I Detach Here and Mail With Your Payment I

Calendar Year '

Department of the Treasury
Internal Revenue Service Due 04/15/2024 2024 Form 1040-ES Payment Voucher 1
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2024 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 675.
REV 09/17/24 PRO 1555

759-50-2785
LORENZO OLEGARIO HERNANDEZ MARTINE
INTERNAL REVENUE SERVICE
1072 ALLVIEW AVE PO BOX 802502
EL SOBRANTE CA 94803 CINCINNATI OH 45280-2502

759502785 WL HERN 30 0 202412 430

 I Detach Here and Mail With Your Payment I
Calendar Year '
Department of the Treasury
Internal Revenue Service Due 06/17/2024 2024 Form 1040-ES Payment Voucher 2
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2024 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 675.
REV 09/17/24 PRO 1555

759-50-2785
LORENZO OLEGARIO HERNANDEZ MARTINE
INTERNAL REVENUE SERVICE
1072 ALLVIEW AVE PO BOX 802502
EL SOBRANTE CA 94803 CINCINNATI OH 45280-2502

759502785 WL HERN 30 0 202412 430

 I Detach Here and Mail With Your Payment I
Calendar Year '
Department of the Treasury
Internal Revenue Service Due 09/16/2024 2024 Form 1040-ES Payment Voucher 3
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2024 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 675.
REV 09/17/24 PRO 1555

759-50-2785
LORENZO OLEGARIO HERNANDEZ MARTINE
INTERNAL REVENUE SERVICE
1072 ALLVIEW AVE PO BOX 802502
EL SOBRANTE CA 94803 CINCINNATI OH 45280-2502

759502785 WL HERN 30 0 202412 430

 I Detach Here and Mail With Your Payment I
Calendar Year '
Department of the Treasury
Internal Revenue Service Due 01/15/2025 2024 Form 1040-ES Payment Voucher 4
File only if you are making a payment of estimated tax by check or money order. Mail this Amount of estimated tax
voucher with your check or money order payable to the 'United States Treasury.' Write your
social security number and ' 2024 Form 1040-ES' on your check or money order. Do not send you are paying by check
cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . . G 675.
REV 09/17/24 PRO 1555

759-50-2785
LORENZO OLEGARIO HERNANDEZ MARTINE
INTERNAL REVENUE SERVICE
1072 ALLVIEW AVE PO BOX 802502
EL SOBRANTE CA 94803 CINCINNATI OH 45280-2502

759502785 WL HERN 30 0 202412 430

Form 8879 IRS e-file Signature Authorization
(Rev. January 2021) OMB No. 1545-0074
a
ERO must obtain and retain completed Form 8879.
Department of the Treasury
a Go to www.irs.gov/Form8879 for the latest information.
Internal Revenue Service

F
Submission Identification Number (SID) 68890420241420aw0mte
Taxpayer’s name Social security number

LORENZO OLEGARIO HERNANDEZ MARTINEZ 759-50-2785

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 66,624.
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 8,089.
3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . . 3 5,389.
4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . 4
5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . .
2,797.. . . . . 5
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
0 2 7 8 5
I authorize Multiple Pardocument Services 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 a Date a

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 a Date a

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 8 8 9 0 4 9 4 8 0 6
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 a Multiple Pardocument Services Date a

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. BAA REV 09/17/24 PRO Form 8879 (Rev. 01-2021)
 Department of the Treasury - Internal Revenue Service
Form 9325 Acknowledgement and General Information for
(January 2017)
Taxpayers Who File Returns Electronically
Thank you for participating in IRS e-file.
759-50-2785
Taxpayer name LORENZO OLEGARIO HERNANDEZ MARTINEZ

Taxpayer address (optional)

1072 ALLVIEW AVE
EL SOBRANTE, CA 94803

1. Your federal income tax return for 2023 was filed electronically with the Fresno
Submission Processing Center. The electronic filing services were provided by Multiple Pardocument Services .

2. Your return was accepted on 05/21/2024 using a Personal Identification Number (PIN) as your electronic
signature. You entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN
for you. The Submission ID assigned to your return is 68890420241420aw0mte .

3. Your return was accepted on Allow 4 to 6 weeks for the processing of your return.
The Earned Income Credit or a dependent's exemption on your return may be reduced or disallowed due to a
child's name and social security number mismatch.

4. Your electronic funds withdrawal payment request was accepted for processing.

5. Your electronic funds withdrawal payment request was not accepted for processing. Refer to the "If You Owe
Tax" section.

6. Your Form 4868, Application for Automatic Extension of Time to File U.S. Individual Income Tax Return, was
accepted on . The Submission ID assigned to your extension
is .

DO NOT SEND A PAPER COPY OF YOUR RETURN TO THE IRS.

IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN.

If You Need to Make a Change to Your Return

If you need to make a change or correct the return you filed electronically, you should send a Form 1040X, Amended U.S.
Individual Income Tax Return, to the IRS Submission Processing Center that processes paper returns for your area. The
address is available at www.irs.gov, or you can call the IRS toll-free at 1-800-829-1040.

If You Need to Ask About Your Refund

The IRS notifies your Electronic Return Originator (ERO) when your return is accepted, usually within 48 hours. If your
return was not accepted, the IRS notifies your ERO of the reasons for rejection. If it has been more than three weeks
since the IRS accepted your return and you have not received your refund, go to www.irs.gov and click on "Where's My
Refund?" to view your refund status. Exception: If box 3 above is checked, allow 4 to 6 weeks for processing of your
return. A notice will be sent to you advising of changes to your return.

Also, you can call the TeleTax line at 1-800-829-4477, for automated refund information. You should have available the
first social security number shown on your return, your filing status, and the exact amount of the refund you expect.
TeleTax gives you the date for mailing or depositing your refund. You should receive your refund check within 30 days of
the date given by TeleTax, or within one week of that date, if you chose direct deposit. If you do not receive it by then, or if
TeleTax does not give your refund information, call the Refund Hotline at 1-800-829-1954.
BAA REV 09/17/24 PRO Form 9325 (Rev. 1-2017)
The IRS uses refunds to cover overdue taxes and notifies you when this occurs. The Fiscal Service offsets refunds
through the Treasury Offset Program to cover past due child support, federal agency non-tax debts such as student loans
and state income tax obligations. Fiscal Service sends you an offset notice if it applies your refund or part of your refund
to non-tax debts. If you have questions about the offset, contact the agency identified in the notice. You may also call the
Treasury Offset Program Call Center at 1-800-304-3107, if you have additional questions.

If You Owe Tax

If your return has a balance due, you must pay the amount you owe by the prescribed due date. If you paid by electronic
funds withdrawal (direct debit) or by credit card, no voucher is needed. The credit card service providers will charge a
convenience fee based on the amount of taxes you are paying. The fees and the type of credit or debit cards accepted
may vary between providers. You will be told the amount of the fee during the transaction and you will be given the option
to either continue or end the transaction. For information on paying your taxes electronically, including by credit or debit
card, go to www.irs.gov/e-pay.

If you are not paying electronically you may use Form 1040-V, Payment Voucher, which you can obtain from your
Electronic Return Originator. If the IRS does not receive your payment by the prescribed due date, you will receive a
notice that requests full payment of the tax due, plus penalties and interest. If you can not pay the amount in full, complete
Form 9465, Installment Agreement Request, which you may file electronically. To apply for an installment agreement
online, go to www.irs.gov. You may also order Form 9465 by calling 1-800-TAX-FORM (1-800-829-3676). If approved, the
IRS charges a user fee to set up an installment agreement.

If You Need to Inquire About Your Electronic Funds Withdrawal Payment

You may call 1-888-353-4537 to inquire about the status of your electronic funds withdrawal payment. If there is a change
to the bank account information included on your return, you should call this number to cancel a scheduled payment. You
should have available the social security number of the first person listed on the tax return, the payment amount, and the
bank account number. Cancellation requests must be received no later than 11:59 p.m. E.T. two business days prior to
the scheduled payment date.

Tax Refund Related Financial Products

Financial institutions offer a variety of financial products to taxpayers based on their refunds. Contracts for financial
products are between you and the financial institution. The IRS is not associated with the contract. If you have questions
about tax refund related products, contact your Electronic Return Originator or the lender.

Catalog Number 12901K BAA www.irs.gov REV 09/17/24 PRO Form 9325 (Rev. 1-2017)
Form 1040-V (2022) 2023 Page 2

IF you live in... THEN use this address to send in your payment...

Alabama, Florida, Georgia, Louisiana, Mississippi, North Internal Revenue Service

Carolina, South Carolina, Tennessee, Texas P.O. Box 1214
Charlotte, NC 28201-1214
Arkansas, Connecticut, Delaware, District of Columbia, Illinois,
Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Internal Revenue Service
Minnesota, Missouri, New Hampshire, New Jersey, New York, P.O. Box 931000
Oklahoma, Rhode Island, Vermont, Virginia, West Virginia, Louisville, KY 40293-1000
Wisconsin

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Kansas,

Internal Revenue Service
Michigan, Montana, Nebraska, Nevada, New Mexico, North
P.O. Box 802501
Dakota, Ohio, Oregon, Pennsylvania, South Dakota, Utah,
Cincinnati, OH 45280-2501
Washington, Wyoming

A foreign country, American Samoa, or Puerto Rico (or are

excluding income under Internal Revenue Code section 933), or Internal Revenue Service
use an APO or FPO address, or file Form 2555 or 4563, or are a P.O. Box 1303
dual-status alien or nonpermanent resident of Guam or the U.S. Charlotte, NC 28201-1303
Virgin Islands

MAIL FORM 1040-V TO THE INTERNAL REVENUE SERVICE CENTER AT THE ADDRESS LISTED BELOW.

Form 1040-V 2023

I Detach Here and Mail With Your Payment and Return I
Department of the Treasury
Internal Revenue Service 2023 Form 1040-V Payment Voucher
G Use this voucher when making a payment with Form 1040.
G Do not staple this voucher or your payment to Form 1040.
G Make your check or money order payable to the 'United States Treasury.' Enter the amount
G Write your social security number (SSN) on your check or money order. of your payment. . . . . . . . . G 2,797.
REV 09/17/24 PRO 1555

LORENZO OLEGARIO HERNANDEZ MARTIN INTERNAL REVENUE SERVICE

P.O. BOX 802501
1072 ALLVIEW AVE CINCINNATI, OH 45280-2501
EL SOBRANTE CA 94803

759502785 WL HERN 30 0 202312 610

 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
LORENZO OLEGARIO HERNANDEZ MARTINEZ 759 50 2785
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
1072 ALLVIEW AVE 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
EL SOBRANTE CA 94803 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

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
• Married filing
jointly or 8 Additional income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . 8 69,208.
Qualifying
surviving spouse, 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 69,208.
$27,700 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10 2,584.
• Head of
household, 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 66,624.
$20,800
• If you checked
12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 33,925.
any box under 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 6,540.
Standard
Deduction, 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 40,465.
see instructions.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . 15 26,159.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. 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 2,921.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 2,921.
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 2,921.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 5,168.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 8,089.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c 5,389.
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 5,389.
If you have a 26 2023 estimated tax payments and amount applied from 2022 return . . . . . . . . . . 26
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . .No. . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
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
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 5,389.
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a
Direct deposit? b Routing number X X X X X X X X X c Type: Checking Savings
See instructions.
d Account number X X X X X X X X X X X X X X X X X
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 2,797.
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38 97.
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)

Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
Joint return? LABOR (see inst.)
See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)

Phone no. Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Linda M. Mayorga 02/07/2025 P00543591 Self-employed
Preparer
Firm’s name Multiple Pardocument Services Phone no.
Use Only 1134 23rd St Richmond CA 94804
Firm’s address Firm’s EIN 94-3343036
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 09/17/24 PRO 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
LORENZO OLEGARIO HERNANDEZ MARTINEZ 759-50-2785
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 36,574.
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 32,634.
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 32,634.
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 69,208.
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2023
Schedule 1 (Form 1040) 2023 Page 2

Part II Adjustments to Income

11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
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 2,584.
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 2,584.
BAA REV 09/17/24 PRO 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
LORENZO OLEGARIO HERNANDEZ MARTINEZ 759-50-2785
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 5,168.
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. 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
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 5,168.
BAA REV 09/17/24 PRO Schedule 2 (Form 1040) 2023
SCHEDULE A Itemized Deductions OMB No. 1545-0074
(Form 1040)
Department of the Treasury
Attach to Form 1040 or 1040-SR.
Go to www.irs.gov/ScheduleA for instructions and the latest information. 2023
Attachment
Internal Revenue Service Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 16. Sequence No. 07
Name(s) shown on Form 1040 or 1040-SR Your social security number
LORENZO OLEGARIO HERNANDEZ MARTINEZ 759-50-2785
Medical Caution: Do not include expenses reimbursed or paid by others.
and 1 Medical and dental expenses (see instructions) . . . . . . . 1
Dental 2 Enter amount from Form 1040 or 1040-SR, line 11 2
Expenses 3 Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . . 3
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . 4
Taxes You 5 State and local taxes.
Paid a State and local income taxes or general sales taxes. You may include
either income taxes or general sales taxes on line 5a, but not both. If
you elect to include general sales taxes instead of income taxes,
check this box . . . . . . . . . . . . . . . . . 5a 1,291.
b State and local real estate taxes (see instructions) . . . . . . . 5b
c State and local personal property taxes . . . . . . . . . . 5c
d Add lines 5a through 5c . . . . . . . . . . . . . . . 5d 1,291.
e Enter the smaller of line 5d or $10,000 ($5,000 if married filing
separately) . . . . . . . . . . . . . . . . . . . 5e 1,291.
6 Other taxes. List type and amount:
6
7 Add lines 5e and 6 . . . . . . . . . . . . . . . . . . . . . . . 7 1,291.
Interest 8 Home mortgage interest and points. If you didn’t use all of your home
You Paid mortgage loan(s) to buy, build, or improve your home, see
Caution: Your instructions and check this box . . . . . . . . . .
mortgage interest
deduction may be a Home mortgage interest and points reported to you on Form 1098.
limited. See See instructions if limited . . . . . . . . . . . . . . 8a
instructions.
b Home mortgage interest not reported to you on Form 1098. See
instructions if limited. If paid to the person from whom you bought the
home, see instructions and show that person’s name, identifying no.,
and address . . . . . . . . . . . . . . . . . . . 8b

c Points not reported to you on Form 1098. See instructions for special
rules . . . . . . . . . . . . . . . . . . . . . 8c
d Reserved for future use . . . . . . . . . . . . . . . 8d
e Add lines 8a through 8c . . . . . . . . . . . . . . . 8e
9 Investment interest. Attach Form 4952 if required. See instructions 9
10 Add lines 8e and 9 . . . . . . . . . . . . . . . . . . . . . . . . 10
Gifts to 11 Gifts by cash or check. If you made any gift of $250 or more, see
Charity instructions . . . . . . . . . . . . . . . . . . . 11
Caution: If you 12 Other than by cash or check. If you made any gift of $250 or more,
made a gift and
got a benefit for it, see instructions. You must attach Form 8283 if over $500 . . . 12
see instructions. 13 Carryover from prior year . . . . . . . . . . . . . . 13
14 Add lines 11 through 13 . . . . . . . . . . . . . . . . . . . . . . 14
Casualty and 15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified
Theft Losses disaster losses). Attach Form 4684 and enter the amount from line 18 of that form. See
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Other 16 Other—from list in instructions. List type and amount:
Itemized GAMBLING LOSSES
Deductions 16 32,634.
Total 17 Add the amounts in the far right column for lines 4 through 16. Also, enter this amount on
Itemized Form 1040 or 1040-SR, line 12 . . . . . . . . . . . . . . . . . . . . 17 33,925.
Deductions 18 If you elect to itemize deductions even though they are less than your standard deduction,
check this box . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see the Instructions for Form 1040. BAA REV 09/17/24 PRO Schedule A (Form 1040) 2023
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)
LORENZO OLEGARIO HERNANDEZ MARTINEZ 759-50-2785
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
CONSTRUCTION 2 3 6 1 0 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
LORENZO
E Business address (including suite or room no.) 1072 ALLVIEW AVE
City, town or post office, state, and ZIP code EL SOBRANTE, CA 94803
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 73,260.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 73,260.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 73,260.
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 73,260.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) . 18 1,200.
9 Car and truck expenses 19 Pension and profit-sharing plans . 19
(see instructions) . . . 9 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 7,200.
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21 180.
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22
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 1,302. 25 Utilities . . . . . . . . 25 1,380.
16 Interest (see instructions): 26 Wages (less employment credits) 26
a Mortgage (paid to banks, etc.) 16a 27a Other expenses (from line 48) . . 27a 25,424.
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 36,686.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 36,574.
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

}
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 36,574.
• 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. BAA REV 09/17/24 PRO 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

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

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
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and
are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file
Form 4562.

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

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

a Business 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.

PROTECTIVE GEAR 1,253.

TOOLS 2,120.

DMV 562.

FASTRAK 385.

GAS,OIL CHANGE, REPAIRS 1,463.

MATERIALS PURCHASED 19,641.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48 25,424.

REV 09/17/24 PRO Schedule C (Form 1040) 2023
SCHEDULE SE
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
LORENZO OLEGARIO HERNANDEZ MARTINEZ with self-employment income 759-50-2785
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 36,574.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . . 3 36,574.
4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . 4a 33,776.
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 33,776.
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 33,776.
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 4,188.
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . 11 980.
12 Self-employment tax. Add lines 10 and 11. Enter here and on Schedule 2 (Form 1040), line 4, or
Form 1040-SS, Part I, line 3 . . . . . . . . . . . . . . . . . . . . . . . . 12 5,168.
13 Deduction for one-half of self-employment tax.
Multiply line 12 by 50% (0.50). Enter here and on Schedule 1 (Form 1040),
line 15 . . . . . . . . . . . . . . . . . . . . . . . . 13 2,584.
For Paperwork Reduction Act Notice, see your tax return instructions. 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
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.
REV 09/17/24 PRO Schedule SE (Form 1040) 2023
BAA
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
LORENZO OLEGARIO HERNANDEZ MARTINEZ 759-50-2785
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)

i LORENZO 759-50-2785 33,990.

ii

iii

iv

v
2 Total qualified business income or (loss). Combine lines 1i through 1v,
column (c) . . . . . . . . . . . . . . . . . . . . . . 2 33,990.
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 33,990.
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 6,798.
6 Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
(see instructions) . . . . . . . . . . . . . . . . . . . . 6
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
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . 9
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . 10 6,798.
11 Taxable income before qualified business income deduction (see instructions) 11 32,699.
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 32,699.
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 6,540.
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 6,540.
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. REV 09/17/24 PRO Form 8995 (2023)
 Form at bottom of page

Payment 1: File and Pay by April 15, 2024.

If amount of payment is zero, do not mail this form.
When the due date falls on a weekend or holiday, the deadline to file and pay without penalty
is extended to the next business day.

Pay online: Go Green! Enjoy the ease and secure options for online payments.
You can make an immediate payment or schedule a payment up to a year in
advance.
• Bank Account – Web Pay (free)
• Credit Card (service fee)
Go to ftb.ca.gov/pay for more information. Do not mail this form if you pay online.

Where to pay: Using black or blue ink, make check or money order payable to the
“Franchise Tax Board.” Write the taxpayer’s social security number (SSN) or individual taxpayer
identification number (ITIN) and “2024 Form 540-ES” on the check or money order. Detach the
form below. Enclose, but do not staple, payment with the form and mail to:
FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0008
Make all checks or money orders payable in U.S. dollars and drawn against a U.S. financial
institution.

DETACH HERE IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM DETACH HERE
CAUTION: You may be required to pay electronically. See instructions. File and Pay by April 15, 2024
TAXABLE YEAR CALIFORNIA FORM

2024 Estimated Tax for Individuals 540-ES

759-50-2785 HERN 24 APE 0
LORENZOOLEG HERNANDEZMARTINEZ

1072 ALLVIEW AVE

EL SOBRANTE CA 94803

Amount of Payment 186.

REV 09/12/24 PRO

For Privacy Notice, get FTB 1131 EN-SP. 175 1201246 Form 540-ES 2023
 Form at bottom of page

Payment 2: File and Pay by June 17, 2024.

If amount of payment is zero, do not mail this form.
When the due date falls on a weekend or holiday, the deadline to file and pay without penalty
is extended to the next business day.

Pay online: Go Green! Enjoy the ease and secure options for online payments.
You can make an immediate payment or schedule a payment up to a year in
advance.
• Bank Account – Web Pay (free)
• Credit Card (service fee)
Go to ftb.ca.gov/pay for more information. Do not mail this form if you pay online.

Where to pay: Using black or blue ink, make check or money order payable to the
“Franchise Tax Board.” Write the taxpayer’s social security number (SSN) or individual taxpayer
identification number (ITIN) and “2024 Form 540-ES” on the check or money order. Detach the
form below. Enclose, but do not staple, payment with the form and mail to:
FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0008
Make all checks or money orders payable in U.S. dollars and drawn against a U.S. financial
institution.

DETACH HERE IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM DETACH HERE
CAUTION: You may be required to pay electronically. See instructions. File and Pay by June 17, 2024
TAXABLE YEAR CALIFORNIA FORM

2024 Estimated Tax for Individuals 540-ES

759-50-2785 HERN 24 APE 0
LORENZOOLEG HERNANDEZMARTINEZ

1072 ALLVIEW AVE

EL SOBRANTE CA 94803

Amount of Payment 248.

REV 09/12/24 PRO

For Privacy Notice, get FTB 1131 EN-SP. 175 1201246 Form 540-ES 2023
 Form at bottom of page

Payment 4: File and Pay by Jan 15, 2025.

If amount of payment is zero, do not mail this form.
When the due date falls on a weekend or holiday, the deadline to file and pay without penalty
is extended to the next business day.

Pay online: Go Green! Enjoy the ease and secure options for online payments.
You can make an immediate payment or schedule a payment up to a year in
advance.
• Bank Account – Web Pay (free)
• Credit Card (service fee)
Go to ftb.ca.gov/pay for more information. Do not mail this form if you pay online.

Where to pay: Using black or blue ink, make check or money order payable to the
“Franchise Tax Board.” Write the taxpayer’s social security number (SSN) or individual taxpayer
identification number (ITIN) and “2024 Form 540-ES” on the check or money order. Detach the
form below. Enclose, but do not staple, payment with the form and mail to:
FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0008
Make all checks or money orders payable in U.S. dollars and drawn against a U.S. financial
institution.

DETACH HERE IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM DETACH HERE
CAUTION: You may be required to pay electronically. See instructions. File and Pay by Jan. 15, 2025
TAXABLE YEAR CALIFORNIA FORM

2024 Estimated Tax for Individuals 540-ES

759-50-2785 HERN 24 APE 0
LORENZOOLEG HERNANDEZMARTINEZ

1072 ALLVIEW AVE

EL SOBRANTE CA 94803

Amount of Payment 186.

REV 09/12/24 PRO

For Privacy Notice, get FTB 1131 EN-SP. 175 1201246 Form 540-ES 2023
175
DO NOT MAIL THIS FORM TO THE FTB
TAXABLE YEAR FORM

2023 California e-file Signature Authorization for Individuals 8879

Your name Your SSN or ITIN

LORENZO OLEGARIO HERNANDEZ MARTINEZ 759-50-2785

Spouse’s/RDP’s name Spouse’s/RDP’s SSN or ITIN

Part I Tax Return Information (whole dollars only)

1 California adjusted gross income (AGI). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 66624
2 Amount you owe. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 645
3 Refund or no amount due. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Part II Taxpayer Declaration and Signature Authorization (Be sure you obtain and keep a copy of your return.)
Under penalties of perjury, I declare that I have examined a copy of my individual income tax return and accompanying schedules and statements for the tax year
ending December 31, 2023, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the information I provided to my
electronic return originator (ERO), transmitter, or intermediate service provider, including my name, address, and social security number (SSN) or individual tax
identification number (ITIN), and the amounts shown in Part I above agree with the information and amounts shown on the corresponding lines of my electronic
income tax return. If applicable, I authorize an electronic funds withdrawal of the amount on line 2 and/or the estimated tax payments as shown on my return
and on form FTB 8455, California e-file Payment Record for Individuals, or a comparable form. If applicable, I declare that direct deposit refund amount on line 3
agrees with the direct deposit authorization stated on my return. If I have filed a joint return, this is an irrevocable appointment of the other spouse/registered
domestic partner (RDP) as an agent to authorize an electronic funds withdrawal or direct deposit. I authorize my ERO, transmitter, or intermediate service
provider to transmit my complete return to the Franchise Tax Board (FTB). If the processing of my return or refund is delayed, I authorize the FTB to disclose
to my ERO, intermediate service provider, and/or transmitter the reason(s) for the delay or the date when the refund was sent. If I am filing a balance due
return, I understand that if the FTB does not receive full and timely payment of my tax liability, I remain liable for the tax liability and all applicable interest and
penalties. I acknowledge that I have read and consent to the Electronic Funds Withdrawal Consent included on the copy of my electronic income tax return. I have
selected a personal identification number (PIN) as my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent.

Taxpayer’s PIN: check one box only

◽ I authorize MULTIPLE PARDOCUMENT SERVICES to enter my PIN 0 2 7 8 5

ERO firm name Do not enter all zeros
as my signature on my 2023 e-filed California individual income tax return.

◽ I will enter my PIN as my signature on my 2023 e-filed California individual income tax return. 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 ▸

Spouse’s/RDP’s PIN: check one box only

◽ I authorize to enter my PIN

ERO firm name Do not enter all zeros
as my signature on my 2023 e-filed California individual income tax return.

◽ I will enter my PIN as my signature on my 2023 e-filed California individual income tax return. 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/RDP’s signature ▸ Date ▸

Practitioner PIN Method Returns Only -- continue below

Part III Certification and Authentication — Practitioner PIN Method Only
ERO’s Electronic Filer Identification Number (EFIN)/PIN.
Enter your six-digit EFIN followed by your five-digit self-selected PIN. 6 8 8 9 0 4 9 4 8 0 6
Do not enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the 2023 California individual income tax return 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 FTB Pub. 1345, 2023 Handbook for Authorized
e-file Providers.

ERO’s signature ▸ MULTIPLE PARDOCUMENT SERVICES Date ▸ 02/07/2025

For Privacy Notice, get FTB 1131 EN-SP. REV 09/12/24 PRO FTB 8879 2023
 Voucher at bottom of page
Do not mail a paper copy of your tax return with the payment voucher.
If amount of payment is zero, do not mail this voucher.

When to pay: Calendar Year – File and pay by April 15, 2024
When a due date falls on a weekend or holiday, the deadline to file and pay without penalty is
extended to the next business day.

Pay online: Go Green! Enjoy the ease and secure options for online payments.
You can make an immediate payment or schedule a payment up to a year in
advance.
• Bank Account – Web Pay (free)
• Credit Card (service fee)
Go to ftb.ca.gov/pay for more information.
Do not mail this voucher if you pay online.

Where to pay: Using black or blue ink, make your check or money order payable to the
“Franchise Tax Board.” Write the taxpayer’s social security number (SSN) or individual
taxpayer identification number(ITIN) and 2023 FTB 3582 on the check or money order.
Detach the voucher below. Enclose, but do not staple, payment with the voucher and mail to:
FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0008
Make all checks or money orders payable in U.S. dollars and drawn against a U.S. financial
institution.

DETACH HERE IF NO PAYMENT IS DUE, DO NOT MAIL THIS VOUCHER DETACH HERE
CAUTION: You may be required to pay electronically. See instructions.
TAXABLE YEAR CALIFORNIA FORM
Payment Voucher for
2023 Individual e-filed Returns 3582 (e-file)
759-50-2785 HERN 23
LORENZOOLEG HERNANDEZ MARTINEZ

1072 ALLVIEW AVE

EL SOBRANTE CA 94803

Amount of Payment 645.

REV 09/12/24 PRO

For Privacy Notice, get FTB 1131 EN-SP. 175 1251236 FTB 3582 2023
 TAXABLE YEAR FORM

2023 California Resident Income Tax Return 540

APE ATTACH FEDERAL RETURN
759-50-2785 HERN 23 PBA 236100
LORENZOOLEG HERNANDEZ MARTINEZ

1072 ALLVIEW AVE

EL SOBRANTE CA 94803

08-10-1981

Enter your county at time of filing (see instructions)

CONTRA COSTA
Principal Residence

If your address above is the same as your principal/physical residence address at the time of filing, check this box . . .
If not, enter below your principal/physical residence address at the time of filing.
Street address (number and street) (If foreign address, see instructions.) Apt. no/ste. no.

City State ZIP code

If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . .

1 Single 4 Head of household (with qualifying person). See instructions.

Filing Status

2 Married/RDP filing jointly (even if 5 Qualifying surviving spouse/RDP. Enter year spouse/RDP died.
only one spouse/RDP had income).
See instructions. See instructions.

3 Married/RDP filing separately. Enter spouse’s/RDP’s SSN or ITIN above and full name here.

6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See instr. . . . . . . ● 6

▶ For line 7, line 8, line 9, and line 10: Multiply the number you enter in the box by the pre-printed dollar amount for that line.
Whole dollars only
7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked
Exemptions

box 2 or 5, enter 2 in the box. If you checked the box on line 6, see instructions. 7 1 X $144 = ● $ 144
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;
if both are visually impaired, enter 2. See instructions . . . . . . . . . . . . . . . . . . . . . 8 X $144 = $
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1;
if both are 65 or older, enter 2. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . ●9 X $144 = $
REV 09/12/24 PRO

175 3101234 Form 540 2023 Side 1

Your name: HERNANDEZ MARTINEZ Your SSN or ITIN: 759-50-2785
10 Dependents: Do not include yourself or your spouse/RDP.
Dependent 1 Dependent 2 Dependent 3
First Name

Last Name
Exemptions

SSN. See
instructions. ● ● ●
Dependent’s
relationship
to you

Total dependent exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 10 X $446 = $

11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32 . . . . . . . . . . . . . 11 $ 144

12 State wages from your federal

Form(s) W-2, box 16 . . . . . . . . . . . . . . . . . . . . . . ● 12 . 00

13 Enter federal adjusted gross income from federal Form 1040 or 1040-SR, line 11 . . . . . . . . 13 66624 . 00
14 California adjustments – subtractions. Enter the amount from Schedule CA (540),
Part I, line 27, column B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 14 . 00
15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses.
66624 . 00
Taxable Income

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 California adjustments – additions. Enter the amount from Schedule CA (540),
Part I, line 27, column C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 16 . 00

17 California adjusted gross income. Combine line 15 and line 16 . . . . . . . . . . . . . . . . . . . . . . . ● 17 66624 . 00

{ {
18 Enter the Your California itemized deductions from Schedule CA (540), Part II, line 30; OR
larger of Your California standard deduction shown below for your filing status:
• Single or Married/RDP filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,363
• Married/RDP filing jointly, Head of household, or Qualifying surviving spouse/RDP. $10,726
If Married/RDP filing separately or the box on line 6 is checked, STOP. See instructions. . ● 18
32634 . 00
19 Subtract line 18 from line 17. This is your taxable income.
If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 33990 . 00

Tax Table Tax Rate Schedule

31 Tax. Check the box if from:
● FTB 3800 ● FTB 3803 . . . . . . . . . . . . . . . . ● 31 762 . 00
32 Exemption credits. Enter the amount from line 11. If your federal AGI is more than
$237,035, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 144 . 00
Tax

33 Subtract line 32 from line 31. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 618 . 00

34 Tax. See instructions. Check the box if from: ● Schedule G-1 ● FTB 5870A . . ● 34 . 00

35 Add line 33 and line 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 618 . 00

●
Special Credits

40 Nonrefundable Child and Dependent Care Expenses Credit. See instructions. . . . . . . . . . . . . 40 . 00

43 Enter credit name code ● and amount. . . ● 43 . 00

44 Enter credit name code ● and amount. . . ● 44 . 00

REV 09/12/24 PRO

Side 2 Form 540 2023 175 3102234

 Your name: HERNANDEZ MARTINEZ Your SSN or ITIN: 759-50-2785

45 To claim more than two credits, see instructions. Attach Schedule P (540) . . . . . . . . . . . . . . ● 45 . 00
Special Credits

46 Nonrefundable Renter’s Credit. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 46 . 00

47 Add line 40 through line 46. These are your total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 . 00

48 Subtract line 47 from line 35. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 618 . 00

61 Alternative Minimum Tax. Attach Schedule P (540) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 61 . 00

Other Taxes

62 Mental Health Services Tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 62 . 00

63 Other taxes and credit recapture. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 63 . 00

64 Add line 48, line 61, line 62, and line 63. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . ● 64 618 . 00

71 California income tax withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 71 . 00

72 2023 California estimated tax and other payments. See instructions . . . . . . . . . . . . . . . . . . . ● 72 . 00

73 Withholding (Form 592-B and/or Form 593). See instructions. . . . . . . . . . . . . . . . . . . . . . . . ● 73 . 00

Payments

74 Excess SDI (or VPDI) withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 74 . 00

75 Earned Income Tax Credit (EITC). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 75 . 00

76 Young Child Tax Credit (YCTC). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 76 . 00

77 Foster Youth Tax Credit (FYTC). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 77 . 00

78 Add line 71 through line 77. These are your total payments.
See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 . 00

●
Use Tax

91 Use Tax. Do not leave blank. See instructions . . . . . . . . . . . . . . . . . . . . . . 91 0 . 00

If line 91 is zero, check if: No use tax is owed. You paid your use tax obligation directly to CDTFA.

92 If you and your household had full-year health care coverage, check the box.
●
Penalty

See instructions. Medicare Part A or C coverage is qualifying health care coverage. . . . . . . .

ISR

If you did not check the box, see instructions.

Individual Shared Responsibility (ISR) Penalty. See instructions . . . . . . . . ● 92 . 00

93 Payments balance. If line 78 is more than line 91, subtract line 91 from line 78 . . . . . . . . . . 93 . 00
Overpaid Tax/Tax Due

94 Use Tax balance. If line 91 is more than line 78, subtract line 78 from line 91 . . . . . . . . . . . 94 . 00
95 Payments after Individual Shared Responsibility Penalty. If line 93 is more than line 92,
subtract line 92 from line 93. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 . 00
96 Individual Shared Responsibility Penalty Balance. If line 92 is more than line 93,
subtract line 93 from line 92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 . 00

97 Overpaid tax. If line 95 is more than line 64, subtract line 64 from line 95. . . . . . . . . . . . . . . 97 . 00
REV 09/12/24 PRO

175 3103234 Form 540 2023 Side 3

Your name:
HERNANDEZ MARTINEZ Your SSN or ITIN: 759-50-2785

98 Amount of line 97 you want applied to your 2024 estimated tax . . . . . . . . . . . . . . . . . . . . . . ● 98 . 00

Tax/Tax Due
Overpaid

99 Overpaid tax available this year. Subtract line 98 from line 97 . . . . . . . . . . . . . . . . . . . . . . . . ● 99 . 00

100 Tax due. If line 95 is less than line 64, subtract line 95 from line 64 . . . . . . . . . . . . . . . . . . . 100 618 . 00
Code Amount

California Seniors Special Fund. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 400 . 00

Alzheimer’s Disease and Related Dementia Voluntary Tax Contribution Fund . . . . . . . . . . . . . ● 401 . 00

Rare and Endangered Species Preservation Voluntary Tax Contribution Program . . . . . . . . . ● 403 . 00

California Breast Cancer Research Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . ● 405 . 00

California Firefighters’ Memorial Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . ● 406 . 00

Emergency Food for Families Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . ● 407 . 00

California Peace Officer Memorial Foundation Voluntary Tax Contribution Fund. . . . . . . . . . . ● 408 . 00

California Sea Otter Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 410 . 00

Contributions

California Cancer Research Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . ● 413 . 00

School Supplies for Homeless Children Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . ● 422 . 00

State Parks Protection Fund/Parks Pass Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 423 . 00

Protect Our Coast and Oceans Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . ● 424 . 00

Keep Arts in Schools Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 425 . 00

California Senior Citizen Advocacy Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . ● 438 . 00

Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . ● 439 . 00

Rape Kit Backlog Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 440 . 00

Suicide Prevention Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 444 . 00

Mental Health Crisis Prevention Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . ● 445 . 00

110 Add amounts in code 400 through code 445. This is your total contribution . . . . . . . . . . . . . ● 110 . 00

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Side 4 Form 540 2023 175 3104234

Your name: HERNANDEZ MARTINEZ Your SSN or ITIN: 759-50-2785
You Owe
Amount

111 AMOUNT YOU OWE. If you do not have an amount on line 99, add line 94, line 96, line 100, and line 110. See instructions. Do not send cash.
Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001. . . . . ● 111 618 . 00
Pay Online – Go to ftb.ca.gov/pay for more information.

112 Interest, late return penalties, and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 . 00
Interest and
Penalties

113 Underpayment of estimated tax.

Check the box: ● FTB 5805 attached ● FTB 5805F attached . . . . . . . . . . . ● 113 27 . 00

114 Total amount due. See instructions. Enclose, but do not staple, any payment . . . . . . . . . . . . 114 645 . 00

115 REFUND OR NO AMOUNT DUE. Subtract the sum of line 110, line 112, and line 113 from line 99. See instructions.

Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0001. . . . . . . ● 115 . 00
Refund and Direct Deposit

Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip.
See instructions. Have you verified the routing and account numbers? Use whole dollars only.
All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:
● Type
● Routing number Checking ● Account number ● 116 Direct deposit amount

. 00
Savings

The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
● Type
● Routing number Checking ● Account number ● 117 Direct deposit amount

. 00
Savings
Voter Info.

For voter registration information, check the box and go to sos.ca.gov/elections. See instructions . . . . . . . . . . . . . . . .
Coverage Info.
Health Care

Do you want information on no-cost or low-cost health care coverage? By checking the "Yes" box, you authorize
the FTB to share limited information from your tax return with Covered California. See instructions . . . . . . . . . . . . . Yes No

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Sign your tax return on Side 6

175 3105234 Form 540 2023 Side 5

Your name: HERNANDEZ MARTINEZ Your SSN or ITIN: 759-50-2785

IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal tax return.
Our privacy notice can be found in annual tax booklets or online. Go to ftb.ca.gov/privacy to learn about our privacy policy statement, or go to ftb.ca.gov/forms and search for 1131
to locate FTB 1131 EN-SP, Franchise Tax Board Privacy Notice on Collection. To request this notice by mail, call 800.338.0505 and enter form code 948 when instructed.
Under penalties of perjury, I declare that I have examined this tax return, including accompanying schedules and statements, and to the best of my knowledge and belief, it
is true, correct, and complete.
Your signature Date Spouse’s/RDP’s signature (if a joint tax return, both must sign)

Your email address. Enter only one email address. Preferred phone number

5103340422
Sign
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
Here
It is unlawful
to forge a
spouse’s/
Firm’s name (or yours, if self-employed) ● PTIN
RDP’s MULTIPLE PARDOCUMENT SERVICES P00543591
signature.
Firm’s address ● Firm’s FEIN
Joint tax
return? 1134 23RD ST RICHMOND CA 94804 943343036
See
instructions.
Do you want to allow another person to discuss this tax return with us? See instructions . . . . . . . ● Yes No
Print Third Party Designee’s Name Telephone Number

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Side 6 Form 540 2023 175 3106234

 TAXABLE YEAR SCHEDULE

2023 California Adjustments — Residents CA (540)

Important: Attach this schedule behind Form 540, Side 6 as a supporting California schedule.
Name(s) as shown on tax return SSN or ITIN

LORENZO OLEGARIO HERNANDEZ MARTINEZ 759502785

Part I Income Adjustment Schedule Federal Amounts Subtractions Additions
Section A – Income from federal Form 1040 or 1040-SR
A (taxable amounts from your
federal tax return)
B See instructions C See instructions

1 a Total amount from federal

Form(s) W-2, box 1. See instructions . . . . . . . 1a
b Household employee wages not reported
on federal Form(s) W-2 . . . . . . . . . . . . . . . . . . 1b

c Tip income not reported on line 1a . . . . . . . . . 1c

d Medicaid waiver payments not reported
on federal Form(s) W-2. See instructions . . . . 1d
e Taxable dependent care benefits
from federal Form 2441, line 26 . . . . . . . . . . . 1e
f Employer-provided adoption benefits
from federal Form 8839, line 29 . . . . . . . . . . . 1f

g Wages from federal Form 8919, line 6. . . . . . . 1g

h Other earned income. See instructions . . . . . . 1h

i Nontaxable combat pay election.
See instructions. . . . . . . . . . . . . . . . . . . . . . . . 1i

z Add line 1a through line 1i. . . . . . . . . . . . . . . . 1z

2 Taxable interest. a 2b
3 Ordinary dividends.
See instructions. a 3b
4 IRA distributions.
See instructions. a 4b
5 Pensions and
annuities. See
instructions. a 5b
6 Social security
benefits. a 6b

7 Capital gain or (loss). See instructions . . . . . . . . 7

Section B – Additional Income from federal Schedule 1 (Form 1040)
1 Taxable refunds, credits, or offsets of state
and local income taxes . . . . . . . . . . . . . . . . . . . . .1

2 a Alimony received. See instructions. . . . . . . . . 2a

3 Business income or (loss). See instructions. . . . .3 36574

4 Other gains or (losses) . . . . . . . . . . . . . . . . . . . . .4
5 Rental real estate, royalties, partnerships,
S corporations, trusts, etc. . . . . . . . . . . . . . . . . . .5

6 Farm income or (loss) . . . . . . . . . . . . . . . . . . . . .6

7 Unemployment compensation . . . . . . . . . . . . . . .7
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For Privacy Notice, get FTB 1131 EN-SP. 175 7731234 Schedule CA (540) 2023 Side 1
Section B – Additional Income Federal Amounts Subtractions Additions
Continued A (taxable amounts from your B See instructions C See instructions
federal tax return)
8 Other income:
a Federal net operating loss . . . . . . . . . . . . . . . . .8a ( )

b Gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b 32634
c Cancellation of debt . . . . . . . . . . . . . . . . . . . . . 8c
d Foreign earned income exclusion from
federal Form 2555 . . . . . . . . . . . . . . . . . . . . . . 8d ( )

e Income from federal Form 8853 . . . . . . . . . . . 8e

f Income from federal 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. . . . . . . . . . . . . . . . . . . . . . . . . . . 8m

n IRC Section 951(a) inclusion . . . . . . . . . . . . . . 8n

o IRC Section 951A(a) inclusion. . . . . . . . . . . . . 8o

p IRC Section 461(l) excess business loss adjustment 8p

q Taxable distributions from an ABLE account . . 8q

r Scholarship and fellowship grants
not reported on federal Form(s) W-2 . . . . . . . . 8r
s Nontaxable amount of Medicaid waiver payments
included on federal Form 1040, line 1a or line 1d. .8s ( )

t Pension or annuity from a nonqualified

deferred compensation plan or a
nongovernmental IRC Section 457 plan . . . . . . 8t

u Wages earned while incarcerated. . . . . . . . . . . 8u

z Other income. List type and amount.
8z
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Side 2 Schedule CA (540) 2023 175 7732234

Section B – Additional Income Federal Amounts Subtractions Additions
Continued A (taxable amounts from your B See instructions C See instructions
federal tax return)

9 a Total other income. Add lines 8a through 8z. . 9a 32634

b1 Disaster loss deduction from form FTB 3805V. . 9b1

b2 NOL deduction from form FTB 3805V . . . . . . 9b2

b3 NOL deduction from form FTB 3805Z,
3807, or 3809 . . . . . . . . . . . . . . . . . . . . . . . . 9b3
10 Total. Combine Section A, line 1z through line 7,
and Section B, line 1 through line 7, and line 9a
in column A and column C. Add Section A, line 1z
through line 7, and Section B, line 1 through line 7,
line 9a, and line 9b1 through line 9b3 in column B
(as applicable). See instructions. . . . . . . . . . . . . . . .10 69208
Section C – Adjustments to Income
from federal Schedule 1 (Form 1040)

11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . .11

12 Certain business expenses of reservists, performing
artists, and fee-basis government officials. . . . . . .12

13 Health savings account deduction . . . . . . . . . . .13

14 Moving expenses. Attach form FTB 3913.
See instructions . . . . . . . . . . . . . . . . . . . . . . . . .14
15 Deductible part of self-employment tax.
See instructions. . . . . . . . . . . . . . . . . . . . . . . . .15 2584

16 Self-employed SEP, SIMPLE, and qualified plans. .16

17 Self-employed health insurance deduction.
See instructions. . . . . . . . . . . . . . . . . . . . . . . . .17

18 Penalty on early withdrawal of savings . . . . . . . .18

19 a Alimony paid. . . . . . . . . . . . . . . . . . . . . . . . .19a

b Recipient’s: SSN

Last Name

20 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21 Student loan interest deduction . . . . . . . . . . . . . . 21

22 Reserved for future use . . . . . . . . . . . . . . . . . . . . 22

23 Archer MSA deduction. . . . . . . . . . . . . . . . . . . . . 23

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175 7733234 Schedule CA (540) 2023 Side 3

Section C – Adjustments to Income Federal Amounts Subtractions Additions
Continued A (taxable amounts from your B See instructions C See instructions
federal tax return)
24 Other adjustments:
a Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 federal Trade Act of 1974 . . . . 24e
f Contributions to IRC Section 501(c)(18)(D)
pension plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24f
g Contributions by certain chaplains to
IRC Section 403(b) plans . . . . . . . . . . . . . . . . . . . 24g
h Attorney fees and court costs for actions involving
certain unlawful discrimination claims . . . . . . . . . 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 federal Form 2555 . . . . . 24j

k Excess deductions of IRC Section 67(e) expenses
from federal Schedule K-1 (Form 1041) . . . . . . . . 24k
z Other adjustments. List type and amount.

24z
25 Total other adjustments. Add line 24a through
line 24z . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Add line 11 through line 23 and line 25 in
columns A, B, and C. See instructions . . . . . . . . . . . 26 2584
27 Total. Subtract line 26 from line 10 in
columns A, B, and C. See instructions . . . . . . . . . . . 27
66624
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Side 4 Schedule CA (540) 2023 175 7734234

Part II Adjustments to Federal Itemized Deductions

Check the box if you did NOT itemize for federal but will itemize for California . . . . . . . . . . .
Federal Amounts Subtractions Additions
A (from federal Schedule A B See instructions C See instructions
(Form 1040))
Medical and Dental Expenses See instructions.
1 Medical and
dental expenses . . . . 1
2 Enter amount from
federal Form 1040
or 1040-SR, line 11. . 66624 2
3 Multiply line 2
by 7.5% (0.075) . . . . 4997 3
4 Subtract line 3 from line 1.
If line 3 is more than line 1, enter 0 . . . . . . . . . . . . . .4
Taxes You Paid
5 a State and local income tax or general sales taxes. .5a 1291 1291

b State and local real estate taxes . . . . . . . . . . . . . . .5b

c State and local personal property taxes . . . . . . . . .5c

d Add line 5a through line 5c. . . . . . . . . . . . . . . . . . .5d 1291

e Enter the smaller of line 5d or $10,000 ($5,000 if

married filing separately) in column A.
Enter the amount from line 5a, column B
in line 5e, column B.
Enter the difference from line 5d and line 5e,
column A in line 5e, column C . . . . . . . . . . . . . . . .5e 1291 1291 0

6 Other taxes. List type 6

7 Add line 5e and line 6 . . . . . . . . . . . . . . . . . . . . . . . . .7 1291 1291 0

Interest You Paid
8 a Home mortgage interest and points reported to
you on federal Form 1098 . . . . . . . . . . . . . . . . . . .8a
b Home mortgage interest not reported to you
on federal Form 1098 . . . . . . . . . . . . . . . . . . . . . . .8b

c Points not reported to you on federal Form 1098. .8c

d Reserved for future use . . . . . . . . . . . . . . . . . . . . .8d

e Add line 8a through line 8c. . . . . . . . . . . . . . . . . . .8e

9 Investment interest. . . . . . . . . . . . . . . . . . . . . . . . . . .9

10 Add line 8e and line 9 . . . . . . . . . . . . . . . . . . . . . . . .10

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175 7735234 Schedule CA (540) 2023 Side 5

Part II Adjustments to Federal Itemized Deductions Federal Amounts Subtractions Additions
Continued A (from federal Schedule A B See instructions C See instructions
(Form 1040))
Gifts to Charity
11 Gifts by cash or check. . . . . . . . . . . . . . . . . . . . . . . .11

12 Other than by cash or check. . . . . . . . . . . . . . . . . . .12

13 Carryover from prior year. . . . . . . . . . . . . . . . . . . . .13

14 Add line 11 through line 13 . . . . . . . . . . . . . . . . . . .14

Casualty and Theft Losses
15 Casualty or theft loss(es) (other than net qualified disaster
losses). Attach federal Form 4684. See instructions . .15

Other Itemized Deductions

16 Other—from list in federal instructions.. . . . . . . . . .16 32634
17 Add lines 4, 7, 10, 14, 15, and 16 in
columns A, B, and C. . . . . . . . . . . . . . . . . . . . . . . . .17 33925 1291 0

18 Total. Combine line 17 column A less column B plus column C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 32634

Job Expenses and Certain Miscellaneous Deductions

19 Unreimbursed employee expenses: job travel, union dues, job education, etc.
Attach federal Form 2106 if required. See instructions . . . . . . . . . . . . . . . . . . . . . . . 19

20 Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21 Other expenses: investment, safe deposit
box, etc. List type . . . . . . . . . . . . . . . . . . . . . . 21 0

22 Add line 19 through line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 0

23 Enter amount from federal Form 1040
or 1040-SR, line 11 . . . . . . . . . . . . . . . . . . . . 66624

24 Multiply line 23 by 2% (0.02). If less than zero, enter 0. . . . . . . . . . . . . . . . . . . . . . . 24 1332

25 Subtract line 24 from line 22. If line 24 is more than line 22, enter 0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 0

26 Total Itemized Deductions. Add line 18 and line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 32634

27 Other adjustments. See instructions. Specify. 27

28 Combine line 26 and line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 32634

29 Is your federal AGI (Form 540, line 13) more than the amount shown below for your filing status?
Single or married/RDP filing separately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $237,035
Head of household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $355,558
Married/RDP filing jointly or qualifying surviving spouse/RDP . . . . . . . . . . . . . . . . $474,075
No. Transfer the amount on line 28 to line 29.
Yes. Complete the Itemized Deductions Worksheet in the instructions for Schedule CA (540), line 29 . . . . . . . . . . . 29 32634
30 Enter the larger of the amount on line 29 or your standard deduction shown below:
Single or married/RDP filing separately. See instructions . . . . . . . . . . . . . . . . . . . . . $5,363
Married/RDP filing jointly, head of household, or qualifying surviving spouse/RDP . . $10,726
Transfer the amount on line 30 to Form 540, line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 32634
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Side 6 Schedule CA (540) 2023 175 7736234

 TAXABLE YEAR CALIFORNIA FORM
Underpayment of Estimated Tax
2023 by Individuals and Fiduciaries 5805
Attach this form to the back of your Form 540, Form 540NR, or Form 541. Also, check the box for underpayment of estimated tax
located on Form 540, line 113; Form 540NR, line 123; or Form 541, line 44, whichever applies.

Name(s) as shown on return SSN, ITIN, or FEIN

LORENZO OLEGARIO HERNANDEZ MARTINEZ 759502785

IMPORTANT: In most cases, the Franchise Tax Board (FTB) can figure the penalty for you and you do not have to complete this form.
See General Information B.
If you meet any of the following conditions, you do not owe a penalty for underpayment of estimated tax. Do not complete or file
this form if:
• The amount of your tax liability (not including tax on lump-sum distributions and accumulation distribution of trusts) less credits
(including the withholding credit) but not including estimated tax payments for either 2022 or 2023 was less than $500 (or less than
$250 if married/RDP filing a separate return).
• Your 2022 return was for a full 12 months (or would have been if you were required to file) and you did not have any tax liability
on that return.
• The amount of your withholding plus your estimated tax payments, if paid in the required installments, is at least 90% of the tax shown
on your 2023 return or 100% of the tax shown on your 2022 return (110% if California adjusted gross income (AGI) was more than
$150,000 or $75,000 if married/RDP filing a separate return) and you are not using the annualized income installment method. Taxpayers
with California AGI equal to or greater than $1,000,000 (or $500,000 if married/RDP filing a separate return) must use the tax shown on
their 2023 tax return if they do not meet one of the two conditions above.

Part I Questions. All filers must complete this part. Estates and Trusts, see General information E.
1 Are you requesting a waiver of the penalty? If “Yes,” provide an explanation below and be sure to check the box
on Form 540, line 113; Form 540NR, line 123; or Form 541, line 44. If you need additional space,
attach a statement. See General Information C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Yes No

2 Did you use the annualized income installment method? If “Yes,” see instructions for Part III and be sure
to check the box on Form 540, line 113; Form 540NR, line 123; or Form 541, line 44 . . . . . . . . . . . . . . . . . . . . . . . . .2 Yes No

3 Was your California withholding not withheld in equal installments and are you able to show the
actual amounts withheld per period and the actual dates withheld? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Yes No

N/A

If “Yes,” enter the actual uneven amounts withheld on the spaces provided below. The total of the four amounts must equal the total
withholding reported on Form 540, line 71 and line 73; Form 540NR, line 81 and line 83; or Form 541, line 29 and line 31.

4/15/23 $ ; 6/15/23 $ ;

9/15/23 $ ; 1/15/24 $ .

4 For estates and trusts: Was the date of death less than two years from the end of the taxable year?
See General Information E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Yes No

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For Privacy Notice, get FTB 1131 EN-SP. 175 7671234 FTB 5805 2023 Side 1
Part II Required Annual Payment. All filers must complete this part.

1 Current year tax. Enter your 2023 tax after credits. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 618 . 00

2 Multiply line 1 by 90% (.90). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 556 . 00

3 Withholding taxes. Do not include any estimated tax payments on this line. See instructions . . . . . . . . . . . . 3 . 00

4 Subtract line 3 from line 1. If less than $500 (or less than $250 if married/RDP filing a separate
return), stop here. You do not owe the penalty. Do not file form FTB 5805 . . . . . . . . . . . . . . . . . . . . . . . . . . 4 618 . 00

5 Enter the tax shown on your 2022 tax return. See instructions. (110% (1.10) of that amount if the
adjusted gross income shown on that return is more than $150,000, or if married/RDP filing a
separate return for 2023, more than $75,000). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . 00

6 Required annual payment. Enter the smaller of line 2 or line 5. (If your California AGI is equal to or
greater than $1,000,000/$500,000 for married/RDP filing a separate return, use line 2) . . . . . . . . . . . . . . . . 6 556 . 00

Short Method
Caution: See the instructions to find out if you can use the short method. If you answered “Yes’’ to Question 2 in Part I, skip this part and go to Part III.
If you answered “No’’ to Question 2 in Part I and you cannot use the short method, go to Worksheet II, Regular Method to Figure Your
Underpayment and Penalty, on page 4 of the instructions.

7 Enter the amount, if any, from Part II, line 3 above . . . . . . . . . . . . 7 . 00

8 Enter the total amount, if any, of estimated tax

payments you made . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . 00

9 Add line 7 and line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . 00

10 Total underpayment for the year. Subtract line 9 from line 6. If zero or less, stop here.
You do not owe the penalty. Do not file form FTB 5805 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 556 . 00

11 Multiply line 10 by .04799165 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 27 . 00

12 • If the amount on line 10 was paid on or after 4/15/24, enter -0-.

• If the amount on line 10 was paid before 4/15/24, enter the result of the following computation:
Amount on Number of days paid
line 10 X before 4/15/24 X .00019 . . . . . . . . . . . . . . . . . . . 12 0 . 00

13 PENALTY. Subtract line 12 from line 11. Enter the result here and on Form 540, line 113;
Form 540NR, line 123; or Form 541, line 44. Also, check the box for “FTB 5805.’’ ▶ ............ 13 27 . 00

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Side 2 FTB 5805 2023 175 7672234

FDIW601

Part III Annualized Income Installment Method Schedule.

Use this schedule ONLY if you earned taxable income at an UNEVEN RATE during 2023 (see Example A). If you earned your income at approximately the
same rate each month (see Example B), then you should not complete this schedule. If you choose to figure the penalty, see Worksheet II, on page 4 of
the instructions.
Example A: If you were a commissioned salesperson who earned no income during the first three months of the year, earned most of your income during
the following six months, and earned very little during the last three months, you should complete this schedule. You may be able to benefit by using the
annualized income installment method. The required installment of estimated tax figured using the annualized method may be less than your required
installment figured using the required installment method.
Example B: If you worked all year and earned a monthly salary that did not change much during the year, you should not complete this schedule.

To complete this schedule correctly, you must first

complete Side 2, Part II, line 1 through line 6.
Estates and trusts, do not use the period ending dates
shown to the right. Instead, use the following: 2/28/23,
4/30/23, 7/31/23, and 11/30/23. (a) (b) (c) (d)
Fiscal year filers must adjust dates accordingly. 1/1/23 to 3/31/23 1/1/23 to 5/31/23 1/1/23 to 8/31/23 1/1/23 to 12/31/23

1 Enter your California adjusted gross income (AGI)

for each period. Form 540NR filers, see instructions.
Estates or Trusts, enter the amount from Form 541,
line 20 attributable to each period. See instructions . . . . 1
2 Annualization amounts. Estates or Trusts,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4 2.4 1.5 1

3 Annualized income. Multiply line 1 by line 2 . . . . . . . . . . 3

4 Enter your itemized deductions for the period shown in each
column. If you do not itemize deductions, enter -0- here and
on line 6. Estates or Trusts, enter -0- here, skip to line 9,
and enter the amount from line 3 on line 9 . . . . . . . . . . . 4

5 Annualization amounts. . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4 2.4 1.5 1

6 Annualized itemized deductions. Multiply line 4 by line 5.
See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Enter your standard deduction from your 2023 Form 540
or Form 540NR, line 18. Enter the total standard
deduction amount in each column. See instructions . . . . 7

8 Enter line 6 or line 7, whichever is larger . . . . . . . . . . . . 8

9 Subtract line 8 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Figure the tax on the amount in each column of line 9 using
the tax table or the tax rate schedule in the instructions for
Form 540, Form 540NR, or Form 541. Also, include any tax
from form FTB 3803. Estates or Trusts, see instructions. . 10
11 Enter the total amount of exemption credits from your
2023 Form 540, line 32 or Form 541, line 22. If you filed
Form 540NR, see instructions . . . . . . . . . . . . . . . . . . . . . 11
12 Subtract line 11 from line 10. Form 540NR filers,
complete Worksheet I on page 3 of the instructions . . . . 12
13 Enter the total credit amount from your 2023 Form 540,
line 47; or Form 541, line 23. Form 540NR filers,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

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175 7673234 FTB 5805 2023 Side 3

Part III Annualized Income Installment Method Schedule. continued

(a) (b) (c) (d)

1/1/23 to 3/31/23 1/1/23 to 5/31/23 1/1/23 to 8/31/23 1/1/23 to 12/31/23

14 a Subtract line 13 from line 12.

If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . .14a
b Enter the alternative minimum tax and
mental health tax. See instructions. . . . . . . . . . . . . . .14b

c Add line 14a and line 14b . . . . . . . . . . . . . . . . . . . . . 14c

d Enter the excess SDI from Form 540, line 74
or Form 540NR, line 84 . . . . . . . . . . . . . . . . . . . . . .14d
e Subtract line 14d from line 14c.
If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . .14e

15 Applicable percentage . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 27% 63% 63% 90%

16 Multiply line 14e by line 15 . . . . . . . . . . . . . . . . . . . . . . . 16

Complete line 17 through line 23 of each column before you go to the next column.
17 Enter the combined amounts shown on line 23
from all preceding columns . . . . . . . . . . . . . . . . . . . . . . . 17
18 Subtract line 17 from line 16. If zero or less,
enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Enter 30% of the amount shown on form FTB 5805,
Part ll, line 6 in columns (a & d), enter 40% of the
amount on line 6 in column b, enter -0- in column c. . . . 19
20 Enter the amount from line 22 from
the preceding column . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21 Add line 19 and line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Subtract line 18 from line 21. If zero or less,

enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

23 Enter line 18 or line 21, whichever is less, for each column. Transfer these amounts to Worksheet II, line 1, on page 4 of the instructions.
(a) (b) (c) (d)
1/1/23 to 3/31/23 1/1/23 to 5/31/23 1/1/23 to 8/31/23 1/1/23 to 12/31/23

If you use the annualized income installment method for one payment due date, you must use it for all payment due dates.
This schedule automatically selects the smaller of your annualized income installment or your regular installment.

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Side 4 FTB 5805 2023 175 7674234