . . . . .
Additionally, you
may be required b If you are required to file FinCEN Form 114, list the name(s) of the foreign country(-ies) where the
to file Form 8938, financial account(s) is (are) located:
Statement of
Specified Foreign
Financial Assets. 8 During 2023, did you receive a distribution from, or were you the grantor of, or transferor to, a
See instructions. foreign trust? If “Yes,” you may have to file Form 3520. See instructions . . . . . . . . . X
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B (Form 1040) 2023
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SCHEDULE D OMB No. 1545-0074
(Form 1040) Capital Gains and Losses
Attach to Form 1040, 1040-SR, or 1040-NR.
Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10.
2023
Department of the Treasury Attachment
Internal Revenue Service Go to www.irs.gov/ScheduleD for instructions and the latest information. Sequence No. 12

Name(s) shown on return Your social security number

CHRISTOPHER M COCHRAN & AMY B COCHRAN 218-68-6047

Did you dispose of any investment(s) in a qualified opportunity fund during the tax year? Yes X No
If “Yes,” attach Form 8949 and see its instructions for additional requirements for reporting your gain or loss.

Part I Short-Term Capital Gains and Losses—Generally Assets Held One Year or Less (see instructions)
See instructions for how to figure the amounts to enter on the (g) (h) Gain or (loss)
lines below. (d) (e) Adjustments Subtract column (e)
Proceeds Cost to gain or loss from from column (d) and
This form may be easier to complete if you round off cents to (sales price) (or other basis) Form(s) 8949, Part I, combine the result
whole dollars. line 2, column (g) with column (g)

1a Totals for all short-term transactions reported on Form

1099-B for which basis was reported to the IRS and for
which you have no adjustments (see instructions).
However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line 1b .
1b Totals for all transactions reported on Form(s) 8949 with
Box A checked . . . . . . . . . . . . .
2 Totals for all transactions reported on Form(s) 8949 with
Box B checked . . . . . . . . . . . . .
3 Totals for all transactions reported on Form(s) 8949 with
Box C checked . . . . . . . . . . . . .
4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . . 4
5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover
Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . 6 ( )
7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-
term capital gains or losses, go to Part II below. Otherwise, go to Part III on the back . . . . . . 7
Part II Long-Term Capital Gains and Losses—Generally Assets Held More Than One Year (see instructions)
See instructions for how to figure the amounts to enter on the (g) (h) Gain or (loss)
lines below. (d) (e) Adjustments Subtract column (e)
Proceeds Cost to gain or loss from from column (d) and
This form may be easier to complete if you round off cents to (sales price) (or other basis) Form(s) 8949, Part II, combine the result
whole dollars. line 2, column (g) with column (g)

8a Totals for all long-term transactions reported on Form

1099-B for which basis was reported to the IRS and for
which you have no adjustments (see instructions).
However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line 8b . 87,722. 77,875. 9,847.
8b Totals for all transactions reported on Form(s) 8949 with
Box D checked . . . . . . . . . . . . .
9 Totals for all transactions reported on Form(s) 8949 with
Box E checked . . . . . . . . . . . . .
10 Totals for all transactions reported on Form(s) 8949 with
Box F checked . . . . . . . . . . . . . .
11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss)
from Forms 4684, 6781, and 8824 . . . . . . . . . . . . . . . . . . . . . . . 11
12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 12
13 Capital gain distributions. See the instructions . . . . . . . . . . . . . . . . . . . 13
14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover
Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . 14 ( )
15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then, go to Part III
on the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 9,847.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11338H Schedule D (Form 1040) 2023

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Schedule D (Form 1040) 2023 Page 2

Part III Summary

16 Combine lines 7 and 15 and enter the result . . . . . . . . . . . . . . . . . . 16 9,847.

• If line 16 is a gain, enter the amount from line 16 on Form 1040, 1040-SR, or 1040-NR, line 7.
Then, go to line 17 below.
• If line 16 is a loss, skip lines 17 through 20 below. Then, go to line 21. Also be sure to complete
line 22.
• If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, 1040-SR, or
1040-NR, line 7. Then, go to line 22.

17 Are lines 15 and 16 both gains?

X Yes. Go to line 18.
No. Skip lines 18 through 21, and go to line 22.

18 If you are required to complete the 28% Rate Gain Worksheet (see instructions), enter the
amount, if any, from line 7 of that worksheet . . . . . . . . . . . . . . . . . . 18

19 If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see
instructions), enter the amount, if any, from line 18 of that worksheet . . . . . . . . . . 19

20 Are lines 18 and 19 both zero or blank and you are not filing Form 4952?
X Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions
for Form 1040, line 16. Don’t complete lines 21 and 22 below.

No. Complete the Schedule D Tax Worksheet in the instructions. Don’t complete lines 21
and 22 below.

21 If line 16 is a loss, enter here and on Form 1040, 1040-SR, or 1040-NR, line 7, the smaller of:

• The loss on line 16; or

• ($3,000), or if married filing separately, ($1,500) } . . . . . . . . . . . . . . . 21 ( )

Note: When figuring which amount is smaller, treat both amounts as positive numbers.

22 Do you have qualified dividends on Form 1040, 1040-SR, or 1040-NR, line 3a?

Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions
for Form 1040, line 16.

No. Complete the rest of Form 1040, 1040-SR, or 1040-NR.

Schedule D (Form 1040) 2023

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Form 8962 Premium Tax Credit (PTC)
OMB No. 1545-0074

2023
Department of the Treasury
Attach to Form 1040, 1040-SR, or 1040-NR.
Attachment
Internal Revenue Service Go to www.irs.gov/Form8962 for instructions and the latest information. Sequence No. 73
Name shown on your return Your social security number

CHRISTOPHER M COCHRAN & AMY B COCHRAN 218-68-6047

A. You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception. See instructions. If you qualify, check the box
Part I Annual and Monthly Contribution Amount
1 Tax family size. Enter your tax family size. See instructions . . . . . . . . . . . . . . . . . 1 2
2a Modified AGI. Enter your modified AGI. See instructions . . . . . . . . . 2a 21,093.
b Enter the total of your dependents’ modified AGI. See instructions . . . . . . 2b
3 Household income. Add the amounts on lines 2a and 2b. See instructions . . . . . . . . . . . . 3 21,093.
4 Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3. See instructions. Check the
appropriate box for the federal poverty table used. a Alaska b Hawaii c X Other 48 states and DC 4 18,310.
5 Household income as a percentage of federal poverty line (see instructions) . . . . . . . . . . . . 5 115%
6 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Applicable figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions . . 7 0
8a Annual contribution amount. Multiply line 3 by b Monthly contribution amount. Divide line 8a
line 7. Round to nearest whole dollar amount 8a by 12. Round to nearest whole dollar amount 8b
Part II Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit
9 Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage? See instructions.
Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage. X No. Continue to line 10.
10 See the instructions to determine if you can use line 11 or must complete lines 12 through 23.
X Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23 No. Continue to lines 12–23. Compute
and continue to line 24. your monthly PTC and continue to line 24.
(a) Annual enrollment (b) Annual applicable (c) Annual (d) Annual maximum (e) Annual premium tax (f) Annual advance
Annual SLCSP premium premium assistance
premiums (Form(s) contribution amount credit allowed payment of PTC (Form(s)
Calculation (Form(s) 1095-A, (subtract (c) from (b); if
1095-A, line 33A) (line 8a) (smaller of (a) or (d)) 1095-A, line 33C)
line 33B) zero or less, enter -0-)

11 Annual Totals 13,586. 12,846. 12,846. 12,846. 12,852.

(c) Monthly
(a) Monthly enrollment (b) Monthly applicable (d) Monthly maximum (f) Monthly advance
contribution amount (e) Monthly premium tax
Monthly premiums (Form(s) SLCSP premium premium assistance payment of PTC (Form(s)
(amount from line 8b credit allowed
Calculation 1095-A, lines 21–32, (Form(s) 1095-A, lines (subtract (c) from (b); if 1095-A, lines 21–32,
or alternative marriage (smaller of (a) or (d))
column A) 21–32, column B) zero or less, enter -0-) column C)
monthly calculation)

12 January
13 February
14 March
15 April
16 May
17 June
18 July
19 August
20 September
21 October
22 November
23 December
24 Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here 24 12,846.
25 Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here 25 12,852.
26 Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and
on Schedule 3 (Form 1040), line 9. If line 24 equals line 25, enter -0-. Stop here. If line 25 is greater than line 24,
leave this line blank and continue to line 27 . . . . . . . . . . . . . . . . . . . . . 26
Part III Repayment of Excess Advance Payment of the Premium Tax Credit
27 Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here 27 6.
28 Repayment limitation (see instructions) . . . . . . . . . . . . . . . . . . . . . . 28 700.
29 Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2
(Form 1040), line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 6.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37784Z Form 8962 (2023)

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