Transcription of 2017 Form 8962 - IRS tax forms
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form 8962 Department of the Treasury Internal Revenue ServicePremium Tax Credit (PTC) Attach to form 1040, 1040A, or 1040nr . Go to for instructions and the latest No. 1545-00742017 Attachment Sequence No. 73 Name shown on your returnYour social security numberYou cannot take the PTC if your filing status is married filing separately unless you qualify for an exception (see instructions). If you qualify, check the box .. Part IAnnual and Monthly Contribution Amount 1 Tax family size. Enter the number of exemptions from form 1040 or form 1040A, line 6d, or form 1040nr , line 7d 12aModified AGI. Enter your modified AGI (see instructions)..2abEnter the total of your dependents' modified AGI (see instructions).
Enter the number of exemptions from Form 1040 or Form 1040A, line 6d, or Form 1040NR, line 7d . 1 2. a. ... Form 8962 (2017) Page . 2 Part IV: Allocation of Policy Amounts: Complete the following information for up to four policy amount allocations. See instructions for allocation details.
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