IMPRIMIR TAXBACK

8/10/2019 IMPRIMIR TAXBACK

http://slidepdf.com/reader/full/imprimir-taxback 1/9

www.taxback.com

US

TAX RETURN

taxback.com, IDA Business & Technology Park, Ring Road, Kilkenny, Ireland

SPANISH VERSION

taxback.com

333 N. Michigan Ave

Suite 2415Chicago 60601 IL

USA

taxback.com

IDA Business &

Technology ParkRing Road, Kilkenny

IRELAND

taxback.com

1st Floor,

277281 Oxford StreetLondon W1C 2DL

UNITED KINGDOM

taxback.com

Level 2,

600 George StreetSydney, NSW 2000

AUSTRALIA

INSTRUCCIONES

IT’S QUICK AND EASY TO GET YOUR US TAX REFUND. JUST FOLLOW THE STEPS BELOW.

1. Formulario de AplicaciónCompleta toda esta página. Mientras más detallesproporciones, más rápido podremos procesar tu

solicitud.

2. Formulario 2848Firma y fecha el formulario enla segunda página del formulario donde está el .

Nota: Si estás casado, cada cónyuge debe irmar una copia

separada del formulario 2848.

3. Formularios 8821 y 8822Solo irma el formulario al costado del .

4. Acuerdo del Cliente y Carta Poder

Por favor irma y fecha el formulario al costado del .

5. IdentiicaciónEnvíanos una fotocopia de tu social security card. Si no

tienes una, por favor envíanos copia de tu visa o de lapágina de identiicación en tu pasaporte.

6. Tus documentos de pago

Envíanos los últimos documentos de pago de cada

empleador – formularios w2, últimos paychecks o

cualquier otra declaración de ingresos acumulativa

que demuestre Ingresos de fuentes Estadounidenses o

impuestos pagados a EE.UU

Asegúrate de establecer el tamaño de papel en A4 y la resolución a un mínimo de 300dpi. Guarda el archivo en

formato PDF, JPG o JPEG antes de enviárnoslos por mail. Cada archivo no debe exceder los 2MB

Si tienes diicultades escaneando tus documentos, por favor habla con nosotros www.taxback.com/chat o llama

a la oicina más cercana www.taxback.com/contactus.asp

taxback.com

333 N. Michigan Ave

Suite 2415Chicago 60601 IL

USA

taxback.com

IDA Business &

Technology ParkRing Road, Kilkenny

IRELAND

taxback.com

1st Floor

277281 Oxford StreetLondon W1C 2DL

UNITED KINGDOM

taxback.com

Suite 3, Level 13

222 Pitt StreetSydney, NSW 2000

AUSTRALIA

ES RÁPIDO Y FÁCIL OBTENER TU REEMBOLSO DE IMPUESTOS. SOLO SIGUE LOS SIGUIENTES PASOS.

Por favor imprime todos los

formularios

Sigue las instrucciones Escanea los documentos y envíalos por

email a [email protected]

Gracias por elegir taxback.com. Estamos ansiosos de trabajar contigo para aplicar por tu declaraciónde impuestos. En este pack, encontrarás todo lo que necesitas para autorizar a taxback.comdeclarar tus impuestos en tu nombre. Por favor lee cuidadosamente este pack, írmalo y envíalo [email protected].

INSTRUCCIONES DE LOS FORMULARIOS

INSTRUCCIONES PARA ESCANEAR

1 2 3



www.taxback.com

US

TAX RETURN SPANISH VERSION

FORMULARIO DE REGISTRO / APPLICATION FORM

INFORMACIÓN DE CONTACTO / CONTACT INFORMATION POR FAVOR ESCRIBE EN LETRA IMPRENTA

Sr Sra Stra Mr Mrs Ms

NombresFirst Name

ApellidosSurname

Fecha de Nacimiento _____ / _____ / _________Date of Birth

TelephoneCelularMobile

Email País de origenHome Country

Dirección de DomicilioPostal address

¿Cómo te enteraste de nuestro servicio?How did you hear about our company?

INFORMACIÓN DE VISADO / VISA INFORMATION

Tipo de Programa / Program type: Work & Travel Intern

Otro / Other (please list):

Tipo de visa / Visa Type: J1 F1 H1B H2B Q L

E P O Other / Otro:

Fecha de llegada a EE.UU.Date of arrival in the USA _____ / _____ / _________

Fecha de salida de EE.UU.Date of departure from the USA _____ / _____ / _________

¿Has solicitado este reembolso antes? Sí NoHave you applied for this refund before Yes No

¿Cuál fue el costo de tu programa a los EE.UU.?What was the cost of your programme to the US? $

¿Cuál fue el costo de tu boleto aéreo a EE.UU.? / What was the cost of your flight to the US? $

Personas con visa que paguen por gastos de vivienda en sus paises de origen mientras esten en su programa de EE.UU. podrían recibir reembolsos de impuestos legalmentemayores.

Por favor selecciona qué gastos de vivienda pagaste en tu país de origen, mientras estuviste en tu programa de EE.UU.

Please tick which living expenses you paid for in your home country, while you were on your US program:

Seguro (médico, de vivienda, vehicular, etc.) / Insurance (medical, home, vehicle, etc) Gastos de telefonía celular / Mobile phone costs

Membresía de club (gimnasio, deportivo, social, etc) / Club membership (gym, sports, social, etc) Gastos de vivienda (alquiler, hipoteca, pensión, etc) /

Housing costs (rent, mortgage, board, etc) Transporte (automóvil, motocicleta, bicicleta, etc) / Transportation (car, motorbike, bicycle, etc) Otros / Other

Podrías tener derecho a un reembolso legalmente mayor si tuviste un trabajo a tiempo completo/parcial en tu país de origen antes y después de tuprograma de EE.UU., y/o si mantuviste a alguien en tu país de origen mientras estuviste en los EE.UU.

¿Tuviste un empleo en tu país de origen? Sí NoDid you have a job in your home country? Yes No

¿Piensas retornar a ese empleo cuando dejes los EE.UU.? Sí NoDo you intend to return to that job when you leave the US? Yes No

¿Tienes una dirección domiciliar permanente en tupaís de origen? Sí NoDo you have a permanent address in your home country? Yes No

¿Piensas retornar a esta dirección cuando dejes los EE.UU.? Sí NoDo you intend to return to this address when you leave the US? Yes No

¿Pagaste dinero hacia alguna vivienda en tu país de origen mientrasestuviste en los EE.UU.? Sí/Yes No/No Did you pay money towards a household in your home country while in the US?

¿Tienes derecho de votar en tu país de origen? Sí No Are you entitled to vote in your home country? Yes No

¿Tienes una cuenta bancaria en tu pais de orígen? Sí NoDo you have a bank account in your home country? Yes No

¿Recibiste correspondencia en tu dirección domiciliar mientras estuviste

en los EE.UU.? Sí NoDid you receive mail to your home address while in the US? Yes No

INFORMACIÓN DE EMPLEO / EMPLOYMENT INFORMATION

Nombre de 1er Empleador1st Company name

Último día de trabajo ____ / ____ / ________Final work date

Ciudad / City Estado / State Telephone

¿Tienes tu formulario W2? Sí NoDo you have your W2 Form? Yes No

Si contestaste No, ¿te gustaría que consigamos un duplicado por ti? Sí NoIf no, would you like us to get a replacement for you?* Yes No

Nombre de 2do Empleador2nd Company name

Último día de trabajo / Final work date ____ / ____ / ________

Ciudad / City Estado / State Telephone

¿Tienes tu formulario W2? Sí NoDo you have your W2 Form? Yes No

Si contestaste No, ¿te gustaría que consigamos un duplicado por ti? Sí NoIf no, would you like us to get a replacement for you?* Yes No

Si tuviste más de dos empleadores por favor incluye la información en una hoja separada

* Se aplicará una tarifa de Recuperación de Documento / Document retrieval fee applies

David Felipe

Camacho Alba



www.taxback.com

US

TAX RETURN


SPANISH VERSION

ACUERDO DEL CLIENTE / CUSTOMER AGREEMENT

Nombre en imprenta

Name in print

Fecha _______ / _______ / _____________

Date

Firma Signature

Número de Social SecuritySocial Security Number

Yo confirmo que / I confirm that:

1. Entiendo que taxback.com es el nombre comercial de Taxback Inc., Chicago, USA, y por la presente contrato a Taxback Inc. para llevar a cabo los serviciosdescritos en la misma / I understand that taxback.com is a trading name for the services of Taxback Inc., Chicago, USA, and hereby contract with Taxback Inc. tocarry out the services described herewith.

2. Entiendo que Taxback Inc utilizará a su empresa madre Taxback y sus subsidiarias y compañías afiliadas para reunir información referente a los servicios,donde sea necesario y que el contrato permanece con Taxback Inc por la duración del servicio. / I understand that Taxback Inc will utilize its parent companyTaxback and its subsidiary and affiliate companies to gather information regarding the services where necessary and that the contract remains with Taxback Incfor the duration of the service.

3. He firmado los poderes necesarios para autorizar a Taxback. Inc, y / o sus subsidiarias comercializando como taxback.com y en adelante referido comoel Agente, a preparar esta solicitud de reembolso de impuestos y representarme ante las Autoridades Tributarias de los EE.UU. (IRS and State TaxAuthorities). / I have signed the necessary power of attorneys to authorize Taxback. Inc, and / or its subsidiary undertakings trading as taxback.com and referredto hereafter as the Agent, to prepare this tax return and represent me before the US Tax Authorities (IRS and State Tax Authorities).

4. Autorizo al Agente a recibir toda correspondencia de las Autoridades Tributarias de los EE.UU. en nombre mío. / I authorize the Agent to receive allcorrespondence from the US Tax Authorities on my behalf.

5. Deseo hacer opción de la oferta “sin pagos de antemano” cuando acepte el servicio. Para poder seleccionar esta opción, entiendo que el cobro de la tarifa tendráque ser pagada por mi cuando el reembolso haya sido emitido por las Autoridades Tributarias de EE.UU / I want to avail of the offer to “pay no fee up-front” whenI sign up for the ser vice. In order to avail of this option, I understand that the fee will need to be paid by me when the refund has been issued by the US Tax Authorities.

6. Autorizo al Agente para recibir mi cheque(s) de reembolso de las Autoridades Tributarias. / I authorize the Agent to receive my refund cheque(s) from the Tax Authorities.

7. Asimismo autorizo al Agente endosar los cheques, descontar la tarifa necesaria y enviarme el monto remanente. / I further authorize the Agent to endorsethe cheques, deduct the necessary fee and to send me the remaining amount.

8. Entiendo que una vez que se haya procesado mi reembolso, seré contactado por un Asesor con referencia a las opciones de pago para recibir mireembolso y podré brindar mis detalles bancarios. / I understand that once my refund is processed, I will be contacted by the Agent with regard to paymentoptions for receiving my refund and will be able to provide my bank details.

9. En caso que el Agente elija por alguna razón no endosar el cheque, entiendo y estoy de acuerdo de que pagaré la tarifa debida y cobraré el cheque dereembolso de impuestos por mi cuenta. / Should the Agent choose for any reason not to endorse the cheque, I understand and agree that I will pay the fee dueand will cash the tax office refund cheque myself.

10. En caso reciba mi reembolso directamente de otra fuente que no sea el Agente, entiendo y estoy de acuerdo que pagaré la tarifa correspondiente al

Agente por el trabajo realizado. / Should I receive the refund directly from any other source other than the Agent, I understand and agree that I will pay the feedue to the Agent for the work completed.

11. En caso de estar debiendo impuestos por otros años fiscales, y las Autoridades Tributarias de los EE.UU. descuenten esta deuda pendiente de otros añosfiscales, entiendo y estoy de acuerdo que necesitaré pagar al Agente la tarifa de procesamiento por cada año fiscal que se haya solicitado un reembolso.

/ Should I owe income tax for other tax years, and the US Tax Authorities deduct this owed money from the refund due for other tax year (s), I understand andagree that I need to pay the Agent processing fee for each tax year for which a tax return was processed.

12. Entiendo que las Autoridades Tributarias de los EE.UU. tomarán la decisión final sobre el valor de cualquier reembolso que se deba. Entiendo que el Agentebrindará el mejor cálculo Estimado posible basándose en las actuales leyes tributarias y la información proporcionada, sin embargo este cálculo es solo unestimado, no una garantía. / I understand that the US Tax Authorities will make the final decision on the value of any refund due. I understand that the Agent will

provide the best estimation possible based on current tax law and information given, however this is estimation only, not a guarantee.

13. Estoy de Acuerdo con los términos y las condiciones de servicios, tal y como descritos en línea en www.taxback.com, y como podrían ser modificados en algúnmomento, y con las tarifas del Agente que representan los servicios del cual he aceptado del Agente. / I agree to and accept the terms and conditions of serviceas written online at www.taxback.com and to any changes in the terms and conditions which Taxback Inc may affect from time to time, and to the fees of theagent which represents the services I have requested and which are provided by Taxback Inc and/or its affiliate companies.

14. Entiendo que la información recolectada por escrito y / o verbalmente para los servicios de presentar una solicitud de reembolso de impuestos podría serutilizada para propósitos de auditoría interna de taxback.com y proporcionada a las Autoridades Tributarias de los EE.UU. (IRS and State Tax Authorities)

para propósitos de auditoria externa, sujeto a la legislación correspondiente a la protección de datos. / I understand that information collected in writing and/or verbally for US tax return filing services can and may be used for internal auditing purposes by taxback.com and provided to the US Tax Authorities (IRS and State Tax Authorities) for external auditing purposes, subject to relevant data protection legislation.

15.Confirmo que le he brindado al Agente toda la información necesaria y que haya estado a mi disposición. / I confirm that I have given the Agent allinformation needed and available to me.

16. Me comprometo a actualizar con el Agente, cualquier detalle de contacto mío que cambie. / I commit to updating the Agent of any change in my contactdetails.

17. Entiendo que taxback.com enviará mi aplicación a la oficina fiscal relevante tan pronto como yo haya sido informado del monto de reembolso y hayaenviado todos los documentos necesarios. Si deseará cancelar mi aplicación, contactaré a taxback.com inmediatamente. Entiendo que aunque taxback.com hará todo el esfuerzo para cancelar mi aplicación, esto puede no ser posible./ I understand that taxback.com will submit my application to the relevanttax office as soon as I have been informed of the refund amount and have sent all necessary documentation. Should I wish to cancel my application, I will contacttaxback.com immediately. I understand that while taxback.com will make every effort to recall my application, this may not be possible.

Los términos y condiciones abajo refieren al servicio de declaración de impuestos y reembolsos de taxback.comPor favor lee los siguientes puntos por completo y asegúrate de entenderlos antes de firmar



Form 2848(Rev. March 2012)Department of the TreasuryInternal Revenue Service

Power of Attorneyand Declaration of Representative

Type or print.

See the separate instructions.

OMB No. 1545-0150

For IRS Use Only

Received by:

Name

Telephone

Function

Date / /

Part I Power of Attorney

Caution: A separate Form 2848 should be completed for each taxpayer. Form 2848 will not be honored

for any purpose other than representation before the IRS.1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7.

Taxpayer name and address Taxpayer identification number(s)

Daytime telephone number Plan number (if applicable)

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

2 Representative(s) must sign and date this form on page 2, Part II.

Name and address

Check if to be sent notices and communications

CAF No.

PTIN

Telephone No.

Fax No.

Check if new: Address Telephone No. Fax No.

Name and address

Check if to be sent notices and communications

CAF No.

PTIN

Telephone No.

Fax No.


Name and address CAF No.

PTIN

Telephone No.

Fax No.


to represent the taxpayer before the Internal Revenue Service for the following matters:

3 Matters

Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower,

Practitioner Discipline, PLR, FOIA, Civil Penalty, etc.) (see instructions for line 3)

Tax Form Number

(1040, 941, 720, etc.) (if applicable)

Year(s) or Period(s) (if applicable)

(see instructions for line 3)

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 the instructions for Line 4. Specific Uses Not Recorded on CAF . . . . . . . . . . . . . .

5 Acts authorized. Unless otherwise provided below, the representatives generally are authorized to receive and inspect confidential taxinformation and to perform any and all acts that I can perform with respect to the tax matters described on line 3, for example, the authority tosign any agreements, consents, or other documents. The representative(s), however, is (are) not authorized to receive or negotiate anyamounts paid to the client in connection with this representation (including refunds by either electronic means or paper checks). Additionally,

unless the appropriate box(es) below are checked, the representative(s) is (are) not authorized to execute a request for disclosure of tax returnsor return information to a third party, substitute another representative or add additional representatives, or sign certain tax returns.

Disclosure to third part ies; Substitute or add representative(s); Signing a return;

Other acts authorized:

(see instructions for more information)

Exceptions. An unenrolled return preparer cannot sign any document for a taxpayer and may only represent taxpayers in limited situations. An enrolled actuary may only represent taxpayers to the extent provided in section 10.3(d) of Treasury Department Circular No. 230 (Circular230). An enrolled retirement plan agent may only represent taxpayers to the extent provided in section 10.3(e) of Circular 230. A registered taxreturn preparer may only represent taxpayers to the extent provided in section 10.3(f) of Circular 230. See the line 5 instructions for restrictionson tax matters partners. In most cases, the student practitioner’s (level k) authority is limited (for example, they may only practice under thesupervision of another practitioner).

List any specific deletions to the acts otherwise authorized in this power of attorney:

For Privacy Act and Paperwork Reduction Act Notice, see the instructions. Cat. No. 11980J Form 2848 (Rev. 3-2012)

TB Refund, IDA Business & Technology Park,

Ring Road, Kilkenny, Ireland

AK Tax Services, Inc . 1835 N. Milwaukee,

Chicago, IL 60647

773-252-8080

Taxback Inc., 333 N. Michigan Ave, Suite 2415,

Chicago, IL 60601

888-203-8900

312-873-4202

INDIVIDUAL INCOME TAX 1040, 1040-NR 2013, 2012, 2011, 2010

FICA TAX 843, 8316 2013, 2012, 2011, 2010

✔ This Power of Attorney is being

filed pursuant to Regulations Section 1.6012-1(a)(5) by reason of continuous absence from the USA.

David Felipe Camacho Alba



Form 2848 (Rev. 3-2012) Page 2

6 Retention/revocation of prior power(s) of attorney. The filing of this power of attorney automatically revokes all earlier power(s) of

attorney on file with the Internal Revenue Service for the same matters and years or periods covered by this document. If you do not want

to revoke a prior power of attorney, check here . . . . . . . . . . . . . . . . . . . . . . . . . .

YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.

7 Signature of taxpayer. If a tax matter concerns a year in which a joint return was filed, the husband and wife must each file a separate power

of attorney even if the same representative(s) is (are) being appointed. If signed by a corporate officer, partner, guardian, tax matters partner,executor, receiver, administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of thetaxpayer.

IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED TO THE TAXPAYER.

Signature Date Title (if applicable)

Print Name PIN Number Print name of taxpayer from line 1 if other than individual

Part II Declaration of RepresentativeUnder penalties of perjury, I declare that:

• I am not currently under suspension or disbarment from practice before the Internal Revenue Service;

• I am aware of regulations contained in Circular 230 (31 CFR, Part 10), as amended, concerning practice before the Internal Revenue Service;

• I am authorized to represent the taxpayer identified in Part I for the matter(s) specified there; and

• I am one of the following:

a Attorney—a member in good standing of the bar of the highest court of the jurisdiction shown below.

b Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below.

c Enrolled Agent—enrolled as an agent under the requirements of Circular 230.

d Officer—a bona fide officer of the taxpayer’s organization.

e Full-Time Employee—a full-time employee of the taxpayer.

f Family Member—a member of the taxpayer’s immediate family (for example, spouse, parent, child, grandparent, grandchild, step-parent, step-child, brother, or sister).

g Enrolled Actuary—enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the authority to practice beforethe Internal Revenue Service is limited by section 10.3(d) of Circular 230).

h Unenrolled Return Preparer—Your authority to practice before the Internal Revenue Service is limited. You must have been eligible to sign thereturn under examination and have signed the return. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolledreturn preparers in the instructions.

i Registered Tax Return Preparer—registered as a tax return preparer under the requirements of section 10.4 of Circular 230. Your authority topractice before the Internal Revenue Service is limited. You must have been eligible to sign the return under examination and have signed thereturn. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolled return preparers in the instructions.

k Student Attorney or CPA—receives permission to practice before the IRS by virtue of his/her status as a law, business, or accounting studentworking in LITC or STCP under section 10.7(d) of Circular 230. See instructions for Part II for additional information and requirements.

r Enrolled Retirement Plan Agent—enrolled as a retirement plan agent under the requirements of Circular 230 (the authority to practice before theInternal Revenue Service is limited by section 10.3(e)).

IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED AND DATED, THE POWER OF ATTORNEY WILL BERETURNED. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN LINE 2 ABOVE. See the instructions for Part II.

Note: For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column. See the instructions for Part IIfor more information.

Designation—Insert

above letter (a–r)

Licensing jurisdiction

(state) or other

licensing authority

(if applicable)

Bar, license, certification,

registration, or

enrollment number

(if applicable). See

instructions for Part II for

more information.

Signature Date

Form 2848 (Rev. 3-2012)

B ILLINOIS

H




Form 8821(Rev. October 2012)

Department of the TreasuryInternal Revenue Service

Tax Information Authorization

▶ Information about Form 8821 and its instructions is at www.irs.gov/form8821.▶ Do not sign this form unless all applicable lines have been completed.

▶ To request a copy or transcript of your tax return, use Form 4506, 4506-T, or 4506T-EZ.

OMB No. 1545-1165

For IRS Use Only

Received by:

Name

Telephone

Function

Date

1 Taxpayer information. Taxpayer must sign and date this form on line 7.Taxpayer name and address (type or p rint) Taxpayer identification number(s)

Daytime telephone number Plan number (if applicable)

2 Appointee. If you wish to name more than one appointee, attach a list to this form.

Name and address CAF No.

PTIN

Telephone No.

Fax No.


3 Tax matters. The appointee is authorized to inspect and/or receive confidential tax information for the tax matters listed on thisline. Do not use Form 8821 to request copies of tax returns.

(a) Type of Tax

(Income, Employment, Payroll, Excise, Estate,Gift, Civil Penalty, etc.) (see instructions)

(b)

Tax Form Number

(1040, 941, 720, etc.)

(c)

Year(s) or Period(s)

(see the instructions for line 3)

(d)

Specific Tax Matters (see instr.)

4 Specific use not recorded on Centralized Authorization File (CAF). If the tax information authorization is for a specificuse not recorded on CAF, check this box. See the instructions. If you check this box, skip lines 5 and 6 . . . . . . ▶

5 Disclosure of tax information (you must check a box on line 5a or 5b unless the box on line 4 is checked):

a If you want copies of tax information, notices, and other written communications sent to the appointee on an ongoingbasis, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Note. Appointees will no longer receive forms, publications and other related materials with the notices.

b If you do not want any copies of notices or communications sent to your appointee, check this box . . . . . . . ▶

6 Retention/revocation of tax information authorizations. This tax information authorization automatically revokes all priorauthorizations for the same tax matters you listed on line 3 above unless you checked the box on line 4. If you do not wantto revoke a prior tax information authorization, you must attach a copy of any authorizations you want to remain in effectand check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

To revoke this tax information authorization, see the instructions.

7 Signature of taxpayer. If signed by a corporate officer, partner, guardian, executor, receiver, administrator, trustee, orparty other than the taxpayer, I certify that I have the authority to execute this form with respect to the tax matters and taxperiods shown on line 3 above.

▶ IF NOT SIGNED AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED.

▶ DO NOT SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE.

Signature Date

Print Name Title (if applicable)

PIN number for electronic signature

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11596PForm

8821 (Rev. 10-2012)

Taxback Inc., 333 North Michigan Ave., Suite 2415

Chicago, IL 60601

888 203 8900

312 873 4202

Individual Income Tax 1040, 1040NR 2013, 2012, 2011, 2010



Form 8822(Rev. January 2012)

Department of the TreasuryInternal Revenue Service

Change of Address

(For Individual, Gift, Estate, or Generation-Skipping Transfer Tax Returns) Please type or print.

See instructions on back. Do not attach this form to your return.

OMB No. 1545-1163

Part I Complete This Part To Change Your Home Mailing Address

Check all boxes this change affects:

1 Individual income tax returns (Forms 1040, 1040A, 1040EZ, 1040NR, etc.) If your last return was a joint return and you are now establishing a residence separate from the spouse with whom

you filed that return, check here . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Gift, estate, or generation-skipping transfer tax returns (Forms 706, 709, etc.) For Forms 706 and 706-NA, enter the decedent’s name and social security number below.

Decedent’s name Social security number

3a Your name (first name, initial, and last name) 3b Your social security number

4a Spouse’s name (first name, initial, and last name) 4b Spouse’s social security number

5a Your prior name(s). See instructions.

5b Spouse's prior name(s). See instructions.

6a Your old address (no., street, apt. no., city or town, state, and ZIP code). If a P.O. box, see instructions. If foreign address, also complete spaces below,see instructions.

Foreign country name Foreign province/county Foreign postal code

6b Spouse’s old address, if different from line 6a (no., street, apt. no., city or town, state, and ZIP code). If a P.O. box, see instructions. If foreign address, alsocomplete spaces below, see instructions.


7 New address (no., street, apt. no., city or town, state, and ZIP code). I f a P.O. box, see instructions. If foreign address, also complete spaces below, seeinstructions.


Part II Signature

Daytime telephone number of person to contact (optional)

Sign

Here

Your signature Date

Signature of representative, executor, administrator/if applicable Date

If joint return, spouse’s signature Date

Title

For Privacy Act and Paperwork Reduction Act Notice, see back of form. Cat. No. 12081V Form 8822 (Rev. 1-2012)

✔

TB REFUND, IDA BUSINESS & TECHNOLOGY PARK, RING ROAD, KILKENNY,

IRELAND



0292100094

Taxpayer’s identification numberPage 2 of 4 POA-1 (9/10)

Affix corporate seal here, if applicable

Signature Taxpayer’s telephone number Taxpayer’s fax number Date

( ) ( )Name of person signing this form (type or print) Title, if applicable

Spouse’s signature Spouse’s telephone number Spouse’s fax number Date

( ) ( )

4. Retention/revocation of prior power(s) of attorney

This power of attorney (POA) only applies to tax matters administered by the New York State Tax Department, the New York CityDepartment of Finance, or both. Executing and filing this POA revokes all powers of attorney previously executed and filed with anagency for the same tax matter(s) and year(s), period(s) or transaction(s) covered by this document. If there is an existing POA thatyou do not want revoked, attach a signed and dated copy of each POA you want to remain in effect and mark an X in this box. .........

5. Notices and certain other communications

In those instances where statutory notices and certain other communications involving the tax matter(s) listed on page 1 are sent to arepresentative, these documents will be sent to the first representative named in section 2. If you do not want notices and certain othercommunications sent to the first representative, enter the name of the representative designated on page 1 (or on the attached power ofattorney previously filed and remaining in effect) that you want to receive notices, etc.

Representative’s name: _________________________________________________________________If you do not want notices and certain other communications to go to any representative, enter None on the line above.

6. Taxpayer signature

If a joint tax return was filed for New York State, New York City, or both, and both spouses request the same representative(s), both spousesmust sign below.

If the taxpayer named in section 1 is other than an individual: I certify that I am acting in the capacity of a corporate officer, partner(except a limited partner), member or manager of a limited liability company, or fiduciary on behalf of the taxpayer, and that I havethe authority to execute this power of attorney on behalf of the taxpayer.

7. Acknowledgment or witnessing the power of attorney

This power of attorney must be acknowledged by the taxpayer(s) before a notary public (see next page for acknowledgment formats)or witnessed by two disinterested individuals, unless the appointed representative(s) is licensed to practice in New York State as anattorney-at-law, certified public accountant, public accountant, or is a New York State resident enrolled as an agent to practice before theInternal Revenue Service.

The person(s) signing as the above taxpayer(s) appeared before us and executed this power of attorney.

IF NOT SIGNED AND DATED, THIS POWER OF ATTORNEY WILL BE RETURNED.

Signature of witness Signature of witness

Name of witness (type or print) Date Name of witness (type or print) Date

Mailing address of witness (type or print) Mailing address of witness (type or print)

City State ZIP code City State ZIP code

I /We authorize the above representative(s) to sign tax returns for the tax matter(s) indicated above. (If joint return, both taxpayers must sign.)

I /We authorize the above representative(s) to delegate his/her/their authority to another. (If joint return, both taxpayers must sign.)

Your signature Date Spouse’s signature Date

Your signature Date Spouse’s signature Date



www.taxback.com

US

TAX RETURN


SPANISH VERSION

POWER OF ATTORNEY

Taxpayer Name

Date of birth _____ / ______ / _________ SSN (last 4 digits)

Taxpayer Signature Date _____ / ______ / _________

A) to review, receive and collect original and copied W-2 forms, tax information statements, earningsstatements an any other payroll, tax and income related forms and information.

B) to deal with my Social Security and MediCare (FICA) tax rebate and to receive tax information andrefund checks issued in my name at the address stated above.

This Power of Attorney shall become effective immediately on the date signed and shall terminate onthe date these matters are completed.

This Power of Attorney revokes all prior Power of Attorney(s) filed.

I am fully informed as to all the contents of this form and understand the full import of granting thesepowers to my representative.

hereby appoint the following representative as attorney- in fact:

Taxback Inc., 333 N. Michigan Avenue, Suite 2415, Chicago IL 60601

to act as my legal representative before my employer(s), to perform any and all acts I can performwith regards to the following matters:

Please only fill out the fields where you see the indicated.


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