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Prepared For:

GINTARE RADAUSKAITE

04/12/2017

Today's Savings

* In simple terms, the Marginal Tax Rate is the tax rate that you pay on your last dollar of taxable
income. It is the highest federal tax bracket that affects your tax calculation. The Effective Tax
Rate is the percentage of your total income that you paid in taxes. For 2016, your Marginal Tax
Rate is 0% and your Effective Tax Rate is 0%.

Total Savings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0.00

Filing, Refund and Balance Due Information

Refund /
Tax Return efile (Balance Due) Summary Message
Federal Yes $663.00 Refund $663.00 See the Filing Checklist for instructions.

Massachusetts No $369.00 Refund $369.00 See the Filing Checklist for mailing instructions.

Th is H &R B lock Ad vant age d ocument provid es inf ormat ion t h at could h elp y ou improve y our t ax and f inancial sit uat ion. It s cont ent s sh ould b e consid ered in conj unct ion w it h
inf ormat ion you receive f rom ot h er sources t h at are f amiliar w it h your specif ic circumst ances. Tax services of f ered t h rough sub sid iaries of H RB Tax Group, Inc.

Advantage (2016) FDADVICE-1WV 1.0


Form Sof t w are Copyrigh t 1996 - 2017 H RB Tax Group, Inc.
2016 Tax Return Summary

Federal Year over Year Comparison


INCOME Year 2016 Year 2015 Change($)
Wages, salaries, tips $7,241 $0 $7,241
Total income $7,241 $0 $7,241

ADJUSTED GROSS INCOME


Total income less total adjustments $7,241 $0 $7,241

PAYMENTS
Federal withholding $663 $0 $663
Total payments $663 $0 $663

REFUND
Overpayment $663 $0 $663
Refund due $663 $0 $663

OTHER COMPUTATIONS
Alternative minimum taxable income $7,241 $0 $7,241
Filing status Single

Client Sum (2016) FDBASUM-1WV 1.0


Form Sof t w are Copyrigh t 1996 - 2017 H RB Tax Group, Inc.
GINTARE RADAUSKAITE

Tax Return Signature/Consent to Disclosure


On-Line Self Select PIN without Direct Debit

Perjury Statement
Under penalties for perjury, I declare that I have examined this return, including any accompanying statements and schedules and, to the best of my
knowledge and belief, it is true, correct, and complete.

Consent to Disclosure
I consent to allow my Intermediate Service Provider, transmitter, or Electronic Return Originator (ERO) to send my return to IRS and to receive the following
information from IRS: a) an acknowledgement of receipt or reason for rejection of transmission; b) an indication of any refund offset; c) the reason
for any delay in processing or refund; and, d) the date of any refund.

I am signing this Tax Return and Electronic Funds Withdrawal Consent, if applicable, by entering my Self
Select PIN below.

Taxpayer's PIN: 12345 Date: 04/12/2017


Taxpayer's Date of Birth: 08/11/1992
Taxpayer's Prior Year Adjusted Gross Income: 0.
Taxpayer's Prior year PIN
Taxpayer's Electronic Filing PIN
Spouse's PIN:
Spouse's Date of Birth:
Spouse's Prior Year Adjusted Gross Income:
Spouse's Prior year PIN
Spouse's Electronic Filing PIN

8453OL(D) (2016) FD8453OD-1WV 1.0


Form Sof t w are Copyrigh t 1996 - 2017 H RB Tax Group, Inc.
2016 Federal Tax Return Filing Instructions
FOR THE YEAR ENDING
December 31, 2016

GINTARE RADAUSKAITE
Prepared for

Gross Income $ 7,241


Tax Adjusted Gross Income $ 7,241
Summary Total Deductions $ 10,350
Total Taxable Income $ 0
Total Tax $ 0
Total Payments $ 663
Refund Amount $ 663
Amount You Owe $ 0

Make check United States Treasury


payable to

Since you are filing your return electronically and you chose
Mailing to use an electronic signature, you do not mail your return.
Address

Instructions
STEP 1 - Once your e-filed return has been accepted, you will receive
an e-mail
STEP 2 - Keep a copy
Print a copy of the return for your records.
Please attach a copy of each W-2, W-2G, 1099G and 1099R to your return.

Checklist (2016) FDCHECKE-1WV 1.0


Form Sof t w are Copyrigh t 1996 - 2017 H RB Tax Group, Inc.
D epart ment of t h e Treasury - Int ernal Revenue Service
Form Income Tax Return for Single and
1040EZ Joint Filers With No Dependents (99) 2016 OMB No. 1545-0074
Your social security number
018-73-0284
GINTARE RADAUSKAITE Spouse's social security number
JURGINU ST APT 22
MIKLUSENAI M ak e sure t h e SSN(s)
ab ove are correct .

Presidential Election Campaign


Ch eck h ere if y ou, or y our spouse if f iling
j oint ly , w ant $3 t o go t o t h is f und . Ch eck ing
Foreign count ry name Foreign province/ st at e/ Foreign post al cod e a b ox b elow w ill not ch ange y our t ax or
county refund.
LITHUANIA ALYTUS REG 62471 You Spouse
1 Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W- 2.
Income
Attach your Form(s) W-2. 1 7,241.
Attach
Form(s) W-2
here. 2 Taxable interest. If the total is over $1,500, you cannot use Form 1040EZ. 2
Enclose, but
do not attach, 3 Unemployment compensation and Alaska Permanent Fund dividends (see instructions). 3
any payment.

4 Add lines 1, 2, and 3. This is your adjusted gross income. 4 7,241.


5 If someone can claim you (or your spouse if a joint return) as a dependent, check the
applicable box(es) below and enter the amount from the worksheet on page 2.
You Spouse
If no one can claim you (or your spouse if a joint return), enter $10,350 if single;
$20,700 if married filing jointly. See page 2 for explanation. 5 10,350.
6 Subtract line 5 from line 4. If line 5 is larger than line 4, enter - 0- .
This is your taxable income. 6 0.
Payments,
Credits, 7 Federal income tax withheld from Form(s) W-2 and 1099. 7 663.
and Tax
8a Earned income credit (EIC) (see instructions) NO 8a
b Nontaxable combat pay election. 8b

9 Add lines 7 and 8a. These are your total payments and credits. 9 663.
10 Tax. Use the amount on line 6 above to find your tax in the tax table in the
instructions. Then, enter the tax from the table on this line. 10
11 Health care: individual responsibility (see instructions) Full-year coverage X 11
12 Add lines 10 and 11. This is your total tax. 12
Refund 13a If line 9 is larger than line 12, subtract line 12 from line 9. This is your refund.
H ave it d irect ly
d eposit ed ! See If Form 8888 is attached, check here 13a 663.
inst ruct ions and
f ill in 13b , 13c, b Routing number c Type: Checking Savings
and 13d, or
Form 8888. d Account number
Amount 14 If line 12 is larger than line 9, subtract line 9 from line 12. This is
You Owe the amount you owe. For details on how to pay, see instructions. 14
Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. X No
Third Party
Designee's name Phone no. Personal ID number
Designee
(PIN)
Sign Under penalties of perjury, I declare that I have examined this return and, to the best of my knowledge and belief, it is true, correct, and
accurately lists all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is
Here based on all information of which the preparer has any knowledge.
Joint return?
See Your signature Date Your occupation Daytime phone number
instructions.
SINGER
Keep a copy for If t h e IRS sent y ou an ID Prot ec-
your records. Spouse's signature. If a joint return, both must sign. Date Spouse's occupation t ion PIN, ent er it h ere (see inst .)

Print/Type preparer's name Preparer's signature Date Check if PTIN


Paid self-employed
Preparer
Firm's name Firm's EIN
Use Only
Firm's address Phone no.
KBA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040EZ (2016)

1040EZ (2016) FD1040EZ-1WV 1.2


Form Sof t w are Copyrigh t 1996 - 2017 H RB Tax Group, Inc.
2016 STATE TAX RETURN FILING INSTRUCTIONS
MASSACHUSETTS
FOR THE YEAR ENDING
December 31, 2016

Prepared for GINTARE RADAUSKAITE

Tax Gross Income $ 7,241


Summary Adjusted Gross Income $ 7,241
Total Deductions $ 132
Total Taxable Income $ 5,771
Total Tax $ 0
Total Payments $ 369
Refund Amount $ 369
Amount You Owe $ 0

Make check Not Applicable


payable to

Mailing Massachusetts Department of Revenue


Address P.O. Box 7001
Boston, MA 02204-7001

Special SIGN AND DATE YOUR RETURN


Instructions Please sign and date Form 1-NR/PY.
ASSEMBLE WHAT YOU NEED TO MAIL
Attach any schedules and forms behind Form 1-NR/PY. If there
are supporting statements, arrange them in the same order as
the schedules and forms they support and attach them last.
Attach a copy of each W-2, W-2G, 1099R and 1099G for which MA
tax has been withheld.
MAIL FORM 1-NR/PY & OTHER DOCUMENTS TO:
Mailing Address listed above.
To retain the proof of mailing, we recommend using certified
mail to send your form(s). When mailing to an address without
a P.O. box, you may also use:
Airborne Express, DHL Worldwide Express, FedEx, or UPS.
KEEP A COPY
Click on Main Menu and then E-File or Print to print your
return. Attach your copy of each W-2, W-2G, 1099R or 1099G
with withholding. Keep with your records for three years.

Check List (2016) STCHECK-1WV 1.0


Form Sof t w are Copyrigh t 1996 - 2017 H RB Tax Group, Inc.
2016 Form 1-NR/PY
MA16006011029
Massachusetts Nonresident/Part-Year Resident
Income Tax Return
For t h e year J anuary 1- D ecemb er 31, 2016 or ot h er t axab le

Year beginning Ending

GINTARE RADAUSKAITE 018-73-0284


JURGINU ST APT 22 MIKLUSENAI
ALYTUS REGION LITHUANIA
Fill in if: X Original return Amended return Amended return due to federal change Apt. no.
State Election Campaign Fund: $1 You $1 Spouse TOTAL
Fill in if vet of U.S. armed forces who served in Operation Enduring Freedom, Iraqi Freedom or Noble Eagle You Spouse
Taxpayer deceased You Spouse
Fill in if under age 18 You Spouse
Check one: Nonresident Filing as both nonresident and part-year resident Name/address changed since 2015
X Part-year resident Nonresident composite Fill in if noncustodial parent
a. Total federal income 7241
b. Federal adjusted gross income 7241
1. Filing status (select one only): X Single Fill in if filing Schedule TDS
Married filing jointly
Married filing separate return
Head of household You are a custodial parent who has released claim to exemption for child(ren)
2. Part- year residents. Enter dates as Massachusetts resident: From 05252016 To 09122016
3. Total days as Massachusetts resident _.. 365 =
111 3041 3
.
4. Exemptions:
a. Personal exemptions 4a 4400
b. Number of dependents. (D o not includ e yourself or your spouse.) Ent er numb er x $1,000 = 4b
c. Age 65 or over before 2017 You + Spouse = x $700 = 4c
d. Blindness You + Spouse = x $2,200 = 4d
e. 1. Med/dental 2. Adoption 1 + 2 = 4e
f. Total exemptions. Add items 4a through 4e. Enter here and on line 22a 4f 4400
5. Wages, salaries, tips 5 7241
SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge & belief this return & enclosures are true, correct & complete.
Your signature Date Spouse's signature Date

May the Dept of Revenue discuss this return with the preparer shown here? Yes
I do not want preparer to file my return electronically (this may delay your refund)
Print paid preparer's name Date Check if self-employed Paid preparer's SSN

Paid preparer's signature Paid preparer's phone Paid preparer's EIN

PRIVACY ACT NOTICE AVAILABLE UPON REQUEST

04/12/2017 8:27
2016 Form 1-NR/PY, pg. 2
MA16006021029
Massachusetts Nonresident/
Part-Year Resident Income Tax Return
018-73-0284

6. Taxable pensions and annuities 6


7. Mass. bank interest: a. - b. exemption = 7
8. Business/profession or farm income or loss 8
9. Rental, royalty and REMIC, partnership, S corp., trust income/loss 9
10a. Unemployment 10a
10b. Mass. lottery winnings 10b
11. Other income 11
12. TOTAL 5.1% INCOME 12 7241
13. NONRESIDENT APPORTIONMENT WORKSHEET. You cannot apportion Mass. wages as shown on Form W- 2. Do not use this wksht if you know
the exact amt of your Mass. source income. Only use when income from employment/business is earned both inside and outside Mass. and the exact
Mass. amt is not known.Basis: working days miles sales other:
Working days (or other basis) outside Massachusetts 13a
Working days (or other basis) inside Massachusetts 13b
Total working days 13c
Nonworking days (holidays, weekends, etc.) 13d
Massachusetts ratio 13e
Total income being apportioned. You cannot apportion Massachusetts wages as shown on Form W- 2 13f
Massachusetts income 13g
14. NONRESIDENT DEDUCTION AND EXEMPTION RATIO
a. Total 5.1% income 14a
b. Interest income 14b
c. Total capital gain income 14c
d. Total income this return 14d
e. Non- Massachusetts source income. Not less than "0" 14e
f. Total income 14f
g. Deduction and exemption ratio 14g
15a. Amount paid to Soc. Sec., Medicare, R.R., U.S. or Mass. Retirement 15a 132
15b. Amount your spouse paid to Soc. Sec., Medicare, R.R., U.S. or Mass. Retirement 15b

BE SURE TO INCLUDE THIS PAGE WITH FORM 1- NR/PY, PAGE 1

04/12/2017 8:27
2016 Form 1-NR/PY, pg. 3
MA16006031029
Massachusetts Nonresident/
Part-Year Resident Income Tax Return

GINTARE RADAUSKAITE 018-73-0284

16. Child under age 13, or disabled dependent/spouse care expenses 16


17. Number of dependent member(s) of household under age 12, or dependents age 65 or over (not you or your spouse) as of
12/31/16, or disabled dependent(s)
Not more than two. a. x $3,600 = 17
18. Rental deduction. a. _.. 2 = 18
Nonresidents, during 2016, did you have a family home or any other dwelling outside Massachusetts to which you generally
or customarily returned or intend to return in the future? Yes No. If "Yes," you do not qualify for this deduction.
19. Other deductions from Schedule Y, line 18 19
20. Total deductions. Add lines 15 through 19 20 132
21. 5.1% INCOME AFTER DEDUCTIONS. Subtract line 20 from line 12. Not less than "0" 21 7109
22. Exemption amount. a. 4400 22 1338
23. 5.1% INCOME AFTER EXEMPTIONS. Subtract line 22 from line 21. Not less than "0" 23 5771
24. INTEREST AND DIVIDEND INCOME 24
25. TOTAL TAXABLE 5.1% INCOME. Add lines 23 and 24 25 5771
26. TAX ON 5.1% INCOME. Note: If choosing the optional 5.85% tax rate, fill in and multiply line 25 and the
amount in Schedule D, line 21 by .0585 26 295
27. 12% INCOME. Not less than "0." a. x .12 = 27
28. TAX ON LONG- TERM CAPITAL GAINS. Not less than "0." Fill in if filing Sch D- IS 28
Fill in if any excess exemptions were used in calculating lines 24, 27 or 28
29. Credit recapture amount (from Credit Recapture Schedule) 29
30. Additional tax on installment sale 30
31. If you qualify for No Tax Status, fill in and enter "0" on line 32 X
32. TOTAL INCOME TAX. Add lines 26 through 30 32 0
33. Limited Income Credit 33
34. Income tax paid to another state or jurisdiction 34
35. Other credits (from Credit Manager Schedule) 35
36. INCOME TAX AFTER CREDITS. Subtract the total of lines 33 through 35 from line 32. Not less than "0" 36 0
BE SURE TO INCLUDE THIS PAGE WITH FORM 1- NR/PY, PAGE 1

04/12/2017 8:27
2016 Form 1-NR/PY, pg. 4
MA16006041029
Massachusetts Nonresident/
Part-Year Resident Income Tax Return
018-73-0284

37. Voluntary Contributions


a. Endangered Wildlife Conservation 37a
b. Organ Transplant Fund 37b
c. Massachusetts AIDS Fund 37c
d. Massachusetts U.S. Olympic Fund 37d
e. Massachusetts Military Family Relief Fund 37e
f . Homeless Animal Prevention and Care 37f
Total. Add lines 37a through 37f 37
38. Use tax due on Internet, mail order and other out-of-state purchases 38 0
39. Health care penalty a. You + b.Spouse -c. Fed.health care penalty 39
40. INCOME TAX AFTER CREDITS PLUS CONTRIBUTIONS AND USE TAX. Add lines 36 through 39 40 0
41. Massachusetts income tax withheld 41 369
42. 2015 overpayment applied to your 2016 estimated tax 42
43. 2016 Massachusetts estimated tax payments 43
44. Payments made with extension 44
45. Earned Income Credit. a.Number of qualifying children Amount from U.S. return x .23 = 45
46. Senior Circuit Breaker Credit 46
47. Other Refundable Credits 47
48. TOTAL. Add lines 41 through 47 48 369
49. Overpayment. Subtract line 40 from line 48 49 369
50. Amount of overpayment you want applied to your 2017 estimated tax 50
51. Refund. Subtract line 50 from line 49. Mail to: Massachusetts DOR, PO Box 7001, Boston, MA 02204 51 369
Direct deposit of refund. Type of account checking
savings
RTN # account #

52. Tax due. Pay online at www.mass.gov/dor/payonline. Mail to: Mass. DOR, PO Box 7002, Boston, MA 02204 52
Interest Penalty M-2210 amt. EX enclose
Form M-2210

BE SURE TO INCLUDE THIS PAGE WITH FORM 1- NR/PY, PAGE 1

04/12/2017 8:27
2016 Schedule NTS-L-NR/PY
MA16021011029
No Tax Status and Limited Income Credit
018-73-0284

Schedule NTS-L-NR/PY. No Tax Status and Limited Income Credit

1. Total 5.1% income 1 7241


2. Adjustments to income 2
3. Adjusted 5.1% income. Subtract line 2 from line 1. Do not enter if less than "0" 3 7241
4. Interest exemption used 4
5. Adjusted gross interest, dividends and certain capital gains 5
6. Long-term capital gain 6
7. Additional income/loss while a nonresident/part-year resident 7
8. Total income. Combine lines 3 through 7 8 7241
9. Additional adjustments to income while a nonresident/part-year resident 9
10. Massachusetts Adjusted Gross Income (AGI) 10 7241
If you are single and the total in line 10 is $8,000 or less, you qualify for No Tax Status
11. If married and filing a joint return, multiply the number of dependents (from Form 1- NR/PY, line 4b) by $1,000 and
add $16,400 to that amount. If head of household, multiply the number of dependents (from Form 1- NR/PY, line 4b)
by $1,000 and add $14,400 to that amount 11
12. If you do not qualify for No Tax Status and you are married and filing a joint return, multiply the number of dependents (from Form 1- NR/PY, line 4b)
by $1,750 and add $28,700 to that amount. If head of household, multiply the number of dependents (from Form 1- NR/PY, line 4b) by $1,750
and add $25,200 to that amount 12
13. No Tax Status threshold 13
14. Income for Limited Income Credit 14
15. Tax before adjustments 15
16. Tax for Limited Income Credit 16
17. Limited Income Credit 17

04/12/2017 8:27
2016 Schedule HC
MA16029011029
Schedule HC, Health Care Information, must be completed by all
full-year residents and certain part-year residents (see instructions).
Note: Schedule HC must be enclosed with your Form 1 or Form
1- NR/PY. Failure to do so will delay the processing of your return.
GINTARE RADAUSKAITE 018-73-0284

1a. Date of birth 08111992 1b. Spouse's date of birth 1c. Family size 1
2. Federal adjusted gross income 2 7241
3. Indicate the time period that you were enrolled in a Minimum Creditable Coverage (MCC) health insurance plan(s). The Form MA 1099- HC from
your insurer will indicate whether your insurance met MCC req. Note: MassHealth, Medicare, and health coverage for U.S. Military, including
Veterans Administration and Tri- Care, meet the MCC requirements. If you did not receive a Form MA 1099- HC from your insurer, or you had
insurance that did not meet MCC requirements, see the special section on MCC requirements in the instructions.

See instructions if, during 2016, you turned 18, you 3a You: X Full-year MCC Part-year MCC No MCC/None
were a part-year resident or a taxpayer was deceased. 3b Spouse: Full-year MCC Part-year MCC No MCC/None
If you checked the full- year or part- year MCC box, go to line 4. If you checked No MCC/None, go to line 6.

4. Indicate the health insurance plan(s) that met the Minimum Creditable Coverage (MCC) requirements in which you were enrolled in 2016, as
shown on Form MA 1099- HC (check all that apply). If you did not receive this form, fill in line(s) 4f and/or 4g and see instructions. Fill in if you were
enrolled in private insurance and MassHealth or Commonwealth Care and enter your private insurance information in line(s) 4f and/or 4g and go
to line 5.
4a. Private insurance, including ConnectorCare (complete line(s) 4f and/or 4g below) You Spouse
4b. MassHealth. Fill in and go to line 5 You Spouse
4c. Medicare (including a replacement or supplemental plan). Fill in and go to line 5 You Spouse
4d. U.S. Military (including Veterans Administration and Tri- Care). Fill in and go to line 5 You Spouse
4e. Other government program (enter the program name(s) only in lines 4f and/or 4g below). Note: Health Safety X You Spouse
Net is not considered insurance or minimum creditable coverage.

4f. Your Health Insurance. Complete if you answered line(s) 4a or 4e and go to line 5. Fill in if you were not issued Form MA 1099- HC.
INTRAX

4g. Spouse's Health Ins. Complete if you answered line(s) 4a or 4e and go to line 5. Fill in if you were not issued Form MA 1099- HC.

5. If you had health insurance that met MCC requirements for the full- year, including private insurance, MassHealth, Commonwealth Care or
ConnectorCare, you are not subject to a penalty. Skip the remainder of this sch and continue completing your tax return. Otherwise, go to line 6.

If you had Medicare (including a replacement or supplemental plan), U.S. Military (including Veterans Administration and Tri- Care), or other
government insurance at any point during 2016, you are not subject to a penalty. Skip the remainder of this schedule and continue completing
your tax return. Otherwise, go to line 6.

04/12/2017 8:27

Schedule HC (2016) MAHC-1WV 1.0


Form Sof t w are Copyrigh t 1996 - 2017 H RB Tax Group, Inc.
2016 Schedule INC
MA16INC011029

GINTARE RADAUSKAITE 018-73-0284


Form W-2 and 1099 Information
A. FED ERAL ID B. STATE TAX C. STATE WAGES/ D. TAXPAYER SS E. SPOUSE SS F. SOURCE OF
NUM B ER WITH H EL D INCOME WITH H EL D WITH H EL D WITH H OL D ING
20-0917942 281 5516 W2
04-3420977 88 1725 132 W2

TOTALS
369 7241 132

04/12/2017 8:27