U.S. Tax Return for Seniors Revision Date 12/05/2022

• Legal Form Number: 1040-SR
• Year: 2023
• Issuer: Treasury Department
• Section: Treasury Department

Form

1040-SR

2023

U.S. Tax Return for Seniors

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

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. Apt. no.

City, town, or post office. If you have a foreign address, also complete spaces below.

State ZIP code

Foreign country name Foreign province/state/county

Foreign postal code

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.

You Spouse

Filing

Status

Check only

one box.

Single

Married filing jointly (even if only one had income)

Married filing separately (MFS)

Head of household (HOH)

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

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.) . . . . . . . . . Yes No

Standard

Deduction

Someone can claim: You as a dependent

Your spouse as a dependent

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

Age/Blindness

{

You: Were born before January 2, 1959 Are blind

Spouse: Was born before January 2, 1959 Is blind

Dependents

(see instructions):

If more than four

dependents, see

instructions and

check here

(2) Social security number (3) Relationship to

you

(4)

Check the box 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.

1 a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . 1a

bHousehold employee wages not reported on Form(s) W-2 . . . . . . 1b

cTip income not reported on line 1a (see instructions) . . . . . . . . 1c

d

Medicaid waiver payments not reported on Form(s) W-2 (see instructions)

1d

eTaxable dependent care benefits from Form 2441, line 26 . . . . . . 1e

fEmployer-provided adoption benefits from Form 8839, line 29 . . . . 1f

gWages from Form 8919, line 6 . . . . . . . . . . . . . . . . . 1g

hOther earned income (see instructions) . . . . . . . . . . . . . . 1h

iNontaxable combat pay election (see instructions) . 1i

zAdd lines 1a through 1h . . . . . . . . . . . . . . . . . . . . 1z

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)