Case Study :

Norman K. Neubauer

Using the information below, complete the 2021 tax return for Norman K. Neubauer. Read the scenario carefully before beginning.

Topics	Current H&R Block Course
All previously required knowledge plus
Cancellation of Debt Income	Intermediate Cancellation of Debt Income
Retirement Contributions and Distributions	Intermediate Retirement
Small Business	Intermediate Sole Proprietorships Tax in Small Business: Introduction to Entities Spotlight on Schedule C
Casualties	Intermediate Casualties
Rental Income - Personal & Real	Intermediate Rental Real Estate
Net Operating Losses	Intermediate Net Operating Losses
Depreciation	Intermediate Depreciation
Stock Options	Intermediate Employee Stock Options
Basis	Introduction to Basis
Income from Schedules K-1	Intermediate Schedules K-1
Investment Income	Capital Gains and Losses: Fundamentals and Beyond

Introduction

Norman had his taxes prepared by an H&R Block tax preparer several years ago, but for the last few years, he has prepared his own taxes using a competitor's software. He believes his return is more complicated this year, and he decided to seek professional assistance. He was also happy with the service he received in September 2021, after he received a notice from his state. An H&R Block preseason Tax Professional helped him resolve the issue.

Taxpayer Information

Taxpayer name:	Norman K. Neubauer
Taxpayer SSN:	365-00-3070
Taxpayer DOB:	October 15, 1973
Occupation:	Truck Driver
Address:	8910 Mulholland Drive
	Your City, YS XXXXX
Preferred phone:	(XXX) 555-2370; Type: Cell; OK to call; FCC: Yes; Best time: Anytime
Taxpayer email:
Consents to H&R Block Personalized Services?	Yes
H&R Block Personalized Services includes personalized tax advice, exclusive offers, tax law updates, and valuable products and services.
Health Insurance
Did everyone in the household have health insurance for all 12 months in 2021?	Yes
Total months covered through a state exchange or federal Marketplace:	0
Total months covered through another plan:	12
Was a Form 1095-A issued?	No
Taxpayer did not provide a Form 1095-B or Form 1095-C, but he stated that he had qualifying health care coverage through his employer all year.

Norman is single. His SSN is valid for work in the U.S. and was received before the original filing due date of his return (including extensions). He is a U.S. citizen. No one may claim him as a dependent. Norman wishes to designate $3 to the Presidential Election Campaign Fund. He is not blind or disabled. He is not a student.

He has not received a notice from the IRS within the last year. As noted in the introduction, he did receive a state notice in September 2021, and an H&R Block preseason Tax Professional helped him resolve the issue. He did not provide a driver's license or state identification.

Norman did not suffer any casualty losses during 2021. He did not receive, sell, send, exchange, or otherwise dispose of any financial interest in any virtual currency. He does not have a financial interest in or signature authority over a foreign account, and he did not receive a distribution from, nor was he the grantor of or transferor to, a foreign trust. The IRS has not issued an Identity Protection ID Number for his return.

Unemployment, Charitable Contributions, and Distributions

Norman did not receive any unemployment income. He did not make any charitable contributions. He did not take advantage of any COVID-19 or disaster-related relief for retirement plans and IRAs in a prior year.

American Rescue Plan Act Information

Norman did receive the IRS Economic Impact Payment in the amount of $2,800. He claimed Maxx as a dependent in 2020 and received a $1,400 EIP for him.

Qualified Sick and/or Family Leave Credit

Norman did not receive qualified sick and/or family leave credits, and he does not qualify for the Health Coverage Tax Credit.

Household Information

Norman owns his home. No one else lives with him. However, Norman would like to know if he can claim any tax benefit for his father, Maxx, whom Norman helps support. Maxx lives in an apartment community for senior citizens near Norman's home.

The following individual may or may not qualify the taxpayer for certain credits or deductions.

Name:	Maxx Neubauer
SSN:	365-00-2331
DOB:	October 20, 1938
Relationship:	Father
Time in household:	0 months
Gross income:	$0
Support:	Does not provide over half of his own support

Maxx lived at the Green Acres Retired Living Center for all of 2021. Maxx received $12,287 in social security benefits in 2021, and he received an Economic Impact Payment of $1,400 in April 2021. He had no other income during the year. He put $4,000 in savings for a rainy day, and he used the rest of his income to pay rent at the facility. He is not disabled and is not married. Maxx is a U.S. citizen with an SSN valid for work in the U.S., which was received before the original filing due date of the return (including extensions).

Norman is not sure if he can claim anything for his father, but he has provided records of the support he provides and his father's information. Norman paid $1,150 per month to Happy Acres to cover the rest of his father's rent. Happy Acres is not a skilled nursing facility, and Maxx does not live there because he requires medical or nursing attention. Rather, he moved there for its convenient location and because the facility offers opportunities for social interaction.

The rent at the facility includes some meals and all utilities. Norman also paid $1,340 for medical bills that medicare did not cover for Maxx. Norman can provide documentation upon request for the paid medical bills.

Prior-Year Return

Norman provides a copy of his prior-year return. His prior-year adjusted gross income was $74,115, and his taxable income was $61,715. He claimed a refund of $475 when he timely filed his 2020 federal return; he received the refund a few weeks later. He had a state balance due, as shown in the Itemized Deductions section below.

2019 Earned Income

Norman's 2019 earned income was less than his 2021 earned income.

Other Income Information

Canceled Debt

Norman purchased a 2018 pickup truck on October 18, 2018, for $33,457 for his personal use. Unfortunately, he was not able to keep up with the payments on his pickup. He did not refinance the loan prior to the cancellation of debt, and he was not eligible for any pandemic-related accommodations. The vehicle was repossessed on February 3, 2021. He received a Form 1099-C.

At the time of the cancellation, the balance of his loan was $28,752, and the fair market value (FMV) of the truck was $17,463.15. His other assets consisted of his home, purchased for $230,157 and valued at $215,476, with a loan balance of $210,577. His credit card balance was $4,753. The value of his 401(k) is $457. He had almost depleted his savings account, but he did have a balance of $1,500 in the account immediately before the debt was discharged. The value of his stock portfolio was $10,943. Norman also has an outstanding balance on a student loan of $18,508. The furnishings in the home were purchased for $23,850 over the years and are now valued at $7,980. The basis in the home and furnishings did not change from the discharge date to the beginning of the year after the year of the discharge.

You may use the Canceled Debt Worksheet to determine Norman's insolvency, which will help you determine the taxable amount of the canceled debt.

Put Option

Norman purchased a put option for $300 on March 18, 2021. The option gave him the right to sell 200 shares of BGD stock for $50 a share. The option expired unexercised on June 18, 2021.

Incentive Stock Option

Over the past couple of years, Norman has been granted incentive stock options (ISOs) by his employer, Open Road Freight. He was granted the first option on October 1, 2019. This option allowed him to buy 300 shares of the company's stock at $33 per share. On February 3, 2020, Norman exercised his option, meaning that he purchased 300 shares of the stock at the grant price of $33 per share. The fair market value of the stock at the time was $35 per share. In January 2021, Norman received a Form 3921 from Open Road Freight reporting this purchase. He thought this form might be important, so he kept a copy of it. On March 5, 2021, Norman sold the shares he had acquired when he exercised that option.

Norman's employer granted a second incentive stock option on June 1, 2020. This option allowed him to buy 100 shares of the company's stock at $40 per share. Norman exercised this second option on November 2, 2021, when the fair market value of the stock was $50 per share. Norman has not yet sold any of these shares, but he did receive another Form 3921 in January 2022 reporting the purchase.

Gambling

Norman is not a professional gambler, but he enjoys playing slot machines every so often. He had some winnings and losses this year. He followed advice he received last year to document all his gambling expenses, and he provides a copy of the ledger sheet shown below.

2021 Gambling Log
Date	Type	Name of Casino	Winnings	Losses	Documentation
04/24/2021	Slots	White Star Casino, 77 Star Ave., YC, YS	$0	$500	ATM receipt, $500
05/08/2021	Slots	White Star Casino, 77 Star Ave., YC, YS	$350	$125	Copy of check and deposit receipt
05/15/2021	Slots	Grey Hawk Casino, 123 Grey Hawk Rd., YC, YS	$0	$1,000	Credit card receipt and statement
05/21/2021	Slots	Grey Hawk Casino, 123 Grey Hawk Rd., YC, YS	$0	$500	ATM receipt, $500
05/22/2021	Slots	Grey Hawk Casino, 123 Grey Hawk Rd., YC, YS	$2,600	$500	Copy of check and deposit receipt
06/19/2021	Slots	Grey Hawk Casino, 123 Grey Hawk Rd., YC, YS	$0	$1,200	Credit card receipt and statement
07/10/2021	Slots	River Rock Casino, 400 River Rd., YC, YS	$0	$500	ATM receipt, $500
10/02/2021	Slots	River Rock Casino, 400 River Rd., YC, YS	$2,060	$900	Copy of check and deposit receipt
12/17/2021	Slots	River Rock Casino, 400 River Rd., YC, YS	$275	$100	Copy of check and deposit receipt
Total:			$5,285	$5,325

Itemized Deductions

If Norman itemizes his deductions, he would like to deduct state and local taxes, rather than sales tax. In addition to his home mortgage interest, real estate taxes, and gambling losses, Norman paid the following personal expenses in 2021.

Description	Amount
Out-of-pocket copays for doctor visits	$310
Out-of-pocket prescriptions	$663
Personal property tax on his vehicle, based on value	$417
State balance due for prior-year return, paid May 3, 2021	$107

Future Planning

Norman is concerned he is not saving enough for retirement. Norman's employer sponsors a 401(k) plan and offers a match on the first 5% of contributions from each employee. Norman started contributing 2% of his salary to the plan just this year.

Information Documents

Norman had income from several sources. He provides a Form W-2 reporting income from wages. He also provides a Form 1099-INT reporting interest income, although he had to pay an early withdrawal penalty when he withdrew funds from a certificate of deposit before it matured. In addition, Norman purchased a put option which expired, and he sold shares of stock through an employee stock option plan. He provides two Forms 1099-B and two Forms 3921. Norman also won some money playing slot machines, and he provides two Forms W-2G. Some of Norman's winnings were for smaller amounts for which he did not receive a Form W-2G, but he provides a document listing all winnings and losses. Norman's only other income consisted of income from cancellation of debt, and he provides a Form 1099-C he received from the creditor. Finally, Norman provides a Form 1098 he received from his mortgage lender.

Norman did not provide a Form 1095-B or 1095-C, but as noted above, he tells you that he had qualifying health care coverage through his employer all year. He states that his father was covered under medicare.

Copies of all forms and further details regarding Norman's income are provided below.

CORRECTED (if checked) TRANSFEROR'S name, street address, city or town, state or province, 1 Date option granted OMB No. 1545-2129 country, and ZIP or foreign postal code Exercise of an OPEN ROAD FREIGHT 10/01/2019 Form 3921 Incentive Stock 4519 WEST 19TH STREET 2 Date option exercised Option Under YOUR CITY, YS XXXXX (Rev. October 2017) Section 422(b) 02/03/2020 TRANSFEROR'S TIN EMPLOYEE'S TIN 3 Exercise price per share 4 Fair market value per share Copy B 07-3652301 365-00-3070 on exercise date For Employee EMPLOYEE'S name $ 33.00 $ 35.00 This is important tax NORMAN K. NEUBAUER 5 No. of shares transferred information and is 300.00 being furnished to the IRS. If you are required Street address (including apt. no.) 6 If other than TRANSFEROR, name, address, and TIN of to file a return, a 8910 MULHOLLAND DRIVE corporation whose stock is being transferred negligence penalty or other sanction may be City or town, state or province, country, and ZIP or foreign postal code imposed on you if this YOUR CITY, YS XXXXX item is required to be reported and the IRS Account number (see instructions) determines that it has not been reported. Form 3921 (Rev. October 2017) (keep for your records) www.irs.gov/Form3921 Department of the Treasury - Internal Revenue ServiceCORRECTED (if checked) TRANSFEROR'S name, street address, city or town, state or province, 1 Date option granted OMB No. 1545-2129 country, and ZIP or foreign postal code Exercise of an OPEN ROAD FREIGHT 06/01/2020 Form 3921 Incentive Stock 4519 WEST 19TH STREET 2 Date option exercised Option Under YOUR CITY, YS XXXXX (Rev. October 2017) Section 422(b) 11/02/2021 TRANSFEROR'S TIN EMPLOYEE'S TIN 3 Exercise price per share 4 Fair market value per share Copy B 07-3652301 365-00-3070 on exercise date For Employee EMPLOYEE'S name $ 40.00 $ 50.00 This is important tax NORMAN K. NEUBAUER 5 No. of shares transferred information and is 100.00 being furnished to the IRS. If you are required Street address (including apt. no.) 6 If other than TRANSFEROR, name, address, and TIN of to file a return, a 8910 MULHOLLAND DRIVE corporation whose stock is being transferred negligence penalty or other sanction may be City or town, state or province, country, and ZIP or foreign postal code imposed on you if this YOUR CITY, YS XXXXX item is required to be reported and the IRS Account number (see instructions) determines that it has not been reported. Form 3921 (Rev. October 2017) (keep for your records) www.irs.gov/Form3921 Department of the Treasury - Internal Revenue Servicea Employee's social security number Safe, accurate, Onse ~ file Visit the IRS website at 365-00-3070 OMB No. 1545-0008 FAST! Use www.irs.gov/efile b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld 07-3652301 95,721.48 14,078.00 c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld 6,110.80 OPEN ROAD FREIGHT 98,561.26 5 Medicare wages and tips 6 Medicare tax withheld 4519 WEST 19TH STREET 98,561.26 1,429.14 YOUR CITY, YS XXXXX 7 Social security tips 8 Allocated tips d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12 NORMAN K. NEUBAUER 2,839.78 13 Statutory Retirement Third-party employee sick pay 12b plan X DD 7,866.00 8910 MULHOLLAND DRIVE 14 Other 12c ISODD $600 YOUR CITY, YS XXXXX 12d f 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 YS 073652301A 95,721.48 6,107.06 Form W-2 Wage and Tax Statement 2021 Department of the Treasury-Internal Revenue Service Copy B-To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service.CORRECTED (if checked) PAYER'S name, street address, city or town, state or province, country, ZIP Payer's RTN (optional) OMB No. 1545-0112 or foreign postal code, and telephone no. Interest STATE BANK 2021 1 Interest income 3961 FINANCIAL WAY Income YOUR CITY, YS XXXXX $ 21.76 Form 1099-INT (XXX) 555-2303 2 Early withdrawal penalty Copy B PAYER'S TIN RECIPIENT'S TIN $ 11.85 For Recipient 3 Interest on U.S. Savings Bonds and Treas. obligations 07-3652302 365-00-3070 $ RECIPIENT'S name 4 Federal income tax withheld 5 Investment expenses This is important tax NORMAN K. NEUBAUER $ $ information and is being furnished to the 6 Foreign tax paid 7 Foreign country or U.S. possession IRS. If you are Street address (including apt. no.) $ required to file a 8 Tax-exempt interest 9 Specified private activity bond return, a negligence 8910 MULHOLLAND DRIVE interest penalty or other sanction may be City or town, state or province, country, and ZIP or foreign postal code $ $ imposed on you if 10 Market discount 11 Bond premium this income is YOUR CITY, YS XXXXX taxable and the IRS determines that it has FATCA filing $ $ not been reported. requirement 12 Bond premium on Treasury obligations | 13 Bond premium on tax-exempt bond $ $ Account number (see instructions) 14 Tax-exempt and tax credit 15 State 16 State identification no. 17 State tax withheld bond CUSIP no. 12345656 Form 1099-INT (keep for your records) www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue ServiceCORRECTED (if checked) PAYER'S name, street address, city or town, state or province, country, ZIP | Applicable checkbox on Form 8949 OMB No. 1545-0715 or foreign postal code, and telephone no. Proceeds From A 2021 Broker and NRL INVESTMENT BROKERS Barter Exchange Transactions 922 MAIN STREET Form 1099-B YOUR CITY, YS XXXXX 1a Description of property (Example: 100 sh. XYZ Co.) 200 BGD JUN 50 PUT (816)555-1023 1b Date acquired 1c Date sold or disposed 03/18/2021 06/18/2021 PAYER'S TIN RECIPIENT'S TIN 1d Proceeds le Cost or other basis Copy B $ $ 300.00 For Recipient 07-3652303 365-00-3070 if Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENT'S name 2 Short-term gain or loss V 3 If checked, proceeds from: NORMAN K. NEUBAUER Long-term gain or loss Collectibles Ordinary QOF This is important tax Street address (including apt. no.) 4 Federal income tax withheld 5 If checked, noncovered information and is security 8910 MULHOLLAND DRIVE $ being furnished to 6 Reported to IRS: 7 If checked, loss is not allowed the IRS. If you are City or town, state or province, country, and ZIP or foreign postal code based on amount in 1d required to file a Gross proceeds return, a negligence YOUR CITY, YS XXXXX Net proceeds penalty or other 8 Profit or (loss) realized in Unrealized profit or (loss) on sanction may be 2021 on closed contracts open contracts- 12/31/2020 imposed on you if Account number (see instructions) 12345657 this income is $ $ taxable and the IRS CUSIP number FATCA filing 10 Unrealized profit or (loss) on 11 Aggregate profit or (loss) determines that it requirement open contracts -12/31/2021 on contracts has not been 14 State name 15 State identification no. 16 State tax withheld $ $ reported. YS 12 If checked, basis reported 13 Bartering to IRS V $ Form 1099-B (Keep for your records) www.irs.gov/Form1099B Department of the Treasury - Internal Revenue ServiceCORRECTED (if checked) 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. D 2021 Broker and STOCK OPTIONS EXPERTS Barter Exchange Transactions 608 INVESTMENT ROAD Form 1099-B YOUR CITY, YS XXXXX 1a Description of property (Example: 100 sh. XYZ Co.) 300 SH ORF (816)555-2323 1b Date acquired 1c Date sold or disposed 02/03/2020 03/05/2021 PAYER'S TIN RECIPIENT'S TIN 1d Proceeds le Cost or other basis Copy B $ 12,000.00 $ 9.900.00 For Recipient 07-3652304 365-00-3070 If Accrued market discount 1g Wash sale loss disallowed $ $ RECIPIENT'S name 2 Short-term gain or loss 3 If checked, proceeds from: NORMAN K. NEUBAUER Long-term gain or loss Collectibles Ordinary QOF This is important tax Street address (including apt. no.) 4 Federal income tax withheld 5 If checked, noncovered information and is $ security being furnished to 8910 MULHOLLAND DRIVE 6 Reported to IRS: 7 If checked, loss is not allowed the IRS. If you are based on amount in 1d required to file a City or town, state or province, country, and ZIP or foreign postal code Gross proceeds return, a negligence YOUR CITY, YS XXXXX Net proceeds penalty or other 8 Profit or (loss) realized in Unrealized profit or (loss) on sanction may be 2021 on closed contracts open contracts- 12/31/2020 imposed on you if Account number (see instructions) 12345658 this income is $ $ taxable and the IRS CUSIP number FATCA filing 10 Unrealized profit or (loss) on 11 Aggregate profit or (loss) determines that it requirement open contracts -12/31/2021 on contracts has not been reported. 14 State name 15 State identification no. 16 State tax withheld $ $ YS 12 If checked, basis reported 13 Bartering to IRS V $ Form 1099-B (Keep for your records) www.irs.gov/Form1099B Department of the Treasury - Internal Revenue ServiceCORRECTED (if checked) PAYER'S name, street address, city or town, province or state, country, 1 Reportable winnings 2 Date won OMB No. 1545-0238 and ZIP or foreign postal code GREY HAWK CASINO $ 2,600.00 05/22/2021 Form W-2G Certain 3 Type of wager 4 Federal income tax withheld 123 GREY HAWK ROAD Gambling SLOTS $ 260.00 Winnings YOUR CITY, YS XXXXX 5 Transaction 6 Race (Rev. January 2021) #019019 For calendar year 7 Winnings from identical wagers 8 Cashier 20 PAYER'S federal identification number PAYER'S telephone number $ O.HENRY 9 Winner's taxpayer identification no. 10 Window 07-3652306 888-555-7777 365-00-3070 This information is being furnished WINNER'S name 11 First identification 12 Second identification to the Internal Revenue Service. NORMAN K. NEUBAUER YS01-101023 365-00-3070 Street address (including apt. no.) 13 State/Payer's state identification no. 14 State winnings 8910 MULHOLLAND DRIVE YS/101023006 2,600.00 Copy B $ Report this income City or town, province or state, country, and ZIP or foreign postal code 15 State income tax withheld 16 Local winnings on your federal tax YOUR CITY, YS XXXXX return. If this form 130.00 $ shows federal 17 Local income tax withheld|18 Name of locality income tax withheld in box 4, attach this copy $ to your return. Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments. Signature Norman K. Neubauer Date 5/22/2021 Form W-2G (Rev. 1-2021) www.irs.gov/FormW2G Department of the Treasury - Internal Revenue ServiceCORRECTED (if checked) PAYER'S name, street address, city or town, province or state, country, 1 Reportable winnings 2 Date won OMB No. 1545-0238 and ZIP or foreign postal code $ 2,060.00 10/02/2021 Form W-2G RIVER ROCK CASINO Certain 3 Type of wager 4 Federal income tax withheld 400 RIVER ROAD Gambling SLOTS $ 206.00 Winnings YOUR CITY, YS XXXXX 5 Transaction 6 Race (Rev. January 2021) #029029 For calendar year 7 Winnings from identical wagers 8 Cashier 20 PAYER'S federal identification number PAYER'S telephone number $ T.SMITH 9 Winner's taxpayer identification no. 10 Window 07-3652307 888-555-5577 365-00-3070 This information is being furnished WINNER'S name 11 First identification 12 Second identification to the Internal Revenue Service. NORMAN K. NEUBAUER YS01-101024 365-00-3070 Street address (including apt. no.) 13 State/Payer's state identification no. 14 State winnings 8910 MULHOLLAND DRIVE YS/101023007 2,060.00 Copy B $ Report this income City or town, province or state, country, and ZIP or foreign postal code 15 State income tax withheld 16 Local winnings on your federal tax YOUR CITY, YS XXXXX return. If this form 103.00 $ shows federal 17 Local income tax withheld |18 Name of locality income tax withheld in box 4, attach this copy $ to your return. Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments. Signature Norman K. Neubauer Date 10/02/2021 Form W-2G (Rev. 1-2021) www.irs.gov/FormW2G Department of the Treasury - Internal Revenue ServiceCORRECTED (if checked) RECIPIENT'S/LENDER'S name, street address, city or town, state or Caution: The amount shown may| OMB No. 1545-1380 province, country. ZIP or foreign postal code, and telephone no. not be fully deductible by you. Limits based on the loan amount Mortgage and the cost and value of the HOME BANK secured property may apply. Also, 2021 Interest you may only deduct interest to the 1098 N. 34TH STREET, SUITE 300 extent it was incurred by you, Statement actually paid by you, and not YOUR CITY, YS XXXXX reimbursed by another person. Form 1098 (XXX) 524-5552 1 Mortgage interest received from payer(s)/borrower(s)* Copy B $ 7,645.51 For Payer/ RECIPIENT'S/LENDER'S TIN PAYER'S/BORROWER'S TIN 2 Outstanding mortgage 3 Mortgage origination date Borrower principal The information in boxes 1 $ 201,304.00 01/30/2017 through 9 and 11 is 07-3652308 365-00-3070 4 Refund of overpaid 5 Mortgage insurance important tax information interest premiums and is being furnished to PAYER'S/BORROWER'S name $ $ the IRS. If you are required to file a return, a negligence NORMAN K. NEUBAUER 6 Points paid on purchase of principal residence penalty or other sanction $ may be imposed on you if the IRS determines Street address (including apt. no.) 7 v if address of property securing mortgage is the same that an underpayment of as PAYER'S/BORROWER'S address, the box is checked, or tax results because you 8910 MULHOLLAND DRIVE the address or description is entered in box 8. overstated a deduction for this mortgage interest or for City or town, state or province, country, and ZIP or foreign postal code 8 Address or description of property securing mortgage these points, reported in boxes 1 and 6; or because YOUR CITY, YS XXXXX you didn't report the refund of interest (box 4); or 9 Number of properties securing the 10 Other because you claimed a mortgage nondeductible item. RE TAX $3,425.54 11 Mortgage Account number (see instructions) acquisition date 78081098 Form 1098 (Keep for your records) www.irs.gov/Form1098 Department of the Treasury - Internal Revenue ServiceCORRECTED (if checked) CREDITOR'S name, street address, city or town, state or province, country, 1 Date of identifiable event OMB No. 1545-1424 ZIP or foreign postal code, and telephone no. 02/03/2021 TOWN AND COUNTRY VEHICLES 2 Amount of debt discharged Cancellation 3456 PACKARD AVENUE $ 11.288.85 2021 of Debt YOUR CITY, YS XXXXX 3 Interest, if included in box 2 (XXX) 746-9523 $ 221.85 Form 1099-C CREDITOR'S TIN DEBTOR'S TIN 4 Debt description Copy B 07-3652305 365-00-3070 For Debtor DEBTOR'S name 2018 PICKUP TRUCK This is important tax NORMAN K. NEUBAUER information and is being furnished to the IRS. If you are required to file a Street address (including apt. no.) 5 If checked, the debtor was personally liable for return, a negligence penalty or other 8910 MULHOLLAND DRIVE repayment of the debt sanction may be City or town, state or province, country, and ZIP or foreign postal code imposed on you if taxable income results YOUR CITY, YS XXXXX from this transaction and the IRS determines Account number (see instructions) 6 Identifiable event code 7 Fair market value of property that it has not been G $ 17,463.15 reported. Form 1099-C (keep for your records) www.irs.gov/Form1099C Department of the Treasury - Internal Revenue Service