$ Document Review Simulation - Mark and Barbara Matthews - FALL 2020 NOTE: All you will turn in for grading is page 1 of this document. Based on the interview notes and the documents below, answer the following items relative to their 2019 Form 1040. If the amount is negative, put a minus (-) before the number. If the amount is zero, write 0. 1. Wages, salaries, tips, etc. $ 2. Taxable interest $ 3. Taxable dividends $ 4. Business income or (deductible loss) $ 5. Capital gain or (deductible loss) $ 6. Taxable IRA distribution $ 7. Taxable pension distribution $ 8. Rental real estate income or (deductible loss) $ 9. Taxable social security benefits $ 10. Taxable other income $ 11. Qualified business income (QBI) deduction $ 12. Federal income tax withheld $ 13. Foreign tax credit $ 14. What is the tax rate on their qualified dividends? 15. Is Barbara's business a specified service trade/business (SSTB)? YES?NO Mark (DOB 02/02/1950) and Barbara (DOB 04/03/1957) Matthews, are married and file jointly. Mark is retired. Barbara is a part-time accounting assistant at Conway Company but also has a bookkeeping practice. They had minimum essential health insurance coverage all year. They have provided you with documentation for their 2019 income and expenses --- see below. You also have obtained the following information from interviewing them: $ 1 INTERVIEW NOTES 1. They tell you in the interview that they have $800 of bingo winnings (no W-2G required to be issued) but also $500 of bingo losses. 2. In addition to being a part-time employee at Conway Company, Barbara is also a self-employed bookkeeper. In 2019, she has documents to prove the following income and expenses: Fees received $90,100 Advertising expenses 1,900 Business meals ($1,400) and business entertainment ($600) 2,000 Office expenses 3,550 Business gifts to 20 clients ($200 Lalique vase to each) 4,000 Business computer purchased and put into service 12/1/19 3,160 Simplified method home office: 380 square foot office (1,900 square foot home) They would like to take the maximum deduction for their expenses in 2019. 3. The Matthews purchased a rent house on 1/2/19 for $180,000 ($120,000 allocated to the structure and $60,000 allocated to the land). They immediately rented it and have the following income and expenses for 2019: Rental income received ($800 x 12) $9,600 Mortgage interest 6,800 Real estate taxes 3,510 Maintenance expense 850 Homeowner's insurance 2,340 Repair expense 1,970 The Matthews actively participated in the management of the rent house but they do not qualify as real estate professionals. The rental activity is not a qualified trade/business. 2 4. Mark retired and began receiving retirement income on March 1, 2017. No distributions were received prior to his retirement. Mark selected a single life annuity for these payments. The plan cost at the annuity start date was $14,500. Mark has already recovered $1,519 of his cost in the plan. They use the simplified method to determine the taxable amount. 5. The Matthews made timely quarterly tax payments for 2019 to IRS of $5,000 each quarter ($20,000 total). DOCUMENTS See the next five pages. 3 Garte, OM N. 1545-0.08 PASTI e file Visit the 11 balet Mw..we 2 Income tax with 2,784.00 ERPUSU 310-00-XXXX En yerin unter 40-000XXXX Empyrerne, adres, and IP code CONWAY COMPANY 25 IMPERIAL LANE YOUR CITY, STATE ZIP 28,500.00 3 Snymages 28,500.00 Medinewegende 28,500.00 7 Socialecarly 1,767.00 Madox held 413.25 8 Allocated 1 1 Dependent cober Lry's first med i Last 1. 11 Noguers 1 eiers for ber 12 13 TY 125 w BARBARA MATTHEWS 742 RED ROOSTER YOUR CITY, STATE ZIP 14 Othe 120 1944 Eye's and Peode 1 LIGGUR 1.Link 20 LOGO YS 34-500XXXX 18 Sess, s. 17 Sencore las 28,500.00 1.400.00 Dentelle Trasy-Ingleverence W-2 statement 2019 Wage and Tax form Copy B-To the Fed With Employee's FEDERAL Tax Return This information is being trnished to the Intema Revenue Service 2019 CORRECTED Of checked PAYER S name, street address, city or town, or province 1 Gross distribution OMB No. 140-011 Distributions From country. IP or forsign postal code, and phone no Pensions, Annuities, 22,532.00 Retirement or PINE CORPORATION Protit-Sharing Plans, 1809 GULF DRIVE 2a Taxable amount IRAs, Insurance YOUR CITY, STATE ZIP Contracts, etc. For 1099-R 2b Taxable amount Total Copy B not determined X distribution Report this PAYERS TIN RECIPIENT'S TIN 3 Capital gain Included Fede income tax income on your Inbox 28 withhold federal tax return. If this form shows 40-100XXXX 317-00-XXXX 2,253.00 federal income RECIPENT S name 5 Employee contributions Net realized tax withheld in Designated Roth appreciation in contbutors or amployer's securities box 4, attach MARK MATTHEWS insurance premis this copy to your return. Stroot address including ept.no) 7 Distribution RAY 8 Other SEP codels SIMPLE This information is 742 RED ROOSTER 7 being lumished to City or low state or province, country, and ZIP or foreign postal code a Your percentage of the total amployer cettes the IRS YOUR CITY, STATE ZIP distribution 15 14,500.00 10 Amour locable to I 11 1st year FATCA fing 12 state tax withheld 13 St Payer's sistono 14 Stat distribution within 5 years delig. Rothcob rogramani Asiant number neordions! 16 Name of locality 17 Local distribution Date of 15 Local tax withhad payment $ $ www.egworm 1000R For 1099-R Deparment of the Treasurya Pro Service 2019 CORRECTED (if checked PAYERS na, sireet adress, chty or town, state or province, 1 Gross distribution OMB NO. 1545-019 Distributions From country. ZIP or foreign postal code and phone no. Pensions, Anities, 3.200.00 Retirement or ESSEX BANK, CUSTODIAN Profit-Sharing Plans FOR ROTH IRA OF MARK MATTHEWS 12 Taxwale amount IRAS, Insurance 300 MARIN STREET Contracts, etc. YOUR CITY, STATE ZIP 0.00 For 1099-R 2b Tetable amount Total Copy B not determined distribution Report this PAYERS TIN RECIPIENTS TIN 3 Capital gain (included 4 Federal income income on your in box 2 federal tax return. If this 48-100XXXX 317-00-XXXX form shows federal income RECIPIENT'S m 5 Employer comoNet uvented tex withheld in Degral Poin appreciation in contributions employer's securities box 4, attach MARK MATTHEWS Insurance premium this copy to your retum. Street address including apl. no.) T Distribution IFA & Other SEPS SIMPLE 742 RED ROOSTER This information is Q being fumised to Cry or town, sain or province, country, and 2P or Foreign postal code Sa Your percentage of broerpop canibaliona the IRS YOUR CITY STATE ZIP darbui *$ 10 Amount tocable to RR 11 1st your FATCA fing 12 Slate the whold 13 State/Payer's state no 14 Siste distribution wein 5 years | darip Rathoonts. | I$ Account number se instruction Date of 15 Local tax withheld 16 Name of locally 17 Local distribution payment For 1099-R www.igo9R Department of the Tremur ve Service 2019 FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT PART OF YOUR BOCAL SECURITY BENEFITSEROWNIK EOK 5 MAY BE TAKABLE INCOME SEE THE AVERE FOR MORE INFORMATION Box 1. Nate Box 2. Benry Bocal Security MARK MATTHEWS 317-00-XXXX Faxa. Pe in 2019 Bax 4. Betapa lo 8 i 2019 exa Ne Bures20 $17 214.00 $17.214.00 DESCRIPTION OF AMOUNT IN BOX 3 DESCRIPTION OF AMOUNT IN BOX 4 Paid by check or direct deposit: $13,867.00 Medicare Part B premiums deducted from your benefits: $1,626.00 Total Additions: Benefits for 2019: $17,214 Ben Volway Force Tow Wide $1,721.00 Box 7. Address 742 Red Rooster Your City, State ZIP B Clin Nurhavn Draft as of June 21, 2019 . Subject to change Fawe GA-1200-EM - DO NOT RETURN THIS FORM TO SAOR IS ABC INVESTMENTS 456 Pima Plaza Your City. YS ZIP 2019 TAX REPORTING STATEMENT Mark and Barbara Matthews 742 Red Rooster Road Your City, YS ZIP Account No. 111-222 Recipient ID No. 317-00-XXXX Payer's Fed ID Number: 40-200XXXX .220.00 189.00 .300.00 .0.00 0.00 -0.00 .50.00 -0.00 -0.00 -0.00 18.00 .0.00 -0.00 0.00 .0.00 .0.00 -0.00 Form 1099-DIV 2019 Dividends and Distributions Copy for Recipient (OMB NO. 1545-0110) 1a Total Ordinary Dividends 1b Qualified Dividends. 2a Total Capital Gain Distributions (Includes 2b-2d). 2b Capital Gains that represent Unrecaptured 1250 Gain 2c Capital Gains that represent Section 1202 Gain. 2d Capital Gains that represent Collectibles (28%) Gain. 3 Nondividend Distributions ... 4 Federal Income Tax Withheld 5 Section 199A Dividends 6 Investment Expenses 7 Foreign Tax Paid. 8 Foreign country or U.S. Possession 9 Cash Liquidation Distributions 10 Non-Cash Liquidation Distributions. 11 Exempt Interest Dividends .12 Specified Private Activity Bond Interest Dividends 13 State ... 14 State Identification No. 15 State Tax Withheld Form 1099-MISC* 2019 Miscellaneous Income Copy B for Resplent OMB NO. 1545-0115) 2 Royalties.. 4 Federal Income Tax Withheld 8 Substitute Payments in Lleu of Dividends or Interest 16 State Tax Withheld 17 State Payer's State No. 18 State Income... Form 1099-INT* 2019 Interest Income Copy Bfor Recipient OMB NO. 1545-01121 1 Interest Income 2 Early Withdrawal Penalty 3 Interest on U.S. Savings Bonds and Treas. Obligations. 4 Federal Income Tax Withheld 5 Investment Expenses. 6 Foreign Tax Pald 7 Foreign country or U.S. Possession 8 Tax-Exempt Interest .. 9 Specified Private Activity Bond Interest 14 Tax-Exempt Bond CUSIP No... Summary of 2019 Proceeds From Broker and Barter Exchange Transactions Sales Price of Stocks, Bonds, etc.. Federal Income Tax Withheld 0.00 ..0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 .0.00 .0.00 0.00 .0.00 6,300.00 ..0.00 Greas Process from each of your security ansactions are reported individusly to the IRS. Refer to the Form 1000-8 action of this statement Report gros procedendidually for each securly on the appropriate moun Do not report gross proceeds in aggregate Page 1 of 2 ABC INVESTMENTS 456 Pima Plaza Your City, YS ZIP 2019 TAX REPORTING STATEMENT Mark and Barbara Matthews 742 Red Rooster Road Your City, YS ZIP Account No. 111-222 Recipient ID No. 317-00-XXXX Payer's Fed ID Number: 40-200XXXX FORM 1099-B* 2019 Proceeds from Broker and Barter Exchange Transactions Capy B for Rent OMB NO. 1545-0715 Short-term transactions for which basis is reported to the IRS Report on Form 8949 with Box A checked and/or Schedule D. Part 1 This is a Bubute for lo ) 8 Description, 1d Stock or Other Symbol, CUSIP (RS Form 1096-B box numbers are shown below in bokltype) Adlon Due 16 Date old ta Quarrity 1d Proceeds te Costor Gan/Con 4 lg Wow Sale Federal Income 14 15 to 18 Acquired ded Sold Other Bags Los Dislowed Tax Wired State Wild Idaho Co. Common Stock Sale 02/01/2018 10/01/2019 250.000 TOTALS (489.00) 1,700.00 1,700.00 2,189.00 2,189.00 FORM 1099-3* 2019 Proceeds from Broker and Barter Exchange Transactions Copy for pent ONB NO. 1546-0715 Long-term transactions for which basis is not reported to the IRS Report on Form 8949 with Box E checked and/or Schedule D, Part II (This Lata Babattute for Beste & 6) Description, 1d Stockor Other Symbol, CUSP ORS Form 1090-8 bok numbers are shown below in bold type) Action 16 Date 1 Date sold ta Quality 1d Proceeds Gain Loss 1 Wash Sale Federal income 14 15 Status Aquired dispod Other Basis Los Disslowed Tax withheld lowa Co. Common Stock Sale 06/15/1999 03/01/2019 200.000 4,800.00 1,700.00 2,900.00 TOTALS 4,600.00 1,700.00 This is important to information and is being fumished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other action may be imposed on you if this income is taxable and the IRS determines that it has not been reported. Page 2 of 2 CORRECTED (if checked) PAYER'Sams, street doros, skyrton, provocoury, ZIP Papers RTN Soal OMB No 1545-0112 or foreign portal de und schon no. Adelphi Bank and Trust 2019 Interest 8020 Yonkers Blvd 1 Indicom Income YOUR CITY, STATE ZIP $ 300.00 For 1099-INT 2 Garty withdrawalparailty Copy B PAYERS TO RECIPIENTS TN For Recipient 3 Interest as U.S. Savings fonds and Treas, olio 34-7XXXXXX 317-00-XXXX RECPIENT'S Federalnom i inwesimest per This is importante $ 20.00 $ Information and is MARK MATTHEWS being funished to the Bort tax paid 7 Frigy US ON RS. you are Streal address including ap.) $ recuired to find return, a negligence 742 RED ROOSTER 8 Tex-ceprest pred hotelyben penalty or other action may be Oty or stata presuntry, and 2 or foreign postal code S imposed on you 10 Marker clocount YOUR CITY, STATE ZIP 11 Bond Drown this income is laxace and the IRS determines that it has FATCAS not be reported requirement 12 personer 13 Border bei Account berec ** Taman NCHI 10 Semester 17Saletas bond CSP Por 1099-INT keep for your records www.goNT Department of the Treasury Internal Revenue Service 1234 Mark and Barbara Matthews 742 Red Rooster Road Your City State 00000 PAY TO THE ORDER OF $ VOID DOLLARS Adelphe Bank and Trust Anylow, State 00000 Fer : 111000025 : 123456789 1234 $ Document Review Simulation - Mark and Barbara Matthews - FALL 2020 NOTE: All you will turn in for grading is page 1 of this document. Based on the interview notes and the documents below, answer the following items relative to their 2019 Form 1040. If the amount is negative, put a minus (-) before the number. If the amount is zero, write 0. 1. Wages, salaries, tips, etc. $ 2. Taxable interest $ 3. Taxable dividends $ 4. Business income or (deductible loss) $ 5. Capital gain or (deductible loss) $ 6. Taxable IRA distribution $ 7. Taxable pension distribution $ 8. Rental real estate income or (deductible loss) $ 9. Taxable social security benefits $ 10. Taxable other income $ 11. Qualified business income (QBI) deduction $ 12. Federal income tax withheld $ 13. Foreign tax credit $ 14. What is the tax rate on their qualified dividends? 15. Is Barbara's business a specified service trade/business (SSTB)? YES?NO Mark (DOB 02/02/1950) and Barbara (DOB 04/03/1957) Matthews, are married and file jointly. Mark is retired. Barbara is a part-time accounting assistant at Conway Company but also has a bookkeeping practice. They had minimum essential health insurance coverage all year. They have provided you with documentation for their 2019 income and expenses --- see below. You also have obtained the following information from interviewing them: $ 1 INTERVIEW NOTES 1. They tell you in the interview that they have $800 of bingo winnings (no W-2G required to be issued) but also $500 of bingo losses. 2. In addition to being a part-time employee at Conway Company, Barbara is also a self-employed bookkeeper. In 2019, she has documents to prove the following income and expenses: Fees received $90,100 Advertising expenses 1,900 Business meals ($1,400) and business entertainment ($600) 2,000 Office expenses 3,550 Business gifts to 20 clients ($200 Lalique vase to each) 4,000 Business computer purchased and put into service 12/1/19 3,160 Simplified method home office: 380 square foot office (1,900 square foot home) They would like to take the maximum deduction for their expenses in 2019. 3. The Matthews purchased a rent house on 1/2/19 for $180,000 ($120,000 allocated to the structure and $60,000 allocated to the land). They immediately rented it and have the following income and expenses for 2019: Rental income received ($800 x 12) $9,600 Mortgage interest 6,800 Real estate taxes 3,510 Maintenance expense 850 Homeowner's insurance 2,340 Repair expense 1,970 The Matthews actively participated in the management of the rent house but they do not qualify as real estate professionals. The rental activity is not a qualified trade/business. 2 4. Mark retired and began receiving retirement income on March 1, 2017. No distributions were received prior to his retirement. Mark selected a single life annuity for these payments. The plan cost at the annuity start date was $14,500. Mark has already recovered $1,519 of his cost in the plan. They use the simplified method to determine the taxable amount. 5. The Matthews made timely quarterly tax payments for 2019 to IRS of $5,000 each quarter ($20,000 total). DOCUMENTS See the next five pages. 3 Garte, OM N. 1545-0.08 PASTI e file Visit the 11 balet Mw..we 2 Income tax with 2,784.00 ERPUSU 310-00-XXXX En yerin unter 40-000XXXX Empyrerne, adres, and IP code CONWAY COMPANY 25 IMPERIAL LANE YOUR CITY, STATE ZIP 28,500.00 3 Snymages 28,500.00 Medinewegende 28,500.00 7 Socialecarly 1,767.00 Madox held 413.25 8 Allocated 1 1 Dependent cober Lry's first med i Last 1. 11 Noguers 1 eiers for ber 12 13 TY 125 w BARBARA MATTHEWS 742 RED ROOSTER YOUR CITY, STATE ZIP 14 Othe 120 1944 Eye's and Peode 1 LIGGUR 1.Link 20 LOGO YS 34-500XXXX 18 Sess, s. 17 Sencore las 28,500.00 1.400.00 Dentelle Trasy-Ingleverence W-2 statement 2019 Wage and Tax form Copy B-To the Fed With Employee's FEDERAL Tax Return This information is being trnished to the Intema Revenue Service 2019 CORRECTED Of checked PAYER S name, street address, city or town, or province 1 Gross distribution OMB No. 140-011 Distributions From country. IP or forsign postal code, and phone no Pensions, Annuities, 22,532.00 Retirement or PINE CORPORATION Protit-Sharing Plans, 1809 GULF DRIVE 2a Taxable amount IRAs, Insurance YOUR CITY, STATE ZIP Contracts, etc. For 1099-R 2b Taxable amount Total Copy B not determined X distribution Report this PAYERS TIN RECIPIENT'S TIN 3 Capital gain Included Fede income tax income on your Inbox 28 withhold federal tax return. If this form shows 40-100XXXX 317-00-XXXX 2,253.00 federal income RECIPENT S name 5 Employee contributions Net realized tax withheld in Designated Roth appreciation in contbutors or amployer's securities box 4, attach MARK MATTHEWS insurance premis this copy to your return. Stroot address including ept.no) 7 Distribution RAY 8 Other SEP codels SIMPLE This information is 742 RED ROOSTER 7 being lumished to City or low state or province, country, and ZIP or foreign postal code a Your percentage of the total amployer cettes the IRS YOUR CITY, STATE ZIP distribution 15 14,500.00 10 Amour locable to I 11 1st year FATCA fing 12 state tax withheld 13 St Payer's sistono 14 Stat distribution within 5 years delig. Rothcob rogramani Asiant number neordions! 16 Name of locality 17 Local distribution Date of 15 Local tax withhad payment $ $ www.egworm 1000R For 1099-R Deparment of the Treasurya Pro Service 2019 CORRECTED (if checked PAYERS na, sireet adress, chty or town, state or province, 1 Gross distribution OMB NO. 1545-019 Distributions From country. ZIP or foreign postal code and phone no. Pensions, Anities, 3.200.00 Retirement or ESSEX BANK, CUSTODIAN Profit-Sharing Plans FOR ROTH IRA OF MARK MATTHEWS 12 Taxwale amount IRAS, Insurance 300 MARIN STREET Contracts, etc. YOUR CITY, STATE ZIP 0.00 For 1099-R 2b Tetable amount Total Copy B not determined distribution Report this PAYERS TIN RECIPIENTS TIN 3 Capital gain (included 4 Federal income income on your in box 2 federal tax return. If this 48-100XXXX 317-00-XXXX form shows federal income RECIPIENT'S m 5 Employer comoNet uvented tex withheld in Degral Poin appreciation in contributions employer's securities box 4, attach MARK MATTHEWS Insurance premium this copy to your retum. Street address including apl. no.) T Distribution IFA & Other SEPS SIMPLE 742 RED ROOSTER This information is Q being fumised to Cry or town, sain or province, country, and 2P or Foreign postal code Sa Your percentage of broerpop canibaliona the IRS YOUR CITY STATE ZIP darbui *$ 10 Amount tocable to RR 11 1st your FATCA fing 12 Slate the whold 13 State/Payer's state no 14 Siste distribution wein 5 years | darip Rathoonts. | I$ Account number se instruction Date of 15 Local tax withheld 16 Name of locally 17 Local distribution payment For 1099-R www.igo9R Department of the Tremur ve Service 2019 FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT PART OF YOUR BOCAL SECURITY BENEFITSEROWNIK EOK 5 MAY BE TAKABLE INCOME SEE THE AVERE FOR MORE INFORMATION Box 1. Nate Box 2. Benry Bocal Security MARK MATTHEWS 317-00-XXXX Faxa. Pe in 2019 Bax 4. Betapa lo 8 i 2019 exa Ne Bures20 $17 214.00 $17.214.00 DESCRIPTION OF AMOUNT IN BOX 3 DESCRIPTION OF AMOUNT IN BOX 4 Paid by check or direct deposit: $13,867.00 Medicare Part B premiums deducted from your benefits: $1,626.00 Total Additions: Benefits for 2019: $17,214 Ben Volway Force Tow Wide $1,721.00 Box 7. Address 742 Red Rooster Your City, State ZIP B Clin Nurhavn Draft as of June 21, 2019 . Subject to change Fawe GA-1200-EM - DO NOT RETURN THIS FORM TO SAOR IS ABC INVESTMENTS 456 Pima Plaza Your City. YS ZIP 2019 TAX REPORTING STATEMENT Mark and Barbara Matthews 742 Red Rooster Road Your City, YS ZIP Account No. 111-222 Recipient ID No. 317-00-XXXX Payer's Fed ID Number: 40-200XXXX .220.00 189.00 .300.00 .0.00 0.00 -0.00 .50.00 -0.00 -0.00 -0.00 18.00 .0.00 -0.00 0.00 .0.00 .0.00 -0.00 Form 1099-DIV 2019 Dividends and Distributions Copy for Recipient (OMB NO. 1545-0110) 1a Total Ordinary Dividends 1b Qualified Dividends. 2a Total Capital Gain Distributions (Includes 2b-2d). 2b Capital Gains that represent Unrecaptured 1250 Gain 2c Capital Gains that represent Section 1202 Gain. 2d Capital Gains that represent Collectibles (28%) Gain. 3 Nondividend Distributions ... 4 Federal Income Tax Withheld 5 Section 199A Dividends 6 Investment Expenses 7 Foreign Tax Paid. 8 Foreign country or U.S. Possession 9 Cash Liquidation Distributions 10 Non-Cash Liquidation Distributions. 11 Exempt Interest Dividends .12 Specified Private Activity Bond Interest Dividends 13 State ... 14 State Identification No. 15 State Tax Withheld Form 1099-MISC* 2019 Miscellaneous Income Copy B for Resplent OMB NO. 1545-0115) 2 Royalties.. 4 Federal Income Tax Withheld 8 Substitute Payments in Lleu of Dividends or Interest 16 State Tax Withheld 17 State Payer's State No. 18 State Income... Form 1099-INT* 2019 Interest Income Copy Bfor Recipient OMB NO. 1545-01121 1 Interest Income 2 Early Withdrawal Penalty 3 Interest on U.S. Savings Bonds and Treas. Obligations. 4 Federal Income Tax Withheld 5 Investment Expenses. 6 Foreign Tax Pald 7 Foreign country or U.S. Possession 8 Tax-Exempt Interest .. 9 Specified Private Activity Bond Interest 14 Tax-Exempt Bond CUSIP No... Summary of 2019 Proceeds From Broker and Barter Exchange Transactions Sales Price of Stocks, Bonds, etc.. Federal Income Tax Withheld 0.00 ..0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 .0.00 .0.00 0.00 .0.00 6,300.00 ..0.00 Greas Process from each of your security ansactions are reported individusly to the IRS. Refer to the Form 1000-8 action of this statement Report gros procedendidually for each securly on the appropriate moun Do not report gross proceeds in aggregate Page 1 of 2 ABC INVESTMENTS 456 Pima Plaza Your City, YS ZIP 2019 TAX REPORTING STATEMENT Mark and Barbara Matthews 742 Red Rooster Road Your City, YS ZIP Account No. 111-222 Recipient ID No. 317-00-XXXX Payer's Fed ID Number: 40-200XXXX FORM 1099-B* 2019 Proceeds from Broker and Barter Exchange Transactions Capy B for Rent OMB NO. 1545-0715 Short-term transactions for which basis is reported to the IRS Report on Form 8949 with Box A checked and/or Schedule D. Part 1 This is a Bubute for lo ) 8 Description, 1d Stock or Other Symbol, CUSIP (RS Form 1096-B box numbers are shown below in bokltype) Adlon Due 16 Date old ta Quarrity 1d Proceeds te Costor Gan/Con 4 lg Wow Sale Federal Income 14 15 to 18 Acquired ded Sold Other Bags Los Dislowed Tax Wired State Wild Idaho Co. Common Stock Sale 02/01/2018 10/01/2019 250.000 TOTALS (489.00) 1,700.00 1,700.00 2,189.00 2,189.00 FORM 1099-3* 2019 Proceeds from Broker and Barter Exchange Transactions Copy for pent ONB NO. 1546-0715 Long-term transactions for which basis is not reported to the IRS Report on Form 8949 with Box E checked and/or Schedule D, Part II (This Lata Babattute for Beste & 6) Description, 1d Stockor Other Symbol, CUSP ORS Form 1090-8 bok numbers are shown below in bold type) Action 16 Date 1 Date sold ta Quality 1d Proceeds Gain Loss 1 Wash Sale Federal income 14 15 Status Aquired dispod Other Basis Los Disslowed Tax withheld lowa Co. Common Stock Sale 06/15/1999 03/01/2019 200.000 4,800.00 1,700.00 2,900.00 TOTALS 4,600.00 1,700.00 This is important to information and is being fumished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other action may be imposed on you if this income is taxable and the IRS determines that it has not been reported. Page 2 of 2 CORRECTED (if checked) PAYER'Sams, street doros, skyrton, provocoury, ZIP Papers RTN Soal OMB No 1545-0112 or foreign portal de und schon no. Adelphi Bank and Trust 2019 Interest 8020 Yonkers Blvd 1 Indicom Income YOUR CITY, STATE ZIP $ 300.00 For 1099-INT 2 Garty withdrawalparailty Copy B PAYERS TO RECIPIENTS TN For Recipient 3 Interest as U.S. Savings fonds and Treas, olio 34-7XXXXXX 317-00-XXXX RECPIENT'S Federalnom i inwesimest per This is importante $ 20.00 $ Information and is MARK MATTHEWS being funished to the Bort tax paid 7 Frigy US ON RS. you are Streal address including ap.) $ recuired to find return, a negligence 742 RED ROOSTER 8 Tex-ceprest pred hotelyben penalty or other action may be Oty or stata presuntry, and 2 or foreign postal code S imposed on you 10 Marker clocount YOUR CITY, STATE ZIP 11 Bond Drown this income is laxace and the IRS determines that it has FATCAS not be reported requirement 12 personer 13 Border bei Account berec ** Taman NCHI 10 Semester 17Saletas bond CSP Por 1099-INT keep for your records www.goNT Department of the Treasury Internal Revenue Service 1234 Mark and Barbara Matthews 742 Red Rooster Road Your City State 00000 PAY TO THE ORDER OF $ VOID DOLLARS Adelphe Bank and Trust Anylow, State 00000 Fer : 111000025 : 123456789 1234