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-F 2ot4-2o15 Independent
C$dff,["n%%ol.on,o'. Student Verifi cation WorksheetLo Plqtq' leonordtown Pflnce Frededck Woldorf
The College of Southern Maryland's Financial Assistance Department verifies all students who have been selected forverification by the federal processor, or when conflicting information needs to be resolved. The verification process cantake up to 6 weeks from the time the student submits the final document needed to complete the verification.
lo tq tr6 a29ot q-tc. aurfPhone Number (include area code)
In the box below, list:1. Yourself (and your spouse)2. Your children, if you will provide more than half of their support between July 1, 2014 and June 30, 2015.4. Other people, if they now live with you, you provide more than half of their support AND you will continue to providemore than half of their support between July 1, 2014 and June 30, 2015.
( ) _ettena
lf more than twelve are in the submit additional information and student lD on the
Name of College(lf aplicable)
WIII be EnrolledatLeast Half
Time@adegreeor
e+e+er o<JOl3\Student lD
,il_,_]3_l. As of the date you originally signed your FAFSA, whatwas the total in cash,savings and checking acounts.
2. As of the date you originally signed your FAFSA, what was the net worth ofyour investments, induding real estate (Do not include the value of the home you reside in)?Net worth means cunent value minus debt
3. As of the date you originally signed your FAFSA" what uras the net worth ofyour or your spouse's cunent businesses and/orinvestment farms?
co
I fnru" attest I have not and am not requircd to file taxes for 2013
Spouse Signature(Optional)
Date: fl tfl tq, l
ffi fnn" have filed taxes. (2013 IRS issued tax return transcript required OR unchanged IRS Data RetrievalTool used)
l_l nrue will file taxes and will submit either a 2013 IRS issued tax return transcript OR use the IRS Data RetrievalTool(if eiigible) that is part of the FAFSA on the Web at FAFSA.gov and make no changes to the information.
Did you work at any time in 20'13? -/ Yes (submitcopies of ALLW-2'sfor2013)
No (l did not work at any time in 2013)
By signing this worksheet, I certify that all the information rcported on this worksheet is complete and correct. Ifurther understand
Studenfs Signature(Required)
doeumentation may be rcquircd in orderto complete veriftcation.
Date:
WARNING: lf you purposetully give false or misleading information on thisworksheet, vou may be fined up to $20,000, be sentenced to iail, or both.
Send All Gorreopondence to:College of Southem Maryland " Financial Assistance Department
P.O. Box 910 * La Plata. MD 2(n|6 " Fax 301-93t1-789t1Telephone: 301-9*2251,301€70.3008, 301S84S131, erd. 7531, or 301-93+7531 (Direct Line)
EMPTOYEE W.2 WAGE SUMMARY 2013gogit-loarExl1 1xnqn The ctart below indicates your 2013 voluntary payroll adiustments
which are incltded {+}, orcluded {-}, or did not affcct {?t/A} your foderalBRENNAN TITLE CORPORATION wages {Box 1} and state wages.3481 OLOWASHINGTON ROSUITE ilXOWALDORFMD206O2 YltLUlUIAnYflrJllSItlEItIS YTDAHO|rI{I FE0CBATWAGES ll0WAeES
PREIXHITH nS -6Am -$.S
FEoEnAtwrrilHotlttcEreflFTtofls S 2rDwnlrH0lDttrcExEilFlrolrs s 1
REGI'I.ARWAGES FOBzOI3 EZE.M
BFITTNEY C THOMA$SE11602 BARD|TTOOR gTWALDORFMO20602
14003PAYRoI-IsBY PAYCTIEX'
Copy C, fur employees records
Th[sinlormafMisbeirufmistg|t0thherna|fevenugs€nice.lfyNafe'eq,,iedbfeata(refm,argtgencepertdty0'0tErs$cli0r|mayimdmr
Copy B, to be filed with employees FEDEML tax retumForm W-2 Wage and Tax Statement 2013
Form W-2 Wage and Tax Statement 2013oo32- 1o3oExt1 I
voron n n n n n n r < t - n n ^ o n n I
tmploynrs [ame, aodrtss, and zlP c00e
BRENT{AN 1ITLE CORPORA?ION3261 OLD WASEINGTON RDsur fE 3040wAr.DoRE MD 20602
Dopartment of the Tr€asury - lnlernal Fevenue ServiceoMB t{0. 1545-0008
5 2 - 1 7 4 9 2 4 2 I z L A - 3 7 - 2 1 7 7 ,[ps,@swpeoru6 1 8 6 . 0 0
I Fsdenl in$trp ta( wilhhdd5 0 5 . 6 0
empEYeerxru-y.
Dhn siek tay uooal secunly v{ages6 1 8 6 . 0 0 3 8 3 , 5 3
t4 u lne t r tmptoyee's nam€, adoress, ano llP code
BRITTNEY C TI{OMASSET11602 8AX.DM00R CTWALDORF I,'D 20602
Meolcare wages ang ltps6 1 8 6 . 0 0 a9 -70
Social security tips I Allocated tips
, Advance EIC payment 0 uegcndeil caro benelds
I nonquailile0 plans
l5 $tate
MD
Employer's state lD No.
o6337236
t6 Slate waoes, tips, elc.
6 1 8 6 . 0 0
1 7 $tale income tax
3 8 0 . 7 8
18 Local wages, tips, elc '19 Local income tax 20 Locality name
r Gontrolnumber 0032_10308X11 I Void
0000000251 -oo0900 |: Employels name, address, and ZIP code
BRENNAN TTTI,E COR?ORATTON3261 OLD WASEINSTOI{ RDsurTB 3040WALDORF MD 24602
Deparlment ol the Treasury - lnternal Revenue Service0MB ltlo, 1545-0008
Dl,r{bcrgfilicdmnwlbs ld
ttrtployeess@blwdymflts
5 2 - 1 7 4 9 2 8 2 I 2 r 8 - 3 r - 2 1 7 7 , xps, mff cotrpEnsu6 1 8 6 , O 0
Z l-ederal rncorne hx wltrhdd5 0 5 . 6 0
empoyee pnn sic* 0oysocral secuflly lYages
6 1 8 6 . 0 0SECUUty KX WIItrflEIU
3 8 3 . 5 3l2 see lnstrs. lor tsox 1 '14 olher I Employee's name, address, and ZIP code
BRTTTNEY C TEOI'TASSET11602 BAT'MOOR CT}'ALDORF UD 20602
) Medlcare wages and tlps6 1 8 6 . 0 0
ti Meorcare lax wrtnheld8 9 - 7 A
' Social security tips I Allocated t,ps
Advdnc€ EIC payment u ue0enoem carc oenenrs
ilonqua[ned plans
15 Shte
UD
Employer's slate lD ilo.
06337236
l6 Stale sages, tips, etc.
6 1 8 6 . 0 0
7 Stale incom8 tax
3 8 0 . 7 8
l8 Local wages, tips, etc- 1 g Local income bx 20 Loaality name
Thbiddmalimbbeimtuml$edt0thehleml8ssuSdvbe. lfvflmrmuircdt0fleati lretum.eMlberemd$trolh*s*f,l i i lmavb€immsedmwifthhinmmeistadlesndwfdltorewtil
.;i.if l
iifi,i . ],.,,li i
.
1,ii
,'il'
i"*
' . , ]' geg .
oo ,
lf,nqia:i$^
*S"d.ng
ia .3+,i zg .o1
OePt' ot tne Treasury - IRS
Form 1099-R
: y,'li i lii jf ' t 6'fi ri':'i'dbWsuNTRUsr BANKS rr,rc 4oi" i i i l " 'l :9 , . lox coss MArI coDe' r iosaATLANTA GA 30302865-855-5738
9 0 . 4 2
1 cross distribution--OMB No. 1545-01 19
2@13Form 1099-R
Distributions FromPensions, Annuities,
Retirement orProfit-Sharinq
Ptans. tRAsIInsurance
Contracts, etc.
2a Taxable amount
9 0 . 4 2zo taxabte amount lo ta l
not determined distributionPAYEFT'S federat identif iciGnlimoer
5 9 - 3 4 8 2 8 5 5 0 8 0 1R E C I P I E N T'S identif icatiom u m be r-
xxx-xx-"L77 In box 2a)4 Federal income tax wittrneta-
1 8 . 0 8
5 Employee contibutions -
/Designated Roth confibutions orInsurance pTemtums
fiiii*lFXnF,lHffiril 5 Net unrealized appreciationrn emptoyefs securit ies
7 Distribution code(s)
I SIIVPLE
9a Your percentage of totit d[iiibr-ibu,on 9b Total employee contributioni
o*"ti'tfig?$ufi_tiboo1 1 1 st year of desig. Floth contiib13 State/Payels state no.
I0603166--
14 State distributionEE
- - - - - - - - - 9 U . q Zr.opy ttR€porl lh is income 0n your lederal lax relurn. t t thts l0rmsn0ws tederat income lax withhetd in box 4, ai lach Ihis
f,llil,1i.ffi litll;,lj's jntomarion is beins rurnished
10 Amount allocable to IRB wlthjn 5 years16 Name of local i ty 17 Locat distribution
t
www.trs.gov/form 1 099r
L 3 4 7 L 4 7 L
t s47 r47 t
t347 L47 L
Department of the Treasury - Internal R"u"nue SurVG
Fromrities,)nt or
Depanment of the treasury - 161g;;;;;;E;;il
Form 1099-R cnFtptra
8 5 5 - 8 5 5 - 5 7 5 8
ffi + HU iT tfn #:'r Hfr :q fl rft'dnp, r-r4mrc' *"itfli*?g*uf .3;=Ulri cooe "riose
I Gross distribution
9 8 . 4 2 ","e'ji:"Distributions FromPensions, Annuities.
Retirement oiProfit-sharino
Plans, lRAs]Insurance
Contracts, etc.
2a Taxabte amount
; 9 0 , 4 22b Taxable amounl
----T"td-
not detemined distributionPAYER'S federat identificailon num6el
59-348?835 0801FECIPIENT'S identif icatton numG
xxx-xx-2t77uaprra gatn (rnctudectin box 2a)
4 Federal income ta witnnelO-
; 1 8 . 0 8
5 erptoyge contioutioro-/Estgnated Roth dnfibutjon, orrnSUran@ premiufts
fl ii I i I P hililH'ilg d $lFlmn il'ins il s a'le' cen'lry' and z P or ro'asn om'lalii'
in €mploy6r's $€curil ies
I
code(s) IHA"/SEF/
IIMPLE
8 Other
ea Your percsr:se or totar oisGour6i-- 9b Totat emptoyee contriturili!
t2 State tax withhetd t3 State/Payer's state no.
roeoaiee --'riii'ilB?iii?"Lfitoo1 1sl year of desig. Roth conkib.
__-- - - - -90:42vopy zFile this copy with your state, city, orlocal income tax relurn. when required.
10 Amount ailocabte to tnnGtninTl;E
@:'i:l:::::i___l 17 Ltral distribution
l - - - - - - - - -
Form 1099-RPAY-EBSnamest ree taddress ,c i l yor toWn,p 'ou in . "o ,@
l ! . |!!IE!lrI BANK rAc RETTREMENT stR.S U N T R U S T B A N K S I N C 4 O i " i i i ' ' ' 'l :g:. . !gx 46s5 t4ArL coue-i i6tsATLANTA GA 505028 6 5 - 8 5 5 - 5 7 3 8
'I Gross distribution
9 0 . 4 2OMB No. 1545-01 19
2@13Form 1099-R
Distributions FromPensions, Annuities.
Retirement oiProfit-Sharinq
Ptans, lRAs]Insurance
Contracts, etc.
2a Taxable amount
9 0 . 4 2zo I axable amount Total
not determined distr ibut ionPAYEB'S federat iOentif ication nuilOer
59-3482833 0801 xxx-xx-2L77uaptrat gatn ( tncludedin box 2a)
4 Federal income ta" withheld-
; 1 8 . 0 8
C Employee Con l f lbu t ions/Designated Foth confibutjons olInsurance premiums
RECIPIENTS name. slreel adOr"r fr,l,
illll'FX*8'68R'Eor*,W A L D O R F M D T O 6 O Z
6 Net unrealized appreciationin employer's securit ies
code(s)
1
I RA/
SIMPLE
8 Other
va your percentage ol total distribunon 9b Total employee contributions
^*""[iTilg?4iifi[%oo'11 1st year of desig. Fioth contrib.13 State/Payer's state no.MDI05-08-16-6 - -
'14 State distributionIt - - - - - - - - - 9 U : 4 2uopy c
For Recipient's RecordsI nts tntormation is bernq furnished tothe lnternal Revenue Seryice.
10 Amount allocable to IRR wilhin 5 years 15 Local tax withheld ro t \drne oI tocalt ly 17 Local distributionD: - - - - - - - -
www.irs. gov/form1 09gr(keep for your records) Department of the Treasury - Internal Reu"nre S"rG
c Employe/s
AEROTEKname, addre$, dd z|P @de I
Z. S@ itrstudims for box 12
l $
Wags, tips, oth6r ompenslioh
878.502 Fede€l in@me tax withhetd-
57.9712b
t $3 Social writy wgs
878.50,l S@ialwrity tax withheld
54.47730,I PARKWAY DRHANOVER, MD 21076e ficl
l2c
a l-ct s
5 lrediqe wag6 ad tips
878.506 Medi@c tar withheld
12.74
Sufi-
7 S@ial sdrity tips 8 Ail@ated tips
BRITTNEY C THOMASSET
11602 BARDMOOR COURTWALDORF, MD 20602
2e
t $
hport Code: PRTP4yTI
9
It Nequalified plars
t0 Dependst @E bselitsh6 hlmdim Ebmqhished totunrmdRevfre WF
13 urulry RdffiEr--T#amruy* dan shk !n [ - l r -Copy B To Be Filed With
Employee's FEDERALTax Retum
' l 4 o f i * %
I- - +
l Empto!@'s sjd serunty n tnt21&31-2177I 5 Sbre I Ehploye/s $ale lD numb*
MD I o687ss3o$aie mg6, tip6, dc
878_5017 Sate i@me tax
51.9118 Locd Eges, tips, etc.
B To Be Fited With Emptov;E
ffi s2-1822806AEROTEK
12.
l q
r wag6, tips, o&tsmpenstiq
878.50Z Fede€l in@me tax withheld
57.97
730.I PARKWAY DRHANOVER, MD 21076-e Emp@ye s rd mre and inilial Last name
1 o f 1
BRITTNEY C THOMASSET
,I1602 BARDMOOR COURTWALDORF, MD 20602
2b
l$3 Sftid *flrity wag6
878.504 Social setufty tax witntrEta-
54.4712c
i$
ls12d
5 Medi€re kgs and tjF
878.506 Medlde tax withhetd
12.74I S@ial esrity tipi 5 AMed tips
l2e
9
l{ Nonqualifed olans
t0 Depondont €re b€nefits
Copy 2 To Be Filed WithEmployee's STATE, ClTy orLOCAL Income Tax Retum
mFoyee Sn d dv '
Olher
I 5 State
MD
lmport Code: PRTp4yTf Employee's wid srority numG218-31-2177Emptoyers $ate lD number
06875530Ste wagreq tips, ei*
* _ _ glB.so17$aieln(Metax
1tf fcEa|mge;?;ffi51 .91 |
W-2 Wage and Tax Statement 201 S.Rejssued
AEROTEK
2z
l$tjp6, oths @pqsation
878.50? Fod6al intMe l,ar wilhheld
57.97
7301 PARKWAY DRHANOVFR N,|N '1N'
zb
t $3 S@ials@rityMgs
878.504 Smialseority cx rvit-heE-
54.472c
t$5 Medi€re wag€ and lips
878"506 Medicare tax wifhhdd
12.74e Employee s fict nam. rna initiA
2d
l$7 Sociel ssuritytips t tips
1 o f
BRITTNEY C THOMASSET
11602 BARDMOOR COURTWALDORF, MD 20602
2eI l0 Oependent €E benefts
11 Ndnuagfiod Dlans 13 s,ylry nermo ---Tiro-frry. ds $ddv-n T-l rr'Copy 2 To Be Filed With
Employee's STATE, CIW orLOC/{- Income Tax Retum
l4 Oher
lmport Code: PR7p4y.ff t Employee's $cial s6drity h218-31-2177
I 5 StateM D
Employe/s sbte lD number06875530
l7 Sate in@ rax lt- LmiGles, !ps, etc.51.91 |878.50 20 Loelity name
W-2 Wage and Tax Statment 201 gRei$ued ibtemenl
T@sury-lntmal Revenue Seryi@ OMB # 154+0008 Copt 2 To Be Filed With Employe,s State, Clry or L@l Tax DeDartments
I.=""J-!t j1 R:y'lsag _oIBj lysoooe_ c"py z@Departments
J
c Emdc
AERO52-1822ffi6 | 2a Se instruaims fo box 1
l sI Wag6, tips, gther @mpensaiion
878.50rEK 57.97
7301 PARKWAY DRHANOVER, MD21076-e Employe s fi Et nam" ana initaG
1 o f 1BRITTNEY C THOMASSET
11602 BARDMOOR COURTWALDORF, MD 20602
lmport Code: PRTp4yTt
b
l $3scidwritywage
-
878.50a Socid [email protected] tax wihheld
54.47l2c
l $t2d
5 Medi€E wag6 and 6As
878.506 Medi€re trax withhdd
12.74TSsidwritytiF I Atlffir€d 0p€
2e
t e t0 Dependenl @@ benefitsin6 hmM 6bDq tun#d bh hhd
|M,aqrq@Fd! orituffi n@
ffril?S*d prhs hctre,s raa& d yi{
11 Norqualified plans ;ffiHfl f-rr v v ! v I v t L t v t r l v I r : l
IECORDS. (See Notjce to:mdovee on trac*-l
14 Olhd
20L@litynre
t erdote's*"iawrity*G2.18-31_2177
T :,". | .:*l"j^"^"ra reffiw r u - U r o ! 1 c c r l u
| _ _ _ 8 1 8 5 0t7 S'tate in@me lax I f S foet wages, tps,;d-
5 1 . 9 1 |
Fom W-2 Wage and Tax Sbtement 2013 - ReissuedoMB # .1545-0008
Copy C for Employee's Re@rds
li3iJll"'ffiEmployee Reference Copy
YV.-,?.",."""":3!;"#1'* ?pl._3""""d Control number0000088106 v5c
Dept.|50002
Corp. J
Employef use only
VVs I A A516AEmploye/s name, address, and Zlp cod6PNC BANK NA4100 w 't50TH sT B7-Y832-02-1CLEVELAND, OH 44135
e/f Employee's name, addreaa, and ZIP cods
BRITTNEY C THOMASSET11602 BARDMOOR COURTWALDORF, MD 20602
Employers FEO lO numb€r22-1146430
a Employee'3 SSA number218-31-2177
I wagea, tipa, other comp.
a4' f4 i t
2 Federal income tax withhsld
lnt nn3 Social security wages
4175.424 Social Eecuilty tax withheld
258.88Medicarc wages and tipa
L,l'r1 atMedicare tax withheld
ANSocial security tipa AIOCated tips
l0 Depondont caro benefits
lr Nonqual i f ied plana lza Seeinstuctions for box 12DDr 3-72
14 Otherl2c
t2d13 Sht empl Ret. plan|3rd party sick pa,
'15 State lEmployeds stato lD noMD I 0677990 8
6 State wagss, tip6, otc.417 1 i t
17 Stat6 income tax 8 Local wages, tips, stc-
19 Local incometax l0 Locality namo
2013 W-2 and EARNTNGS SUMMARYThis -surmary sec t ion is inc luded w i th your l l -2 to he lp descr ibe th lsport lon in more detai l . The reverse side Includes genlral informatlon that{: l t11{ l l_:9 f ind helpful. The fol lowtng ref lects }our f inal pay stut,-piusany adJustments made by your employer.
GRoSS pAy 4,175-.42 socIAL sEcuRITy 258.88
FED. I]ICOMETAX WITHHELDBox 02 0F }'|-2
STATE IIICOME TAXBox 17 0F }t-2TOCAL IIICOME TAXBox t9 0F l.|-2
6 2011 ADP. tNC
BRITTNEY C THOMASSET11602 BARDMOOR COURTWALDORF, MD 20602
402.00
273.53
0 .00
TAX WITHHETDBox 04 0F ll-2MEDICARE TAX}{ITHHEIDBox 06 0F tf-2
SUI/SDIBox 14 0F l,l-2
60.54
0 . 0 0
Social Security Numbor 218-31-2177Taxable Marital Statua:
SINGLEExomptions,/Allowances:
Fodera l :2Stat6i 1Local: 0
To change your employee W-4 profi le informatlonfi le a new W-4 with your-payrol l department
PAGE 01 OF 01
wages, tlps, other comp.4175.42
2 FsdeEl income tax withhold402.00
3 Social Eocurity wagos4175.42
4 Social security tax withheld258.88
5 Medicaro wagss and tips4175.42
6 Modicaretaxwithhetd60.54
d Control number0000088106 vsc
Dept.150002
CoO. I Employer use onlyLWs I A 65156
c Employsr's name, address, and Zlp codoPNC BANK NA4100 w 150TH ST B7-Y832-O2-1CLEVELAND, OH 44135
Employer's FED lD numbet22-11L6Aan
yuc s 0oA numol21431-2't77
7 Social Eocurity tips U Ailocated tipa
9: l0 Dependontcare bonofits
I Nonqualified plans 2a See instructions for box 12DDI 3.72
14 Other
26
lJ Stat emplR€t. plan prd pady sick pay
e/f Employee'a name, address and Zlp codo
BRITTNEY C THOMASSET,I1602 BARDMOOR COURTWALDORF, MD 20602
15 Stat€MD
Employeds state lD no0677990 8
6 State wagea, tipa, etc.4175.42
17 Stato incometax273.53
l8 Local wages, tips, etc,
19 Localincomstax 20 Locality nams
Federal Filing Copy
w-2 *3?;"#1 '"- ?"pJS"..,
1 Wages, tips, other comp.4175.42
2 Foderal income tax withheld
402.003 Social socurity wagos
4175.424 social socurity t"iHd,Hf'o
5 Medicare wages and tips4175.42
6 Medicare tax withheld60.54
d Control number0000088106 v5c
Dept,t50002
Corp. I Employer use onlyLWs I A 6515e
c Employe/s nams, addrsss, and Zlp codoPNC BANK NA4100 w 150TH ST B7-YB32-02-ICLEVELAND, OH 44135
ErrProyar s rEu tu nl22-1146430
t Employee's SSA number218-31-2177
Social security tips Allocatod tips
| , ' , : . . ' ' : : : ' . , j : ' . . : ' : : : : : : . , , ' , ' ' . : . : i 0 Dopendentcare benefits
I Nonqualitied plans lza3.72DDI
14 Other a0
J Stat emplRet. planl3rd party sick pa,
o/f Employoo's name, addross and Zlp
BRITTNEY C THOMASSET11602 BARDMOOR COURTWALDORF, MD 20602
code
:mploy€Cs state lD no0677990 I
15 Stat(MD
16 State wagos, tips, etc.4175.42
17 State incometax273.53
18 Local wages, tipa, etc.
19 Locat ancomotax ItJ Localty namo
MD. State Fiting Copy
W-2 *3?"","#1 '"' ?.0'!.3"""
Wages, tips, other comp.4175.42
2 Federal income tax withheld
402.003 Social security wa?es42 4 Social socurity tax withheld
258.885 Medicare wages and tips
4175.42Medicare tax withheld
60.54t Control number I Deot.0000088106 vsc bsoooz
Corp. I Employer use onlyLWs I A 6515G
c Employer's namo, address, and Zlp codePNC BANK NA4100 w 150TH ST B7-Y832-02-1CLEVELAND, OH 44135
Employe/s FED lD r22-1146430
a Emptoyee's ssA numbor21a31-2177
7 Social security tips 8 Allocatod tips
0 Dependent cars bsnefits
l l Nonqual i f ied plans
DDI 3.7214 Other tzo
tzc
J Stal 6mp]Ret. ptanl3rd pafry srck pa
o/f Employec's name, addrsss and Ztp csle
BRITTNEY C THOMASSETI,1602 BARDMOOR COURTWALDORF, MD 20602
15 Stat(
MDEmploye/s state lD no
0677990 816 State wagea, tips, otc.
4175.4217 State incometax
273.5318 Local waggs, t ips, etc.
l9 Locat ancometax lO Locality namo
City or Local Filing Copy
-2 *3?;"#1 0"' 2013
ffi Internal RevEnuE S ervicearrer" United States Department af the rreaiuryThis Product Contains Sensitive Taxpayer Data
Request Date : 05- l -8-201-4Response Da te : 05 -L8 -2014
Tracking Number: 100197393711
Tax Return TranscriDt
SSN P rov idedz 2 ra -3 r -2 I77Tax Per i -od Ending: Dec. 3L, 2013
The following ilems reflect the amount as shown on the return (pR), andthe amount as adjusted (PC), if applicable. They do not shor^r aubsequentactiwi-trr on the account.
S S N :SPOUSE SSN:
NAME(S) SHOWN ON RETURN: BRITTNEY C THOMASSET
ADDRESS: L1502 BARDMOOR CTWALDORF, IVID 20602-31-03-021
FILING STATUS:FORM NIJMBER:CYCLE POSTED:RECEIVED DATE:REMITTA\ICE:EXEMPTION NTIMBER:DEPENDEM| ]- NAME CTRI:DEPENDENT 1 SSN:DEPENDEIfT 2 NAME CTRL:DEPENDE}{I 2 SSN:DEPENDENT 3 NAME CTRL:DEPENDENT 3 SSN:DEPENDENT 4 NAME CTRL:DEPENDENT 4 SSN:IDENTITY THEFT PERSONAL fD NUMBER:PT IN :PREPARER EIN:
Income
z 1 6 - 5 r - z t I I
Single1 0 4 0
20140504A p r . L 5 . 2 0 1 4
$ o . o o1
0 0 0 0 0 0
WAGES, SALARIES , T IPS , ETC: . f i 1 , 6 ,377 .00T A X A B L E I N T E R E S T I N C O M E : S C H B : . . . . . . 3 0 . 0 0TAX-EXEMPT INTEREST: . . . .S0 .00ORDINARY DfVIDEND INCOME: SCH B: . . .50.00QUAL IF IED D IVTDENDS: . . g0 .00REFLINDS OF STATE/LOCAI TAXES: . .50.00A L I M O N Y R E C E I V E D : . . . . . . 9 0 . 0 0BUSINESS INCOME OR IOSS (Schedule C) : . . . . $0.00BUSINESS INCOME OR LOSS: SCH C PER COMPUTER: . . .90.00C A P I T A I G A I N O R L O S S : ( S c h e d u l e D ) : . . . . . . . 9 0 . 0 0CAPITAL GA INS OR LOSS: SCH D PER COMPI ITER: . . . . . .S0 .00O T H E R G A I N S O R L O S S E S ( F o r n 4 7 9 7 ) : . . . . . . . . . 5 0 . 0 0T O T A ! I R A D I S T R I B I I T I O N S : . . . . . . . $ 0 . 0 0TAXABLE IRA DISTRIBIITIONS: . .50.00TOTAL PENSIONS AND ANNUITIES: . io.ooTAXABLE PENSION/ANNUITY AMOUNT: . .S270.00RENT/ROYALTY/PARn{ERSH]P/ESTATE (Schedut_e E) : . . . .50.00RENT/RoYALTY/PARTNERSHIP/ESTATE (schedule E) pER CoMpIITER: ...50.00RENT/ROyAr,Try TNCOME/LOSS pER COMPUTER:. . . . .50.00ESTATE/TRUST INCOME/LOSS pER COMpTTTER: . . . .90.00PARTNERSHIP/S.CORP INCOME/IOSS PER COMPUTER:. . . . .$O.OOFARM INCOME OR LOSS (Schedu1e F) : . . . .90.00FARM INCOME OR LOSS (Schedule F) PER COMPIITER: . . .50.00UNEMPtOYMnf r f COMPENSATION: . . . . . . 91 ,143 .00TOTAI SOCIAL SECURITY BENEFITS : . . . . .S0 .00TAXABLE SOCIAI, SECURITY BENEFITS: . . . .S0.00TAXABLE SOCIAL SECURITY BENEFITS PER COMPUTER: . . . . . . . . .S0 .00O T ] I { E R I N C O M E : . . . . . . . . . S 8 5 6 . 0 0SCHEDI ILE E IC SE INCOME PER COMPUTER: . . . . . . .S0 .00SCI{EDULE EIC EARNED INCOME PER COMPUTER:. - - - . . . .S0.00S C H E I C D I S Q U A L I F I E D I N C C O M P U T E R : . . . . . . . . g 0 . 0 0T O T A L I N C O M E : . - . . . . . 9 1 8 , 5 4 6 . 0 0TOTAT , TNCOME PER COMPI IPER: . . . . $18 ,546 .00
Adjustments to Income
EDUCATOR EXPENSES: .50.00EDUCATOR EXPENSES PER COMPI I |ER : - . . . . . $0 .00RESERVIST AND OTHER BUSINESS EXPENSE: . . . . . . $0 .00
HEALTH SAVINGS ACCT DEDUCTION: . . . . . . . g0 .00HEALTH SAVINGS AccT DEDUCTTON pER COMpTR: .$O.OOM O V T N G E X P E N S E S : F 3 9 0 3 : . . . . . 9 0 . 0 0SELF EMPLOYMENT TAX DEDUCTION: . . . . . g0 .00SEIJF EMPIJOYMENT TAX DEDUCTION pER COMPIITER:. . . . . .$0.00KEOGH/SEP CONTRIBUTION DEDUCTION: .$O.OOSELF-EMP HEALT ' I I INS DEDUCTION: . . . . $0 .00EARIY WfTHDRAWAL OF SAVINGS PENAI,Ty: . . . . . .$0.00A],IMONY PAID SSN:A L I M O N Y P A I D : . . . g 0 . 0 0I R A D E D U C T I O N : . . - . . . . 9 0 . 0 0IRA DEDUCTION PER COMPIITER: . . 90.00S T U D E N T L O A N I N T E R E S T D E D U C T I O N : - . . . . . . . . . 5 0 . 0 0STUDENT LOAN INTEREST DEDUCTION pER COMPUTER: . . . . . . . . . . $0 .00TUIT ION AND FEES DEDUCTION: . . . . 90 .00TUTT ION AND FEES DEDUCTION pER COMPITTER: . . . . . . . . . g0 .00, JURY D IJ |Y PAY DEDUCTTON: . . . . . $0 .00DOMESTIC PRODUCTION ACTIVITIES DEDUCTION: .$0.00O T H E R A D J U S T M E N T S : . . . . . $ 0 . 0 0A R C H E R M S A D E D U C T I O N : . . . . . . $ 0 . 0 0ARCHER MSA DEDUCTIoN PER COMpUTER: .$O.OOT O T A I A D , J U S T M E N T S ] . . . . . . $ O . o OT O T A L A D , J U S T M E N T S P E R C O M P I I 1 | E R : . . . . . . . . . . g 0 . 0 0A D W S T E D G R O S S I N c o M E : . . . . . . . . . $ 1 8 , 6 4 6 . 0 0AD,JUSTED GROSS INCOME PER COMPTITER: . . . . . . . 519 ,645 .00
Tax and Credits
6 5 - O R - O V E R : . . . . . . . . N OB L f N D : . . . . . N oS P O U S E 6 5 - O R - O V E R : . . . . . . N OS P O U S E B T I N D : . . . . . . . N OSTANDARD DEDUCTION PER COMPUIER: . . . . $6, 100. OOADDIT IONAI , STANDARD DEDUCTION pER COMPIJTER: . . . - . . . . . $0 .00TAX TABLE INCOME pER COMp l r rER : . . . . . . 912 ,5A6 .00E X E M P T I O N A M O U N T p E R C O M P U T E R : . . . . . . . . + : . g o o . o oT A X A B L E I N C O M E : . . . $ e , e + e . O OTAXABLE fNCOME PER COMPI I |ER : . . . . $e ,eae .OOT O T A T J P O S T T I V E T N C O M E p E R C O M P U T E R : . . . . . . . . . S i e , 5 4 6 . 0 0T E N T A T I V E T A X : . . . . . . . 5 9 6 3 . 0 0TENTATTVE TAX PER COMPUTER: g853.00FORM 881-4 ADDITTONAL TAX AMOUNT: . . . $0. OOTAX ON INCOME LESS SOC SEC INCOME pER COMPII fER:. . . . .$0.00F O R M 6 2 5 1 A L T E R N A T I V E M I N I M U M T A X : . . . . . . . $ 0 . 0 0FORM 6251 AITERNATIVE MINIMLM TAX pER COMpIJTER: ..$0.00FOREIGN TAX CREDIT : . . . g0 .00F O R E I G N T A X C R E D I T P E R C O M P U : [ E R : . . . . . . . . . . S 0 . 0 0FOREIGN INCOI {E EXCLUSION pER COMP{ I |ER : . . . . . . . . $0 .00FOREIGN INCOME EXCLUSION TAX PER COMpII |ER: . . . . . .$0.00C H r L D & D E P E N D E N T C A R E C R E D T T : . . . . . . . $ 0 . 0 0CHILD & DEPENDENT CARE CREDIT pER COMPUTER: . . . . . . $O .OOC R E D I T F O R E L D E R L Y A N D D I S A B L E D : . . . . . . . . $ 0 . 0 0C R E D I T F O R E L D E R L Y A N D D I S A B L E D p E R C O M P I I T E R : . . . . . . . . . $ 0 . 0 0E D U C A T T O N C R E D I T : . . . . . . 9 0 . 0 0EDUCATION CREDIT PER COMPI ITER: . . . . . . . 90 .00GROSS EDUCATION CREDTT PER COMPI ITER: . . . . . . . $0 .00RET IREMEN| SAV INGS CMTRB CREDIT : . . . . . . . . $0 .00RET IREMEMT SAVINGS CNTRB CREDIT pER COMPI I |ER : . . . . . . . , g0 .00P R I M R E T S A V C N T R B : F 8 8 8 0 L N G A : . . . . . $ 0 . 0 0SEC RET SAV CNTRB: F8880 LN6B : . $O .OoTOTAI RETfREMEN| SAVINGS CONTRIBIITION: F8BB0 CMpTR: . .$0.00RESIDENTIAL ENERGY CREDIT : . . . . $0 .00RESIDENTIA I , ENERGY CREDIT PER COMPI I |ER : . . . . . . . . . . g0 .00CHILD TAX CREDIT : .S0 .00C H I L D T A X C R E D I T P E R C O M P U T E R : . . . . . . . $ 0 . 0 0A D O P T I O N C R E D I T : F 8 8 3 9 : . . . . . . $ 0 . 0 0A D O P T I O N C R E D I T P E R C O M P I I | E R : . . . . . . . . 5 0 . 0 0FORM 8839 REFUND ADOPTION CREDIT AMOUNT: . .g0.00DC LST TIME HOMEBIIYERS CREDIT: . . . . g0.00DC L5T TIME HOMEBUYERS CREDIT pER COMprrrER: . . . . . . $0.00FORM 8396 MORTGAGE CERTIFICATE CREDIT: . . . . F0.00FORM 8396 MORTGAGE CERTIF ICATE CREDIT pER COMPI ITER: . . . . . . . . . . g0 .00F3800 , F8801 AND OTTTER CREDIT AMOUNT: . . . . . $0 .00FORM 3800 GENERAL BUSINESS CREDITS: .$0.00FORM 3800 GENERAL BUSINESS CREDITS pER COMPIITER: . . . . . $0.00P R I O R Y R M f N T A X C R E D I T : F 8 8 0 j - : . . . . . 9 0 . 0 0PRIOR YR MIN TAx CREDIT : F8801 PER CoMPL I I |ER : . . . . * o .ooF8834 ELECTRIC VEHIC IJE CREDIT AMOI INT : . . . . $0 .00F8935 ELECTRTC MOTOR VEHICLE CREDIT AMOUIi IF: . . .$0.00F89l-0 AI ,TERNATIVE MOTOR VEHfCI,E CREDfT AMOITNT: . . .$0.009IITI 9l IPl: : ' " ' .so.oor v r , * L K E U T I D : . . .
. $ 0 . 0 0TOTAI, CREDITS PER CoMPII|ER: . . g0.00INCOME TAX AFTER CREDITS pER COMPUTER: . . . . . . . .S8G3 .00
Other Taxes
s E T A X : . . . . $ o . o oS E T A X P E R C O M P I I | E R : . . . . . . . . $ 0 . 0 0SOCIAI SECURITY AND MEDICARE TAX ON UNREPORTED TIpS:. . .$0.00socrAl, SECURTTY AND MEDTCARE TAx oN IINREPORTED Trps pER coMpurER: ..$o.oo
TAx oN QUALIFIED PLANS F5329 (PR) : . . ' ' $27 ' 00
TAX ON QUA] , IF IED P I ,ANS F5329 PER COMPUTER: . . . . . $27 .00
I R A F T A X P E R C O M P U T E R : . . . . " $ 0 ' 0 0TP TAX FIGURES (REDUCED BY IRAF) PER COMPIITER: . . . . . . $89O. OO
IMF TOTA! TAx (REDUCED BY IRAF) PER COMPI ITER: . - - - " " $890 '00' OTHER TAXES PER COMPUIER: " " '$0 '00
U N P A I D F I C A O N R E P O R T E D T I P S : . ' ' ' ' $ 0 ' 0 0
o r H E R T A X E S : ' " " " $ o ' o oR E C A P T U R E T A X : F 8 5 l - L : . . . . . " ' $ 0 ' 0 0
HOUSEHOLD EMPLOYMEN| TAXES: '$0'00
HOUSEHOLD EMPLOYMENT TAXES PER COMPII|ER: " '$0'00
RECAPTURE TAXES: '$0 '00
TOTAI ASSESSMEI{I PER COMPTJIER; " '$890'00
TOTAL TAX LIABILITIT TP FIGURES: ' ' ' $890 ' 00
TOTAI, TAX LIABILITY TP FIGURES PER COMPII : |ER: - . . . " "$890'00
PaymenEs
FEDERAL INCOME TAX WIT I1HELD: . . . . ' $1 ,489 '00
COBRA PREMfUM SLIBSIDY: "$0'00EST IMATED TAx PAYMENTS: . . . . ' $0 ' 00
OTHER PAYMENT CREDIT: '$0 '00
MAKING WORK PAY AND GOV'T RET CREDIT PER COMPUTER:-. . . '$0 '00
REFUNDABLE EDUCATION CREDIT: "$0'00REFUNDABLE EDUCATION CREDIT PER COMPII IER:. . . . " "$0'00REFUNDABLE EDUCATfON CREDIT VERIFIED: " "$0'00EARNED INCOME CREDIT: " '$0 '00
EARNED INCOME CREDIT PER COMPUTER: . . . . . ' ' $0 ' 00
EARNED INCOME CREDIT NONTAXABLE COMBAT PAY:.. " '$0'00
SCHEDIJLE 8812 NONTAXABLE COMBAT PAY:. - "$0'00EXCESS SOCIAL SECURITY & RRTA TAX WITHHELD: . . . . . " " " $0 ' 00scHEDUr,E 8812 TOT SS/MEDTCARE WTTHHELD: . . - .$0-00
SCHEDULE 8812 ADDITIONAL CHfLD TAX CREDIT: " "$0'00SCEEDULE 8812 ADDITIONAL CHILD TAx CREDIT PER COMPUTER: " " "$0'00SCHEDULE 881-2 ADDITIONAL CHILD TAX CREDIT VERIFIED: " "$0'00A M O U N T P A I D W I T H F O R M 4 8 6 8 : . . . . . " " $ 0 ' 0 0FORM 2439 REGITLATED INVESTMENT COMPANY CREDIT: " '$0'00
FORM 4136 CREDIT FOR FEDERAL TAx ON FUELS: " '$0 '00
FORM 4135 CREDIT FOR FEDERAL TAX ON FUELS PER COMPUTER: "" '$0 '00HEALTH COVERAGE TX CR: F8885: ' ' $0 ' 00
FORM 8801 REFIJNDABLE CREDIT FOR PRIOR YEAR MIN. TAX:. ' " " '$0 '00F IRST T IME HOME B I r yER CREDIT PER COMPI ITER: - . . . " ' $0 ' 00FIRST TIME HOME B{fvER CREDIT: " " "$0'00FIRST TIME HOME BUYER CREDIT VERIFIED: " '$0 '00PRIMARY NAP FIRST TIME HOME BUYER INSTAI,LMENT AMT: " "$0'00SECONDARY NAP FIRST TIME HOME BITYER INSTALLMEMT AMT: "'$0'00FIRST TIME HOMEBUYER CREDIT REPAYMENT AMOUNI: " '$0'00
FORM 25s5 COMBINED EARNED INCOME AMOIJI{T PER COMPIITER:. "' " '$0'00
FORM 5405 TOTAL HOMEBUYERS CREDIT REPAYMENT PER COMPUTER:"" """$0'00SMALL EMPI,OYER I IEALTH INSURANCE PER COMPUTER:.-- - """$0'00SMALJ, EMPLOYER HEALrI I INSI]RANCE PER COMPUTER (2): . . . .$O.OO
FORM 2439 , 8801 , and OTHER CREDIT TOTAL AMf : - - . ' $0 ' 00To rA r ' PAYMENTS: " ' $1 ' 489 'ooTOTAL PAYMENTS PER COMPUTER: "$1,489'00
Refund or Amount Owed
R E F U N D A M o u N T : " " ' $ - 5 9 9 ' o oAPPLIED TO NEXT YEiAR'S ESTIMATED TAX:. . " "$0'00E S T I M A T E D T A X P E N A T T Y : . . . . . " " " $ 0 ' 0 0TAX ON INCOME LESS STATE REFUND PER COMPU1IER: . . - - " " $0 ' 00BAI, DUE/OVER PYMI USING TP FIG PER COMPUTER: . .$_599.00
BAL DUE/OVER PYMT US ING COMPI ITER F IGURES: . . . . . . " " ' $ -599 '00FORM 8888 TOTAI REFUND PER COMPII|ER: - . . . " $0 ' 00
Third Party Desiginee
THIRD PARTY DESIGNEE ID NIJMBER:A I I T H O R I Z A T I O N I N D I C A T O R : . . . . " " " " " 0THIRD PARTY DESIGNEE NAME:.
Form 8863 - Education Credits (Hope and Lifetime Learning crediLs)
PART III . AL],OWABIE EDUCATION CREDITS
GROSS EDUCATION CR PER COMPUTER: . . . . " " $0 ' 00TOTAL EDUCATION CREDIT AMOUNT: " ' " ' $0 ' 00TOTAL EDUCATION CREDIT AMOUI{: I PER COMPUTER:. . . . " " '$0 '00
This Product Contains Sensitive Taxpayer Data
