This Product Contains Sensitive Taxpayer Data |
Wage and Income Transcript |
Request Date: | 12-30-2021 |
Response Date: | 12-30-2021 |
Tracking Number: | 999999999999 |
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Employer: | ||
Employer Identification Number (EIN): 00-6052210 | ||
SAMPLE PAYER 1 | ||
9589 NINTH AVE | ||
BIRMINGHAM, AL 35064 | ||
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Employee: | ||
Employee's Social Security Number: 976-00-1879 | ||
BRIAN MARTIN | ||
7967 MAPLE ST | ||
KNOXVILLE, TN 37918 | ||
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Submission Type: | Original document | |
Wages, Tips and Other Compensation: | $13,804.00 | |
Federal Income Tax Withheld: | $1,931.00 | |
Social Security Wages: | $13,804.00 | |
Social Security Tax Withheld: | $579.00 | |
Medicare Wages and Tips: | $13,804.00 | |
Medicare Tax Withheld: | $200.00 | |
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: | Yes - retirement plan | |
Statutory Employee: | Not Statutory Employee |
Payer: | ||
Payer's Federal Identification Number (FIN): 00-2615374 | ||
SAMPLE PAYER 2 | ||
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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): | $18,760.00 | |
Tax Withheld: | 0.00 | |
Repayments: | 0.00 | |
Workman's Compensation Offset: | 0.00 | |
TY 2010 Payments: | 0.00 | |
TY 2009 Payments: | 0.00 | |
TY 2008 Payments: | 0.00 | |
TY 2007 Payments: | 0.00 | |
Trust Fund Indicator: | Disability | |
SSA/RRB Payments: | Either RRB or SSA payments |
Payer: | ||
Payer's Federal Identification Number (FIN): 00-7904828 | ||
SAMPLE PAYER 3 | ||
2526 FIRST ST | ||
PHOENIX, AZ 85005 | ||
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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: | $1,871.00 | |
Taxable Amount: | $1,871.00 | |
Eligible Capital Gains: | $0.00 | |
Amount to IRR: | $0.00 |
This Product Contains Sensitive Taxpayer Data |