This assignment has two parts.
- Part 1 of your assignment is to prepare the couples federal income tax return, Form 1040 for the year ended December 31, 2020 plus any additional schedules necessary. Please utilize the facts and the information included in the Smithfield Family Tax Documents (both below) to complete this assignment. We will be using the 2020 federal income tax forms, rates, and laws. For any information not provided, please use reasonable assumptions.
- Part 2 of your assignment is to write a short memo explaining what you would advise them to do in order to save more for retirement and pay fewer taxes or any other ideas.
Scenario Information
You have new clients coming into your accounting firm today. They are Benjamin and his wife Carmen Smithfield who will file a joint return for income tax purposes.
Benjamin and Carmen are U.S. citizens and lived in the U.S. for the entire year. Neither Benjamin or Carmen are the qualifying child or dependent of anyone else.
They have four children.
- Chastity is currently living at home. She is a freshman at a local college.
- Paul and is a sophomore in high school.
- Mary and Markie are their two children attending seventh grade.
Taxpayer Information
Taxpayer Information for Benjamin Smithfield | Name | Benjamin Smithfield |
| SSN | 023-11-1115 |
| Date of Birth | 09-17-1975 |
| Occupation | Registered Nurse |
Information for Carmen Smithfield | Name | Carmen Smithfield |
| SSN | 023-11-1114 |
| Date of Birth | 05-01-1978 |
| Occupation | Nutritionist |
Address: 55 Cedar Crest Lane in Middletown, PA 17057.
Dependent Information
Dependent Information for Chastity Smithfield | Name | Chastity Smithfield (daughter) |
| SSN | 023-11-1113 |
| Date of Birth | 12-16-2002 |
Dependent Information for Paul Smithfield | Name | Paul Smithfield (son) |
| SSN | 023-11-1113 |
| Date of Birth | 06-12-2005 |
Dependent Information for Mary and Markie Smithfield | Name | Mary and Markie Smithfield (daughters) |
| SSN | 023-11-1111 and 023-11-1112 |
| Dates of Birth | 07-04-2012 |
Income
Benjamin works as a registered nurse at the VA hospital. Carmen is a nutritionist for UPMC.
Landscaping Business
Benjamin also has a small landscaping business where he does simple things like mulch, cut grass, and trim bushes for friends and people who he knows from his church. He says last year he made about $15,000 from his landscaping business.
Landscaping Business Expenses | John Deere Lawnmower | $1,899.00 |
| Gardening Gloves | $ 35.00 |
| Electric Tree Trimmer | $ 495.00 |
| Hedge Clippers | $ 145.00 |
| Weed Wacker | $ 75.00 |
| Composters | $ 299.85 |
| Total Landscaping Expenses | $2,948.85 |
Rental Properties
They also own several rental properties which Carmen manages. Carmen has no other experience in real estate. The first property at 55 Oak Terrace in Middletown PA was purchased for $75,000 fifteen years ago. That property had $10,800 in rent last year. The second property is located at 25 Spruce Street in Middletown PA and has two apartments in it, each one is rented out for $600 a month. It was rented the full year. That property was bought for $120,000 five years ago.
In 2020 Benjamin and Carmen purchased a new 2020 Ford 150 to use exclusively for the rental business so they could do repairs and maintenance on the properties easier themselves. The Ford 150 cost $40,000. The oil, gas, insurance, and maintenance of the truck cost them $7,892. The business-related mileage was 5,498 miles.
The real estate taxes for the rental properties were $3,100 and $3,500. The property taxes for their home was $4,200. The mortgage interest for the properties is provided in the attached documents.
55 Oak Terrace | Oak Terrace Taxes | $ 3,100.00 |
| Oak Terrace Repairs | $ 495.00 |
| Oak Terrace Property Insurance | $ 540.00 |
| Total Expenses | $ 4,135.00 |
25 Spruce Street | Spruce Street Taxes | $ 3,500.00 |
| Spruce Street Repairs | $ 900.00 |
| Spruce Street Property Insurance | $ 735.00 |
| Spuce Street Municipal Fine for Uncut Grass | $ 250.00 |
| Total Expenses | $ 5,385.00 |
Ford F150 Expenses | Gas | $ 6,642.00 |
| Oil & Filters | $ 195.00 |
| Tires | $ 1,055.00 |
| Total Expenses | $ 7,892.00 |
| F150 Mileage | 5,498 |
Miscellaneous Deductions
Benjamin is a member of a nurses association at his job. His union dues for this association were $1,250 last year. He also buys his own nurse's uniform scrubs and a stethoscope which cost him $1,550.
They donated $3,750 to their church last year and donated $500 to the Sierra Conservation Organization.
They spent $2,500 on dental braces for Chastity last year. Miscellaneous doctors' bills totaled $6,325. Cosmetic surgery for Chastity cost $900 after she fell down some steps and broke her nose. They spent $1,750 for a chiropractor for Benjamin's back, because he works very hard, and $1,500 for an optometrist for Carmen so she can see better. Prescription drugs cost $4,850 and vitamins cost them $1,250.
Carmen's job offers her a 401K. However, Carmen and Benjamin don't like having money taken out of her paychecks because they like to contribute the maximum possible to their Roth IRA. They would like your advice on ways they can save the most money for retirement and pay the least amount of taxes.
Tax Documents
The Smithfield family provided the following documents: Smithfield Family Tax Documents
Requirements
Complete the 2020 Federal Income Tax Return for the Smithfield family. Attach all supplemental schedules to complete your federal income tax return. Please utilize the tax rates found in the Tax Return Project Fact Pattern file.
Files and Forms
1040, Schedule 1,A,B,C,D, E, form 8949
a Employee's social security number 111-11-1115 b Employer identification number (EIN) 11-2222222 c Employer's name, address, and ZIP code VETERANS AFFAIRS HOSPITAL 100 MILITARY WAY This information is being furnished to the Internal Revenue Service. If you OMB No. 1545-000s are required to file a tax retum, a negligence penalty or other sanction may be imposed on you this income taxable and you fail to report it 1 Wages, tips other compensation 2 Federal income tax withheld $40,000.00 $2,900.00 3 Social security wages 4 Social security tax withhold $40,000.00 $2,480.00 5 Medicare wages and tips 6 Medicare tax withhold $40,000.00 $580.00 7 Social security tips 8 Allocated tips LEBANON PA 17243 d Control number 9 10 Dependent care benefits Last name Suff. 11 Nonqualified plans 12a See instructions for box 12 Employee's first name and initial PHILLIP SMITH 13 That 12b 55 CEDAR CREST LANE n 14 Other 126 MIDDLESBURG PA 17555 120 1 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 Form W-2 Wage and Tax 2019 Department of the Treasury-Internal Revenue Service Sate, accurate. FAST! Use e-file Statement Copy C-For EMPLOYEE'S RECORDS (See Notice to Employee on the back of Copy B.) ) a Employee's social security number 111-11-1114 b Employer identification number (EIN 99-9999999 c Employer's name, address, and ZIP code WIC CLINIC 350 BAYLOR ROAD This information is being furnished to the Internal Revenue Service. If you OMB No 1545-0008 are required to file a tax return, a negligence penalty or other sanction may ay be imposed on you if this income is taxable and you tal to report it 1 Wages, tips, other compensation 2 Federal income tax withheld $25,650.00 $4,500.00 3 Social security wages 4 Social security tax withheld $25,650.00 $1,690.00 5 Medicare wages and tips 6 Medicare tax withheld 6 $25,650.00 $372.00 7 Social security tips 8 Allocated tips HARRISBURG PA 17755 d Control number 9 10 Dependent care benefits Suft. 11 Nonqualified plans 12a See instructions for box 12 e Employee's first name and initial ABIGAIL 55 CEDAR CREST LANE Last name SMITH Burma 13 Station nal Thu Nicky 12b 14 Other 120 MIDDLESBURG PA 17555 12d + 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 Department of the Treasury -- Internal Revenue Service W-2 Statement Wage and Tax Form Copy C-For EMPLOYEE'S RECORDS (See Notice to Employee on the back of Copy B.) 2019 Safe, accurate re-file FAST! Use Interest Income VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, Zip Payer's RTN (optional ZIP OMB No. 1545-0112 or foreign postal code, and telephone no FIRST BANK 2019 1 BANK STREET 1 1 Interest income MIDDLESBURG, PA 17555 S 210 Form 1099-INT 2 Early withdrawal penalty PAYER'S TIN RECIPIENT'S TIN 111-11-1115 3 Interest on U.S. Savings Bonds and Treas, obligations Copy C For Payer RECIPIENT'S name 4 Federal income tax withheld 5 Investment expenses PHILLIP SMITH $ IS 6 Foreign tax paid 7 Foreign country or US, possession For Privacy Act Street address (including apt. 10.) IS and Paperwork 55 CEDAR CREST LANE Reduction Act 8 Tax-exempt interest 9 Specified private activity bond interest Notice, see the City or town, state or province, country, and ZIP or foreign postal code $ 2019 General $ $ Instructions for MIDDLESBURG, PA 17555 10 Market discount 11 Bond premium Certain Information FATCA filings Is Returns. requirement 12 Bord premium on Treasury cities 13 Bond premium an t-art bond 1$ Account number isee instructions) 2nd TIN not 14 Tax-exempt and tax credit 15 State 16 State identification no. 17 State tax withheld bond CUSIPO IS Form 1099-INT www.insgow Form 1099INT Department of the Treasury - Internal Revenue Service - VOID CORRECTED OMB No 1545-0110 PAYER'S name, street address, city or town, state or province, country, ZIP ta Total ordinary dividends or foreign postal code, and telephone no. FUNDAMENTAL INVESTORS $ 325.00 2019 1b Qualified dividends Dividends and Distributions $ 325.00 2a Total capital gain distr. . $ 160.50 2c Section 1202 gain Form 1099-DIV 2b Unrecap. Sec. 1250 gain $ 2d Collectibles (28%) gain Copy C For Payer PAYER'S TIN RECIPIENTS TIN 111-11-1115 $ RECIPIENT'S name 3 Nondividend distributions 4 Federal income tax withheld PHILLIP SMITH $ o$ For Privacy Act 5 Section 199A dividends Investment expenses and Paperwork Street address (including apt, no.) .) $ $ $ Reduction Act Notice, see the 55 CEDAR CREST LANE 7 Foreign tax paid 8 Foreign country or US presin 2019 General Instructions for City or town, state or province, country, and ZIP or foreign postal code $ Certain MIDDLESBURG, PA 17555 9 Cash liquidation distributions 10 Noncash liquidation distribution Information $ $ Returns. FATCA filing 11 Exempt-interest dividends 12 Specified private activity requirement bond interest dividends $ 0 Account number (see instructions) 2nd TIN not. 13 State 14 State identification no15 State tax withheld D $ $ Form 1099-DIV www.in.gov/Fom1090DIV Department of the Treasury - Internal Revenue Service 3 of 9 VOID CORRECTED PAYER'S name, street address, city or town, state or province. country, Zip 1a Total ordinary dividends OMB No. 1545-0110 or foreign postal code, and telephone no. NEW PERSPECTIVE FUND $ 1550.26 2019 1b Qualified dividends Dividends and Distributions 1550.25 Form 1099-DIV 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain $ 4005.00 $ 2e Section 1202 gain 2d Collectibles (28%) gain Copy C For Payer PAYER'S TIN RECIPIENT'S TIN 111-11-1115 $ RECIPIENTS name 3 Nondividend distributions 4 Federal income tax withheld PHILLIP SMITH $ $ 0 $ 200.00 For Privacy Act 5 Section 190A dividends 6 Investment expenses and Paperwork Street address (including apt. no.) $ ) Reduction Act $ Notice, see the 55 CEDAR CREST LANE 7 7 Foreign tax paid 8 Foreign country or U.S. possession 2019 General Instructions for City or town, state or province, country, and ZIP or foreign postal code , , $ Certain MIDDLESBURG, PA 17555 , 9 Cash liquidation distributions 10 Noncash liquidation distribution 9 Information $ Returns. FATCA Sing 11 Exempt-interest dividende 12 Specified private activity requirement bond interest dividends $ os Account number (see instructions) ( and TIN not. 13 State 14 State dentification ne 15 State tax withheld $ $ Form 1099-DIV www.irs.gov/Form 109901 Department of the Treasury - Internal Revenue Service VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP ta Total ordinary dividends , OMB No 1545-0110 or foreign postal code, and telephone no. $ WASHINGTON MUTUAL INVESTORS FUND 428.00 2019 1b Qualified dividends Dividends and Distributions $ 426.00 2a Total capital gain distr. $ 1274.00 2c Section 1202 gain Form 1099-DIV 2b Unrecap. Sec. 1250 gain $ 2d Collectibles (28%) gain Copy C For Payer PAYER'S TIN RECIPIENT'S TIN 111-11-1115 $ $ RECIPIENTS name 3 Nondividend distributions 4 Federal income tax withheld PHILLIP SMITH $ o $ For Privacy Act 5 Section 199A dividends 6 Investment expenses and Paperwork Street address (including apt. no.) $ $ Reduction Act Notice, see the 55 CEDAR CREST LANE 7 Foreign tax paid 8 Foreign country or U.S. pression 2019 General Instructions for City or town, state or province, country, and ZIP or foreign postal code $ Certain MIDDLESBURG, PA 17555 9 Cash liquidation distributions 10 Noncash liquidation distribution Information $ $ $ Returns. FATCA filing 11 Exempt-interest dividends 12 Specified private activity requirement bond interest dividends $ o $ Account number (see instructions) 2nd TIN not 13 State 14 Sute identification 15 State tax withhold $ $ Form 1099-DIV www.lrs.gow/Form1000DIV Department of the Treasury - Internal Revenue Service 4 of 9 VOID CORRECTED PAYER S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 1949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no Broker and NEW PERSPECTIVE FUNDA 2019 Barter Exchange Form 1099-B Transactions 1a Description of property (Example: 100 sh.XYZ Co.) 100 SHARES 1b Date acquired 1c Date sold or disponed 3/15/19 12/7719 PAYER'S TIN RECIPIENTS TIN 1d Proceeds te Cost or other basis Copy c $ 111-11-1115 5000 $ 3500 For Payer 1f Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check if proceeds from PHILLIP SMITH Long-term gain or loss Collectibles D Ordinary OOF Street address (including apt. no.) 4 Federal income tax withheld 5 Check if noncovered Security 55 CEDAR CREST LANE For Privacy Act 6 Reported to IRS 7 Check ifloss is not allowed City or town, state or province, country. and ZIP or foreign postal code and Paperwork , Gross proceeds based on amount ind Reduction Act MIDDLESBURG, PA 17555 , Net proceeds Notice, see the 8 Profit or loss realized in 9 Unrealized profit or losion 2019 General Account number (see instructions) 2019 on closed contracts ( 2nd TIN not open contracts-12/31/2018 Instructions for Certain I Information CUSIP number FATCA filing 10 Unrealized profit or loosi on 11 Aggregate profit or loss) requirement Returns. open contracts - 12/31/2019 on contracts 14 State name 15 State identification no. 16 State tax withheld 12 Check if basis reported to 13 Bartering IRS $ www.irs.gov/Form10998 Department of the Treasury - Internal Revenue Service Form 1099-B VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds From or foreign postal code and telephone no 2019 Barter Exchange Broker and NEW PERSPECTIVE FUND A A Form 1099-B Transactions 1a Description of property (Example: 100 sh.XYZ Co.) 130 SHARES 1 Date acquired tc Date sold or disposed 7/28/17 12/7/19 PAYER'S TIN RECIPIENTS TIN 1d Proceeds te Cost or other basis Copy C 111-11-1115 $ 10.400 $ 555 For Payer 1f Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check it proceeds from PHILLIP SMITH Long-term gain or loss Collectibles Ordinary D QOF Street address including apt.no) . 4 Federal income tax withheld 5 Check it noncovered $ security 55 CEDAR CREST LANE 0 6 Reported to IRS 7 Check ifloss is not allowed For Privacy Act based on amount ind City or town, state or province, country, and ZIP or foreign postal code and Paperwork Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds Notice, see the 8 Profit or loss) realized in 9 Unrealized profit or losa on 2019 General Account number ince instructions) 2nd TIN not. 2019 on closed contracts open contracte-12/31/2018 Instructions for $ Certain Information CUSIP number FATCA filing 10 Unrealed profit or loss on 11 Aggregate profit or loss requirement Returns. on contracts open contracts-12/01/2019 14 State name 15 State identification no. 16 State tax withheld $ $ 12 Check if basis reported to 13 Bartering IRS $ ms $ Form 1099-B www.in.gov/Form10998 Department of the Treasury - Internal Revenue Service 5 of 9 VOID CORRECTED PAYERS name, street address, city or town, state or province, country. ZIP Applicable checkbox on Form 3949 , OMB NO. 1545-0715 Proceeds From or foreign postal code, and telephone no Broker and WASHINGTON MUTUAL INVESTORS FUND 2019 Barter Exchange Form 1099-B 1a Description of property (Example: 100 sh.XYZ CO. 90 SHARES 1b Date acquired tc Date sold or disposed 2/12/19 12/7/19 PAYER'S TIN RECIPIENTS TIN id Proceeds 1d te Cost or other basis Copy C S 111-11-1115 4950 $ 5025 For Payer 11 Accrued market discount 1g Wash sale loss disallowed $ $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check it proceeds from PHILLIP SMITH Long term gain or los Collectibles Ordinary OOF Street address including apt.no) . 4 Federal income tax withheld 5 Check if noncovered security 55 CEDAR CREST LANE 0 For Privacy Act 6 Reported to IRS 7 Check ifloss is not allowed City or town, state or province, country, and ZIP or foreign postal code and Paperwork based on amount in 1d Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds D Notice, see the Profit or (los) realized in 9 Unrealized profit or foon 2019 General 2nd TIN not 2019 on closed contracts Account number (see instructions) open contracts-12/31/2018 Instructions for Certain Information CUSIP number FATCA filing 10 Unrealized profit or loss on 11 Aggregate profit or loss Returns. requirement open contracts-12/31/2019 on contracts D 14 State name 15 State identification no. 16 State tax withheld $ 12 Check if basis reported to 13 Bartering D$ Form 1099-B www.irs.gov/Form 10998 Department of the Treasury - Intemal Revenue Service IRS 2019 Barter Exchange 1500 $ VOID CORRECTED PAYER S name, street address, city or town, state or province, country. ZIP Applicable checkbox on Form 1949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no. Broker and FUNDAMENTAL INVESTORS Transactions Form 1099-B 1a Description of property (Example: 100 sh. XYZ Co.) 75 SHARES 1b Date acquired 1c Date sold or disposed 3/4/19 9/7/19 PAYER'S TIN RECIPIENT'S TIN 1d Proceeds te Cost or other basis Copy C $ 111-11-1115 450 For Payer 16 Accrued market discount 1g Wash sale lots disallowed $ $ RECIPIENT'S name 2 Short-term gain or loss 3 Check if proceeds from: - PHILLIP SMITH Long-term gain or loss Collectibles D Ordinary OOF Street address including apt. no.) 4 Federal income tax withheld 5 Check it noncovered $ security 55 CEDAR CREST LANE O For Privacy Act 6 Reported to IRS 7 Check ifloss is not allowed based on amount in 1d and Paperwork City or town, state or province, country, and ZIP or foreign postal code Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds Notice, see the 8 Profit or lon) realized in 9 Unrealized profit or ons on 2019 General 2nd TIN not Account number (see instructions) 2019 on closed contracts open contracts-12/31/2018 Instructions for Certain E $ Information CUSIP number FATCA filing 10 Unrealized profit or lose on 11 Aggregate profit oros) requirement open contracts-12/31/2019 Returns. on contracts 14 State name 15 State identification no. 16 State tax withheld $ IS 12 Check it basis reported to 13 Bartering IRS $ D $ For 1099-B www.lrs.gov/Form10998 Department of the Treasury - Internal Revenue Service 6 of 9 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 or foreign postal code, and telephone no. OMB No. 1545-0715 2019 Barter Exchange Proceeds From Broker and Transactions Copy C For Payer 2123.17 $ BARTER TRADES FUND Form 1099-B 1a Description of property (Example: 100 sh.XYZ Co.) 12 SHARES 1b Date acquired 1c Date sold or disposed VARIOUS 9/4/19 PAYER'S TIN RECIPIENTS TIN 1d Proceeds 1e Cost or other basis $ 111-11-1115 1667.48 16 Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check if proceeds from: PHILLIP SMITH Long-term gain or loss Collectibles Ordinary D QOF Street address (including apt. no.) 4 Federal income tax withheld 5 Check if noncovered $ security 55 CEDAR CREST LANE 0 6 Reported to IRS 7 Check if loss is not allowed based on amount in 1d City or town, state or province, country, and ZIP or foreign postal code D Gross proceeds MIDDLESBURG, PA 17555 Net proceeds 8 Profit or loss) realized in 9 Unrealized profit or loss) on 2nd TIN not. 2019 on closed contracts Account number (see instructions) open contracts-12/31/2018 $ $ CUSIP number 10 Unrealized profit or loss) on 11 Aggregate profit or loss) requirement open contracts-12/31/2019 on contracts For Privacy Act and Paperwork Reduction Act Notice, see the 2019 General Instructions for Certain Information Returns. FATCA filing 14 State name 15 State identification no. 16 State tax withheld $ S S $ 12 Check if basis reported to 13 Bartering IRS Form 1099-B www.irs.gov/Form 1099B Department of the Treasury - Intemal Revenue Service 2019 Barter Exchange VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no. Broker and THE BANK 123 MAIN STREET Form 1099-B Transactions HARRISBURG, PA 17111 1a Description of property (Example: 100 sh.XYZ Co.) 100 SHARES 1b Date acquired 1c Date sold or disposed VARIOUS 8/1/19 PAYER'S TIN RECIPIENTS TIN 1d Proceeds 1e Cost or other basis Copy C $ 10-0000000 111-11-1115 8000 $ 6500 For Payer 1f Accrued market discount 1g Wash sale loss disallowed $ RECIPIENT'S name 2 Short-term gain or loss 3 Check if proceeds from: PHILLIP SMITH Long-term gain or loss Collectibles Ordinary O QOF Street address (including apt. no.) 4 Federal income tax withheld 5 Check if noncovered $ security 55 CEDAR CREST LANE 0 D For Privacy Act 6 Reported to IRS: 7 Check ifloss is not allowed City or town, state or province, country, and ZIP or foreign postal code based on amount in 1d and Paperwork Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds D Notice, see the 8 Profit or loss) realized in 9 Unrealized profit or loss) on 2019 General Account number (see instructions) 2nd TIN not. 2019 on closed contracts open contracts - 12/31/2018 Instructions for 6002 Certain D $ $ Information CUSIP number FATCA filing 10 Unrealized profit or loss) on 11 Aggregate profit or loss) Returns. requirement open contracts-12/31/2019 on contracts D 14 State name 15 State identification no. 16 State tax withheld $ $ 12 Check if basis reported to 13 Bartering IRS D Form 1099-B www.irs.gov/Form1099B Department of the Treasury - Internal Revenue Service of VOID CORRECTED RECIPIENTS/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. OMB No. 1545-1380 2019 FIRST BANK 1 NORTH OAK STREET MIDDLESBURG, PA 17555 Mortgage Interest Statement Copy C For Recipient Lender RECIPIENT S/LENDER'S TIN PAYER'S/BORROWER'S TIN 111-11-1115 Form 1098 1 Mortgage interest received from payer(s) borrower(s) $ 4200 2 Outstanding mortgage 3 Mortgage origination date principal $ 120.000 7/8/02 4 Refund of overpaid 5 Mortgage insurance interest premiums $ $ 6 Points paid on purchase of principal residence $ 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. PAYER'S/BORROWER'S name PHILLIP SMITH For Privacy Act and Paperwork Reduction Act Notice, see the 2019 General Instructions for Certain Information Returns. Street address (including apt. no.) 55 CEDAR CREST LANE City or town, state or province, country, and ZIP or foreign postal code MIDDLESBURG, PA 17555 8 Address or description of property securing mortgage (see instructions) 9 Number of properties securing the 10 Other mortgage 11 Mortgage acquisition date Account number (see instructions) Form 1098 www.irs.gov/Form 1098 Department of the Treasury - Internal Revenue Service 8 of 9 The Rock Church 1 Church Street Middlesburg, PA 17555 January 26, 2020 Dear Mr. & Mrs. Smith, On behalf of The Rock Church, I thank you for your generosity and support of our parish. I realize the sacrifices that you have made, and please know it is greatly appreciated! May God bless you and your family in a special way. If you made any pledge or any gift to our Debt Campaign, this statement reflects only the payments received during 2019. Any gift you may have made to the Diocesan Lenten Appeal is not included on this You will rec a ment directly from the Diocese Harrisburg for your Lenten Appeal contribution. Our records show that you have contributed the following amounts. Please retain this statement for income tax purposes. Amount Paid: Commitment to Parish Life Fund: Donations to Church $ 2,400.00 Diocesan Collections Fund: Diocesan Collections 100.00 Total amount paid: S 2,500.00 Total tax-deductible amount: $ 2.500.00 Thank you again for your past support. Your continued contributions are greatly appreciated! With warm affection and prayers, Pastor Gilbert 9 of 9 IMPACT OFFICIAL RECEIPT Please retain for your tax records. THE CAMPAIGNS GIFT DATE: 2019 AMOUNT: $ 500.00 GIFT ID: 2019-12 DESIGNATION AMOUNT Sierra Club Conservation Organization $ 500.00 RECEIVED FROM: Phillip Smith a Employee's social security number 111-11-1115 b Employer identification number (EIN) 11-2222222 c Employer's name, address, and ZIP code VETERANS AFFAIRS HOSPITAL 100 MILITARY WAY This information is being furnished to the Internal Revenue Service. If you OMB No. 1545-000s are required to file a tax retum, a negligence penalty or other sanction may be imposed on you this income taxable and you fail to report it 1 Wages, tips other compensation 2 Federal income tax withheld $40,000.00 $2,900.00 3 Social security wages 4 Social security tax withhold $40,000.00 $2,480.00 5 Medicare wages and tips 6 Medicare tax withhold $40,000.00 $580.00 7 Social security tips 8 Allocated tips LEBANON PA 17243 d Control number 9 10 Dependent care benefits Last name Suff. 11 Nonqualified plans 12a See instructions for box 12 Employee's first name and initial PHILLIP SMITH 13 That 12b 55 CEDAR CREST LANE n 14 Other 126 MIDDLESBURG PA 17555 120 1 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 Form W-2 Wage and Tax 2019 Department of the Treasury-Internal Revenue Service Sate, accurate. FAST! Use e-file Statement Copy C-For EMPLOYEE'S RECORDS (See Notice to Employee on the back of Copy B.) ) a Employee's social security number 111-11-1114 b Employer identification number (EIN 99-9999999 c Employer's name, address, and ZIP code WIC CLINIC 350 BAYLOR ROAD This information is being furnished to the Internal Revenue Service. If you OMB No 1545-0008 are required to file a tax return, a negligence penalty or other sanction may ay be imposed on you if this income is taxable and you tal to report it 1 Wages, tips, other compensation 2 Federal income tax withheld $25,650.00 $4,500.00 3 Social security wages 4 Social security tax withheld $25,650.00 $1,690.00 5 Medicare wages and tips 6 Medicare tax withheld 6 $25,650.00 $372.00 7 Social security tips 8 Allocated tips HARRISBURG PA 17755 d Control number 9 10 Dependent care benefits Suft. 11 Nonqualified plans 12a See instructions for box 12 e Employee's first name and initial ABIGAIL 55 CEDAR CREST LANE Last name SMITH Burma 13 Station nal Thu Nicky 12b 14 Other 120 MIDDLESBURG PA 17555 12d + 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 Department of the Treasury -- Internal Revenue Service W-2 Statement Wage and Tax Form Copy C-For EMPLOYEE'S RECORDS (See Notice to Employee on the back of Copy B.) 2019 Safe, accurate re-file FAST! Use Interest Income VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, Zip Payer's RTN (optional ZIP OMB No. 1545-0112 or foreign postal code, and telephone no FIRST BANK 2019 1 BANK STREET 1 1 Interest income MIDDLESBURG, PA 17555 S 210 Form 1099-INT 2 Early withdrawal penalty PAYER'S TIN RECIPIENT'S TIN 111-11-1115 3 Interest on U.S. Savings Bonds and Treas, obligations Copy C For Payer RECIPIENT'S name 4 Federal income tax withheld 5 Investment expenses PHILLIP SMITH $ IS 6 Foreign tax paid 7 Foreign country or US, possession For Privacy Act Street address (including apt. 10.) IS and Paperwork 55 CEDAR CREST LANE Reduction Act 8 Tax-exempt interest 9 Specified private activity bond interest Notice, see the City or town, state or province, country, and ZIP or foreign postal code $ 2019 General $ $ Instructions for MIDDLESBURG, PA 17555 10 Market discount 11 Bond premium Certain Information FATCA filings Is Returns. requirement 12 Bord premium on Treasury cities 13 Bond premium an t-art bond 1$ Account number isee instructions) 2nd TIN not 14 Tax-exempt and tax credit 15 State 16 State identification no. 17 State tax withheld bond CUSIPO IS Form 1099-INT www.insgow Form 1099INT Department of the Treasury - Internal Revenue Service - VOID CORRECTED OMB No 1545-0110 PAYER'S name, street address, city or town, state or province, country, ZIP ta Total ordinary dividends or foreign postal code, and telephone no. FUNDAMENTAL INVESTORS $ 325.00 2019 1b Qualified dividends Dividends and Distributions $ 325.00 2a Total capital gain distr. . $ 160.50 2c Section 1202 gain Form 1099-DIV 2b Unrecap. Sec. 1250 gain $ 2d Collectibles (28%) gain Copy C For Payer PAYER'S TIN RECIPIENTS TIN 111-11-1115 $ RECIPIENT'S name 3 Nondividend distributions 4 Federal income tax withheld PHILLIP SMITH $ o$ For Privacy Act 5 Section 199A dividends Investment expenses and Paperwork Street address (including apt, no.) .) $ $ $ Reduction Act Notice, see the 55 CEDAR CREST LANE 7 Foreign tax paid 8 Foreign country or US presin 2019 General Instructions for City or town, state or province, country, and ZIP or foreign postal code $ Certain MIDDLESBURG, PA 17555 9 Cash liquidation distributions 10 Noncash liquidation distribution Information $ $ Returns. FATCA filing 11 Exempt-interest dividends 12 Specified private activity requirement bond interest dividends $ 0 Account number (see instructions) 2nd TIN not. 13 State 14 State identification no15 State tax withheld D $ $ Form 1099-DIV www.in.gov/Fom1090DIV Department of the Treasury - Internal Revenue Service 3 of 9 VOID CORRECTED PAYER'S name, street address, city or town, state or province. country, Zip 1a Total ordinary dividends OMB No. 1545-0110 or foreign postal code, and telephone no. NEW PERSPECTIVE FUND $ 1550.26 2019 1b Qualified dividends Dividends and Distributions 1550.25 Form 1099-DIV 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain $ 4005.00 $ 2e Section 1202 gain 2d Collectibles (28%) gain Copy C For Payer PAYER'S TIN RECIPIENT'S TIN 111-11-1115 $ RECIPIENTS name 3 Nondividend distributions 4 Federal income tax withheld PHILLIP SMITH $ $ 0 $ 200.00 For Privacy Act 5 Section 190A dividends 6 Investment expenses and Paperwork Street address (including apt. no.) $ ) Reduction Act $ Notice, see the 55 CEDAR CREST LANE 7 7 Foreign tax paid 8 Foreign country or U.S. possession 2019 General Instructions for City or town, state or province, country, and ZIP or foreign postal code , , $ Certain MIDDLESBURG, PA 17555 , 9 Cash liquidation distributions 10 Noncash liquidation distribution 9 Information $ Returns. FATCA Sing 11 Exempt-interest dividende 12 Specified private activity requirement bond interest dividends $ os Account number (see instructions) ( and TIN not. 13 State 14 State dentification ne 15 State tax withheld $ $ Form 1099-DIV www.irs.gov/Form 109901 Department of the Treasury - Internal Revenue Service VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP ta Total ordinary dividends , OMB No 1545-0110 or foreign postal code, and telephone no. $ WASHINGTON MUTUAL INVESTORS FUND 428.00 2019 1b Qualified dividends Dividends and Distributions $ 426.00 2a Total capital gain distr. $ 1274.00 2c Section 1202 gain Form 1099-DIV 2b Unrecap. Sec. 1250 gain $ 2d Collectibles (28%) gain Copy C For Payer PAYER'S TIN RECIPIENT'S TIN 111-11-1115 $ $ RECIPIENTS name 3 Nondividend distributions 4 Federal income tax withheld PHILLIP SMITH $ o $ For Privacy Act 5 Section 199A dividends 6 Investment expenses and Paperwork Street address (including apt. no.) $ $ Reduction Act Notice, see the 55 CEDAR CREST LANE 7 Foreign tax paid 8 Foreign country or U.S. pression 2019 General Instructions for City or town, state or province, country, and ZIP or foreign postal code $ Certain MIDDLESBURG, PA 17555 9 Cash liquidation distributions 10 Noncash liquidation distribution Information $ $ $ Returns. FATCA filing 11 Exempt-interest dividends 12 Specified private activity requirement bond interest dividends $ o $ Account number (see instructions) 2nd TIN not 13 State 14 Sute identification 15 State tax withhold $ $ Form 1099-DIV www.lrs.gow/Form1000DIV Department of the Treasury - Internal Revenue Service 4 of 9 VOID CORRECTED PAYER S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 1949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no Broker and NEW PERSPECTIVE FUNDA 2019 Barter Exchange Form 1099-B Transactions 1a Description of property (Example: 100 sh.XYZ Co.) 100 SHARES 1b Date acquired 1c Date sold or disponed 3/15/19 12/7719 PAYER'S TIN RECIPIENTS TIN 1d Proceeds te Cost or other basis Copy c $ 111-11-1115 5000 $ 3500 For Payer 1f Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check if proceeds from PHILLIP SMITH Long-term gain or loss Collectibles D Ordinary OOF Street address (including apt. no.) 4 Federal income tax withheld 5 Check if noncovered Security 55 CEDAR CREST LANE For Privacy Act 6 Reported to IRS 7 Check ifloss is not allowed City or town, state or province, country. and ZIP or foreign postal code and Paperwork , Gross proceeds based on amount ind Reduction Act MIDDLESBURG, PA 17555 , Net proceeds Notice, see the 8 Profit or loss realized in 9 Unrealized profit or losion 2019 General Account number (see instructions) 2019 on closed contracts ( 2nd TIN not open contracts-12/31/2018 Instructions for Certain I Information CUSIP number FATCA filing 10 Unrealized profit or loosi on 11 Aggregate profit or loss) requirement Returns. open contracts - 12/31/2019 on contracts 14 State name 15 State identification no. 16 State tax withheld 12 Check if basis reported to 13 Bartering IRS $ www.irs.gov/Form10998 Department of the Treasury - Internal Revenue Service Form 1099-B VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds From or foreign postal code and telephone no 2019 Barter Exchange Broker and NEW PERSPECTIVE FUND A A Form 1099-B Transactions 1a Description of property (Example: 100 sh.XYZ Co.) 130 SHARES 1 Date acquired tc Date sold or disposed 7/28/17 12/7/19 PAYER'S TIN RECIPIENTS TIN 1d Proceeds te Cost or other basis Copy C 111-11-1115 $ 10.400 $ 555 For Payer 1f Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check it proceeds from PHILLIP SMITH Long-term gain or loss Collectibles Ordinary D QOF Street address including apt.no) . 4 Federal income tax withheld 5 Check it noncovered $ security 55 CEDAR CREST LANE 0 6 Reported to IRS 7 Check ifloss is not allowed For Privacy Act based on amount ind City or town, state or province, country, and ZIP or foreign postal code and Paperwork Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds Notice, see the 8 Profit or loss) realized in 9 Unrealized profit or losa on 2019 General Account number ince instructions) 2nd TIN not. 2019 on closed contracts open contracte-12/31/2018 Instructions for $ Certain Information CUSIP number FATCA filing 10 Unrealed profit or loss on 11 Aggregate profit or loss requirement Returns. on contracts open contracts-12/01/2019 14 State name 15 State identification no. 16 State tax withheld $ $ 12 Check if basis reported to 13 Bartering IRS $ ms $ Form 1099-B www.in.gov/Form10998 Department of the Treasury - Internal Revenue Service 5 of 9 VOID CORRECTED PAYERS name, street address, city or town, state or province, country. ZIP Applicable checkbox on Form 3949 , OMB NO. 1545-0715 Proceeds From or foreign postal code, and telephone no Broker and WASHINGTON MUTUAL INVESTORS FUND 2019 Barter Exchange Form 1099-B 1a Description of property (Example: 100 sh.XYZ CO. 90 SHARES 1b Date acquired tc Date sold or disposed 2/12/19 12/7/19 PAYER'S TIN RECIPIENTS TIN id Proceeds 1d te Cost or other basis Copy C S 111-11-1115 4950 $ 5025 For Payer 11 Accrued market discount 1g Wash sale loss disallowed $ $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check it proceeds from PHILLIP SMITH Long term gain or los Collectibles Ordinary OOF Street address including apt.no) . 4 Federal income tax withheld 5 Check if noncovered security 55 CEDAR CREST LANE 0 For Privacy Act 6 Reported to IRS 7 Check ifloss is not allowed City or town, state or province, country, and ZIP or foreign postal code and Paperwork based on amount in 1d Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds D Notice, see the Profit or (los) realized in 9 Unrealized profit or foon 2019 General 2nd TIN not 2019 on closed contracts Account number (see instructions) open contracts-12/31/2018 Instructions for Certain Information CUSIP number FATCA filing 10 Unrealized profit or loss on 11 Aggregate profit or loss Returns. requirement open contracts-12/31/2019 on contracts D 14 State name 15 State identification no. 16 State tax withheld $ 12 Check if basis reported to 13 Bartering D$ Form 1099-B www.irs.gov/Form 10998 Department of the Treasury - Intemal Revenue Service IRS 2019 Barter Exchange 1500 $ VOID CORRECTED PAYER S name, street address, city or town, state or province, country. ZIP Applicable checkbox on Form 1949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no. Broker and FUNDAMENTAL INVESTORS Transactions Form 1099-B 1a Description of property (Example: 100 sh. XYZ Co.) 75 SHARES 1b Date acquired 1c Date sold or disposed 3/4/19 9/7/19 PAYER'S TIN RECIPIENT'S TIN 1d Proceeds te Cost or other basis Copy C $ 111-11-1115 450 For Payer 16 Accrued market discount 1g Wash sale lots disallowed $ $ RECIPIENT'S name 2 Short-term gain or loss 3 Check if proceeds from: - PHILLIP SMITH Long-term gain or loss Collectibles D Ordinary OOF Street address including apt. no.) 4 Federal income tax withheld 5 Check it noncovered $ security 55 CEDAR CREST LANE O For Privacy Act 6 Reported to IRS 7 Check ifloss is not allowed based on amount in 1d and Paperwork City or town, state or province, country, and ZIP or foreign postal code Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds Notice, see the 8 Profit or lon) realized in 9 Unrealized profit or ons on 2019 General 2nd TIN not Account number (see instructions) 2019 on closed contracts open contracts-12/31/2018 Instructions for Certain E $ Information CUSIP number FATCA filing 10 Unrealized profit or lose on 11 Aggregate profit oros) requirement open contracts-12/31/2019 Returns. on contracts 14 State name 15 State identification no. 16 State tax withheld $ IS 12 Check it basis reported to 13 Bartering IRS $ D $ For 1099-B www.lrs.gov/Form10998 Department of the Treasury - Internal Revenue Service 6 of 9 VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 or foreign postal code, and telephone no. OMB No. 1545-0715 2019 Barter Exchange Proceeds From Broker and Transactions Copy C For Payer 2123.17 $ BARTER TRADES FUND Form 1099-B 1a Description of property (Example: 100 sh.XYZ Co.) 12 SHARES 1b Date acquired 1c Date sold or disposed VARIOUS 9/4/19 PAYER'S TIN RECIPIENTS TIN 1d Proceeds 1e Cost or other basis $ 111-11-1115 1667.48 16 Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENTS name 2 Short-term gain or loss 3 Check if proceeds from: PHILLIP SMITH Long-term gain or loss Collectibles Ordinary D QOF Street address (including apt. no.) 4 Federal income tax withheld 5 Check if noncovered $ security 55 CEDAR CREST LANE 0 6 Reported to IRS 7 Check if loss is not allowed based on amount in 1d City or town, state or province, country, and ZIP or foreign postal code D Gross proceeds MIDDLESBURG, PA 17555 Net proceeds 8 Profit or loss) realized in 9 Unrealized profit or loss) on 2nd TIN not. 2019 on closed contracts Account number (see instructions) open contracts-12/31/2018 $ $ CUSIP number 10 Unrealized profit or loss) on 11 Aggregate profit or loss) requirement open contracts-12/31/2019 on contracts For Privacy Act and Paperwork Reduction Act Notice, see the 2019 General Instructions for Certain Information Returns. FATCA filing 14 State name 15 State identification no. 16 State tax withheld $ S S $ 12 Check if basis reported to 13 Bartering IRS Form 1099-B www.irs.gov/Form 1099B Department of the Treasury - Intemal Revenue Service 2019 Barter Exchange VOID CORRECTED PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no. Broker and THE BANK 123 MAIN STREET Form 1099-B Transactions HARRISBURG, PA 17111 1a Description of property (Example: 100 sh.XYZ Co.) 100 SHARES 1b Date acquired 1c Date sold or disposed VARIOUS 8/1/19 PAYER'S TIN RECIPIENTS TIN 1d Proceeds 1e Cost or other basis Copy C $ 10-0000000 111-11-1115 8000 $ 6500 For Payer 1f Accrued market discount 1g Wash sale loss disallowed $ RECIPIENT'S name 2 Short-term gain or loss 3 Check if proceeds from: PHILLIP SMITH Long-term gain or loss Collectibles Ordinary O QOF Street address (including apt. no.) 4 Federal income tax withheld 5 Check if noncovered $ security 55 CEDAR CREST LANE 0 D For Privacy Act 6 Reported to IRS: 7 Check ifloss is not allowed City or town, state or province, country, and ZIP or foreign postal code based on amount in 1d and Paperwork Gross proceeds Reduction Act MIDDLESBURG, PA 17555 Net proceeds D Notice, see the 8 Profit or loss) realized in 9 Unrealized profit or loss) on 2019 General Account number (see instructions) 2nd TIN not. 2019 on closed contracts open contracts - 12/31/2018 Instructions for 6002 Certain D $ $ Information CUSIP number FATCA filing 10 Unrealized profit or loss) on 11 Aggregate profit or loss) Returns. requirement open contracts-12/31/2019 on contracts D 14 State name 15 State identification no. 16 State tax withheld $ $ 12 Check if basis reported to 13 Bartering IRS D Form 1099-B www.irs.gov/Form1099B Department of the Treasury - Internal Revenue Service of VOID CORRECTED RECIPIENTS/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. OMB No. 1545-1380 2019 FIRST BANK 1 NORTH OAK STREET MIDDLESBURG, PA 17555 Mortgage Interest Statement Copy C For Recipient Lender RECIPIENT S/LENDER'S TIN PAYER'S/BORROWER'S TIN 111-11-1115 Form 1098 1 Mortgage interest received from payer(s) borrower(s) $ 4200 2 Outstanding mortgage 3 Mortgage origination date principal $ 120.000 7/8/02 4 Refund of overpaid 5 Mortgage insurance interest premiums $ $ 6 Points paid on purchase of principal residence $ 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. PAYER'S/BORROWER'S name PHILLIP SMITH For Privacy Act and Paperwork Reduction Act Notice, see the 2019 General Instructions for Certain Information Returns. Street address (including apt. no.) 55 CEDAR CREST LANE City or town, state or province, country, and ZIP or foreign postal code MIDDLESBURG, PA 17555 8 Address or description of property securing mortgage (see instructions) 9 Number of properties securing the 10 Other mortgage 11 Mortgage acquisition date Account number (see instructions) Form 1098 www.irs.gov/Form 1098 Department of the Treasury - Internal Revenue Service 8 of 9 The Rock Church 1 Church Street Middlesburg, PA 17555 January 26, 2020 Dear Mr. & Mrs. Smith, On behalf of The Rock Church, I thank you for your generosity and support of our parish. I realize the sacrifices that you have made, and please know it is greatly appreciated! May God bless you and your family in a special way. If you made any pledge or any gift to our Debt Campaign, this statement reflects only the payments received during 2019. Any gift you may have made to the Diocesan Lenten Appeal is not included on this You will rec a ment directly from the Diocese Harrisburg for your Lenten Appeal contribution. Our records show that you have contributed the following amounts. Please retain this statement for income tax purposes. Amount Paid: Commitment to Parish Life Fund: Donations to Church $ 2,400.00 Diocesan Collections Fund: Diocesan Collections 100.00 Total amount paid: S 2,500.00 Total tax-deductible amount: $ 2.500.00 Thank you again for your past support. Your continued contributions are greatly appreciated! With warm affection and prayers, Pastor Gilbert 9 of 9 IMPACT OFFICIAL RECEIPT Please retain for your tax records. THE CAMPAIGNS GIFT DATE: 2019 AMOUNT: $ 500.00 GIFT ID: 2019-12 DESIGNATION AMOUNT Sierra Club Conservation Organization $ 500.00 RECEIVED FROM: Phillip Smith
