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This Product Contains Sensitive Taxpayer Data

Wage and Income Transcript

Request Date: 11-10-2021
Response Date: 11-10-2021
Tracking Number: 999999999999

SSN Provided: 342-00-5838
Tax Period Requested: December, 2011

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-7157552
SAMPLE PAYER 1
1945 PINE ST
BOSTON, MA 02123

Employee:

Employee's Social Security Number: 342-00-5838
DANIEL WASHINGTON
8676 HAMPSHIRE GLEN DR S
JACKSONVILLE, FL 32256

Submission Type:Original document
Wages, Tips and Other Compensation:$74,144.00
Federal Income Tax Withheld:$11,088.00
Social Security Wages:$74,144.00
Social Security Tax Withheld:$3,114.00
Medicare Wages and Tips:$74,144.00
Medicare Tax Withheld:$1,075.00
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 W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-0323306
SAMPLE PAYER 2
7493 PINE AVE
NEW YORK, NY 10005

Employee:

Employee's Social Security Number: 342-00-5838
DANIEL WASHINGTON
8676 HAMPSHIRE GLEN DR S
JACKSONVILLE, FL 32256

Submission Type:Original document
Wages, Tips and Other Compensation:$59,033.00
Federal Income Tax Withheld:$8,120.00
Social Security Wages:$62,037.00
Social Security Tax Withheld:$2,605.00
Medicare Wages and Tips:$62,037.00
Medicare Tax Withheld:$899.00
Social Security Tips:$0.00
Allocated Tips:$0.00
Dependent Care Benefits:$0.00
Deferred Compensation:$3,004.00
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:Yes - retirement plan
Statutory Employee:Not Statutory Employee

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-7729618
SAMPLE PAYER 3
5334 MAIN ST
CHICAGO, IL 60603

Employee:

Employee's Social Security Number: 342-00-5838
DANIEL WASHINGTON
8676 HAMPSHIRE GLEN DR S
JACKSONVILLE, FL 32256

Submission Type:Original document
Wages, Tips and Other Compensation:$50.00
Federal Income Tax Withheld:$12.00
Social Security Wages:$50.00
Social Security Tax Withheld:$2.00
Medicare Wages and Tips:$50.00
Medicare Tax Withheld:$0.00
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 1098-T

Payer:

Payer's Federal Identification Number (FIN): 00-2983664
SAMPLE PAYER 4
3113 PINE ST
NEW ORLEANS, LA 70032

Recipient:

Recipient's Identification Number: 342-00-5838
DANIEL WASHINGTON
8676 HAMPSHIRE GLEN DR S
JACKSONVILLE, FL 32256

Submission Type:Original document
Account Number (Optional):
Qualified Tuition and Related Expense:$0.00
Scholarships or Grants:$0.00
Half Time Student Indicator:Grtr than or Eq to Half Time Student
Graduate Student Indicator:Not a Graduate Student
Academic Period Code:Academic Period Box Not Checked
Method of Reporting Indicator:No Change in Reporting Method from the Previous Year
Amounts Billed for Qualified Tuition & Related Expenses:$2,727.00
Adjustments Made for Prior Year:$0.00
Adjustments to Scholarships or Grants for a Prior Year:$0.00
Reimbursements/Refunds from an Insurance Contract:$0.00

Form 1099-G

Payer:

Payer's Federal Identification Number (FIN): 00-4923380
SAMPLE PAYER 5
4770 MAIN ST
JACKSONVILLE, FL 32256

Recipient:

Recipient's Identification Number: 342-00-5838
DANIEL WASHINGTON
8676 HAMPSHIRE GLEN DR S
JACKSONVILLE, FL 32256

Submission Type:Original document
Account Number (Optional):999999999
ATAA Payments:$0.00
Tax Withheld:$0.00
Taxable Grants:$0.00
Unemployment Compensation:$0.00
Agricultural Subsidies:$0.00
Prior Year Refund:$258.00
Market gain on Commodity Credit Corporation loans repaid:$0.00
Year of Refund:2010
1099G Offset:Not Refund, Credit, or Offset for Trade or Business

Form 1099-MISC

Payer:

Payer's Federal Identification Number (FIN): 00-2902750
SAMPLE PAYER 6
9852 FOURTH AVE
NEW ORLEANS, LA 70032

Recipient:

Recipient's Identification Number: 342-00-5838
DANIEL WASHINGTON
8676 HAMPSHIRE GLEN DR S
JACKSONVILLE, FL 32256

Submission Type:Original document
Account Number (Optional):999999999
Tax Withheld:$0.00
Non-Employee Compensation:$0.00
Medical Payments:$0.00
Fishing Income:$0.00
Rents:$0.00
Royalties:$0.00
Other Income:$50.00
Substitute Payments for Dividends:$0.00
Excess Golden Parachute:$0.00
Crop Insurance:$0.00
Attorney Fees:$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