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Get IRS 8965 2016

5 and its separate instructions is at www.irs.gov/form8965. Name as shown on return 2016 Attachment Sequence No. 75 Your social security number Complete this form if you have a Marketplace-granted coverage exemption or you are claiming a coverage exemption on your return. Part I Marketplace-Granted Coverage Exemptions for Individuals. If you and/or a member of your tax household have an exemption granted by the Marketplace, complete Part I. (a) Name of Individual (b) SSN (c) Exemption Ce.

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