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Exhibit B Substitute Forms Checksheet

Exhibit C Form 1040 With Grid

Publication 1167 — General Rules and Specifications for Substitute Forms and Schedules · 2026-10-03 edition · updated 2026-10-04 · United States

04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82

03


































03
04 04
05 05
06 rm

De
pa
rtm
en
t
of t
he
T
rea
su
ry
—I
nte
rna
l
Re
ven
ue
S
er
vic
e		 06
07 F U . . ** I** ** n** ** di** ** v** ** id** ** u** ** a** ** l** ** In** ** c** ** o** ** m** ** e** ** T** ** R** ** e** ** tu** ** r** ** n** O M B No . 15 45 -0 07 4 IR S Us e Onl y– Do no t w rit e o r s tap le in thi s s pa ce. 07
08

Yo

ur

fir

st

n

am

e

an

d

mi

dd

le

in

itia

l

La
st
na
m
e		 Yo ur ** s** ** oc** ** ia** ** l s** ** e** ** cu** ** rit** ** y** ** nu** ** m** ** be** ** r** 08
09 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 9 9 9 9 9 9 9 9 9 09
10

If j

oi

nt

ret

ur

n,

sp

ou

se

**’**s

fir

st

n

am

e		 an d mi dd le in itia l La st na m e Sp ou s e’s ** s** ** oc** ** ial** ** s** ** ec** ** ur** ** ity** ** n** ** um** ** b** ** er** 10
11 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 9
 9
 9
 9
 9
 9
 9
 9
 9
 11
12
Ho
m
e
ad
dr
es
s (
nu
m
be
r a
n
d s
tre
et		 ). If yo u ha ve a P. O bo x, s ee in str uc tio ns . Ap t. no . Ta xp a ye r D ** at** ** e** ** of** ** D** ** ea** ** th** 12
13 0 1 / 0 1 / 0 1 13
14 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Sp o us e’ s ** Da** ** te** ** of** ** D** ** ea** ** th** 14
15 Cit y, to w n o r po st off ic e. If yo u h a ve a fo rei gn a dd re ss, a lso c om pl et e sp ac es b elo w. Sta te ZI P co de 0 1 / 0 1 / 0 1 15
16 X X X X X X X X X X X X X X X X X X X X X X 9 9 9 9 9 9 9 9 9 9 16
17 Fo re ign c ou nt ry na m e

Fo		 re ign pr ovi nc e/ sta te /c ou nty Fo re ign p os ta l c od e 17
18 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 9 9 9 99 9 9 9 99 9 9 9 9 99 9 18
19 Fi lin g ** S** ** ta** ** tu** ** s** St a d ar d ** D** ** ed** ** u** ** cti** ** o** ** n** ** -** ** o** ** m** ** eo** ** n** ** e** ** ca** ** n** ** c** ** lai** ** m** ** :** Pr es id en tia l ** El** ** ec** ** tio** ** n** ** C** ** am** ** p** ** ai** ** gn** 19
20


Ch
ec
k
on
 ly
 X

 Si ng e X

Yo
u
as
a
d
ep
en
de
nt		 X

Yo
ur
s
po
us
e
as
a		 de p n de nt

Ch

 ec

 k

 he

 re

 if

 yo

 u,

 or

 y

 ou

 r

20
21 on e ~~ bo~~ ~~ x.~~ X
M
 arr
 ied
 f ilin g joi ntl y X
Sp
 ou
 s
 it
 e
 iz
 es
 o
 n
 a se pa rat
 e
 ret
 ur
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 r
 yo
 u
 we
 re
 a
 d
 ual
 -st
 at us al ie

sp
ou
se
~~ if~~
~~ fil~~
~~ in~~
~~ j~~
~~ in~~
~~ tly~~
~~ ,~~
~~ a~~
~~ nt~~
~~ $3~~		 21
22 X

M
arr
ied
f
ilin
g
se
pa
ra		 tel y (M FS ) A
e/
Bl
in
dn
es
s
Y
o
u

p
ou
se

bo
to		 x
~~ g~~		 ~~ be~~
~~ t~~		 ~~ o~~
~~ t~~
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~~ f~~		 ~~ n~~
~~ n~~		 ~~ ot~~
~~ .~~		 ~~ ch~~
 ~~ a~~
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~~ ki~~
~~ g~~		 ~~ a~~ 22
23 X
He
 a
 d o
 f
 ho
 us
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 H
 OH
 )
B
 orn
be
 fo
 re
 1
 /2/ 19 5 8: X

 X
yo
 ur
 ta
 x
 or
 re
 fun
 d.
23
24 X

Q
ual
ify
in
s
ur
viv
in
g
sp
ou
se		 ( QS S

Bl
in
d:		 X X X
Y
ou		 X
 S o us e 24
25
26		 pe
If		 rs
yo		 on
u		 is
ch		 a
ec		 ch
ke		 ild
d t		 b
he
 ut
M
 n
F
 ot
S
 yo
bo
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x,
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en
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te
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r t
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he
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n
am
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e
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of
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yo
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ur
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po		 X
us
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e.
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If
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yo
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u		 X
ch		 X
ec		 X
ke		 X
d t		 X
he		 X
H		 X
O		 X
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or		 X
Q		 X
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b		 X
ox		 X

, e		 X

nt		 X
er		 X
th		 X
e		 X
ch		 X

ild		 X

’s		 X
na		 X
m		 X
e i		 f t he q ual ify in g 25
26
27 Di
 gi
 ta
 l
 At a ny ti me d uri ng 2 0X X, d d yo u: (a ) r ec ei e (a s a r ew ar d, a wa rd , o r a ym en t f or pr op er ty or s erv ic es ); or (b s ell , 27
28 A ss et s

ex
ch
an
ge
,
gift
, o
r
ot
her
wi
se
d
isp
os
e
of
a
di
git
al
as
se
t (
or
a
fin
an
ci
al
int
er
es
t i
n a
d
igi
tal
a
ss
et)
?
(S
ee
in
st
ruc
tio
ns
.)		 X Y es X N o 28
29 D p en d en ts ( se e in st ru cti on s) : (4) C he
ck
t
he
b
ox
if
qu
ali		 fie s f or 29
30 (1)
 F
 irs
 t n
 a
 me
La st n m e (2 ) S o cia l s e ur ity (3 )
Re
lat
io
ns		 hip (s
 ee
 in
st
ru
cti
on
s):


30
31 If mor e n
 um
 b
 er
 t
 o
 yo
 u
 C hil d t ax c re dit r
d		 di
ep		 ~~ f~~
en		 ~~ r~~
de		 ~~ ot~~
nt		 ~~ e~~
s		 31
32 tha n f ou r X
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33
se
de		 ~~ i~~
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,		 ~~ ns~~ X
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 33
34 an
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X
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 34
35 her
 e
 x X X X X X X X X X X X X X X X X X X X X X X X X X 9 9 9 9 9 9 9 9 9 X X X X X X X X X X X X X X
 35
36 In c o m e 1 a T ta l am o un t fro m F or m (s ) W- 2, b ox 1 ( se e in st ru cti on s) 1a 9
 9
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 ,
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37


At
ta
ch
** F**
** or**
** m**
** s)**

b
 H
 ou
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n
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 (s)
W-
 2 1b
 9
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 37
38


W
-2
** he**
** re**
** .**
** Als**
** o**

c
 Ti
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 38
39


t
W
a
-2
h
G
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d
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 )
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 39
40


10
 s
99
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-R
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 40
41






f
E
mp
lo
ye
r-
pr
ov
id
ed
a
d
op
tio
n
b
en
efi
ts
fr
o
m
Fo
rm

88
3
9,
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e		 2 9 1f
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 41
42
ge
If		 t
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1g
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43
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 (s
 ee
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 ct io ns ) 1h
 9 9 9 , 9 9 9 , 9 9 9 43
44

ins
tru
ct
ion
s.		 i
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45 z
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45
46 Att ac h S ch . B 2 a
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x-
ex
em
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2		 a 9
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47 if r eq uir ed. 3
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Or
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48 4
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 48
48
49 5
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49 ta d r
50 D

ed
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tio
n
 ** fo** ** r –** 6
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So
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al
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c.
be
n.
6 a 9 9 9 , 9 9 9 , 9 9 9 b
Ta
xa
bl
e
am
o
un
t		 6b 9 9 9 , 9 9 9 , 9 9 9 50
51 • Si

M		 ngl
arr		 e
ed		 r
~~ fil~~		 ~~ ng~~ c
 If
 yo
 u
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 t
 to
 u
 se th e lu
 m
 p- su m e le cti on me th od , ch ec
 k
 h
 er
 e (
 se
 e
 in
 st
 ru
 cti on s) X 51
52 se
 pa
 rat
 ely,
 7
C
ap
ita
l
ga
in
o
r (
lo
ss
).
At
ta
ch
S
c
he
du
le
D
if
r
eq
ui
re
d.		 52
53 $

 2,

 50

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 no
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 , c
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X 7 9
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 53
54 • jo
M		 ntl
arr		 ~~ o~~
ed		 ~~ r~~
~~ fili~~		 ~~ ng~~ 8 O
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55

Q

ual

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ng		 9 A
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56 $
s		 5,
rvi		 00
vin		 ~~ po~~ ~~ us~~ , 1 0
A
dju
st
m
en
ts
t
o i
nc
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me
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ro
m
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e
du
le
1,
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2
6		 10
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57 • H ead of 1
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 57
58 $
h		 9,
us		 00
eh		 ld, 1
 2
 St
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 )
 12 9
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 58
59 • If yo u c he ke d 1 3
Q
ua
lifi
ed

u
sin
e
ss
in
c
om
e
d
ed
u
ti
on
fr
o
m
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r
m
89
9
5
or
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or
m
8
99		 5- A 13 9
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 59
60 an
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 box
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 nde
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 1 4
A
dd
li
ne
s
12
a
n
1
3		 14
 9 9 9 , 9 9 9 , 9 9 9 60
61 D
S		 d
an		 ct
da		 n
d		 1
 5
 S
 ub
 tra
 ct
 li
 ne
 1
 4
 fr
 om
 l n e 11 . I f z er o or le s s, en te r -0 -. 61
62 se e ins tru ctio ns.
Th
is
is
y
o
ur
ta
xa
b
le
** in**
** c**
** o**
** me**
15 9 9 9 , 9 9 9 , 9 9 9 62
63
63
64

Fo
 r
 ** D** ** is** ** cl** ** os** ** ur** ** e,** ** P** ** ri** ** va** ** cy** ** c** ** t,** ** a** ** d** ** P** ** a** ** pe** ** rw** ** o** ** rk** ** R** ** e** ** du** ** ct** ** io** ** n** ** A** ** ct** ** N** ** o** ** ic** ** e,** ** s** ** ee** ** s** ** e** ** pa** ** ra** ** te** ** i** ** ns** ** tr** ** uc** ** ti** ** on** ** s.** Fo rm ** 10** ** 4** ** 0** (2 0X X ) 64
04 05
 06
DA		 07
A		 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 2 3 2 4 2 5 2 6 2 7 2 8 29 30 31 32 33 34 35 36 37 38 39 4 0 4 1 4 2 43 44 45 46 47 48 49 50 5 1 5 2 5 3 54 55 56 57 58 59 6 0 6 1 62 63 64 65 66 67 6 8 6 9 70 71 72 73 74 7 5 76 77 78 79 80 8 1 82

42

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▸Contents — Publication 1167 — General Rules and Specifications for Substitute Forms and Schedules
Publication 1167 — General Rules and Specifications for Substitute Forms and Schedules

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