John and Jane Doe are married retired taxpayers who care for their three-year-old grandson. The following information was provided to you as documentation necessary to prepare their 2017 tax return. You will gather the appropriate information and complete forms 1040, Schedule A, Schedule B and Schedule D in preparation of their tax file. Please note that the forms provided may not match the tax year of the course, as IRS forms are not available until just before the start of the filing season, and this course generally is approximately a year ahead of the actual form releases. Therefore, do not worry about the year on top of the forms, but utilize information for the current year of the textbook in use for this course when determining deduction amounts, exemption amounts, and tax rates.
Taxpayer:
Name: John Doe
DOB: 6/29/1950
SSN: 555-12-3456
Spouse:
Name: Jane Doe
DOB: 7/4/1948
SSN: 555-65-4321
Dependent:
Name: Jimmy Doe
DOB: 1/12/2014
SSN: 555-68-9101
Mailing Address:
12345 Any Street
Los Angeles, Ca 90124
Deductions
Prescription Medication: $638
Doctors Visits: $2,904
Insurance Premiums out of pocket (not including Medicare premiums deducted from social security): $5,125
Medical Miles Driven: 410
Deductible DMV registration fees: $170
Income:
Received a gift from Janes mother, $12,000
Sold Stock with a basis of $10,000 for $13,500. Held the stock for more than one year
Sold stock with a basis of $5,000 for $5,500. Held the stock for less than one year.
All three members of the family had qualifying health insurance for the entire year.
Additional Documents:
Government Personnel Mutual Life Ins co: Interest income $56.98
Verizon Communications Inc. Dividends & Distributions: 1a total ordinary dividens- $1404.41 1b qualified dividends $1404.41
Public Storage Dividends & Distributions: 1a total ordinary dividends $2109.70
PTC Cust rollover IRA FBO
FATCA filing requirement: 1 gross distribution $17,700.00 2a taxable amount $17,700.00 4 federal income tax withhled $3,540.00 12 state tax withheld $884.88 13 state CA
Statement of Annuity paid
1 gross distribution $41016.00 2a taxable amount $38553.00 4 federal income tax withheld $3942.00 5 employee contributions $2641.80 7 Distribution Codes 7-nondisability 9b total employee contributions $73891.00 12 state tax withheld $1440.00 12 state tax withtheld none 13 state.payers state no CA
Form SSA 1099 Social Security Benefit Statement: box 3 benefits paid in 2016 $19894.80 box4 benefits repaid to SSA in 2016 NONE box 5 Net Benefits for 2016 (box3 minus box4) $19,894.80 Description of amount in box 3: paid by check or direct deposit $18,636.00 medicare part B premiums deducted from your benefits $1,258.80 Total additions $19,894.80 Benefits for 2016 $19,894.80 Description of amount in box 4 NONE box 6 voluntary federal income tax withheld NONE
Contributions Summary Family Statement
Fund: Building fund drivePmt/pledge $80.00
Fund: Christmas $20.00
Fund: Seminary Support $15.00
Fund: World Mission Sunday $20.00
Fund: Cemetary Improvement Fund $10.00
Fund: contributions $390.00
Fund: SVDP contributions $90.00
Total Contributions: $625.00
Mortgage Interest Statement
1 mortgage interest received from payers/borrows $12,215
2 outstanding mortgage principal as of 01/01/2016 $74,101.26
3 mortgage origination date loan origination date 06/28/2006
4 refund of overpaid interest $0.00
5 mortgage insurance premiums $0.00
6 points paid on purchase or principal residence $0.00
10 other real estate tax paid $2,215
2016 Interest Income CORRECTED (if checked) PAYER S name, streel address, city or town, state or province country. Payer's RTN (optional OMB No. 1545-0112 ZIP or foreign postal code, and telephone no GOVERNMENT PERSONNEL MUTUAL LIFE INS CO 2211 NE LOOP 410 1 Interest income P.O. BOX 659567 SAN ANTONIO, TX 78265-9567 $56.98 800-929-4765 2 Early waherawal penalty Form 1099-INT 3 Interest on U.S. Savings Bonds and Treas, obligations PAYER S lederal identification number RECIPIENTS Identification number 74-0651020 RECIPIENTS name Street address, city or town, state or province, 4 Federal income tax withhold S investment expenses country, and ZIP ortod postal code 6 Foreign lax paid 7 Foreign country or U.S. possession John Doe 12345 Any Street Los Angeles, Ca 90124 Copy B For Recipient This is important tax Information and is being furnished to the Internal Revenue Service. If you are required to file a retur, a negligence penalty or other sanction may be imposed on you if this Income is taxable and the IRS delermines that it has not been reported. 8 Tax-exempt interest 9 Specified private actity Dond interest 10 Maikel discount 111 Bond premium 12 Band premium on Treasury obligations "13 Bond premium on tax-exempt bond Account number (See instructions 000275767 14 Tax-exempt and tax crede bond CUSIP no FATCA fing requirement (keep for your records) 15 State 16 State identification no. 17 State lax withheld NM : 03-221595-00-9 Department of the Treasury - Intemal Revenue Service Form 1099-INT www.irs.gov/form 1099int OORTOB (Rev. 12/15) CORRECTED (if checked) Dividends and Distributions Verizon Communications Inc. OMB No. 1545-0110 2016 PAYER'S Federal identification number: 23-2259884 PAYER'S name, street address, city, state, and ZIP code VERIZON COMMUNICATIONS INC. C/O COMPUTERSHARE PO BOX 43078 PROVIDENCE RI 02940-3078 1a Total ordinary dividends 1b Qual fied dividends S 1404.41 $ 1404.41 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain $ 0.00 $ 0.00 2c Section 1202 gain 2d Collectibles (28%) gain $ 0.00 $ 0.00 3 Nondividend distributions 4 Federal income tax withheld $ 0.00 $ 0.00 5 Investment expenses 6 Foreign tax paid $ 0.00 | 7 Foreign country or U.S. possession 8 Cash liquidation distributions s 0.00 10 Exempl-interest dividend 11 Specledprte chyberdirtenesten $ 0.00 Is 0.00 Form 1099-DIV RECIPIENT'S ID No. ending in: *****-6711 Account number (see instructions): C0001413651 RECIPIENT'S name, street address, city, state, ZIP code Copy B For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you this income is taxable and the IRS determines that has not been reported. The reportable amounts above include the following additional income: John & Jane Doe 12345 Any Street Los Angeles, Ca 90124 Company Paid Service Charges s 0.00 Company Paid Fees $ 0.00 Discount on Reinvestment $ 0.00 Form 1099-DIV (keep for your records) Department of the Treasury - Internal Revenue Service OORTOB (Rev. 12/15) CORRECTED (if checked) Dividends and Distributions Public Storage OMB No. 1545-0110 bc 2016 PAYER'S Federal identification number: 95-3551121 PAYER'S name, street address, city, state, and ZIP code PUBLIC STORAGE CIO COMPUTERSHARE PO BOX 43078 PROVIDENCE RI 02940-3078 1a Total ordinary dividends 16 Qualified dividends $ 2109.70 $ 0.00 2a Total capital gain distr. 26 Unrecap. Sec. 1250 gain $ 0.00 $ 0.00 2c Section 1202 gain 2d Collectibles (28%) gain $ 0.00 $ 0.00 3 Nondividend distributions 4 Federal income tax withheld $ 0.00 $ 0.00 5 Investment expenses 6 Foreign tax paid $ 0.00 7 Foreign country or U.S. possessions Cash liquidation distributions $ 0.00 10 Exempt-interest dividend 11 Spedited pheachty bond testider $ 0.00 $ 0.00 Form 1099-DIV RECIPIENT'S name, street address, city, state, ZIP code John & Jane Doe 12345 Any Street Los Angeles, Ca 90124 Copy B For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported. The reportable amounts above include the following additional Income: Company Paid Fees Company Paid Service Charges Discount on Reinvestment Form 1099-DIV (keep for your records) Department of the Treasury - Internal Revenue Service 95-2834236 RECIPIENTS identification number: Recinient: PTC CUST ROLLOVER IRA FBO PAYER's federal identification number: Payer: LPL Financial 1055 LPL Way Fort Mill, SC 29715 Jane Doe 12345 Any Street Los Angeles, Ca 90124 FATCA filing requirement 1 Gross distribution 2a Taxable amount 2b Taxable amount not determined Total distribution 3 Capital gain (included on line 2a) 4 Federal income tax withheld 5 Employee contributions/Designated Roth contributions or insurance premiums 6 Net unrealized appreciation - employer's securities Distribution code(s) IRA/SEP/SIMPLE $17,700.00 8 Other amount $17,700.00 Other amount percentage (X) 9a Your percentage of total distribution ( 9b Total employee contributions 10 Amount allocable to IRR within 5 years $3,540.00 11 1st year of desig. Roth contrib. 12 State tax withheld 13 State Payer's state number 7 14 State distribution $884.88 CA 02-074630 00 0 7 2016 OMB No. 1545-01 Form: 1099 Distributions Fri Pensions, Annuit Retirement or Pro Sharing Plans, IR Insurance Contracts, 1. Gross distribution 41016.00 OFFICE OF PERSONNEL MANAGEMENT STATEMENT OF ANNUITY PAID RETIREMENT OPERATIONS Copy 2A-To be filed with annuitant's state or local P.O. BOX 45 tax return BOYERS, PA 16017-0045 PAYER's Federal identification Recipient's ID No. (Annuitant) Account number Retirement Claim No.) 52-6083699 1. Employee Contributions Designated ROTH Contributions PAID or Insurance Premiums TO John Doe 2641.80 12345 Any Street Los Angeles, Ca 90124 7. Distribution Codes) 12. State tax withheld 7-NONDISABILITY 1440.00 96. Total Employee Contributions 12. State tax withheld 73891.00 NONE 2a. Taxable amount 38553.00 4. Federal Income Tax Withheld 3942.00 13. State Payer's state no. I CA 13. State Payer's state no. FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT 2016: SRETIGNE VE PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME. SEE THE REVERSE FOR MORE INFORMATION. Box 2. Beneficiary's Social Security Number Box 1. Name Jane Doe Box 3. Benefits Paid in 2016 Box 4. Benefits Repaid to SSA in 2016 Box 5. Net Benefits for 2016 (Bax 3 minus Box 4) NONE $19,894.80 $19,894.80 DESCRIPTION OF AMOUNT IN BOX 3 DESCRIPTION OF AMOUNT IN BOX 4 $18,636.00 NONE Paid by check or direct deposit Medicare Part B premiums deducted from your benefits Total Additions Benefits for 2016 $1,258.80 $19,894.80 $19,894.80 Box 6. Voluntary Federal Income Tax Withheld NONE Box 7. Address ohn & Jane Doe 12345 Any Street Los Angeles, Ca 90124 Below is your monetary gifts to San Clemente Parish for the period January 1, 2016 - December 31, 2016. Without your support of time, talent and treasure, San Clemente Parish would not be a vibrant and faithful community. Your donations support many needed activities for the youth, elderly, religious education of our members, the poor and the works of the Archdiocese of Santa Fe and the Catholic Church as a whole. Please keep this letter as receipt of your contributions for tax purposes. If you need to update your parish registration information, please contact the parish office. If you have any questions, please feel free to contact the parish office at San Clemente did not provide any goods or services for any donations received. Deacon Jim Snell Business Manager San Clemente Parish Fund Amount Fund Amount Building Fund DrivePmtPledge Christmas Seminary Support World Mission Sunday Total Contributions: $80.00 $20.00 $15.00 $20.00 Cemetary Improvement Fund contributions SVDP Contributions $10.00 $390.00 $90.00 $625.00 2016 Mortgage Interest Statement O CORRECTED (if checked) RECIPIENT SLENDER'S name, street address, city or town, state or "Caution: The amount shown may OMB No. 1545-0901 province, country, ZIP or foreign postal cods, and telephone no. not be fully deductible by you. Limits based on the loan amount John & Jane Doe and the cost and value of the secured property may apply. Also, 12345 Any Street you may only deduct Interest to the (Rev.July 2016) content it was incurred by you Los Angeles, Ca 90124 actually paid by you, and not reimbursed by another person Form 1098 1 Mortonon interest received from Dave's borrower(s) $ 12,215 RECIPIENT'S/LENDER'S federal PAYER'S/BORROWER'S taxpayer 2 Outstanding mortgage 3 Mortgage origination date identification number identification no. principal as of 1/1/2016 LOAN ORIGINATION $ 74, 101.26 DATE: 06/28/2006 73-0780382 4 Refund of overpeid 5 Mortgage Insurance interest premiurns PAYER'S/BORROWER'S name $0.00 $0.00 6 Points paid on purchase of principal residence $ 0.00 Street address including apt. no.) 7 is address of property securing mortgage same as PAYER'S/BORAOWER'S address? Yes, box is checked. . . . . . . . If No, see box 8 or 9, below City or town, state or province, country, and ZIP or foreign postal code Address of property securing mortgage Copy B For Payer/ Borrower The information in boxes 1 through 9 is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a retum, a nagigence penalty or other sanction may be mposed on you if the IRS determines that an underpayment of tax results because you overstated a daduction for this mortgage Interest or for these points, reported in boxes 1 and 6; or because you didn't report the refund of interest (box 4; or because you claimed a non-deductible item. 10 Other Real Estate Tax Paid: $2,215 9 l property securing mortgage has no address, balow is the description of the property Account number (see Instructions Form 1098 Keep for your records www.lrs.gov/form1098 Department of the Treasury - Internal Revenue Service 2016 Interest Income CORRECTED (if checked) PAYER S name, streel address, city or town, state or province country. Payer's RTN (optional OMB No. 1545-0112 ZIP or foreign postal code, and telephone no GOVERNMENT PERSONNEL MUTUAL LIFE INS CO 2211 NE LOOP 410 1 Interest income P.O. BOX 659567 SAN ANTONIO, TX 78265-9567 $56.98 800-929-4765 2 Early waherawal penalty Form 1099-INT 3 Interest on U.S. Savings Bonds and Treas, obligations PAYER S lederal identification number RECIPIENTS Identification number 74-0651020 RECIPIENTS name Street address, city or town, state or province, 4 Federal income tax withhold S investment expenses country, and ZIP ortod postal code 6 Foreign lax paid 7 Foreign country or U.S. possession John Doe 12345 Any Street Los Angeles, Ca 90124 Copy B For Recipient This is important tax Information and is being furnished to the Internal Revenue Service. If you are required to file a retur, a negligence penalty or other sanction may be imposed on you if this Income is taxable and the IRS delermines that it has not been reported. 8 Tax-exempt interest 9 Specified private actity Dond interest 10 Maikel discount 111 Bond premium 12 Band premium on Treasury obligations "13 Bond premium on tax-exempt bond Account number (See instructions 000275767 14 Tax-exempt and tax crede bond CUSIP no FATCA fing requirement (keep for your records) 15 State 16 State identification no. 17 State lax withheld NM : 03-221595-00-9 Department of the Treasury - Intemal Revenue Service Form 1099-INT www.irs.gov/form 1099int OORTOB (Rev. 12/15) CORRECTED (if checked) Dividends and Distributions Verizon Communications Inc. OMB No. 1545-0110 2016 PAYER'S Federal identification number: 23-2259884 PAYER'S name, street address, city, state, and ZIP code VERIZON COMMUNICATIONS INC. C/O COMPUTERSHARE PO BOX 43078 PROVIDENCE RI 02940-3078 1a Total ordinary dividends 1b Qual fied dividends S 1404.41 $ 1404.41 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain $ 0.00 $ 0.00 2c Section 1202 gain 2d Collectibles (28%) gain $ 0.00 $ 0.00 3 Nondividend distributions 4 Federal income tax withheld $ 0.00 $ 0.00 5 Investment expenses 6 Foreign tax paid $ 0.00 | 7 Foreign country or U.S. possession 8 Cash liquidation distributions s 0.00 10 Exempl-interest dividend 11 Specledprte chyberdirtenesten $ 0.00 Is 0.00 Form 1099-DIV RECIPIENT'S ID No. ending in: *****-6711 Account number (see instructions): C0001413651 RECIPIENT'S name, street address, city, state, ZIP code Copy B For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you this income is taxable and the IRS determines that has not been reported. The reportable amounts above include the following additional income: John & Jane Doe 12345 Any Street Los Angeles, Ca 90124 Company Paid Service Charges s 0.00 Company Paid Fees $ 0.00 Discount on Reinvestment $ 0.00 Form 1099-DIV (keep for your records) Department of the Treasury - Internal Revenue Service OORTOB (Rev. 12/15) CORRECTED (if checked) Dividends and Distributions Public Storage OMB No. 1545-0110 bc 2016 PAYER'S Federal identification number: 95-3551121 PAYER'S name, street address, city, state, and ZIP code PUBLIC STORAGE CIO COMPUTERSHARE PO BOX 43078 PROVIDENCE RI 02940-3078 1a Total ordinary dividends 16 Qualified dividends $ 2109.70 $ 0.00 2a Total capital gain distr. 26 Unrecap. Sec. 1250 gain $ 0.00 $ 0.00 2c Section 1202 gain 2d Collectibles (28%) gain $ 0.00 $ 0.00 3 Nondividend distributions 4 Federal income tax withheld $ 0.00 $ 0.00 5 Investment expenses 6 Foreign tax paid $ 0.00 7 Foreign country or U.S. possessions Cash liquidation distributions $ 0.00 10 Exempt-interest dividend 11 Spedited pheachty bond testider $ 0.00 $ 0.00 Form 1099-DIV RECIPIENT'S name, street address, city, state, ZIP code John & Jane Doe 12345 Any Street Los Angeles, Ca 90124 Copy B For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported. The reportable amounts above include the following additional Income: Company Paid Fees Company Paid Service Charges Discount on Reinvestment Form 1099-DIV (keep for your records) Department of the Treasury - Internal Revenue Service 95-2834236 RECIPIENTS identification number: Recinient: PTC CUST ROLLOVER IRA FBO PAYER's federal identification number: Payer: LPL Financial 1055 LPL Way Fort Mill, SC 29715 Jane Doe 12345 Any Street Los Angeles, Ca 90124 FATCA filing requirement 1 Gross distribution 2a Taxable amount 2b Taxable amount not determined Total distribution 3 Capital gain (included on line 2a) 4 Federal income tax withheld 5 Employee contributions/Designated Roth contributions or insurance premiums 6 Net unrealized appreciation - employer's securities Distribution code(s) IRA/SEP/SIMPLE $17,700.00 8 Other amount $17,700.00 Other amount percentage (X) 9a Your percentage of total distribution ( 9b Total employee contributions 10 Amount allocable to IRR within 5 years $3,540.00 11 1st year of desig. Roth contrib. 12 State tax withheld 13 State Payer's state number 7 14 State distribution $884.88 CA 02-074630 00 0 7 2016 OMB No. 1545-01 Form: 1099 Distributions Fri Pensions, Annuit Retirement or Pro Sharing Plans, IR Insurance Contracts, 1. Gross distribution 41016.00 OFFICE OF PERSONNEL MANAGEMENT STATEMENT OF ANNUITY PAID RETIREMENT OPERATIONS Copy 2A-To be filed with annuitant's state or local P.O. BOX 45 tax return BOYERS, PA 16017-0045 PAYER's Federal identification Recipient's ID No. (Annuitant) Account number Retirement Claim No.) 52-6083699 1. Employee Contributions Designated ROTH Contributions PAID or Insurance Premiums TO John Doe 2641.80 12345 Any Street Los Angeles, Ca 90124 7. Distribution Codes) 12. State tax withheld 7-NONDISABILITY 1440.00 96. Total Employee Contributions 12. State tax withheld 73891.00 NONE 2a. Taxable amount 38553.00 4. Federal Income Tax Withheld 3942.00 13. State Payer's state no. I CA 13. State Payer's state no. FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT 2016: SRETIGNE VE PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME. SEE THE REVERSE FOR MORE INFORMATION. Box 2. Beneficiary's Social Security Number Box 1. Name Jane Doe Box 3. Benefits Paid in 2016 Box 4. Benefits Repaid to SSA in 2016 Box 5. Net Benefits for 2016 (Bax 3 minus Box 4) NONE $19,894.80 $19,894.80 DESCRIPTION OF AMOUNT IN BOX 3 DESCRIPTION OF AMOUNT IN BOX 4 $18,636.00 NONE Paid by check or direct deposit Medicare Part B premiums deducted from your benefits Total Additions Benefits for 2016 $1,258.80 $19,894.80 $19,894.80 Box 6. Voluntary Federal Income Tax Withheld NONE Box 7. Address ohn & Jane Doe 12345 Any Street Los Angeles, Ca 90124 Below is your monetary gifts to San Clemente Parish for the period January 1, 2016 - December 31, 2016. Without your support of time, talent and treasure, San Clemente Parish would not be a vibrant and faithful community. Your donations support many needed activities for the youth, elderly, religious education of our members, the poor and the works of the Archdiocese of Santa Fe and the Catholic Church as a whole. Please keep this letter as receipt of your contributions for tax purposes. If you need to update your parish registration information, please contact the parish office. If you have any questions, please feel free to contact the parish office at San Clemente did not provide any goods or services for any donations received. Deacon Jim Snell Business Manager San Clemente Parish Fund Amount Fund Amount Building Fund DrivePmtPledge Christmas Seminary Support World Mission Sunday Total Contributions: $80.00 $20.00 $15.00 $20.00 Cemetary Improvement Fund contributions SVDP Contributions $10.00 $390.00 $90.00 $625.00 2016 Mortgage Interest Statement O CORRECTED (if checked) RECIPIENT SLENDER'S name, street address, city or town, state or "Caution: The amount shown may OMB No. 1545-0901 province, country, ZIP or foreign postal cods, and telephone no. not be fully deductible by you. Limits based on the loan amount John & Jane Doe and the cost and value of the secured property may apply. Also, 12345 Any Street you may only deduct Interest to the (Rev.July 2016) content it was incurred by you Los Angeles, Ca 90124 actually paid by you, and not reimbursed by another person Form 1098 1 Mortonon interest received from Dave's borrower(s) $ 12,215 RECIPIENT'S/LENDER'S federal PAYER'S/BORROWER'S taxpayer 2 Outstanding mortgage 3 Mortgage origination date identification number identification no. principal as of 1/1/2016 LOAN ORIGINATION $ 74, 101.26 DATE: 06/28/2006 73-0780382 4 Refund of overpeid 5 Mortgage Insurance interest premiurns PAYER'S/BORROWER'S name $0.00 $0.00 6 Points paid on purchase of principal residence $ 0.00 Street address including apt. no.) 7 is address of property securing mortgage same as PAYER'S/BORAOWER'S address? Yes, box is checked. . . . . . . . If No, see box 8 or 9, below City or town, state or province, country, and ZIP or foreign postal code Address of property securing mortgage Copy B For Payer/ Borrower The information in boxes 1 through 9 is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a retum, a nagigence penalty or other sanction may be mposed on you if the IRS determines that an underpayment of tax results because you overstated a daduction for this mortgage Interest or for these points, reported in boxes 1 and 6; or because you didn't report the refund of interest (box 4; or because you claimed a non-deductible item. 10 Other Real Estate Tax Paid: $2,215 9 l property securing mortgage has no address, balow is the description of the property Account number (see Instructions Form 1098 Keep for your records www.lrs.gov/form1098 Department of the Treasury - Internal Revenue Service
