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MODEL Tax Refund Form

This is a model tax refund form

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Cristi
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376 views7 pages

MODEL Tax Refund Form

This is a model tax refund form

Uploaded by

Cristi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
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ADIRA INTEREXCHANGE ‘VA RUGAM SA FOLOSITI LITERE DIN ALFABETUL ENGLEZESC! Prenume: LANA Al doilea prenume: DBL A. Nume: POP ESE Adresa de e-mail BNAMBRIBLO® YAHOO. COM Data nasteri 1993 [08/282 ia a z [co40-F44- 62 274 40-74 620 25, Tipul rambursarii TRADITIONAL (90-150 de zile) RAPIO (45 de zile) EXPRES (7 de le) Numér Social Security: 4\(3) [2] — lle] ~ MHI Data in care ai ajuns in SUA: 20/6 3/961//f2 Pentru ce an(i) doresti ca RT Tax sé-ti recupereze taxele? ‘Ai mai aplcat pentru recuperarea acestor taxe la 0 alt8 companie sau individual? Cati angajatori ai avut: Data in care ai parasit SUA: 20/6. 2/7Q1/062 PUA Da x Incare stat ailucrat?, __ WH NY Jnw Informatii loc de munca Compania; WC _Donvacd P 2.Compania:_ DU/VKIN DONUTS. adresa: 22 4B STREET Adresa: LL RIVER STREET TH Cone NH, 5 ZAKE PLACID, NY, OOOO TeFax _0— 000- 0900 TelFax. 200 = 1-7, E-mail fre Lenal. ip @ yahoo. Cem E-mail: ddenupsG yahoo. On? ‘An formularl Wz sau URimul paylip dea in formolarul Wu um pays de estloc de munca mee OE CL tor deonnes cae 2 Mw Oo acd NU, doresc ca RT Tax sd-Irecupereze 03 [] Nu [ZX —dacS NU, doresc ca RT Tax sd-trecupereze 3 [] Nu elient notes 3. Compani Adres: Tel/Fax: E-mail ‘Am frmularl WFSBU URTOTPaT IB AETS— acest loc de muncé aOwO fr Tex notes: Daca NU, dovesc c@RT Tax se-recuperere da [] nu [— Income: 4. Companiz Taxes paid: Adresa: Tel/Fax: Emr Am formularul W-2 sau ultimul pay-sip dela, =. axestloc de munca ew acd NU, dovesc caRT Tax sé recuperere 08 [[] Nu [7 ‘Semnénd acest formular declar <8 informatile, oferite de mine sunt corecte si complete. x x Semnatura: Date: Information about Form 2648 and its instructions is at www.irs.gov/form2648. Na Power of Atomey ‘Caution: A separate Form 2848 must be completed for each taxpayer. Form 2648 will not be honored | Funcion “Telphore. for any purpose other than representation botor the IS. TET Taxpayer information. Taxpayer must sign and date ti erm on page ne 7. Taxpayer name and address AAV AIALIA POPESE “Taxpayer identification number(s) Dayle laphone rar | Plan number aoateabie R. LIVI REBREANU NR My , CLUJ-NAPOCA, CUT Y O44ly bLB_LID Hereby appoints te flowing representatve() as atomeVspir-fac 2_Representative(s) must sign and date this form on page 2, Par I. ‘Name and agaress Check ito be sent copies of notices and communications [1] | Check new: Address") Talaphone No. C] Fax No.) Name and address (CAF No. | PIN Telephone No. Fax Ne. Gheck if to be sent copies of notices and communications] Check i new: Address L] “Telephone No. [] “Fax No. 1 Name and address CAF No. Pm Telephone No. Fax No. (Note IS sends noes and communications toni wo represeriatves) | Checkit new: Adcres Name and adress (Note: IRS sends notices and communications to only wo representatives) _|_Check fnew Address [1 “Yeiestone No. CJ ""FaxNo. to represent the taxpayer before he Internal Revenue Service and perfarm the following acts: 3 ‘Acts authorized (you are required to complete this ine). With te exception ofthe ats desrbed inline S, | authorize my representatives to rcsive and inspect my confdental tax iformation and to perform acts hat can perform wih respect othe taxmaterscascrbed beon, For exam my representa) _hallhave the euthrty to sgn any agrees, consents or sine documents se instrctions frie Sa for authoringarepresentatie to sin areturh, Description of Mater car, Employne, Paya Exe, Etat, it, Wistbowe, Practoner Oe, PLR, FOV, Cv Peray, Sc. OCDA Shard enon Payment, Sec. 90H Stared Pesprsibiy Payne ec) ee stcters) “Tax Form Number (1040, 94, 720, st) if applicable) ‘Yea(s) r Periods) (fappicabl) (eee instructions} Ines ncome Tax 104062, 10¢0NR-£2, 1040NR, 4052 2016, 2016, 2014, 2013, ICA Tax 243, £316 2016, 2018, 2014, 2013 ‘State Income Tex 2018, 2015, 2014, 2018, “4 Specific use not recorded on Centralized Authorization File (CAP. I the power of aliormey efor a specific use not recordad on CAF, check ths box. See the instructions for Line 4, Specific Use Not Recorded on CAF > ‘5a Additional acts authorized. In action tothe acts listed online 2 above instructions frie Sa for more information): Diastnorizecisclosurete third parties; C] Substitute or ac representatives); Signa retum; Tuterze my repre] operon the folowing ot (eo Dd other acts authorized For Privacy Act and Paperwork Reduction Act Notice, ee the Instructions. ‘Cat No. OBR Fem D848 Fv i2-2075) Fom 2648 Rev. 12.2015) Pave 1b Specific acts not authorized. My representatives (are) not authorized to endorse or otherwise negotiate any check (ncluding directing or accepting payment by any means, electronic or ctherwse, nto an accaunt owned or conrad by the representatives) or any frm or other entry with whom the representatives) is (are) associated) issued by the government in respect ofa federal tax abil. st anyother specific deletions to the acts otherwise authorized inthis power of attomey (08 intructions for ine Sb), __ 6 Retention/revocation of prior power(s) of attomey. The ‘ing of this power of attomey automatically revokes all eater powers) of _attomey on fle with the Intemal Revenue Service for the same matters and years or peed covered by this cocument. If you do not want to revoke a prior power of attorney, cneckchere a 5 Se to EEE ‘YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT. 7. Signature of taxpayer. a tax matter concerns a yearn which a joint retum was fled, each spouse must fle @ separate power ofatorney even it they are appointing the same representatve(s) H signed by © corporate offer, partner, guardian, tax mettor parr, executor, receiver, {dministrator, or trustee on bel ofthe taxcayer, | cerity that have the legal author to execute this form on behalf ofthe taxpayer. > IF NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF ATTORNEY TO THE TAXPAYER. ‘Signature “ile Gt applicable) X_ANA PIPRIA POPESCU Priam Declaration of Representative Une penis of ay, by my sete bow dodare a + ar rot caren sutpenced or Gsbared tom retin orn for practice, before the eal Raver Sens +. sect oregon cortand Cr 250 (1 OF, SbtilA Pat Cas ance, govern orton before thine Revenue Sees "Tam authorized orepreent the txpayer atid in Par forthe ators) spesed hr: ane “amon ofthe fotowing 2: Atomey—a maberin god tard ofthe bar fhe highest court fhe juiscon shown below © Cored Puc Accoutart—loareed io proce asa eri pu courte save ne juson shown blow, € Erle Agent~ ero san ager byte inernl Revue Serve pe the requramans of Ger 290 4 Ofer boa de fer of he taxpayer egrzaton, ¢ Ful-TneEngoye a fine employee te taxpye. £ Famiy Merber— member ofthe texpayers immediate ay apse, pret ch grace, ranch, separ se ci, roeose 0 Ered Actuary evoled a an acuaryy the on Boar the vtmet of Acuaes unde 29.8. 42 Me aunty to prion toe tre imral Revenue Sere nied oy eston 10S ot Gree 29" 1 Unewated Ratu Preparer~ Ato orate before tented. An era elu prepare my repress coded th preparer) Drepared and grad te rum oro fr hun rpropura i tres ne spare space ov fc erty ene ee Oa eee afore hand TR: and) possess fe equ) Rua i Sesen Prem coe Canes few sea Fees tnd Requirements for Unrated Reta Preparers Ins raion lor seston wfsrnaton ‘ Surt Atomeyo” PA receives pemisono reper npayrs efor toy vine of ise tats a law, bss or accounting Sort worang in anor STOP Soe rucons fr Pan fey edstsad mioraeon easiness + Evol Rtremect Pan Agert cele a retreat pon agert nce te rqurements of Clr 20 the ahr to rate bore the iremal everve Sere tes by scion TOS > IF THils DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN PRAT LINE 2 Note: For designations d, enter your ttle, poston, of relationchip tothe taxpayer in the Licensing jurisiction® column. “int name of taxbayar rom line if ther than individual Designation [Sensing rscction] Bar, tcerse, cerfcaton, eaten eran | rpkraioy serait es =f seam sore | Soci mary | “Rane eptonie sia ce areal Form 2848 Fo. 12-2075) 8821 Tax Information Authorization | ert ear Information about Form 8821 and its instructions is at wow.irs. gov formB821. oad (ev, Mare 2019) > Do not sign this form unless all applicable lines have been completed. ere reas ed > Do not use Form 8821 to request copes of yur tax returns tral Revere Sov "| ‘orto authorize someone to represent you. = 1 Taxpayer information, Taxpayer must sign and date this form on line 7, Taxpayer name and address AN MALIA PEPEICT ‘Taxpayer Wentfication numberfa) Daytime telephone number] Plan number (f appicable) STR. Lact) REBREANUY Ve 14 ,CLUT ~NAP OCA, CLH 2 Appointee. If you wish to name more than one appointee, attach alist to this form. Check here it list of additional appointees is attached > [] Name and address CAF No. PTIN Telephone No, FaxNo, Check iffien: Address” EI Telephone No. ‘Tax Information. Appointee is authorized to inspect and/or receive confidential tax information forthe type of tax, forms, Periods, and specific matters you list below. See the line 3 instructions, Bienen ceed ana sa seas otae GR Pera Sor 46084 Baymont (1040, 941, 720, ete) Socal cote eas Ges asia wT ‘ Specine use not recorded on Cantralized Authorization Fle (CAP) the tx rfornation authorization is for a specific se not recorded on CAF, check this box. See the instructions. If you check this box, skp lines 8 and 6 '5_ Disclosure of tax information (you must check a box on line 6a or Sb unless the box on line 4 is checked 1 you want copies of tex formation, notes, and cher wren comranicatons cent tothe appre onan onging basis, check this box... Peel Note. Appointes wil no longer receive forms, publications, and other related materials with the notices, bbif you donot want any copies of notices or communications senfto your appointee, check thisbox .. . . . . he O © Retention/revocation of prior tax information authorizations. Ifthe line 4 box Is checked, skip this ne. Ifthe ine 4 box: isnot checked, the IRS will automatically revoke all prior Tax Information Authorizations on fle unless you check the line 6 bbox and attach a copy of the Tax Information Authorizations) that you want torretain. . oO “To revoke a prior tax information authorization() without submiting @ new authorization, see the ine 6 instructions. 7 Signature of taxpayer. If signed by a corporate officer, partner, guardian, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that Ihave the authority to execute this form with respect to the tax matters and tax Periods shown online 3 above. IF NOT COMPLETE, SIGNED, AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED. > DO NOT SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE. Xo pce ret \tol6 [41/24 ate Sonaure X__ANA NMpeIA POPESC Pont Nee Tie apnea) For Privacy Act and Paperwork Reduction Act Natice, ee instructions. (Cat No.8 Fem GB21 fan 52055) Agreement “a Srves greet (be “Agrees ese by a4 betwee: onto [29 one ete ree aa Lat acl Sea pom PT ANA. MAID. PopEree est 1OSIOE LB ee ee we OE Slates sai wiis Wa eiaeaaTa The Senee Poe provides rend and rete serves and me Cnt wanes recover he person income tx pi ef werk bond on hee The Paes sh oar onthe ems ad contin ax end Stet mater Ingerernce nth te ema and codes sti saree he ere Poe shallot the Chex a lund an ete servis shall a wp he cams ‘eesay ihe ered he ne plc he et the Ue Sas ofA, ied Kron eee ern, Seman, ora, and New en Aas ‘oberon nd shal resent he oh aresbndng ix are a he conpeea estos (earner) ance ion sat Ste ard ear ach {yin Azeemer the Chent aus the Serve roe pepe sgn anil astra torecee ll erespandnc, cng ae relud ches, om axauthres ‘Shvce roe wil necesay dase a Pe acing she oreo te chet sna hace reac ne area on Sena he ee “aes wb elo oh le by» bark aster ole refnded aout o the ark scour pepad cet cat by aban ease own he ame the let Tax [etnd hago rece, he Cheque salle coleced athe nuns srt aloe arson othe hr hy he Aeon Sees Pdr acrance the ere ‘aan tne Cleon agreement exteted between the Cent andthe alecan seves outer ‘The fal oun ees be eluded ral be estas competetive aun. The amas cused ye ere Poe at frinormaton Buse ory add not ene een fo clan he reisy let oun ome af own of Srscas, Toprende he cert rrmatn nthe ocamers thatthe Cher needs spt othe Sere Prove ft he orpose of ng ore a elu toeateescomsec ang sgh he eqed fms reueis ander elated decent an behalf he lent tesaomt he rere cers to the rapt athe” ther ose nsten at te epoch for atu {Skfom te Get shout the ocr of tea tod an ste ate rates ate Cents ee {Storaer te fax hetond chance Coecbon Sees Pav fe econ une te Colca cern exesed eee heen andthe lection Seve Frode toate he noun to vrtr he xen aman oe Calcion eres Prose bree wane ax eung amount tte cen a2 The hentherey ener: 32s. lepronde tothe Sema Mowe complete, wv ad acate frat nd doin ss and copes) ered ete coneltn ofthe tox refi The hent I ened te prone the nematon ether by ttg hs pape oma powded by Sovces Prod by Ang whe enneinarmatan Ta sala te See 222, lilnand sign an os ad ote acme eure fr he ongetan fhe tat eine 323, inten te Seve Poverty meh aves nt er an tan 5) athe on tr ter utr wastes he fended amount 3 part Shel ote actin ee eich se ot re Seether ye Src ere ee Poa, 224, myth vty tm ol ts Acme tabi am eeeng old series agrees th het ere Bowser 225 forte the sere Powder oe new enloyment or setcerseymentin rg ety 338. teint te Sere onder ef any danger nthe Chnts coat Gras hou oy ote changes tht may have nace tat fund. 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