2023 Tax Return

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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)
Taxpayer’s name Social security number

CHARLES UPSHUR 578-88-9141

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 443091
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 155596
3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . . 3 450000
4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . 4 294404
5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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
4 1 2 0 0
I authorize 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.
X 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.
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 TAXSLAYER 02/06/2024 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. b
Form 8879 (Rev. 01-2021)
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 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
CHARLES UPSHUR 578-88-9141
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
4001 SOUTH CAPITOL STREET SW 443 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
WASHINGTON DC 20032 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Filing Status x 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 X 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 458901
Qualifying
surviving spouse, 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 458901
$27,700 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10 15810
• Head of
household, 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 443091
$20,800
• If you checked
12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 13850
any box under 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
Standard
Deduction, 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 13850
see instructions.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . 15 429241
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2023)

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 UPSHUR 578-88-9141
Form 1040 (2023) Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 122129
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 122129
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 122129
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 33467
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 155596
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c 450000
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 450000
If you have a 26 2023 estimated tax payments and amount applied from 2022 return . . . . . . . . . . 26
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 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 450000
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 294404
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 294404
Direct deposit? b Routing number 1 1 1 0 0 0 0 2 5 c Type: X Checking Savings
See instructions.
d Account number 5 8 6 0 3 8 4 5 1 4 8 8
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
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
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
(see inst.)
Joint return? FARMER 927752
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. (717) 229-7047 Email address [email protected]

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2023)

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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
CHARLES UPSHUR 578-88-9141
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
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 438901
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income:
a Net operating loss . . . . . . . . . . . . . . . . . . . 8a ( )
b Gambling . . . . . . . . . . . . . . . . . . . . . . 8b
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 20000
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 20000
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 458901
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2023
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 CHARLES UPSHUR 578-88-9141
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 15810
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 15810
QNA 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
CHARLES UPSHUR 578-88-9141
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 31619
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 1848
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
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 CHARLES UPSHUR 578-88-9141
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 33467
Schedule 2 (Form 1040) 2023
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SCHEDULE F Profit or Loss From Farming OMB No. 1545-0074

2023
(Form 1040)
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, 1041, or 1065.
Department of the Treasury Attachment
Go to www.irs.gov/ScheduleF for instructions and the latest information.
Internal Revenue Service Sequence No. 14
Name of proprietor 1 Social security number (SSN)
CHARLES UPSHUR 578-88-9141
A Principal crop or activity B Enter code from Part IV C Accounting method: D Employer ID number (EIN) (see instr.)
CHICKEN AND GOAT FARMING 1 1 2 4 0 0 X Cash Accrual 9 9 1 1 3 7 9 1 6
E Did you “materially participate” in the operation of this business during 2023? If “No,” see instructions for limit on passive losses X Yes No
F Did you make any payments in 2023 that would require you to file Form(s) 1099? See instructions . . . . . . . . Yes X No
G If “Yes,” did you or will you file required Form(s) 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Farm Income—Cash Method. Complete Parts I and II. (Accrual method. Complete Parts II and III, and Part I, line 9.)
1a Sales of purchased livestock and other resale items (see instructions) . . . . . 1a 300000
b Cost or other basis of purchased livestock or other items reported on line 1a . . . 1b 150000
c Subtract line 1b from line 1a . . . . . . . . . . . . . . . . . . . . . . . . . . 1c 150000
2 Sales of livestock, produce, grains, and other products you raised . . . . . . . . . . . . . . 2 255401
3a Cooperative distributions (Form(s) 1099-PATR) . 3a 3b Taxable amount . . . 3b
4a Agricultural program payments (see instructions) . 4a 4b Taxable amount . . . 4b
5a Commodity Credit Corporation (CCC) loans reported under election . . . . . . . . . . . . . . 5a
b CCC loans forfeited . . . . . . . . . 5b 5c Taxable amount . . . 5c
6 Crop insurance proceeds and federal crop disaster payments (see instructions):
a Amount received in 2023 . . . . . . . 6a 6b Taxable amount . . . 6b
c If election to defer to 2024 is attached, check here . . . . . . . 6d Amount deferred from 2022 6d
7 Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . . . 8 255000
9 Gross income. Add amounts in the right column (lines 1c, 2, 3b, 4b, 5a, 5c, 6b, 6d, 7, and 8). If you use the
accrual method, enter the amount from Part III, line 50. See instructions . . . . . . . . . . . . . 9 660401
Part II Farm Expenses—Cash and Accrual Method. Do not include personal or living expenses. See instructions.
10 Car and truck expenses (see 23 Pension and profit-sharing plans . . 23
instructions). Also attach Form 4562 10 24 Rent or lease (see instructions):
11 Chemicals . . . . . . . . 11 40500 a Vehicles, machinery, equipment . . 24a
12 Conservation expenses (see instructions) 12 50500 b Other (land, animals, etc.) . . . . 24b 35000
13 Custom hire (machine work) . . . 13 60500 25 Repairs and maintenance . . . . 25 35000
14 Depreciation and section 179 expense 26 Seeds and plants . . . . . . 26
(see instructions) . . . . . . 14 27 Storage and warehousing . . . 27
15 Employee benefit programs other than 28 Supplies . . . . . . . . . 28
on line 23 . . . . . . . . 15 29 Taxes . . . . . . . . . 29
16 Feed . . . . . . . . . 16 30 Utilities . . . . . . . . . 30
17 Fertilizers and lime . . . . . 17 31 Veterinary, breeding, and medicine . 31
18 Freight and trucking . . . . . 18 32 Other expenses (specify):
19 Gasoline, fuel, and oil . . . . . 19 a 32a
20 Insurance (other than health) . . 20 b 32b
21 Interest (see instructions): c 32c
a Mortgage (paid to banks, etc.) . . 21a d 32d
b Other . . . . . . . . . 21b e 32e
22 Labor hired (less employment credits) 22 f 32f
33 Total expenses. Add lines 10 through 32f. If line 32f is negative, see instructions . . . . . . . . . . 33 221500
34 Net farm profit or (loss). Subtract line 33 from line 9 . . . . . . . . . . . . . . . . . . 34 438901
If a profit, stop here and see instructions for where to report. If a loss, complete line 36.
35 Reserved for future use.
36 Check the box that describes your investment in this activity and see instructions for where to report your loss:
a All investment is at risk. b Some investment is not at risk.
For Paperwork Reduction Act Notice, see the separate instructions. Schedule F (Form 1040) 2023
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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
CHARLES UPSHUR with self-employment income 578-88-9141
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 438901
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 AH 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
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . . 3 438901
4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . 4a 405325
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 405325
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
6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 405325
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 160200
10 Multiply the smaller of line 6 or line 9 by 12.4% (0.124) . . . . . . . . . . . . . . . . 10 19865
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . 11 11754
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 31619
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 15810
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule SE (Form 1040) 2023
QNA
Form 8959 Additional Medicare Tax
If any line does not apply to you, leave it blank. See separate instructions.
OMB No. 1545-0074

2023
Department of the Treasury Attach to Form 1040, 1040-SR, 1040-NR, or 1040-SS. Attachment
Internal Revenue Service Go to www.irs.gov/Form8959 for instructions and the latest information. Sequence No. 71
Name(s) shown on return Your social security number
CHARLES UPSHUR 578-88-9141
Part I Additional Medicare Tax on Medicare Wages
1 Medicare wages and tips from Form W-2, box 5. If you have more than one
Form W-2, enter the total of the amounts from box 5 . . . . . . . . 1
2 Unreported tips from Form 4137, line 6 . . . . . . . . . . . . . 2
3 Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . 3
4 Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . 4
5 Enter the following amount for your filing status:
Married filing jointly . . . . . . . . . . . . . . . $250,000
Married filing separately . . . . . . . . . . . . . . $125,000
Single, Head of household, or Qualifying surviving spouse . . . $200,000 5
6 Subtract line 5 from line 4. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 6
7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and go to
Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Part II Additional Medicare Tax on Self-Employment Income
8 Self-employment income from Schedule SE (Form 1040), Part I, line 6. If you
had a loss, enter -0- . . . . . . . . . . . . . . . . . . . 8 405325
9 Enter the following amount for your filing status:
Married filing jointly . . . . . . . . . . . . . . . . $250,000
Married filing separately . . . . . . . . . . . . . . $125,000
Single, Head of household, or Qualifying surviving spouse . . . $200,000 9 200000
10 Enter the amount from line 4 . . . . . . . . . . . . . . . . 10
11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . 11 200000
12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 12 205325
13 Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (0.009). Enter here and
go to Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1848
Part III Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation
14 Railroad retirement (RRTA) compensation and tips from Form(s) W-2, box 14
(see instructions) . . . . . . . . . . . . . . . . . . . . 14
15 Enter the following amount for your filing status:
Married filing jointly . . . . . . . . . . . . . . . $250,000
Married filing separately . . . . . . . . . . . . . . $125,000
Single, Head of household, or Qualifying surviving spouse . . . $200,000 15
16 Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . 16
17 Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 16 by 0.9% (0.009).
Enter here and go to Part IV . . . . . . . . . . . . . . . . . . . . . . . . . 17
Part IV Total Additional Medicare Tax
18 Add lines 7, 13, and 17. Also include this amount on Schedule 2 (Form 1040), line 11 (Form 1040-SS
filers, see instructions), and go to Part V . . . . . . . . . . . . . . . . . . . . . 18 1848
Part V Withholding Reconciliation
19 Medicare tax withheld from Form W-2, box 6. If you have more than one Form
W-2, enter the total of the amounts from box 6 . . . . . . . . . . 19
20 Enter the amount from line 1 . . . . . . . . . . . . . . . . 20
21 Multiply line 20 by 1.45% (0.0145). This is your regular Medicare tax
withholding on Medicare wages . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 19. If zero or less, enter -0-. This is your Additional Medicare Tax
withholding on Medicare wages . . . . . . . . . . . . . . . . . . . . . . . 22
23 Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box
14 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Total Additional Medicare Tax withholding. Add lines 22 and 23. Also include this amount with
federal income tax withholding on Form 1040, 1040-SR, or 1040-NR, line 25c (Form 1040-SS filers,
see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
For Paperwork Reduction Act Notice, see your tax return instructions. Form 8959 (2023)
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