This figure represents page 1 of Form 1040-SS:The name is Helen Fensol.The TIN is 000-00-8445.The address is 222 Nelansa Lane in Hagatna, GU, and the Zip code is 96932.The taxpayer checked the box for married filing separately.There is a red 3 edited to the left of the filing status area to show that the return is filed married filing separately.The taxpayer claimed three (3) dependents (Douglas Fensol, TIN: 000-00-7590, relationship: son; Benjamin Fensol, TIN: 000-00-1158, relationship: nephew; and Edward Fensol, TIN: 000-00-8965, relationship: grandson).There is an amount of 3000 on lines 9, 12, and 14a.The form also contains the taxpayer’s signature.There is also blurb which states The taxpayer does not reside in Puerto Rico, and therefore is not eligible to claim the additional child tax credit.The amount that is shown on line 9 of 3000 is X-ed in red to show that the taxpayer does not qualify.The dependents listed in 2(a) are also each X-ed in red to the left of the names to indicate their ineligibility to be claimed.The beginning of the routing number and account number boxes has one big X edited.