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This Product Contains Sensitive Taxpayer Data

Wage and Income Transcript

Request Date: 01-04-2024
Response Date: 01-04-2024
Tracking Number: 999999999999

SSN Provided: 503-00-1959
Tax Period Requested: December, 2017

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-1909386
SAMPLE PAYER 1
4159 SECOND AVE
PHOENIX, AZ 85005

Employee:

Employee's Social Security Number: 503-00-1959
CHRIS JOHNSON

Submission Type:Original document
Wages, Tips and Other Compensation:$33,247.00
Federal Income Tax Withheld:$2,883.00
Social Security Wages:$33,247.00
Social Security Tax Withheld:$2,061.00
Medicare Wages and Tips:$33,247.00
Medicare Tax Withheld:$482.00
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

Form 1099-C Cancellation of Debt

Creditor:

Creditor's Federal Identification Number (FIN): 00-1067173
SAMPLE PAYER 2
2249 WASHINGTON AVE
DETROIT, MI 48216

Debtor:

Debtor's Identification Number: 503-00-1959
CHRIS JOHNSON
1990 FOURTH ST
TAMPA, FL 33607

Submission Type:Original document
Account Number (Optional):
Date Canceled:00-00-0000
Property Fair Market Value:$36,699.00
Amount of Debt Discharged:$36,699.00
Interest Forgiven Amount:$15,825.00
Identifiable Event Code:Insignificant
Debt Description:?? E?7- Y?????E?V 1-
Personal Liability Indicator:Box checked-Personally Liable

Form 1099-G

Payer:

Payer's Federal Identification Number (FIN): 00-9169355
SAMPLE PAYER 3
2658 SIXTH ST
KANSAS CITY, MO 64112

Recipient:

Recipient's Identification Number: 503-00-1959
CHRIS JOHNSON
1990 FOURTH ST
TAMPA, FL 33607

Submission Type:Original document
Account Number (Optional):999999999
ATAA Payments:$0.00
Tax Withheld:$0.00
Taxable Grants:$0.00
Unemployment Compensation:$5,598.00
Agricultural Subsidies:$0.00
Prior Year Refund:$0.00
Market gain on Commodity Credit Corporation loans repaid:$0.00
Year of Refund:Not Set
1099G Offset:Not Refund, Credit, or Offset for Trade or Business

Form 1099-INT

Payer:

Payer's Federal Identification Number (FIN): 00-4047926
SAMPLE PAYER 4
2543 THIRD ST
AKRON, OH 44223

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
Second Notice Indicator:No Second Notice
Foreign Country or US Possession:
CUSIP Number:88888888888
FATCA Filing Requirement:Box not checked no Filing Requirement

Form 1099-MISC

Payer:

Payer's Federal Identification Number (FIN): 00-8129312
SAMPLE PAYER 5
8931 MAPLE ST
DETROIT, MI 48216

Recipient:

Recipient's Identification Number: 503-00-1959
CHRIS JOHNSON
1990 FOURTH ST
TAMPA, FL 33607

Submission Type:Original document
Account Number (Optional):999999999
Tax Withheld:$0.00
Non-Employee Compensation:$18,157.00
Medical Payments:$0.00
Fishing Income:$0.00
Rents:$0.00
Royalties:$0.00
Other Income:$0.00
Substitute Payments for Dividends:$0.00
Excess Golden Parachute:$0.00
Crop Insurance:$0.00
Attorney Fees:$0.00
Foreign Tax Paid:$0.00
Section 409A Deferrals:$0.00
Section 409A Income:$0.00
Direct Sales Indicator:Not Direct Sales
FATCA Filing Requirement:Box not checked no Filing Requirement
Second Notice Indicator:No Second Notice

This Product Contains Sensitive Taxpayer Data