2023Mod3FEScen1040CANONMOODLE
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Form1040 2023U.S. Individual Income Tax ReturnDepartment of the Treasury—Internal Revenue Service OMB No. 1545-0074IRS 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 If joint return, spouse’s first name and middle initialLast name Spouse’s social security numberHome address (number and street). If you have a P.O. box, see instructions. Apt. no. City, town, or post office. If you have a foreign address, also complete spaces below. StateZIP codeForeign country nameForeign province/state/countyForeign postal code Presidential Election CampaignCheck 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. You Spouse Filing StatusCheck only one box. Single Head of household (HOH)Married filing jointly (even if only one had income) Married filing separately (MFS)Qualifying surviving spouse (QSS)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 AssetsAt 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.) Yes NoStandard DeductionSomeone can claim:You as a dependentYour spouse as a dependentSpouse itemizes on a separate return or you were a dual-status alienAge/BlindnessYou:Were born before January 2, 1959Are blindSpouse:Was born before January 2, 1959Is blindDependents(see instructions):If more than four dependents,see instructionsand check here ..(2) Social security number(3)Relationshipto you(4) Check the box if qualifies for (see instructions):(1)First name Last nameChild tax creditCredit for other dependentsIncome 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.1aTotal amount from Form(s) W-2, box 1 (see instructions) .............1abHousehold employee wages not reported on Form(s) W-2 .............1bcTip income not reported on line 1a (see instructions)..............1cdMedicaid waiver payments not reported on Form(s) W-2 (see instructions) ........1deTaxable dependent care benefits from Form 2441, line 26 ............1efEmployer-provided adoption benefits from Form 8839, line 29 ...........1fgWages from Form 8919, line 6 .....................1ghOther earned income (see instructions) ..................1hiNontaxable combat pay election (see instructions) .......1izAdd lines 1a through 1h ......................1zAttach Sch. B if required.2aTax-exempt interest ...2a b Taxable interest .....2b 3aQualified dividends ...3a b Ordinary dividends .....3b 4aIRA distributions ....4a b Taxable amount ......4b 5aPensions and annuities ..5ab Taxable amount ......5b6aSocial security benefits ..6a b Taxable amount ......6b cIf you elect to use the lump-sum election method, check here (see instructions) .....7Capital gain or (loss). Attach Schedule D if required. If not required, check here .....78Additional income from Schedule 1, line 10 .................89Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income ..........910 Adjustments to income from Schedule 1, line 26 ...............1011Subtract line 10 from line 9. This is your adjusted gross income..........11Standard Deduction for—• Single or Married filing separately, $13,850• Married filingjointly or Qualifyingsurviving spouse,$27,700• Head of household, $20,800• If you checked any box under Standard Deduction, see instructions.12Standard deductionoritemized deductions(from Schedule A) ..........1213Qualified business income deduction from Form 8995 or Form 8995-A .........1314Add lines 12 and 13 ........................1415Subtract line 14 from line 11. If zero or less, enter -0-. This is yourtaxable income.....15For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040(2023)PIERCECANON219001140SHARONCANON2890022221210 PINKERTON DRIVEYOUR CITYYOUR STATEYOUR ZIP✔✔MIA CANON3 6 9 0 0 5 4 7 8 DAUGHTER✔MAYA CANON3 6 9 0 0 5 4 7 9 DAUGHTER✔164,9002,3851,0072,50026170,818170,81832,65632,656138,162
Form 1040 (2023)Page 2Tax and Credits 16Tax (see instructions). Check if any from Form(s): 18814 249723..1617Amount from Schedule 2, line 3 ....................1718Add lines 16 and 17 ........................ 1819Child tax credit or credit for other dependents from Schedule 8812 ..........1920Amount from Schedule 3, line 8 ....................2021Add lines 19 and 20 ........................2122Subtract line 21 from line 18. If zero or less, enter -0- ..............2223Other taxes, including self-employment tax, from Schedule 2, line 21 .........2324Add lines 22 and 23. This is your total tax.................24Payments 25Federal income tax withheld from:aForm(s) W-2 ..................25ab Form(s) 1099 ..................25bcOther forms (see instructions) .............25cd Add lines 25a through 25c ......................25d262023 estimated tax payments and amount applied from 2022 return ..........26If you have a qualifying child, attach Sch. EIC.27Earned income credit (EIC) ..............2728Additional child tax credit from Schedule 8812........2829American opportunity credit from Form 8863, line 8 .......2930Reserved for future use ...............3031Amount from Schedule 3, line 15 ............3132Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits.. 3233Add lines 25d, 26, and 32. These are your total payments ............33Refund 34If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid ..3435aAmount of line 34 you want refunded to you. If Form 8888 is attached, check here ....35aDirect deposit?See instructions.b Routing number c Type: Checking Savingsd Account number36Amount of line 34 you want applied to your 2024 estimated tax...36Amount You Owe37 Subtract line 33 from line 24. This is the amount you owe. For details on how to pay, go to www.irs.gov/Paymentsor see instructions ........ 3738Estimated tax penalty (see instructions) ..........38Third Party Designee Do you want to allow another person to discuss this return with the IRS? See instructions ..................... Yes. Complete below. NoDesignee’s name Phone no. Personal identification number (PIN) 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 If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupationIf the IRS sent your spouse an Identity Protection PIN, enter it here (see inst.) Phone no. Email address Paid Preparer Use Only Preparer’s name Preparer’s signature Date PTINCheck if:Self-employedFirm’s name Phone no. Firm’s address Firm’s EIN Go to www.irs.gov/Form1040for instructions and the latest information.Form 1040(2023)20,83620,8364,00004,00016,83616,83623,50023,50023,5006,6646,664XXXXXXXXX✔XXXXXXXXXXXXXXXXXTAX PREPARERP55555555PROFESSIONAL PREPARER, INC.555-555-55551040 UNCLE SAM LOOP, RICHMOND, VA 2322655-5555555
SCHEDULE 1 (Form 1040)2023Additional Income and Adjustments to IncomeDepartment of the Treasury Internal Revenue Service Attach to Form 1040, 1040-SR, or 1040-NR. Go to www.irs.gov/Form1040for instructions and the latest information.OMB No. 1545-0074Attachment Sequence No. 01Name(s) shown on Form 1040, 1040-SR, or 1040-NRYour social security numberPart I Additional Income1Taxable refunds, credits, or offsets of state and local income taxes .........12aAlimony received ...........................2abDate of original divorce or separation agreement (see instructions):3Business income or (loss). Attach Schedule C .................34Other gains or (losses). Attach Form 4797 ..................45Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .56Farm income or (loss). Attach Schedule F ...................67Unemployment compensation .......................78Other income:aNet operating loss ...................8a()bGambling ......................8bcCancellation of debt ..................8cdForeign earned income exclusion from Form 2555 .......8d()eIncome from Form 8853 .................8efIncome from Form 8889 .................8fgAlaska Permanent Fund dividends .............8ghJury duty pay .....................8hiPrizes and awards ...................8ijActivity not engaged in for profit income ...........8jkStock options .....................8klIncome from the rental of personal property if you engaged in the rentalfor profit but were not in the business of renting such property ...8lm Olympic and Paralympic medals and USOC prize money (see instructions) .....................8mnSection 951(a) inclusion (see instructions) ..........8noSection 951A(a) inclusion (see instructions) ..........8opSection 461(l) excess business loss adjustment ........8pqTaxable distributions from an ABLE account (see instructions) ...8qrScholarship and fellowship grants not reported on Form W-2 ...8rs Nontaxable amount of Medicaid waiver payments included on Form 1040, line 1a or 1d ...................8s()t Pension or annuity from a nonqualifed deferred compensation plan or a nongovernmental section 457 plan ............8tuWages earned while incarcerated .............8uzOther income. List type and amount:8z9Total other income. Add lines 8a through 8z ..................910 Combine lines 1 through 7 and 9. This is your additional income. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8 .....................10For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71479FSchedule 1 (Form 1040) 2023PIERCE AND SHARON CANON2626219-00-1140
Schedule 1 (Form 1040) 2023Page 2Part IIAdjustments to Income11Educator expenses ...........................1112 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 ........................1213Health savings account deduction. Attach Form 8889 ..............1314Moving expenses for members of the Armed Forces. Attach Form 3903 .......1415Deductible part of self-employment tax. Attach Schedule SE ...........1516Self-employed SEP, SIMPLE, and qualified plans ................1617Self-employed health insurance deduction ..................1718Penalty on early withdrawal of savings ....................1819aAlimony paid .............................19abRecipient’s SSN ......................cDate of original divorce or separation agreement (see instructions):20IRA deduction .............................2021Student loan interest deduction ......................2122Reserved for future use .........................2223Archer MSA deduction .........................2324Other adjustments:aJury duty pay (see instructions) ..............24ab Deductible expenses related to income reported on line 8l from the rental of personal property engaged in for profit ........24bc Nontaxable amount of the value of Olympic and Paralympic medals and USOC prize money reported on line 8m ..........24cdReforestation amortization and expenses ...........24de Repayment of supplemental unemployment benefits under the Trade Act of 1974 ......................24efContributions to section 501(c)(18)(D) pension plans .......24fgContributions by certain chaplains to section 403(b) plans ....24gh Attorney fees and court costs for actions involving certain unlawful discrimination claims (see instructions) ............24hi Attorney fees and court costs you paid in connection with an award from the IRS for information you provided that helped the IRS detect tax law violations ...................24ijHousing deduction from Form 2555 .............24jk Excess deductions of section 67(e) expenses from Schedule K-1 (Form 1041) ........................24kzOther adjustments. List type and amount:24z25Total other adjustments. Add lines 24a through 24z ...............2526 Add lines 11 through 23 and 25. These are your adjustments to income. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 10 ..................26Schedule 1 (Form 1040) 2023
SCHEDULE A (Form 1040) Department of the Treasury Internal Revenue Service Itemized DeductionsAttach to Form 1040 or 1040-SR.Go to www.irs.gov/ScheduleA for instructions and the latest information.Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 16.OMB No. 1545-00742023Attachment Sequence No. 07Name(s) shown on Form 1040 or 1040-SRYour social security numberMedical and Dental Expenses Caution: Do not include expenses reimbursed or paid by others. 1 Medical and dental expenses (see instructions).......1 2Enter amount from Form 1040 or 1040-SR, line 11 2 3 Multiply line 2 by 7.5% (0.075) .............3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0-.........4 Taxes You Paid 5State and local taxes.a State and local income taxes or general sales taxes. You may include either income taxes or general sales taxes on line 5a, but not both. Ifyou elect to include general sales taxes instead of income taxes, check this box .................5abState and local real estate taxes (see instructions).......5b cState and local personal property taxes..........5c dAdd lines 5a through 5c...............5d e Enter the smaller of line 5d or $10,000 ($5,000 if married filing separately)...................5e 6 Other taxes. List type and amount: 6 7Add lines 5e and 6 .......................7Interest You PaidCaution: Your mortgage interest deduction may be limited. See instructions.8 Home mortgage interest and points. If you didn’t use all of your homemortgage loan(s) to buy, build, or improve your home, see instructions and check this box..........a Home mortgage interest and points reported to you on Form 1098. See instructions if limited..............8ab Home mortgage interest not reported to you on Form 1098. Seeinstructions if limited. If paid to the person from whom you bought thehome, see instructions and show that person’s name, identifying no., and address ...................8bc Points not reported to you on Form 1098. See instructions for special rules.....................8cdReserved for future use...............8d eAdd lines 8a through 8c...............8e9 Investment interest. Attach Form 4952 if required. See instructions 910Add lines 8e and 9 ........................10Gifts to CharityCaution: If you made a gift and got a benefit for it, see instructions.11 Gifts by cash or check. If you made any gift of $250 or more, see instructions ...................1112 Other than by cash or check. If you made any gift of $250 or more, see instructions. You must attach Form 8283 if over $500 ...12 13Carryover from prior year..............13 14Add lines 11 through 13......................14 Casualty and Theft Losses 15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified disaster losses). Attach Form 4684 and enter the amount from line 18 of that form. See instructions ..........................15Other Itemized Deductions 16Other—from list in instructions. List type and amount: 16 Total Itemized Deductions 17 Add the amounts in the far right column for lines 4 through 16. Also, enter this amount on Form 1040 or 1040-SR, line 12 ....................1718 If you elect to itemize deductions even though they are less than your standard deduction, check this box........................For Paperwork Reduction Act Notice, see the Instructions for Form 1040. Cat. No. 17145C Schedule A (Form 1040) 2023SHARON AND CANON PIERCE10,157170,81812,811011,5433,2851,38516,21310,00010,00014,53614,53614,5364,4753,6458,12032,656219-00-1140
SCHEDULE 8812 (Form 1040)Department of the Treasury Internal Revenue ServiceCredits for Qualifying Children and Other DependentsAttach to Form 1040, 1040-SR, or 1040-NR.Go to www.irs.gov/Schedule8812 for instructions and the latest information.OMB No. 1545-00742023Attachment Sequence No. 47Name(s) shown on return Your social security number Part IChild Tax Credit and Credit for Other Dependents1Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR ............12aEnter income from Puerto Rico that you excluded ...........2abEnter the amounts from lines 45 and 50 of your Form 2555 ........2bcEnter the amount from line 15 of your Form 4563 ...........2cdAdd lines 2a through 2c ...........................2d3Add lines 1 and 2d ............................34Number of qualifying children under age 17 with the required social security number45Multiply line 4 by $2,000 ..........................56Number of other dependents, including any qualifying children who are not under age 17 or who do not have the required social security number ........Caution:Do not include yourself, your spouse, or anyone who is not a U.S. citizen, U.S. national, or U.S. resident alien. Also, do not include anyone you included on line 4.67Multiply line 6 by $500 ...........................78Add lines 5 and 7 .............................89Enter the amount shown below for your filing status.• Married filing jointly—$400,000• All other filing statuses—$200,000}......................910Subtract line 9 from line 3.• If zero or less, enter -0-.• If more than zero and not a multiple of $1,000, enter the next multiple of $1,000. Forexample, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc.}.......1011Multiply line 10 by 5% (0.05) .........................1112Is the amount on line 8 more than the amount on line 11? .................12No.STOP.You cannot take the child tax credit, credit for other dependents, or additional child tax credit. Skip Parts II-A and II-B. Enter -0- on lines 14 and 27.Yes.Subtract line 11 from line 8. Enter the result.13Enter the amount from Credit Limit Worksheet A..................1314 Enter the smaller of line 12 or line 13. This is your child tax credit and credit for other dependents...14Enter this amount on Form 1040, 1040-SR, or 1040-NR, line 19.If the amount on line 12 is more than the amount on line 14, you may be able to take the additional child tax crediton Form 1040, 1040-SR, or 1040-NR, line 28. Complete your Form 1040, 1040-SR, or 1040-NR through line 27 (also complete Schedule 3, line 11) before completing Part II-A. For Paperwork Reduction Act Notice, see your tax return instructions.Cat. No. 59761MSchedule 8812 (Form 1040) 2023PIERCE AND SHARON CANON170,818170,81824,000004,000400,000004,000✔20,8364,000219-00-1140
Schedule 8812 (Form 1040) 2023Page 2Part II-AAdditional Child Tax Credit for All FilersCaution: If you file Form 2555, you cannot claim the additional child tax credit.15 Check this box if you do notwant to claim the additional child tax credit. Skip Parts II-A and II-B. Enter -0- on line 27 .....16aSubtract line 14 from line 12. If zero, stop here; you cannot take the additional child tax credit. Skip Parts II-A and II-B. Enter -0- on line 27.........................16abNumber of qualifying children under 17 with the required social security number:x $1,600. Enter the result. If zero, stophere; you cannot claim the additional child tax credit. Skip Parts II-A and II-B. Enter -0- on line 27............................16bTIP: The number of children you use for this line is the same as the number of children you used for line 4.17Enter the smaller of line 16a or line 16b ......................1718a Earned income (see instructions) ................18ab Nontaxable combat pay (see instructions) ......18b19Is the amount on line 18a more than $2,500? No.Leave line 19 blank and enter -0- on line 20. Yes.Subtract $2,500 from the amount on line 18a. Enter the result ....1920Multiply the amount on line 19 by 15% (0.15) and enter the result ..............20Next. On line 16b, is the amount $4,800 or more?No.If you are a bona fide resident of Puerto Rico, go to line 21. Otherwise, skip Part II-B and enter the smallerof line 17 or line 20 on line 27. Yes.If line 20 is equal to or more than line 17, skip Part II-B and enter the amount from line 17 on line 27. Otherwise, go to line 21. Part II-BCertain Filers Who Have Three or More Qualifying Children and Bona Fide Residents of Puerto Rico21Withheld social security, Medicare, and Additional Medicare taxes from Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s amounts with yours. If your employer withheld or you paid Additional Medicare Tax or tier 1 RRTA taxes, or if you are a bona fide resident of Puerto Rico, see instructions........2122Enter the total of the amounts from Schedule 1 (Form 1040), line 15; Schedule 2 (Form 1040), line 5; Schedule 2 (Form 1040), line 6; and Schedule 2 (Form 1040), line 13 .2223Add lines 21 and 22 ....................23241040 and 1040-SR filers:Enter the total of the amounts from Form 1040 or 1040-SR, line 27, and Schedule 3 (Form 1040), line 11.1040-NR filers: Enter the amount from Schedule 3 (Form 1040), line 11. }2425Subtract line 24 from line 23. If zero or less, enter -0- ..................2526Enter the largerof line 20 or line 25 .......................26Next,enter the smaller of line 17 or line 26 on line 27. Part II-CAdditional Child Tax Credit27This is your additional child tax credit. Enter this amount on Form 1040, 1040-SR, or 1040-NR, line 28..27Schedule 8812 (Form 1040) 2023
Form 8867(Rev. November 2023)Department of the Treasury Internal Revenue Service Paid Preparer’s Due Diligence ChecklistEarned Income Credit (EIC), American Opportunity Tax Credit (AOTC), Child Tax Credit (CTC) (including the Additional Child Tax Credit (ACTC) and Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing StatusTo be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS. Go to www.irs.gov/Form8867for instructions and the latest information.OMB No. 1545-0074For tax year20Attachment Sequence No. 70 Taxpayer name(s) shown on returnTaxpayer identification numberPreparer’s namePreparer tax identification numberPart I Due Diligence RequirementsPlease check the appropriate box for the credit(s) and/or HOH filing status claimed on the return and complete the related Parts I–V for the benefit(s) claimed (check all that apply). EICCTC/ACTC/ODCAOTCHOHYes No 1 Did you complete the return based on information for the applicable tax year provided by the taxpayer or reasonably obtained by you? .......................N/A2If credits are claimed on the return, did you complete the applicable EIC and/or CTC/ACTC/ODC worksheets found in the Form 1040, 1040-SR, 1040-NR, 1040-PR, 1040-SS, or Schedule 8812 (Form1040) instructions, and/or the AOTC worksheet found in the Form 8863 instructions, or your ownworksheet(s) that provides the same information, and all related forms and schedules for each credit claimed? ...............................3 Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both ofthe following.• Interview the taxpayer, ask questions, and contemporaneously document the taxpayer’s responses todetermine that the taxpayer is eligible to claim the credit(s) and/or HOH filing status.• Review information to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filingstatus and to figure the amount(s) of any credit(s) .................4 Did any information provided by the taxpayer or a third party for use in preparing the return, or information reasonably known to you, appear to be incorrect, incomplete, or inconsistent? (If “Yes,”answer questions 4a and 4b. If “No,”go to question 5.) ...............aDid you make reasonable inquiries to determine the correct, complete, and consistent information? .b Did you contemporaneously document your inquiries? (Documentation should include the questionsyou asked, whom you asked, when you asked, the information that was provided, and the impact theinformation had on your preparation of the return.) .................5 Did you satisfy the record retention requirement? To meet the record retention requirement, you must keep a copy of your documentation referenced in question 4b, a copy of this Form 8867, a copy of anyapplicable worksheet(s), a record of how, when, and from whom the information used to prepare Form8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by thetaxpayer that you relied on to determine eligibility for the credit(s) and/or HOH filing status or to figure the amount(s) of the credit(s) ........................List those documents provided by the taxpayer, if any, that you relied on:6 Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for thecredit(s) and/or HOH filing status and the amount(s) of any credit(s) claimed on the return if his/her return is selected for audit? .........................7Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year? ..(If credits were disallowed or reduced, go to question 7a; if not, go to question 8.)aDid you complete the required recertification Form 8862? ...............8 If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and correct Schedule C (Form 1040)? .......................For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 26142HForm8867(Rev. 11-2023) PIERCE AND SHARON CANONTAX PREPARERP55555555✔✔✔✔✔✔219-00-1140
Form 8867 (Rev. 11-2023)Page 2 Part IIDue Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.)9 a Have you determined that the taxpayer is eligible to claim the EIC for the number of qualifying childrenclaimed, or is eligible to claim the EIC without a qualifying child? (If the taxpayer is claiming the EICand does not have a qualifying child, go to question 10.) ..............Yes No N/Ab Did you ask the taxpayer if the child lived with the taxpayer for over half of the year, even if the taxpayer has supported the child the entire year? .....................c Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child ofmore than one person (tiebreaker rules)? ....................Part IIIDue Diligence Questions for Returns Claiming CTC/ACTC/ODC (If the return does not claim CTC, ACTC, or ODC, go to Part IV.)10 Have you determined that each qualifying person for the CTC/ACTC/ODC is the taxpayer’s dependent who is a citizen, national, or resident of the United States?..................Yes No N/A11 Did you explain to the taxpayer that he/she may not claim the CTC/ACTC if the child has not lived withthe taxpayer for over half of the year, even if the taxpayer has supported the child, unless the child’s custodial parent has released a claim to exemption for the child? ............12 Did you explain to the taxpayer the rules about claiming the CTC/ACTC/ODC for a child of divorced or separated parents (or parents who live apart), including any requirement to attach a Form 8332 or similar statement to the return?..........................Part IVDue Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.)13 Did the taxpayer provide substantiation for the credit, such as a Form 1098-T and/or receipts for the qualified tuition and related expenses for the claimed AOTC? ....................Yes No Part VDue Diligence Questions for Claiming HOH (If the return does not claim HOH filing status, go to Part VI.)14 Have you determined that the taxpayer was unmarried or considered unmarried on the last day of the tax year and provided more than half of the cost of keeping up a home for the year for a qualifying person? ....Yes No Part VIEligibility CertificationYou will have complied with all due diligence requirements for claiming the applicable credit(s) and/or HOH filing status on the return of the taxpayer identified above if you:A. Interview the taxpayer, ask adequate questions, contemporaneously document the taxpayer’s responses on the return or in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s);B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for any applicable credit(s) claimed and HOH filing status, if claimed;C. Submit Form 8867 in the manner required; andD. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions under Document Retention.1. A copy of this Form 8867.2. The applicable worksheet(s) or your own worksheet(s) for any credit(s) claimed.3. Copies of any documents provided by the taxpayer on which you relied to determine the taxpayer’s eligibility for the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s).4. A record of how, when, and from whom the information used to prepare this form and the applicable worksheet(s) was obtained.5. A record of any additional information you relied upon, including questions you asked and the taxpayer’s responses, to determine the taxpayer’s eligibility for the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s).If you have not complied with all due diligence requirements, you may have to pay a penalty for each failure to comply related to a claim of an applicable credit or HOH filing status (see instructions for more information).15 Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and complete? .................................Yes No Form8867(Rev. 11-2023) ✔✔✔✔
Form 8283 (Rev. December 2023)Noncash Charitable ContributionsDepartment of the Treasury Internal Revenue Service Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property. Go to www.irs.gov/Form8283 for instructions and the latest information.OMB No. 1545-0074Attachment Sequence No. 155Name(s) shown on your income tax return Identifying number Enter the entity name and identifying number from the tax return where the noncash charitable contribution was originally reported, if different from above.Name:Identifying number:Check this box if a family pass-through entity made the noncash charitable contribution. See instructions ........Note: Figure the amount of your contribution deduction before completing this form. See your tax return instructions. Section A. Donated Property of $5,000 or Less and Publicly Traded Securities—List in this section only anitem (or a group of similar items) for which you claimed a deduction of $5,000 or less. Also list publicly traded securities and certain other property even if the deduction is more than $5,000. If you need more space, attach a statement. See instructions. 1 (a) Name and address of the donee organization(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number (unless Form 1098-C is attached).(c) Description and condition of donated property (For a vehicle, enter the year, make, model, and mileage. For securities and other property, see instructions.) A B C D Note: If the amount you claimed as a deduction for an item is $500 or less, you do not have to complete columns (e), (f), and (g). (d) Date of the contribution (e) Date acquired by donor (mo., yr.) (f) How acquired by donor (g) Donor’s cost or adjusted basis (h) Fair market value (see instructions) (i) Method used to determine the fair market value A B C DSection B. Donated Property Over $5,000 (Except Publicly Traded Securities, Vehicles, Intellectual Property or Inventory Reportable in Section A)—Complete this section for one item (or a group of similar items) for which you claimed a deduction of more than $5,000 per item or group (except contributions reportable in Section A). Provide a separate form for each item donated unless it is part of a group of similar items. A qualified appraisal is required for items reportable in Section B and in certain cases must be attached. See instructions.Part I Information on Donated Property2Check the box that describes the type of property donated. See instructions for definitions.aArt (contribution of $20,000 or more) bQualified conservation contribution b(1)Certified historic structurecArt (contribution of less than $20,000)NPS #dOther real estateeEquipmentfSecuritiesgCollectibles hIntellectual property iVehiclesjClothing and household itemskDigital assets lOther 3(a) Description of donated property (if you need more space, attach a separate statement) (b) If any tangible personal property or real property was donated, give a brief summary of the overallphysical condition of the property at the time of the gift.(c)Appraised fair market value A B C (d)Date acquired by donor (mo., yr.) (e) How acquired by donor (f) Donor’s cost or adjusted basis (g) For bargain sales, enter amount received (h)Qualified conservation contribution relevant basis (see instructions)(i)Amount claimed as a deduction (see instructions)ABCFor Paperwork Reduction Act Notice, see separate instructions.Cat. No. 62299JForm 8283(Rev. 12-2023)PIERCE AND SHARON CANONTHE SALVATION ARMY, 6100 MIDLOTHIANTURNPIKE, YOUR CITY, YOUR STATE, ZIPDONATED CLOTHINGTHE CHILDREN'S MIRACLE NETWORK,8795 LOVING AVE, YOUR CITY, STATE, ZIPDONATED LAPTOPS11/25/2023VARIOUSPURCHASE4,600945 CONSIGNMENT3/20/20233/20/2023PURCHASE2,7002,700PURCHASE PRICE219-00-1140
Form 8283 (Rev. 12-2023)Page 2 Name(s) shown on your income tax return Identifying number Part II Partial Interests and Restricted Use Property (Other Than Qualified Conservation Contributions)—Complete lines 4a through 4e if you gave less than anentire interest in a property listed in Section B, Part I. Complete lines 5a through 5c if conditions were placed on acontribution listed in Section B, Part I; also attach the required statement. See instructions. 4aEnter the letter from Section B, Part I that identifies the property for which you gave less than an entire interestIf Section B, Part II applies to more than one property, attach a separate statement. b Total amount claimed as a deduction for the property listed in Section B, Part I: (1) For this tax year ..(2)For any prior tax yearsc Name and address of each organization to which any such contribution was made in a prior year (complete only if different from the donee organization in Section B, Part V, below): Name of charitable organization (donee) Address (number, street, and room or suite no.) City or town, state, and ZIP code d For tangible property, enter the place where the property is located or kepte Name of any person, other than the donee organization, having actual possession of the propertyYes No 5aIs there a restriction, either temporary or permanent, on the donee’s right to use or dispose of the donated property?b Did you give to anyone (other than the donee organization or another organization participating with the donee organization in cooperative fundraising) the right to the income from the donated property or to the possession of the property, including the right to vote donated securities, to acquire the property by purchase or otherwise, or to designate the person having such income, possession, or right to acquire?.............c Is there a restriction limiting the donated property for a particular use? ..............Part IIITaxpayer (Donor) Statement—List each item included in Section B, Part I above that the appraisal identifies as having a value of $500 or less. See instructions. I declare that the following item(s) included in Section B, Part I above has to the best of my knowledge and belief an appraised value of not more than $500 (per item). Enter identifying letter from Section B, Part I and describe the specific item. See instructions. Signature of taxpayer (donor) Date Part IVDeclaration of Appraiser—See instructions.I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any of the foregoing persons, or married to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or party to the transaction, I performed the majority of my appraisals during my tax year for other persons.Also, I declare that I perform appraisals on a regular basis; and that because of my qualifications as described in the appraisal, I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based on a percentage of the appraised property value. Furthermore, I understand that a false or fraudulent overstatement of the property value as described in the qualified appraisal or this Form 8283 may subject me to the penalty under section 6701(a) (aiding and abetting the understatement of tax liability). I understand that my appraisal will be used in connection with a return or claim for refund. I also understand that, if there is a substantial or gross valuation misstatement of the value of the property claimed on the return or claim for refund that is based on my appraisal, I may be subject to a penalty under section 6695A of the Internal Revenue Code, as well as other applicable penalties. I affirm that I have not been at any time in the three-year period ending on the date of the appraisal barred from presenting evidence or testimony before the Department of the Treasury or the Internal Revenue Service pursuant to 31 U.S.C. 330(c).Sign Here Appraiser signature Date Appraiser name TitleBusiness address (including room or suite no.) Identifying number City or town, state, and ZIP code Part V Donee Acknowledgment—See instructions.This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property as described in Section B, Part I, above on the following date Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section B, Part I (or any portion thereof) within 3 years after the date of receipt, it will file Form 8282, Donee Information Return, with the IRS and give the donor a copy of that form. This acknowledgment does not represent agreement with the claimed fair market value. Does the organization intend to use the property for an unrelated use? ...............YesNoName of charitable organization (donee) Employer identification number Address (number, street, and room or suite no.) City or town, state, and ZIP code Authorized signature Title Date Form 8283(Rev. 12-2023)219-00-1140PIECE AND SHARON CANON
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