race ce BURSA SE BA | Repubska ng Pinas ‘Annual Income Tax Return BIR Form No. Recerca ee thea a 1700 Kawartamae | ener quad nermelan SATIN LETTERS stp BLACK Ins Mark appleale| a8 201398) Tea FRI eae oe eee (20 LPR Treo Jno [2 Lives Ino | some lecemaie, Cette ee —— ra _ umber cn L “11 =|) =|0/0 00} Tee |) | | “cove |) | Br aera ee dd a L Liiiiiiiiiis Li Litiiiii t 19 Adress (deal complete registered acess; Mectress has changed, markhere | | andenternewedeessin Table 1) L Pipi yy yyy ypiviiiy pire iiii s To Date oC Bm WaaDB HVE) —| Teal Aaarees t Wy 72 Contact Nunbar CMSs TIT TTTTiiy Single Waied Legally Separated Widewier 14 Claiming Additional Exemptions? Yes LINo Bare eee a7Spowse'stiN|— |=}. =| ¢{-|0.0,00["wmel sp) i pie 19 Dale of 8th (MODY) — [20 Emal Aarons rt Fy | py i ti Pi iii i i L 24 Claiming Additional Exemptions? _[_]Y¥es [_]No | TES oe nab oom a Doe ay Part = Total Tax Payable [De NOT enter Centavos) 23 Tax Filer Tax Due (rn Pathan ts Colina A boiinis 24 Spouse's Tax Due (Fon Parvo 14 Cole 8) Loita 25 Total Income Tax Due (smote 254 29 Loiipit 26 Loss: Tax Fler's Tax Credits/Payments (rom Pati tem 19 Cau A) Lottie 27__ Spouse's Tax Credits/Payments (rom Pu vt Gaur) Latitit 28 Net Tax Payable (Overpayment) ton 25a tone 25427) oe ee 29 Less: Potion of Tax Payable Allowed for 2% nstalinent nee paimerewtr any aWromeanivien2 |) 4 | | 4. | 30 Add: Total Penalties rom Par ann 27) boiipit ‘34 TOTAL AMOUNT PAYABLE Upon Filing (Overpayment) sn 28 est 2am 0) ee ‘Number of pages fled Sigua er aie Vax Fro RT Rep EGov ha Faso Cnet Tax Owens CTO} | | 83 Dale of Issue (MMVDDIYYYY) Sa Amount, OTC Litiiiyiiiiit rrr 1 Loitrit 35 Place of issue aa ‘lari of Racaiing Offca/AAB and Dato of Recot LE |e] 0 seneturetient Tee's inten frase] bit Macins Vasat Revere fica Reco Das ree wh a Atv Art Bark)(To be filed uo bythe BIR) DLN: sic: Psoc: a ska ng Pipa Account @ ree wena Information Form 1/071AIF Tobe accomphed & led wth BIR Form No. 1704 Eor Self-Employed and Professional individuals! tees taxpayer opted for OplonalStandarg Beduckon) D ENCS) Estate and Trusts (Engaged in Trade or Business) Torte Yoo T Campy Tanereria [] Sat Esored |] Penna? Ca com (arcane) spouse om ie Seco un TaERRTI Tr 3 traaton No. . 0,00 } tan Nana aot Dea Tas Ra aa iia, ae TO {) — Samm cna aa i Naa 5 a ane] 35 oto Soa Ge tad oas Rogan (Speaty) Manual [] computerized [_] Looseteet [] eouna (J rea ines wend taTerreR! aa pane eo lp cree suleureveneenecoeFo 7A Jb shure tom Conor Prose Parry nae a fice pene ecco o SaesDicomns tc to netsdeevreserts Fer (ten an Sie em 9) ton ft Las: Coster Sle/sevone (Scud 1) tia 2 Gros Prof fom Operators (tom 0s tem 11) tt Aa: Nan operat eae 13 Gan tom Sco / Exchanges of Rea Propets (Sch) 138 1. Gator Suen /Cicarger nerfed here Srep. om: 108 18. Gan tom Sues / changes of Sesto ta 46 Ofveriname Schade 5) tea 7 Toa Goes inca Si tems 1210 16) 1% (ee pore 18. Slates re Avon tan 42. ring Brett im 20-558, GSI, Medoae, HOME and ter Contre 208 aes ma 22 Outta Servos za 23 havering aa 26 Rent ma paired 2A 28. Foyain 2A eer eer mA 28 Roprseriatn and Enrert mA palreeeectsel aad 2A 30 Fucland on a 31° Communicator, Light rd Wer a 22 siplee 20 39 heest Ba 34 Tors nd conse (Schule 2) baa eat 25 36 Bad Dots ea 28 Arran of iargbes a 2 Dopeton 9eta mB) E < ie 2 = i 5 3 3 8 <=