1040 Tax Return Summary 2023

Taxpayer

THERESA L KALEIKAU
XXX-XX-4095

2324 West St
Pueblo, CO 81003

Dependents
Name SSN Relationship
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2023 Federal Return Information Prepared: 02-02-2024

Filing Status: Single

Wages, Salaries, Tips, etc.: $ 0

Total Income: $ 0
Total Adjustments: $ 0
Adjusted Gross Income: $ 0
Total Deductions: $ 13,850
QBI Amount: $ 0
Taxable Income: $ 0
Tax (before credits): $ 0
Total Non-Refundable Credits: $ 0
Tax (after credits): $ 0
Earned Income Credit: $ 0
Total Payments, Refundable Credits: $ 0
Amount You Overpaid: $ 0
Your Tax Refund: $ 0
Refund You Applied to 2024: $ 0
Amount of Tax Owed (balance due): $ 0

Tax Rate (percentage): 10

State Return Information Resident State: CO

State AGI Taxable Income Tax Refund Balance Due

HI
CO $ (13,850) $ (13,850) $ 800
 Department of the Treasury-Internal Revenue Service

1040 U.S. Individual Income Tax Return 2023

Form
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 See separate instructions.
Your first name and middle initial Last name Your social security number
THERESA L KALEIKAU 270-70-4095
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
2324 West St Check here if you, or your
City, town, or post office. If you have a foreign address, also complete spaces below. spouse if filing jointly, want $3
State ZIP code
to go to this fund. Checking a
Pueblo CO 81003 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
X 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 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 if qualifies for (see instructions):
(1) First name number to you Child tax credit Credit for other dependents
Last name
If more
than four lee seung X
dependents,
see instructions
and check
here . .
1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . . . . . . . . . . 1a
Income b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . 1b
Attach Form(s) c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 1c
W-2 here. Also
d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . . . . . . 1d
attach Forms
W-2G and e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . . . . . . . . . . 1e
1099-R if tax f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . . . . . . . . . 1f
was withheld.
g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1g
If you did not
get a Form h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1h
W-2, see i Nontaxable combat pay election (see instructions) ........... 1i
instructions.
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 1,920 b Taxable amount . . . . . . . . . 6b 0
Married filing
separately, c If you elect to use the lump-sum election method, check here (see instructions) ........
$13,850
Married filing
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . . 7
jointly or 8 Additional income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Qualifying
surviving spouse, 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income. . . . . . . . . . . . . . . . . 9 0
$27,700
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Head of
household, 11 Subtract line 10 from line 9. This is your adjusted gross income. . . . . . . . . . . . . . . . . . 11 0
$20,800
If you checked
12 Standard deduction or itemized deductions (from Schedule A). . . . . . . . . . . . . . . . . . 12 13,850
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 13,850
see instructions.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . . . . . 15 0
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2023)

EEA
Form 1040 (2023) THERESA L KALEIKAU 270-70-4095 Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 ... 16 0
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 0
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 0
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . 22 0
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . . . . . . . . 23
24 Add lines 22 and 23. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 0
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d
If you have a 26 2023 estimated tax payments and amount applied from 2022 return . . . . . . . . . . . . . . . . 26
qualifying child, 27 Earned income credit (EIC) . . . . . . NO................. 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 0
33 Add lines 25d, 26, and 32. These are your total payments. . . . . . . . . . . . . . . . . . . . . 33 0
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid. . . . 34 0
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here ....... 35a 0
Direct deposit? b Routing number c Type: Checking Savings
See instructions.
d Account number
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 0
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. X 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 If the IRS sent you an Identity
Your signature Date Your occupation
Protection PIN, enter it here
Joint return? (see inst.)
Retired
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. 719-644-9601 Email address

Preparer's signature Date PTIN Check if:
Paid Self-employed
Preparer Preparer's name Phone no.
Use Only Firm's name
Firm's address
Firm's EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2023)
EEA
SCHEDULE 8812 Credits for Qualifying Children OMB No. 1545-0074
(Form 1040)
and Other Dependents
Attach to Form 1040, 1040-SR, or 1040-NR.
2023
Department of the Treasury Attachment
Internal Revenue Service Go to www.irs.gov/Schedule8812 for instructions and the latest information. Sequence No. 47

Name(s) shown on return Your social security number

THERESA L KALEIKAU 270-70-4095
Part I Child Tax Credit and Credit for Other Dependents
1 Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . 1
2a Enter income from Puerto Rico that you excluded .................. 2a
b Enter the amounts from lines 45 and 50 of your Form 2555 .............. 2b
c Enter the amount from line 15 of your Form 4563 . . . . . . . . . . . . . . . . . . . 2c
d Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
3 Add lines 1 and 2d .............................................. 3
4 Number of qualifying children under age 17 with the required social security number . . 4
5 Multiply line 4 by $2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 0
6 Number of other dependents, including any qualifying children who are not under age
17 or who do not have the required social security number . . . . . . . . . . . . . . 6 1
Caution: Do not include yourself, your spouse, or anyone who is not a U.S. citizen, U.S. national, or U.S. resident
alien. Also, do not include anyone you included on line 4.
7 Multiply line 6 by $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 500
8 Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 500
9 Enter the amount shown below for your filing status.
• Married filing jointly-$400,000
• All other filing statuses-$200,000 } .................................... 9 200,000
10 Subtract line 9 from line 3.
• If zero or less, enter -0-.

11
• If more than zero and not a multiple of $1,000, enter the next multiple of $1,000. For
}
example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc. ...........
Multiply line 10 by 5% (0.05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
11
0

12 Is the amount on line 8 more than the amount on line 11? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 500
No. STOP. You cannot take the child tax credit, credit for other dependents, or additional child tax credit.
Skip Parts II-A and II-B. Enter -0- on lines 14 and 27.
X Yes. Subtract line 11 from line 8. Enter the result.
13 Enter the amount from the Credit Limit Worksheet A ............................... 13 0
14 Enter the smaller of line 12 or 13. This is your child tax credit and credit for other dependents .......... 14 0
Enter this amount on Form 1040, 1040-SR, or 1040-NR, line 19.
If the amount on line 12 is more than the amount on line 14, you may be able to take the additional child tax credit
on Form 1040, 1040-SR, or 1040-NR, line 28. Complete your Form 1040, 1040-SR, or 1040-NR through line 27
(also complete Schedule 3, line 11) before completing Part II-A.

For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 8812 (Form 1040) 2023
EEA
Schedule 8812 (Form 1040) 2023 THERESA L KALEIKAU 270-70-4095 Page 2
Part II-A Additional Child Tax Credit for All Filers
Caution: If you file Form 2555, you cannot claim the additional child tax credit.
15 Check this box if you do not want to claim the additional child tax credit. Skip Parts II-A and II-B. Enter -0- on line .
27. . . . . . . . . . . .
16a Subtract line 14 from line 12. If zero, stop here; you cannot take the additional child tax credit. Skip Parts II-A
and II-B. Enter -0- on line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16a 500
b Number of qualifying children under 17 with the required social security number: x $1,600.
Enter the result. If zero, stop here; you cannot claim the additional child tax credit. Skip Parts II-A and II-B.
Enter -0- on line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16b 0
TIP: The number of children you use for this line is the same as the number of children you used for line 4.
17 Enter the smaller of line 16a or line 16b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18a Earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
b Nontaxable combat pay (see instructions) . . . . . . . . . 18b
19 Is the amount on line 18a more than $2,500?
No. Leave line 19 blank and enter -0- on line 20.
Yes. Subtract $2,500 from the amount on line 18a. Enter the result . . . . . . . . 19
20 Multiply the amount on line 19 by 15% (0.15) and enter the result . . . . . . . . . . . . . . . . . . . . . . . . . 20
Next. On line 16b, is the amount $4,800 or more?
No. If you are a bona fide resident of Puerto Rico, go to line 21. Otherwise, skip Part II-B and enter the
smaller of line 17 or line 20 on line 27.
Yes. If line 20 is equal to or more than line 17, skip Part II-B and enter the amount from line 17 on line 27.
Otherwise, go to line 21.
Part II-B Certain Filers Who Have Three or More Qualifying Children and Bona Fide Residents of Puerto Rico
21 Withheld social security, Medicare, and Additional Medicare taxes from Form(s) W-2,
boxes 4 and 6. If married filing jointly, include your spouse’s amounts with yours. If
your employer withheld or you paid Additional Medicare Tax or tier 1 RRTA taxes, or
if you are a bona fide resident of Puerto Rico, see instructions ............ 21
22 Enter the total of the amounts from Schedule 1 (Form 1040), line 15; Schedule 2 (Form
1040), line 5; Schedule 2 (Form 1040), line 6; and Schedule 2 (Form 1040), line 13 . . . 22
23 Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 1040 and
1040-SR filers: Enter the total of the amounts from Form 1040 or 1040-SR, line 27,

25
and Schedule 3 (Form 1040), line 11.
1040-NR filers: Enter the amount from Schedule 3 (Form 1040), line 11. } 24
Subtract line 24 from line 23. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Enter the larger of line 20 or line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Next, enter the smaller of line 17 or line 26 on line 27.
Part II-C Additional Child Tax Credit
27 This is your additional child tax credit. Enter this amount on Form 1040, 1040-SR, or 1040-NR, line 28 .... 27 0
EEA Schedule 8812 (Form 1040) 2023
 Credit Limit Worksheet A
Schedule 8812 (This page is not filed with the return. It is for your records only.) 2023
Name(s) as shown on return Tax ID Number

THERESA L KALEIKAU 270-70-4095

Credit Limit Worksheet A

1. Enter the amount from Line 18 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . 1. 0

2. Add the following amounts (if applicable) from:

Schedule 3, Line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, Line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, Line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, line 5b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, line 6d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, line 6f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, line 6l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
Schedule 3, line 6m. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +

Enter the total. 2.

3. Subtract line 2 from line 1 ............................................ 3.

Complete Credit Limit Worksheet B only if you meet all of the following.

1. You are claiming one or more of the following credits.

a. Mortgage interest credit, Form 8396.
b. Adoption credit, Form 8839.
c. Residential clean energy credit, Form 5695, Part I.
d District of Columbia first-time homebuyer credit, Form 8859.

2. You are not filing Form 2555.

3. Line 4 of Schedule 8812 is more than zero.

4. If you are not completing Credit Limit Worksheet B, enter -0-; otherwise, enter
the amount from Credit Limit Worksheet B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 0

5. Subtract line 4 from line 3. Enter here and on Schedule 8812, line 13 ...................... 5. 0

WK_8812.LD
TAXPAYER COPY ONLY - DO NOT MAIL THIS FORM

230104 11024
DR 0104 (11/28/23)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
Page 1 of 4

(0013)

2023 Colorado Individual Income Tax Return

X Full-Year Part-Year or Nonresident (or resident, part-year, Mark if Abroad on due date -
non-resident combination) *Must include DR 0104PN see instructions
Your Last Name Your First Name Middle Initial

KALEIKAU THERESA L
Date of Birth (MM/DD/YYYY) SSN or ITIN Deceased
If checked and claiming a refund, you must include
07/02/1961 270-70-4095 the DR 0102 and death certificate with your return.
State of Issue Last 4 characters of ID number Date of Issuance
Enter the following information from your current
driver license or state identification card.
If Joint, Spouse's Last Name Spouse's First Name Middle Initial

Spouse's Date of Birth (MM/DD/YYYY) Spouse's SSN or ITIN Deceased

If checked and claiming a refund, you must include
the DR 0102 and death certificate with your return.
State of Issue Last 4 characters of ID number Date of Issuance
Enter the following information from your spouse's
current driver license or state identification card.
Mailing Address Phone Number

2324 West St 719-644-9601

City State ZIP Code Foreign Country (if applicable)

Pueblo CO 81003
To see if you or members of your household qualify for free or reduced-cost health coverage, check this box if:
You are a Colorado resident and at least one person in your household does not have health coverage
AND
You give permission for the Colorado Department of Revenue to share the information on Form DR 0104EE with Connect
for Health Colorado (the Colorado Health Benefit Exchange) and the Department of Health Care Policy & Financing.
Round To The Nearest Dollar
1. Enter Federal Taxable Income from your federal income tax form:
1040, 1040 SR, or 1040 SP AGI less STD/ITM deduction1 (13,850) 00
Include W-2s and 1099s with CO withholding.
Additions to Federal Taxable Income
2. State and Local Income taxes or general sales taxes claimed on federal form 1040,
Schedule A. (see instructions) 2 00

3. Qualified Business Income Deduction Addback (see instructions) 3 00

TAXPAYER COPY ONLY - DO NOT MAIL THIS FORM
DR 0104 (11/28/23)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
230104 21024 Page 2 of 4

Name SSN or ITIN

THERESA L KALEIKAU 270-70-4095

4. Federal Deduction addback (see instructions) 4 00

5. Nonqualified CollegeInvest Tuition Savings Account distributions
(see instructions) 5 00

6. Nonqualified Colorado ABLE Account distributions (see instructions) 6 00

7. Other Additions, explain (see instructions) 7 00

Explain:

8. Subtotal, sum of lines 1 through 7 8 (13,850) 00

Colorado Subtractions
9. Subtractions from the DR 0104AD Schedule, line 23, you must submit the
DR 0104AD schedule with your return. 9 00

10. Colorado Taxable Income, subtract line 9 from line 8 10 (13,850) 00

Tax, Prepayments and Credits: see 104 Book for full-year tax table and part-year DR 0104PN Schedule
11. Colorado Tax from tax table or the DR 0104PN line 36, you must submit the
DR 0104PN with your return if applicable. 11 0 00
12. Alternative Minimum Tax from the DR 0104AMT line 8, you must submit the
DR 0104AMT with your return. 12 00

13. Recapture of prior year credits 13 00

14. Subtotal, sum of lines 11 through 13 14 0 00

15. Nonrefundable Credits from the DR 0104CR line 54, the sum of lines 15, 16, and 17
cannot exceed line 14, you must submit the DR 0104CR with your return. 15 00
16. Total Nonrefundable Enterprise Zone credits used - as calculated, or from the
DR 1366 line 85, the sum of lines 15, 16, and 17 cannot exceed line 14, you must
submit the DR 1366 with your return. 16 00
17. Strategic Capital Tax Credit from DR 1330, the sum of lines 15, 16, and 17 cannot
exceed line 14, you must submit the DR 1330 with your return. 17 00

18. Net Income Tax, sum of lines 15, 16, and 17. Subtract that sum from line 14. 18 0 00
19. Use Tax reported on the DR 0104US schedule line 7, you must submit the
DR 0104US with your return. 19 00

20. Net Colorado Tax, sum of lines 18 and 19 20 0 00

21. CO Income Tax Withheld from W-2s and 1099s, you must submit the W-2s and/or
1099s claiming Colorado withholding with your return. 21 00

22. Prior-year Estimated Tax Carryforward 22 00

23. Estimated Tax Payments, enter the sum of the quarterly payments remitted for
this tax year 23 00

24. Extension Payment remitted with the DR 0158-I 24 00

TAXPAYER COPY ONLY - DO NOT MAIL THIS FORM
DR 0104 (11/28/23)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
230104 31024 Page 3 of 4

Name SSN or ITIN

THERESA L KALEIKAU 270-70-4095

25. Other Prepayments: DR 0104BEP DR 0108 DR 1079 25

00
26. Gross Conservation Easement Credit from the DR 1305G line 33, you must submit
the DR 1305G with your return. 26 00
27. Innovative Motor Vehicle and Innovative Truck Credit from the DR 0617, you must
submit each DR 0617 with your return. 27 00
28. Refundable Credits from the DR 0104CR line 16, you must submit the DR 0104CR
with your return. 28 00

29. Subtotal, sum of lines 21 through 28 29 00

Modified AGI for TABOR
Lines 30 through 33 are only used to calculate your TABOR Credit, they do not affect your Colorado tax liability.
30 Federal Adjusted Gross Income from your federal income tax form: 1040, 1040 SR,
or 1040 SP 30 0 00

31. Nontaxable Social Security Income 31 1,920 00

32. Nontaxable interest income from state and local bonds 32 00

33. Sum of lines 30 through 32: Modified AGI for TABOR 33 1,920 00

This space is reserved for future use.

34. State Sales Tax Refund: For full-year Colorado residents, born before 2005, or
full-year Colorado residents who are under the age of eighteen but are required
to file a return. Enter $800 for one qualifying taxpayer or $1,600 for two qualifying
taxpayers filing jointly. See instructions if you are filing an extension. 34 800 00

35. Sum of lines 29 and 34 35 800 00

36. Overpayment, if line 35 is greater than line 20 then subtract line 20 from line 35 36 800 00

37. Estimated Tax Credit Carryforward to 2024 first quarter, if any. 37 00

If you have an overpayment on line 38 below and would like to donate all or a portion of your overpayment to a qualified
Colorado charity, include Form DR 0104CH to contribute.

38. Refund, subtract line 37 from line 36 (see instructions) 38 800 00

Routing Number Type: Checking Savings CollegeInvest 529

Direct
Deposit Account Number

For questions regarding CollegeInvest direct deposit or to open an account, visit CollegeInvest.org or call 800-448-2424.
TAXPAYER COPY ONLY - DO NOT MAIL THIS FORM
DR 0104 (11/28/23)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
230104 41024 Page 4 of 4

Name SSN or ITIN

THERESA L KALEIKAU 270-70-4095

39. Net Tax Due, subtract line 35 from line 20 39 00

40. Delinquent Payment Penalty (see instructions) 40 00

41. Delinquent Payment Interest (see instructions) 41 00

42. Estimated Tax Penalty, you must submit the DR 0204 with your return
(see instructions) 42 00

43. Amount You Owe, sum of lines 39 through 42 43

The State may convert your check to a one-time electronic banking transaction. Your bank account may be debited as early as the same day received
by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of
Revenue may collect the payment amount directly from your bank account electronically.
Third Party Designee
Do you want to allow another person to discuss this
return and any related information with the Colorado X No Yes. Complete the following:
Department of Revenue? See the instructions.
Designee's Name Phone Number

Sign Below Under penalties of perjury, I declare that to the best of my knowledge and belief, this return is true, correct and complete.
Your Signature Date (MM/DD/YY)

Spouse's Signature. If joint return, BOTH must sign. Date (MM/DD/YY)

Paid Preparer's Name Paid Preparer's Phone

Paid Preparer's Address City State ZIP Code

File and pay at: Colorado.gov/RevenueOnline

If you are filing this return with a check or If you are filing this return without a check or
payment, please mail the return to: payment, please mail the return to:
COLORADO DEPARTMENT OF REVENUE COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0006 Denver, CO 80261-0005

These addresses and zip codes are exclusive to the Colorado Department of Revenue, so a street address is not required.
 FORM STATE OF HAWAII - DEPARTMENT OF TAXATION DO NOT WRITE IN THIS AREA
N-15
(Rev. 2023)
Individual Income Tax Return
NONRESIDENT and PART-YEAR RESIDENT
Calendar Year 2023
OR
N15_T 2023A 01 VID30 Tax Year thru

Part-Year Resident
X Nonresident Nonresident Alien or Dual-Status Alien MSRRA Composite
(Enter period of Hawaii residency above)
AMENDED Return
NOL Carryback FOR OFFICE USE ONLY
IRS Adjustment
First Time Filer

Do NOT Submit a Photocopy!!

ATTACH A COPY OF YOUR 2023 FEDERAL

INCOME TAX RETURN
Your First Name M.I. Your Last Name Suffix

IMPORTANT - Complete this Section

THERESA L KALEIKAU
ATTACH COPY 2 OF FORM W-2 HERE

Enter the first four letters

Spouse's First Name M.I. Spouse's Last Name Suffix of your last name.
Use ALL CAPITAL letters KALE
Your Social
Care Of (See Instructions, page 8.) Security Number 270 - 70 - 4095
Deceased Date of Death
Present mailing or home address (Number and street, including Rural Route)
Enter the first four letters
of your Spouse's last name.
2324 West St Use ALL CAPITAL letters
City, town or post office State Postal/ZIP code
Spouse's Social
Security Number
Pueblo CO 81003
If Foreign address, enter Province and/or State Country Deceased Date of Death

(Place an X in only ONE box)

1 X Single 4 Head of household (with qualifying person). If the qualifying
2 Married filing joint return (even if only one had income). person is a child but not your dependent, enter the child's full
3 Married filing separate return. Enter spouse's SSN and name.
ATTACH CHECK OR MONEY ORDER HERE

the first four letters of last name above. Enter spouse's full
name here. 5 Qualifying surviving spouse (see page 9 of the Instructions)

CAUTION: If you can be claimed as a dependent on another person's tax return (such as your parents'), DO NOT place an X on line 6a, but be sure to place an X below line 37.
6a X Enter the number of Xs
6b
Yourself . . . . . . . . . . . . .
Spouse . . . . . . . . . . . . .
Age 65 or over . . . . . . . . . . . . . . . . . . .
Age 65 or over . . . . . . . . . . . . . . . . . . . }
on 6a and 6b . . . . .
1
If you placed an X on lines 3 and 6b above, see the Instructions on page 10 and if your spouse meets the qualifications, place an X here

6c Dependents: If more than 6 dependents 2. Dependent's social

1. First and last name use attachment security number 3. Relationship
and
6d lee seung Enter number of
your children listed 6c
Enter number of
other dependents 6d 1

6e . . . . . . . . . . . . . . . 6e
Total number of exemptions claimed. Add numbers entered in boxes 6a thru 6d above 2

N151E3T4 ID NO 30 FORM N-15 (REV. 2023)

 Page 2 of 4
Form N-15 (Rev. 2023)
Your Social Security Number Your Spouse's SSN

270 - 70 - 4095
Name(s) as shown on return
THERESA L KALEIKAU
N15_T 2023A 02 VID30

Col. A - Total Income Col. B - Hawaii Income

7 Wages, salaries, tips, etc. (attach Form(s) W-2) . . . 7

8 Interest income from the worksheet on page 38 of
the Instructions . . . . . . . . . . . . . . . . . . . 8

9 Ordinary dividends . . . . . . . . . . . . . . . . . 9
10 State income tax refund from the worksheet on
page 38 of the Instructions . . . . . . . . . . . . . 10

11 Alimony received .................. 11

12 Business or farm income or (loss) . . . . . . . . . . 12

13 Capital gain or (loss) from the worksheet on
page 38 of the Instructions . . . . . . . . . . . . . 13
14 Supplemental gains or (losses)
(attach Schedule D-1) . . . . . . . . . . . . . . . 14

15 IRA distributions . . . . . . . . . . . . . . . . . . 15
16 Pensions and annuities (see Instructions and
attach Schedule J, Form N-11/N-15/N-40). . . . . . . . . 16

17 Rents, royalties, partnerships, estates, trusts, etc. . . . . . 17

18 Unemployment compensation (insurance) ...... 18

19 Other income (state nature and source)
....... 19

20 Add lines 7 through 19 . . . . . Total Income 20

21 Certain business expenses of reservists, performing
artists, and fee-basis government officials . . . . . . 21

22 IRA deduction . . . . . . . . . . . . . . . . . . . 22
23 Student loan interest deduction from the worksheet
on page 42 of the Instructions . . . . . . . . . . . 23

24 Health savings account deduction .......... 24

25 Moving expenses (attach Form N-139) ....... 25

26 Deductible part of self-employment tax ....... 26

27 Self-employed health insurance deduction ..... 27

28 Self-employed SEP, SIMPLE, and qualified plans .. 28

29 Penalty on early withdrawal of savings . . . . . . . . 29

30 Alimony paid (Enter name and SS No. of recipient)

....... 30

31 Payments to an individual housing account . 31

32 First $7,683 of military reserve or Hawaii
national guard duty pay . . . . . . . . . . . 32

FORM N-15 (REV. 2023)

N152E3T4 ID NO 30
Form N-15 (Rev. 2023) Page 3 of 4
Your Social Security Number Your Spouse's SSN

270 - 70 - 4095
Name(s) as shown on return
THERESA L KALEIKAU
N15_T 2023 03 VID30

33 Exceptional trees deduction (attach affidavit)

(see page 21 of the Instructions) . . . . . . . . . 33

34 Add lines 21 through 33 . . .Total Adjustments 34

35 Line 20 minus line 34. . Adjusted Gross Income 35

36 Federal adjusted gross income (see page 21 of the Instructions) . . . 36

37 Ratio of Hawaii AGI to Total AGI. Divide line 35, Column B, by line 35, Column A (Compute to 3 decimal places and round to 2 decimal places) .. 37 0.00
CAUTION: If you can be claimed as a dependent on another person's return, see the Instructions on page 21, and place an X here.
38 If you do not itemize deductions, enter zero on line 39 and go to line 40a. Otherwise go to page 22 of the Instructions and enter your Hawaii itemized deductions here.

38a Medical and dental expenses

(from Worksheet NR-1 or PY-1) . . . . . . . . . 38a

38b Taxes (from Worksheet NR-2 or PY-2) ..... 38b TOTAL ITEMIZED
DEDUCTIONS
38c Interest expense (from Worksheet NR-3 or PY-3) ... 38c 39 If your Hawaii adjusted gross
income is above a certain
amount, you may not be
38d Contributions (from Worksheet NR-4 or PY-4) ..... 38d
able to deduct all of your
38e Casualty and theft losses itemized deductions. See the
(from Worksheet NR-5 or PY-5) ........ 38e Instructions on page 27. Enter
total here and go to line 41.
38f Miscellaneous deductions
(from Worksheet NR-6 or PY-6) ........ 38f

40a If you checked filing status box: 1 or 3 enter $2,200; 2200

2 or 5 enter $4,400; 4 enter $3,212 . . . . . . . . . 40a

40b Multiply line 40a by the ratio on line 37 . . . . . . . . . Prorated Standard Deduction 40b

41 Line 35, Column B minus line 39 or 40b, whichever applies. (This line MUST be filled in) .. 41 0
42a Multiply $1,144 by the total number of exemptions claimed on line 6e. If you and/or your spouse are blind, deaf,
or disabled, place an X in the applicable box(es), and see the Instructions.

Yourself Spouse . . . . . . . . . . . . . 42a 2288

42b Multiply line 42a by the ratio on line 37 ............ Prorated Exemption(s) 42b 0

43 Taxable Income. Line 41 minus line 42b (but not less than zero). . . . Taxable Income 43 0
44 Tax. Place an X if from: X Tax Table; Tax Rate Schedule; or Capital Gains Tax Worksheet on page 41 of the Instructions.
( Place an X if tax from Forms N-2, N-103, N-152, N-168, N-312, N-338, N-344, N-348, N-405,

N-586, N-615, or N-814 is included.) . . . . . . . . . . . . . . . . . . . . . . . . . .Tax 44

0
44a If tax is from the Capital Gains Tax Worksheet, enter
the net capital gain from line 8 of that worksheet . . . . . . . . . . . . 44a
45 Refundable Food/Excise Tax Credit
(attach Form N-311) DHS, etc. exemptions . . 45
46 Credit for Low-Income Household
Renters (attach Schedule X) . . . . . . . . . . . . . 46
47 Credit for Child and Dependent Care
Expenses (attach Schedule X) . . . . . . . . . . . . 47
48 Credit for Child Passenger Restraint
System(s) (attach a copy of the invoice) . . . . . . . . 48
49 Total refundable tax credits from
Schedule CR (attach Schedule CR). . . . . . . 49
50 Add lines 45 through 49 . . . . . . . . . . . . . . . . Total Refundable Credits 50 0

51 Line 44 minus line 50. If line 51 is zero or less, see Instructions. . . Adjusted Tax Liability 51

N153E3T4 ID No 30 FORM N-15 (REV. 2023)

 Page 4 of 4
Form N-15 (Rev. 2023)
Your Social Security Number Your Spouse's SSN

270 - 70 - 4095
THERESA L KALEIKAU
Name(s) as shown on return
N15_T 2023A 04 VID30

52 Total nonrefundable tax credits (attach Schedule CR) .................... 52

53 Line 51 minus line 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Balance 53

54 Hawaii State Income tax withheld (attach W-2s)
(see page 29 of the Instructions for other attachments) 54
55 2023 estimated tax payments on
Forms N-200V ; N-288A . . 55 TOTAL
PAYMENTS
56 Amount of estimated tax applied from 2022 return . . . 56 58 Add lines 54 through 57.

57 Amount paid with extension . . . . . . . . . . . . . 57 0

59 If line 58 is larger than line 53, enter the amount OVERPAID
(line 58 minus line 53) (see Instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 59
60 Contributions to (see page 30 of the Instructions): . . . . . . Yourself Spouse
60a Hawaii Schools Repairs and Maintenance Fund . . . . . $2 $2
60b Hawaii Public Libraries Fund . . . . . . . . . . . . . . . $5 $5
60c Domestic and Sexual Violence / Child Abuse and Neglect Funds ... $5 $5
61 Add the amounts of the Xs on lines 60a through 60c and enter the total here . . . . . . . . . 61

62 Line 59 minus line 61 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

63 Amount of line 62 to be applied to
your 2024 ESTIMATED TAX . . . . . . . . . . . . . .63
64a Amount to be REFUNDED TO YOU (line 62 minus line 63) If filing late, see page 30 of Instructions. Place an X here if this refund will
ultimately be deposited to a foreign (non-U.S.) bank. Do not complete lines 64b, 64c, or 64d.

64b Routing number 64c Type: Checking Savings

64d Account number . . . . . . . . . . . 64a

65 AMOUNT YOU OWE (line 53 minus line 58) . . . . . . . . . . . . . . . . . . . . . . . . 65

66 PAYMENT AMOUNT Submit payment online at hitax.hawaii.gov or attach check or
money order payable to "Hawaii State Tax Collector" . . . . . . . . . . . . . . . . . . . . 66
67 Estimated tax penalty. (See page 31 of Instr.) Do not include this amount
in line 59 or 65. Place an X in this box if Form N-210 is attached 67
68 AMENDED RETURN ONLY - Amount paid (overpaid) on original return. (See Instructions) (attach Sch. AMD) . . 68

69 AMENDED RETURN ONLY - Balance due (refund) with amended return. (See Instructions) (attach Sch. AMD) . . 69
D G If designating another person to discuss this return with the Hawaii Department of Taxation, complete the following. This is not a full power of
E N
S E attorney. See page 32 of the Instructions.
I E
- Designee's name Phone no. Identification number
HAWAII ELECTION Indicate if you want $3 to go to the Hawaii Election Campaign Fund. X Yes Note: Placing an X in the "Yes" box will
CAMPAIGN FUND
(See page 32 of the Instructions) If joint return, indicate if your spouse designates $3 to go to the fund. Yes not change your tax or refund.

DECLARATION - I declare, under the penalties set forth in section 231-36, HRS, that this return (incl. accompanying schedules or statements) has been examined by me and, to the best
of my knowledge and belief, is a true, correct, and complete return, made in good faith, for the taxable year stated, pursuant to the Hawaii Income Tax Law, Chapter 235,HRS.
SIGN HERE

Your signature Date Spouse's signature (if filing jointly, BOTH must sign) Date
PLEASE

Your Occupation Daytime Phone Number Your Spouse's Occupation Daytime Phone Number
Retired (719)644-9601
Paid Date Check if self- PTIN
Preparer's
Preparer's Signature employed
Information
Print
Preparer's Name Federal E.I. No.

Firm's name (or yours

if self-employed), Phone No.
Address, and ZIP Code

N154CE3T4 ID NO 30 FORM N-15 (REV. 2023)

 For your records only. 2023 AGI
HIWK_AGI Adjusted Gross Income Split Worksheet FD/ST Summary
Name(s) as shown on state return Social Security Number
THERESA L KALEIKAU 270-70-4095
Federal State
Federal 1040 Income and Adjustments
Col. A Col. B Col. A Col. B
Taxpayer Spouse Taxpayer Spouse
Federal 1040
1 Wages, salaries, tips, etc. . . . . . . . . . . . . . . 1
2b Taxable interest . . . . . . . . . . . . . . . . . . 2b
3b Ordinary dividends . . . . . . . . . . . . . . . . . 3b
4b Taxable amount of IRA distributions . . . . . . . . . 4b
5b Taxable amount of Pensions and annuities . . . . . . 5b
6b Taxable amount of Social security benefits . . . . . . 6b
7 Capital gain or (loss) . . . . . . . . . . . . . . . . 7
8 Other income from Schedule 1 . . . . . . . . . . . 8
9 Total income (Sum of Lines 1-8) . . . . . . . . . . 9
10 Adjustments to income from Schedule 1 ...... 10
11 Adjusted Gross Income (line 9 - line 10) . . . . . . 11

Schedule 1 - Additional Income

1 Taxable refunds, credits, or offsets
of state and local income taxes . . . . . . . . . . . 1
2a Alimony received . . . . . . . . . . . . . . . . . . 2a
3 Business income or (loss) . . . . . . . . . . . . . . 3
4 Other gains or (losses) . . . . . . . . . . . . . . . 4
5 Rental real estate, royalties, partnerships,
S corporations, trusts, etc. . . . . . . . . . . . . . 5
6 Farm income or (loss). . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . 7
8 Other income.. . . . . . . . . . . . . . . . . . . . 8
10 Total Additional Income (Sum of lines 1-8) . . . . . . 10

Schedule 1 - Adjustments to Income

11 Educator Expenses . . . . . . . . . . . . . . . . . 11
12 Certain business expenses of reservists,
performing artists, & fee-basis gov. officials 12
13 Health savings account deduction . . . . . . . . . . 13
14 Moving expenses . . . . . . . . . . . . . . . . . . 14
15 Deductible part of self-employment tax . . . . . . . 15
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
20 IRA deduction. . . . . . . . . . . . . . . . . . . . 20
21 Student loan interest deduction . . . . . . . . . . . 21
22 Reserved . . . . . . . . . . . . . . . . . . . . . 22
23 Archer MSA Deduction . . . . . . . . . . . . . . . 23
24 Other Deductions (see STWK_ADJ) . . . . . . . . 24
26 Total Adjustments to income (Sum of lines 11-24) . . 26

HIWK_AGI.LD