1040 U.S.

Individual Income Tax Return 2023

Department of the Treasury—Internal Revenue Service
Form

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
SANDRA SANJUAN INSIGNARES 1 2 1 5 9 3 5 9 0
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. Presidential Election Campaign
18800 LINA STREET APT 1811 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
Dallas TX 75287 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Filing Status Single ✘ Head of household (HOH)

Married filing jointly (even if only one had income)
Check only
one box. 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 At any time during 2023, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) . Yes ✘ 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: Were born before January 2, 1959 Are blind Spouse: Was born before January 2, 1959 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four CARLENYS CENTENO SANJUAN 8 6 7 0 3 4 6 8 3 DAUGHTER ✘
dependents, SANTIAGO GARRIDO SANJUAN 8 0 7 4 6 5 3 3 5 SON ✘
see instructions
and check SUSEJ SANJUAN INSIGNARES 5 7 4 6 3 5 6 8 0 DAUGHTER ✘
here . .

Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 0

b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b 0
Attach Form(s)
W-2 here. Also c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c 0
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d 0
W-2G and
1099-R if tax e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e 0
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f 0
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g 0
get a Form
W-2, see
h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h 0
instructions. i Nontaxable combat pay election (see instructions) . . . . . . . 1i 0
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 0
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a 0 b Taxable amount . . . . . . 4b 0
Standard
Deduction for— 5a Pensions and annuities . . 5a 0 b Taxable amount . . . . . . 5b 0
• Single or 6a Social security benefits . . 6a 0 b Taxable amount . . . . . . 6b 0
Married filing
separately, c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
$13,850 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7 0
• Married filing
jointly or 8 Additional income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . 8 38,330
Qualifying
surviving spouse, 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 38,330
$27,700 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10 2,708
• Head of
household, 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 35,622
$20,800
12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 20,800
• If you checked
any box under 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 2,964
Standard
Deduction, 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 23,764
see instructions.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . 15 11,858
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2023)
Form 1040 (2023) Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 1,188
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17 0
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 1,188
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19 1,188
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20 0
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21 1,188
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 0
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 5,416
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 5,416
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 0
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b 0
c Other forms (see instructions) . . . . . . . . . . . . . 25c 0
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 0

If you have a 26 2023 estimated tax payments and amount applied from 2022 return . . . . . . . . . . 26
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 27 4,467
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28 4,800
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29 0
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31 0
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32 9,267
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . 0. . . . . . 33 9,267
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 3,851
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 3,851
Direct deposit? b Routing number 1 1 1 0 0 0 6 1 4 c Type: ✘ Checking Savings
See instructions.
d Account number 9 1 8 9 6 7 8 2 6
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 0
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38 0
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. ✘ 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 information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
05/16/2024 JANITORIAL (see inst.)
Joint return?
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.)

Phone no. Email address SANDRAINSIGNARES060@GMAIL.COM

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid GENYVE G FUENMAYOR 05/16/2024 P03185153 Self-employed
Preparer
Firm’s name GF CONSULTING & TAX SERVICES LLC Phone no. (470)884-4014
Use Only
Firm’s address 1060 CHANDLER PARK CT Lawrenceville GA 30043 Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2023)
SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
(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. 01
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
SANDRA SANJUAN INSIGNARES 121-59-3590
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . 1
2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Date of original divorce or separation agreement (see instructions):
3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . 3 38,330
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . 4 0
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . 5 0
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . 6 0
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . 7 0
8 Other income:
a Net operating loss . . . . . . . . . . . . . . . . . . . 8a ( 0)
b Gambling . . . . . . . . . . . . . . . . . . . . . . 8b 0
c Cancellation of debt . . . . . . . . . . . . . . . . . . 8c 0
d Foreign earned income exclusion from Form 2555 . . . . . . . 8d ( )
e Income from Form 8853 . . . . . . . . . . . . . . . . . 8e 0
f Income from Form 8889 . . . . . . . . . . . . . . . . . 8f 0
g Alaska Permanent Fund dividends . . . . . . . . . . . . . 8g
h Jury duty pay . . . . . . . . . . . . . . . . . . . . . 8h
i Prizes and awards . . . . . . . . . . . . . . . . . . . 8i
j Activity not engaged in for profit income . . . . . . . . . . . 8j 0
k Stock options . . . . . . . . . . . . . . . . . . . . . 8k
l Income from the rental of personal property if you engaged in the rental
for profit but were not in the business of renting such property . . . 8l
m Olympic and Paralympic medals and USOC prize money (see
instructions) . . . . . . . . . . . . . . . . . . . . . 8m
n Section 951(a) inclusion (see instructions) . . . . . . . . . . 8n
o Section 951A(a) inclusion (see instructions) . . . . . . . . . . 8o
p Section 461(l) excess business loss adjustment . . . . . . . . 8p 0
q Taxable distributions from an ABLE account (see instructions) . . . 8q
r Scholarship and fellowship grants not reported on Form W-2 . . . 8r
s Nontaxable amount of Medicaid waiver payments included on Form
1040, line 1a or 1d . . . . . . . . . . . . . . . . . . . 8s ( 0)
t Pension or annuity from a nonqualifed deferred compensation plan or
a nongovernmental section 457 plan . . . . . . . . . . . . 8t
u Wages earned while incarcerated . . . . . . . . . . . . . 8u
z Other income. List type and amount:
8z 0
9 Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . . . 9 0
10 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 . . . . . . . . . . . . . . . . . . . . . 10 38,330
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71479F Schedule 1 (Form 1040) 2023
Schedule 1 (Form 1040) 2023 Page 2

Part II Adjustments to Income

11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 0
12 Certain business expenses of reservists, performing artists, and fee-basis government
officials. Attach Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . 12 0
13 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . 13 0
14 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . 14 0
15 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . 15 2,708
16 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . 16 0
17 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . 17 0
18 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . 18
19a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19a 0
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . . .
c Date of original divorce or separation agreement (see instructions):
20 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 0
21 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . 21 0
22 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Archer MSA deduction . . . . . . . . . . . . . . . . . . . . . . . . . 23 0
24 Other adjustments:
a Jury duty pay (see instructions) . . . . . . . . . . . . . . 24a
b Deductible expenses related to income reported on line 8l from the
rental of personal property engaged in for profit . . . . . . . . 24b
c Nontaxable amount of the value of Olympic and Paralympic medals
and USOC prize money reported on line 8m . . . . . . . . . . 24c
d Reforestation amortization and expenses . . . . . . . . . . . 24d 0
e Repayment of supplemental unemployment benefits under the Trade
Act of 1974 . . . . . . . . . . . . . . . . . . . . . . 24e 0
f Contributions to section 501(c)(18)(D) pension plans . . . . . . . 24f 0
g Contributions by certain chaplains to section 403(b) plans . . . . 24g
h Attorney fees and court costs for actions involving certain unlawful
discrimination claims (see instructions) . . . . . . . . . . . . 24h
i 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 . . . . . . . . . . . . . . . . . . . 24i
j Housing deduction from Form 2555 . . . . . . . . . . . . . 24j 0
k Excess deductions of section 67(e) expenses from Schedule K-1 (Form
1041) . . . . . . . . . . . . . . . . . . . . . . . . 24k 0
z Other adjustments. List type and amount:
24z 0
25 Total other adjustments. Add lines 24a through 24z . . . . . . . . . . . . . . . 25 0
26 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 . . . . . . . . . . . . . . . . . . 26 2,708
Schedule 1 (Form 1040) 2023
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
SANDRA SANJUAN INSIGNARES 121-59-3590
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . 1 0

2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . 2 0

3 Add lines 1 and 2. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3 0
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . 4 5,416

5 Social security and Medicare tax on unreported tip income.

Attach Form 4137 . . . . . . . . . . . . . . . . . . 5 0

6 Uncollected social security and Medicare tax on wages. Attach

Form 8919 . . . . . . . . . . . . . . . . . . . . . 6 0

7 Total additional social security and Medicare tax. Add lines 5 and 6 . . . . . . 7 0

8 Additional tax on IRAs or other tax-favored accounts. Attach Form 5329 if required.
If not required, check here . . . . . . . . . . . . . . . . . . . . . 8 0

9 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . 9 0

10 Repayment of first-time homebuyer credit. Attach Form 5405 if required . . . . . 10 0

11 Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . 11 0

12 Net investment income tax. Attach Form 8960 . . . . . . . . . . . . . . . 12 0

13 Uncollected social security and Medicare or RRTA tax on tips or group-term life
insurance from Form W-2, box 12 . . . . . . . . . . . . . . . . . . . . 13 0

14 Interest on tax due on installment income from the sale of certain residential lots
and timeshares . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 0

15 Interest on the deferred tax on gain from certain installment sales with a sales price
over $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 0

16 Recapture of low-income housing credit. Attach Form 8611 . . . . . . . . . . 16 0

(continued on page 2)
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71478U Schedule 2 (Form 1040) 2023
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 0

b Recapture of federal mortgage subsidy, if you sold your home

see instructions . . . . . . . . . . . . . . . . . . . 17b 0

c Additional tax on HSA distributions. Attach Form 8889 . . . . 17c 0

d Additional tax on an HSA because you didn’t remain an eligible

individual. Attach Form 8889 . . . . . . . . . . . . . . 17d 0

e Additional tax on Archer MSA distributions. Attach Form 8853 . 17e 0

f Additional tax on Medicare Advantage MSA distributions. Attach

Form 8853 . . . . . . . . . . . . . . . . . . . . . 17f 0

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 0

k Golden parachute payments . . . . . . . . . . . . . . 17k 0

l Tax on accumulation distribution of trusts . . . . . . . . . 17l 0

m Excise tax on insider stock compensation from an expatriated

corporation . . . . . . . . . . . . . . . . . . . . . 17m 0

n Look-back interest under section 167(g) or 460(b) from Form

8697 or 8866 . . . . . . . . . . . . . . . . . . . . 17n 0

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 0

q Any interest from Form 8621, line 24 . . . . . . . . . . . 17q 0

z Any other taxes. List type and amount:

17z 0

18 Total additional taxes. Add lines 17a through 17z . . . . . . . . . . . . . . 18 0

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 5,416
Schedule 2 (Form 1040) 2023
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074
(Form 1040)
Department of the Treasury
(Sole Proprietorship)
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065. 2023
Attachment
Internal Revenue Service Go to www.irs.gov/ScheduleC for instructions and the latest information. Sequence No. 09
Name of proprietor Social security number (SSN)
SANDRA SANJUAN INSIGNARES 1 2 1 - 5 9 - 3 5 9 0
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
Administrative & Support Services 5 6 1 7 2 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)

E Business address (including suite or room no.) 18800 LINA STREET APT 1811
City, town or post office, state, and ZIP code Dallas TX 75287
F Accounting method: (1) ✘ Cash (2) Accrual (3) Other (specify)
G Did you “materially participate” in the operation of this business during 2023? If “No,” see instructions for limit on losses . ✘ Yes No
H If you started or acquired this business during 2023, check here . . . . . . . . . . . . . . . . . .
I Did you make any payments in 2023 that would require you to file Form(s) 1099? See instructions . . . . . . . . Yes ✘ No
J If “Yes,” did you or will you file required Form(s) 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . 1 50,500
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 50,500
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4 0
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 50,500
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . 7 50,500
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 650 18 Office expense (see instructions) . 18 1,350
9 Car and truck expenses 19 Pension and profit-sharing plans . 19 0
(see instructions) . . . 9 0 20 Rent or lease (see instructions):
10 Commissions and fees . 10 0 a Vehicles, machinery, and equipment 20a 0
11 Contract labor (see instructions) 11 0 b Other business property . . . 20b 0
12 Depletion . . . . . 12 0 21 Repairs and maintenance . . . 21 1,200
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 5,540
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23 0
instructions) . . . . 13 0 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a 1,250
(other than on line 19) . 14 0 b Deductible meals (see instructions) 24b 0
15 Insurance (other than health) 15 0 25 Utilities . . . . . . . . 25 1,680
16 Interest (see instructions): 26 Wages (less employment credits) 26 0
a Mortgage (paid to banks, etc.) 16a 0 27a Other expenses (from line 48) . . 27a 0
b Other . . . . . . 16b 0 b Energy efficient commercial bldgs
17 Legal and professional services 17 500 deduction (attach Form 7205) . . 27b 0
28 Total expenses before expenses for business use of home. Add lines 8 through 27b . . . . . . . 28 12,170
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 38,330
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method. See instructions.
Simplified method filers only: Enter the total square footage of (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30 0

}
31 Net profit or (loss). Subtract line 30 from line 29.
• If a profit, enter on both Schedule 1 (Form 1040), line 3, and on Schedule SE, line 2. (If you
checked the box on line 1, see instructions.) Estates and trusts, enter on Form 1041, line 3. 31 38,330
• If a loss, you must go to line 32.

}
32 If you have a loss, check the box that describes your investment in this activity. See instructions.

• If you checked 32a, enter the loss on both Schedule 1 (Form 1040), line 3, and on Schedule
SE, line 2. (If you checked the box on line 1, see the line 31 instructions.) Estates and trusts, enter on 32a All investment is at risk.
Form 1041, line 3. 32b Some investment is not
• If you checked 32b, you must attach Form 6198. Your loss may be limited. at risk.
For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11334P Schedule C (Form 1040) 2023
Schedule C (Form 1040) 2023 Page 2
Part III Cost of Goods Sold (see instructions)

33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35 0

36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36

37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40 0

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42 0
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and
are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file
Form 4562.

43 When did you place your vehicle in service for business purposes? (month/day/year) / /

44 Of the total number of miles you drove your vehicle during 2023, enter the number of miles you used your vehicle for:

a Business 0 b Commuting (see instructions) c Other

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . ✘ Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes ✘ No

47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . ✘ Yes No

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . ✘ Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26, line 27b, or line 30.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48 0

Schedule C (Form 1040) 2023
SANDRA SANJUAN INSIGNARES 121-59-3590
Statement - Part I - Income - 1 A - Additional Cash Income
Description Amount
CASH INCOME 50,500
Total: 50,500

Part II : Expenses Enter expenses for business use of your home only on line 30 - Line 8 - Advertising
Description Amount
BUSINESS CARDS 150
FLYERS 200
SOCIAL REDES 300
Total: 650

Part II : Expenses Enter expenses for business use of your home only on line 30 - Line 22 - Supplies (not included in part III)
Description Amount
CLEANING SUPPLIES 4,890
CLEANING EQUIPMENT 650
Total: 5,540
SCHEDULE SE OMB No. 1545-0074
(Form 1040) Self-Employment Tax
Department of the Treasury
Attach to Form 1040, 1040-SR, 1040-SS, or 1040-NR. 2023
Attachment
Internal Revenue Service Go to www.irs.gov/ScheduleSE for instructions and the latest information. Sequence No. 17
Name of person with self-employment income (as shown on Form 1040, 1040-SR, 1040-SS, or 1040-NR) Social security number of person
121-59-3590
SANDRA SANJUAN INSIGNARES with self-employment income
Part I Self-Employment Tax
Note: If your only income subject to self-employment tax is church employee income, see instructions for how to report your income
and the definition of church employee income.
A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had
$400 or more of other net earnings from self-employment, check here and continue with Part I . . . . . . . . .
Skip lines 1a and 1b if you use the farm optional method in Part II. See instructions.
1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a 0
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code AQ 1b ( )
Skip line 2 if you use the nonfarm optional method in Part II. See instructions.
2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other than
farming). See instructions for other income to report or if you are a minister or member of a religious order 2 38,330
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . . 3 38,330
4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . 4a 35,398
Note: If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions.
b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here . . . . . 4b 0
c Combine lines 4a and 4b. If less than $400, stop; you don’t owe self-employment tax. Exception: If
less than $400 and you had church employee income, enter -0- and continue . . . . . . . . 4c 35,398
5a Enter your church employee income from Form W-2. See instructions for
definition of church employee income . . . . . . . . . . . . . 5a
b Multiply line 5a by 92.35% (0.9235). If less than $100, enter -0- . . . . . . . . . . . . . 5b 0
6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 35,398
7 Maximum amount of combined wages and self-employment earnings subject to social security tax or
the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2023 . . . . . . . . . . . 7 160,200
8a Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2)
and railroad retirement (tier 1) compensation. If $160,200 or more, skip lines
8b through 10, and go to line 11 . . . . . . . . . . . . . . . 8a 0
b Unreported tips subject to social security tax from Form 4137, line 10 . . . 8b
c Wages subject to social security tax from Form 8919, line 10 . . . . . . 8c
d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . . . . 8d 0
9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . . . . 9 160,200
10 Multiply the smaller of line 6 or line 9 by 12.4% (0.124) . . . . . . . . . . . . . . . . 10 4,389
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . 11 1,027
12 Self-employment tax. Add lines 10 and 11. Enter here and on Schedule 2 (Form 1040), line 4, or
Form 1040-SS, Part I, line 3 . . . . . . . . . . . . . . . . . . . . . . . . 12 5,416
13 Deduction for one-half of self-employment tax.
Multiply line 12 by 50% (0.50). Enter here and on Schedule 1 (Form 1040),
line 15 . . . . . . . . . . . . . . . . . . . . . . . . 13 2,708
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11358Z Schedule SE (Form 1040) 2023
Schedule SE (Form 1040) 2023 Page 2
Part II Optional Methods To Figure Net Earnings (see instructions)
Farm Optional Method. You may use this method only if (a) your gross farm income1 wasn’t more than
$9,840, or (b) your net farm profits2 were less than $7,103.
14 Maximum income for optional methods . . . . . . . . . . . . . . . . . . . . . 14 6,560
15 Enter the smaller of: two-thirds (2/3) of gross farm income1 (not less than zero) or $6,560. Also, include
this amount on line 4b above . . . . . . . . . . . . . . . . . . . . . . . . 15
Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits3 were less than $7,103
and also less than 72.189% of your gross nonfarm income,4 and (b) you had net earnings from self-employment
of at least $400 in 2 of the prior 3 years. Caution: You may use this method no more than five times.
16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . . . . 16 0
17 Enter the smaller of: two-thirds (2/3) of gross nonfarm income4 (not less than zero) or the amount on
line 16. Also, include this amount on line 4b above . . . . . . . . . . . . . . . . . 17
1 3
From Sch. F, line 9; and Sch. K-1 (Form 1065), box 14, code B. From Sch. C, line 31; and Sch. K-1 (Form 1065), box 14, code A.
2 4
From Sch. F, line 34; and Sch. K-1 (Form 1065), box 14, code A—minus the amount From Sch. C, line 7; and Sch. K-1 (Form 1065), box 14, code C.
you would have entered on line 1b had you not used the optional method.
Schedule SE (Form 1040) 2023
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040) Qualifying Child Information
Complete and attach to Form 1040 or 1040-SR only if you have a qualifying child.
2023
Department of the Treasury Attachment
Go to www.irs.gov/ScheduleEIC for the latest information. Sequence No. 43
Internal Revenue Service
Name(s) shown on return Your social security number
SANDRA SANJUAN INSIGNARES 1 2 1 - 5 9 - 3 5 9 0

If you are separated from your spouse, filing a separate return, and meet the requirements to claim the EIC (see instructions), check here

Before you begin: • See the instructions for Form 1040, line 27, to make sure that (a) you can take the EIC, and (b) you have a
qualifying child. See also Pub. 596.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social
security card. Otherwise, at the time we process your return, we may reduce your EIC. If the name or SSN on
the child’s social security card is not correct, call the Social Security Administration at 800-772-1213.
• If you have a child who meets the conditions to be your qualifying child for purposes of claiming the EIC, but that
child doesn’t have an SSN as defined in the instructions for Form 1040, line 27, see the instructions.
• You can’t claim the EIC for a child who didn’t live with you for more than half of the year.

▲
!
CAUTION
• If your child doesn’t have an SSN as defined in the instructions for Form 1040, line 27, see the instructions.
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.

Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name First name Last name First name Last name First name Last name

If you have more than three qualifying

children, you have to list only three to get
CARLENYS CENTENO SANJUAN SANTIAGO GARRIDO SANJUAN SUSEJ SANJUAN INSIGNARES
the maximum credit.
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040, line 27,
unless the child was born and died in 2023
or you are claiming the self-only EIC (see
instructions). If your child was born and
died in 2023 and did not have an SSN,
enter “Died” on this line and attach a copy
of the child’s birth certificate, death 867-03-4683 807-46-5335 574-63-5680
certificate, or hospital medical records
showing a live birth.
3 Child’s year of birth Year 2 0 1 3 Year 2 0 1 6 Year 2 0 1 9
If born after 2004 and the child is If born after 2004 and the child is If born after 2004 and the child is
younger than you (or your spouse, younger than you (or your spouse, younger than you (or your spouse,
if filing jointly), skip lines 4a and if filing jointly), skip lines 4a and if filing jointly), skip lines 4a and
4b; go to line 5. 4b; go to line 5. 4b; go to line 5.

4a Was the child under age 24 at the end of

2023, a student, and younger than you (or Yes. No. Yes. No. Yes. No.
your spouse, if filing jointly)?
Go to Go to line 4b. Go to Go to line 4b. Go to Go to line 4b.
line 5. line 5. line 5.
b Was the child permanently and totally
disabled during any part of 2023? Yes. No. Yes. No. Yes. No.
Go to The child is not a Go to The child is not a Go to The child is not a
line 5. qualifying child. line 5. qualifying child. line 5. qualifying child.
5 Child’s relationship to you
(for example, son, daughter, grandchild, DAUGHTER SON DAUGHTER
niece, nephew, eligible foster child, etc.)

6 Number of months child lived

with you in the United States
during 2023
• If the child lived with you for more than
half of 2023 but less than 7 months,
enter “7.”
• If the child was born or died in 2023 and
your home was the child’s home for more
12 months 12 months 12 months
than half the time he or she was alive Do not enter more than 12 Do not enter more than 12 Do not enter more than 12
during 2023, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13339M Schedule EIC (Form 1040) 2023
SCHEDULE 8812 Credits for Qualifying Children OMB No. 1545-0074
(Form 1040) and Other Dependents
Attach to Form 1040, 1040-SR, or 1040-NR.
2023
Department of the Treasury Attachment
Internal Revenue Service Go to www.irs.gov/Schedule8812 for instructions and the latest information. Sequence No. 47
Name(s) shown on return Your social security number
SANDRA SANJUAN INSIGNARES 121-59-3590
Part I Child Tax Credit and Credit for Other Dependents
1 Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . 1 35,622
2a Enter income from Puerto Rico that you excluded . . . . . . . . . . . 2a 0
b Enter the amounts from lines 45 and 50 of your Form 2555 . . . . . . . . 2b 0
c Enter the amount from line 15 of your Form 4563 . . . . . . . . . . . 2c 0
d Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d 0
3 Add lines 1 and 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 35,622
4 Number of qualifying children under age 17 with the required social security number 4 3
5 Multiply line 4 by $2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6,000
6 Number of other dependents, including any qualifying children who are not under age
17 or who do not have the required social security number . . . . . . . . 6 0
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.
7 Multiply line 6 by $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 0
8 Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 6,000
9 Enter the amount shown below for your filing status.
• Married filing jointly—$400,000
• All other filing statuses—$200,000 } . . . . . . . . . . . . . . . . . . . . . . 9 200,000
10 Subtract 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. For
example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc. . . . . . . . 10 0
11 Multiply line 10 by 5% (0.05) . . . . . . . . . . . . . . . . . . . . . . . . . 11 0
12 Is the amount on line 8 more than the amount on line 11? . . . . . . . . . . . . . . . . . 12 6,000
No. 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.
13 Enter the amount from Credit Limit Worksheet A . . . . . . . . . . . . . . . . . . 13 1,188
14 Enter the smaller of line 12 or line 13. This is your child tax credit and credit for other dependents . . . 14 1,188
Enter 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 credit
on 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. 59761M Schedule 8812 (Form 1040) 2023
Schedule 8812 (Form 1040) 2023 Page 2
Part II-A Additional Child Tax Credit for All Filers
Caution: If you file Form 2555, you cannot claim the additional child tax credit.
15 Check this box if you do not want to claim the additional child tax credit. Skip Parts II-A and II-B. Enter -0- on line 27 . . . . .
16a Subtract 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 . . . . . . . . . . . . . . . . . . . . . . . . . 16a 4,812
b Number of qualifying children under 17 with the required social security number: 3 x $1,600.
Enter the result. If zero, stop here; you cannot claim the additional child tax credit. Skip Parts II-A and II-B.
Enter -0- on line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16b 4,800
TIP: The number of children you use for this line is the same as the number of children you used for line 4.
17 Enter the smaller of line 16a or line 16b . . . . . . . . . . . . . . . . . . . . . . 17 4,800
18a Earned income (see instructions) . . . . . . . . . . . . . . . . 18a 35,622
b Nontaxable combat pay (see instructions) . . . . . . 18b 0
19 Is 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 . . . . 19 33,122
20 Multiply the amount on line 19 by 15% (0.15) and enter the result . . . . . . . . . . . . . . 20 4,968
Next. 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
smaller of 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-B Certain Filers Who Have Three or More Qualifying Children and Bona Fide Residents of Puerto Rico
21 Withheld 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. . . . . . . . 21 0
22 Enter 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 . 22 0
23 Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . . 23 0
24 1040 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. 24 0
25 Subtract line 24 from line 23. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 25 0
26 Enter the larger of line 20 or line 25 . . . . . . . . . . . . . . . . . . . . . . . 26 0
Next, enter the smaller of line 17 or line 26 on line 27.
Part II-C Additional Child Tax Credit
27 This is your additional child tax credit. Enter this amount on Form 1040, 1040-SR, or 1040-NR, line 28 . . 27 4,800
Schedule 8812 (Form 1040) 2023
Form 8995 Qualified Business Income Deduction OMB No. 1545-2294

Simplified Computation
Attach to your tax return.
2023
Department of the Treasury Attachment
Internal Revenue Service Go to www.irs.gov/Form8995 for instructions and the latest information. Sequence No. 55
Name(s) shown on return Your taxpayer identification number
SANDRA SANJUAN INSIGNARES 121-59-3590
Note. You can claim the qualified business income deduction only if you have qualified business income from a qualified trade or
business, real estate investment trust dividends, publicly traded partnership income, or a domestic production activities deduction
passed through from an agricultural or horticultural cooperative. See instructions.
Use this form if your taxable income, before your qualified business income deduction, is at or below $182,100 ($364,200 if married
filing jointly), and you aren’t a patron of an agricultural or horticultural cooperative.

1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)

SANDRA SANJUAN INSIGNARES 121-59-3590 35,622

i

ii

iii

iv

v
2 Total qualified business income or (loss). Combine lines 1i through 1v,
column (c) . . . . . . . . . . . . . . . . . . . . . . 2 35,622
3 Qualified business net (loss) carryforward from the prior year . . . . . . . 3 ( )
4 Total qualified business income. Combine lines 2 and 3. If zero or less, enter -0- 4 35,622
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 7,124
6 Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
(see instructions) . . . . . . . . . . . . . . . . . . . . 6 0
7 Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
year . . . . . . . . . . . . . . . . . . . . . . . . . 7 ( )
8 Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero
or less, enter -0- . . . . . . . . . . . . . . . . . . . . 8 0
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . 9 0
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . 10 7,124
11 Taxable income before qualified business income deduction (see instructions) 11 14,822
12 Enter your net capital gain, if any, increased by any qualified dividends
(see instructions) . . . . . . . . . . . . . . . . . . . . 12 0
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . 13 14,822
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 2,964
15 Qualified business income deduction. Enter the smaller of line 10 or line 14. Also enter this amount on
the applicable line of your return (see instructions) . . . . . . . . . . . . . . . . . 15 2,964
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . 16 ( 0)
17 Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 ( 0)
For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 37806C Form 8995 (2023)
Form 8867 Paid Preparer’s Due Diligence Checklist
Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC),
OMB No. 1545-0074
For tax year
(Rev. November 2023)
Child Tax Credit (CTC) (including the Additional Child Tax Credit (ACTC) and 20 23
Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing Status
Department of the Treasury To be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS. Attachment
Internal Revenue Service Go to www.irs.gov/Form8867 for instructions and the latest information. Sequence No. 70
Taxpayer name(s) shown on return Taxpayer identification number
SANDRA SANJUAN INSIGNARES 1 2 1 - 5 9 - 3 5 9 0
Preparer’s name Preparer tax identification number

GENYVE G FUENMAYOR P 0 3 1 8 5 1 5 3
Part I Due Diligence Requirements
Please 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). ✘ EIC ✘ CTC/ACTC/ODC AOTC ✘ HOH
1 Did you complete the return based on information for the applicable tax year provided by the taxpayer Yes No N/A
or reasonably obtained by you? . . . . . . . . . . . . . . . . . . . . . . . ✘
2 If 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 (Form
1040) instructions, and/or the AOTC worksheet found in the Form 8863 instructions, or your own
worksheet(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 of
the following.
• Interview the taxpayer, ask questions, and contemporaneously document the taxpayer’s responses to
determine 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 filing
status 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.) . . . . . . . . . . . . . . . ✘
a Did you make reasonable inquiries to determine the correct, complete, and consistent information? .
b Did you contemporaneously document your inquiries? (Documentation should include the questions
you asked, whom you asked, when you asked, the information that was provided, and the impact the
information 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 any
applicable worksheet(s), a record of how, when, and from whom the information used to prepare Form
8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by the
taxpayer 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 the
credit(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? . . . . . . . . . . . . . . . . . . . . . . . . . ✘
7 Did 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.)
a Did 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. 26142H Form 8867 (Rev. 11-2023)
Form 8867 (Rev. 11-2023) Page 2
Part II Due Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.)
9a Have you determined that the taxpayer is eligible to claim the EIC for the number of qualifying children Yes No N/A
claimed, or is eligible to claim the EIC without a qualifying child? (If the taxpayer is claiming the EIC
and does not have a qualifying child, go to question 10.) . . . . . . . . . . . . . . ✘
b 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 of
more than one person (tiebreaker rules)? . . . . . . . . . . . . . . . . . . . .
Part III Due 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 Yes No N/A
a citizen, national, or resident of the United States? . . . . . . . . . . . . . . . . . . ✘
11 Did you explain to the taxpayer that he/she may not claim the CTC/ACTC if the child has not lived with
the 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 IV Due 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 Yes No
tuition and related expenses for the claimed AOTC? . . . . . . . . . . . . . . . . . . . .
Part V Due 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 Yes No
and provided more than half of the cost of keeping up a home for the year for a qualifying person? . . . . ✘
Part VI Eligibility Certification
You 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; and
D. 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 Yes No
complete? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ✘
Form 8867 (Rev. 11-2023)