Charlotte Squab Financial Services

EIN: 13-5596127

123 Wall Street

New York, NY 10022

December 31, 2019

Joan and Noah Arc

1265 W. Riverview Avenue

Dayton, OH 45402

SSN: 456-87-5432

Dividends
Payor	Box 1 a Ordinary Dividends	Box 1b Qualified Dividends	Box 2a Capital Gain Distributions	Box 4 Federal Income Tax Withheld	Box 6 Foreign Tax Paid	Box 10 Tax- Exempt Dividends
Exxon Mobil	308.00	308.00	00.00	00.00	00.00	00.00
Texas Utilities	1,220.00	1,220.00	00.00	00.00	00.00	00.00
Coca-Cola	320.00	320.00	00.00	00.00	00.00	00.00

Stock Transactions
Description	Date Acquired	Date Sold	Proceeds	Basis Reported To IRS
100 shares Blue Corp.	02/11/2019	08/15/2019	4,500.00	2,500.00
50 shares Yellow Corp.	01/13/2019	06/05/2019	6,100.00	5,300.00
25 shares Red corp.	10/02/2008	10/07/2019	12,300.00	1,600.00

ROUNDUP DAYCARE CENTER 245 N. WILKINSON TREET DAYTON, OH 45402

January 12, 2020

Noah and Joan Arc

1265 W. Riverview Avenue

Dayton, OH 45402

Dear Joan and Noah,

Thank you for a great 2019 at Roundup! We appreciate your patronage during the year and hope to provide excellent service for Mary Sue in 2020. We have provided the tax information for calendar year 2019 below. Please let us know if you need any additional informational.

Sincerely,

Charles F. Burgundian

Charles F. Burgundian

Executive Director, Roundup Day Care

EIN 54-0983456

Date of Service	Amount Paid	Child’s Name
Jan 01, 2019 to Dec 31, 2019	$2,700	Mary Sue Arc

  

Transcribed Image Text:

a Employee's social security number 456-87-5432 OMB No. 1545-0008 22222 b Employer identification number (EIN) 33-4382966 c Employer's name, address, and ZIP code City of Dayton Fire & Rescue 123 Warren Street Dayton, OH 45402 d Control number e Employee's first name and initial Last name Joan Are 1265 W. Riverview Avenue Dayton, OH 45402 1 Employee's address and ZIP code 15 State Employer's state ID number OH 1126= 870 21. Form W-2 Wage and Tax Statement Copy 1-For State, City, or Local Tax Department 1 Wages, tips, other compensation 30,000.00. 2019 3 Social security wages 30,000.00 5 Medicare wages and tips 30,000.00 Suff. 11 Nonqualified plans Retirement plan 7 Social security tips 13 Statutory employee 14 Other Third-party sick piry 2 Federal income tax withheld 5,000.00 4 Social security tax withheld 1860.00 435,00 6 Medicare tax withheld 8 Allocated tips 10 Dependent care benefits 12a 10D | 12,200.00 12b 12c 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 30,000.00 1.840.00 12d Department of the Treasury-Internal Revenue Service a Employee's social security number 456-87-5432 OMB No. 1545-0008 22222 b Employer identification number (EIN) 33-4382966 c Employer's name, address, and ZIP code City of Dayton Fire & Rescue 123 Warren Street Dayton, OH 45402 d Control number e Employee's first name and initial Last name Joan Are 1265 W. Riverview Avenue Dayton, OH 45402 1 Employee's address and ZIP code 15 State Employer's state ID number OH 1126= 870 21. Form W-2 Wage and Tax Statement Copy 1-For State, City, or Local Tax Department 1 Wages, tips, other compensation 30,000.00. 2019 3 Social security wages 30,000.00 5 Medicare wages and tips 30,000.00 Suff. 11 Nonqualified plans Retirement plan 7 Social security tips 13 Statutory employee 14 Other Third-party sick piry 2 Federal income tax withheld 5,000.00 4 Social security tax withheld 1860.00 435,00 6 Medicare tax withheld 8 Allocated tips 10 Dependent care benefits 12a 10D | 12,200.00 12b 12c 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 30,000.00 1.840.00 12d Department of the Treasury-Internal Revenue Service

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