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Status: 2 Exemptions 65 and over Blind Accelerated Refund: X Address Change: Dependents Amended: Virginia return not filed last year: Total 1 1 Yourself Spouse RESERVED AREA FOR 2D BARCODE Locality: NOL: 139 2 Your SSN Certified Vendor(s): 1. Fed Adj Gross Income 62800. 2. Additions, see pg 2, line 3 024545524 Spouse s SSN 1037 BUNN BUNN 041186457 1000. 16a. Your VAGI 16b. Spouse s VAGI 17. Net Tax 2859. 18a. Your Withholding 3. 3000. 63800. Subtotal 4a.

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