2018 _ Form 1040 _ Tax Returns - Laserfiche WebLink

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Part V Part IV Complete the following information for up to four policy amount allocations. See instructions for allocation details. Allocation 1 (a)30 Policy Number (Form 1095-A, line 2) SSN of other taxpayer(b) (c)Allocation start month Allocation stop month(d) Allocation percentage applied to monthly amounts amounts applied to monthly Allocation percentage Allocation stop monthAllocation start monthPolicy Number (Form 1095-A, line 2)31 Allocation 2 Allocation 3 32 Policy Number (Form 1095-A, line 2) Allocation start month Allocation stop month Allocation percentage applied to monthly amounts amounts applied to monthly Allocation percentage Allocation stop monthAllocation start monthPolicy Number (Form 1095-A, line 2)33 Allocation 4 Form 8962 (2018)Page 2 (e) Premium Percentage (f) SLCSP Percentage (g) Advance Payment of the PTC Percentage Percentage Percentage Percentage 34 Have you completed all policy amount allocations? Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non- allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24. No. See the instructions to report additional policy amount allocations. Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9. To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V. 35 36 Alternative entries for your SSN Alternative entries for your spouse's SSN (a)Alternative family size (b)Alternative monthly (c)Alternative start month (d)Alternative stop month Alternative stop monthAlternative start monthAlternative monthlyAlternative family size Form 8962 (2018) DAA Allocation of Policy Amounts (d)(c)(b)(a) (d)(c)(b)(a) (d)(c)(b)(a) (g) Advance Payment of the PTC(f) SLCSP Percentage(e) Premium Percentage (g) Advance Payment of the PTC(f) SLCSP Percentage(e) Premium Percentage (g) Advance Payment of the PTC(f) SLCSP Percentage(e) Premium Percentage SSN of other taxpayer SSN of other taxpayer SSN of other taxpayer (d)(c)(b)(a) Alternative Calculation for Year of Marriage contribution amount contribution amount WESLEY C BROWN & SHANON M LARIMER 595-42-0794