Form 481.0 - Short Form - Individual Income Tax Return

Form 481.0 - Short Form - Individual Income Tax Return - 2002 Page 3

Form 481.0, Rev. 05.02 - Page 3

Part 4

11.

(28)

12.

(29)

13.

(30)

14.

(31)

15.

(32)

(33)

(34)

16.

(35)

17.

(36)

18.

(37)

19.

(a)

(38)

(b)

(39)

(c)

(40)

(d)

(41)

20.

(42)

21.

(50)

Part 5

AUTORIZATION FOR THE DIRECT DEPOSIT OF THE REFUND

Route/transit number

Type of account

Account number

;

Checks

Savings

and

Account in the name of

(Complete name in print letter as it appears on your account. If married and filing jointly, include your spouse's name)

OATH

I hereby declare under the penalty of perjury that this return (including the statements, schedules and other documents attached) has been examined by

me and to the best of my knowledge and belief is a true, correct and complete return. I also declare that I have provided more than 50% of the support

for all dependents claimed. The declaration of the person that prepares this return (except the taxpayer) is with respect to the information received, and

this information has been verified.

Taxpayer's Signature

Spouse's Signature

;

NOTE TO TAXPAYER