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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, 2021

Form 5498 Individual Retirement Arrangement Contribution Information

Trustee:

Trustee/Issuer's Federal Identification Number (FIN): 00-7412733
SAMPLE PAYER 1
5071 NINTH 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:$100.00
Rollover Contributions:$0.00
Roth Conversion Amount:$0.00
Recharacterized Contributions:$0.00
Fair Market Value of Account:$101.00
Life Insurance Cost Included in Box 1:$0.00
SEP Code:Not Checked
IRA Code:Checked
Simple Code:Not Checked
Roth IRA Code:Not 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:$0.00
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

Form 1099-INT

Payer:

Payer's Federal Identification Number (FIN): 00-7758501
SAMPLE PAYER 2
9254 FIFTH 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
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:
FATCA Filing Requirement:Box not checked no Filing Requirement

This Product Contains Sensitive Taxpayer Data