1. Prepare the tax return by hand or by using the line forms such as: (Use any necessary from but form 1040 must be completed)

• Form 1040, U.S. Individual Income Tax Return
• Schedule 1, Additional Income and Adjustments to Income
• Schedule 2, Additional Taxes
• Schedule 3, Additional Credits and Payments
• Schedule A, Itemized Deductions
• Schedule C, Profit or Loss from Business
• Schedule D, Capital Gains and Losses
• Schedule SE, Self-Employment Tax
• Form 2441, Child and Dependent Care Expenses
• Form 8995, Qualified Business Income Deduction Simplified Computation
• 2019 Qualified Business Income Deduction Worksheet
• Form 8867, Paid Preparer's Due Diligence Checklist
• 2019 IRA Deduction Worksheet Schedule 1, Line 19
• 2019 Child Tax Credit and Credit for Other Dependents Worksheet - Line 13A

Instructions You should prepare the return by hand. You will find the forms you need in the workbook. If you prefer using online, fillable forms, click on the links at the end of this case study to access the forms. Taxpayer Information Bruce H. Harrison Taxpayer name: Taxpayer SSN: Taxpayer DOB: Taxpayer occupation: 201-00-0045 April 1, 1977 Contractor Spouse name: Spouse SSN: Spouse DOB: Spouse occupation: Lois A. Harrison 201-00-1451 March 28, 1982 Newscaster Address: Cell phone (T): 1312 Locust Street Your City, YS XXXXX (XXX) 555-6336; Preferred: Anytime; FCC: Yes; OK to call (XXX) 555-6363; Anytime; FCC: Yes; OK to call bhharrison@net.net Tharrison@net.net Cell phone (S): Taxpayer email: Spouse email: Yes Health Insurance Information Did everyone in the household have health insurance in 2019? Total months covered through a state exchange or federal marketplace: Total months covered through an employer-sponsored plan: Was a Form 1095-A issued? 0 12 No Bruce and Lois Harrison are new clients. Last year, they prepared their own return using online software, but this year, they would like professional assistance. They are married and wish to file a joint tax return. Both of their SSNs are valid for work in the U.S. and were received before the original filing due date of their return (including extensions). Both are U.S. citizens. No one may claim them as dependents. Neither is a student. They both wish to designate $3 to the Presidential Election Campaign Fund. Neither is blind or disabled. Bruce and Lois did not suffer any casualty losses during the current tax year. They did not receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency. Neither Bruce nor Lois have a financial interest in or signature authority over a foreign account. They did not receive a distribution from, nor were they the grantors of or transferor to, a foreign trust. The IRS has not issued any Identity Protection ID Numbers for their return. They did not receive a notice from the IRS or any state or local taxing authority within the last year. Neither Bruce nor Lois provide a driver's license or state identification. Household Information Bruce and Lois own their home. They have two children. Dependent name: Dependent SSN: Dependent DOB: Dependent relationship: Time in household: Gross income: Support: Lyla B. Harrison 201-00-2451 July 12, 2014 Daughter 12 months $0 Does not provide over half of her own support Kevin E. Harrison 201-00-2452 October 15, 2016 Dependent name: Dependent SSN: Dependent DOB: Dependent relationship: Time in household: Gross income: Support: Son 12 months $0 Does not provide over half of his own support Lyla and Kevin lived with Bruce and Lois all year, and they did not have any income. Neither is married or disabled. They are both U.S. citizens. Lyla and Kevin have SSNs that are valid for work in the United States and were received before the due date for the return (including extensions). Bruce and Lois brought in copies of medical records for both children. Adjustments Lois contributed $2,500 to a traditional IRA during the year. She only has one IRA account, and the value of this account on December 31, 2019, was $13,097.85. All of her previous contributions were deductible. Lois has never taken a distribution from this or any other retirement account. Bruce is covered by an employer-sponsored retirement plan, but Lois is not. Credits Bruce and Lois paid Little Ones Learning Center $7,200 ($3,600 for each child) to care for Kevin and Lyla while they worked. The center's EIN is 09-2014501. It is located at 1521 West Plain Road, Your City, YS XXXXX. The phone number for the Center is (XXX) 555-0034. Bruce and Lois have documentation substantiating this expense. Self-Employment Income Lois has always been an avid reader, and during the year, she had an opportunity to lead a book club at a nearby community center. The community center paid Lois for this work. At the end of the year, they sent Lois a Form 1099-MISC reporting an amount for nonemployee compensation in box 7 of the form. This form is shown in the Information Documents section. The community center is within walking distance of the couple's home, so Lois did not have any vehicle or travel expenses. Her only business- related expense was for $225 in supplies. For purposes of the qualified business income deduction (QBID), this is not a specified service trade or business (SSTB). Lois did not pay any qualified wages, nor does she have any qualified business property, or any losses or short-term gains from asset disposition. Capital Assets Bruce was unhappy with the performance of an investment he had made in 2017. He sold the shares of stock on November 7, 2019, for fear the stock would continue its downward trend. Information relating to this sale was reported on a Form 1099-B. This form is shown in the Information Documents section. Itemized Deductions Bruce and Lois want to itemize deductions if it will be more beneficial than taking the standard deduction. They bring a Form 1098 reporting mortgage interest and real estate taxes paid on their personal residence. This is shown in the Information Documents section. Bruce and Lois would prefer to take the state income tax deduction rather than the sales tax deduction. They also had the following potentially deductible items for 2019: Item Amount Notes 2018 State balance due $582 Made this payment on April 10, 2019 Cash donation to Cancer Research Foundation $475 Paid March 4, 2019 Information Documents a Employee's social security number XXX-XX-0045 b Employer identification number EIN) 09-2014502 c Employer's name, address, and ZIP code ELM CONSTRUCTION AGENCY 6 GREENWOOD LANE YOUR CITY, YS XXXXX Safe, accurate, Visit the IFS website at OMB No 1545-0008 FAST! Use e file www.is.govletle Viages, tips other compensation 2 Federal income tax withheld 39,950.00 2,671.05 3 Social Security wages 4 Social security to withheld 42,950.00 6 Medicare wages and tips 6 Modicare tax withhold 42,950.00 622.78 7 Social secunty lps 8 Allocated tips 2,662.90 d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suff 11 Nonqunified plans 113 Sutuloy Pent This party BRUCE H. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX 12a See instructions for box 12 DD 17,485.00 12b D 3,000.00 12c 14 Other 120 1 Employee's address and ZIP code 15 State Employer's state ID number YS 490020210A 18 Local wages, tips, to 19 Local income tax 20 Locality name 16 Sate wages, tips to 39,950.00 17 State income tax 2,197.25 Department of the Treasury-Internal Revenue Service Form W-2 wage and Tax 2019 Statement Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service a Employee's social secunty number 201-00-1451 b Employer identification number EIN) 09-2014503 c Employer's name, address, and ZIP code LOCAL NEWS NETWORK 112 NORTHERN STREET YOUR CITY, YS XXXXX Safe, accurate, Visit the IRS website at OMB No 1545-0008 FAST! Use se file www.irs.govine 1 Wages, tips other compensation 2 Federal income tax withheld 44,500.00 3,517.79 3 Social Security wages 4 Social Security tax withhold 44,500.00 2,759.00 5 Medicare wages and tips 6 Medicare tax withheld 44,500.00 645.25 7 Social security fps 8 Allocated tips d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suft 11 Nonqualified plans 12a See instructions for box 12 13 Uly Logowe 12b LOIS A. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX Tid party sky I 14 Other 12c 12d 1 Employee's address and ZIP code 15 Stue Employer's stalo ID number YS 490020211A 16 State Wago, tips, to 18 Local wages, tips, to , 17 State income tax 2,447.50 19 Local income tax 20 Locality name 44,500.00 Department of the Treasury-Internal Revenue Service 2019 Form Statement Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service. OMB No. 1545-0115 2019 CORRECTED (f checked) PAYER'S name, street address, city or town, state or province, country. ZIP 1 Rents or foreign postal code, and telephone no . NEIGHBORHOOD COMMUNITY CENTER 2 Royalties 1511 CHERRY STREET YOUR CITY, YS XXXXX $ 816-555-XXXX 3 Other income $ PAYER'S TIN RECIPIENT'S TIN 5 Fishing boat proceeds Miscellaneous Income Form 1099-MISC 4 Federal income tax withheld Copy B For Recipient 6 Medical and heat care payments 09-2014504 201-00-1451 RECIPIENT'S name LOIS A. HARRISON Street address (including apt. no.) . 1312 LOCUST STREET City or town, state or province, country, and ZIP or foreign postal code YOUR CITY, YS XXXXX Account raumber (see instructions ) FATCA Sling requirement $ $ 7 Nonemployee compensation 8 Substituto payments in our dividends or inforest This is important tax information and is being furnished to $1,550.00 $ the IRS. If you are 9 Payer made direct sale of 10 Crop insurance proceeds required to file a $5,000 or more of consumo return, a negligence products to a buyer penalty or other frecipient for $ sanction may be 11 12 imposed on you if this income is taxable and the IRS 13 Exoss golden parachute 14 Gross proceeds paid to an determines that it payments atomy has not been reported $ $ 16 State tax withheld 17 State/Payer's state no. 18 State income $ $ , 15a Section 409A deferrals 15b Section 400A income $ Form 1099-MISC $ (keep for your records) www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service 2019 Barter Exchange CORRECTED (if checked) PAYER'S name, street address, aty or town, state or province, country, ZIP Applicable checkbox on Form 8049 OMB No 1545-0715 Proceeds From or foreign postal code, and tolephone no. D Broker and I TRADE ONLINE INVESTMENTS 5621 LA HABRA PARKWAY, STE 13 Form 1099-B Transactions YOUR CITY, YS XXXXX 1a Description of property (Example: 100 sh.XYZ Co.) 816-555-XXXX 100 SHARES ALX 1b Date acquired 1o Date sold or disposed 05/05/2017 11/01/2019 PAYER'S TIN RECIPIENT'S TIN 1d Proceeds 1e Cost or other basis Copy B $ 2,700.00 $ 3,100.00 For Recipient 09-2014505 XXX-XX-0045 1f Accrued market discount 1g Wash sale loss disallowed $ RECIPIENT'S name 2 Short form gain or loss 3 It checked, proceeds from BRUCE H. HARRISON Long-term gain or loss X Collectibles Ordinary QOF This is important tax Street address including apt, no! 4 Federal income tax withheld 5 checked, noncovered information and is security $ being furnished to 1312 LOCUST STREET : 6 Reported to RS: the IRS. If you are 7 It checked, los is not allowed City or town, state or province, country, and ZP or foreign postal code required to file a , based on amount in 1d Gross proceeds return, a negligence YOUR CITY, YS XXXXX Net proceeds penalty or other 8 Profit ordons realized in 9 Unrealized profit or loss) on sanction may be 2019 on closed contracts open contracts-12/31/2018 imposed on your Account number (see instructions) 12-34567891 this income is $ taxable and the IRS CUSIP number FATCA filing 10 Unrealed profit of four on 11 Aggregate profit or (0) determines that it open contracts - 12/31/2019 on contracts has not been reported 14 State name 15 State identification no 16 State tax withheld $ $ 12 I checked, basis reported 13 Bartering to RS requirement n Form 1099-B (Keep for your records) www.is.gov/Form 10000 Department of the Treasury Internal Revenue Service - 2019 principal CORRECTED (if checked) RECIPIENTS/LENDER'S name, street address, city or town, state or 'Caution: The amount shown may OMB No 1545-1380 province, country, ZP or foreign postal code, and telephone no. not be fully deductible by you. Limits based on the loan amount Mortgage and the cost and value of the secured properly may apply. Also, Interest REALTY MORTGAGE COMPANY you may only deduct interest b the extent was incurred by you Statement 691 PLEASANT GROVE Jadually paid by you, and nc reimbursed by another person Form 1098 YOUR CITY, YS XXXXX XXX-555-XXXX 1 Mortgage interest received from payer(s)borrower(s) Copy B $ 8,241.64 For Payer/ RECIPIENTS/LENDER'S TIN PAYER'S BORROWER'S TIN 2 Outstanding mortgage 3 Mortgage origination date Borrower 05/04/2014 $ 125,067.00 09-2014506 The information in boxes XXX-XX-0045 through 9 and 11 is important 4 Refund of overpaid 5 Mortgage insurance interest premiums tax information and is being PAYER'S/BORROWER'S name furnished to the IRS. If you are / $ $ required to file a return, a BRUCE AND LOIS HARRISON 6 Points paid on purchase of principal residence negligence penaty or other $ sanction may be imposedon you if the IRS determines that Street address (including apt. no.) 7 X I address of property securing mortgage is the same an underpayment of tax as PAYER'S/BORROWER'S address, the box is checked, or results because you 1312 LOCUST STREET the address or description is entered in box 8. overstated a deduction for this mortgage interest or for City or town, state or province, country, and ZIP or foreign postal code 8 Address or description of property securing mortgage (see these points, reported in instructions) boxes 1 and 6, or because YOUR CITY, YS XXXXX you didn't report the round of interest box 4; or because 9 Number of properties securing the 10 Other you claimed a nondeductible mortgage item RE TAX: $2,315 11 Mortgage acquisition date Account number (see instructions) Form 1098 Keep for your records) www.is.gov/Form 1098 Department of the Treasury - Internal Revenue Service - Instructions You should prepare the return by hand. You will find the forms you need in the workbook. If you prefer using online, fillable forms, click on the links at the end of this case study to access the forms. Taxpayer Information Bruce H. Harrison Taxpayer name: Taxpayer SSN: Taxpayer DOB: Taxpayer occupation: 201-00-0045 April 1, 1977 Contractor Spouse name: Spouse SSN: Spouse DOB: Spouse occupation: Lois A. Harrison 201-00-1451 March 28, 1982 Newscaster Address: Cell phone (T): 1312 Locust Street Your City, YS XXXXX (XXX) 555-6336; Preferred: Anytime; FCC: Yes; OK to call (XXX) 555-6363; Anytime; FCC: Yes; OK to call bhharrison@net.net Tharrison@net.net Cell phone (S): Taxpayer email: Spouse email: Yes Health Insurance Information Did everyone in the household have health insurance in 2019? Total months covered through a state exchange or federal marketplace: Total months covered through an employer-sponsored plan: Was a Form 1095-A issued? 0 12 No Bruce and Lois Harrison are new clients. Last year, they prepared their own return using online software, but this year, they would like professional assistance. They are married and wish to file a joint tax return. Both of their SSNs are valid for work in the U.S. and were received before the original filing due date of their return (including extensions). Both are U.S. citizens. No one may claim them as dependents. Neither is a student. They both wish to designate $3 to the Presidential Election Campaign Fund. Neither is blind or disabled. Bruce and Lois did not suffer any casualty losses during the current tax year. They did not receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency. Neither Bruce nor Lois have a financial interest in or signature authority over a foreign account. They did not receive a distribution from, nor were they the grantors of or transferor to, a foreign trust. The IRS has not issued any Identity Protection ID Numbers for their return. They did not receive a notice from the IRS or any state or local taxing authority within the last year. Neither Bruce nor Lois provide a driver's license or state identification. Household Information Bruce and Lois own their home. They have two children. Dependent name: Dependent SSN: Dependent DOB: Dependent relationship: Time in household: Gross income: Support: Lyla B. Harrison 201-00-2451 July 12, 2014 Daughter 12 months $0 Does not provide over half of her own support Kevin E. Harrison 201-00-2452 October 15, 2016 Dependent name: Dependent SSN: Dependent DOB: Dependent relationship: Time in household: Gross income: Support: Son 12 months $0 Does not provide over half of his own support Lyla and Kevin lived with Bruce and Lois all year, and they did not have any income. Neither is married or disabled. They are both U.S. citizens. Lyla and Kevin have SSNs that are valid for work in the United States and were received before the due date for the return (including extensions). Bruce and Lois brought in copies of medical records for both children. Adjustments Lois contributed $2,500 to a traditional IRA during the year. She only has one IRA account, and the value of this account on December 31, 2019, was $13,097.85. All of her previous contributions were deductible. Lois has never taken a distribution from this or any other retirement account. Bruce is covered by an employer-sponsored retirement plan, but Lois is not. Credits Bruce and Lois paid Little Ones Learning Center $7,200 ($3,600 for each child) to care for Kevin and Lyla while they worked. The center's EIN is 09-2014501. It is located at 1521 West Plain Road, Your City, YS XXXXX. The phone number for the Center is (XXX) 555-0034. Bruce and Lois have documentation substantiating this expense. Self-Employment Income Lois has always been an avid reader, and during the year, she had an opportunity to lead a book club at a nearby community center. The community center paid Lois for this work. At the end of the year, they sent Lois a Form 1099-MISC reporting an amount for nonemployee compensation in box 7 of the form. This form is shown in the Information Documents section. The community center is within walking distance of the couple's home, so Lois did not have any vehicle or travel expenses. Her only business- related expense was for $225 in supplies. For purposes of the qualified business income deduction (QBID), this is not a specified service trade or business (SSTB). Lois did not pay any qualified wages, nor does she have any qualified business property, or any losses or short-term gains from asset disposition. Capital Assets Bruce was unhappy with the performance of an investment he had made in 2017. He sold the shares of stock on November 7, 2019, for fear the stock would continue its downward trend. Information relating to this sale was reported on a Form 1099-B. This form is shown in the Information Documents section. Itemized Deductions Bruce and Lois want to itemize deductions if it will be more beneficial than taking the standard deduction. They bring a Form 1098 reporting mortgage interest and real estate taxes paid on their personal residence. This is shown in the Information Documents section. Bruce and Lois would prefer to take the state income tax deduction rather than the sales tax deduction. They also had the following potentially deductible items for 2019: Item Amount Notes 2018 State balance due $582 Made this payment on April 10, 2019 Cash donation to Cancer Research Foundation $475 Paid March 4, 2019 Information Documents a Employee's social security number XXX-XX-0045 b Employer identification number EIN) 09-2014502 c Employer's name, address, and ZIP code ELM CONSTRUCTION AGENCY 6 GREENWOOD LANE YOUR CITY, YS XXXXX Safe, accurate, Visit the IFS website at OMB No 1545-0008 FAST! Use e file www.is.govletle Viages, tips other compensation 2 Federal income tax withheld 39,950.00 2,671.05 3 Social Security wages 4 Social security to withheld 42,950.00 6 Medicare wages and tips 6 Modicare tax withhold 42,950.00 622.78 7 Social secunty lps 8 Allocated tips 2,662.90 d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suff 11 Nonqunified plans 113 Sutuloy Pent This party BRUCE H. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX 12a See instructions for box 12 DD 17,485.00 12b D 3,000.00 12c 14 Other 120 1 Employee's address and ZIP code 15 State Employer's state ID number YS 490020210A 18 Local wages, tips, to 19 Local income tax 20 Locality name 16 Sate wages, tips to 39,950.00 17 State income tax 2,197.25 Department of the Treasury-Internal Revenue Service Form W-2 wage and Tax 2019 Statement Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service a Employee's social secunty number 201-00-1451 b Employer identification number EIN) 09-2014503 c Employer's name, address, and ZIP code LOCAL NEWS NETWORK 112 NORTHERN STREET YOUR CITY, YS XXXXX Safe, accurate, Visit the IRS website at OMB No 1545-0008 FAST! Use se file www.irs.govine 1 Wages, tips other compensation 2 Federal income tax withheld 44,500.00 3,517.79 3 Social Security wages 4 Social Security tax withhold 44,500.00 2,759.00 5 Medicare wages and tips 6 Medicare tax withheld 44,500.00 645.25 7 Social security fps 8 Allocated tips d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suft 11 Nonqualified plans 12a See instructions for box 12 13 Uly Logowe 12b LOIS A. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX Tid party sky I 14 Other 12c 12d 1 Employee's address and ZIP code 15 Stue Employer's stalo ID number YS 490020211A 16 State Wago, tips, to 18 Local wages, tips, to , 17 State income tax 2,447.50 19 Local income tax 20 Locality name 44,500.00 Department of the Treasury-Internal Revenue Service 2019 Form Statement Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service. OMB No. 1545-0115 2019 CORRECTED (f checked) PAYER'S name, street address, city or town, state or province, country. ZIP 1 Rents or foreign postal code, and telephone no . NEIGHBORHOOD COMMUNITY CENTER 2 Royalties 1511 CHERRY STREET YOUR CITY, YS XXXXX $ 816-555-XXXX 3 Other income $ PAYER'S TIN RECIPIENT'S TIN 5 Fishing boat proceeds Miscellaneous Income Form 1099-MISC 4 Federal income tax withheld Copy B For Recipient 6 Medical and heat care payments 09-2014504 201-00-1451 RECIPIENT'S name LOIS A. HARRISON Street address (including apt. no.) . 1312 LOCUST STREET City or town, state or province, country, and ZIP or foreign postal code YOUR CITY, YS XXXXX Account raumber (see instructions ) FATCA Sling requirement $ $ 7 Nonemployee compensation 8 Substituto payments in our dividends or inforest This is important tax information and is being furnished to $1,550.00 $ the IRS. If you are 9 Payer made direct sale of 10 Crop insurance proceeds required to file a $5,000 or more of consumo return, a negligence products to a buyer penalty or other frecipient for $ sanction may be 11 12 imposed on you if this income is taxable and the IRS 13 Exoss golden parachute 14 Gross proceeds paid to an determines that it payments atomy has not been reported $ $ 16 State tax withheld 17 State/Payer's state no. 18 State income $ $ , 15a Section 409A deferrals 15b Section 400A income $ Form 1099-MISC $ (keep for your records) www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service 2019 Barter Exchange CORRECTED (if checked) PAYER'S name, street address, aty or town, state or province, country, ZIP Applicable checkbox on Form 8049 OMB No 1545-0715 Proceeds From or foreign postal code, and tolephone no. D Broker and I TRADE ONLINE INVESTMENTS 5621 LA HABRA PARKWAY, STE 13 Form 1099-B Transactions YOUR CITY, YS XXXXX 1a Description of property (Example: 100 sh.XYZ Co.) 816-555-XXXX 100 SHARES ALX 1b Date acquired 1o Date sold or disposed 05/05/2017 11/01/2019 PAYER'S TIN RECIPIENT'S TIN 1d Proceeds 1e Cost or other basis Copy B $ 2,700.00 $ 3,100.00 For Recipient 09-2014505 XXX-XX-0045 1f Accrued market discount 1g Wash sale loss disallowed $ RECIPIENT'S name 2 Short form gain or loss 3 It checked, proceeds from BRUCE H. HARRISON Long-term gain or loss X Collectibles Ordinary QOF This is important tax Street address including apt, no! 4 Federal income tax withheld 5 checked, noncovered information and is security $ being furnished to 1312 LOCUST STREET : 6 Reported to RS: the IRS. If you are 7 It checked, los is not allowed City or town, state or province, country, and ZP or foreign postal code required to file a , based on amount in 1d Gross proceeds return, a negligence YOUR CITY, YS XXXXX Net proceeds penalty or other 8 Profit ordons realized in 9 Unrealized profit or loss) on sanction may be 2019 on closed contracts open contracts-12/31/2018 imposed on your Account number (see instructions) 12-34567891 this income is $ taxable and the IRS CUSIP number FATCA filing 10 Unrealed profit of four on 11 Aggregate profit or (0) determines that it open contracts - 12/31/2019 on contracts has not been reported 14 State name 15 State identification no 16 State tax withheld $ $ 12 I checked, basis reported 13 Bartering to RS requirement n Form 1099-B (Keep for your records) www.is.gov/Form 10000 Department of the Treasury Internal Revenue Service - 2019 principal CORRECTED (if checked) RECIPIENTS/LENDER'S name, street address, city or town, state or 'Caution: The amount shown may OMB No 1545-1380 province, country, ZP or foreign postal code, and telephone no. not be fully deductible by you. Limits based on the loan amount Mortgage and the cost and value of the secured properly may apply. Also, Interest REALTY MORTGAGE COMPANY you may only deduct interest b the extent was incurred by you Statement 691 PLEASANT GROVE Jadually paid by you, and nc reimbursed by another person Form 1098 YOUR CITY, YS XXXXX XXX-555-XXXX 1 Mortgage interest received from payer(s)borrower(s) Copy B $ 8,241.64 For Payer/ RECIPIENTS/LENDER'S TIN PAYER'S BORROWER'S TIN 2 Outstanding mortgage 3 Mortgage origination date Borrower 05/04/2014 $ 125,067.00 09-2014506 The information in boxes XXX-XX-0045 through 9 and 11 is important 4 Refund of overpaid 5 Mortgage insurance interest premiums tax information and is being PAYER'S/BORROWER'S name furnished to the IRS. If you are / $ $ required to file a return, a BRUCE AND LOIS HARRISON 6 Points paid on purchase of principal residence negligence penaty or other $ sanction may be imposedon you if the IRS determines that Street address (including apt. no.) 7 X I address of property securing mortgage is the same an underpayment of tax as PAYER'S/BORROWER'S address, the box is checked, or results because you 1312 LOCUST STREET the address or description is entered in box 8. overstated a deduction for this mortgage interest or for City or town, state or province, country, and ZIP or foreign postal code 8 Address or description of property securing mortgage (see these points, reported in instructions) boxes 1 and 6, or because YOUR CITY, YS XXXXX you didn't report the round of interest box 4; or because 9 Number of properties securing the 10 Other you claimed a nondeductible mortgage item RE TAX: $2,315 11 Mortgage acquisition date Account number (see instructions) Form 1098 Keep for your records) www.is.gov/Form 1098 Department of the Treasury - Internal Revenue Service