AS AMENDED RETURN COPY

1040 U.S. Individual Income Tax Return 2023

Form Department of the Treasury—Internal Revenue Service

OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2023, or other tax year beginning , 2023, ending , 20 See separate instructions.
Your first name and middle initial Last name Your social security number
SHANA T OWENS 251 33 2906
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
PO BOX 2211 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
GOOSE CREEK SC 29445 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Filing Status Single X 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 X No
Standard Someone can claim: You as a dependent Your spouse as a dependent
Deduction Spouse itemizes on a separate return or you were a dual-status alien

Age/Blindness You: 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 DONALD REID 251 27 2328 UNCLE X
dependents, X
see instructions
SHARAY FLETCHER 656 10 0649 NIECE
and check
here . .

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

b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s)
W-2 here. Also c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and
1099-R if tax e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form
W-2, see
h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h
instructions. i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z
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 b Taxable amount . . . . . . 4b
Standard
Deduction for— 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
• Single or 6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
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 9,484.
Qualifying
surviving spouse, 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 9,484.
$27,700
• Head of
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10 970.
household, 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 8,514.
$20,800
• If you checked
12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 20,800.
any box under 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
Standard
Deduction, 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 20,800.
see instructions.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . 15 0.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2023)

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Form 1040 (2023)
AS
SHANA T OWENS AMENDED RETURN COPY 251-33-2906 Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1

2 4972 3 8814 . . 16 0.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17 0.
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 0.
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20 0.
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21 0.
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 1,340.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 1,340.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d
If you have a 26 2023 estimated tax payments and amount applied from 2022 return . . . . . . . . . . 26
qualifying child,
attach Sch. EIC.
27 Earned income credit (EIC) . . . . . . . . . . . . . . 27 3,001.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29 2,000.
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32 5,001.
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 5,001.
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 3,661.
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 3,661.
Direct deposit? b Routing number 0 9 1 3 0 2 9 6 6 c Type: X Checking Savings
See instructions.
d Account number 3 0 4 2 0 2 9 6 8 4 8 9
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
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. X No
Designee’s Phone Personal identification
name no. number (PIN)

Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all 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
(see inst.)
Joint return? SELF EMPLOYED
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. 843-940-4441 Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
SELF-PREPARED
Preparer
Firm’s name Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2023)

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SCHEDULE 1
AS AMENDED RETURN COPY 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
SHANA T OWENS 251-33-2906
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 9,484.
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . 4
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . 5
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income:
a Net operating loss . . . . . . . . . . . . . . . . . . . 8a ( )
b Gambling . . . . . . . . . . . . . . . . . . . . . . 8b
c Cancellation of debt . . . . . . . . . . . . . . . . . . 8c
d Foreign earned income exclusion from Form 2555 . . . . . . . 8d ( )
e Income from Form 8853 . . . . . . . . . . . . . . . . . 8e
f Income from Form 8889 . . . . . . . . . . . . . . . . . 8f
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
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
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 ( )
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
9 Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . . . 9
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 9,484.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71479F Schedule 1 (Form 1040) 2023

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Schedule 1 (Form 1040) 2023
AS AMENDED RETURN COPY Page 2

Part II Adjustments to Income

11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 300.
12 Certain business expenses of reservists, performing artists, and fee-basis government
officials. Attach Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . 13
14 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . 14
15 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . 15 670.
16 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . 16
17 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . 17
18 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . 18
19a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . . .
c Date of original divorce or separation agreement (see instructions):
20 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . 21
22 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Archer MSA deduction . . . . . . . . . . . . . . . . . . . . . . . . . 23
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
e Repayment of supplemental unemployment benefits under the Trade
Act of 1974 . . . . . . . . . . . . . . . . . . . . . . 24e
f Contributions to section 501(c)(18)(D) pension plans . . . . . . . 24f
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
k Excess deductions of section 67(e) expenses from Schedule K-1 (Form
1041) . . . . . . . . . . . . . . . . . . . . . . . . 24k
z Other adjustments. List type and amount:
24z
25 Total other adjustments. Add lines 24a through 24z . . . . . . . . . . . . . . . 25
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 . . . . . . . . . . . . . . . . . . 26 970.
Schedule 1 (Form 1040) 2023

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SCHEDULE 2
AS AMENDED RETURN COPY 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
SHANA T OWENS 251-33-2906
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . 2
3 Add lines 1 and 2. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . 4 1,340.
5 Social security and Medicare tax on unreported tip income.
Attach Form 4137 . . . . . . . . . . . . . . . . . . 5
6 Uncollected social security and Medicare tax on wages. Attach
Form 8919 . . . . . . . . . . . . . . . . . . . . . 6
7 Total additional social security and Medicare tax. Add lines 5 and 6 . . . . . . 7
8 Additional tax on IRAs or other tax-favored accounts. Attach Form 5329 if required.
If not required, check here . . . . . . . . . . . . . . . . . . . . . 8
9 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . 9
10 Repayment of first-time homebuyer credit. Attach Form 5405 if required . . . . . 10
11 Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . 11
12 Net investment income tax. Attach Form 8960 . . . . . . . . . . . . . . . 12
13 Uncollected social security and Medicare or RRTA tax on tips or group-term life
insurance from Form W-2, box 12 . . . . . . . . . . . . . . . . . . . . 13
14 Interest on tax due on installment income from the sale of certain residential lots
and timeshares . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Interest on the deferred tax on gain from certain installment sales with a sales price
over $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Recapture of low-income housing credit. Attach Form 8611 . . . . . . . . . . 16
(continued on page 2)
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71478U Schedule 2 (Form 1040) 2023

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Schedule 2 (Form 1040) 2023
AS AMENDED RETURN COPY Page 2

Part II Other Taxes (continued)

17 Other additional taxes:
a Recapture of other credits. List type, form number, and amount:
17a
b Recapture of federal mortgage subsidy, if you sold your home
see instructions . . . . . . . . . . . . . . . . . . . 17b
c Additional tax on HSA distributions. Attach Form 8889 . . . . 17c
d Additional tax on an HSA because you didn’t remain an eligible
individual. Attach Form 8889 . . . . . . . . . . . . . . 17d
e Additional tax on Archer MSA distributions. Attach Form 8853 . 17e
f Additional tax on Medicare Advantage MSA distributions. Attach
Form 8853 . . . . . . . . . . . . . . . . . . . . . 17f
g Recapture of a charitable contribution deduction related to a
fractional interest in tangible personal property . . . . . . . 17g
h Income you received from a nonqualified deferred compensation
plan that fails to meet the requirements of section 409A . . . 17h
i Compensation you received from a nonqualified deferred
compensation plan described in section 457A . . . . . . . 17i
j Section 72(m)(5) excess benefits tax . . . . . . . . . . . 17j
k Golden parachute payments . . . . . . . . . . . . . . 17k
l Tax on accumulation distribution of trusts . . . . . . . . . 17l
m Excise tax on insider stock compensation from an expatriated
corporation . . . . . . . . . . . . . . . . . . . . . 17m
n Look-back interest under section 167(g) or 460(b) from Form
8697 or 8866 . . . . . . . . . . . . . . . . . . . . 17n
o Tax on non-effectively connected income for any part of the
year you were a nonresident alien from Form 1040-NR . . . . 17o
p Any interest from Form 8621, line 16f, relating to distributions
from, and dispositions of, stock of a section 1291 fund . . . . 17p
q Any interest from Form 8621, line 24 . . . . . . . . . . . 17q
z Any other taxes. List type and amount:
17z
18 Total additional taxes. Add lines 17a through 17z . . . . . . . . . . . . . . 18
19 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Section 965 net tax liability installment from Form 965-A . . . 20
21 Add lines 4, 7 through 16, and 18. These are your total other taxes. Enter here and
on Form 1040 or 1040-SR, line 23, or Form 1040-NR, line 23b . . . . . . . . . 21 1,340.
Schedule 2 (Form 1040) 2023

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 AS AMENDED RETURN COPY
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074

2023
(Form 1040) (Sole Proprietorship)
Department of the Treasury
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
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)
SHANA T OWENS 251-33-2906
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
CHILDCARE SERVICE AND SCREENPRINTING 6 2 4 4 1 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
SHAYS CREATIONS 8 5 1 4 2 0 0 9 6
E Business address (including suite or room no.)
City, town or post office, state, and ZIP code
F Accounting method: (1) X 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 . X 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 X 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 24,879.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 24,879.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 24,879.
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 24,879.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) . 18 1,214.
9 Car and truck expenses 19 Pension and profit-sharing plans . 19
(see instructions) . . . 9 12,188. 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 945.
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23
instructions) . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a
(other than on line 19) . 14 b Deductible meals (see instructions) 24b
15 Insurance (other than health) 15 25 Utilities . . . . . . . . 25
16 Interest (see instructions): 26 Wages (less employment credits) 26
a Mortgage (paid to banks, etc.) 16a 27a Other expenses (from line 48) . . 27a
b Other . . . . . . 16b b Energy efficient commercial bldgs
17 Legal and professional services 17 deduction (attach Form 7205) . . 27b
28 Total expenses before expenses for business use of home. Add lines 8 through 27b . . . . . . . 28 14,347.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 10,532.
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 1,048.

}
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 9,484.
• 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

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SCHEDULE SE
AS AMENDED RETURN COPY
Self-Employment Tax
OMB No. 1545-0074

2023
(Form 1040)
Attach to Form 1040, 1040-SR, 1040-SS, or 1040-NR.
Department of the Treasury 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
SHANA T OWENS with self-employment income 251-33-2906
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
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 9,484.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . . 3 9,484.
4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . 4a 8,758.
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
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 8,758.
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
6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 8,758.
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
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
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 1,086.
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . 11 254.
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 1,340.
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 . . . . . . . . . . . . . . . . . . . . . . . . 13 670.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11358Z Schedule SE (Form 1040) 2023

CDA
Schedule SE (Form 1040) 2023
AS AMENDED RETURN COPY 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
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
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

CDA
SCHEDULE EIC
AS AMENDED RETURN COPY
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

SHANA T OWENS 251-33-2906

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.

F
!
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
the maximum credit. SHARAY FLETCHER
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
certificate, or hospital medical records
showing a live birth. 656-10-0649
3 Child’s year of birth Year 2 0 0 1 Year Year
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. X 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? X 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,
niece, nephew, eligible foster child, etc.)
NIECE
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 months 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
CDA
 AS AMENDED RETURN COPY
8863 Education Credits OMB No. 1545-0074
(American Opportunity and Lifetime Learning Credits)
2023
Form

Department of the Treasury Attach to Form 1040 or 1040-SR.

Attachment
Internal Revenue Service Go to www.irs.gov/Form8863 for instructions and the latest information. Sequence No. 50
Name(s) shown on return Your social security number

SHANA T OWENS 251-33-2906

F
!
CAUTION
Complete a separate Part III on page 2 for each student for whom you’re claiming either credit before
you complete Parts I and II.

Part I Refundable American Opportunity Credit

1 After completing Part III for each student, enter the total of all amounts from all Parts III, line 30 . . 1 5,000.
2 Enter: $180,000 if married filing jointly; $90,000 if single, head of household,
or qualifying surviving spouse . . . . . . . . . . . . . . . . 2 90,000.
3 Enter the amount from Form 1040 or 1040-SR, line 11. But if you’re filing Form
2555 or 4563, or you’re excluding income from Puerto Rico, see Pub. 970 for
the amount to enter instead . . . . . . . . . . . . . . . . . 3 8,514.
4 Subtract line 3 from line 2. If zero or less, stop; you can’t take any education
credit . . . . . . . . . . . . . . . . . . . . . . . . 4 81,486.
5 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or
qualifying surviving spouse .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.





5 10,000.


6 If line 4 is:
• Equal to or more than line 5, enter 1.000 on line 6 . . . . . . . . . . . . .
• Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to
at least three places) . . . . . . . . . . . . . . . . . . . . . .
}
.
.
.
6 1.000

7 Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet the
conditions described in the instructions, you can’t take the refundable American opportunity credit;
skip line 8, enter the amount from line 7 on line 9, and check this box . . . . . . . . . . 7 5,000.
8 Refundable American opportunity credit. Multiply line 7 by 40% (0.40). Enter the amount here and
on Form 1040 or 1040-SR, line 29. Then go to line 9 below. . . . . . . . . . . . . . . 8 2,000.
Part II Nonrefundable Education Credits
9 Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions) . 9 3,000.
10 After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If
zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19 . . . . . . . . . . . 10
11 Enter the smaller of line 10 or $10,000 . . . . . . . . . . . . . . . . . . . . . 11
12 Multiply line 11 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or
qualifying surviving spouse . . . . . . . . . . . . . . . . . 13
14 Enter the amount from Form 1040 or 1040-SR, line 11. But if you’re filing Form
2555 or 4563, or you’re excluding income from Puerto Rico, see Pub. 970 for
the amount to enter instead . . . . . . . . . . . . . . . . . 14
15 Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0- on
line 18, and go to line 19 . . . . . . . . . . . . . . . . . 15
16 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or
qualifying surviving spouse . . . . . . . . . . . . . . . . . 16
17 If line 15 is:
• Equal to or more than line 16, enter 1.000 on line 17 and go to line 18 . . . . . .
• Less than line 16, divide line 15 by line 16. Enter the result as a decimal (rounded to at
least three places) . . . . . . . . . . . . . . . . . . . . . . .
} . . . 17

18 Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) . 18
19 Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see
instructions) here and on Schedule 3 (Form 1040), line 3 . . . . . . . . . . . . . . . 19
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 25379M Form 8863 (2023)

CDA
Form 8863 (2023)
AS AMENDED RETURN COPY Page 2
Name(s) shown on return Your social security number

SHANA T OWENS 251-33-2906

F
!
CAUTION
Complete Part III for each student for whom you’re claiming either the American opportunity
credit or lifetime learning credit. Use additional copies of page 2 as needed for each student.

Part III Student and Educational Institution Information. See instructions.

20 Student name (as shown on page 1 of your tax return) 21 Student social security number (as shown on page 1 of
your tax return)
SHANA T OWENS 251-33-2906
22 Educational institution information (see instructions)
a. Name of first educational institution b. Name of second educational institution (if any)
AUGUSTE ESCOFFIER SCHOOL OF CULIN
(1) Address. Number and street (or P.O. box). City, town or (1) Address. Number and street (or P.O. box). City, town or
post office, state, and ZIP code. If a foreign address, see post office, state, and ZIP code. If a foreign address, see
instructions. instructions.
637 S BROADWAY ST SUITE H
BOULDER
CO 80305
(2) Did the student receive Form 1098-T (2) Did the student receive Form 1098-T
X Yes No Yes No
from this institution for 2023? from this institution for 2023?
(3) Did the student receive Form 1098-T (3) Did the student receive Form 1098-T
from this institution for 2022 with box Yes No from this institution for 2022 with box Yes No
7 checked? 7 checked?
(4) Enter the institution’s employer identification number (EIN) (4) Enter the institution’s employer identification number (EIN)
if you’re claiming the American opportunity credit or if you if you’re claiming the American opportunity credit or if you
checked “Yes” in (2) or (3). You can get the EIN from Form checked “Yes” in (2) or (3). You can get the EIN from Form
1098-T or from the institution. 1098-T or from the institution.

27-2356045
23 Has the American opportunity credit been claimed for this
Yes — Stop!
student for any 4 prior tax years?
Go to line 31 for this student.
X No — Go to line 24.

24 Was the student enrolled at least half-time for at least one

academic period that began or is treated as having begun
in 2023 at an eligible educational institution in a program No — Stop! Go to line 31
leading towards a postsecondary degree, certificate, or X Yes — Go to line 25.
for this student.
other recognized postsecondary educational credential?
See instructions.
25 Did the student complete the first 4 years of postsecondary
Yes — Stop!
education before 2023? See instructions.
Go to line 31 for this student.
X No — Go to line 26.

26 Was the student convicted, before the end of 2023, of a

Yes — Stop! No — Complete lines 27
felony for possession or distribution of a controlled
Go to line 31 for this student.
X through 30 for this student.
substance?

F
!
CAUTION
You can’t take the American opportunity credit and the lifetime learning credit for the same student in the same year. If
you complete lines 27 through 30 for this student, don’t complete line 31.

American Opportunity Credit

27 Adjusted qualified education expenses (see instructions). Don’t enter more than $4,000 . . . . . 27 4,000.
28 Subtract $2,000 from line 27. If zero or less, enter -0- . . . . . . . . . . . . . . . . 28 2,000.
29 Multiply line 28 by 25% (0.25) . . . . . . . . . . . . . . . . . . . . . . . . 29 500.
30 If line 28 is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and
enter the result. Skip line 31. Include the total of all amounts from all Parts III, line 30, on Part I, line 1 . 30 2,500.
Lifetime Learning Credit
31 Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts
III, line 31, on Part II, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . 31
Form 8863 (2023)

CDA
Form 8863 (2023)
AS AMENDED RETURN COPY Page 2
Name(s) shown on return Your social security number

SHANA T OWENS 251-33-2906

F
!
CAUTION
Complete Part III for each student for whom you’re claiming either the American opportunity
credit or lifetime learning credit. Use additional copies of page 2 as needed for each student.

Part III Student and Educational Institution Information. See instructions.

20 Student name (as shown on page 1 of your tax return) 21 Student social security number (as shown on page 1 of
your tax return)
DONALD REID 251-27-2328
22 Educational institution information (see instructions)
a. Name of first educational institution b. Name of second educational institution (if any)
AUGUSTE ESCOFFIER SCHOOL OF CULIN
(1) Address. Number and street (or P.O. box). City, town or (1) Address. Number and street (or P.O. box). City, town or
post office, state, and ZIP code. If a foreign address, see post office, state, and ZIP code. If a foreign address, see
instructions. instructions.
637 S BROADWAY ST SUITE H
BOULDER
CO 80305
(2) Did the student receive Form 1098-T (2) Did the student receive Form 1098-T
X Yes No Yes No
from this institution for 2023? from this institution for 2023?
(3) Did the student receive Form 1098-T (3) Did the student receive Form 1098-T
from this institution for 2022 with box Yes No from this institution for 2022 with box Yes No
7 checked? 7 checked?
(4) Enter the institution’s employer identification number (EIN) (4) Enter the institution’s employer identification number (EIN)
if you’re claiming the American opportunity credit or if you if you’re claiming the American opportunity credit or if you
checked “Yes” in (2) or (3). You can get the EIN from Form checked “Yes” in (2) or (3). You can get the EIN from Form
1098-T or from the institution. 1098-T or from the institution.

27-2356045
23 Has the American opportunity credit been claimed for this
Yes — Stop!
student for any 4 prior tax years?
Go to line 31 for this student.
X No — Go to line 24.

24 Was the student enrolled at least half-time for at least one

academic period that began or is treated as having begun
in 2023 at an eligible educational institution in a program No — Stop! Go to line 31
leading towards a postsecondary degree, certificate, or X Yes — Go to line 25.
for this student.
other recognized postsecondary educational credential?
See instructions.
25 Did the student complete the first 4 years of postsecondary
Yes — Stop!
education before 2023? See instructions.
Go to line 31 for this student.
X No — Go to line 26.

26 Was the student convicted, before the end of 2023, of a

Yes — Stop! No — Complete lines 27
felony for possession or distribution of a controlled
Go to line 31 for this student.
X through 30 for this student.
substance?

F
!
CAUTION
You can’t take the American opportunity credit and the lifetime learning credit for the same student in the same year. If
you complete lines 27 through 30 for this student, don’t complete line 31.

American Opportunity Credit

27 Adjusted qualified education expenses (see instructions). Don’t enter more than $4,000 . . . . . 27 4,000.
28 Subtract $2,000 from line 27. If zero or less, enter -0- . . . . . . . . . . . . . . . . 28 2,000.
29 Multiply line 28 by 25% (0.25) . . . . . . . . . . . . . . . . . . . . . . . . 29 500.
30 If line 28 is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and
enter the result. Skip line 31. Include the total of all amounts from all Parts III, line 30, on Part I, line 1 . 30 2,500.
Lifetime Learning Credit
31 Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts
III, line 31, on Part II, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . 31
Form 8863 (2023)

CDA
 AS AMENDED RETURN COPY
5695 Residential Energy Credits
OMB No. 1545-0074

2023
Form
Attach to Form 1040, 1040-SR, or 1040-NR.
Department of the Treasury Attachment
Internal Revenue Service Go to www.irs.gov/Form5695 for instructions and the latest information. Sequence No. 75
Name(s) shown on return Your social security number

SHANA T OWENS 251-33-2906

Part I Residential Clean Energy Credit (See instructions before completing this part.)

Note: Skip lines 1 through 11 if you only have a credit carryforward from 2022.
Enter the complete address of the home where you installed the property and/or technology associated with lines 1 through 4 and 5b.
For more than one home, see instructions.
510 BAYSHORE BLVD GOOSE CREEK SC 29445
Number and street Unit no. City or town State ZIP code

1 Qualified solar electric property costs . . . . . . . . . . . . . . . . . . . . . 1

2 Qualified solar water heating property costs . . . . . . . . . . . . . . . . . . . 2 1,216.

3 Qualified small wind energy property costs . . . . . . . . . . . . . . . . . . . 3

4 Qualified geothermal heat pump property costs . . . . . . . . . . . . . . . . . . 4

5a Qualified battery storage technology. Does the qualified battery storage technology have a capacity of
at least 3 kilowatt hours? (See instructions.) If you checked the “No” box, you cannot claim a credit
for qualified battery storage technology . . . . . . . . . . . . . . . . . . . . . 5a Yes No
b If you checked the “Yes” box, enter the qualified battery technology costs . . . . . . . . . 5b

6a Add lines 1 through 5b . . . . . . . . . . . . . . . . . . . . . . . . . . 6a 1,216.

b Multiply line 6a by 30% (0.30) . . . . . . . . . . . . . . . . . . . . . . . . 6b 365.
7a Qualified fuel cell property. Was qualified fuel cell property installed on, or in connection with, your
main home located in the United States? (See instructions.) . . . . . . . . . . . . . . 7a Yes No
If you checked the “No” box, you cannot claim a credit for qualified fuel cell property. Skip lines 7b
through 11.
b Enter the complete address of the main home where you installed the fuel cell property.

Number and street Unit no. City or town State ZIP code

8 Qualified fuel cell property costs . . . . . . . . . . . . . . . 8

9 Multiply line 8 by 30% (0.30) . . . . . . . . . . . . . . . . 9

10 Kilowatt capacity of property on line 8 above . . . . x $1,000 10

11 Enter the smaller of line 9 or line 10 . . . . . . . . . . . . . . . . . . . . . . 11

12 Credit carryforward from 2022. Enter the amount, if any, from your 2022 Form 5695, line 16 . . . 12

13 Add lines 6b, 11, and 12 . . . . . . . . . . . . . . . . . . . . . . . . . . 13 365.

14 Limitation based on tax liability. Enter the amount from the Residential Clean Energy Credit Limit
Worksheet. (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Residential clean energy credit. Enter the smaller of line 13 or line 14. Also include this amount on
Schedule 3 (Form 1040), line 5a . . . . . . . . . . . . . . . . . . . . . . . 15

16 Credit carryforward to 2024. If line 15 is less than line 13, subtract line 15
from line 13 . . . . . . . . . . . . . . . . . . . . . . 16 365.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13540P Form 5695 (2023)
CDA
Form 5695 (2023)
AS AMENDED RETURN COPY Page 2

Part II Energy Efficient Home Improvement Credit

Section A—Qualified Energy Efficiency Improvements

17a Are the qualified energy efficiency improvements installed in or on your main home located in the
United States? (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . 17a Yes No
b Are you the original user of the qualified energy efficiency improvements? . . . . . . . . . 17b Yes No
c Are the components reasonably expected to remain in use for at least 5 years? . . . . . . . 17c Yes No
If you checked the “No” box for line 17a, 17b, or 17c, you cannot claim the energy efficient home
improvement credit. Do not complete Part II, Section A.
d Enter the complete address of the main home where you made the qualifying improvements.
Caution: You can only have one main home at a time. (See instructions.)

Number and street Unit no. City or town State ZIP code
e Were any of these improvements related to the construction of this main home? . . . . . . . 17e Yes No
If you checked the “Yes” box, you can only claim the energy efficient home improvement credit for
qualifying improvements that were not related to the construction of the home. Do not include expenses
related to the construction of your main home, even if the improvements were made after you moved
into the home.
18 Insulation or air sealing material or system.
a Enter the cost of insulation material or system (include air sealing material or
system) specifically and primarily designed to reduce heat loss or gain of your
home that meets the criteria established by the IECC. (See instructions.) . . . 18a
b Multiply line 18a by 30% (0.30). Enter the results. Do not enter more than $1,200 . . . . . . . 18b
19 Exterior doors that meet the applicable Energy Star requirements.
a Enter the cost of the most expensive door you bought . . . . . . . . 19a
b Multiply line 19a by 30% (0.30). Do not enter more than $250 . . . . . 19b
c Enter the cost of all other qualifying exterior doors . . . . . . . . . 19c
d Multiply line 19c by 30% (0.30) . . . . . . . . . . . . . . . . 19d
e Add lines 19b and 19d. Do not enter more than $500 . . . . . . . . . . . . . . . . 19e
20 Windows and skylights that meet the Energy Star certification requirements.
a Enter the cost of exterior windows and skylights that meet the Energy Star
certification requirements. (See instructions.) . . . . . . . . . . . 20a
b Multiply line 20a by 30% (0.30). Enter the results. Do not enter more than $600 . . . . . . . . 20b
Section B—Residential Energy Property Expenditures
21a Did you incur costs for qualified energy property installed on or in connection with a home located in
the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21a Yes No
b Was the qualified energy property originally placed into service by you? . . . . . . . . . . 21b Yes No
If you checked the “No” box for line 21a or 21b, you cannot claim the credit for your residential
energy property costs. Skip lines 22 through 25 and line 29. Go to line 26.
c Enter the complete address of each home where you installed qualified energy property.
Number and street Unit no. City or town State ZIP code

22 Residential energy property costs (include labor costs for onsite preparation,
assembly, and original installation). (See instructions.)
a Enter the cost of central air conditioners . . . . . . . . . . . . 22a
b Multiply line 22a by 30% (0.30). Enter the results. Do not enter more than $600 . . . . . . . . 22b
23a Enter the cost of natural gas, propane, or oil water heaters . . . . . . 23a
b Multiply line 23a by 30% (0.30). Enter the results. Do not enter more than $600 . . . . . . . . 23b
24a Enter the cost of natural gas, propane, or oil furnace or hot water boilers . . 24a
b Multiply line 24a by 30% (0.30). Enter the results. Do not enter more than $600 . . . . . . . . 24b
Form 5695 (2023)

CDA
Form 5695 (2023)
AS AMENDED RETURN COPY Page 3

Section B—Residential Energy Property Expenditures (continued)

25a Enter the cost of improvements or replacement of panelboards, subpanelboards,
branch circuits, or feeders . . . . . . . . . . . . . . . . . 25a
b Multiply line 25a by 30% (0.30). Enter the results. Do not enter more than $600 . . . . . . . . 25b
26 Home energy audits.
a Did you incur costs for a home energy audit that included an inspection of your main home located in
the United States and a written report prepared by a certified home energy auditor? (See instructions.) 26a Yes No
If you checked the “No” box, you cannot claim the home energy audit credit. Stop. Go to line 27.
b Enter the cost of the home energy audits . . . . . . . . . . . . 26b
c Multiply line 26b by 30% (0.30). Enter the results. Do not enter more than $150 . . . . . . . . 26c
27 Add lines 18b, 19e, 20b, 22b, 23b, 24b, 25b, and 26c . . . . . . . . 27
28 Enter the smaller of line 27 or $1,200 . . . . . . . . . . . . . . . . . . . . . . 28
29 Heat pumps and heat pump water heaters; biomass stoves and biomass boilers.
a Enter the cost of electric or natural gas heat pumps . . . . . . . . . 29a
b Enter the cost of electric or natural gas heat pump water heaters . . . . 29b
c Enter the cost of biomass stoves and biomass boilers . . . . . . . . 29c
d Add lines 29a, 29b, and 29c . . . . . . . . . . . . . . . . . 29d
e Multiply line 29d by 30% (0.30). Enter the results. Do not enter more than $2,000 . . . . . . . 29e
30 Add lines 28 and 29e . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31 Limitation based on tax liability. Enter the amount from the Energy Efficient Home Improvement Credit
Limit Worksheet. (See instructions.) . . . . . . . . . . . . . . . . . . . . . . 31
32 Energy efficient home improvement credit. Enter the smaller of line 30 or line 31. Also include this
amount on Schedule 3 (Form 1040), line 5b . . . . . . . . . . . . . . . . . . . 32
Form 5695 (2023)

CDA
 AS AMENDED RETURN COPY
Form 8829 Expenses for Business Use of Your Home
File only with Schedule C (Form 1040). Use a separate Form 8829 for each home you used
OMB No. 1545-0074

2023
Department of the Treasury for business during the year.
Attachment
Internal Revenue Service Go to www.irs.gov/Form8829 for instructions and the latest information. Sequence No. 176
Name(s) of proprietor(s) Your social security number

SHANA T OWENS 251-33-2906

Part I Part of Your Home Used for Business
1 Area used regularly and exclusively for business, regularly for daycare, or for storage of inventory
or product samples (see instructions) . . . . . . . . . . . . . . . . . . . . 1 326.
2 Total area of home . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1,591.
3 Divide line 1 by line 2. Enter the result as a percentage . . . . . . . . . . . . . . . 3 20.490 %
For daycare facilities not used exclusively for business, go to line 4. All others, go to line 7.
4 Multiply days used for daycare during year by hours used per day . . 4 hr.
5 If you started or stopped using your home for daycare during the year,
see instructions; otherwise, enter 8,760 . . . . . . . . . . . 5 hr.
6 Divide line 4 by line 5. Enter the result as a decimal amount . . . . 6
7 Business percentage. For daycare facilities not used exclusively for business, multiply line 6 by
line 3 (enter the result as a percentage). All others, enter the amount from line 3 . . . . . . 7 20.490 %
Part II Figure Your Allowable Deduction
8 Enter the amount from Schedule C, line 29, plus any gain derived from the business use of your home,
minus any loss from the trade or business not derived from the business use of your home. See instructions. 8 10,532.
See instructions for columns (a) and (b) before completing lines 9–22. (a) Direct expenses (b) Indirect expenses
9 Casualty losses (see instructions) . . . . . . 9 0.
10 Deductible mortgage interest (see instructions) . 10
11 Real estate taxes (see instructions) . . . . . 11
12 Add lines 9, 10, and 11 . . . . . . . . . 12
13 Multiply line 12, column (b), by line 7 . . . . . . . . . . . . 13
14 Add line 12, column (a), and line 13 . . . . . . . . . . . . . . . . . . . . . 14 0.
15 Subtract line 14 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . 15 10,532.
16 Excess mortgage interest (see instructions) . . 16
17 Excess real estate taxes (see instructions) . . . 17
18 Insurance . . . . . . . . . . . . . . 18
19 Rent . . . . . . . . . . . . . . . 19 1,875.
20 Repairs and maintenance . . . . . . . . 20 1,217.
21 Utilities . . . . . . . . . . . . . . 21 986.
22 Other expenses (see instructions) . . . . . . 22
23 Add lines 16 through 22 . . . . . . . . . 23 4,078.
24 Multiply line 23, column (b), by line 7 . . . . . . . . . . . . 24 836.
25 Carryover of prior year operating expenses (see instructions) . . . . 25
26 Add line 23, column (a), line 24, and line 25 . . . . . . . . . . . . . . . . . . . 26 836.
27 Allowable operating expenses. Enter the smaller of line 15 or line 26 . . . . . . . . . . 27 836.
28 Limit on excess casualty losses and depreciation. Subtract line 27 from line 15 . . . . . . . 28 9,696.
29 Excess casualty losses (see instructions) . . . . . . . . . . 29 0.
30 Depreciation of your home from line 42 below . . . . . . . . . 30 212.
31 Carryover of prior year excess casualty losses and depreciation (see instructions) 31 0.
32 Add lines 29 through 31 . . . . . . . . . . . . . . . . . . . . . . . . . 32 212.
33 Allowable excess casualty losses and depreciation. Enter the smaller of line 28 or line 32 . . . 33 212.
34 Add lines 14, 27, and 33 . . . . . . . . . . . . . . . . . . . . . . . . . 34 1,048.
35 Casualty loss portion, if any, from lines 14 and 33. Carry amount to Form 4684. See instructions . 35
36 Allowable expenses for business use of your home. Subtract line 35 from line 34. Enter here
and on Schedule C, line 30. If your home was used for more than one business, see instructions . 36 1,048.
Part III Depreciation of Your Home
37 Enter the smaller of your home’s adjusted basis or its fair market value. See instructions . . . 37 46,208.
38 Value of land included on line 37 . . . . . . . . . . . . . . . . . . . . . . 38
39 Basis of building. Subtract line 38 from line 37 . . . . . . . . . . . . . . . . . 39 46,208.
40 Business basis of building. Multiply line 39 by line 7 . . . . . . . . . . . . . . . . 40 9,468.
41 Depreciation percentage (see instructions) . . . . . . . . . . . . . . . . . . . 41 2.2436 %
42 Depreciation allowable (see instructions). Multiply line 40 by line 41. Enter here and on line 30 above 42 212.
Part IV Carryover of Unallowed Expenses to 2024
43 Operating expenses. Subtract line 27 from line 26. If less than zero, enter -0- . . . . . . . 43 0.
44 Excess casualty losses and depreciation. Subtract line 33 from line 32. If less than zero, enter -0- . 44
CDA Cat. No. 13232M Form 8829 (2023)
 AS AMENDED RETURN COPY
4562 Depreciation and Amortization OMB No. 1545-0172

2023
Form
(Including Information on Listed Property)
Department of the Treasury Attach to your tax return.
Attachment
Internal Revenue Service Go to www.irs.gov/Form4562 for instructions and the latest information. Sequence No. 179
Name(s) shown on return Business or activity to which this form relates Identifying number

SHANA T OWENS SHAYS CREATIONS 251-33-2906

Part I Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1 Maximum amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 1
2 Total cost of section 179 property placed in service (see instructions) . . . . . . . . . . . 2
3 Threshold cost of section 179 property before reduction in limitation (see instructions) . . . . . . 3
4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- . . . . . . . . . . 4
5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 (a) Description of property (b) Cost (business use only) (c) Elected cost

7 Listed property. Enter the amount from line 29 . . . . . . . . . 7

8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 . . . . . . 8
9 Tentative deduction. Enter the smaller of line 5 or line 8 . . . . . . . . . . . . . . . . 9
10 Carryover of disallowed deduction from line 13 of your 2022 Form 4562 . . . . . . . . . . . 10
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5. See instructions 11
12 Section 179 expense deduction. Add lines 9 and 10, but don’t enter more than line 11 . . . . . . 12
13 Carryover of disallowed deduction to 2024. Add lines 9 and 10, less line 12 . 13
Note: Don’t use Part II or Part III below for listed property. Instead, use Part V.
Part II Special Depreciation Allowance and Other Depreciation (Don’t include listed property. See instructions.)
14 Special depreciation allowance for qualified property (other than listed property) placed in service
during the tax year. See instructions . . . . . . . . . . . . . . . . . . . . . . . 14
15 Property subject to section 168(f)(1) election . . . . . . . . . . . . . . . . . . . . 15
16 Other depreciation (including ACRS) . . . . . . . . . . . . . . . . . . . . . . 16
Part III MACRS Depreciation (Don’t include listed property. See instructions.)
Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2023 . . . . . . . 17
18 If you are electing to group any assets placed in service during the tax year into one or more general
asset accounts, check here . . . . . . . . . . . . . . . . . . . . . . .
Section B—Assets Placed in Service During 2023 Tax Year Using the General Depreciation System
(b) Month and year (c) Basis for depreciation
(d) Recovery
(a) Classification of property placed in (business/investment use (e) Convention (f) Method (g) Depreciation deduction
period
service only—see instructions)
19a 3-year property
b 5-year property
c 7-year property
d 10-year property
e 15-year property
f 20-year property
g 25-year property 25 yrs. S/L
h Residential rental 27.5 yrs. MM S/L
property 27.5 yrs. MM S/L
i Nonresidential real 02/23 9,468. 39 yrs. MM S/L 212.
property MM S/L
Section C—Assets Placed in Service During 2023 Tax Year Using the Alternative Depreciation System
20a Class life S/L
b 12-year 12 yrs. S/L
c 30-year 30 yrs. MM S/L
d 40-year 40 yrs. MM S/L
Part IV Summary (See instructions.)
21 Listed property. Enter amount from line 28 . . . . . . . . . . . . . . . . . . . . 21
22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter
here and on the appropriate lines of your return. Partnerships and S corporations—see instructions . 22 212.
23 For assets shown above and placed in service during the current year, enter the
portion of the basis attributable to section 263A costs . . . . . . . . . 23
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 12906N Form 4562 (2023)
CDA
Form 4562 (2023)
AS AMENDED RETURN COPY Page 2
Part V Listed Property (Include automobiles, certain other vehicles, certain aircraft, and property used for
entertainment, recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a,
24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section A—Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24a Do you have evidence to support the business/investment use claimed? X Yes No 24b If “Yes,” is the evidence written? X Yes No
(c) (e)
(a) (b) (f) (g) (h) (i)
Business/ (d) Basis for depreciation
Type of property (list Date placed Recovery Method/ Depreciation Elected section 179
investment use Cost or other basis (business/investment
vehicles first) in service period Convention deduction cost
percentage use only)
25 Special depreciation allowance for qualified listed property placed in service during
the tax year and used more than 50% in a qualified business use. See instructions . 25
26 Property used more than 50% in a qualified business use:
FORD EDGE 04/12/23 100.0%
KIA SOUL 02/08/23 100.0%
%
27 Property used 50% or less in a qualified business use:
% S/L –
% S/L –
% S/L –
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 . 28
29 Add amounts in column (i), line 26. Enter here and on line 7, page 1 . . . . . . . . . . . . 29
Section B—Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other “more than 5% owner,” or related person. If you provided vehicles
to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.
(a) (b) (c) (d) (e) (f)
Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6
30 Total business/investment miles driven during
the year (don’t include commuting miles) . 1,691 863
31 Total commuting miles driven during the year
32 Total other personal (noncommuting)
miles driven . . . . . . . . .
33 Total miles driven during the year. Add
lines 30 through 32 . . . . . . . 1,691 863
34 Was the vehicle available for personal Yes No Yes No Yes No Yes No Yes No Yes No
use during off-duty hours? . . . . . X X
35 Was the vehicle used primarily by a more
than 5% owner or related person? . . X X
36 Is another vehicle available for personal use? X X
Section C—Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who aren’t
more than 5% owners or related persons. See instructions.
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by Yes No
your employees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners . .
39 Do you treat all use of vehicles by employees as personal use? . . . . . . . . . . . . . . . .
40 Do you provide more than five vehicles to your employees, obtain information from your employees about the
use of the vehicles, and retain the information received? . . . . . . . . . . . . . . . . . . .
41 Do you meet the requirements concerning qualified automobile demonstration use? See instructions . . . .
Note: If your answer to 37, 38, 39, 40, or 41 is “Yes,” don’t complete Section B for the covered vehicles.
Part VI Amortization
(e)
(b)
(a) (c) (d) Amortization (f)
Date amortization
Description of costs Amortizable amount Code section period or Amortization for this year
begins
percentage
42 Amortization of costs that begins during your 2023 tax year (see instructions):

43 Amortization of costs that began before your 2023 tax year . . . . . . . . . . . . . 43

44 Total. Add amounts in column (f). See the instructions for where to report . . . . . . . . 44
Form 4562 (2023)

CDA
 2023
AS AMENDED RETURN COPY
Name(s) as shown on federal return Social Security Number
SHANA T OWENS 251-33-2906

ACA Explanation
TAXPAYER OR DEPENDENTS WERE RESPONSIBLE OR PAID FOR HEALTHCARE
INSURANCE. SOMEONE ELSE PAID FOR THE PREMIUM

CDA
 2023
AS AMENDED RETURN COPY
Name(s) as shown on federal Schedule C Social Security Number
SHANA T OWENS 251-33-2906

Federal Schedule C Depreciation Schedule

Business Activity: SHAYS CREATIONS
Date In Asset Cost Bus % Current Current Life Conv Depr %
Service 179 Bonus
Asset Description
Current
Date Sold Depr Basis Land Prior 179 Prior Bonus Method Prior Depr Depr

04/12/23 100.00

FORD EDGE
02/08/23 100.00

KIA SOUL
02/13/23 46,208. 20.49 39.00 MM 2.2436

DAYCARE CENTER 9,468. SL 212.

CDA
 2023
AS AMENDED RETURN COPY
Name(s) as shown on federal Schedule C Social Security Number
SHANA T OWENS 251-33-2906

Alternative Minimum Tax Depreciation Report

Business Activity: SHAYS CREATIONS
Depr Current
Description Cost Life Method Prior Depr AMT Adj
Basis Depr

FORD EDGE .0
KIA SOUL .0
DAYCARE CENTER 46,208. 9,468. 39.0 SL 212.

CDA