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For Privacy Notice, get form Fro 113). <br />FORM <br />For Privacy Notice, get form Fro 113). <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 <br />06 <br />09 <br />10 <br />12 <br />14 <br />16 <br />17 <br />18 <br />31 <br />34 <br />41 <br />42 <br />43 <br />44 <br />45 <br />46 <br />61 <br />62 <br />63 <br />64 <br />71 <br />Sign <br />Here <br />It Is Unlawful <br />ro forge a <br />sppouaC'S?RDP's <br />signature. <br />John return? <br />(fee <br />instructions) <br />10 PBA <br />C <br />07-08-1961 <br />FORM <br />540 DI Side I <br />ATTACH FEDERAL RETURN <br />P <br />621610 AC <br />A <br />R <br />RP <br />02-22-1971 <br />2 <br />72 <br />0 <br />408 <br />0 <br />APE 0 <br />0 <br />73 <br />0 <br />410 <br />0 <br />FS 0 <br />0 <br />74 <br />0 <br />413 <br />0 <br />3800 0 <br />1 <br />75 <br />0 <br />415 <br />0 <br />3803 0 <br />0 <br />76 <br />0 <br />416 <br />0 <br />SCHG1 0 <br />0 <br />77 <br />0 <br />417 <br />0 <br />5870A 0 <br />0 <br />78 <br />0 <br />418 <br />0 <br />5805 5805F 0 <br />14521 <br />91 <br />0 <br />110 <br />0 <br />DESIGNEE 0 <br />7340 <br />92 <br />0 <br />111 <br />0 <br />TPIDP 01214409 <br />90 <br />93 <br />0 <br />112 <br />0 <br />FN <br />0 <br />94 <br />0 <br />113 <br />0 <br />0 <br />95 <br />0 <br />115 <br />0 <br />0 <br />400 <br />0 <br />116 <br />0 <br />0 <br />401 <br />0 <br />117 <br />0 <br />0 <br />402 <br />0 <br />0 <br />403 <br />0 <br />0 <br />404 <br />0 <br />0 <br />405 <br />0 <br />0 <br />406 <br />0 <br />0 <br />407 <br />0 <br />0 <br />0 <br />Your flgmaure SpouceWDWsalgnetum(tf.)gn etprf�ljgl)rr uj abn) <br />Daybimaphorenumbar(optional) Date u �L4�11 <br />Your email address (opoone9. Enter only one. <br />Peld pmparey ono p1lferee14 s`d oywll lnrdrmatlen M which preparer has any knowledge) <br />nnay+ <br />I'a -*Wyq '460' <br />• FEIN <br />14409 <br />JOSE LUIS TERRONES 628 N BRISTOL ST SUITE 100 SANTA MA CA 92701 <br />Do you want to allow srrolher person to discuss this return with us (see lMtmcllpnS) . . . . . . . . .. . . ... OU Yes M No <br />Print Third Party Designee's Name 'telephone Number <br />068 3101106 r— <br />