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May 15, 2023

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Form ****-V

II Detach Here and Mail With Your Payment and Return

Internal Department Revenue of the Service Treasury Form 1040-V Payment Voucher G Use this voucher when making a payment with Form 1040. G Do not staple this voucher or your payment to Form 1040. G Make your check or money order payable to the 'United States Treasury.' Enter the amount G Write your social security number (SSN) on your check or money order. of your payment. . . . . . . . . G

(99)

Form 1040-V Page 2

IF you live in . . . THEN use this address to send in your payment . . . Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas

Internal Revenue Service

P.O. Box 1214

Charlotte, NC 28201-1214

Arkansas, Connecticut, Delaware, District of Columbia, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, New York, Oklahoma, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin

Internal Revenue Service

P.O. Box 931000

Louisville, KY 40293-1000

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Kansas, Michigan, Montana, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, South Dakota, Utah, Washington, Wyoming

Internal Revenue Service

P.O. Box 802501

Cincinnati, OH 45280-2501

A foreign country, American Samoa, or Puerto Rico (or are excluding income under Internal Revenue Code 933), or use an APO or FPO address, or file Form 2555 or 4563, or are a dual-status alien or nonpermanent resident of Guam or the U.S. Virgin Islands Internal Revenue Service

P.O. Box 1303

Charlotte, NC 28201-1303

206.

P.O. BOX 1214

CHARLOTTE, NC 28201-1214

INTERNAL REVENUE SERVICE

765 SHORTER TER NW

ATLANTA GA 30318-7140

TO PAY YOUR TAXES DUE BY CHECK, MAIL THIS FORM TO THE ADDRESS LISTED BELOW. 2021

2021

REV 02/17/22 INTUIT.CG. 1555

PAUL M FULLER

048541424 AT FULL 30 0-202***-***

Form

1040 U.S. Individual Income Tax Return 2021

Department of the Treasury—Internal Revenue Service (99) OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. Filing Status

Check only

one box.

Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW) If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying person is a child but not your dependent a

Your first name and middle initial Last name Your social security number If joint return, spouse’s first name and middle initial Last name Spouse’s social security number Home address (number and street). If you have a P.O. box, see instructions. Apt. no. City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code Foreign country name Foreign province/state/county Foreign postal code Presidential Election Campaign

Check here if you, or your

spouse if filing jointly, want $3

to go to this fund. Checking a

box below will not change

your tax or refund.

You Spouse

At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes No Standard

Deduction

Someone can claim: You as a dependent Your spouse as a dependent Spouse itemizes on a separate return or you were a dual-status alien Age/Blindness You: Were born before January 2, 1957 Are blind Spouse: Was born before January 2, 1957 Is blind Dependents (see instructions):

If more

than four

dependents,

see instructions

and check

here a

(2) Social security

number

(3) Relationship

to you

(4) if qualifies for (see instructions):

(1) First name Last name Child tax credit Credit for other dependents 1 Wages, salaries, tips, etc. Attach Form(s) W-2 1 Attach

Sch. B if

required.

2a Tax-exempt interest . . . 2a b Taxable interest 2b 3a Qualified dividends . . . 3a b Ordinary dividends 3b 4a IRA distributions 4a b Taxable amount 4b 5a Pensions and annuities . . 5a b Taxable amount 5b 6a Social security benefits . . 6a b Taxable amount 6b 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here a 7 8 Other income from Schedule 1, line 10 8 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income a 9 10 Adjustments to income from Schedule 1, line 26 10 11 Subtract line 10 from line 9. This is your adjusted gross income a 11 Standard

Deduction for—

• Single or

Married filing

separately,

$12,550

• Married filing

jointly or

Qualifying

widow(er),

$25,100

• Head of

household,

$18,800

• If you checked

any box under

Standard

Deduction,

see instructions.

12a Standard deduction or itemized deductions (from Schedule A) . . 12a b Charitable contributions if you take the standard deduction (see instructions) 12b c Add lines 12a and 12b 12c 13 Qualified business income deduction from Form 8995 or Form 8995-A 13 14 Add lines 12c and 13 14 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- 15 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2021) 300.

Fuller ***-**-****

765 Shorter Ter NW

Atlanta GA 303187140

102,681.

12,550.

12,850.

89,831.

Paul M

Form 1040 (2021) Page 2

16 Tax (see instructions). Check if any from Form(s): 1-881*-*-**** 3 .. 16 17 Amount from Schedule 2, line 3 17 18 Add lines 16 and 17 18 19 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 19 20 Amount from Schedule 3, line 8 20 21 Add lines 19 and 20 21 22 Subtract line 21 from line 18. If zero or less, enter -0- 22 23 Other taxes, including self-employment tax, from Schedule 2, line 21 23 24 Add lines 22 and 23. This is your total tax a 24 25 Federal income tax withheld from:

a Form(s) W-2 25a

b Form(s) 1099 25b

c Other forms (see instructions) 25c d Add lines 25a through 25c 25d 26 2021 estimated tax payments and amount applied from 2020 return 26 If you have a

qualifying child,

attach Sch. EIC.

27a Earned income credit (EIC) 27a

Check here if you were born after January 1, 1998, and before January 2, 2004, and you satisfy all the other requirements for taxpayers who are at least age 18, to claim the EIC. See instructions a b Nontaxable combat pay election 27b

c Prior year (2019) earned income 27c

28 Refundable child tax credit or additional child tax credit from Schedule 8812 28 29 American opportunity credit from Form 8863, line 8 29 30 Recovery rebate credit. See instructions 30 31 Amount from Schedule 3, line 15 31 32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits a 32 33 Add lines 25d, 26, and 32. These are your total payments a 33 Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid .. 34 35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . a 35a Direct deposit?

See instructions.

a b Routing number a c Type: Checking Savings

a d Account number

36 Amount of line 34 you want applied to your 2022 estimated tax ..a 36 Amount

You Owe

37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . a 37 38 Estimated tax penalty (see instructions) a 38 Third Party

Designee

Do you want to allow another person to discuss this return with the IRS? See instructions a Yes. Complete below. No Designee’s

name a

Phone

no. a

Personal identification

number (PIN) a

Sign

Here

Joint return?

See instructions.

Keep a copy for

your records.

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, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation If the IRS sent you an Identity Protection PIN, enter it here

(see inst.) a

Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an Identity Protection PIN, enter it here

(see inst.) a

Phone no. Email address

Paid

Preparer

Use Only

Preparer’s name Preparer’s signature Date PTIN Check if: Self-employed

Firm’s name a Phone no.

Firm’s address a Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2021)

860-***-****

Mail Handler

15,373.

15,579.

15,373.

X X X X X X X X X

X X X X X X X X X X X X X X X X X

206.

Self-Prepared

15,579.

BAA REV 02/17/22 Intuit.cg.cfp.sp

2021

Revised: 10/05/2021

Form CT-1040 Required Fields

The following fields are required to be automatically populated or completed for taxpayers to continue filing, or must be completed in response to the selection of other fields. Required to be Automatically-Populated Fields

Each page of each form submitted to DRS must include the following automatically populated fields: 1. Document Identification Numbers - Three occurrences of the Document Identification Number (DIN) must be on each page. The QR Code and two DINs must be on each scannable page. (See Document Identification Number and Quick Reference (QR) Code, on Page 4.)

2. Social Security Number - The Social Security Number must appear at the top of Form CT-1040, Pages 2, 3, and 4.

3. In addition, the following Checklist for filing your Connecticut income tax return must be included when hard copies of the form are printed. Taxpayers should not send the checklist to DRS with the return. Do not send this sheet with your return.

Checklist for filing your Connecticut income tax return: 1. Be sure that Page 1 of your return is not printed on the back of this sheet. 2. Do not send “Draft” or “Unapproved” versions of your return. This will delay or stop the processing of your return. 3. Do not make manual (hand written or typed) corrections to your return; this is a machine readable return. Changes may only be made by reentering information in your software and re-printing the return. 4. Do not attach or send copies of forms W-2 or 1099. 5. Verify that the address lines on the return are correct and proper abbreviations are used. 6. If the Employer or Payer’s Federal ID # is not listed on Page 2, Lines 18a through 18e, Column A, all withholding claimed will be disallowed and your return will not be successfully processed. 7. Do not attempt to remove or modify the solid boxes that print out on your return. Altering target marks may affect the processing of your return.

8. Do not use this return to change or amend previously filed returns. You must use Form CT-1040X to change or amend a previously filed Connecticut income tax return.

9. Send all completed pages of CT-1040, Schedule CT-EITC, Schedule CT-CHET, Supplemental Schedule CT-1040WH, Schedule CT-IT Credit, Schedule CT-PE, and Form CT-6251. Send all four pages of your completed return, both pages of your completed CT-EITC schedule, the completed Schedule CT-CHET, and any other supporting schedules. 10. Make check payable to: Commissioner of Revenue Services 11. To ensure proper posting, write your SSN(s) (optional) and “ Form CT-1040” on your check. 12. To mail your return, use the following addresses: For all tax returns with payment:

Department of Revenue Services

PO Box 2977

Hartford CT 06104-2977

For refunds and tax returns without payment:

Department of Revenue Services

PO Box 2976

Hartford CT 06104-2976

13. Verify that all fields print completely and any preparer information is filled out and legible before filing this return. If you find any errors, do not make manual changes. Re-enter information in your software and re-print the return. 14. If you wish to directly deposit a refund into a checking or savings bank account, confirm that Lines 25a through 25d have been completed. You must enter bank information on both the federal and Connecticut returns for each to be correctly deposited. Alpha characters are not allowed in Routing or Account Number fields. 15. When making payment using Form CT-1040V, DO NOT attach copies of your previously filed Form CT-1040. Do not send this sheet with your return.

Paul M Fuller REV 02/10/22 Intuit.cg.cfp.sp

1. Federal adjusted gross income (from federal Form 1040, Line 11, or federal Form 1040 SR, Line 11) 1. 2. Additions to federal adjusted gross income (from Schedule 1, Line 38) 2. 3. Add Line 1 and Line 2 3.

4. Subtractions from federal adjusted gross income (from Schedule 1, Line 50) 4. 5. Connecticut adjusted gross income: Line 4 subtracted from Line 3. 5. 6. Income tax 6.

7. Credit for income taxes paid to qualifying jurisdictions (from Schedule 2, Line 59) 7. 8. Line 7 subtracted from Line 6. If Line 7 is greater than Line 6, “0” is entered. 8. 9. Connecticut alternative minimum tax (from Form CT-6251) 9. 10. Add Line 8 and Line 9. 10.

11. Credit for property taxes paid on your primary residence, motor vehicle, or both (from Schedule 3, Line 68) 11. 12. Line 11 subtracted from Line 10. If less than zero, “0” is entered. 12. 13. Total allowable credits (from Schedule CT-IT Credit, Part 1, Line 11) 13. 14. Connecticut income tax: Line 13 subtracted from Line 12. If less than zero, “0” is entered. 14. 15. Individual use tax (from Schedule 4, Line 69). If no tax is due, “0” is entered. 15. 16. Total tax: Add Line 14 and Line 15. 16.

CT-2210

CT-1040 CRC Federal Form 1310

CT-8379

- - - -

Dec.

FJ MFS HOH QW

Form CT-1040 - 2021

Connecticut Resident Income Tax Return

(Rev. 12/21)

Page 1 of 4

Other tax year, beginning: and ending:

Clip check here. Do not use staples.

Do not send Forms W-2 or 1099, or Schedules CT K 1.

Visit us at portal.ct.gov/DRS for more information. 102681

102681

5411

PAUL M FULLER

765 SHORTER TER NW

ATLANTA GA

Y N N N N

5411

N N

REV 02/10/22 INTUIT.CG.CFP.SP

10401221V011555

048 54 1424

30318 7140

Sign Here

Keep a copy for your records.

Form CT-1040, Page 2 of 4

Designee’s name Telephone number Personal identification number (PIN) Your signature Date Home/cell telephone number

Spouse’s signature (if joint return) Date Daytime telephone number Paid preparer’s signature Date Telephone number Paid Preparer’s PTIN Paid preparer’s name FEIN

Firm’s name, address and ZIP code

Declaration: I declare under penalty of law that I have examined this return and all accompanying schedules and statements, including reporting and payment of any use tax due, and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.

Third Party Designee - Complete the following to authorize DRS to contact another person about this return.

17. Amount from Line 16 17.

Forms W-2, W-2G, and 1099 Information

Col. A - Employer or Payer’s Fed. ID # Col. B - CT Wages, Tips, etc. Col. C - CT Income Tax Withheld 18a.

18b.

18c.

18d.

18e.

18f. Additional Connecticut withholding (from Supplemental Schedule CT-1040WH, Line 3) 18f. 18. Total Connecticut income tax withheld: Amounts in Column C. 18. 19. All 2021 estimated tax payments and any overpayments applied from a prior year 19. 20. Payments made with Form CT-1040 EXT 20.

20a. Earned income tax credit (from Schedule CT-EITC, Line 16). 20a. 20b. Claim of right credit (from Form CT-1040 CRC, Line 6). 20b. 20c. Pass-through entity tax credit: (from Schedule CT-PE, Line 1). Schedule must be attached. 20c. 21. Total payments and refundable credits: Add Lines 18, 19, 20, 20a, 20b and 20c. 21. 22. Overpayment: If Line 21 is more than Line 17, Line 17 subtracted from Line 21. 22. 23. Amount of Line 22 you want applied to your 2022 estimated tax 23. 24. Amount of Line 22 you want applied as a CHET contribution (from Schedule CT-CHET, Line 4) 24. 24a. Total contributions of refund to designated charities (from Schedule 5, Line 70) 24a. 25. Refund: Lines 23, 24, and 24a subtracted from Line 22. 25. If you have not elected to direct deposit, a refund check will be issued and processing may be delayed. 25d. Refund going to a bank account outside the U.S. 25d. 26. Tax due: If Line 17 is more than Line 21, Line 21 subtracted from Line 17. 26. 27. If late: Penalty entered. Line 26 multiplied by 10% (.10). 27. 28. If late: Interest entered.

Line 26 multiplied by number of months or fraction of a month late, then by 1% (.01). 28. 29. Interest on underpayment of estimated tax (from Form CT-2210) 29. 30. Total amount due: Add Lines 26 through 29. 30.

25a. Acct. type Ck. Sv. 25b. Rout. # 25c. Acct. #

Self-employed

Visit us at portal.ct.gov/DRS for more information. 048541424

860-***-****

SELF-PREPARED

5411

5429

Y N 221172186 048*******

41-076****-****** 5429

REV 02/10/22 INTUIT.CG.CFP.SP

10401221V021555

0.00

Form CT-1040, Page 3 of 4

Schedule 1 - Modifications to Federal Adjusted Gross Income 31. Interest on state and local government obligations other than Connecticut 31. 32. Mutual fund exempt-interest dividends from non-Connecticut state or municipal government obligations 32.

33. Taxable amount of lump-sum distributions from qualified plans not included in federal adjusted gross income 33.

34. Beneficiary’s share of Connecticut fiduciary adjustment: Entered only if greater than zero. 34. 35. Loss on sale of Connecticut state and local government bonds 35. 36. Section 168(k) federal bonus depreciation deduction allowed for property placed in service during this year. 36. 36a. 80% of Section 179 federal deduction. 36a.

37. Other - specify 37.

38. Total additions: Add Lines 31 through 37. 38.

39. Interest on U.S. government obligations 39.

40. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations 40. 41. Social Security benefit adjustment (from Social Security Benefit Adjustment Worksheet) 41. 42. Refunds of state and local income taxes 42.

43. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities 43. 44. Military retirement pay 44.

45. 50% of income received from Connecticut Teachers’ Retirement System 45. 46. Beneficiary’s share of Connecticut fiduciary adjustment: Entered only if less than zero. 46. 47. Gain on sale of Connecticut state and local government bonds 47. 48. CHET contributions made in 2021 or

an excess carried forward from a prior year Acct. #: 48. 48a. 25% of Section 168(k) federal bonus depreciation deduction added back in preceding four years. 48a. 48b. 42% of pension or annuity income. 48b.

49. Other - specify 49.

50. Total subtractions: Add Lines 39 through 49. 50.

Schedule 2 - Credit for Income Taxes Paid to Qualifying Jurisdictions 51. Modified Connecticut adjusted gross income 51. Col. A Col. B

52. Qualifying jurisdiction’s name and two-letter code 52. 53. Non-Connecticut income included on Line 51 and reported on a qualifying jurisdiction’s income tax return (from Schedule 2 worksheet) 53. 54. Line 53 divided by Line 51 54.

55. Income tax liability: Line 11 subtracted from Line 6. 55. 56. Line 54 multiplied by Line 55 56.

57. Income tax paid to a qualifying jurisdiction 57. 58. Lesser of Line 56 or Line 57 58.

59. Total credit: Add Line 58, all columns. 59.

Visit us at portal.ct.gov/DRS for more information. 048541424

REV 02/10/22 INTUIT.CG.CFP.SP

10401221V031555

0 0

0.0000 0.0000

0 0

Qualifying Property Primary Residence Auto 1 Auto 2 Name of Connecticut Tax Town or District

Description of Property

Date(s) Paid

Amount Paid 60. 61. 62.

63. Total property tax paid: Add Lines 60, 61, and 62. 63. 64. Maximum property tax credit allowed 64.

65. Lesser of Line 63 or Line 64. 65.

66. Property tax credit limitation decimal amount: If zero, the amount from Line 65 is entered on Line 68. 66. 67. Line 65 multiplied by Line 66. 67.

68. Line 67 subtracted from Line 65. 68.

Schedule 4 - Individual Use Tax

Schedule 3 - Property Tax Credit

200

Schedule 5 - Contributions to Designated Charities 70a. AR 70a.

70b. OT 70b.

70c. ES/W 70c.

70d. BCR 70d.

70e. SNS 70e.

70f. MR 70f.

70g. CBS 70g.

70h. MHCIA 70h.

70. Total Contributions: Add Lines 70a through 70h. 70. Taxpayer email

69a. Use tax at 1% (from Connecticut Individual Use Tax Worksheet, Section A, Column 7) 69a. 69b. Use tax at 6.35% (from Connecticut Individual Use Tax Worksheet, Section B, Column 7) 69b. 69c. Use tax at 7.75% (from Connecticut Individual Use Tax Worksheet, Section C, Column 7) 69c. 69d. Use tax at 2.99% (from Connecticut Individual Use Tax Worksheet, Section D, Column 7) 69d. 69. Individual use tax: Add Lines 69a, 69b, 69c, and 69d. 69.

Form CT-1040, Page 4 of 4

65 years or older One or more dependents on federal return

Visit us at portal.ct.gov/DRS for more information. 048541424

N N

REV 02/10/22 INTUIT.CG.CFP.SP

10401221V041555

0.00

0 0

Contact this candidate