Form Department of the Treasury—Internal Revenue Service

1040A U.S. Individual Income Tax Return (99) 2014 IRS Use Only—Do not write or staple in this space.
Your first name and initial Last name OMB No. 1545-0074
Your social security number
Jonathan Vivar 043 98 8852
If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
229 Oak Street and on line 6c are correct.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
Manchester CT 06040 Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign country name Foreign province/state/county Foreign postal code a box below will not change your tax or
refund. You Spouse

Filing 1 Single 4 Head of household (with qualifying person). (See instructions.)

status 2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent,
Check only 3 Married filing separately. Enter spouse’s SSN above and enter this child’s name here. a
one box. full name here. a 5 Qualifying widow(er) with dependent child (see instructions)

}
Exemptions 6a Yourself. If someone can claim you as a dependent, do not check Boxes
checked on
box 6a. 6a and 6b 1
b Spouse No. of children
on 6c who:
c Dependents: (4)  if child under
(3) Dependent’s
(2) Dependent’s social • lived with
age 17 qualifying for
If more than six security number you
relationship to you child tax credit (see
dependents, see (1) First name Last name instructions) • did not live
instructions. with you due to
Aida L Vivar de Custodio 046-13-8267 Aunt divorce or
separation (see
instructions)
Dependents
on 6c not
entered above 1
Add numbers
on lines
d Total number of exemptions claimed. above a 2
Income
7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7 40,495.
Attach
Form(s) W-2 8a Taxable interest. Attach Schedule B if required. 8a
here. Also b Tax-exempt interest. Do not include on line 8a. 8b
attach
Form(s) Ordinary dividends. Attach Schedule B if required. 9a
1099-R if tax b Qualified dividends (see instructions). 9b
was 10 Capital gain distributions (see instructions). 10
withheld. 11a IRA 11b Taxable amount
If you did not distributions. 11a (see instructions). 11b
get a W-2, see 12a Pensions and 12b Taxable amount
instructions.
annuities. 12a (see instructions). 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 13

14a Social security 14b Taxable amount
benefits. 14a (see instructions). 14b

15 Add lines 7 through 14b (far right column). This is your total income. a 15 40,495.
Adjusted
gross 16 Educator expenses (see instructions). 16
income 17 IRA deduction (see instructions). 17
18 Student loan interest deduction (see instructions). 18 547.

19 Tuition and fees. Attach Form 8917. 19

20 Add lines 16 through 19. These are your total adjustments. 20 547.

21 Subtract line 20 from line 15. This is your adjusted gross income. a 21 39,948.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040A (2014)
BAA REV 05/19/15 Intuit.cg.cfp.sp
Form 1040A (2014) Page 2
Tax, credits, 22 Enter the amount from line 21 (adjusted gross income). 22 39,948.
and
payments
23a Check
if: {
You were born before January 2, 1950,
Spouse was born before January 2, 1950,
Blind Total boxes
Blind checked a 23a }
b If you are married filing separately and your spouse itemizes
Standard deductions, check here a 23b
Deduction
for— 24 Enter your standard deduction. 24 6,200.
• People who 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25 33,748.
check any
box on line 26 Exemptions. Multiply $3,950 by the number on line 6d. 26 7,900.
23a or 23b or
who can be 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
claimed as a This is your taxable income. a 27 25,848.
dependent,
see 28 Tax, including any alternative minimum tax (see instructions). 28 3,420.
instructions.
29 Excess advance premium tax credit repayment. Attach
• All others:
Single or Form 8962. 29
Married filing 30 Add lines 28 and 29. 30 3,420.
separately,
$6,200 31 Credit for child and dependent care expenses. Attach
Married filing Form 2441. 31
jointly or
Qualifying 32 Credit for the elderly or the disabled. Attach
widow(er),
$12,400 Schedule R. 32
Head of 33 Education credits from Form 8863, line 19. 33
household,
$9,100 34 Retirement savings contributions credit. Attach Form 8880. 34
35 Child tax credit. Attach Schedule 8812, if required. 35
36 Add lines 31 through 35. These are your total credits. 36
37 Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-. 37 3,420.
38 Health care: individual responsibility (see instructions). Full-year coverage 38 298.
39 Add line 37 and line 38. This is your total tax. 39 3,718.
40 Federal income tax withheld from Forms W-2 and 1099. 40 5,585.
If you have
41 2014 estimated tax payments and amount applied
a qualifying from 2013 return. 41
child, attach 42a Earned income credit (EIC). 42a
Schedule
EIC. b Nontaxable combat pay election. 42b
43 Additional child tax credit. Attach Schedule 8812. 43
44 American opportunity credit from Form 8863, line 8. 44
45 Net premium tax credit. Attach Form 8962. 45
46 Add lines 40, 41, 42a, 43, 44, and 45. These are your total payments. a 46 5,585.
47 If line 46 is more than line 39, subtract line 39 from line 46.
Refund This is the amount you overpaid. 47 1,867.
Direct 48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here a 48a 1,867.
deposit?
See a b
Routing a c Type: Checking Savings
instructions number 2 1 1 1 7 6 8 9 1
and fill in
48b, 48c, a d
Account
and 48d or number 0 3 0 1 6 8 8 4 4 4 7
Form 8888. 49 Amount of line 47 you want applied to your
2015 estimated tax. 49
Amount 50 Amount you owe. Subtract line 46 from line 39. For details on how to pay,
you owe see instructions. a 50
51 Estimated tax penalty (see instructions). 51
Third party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No
Designee’s Phone Personal identification
designee name a no. a number (PIN) a

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other
than the taxpayer) is based on all information of which the preparer has any knowledge.
here Your signature Date Your occupation Daytime phone number
F

Joint return?
See instructions. Technology Specialist (860)533-2347
Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
Keep a copy PIN, enter it
for your records. here (see inst.)
Print/type preparer's name Preparer’s signature Date PTIN
Paid Check a if
self-employed
preparer Firm's name a Firm's EIN a
Self-Prepared
use only Firm's address a Phone no.
REV 05/19/15 Intuit.cg.cfp.sp Form 1040A (2014)
 Tax History Report 2014
G Keep for your records

Name(s) Shown on Return

Jonathan Vivar

Five Year Tax History:

2010 2011 2012 2013 2014

Filing status Single Single Single

Total income 39,819. 39,213. 40,495.

Adjustments to income 680. 357. 547.

Adjusted gross income 39,139. 38,856. 39,948.

Tax expense 1,554. 1,486. 1,635.

Interest expense

Contributions

Miscellaneous
deductions

Other Itemized
Deductions

Total itemized/
standard deduction 5,950. 6,100. 6,200.

Exemption amount 7,600. 7,800. 7,900.

Taxable income 25,589. 24,956. 25,848.

Tax 3,401. 3,300. 3,420.

Alternative min tax

Total credits

Other taxes 298.

Payments 5,750. 5,460. 5,585.

Form 2210 penalty

Amount owed

Applied to next
year’s estimated tax

Refund 2,349. 2,160. 1,867.

Effective tax rate % 8.69 8.49 8.56

**Tax bracket % 15.0 15.0 15.0

**Tax bracket % is based on Taxable income.

Sunrise Banks N.A. Refund Processing Agreement (’Agreement’)

Name Jonathan Vivar

Social Security No. 043-98-8852

This Agreement contains important terms, conditions and disclosures about the processing of your refund by
Sunrise Banks N.A. of St. Paul, Minnesota (’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 2014 federal income tax return is a joint return (individually and collectively, ’Applicant’).
The words ’we,’ ’us’ and ’our’ refer to BANK and Processor. The term ’Servicer’ or ’Processor’ refer to the
third party processor, Santa Barbara Tax Products Group, LLC.

1. NOTICE: No Requirement To Have BANK Process Your Refund In Order To File Electronically.
IF YOU USE THE REFUND-PROCESSING SERVICE, YOU CAN EXPECT TO RECEIVE THE PROCEEDS FROM
YOUR FEDERAL TAX REFUND WITHIN 21 DAYS FROM WHEN THE IRS ACCEPTS YOUR RETURN UNLESS
THERE ARE PROCESSING DELAYS BY THE IRS. THE REFUND PROCESSING SERVICE WILL NEITHER
SPEED UP NOR DELAY YOUR FEDERAL TAX REFUND. IF YOU DO NOT USE THE REFUND PROCESSING
SERVICE, BUT DO FILE YOUR TAX RETURN ELECTRONICALLY, AND HAVE YOUR FEDERAL TAX REFUND
DIRECTLY DEPOSITED INTO A BANK ACCOUNT, YOU CAN EXPECT TO RECEIVE YOUR REFUND WITHIN 21
DAYS FROM WHEN THE IRS ACCEPTS YOUR RETURN UNLESS THERE ARE PROCESSING DELAYS BY THE
IRS. IF YOU ELECT TO RECEIVE YOUR FEDERAL TAX REFUND THROUGH THE MAIL, YOU CAN EXPECT TO
RECEIVE YOUR REFUND IN 3 TO 4 WEEKS FROM WHEN THE IRS ACCEPTS YOUR RETURN. 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 Internal Revenue Service (’IRS’) to
disclose any information to BANK and Processor related to the funding of your 2014 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 to share your information with Intuit. Neither Intuit,
BANK nor 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. For more information concerning our privacy policy please see the disclosures at the end
of this Agreement describing how BANK may use or share your personal information.

3. Summary of Terms

Expected Federal Refund $ 1,867.00

Less TurboTax Fees $ 57.98
Less Additional Products and Services Purchased $
Expected Proceeds* $ 1,809.02

*These charges are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes, and if
applicable, a returned item and other processing fee paid to Processor as set forth in paragraphs 4 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 2014 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
BANK or Processor to deduct from your Deposit Account the following amounts: (i) the fees and charges
related to the preparation, processing and transmission of your tax return (TurboTax Fees); and, (ii) amounts
to pay for additional products and services purchased plus applicable taxes. You also authorize BANK to
deduct twenty dollars ($20) as a returned item processing fee from your Deposit Account in the event that
your deposit is returned or you provide incorrect bank account or routing information, as set forth in the Note
below paragraph 7 below. This fee shall be paid by BANK to its Processor. You authorize BANK 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 to automatically deduct such fees (or
any portion thereof) via ACH, electronic check, or wire transfer directly from the account or card in which you
authorize 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.
Jonathan Vivar 043-98-8852 Page 2

5. Acknowledgments. (a) You understand that: (i) BANK cannot guarantee the amount of your tax year
2014 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
(both spouses if this is a jointly filed return) tax year 2014 federal tax refund. No other deposits may be
made to the Deposit Account. No withdrawals will be allowed from the Deposit Account except 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 if the refund cannot be
delivered as directed in Section 4 of this application. An Account Research and Legal Processing fee of $25
may be charged if we are required to provide additional processing to return the funds to the IRS. These
fees will be paid by Bank to the Processor. Questions or concerns about the Deposit Account should be
directed to: Sunrise Banks NA, c/o Santa Barbara Tax Products Group, LLC, 11085 North Torrey Pines
Road, Suite 210, La Jolla, CA 92037 or via the Internet at http://cisc.sbtpg.com.

7. Disbursement Method: You agree that the disbursement method selected below will be used by BANK
to disburse funds to you.

a Direct Deposit to Prepaid Debit Card: If you choose this option, you authorize BANK to transfer
the balance of your Deposit Account to the financial institution that supports your prepaid debit card,
so that the financial institution may deposit the balance of your refund, as directed by you, on the
respective prepaid debit card you have selected. Additional fees may be charged for the use of the card.
Please review the cardholder agreement associated with the use of your prepaid debit card provided
by the participating financial institution to learn of other fees, charges, terms and conditions that will
apply. BANK will not be responsible for your funds once they have been deposited with the respective
financial institution.

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 #: 211176891 ACCOUNT #: 03016884447

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 returned item processing fee will be disbursed to you via a cashier’s check mailed to your
physical address of record. The BANK, its processor or Intuit is 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 the BANK has received your federal tax refund but is unable to deliver the funds directly to
you, funds may be held at the BANK until claimed, or returned to the IRS or State of residency. Additional
return item and processing fees may be deducted from the Deposit Account for federal tax refunds that
continue to be undeliverable and unclaimed and must be returned to the IRS or State. The amount of
additional processing fees will be determined by the efforts required and the complexity of the transaction
but will not exceed $25. Processing fees will be paid by BANK to Processor.

You must notify BANK in writing 3 business days prior o 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: Sunrise Banks, N.A., c/o Santa Barbara Tax Products
Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037.
Jonathan Vivar 043-98-8852 Page 3

8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES. The Federal Electronic Fund Transfer
Act provides you with certain rights and obligations regarding the Federal and state income tax refund that
will be electronically deposited into your Account established at Sunrise Banks N.A. for that purpose. If you
believe that there is an error or if you have a question about your Account, write to Sunrise Banks N.A., c/o
Santa Barbara Tax Products Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California
92037 or telephone (877) 908-7228 and provide Sunrise Banks N.A. with your name, a description or
explanation of the error and the dollar amount of the suspected error. Sunrise Banks N.A. will advise you of
the results of its investigation within 10 business days.

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; or
? To comply with government agency or court orders; or
? If you give us your written permission; or
? As explained in the Privacy section of this disclosure

Our Liability: If we do not complete a transfer to your account on time or in the correct amount according to
our agreement with you, we may be liable for your losses or damages. In addition to all other limitations of
our 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 we have taken.
? The funds in your account are subject to legal process or other claim restricting such transfer.

9. 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
South Dakota.

10. 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 thereof. 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, BANK or Processor agree to pay those fees for you. By agreeing to arbitration, you,
BANK and Processor 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.

11. USA Patriot Act Disclosure. To help the government fight the funding of terrorism and money
laundering activities, Federal law requires all financial institutions to obtain, verify, and record information
that identifies each person who opens an account. What this means for you: When we open a Deposit
Account for you for the purpose of receiving your IRS federal tax refund or if you apply for one of our
products, we will ask for your name, address, date of birth, and other information that will allow us to
identify you. We may also ask for your driver’s license information or information from other identifying
documents of yours.

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 2014 federal tax refund from the IRS and to make the
deductions from your refund described in the Agreement, (ii) You agree to receive all Communications
electronically in accordance with the ’Consent to Conduct Business Electronically’ section of the License
Agreement for Tax Year 2014 TurboTax Software and Services, as the term ’Communications’ is defined
therein, (iii) You consent to the release of your 2014 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.
Jonathan Vivar 043-98-8852

Sunrise Banks, N.A. Tax Product Privacy

FACTS What does Sunrise Banks, N.A. 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 Date of Birth
? Address of Residence
? Government Issued Identification Card
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 Sunrise Banks, N.A. chooses to share and
whether you can limit the sharing.

Reasons we can share your personal information Does Sunrise Can you limit this sharing?
Banks, N.A. share?
For our everyday business purposes ' such as to
process your transaction, maintain your account(s),
respond to court orders and legal investigations, or Yes No
report to credit bureaus.

For our marketing purposes ' to offer our products Yes No

and services to you.

For joint marketing with other financial companies. Yes No

For our affiliates’ everyday business purposes '

information about your transactions and experiences. Yes No

For our affiliates’ everyday business purposes '

information about your creditworthiness. No We Don’t Share

For our affiliates to market to you. No We Don’t Share

For non affiliates to market to you. No We Don’t Share

Questions? Toll Free 877-908-7228

Jonathan Vivar 043-98-8852 Page 2
Who We Are
Who is providing this notice? Sunrise Banks, N.A.
What We Do
How does Sunrise Banks, N.A. To protect your personal information from unauthorized access
protect my personal information? and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings. Your information is accessible only to employees
who need the information in order to process your product request,
answer your questions or determine the types of additional
products or services that we think may interest you. We train our
employees on their responsibility to maintain the privacy of your
personal information.

How does Sunrise Banks, N.A. We collect personal information about you when you apply for a tax
collect my personal information? related product. This includes information in your application and
your tax return in each year that you applied for a tax-related bank
product, such as your name, address, social security number,
income, deductions, refund and the like. We also collect
information about your transactions with us, such as payment
histories, balances due, and tax information. We also collect your
personal information from others, such as credit bureaus, 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.
Definitions
Affiliates Companies related by common ownership or control. They can be
financial and non financial companies
? Our affiliates include financial companies such as University
Financial Corp. dba Sunrise Banks.

Non affiliates Companies not related by common ownership or control. They can
be financial or non financial companies.

Sunrise Banks, N.A. does not share with nonaffiliates so they can
market to you.

Joint Marketing A formal joint marketing agreement between non affiliated

financial companies that together market financial products or
services to you.

We may disclose all of the Confidential Information that we collect

as described above to companies that perform marketing services
on our behalf or to other tax product providers with whom we have
joint marketing agreements.
Other Important Information
This Notice is adopted in recognition of our obligations under Title V of Gramm-Leach Bliley Act of 1999.
This Notice applies only to individuals who have applied for a tax-related bank product.
 CUSTOMER SERVICE: 877-908-7228

The Citizens Banking Company Refund Processing Agreement (’Agreement’)

Name Social Security No.

This Agreement contains important terms, conditions and disclosures about the processing of your refund by
The Citizens Banking Company of Sandusky, OH ("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 2014 federal income tax return is a joint return (individually and collectively, ’Applicant’).
The words ’we,’ ’us’ and ’our’ refer to BANK. The term ’Servicer’ or "Processor’ refer to the third party
processor, Santa Barbara Tax Products Group, LLC.

1. NOTICE: No Requirement To Have BANK Process Your Refund In Order To File Electronically.
IF YOU USE THE REFUND PROCESSING SERVICE, YOU CAN EXPECT TO RECEIVE THE PROCEEDS FROM
YOUR FEDERAL TAX REFUND WITHIN 21 DAYS FROM WHEN THE IRS ACCEPTS YOUR RETURN UNLESS
THERE ARE PROCESSING DELAYS BY THE IRS. THE REFUND PROCESSING SERVICE WILL NEITHER
SPEED UP NOR DELAY YOUR FEDERAL TAX REFUND. IF YOU DO NOT USE THE REFUND PROCESSING
SERVICE, BUT DO FILE YOUR TAX RETURN ELECTRONICALLY, AND HAVE YOUR TAX REFUND DIRECTLY
DEPOSITED INTO A BANK ACCOUNT, YOU CAN EXPECT TO RECEIVE YOUR REFUND WITHIN 21 DAYS
FROM WHEN THE IRS ACCEPTS YOUR RETURN UNLESS THERE ARE PROCESSING DELAYS BY THE IRS.
IF YOU ELECT TO RECEIVE YOUR FEDERAL TAX REFUND THROUGH THE MAIL, YOU CAN EXPECT
EXPECT TO RECEIVE YOUR REFUND IN 3 TO 4 WEEKS FROM WHEN THE IRS ACCEPTS YOUR RETURN.
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 Internal Revenue Service (’IRS’) to
disclose any information to BANK and Processor related to the funding of your 2014 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 to share your information with Intuit. Neither Intuit,
BANK nor 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. For more information concerning our privacy policy please see the disclosures at the end
of this Agreement describing how BANK may use or share your personal information.

3. Summary of Terms
Expected Federal Refund $
Less TurboTax Fees $
Less Additional Products and Services Purchased $
Expected Proceeds* $
*These charges are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes, and if
applicable, a returned item and other processing fee paid to BANK’s Processor as set forth in paragraphs 4 and 7 below.
 Page 2

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 2014 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
BANK or Processor to deduct from your Deposit Account the following amounts: (i) the fees and charges
related to the preparation, processing and transmission of your tax return (TurboTax Fees); and, (ii) amounts
to pay for additional products and services purchased plus applicable taxes. You also authorize BANK or
Processor to deduct twenty dollars ($20) as a returned item processing fee from your Deposit Account in the
event that your deposit is returned or you provide incorrect bank account or routing information, as set forth
in the Note below paragraph 7 below. This fee shall be paid by BANK to its 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 to
automatically deduct such fees (or any portion thereof) via ACH, electronic check, or wire transfer directly
from the account or card in 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) BANK cannot guarantee the amount of your tax year
2014 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.

6. Truth in Savings Disclosure. The Deposit Account is being opened for the purpose of receiving your
(both spouses if this is a jointly filed return) tax year 2014 federal tax refund. No other deposits may be
made to the Deposit Account. No withdrawals will be allowed from the Deposit Account except as provided
in Section 4. No interest is payable on the funds 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 if the
refund cannot be delivered as directed in Section 4 of this application. an Account Research and Legal
Processing fee of $25 may be charged if we are required to provide additional processing to return the funds
to the IRS. These fees will be paid by BANK to its Processor. Questions or concerns about the Deposit
Account should be directed to: The Citizens Banking Company, c/o Santa Barbara Tax Products Group, LLC,
11085 North Torrey Pines Road, Suite 210, La Jolla, CA 92037 or via the Internet at http://cisc.sbtpg.com.

7. Disbursement Method: You agree that the disbursement method selected below will be used by BANK to
disburse funds to you.
a Direct Deposit to Prepaid Debit Card: If you choose this option, you authorize BANK to transfer
the balance of your Deposit Account to the financial institution that supports your prepaid debit card,
so that the financial institution may deposit the balance of your refund, as directed by you, on the
respective prepaid debit card you have selected. Additional fees may be charged for the use of the
card. Please review the cardholder agreement associated with the use of your prepaid debit card
provided by the participating financial institution to learn of other fees, charges, terms and conditions
that will apply. BANK will not be responsible for your funds once they have been deposited with the
respective financial institution.

b 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:

Checking
Savings
RTN #
Account #

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 returned item processing fee will be disbursed to you via a
cashier’s check mailed to your physical address of record. The BANK, the processor or Intuit is not
responsible for the misapplication of a direct deposit that results from error, negligence or malfeasance
on the part of you or your representative. The BANK will make every effort to deliver your Deposit
Account balance to you. 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 the BANK until claimed, or returned to the IRS
or State of residency. Additional return item and processing fees may be deducted from the Deposit
Account for federal tax refunds that continue to be undeliverable and unclaimed and must be returned
to the IRS or State. The amount of additional processing fees will be determined by the efforts
required and the complexity of the transaction but will not exceed $25. Processing fees will be paid by
BANK to Processor.

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: The Citizens Banking, c/o Santa Barbara Tax Products
Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037.
 Page 3

8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES: The Federal Electronic Fund Transfer Act
provides you with certain rights and obligations regarding the Federal and state income tax refund that will
be electronically deposited into your Account established at The Citizens Banking Company for that purpose.
If you believe that there is an error or if you have a question about your Account, write to The Citizens
Banking Company, c/o Santa Barbara Tax Products, Group, LLC, 11085 North Torrey Pines Road, Suite
210, La Jolla, California 92037 or telephone (877) 908-7228 and provide The Citizens Banking Company with
your name, a description or explanation of the error and the dollar amount of the suspected error. The
Citizens Banking Company will advise you of the results of its investigation within 10 business days.

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; or
? To comply with government agency or court orders; or
? If you give us your written permission; or
? As explained in the Privacy section of this disclosure

Our Liability: If we do not complete a transfer to your account on time or in the correct amount according to
our agreement with you, we may be liable for your losses or damages. In addition to all other limitations of
our 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 we have taken.
? The funds in your account are subject to legal process or other claim restricting such transfer.

9. 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.

10. 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 thereof. 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, Bank or Processor agrees to pay those fees for you. By agreeing to arbitration, you,
Bank and Processor 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.

11. USA Patriot Act Disclosure. To help the government fight the funding of terrorism and money laundering
activities. Federal law requires all financial institutions to obtain, verify, and record information that identifies
each person who opens an account. What this means for you: When we open a Deposit Account for you for
the purpose of receiving your IRS federal tax refund or if you apply for one of our products, we will ask for
your name, address, date of birth, and other information that will allow us to identify you. We may also ask
for your driver’s license information or information from other identifying documents of yours.

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 2014 federal tax refund from the IRS and to make the
deductions from your refund described in the Agreement, (ii) You agree to receive all Communications
electronically in accordance with the ’Consent to Conduct Business Electronically’ section of the License
Agreement for Tax Year 2014 TurboTax(R) Software and Services, as the term ’Communications’ is
defined therein, (iii) You consent to the release of your 2014 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 this Agreement.
 CUSTOMER SERVICE 877-908-7228

The Citizens Banking Company’s Tax Product Privacy Policy

FACTS What does The Citizens Banking Company 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

? payment history and transaction history
? overdraft history and account transactions

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 The Citizens Banking Company chooses to share
and whether you can limit the sharing.

Reasons we can share your Does The Citizens Banking Can you limit this sharing?
personal information Company Share?
For our everyday business purposes
such as to process your transaction,
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 ' No We don’t share
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 non affiliates to market to you. No We don’t share

Questions? Toll Free: 877-908-7228 or go to www.citizensbankco.com

 Page 2

Who we are

Who is providing this notice? The Citizens Banking Company

What we do

How does The Citizens Banking To protect your personal information from unauthorized access
Company 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 The Citizens Banking We collect personal information about you when you apply for a tax
Company collect my related product. This includes information in your application, such
personal information? as your name, address, social security number, income, deductions,
refund and the like. We also collect information about your
transactions with us, tax preparers and similar providers, such as
payment histories, balances due, and tax information. We may also
collect information concerning your credit history from a consumer
reporting agency.

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.

Definitions

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

financial and nonfinancial companies.

? The Citizens Banking Company does not share with our affiliates.

Non affiliates Companies not related by common ownership or control. They can
be financial or nonfinancial companies.

? The Citizens Banking Company does not share with non

affiliates so they can market to you.

Joint Marketing A formal joint marketing agreement between non affiliated

financial companies that together market financial products or
services to you.

? The Citizens Banking Company does not jointly market.

Other Important Information

This Notice is adopted in recognition of our obligations under Title V of Gramm-Leach Bliley Act of 1999.

This Notice applies only to individuals who have applied for a tax-related bank product.

sbia2301.SCR 12/21/14
 Consent to Use of Tax Return Information

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].

The following statements apply:

I authorize Intuit, the maker of TurboTax, to use my 2014 tax

return information to determine if I am eligible for:
- Added ways to get my refund, refund bonus
- Extra benefits beyond my refund
- IRA contribution options

Sign this agreement by entering your name and the date below.

jonathan vivar
First Name Last Name

03/15/2015
Date

SBIA1001.SCR 04/30/15
Read and accept this Disclosure Consent
This is an IRS requirement to transfer your information to purchase Amazon.com Gift Cards from Intuit.

To complete your purchase of Amazon.com Gift Card(s) we need to send your name, email address
and refund amount to Sunrise Banks N.A. of St. Paul, Minnesota (’BANK’) and to Santa Barbara Tax
Products Group (’SBTPG’). They will process your request and forward your name and email address
to ACI Gift Cards, Inc., a subsidiary of Amazon.com, Inc. (’ACI’). ACI will email the Amazon.com Gift
Card(s) to you at the email address you have provided.

We send this information via an encrypted transmission for the sole purpose of providing you with this
refund option. The parties referred to above will protect your confidentiality and use this information
only per the refund processing agreement and their privacy policies.

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 are requesting disclosure of personal information from a joint return, you are representing that
we have consent for both parties on the return.

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, simply enter your name and date in the boxes below after reading this consent
and select "I Agree".

I authorize Intuit, the maker of TurboTax, to disclose to BANK and SBTPG my name, email address
and refund amount, necessary to enable processing of my refund. SBTPG will send my name and
email address to ACI so the Amazon.com Gift Card(s) I am buying from Intuit can be emailed to me.

First Name Last Name

Please type the date below:

Date

sbia0101.SCR 08/24/13
Read and accept this Disclosure Consent
This is an IRS requirement to transfer your information to purchase Amazon.com Gift Cards from Intuit.

To complete your purchase of Amazon.com Gift Card(s) we need to send your name, email address
and refund amount to The Citizens Banking Company of Sandusky, OH (’BANK’) and to Santa Barbara
Tax Products Group (’SBTPG’). They will process your request and forward your name and email
address to ACI Gift Cards, Inc., a subsidiary of Amazon.com, Inc. (’ACI’). ACI will email the
Amazon.com Gift Card(s) to you at the email address you have provided.

We send this information via an encrypted transmission for the sole purpose of providing you with this
refund option. The parties referred to above will protect your confidentiality and use this information
only per the refund processing agreement and their privacy policies.

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 are requesting disclosure of personal information from a joint return, you are representing that
we have consent for both parties on the return.

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, simply enter your name and date in the boxes below after reading this consent
and select "I Agree".

I authorize Intuit, the maker of TurboTax, to disclose to BANK and SBTPG my name, email address
and refund amount, necessary to enable processing of my refund. SBTPG will send my name and
email address to ACI so the Amazon.com Gift Card(s) I am buying from Intuit can be emailed to me.

First Name Last Name

Please type the date below:

Date
Let’s see if you’re eligible for this offer
This is an IRS requirement

If you tell us it’s okay, we’ll use some of your tax information in order to make sure your correct
refund amount is processed for your e-gift card.

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 are requesting use of personal information from a joint return, you are representing that we
have consent for both parties on the return.

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].

I authorize Intuit, the maker of TurboTax, to use the information provided in this 2014 return to
determine whether I am eligible to purchase an Amazon.com Gift Card and receive the associated
bonus

jonathan vivar
First Name Last Name

Please type the date below:

03/15/2015
Date
Before you finish, we need your consent to keep you advised on
how the new healthcare law may affect you

A new law, the Affordable Care Act (sometimes referred to as Obamacare) is offering money-saving
tax credits and benefits to help you pay for your health insurance, even if you’re already covered. By
signing this agreement, you give TurboTax permission to send you personalized information that will
keep you informed on this issue. We will not share your data with any third parties. You do not need to
sign this in order to file.

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(s) 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 review the information in my 2014 return to provide
the best recommendations to me to maximize my savings and benefits for health coverage.

Taxpayer’s First Name Taxpayer’s Last Name

Spouse’s First Name Spouse’s Last name

(if applicable) (if applicable)

Please type the date below:

Date
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 are requesting use of personal information from a joint return, you are representing that we
have consent for both parties on the return.

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 2014 return to
determine whether a portion of the refund can be used to pay for tax preparation.

jonathan vivar
First Name Last Name

Please type the date below:

03/15/2015
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
Sunrise Banks N.A. of St. Paul, Minnesota (’BANK’) and to Santa Barbara Tax Products Group
(’SBTPG’), the administrator and servicer of this payment option: your identifying information and your
refund amount. We transmit this information using bank-level security for the sole purpose of providing
you with this payment option. Both the BANK and SBTPG will protect your confidentiality and use your
information only per the refund processing agreement and their privacy policies.

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 are requesting disclosure of personal information from a joint return, you are representing that
we have consent for both parties on the return.

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
2014 tax return information that is necessary to enable BANK and SBTPG to process my
refund and pay my fees.

Sign this agreement by entering your name:

jonathan vivar

Please type the date below:

03/15/2015
Date

sbia1301.SCR 04/30/15
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
The Citizens Banking Company of Sandusky, OH (’BANK’) and to Santa Barbara Tax Products Group
(’SBTPG’), the administrator and servicer of this payment option: your identifying information and your
refund amount.

We transmit this information using bank-level security for the sole purpose of providing you with this
payment option. Both the BANK and SBTPG will protect your confidentiality and use your information
only per the refund processing agreement and their privacy policies.

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 are requesting disclosure of personal information from a joint return, you are representing that
we have consent for both parties on the return.

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 tax
return information that is necessary to enable BANK and SBTPG to process my 2014 refund
and pay my fees.

Sign this agreement by entering your name:

Please type the date below:

Date

sbia1301.SCR 04/30/15
 Form 8960 Form 8960 Worksheet 2014
Lines 4b, 5b, 7, 9, 10

Name(s) Shown on Return Your SSN

Jonathan Vivar 043-98-8852

Line 4b - Adjustment for trade or business income or loss

(a) Activity name (b) Gain or

loss

Enter additional adjustments not included above:

Adjustment for trade or business income not subject to net investment tax

Line 5b - Adjustment for gain or loss on dispositions

(a) Activity name (b) Gain or

loss

Capital loss carryover adjustment from 2013 for net investment tax purposes 0.
Enter additional adjustments not included above and check the box if a capital gain or loss:

Net gain or loss from disposition of property not subject to net investment tax 0.

Capital gain/loss not included in net investment income

(a) Activity name (b) Capital

Gain or Loss

Capital gain or loss from sale of property not subject to net investment income tax

Calculation of line 5b adjustment due to capital loss carryforward

1 Net capital loss not included in net investment income 1 0.

2 Capital loss carryover to next year 2
3 Lesser of line 1 or line 2 (Included as an adjustment on line 5b table above) 3 0.

Line 7 - Other modifications to investment income

1 Casualty and theft losses reported on Schedule A, line 20 1

2 Amounts reported on Form 8814, line 21 2
3 Adjustment for distributions from estates and trusts 3
4 Schedules C and F income/loss included in net investment income 4
5 Substitute interest and dividend payments 5
6 Recovery of a prior year deduction 6
7 7

8 Total other modifications to investment income 8

Jonathan Vivar 043-98-8852 Page 2

Line 9b - State income tax allocable to net investment income

1 State, local, and foreign income taxes 1

2 Investment income 2
3 Total adjusted gross income 3
4 Divide line 2 by line 3. Enter result as a decimal amount 4
5 State, local and foreign income taxes allocable to investment income 5

Line 10 - Tax preparations fees allocable to net investment income

1 Tax preparations fees 1

2 Investment income 2
3 Total adjusted gross income 3
4 Divide line 2 by line 3. Enter result as a decimal amount 4
5 Tax preparations fees allocable to investment income 5

Lines 9 and 10 - Application of Itemized Deduction Limitations Worksheet

Part I - Application of Section 67 to Deductions Properly Allocable to Investment Income

1 Enter the amount of Miscellaneous Itemized Deductions properly

allocable to investment income before any itemized deductions limitations:

2 Enter the total of all items listed on line 1 2

3 Enter the amount of all Miscellaneous Itemized Deductions after the application
of the section 67 limitation (Schedule A (Form 1040), line 27) 3
4 Enter the lesser of the total reported on line 2 or line 3 4

Part II - Application of Section 67 Limitation to Specific Deductions

(A) (B) (C)
Reenter the amounts and descriptions from Part I, line 1 Fraction Column A
(see Help) times B
x =
x =
x =
x =

Part III - Application of Section 68 to Deductions Properly Allocable to Investment Income

1 Enter the amount of Miscellaneous Itemized Deductions properly

allocable to investment income from Column(C) of Part II:

1
2 Enter the amount of state, local, and foreign income taxes that are properly
allocable to investment income 2
3 Enter the amount of other Itemized Deductions subject to the section 68
limitation and properly allocable to investment income before any itemized
deduction limitation:

3
4 Enter the total deductions properly allocable to investment income subject to
the section 68 limitation. Enter the sum of lines 1 through 3 4
5 Enter the amount of total itemized deductions allowed after the section 68
limitation. Form 1040, line 40 5
6 Enter all other itemized deductions allowed but not subject to the section 68
deduction limitation: 6
7 Subtract line 6 from line 5 7
8 Enter the lesser of line 7 or line 4 8
Jonathan Vivar 043-98-8852 Page 3

Part IV - Reconciliation of Schedule A Deductions to Form 8960 plus additional expenses, lines 9 and 10
(A) (B) (C)
Reenter the amounts and descriptions from Part III, lines 1-3 Fraction Column A
(see Help) times B
Miscellaneous Itemized Deductions properly allocable to Investment
Income reportable on Form 8960, line 9c:
1 x =
x =
x =
x =
Total miscellaneous investment expenses to Form 8960, line 9c

2 State, local, and foreign income taxes x =

Itemized Deductions Subject to Section 68 reportable on Form 8960, line 10:

3 x =
x =
x =
x =
Penalty on early withdrawal of savings
Other modifications:

Total additional modifications to Form 8960, line 10

Calculation of Former Passive Activity Suspended Losses Allowed as Deduction Against NII

1) Former Passive Activity Suspended Losses

(a) Activity name (b) Suspended (c) Suspended (d) Used against (e) Used against
12/31/2013 12/31/2014 activity other passive

2) Former Passive Activity Suspended Losses - Schedule D

(a) Activity name (b) Suspended (c) Suspended (d) Used against (e) Used against
12/31/2013 12/31/2014 activity other passive

3) Former Passive Activity Suspended Losses - Form 4797

(a) Activity name (b) Suspended (c) Suspended (d) Used against (e) Used against
12/31/2013 12/31/2014 activity other passive
 Form 8960 Deduction Recoveries Worksheet 2014
Line 7

Name(s) Shown on Return Your SSN

Jonathan Vivar 043-98-8852

Was the recovery taken into account in computing a section 1411 net operating loss? YES NO X

1 Enter total amount of recovery included in gross income 0.

* Do not include recoveries of items that are included in net
investment income in the year of recovery (included on lines 1-6)
* Do not include recoveries of items if the amount relates to a
deduction taken in a tax year beginning before 2013
* Do not include recoveries of items if the amount relates to a
deduction taken in a tax year beginning after 2012, and you were
not subject to the NIIT solely because your MAGI was below the
applicable threshold.
2 Amount of the recovery that would have been included in gross
income but for the application of the tax benefit rule under
section 111 0.
3 Total amount of the recovery (add lines 1 and 2) 0.
4 Enter as a decimal the percentage of the deduction allocated to
net investment income in the prior year. (If the deduction was not
allocated between investment income and non-investment
income, enter 1.0000)
5 Enter the lesser of (a) line 3 mutiplied by line 4, or (b) the total amount deducted
on the prior year Form 8960 attributable to item recovered (after any deduction
limitations imposed by section 67 or 68)

Calculation of recoveries when the deduction is not taken into account in computing your section 1411 NOL

6 Multiply line 5 by .038

7 Enter the amount of net investment income in the year of the
deduction (previous year’s Form 8960, line 12, unless line 12 is
zero, then previous year’s Form 8960, line 8 minus line 11)
8 Add the amount of line 5 to line 7
9 Using the previous year’s Form 8960, recalculate the NIIT for the
year of the deduction by replacing the amount reported on line 12
with the amount reported on line 8 of this worksheet (do not use
the net investment income reported on that year’s Form 8960,
line 12). Enter your recalculated NIIT here
10 Enter the NIIT reported for the year of the deduction 0.
11 Subtract line 10 from line 9
12 Enter the smaller of line 6 or line 11
13 Divide line 12 by 3.8%. Enter the result here and include on Form 8960, line 7

Calculation of recoveries when the deduction is taken into account in computing your section 1411 NOL

14 Enter the amount of the section 1411 NOL in the year of the
deduction (entered as a positive number)
15 Enter the amount of the section 1411 NOL in the year of the
deduction recomputed without the amount on line 5 (entered as a
positive number, but not less than zero)
16 Subtract line 15 from line 14.Enter the result here and include on Form 8960, line 7
 Federal Information Worksheet 2014
G Keep for your records
Part I ' Personal Information
Information in Part I is completely calculated from entries on Personal Information Worksheets.
Taxpayer: Spouse:
First name Jonathan First name
Middle initial Suffix Middle initial Suffix
Last name Vivar Last name
Social security no. 043-98-8852 Social security no.
Occupation Technology Specialist Occupation
Date of birth 07/10/1981 (mm/dd/yyyy) Date of birth (mm/dd/yyyy)
Age as of 1-1-2015 33 Age as of 1-1-2015
Daytime phone (860)533-2347 Ext Daytime phone Ext
Legally blind Legally blind
Date of death Date of death

Dependent of Someone Else: Dependent of Someone Else:

Can taxpayer be claimed as dependent of another Can spouse be claimed as dependent of another
person (such as parent)? Yes X No person (such as parent)? Yes No
If yes, was taxpayer claimed as dependent on that If yes, was spouse claimed as dependent on that
person’s return? Yes No person’s return? Yes No

Credit for the Elderly or Disabled (Schedule R): Credit for the Elderly or Disabled (Schedule R):
Is the taxpayer retired on total Is the spouse retired on total
and permanent disability? Yes No and permanent disability? Yes No
Presidential Election Campaign Fund: Presidential Election Campaign Fund:
Does the taxpayer want $3 to go to the Presidential Does the spouse want $3 to go to the Presidential
Election Campaign Fund? Yes No Election Campaign Fund? Yes No

Part II ' Address and Federal Filing Status (enter information in this section)
Address 229 Oak Street Apt no.
City Manchester State CT ZIP code 06040
Foreign code Foreign country
Foreign province/county Foreign postal code

APO/FPO/DPO address, check if appropriate APO FPO DPO

Home phone
Check to print phone number on Form 1040 Home X Taxpayer daytime Spouse daytime

Federal filing status:

X 1 Single
2 Married filing jointly
3 Married filing separately
Check this box if you did not live with your spouse at any time during the year
Check this box if you are eligible to claim your spouse’s exemption (see Help)
4 Head of household
If the ’qualifying person’ is your child but not your dependent:
Child’s First name MI Last Name Suff
Child’s social security number
5 Qualifying widow(er)
Check the appropriate box for the year your spouse died 2012
2013

Part III ' Dependent/Earned Income Credit/Child and Dependent Care Credit Information
Information in Part III is completely calculated from entries on Dependent/Nondependent Info Worksheets.
Date of birth Date of death
(mm/dd/yyyy) (mm/dd/yyyy)

Qualified
Not child/dep Lived
C qual care exps with Educ *
Social security o for incurred E taxpyr Tuitn D
First name MI number d child and paid I in and e
Last name Suff Relationship Age e tax cr 2014 C U.S. Fees p

Aida L 046-13-8267 08/19/1940

Vivar de Custodio Aunt 74 O N Yes

* "Yes" - qualifies as dependent, "No" - does not qualify as dependent

Jonathan Vivar 043-98-8852 Page 2

Part IV ' Earned Income Credit Information (you must answer these questions to calculate EIC)
Is the taxpayer or spouse a qualifying child for EIC for another person? Yes No
Was the taxpayer’s (and spouse’s if married filing jointly) home in the United States
for more than half of 2014? Yes No
If the SSN of the taxpayer, or spouse if married filing jointly, was obtained to
get a federally funded benefit, such as Medicaid, and the Social Security card
contains the legend Not Valid for Employment, check this box (see Help)
Check if you are filing head of household and your spouse is a nonresident alien
and you lived with your spouse during the last six months of 2014
Was EIC disallowed or reduced in a previous year and are you required to file
Form 8862 this year? Yes No
Check if you were notified by the IRS that EIC cannot be claimed in 2014 or
if you are ineligible to claim the EIC in 2013 for any other reason

Part V ' Direct Deposit or Direct Debit Information (not applicable for Form 9465)
Do you want to elect direct deposit of any federal tax refund? X Yes No

Do you want to elect direct debit of federal balance due (Electronic filing only)? Yes No

If you selected either of the options above, fill out the information below:
Name of Financial Institution (optional) American Eagle
Check the appropriate box Checking X Savings
Routing number 211176891 Account number 03016884447

Enter the following information only if you are requesting direct debit of balance due:
Enter the payment date to withdraw from the account above
Balance-due amount from this return

Part VI ' Additional Information for Your Federal Return

Standard Deduction/Itemized Deductions:

Check this box if you are itemizing for state tax or other purposes even though your itemized
deductions are less than your standard deduction
Check this box if you are married filing separately and your spouse itemized deductions
Check this box to take the standard deduction even if less than itemized deductions

Main Form Selection:

Check this box to calculate Form 1040 even if you qualify to use Form 1040A or 1040EZ

Real Estate Professionals:

Do you or your spouse qualify for the special passive activity rules for
taxpayers in real property business? (see Help) Yes No

Credit for Qualified Retirement Savings Contributions (Form 8880):

Is the taxpayer a full-time student? Yes No
Is the spouse a full-time student? Yes No

Foreign Tax Credit (Form 1116):

Check this box to file Form 1116 even if you’re not required to file Form 1116
Resident country USA
Excludable Income from Am. Samoa, Guam, Commonwealth of the N. Mariana Islands, or Puerto Rico:
Excludable income of bona fide residents of American Samoa, Guam, or the
Commonwealth of the Northern Mariana Islands
Excludable income from Puerto Rico

Dual Status Alien Return:

Check this box if you are a dual-status alien

Third Party Designee:

Caution: Review transferred information for accuracy.
Do you want to allow another person to discuss this return with the IRS? Yes No
If Yes, complete the following:
Third party designee name
Third party designee phone number
Personal Identification number (enter any 5 numbers)
If you are entitled to a filing extension or other disaster relief provision as declared by the IRS,
enter the appropriate information (see Help)
Jonathan Vivar 043-98-8852 Page 3

Part VI ' Additional Information for Your Federal Return - Continued

Personal Representative for deceased taxpayers:

Name of personal representative required for E-filed
returns when Form 1310 is not filed or it is not the
surviving spouse

Part VII ' State Filing Information

Identity Protection PIN:

If the IRS sent the taxpayer an Identity Protection PIN, enter it here
If the IRS sent the spouse an Identity Protection PIN, enter it here

Taxpayer:
Enter the taxpayer’s state of residence as of December 31, 2014 CT
Check the appropriate box:
Taxpayer is a resident of the state above for the entire year X
Taxpayer is a resident of the state above for only part of year
Date the taxpayer established residence in state above
In which state (or foreign country) did the taxpayer reside before this change?
Spouse:
Enter the spouse’s state of residence as of December 31, 2014
Check the appropriate box:
Spouse is a resident of the state above for the entire year
Spouse is a resident of the state above for only part of year
Date the spouse established residence in state above
In which state (or foreign country) did the spouse reside before this change?

Nonresident states:

Nonresident State(s) Taxpayer/Spouse/Joint

Check this box if you are in a Registered Domestic Partnership or a civil union
If you checked the box on the line above, also check the appropriate box below:
Check if this is your individual federal return you are filing with the IRS
Check if this is the joint return created to file joint state tax return (see Help)

Check this box if you are in a same-sex marriage

If you checked the box on the line above, also check the appropriate box below:
Check if this is your federal return to be filed.
Check if this is your individual return for filing state return only (see Help)
Jonathan Vivar 043-98-8852 Page 4
Use the IRS web site or call the IRS automated response system to get your Electronic Filing PIN
Electronic Filing PIN assigned to the taxpayer by the IRS
Electronic Filing PIN assigned to the spouse by the IRS

These signature PINs are chosen by the taxpayer and spouse and used for e-filing your tax return
Taxpayer’s PIN used to sign the return 62278
Spouse’s PIN used to sign the return
 Personal Information Worksheet 2014
For the Taxpayer
G Keep for your records

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Part I ' Taxpayer's Personal Information

First name Jonathan Middle initial Last name Vivar

Suffix
Social security no. 043-98-8852 Member of U.S. Armed Forces in 2014? Yes X No

Date of birth 07/10/1981 (mm/dd/yyyy) age as of 1-1-2015 33

Occupation Technology Specialist Daytime phone (860)533-2347 Ext

Marital status Single

If widowed, check the appropriate box for the year your spouse died:
After 2014 2014 2013 2012 Before 2012

Are you retired on total and permanent disability? (for Schedule R, see Help). Yes No
Check if this person is legally blind
If deceased, enter the date of death (mm/dd/yyyy)

Were you under the age of 16 as of 1-1-2015 and this is the first year you
are filing a tax return? Yes No

Do you want $3 to go to Presidential Election Campaign Fund? Yes No

Part II ' Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer

1 Can someone (such as your parent) claim you as a dependent? Yes X No

2 If you answered ’Yes’ to question 1, are you actually claimed as a dependent
on that person’s tax return? Yes No
Questions 3 through 5 are only required for individuals who claim the
American Opportunity Credit.
3 Were you a full-time student during any part of five months during 2014? Yes No
4 Did your earned income exceed one-half of your support? Yes No
5 Was at least one of your parents alive on December 31, 2014? Yes No

Part III ' Taxpayer's State Residency Information

Enter this person’s state of residence as of December 31, 2014 CT

Check the appropriate box:
This person is a resident of the state above for the entire year X
This person is a resident of the state above for only part of year
Date this person established residence in state above
In which state (or foreign country) did this person reside before this change?

Part IV ' Dependent Care Expenses

Qualified dependent care expenses incurred and paid for this person in 2014
 Personal Information Worksheet 2014
For the Spouse
G Keep for your records

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Part I ' Spouse's Personal Information

First name Middle initial Last name

Suffix
Social security no. Member of U.S. Armed Forces in 2014? Yes No

Date of birth (mm/dd/yyyy) age as of 1-1-2015

Occupation Daytime phone Ext

Marital status
If widowed, check the appropriate box for the year your spouse died:
After 2014 2014 2013 2012 Before 2012

Are you retired on total and permanent disability? (for Schedule R, see Help). Yes No
Check if this person is legally blind
If deceased, enter the date of death (mm/dd/yyyy)

Were you under the age of 16 as of 1-1-2015 and this is the first year you
are filing a tax return? Yes No

Do you want $3 to go to Presidential Election Campaign Fund? Yes No

Part II ' Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer

1 Can someone (such as your parent) claim you as a dependent? Yes No

2 If you answered ’Yes’ to question 1, are you actually claimed as a dependent
on that person’s tax return? Yes No
Questions 3 through 5 are only required for individuals who claim the
American Opportunity Credit.
3 Were you a full-time student during any part of five months during 2014? Yes No
4 Did your earned income exceed one-half of your support? Yes No
5 Was at least one of your parents alive on December 31, 2014? Yes No

Part III ' Spouse's State Residency Information

Enter this person’s state of residence as of December 31, 2014

Check the appropriate box:
This person is a resident of the state above for the entire year
This person is a resident of the state above for only part of year
Date this person established residence in state above
In which state (or foreign country) did this person reside before this change?

Part IV ' Dependent Care Expenses

Qualified dependent care expenses incurred and paid for this person in 2014
 Dependent and Nondependent Information Worksheet 2014
G Keep for your records

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Part I ' Personal Information

First name Aida Middle initial L Last name Vivar de Custodio

Suffix
Social security no. 046-13-8267

Date of birth 08/19/1940 (mm/dd/yyyy) age as of 12-31-2014 74

Did this person pass away in 2014 (deceased)? Yes No Date of death

Relationship to taxpayer or spouse Aunt

CAUTION: If claiming a child other than your own, see Relationship in the Tax Help.

NOTE: The ability to set your answers to being the same as last year for the dependent is only
available in Step-by-Step mode and not in Forms mode.
Are the answers to the questions below for this person, to determine
whether they are your dependent, the same as they were last year? X Yes No

Dependency code * O Other dependent

*Dependency code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet

Dependent is disabled

Part II ' Earned Income Credit and Child Tax Credit

Is this person a U.S. citizen, U.S. national, or a U.S. resident? X Yes No

Is this person a resident of Canada or Mexico? Yes No

This person is adopted and you are a U.S. citizen or U.S. national
The adopted child lived with you all year
*If the child is adopted, you are a U.S. citizen or U.S. national and they lived with you
all year, they are considered to meet the citizen test and the U.S. citizen box will
automatically be checked yes.

Child is a potentially qualifying child for earned income credit Yes No

Child is a nondependent, but may qualify for earned income credit Yes No

Qualifying for the earned income credit * N Non-qualifying person

*EIC code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet
Months lived with taxpayer in the United States

Check if this person is not a qualifying child for the child tax credit

If this dependent has an ITIN issued by the IRS instead of a

social security number issued by the social security administration,
did they meet the substantial presence test? (see Schedule 8812 Instructions) Yes No

Part III ' Dependent Care Expenses

Qualified child or dependent care expenses incurred and paid in 2014

 Form 1040 Forms W-2 & W-2G Summary 2014
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Form W-2 Summary

Box No. Description Taxpayer Spouse Total

1 Total wages, tips and compensation:

Non-statutory & statutory wages not on Sch C 40,495. 40,495.
Statutory wages reported on Schedule C
Foreign wages included in total wages
Unreported tips
2 Total federal tax withheld 5,585. 5,585.
3 & 7 Total social security wages/tips 42,681. 42,681.
4 Total social security tax withheld 2,646. 2,646.
5 Total Medicare wages and tips 42,681. 42,681.
6 Total Medicare tax withheld 619. 619.
8 Total allocated tips
9 Not used
10 Total dependent care benefits
11 Total distributions from nonqualified plans
12 a Total from Box 12 9,509. 9,509.
b Elective deferrals to qualified plans 2,186. 2,186.
c Roth contributions to 401(k) & 403(b) plans
d Deferrals to government 457 plans
e Deferrals to non-government 457 plans
f Deferrals 409A nonqual deferred comp plan
g Income 409A nonqual deferred comp plan
h Uncollected Medicare tax
i Uncollected social security and RRTA tier 1
j Uncollected RRTA tier 2
k Income from nonstatutory stock options
l Non-taxable combat pay
m Total other items from box 12 7,323. 7,323.
14 a Total deductible mandatory state tax
b Total deductible charitable contributions
c This line does not apply to TurboTax
d Total RR Compensation
e Total RR Tier 1 tax
f Total RR Tier 2 tax
g Total RR Medicare tax
h Total RR Additional Medicare tax
i Total RRTA tips
j Total other items from box 14 1,073. 1,073.
16 Total state wages and tips 40,495. 40,495.
17 Total state tax withheld 1,635. 1,635.
19 Total local tax withheld
Form W-2 Wage and Tax Statement 2014
G Keep for your records

Name Social Security Number

Jonathan Vivar 043-98-8852

Spouse’s W-2 Military: Complete Part VI on Page 2 below

Do not transfer this W-2 to next year

a Employee’s social security No 043-98-8852 1 Wages, tips, other 2 Federal income

b Employer’s ID number 06-0853106 compensation tax withheld
c Employer’s name, address, and ZIP code 40,495.00 5,585.00
Capitol Region Educ. Council 3 Social security wages 4 Social security tax withheld
42,681.00 2,646.00
Street 111 CHARTER OAK AVENUE 5 Medicare wages and tips 6 Medicare tax withheld
City HARTFORD 42,681.00 619.00
State CT ZIP Code 06106 7 Social security tips 8 Allocated tips
Foreign Country
9 10 Dependent care benefits
d Control number
11 Nonqualified plans Distributions from sect. 457
X Transfer employee information from and nonqualified plans
the Federal Information Worksheet (Important, see Help)
e Employee’s name 12 Enter box 12 below
First Jonathan M.I.
Last Vivar Suff. 13 Statutory employee
f Employee’s address and ZIP code X Retirement plan
Street 229 Oak Street Third-party sick pay
City Manchester
State CT ZIP Code 06040 14 Enter box 14 below after entering boxes 18, 19, and 20.
Foreign Country NOTE: Enter box 15 before entering box 14.

Box 12 Box 12 If Box 12 code is:

Code Amount A: Enter amount attributable to RRTA Tier 2 tax
C 35.00 M: Enter amount attributable to RRTA Tier 2 tax
E 2,186.00 P: Double click to link to Form 3903, line 4
DD 7,288.00 R: Enter MSA contribution for Taxpayer
Spouse
W: Enter HSA contribution for Taxpayer
Spouse
G: Employer is not a state or local government

Box 15 Box 16 Box 17

State Employer’s state I.D. no. State wages, tips, etc. State income tax
CT 0547372001 40,495.00 1,635.00

Box 20 Box 18 Box 19 Associated

Locality name Local wages, tips, etc. Local income tax State

Box 14 TurboTax Identification of Description or Code

Description or Code (Identify this item by selecting the identification from
on Actual Form W-2 Amount the drop down list. If not on the list, select Other).
OPT. LTD 39.00 Other (not classified)
HEALTH PREMIUM 1,034.00 Other (not classified)
 Form 1095-OTH Health Insurance Coverage 2014

G Keep for your records

QuickZoom to Form 1095-A, Health Insurance Marketplace Statement

QuickZoom to Form 1095-B, Health Coverage
QuickZoom to Form 1095-C, Employer-Provided Health Insurance Offer and Coverage
QuickZoom to Form 1095, Worksheet
QuickZoom to Form 8962, Premium Tax Credit (PTC)
QuickZoom to Form 8965, Health Coverage Exemptions

Health Insurance Coverage for Individuals - This form may be used to report health insurance coverage information
for each individual whose health coverage is NOT reported on a Form 1095-A. If reporting an individual’s periods of
coverage from Form 1095-B or Form 1095-C, that individual’s health coverage information should not be reported below.

Check the box to populate the Name, SSN, and DOB for everyone listed on the return below.
Note: Checking this box again will repopulate the information below and overwrite existing entries.

Covered Individual:
a. Name of covered individual(s) Covered all
b. SSN c. DOB 12 months Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
17 Jonathan
043-98-8852 07/10/81 X X X X X X X X X X X X
18 Aida Vivar de Custodio
046-13-8267 08/19/40
19

20

21

22
 Wages, Salaries, & Tips Worksheet 2014
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

The following amounts are included in the total entered on line 7 of Form 1040 (or Form 1040A), on line 1
of Form 1040EZ, on line 8 of Form 1040NR:

Taxpayer Spouse Total

1 Wages, from Form W-2 40,495. 40,495.

2 Miscellaneous income, from Form 8919
3 Items from Form 1099-R:
a Disability before minimum retirement age
b Return of contributions
4 Excess reimbursement, from Form 2106
5a Taxable tips, from Form 4137
b Noncash tips
6 Excess moving expense reimbursement,
from Form 3903
7 Wages earned as a household employee (if
less than $1,800 and without a Form W-2)
8 Items not on Form W-2 or Form 1099-R:
a Sick pay or disability payments
b Total foreign source income
c Check this box if the amount on line 8b is
eligible for the foreign exclusion/deduction
d Ordinary income from employer stock
transactions not reported on Form W-2
9 Other earned income

10 Subtotal.
Add lines 1 through 9 40,495. 40,495.
11 Taxable employer-provided dependent care
benefits, from Form 2441
12 Taxable employer-provided adoption benefits
less any excluded benefits from Form 8839
13 Scholarship/fellowship income not on
Form W-2
14 Other non-earned income

15 Total of lines 10 through 14 40,495. 40,495.

 Schedule D Unrecaptured Section 1250 Gain Worksheet 2014
Line 19 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Regular Alternative
Tax Minimum Tax

If you are not reporting a gain on Form 4797, line 7, skip lines 1
through 9 and go to line 10.
1 If you have a section 1250 property in Part III of Form 4797 for
which you made an entry in Part I of Form 4797 (but not Form
6252), enter the smaller of line 22 or line 24 of Form 4797 for that
property. If you did not have any such property, go to line 4. 1
2 Enter the amount from Form 4797, line 26g, for the property for
which you made an entry on line 1 2
3 Subtract line 2 from line 1 3
4 Enter the total unrecaptured section 1250 gain included on lines
26 or 37 of Form(s) 6252 from installment sales of trade or
business property held more than one year 4
5 Enter the total of any amounts reported on a Schedule K-1 from a
partnership or an S corporation as "unrecaptured section 1250
gain". 5
6 Add lines 3 through 5 6
7 Enter the smaller of line 6 or the gain from Form
4797, line 7 7
8 Enter the amount, if any, from Form 4797, line 8 8
9 Subtract line 8 from line 7. If zero or less, enter -0- 9
10 Enter the amount of any gain from sale of an interest in a
partnership attributable to unrecaptured section 1250 gain 10
11 Enter the total of any amounts reported to you as "unrecaptured
section 1250 gain" from an estate, trust, real estate investment
trust or mutual fund
Regular AMT
a On Form 1099-DIV
b On Form 2439
c On Schedule(s) K-1
d On Form 1099-R
e From Form 8814
f Other
Total 11
12 Enter the total of any unrecaptured section 1250 gain from sales
(including installment sales) or other dispositions of section 1250
property held more than 1 year for which you did not make
an entry in Part I of Form 4797 for the year of sale 12
13 Add lines 9 through 12 13
14 If you had any section 1202 gain or collectibles gain or (loss),
enter the total of lines 1 thru 4 of the 28% Rate Gain Worksheet.
Otherwise, enter -0- 14 0. 0.
15 Enter the (loss), if any, from Schedule D, line 7. If Schedule D, line
7, is zero or a gain, enter -0- 15 0. 0.
16 Enter your long-term capital loss carryovers from Schedule D, line
14, and Schedule K-1 (Form 1041), line 11, code C 16
a Enter your capital gain excess, if you are filing Form 2555 a 0.
17 Combine lines 14 through 16a. If the result is a (loss), enter it as a
positive amount. If the result is zero or a gain, enter -0- 17 0. 0.
18 Unrecaptured section 1250 gain. Subtract line 17 from line 13. If
zero or less, enter -0-. If more than zero, enter the result here and
on Schedule D, line 19 18
 Schedule D 28% Rate Gain Worksheet 2014
Line 18 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Regular Alternative
Tax Minimum Tax

1 Enter the total of all collectibles gain or (loss) from items you
reported on Form 8949, Part II 1
2 Enter as a positive number the amount of any section 1202
exclusion you reported in column (g) of Form 8949, Part II, with
code "Q" in column (f), for which you excluded 50% of the
gain, plus 2/3 of any section 1202 exclusion you reported in
column (g) of Form 8949, Part II, with code "Q" in column (f),
for which you excluded 60% of the gain, plus 1/3 of any
section 1202 exlusion you reported in column (g) of Form 8949,
Part II, with code "Q" in column (f) for which you excluded
75% of the gain.
50 % 60 % 75%
Exclusion Exclusion Exclusion
a Schedule D
b Form 8814
c Schedule B
d Form 6252
e Form 2439
f Other
Total 2
3 Enter the total of all collectibles gain or (loss) from:
Regular AMT
a Form 4684, line 4 (but only
if line 15 is more than zero)
b Form 6252
c Form 6781, Part II
d Form 8824
Total 3
4 Enter the total of any collectibles gain reported to you on:
Regular AMT
a Form 1099-DIV, box 2d
b Form 2439, box 1d
c Schedule K-1 from a
partnership, S corporation,
estate, or trust
d Disposition of interest in
partnership or S corporation
e Other
Total 4
5 Enter your long-term capital loss carryovers from Schedule D,
line 14, and Schedule K-1 (Form 1041), line 11, code C 5
6 If Schedule D, line 7, is a (loss), enter that (loss) here.
Otherwise, enter -0-. 6
7 Combine lines 1 through 6. If zero or less, enter -0-. If more
than zero, also enter this amount on Schedule D, line 18 7
8 Enter the amount of any capital gain excess 8 0.
9 Subtract line 8 from line 7. If zero or less, enter -0-.
Enter this amount on Schedule D Tax Worksheet, line 11a 9 0. 0.
 Form 1040 Schedule D Tax Worksheet 2014
Line 44 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

1 a Enter your taxable income from Form 1040, line 43 1a 25,848.

b Enter the amount from your (and your spouse’s) Form 2555, line 45 b
c Add lines 1a and 1b 1c 25,848.
2 a Enter your qualified dividends
from Form 1040, line 9b 2a
b Enter any capital gain excess
attributable to qualified dividends b
c Subtract line 2b from line 2a 2c
3 Amount from Form 4952, line 4g 3
4 a Amount from Form 4952, line 4e 4 a
b Amount from the dotted line
next to Form 4952, line 4e b
c Line 4b, if applicable, 4a, if not c
5 Subtract line 4c from line 3. 5 0.
6 Subtract line 5 from line 2c. If zero or less, enter -0- 6 0.
7 a Enter line 15 of Schedule D 7a
b Enter line 16 of Schedule D b
c Enter the smaller of line 7a or line 7b 7c 0.
8 Enter the smaller of line 3 or line 4c 8
9 a Subtract line 8 from line 7. 9a 0.
b Enter any capital gain excess attributable to
capital gains b
c Subtract line 9b from line 9a 9c 0.
10 Add lines 6 and 9c 10 0.
11 a Enter the amount from Schedule D, line 18 11 a 0.
b Enter the amount from Schedule D, line 19 b
c Add lines 11a and 11b 11 c 0.
12 Enter the smaller of line 9c or line 11c 12 0.
13 Subtract line 12 from line 10 13 0.
14 Subtract line 13 from line 1c. If zero or less, enter -0- 14 25,848.
15 Enter:
? $36,900 if single or married filing separately;
? $73,800 if married filing jointly or qualifying widow(er); or 15 36,900.
? $49,400 if head of household.
16 Enter the smaller of line 1c or line 15 16 25,848.
17 Enter the smaller of line 14 or line 16 17 25,848.
18 Subtr ln 10 from ln 1c. If zero or less, enter -0- 18 25,848.
19 Enter the larger of line 17 or line 18 19 25,848.
20 Subtract line 17 from line 16. This amount is taxed at 0% 20 0.
If lines 1c and 16 are the same, skip lines 21 through 41
and go to line 42. Otherwise, go to line 21.
21 Enter the smaller of line 1c or line 13 21
22 Enter the amount from line 20 (if line 20 is blank, enter -0-) 22
23 Subtract line 22 from line 21. If zero or less, enter -0- 23
24 Enter:
? $406,750 if single,
? $228,800 if married filing separately, 24
? $457,600 if married filing jointly or qualifying widow(er),
? $432,200 if head of household.
25 Enter the smaller of line 1c or line 24 25
26 Add lines 19 and 20 26
27 Subtract line 26 from line 25. If zero or less, enter -0- 27
28 Enter the smaller of line 23 or line 27 28
29 Multiply line 28 by 15% (.15) 29
30 Add lines 20 and 28 30
31 Subtract line 30 from line 21 31
32 Multiply line 31 by 20% (.20) 32

If Schedule D, line 19, is zero or blank, skip lines 33 through 38

and go to line 39. Otherwise, go to line 33.
33 Enter the smaller of line 9c above or Schedule D, line 19 33
34 Add lines 10 and 19 34
35 Enter the amount from line 1c above 35
36 Subtract line 35 from line 34. If zero or less, enter -0- 36
37 Subtract line 36 from line 33. If zero or less, enter -0- 37
38 Multiply line 37 by 25% (.25) 38
 If Schedule D, line 18, is zero or blank, skip lines 39 through 41
and go to line 42. Otherwise, go to line 39.
39 Add lines 19, 20, 28, 31, and 37 39
40 Subtract line 39 from line 1c 40
41 Multiply line 40 by 28% (.28) 41

42 Figure the tax on the amount on line 19. If the amount on line 19 is less than $100,000,
use the Tax Table to figure this tax. If the amount on line 19 is $100,000 or more,
use the Tax Computation Worksheet 42 3,420.
43 Add lines 29, 32, 38, 41, and 42 43 3,420.
44 Figure the tax on the amount on line 1c. If the amount on line 1c is less than $100,000,
use the Tax Table to figure this tax. If the amount on line 1c is $100,000 or more,
use the Tax Computation Worksheet 44 3,420.
45 Tax on all taxable income (including capital gains and qualified dividends).
Enter the smaller of line 43 or line 44. Also include this amount on Form 1040, line 44 45 3,420.
 Form 1040 Qualified Dividends and Capital Gain Tax Worksheet 2014
Line 44 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

1 Enter the amount from Form 1040, line 43 1

2 Enter the amount from Form
1040, line 9b 2
3 Are you filing Schedule D?
Yes. Enter the smaller of line 15
or 16 of Schedule D. If
either line 15 or 16 is blank
or loss, enter -0- 3
No. Enter the amount from Form
1040, line 13.
4 Add lines 2 and 3 4
5 If filing Form 4952 (used to figure
investment interest expense
deduction), enter any amount from line
4g of that form. Otherwise, enter -0-. 5
6 Subtract line 5 from line 4. If zero or less, enter -0- 6
7 Subtract line 6 from line 1. If zero or less, enter -0- 7
8 Enter:
$36,900 if single or married filing separately,
$73,800 if married filing jointly or qualifying widow(er), 8
$49,400 if head of household.
9 Enter the smaller of line 1 or line 8 9
10 Enter the smaller of line 7 or line 9 10
11 Subtract line 10 from line 9 (this amount taxed at 0%) 11
12 Enter the smaller of line 1 or line 6 12
13 Enter the amount from line 11 13
14 Subtract line 13 from line 12. 14
15 Enter:
$406,750 if single,
$228,800 if married filing separately, 15
$457,600 if married filing jointly or qualifying widow(er),
$432,200 if head of household.
16 Enter the smaller of line 1 or line 15 16
17 Add lines 7 and 11 17
18 Subtract line 17 from line 16. If zero or less, enter -0- 18
19 Enter the smaller of line 14 or line 18 19
20 Multiply line 19 by 15% (.15) 20
21 Add lines 11 and 19 21
22 Subtract line 21 from line 12 22
23 Multiply line 22 by 20% (.20) 23
24 Figure the tax on the amount on line 7. If the amount on line 7 is less than
$100,000, use the Tax Table to figure the tax. If the amount on line 7 is
$100,000 or more, use the Tax Computation Worksheet 24
25 Add lines 20, 23, and 24 25
26 Figure the tax on the amount on line 1. If the amount on line 1 is less than
$100,000, use the Tax Table to figure this tax. If the amount on line 1 is
$100,000 or more, use the Tax Computation Worksheet 26
27 Tax on all taxable income. Enter the smaller of line 25 or line 26 here and on
Form 1040, line 44. 27
 Tax Payments Worksheet 2014
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Estimated Tax Payments for 2014 (If more than 4 payments for any state or locality, see Tax Help)

Federal State Local

Date Amount Date Amount ID Date Amount ID

1 04/15/14 04/15/14 04/15/14

2 06/16/14 06/16/14 06/16/14

3 09/15/14 09/15/14 09/15/14

4 01/15/15 01/15/15 01/15/15

Tot Estimated
Payments

Tax Payments Other Than Withholding Federal State ID Local ID

(If multiple states, see Tax Help)

6 Overpayments applied to 2014

7 Credited by estates and trusts
8 Totals Lines 1 through 7
9 2014 extensions

Taxes Withheld From: Federal State Local

10 Forms W-2 5,585. 1,635.

11 Forms W-2G
12 Forms 1099-R
13 Forms 1099-MISC and 1099-G
14 Schedules K-1
15 Forms 1099-INT, DIV and OID
16 Social Security and Railroad Benefits
17 Form 1099-B St Loc
18 a Other withholding St Loc
b Other withholding St Loc
c Other withholding St Loc
d Positive Adjustment St Loc
e Negative Adjustment St Loc
f Additional Medicare Tax
19 Total Withholding Lines 10 through 18f
5,585. 1,635.
20 Total Tax Payments for 2014 5,585. 1,635.

Prior Year Taxes Paid In 2014 State ID Local ID

(If multiple states or localities, see Tax Help)

21 Tax paid with 2013 extensions

22 2013 estimated tax paid after 12/31/2013
23 Balance due paid with 2013 return
24 Other (amended returns, installment payments, etc)
 Schedule A Tax and Interest Deduction Worksheet 2014
Lines 5 - 12 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Tax Deductions

1 State and local taxes:

Optional Sales Tax Tables
a Available Income:
(1) Income from Form 1040, line 38 39,948.
(2) Nontaxable income entered elsewhere on return
(3) Available income: 2013 refundable credits in excess of tax 0.
(4) Enter any additional nontaxable income
(5) Total available income 39,948.
b Sales Tax Per State of Residence:
Enter state in column (1), then enter total (combined) state and local sales tax rate in column (4).
Colorado, Illinois, Louisiana, New Jersey, New York or South Carolina only:
Double-click in column (4) to select your locality for each state entered.

(1) (2) (3) (4) (5) (6) (7) (8) (9)

S Date Date Enter State Local State Local Prorated
t Lived in Lived in Total Sales Sales Sales Sales or Total
a State State State & Tax Tax Tax Tax Amount
t From To Local Rate Rate (%) Table Amount
e Rate (%) (%) (4) - (5) Amount

c Total general sales tax using tables

d Sales Tax Paid on Specific Items (see help):

(1) (2) (3) (4) (5) (6) (7) (8)

ST Total Description Type Cost Rate if Actual Specific
State & Different Sales Tax Item
Local Amount Deduction
Rate Paid

e Total sales tax deduction on specific items

f Total general sales tax per tables plus sales tax on specific items
g Actual State and Local General Sales Tax:
Actual sales taxes (enter the total sales taxes paid during the year on all items)
h State and Local Income Taxes:
State and Local Income taxes 1,635.00
i State and Local Tax Deduction to Schedule A, line 5:
Greater of line 1f, line 1g, or line 1h (to Schedule A, line 5) 1,635.00
j Check a box to choose to use income taxes paid, sales taxes paid, or whichever
provides the greater deduction:
Income Taxes Sales Taxes Greater amount X

2 Real estate taxes:

a Real estate taxes paid on principal residence not entered on Form 1098
 b Real estate taxes paid on principal residence entered on Form 1098
c Real estate taxes paid on additional homes or land
Personal portion of real estate taxes from Schedule E Worksheet for:
d Principal residence
e Vacation home
f Less real estate taxes deducted on Form 8829
g Add lines 2a through 2f (to Schedule A, line 6)
3 Personal property taxes:
a Auto registration fees based on the value of the vehicle.
2013 Amount Enter 2014 description:

b Non-business portion of personal property taxes from Car & Truck Exp Wks
c Other personal property taxes
d Add lines 3a through 3c (to Schedule A, line 7)
4 Other taxes:
a Other taxes from Schedule(s) K-1
b Foreign taxes from interest and dividends
c Foreign taxes from Schedule(s) K-1
d Other foreign taxes (not used to claim a foreign tax credit)
e Other taxes.
2013 Amount Enter 2014 description:

f Add lines 4a through 4e (to Schedule A, line 8)

Interest Deductions

5 Home mortgage interest and points reported on Form 1098:

a Mortgage interest and points from the Home Mortgage Interest Worksheet
b Qualified mortgage interest from Schedule E Worksheet
c Less home mortgage interest/points deducted on Form 8829
d Less home mortgage interest from Form 8396, line 3
e Add lines 5a through 5d (to Sch A, line 10) or line A2 from above
6 Home mortgage interest not reported on Form 1098:
a Mortgage interest from the Home Mortgage Interest Worksheet
b Less home mortgage interest deducted on Form 8829
c Add lines 6a and 6b (to Sch A, line 11) or line B2 from above
7 Points not reported on Form 1098:
a Amortizable points from the Home Mortgage Interest Worksheet
b Other points not on Form 1098 from the Home Mortgage Interest Worksheet
c Less points deducted on Form 8829
d Add lines 7a through 7c (to Schedule A, line 12) or line C2 from above
 Schedule A State and Local Tax Deduction Worksheet 2014
Line 5 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

State and Local Income Taxes

State income taxes:

1 State income tax withheld 1 1,635.
2 2014 state estimated taxes paid in 2014 2
3 2013 state estimated taxes paid in 2014 3
4 Amount paid with 2013 state application for extension 4
5 Amount paid with 2013 state income tax return 5
6 Overpayment on 2013 state income tax return applied to 2014 tax 6
7 Other amounts paid in 2014 (amended returns, installment payments, etc.) 7
8 State estimated tax from Schedule(s) K-1 (Form 1041) 8
Local income taxes:
9 Local income tax withheld 9
10 2014 local estimated taxes paid in 2014 10
11 2013 local estimated taxes paid in 2014 11
12 Amount paid with 2013 local application for extension 12
13 Amount paid with 2013 local income tax return 13
14 Overpayment on 2013 local income tax return applied to 2014 tax 14
15 Other amounts paid in 2014 (amended returns, installment payments, etc.) 15
16 Local estimated tax from Schedule(s) K-1 (Form 1041) 16
Other:
17 17
18 Total Add lines 1 through 17 18 1,635.
19 State and local refund allocated to 2014 19
20 Nondeductible state income tax from line 28 20
21 Total reductions Add lines 19 and 20. 21
22 Total state and local income tax deduction Line 18 less line 21 22 1,635.

Nondeductible State Income Tax (Hawaii Only)

23 Nontaxable federal employee cost of living allowance 23

24 Adjusted gross income 24
25 Add lines 23 and 24 25
26 Nondeductible percent. Line 23 divided by line 25 26 %
27 Hawaii state income tax included in line 18 27
28 Nondeductible Hawaii state income tax. Multiply line 26 by line 27. 28
 Charitable Deduction Limits Worksheet 2014
For Current Year Contributions
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Step 1. List your qualified charitable contributions made during the year.
1 RESERVED for future use
Step 2. List your other charitable contributions made during the year.
2 Enter your contributions to 50% limit organizations. Do not include contributions of capital
gain property deducted at fair market value. Do not include contributions entered on line 1.
3 Enter your contributions to 50% limit organizations of capital gain property deducted at fair
market value
4 Enter your contributions (other than of capital gain property) to organizations that are not
50% limit organizations
5 Enter your contributions "for the use" of any qualified organization
6 Add lines 4 and 5
7 Enter your contributions of capital gain property to or for the use of any qualified
organization. (But do not enter here any amount entered on line 1 or 2)
Step 3. Figure your deduction for the year and your carryover to the next year.
8 Enter your adjusted gross income 39,948.
9 Multiply line 8 by 0.5. This is your 50% limit. 19,974.

Limits Deduct Carryover

this year to next
Cash and Other Capital gain year

50% Other 50% Other

Org Org

Contributions to 50% limit

organizations
10 Enter the smaller of line 2 or line 9 0.
11 Subtract line 10 from line 2 0.
12 Subtract line 10 from line 9 19,974.

Contributions not to 50% limit

organizations
13 Add lines 2 and 3
14 Multiply line 8 by 0.3. This is your 30%
limit. 11,984. 11,984.
15 Subtract line 13 from line 9 19,974.
16 Enter the smallest of line 6, 14, or 15 0.
17 Subtract line 16 from line 6 0.
18 Subtract line 16 from line 14 11,984.

Capital gain property to 50% limit

organizations
19 Enter the smallest of line 3, 12, or 14 0.
20 Subtract line 19 from line 3 0.
21 Subtract line 16 from line 15 19,974.
22 Subtract line 19 from line 14 11,984.

Capital gain property not to 50% limit

organizations
23 Multiply line 8 by 0.2. This is your 20%
limit. 7,990.
24 Enter the smaller of line 7, 18, 21, 22,
or 23 0.
25 Subtract line 24 from line 7 0.

26 Add lines 10, 16, 19, and 24.

Amount for Schedule A, Line 19 0.
27 Reserved for future use
28 Reserved for future use
29 Reserved for future use
30 Add lines 11, 17, 20, and 25. Carry
to next year. 0.
 Charitable Deduction Limits Worksheet 2014
For Carryover Contributions
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Step 1. List your qualified charitable contributions made during the year.
1 RESERVED for future use
Step 2. List your other charitable contributions made during the year.
2 Enter your contributions to 50% limit organizations. Do not include contributions of capital
gain property deducted at fair market value. Do not include contributions entered on line 1.
3 Enter your contributions to 50% limit organizations of capital gain property deducted at fair
market value
4 Enter your contributions (other than of capital gain property) to organizations that are not
50% limit organizations
5 Enter your contributions "for the use" of any qualified organization
6 Add lines 4 and 5
7 Enter your contributions of capital gain property to or for the use of any qualified
organization. (But do not enter here any amount entered on line 1 or 2)
Step 3. Figure your deduction for the year and your carryover to the next year.
8 Enter your adjusted gross income 39,948.
9 Multiply line 8 by 0.5. This is your 50% limit. 19,974. less 0. 19,974.

Limits Deduct Carryover

this year to next
Cash and Other Capital gain year

50% Other 50% Other

Org Org

Contributions to 50% limit

organizations
10 Enter the smaller of line 2 or line 9 0.
11 Subtract line 10 from line 2 0.
12 Subtract line 10 from line 9 19,974.

Contributions not to 50% limit

organizations
13 Add lines 2 and 3 0.
14 Multiply line 8 by 0.3. This is your 30%
limit. 11,984. 11,984.
15 Subtract line 13 from line 9 19,974.
16 Enter the smallest of line 6, 14, or 15 0.
17 Subtract line 16 from line 6 0.
18 Subtract line 16 from line 14 11,984.

Capital gain property to 50% limit

organizations
19 Enter the smallest of line 3, 12, or 14 0.
20 Subtract line 19 from line 3 0.
21 Subtract line 16 from line 15 19,974.
22 Subtract line 19 from line 14 11,984.

Capital gain property not to 50% limit

organizations
23 Multiply line 8 by 0.2. This is your 20%
limit. 7,990.
24 Enter the smaller of line 7, 18, 21, 22,
or 23 0.
25 Subtract line 24 from line 7 0.

26 Add lines 10, 16, 19, and 24.

Amount for Schedule A, Line 19 0.
27 Reserved for future use
28 Reserved for future use
29 Reserved for future use
30 Add lines 11, 17, 20, and 25. Carry
to next year. 0.
 Charitable Contributions Summary 2014
G Keep for your records
Name(s) Shown on Return Social Security Number
Jonathan Vivar 043-98-8852
Part I Cash Contributions Summary
(a) (b) (c) (d)
Name of Charitable Organization Total 50% 30% RESERVED
Limit Limit for future
use

Totals:

Part II Non-Cash Contributions Summary

Total Other Property Capital Gain Property

(a) (b) (c) (d) (e)

Name of Charitable Organization Total 50% 30% 30% 20%
Limit Limit Limit Limit

Totals:
Part III Contribution Carryovers to 2015
Total Cash and Other Capital Gain
Non-Capital Gain Property Property
(a) (b) (c) (d) (e) (f)
Total RESERVED 50% 30% 30% 20%
Limit Limit Limit Limit
1 2014 contributions
2 2014 contributions
allowed 0. 0. 0. 0. 0.
3 Carryovers from:
a 2013 tax year
b 2012 tax year
c 2011 tax year
d 2010 tax year
e 2009 tax year
4 Carryovers
allowed in 2014 0. 0. 0. 0. 0.
5 Carryovers
disallowed in 2014 0. 0. 0. 0. 0.
6 Carryovers to 2015:
a From 2014 0. 0. 0. 0. 0.
b From 2013
c From 2012
d From 2011
e From 2010
f From 2009 (expired)

Part IV Special Situations in Your Return for Current Year Donations

1 Was the entire interest given for all property donated to all charities? X Yes No
2 Were restrictions attached to any charities’s right
to use or dispose of any property donated to any charity? Yes X No
3 Did you give to anyone other than the charity the right to income from any
of the donated property or to possession of any of the donated property? Yes X No
4 Was any charity other than a 50% charity? Yes X No
 Schedule A Itemized Deductions Worksheet 2014
Line 29 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

1 Add the amounts on Schedule A, lines 4, 9, 15, 19, 20, 27 and 28 1 1,635.
2 Add the amounts on Schedule A, lines 4, 14 and 20, plus any gambling
and casualty or theft losses included on line 28 2
CAUTION: Be sure your total gambling and casualty or theft losses are clearly
identified on the Miscellaneous Itemized Deductions Statement.
3 Is the amount on line 2 less than the amount on line 1?
No. STOP. Your deduction is not limited. Enter the amount from
line 1 above on Schedule A, line 29.
X Yes. Subtract line 2 from line 1 3 1,635.
4 Multiply line 3 by 80% (.80) 4 1,308.
5 Enter the amount from Form 1040, line 38 5 39,948.
6 Enter $254,200 if single; $305,050 if married filing
jointly or qualifying widow(er); $279,650 if head of
household, $152,525 if married filing separately 6 254,200.
7 Is the amount on line 6 less than the amount on
line 5?
X No. STOP. Your deduction is not limited.
Enter the amount from line 1 above on
Schedule A, line 29.
Yes. Subtract line 6 from line 5 7
8 Multiply line 7 by 3% (.03) 8
9 Enter the smaller of line 4 or line 8 9
10 Total itemized deductions. Subtract line 9 from line 1.
(to Schedule A, line 29) 10
 Form 1040 Standard Deduction Worksheet for Dependents 2014
Line 40 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Use this worksheet only if someone can claim you, or your spouse if filing jointly, as a dependent.
1 Is your earned income* more than $650?
Yes. Add $350 to your earned income. Enter the total 1
No. Enter $1,000
2 Enter the amount shown below for your filing status.
? Single or married filing separately ' $6,200
? Married filing jointly or Qualifying widow(er) ' $12,400 2 6,200.
? Head of household ' $9,100
3 Standard deduction.
3 a Enter the smaller of line 1 or line 2. If born after January 1, 1950, and not
blind, stop here and enter this amount on Form 1040, line 40. Otherwise go
to line 3b 3a
3 b If born before January 2, 1950, or blind, multiply the number on Form 1040,
line 39a, by $1,200 ($1,550 if single or head of household) 3b
3 c Add lines 3a and 3b. Enter the total here and on Form 1040, line 40 3c

*Earned income includes wages, salaries, tips, professional fees, and other compensation received for
personal services you performed. It also includes any amount received as a scholarship that you must
include in your income. Generally, your earned income is the total of the amount(s) you reported on Form
1040, lines 7, 12, and 18, minus the amount, if any, on line 27; or on Form 1040A, line 7.
 Form 1040 Deduction for Exemptions Worksheet 2014
Line 42 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

1 Multiply $3,950 by the total number of exemptions claimed on Form

1040, line 6d 1 7,900.
2 Enter the amount from Form 1040, line 38 2 39,948.
3 Enter the amount shown below for your filing status:
? Single, enter $254,200
? Married filing jointly or qualifying widow(er), enter $305,050
? Married filing separately, enter $152,525
? Head of household, enter $279,650 3 254,200.
4 Subtract line 3 from line 2. If zero or less, stop; enter the amount from
line 1 above on Form 1040, line 42 4 -214,252.
5 Is line 4 more than $122,500 ($61,250 if married filing separately)?
Yes. You cannot take a deduction for exemptions.
Enter zero here and on Form 1040, line 42.
Do not complete the rest of this worksheet.
No. Divide line 4 by $2,500 ($1,250 if married filing separately). If the
result is not a whole number, increase it to the next whole number
(for example, increase .0004 to 1) 5
6 Multiply line 5 by 2% (.02) and enter the result as a decimal 6
7 Multiply line 1 by line 6 7
8 Deduction for exemptions. Subtract line 7 from line 1. Enter the result here
and on Form 1040, line 42 8
 Earned Income Worksheet 2014
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Part I ' Earned Income Credit Wks Computation Taxpayer Spouse Total

1 If filing Schedule SE:

a
Net self-employment income
b
Optional Method and Church Employee income
c
Add lines 1a and 1b
d
One-half of self-employment tax
e
Subtract line 1d from line 1c
2 If not required to file Schedule SE:
a Net farm profit or (loss)
b Net nonfarm profit or (loss)
c Add lines 2a and 2b
3 If filing Schedule C or C-EZ as a statutory
employee, enter the amount from line 1
of that Schedule C or C-EZ
4 Add lines 1e, 2c and 3. To EIC Wks, line 5

Part II ' Form 2441 and Standard Deduction Worksheet Computations

5 Net self-employment earnings (line 4 above)

6 Wages, salaries, and tips less distributions
from nonqualified or section 457 plans, etc 40,495. 40,495.
7 Taxable employer-provided adoption benefits
8 Add lines 5 through 7. To Form 2441, lines 19
and 20 40,495. 40,495.
9 a Taxable dependent care benefits
b Nontaxable combat pay
10 Add lines 8, 9a and 9b . To Form 2441, lines 4
and 5 40,495. 40,495.
11 Scholarship or fellowship income not on W-2
12 SE exempt earnings less nontaxable income
13 Distributions from nonqualified/Sec. 457 plans
14 Add lines 8, 9a and 11 through 13. To Standard
Deduction Worksheet 40,495. 40,495.

Part III ' IRA Deduction Worksheet Computation

15 Net self-employment income or (loss)

16 Wages, salaries, tips, etc 40,495. 40,495.
17 Net self-employment loss
18 Alimony received
19 Nontaxable combat pay
20 Foreign earned income exclusion
21 Keogh, SEP or SIMPLE deduction
22 Combine lines 15 through 21. To IRA Wks, ln 2 40,495. 40,495.

Part IV ' Schedule 8812 and Child Tax Credit Line 11 Worksheet Computations

23 Self-employed, church and statutory employees

24 Wages, salaries, tips, etc 40,495. 40,495.
25 Nontaxable combat pay
26 Foreign earned income exclusion
27 Combine lines 23 through 26. To Schedule
8812, line 4a & Line 11 Wks, line 2 40,495. 40,495.
 Form 4952 Investment Interest Expense Worksheet 2014
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Investment Interest Expense ( Form 4952, line 1)

1 Investment interest expense, from Schedule K-1 1
2 Investment interest expense from royalties 2
3 Other investment interest expense:
a 3a
b b
c c
d d
4 Total investment interest expense. Add lines 1 through 3. 4

Gross Income from Property Held for Investment (Form 4952, line 4a)
5 Taxable investment income:
a From Schedule B, Interest and Dividend Income 5a
b From Schedules K-1, Partnerships, S Corporations, Estates and Trusts b
c From Form 8814, Parents’ Election to Report Child’s Interest and Dividends c
d Total d
6 Royalty income, from Schedule E 6
7 Net passive income from publicly traded partnerships 7
8 Income from nonpassive trade or business without material participation 8
9 Other investment income:
a 9a
b b
c c
d d
10 Total investment income. Add lines 5d through 9. 10

Net Capital Gain Income (Form 4952, lines 4d and 4e)

Regular Tax Alt Min Tax

11 a Net gains from Schedule D, line 16 11 a

b Less net gains from property not held for investment b
c Net gains from property held for investment. c

12 a Net capital gains from Schedule D, lesser of ln 15 or ln 16 12 a

b Less net capital gains from property not held for investment b
c Net capital gains from property held for investment. c

Investment Expenses (Form 4952, line 5)

13 Royalty expenses 13
14 Investment expenses included as itemized deductions (after the 2% limitation) 14
15 Investment expenses included as itemized deductions (no 2% limitation) 15
16 Expenses from nonpassive trade or business without material participation 16
17 Other investment expenses:
a 17 a
b b
c c
d d
18 Total investment expenses. Add lines 13 through 17. 18

Allocation of Investment Interest Expense (Schedule A, line 14)

Regular Tax Alt Min Tax

19 Allowed investment interest expense, Form 4952, line 8 19

20 Less amount deducted on other forms and schedules: 20
a Deducted on Schedule E, page 2 for passthru entities a
b Deducted on Schedule E, page 1 for royalties b
c Other amounts deducted on other forms and schedules c
d Total amount deducted on other forms and schedules d
21 Investment interest expense. 21
 Form 1040 Earned Income Credit Worksheet 2014
Line 66 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

QuickZoom to Schedule EIC

QuickZoom to Dependent Information Worksheet to enter qualifying children information
QuickZoom to Wages, Salaries, & Tips Worksheet to enter earned and non-earned income
QuickZoom to page 2 of this worksheet, if credit is not calculated on line 7

1 Enter the amount from Form 1040 or 1040A, line 7, or Form 1040EZ, line 1,
less amounts considered not earned for EIC purposes 1 40,495.
2 Adjustments to line 1 amount:
a Income reported as wages and as self-employment income 2a
b Other income entered as wages that is not considered earned income b
c Distributions from section 457 and other nonqualified plans reported on W-2 c
3 Subtract lines 2a, 2b and 2c from line 1 3 40,495.
4a Taxpayer’s nontaxable combat pay election for EIC 4a
b Spouse’s nontaxable combat pay election for EIC b
c Total nontaxable combat pay election 4c
5 If you were self-employed or used Schedule C or Schedule C-EZ
as a statutory employee, enter the amount from the
Earned Income Worksheet, line 4 5
6 Earned income. Add lines 3, 4c, and 5 6 40,495.
7 Enter the credit, from the EIC Table, for the amount on line 6. Be sure to use
the correct column for filing status and number of children 7

If line 7 is zero, stop. You cannot take the credit.

Enter "No" on the dotted line next to Form 1040, line 66a.

8 Enter your AGI from Form 1040, line 38 8

9 If you have:
? No qualifying children, is the amount on line 8 less than $8,150
($13,550 if married filing jointly)?
? 1 or more qualifying children, is the amount on line 8 less than $17,850
($23,300 if married filing jointly)?

X Yes. Go to line 10 now.

No. Enter the credit, from the EIC Table, for the amount on line 8. Be
sure to use the correct column for filing status and number of children 9
10 Earned income credit.
? If ’Yes’ on line 9, enter the amount from line 7
? If ’No’ on line 9, enter the smaller of line 7 or line 9 10

Enter line 10 amount on Form 1040, line 66a, Form 1040A, line 42a, or Form 1040EZ, line 8a.
Jonathan Vivar 043-98-8852 Page 2

If one or more of the boxes below are checked, the earned income credit is not allowed.

1 The total taxable earned income (line 6 above) is equal to or more than:
X $14,590 ($20,020 if married filing jointly) without a qualifying child.
$38,511 ($43,941 if married filing jointly) with one qualifying child.
$43,756 ($49,186 if married filing jointly) with two qualifying children.
$46,997 ($52,427 if married filing jointly) with more than two qualifying children.

2 The Adjusted Gross Income (line 8 above) is equal to or more than:

X $14,590 ($20,020 if married filing jointly) without a qualifying child.
$38,511 ($43,941 if married filing jointly) with one qualifying child.
$43,756 ($49,186 if married filing jointly) with two qualifying children.
$46,997 ($52,427 if married filing jointly) with more than two qualifying children.

3 Investment income is more than $3,350.

(Investment Income Smart Worksheet, item H above)

4 The married filing separate return status is checked.

(Information Worksheet, Part II)

5 Taxpayer (or spouse if filing joint) is a qualifying child of another person.

(Information Worksheet, Part IV)

6 Without a qualifying child, and your (or your spouse’s, if married filing jointly)
main home is in the U.S. less than half the year.
(Information Worksheet, Part IV)

7 Without a qualifying child, and taxpayer (and spouse if filing joint) are under age 25
or over age 64.
(Information Worksheet, Part I)

8 Without a qualifying child, and taxpayer (or spouse if filing joint) is eligible to be claimed
as a dependent on someone else’s return.
(Information Worksheet, Part I)

9 Social Security Number is missing, or invalid for EIC purposes, for taxpayer, (or spouse,
if married filing joint).
(Information Worksheet, Part I)

10 Have qualifying children, but all are either

a qualifying children of another person, or
b have missing or invalid social security numbers for EIC purposes.
(Information Worksheet, Part III)

11 Disallowed by IRS to claim Earned Income Credit in 2014.

(Information Worksheet, Part IV)

12 Filing Form 2555, Foreign Earned Income.

13 Not a citizen or resident alien for the entire year, claiming dual status.
(Information Worksheet, Part VI)

14 Head of household filing status and lived with nonresident alien spouse during the last six
months of the year.
(Information Worksheet, Part IV)
 Page 3

Compliance and Due Diligence Information

1 Is the info about your income correct?

? I’ve entered all of my income.
? If I had any investment income, the total was under $3,350.
? I had no foreign earned income.
Yes, all of the above is correct.
No, I’ll go to Wages & Income and review what I entered.
Once you’ve reviewed your Wages & Income, come back and confirm your info is correct.

2 Is this info about you correct?

? I’m not filing my taxes as Married Filing Separately.
? I have a valid Social Security number.
? I was a U.S. citizen or resident alien for all of 2014.
? I lived in the U.S. for at least six months during 2014.
? I’m not the qualifying child or dependent of another person.
? If I have no qualifying children, I’m between 25 and 65 years old.
Yes, all of the above is correct.
No, I’ll go to Personal Info and review what I entered.
Once you’ve reviewed your Personal Info, come back and confirm your info is correct.

3 Is this info correct for all of your qualifying dependents for the Earned Income Credit?
? They are my children (or descendents of my children) and not married.
? They lived with me in the U.S. for more than half the year.
? They have valid Social Security numbers.
? They are not being claimed by anyone else specifically for the Earned Income Credit, as far as I know.
? They are under age 19, or under 24 and a full-time student, or permanently or totally disabled.
Yes, all of the above is correct.
No, I’ll go to Personal Info and review my dependent info.
OK, once you’ve reviewed your Personal Info, come back and confirm your info is correct.

Compliance and Due Diligence Indicator

The IRS expects everyone who gets the Earned Income Credit to meet all the requirements and be able
to show they’re eligible with proof such as documents.
 Form 1040A Student Loan Interest Deduction Worksheet 2014
Line 18 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Part I Information from Form(s) 1098-E, Student Loan Interest Statement

(a) (b) (c) (d) (e)

Lender’s name Borrower Borrower’s Prior Year Student loan
(Taxpayer, social security Student Loan interest
Spouse) number Interest (Box 1)

U.S Department of Education Taxpayer 043-98-8852 357. 547.

Total student loan interest 547.

Part II Computation of Student Loan Interest Deduction

1 Enter the total interest you paid in 2014 on qualified student loans 1 547.
(see Form 1040 instructions).
2 Enter the smaller of line 1 or $2,500 2 547.
3 Modified AGI 3 40,495.
Note: If line 3 is $80,000 or more if single, head of household, or qualifying
widow(er) or $160,000 or more if married filing jointly, stop here. You cannot
take the deduction.
4 Enter: $65,000 if single, head of household, or qualifying widow(er);
$130,000 if married filing jointly 4 65,000.
5 Subtract line 4 from line 3. If zero or less, enter -0- here and on line 7, skip
line 6, and go on to line 8 5 0.
6 Divide line 5 by $15,000 or $30,000 if married filing jointly.
Enter the result as a decimal (rounded to at least three places) 6
7 Multiply line 2 by line 6 7 0.
8 Student loan interest deduction. Subtract line 7 from line 2. Enter the result
here and on Form 1040, line 33. Do not include this amount in figuring any
other deduction on your return (such as on Schedule A, C, E, etc.) 8 547.

* Modified AGI is the amount from Form 1040, line 22, increased by any excludable income from Puerto
Rico, or of bona fide residents of American Samoa, Guam, or the Commonwealth of the Northern
Mariana Islands, and foreign earned income/housing exclusion, and decreased by amounts on
Form 1040, lines 23 through 32 and any write-in amount next to line 36, not including the
Foreign housing deduction on line A of the Other Adjustments to Income Smart Worksheet.
 Form 6251 Schedule D Tax Worksheet 2014
Line 37 as refigured for the
Alternative Minimum Tax
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

(a) (b) (c)

Before Allocation of After
Allocation of Capital Gain Allocation of
Capital Gain Excess * Capital Gain
Excess * Excess

1 Not applicable
2 Enter your total qualified dividends as refigured for
the Alternative Minimum Tax (AMT):
a Total qualified dividends
b Adjustment from Schedules K-1
c Other adjustments to qualified dividends
d Total. Combine lines 2a, 2b, and 2c 0. 0.
3 Enter the amount from Form 4952 for AMT, line 4g
4 Enter the amount from Form 4952 for AMT, line 4e
5 Subtract line 4 from line 3. If zero or less, enter -0- 0. 0.
6 Subtract line 5 from line 2. If zero or less, enter -0- 0. 0.
7 Net long-term capital gain:
a Enter the gain from line 15 of Schedule D
as refigured for the AMT 0.
b Enter the gain from line 16 of Schedule D
as refigured for the AMT 0.
c Enter the smaller of line 7a or line 7b 0. 0.
8 Enter the smaller of line 3 or line 4
9 Subtract line 8 from line 7c. If zero or less, enter -0- 0. 0. 0.
10 Add lines 6 and 9 0. 0.
A Enter the amount from Form 6251, line 30. 0.
B Capital gain excess. Subtract line A from line 10. * 0.
11 Total 28% rate and unrecaptured section 1250 gain:
a Enter the gain from line 18 of Schedule D
as refigured for the AMT 0.
b Enter the gain from line 19 of Schedule D
as refigured for the AMT
c Add lines 11a and 11b 0.
12 Enter the smaller of line 9 or line 11c 0.
13 Subtract line 12 from line 10. Also enter this amount
on Form 6251, line 37. 0.

* Capital gain excess applies only if filing Form 2555, Foreign Earned Income.
Form 6251 Form 1040A Worksheet 2014
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

1 Enter the amount from Form 1040A, line 22 1 39,948.

2 Enter the amount shown below for your filing status.
? Single or Head of Household, enter $52,800
? Married Filing Joint or Qualifying widow(er), enter $82,100
? Married Filing Separately, enter $41,050 2 52,800.
3 Subtract line 2 from line 1. If zero or less, stop here; you don’t owe this tax 3 -12,852.
4 Enter the amount shown below for your filing status.
? Single or Head of Household, enter $117,300
? Married Filing Joint or Qualifying widow(er), enter $156,500
? Married Filing Separately, enter $78,250 4
5 Subtract line 4 from line 1. If zero or less, enter -0- here and on line 6,
and go to line 7 5
6 Multiply line 5 by 25% (.25) 6
7 Add lines 3 and 6 7
8 If line 7 is $182,500 or less ($91,250 or less if married filing separately)
multiply line 7 by 26% (.26). Otherwise, multiply line 7 by 28% (.28) and
subtract $3,650 ($1,825 if married filing separately) from the result 8
9 Did you use the Qualified Dividends and Capital Gain Tax Worksheet to figure
the tax on the amount on Form 1040A, line 27?
No. Skip lines 9 through 19 enter the amount from
line 8 on line 20 and go to line 21,
Yes. Enter the amount from line 6 of that worksheet 9
10 Enter the smaller of line 7 or line 9 10
11 Subtract line 10 from line 7 11
12 If line 11 is $182,500 or less ($91,250 or less if married filing separately),
multiply line 11 by 26% (.26). Otherwise, multiply line 11 by 28% (.28) and
subtract $3,650 ($1,825 if married filing separately) from the result 12
13 Enter the amount shown below for your filing status:
? Single or married filing separately- $36,900
? Married filing jointly or qualifying widow(er) - $73,800
? Head of household- $49,400 13
14 Enter the amount from line 7 of Qualified Dividends and Capital Gain Tax Wkst 14
15 Subtract line 14 from line 13. If zero or less, enter -0- 15
16 Enter the smaller of line 10 or line 15 16
17 Subtract line 16 from line 10 17
18 Multiply line 17 by 15% (.15) 18
19 Add lines 12 and 18 19
20 Enter the smaller of line 8 or line 19 20
21 Enter the amount you would enter on Form 1040A, line 30, if you do not
owe this tax 21
22 Alternative Minimum Tax. Is the amount on line 20 more than the amount
on line 21?
No. You do not owe this tax.
Yes. Subtract line 21 from line 20. Also include this amount in the total
on Form 1040A, line 28. Enter "AMT" and show the amount in the
space to the left of ln 28 22
 Form 6251 Alternative Minimum Tax Worksheet 2014
G Keep for your records
Name(s) Shown on Return Social Security Number
Jonathan Vivar 043-98-8852

Taxable Income ' Line 1

1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41.
Otherwise, enter the amount from Form 1040, line 38. (If less than zero,
enter as a negative amount.) 1 39,948.
2 Additions to income 2
3 Add lines 1 and 2 3 39,948.
4 Subtractions from income 4
5 Subtract line 4 from line 3. Enter on Form 6251, line 1 5 39,948.

Taxes ' Line 3

1 Generation skipping transfer taxes included on Schedule A, line 8 1

Home Mortgage Interest Adjustment ' Line 4

(a) (b) (c)
NOT Total
Deductible Deductible Home
for AMT for AMT Mortgage
Purposes Purposes Interest

1 Attributable to mortgage used to purchase, build, or

improve:
a Main home or second home that is house, apartment,
condominium or non-transient mobile home
b Second home that is transient mobile home or boat
c Total
2 Attributable to mortgage used to refinance:
a To pay off mortgage
b For other purposes
c Total
3 Attributable to other mortgage deductible for AMT:
a Pre-July 1, 1982 mortgage

4 Total column (a)

5 Total column (b). Enter result on Form 6251, line 4.
6 Total mortgage interest from Schedule A

Refund of Taxes ' Line 7

1 Taxable refund of state and local income tax 1 0.
2 Amount and description of any refund of state and local personal property
taxes, foreign income or real property taxes deducted after 1986 2
3 Total tax refund adjustment. Enter on Form 6251, line 7 3 0.
Alternative Tax Net Operating Loss Deduction (ATNOLD) ' Line 11

1 Alternative minimum taxable income (AMTI) without ATNOLD 1 39,948.

2 Enter adjustments 2
3 Adjustment for domestic production activities deduction 3
4 Adjusted AMTI without ATNOLD. Add lines 1-3 4 39,948.
5 ATNOLD limitation. Multiply line 4 by 90% 5 35,953.
6 Enter ATNOL carried to 2013 from other year(s) 6
7 Enter ATNOL included above attributable to qualified disaster losses 7
8 ATNOL above not attributable to qualified disaster losses. Line 6 minus 7 8
9 ATNOL deduction other than qualified disaster losses. Lesser of line 5 or 8 9
10 ATNOL Disaster Deduction. Lesser of line 7 or (line 4 minus line 9) 10
11 ATNOLD. Add lines 9 and 10. Enter on Form 6251, line 11, as neg 11

Incentive Stock Options ' Line 14

1 Incentive stock options adjustment from Schedule K-1 worksheets 1

2 Incentive stock options from Employer Stock Transaction Worksheets 2
3 Incentive stock options from Exercise of Stock Options Worksheets 3
4 Other incentive stock options 4
5 Total incentive stock options. Enter on Form 6251, line 14 5
Jonathan Vivar 043-98-8852 Page 3
Alternative Minimum Taxable Income ' Line 28

If married filing separately and Form 6251, line 28, is more than $242,450:
1 Alternative minimum taxable income, Form 6251 1
2 Threshold amount 2
3 Subtract line 2 from line 1 3
4 Multiply line 3 by 25% (.25) 4
5 Smaller of line 4 or $41,050 5
6 Add line 1 and line 5. Enter on Form 6251, line 28 6

Exemption ' Line 29

1 Enter $52,800 if single or head of household, $82,100 if married filing jointly

or qualifying widow(er), $41,050 if married filing separately 1 52,800.
2 Enter your alternative minimum taxable income from Form 6251, line 28 2 39,948.
3 Enter $117,300 if single or head of household, $156,500 if married filing
jointly or qualifying widow(er), $78,250 if married filing separately 3 117,300.
4 Subtract line 3 from line 2. If zero or less, enter -0- 4 0.
5 Multiply line 4 by 25% (.25) 5 0.
6 Subtract line 5 from line 1. If zero or less, enter -0- 6 52,800.
If any of the three conditions under Certain Children Under Age 24 apply, go
to line 7. Otherwise, enter this amount on Form 6251, line 29.
7 Minimum exemption amount for certain children under age 24 7
8 a Enter the child’s earned income, if any 8a
b Enter any adjustments b
9 Add lines 7, 8a and 8b. If zero or less, enter -0- 9
10 Enter the smaller of line 6 or line 9 here and on Form 6251, line 29. 10
 Form 6251 Foreign Earned Income 2014
Line 31 Alternative Minimum Tax Worksheet
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

1 Enter amount from Form 6251, line 30 1

2 a Enter amount from Form(s) 2555, lines 45 and 50 2a
b Enter the total amount of any itemized deductions or exclusions you could not
claim because they are related to excluded income 2b
c Subtract line 2b from line 2a. If zero or less, enter 0 2c
3 Add line 1 and line 2c. Enter the result here and on Form 6251 line 36 3
4 Tax on amount on line 3
? If you reported capital gain distributions directly on Form 1040, line 13; or
you reported qualified dividends on Form 1040, line 9b; or you had a gain
on both line 15 and 16 of Schedule D (Form 1040), enter the amount from
line 3 of this worksheet on Form 6251, line 36. Complete the rest of Part III
of Form 6251. However, before completing Part III, see Form 2555 to see
if you must complete Part III with certain modifications. Then enter the
amount from Form 6251, line 64 here.
? All Others: If line 3 is $182,500 or less ($91,250 or less if married filing
separately), multiply line 3 by 26% (.26). Otherwise, multiply line 3 by 28%
(.28) and subtract $3,650 ($1,825 if married filing separately) from
the result. 4
5 Tax on amount on line 2c. If line 2c is $182,500 or less ($91,250 or less if
married filing separately), multiply line 2c by 26% (.26). Otherwise, multiply
line 2c by 28% (.28) and subtract $3,650 ($1,825 if married filing separately)
from the result 5
6 Subtract line 5 from line 4. Enter here and on Form 6251, line 31. If zero or
less, enter 0 6
 Federal Carryover Worksheet 2014
G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

2013 State and Local Income Tax Information (See Tax Help)

(a) (b) (c) (d) (e) (f) (g)

State or Paid With Estimates Pd Total With- Paid With Total Over- Applied
Local ID Extension After 12/31 held/Pmts Return payment Amount
CT 1,486. 282.

Totals 1,486. 282.

Other Tax and Income Information 2013 2014

1 Filing status 1 1 Single 1 Single

2 Number of exemptions for blind or over 65 (0 - 4) 2
3 Itemized deductions 3 1,486. 1,635.
4 Check box if required to itemize deductions 4
5 Adjusted gross income 5 38,856. 39,948.
6 Tax liability for Form 2210 or Form 2210-F 6 3,300. 3,420.
7 Alternative minimum tax 7
8 Federal overpayment applied to next year estimated tax 8

QuickZoom to the IRA Information Worksheet for IRA information

Excess Contributions 2013 2014

9a Taxpayer’s excess Archer MSA contributions as of 12/31 9a

b Spouse’s excess Archer MSA contributions as of 12/31 b
10 a Taxpayer’s excess Coverdell ESA contributions as of 12/31 10 a
b Spouse’s excess Coverdell ESA contributions as of 12/31 b
11 a Taxpayer’s excess HSA contributions as of 12/31 11 a
b Spouse’s excess HSA contributions as of 12/31 b

Loss and Expense Carryovers 2013 2014

Note: Enter all entries as a positive amount

12 a Short-term capital loss 12 a

b AMT Short-term capital loss b
13 a Long-term capital loss 13 a
b AMT Long-term capital loss b
14 a Net operating loss available to carry forward 14 a
b AMT Net operating loss available to carry forward b
15 a Investment interest expense disallowed 15 a
b AMT Investment interest expense disallowed b
16 Nonrecaptured net Section 1231 losses from: a 2014 16 a
b 2013 b
c 2012 c
d 2011 d
e 2010 e
f 2009 f
Federal Carryover Worksheet page 2 2014
Jonathan Vivar 043-98-8852

Loss and Expense Carryovers (cont’d) 2013 2014

17 AMT Nonrecap’d net Sec 1231 losses from: a 2014 17 a

b 2013 b
c 2012 c
d 2011 d
e 2010 e
f 2013 f

Credit Carryovers 2013 2014

18 General business credit 18

19 Adoption credit from: a 2014 19 a
b 2013 b
c 2012 c
20 Mortgage interest credit from: a 2014 20 a
b 2013 b
c 2012 c
d 2011 d
21 Credit for prior year minimum tax 21
22 District of Columbia first-time homebuyer credit 22
23 Residential energy efficient property credit 23

Other Carryovers 2013 2014

24 Section 179 expense deduction disallowed 24

25 Excess a Taxpayer (Form 2555, line 46) 25 a
foreign b Taxpayer (Form 2555, line 48) b
housing c Spouse (Form 2555, line 46) c
deduction: d Spouse (Form 2555, line 48) d

Charitable Contribution Carryovers

26 2013 Carryover of Other Property Capital Gain

charitable contributions
from: (a) 50% (b) 30% (c) 30% (d) 20%

a 2013
b 2012
c 2011
d 2010
e 2009

27 2014 Carryover of Other Property Capital Gain

charitable contributions
from: (a) 50% (b) 30% (c) 30% (d) 20%

a 2014
b 2013
c 2012
d 2011
e 2010

28 Amount overpaid less earned income credit 2,160.

2013 State Capital Loss Carryovers (For users not transferring from the prior year)

State Short-term AMT Short-term Long-term AMT Long-term Capital Loss AMT Capital Loss
ID Capital Loss Capital Loss Capital Loss Capital Loss (combined) (combined)
for State for State for State for State for State for State
 Form 8582 Modified Adjusted Gross Income Worksheet 2014
Line 7 G Keep for your records

Name(s) Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Description Amount

Income

Wages 40,495.
Interest income before Series EE bond exclusion
Dividend income
Tax refund 0.
Alimony received
Nonpassive business income or loss
Royalty and nonpassive rental activities income or loss
Nonpassive partnership income or loss
Nonpassive S corporation income or loss
Nonpassive farm rental income or loss
Nonpassive farm income or loss
Nonpassive estate and trust income or loss
Real estate mortgage investment conduits
Business gains and losses from nonpassive activities
Capital gains and losses
Taxable IRA distributions
Taxable pension distributions
Unemployment compensation
Other income

Total income 40,495.

Adjustments

Educator expenses
Certain business expenses of reservists, performing artists, and government officials
Health savings account deduction
Moving expenses
Self-employed SEP, SIMPLE, and qualified plans
Self-employed health insurance deduction
Penalty on early withdrawals of savings
Alimony paid
Other adjustments

Total adjustments

Modified adjusted gross income 40,495.

 Two-Year Comparison 2014

Name(s) Shown on Return Social Security Number

Jonathan Vivar

Income 2013 2014 Difference %

Wages, salaries, tips, etc 39,213. 40,495. 1,282. 3.27

Interest and dividend income
State tax refund 0. 0. 0.
Business income (loss)
Capital and other gains (losses)
IRA distributions
Pensions and annuities
Rents and royalties
Partnerships, S Corps, etc
Farm income (loss)
Social security benefits
Income other than the above
Total Income 39,213. 40,495. 1,282. 3.27
Adjustments to Income 357. 547. 190. 53.22
Adjusted Gross Income 38,856. 39,948. 1,092. 2.81

Itemized Deductions
Medical and dental
Income or sales tax 1,486. 1,635. 149. 10.03
Real estate taxes
Personal property and other taxes
Interest paid
Gifts to charity
Casualty and theft losses
Miscellaneous
Phaseout of itemized deductions
Total Itemized Deductions 1,486. 1,635. 149. 10.03
Standard or Itemized Deduction 6,100. 6,200. 100. 1.64
Exemption Amount 7,800. 7,900. 100. 1.28

Taxable Income 24,956. 25,848. 892. 3.57

Income tax 3,300. 3,420. 120. 3.64

Additional income taxes
Alternative minimum tax
Total Income Taxes 3,300. 3,420. 120. 3.64
Nonbusiness credits
Business credits
Total Credits
Self-employment tax
Other taxes 298. 298.
Total Tax After Credits 3,300. 3,718. 418. 12.67
Withholding 5,460. 5,585. 125. 2.29
Estimated and extension payments
Earned income credit
Additional child tax credit
Other payments
Total Payments 5,460. 5,585. 125. 2.29
Form 2210 penalty
Applied to next year’s estimated tax
Refund 2,160. 1,867. -293. -13.56
Balance Due

Current year effective tax rate 8.56 %

 Tax Summary 2014
G Keep for your records

Name (s)
Jonathan Vivar

Total income 40,495.

Adjustments to income 547.
Adjusted gross income 39,948.
Itemized/standard deduction 6,200.
Exemption amount 7,900.
Taxable income 25,848.
Tentative tax 3,420.
Additional taxes
Alternative minimum tax
Total credits
Other taxes 298.
Total tax 3,718.
Total payments 5,585.
Estimated tax penalty
Amount Overpaid 1,867.
Refund 1,867.
Amount Applied to Estimate
Balance due 0.

Which Form 1040 to file?

You must use Form 1040A or Form 1040 because
you had a dependent.
 Compare to U. S. Averages 2014
G Keep for your records

Name(s) Shown on Return Social Security No

Jonathan Vivar 043-98-8852

Your 2014 adjusted gross income (AGI) 39,948.

National adjusted gross income range used below from 30,000. to 49,999.

Note: National average amounts have been adjusted for inflation. See Help for details.

Actual National
Selected Income, Deductions, and Credits Per Return Average

Salaries and wages 40,495. 37,697.

Taxable interest 952.
Tax-exempt interest 6,096.
Dividends 2,922.
Business net income 14,841.
Business net loss 7,313.
Net capital gain 3,834.
Net capital loss 2,342.
Taxable IRA 10,016.
Taxable pensions and annuities 18,353.
Rent and royalty net income 7,074.
Rent and royalty net loss 8,650.
Partnership and S corporation net income 15,446.
Partnership and S corporation net loss 11,514.
Taxable social security benefits 7,561.

Medical and dental expenses deduction 7,216.

Taxes paid deduction 1,635. 4,089.
Interest paid deduction 7,328.
Charitable contributions deduction 2,500.
Total itemized deductions 1,635. 16,110.

Child care credit 599.

Education tax credits 1,077.
Child tax credit 1,047.
Retirement savings contributions credit 196.
Earned income credit 1,470.

Other Information Actual National

Per Return Average

Adjusted gross income 39,948. 40,630.

Taxable income 25,848. 22,434.
Income tax 3,420. 2,925.
Alternative minimum tax 10,400.
Total tax liability 3,718. 3,081.
 ELECTRONIC POSTMARK - CERTIFICATION OF ELECTRONIC FILING

Taxpayer: Jonathan Vivar

Primary SSN: 043-98-8852

Federal Return Submitted: March 15, 2015 11:12 AM PDT

Federal Return Acceptance Date:

Your return was electronically transmitted on 03/15/2015

The Intuit Electronic Postmark shows the date and time Intuit received your federal tax return. The Intuit
Electronic Postmark documents the filing date of your income tax return, and the electronic postmark
information should be kept on file with your tax return and other tax-related documentation.

There are two important aspects of the Intuit Electronic Postmark:

1. THE INTUIT ELECTRONIC POSTMARK.

The electronic postmark shows the date and time Intuit received the federal return, and is deemed the
filing date if the date of the electronic postmark is on or before the date prescribed for filing of the
federal individual income tax return.

TIMELY FILING:
For your federal return to be considered filed on time, your return must be postmarked on or before
midnight April 15, 2015. Intuit’s electronic postmark is issued in the Pacific Time (PT) zone. If you are
not filing in the PT zone, you will need to add or subtract hours from the Intuit Electronic Postmark time
to determine your local postmark time. For example, if you are filing in the Eastern Time (ET) zone and
you electronically file your return at 9 AM on April 15, 2015, your Intuit electronic postmark will indicate
April 15, 2015, 6 AM. If your federal tax return is rejected, the IRS still considers it filed on time if the
electronic postmark is on or before April 15, 2015, and a corrected return is submitted and accepted
before April 20, 2015. If your return is submitted after April 20, 2015, a new time stamp is issued to
reflect that your return was submitted after the IRS deadline and, consequently, is no longer considered
to have been filed on time.

If you request an automatic six-month extension, your return must be electronically postmarked by
midnight October 15, 2015 If your federal tax return is rejected, the IRS will still consider it filed on time
if the electronic postmark is on or before October 15, 2015, and the corrected return is submitted and
accepted by October 20, 2015.

2. THE ACCEPTANCE DATE.

Once the IRS accepts the electronically filed return, the acceptance date will be provided by the Intuit
Electronic Filing Center. This date is proof that the IRS accepted the electronically filed return.
Jonathan Vivar 043-98-8852 1

Smart Worksheets from your 2014 Federal Tax Return

SMART WORKSHEET FOR: Form 1040A: Individual Tax Return

Tax Smart Worksheet

A Tax 3,420.
Check if from:
1 Tax table X
2 Qualified Dividends and Capital Gain Tax Worksheet
3 Form 8615
B Recapture tax from Form 8863
C Alternative minimum tax
D Tax. Add lines A through C. Enter the result here and on line 28 3,420.

SMART WORKSHEET FOR: Form 8960 Deduction Recoveries Worksheet

Line 9 - Recalculated Prior Year Net Investment Income Tax Smart Worksheet

A Prior year Form 8960, line 13, modified adjusted gross income 38,856.
B Prior year Form 8960, line 14, threshold based on filing status 200,000.
C Prior year Form 8960, line 15, Subtract line B from A, not less than zero
D Smaller of line 8 or line C
E Recomputed net investment income tax. Multiply line D by 3.8% (.038)
Jonathan Vivar 043-98-8852 2

SMART WORKSHEET FOR: Dependent Information Worksheet (Aida)

Dependency Exemption/EIC Smart Worksheet

NOTE: It is recommended that you answer the questions below using the Step-by-Step mode.
That will help insure that answers to the questions are not inconsistent.

A How many months did this person live with you?

Note: if born or died in current year and lived with you entire
time or qualified missing child select "The whole year". If
more than one-half the year select 7 or more The whole year
B Who are the parents of this person?
To determine if additional questions are necessary for
children of divorced parents.
Both Taxpayer and spouse
Taxpayer
Spouse
C Did this person provide more than 1/2 their own support? Yes X No
D Was this person married on December 31, 2014 and
filing a joint return for the year (You may answer no if the
only reason the joint return is filed is to get a refund of tax
withheld or estimated tax payments and neither spouse
would have a tax liability on their return if they filed
separate returns)? Yes X No
E Is this person a Full time student? Yes No
F Is this person’s gross income less than $3,950? X Yes No
1 Did you provide over 1/2 the support for this person?
or
Did you provide over 10% of the support for the person
and with other individuals who would be able to claim
the person except for the support test over 1/2 the
support and all of you have agreed that you alone will
claim the person and you have filled out the Multiple
Support Declaration, Form 2120, to attach to your return? X Yes No
G Is there an agreement with this person’s other parent
about who can claim this person as a dependent? Yes No
Note: The noncustodial parent claiming the exemption for
the child must attach to their return Form 8332 from the
custodial parent releasing the claim to the exemption
for the child
H Who will be claiming this person as a dependent as a result
of
an agreement between the parents
or
as a result of the rules controlling who can claim a qualifying
child when the child meets the conditions to be a
qualifying child of more than one person?
Taxpayer (includes spouse if married filing
joint) in this return? X
Other parent in different return?
Someone else in different return?
Jonathan Vivar 043-98-8852 3

SMART WORKSHEET FOR: Earned Income Credit Worksheet

Nontaxable Combat Pay Election Smart Worksheet

QuickZoom to enter nontaxable combat pay on Form W-2

A Taxpayer:
1 Taxpayer, nontaxable combat pay
2 Election for earned income credit (EIC):
Elect taxpayer’s nontaxable combat pay as earned income for EIC? Yes No
3 Election for dependent care benefits (DCB):
Elect taxpayer’s nontaxable combat pay as earned income for DCB? Yes No
4 Election for child and dependent care credit:
Elect taxpayer’s nontaxable combat pay as earned income
for child and dependent care credit? Yes No

B Spouse:
1 Spouse, nontaxable combat pay
2 Election for earned income credit (EIC):
Elect spouse’s nontaxable combat pay as earned income for EIC? Yes No
3 Election for dependent care benefits (DCB):
Elect spouse’s nontaxable combat pay as earned income for DCB? Yes No
4 Election for child and dependent care credit:
Elect spouse’s nontaxable combat pay as earned income
for child and dependent care credit? Yes No

C You may compare the tax benefit of electing or not electing by checking a box on line A or
line B and reviewing the overpayment or amount due below:

Overpayment 1,867. Amount due

SMART WORKSHEET FOR: Earned Income Credit Worksheet

Investment Income Smart Worksheet

A Taxable and tax exempt interest

B Dividend income
C Capital gain net income
D Royalty and rental of personal property net income
E Passive activity net income:
1 Rental real estate net income or loss
2 Farm rental net income or loss
3 Partnerships and S corporations net income or loss
4 Estates and trusts net income or loss
5 Total of lines 1 through 4
6 Total passive activity net income, line 5 if greater than zero
F Interest and dividends from Forms 8814
G Adjustments
H Total investment income, add lines A through G 0.

Is line H, total investment income over $3,350?

X No. You may take the credit.
Yes. Stop. You cannot take the credit.
 Do not send this sheet with your return.
Checklist for filing your Connecticut income tax return:
1. Be sure that Page 1 of your return is not printed on the back of this sheet.
2. Verify that the address lines on the return are correct and proper abbreviations are used.
3. If the Employer or Payer’s Federal ID # is not listed on Page 2, Lines 18a through 18e, Column A, all withholding
claimed will be disallowed and your return will not be successfully processed.
4. Do not attempt to remove or modify the solid boxes that print out on your return. Altering target marks may affect the
processing of your return.
5. Do not send “Draft” or “Unapproved” versions of your return. This will delay or stop the processing of your return.
6. Do not make manual (hand written or typed) corrections to your return; this is a machine readable return. Changes
may only be made by reentering information in your software and re-printing the return.
7. Do not use this return to change or amend previously filed returns. You must use Form CT-1040X to change or amend
a previously filed Connecticut income tax return. (File Form CT-1040X electronically at www.ct.gov/TSC using the
Taxpayer Service Center.)
8. Do not attach or send copies of forms W-2 or 1099.
9. Send all completed pages of CT-1040, Schedule CT-EITC, and Schedule CT-CHET. Send all four pages of your
completed return, both pages of your completed CT EITC schedule, the completed Schedule CT-CHET, and any other
supporting schedules.
10. Make check payable to: Commissioner of Revenue Services
11. To ensure proper posting, write your SSN(s) (optional) and “2014 Form CT-1040” on your check.
12. To mail your return, use the following addresses:
For all tax returns with payment:
Department of Revenue Services
PO Box 2935
Hartford CT 06104-2935
For refunds and tax returns without payment:
Department of Revenue Services
PO Box 5002
Hartford CT 06102-5002
13. Verify that all fields print completely and any preparer information is filled out and legible before filing this return. If
you find any errors, do not make manual changes. Re-enter information in your software and re-print the return.
14. If you wish to directly deposit a refund into a checking or savings bank account, confirm that Lines 25a through 25d
have been completed. You must enter bank information on both the federal and Connecticut returns for each to be
correctly deposited.

Do not send this sheet with your return.

Jonathan Vivar

REV 12/16/14 Intuit.cg.cfp.sp

 20
1401115553

Form CT-1040 - 2014, Page 1 of 4

Connecticut Resident Income Tax Return

Other taxable year, beginning: 2014 and ending:

Y S N FJ N FS N HH N QW

043 - 98 - 8852 - -
JONATHAN VIVAR N Dec.

N Dec.

229 OAK ST N CT-2210

N CT-8379 N CT-1040CRC

MANCHESTER CT 06040 

1. Federal adjusted gross income (from federal Form 1040, Line 37; Form 1040A, Line 21; or
Form 1040EZ, Line 4) 1. 39948
2. Additions to federal adjusted gross income (from Schedule 1, Line 39) 2. 0
3. Add Line 1 and Line 2 3. 39948
4. Subtractions from federal adjusted gross income (from Schedule 1, Line 50) 4. 0
5. Connecticut adjusted gross income: Line 4 subtracted from Line 3. 5. 39948
6. Income tax 6. 1459
7. Credit for income taxes paid to qualifying jurisdictions (from Schedule 2, Line 59) 7. 0
8. Line 7 subtracted from Line 6. If Line 7 is greater than Line 6, “0” is entered. 8. 1459
 9. Connecticut alternative minimum tax (from Form CT-6251) 9. 0
10. Add Line 8 and Line 9. 10. 1459
11. Credit for property taxes paid on your primary residence, motor vehicle, or both (from Schedule 3, Line 68) 11. 202
Do not send W-2 or 1099 forms.
Clip check here. Do not staple.

12. Line 11 subtracted from Line 10. If less than zero, “0” is entered. 12. 1257
13. Total allowable credits (from Schedule CT-IT Credit, Part 1, Line 11) 13. 0
14. Connecticut income tax: Line 13 subtracted from Line 12. If less than zero, “0” is entered. 14. 1257
15. Individual use tax (from Schedule 4, Line 69). If no tax is due, “0” is entered. 15. 0
16. Total tax: Add Line 14 and Line 15. 16. 1257

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REV 01/19/15 INTUIT.CG.CFP.SP
 1401215551 Form CT-1040, Page 2 of 4  043988852
17. Amount from Line 16 17.  1257
W-2, W-2G, and 1099 Information
Col. A - Employer or Payer’s Fed. ID # Col. B - CT Wages, Tips, etc. Col. C - CT Income Tax Withheld

18a. 06 - 0853106  40495 1635

18b. -  0 0
18c. -  0 0
18d. -  0 0
18e. -  0 0
18f. Additional Connecticut withholding (from Supplemental Schedule CT-1040WH, Line 3) 18f. 0
18. Total Connecticut income tax withheld: Amounts in Column C. 18. 1635
19. All 2014 estimated tax payments and any overpayments applied from a prior year 19. 0
20. Payments made with Form CT-1040 EXT 20. 0
20a. Earned income tax credit (from Schedule CT-EITC, Line 16) 20a. 0
20b. Claim of right credit (from Form CT-1040CRC, Line 6) 20b. 0
21. Total payments: Add Lines 18, 19, 20, 20a, and 20b. 21. 1635
22. Overpayment: If Line 21 is more than Line 17, Line 17 subtracted from Line 21. 22. 378
23. Amount of Line 22 you want applied to your 2015 estimated tax 23. 0
24. CHET contribution (from Schedule CT-CHET, Line 4) 24. 0
24a. Total contributions of refund to designated charities (from Schedule 5, Line 70) 24a. 0
25. Refund: Lines 23, 24, and 24a subtracted from Line 22. 25. 378
If you have not elected to direct deposit, the refund may be issued by debit card or check.
25a. Acct. type Y Ck. N Sv. 25b. Rout. # 211176891 25c. Acct. # 03016884447
25d. Refund going to a bank account outside the U.S. 25d. N 25e. Debit card
26. Tax due: If Line 17 is more than Line 21, Line 21 subtracted from Line 17. 26. 0
27. If late: Penalty entered. Line 26 multiplied by 10% (.10). 27. 0
28. If late: Interest entered.
Line 26 multiplied by number of months or fraction of a month late, then by 1% (.01). 28. 0
29. Interest on underpayment of estimated tax (from Form CT-2210) 29. 0
30. Total amount due: Add Lines 26 through 29. 30. 0
I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to
the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return
or document to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both. The declaration of
a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Home/cell telephone number
Your signature Date

 
Keep a copy for your records.

Spouse’s signature (if joint return) Date Daytime telephone number

  
Sign Here

Paid preparer’s signature Date Telephone number Preparer’s SSN or PTIN

  
Firm’s name, address, and ZIP code FEIN

 SELF-PREPARED
Third Party Designee - Complete the following to authorize DRS to contact another person about this return.
Designee’s name Telephone number Personal identification number (PIN)

  

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REV 01/19/15 INTUIT.CG.CFP.SP
 1401315559 Form CT-1040, Page 3 of 4  043988852

Schedule 1 - Modifications to Federal Adjusted Gross Income

31. Interest on state and local government obligations other than Connecticut 31. 0
32. Mutual fund exempt-interest dividends from non-Connecticut state or municipal government
obligations 32. 0
33. Reserved for future use. 33.
34. Taxable amount of lump-sum distributions from qualified plans not included in federal adjusted
gross income 34. 0
35. Beneficiary’s share of Connecticut fiduciary adjustment: Entered only if greater than zero. 35. 0
36. Loss on sale of Connecticut state and local government bonds 36. 0
37. Domestic production activities (from federal Form 1040, Line 35) 37. 0
38. Other - specify  38. 0
39. Total additions: Add Lines 31 through 38. 39. 0
40. Interest on U.S. government obligations 40. 0
41. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations 41. 0
42. Social Security benefit adjustment (from Social Security Benefit Adjustment Worksheet) 42. 0
43. Refunds of state and local income taxes 43. 0
44. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities 44. 0
45. 50% of military retirement pay 45. 0
46. Beneficiary’s share of Connecticut fiduciary adjustment: Entered only if less than zero. 46. 0
47. Gain on sale of Connecticut state and local government bonds 47. 0
48. CHET contributions Acct. #: 48. 0
49. Other - specify  49. 0
50. Total subtractions: Add Lines 40 through 49. 50. 0
Schedule 2 - Credit for Income Taxes Paid to Qualifying Jurisdictions
51. Modified Connecticut adjusted gross income 51. 0
Col. A Col. B

52. Qualifying jurisdiction’s name and two-letter code 52.  

53. Non-Connecticut income included on Line 51 and reported

on a qualifying jurisdiction’s income tax return 53. 0 0
54. Line 53 divided by Line 51 54. 0.0000 0.0000

55. Income tax liability: Line 11 subtracted from Line 6. 55. 0 0

56. Line 54 multiplied by Line 55 56. 0 0

57. Income tax paid to a qualifying jurisdiction 57. 0 0
58. Lesser of Line 56 or Line 57 58. 0 0
59. Total credit: Add Line 58, all columns. 59. 0

1401315559 1401315559
REV 01/19/15 INTUIT.CG.CFP.SP
 1401415557 Form CT-1040, Page 4 of 4  043988852
Schedule 3 - Property Tax Credit
Qualifying Property Primary Residence Auto 1 Auto 2

Name of Connecticut Tax Town or District   MANCHESTE 

Description of Property   2006,MITS 
Date(s) Paid   08012014 
  
Amount Paid 60. 0 61. 202 62. 0
63. Total property tax paid: Add Lines 60, 61, and 62. 63. 202
64. Maximum property tax credit allowed 64.  300
65. Lesser of Line 63 or Line 64. 65.  202
66. Property tax credit limitation decimal amount: If zero, the amount from Line 65 is entered on Line 68. 66.  0.00
67. Line 65 multiplied by Line 66. 67.  0
68. Line 67 subtracted from Line 65. 68. 202
Schedule 4 - Individual Use Tax

69a. Use tax at 1% (from Connecticut Individual Use Tax Worksheet, Section A, Column 7) 69a. 0

69b. Use tax at 6.35% (from Connecticut Individual Use Tax Worksheet, Section B, Column 7) 69b. 0

69c. Use tax at 7% (from Connecticut Individual Use Tax Worksheet, Section C, Column 7) 69c. 0

69. Individual use tax: Add Lines 69a, 69b, and 69c. 69.  0

Schedule 5 - Contributions to Designated Charities

70a. AR 70a. 0
70b. OT 70b. 0
70c. ES/W 70c. 0
70d. BCR 70d. 0
70e. SNS 70e. 0
70f. MR 70f. 0
70g. CBS 70g. 0
70. Total Contributions: Add Lines 70a through 70g. 70.  0
Taxpayer email

1401415557 1401415557
REV 01/19/15 INTUIT.CG.CFP.SP
 Connecticut Information Worksheet 2014
G Keep for your records

Part I ' Personal Information

Taxpayer: Spouse:
Last Name Vivar Last Name
First Name Jonathan First Name
Middle Initial Suffix Middle Initial Suffix
Social Security No. 043-98-8852 Social Security No.
Date of Birth 07/10/1981 Date of Birth
Date of Death Date of Death
Daytime Phone (860)533-2347 * Daytime Phone *
Home Phone * Home Phone *
* Check one box for taxpayer and one box for spouse to print daytime phone numbers on Form CT-1040
or CT-1040NR, page 2. Check daytime or home box to print on Form CT-1040EXT or CT-1040X.

Address 229 OAK ST Apt no.

City MANCHESTER State CT ZIP Code 06040
Taxpayer email address

Connecticut forms provide only two lines of 30 characters each for the main address (not including City,
State, and Zip). We may have abbreviated certain words in your address. If the address below is
incorrect or incomplete, please adjust. If using "c/o" or "Attn:", enter these on the first Address line only.
Address, Line 1 229 OAK ST
Address, Line 2

Part II ' Main Form

X Form CT-1040: Resident Tax Return (Long form)

Form CT-1040NR/PY: Nonresident Tax Return
Form CT-1040NR/PY: Part-Year Resident Tax Return
Connecticut residency dates (use MM/DD/YYYY format) From To

Part III ' Filing Status

X Single
Married filing jointly
Married filing separately
Spouse’s full name
Spouse’s social security number
Taxpayer did not live with spouse for the entire year
Head of household (with qualifying person)
Qualifying widow(er) with dependent child

Part IV ' Other Information

I qualify as a farmer or fisherman

Yes No
X My city and zip code of residence are different than what’s entered above
If so, enter resident City 5 digit resident Zip code
Jonathan Vivar 043-98-8852 Page 2

Part V ' Direct Deposit Information or Direct Debit Information

Yes No
X Elect direct deposit of state tax refund
Use direct debit of state tax payment (Electronic Filing Only)

Bank Information:
If you selected either of the options above, fill out the information below:
Name of Financial Institution (optional) American Eagle
Account type Checking X Savings
Routing number 211176891
Account number 03016884447

Payment date to withdraw from the account above

State balance-due amount from this return
Yes No
Elect to receive a state issued debit card instead of a paper check
International ACH Transactions
Yes No
X Will the funds for this refund (or payment) go to (or come from) an account outside the U.S.?

Part VI ' Third Party Designee Information

Yes No
Do you want to allow another person to discuss this return with Connecticut?

If Yes, complete the following:

Designee’s name
Designee’s phone number
Personal identification number

Part VII ' Extension Status

Yes No
X Tax return due date extended?
Extended due date
QuickZoom to Form CT-1040 EXT: Application for Extension of Time to File Inc Tax Return

Part VIII ' Amended Return

Filing a Connecticut amended return

Enter the tax year you are amending
Previous Connecticut payment made
Previous Connecticut refund received
QuickZoom to Form CT1040-X: Amended Income Tax Return

QuickZoom to Form CT-1040: Resident Income Tax Return

QuickZoom to Form CT-1040NR/PY: Nonresident and Part-Year Resident Income Tax Return

ctiw1201.SCR 04/30/15
Form CT-1040ES Estimated Tax Worksheet 2015
G Keep for your records

Name(s) Shown on Return Your Social Security Number

Jonathan Vivar 043-98-8852

Part I 2015 Estimated Tax Amount Options

1 Select One of Six Ways to Calculate the Required Annual Payment for 2015 Estimates:
a 100% of 2014 taxes (default, see Tax Help) X 1,257.
b 100% of tax on 2015 estimated taxable income 1,392.
c 90% of tax on 2015 estimated taxable income 1,253.
d 66-2/3% of tax on 2015 estimated taxable income (farmers and fishermen) 928.
e Equal to 100% of overpayment (no vouchers) 378.
f Enter total amount you want to use for estimates and check box
2 Selected estimated tax amount:
a 2015 Required Annual Payment based on your choice above 1,257.
b Estimated amount of 2015 state income tax withholding 1,635.
c Total of estimated tax payments required for 2015 (line 2a less line 2b) 0.
3 Select Estimated Tax Payment option:
a Calculate estimates if $1000 or more (default) X
b Calculate estimates if (specify amount) or more
c Calculate estimates regardless of amount
d Do not calculate estimates

Part II Overpayment Application Options

1 Amount of overpayment available (Form CT-1040, line 22,

or Form CT-1040NR/PY, line 24) 378.
2 Select Overpayment Application Amount Option:
a Apply none (refund entire overpayment) X
b Apply all (increase estimate if required)
c Apply to extent of total estimated tax and refund excess
d Apply to extent of first quarter amount and refund excess
e Enter amount you want to apply
f Amount applied to 2015 estimated tax 0.
g Overpayment to be refunded (line 1 less line 2f) 378.
3 Select Overpayment Application Sequence:
a X H Consecutively b H Evenly

Part III Rounding and Printing Options

1 Select Rounding Option:

aX H Round up to b H Round up to c H Round up to d H Round to
next $1 next $10 next $100 nearest $1
2 Select Voucher Printing Option:
a H Print (per Part I, lines 3a - c) b H Print only name, etc. c X H Do not print vouchers

Part IV Estimated Tax Payment Summary

1 2 3 4 Total
4/15/2015 6/15/2015 9/15/2015 1/15/2016

1 If you have already

made payments,
enter amounts
2 Indicate which payment is
due next. (e.g. if it is now
April 25, 2015, check col. 2) X

3 Required Payment
4 Overpayment applied
5 Net payment due

6 Voucher amounts

QuickZoom to voucher
Jonathan Vivar 043-98-8852 Page 2

Part V Changes to Income, Deductions and Withholding for 2015

2014 income and deductions are shown in the 2014 Actual column below.
*Caution: For each line in the 2015 Estimated column, enter the estimated 2015 amount if different
from 2014. Otherwise, the 2014 Actual amount will be used for that line. If zero, you must enter zero.

2014 Actual 2015 Estimated

1 Adjusted gross income 39,948.
2 Allowable Connecticut adjustments
3 Allowable credits from Schedule CT-IT Credit
4 Net credit for taxes paid to other jurisdictions
5 Connecticut alternative minimum tax
6 Income tax withheld 1,635.
Non- or part-year residents only:
7 Income from Connecticut sources
8 The greater of Part VII, line 3 or Part V, line 7

Part VI Filing Status for 2015

Choose your 2015 filing status:

X Single
Married filing jointly
Married filing separately
Head of household (with qualifying person)
Qualifying widow(er) with dependent child

Part VII 2015 Estimated Taxable Income and Tax

1 Federal adjusted gross income you expect in the 2015 taxable year (from
2015 federal Form 1040ES, 2015 Estimated Tax Worksheet, line 1) 1 39,948.
2 Allowable Connecticut modifications (additions or subtractions (to your AGI),
see instructions) 2
3 Connecticut adjusted gross income (combine line 1 and line 2)
Nonresidents and Part-Year Residents: Enter your Connecticut source
income if greater than your Connecticut adjusted gross income. 3 39,948.
4 Connecticut income tax 4 1,392.
5 Apportionment factor (Connecticut residents enter 1.0000. Nonresidents and
part-year residents, see instructions) 5 1.0000
6 Multiply line 5 by line 4 6 1,392.
7 Credit for income taxes paid to qualifying jurisdictions 7
8 Subtract line 7 from line 6 8 1,392.
9 Estimated Connecticut alternative minimum tax 9
10 Add line 8 and line 9 10 1,392.
11 Estimated allowable credits from Schedule CT-IT Credit 11
12 Total estimated income tax (subtract line 11 from line 10) 12 1,392.

Caution: Generally, you may owe interest if you do not prepay (through timely estimates, or withholding, or
both) the lesser of 100% of the income tax shown on your 2014 CT income tax return, or 90% of
the income tax shown on your 2015 CT income tax return. To avoid interest charges, make sure
your estimate is as accurate as possible. You may prefer to pay 100% of the income tax shown on your
2014 Connecticut income tax return.

CTIW0412.SCR 04/30/15
 Form Connecticut
CT-1040TCS Tax Calculation Schedule 2014
G Keep for your records

Name as Shown on Return Social Security No.

Jonathan Vivar 043-98-8852

1 Enter Connecticut adjusted gross income from Form CT-1040, Line 5, or Form
CT-1040NR/PY, Line 7. Form CT-1040NR/PY filers must enter income from
Connecticut sources if it exceeds Connecticut adjusted gross income 1
2 Enter the exemption amount from Table A, Personal Exemptions. If zero, enter 0 2
3 Connecticut Taxable Income: Subtract Line 2 from Line 1. If less than zero,
enter ’0.’ 3
4 Enter amount from Table B,Initial Tax Calculation 4
5 Enter amount from Table C, 3% Tax Rate Phase-Out Add-Back.
If zero, enter ’0.’ 5
6 Enter the amount from Table D, Tax Recapture. If zero, enter ’0.’ 6
7 Connecticut Income Tax: Add Lines 4, 5, and 6 7
8 Enter the decimal amount from Table E, Personal Tax Credits. If zero, enter ’0.’ 8
9 Multiply the amount on Line 7 by the decimal amount on Line 8 9
10 Connecticut Income Tax: Subtract Line 9 from Line 7. Enter here and on
Form CT-1040, Line 6 or Form CT-1040NR/PY, Line 8 10

ctia0801.SCR 04/30/15
 Social Security Benefit 2014
Adjustment Worksheet
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Name as Shown on Return Social Security Number

Jonathan Vivar 043-98-8852

Enter the amount from Form CT-1040, line 1 or Form CT-1040NR/PY, line 1 39,948.
If your filing status is single or filing separately, is the amount on Line 1 $50,000 or more?
Yes: Complete this worksheet.
X No: Do not complete this worksheet. Enter the amount of federally taxable Social
Security benefits you reported on federal Form 1040, Line 20b, or federal Form
1040A, Line 14b, on Form CT-1040, Line 42, or Form CT-1040NR/PY, Line 44.

If your filing status is filing jointly, qualifying widow(er), or head of household, is the amount
on Line 1 $60,000 or more?
Yes: Complete this worksheet.
No: Do not complete this worksheet. Enter the amount of federally taxable Social
Security benefits you reported on federal Form 1040, Line 20b, or federal Form
1040A, Line 14b, on Form CT-1040, Line 42, or Form CT-1040NR/PY, Line 44.

A Enter the amount reported on your 2014 federal Social Security Benefits
Worksheet, Line 1 A
If line A is zero or less, stop here and enter "0" on line 42, Form CT-1040,
or line 44, Form CT-1040NR/PY. Otherwise, go to line B.
B Enter the amount reported on your 2014 federal Social Security Benefits
Worksheet, Line 9 B
However, if filing separately and you lived with your spouse at anytime during
2014, enter the amount reported on Line 7 of your federal Social Security
Benefits Worksheet.
If line B is zero or less, stop here. Otherwise, go to Line C.
C Enter the lesser of Line A or Line B C
D Multiply Line C by 25% (.25) D
E Taxable amount of Social Security benefits reported on your 2014 federal
Social Security Benefits Worksheet, Line 18 E
F Social Security Benefit Adjustment ' Subtract Line D from Line E. Enter the
amount here and on Form CT-1040, line 42, or Form CT-1040NR/PY, line 44.
(If Line D is greater than or equal to Line E, enter "0") F

ctiw1701.SCR 04/30/15
 Tax Payments Worksheet 2014
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Name Social Security Number

Jonathan Vivar 043-98-8852

Tax Payments for the Current Year

State

Date Payment

1 First Payment
2 Second Payment
3 Third Payment
4 Fourth Payment

Additional Payments
5 Payment
Payment
Payment
Payment
Payment

6 Overpayment from previous year applied to current year 6

7 Amount paid with current year extension 7

8 Total tax payments 8

Income Taxes Withheld for the Current Year

9 State withholding on Forms W-2 9 1,635.

10 State withholding on Forms W-2G 10
11 State withholding on Forms 1099-R 11
12 a State withholding on Forms 1099-MISC 12 a
b State withholding on Forms 1099-G b
13 Other state tax withholding 13

14 Total income tax withheld 14 1,635.

15 Date return will be filed and balance paid 15 04/15/2015

OTHV0301.SCR 04/30/15
 Tax Summary 2014
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Name(s)
Jonathan Vivar

Federal adjusted gross income 39,948.

Adjustments to federal adjusted gross income
Connecticut adjusted gross income 39,948.
Total tax 1,257.
Total tax payments including earned
income tax credit 1,635.
Overpayment amount 378.
Amount applied to tax year 2015 estimated tax
Contribution amount
Refund amount 378.
Tax due
Penalty amount
Total tax due with penalty