IRS Logo

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, 2016

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-5230146
SAMPLE PAYER 1
1151 FOURTH ST
NEW ORLEANS, LA 70032

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:$30,982.00
Federal Income Tax Withheld:$2,699.00
Social Security Wages:$30,982.00
Social Security Tax Withheld:$1,920.00
Medicare Wages and Tips:$30,982.00
Medicare Tax Withheld:$449.00
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
W2 Submission Type:Original
W2 WHC SSN Validation Code:Correct SSN

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-0164155
SAMPLE PAYER 2
2268 WASHINGTON ST
CHICAGO, IL 60603

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:$1,316.00
Federal Income Tax Withheld:$36.00
Social Security Wages:$1,316.00
Social Security Tax Withheld:$81.00
Medicare Wages and Tips:$1,316.00
Medicare Tax Withheld:$19.00
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
W2 Submission Type:Original
W2 WHC SSN Validation Code:Correct SSN

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN): 00-8850797
SAMPLE PAYER 3
3445 SIXTH ST
LOS ANGELES, CA 90013

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:$1,785.00
Federal Income Tax Withheld:$58.00
Social Security Wages:$1,785.00
Social Security Tax Withheld:$110.00
Medicare Wages and Tips:$1,785.00
Medicare Tax Withheld:$25.00
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
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): 00-9482366
SAMPLE PAYER 4
6196 PINE AVE
NEW ORLEANS, LA 70032

Participant:

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

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:$25.00
Life Insurance Cost Included in Box 1:$0.00
SEP Code:Not Checked
IRA Code:Not Checked
Simple Code:Not Checked
Roth IRA Code: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:$25.00
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 1099-B Proceeds From Broker and Barter Exchange Transactions

Payer:

Payer's Federal Identification Number (FIN): 00-6606422
SAMPLE PAYER 5
2545 SIXTH ST
JACKSONVILLE, FL 32034

Recipient:

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

Submission Type:Original document
Account Number:999999999
Date Sold or Disposed:09-09-2016
CUSIP Number:88888888888
Gross Proceeds:Gross proceeds
Bartering:$0.00
Federal Income Tax Withheld:$0.00
Proceeds:$5.00
Aggregate Profit or (Loss):$0.00
Realized Profit or (Loss):$0.00
Unrealized Profit or (Loss) 12/31 Prior Year:$0.00
Unrealized Profit or (Loss) 12/31 Current Year:$0.00
Cost or Basis:$5.00
Wash Sale Loss Disallowed:$0.00
Accrued Market Discount Amount:$0.00
Description:ISHARES CORE MODERATE ALLOCATION FUND E
Second Notice Indicator:
Date Acquired:07-27-2016
Noncovered Security Indicator:Nothing checked
Type of Gain or Loss Code:Short-term
Applicable Check Box on Form 8949:Short term transaction for which the cost or other basis is being reported to the IRS
Loss Not Allowed Indicator:
FATCA Filing Requirement:Box not checked no Filing Requirement
Proceeds from Collectibles:Box not checked not reporting

Form 1099-INT

Payer:

Payer's Federal Identification Number (FIN): 00-9808737
SAMPLE PAYER 6
9400 FIFTH AVE
ATLANTA, GA 30305

Recipient:

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

Submission Type:Original document
Account Number (Optional):999999999
Interest:$0.00
Tax Withheld:$0.00
Savings Bonds:$0.00
Investment Expense:$0.00
Interest Forfeiture:$0.00
Foreign Tax Paid:$0.00
Tax-Exempt Interest:$0.00
Specified Private Activity Bond Interest:$0.00
Market Discount:$0.00
Bond Premium:$0.00
Bond Premium on Tax Exempt Bond:$0.00
Bond Premium on Treasury Obligations:$0.00
Second Notice Indicator:No Second Notice
Foreign Country or US Possession:
CUSIP Number:88888888888
FATCA Filing Requirement:Box not checked no Filing Requirement

This Product Contains Sensitive Taxpayer Data