| | a Employee's social security number 571-78-5974 | OMB No. 1545-0008 | Safe, accurate, FAST! Use | IRS e ~ file | Visit the IRS website at www.irs.gov/efile | | b | Employer identification number (EIN) 34-7654321 | 1 | Wages, tips, other compensation 76,600.00 | 2 | Federal income tax withheld 9,785.00 | | c | Employer's name, address, and ZIP code Granny Smith Apple Co. 200 Ahtanum Rd. Yakima, WA 98903 | 3 | Social security wages 76,600.00 | 4 | Social security tax withheld 4,749.20 | | 5 | Medicare wages and tips 76,600.00 | 6 | Medicare tax withheld 1,110.70 | | 7 | Social security tips | 8 | Allocated tips | | d | Control number | 9 | Verification code | 10 | Dependent care benefits | | | | e | Employee's first name and initial | Last name | Suff. | 11 | Nonqualified plans | 12a | See instructions for box 12 | | C o d e | | | | John Fuji 468 Bonnie Doon Ave. Yakima, WA 98902 | 13 | | Statutory employee | Retirement plan | Third-party sick pay | | | | | 12b | | | | C o d e | | | | | 14 | Other | 12c | | | | | C o d e | | | | | 12d | | | | | C o d e | | | 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 | | WA | | | | | | | | | | | | | | | | | | | | | | Form W-2 Wage and Tax Statement | 2017 | Department of the TreasuryInternal Revenue Service | | Copy BTo Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. John's other income includes interest on a Certificate of Deposit reported on a Form 1099-INT: | PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Braeburn National Bank 1600 W. Nob Hill Blvd. Yakima, WA 98902 | Payer's RTN (optional) | OMB No. 1545-0112 2017 Form 1099-INT | Interest Income | | | | | 1 | Interest Income | | $ | 1,295.00 | | 2 | Early withdrawal penalty | 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 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. | | $ | | | PAYER'S federal identification number | RECIPIENT'S identification number | 3 | Interest on U.S. Savings Bonds and Treas. obligations | | 54-9019016 | 571-78-974 | $ | | | RECIPIENT'S name John Fuji Street address (including apt. no.) 468 Bonnie Doon Ave City or town, state or province, country, and ZIP or foreign postal code Yakima, WA 98902 | 4 | Federal income tax withheld | 5 | Investment expenses | | $ | 0.00 | $ | | | 6 | Foreign tax paid | 7 | Foreign country or U.S. possession | | $ | | | 8 | Tax-exempt interest | 9 | Specified private activity bond interest | | $ | | $ | | | | 10 $ | Market discount | 11 $ | Bond premium | | | | FATCA filing requirement | 12 | Bond premium on Treasury obligations | 13 | Bond premium on tax-exempt bond | | | | $ | | $ | | | Account number (see instructions) | 14 | Tax-exempt and tax credit bond CUSIP no. | 15 | State | 16 | State identification no. | 17 | State tax withheld | | | | | | | | $ | | | | | | | $ | | | Form 1099-INT John received the following Form 1098 that reports his mortgage interest and property taxes. | CORRECTED (if checked) | | RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Braeburn National Bank 1600 W. Nob Hill Blvd. Yakima, WA 98902 | *Caution: The amount shown may not be fully deductible by you. Limits based on the loan amount and the cost and value of the secured property may apply. Also, you may only deduct interest to the extent it was incurred by you, actually paid by you, and not reimbursed by another person. | OMB No. 1545-0901 2017 (Rev. July 2017) Form 1098 | | Mortgage Interest Statement | | 1 Mortgage interest received from payer(s)/borrower(s)* $ 7,780.00 | Copy B For Payer/Borrower The information in boxes 1 through 9 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 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 item. | | RECIPIENT'S/LENDER'S federal identification number 54-9019016 | PAYER'S/BORROWER'S taxpayer identification no. 571-78-5974 | 2 Outstanding mortgage principal as of 1/1/2017 $254,678.00 | 3 Mortgage origination date 12/1/2016 | | 4 Refund of overpaid interest $ | 5 Mortgage insurance premiums $ | | PAYER'S/BORROWER'S name John Fuji | 6 Points paid on purchase of principal residence $ | | Street address (including apt. no.) 468 Bonnie Doon Ave. | | 7 Is address of property securing mortgage same as PAYER'S/BORROWER'S address? | | If "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 Yakima, WA 98902 | | 10 Number of mortgaged properties 1 | 11 Other Prop taxes $2,083 | 8 Address of property securing mortgage | | Account number (see instructions) | 9 If property securing mortgage has no address, below is the description of the property | | Form 1098 | (keep for your records) | www.irs.gov/form1098 | Department of the Treasury - Internal Revenue Service | | (keep for your records) | www.irs.gov/form1099int | Department of the Treasury - Internal Revenue Service | | | |
