Electronic Filing Instructions for your 2019 Federal Tax Return

Important: Your taxes are not finished until all required steps are completed.

Adonis Leyva Bravo

1033 E Tennessee St
Tucson, AZ 85714-3211
|
Balance | Your federal tax return (Form 1040) shows a refund due to you in the
Due/ | amount of $6,637.00. Applicable fees were deducted from your original
Refund | refund amount of $6,637.00. Your refund is now $6,457.00. Because you
| chose to have your TurboTax fees deducted from your refund, you will
| receive e-mail from Civista Bank, which handles this transaction.
| Your tax refund will be direct deposited into your account. The
| account information you entered - Account Number: 555715926 Routing
| Transit Number: 122100024.
|
______________________________________________________________________________________
|
When Will | The IRS issued more than 9 out of 10 refunds to taxpayers in less
You Get | than 21 days last year. The same results are expected in 2020. To
Your | get your estimated refund date from TurboTax, log into My TurboTax at
Refund? | www.turbotax.com. If you do not receive your refund within 21 days,
| or the amount you get is not what you expected, contact the Internal
| Revenue Service directly at 1-800-829-4477. You can also check
| www.irs.gov and select the "Where's my refund?" link.
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | Printed copy of your federal return
Keep |
|
______________________________________________________________________________________
|
2019 | Adjusted Gross Income $ 29,153.00
Federal | Taxable Income $ 10,803.00
Tax | Total Tax $ 0.00
Return | Total Payments/Credits $ 6,637.00
Summary | Amount to be Refunded $ 6,637.00
| Effective Tax Rate -22.27%
|
______________________________________________________________________________________

Page 1 of 1
Hi Adonis,

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your taxes easy and accurate, year after year.

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We'll ask you questions about what changed since we last talked, and
we'll be ready to get you the credits and deductions you deserve, no
matter what life throws at you.

Here's the final wrap up for your 2019 taxes:

Your federal refund is: $ 6,637.00

You qualified for these important credits:

- Child Tax Credit
- Earned Income Credit

Your Guarantee of Accuracy:

Breathe easy. The calculations on your return are backed with our
100% Accuracy Guarantee.
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Many happy returns from TurboTax.

 1040 U.S. Individual Income Tax Return 2019
Form 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 Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying person is
one box.
a child but not your dependent. a
Your first name and middle initial Last name Your social security number
Adonis Leyva Bravo 601-57-0827
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. Presidential Election Campaign
Check here if you, or your spouse if filing
1033 E Tennessee St
jointly, want $3 to go to this fund.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your
Tucson AZ 85714-3211 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and  here a

Standard Someone can claim: You as a dependent Your spouse as a dependent

Deduction Spouse itemizes on a separate return or you were a dual-status alien

Age/Blindness You: Were born before January 2, 1955 Are blind Spouse: Was born before January 2, 1955 Is blind
Dependents (see instructions): (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

Alejandro Flores Bravo 764-44-8131 Brother

David Flores Bravo 764-44-8132 Brother

1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . 1 29,153.

2a Tax-exempt interest . . . . 2a b Taxable interest. Attach Sch. B if required 2b
3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b
Standard
Deduction for— 4a IRA distributions . . . . . 4a b Taxable amount . . . . . . 4b
• Single or Married
filing separately,
c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a 0.
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b 29,153.
household,
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b 29,153.
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 18,350.
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 18,350.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 10,803.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
 Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 1,083.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 1,083.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a 931.
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b 1,083.
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 0.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 0.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 0.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17 146.
• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a 3,691.
attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b 2,800.
nontaxable c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c
combat pay, see
instructions. d Schedule 3, line 14 . . . . . . . . . . . . . . . . . 18d
e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . a 18e 6,491.
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 6,637.
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 6,637.
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 6,637.
Direct deposit? a b Routing number 1 2 2 1 0 0 0 2 4 a c Type: Checking Savings
See instructions.
a d Account number 5 5 5 7 1 5 9 2 6
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a 23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 24
Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below.
Designee No
(Other than Designee’s Phone Personal identification
paid preparer) name a no. a number (PIN) a

Sign 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.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
F

Joint return? Interpreter (see inst.)

See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)

Phone no. Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid 3rd Party Designee
Preparer Self-employed
Firm’s name a Self-Prepared Phone no.
Use Only
Firm’s address a Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 01/15/20 TTO Form 1040 (2019)
SCHEDULE 3 OMB No. 1545-0074
Additional Credits and Payments
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 03
Name(s) shown on Form 1040 or 1040-SR Your social security number
Adonis Leyva Bravo 601-57-0827
Part I Nonrefundable Credits
1 Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . . . . . . . 1
2 Credit for child and dependent care expenses. Attach Form 2441 . . . . . . . . . . . . 2
3 Education credits from Form 8863, line 19 . . . . . . . . . . . . . . . . . . . . 3
4 Retirement savings contributions credit. Attach Form 8880 . . . . . . . . . . . . . . 4 152.
5 Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . . . . . . . 5
6 Other credits from Form: a 3800 b 8801 c 6
7 Add lines 1 through 6. Enter here and include on Form 1040 or 1040-SR, line 13b . . . . . . . 7 152.
Part II Other Payments and Refundable Credits
8 2019 estimated tax payments and amount applied from 2018 return . . . . . . . . . . . 8
9 Net premium tax credit. Attach Form 8962 . . . . . . . . . . . . . . . . . . . . 9
10 Amount paid with request for extension to file (see instructions) . . . . . . . . . . . . . 10
11 Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . . . . . . . . 11
12 Credit for federal tax on fuels. Attach Form 4136 . . . . . . . . . . . . . . . . . . 12
13 Credits from Form: a 2439 b Reserved c 8885 d 13
14 Add lines 8 through 13. Enter here and on Form 1040 or 1040-SR, line 18d . . . . . . . . . 14
For Paperwork Reduction Act Notice, see your tax return instructions. REV 01/15/20 TTO Schedule 3 (Form 1040 or 1040-SR) 2019
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040 or 1040-SR) 1040 `
Qualifying Child Information
2019
.........
1040-SR
a Complete and attach to Form 1040 or 1040-SR only if you have a
Department of the Treasury qualifying child. EIC Attachment
Internal Revenue Service (99) a Go to www.irs.gov/ScheduleEIC for the latest information. Sequence No. 43
Name(s) shown on return Your social security number
Adonis Leyva Bravo 601-57-0827
• See the instructions for Form 1040 or 1040-SR, line 18a, to make sure that (a) you can take the EIC, and (b)
Before you begin: you have a qualifying child.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card.
Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s
social security card is not correct, call the Social Security Administration at 1-800-772-1213.

F
!
CAUTION
• You can't claim the EIC for a child who didn't live with you for more than half of the year.
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.

Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name First name Last name First name Last name First name Last name

If you have more than three qualifying

children, you have to list only three to get
the maximum credit. Alejandro Flores Bravo David Flores Bravo
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040 or
1040-SR, line 18a, unless the child was
born and died in 2019. If your child was
born and died in 2019 and did not have an
SSN, enter “Died” on this line and attach a
copy of the child’s birth certificate, death
certificate, or hospital medical records
showing a live birth. 764-44-8131 764-44-8132
3 Child’s year of birth
Year 2 0 0 4 Year 2 0 0 4 Year
If born after 2000 and the child is If born after 2000 and the child is If born after 2000 and the child is
younger than you (or your spouse, if younger than you (or your spouse, if younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b;
go to line 5. go to line 5. go to line 5.

4 a Was the child under age 24 at the end of

2019, a student, and younger than you (or Yes. No. Yes. No. Yes. No.
your spouse, if filing jointly)?
Go to Go to line 4b. Go to Go to line 4b. Go to Go to line 4b.
line 5. line 5. line 5.

b Was the child permanently and totally

disabled during any part of 2019? Yes. No. Yes. No. Yes. No.
Go to The child is not a Go to The child is not a Go to The child is not a
line 5. qualifying child. line 5. qualifying child. line 5. qualifying child.

5 Child’s relationship to you

(for example, son, daughter, grandchild,
niece, nephew, eligible foster child, etc.) Brother Brother
6 Number of months child lived
with you in the United States
during 2019

• If the child lived with you for more than

half of 2019 but less than 7 months,
enter “7.”
• If the child was born or died in 2019 and 12 months 12 months months
your home was the child’s home for more
than half the time he or she was alive Do not enter more than 12 Do not enter more than 12 Do not enter more than 12
during 2019, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax REV 01/15/20 TTO Schedule EIC (Form 1040 or 1040-SR) 2019
BAA
return instructions.
SCHEDULE 8812 OMB No. 1545-0074
Additional Child Tax Credit . . 1040
.......
`
2019
(Form 1040 or 1040-SR) 1040-SR
.........
a
Attach to Form 1040, 1040-SR, or 1040-NR. 1040-NR
Department of the Treasury
a Go to www.irs.gov/Schedule8812 for instructions and the latest 8812 Attachment
Internal Revenue Service (99) information. Sequence No. 47

Name(s) shown on return Your social security number

Adonis Leyva Bravo 601-57-0827
Part I All Filers
Caution: If you file Form 2555, stop here; you cannot claim the additional child tax credit.
1 If you are required to use the worksheet in Pub. 972, enter the amount from line 10 of the Child Tax Credit
and Credit for Other Dependents Worksheet in the publication. Otherwise:
1040 and Enter the amount from line 8 of your Child Tax Credit and Credit for Other Dependents
1040-SR filers: Worksheet (see the instructions for Forms 1040 and 1040-SR, line 13a).
1040-NR filers: Enter the amount from line 8 of your Child Tax Credit and Credit for Other Dependents
Worksheet (see the instructions for Form 1040-NR, line 49).
} 1 4,000.

2 Enter the amount from Form 1040, line 13a; Form 1040-SR, line 13a; or Form 1040-NR, line 49 . . . . . 2 931.
3 Subtract line 2 from line 1. If zero, stop here; you cannot claim this credit . . . . . . . . . . . . 3 3,069.
4 Number of qualifying children under 17 with the required social security number: 2 x $1,400.
Enter the result. If zero, stop here; you cannot claim this credit . . . . . . . . . . . . . . . 4 2,800.
TIP: The number of children you use for this line is the same as the number of children you used for line 1 of the
Child Tax Credit and Credit for Other Dependents Worksheet.
5 Enter the smaller of line 3 or line 4 . . . . . . . . . . . . . . . . . . . . . . . 5 2,800.
6a Earned income (see instructions) . . . . . . . . . . . . . . . . 6a 29,153.
b Nontaxable combat pay (see instructions) . . . . . . 6b
7 Is the amount on line 6a more than $2,500?
No. Leave line 7 blank and enter -0- on line 8.
Yes. Subtract $2,500 from the amount on line 6a. Enter the result . . . . . 7 26,653.
8 Multiply the amount on line 7 by 15% (0.15) and enter the result . . . . . . . . . . . . . . . 8 3,998.
Next. On line 4, is the amount $4,200 or more?
No. If line 8 is zero, stop here; you cannot claim this credit. Otherwise, skip Part II and enter the smaller
of line 5 or line 8 on line 15.
Yes. If line 8 is equal to or more than line 5, skip Part II and enter the amount from line 5 on line 15.
Otherwise, go to line 9.
Part II Certain Filers Who Have Three or More Qualifying Children
9 Withheld social security, Medicare, and Additional Medicare taxes from
Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s amounts
with yours. If your employer withheld or you paid Additional Medicare Tax or tier 1
RRTA taxes, see instructions . . . . . . . . . . . . . . . . . 9

}
10 1040 and Enter the total of the amounts from Schedule 1 (Form 1040 or 1040-SR),
1040-SR filers: line 14, and Schedule 2 (Form 1040 or 1040-SR), line 5, plus any taxes
that you identified using code “UT” and entered on Schedule 2 (Form
1040 or 1040-SR), line 8. 10
1040-NR filers: Enter the total of the amounts from Form 1040-NR, lines 27 and
56, plus any taxes that you identified using code “UT” and
entered on line 60.
11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . 11
12 1040 and Enter the total of the amounts from Form 1040 or 1040-SR, line
1040-SR filers: 18a, and Schedule 3 (Form 1040 or 1040-SR), line 11.
1040-NR filers: Enter the amount from Form 1040-NR, line 67.
} 12
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 13
14 Enter the larger of line 8 or line 13 . . . . . . . . . . . . . . . . . . . . . . . 14
Next, enter the smaller of line 5 or line 14 on line 15.
Part III Additional Child Tax Credit
15 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . . 15 2,800.
Enter this amount on
Form 1040, line 18b;
Form 1040-SR, line 18b; or
. . 1040
.......
Form 1040-NR, line 64.
1040-SR
.........
1040-NR `

For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 01/15/20 TTO Schedule 8812 (Form 1040 or 1040-SR) 2019
Form 8880 Credit for Qualified Retirement Savings Contributions OMB No. 1545-0074

2019
a Attach to Form 1040, 1040-SR, or 1040-NR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form8880 for the latest information. Sequence No. 54
Name(s) shown on return Your social security number
Adonis Leyva Bravo 601-57-0827
You cannot take this credit if either of the following applies.

F
!
CAUTION
• The amount on Form 1040 or 1040-SR, line 8b; or Form 1040-NR, line 35, is more than $32,000 ($48,000 if head of household;
$64,000 if married filing jointly).
• The person(s) who made the qualified contribution or elective deferral (a) was born after January 1, 2002; (b) is claimed as a
dependent on someone else’s 2019 tax return; or (c) was a student (see instructions).
(a) You (b) Your spouse
1 Traditional and Roth IRA contributions, and ABLE account contributions by the
designated beneficiary for 2019. Do not include rollover contributions . . . . . 1 0.
2 Elective deferrals to a 401(k) or other qualified employer plan, voluntary employee
contributions, and 501(c)(18)(D) plan contributions for 2019 (see instructions) . . 2 758.
3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . 3 758.
4 Certain distributions received after 2016 and before the due date (including
extensions) of your 2019 tax return (see instructions). If married filing jointly, include
both spouses’ amounts in both columns. See instructions for an exception . . . 4
5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . 5 758.
6 In each column, enter the smaller of line 5 or $2,000 . . . . . . . . . . 6 758.
7 Add the amounts on line 6. If zero, stop; you can’t take this credit . . . . . . . . . . . . 7 758.
8 Enter the amount from Form 1040 or 1040-SR, line 8b;* or Form 1040-NR, line
35 . . . . . . . . . . . . . . . . . . . . . . . . . 8 29,153.
9 Enter the applicable decimal amount from the table below.

If line 8 is— And your filing status is—

Married Head of Single, Married filing
But not
Over— filing jointly household separately, or
over—
Enter on line 9— Qualifying widow(er)
--- $19,250 0.5 0.5 0.5
$19,250 $20,750 0.5 0.5 0.2
$20,750 $28,875 0.5 0.5 0.1 9 x0 .2
$28,875 $31,125 0.5 0.2 0.1
$31,125 $32,000 0.5 0.1 0.1
$32,000 $38,500 0.5 0.1 0.0
$38,500 $41,500 0.2 0.1 0.0
$41,500 $48,000 0.1 0.1 0.0
$48,000 $64,000 0.1 0.0 0.0
$64,000 --- 0.0 0.0 0.0
Note: If line 9 is zero, stop; you can’t take this credit.
10 Multiply line 7 by line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . 10 152.
11 Limitation based on tax liability. Enter the amount from the Credit Limit Worksheet in the instructions 11 1,083.
12 Credit for qualified retirement savings contributions. Enter the smaller of line 10 or line 11 here
and on Schedule 3 (Form 1040 or 1040-SR), line 4; or Form 1040-NR, line 48 . . . . . . . . 12 152.

* See Pub. 590-A for the amount to enter if you claim any exclusion or deduction for foreign earned income, foreign housing, or income from
Puerto Rico or for bona fide residents of American Samoa.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 01/15/20 TTO Form 8880 (2019)
IMPORTANT DISCLOSURES

If you are owed a federal tax refund, you have a right to choose how you will receive the refund. There
are several options available to you. Some options cost money and some options are free. Please read
about these options below.

You can file your federal tax return electronically or by paper and obtain your federal tax refund directly
from the Internal Revenue Service ("IRS") for free. If you file your tax return electronically, you can
receive a refund check directly from the IRS through the U.S. Postal Service in 21 to 28 days
from the time you file your tax return or the IRS can deposit your refund directly into your
bank account in less than 21 days from the time you file your tax return unless there are
delays by the IRS. If you file a paper return through the U.S. Postal Service, you can receive
a refund check directly from the IRS through the U.S. Postal Service in 6 to 8 weeks from the
time the IRS receives your return or the IRS can deposit your refund directly into your bank
account in 6 to 8 weeks from the time the IRS receives your return. However, if your return
contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS will issue your
refund no earlier than February 15, 2020.

You can file your tax return electronically, select the Refund Processing Service ("RPS") for an additional fee
of $40.00 (the "RPS fee"), and have your federal income tax refund processed through a processor using banking
services of a financial institution. The RPS allows your refund to be deposited into a bank account intended for
one-time use at Civista Bank ("Bank") and deducts your TurboTax fees and other fees you authorize from your
refund. The balance is delivered to you via the disbursement method you select. If you file your tax return
electronically and select the RPS, the IRS will deposit your refund with Bank. Upon Bank's receipt of your refund,
Santa Barbara Tax Products Group, LLC, a processor, will deduct and pay from your refund the RPS fee, any fees
charged by TurboTax for the preparation and filing of your tax return and any other amounts authorized by you and
disburse the balance of your refund proceeds to you. Unless there are delays by the IRS, refunds are received in
less than 21 days from the time you file your tax return electronically. However, if your return contains
Earned Income Tax Credit or Additional Child Tax Credit, the IRS will issue your refund no earlier than
February 15, 2020.

The RPS is not necessary to obtain your refund. If you have an existing bank account, you do not need to
use the RPS, which requires the payment of a fee, in order to receive a direct deposit from the IRS. You
may consult the IRS website (IRS.gov) for information about tax refund processing.

If you select the RPS, no prior debt you may owe to Bank will be deducted from your refund.

You can change your income tax withholdings which might result in you receiving additional funds
throughout the year rather than waiting to receive these funds potentially in an income tax refund next
year. Please consult your employer or tax advisor for additional details.

This Agreement requires all disputes to be resolved by way of binding arbitration.

The terms of the arbitration provision appear in Section 11.

Information regarding low-cost deposit accounts may be available at www.mymoney.gov .

The chart below shows the options for filing your tax return (e-file or paper return), the RPS product,
refund disbursement options, estimated timing for obtaining your tax refund proceeds, and costs
associated with the various options.
 WHAT TYPE WHAT ARE YOUR WHAT IS THE WHAT COSTS DO YOU
OF FILING DISBURSEMENT ESTIMATED TIME TO INCUR IN ADDITION
METHOD? OPTIONS? RECEIVE REFUND? TO TAX PREPARATION
FEES?

PAPER RETURN IRS direct deposit to Approximately No additional cost.

your personal bank 6 to 8 weeks 2
No Refund Processing account.
Service
Check mailed by IRS Approximately
to address on tax 6 to 8 weeks 2
return.

ELECTRONIC IRS direct deposit to Usually within No additional cost.

FILING your personal bank 21 days 2
(E-FILE) account.

No Refund Processing Check mailed by IRS Approximately

Service to address on tax 21 to 28 days 2
return.

ELECTRONIC (a) Direct deposit to Usually within $ 40.00 3

FILING your personal bank 21 days 2
(E-FILE) account, or

Refund Processing (b) Load to your

Service debit card 1.

1You may incur additional charges from the issuer of the debit card if you select to have your tax refund
loaded on a debit card. Bank is not affiliated with the issuer of the debit card.

2However, if your return contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS will
issue your refund no earlier than February 15, 2020.

3Thisfee consists of an RPS Fee, a TurboTax fee and any fees for additional products and services purchased.
See Section 4 of the Refund Processing Service Agreement for more details.

Questions? Call 877-908-7228

We need your consent to process with this payment option
This is an IRS requirement

The purpose of this agreement is to confirm that you are eligible for this payment option. By
agreeing, you allow Intuit, the maker of TurboTax software, to verify that your refund is enough
to cover total fees and applicable sales tax and to evaluate your current and future eligibility for the
Refund Processing Service.

IRS regulations require the following statements:

"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use
your tax return information for purposes other than the preparation and filing of your tax return without
your consent. If you consent to the disclosure of your tax return information, Federal law may not
protect your tax return information from further use or distribution.

You are not required to complete this form to engage our tax return preparation services. If we obtain
your signature on this form by conditioning our tax return preparation services on your consent, your
consent will not be valid. You specify that your consent is valid for three years from the date of this
signature."

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.

To agree, enter your name(s) and date in the boxes below and select the "I Agree" button on the
bottom of the page.

I authorize Intuit, the maker of TurboTax, to use the information provided in this 2019 return to
determine whether a portion of the refund can be used to pay my fees and to evaluate my current
and future eligibility for the Refund Processing Service.

Adonis Leyva Bravo

First Name Last Name

Please type the date below:

01/22/2020
Date

sbia5009 3/11/2019
Read and accept this Disclosure Consent
This is an IRS requirement

In order to finalize your request for this payment option, we need to send the following information to
Civista Bank of Sandusky, OH (’BANK’) and to Santa Barbara Tax Products Group, LLC (’SBTPG’),
the administrator and servicer of this payment option: your identifying information, your deposit
information and your refund amount.

We transmit this information so that you may use this payment option. BANK and SBTPG will use
your information in accordance with their applicable refund processing service agreement and
privacy policy.

IRS regulations require the following statements:

"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot
disclose your tax return information to third parties for purposes other than the preparation and filing of
your tax return without your consent. If you consent to the disclosure of your tax return information,
Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage our tax return preparation services. If we obtain
your signature on this form by conditioning our tax return preparation services on your consent, your
consent will not be valid. If you agree to the disclosure of your tax return information, your consent is
valid for the amount of time that you specify. If you do not specify the duration of your consent, your
consent is valid for one year from the date of signature."

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.

To agree, enter your name and date in the boxes below and select the "I Agree" button on the
bottom of the page.

I authorize Intuit, the maker of TurboTax, to disclose to BANK and SBTPG that portion of my
2019 tax return information that is necessary to enable BANK and SBTPG to process
my refund.

Sign this agreement by entering your name:

Adonis Leyva Bravo

Please type the date below:

01/22/2020
Date

sbia1301.SCR 12/17/15
 CUSTOMER SERVICE: 877-908-7228
Santa Barbara Tax Products Group, LLC

and Civista Bank Refund Processing Service Agreement ("Agreement")

Name Adonis Leyva Bravo

Social Security No. 601-57-0827

This Agreement contains important terms, conditions and disclosures about the processing of your refund
(the "Refund Processing Service") by Santa Barbara Tax Products Group, LLC ("Processor"), a third party
processor using banking services of Civista Bank ("Bank"). Read this Agreement carefully before
accepting its terms and conditions, and print a copy and/or retain this information electronically for future
reference. As used in this Agreement, the words "you" and "your" refer to the applicant or both the applicant
and joint applicant if the 2019 federal income tax return is a joint return (individually and collectively,
"Applicant"). The words "we," "us" and "our" refer to Bank and Processor.

1. NOTICE: No Requirement To Use the Refund Processing Service In Order To File Electronically.
YOU UNDERSTAND THAT A REFUND PROCESSING FEE OF $40.00 ("REFUND PROCESSING FEE") IS
CHARGED BY PROCESSOR TO ESTABLISH A TEMPORARY ACCOUNT TO RECEIVE YOUR FEDERAL TAX
REFUND, TO PROCESS IT, TO DEDUCT YOUR TURBOTAX FEES, AND OTHER AUTHORIZED FEES FROM
THAT ACCOUNT, AND TO FORWARD FUNDS TO YOU. THE REFUND PROCESSING FEE IS NOT A LOAN; IT
IS DUE TO PROCESSOR WHETHER OR NOT THE FEDERAL TAX REFUND OCCURS BUT PROCESSOR WILL
NOT PURSUE COLLECTION OF THE REFUND PROCESSING FEE IF YOUR FEDERAL TAX REFUND DOES
NOT OCCUR. THIS FEE IS COLLECTED ONLY AT THE TIME THE REFUND OCCURS. YOU CAN AVOID THIS
FEE AND NOT USE THE REFUND PROCESSING SERVICE BY INSTEAD PAYING THE APPLICABLE
TURBOTAX FEES TO INTUIT INC. BY CREDIT OR DEBIT CARD AT THE TIME YOU FILE YOUR
2019 FEDERAL INCOME TAX RETURN AND ELECTING TO HAVE YOUR REFUND DIRECTLY DEPOSITED IN
YOUR OWN BANK ACCOUNT OR MAILED TO YOU. IF YOU DO USE THE REFUND PROCESSING SERVICE,
YOU CAN EXPECT TO RECEIVE THE PROCEEDS FROM YOUR FEDERAL TAX REFUND WITHIN 21 DAYS
FROM WHEN THE INTERNAL REVENUE SERVICE ("IRS") ACCEPTS YOUR RETURN UNLESS THERE
ARE PROCESSING DELAYS BY THE IRS (OR UNLESS YOUR RETURN CONTAINS EARNED INCOME TAX
CREDIT OR ADDITIONAL CHILD TAX CREDIT, IN WHICH CASE THE IRS WILL ISSUE YOUR REFUND NO
EARLIER THAN FEBRUARY 15, 2020). THE REFUND PROCESSING SERVICE WILL NEITHER SPEED UP
NOR DELAY YOUR FEDERAL TAX REFUND. THE COST OF PREPARING YOUR TAX RETURN IS NOT ANY
MORE OR LESS IF YOU PURCHASE THE REFUND PROCESSING SERVICE.

2. Authorization to Release Personal Information. You authorize the IRS to disclose any information to
Bank and Processor related to the funding of your 2019 federal tax refund. You also authorize Intuit Inc., as
the transmitter of your electronically filed tax return, to disclose your tax return and contact information to
Bank and Processor for use in connection with the Refund Processing Service being provided pursuant to
this Agreement and Bank and Processor to share your information with Intuit Inc. You also represent that
any authorizations you have made in this Section 2 have also been obtained from and are made with respect
to your spouse, if this is a jointly filed return. None of Intuit Inc., Bank or Processor will disclose or use your
tax return information for any other purpose, except as permitted by law. Bank and Processor will not use
your tax information or contact information for any marketing purpose. Please see the Privacy Policy
at the end of this Agreement describing how Bank may use or share your personal information.

3. Summary of Terms
Expected Federal Refund $ 6,637.00
Less Processor Refund Processing Fee $ 40.00
Less TurboTax Fees $ 140.00
Less Fees for Additional Products and Services Purchased $
Expected Proceeds* $ 6,457.00
* These charges are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes, and if
applicable, a Return Item Fee and an Account Research and Processing Fee paid to Processor as set forth in Sections 4, 6 and
7 below.

4. Temporary Deposit Account Authorization. You hereby authorize Bank to establish a temporary deposit
account ("Deposit Account") for the purpose of receiving your tax year 2019 federal tax refund from the IRS.
Bank or Processor must receive an acknowledgement from the IRS that your return has been electronically
filed and accepted for processing before the Deposit Account can be opened. You authorize Processor to
deduct from your Deposit Account the following amounts: (i) the Refund Processing Fee; (ii) the fees and
charges related to the preparation, processing and transmission of your tax return ("TurboTax Fees"); and
(iii) fees for Additional Products and Services Purchased, plus applicable taxes. You also authorize Processor
Adonis Leyva Bravo 601-57-0827 Page 2

to deduct thirty dollars ($30.00) as a returned item processing fee (the "Return Item Fee") from your Deposit
Account for the additional processing required in the event that your deposit is returned or cannot be
delivered as directed in Section 7 below. A fee of $30.00 (the "Account Research and Processing Fee") may
be charged if we are required to provide additional processing to return the funds to the IRS. These fees will
be deducted from the Deposit Account and will be retained by Processor. You authorize Processor to
disburse the balance of the Deposit Account to you after making all authorized deductions or payments. If
the Deposit Account does not have sufficient funds to pay the TurboTax Fees and the fees for Additional
Products and Services Purchased as set forth in Section 3, (a) you authorize Processor to automatically
deduct such fees (or any portion thereof) via ACH, electronic check, or wire transfer directly from the
account into which you authorized Processor to deposit your expected proceeds as set forth in Section
7, and (b) if you made alternative arrangements with TurboTax for payment of such fees, those
arrangements will be attempted prior to any automatic deduction.

5. Acknowledgements. . (a) You understand that: (i) neither Bank nor Processor can guarantee the
amount of your tax year 2019 federal tax refund or the date it will be issued, and (ii) neither Bank nor
Processor is affiliated with the transmitter of the tax return (Intuit Inc.) and neither warrants the accuracy of
the software used to prepare the tax return. (b) You agree that Intuit Inc. is not acting as your agent and is
not under any fiduciary duty with respect to the processing of your refund by Bank and Processor. (c) Your
refund may be held or returned to the IRS if it is suspected of fraud or identity theft.

6. Truth in Savings Disclosure. The Deposit Account is being opened for the purpose of receiving your (or
both spouses if this is a jointly filed return) tax year 2019 federal tax refund. Processor and Bank will deduct
from the Deposit Account the fees set forth in Section 3, including the $ 40.00 Refund Processing Fee for
opening and maintaining the Deposit Account and processing your tax refund. No other deposits may be
made to the Deposit Account. No withdrawals will be allowed from the Deposit Account except to collect the
fees stated in this Section, Section 3, Section 7, and as provided in Section 4. No interest is payable on the
deposit; thus, the annual percentage yield and interest rate are 0%. The Deposit Account will be closed after
all authorized deductions have been made and any remaining balance has been disbursed to you. We will
also charge a Return Item Fee of $30.00 if the refund cannot be delivered as directed in Section 7 of this
Agreement. A $30.00 Account Research and Processing Fee may be charged if we are required to provide
additional processing to return the funds to the IRS. These fees will be deducted from the Deposit Account
and will be retained by Processor. Questions or concerns about the Deposit Account should be directed to
Santa Barbara Tax Products Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, CA 92037 or
via the Internet at http://sbtpg.com.

7. Disbursement Methods (Select One): You agree that the disbursement method selected below
will be used by Processor to disburse funds to you.
a) Direct Deposit to Turbo(SM) Debit Visa(R) Card: If you choose this option, you authorize and
request Processor to transfer the balance of your Deposit Account to Green Dot Bank, which issues
the Turbo(SM) Debit Visa Card ("Card") you have obtained or are obtaining, so that Green Dot Bank
may deposit the balance of your refund into your Card account. Additional fees may be charged for
the use of the Card. Please review the Deposit Account Agreement associated with the use of your
Card to learn of other fees, charges, terms and conditions that will apply. Neither Bank nor
Processor will be responsible for your funds once they have been deposited with Green Dot Bank.

b) X Direct Deposit to Checking or Savings Account: If you choose this option, the balance of your
Deposit Account will be disbursed to you electronically by ACH direct deposit to your personal bank
account designated below. If a joint return is filed, the bank account may be a joint account or the
individual account of either spouse.

DIRECT DEPOSIT ACCOUNT TYPE:

X Checking
Savings
RTN # 122100024
Account # 555715926
Note: To ensure that there are no delays in receiving your refund, please contact your financial
institution to confirm that you are using the correct RTN (routing) and account number. If you or your
representative enter your account information incorrectly and your deposit is returned to
Bank, the Deposit Account balance minus a $30.00 Return Item Fee will be disbursed to you via a
cashier’s check mailed to your physical address of record. Bank, Processor and Intuit Inc. are not
responsible for the misapplication of a direct deposit that results from error, negligence or malfeasance
on the part of you or your representative. In cases where Bank has received your federal tax refund
but is unable to deliver the funds directly to you, funds may be held at Bank until claimed, or returned
to the IRS. An Account Research and Processing Fee of $30.00 may be charged if we are required to
Adonis Leyva Bravo 601-57-0827 Page 3

provide additional processing to return the funds to the IRS. Return Item and Account Research and
Processing Fees will not exceed $60.00 in the aggregate, and will be deducted from the Deposit
Account for federal tax refunds that continue to be undeliverable and unclaimed and must be returned
to the IRS. These fees will be retained by Processor. Due to the risk of fraudulent diversion of tax
refunds, we will not process any address or account changes for purposes of disbursing your tax
refund. If we become aware that your address or checking or savings account has changed after you
sign this Agreement but before your federal tax refund is received by us, upon receipt of your federal
tax refund from the IRS we will return your tax refund to the IRS after deducting our Refund Processing
Fee, TurboTax Fees and other applicable fees. We will do our best to escalate the return of your
federal tax refund to the IRS and you will need to work with the IRS directly for disbursement.

You must notify Processor in writing 3 business days prior to the date the account will be debited
(as set forth in the email and/or written notices sent to you) to revoke the authorization
for applicable fees agreed to in Section 4, and to afford Processor a reasonable opportunity
to act on your request. You may notify us in writing at: Santa Barbara Tax Products Group, LLC,
11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037.

8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES: In case of errors or questions about
electronic transfers to or from the Deposit Account, write to Santa Barbara Tax Products Group, LLC, 11085
North Torrey Pines Road, Suite 210, La Jolla, California 92037 or telephone (877) 908-7228 and provide
your name, a description or explanation of the error, and the dollar amount of the suspected error. We will
determine whether an error occurred within 10 business days after we hear from you and will correct any
error promptly. If we need more time, however, we may take up to 45 business days to investigate your
complaint or question. If we decide to do this, we will credit your Deposit Account within 10 business days
for the amount you think is in error, although in most circumstances you won’t have use of the money until
we complete our investigation. If we ask you to put your complaint or question in writing and we do not
receive it within 10 business days, we may not credit your Deposit Account. For errors involving transfers of
funds to or from the Deposit Account within 30 business days after the first deposit to the Deposit Account
was made, (i) we may take up to 90 business days to investigate your complaint or question, and (ii) we
may take up to 20 business days to credit your Deposit Account for the amount you think is in error. We will
tell you the results within three business days after completing our investigation. If we decide that there
was no error, we will send you a written explanation. You may ask for copies of the documents that we
used in our investigation.

Business Days: Our business days are Monday through Friday, excluding federal holidays. Saturday,
Sunday, and federal holidays are not considered business days, even if we are open.

Confidentiality: We will disclose information to third parties about your account or the transfers you make:

? To complete transfers as necessary;

? To verify the existence and condition of your account upon the request of a third party, such as a credit
bureau or merchant;
? To comply with government agency or court orders;
? If you give us your written permission; or
? As explained in the Privacy Policy following this Agreement.

Our Liability: If we do not complete a transfer to your account on time or in the correct amount according to
this Agreement, we may be liable for your losses or damages. In addition to all other limitations of liability
set forth in this Agreement, we will not be liable to you if, among other things:
? Circumstances beyond our control (natural disasters, such as fire or flood) prevent the transfer, despite
reasonable precautions that have been taken.
? The funds in your account are subject to legal process or other claim restricting such transfer.
? You or your representative provide us with inaccurate information.

9. Compensation. In addition to any fees paid directly by you to Intuit Inc., Processor will pay
compensation to Intuit Inc. in consideration of Intuit Inc.’s provision of various programming, testing, data
processing, transmission, systems maintenance, status reporting and other software, technical and
communications services. The Refund Processing Fee will be retained by Processor for its Refund
Processing Service. Processor shall pay Bank for its banking services.

10. Governing Law. The enforcement and interpretation of this Agreement and the transactions
contemplated herein shall be governed by the laws of the United States, including the Electronic Signatures
in Global and National Commerce Act, and, to the extent state law applies, the substantive laws of Ohio.
Adonis Leyva Bravo 601-57-0827 Page 4

11. Arbitration Provision. You acknowledge that the services set forth in this Agreement are being made
available and priced by Processor on the basis of your acceptance of the following arbitration provision
("Arbitration Provision"). By entering into this Agreement, you acknowledge that you are giving up the right
to litigate Claims (as defined below) if you, Bank or Processor elects arbitration of the Claims pursuant to
this provision, except as otherwise expressly provided herein, and you hereby knowingly and voluntarily
waive the right to trial of all Claims subject to this Agreement. You further acknowledge that you have read
this Arbitration Provision carefully, agree to its terms, and are entering into this Agreement voluntarily and
not in reliance on any promises or representations whatsoever except those contained in this Agreement.

ARBITRATION NOTICE
THIS AGREEMENT CONTAINS AN ARBITRATION PROVISION. PLEASE READ THIS PROVISION
CAREFULLY, AS IT AFFECTS YOUR LEGAL RIGHTS.

11.1. Arbitration of Claims: Except as expressly provided herein, any claim, dispute or controversy
(whether based upon contract; tort, intentional or otherwise; constitution; statute; common law; or equity
and whether pre-existing, present or future), including initial claims, counter-claims, cross-claims and
third-party claims, arising from or relating directly or indirectly to this Agreement, including the validity,
enforceability, interpretation, scope, or application of the Agreement and this Arbitration Provision (except
for the prohibition on class or other non-individual claims, which shall be for a court to decide) ("Claim")
shall be decided, upon the election of you, Bank or Processor (or our agents, employees, successors,
representatives, affiliated companies, or assigns), by binding arbitration before the American Arbitration
Association ("AAA"). Arbitration replaces the right to litigate a claim in court or to have a jury trial. The
AAA’s phone number is 800-778-7879 and website is http://www.adr.org. You may obtain copies of the
current rules, forms, and instructions for initiating an arbitration using the above information.

11.2. Other Claims Subject to Arbitration: In addition to Claims brought by you, Claims made by anyone
connected with you or anyone making a Claim through you (including a taxpayer filing jointly, employee,
agent, representative, affiliated company, predecessor or successor, heir, assignee, or trustee in bankruptcy)
against us shall be subject to arbitration as described herein.

11.3. Exceptions: We agree not to invoke our right to arbitrate any individual Claim you bring in small
claims court or an equivalent court so long as the Claim is pending only in that court. This Arbitration
Provision also does not limit or constrain our right to interplead funds in the event of claims to the Account
by several parties.

11.4. Individual Claims Only: Claims may be submitted to arbitration on an individual basis only. Claims
subject to this Arbitration Provision may not be joined or consolidated in arbitration with any Claim of any
other person or be arbitrated on a class basis, in a representative capacity on behalf of the general public
or on behalf of any other person, unless otherwise agreed to by the parties in writing. However, taxpayers
filing jointly and party to this Agreement are considered as one person; Processor and its officers, directors,
employees, agents, and affiliates are considered as one person; and Bank and its officers, directors,
employees, agents, and affiliates are considered as one person.

11.5. Arbitration Fees: If you initiate arbitration, we will advance any arbitration fees, including any required
deposit. If we initiate or elect arbitration, we will pay the entire amount of the arbitration fees, including any
required deposit. We will also be responsible for payment and/or reimbursement of any arbitration fees to
the extent that such fees exceed the amount of the filing fees you would have incurred if your Claim had
been brought in the state or federal court nearest your residence with jurisdiction over the Claims.

11.6. Procedure: A single arbitrator will resolve the Claims. The arbitrator will be a lawyer with at least ten
years experience or who is a former or retired judge. The arbitration shall follow the rules and procedures of
the arbitration administrator in effect on the date the arbitration is filed, except when there is a conflict or
inconsistency between the rules and procedures of the arbitration administrator and this Arbitration
Provision, in which case this Arbitration Provision shall govern. Any in-person arbitration hearing for a Claim
shall take place within the federal judicial district in which you live or at such other reasonably convenient
location as agreed by the parties. The arbitrator shall apply applicable substantive law consistent with the
Federal Arbitration Act, 9 U.S.C. § 1 et seq. (the "FAA") and shall honor all claims of privilege and
confidentiality recognized at law. All statutes of limitations that would otherwise be applicable shall apply
to any arbitration proceeding. The arbitrator shall be empowered to grant whatever relief would be available
in court under law or in equity. Any appropriate court may enter judgment upon the arbitrator’s award.
This Arbitration Provision is made pursuant to a transaction involving interstate commerce, and shall be
governed by the FAA.
Adonis Leyva Bravo 601-57-0827 Page 5

12. Customer Identity Validation Disclosure. To help Bank, Processor and the government identify and fight
tax refund fraud, as well as fight the funding of terrorism and money laundering activities, Bank and
Processor obtain, verify, and record information that identifies each Refund Processing Service client. What
this means for you: When you apply to use the Refund Processing Service for the purpose of receiving your
federal tax refund, we will ask for your name, address, date of birth, and other information that will allow us
to identify you. We may also ask to see your driver’s license or other identifying documents if we need to
perform additional due diligence on your account.

YOUR AGREEMENT

Bank and Processor agree to all of the terms of this Agreement. By selecting the "I Agree" button in
TurboTax: (i) You authorize Bank to receive your 2019 federal tax refund from the IRS and Processor to
make the deductions from your refund described in the Agreement, (ii) You agree to receive all
communications electronically in accordance with the "Communications" section of the Tax Year 2019
TurboTax(R) User Agreement, (iii) You consent to the release of your 2019 federal tax refund deposit
information and application information as described in Section 2 of this Agreement; and (iv) You
acknowledge that you have reviewed, and agree to be bound by, the Agreement’s terms and conditions. If
this is a joint return, selecting "I Agree" indicates that both spouses agree to be bound by the terms and
conditions of the Agreement.
Adonis Leyva Bravo 601-57-0827

Rev. 02/2015

Civista Bank Tax Product Privacy Policy

FACTS What does Civista Bank do with your Personal Information?

Why? Financial Companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you how
we collect, share and protect your personal information. Please read this notice carefully to
understand what we do.

What? The types of personal information that we collect and share depend on the product or service
you have with us. This can include:

? Social Security number and account balances

? payment history and transaction history
? overdraft history and account transactions

When you are no longer our customer, we continue to share your information as described in
this notice.

How? All Financial Companies need to share customers’ personal information to run their everyday
business. In the section below we list the reasons financial companies can share their
customers’ personal information; the reasons Civista Bank chooses to share
and whether you can limit the sharing.

Reasons we can share your Does Civista Bank Can you limit this sharing?
personal information Share?

For our everyday business purposes '

such as to process your transaction,
maintain your account(s), respond to court Yes No
orders and legal investigations, or report to
credit bureaus.

For our marketing purposes ' No We don’t share

to offer our products and services to you.

For joint marketing with other No We don’t share

financial companies.

For our affiliates’ everyday

business purposes ' No We don’t share
information about your transactions
and experiences.

For our affiliates’ everyday

business purposes ' No We don’t share
information about your creditworthiness.

For our affiliates to market to you. No We don’t share

For non affiliates to market to you. No We don’t share

Questions? Call Toll Free: 800-901-6663 or go to www.civistabank.com

Adonis Leyva Bravo 601-57-0827 Page 2

Who we are

Who is providing this notice? Civista Bank

What we do

How does Civista Bank To protect your personal information from unauthorized access
protect my and use, we use security measures that comply with federal law.
personal information? These measures include computer safeguards and secured files
and buildings.

How does Civista Bank We collect personal information about you when you apply for a tax
collect my related product. This includes information in your application, such
personal information? as your name, address, social security number, income,
deductions, refund and the like. We also collect information about
your transactions with us, tax preparers and similar providers, such
as payment histories, balances due, and tax information. We may
also collect information concerning your credit history from a
consumer reporting agency.

Why can’t I limit all sharing? Federal law gives you the right to limit only:

? Sharing for affiliates everyday business purposes '

information about your creditworthiness,
? Affiliates from using your information to market to you,
? Sharing for non affiliates to market to you.

State laws and individual companies may give you additional rights
to limit sharing.

Definitions

Affiliates Companies related by common ownership or control. They can be

financial and nonfinancial companies.

? Civista Bank does not share with our affiliates.

Non affiliates Companies not related by common ownership or control. They can
be financial or nonfinancial companies.

? Civista Bank does not share with non

affiliates so they can market to you.

Joint Marketing A formal joint marketing agreement between non affiliated financial
companies that together market financial products or services
to you.

? Civista Bank does not jointly market.

Other Important Information

This Notice is adopted in recognition of our obligations under Title V of Gramm-Leach Bliley Act of 1999.
This Notice applies only to individuals who have applied for a tax-related bank product.

sbia1514.SCR 01/13/20
Electronic Filing Instructions for your 2019 Arizona Tax Return
Important: Your taxes are not finished until all required steps are completed.

Adonis Leyva Bravo

1033 E Tennessee St
Tucson, AZ 85714-3211
|
Balance | Your Arizona state tax return (Form 140) shows a refund due to you in
Due/ | the amount of $433.00. Your tax refund will be direct deposited into
Refund | your account. The account information you entered - Account Number:
| 555715926 Routing Transit Number: 122100024.
|
______________________________________________________________________________________
|
Where's My | Before you call the Arizona Department of Revenue with questions
Refund? | about your refund, give them 21 days processing time from the date
| your return is accepted. If then you have not received your refund,
| or the amount is not what you expected, contact the Arizona
| Department of Revenue directly at 1-602-255-3381. From outside of
| Arizona use 1-800-352-4090. You can also visit the Arizona Department
| of Revenue web site at www.azdor.gov.
|
______________________________________________________________________________________
|
What You | Sign and date E-File Signature Authorization within 1 day(s) of
Need to | acceptance.
Sign |
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | Printed copy of your state and federal returns
Keep |
|
______________________________________________________________________________________
|
2019 | Taxable Income $ 10,803.00
Arizona | Total Tax $ 80.00
Tax | Total Payments/Credits $ 513.00
Return | Amount to be Refunded $ 433.00
Summary |
|
______________________________________________________________________________________

Page 1 of 1
 Arizona Form

AZ-8879 E-file Signature Authorization 2019

Do not mail this form to the Arizona Department of Revenue. The ERO must retain this document a minimum of four years.
Your First Name and Initial Last Name Your Social Security Number*
Enter
Adonis Leyva Bravo 601 57 0827
your
Your Spouse’s First Name and Initial (if filed joint) Last Name Spouse’s Social Security No.*
SSN(s).
*Do Not Truncate
PART 1 – PURPOSE
• To certify the truthfulness, correctness, and completeness of the taxpayer’s electronic income tax return.
• To authorize the Electronic Return Originator (ERO) to affirm that the taxpayer wishes to use the taxpayer’s electronic signature to the taxpayer’s
federal individual income tax return as the taxpayer’s signature to the taxpayer’s electronic Arizona individual income tax return.
PART 2 – TAX RETURN INFORMATION PART 3 – FINANCIAL INSTITUTION INFORMATION
Must be present when requesting direct debit or deposit.
1 Arizona Adjusted Gross Income 29,153 00  Foreign Account Deposit/Debit: See instructions below.
2 Balance Of Tax.......................... 80 00 TYPE OF ACCOUNT ROUTING NUMBER

3 Arizona Income Tax Withheld.... 513 00  Checking  Savings 1 2 2 1 0 0 0 2 4

Check box 4 or box 5: ACCOUNT NUMBER

4 REFUND: Enter the amount of refund...................... 433 00 5 5 5 7 1 5 9 2 6

5 AMOUNT YOU OWE: Enter the amount owed......... 00 DIRECT DEBIT REQUEST DATE DIRECT DEBIT PAYMENT AMOUNT

Box 4 Checkbox – Refund: You are due a refund based on the information
provided on your tax return. Your refund amount will be deposited in the
account listed in the Financial Institution Information Section (Part 3).
Box 5 Checkbox – Amount You Owe: You owe taxes based on the
information provided on your tax return. You have elected to direct debit
for payment. The payment will be withdrawn from the account and on the
date listed in the Financial Institution Information Section (Part 3).
MM D D Y Y Y Y $ .00
Foreign Account Deposit/Debit Checkbox: Check the “Foreign Account
Deposit/Debit” box if your deposit will be ultimately placed in or come
from a foreign account. If you check this box, do not enter your account
numbers. If this box is checked, we will not direct deposit or debit your
account. If you are due a refund, we will send you a check instead. If you
owe tax, you must mail a check to the Arizona Department of Revenue,
PO Box 29085, Phoenix, AZ 85038-9085.

PART 4 – DECLARATION AND SIGNATURE AUTHORIZATION (Sign only after completing Part 2)
Under penalties of perjury, I declare that I have examined a copy of my
electronic Arizona individual income tax return and accompanying schedules
and statements for the year ending December 31, 2019, and to the best of
my knowledge and belief, it is true, correct, and complete. I further declare
that the amounts of Arizona adjusted gross income, total tax, Arizona
income tax withheld, and refund (or amount owed) listed above are the
amounts shown on the copy of my electronic Arizona income tax return.
6a 
I consent that my refund be directly deposited as designated in the
electronic portion of my 2019 Arizona individual income tax return.
If I have filed a joint return, this is an irrevocable appointment of
the other spouse as an agent to receive the refund.

6b I do not want direct deposit of my refund or I am not receiving a
refund.
6c 
I authorize the Arizona Department of Revenue (ADOR) and its
designated Financial Agent to initiate an ACH electronic funds
withdrawal (direct debit) entry to the financial institution account
indicated in the tax preparation software for payment of my Arizona
taxes owed on this return. I also authorize the financial institutions
involved in the processing of the electronic payment of taxes to
receive confidential information necessary to answer inquiries and
resolve issues related to the payment.
If I have filed a balance due return, I understand that if the ADOR does not
receive full and timely payment of my tax liability by April 15, 2020, I will
remain liable for the tax liability and all applicable interest and penalties.
When electronically filing my federal and state tax returns, I understand
that if there is an error on my federal return, state return will also be
rejected.
I consent to my Electronic Return Originator (ERO) or On-Line Service
Provider (OLSP) sending my electronic Arizona individual income tax
return and accompanying schedules and statements to ADOR, and I
consent to my ERO or OLSP sending such information to ADOR through a
transmitter. I consent to ADOR sending my ERO, OLSP and/or transmitter
an acknowledgement of receipt of transmission and an indication of
whether or not the transmission of my return is accepted and, if the return
is rejected, the reason(s) for the rejection. If the processing of my return
or refund is delayed, I authorize ADOR to disclose to my ERO, OLSP and/
or transmitter the reason(s) for the delay, or when the refund was sent.
If ADOR contacts my ERO for a copy of my return, any documents or
schedules to my return, and/or this authorization form, I authorize my ERO
to release copies of the requested documents to ADOR.
I authorize Self-Prepared
(ELECTRONIC RETURN ORIGINATOR)
to make the election that I want my electronic signature to my electronic
federal individual income tax return to serve as my signature to my
electronic Arizona individual income tax return for the year ending
December 31, 2019. I understand that when my ERO makes the election
that my electronic signature to my federal individual income tax return will
serve as my signature to my Arizona individual income tax return, I will
have signed my Arizona individual income tax return and declared under
penalties of perjury that to the best of my knowledge and belief the return
is true, correct and complete.


PLEASE SIGN HERE

YOUR PEN AND INK SIGNATURE DATE


SPOUSE’S PEN AND INK SIGNATURE DATE

ADOR 10549 (19) REV 01/17/20 TTO

1555
DO NOT STAPLE ANY ITEMS TO THE RETURN. Arizona Form FOR CALENDAR YEAR
Resident Personal Income Tax Return 2019
Check box 82F
140
82F if filing under extension OR FISCAL YEAR BEGINNING MM D D 2 0 1 9 AND ENDING MM D D Y Y Y Y . 66F

Your First Name and Middle Initial Last Name Your Social Security Number
Enter
1 Adonis Leyva Bravo 601 57 0827
your
Spouse’s First Name and Middle Initial (if box 4 or 6 checked) Last Name Spouse’s Social Security No.
SSN(s).
1
Current Home Address - number and street, rural route Apt. No. Daytime Phone (with area code)
2 1033 E Tennessee St 94 (520)445-5053
City, Town or Post Office State ZIP Code Last Names Used in Last Four Prior Year(s) (if different)
3 Tucson AZ 85714-3211 97

… …
FILING STATUS

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

4 Married filing joint return 4a Injured Spouse Protection of Joint Overpayment
88
5 … Head of household: Enter name of qualifying child or dependent on next line:
Adonis Leyva Bravo
6 … Married filing separate return: Enter spouse’s name and Social Security Number above.
7 … Single
 ÐEnter the number claimed. Do not put a check mark.
8 Age 65 or over (you and/or spouse) If completing lines 8, 9, and 11a, also complete lines 38,
39, and 41. For lines 10a and 10b, also complete line 49. 81 PM 80 RCVD
Exemptions 8, 9, and 11a - Dependents 10a and 10b

9 Blind (you and/or spouse)

10a 2 Dependents: under age of 17. 10b Dependents: Age 17 and over.
11a Qualifying parents and grandparents
(Box 10a and 10b): Dependent Information. See instructions. For more space, check the box … and complete page 4, Part 1.
(a) (b) (c) (d) (e) (f)
FIRST AND LAST NAME SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS 9Dependent Age
included in:
9 if you did not claim
LIVED IN YOUR this person on your
(Do not list yourself or spouse) federal return due to
HOME IN 2019 1 2
educational credits
(Box 10a) (Box 10b)
10c Alejandro Flores Bravo 764-44-8131 Brother 12 …… …
10d David Flores Bravo 764-44-8132 Brother 12 …… …
10e …… …
(Box 11a): Qualifying parents and grandparents. See instructions. For more space, check the box … and complete page 4, Part 2.
Place any required federal and AZ schedules or other documents after Form 140.

(a) (b) (c) (d) (e) (f)

FIRST AND LAST NAME SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS 9IF AGE 65 OR 9 IF DIED IN
(Do not list yourself or spouse.) LIVED IN YOUR OVER 2019
HOME IN 2019

11b … …
11c … …
12 Federal adjusted gross income (from your federal return) ................................................................................... 12 29,153 00
13 Non-Arizona municipal interest.................................................................................................................................... 13 00
14 Partnership Income adjustment: See instructions ......................................................................................................... 14 00
Additions

15 Total federal depreciation ............................................................................................................................................ 15 00

16 Net capital (loss) derived from the exchange of legal tender: See instructions .............................................................. 16 00
17 Other Additions to Income: Complete Adjustments to Arizona Gross Income schedule on page 5........................... 17 00
18 Subtotal: Add lines 12 through 17 and enter the total ....................................................................................................... 18 29,153 00
19 Total net capital gain or (loss): See instructions ..................................................................... 19 00
20 Total net short-term capital gain or (loss): See instructions .................................................... 20 00
21 Total net long-term capital gain or (loss): See instructions ...................................................... 21 00
22 Net long-term capital gain from assets acquired after December 31, 2011. See instructions. 22 0 00
23 Multiply line 22 by 25% (.25) and enter the result ....................................................................................................... 23 0 00
24 Net capital gain derived from investment in qualified small business.......................................................................... 24 00
This box may be blank or may contain a printed barcode of data from your return.
25 Net capital gain exchange of legal tender 25 00
Subtractions

26 Recalculated Arizona depreciation .......... 26 00

27 Partnership Income adjustment............... 27 00
28 Interest on U.S. obligations ..................... 28 00
29a Exclusion for fed., AZ state or local govt. pensions . 29a 00
29b Pensions-Uniformed Services retired/retainer pay 29b 00
30 U.S. Social Security or Railroad Retirement Act 30 00
31 Certain wages of American Indians ......... 31 00
32 Pay received for being an active service member . 32 00
33 Net operating loss adjustment ................. 33 00
34 Contributions to 529 College Savings Plans..... 34 00
35 Subtract lines 23 through 34 from line18 35 29,153 00
ADOR 10413 (19) AZ Form 140 (2019) REV 01/17/20 TTO Page 1 of 5
1555
 Your Name (as shown on page 1) Your Social Security Number

Adonis Leyva Bravo 601-57-0827

36 Other Subtractions from Income. Complete Adjustments to Arizona Gross Income schedule on page 5..................... 36 00
37 Subtract line 36 from line 35 and enter the difference .................................................................................................... 37 29,153 00
38 Age 65 or over: Multiply the number in box 8 by $2,100 ....................................................................................................... 38 00
Exemptions

39 Blind: Multiply the number in box 9 by $1,500 ...................................................................................................................... 39 00

40 Other Exemptions. See instructions......40E Multiply the number in box 40E by $2,300............................................. 40 00
41 Qualifying parents and grandparents: Multiply the number in box 11a by $10,000........................................................................ 41 00
42 Arizona adjusted gross income: Subtract lines 38 through 41 from line 37 and enter the difference .................................... 42 29,153 00
43 Deductions: Check box and enter amount. See instructions ........................ 43I… ITEMIZED...43S… STANDARD 43 18,350 00
44 If you checked box 43S and claim charitable deductions, Check 44C … Complete page 3. See instructions........................ 44 00
45 Arizona taxable income: Subtract lines 43 and 44 from line 42. If less than zero, enter “0” ..................................................... 45 10,803 00
46 Compute the tax using amount on line 45 and Tax Table X, Y or Optional Tax Tables ................................................... 46 280 00
Balance of Tax

47 Tax from recapture of credits from Arizona Form 301, Part 2, line 35 ............................................................................ 47 00
48 Subtotal of tax: Add lines 46 and 47 and enter the total ....................................................................................................... 48 280 00
49 Dependent Tax Credit. See instructions ........................................................................................................................ 49 200 00
50 Family income tax credit (from the worksheet - see instructions) .......................................................................................... 50 00
51 Nonrefundable Credits from Arizona Form 301, Part 2, line 67 ...................................................................................... 51 00
52 Balance of tax: Subtract lines 49, 50 and 51 from line 48. If the sum of lines 49, 50 and 51 is greater than line 48, enter “0” ....... 52 80 00
53 2019 AZ income tax withheld.......................................................................................................................................... 53 513 00
00 Claim of Right 54b 00 Add 54a and 54b .. 54c 00
Total Payments and
Refundable Credits

54 2019 AZ estimated tax payments.. 54a

55 2019 AZ extension payment (Form 204) ........................................................................................................................ 55 00
56 Increased Excise Tax Credit (from the worksheet - see instructions) .................................................................................... 56 00
57 Property Tax Credit from Arizona Form 140PTC ............................................................................................................ 57 00
58 Other refundable credits: Check the box(es) and enter the total amount .......................................... 581…308-I 582…349 58 00
59 Total payments and refundable credits: Add lines 53 through 58 and enter the total ................................ 59 513 00
00
Overpayment

60 TAX DUE: If line 52 is larger than line 59, subtract line 59 from line 52 and enter amount of tax due. Skip lines 61, 62 and 63........ 60
Tax Due or

61 OVERPAYMENT: If line 59 is larger than line 52, subtract line 52 from line 59 and enter amount of overpayment ........................ 61 433 00
62 Amount of line 61 to be applied to 2020 estimated tax................................................................................................... 62 0 00
63 Balance of overpayment: Subtract line 62 from line 61 and enter the difference .................................................................... 63 433 00
Solutions Teams
64 - 74 Voluntary Gifts to: 00 Arizona Wildlife ............... 65 00
Voluntary Gifts

Assigned to Schools ........... 64

Child Abuse Prevention ........... 66 00 Domestic Violence Shelter . 67 00 Political Gift..................... 68 00

Neighbors Helping Neighbors.. 69 00 Special Olympics ................ 70 00 Veterans’ Donations Fund 71 00
Sustainable State Parks
I Didn’t Pay Enough Fund........ 72 00 and Road Fund ................... 73 00 Spay/Neuter of Animals .. 74 00
75 Political Party (if amount is entered on line 68 - check only one): 751…Democratic 752…Green Party 753…Libertarian 754…Republican
00
Penalty

76 Estimated payment penalty ............................................................................................................................................ 76

77 771…Annualized/Other 772…Farmer or Fisherman 773…Form 221 included

78 Add lines 64 through 74 and 76; enter the total.............................................................................................................. 78 00

79 REFUND: Subtract line 78 from line 63. If less than zero, enter amount owed on line 80 .......................................................... 79 433 00
Direct Deposit of Refund: Check box 79A if your deposit will be ultimately placed in a foreign account; see instructions. 79A…
Amount Owed
Refund or

ROUTING NUMBER ACCOUNT NUMBER

C… Checking or
98 S … Savings 1 2 2 1 0 0 0 2 4 5 5 5 7 1 5 9 2 6
80 AMOUNT OWED: Add lines 60 and 78. Make check payable to Arizona Department of Revenue; write your SSN on payment;
and include with your return ................................................................................................................................................. 80 00
Under penalties of perjury, I declare that I have read this return and any documents with it, 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.
PLEASE SIGN HERE

Ä Interpreter
YOUR SIGNATURE DATE OCCUPATION

Ä
SPOUSE’S SIGNATURE DATE SPOUSE’S OCCUPATION

Self Prepared
PAID PREPARER’S SIGNATURE DATE FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

PAID PREPARER’S STREET ADDRESS PAID PREPARER’S TIN

PAID PREPARER’S CITY STATE ZIP CODE PAID PREPARER’S PHONE NUMBER

If you are also sending a payment, mail to Arizona Department of Revenue, PO Box 52016, Phoenix, AZ 85072-2016 (PO Box 29204, Phoenix, AZ 85038-9204 if your return has a barcode).
If you are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ 85072-2138 (PO Box 29205, Phoenix, AZ 85038-9205 if your return has a barcode).

ADOR 10413 (19) 1555 AZ Form 140 (2019) REV 01/17/20 TTO Page 2 of 5
Your Name (as shown on page 1) Your Social Security Number
Adonis Leyva Bravo 601-57-0827

2019 Form 140 Dependent and Other Exemption Information

Include page 4 with your return if:
• You are listing additional dependents (for box 10a and 10b) from page 1.
• You are listing additional qualifying parents and grandparents (for box 11a) from page 1.
• You are claiming Other Exemptions on page 2, line 40.

Part 1: Dependents (Box 10a and 10b) continued from page 1

Information used to compute your allowable Dependent Tax Credit on page 2, line 49.
NOTE: If you have more than three qualifying dependents, you must complete Part 1 and the worksheet in the instructions, to
compute your Dependent Tax Credit on line 49.
(a) (b) (c) (d) (e) (f)
FIRST AND LAST NAME SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS 9Dependent Age 9IF YOU DID NOT
(Do not list yourself or spouse.) CLAIM THIS PERSON
LIVED IN YOUR included in: ON YOUR FEDERAL
HOME IN 2019 RETURN DUE TO
1 2 EDUCATIONAL
(Box 10a) (Box 10b) CREDITS

10f …… …
10g …… …
10h …… …
10i …… …
10j …… …
10k …… …
10l …… …
10m …… …
10n …… …
10o …… …
10p …… …
Part 2: Qualifying parents and grandparents (Box 11a) continued from page 1
Additional qualifying parents and grandparents information used to compute your allowable exemption on page 2, line 41.
(a) (b) (c) (d) (e) (f)
FIRST AND LAST NAME SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS 9 IF AGE 65 OR 9 IF DIED IN
(Do not list yourself or spouse.) LIVED IN YOUR OVER 2019
HOME IN 2019

11d … …
11e … …
11f … …
11g … …
11h … …
11i … …
Part 3: Other Exemptions
Information used to compute your allowable Other Exemptions on page 2, line 40.
(a) (b) (c) (d)
FIRST AND LAST NAME SOCIAL SECURITY NO. 9AGE 65 OR OVER 9STILLBORN
(Do not list yourself or spouse.) (see instructions) CHILD IN 2019

C1 C2
1 …… …
2 …… …
3 …… …
4 …… …
5 …… …
6 …… …
7 …… …
8 …… …
9 …… …
10 …… …
Enter the total number of individuals listed in Part 3 in box 40E on page 2, line 40.
REV 01/17/20 TTO
ADOR 10413 (19)
1555 AZ Form 140 (2019) Page 4 of 5