Noah and Joan Arc's Tax Return Note: This problem is divided into three parts. You will need to complete some of the forms In the other parts in order to determine the amounts to be used on Form 1040. Some of the data Information will be reproduced in the other parts for convenience Noah and Joan Arc live with their family in Dayton, OH. Noah's Social Security number Is 434-11-3311. Noah was born on February 22, 1988, and Joan was born on July 1, 1989. Both enjoy good health and eyesight. Noah owns and operates a pet store, and Joan Is a firefighter for the city of Dayton. 1. The Arcs have two children, a son named Shem (Social Security number 598-01-2345), born on March 21, 2016, and a daughter named Nora (Social Security number 554-33-2411), born on December 3, 2019. 2. Joan and Noah brought a folder of tax documents (see Forms W-2 and 1098). In addition, they received a Substitute 1099 Statement from Charlotte Shaws Financial Services (located on a separate tab) regarding their stock transactions for the year. 3. Noah's pet store is located at 1415 S. Patterson Blud, Dayton, OH 45409. The name of the store Is "The Arc" and its taxpayer Identification number Is 95-9876556. Since you handle Noah's bookkeeping, you have printed the Income statement from your Quickbooks software, shown In the table below. The Arc 95-9876556 Income Statement For the Year Ended December 31, 2023 Revenue: Gross Sales $150,500.00 Less: Sales Returns and Allowances Net Sales $150,500.00 Cost of Goods Sold: Beginning Inventory $11,000.00 Add: Purchases 56,000.00 77,000.00 Less: Ending Inventory 10,200.00 Cost of Goods Sold 66,800.00 Gross Profit (Loss) $83,700.00 Expenses: Dues and Subscriptions Estimated Federal Tax Payments 4,100.00 Estimated State Tax Payments 3,800.00 Insurance 4,000.00 Meals and Entertainment 1,600.00 Miscellaneous 300.00 Payroll Taxes 4,000.00 Professional Fees 1,800.00 Rent 8,500.00 Travel 1,300.00 tilities 1,500.00 Vehicle Expenses wages 25,000.00 Total Expenses 55,900.00 Net Operating Income $27,800.00 4. Details of The Arc's meals and entertainment: Meals associated with business trave $500 Arc employee holiday party 300 Overtime meals for employees 200 Sports tickets for entertaining large customers 600 $1,600 5. Travel costs are business related and do not Include meals. Miscellaneous expense is a $300 contribution to Re-elect Goldle Wilson, Mayor of Dayton. 6. Noah and Joan paid the following amounts during the year (all by check): Contributions to Re-elect Goldle Wilson, Mayor of Dayton $250 Church donations (for which a written acknowledgment was received) 5,20 Real estate taxes on their home 2,40 Medical co-pays for doctor visits 650 Mortgage Interest for purchase of home (See Form 1098) Tax return preparation fees 350 Credit card Interest 220 Automobile Insurance premiums 600 Uniforms for Joan 125 Contribution to Noah's Individual retirement account (made on 5,00 April 1, 2024) 7. Noah has a long-term capital loss carryover from last year of $1, 100. 8. Noah and Joan own a condo and use it as a rental property. The condo is located at 16 Oakwood Ave, Unit A, Dayton, OH 45409. Noah provides the management services for the rental Includi selection of tenants, maintenance, repairs, rent collection, and other services as needed. On average, Noah spends about two hours per week on the rental activity. The revenue and expenses for the year are as follows: Rental Income received $16,20 Insurance 800 Interest expense 2,800 Property taxes 1,500 Miscellaneous expenses 500 Rental Income Includes $1, 150 per month for two months under the previous lease (which ended February 28, 2023). The new lease Is $1,300 per month for ten months under the new lease but the tenant paid only $900 In May 2023 because the tenant paid $400 for repairs to the apartment, and with the Arc's permission, reduced May's rent by $400. The new lease also required the tenant to pay last month's $1,300 rent In February 2023. The home was acquired for $95,000 In 2007. On May 12, 2023, the Arcs Installed new fixtures (7-year recovery period) at a cost of $5,500. They wish to maximize the cost recovery on the new fixtures but make no elections. 9. The Arcs paid Ohio general sales tax of $1,076 during the year. Required: You are to prepare the Arcs' federal Income tax return In good form. You are not to complete an Ohio state Income tax return. The following forms and schedules are required and may be found in parts 1, 2, or 3: Part 1 Part 2 Part 3 Form 2441 Form 1040 Schedule C (Only page 1 Is required) Schedule 1 Schedule D Schedule E Schedule 2 Schedule SE Form 4562 Schedule 3 Qualified Dividends and Capital Gain Tax Worksheet Schedule 8812 Schedule A Form 8995 Schedule B. Make realistic assumptions about any missing data that you may need. Substitute 1099 Statement from Charlotte Shaws Financial Services Charlotte Shaws Financial Services 123 Wall Street New York, NY 10005 Joan and Noah Arc 1265 W. Riverview Avenue Dayton, OH 45402 SSN: 456-87-5432 Date Substitute 1099 Statement December 31, 2023 Dividends Box Ia Box ID Box 4 Federal Box Box 11 Tax- Ordinary Qualified Box 2a Cap Income Tax Foreign Tax exempt Payor Dividends Dividends Gain Distrib withheld Paid Dividends ExxonMobil 300.00 300.00 0.00 0.00 0.00 0.00 Texas Util. 1,250.00 ,250.00 0.00 0.00 0.00 CS Growth 405.00 390.00 260.00 0.00 25.00 0.00 Fund Stock Transactions Box la Box 1b Box Ic Box 1d Box le Box 2 Description Date Acq. Date Sold Net Proceeds |Basis (reported to IRS) Character 100 shs. Blue Corp. 02/11/2013 08/15/202. 1,800.00 ,700.00 LT 50 shs. Yellow Corp. DI/13/2023 06/05/202 5,050.00 5,500.00 ST 25 shs. Red Co. 10/02/2014 10/07/2023 11,500.00 2,000.00 LT Roundup Day Care Center Statement ROUNDUP DAY CARE CENTER 245 N. WILKINSON STREET DAYTON, OH 45402 January 12, 2024 Joan and Noah Arc 1265 W. Riverview Avenue Dayton, OH 45402 Dear Joan and Noah, Thank you for a great 2023 at Roundup! We appreciate your patronage during the year and hope to continue to provide excellent service for Nora In 2024. We have provided the tax Information for calendar year 2023 below. Please let us know If you need any additional Information. Sincerely, Charles F. Burgundian Charles F. Burgundlan Executive Director, Roundup Day Care EIN 54-0983456 Date of service Amount Pald Child January 1, 2023 - December 31, 2023 $7,300.00 Nora Arc1040 U.S. Individual Income Tax Return 2023 OMB No. 1545-6074 IRS Use Only For the year Jan. 1-Dec. 31, 2023, or other tax year beginning - . 2023, anding See separate instructions. our first name and middle initial ast name Your social security number Noah 434-11-3311 If joint return, spouse's first name and middle initial Last name spouse's social security number Joan 456-87-5432 Home address (number and street). If you have a R.O. box, see instructions. Presidential Election Campaign 1265 W. Riverview Ave. check here if you, or your spouse if City, town, or post office. If you have a foreign address, also complete spaces State filing jointly, mant $3 to go to this balom. OH und. Checking a box below will not change your tax or refund. None Foreign country name oreign province/state/county| Foreign postal code Filing Married filing jointly - Status Digital at any time during 2023, did you! (a) receive (as a reward, award, or payment for property or services) r (bj sell, exchange, or otherwise dispose of a digital asset for a financial interest in a digital asset)? Asset No - V Standard Deduction Someone can claim: None Age/ Blindness You: None - Spouse: None Dependents (see instructions]: 2) Social security (3) Relationship | (4) Check the box if qualifies for (see instructions): If more than four (1) First name Last name number to you Child tax credit Credit for other dependents dependents, see instructions and check 598-01-2345 Son No - 554-33-2411 Daughter Income ia Total amount 1a 32,000 Attach Form(s) W-2 here. Also attach Forms w-20 and 1099-R if tas was withheld. Taxable d If you did not get a fumes r provided adoption benefits from Form 6839, line 2 W-2, see instructions Wages from Form 8919, line 6 .. - . . . . .. 11 2 Add lines in through 1h . 32,000 Attach Sch. B ir 2a Tax exempt interest . .. |2a Taxable interest . . . . . . . . . required. 3a Qualified dividends . . . . 3a 1,940 Ordinary dividends . . 1,955 4a IRA di 4a Standard 5a annuities Sa Taxable an Deduction for- 6a Single or Married filing If you elect e the lump-sum election separately, $13,850 Married filing 7 11,310 Additional income from Schedule 1, line 10 . . .. .. . . . . .. qualifying spouse 9 Add lines 12, 2b, 3b, 4b, 56, 6b, 7, and &. This is your total incom $27,700 Head of 10 Adju 7,611 household $20,800 11 Subb If you checked any but under 12 andard deduction or itemized deductions (from Schedule A) . . Standard 27,700 Deduction, see instructions. 13 Qualified business income deduction from Form 8995 or Form 8995.A .. . . 14 Add lines 12 and 13 . 15 Subtract line 14 from ine 11. If zero or less, enter -0-. This is your taxable income . For Disclosure, Privacy Act, and , see separate instructions. Cat. No. 113208 Farm 1040 (2023) Form 1040 (2023) Noah and Joan Are 434-11-3311 Tax and 16 Tax (see instructions). Check if any from Form(s): 1 0 6814 2 0 4972 3 0 Credits 17 Ammount from Schedule 2, line 3 . . . 18 Add lines 16 and 13 . . 19 20 625 21 Add lines 19 and 20 . . . . 22 Subtract line 21 from line 18. If zero a 23 24 Add lines 22 and 23. This is your total tax Payments 25 Federal income tax withheld from: form[s) W-2 . .. 5,300 Form[s) 1099 . - 25d 5,300 2023 estimated tax paymer bunt applied from 2022 return . . . . . . . . . . . . . . 26 4,100 If you have a qualifying child, 27 27 attach Sch. EIC. 29 credit from Farm 8863, line B . . 30 Reserved for future use. . . 31 2 Add lines 23, 28, 20, and 31. These are y payments and refundable $3 Refund 34 If line 33 is 33. This is the amount you overpaid . . $5a Amount of line 34 you want refunded to you. If Form 8988 is attached, check here u Direct deposit? Routing number - Type: D Checking D Savings See instructions. d Account number 36 Amount of line 34 you want applied to your 2024 estimated tax . . Amount 37 Subtract line 33 from line 24. This is the amount you owe. For details on hom to pay, go to www.is. gowyPayments or see instructions . . . 37 You Owe 38 Third Party Do you want to allow another person to discuss this return with the IRS? See instructions. O Yes. Complete below. Designee Designce's Phone Personal identification name number [PIN) Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than Here axpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation If the IRS sent you an Identity Joint return? Protection PIN, enter it here See Pet Store Owne instructions. see inst.) Keep a copy for Spouse's signature. If a joint Date Spouse's occupation If the IRS sent your spouse an your records. return, both must sign. Identity Protection PIN, enter it here Firefighter he inst. Phone no. Email addre Paid Preparer's name Preparer's signature PTIN Check if: Self-employed Preparer Firm's name Phone no. Use Only Firm's address Firm's EIN do to www.ira.gov/Form1040 for instructions and the latest information Form 1040 (2023)SCHEDULE 1 OMB No. 1545-0074 (Form 1040) Additional Income and Adjustments to Income 2023 Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. Attachment Internal Revenue S de to www.dra.gov/Form1040 for instructions and the latest information. Sequence No. 01 Narme(s) shown on Form 1040, 1040-SR, or 1040-NR. Your social security number Noah and Joan Are 434-11-3311 Part I Additional Income Taxable refunds, credits, or ulfsets of s Alimony received . 2a Date of orig Business income or [lass). Attach Schedule C. . 36,950 V Other gains or [lassies). Attach Form 4797 . Mental real estate, royalties, part Farm income or (loss). Attach Schedule F. . Unemployment compensation . Other income: a Net operating loss b Gambling . . . e Cancellation of debt . . Foreign tamed income Income from Form 6853 .. Incorte from Form 8589 . Alaska Permanent Fund dividends In Jury duty pay . . i Prices and amards . . . . J Activity not engaged in for profit income . . k Stock options - . I Incorme from the rental of parsonal prop angaged in the rental for profit but were not in the b ting such property . m Olympic and Paralympic medals and USOC prize money (see instructions) Section 951(a) inclusion (see instructions) . Section 951A(a) inclusion [see instructions) . Section 451(1) excess ba Scholarship and fellowship grants not reported on Farm W-2 . - . . . Nontaxable amount of Medicaid waiver paym ints included an Farm 1040, line ia or id . . t Pinsion or annuity from a manqualifed on plan or a section 457 plan . . . . u Wages earned while inca . . . . 2 Other income. List type and amount: Total other income. Add lines Sa through 52 . . 10 Combine lines 1 through 7 and 9. This is your additional income. Enter here and un Form 1040, 1040-SR, a 1040-NR, line 8 . . . . - -. 10 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71479F Schedule 1 (Form 1040) 2023 Schedule 1 (Form 1040) 2023 Noah and Joan Are 434-11-3311 Page Part II Adjustments to Income 11 Educator expert 11 12 Certain business exp 2106 . . 12 13 Health savings account deduction. Attach Form 8589 . 14 Moving expenses for members of the Armed Forces. Attach Form 3903 . 14 15 Deductible part of self-amp 15 2,611 16 Self-amplayed SEP. SIMPLE, and qual 16 17 Self-amplayed health insurance da 17 18 Pinakty on early withdrawal of sa 18 19a Alimony paid .. 19a b Recipient's SSN c Date of orig 20 IRA deduction . . 21 Student loan interest dedu 22 Reserved for future use . 23 Archer MSA deduction . 23 24 Other adjustments: Jury duty pay (ace instructions) . 24a Deductible experthis related to income reported on line 8 from the rental of personal property eng 24b Nontaxable amount of the value of Olympic medals and USOC prize money reported on line am . . . 240 i Reforestation amortization and expenses . 24d Repayment of supplemental want benefits under the Trade Act of 1974 24e Contributions to section 501 [c)(18)(D) pansion plans . .. 241 g Contributions by cartain chaplains to saction 403(b) plans . 249 Attomey fees and court coats for claims (see instructions) . 24h brits you h award from the IRS for information you provided that helped the IRS detect tax law violations . . 241 Housing deduction from Form 2555 . 241 this from Schedule K-1 (Form 1041) . . . . 24k 2 Other adjustments. List type and amount: 242 25 Total other adjustments. Add linas 24a through 242 . 25 26 Add lines 11 through 23 and 25. These a are and on Farm 1040, 1040-SA, or 1040-NR, line 10 . . .. 26 7,611 Schedule 1 (Form 1040) 2023Complete the Are's Schedule 2. SCHEDULE 2 OMB No. 1545-0074 [Form 1040) Additional Taxes 2023 Department of the Treasury Attach to Form 1040, 1040-SA, or 1040-NR. Attachment Internal Revenue Service Go to www.Mrs.gov/Form1040 for instructions and the latest information. Saquince No. 02 Marmala) shown on Form 1040, 1040-SR, or 1040-NR Your social security number Noah and Joan Are 434-11-3311 Part 1 Tax Alternative minimum Liz. Attach Farm 6251 . .. 1 Excited Advance premium tax credit repayment. Attach Farm 8962 .. 3 Add lines 1 and 2. Enter here and an Form 1040, 1040-SR, or 1040-Nit, line 17 . . . . . . . 3 Part 1I Other Taxes Sallam playmant tax. Attach Schedule SE . . .. Social security and Medicare tax on unreported tip income. Attach Form 4137 . 6 Uncollected social security and Medicare tax on wages. Attach Farm 8919 . . . Total additional social security and Medicare tax. Add lines 5 and 6 . Additional tax on ItAs or other tax-favored accounts. Attach Farm 5329 if required. If not required, chack here . Household employment taxes. Attach Schadula H . . Lo Repayment of first-time homebuyer credit. Attach Form 5405 if required .. 10 11 Additional Medicare Tax. Attach Form 8959 . 11 12 Net investment income tax. Attach Form 8950 . . 12 13 Uncollected social security and Medicare or ARTA tax on tips or group-term life insurance from Form W-2, bax 12 . . . . 13 14 Interest on tax due on installment income from the sale of curtain residential lots and timeshares . 14 15 Interest on the deferred tax on gain from certain installment sales with a sales price over $150,000 . 15 16 Recapture of low income housing credit. Attach Form 8611. 16 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 7147BU Schedule 2 (Form 1040) 2023 Schadule 2 [form 1040) 2023 Noah and Joan Are 434-11-3311 Page 2 Part 1 Other Taxes (condnued 17 Outer additional cakes: a Ioncapture of other credits. List type, form number, and amount: Recapture of federal mortgage subsidy, if you sold your home see instructions . . . 176 C Additional tax on HSA distributions. Attach Form 8689 . . . 172 d Additional tax on an HSA because you didn't remain an eligible individual. Attach Form 8584 .. 17d a Additional tax on Archer MSA distributions. Attach Form 8853 . - . . . . 17 1 Additional tax on Medicare Advantage MSA distributions. Attach Farm 8853 . . . 171 a Recapture of a charitable contribution deduction related to a fractional interest in tangible personal property . 179 h Income you received from a nonqualified deferred compensation plan that fails to meet the requirements of section 4094 . 17h I Compensation you received from a nonqualified deferred compensation plan described in section 4574 . ... 171 j Saction 71(m)[5) excess benefits tax . . 17 k Golden parachute payments . . 17k I Tax on accumulation distribution of trusts . 171 im Excise tax on insider stuck compensation from an expatriated corporation . . . . . . . 17m m Look-back interest under section 167[g) or 460[1) from Form 8607 or 8866 . .. . . 17m Tax on non-effectively connected income for any part of the year you were a nonresident alien from Farm 1040-NR . . 170 Any interest from Form 8621, line 16f, relating to distributions from, and disposition of, stuck of a section 1291 fund . 17p q Any interest from Form 8621, line 24 . .. . 17g Any other taxes. List type and amount!_ 172 18 Total additional taxis. Add lines 17a through 171 . . . . 18 19 Reserved for future use . . 19 20 Section 965 mat tax liability installment from Farm 965-A . .. 20 21 Add lines 4, 7 through 16, and 18. These are your total other taxes. Enter hare and on Farm 1040 or 1040- Sit, line 23, or Furr 1040-NR, line 23b . .. - . 21 Schedule 2 (Form 1040) 2023SCHEDULE 3 OMB No. 1545-0074 (Form 1040) Additional Credits and Payments 2023 Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. ltachment Internal Revenue Service Go to www.irs.gov/Form1040 for instructions and the latest information Sequence No. 03 Name(s) shown on Form 1040, 1040-SR, or 1040-Nik Your social security number Noah and Joan Are 434-11-3311 Part 1 Foreign tax credit. Attach Form 1116 if requit 25 600 5695, Wine 32 .. Other nonrefundable credits: credit. Attach Form 3800 . .. Credit for prior year minimum Credit for the elderly or disabled. Attach de credk. Attach em 8936 . . Columbia first-time re fuel vehicle ref at on Farm 8978, line 14. See in Credit for pre Other nonrefundable credits. List type and an Total other nonrefundable credits. Add lines 6a through 62 . Add lines 1 through 4, Sa, Sb, and 7. 8 625 (continued an pape 2) For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 714806 Schedule 3 (Form 1040) 2023 Schedule 3 (Form 1040) 2023 Noah and Joan Are 434-11-3311 Page 2 Part II Other Payments and Refundable Credits Net premium tax credit. Attach Form 8962 . . 12 13 Other payments or refundable credits: 130 Credit for repa d Deferred a 14 Total other payments or refundable credits. Add lines 13a through 132 . . . 14 15 Add lines 9 through 12 and 14. Enter here a 1040-NR, line 31 . . -. . . ... 15 Schedule 3 (Form 1040) 2023 Feedance Check My Work Correct Schedule A Complete Sched sayers will Zemize the or use the standard deduction SCHEDULE A Itemized Deductions OMB No. 1545-6074 (Form 1040) Attach to Form 1040 or 1040-SR. 2023 to to www.irs.gov/Scheduled for instructions and the latest information. Department of the Treasury Caution: If you are claiming a net qualified disaster loss on Form 4684, see the attachment Internal Revenue Service instructions for line 16. Sequence No. 07 Name(s) shown on Form 1040 or 1040-SR our social security number oah and Joan Are 434-11-3311 Caution: Do not Include exp reimbursed or paid by others. Medical 1 Medical and dental exp - . ... ..... 1 650 and Enter amount from Farm 104 Dental SR, line 11 . . . .. Expenses Multiply line 2 by 7.5%% (0.075) -. Subtract line 3 from line 1. If line 3 is more than line 1, enter -0. . . . . . . . . . . . . . . . . . . .- Taxes You 5 State and local taxes. Paid a State and local income taxes or general sales taxes. You may include either income taxes or general sales taxes on line Sa, but not both. If you elect to include general sales taxes instead of income taxes, check this box . . .. Sa 6,605 Sb 2,405 V e State and local personal prop d Add lines Sa through Sc. 9,010 Enter the smaller of line 5d or $10,600 ($ ad fling separately) . . Se 9,010 Other taxes. List type and am Add lines Se and 6 . . . . . . . . . . ....... 7 9,010 Interest 8 Home mortgage interest and points. If you didn't use all of your You Paid home mortgage loan(s) to buy, build, or improve your home, see structions and check this box . . . . ... .. Caution: Your mortgage a Home mortgage interest an Form 1098. 9,987 interest deduction may be Home mortgage interest not re to you on Farm 1098. See be limited See instructions if limited. If paid to the arson from whom you bough instructions. the home, see instruction and show that person's name, identifying na., and address . . . . . . .. sb e Add lines Ba through ac . .. 9.987 0 Add lines Se and 9 . . . . . . . . .. . 10 9,987 Gifts to 11 Gifts by cash or chick. If yo any gift of $250 or mare, Charity S,200 Caution: If you 12 Other than by cash or check. If you made a git and any gift of $250 or mare, gut a benefit for Form 8283 if over $500 . 12 15 Cryover from prior year . . instructions. Add lines 11 through 13 . . . . . . . .... S,200 Casualty and 15 Casualty and theft loss(es) from a federally declared disaster [other than net qualified disaster Theft Losses losses). Attach Farm 4684 and enter the amount from line 18 of that form. See instructions 15 Other 16 Other-from list in inst Itemized Deductions 16 Total 17 Add the amounts in the far right column for lines 4 through 16. Also, enter this amount on So Itemized Form 1040 or 1040-SR, line 12 . . . Deductions 18 If you elect to it uction,SCHEDULE B OMB No. 1545-0074 [Form 1040] Interest and Ordinary Dividends 2023 Department of the Treasury Attach to Form 1040 er 1040-SIL. Internal Revenue Service To to www.Mrs.gov/Schedules for instructions and the latest information Sequence No. OB Narmats) shown on return Your social security number Noah and Joan Are 434 11 3311 Part I 1 List name of paper. If any interest is from a seller financed mortgage and the Ammount buyer used the property as a personal residence, see the instructions and list this Interest internet first. Also, show that buyer's social security number and address: (See instructions and the instructions for Forma 1040, line 26. j Note: If you received a Form 1099-INT, Form 1099-OID, or substitute statement from a brokerage firm, list the firm's 2 And the amounts on name as the payer and enter the total Exduckable interest on series BE and ] U.S. savings bands issued after 1989. interest shown on Allach Form 8815 . that form. 4 Subtract line 3 from line 2. Enter the result hare and on Form 1040 or 1040-50, Ina 20 . . . . Note: If line 4 b over $1,500, you must complete Part III. Amount Part II 9 List name of paper- _ Exxon Mobil 300 W Ordinary Dividends Texas Utilities 1,250 Cy Growth Fund (See instructions and 405 w the instructions for Forma 1040, line Note: If you wilyad a Form 1099-OfV er substitute staterant from a brokerage firm, list the firm's name as the payer and enter the ordinary dividends shown on that form. Andd the amounts on line 5. Enter the total here and on Form 1040 or 1040-58, line 3b . . 1,935 Note: If line 6 is over $1,500, you must complete Part III. Part III Foreign You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign Account account; or (c) received a distribution from, or ware a granter of, or a transferor to, a foreign trust. and Trusts Caution: If required, Yes No failure to file FinCEN a At any time during 2023, did you have a financial interest in or signature authority over a Form 114 may result financial account (such as a bank account, securities account, or brokerage account] located in a in substantial foreign country? See instructions . penalties. - . . . Additionally, you may If "Yes, " are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts be required be file (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its Form 8938, instructions for filing requirements and exceptions to these requirements . Statement of Specified Foreign Financial Assets. Some b If you are required to file FinCEN Form 114, Itat the name(s) of the foreign country(-les) where instructions. the financial account(s) is (are) located: _ _ During 2023, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If "yes, " you may have to file Form 3520. See instructions . . . . . . . .. For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B [For Soa Employee's social security number Safe, accurate, Visit the IRS website at 456-87-5432 OMB No. 15450008 prsT1 Use rs @ ~ file www.irs govlefile b Employer identification number (EIN) | 1 Wages, tips, other compensation 2 Federal income tax withheld 33-4382966 32,000.00 5,300.00 Employer's name, address, and ZIP 3 Social security wages 4 Social security tax withheld code 32,000.00 1,984.00 i i 5 Medicare wages and tips 6 Medicare tax withheld City of Dayton Fire and Rescue 32,000.00 464.00 123 Warren Street - - Dayton, OH 45402 7 Social security tips 8 Allocated tips d Control number 9 10 Dependent care benefits Employee's first name Last Suff.| 11 Nonqualified plans 12a See instructions for box 12 and initial name c ;DD |9,876.00 Joan Arc 13 Statutory Retirement Third-party 12b 1265 W. Riverview Avenue employee plan sick pay c Dayton, OH 45402 O O 14 Other f Employee's address and ZIP code 15 State Employer's state ID 16 State wages, tips, |17 State income |18 Local wages, tips, |19 Local income |20 Locality number etc. tax etc. tax name 1126-87021 32,000.00 2,000.00 32,000.00 805.00 DAYTN Form W=2 Wage and Tax Statement 2023 Department of the Treasury Internal Revenue Service Copy BTo Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. CORRECTED (if checked) RECIPIENT'S/LENDER'S name, street address, city or town, | *Caution: The amount state or province, country, ZIP or foreign postal code, and shown may not be fully OMB No. 1545-0110 telephone no. deductible by you. Limits based on the loan amount F 1098 Chase Mortgage and the cost and value of the orm Mortgage 100 Park Avenue secured property may apply. New York, NY 10017 Also, you may only deduct | (Rev-January 2022) Interest interest to the extent it was Statement incurred by you, actually paid by you, and not For calendar year reimbursed by another 2023 person. 1 Mortgage interest received from payer(s)/borrower(s)* $ 9,987.23 Copy B For Payer/ RECIPIENT'S/LENDER'S PAYER'S/BORROWER'S 2 Outstanding mortgage 3 Mortgage origination date Borro)\\:ver TIN TIN principal $ 287,245.66 03/13/2014 The information in boxes 1 through 9 and 11 is 13-4296127 434-11-3311 important tax information 4 Refund of overpaid 5 Mortgage insurance and is being furnished to the interest premiums IRS. If you are required to file a return, a negligence $ $ penalty or other sanction PAYER'S/BORROWER'S name 6 Points paid on purchase of principal residence may be 1mposeld on you if the IRS determines that an Noah and Joan Arc $ underpayment of tax results Street address (including apt. no.) 7 If address of property securing mortgage is the same as because you overstated a 1265 W. Riverview Avenue PAYER'S/BORROWER'S address, the box is checked, or the | deduction for this mortgage address or description is entered in box 8. interest or for these points, City or town, state or province, country, and ZIP or foreign 8 Address or description of property securing mortgage reported in boxes 1 and 6; or postal code because you didn't report the Dayton, OH 45402 refund of interest (box 4); or ' because you claimed a nondeductible item. 9 Number of properties 11 Mortgage acquisition securing the mortgage date Account number (see instructions) Form 1098 (rev.1-2022y (Keep for your records) www.irs.gov/Form1098 Department of the Treasury - Internal Revenue Service