Benchmarks

Form 1040

Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return

2024

OMB No. 1545-0074

IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2024, or other tax year beginning

1/01

, 2024, ending

12/31

, 2024

See separate instructions.

Your first name and middle initial

Hobart A

Last name

Kozey

Your social security number

657-27-3080

If joint return, spouse's first name and middle initial

Fannie S

Last name

Raynor

Spouse's social security number

941-87-0424

Home address (number and street). If you have a P.O. box, see instructions.

8660 Halvorson Ways

Apt. no.

Suite 127

Presidential Election Campaign

Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund.

City, town, or post office. If you have a foreign address, also complete spaces below.

Hazelstad

State

NC

ZIP code

28378

Foreign country name

Foreign province/state/county

Foreign postal code

You Spouse

Filing Status

Check only one box.

Single Married filing jointly (even if only one had income) Married filing separately (MFS) Head of household (HOH) 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:

If treating a nonresident alien or dual-status alien spouse as a U.S. resident for the entire tax year, check the box and enter their name (see instructions and attach statement if required):

Digital Assets

At any time during 2024, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.)

Yes No

Standard Deduction

Someone can claim: You as a dependent Your spouse as a dependent Spouse itemizes on a separate return or you were a dual-status alien

Age/Blindness

You: Were born before January 2, 1960 Are blind

Spouse:

Was born before January 2, 1960 Is blind

Dependents

(see instructions):

If more than four dependents, see instructions and check here

(1) First name	Last name	(2) Social security number	(3) Relationship to you	(4) Check the box if qualifies for (see instructions):
				Child tax credit	Credit for other dependents
Mathew	Kozey	507 44 2740	parent
Claudia	Kozey	293 98 9269	children

Income

Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld.

If you did not get a Form W-2, see instructions.

Attach Sch. B if required.

Standard Deduction for—

• Single or Married filing separately, $14,600

• Married filing jointly or Qualifying surviving spouse, $29,200

• Head of household, $21,900

• If you checked any box under Standard Deduction, see instructions.

1a	Total amount from Form(s) W-2, box 1 (see instructions)	1a	$39,967.00
b	Household employee wages not reported on Form(s) W-2	1b	$3,956.00
c	Tip income not reported on line 1a (see instructions)	1c	$0.00
d	Medicaid waiver payments not reported on Form(s) W-2 (see instructions)	1d	$1,629.00
e	Taxable dependent care benefits from Form 2441, line 26	1e	$0.00
f	Employer-provided adoption benefits from Form 8839, line 29	1f	$7,035.00
g	Wages from Form 8919, line 6	1g	$0.00
h	Other earned income (see instructions)	1h	$0.00
i	Nontaxable combat pay election (see instructions)	1i	$803.00
z	Add lines 1a through 1h	1z	$53,390.00
2a	Tax-exempt interest	2a	$0.00
	b Taxable interest	2b	$2,450.00
3a	Qualified dividends	3a	$0.00
	b Ordinary dividends	3b	$2,798.00
4a	IRA distributions	4a	$8,553.00
	b Taxable amount	4b	$0.00
5a	Pensions and annuities	5a	$0.00
	b Taxable amount	5b	$5,120.00
6a	Social security benefits	6a	$2,120.00
	b Taxable amount	6b	$0.00
c	If you elect to use the lump-sum election method, check here (see instructions)
7	Capital gain or (loss). Attach Schedule D if required. If not required, check here	7	$0.00
8	Additional income from Schedule 1, line 10	8	$750.00
9	Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income	9	$64,508.00
10	Adjustments to income from Schedule 1, line 26	10	$0.00
11	Subtract line 10 from line 9. This is your adjusted gross income	11	$64,508.00
12	Standard deduction or itemized deductions (from Schedule A)	12	$0.00
13	Qualified business income deduction from Form 8995 or Form 8995-A	13	$0.00
14	Add lines 12 and 13	14	$0.00
15	Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income	15	$64,508.00

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11320B

Form 1040 (2024)