04/15/2024

Federal Tax Return

Martha Pelegrin Diaz
2023
 04/10/2024

MB TAX ACCOUNTING CORP

3785 NW 82ND AVE SUITE 309
Doral, FL 33166
Phone: (305) 842-6309

Martha Pelegrin Diaz

Apt. #: 323
3933 MONTEGO DR
Corpus Christi, TX 78415

Instructions for filing your 2023 federal form 1040.

. Your return has a balance due of $4,578.

. You have elected to file your Federal return ELECTRONICALLY.
. You must sign Form 8879 IRS e-file authorization.
. Make a check for $4,578 payable to: UNITED STATES TREASURY
. Write your SSN, day phone number, and 2023 1040 on the check.
. Mail only Form 1040V, and your check, as soon as possible to:

Department of the Treasury

Internal Revenue Service
P.O. Box 1214
Charlotte, NC 28201-1214

Your business is appreciated. Please call if you have any questions.

Sincerely,

Christopher Bailey
Martha Pelegrin Diaz XXX-XX-8216
Tax Summary

Income Credit Tax Payment

Wages & Salary $43,492.00 Foreign tax $0.00 Tax on Income $3,707.00 Income tax withheld $0.00
Interest & Dividend $0.00 Child & dependent care $0.00 AMT $0.00 Estimated tax payment $0.00
Business Income $4,154.00 Elderly or disabled $0.00 Other taxes $587.00 Other payments $0.00
Capital Gain $0.00 Education $0.00 Total Tax $4,578.00 Estimated tax penalty $0.00
Farm Income $0.00 Retirement savings contri. $0.00 Refundable credits $0.00
Other Income $4,154.00 EIC $0.00 Balance Due $4,578.00
Total Income $47,646.00 CTC $0.00 Refund $0.00
Total Adjustment $0.00 Adoption $0.00
AGI $47,352.00 Additional child care $0.00
Itemized / Std.Deduction $13,850.00 Other Credit $0.00
Taxable income $32,730.00 Total Credit $0.00
Form 8879 IRS e-file Signature Authorization
(Rev. January 2021) OMB No. 1545-0074
▶ERO must obtain and retain completed Form 8879.
Department of the Treasury
▶ Go to www.irs.gov/Form8879 for the latest information.
Internal Revenue Service

▲
Submission Identification Number (SID) 60270420241064ck86ce

Taxpayer’s name Social security number

Martha Pelegrin Diaz 794-52-8216
Spouse’s name Spouse’s social security number

Part I Tax Return Information — Tax Year Ending December 31, 2023 (Enter year you are authorizing.)
Enter whole dollars only on lines 1 through 5.
Note: Form 1040-SS filers use line 4 only. Leave lines 1, 2, 3, and 5 blank.
1 Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . 1 47,352
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4,578
3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . . 3 0
4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . 4 0
5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4,578
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of the income tax return (original or amended) I am now authorizing, and to the best of
my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from the income tax
return (original or amended) I am now authorizing. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO)
to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason
for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial
Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for
payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This
authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a
payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2
business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of
taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the
personal identification number (PIN) below is my signature for the income tax return (original or amended) I am now authorizing and, if applicable, my
Electronic Funds Withdrawal Consent.
Taxpayer’s PIN: check one box only 2 8 2 1 6
✘ I authorize MB TAX ACCOUNTING CORP to enter or generate my PIN as my
Enter five digits, but
ERO firm name don’t enter all zeros
signature on the income tax return (original or amended) I am now authorizing.
I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only
if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III
below.
Your signature ▶ Date ▶ 04/10/2024

Spouse’s PIN: check one box only

I authorize to enter or generate my PIN as my
ERO firm name Enter five digits, but
signature on the income tax return (original or amended) I am now authorizing. don’t enter all zeros

I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only
if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III
below.

Spouse’s signature ▶ Date ▶

Practitioner PIN Method Returns Only—continue below
Part III Certification and Authentication — Practitioner PIN Method Only
ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. 6 0 2 7 0 4 5 1 2 3 4
Don’t enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the electronic individual income tax return (original or amended) I am now
authorized to file for tax year indicated above for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the
requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.

ERO’s signature ▶ Date ▶ 04/10/2024

ERO Must Retain This Form — See Instructions
Don’t Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 32778X Form 8879 (Rev. 01-2021)
 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
Martha Pelegrin Diaz 7 9 4 5 2 8 2 1 6
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
3933 MONTEGO DR 323 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
Corpus Christi TX 78415 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
dependents,
see instructions
and check
here . .

Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 43,492
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 43,492
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 4,154
Qualifying
surviving spouse, 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 47,646
$27,700 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10 294
• Head of
household, 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 47,352
$20,800
12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 13,850
• If you checked
any box under 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 772
Standard
Deduction, 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 14,622
see instructions.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . 15 32,730
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 3,707
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17 284
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 3,991
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19 0
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 3,991
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 587
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 4,578
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 0
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28 0
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 0
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . 0. . . . . . 33 0
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 0
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 0
Direct deposit? b Routing number c Type: Checking Savings
See instructions.
d Account number
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 4,578
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 Christopher Bailey no. (305) 842-6309 number (PIN) 51234
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
04/10/2024 EMPLOYEE (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. (561)800-7350 Email address [email protected]

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Christopher Bailey 04/10/2024 P03151234 Self-employed
Preparer
Firm’s name MB TAX ACCOUNTING CORP Phone no. (305) 842-6309
Use Only
Firm’s address 3785 NW 82ND AVE SUITE 309 Doral FL 33166 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
Martha Pelegrin Diaz 794-52-8216
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 4,154
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 ( 0)
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:
Form 1040 or1040-SR Schedule 1 Part 1: Other Income List 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 4,154
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 . . . . . . . . . . . 15 294
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 . . . . . . . . . . . . . . . . . . 26 294
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
Martha Pelegrin Diaz 794-52-8216
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . 1 0

2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . 2 284

3 Add lines 1 and 2. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3 284
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . 4 587

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 . . . . . . . . . 21 587
Schedule 2 (Form 1040) 2023
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
794-52-8216
Martha Pelegrin Diaz 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 4,154
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . . 3 4,154
4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . 4a 3,836
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 3,836
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 3,836
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 43,492
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 43,492
9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . . . . 9 116,708
10 Multiply the smaller of line 6 or line 9 by 12.4% (0.124) . . . . . . . . . . . . . . . . 10 476
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . 11 111
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 . . . . . . . . . . . . . . . . . . . . . . . . 12 587
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 . . . . . . . . . . . . . . . . . . . . . . . . 13 294
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
Form 8962 Premium Tax Credit (PTC)
OMB No. 1545-0074

2023
Department of the Treasury
Attach to Form 1040, 1040-SR, or 1040-NR.
Attachment
Internal Revenue Service Go to www.irs.gov/Form8962 for instructions and the latest information. Sequence No. 73
Name shown on your return Your social security number
Martha Pelegrin Diaz 794-52-8216
A. You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception. See instructions. If you qualify, check the box
Part I Annual and Monthly Contribution Amount
1 Tax family size. Enter your tax family size. See instructions . . . . . . . . . . . . . . . . . 1 1
2a Modified AGI. Enter your modified AGI. See instructions . . . . . . . . . 2a 47,352
b Enter the total of your dependents’ modified AGI. See instructions . . . . . . 2b 0
3 Household income. Add the amounts on lines 2a and 2b. See instructions . . . . . . . . . . . . 3 47,352
4 Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3. See instructions. Check the
appropriate box for the federal poverty table used. a Alaska b Hawaii c ✘ Other 48 states and DC 4 13,590
5 Household income as a percentage of federal poverty line (see instructions) . . . . . . . . . . . . 5 348 %
6 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Applicable figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions . . 7 0.0720
8a Annual contribution amount. Multiply line 3 by b Monthly contribution amount. Divide line 8a
line 7. Round to nearest whole dollar amount 8a 3,409 by 12. Round to nearest whole dollar amount 8b 284
Part II Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit
9 Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage? See instructions.
Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage. ✘ No. Continue to line 10.
10 See the instructions to determine if you can use line 11 or must complete lines 12 through 23.
Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23 ✘ No. Continue to lines 12–23. Compute
and continue to line 24. your monthly PTC and continue to line 24.
(a) Annual enrollment (b) Annual applicable (c) Annual (d) Annual maximum (e) Annual premium tax (f) Annual advance
Annual SLCSP premium premium assistance
premiums (Form(s) contribution amount credit allowed payment of PTC (Form(s)
Calculation (Form(s) 1095-A, (subtract (c) from (b); if
1095-A, line 33C)
1095-A, line 33A) line 33B) (line 8a) zero or less, enter -0-) (smaller of (a) or (d))

11 Annual Totals 0 0 0 0 0 0
(c) Monthly
(a) Monthly enrollment (b) Monthly applicable (d) Monthly maximum (f) Monthly advance
contribution amount (e) Monthly premium tax
Monthly premiums (Form(s) SLCSP premium premium assistance payment of PTC (Form(s)
(amount from line 8b credit allowed
Calculation 1095-A, lines 21–32, (Form(s) 1095-A, lines (subtract (c) from (b); if 1095-A, lines 21–32,
or alternative marriage (smaller of (a) or (d))
column A) 21–32, column B) zero or less, enter -0-) column C)
monthly calculation)

12 January 1,098 1,042 284 758 758 1,042

13 February 0 0 0 0 0 0
14 March 0 0 0 0 0 0
15 April 0 0 0 0 0 0
16 May 0 0 0 0 0 0
17 June 0 0 0 0 0 0
18 July 0 0 0 0 0 0
19 August 0 0 0 0 0 0
20 September 0 0 0 0 0 0
21 October 0 0 0 0 0 0
22 November 0 0 0 0 0 0
23 December 0 0 0 0 0 0
24 Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here 24 758
25 Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here 25 1,042

26 Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and
on Schedule 3 (Form 1040), line 9. If line 24 equals line 25, enter -0-. Stop here. If line 25 is greater than line 24,
leave this line blank and continue to line 27 . . . . . . . . . . . . . . . . . . . . . 26 0
Part III Repayment of Excess Advance Payment of the Premium Tax Credit
27 Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here 27 284
28 Repayment limitation (see instructions) . . . . . . . . . . . . . . . . . . . . . . 28 1,500
29 Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2
(Form 1040), line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 284
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37784Z Form 8962 (2023)
Form 8962 (2023) Page 2
Part IV Allocation of Policy Amounts
Complete the following information for up to four policy amount allocations. See instructions for allocation details.
Allocation 1
30 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 2
31 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 3
32 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 4
33 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

34 Have you completed all policy amount allocations?

Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non-
allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on
lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24.
No. See the instructions to report additional policy amount allocations.

Part V Alternative Calculation for Year of Marriage

Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9.
To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V.
(a) Alternative family size (b) Alternative monthly (c) Alternative start month (d) Alternative stop month
35 Alternative entries contribution amount
for your SSN

(a) Alternative family size (b) Alternative monthly (c) Alternative start month (d) Alternative stop month
36 Alternative entries contribution amount
for your spouse’s
SSN
Form 8962 (2023)
Form 9465
(Rev. September 2020)
▶ Go
Installment Agreement Request
to www.irs.gov/Form9465 for instructions and the latest information. OMB No. 1545-0074
▶ If you are filing this form with your tax return, attach it to the front of the return.
Department of the Treasury
Internal Revenue Service ▶ See separate instructions.

Tip: If you owe $50,000 or less, you may be able to avoid filing Form 9465 and establish an installment agreement online, even if you
haven’t yet received a tax bill. Go to www.irs.gov/OPA to apply for an Online Payment Agreement. If you establish your installment
agreement using the Online Payment Agreement application, the user fee that you pay will be lower than it would be with Form 9465.
Part I Installment Agreement Request
This request is for Form(s) (for example, Form 1040 or Form 941) ▶ FORM 1040
Enter tax year(s) or period(s) involved (for example, 2018 and 2019, or January 1, 2019, to June 30, 2019) ▶ 2023
1a Your first name and initial Last name Your social security number
Martha Pelegrin Diaz 794-52-8216
If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Current address (number and street). If you have a P.O. box and no home delivery, enter your box number. Apt. number
3933 MONTEGO DR 323
City, town or post office, state, and ZIP code. If a foreign address, also complete the spaces below (see instructions).
Corpus Christi TX 78415
Foreign country name Foreign province/state/county Foreign postal code

1b If this address is new since you filed your last tax return, check here . . . . . . . . . . . . . . . . . ▶

2 Name of your business (must no longer be operating) Employer identification number (EIN)

3 (561)800-7350 4 (561)800-7350
Your home phone number Best time for us to call Your work phone number Ext. Best time for us to call
5 Enter the total amount you owe as shown on your tax return(s) (or notice(s)) . . . . . . . . 5 4,578
6 If you have any additional balances due that aren’t reported on line 5, enter the amount here (even if
the amounts are included in an existing installment agreement) . . . . . . . . . . . . 6
7 Add lines 5 and 6 and enter the result . . . . . . . . . . . . . . . . . . . . 7 4,578
8 Enter the amount of any payment you’re making with this request. See instructions . . . . . 8
9 Amount owed. Subtract line 8 from line 7 and enter the result . . . . . . . . . . . . 9 4,578
10 Divide the amount on line 9 by 72.0 and enter the result . . . . . . . . . . . . . . 10 64
11a Enter the amount you can pay each month. Make your payment as large as possible to limit interest
and penalty charges, as these charges will continue to accrue until you pay in full. If you have
an existing installment agreement, this amount should represent your total proposed monthly
payment amount for all your liabilities. If no payment amount is listed on line 11a, a payment will
be determined for you by dividing the balance due on line 9 by 72 months . . . . . . . 11a $ 64
b If the amount on line 11a is less than the amount on line 10 and you’re able to increase your payment
to an amount that is equal to or greater than the amount on line 10, enter your revised monthly payment 11b $
• If you can’t increase your payment on line 11b to more than or equal to the amount shown on line 10, check the box. Also,
complete and attach Form 433-F, Collection Information Statement . . . . . . . . . . . . . . . . . . .
• If the amount on line 11a (or 11b, if applicable) is more than or equal to the amount on line 10 and the amount you owe is
over $25,000 but not more than $50,000, then you don’t have to complete Form 433-F. However, if you don’t complete Form
433-F, then you must complete either line 13 or 14.
• If the amount on line 9 is greater than $50,000, complete and attach Form 433-F.
12 Enter the date you want to make your payment each month. Don’t enter a date later than the 28th 12 28
13 If you want to make your payments by direct debit from your checking account, see the instructions and fill in lines 13a and
13b. This is the most convenient way to make your payments and it will ensure that they are made on time.
▶ a Routing number 0 6 3 1 0 7 5 1 3 ▶ b Account number 7 8 7 2 5 1 1 5 8 4
I authorize the U.S. Treasury and its designated Financial Agent to initiate a monthly ACH debit (electronic withdrawal) entry to the financial institution account
indicated for payments of my federal taxes owed, and the financial institution to debit the entry to this account. This authorization is to remain in full force and
effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke payment, I must contact the U.S. Treasury Financial Agent at
1-800-829-1040 no later than 14 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the
electronic payments of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payments.
c Low-income taxpayers only. If you’re unable to make electronic payments through a debit instrument by providing your
banking information on lines 13a and 13b, check this box and your user fee will be reimbursed upon completion of your
installment agreement. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 If you want to make payments by payroll deduction, check this box and attach a completed Form 2159 . . . . . . .
By signing and submitting this form, I authorize the IRS to contact third parties and to disclose my tax information to third parties in order to process this
request and administer the agreement over its duration. I also agree to the terms of this agreement, as provided in the instructions, if it’s approved by the IRS.
Your signature Date Spouse’s signature. If a joint return, both must sign. Date

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 14842Y Form 9465 (Rev. 9-2020)
Form 9465 (Rev. 9-2020) Page 2
Part II Additional Information
Complete this Part only if all three conditions below apply:
1. You defaulted on an installment agreement in the past 12 months;
2. You owe more than $25,000 but not more than $50,000; and
3. The amount on line 11a (or 11b, if applicable) is less than line 10.
Note: If you owe more than $50,000, also complete and attach Form 433-F.
15 In which county is your primary residence? FL

16a Marital status:

Single. Skip question 16b and go to question 17.
Married. Go to question 16b.

b Do you share household expenses with your spouse?

Yes.
No.

17 How many dependents will you be able to claim on this year’s tax return?. . . . . . . . . 17

18 How many people in your household are 65 or older? . . . . . . . . . . . . . . . 18

19 How often are you paid?

Once a week.
Once every 2 weeks.
Once a month.
Twice a month.

20 What is your net income per pay period (take home pay)? . . . . . . . . . . . . . . 20 $

Note: Complete lines 21 and 22 only if you have a spouse and meet certain conditions (see instructions). If you don’t
have a spouse, go to line 23.

21 How often is your spouse paid?

Once a week.
Once every 2 weeks.
Once a month.
Twice a month.

22 What is your spouse’s net income per pay period (take home pay)? . . . . . . . . . . . 22 $

23 How many vehicles do you own? . . . . . . . . . . . . . . . . . . . . . . 23

24 How many car payments do you have each month? . . . . . . . . . . . . . . . . . . . 24

25a Do you have health insurance?

Yes. Go to question 25b. No. Skip question 25b and go to question 26a.

b Are your health insurance premiums deducted from your paycheck?

Yes. Skip question 25c and go to question 26a. No. Go to question 25c.

c How much are your monthly health insurance premiums? . . . . . . . . . . . . . . 25c $

26a Do you make court-ordered payments?

Yes. Go to question 26b. No. Go to question 27.

b Are your court-ordered payments deducted from your paycheck?

Yes. Go to question 27. No. Go to question 26c.

c How much are your court-ordered payments each month? . . . . . . . . . . . . . 26c $

27 Not including any court-ordered payments for child and dependent support, how much do you pay
for child or dependent care each month? . . . . . . . . . . . . . . . . . . . 27 $
Form 9465 (Rev. 9-2020)
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)
Martha Pelegrin Diaz 7 9 4 - 5 2 - 8 2 1 6
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
Transportation & Warehousing 4 8 8 0 0 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.) 3933 MONTEGO DR APT 323
City, town or post office, state, and ZIP code Corpus Christi TX 78415
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 6,774
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 6,774
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4 0
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 6,774
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 6,774
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 0 18 Office expense (see instructions) . 18 0
9 Car and truck expenses 19 Pension and profit-sharing plans . 19 0
(see instructions) . . . 9 2,620 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 0
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 0
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 0
(other than on line 19) . 14 0 b Deductible meals (see instructions) 24b 0
15 Insurance (other than health) 15 0 25 Utilities . . . . . . . . 25 0
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 0 deduction (attach Form 7205) . . 27b 0
28 Total expenses before expenses for business use of home. Add lines 8 through 27b . . . . . . . 28 2,620
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 4,154
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 4,154
• 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) 0 1/ 0 2 /2 0 2 3

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 4000 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
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
Martha Pelegrin Diaz 794-52-8216
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)

Martha Pelegrin Diaz 794-52-8216 3,860

i

ii

iii

iv

v
2 Total qualified business income or (loss). Combine lines 1i through 1v,
column (c) . . . . . . . . . . . . . . . . . . . . . . 2 3,860
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 3,860
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 772
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 . . . . . . 10 772
11 Taxable income before qualified business income deduction (see instructions) 11 33,502
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 33,502
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 6,700
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) . . . . . . . . . . . . . . . . . 15 772
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 1095-A Health Insurance Marketplace Statement VOID OMB No. 1545-2232

Department of the Treasury

Internal Revenue Service
Do not attach to your tax return. Keep for your records.
Go to www.irs.gov/Form1095A for instructions and the latest information.
CORRECTED 2023
Part I Recipient Information
1 Marketplace identifier 2 Marketplace-assigned policy number 3 Policy issuer’s name
FL 121505434 Florida Blue HMO (a BlueCross BlueShield FL compan
4 Recipient’s name 5 Recipient’s SSN 6 Recipient’s date of birth
Martha Pelegrin Diaz 794-52-8216 07/15/1960
7 Recipient’s spouse’s name 8 Recipient’s spouse’s SSN 9 Recipient’s spouse’s date of birth

10 Policy start date 11 Policy termination date 12 Street address (including apartment no.)
01/01/2023 01/31/2023 3933 MONTEGO DR APT 323
13 City or town 14 State or province 15 Country and ZIP or foreign postal code
Corpus Christi TX 78415

Part II Covered Individuals

A. Covered individual name B. Covered individual SSN C. Covered individual D. Coverage start date E. Coverage termination date
date of birth

Martha Pelegrin Diaz 794-52-8216 07/15/1960 01/01/2023 01/31/2023

16

17

18

19

20

Part III Coverage Information

A. Monthly enrollment premiums B. Monthly second lowest cost silver C. Monthly advance payment of
Month
plan (SLCSP) premium premium tax credit

1098.32 1041.89 1042

21 January

22 February

23 March

24 April

25 May

26 June

27 July

28 August

29 September

30 October

31 November

32 December

1,098 1,042 1,042

33 Annual Totals
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 60703Q Form 1095-A (2023)
 2023 Form 1099-NEC Nonemployee Compensation Report

Recipient's Name Payer Name 1. Nonemployee Compensation 4. Federal Income Tax

Withheld
Parent form: Schedule C
Martha Pelegrin Diaz DOORDASH INC 6,774

Total : 6,774 0
 2023 Form W-2 Wage and Tax Statement Report

E. Employee's Name C. Employer's Name 1. Wages 2. Federal 3. Social 4. Social 5. Medicare 6. Medicare
Income Tax Security Security Wages Tax
Withheld Wages Tax Withheld
Withheld
Martha Pelegrin Diaz HCS RENEWABLE ENERGY LLC 10,548 10,548 654 10,548 153
Martha Pelegrin Diaz BLATTNER ENERGY LLC 32,944 32,944 2,043 32,944 478

Total : 43,492 0 43,492 2,697 43,492 631