Acc 401
Appendix APlease use this information for your Tax Return and Paper.
*All people, businesses, and information are fictional. Any relation to an actual person or business is accidental.
Kenneth Jones
SSN: 0XX-01-1XXX
Date of Birth (DOB): 05/27/1977
Gross Pay: $64,628
401(k) contributions: $5,250
Healthcare costs (payroll deductions): $2,438
Reported wages: $56,940
Social Security Wages: $62,190
Medicare Wages: $62,190
State Wages: $56,940
Taxes withheld:
Federal: $5,640
Social Security: $3,855.78
Medicare: $901.76
State: $723.56
SDI (mandatory disability insurance): $581.65
Employer: PointMark, INC
Address: 1111 One Park Place
City: One City
State: California
Zip code: 11111
Employer’s FED ID number: 33-01XXX11
Naomi Jones
SSN: 001-02-XXXX
DOB: 08/11/1980
Gross Pay: $58,192
401(k) contributions: $5,000
Healthcare costs (payroll deductions): $2,164
Reported wages: $51,028
Social Security Wages: $56,028
Medicare Wages: $56,028
State Wages: $51,028
Taxes withheld:
Federal: $4,704
Social Security: $3,473.74
Medicare: $812.41
State: $704.82
SDI (mandatory disability insurance): $523.73
Employer: CompanyOne
Address: 1111 Place Road
City: One City
State: California
Zip code: 11112
Employer’s FED ID number: 33-01XXX22
Dependent: Home address:
Derek Jones 123 Rolling Road
SSN: 001-XX-XX00 One City, CA 11111
DOB: 12/29/2013
Child Care Costs: $11,200
Child Care Provider: Kidland Daycare Center
Address: 121 Place Road
City: One City
State: California
Zip code: 11111
Identifying number: 33-XXXX011
Life Change Events
Home Sale:
Primary residence sale price $615,000
Cost basis (incurred three years prior) $400,000
Property Tax paid: $4,700
Mortgage Interest paid: $16,300
