This Product Contains Sensitive Taxpayer Data |
Wage and Income Transcript |
Request Date: | 04-28-2022 |
Response Date: | 04-28-2022 |
Tracking Number: | 999999999999 |
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Payer: | ||
Payer's Federal Identification Number (FIN): 00-4862514 | ||
SAMPLE PAYER 1 | ||
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Payee: | ||
Payee's Identification Number: 976-00-1879 | ||
BRIAN MARTIN | ||
7967 MAPLE ST | ||
KNOXVILLE, TN 37918 | ||
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Submission Type: | Original document | |
Account Number (Optional): | N/A | |
Pensions and Annuities (Total Benefits Paid): | $20,370.00 | |
Tax Withheld: | 0.00 | |
Repayments: | 0.00 | |
Workman's Compensation Offset: | 0.00 | |
TY 2011 Payments: | 0.00 | |
TY 2010 Payments: | 0.00 | |
TY 2009 Payments: | 0.00 | |
TY 2008 Payments: | 0.00 | |
Trust Fund Indicator: | Disability | |
SSA/RRB Payments: | Either RRB or SSA payments |
Payer: | ||
Payer's Federal Identification Number (FIN): 00-2971745 | ||
SAMPLE PAYER 2 | ||
9651 CEDAR ST | ||
KNOXVILLE, TN 37918 | ||
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Recipient: | ||
Recipient's Identification Number: 976-00-1879 | ||
BRIAN MARTIN | ||
7967 MAPLE ST | ||
KNOXVILLE, TN 37918 | ||
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Submission Type: | Original document | |
Account Number (Optional): | 999999999 | |
Distribution Code Value: | Disability | |
Distribution Code: | 3 | |
Distribution Code Value: | Not significant | |
Distribution Code: | Blank | |
Tax Amount Undetermined Code: | Not checked | |
Total Distribution Code: | Not checked | |
First Year Roth Contribution: | 0000 | |
SEP Indicator: | IRA/SEP/SIMP box not checked | |
Tax Withheld: | $2,000.00 | |
Total Employee Contributions: | $0.00 | |
Unrealized Appreciation: | $0.00 | |
Other Income: | $0.00 | |
Gross Distribution: | $10,000.00 | |
Taxable Amount: | $10,000.00 | |
Eligible Capital Gains: | $0.00 | |
Amount to IRR: | $0.00 |
Payer: | ||
Payer's Federal Identification Number (FIN): 00-9842524 | ||
SAMPLE PAYER 3 | ||
9159 PINE AVE | ||
NEW ORLEANS, LA 70032 | ||
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Recipient: | ||
Recipient's Identification Number: 976-00-1879 | ||
BRIAN MARTIN | ||
7967 MAPLE ST | ||
KNOXVILLE, TN 37918 | ||
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Submission Type: | Original document | |
Account Number (Optional): | 999999999 | |
Distribution Code Value: | Disability | |
Distribution Code: | 3 | |
Distribution Code Value: | Not significant | |
Distribution Code: | Blank | |
Tax Amount Undetermined Code: | Not checked | |
Total Distribution Code: | Not checked | |
First Year Roth Contribution: | 0000 | |
SEP Indicator: | IRA/SEP/SIMP box not checked | |
Tax Withheld: | $0.00 | |
Total Employee Contributions: | $0.00 | |
Unrealized Appreciation: | $0.00 | |
Other Income: | $0.00 | |
Gross Distribution: | $14,203.00 | |
Taxable Amount: | $14,203.00 | |
Eligible Capital Gains: | $0.00 | |
Amount to IRR: | $0.00 |
This Product Contains Sensitive Taxpayer Data |