Laserfiche WebLink
uailrorma Resident <br />For Privacy Notice, gel farm F7➢ 1131. <br />FORM <br />621-10-4397 RODR 605-27-2405 <br />XAVIER RODRIGUEZ <br />MARIADEL R DIAZRODRIGUEZ <br />100 S HIGHLAND AVE APT <br />PLACENTIA CA 92870-0000 <br />01 2 72 0 <br />06 0 73 0 <br />09 0 74 0 <br />10 1 75 0 <br />12 0 76 p <br />14 0 77 0 <br />16 0 78 0 <br />17 9897 91 0 <br />18 7274 92 0 <br />31 33 93 0 <br />34 0 94 0 <br />41 0 95 0 <br />42 0 400 0 <br />43 0 401 0 <br />44 0 402 0 <br />45 0 403 0 <br />46 0 404 0 <br />61 0 405 0 <br />62 0 406 0 <br />63 0 407 0 <br />64 0 <br />71 0 <br />M <br />C <br />408 <br />0 <br />409 <br />0 <br />410 <br />0 <br />411 <br />0 <br />412 <br />0 <br />413 <br />0 <br />414 <br />0 <br />110 <br />0 <br />111 <br />0 <br />112 <br />0 <br />113 <br />0 <br />115 <br />0 <br />116 <br />0 <br />117 <br />0 <br />FORM <br />540 CI side t <br />ATTACH FEDERAL RETURN <br />P <br />PBA 621610 AO <br />A <br />R <br />RP <br />APE 0 <br />FS 0 <br />3800 0 <br />3803 0 <br />SCHG1 0 <br />5870A 0 <br />5805 5805F 0 <br />DESIGNEE 0 <br />TPID 604144124 <br />FN 604144124 <br />no ow 0 you should etlach . copy a your complete federal return Under p= of i,anury, I daclera that Thaw Sign ea.mlrod this <br />return, I in pechndulu end sb emaas,vAd tothe East of my anasdedae and belief, it Is true, correct an com deh. <br />Here Your signature Spouse'sIROPs signature(1apint mhm, both must syn) a 2 <br />Daytime phone umber option Date � ( — It <br />It is unlawful Paid prepauh—sldriatur hi"-Lrettenef reperarl W danalltnl-11-don W"Ichpr%paTre hay.ny newledyq <br />tD forge a 1( i • Paid prepaur's SSNIPTIN <br />spouso's/RDP's L .foss LUIS TERRONEE // 604-14-4124 <br />stgnalum. Fir(n's name (or yours, self-employed) Mam's address • FFIN <br />JointIctunt? JOSE LUIS TERRONES 828 N BRISTOL ST SUITE 100 SANTA MA CA 92703 60-4144124 <br />(sec Do you want 10 allow another, person to discuss this return with us (see In moctlons) .. imaructiont) . . . • Yes No <br />Print third Party Deslgmx's Name Telephone Number <br />068 3103.096 �— <br />