Free Motion to Dismiss - Rule 12(b)(1) - District Court of Federal Claims - federal

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 1 of 17

IN THE UNITED STATES COURT OF FEDERAL CLAIMS No. 08-194 T

(Judge Margaret M. Sweeney)

ADRIAN GLUCK & SUSAN GLUCK,
Plaintiffs
v.

THE UNITED STATES,
Defendant

DECLARATION OF KAREN M. GROEN

I, Karen M. Groen, make the following declaration based on personal knowledge of the
following facts:

1. I am the attorney assigned to the defense of the above captioned case.
2. Within my official capacity, I have temporary custody of

the Department of Justice

and Internal Revenue Service ("IRS") files for the above-captioned case.

3. Attached hereto are true and correct copies of the following documents, which are

contained in the offcial files of the IRS and the Justice Department:

a. Exhibit 1: A true Form 4340, Certificate of Assessments, Payments, and Other
Specified Matters for Adrian and Susan Gluck, covering United States Individual Income
Tax for the period ending December 31, 1996.

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 2 of 17

b. Exhibit 2: Plaintiffs' Form 1040 U.S. Individual Income Tax Return for 1996,

dated March 24, 1999.

I declare, under penalty of

perjury, in accordance with 28 U.S.c. § 1746, that the foregoing is

true and correct to the best of my knowledge and belief.
Executed in Washington, D.C. under penalty of

perjury on June 17,2008.

s/ Karen M. Groen KAREN M. GROEN Attorney of Record U.S. Department of Justice Tax Division Court of Federal Claims Section P.O. Box 26 Ben Franklin Post Offce Washington, D.C. 20044 (202) 307-0508

2

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 3 of 17

United States

of America

Department of the Treasury

Internal Revenue Service
Date: March 31,2008

CERTIFICATE OF OFFICIAL RECORD

I certify that the annexed: is a true Form 4340, Certificate of Assessments, Payments, and Other
Specified Matters for Adrian and Susan Gluck, Social Security Numbers: Income Tax respectively, covering United States Individual December 31, 1996
".,,-

and ending
,.-',.....
-,..--

,/"~

.......,.

~,~ ,-' ,.,.

~.....

..~_.r
"r""''

~'

~~~'/"-"~'

-""","

",......

under the custody of this offce.
IN WITNESS WHEREOF, I have hereunto set my hand,

~-

and caused the seal of this offce to be affxed, on the day
and year first above written.

By direction of the Secretary of the Treasury:

~~-\
Catalog Number 19002E
3

.i
1

Chief, Accounting Operations

Form 2866 (Rev, 09-1997)

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 4 of 17

- - - - - -- - - -- - -- - --- - --- -- - -- - - - - - - - - - -- - - --- -- -- - -- ----- -- - - - - -- -- - -- - - -- -- -- ---ADRIAN & SUSAN GLUCK

CERTI FI CA TE OF ASSESSMENTS, PAVMENTS, AND OTHER SPECI FI ED MATTERS

EIN/SSN:

TYPE OF TAX: U.S. INDIVIDUAL INCOME TAX RETURN

FORM: 1040 TAX PERIOD: DEC 1996
DATE

EXPLANATION OF TRANSACTION

ASSESSMENT, OTHER DEBITS

PAYMENT,

ASSESSMENT

(REVERSAi)

CREDIT ( REVERSAi)

DATE (23C, RAC 006 )

- - - - - - --- - - - -- -- - - - - - - - - -- - -- - - - - - -- --- - ---- --- -- - - -- - - - --- - --- - - - - - -- - -- - - - - --ADJUSTED GROSS INCOME

198,729.00
TAXABLE INCOME

175,601.00
SELF EMPLOYMENT TAX

13,131.00
04-24-1999 RETURN FILED & TAX ASSESSED

60,842.36

05-31-1999

33221-114 - 94924 - 9 199920
04-15-1997 EXTENSION OF TIME TO FILE

EXT. DATE 08-15-1997
04-15-1997 EXTENSION OF TIME TO FILE

EXT. DATE 10-15-1997
11-03-1998 RECEIVED POA/TIA
ESTIMATED TAX PENALTY

950.66

05-31-1999 05-31-1999 05-31-1999

19992008
LATE FILING PENALTY

13,689.53

19992008
FAILURE TO PAY TAX
PENAL TV

7,756.84

19992008
INTEREST ASSESSED

13,727.18

05-31-1999

19992008
01-17-2000 REMOVED POA/TIA

02-21-2000 RECEIVED POA/TIA
07-10-2000 MODULE BLOCKED OR RELEASED FRDM FEDERAL PAYMENT LEVY PROGRAM
FORM 4340 (REV.

01-2002)

PAGE

1

4

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 5 of 17

CERT I FI CA TE OF ASSESSMENTS, PAVMENTS, AND OTHER SPECI FI ED MATTERS

ADRIAN & SUSAN GLUCK

EIN/SSN:

TYPE OF TAX: U. S. INDIVIDUAL INCOME TAX RETURN

FORM: 1040 TAX PERIOD: DEC 1996
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

ASSESSMENT

DATE

DATE (23C, RAC 006 ) (REVERSAi) .. - - _.... -_................................ --- - - - - -- -- - _....- -- - - -- - - _.. - _.. - - - - - -- - - _.. - --_.. -- - - - - - - - _..
EXPLANATION OF TRANSACTION
CREDIT

10-20-2000 FEDERAL TAX LIEN

02-07-2001 INTENT TO LEVY COLLECTION DUE PROCESS NOTICE LEVY NOTICE ISSUED 02-07-2001 INTENT TO LEVY COLLECTION DUE PROCESS NOTICE LEVY NOTICE ISSUED
12-07-2000 AMENDED RETURN FILED

89277-445-04012-1
02-14-2001 INTENT TO LEVY COLLECTION DUE PROCESS NOTICE RETURN RECEIPT SIGNED
05-08-2001 ASSESSMENT STATUTE EXPIR DATE EXTEND TO 04-24-2002

ADDITIONAL TAX ASSESSED BY EXAMINATION
AUDIT REVI EW

0.00

12-31-2001

89247-744-00496-1 20015108
01-07-2002 REVERSAL OF MODULE BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM
FORM 4340 (REV.

01-2002)

PAGE

2

5

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 6 of 17

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

- - - -- - - _...... - _.. -- -_........ -- -_.................................... -- ---_.. -- -_.. _.......... -_.... -_........ -_........-ADRIAN & SUSAN GLUCK

EIN/SSN:

TYPE OF TAX: U.S. INDIVIDUAL INCOME TAX RETURN

FORM: 1040 TAX PERIOD: DEC 1996
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

ASSESSMENT

DATE

EXPLANATION OF TRANSACTION

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

.......................... --- -_..............- -_................ -_.. -_.......... -_.... -- --_............ -_.... ---_.. -- --- -- -_..
01-07-2002 MODULE IN FEDERAL PAYMENT LEVY PROGRAM
10-14-2002 MODULE REVERSED OUT OF FEDERAL PAYMENT LEVY
PROGRAM

02-09-2004 MODULE IN FEDERAL PAYMENT LEVY PROGRAM ADDITIONAL TAX ASSESSED BY EXAMINATION AUDIT, CLOSED TO APPEALS PRIOR TO 90 DAY LETTER 29247-464-10046-4 20041008 ADDITIONAL TAX ASSESSED BY EXAMINATION AUDIT REVIEW 29247-486-70021-6 20061408
04 - 17 - 2006 RENUMBERED RETURN 29247 - 4 8 6 - 70021 - 6
o . 00

03-22-2004

0.00

04-17-2006

FAILURE TO PAY TAX
PENAL TY

7,453.75

06-05-2006

20062108
11-19-2007 MODULE REVERSED OUT OF FEDERAL PAYMENT LEVY
PROGRAM
FORM 4340 (REV.

01-2002)

PAGE

3

6

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 7 of 17

- _.. - - - _.. _.. - - -_.. - - - _.. - - --- -- - _.... - - --- - - - --_.. -- - --_.. ---- --- - -- - -- - -- - - -- -_.. - - - - - _..
ADRIAN & SUSAN GLUCK

CERTI FI CA TE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECI FI ED MATTERS

EIN/SSN:

TYPE OF TAX: U. S. INDIVIDUAL INCOME TAX RETURN

FORM: 1040 TAX PERIOD: DEC 1996
ASSESSMENT, OTHER DEBITS
PAYMENT,

ASSESSMENT

DATE

EXPLANATION OF TRANSACTION

CREDIT

(REVERSAi)

(REVERSAi)

DATE (23C, RAC 006 )

_........ - -_...... -_.... --_.... -_....-.._........................ ..-_.... --- -- --- --_.. ..-_.... -- -_........ -- -_........_....

12-31-2007

MODULE IN FEDERAL PAYMENT

LEVY PROGRAM

05-31-1999 Statutory Notice of Balance

Due

06-21-1999 Statutory Notice of Intent to Levy

09-30-2002 Notice of Balance Due
11-04-2002
No tic e

of Balance Due

02-24-2003 Statutory Notice of Intent to Levy 06-05-2006 Statutory Notice of Balance 06-04-2007 Statutory Notice of Balance
FORM 4340
Due

Due

(REV.

01-2002)

PAGE

4

7

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Page 8 of 17

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

ADRIAN & SUSAN GLUCK

EIN/SSN:

TYPE OF TAX: U.S. INDIVIDUAL

INCOME TAX RETURN

FORM: 1040 TAX PERIOD: DEC 1996

BALANCE

104,420.32

I CERTIFY THAT THE FOREGOING TRANSCRIPT OF THE TAXPAYER NAMED ABOVE IN RESPECT TO THE TAXES SPECIFIED IS A TRUE AND COMPLETE TRANSCRIPT FOR THE PERIOD STATED, AND ALL ASSESSMENTS, ABATEMENTS, CREDI TS, REFUNDS, AND ADVANCE OR UNIDENTI FI ED PAYMENTS, AND THE ASSESSED BALANCE RELATING THERETO, AS DI SCLOSED BY THE RECORDS OF THIS OFFICE AS OF THE ACCOUNT STATUS DATE ARE SHOWN THEREIN. I FURTHER CERTIFY THAT THE OTHER SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFFICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

SIGNATURE OF GERTIFYING OFFIGER'~~---PRINT NAME: L.Marott
TIT L E:_ Chief,A.ccounting~QEerati0I!

DELEGATION ORDER:

WI-11-5

LOCATION: INTERNAL REVENUE SERVICE

ACCOUNT STATUS DATE 03/31/2008

FORM 4340 (REV. 01-2002)

PAGE

5

8

Case ,,-_.~iØ...~_
a
M

1:08-cv-00194-MMS

F

R

10'40

:p2.riment

~

Document 7-2

Filed 06/18/2008

Page 9 of 17

,reasury - Internal Revenue Service

U.S. Inciividuallncome Tax Return
Your First Name
MI

For the year Jan 1 - Dee 31, 1996, or other tax year beginnirt '-/¿~ ..-,-,"

\ ,1996

,1996, ending ,19 I ?~~874
o.

1332211'149492 \.-g
(99) IRS use only - Do not write or staple in this space.
ity No.

Labeil
(See instruc

Last Name

ADRIAN
If a Joint Return, Spouse's First Name
MI

GLUCK
Last Name

USê the

IRS label.
or type.

Otherwise, please print

SUSAN

GLUCK
Apartment No.

Home Address (number and street). If You Have a P.O. Box, See Instructions.

5 BLESSING
City, Town or Post Ofce. If You Have a Foreign Address, See Instructions.
State zip Code

instrctions, see
CA

For help finding line

instructions in the booklet.

Presidential Election Campaign
(See instructions.)

IRVINE
~ Do you want $3 to go to this fund? ....... ..................

92612

Yes

No
X
X

Note: Checking
you, refund.

your fax or reduce

'Yes' will not change

If a joint return, does your spouse want $3 to go to this fund?

Filing Status
Check only one box.

1 Single
2 Married filing joint return (even if only one had income)

3 Married filing separate return. Enter spouse's SSN above & full name here ~

4 Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent, enter this child's name here ~
5 Qualifying widow(er) with dependent child (year spouse died ~ 19 ). (See instructions.)

Exemptions

6a X Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax return, do not check box 6a ........... . . . . . . . . . .

"" . bOO Spouse ....... , )7 c¡ ,.,.. .
c Dependents:

",.... .

.,. .

(2) Dependent's social

--

.... . ... . .... .

,..... .

... .

12 12 12 12 12

~ No. of boxes checked on lines
6a & 6b ......

2

security number. If

(3) Dependent's relationship
to you

children on

No. of your

months lived

(4) No. of

line 6c who:
· lived with you

6 dependents,

If more than

see the instructions for line 6c.

GLUCK STACEY GLUCK CARLA GLUCK JONATHAN GLUCK MICHAEL J GLUCK

LESLIE

(1) First name

Last name

born in December 1996, see Instructions

in your home in 1996

5

624-05-3291 624-05-4416 624-05-4039 624-05-3661

DAUGHTER DAUGHTER DAUGHTER SON SON

with you due to divorce or separation (see instructions)

. did not live

Dependents on line 6c not

t:niE:red above
Add numbers

d Total number of exem tions claimed. . .

¡¡~::;~i;;e ~
7

1\
25.

Income
Attach

7 Wages, salaries, tips, etc. Attach Form(s) W-2 ......................

8a Taxable interest. Attach Schedule B if over $400

8a
9

your Forms

Copy B of

b Tax-exempt interest. Do not include on line 8a . . . . . . . . . . . . ..1 8bl 9 Dividend income. Attach Schedule B if over $400 . . . . . . . . . .
10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions)
11 Alimony received

10
11

W-2, W-2G, & 1099-R here.

get a W-2, see
the instructions
for line 7.

If you did not

12 Business income or (loss). Attach Schedule C or C-EZ 13 Capital gain or (loss). If required, attach Schedule D 14 Other gains or (losses). Attach Form 4797
15a Total

12 13

200,000. 5,270.

14

Enclose, but do

16a Total pensions and annuities . . . ~ TaxableTaxable amount (see instrs) I bb amount (see instrs)
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Sch E . 18 Farm income or (loss). Attach Schedule F .

IRA distributions.... .1

15al

15b 16b
17 18 19

not attach, any payment. Also, please enclose
Form 1040-V

19 Unemployment compensation .....
20 a Social security benefits . . . . . . I 20 a I 21 Other income. List type and amount - see instructions

(see the instructions for line 62).

b Taxable amount (see instrs)

20b

22 Add the amounts in the far ri ht column for lines 7 - 21. This is our total income

~ 22

21

205,295.\)

/

Adjusted Gross Income
under $28,495 (under $9,500 if a child did not live with you), see the instructions for line 54.

23a Your IRA deduction (see instructions) . 23a b Spouse's IRA deduction (see instructions) 23b
24 Moving expenses. Attach Form 3903 or 3903-F . 24

If line 31 is

25 One-half of self-employment tax. Attach Schedule SE 25 26 Self-employed health insurance deduction (see instructions) 26
27 Keogh and self-employed SEP plans. If SEP, check .... ~ D 27

6,566.

28 Penalty on early withdra' 28
30 Add lines 23a - 29
¡IAOI12 12103/96

2
~
30
31

29 Alimony paid. Recipient's SSN 29
31 Subtract line 30 from line õted gross income

6.566. 198,729.
Form 1040 (1996)

BAA For Privacy Act and Paperwork Reduction fJrl t.nlir" """ ~nstructions.
9

Case 1:08-cv-00194-MMS
Computation

Document 7-2

Filed 06/18/2008

Page 10 of 17
572 - 91 - 9213
32

i Form 10ii (1996' AÒRIAN & SUSAN GLUCK , 32, AmouÝiL from line 31 (adjusted gross income) Tax

,....... . .... .

.",.. . ............. .

198,729.

p aç¡e 2

33a Check if: 0 You were 65/01der, 0 Blind; 0 Spouse was 65/older,

Add the number of boxes checked above and enter the total here.

D

Blind

~

33a
33b

b If you are married filing separately and your spouse itemizes deductions
or you were a dual-status alien, see instructions and check here ..........

L
D

34 E,t~ ~temt"d deducton. (.-m Sohedule A, line 28, 0, ~
the
of instructions if you checked any box on line 33a or b or someone your. can claim you as a dependent.

larger _ Standard deduction shown below for your filing status. But see the

- ........ .

~

· Single - $4,000 . Married filing jointly or Qualifying widow(er) - $6,700 · Married filing separately - $3,350 . Head of household - $5,900

34

10,582.

35
If you want
the IRS to

Subtract line 34 from line 32

................ .

... ... .

............ .

.... .

36

If line 32 is $88,475 or less, multiply $2,550 by the total number of exemptions claimed 01 line 6J!qite 32

figure your
for line 37.

is over $88,475, see the worksheet in the instructions for the amount to enter . . . . . . . .. å(.s, ..,. I"'?.

tax, see the

instructions

Credits

Other Taxes

37 Taxable income. Subtract line 36 from line 35. If line 36 is more than line 35, enter -0- .. . a D Form(s) 8814 38 Tax. See instructions. Check if total includes any tax from b . n Form 4972 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..."....... . ... . .......,. . ~ 39 39 Credit for child and dependent care expenses. Attach Form 2441 40 40 Credit for the elderly or the disabled. Attach Sch R . ... . 41 41 Foreign tax credit. Attach Form 1116 ..... . .,.. . b D Form 3800 42 Other. Check if from. . . . . . . . . a Form 8801 d Form (spec) 42 Form 8396 c 43 Add lines 39 through 42 ......... . ,.. . ~ 44 Subtract line 43 from line 38. If line 43 is more than line 38, enter -0- ......, . ....,. . - 45 Self-employment tax. Attach Schedule SE 46 Alternative minimum tax. Attach Form 6251 .. .

Jv
37 38

35

188,147.

14,637. 173,510.

46,537.

0

B

. . ........... 47 SS and Medicare tax on tip income not reported to employer. Attach Form 4137 48 Tax on qualified retirement plans, including IRAs. If required, attach Form 5329 49 Advance earned income credit payments from Form(s) W-2 .... . ........... . ..... .

.

50
51

Household employment taxes. Attach Schedule H
Add Ins 44 - 50. This is your total tax
..... . ... , .. .

. . ,... . ...... .
.... . . . .. ..

... ... .

...........,... .
~

43 44 45 46 47 48 49 50
51

46,537. 13,131.

. ...... . ... .

59,668.

Payments

52 53

Federal income tax withheld from Forms W-2 and 1099 . .

52 53

from 1995 return .

1996 estimated tax payments and amount applied

.................. ,

... ..... .

54
Attach Forms W-2, W-2G,

Earned income credit. Attach Schedule EIC if you have a qualifying child. Nontaxable earned income: amount. . . .

54 55 Amount paid with Form 4868 (request for extension) . . ..... . 55 and 1099-R 56 to page 1. 56 Excess social security and RRTA tax withheld (see instrs) Form 2439 57 other payments. Check if from . .. a 57 b..D Form 4136 .. ............... . .... . ... . 58 Add lines 52 - 57. These are your total payments. . ........... . ... . 59 If line 58 is more than line 51, subtract line 51 from line 58. This is the amount you Overpaid Refund 6Da Amount of line 59 you want Refunded to You .... . ............ . .. . .. . Have it sent directly to your ~ b Routing number cType: Checking bank account! See instructions and fill ~ d Account number . .
and type. . .

~

- - --- ------ --- --- -----

~

0

,...... . ~ 58
........ .

0

0

~ 6Da
Savings

59

in 60b, c, and d.

61

Amount of line 59 you want Applied to Your 1997 Estimated Tax . . . . . . ~ i 61
If line 51 is more than line 58, subtract line 58 from line 51. This is the Amount

i

Amount You

Owe

62 63

You Owe.
I

For details on how to pay and use Form 104O-V, see instructions Estimated tax penalty. Also include on line 62 ,... . ".... . .163

~ 62

.................................................................................. ............................................ ................... . ........................ ............................ ...................... ................ .

59,668.

Sign Here
of this return for your records.
Keep a copy

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correcr;'t, nd. complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. -)

Paid Preparer's
Use Only

Preparer's ~~~~.~~~.. Signature ~ ~ ~~
Firm's Name (or yours if self.employed)
and Address

~i r ' ¡/

~i / &''-l- / 3 2Lf î''1 CONSULTANT
Spouse's i ature. lf Joint Return, BOTH Must Sign. Date Spouse's Occupation
HOMEMAKER
Date

Your Signature d ~ Date I Your Occupation

/

~"\\'~'\

ity
Check if

self.employed X
EIN

SELWYN M. HERSOWITZ, C.P.A. ~ 7 CORPORATE PARK, STE 100 IRVINE
FDIAOl12 11/25/96

33-0301479
92714

CA zip Code

10

Case 1:08-cv-00194-MMS
Schedule A
(Form 1040) Department of the Treasury
In(teinal Revenue Service
I

Document 7-2

Filed 06/18/2008

Page 11 of 17
OMB No. 154.0074

Schedule A (99)

Itemized Dèductions

~ Attch to Form 1040.

1996
07
I

~ See Instructions for Schedule A (Form 1040).

Name(s) Shown on Form 104

ADRIAN M~dical

&

SUSAN GLUCK

and

Caution: Do not include expenses reimbursed or paid by others.
1

Dental

Expenses

2
3

4
Taxes You
5
6

Paid

(See instructions.)

7
8
9

-- ---5 ------. . ------ --- ----- - ---- 8. .......... . ......... Add lines through 8 . . .
.,. ....... , ... .

.. Medical and dental expenses (see instructions) .. .,.... . 198,729. Enter amount from Form 1040, line 32 . . . . . . i 2 I ...... . Multiply line 2 above by 7.5% (.075) ........... . . . Subtract line 3 from line 1. If line 3 is more than line 1, enter -0.., ... ........ . State and local income taxes .. .. .... . Real estate taxes (see instructions) Personal property taxes other taxes. List type and amount ~

1

12,710.
14,905.
0... . .... . .

3

. ......... .

4

O.

5
6

7

141. 935.
..... . .... . .

.

........., .

9

1,076.

You Paid

Interest

10

Home mortgage interest and points reported to you on Form 1098

10

2,130.

"

Home mortgage interest not reported to you on Form 1098. If paid to

the person from whom you bought the home, see instructions and show

(See instructions.)
Note:

Personal

deductible.
Gifts to Charity
15
16

interest is not

12 13

-- --- --- -- - --- --- --- - ----- ------ --- --- --- --- --- --- --- --- ------ --- --- --- --- --- --- --------~- " 12
Points not reported to you on Form 1098. See instructions for special rules.

that person's name, identifying number, and address ~

Investment interest. If required, attach Form 4952. (See instructions.)

". .

....... ,

.....0.' .

... . ..0.. .

.. ... .

13
... . ..... . ...... .

14 Add lines 10 through 13

.. ..0. .

...0.. . 14

2,130.

Gifts by cash or check. If you made any gift of $250 or more, see instructions

15

9,799.

a gift and

If you made

fiot it,benefit or a see instructions.
Casualt and

Other than by cash or check. If any gift of $250 Dr more, see instructions. If over $500, you Must .. . attach Form 8283 ....0 17 Carryover from prior year. 18 Add lines 15 through 17 .0... . .. . ...... . ..... . . .

16 17
.... , .. . ..... . .,. .

18 19

9,799.

Theft Losses
and Most

19 Casualty or theft loss(es). Attach Form 4684. (See instructions.) .
job education, etc. If required, you Must attach Form 2106 or 2106-EZ. (See instructions.) ~
... .

...... .

Job Expenses 20 Unreimbursed employee expenses - job travel, union dues,
Other Miscellaneous Deductions
21

-- preparation fees. . . --- ------ --- --- ------ --- --Tax
..

---------------

20
21

22

(See instructions for expenses to deduct here.)

Other Miscellaneous Deductions

22 23 .. . 23 24 i 24 Enter amount from Form 1040, line 32 I 25 ,... . .........,.., . 25 Multiply line 24 above by 2% (.02) 26 Subtract line 25 from line 23. If line 25 is more than line 23, enter -027 Other - from list in the instructions. List type and amount ~

----- --- --- --- --- --- ------ ------ ------ ---22--- --- --- ------ - --Add lines 20 through

type and amount

other expenses - investment, safe deposit box, etc. List ~

-------------------

-- - -- --- --- --- --- --- --- --- - -- --- --- -- - ---Is Form 1040, line 32, over $117,950 (over $58,975 if married filing separately)?
No. Your deduction is not limited. Add the amounts in the far right column for

-------------~

0......... .

... 0

26

27

Total Itemized

28

Deductions

lines 4 through 27. Also, enter on Form 1040, line 34, the larger of this amount or your standard deduction.

~ 28

10,582.

Yes. Your deduction may be limited. See instructions for the amount to enter.

Itemized Deductions Limited per IRC Sec. 68.
BAA For Paperwork Reduction Act Notice, see instructions.
FDIA0301 10/14/96

Schedu I e A (F orm 1040) 1996
11

Case 1:08-cv-00194-MMS Document 7-2 Schedule A & B (Form 1040) 1996 OMS No, 1540074
Name(s) Shown on Form 104, ,Do Not Entu Name and Social Security Number if Shown on Schedule A.

. i'"
1

Filed 06/18/2008

Page 12 of 17
Page 2
umber

ADRIAN & SUSAN GLUCK

Schedule B - Interest and Dividend Income

08
Amount

'Part I

Interest
Inèome
(See instructions.)

Note: If you had over $400 in taxable interest income, you must also complete Part III

List name of payer. If any interest is from a seller-financed mortgafle and the buyer used

the propert as a personal residence, see the instructions and list t is interest first. Also,

BANK --------AMERICA -----OF NATIONAL ------ ------ ------ --- --- ----LIBERTY

show that buyer's social security number and address. . . , . . . . , . , , . . , . . . . . . . . . . . , . . . . , . ,

~

~~~~:i~iorm
substitute statement from a brokerage
firm, list the firm's
name as the payer and enter the total interest shown on that form,

- - -- - --- - -- - - - - - - - -- -- - - - - - - - - - - --- - - - --- --GLENDALE -FED -BANK- --- --- --- - - - -- - - -- -- - - - - - - - -- --- -- -- --

1099-INT, Form 1099-0ID, or

-- ------ ------------ ------ --- --- --- --------- ------ ------ ------ ------ --- --- ------------------ --- --- ------ --- --- --- --- --- --- ----- - --- - - - - - - --- --- - - - --- - - - -- - - -- - - - - - - - -- --- ------ -- ---- ------ --- --- --- --- --- --------------- --- --- --- --- ------ ------ --- --- --- --

20. 333. 5.

1

- - - -- - - - - - - - -- --- - - - - - - - - - - - - - - - - -- -- - - - - -- - - -- - - - -- - --- - -- -- - -- - - - - - - - - - - - - - -- ----Add the amounts on line 1 .""",."...."""".......,....,...""""".., . .......,

~,,-N'~-,

1-.

~~~~~rDi SUib~i 00- - -- - -- - -- - - _.. - -1(- - -- - ---------------------------------- - ------2 3

--

358.
- 333

----- --- ------ ------ --- --- ------ - --- -----

2
3

25. 25.
Amount

Excludable interest on series EE U.S. savings bonds issued after 1989 from Form 8815, .... . ........ . ......... . line 14. You must attach Form 8815 to Form 1040 ..... ..... , 4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a .......... . , . ~

4

Part II

Dividend Income
(See instructions.)

Note: If you had over $400 in gross dividends and/or other distributions on stock, you must also complete Part III.
5
List name of

from a brokerage

Note: If you received a Form 1099-DIV, or substitute statement

firm, list the firm's name as the payer and enter the total dividends shown on that form.

6

- - - - - - - - - - - --- - - - - - - - - - - - - -- - - - - - - - - -- -- - - - - - -- - - - - - - - - - - - - - - - -- - -- - - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - --- - - - - - - - - - - -- -- - - - - - -- - -- - - - - - - - - - - - - - -- --- - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - -- -- - - - - -- - - - - - - - - -- - - - -- - - - - - - - - - - -- - - - - - - - - - - -- - -- - - - - - - - - - - - - - - - - -- - - - - - - - --- - - - - - - - - - -- - - - - --- -- - - - - - - - -- - - - - - - - --- --- - - - - -- - - - -- - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - - -- - - - - - - - - - - -- - - - - - - - - - - - - -- - - -- - - - - -- - -- -- - - - - - - - - - - - - - - - - --- - - - - - - - - - - -- -- - - -- -- - - - - - - - --- -- - - - - - - - -- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - -- - -- - --- - - - - - - - -- - - - - - - --- - - - - - - -- - - Add the amounts on line 5 Capital gain distributions. Enter here and on Schedule D*
Nontaxable distributions. (See Instructions for Form 1040, line 9.)

capital gain istributions an nontaxable

gayer. Include ~ross dividends

d i stri buti ons will

and/or other distri buti ons on stock here. Any be deducted on lines 7 and 8 ~

5

6

7
8 9 10

9 Add lines 7 and 8 ~ 10 from line 6. Enter the resu I t here and on Form 1040, line 9 Subtract line 9 *If you do not need Schedule 0 to report any other gains or losses, see the instructions for Form 7040, line

.K-

Part II Foreign Accounts and Trusts
(See instructions.)

You must comp'lete this part if you (a) had over $400 of interest or dividends; (b) had a foreign account; or (c) received a äistribution from, or were a grantor of, or a transferor to, a foreign trust

11 a At any time during 1996, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See instructions for exceptions and filing requirements for Form TD F 90-22.1

b If 'yes,' enter the name of the foreign country

~

12 During 1996, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If 'yes', see instructions for other forms you may have to file. . . . . , , . , , , , . . , , . . . . . . , , , , , , . , , , , , , . . . , . , , , , , , ' X

BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule B (Form 1040) 1996
FDIA041 10/03/96

12

Case 1:08-cv-00194-MMS
Schedule C-EZ
(Form 1040)
Dep;'rtment of the Treasury
I!ìternal Revenue Service

Document 7-2

Filed 06/18/2008

Page 13 of 17
OMS No. 154.0074

Net Profit from Busi'ness
~ Partnerships, joint ventures, etc, must fie Form 1065.
~ Attch to Form 1040 or Form 1 041. ~ See instrctions.

(Sole Proprietorship)

1996
09A
r (SSN)

NatT of Proprietor

.. ADRIAN GLUCK
IPll::lttttl General

Information
· Had business expenses of $2,500

-.
You May

or less.

Use this

. Use the cash method of accounting.
. Did not have an inventory at any

Only if You:

Schedule

time during the year.

I
i And You: I

. Had no employees during the year.
. Are not required to file Form 4562, Depreciation and Amortization, for this business. See the instructions for Schedule C, line 13, to find out if you must file.
. Do not deduct expenses for business use of your home.

. Did not have a net loss from your

business,

. Had only one business as a sole

proprietor,

A Principal business or profession, including product or service
CONSUL TING

T
., . .... ,

. Do not have prior year unallowed passive activity losses from this

business.

B Enter principal business code

~ 7286
D Employer ID number (EIN), if any

C Business name. If no separate business name, leave blank,

E Business address (including suite or room number). Address not required if same as on Form 1040, page 1,

5 BLESSING
City, town or post office, state, and ZiP code

IRVINE, CA 92612

I:Pift¡:lrm/rl Figure Your Net Profit
1

Gross receipts. Caution: If this income was reported to you on Form W-2 and the 'Statutory employee' box on that form was checked, see Statutory Employees in the instructions for Schedule C, line 7,
and check here
..... . ..... . ... .... .

....... .

..... . .... . .. ,... ...... ,

~

2 3

Total expenses. If more than $2,500, you must use Schedule C

0
,,

1

200,000.

2

Net profit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on Form 1040,
not report i~~: 1~'E~~~t:~s~n~nt~~~:.d~~~e;~'nliP~r~ ~ï~tW~~ ~)pioY,ees ,do

thiS, ~rnount on, SCh,edul,e ,SE, ,

3

200,000.

l:fbiiiJlf??1 Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2,
4 When did you place your vehicle in service for business purposes? (month, day, year)
5 Of the total number of miles you drove your vehicle during 1996, enter the number of miles you used your vehicle for:

6 Do you (or your spouse) have another vehicle available for personal use? ' , . , , , , , , , '
7 Was your vehicle available for use during off-duty hours? '" Sa Do you have evidence to support your deduction?

a Business b Commuting c Other
b If 'Yes,' is the evidence written? ""","'"

Yes Yes Yes Yes

No No No No

BAA For Paperwork Reduction Act Notice, see Form 1040 instrctions.

Schedule C-EZ (Form 1040) 1996

FDIA8301 09/24/96

13

Case 1:08-cv-00194-MMS
Sched'ule D
(Form 1040)
Department of the Treasury

Document 7-2

Filed 06/18/2008

Page 14 of 17
OMS No. 154.0074

Capital Gains and Losses
~ Attch to Form 1040. ~ See instrctions for Schedule 0 (Form 1040).

1996
12
umber

I~ternal Revenue Service (99)

~ Use lines 20 and 22 for more space to list transactions for lines 1 and 9.

Name(s) Shown on Form 104

~ (e) is more than (d), subtract (d) from (e)

(f) ioss

If (d) is more than (e), subtract (e) from (d)

(g) GAIN

1

2 Enter your short-term totals, if any, from line 21 . . . . . . . . . . . . . . . . . . . . . . . 2
3 Total short-term sales price amounts.

Add column (d) of lines 1 and 2 . 3
Forms 4684,6781, and 8824 ............................................... 4

4 Short-term gain from Forms 2119 and 6252, and short-term gain or loss from

5 Net short-term gain or loss from partnerships, S corporations, estates, and trusts
6 Short-term capital

from Schedule(s) K- 1. 5
loss carryover. Enter the amount, if any, from line 9 of your 1995 Capital Loss Carryover Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Add lines 1 through 6 in columns (f) and (g) . . 7

~ 8
34000 SHRS INTE PAC
9

VARIOUS

01/18/96 01/18/96

2,780.

2,780.
2,457.
33.

30000 SHRS INTE PAC
VARIOUS 500 SHRS I TE PAC VARIOUS
10

2,457.
33.

01/19/68
10

Enter your long-term totals, if any, from line 23 .

11 Total

Add column (d) of lines 9 and 10 11 5,270.
long-term gain or loss from Forms 4684, 6781, and 8824 .
trusts from Schedule(s) K- 1

long-term sales price amounts.

12 Gain from Form 4797; long-term gain from Forms 21 19,2439, and 6252; and

13 Net long-term gain or loss from partnerships, S corporations, estates, and

14 Capital gain distributions. . . .
15 Long-term capital loss carryover. Enter the amount, if any, from line 14 of your 1995 Capital Loss Carryover Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

16 Add lines 9 through 15 in columns (f) and (g)
of line

16
16

5,270.
~ 17

5,270. 5,270.

18 Combine lines 8 and 17. If a loss, go to line 19. If a gain, enter the gain on Form 1040, line 13. Note: If both lines 77 and 78 are gains, see the Capital Gain Tax Worksheet in the instructions. 19 If line 18 is a loss, enter here and as a (loss) on Form 1040, line 13, the smaller of these losses:

18

a The loss on line 18; or b ($3,000) or, if married filing separately, ($1,500) .
Note: See the Capital Loss Carryover Worksheet in the instructions if the loss on line 78 exceeds the loss on line 79 or if Form 7040, line 35, is a loss. BAA For Paperwork Reduction Act Notice, see Form 1040 instructions.
FDIA0612 09/18/96

19

Schedule 0 (Form 1040) 1996

14

Case 1:08-cv-00194-MMS
Schedule SE '
(Form 1040)
Dep;irtment of the Treasury
¡"ternal Revenue Service (99)

Document 7-2

Filed 06/18/2008

Page 15 of 17
OMS No. 154.0074

Self-Employment Tax
~ See instructions for Schedule SE (Form 1040).

1996
17

Name of Person with Self~Employment Income (as shown on Form 104)

~ Attach to Form 1040. Social Security Number of Person
with Self-Employment Income ~

A~RIAN GLUCK

Who Must File Schedule SE
You must file Schedule SE if:

. You had net earnings from self-employment from other than church employee income (line 4 of Short Schedule SE or line 4c of Long Schedule SE) of $400 or more, Or . You had church employee income of $108.28 or more. Income from services you performed as a minister or a member of a religious order is not church employee income. See instructions.
Note: Even if you have a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and use

either 'optional method' in Part" of Long Schedule SE. See instructions.

Exception: If your only self-employment income was from earnings as a minister, member of a religious order, or Christian Science practitioner, and you filed Form 4361 and received IRS approval not to be taxed on those earnings, do not file Schedule SE. Instead,

write 'Exempt - Form 4361' on Form 1040, line 45.

May I use Short Schedule SE or Must I use Long Schedule SE?
Did You Receive Wages or Tips in 1996?

No

Yes

Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings?

-Yes

Was the total of your wages and tips subject to social

security or railroad retirement tax plus your net earnings from self-employment more than $62,700?
lNO

-Yes

lNO

Are you using one of the optional methods to figure your I~

No Did you receive tips subject to social security or Medicare \~

net earnings? (see instructions) --,.
lNO Did you receive church employee income reported on Yes

-- tax that you did not report to your employer? - ,.

Form W-2 of $108.28 or more? -lNO
You May Use Short Schedule SE Below

You Must Use Long Schedule SE

Section A - Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE.
1

Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K- 1 (Form 1065),
line 15a ....... ...... .
........ . .. ..... . .... .

....... .

.... .

1

2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; and Schedule K- 1 (Form 1065), line 15a (other than farming). Ministers and members of religious orders see instructions for amounts .... . ....... . to report on this line. See instructions for other income to report. . .... .
3

2
3
.... .

200,000. 200,000.
184,700.

Combine lines 1 and 2

...... .

..... .

........ .

4 Net earnings from self-employment. Multiply line 3 by 92.35% (.9235). If less than $400, do not file
. $62,700 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 45.
· More than $62,70~ multi8~ line 4 W. 2.9% (.029). Then, add $7,774.80 to the result. Enter the

this schedule; you do not owe self-employment tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 5 Self-employment tax. If the amount on line 4 is:

~

4
5

total here and on orm 1 0, line 4 .

6

Deduction for one-half of self-empl~ment tax. Multiply line 5 by 50% (.5). Enter the result here and on Form 1 40, line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . .
FDIAllOI 09109196

J
6,566.

13,131.

I

6

I

BAA For Paperwork Reduction Act Notice, see Form 1040 instructions.
15

Schedule SE (Form 1040) 1996

Case 1:08-cv-00194-MMS

Document 7-2

Filed 06/18/2008

Form 2848
(Rev December 1997)
Department of the Treasury Internal Revenue Servce

G/( Power of Attorney and Declaration of Representative
~ See the separate instructions.

fhlJJ

Page 16 of 17
ZA
)

OMB No 1545-0150
For IRS Use Only
Received ,by:

-

Name "'fY~
Telephone g)(1li5?'5ì 2,

I Part I
1

I

Power of Attorney (Please type or print.)
r(s)

Function Sß of,
Date &j I 2/ ()/

Taxpayer information (Taxpayer(s) must sign and date this form on pag

Taxpayer name(s) and address

Employer identification number

ADRIAN
SUSAN
T

GLUCK

GLUCK
ber
Plan number (if applicable)

6 VERNON

NEWPORT BEACH

CA

92657

hereby appoint(s) the following representative(s) as attorney(s)-in-fact:

Name and JD, MBA, PhD Telephone No. 310 Joyce Rebhun, address CAF No.
2 Representative(s) (Representative(s) must sign and date this form on page 2, Part II.)

Name and address CAF No.
Beverl Hills CA 90211 Check if

8500 Wilshire Boulevard, Ste. 519 FaxNo.310 657 new: Address 0
Telephone No.
Fax No.

Telephone No. 0

Name and address CAF No.
Fax No.

Check if new: Address 0
Telephone No.

Telephone No. 0

Check if new: Address 0
to represent the taxpayer(s) before the Internal Revenue Service for the following tax matters:
3 Tax matters
Type of Tax (Income, Employment, Excise, etc.)

Telephone No. 0

Tax Form Number (1040, 941, 720, etc.)

Year(s) or Period(s)

Indi vidual income tax

FORM

1040
1994 1995 1996

1997

1998 1999 2000

4 Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded
on CAF, check this box. (See instruction for Line 4 - Specific uses not recorded on CAE) ............ . . . . . . . . . . ~ 0

5 Acts authorized. The representatives are authorized to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform with respect to the tax matters described on line 3, for example, the authority to sign any agreements, consents, or other documents. The authority does not include the power to receive refund checks (see line 6 below), the power to
List any specific additions or deletions to the acts otherwise authorized in this power of attorney:

substitute another representative unless specifically added below, or the power to sign certain returns (see instruction for Line 5Acts authorized).

Power to sign returns,

Note: In general, an unenrolled preparer of tax returns cannot sign any document for a taxpayer. See Revenue Procedure 81-38, printed as Pub. 470, for more information.

Note: The tax matters partner of a partnership is not permitted to authorize representatives to perform certain acts. See the instructions
for more information.

6 Receipt of refund checks. If you want to authorize a representative named on line 2 to receive, BUT NOT TO ENDORSE OR

CASH, refund checks, initial here and list the name of that representative below.
Name of representative to receive refull check(s) ~
For Paperwork Reduction and Privacy Act Notice, see the separate instructions.
Form 2848 (Rev 12-97)

ISA
SIT FED4675F 1

16

Case 1:08-cv-00194-MMS
3131-:2

Document 7-2

Filed 06/18/2008

JUL Ø8 . 99 11 : 59~-'1 JOYCE REBHlN CO.

Page 17 of 17 P.2

465 ;-9&

PlIS" 2
fQlm2iWI(Rliv_ IZ,s7¡
7

Noùces and comunicatiDns. Orlrw notîes and ether wri:ei communictins wil be sent Lo YolJ srid 9 MPY (0 thQ first repf$Sentll,Ì\'e listed on line 2. unless yolicheK nne () more (If iMooiies below.
a If you want the first rtip;esentative Usti; on iiteZ to receive the originaL. an': YO!Jrs~lf a Cùpy. of sl.h nohce1 or

commuriícfltioM.. cneck this box , . . . . . . . . . . _ . . . . . , . . . . , . . ., . .. 0
b If yui.ì also wclnt the $Ccond rep"~"VilÌ..é !isUld to riicQÎve a cop)' of such notÌL!l$ i'd communicaiiOllS. c.tieck ~h¡s

00)( . .. ......,................,........... II 0
pow~r($l of attorney Qn me; with the ¡n~mal r~w/'ueSeMce lor Cht $limQ IlX matteri¡ and years or period!j CO'Jereo by
Lhi:i ÒOlurl',èot. 11 you do ni)~ w~nl to revoi(e a prior powÐr ofaiwrMy, chacll hero. . . . . . , . . ~. . ' . II 0

C If OV QQ not want an ritiCIi5 or communìcalíll ~flt to Out re reseMtative(s). check this boii . ..
S Relertiòl1/\'voçaùon of prior powerl,) of aUgrnlY. T:l& 1111nq nf ths power of altomay i1yIOmsl¡csJ¡y rev"-as 'aR ~ildìe(

VOU MUST ATTACH A. COpy OF ANY POWER OF' ATTORNEY YOU WANT TO REMAIN 'N ~fH.CT.

S S,ignaiure of inPlyer(s). i~ a taii matte oonwns a Joinl retrn. both husband ami wile must sign If joint r~¡m:lsßnll\UOil ì5

requeste. otherwise, S.,E ihe in$trctns. If 5igrisd by a corporllte offcer, ptnner. guardin. tal' miine paitw. executQr,
reCeiV!lL administraw. ~r llustl1l! on behalt or the taxp.oyer, I r.enily lhat I have the. !Iuthorlty to e¡(acute thiii form on béhaii

.. IF NOT SIGNED AND DATld.l, lHl$ POWER OF ATTRNEY Wll.t BE RETURNED.
.-,

of (nil ~1ì:tp?'iBr. .
no ~_..~. /'~/ .~

--ì ,1/ ;-(7 L, .' -.." , "..
'0 ....¡.......;....... .
O~tl!

'Á Ii o I".1\ I//J 1.. /ì - 1 1 l.r t/ c,:/l i. // \l::~ '1 I\,.in
.......... u....f ~t\''''.P.(''''sig¡'àwrë ..... ..... ..... .............'. ,.d.
oC!..!-- ,,(..,., iF- :...~ \_/ Vl='-~---~ or

i I'D (' .' ¡
......".. " '.¡it.'ii;'~p¡;ìi-;¿bí¿J""'-

I \ ".,.............. ...,...¡._. _. n 1.J J~:. ¡ f"' tt:~ ~~~i ~ v- '~.;. ~~~"'" _,_.... .......... ............... ..n..._.' .........,.....

. lL....~.. Print Ni~~l1
'/ .....'&~~",.... .sr~01.~~.......n......._.

.....'..L~:L./ f
Date

-~1' / ¡ ~.::~l J f)('~)
. .............iiijè.Õï~ppliëåbië¡........

....,~ .! '" - --

,~, \.J:,~. /f:"t 1': (-.-~ L.ll C.~ .,.(_.

. ____.. ..... ........"..... P~i~t Ñ~~ëu........ u..u.........',.........

&n'11 Declaration Of Representalive
Under penalU6¡ of perji.ry. i i.eèlaré that:
. I ~IT nQl i.um¡~t1y undClr ~'Jpi!nsion or diibiirmenl from pr¡iùi;~ oefo(e ihe Intenal R~r;tle $èric6:

.. I am aware Qr regull1lilJris. çonlai1&d in TrQasul) Oeparo~ht CirculAr No. 230 (031 em. Part 1D). a& iimef1óed, conc~;ning ihe practice 01 atlar(1e~s. certified p\AbliC 8CXunUlnl1l. enrollei: agts, ¡mroUEt a¡¡i\Jiirl~, imd others; . I am authorized to repre~enl the tiiiiptl)'attsl idenlWjQ 11' Port 110l the tax mattar(s) specified thOro; and
. I ~m em!! Qf !.e following:

3 Altorney-. mem in gooo srsdi!1 ot the bar Qf the highest coUtt or the jurlsdii;tion shown below.
b Certfied Public Accouniint-duly qualified to piaclic as a ciintleó pUblic lcc:oLlnlenr In âiElJurí5ìiCtlOn -snown belOW.

i; Ei'rolled Agent.nrölledas an agent under the i'ùimments of Treasur D&p.1meri~ Citcular No. 230.

d Qmcer-¡¡ bonà fidEl oJlCQr of th\l tiiiqyer's orgnfzation. e Full. TIme E.m;iloye~a I'JII.lime ampioy or the l1xpayer. f Family Miirnber-a memlxu oftl1e w;ip~ye¡', immediate flimHy V.c., spouse. parent, cl';ld, brother. or 'ii!mir). 9 EnrQIlEtd ActLîiir9-el'oiled a:õ' an actl.~fJ oJ the JóírH &lard for th Enr!lmeN. ot Aciuarill Ul'def 29 U.S.C. 1242 (the
iiulhOCily to practïi:e beor Lhe Service Is lin1itea 0)' section '10.3(d)(1 of Treasury Oe-pill1ment ClfCulsi No, 2301.
h lJrienroled Return Preparer--li un!tK""Olled return prep.:l'er under sec;lson iO.7(c)(vim of Tresury Depalt!lr.t C¡icuiar
No.

230.

.. IF THIS DECLARATION OF REPRESiNTATlV£ IS NO SIGNED A.NO DATED. TH£ POWE Of ATTORNf: WILL.
BE RETURNED.
De!i19nallon~lmÍP"rt
zibove letter ii-h)

Date

a.

~

a.

17