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MM-DD-YYYY Response Date: MM-DD-YYYY Tracking Number: 100000000000000 111-11-1111 Tax Period Ending: Dec. 31, YYYY SSN: PL 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. NAME(S) SHOWN ON RETURN: 222-22-2222 FIRST M & SPOUSE M LAST AC 999 AVENUE RD CITY, ST 10.000-90.00-800 ADDRESS: Married Filing Joint FORM NUMBER: 1040 CYCLE POSTED: RECEIVED DATE: YYYYMMD.

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