Exhibit 203h — USA v. Alexandra Acosta (Dkt. 81.21)

Record facts

U.S. District Court for the Southern District of Florida · No. 0:23-cr-60170-RNS · Doc. 81-21 · 2024-06-14 · Docket on CourtListener

Full text

Corrected Report Pege__2 __ of __.2 __
Name of taxpayer [Tae er identification number Return form number
ALEMANDRA ACOSTA

17. Penalties, additions to tax, and additional amounts ~ (RC sections Partog Ended sat po Perlod Ended
a.

b.

i IRS — RECEIVED

. SB/SE - EXAMINATION

: SOUTH ATLANTIC AREA

= Apr 13 2021

i PLANTATION TERRITORY

7 PLANTATION, FLORIDA ;

1

2

n.
18 Tote! penalties, additions to tax, and additional amounts

19. Summary of taxes, penalties and inferest

@. Balance due cr (overpayment) taxes » (line 16, page 1) 9,042.60 41,071.00

b. Penalties and additions (line 18) - computed to 04/01/2022

c. Interest* (RC § 6601) - estimated and computed to 95/01/2021 $27.65 o8.0a

J. Amount due or (refund) « (sum of lines 4, 5, end c} $,869.55 4,169.94
"interest, as provided by law, will be charged on eny unpaid amount until itis paid in full,
Other information

Tais Report Supersedes the Renort Issued 3/3/2021
Examiner's rame | Employee 10 Office
Phyllis Kamomeyer 1001684408 Plantation, FL
Examiner's signature Dale
04/01/2021

Consent to Assessment and Collection-! d@ not wish to exercise my appeal righls wilh thd Internal Revenue Service or to Contest in the United States
Tax Court tha findings in this repart. Thereforn, | give my consent to the immediate assessment and col'ection of any increase in tax and penalties, and
accept any decrease in tax end peanaltios shown above, plus additional interest as provided by law. itis understood thal (his report Is subject to
accaptance by the Area Director, Area Manager, Speciatty Tax Program Chiat, or Director of Field Operations.

Note; if a joint return was filed, BOTH taxpayers must sign
Date Signature of taxpayer

Date

By Title ; ; Dale

Catalog Number 23 105A Www. irs.gov Form 4649 (Rev. 8-2019)

RECEIVED BY IRS-EEFAX 04/13/2021 9:06AM (GMT-Nu-nny

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