14. How do Jennifer's educator expenses affect her tax return?

a. Jennifer can claim these expenses as a miscellaneous itemized deduction on her Schedule A.

b. These expenses do not affect her tax return.

c. $250 is deducted as an adjustment to income on Form 1040, Schedule 1.

d. Jennifer is entitled to deduct the full $350 as an adjustment to income on Form 1040, Schedule 1.

15. What is the amount of Jennifer's child and dependent care credit shown on Form 2441, Child and Dependent Care Expenses?

a. $0

b. $525

c. $650

d. $2,500

16. The total amount of qualified education expenses used in the calculation of Jennifer's 2019 American opportunity credit is:

a. $3,000

b. $3,650

c. $3,970

d. $4,000

Advanced Scenario 6: Jennifer Morrison Directions Using the tax software, complete the tax return, including Form 1040 and all appropri ate forms, schedules, or worksheets. Answer the questions following the scenario. Note: When entering Social Security numbers (SSNs) or Employer Identification Numbers (EINS), replace the Xs as directed, or with any four digits of your choice. Interview Notes Jennifer was divorced from her husband in 2014 and has not remarried. Jennifer provided the entire cost of maintaining the household and over half of the support for her children, Carla and Ollie, in 2019. Jennifer claimed earned income credit (EIC) for Ollie and Carla in 2016, but they lived with their father for 8 months that year. Jennifer received a letter from Internal Revenue Service disallowing EIC for tax years 2017 and 2018 Jennifer is a full-time kindergarten teacher and spent $350 to buy books and supplies for her class. Ollie attended daycare while Jennifer worked. In August 2019, Jennifer's daughter, Carla, enrolled in college to pursue a bachelor's degree. She had no previous post-secondary education. Yuma College is a qualified educational institution Carla does not have a felony drug conviction Jennifer brought a Form 1098-T and an account statement from the college. Carla's purchases at the college bookstore were for course-related books The terms of Carla's scholarship require that it be used to pay for tuition. Jennifer received a Form 1099-C for canceled credit card debt. Using the insolvency determination worksheet in Publication 4012, Jennifer determined the value of her assets exceeded her liabilities and that she was solvent at the time the credit card debt was canceled. Jennifer purchased her own health insurance through the Marketplace. She received Form 1095-A. Carla and Ollie were on their father's health insurance plan through his employer all year SOCIAL SECURIT SOCIAL SECURITY L SECO 602-00-XXXX www SECE AL 601-00-XXXX Carla Davis Jennifer Morrison Cada Dais Janifer Menisn tu SOCIAL SECURIT AL SEC 603-00-XXXX Ollie Morrison rww. Ollie Memian Department of the Treasury- Internal Revenue Service Form 13614-C (October 2019) OMB Number Intake/Interview & Quality Review Sheet 1545-1964 Please complete pages 1-4 of this form. You are responsible for the information on your return. Please provide complete and accurate information. if you have questions, please ask the IRS-certified volunteer preparer You will need: Tax Information such as Forms W-2, 1099, 1098, 1095 Social security cards or ITIN letters for all persons on your tax return Picture ID (such as valid driver's license) for you and your spouse. Volunteers are trained to provide high quality service and uphold the highest ethical standards. To report unethical behavior to the IRS, email us at wi.voltax@irs.gov PartI-Your Personal Information (If you are filing a joint retum, enter your names in the same order as last year's return) Last name MORRISON 1. Your first name JENNIFER Daytime telephone number Are you a U.S. citizen? Yes M.I. YOUR PHONE# No 2. Your spouse's first name M.I. Last name Daytime telephone number Is your spouse a U.S. citizen? Yes State YS No ZIP code YOUR ZIP 3. Mailing address 450 SARASOTA TERRACE Apt # City YOUR CITY 4. Your Date of Birth 5. Your job title TEACHER 6. Last year, were you: a. Full-time student Yes No Yes No Yes No Yes No b. Totally and permanently disabled 04/15/1975 Yes XNo C. Legally blind 7. Your spouse's Date of Birth 8. Your spouse's job title 9. Last year, was your spouse: b. Totally and permanently disabled Yes No Unsure a. Full-time student C. Legally blind Yes No 10. Can anyone claim you or your spouse as a dependent? 11. Have you, your spouse, or dependents been a victim of tax related identity theft or been issued an Identity Protection PIN? Part II Marital Status and Household Information 1. As of December 31, 2019, what Never Married Yes No (This includes registered domestic partnerships, civil unions, or other formal relationships under state law) was your marital status? Married Yes No a. If Yes, Did you get married in 2019? b. Did you live with your spouse during any part of the last six months of 2019? Date of final decree Yes No 7/23/2014 Divorced Legally Separated Date of separate maintenance decree Year of spouse's death Widowed 2. List the names below of: everyone who lived with you last year (other than your spouse) anyone you supported but did not live with you last year If additional space is needed check hereand list on page 3 To be completed by a Certified Volunteer Preparer Did this person have less child/relative more than than $4,200 than 50 % of half the cost of of any other 50 % of his / of income? support for (yesho) Relationship Number of US months lived in your home last year Resident Single or of US Did this |ron provide Did the txayer(s) provide more pay more than Did the taxpayer(s) Ful-time Totally and Is this Married as Student Permanently person a qualifying Name (first, last) Do not enter your name or spouse's name below Date of Birth Citizen (mm/ddlyy) to you (for example: Son, daughter parent none, etc) (c) (yesho) Canada. of 12/31/19 ast year Disabled or Mexico (SM) last year (yes/ho) (yes/ho) (yesho) maintaining a this person? home for this (yeshanWA) person? (yesho) her own support? (yesho) person? (yesho) (i) (a) CARLA DAVIS (b) (d) (e) (9) S (h) DAUGHTER 07/15/00 12 YES YES YES NO 03/12/10 SON YES S NO OLLIE MORRISON 12 YES YES Form 13614-C (Rev. 10-2019) Catalog Number 52121E .irs gov Page 2 Check appropriate box for each question in each section Yes No Unsure Part Il Income Last Year, Did You (or Your Spouse) Receive 1. (B) Wages or Salary? (Form W-2)If yes, how many jobs did you have last year? 1 2. (A) Tip Income? 3. (B) Scholarships? (Forms W-2, 1098-T) 4. (B) Interest/Dividends from: checking/savings accounts, bonds, CDs, brokerage? (Forms 1099-INT, 1099-DIV) 5. (B) Refund of state/local income taxes? (Form 1099-G) 6. (B) Alimony income or separate maintenance payments? 7. (A) Self-Employment income? (Form 1099-MISC, cash) 8. (A) Cash/check payments for any work performed not reported on Forms W-2 or 1099? 9. (A) Income (or loss) from the sale of Stocks, Bonds or Real Estate? (including your home) (Forms 1099-S, 1099-B) 10. (B) Disability income? (such as payments from insurance, or workers compensation) (Forms 1099-R, W-2) 11. (A) Retirement income or payments from Pensions. Annuities, and or IRA? (Form 1099-R) 12. (B) Unemployment Compensation? (Form 1099G) 13. (B) Social Security or Railroad Retirement Benefits? (Forms SSA-1099, RRB-1099) 14. (M) Income (or loss) from Rental Property? 15. (B) Other income? (gambling, lottery, prizes, awards, jury duty, Sch K-1, royalties, foreign income, etc.) Specify FORM 1099-C No Unsure Part IV - Expenses Last Year, Did You (or Your Spouse) Pay 1. (B) Alimony or separate maintenance payments? Yes If yes, do you have the recipient's SSN? Yes No IRA (A) 401K (B) Roth IRA (B) 2. Contributions to a retirement account? Other 3. (B) College or post secondary educational expenses for yourself, spouse or dependents? (Form 1098-T) 4. (A) Any of the following? Medical & Dental (including insurance premiums) Mortgage Interest (Form 1098) Charitable Contributions Taxes (State, Real Estate, Personal Property, Sales) 5. (B) Child or dependent care expenses such as daycare? 6. (B) For supplies used as an eligible educator such as a teacher, teacher's aide, counselor, etc.? 7. (A) Expenses related to self-employment income or any other income you received? 8. (B) Student loan interest? (Form 1098-E) Yes No Unsure Part V- Life Events Last Year, Did You (or Your Spouse) 1. (HSA) Have a Health Savings Account? (Forms 5498-SA, 1099-SA, W-2 with code W in box 12) 2. (A) Have credit card or mortgage debt cancelled/forgiven by a lender or have a home foreclosure? (Forms 1099-C, 1099-A) 3. (A) Adopt a child? 4. (B) Have Earned Income Credit, Child Tax Credit or American Opportunity Credit disallowed in a prior year? If yes, for which tax year? 2016 5. (A) Purchase and install energy-efficient home items? (such as windows, furnace, insulation, etc.) 6. (A) Receive the First Time Homebuyers Credit in 2008? 7. (B) Make estimated tax payments or apply last year's refund to this year's tax? If so how much? 8. (A) File a federal return last year containing a "capital loss carryover" on Form 1040 Schedule D? 9. (A) Have health coverage through the Marketplace (Exchange)? [Provide Form 1095-A] Form 13614-C (Rev. 10-2019) Catalog Number 52121E www.irs.gov Page 3 Additional Information and Questions Related to the Preparation of Your Return 1. Provide an email address (optional) (this email address will not be used for contacts from the Intermal Revenue Service) 2. Presidential Election Campaign Fund (If you check a box, your tax or refund will not change) Check here if you, or your spouse if filing jointly, want $3 to go to this fund 3. If you are due a refund, would you like: You b. To purchase U.S. Savings Bonds Yes Spouse a. Direct deposit Yes 4. If you have a balance due, would you like to make a payment directly from your bank account? c. To split your refund between different accounts Yes No No No No Yes 5. Live in an area that was declared a Federal disaster area? Yes No If yes, where? 6. Did you, or your spouse if filing jointly, receive a letter from the IRS? Many free tax preparation sites operate by receiving grant money or other federal financial assistance. The data from the following questions may be used by this site to apply for these grants or to support continued receipt of financial funding. Your answer will be used only for statistical purposes. These questions Yes No are optional. 7. Would you say you can carry on a conversation in English, both understanding & speaking? Very well 8. Would you say you can read a newspaper or book in English? Well Not well Not at allPrefer not to answer Very well Well Prefer not to answer Not well Prefer not to answer Not at all No No 9. Do you or any member of your household have a disability? Yes 10. Are you or your spouse a Veteran from the U.S. Armed Forces? Yes Prefer not to answer 11. Your race? American Indian or Alaska Native Asian Black or African American Native Hawaian or other Pacific Islander White Prefer not to answer 12. Your spouse's race? American Indian or Alaska Native 13. Your ethnicity? 14. Your spouse's ethnicity? Asian Black or African American Hispanic or Latino Hispanic or Latino White Native Hawaiian or other Pacific Islander Prefer not to answer Not Hispanic or Latino Prefer not to answer Not Hispanic or Latino Prefer not to answer Additional comments Privacy Act and Paperwork Reduction Act Notice The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 US.C. 301. We are asking for this information to assist us in contacting you relative to your interest and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be funished to others who coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective controls, send correspondence and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to use your assistance in these programs. The Paperwork Reduction Act requires that the IRS display an OMB control number on all public information requests. The OMB Control Number for this study is 1545-1964. Also, if you have any comments regarding the time estimates associated with this study or suggestion on making this process simpler, please write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR MP:TTSP, 1111 Constitution Ave. NW, Washington, DC 20224 Form 13614-C (Rev. 10-2019) Catalog Number 52121E www.irs.gov a Employee's social security rumber 601-00-XXXX Safe, accurate, Visit the IRS website at se file www.irs.gowlele OMB No. 1545-0008 FAST! Use b Employar identification number (EIN 2 Federal income tax withheld 2,200.00 4 Social security tax withheld 1 Wages, tips, other compensaton 41,000.00 3 Social security wages 34-600XXXX c Employer's name, addreas, and ZIP code 43,000.00 2,666.00 GILMER ELEMENTARY SCHOOL 5 Medicare wages and tips 6 Medicare tax withheld 2250 DELTA AVENUE 43,000.00 624.00 YOUR CITY, STATE ZIP Social security tips 8 Alocated tips 7 d Control number 10 Dependent care benelits Suff. 11 Nonquaified plane Employee's firat name and initial Last name 12a See instructions for box 12 2,000.00 E 12b 13 r erpioyee Third-paty sck pay JENNIFER MORRISON Rerenant plan 450 SARASOTA TERRACE X YOUR CITY, STATE ZIP 14 Other 12c 12d f Employee's address and ZIP code Employer's state ID number 18 Local wages, tips, etc. 19 Local income tax 16 State wages, tips, etc. 17 State income tax |20 Locality name 15 State YS 34-600XXxx 41,000.00 1,800.00 Wage and Tax Statement W-2 2019 Department of the Treasury-Internal Revenue Service Form Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Intemal Revenue Service. CORRECTED (if checked) CREDITOR'S name, street address, city or town, state or province, country, 1 Date of identifiable event ZIP or foreign postal code, and telephone no. OMB No. 1545-1424 06/15/19 Cancellation 2 Amount of debt discharged $ PRAIRIE BANK 2019 of Debt 1727 OSAGE WAY YOUR CITY, STATE ZIP 1,100.00 3 Interest if included in box 2 $ Form 1099-C Copy B CREDITOR'S TIN DEBTORS TIN 4 Debt description 601-00-XXXX 30-600XXXX For Debtor CREDIT CARD DEBTOR'S name This is important tax information and is being fumished to the IRS. if you are required to file a retun, a neglgence JENNIFER MORRISON Street address (inckuding apt. no) 5 If checked, the debtor was personally liable for repayment of the debt 450 SARASOTA TERRACE sanction miy be imposed on you if taxable income results from this transaction and the IRS determines that it has not been reported City or town, state or province, country, and ZIP or foreign postal code YOUR CITY, STATE ZIP 6 ldentifiable event code Account number (see instructions) 7 Fair market value of property G Form 1099-C (keep for your records) Department of the Treasury Internal Revenue Service www.irs.gow/Fom1099C CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or 1 Payments received for foreign postal code, and telephone rumber OMB No. 1545-1574 qualifed tuition and related xpenses Tuition 2019 YUMA COLLEGE 7,200.00 Statement 2 10 COLLEGE AVE YOUR CITY, STATE ZIP Form 1098-T Copy B FILER'S employer identitication no. STUDENT S TIN 3 37-700XXXX STUDENT'S name 602-00-XXXX For Student 5 Scholarships or grants 4 Adjustments made for a prior year This is important tax information and is being furnished to the IRS. This form must be used to complete Form 8863 to cleim education credits. Give it to the tax proparer or use it to prepare the tax return CARLA DAVIS 4,200.00 Street address (including apt. no) 6 Adjustments to scholarships or grants for a prior year 7 Checked if the amount in box 1 includes amounts for an academic period beginning January 450 SARASOTA TERRACE City or town, state or province, oountry, and 2P or foreign postal code YOUR CITY, STATE ZIP Service Providen/Acct. No. see instr.) March 2020 10 Ins. contract reimb/retund 9 Checked if a graduate 8 Check if at least half-time student student Form 1098-T Department of the Treasury-Internal Revenue Service keep for your records) www.irs.gow/Form1098T Health Insurance Marketplace Statement Form 1095-A VOID OMB No. 1545-2232 2019 Do not attach to your tax return. Keep for your records Go to www.irs.gov/Form 1095A for instructions and the latest information CORRECTED Department of the Treasury Intemal Revenue Service Recipient Information Part 3 Policy issuer's name INSURER 1 Marketplace identifier 2 Marketplace-assigned policy number 12-3456789 987654 4 Recipient's name 5 Recipient's SSN 6 Recipient's date of birth 04/15/1975 JENNIFER MORRISON 601-XX-XXXX 9 Recipient's spouse's date of birth 7 Recipient's spouse's name 8 Recipient's spouse's 5SN 12 Street address Gincluding apartment no 10 Policy start date 11 Policy termination date 450 SARASOTA TERRACE 15 Country and ZIP or foreign postal code 12/31/2019 01/01/2019 13 City or town YOUR CITY 14 State or peavince YOUR STATE YOUR ZIP Part II Covered Individuals C. Covered individual date of birth D. Coverage start date A, Covered individual name B. Covered individual SSN E. Coverage termination date JENNIFER MORRISON 16 601-XX-XXXX 12/31/2019 04/15/1975 01/01/2019 17 18 19 20 Part I Coverage Information C. Monthly advance payment of premium tax credit A. Monthly enrollment premiums B. Monthly second lowest cost silver plan (SLCSP) premium Month $452.58 $375.00 $125.00 21 January $452.58 $375.00 $125.00 22 February $452.58 $375.00 $125.00 23 March $452.58 24 April $375.00 $125.00 $452.58 $375.00 $125.00 25 May $452.58 $375.00 $125.00 26 June $452.58 $375.00 $125.00 27 July $452.58 $375.00 $125.00 28 August $452.58 $375.00 $125.00 29 September $452.58 $375.00 $125.00 30 October $452.58 $375.00 $125.00 31 November $452.58 $375.00 $125.00 32 December $5,430.96 $4,500.00 $1,500.00 33 Annual Totals Form 1095-A (2018 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions Cat. No.60703Q Yuma College Statement of Account December 31, 2019 Carla Davis Student ID 602-00-xxxx Date Transaction Amount Billed Amount Paid 08/30/2019 Tuition Fall Semester 2019 +$7,200.00 08/30/2019 Scholarship -$4,200.00 09/03/2019 Meal plan 09/03/2019 Parking pass +$ 320.00 +$ 75.00 Campus Bookstore charge to student account + 650.00 09/04/2019 Payment- check # 1234 -$4,045.00 09/05/2019 12/31/2019 Account Balance... $0.00 303 Twiggs Trail Your City, Your State Your Zip Ph: (555) 555-1234 Busy Bee Day Care December 31, 2019 Received from Jennifer Morrison: $2,500 for after-school care for Ollie Morrison $2,500 Total amount received for child care in 2019 Ellen River EIN: 35-900XXXX 1234 Jennifer Morrison 450 Sarasota Terrace Your City, State 00000 20 PAY TO THE ORDER OF DOLLARS Adelphi Bank and Trust Anytown, State 00000 For :111000025 : 123456789 1234 Advanced Scenario 6: Jennifer Morrison Directions Using the tax software, complete the tax return, including Form 1040 and all appropri ate forms, schedules, or worksheets. Answer the questions following the scenario. Note: When entering Social Security numbers (SSNs) or Employer Identification Numbers (EINS), replace the Xs as directed, or with any four digits of your choice. Interview Notes Jennifer was divorced from her husband in 2014 and has not remarried. Jennifer provided the entire cost of maintaining the household and over half of the support for her children, Carla and Ollie, in 2019. Jennifer claimed earned income credit (EIC) for Ollie and Carla in 2016, but they lived with their father for 8 months that year. Jennifer received a letter from Internal Revenue Service disallowing EIC for tax years 2017 and 2018 Jennifer is a full-time kindergarten teacher and spent $350 to buy books and supplies for her class. Ollie attended daycare while Jennifer worked. In August 2019, Jennifer's daughter, Carla, enrolled in college to pursue a bachelor's degree. She had no previous post-secondary education. Yuma College is a qualified educational institution Carla does not have a felony drug conviction Jennifer brought a Form 1098-T and an account statement from the college. Carla's purchases at the college bookstore were for course-related books The terms of Carla's scholarship require that it be used to pay for tuition. Jennifer received a Form 1099-C for canceled credit card debt. Using the insolvency determination worksheet in Publication 4012, Jennifer determined the value of her assets exceeded her liabilities and that she was solvent at the time the credit card debt was canceled. Jennifer purchased her own health insurance through the Marketplace. She received Form 1095-A. Carla and Ollie were on their father's health insurance plan through his employer all year SOCIAL SECURIT SOCIAL SECURITY L SECO 602-00-XXXX www SECE AL 601-00-XXXX Carla Davis Jennifer Morrison Cada Dais Janifer Menisn tu SOCIAL SECURIT AL SEC 603-00-XXXX Ollie Morrison rww. Ollie Memian Department of the Treasury- Internal Revenue Service Form 13614-C (October 2019) OMB Number Intake/Interview & Quality Review Sheet 1545-1964 Please complete pages 1-4 of this form. You are responsible for the information on your return. Please provide complete and accurate information. if you have questions, please ask the IRS-certified volunteer preparer You will need: Tax Information such as Forms W-2, 1099, 1098, 1095 Social security cards or ITIN letters for all persons on your tax return Picture ID (such as valid driver's license) for you and your spouse. Volunteers are trained to provide high quality service and uphold the highest ethical standards. To report unethical behavior to the IRS, email us at wi.voltax@irs.gov PartI-Your Personal Information (If you are filing a joint retum, enter your names in the same order as last year's return) Last name MORRISON 1. Your first name JENNIFER Daytime telephone number Are you a U.S. citizen? Yes M.I. YOUR PHONE# No 2. Your spouse's first name M.I. Last name Daytime telephone number Is your spouse a U.S. citizen? Yes State YS No ZIP code YOUR ZIP 3. Mailing address 450 SARASOTA TERRACE Apt # City YOUR CITY 4. Your Date of Birth 5. Your job title TEACHER 6. Last year, were you: a. Full-time student Yes No Yes No Yes No Yes No b. Totally and permanently disabled 04/15/1975 Yes XNo C. Legally blind 7. Your spouse's Date of Birth 8. Your spouse's job title 9. Last year, was your spouse: b. Totally and permanently disabled Yes No Unsure a. Full-time student C. Legally blind Yes No 10. Can anyone claim you or your spouse as a dependent? 11. Have you, your spouse, or dependents been a victim of tax related identity theft or been issued an Identity Protection PIN? Part II Marital Status and Household Information 1. As of December 31, 2019, what Never Married Yes No (This includes registered domestic partnerships, civil unions, or other formal relationships under state law) was your marital status? Married Yes No a. If Yes, Did you get married in 2019? b. Did you live with your spouse during any part of the last six months of 2019? Date of final decree Yes No 7/23/2014 Divorced Legally Separated Date of separate maintenance decree Year of spouse's death Widowed 2. List the names below of: everyone who lived with you last year (other than your spouse) anyone you supported but did not live with you last year If additional space is needed check hereand list on page 3 To be completed by a Certified Volunteer Preparer Did this person have less child/relative more than than $4,200 than 50 % of half the cost of of any other 50 % of his / of income? support for (yesho) Relationship Number of US months lived in your home last year Resident Single or of US Did this |ron provide Did the txayer(s) provide more pay more than Did the taxpayer(s) Ful-time Totally and Is this Married as Student Permanently person a qualifying Name (first, last) Do not enter your name or spouse's name below Date of Birth Citizen (mm/ddlyy) to you (for example: Son, daughter parent none, etc) (c) (yesho) Canada. of 12/31/19 ast year Disabled or Mexico (SM) last year (yes/ho) (yes/ho) (yesho) maintaining a this person? home for this (yeshanWA) person? (yesho) her own support? (yesho) person? (yesho) (i) (a) CARLA DAVIS (b) (d) (e) (9) S (h) DAUGHTER 07/15/00 12 YES YES YES NO 03/12/10 SON YES S NO OLLIE MORRISON 12 YES YES Form 13614-C (Rev. 10-2019) Catalog Number 52121E .irs gov Page 2 Check appropriate box for each question in each section Yes No Unsure Part Il Income Last Year, Did You (or Your Spouse) Receive 1. (B) Wages or Salary? (Form W-2)If yes, how many jobs did you have last year? 1 2. (A) Tip Income? 3. (B) Scholarships? (Forms W-2, 1098-T) 4. (B) Interest/Dividends from: checking/savings accounts, bonds, CDs, brokerage? (Forms 1099-INT, 1099-DIV) 5. (B) Refund of state/local income taxes? (Form 1099-G) 6. (B) Alimony income or separate maintenance payments? 7. (A) Self-Employment income? (Form 1099-MISC, cash) 8. (A) Cash/check payments for any work performed not reported on Forms W-2 or 1099? 9. (A) Income (or loss) from the sale of Stocks, Bonds or Real Estate? (including your home) (Forms 1099-S, 1099-B) 10. (B) Disability income? (such as payments from insurance, or workers compensation) (Forms 1099-R, W-2) 11. (A) Retirement income or payments from Pensions. Annuities, and or IRA? (Form 1099-R) 12. (B) Unemployment Compensation? (Form 1099G) 13. (B) Social Security or Railroad Retirement Benefits? (Forms SSA-1099, RRB-1099) 14. (M) Income (or loss) from Rental Property? 15. (B) Other income? (gambling, lottery, prizes, awards, jury duty, Sch K-1, royalties, foreign income, etc.) Specify FORM 1099-C No Unsure Part IV - Expenses Last Year, Did You (or Your Spouse) Pay 1. (B) Alimony or separate maintenance payments? Yes If yes, do you have the recipient's SSN? Yes No IRA (A) 401K (B) Roth IRA (B) 2. Contributions to a retirement account? Other 3. (B) College or post secondary educational expenses for yourself, spouse or dependents? (Form 1098-T) 4. (A) Any of the following? Medical & Dental (including insurance premiums) Mortgage Interest (Form 1098) Charitable Contributions Taxes (State, Real Estate, Personal Property, Sales) 5. (B) Child or dependent care expenses such as daycare? 6. (B) For supplies used as an eligible educator such as a teacher, teacher's aide, counselor, etc.? 7. (A) Expenses related to self-employment income or any other income you received? 8. (B) Student loan interest? (Form 1098-E) Yes No Unsure Part V- Life Events Last Year, Did You (or Your Spouse) 1. (HSA) Have a Health Savings Account? (Forms 5498-SA, 1099-SA, W-2 with code W in box 12) 2. (A) Have credit card or mortgage debt cancelled/forgiven by a lender or have a home foreclosure? (Forms 1099-C, 1099-A) 3. (A) Adopt a child? 4. (B) Have Earned Income Credit, Child Tax Credit or American Opportunity Credit disallowed in a prior year? If yes, for which tax year? 2016 5. (A) Purchase and install energy-efficient home items? (such as windows, furnace, insulation, etc.) 6. (A) Receive the First Time Homebuyers Credit in 2008? 7. (B) Make estimated tax payments or apply last year's refund to this year's tax? If so how much? 8. (A) File a federal return last year containing a "capital loss carryover" on Form 1040 Schedule D? 9. (A) Have health coverage through the Marketplace (Exchange)? [Provide Form 1095-A] Form 13614-C (Rev. 10-2019) Catalog Number 52121E www.irs.gov Page 3 Additional Information and Questions Related to the Preparation of Your Return 1. Provide an email address (optional) (this email address will not be used for contacts from the Intermal Revenue Service) 2. Presidential Election Campaign Fund (If you check a box, your tax or refund will not change) Check here if you, or your spouse if filing jointly, want $3 to go to this fund 3. If you are due a refund, would you like: You b. To purchase U.S. Savings Bonds Yes Spouse a. Direct deposit Yes 4. If you have a balance due, would you like to make a payment directly from your bank account? c. To split your refund between different accounts Yes No No No No Yes 5. Live in an area that was declared a Federal disaster area? Yes No If yes, where? 6. Did you, or your spouse if filing jointly, receive a letter from the IRS? Many free tax preparation sites operate by receiving grant money or other federal financial assistance. The data from the following questions may be used by this site to apply for these grants or to support continued receipt of financial funding. Your answer will be used only for statistical purposes. These questions Yes No are optional. 7. Would you say you can carry on a conversation in English, both understanding & speaking? Very well 8. Would you say you can read a newspaper or book in English? Well Not well Not at allPrefer not to answer Very well Well Prefer not to answer Not well Prefer not to answer Not at all No No 9. Do you or any member of your household have a disability? Yes 10. Are you or your spouse a Veteran from the U.S. Armed Forces? Yes Prefer not to answer 11. Your race? American Indian or Alaska Native Asian Black or African American Native Hawaian or other Pacific Islander White Prefer not to answer 12. Your spouse's race? American Indian or Alaska Native 13. Your ethnicity? 14. Your spouse's ethnicity? Asian Black or African American Hispanic or Latino Hispanic or Latino White Native Hawaiian or other Pacific Islander Prefer not to answer Not Hispanic or Latino Prefer not to answer Not Hispanic or Latino Prefer not to answer Additional comments Privacy Act and Paperwork Reduction Act Notice The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 US.C. 301. We are asking for this information to assist us in contacting you relative to your interest and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be funished to others who coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective controls, send correspondence and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to use your assistance in these programs. The Paperwork Reduction Act requires that the IRS display an OMB control number on all public information requests. The OMB Control Number for this study is 1545-1964. Also, if you have any comments regarding the time estimates associated with this study or suggestion on making this process simpler, please write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR MP:TTSP, 1111 Constitution Ave. NW, Washington, DC 20224 Form 13614-C (Rev. 10-2019) Catalog Number 52121E www.irs.gov a Employee's social security rumber 601-00-XXXX Safe, accurate, Visit the IRS website at se file www.irs.gowlele OMB No. 1545-0008 FAST! Use b Employar identification number (EIN 2 Federal income tax withheld 2,200.00 4 Social security tax withheld 1 Wages, tips, other compensaton 41,000.00 3 Social security wages 34-600XXXX c Employer's name, addreas, and ZIP code 43,000.00 2,666.00 GILMER ELEMENTARY SCHOOL 5 Medicare wages and tips 6 Medicare tax withheld 2250 DELTA AVENUE 43,000.00 624.00 YOUR CITY, STATE ZIP Social security tips 8 Alocated tips 7 d Control number 10 Dependent care benelits Suff. 11 Nonquaified plane Employee's firat name and initial Last name 12a See instructions for box 12 2,000.00 E 12b 13 r erpioyee Third-paty sck pay JENNIFER MORRISON Rerenant plan 450 SARASOTA TERRACE X YOUR CITY, STATE ZIP 14 Other 12c 12d f Employee's address and ZIP code Employer's state ID number 18 Local wages, tips, etc. 19 Local income tax 16 State wages, tips, etc. 17 State income tax |20 Locality name 15 State YS 34-600XXxx 41,000.00 1,800.00 Wage and Tax Statement W-2 2019 Department of the Treasury-Internal Revenue Service Form Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Intemal Revenue Service. CORRECTED (if checked) CREDITOR'S name, street address, city or town, state or province, country, 1 Date of identifiable event ZIP or foreign postal code, and telephone no. OMB No. 1545-1424 06/15/19 Cancellation 2 Amount of debt discharged $ PRAIRIE BANK 2019 of Debt 1727 OSAGE WAY YOUR CITY, STATE ZIP 1,100.00 3 Interest if included in box 2 $ Form 1099-C Copy B CREDITOR'S TIN DEBTORS TIN 4 Debt description 601-00-XXXX 30-600XXXX For Debtor CREDIT CARD DEBTOR'S name This is important tax information and is being fumished to the IRS. if you are required to file a retun, a neglgence JENNIFER MORRISON Street address (inckuding apt. no) 5 If checked, the debtor was personally liable for repayment of the debt 450 SARASOTA TERRACE sanction miy be imposed on you if taxable income results from this transaction and the IRS determines that it has not been reported City or town, state or province, country, and ZIP or foreign postal code YOUR CITY, STATE ZIP 6 ldentifiable event code Account number (see instructions) 7 Fair market value of property G Form 1099-C (keep for your records) Department of the Treasury Internal Revenue Service www.irs.gow/Fom1099C CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or 1 Payments received for foreign postal code, and telephone rumber OMB No. 1545-1574 qualifed tuition and related xpenses Tuition 2019 YUMA COLLEGE 7,200.00 Statement 2 10 COLLEGE AVE YOUR CITY, STATE ZIP Form 1098-T Copy B FILER'S employer identitication no. STUDENT S TIN 3 37-700XXXX STUDENT'S name 602-00-XXXX For Student 5 Scholarships or grants 4 Adjustments made for a prior year This is important tax information and is being furnished to the IRS. This form must be used to complete Form 8863 to cleim education credits. Give it to the tax proparer or use it to prepare the tax return CARLA DAVIS 4,200.00 Street address (including apt. no) 6 Adjustments to scholarships or grants for a prior year 7 Checked if the amount in box 1 includes amounts for an academic period beginning January 450 SARASOTA TERRACE City or town, state or province, oountry, and 2P or foreign postal code YOUR CITY, STATE ZIP Service Providen/Acct. No. see instr.) March 2020 10 Ins. contract reimb/retund 9 Checked if a graduate 8 Check if at least half-time student student Form 1098-T Department of the Treasury-Internal Revenue Service keep for your records) www.irs.gow/Form1098T Health Insurance Marketplace Statement Form 1095-A VOID OMB No. 1545-2232 2019 Do not attach to your tax return. Keep for your records Go to www.irs.gov/Form 1095A for instructions and the latest information CORRECTED Department of the Treasury Intemal Revenue Service Recipient Information Part 3 Policy issuer's name INSURER 1 Marketplace identifier 2 Marketplace-assigned policy number 12-3456789 987654 4 Recipient's name 5 Recipient's SSN 6 Recipient's date of birth 04/15/1975 JENNIFER MORRISON 601-XX-XXXX 9 Recipient's spouse's date of birth 7 Recipient's spouse's name 8 Recipient's spouse's 5SN 12 Street address Gincluding apartment no 10 Policy start date 11 Policy termination date 450 SARASOTA TERRACE 15 Country and ZIP or foreign postal code 12/31/2019 01/01/2019 13 City or town YOUR CITY 14 State or peavince YOUR STATE YOUR ZIP Part II Covered Individuals C. Covered individual date of birth D. Coverage start date A, Covered individual name B. Covered individual SSN E. Coverage termination date JENNIFER MORRISON 16 601-XX-XXXX 12/31/2019 04/15/1975 01/01/2019 17 18 19 20 Part I Coverage Information C. Monthly advance payment of premium tax credit A. Monthly enrollment premiums B. Monthly second lowest cost silver plan (SLCSP) premium Month $452.58 $375.00 $125.00 21 January $452.58 $375.00 $125.00 22 February $452.58 $375.00 $125.00 23 March $452.58 24 April $375.00 $125.00 $452.58 $375.00 $125.00 25 May $452.58 $375.00 $125.00 26 June $452.58 $375.00 $125.00 27 July $452.58 $375.00 $125.00 28 August $452.58 $375.00 $125.00 29 September $452.58 $375.00 $125.00 30 October $452.58 $375.00 $125.00 31 November $452.58 $375.00 $125.00 32 December $5,430.96 $4,500.00 $1,500.00 33 Annual Totals Form 1095-A (2018 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions Cat. No.60703Q Yuma College Statement of Account December 31, 2019 Carla Davis Student ID 602-00-xxxx Date Transaction Amount Billed Amount Paid 08/30/2019 Tuition Fall Semester 2019 +$7,200.00 08/30/2019 Scholarship -$4,200.00 09/03/2019 Meal plan 09/03/2019 Parking pass +$ 320.00 +$ 75.00 Campus Bookstore charge to student account + 650.00 09/04/2019 Payment- check # 1234 -$4,045.00 09/05/2019 12/31/2019 Account Balance... $0.00 303 Twiggs Trail Your City, Your State Your Zip Ph: (555) 555-1234 Busy Bee Day Care December 31, 2019 Received from Jennifer Morrison: $2,500 for after-school care for Ollie Morrison $2,500 Total amount received for child care in 2019 Ellen River EIN: 35-900XXXX 1234 Jennifer Morrison 450 Sarasota Terrace Your City, State 00000 20 PAY TO THE ORDER OF DOLLARS Adelphi Bank and Trust Anytown, State 00000 For :111000025 : 123456789 1234