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This Product Contains Sensitive Taxpayer Data

Tax Return Transcript

Request Date: 08-30-2019
Response Date: 08-30-2019
TrackingNumber: 100200238983
CustomerFileNumber: 0987654321

SSN Provided: XXX-XX-6870

Tax Period Ending: Dec.31,2018

The following items reflect the amount as shown on the return (PR), and the amount as adjusted (PC), if
applicable. They do not show subsequent activity on the account.

SSN: XXX-XX-6870
SPOUSE SSN:
NAME(S)SHOWNONRETURN: CHARLESMICHAEL PATTERSON

ADDRESS: 9822TAPESTRYPARKCIRSTE208
JACKSONVILLE,FL,32246

FILING STATUS: Single

FORM NUMBER: 1040
CYCLE POSTED: 20191205
RECEIVED DATE: Apr.15, 2019
REMITTANCE: $0.00
EXEMPTION NUMBER: 5

DEPENDENT 1 NAME CTRL:

DEPENDENT 1 SSN:
DEPENDENT 2 NAME CTRL:
DEPENDENT 2 SSN:
DEPENDENT 3 NAME CTRL:
DEPENDENT 3 SSN:
DEPENDENT 4 NAME CTRL:
DEPENDENT 4 SSN:
PTIN:
PREPARER EIN:

Income
WAGES, SALARIES, TIPS, ETC: $108,00.00
TAXABLE INTEREST INCOME: SCH B: $1410.75
TAX-EXEMPT INTEREST: $0.00
ORDINARY DIVIDEND INCOME: SCH B: $0.00
QUALIFIED DIVIDENDS: $0.00
REFUNDS OF STATE/LOCAL TAXES: $0.00

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ALIMONY RECEIVED: $0.00

BUSINESS INCOME OR LOSS (Schedule C): $108,000.00
BUSINESS INCOME OR LOSS: SCH C PER COMPUTER: $85,160.00
CAPITAL GAIN OR LOSS: (Schedule D): $0.00
CAPITAL GAINS OR LOSS: SCH D PER COMPUTER: $0.00
OTHER GAINS OR LOSSES (Form 4797): $0.00
TOTAL IRA DISTRIBUTIONS: $0.00
TAXABLE IRA DISTRIBUTIONS: $0.00
TOTAL PENSIONS AND ANNUITIES: $0.00
TAXABLE PENSION/ANNUITY AMOUNT: $0.00
RENT/ROYALTY/PARTNERSHIP/ESTATE (Schedule E): $0.00
RENT/ROYALTY/PARTNERSHIP/ESTATE (Schedule E) PER COMPUTER: $0.00
RENT/ROYALTY INCOME/LOSS PER COMPUTER: $0.00
ESTATE/TRUST INCOME/LOSS PER COMPUTER: $0.00
PARTNERSHIP/S-CORP INCOME/LOSS PER COMPUTER: $0.00
FARM INCOME OR LOSS (Schedule F): $0.00
FARM INCOME OR LOSS (Schedule F) PER COMPUTER: $0.00
UNEMPLOYMENT COMPENSATION: $0.00
TOTAL SOCIAL SECURITY BENEFITS: $0.00
TAXABLE SOCIAL SECURITY BENEFITS: $0.00
TAXABLE SOCIAL SECURITY BENEFITS PER COMPUTER: $0.00
OTHER INCOME: $0.00
SCHEDULE EIC SE INCOME PER COMPUTER: $2,323.00
SCHEDULE EIC EARNED INCOME PER COMPUTER: $15,323.00
SCH EIC DISQUALIFIED INC COMPUTER: $0.00
TOTAL INCOME: $15,500.00
TOTAL INCOME PER COMPUTER: $15,500.00

Adjustments to Income
EDUCATOR EXPENSES: $0.00
EDUCATOR EXPENSES PER COMPUTER: $0.00
RESERVIST AND OTHER BUSINESS EXPENSE: $0.00
HEALTH SAVINGS ACCT DEDUCTION: $0.00
HEALTH SAVINGS ACCT DEDUCTION PER COMPTR: $0.00
MOVING EXPENSES: F3903: $0.00
SELF EMPLOYMENT TAX DEDUCTION: $177.00
SELF EMPLOYMENT TAX DEDUCTION PER COMPUTER: $177.00
SELF EMPLOYMENT TAX DEDUCTION VERIFIED: $0.00
KEOGH/SEP CONTRIBUTION DEDUCTION: $0.00
SELF-EMP HEALTH INS DEDUCTION: $0.00
EARLY WITHDRAWAL OF SAVINGS PENALTY: $0.00
ALIMONY PAID SSN:
ALIMONY PAID: $0.00
IRA DEDUCTION: $0.00
IRA DEDUCTION PER COMPUTER: $0.00
STUDENT LOAN INTEREST DEDUCTION: $0.00
STUDENT LOAN INTEREST DEDUCTION PER COMPUTER: $0.00
STUDENT LOAN INTEREST DEDUCTION VERIFIED: $0.00
TUITION AND FEES DEDUCTION: $0.00
TUITION AND FEES DEDUCTION PER COMPUTER: $0.00
DOMESTIC PRODUCTION ACTIVITIES DEDUCTION: $0.00

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DOMESTIC PRODUCTION ACTIVITIES DEDUCTION PER COMPUTER: $0.00

OTHER ADJUSTMENTS: $0.00
ARCHER MSA DEDUCTION: $0.00
ARCHER MSA DEDUCTION PER COMPUTER: $0.00
TOTAL ADJUSTMENTS: $177.00
TOTAL ADJUSTMENTS PER COMPUTER: $177.00
ADJUSTED GROSS INCOME: $108,000.00
$108,000.00
ADJUSTED GROSS INCOME PER COMPUTER:

Tax and Credits

65-OR-OVER: YES
BLIND: NO
SPOUSE 65-OR-OVER: NO
SPOUSE BLIND: NO

STANDARD DEDUCTION PER COMPUTER: $4,850.00

ADDITIONAL STANDARD DEDUCTION PER COMPUTER: $0.00
TAX TABLE INCOME PER COMPUTER: $10,473.00
EXEMPTION AMOUNT PER COMPUTER: $3,100.00
TAXABLE INCOME: $7,373.00
TAXABLE INCOME PER COMPUTER: $7,373.00
TOTAL POSITIVE INCOME PER COMPUTER: $$108,000.00
TENTATIVE TAX: $749.00
TENTATIVE TAX PER COMPUTER: $749.00
FORM 8814 ADDITIONAL TAX AMOUNT: $0.00
TAX ON INCOME LESS SOC SEC INCOME PER COMPUTER: $0.00
FORM 6251 ALTERNATIVE MINIMUM TAX: $0.00
FORM 6251 ALTERNATIVE MINIMUM TAX PER COMPUTER: $0.00
FOREIGN TAX CREDIT: $0.00
FOREIGN TAX CREDIT PER COMPUTER: $0.00
FOREIGN INCOME EXCLUSION PER COMPUTER: $0.00
FOREIGN INCOME EXCLUSION TAX PER COMPUTER: $0.00
EXCESS ADVANCE PREMIUM TAX CREDIT REPAYMENT AMOUNT: $0.00
EXCESS ADVANCE PREMIUM TAX CREDIT REPAYMENT VERIFIED AMOUNT: $0.00
CHILD & DEPENDENT CARE CREDIT: $0.00
CHILD & DEPENDENT CARE CREDIT PER COMPUTER: $0.00
CREDIT FOR ELDERLY AND DISABLED: $0.00
CREDIT FOR ELDERLY AND DISABLED PER COMPUTER: $0.00
EDUCATION CREDIT: $0.00
EDUCATION CREDIT PER COMPUTER: $0.00
GROSS EDUCATION CREDIT PER COMPUTER: $0.00
RETIREMENT SAVINGS CNTRB CREDIT: $0.00
RETIREMENT SAVINGS CNTRB CREDIT PER COMPUTER: $0.00
PRIM RET SAV CNTRB: F8880 LN6A: $0.00
SEC RET SAV CNTRB: F8880 LN6B: $0.00
TOTAL RETIREMENT SAVINGS CONTRIBUTION: F8880 CMPTR: $0.00
RESIDENTIAL ENERGY CREDIT: $0.00
RESIDENTIAL ENERGY CREDIT PER COMPUTER: $0.00
CHILD TAX CREDIT: $0.00
CHILD TAX CREDIT PER COMPUTER: $0.00
ADOPTION CREDIT: F8839: $0.00
ADOPTION CREDIT PER COMPUTER: $0.00

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FORM 8396 MORTGAGE CERTIFICATE CREDIT: $0.00

FORM 8396 MORTGAGE CERTIFICATE CREDIT PER COMPUTER: $0.00
F3800, F8801 AND OTHER CREDIT AMOUNT: $0.00
FORM 3800 GENERAL BUSINESS CREDITS: $0.00
FORM 3800 GENERAL BUSINESS CREDITS PER COMPUTER: $0.00
PRIOR YR MIN TAX CREDIT: F8801: $0.00
PRIOR YR MIN TAX CREDIT: F8801 PER COMPUTER: $0.00
F8936 ELECTRIC MOTOR VEHICLE CREDIT AMOUNT: $0.00
F8936 ELECTRIC MOTOR VEHICLE CREDIT PER COMPUTER: $0.00
F8910 ALTERNATIVE MOTOR VEHICLE CREDIT AMOUNT: $0.00
F8910 ALTERNATIVE MOTOR VEHICLE CREDIT PER COMPUTER: $0.00
OTHER CREDITS: $0.00
TOTAL CREDITS: $0.00
TOTAL CREDITS PER COMPUTER: $0.00
INCOME TAX AFTER CREDITS PER COMPUTER: $749.00

Other Taxes
SE TAX: $354.00
SE TAX PER COMPUTER: $354.00
SOCIAL SECURITY AND MEDICARE TAX ON UNREPORTED TIPS: $0.00
SOCIAL SECURITY AND MEDICARE TAX ON UNREPORTED TIPS PER COMPUTER: $0.00
TAX ON QUALIFIED PLANS F5329 (PR): $0.00
TAX ON QUALIFIED PLANS F5329 PER COMPUTER: $0.00
IRAF TAX PER COMPUTER: $0.00
TP TAX FIGURES (REDUCED BY IRAF) PER COMPUTER: $1,103.00
IMF TOTAL TAX (REDUCED BY IRAF) PER COMPUTER: $1,103.00
OTHER TAXES PER COMPUTER: $0.00
UNPAID FICA ON REPORTED TIPS: $0.00
OTHER TAXES: $0.00
RECAPTURE TAX: F8611: $0.00
HOUSEHOLD EMPLOYMENT TAXES: $0.00
HOUSEHOLD EMPLOYMENT TAXES PER COMPUTER: $0.00
HEALTH CARE RESPONSIBILITY PENALTY: $0.00
HEALTH CARE RESPONSIBILITY PENALTY VERIFIED: $0.00
HEALTH COVERAGE RECAPTURE: F8885: $0.00
RECAPTURE TAXES: $0.00
TOTAL ASSESSMENT PER COMPUTER: $1,103.00
TOTAL TAX LIABILITY TP FIGURES: $1,103.00
TOTAL TAX LIABILITY TP FIGURES PER COMPUTER: $1,103.00

Payments
FEDERAL INCOME TAX WITHHELD: $1582.75
HEALTH CARE: INDIVIDUAL RESPONSIBILITY: $130.50
HEALTH CARE FULL-YEAR COVERAGE INDICATOR: 1
ESTIMATED TAX PAYMENTS: $0.00
OTHER PAYMENT CREDIT: $0.00
REFUNDABLE EDUCATION CREDIT: $0.00
REFUNDABLE EDUCATION CREDIT PER COMPUTER: $0.00
REFUNDABLE EDUCATION CREDIT VERIFIED: $0.00
EARNED INCOME CREDIT: $0.00
EARNED INCOME CREDIT PER COMPUTER: $0.00
EARNED INCOME CREDIT NONTAXABLE COMBAT PAY: $0.00

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SCHEDULE 8812 NONTAXABLE COMBAT PAY: $0.00

EXCESS SOCIAL SECURITY & RRTA TAX WITHHELD: $0.00
SCHEDULE 8812 TOT SS/MEDICARE WITHHELD: $0.00
SCHEDULE 8812 ADDITIONAL CHILD TAX CREDIT: $0.00
SCHEDULE 8812 ADDITIONAL CHILD TAX CREDIT PER COMPUTER: $0.00
SCHEDULE 8812 ADDITIONAL CHILD TAX CREDIT VERIFIED: $0.00
AMOUNT PAID WITH FORM 4868: $0.00
FORM 2439 REGULATED INVESTMENT COMPANY CREDIT: $0.00
FORM 4136 CREDIT FOR FEDERAL TAX ON FUELS: $0.00
FORM 4136 CREDIT FOR FEDERAL TAX ON FUELS PER COMPUTER: $0.00
HEALTH COVERAGE TX CR: F8885: $0.00
PREMIUM TAX CREDIT AMOUNT: $0.00
PREMIUM TAX CREDIT VERIFIED AMOUNT: $0.00
PRIMARY NAP FIRST TIME HOME BUYER INSTALLMENT AMT: $0.00
SECONDARY NAP FIRST TIME HOME BUYER INSTALLMENT AMT: $0.00
FIRST TIME HOMEBUYER CREDIT REPAYMENT AMOUNT: $0.00
FORM 5405 TOTAL HOMEBUYERS CREDIT REPAYMENT PER COMPUTER: $0.00
SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER: $0.00
SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER (2): $0.00
FORM 2439 AND OTHER CREDITS: $0.00
TOTAL PAYMENTS: $1582.75
TOTAL PAYMENTS PER COMPUTER: $1582.75

Refund or Amount Owed

AMOUNT YOU OWE: $103.00
APPLIED TO NEXT YEAR'S ESTIMATED TAX: $0.00
ESTIMATED TAX PENALTY: $0.00
TAX ON INCOME LESS STATE REFUND PER COMPUTER: $0.00
BAL DUE/OVER PYMT USING TP FIG PER COMPUTER: $103.00
BAL DUE/OVER PYMT USING COMPUTER FIGURES: $103.00
FORM 8888 TOTAL REFUND PER COMPUTER: $0.00

Third Party Designee

THIRD PARTY DESIGNEE ID NUMBER:
AUTHORIZATION INDICATOR: 0
THIRD PARTY DESIGNEE NAME:

Schedule C--Profit or Loss From Business

SOCIAL SECURITY NUMBER:
EMPLOYER ID NUMBER:
BUSINESS NAME: CHARLESMICHAELPATTERSON
DESCRIPTION OF BUSINESS/PROFESSION: OIL AND GAS PIPELINE AND RELATED STRUCTURE CONSTRUCTION
NAICS CODE: 237120
ACCT MTHD:
FIRST TIME SCHEDULE C FILED: N
STATUTORY EMPLOYEE IND: N
INCOME
GROSS RECEIPTS OR SALES: $108,000.00
RETURNS AND ALLOWANCES: $0.00
NET GROSS RECEIPTS: $0.00
COST OF GOODS SOLD: $0.00
SCHEDULE C FORM 1099 REQUIRED: NONE

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SCHEDULE C FORM 1099 FILED: NONE

OTHER INCOME: $0.00
EXPENSES
CAR AND TRUCK EXPENSES: $2,400.00
DEPRECIATION: $0.00
INSURANCE (OTHER THAN HEALTH): $0.00
MORTGAGE INTEREST: $0.00
LEGAL AND PROFESSIONAL SERVICES: $0.00
REPAIRS AND MAINTENANCE: $1600.00
TRAVEL: $1980.00
MEALS AND ENTERTAINMENT: $0.00
WAGES: $0.00
OTHER EXPENSES: $410.00
TOTAL EXPENSES: $6,390.00
EXP FOR BUSINESS USE OF HOME: $0.00
SCH C NET PROFIT OR LOSS PER COMPUTER: $2,500.00
AT RISK CD:
OFFICE EXPENSE AMOUNT: $470.00
UTILITIES EXPENSE AMOUNT: $1150.00

COST OF GOODS SOLD

INVENTORY AT BEGINNING OF YEAR: $0.00
INVENTORY AT END OF YEAR: $0.00

Schedule SE--Self-Employment Tax

SSN OF SELF-EMPLOYED TAXPAYER: XXX-XX-6870
NET FARM PROFIT/LOSS: SCH F: $0.00
CONSERVATION RESERVE PROGRAM PAYMENTS: $0.00
NET NONFARM PROFIT/LOSS: $2,500.00
TOTAL SE INCOME: $2,500.00
SE QUARTERS COVERED: 4
TOTAL SE TAX PER COMPUTER: $353.12
SE INCOME COMPUTER VERIFIED: $0.00
SE INCOME PER COMPUTER: $2,308.00
TOTAL NET EARNINGS PER COMPUTER: $2,308.00

LONG FORM ONLY

TENTATIVE CHURCH EARNINGS: $0.00
TOTAL SOC SEC & RR WAGES: $0.00
SE SS TAX COMPUTER: $286.19
SE MEDICARE INCOME PER COMPUTER: $2,308.00
SE MEDICARE TAX PER COMPUTER: $66.93
SE FARM OPTION METHOD USED: 0
SE OPTIONAL METHOD INCOME: $0.00

Form 8863 - Education Credits (Hope and Lifetime Learning

Credits)
PART III - ALLOWABLE EDUCATION CREDITS
GROSS EDUCATION CR PER COMPUTER: $0.00
TOTAL EDUCATION CREDIT AMOUNT: $0.00
TOTAL EDUCATION CREDIT AMOUNT PER COMPUTER: $0.00
This Product Contains Sensitive Taxpayer Data

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