Required: Complete federal tax return on Form 1040

OMB No. 1545-0110 2020 Dividends and Distributions 9191 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends or foreign postal code, and telephone no. $ 3674.36 LA Investment Company 1b Qualified dividends 5 Lake Avenue 145.96 Pasadena, CA 91106 $ 2a Total capital gain distr. $ 622.78 PAYER'S federal identification number RECIPIENT'S identification number 2c Section 1202 gain 90-0077001 500-00-1000 Form 1099-DIV 2b Unrecap. Sec. 1250 gain $ 2d Collectibles (28%) gain Copy A For Internal Revenue Service Center File with Form 1096. $ RECIPIENT'S name $ 3 Nondividend distributions $ Marc Pennyworth 4 Federal income tax withheld $ 5 Investment expenses $ 7 Foreign country or U.S. possession Street address (including apt. no.) 6 Foreign tax paid 100 Major Street Apt 408 City or town, state or province, country, and ZIP or foreign postal code Pasadena, CA 91106 For Privacy Act and Paperwork Reduction Act Notice, see the General Instructions for Certain Information Returns. 8 Cash liquidation distributions $ 10 Exempt-interest dividends 9 Noncash liquidation distributions $ 11 Specified private activity bond interest dividends $ $ Account number (see instructions) 2nd TIN not. 12 State 13 State identification no. 14 State tax withheld $ $ Form 1099-DIV Cat. No. 14415N www.lrs.gov/form1099div Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page 9292 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Payer's RTN (optional) or foreign postal code, and telephone no. OMB No. 1545-0112 2019 1 Interest income Interest Income Everyday Bank PO Box 333 Alameda, CA 94501 50.99 $ 2 Early withdrawal penalty Form 1099-INT Copy A PAYER'S federal identification number RECIPIENT'S identification number $ 92-0000020 3 Interest on U.S. Savings Bonds and Treas. obligations 500-00-1000 For Internal Revenue Service Center $ 4 Federal income tax withheld 5 Investment expenses RECIPIENT'S name File with Form 1096. Marc Pennyworth $ 6 Foreign tax paid $ 7 Foreign country or U.S. possession Street address (including apt. no.) 100 Major Street #408 $ 8 Tax-exempt interest City or town, state or province, country, and ZIP or foreign postal code 9 Specified private activity bond interest For Privacy Act and Paperwork Reduction Act Notice, see the 201X General Instructions for Certain Information Returns. Pasadena, CA 91106 $ 10 Market discount $ 11 Bond premium $ 2nd TIN not. 12 Tax-exempt bond CUSIP no. Account number (see instructions) 13 State 14 State identification no. 15 State tax withheld Form 1099-INT Cat. No. 14410K www.irs.gov/form 1099int Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page VOID O CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensation OMB No. 1545-0120 or foreign postal code, and telephone no. Certain State of California Franchise Tax Board 2018 Government 2 State or local income tax PO Box 942840 refunds, credits, or offsets Payments Sacramento, CA 94240 $ 2314 Form 1099-G PAYER'S federal identification number RECIPIENT'S identification number 3 Box 2 amount is for tax year 4 Federal income tax withheld Copy A 68-0204061 500-00-1000 2017 1$ For RECIPIENT'S name 5 RTAA payments 6 Taxable grants Internal Revenue Marc W Pennyworth $ Service Center 7 Agriculture payments 8 Check if box 2 is File with Form 1096. trade or business Street address (including apt. no.) income For Privacy Act D 100 Major Street Apt 408 9 Market gain and Paperwork Reduction Act City or town, state or province, country, and ZIP or foreign postal code Notice, see the Pasadena, CA 91106 10a State 10b State identification no 11 State income tax withheld General Instructions for Account number (see instructions) Certain Information Returns. Form 1099-G Cat. No. 14438M www.irs.gov/form10999 Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page > Assume the following for the client's Prior Year Tax Return: Schedule A Line 5: $11,732 Schedule A Line 29: $39,301 AGI: $147,513 Taxable income: $ 108,212 No entry for Line 39a Filing Status: MFJ OMB No. 1545-0110 2020 Dividends and Distributions 9191 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends or foreign postal code, and telephone no. $ 3674.36 LA Investment Company 1b Qualified dividends 5 Lake Avenue 145.96 Pasadena, CA 91106 $ 2a Total capital gain distr. $ 622.78 PAYER'S federal identification number RECIPIENT'S identification number 2c Section 1202 gain 90-0077001 500-00-1000 Form 1099-DIV 2b Unrecap. Sec. 1250 gain $ 2d Collectibles (28%) gain Copy A For Internal Revenue Service Center File with Form 1096. $ RECIPIENT'S name $ 3 Nondividend distributions $ Marc Pennyworth 4 Federal income tax withheld $ 5 Investment expenses $ 7 Foreign country or U.S. possession Street address (including apt. no.) 6 Foreign tax paid 100 Major Street Apt 408 City or town, state or province, country, and ZIP or foreign postal code Pasadena, CA 91106 For Privacy Act and Paperwork Reduction Act Notice, see the General Instructions for Certain Information Returns. 8 Cash liquidation distributions $ 10 Exempt-interest dividends 9 Noncash liquidation distributions $ 11 Specified private activity bond interest dividends $ $ Account number (see instructions) 2nd TIN not. 12 State 13 State identification no. 14 State tax withheld $ $ Form 1099-DIV Cat. No. 14415N www.lrs.gov/form1099div Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page 9292 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Payer's RTN (optional) or foreign postal code, and telephone no. OMB No. 1545-0112 2019 1 Interest income Interest Income Everyday Bank PO Box 333 Alameda, CA 94501 50.99 $ 2 Early withdrawal penalty Form 1099-INT Copy A PAYER'S federal identification number RECIPIENT'S identification number $ 92-0000020 3 Interest on U.S. Savings Bonds and Treas. obligations 500-00-1000 For Internal Revenue Service Center $ 4 Federal income tax withheld 5 Investment expenses RECIPIENT'S name File with Form 1096. Marc Pennyworth $ 6 Foreign tax paid $ 7 Foreign country or U.S. possession Street address (including apt. no.) 100 Major Street #408 $ 8 Tax-exempt interest City or town, state or province, country, and ZIP or foreign postal code 9 Specified private activity bond interest For Privacy Act and Paperwork Reduction Act Notice, see the 201X General Instructions for Certain Information Returns. Pasadena, CA 91106 $ 10 Market discount $ 11 Bond premium $ 2nd TIN not. 12 Tax-exempt bond CUSIP no. Account number (see instructions) 13 State 14 State identification no. 15 State tax withheld Form 1099-INT Cat. No. 14410K www.irs.gov/form 1099int Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page VOID O CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensation OMB No. 1545-0120 or foreign postal code, and telephone no. Certain State of California Franchise Tax Board 2018 Government 2 State or local income tax PO Box 942840 refunds, credits, or offsets Payments Sacramento, CA 94240 $ 2314 Form 1099-G PAYER'S federal identification number RECIPIENT'S identification number 3 Box 2 amount is for tax year 4 Federal income tax withheld Copy A 68-0204061 500-00-1000 2017 1$ For RECIPIENT'S name 5 RTAA payments 6 Taxable grants Internal Revenue Marc W Pennyworth $ Service Center 7 Agriculture payments 8 Check if box 2 is File with Form 1096. trade or business Street address (including apt. no.) income For Privacy Act D 100 Major Street Apt 408 9 Market gain and Paperwork Reduction Act City or town, state or province, country, and ZIP or foreign postal code Notice, see the Pasadena, CA 91106 10a State 10b State identification no 11 State income tax withheld General Instructions for Account number (see instructions) Certain Information Returns. Form 1099-G Cat. No. 14438M www.irs.gov/form10999 Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page > Assume the following for the client's Prior Year Tax Return: Schedule A Line 5: $11,732 Schedule A Line 29: $39,301 AGI: $147,513 Taxable income: $ 108,212 No entry for Line 39a Filing Status: MFJ