This Product Contains Sensitive Taxpayer Data Wage and Income Transcript Request Date: 06-08-2013 Response Date: 06-08-2013 Tracking Number: 100163598522 SSN Provided: 297-44-3727 Tax Period Requested: December, 2012 & Date of Sale or Exchange: 09-14-2012 Federal Income Stocks and Bonds: $2,468.00 Description: 67 SHARES GABELLI SMALL CAP GROWTH Quantity Sold: 0000000000067 & Date of Sale or Exchange: 11-27-2012 Federal Income Stocks and Bonds: $117.00
Description: 3 SHARES GABELLI SMALL CAP GROWTH Quantity Sold: 0000000000003 & Date of Sale or Exchange: 11-27-2012 Federal Income Stocks and Bonds: $2,319.00 Description: 64 SHARES GABELLI SMALL CAP GROWTH Quantity Sold: 0000000000064 Form SSA-1099 Benefits Statement Payer's Federal Identification Number (FIN): 526004813 SOCIAL SECURITY ADMINISTRATION Payee: Payee's Identification Number: 297-44-3727 N/A Pensions and Annuities (Total Benefits Paid): $21,262.00 Repayments: 0.00 Workman's Compensation Offset: 0.00 TY 2011 Payments: 0.00 TY 2010 Payments: 0.00 TY 2009 Payments: 0.00 TY 2008 Payments: 0.00 Trust Fund Indicator: Retirement SSA/RRB Payments: Either RRB or SSA payments Form 1099-G Payer's Federal Identification Number (FIN): 453695561 SOUTH CAROLINA DEPARTMENT OF REVENUE PO BOX 125 COLUMBIA, SC 29214-0000 ROUSH RICHARD
GREENWOOD, SC 29649-0032 00000000000001408473 ATAA Payments: 0.00 Taxable Grants: 0.00 Unemployment Compensation: 0.00 Agricultural Subsidies: 0.00 Prior Year Refund: $3,781.00 Market gain on Commodity Credit Corporation loans repaid on or after January 1, 2007: 0.00 Year of Refund: 2011 1099G Offset: Not Refund, Credit, or Offset for Trade or Business Form 1099-DIV Payer's Federal Identification Number (FIN): 223703799 PRUDENTIAL FINANCIAL INC TA> C O COMPUTERSHARE P O BOX 43010 PROVIDENCE, RI 02940-3010 PRU C001763656100001 Capital Gains: 0.00 Non-Dividend Distribution : 0.00 Cash Liquidation Distribution: 0.00 Non-Cash Liquidation Distribution: 0.00 Investment Expense: 0.00 Ordinary Dividend: $99.00 Collectibles (28%) Gain: 0.00 Unrecaptured Section 1250 Gain: 0.00 Section 1202 Gain: 0.00 Foreign Tax Paid: 0.00 Qualified Dividends: $99.00 No Second Notice Exempt Interest Dividends: 0.00 Specified Private Activity Bond Interest Dividend: 0.00 Form 1099-INT & 13325611 Interest: 0.00 Savings Bonds: 0.00 Investment Expense: 0.00 Interest Forfeiture: 0.00 Foreign Tax Paid: 0.00 Tax-Exempt Interest: 0.00 Specified Private Activity Bond Interest: 0.00 No Second Notice Foreign Country or US Possession:
Payer's Federal Identification Number (FIN): 132570714 PRESIDENTIAL LIFE INSURANCE COMPANY 69 LYDECKER STREET NYACK, NY 10960-0000 00701237A 7 IRA/SEP/SIMP box not checked Tax Withheld: $79.00 Gross Distribution: $396.00 Taxable Amount: $396.00 Payer's Federal Identification Number (FIN): 135581829 METROPOLITAN LIFE INSURANCE CO METLIFE R S PO BOX 14710 LEXINGTON, KY 40512-4710 RICK ROUSH GREENWOOD, SC 29649-0032 07A1107049 040 7 IRA/SEP/SIMP box not checked Gross Distribution: $2,201.00 Taxable Amount: $2,201.00 76614177
7 Tax amount not determined IRA/SEP/SIMP box checked Tax Withheld: $8,500.00 Gross Distribution: $39,326.00 Taxable Amount: $39,326.00 This Product Contains Sensitive Taxpayer Data