Name

Tax Refund, Tax Data and Tax Documents

.. for the last three years.

A negative item in red ($-0.00) indicate an amount you owe.

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Refund

2022

2023

2024

Federal

00

00

00

State

00

00

00

Total

00

00

00

Fee

00

00

00

1099's / W-2's

00

00

00

Documents

Please print, sign and date the Signature Pages below.

You must email them back to us before your Tax Return is submitted to IRS..

Please read, print and sign the Republic Bank Tax Refund Transfer Agreement - If it applies to you.

Documents

2022

2023

2024

Signature

Rep. Bank

Tax Return

Misc