John Fuji (birthdate June 6, 1981) moved from California to Washington in December 2018. His earnings and income tax withholding for 2019 for his job as a manager at a Washington apple-processing plant are reported on his W-2 form (see separate tab).

John's other income includes interest on a Certificate of Deposit reported on a Form 1099-INT (see separate tab).

Also, in accordance with the January 2019 divorce decree, he paid $500 per month alimony to his ex-wife (Dora Fuji, Social Security number 573-79-6075) starting with February 2019.

John received a Form 1098 that reports his mortgage interest and property taxes (see separate tab).

During 2019, John paid the following amounts (all of which can be substantiated)

His earnings and income tax withholding for 2019 for his job as a manager at a Washington apple-processing plant are:

a Employee's social security number 571-78-5974

OMB No. 1545-0008

Safe, accurate, FAST! Use

IRSe ~ file

Visit the IRS website at www.irs.gov/efile

b

Employer identification number (EIN) 34-7654321

1

Wages, tips, other compensation 77,300.00

2

Federal income tax withheld 8,100.00

c

Employer's name, address, and ZIP code Granny Smith Apple Co. 200 Ahtanum Rd. Yakima, WA 98903

3

Social security wages 77,300.00

4

Social security tax withheld 4,792.60

5

Medicare wages and tips 77,300.00

6

Medicare tax withheld 1,120.85

7

Social security tips

8

Allocated tips

d

Control number

9

10

Dependent care benefits

e

Employee's first name and initial

Last name

Suff.

11

Nonqualified plans

12a

See instructions for box 12

C o d e

John Fuji 468 Bonnie Doon Ave. Yakima, WA 98902

13

Statutory employee	Retirement plan	Third-party sick pay

12b

C o d e

14

Other

12c

C o d e

12d

C o d e

f

Employee's address and ZIP code

15	State	Employer's state ID number	16	State wages, tips, etc.	17	State income tax	18	Local wages, tips, etc.	19	Local income tax	20	Locality name
	WA

Form W-2 Wage and Tax Statement	2019	Department of the TreasuryInternal Revenue Service
Copy BTo Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service.

John's other income includes interest on a Certificate of Deposit reported on a Form 1099-INT:

VOID CORRECTED
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Braeburn National Bank 1600 W. Nob Hill Blvd. Yakima, WA 98902			OMB No. 1545-0380 2019 Form 1098		Mortgage Interest Statement
		1 Mortgage interest received from payer(s)/borrower(s)* $ 7,775.13			Copy B For Recipient/ Lender For Privacy Act and Paperwork Reduction Act Notice, see the 2019 General Instructions for Certain Information Returns.
RECIPIENT'S/LENDER'S TIN 54-9019016	PAYER'S/BORROWER'S TIN 571-78-5974	2 Outstanding mortgage principal $255,321.78	3 Mortgage origination date 12/1/2017
		4 Refund of overpaid interest $	5 Mortgage insurance premiums $
PAYER'S/BORROWER'S name John Fuji		6 Points paid on purchase of principal residence $
Street address (including apt. no.) 468 Bonnie Doon Ave.		7 If address of property securing mortgage is the same as PAYER'S/BORROWER'S address, check the box, or enter the address or description in box 8.
City or town, state or province, country, and ZIP or foreign postal code Yakima, WA 98902		8 Address or description of property securing mortgage (see instructions)
9 Number of properties securing the mortgage 1	10 Other Prop. Taxes $2,100				11 Mortgage acquisition date
Account number (see instructions)

Form 1098

www.irs.gov/Form1098

Department of the Treasury - Internal Revenue Service