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line 36 from line 22. This is your adjusted gross Income 37 Last name (2)Orneridenre Serial security number O.04endenEs relatkentalp 10 you Boxes aced on Ea and Ea No of children thig 6c ho. min age 17 p lend with you 1004019 NI hr4 did not Ma with grardt you due tO Ovate a Separatio
the best of my knowledge and belief. it is true. correct. and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO's PIN 13769913349 (enter EFIN plus 5 self-selected numerics) Taxpayer Declarations P
ndents social way numb. (310ependenrs m you asonsuo to IAm o Al Mid iallUil fleichl iaw 17 wow SON X d Total number of exemptions claimed Boxes checked en Ca and (1b No. of children on 6c who: * Ned with you • did nettle., with you OA to &KW9 Cr separation lane rtstructmal Oroenclant
the best of my knowledge and belief. it is true. correct, and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO's PIN 044549 (enter EFIN plus 5 self-selected numerics) Taxpayer Declarations Perjur
ttach Schedule D if required. If not required, check here Other gains or (losses). Attach Form 4797 IRA distnbutians 1 151 I b Taxable amount Boxes checked on 6a and Etc No 01 children o 6c tio. *Pad with you %did not We with you due to OlvOrCe a Separation InStructiathl Dapanden% on 6c
the best of my knowledge and belief. it is true. correct, and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO 's PIN 262982 (enter E.RN plus 5 self-selected numerics) Taxpayer Declarations Perju
Entities connected to both Boxes and ERO Signature

United States
LOCATIONC-EZ
ORGANIZATIONthe U.S. Treasury Financial Agent
ORGANIZATIONSpouse
ORGANIZATIONthe Foreign Earned Income Tax Worksheet
ORGANIZATION
U.S. Treasury
ORGANIZATIONSchedule SE
PERSON
Joi Ito
PERSON
FinCEN
ORGANIZATIONConservation Reserve Program
ORGANIZATIONFiler
PERSONUtilities
ORGANIZATIONConservation Reserve
ORGANIZATIONJurat/Disclosure
ORGANIZATIONBox B
ORGANIZATIONBox E
ORGANIZATIONBox F
ORGANIZATIONSchedules 0
ORGANIZATIONIndividual, Estate
ORGANIZATIONExchanges of Property
ORGANIZATION