comple 2019 1040 return

Taxpayer Information Taxpayer name: Taxpayer SSN: Taxpayer DOB: Taxpayer occupation: Bruce H. Harrison 201-00-0045 April 1, 1977 Contractor Spouse name: use 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 Iharrison@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 ependents. 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 Dependent name: Dependent SSN: Dependent DOB: Dependent relationship: Time in household: Gross income: Support: Kevin E. Harrison 201-00-2452 October 15, 2016 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 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: Amount Notes Item $582 Made this payment on April 10, 2019 2018 State balance due $475 Paid March 4, 2019 Cash donation to Cancer Research Foundation a Employee Soon Sounity rumbu XXX-XX-0045 b Employer identication number EIN) 09-2014502 e Employer's name, address, und ZIP code ELM CONSTRUCTION AGENCY 6 GREENWOOD LANE YOUR CITY, YS XXXXX Sole, accurate, VISIT WW OMB No 1548-0008 FASTI Use re- file www.gorillo Wages, promaten 2 FO nome WAR 39,950.00 2,671.05 3 Social Security wages Society 42,950.00 2,662.90 6 Modicor wages and tips 6 Medicarota withald 42,950.00 622.78 7 So Seounty tips & Allocated tips d Control number 9 10 Dependente benefits Employee's first name and in Line Sun 11 Nongusilied plans 13 Vie BRUCE H. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX 12a Serructions for boa 12 DD 17,485.00 120 D 3,000.00 120 14 Other 120 18 Low 10 Loow income tax 1 Employee's dos and ZP code 15 Employer's number YS 490020210A Local 16 Step 39,950.00 17 Stas income tax 2,197.25 Department of the Treasury-Internal Revenue Service W-2 Wage and Tax 2019 Form Statement Copy B-To Be Fled With Employee's FEDERAL Tax Return This information is being furnished to the internal Revenue Service Employee Soon Security numor 201-00-1451 b Employer location number ) 09-2014503 G Employer's name, address and ZIP code LOCAL NEWS NETWORK 112 NORTHERN STREET YOUR CITY, YS XXXXX Sale, accurate, VATTIR Weber OMB No 1546-0008 FASTI Use me-file www.sgordeli Wa, competion 2 rooms with 44,500.00 3,517.79 3 Scat Leonly wages 4 SOCI Security withhold 44,500.00 2,759.00 5 Modicoro wages and tips 6 Medicare fac withheld 44,500.00 645.25 7 social sountly to & Alocado d Control number 9 10 Dependent care benefits Employee's first name and Last Su 11 Nonqunt bed plans 12a See instructions for bom 12 113 AN TO 12 LOIS A. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX 14 Other 12e 12d 1 Employee's so and ZP code 15 Employer's number YS 490020211A 18 Lool wig pada 10 Local come tax 16 Sewage tips 44,500.00 17 State income tax 2,447.50 Department of the Treasury-In Revenue Sec W-2 Statement Wage and Tax Form Copy B-To Be Fled With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service 2019 CORRECTED I checked) PAYER mesto day to earn awdy, Ponto CLS NESOFT Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service OM NOM5-0115 CORRECTED (t checked) PAYER'S name, street address, oily or town, state or pronon, country.ZIP 1 Rants oboran postcode, and telephone no. NEIGHBORHOOD COMMUNITY CENTER 2 Royalties 1511 CHERRY STREET YOUR CITY, YS XXXXX 816-555-XXXX Dother one 2019 Miscellaneous Income Form 1099-MISC 4 Federatiewe $ OS Copy B For Recipient PAYERS TIN RECIPIENTS TN 5Fwgbroede 09-2014504 201-00-1451 RECPIENT'Same $ 7 Noyee.com Sutisepums dworst LOIS A. HARRISON Set address inducing eplna) 1312 LOCUST STREET City towar porno, outry, and ZP or foreign petal code YOUR CITY, YS XXXXX ) FATCA $ 1,550.00 $ Pays dream of 10 Crope procede $5400 or if pro D$ 11 12 This is important tax information and is being furnished to the IRS. If you are required to file return, a negligence penalty or other sanction may be imposed on your this income is taxable and the IRS determines that it has not been reported 14 Geo proceed paid to an wony 13 Exona olen paradite payments $ 16 State tax wild 16 Second 16 Sedan 400 WG 17 Stellen stalne $ $ Depenthe Trendy-walowe Service $ Fem 1099-MISC $ op for your records) www.gam1000LASC CORRECTED (if checked) 5.0715 CORRECTED (it checked PAYER'S namo, cercet addres, aty or town, state or province, country, ZP Popolo checkbox on Form 2010 OMB No 1545-0715 oxforeign postal code and telephone no. Proceeds From D I TRADE ONLINE INVESTMENTS 2019 Broker and Barter Exchange 5621 LA HABRA PARKWAY, STE 13 Form 1099-B Transactions YOUR CITY, YS XXXXX 18 Description of property (Example: 100 sh.XYZ Co.) 816-555-XXXX 100 SHARES ALX 1b Date aoqured 1c Date sold or disposed 05/06/2017 11/01/2019 PAYER'S TN RECPENT'S TIN 1d Proceeds Te Cost or other basis Copy B $ 2,700.00 $ 3,100.00 For Recipient 09-2014505 XXX-XX-0045 11 Accrued market discount 19 Wash sale loss disallowed RECPENT'Shame BRUCE H. HARRISON Street address including pl.no 1312 LOCUST STREET City or town, state or province, country, and ZP or foreign pantal.code YOUR CITY, YS XXXXX 2 Short-term gun or loss 3 I checked. proceeds from Long-term gain or los Collectibles Ordinwy Qof This is important tax 4 Federal income tax wild 6 I checked, noored information and is $ security being furnished to 6 Reported to RS 7 checked, lors is not allowed the IRS. If you are based on amount ind required to file a Groe proceeds return, a negligence Nel proceeds penalty or other 8 Pro or los realized in Ured poto doo sanction may be 2019 on closed contracts opac-1231/2016 imposed on your this income is $ taxable and the IRS 10 Ured poto 11 Agregate preto determines that it open contracts-1231 2010 o contacts has not been reported Account (inction 12-34567891 CUSP number FATCA ling ment 14 Stato namo 16 Sudan 16 state tax with $ $ (Keep for your records) 12 checked, bass reported 13 Burtoning to RS Form 1099-B www.sgow Farm 1000B Department of the Treasury - Revenue Service Form 1099-B (Keep for your records) www.FB Department of the Treasury - We Revenue 2019 REALTY MORTGAGE COMPANY CORRECTED (if checked) RECPIENT SENDER S name, street address, city of town, Caution: The aim owny OMB No 1545-1300 province, country, ZP or foreign postal code and telephone no not be by you La don the loan amount and the costan var of the Mortgage plynuyas Ave, Interest You only od rest to was not 691 PLEASANT GROVE Statement day party w by where YOUR CITY, YS XXXXX Fem 1098 XXX-556-XXXX 1 Metry interest received from payers borrowers] Copy B $ 8,241.64 For Payer/ RECPENT SENDER'S TIN PAYER MERROWERS TIN 2Manding mortgage 3 Mortgage anginan dete Borrower 09-2014506 $ 125,067.00 The formation in borst XXX-XX-0045 05/04/2014 kind overal Mortgage mura trough and 11 a inportant pres to information and a bang wie uned to RS you as PAYER'SBORROWER'S e $ reared to runa Pats padon purchase of propaledice agligence party BRUCE AND LOIS HARRISON sanctions benoudon bouilted that Street address ang pt.no) 7 X address of property ring mortgage is the same andment of PAYER'SVEROWER'Saddress, we bris decked, because you 1312 LOCUST STREET the address or description is entered in box 8. Over deduction for homonage resort Cry or town, state provide country, and ZP of foreign postal code 8 Addis description properly securing mortgage fee rese por ported in instrucione) bousandor because YOUR CITY, YS XXXXX you dont porter under are borobic you can donate Number of properties in the 10 Other mortgage RE TAX: $2,316 Account number we structors Form 1098 Kemp for your record www.Form 100 Department of the Treasury Revenue Service SL0316 1095-B 560118 Health Coverage VOD OME Do not attach to your tax return. Ker for your CORRECTED 2019 www Go to www.imfos fine the dermati Parti Responsible Individual 1 7 BRUCE HARRISON XXX-XX-0045 Eng Oh OS Taxe 1312 LOCUST STREET YOUR CITY YS USA XXXXX Endring Origin of the Cowans for Part It Information About Cortin Employer Sponsored Coverage see instructions 10 11 NON ELM CONSTRUCTION AGENCY 09-2014502 15 C 6 GREENWOOD LANE YOUR CITY YS USA XXXXX Part Iuer or Other Coverage Provider instructions) 1 min C. GENERAL INSURANCE COMPANY 09-2014607 (XXX) 662-5543 30 CP 1776 TURNBULL CANYON YOUR CITY YS USA XXXXX Part N Covered individuals Enter the information for each covered individu Jan Feb Apr M M A Od De DOO DO BRUCE H. HARRISON XXX-XX-0045 XO Los A HARRISON 201-00-1451 DO BD x D > LYLA B. HARRISON 201-00-2451 OOO ODD BD DO KEVIN E. HARRISON 201-00-2462 O Forms Taxpayer Information Taxpayer name: Taxpayer SSN: Taxpayer DOB: Taxpayer occupation: Bruce H. Harrison 201-00-0045 April 1, 1977 Contractor Spouse name: use 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 Iharrison@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 ependents. 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 Dependent name: Dependent SSN: Dependent DOB: Dependent relationship: Time in household: Gross income: Support: Kevin E. Harrison 201-00-2452 October 15, 2016 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 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: Amount Notes Item $582 Made this payment on April 10, 2019 2018 State balance due $475 Paid March 4, 2019 Cash donation to Cancer Research Foundation a Employee Soon Sounity rumbu XXX-XX-0045 b Employer identication number EIN) 09-2014502 e Employer's name, address, und ZIP code ELM CONSTRUCTION AGENCY 6 GREENWOOD LANE YOUR CITY, YS XXXXX Sole, accurate, VISIT WW OMB No 1548-0008 FASTI Use re- file www.gorillo Wages, promaten 2 FO nome WAR 39,950.00 2,671.05 3 Social Security wages Society 42,950.00 2,662.90 6 Modicor wages and tips 6 Medicarota withald 42,950.00 622.78 7 So Seounty tips & Allocated tips d Control number 9 10 Dependente benefits Employee's first name and in Line Sun 11 Nongusilied plans 13 Vie BRUCE H. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX 12a Serructions for boa 12 DD 17,485.00 120 D 3,000.00 120 14 Other 120 18 Low 10 Loow income tax 1 Employee's dos and ZP code 15 Employer's number YS 490020210A Local 16 Step 39,950.00 17 Stas income tax 2,197.25 Department of the Treasury-Internal Revenue Service W-2 Wage and Tax 2019 Form Statement Copy B-To Be Fled With Employee's FEDERAL Tax Return This information is being furnished to the internal Revenue Service Employee Soon Security numor 201-00-1451 b Employer location number ) 09-2014503 G Employer's name, address and ZIP code LOCAL NEWS NETWORK 112 NORTHERN STREET YOUR CITY, YS XXXXX Sale, accurate, VATTIR Weber OMB No 1546-0008 FASTI Use me-file www.sgordeli Wa, competion 2 rooms with 44,500.00 3,517.79 3 Scat Leonly wages 4 SOCI Security withhold 44,500.00 2,759.00 5 Modicoro wages and tips 6 Medicare fac withheld 44,500.00 645.25 7 social sountly to & Alocado d Control number 9 10 Dependent care benefits Employee's first name and Last Su 11 Nonqunt bed plans 12a See instructions for bom 12 113 AN TO 12 LOIS A. HARRISON 1312 LOCUST STREET YOUR CITY, YS XXXXX 14 Other 12e 12d 1 Employee's so and ZP code 15 Employer's number YS 490020211A 18 Lool wig pada 10 Local come tax 16 Sewage tips 44,500.00 17 State income tax 2,447.50 Department of the Treasury-In Revenue Sec W-2 Statement Wage and Tax Form Copy B-To Be Fled With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service 2019 CORRECTED I checked) PAYER mesto day to earn awdy, Ponto CLS NESOFT Copy B-To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service OM NOM5-0115 CORRECTED (t checked) PAYER'S name, street address, oily or town, state or pronon, country.ZIP 1 Rants oboran postcode, and telephone no. NEIGHBORHOOD COMMUNITY CENTER 2 Royalties 1511 CHERRY STREET YOUR CITY, YS XXXXX 816-555-XXXX Dother one 2019 Miscellaneous Income Form 1099-MISC 4 Federatiewe $ OS Copy B For Recipient PAYERS TIN RECIPIENTS TN 5Fwgbroede 09-2014504 201-00-1451 RECPIENT'Same $ 7 Noyee.com Sutisepums dworst LOIS A. HARRISON Set address inducing eplna) 1312 LOCUST STREET City towar porno, outry, and ZP or foreign petal code YOUR CITY, YS XXXXX ) FATCA $ 1,550.00 $ Pays dream of 10 Crope procede $5400 or if pro D$ 11 12 This is important tax information and is being furnished to the IRS. If you are required to file return, a negligence penalty or other sanction may be imposed on your this income is taxable and the IRS determines that it has not been reported 14 Geo proceed paid to an wony 13 Exona olen paradite payments $ 16 State tax wild 16 Second 16 Sedan 400 WG 17 Stellen stalne $ $ Depenthe Trendy-walowe Service $ Fem 1099-MISC $ op for your records) www.gam1000LASC CORRECTED (if checked) 5.0715 CORRECTED (it checked PAYER'S namo, cercet addres, aty or town, state or province, country, ZP Popolo checkbox on Form 2010 OMB No 1545-0715 oxforeign postal code and telephone no. Proceeds From D I TRADE ONLINE INVESTMENTS 2019 Broker and Barter Exchange 5621 LA HABRA PARKWAY, STE 13 Form 1099-B Transactions YOUR CITY, YS XXXXX 18 Description of property (Example: 100 sh.XYZ Co.) 816-555-XXXX 100 SHARES ALX 1b Date aoqured 1c Date sold or disposed 05/06/2017 11/01/2019 PAYER'S TN RECPENT'S TIN 1d Proceeds Te Cost or other basis Copy B $ 2,700.00 $ 3,100.00 For Recipient 09-2014505 XXX-XX-0045 11 Accrued market discount 19 Wash sale loss disallowed RECPENT'Shame BRUCE H. HARRISON Street address including pl.no 1312 LOCUST STREET City or town, state or province, country, and ZP or foreign pantal.code YOUR CITY, YS XXXXX 2 Short-term gun or loss 3 I checked. proceeds from Long-term gain or los Collectibles Ordinwy Qof This is important tax 4 Federal income tax wild 6 I checked, noored information and is $ security being furnished to 6 Reported to RS 7 checked, lors is not allowed the IRS. If you are based on amount ind required to file a Groe proceeds return, a negligence Nel proceeds penalty or other 8 Pro or los realized in Ured poto doo sanction may be 2019 on closed contracts opac-1231/2016 imposed on your this income is $ taxable and the IRS 10 Ured poto 11 Agregate preto determines that it open contracts-1231 2010 o contacts has not been reported Account (inction 12-34567891 CUSP number FATCA ling ment 14 Stato namo 16 Sudan 16 state tax with $ $ (Keep for your records) 12 checked, bass reported 13 Burtoning to RS Form 1099-B www.sgow Farm 1000B Department of the Treasury - Revenue Service Form 1099-B (Keep for your records) www.FB Department of the Treasury - We Revenue 2019 REALTY MORTGAGE COMPANY CORRECTED (if checked) RECPIENT SENDER S name, street address, city of town, Caution: The aim owny OMB No 1545-1300 province, country, ZP or foreign postal code and telephone no not be by you La don the loan amount and the costan var of the Mortgage plynuyas Ave, Interest You only od rest to was not 691 PLEASANT GROVE Statement day party w by where YOUR CITY, YS XXXXX Fem 1098 XXX-556-XXXX 1 Metry interest received from payers borrowers] Copy B $ 8,241.64 For Payer/ RECPENT SENDER'S TIN PAYER MERROWERS TIN 2Manding mortgage 3 Mortgage anginan dete Borrower 09-2014506 $ 125,067.00 The formation in borst XXX-XX-0045 05/04/2014 kind overal Mortgage mura trough and 11 a inportant pres to information and a bang wie uned to RS you as PAYER'SBORROWER'S e $ reared to runa Pats padon purchase of propaledice agligence party BRUCE AND LOIS HARRISON sanctions benoudon bouilted that Street address ang pt.no) 7 X address of property ring mortgage is the same andment of PAYER'SVEROWER'Saddress, we bris decked, because you 1312 LOCUST STREET the address or description is entered in box 8. Over deduction for homonage resort Cry or town, state provide country, and ZP of foreign postal code 8 Addis description properly securing mortgage fee rese por ported in instrucione) bousandor because YOUR CITY, YS XXXXX you dont porter under are borobic you can donate Number of properties in the 10 Other mortgage RE TAX: $2,316 Account number we structors Form 1098 Kemp for your record www.Form 100 Department of the Treasury Revenue Service SL0316 1095-B 560118 Health Coverage VOD OME Do not attach to your tax return. Ker for your CORRECTED 2019 www Go to www.imfos fine the dermati Parti Responsible Individual 1 7 BRUCE HARRISON XXX-XX-0045 Eng Oh OS Taxe 1312 LOCUST STREET YOUR CITY YS USA XXXXX Endring Origin of the Cowans for Part It Information About Cortin Employer Sponsored Coverage see instructions 10 11 NON ELM CONSTRUCTION AGENCY 09-2014502 15 C 6 GREENWOOD LANE YOUR CITY YS USA XXXXX Part Iuer or Other Coverage Provider instructions) 1 min C. GENERAL INSURANCE COMPANY 09-2014607 (XXX) 662-5543 30 CP 1776 TURNBULL CANYON YOUR CITY YS USA XXXXX Part N Covered individuals Enter the information for each covered individu Jan Feb Apr M M A Od De DOO DO BRUCE H. HARRISON XXX-XX-0045 XO Los A HARRISON 201-00-1451 DO BD x D > LYLA B. HARRISON 201-00-2451 OOO ODD BD DO KEVIN E. HARRISON 201-00-2462 O Forms