| |
Employer:
| |
Employer Identification Number (EIN):
00-5230146 |
SAMPLE PAYER 1 | |
1151 FOURTH ST | |
NEW ORLEANS, LA 70032 | |
| |
Employee:
| |
Employee's Social Security Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Wages, Tips and Other Compensation: | $30,982.00 |
Federal Income Tax Withheld: | $2,699.00 |
Social Security Wages: | $30,982.00 |
Social Security Tax Withheld: | $1,920.00 |
Medicare Wages and Tips: | $30,982.00 |
Medicare Tax Withheld: | $449.00 |
Social Security Tips: | $0.00 |
Allocated Tips: | $0.00 |
Dependent Care Benefits: | $0.00 |
Deferred Compensation: | $0.00 |
Code "Q" Nontaxable Combat Pay: | $0.00 |
Code "W" Employer Contributions to a Health Savings Account: | $0.00 |
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan: | $0.00 |
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan: | $0.00 |
Code "R" Employer's Contribution to MSA: | $0.00 |
Code "S" Employer's Contribution to Simple Account: | $0.00 |
Code "T" Expenses Incurred for Qualified Adoptions: | $0.00 |
Code "V" Income from exercise of non-statutory stock options: | $0.00 |
Code "AA" Designated Roth Contributions under a Section 401(k) Plan: | $0.00 |
Code "BB" Designated Roth Contributions under a Section 403(b) Plan: | $0.00 |
Code "DD" Cost of Employer-Sponsored Health Coverage: | $0.00 |
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan: | $0.00 |
Third Party Sick Pay Indicator: | Unanswered |
Retirement Plan Indicator: | Unanswered |
Statutory Employee: | Not Statutory Employee |
W2 Submission Type: | Original |
W2 WHC SSN Validation Code: | Correct SSN |
| |
Employer:
| |
Employer Identification Number (EIN):
00-0164155 |
SAMPLE PAYER 2 | |
2268 WASHINGTON ST | |
CHICAGO, IL 60603 | |
| |
Employee:
| |
Employee's Social Security Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Wages, Tips and Other Compensation: | $1,316.00 |
Federal Income Tax Withheld: | $36.00 |
Social Security Wages: | $1,316.00 |
Social Security Tax Withheld: | $81.00 |
Medicare Wages and Tips: | $1,316.00 |
Medicare Tax Withheld: | $19.00 |
Social Security Tips: | $0.00 |
Allocated Tips: | $0.00 |
Dependent Care Benefits: | $0.00 |
Deferred Compensation: | $0.00 |
Code "Q" Nontaxable Combat Pay: | $0.00 |
Code "W" Employer Contributions to a Health Savings Account: | $0.00 |
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan: | $0.00 |
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan: | $0.00 |
Code "R" Employer's Contribution to MSA: | $0.00 |
Code "S" Employer's Contribution to Simple Account: | $0.00 |
Code "T" Expenses Incurred for Qualified Adoptions: | $0.00 |
Code "V" Income from exercise of non-statutory stock options: | $0.00 |
Code "AA" Designated Roth Contributions under a Section 401(k) Plan: | $0.00 |
Code "BB" Designated Roth Contributions under a Section 403(b) Plan: | $0.00 |
Code "DD" Cost of Employer-Sponsored Health Coverage: | $0.00 |
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan: | $0.00 |
Third Party Sick Pay Indicator: | Unanswered |
Retirement Plan Indicator: | Unanswered |
Statutory Employee: | Not Statutory Employee |
W2 Submission Type: | Original |
W2 WHC SSN Validation Code: | Correct SSN |
| |
Employer:
| |
Employer Identification Number (EIN):
00-8850797 |
SAMPLE PAYER 3 | |
3445 SIXTH ST | |
LOS ANGELES, CA 90013 | |
| |
Employee:
| |
Employee's Social Security Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Wages, Tips and Other Compensation: | $1,785.00 |
Federal Income Tax Withheld: | $58.00 |
Social Security Wages: | $1,785.00 |
Social Security Tax Withheld: | $110.00 |
Medicare Wages and Tips: | $1,785.00 |
Medicare Tax Withheld: | $25.00 |
Social Security Tips: | $0.00 |
Allocated Tips: | $0.00 |
Dependent Care Benefits: | $0.00 |
Deferred Compensation: | $0.00 |
Code "Q" Nontaxable Combat Pay: | $0.00 |
Code "W" Employer Contributions to a Health Savings Account: | $0.00 |
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan: | $0.00 |
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan: | $0.00 |
Code "R" Employer's Contribution to MSA: | $0.00 |
Code "S" Employer's Contribution to Simple Account: | $0.00 |
Code "T" Expenses Incurred for Qualified Adoptions: | $0.00 |
Code "V" Income from exercise of non-statutory stock options: | $0.00 |
Code "AA" Designated Roth Contributions under a Section 401(k) Plan: | $0.00 |
Code "BB" Designated Roth Contributions under a Section 403(b) Plan: | $0.00 |
Code "DD" Cost of Employer-Sponsored Health Coverage: | $0.00 |
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan: | $0.00 |
Third Party Sick Pay Indicator: | Unanswered |
Retirement Plan Indicator: | Unanswered |
Statutory Employee: | Not Statutory Employee |
W2 Submission Type: | Original |
W2 WHC SSN Validation Code: | Correct SSN |
| |
Trustee:
| |
Trustee/Issuer's Federal Identification Number (FIN):
00-9482366 |
SAMPLE PAYER 4 | |
6196 PINE AVE | |
NEW ORLEANS, LA 70032 | |
| |
Participant:
| |
Participant's Identification Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Account Number (Optional): | 999999999 |
IRA Contributions: | $0.00 |
Rollover Contributions: | $0.00 |
Roth Conversion Amount: | $0.00 |
Recharacterized Contributions: | $0.00 |
Fair Market Value of Account: | $25.00 |
Life Insurance Cost Included in Box 1: | $0.00 |
SEP Code: | Not Checked |
IRA Code: | Not Checked |
Simple Code: | Not Checked |
Roth IRA Code: | Checked |
RMD For Subsequent Year: | RMD box not checked |
RMD Date: | 00-00-0000 |
Year: | |
Postponed Contribution Code: | |
Repayments Code: | |
Fair Market Value of certain specified assets: | N/A |
SEP Contributions: | $0.00 |
SIMPLE Contributions: | $0.00 |
Roth IRA Contributions: | $25.00 |
Required Minimum Distribution Amount: | $0.00 |
Postponed Contributions: | $0.00 |
Repayment of a qualified reservist distribution or federally designated disaster withdrawal repayment: | $0.00 |
Fair Market Value of Certain Specified Assets: | $0.00 |
| |
Payer:
| |
Payer's Federal Identification Number (FIN):
00-6606422 |
SAMPLE PAYER 5 | |
2545 SIXTH ST | |
JACKSONVILLE, FL 32034 | |
| |
Recipient:
| |
Recipient's Identification Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Account Number: | 999999999 |
Date Sold or Disposed: | 09-09-2018 |
CUSIP Number: | 88888888888 |
Gross Proceeds: | Gross proceeds |
Bartering: | $0.00 |
Federal Income Tax Withheld: | $0.00 |
Proceeds: | $5.00 |
Aggregate Profit or (Loss): | $0.00 |
Realized Profit or (Loss): | $0.00 |
Unrealized Profit or (Loss) 12/31 Prior Year: | $0.00 |
Unrealized Profit or (Loss) 12/31 Current Year: | $0.00 |
Cost or Basis: | $5.00 |
Wash Sale Loss Disallowed: | $0.00 |
Accrued Market Discount Amount: | $0.00 |
Description: | ISHARES CORE MODERATE ALLOCATION FUND E |
Second Notice Indicator: | |
Date Acquired: | 07-27-2018 |
Noncovered Security Indicator: | Nothing checked |
Type of Gain or Loss Code: | Short-term |
Applicable Check Box on Form 8949: | Short term transaction for which the cost or other basis is being reported to the IRS |
Loss Not Allowed Indicator: | |
FATCA Filing Requirement: | Box not checked no Filing Requirement |
Proceeds from Collectibles: | Box not checked not reporting |
| |
Payer:
| |
Payer's Federal Identification Number (FIN):
00-9808737 |
SAMPLE PAYER 6 | |
9400 FIFTH AVE | |
ATLANTA, GA 30305 | |
| |
Recipient:
| |
Recipient's Identification Number:
503-00-1959 |
CHRIS JOHNSON | |
1990 FOURTH ST | |
TAMPA, FL 33607 | |
| |
Submission Type: | Original document |
Account Number (Optional): | 999999999 |
Interest: | $0.00 |
Tax Withheld: | $0.00 |
Savings Bonds: | $0.00 |
Investment Expense: | $0.00 |
Interest Forfeiture: | $0.00 |
Foreign Tax Paid: | $0.00 |
Tax-Exempt Interest: | $0.00 |
Specified Private Activity Bond Interest: | $0.00 |
Market Discount: | $0.00 |
Bond Premium: | $0.00 |
Bond Premium on Tax Exempt Bond: | $0.00 |
Bond Premium on Treasury Obligations: | $0.00 |
Second Notice Indicator: | No Second Notice |
Foreign Country or US Possession: | |
CUSIP Number: | 88888888888 |
FATCA Filing Requirement: | Box not checked no Filing Requirement |