TaxReturn Kayla
TaxReturn Kayla
, a Delaware corporation
Early Refund Processing Agreement (“Agreement”)
This Agreement contains important terms, conditions and disclosures about the program for processing of your refund(s) (the “Early Refund Processing
Service” or “ERPS”) by Intuit Payments Inc, a subsidiary of Intuit Inc., a Delaware corporation (“IPI”, “we”, “our”, or “us”) using an account created for
you at a partner financial institution, such as Cross River Bank (“Bank”). If you participate in ERPS, you have chosen to receive your federal tax refund
five (5) days early, subject to eligibility.
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 2024 federal
income tax return(s) is a joint return (individually and collectively, “Applicant”). The words “we,” “us” and “our” refer to IPI. The ERPS includes money
transfer services provided by IPI, which is licensed as a money transmitter in the U.S. jurisdictions listed at:
[Link] While the ERPS is provided by IPI, under certain circumstances, IPI may not be required to
provide such services under its money transmitter licenses.
1. NOTICE: No Requirement To Use the Early Refund Processing Service In Order To File Electronically.
2. Authorization to Release Personal Information. You authorize the IRS to disclose any information to Bank and IPI related to the funding of your 2024
federal tax refund(s). You also authorize Intuit Inc., as the transmitter of your electronically filed tax return(s), Bank and IPI to disclose to each other
certain information about you and your tax return(s) for the purpose of providing the services contemplated under this Agreement and other services
offered by Intuit Inc. and its subsidiaries. You also represent that any authorizations you have made in this Section 2 have also been obtained from and
are made with respect to your spouse, if this is a jointly filed return. Please see the Privacy Policy at the end of this Agreement describing how IPI may
use or share your personal information.
3. Temporary Router Account Authorization. You hereby authorize us to establish a temporary router account (“Router Account”) for you at Bank for
the sole purpose of receiving your tax year 2024 federal tax refund(s) from the IRS. We must receive an acknowledgement from the IRS that your
return(s) has been electronically filed and accepted for processing before the Router Account can be opened. All fees discussed in this Section 3 are
each, a “Fee.” You authorize IPI to deduct from your federal tax refund and/or Router Account all of the following amounts: (i) the Early Refund
Processing Fee; (ii) if applicable, any fees for additional products and services purchased via TurboTax, and (iii) all applicable taxes (collectively, “Fees”).
By using the ERPS, you will receive your federal tax refund up to five (5) days early for an additional fee of $______.
25.00 IPI will deduct from the refund
amount the ERPS fee, if you receive your federal refund proceeds at least 5 days early.
You authorize us to disburse the balance of your refund(s) to you with the ERPS after making all authorized deductions for Fees. If your refund(s) does
not have sufficient funds to pay any portion of the Fees, you authorize us to disburse the entire refund amount to the account into which you
authorized IPI to deposit your expected tax refund proceeds as set forth in Section 6 (“Authorized Destination Account”).
4. Acknowledgements. (a) You understand that: (i) IPI cannot guarantee the amount of your tax year 2024 federal tax refund(s) or the date it will be
issued, and (ii) IPI’s role is limited to the ERPS described in this Agreement. IPI does not warrant the accuracy of the software used to prepare the tax
return(s). (b) You understand that (i) Intuit Inc. is the party that sends your tax return filings to the appropriate taxing authority and provides the
software used to prepare your tax return, and (ii) You agree that Intuit Inc. is not acting as your agent and is not under any fiduciary duty with respect
to the processing of your refund by IPI. Intuit Inc. does not provide the ERPS. Again, the ERPS is provided by IPI. (c) Your refund(s) may be held or returned
to the IRS if it is suspected of fraud or identity theft.
5. General Disclosures. The Router Account is being opened for the sole purpose of receiving your (or both spouses if this is a jointly filed return) tax
year 2024 federal tax refund(s). IPI will deduct from the refund amount the Fees, if you receive your federal refund proceeds at least 5 days early. No
Intuit, Inc
ATTN: 5DEE Inquiries
2535 Garcia Ave
Mountain View, CA 94043
6. Disbursement Method. You agree that the disbursement method selected below will be used by IPI to disburse funds to you.
By using the Direct Deposit method of disbursement, the balance of your refund amount, minus any authorized fees associated with the ERPS, will be
disbursed to you electronically by RTP or same day ACH direct disbursement to your Authorized Destination Account designated below. If your refund
does not qualify to be processed with the ERPS, the entire refund amount will be sent electronically by standard ACH. If a joint return is filed, the bank
account may be a joint account or the individual account of either spouse.
021200025
RTN#: __ __ __ __ __ __ __ __ __ ACCOUNT #: __ __5856406375
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Note: To ensure that there are no delays in receiving your refund(s), please contact your financial institution that maintains your Authorized
Destination Account to confirm that you are using the correct RTN (routing) and account number. IPI and Intuit Inc. are not responsible for the
misapplication of a direct disbursement that results from error, negligence or malfeasance on the part of you or your representative. In cases where
Bank, on behalf of IPI, has received your federal tax refund(s) but IPI is unable to deliver the funds directly to you (including, for example, if you or your
representative enter your account information incorrectly and your disbursement is returned to the Bank), funds may (i) be disbursed via check mailed
to your physical address of record, (ii) be held at Bank until claimed, or (iii) returned to the IRS. Due to the risk of fraudulent diversion of tax refunds, we
will not process any address or account changes for purposes of disbursing your tax refund(s). If we become aware that your address or checking or
savings account has changed after you sign this Agreement but before your federal tax refund(s) is received by us, upon receipt of your federal tax
refund(s) from the IRS or applicable state agency, we will return your tax refund(s) to the applicable agency. We will do our best to escalate the return
of your federal tax refund(s) to the applicable agency and you will need to work with the applicable agency directly for disbursement.
7. 5 Days Early. By using the ERPS, you will receive your federal tax refund up to five (5) days early for an additional fee of $______.
25.00 The availability of
the ERPS is subject to: (a) your bank’s participation in the Real‐Time Payments (RTP) system or eligibility to receive same day ACH, (b) availability of
funds for this program at the time you receive your refund, and (c) your federal tax refund is not greater than $20,000. You will not be charged the
$____
25.00 fee if (a) you select the ERPS and for any reason you are not eligible or (b) you do not receive your refund at least 5 days early. The ERPS may
change or discontinue at any time. If you are eligible for the ERPS, then you also authorize us to make all authorized deductions or payments owed to
us (or our affiliates that offer TurboTax), including for any Fees, prior to disbursing your federal tax refund to you five (5) days early.
8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES. In case of errors or questions about electronic transfers to or from the Router Account,
contact us either by telephone by calling 1‐800‐446‐8848 or write to Intuit Payments Inc c/o Intuit, Inc ATTN: 5DEE Inquiries 2535 Garcia Ave Mountain
View, CA 94043 and provide your name, a description or explanation of the error, and the dollar amount of the suspected error. We will determine
whether an error occurred within 10 business days after we hear from you and will correct any error promptly. If we need more time, however, we may
take up to 45 business days to investigate your complaint or question. If we decide to do this, we will credit your Router Account within 10 business
days of receiving the notice of error for the amount you think is in error, although in most circumstances you won’t have use of the money until we
complete our investigation. If we ask you to put your complaint or question in writing and we do not receive it within 10 business days, we may not
credit your Router Account. For errors involving transfers of funds to or from the Router Account within 30 business days after the first deposit to the
Router Account was made, (i) we may take up to 90 business days to investigate your complaint or question, and (ii) we may take up to 20 business days
to credit your Router Account for the amount you think is in error. We will tell you the results within three business days after completing our
investigation. If we decide that there was no error, we will send you a written explanation. You may ask for copies of the documents that we used in our
investigation.
Business Days: Our business days are Monday through Friday, excluding federal holidays. Saturday, Sunday, and federal holidays are not considered
business days, even if we are open.
Confidentiality: We will disclose information to third parties about your account or the transfers you make:
● To complete transfers as necessary;
● To verify the existence and condition of your account upon the request of a third party, such as a credit bureau or merchant;
● To comply with government agency or court orders;
● If you give us your written permission; or
● As explained in the Privacy Policy following this Agreement.
Our Liability: If we do not complete a transfer to your account on time or in the correct amount according to this Agreement, we may be liable for your
losses or damages. In addition to all other limitations of liability set forth in this Agreement, we will not be liable to you if, among other things:
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 laws
of Delaware.
* These amounts are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes. The above deductions will be subtracted from your
federal refund, where applicable.
11. Arbitration Provision. You acknowledge that the services set forth in this Agreement are being made available and priced by IPI on the basis of
your acceptance of the following arbitration provision (“Arbitration Provision”). By entering into this Agreement, you acknowledge that you are
giving up the right to litigate Claims (as defined below) if you or IPI elects arbitration of the Claims pursuant to this provision, except as otherwise
expressly provided herein, and you hereby knowingly and voluntarily waive the right to trial of all Claims subject to this Agreement. You further
acknowledge that you have read this Arbitration Provision carefully, agree to its terms, and are entering into this Agreement voluntarily and not in
reliance on any promises or representations whatsoever except those contained in this Agreement.
ARBITRATION NOTICE
THIS AGREEMENT CONTAINS AN ARBITRATION PROVISION. PLEASE READ THIS PROVISION CAREFULLY, AS IT AFFECTS YOUR LEGAL RIGHTS.
11.1. Arbitration of Claims: If you elect to seek arbitration, you must first send to IPI a written Notice of your Claim ("Notice of Claim"). The Notice of
Claim to IPI should be sent in care of our registered agent Corporation Service Company, 251 Little Falls Drive, Wilmington, DE 19808. The Notice of
Claim should include both the mailing address and email address you would like IPI to use to contact you. If IPI elects to seek arbitration, it will send, by
certified mail, a written Notice of Claim to your address on file. A Notice of Claim must (a) describe the nature and basis of the claim or dispute; and (b)
set forth the specific amount of damages or other relief sought.
You agree that good‐faith informal efforts to resolve disputes often can result in a prompt, low‐cost and mutually beneficial outcome. You and IPI
therefore agree that, after a Notice of Claim is sent but before either you or IPI commence arbitration or file a claim in small claims court against the
other, we will personally meet, via telephone or videoconference, in a good‐faith effort to confer with each other and try to resolve informally any Claim
covered by this Agreement. If you are represented by counsel, your counsel may participate in the conference as well, but you agree to fully participate
in the conference. Likewise, if IPI is represented by counsel, its counsel may participate in the conference as well, but IPI agrees to have a company
representative fully participate in the conference. The statute of limitations and any filing fee deadlines shall be tolled while the parties engage in the
informal dispute resolution process required by this paragraph.
If we do not reach an agreement to resolve the Claim within sixty (60) days after the Notice of Claim is received, you or IPI may commence an arbitration
proceeding by filing a Demand for Arbitration or, alternatively, by filing a Claim in small claims court. You agree that you may not commence any
arbitration or file a claim in small claims court unless you and IPI are unable to resolve the claim within 60 days after we receive your completed Notice
of Claim and you have made a good faith effort to resolve your claim directly with IPI during that time. If a Claim qualifies for small claims court, but a
party commences an arbitration proceeding, you and IPI agree that either party may elect instead to have the Claim resolved in small claims court, and
upon written notice of a party's election, the American Arbitration Association ("AAA") will administratively close the arbitration proceeding. Any dispute
about whether a Claim qualifies for small claims court shall be resolved by that court, not by an arbitrator. In the event of any such dispute, the arbitration
proceeding shall remain closed unless and until a decision by the small claims court that the Claim should proceed in arbitration. You may download or
copy a form of notice and a form to initiate arbitration at [Link] or by calling 1‐800‐778‐7879. The arbitration will be conducted by the AAA before
a single AAA arbitrator under the AAA's rules, which are available at [Link] or by calling 1‐800‐778‐7879, except as modified by this Agreement.
Unless IPI and you agree otherwise, any arbitration hearings will take place in the county (or parish) of either your residence or of the mailing address
you provided in your Notice of Claim.
11.2. Other Claims Subject to Arbitration: In addition to Claims brought by you, Claims made by anyone connected with you or anyone making a Claim
through you (including a taxpayer filing jointly, employee, agent, representative, affiliated company, predecessor or successor, heir, assignee, or trustee
in bankruptcy) against us shall be subject to arbitration as described herein.
11.3. Exceptions: We agree not to invoke our right to arbitrate any individual Claim you bring in small claims court or an equivalent court so long as the
Claim is pending only in that court. This Arbitration Provision also does not limit or constrain our right to interplead funds in the event of claims to the
Account by several parties.
11.5. Arbitration Fees: Payment of all filing, administration and arbitrator fees will be governed by the AAA Rules. You are required to pay AAA's initial
filing fee, but IPI will reimburse you for this filing fee at the conclusion of the arbitration to the extent it exceeds the fee for filing a complaint in a federal
or state court in your county of residence or in Santa Clara County, California. If the arbitrator finds that either the substance of your Claim or the relief
sought in your Demand for Arbitration was frivolous or was brought for an improper purpose (as measured by the standards set forth in Federal Rule of
Civil Procedure 11(b)), then the payment of all fees will be governed by the AAA Rules and IPI will not reimburse your initial filing fee. The parties agree
that the AAA has discretion to modify the amount or timing of any administrative or arbitration fees due under the AAA Rules where it deems
appropriate, provided that such modification does not increase the AAA fees to you or IPI and you and IPI waive any objection to such fee modification.
11.6. Procedure: A single arbitrator will resolve the Claims. The arbitrator will be either (1) a retired judge or (2) an attorney specifically licensed to
practice law in the state of California or the state of your residence and will be selected by the parties from the AAA's National Roster of arbitrators. The
arbitrator will be selected using the following procedure: (a) the AAA will send the parties a list of five candidates meeting this criteria; (b) if the parties
cannot agree on an arbitrator from the list, each party shall return its list to the AAA within 10 days, striking up to two candidates, and ranking the
remaining candidates in order of preference; (c) the AAA shall appoint as arbitrator the candidate with the highest aggregate ranking; and (d) if for any
reason the appointment cannot be made according to this procedure, the AAA may exercise its discretion in appointing the arbitrator. The arbitrator is
bound by this Agreement. Except as otherwise provided below, all issues are for the arbitrator to decide, including issues relating to the scope and
enforceability of this arbitration provision.
The arbitration shall follow the rules and procedures of the arbitration administrator in effect on the date the arbitration is filed, except when there is
a conflict or inconsistency between the rules and procedures of the arbitration administrator and this Arbitration Provision, in which case this Arbitration
Provision shall govern. Any in‐person arbitration hearing for a Claim shall take place within the federal judicial district in which you live or at such other
reasonably convenient location as agreed by the parties. The parties agree that an administrative conference with the AAA shall be conducted in each
arbitration proceeding, and you and an IPI company representative shall appear at the administrative conference via telephone. If you fail to appear at
the administrative conference, regardless of whether your counsel attends, the AAA will administratively close the arbitration proceeding without
prejudice, unless you show good cause as to why you were not able to attend the conference.
The arbitrator shall issue a reasoned written decision sufficient to explain the essential findings and conclusions on which the award is based. The award
shall be binding only among the parties and shall have no preclusive effect in any other arbitration or other proceeding involving a different party. IPI
will not seek to recover its attorneys' fees and costs in arbitration from you unless the arbitrator finds that either the substance of your claim or the
relief sought in your Demand for Arbitration was frivolous or was brought for an improper purpose (as measured by the standards set forth in Federal
Rule of Civil Procedure 11(b)). Judgment on any award may be entered in any court having jurisdiction. This agreement to arbitrate shall not preclude
any party to the arbitration from at any time seeking injunctions or other forms of equitable relief in aid of arbitration from a court of appropriate
jurisdiction including whether a Demand for Arbitration is filed in violation of this Agreement.
12. Taxpayer Identity Validation Disclosure. To help IPI and the government identify and fight tax refund fraud, as well as fight the funding of terrorism
and money laundering activities, IPI shall obtain, verify, and record information that identifies each ERPS taxpayer. What this means for you: When you
apply to use the ERPS for the purpose of receiving your federal tax refund(s), we will ask for your name, address, date of birth, and other information
that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents if we need to perform additional due
diligence on your account.
13. Conflicts. To the extent there is any conflict between the terms of this Agreement and the TurboTax Terms of Service available at
[Link] the provisions of this Agreement shall control with respect to any issues concerning the Program.
YOUR AGREEMENT
IPI agrees to all of the terms of this Agreement. By selecting the “I Agree” button in TurboTax: (i) You authorize IPI and/or Bank to receive your 2024
federal tax refund(s) from the IRS, and IPI to make the deductions from your federal refund(s) as described in the Agreement, (ii) You agree to receive
all communications electronically in accordance with the “Communications” section of the Tax Year 2024 TurboTax® User Agreement, (iii) You consent
to the release of your 2024 federal tax refund(s) disbursement information and application information as described in 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.
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 we collect and share depend on the product or service you
have with us. This information can include:
▪ Social Security number and transaction history
▪ account balances and payment history
▪ credit history and credit scores
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 Intuit chooses to share; and whether you can limit this sharing.
Reasons we can share your information Does Intuit share? Can you limit this sharing?
For our everyday business purposes— such as
to process your transactions, maintain your
account(s), respond to court orders and legal Yes No
investigations, or report to credit bureaus
For our marketing purposes— to offer
our products and services to you Yes No
Page 2
Who we are
Who is providing this notice? This notice is provided by Intuit Inc. and is applicable to your U.S. Intuit account.
What we do
How does Intuit protect To protect your personal information from unauthorized access and use, we
my personal information? use security measures that comply with federal law. These measures include
computer safeguards and secured files and buildings.
How does Intuit collect my We collect your personal information, for example, when you
personal information? ▪ open an account or seek financial or tax advice
▪ give us your contact information or give us your income information
▪ apply for a loan
We also collect your personal information from others, such as credit bureaus,
affiliates, or other companies.
Why can’t I limit all sharing? Federal law gives you the right to limit only
▪ sharing for affiliates’ everyday business purposes—information about your
creditworthiness
▪ affiliates from using your information to market to you
▪ sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to limit sharing.
See below for more on your rights under state law.
Definitions
Affiliates Companies related by common ownership or control. They can be financial and
nonfinancial companies.
▪ Our affiliates include companies with the Intuit name (operating as TurboTax,
QuickBooks, Mint, Credit Karma, and Mailchimp)
Nonaffiliates Companies not related by common ownership or control. They can be financial and
nonfinancial companies.
Joint marketing A formal agreement between nonaffiliated financial companies that together
market financial products or services to you.
For California Customers: In accordance with California law, we will not share information we collect about California
residents with nonaffiliates, unless the law allows. For example, we may share information with your consent, to service your
accounts. We will limit sharing among our companies to the extent required by California law.
*We do not share information about your creditworthiness with affiliates for their everyday business purposes.
However, we may share information about your creditworthiness with affiliates for other purposes, with your consent.
IMPORTANT DISCLOSURES
If you are owed federal tax refund(s), you have a right to choose how you will receive the refund(s). There are several
options available to you. Some options cost money and some options are free. Please read about these options below.
You can file your federal tax return(s) electronically or by paper and obtain your federal tax refund(s) directly from the
Internal Revenue Service (“IRS”) for free. If you file your federal tax return(s) electronically, you can receive refund checks
directly from the IRS through the U.S. Postal Service in 21 to 28 days from the time you file your tax return(s) or the IRS
can disburse your refund(s) directly into your bank account in less than 21 days from the time you file your tax return(s)
unless there are delays by the IRS. If you file a paper federal tax return(s) through the U.S. Postal Service, you can receive
refund checks directly from the IRS through the U.S. Postal Service in 6 to 8 weeks from the time the IRS receives your
return(s) or the IRS can disburse your refund(s) directly into your bank account in 6 to 8 weeks from the time the IRS
receives your return(s). However, if your federal tax return(s) contains Earned Income Tax Credit or Additional Child Tax
Credit, the IRS will issue your refund(s) no earlier than February 15, 2025.
You can file your federal tax return(s) electronically, select the Early Refund Processing Service (the “ERPS”), and have
your federal tax refund(s) processed with Intuit Payments, Inc. (“IPI”, “we”, “our”, or “us”). Your refund will be processed
through an account created for you at a partner financial institution, such as Cross River Bank (“Bank”). The ERPS allows
us to track your refund and provide the refund amount to you 5 days earlier than the communicated IRS settlement date.
This is accomplished when you elect to have your federal refund(s) disbursed into an account at Bank and we receive
notice of the refund settlement date and can send the refund amount, minus any authorized fees for the service, to the
bank account indicated on your tax return. If you file your tax return(s) electronically and select the ERPS, the IRS will
deposit your refund(s) with Bank. Unless there are unexpected delays, federal refunds are received in less than 21 days
from the time you file your tax return(s) electronically. However, if your return(s) contains Earned Income Tax Credit or
Additional Child Tax Credit, the IRS will issue your refund(s) no earlier than February 15, 2025. Your selection of the ERPS
means, if eligible, you will receive your federal refund proceeds five (5) days early.
The ERPS is not necessary to obtain your refund(s). If you have an existing bank account and do not desire to receive the
ERPS, you do not need to use the ERPS in order to receive a direct disbursement from the. You may consult the IRS website
([Link]) for information about federal tax refund processing.
If you select the ERPS, no prior debt you may owe to Bank will be deducted from your refund(s).
You can change your income tax withholdings which might result in you retaining more of your compensation throughout
the year rather than waiting to receive withheld amounts potentially in tax refund(s) next year. Please consult your
employer or tax advisors for additional details.
This Agreement requires all disputes to be resolved by way of binding arbitration. The terms of the arbitration provision
appear in Section 11.
The chart below shows the options for filing your federal tax returns (e‐file or paper returns), the ERPS product, refund
disbursement options, estimated timing for obtaining your federal tax refund proceeds, and costs associated with the
various options.
WHAT TYPE OF FILING WHAT ARE YOUR WHAT IS THE ESTIMATED TIME WHAT COSTS DO YOU
METHOD? DISBURSEMENT OPTIONS? TO RECEIVE REFUND(S)? INCUR IN ADDITION TO
TAX PREPARATION
FEES?
1
You may experience delays with your tax refund(s) if, for example, you enter incorrect bank account or contact
information, you enter a bank account in someone else’s name, or if possible suspicious activity is detected. If your
return(s) contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS will issue your refund(s) no earlier than
February 15, 2025.
2
If you select and obtain ERPS to receive your federal refund proceeds five (5) days early, you will be charged a $_________
25.
fee.
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2024, or other tax year beginning , 2024, ending , 20 See separate instructions.
Your first name and middle initial Last name Your social security number
Kayla A Morrissette 136 02 1091
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
247 Pandolfi Ave Check here if you, or your
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code spouse if filing jointly, want $3
to go to this fund. Checking a
Secaucus NJ 070943036 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse
Digital At any time during 2024, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes No
Standard Someone can claim: You as a dependent Your spouse as a dependent
Deduction Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness You: Were born before January 2, 1960 Are blind Spouse: Was born before January 2, 1960 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here . .
Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 44,321.
b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s)
W-2 here. Also c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and
1099-R if tax e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form
W-2, see
h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h 0.
instructions. i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 44,321.
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
Standard
Deduction for— 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
• Single or 6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
Married filing
separately, c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
$14,600 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7
• Married filing
jointly or 8 Additional income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . 8
Qualifying
surviving spouse, 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 44,321.
$29,200 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
• Head of
household, 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 44,321.
$21,900
• If you checked
12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 14,600.
any box under 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
Standard
Deduction, 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 14,600.
see instructions.
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . . 15 29,721.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2024)
Form 1040 (2024) Page 2
Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 3,335.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 3,335.
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 3,335.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 0.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 3,335.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 4,103.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 4,103.
If you have a 26 2024 estimated tax payments and amount applied from 2023 return . . . . . . . . . . 26
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . .No. . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 4,103.
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 768.
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 768.
Direct deposit? b Routing number 0 2 1 2 0 0 0 2 5 c Type: Checking Savings
See instructions.
d Account number 5 8 5 6 4 0 6 3 7 5
36 Amount of line 34 you want applied to your 2025 estimated tax . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to [Link]/Payments or see instructions . . . . . . . . 37
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
Sign 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.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
Joint return? Driver (see inst.)
See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)