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Last, First, Middle Initial GEN 0060, GEN 0070 D/5 Mailing Address (Number and Street including Apartment Number or P.O. Box) 6 GEN 0075 State City, Town or Post Office GEN 0085 FAMILY SIZE 1 GEN 0320 POLITICAL PARTY FUND ZIP Code GEN 0095 GEN 0100 Designating $2 will not change your refund or tax due. Mark an X in Box 1 for Democratic, Box 2 for Republican, or Box 3 for No Designation. 1 GEN 2 0305 3 INCOME 1. Enter federal Adjusted Gross Income from.

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