Interview Notes

Sheila is single and 45 years old.

Sheila has two children. Rebecca, age 18, has a job and earned wages of $4,900. John, age 25, also worked and earned wages of $4,500. Both children lived with her all year.

Sheila paid all the cost of keeping up the home and more than half the support for her children.

Sheila received disability pension benefits, but she has not reached the minimum retirement age of her employers plan.

She does not have enough expenses to itemize for the 2021 tax year.

Sheila received a $2,800 Economic Impact Payment (EIP3) in 2021.

Shelia, Rebecca, and John are U.S. citizens and have valid Social Security numbers. They all lived in the United States for the entire year.

If she has any balance due or refund, she would like to use Branch Bank: Bank Routing number is 128760000, Checking Account number is 123456

Questions:

22. The amount of Sheilas EITC is $________.

23. Who qualifies as Sheilas dependent ?

a. Rebecca

b. John

c. Both John and Rebecca

d. Neither John nor Rebecca

Total CORRECTED (if checked) PAYER'S name, street address, city or town, state or province, 1 Gross distribution OMB No. 1545-0119 Distributions From country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, $ 39,500.00 Retirement or DELK CORPORATION 2a Taxable amount 2021 Profit-Sharing Plans, 983 GREEN STREET IRAs, Insurance Contracts, etc. YOUR CITY, YOUR STATE, ZIP $ 39,500.00 Form 1099-R 2b Taxable amount not determined o Copy B distribution Report this PAYER'S TIN RECIPIENT'S TIN 3 Capital gain (included in 4 Federal income tax income on your box 2a) withheld federal tax return. If this 56-700XXXX 127-00-XXXX $ $ $100.00 form shows RECIPIENT'S name 5 Employee contributions/ 6 Net unrealized federal income Designated Roth appreciation in tax withheld in contributions or SHEILA PARSONS employer's securities insurance premiums box 4, attach $ $ this copy to Street address including apt. no.) 7 Distribution your return. 8 Other SEPI code(s) 320 MAIN STREET SIMPLE 3 $ This information is being fumished to City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions the IRS. YOUR CITY, YOUR STATE, ZIP distribution %$ 10 Amount allocable to IRR 11 1st year of desig. 12 FATCA filing 14 State tax withheld 15 State/Payer's state no. 16 State distribution within 5 years Roth contrib. requirement $ $ $ Account number (see instructions) 13 Date of 17 Local tax withheld 18 Name of locality 19 Local distribution payment $ $ RA Form 1099-R www.rs.gov/Form 1099R Department of the Treasury - Internal Revenue Service Total CORRECTED (if checked) PAYER'S name, street address, city or town, state or province, 1 Gross distribution OMB No. 1545-0119 Distributions From country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, $ 39,500.00 Retirement or DELK CORPORATION 2a Taxable amount 2021 Profit-Sharing Plans, 983 GREEN STREET IRAs, Insurance Contracts, etc. YOUR CITY, YOUR STATE, ZIP $ 39,500.00 Form 1099-R 2b Taxable amount not determined o Copy B distribution Report this PAYER'S TIN RECIPIENT'S TIN 3 Capital gain (included in 4 Federal income tax income on your box 2a) withheld federal tax return. If this 56-700XXXX 127-00-XXXX $ $ $100.00 form shows RECIPIENT'S name 5 Employee contributions/ 6 Net unrealized federal income Designated Roth appreciation in tax withheld in contributions or SHEILA PARSONS employer's securities insurance premiums box 4, attach $ $ this copy to Street address including apt. no.) 7 Distribution your return. 8 Other SEPI code(s) 320 MAIN STREET SIMPLE 3 $ This information is being fumished to City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions the IRS. YOUR CITY, YOUR STATE, ZIP distribution %$ 10 Amount allocable to IRR 11 1st year of desig. 12 FATCA filing 14 State tax withheld 15 State/Payer's state no. 16 State distribution within 5 years Roth contrib. requirement $ $ $ Account number (see instructions) 13 Date of 17 Local tax withheld 18 Name of locality 19 Local distribution payment $ $ RA Form 1099-R www.rs.gov/Form 1099R Department of the Treasury - Internal Revenue Service