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Form 8962 (2017) Page 2 <br />Part IV <br />Complete the following information for up to four policy amount allocations. See instructions for allocation details. <br />Allocation 1 <br />30 (a) Policy Number (Form 1095-A, line 2)(b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month <br />Allocation percentage <br />applied to monthly <br />amounts <br />(e) Premium Percentage (f)SLCSP Percentage (g) Advance Payment of the PTC <br />Percentage <br />Allocation 2 <br />31 <br />Allocation 3 <br />32 <br />Allocation 4 <br />33 <br />34 Have you completed all policy amount allocations? <br />Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non- <br />allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on <br />lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24. <br />No. See the instructions to report additional policy amount allocations. <br />Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9. <br />To complete line(s) 35 and/or 36 and compute the amounts for lines 12-23, see the instructions for this Part V. <br />35 <br /> <br />Alternative entries <br />for your SSN <br />(a) Alternative family size (b) (c) Alternative start month (d) Alternative stop month <br />36 <br /> <br /> <br />Alternative entries <br />for your spouse's <br />SSN <br />(a) Alternative family size (b) (c) Alternative start month (d) Alternative stop month <br />Form 8962 (2017) <br />(a) Policy Number (Form 1095-A, line 2)(b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month <br />Allocation percentage <br />applied to monthly <br />amounts <br />(e) Premium Percentage (f)SLCSP Percentage (g) Advance Payment of the PTC <br />Percentage <br />(a) Policy Number (Form 1095-A, line 2)(b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month <br />Allocation percentage <br />applied to monthly <br />amounts <br />(e) Premium Percentage (f)SLCSP Percentage (g) Advance Payment of the PTC <br />Percentage <br />(a) Policy Number (Form 1095-A, line 2)(b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month <br />Allocation percentage <br />applied to monthly <br />amounts <br />(e) Premium Percentage (f)SLCSP Percentage (g) Advance Payment of the PTC <br />Percentage <br />UYA <br />Allocation of Policy Amounts <br />Alternative Calculation for Year of MarriagePart V <br />Wesley C Brown and Shanon M Larimer 595-42-0794