1040 U.S.

Individual Income Tax Return 2022

Form Department of the Treasury—Internal Revenue Service

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 surviving
Check only spouse (QSS)
one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s name if the qualifying
person is a child but not your dependent:
Your first name and middle initial Last name Your social security number
Yuliana Madrid 152-06-5029
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
37 Lucille Pl 7 Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Passaic NJ 070554245 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Digital At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes No
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, 1958 Are blind Spouse: Was born before January 2, 1958 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here . .

Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 18,809.
b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s) c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
W-2 here. Also
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
1099-R if tax
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h 0.
W-2, see
instructions.
i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 18,809.
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
Standard 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Deduction for—
6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
• Single or
Married filing c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
separately,
$12,950 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7
• Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8
jointly or
Qualifying 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 18,809.
surviving spouse,
$25,900
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
• Head of 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 18,809.
household,
$19,400 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12,950.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12,950.
Deduction, 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . .
see instructions.
15 5,859.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2022)
Form 1040 (2022) Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 588.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 588.
19 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- . . . . . . . . . . . . . . 22 588.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 0.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 588.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 1,576.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 1,576.
26 2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . 26
If you have a
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 1,576.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 988.
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 988.
Direct deposit? b Routing number 0 3 1 2 0 7 6 0 7 c Type: Checking Savings
See instructions.
d Account number 8 1 3 2 8 0 2 0 3 6
36 Amount of line 34 you want applied to your 2023 estimated tax . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . 37
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
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
Sign 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
Joint return? Employee (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. (862)281-9680 Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name Self-Prepared Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 03/22/23 Intuit.cg.cfp.sp Form 1040 (2022)
 FORM
40 Alabama 2022
Individual Income Tax Return
RESIDENTS & PART-YEAR RESIDENTS
For the year Jan. 1 - Dec. 31, 2022, or other tax year:

Beginning: • Ending: •

Your social security number Spouse’s SSN if joint return

• 152-06-5029 •
•  Check if primary is deceased •  Check if spouse is deceased
Primary’s deceased date Spouse’s deceased date
(mm/dd/yyyy) • (mm/dd/yyyy) •
Your first name Initial Last name
• YULIANA • • MADRID
Spouse’s first name Initial Last name
• • •
Present home address (number and street or P.O. Box number)  CHECK BOX IF AMENDED RETURN •
• 37 LUCILLE PL 7
City, town, or post office State ZIP code Foreign Country
Check if address
• PASSAIC •NJ • 07055-4245 •  is outside U.S.
Filing Status/ 1 • $1,500 Single 3 •  $1,500 Married filing separate. Complete Spouse SSN •  NRA
Exemptions 2 • $3,000 Married filing joint 4 •  $3,000 Head of Family (with qualifying person).Complete Schedule HOF
5a Alabama Income Tax Withheld (from Schedule W-2, line 18, column G) . . . . . . . . . A – Alabama tax withheld B – Income
5b Wages, salaries, tips, etc. (from Schedule W-2, line 18, column I plus J): . . . . . . . . . . . . 5a • 669 5b • 15,953
Income 6 Interest and dividend income (also attach Schedule B if over $1,500) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 •
and 7 Other income (from page 2, Part I, line 9). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 •
Adjustments 8 Total income. Add amounts in the income column for line 5b through line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 • 15,953
9 Total adjustments to income (from page 2, Part II, line 16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 •
10 Adjusted gross income. Subtract line 9 from line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 • 15,953
11 Box a or b MUST be checked.
Check box a, if you itemize deductions, and enter amount from Schedule A, line 27.
Deductions
Check box b, if you do not itemize deductions, and enter standard deduction (see instructions)
If claiming a deduc- • a  Itemized Deductions • b  Standard Deduction . . . . . . . . . 11 • 3,000
tion on line 12, you
must attach page
1,2 and Schedule 1
12 Federal tax deduction (see instructions)
of your Federal Re- DO NOT ENTER THE FEDERAL TAX WITHHELD FROM YOUR FORM W-2(S) 12 • 499
turn, if applicable.
13 Personal exemption (from line 1, 2, 3, or 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 • 1,500
14 Dependent exemption (from page 2, Part III, line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 •
15 Total deductions. Add lines 11, 12, 13, and 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 • 4,999
16 Taxable income. Subtract line 15 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 • 10,954
17 Income Tax due. Enter amount from tax table or check if from •  Form NOL-85A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 • 508
Tax 18 Net tax due Alabama. Check box if computing tax using Schedule OC • , otherwise enter amount from line 17. . . . 18 • 508
Staple Form(s) W-2, 19 Additional taxes (from Schedule ATP, Part I, Line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 • 0
W-2G, and/or 1099
20 Alabama Election Campaign Fund. You may make a voluntary contribution to the following:
here. Attach Sched-
ule W-2 to return. a Alabama Democratic Party  $1  $2  none . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20a •
b Alabama Republican Party  $1  $2  none . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20b •
21 Total tax liability and voluntary contribution. Add lines 18, 19, 20a, and 20b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 • 508
22 Alabama income tax withheld (from column A, line 5a) . . . . . . . . . . . . . . . . . . . . . . 22 • 669
23 2022 estimated tax payments/Automatic Extension Payment . . . . . . . . . . . . . . . . . . 23 •
24 Amended Returns Only — Previous payments (see instructions) . . . . . . . . . . . . . . . 24 •
Payments 25 Refundable Credits. Enter the amount from Schedule OC, Section F, line F4 . . . 25 •
26 Payments from Schedule CP, Section B, Line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 •
27 Total payments. Add lines 22, 23, 24, 25, and 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 • 669
28 Amended Returns Only — Previous refund (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 •
29 Adjusted Total Payments. Subtract line 28 from line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 • 669
30 If line 21 is larger than line 29, subtract line 29 from line 21, and add line 31 and enter AMOUNT YOU OWE.
AMOUNT
Place payment, along with Form 40V, loose in the mailing envelope. (FORM 40V MUST ACCOMPANY PAYMENT.) 30 •
YOU OWE
31 Penalties (from Schedule ATP, Part II, line 3) (see instructions) . . . . . . . . . . . . . . . . 31 •
32 If line 29 is larger than line 21, subtract line 21 from line 29, and enter AMOUNT OVERPAID . . . . . . . . . . . . . . . . . . . . . . . . . 32 • 161
OVERPAID
33 Amount of line 32 to be applied to your 2023 estimated tax . . . . . . . . . . . . . . . . . . . 33 •
Donations 34 Total Donation Check-offs from Schedule DC, line 2. . . . . . . . . . . . . . . . . . . . . . . . . . 34 •
35 REFUNDED TO YOU. (CAUTION: You must sign this return on the reverse side.)
REFUND If line 32 is greater than zero, subtract lines 31, 33, and 34 from line 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 • 161
For Direct Deposit, check here •  and complete Part V, Page 2.
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 Form 40 (2022) Page 2

PART I 1 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 •

2 Business income or (loss) (attach Federal Schedule C or C-EZ) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 •
3 Gain or (loss) from sale of Real Estate, Stocks, Bonds, etc. (attach Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 •
Other 4a Total IRA distributions 4a • 4b Taxable amount (see instructions) . . . . . . . . . . . . 4b •
Income 5a Total pensions and annuities 5a • 5b Taxable amount (see instructions) . . . . . . . . . . . . 5b •
(See 6 Rents, royalties, partnerships, estates, trusts, etc. (attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 •
instructions)
7 Farm income or (loss) (attach Federal Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 •
8 Other income (state nature and source — see instructions) 8 •
9 Total other income. Add lines 1 through 8. Enter here and also on page 1, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 •
PART II 1a Your IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a •
b Spouse’s IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b •
2 Payments to a Keogh retirement plan and self-employment SEP deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 •
3 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 •
4 Alimony paid. Recipient’s last name SSN • 4 •
5 Adoption expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 •
Adjustments 6 Moving Expenses (Attach Federal Form 3903) to:
to Income
(See City State ZIP 6 •
instructions) 7 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 •
8 Payments to Alabama College Counts 529 Fund or Alabama PACT Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 •
9 Health insurance deduction for small employer employee (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 •
10 Costs to retrofit or upgrade home to resist wind or flood damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 •
11 Deposits to a catastrophe savings account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 •
12 Contributions to a health savings account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 •
13 Deposits to an Alabama First-Time and Second Chance Home Buyer Savings Account (see instructions). . . . . . . . . . . . . . . . . . . 13 •
14 Firefighter’s Insurance Premium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 •
15 Contributions to an Achieving a Better Life Experience (ABLE) savings account.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 •
16 Total adjustments. Add lines 1 through 15. Enter here and also on page 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 •
PART III 1 Total number of dependents from Schedule DS, line 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 •
2 Amount allowed. Multiply total number of dependents claimed on line 1 by the amount on the dependent chart
Dependents 2 •
in the instructions. Enter amount here and on page 1, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART IV 1 Residency Check only one box •  Full Year •  Part Year From 09-18 2022 through 12-31 2022.
2 Did you file an Alabama income tax return for the year 2021? • Yes • No If no, state reasonWORKED IN NEW JERSEY 2021
General
Information 3 Give name and address of present employer(s). Yours CHEROKEE GIN & COTTON COMPANY 6000 US HWY 411 N CENTRE AL 35960
Your Spouse’s
All Taxpayers
Must 4 Enter the Federal Adjusted Gross Income • $ 18,809 and Federal Taxable Income • $ 5,859 as reported on your
Complete 2022 Federal Individual Income Tax Return.
5 Do you have income which is reported on your Federal return, but not reported on your Alabama return (other than your state tax refund)? • Yes • No
This
Section.
If yes, enter source(s) and amount(s) below: (other than state income tax refund)
(See
Source • Amount •
instructions)
Source • Amount •
PART V For Direct Deposit of your refund, complete 1, 2, 3, and 4 below. (See Page 17 of instructions to see if you qualify.)
Direct 1 Routing Number: 031207607 2 Type:  Checking  Savings 3 Account Number: 8132802036
Deposit 4 Is this refund going to or through an account that is located outside of the United States?  Yes  No
DOB Iss date Exp date
Drivers (mm/dd/yyyy) • Your state • DL# • (mm/dd/yyyy) • (mm/dd/yyyy) •
DOB Iss date Exp date
License Info (mm/dd/yyyy) • Spouse state • DL# • (mm/dd/yyyy) • (mm/dd/yyyy) •

•  I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.
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 com-
plete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign Here Your Signature Date Daytime Telephone Number Your Occupation
In Black Ink
Keep a copy (862)281-9680 EMPLOYEE
of this return Spouse’s Signature (if joint return, BOTH must sign) Date Daytime Telephone Number Spouse’s Occupation
for your
records.
Preparer’s Signature Date Check if Self-employed Preparer’s SSN or PTIN E.I. Number
Paid SELF PREPARED  •
Preparer’s Firms’s Name (or yours Daytime ZIP
if self employed) Telephone No. Code
Use Only
Address
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REV 02/18/23 INTUIT.CG.CFP.SP
 SCHEDULE
AlAbAmA DepArtment of revenue
ATP Income tAx ADmInIstrAtIon DIvIsIon
Additional taxes & penalties
2022
NAME(S) AS SHOWN ON THE TAX RETURN SOCIAL SECURITY NUMBER

YULIANA MADRID 152-06-5029

Additional Taxes
PART I
1 Consumer Use Tax (see instructions). If you certify that no use tax is due, check box •  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 • 0
2 Catastrophe savings tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 •
3 Total Additional Taxes. Add line 1 and line 2. Enter here and also on Form 40, page 1, line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 • 0

PART II Penalties
1 Estimated Tax Penalty (see instructions). Farmers and Fishermen that meets IRC §6654, check box •  . . . . . . . . . . . . . . . . . . . . . . . . . . 1 •
2 First-time Second chance Home Buyer Savings Account penalty (from Schedule HBC, Part IV, Line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 •
3 Total penalties. Add line 1 and line 2. Enter here and also on Form 40, page 1, line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 •

1555
REV 02/18/23 INTUIT.CG.CFP.SP
 SCHEDULE

W-2
(FORM 40, 40A, or 40NR)
2022
Alabama Department of Revenue
Wages, Salaries, Tips, etc.
Schedule W-2 must be completed fully and included with your return in order to receive proper credit for your Alabama
income tax withheld. Attach a copy of all withholding statements to your return.
NAME(S) AS SHOWN ON TAX RETURN PRIMARYʼS SOCIAL SECURITY NO. SPOUSEʼS SOCIAL SECURITY NO.
YULIANA MADRID 152-06-5029

A B C D E F G H I J
Employer’s Schedule Alabama
Employee’s Social Identification Number Statutory C/C-EZ State Employer’s Alabama State Federal Wages Alabama State Wages Additional Taxable Wages –
Security Number (EIN) Employee Filed? Code State ID Number Income Tax Withheld (Box 1 of Form W-2) (Box 16 of Form W-2) Other States
1 •
152-06-5029 • 474334715 • 6 • 6 • OS • • • 112 • • 0
2 • 152-06-5029 • 832137876 • 6 • 6 • OS • • • 2,744 • • 0
3 •
152-06-5029 • 631256288 • 6 • 6 • AL • 0000383942 • 669 • 15,953 • 15,953 •

4 • • • 6 • 6 • • • • • •

5 • • • 6 • 6 • • • • • •

6 • • • 6 • 6 • • • • • •

7 • • • 6 • 6 • • • • • •

8 • • • 6 • 6 • • • • • •

9 • • • 6 • 6 • • • • • •

10 • • • 6 • 6 • • • • • •

11 • • • 6 • 6 • • • • • •

12 • • • 6 • 6 • • • • • •

13 • • • 6 • 6 • • • • • •

14 • • • 6 • 6 • • • • • •

15 • • • 6 • 6 • • • • • •

16 TOTAL ALABAMA TAX WITHHELD FROM W-2s. Total lines 1-15, Column G and enter the amount here . . • 669
17 ALABAMA TAX WITHHELD FROM 1099s AND W-2Gs. Enter the total Alabama Income Tax Withheld
from all Form 1099s and Form W-2Gs received. See instructions on where to report the income from
these statements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 0
18 TOTAL WAGES AND TOTAL ALABAMA TAX WITHHELD FROM W-2s, 1099s, AND W-2Gs.
See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 669 • 18,809 • 15,953 • 0

THIS SCHEDULE CAN ONLY BE SUBMITTED AND/OR PRINTED VIA LANDSCAPE

REV 02/18/23 INTUIT.CG.CFP.SP

1555
 ALABAMA DEPARTMENT OF REVENUE
2022
FORM

AL8453 Individual Income Tax Declaration for Electronic Filing

For the year January 1 – December 31, 2022

Your first name and initial Last name

.
Your social security number
.
YULIANA MADRID 1 5 2 .. 0 6 ..5 0 2 9
If a joint return, spouse’s first name and initial Last name Spouse's soc. sec. no. if joint return
.. ..
. .
Home address (number and street). If a P.O. Box, see instructions. Apt. no. Telephone number (optional)

37 LUCILLE PL 7 (862)281-9680
City, town or post office, state, and ZIP code

PASSAIC NJ 07055-4245
Part I 1 Alabama taxable income (Form 40, line 16 or Form 40NR, line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 10,954
Tax Return 2 Total tax liability (Form 40, line 21) or Net tax due (Form 40NR, line 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 508
Information 3 Total payments (Form 40, line 27 or Form 40NR, line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
(Whole dollars only.)
669
4 Refund (Form 40, line 35 or Form 40NR, line 33) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 161
5 Amount you owe (Form 40, line 30 or Form 40NR, line 29) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part II
Refund
1 Routing number: 666666666
0 3 1 2 0 7 6 0 7

and 2 Account number: 66666666666666666

8 1 3 2 8 0 2 0 3 6
Payment
3 Type of account: 6 Checking 6 Savings
Information
4 Type of transaction: 6 Direct Deposit 6 Direct Debit

5 6 Paper Check (Check this box to have your refund issued by a paper check.)
Part III Under penalties of perjury, I declare that I have compared the information contained on my return with the information I have provided to my electronic return originator and
that the amounts described in Part 1 above agree with the amounts shown on the corresponding lines of my 2022 Alabama individual income tax return. To the best of my
Declaration knowledge and belief, this return, including any accompanying schedules and statements, is true, correct, and complete. Also, I hereby authorize the Alabama Department
of Revenue to disclose to my ERO described below, any information concerning the disbursement of the refund requested or any problems encountered in the processing
of Taxpayer of my return.
(Sign only after Part I
is completed.) 6 I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.

Sign
t

Here
Your signature Date Spouse’s signature. If a joint return, BOTH must sign. Date

Part IV I declare that I have reviewed the above taxpayer’s Alabama individual income tax return and that the entries on this form are complete and correctly represented based on
all information of which I have any knowledge. I also declare that I have followed all other requirements described in IRS PUB. 1345, Revenue Procedures for Electronic
Declaration Filing of Individual Income Tax Returns (Tax Year 2022), and the Alabama Handbook for Electronic Filers of Individual Income Tax Returns (Tax Year 2022). By using a
of computer system and software to prepare and transmit my client’s return electronically, I consent to the disclosure of all information pertaining to my use of the system and
software to create my client’s return and to the electronic transmission of my client’s tax return to the Alabama Department of Revenue, as applicable by law. If I am also
Electronic the paid preparer, under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my
Return knowledge and belief, they are true, correct, and complete.
Originator ERO’s Use Only
(ERO) and Date
Check if also
Preparer’s PTIN
6
t

ERO’s
Paid signature paid preparer
Preparer Firm’s name (or yours E.I. No.
t

(See instructions.) if self-employed)

and address ZIP Code

Paid Preparer’s Use Only

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.
Date Preparer’s PTIN
Check if
6
t

Preparer’s
signature self-employed
SELF-PREPARED
Firm’s name (or yours E.I. No.
t

if self-employed)
and address ZIP Code
Form AL8453 2022

DO NOT MAIL TO ALABAMA DEPT. OF REVENUE 1555

REV 02/18/23 INTUIT.CG.CFP.SP

 Income Worksheet 2022

Name as Shown on Return Social Security Number

YULIANA MADRID 152-06-5029

Wages, Salaries, Tips, Etc for Line 5 of Form 40/40NR

Special Type Indicator (X = Income will not be included in your return)
Check this box to exclude income from your Alabama return.

Check this box if you are excluding income and plan to attempt to electronically file your return.
NOTE: Part-year residents may use this worksheet to remove non Alabama source income. Resident and
Non-Resident returns may be rejected during electronic filing if you exclude income by marking boxes in
the # column.

Payer’s name State Gross Alabama Alabama tax

# name earnings wages withheld

Radical Staffing NJ 112. 0.

The Phoenix Empire LLC. NJ 2,744. 0.
CHEROKEE GIN & COTTON COM AL 15,953. 15,953. 669.

Total 18,809. 15,953. 669.

Other Income for Form 40/40NR

# Special Type Indicator (X = Income will not be included in your return)
Check this box to exclude income from your Alabama return.

Description Total Alabama

# amount amount

Total
 1040 U.S. Individual Income Tax Return 2022
Form Department of the Treasury—Internal Revenue Service

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 surviving
Check only spouse (QSS)
one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s name if the qualifying
person is a child but not your dependent:
Your first name and middle initial Last name Your social security number
Yuliana Madrid 152-06-5029
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
37 Lucille Pl 7 Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Passaic NJ 070554245 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Digital At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes No
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, 1958 Are blind Spouse: Was born before January 2, 1958 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here . .

Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 18,809.
b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s) c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
W-2 here. Also
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
1099-R if tax
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h 0.
W-2, see
instructions.
i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 18,809.
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
Standard 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Deduction for—
6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
• Single or
Married filing c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
separately,
$12,950 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7
• Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8
jointly or
Qualifying 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 18,809.
surviving spouse,
$25,900
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
• Head of 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 18,809.
household,
$19,400 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12,950.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12,950.
Deduction, 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . .
see instructions.
15 5,859.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2022)
Form 1040 (2022) Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 588.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 588.
19 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- . . . . . . . . . . . . . . 22 588.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 0.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 588.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 1,576.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 1,576.
26 2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . 26
If you have a
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 1,576.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 988.
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 988.
Direct deposit? b Routing number 0 3 1 2 0 7 6 0 7 c Type: Checking Savings
See instructions.
d Account number 8 1 3 2 8 0 2 0 3 6
36 Amount of line 34 you want applied to your 2023 estimated tax . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . 37
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
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
Sign 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
Joint return? Employee (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. (862)281-9680 Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name Self-Prepared Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 03/22/23 Intuit.cg.cfp.sp Form 1040 (2022)
 2022 NJ-1040
New Jersey Resident Income Tax Return

For Privacy Act Notification, See Instructions

NJ-1040 1555
2022
Page 1
040MP01220
Your Social Security Number (required) Last Name, First Name, Initial (Joint Filers enter first name and middle initial of each. Enter spouse’s/CU partner’s last name ONLY if different.)

152065029 MADRID YULIANA

Spouse’s/CU Partner’s SSN (if filing jointly)

Home Address (Number and Street, including apartment number)

County/Municipality Code (See Table page 50) 37 LUCILLE PL APT 7
1808
City, Town, Post Office State ZIP Code
PASSAIC NJ 070554245
Driver’s License Number (Voluntary) (See instructions)
M01137900051002

Federal extension filed.

The address above is a foreign address.
Your address has changed.
Death certificate is enclosed.
Do not want a paper form next year.
I authorize the Division of Taxation to discuss my return and enclosures with my preparer.
NJ-1040-O is enclosed.

Gubernatorial Elections Fund Note: This does not reduce your refund or increase your balance due.
Do you want to designate $1 to the Gubernatorial Elections Fund? You Yes No
If joint return, does your spouse want to designate $1? Spouse/CU Partner Yes No

Direct Deposit Information

dd1. Direct deposit indicator (1 for direct deposit, 4 for no direct deposit) dd1. 1
dd2. Account type (C for checking, S for savings) dd2. C
dd3. Fill in the checkbox if the direct deposit is going to an account outside the United States dd3.
dd4. Routing number dd4. 031207607
dd5. Account number dd5. 8132802036

REV 03/18/23 Intuit.cg.cfp.sp

 Name(s) as shown on Form NJ-1040
MADRID YULIANA
Your Social Security Number
NJ-1040 152065029 1555
2022
Page 2
040MP02220
Part-year residents, provide months/days you were a New Jersey resident during 2022: Fiscal year filers only:
From: 010122 To: 091722 Enter month of your year end 2 02 3

Filing Status
Fill in only one.

1. Single
2. Married/CU Couple, filing joint return
3. Married/CU Partner, filing separate return
4. Head of Household Enter spouse’s/CU partner’s SSN
5. Qualifying Widow(er)/Surviving CU Partner
Indicate the year of your spouse’s/CU partner’s death: 2020 2021

Exemptions
Fill in the ovals that apply. You must enter a total in the boxes to the right and complete the calculation.

6. Regular Self Spouse/CU Partner Domestic Partner 1 1000

x $1,000 = _________
7. Senior 65+ (Born in 1957 or earlier) Self Spouse/CU Partner x $1,000 = _________
8. Blind/Disabled Self Spouse/CU Partner x $1,000 = _________
9. Veteran Self Spouse/CU Partner x $6,000 = _________
10. Qualified Dependent Children x $1,500 = _________
11. Other Dependents x $1,500 = _________
12. Dependents Attending Colleges (See instructions) x $1,000 = _________
13. Total Exemption Amount (Add totals from the lines at 6 through 12) 13. 1000 .

14. Dependent Information. Provide the following information for each dependent.
Last Name, First Name, Middle Initial Social Security Number Birth Year No Health Insurance
a. _________________________________________________________________
b. _________________________________________________________________
c. _________________________________________________________________
d. _________________________________________________________________

REV 03/18/23 Intuit.cg.cfp.sp

 Name(s) as shown on Form NJ-1040
MADRID YULIANA
Your Social Security Number
NJ-1040 152065029 1555
2022
Page 3
040MP03220

15. Wages, salaries, tips, and other employee compensation (State wages from Box 16 of enclosed W-2(s)) (See instructions) 15. 2856 .
16a. Taxable interest income (Enclose federal Schedule B if over $1,500) (See instructions) 16a. .
16b. Tax-exempt interest income (Enclose Schedule) (See instructions) Do not include on line 16a 16b. .
17. Dividends 17. .
18. Net profits from business (Schedule NJ-BUS-1, Part I, line 4) (Enclose federal Schedule C) 18. .
19. Net gains or income from disposition of property (Schedule NJ-DOP, line 4) 19. .
20a. Taxable pensions, annuities, and IRA distributions/withdrawals (See instructions) 20a. .
20b. Excludable pension, annuity, and IRA distributions/withdrawals 20b. .
21. Distributive Share of Partnership Income (Schedule NJ-BUS-1, Part II, line 4) (Enclose Schedule NJK-1 or federal Schedule K-1) 21. .
22. Net pro rata share of S Corporation Income (Schedule NJ-BUS-1, Part III, line 4) (Enclose Schedule NJ-K-1 or federal Schedule K-1) 22. .
23. Net gains or income from rents, royalties, patents, and copyrights (Schedule NJ-BUS-1, Part IV, line 4) 23. .
24. Net gambling winnings (See instructions) 24. .
25. Alimony and separate maintenance payments received 25. .
26. Other (Enclose documents) (See instructions) 26. .
27. Total Income (Add lines 15, 16a, 17 through 20a, and 21 through 26) 27. 2856 .
28a. Pension/Retirement Exclusion (See instructions) 28a. .
28b. Other Retirement Income Exclusion (See Worksheet D and instructions pages 19-20) 28b. .
28c. Total Exclusion Amount (Add lines 28a and 28b) 28c. .
29. New Jersey Gross Income (Subtract line 28c from line 27) (See instructions) 29. 2856 .
30. Exemption Amount (Enter amount from line 13. Part-year residents see instr.) 30. 750 .
31. Medical Expenses (See Worksheet F and instructions) 31. .
32. Alimony and separate maintenance payments (See instructions) 32. .
33. Qualified Conservation Contribution 33. .
34. Health Enterprise Zone Deduction 34. .
35. Alternative Business Calculation Adjustment (Schedule NJ-BUS-2, line 11) 35. 0 .
36. Organ/Bone Marrow Donation Deduction (See instructions) 36. .
37a. NJBEST Deduction 37a. .
37b. NJCLASS Deduction 37b. .
37c. NJ Higher Ed. Tuition Deduction 37c. .
38. Total Exemptions and Deductions (Add lines 30 through 37c) 38. 750 .
39. Taxable Income (Subtract line 38 from line 29) 39. 2106 .
40a. Total Property Taxes (18% of Rent) Paid (See instructions page 25) 40a. .
40b. Indicate your residency status during 2022 (fill in only one) Homeowner Tenant Both
41. Property Tax Deduction (From Worksheet H) (See instructions) 41. .
42. New Jersey Taxable Income (Subtract line 41 from line 39) 42. 2106 .
43. Tax on amount on line 42 (Tax Table page 52) 43. 30 .
44. Credit For Income Taxes Paid to Other Jurisdictions (Enclose Schedule NJ-COJ) (See instructions) 44. .
Enter Code
45. Balance of Tax (Subtract line 44 from line 43) 45. 30 .
46. Sheltered Workshop Tax Credit 46. .
47. Gold Star Family Counseling Credit (See instructions) 47. .
48. Credit for Employer of Organ/Bone Marrow Donor (See instructions) 48. .
49. Total Credits (Add lines 46 through 48) 49. .
50. Balance of Tax After Credits (Subtract line 49 from line 45) If zero or less, make no entry 50. 30 .
51. Use Tax Due on Internet, Mail-Order, or Other Out-of-State Purchases (See instructions) If no Use Tax, enter 0 51. 0 .
52. Interest on Underpayment of Estimated Tax 52. .
Fill in if Form NJ-2210 is enclosed
53. Shared Responsibility Payment (See instructions) REQUIRED Enclose Schedule HCC and fill in 53. 0 .

REV 03/18/23 Intuit.cg.cfp.sp

 Name(s) as shown on Form NJ-1040
MADRID YULIANA
Your Social Security Number
NJ-1040 152065029 1555
2022
Page 4
040MP04220

54. Total Tax Due (Add lines 50 through 53) 54. 30 .

55. Total NJ Income Tax Withheld (Enclose Forms W-2 and 1099) (Part year, see instructions) 55. 48 .
56. Property Tax Credit (See instructions page 24) 56. .
57. New Jersey Estimated Tax Payments/Credit from 2021 tax return 57. .
58. New Jersey Earned Income Tax Credit (See instructions) 58. .
Fill in if you had the IRS calculate your federal earned income credit
Fill in if you are a CU couple claiming the NJ Earned Income Tax Credit
59. Excess New Jersey UI/WF/SWF Withheld (Enclose Form NJ-2450) (See instructions) 59. .
60. Excess New Jersey Disability Insurance Withheld (Enclose Form NJ-2450) (See instructions) 60. .
61. Excess New Jersey Family Leave Insurance Withheld (Enclose Form NJ-2450) (See instructions) 61. .
62. Wounded Warrior Caregivers Credit (See instructions) 62. .
63. Pass-Through Business Alternative Income Tax Credit (See instructions) 63. .
64. Child and Dependent Care Credit (See instructions) 64. .
Fill in if you are a CU couple claiming the Child and Dependent Care Credit
65. New Jersey Child Tax Credit (See instructions) 65. .
Number of dependents under age 6 on 12/31/2022
66. Total Withholdings, Credits, and Payments (Add lines 55 through 65) 66. 48 .
67. If line 66 is less than line 54, you have tax due. Subtract line 66 from line 54 and enter the amount you owe 67. .
If you owe tax, you can still make a donation on lines 70 through 77.
68. If the total on line 66 is more than line 54, you have an overpayment. Subtract line 54 from line 66 and enter the overpayment 68. 18 .
69. Amount from line 68 you want to credit to your 2023 tax 69. .
70. Contribution to N.J. Endangered Wildlife Fund 70. .
71. Contribution to N.J. Children’s Trust Fund to Prevent Child Abuse 71. .
72. Contribution to N.J. Vietnam Veterans’ Memorial Fund 72. .
73. Contribution to N.J. Breast Cancer Research Fund 73. .
74. Contribution to U.S.S. New Jersey Educational Museum Fund 74. .
75. Other Designated Contribution (See instructions) Enter Code 75. .
76. Other Designated Contribution (See instructions) Enter Code 76. .
77. Other Designated Contribution (See instructions) Enter Code 77. .
78. Total Adjustments to Tax Due/Overpayment amount (Add lines 69 through 77) 78. .
79. Balance due (If line 67 is more than zero, add line 67 and line 78) 79. .
80. Refund amount (If line 68 is more than zero, subtract line 78 from line 68) 80. 18 .

Under penalties of perjury, I declare that I have examined this Income Tax return, including accompanying schedules and statements, and to Tax Due Address
the best of my knowledge and belief, it is true, correct, and complete. If prepared by a person other than the taxpayer, this declaration is Enclose payment along with the NJ-1040-V payment
voucher and tax return. Use the labels provided with the
based on all information of which the preparer has any knowledge.
envelope and mail to:
State of New Jersey
Division of Taxation
Revenue Processing Center - Payments
Your Signature Date Spouse’s/CU Partner’s Signature (required if filing jointly) Date PO Box 111
Trenton, NJ 08645-0111
Include Social Security number and make check or
Paid Preparer's Signature Federal Identification Number money order payable to:
State of New Jersey – TGI
You can also make a payment on our website:
nj.gov/taxation
Refund or No Tax Due Address
Use the labels provided with the envelope and mail to:
Firm's Name Firm’s Federal Employer Identification Number
New Jersey Division of Taxation
Revenue Processing Center - Refunds
PO Box 555
SELF PREPARED Trenton, NJ 08647-0555

Division Use: 1 _______________ 2 _______________ 3 _______________ 4 _______________ 5 _______________ 6 _______________ 7 _______________

REV 03/18/23 Intuit.cg.cfp.sp