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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, 2013

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-1385428
SAMPLE PAYER 1
8501 CEDAR ST
TAMPA, FL 33607

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:$7,788.00
Federal Income Tax Withheld:$854.00
Social Security Wages:$7,788.00
Social Security Tax Withheld:$482.00
Medicare Wages and Tips:$7,788.00
Medicare Tax Withheld:$112.00
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): 00-9196971
SAMPLE PAYER 2
7550 PARK ST
JACKSONVILLE, FL 32034

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:$2,914.00
Federal Income Tax Withheld:$218.00
Social Security Wages:$2,914.00
Social Security Tax Withheld:$180.00
Medicare Wages and Tips:$2,914.00
Medicare Tax Withheld:$42.00
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): 00-3904163
SAMPLE PAYER 3
7047 FOURTH ST
TAMPA, FL 33607

Recipient:

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

Submission Type:Original document
Account Number (Optional):999999999
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: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:$3,762.00
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-C Cancellation of Debt

Creditor:

Creditor's Federal Identification Number (FIN): 00-5687720
SAMPLE PAYER 4
2692 SIXTH ST
NEW YORK, NY 10005

Debtor:

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

Submission Type:Original document
Account Number (Optional):999999999
Date Canceled:12-31-2013
Property Fair Market Value:$0.00
Amount of Debt Discharged:$11,263.00
Interest Forgiven Amount:$0.00
Identifiable Event Code:Insignificant
Debt Description:
Personal Liability Indicator:Box checked-Personally Liable

Form 1099-C Cancellation of Debt

Creditor:

Creditor's Federal Identification Number (FIN): 00-2731499
SAMPLE PAYER 5
6297 MAPLE AVE
BOSTON, MA 02123

Debtor:

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

Submission Type:Original document
Account Number (Optional):999999999
Date Canceled:05-05-2013
Property Fair Market Value:$0.00
Amount of Debt Discharged:$600.00
Interest Forgiven Amount:$0.00
Identifiable Event Code:Insignificant
Debt Description:2013 ECA LOAN FORGIVENESS
Personal Liability Indicator:

This Product Contains Sensitive Taxpayer Data