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This Product Contains Sensitive Taxpayer Data

Wage and Income Transcript

Request Date: 12-21-2021
Response Date: 12-21-2021
Tracking Number: 999999999999

SSN Provided: 707-00-8679
Tax Period Requested: December, 2017

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-6425918
SAMPLE PAYER 1
7486 SIXTH AVE
CHICAGO, IL 60603

Employee:

Employee's Social Security Number: 707-00-8679
BRIAN TAYLOR
8721 Flint Falls Dr
DALLAS, TX 75243

Submission Type:Original document
Wages, Tips and Other Compensation:$94,540.00
Federal Income Tax Withheld:$7,014.00
Social Security Wages:$94,540.00
Social Security Tax Withheld:$5,861.00
Medicare Wages and Tips:$94,540.00
Medicare Tax Withheld:$1,370.00
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
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): 00-9605008
SAMPLE PAYER 2
6494 WASHINGTON ST
BOSTON, MA 02123

Participant:

Participant's Identification Number: 707-00-8679
BRIAN TAYLOR
8721 Flint Falls Dr
DALLAS, TX 75243

Submission Type:Original document
Account Number (Optional):999999999
IRA Contributions:$0.00
Rollover Contributions:$0.00
Roth Conversion Amount:$0.00
Recharacterized Contributions:$0.00
Fair Market Value of Account:$14.00
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

Schedule K-1 1065

Partnership:

Partnership's Employer Identification Number: 00-0783475
SAMPLE PAYER 3
9326 THIRD ST
AKRON, OH 44223

Partner:

Partner's Identifying Number: 707-00-8679
BRIAN TAYLOR
8721 Flint Falls Dr
DALLAS, TX 75243

Submission Type:Original document
Partner Share of Capital Beginning:10.83%
Partner Share of Capital Ending:10.83%
IRA SEP KEOGH Indicator:Box is not checked
Beginning Tax Period:201701
Ending Tax Period:201712
Dividends:$0.00
Interest:$1,124.00
Royalties:$0.00
Ordinary Income K-1:-$5,209.00
Real Estate:$0.00
Other Rental:$206.00
Guaranteed Payments:$0.00
Section 179 Expenses:$0.00
Short Term Capital Gain:$0.00
Long Term Capital Gain:$0.00

This Product Contains Sensitive Taxpayer Data