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This Product Contains Sensitive Taxpayer Data

Wage and Income Transcript

Request Date: 01-04-2022
Response Date: 01-04-2022
Tracking Number: 999999999999

SSN Provided: 503-00-1959
Tax Period Requested: December, 2020

Form 1099-K: Payment Card and Third Party Network Transactions

Transferor:

Transferor's Federal Identification Number (FIN): 00-9102603
SAMPLE PAYER 1
5963 LAKE ST
DALLAS, TX 75089

Employee:

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

Submission Type:Original document
Account Number (Optional):999999999
PSE-EPF Indicator:Check box if FILER is Payment Settlement Entity (PSE)
Merchant Category Code:8931
Transactions Reported:Check box if TRANSACTIONS are Payment Card
Number of Payment Transactions:10
Second TIN Notice Indicator:
Federal Income Tax Withheld:$0.00
Gross Amount of Payment Card/Third Party Transactions:$9,087.00
January Payments:$2,585.00
February Payments:$2,585.00
March Payments:$3,917.00
April Payments:$0.00
May Payments:$0.00
June Payments:$0.00
July Payments:$0.00
August Payments:$0.00
September Payments:$0.00
October Payments:$0.00
November Payments:$0.00
December Payments:$0.00
Card Not Present Transactions:$9,087.00

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-2126816
HILLSBOROUGH PUBLIC SCHOOLS
901 EAST KENNEDY BLVD
TAMPA, FL 33602

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:$30,477.00
Federal Income Tax Withheld:$5,662.00
Social Security Wages:$30,477.00
Social Security Tax Withheld:$1,888.00
Medicare Wages and Tips:$30,477.00
Medicare Tax Withheld:$441.00
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
Code "FF" Permitted benefits under a qualified small employer health reimbursement arrangement:$0.00
Code "GG" Income from Qualified Equity Grants Under Section 83(i):$0.00
Code "HH" Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year:$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

Form 5498 Individual Retirement Arrangement Contribution Information

Trustee:

Trustee/Issuer's Federal Identification Number (FIN): 00-2345281
CHARLES SCHWAB
P.O. BOX 628291
ORLANDO, FL 32862

Participant:

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

Submission Type:Original document
Account Number (Optional): 271155002
IRA Contributions:$0.00
Rollover Contributions:$0.00
Roth Conversion Amount:$0.00
Recharacterized Contributions:$0.00
Fair Market Value of Account:$103.00
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 W-2G

Payer:

Payer's Federal Identification Number (FIN): 00-8880210
SAMPLE PAYER 5
4795 THIRD ST
ATLANTA, GA 30305

Winner:

Winner's Taxpayer Identification Number (TIN): 503-00-1959
CHRIS JOHNSON
1990 FOURTH ST
TAMPA, FL 33607

Submission Type:Original document
Gross Winnings:$1,000.00
Federal Income Tax Withheld:$0.00
Type of Wager:State Lottery
Date Won:09-21-2020
Winnings from Identical Wagers:$0.00

Form 1099-G

Payer:

Payer's Federal Identification Number (FIN): 00-6394226
STATE OF FLORIDA
3914 PARK ST
TALLAHASSEE, FL   32301

Recipient:

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

Submission Type:Original document
Account Number (Optional):
ATAA Payments:$0.00
Tax Withheld:$679.00
Taxable Grants:$0.00
Unemployment Compensation:$21,636.00
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
Second TIN Notice:

This Product Contains Sensitive Taxpayer Data