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 the forms provided in Blackboard (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.
Name: John Doe
Name: Jane Doe
Name: Jimmy Doe
12345 Any Street
Los Angeles, Ca 90124
Prescription Medication: $638
Doctor’s 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
Received a gift from Jane’s 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.
Finally, all three members of the family had qualifying health insurance for the entire year.
CORRECTED (if checked) Payers RTN (optional) OMB No 1545-0112 PAYER S name, streel address, city of town, state or province country. ZIP or foreign postal code and telephone no GOVERNMENT PERSONNEL MUTUAL LIFE INS CO 2211 NE LOOP 410 P.O. BOX 659567 SAN ANTONIO, TX 78265-9567 800-929-4765 2016 Interest Income 1 Interest income $56.98 2 Early wahdrawal penalty Form 1099-INT 3 Interest on U.S. Savings Bonds and Treas, obligations PAYER Stederal identification number RECIPIENTS Identification number 74-0651020 RECIPIENTS name, street address, city or town, state or province country, and ZIP or foreign postal code 4 Federal income tax withhold Investment expenses 6 Foreign lax paid 17 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 retum, a negligence penalty or other sanction may be imposed on you this income is taxable and the IRS delermines that it has not been reported 8 Tax-exempt interest 9 Specified private activity bond interest 10 Maikel discount 11 Bond premium 12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond 114 Tax-exempt and tax credeband CUSIP no Account number see instructions 000275767 Form 1099-INT FATCA fing requirement (keep for your records) 15 State 16 State identification no. 17 State lax withbeid NM 03-221595-009 Department of the Treasury - Intemal Revenue Service www.irs.gov/form 1099int
OORTOB (Rev. 12/15) O CORRECTED (if checked) Dividends and Distributions Verizon Communications Inc. OMB No. 1545-0110 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 2016 1a Total ordinary dividends $ 1404.41 2a Total capital gain distr. $ 0.00 2c Section 1202 gain $ 0.00 3 Nondividend distributions $ 0.00 5 Investment expenses $ 0.00 | 7 Foreign country or U.S. possession 1b Qual fied dividends $ 1404.41 2b Unrecap. Sec. 1250 gain $ 0.00 2d Collectibles (28%) gain $ 0.00 4 Federal income tax withheld $ 0.00 6 Foreign tax paid Form 1099-DIV Copy B For Recipient RECIPIENT'S ID No. ending in: ****-6711 Account number (see instructions): C0001413651 RECIPIENT'S name, street address, city, state, ZIP code 8 Cash liquidation distributions $ 0.00 11 Spected private achty bendirteressen $ 0.00 10 Exempl-interest dividend $ 0.00 John & Jane Doe 12345 Any Street Los Angeles, Ca 90124 The reportable amounts above include the following additional income: Company Paid Fees Company Paid Service Charges $ 0.00 $ 0.00 Discount on Reinvestment $ 0.00 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 it has not been reported. Form 1099-DIV (keep for your records) Department of the Treasury - Internal Revenue Service
QORTOB (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 C/O 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 is 0.00 2c Section 1202 gain 2d Collectibles (28%) gain $ 0.00 $ 0.00 3 Nondividend distributions 4 Federal income tax withheld s 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 Exempt-interest dividend 11 Speaked phakady tondre $ 0.00 $ 0.00 Form 1099-DIV Copy BC end The reportable amounts above include the following additional income: RECIPIENT'S name, street address, city, state, ZIP code John & Jane Doe 12345 Any Street Los Angeles, Ca 90124 For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to fle 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. Company Paid Fees Company Paid Service Charges Discount on Reinvestment $ Form 1099-DIV (keep for your records) Department of the Treasury - Internal Revenue Service
95-28342364 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) Federal income tax withheld Employee contributions/Designated Roth contributions or insurance premiums 6 Net unrealized appreciation - employer's securities Distribution code(s) IRA/SEPISIMPLE OL $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 (X) $884.88 CA 02-074630 00 0
OMB No. 1545-01 OFFICE OF PERSONNEL MANAGEMENT STATEMENT OF ANNUITY PAID Form: 1099 2016 Distributions Fr RETIREMENT OPERATIONS Copy 2A-To be filed with annuitant's state or local Pensions, Annuit P.O. BOX 45 Retirement or Pro tax return Sharing Plans, IR BOYERS, PA 16017-0045 Insurance Contracts, PAYER's Federal identification Recipient's ID No. (Annuitant) Account number Retirement Claim No.) 1. Gross distribution 52-6083699 41016.00 5. Employee Contributions 2a. Taxable amount Designated ROTH Contributions PAID 38553.00 or Insurance Premiums TO John Doe 4. Federal Income Tax Withheld 2641.80 12345 Any Street 3942.00 Los Angeles, Ca 90124 7. Distribution Codes) 12. State tax withheld 13. State Payer's state no. 7-NONDISABILITY 1440.00 ICA 96. Total Employee Contributions 12. State tax withheld 13. State Payer's state no. 73891.00 NONE
FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT 2016: SARI • 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 (Box 3 minus Box 4) $19.894.80 NONE $19,894.80 DESCRIPTION OF AMOUNT IN BOX 4 DESCRIPTION OF AMOUNT IN BOX 3 $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
John & 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 DrivePmt/Pledge Christmas Seminary Support World Mission Sunday $80.00 $20.00 $15.00 $20.00 Cemetary Improvement Fund contributions SVDP Contributions $10.00 $390.00 $90.00 Total Contributions: $625.00
2016 Mortgage Interest Statement CORRECTED (if checked) RECIPIENT SVLENDER'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 deductblo 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 Intereet to the content i was incurred by you (Rev. July 2016) Los Angeles, Ca 90124 actually paid by you, and not reimbursed by another person Form 1098 1 Mortcada interest received from Daverisy borrowers) $ 12,215 RECIPIENT'S/LENDER'S federal PAYER'S/BORROWER'S taxpayer 2 Outstanding mortgage 3 Mortgage origination date identification number identification nn. principal as of 1/1/2016 LOAN ORIGINATION $ 74,101.26 DATE: 06/28/2006 73 - 0780382 4 Refund of overpaid 5 Mortgage Insurance Interest premiumns 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/BORROWER'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 boing furnished to the Internal Revenue Service. If you are required to file a retum, a negligence penalty or other sanction may be mposed on you if the IRS determines that an underpayment of tax results because you overstated a deduction 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 10 Other Real Estate Tax Paid: $2,215 9 property securing mortgage has no address, balow is the description of the property Account number (See Instructions tem Form 1098 Keep for your records www.irs.gov/form1098 Department of the Treasury - Internal Revenue Service