EFTA Document EFTA01280212

Internal Revenue Service United States Department of the Treasury This Product Contains Sensitive Taxpayer Data Tax Return Transcript Request Date: Response Date: Tracking Number: SSN Provided: Tax Period Ending: Dec. 31, 2012 10-20-2014 10-20-2014 The following items reflect the amount as shown on the return (PR). and the amount as adjusted (PC). if applicable. They do not show subsequent activity on the account. SSN: SPOUSE NAME(S) ADDRESS: SSN: SHOWN ON RETURN: I FILING STA