IRPF 2022 2021 Origi Imagem Declaracao01

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I, RODRIGO DECCO, translator, bearer of ID no. 106.140.

256-80, hereby CERTIFY this is the description and


faithful translation of a DOCUMENT written in Portuguese, which I translate as follows:

NAME: BRUNA AMORIM PAVAN


CPF: 394.303.948-00 INCOME TAX - INDIVIDUALS
ANNUAL ADJUSTMENT FISCAL 2022 CALENDAR YEAR 2021
STATEMENT YEAR
TAXPAYER ID
Name: BRUNA AMORIM PAVAN CPF: 394.303.948-00
Date of Birth: 22/04/1994 Electoral Title: 388706990167
Do you have a spouse or partner? Yes Was Spouse's or partner's social security number: 428,738,538-16
there a change in registration data? Yes
Is one of the declarants a person with a serious illness or a physical or mental disability? No

Address: STREET ARCIPRESTE EZEQUIAS Number: 473


Complement: APTO 1501 Neighborhood/District: VILA SÃO JOSÉ
Municipality: SÃO PAULO UF: SP
ZIP Code: 04271-060 DDD/Phone: (11) 98052-2785
E-mail: BRUNA.PAVAN@OUTLOOK.COM DDD/Mobile: (11) 98052-2785

Nature of Occupation: 01 - EMPLOYEE OF PRIVATE SECTOR COMPANY, EXCEPT FINANCIAL INSTITUTIONS Main Occupation:
000 - OTHER OCCUPATIONS NOT PREVIOUSLY SPECIFIED
Claim Type: Original Annual Adjustment Statement
Receipt number of the last declaration delivered from the 2021 exercise: 08.67.07.79.51-04

DEPENDENTS

No Information

FEEDINGS

No Information

TAXABLE INCOME RECEIVED FROM A LEGAL ENTITY BY THE HOLDER (Amounts in Reais)

NAME OF REND PAYING SOURCE. RECEIVED CONTR. PREVID. WITHHELD TAX 13th SALARY IRRF ON 13TH
FROM PES. OFFICIAL LEGAL AT SOURCE WAGE

C.C.COML MARKET PLACE 21,992.66 2,759.79 1,259.59 0,00 0,00

CNPJ/CPF: 00.102.759/0001-85

IGUATEMI EMPR. SHOP. CENT 41.891,35 4.813,33 3.548,30 4.817,14 628,08

CNPJ/CPF: 51.218.147/0001-93

TOTAL 63.884,01 7.573,12 4.807,89 4.817,14 628,08

TAXABLE INCOME RECEIVED FROM LEGAL ENTITY BY DEPENDENTS

No Information

TAXABLE INCOME RECEIVED FROM INDIVIDUALS AND ABROAD BY THE HOLDER

No Information

TAXABLE INCOME RECEIVED FROM INDIVIDUALS AND ABROAD BY DEPENDENTS

No Information

EXEMPT AND NON-TAXABLE INCOME (Amounts in Reais)

TOTAL 0.00

INCOME SUBJECT TO EXCLUSIVE / DEFINITIVE TAXATION (Amounts in Reais)

01. 13th salary 4,817.14

TOTAL 4,817.14

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