Preview
FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
EXHIBIT B
FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
NAPOLI
SHKOLNIK PLLC
ATTORNEYS AT LAW
October 3,2022
Betancourt Van Hemmen Greco & Kenyon LLC
151 Bodman Place, Suite 200
Red Bank, NJ 07701
Re: Darryl Nowak v. Sea Wolf Marine Transportation LLC, et al..
Dear Counselors
In response to you demands enclosed please find duly executed authorizations for IRS
records for 2019,2020,2021 and for the following medical providers:
Adrian Padkowsky MD (previously provided to your office on December 18, 2019)
George Padkowsky, MD
Charlie Conzales, MD
Mark McMahon, MD
Momentum Medicine Plus LLC
Jersey City Diagnostic Center
Paul F. Furlaford, PH. D
Alexander Visco, MD
Nicole Angelo, DO
Shahnaz Akhtar, MD
Ashish Kapoor, MD
Karl Coutinho, MD
We also enclose the following documents:
Complete copy of plaintiff s recent passport
IRS Decision
NAPOLILAW.CO
'VI
360 LEXTNGTON AVENUE, 11TH FLOOR, NEWYORK, NEWYORK 10017 (212)397-1000
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
IRS correspondence
Tax returns for 2019-2021
All these discoveries were previously emailed to your office
Plaintiff fully complied with all outstanding discovery. Please withdraw your motion
returnable on October 11,2022.
Y
Cc:
Mahoney & Keane LLP
61 Broadway, Suite 905
New York, NY 10006
NAPO LILAW.CO lvl
360 LEXINGTONAVENUE, 1'ITH FLOOR, NEWYORK, NEWYORK 10017 (212)397.1OO0
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
Porvc-r of Attgllntry
To Execute HIPAA Medical Record Authorization Forms Pursuanl To the HEALTH
INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 PUBLIC LAW
104-191, August 21, 1996
t, T'- \ Nor,qtt
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(msert your name snd adflress)
do hereb.y appoint: Nnpoli I l'1 f loot'
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@ay.whichlntyse|lcoulddo,ifIworcper.sonall{9f::'I!:-1-::j: To the }IEALTI{ INSIIRANCII
Uff*A Medicrl RsclrdAuthorizatlon f;'orms,Pursuant
LA\il
PORTABILITY AND ACCOUNTABILITY ACT Otr. I'96 P{JIII,IC IO4.I9.1I AqgU.Tt
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
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a copyof "Kn v BeforeVoisGo" and."Pets,WildNfe- Licensing
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C. AGRICULTUREFora copyof ''Travele TipsOn Bringing-Food.Plant.
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FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
E Departmentof theTreasury-internalRevenueService
(99)
2 " U.S. Individual Income Tax Return OMB No. 1545-0074 IRSuse Only- Donotwriteor staplein thisspace
Filing Status O Single Married jointly
filing ¡ Marriedfiling
separately(MFS) ¡ Head of household(HOH) ¡ widow(er)
Qualifying (QW)
Check only If you
checked theMFS box. enter thename of your
spouse. If youchecked theHOH or QW box, enter the name if the qualifying
child's
one box.
person but
is a child not yourdependent º
Your first name and middle initial Last name number
Your social security
Darryl A Nowak
Last name
If joint return, spouse's first name and middle initial Spouse's social security number
Elaine M Nowak
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Election
Presidential Campaign
927 Check here if you, or your
Broadway
spouse want $3
if filing jointly,
State
City, town, or post office. If you have a foreign address, also complete spaces below. ZIP code
to go to this fund.
Checking a
Bayonne NJ 070023050 box below will not change
Foreign country name Foreign province/state/county Foreignpostalcodeyour tax or refund.
¡ You ¡ Spouse
I
At any timeduring2021, didyou receive,sell,
exchange, or otherwisedispose of any financial
interest
in any virtual
currency? ¡ Yes No
Standard Someone can claim: O You as a dependent O Your spouse as a dependent
Deduction O Spouse itemizeson a separatereturnor youwere a dual-statusalien
Age/Blindness You: O Were born beforeJanuary 2, 1957 ¡ Are blind Spouse: O Was bornbeforeJanuary 2, 1957 ¡ Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Vif qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Creditfor otherdependents
If more
than four
dependents,
sco instructions
and check
hereº ¡
1 Wages, tips,
salaries, etc.AttachForrr (s) W-2 . . . . . . . . . . . . . . . . 1
Attach 2a Tax-exempt interest. . . 2a 2b
b Taxable interest . . . . .
Sch. B if
3a Qualifieddividends . . . 3a 102 . b Ordinary dividends . . . . . 3b 102 .
required.
4a IRA distributions. . . . 4a b Taxable amount . . . . . . 4b
5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b 57 , 259 .
Standard 6a Socialsecuritybenefits . . 6a 33 , 426 . b Taxable amount . . . . . . 6b 10 , 085 .
Deductionfor-
" Single or
7 Capitalgain Attach
or (loss). Schedule D if required.
If not required,
check here . . . . º O 7
Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8 -25 , 26 8 .
5 o 9 Add lines1, 2b,3b,4b, 5b,6b, 7, and8. This total
is your income . . . . . . . . . º 9 42 , 178 .
" Married filing
10 Adjustments toincome fromSchedule 1, line 26 . . . . . . . . . . . . . . . 10
jointly or
oualifying 11 Subtractline 10 from
line 9. This
is your
adjusted gross income . . . . . . . . . º 11 42,178 .
O(er), 12a Standard deduction oritemized deductions (fromSchedule . . 12a 25 , 100 .
d5 A)
" Head of b Charitable if you take the standard
contributions deduction(see instructions) 12b 600 .
S300h0°
'
c Add lines12a and 12b . . . . . . . . . . . . . . . . . . . . . . . 12c 25 , 700 .
" If you checked
13 Qualifiedbusinessincome deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 0 .
any box under
Standard 14 Add 12c
lines and 13 . . . . . . . . . . . . . . . . . . . . . . . 14 25 ,700 .
15 Taxable income. Subtract line 11. If zero
line 14 from or less,enter-0- . . . . . . . . . 15 16,47 8 .
ee nst uctions.
For Disclosure, and Paperwork
Privacy Act, Reduction see separate
Act Notice, instructions. Form 1040 (2021)
FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022
Form 1040 (2021) Page2
16 Tax (see instructions).
Check if any from
Form(s):1 ¡ 8814 2 ¡ 4972 3 ¡ . . 16 1 , 638 .
17 Amount from Schedule 2, line 3 . . . . . . . . . - . . . . . . . . . . 17
18 Add lines16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 1,638 .
19 Nonrefundablechildtaxcreditor credit
forother dependents from Schedule 8812 . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from
line 18. If zero enter
or less, -0- . . . . . . . . . . . . . . 22 1 , 638 .
23 Other taxes,includingself-employmenttax,from Schedule 2, line 21 . . . . . . . . . 23 0 .
24 Add lines22 and 23. Thisis your
totaltax . . . . . . . . . . . . . . . . º 24 1 , 638 .
25 Federalincome taxwithheldfrom:
a Form(s)W-2 . . . . . . . . . . . . . . . . . . 25a
b Form(s)1099 . . . . . . . . . . . . . . . . . . 25b 2 432 .
c Other forms (see instructions)
. . . . . . . . . . . . . 25c
d Add lines
25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 2 , 432 .
) 26 2021 estimated taxpayments and amount appliedfrom 2020 retur . . . . . . . . . '6
if you havea
27a
qualifyingchild, Earned income credit(EIC) . . . . . . . . . . . . . . 27a
attach Sch. EIC.
Check here if you were born after January 1, 1998, and before --
January 2, 2004, and you satisfyallthe other requirements for
taxpayerswho are at least
age 18, to
claim the º
EIC. See instructions O
b Nontaxablecombat pay election . . . . 27b
c Prioryear(2019)earned income . . . . 27c J
28 Refundablechildtax credit
or additional
childtax credit
fromSchedule 8812 28
29 American opportunitycreditfrom Form 8863, line 8 .. . . . . . 29
30 Recovery rebate credit.
See instructions. . . . . . . . . . 30 2 , 800 .
31 Amount from Schedule 3,line15 . . . . . . . . . . . . 31
32 Add lines 27a
and 28 through31. These are yourtotalother payments and refundable credits º 32 2 , 800 .
33 Add lines 25d,26, and 32. These
are yourtotal payments . . . . . . . . . . . º 33 5 , 232 .
34 If line 33 is more
than line 24, subtract
line 24 from
line 33. This
is the
amount youoverpaid . . 34 3 , 5 94 .
Refund
35a Amount of line 34 you
want refunded to you.If Form8888 is attached,check here . . . º ¡ 35a 3 , 594 .
Direct deposit?º b Routingnumber | O 2 1 O 0 O 0 2 | 1 º c Type: Checking ¡ Savings
See instructions.
º d Account number 8 1 0 3 3 4 9 3 8
36 Amount of line 34 you
want applied to your2022 estimated tax . . º 36
Amount 37 Amount you owe. Subtract line 33 fromline 24. For details
on how topay, see instructions . º 37
YouOwe 38 Estimated taxpenalty (seeinstructions). . . . . . . . . º 38
ThirdParty Do you want to allow another person todiscuss this returnwith the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . º O Yes. Complete below. No
Designee's Phone Personal identification
name º no. º number (PIN) º
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 bas
Preview
FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 EXHIBIT B FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 NAPOLI SHKOLNIK PLLC ATTORNEYS AT LAW October 3,2022 Betancourt Van Hemmen Greco & Kenyon LLC 151 Bodman Place, Suite 200 Red Bank, NJ 07701 Re: Darryl Nowak v. Sea Wolf Marine Transportation LLC, et al.. Dear Counselors In response to you demands enclosed please find duly executed authorizations for IRS records for 2019,2020,2021 and for the following medical providers: Adrian Padkowsky MD (previously provided to your office on December 18, 2019) George Padkowsky, MD Charlie Conzales, MD Mark McMahon, MD Momentum Medicine Plus LLC Jersey City Diagnostic Center Paul F. Furlaford, PH. D Alexander Visco, MD Nicole Angelo, DO Shahnaz Akhtar, MD Ashish Kapoor, MD Karl Coutinho, MD We also enclose the following documents: Complete copy of plaintiff s recent passport IRS Decision NAPOLILAW.CO 'VI 360 LEXTNGTON AVENUE, 11TH FLOOR, NEWYORK, NEWYORK 10017 (212)397-1000 .1iJ(r'; .1, ?q"1D,Oi,.lS,)'.",',,,.' t i.)^tVai/. ",'': FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 IRS correspondence Tax returns for 2019-2021 All these discoveries were previously emailed to your office Plaintiff fully complied with all outstanding discovery. Please withdraw your motion returnable on October 11,2022. Y Cc: Mahoney & Keane LLP 61 Broadway, Suite 905 New York, NY 10006 NAPO LILAW.CO lvl 360 LEXINGTONAVENUE, 1'ITH FLOOR, NEWYORK, NEWYORK 10017 (212)397.1OO0 {rres1artpr i'ri^l.,.:r'- )ia3ror_,1r',nri:>(i',. FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 Porvc-r of Attgllntry To Execute HIPAA Medical Record Authorization Forms Pursuanl To the HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 PUBLIC LAW 104-191, August 21, 1996 t, T'- \ Nor,qtt of NJT O?opZ (msert your name snd adflress) do hereb.y appoint: Nnpoli I l'1 f loot' Shkolnik. Pt,,l,.C. rvith ollices nt ?60 t'rixiilSlon AY.entrc, Gi;v;r..iWio"@th)acl(encha3ontrnayitctseparate!Y)inmyname, @ay.whichlntyse|lcoulddo,ifIworcper.sonall{9f::'I!:-1-::j: To the }IEALTI{ INSIIRANCII Uff*A Medicrl RsclrdAuthorizatlon f;'orms,Pursuant LA\il PORTABILITY AND ACCOUNTABILITY ACT Otr. I'96 P{JIII,IC IO4.I9.1I AqgU.Tt attorney may be revokcStatos may QUESEINDIC ‚C ÃC,0Nt, d .TôOinïay.pme plackstarns or malp notatons6r.additions16thisp ssp Namo . / Nom/ Nambre. . -foriyour Whconóenicice or updatopersonalinforrnatiOh n thefadjOlning e . -- PERSONALDATAANDEMERGENCY CONTÄC Addren/ Adresse HNe566n .. FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 The principle soillEis of free governmems adhet·esto ihe American bedde.d inÉinú%ovable as idihddmains . Dmital We6wr IMPORTANT INFORMATION INFORMATIONConwitom Consular(ttformation5hoots,Travel 1. TRAVEL BE'MNDFULOFSECURITYTHREATSDoIot tenveluggage unattendedin andPublicAnnouncements Wamings, athttp.Kuavetstate.gov ttoracceptpacicagoshom public.areas, strangers, 2. HEAtTHANDVACC1NATIONSContactthe Centesfor DiseaseContro( 10. DISA5TERE ANDCATASTEOPHtCEVENTSifa catasirophic eventoccurs, info uno, at t8773347+ andProvention(CDC)via the lmemationalTravators arookey.'fyoufequ)re4ssistancej cal hometo)et faÿily andfrkedsknow.y'ou o 8747.rhap://wwmedc.gov contactthenearestU.S.embassy or consulate. 3. HEALTHINSURANCEMedicatefMedicaid .doesnot coverhealthcare 11. REdSTERWITHU".S.EN)AS$x Whenvisitinga forelgr¬ountryfor a costscutsidethe U.S. DoesyourTnsurance indudingmodkal applyoverseas. or residingoverseas, prolongedhay, travelingto remote67volatee.¼reas, paymentto a hospitalor doctoroverseaN evacuatson. or reimbursoment to telephone,fan or in person registerwith the U.S embusy $Âonsulat.eÆy, youtater? Seeour brochure"Medlcubinformation For AÆericans Traveling or registqronline through the pepitman fageat g s ation 4tyr7 AbtoodCor consuhhttp:HeraveLstate.gov https-#travedarg(stration state.go b .N 4tOUR P 55PORT youhavea signestyalidpassportand oreign Makenur.e 12. PARENTALGHILD DUÒRON o Ï6f 9 reventiereof, ontry;viangifrequired Maketwo photocep(es of yourSiapsp}i• den page Internationÿch d doct on, är he)pif y cljd.as contacEthe . - Department.ofSiü!ssGf CusypheppopwftDyouin äseparateplacefromyoprpasspoit. eãveoneat Bdren'sssus o c ttskit homeivith)¾mly Witha.gopyfo[youfpro qandyalodg cht nerii!.' . où(homepago tc.go . 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Do notwearconspicuous clptl pg pr couÑry'sjurisdiction.Indudinponscription O rmwicek (or,m("t)û@ all oülity jewelry,anddo notcurryexcessive owpondve of moneyor·unnecesasty emounts .S.consuiargicotectiori mayhampereffortsto provid tosdpahilikendql.lie creditcards-Consularin0matan Sheetsincludeasecurhy.and cr7nesedion fore count®of tl¾lrothmnatWality.Dual zenswhoesotïnterW¿oblwns condtionsin specificcoontriei.Consett"Asafe TripAWcad at thatdscusses abroadshouldtootacthie nearestUiS.emb y orconsulate hnp:ntravel,state.gov . FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 -...;.. . FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 a - j - ·- - T - - - - - -r .. FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 Jr king, LÈtierh*irtlin dream... L776, dream.a have We herto pebe:t will Anérica ihatgrant and.God in backwdy it started great FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 y e e & suc aY06f . 1 I j®d166 - . I pt)e .- yal sttry a dD aDaginute. e ¡ . e prdetto Ùt ili · ' pr. in #8)foes sininó is%os it .6 hicnd ýh-eiber I. miy support kno¾ . Æition nn^hm1ship c\ry Let . FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 -r - - .-, 1 Z- - lj - - - ,- 11. . - - . FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 c . - - . ·. . -L" -.. . - FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 hî . . - . . s R t nisp . · b O -th - S o u r0U1ft i bend · . ,;i wí11 en1ÍplOW05 thÜ1bbrosis we ·· 11d . 1 yeleome 6 I t11 We- ATV0 Z C. g? TMt eóú1l1 r BV Wodd 10CflCh$d T abew OS,d$ L U 5 .Is FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 ..';r .; . .;r': r-".' : ,i ' FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 - i . - .. . . - -. o ; - - -- -- -. cc . - . p · _ y=a _· - .- --- p - .- -- ..- l ra - C - · T FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 .F.h d tt I t' / t tl a'nti otab c ^r. ^i FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 minds Every generation hasthe obligatiott lo fren mm for a look at new worlds . . . to lookout·fraiÿ a higher rdalcauthán the llist gen ration . Bliwn S.Oniinka This document contains -sensitive electronics.. For best performance, do not bend, perforate or expose to extreme temperatures. A.- RESTRICTIONS ÒN IMPORTATIONOF G,00D5 AND SERVICESFor Office di FmciggAssets information,•fite tim Departmentof the Treasury. AvenueN.W.4Wahington,D.C. Annex.1500Petinsylvania Control.Treasury p . or 20 20. !p://wwn ccin^sult \toss.govlofac . B. CUSTOMS.& CoritactCustoms& DorderProtection BO.RDERPROTECTION a copyof "Kn v BeforeVoisGo" and."Pets,WildNfe- Licensing (CDP),lor and HealthRequirements," at http;//www.cbp.gov/IStegovttravell C. AGRICULTUREFora copyof ''Travele TipsOn Bringing-Food.Plant. of andAnimalProductslnto the UFited5tates contact.the0.5e.Department Agriculture,http://www.nphis-usda.gov/travel SeealsoU.S.FishandWildlife _4 forother important httpVAww.Io.fws.gov/TipsforTravelers.hmr Service, .i- Fravders." "Informationfor International D. U.S.T†XESAll U.S.citizensworkingand residingabroad:arerequired to fde and reporton their worldwideincome. ConsultlVSPublication54 "TaxGuidefor U.S.CitizensandResidentAliensAbroad" availaMeat http://irs gov/pudications/p54/index.htmi Writoto the SocialSecurityAdministration, E. SOCIALSECURITY Officeof . IntrinationalOpeiations.P.O.Box 17749,Baltintore.MD 21235,or consult ht!p:/hv,w.ssa.govlintematio·al aboutrecéivingpayinontswhileoutsidethe U1. or contactÆenearestSodalSecurityoHiceInthe UnitedStatesor at a or consulateabroad. U.S.embassy EXACTWEBSITE AÖDRESSES TO CHANGE.. SUBJ.ECT FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 E Departmentof theTreasury-internalRevenueService (99) 2 " U.S. Individual Income Tax Return OMB No. 1545-0074 IRSuse Only- Donotwriteor staplein thisspace Filing Status O Single Married jointly filing ¡ Marriedfiling separately(MFS) ¡ Head of household(HOH) ¡ widow(er) Qualifying (QW) Check only If you checked theMFS box. enter thename of your spouse. If youchecked theHOH or QW box, enter the name if the qualifying child's one box. person but is a child not yourdependent º Your first name and middle initial Last name number Your social security Darryl A Nowak Last name If joint return, spouse's first name and middle initial Spouse's social security number Elaine M Nowak Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Election Presidential Campaign 927 Check here if you, or your Broadway spouse want $3 if filing jointly, State City, town, or post office. If you have a foreign address, also complete spaces below. ZIP code to go to this fund. Checking a Bayonne NJ 070023050 box below will not change Foreign country name Foreign province/state/county Foreignpostalcodeyour tax or refund. ¡ You ¡ Spouse I At any timeduring2021, didyou receive,sell, exchange, or otherwisedispose of any financial interest in any virtual currency? ¡ Yes No Standard Someone can claim: O You as a dependent O Your spouse as a dependent Deduction O Spouse itemizeson a separatereturnor youwere a dual-statusalien Age/Blindness You: O Were born beforeJanuary 2, 1957 ¡ Are blind Spouse: O Was bornbeforeJanuary 2, 1957 ¡ Is blind Dependents (see instructions): (2) Social security (3) Relationship (4) Vif qualifies for (see instructions): (1) First name Last name number to you Child tax credit Creditfor otherdependents If more than four dependents, sco instructions and check hereº ¡ 1 Wages, tips, salaries, etc.AttachForrr (s) W-2 . . . . . . . . . . . . . . . . 1 Attach 2a Tax-exempt interest. . . 2a 2b b Taxable interest . . . . . Sch. B if 3a Qualifieddividends . . . 3a 102 . b Ordinary dividends . . . . . 3b 102 . required. 4a IRA distributions. . . . 4a b Taxable amount . . . . . . 4b 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b 57 , 259 . Standard 6a Socialsecuritybenefits . . 6a 33 , 426 . b Taxable amount . . . . . . 6b 10 , 085 . Deductionfor- " Single or 7 Capitalgain Attach or (loss). Schedule D if required. If not required, check here . . . . º O 7 Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8 -25 , 26 8 . 5 o 9 Add lines1, 2b,3b,4b, 5b,6b, 7, and8. This total is your income . . . . . . . . . º 9 42 , 178 . " Married filing 10 Adjustments toincome fromSchedule 1, line 26 . . . . . . . . . . . . . . . 10 jointly or oualifying 11 Subtractline 10 from line 9. This is your adjusted gross income . . . . . . . . . º 11 42,178 . O(er), 12a Standard deduction oritemized deductions (fromSchedule . . 12a 25 , 100 . d5 A) " Head of b Charitable if you take the standard contributions deduction(see instructions) 12b 600 . S300h0° ' c Add lines12a and 12b . . . . . . . . . . . . . . . . . . . . . . . 12c 25 , 700 . " If you checked 13 Qualifiedbusinessincome deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 0 . any box under Standard 14 Add 12c lines and 13 . . . . . . . . . . . . . . . . . . . . . . . 14 25 ,700 . 15 Taxable income. Subtract line 11. If zero line 14 from or less,enter-0- . . . . . . . . . 15 16,47 8 . ee nst uctions. For Disclosure, and Paperwork Privacy Act, Reduction see separate Act Notice, instructions. Form 1040 (2021) FILED: NEW YORK COUNTY CLERK 10/06/2022 04:58 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 191 RECEIVED NYSCEF: 10/06/2022 Form 1040 (2021) Page2 16 Tax (see instructions). Check if any from Form(s):1 ¡ 8814 2 ¡ 4972 3 ¡ . . 16 1 , 638 . 17 Amount from Schedule 2, line 3 . . . . . . . . . - . . . . . . . . . . 17 18 Add lines16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 1,638 . 19 Nonrefundablechildtaxcreditor credit forother dependents from Schedule 8812 . . . . . 19 20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20 21 Add lines19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21 22 Subtract line 21 from line 18. If zero enter or less, -0- . . . . . . . . . . . . . . 22 1 , 638 . 23 Other taxes,includingself-employmenttax,from Schedule 2, line 21 . . . . . . . . . 23 0 . 24 Add lines22 and 23. Thisis your totaltax . . . . . . . . . . . . . . . . º 24 1 , 638 . 25 Federalincome taxwithheldfrom: a Form(s)W-2 . . . . . . . . . . . . . . . . . . 25a b Form(s)1099 . . . . . . . . . . . . . . . . . . 25b 2 432 . c Other forms (see instructions) . . . . . . . . . . . . . 25c d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 2 , 432 . ) 26 2021 estimated taxpayments and amount appliedfrom 2020 retur . . . . . . . . . '6 if you havea 27a qualifyingchild, Earned income credit(EIC) . . . . . . . . . . . . . . 27a attach Sch. EIC. Check here if you were born after January 1, 1998, and before -- January 2, 2004, and you satisfyallthe other requirements for taxpayerswho are at least age 18, to claim the º EIC. See instructions O b Nontaxablecombat pay election . . . . 27b c Prioryear(2019)earned income . . . . 27c J 28 Refundablechildtax credit or additional childtax credit fromSchedule 8812 28 29 American opportunitycreditfrom Form 8863, line 8 .. . . . . . 29 30 Recovery rebate credit. See instructions. . . . . . . . . . 30 2 , 800 . 31 Amount from Schedule 3,line15 . . . . . . . . . . . . 31 32 Add lines 27a and 28 through31. These are yourtotalother payments and refundable credits º 32 2 , 800 . 33 Add lines 25d,26, and 32. These are yourtotal payments . . . . . . . . . . . º 33 5 , 232 . 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount youoverpaid . . 34 3 , 5 94 . Refund 35a Amount of line 34 you want refunded to you.If Form8888 is attached,check here . . . º ¡ 35a 3 , 594 . Direct deposit?º b Routingnumber | O 2 1 O 0 O 0 2 | 1 º c Type: Checking ¡ Savings See instructions. º d Account number 8 1 0 3 3 4 9 3 8 36 Amount of line 34 you want applied to your2022 estimated tax . . º 36 Amount 37 Amount you owe. Subtract line 33 fromline 24. For details on how topay, see instructions . º 37 YouOwe 38 Estimated taxpenalty (seeinstructions). . . . . . . . . º 38 ThirdParty Do you want to allow another person todiscuss this returnwith the IRS? See Designee instructions . . . . . . . . . . . . . . . . . . . . º O Yes. Complete below. No Designee's Phone Personal identification name º no. º number (PIN) º 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 bas