Form

1040 U.S. Individual Income Tax Return 2013

Department of the Treasury - Internal Revenue Service

(99)

OMB No. 1545-0074

,20

IRS Use Only-Do not write or staple in this space.

For the year Jan. 1-Dec. 31, 2013, or other tax year beginning

,2013, ending

See separate instructions.

Your social security number

Your first name and initial

Last name

Tan Le
If a joint return, spouse's first name and initial Last name Home address (number and street). If you have a P.O. box, see instructions. Apt. no.

123-45-6789
Spouse's social security number

8000 Yord Road

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

BALTIMORE MD 21252Foreign country name Foreign province/county Foreign postal code

Filing Status
Check only one box.

1 2 3

Exemptions

6a b c

You Spouse Single 4 Head of household (with qualifying person). (See instructions.) Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, enter Married filing separately. Enter spouse's SSN above this child's name here.j and full name here. j 5 Qualifying widow(er) with dependent child X Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . . checked on j Boxes 6a and 6b 1 Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /if child under No. of children (4) V Dependents: (2) Dependent's (3) Dependent's under age 17
social security number relationship to you
qualifying for child tax credit (see instr.)

Last name If more than (1) First name four dependents, see instructions and check here j d Total number of exemptions claimed

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Income

Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . Tax-exempt interest. Do not include on line 8a . . . . 8b Attach Forms(s) Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . W-2 here. Also Qualified dividends . . . . . . . . . . . . . . . . . . . 9b attach Forms Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . W-2G and Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1099-R if tax was withheld. Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . Capital gain or (loss). Attach Schedule D if required. If not required, check here j If you did not Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . get a W-2, IRA distributions .......... 15a b Taxable amount . . . . see instructions. Pensions and annuities .... 16a b Taxable amount . . . . Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . Social security benefits .... 20a b Taxable amount . . . . Other income. List type and amount Combine the amounts in the far right col for lines 7 through 21.This is your total income Educator expenses . . . . . . . . . . . . . . . . . . 23 Adjusted Certain business expenses of reservists, performing artists, Gross and fee-basis gov. officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889 25 26 Moving expenses. Attach Form 3903 . . . . . . . . . 26 27 Deductible part of self-employment tax. Attach Schedule SE 27 28 Self-employed SEP, SIMPLE, and qualified plans . . . . 28 29 Self-employed health insurance deduction . . . . . . . 29 30 Penalty on early withdrawal of savings . . . . . . . . . 30 31a Alimony paid b Recipient's SSNj 31a 32 IRA deduction . . . . . . . . . . . . . . . . . . . . 32 33 Student loan interest deduction . . . . . . . . . . . . 33 34 Tuition and fees. Attach Form 8917 . . . . . . . . . . 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
BCA

7 8a b 9a b 10 11 12 13 14 15a 16a 17 18 19 20a 21 22 23 24

. .

. . .

. . .

. . .

. .

Make sure the SSN(s) above and on line 6c are correct.

Presidential Election Campaign

Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund.

on 6c who: . with you . lived did not live with

0 0 0 1

you due to divorce or separation (see instructions)

Dependents on 6c not entered above Add numbers on lines above

7 8a 9a 10 11 12 13 14 15b 16b 17 18 19 20b 21 22

10,000.

10,000.

36 37

10,000.
Form

1040 (2013)

Form 1040 (2013)

Tan Le
j

123-45-6789
.

Page

Tax and Credits

Standard Deduction for-

|People who
check any box on line 39a or 39b or who can be claimed as a dependent, see instructions.

| All others:
Single or Married filing separately, $6,100 Married filing jointly or Qualifying widow(er), $12,200 Head of household, $8,950

38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . 39a Check You were born before Jan. 2, 1949, Blind. j Total boxes if: Spouse was born before Jan. 2, 1949, Blind. checked j 39a b If your spouse itemizes on a separate return or you were a dual-status alien, check here j 39b 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Exemptions. If line 38 is $150,000 or less, multiply $3,900 by the number on line 6d. Otherwise, see instructions 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . 46 Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Foreign tax credit. Attach Form 1116 if required . . . . . 47 48 Credit for child and dependent care expenses. Attach Form 2441 48 49 Education credits from Form 8863, line 19 . . . . . . . 49 50 Retirement savings contributions credit. Attach Form 8880 50 51 Child tax credit. Attach Schedule 8812, if required . . . . 51 52 Residential energy credits. Attach Form 5695 . . . . . . 52 53 Other credits from Form: a 3800 b 8801 c 53 54 Add lines 47 through 53. These are your total credits . . . . . . . . . . . . . . . . 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- . . . . . . . . . .

38

10,000.

. .

. .

40 41 42 43 44 45 46

6,100. 3,900. 3,900. 0

. .

Other Taxes

Payments
If you have a qualifying child, attach Schedule EIC.

Refund
Direct deposit? See instructions

Amount You Owe Third Party Designee

56 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . 57 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . . 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59a Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . . 60 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 61 Add lines 55 through 60. This is your total tax . . . . . . . . . . . . . . . . . . . . . j 1,000. 62 Federal income tax withheld from Forms W-2 and 1099 . . 62 63 2013 estimated tax payments and amount applied from 2012 return 63 64a Earned income credit (EIC) . . . . . . . .NO . . . . . 64a b Nontaxable combat pay election 64b 65 Additional child tax credit. Attach Form 8812 . . . . . 65 66 American opportunity credit from Form 8863, line 8 . . . 66 67 Reserved . . . . . . . . . . . . . . . . . . . . . . . . 67 68 Amount paid with request for extension to file . . . . . . 68 69 Excess social security and tier 1 RRTA tax withheld . . 69 70 Credit for federal tax on fuels. Attach Form 4136 . . . . . 70 Re71 Credits from Form: a 2439 b 8885 d 71 served c 72 Add lines 62, 63, 64a, and 65 through 71. These are your total payments . . . . . . . j 73 If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check herej Routing Savings j b number j c Type: Checking j d Account number 75 Amount of line 73 you want applied to your 2014 estimated tax j 75 76 Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions j 77 Estimated tax penalty (see instructions) . . . . . . . . . . 77 Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes.

54 55 56 57 58 59a 59b 60 61

72 73 74a

1,000. 1,000. 1,000.

76 Complete below.

No

Sign Here
Joint return? See instructions Keep a copy for your records.

Designee's Personal identification Phone number (PIN) name no. Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature

Date

Your occupation

Daytime phone number

k l Spouse's signature. If a joint return, both must sign.

Print/Type preparer's name

Student
Date Spouse's occupation

443-866-1234
If the IRS sent you an Identity Protection PIN, enter it here (see inst.)

Preparer's signature

Date

Paid TOWSON UNIVERSITY Preparer Firm's name j TOWSON UNIVERSITY Use Only Firm's address j 8000 YORK RD
BALTIMORE MD 21252
BCA

Check if self-employed Firm's EIN Phone no.

PTIN

S20014366

j
Form

410-704-3781

1040 (2013)

Form

8879
j

IRS e-file Signature Authorization

Do not send to the IRS. This is not a tax return. j Keep this form for your records. Information about Form 8879 and its instructions is at www.irs.gov/form8879.

OMB No. 1545-0074

Department of the Treasury Internal Revenue Service

2013

Submission Identification Number (SID

Taxpayer's name

k l
Social security number

Tan Le
Spouse's name

123-45-6789
Spouse's social security number

Part I
1 2 3 4 5

Tax Return Information-Tax Year Ending December 31, 2013 (Whole Dollars Only)
. . . . . . . . . .

Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4) . . . . Total tax (Form 1040, line 61; Form 1040A, line 35; Form 1040EZ, line 10) . . . . . . . . . . . Federal income tax withheld (Form 1040, line 62; Form 1040A, line 36; Form 1040EZ, line 7) . Amount you owe (Form 1040, line 76; Form 1040A, line 45; Form 1040EZ, line 12).

Refund (Form 1040, line 74a; Form 1040A, line 43a; Form 1040EZ, line 11a; Form 1040-SS, Part I, line 12a) .

. . . . . . . . .

1 2 3 4 5

10,000. 1,000. 1,000.

Part II

Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)

Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 31, 2013, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgment of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable my Electronic Funds Withdrawal Consent. Taxpayer's PIN: check one box only

12345 to enter or generate my PIN ERO firm name Enter five numbers, but as my signature on my tax year 2013 electronically filed income tax return. do not enter all zeros I will enter my PIN as my signature on my tax year 2013 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. Your signature j Date j 04/16/2014
I authorize Spouse's PIN: check one box only to enter or generate my PIN ERO firm name Enter five numbers, but as my signature on my tax year 2013 electronically filed income tax return. do not enter all zeros I will enter my PIN as my signature on my tax year 2013 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. Spouse's signature j Date j I authorize

TOWSON UNIVERSITY

Practitioner PIN Method Returns Only-continue below

Part III Certification and Authentication-Practitioner PIN Method Only

ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.

52921498765
Do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the tax year 2013 electronically filed income tax return for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Publication 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns. ERO's signature j S20014366 TOWSON UNIVERSITY Date j 04/16/2014

ERO Must Retain This Form - See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see your tax return instructions.
BCA

Form

8879 (2013)

MARYLAND FORM

502

RESIDENT INCOME TAX RETURN

2013, ENDING Spouse's Social Security Number

2013
$

OR FISCAL YEAR BEG. Social Security Number

135020018
Attachment Sequence No. 02

123456789
Print Using Blue or Black Ink Only Your First Name Initial Last Name

Tan
Spouse's First Name Initial Present Address (No. and street)

Le
Last Name

8000 Yord Road

City or Town State ZIP code

BALTIMORE
Name of county and incorporated city, town or special taxing area in which you resided on the last day of the taxable period. (See Instruction 6)

MD
Maryland County

21252
City, Town or Taxing Area

BL
(If you can be claimed on another person's

FILING STATUS
See Instruction 1 to determine if you are required to file.

CHECK ONE BOXj

1. X Single tax return, use Filing Status 6.) 2. Married filing joint return or spouse had no income 3. Married filing separately j
Spouse's Social Security Number

4. 5. 6.

Head of household Qualifying widow(er) with dependent child Dependent taxpayer (Enter 0 in Exemption Box (A) - See Instruction 7)

PART-YEAR RESIDENT
See Instruction 26 If you began or ended legal residence in Maryland in 2013 place a P in the box

Exemptions

j
Place an M or P in this box

See Instruction 10. Check appropriate box(es). NOTE: If you are claiming dependents, you must attach the Dependents' Information Form 502B to this form in order to receive the applicable exemption amount.

X
j j

Yourself 65 or over Blind

Spouse

A. Enter No. Checked

1 See Instruction 10
x $1,000

A. $

3200

Dates of Maryland Residence

MO DAY YEAR

FROM TO
Other state of residence:

j j

65 or over Blind B. Enter No. Checked

......

B. $

Enter No. from line 3 of Dependent Form 502B............

See Instruction 10 C. $

MILITARY: If you or your spouse has non-MD military income, place an M in the box. (See Instruction 26) Enter amount here: INCOME

D Enter Total Exemptions (Add A, B and C) ............ j 1 Total Amount D. $ 3200 Check here if you authorize us to share your tax information with the Medical Assistance Program for help finding health insurance. .............................................................. j 1. Adjusted gross income from your federal return (See Instruction 11) ............................ j 1 10000 1a. Wages, salaries and/or tips (See Instruction 11) ................ j 1a 10000 1b. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Place CHECK or MONEY ORDER on top of your W-2 wage and tax statements and ATTACH HERE with ONE staple.

(See Instruction 12)

TO INCOME

ADDITIONS

10000 Earned income (See Instruction 11.) .......................... j 1b Tax-exempt interest on state and local obligations (bonds) other than Maryland .................. j State retirement pickup ...................................................................... j Lump sum distributions (from worksheet in Instruction 12) ...................................... j
Other additions (Enter code letter(s) from Instruction 12)

DEDUCTION METHOD (See Instruction 16)

Total additions to Maryland income (Add lines 2 through 5) .................................... j Total federal adjusted gross income and Maryland additions (Add lines 1 and 6) ................ Taxable refunds, credits or offsets of state and local income taxes included in line 1 above ...... j Child and dependent care expenses .......................................................... j Pension exclusion from worksheet in Instruction 13 ............................................ j Taxable Social Security and RR benefits (Tier I, II and supplemental) included in line 1 above .... j 12. Income received during period of nonresidence (See Instruction 26).............................. j 13. Subtractions from attached Form 502SU (See Instruction 13) j ........ j 14. Two-income subtraction from worksheet in Instruction 13 ...................................... j 15. Total subtractions from Maryland income (Add lines 8 through 14) .............................. j 16. Maryland adjusted gross income (Subtract line 15 from line 7) ...................................... (All taxpayers must select one method and check the appropriate box ) ..............................
STANDARD DEDUCTION METHOD (Enter amount on line 17) ITEMIZED DEDUCTION METHOD (Complete lines 17a and 17b)
........................................

..........

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

10000

SUBTRACTIONS FROM INCOME (See Instruction 13)

10000

......................................

X
j j
17 18 19 20

17a. Total federal itemized deductions (from line 29, federal Schedule A) .. j 17a. 17b. State and local income taxes (See Instruction 14.) .................. j 17b. Subtract line 17b from line 17a and enter amount on line 17. 17. Deduction amount (Part-year residents see Instruction 26 (l and m)) ............................ j 18. Net income (Subtract line 17 from line 16) .......................................................... 19. Exemption amount from Exemptions area above (See Instruction 10) ................................ 20. Taxable net income (Subtract line 19 from line 18) ..................................................
13-18

1500 8500 3200 5300

COM/RAD-009

MARYLAND FORM

502 2013

RESIDENT INCOME TAX RETURN

135020118

Page 2

NAME Le SSN 123456789 MARYLAND TAX COMPUTATION 21. Amount from line 20 (taxable net income) GO TO TAX TABLE in the Resident instructions. Enter the tax on line 22 21 5300 ........ 22. Maryland tax (from Tax Table or Computation Worksheet Schedules I or II) .................................. 22 200 23. Earned income credit (1/2 of federal earned income credit. See Instruction 18) .............................. j 23 24. Poverty level credit (See Instruction 18) .................................................................... j 24 500 25. Other income tax credits for individuals from Part H, line 8 of Form 502CR (Attach Form 502CR)................ 25 26. Business tax credits ................................ You must file this form electronically to claim business tax credits on Form 500CR. 27. Total credits (Add lines 23 through 26) ...................................................................... 27 500 28. Maryland tax after credits (Subtract line 27 from line 22) If less than 0, enter 0 ................................ 28 LOCAL TAX COMPUTATION 29. Local tax (See Instruction 19 for tax rates and worksheet.) Multiply line 21 by your local tax rate .0 283 or use the Local Tax Worksheet .................................................... 30. Local earned income credit (from Local Earned Income Credit Worksheet in Instruction 19.) .................... 31. Local poverty level credit (from Local Poverty Level Credit Worksheet in Instruction 19.) ........................ 32. Total credits (Add lines 30 and 31.) .......................................................................... 33. Local tax after credits (Subtract line 32 from line 29) If less than 0, enter 0 .................................... 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. Total Maryland and local tax (Add lines 28 and 33.) .......................................................... Contribution to Chesapeake Bay and Endangered Species Fund (See Instruction 20.) ........................ j Contribution to Developmental Disabilities Waiting List Equity Fund (See Instruction 20.) .................... j Contribution to Maryland Cancer Fund (See Instruction 20.) ................................................ j Total Maryland income tax, local income tax and contributions (Add lines 34 through 37.) ................ Total Maryland and local tax withheld (Enter total from your W-2 and 1099 forms if MD tax is withheld and attach.) .............................................................................................. j
2013 estimated tax payments, amount applied from 2012 return, payment made with an extension request, Form MW506NRS
..........

29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

150 283 283

1000

Refundable earned income credit (from worksheet in Instruction 21) ........................................ Refundable income tax credits from Part I, line 6 of Form 502CR (Attach Form 502CR. See Instruction 21.) .... Total payments and credits (Add lines 39 through 42.) ........................................................ .................................... Balance due (If line 38 is more than line 43, subtract line 43 from line 38.) .................................. j Overpayment (If line 38 is less than line 43, subtract line 38 from line 43.) .................................. j

j j

1000 1000 1000

Amount of overpayment TO BE APPLIED TO 2014 ESTIMATED TAX j 46 Amount of overpayment TO BE REFUNDED TO YOU (Subtract line 46 from line 45) See line 50 REFUND j 47 Interest charges from Form 502UP or for late filing (See Instruction 22) Total j 48 TOTAL AMOUNT DUE (Add lines 44 and 48) IF $1 OR MORE, PAY IN FULL WITH THIS RETURN .......... 49

DIRECT DEPOSIT OF REFUND (See Instruction 22.) Please be sure the account information is correct. For Splitting Direct Deposit, see Form 588. To comply with banking rules, please, check here j if this refund will go to an account outside the United States. If checked, see Instruction 22. Checking For the direct deposit option, complete the following information clearly and legibly. 50a. Type of account: j Savings 50b. Routing Number j 50c. Account number j (9-digit)

4438661234
Daytime telephone no. Home telephone no.
if you authorize your preparer to discuss this return with us. Check

j j
here if

Check here

you authorize your paid preparer not to file electronically. Check here if you agree to receive your 1099G Income Tax Refund statement electronically. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements and to the best of my knowledge and belief it is true, correct and complete. If prepared by a person other than taxpayer, the declaration is based on all information of which the preparer has any knowledge.

CODE NUMBERS (3 digits per box) Make checks payable and mail to: Comptroller of Maryland, Revenue Administration Division 110 Carroll Street, Annapolis, Maryland 21411-0001 (It is recommended that you include your Social Security number on check.)
Preparer's PTIN (required by law) Signature of preparer other than taxpayer

j S20014366
Your signature Date

8000 YORK RD
Spouse's signature Date Address of preparer

COM/RAD-009

13-18

BALTIMORE MD 21252 Telephone number of preparer 4107043781

DO NOT MAIL
MARYLAND FORM

EL101
Tan

e-File DECLARATION FOR ELECTRONIC FILING

131010018

2013

Keep this form for your records. Do not send this form to the State of Maryland unless requested to do so. See Instructions on Page 2. Taxpayer's first name and middle initial Last name SSN/Taxpayer identification Number

Le
Last name City or town

123456789
SSN/Taxpayer identification Number State ZIP code

Spouse's first name and middle initial

Present address (number and street)

8000 Yord Road

Part I

BALTIMORE

MD

21252 1000

1. Amount of overpayment to be applied to 2014 estimated tax .......................................... j 1. 2. Amount of overpayment to be refunded to you .............................................. REFUND j 2. 3. Total amount due (Pay in full by April 15, 2014. See instructions) .................................... j 3. If you file your Maryland Income tax return electronically by 4/15/14, you have until 4/30/14 to make your electronic payment. Direct deposit or direct debit options are not eligible for Amended returns.

Tax Return Information (whole dollars only)

Part II

Taxpayer Declaration and Signature Authorization

Direct Deposit of refund or Electronic Funds Withdrawal (direct debit)

Check appropriate box to consent to:

1. Amount to be withdrawn from / deposited in first account ...................................... j 1. Routing number (9-digit) j cj Checking Savings Account number j Direct Debit Settlement Date (Enter the date you want your payment withdrawn from your account.) 2. Amount to be deposited in second account .................................................. j 2. Routing number (9-digit) j cj Checking Savings Account number j 3. Amount to be deposited in third account Routing number (9-digit) j Account number j 4a.
......................................................

Checking

3. Savings

I consent that my refund be directly deposited as designated above and declare the information shown is correct. The State of Maryland is not responsible for a lost refund if I enter the incorrect account information. If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund. By consenting, I also agree to disclose to the Maryland State Treasurer's Office certain income tax information including name, amount of refund and bank information. This disclosure is necessary to effect direct deposit. I authorize the State of Maryland and its designated financial agent to initiate an electronic funds withdrawal payment (direct debit) to the financial institution account indicated on above for payment of my Maryland and local taxes owed, and the financial institution to debit the entry to this account. Upon confirmation of consent during the filing of my state return, this authorization is to remain in full force and effect, and I may not terminate the authorization. I also authorize the financial institutions involved in the processing of this electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment.

4b.

4c.

I do not want direct deposit of my refund or an electronic funds withdrawal (direct debit) of my balance due.

Under penalties of perjury, I declare that I have compared the information contained on my electronic return with the information that I provided to my electronic return originator or entered on-line and that the name(s), address and amounts described above agree with the amounts shown on the corresponding lines of my 2013 Maryland electronic income tax return. To the best of my knowledge and belief, my return is true, correct and complete. I consent that my return, including accompanying schedules and statements, be sent to the Maryland Revenue Administration Division by my electronic return originator or by my electronic return software provider. Please Sign Here

k l Taxpayer's signature

Date

k l Spouse's signature (if joint return, both must sign)

Date

Please wait ten (10) days after the receipt of a valid acknowledgement before calling 410-260-7701 from Central Maryland, or 1-800-218-8160 from elsewhere, about your refund.

Part III

Declaration of Electronic Return Originator (paid preparer)

I declare that I have reviewed the taxpayer's return and that the entries on this form are complete and correct to the best of my knowledge. I have obtained the taxpayer's signature before submitting the return to the Maryland Revenue Administration Division, have provided the taxpayer with a copy of all forms and information to be filed with the Maryland Revenue Administration Division, and have followed all other requirements described in the Handbook for Electronic Filers of Maryland Income Tax Returns. This declaration is to be retained at the site of the electronic return originator. Electronic Originator's k Date EFIN Return signature 04162014 529214 l Originator TOWSON UNIVERSITY Use Only Firm's name (or
yours if selfemployed) and address
COM/RAD-059 13-18

k 8000 YORK RD l BALTIMORE MD

ZIP code

Phone

21252

41070437