Electronic Filing Instructions for your 2017 Federal Tax Return

Important: Your taxes are not finished until all required steps are completed.

quanikqa C lovett, ms
450 little place, Apt. 57
north plainfield, NJ 07060
|
Balance | Your federal tax return (Form 1040A) shows a refund due to you in the
Due/ | amount of $7,233.00. Applicable fees were deducted from your original
Refund | refund amount of $7,233.00. Your refund is now $7,116.03. Because you
| chose to have your TurboTax fees deducted from your refund, you will
| receive e-mail from Green Dot Bank, which handles this transaction.
| Your tax refund will be direct deposited into your account. The
| account information you entered - Account Number: 381043180732
| Routing Transit Number: 021200339.
|
______________________________________________________________________________________
|
When Will | The IRS issued more than 9 out of 10 refunds to taxpayers in less
You Get | than 21 days last year. The same results are expected in 2018. To
Your | get your estimated refund date from TurboTax, log into My TurboTax at
Refund? | www.turbotax.com. If you do not receive your refund within 21 days,
| or the amount you get is not what you expected, contact the Internal
| Revenue Service directly at 1-800-829-4477. You can also check
| www.irs.gov and select the "Where's my refund?" link.
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | Printed copy of your federal return
Keep |
|
______________________________________________________________________________________
|
2017 | Adjusted Gross Income $ 32,837.00
Federal | Taxable Income $ 11,337.00
Tax | Total Tax $ 0.00
Return | Total Payments/Credits $ 7,233.00
Summary | Amount to be Refunded $ 7,233.00
| Effective Tax Rate -13.90%
|
______________________________________________________________________________________

Page 1 of 1
Hi quanikqa,

We just want to thank you for using TurboTax this year! It's our goal to make
your taxes easy and accurate, year after year.

With TurboTax Deluxe:

Your Head Start On Next Year:
When you come back next year, taxes will be so easy! We'll have all
your information saved and ready to transfer in to your new return.
We'll ask you questions about what changed since we last talked, and
we'll be ready to get you the credits and deductions you deserve, no
matter what life throws at you.

Here's the final wrap up for your 2017 taxes:

Your federal refund is: $ 7,233.00

You qualified for these important credits:

- Child and Dependent Care Credit
- Child Tax Credit
- Earned Income Credit

Your Guarantee of Accuracy:

Breathe easy. The calculations on your return are backed with our
100% Accuracy Guarantee.
- We double checked your return for errors along the way.
- We helped with step-by-step guidance to get your answers on the right
IRS forms.
- We made sure you didn't miss a deduction even if something in your life
changed, like a new job, new house - or more kids!

Also included:
- We provide the Audit Support Center free of charge, in the unlikely
event you get audited.

Many happy returns from TurboTax.

quanikqa C lovett, ms 152 90 4641

450 little place 57

north plainfield NJ 07060

Mya M Camino 883-99-8654 Daughter

Erika J Vasquez 149-21-2084 Sister

31,070.

1,767.

32,837.

32,837.
REV 01/20/18 TTO
BAA
 32,837.

9,350.
23,487.
12,150.

11,337.
1,133.

1,133.

1,133.

0.
1,133.
0.
0.
0.
2,668.

2,565.

2,000.

7,233.

7,233.
7,233.

0 2 1 2 0 0 3 3 9

3 8 1 0 4 3 1 8 0 7 3 2

medical assistant (908)636-9225

Self-Prepared

REV 01/20/18 TTO

quanikqa C lovett, ms 152-90-4641

513 west 3rd street

zoila rodriguez plainfield NJ 07060 581-08-8192 5,200.

Mya M Camino 883-99-8654 5,200.

Erika J Vasquez 149-21-2084 0.

5,200.
31,070.

31,070.
5,200.

32,837.

.26

1,352.

1,133.

1,133.
BAA REV 12/05/17 TTO
quanikqa C lovett, ms 152-90-4641

Mya M Camino Erika J Vasquez

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BAA REV 12/18/17 TTO

SCHEDULE 8812 1040 OMB No. 1545-0074
Child Tax Credit `
(Form 1040A or 1040)
a Attach to Form 1040, Form 1040A, or Form 1040NR.
1040A
1040NR 2017
Department of the Treasury
a Go to www.irs.gov/Schedule8812 for instructions and the latest 8812 Attachment
Internal Revenue Service (99) information. Sequence No. 47
Name(s) shown on return Your social security number
quanikqa C lovett, ms 152-90-4641
Part I Filers Who Have Certain Child Dependent(s) with an Individual Taxpayer Identification Number (ITIN)

F
!
CAUTION
Complete this part only for each dependent who has an ITIN and for whom you are claiming the child tax credit.
If your dependent is not a qualifying child for the credit, you cannot include that dependent in the calculation of this credit.

Answer the following questions for each dependent listed on Form 1040, line 6c; Form 1040A, line 6c; or Form 1040NR, line 7c, who has an
Individual Taxpayer Identification Number (ITIN) and that you indicated is a qualifying child for the child tax credit by checking column (4) for that
dependent.
A For the first dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

B For the second dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

C For the third dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

D For the fourth dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

Note: If you have more than four dependents identified with an ITIN and listed as a qualifying child for the child tax credit, see separate instructions
and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a

Part II Additional Child Tax Credit Filers

}
1 If you file Form 2555 or 2555-EZ, stop here; you cannot claim the additional child tax credit.

If you are required to use the worksheet in Pub. 972, enter the amount from line 8 of the Child Tax
Credit Worksheet in the publication. Otherwise:
1040 filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the 1 2,000.
instructions for Form 1040, line 52).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
instructions for Form 1040A, line 35).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
instructions for Form 1040NR, line 49).
2 Enter the amount from Form 1040, line 52; Form 1040A, line 35; or Form 1040NR, line 49 . . . . . 2 0.
3 Subtract line 2 from line 1. If zero, stop here; you cannot claim this credit . . . . . . . . . . . 3 2,000.
4a Earned income (see separate instructions) . . . . . . . . . . . 4a 31,070.
b Nontaxable combat pay (see separate
instructions) . . . . . . . . . . . 4b
5 Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
Yes. Subtract $3,000 from the amount on line 4a. Enter the result . . . 5 28,070.
6 Multiply the amount on line 5 by 15% (0.15) and enter the result . . . . . . . . . . . . . . 6 4,211.
Next. Do you have three or more qualifying children?
No. If line 6 is zero, stop here; you cannot claim this credit. Otherwise, skip Part III and enter the
smaller of line 3 or line 6 on line 13.
Yes. If line 6 is equal to or more than line 3, skip Part III and enter the amount from line 3 on line 13.
Otherwise, go to line 7.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 11/13/17 TTO Schedule 8812 (Form 1040A or 1040) 2017
Schedule 8812 (Form 1040A or 1040) 2017 Page 2
Part III Certain Filers Who Have Three or More Qualifying Children
7 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, see separate instructions . . . . . . 7

}
8 1040 filers: Enter the total of the amounts from Form 1040, lines
27 and 58, plus any taxes that you identified using code
“UT” and entered on line 62.
1040A filers: Enter -0-. 8
1040NR filers: Enter the total of the amounts from Form 1040NR,
lines 27 and 56, plus any taxes that you identified using
code “UT” and entered on line 60.
9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . 9

}
10 1040 filers: Enter the total of the amounts from Form 1040, lines
66a and 71.
1040A filers: Enter the total of the amount from Form 1040A, line
42a, plus any excess social security and tier 1 RRTA 10
taxes withheld that you entered to the left of line 46
(see separate instructions).
1040NR filers: Enter the amount from Form 1040NR, line 67.
11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 11
12 Enter the larger of line 6 or line 11 . . . . . . . . . . . . . . . . . . . . . . 12
Next, enter the smaller of line 3 or line 12 on line 13.
Part IV Additional Child Tax Credit
13 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . 13 2,000.
Enter this amount on
1040 Form 1040, line 67,
Form 1040A, line 43, or
1040A Form 1040NR, line 64.
1040NR `

REV 11/13/17 TTO Schedule 8812 (Form 1040A or 1040) 2017

IMPORTANT DISCLOSURES

If you are owed a federal tax refund, you have a right to choose how you will receive the
refund. There are several options available to you. Some options cost money and some
options are free. Please read about these options below.

You can file your tax return electronically or by paper and obtain your refund directly from
Internal Revenue Service ("IRS") for free. If you file your tax return electronically, you can
receive a refund check directly from the IRS through the U.S. Postal Service in 21 to 28 days
from the time you file your tax return or the IRS can deposit your refund directly into your
bank account in less than 21 days from the time you file your tax return unless there are
delays by the IRS. If you file a paper return through the U.S. Postal Service, you can receive
a refund check directly from the IRS through the U.S. Postal Service in 6 to 8 weeks from the
time the IRS receives your return or the IRS can deposit your refund directly into your bank
account in 6 to 8 weeks from the time the IRS receives your return. However, if your return
contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS will issue your
refund no earlier than February 15, 2018.

You can file your tax return electronically, select the Refund Processing Service ("RPS")
for an additional fee of $34.99 (the "RPS fee"), and have your federal income tax refund processed
through a processor using bank services of a financial institution. The RPS allows your refund to
be deposited into a bank account intended for one-time use at Green Dot Bank ("Bank") and deducts
your TurboTax fees and other fees you authorize from your refund. The balanceis delivered to you
via the disbursement method you select. If you file your tax return electronically and select the
RPS, the IRS will deposit your refund with Bank. Upon receipt of your refund, Santa Barbara Tax
Products Group, LLC, a processor, will deduct and pay from your refund the RPS fee, any fees
charged by TurboTax for the preparation and filing of your tax return and any other amounts
authorized by you and disburse the balance of your refund proceeds to you. Unless there are delays
by the IRS, refunds are received in less than 21 days from the time you file your tax return
electronically. However, if your return contains Earned Income Tax Credit or Additional Child Tax
Credit, the IRS will issue your refund no earlier than February 15, 2018.

The RPS is not necessary to obtain your refund. If you have an existing bank account,
you do not need to use the RPS, which requires the payment of a fee, in order to receive a
direct deposit from the IRS. You may consult the IRS website (irs.gov) for information
about tax refund processing.

If you select the RPS, no prior debt you may owe to Bank will be deducted from your
refund.

You can change your income tax withholdings which might result in you receiving additional
funds throughout the year rather than waiting to receive these funds potentially in an
income tax refund next year. Please consult your employer or tax advisor for additional
details.

Information regarding low-cost deposit accounts may be available at www.mymoney.gov .

The chart below shows the options for filing your tax return (e-file or paper return), the RPS
product, refund disbursement options, estimated timing for obtaining your tax refund
proceeds, and costs associated with the various options.
 WHAT TYPE WHAT ARE YOUR WHAT IS THE WHAT COSTS DO YOU
OF FILING DISBURSEMENT ESTIMATED TIME TO INCUR IN ADDITION
METHOD? OPTIONS? RECEIVE REFUND? TO TAX PREPARATION
FEES?

PAPER RETURN IRS direct deposit to Approximately No additional cost.

your personal bank 6 to 8 weeks 2
No Refund Processing account.
Service
Check mailed by IRS Approximately
to address on tax 6 to 8 weeks 2
return.

ELECTRONIC IRS direct deposit to Usually within 21 days2 No additional cost.

FILING your personal bank
(E-FILE) account.

No Refund Processing Check mailed by IRS Approximately

Service to address on tax 21 to 28 days 2
return.

ELECTRONIC (a) Direct deposit to Usually within $ 39.99

FILING your personal bank 21 days 2
(E-FILE) account, or

Refund Processing (b) Load to your

Service prepaid card 1.

1 Youmay incur additional charges from the issuer of the prepaid card if you select to have your tax
refund loaded on a prepaid debit card.

2 Youmay experience delays with your tax refund if, for example, you enter incorrect bank account or
contact information, you enter a bank account in someone else's name, or if possible suspicious activity
is detected. If your return contains Earned Income Tax Credit or Additional Child Tax Credit,
the IRS will issue your refund no earlier than February 15, 2018.

Questions? Call 1-877-908-7228

We need your consent to process with this payment option
This is an IRS requirement

The purpose of this agreement is to confirm that you are eligible for this payment option. By
agreeing, you allow Intuit, the maker of TurboTax software, to verify that your refund is enough
to cover total fees and applicable sales tax.

IRS regulations require the following statements:

"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use
your tax return information for purposes other than the preparation and filing of your tax return without
your consent.

You are not required to complete this form to engage our tax return preparation services. If we obtain
your signature on this form by conditioning our tax return preparation services on your consent, your
consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not
specify the duration of your consent, your consent is valid for one year from the date of signature."

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at [email protected].

To agree, enter your name and date in the boxes below and select the "I Agree" button on the
bottom of the page.

I authorize Intuit, the maker of TurboTax, to use the information provided in this 2017 return to
determine whether a portion of the refund can be used to pay for tax preparation.

Quanikqa Lovett
First Name Last Name

Please type the date below:

01/28/2018
Date
Read and accept this Disclosure Consent
This is an IRS requirement

In order to finalize your request for this payment option, we need to send the following information to
Green Dot Bank, Member FDIC (’BANK’) and to Santa Barbara Tax Products Group, LLC (’SBTPG’),
the administrator and servicer of this payment option: your identifying information, your deposit
information and your refund amount.

We transmit this information so that you may use this payment option. BANK and SBTPG will use
your information in accordance with their applicable refund processing service agreement and
privacy policy.

IRS regulations require the following statements:

"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot
disclose your tax return information to third parties for purposes other than the preparation and filing of
your tax return without your consent. If you consent to the disclosure of your tax return information,
Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage our tax return preparation services. If we obtain
your signature on this form by conditioning our tax return preparation services on your consent, your
consent will not be valid. If you agree to the disclosure of your tax return information, your consent is
valid for the amount of time that you specify. If you do not specify the duration of your consent, your
consent is valid for one year from the date of signature."

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at [email protected].

To agree, enter your name and date in the boxes below and select the "I Agree" button on the
bottom of the page.

I authorize Intuit, the maker of TurboTax, to disclose to BANK and SBTPG that portion of my
2017 tax return information that is necessary to enable BANK and SBTPG to process
my refund.

Sign this agreement by entering your name:

Quanikqa Lovett

Please type the date below:

01/28/2018
Date

sbia1301.SCR 12/17/15
 CUSTOMER SERVICE: 877-908-7228

Santa Barbara Tax Products Group LLC

and Green Dot Bank Refund Processing Agreement ("Agreement")

Name quanikqa C lovett, ms

Social Security No. 152-90-4641

This Agreement contains important terms, conditions and disclosures about the processing of your refund
(the "Refund Processing Service") by Santa Barbara Tax Products Group, LLC ("Processor"), a third party
processor using banking services of Green Dot Bank ("Bank"). Read this Agreement carefully before
accepting its terms and conditions, and print a copy and/or retain this information electronically for future
reference. As used in this Agreement, the words "you" and "your" refer to the applicant or both the applicant
and joint applicant if the 2017 federal income tax return is a joint return (individually and collectively,
"Applicant"). The words "we," "us" and "our" refer to Bank and Processor.

1. NOTICE: No Requirement To Use the Refund Processing Service In Order To File Electronically.
YOU UNDERSTAND THAT A REFUND PROCESSING FEE OF $39.99 ("REFUND PROCESSING FEE") IS
CHARGED BY PROCESSOR TO ESTABLISH A TEMPORARY ACCOUNT TO RECEIVE YOUR FEDERAL TAX
REFUND, TO PROCESS IT, TO DEDUCT YOUR TURBOTAX FEES AND OTHER AUTHORIZED FEES FROM
THAT ACCOUNT, AND TO FORWARD FUNDS TO YOU. THE REFUND PROCESSING FEE IS NOT A LOAN; IT
IS DUE TO PROCESSOR WHETHER OR NOT THE FEDERAL TAX REFUND OCCURS BUT PROCESSOR WILL
NOT PURSUE COLLECTION OF THE REFUND PROCESSING FEE IF YOUR FEDERAL TAX REFUND DOES
NOT OCCUR. THIS FEE IS COLLECTED ONLY AT THE TIME THE REFUND OCCURS. YOU CAN AVOID THIS
FEE AND NOT USE THE REFUND PROCESSING SERVICE BY INSTEAD PAYING THE APPLICABLE
TURBOTAX FEES TO INTUIT BY CREDIT OR DEBIT CARD AT THE TIME YOU FILE YOUR 2017 FEDERAL
INCOME TAX RETURN AND ELECTING TO HAVE YOUR REFUND DIRECTLY DEPOSITED IN YOUR OWN
BANK ACCOUNT OR MAILED TO YOU. IF YOU DO USE THE REFUND PROCESSING SERVICE, YOU CAN
EXPECT TO RECEIVE THE PROCEEDS FROM YOUR FEDERAL TAX REFUND WITHIN 21 DAYS FROM WHEN
THE INTERNAL REVENUE SERVICE ("IRS") ACCEPTS YOUR RETURN UNLESS THERE ARE PROCESSING
DELAYS BY THE IRS (OR UNLESS YOUR RETURN CONTAINS EARNED INCOME TAX CREDIT OR
ADDITIONAL CHILD TAX CREDIT, IN WHICH CASE THE IRS WILL ISSUE YOUR REFUND NO EARLIER THAN
FEBRUARY 15, 2018). THE REFUND PROCESSING SERVICE WILL NEITHER SPEED UP NOR DELAY YOUR
FEDERAL TAX REFUND. THE COST OF PREPARING YOUR TAX RETURN IS NOT ANY MORE OR LESS IF
YOU PURCHASE THE REFUND PROCESSING SERVICE.

2. Authorization to Release Personal Information. You authorize the IRS to disclose any information to
Bank and Processor related to the funding of your 2017 federal tax refund. You also authorize Intuit, as the
transmitter of your electronically filed tax return, to disclose your tax return and contact information to Bank
and Processor for use in connection with the refund processing services being provided pursuant to this
Agreement and Bank and Processor to share your information with Intuit. None of Intuit, Bank or Processor
will disclose or use your tax return information for any other purpose, except as permitted by law. Bank and
Processor will not use your tax information or contact information for any marketing purpose. Please see the
Privacy Policy at the end of this Agreement describing how Bank may use or share your personal
information.

3. Summary of Terms
Expected Federal Refund $ 7,233.00
Less Processor Refund Processing Fee $ 39.99
Less TurboTax Fees $ 76.98
Less Additional Products and Services Purchased $
Expected Proceeds* $ 7,116.03
* These charges are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes, and if
applicable, a Return Item Fee and an Account Research and Processing Fee paid to Processor as set forth in Sections 4, 6 and
7 below.

4. Temporary Deposit Account Authorization. You hereby authorize Bank to establish a temporary deposit
account ("Deposit Account") for the purpose of receiving your tax year 2017 federal tax refund from the IRS.
Bank or Processor must receive an acknowledgement from the IRS that your return has been electronically
filed and accepted for processing before the Deposit Account can be opened. You authorize Processor to
deduct from your Deposit Account the following amounts: (i) the Refund Processing Fee; (ii) the fees and
charges related to the preparation, processing and transmission of your tax return ("TurboTax Fees"); and
(iii) fees for Additional Products and Services Purchased, plus applicable taxes. You also authorize Bank to
deduct twenty dollars ($20.00) as a returned item processing fee (the "Return Item Fee") from your Deposit
Account for the additional processing required in the event that your deposit is returned or cannot be
delivered as directed in Section 7 below. A fee of $25.00 (the "Account Research and Processing Fee") may
be charged if we are required to provide additional processing to return the funds to the IRS. These fees will
quanikqa C lovett, ms 152-90-4641 Page 2

be deducted from the Deposit Account and will be retained by Processor. You authorize Bank and Processor
to disburse the balance of the Deposit Account to you after making all authorized deductions or payments. If
the Deposit Account does not have sufficient funds to pay the TurboTax Fees and the fees for Additional
Products and Services Purchased as set forth in Section 3, (a) you authorize Bank and/or Processor to
automatically deduct such fees (or any portion thereof) via ACH, electronic check, or wire transfer directly
from the account into which you authorized Bank to deposit your Expected Proceeds as set forth in Section
7, and (b) if you made alternative arrangements with TurboTax for payment of such fees, those
arrangements will be attempted prior to any automatic deduction.
5. Acknowledgements. (a) You understand that: (i) neither Bank nor Processor can guarantee the amount
of your tax year 2017 federal tax refund or the date it will be issued, and (ii) neither Bank nor Processor is
affiliated with the transmitter of the tax return (Intuit) and neither warrants the accuracy of the software
used to prepare the tax return. (b) You agree that Intuit is not acting as your agent and is not under any
fiduciary duty with respect to the processing of your refund by Bank and Processor. (c) Your refund may
be held or returned to the IRS if it is suspected of fraud or identity theft.

6. Truth in Savings Disclosure. The Deposit Account is being opened for the purpose of receiving your (or
both spouses if this is a jointly filed return) tax year 2017 federal tax refund. Processor and Bank will deduct
from the Deposit Account the fees set forth in Section 3, including the 39.99 Refund Processing Fee for
opening and maintaining the Deposit Account and processing your tax refund. No other deposits may be
made to the Deposit Account. No withdrawals will be allowed from the Deposit Account except to collect the
fees stated in this Section, Section 3, Section 7, and as provided in Section 4. No interest is payable on the
deposit; thus, the annual percentage yield and interest rate are 0%. The Deposit Account will be closed after
all authorized deductions have been made and any remaining balance has been disbursed to you. We will
also charge a Return Item Fee of $20.00 if the refund cannot be delivered as directed in Section 7 of this
Agreement. A $25.00 Account Research and Processing Fee may be charged if we are required to provide
additional processing to return the funds to the IRS. These fees will be deducted from the Deposit Account
and will be retained by Processor. Questions or concerns about the Deposit Account should be directed to
Santa Barbara Tax Products, Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, CA 92037 or
via the Internet at http://sbtpg.com.

7. Disbursement Methods: You agree that the disbursement method selected below will be used by Bank
and Processor to disburse funds to you.
a) Direct Deposit to Turbo(SM) Prepaid Visa(R) Card: If you choose this option, you authorize and
request Bank and Processor to transfer the balance of your Deposit Account to Bank, which
issues the Turbo(SM) Prepaid Visa Card ("Card") you have obtained or are obtaining, so that Bank
may deposit the balance of your refund into your Card account. Additional fees may be charged
for the use of the Card. Please review the cardholder agreement associated with the use of
your Card to learn of other fees, charges, terms and conditions that will apply. Processor
will not be responsible for your funds once they have been deposited with Bank.

b) X Direct Deposit to Checking or Savings Account: If you choose this option, the balance of your
Deposit Account will be disbursed to you electronically by ACH direct deposit to your personal bank
account designated below. If a joint return is filed, the bank account may be a joint account or the
individual account of either spouse.

DIRECT DEPOSIT ACCOUNT TYPE:

X Checking
Savings
RTN # 021200339
Account # 381043180732
Note: To ensure that there are no delays in receiving your refund, please contact your financial
institution to confirm that you are using the correct RTN (routing) and account number. If you or your
representative enter your account information incorrectly and your deposit is returned to Bank, the
Deposit Account balance minus a $20.00 Return Item Fee will be disbursed to you via a cashier’s
check mailed to your physical address of record. Bank, Processor and Intuit are not responsible for the
misapplication of a direct deposit that results from error, negligence or malfeasance on the part of you
or your representative. In cases where Bank has received your federal tax refund but is unable to
deliver the funds directly to you, funds may be held at Bank until claimed, or returned to the IRS. An
Account Research and Processing Fee of $25.00 may be charged if we are required to provide
additional processing to return the funds to the IRS. Return Item and Account Research and
Processing Fees will not exceed $45.00 in the aggregate, and will be deducted from the Deposit
Account for federal tax refunds that continue to be undeliverable and unclaimed and must be returned
to the IRS. These fees will be retained by Processor. Due to the risk of fraudulent diversion of tax
quanikqa C lovett, ms 152-90-4641 Page 3

refunds, we will not process any address or account changes. If we become aware that your address
or checking or savings account has changed after you sign this Agreement but before your federal tax
refund is received by us, upon receipt of your federal tax refund from the IRS we will return your tax
refund to the IRS after deducting our Refund Processing Fee, TurboTax Fees and other applicable
fees. We will do our best to escalate the return of your federal tax refund to the IRS and you will need
to work with the IRS directly for disbursement.

You must notify Bank in writing 3 business days prior to the account being debited to revoke the
authorization for applicable fees agreed to in Section 4, and to afford Bank a reasonable opportunity
to act on your request. You may notify us in writing at: Green Dot Bank, c/o Santa Barbara Tax
Products Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037.

8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES: In case of errors or questions about
electronic transfers to or from the Deposit Account, write to Santa Barbara Tax Products, Group, LLC, 11085
North Torrey Pines Road, Suite 210, La Jolla, California 92037 or telephone (877) 908-7228 and provide
your name, a description or explanation of the error, and the dollar amount of the suspected error. We will
determine whether an error occurred within 10 business days after we hear from you and will correct any
error promptly. If we need more time, however, we may take up to 45 days to investigate your complaint or
question. If we decide to do this, we will credit your Deposit Account within 10 business days for the amount
you think is in error, so that you will have the use of the money during the time it takes us to complete our
investigation. If we ask you to put your complaint or question in writing and we do not receive it within 10
business days, we may not credit your Deposit Account. For errors involving transfers of funds to or from the
Deposit Account within 30 days after the first deposit to the Deposit Account was made, (i) we may take up
to 90 days to investigate your complaint or question, and (ii) we may take up to 20 business days to credit
your Deposit Account for the amount you think is in error. We will tell you the results within three business
days after completing our investigation. If we decide that there was no error, we will send you a written
explanation. You may ask for copies of the documents that we used in our investigation.

Business Days: Our business days are Monday through Friday, excluding federal holidays. Saturday,
Sunday, and federal holidays are not considered business days, even if we are open.

Confidentiality: We will disclose information to third parties about your account or the transfers you make:

? To complete transfers as necessary;

? To verify the existence and condition of your account upon the request of a third party, such as a credit
bureau or merchant;
? To comply with government agency or court orders;
? If you give us your written permission; or
? As explained in the Privacy Policy following this Agreement.

Our Liability: If we do not complete a transfer to your account on time or in the correct amount according to
this Agreement, we may be liable for your losses or damages. In addition to all other limitations of liability
set forth in this Agreement, we will not be liable to you if, among other things:
? Circumstances beyond our control (natural disasters, such as fire or flood) prevent the transfer, despite
reasonable precautions that have been taken.
? The funds in your account are subject to legal process or other claim restricting such transfer.
? You or your representative provide us with inaccurate information.

9. Compensation. In addition to any fees paid directly by you to Intuit, Processor will pay compensation to
Intuit in consideration of Intuit’s provision of various programming, testing, data processing, transmission,
systems maintenance, status reporting and other software, technical and communications services. The
Refund Processing Fee will be retained by Processor for its refund processing services. Processor shall pay
Bank for its banking services.

10. Governing Law. The enforcement and interpretation of this Agreement and the transactions
contemplated herein shall be governed by the laws of the United States, including the Electronic Signatures
in Global and National Commerce Act, and, to the extent state law applies, the substantive law of Ohio.
quanikqa C lovett, ms 152-90-4641 Page 4

11. Arbitration Provision. This arbitration provision is made pursuant to a transaction involving interstate
commerce and shall be governed by the Federal Arbitration Act. You agree that any and all disputes which
in any way arise out of or relate to this Agreement, shall be resolved solely by binding arbitration before the
American Arbitration Association ("AAA") before a single arbitrator in arbitration commenced as close as
possible to where you reside. Any and all disputes must be brought in the parties’ individual capacity, and
not as a plaintiff or class member in any purported class or representative proceeding. Judgment on the
award rendered by the arbitrator may be entered in any court having jurisdiction over the dispute. Each party
to any such arbitration shall bear its own separate costs and expenses of the arbitration and shall share
equally in the charges of the AAA, including the fee of the arbitrator. However, if you are unable to pay any
fee of the AAA or the arbitrator, we agree to pay those fees for you. By agreeing to arbitration, you and we
are waiving our rights to file a lawsuit and proceed in court and to have a jury trial to resolve disputes. The
word "disputes" is given its broadest possible meaning, and includes all claims; disputes or controversies,
including without limitation any claim or attempt to set aside this arbitration provision. You may choose to
opt-out of this arbitration provision but only by following the process set forth below. If you do not wish to
be subject to this arbitration provision, then you must notify us in writing within sixty (60) calendar days of
the date of this Agreement at the following address: Santa Barbara Tax Products Group, LLC, 11085 North
Torrey Pines Road, Suite 210, La Jolla, CA 92037, Attn. Arbitration Opt-Out. Your written notice must
include your name, address, Social Security Number, the date of this Agreement, and a statement that you
wish to opt out of the arbitration provision. If you choose to opt out, then your choice will apply only to this
Agreement.

12. Customer Identity Validation Disclosure: To help Bank, Processor and the government identify and fight
tax refund fraud, as well as fight the funding of terrorism and money laundering activities, Bank and
Processor obtain, verify, and record information that identifies each Refund Processing Service client. What
this means for you: When you apply to use the Refund Processing Service for the purpose of receiving your
federal tax refund, we will ask for your name, address, date of birth, and other information that will allow us
to identify you. We may also ask to see your driver’s license or other identifying documents if we need to
perform additional due diligence on your account.

YOUR AGREEMENT

Bank and Processor agree to all of the terms of this Agreement. By selecting the "I Agree" button in
TurboTax: (i) You authorize Bank to receive your 2017 federal tax refund from the IRS and Processor to
make the deductions from your refund described in the Agreement, (ii) You agree to receive all
communications electronically in accordance with the "Communications" section of the Tax Year 2017
TurboTaxfi User Agreement, (iii) You consent to the release of your 2017 federal tax refund deposit
information and application information as described in Section 2 of this Agreement; and (iv) You
acknowledge that you have reviewed, and agree to be bound by, the Agreement’s terms and conditions. If
this is a joint return, selecting "I Agree" indicates that both spouses agree to be bound by the terms and
conditions of the Agreement.

quanikqa C lovett, ms 152-90-4641

 Rev. 09/2017

Green Dot Bank’s Privacy Policy

FACTS WHAT DOES GREEN DOT BANK DO WITH YOUR PERSONAL INFORMATION?

Why? Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you how
we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.

What? The types of personal information that we collect and share depend on the product or service
you have with us. This can include:

? Social Security number and account balances

? account transactions and purchase history
? transaction history and overdraft history

When you are no longer our customer, we continue to share your information as described in
this notice.

How? All financial companies need to share customers’ personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers’ personal information; the reasons Green Dot Bank chooses to share; and whether you
can limit this sharing.

Reasons we can share your Does Green Dot Bank Can you limit this sharing?
personal information Share?

For our everyday business purposes '

such as to process your transactions,
maintain your account(s), respond to court Yes No
orders and legal investigations, or report to
credit bureaus.

For our marketing purposes ' No We don’t share

to offer our products and services to you.

For joint marketing with other No We don’t share

financial companies.

For our affiliates’ everyday

business purposes ' Yes No
information about your transactions
and experiences.

For our affiliates’ everyday

business purposes ' No We don’t share
information about your creditworthiness.

For our affiliates to market to you. No We don’t share

For nonaffiliates to market to you. No We don’t share

Questions? Call 1-866-795-7597 or go to www.greendot.com

quanikqa C lovett, ms 152-90-4641 Page 2

Page 2

What we do

How does Green Dot Bank To protect your personal information from unauthorized access
protect my and use, we use security measures that comply with federal law.
personal information? These measures include computer safeguards and secured files
and buildings.

How does Green Dot We collect your personal information, for example, when you
collect my
personal information? ? open an account or make deposits or withdrawals from your
account
? use your debit card or provide account information
? give us your contact information

We also collect your personal information from others, such as

credit bureaus, affiliates, or other companies.

Why can’t I limit all sharing? Federal law gives you the right to limit only

? Sharing for affiliates’ everyday business purposes ' information

about your creditworthiness
? Affiliates from using your information to market to you
? Sharing for non affiliates to market to you.

State laws and individual companies may give you additional rights
to limit sharing.
See below for more on your rights under state law.

Definitions

Affiliates Companies related by common ownership or control. They can be

financial and nonfinancial companies.

? Our affiliates include companies with a common corporate

identity of Green Dot (such as our parent bank holding company
Green Dot Corporation), financial companies such as
Unirush, LLC and tax processing services companies such
as Santa Barbara Tax Products Group, LLC.

Nonaffiliates Companies not related by common ownership or control. They can

be financial or nonfinancial companies.

? Green Dot Bank does not share with non

affiliates so they can market to you.

Joint marketing A formal joint marketing agreement between nonaffiliated financial

companies that together market financial products or services
to you.

? Green Dot Bank does not jointly market

Other important information

Depending on where you live, you may have additional privacy protections under state law. We will comply
with applicable state laws before sharing nonpublic personal information about you. We may do this by
sending a separate notice of those rights to you. For example, if you are a resident of California or Vermont,
we will not share with nonaffiliates except for our everyday business purposes or with your consent.

sbia0912.SCR 10/31/17
Electronic Filing Instructions for your 2017 New Jersey Tax Return
Important: Your taxes are not finished until all required steps are completed.

quanikqa C lovett, ms
450 little place, Apt. 57
north plainfield, NJ 07060
|
Balance | Your New Jersey state tax return (Form NJ-1040) shows a refund due to
Due/ | you in the amount of $910.00. Your tax refund will be direct
Refund | deposited into your account. The account information you entered -
| Account Number: 381043180732 Routing Transit Number: 021200339.
|
______________________________________________________________________________________
|
Where's My | Before you call the New Jersey Division of Revenue with questions
Refund? | about your refund, give them 21 days processing time from the date
| your return is accepted. If then you have not received your refund,
| or the amount is not what you expected, contact the New Jersey
| Division of Revenue directly at 1-609-292-6400. From outside of New
| Jersey use 1-800-323-4400.
|
______________________________________________________________________________________
|
No | No signature form is required since you signed your return
Signature | electronically.
Document |
Needed |
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | Printed copy of your state and federal returns
Keep |
|
______________________________________________________________________________________
|
2017 | Taxable Income $ 33,874.00
New Jersey | Total Tax $ 523.00
Tax | Total Payments/Credits $ 1,433.00
Return | Amount to be Refunded $ 910.00
Summary |
|
______________________________________________________________________________________

Page 1 of 1
 STATE OF NEW JERSEY INCOME TAX – RESIDENT RETURN

For Privacy Act Notification, See Instructions

For Tax Year Jan. – Dec. 2017 or Other Tax Year
NJ-1040
Beginning __________, 20___ Month Ending __________, 20___
2017
On-line Federal Extension Confirmation #___________________
Page 1

040MP01170

LOVETT MS QUANIKQA C

450 LITTLE PLACE APT 57

NORTH PLAINFIELD NJ 07060 1814

1555

152904641

L68556356353912

Under the penalties of perjury, I declare that I have examined this income tax return, including accompanying schedules Pay amount on Line 56 in full. Write Social Security
number(s) on check or money order and make payable
and statements, and to the best of my knowledge and belief, it is true, correct and complete. If prepared by a person other to: STATE OF NEW JERSEY – TGI
than the taxpayer, this declaration is based on all information of which the preparer has any knowledge.
Mail your return in the envelope provided and affix the
appropriate mailing label.
> >
If you have an amount due on Line 56, enclose your
Your Signature Date Spouse/CU Partner’s Signature (If filed jointly both must sign) check and NJ-1040-V payment voucher with your return
and use the label for PO Box 111.
Fill in if NJ-1040-O is enclosed
If not, use the label for PO Box 555.
If enclosing copy of death certificate for deceased taxpayer, check box (See instruction page 12) You may also pay by e-check or credit card. See
instruction page 11.
Paid Preparer's Signature Federal Identification Number

Firm's Name Federal Employer Identification Number

SELF PREPARED

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 NJ-1040 (2017) PAGE 2

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Residency Status IF YOU WERE A NEW JERSEY RESIDENT FOR ONLY PART OF THE TAXABLE YEAR GIVE THE PERIOD OF NEW JERSEY RESIDENCY
FROM TO
FILING STATUS EXEMPTIONS
1. SINGLE 6. REGULAR 1
2. MARRIED/CU COUPLE FILING JOINT RETURN 7. AGE 65 OR OVER
3. MARRIED/CU COUPLE FILING SEPARATE RETURN 8. BLIND OR DISABLED
4. HEAD OF HOUSEHOLD 9. NUMBER OF QUALIFIED DEPENDENT CHILDREN 2
5. QUALIFYING WIDOW(ER)/SURVIVING CU PARTNER 10. NUMBER OF OTHER DEPENDENTS
CHECKBOXES FOR EXEMPTIONS 11. DEPENDENTS ATTENDING COLLEGE
REGULAR SPOUSE/CU PARTNER DOMESTIC PARTNER 12A. TOTAL (LINE 12A - ADD LINES 6, 7, 8, AND 11) 1
AGE 65 OR OLDER YOURSELF SPOUSE/CU PARTNER 12B. TOTAL (LINE 12B - ADD LINES 9 AND 10) 2
BLIND OR DISABLED YOURSELF SPOUSE/CU PARTNER 12C. VETERAN EXEMPTION
VETERAN EXEMPTION YOURSELF SPOUSE/CU PARTNER

DEPENDENT'S INFORMATION FROM LINES 9 AND 10 (ATTACH RIDER IF MORE THAN FOUR)
LAST NAME, FIRST NAME, MIDDLE INITIAL SOCIAL SECURITY NUMBER BIRTH YEAR HEALTH INS IND
A. Camino, Mya M 883-99-8654 2011
B. Vasquez, Erika J 149-21-2084 2009
C.
D.
GUBERNATORIAL ELECTIONS FUND
DO YOU WISH TO DESIGNATE $1 OF YOUR TAXES FOR THIS FUND? YES NO
IF JOINT RETURN, DOES YOUR SPOUSE/CU PARTNER WISH TO DESIGNATE $1? YES NO

14. WAGES, SALARIES, TIPS, AND OTHER EMPLOYEE COMPENSATION (ENCL W-2) BE SURE TO USE STATE WAGES FROM BOX 16 OF YOUR W-2(S) (SEE INSTR.) 14. 37874 .
15A. TAXABLE INTEREST INCOME (SEE INSTRUCTIONS) (ENCLOSE FEDERAL SCHEDULE B IF OVER $1,500) 15A. .
15B. TAX EXEMPT INTEREST INCOME (SEE INSTRUCTIONS) (ENCLOSE SCHEDULE) DO NOT INCLUDE ON LINE 15A 15B. .
16. DIVIDENDS 16. .
17. NET PROFITS FROM BUSINESS (SCHEDULE NJ-BUS-1, PART 1, LINE 4) (ENCLOSE COPY OF FEDERAL SCHEDULE C, FORM 1040) 17. .
18. NET GAINS FROM DISPOSITION OF PROPERTY (SCHEDULE B, LINE 4) 18. .
19A. PENSIONS, ANNUITIES, AND IRA WITHDRAWALS (SEE INSTRUCTION PAGE 22) 19A. .
19B. EXCLUDABLE PENSIONS, ANNUITIES, AND IRA WITHDRAWALS 19B. .
20. DISTRIBUTIVE SHARE OF PARTNERSHIP INCOME (SCH. NJ-BUS-1, PART II, LINE 4) (SEE INSTR. PAGE 25) (ENCLOSE SCH. NJK-1 OR FEDERAL SCH. K-1) 20. .
21. NET PRO RATA SHARE OF S CORPORATION INCOME (SCH. NJ-BUS-1, PART III, LINE 4) (SEE INSTR. PAGE 25) (ENCLOSE SCH. NJ-K-1 OR FEDERAL SCH. K-1) 21. .
22. NET GAIN OR INCOME FROM RENTS, ROYALTIES, PATENTS & COPYRIGHTS (SCHEDULE NJ-BUS-1, PART IV, LINE 4) 22. .
23. NET GAMBLING WINNINGS (SEE INSTRUCTION PAGE 25) 23. .
24. ALIMONY AND SEPARATE MAINTENANCE PAYMENTS RECEIVED 24. .
25. OTHER (ENCLOSE SCHEDULE) (SEE INSTRUCTION PAGE 25) 25. .
26. TOTAL INCOME (ADD LINES 14, 15A, 16, 17, 18, 19A, AND 20 THROUGH 25) 26. 37874 .
27A. PENSION EXCLUSION (SEE INSTRUCTION PAGE 26) 27A. .
27B. OTHER RETIREMENT INCOME EXCLUSIONS (SEE WORKSHEET AND INSTRUCTION PAGE 26) 27B. .
27C. TOTAL EXCLUSION AMOUNT (ADD LINE 27A AND LINE 27B) 27C. .
28. NEW JERSEY GROSS INCOME (SUBTRACT LINE 27C FROM LINE 26) (SEE INSTRUCTION PAGE 28) 28. 37874 .
29. TOTAL EXEMPTION AMOUNT (SEE INSTRUCTION PAGE 28 TO CALCULATE AMOUNT) (PART YEAR RESIDENTS SEE INSTRUCTION PAGE 7) 29. 4000 .
30. MEDICAL EXPENSES (SEE WORKSHEET AND INSTRUCTION PAGE 28) 30. .
31. ALIMONY AND SEPARATE MAINTENANCE PAYMENTS 31. .
32. QUALIFIED CONSERVATION CONTRIBUTION 32. .
33. HEALTH ENTERPRISE ZONE DEDUCTION 33. .
34. ALTERNATIVE BUSINESS CALCULATION ADJUSTMENT (SCHEDULE NJ-BUS-2, LINE 11) 34. .
35. TOTAL EXEMPTIONS AND DEDUCTIONS (ADD LINES 29 THROUGH 34) 35. 4000 .
36. TAXABLE INCOME (SUBTRACT LINE 35 FROM LINE 28) IF ZERO OR LESS, MAKE NO ENTRY 36. 33874 .

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 NJ-1040 (2017) PAGE 3

LOVETT MS QUANIKQA C

152904641 1555
040MP03170

37A. TOTAL PROPERTY TAXES PAID (SEE INSTRUCTION PAGE 30) 37A. .
37B. BLOCK, LOT, AND QUALIFIER (TO BE ENTERED ON PAGE 1) 37B.
37C. COUNTY/MUNICIPALITY CODE (TO BE ENTERED ON PAGE 1) 37C.
38. PROPERTY TAX DEDUCTION (SEE INSTRUCTION PAGE 33) 38. .
39. NEW JERSEY TAXABLE INCOME (SUBTRACT LINE 38 FROM LINE 36) IF ZERO OR LESS, MAKE NO ENTRY 39. 33874 .
40. TAX (FROM TAX TABLES, PAGE 52) 40. 523 .
41. CREDIT FOR INCOME TAXES PAID TO OTHER JURISDICTIONS 41. .
41A. JURISDICTION CODE (SEE INSTRUCTIONS) 41A.
42. BALANCE OF TAX (SUBTRACT LINE 41 FROM LINE 40) 42. 523 .
43. SHELTERED WORKSHOP TAX CREDIT 43. .
44. BALANCE OF TAX AFTER CREDIT (SUBTRACT LINE 43 FROM LINE 42) 44. 523 .
45. USE TAX DUE ON INTERNET, MAIL-ORDER, OR OTHER OUT-OF-STATE PURCHASES (SEE WKST AND INSTR. PAGE 36) IF NO USE TAX, ENTER ZERO 45. 0 .
46. PENALTY FOR UNDERPAYMENT OF ESTIMATED TAX 46. .
46A. FILL IN IF FORM 2210 IS ENCLOSED 46A.
47. TOTAL TAX AND PENALTY (ADD LINES 44, 45, AND 46) 47. 523 .
48. TOTAL NEW JERSEY INCOME TAX WITHHELD (ENCLOSE FORMS W-2 AND 1099) 48. 535 .
49. PROPERTY TAX CREDIT (SEE INSTRUCTION PAGE 30) 49. .
50. NEW JERSEY ESTIMATED TAX PAYMENTS/CREDIT FROM 2016 TAX RETURN 50. .
51. NEW JERSEY EARNED INCOME TAX CREDIT (SEE INSTRUCTION PAGE 38) 51. 898 .
51B. FILL IN THE BOX IF YOU HAD THE IRS FIGURE YOUR FEDERAL EARNED INCOME CREDIT 51B.
51C. FILL IN THE BOX IF YOU ARE A CU COUPLE CLAIMING THE NJ EARNED INCOME TAX CREDIT 51C.
52. EXCESS NEW JERSEY UI/SF/SWF WITHHELD (SEE INSTRUCTION PAGE 38) (ENCLOSE FORM NJ-2450) 52. .
53. EXCESS DISABILITY INSURANCE WITHHELD (SEE INSTRUCTION PAGE 38) (ENCLOSE FORM NJ-2450) 53. .
54. EXCESS NEW JERSEY FAMILY LEAVE WITHHELD (SEE INSTRUCTION PAGE 38) (ENCLOSE FORM NJ-2450) 54. .
55. TOTAL PAYMENTS/CREDITS (ADD LINES 48 THROUGH 54) 55. 1433 .
56. IF LINE 55 IS LESS THAN LINE 47, ENTER AMOUNT YOU OWE
IF YOU OWE TAX, YOU MAY MAKE A DONATION BY ENTERING AN AMOUNT ON LINES 59, 60, 61, 62, 63, AND/OR 64 AND ADDING THIS TO YOUR PAYMENT AMOUNT
56. .
57. IF LINE 55 IS MORE THAN LINE 47, ENTER OVERPAYMENT
DEDUCTIONS FROM OVERPAYMENT ON LINE 57 WHICH YOU ELECT TO CREDIT TO: 57. 910 .
58. YOUR 2018 TAX 58. .
59. NEW JERSEY ENDANGERED WILDLIFE FUND 59. .
60. NEW JERSEY CHILDREN'S TRUST FUND 60. .
61. NEW JERSEY VIETNAM VETERANS' MEMORIAL FUND 61. .
62. NEW JERSEY BREAST CANCER RESEARCH FUND 62. .
63. U.S.S. NEW JERSEY EDUCATIONAL MUSEUM FUND 63. .
64. OTHER DESIGNATED CONTRIBUTION (SEE INSTRUCTION PAGE 39) 64. .
64C. DESIGNATION CODE 64C.
65. TOTAL DEDUCTIONS FROM OVERPAYMENT (ADD LINES 58 THROUGH 64) 65. .
66. REFUND (AMOUNT TO BE SENT TO YOU. SUBTRACT LINE 65 FROM LINE 57) 66. 910 .

DIRECT DEPOSIT INFORMATION

dd1. REFUND CHECK BOX ('1' FOR REFUND, '4' FOR NO REFUND) dd1. 1
dd2. ACCOUNT TYPE ('C' FOR CHECKING, 'S' FOR SAVINGS) dd2. C
dd3. FILL IN THE CHECKBOX IF REFUND IS GOING TO AN ACCOUNT OUTSIDE THE UNITED STATES dd3.
dd4. ROUTING NUMBER dd4. 021200339
dd5. ACCOUNT NUMBER dd5. 381043180732
dnm. DO NOT MAIL INDICATOR dnm.
pa. POWER OF ATTORNEY INDICATOR pa.
pdr. PRESIDENTIAL DISASTER RELIEF INDICATOR pdr.

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