• Read the statement of facts.
• Visit the IRS forms websiteLinks to an external site..
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  • Form 1099-S, Form 1099-C, and Form 8949;
  • Schedule 1 and Schedule D; and
  • Form 1040 (page 1 only).

Statement of Facts

Taxpayer Jane Doe has the following personal information:

Name: Jane Doe

SSN: 444-44-4444

Address: 555 Any Street, Anytown, CA 90000

Marital Status: Separated - Living apart

Minor Children: 1 (lives with ex-husband)

Elections: Standard deduction (never itemized)

Summary:

Jane Doe (DOE) was an employee at ABC, Inc. (benefit details below). After being injured on the job, DOE received three monthly payments from an disability policy (benefit details below). At the start of the tax year, DOE sold her residence for $600,000 (Payer #1). DOE bought the house she sold for $300,000 and lived in the house for 10 years prior to the sale. During the tax year, DOE received $25,000 in workers compensation payments. By the end of the tax year, DOE had substantial gambling debts that exceed her total assets. Realizing the her debt of $30,000 was uncollectable, the casino (Payer #2) forgave DOE's gambling debt and issued her a Form 1099. During the tax year, DOE received the following:

• $1,500 in winnings from slot machines; and
• $1,000 from a state income tax refund;.

With regard to DOE's job at ABC, Inc., DOE received wages of $20,000 for time she worked. In addition to her salary, DOE received the following employee benefits from ABC, Inc.:

• Employer paid health care of $15,000;
• $5,000 in sick pay benefits;
• $5,000 in vacation benefits; and
• Employer paid group term life insurance with $50,000 in coverage.

With regard to DOE's disability policy, DOE receives $2,000 per month. DOE purchased the private disability policy with her own funds.

Payer #1: Anytown Escrow, Inc.

EIN: 99-9999999

Address: 111 Corp. Blvd. Ste 100, Anytown, CA 90000

Payer #2: The House Always Wins, LLC

EIN: 99-9999998

Address: 444 Casino Blvd., Anytown, CA 90000