text,label,label_id,label_name,record_id,group_id,document_status,tax_year,source_record_id,origin,layout,title_mode,ocr_noise,sub_kind
"Form W-2: Wage and Tax Statement
Calendar year: 2023
Statement issued to Example Person 0.
wages: USD 10,000.00
federal income tax withheld: USD 1,000.00
employer: Example Entity 0-0-2
employee: Example Entity 0-0-3",W-2,38,W-2,fdc-28de8104199562f257a03bd6,synthetic-form-layout-00,original,2023,fte-8fe5f692281a367fc34dd921,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Calendar year: 2024
Statement issued to Example Person 1.
wages: USD 10,083.00
federal income tax withheld: USD 1,008.30
employer: Example Entity 0-1-2
employee: Example Entity 0-1-3",W-2,38,W-2,fdc-6663dce478b778a037d3b062,synthetic-form-layout-00,original,2024,fte-a88e6b977d5d59921ab5a5b3,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Calendar year: 2025
Statement issued to Example Person 2.
wages: USD 10,166.00
federal income tax withheld: USD 1,016.60
employer: Example Entity 0-2-2
employee: Example Entity 0-2-3",W-2,38,W-2,fdc-f404747f5dc4b8ecda8840a6,synthetic-form-layout-00,original,2025,fte-cfda6ac1990705d407fdcd93,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Calendar year: 2023
Statement issued to Example Person 3.
wages: USD 10,249.00
federal income tax withheld: USD 1,024.90
employer: Example Entity 0-3-2
employee: Example Entity 0-3-3",W-2,38,W-2,fdc-5fa46e2fc864f4e30db972b8,synthetic-form-layout-00,original,2023,fte-77ba524937e94b21415f4c74,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Calendar year: 2024
Statement issued to Example Person 4.
wages: USD 10,332.00
federal income tax withheld: USD 1,033.20
employer: Example Entity 0-4-2
employee: Example Entity 0-4-3",W-2,38,W-2,fdc-41948ba5132eb2ba7965524f,synthetic-form-layout-00,original,2024,fte-3bfd426d741df2d21b875323,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Calendar year: 2025
Statement issued to Example Person 5.
wages: USD 10,415.00
federal income tax withheld: USD 1,041.50
employer: Example Entity 0-5-2
employee: Example Entity 0-5-3",W-2,38,W-2,fdc-0d82561a9e57747c57567349,synthetic-form-layout-00,original,2025,fte-581db57a38bb8784a9e4f344,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Calendar year: 2023
Statement issued to Example Person 6.
wages: USD 10,498.00
federal income tax withheld: USD 1,049.80
employer: Example Entity 0-6-2
employee: Example Entity 0-6-3",W-2,38,W-2,fdc-126790b9a68e68402d762309,synthetic-form-layout-00,original,2023,fte-3231fd28beaf4f12c5f08a25,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Calendar year: 2024
Statement issued to Example Person 7.
wages: USD 10,581.00
federal income tax withheld: USD 1,058.10
employer: Example Entity 0-7-2
employee: Example Entity 0-7-3",W-2,38,W-2,fdc-44bcf91a790b79e0e02b0aae,synthetic-form-layout-00,original,2024,fte-27d47b7be0cbf95a3e22a05a,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 100
wages: USD 10,137.00 | federal income tax withheld: USD 1,013.70 | employer: Example Entity 1-0-2 | employee: Example Entity 1-0-3",W-2,38,W-2,fdc-6123dcb265895315ba65b2a0,synthetic-form-layout-01,original,2023,fte-05963fdceef5de73a83c0cf7,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 101
wages: USD 10,220.00 | federal income tax withheld: USD 1,022.00 | employer: Example Entity 1-1-2 | employee: Example Entity 1-1-3",W-2,38,W-2,fdc-b1dd0ba9362e74bfeb105414,synthetic-form-layout-01,original,2024,fte-aac0a4adb41d09bd8001662e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 102
wages: USD 10,303.00 | federal income tax withheld: USD 1,030.30 | employer: Example Entity 1-2-2 | employee: Example Entity 1-2-3",W-2,38,W-2,fdc-02c78e3879ed5862c3e9f672,synthetic-form-layout-01,original,2025,fte-34f9b3ae9ef3e9f466330ede,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 103
wages: USD 10,386.00 | federal income tax withheld: USD 1,038.60 | employer: Example Entity 1-3-2 | employee: Example Entity 1-3-3",W-2,38,W-2,fdc-dccd0da98bc23a8b283a54f5,synthetic-form-layout-01,original,2023,fte-8d31885f6bc712de5ced0cba,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 104
wages: USD 10,469.00 | federal income tax withheld: USD 1,046.90 | employer: Example Entity 1-4-2 | employee: Example Entity 1-4-3",W-2,38,W-2,fdc-d6f00f45e6c4ec3eca6c9b50,synthetic-form-layout-01,original,2024,fte-bda8b545cd5fca727bc75d5e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 105
wages: USD 10,552.00 | federal income tax withheld: USD 1,055.20 | employer: Example Entity 1-5-2 | employee: Example Entity 1-5-3",W-2,38,W-2,fdc-cd8f280b858ce9e68f5f43a0,synthetic-form-layout-01,original,2025,fte-3f0160486dbfda57ca4335bc,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 106
wages: USD 10,635.00 | federal income tax withheld: USD 1,063.50 | employer: Example Entity 1-6-2 | employee: Example Entity 1-6-3",W-2,38,W-2,fdc-1de2b4931cafc49fa87cbc9a,synthetic-form-layout-01,original,2023,fte-c18c2ae3deceea3e651068c1,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2: Wage and Tax Statement
Recipient record: Example Person 107
wages: USD 10,718.00 | federal income tax withheld: USD 1,071.80 | employer: Example Entity 1-7-2 | employee: Example Entity 1-7-3",W-2,38,W-2,fdc-4c1a5327f054027beb279cf5,synthetic-form-layout-01,original,2024,fte-8d12af87189461feba3e657b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2: Wage and Tax Statement.
wages: USD 10,274.00; federal income tax withheld: USD 1,027.40; employer: Example Entity 2-0-2; employee: Example Entity 2-0-3. Recipient: Example Household 200.",W-2,38,W-2,fdc-414f00616d139b0272d55a69,synthetic-form-layout-02,original,2023,fte-64e8d5a4602f299177181ef5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2: Wage and Tax Statement.
wages: USD 10,357.00; federal income tax withheld: USD 1,035.70; employer: Example Entity 2-1-2; employee: Example Entity 2-1-3. Recipient: Example Household 201.",W-2,38,W-2,fdc-3a45975f87833eb765e8002f,synthetic-form-layout-02,original,2024,fte-439beccf16a53a90b2dc3f24,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-2: Wage and Tax Statement.
wages: USD 10,440.00; federal income tax withheld: USD 1,044.00; employer: Example Entity 2-2-2; employee: Example Entity 2-2-3. Recipient: Example Household 202.",W-2,38,W-2,fdc-f4eb4fbd0a2fde1499863287,synthetic-form-layout-02,original,2025,fte-047e35ecc8e8245413d79d1e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2: Wage and Tax Statement.
wages: USD 10,523.00; federal income tax withheld: USD 1,052.30; employer: Example Entity 2-3-2; employee: Example Entity 2-3-3. Recipient: Example Household 203.",W-2,38,W-2,fdc-67c0d26885cb859b43862728,synthetic-form-layout-02,original,2023,fte-b6b338187436b525b33f6679,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2: Wage and Tax Statement.
wages: USD 10,606.00; federal income tax withheld: USD 1,060.60; employer: Example Entity 2-4-2; employee: Example Entity 2-4-3. Recipient: Example Household 204.",W-2,38,W-2,fdc-c53d3f69abbc968ef88b219e,synthetic-form-layout-02,original,2024,fte-9f40742122fd3ce08a018028,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-2: Wage and Tax Statement.
wages: USD 10,689.00; federal income tax withheld: USD 1,068.90; employer: Example Entity 2-5-2; employee: Example Entity 2-5-3. Recipient: Example Household 205.",W-2,38,W-2,fdc-5f2d16cf8e4b1f184185731d,synthetic-form-layout-02,original,2025,fte-5a7fd3d4a39f821e58fb3d7a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2: Wage and Tax Statement.
wages: USD 10,772.00; federal income tax withheld: USD 1,077.20; employer: Example Entity 2-6-2; employee: Example Entity 2-6-3. Recipient: Example Household 206.",W-2,38,W-2,fdc-2f15b7ad0450d2cbc84c4e08,synthetic-form-layout-02,original,2023,fte-f0e0464d8933ea106156e007,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2: Wage and Tax Statement.
wages: USD 10,855.00; federal income tax withheld: USD 1,085.50; employer: Example Entity 2-7-2; employee: Example Entity 2-7-3. Recipient: Example Household 207.",W-2,38,W-2,fdc-f1bb00e3882b845fe9c8da4c,synthetic-form-layout-02,original,2024,fte-d6a65376ba6c0e01d9afeb9a,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2023.
Details: wages: USD 10,411.00, federal income tax withheld: USD 1,041.10, employer: Example Entity 3-0-2, employee: Example Entity 3-0-3. Account holder: Example Person 300.",W-2,38,W-2,fdc-4d5c624f8de4fcfb5c6caec2,synthetic-form-layout-03,original,2023,fte-bf3d66e0f0d381e5c16ac8c6,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2024.
Details: wages: USD 10,494.00, federal income tax withheld: USD 1,049.40, employer: Example Entity 3-1-2, employee: Example Entity 3-1-3. Account holder: Example Person 301.",W-2,38,W-2,fdc-6dead891b56f55d785808ed9,synthetic-form-layout-03,original,2024,fte-6cc96a590e5de2834c88b4d1,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2025.
Details: wages: USD 10,577.00, federal income tax withheld: USD 1,057.70, employer: Example Entity 3-2-2, employee: Example Entity 3-2-3. Account holder: Example Person 302.",W-2,38,W-2,fdc-8a98a9c448582e836526e9ba,synthetic-form-layout-03,original,2025,fte-0a79cadb9ecc376c9f693b75,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2023.
Details: wages: USD 10,660.00, federal income tax withheld: USD 1,066.00, employer: Example Entity 3-3-2, employee: Example Entity 3-3-3. Account holder: Example Person 303.",W-2,38,W-2,fdc-745d1a3bfc8f5652c0f52ee3,synthetic-form-layout-03,original,2023,fte-b7b6d90053d45a8e03f2adff,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2024.
Details: wages: USD 10,743.00, federal income tax withheld: USD 1,074.30, employer: Example Entity 3-4-2, employee: Example Entity 3-4-3. Account holder: Example Person 304.",W-2,38,W-2,fdc-c0d0b3e597e952aea3f338d4,synthetic-form-layout-03,original,2024,fte-0ed8a7f2703ae942aa3e32b8,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2025.
Details: wages: USD 10,826.00, federal income tax withheld: USD 1,082.60, employer: Example Entity 3-5-2, employee: Example Entity 3-5-3. Account holder: Example Person 305.",W-2,38,W-2,fdc-e7fedc950dc54d3312ac6162,synthetic-form-layout-03,original,2025,fte-e8fc9f4fa19c2613c5a121e9,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2023.
Details: wages: USD 10,909.00, federal income tax withheld: USD 1,090.90, employer: Example Entity 3-6-2, employee: Example Entity 3-6-3. Account holder: Example Person 306.",W-2,38,W-2,fdc-bcf6a4f59c8bc3b17eeef906,synthetic-form-layout-03,original,2023,fte-ad279dfc14c47e85a455a21e,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement
Reporting period ended 12/31/2024.
Details: wages: USD 10,992.00, federal income tax withheld: USD 1,099.20, employer: Example Entity 3-7-2, employee: Example Entity 3-7-3. Account holder: Example Person 307.",W-2,38,W-2,fdc-27b7485e2f93380978a4e94d,synthetic-form-layout-03,original,2024,fte-605a29e020935c83cbafe8fc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2023
employee: Example Entity 4-0-3
employer: Example Entity 4-0-2
federal income tax withheld: USD 1,054.80
wages: USD 10,548.00
Named party: Example Person 400",W-2,38,W-2,fdc-7c3c4d5569d155ef94349be6,synthetic-form-layout-04,original,2023,fte-6b8bc3ca51fdcac6c6b68992,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2024
employee: Example Entity 4-1-3
employer: Example Entity 4-1-2
federal income tax withheld: USD 1,063.10
wages: USD 10,631.00
Named party: Example Person 401",W-2,38,W-2,fdc-9e5a104ce75d03c086eda287,synthetic-form-layout-04,original,2024,fte-245fbbe6131328d3e973e656,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2025
employee: Example Entity 4-2-3
employer: Example Entity 4-2-2
federal income tax withheld: USD 1,071.40
wages: USD 10,714.00
Named party: Example Person 402",W-2,38,W-2,fdc-dd715867c2fe91ac8d50517b,synthetic-form-layout-04,original,2025,fte-96f93a3dd7f2e697dcce5c60,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2023
employee: Example Entity 4-3-3
employer: Example Entity 4-3-2
federal income tax withheld: USD 1,079.70
wages: USD 10,797.00
Named party: Example Person 403",W-2,38,W-2,fdc-0decb0796ef886f9bacb23a6,synthetic-form-layout-04,original,2023,fte-55c936a5221e56694a15c5c3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2024
employee: Example Entity 4-4-3
employer: Example Entity 4-4-2
federal income tax withheld: USD 1,088.00
wages: USD 10,880.00
Named party: Example Person 404",W-2,38,W-2,fdc-26a26ee66ec7cc17bd028a90,synthetic-form-layout-04,original,2024,fte-6d99499d669f25dc0005bd90,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2025
employee: Example Entity 4-5-3
employer: Example Entity 4-5-2
federal income tax withheld: USD 1,096.30
wages: USD 10,963.00
Named party: Example Person 405",W-2,38,W-2,fdc-9532faca90b2052230d8c909,synthetic-form-layout-04,original,2025,fte-0bb67d95304dbd293b321bf2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2023
employee: Example Entity 4-6-3
employer: Example Entity 4-6-2
federal income tax withheld: USD 1,104.60
wages: USD 11,046.00
Named party: Example Person 406",W-2,38,W-2,fdc-fd0f163cbcb924f9511ab934,synthetic-form-layout-04,original,2023,fte-a6690a9ff772cb5c85cd65a8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2: Wage and Tax Statement
Tax reporting year 2024
employee: Example Entity 4-7-3
employer: Example Entity 4-7-2
federal income tax withheld: USD 1,112.90
wages: USD 11,129.00
Named party: Example Person 407",W-2,38,W-2,fdc-8640304bac0cd937498a150d,synthetic-form-layout-04,original,2024,fte-97ec317e0006c1a84918b839,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2023
wages: USD 10,685.00 / federal income tax withheld: USD 1,068.50 / employer: Example Entity 5-0-2 / employee: Example Entity 5-0-3
Delivery copy for Example Party 500",W-2,38,W-2,fdc-54de5a868ff525d45f1c5b99,synthetic-form-layout-05,original,2023,fte-f67ab88cf3160fc75412ddf1,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2024
wages: USD 10,768.00 / federal income tax withheld: USD 1,076.80 / employer: Example Entity 5-1-2 / employee: Example Entity 5-1-3
Delivery copy for Example Party 501",W-2,38,W-2,fdc-e7586e3753587ed6d14b8b37,synthetic-form-layout-05,original,2024,fte-3b3990211d555a1257d90c9f,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2025
wages: USD 10,851.00 / federal income tax withheld: USD 1,085.10 / employer: Example Entity 5-2-2 / employee: Example Entity 5-2-3
Delivery copy for Example Party 502",W-2,38,W-2,fdc-7a9a81bd4e3527e38f4f9837,synthetic-form-layout-05,original,2025,fte-c893ac07fce1f269a556d0b1,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2023
wages: USD 10,934.00 / federal income tax withheld: USD 1,093.40 / employer: Example Entity 5-3-2 / employee: Example Entity 5-3-3
Delivery copy for Example Party 503",W-2,38,W-2,fdc-4904afe7da2f282967445a37,synthetic-form-layout-05,original,2023,fte-c5648d50f979eb9ebb879096,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2024
wages: USD 11,017.00 / federal income tax withheld: USD 1,101.70 / employer: Example Entity 5-4-2 / employee: Example Entity 5-4-3
Delivery copy for Example Party 504",W-2,38,W-2,fdc-0f32d282fcf47ac914923662,synthetic-form-layout-05,original,2024,fte-f1d330b7472c77c8dacc4dc3,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2025
wages: USD 11,100.00 / federal income tax withheld: USD 1,110.00 / employer: Example Entity 5-5-2 / employee: Example Entity 5-5-3
Delivery copy for Example Party 505",W-2,38,W-2,fdc-60bb3862c4c9f433afe4ffc1,synthetic-form-layout-05,original,2025,fte-d617de4cd93d906e0fbfaa37,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2023
wages: USD 11,183.00 / federal income tax withheld: USD 1,118.30 / employer: Example Entity 5-6-2 / employee: Example Entity 5-6-3
Delivery copy for Example Party 506",W-2,38,W-2,fdc-fbefaae7590233fec10f8f24,synthetic-form-layout-05,original,2023,fte-d6e61e01cb0f22c22ddf6977,synthetic_AI_labeled,v1_template,top,False,
"Form W-2: Wage and Tax Statement -- reporting year 2024
wages: USD 11,266.00 / federal income tax withheld: USD 1,126.60 / employer: Example Entity 5-7-2 / employee: Example Entity 5-7-3
Delivery copy for Example Party 507",W-2,38,W-2,fdc-0641b7f6eab9e0642a22dede,synthetic-form-layout-05,original,2024,fte-dd18f38eb219b4cd20e74bf5,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2023
Statement issued to Example Person 0.
previously reported wages: USD 10,000.00
correct wages: USD 10,000.00
employer: Example Entity 0-0-2
employee: Example Entity 0-0-3",W-2,38,W-2,fdc-8a21e2f71518e021c9ed5f70,synthetic-form-layout-00,corrected,2023,fte-cc888474c1faf5c6ec4da62b,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2024
Statement issued to Example Person 1.
previously reported wages: USD 10,083.00
correct wages: USD 10,083.00
employer: Example Entity 0-1-2
employee: Example Entity 0-1-3",W-2,38,W-2,fdc-773ef66c678780302c9628ed,synthetic-form-layout-00,corrected,2024,fte-ef6b1dc401e616280d453c88,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2025
Statement issued to Example Person 2.
previously reported wages: USD 10,166.00
correct wages: USD 10,166.00
employer: Example Entity 0-2-2
employee: Example Entity 0-2-3",W-2,38,W-2,fdc-1d0a29689225884c7482ae18,synthetic-form-layout-00,corrected,2025,fte-c50be7065dba427f4745168a,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2023
Statement issued to Example Person 3.
previously reported wages: USD 10,249.00
correct wages: USD 10,249.00
employer: Example Entity 0-3-2
employee: Example Entity 0-3-3",W-2,38,W-2,fdc-4e6eb7f0515b1585039a0bf8,synthetic-form-layout-00,corrected,2023,fte-4c6c139088567b045015cc6f,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2024
Statement issued to Example Person 4.
previously reported wages: USD 10,332.00
correct wages: USD 10,332.00
employer: Example Entity 0-4-2
employee: Example Entity 0-4-3",W-2,38,W-2,fdc-928bbb2311e9b1cb4ad9e5a5,synthetic-form-layout-00,corrected,2024,fte-021357feef0862c0ba7babe2,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2025
Statement issued to Example Person 5.
previously reported wages: USD 10,415.00
correct wages: USD 10,415.00
employer: Example Entity 0-5-2
employee: Example Entity 0-5-3",W-2,38,W-2,fdc-ba5d65698ffb6511ce8f2fc1,synthetic-form-layout-00,corrected,2025,fte-1b1d52affce799c4c6a8f74f,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2023
Statement issued to Example Person 6.
previously reported wages: USD 10,498.00
correct wages: USD 10,498.00
employer: Example Entity 0-6-2
employee: Example Entity 0-6-3",W-2,38,W-2,fdc-c8589e73f01fe60edfe43d34,synthetic-form-layout-00,corrected,2023,fte-7d248c7947f26c680d1b0981,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Calendar year: 2024
Statement issued to Example Person 7.
previously reported wages: USD 10,581.00
correct wages: USD 10,581.00
employer: Example Entity 0-7-2
employee: Example Entity 0-7-3",W-2,38,W-2,fdc-7e18fcbd37874a0e2e5ba9b3,synthetic-form-layout-00,corrected,2024,fte-80a9bd9fe5a1023190f3cec6,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 100
previously reported wages: USD 10,137.00 | correct wages: USD 10,137.00 | employer: Example Entity 1-0-2 | employee: Example Entity 1-0-3",W-2,38,W-2,fdc-e0b91f31663f7bea27f6ed55,synthetic-form-layout-01,corrected,2023,fte-9edb82706168777bd1004a2f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 101
previously reported wages: USD 10,220.00 | correct wages: USD 10,220.00 | employer: Example Entity 1-1-2 | employee: Example Entity 1-1-3",W-2,38,W-2,fdc-96336ddfebe0c386fe4a5787,synthetic-form-layout-01,corrected,2024,fte-6f05f18e1d07649a31b0f5c1,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 102
previously reported wages: USD 10,303.00 | correct wages: USD 10,303.00 | employer: Example Entity 1-2-2 | employee: Example Entity 1-2-3",W-2,38,W-2,fdc-465994756fbc7c09623715a0,synthetic-form-layout-01,corrected,2025,fte-513f91fea9c2c04fb0393e2f,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 103
previously reported wages: USD 10,386.00 | correct wages: USD 10,386.00 | employer: Example Entity 1-3-2 | employee: Example Entity 1-3-3",W-2,38,W-2,fdc-89b536569cd5a50d1034ece5,synthetic-form-layout-01,corrected,2023,fte-092124f3cf031835b92d6cc1,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 104
previously reported wages: USD 10,469.00 | correct wages: USD 10,469.00 | employer: Example Entity 1-4-2 | employee: Example Entity 1-4-3",W-2,38,W-2,fdc-a7d5ccba51323294711c579a,synthetic-form-layout-01,corrected,2024,fte-7baeb9a704e01f7acb158231,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 105
previously reported wages: USD 10,552.00 | correct wages: USD 10,552.00 | employer: Example Entity 1-5-2 | employee: Example Entity 1-5-3",W-2,38,W-2,fdc-8cc012872f42263b0310abc3,synthetic-form-layout-01,corrected,2025,fte-0e61c389310fe3011dbb407d,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 106
previously reported wages: USD 10,635.00 | correct wages: USD 10,635.00 | employer: Example Entity 1-6-2 | employee: Example Entity 1-6-3",W-2,38,W-2,fdc-2b6eccf4e2d0ee2858652f40,synthetic-form-layout-01,corrected,2023,fte-a277bc0eba665545f5e4913d,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2c: Corrected Wage and Tax Statement
Recipient record: Example Person 107
previously reported wages: USD 10,718.00 | correct wages: USD 10,718.00 | employer: Example Entity 1-7-2 | employee: Example Entity 1-7-3",W-2,38,W-2,fdc-ba9113f0f06568304aa6fb6e,synthetic-form-layout-01,corrected,2024,fte-3ea01d9466b237e325b00b97,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,274.00; correct wages: USD 10,274.00; employer: Example Entity 2-0-2; employee: Example Entity 2-0-3. Recipient: Example Household 200.",W-2,38,W-2,fdc-743cf19e50c05ed5945af42e,synthetic-form-layout-02,corrected,2023,fte-605db88f26ae644f7481abe2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,357.00; correct wages: USD 10,357.00; employer: Example Entity 2-1-2; employee: Example Entity 2-1-3. Recipient: Example Household 201.",W-2,38,W-2,fdc-3ec3271d206637e2c73ead60,synthetic-form-layout-02,corrected,2024,fte-d372b3ef677292e48f79dd85,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,440.00; correct wages: USD 10,440.00; employer: Example Entity 2-2-2; employee: Example Entity 2-2-3. Recipient: Example Household 202.",W-2,38,W-2,fdc-d4702249f30a91ef74c06cbf,synthetic-form-layout-02,corrected,2025,fte-2466cb4fd58b288f2d27fd0c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,523.00; correct wages: USD 10,523.00; employer: Example Entity 2-3-2; employee: Example Entity 2-3-3. Recipient: Example Household 203.",W-2,38,W-2,fdc-21c03c06cb524494dd35292a,synthetic-form-layout-02,corrected,2023,fte-11093c8194a371c5ab3e2857,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,606.00; correct wages: USD 10,606.00; employer: Example Entity 2-4-2; employee: Example Entity 2-4-3. Recipient: Example Household 204.",W-2,38,W-2,fdc-b90fa1503081020e8079976f,synthetic-form-layout-02,corrected,2024,fte-bbdfa7fcc754e484326921e3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,689.00; correct wages: USD 10,689.00; employer: Example Entity 2-5-2; employee: Example Entity 2-5-3. Recipient: Example Household 205.",W-2,38,W-2,fdc-fb81505220d52b2bf8072a48,synthetic-form-layout-02,corrected,2025,fte-ee379bf8969f23fcb82978fb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,772.00; correct wages: USD 10,772.00; employer: Example Entity 2-6-2; employee: Example Entity 2-6-3. Recipient: Example Household 206.",W-2,38,W-2,fdc-4dd5199ea31f47d43d1ceb37,synthetic-form-layout-02,corrected,2023,fte-290afa56fa9faacd3878b16e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2c: Corrected Wage and Tax Statement.
previously reported wages: USD 10,855.00; correct wages: USD 10,855.00; employer: Example Entity 2-7-2; employee: Example Entity 2-7-3. Recipient: Example Household 207.",W-2,38,W-2,fdc-39678b3a70661f81ccce96a4,synthetic-form-layout-02,corrected,2024,fte-31a6c3c24d6f5eb41933473f,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2023.
Details: previously reported wages: USD 10,411.00, correct wages: USD 10,411.00, employer: Example Entity 3-0-2, employee: Example Entity 3-0-3. Account holder: Example Person 300.",W-2,38,W-2,fdc-28286cf01e774a610703613d,synthetic-form-layout-03,corrected,2023,fte-21ce457157502decea64ae4e,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2024.
Details: previously reported wages: USD 10,494.00, correct wages: USD 10,494.00, employer: Example Entity 3-1-2, employee: Example Entity 3-1-3. Account holder: Example Person 301.",W-2,38,W-2,fdc-19352b935f3672a599ecf253,synthetic-form-layout-03,corrected,2024,fte-ef4eb18350e6c033050a626e,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2025.
Details: previously reported wages: USD 10,577.00, correct wages: USD 10,577.00, employer: Example Entity 3-2-2, employee: Example Entity 3-2-3. Account holder: Example Person 302.",W-2,38,W-2,fdc-fa2b98113b3d0391c952a101,synthetic-form-layout-03,corrected,2025,fte-390077ebc9720b9a3ba6dcb3,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2023.
Details: previously reported wages: USD 10,660.00, correct wages: USD 10,660.00, employer: Example Entity 3-3-2, employee: Example Entity 3-3-3. Account holder: Example Person 303.",W-2,38,W-2,fdc-faf0c8ae4221d9b34cc34508,synthetic-form-layout-03,corrected,2023,fte-ae0e239cec5b4df19a3e8c5a,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2024.
Details: previously reported wages: USD 10,743.00, correct wages: USD 10,743.00, employer: Example Entity 3-4-2, employee: Example Entity 3-4-3. Account holder: Example Person 304.",W-2,38,W-2,fdc-4b2fcd88690601ef95951b0e,synthetic-form-layout-03,corrected,2024,fte-681e3116d8040dc269714469,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2025.
Details: previously reported wages: USD 10,826.00, correct wages: USD 10,826.00, employer: Example Entity 3-5-2, employee: Example Entity 3-5-3. Account holder: Example Person 305.",W-2,38,W-2,fdc-1adfb9a5eeccfe12a5f8f3a3,synthetic-form-layout-03,corrected,2025,fte-8d30bbcb0af4829cc4b439f2,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2023.
Details: previously reported wages: USD 10,909.00, correct wages: USD 10,909.00, employer: Example Entity 3-6-2, employee: Example Entity 3-6-3. Account holder: Example Person 306.",W-2,38,W-2,fdc-7fbf029a4ddf32ed083529b5,synthetic-form-layout-03,corrected,2023,fte-638f572d011216f4e80a6078,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement
Reporting period ended 12/31/2024.
Details: previously reported wages: USD 10,992.00, correct wages: USD 10,992.00, employer: Example Entity 3-7-2, employee: Example Entity 3-7-3. Account holder: Example Person 307.",W-2,38,W-2,fdc-be3c060ba991d758b1df796d,synthetic-form-layout-03,corrected,2024,fte-e1db5544a89f3a52329c114e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2023
employee: Example Entity 4-0-3
employer: Example Entity 4-0-2
correct wages: USD 10,548.00
previously reported wages: USD 10,548.00
Named party: Example Person 400",W-2,38,W-2,fdc-4ad297472efff7cff6420d86,synthetic-form-layout-04,corrected,2023,fte-27cf5b0cdb16c60da350e090,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2024
employee: Example Entity 4-1-3
employer: Example Entity 4-1-2
correct wages: USD 10,631.00
previously reported wages: USD 10,631.00
Named party: Example Person 401",W-2,38,W-2,fdc-623bdc6e275e8877b4ab98aa,synthetic-form-layout-04,corrected,2024,fte-c6a783c0909e23519e6c7f6f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2025
employee: Example Entity 4-2-3
employer: Example Entity 4-2-2
correct wages: USD 10,714.00
previously reported wages: USD 10,714.00
Named party: Example Person 402",W-2,38,W-2,fdc-6c7ddeedc91dbd01aee2328b,synthetic-form-layout-04,corrected,2025,fte-e0008d69c9a07b6fa53634c0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2023
employee: Example Entity 4-3-3
employer: Example Entity 4-3-2
correct wages: USD 10,797.00
previously reported wages: USD 10,797.00
Named party: Example Person 403",W-2,38,W-2,fdc-79f1a8ecd241e10f26eec740,synthetic-form-layout-04,corrected,2023,fte-575a1152d8bdab92dea84c62,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2024
employee: Example Entity 4-4-3
employer: Example Entity 4-4-2
correct wages: USD 10,880.00
previously reported wages: USD 10,880.00
Named party: Example Person 404",W-2,38,W-2,fdc-0b90354c920c1524a3f402af,synthetic-form-layout-04,corrected,2024,fte-1320934237cbe062ca58a49f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2025
employee: Example Entity 4-5-3
employer: Example Entity 4-5-2
correct wages: USD 10,963.00
previously reported wages: USD 10,963.00
Named party: Example Person 405",W-2,38,W-2,fdc-258a7c90c26fa56b6c32afde,synthetic-form-layout-04,corrected,2025,fte-12f93a834e6d50b65ccde377,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2023
employee: Example Entity 4-6-3
employer: Example Entity 4-6-2
correct wages: USD 11,046.00
previously reported wages: USD 11,046.00
Named party: Example Person 406",W-2,38,W-2,fdc-df785f3a18dacbd12c283e6b,synthetic-form-layout-04,corrected,2023,fte-64792fb987143f50f705249e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2c: Corrected Wage and Tax Statement
Tax reporting year 2024
employee: Example Entity 4-7-3
employer: Example Entity 4-7-2
correct wages: USD 11,129.00
previously reported wages: USD 11,129.00
Named party: Example Person 407",W-2,38,W-2,fdc-be33def69061b7474777cae8,synthetic-form-layout-04,corrected,2024,fte-35a9266317b0cd80e8678eb1,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2023
previously reported wages: USD 10,685.00 / correct wages: USD 10,685.00 / employer: Example Entity 5-0-2 / employee: Example Entity 5-0-3
Delivery copy for Example Party 500",W-2,38,W-2,fdc-cf14f068b51559eb7bb53e52,synthetic-form-layout-05,corrected,2023,fte-3dc8613ff761eeb79959c024,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2024
previously reported wages: USD 10,768.00 / correct wages: USD 10,768.00 / employer: Example Entity 5-1-2 / employee: Example Entity 5-1-3
Delivery copy for Example Party 501",W-2,38,W-2,fdc-fa912acbf3daa374c7603cf2,synthetic-form-layout-05,corrected,2024,fte-ce22eedd1526f3cfdf4fdf64,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2025
previously reported wages: USD 10,851.00 / correct wages: USD 10,851.00 / employer: Example Entity 5-2-2 / employee: Example Entity 5-2-3
Delivery copy for Example Party 502",W-2,38,W-2,fdc-4c81c8048a2a1e8ba4aa649a,synthetic-form-layout-05,corrected,2025,fte-3859339edf9030231bd5e57b,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2023
previously reported wages: USD 10,934.00 / correct wages: USD 10,934.00 / employer: Example Entity 5-3-2 / employee: Example Entity 5-3-3
Delivery copy for Example Party 503",W-2,38,W-2,fdc-ec5d4bc3a0f4ecf4d011599c,synthetic-form-layout-05,corrected,2023,fte-e4b00ccb473913f20955664b,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2024
previously reported wages: USD 11,017.00 / correct wages: USD 11,017.00 / employer: Example Entity 5-4-2 / employee: Example Entity 5-4-3
Delivery copy for Example Party 504",W-2,38,W-2,fdc-bf366f78dc41a2cd39e1d895,synthetic-form-layout-05,corrected,2024,fte-98e69fc910750c37aa59b86d,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2025
previously reported wages: USD 11,100.00 / correct wages: USD 11,100.00 / employer: Example Entity 5-5-2 / employee: Example Entity 5-5-3
Delivery copy for Example Party 505",W-2,38,W-2,fdc-11f22d6cd1f34b0c290a4401,synthetic-form-layout-05,corrected,2025,fte-18ff5723253916bfb5095550,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2023
previously reported wages: USD 11,183.00 / correct wages: USD 11,183.00 / employer: Example Entity 5-6-2 / employee: Example Entity 5-6-3
Delivery copy for Example Party 506",W-2,38,W-2,fdc-b97312a80491aa6038de7cf7,synthetic-form-layout-05,corrected,2023,fte-0b5f77bc33ddc4b7a4c771f7,synthetic_AI_labeled,v1_template,top,False,
"Form W-2c: Corrected Wage and Tax Statement -- reporting year 2024
previously reported wages: USD 11,266.00 / correct wages: USD 11,266.00 / employer: Example Entity 5-7-2 / employee: Example Entity 5-7-3
Delivery copy for Example Party 507",W-2,38,W-2,fdc-6f685a9e72653c7d83459eb8,synthetic-form-layout-05,corrected,2024,fte-96aa55498ff1f42df65f9093,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2023
Statement issued to Example Person 0.
reportable winnings: USD 10,000.00
date won: 2023-03-01
federal income tax withheld: USD 1,000.00",W-2G,39,W-2G,fdc-73af5ae08d1c3e4ec1583b91,synthetic-form-layout-00,original,2023,fte-674b031503cf615474e8e254,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2024
Statement issued to Example Person 1.
reportable winnings: USD 10,083.00
date won: 2024-03-02
federal income tax withheld: USD 1,008.30",W-2G,39,W-2G,fdc-b7d46faa4b0362f3e1cb917d,synthetic-form-layout-00,original,2024,fte-0d113181dd05aee8a03b888c,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2025
Statement issued to Example Person 2.
reportable winnings: USD 10,166.00
date won: 2025-03-03
federal income tax withheld: USD 1,016.60",W-2G,39,W-2G,fdc-20762c5af5cad2391626d5ff,synthetic-form-layout-00,original,2025,fte-0887831720cb254188e6c267,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2023
Statement issued to Example Person 3.
reportable winnings: USD 10,249.00
date won: 2023-03-04
federal income tax withheld: USD 1,024.90",W-2G,39,W-2G,fdc-c1cb494424ab3a0191b04e8c,synthetic-form-layout-00,original,2023,fte-752d80c163d5b67c234b1fcc,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2024
Statement issued to Example Person 4.
reportable winnings: USD 10,332.00
date won: 2024-03-05
federal income tax withheld: USD 1,033.20",W-2G,39,W-2G,fdc-0d80bcc869a10373cd5f102a,synthetic-form-layout-00,original,2024,fte-ceebecca106cce67111321d7,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2025
Statement issued to Example Person 5.
reportable winnings: USD 10,415.00
date won: 2025-03-06
federal income tax withheld: USD 1,041.50",W-2G,39,W-2G,fdc-634ac870d08d6db5baaa5ca8,synthetic-form-layout-00,original,2025,fte-6c6675409d797da00148261b,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2023
Statement issued to Example Person 6.
reportable winnings: USD 10,498.00
date won: 2023-03-07
federal income tax withheld: USD 1,049.80",W-2G,39,W-2G,fdc-770ccd2ca20bb1f58ad05b54,synthetic-form-layout-00,original,2023,fte-62018251a34de8ae09e41cf5,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Calendar year: 2024
Statement issued to Example Person 7.
reportable winnings: USD 10,581.00
date won: 2024-03-08
federal income tax withheld: USD 1,058.10",W-2G,39,W-2G,fdc-b4595df0b8277558f5d064c6,synthetic-form-layout-00,original,2024,fte-ea5bc744537a7a2423b45c67,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 100
reportable winnings: USD 10,137.00 | date won: 2023-03-01 | federal income tax withheld: USD 1,013.70",W-2G,39,W-2G,fdc-c4a60053f5be78cd84802a8b,synthetic-form-layout-01,original,2023,fte-39321641a93396d8e3bc4f3c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 101
reportable winnings: USD 10,220.00 | date won: 2024-03-02 | federal income tax withheld: USD 1,022.00",W-2G,39,W-2G,fdc-b20df2883730d571908291a4,synthetic-form-layout-01,original,2024,fte-55016bb014d72b68d28b3f18,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 102
reportable winnings: USD 10,303.00 | date won: 2025-03-03 | federal income tax withheld: USD 1,030.30",W-2G,39,W-2G,fdc-247eece22453e30d8fc57d5c,synthetic-form-layout-01,original,2025,fte-d88984e8b280f2897f517f27,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 103
reportable winnings: USD 10,386.00 | date won: 2023-03-04 | federal income tax withheld: USD 1,038.60",W-2G,39,W-2G,fdc-b33a987a257701e0548e103c,synthetic-form-layout-01,original,2023,fte-f50aca33c404338ee33fc756,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 104
reportable winnings: USD 10,469.00 | date won: 2024-03-05 | federal income tax withheld: USD 1,046.90",W-2G,39,W-2G,fdc-40125a29d1862237c8b7e052,synthetic-form-layout-01,original,2024,fte-6c5071ff42796df129b1070c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 105
reportable winnings: USD 10,552.00 | date won: 2025-03-06 | federal income tax withheld: USD 1,055.20",W-2G,39,W-2G,fdc-958764fa5ff3b237f1a50de6,synthetic-form-layout-01,original,2025,fte-72bfb9d6208502a9117a3310,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 106
reportable winnings: USD 10,635.00 | date won: 2023-03-07 | federal income tax withheld: USD 1,063.50",W-2G,39,W-2G,fdc-6a3250684a49772ced9dc801,synthetic-form-layout-01,original,2023,fte-d5ba1f819f40aa9e69c70793,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-2G: Certain Gambling Winnings
Recipient record: Example Person 107
reportable winnings: USD 10,718.00 | date won: 2024-03-08 | federal income tax withheld: USD 1,071.80",W-2G,39,W-2G,fdc-961ad256dc98e8894253f7f4,synthetic-form-layout-01,original,2024,fte-c866d5535189aa0098a05467,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,274.00; date won: 2023-03-01; federal income tax withheld: USD 1,027.40. Recipient: Example Household 200.",W-2G,39,W-2G,fdc-d6b310be6b01989e3b8f21f5,synthetic-form-layout-02,original,2023,fte-6b991b2913748dc38f33f6e7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,357.00; date won: 2024-03-02; federal income tax withheld: USD 1,035.70. Recipient: Example Household 201.",W-2G,39,W-2G,fdc-0d240f026037f15795787874,synthetic-form-layout-02,original,2024,fte-2b3cb68a0adbde5ac4027bb2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,440.00; date won: 2025-03-03; federal income tax withheld: USD 1,044.00. Recipient: Example Household 202.",W-2G,39,W-2G,fdc-fa3214a2951024c3c7a8c969,synthetic-form-layout-02,original,2025,fte-2a01fd68872abbaa19f76378,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,523.00; date won: 2023-03-04; federal income tax withheld: USD 1,052.30. Recipient: Example Household 203.",W-2G,39,W-2G,fdc-055a4f71bcfe38eb7665a4a7,synthetic-form-layout-02,original,2023,fte-d75343d6945f423d3f1b9a92,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,606.00; date won: 2024-03-05; federal income tax withheld: USD 1,060.60. Recipient: Example Household 204.",W-2G,39,W-2G,fdc-aaec1003aa8e685b3d86f830,synthetic-form-layout-02,original,2024,fte-0e5378a327a3c21bda0122bc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,689.00; date won: 2025-03-06; federal income tax withheld: USD 1,068.90. Recipient: Example Household 205.",W-2G,39,W-2G,fdc-d867badd33900cd17678f823,synthetic-form-layout-02,original,2025,fte-019da9e51d5e8692303b6b13,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,772.00; date won: 2023-03-07; federal income tax withheld: USD 1,077.20. Recipient: Example Household 206.",W-2G,39,W-2G,fdc-2acd15575511b9b343e5062b,synthetic-form-layout-02,original,2023,fte-9cf7b1e6552e1a05e7afe967,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-2G: Certain Gambling Winnings.
reportable winnings: USD 10,855.00; date won: 2024-03-08; federal income tax withheld: USD 1,085.50. Recipient: Example Household 207.",W-2G,39,W-2G,fdc-9f32a9e2b63a98c170bf6c0d,synthetic-form-layout-02,original,2024,fte-48c9d85bcf9d17246668523d,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2023.
Details: reportable winnings: USD 10,411.00, date won: 2023-03-01, federal income tax withheld: USD 1,041.10. Account holder: Example Person 300.",W-2G,39,W-2G,fdc-8b797242819496254b41c43f,synthetic-form-layout-03,original,2023,fte-da8e99d6f29687da3293a131,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2024.
Details: reportable winnings: USD 10,494.00, date won: 2024-03-02, federal income tax withheld: USD 1,049.40. Account holder: Example Person 301.",W-2G,39,W-2G,fdc-5b80e4e307cf0e5f82805eca,synthetic-form-layout-03,original,2024,fte-4b817dedadd0003e41ec94da,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2025.
Details: reportable winnings: USD 10,577.00, date won: 2025-03-03, federal income tax withheld: USD 1,057.70. Account holder: Example Person 302.",W-2G,39,W-2G,fdc-3390678f5f9c5b3f7ad498d5,synthetic-form-layout-03,original,2025,fte-b91f7317c77ff228d4de0bf2,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2023.
Details: reportable winnings: USD 10,660.00, date won: 2023-03-04, federal income tax withheld: USD 1,066.00. Account holder: Example Person 303.",W-2G,39,W-2G,fdc-04abdeb7d47b3a4a39ad6aaf,synthetic-form-layout-03,original,2023,fte-569b30408a8c837f43639654,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2024.
Details: reportable winnings: USD 10,743.00, date won: 2024-03-05, federal income tax withheld: USD 1,074.30. Account holder: Example Person 304.",W-2G,39,W-2G,fdc-fa15c69f45397cf66cb938df,synthetic-form-layout-03,original,2024,fte-f7e506410e9209077bca2fb4,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2025.
Details: reportable winnings: USD 10,826.00, date won: 2025-03-06, federal income tax withheld: USD 1,082.60. Account holder: Example Person 305.",W-2G,39,W-2G,fdc-061fbe1cfa69d184aed7f6e4,synthetic-form-layout-03,original,2025,fte-348995f4ab4bbafd81eb53fd,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2023.
Details: reportable winnings: USD 10,909.00, date won: 2023-03-07, federal income tax withheld: USD 1,090.90. Account holder: Example Person 306.",W-2G,39,W-2G,fdc-020c9020291fe6443409487e,synthetic-form-layout-03,original,2023,fte-7e23fe10dcebae69bb7b84bf,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings
Reporting period ended 12/31/2024.
Details: reportable winnings: USD 10,992.00, date won: 2024-03-08, federal income tax withheld: USD 1,099.20. Account holder: Example Person 307.",W-2G,39,W-2G,fdc-bd60bd140661e7141e110050,synthetic-form-layout-03,original,2024,fte-e05f5ca43dc1a36e45077aa1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2023
federal income tax withheld: USD 1,054.80
date won: 2023-03-01
reportable winnings: USD 10,548.00
Named party: Example Person 400",W-2G,39,W-2G,fdc-603bbda40825ebea84220315,synthetic-form-layout-04,original,2023,fte-e5350d3402df7a385fecac7c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2024
federal income tax withheld: USD 1,063.10
date won: 2024-03-02
reportable winnings: USD 10,631.00
Named party: Example Person 401",W-2G,39,W-2G,fdc-6b37b5531377d521028bf79d,synthetic-form-layout-04,original,2024,fte-9c418245829b86d111de1a08,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2025
federal income tax withheld: USD 1,071.40
date won: 2025-03-03
reportable winnings: USD 10,714.00
Named party: Example Person 402",W-2G,39,W-2G,fdc-7d97930de6c065f66e72db81,synthetic-form-layout-04,original,2025,fte-84a52a765a4670adb285d9e3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2023
federal income tax withheld: USD 1,079.70
date won: 2023-03-04
reportable winnings: USD 10,797.00
Named party: Example Person 403",W-2G,39,W-2G,fdc-16c64810eecf46d1742be20f,synthetic-form-layout-04,original,2023,fte-a2397f84df7a3541898d6cb3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2024
federal income tax withheld: USD 1,088.00
date won: 2024-03-05
reportable winnings: USD 10,880.00
Named party: Example Person 404",W-2G,39,W-2G,fdc-f090fa4c8212c345ba596c9f,synthetic-form-layout-04,original,2024,fte-d77e74313eb1520d572d4b9d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2025
federal income tax withheld: USD 1,096.30
date won: 2025-03-06
reportable winnings: USD 10,963.00
Named party: Example Person 405",W-2G,39,W-2G,fdc-b682e3ddaab2a5593d747b5b,synthetic-form-layout-04,original,2025,fte-f10685232a642e763b582f33,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2023
federal income tax withheld: USD 1,104.60
date won: 2023-03-07
reportable winnings: USD 11,046.00
Named party: Example Person 406",W-2G,39,W-2G,fdc-663d0057e717bea5f9253322,synthetic-form-layout-04,original,2023,fte-bd47fa336d85e04765a3c649,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-2G: Certain Gambling Winnings
Tax reporting year 2024
federal income tax withheld: USD 1,112.90
date won: 2024-03-08
reportable winnings: USD 11,129.00
Named party: Example Person 407",W-2G,39,W-2G,fdc-d286168e412b8139c4dc94bc,synthetic-form-layout-04,original,2024,fte-f3e5c8d88b3f1e49d455a797,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2023
reportable winnings: USD 10,685.00 / date won: 2023-03-01 / federal income tax withheld: USD 1,068.50
Delivery copy for Example Party 500",W-2G,39,W-2G,fdc-7840054938ae05f95018bb25,synthetic-form-layout-05,original,2023,fte-a45d8a78f110c8e067318ed4,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2024
reportable winnings: USD 10,768.00 / date won: 2024-03-02 / federal income tax withheld: USD 1,076.80
Delivery copy for Example Party 501",W-2G,39,W-2G,fdc-e428f7ae4217c00120a81483,synthetic-form-layout-05,original,2024,fte-6ef8b24c7cace3f93f956def,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2025
reportable winnings: USD 10,851.00 / date won: 2025-03-03 / federal income tax withheld: USD 1,085.10
Delivery copy for Example Party 502",W-2G,39,W-2G,fdc-d2b0f7732c8dce35e11f9302,synthetic-form-layout-05,original,2025,fte-d183414dc067e706c16506a3,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2023
reportable winnings: USD 10,934.00 / date won: 2023-03-04 / federal income tax withheld: USD 1,093.40
Delivery copy for Example Party 503",W-2G,39,W-2G,fdc-67dfe6d08ada4ffdd9a4c197,synthetic-form-layout-05,original,2023,fte-8ecc4dcacd411182bd4eda75,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2024
reportable winnings: USD 11,017.00 / date won: 2024-03-05 / federal income tax withheld: USD 1,101.70
Delivery copy for Example Party 504",W-2G,39,W-2G,fdc-1c84183e2f2addaa65e26168,synthetic-form-layout-05,original,2024,fte-830b2428cafe811a19946dbd,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2025
reportable winnings: USD 11,100.00 / date won: 2025-03-06 / federal income tax withheld: USD 1,110.00
Delivery copy for Example Party 505",W-2G,39,W-2G,fdc-3484e023231387caa8832602,synthetic-form-layout-05,original,2025,fte-51fefc31356b718fdf65ad93,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2023
reportable winnings: USD 11,183.00 / date won: 2023-03-07 / federal income tax withheld: USD 1,118.30
Delivery copy for Example Party 506",W-2G,39,W-2G,fdc-a2d7b6f9ca949f8493cdab4d,synthetic-form-layout-05,original,2023,fte-d70b87104215c98d77d27ed1,synthetic_AI_labeled,v1_template,top,False,
"Form W-2G: Certain Gambling Winnings -- reporting year 2024
reportable winnings: USD 11,266.00 / date won: 2024-03-08 / federal income tax withheld: USD 1,126.60
Delivery copy for Example Party 507",W-2G,39,W-2G,fdc-8b71239e67a557fabee647a8,synthetic-form-layout-05,original,2024,fte-9fb06e1053ac584a40d840a2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2023
Statement issued to Example Person 0.
nonemployee compensation: Example Entity 0-0-0
payer: Example Entity 0-0-1
recipient: Example Entity 0-0-2
tax withheld: USD 1,000.00",1099,5,1099,fdc-2e302d7aed7df354a4091987,synthetic-form-layout-00,original,2023,fte-11271a4975d79b6e84c3de3e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2024
Statement issued to Example Person 1.
nonemployee compensation: Example Entity 0-1-0
payer: Example Entity 0-1-1
recipient: Example Entity 0-1-2
tax withheld: USD 1,008.30",1099,5,1099,fdc-ef4970acebd56462e0e9869e,synthetic-form-layout-00,original,2024,fte-b7d9aaaefe6e045d6fc1cc07,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2025
Statement issued to Example Person 2.
nonemployee compensation: Example Entity 0-2-0
payer: Example Entity 0-2-1
recipient: Example Entity 0-2-2
tax withheld: USD 1,016.60",1099,5,1099,fdc-d5b9b97eb2a4529c4f9d4e0b,synthetic-form-layout-00,original,2025,fte-7d95eb6f97f2d99c14b78f26,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2023
Statement issued to Example Person 3.
nonemployee compensation: Example Entity 0-3-0
payer: Example Entity 0-3-1
recipient: Example Entity 0-3-2
tax withheld: USD 1,024.90",1099,5,1099,fdc-54657cc1494e505b099429bf,synthetic-form-layout-00,original,2023,fte-d0ca94bffae77a389309eeef,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2024
Statement issued to Example Person 4.
nonemployee compensation: Example Entity 0-4-0
payer: Example Entity 0-4-1
recipient: Example Entity 0-4-2
tax withheld: USD 1,033.20",1099,5,1099,fdc-58af91bf3140e2224942f3bc,synthetic-form-layout-00,original,2024,fte-2fa079b08b54e871290f034b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2025
Statement issued to Example Person 5.
nonemployee compensation: Example Entity 0-5-0
payer: Example Entity 0-5-1
recipient: Example Entity 0-5-2
tax withheld: USD 1,041.50",1099,5,1099,fdc-c6f2f8d030e2ceec5369a1bf,synthetic-form-layout-00,original,2025,fte-a17cabb1edc699b2f85e9a88,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2023
Statement issued to Example Person 6.
nonemployee compensation: Example Entity 0-6-0
payer: Example Entity 0-6-1
recipient: Example Entity 0-6-2
tax withheld: USD 1,049.80",1099,5,1099,fdc-5d68715b379a97e4ab89cd2d,synthetic-form-layout-00,original,2023,fte-26246253928bab254388ffbf,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Calendar year: 2024
Statement issued to Example Person 7.
nonemployee compensation: Example Entity 0-7-0
payer: Example Entity 0-7-1
recipient: Example Entity 0-7-2
tax withheld: USD 1,058.10",1099,5,1099,fdc-e688db4148b12cadb44bb67d,synthetic-form-layout-00,original,2024,fte-e8e294ed17fb5365cd6cb51b,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 100
nonemployee compensation: Example Entity 1-0-0 | payer: Example Entity 1-0-1 | recipient: Example Entity 1-0-2 | tax withheld: USD 1,013.70",1099,5,1099,fdc-3f7bfe1c74ee6ba3413bb0f2,synthetic-form-layout-01,original,2023,fte-3fc340b4c60c213154e1135b,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 101
nonemployee compensation: Example Entity 1-1-0 | payer: Example Entity 1-1-1 | recipient: Example Entity 1-1-2 | tax withheld: USD 1,022.00",1099,5,1099,fdc-a738545622826735b10ab038,synthetic-form-layout-01,original,2024,fte-8305601adb82da1d5576477c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 102
nonemployee compensation: Example Entity 1-2-0 | payer: Example Entity 1-2-1 | recipient: Example Entity 1-2-2 | tax withheld: USD 1,030.30",1099,5,1099,fdc-a523cd26a77d5d8c9b05c219,synthetic-form-layout-01,original,2025,fte-8c0370ab6976b928daa10b6d,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 103
nonemployee compensation: Example Entity 1-3-0 | payer: Example Entity 1-3-1 | recipient: Example Entity 1-3-2 | tax withheld: USD 1,038.60",1099,5,1099,fdc-3652298ee34c328bac0626f1,synthetic-form-layout-01,original,2023,fte-fe8820f6484593dd1598886f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 104
nonemployee compensation: Example Entity 1-4-0 | payer: Example Entity 1-4-1 | recipient: Example Entity 1-4-2 | tax withheld: USD 1,046.90",1099,5,1099,fdc-37e9cdcd3b40bfa487342cce,synthetic-form-layout-01,original,2024,fte-3eb69d3334a5ff2bbc06070a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 105
nonemployee compensation: Example Entity 1-5-0 | payer: Example Entity 1-5-1 | recipient: Example Entity 1-5-2 | tax withheld: USD 1,055.20",1099,5,1099,fdc-1191492871ce07febf017a98,synthetic-form-layout-01,original,2025,fte-04467bed6b2390e48a8f0a12,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 106
nonemployee compensation: Example Entity 1-6-0 | payer: Example Entity 1-6-1 | recipient: Example Entity 1-6-2 | tax withheld: USD 1,063.50",1099,5,1099,fdc-13fceca1d4b14164dfe14671,synthetic-form-layout-01,original,2023,fte-4a521b0c90e9197d47ef5cad,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-NEC: Nonemployee Compensation
Recipient record: Example Person 107
nonemployee compensation: Example Entity 1-7-0 | payer: Example Entity 1-7-1 | recipient: Example Entity 1-7-2 | tax withheld: USD 1,071.80",1099,5,1099,fdc-45a59d15716e0c64a71e86cf,synthetic-form-layout-01,original,2024,fte-750c57d10620fd21b72db6e6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-0-0; payer: Example Entity 2-0-1; recipient: Example Entity 2-0-2; tax withheld: USD 1,027.40. Recipient: Example Household 200.",1099,5,1099,fdc-a7d2b9d6fbc1a4643b54cdc6,synthetic-form-layout-02,original,2023,fte-79246df25a5f333dd72bf62f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-1-0; payer: Example Entity 2-1-1; recipient: Example Entity 2-1-2; tax withheld: USD 1,035.70. Recipient: Example Household 201.",1099,5,1099,fdc-48b59e5cecfae80135975065,synthetic-form-layout-02,original,2024,fte-5268025c152cab116f2c59e7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-2-0; payer: Example Entity 2-2-1; recipient: Example Entity 2-2-2; tax withheld: USD 1,044.00. Recipient: Example Household 202.",1099,5,1099,fdc-24e9b6be74ad878dcb6be143,synthetic-form-layout-02,original,2025,fte-72c112a18032f4461aeba3c5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-3-0; payer: Example Entity 2-3-1; recipient: Example Entity 2-3-2; tax withheld: USD 1,052.30. Recipient: Example Household 203.",1099,5,1099,fdc-6a1f318854368a3d8c239927,synthetic-form-layout-02,original,2023,fte-9b11245a36ad0457fc2ed63c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-4-0; payer: Example Entity 2-4-1; recipient: Example Entity 2-4-2; tax withheld: USD 1,060.60. Recipient: Example Household 204.",1099,5,1099,fdc-6ef115ae99dda69ad6818789,synthetic-form-layout-02,original,2024,fte-35c36000fcc76e391ea9eca6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-5-0; payer: Example Entity 2-5-1; recipient: Example Entity 2-5-2; tax withheld: USD 1,068.90. Recipient: Example Household 205.",1099,5,1099,fdc-e9462a23ae84de0d9e8d5aaf,synthetic-form-layout-02,original,2025,fte-b10b379dc8de904c368d6a45,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-6-0; payer: Example Entity 2-6-1; recipient: Example Entity 2-6-2; tax withheld: USD 1,077.20. Recipient: Example Household 206.",1099,5,1099,fdc-0e992f85ea13f18b4093fe61,synthetic-form-layout-02,original,2023,fte-fdebae76c6dcad8a0bd95821,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-NEC: Nonemployee Compensation.
nonemployee compensation: Example Entity 2-7-0; payer: Example Entity 2-7-1; recipient: Example Entity 2-7-2; tax withheld: USD 1,085.50. Recipient: Example Household 207.",1099,5,1099,fdc-13599ecd88d0417a4c8ad935,synthetic-form-layout-02,original,2024,fte-b7b240d5dff640ac114aac77,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2023.
Details: nonemployee compensation: Example Entity 3-0-0, payer: Example Entity 3-0-1, recipient: Example Entity 3-0-2, tax withheld: USD 1,041.10. Account holder: Example Person 300.",1099,5,1099,fdc-ae099a7ad2d1cba5ddade3dd,synthetic-form-layout-03,original,2023,fte-d3b903db97b70ef5fdf6222b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2024.
Details: nonemployee compensation: Example Entity 3-1-0, payer: Example Entity 3-1-1, recipient: Example Entity 3-1-2, tax withheld: USD 1,049.40. Account holder: Example Person 301.",1099,5,1099,fdc-ca602c89ff541b73c04eac1e,synthetic-form-layout-03,original,2024,fte-a1dd39c639d38937f3baee43,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2025.
Details: nonemployee compensation: Example Entity 3-2-0, payer: Example Entity 3-2-1, recipient: Example Entity 3-2-2, tax withheld: USD 1,057.70. Account holder: Example Person 302.",1099,5,1099,fdc-e3e4913fb959688e0d63f1d8,synthetic-form-layout-03,original,2025,fte-145b0fbac8eacaa8f0c5ffa2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2023.
Details: nonemployee compensation: Example Entity 3-3-0, payer: Example Entity 3-3-1, recipient: Example Entity 3-3-2, tax withheld: USD 1,066.00. Account holder: Example Person 303.",1099,5,1099,fdc-b2625cc3df004992cd402a0b,synthetic-form-layout-03,original,2023,fte-19223bee3aa8ee71eb00dc25,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2024.
Details: nonemployee compensation: Example Entity 3-4-0, payer: Example Entity 3-4-1, recipient: Example Entity 3-4-2, tax withheld: USD 1,074.30. Account holder: Example Person 304.",1099,5,1099,fdc-123c8af25dd1220083a84145,synthetic-form-layout-03,original,2024,fte-f16b30cded75c784c3733c5e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2025.
Details: nonemployee compensation: Example Entity 3-5-0, payer: Example Entity 3-5-1, recipient: Example Entity 3-5-2, tax withheld: USD 1,082.60. Account holder: Example Person 305.",1099,5,1099,fdc-d0bc6c51679963fec74e8162,synthetic-form-layout-03,original,2025,fte-7d52a4d2652bafee5d56ec2d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2023.
Details: nonemployee compensation: Example Entity 3-6-0, payer: Example Entity 3-6-1, recipient: Example Entity 3-6-2, tax withheld: USD 1,090.90. Account holder: Example Person 306.",1099,5,1099,fdc-463a5c042ce2a2a27a23e4ca,synthetic-form-layout-03,original,2023,fte-bf977497f5dd0a583e3061a6,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation
Reporting period ended 12/31/2024.
Details: nonemployee compensation: Example Entity 3-7-0, payer: Example Entity 3-7-1, recipient: Example Entity 3-7-2, tax withheld: USD 1,099.20. Account holder: Example Person 307.",1099,5,1099,fdc-ff0e93f51e4c6d041e2a7fe8,synthetic-form-layout-03,original,2024,fte-0da2ad0a88c96778a740c2c8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2023
tax withheld: USD 1,054.80
recipient: Example Entity 4-0-2
payer: Example Entity 4-0-1
nonemployee compensation: Example Entity 4-0-0
Named party: Example Person 400",1099,5,1099,fdc-c6fd8d2660e29a1e24c5ecb3,synthetic-form-layout-04,original,2023,fte-b3830d7409e08b5d8b9f56fa,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2024
tax withheld: USD 1,063.10
recipient: Example Entity 4-1-2
payer: Example Entity 4-1-1
nonemployee compensation: Example Entity 4-1-0
Named party: Example Person 401",1099,5,1099,fdc-ad7480d43c68fb26d544d82d,synthetic-form-layout-04,original,2024,fte-74fe4d71bc9751c5feb5bb64,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2025
tax withheld: USD 1,071.40
recipient: Example Entity 4-2-2
payer: Example Entity 4-2-1
nonemployee compensation: Example Entity 4-2-0
Named party: Example Person 402",1099,5,1099,fdc-14e68479323abe544105e93f,synthetic-form-layout-04,original,2025,fte-be5d86235c89ea300c16a992,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2023
tax withheld: USD 1,079.70
recipient: Example Entity 4-3-2
payer: Example Entity 4-3-1
nonemployee compensation: Example Entity 4-3-0
Named party: Example Person 403",1099,5,1099,fdc-e86eb1209ea77ffab1a271ae,synthetic-form-layout-04,original,2023,fte-cfda0c35cfbc18e6ddc699b2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2024
tax withheld: USD 1,088.00
recipient: Example Entity 4-4-2
payer: Example Entity 4-4-1
nonemployee compensation: Example Entity 4-4-0
Named party: Example Person 404",1099,5,1099,fdc-f2da0ce73d49127528ca78d6,synthetic-form-layout-04,original,2024,fte-b2d694dde57199d9a21dbf71,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2025
tax withheld: USD 1,096.30
recipient: Example Entity 4-5-2
payer: Example Entity 4-5-1
nonemployee compensation: Example Entity 4-5-0
Named party: Example Person 405",1099,5,1099,fdc-ccb2ae381ae65036f152af88,synthetic-form-layout-04,original,2025,fte-5a2b1cf4ff9024a9510d4c20,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2023
tax withheld: USD 1,104.60
recipient: Example Entity 4-6-2
payer: Example Entity 4-6-1
nonemployee compensation: Example Entity 4-6-0
Named party: Example Person 406",1099,5,1099,fdc-8c5fa63bbe1c9a4fbf825462,synthetic-form-layout-04,original,2023,fte-2b47e04e00156aea0ad35f5f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-NEC: Nonemployee Compensation
Tax reporting year 2024
tax withheld: USD 1,112.90
recipient: Example Entity 4-7-2
payer: Example Entity 4-7-1
nonemployee compensation: Example Entity 4-7-0
Named party: Example Person 407",1099,5,1099,fdc-46c7d19c11dbafc993a49366,synthetic-form-layout-04,original,2024,fte-c0262b4fc8c15a5ea8c4eb20,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2023
nonemployee compensation: Example Entity 5-0-0 / payer: Example Entity 5-0-1 / recipient: Example Entity 5-0-2 / tax withheld: USD 1,068.50
Delivery copy for Example Party 500",1099,5,1099,fdc-af7aac7578496004c6b830fe,synthetic-form-layout-05,original,2023,fte-02242658d5f51dc88fd65ad2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2024
nonemployee compensation: Example Entity 5-1-0 / payer: Example Entity 5-1-1 / recipient: Example Entity 5-1-2 / tax withheld: USD 1,076.80
Delivery copy for Example Party 501",1099,5,1099,fdc-4fba6905b7a5988002d8c583,synthetic-form-layout-05,original,2024,fte-e02e3523d44542fcd0bd03de,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2025
nonemployee compensation: Example Entity 5-2-0 / payer: Example Entity 5-2-1 / recipient: Example Entity 5-2-2 / tax withheld: USD 1,085.10
Delivery copy for Example Party 502",1099,5,1099,fdc-8a236928f64e3d9f6d7d4047,synthetic-form-layout-05,original,2025,fte-3fe3d67a97ceef3ca07fd4d8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2023
nonemployee compensation: Example Entity 5-3-0 / payer: Example Entity 5-3-1 / recipient: Example Entity 5-3-2 / tax withheld: USD 1,093.40
Delivery copy for Example Party 503",1099,5,1099,fdc-49ee136bce61f0442c350046,synthetic-form-layout-05,original,2023,fte-dc60c0db32b3061891cfdb86,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2024
nonemployee compensation: Example Entity 5-4-0 / payer: Example Entity 5-4-1 / recipient: Example Entity 5-4-2 / tax withheld: USD 1,101.70
Delivery copy for Example Party 504",1099,5,1099,fdc-419d46e4b69f1439a213657d,synthetic-form-layout-05,original,2024,fte-6252eb95370671b243181771,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2025
nonemployee compensation: Example Entity 5-5-0 / payer: Example Entity 5-5-1 / recipient: Example Entity 5-5-2 / tax withheld: USD 1,110.00
Delivery copy for Example Party 505",1099,5,1099,fdc-c6d5c7ff64ed98887df96764,synthetic-form-layout-05,original,2025,fte-2b4a45fc8ae90a7a768cc8f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2023
nonemployee compensation: Example Entity 5-6-0 / payer: Example Entity 5-6-1 / recipient: Example Entity 5-6-2 / tax withheld: USD 1,118.30
Delivery copy for Example Party 506",1099,5,1099,fdc-1faa66f3b185a5c7e2edbb9e,synthetic-form-layout-05,original,2023,fte-fd1ba6b0b3bc446982a61fa9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-NEC: Nonemployee Compensation -- reporting year 2024
nonemployee compensation: Example Entity 5-7-0 / payer: Example Entity 5-7-1 / recipient: Example Entity 5-7-2 / tax withheld: USD 1,126.60
Delivery copy for Example Party 507",1099,5,1099,fdc-c70b0b12f84e6f453760bc8b,synthetic-form-layout-05,original,2024,fte-dc1831c410702a72b516a72f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2023
Statement issued to Example Person 0.
rents: USD 10,000.00
royalties: USD 10,000.00
other income: USD 10,000.00
payer: Example Entity 0-0-3
recipient: Example Entity 0-0-4",1099,5,1099,fdc-b9b25dab1513418101c56f4e,synthetic-form-layout-00,original,2023,fte-4b8380759eb54105387554a9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2024
Statement issued to Example Person 1.
rents: USD 10,083.00
royalties: USD 10,083.00
other income: USD 10,083.00
payer: Example Entity 0-1-3
recipient: Example Entity 0-1-4",1099,5,1099,fdc-231d8653901ae3388b1d1c6a,synthetic-form-layout-00,original,2024,fte-ec4739c0246928722c2b7b95,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2025
Statement issued to Example Person 2.
rents: USD 10,166.00
royalties: USD 10,166.00
other income: USD 10,166.00
payer: Example Entity 0-2-3
recipient: Example Entity 0-2-4",1099,5,1099,fdc-b3cfc328b82770f087ae7a6d,synthetic-form-layout-00,original,2025,fte-c5e0199d25372f48762a399b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2023
Statement issued to Example Person 3.
rents: USD 10,249.00
royalties: USD 10,249.00
other income: USD 10,249.00
payer: Example Entity 0-3-3
recipient: Example Entity 0-3-4",1099,5,1099,fdc-f5215481656e671dedb82c19,synthetic-form-layout-00,original,2023,fte-d741325f3d26e1ccd840a07a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2024
Statement issued to Example Person 4.
rents: USD 10,332.00
royalties: USD 10,332.00
other income: USD 10,332.00
payer: Example Entity 0-4-3
recipient: Example Entity 0-4-4",1099,5,1099,fdc-be814ed9a654f7a7a25a50c4,synthetic-form-layout-00,original,2024,fte-a6397063fa198c4dce71ef01,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2025
Statement issued to Example Person 5.
rents: USD 10,415.00
royalties: USD 10,415.00
other income: USD 10,415.00
payer: Example Entity 0-5-3
recipient: Example Entity 0-5-4",1099,5,1099,fdc-7f06f1db2d1ab0879bdced19,synthetic-form-layout-00,original,2025,fte-07a6fbda0b2e1f054c74df61,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2023
Statement issued to Example Person 6.
rents: USD 10,498.00
royalties: USD 10,498.00
other income: USD 10,498.00
payer: Example Entity 0-6-3
recipient: Example Entity 0-6-4",1099,5,1099,fdc-4e12c04346d6d1e4715dfc73,synthetic-form-layout-00,original,2023,fte-2e9268f176632c8927d6aeab,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Calendar year: 2024
Statement issued to Example Person 7.
rents: USD 10,581.00
royalties: USD 10,581.00
other income: USD 10,581.00
payer: Example Entity 0-7-3
recipient: Example Entity 0-7-4",1099,5,1099,fdc-b8654b51a1d946f77129075c,synthetic-form-layout-00,original,2024,fte-ee08b3ddb1b8241ad79455a6,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 100
rents: USD 10,137.00 | royalties: USD 10,137.00 | other income: USD 10,137.00 | payer: Example Entity 1-0-3 | recipient: Example Entity 1-0-4",1099,5,1099,fdc-09b508cd8069685b9e5acb98,synthetic-form-layout-01,original,2023,fte-413b6d315249b83815dd1c08,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 101
rents: USD 10,220.00 | royalties: USD 10,220.00 | other income: USD 10,220.00 | payer: Example Entity 1-1-3 | recipient: Example Entity 1-1-4",1099,5,1099,fdc-303ad1487d81c6f2dd78d95f,synthetic-form-layout-01,original,2024,fte-3c70d4a28951ee5d8cce07e9,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 102
rents: USD 10,303.00 | royalties: USD 10,303.00 | other income: USD 10,303.00 | payer: Example Entity 1-2-3 | recipient: Example Entity 1-2-4",1099,5,1099,fdc-3ac3279b422ae0d6cb65aad5,synthetic-form-layout-01,original,2025,fte-a1273fc9a5ccf8a17a9a8c02,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 103
rents: USD 10,386.00 | royalties: USD 10,386.00 | other income: USD 10,386.00 | payer: Example Entity 1-3-3 | recipient: Example Entity 1-3-4",1099,5,1099,fdc-22f6c40d2f0273346fa931d2,synthetic-form-layout-01,original,2023,fte-1d32211a92f97613afe33814,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 104
rents: USD 10,469.00 | royalties: USD 10,469.00 | other income: USD 10,469.00 | payer: Example Entity 1-4-3 | recipient: Example Entity 1-4-4",1099,5,1099,fdc-69133ec162f9d9dec5346553,synthetic-form-layout-01,original,2024,fte-34828d75e563dcc8d3a52a53,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 105
rents: USD 10,552.00 | royalties: USD 10,552.00 | other income: USD 10,552.00 | payer: Example Entity 1-5-3 | recipient: Example Entity 1-5-4",1099,5,1099,fdc-740d46fd88c1f6334cc82ce4,synthetic-form-layout-01,original,2025,fte-40a697d2a56fb6d26e7342b4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 106
rents: USD 10,635.00 | royalties: USD 10,635.00 | other income: USD 10,635.00 | payer: Example Entity 1-6-3 | recipient: Example Entity 1-6-4",1099,5,1099,fdc-83e4d5d44777f026f800f9b2,synthetic-form-layout-01,original,2023,fte-f922e5de34ba738823a0509d,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-MISC: Miscellaneous Information
Recipient record: Example Person 107
rents: USD 10,718.00 | royalties: USD 10,718.00 | other income: USD 10,718.00 | payer: Example Entity 1-7-3 | recipient: Example Entity 1-7-4",1099,5,1099,fdc-e5f711a6d5af3e8fe2704c5d,synthetic-form-layout-01,original,2024,fte-59db2b14a1821f8fcc4e4430,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,274.00; royalties: USD 10,274.00; other income: USD 10,274.00; payer: Example Entity 2-0-3; recipient: Example Entity 2-0-4. Recipient: Example Household 200.",1099,5,1099,fdc-a2f021a245615a1cc5c6e15c,synthetic-form-layout-02,original,2023,fte-c6d7ae51824f39ed625c249f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,357.00; royalties: USD 10,357.00; other income: USD 10,357.00; payer: Example Entity 2-1-3; recipient: Example Entity 2-1-4. Recipient: Example Household 201.",1099,5,1099,fdc-0cc9b2b6405708b189d2ad72,synthetic-form-layout-02,original,2024,fte-ebe27b1bcbf09ef448b02033,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,440.00; royalties: USD 10,440.00; other income: USD 10,440.00; payer: Example Entity 2-2-3; recipient: Example Entity 2-2-4. Recipient: Example Household 202.",1099,5,1099,fdc-eb95ddd98335e00d1b34c307,synthetic-form-layout-02,original,2025,fte-6c61f84c1e28dfb65a2912f5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,523.00; royalties: USD 10,523.00; other income: USD 10,523.00; payer: Example Entity 2-3-3; recipient: Example Entity 2-3-4. Recipient: Example Household 203.",1099,5,1099,fdc-8f6302641ef5bd1b08f2cd49,synthetic-form-layout-02,original,2023,fte-7a99c53b4d808b1514603134,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,606.00; royalties: USD 10,606.00; other income: USD 10,606.00; payer: Example Entity 2-4-3; recipient: Example Entity 2-4-4. Recipient: Example Household 204.",1099,5,1099,fdc-34a4cd201eb443dabf457b42,synthetic-form-layout-02,original,2024,fte-17885b1766738436071d11c5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,689.00; royalties: USD 10,689.00; other income: USD 10,689.00; payer: Example Entity 2-5-3; recipient: Example Entity 2-5-4. Recipient: Example Household 205.",1099,5,1099,fdc-bc125030d5320c2ffc93b8c0,synthetic-form-layout-02,original,2025,fte-354f82a50495aee5f2fe0d4e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,772.00; royalties: USD 10,772.00; other income: USD 10,772.00; payer: Example Entity 2-6-3; recipient: Example Entity 2-6-4. Recipient: Example Household 206.",1099,5,1099,fdc-3fe572420f1815f5f7571c97,synthetic-form-layout-02,original,2023,fte-e5f6d5cf864fa6102186e38d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-MISC: Miscellaneous Information.
rents: USD 10,855.00; royalties: USD 10,855.00; other income: USD 10,855.00; payer: Example Entity 2-7-3; recipient: Example Entity 2-7-4. Recipient: Example Household 207.",1099,5,1099,fdc-ab6096e38c14d88413b6720d,synthetic-form-layout-02,original,2024,fte-9572c09f14ed1d593fcc606b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2023.
Details: rents: USD 10,411.00, royalties: USD 10,411.00, other income: USD 10,411.00, payer: Example Entity 3-0-3, recipient: Example Entity 3-0-4. Account holder: Example Person 300.",1099,5,1099,fdc-c24c00ba3324a2b6570df755,synthetic-form-layout-03,original,2023,fte-dd03d53016cc8d746cb17ad9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2024.
Details: rents: USD 10,494.00, royalties: USD 10,494.00, other income: USD 10,494.00, payer: Example Entity 3-1-3, recipient: Example Entity 3-1-4. Account holder: Example Person 301.",1099,5,1099,fdc-6f144689fcab8f5aac45da60,synthetic-form-layout-03,original,2024,fte-161b634c9bddc3ac600dc8ff,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2025.
Details: rents: USD 10,577.00, royalties: USD 10,577.00, other income: USD 10,577.00, payer: Example Entity 3-2-3, recipient: Example Entity 3-2-4. Account holder: Example Person 302.",1099,5,1099,fdc-c02cc715cb291f6800a87aef,synthetic-form-layout-03,original,2025,fte-82ca2f49f443bdc2792269f4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2023.
Details: rents: USD 10,660.00, royalties: USD 10,660.00, other income: USD 10,660.00, payer: Example Entity 3-3-3, recipient: Example Entity 3-3-4. Account holder: Example Person 303.",1099,5,1099,fdc-def6ed2a56ee72e1b64c506d,synthetic-form-layout-03,original,2023,fte-6dffa9060ee9bf482d5866f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2024.
Details: rents: USD 10,743.00, royalties: USD 10,743.00, other income: USD 10,743.00, payer: Example Entity 3-4-3, recipient: Example Entity 3-4-4. Account holder: Example Person 304.",1099,5,1099,fdc-bbaa6861ecd9c183cf242a38,synthetic-form-layout-03,original,2024,fte-847bac4b9cb536d9a8e35470,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2025.
Details: rents: USD 10,826.00, royalties: USD 10,826.00, other income: USD 10,826.00, payer: Example Entity 3-5-3, recipient: Example Entity 3-5-4. Account holder: Example Person 305.",1099,5,1099,fdc-d2b919912469ee1cba6fadf7,synthetic-form-layout-03,original,2025,fte-10380ae5f8bb0c1156598ee9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2023.
Details: rents: USD 10,909.00, royalties: USD 10,909.00, other income: USD 10,909.00, payer: Example Entity 3-6-3, recipient: Example Entity 3-6-4. Account holder: Example Person 306.",1099,5,1099,fdc-bb2fb15b6f9954355446ba0a,synthetic-form-layout-03,original,2023,fte-e808cda5708f477f37ec1af6,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information
Reporting period ended 12/31/2024.
Details: rents: USD 10,992.00, royalties: USD 10,992.00, other income: USD 10,992.00, payer: Example Entity 3-7-3, recipient: Example Entity 3-7-4. Account holder: Example Person 307.",1099,5,1099,fdc-c1ec18bc994933702a1ab52d,synthetic-form-layout-03,original,2024,fte-e962a4d9fb98b66717c32814,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2023
recipient: Example Entity 4-0-4
payer: Example Entity 4-0-3
other income: USD 10,548.00
royalties: USD 10,548.00
rents: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-9802e71316915cfd0cf54f01,synthetic-form-layout-04,original,2023,fte-ca1f08dece573be3887d9b34,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2024
recipient: Example Entity 4-1-4
payer: Example Entity 4-1-3
other income: USD 10,631.00
royalties: USD 10,631.00
rents: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-31ad8767f9458e72616311a6,synthetic-form-layout-04,original,2024,fte-3a22fea2b4cdd3c2c0a59660,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2025
recipient: Example Entity 4-2-4
payer: Example Entity 4-2-3
other income: USD 10,714.00
royalties: USD 10,714.00
rents: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-5c3c33c8abb115d09dc1cc23,synthetic-form-layout-04,original,2025,fte-6ee0dfb42d6961c91c96d38d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2023
recipient: Example Entity 4-3-4
payer: Example Entity 4-3-3
other income: USD 10,797.00
royalties: USD 10,797.00
rents: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-7cfb8c1c843015189da4960b,synthetic-form-layout-04,original,2023,fte-be9efd5c3fbf83e68c97b533,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2024
recipient: Example Entity 4-4-4
payer: Example Entity 4-4-3
other income: USD 10,880.00
royalties: USD 10,880.00
rents: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-0ef69fa2a833425047036dcd,synthetic-form-layout-04,original,2024,fte-9559e585c0f38b8b3de7be8e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2025
recipient: Example Entity 4-5-4
payer: Example Entity 4-5-3
other income: USD 10,963.00
royalties: USD 10,963.00
rents: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-cfbe2d56572668ca7feee55b,synthetic-form-layout-04,original,2025,fte-22001e6312929dc8e6d24919,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2023
recipient: Example Entity 4-6-4
payer: Example Entity 4-6-3
other income: USD 11,046.00
royalties: USD 11,046.00
rents: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-4fc441d49a902dce86fb1cea,synthetic-form-layout-04,original,2023,fte-1393133a2592358cd0869644,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-MISC: Miscellaneous Information
Tax reporting year 2024
recipient: Example Entity 4-7-4
payer: Example Entity 4-7-3
other income: USD 11,129.00
royalties: USD 11,129.00
rents: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-7f90773f51511a6761140574,synthetic-form-layout-04,original,2024,fte-3badd77532da6b4560177b51,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2023
rents: USD 10,685.00 / royalties: USD 10,685.00 / other income: USD 10,685.00 / payer: Example Entity 5-0-3 / recipient: Example Entity 5-0-4
Delivery copy for Example Party 500",1099,5,1099,fdc-fe2e4f38cd73c407d156a8cd,synthetic-form-layout-05,original,2023,fte-55c87eaa9878a6919ebee89f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2024
rents: USD 10,768.00 / royalties: USD 10,768.00 / other income: USD 10,768.00 / payer: Example Entity 5-1-3 / recipient: Example Entity 5-1-4
Delivery copy for Example Party 501",1099,5,1099,fdc-47e66d50b365ea88616c9180,synthetic-form-layout-05,original,2024,fte-e6ba52a24419fe51a6ea10dd,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2025
rents: USD 10,851.00 / royalties: USD 10,851.00 / other income: USD 10,851.00 / payer: Example Entity 5-2-3 / recipient: Example Entity 5-2-4
Delivery copy for Example Party 502",1099,5,1099,fdc-2c006005ba7e4d008ef6d1cb,synthetic-form-layout-05,original,2025,fte-4c07e97429bc541884ac460d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2023
rents: USD 10,934.00 / royalties: USD 10,934.00 / other income: USD 10,934.00 / payer: Example Entity 5-3-3 / recipient: Example Entity 5-3-4
Delivery copy for Example Party 503",1099,5,1099,fdc-620cae0db532b17e5e760eea,synthetic-form-layout-05,original,2023,fte-62aa52bd04c3a91c988189b6,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2024
rents: USD 11,017.00 / royalties: USD 11,017.00 / other income: USD 11,017.00 / payer: Example Entity 5-4-3 / recipient: Example Entity 5-4-4
Delivery copy for Example Party 504",1099,5,1099,fdc-c282fae8a972d42b6ddbe972,synthetic-form-layout-05,original,2024,fte-ee8e805fd5198ade21aa5db1,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2025
rents: USD 11,100.00 / royalties: USD 11,100.00 / other income: USD 11,100.00 / payer: Example Entity 5-5-3 / recipient: Example Entity 5-5-4
Delivery copy for Example Party 505",1099,5,1099,fdc-fd05a8c0ae66d2a62bf246b7,synthetic-form-layout-05,original,2025,fte-781a910f2c95314511075a87,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2023
rents: USD 11,183.00 / royalties: USD 11,183.00 / other income: USD 11,183.00 / payer: Example Entity 5-6-3 / recipient: Example Entity 5-6-4
Delivery copy for Example Party 506",1099,5,1099,fdc-f29f535f2dde657a29c7698f,synthetic-form-layout-05,original,2023,fte-d6b63636451faee0cd8131ed,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-MISC: Miscellaneous Information -- reporting year 2024
rents: USD 11,266.00 / royalties: USD 11,266.00 / other income: USD 11,266.00 / payer: Example Entity 5-7-3 / recipient: Example Entity 5-7-4
Delivery copy for Example Party 507",1099,5,1099,fdc-1e64b7c9b99b54324bb92cf0,synthetic-form-layout-05,original,2024,fte-ba4df6eedbc21ab3546c0d6e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2023
Statement issued to Example Person 0.
gross payment amount: USD 10,000.00
transactions: USD 10,000.00
payment settlement entity: USD 10,000.00
payee: USD 10,000.00",1099,5,1099,fdc-edb497686fbaad70d411a43f,synthetic-form-layout-00,original,2023,fte-e2bf567da0d1286385222af4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2024
Statement issued to Example Person 1.
gross payment amount: USD 10,083.00
transactions: USD 10,083.00
payment settlement entity: USD 10,083.00
payee: USD 10,083.00",1099,5,1099,fdc-80f6d18e2cdc435c878dae1e,synthetic-form-layout-00,original,2024,fte-a04abe1b75f67576f6624a4e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2025
Statement issued to Example Person 2.
gross payment amount: USD 10,166.00
transactions: USD 10,166.00
payment settlement entity: USD 10,166.00
payee: USD 10,166.00",1099,5,1099,fdc-3524b3811ef9b51dee80d2ac,synthetic-form-layout-00,original,2025,fte-c85e8ebec066bcda2f610b32,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2023
Statement issued to Example Person 3.
gross payment amount: USD 10,249.00
transactions: USD 10,249.00
payment settlement entity: USD 10,249.00
payee: USD 10,249.00",1099,5,1099,fdc-daadf1f618dbc20d3ea893d1,synthetic-form-layout-00,original,2023,fte-bc2d53a7c0536284e2d62866,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2024
Statement issued to Example Person 4.
gross payment amount: USD 10,332.00
transactions: USD 10,332.00
payment settlement entity: USD 10,332.00
payee: USD 10,332.00",1099,5,1099,fdc-42013e8fca681d2a537382e9,synthetic-form-layout-00,original,2024,fte-87c1b96b2cceb2144ef22bf1,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2025
Statement issued to Example Person 5.
gross payment amount: USD 10,415.00
transactions: USD 10,415.00
payment settlement entity: USD 10,415.00
payee: USD 10,415.00",1099,5,1099,fdc-adee8f5c66be27f763177131,synthetic-form-layout-00,original,2025,fte-157ca2359da0dc64ed23a05f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2023
Statement issued to Example Person 6.
gross payment amount: USD 10,498.00
transactions: USD 10,498.00
payment settlement entity: USD 10,498.00
payee: USD 10,498.00",1099,5,1099,fdc-f95c8182633a77990e8ca42c,synthetic-form-layout-00,original,2023,fte-a5ef03f12262cfdbae17154c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Calendar year: 2024
Statement issued to Example Person 7.
gross payment amount: USD 10,581.00
transactions: USD 10,581.00
payment settlement entity: USD 10,581.00
payee: USD 10,581.00",1099,5,1099,fdc-bfde281a980e68a693751680,synthetic-form-layout-00,original,2024,fte-9e6c092744ca3467edec1267,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 100
gross payment amount: USD 10,137.00 | transactions: USD 10,137.00 | payment settlement entity: USD 10,137.00 | payee: USD 10,137.00",1099,5,1099,fdc-d0e61b802de03795a6d877a0,synthetic-form-layout-01,original,2023,fte-14259ed2fbac23312746712b,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 101
gross payment amount: USD 10,220.00 | transactions: USD 10,220.00 | payment settlement entity: USD 10,220.00 | payee: USD 10,220.00",1099,5,1099,fdc-5a2716a42df4d10e118c242a,synthetic-form-layout-01,original,2024,fte-5836dd173482e7e9316f1038,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 102
gross payment amount: USD 10,303.00 | transactions: USD 10,303.00 | payment settlement entity: USD 10,303.00 | payee: USD 10,303.00",1099,5,1099,fdc-9a0a19e7daf4f699a26a985c,synthetic-form-layout-01,original,2025,fte-5dfbc194d5e42d39486442c9,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 103
gross payment amount: USD 10,386.00 | transactions: USD 10,386.00 | payment settlement entity: USD 10,386.00 | payee: USD 10,386.00",1099,5,1099,fdc-bf130fdebefd053aa483a7f0,synthetic-form-layout-01,original,2023,fte-8087cdc8026d4472d00ba34b,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 104
gross payment amount: USD 10,469.00 | transactions: USD 10,469.00 | payment settlement entity: USD 10,469.00 | payee: USD 10,469.00",1099,5,1099,fdc-21cf120011794dc7ed191198,synthetic-form-layout-01,original,2024,fte-42a2231863dba8352cbea4bd,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 105
gross payment amount: USD 10,552.00 | transactions: USD 10,552.00 | payment settlement entity: USD 10,552.00 | payee: USD 10,552.00",1099,5,1099,fdc-c45134e786c1992d162ada24,synthetic-form-layout-01,original,2025,fte-6e342d1f2064a515cd85d89f,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 106
gross payment amount: USD 10,635.00 | transactions: USD 10,635.00 | payment settlement entity: USD 10,635.00 | payee: USD 10,635.00",1099,5,1099,fdc-ec2523880ab837a4f4399e1e,synthetic-form-layout-01,original,2023,fte-5bc7623395ffcab38b56ce39,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-K: Payment Card and Third Party Network Transactions
Recipient record: Example Person 107
gross payment amount: USD 10,718.00 | transactions: USD 10,718.00 | payment settlement entity: USD 10,718.00 | payee: USD 10,718.00",1099,5,1099,fdc-0a6af2affd8d050534745be3,synthetic-form-layout-01,original,2024,fte-cf7ad42ceac0ea757de20428,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,274.00; transactions: USD 10,274.00; payment settlement entity: USD 10,274.00; payee: USD 10,274.00. Recipient: Example Household 200.",1099,5,1099,fdc-b38bc6696f68a8f3a3b599e3,synthetic-form-layout-02,original,2023,fte-97f7447a7dc14ad6b36309db,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,357.00; transactions: USD 10,357.00; payment settlement entity: USD 10,357.00; payee: USD 10,357.00. Recipient: Example Household 201.",1099,5,1099,fdc-2f2f9b481074943c112553a3,synthetic-form-layout-02,original,2024,fte-7635e4397eed3a2c18703f24,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,440.00; transactions: USD 10,440.00; payment settlement entity: USD 10,440.00; payee: USD 10,440.00. Recipient: Example Household 202.",1099,5,1099,fdc-c7c83a7c3407c75951dc9d83,synthetic-form-layout-02,original,2025,fte-a5976c33c3fbca50ca6397ad,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,523.00; transactions: USD 10,523.00; payment settlement entity: USD 10,523.00; payee: USD 10,523.00. Recipient: Example Household 203.",1099,5,1099,fdc-475b50979ef5c680a3a5f74f,synthetic-form-layout-02,original,2023,fte-7b1508fa9ca4f7522c7a09ee,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,606.00; transactions: USD 10,606.00; payment settlement entity: USD 10,606.00; payee: USD 10,606.00. Recipient: Example Household 204.",1099,5,1099,fdc-54a017ee671c2e4c4e7313d5,synthetic-form-layout-02,original,2024,fte-e9e748a0fdb8f7e5ab147372,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,689.00; transactions: USD 10,689.00; payment settlement entity: USD 10,689.00; payee: USD 10,689.00. Recipient: Example Household 205.",1099,5,1099,fdc-f36ca091ba6075b61f8e89e6,synthetic-form-layout-02,original,2025,fte-38a026e1174e48b38d36880e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,772.00; transactions: USD 10,772.00; payment settlement entity: USD 10,772.00; payee: USD 10,772.00. Recipient: Example Household 206.",1099,5,1099,fdc-d8e21fa58b4f40bda2b22d3a,synthetic-form-layout-02,original,2023,fte-e1d4441b7d68d1ced594c1b3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-K: Payment Card and Third Party Network Transactions.
gross payment amount: USD 10,855.00; transactions: USD 10,855.00; payment settlement entity: USD 10,855.00; payee: USD 10,855.00. Recipient: Example Household 207.",1099,5,1099,fdc-d8ed2be478faf79975148c73,synthetic-form-layout-02,original,2024,fte-2768078ec4d9aae1c46cd9c3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2023.
Details: gross payment amount: USD 10,411.00, transactions: USD 10,411.00, payment settlement entity: USD 10,411.00, payee: USD 10,411.00. Account holder: Example Person 300.",1099,5,1099,fdc-488dcfdd1286a58084433453,synthetic-form-layout-03,original,2023,fte-ec86724af6d8529c0cf1ab77,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2024.
Details: gross payment amount: USD 10,494.00, transactions: USD 10,494.00, payment settlement entity: USD 10,494.00, payee: USD 10,494.00. Account holder: Example Person 301.",1099,5,1099,fdc-af9af4dae0c7118f455c656a,synthetic-form-layout-03,original,2024,fte-71623512236e978f002efd7b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2025.
Details: gross payment amount: USD 10,577.00, transactions: USD 10,577.00, payment settlement entity: USD 10,577.00, payee: USD 10,577.00. Account holder: Example Person 302.",1099,5,1099,fdc-9d72dc58ec03a8a6d9b7c316,synthetic-form-layout-03,original,2025,fte-10eb0e7e0b09619e3f464c18,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2023.
Details: gross payment amount: USD 10,660.00, transactions: USD 10,660.00, payment settlement entity: USD 10,660.00, payee: USD 10,660.00. Account holder: Example Person 303.",1099,5,1099,fdc-e055e3e656c34e330d7e1313,synthetic-form-layout-03,original,2023,fte-b507841849774fd0959bef9c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2024.
Details: gross payment amount: USD 10,743.00, transactions: USD 10,743.00, payment settlement entity: USD 10,743.00, payee: USD 10,743.00. Account holder: Example Person 304.",1099,5,1099,fdc-e35f5be8ae7261f64379874a,synthetic-form-layout-03,original,2024,fte-ba78b98d2a92d7389ee8c1ff,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2025.
Details: gross payment amount: USD 10,826.00, transactions: USD 10,826.00, payment settlement entity: USD 10,826.00, payee: USD 10,826.00. Account holder: Example Person 305.",1099,5,1099,fdc-bfbe57321e457a37fae3d2f5,synthetic-form-layout-03,original,2025,fte-3f9cf2c1e03aab85afecb3e4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2023.
Details: gross payment amount: USD 10,909.00, transactions: USD 10,909.00, payment settlement entity: USD 10,909.00, payee: USD 10,909.00. Account holder: Example Person 306.",1099,5,1099,fdc-1e83e021eeff58a1a84cbc4f,synthetic-form-layout-03,original,2023,fte-7901902809a257dbb57157b2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions
Reporting period ended 12/31/2024.
Details: gross payment amount: USD 10,992.00, transactions: USD 10,992.00, payment settlement entity: USD 10,992.00, payee: USD 10,992.00. Account holder: Example Person 307.",1099,5,1099,fdc-26be78cbd4576cdce782fa25,synthetic-form-layout-03,original,2024,fte-d454b62868736760ad08fbc2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2023
payee: USD 10,548.00
payment settlement entity: USD 10,548.00
transactions: USD 10,548.00
gross payment amount: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-a32c41c73c4e62fb39456ec1,synthetic-form-layout-04,original,2023,fte-5499f1f6a232d1a18200ffbd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2024
payee: USD 10,631.00
payment settlement entity: USD 10,631.00
transactions: USD 10,631.00
gross payment amount: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-2894edc858ccf8dd73a1e615,synthetic-form-layout-04,original,2024,fte-0f6a0604c15de473d3c27c19,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2025
payee: USD 10,714.00
payment settlement entity: USD 10,714.00
transactions: USD 10,714.00
gross payment amount: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-e4bbb07faba66fa6b10922e2,synthetic-form-layout-04,original,2025,fte-110eb0259fe1a9e034270a39,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2023
payee: USD 10,797.00
payment settlement entity: USD 10,797.00
transactions: USD 10,797.00
gross payment amount: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-8334c5bcedc79fbcad252d4b,synthetic-form-layout-04,original,2023,fte-416aa84911aff99afe177028,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2024
payee: USD 10,880.00
payment settlement entity: USD 10,880.00
transactions: USD 10,880.00
gross payment amount: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-06a6dcb761f16c849683fc97,synthetic-form-layout-04,original,2024,fte-cc288efce58500e1fc989cf6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2025
payee: USD 10,963.00
payment settlement entity: USD 10,963.00
transactions: USD 10,963.00
gross payment amount: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-5be7026ab482ea76dac2c773,synthetic-form-layout-04,original,2025,fte-d8763746ffb9ae864b5528d3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2023
payee: USD 11,046.00
payment settlement entity: USD 11,046.00
transactions: USD 11,046.00
gross payment amount: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-afeafa5e2dfd43424402c502,synthetic-form-layout-04,original,2023,fte-2a148944c2e3d2b37ed5cfcb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-K: Payment Card and Third Party Network Transactions
Tax reporting year 2024
payee: USD 11,129.00
payment settlement entity: USD 11,129.00
transactions: USD 11,129.00
gross payment amount: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-3c61707dd81bb9c9639f80cc,synthetic-form-layout-04,original,2024,fte-3b4c6f7367f07dbf2db6e112,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2023
gross payment amount: USD 10,685.00 / transactions: USD 10,685.00 / payment settlement entity: USD 10,685.00 / payee: USD 10,685.00
Delivery copy for Example Party 500",1099,5,1099,fdc-244a50106bba39ae54872a27,synthetic-form-layout-05,original,2023,fte-c4d4f8485ca61284a625a1c9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2024
gross payment amount: USD 10,768.00 / transactions: USD 10,768.00 / payment settlement entity: USD 10,768.00 / payee: USD 10,768.00
Delivery copy for Example Party 501",1099,5,1099,fdc-5397879dd223147b9f4caca4,synthetic-form-layout-05,original,2024,fte-34aafe1b8f35b45e08ada2b4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2025
gross payment amount: USD 10,851.00 / transactions: USD 10,851.00 / payment settlement entity: USD 10,851.00 / payee: USD 10,851.00
Delivery copy for Example Party 502",1099,5,1099,fdc-bbbec59e9edd67b847037889,synthetic-form-layout-05,original,2025,fte-b139191d9a76f0dec713f81b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2023
gross payment amount: USD 10,934.00 / transactions: USD 10,934.00 / payment settlement entity: USD 10,934.00 / payee: USD 10,934.00
Delivery copy for Example Party 503",1099,5,1099,fdc-fccc57b7ad7475dbb23c3f27,synthetic-form-layout-05,original,2023,fte-f27c24b46b53a0e79ff792c8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2024
gross payment amount: USD 11,017.00 / transactions: USD 11,017.00 / payment settlement entity: USD 11,017.00 / payee: USD 11,017.00
Delivery copy for Example Party 504",1099,5,1099,fdc-54be2547cde294f57a150049,synthetic-form-layout-05,original,2024,fte-37c8a58b62b453e22d9cf967,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2025
gross payment amount: USD 11,100.00 / transactions: USD 11,100.00 / payment settlement entity: USD 11,100.00 / payee: USD 11,100.00
Delivery copy for Example Party 505",1099,5,1099,fdc-96841da2cd1fd453b5aebef1,synthetic-form-layout-05,original,2025,fte-6d4b9da5b45237a99b56f34d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2023
gross payment amount: USD 11,183.00 / transactions: USD 11,183.00 / payment settlement entity: USD 11,183.00 / payee: USD 11,183.00
Delivery copy for Example Party 506",1099,5,1099,fdc-a0424f59e263fea568d994e6,synthetic-form-layout-05,original,2023,fte-60a5bed3e14b9c454fe26231,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-K: Payment Card and Third Party Network Transactions -- reporting year 2024
gross payment amount: USD 11,266.00 / transactions: USD 11,266.00 / payment settlement entity: USD 11,266.00 / payee: USD 11,266.00
Delivery copy for Example Party 507",1099,5,1099,fdc-6c1e796ad9bc008636344795,synthetic-form-layout-05,original,2024,fte-6ecf5d6097521d4b0b58a98b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2023
Statement issued to Example Person 0.
interest income: USD 10,000.00
early withdrawal penalty: USD 10,000.00
payer: Example Entity 0-0-2
recipient: Example Entity 0-0-3",1099,5,1099,fdc-c8da3b538da61bc9296285eb,synthetic-form-layout-00,original,2023,fte-c7024f0902d12bb73611a1b5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2024
Statement issued to Example Person 1.
interest income: USD 10,083.00
early withdrawal penalty: USD 10,083.00
payer: Example Entity 0-1-2
recipient: Example Entity 0-1-3",1099,5,1099,fdc-9dd265486453df45ff73152e,synthetic-form-layout-00,original,2024,fte-fd9d641a230217e79ea286ab,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2025
Statement issued to Example Person 2.
interest income: USD 10,166.00
early withdrawal penalty: USD 10,166.00
payer: Example Entity 0-2-2
recipient: Example Entity 0-2-3",1099,5,1099,fdc-cec0aedc1ce3ee5bec408e85,synthetic-form-layout-00,original,2025,fte-19105ba49aa9e8a39b876107,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2023
Statement issued to Example Person 3.
interest income: USD 10,249.00
early withdrawal penalty: USD 10,249.00
payer: Example Entity 0-3-2
recipient: Example Entity 0-3-3",1099,5,1099,fdc-84282e4b7d83e228ae93baba,synthetic-form-layout-00,original,2023,fte-61ab87cd40cefbf70196d49e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2024
Statement issued to Example Person 4.
interest income: USD 10,332.00
early withdrawal penalty: USD 10,332.00
payer: Example Entity 0-4-2
recipient: Example Entity 0-4-3",1099,5,1099,fdc-e713f86560013a0dd68a196d,synthetic-form-layout-00,original,2024,fte-95bd133137ae7dd274aa1830,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2025
Statement issued to Example Person 5.
interest income: USD 10,415.00
early withdrawal penalty: USD 10,415.00
payer: Example Entity 0-5-2
recipient: Example Entity 0-5-3",1099,5,1099,fdc-2368f9d038c96d7e7e04c1e3,synthetic-form-layout-00,original,2025,fte-63453e782ae9201f5f664c11,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2023
Statement issued to Example Person 6.
interest income: USD 10,498.00
early withdrawal penalty: USD 10,498.00
payer: Example Entity 0-6-2
recipient: Example Entity 0-6-3",1099,5,1099,fdc-38ea030b504dbb6a143e6e13,synthetic-form-layout-00,original,2023,fte-2be2c1dc8d76e0ad55e0470f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Calendar year: 2024
Statement issued to Example Person 7.
interest income: USD 10,581.00
early withdrawal penalty: USD 10,581.00
payer: Example Entity 0-7-2
recipient: Example Entity 0-7-3",1099,5,1099,fdc-496f031b5c29d29a0ef32a09,synthetic-form-layout-00,original,2024,fte-0812fe5fb5e21d347523a1f7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-INT: Interest Income
Recipient record: Example Person 100
interest income: USD 10,137.00 | early withdrawal penalty: USD 10,137.00 | payer: Example Entity 1-0-2 | recipient: Example Entity 1-0-3",1099,5,1099,fdc-e96d2ef6a18ae528d3a18a13,synthetic-form-layout-01,original,2023,fte-273f286443604041171779f7,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-INT: Interest Income
Recipient record: Example Person 101
interest income: USD 10,220.00 | early withdrawal penalty: USD 10,220.00 | payer: Example Entity 1-1-2 | recipient: Example Entity 1-1-3",1099,5,1099,fdc-2e5de0bf165ad9b839ce6582,synthetic-form-layout-01,original,2024,fte-c1d370ed82fe7a73810b72a1,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-INT: Interest Income
Recipient record: Example Person 102
interest income: USD 10,303.00 | early withdrawal penalty: USD 10,303.00 | payer: Example Entity 1-2-2 | recipient: Example Entity 1-2-3",1099,5,1099,fdc-11e904b41063802a2af9637c,synthetic-form-layout-01,original,2025,fte-1177c24adbe36bad742c1b78,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-INT: Interest Income
Recipient record: Example Person 103
interest income: USD 10,386.00 | early withdrawal penalty: USD 10,386.00 | payer: Example Entity 1-3-2 | recipient: Example Entity 1-3-3",1099,5,1099,fdc-cf71ea4bef7bb7f0cef1ba6d,synthetic-form-layout-01,original,2023,fte-b80946a06af96301845713ed,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-INT: Interest Income
Recipient record: Example Person 104
interest income: USD 10,469.00 | early withdrawal penalty: USD 10,469.00 | payer: Example Entity 1-4-2 | recipient: Example Entity 1-4-3",1099,5,1099,fdc-8d537e0f925458ccb531090e,synthetic-form-layout-01,original,2024,fte-e14d480bef0208fcc04bf193,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-INT: Interest Income
Recipient record: Example Person 105
interest income: USD 10,552.00 | early withdrawal penalty: USD 10,552.00 | payer: Example Entity 1-5-2 | recipient: Example Entity 1-5-3",1099,5,1099,fdc-360b0d3c789794722a7eab5b,synthetic-form-layout-01,original,2025,fte-18afe5384e9cc43fdbdc6852,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-INT: Interest Income
Recipient record: Example Person 106
interest income: USD 10,635.00 | early withdrawal penalty: USD 10,635.00 | payer: Example Entity 1-6-2 | recipient: Example Entity 1-6-3",1099,5,1099,fdc-188411969ddb5289d771e8b4,synthetic-form-layout-01,original,2023,fte-58f5c638d20c97819dd3d29f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-INT: Interest Income
Recipient record: Example Person 107
interest income: USD 10,718.00 | early withdrawal penalty: USD 10,718.00 | payer: Example Entity 1-7-2 | recipient: Example Entity 1-7-3",1099,5,1099,fdc-75e9655946364f7f9a7fe63c,synthetic-form-layout-01,original,2024,fte-ab837de4a6b741789717f39f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-INT: Interest Income.
interest income: USD 10,274.00; early withdrawal penalty: USD 10,274.00; payer: Example Entity 2-0-2; recipient: Example Entity 2-0-3. Recipient: Example Household 200.",1099,5,1099,fdc-cd6ee1950ec41ac3959984f7,synthetic-form-layout-02,original,2023,fte-3f0cfff6f32d98c589244ce7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-INT: Interest Income.
interest income: USD 10,357.00; early withdrawal penalty: USD 10,357.00; payer: Example Entity 2-1-2; recipient: Example Entity 2-1-3. Recipient: Example Household 201.",1099,5,1099,fdc-62e78f3f3ec846d9a6986ada,synthetic-form-layout-02,original,2024,fte-edf1d7ab3bef40696650d61b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-INT: Interest Income.
interest income: USD 10,440.00; early withdrawal penalty: USD 10,440.00; payer: Example Entity 2-2-2; recipient: Example Entity 2-2-3. Recipient: Example Household 202.",1099,5,1099,fdc-b5376b56c051ebbeb392de4a,synthetic-form-layout-02,original,2025,fte-4a432b5a560d0fdfc4aa046e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-INT: Interest Income.
interest income: USD 10,523.00; early withdrawal penalty: USD 10,523.00; payer: Example Entity 2-3-2; recipient: Example Entity 2-3-3. Recipient: Example Household 203.",1099,5,1099,fdc-cf1cdf567ebd4f61cdf0a2bf,synthetic-form-layout-02,original,2023,fte-ce7407a28f6347d075483156,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-INT: Interest Income.
interest income: USD 10,606.00; early withdrawal penalty: USD 10,606.00; payer: Example Entity 2-4-2; recipient: Example Entity 2-4-3. Recipient: Example Household 204.",1099,5,1099,fdc-d91f92c7a2c8ed9664c4286b,synthetic-form-layout-02,original,2024,fte-01682595a1b3e868652b1243,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-INT: Interest Income.
interest income: USD 10,689.00; early withdrawal penalty: USD 10,689.00; payer: Example Entity 2-5-2; recipient: Example Entity 2-5-3. Recipient: Example Household 205.",1099,5,1099,fdc-d9ff52bc81a26d00ce2a5553,synthetic-form-layout-02,original,2025,fte-d61cff11901162c7b90cc238,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-INT: Interest Income.
interest income: USD 10,772.00; early withdrawal penalty: USD 10,772.00; payer: Example Entity 2-6-2; recipient: Example Entity 2-6-3. Recipient: Example Household 206.",1099,5,1099,fdc-e80dc748b771cdf3aa50b45c,synthetic-form-layout-02,original,2023,fte-11c656ab7a448cd124ff9270,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-INT: Interest Income.
interest income: USD 10,855.00; early withdrawal penalty: USD 10,855.00; payer: Example Entity 2-7-2; recipient: Example Entity 2-7-3. Recipient: Example Household 207.",1099,5,1099,fdc-36805086fce8ee2f89c82ced,synthetic-form-layout-02,original,2024,fte-c7a5cd9ff9ed3ea8ff70cf9b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2023.
Details: interest income: USD 10,411.00, early withdrawal penalty: USD 10,411.00, payer: Example Entity 3-0-2, recipient: Example Entity 3-0-3. Account holder: Example Person 300.",1099,5,1099,fdc-86ed49de626889b94fcbd5e0,synthetic-form-layout-03,original,2023,fte-85dceda29585e166872fcb68,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2024.
Details: interest income: USD 10,494.00, early withdrawal penalty: USD 10,494.00, payer: Example Entity 3-1-2, recipient: Example Entity 3-1-3. Account holder: Example Person 301.",1099,5,1099,fdc-cedec784fb80fb8c02af143d,synthetic-form-layout-03,original,2024,fte-6a9dfe580f43af9356c73fa3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2025.
Details: interest income: USD 10,577.00, early withdrawal penalty: USD 10,577.00, payer: Example Entity 3-2-2, recipient: Example Entity 3-2-3. Account holder: Example Person 302.",1099,5,1099,fdc-c3abe371cf90bad5867e3c83,synthetic-form-layout-03,original,2025,fte-9ea7ea077b1514941f377b3b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2023.
Details: interest income: USD 10,660.00, early withdrawal penalty: USD 10,660.00, payer: Example Entity 3-3-2, recipient: Example Entity 3-3-3. Account holder: Example Person 303.",1099,5,1099,fdc-e1018c77a914f6e6946ba662,synthetic-form-layout-03,original,2023,fte-c662a54597b131818256aa51,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2024.
Details: interest income: USD 10,743.00, early withdrawal penalty: USD 10,743.00, payer: Example Entity 3-4-2, recipient: Example Entity 3-4-3. Account holder: Example Person 304.",1099,5,1099,fdc-a67f71a3dc0bed1b56fec793,synthetic-form-layout-03,original,2024,fte-9bc6a78c27cf315443e8b0ef,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2025.
Details: interest income: USD 10,826.00, early withdrawal penalty: USD 10,826.00, payer: Example Entity 3-5-2, recipient: Example Entity 3-5-3. Account holder: Example Person 305.",1099,5,1099,fdc-f234e802cdd749c19fd5124a,synthetic-form-layout-03,original,2025,fte-e8ce88acf4e6bab49462f9b2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2023.
Details: interest income: USD 10,909.00, early withdrawal penalty: USD 10,909.00, payer: Example Entity 3-6-2, recipient: Example Entity 3-6-3. Account holder: Example Person 306.",1099,5,1099,fdc-5cbc3f996d254a6dd8ec7752,synthetic-form-layout-03,original,2023,fte-badcab7942637ca1d006fca3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income
Reporting period ended 12/31/2024.
Details: interest income: USD 10,992.00, early withdrawal penalty: USD 10,992.00, payer: Example Entity 3-7-2, recipient: Example Entity 3-7-3. Account holder: Example Person 307.",1099,5,1099,fdc-fd8031cfc306f7b0dab671cd,synthetic-form-layout-03,original,2024,fte-c1aa93d8bc799a2f7f91ea86,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2023
recipient: Example Entity 4-0-3
payer: Example Entity 4-0-2
early withdrawal penalty: USD 10,548.00
interest income: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-0ab2630fd3153ced88cd66ef,synthetic-form-layout-04,original,2023,fte-122b6168832824dcc6ff4597,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2024
recipient: Example Entity 4-1-3
payer: Example Entity 4-1-2
early withdrawal penalty: USD 10,631.00
interest income: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-824e6e92753b8813d7728b4b,synthetic-form-layout-04,original,2024,fte-51999b598fe29da4079a8550,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2025
recipient: Example Entity 4-2-3
payer: Example Entity 4-2-2
early withdrawal penalty: USD 10,714.00
interest income: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-fadb56ae8cff15d1272c018f,synthetic-form-layout-04,original,2025,fte-aaabcf2e92a1a9b6cec68ea2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2023
recipient: Example Entity 4-3-3
payer: Example Entity 4-3-2
early withdrawal penalty: USD 10,797.00
interest income: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-42624c80dfa7306325488478,synthetic-form-layout-04,original,2023,fte-967523707fdc6a2efb9b473f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2024
recipient: Example Entity 4-4-3
payer: Example Entity 4-4-2
early withdrawal penalty: USD 10,880.00
interest income: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-9fc62f84651fc8e3a36a8dfd,synthetic-form-layout-04,original,2024,fte-a58f2c92cbd03ce8ba33ee1b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2025
recipient: Example Entity 4-5-3
payer: Example Entity 4-5-2
early withdrawal penalty: USD 10,963.00
interest income: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-8faf960bffc72ff52aee92f7,synthetic-form-layout-04,original,2025,fte-b644bd3c94d490dd11825435,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2023
recipient: Example Entity 4-6-3
payer: Example Entity 4-6-2
early withdrawal penalty: USD 11,046.00
interest income: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-20d62ad7072ef1a574eaab11,synthetic-form-layout-04,original,2023,fte-b419dd912a56818664b5d340,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-INT: Interest Income
Tax reporting year 2024
recipient: Example Entity 4-7-3
payer: Example Entity 4-7-2
early withdrawal penalty: USD 11,129.00
interest income: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-898f2a5a8cb8fb69e0d8c00c,synthetic-form-layout-04,original,2024,fte-7ec473b865a38ef54ba50600,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2023
interest income: USD 10,685.00 / early withdrawal penalty: USD 10,685.00 / payer: Example Entity 5-0-2 / recipient: Example Entity 5-0-3
Delivery copy for Example Party 500",1099,5,1099,fdc-681665fe63bfebe1a1d85f35,synthetic-form-layout-05,original,2023,fte-df7d12190a0c6797d9f89a63,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2024
interest income: USD 10,768.00 / early withdrawal penalty: USD 10,768.00 / payer: Example Entity 5-1-2 / recipient: Example Entity 5-1-3
Delivery copy for Example Party 501",1099,5,1099,fdc-2351601245039afa29127ef5,synthetic-form-layout-05,original,2024,fte-18243305b413138948f7f1bd,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2025
interest income: USD 10,851.00 / early withdrawal penalty: USD 10,851.00 / payer: Example Entity 5-2-2 / recipient: Example Entity 5-2-3
Delivery copy for Example Party 502",1099,5,1099,fdc-fb883d07a0613be9de346ff3,synthetic-form-layout-05,original,2025,fte-54170218ea62e4a7abd5fb09,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2023
interest income: USD 10,934.00 / early withdrawal penalty: USD 10,934.00 / payer: Example Entity 5-3-2 / recipient: Example Entity 5-3-3
Delivery copy for Example Party 503",1099,5,1099,fdc-9b0b3a47ddcb8d7bf167e551,synthetic-form-layout-05,original,2023,fte-2b0f2ba9f0b06b6030c7ed16,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2024
interest income: USD 11,017.00 / early withdrawal penalty: USD 11,017.00 / payer: Example Entity 5-4-2 / recipient: Example Entity 5-4-3
Delivery copy for Example Party 504",1099,5,1099,fdc-a687d6906d1d9154bb54ef09,synthetic-form-layout-05,original,2024,fte-c0090fff14e73e0980474bc3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2025
interest income: USD 11,100.00 / early withdrawal penalty: USD 11,100.00 / payer: Example Entity 5-5-2 / recipient: Example Entity 5-5-3
Delivery copy for Example Party 505",1099,5,1099,fdc-412dc1015de020af9896eeba,synthetic-form-layout-05,original,2025,fte-e0b1097a4b7a2ef39c4087b5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2023
interest income: USD 11,183.00 / early withdrawal penalty: USD 11,183.00 / payer: Example Entity 5-6-2 / recipient: Example Entity 5-6-3
Delivery copy for Example Party 506",1099,5,1099,fdc-68040edc969a5abbe19ab981,synthetic-form-layout-05,original,2023,fte-26332792f45d8725952ac1a9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-INT: Interest Income -- reporting year 2024
interest income: USD 11,266.00 / early withdrawal penalty: USD 11,266.00 / payer: Example Entity 5-7-2 / recipient: Example Entity 5-7-3
Delivery copy for Example Party 507",1099,5,1099,fdc-2cd5f513ce6ea478f4c5f8f2,synthetic-form-layout-05,original,2024,fte-dc7bda64a6da96b8e0d09176,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2023
Statement issued to Example Person 0.
ordinary dividends: USD 10,000.00
qualified dividends: USD 6,000.00
capital gain distributions: USD 10,000.00",1099,5,1099,fdc-9c1ba6dd8bf5f879c0a7079d,synthetic-form-layout-00,original,2023,fte-f0d4a4cc26ea1841d157ec6b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2024
Statement issued to Example Person 1.
ordinary dividends: USD 10,083.00
qualified dividends: USD 6,049.80
capital gain distributions: USD 10,083.00",1099,5,1099,fdc-a9a502082c472aa425622b9a,synthetic-form-layout-00,original,2024,fte-5012847efcc2b20b205222a6,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2025
Statement issued to Example Person 2.
ordinary dividends: USD 10,166.00
qualified dividends: USD 6,099.60
capital gain distributions: USD 10,166.00",1099,5,1099,fdc-5eff26b0bcf933aecace54fa,synthetic-form-layout-00,original,2025,fte-849cbadf7746cd5c759797b4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2023
Statement issued to Example Person 3.
ordinary dividends: USD 10,249.00
qualified dividends: USD 6,149.40
capital gain distributions: USD 10,249.00",1099,5,1099,fdc-711d038152a024cacb0ea7b3,synthetic-form-layout-00,original,2023,fte-62925492101ec9a4c71fec76,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2024
Statement issued to Example Person 4.
ordinary dividends: USD 10,332.00
qualified dividends: USD 6,199.20
capital gain distributions: USD 10,332.00",1099,5,1099,fdc-c73ca5067ced0de51bbdca13,synthetic-form-layout-00,original,2024,fte-977e19bfd312adb966a4d289,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2025
Statement issued to Example Person 5.
ordinary dividends: USD 10,415.00
qualified dividends: USD 6,249.00
capital gain distributions: USD 10,415.00",1099,5,1099,fdc-1ad95f591d9e3083e5e1dfe2,synthetic-form-layout-00,original,2025,fte-9b8a1d38ea94782b04d2f330,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2023
Statement issued to Example Person 6.
ordinary dividends: USD 10,498.00
qualified dividends: USD 6,298.80
capital gain distributions: USD 10,498.00",1099,5,1099,fdc-516eaed460b556e50ccd46ca,synthetic-form-layout-00,original,2023,fte-ce95a9c6b120836c4153e564,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Calendar year: 2024
Statement issued to Example Person 7.
ordinary dividends: USD 10,581.00
qualified dividends: USD 6,348.60
capital gain distributions: USD 10,581.00",1099,5,1099,fdc-7d4249b127a26f869c29cc56,synthetic-form-layout-00,original,2024,fte-b1d579f277cdbcde930545d5,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 100
ordinary dividends: USD 10,137.00 | qualified dividends: USD 6,082.20 | capital gain distributions: USD 10,137.00",1099,5,1099,fdc-d6dffb4b39069e82e030e2a8,synthetic-form-layout-01,original,2023,fte-a96e85bb2378c8a186472309,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 101
ordinary dividends: USD 10,220.00 | qualified dividends: USD 6,132.00 | capital gain distributions: USD 10,220.00",1099,5,1099,fdc-27199e394d3227400e8ce782,synthetic-form-layout-01,original,2024,fte-9a4d46cf627abf1c4463d60c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 102
ordinary dividends: USD 10,303.00 | qualified dividends: USD 6,181.80 | capital gain distributions: USD 10,303.00",1099,5,1099,fdc-6dfab8c07623fa13ec86668c,synthetic-form-layout-01,original,2025,fte-868842db4254a98ee53a93db,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 103
ordinary dividends: USD 10,386.00 | qualified dividends: USD 6,231.60 | capital gain distributions: USD 10,386.00",1099,5,1099,fdc-a491044ac9a4c10ffb7729a7,synthetic-form-layout-01,original,2023,fte-15888470bb6e9bac0fd1e7ea,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 104
ordinary dividends: USD 10,469.00 | qualified dividends: USD 6,281.40 | capital gain distributions: USD 10,469.00",1099,5,1099,fdc-7a7071c00d7a5908e498d3e9,synthetic-form-layout-01,original,2024,fte-4a4734f9ac9ca220ce750ef0,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 105
ordinary dividends: USD 10,552.00 | qualified dividends: USD 6,331.20 | capital gain distributions: USD 10,552.00",1099,5,1099,fdc-d100abb88f984925bcd5a8ff,synthetic-form-layout-01,original,2025,fte-930e7c710deb8f7220e19ec4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 106
ordinary dividends: USD 10,635.00 | qualified dividends: USD 6,381.00 | capital gain distributions: USD 10,635.00",1099,5,1099,fdc-e94da56bb0fa42624914731e,synthetic-form-layout-01,original,2023,fte-c6c3079a42d4d079b62d4c63,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-DIV: Dividends and Distributions
Recipient record: Example Person 107
ordinary dividends: USD 10,718.00 | qualified dividends: USD 6,430.80 | capital gain distributions: USD 10,718.00",1099,5,1099,fdc-228cfd4043d426c1c516cda6,synthetic-form-layout-01,original,2024,fte-32ca3311a795e4c6bcbf589f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,274.00; qualified dividends: USD 6,164.40; capital gain distributions: USD 10,274.00. Recipient: Example Household 200.",1099,5,1099,fdc-983f1d58c8b1506a0c961189,synthetic-form-layout-02,original,2023,fte-63e3a0c8a5da0a8e5eb09fa1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,357.00; qualified dividends: USD 6,214.20; capital gain distributions: USD 10,357.00. Recipient: Example Household 201.",1099,5,1099,fdc-80b3593be0694f73025d6eaf,synthetic-form-layout-02,original,2024,fte-6ca1fb1751a8514250558ddf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,440.00; qualified dividends: USD 6,264.00; capital gain distributions: USD 10,440.00. Recipient: Example Household 202.",1099,5,1099,fdc-5ebe2d67d45154d61564a261,synthetic-form-layout-02,original,2025,fte-98bb6eeb0fa45b80c0720101,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,523.00; qualified dividends: USD 6,313.80; capital gain distributions: USD 10,523.00. Recipient: Example Household 203.",1099,5,1099,fdc-b296602d38451a334c2cf186,synthetic-form-layout-02,original,2023,fte-64898da8e1c78fa9c3d6fbae,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,606.00; qualified dividends: USD 6,363.60; capital gain distributions: USD 10,606.00. Recipient: Example Household 204.",1099,5,1099,fdc-ff3c1f5bb99c5040f8f608d0,synthetic-form-layout-02,original,2024,fte-f4d46a8df253a8ce83be0922,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,689.00; qualified dividends: USD 6,413.40; capital gain distributions: USD 10,689.00. Recipient: Example Household 205.",1099,5,1099,fdc-57fe1fbd5737b588afded332,synthetic-form-layout-02,original,2025,fte-1930fe9faca72caaefbaaaad,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,772.00; qualified dividends: USD 6,463.20; capital gain distributions: USD 10,772.00. Recipient: Example Household 206.",1099,5,1099,fdc-cb82f425112b080f67ea3844,synthetic-form-layout-02,original,2023,fte-d445ff99daeeff8ac420154e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-DIV: Dividends and Distributions.
ordinary dividends: USD 10,855.00; qualified dividends: USD 6,513.00; capital gain distributions: USD 10,855.00. Recipient: Example Household 207.",1099,5,1099,fdc-a57f7fe25df46c8c6f41ce72,synthetic-form-layout-02,original,2024,fte-e9960efa02281510f924476e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2023.
Details: ordinary dividends: USD 10,411.00, qualified dividends: USD 6,246.60, capital gain distributions: USD 10,411.00. Account holder: Example Person 300.",1099,5,1099,fdc-cba92a4957cbafda9de611b6,synthetic-form-layout-03,original,2023,fte-7959be5f90e17f013fd1c7b9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2024.
Details: ordinary dividends: USD 10,494.00, qualified dividends: USD 6,296.40, capital gain distributions: USD 10,494.00. Account holder: Example Person 301.",1099,5,1099,fdc-3fe61ff379a84850d1f1d39c,synthetic-form-layout-03,original,2024,fte-b297c4bbc9e2b741e21f4762,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2025.
Details: ordinary dividends: USD 10,577.00, qualified dividends: USD 6,346.20, capital gain distributions: USD 10,577.00. Account holder: Example Person 302.",1099,5,1099,fdc-b68abccec23b68662991708b,synthetic-form-layout-03,original,2025,fte-3e30a014d04396c625a1748e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2023.
Details: ordinary dividends: USD 10,660.00, qualified dividends: USD 6,396.00, capital gain distributions: USD 10,660.00. Account holder: Example Person 303.",1099,5,1099,fdc-4d967d0ee203595f78c6d399,synthetic-form-layout-03,original,2023,fte-67044099313a3cbeca4e442e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2024.
Details: ordinary dividends: USD 10,743.00, qualified dividends: USD 6,445.80, capital gain distributions: USD 10,743.00. Account holder: Example Person 304.",1099,5,1099,fdc-9512b8de2386ca5dca716b84,synthetic-form-layout-03,original,2024,fte-fa16dad992436ff628c8052b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2025.
Details: ordinary dividends: USD 10,826.00, qualified dividends: USD 6,495.60, capital gain distributions: USD 10,826.00. Account holder: Example Person 305.",1099,5,1099,fdc-8ead8104e4c9d7cd91d54cec,synthetic-form-layout-03,original,2025,fte-138fc1727815f5f4fe69c0d5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2023.
Details: ordinary dividends: USD 10,909.00, qualified dividends: USD 6,545.40, capital gain distributions: USD 10,909.00. Account holder: Example Person 306.",1099,5,1099,fdc-3dfebdd6e3e77624f539bff3,synthetic-form-layout-03,original,2023,fte-f9e6ec21eb2b1e2ec7baa0f7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions
Reporting period ended 12/31/2024.
Details: ordinary dividends: USD 10,992.00, qualified dividends: USD 6,595.20, capital gain distributions: USD 10,992.00. Account holder: Example Person 307.",1099,5,1099,fdc-e2567d5e8bec7c163b9bb2f9,synthetic-form-layout-03,original,2024,fte-99e9668f68fada4f5f4bd7ae,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2023
capital gain distributions: USD 10,548.00
qualified dividends: USD 6,328.80
ordinary dividends: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-9bca6f09fa2612bce4438a99,synthetic-form-layout-04,original,2023,fte-8bfbe3aaf616188e9eb23f90,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2024
capital gain distributions: USD 10,631.00
qualified dividends: USD 6,378.60
ordinary dividends: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-39a189aacec7e2ac8cfc964b,synthetic-form-layout-04,original,2024,fte-3f05ad3c53401e8c29a12bc6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2025
capital gain distributions: USD 10,714.00
qualified dividends: USD 6,428.40
ordinary dividends: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-e56649c7c3c5324db3f26233,synthetic-form-layout-04,original,2025,fte-62dbaf489c3101ab6d776da3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2023
capital gain distributions: USD 10,797.00
qualified dividends: USD 6,478.20
ordinary dividends: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-d6b5681294d9364062c3d513,synthetic-form-layout-04,original,2023,fte-892a6c5a2d111ab9a73c88da,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2024
capital gain distributions: USD 10,880.00
qualified dividends: USD 6,528.00
ordinary dividends: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-de048e4769ed403b8d7d866d,synthetic-form-layout-04,original,2024,fte-8baa932e2ca3a07ef2b7beec,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2025
capital gain distributions: USD 10,963.00
qualified dividends: USD 6,577.80
ordinary dividends: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-01cc7448a311b6e1c098d62b,synthetic-form-layout-04,original,2025,fte-095c94766b789890e41ae9f0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2023
capital gain distributions: USD 11,046.00
qualified dividends: USD 6,627.60
ordinary dividends: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-f06f6d25fcc3524105536543,synthetic-form-layout-04,original,2023,fte-a48354d8f4bbef4681f0db6c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DIV: Dividends and Distributions
Tax reporting year 2024
capital gain distributions: USD 11,129.00
qualified dividends: USD 6,677.40
ordinary dividends: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-2b69cfeddbe6049b596ea48f,synthetic-form-layout-04,original,2024,fte-38f26f8b3e716d9f92846771,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2023
ordinary dividends: USD 10,685.00 / qualified dividends: USD 6,411.00 / capital gain distributions: USD 10,685.00
Delivery copy for Example Party 500",1099,5,1099,fdc-09b3b2bf9efd7e428339034b,synthetic-form-layout-05,original,2023,fte-14f7a0471f13b9c48b047aa2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2024
ordinary dividends: USD 10,768.00 / qualified dividends: USD 6,460.80 / capital gain distributions: USD 10,768.00
Delivery copy for Example Party 501",1099,5,1099,fdc-10406a2b61d3bce6833552df,synthetic-form-layout-05,original,2024,fte-0e703140272a9f93b6236272,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2025
ordinary dividends: USD 10,851.00 / qualified dividends: USD 6,510.60 / capital gain distributions: USD 10,851.00
Delivery copy for Example Party 502",1099,5,1099,fdc-9772b0dc8ec930e349dd0886,synthetic-form-layout-05,original,2025,fte-4afa9615592bf6f26a395bdd,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2023
ordinary dividends: USD 10,934.00 / qualified dividends: USD 6,560.40 / capital gain distributions: USD 10,934.00
Delivery copy for Example Party 503",1099,5,1099,fdc-56b844b000445aae45bb53d9,synthetic-form-layout-05,original,2023,fte-36ca4652f975199d8037612e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2024
ordinary dividends: USD 11,017.00 / qualified dividends: USD 6,610.20 / capital gain distributions: USD 11,017.00
Delivery copy for Example Party 504",1099,5,1099,fdc-fc1b924719165a97f06c922a,synthetic-form-layout-05,original,2024,fte-4678dc7458f566acac3729a2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2025
ordinary dividends: USD 11,100.00 / qualified dividends: USD 6,660.00 / capital gain distributions: USD 11,100.00
Delivery copy for Example Party 505",1099,5,1099,fdc-51ede8e9de1653e0e24bf0c8,synthetic-form-layout-05,original,2025,fte-260cbf6da0ba41210efc440d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2023
ordinary dividends: USD 11,183.00 / qualified dividends: USD 6,709.80 / capital gain distributions: USD 11,183.00
Delivery copy for Example Party 506",1099,5,1099,fdc-90535f2ca42b42b88f1c64d3,synthetic-form-layout-05,original,2023,fte-f860f82a00a2756c60a61d36,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DIV: Dividends and Distributions -- reporting year 2024
ordinary dividends: USD 11,266.00 / qualified dividends: USD 6,759.60 / capital gain distributions: USD 11,266.00
Delivery copy for Example Party 507",1099,5,1099,fdc-095ba489d40ab4769854194d,synthetic-form-layout-05,original,2024,fte-f99cd628db6db9d9de02e38b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2023
Statement issued to Example Person 0.
original issue discount: USD 10,000.00
other periodic interest: USD 10,000.00
payer: Example Entity 0-0-2
recipient: Example Entity 0-0-3",1099,5,1099,fdc-3143883d79e6701b54330893,synthetic-form-layout-00,original,2023,fte-22e00e4739320704b649c2d5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2024
Statement issued to Example Person 1.
original issue discount: USD 10,083.00
other periodic interest: USD 10,083.00
payer: Example Entity 0-1-2
recipient: Example Entity 0-1-3",1099,5,1099,fdc-357bb34d05db3efa62596334,synthetic-form-layout-00,original,2024,fte-0bd40efdf7a1078a77b852e2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2025
Statement issued to Example Person 2.
original issue discount: USD 10,166.00
other periodic interest: USD 10,166.00
payer: Example Entity 0-2-2
recipient: Example Entity 0-2-3",1099,5,1099,fdc-7184b2fd582883aef387932a,synthetic-form-layout-00,original,2025,fte-79eb443a507588fc845315e9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2023
Statement issued to Example Person 3.
original issue discount: USD 10,249.00
other periodic interest: USD 10,249.00
payer: Example Entity 0-3-2
recipient: Example Entity 0-3-3",1099,5,1099,fdc-b1e0452903eb3848b67d8ab3,synthetic-form-layout-00,original,2023,fte-d3d8eaef5396e91057c1802b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2024
Statement issued to Example Person 4.
original issue discount: USD 10,332.00
other periodic interest: USD 10,332.00
payer: Example Entity 0-4-2
recipient: Example Entity 0-4-3",1099,5,1099,fdc-96c79dd8b3eaf224c6e72816,synthetic-form-layout-00,original,2024,fte-9e7a5388b3d91dd623f532ac,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2025
Statement issued to Example Person 5.
original issue discount: USD 10,415.00
other periodic interest: USD 10,415.00
payer: Example Entity 0-5-2
recipient: Example Entity 0-5-3",1099,5,1099,fdc-02b570461c6ee7397596e478,synthetic-form-layout-00,original,2025,fte-5702b4418518ce47659eb20d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2023
Statement issued to Example Person 6.
original issue discount: USD 10,498.00
other periodic interest: USD 10,498.00
payer: Example Entity 0-6-2
recipient: Example Entity 0-6-3",1099,5,1099,fdc-f24366e4d0940bff9d6b5c38,synthetic-form-layout-00,original,2023,fte-c748e307607918b7fe53a9e6,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Calendar year: 2024
Statement issued to Example Person 7.
original issue discount: USD 10,581.00
other periodic interest: USD 10,581.00
payer: Example Entity 0-7-2
recipient: Example Entity 0-7-3",1099,5,1099,fdc-12186bb6ce63a0093f588b04,synthetic-form-layout-00,original,2024,fte-5ab9e8e47a92d6994d42ac4e,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 100
original issue discount: USD 10,137.00 | other periodic interest: USD 10,137.00 | payer: Example Entity 1-0-2 | recipient: Example Entity 1-0-3",1099,5,1099,fdc-3761c19c098dfe49b51b4f71,synthetic-form-layout-01,original,2023,fte-0c5bc091c11cafd2b9733db0,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 101
original issue discount: USD 10,220.00 | other periodic interest: USD 10,220.00 | payer: Example Entity 1-1-2 | recipient: Example Entity 1-1-3",1099,5,1099,fdc-8d18c23e7cb1216b3dc6afd5,synthetic-form-layout-01,original,2024,fte-41f3e14a938aba99cf77c3db,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 102
original issue discount: USD 10,303.00 | other periodic interest: USD 10,303.00 | payer: Example Entity 1-2-2 | recipient: Example Entity 1-2-3",1099,5,1099,fdc-622bbb5e8ee79d5d278011ff,synthetic-form-layout-01,original,2025,fte-ac95a03e1a472e29e495a24f,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 103
original issue discount: USD 10,386.00 | other periodic interest: USD 10,386.00 | payer: Example Entity 1-3-2 | recipient: Example Entity 1-3-3",1099,5,1099,fdc-f1037463987a48cf77325ed3,synthetic-form-layout-01,original,2023,fte-6963dffa3920cd26e790060c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 104
original issue discount: USD 10,469.00 | other periodic interest: USD 10,469.00 | payer: Example Entity 1-4-2 | recipient: Example Entity 1-4-3",1099,5,1099,fdc-17439e583c628443490414c4,synthetic-form-layout-01,original,2024,fte-f7f604998b147dd5ce281fdf,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 105
original issue discount: USD 10,552.00 | other periodic interest: USD 10,552.00 | payer: Example Entity 1-5-2 | recipient: Example Entity 1-5-3",1099,5,1099,fdc-c35da70412feba7307e8bf3a,synthetic-form-layout-01,original,2025,fte-a9d360f883507b1ca7d26aad,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 106
original issue discount: USD 10,635.00 | other periodic interest: USD 10,635.00 | payer: Example Entity 1-6-2 | recipient: Example Entity 1-6-3",1099,5,1099,fdc-7d8546c1c6ca7a25f4ba9558,synthetic-form-layout-01,original,2023,fte-bcd43981f6617f1356edb02c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-OID: Original Issue Discount
Recipient record: Example Person 107
original issue discount: USD 10,718.00 | other periodic interest: USD 10,718.00 | payer: Example Entity 1-7-2 | recipient: Example Entity 1-7-3",1099,5,1099,fdc-3e3a61a93a0f819cf3102027,synthetic-form-layout-01,original,2024,fte-941c0fcae8b99eb15765cc37,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,274.00; other periodic interest: USD 10,274.00; payer: Example Entity 2-0-2; recipient: Example Entity 2-0-3. Recipient: Example Household 200.",1099,5,1099,fdc-9fd053faced3f46a2df49f09,synthetic-form-layout-02,original,2023,fte-d598cd91fee8558721855a19,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,357.00; other periodic interest: USD 10,357.00; payer: Example Entity 2-1-2; recipient: Example Entity 2-1-3. Recipient: Example Household 201.",1099,5,1099,fdc-8cbc82c26d2379716dc35d2b,synthetic-form-layout-02,original,2024,fte-d63734deb07a7e77aec82ce2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,440.00; other periodic interest: USD 10,440.00; payer: Example Entity 2-2-2; recipient: Example Entity 2-2-3. Recipient: Example Household 202.",1099,5,1099,fdc-203321a118060791e1df05c4,synthetic-form-layout-02,original,2025,fte-11d3d3e41bf6890830864acb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,523.00; other periodic interest: USD 10,523.00; payer: Example Entity 2-3-2; recipient: Example Entity 2-3-3. Recipient: Example Household 203.",1099,5,1099,fdc-166f8dc2e409758b66a018e3,synthetic-form-layout-02,original,2023,fte-beeed0293e2ef944a7d3882a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,606.00; other periodic interest: USD 10,606.00; payer: Example Entity 2-4-2; recipient: Example Entity 2-4-3. Recipient: Example Household 204.",1099,5,1099,fdc-344a738188f077a775cf1848,synthetic-form-layout-02,original,2024,fte-fb791ff71e6480d3c3b5d359,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,689.00; other periodic interest: USD 10,689.00; payer: Example Entity 2-5-2; recipient: Example Entity 2-5-3. Recipient: Example Household 205.",1099,5,1099,fdc-93a6d6602f6a96bfe5c35240,synthetic-form-layout-02,original,2025,fte-4134066485c16b82090dec75,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,772.00; other periodic interest: USD 10,772.00; payer: Example Entity 2-6-2; recipient: Example Entity 2-6-3. Recipient: Example Household 206.",1099,5,1099,fdc-42c4f0e5e46b95471cf60cf3,synthetic-form-layout-02,original,2023,fte-6fbff57d0fce9c00a904c106,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-OID: Original Issue Discount.
original issue discount: USD 10,855.00; other periodic interest: USD 10,855.00; payer: Example Entity 2-7-2; recipient: Example Entity 2-7-3. Recipient: Example Household 207.",1099,5,1099,fdc-915eecf2a127fa99beee91db,synthetic-form-layout-02,original,2024,fte-bda75430907c19aea7907e86,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2023.
Details: original issue discount: USD 10,411.00, other periodic interest: USD 10,411.00, payer: Example Entity 3-0-2, recipient: Example Entity 3-0-3. Account holder: Example Person 300.",1099,5,1099,fdc-e18edbc1819ab40925b38e60,synthetic-form-layout-03,original,2023,fte-3e2318c2991987404643c955,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2024.
Details: original issue discount: USD 10,494.00, other periodic interest: USD 10,494.00, payer: Example Entity 3-1-2, recipient: Example Entity 3-1-3. Account holder: Example Person 301.",1099,5,1099,fdc-08a66a60aece7614f6fec48b,synthetic-form-layout-03,original,2024,fte-f59062e4ec86d6b318901148,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2025.
Details: original issue discount: USD 10,577.00, other periodic interest: USD 10,577.00, payer: Example Entity 3-2-2, recipient: Example Entity 3-2-3. Account holder: Example Person 302.",1099,5,1099,fdc-094e480a764205597564e704,synthetic-form-layout-03,original,2025,fte-bf8386cf4a770484ce0f0926,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2023.
Details: original issue discount: USD 10,660.00, other periodic interest: USD 10,660.00, payer: Example Entity 3-3-2, recipient: Example Entity 3-3-3. Account holder: Example Person 303.",1099,5,1099,fdc-4939104dec9549801d57719c,synthetic-form-layout-03,original,2023,fte-022cfcc4f2e2116731eb008f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2024.
Details: original issue discount: USD 10,743.00, other periodic interest: USD 10,743.00, payer: Example Entity 3-4-2, recipient: Example Entity 3-4-3. Account holder: Example Person 304.",1099,5,1099,fdc-e945b6363eaf47a8df280d73,synthetic-form-layout-03,original,2024,fte-b6ada6aad0837b79f7c9890f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2025.
Details: original issue discount: USD 10,826.00, other periodic interest: USD 10,826.00, payer: Example Entity 3-5-2, recipient: Example Entity 3-5-3. Account holder: Example Person 305.",1099,5,1099,fdc-8a58e9818c7efe6d69eed8d6,synthetic-form-layout-03,original,2025,fte-45e2a9260f4efe5b1f4bd329,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2023.
Details: original issue discount: USD 10,909.00, other periodic interest: USD 10,909.00, payer: Example Entity 3-6-2, recipient: Example Entity 3-6-3. Account holder: Example Person 306.",1099,5,1099,fdc-bb925dd38df7c91d9465c680,synthetic-form-layout-03,original,2023,fte-1276d8630f2d70b0a7844967,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount
Reporting period ended 12/31/2024.
Details: original issue discount: USD 10,992.00, other periodic interest: USD 10,992.00, payer: Example Entity 3-7-2, recipient: Example Entity 3-7-3. Account holder: Example Person 307.",1099,5,1099,fdc-9e495ebedf1c9758b2cd2041,synthetic-form-layout-03,original,2024,fte-e3058610c08bc8eec42b6c14,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2023
recipient: Example Entity 4-0-3
payer: Example Entity 4-0-2
other periodic interest: USD 10,548.00
original issue discount: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-0d6a3fd97b717b90a5bba2c9,synthetic-form-layout-04,original,2023,fte-83b3982e8b9fdf85da350433,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2024
recipient: Example Entity 4-1-3
payer: Example Entity 4-1-2
other periodic interest: USD 10,631.00
original issue discount: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-976e5e9e8ea3fea1536991a5,synthetic-form-layout-04,original,2024,fte-40f8be562f1ba94e41904286,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2025
recipient: Example Entity 4-2-3
payer: Example Entity 4-2-2
other periodic interest: USD 10,714.00
original issue discount: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-945f030d706428fddfce98a1,synthetic-form-layout-04,original,2025,fte-24149856a47b80ce307155b0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2023
recipient: Example Entity 4-3-3
payer: Example Entity 4-3-2
other periodic interest: USD 10,797.00
original issue discount: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-bced96b056e155974036ba60,synthetic-form-layout-04,original,2023,fte-ec5a6c2367909d318a02ffc3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2024
recipient: Example Entity 4-4-3
payer: Example Entity 4-4-2
other periodic interest: USD 10,880.00
original issue discount: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-1873fff6fb79658d8ea06bd9,synthetic-form-layout-04,original,2024,fte-b4ecf13f1e04e69bd8c8474b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2025
recipient: Example Entity 4-5-3
payer: Example Entity 4-5-2
other periodic interest: USD 10,963.00
original issue discount: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-6790dd5174c93988f4013a20,synthetic-form-layout-04,original,2025,fte-26f36854ad174e2b70e2b434,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2023
recipient: Example Entity 4-6-3
payer: Example Entity 4-6-2
other periodic interest: USD 11,046.00
original issue discount: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-899c21781250599ce2282cbe,synthetic-form-layout-04,original,2023,fte-6246cb55e7fcd14e4c3adc76,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-OID: Original Issue Discount
Tax reporting year 2024
recipient: Example Entity 4-7-3
payer: Example Entity 4-7-2
other periodic interest: USD 11,129.00
original issue discount: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-f78886654857e05274cd3549,synthetic-form-layout-04,original,2024,fte-3b8277ff95dd38c6cb50d0c8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2023
original issue discount: USD 10,685.00 / other periodic interest: USD 10,685.00 / payer: Example Entity 5-0-2 / recipient: Example Entity 5-0-3
Delivery copy for Example Party 500",1099,5,1099,fdc-d7c4aa0c140ae55051ef1990,synthetic-form-layout-05,original,2023,fte-37c8f993df81ab6400254b85,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2024
original issue discount: USD 10,768.00 / other periodic interest: USD 10,768.00 / payer: Example Entity 5-1-2 / recipient: Example Entity 5-1-3
Delivery copy for Example Party 501",1099,5,1099,fdc-07be2e3bea9750d5cdfedcc2,synthetic-form-layout-05,original,2024,fte-f927756c3d884017407fe61d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2025
original issue discount: USD 10,851.00 / other periodic interest: USD 10,851.00 / payer: Example Entity 5-2-2 / recipient: Example Entity 5-2-3
Delivery copy for Example Party 502",1099,5,1099,fdc-83a2286dd0587f44d118365d,synthetic-form-layout-05,original,2025,fte-f0bf440030723ce6cf2ab987,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2023
original issue discount: USD 10,934.00 / other periodic interest: USD 10,934.00 / payer: Example Entity 5-3-2 / recipient: Example Entity 5-3-3
Delivery copy for Example Party 503",1099,5,1099,fdc-148fcc571c1c554dad42bb5c,synthetic-form-layout-05,original,2023,fte-597236592fdbfcf739afb96d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2024
original issue discount: USD 11,017.00 / other periodic interest: USD 11,017.00 / payer: Example Entity 5-4-2 / recipient: Example Entity 5-4-3
Delivery copy for Example Party 504",1099,5,1099,fdc-53e85597a2399c6cb3e81bba,synthetic-form-layout-05,original,2024,fte-9fb2c625e4227961890fb338,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2025
original issue discount: USD 11,100.00 / other periodic interest: USD 11,100.00 / payer: Example Entity 5-5-2 / recipient: Example Entity 5-5-3
Delivery copy for Example Party 505",1099,5,1099,fdc-27ed51c16ca7e26adefa7853,synthetic-form-layout-05,original,2025,fte-041963bda8a0ac90b6c0ef81,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2023
original issue discount: USD 11,183.00 / other periodic interest: USD 11,183.00 / payer: Example Entity 5-6-2 / recipient: Example Entity 5-6-3
Delivery copy for Example Party 506",1099,5,1099,fdc-38c6f7382f2fbb5051527a44,synthetic-form-layout-05,original,2023,fte-732bf729e44bd6090e9058c3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-OID: Original Issue Discount -- reporting year 2024
original issue discount: USD 11,266.00 / other periodic interest: USD 11,266.00 / payer: Example Entity 5-7-2 / recipient: Example Entity 5-7-3
Delivery copy for Example Party 507",1099,5,1099,fdc-2d92ae16f84c3d87b4539972,synthetic-form-layout-05,original,2024,fte-ff6950d707910d3242bd5eb2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2023
Statement issued to Example Person 0.
description of property: Example Entity 0-0-0
date acquired: 2023-03-01
proceeds: USD 10,000.00
cost basis: USD 7,000.00",1099,5,1099,fdc-7389035389aa182fbbc3d8c0,synthetic-form-layout-00,original,2023,fte-f20d6d25b925868ef9a93b68,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2024
Statement issued to Example Person 1.
description of property: Example Entity 0-1-0
date acquired: 2024-03-02
proceeds: USD 10,083.00
cost basis: USD 7,058.10",1099,5,1099,fdc-562139da8e04fc1f874ca909,synthetic-form-layout-00,original,2024,fte-522297fd0e7bf679d311b71b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2025
Statement issued to Example Person 2.
description of property: Example Entity 0-2-0
date acquired: 2025-03-03
proceeds: USD 10,166.00
cost basis: USD 7,116.20",1099,5,1099,fdc-8a3f71a4782fa6033f9cde8e,synthetic-form-layout-00,original,2025,fte-f3e5e5a73cc77a3f8f765f54,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2023
Statement issued to Example Person 3.
description of property: Example Entity 0-3-0
date acquired: 2023-03-04
proceeds: USD 10,249.00
cost basis: USD 7,174.30",1099,5,1099,fdc-c67d5d8b82a820f06aac9d75,synthetic-form-layout-00,original,2023,fte-cfb3217c15dc22e36ab980ee,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2024
Statement issued to Example Person 4.
description of property: Example Entity 0-4-0
date acquired: 2024-03-05
proceeds: USD 10,332.00
cost basis: USD 7,232.40",1099,5,1099,fdc-292e3598933b41a19f723f8b,synthetic-form-layout-00,original,2024,fte-94f48f64dd45c6c82480ccae,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2025
Statement issued to Example Person 5.
description of property: Example Entity 0-5-0
date acquired: 2025-03-06
proceeds: USD 10,415.00
cost basis: USD 7,290.50",1099,5,1099,fdc-17a992c76e5a9ed33697b697,synthetic-form-layout-00,original,2025,fte-58a1e3064401d65bcee9037a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2023
Statement issued to Example Person 6.
description of property: Example Entity 0-6-0
date acquired: 2023-03-07
proceeds: USD 10,498.00
cost basis: USD 7,348.60",1099,5,1099,fdc-fd347d6e94082bec47e86e33,synthetic-form-layout-00,original,2023,fte-4be0a51547b17e5823e467ff,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Calendar year: 2024
Statement issued to Example Person 7.
description of property: Example Entity 0-7-0
date acquired: 2024-03-08
proceeds: USD 10,581.00
cost basis: USD 7,406.70",1099,5,1099,fdc-d71980f363472639e927a95e,synthetic-form-layout-00,original,2024,fte-ef3df94ce19e03c31b68cd50,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 100
description of property: Example Entity 1-0-0 | date acquired: 2023-03-01 | proceeds: USD 10,137.00 | cost basis: USD 7,095.90",1099,5,1099,fdc-cd136488f1a2bc9eaeae6cd4,synthetic-form-layout-01,original,2023,fte-ee54b5cb5d57dda927736236,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 101
description of property: Example Entity 1-1-0 | date acquired: 2024-03-02 | proceeds: USD 10,220.00 | cost basis: USD 7,154.00",1099,5,1099,fdc-1b221bbfc92190f44991d2ae,synthetic-form-layout-01,original,2024,fte-937a20577ed0eeabf9cd2b15,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 102
description of property: Example Entity 1-2-0 | date acquired: 2025-03-03 | proceeds: USD 10,303.00 | cost basis: USD 7,212.10",1099,5,1099,fdc-296c942b28e61a8c6616585f,synthetic-form-layout-01,original,2025,fte-03b6d6ffd8701db00dd69f86,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 103
description of property: Example Entity 1-3-0 | date acquired: 2023-03-04 | proceeds: USD 10,386.00 | cost basis: USD 7,270.20",1099,5,1099,fdc-71935d3548f06f036b202c14,synthetic-form-layout-01,original,2023,fte-fa9b6df22fff0f83fc2409a1,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 104
description of property: Example Entity 1-4-0 | date acquired: 2024-03-05 | proceeds: USD 10,469.00 | cost basis: USD 7,328.30",1099,5,1099,fdc-7c19189ced222395330bbb50,synthetic-form-layout-01,original,2024,fte-539b023374e92507feab57e4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 105
description of property: Example Entity 1-5-0 | date acquired: 2025-03-06 | proceeds: USD 10,552.00 | cost basis: USD 7,386.40",1099,5,1099,fdc-61d9764b20b01556c201c9d5,synthetic-form-layout-01,original,2025,fte-9b05c14d1f491f6ab095894c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 106
description of property: Example Entity 1-6-0 | date acquired: 2023-03-07 | proceeds: USD 10,635.00 | cost basis: USD 7,444.50",1099,5,1099,fdc-1a8e57a508b5c13e5df25cac,synthetic-form-layout-01,original,2023,fte-4c4ae8c06582f490304b53a5,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Recipient record: Example Person 107
description of property: Example Entity 1-7-0 | date acquired: 2024-03-08 | proceeds: USD 10,718.00 | cost basis: USD 7,502.60",1099,5,1099,fdc-84d3f1847fab4c1ccd643064,synthetic-form-layout-01,original,2024,fte-030ecfafc1afdfdf78f33a40,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-0-0; date acquired: 2023-03-01; proceeds: USD 10,274.00; cost basis: USD 7,191.80. Recipient: Example Household 200.",1099,5,1099,fdc-6a6e6d6c78c8012d02109525,synthetic-form-layout-02,original,2023,fte-dd9268c7a4700da57f019756,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-1-0; date acquired: 2024-03-02; proceeds: USD 10,357.00; cost basis: USD 7,249.90. Recipient: Example Household 201.",1099,5,1099,fdc-8ee6fb86810c1d97adafddb2,synthetic-form-layout-02,original,2024,fte-569ae7c6f4a92cdd14ca114e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-2-0; date acquired: 2025-03-03; proceeds: USD 10,440.00; cost basis: USD 7,308.00. Recipient: Example Household 202.",1099,5,1099,fdc-1b6b0759d8a7186ba0c5891f,synthetic-form-layout-02,original,2025,fte-8a548317c3fceaf7f5b36a2e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-3-0; date acquired: 2023-03-04; proceeds: USD 10,523.00; cost basis: USD 7,366.10. Recipient: Example Household 203.",1099,5,1099,fdc-186e204c57a5932fb3d15a05,synthetic-form-layout-02,original,2023,fte-8f6be56aade2023d37289454,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-4-0; date acquired: 2024-03-05; proceeds: USD 10,606.00; cost basis: USD 7,424.20. Recipient: Example Household 204.",1099,5,1099,fdc-733ba74402b32551b6f0ae50,synthetic-form-layout-02,original,2024,fte-21b6ef89e531ef3246d6fee9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-5-0; date acquired: 2025-03-06; proceeds: USD 10,689.00; cost basis: USD 7,482.30. Recipient: Example Household 205.",1099,5,1099,fdc-d27c4c736e60f4e34b204aa0,synthetic-form-layout-02,original,2025,fte-7f8b2a1492979d2c075375fb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-6-0; date acquired: 2023-03-07; proceeds: USD 10,772.00; cost basis: USD 7,540.40. Recipient: Example Household 206.",1099,5,1099,fdc-093d5e85b7b35495b434bada,synthetic-form-layout-02,original,2023,fte-bd85f56dc147d6f149c3020f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-B: Proceeds From Broker and Barter Exchange Transactions.
description of property: Example Entity 2-7-0; date acquired: 2024-03-08; proceeds: USD 10,855.00; cost basis: USD 7,598.50. Recipient: Example Household 207.",1099,5,1099,fdc-8391757422b62b49ff944387,synthetic-form-layout-02,original,2024,fte-8c1b3d9098683daa0fc1959d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2023.
Details: description of property: Example Entity 3-0-0, date acquired: 2023-03-01, proceeds: USD 10,411.00, cost basis: USD 7,287.70. Account holder: Example Person 300.",1099,5,1099,fdc-9fa35c9aace0368c720f1e88,synthetic-form-layout-03,original,2023,fte-d4b9f1199b1c07c1bfdc71d7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2024.
Details: description of property: Example Entity 3-1-0, date acquired: 2024-03-02, proceeds: USD 10,494.00, cost basis: USD 7,345.80. Account holder: Example Person 301.",1099,5,1099,fdc-94b0f4881f02f769d9901a40,synthetic-form-layout-03,original,2024,fte-c76d7f8ad35af000f4fa736c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2025.
Details: description of property: Example Entity 3-2-0, date acquired: 2025-03-03, proceeds: USD 10,577.00, cost basis: USD 7,403.90. Account holder: Example Person 302.",1099,5,1099,fdc-542cb49686bf59bbb00c6713,synthetic-form-layout-03,original,2025,fte-2692cf8cf1a01137e3615102,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2023.
Details: description of property: Example Entity 3-3-0, date acquired: 2023-03-04, proceeds: USD 10,660.00, cost basis: USD 7,462.00. Account holder: Example Person 303.",1099,5,1099,fdc-6bd7d42944ac4702b45aa7d4,synthetic-form-layout-03,original,2023,fte-9485e41dc23f12499d2d7450,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2024.
Details: description of property: Example Entity 3-4-0, date acquired: 2024-03-05, proceeds: USD 10,743.00, cost basis: USD 7,520.10. Account holder: Example Person 304.",1099,5,1099,fdc-069cdd2a1be2d4681cee6218,synthetic-form-layout-03,original,2024,fte-d51925e786a230b92c63d5c8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2025.
Details: description of property: Example Entity 3-5-0, date acquired: 2025-03-06, proceeds: USD 10,826.00, cost basis: USD 7,578.20. Account holder: Example Person 305.",1099,5,1099,fdc-df6e2c30f26589aa184e97c2,synthetic-form-layout-03,original,2025,fte-6693b155cd2846ab3cf3def7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2023.
Details: description of property: Example Entity 3-6-0, date acquired: 2023-03-07, proceeds: USD 10,909.00, cost basis: USD 7,636.30. Account holder: Example Person 306.",1099,5,1099,fdc-1748b213ba184d8810af3a6f,synthetic-form-layout-03,original,2023,fte-9cf9d078ddb8b38c7f757a0d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Reporting period ended 12/31/2024.
Details: description of property: Example Entity 3-7-0, date acquired: 2024-03-08, proceeds: USD 10,992.00, cost basis: USD 7,694.40. Account holder: Example Person 307.",1099,5,1099,fdc-071d71a8e5de9a689f86524e,synthetic-form-layout-03,original,2024,fte-54b4603f23eb00cab5d21264,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2023
cost basis: USD 7,383.60
proceeds: USD 10,548.00
date acquired: 2023-03-01
description of property: Example Entity 4-0-0
Named party: Example Person 400",1099,5,1099,fdc-c89a658a34467df3de61efb4,synthetic-form-layout-04,original,2023,fte-2cd4ebaeadeb5bc697217f8d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2024
cost basis: USD 7,441.70
proceeds: USD 10,631.00
date acquired: 2024-03-02
description of property: Example Entity 4-1-0
Named party: Example Person 401",1099,5,1099,fdc-c04d7ed5b4f4091ed7b488a9,synthetic-form-layout-04,original,2024,fte-d391e7f12085728d5071fc14,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2025
cost basis: USD 7,499.80
proceeds: USD 10,714.00
date acquired: 2025-03-03
description of property: Example Entity 4-2-0
Named party: Example Person 402",1099,5,1099,fdc-29b4ce1d85558ce7a67631e2,synthetic-form-layout-04,original,2025,fte-de5d30edd74a89d388a045f5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2023
cost basis: USD 7,557.90
proceeds: USD 10,797.00
date acquired: 2023-03-04
description of property: Example Entity 4-3-0
Named party: Example Person 403",1099,5,1099,fdc-a1b2397b76f710dce0e0966a,synthetic-form-layout-04,original,2023,fte-a265b03791e40715e27201c5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2024
cost basis: USD 7,616.00
proceeds: USD 10,880.00
date acquired: 2024-03-05
description of property: Example Entity 4-4-0
Named party: Example Person 404",1099,5,1099,fdc-8617a8f344c731ca2ac1e510,synthetic-form-layout-04,original,2024,fte-b624cfabd9cc54fa76818034,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2025
cost basis: USD 7,674.10
proceeds: USD 10,963.00
date acquired: 2025-03-06
description of property: Example Entity 4-5-0
Named party: Example Person 405",1099,5,1099,fdc-ad0c013cabe4edff5e0f0787,synthetic-form-layout-04,original,2025,fte-584aa8a7a37914ec298362b3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2023
cost basis: USD 7,732.20
proceeds: USD 11,046.00
date acquired: 2023-03-07
description of property: Example Entity 4-6-0
Named party: Example Person 406",1099,5,1099,fdc-a83aa91b37557fac5ac41851,synthetic-form-layout-04,original,2023,fte-9377bc90db3b75ff74326f11,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-B: Proceeds From Broker and Barter Exchange Transactions
Tax reporting year 2024
cost basis: USD 7,790.30
proceeds: USD 11,129.00
date acquired: 2024-03-08
description of property: Example Entity 4-7-0
Named party: Example Person 407",1099,5,1099,fdc-e6549969524765b3844075be,synthetic-form-layout-04,original,2024,fte-b66ca82de4d4b57aab85d0bf,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2023
description of property: Example Entity 5-0-0 / date acquired: 2023-03-01 / proceeds: USD 10,685.00 / cost basis: USD 7,479.50
Delivery copy for Example Party 500",1099,5,1099,fdc-905545fc7301a225a05fa359,synthetic-form-layout-05,original,2023,fte-1d0623dfe2b8060e6074da10,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2024
description of property: Example Entity 5-1-0 / date acquired: 2024-03-02 / proceeds: USD 10,768.00 / cost basis: USD 7,537.60
Delivery copy for Example Party 501",1099,5,1099,fdc-5131310ef4cb546e57cade3b,synthetic-form-layout-05,original,2024,fte-ae1c97196a79901869188fbf,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2025
description of property: Example Entity 5-2-0 / date acquired: 2025-03-03 / proceeds: USD 10,851.00 / cost basis: USD 7,595.70
Delivery copy for Example Party 502",1099,5,1099,fdc-8d7a37744a28be6bef756b80,synthetic-form-layout-05,original,2025,fte-be844312eba6f0e4ab8a27a3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2023
description of property: Example Entity 5-3-0 / date acquired: 2023-03-04 / proceeds: USD 10,934.00 / cost basis: USD 7,653.80
Delivery copy for Example Party 503",1099,5,1099,fdc-b68540863ab933f5bb63f48b,synthetic-form-layout-05,original,2023,fte-e7eb3d1b3a64e28d147847a4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2024
description of property: Example Entity 5-4-0 / date acquired: 2024-03-05 / proceeds: USD 11,017.00 / cost basis: USD 7,711.90
Delivery copy for Example Party 504",1099,5,1099,fdc-765ec166a6967d55e6f2b3f2,synthetic-form-layout-05,original,2024,fte-0a6a0176d01861f3fdf4da3c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2025
description of property: Example Entity 5-5-0 / date acquired: 2025-03-06 / proceeds: USD 11,100.00 / cost basis: USD 7,770.00
Delivery copy for Example Party 505",1099,5,1099,fdc-b072aa248cba108efda88925,synthetic-form-layout-05,original,2025,fte-0e68e6d0e76dadc9f5c36559,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2023
description of property: Example Entity 5-6-0 / date acquired: 2023-03-07 / proceeds: USD 11,183.00 / cost basis: USD 7,828.10
Delivery copy for Example Party 506",1099,5,1099,fdc-8888b4cccb92086417e899e8,synthetic-form-layout-05,original,2023,fte-d64710a2c157fb9cf27417ba,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-B: Proceeds From Broker and Barter Exchange Transactions -- reporting year 2024
description of property: Example Entity 5-7-0 / date acquired: 2024-03-08 / proceeds: USD 11,266.00 / cost basis: USD 7,886.20
Delivery copy for Example Party 507",1099,5,1099,fdc-dfac0f41efd3580365790e77,synthetic-form-layout-05,original,2024,fte-89cdc54699e6d9a23e84cc59,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 0.
digital asset: USD 10,000.00
proceeds: USD 10,000.00
date sold: 2025-03-01
basis if reported: USD 7,000.00",1099,5,1099,fdc-8cd729c7a68df54f67692b35,synthetic-form-layout-00,original,2025,fte-d454f2634dae3b02063243cf,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 1.
digital asset: USD 10,083.00
proceeds: USD 10,083.00
date sold: 2025-03-02
basis if reported: USD 7,058.10",1099,5,1099,fdc-0a76bce25f132d552e0e96e6,synthetic-form-layout-00,original,2025,fte-3ddef4632e9903587799697a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 2.
digital asset: USD 10,166.00
proceeds: USD 10,166.00
date sold: 2025-03-03
basis if reported: USD 7,116.20",1099,5,1099,fdc-6e8be45d918df603cc0e67fd,synthetic-form-layout-00,original,2025,fte-cc06ca72b07edfb1a1d3ef5e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 3.
digital asset: USD 10,249.00
proceeds: USD 10,249.00
date sold: 2025-03-04
basis if reported: USD 7,174.30",1099,5,1099,fdc-c3b74123ce526629b9cc3e85,synthetic-form-layout-00,original,2025,fte-b5e4c2ca4cbff038ecdffee2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 4.
digital asset: USD 10,332.00
proceeds: USD 10,332.00
date sold: 2025-03-05
basis if reported: USD 7,232.40",1099,5,1099,fdc-aa04db558da14b4b83cfa6ec,synthetic-form-layout-00,original,2025,fte-8d7892c9139a4d9a94f67671,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 5.
digital asset: USD 10,415.00
proceeds: USD 10,415.00
date sold: 2025-03-06
basis if reported: USD 7,290.50",1099,5,1099,fdc-d1000af9df1155b5e8e0303d,synthetic-form-layout-00,original,2025,fte-1d1cce3cfab01127a66507c5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 6.
digital asset: USD 10,498.00
proceeds: USD 10,498.00
date sold: 2025-03-07
basis if reported: USD 7,348.60",1099,5,1099,fdc-8429bdf5b647560d3539abc2,synthetic-form-layout-00,original,2025,fte-67b2da2184a112e3e01914ce,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Calendar year: 2025
Statement issued to Example Person 7.
digital asset: USD 10,581.00
proceeds: USD 10,581.00
date sold: 2025-03-08
basis if reported: USD 7,406.70",1099,5,1099,fdc-b88bdd89722a7ffc76ab6b48,synthetic-form-layout-00,original,2025,fte-e59b7e9ab18729df22ff8db7,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 100
digital asset: USD 10,137.00 | proceeds: USD 10,137.00 | date sold: 2025-03-01 | basis if reported: USD 7,095.90",1099,5,1099,fdc-8bb53c1c999e777dc022ef64,synthetic-form-layout-01,original,2025,fte-03f8790cdd113ebe13c267cc,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 101
digital asset: USD 10,220.00 | proceeds: USD 10,220.00 | date sold: 2025-03-02 | basis if reported: USD 7,154.00",1099,5,1099,fdc-6ec909c965c46ed2daef57c6,synthetic-form-layout-01,original,2025,fte-fab41d3cefdeec858f8b3457,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 102
digital asset: USD 10,303.00 | proceeds: USD 10,303.00 | date sold: 2025-03-03 | basis if reported: USD 7,212.10",1099,5,1099,fdc-45a641795d85c7db3024fa91,synthetic-form-layout-01,original,2025,fte-c449a1a3f1ddf32a033c54ca,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 103
digital asset: USD 10,386.00 | proceeds: USD 10,386.00 | date sold: 2025-03-04 | basis if reported: USD 7,270.20",1099,5,1099,fdc-c7fa0b142c013cddc684d2e0,synthetic-form-layout-01,original,2025,fte-3c2b8e3a5fd244c6d10c61c4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 104
digital asset: USD 10,469.00 | proceeds: USD 10,469.00 | date sold: 2025-03-05 | basis if reported: USD 7,328.30",1099,5,1099,fdc-f42fdb95b6908a1eac417d81,synthetic-form-layout-01,original,2025,fte-828ac21550a36123c8701211,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 105
digital asset: USD 10,552.00 | proceeds: USD 10,552.00 | date sold: 2025-03-06 | basis if reported: USD 7,386.40",1099,5,1099,fdc-0054b65d81afd708b33ae09b,synthetic-form-layout-01,original,2025,fte-4f5a008e3254809014d1c39f,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 106
digital asset: USD 10,635.00 | proceeds: USD 10,635.00 | date sold: 2025-03-07 | basis if reported: USD 7,444.50",1099,5,1099,fdc-7f68c0a65373ad4f24d423db,synthetic-form-layout-01,original,2025,fte-ea5adfe0a7f159e4659d7c02,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Recipient record: Example Person 107
digital asset: USD 10,718.00 | proceeds: USD 10,718.00 | date sold: 2025-03-08 | basis if reported: USD 7,502.60",1099,5,1099,fdc-6917678892a34d5a942e0d2c,synthetic-form-layout-01,original,2025,fte-fe359ac4b77f4bd0563b3e3a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,274.00; proceeds: USD 10,274.00; date sold: 2025-03-01; basis if reported: USD 7,191.80. Recipient: Example Household 200.",1099,5,1099,fdc-a44f7d822a0aec929bb1ff40,synthetic-form-layout-02,original,2025,fte-e23c2a5372fa28c9b060a877,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,357.00; proceeds: USD 10,357.00; date sold: 2025-03-02; basis if reported: USD 7,249.90. Recipient: Example Household 201.",1099,5,1099,fdc-a3d5779198eb0ad9a2b98b69,synthetic-form-layout-02,original,2025,fte-95eec66e36dc6d41b559c68f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,440.00; proceeds: USD 10,440.00; date sold: 2025-03-03; basis if reported: USD 7,308.00. Recipient: Example Household 202.",1099,5,1099,fdc-6192be3427ee5bfbdcf3148c,synthetic-form-layout-02,original,2025,fte-943c3d4394b9e83d6f04f67b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,523.00; proceeds: USD 10,523.00; date sold: 2025-03-04; basis if reported: USD 7,366.10. Recipient: Example Household 203.",1099,5,1099,fdc-7a9f8149586d4887c061c785,synthetic-form-layout-02,original,2025,fte-09d1853fa0b1a107f12ed904,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,606.00; proceeds: USD 10,606.00; date sold: 2025-03-05; basis if reported: USD 7,424.20. Recipient: Example Household 204.",1099,5,1099,fdc-332aab110001c13e3f8eecd5,synthetic-form-layout-02,original,2025,fte-507ab0423aa853328d82a1d8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,689.00; proceeds: USD 10,689.00; date sold: 2025-03-06; basis if reported: USD 7,482.30. Recipient: Example Household 205.",1099,5,1099,fdc-4469f78d312a8106daba9563,synthetic-form-layout-02,original,2025,fte-3b7c35356ad1dbef33ef4e36,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,772.00; proceeds: USD 10,772.00; date sold: 2025-03-07; basis if reported: USD 7,540.40. Recipient: Example Household 206.",1099,5,1099,fdc-b534323bb0994f0f7a49d4d8,synthetic-form-layout-02,original,2025,fte-4199b5297228f226b6f06545,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-DA: Digital Asset Proceeds From Broker Transactions.
digital asset: USD 10,855.00; proceeds: USD 10,855.00; date sold: 2025-03-08; basis if reported: USD 7,598.50. Recipient: Example Household 207.",1099,5,1099,fdc-75b1966ad4fb7a819734fe24,synthetic-form-layout-02,original,2025,fte-cea032d0792bfe9ecffb0cde,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,411.00, proceeds: USD 10,411.00, date sold: 2025-03-01, basis if reported: USD 7,287.70. Account holder: Example Person 300.",1099,5,1099,fdc-1eca5b17e12a8912aa909cb9,synthetic-form-layout-03,original,2025,fte-7d106041aef5dce9eea62a98,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,494.00, proceeds: USD 10,494.00, date sold: 2025-03-02, basis if reported: USD 7,345.80. Account holder: Example Person 301.",1099,5,1099,fdc-3c0f1d66090b7fa2b2f21a83,synthetic-form-layout-03,original,2025,fte-4fe8f623a95f9ec4d60a3d41,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,577.00, proceeds: USD 10,577.00, date sold: 2025-03-03, basis if reported: USD 7,403.90. Account holder: Example Person 302.",1099,5,1099,fdc-526c1e49ef76d4a06d2627fa,synthetic-form-layout-03,original,2025,fte-208fffb4d3c36c5b67cce450,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,660.00, proceeds: USD 10,660.00, date sold: 2025-03-04, basis if reported: USD 7,462.00. Account holder: Example Person 303.",1099,5,1099,fdc-5eaaba574f1d36775e0aafd1,synthetic-form-layout-03,original,2025,fte-984676ba20dc92137abb81d8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,743.00, proceeds: USD 10,743.00, date sold: 2025-03-05, basis if reported: USD 7,520.10. Account holder: Example Person 304.",1099,5,1099,fdc-26c609e752fd6e9894513647,synthetic-form-layout-03,original,2025,fte-5377360d35e98010142f9f36,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,826.00, proceeds: USD 10,826.00, date sold: 2025-03-06, basis if reported: USD 7,578.20. Account holder: Example Person 305.",1099,5,1099,fdc-f2a1a27291653c8db384a37d,synthetic-form-layout-03,original,2025,fte-a612db6ff2bbd1d823dcee82,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,909.00, proceeds: USD 10,909.00, date sold: 2025-03-07, basis if reported: USD 7,636.30. Account holder: Example Person 306.",1099,5,1099,fdc-86181f928e61878be8270270,synthetic-form-layout-03,original,2025,fte-63658bb607f44f3f405cad9f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Reporting period ended 12/31/2025.
Details: digital asset: USD 10,992.00, proceeds: USD 10,992.00, date sold: 2025-03-08, basis if reported: USD 7,694.40. Account holder: Example Person 307.",1099,5,1099,fdc-5b7f1518239d961d6daf7777,synthetic-form-layout-03,original,2025,fte-617740c3af6f24119a6b4812,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,383.60
date sold: 2025-03-01
proceeds: USD 10,548.00
digital asset: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-1f6064e7bc327320ee4329b2,synthetic-form-layout-04,original,2025,fte-e9dca1d6c037d0c9ffba69c1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,441.70
date sold: 2025-03-02
proceeds: USD 10,631.00
digital asset: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-3df98da4bc8028594f64b36d,synthetic-form-layout-04,original,2025,fte-7a5f82c438e8a8fef264fea0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,499.80
date sold: 2025-03-03
proceeds: USD 10,714.00
digital asset: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-6af5f652a4d7c3020d5dd23c,synthetic-form-layout-04,original,2025,fte-79bfd98ef9acaf5b962f064a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,557.90
date sold: 2025-03-04
proceeds: USD 10,797.00
digital asset: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-f7412058d6387706f62ea0be,synthetic-form-layout-04,original,2025,fte-d199bb0cfe711e96fde6ef2a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,616.00
date sold: 2025-03-05
proceeds: USD 10,880.00
digital asset: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-9231d48f7f0013287aa7cc73,synthetic-form-layout-04,original,2025,fte-e15151c54e79e80d977a8296,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,674.10
date sold: 2025-03-06
proceeds: USD 10,963.00
digital asset: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-a1a797f1eb6bc4072c84ca5f,synthetic-form-layout-04,original,2025,fte-ad067b1c64e6f6408f988d78,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,732.20
date sold: 2025-03-07
proceeds: USD 11,046.00
digital asset: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-c9b2215e2457aa4af3631b0a,synthetic-form-layout-04,original,2025,fte-d79668a19cc4f06b1ba0a186,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-DA: Digital Asset Proceeds From Broker Transactions
Tax reporting year 2025
basis if reported: USD 7,790.30
date sold: 2025-03-08
proceeds: USD 11,129.00
digital asset: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-88f1015b9d5084605ad94cc8,synthetic-form-layout-04,original,2025,fte-b4bca429d93d1a6b2c6ab68f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 10,685.00 / proceeds: USD 10,685.00 / date sold: 2025-03-01 / basis if reported: USD 7,479.50
Delivery copy for Example Party 500",1099,5,1099,fdc-0cf974ecf27445c10b578791,synthetic-form-layout-05,original,2025,fte-360a17255aed107a7f9bdd3a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 10,768.00 / proceeds: USD 10,768.00 / date sold: 2025-03-02 / basis if reported: USD 7,537.60
Delivery copy for Example Party 501",1099,5,1099,fdc-1f5ae790f8629278bfcdbf09,synthetic-form-layout-05,original,2025,fte-0a4fbfe0e09eaf8d86a99081,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 10,851.00 / proceeds: USD 10,851.00 / date sold: 2025-03-03 / basis if reported: USD 7,595.70
Delivery copy for Example Party 502",1099,5,1099,fdc-0bf7df9a8bfcab24d2caaaa8,synthetic-form-layout-05,original,2025,fte-898b622a32754a3db3e9cd2b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 10,934.00 / proceeds: USD 10,934.00 / date sold: 2025-03-04 / basis if reported: USD 7,653.80
Delivery copy for Example Party 503",1099,5,1099,fdc-376ef64563fd33aa09dd6709,synthetic-form-layout-05,original,2025,fte-842f8d31568bf45aa559b85c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 11,017.00 / proceeds: USD 11,017.00 / date sold: 2025-03-05 / basis if reported: USD 7,711.90
Delivery copy for Example Party 504",1099,5,1099,fdc-75b6f3cdf795155fffca19e4,synthetic-form-layout-05,original,2025,fte-31f24cb7fb7784dc18ebb276,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 11,100.00 / proceeds: USD 11,100.00 / date sold: 2025-03-06 / basis if reported: USD 7,770.00
Delivery copy for Example Party 505",1099,5,1099,fdc-14e8e79c74166c61310c98d7,synthetic-form-layout-05,original,2025,fte-e244e96a516c148178647e17,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 11,183.00 / proceeds: USD 11,183.00 / date sold: 2025-03-07 / basis if reported: USD 7,828.10
Delivery copy for Example Party 506",1099,5,1099,fdc-b14526ea8d6893711e87d142,synthetic-form-layout-05,original,2025,fte-326304c26c40df18ab5c58ee,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-DA: Digital Asset Proceeds From Broker Transactions -- reporting year 2025
digital asset: USD 11,266.00 / proceeds: USD 11,266.00 / date sold: 2025-03-08 / basis if reported: USD 7,886.20
Delivery copy for Example Party 507",1099,5,1099,fdc-6b005f392d75f34b64cf42e4,synthetic-form-layout-05,original,2025,fte-bb604a72ad46ca1450da4047,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2023
Statement issued to Example Person 0.
property description: Example Entity 0-0-0
proceeds: USD 10,000.00
cost basis: USD 7,000.00
adjustment: USD 10,000.00",8949,22,8949,fdc-e362f5c7faa8aef240016c58,synthetic-form-layout-00,original,2023,fte-d8b2ec1765cf792b700b4a0c,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2024
Statement issued to Example Person 1.
property description: Example Entity 0-1-0
proceeds: USD 10,083.00
cost basis: USD 7,058.10
adjustment: USD 10,083.00",8949,22,8949,fdc-e267a4bf78b4ea1e662da0b5,synthetic-form-layout-00,original,2024,fte-a65114b7707b51f04347cd63,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2025
Statement issued to Example Person 2.
property description: Example Entity 0-2-0
proceeds: USD 10,166.00
cost basis: USD 7,116.20
adjustment: USD 10,166.00",8949,22,8949,fdc-7fdf56e5aa339c631fcd638f,synthetic-form-layout-00,original,2025,fte-67da3071b360cdac100bda4c,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2023
Statement issued to Example Person 3.
property description: Example Entity 0-3-0
proceeds: USD 10,249.00
cost basis: USD 7,174.30
adjustment: USD 10,249.00",8949,22,8949,fdc-72a32cc362f0d6a855d4ab92,synthetic-form-layout-00,original,2023,fte-b7d4e1fd86ea41929a8b3b6b,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2024
Statement issued to Example Person 4.
property description: Example Entity 0-4-0
proceeds: USD 10,332.00
cost basis: USD 7,232.40
adjustment: USD 10,332.00",8949,22,8949,fdc-9dd5af26ee155c6c252557d7,synthetic-form-layout-00,original,2024,fte-d3fbb6f10f12e74b0d8afbe0,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2025
Statement issued to Example Person 5.
property description: Example Entity 0-5-0
proceeds: USD 10,415.00
cost basis: USD 7,290.50
adjustment: USD 10,415.00",8949,22,8949,fdc-5cc7e4fd178aa2615c8a58fc,synthetic-form-layout-00,original,2025,fte-81d48eb213ebbfd1448f25ae,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2023
Statement issued to Example Person 6.
property description: Example Entity 0-6-0
proceeds: USD 10,498.00
cost basis: USD 7,348.60
adjustment: USD 10,498.00",8949,22,8949,fdc-eef98638c12dffceb517a1b9,synthetic-form-layout-00,original,2023,fte-a67f6e8f731e6319c5ae8fb1,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Calendar year: 2024
Statement issued to Example Person 7.
property description: Example Entity 0-7-0
proceeds: USD 10,581.00
cost basis: USD 7,406.70
adjustment: USD 10,581.00",8949,22,8949,fdc-a416378c981ea3fdb7755d74,synthetic-form-layout-00,original,2024,fte-10976fd073b2e910ef4e786f,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 100
property description: Example Entity 1-0-0 | proceeds: USD 10,137.00 | cost basis: USD 7,095.90 | adjustment: USD 10,137.00",8949,22,8949,fdc-71f4ab68d78eacf09e239c3e,synthetic-form-layout-01,original,2023,fte-166176efbf8ed6452fb5df22,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 101
property description: Example Entity 1-1-0 | proceeds: USD 10,220.00 | cost basis: USD 7,154.00 | adjustment: USD 10,220.00",8949,22,8949,fdc-1020cfa4289a20ec57d306dd,synthetic-form-layout-01,original,2024,fte-bf183114a300943433c10ca0,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 102
property description: Example Entity 1-2-0 | proceeds: USD 10,303.00 | cost basis: USD 7,212.10 | adjustment: USD 10,303.00",8949,22,8949,fdc-fba3c5eddea503bf71b31e79,synthetic-form-layout-01,original,2025,fte-0570b38526534c3f93372328,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 103
property description: Example Entity 1-3-0 | proceeds: USD 10,386.00 | cost basis: USD 7,270.20 | adjustment: USD 10,386.00",8949,22,8949,fdc-51265039a1e6cc141df6dead,synthetic-form-layout-01,original,2023,fte-e0771f46b357a7039f9d28b6,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 104
property description: Example Entity 1-4-0 | proceeds: USD 10,469.00 | cost basis: USD 7,328.30 | adjustment: USD 10,469.00",8949,22,8949,fdc-6580aac34f49a3f8ac7ec2bb,synthetic-form-layout-01,original,2024,fte-090b41ab86992606a9a1380c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 105
property description: Example Entity 1-5-0 | proceeds: USD 10,552.00 | cost basis: USD 7,386.40 | adjustment: USD 10,552.00",8949,22,8949,fdc-6ccc486bd4c29c1f001bed9a,synthetic-form-layout-01,original,2025,fte-304ff279e161e01c8d1b03d0,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 106
property description: Example Entity 1-6-0 | proceeds: USD 10,635.00 | cost basis: USD 7,444.50 | adjustment: USD 10,635.00",8949,22,8949,fdc-8074e20ffa47fbd299515798,synthetic-form-layout-01,original,2023,fte-97083edd686ea13ff00e2dc4,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8949: Sales and Other Dispositions of Capital Assets
Recipient record: Example Person 107
property description: Example Entity 1-7-0 | proceeds: USD 10,718.00 | cost basis: USD 7,502.60 | adjustment: USD 10,718.00",8949,22,8949,fdc-47e025b0a4ba5d84e0d04c7e,synthetic-form-layout-01,original,2024,fte-452b2f3a02ef405a4598a943,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-0-0; proceeds: USD 10,274.00; cost basis: USD 7,191.80; adjustment: USD 10,274.00. Recipient: Example Household 200.",8949,22,8949,fdc-3d5edd929f451997c0e70130,synthetic-form-layout-02,original,2023,fte-4eba8bedaab48ca168efb827,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-1-0; proceeds: USD 10,357.00; cost basis: USD 7,249.90; adjustment: USD 10,357.00. Recipient: Example Household 201.",8949,22,8949,fdc-c67d53e889e2955313adbdf1,synthetic-form-layout-02,original,2024,fte-0264793c6e12538beb4d6a13,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-2-0; proceeds: USD 10,440.00; cost basis: USD 7,308.00; adjustment: USD 10,440.00. Recipient: Example Household 202.",8949,22,8949,fdc-e3ddb6cf64a1cc0601b55652,synthetic-form-layout-02,original,2025,fte-80d70b6b0e1778b2eaf510a8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-3-0; proceeds: USD 10,523.00; cost basis: USD 7,366.10; adjustment: USD 10,523.00. Recipient: Example Household 203.",8949,22,8949,fdc-47fea443dfa80bcdea14d5ec,synthetic-form-layout-02,original,2023,fte-9ced845e4fcb6a4282351c7e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-4-0; proceeds: USD 10,606.00; cost basis: USD 7,424.20; adjustment: USD 10,606.00. Recipient: Example Household 204.",8949,22,8949,fdc-a70f54577004b95a14acf7de,synthetic-form-layout-02,original,2024,fte-3fac352446532fb5747c38d2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-5-0; proceeds: USD 10,689.00; cost basis: USD 7,482.30; adjustment: USD 10,689.00. Recipient: Example Household 205.",8949,22,8949,fdc-5be33f146752606b5cad8822,synthetic-form-layout-02,original,2025,fte-8a61b5b29b4e7acfd55f10cf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-6-0; proceeds: USD 10,772.00; cost basis: USD 7,540.40; adjustment: USD 10,772.00. Recipient: Example Household 206.",8949,22,8949,fdc-dbf2f7b00c4224d46b15f8eb,synthetic-form-layout-02,original,2023,fte-ff329168faa3787116725782,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8949: Sales and Other Dispositions of Capital Assets.
property description: Example Entity 2-7-0; proceeds: USD 10,855.00; cost basis: USD 7,598.50; adjustment: USD 10,855.00. Recipient: Example Household 207.",8949,22,8949,fdc-dac62ef765189b9991b871e7,synthetic-form-layout-02,original,2024,fte-a91eb784b45960b671106ab8,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2023.
Details: property description: Example Entity 3-0-0, proceeds: USD 10,411.00, cost basis: USD 7,287.70, adjustment: USD 10,411.00. Account holder: Example Person 300.",8949,22,8949,fdc-3f14d9ae64c937eef3ca9e1e,synthetic-form-layout-03,original,2023,fte-fc7c53534436e118f65a75f3,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2024.
Details: property description: Example Entity 3-1-0, proceeds: USD 10,494.00, cost basis: USD 7,345.80, adjustment: USD 10,494.00. Account holder: Example Person 301.",8949,22,8949,fdc-15a3b9555a16c25317773e0f,synthetic-form-layout-03,original,2024,fte-64ddbb38a96d95bd422b2822,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2025.
Details: property description: Example Entity 3-2-0, proceeds: USD 10,577.00, cost basis: USD 7,403.90, adjustment: USD 10,577.00. Account holder: Example Person 302.",8949,22,8949,fdc-ffd2f3812d5948c6df41d10b,synthetic-form-layout-03,original,2025,fte-2ba5852b90b3c588f1550f1e,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2023.
Details: property description: Example Entity 3-3-0, proceeds: USD 10,660.00, cost basis: USD 7,462.00, adjustment: USD 10,660.00. Account holder: Example Person 303.",8949,22,8949,fdc-dcb33535debc78699d25cbcd,synthetic-form-layout-03,original,2023,fte-f49f15faacbcd8bbf89ddd14,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2024.
Details: property description: Example Entity 3-4-0, proceeds: USD 10,743.00, cost basis: USD 7,520.10, adjustment: USD 10,743.00. Account holder: Example Person 304.",8949,22,8949,fdc-fd6b16f865d73cef6db45a93,synthetic-form-layout-03,original,2024,fte-52c05563a306dcd0084f49d2,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2025.
Details: property description: Example Entity 3-5-0, proceeds: USD 10,826.00, cost basis: USD 7,578.20, adjustment: USD 10,826.00. Account holder: Example Person 305.",8949,22,8949,fdc-ebe834fceb97aed2f896c535,synthetic-form-layout-03,original,2025,fte-bef4087b8fa16e0eaf30ff70,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2023.
Details: property description: Example Entity 3-6-0, proceeds: USD 10,909.00, cost basis: USD 7,636.30, adjustment: USD 10,909.00. Account holder: Example Person 306.",8949,22,8949,fdc-170835b98eb48fca63d16a2d,synthetic-form-layout-03,original,2023,fte-93ab9e094d6b8d92f67aee58,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets
Reporting period ended 12/31/2024.
Details: property description: Example Entity 3-7-0, proceeds: USD 10,992.00, cost basis: USD 7,694.40, adjustment: USD 10,992.00. Account holder: Example Person 307.",8949,22,8949,fdc-b325395c053b1edfc323758a,synthetic-form-layout-03,original,2024,fte-77dfb2e8616feda544d5dc04,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2023
adjustment: USD 10,548.00
cost basis: USD 7,383.60
proceeds: USD 10,548.00
property description: Example Entity 4-0-0
Named party: Example Person 400",8949,22,8949,fdc-7ebf5696d83905452d81d43f,synthetic-form-layout-04,original,2023,fte-64e06dc235081f14998d05a8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2024
adjustment: USD 10,631.00
cost basis: USD 7,441.70
proceeds: USD 10,631.00
property description: Example Entity 4-1-0
Named party: Example Person 401",8949,22,8949,fdc-79c27a3e301f597cf64115dc,synthetic-form-layout-04,original,2024,fte-d4c499c5c0c6e694c5a7d7fe,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2025
adjustment: USD 10,714.00
cost basis: USD 7,499.80
proceeds: USD 10,714.00
property description: Example Entity 4-2-0
Named party: Example Person 402",8949,22,8949,fdc-4f5672218960a67445ae080e,synthetic-form-layout-04,original,2025,fte-1208995cd5cf3f15d1b9b0a5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2023
adjustment: USD 10,797.00
cost basis: USD 7,557.90
proceeds: USD 10,797.00
property description: Example Entity 4-3-0
Named party: Example Person 403",8949,22,8949,fdc-c2a848cacaeb223be83d9faa,synthetic-form-layout-04,original,2023,fte-5baa59d73583343906a055f7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2024
adjustment: USD 10,880.00
cost basis: USD 7,616.00
proceeds: USD 10,880.00
property description: Example Entity 4-4-0
Named party: Example Person 404",8949,22,8949,fdc-37787cc319bf01ac505f9991,synthetic-form-layout-04,original,2024,fte-07969bd13218c36283278d9b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2025
adjustment: USD 10,963.00
cost basis: USD 7,674.10
proceeds: USD 10,963.00
property description: Example Entity 4-5-0
Named party: Example Person 405",8949,22,8949,fdc-27568b65dae8cd68c6b67d0d,synthetic-form-layout-04,original,2025,fte-caaba5a9a42ff47feb0dfe58,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2023
adjustment: USD 11,046.00
cost basis: USD 7,732.20
proceeds: USD 11,046.00
property description: Example Entity 4-6-0
Named party: Example Person 406",8949,22,8949,fdc-f0c4240e78a999836557340b,synthetic-form-layout-04,original,2023,fte-848a292282f5d94de024e54b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8949: Sales and Other Dispositions of Capital Assets
Tax reporting year 2024
adjustment: USD 11,129.00
cost basis: USD 7,790.30
proceeds: USD 11,129.00
property description: Example Entity 4-7-0
Named party: Example Person 407",8949,22,8949,fdc-5631ee148c4565ace3fd9c7d,synthetic-form-layout-04,original,2024,fte-39e63688a682826275ead410,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2023
property description: Example Entity 5-0-0 / proceeds: USD 10,685.00 / cost basis: USD 7,479.50 / adjustment: USD 10,685.00
Delivery copy for Example Party 500",8949,22,8949,fdc-d5b4f00bad9558ca96e25d47,synthetic-form-layout-05,original,2023,fte-0ba8a12ca7c2cc60312c3665,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2024
property description: Example Entity 5-1-0 / proceeds: USD 10,768.00 / cost basis: USD 7,537.60 / adjustment: USD 10,768.00
Delivery copy for Example Party 501",8949,22,8949,fdc-06f74bbe000a1b28433ca79a,synthetic-form-layout-05,original,2024,fte-dfe1058f09ea2e695904dc9d,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2025
property description: Example Entity 5-2-0 / proceeds: USD 10,851.00 / cost basis: USD 7,595.70 / adjustment: USD 10,851.00
Delivery copy for Example Party 502",8949,22,8949,fdc-e0e51b26de8bef90b273138d,synthetic-form-layout-05,original,2025,fte-bcb9d52bac5ec76ed09581ee,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2023
property description: Example Entity 5-3-0 / proceeds: USD 10,934.00 / cost basis: USD 7,653.80 / adjustment: USD 10,934.00
Delivery copy for Example Party 503",8949,22,8949,fdc-8e7671812fdbfc229b0e8408,synthetic-form-layout-05,original,2023,fte-9a43970c5cf48d394d034aca,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2024
property description: Example Entity 5-4-0 / proceeds: USD 11,017.00 / cost basis: USD 7,711.90 / adjustment: USD 11,017.00
Delivery copy for Example Party 504",8949,22,8949,fdc-82998579b7edc33c0148cf3c,synthetic-form-layout-05,original,2024,fte-66cee992283c98ae0590beeb,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2025
property description: Example Entity 5-5-0 / proceeds: USD 11,100.00 / cost basis: USD 7,770.00 / adjustment: USD 11,100.00
Delivery copy for Example Party 505",8949,22,8949,fdc-90394c1aaa6b4c4cd539f808,synthetic-form-layout-05,original,2025,fte-487aaed4f59d95cbd3f26c1d,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2023
property description: Example Entity 5-6-0 / proceeds: USD 11,183.00 / cost basis: USD 7,828.10 / adjustment: USD 11,183.00
Delivery copy for Example Party 506",8949,22,8949,fdc-ae0194157f1bec4ab9d8ace2,synthetic-form-layout-05,original,2023,fte-c9e3939ae79d7ad2ba58bc03,synthetic_AI_labeled,v1_template,top,False,
"Form 8949: Sales and Other Dispositions of Capital Assets -- reporting year 2024
property description: Example Entity 5-7-0 / proceeds: USD 11,266.00 / cost basis: USD 7,886.20 / adjustment: USD 11,266.00
Delivery copy for Example Party 507",8949,22,8949,fdc-8688f6df78d091fafe0d646c,synthetic-form-layout-05,original,2024,fte-2883f2bb2c85367a89b01e57,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2023
Statement issued to Example Person 0.
gross distribution: USD 10,000.00
taxable amount: USD 8,000.00
distribution code: 7",1099,5,1099,fdc-004f8ab4fbeed7a2df64f373,synthetic-form-layout-00,original,2023,fte-976b59f157275efe5bba0c60,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2024
Statement issued to Example Person 1.
gross distribution: USD 10,083.00
taxable amount: USD 8,066.40
distribution code: 7",1099,5,1099,fdc-5b019ea553b6b7bb8c07dd98,synthetic-form-layout-00,original,2024,fte-7484a44bf06ffa7ae579dc47,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2025
Statement issued to Example Person 2.
gross distribution: USD 10,166.00
taxable amount: USD 8,132.80
distribution code: 7",1099,5,1099,fdc-ae0d0065aceb8866a58b9bf3,synthetic-form-layout-00,original,2025,fte-d74a0aeeba95a2646542e29f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2023
Statement issued to Example Person 3.
gross distribution: USD 10,249.00
taxable amount: USD 8,199.20
distribution code: 7",1099,5,1099,fdc-cda9ea0c1bb4a41625d93d92,synthetic-form-layout-00,original,2023,fte-29aa4dac8fced1aa1770161e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2024
Statement issued to Example Person 4.
gross distribution: USD 10,332.00
taxable amount: USD 8,265.60
distribution code: 7",1099,5,1099,fdc-c711ea6b3ee2d6a130000453,synthetic-form-layout-00,original,2024,fte-ba51237068ddba4cf393f5b4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2025
Statement issued to Example Person 5.
gross distribution: USD 10,415.00
taxable amount: USD 8,332.00
distribution code: 7",1099,5,1099,fdc-51c9b610f848234d920816d0,synthetic-form-layout-00,original,2025,fte-d2228c48504309d99d6753b0,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2023
Statement issued to Example Person 6.
gross distribution: USD 10,498.00
taxable amount: USD 8,398.40
distribution code: 7",1099,5,1099,fdc-a118f429b0a7c4d6b016a0c0,synthetic-form-layout-00,original,2023,fte-991bd3eb95573f820ebcbe39,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Calendar year: 2024
Statement issued to Example Person 7.
gross distribution: USD 10,581.00
taxable amount: USD 8,464.80
distribution code: 7",1099,5,1099,fdc-159a2fb7104100ab9f5a2c2c,synthetic-form-layout-00,original,2024,fte-b80a253c0bb8bbb606f81d0c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 100
gross distribution: USD 10,137.00 | taxable amount: USD 8,109.60 | distribution code: 7",1099,5,1099,fdc-fceb173a657904afc1aa8526,synthetic-form-layout-01,original,2023,fte-718c8427c0cfe42ab03f5ee9,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 101
gross distribution: USD 10,220.00 | taxable amount: USD 8,176.00 | distribution code: 7",1099,5,1099,fdc-8ba95a7825a2e1490d4636fe,synthetic-form-layout-01,original,2024,fte-2d972884f701e2690221949b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 102
gross distribution: USD 10,303.00 | taxable amount: USD 8,242.40 | distribution code: 7",1099,5,1099,fdc-b380f9eccd45d3ffde34dee5,synthetic-form-layout-01,original,2025,fte-d2f57602742bb754e3c90576,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 103
gross distribution: USD 10,386.00 | taxable amount: USD 8,308.80 | distribution code: 7",1099,5,1099,fdc-412e511aff004c725603e386,synthetic-form-layout-01,original,2023,fte-99d54c51091906f65e0b8ad1,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 104
gross distribution: USD 10,469.00 | taxable amount: USD 8,375.20 | distribution code: 7",1099,5,1099,fdc-4118dda4f8f3dfa178f32883,synthetic-form-layout-01,original,2024,fte-07e44344b8ec505da146bb66,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 105
gross distribution: USD 10,552.00 | taxable amount: USD 8,441.60 | distribution code: 7",1099,5,1099,fdc-d1c08d95a7229f4b62dce36b,synthetic-form-layout-01,original,2025,fte-75ad71e18f87209772a50c5b,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 106
gross distribution: USD 10,635.00 | taxable amount: USD 8,508.00 | distribution code: 7",1099,5,1099,fdc-bd962fb4736966c581727280,synthetic-form-layout-01,original,2023,fte-b6fb3d6603d81dac5dd722a2,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Recipient record: Example Person 107
gross distribution: USD 10,718.00 | taxable amount: USD 8,574.40 | distribution code: 7",1099,5,1099,fdc-507a35c14bb89f8073fc0e9f,synthetic-form-layout-01,original,2024,fte-a533e82ba49b3d46470d6bc2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,274.00; taxable amount: USD 8,219.20; distribution code: 7. Recipient: Example Household 200.",1099,5,1099,fdc-a60f6b27007652aa0e3e4ceb,synthetic-form-layout-02,original,2023,fte-56f81cf3405a92885678f742,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,357.00; taxable amount: USD 8,285.60; distribution code: 7. Recipient: Example Household 201.",1099,5,1099,fdc-e7bc4be5f344af941cd2d4c7,synthetic-form-layout-02,original,2024,fte-0b7c7689d833f191a91beb99,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,440.00; taxable amount: USD 8,352.00; distribution code: 7. Recipient: Example Household 202.",1099,5,1099,fdc-2285178866133365729e588a,synthetic-form-layout-02,original,2025,fte-9ce81ad362c45d612f6a21d2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,523.00; taxable amount: USD 8,418.40; distribution code: 7. Recipient: Example Household 203.",1099,5,1099,fdc-0ee5b8d7c7e42ef62d92baaa,synthetic-form-layout-02,original,2023,fte-f61fc7e331c535755cb103b8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,606.00; taxable amount: USD 8,484.80; distribution code: 7. Recipient: Example Household 204.",1099,5,1099,fdc-88ff6916de10f818fe39a855,synthetic-form-layout-02,original,2024,fte-637cc0ab33c4b876590588f8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,689.00; taxable amount: USD 8,551.20; distribution code: 7. Recipient: Example Household 205.",1099,5,1099,fdc-4a0bdd92a4e28134b41e9c2a,synthetic-form-layout-02,original,2025,fte-476574cf505130bfebbebfda,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,772.00; taxable amount: USD 8,617.60; distribution code: 7. Recipient: Example Household 206.",1099,5,1099,fdc-e37848cef1360339dfcca185,synthetic-form-layout-02,original,2023,fte-1168d8be556387ef38137fdb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts.
gross distribution: USD 10,855.00; taxable amount: USD 8,684.00; distribution code: 7. Recipient: Example Household 207.",1099,5,1099,fdc-f8b77f19e3ed3135903d7f59,synthetic-form-layout-02,original,2024,fte-03aa8673f2faaaac4487f8b2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,411.00, taxable amount: USD 8,328.80, distribution code: 7. Account holder: Example Person 300.",1099,5,1099,fdc-67e1dc5dd4488257921c0404,synthetic-form-layout-03,original,2023,fte-24a9ed4ae2c337fd9e1eb55a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,494.00, taxable amount: USD 8,395.20, distribution code: 7. Account holder: Example Person 301.",1099,5,1099,fdc-1fcf5bf0921541b522bc3bdd,synthetic-form-layout-03,original,2024,fte-2b78f119305cc6430d2a3eb5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2025.
Details: gross distribution: USD 10,577.00, taxable amount: USD 8,461.60, distribution code: 7. Account holder: Example Person 302.",1099,5,1099,fdc-64c6ef9bd43f0bd0468e63c8,synthetic-form-layout-03,original,2025,fte-f60919310fc99d285fb20a3d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,660.00, taxable amount: USD 8,528.00, distribution code: 7. Account holder: Example Person 303.",1099,5,1099,fdc-5bdfef2ed892d0e8483dd591,synthetic-form-layout-03,original,2023,fte-da90561c7491b403ce7cb5db,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,743.00, taxable amount: USD 8,594.40, distribution code: 7. Account holder: Example Person 304.",1099,5,1099,fdc-112f563fdbb5d956624dc01b,synthetic-form-layout-03,original,2024,fte-bf0e78701e3752e1e97913ea,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2025.
Details: gross distribution: USD 10,826.00, taxable amount: USD 8,660.80, distribution code: 7. Account holder: Example Person 305.",1099,5,1099,fdc-6476561ffde114a54f996b93,synthetic-form-layout-03,original,2025,fte-024e7d9351300df1393eca38,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,909.00, taxable amount: USD 8,727.20, distribution code: 7. Account holder: Example Person 306.",1099,5,1099,fdc-844cd6cab4235a6e1842b956,synthetic-form-layout-03,original,2023,fte-d94c97e363926a5f6e2a21b1,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,992.00, taxable amount: USD 8,793.60, distribution code: 7. Account holder: Example Person 307.",1099,5,1099,fdc-f3eac865031e1122c57c7152,synthetic-form-layout-03,original,2024,fte-28e488ad21d3b90b3f3e96b1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2023
distribution code: 7
taxable amount: USD 8,438.40
gross distribution: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-39e8b3d2165a101259b2bd7b,synthetic-form-layout-04,original,2023,fte-59db28d43c8f47981cba806d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2024
distribution code: 7
taxable amount: USD 8,504.80
gross distribution: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-bd960b7dbb0cca1922e81f28,synthetic-form-layout-04,original,2024,fte-8ede5da9822506f153d02df8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2025
distribution code: 7
taxable amount: USD 8,571.20
gross distribution: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-b3bf15a8149d954f12a14f6a,synthetic-form-layout-04,original,2025,fte-83540ed524fceb113c13104e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2023
distribution code: 7
taxable amount: USD 8,637.60
gross distribution: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-7c64462b5a84f5d90674fb9d,synthetic-form-layout-04,original,2023,fte-d174527fa9f04d7c7bb5bcf4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2024
distribution code: 7
taxable amount: USD 8,704.00
gross distribution: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-b410f06baf4fa3006367ee25,synthetic-form-layout-04,original,2024,fte-a0f985421e38865de400c51e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2025
distribution code: 7
taxable amount: USD 8,770.40
gross distribution: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-4335878ce387ac049481b8a2,synthetic-form-layout-04,original,2025,fte-6b0965c8005d8d4e45952c74,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2023
distribution code: 7
taxable amount: USD 8,836.80
gross distribution: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-6aa20716b6f342abd391f392,synthetic-form-layout-04,original,2023,fte-b9aee4855deab46a7f3cdb60,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts
Tax reporting year 2024
distribution code: 7
taxable amount: USD 8,903.20
gross distribution: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-7715e9c86f426034980ebff6,synthetic-form-layout-04,original,2024,fte-dcd527a3a17585b5d6e9812b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2023
gross distribution: USD 10,685.00 / taxable amount: USD 8,548.00 / distribution code: 7
Delivery copy for Example Party 500",1099,5,1099,fdc-24cdfca534ef938ee0029b22,synthetic-form-layout-05,original,2023,fte-550bd91ea7b2941ba491f181,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2024
gross distribution: USD 10,768.00 / taxable amount: USD 8,614.40 / distribution code: 7
Delivery copy for Example Party 501",1099,5,1099,fdc-b3bd2df98ba6dc41b583882e,synthetic-form-layout-05,original,2024,fte-46bbfc545771a0a65c8f0f02,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2025
gross distribution: USD 10,851.00 / taxable amount: USD 8,680.80 / distribution code: 7
Delivery copy for Example Party 502",1099,5,1099,fdc-f641e3ee1fd68c619eb0b909,synthetic-form-layout-05,original,2025,fte-6b775342236ed5210edb6def,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2023
gross distribution: USD 10,934.00 / taxable amount: USD 8,747.20 / distribution code: 7
Delivery copy for Example Party 503",1099,5,1099,fdc-ef0cbfb9905592d8d28963ff,synthetic-form-layout-05,original,2023,fte-2f21772473989000ed7da0ba,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2024
gross distribution: USD 11,017.00 / taxable amount: USD 8,813.60 / distribution code: 7
Delivery copy for Example Party 504",1099,5,1099,fdc-4b7599fc501d22e63edad758,synthetic-form-layout-05,original,2024,fte-f2310f5d3e8452b6904ebbb3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2025
gross distribution: USD 11,100.00 / taxable amount: USD 8,880.00 / distribution code: 7
Delivery copy for Example Party 505",1099,5,1099,fdc-9a7a5a83d56ecdcd6e53452b,synthetic-form-layout-05,original,2025,fte-151178d8da605fd0bd6a8a77,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2023
gross distribution: USD 11,183.00 / taxable amount: USD 8,946.40 / distribution code: 7
Delivery copy for Example Party 506",1099,5,1099,fdc-f162e489208395f31c7bf548,synthetic-form-layout-05,original,2023,fte-77a416bb67383b193e66ca14,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-R: Distributions From Pensions Annuities Retirement or Profit-Sharing Plans IRAs Insurance Contracts -- reporting year 2024
gross distribution: USD 11,266.00 / taxable amount: USD 9,012.80 / distribution code: 7
Delivery copy for Example Party 507",1099,5,1099,fdc-7ab21feba6e575254463cb93,synthetic-form-layout-05,original,2024,fte-2d0d778cea9ee430b0c4d8bf,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2023
Statement issued to Example Person 0.
IRA contributions: USD 10,000.00
rollover contributions: USD 10,000.00
fair market value: USD 10,000.00",5498,14,5498,fdc-944b0859341e14035321481c,synthetic-form-layout-00,original,2023,fte-d3544ccf6ccebd7c0688dc6c,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2024
Statement issued to Example Person 1.
IRA contributions: USD 10,083.00
rollover contributions: USD 10,083.00
fair market value: USD 10,083.00",5498,14,5498,fdc-2ab387522fa61de2a0ea1afe,synthetic-form-layout-00,original,2024,fte-4df5971015f1a5d4482e10ae,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2025
Statement issued to Example Person 2.
IRA contributions: USD 10,166.00
rollover contributions: USD 10,166.00
fair market value: USD 10,166.00",5498,14,5498,fdc-e63689026f22aff802a78aa0,synthetic-form-layout-00,original,2025,fte-9e3b7bab1dced43bfb61d619,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2023
Statement issued to Example Person 3.
IRA contributions: USD 10,249.00
rollover contributions: USD 10,249.00
fair market value: USD 10,249.00",5498,14,5498,fdc-aebd47b0bc54bcaa6c332cf3,synthetic-form-layout-00,original,2023,fte-8291e8d53e828c8f1afff324,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2024
Statement issued to Example Person 4.
IRA contributions: USD 10,332.00
rollover contributions: USD 10,332.00
fair market value: USD 10,332.00",5498,14,5498,fdc-843349e6f23aa156d9d06767,synthetic-form-layout-00,original,2024,fte-85804e8a3201d8e709dd765a,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2025
Statement issued to Example Person 5.
IRA contributions: USD 10,415.00
rollover contributions: USD 10,415.00
fair market value: USD 10,415.00",5498,14,5498,fdc-8ff39d6af7171859714aca96,synthetic-form-layout-00,original,2025,fte-7dd0956cf88c6c6e9c28d2cd,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2023
Statement issued to Example Person 6.
IRA contributions: USD 10,498.00
rollover contributions: USD 10,498.00
fair market value: USD 10,498.00",5498,14,5498,fdc-eb95c66cd19fb2233435dda9,synthetic-form-layout-00,original,2023,fte-11915fa2a420afe902f03d3c,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Calendar year: 2024
Statement issued to Example Person 7.
IRA contributions: USD 10,581.00
rollover contributions: USD 10,581.00
fair market value: USD 10,581.00",5498,14,5498,fdc-96ac8c31fef685b008a2d61f,synthetic-form-layout-00,original,2024,fte-6059a73d1503c9f92820e19c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498: IRA Contribution Information
Recipient record: Example Person 100
IRA contributions: USD 10,137.00 | rollover contributions: USD 10,137.00 | fair market value: USD 10,137.00",5498,14,5498,fdc-ae4745dd42a2510b4ddbb521,synthetic-form-layout-01,original,2023,fte-819740e69cbe24e590122f22,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498: IRA Contribution Information
Recipient record: Example Person 101
IRA contributions: USD 10,220.00 | rollover contributions: USD 10,220.00 | fair market value: USD 10,220.00",5498,14,5498,fdc-f9400b98b44d19385105bd9b,synthetic-form-layout-01,original,2024,fte-a857860d9fe079fdc2de65d6,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5498: IRA Contribution Information
Recipient record: Example Person 102
IRA contributions: USD 10,303.00 | rollover contributions: USD 10,303.00 | fair market value: USD 10,303.00",5498,14,5498,fdc-5d3c5ca4ba45062b39c4ceda,synthetic-form-layout-01,original,2025,fte-7fc45a8c1915d91ec2f9340b,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498: IRA Contribution Information
Recipient record: Example Person 103
IRA contributions: USD 10,386.00 | rollover contributions: USD 10,386.00 | fair market value: USD 10,386.00",5498,14,5498,fdc-fd3307d96232807005cb13f8,synthetic-form-layout-01,original,2023,fte-2ae9967c4bdf7d1cf69202dc,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498: IRA Contribution Information
Recipient record: Example Person 104
IRA contributions: USD 10,469.00 | rollover contributions: USD 10,469.00 | fair market value: USD 10,469.00",5498,14,5498,fdc-102709b361acb22bcda4fd4d,synthetic-form-layout-01,original,2024,fte-0a627070c1555abd5186b61a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5498: IRA Contribution Information
Recipient record: Example Person 105
IRA contributions: USD 10,552.00 | rollover contributions: USD 10,552.00 | fair market value: USD 10,552.00",5498,14,5498,fdc-3b756030f0cee35f0ad1de9c,synthetic-form-layout-01,original,2025,fte-84eb8365cd8dca472de0c9d0,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498: IRA Contribution Information
Recipient record: Example Person 106
IRA contributions: USD 10,635.00 | rollover contributions: USD 10,635.00 | fair market value: USD 10,635.00",5498,14,5498,fdc-dfbba6ebb065ab5efc9860f0,synthetic-form-layout-01,original,2023,fte-76cfcaf255578f18cdad06c7,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498: IRA Contribution Information
Recipient record: Example Person 107
IRA contributions: USD 10,718.00 | rollover contributions: USD 10,718.00 | fair market value: USD 10,718.00",5498,14,5498,fdc-f8112dddd9b1df051dfc9cb4,synthetic-form-layout-01,original,2024,fte-a3541a598e4077e85822fd6f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,274.00; rollover contributions: USD 10,274.00; fair market value: USD 10,274.00. Recipient: Example Household 200.",5498,14,5498,fdc-96cc7725af642e97721330b9,synthetic-form-layout-02,original,2023,fte-17942c7a5d59c8e066c7b088,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,357.00; rollover contributions: USD 10,357.00; fair market value: USD 10,357.00. Recipient: Example Household 201.",5498,14,5498,fdc-b62179de9758d179197d4d36,synthetic-form-layout-02,original,2024,fte-2bf7c300829ba7f1071a5dcf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,440.00; rollover contributions: USD 10,440.00; fair market value: USD 10,440.00. Recipient: Example Household 202.",5498,14,5498,fdc-6269c1d33b9afeac43840902,synthetic-form-layout-02,original,2025,fte-2be0c9e2d3281e42bc12829d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,523.00; rollover contributions: USD 10,523.00; fair market value: USD 10,523.00. Recipient: Example Household 203.",5498,14,5498,fdc-0966d47765a257e689273515,synthetic-form-layout-02,original,2023,fte-14324332c05e1688b159f8f3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,606.00; rollover contributions: USD 10,606.00; fair market value: USD 10,606.00. Recipient: Example Household 204.",5498,14,5498,fdc-f92501942ec0e5c7a3fb3a59,synthetic-form-layout-02,original,2024,fte-9ce9afe91bca8d9096b94380,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,689.00; rollover contributions: USD 10,689.00; fair market value: USD 10,689.00. Recipient: Example Household 205.",5498,14,5498,fdc-3dc4958a25b976fd0a342399,synthetic-form-layout-02,original,2025,fte-5c132edc07c7a00ba72738a3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,772.00; rollover contributions: USD 10,772.00; fair market value: USD 10,772.00. Recipient: Example Household 206.",5498,14,5498,fdc-ec8f8c7f4429d8717ff629ff,synthetic-form-layout-02,original,2023,fte-6fa0a6ba4008412c331064e9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498: IRA Contribution Information.
IRA contributions: USD 10,855.00; rollover contributions: USD 10,855.00; fair market value: USD 10,855.00. Recipient: Example Household 207.",5498,14,5498,fdc-0afa0e722dca9d1e34cb5193,synthetic-form-layout-02,original,2024,fte-00f0c88a10dc3186bbeba493,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2023.
Details: IRA contributions: USD 10,411.00, rollover contributions: USD 10,411.00, fair market value: USD 10,411.00. Account holder: Example Person 300.",5498,14,5498,fdc-bb20180b336f3c9fff5b458d,synthetic-form-layout-03,original,2023,fte-ec2eb0fc1a77c8b76f8478b2,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2024.
Details: IRA contributions: USD 10,494.00, rollover contributions: USD 10,494.00, fair market value: USD 10,494.00. Account holder: Example Person 301.",5498,14,5498,fdc-ddc3e9b1375468c1d25742dd,synthetic-form-layout-03,original,2024,fte-eeae24d2c6354fbbed1096d6,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2025.
Details: IRA contributions: USD 10,577.00, rollover contributions: USD 10,577.00, fair market value: USD 10,577.00. Account holder: Example Person 302.",5498,14,5498,fdc-0f2010b87e365ff3d5b9c304,synthetic-form-layout-03,original,2025,fte-f2cd8cf480b5527b8795ba3c,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2023.
Details: IRA contributions: USD 10,660.00, rollover contributions: USD 10,660.00, fair market value: USD 10,660.00. Account holder: Example Person 303.",5498,14,5498,fdc-1fd8ebddefc4cfaa0642358d,synthetic-form-layout-03,original,2023,fte-b4f625d651e9de4b76e74de3,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2024.
Details: IRA contributions: USD 10,743.00, rollover contributions: USD 10,743.00, fair market value: USD 10,743.00. Account holder: Example Person 304.",5498,14,5498,fdc-5828a7d2881468d3493e2f94,synthetic-form-layout-03,original,2024,fte-9bdf6a0cb330e312e16be916,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2025.
Details: IRA contributions: USD 10,826.00, rollover contributions: USD 10,826.00, fair market value: USD 10,826.00. Account holder: Example Person 305.",5498,14,5498,fdc-665d65cf55a1f5b7a992e0b9,synthetic-form-layout-03,original,2025,fte-3e851368e7a2d85d2b42d941,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2023.
Details: IRA contributions: USD 10,909.00, rollover contributions: USD 10,909.00, fair market value: USD 10,909.00. Account holder: Example Person 306.",5498,14,5498,fdc-5e639c3f6897be530b19453f,synthetic-form-layout-03,original,2023,fte-d0dd4a06b2f4101f7d1387ba,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information
Reporting period ended 12/31/2024.
Details: IRA contributions: USD 10,992.00, rollover contributions: USD 10,992.00, fair market value: USD 10,992.00. Account holder: Example Person 307.",5498,14,5498,fdc-d88eb43b0904604538c8e517,synthetic-form-layout-03,original,2024,fte-a0f3b066c450dae599e9064e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2023
fair market value: USD 10,548.00
rollover contributions: USD 10,548.00
IRA contributions: USD 10,548.00
Named party: Example Person 400",5498,14,5498,fdc-437601799b00c1a5eecb623b,synthetic-form-layout-04,original,2023,fte-a64c05c671925d69ba70bcc9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2024
fair market value: USD 10,631.00
rollover contributions: USD 10,631.00
IRA contributions: USD 10,631.00
Named party: Example Person 401",5498,14,5498,fdc-5b7a013ce141a29d15393bc6,synthetic-form-layout-04,original,2024,fte-29c9267c78760bf63b3cf54c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2025
fair market value: USD 10,714.00
rollover contributions: USD 10,714.00
IRA contributions: USD 10,714.00
Named party: Example Person 402",5498,14,5498,fdc-11ec2beec1b8fb204e3a2be6,synthetic-form-layout-04,original,2025,fte-bb23fb2b1485364aef1a1337,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2023
fair market value: USD 10,797.00
rollover contributions: USD 10,797.00
IRA contributions: USD 10,797.00
Named party: Example Person 403",5498,14,5498,fdc-9747e0f13b7479d79dd38676,synthetic-form-layout-04,original,2023,fte-38f03481f0eecb275bbdae6f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2024
fair market value: USD 10,880.00
rollover contributions: USD 10,880.00
IRA contributions: USD 10,880.00
Named party: Example Person 404",5498,14,5498,fdc-8825685d0ad63ae1e42c6162,synthetic-form-layout-04,original,2024,fte-8b5b6924eac5537ba5051781,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2025
fair market value: USD 10,963.00
rollover contributions: USD 10,963.00
IRA contributions: USD 10,963.00
Named party: Example Person 405",5498,14,5498,fdc-245495cd6f84eb7f06646b96,synthetic-form-layout-04,original,2025,fte-3c455173f5f18b742c40a679,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2023
fair market value: USD 11,046.00
rollover contributions: USD 11,046.00
IRA contributions: USD 11,046.00
Named party: Example Person 406",5498,14,5498,fdc-23d42ea6f5387950601d1aea,synthetic-form-layout-04,original,2023,fte-951f4bbd1a9e1344d87c4bf1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498: IRA Contribution Information
Tax reporting year 2024
fair market value: USD 11,129.00
rollover contributions: USD 11,129.00
IRA contributions: USD 11,129.00
Named party: Example Person 407",5498,14,5498,fdc-82c2cfacdf7a8e061d75f510,synthetic-form-layout-04,original,2024,fte-43fef88a47f830be4f387727,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2023
IRA contributions: USD 10,685.00 / rollover contributions: USD 10,685.00 / fair market value: USD 10,685.00
Delivery copy for Example Party 500",5498,14,5498,fdc-607aeff197da430f808aec06,synthetic-form-layout-05,original,2023,fte-f67c31193f0cb5e6059a562b,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2024
IRA contributions: USD 10,768.00 / rollover contributions: USD 10,768.00 / fair market value: USD 10,768.00
Delivery copy for Example Party 501",5498,14,5498,fdc-fbfc56f3a547da60c62f95ba,synthetic-form-layout-05,original,2024,fte-889cba986c9a0e4077afa56e,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2025
IRA contributions: USD 10,851.00 / rollover contributions: USD 10,851.00 / fair market value: USD 10,851.00
Delivery copy for Example Party 502",5498,14,5498,fdc-c379710ac2e555fdfb7b40fb,synthetic-form-layout-05,original,2025,fte-79f5b3fd7a0b6f6a06d534b8,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2023
IRA contributions: USD 10,934.00 / rollover contributions: USD 10,934.00 / fair market value: USD 10,934.00
Delivery copy for Example Party 503",5498,14,5498,fdc-1a538fc8c9d2c006706eb61c,synthetic-form-layout-05,original,2023,fte-9228e5f2d84eae7c1f72d31a,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2024
IRA contributions: USD 11,017.00 / rollover contributions: USD 11,017.00 / fair market value: USD 11,017.00
Delivery copy for Example Party 504",5498,14,5498,fdc-4db3e003d2a452664e95ba25,synthetic-form-layout-05,original,2024,fte-36e3997caa2f29b65186a0e8,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2025
IRA contributions: USD 11,100.00 / rollover contributions: USD 11,100.00 / fair market value: USD 11,100.00
Delivery copy for Example Party 505",5498,14,5498,fdc-4db93230aacdcffb89c9ebcc,synthetic-form-layout-05,original,2025,fte-ba432a561205964b345ce5cd,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2023
IRA contributions: USD 11,183.00 / rollover contributions: USD 11,183.00 / fair market value: USD 11,183.00
Delivery copy for Example Party 506",5498,14,5498,fdc-654c37e3a40ecd168e00df19,synthetic-form-layout-05,original,2023,fte-70116887b7e67c331f8a3fcf,synthetic_AI_labeled,v1_template,top,False,
"Form 5498: IRA Contribution Information -- reporting year 2024
IRA contributions: USD 11,266.00 / rollover contributions: USD 11,266.00 / fair market value: USD 11,266.00
Delivery copy for Example Party 507",5498,14,5498,fdc-8c900a69c2a2a4e65ef32942,synthetic-form-layout-05,original,2024,fte-0af049079fd66a1d07f17008,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2023
Statement issued to Example Person 0.
unemployment compensation: USD 10,000.00
state income tax refunds: USD 10,000.00
tax year: 2023",1099,5,1099,fdc-ac3cc225eb5179cd2aa64ed5,synthetic-form-layout-00,original,2023,fte-13fe9647ffc94df22a7ad200,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2024
Statement issued to Example Person 1.
unemployment compensation: USD 10,083.00
state income tax refunds: USD 10,083.00
tax year: 2024",1099,5,1099,fdc-92ea995e470ab0a615da3725,synthetic-form-layout-00,original,2024,fte-93fb4ff40ceeade2864da8af,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2025
Statement issued to Example Person 2.
unemployment compensation: USD 10,166.00
state income tax refunds: USD 10,166.00
tax year: 2025",1099,5,1099,fdc-b39de35fb6264b824cdda554,synthetic-form-layout-00,original,2025,fte-f046402592874ad4dcf69c33,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2023
Statement issued to Example Person 3.
unemployment compensation: USD 10,249.00
state income tax refunds: USD 10,249.00
tax year: 2023",1099,5,1099,fdc-a3b7bbf2c9060d8d262d752c,synthetic-form-layout-00,original,2023,fte-c481239d3b20f3f1724abb64,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2024
Statement issued to Example Person 4.
unemployment compensation: USD 10,332.00
state income tax refunds: USD 10,332.00
tax year: 2024",1099,5,1099,fdc-db2e44e5d86cf87a8118dbee,synthetic-form-layout-00,original,2024,fte-d561a45307ef711b7beda8a0,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2025
Statement issued to Example Person 5.
unemployment compensation: USD 10,415.00
state income tax refunds: USD 10,415.00
tax year: 2025",1099,5,1099,fdc-b1ab716cbed92651bd7451ba,synthetic-form-layout-00,original,2025,fte-ac2803969e8ad63f62bd4938,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2023
Statement issued to Example Person 6.
unemployment compensation: USD 10,498.00
state income tax refunds: USD 10,498.00
tax year: 2023",1099,5,1099,fdc-c9dd55a92f7cc0635ea1085b,synthetic-form-layout-00,original,2023,fte-9d7b65a0abb686947af10697,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Calendar year: 2024
Statement issued to Example Person 7.
unemployment compensation: USD 10,581.00
state income tax refunds: USD 10,581.00
tax year: 2024",1099,5,1099,fdc-1207ce33fae48ebeb89722e7,synthetic-form-layout-00,original,2024,fte-d13a6c52cc465e3355e69ee6,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 100
unemployment compensation: USD 10,137.00 | state income tax refunds: USD 10,137.00 | tax year: 2023",1099,5,1099,fdc-74f26cf2ddc5b96d56b42812,synthetic-form-layout-01,original,2023,fte-96efcb4981ba1f4ee253f3d3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 101
unemployment compensation: USD 10,220.00 | state income tax refunds: USD 10,220.00 | tax year: 2024",1099,5,1099,fdc-781b420089cafc5754abb592,synthetic-form-layout-01,original,2024,fte-0df3c188afbbf8fb89b45d89,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 102
unemployment compensation: USD 10,303.00 | state income tax refunds: USD 10,303.00 | tax year: 2025",1099,5,1099,fdc-8f62945071265bf3d6f30018,synthetic-form-layout-01,original,2025,fte-84be733a05f97c538f908492,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 103
unemployment compensation: USD 10,386.00 | state income tax refunds: USD 10,386.00 | tax year: 2023",1099,5,1099,fdc-77a9115046d484b9f5f253e0,synthetic-form-layout-01,original,2023,fte-11fbb024e05cc6894d294bb8,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 104
unemployment compensation: USD 10,469.00 | state income tax refunds: USD 10,469.00 | tax year: 2024",1099,5,1099,fdc-5f478a09263ef2825471f899,synthetic-form-layout-01,original,2024,fte-165a2115a2f3807a7e3dd438,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 105
unemployment compensation: USD 10,552.00 | state income tax refunds: USD 10,552.00 | tax year: 2025",1099,5,1099,fdc-8c1c1e4bd8074891058f5960,synthetic-form-layout-01,original,2025,fte-190abed5cd87146a8b8a5da9,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 106
unemployment compensation: USD 10,635.00 | state income tax refunds: USD 10,635.00 | tax year: 2023",1099,5,1099,fdc-f38d2284f55d6fdbaad75c46,synthetic-form-layout-01,original,2023,fte-c14186573ef535845993163a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-G: Certain Government Payments
Recipient record: Example Person 107
unemployment compensation: USD 10,718.00 | state income tax refunds: USD 10,718.00 | tax year: 2024",1099,5,1099,fdc-30fb06aee46a99a1d1df36a9,synthetic-form-layout-01,original,2024,fte-6e47a61b30e75647d19a44a9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,274.00; state income tax refunds: USD 10,274.00; tax year: 2023. Recipient: Example Household 200.",1099,5,1099,fdc-4372bef165ee7c56ceacaab1,synthetic-form-layout-02,original,2023,fte-0d37e309a02f6a184a95662e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,357.00; state income tax refunds: USD 10,357.00; tax year: 2024. Recipient: Example Household 201.",1099,5,1099,fdc-c750d431fa43e54de1c3b656,synthetic-form-layout-02,original,2024,fte-b976355ffcbfed2132a76d61,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,440.00; state income tax refunds: USD 10,440.00; tax year: 2025. Recipient: Example Household 202.",1099,5,1099,fdc-1867eb481340497303868135,synthetic-form-layout-02,original,2025,fte-a6f06861560ca14b6948c9d3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,523.00; state income tax refunds: USD 10,523.00; tax year: 2023. Recipient: Example Household 203.",1099,5,1099,fdc-a1491e008e85360fbcd42a42,synthetic-form-layout-02,original,2023,fte-0ccba635112e6b7c12b525fb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,606.00; state income tax refunds: USD 10,606.00; tax year: 2024. Recipient: Example Household 204.",1099,5,1099,fdc-62508b4f7642c59303ef2179,synthetic-form-layout-02,original,2024,fte-1d0f437b4309b93205ed2869,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,689.00; state income tax refunds: USD 10,689.00; tax year: 2025. Recipient: Example Household 205.",1099,5,1099,fdc-1e4879dfeb545ce5ceb8c6db,synthetic-form-layout-02,original,2025,fte-2f952e4260736eb90ebb0232,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,772.00; state income tax refunds: USD 10,772.00; tax year: 2023. Recipient: Example Household 206.",1099,5,1099,fdc-5983b4845e2010ee1aa45cd8,synthetic-form-layout-02,original,2023,fte-22ed2b4e62263cf742e987f2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-G: Certain Government Payments.
unemployment compensation: USD 10,855.00; state income tax refunds: USD 10,855.00; tax year: 2024. Recipient: Example Household 207.",1099,5,1099,fdc-9d7cf03475cae961f8c33493,synthetic-form-layout-02,original,2024,fte-d19fff06e6b637ce73e49a15,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2023.
Details: unemployment compensation: USD 10,411.00, state income tax refunds: USD 10,411.00, tax year: 2023. Account holder: Example Person 300.",1099,5,1099,fdc-3deaad141f8ac0cb48a6855c,synthetic-form-layout-03,original,2023,fte-0f67e957c9724ccd11f61713,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2024.
Details: unemployment compensation: USD 10,494.00, state income tax refunds: USD 10,494.00, tax year: 2024. Account holder: Example Person 301.",1099,5,1099,fdc-e0548b7d10dd2046704d704a,synthetic-form-layout-03,original,2024,fte-068191fee4fa79b79005751b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2025.
Details: unemployment compensation: USD 10,577.00, state income tax refunds: USD 10,577.00, tax year: 2025. Account holder: Example Person 302.",1099,5,1099,fdc-15a1e019a88faf61b43aa2a7,synthetic-form-layout-03,original,2025,fte-d8b33870a1fdf31768bb44ec,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2023.
Details: unemployment compensation: USD 10,660.00, state income tax refunds: USD 10,660.00, tax year: 2023. Account holder: Example Person 303.",1099,5,1099,fdc-726326327b7e4677d56c5eaa,synthetic-form-layout-03,original,2023,fte-f6899dcda5853cb6f68c795c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2024.
Details: unemployment compensation: USD 10,743.00, state income tax refunds: USD 10,743.00, tax year: 2024. Account holder: Example Person 304.",1099,5,1099,fdc-5da1a97612617550c0a7e7f5,synthetic-form-layout-03,original,2024,fte-ceac129fa53e39893a736399,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2025.
Details: unemployment compensation: USD 10,826.00, state income tax refunds: USD 10,826.00, tax year: 2025. Account holder: Example Person 305.",1099,5,1099,fdc-659c3ea1594a2583986ee373,synthetic-form-layout-03,original,2025,fte-b66b3dfc3991cede3684c709,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2023.
Details: unemployment compensation: USD 10,909.00, state income tax refunds: USD 10,909.00, tax year: 2023. Account holder: Example Person 306.",1099,5,1099,fdc-5ae416ece0b50b83cb946bfe,synthetic-form-layout-03,original,2023,fte-818be7876f556763fc90d5e4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments
Reporting period ended 12/31/2024.
Details: unemployment compensation: USD 10,992.00, state income tax refunds: USD 10,992.00, tax year: 2024. Account holder: Example Person 307.",1099,5,1099,fdc-f3e75ac1433cbdee5d99299d,synthetic-form-layout-03,original,2024,fte-b3b913a0bdbf4db68c786a63,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2023
tax year: 2023
state income tax refunds: USD 10,548.00
unemployment compensation: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-485663c6bda8daff566f01d4,synthetic-form-layout-04,original,2023,fte-33c6d2b8885300b906ea8b23,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2024
tax year: 2024
state income tax refunds: USD 10,631.00
unemployment compensation: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-b6a42b98334a7b31e22f4520,synthetic-form-layout-04,original,2024,fte-8b50d215985718e24d955d62,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2025
tax year: 2025
state income tax refunds: USD 10,714.00
unemployment compensation: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-8c4c7d45e5193c583c072071,synthetic-form-layout-04,original,2025,fte-ff16936904838d43a3e01ab1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2023
tax year: 2023
state income tax refunds: USD 10,797.00
unemployment compensation: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-d4b0ad263d3e9db308a59edf,synthetic-form-layout-04,original,2023,fte-712063af7b02964a6b164dc1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2024
tax year: 2024
state income tax refunds: USD 10,880.00
unemployment compensation: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-54ff06ee9a5b676845be2477,synthetic-form-layout-04,original,2024,fte-e67604733b8f3c6d73a0a9a1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2025
tax year: 2025
state income tax refunds: USD 10,963.00
unemployment compensation: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-f0b87fa660fe0c97cb47ba78,synthetic-form-layout-04,original,2025,fte-2d0eb8517bd777b95e10c92a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2023
tax year: 2023
state income tax refunds: USD 11,046.00
unemployment compensation: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-222ce2bee67534f2cfa324a5,synthetic-form-layout-04,original,2023,fte-45c21851c657f0cff234d2c1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-G: Certain Government Payments
Tax reporting year 2024
tax year: 2024
state income tax refunds: USD 11,129.00
unemployment compensation: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-bd76a7a5935c4e8191f3c435,synthetic-form-layout-04,original,2024,fte-96b0d0bf0ccfcc0c8aada727,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2023
unemployment compensation: USD 10,685.00 / state income tax refunds: USD 10,685.00 / tax year: 2023
Delivery copy for Example Party 500",1099,5,1099,fdc-b9e3cc83d46cc94fdc1c12dc,synthetic-form-layout-05,original,2023,fte-6330201b77b0269ab5f8685c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2024
unemployment compensation: USD 10,768.00 / state income tax refunds: USD 10,768.00 / tax year: 2024
Delivery copy for Example Party 501",1099,5,1099,fdc-30f202b5f822cefff6e04011,synthetic-form-layout-05,original,2024,fte-dfe408ff1ccb07ae91307a6c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2025
unemployment compensation: USD 10,851.00 / state income tax refunds: USD 10,851.00 / tax year: 2025
Delivery copy for Example Party 502",1099,5,1099,fdc-923e3f82ddd6fb00c650ced9,synthetic-form-layout-05,original,2025,fte-99b3e64776ab429f26d216a1,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2023
unemployment compensation: USD 10,934.00 / state income tax refunds: USD 10,934.00 / tax year: 2023
Delivery copy for Example Party 503",1099,5,1099,fdc-5c504560e93f9829da6c4c06,synthetic-form-layout-05,original,2023,fte-c16954113f7f62bf3a453740,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2024
unemployment compensation: USD 11,017.00 / state income tax refunds: USD 11,017.00 / tax year: 2024
Delivery copy for Example Party 504",1099,5,1099,fdc-f4bbf121a10fbecf14a3d3fe,synthetic-form-layout-05,original,2024,fte-0c85a0d0b96d22c20440c4ee,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2025
unemployment compensation: USD 11,100.00 / state income tax refunds: USD 11,100.00 / tax year: 2025
Delivery copy for Example Party 505",1099,5,1099,fdc-0054af2b1cb28b8264c15901,synthetic-form-layout-05,original,2025,fte-9255f6f1200486862f4649cc,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2023
unemployment compensation: USD 11,183.00 / state income tax refunds: USD 11,183.00 / tax year: 2023
Delivery copy for Example Party 506",1099,5,1099,fdc-649d0373c875172873ef96b7,synthetic-form-layout-05,original,2023,fte-cb765b307652c64c79fb89f2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-G: Certain Government Payments -- reporting year 2024
unemployment compensation: USD 11,266.00 / state income tax refunds: USD 11,266.00 / tax year: 2024
Delivery copy for Example Party 507",1099,5,1099,fdc-43a592c3c7702cbb9449b3a6,synthetic-form-layout-05,original,2024,fte-69cee0c0c8a92792087d7804,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2023
Statement issued to Example Person 0.
closing date: 2023-03-01
gross proceeds: USD 10,000.00
property address: Example Entity 0-0-2",1099,5,1099,fdc-7492e8b9b88f00286538a6e1,synthetic-form-layout-00,original,2023,fte-9c26fec66c7d4a01fb773fc1,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2024
Statement issued to Example Person 1.
closing date: 2024-03-02
gross proceeds: USD 10,083.00
property address: Example Entity 0-1-2",1099,5,1099,fdc-dfca362320015689202cd34b,synthetic-form-layout-00,original,2024,fte-abce6b4eeb3ec12a8c84c7e9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2025
Statement issued to Example Person 2.
closing date: 2025-03-03
gross proceeds: USD 10,166.00
property address: Example Entity 0-2-2",1099,5,1099,fdc-bd2c7547e945e37261e09b70,synthetic-form-layout-00,original,2025,fte-3cfbd2b6f7a9149f780c28eb,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2023
Statement issued to Example Person 3.
closing date: 2023-03-04
gross proceeds: USD 10,249.00
property address: Example Entity 0-3-2",1099,5,1099,fdc-6167bdcbf60eebd8de57839b,synthetic-form-layout-00,original,2023,fte-f771a8a67ce0489be4ccb059,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2024
Statement issued to Example Person 4.
closing date: 2024-03-05
gross proceeds: USD 10,332.00
property address: Example Entity 0-4-2",1099,5,1099,fdc-05f3bb71e3566481e5d1b7c8,synthetic-form-layout-00,original,2024,fte-8c9cf1536f098c9bd112a0cc,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2025
Statement issued to Example Person 5.
closing date: 2025-03-06
gross proceeds: USD 10,415.00
property address: Example Entity 0-5-2",1099,5,1099,fdc-14d7bb6a39917ba2cc3ba025,synthetic-form-layout-00,original,2025,fte-a733e525f9ca3160eb13ad90,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2023
Statement issued to Example Person 6.
closing date: 2023-03-07
gross proceeds: USD 10,498.00
property address: Example Entity 0-6-2",1099,5,1099,fdc-ee3aa7fa902b9472bf3154f9,synthetic-form-layout-00,original,2023,fte-c42854b4c26d97270b40e5bf,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Calendar year: 2024
Statement issued to Example Person 7.
closing date: 2024-03-08
gross proceeds: USD 10,581.00
property address: Example Entity 0-7-2",1099,5,1099,fdc-0513594539192fe2be5d790a,synthetic-form-layout-00,original,2024,fte-0b1d7c447f561acf58537953,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 100
closing date: 2023-03-01 | gross proceeds: USD 10,137.00 | property address: Example Entity 1-0-2",1099,5,1099,fdc-1a67af7d5ece92d4de369407,synthetic-form-layout-01,original,2023,fte-0bc94055555eb36000a57841,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 101
closing date: 2024-03-02 | gross proceeds: USD 10,220.00 | property address: Example Entity 1-1-2",1099,5,1099,fdc-d7c5bb1e6143dba2807eed90,synthetic-form-layout-01,original,2024,fte-3f5634891a0bf5bb07dbd358,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 102
closing date: 2025-03-03 | gross proceeds: USD 10,303.00 | property address: Example Entity 1-2-2",1099,5,1099,fdc-2602db97250671beffbea7c7,synthetic-form-layout-01,original,2025,fte-69859e3757a05b1630c0f299,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 103
closing date: 2023-03-04 | gross proceeds: USD 10,386.00 | property address: Example Entity 1-3-2",1099,5,1099,fdc-9467daffe6f4f1c06cf0f266,synthetic-form-layout-01,original,2023,fte-346e1459807e07b47836764a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 104
closing date: 2024-03-05 | gross proceeds: USD 10,469.00 | property address: Example Entity 1-4-2",1099,5,1099,fdc-dbc8326c9c6dfbe4767544bb,synthetic-form-layout-01,original,2024,fte-f1346e95a4c0f0c83e9e3863,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 105
closing date: 2025-03-06 | gross proceeds: USD 10,552.00 | property address: Example Entity 1-5-2",1099,5,1099,fdc-9c4605e6bc0891871b33fb69,synthetic-form-layout-01,original,2025,fte-315bdd22eb615ea28288cb8b,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 106
closing date: 2023-03-07 | gross proceeds: USD 10,635.00 | property address: Example Entity 1-6-2",1099,5,1099,fdc-22149e8b17b412eb43786a35,synthetic-form-layout-01,original,2023,fte-852b0eb172a59714941d1db8,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-S: Proceeds From Real Estate Transactions
Recipient record: Example Person 107
closing date: 2024-03-08 | gross proceeds: USD 10,718.00 | property address: Example Entity 1-7-2",1099,5,1099,fdc-71796945035c65df82b33ccc,synthetic-form-layout-01,original,2024,fte-97999212d2dacebe1a8ba985,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2023-03-01; gross proceeds: USD 10,274.00; property address: Example Entity 2-0-2. Recipient: Example Household 200.",1099,5,1099,fdc-47762ec04b48bef491e2b588,synthetic-form-layout-02,original,2023,fte-d4fe00969ce3422e9c768806,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2024-03-02; gross proceeds: USD 10,357.00; property address: Example Entity 2-1-2. Recipient: Example Household 201.",1099,5,1099,fdc-44b6659af0b2aa8c56be57f3,synthetic-form-layout-02,original,2024,fte-bac1c9bb5e69964f600b8cd0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2025-03-03; gross proceeds: USD 10,440.00; property address: Example Entity 2-2-2. Recipient: Example Household 202.",1099,5,1099,fdc-bd9f5829526c339a8b47c4ec,synthetic-form-layout-02,original,2025,fte-3103ccf79bcdccfeb1471662,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2023-03-04; gross proceeds: USD 10,523.00; property address: Example Entity 2-3-2. Recipient: Example Household 203.",1099,5,1099,fdc-f6259967251f8d39278664b1,synthetic-form-layout-02,original,2023,fte-4d32452a6ae34383ef34a8b0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2024-03-05; gross proceeds: USD 10,606.00; property address: Example Entity 2-4-2. Recipient: Example Household 204.",1099,5,1099,fdc-343b4dbcfe7b509b05f9b4af,synthetic-form-layout-02,original,2024,fte-799c84bfd502dd81d291c1d4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2025-03-06; gross proceeds: USD 10,689.00; property address: Example Entity 2-5-2. Recipient: Example Household 205.",1099,5,1099,fdc-d8424ba65ff2580d69dedc97,synthetic-form-layout-02,original,2025,fte-84d8f339cd7c407628326071,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2023-03-07; gross proceeds: USD 10,772.00; property address: Example Entity 2-6-2. Recipient: Example Household 206.",1099,5,1099,fdc-d1b49fe38c0484fb54714c71,synthetic-form-layout-02,original,2023,fte-b727355cc8a364563fe22a5e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-S: Proceeds From Real Estate Transactions.
closing date: 2024-03-08; gross proceeds: USD 10,855.00; property address: Example Entity 2-7-2. Recipient: Example Household 207.",1099,5,1099,fdc-5855775ed6a7999d406eef79,synthetic-form-layout-02,original,2024,fte-3bba0eb24fca18b7536ef4a9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2023.
Details: closing date: 2023-03-01, gross proceeds: USD 10,411.00, property address: Example Entity 3-0-2. Account holder: Example Person 300.",1099,5,1099,fdc-bf6623575807a7f007279f99,synthetic-form-layout-03,original,2023,fte-cc37a8ebf6cabd6b58104c8d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2024.
Details: closing date: 2024-03-02, gross proceeds: USD 10,494.00, property address: Example Entity 3-1-2. Account holder: Example Person 301.",1099,5,1099,fdc-1e332f86c21d06108a699300,synthetic-form-layout-03,original,2024,fte-877ecd554534891620de2fb3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2025.
Details: closing date: 2025-03-03, gross proceeds: USD 10,577.00, property address: Example Entity 3-2-2. Account holder: Example Person 302.",1099,5,1099,fdc-0407e339b02f3a56e92debd0,synthetic-form-layout-03,original,2025,fte-63a78a1032c2e283c48e24eb,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2023.
Details: closing date: 2023-03-04, gross proceeds: USD 10,660.00, property address: Example Entity 3-3-2. Account holder: Example Person 303.",1099,5,1099,fdc-30c479fddb40221d6d738371,synthetic-form-layout-03,original,2023,fte-504e9ae6dc1933257d095545,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2024.
Details: closing date: 2024-03-05, gross proceeds: USD 10,743.00, property address: Example Entity 3-4-2. Account holder: Example Person 304.",1099,5,1099,fdc-ea4ce198b5956e141ea2799f,synthetic-form-layout-03,original,2024,fte-73715a75a14aedcf08d25aca,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2025.
Details: closing date: 2025-03-06, gross proceeds: USD 10,826.00, property address: Example Entity 3-5-2. Account holder: Example Person 305.",1099,5,1099,fdc-762167153d689934e8d14856,synthetic-form-layout-03,original,2025,fte-0300a562571466307d1b7756,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2023.
Details: closing date: 2023-03-07, gross proceeds: USD 10,909.00, property address: Example Entity 3-6-2. Account holder: Example Person 306.",1099,5,1099,fdc-6e27ae699f8eda1aca0e05b6,synthetic-form-layout-03,original,2023,fte-c5fc85c3edd4db4afaa1910d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions
Reporting period ended 12/31/2024.
Details: closing date: 2024-03-08, gross proceeds: USD 10,992.00, property address: Example Entity 3-7-2. Account holder: Example Person 307.",1099,5,1099,fdc-3662f182695af450c4b9a2ca,synthetic-form-layout-03,original,2024,fte-f7d5233e0f9ec0d1ed72f532,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2023
property address: Example Entity 4-0-2
gross proceeds: USD 10,548.00
closing date: 2023-03-01
Named party: Example Person 400",1099,5,1099,fdc-2d36a90a48640e18ceef2311,synthetic-form-layout-04,original,2023,fte-0bad048f997cf5d2fe80a5d7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2024
property address: Example Entity 4-1-2
gross proceeds: USD 10,631.00
closing date: 2024-03-02
Named party: Example Person 401",1099,5,1099,fdc-d9c6fb2201fae2506ef5b4cf,synthetic-form-layout-04,original,2024,fte-eb3afe514857e122198023df,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2025
property address: Example Entity 4-2-2
gross proceeds: USD 10,714.00
closing date: 2025-03-03
Named party: Example Person 402",1099,5,1099,fdc-46391c0438e3bdd69559d535,synthetic-form-layout-04,original,2025,fte-608a49229fa6f2f2edf33998,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2023
property address: Example Entity 4-3-2
gross proceeds: USD 10,797.00
closing date: 2023-03-04
Named party: Example Person 403",1099,5,1099,fdc-64f604c89e1851a0b6da88c8,synthetic-form-layout-04,original,2023,fte-9c45c8452b102ae985a724fb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2024
property address: Example Entity 4-4-2
gross proceeds: USD 10,880.00
closing date: 2024-03-05
Named party: Example Person 404",1099,5,1099,fdc-fa01f165b864bef026776654,synthetic-form-layout-04,original,2024,fte-e576f1fdd8a2dcc9d17bfe18,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2025
property address: Example Entity 4-5-2
gross proceeds: USD 10,963.00
closing date: 2025-03-06
Named party: Example Person 405",1099,5,1099,fdc-94d3434aa22654e99aaef7f7,synthetic-form-layout-04,original,2025,fte-606d29ac94978cf4acdcae65,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2023
property address: Example Entity 4-6-2
gross proceeds: USD 11,046.00
closing date: 2023-03-07
Named party: Example Person 406",1099,5,1099,fdc-a459229deee073d2f7ddcbfb,synthetic-form-layout-04,original,2023,fte-4f2f96f4b50775b1418c05b2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-S: Proceeds From Real Estate Transactions
Tax reporting year 2024
property address: Example Entity 4-7-2
gross proceeds: USD 11,129.00
closing date: 2024-03-08
Named party: Example Person 407",1099,5,1099,fdc-8b09aed7af1a7ad57d3d4438,synthetic-form-layout-04,original,2024,fte-c8011bd6ce8d0d0f7d965a22,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2023
closing date: 2023-03-01 / gross proceeds: USD 10,685.00 / property address: Example Entity 5-0-2
Delivery copy for Example Party 500",1099,5,1099,fdc-28279f5ca8787f475ded78a6,synthetic-form-layout-05,original,2023,fte-57cfb86c907c83cc890c555a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2024
closing date: 2024-03-02 / gross proceeds: USD 10,768.00 / property address: Example Entity 5-1-2
Delivery copy for Example Party 501",1099,5,1099,fdc-ed3520fdc0ac480d951ab66e,synthetic-form-layout-05,original,2024,fte-9729bdf911b5fc96caa16a43,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2025
closing date: 2025-03-03 / gross proceeds: USD 10,851.00 / property address: Example Entity 5-2-2
Delivery copy for Example Party 502",1099,5,1099,fdc-420efe31b1d4360b8c3aba56,synthetic-form-layout-05,original,2025,fte-526aeb2ed1b5ecff3522abf8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2023
closing date: 2023-03-04 / gross proceeds: USD 10,934.00 / property address: Example Entity 5-3-2
Delivery copy for Example Party 503",1099,5,1099,fdc-c1a877c5ad69fcfa1628849e,synthetic-form-layout-05,original,2023,fte-cd2bfc0f0ca40fe53b2d9d6f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2024
closing date: 2024-03-05 / gross proceeds: USD 11,017.00 / property address: Example Entity 5-4-2
Delivery copy for Example Party 504",1099,5,1099,fdc-4f4699f21246689ec7f8f295,synthetic-form-layout-05,original,2024,fte-ef250890cac89ea3233c8e8f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2025
closing date: 2025-03-06 / gross proceeds: USD 11,100.00 / property address: Example Entity 5-5-2
Delivery copy for Example Party 505",1099,5,1099,fdc-6fc59b9459978913d9df4818,synthetic-form-layout-05,original,2025,fte-fc747a928eaa795740db13b7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2023
closing date: 2023-03-07 / gross proceeds: USD 11,183.00 / property address: Example Entity 5-6-2
Delivery copy for Example Party 506",1099,5,1099,fdc-5f785aedf7cc7548be083841,synthetic-form-layout-05,original,2023,fte-f3bdc4bcfeb40b66ba830459,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-S: Proceeds From Real Estate Transactions -- reporting year 2024
closing date: 2024-03-08 / gross proceeds: USD 11,266.00 / property address: Example Entity 5-7-2
Delivery copy for Example Party 507",1099,5,1099,fdc-9faa561551ce2de12f37ca7d,synthetic-form-layout-05,original,2024,fte-5bf783ad441b9f91b183d8dd,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2023
Statement issued to Example Person 0.
acquisition date: 2023-03-01
balance of principal: USD 150,000.00
property description: Example Entity 0-0-2",1099,5,1099,fdc-56a7b5db305ee51341d86fce,synthetic-form-layout-00,original,2023,fte-20db1ecd216ee486bfbb2f40,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2024
Statement issued to Example Person 1.
acquisition date: 2024-03-02
balance of principal: USD 151,245.00
property description: Example Entity 0-1-2",1099,5,1099,fdc-7a55d2daf77843f55ab36f80,synthetic-form-layout-00,original,2024,fte-5897360aed29ed19747798bd,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2025
Statement issued to Example Person 2.
acquisition date: 2025-03-03
balance of principal: USD 152,490.00
property description: Example Entity 0-2-2",1099,5,1099,fdc-45b6fc539e56490724bb8c99,synthetic-form-layout-00,original,2025,fte-6e0c6f43bb7910308364ebef,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2023
Statement issued to Example Person 3.
acquisition date: 2023-03-04
balance of principal: USD 153,735.00
property description: Example Entity 0-3-2",1099,5,1099,fdc-a8612a3831532d9d128ee43d,synthetic-form-layout-00,original,2023,fte-7ac24452f9a21ec88d198343,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2024
Statement issued to Example Person 4.
acquisition date: 2024-03-05
balance of principal: USD 154,980.00
property description: Example Entity 0-4-2",1099,5,1099,fdc-d3e32fdc7071126f42aae001,synthetic-form-layout-00,original,2024,fte-9160b0137a2f6fc60e6a3316,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2025
Statement issued to Example Person 5.
acquisition date: 2025-03-06
balance of principal: USD 156,225.00
property description: Example Entity 0-5-2",1099,5,1099,fdc-b5a27b7cebddea889dfc1f21,synthetic-form-layout-00,original,2025,fte-2ff1656004663be05e5bd6ec,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2023
Statement issued to Example Person 6.
acquisition date: 2023-03-07
balance of principal: USD 157,470.00
property description: Example Entity 0-6-2",1099,5,1099,fdc-0ca0527c67c0d437e51f52bd,synthetic-form-layout-00,original,2023,fte-08bf8eca6effd443c0b8de5f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Calendar year: 2024
Statement issued to Example Person 7.
acquisition date: 2024-03-08
balance of principal: USD 158,715.00
property description: Example Entity 0-7-2",1099,5,1099,fdc-5ba5b7e12916dac37f6131b5,synthetic-form-layout-00,original,2024,fte-2aef7572afb334ccee713076,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 100
acquisition date: 2023-03-01 | balance of principal: USD 152,055.00 | property description: Example Entity 1-0-2",1099,5,1099,fdc-a0eab31e76c94a24c5e923a8,synthetic-form-layout-01,original,2023,fte-6f830e1ce0ad214ff965078d,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 101
acquisition date: 2024-03-02 | balance of principal: USD 153,300.00 | property description: Example Entity 1-1-2",1099,5,1099,fdc-7d74c5b8b7fcbc97a0c51432,synthetic-form-layout-01,original,2024,fte-d5119a4d08cb81d71c02a5ab,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 102
acquisition date: 2025-03-03 | balance of principal: USD 154,545.00 | property description: Example Entity 1-2-2",1099,5,1099,fdc-884fbf554f2c00f249347aee,synthetic-form-layout-01,original,2025,fte-d05a57c88de070dc83015561,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 103
acquisition date: 2023-03-04 | balance of principal: USD 155,790.00 | property description: Example Entity 1-3-2",1099,5,1099,fdc-2725319bd1aba31a455da040,synthetic-form-layout-01,original,2023,fte-3eebb83743dfde0efe3fa60e,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 104
acquisition date: 2024-03-05 | balance of principal: USD 157,035.00 | property description: Example Entity 1-4-2",1099,5,1099,fdc-060d5630eed424708cb3a512,synthetic-form-layout-01,original,2024,fte-fdf61232273c706e98776916,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 105
acquisition date: 2025-03-06 | balance of principal: USD 158,280.00 | property description: Example Entity 1-5-2",1099,5,1099,fdc-82f576a3e2eddcdc97f6f9a6,synthetic-form-layout-01,original,2025,fte-a765e0a6479b4a3a07869481,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 106
acquisition date: 2023-03-07 | balance of principal: USD 159,525.00 | property description: Example Entity 1-6-2",1099,5,1099,fdc-ac41207e6f26a9dab990a989,synthetic-form-layout-01,original,2023,fte-b85bc61b64c815e003458d9b,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-A: Acquisition or Abandonment of Secured Property
Recipient record: Example Person 107
acquisition date: 2024-03-08 | balance of principal: USD 160,770.00 | property description: Example Entity 1-7-2",1099,5,1099,fdc-c14e73afb560376c5cba73d6,synthetic-form-layout-01,original,2024,fte-70fe2f12996df8a49d94c55f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2023-03-01; balance of principal: USD 154,110.00; property description: Example Entity 2-0-2. Recipient: Example Household 200.",1099,5,1099,fdc-a91e7b074c830f60176a769d,synthetic-form-layout-02,original,2023,fte-89980cab6e2964ed56391ae6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2024-03-02; balance of principal: USD 155,355.00; property description: Example Entity 2-1-2. Recipient: Example Household 201.",1099,5,1099,fdc-7660c3cf37a75a96202eebd6,synthetic-form-layout-02,original,2024,fte-09c09b44bcffe178eddb6838,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2025-03-03; balance of principal: USD 156,600.00; property description: Example Entity 2-2-2. Recipient: Example Household 202.",1099,5,1099,fdc-f9dca4def9dcd0a5ff969375,synthetic-form-layout-02,original,2025,fte-8f94b71d32a523475abc8db0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2023-03-04; balance of principal: USD 157,845.00; property description: Example Entity 2-3-2. Recipient: Example Household 203.",1099,5,1099,fdc-a9c494f45dea38f6d4bd588f,synthetic-form-layout-02,original,2023,fte-ec62a4bc6b6fe30cc2d1547c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2024-03-05; balance of principal: USD 159,090.00; property description: Example Entity 2-4-2. Recipient: Example Household 204.",1099,5,1099,fdc-747f62505f9fcdb69be0e528,synthetic-form-layout-02,original,2024,fte-5629be9191305148fd2cf486,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2025-03-06; balance of principal: USD 160,335.00; property description: Example Entity 2-5-2. Recipient: Example Household 205.",1099,5,1099,fdc-538843115164609ae851d9b0,synthetic-form-layout-02,original,2025,fte-2c99261abde89397a37314f9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2023-03-07; balance of principal: USD 161,580.00; property description: Example Entity 2-6-2. Recipient: Example Household 206.",1099,5,1099,fdc-8425d23f4ad03130e7324962,synthetic-form-layout-02,original,2023,fte-b199d9c93701fd33e3c1fab1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-A: Acquisition or Abandonment of Secured Property.
acquisition date: 2024-03-08; balance of principal: USD 162,825.00; property description: Example Entity 2-7-2. Recipient: Example Household 207.",1099,5,1099,fdc-6ccf5d66f0b1aae79b2f93bb,synthetic-form-layout-02,original,2024,fte-595613f936db001142e81625,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2023.
Details: acquisition date: 2023-03-01, balance of principal: USD 156,165.00, property description: Example Entity 3-0-2. Account holder: Example Person 300.",1099,5,1099,fdc-a59dc5eaba84e10faffbd3d6,synthetic-form-layout-03,original,2023,fte-10c87ecc1a0daff5c276e101,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2024.
Details: acquisition date: 2024-03-02, balance of principal: USD 157,410.00, property description: Example Entity 3-1-2. Account holder: Example Person 301.",1099,5,1099,fdc-4129fbaffed0046ee6d3e4d3,synthetic-form-layout-03,original,2024,fte-ffed6f9279a544e1cac2d5ae,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2025.
Details: acquisition date: 2025-03-03, balance of principal: USD 158,655.00, property description: Example Entity 3-2-2. Account holder: Example Person 302.",1099,5,1099,fdc-0d423d5e8ea3c165202e168d,synthetic-form-layout-03,original,2025,fte-00c1d5291806b5eccc023b70,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2023.
Details: acquisition date: 2023-03-04, balance of principal: USD 159,900.00, property description: Example Entity 3-3-2. Account holder: Example Person 303.",1099,5,1099,fdc-41d1ea82b2a2f522a8a6b0d1,synthetic-form-layout-03,original,2023,fte-b016c8accc626951ce6dd59c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2024.
Details: acquisition date: 2024-03-05, balance of principal: USD 161,145.00, property description: Example Entity 3-4-2. Account holder: Example Person 304.",1099,5,1099,fdc-e9a60965f3309a7ecf2d63df,synthetic-form-layout-03,original,2024,fte-41054ab0958733636748d2d0,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2025.
Details: acquisition date: 2025-03-06, balance of principal: USD 162,390.00, property description: Example Entity 3-5-2. Account holder: Example Person 305.",1099,5,1099,fdc-3a268fd94f1ca00f14b0c1e3,synthetic-form-layout-03,original,2025,fte-4930a3caaf237074317133be,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2023.
Details: acquisition date: 2023-03-07, balance of principal: USD 163,635.00, property description: Example Entity 3-6-2. Account holder: Example Person 306.",1099,5,1099,fdc-c2df78f02c6acdd3d80c653d,synthetic-form-layout-03,original,2023,fte-513320a353255967474d7d7a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property
Reporting period ended 12/31/2024.
Details: acquisition date: 2024-03-08, balance of principal: USD 164,880.00, property description: Example Entity 3-7-2. Account holder: Example Person 307.",1099,5,1099,fdc-604e5739e3d6c19fb0a3c5f5,synthetic-form-layout-03,original,2024,fte-d9d9011eccdc45a1ef9b594a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2023
property description: Example Entity 4-0-2
balance of principal: USD 158,220.00
acquisition date: 2023-03-01
Named party: Example Person 400",1099,5,1099,fdc-984d29c724005e27c98c87ee,synthetic-form-layout-04,original,2023,fte-c04ac09d2fbc599d0aa85059,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2024
property description: Example Entity 4-1-2
balance of principal: USD 159,465.00
acquisition date: 2024-03-02
Named party: Example Person 401",1099,5,1099,fdc-27d4d4a26506c50a11f9bbd8,synthetic-form-layout-04,original,2024,fte-c3c16c393463c31ed6c8b875,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2025
property description: Example Entity 4-2-2
balance of principal: USD 160,710.00
acquisition date: 2025-03-03
Named party: Example Person 402",1099,5,1099,fdc-9076e607796ffe25422d9ef4,synthetic-form-layout-04,original,2025,fte-18cabe1ce4b109df526e9883,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2023
property description: Example Entity 4-3-2
balance of principal: USD 161,955.00
acquisition date: 2023-03-04
Named party: Example Person 403",1099,5,1099,fdc-ac74cffe39d1dbc19abfdad8,synthetic-form-layout-04,original,2023,fte-502260c8b19753688aca351a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2024
property description: Example Entity 4-4-2
balance of principal: USD 163,200.00
acquisition date: 2024-03-05
Named party: Example Person 404",1099,5,1099,fdc-8eb30cfb582e98ddd43d32ee,synthetic-form-layout-04,original,2024,fte-514aca34c31e0bdabb96f54e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2025
property description: Example Entity 4-5-2
balance of principal: USD 164,445.00
acquisition date: 2025-03-06
Named party: Example Person 405",1099,5,1099,fdc-f14c0cfceb7f169242fa1786,synthetic-form-layout-04,original,2025,fte-9a02bb13ba40eca31e7bb4b9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2023
property description: Example Entity 4-6-2
balance of principal: USD 165,690.00
acquisition date: 2023-03-07
Named party: Example Person 406",1099,5,1099,fdc-8fd0c221578f258b6f747507,synthetic-form-layout-04,original,2023,fte-eb240303c33e6291e53b667d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-A: Acquisition or Abandonment of Secured Property
Tax reporting year 2024
property description: Example Entity 4-7-2
balance of principal: USD 166,935.00
acquisition date: 2024-03-08
Named party: Example Person 407",1099,5,1099,fdc-a725ce1171bf1a5efe8cf649,synthetic-form-layout-04,original,2024,fte-1f23bd080e0c6fa367d6b65a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2023
acquisition date: 2023-03-01 / balance of principal: USD 160,275.00 / property description: Example Entity 5-0-2
Delivery copy for Example Party 500",1099,5,1099,fdc-b5133f7b9ae38370a2fdd712,synthetic-form-layout-05,original,2023,fte-4c8379bcab5c1e982e5dc5f3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2024
acquisition date: 2024-03-02 / balance of principal: USD 161,520.00 / property description: Example Entity 5-1-2
Delivery copy for Example Party 501",1099,5,1099,fdc-d91b78af4c385c8be5270109,synthetic-form-layout-05,original,2024,fte-cd1ebfe11d1ab0105d5ce990,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2025
acquisition date: 2025-03-03 / balance of principal: USD 162,765.00 / property description: Example Entity 5-2-2
Delivery copy for Example Party 502",1099,5,1099,fdc-dbaa239f0d22ff1b7bdb4611,synthetic-form-layout-05,original,2025,fte-e5654c55975a199f6c574ab3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2023
acquisition date: 2023-03-04 / balance of principal: USD 164,010.00 / property description: Example Entity 5-3-2
Delivery copy for Example Party 503",1099,5,1099,fdc-a753ccbcc6cdad5aa2bab29e,synthetic-form-layout-05,original,2023,fte-d383a58623e29d07276aa756,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2024
acquisition date: 2024-03-05 / balance of principal: USD 165,255.00 / property description: Example Entity 5-4-2
Delivery copy for Example Party 504",1099,5,1099,fdc-29c1f52eb68befa12697e09b,synthetic-form-layout-05,original,2024,fte-1aabaac294effe43f6099d07,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2025
acquisition date: 2025-03-06 / balance of principal: USD 166,500.00 / property description: Example Entity 5-5-2
Delivery copy for Example Party 505",1099,5,1099,fdc-22ffe5e9bbdfc0dcec21f16f,synthetic-form-layout-05,original,2025,fte-72998b6b7115c340e2f8780b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2023
acquisition date: 2023-03-07 / balance of principal: USD 167,745.00 / property description: Example Entity 5-6-2
Delivery copy for Example Party 506",1099,5,1099,fdc-ac4ebc22bd7572ec4c88f782,synthetic-form-layout-05,original,2023,fte-4e1cafa9749906e0788f45f0,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-A: Acquisition or Abandonment of Secured Property -- reporting year 2024
acquisition date: 2024-03-08 / balance of principal: USD 168,990.00 / property description: Example Entity 5-7-2
Delivery copy for Example Party 507",1099,5,1099,fdc-febc2387f945c3f7343aad63,synthetic-form-layout-05,original,2024,fte-51328b172880d2c539e47236,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2023
Statement issued to Example Person 0.
date of identifiable event: 2023-03-01
debt discharged: USD 10,000.00
interest included: USD 10,000.00",1099,5,1099,fdc-6968e50c4e2303d180f12511,synthetic-form-layout-00,original,2023,fte-4b0597cc2fab090c57e89dae,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2024
Statement issued to Example Person 1.
date of identifiable event: 2024-03-02
debt discharged: USD 10,083.00
interest included: USD 10,083.00",1099,5,1099,fdc-68e958f219ebe4d8e4fe89e2,synthetic-form-layout-00,original,2024,fte-519d8646f85bf63395cdf4c2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2025
Statement issued to Example Person 2.
date of identifiable event: 2025-03-03
debt discharged: USD 10,166.00
interest included: USD 10,166.00",1099,5,1099,fdc-073bf95ccc66b41768071219,synthetic-form-layout-00,original,2025,fte-3bdfdf59052f3f2f3bdf09cc,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2023
Statement issued to Example Person 3.
date of identifiable event: 2023-03-04
debt discharged: USD 10,249.00
interest included: USD 10,249.00",1099,5,1099,fdc-697792116731b87a0e4e78bc,synthetic-form-layout-00,original,2023,fte-9d9e21bfcfda8bfe0f5dc043,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2024
Statement issued to Example Person 4.
date of identifiable event: 2024-03-05
debt discharged: USD 10,332.00
interest included: USD 10,332.00",1099,5,1099,fdc-93be4f587d22679e0d8d60ec,synthetic-form-layout-00,original,2024,fte-b6bb7609b2ec58375aa379a6,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2025
Statement issued to Example Person 5.
date of identifiable event: 2025-03-06
debt discharged: USD 10,415.00
interest included: USD 10,415.00",1099,5,1099,fdc-1bf41abc95d278f935b0f65f,synthetic-form-layout-00,original,2025,fte-81f3a074a317e29093bda8ea,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2023
Statement issued to Example Person 6.
date of identifiable event: 2023-03-07
debt discharged: USD 10,498.00
interest included: USD 10,498.00",1099,5,1099,fdc-2be61a305cc70af63dbac654,synthetic-form-layout-00,original,2023,fte-b9062394520335ebaf1383c5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Calendar year: 2024
Statement issued to Example Person 7.
date of identifiable event: 2024-03-08
debt discharged: USD 10,581.00
interest included: USD 10,581.00",1099,5,1099,fdc-bdca6dabff81d92c5461dc5c,synthetic-form-layout-00,original,2024,fte-f5bcea9ae155ddf1cac7fa11,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 100
date of identifiable event: 2023-03-01 | debt discharged: USD 10,137.00 | interest included: USD 10,137.00",1099,5,1099,fdc-9ba86ef89130eeb53edd8577,synthetic-form-layout-01,original,2023,fte-852ace5e6168b625b83f8eaa,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 101
date of identifiable event: 2024-03-02 | debt discharged: USD 10,220.00 | interest included: USD 10,220.00",1099,5,1099,fdc-9955fc6c0379cf6e646e5062,synthetic-form-layout-01,original,2024,fte-382a8e2143de8a404d6e15a6,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 102
date of identifiable event: 2025-03-03 | debt discharged: USD 10,303.00 | interest included: USD 10,303.00",1099,5,1099,fdc-ce86134d5c2e0bb439e252b5,synthetic-form-layout-01,original,2025,fte-ef8723954b288b3e27d0f02e,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 103
date of identifiable event: 2023-03-04 | debt discharged: USD 10,386.00 | interest included: USD 10,386.00",1099,5,1099,fdc-2d13b38c4b5938b0affeaf1c,synthetic-form-layout-01,original,2023,fte-d00bc6aae08a56459f1b3eb9,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 104
date of identifiable event: 2024-03-05 | debt discharged: USD 10,469.00 | interest included: USD 10,469.00",1099,5,1099,fdc-9605f6eb748fb287ec2c5761,synthetic-form-layout-01,original,2024,fte-b617430324727462b9df9e12,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 105
date of identifiable event: 2025-03-06 | debt discharged: USD 10,552.00 | interest included: USD 10,552.00",1099,5,1099,fdc-8af6eaa0e23cd717569e1f39,synthetic-form-layout-01,original,2025,fte-b7d637ce97e73d4a35143070,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 106
date of identifiable event: 2023-03-07 | debt discharged: USD 10,635.00 | interest included: USD 10,635.00",1099,5,1099,fdc-7cc139e3917066ea2d655a42,synthetic-form-layout-01,original,2023,fte-59431ffe268170dcc5dca965,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-C: Cancellation of Debt
Recipient record: Example Person 107
date of identifiable event: 2024-03-08 | debt discharged: USD 10,718.00 | interest included: USD 10,718.00",1099,5,1099,fdc-9a8249564b2e4588364d2a2e,synthetic-form-layout-01,original,2024,fte-11fcb8430de59f7f4e7bc771,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2023-03-01; debt discharged: USD 10,274.00; interest included: USD 10,274.00. Recipient: Example Household 200.",1099,5,1099,fdc-58524104fa3d6399a2dea7ed,synthetic-form-layout-02,original,2023,fte-bebdfd671803d1fb8dba74b5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2024-03-02; debt discharged: USD 10,357.00; interest included: USD 10,357.00. Recipient: Example Household 201.",1099,5,1099,fdc-621a384f3cd16df548c5338e,synthetic-form-layout-02,original,2024,fte-f9ade70f5de2b9c56c7d9d3c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2025-03-03; debt discharged: USD 10,440.00; interest included: USD 10,440.00. Recipient: Example Household 202.",1099,5,1099,fdc-54e63c37cc3b3856294411b4,synthetic-form-layout-02,original,2025,fte-8f3ef9ea5695dfdc56779aa0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2023-03-04; debt discharged: USD 10,523.00; interest included: USD 10,523.00. Recipient: Example Household 203.",1099,5,1099,fdc-ba9096ab24d2ffe7c02f37ca,synthetic-form-layout-02,original,2023,fte-9bcd021cfd1198ae5a47db62,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2024-03-05; debt discharged: USD 10,606.00; interest included: USD 10,606.00. Recipient: Example Household 204.",1099,5,1099,fdc-ce6370177ae062b37692080e,synthetic-form-layout-02,original,2024,fte-dea49430002f38944a76953e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2025-03-06; debt discharged: USD 10,689.00; interest included: USD 10,689.00. Recipient: Example Household 205.",1099,5,1099,fdc-9e62b57cd09921ff6f33b76f,synthetic-form-layout-02,original,2025,fte-395185007cfd67828128795a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2023-03-07; debt discharged: USD 10,772.00; interest included: USD 10,772.00. Recipient: Example Household 206.",1099,5,1099,fdc-6ff4671b1d0769df1d595357,synthetic-form-layout-02,original,2023,fte-4afc6a6e9f7debf433fdf953,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-C: Cancellation of Debt.
date of identifiable event: 2024-03-08; debt discharged: USD 10,855.00; interest included: USD 10,855.00. Recipient: Example Household 207.",1099,5,1099,fdc-d7371fe133d060b2d99eabd8,synthetic-form-layout-02,original,2024,fte-c26b6b22193475d7a16b61b7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2023.
Details: date of identifiable event: 2023-03-01, debt discharged: USD 10,411.00, interest included: USD 10,411.00. Account holder: Example Person 300.",1099,5,1099,fdc-267eef93d04ad501d7d85018,synthetic-form-layout-03,original,2023,fte-bbb562a21e147dc66d520f42,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2024.
Details: date of identifiable event: 2024-03-02, debt discharged: USD 10,494.00, interest included: USD 10,494.00. Account holder: Example Person 301.",1099,5,1099,fdc-12cbe79d16ec20cd63692b44,synthetic-form-layout-03,original,2024,fte-72fe039252da23bb0d0dc827,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2025.
Details: date of identifiable event: 2025-03-03, debt discharged: USD 10,577.00, interest included: USD 10,577.00. Account holder: Example Person 302.",1099,5,1099,fdc-4f746e7b4181de6ed3eef84b,synthetic-form-layout-03,original,2025,fte-cfa98bc21d166aa689399018,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2023.
Details: date of identifiable event: 2023-03-04, debt discharged: USD 10,660.00, interest included: USD 10,660.00. Account holder: Example Person 303.",1099,5,1099,fdc-a158f55627111787264b7c36,synthetic-form-layout-03,original,2023,fte-bc4e9729a198ffca53483a58,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2024.
Details: date of identifiable event: 2024-03-05, debt discharged: USD 10,743.00, interest included: USD 10,743.00. Account holder: Example Person 304.",1099,5,1099,fdc-ddde5cf09da62ed2fa1c4d6e,synthetic-form-layout-03,original,2024,fte-ea0a9257f8ee9d5df12e31b6,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2025.
Details: date of identifiable event: 2025-03-06, debt discharged: USD 10,826.00, interest included: USD 10,826.00. Account holder: Example Person 305.",1099,5,1099,fdc-ed366654f109ee641e4919e7,synthetic-form-layout-03,original,2025,fte-9877731c98bdf99a342ac38e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2023.
Details: date of identifiable event: 2023-03-07, debt discharged: USD 10,909.00, interest included: USD 10,909.00. Account holder: Example Person 306.",1099,5,1099,fdc-35a7abb90acf2dbdd8dbd806,synthetic-form-layout-03,original,2023,fte-0573f6b88078c300ccb4c2d8,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt
Reporting period ended 12/31/2024.
Details: date of identifiable event: 2024-03-08, debt discharged: USD 10,992.00, interest included: USD 10,992.00. Account holder: Example Person 307.",1099,5,1099,fdc-b35e8869e3b3e8bf0b2f29a0,synthetic-form-layout-03,original,2024,fte-f679119368e60c2b00bca397,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2023
interest included: USD 10,548.00
debt discharged: USD 10,548.00
date of identifiable event: 2023-03-01
Named party: Example Person 400",1099,5,1099,fdc-b50283bd149f810769a12496,synthetic-form-layout-04,original,2023,fte-703ff5bc3c04a3512f9f39a2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2024
interest included: USD 10,631.00
debt discharged: USD 10,631.00
date of identifiable event: 2024-03-02
Named party: Example Person 401",1099,5,1099,fdc-3be2b08d0d2dbd08f043495d,synthetic-form-layout-04,original,2024,fte-bbf8b64302394c4df6441c3d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2025
interest included: USD 10,714.00
debt discharged: USD 10,714.00
date of identifiable event: 2025-03-03
Named party: Example Person 402",1099,5,1099,fdc-ccc025a0acce855aaa401573,synthetic-form-layout-04,original,2025,fte-df88a5009bfc2cc493683985,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2023
interest included: USD 10,797.00
debt discharged: USD 10,797.00
date of identifiable event: 2023-03-04
Named party: Example Person 403",1099,5,1099,fdc-ebf6dca5605faa471861773e,synthetic-form-layout-04,original,2023,fte-641c5fc0c67548a92ed8950d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2024
interest included: USD 10,880.00
debt discharged: USD 10,880.00
date of identifiable event: 2024-03-05
Named party: Example Person 404",1099,5,1099,fdc-92a3045c523f42949f657941,synthetic-form-layout-04,original,2024,fte-40d87f71f156d05f33ccf7a1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2025
interest included: USD 10,963.00
debt discharged: USD 10,963.00
date of identifiable event: 2025-03-06
Named party: Example Person 405",1099,5,1099,fdc-bdd8160e7e9465a7c20e68c6,synthetic-form-layout-04,original,2025,fte-d3a2d02c3204a5c1a07d1087,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2023
interest included: USD 11,046.00
debt discharged: USD 11,046.00
date of identifiable event: 2023-03-07
Named party: Example Person 406",1099,5,1099,fdc-fd5761ccc74f08efcbc7786a,synthetic-form-layout-04,original,2023,fte-24076413415de1d95637a8be,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-C: Cancellation of Debt
Tax reporting year 2024
interest included: USD 11,129.00
debt discharged: USD 11,129.00
date of identifiable event: 2024-03-08
Named party: Example Person 407",1099,5,1099,fdc-6ef29b415fb51d4d0d24de67,synthetic-form-layout-04,original,2024,fte-1dbb191c79ab35610201f9e2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2023
date of identifiable event: 2023-03-01 / debt discharged: USD 10,685.00 / interest included: USD 10,685.00
Delivery copy for Example Party 500",1099,5,1099,fdc-625551dd7507b3e562653e1a,synthetic-form-layout-05,original,2023,fte-c1d986f08a0b280f1bba22d1,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2024
date of identifiable event: 2024-03-02 / debt discharged: USD 10,768.00 / interest included: USD 10,768.00
Delivery copy for Example Party 501",1099,5,1099,fdc-f29d6e90257bff87196b575c,synthetic-form-layout-05,original,2024,fte-c30fbc9f3646deef25efa4d7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2025
date of identifiable event: 2025-03-03 / debt discharged: USD 10,851.00 / interest included: USD 10,851.00
Delivery copy for Example Party 502",1099,5,1099,fdc-86b579995989db7b2ed69e2d,synthetic-form-layout-05,original,2025,fte-6a6eba8265b00c4e8fd95d6c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2023
date of identifiable event: 2023-03-04 / debt discharged: USD 10,934.00 / interest included: USD 10,934.00
Delivery copy for Example Party 503",1099,5,1099,fdc-db08757a0a4f6a4ecec5c3d3,synthetic-form-layout-05,original,2023,fte-beb54e1170fc3d26cb26bbee,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2024
date of identifiable event: 2024-03-05 / debt discharged: USD 11,017.00 / interest included: USD 11,017.00
Delivery copy for Example Party 504",1099,5,1099,fdc-9cdcf1e3b8a8289122fef7b5,synthetic-form-layout-05,original,2024,fte-827426348ff7526c70970623,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2025
date of identifiable event: 2025-03-06 / debt discharged: USD 11,100.00 / interest included: USD 11,100.00
Delivery copy for Example Party 505",1099,5,1099,fdc-a7f498d501f4b81830d0fc6a,synthetic-form-layout-05,original,2025,fte-818dcc1e437831ad521e55ce,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2023
date of identifiable event: 2023-03-07 / debt discharged: USD 11,183.00 / interest included: USD 11,183.00
Delivery copy for Example Party 506",1099,5,1099,fdc-09271e782869f700bac38b29,synthetic-form-layout-05,original,2023,fte-41e166afb487cfdaf9f073b4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-C: Cancellation of Debt -- reporting year 2024
date of identifiable event: 2024-03-08 / debt discharged: USD 11,266.00 / interest included: USD 11,266.00
Delivery copy for Example Party 507",1099,5,1099,fdc-6bba408d18c4fe758082df37,synthetic-form-layout-05,original,2024,fte-17cdeb604a482957aef3e3da,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2023
Statement issued to Example Person 0.
mortgage interest received: USD 10,000.00
principal: USD 150,000.00
points: USD 10,000.00
lender: USD 10,000.00",1098,4,1098,fdc-db45fb672f8cd5f49c25abec,synthetic-form-layout-00,original,2023,fte-9611339b1b0d3bb2fb548616,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2024
Statement issued to Example Person 1.
mortgage interest received: USD 10,083.00
principal: USD 151,245.00
points: USD 10,083.00
lender: USD 10,083.00",1098,4,1098,fdc-25a67fdc4e75f98973c7d71c,synthetic-form-layout-00,original,2024,fte-348f0b52c2a47e9b2e585926,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2025
Statement issued to Example Person 2.
mortgage interest received: USD 10,166.00
principal: USD 152,490.00
points: USD 10,166.00
lender: USD 10,166.00",1098,4,1098,fdc-990692d3e575ab12bb2093bb,synthetic-form-layout-00,original,2025,fte-7b6580a7223b9198e5159fa6,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2023
Statement issued to Example Person 3.
mortgage interest received: USD 10,249.00
principal: USD 153,735.00
points: USD 10,249.00
lender: USD 10,249.00",1098,4,1098,fdc-a5e8b17ee6f576d36e20f26c,synthetic-form-layout-00,original,2023,fte-4a8fc3bc3d884c63d5655466,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2024
Statement issued to Example Person 4.
mortgage interest received: USD 10,332.00
principal: USD 154,980.00
points: USD 10,332.00
lender: USD 10,332.00",1098,4,1098,fdc-e775acebe950bfd23829906e,synthetic-form-layout-00,original,2024,fte-af98157d68b635d1bac89350,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2025
Statement issued to Example Person 5.
mortgage interest received: USD 10,415.00
principal: USD 156,225.00
points: USD 10,415.00
lender: USD 10,415.00",1098,4,1098,fdc-3f024e52098b76f54529982d,synthetic-form-layout-00,original,2025,fte-4ba4fe184ad570e72ba5b5c4,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2023
Statement issued to Example Person 6.
mortgage interest received: USD 10,498.00
principal: USD 157,470.00
points: USD 10,498.00
lender: USD 10,498.00",1098,4,1098,fdc-95a9bc4de55a2b57604edd19,synthetic-form-layout-00,original,2023,fte-1e945943603ed884302d1f68,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Calendar year: 2024
Statement issued to Example Person 7.
mortgage interest received: USD 10,581.00
principal: USD 158,715.00
points: USD 10,581.00
lender: USD 10,581.00",1098,4,1098,fdc-a7904c34a855f682ce1f4a05,synthetic-form-layout-00,original,2024,fte-6554d681bffae3d7e4187e93,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 100
mortgage interest received: USD 10,137.00 | principal: USD 152,055.00 | points: USD 10,137.00 | lender: USD 10,137.00",1098,4,1098,fdc-43f2599d2fbd7d2ab5789158,synthetic-form-layout-01,original,2023,fte-22eb9ab34f13292d73c8080a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 101
mortgage interest received: USD 10,220.00 | principal: USD 153,300.00 | points: USD 10,220.00 | lender: USD 10,220.00",1098,4,1098,fdc-ce6230450882055b540ddf70,synthetic-form-layout-01,original,2024,fte-a81f00561f6b0392973050b1,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 102
mortgage interest received: USD 10,303.00 | principal: USD 154,545.00 | points: USD 10,303.00 | lender: USD 10,303.00",1098,4,1098,fdc-2f5af7056b228fb5a513e7a8,synthetic-form-layout-01,original,2025,fte-ecb3525454337a8ac6328003,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 103
mortgage interest received: USD 10,386.00 | principal: USD 155,790.00 | points: USD 10,386.00 | lender: USD 10,386.00",1098,4,1098,fdc-b5083e54af5c6451bc2a169a,synthetic-form-layout-01,original,2023,fte-78eb2502b8d886afcde8777e,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 104
mortgage interest received: USD 10,469.00 | principal: USD 157,035.00 | points: USD 10,469.00 | lender: USD 10,469.00",1098,4,1098,fdc-a40c4d7069db3b878ca7582f,synthetic-form-layout-01,original,2024,fte-9f18a197497879c1cfcf6723,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 105
mortgage interest received: USD 10,552.00 | principal: USD 158,280.00 | points: USD 10,552.00 | lender: USD 10,552.00",1098,4,1098,fdc-04fdfb198b6988533bedbbff,synthetic-form-layout-01,original,2025,fte-10cd91e1a92b9b05dfe5b72e,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 106
mortgage interest received: USD 10,635.00 | principal: USD 159,525.00 | points: USD 10,635.00 | lender: USD 10,635.00",1098,4,1098,fdc-4bfa0d6857d8181ca999e462,synthetic-form-layout-01,original,2023,fte-49574b23bde23dbbbd60c3fa,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098: Mortgage Interest Statement
Recipient record: Example Person 107
mortgage interest received: USD 10,718.00 | principal: USD 160,770.00 | points: USD 10,718.00 | lender: USD 10,718.00",1098,4,1098,fdc-b0532e21200ef59cb23dd838,synthetic-form-layout-01,original,2024,fte-ecde98264b1aafca969bac9c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,274.00; principal: USD 154,110.00; points: USD 10,274.00; lender: USD 10,274.00. Recipient: Example Household 200.",1098,4,1098,fdc-4eaa13fd524ad4c7ef996f30,synthetic-form-layout-02,original,2023,fte-5e46f6ef180195afa157d059,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,357.00; principal: USD 155,355.00; points: USD 10,357.00; lender: USD 10,357.00. Recipient: Example Household 201.",1098,4,1098,fdc-6938fed3c4c3309ea5db1294,synthetic-form-layout-02,original,2024,fte-e945f7a92eebe19e586f468a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,440.00; principal: USD 156,600.00; points: USD 10,440.00; lender: USD 10,440.00. Recipient: Example Household 202.",1098,4,1098,fdc-657a016f64f34b1c5a96874f,synthetic-form-layout-02,original,2025,fte-836cff7d00d0a4e90bb90074,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,523.00; principal: USD 157,845.00; points: USD 10,523.00; lender: USD 10,523.00. Recipient: Example Household 203.",1098,4,1098,fdc-e793d0885da206572d8563ef,synthetic-form-layout-02,original,2023,fte-14f1527909bafb45d5435624,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,606.00; principal: USD 159,090.00; points: USD 10,606.00; lender: USD 10,606.00. Recipient: Example Household 204.",1098,4,1098,fdc-86b9871538d7315c2e96c629,synthetic-form-layout-02,original,2024,fte-b1519f563c7433fba68f0de3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,689.00; principal: USD 160,335.00; points: USD 10,689.00; lender: USD 10,689.00. Recipient: Example Household 205.",1098,4,1098,fdc-70decf472b40bbb3280b39c5,synthetic-form-layout-02,original,2025,fte-c92ace31f88d0ab87a662d34,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,772.00; principal: USD 161,580.00; points: USD 10,772.00; lender: USD 10,772.00. Recipient: Example Household 206.",1098,4,1098,fdc-5e70f83276b2ee0cb7ca67ca,synthetic-form-layout-02,original,2023,fte-8ee680cc55f90939389aeabd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098: Mortgage Interest Statement.
mortgage interest received: USD 10,855.00; principal: USD 162,825.00; points: USD 10,855.00; lender: USD 10,855.00. Recipient: Example Household 207.",1098,4,1098,fdc-e4e9b1d7fd1dc131131d716d,synthetic-form-layout-02,original,2024,fte-7822b9d62b8d801fa5cef248,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2023.
Details: mortgage interest received: USD 10,411.00, principal: USD 156,165.00, points: USD 10,411.00, lender: USD 10,411.00. Account holder: Example Person 300.",1098,4,1098,fdc-828b64ce213be4733a451f8b,synthetic-form-layout-03,original,2023,fte-e485ea0bb11873d245d88d86,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2024.
Details: mortgage interest received: USD 10,494.00, principal: USD 157,410.00, points: USD 10,494.00, lender: USD 10,494.00. Account holder: Example Person 301.",1098,4,1098,fdc-2c95ed0934ba9f761e113801,synthetic-form-layout-03,original,2024,fte-6bb8371ea898587cd8b850ed,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2025.
Details: mortgage interest received: USD 10,577.00, principal: USD 158,655.00, points: USD 10,577.00, lender: USD 10,577.00. Account holder: Example Person 302.",1098,4,1098,fdc-821b376c7a0e11607a2befa0,synthetic-form-layout-03,original,2025,fte-119bbd0e92c3f33696377257,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2023.
Details: mortgage interest received: USD 10,660.00, principal: USD 159,900.00, points: USD 10,660.00, lender: USD 10,660.00. Account holder: Example Person 303.",1098,4,1098,fdc-ee33a8991b6b8736ce996e3b,synthetic-form-layout-03,original,2023,fte-9af1f1ae341be73df5c43e04,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2024.
Details: mortgage interest received: USD 10,743.00, principal: USD 161,145.00, points: USD 10,743.00, lender: USD 10,743.00. Account holder: Example Person 304.",1098,4,1098,fdc-dfbce5fc4c4d196a83ed2641,synthetic-form-layout-03,original,2024,fte-6a046c72ce97f822f7210ca7,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2025.
Details: mortgage interest received: USD 10,826.00, principal: USD 162,390.00, points: USD 10,826.00, lender: USD 10,826.00. Account holder: Example Person 305.",1098,4,1098,fdc-6c9d3dca81ab68040451b9a0,synthetic-form-layout-03,original,2025,fte-4a8dc09a53d6d8a3c088e387,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2023.
Details: mortgage interest received: USD 10,909.00, principal: USD 163,635.00, points: USD 10,909.00, lender: USD 10,909.00. Account holder: Example Person 306.",1098,4,1098,fdc-3f9df81f6fc8e38917f403f3,synthetic-form-layout-03,original,2023,fte-f4806a08acc898ec8e34662c,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement
Reporting period ended 12/31/2024.
Details: mortgage interest received: USD 10,992.00, principal: USD 164,880.00, points: USD 10,992.00, lender: USD 10,992.00. Account holder: Example Person 307.",1098,4,1098,fdc-26e1ff20156745d36ba0320a,synthetic-form-layout-03,original,2024,fte-d2b1c2a30b2088948b4a4212,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2023
lender: USD 10,548.00
points: USD 10,548.00
principal: USD 158,220.00
mortgage interest received: USD 10,548.00
Named party: Example Person 400",1098,4,1098,fdc-e1c7f0196afb216874678c63,synthetic-form-layout-04,original,2023,fte-557367124636e1db2f1ff562,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2024
lender: USD 10,631.00
points: USD 10,631.00
principal: USD 159,465.00
mortgage interest received: USD 10,631.00
Named party: Example Person 401",1098,4,1098,fdc-e33cc5050337f2bdf9ea7a4f,synthetic-form-layout-04,original,2024,fte-fc1329193f5de8a9016f1480,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2025
lender: USD 10,714.00
points: USD 10,714.00
principal: USD 160,710.00
mortgage interest received: USD 10,714.00
Named party: Example Person 402",1098,4,1098,fdc-7680362d23dd584e0e4906f5,synthetic-form-layout-04,original,2025,fte-5bfab8305c855281861ebda1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2023
lender: USD 10,797.00
points: USD 10,797.00
principal: USD 161,955.00
mortgage interest received: USD 10,797.00
Named party: Example Person 403",1098,4,1098,fdc-37deb1076b41d1b71eaec2e4,synthetic-form-layout-04,original,2023,fte-68224534bc02ca7bd6083a61,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2024
lender: USD 10,880.00
points: USD 10,880.00
principal: USD 163,200.00
mortgage interest received: USD 10,880.00
Named party: Example Person 404",1098,4,1098,fdc-566a526bd837a49df1e241dc,synthetic-form-layout-04,original,2024,fte-bdd3822421e84fa765214d2e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2025
lender: USD 10,963.00
points: USD 10,963.00
principal: USD 164,445.00
mortgage interest received: USD 10,963.00
Named party: Example Person 405",1098,4,1098,fdc-aedda86cb7948379375463e6,synthetic-form-layout-04,original,2025,fte-e979f33603f1aabac97c1e11,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2023
lender: USD 11,046.00
points: USD 11,046.00
principal: USD 165,690.00
mortgage interest received: USD 11,046.00
Named party: Example Person 406",1098,4,1098,fdc-48d144a420dcbb85b21f63ac,synthetic-form-layout-04,original,2023,fte-000442d5d6b2f438702e5efa,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098: Mortgage Interest Statement
Tax reporting year 2024
lender: USD 11,129.00
points: USD 11,129.00
principal: USD 166,935.00
mortgage interest received: USD 11,129.00
Named party: Example Person 407",1098,4,1098,fdc-d4b0fff0dd2210373475b479,synthetic-form-layout-04,original,2024,fte-65b090a9adfc812caf7d54df,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2023
mortgage interest received: USD 10,685.00 / principal: USD 160,275.00 / points: USD 10,685.00 / lender: USD 10,685.00
Delivery copy for Example Party 500",1098,4,1098,fdc-2b606c0f1c726d8e5f4c6777,synthetic-form-layout-05,original,2023,fte-c62bb6d01f4a1ee5b57dcee8,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2024
mortgage interest received: USD 10,768.00 / principal: USD 161,520.00 / points: USD 10,768.00 / lender: USD 10,768.00
Delivery copy for Example Party 501",1098,4,1098,fdc-5c9b4ff9eec1f59be33ce8cc,synthetic-form-layout-05,original,2024,fte-dfd52e7aa9c4629af6c92988,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2025
mortgage interest received: USD 10,851.00 / principal: USD 162,765.00 / points: USD 10,851.00 / lender: USD 10,851.00
Delivery copy for Example Party 502",1098,4,1098,fdc-5b73a7b9eb15b35575cdaf12,synthetic-form-layout-05,original,2025,fte-3aafef0605ccff5a6be9be43,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2023
mortgage interest received: USD 10,934.00 / principal: USD 164,010.00 / points: USD 10,934.00 / lender: USD 10,934.00
Delivery copy for Example Party 503",1098,4,1098,fdc-c7465bb1ee971b5c2ceb24e0,synthetic-form-layout-05,original,2023,fte-15226ed3c8c6fe5b479c08aa,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2024
mortgage interest received: USD 11,017.00 / principal: USD 165,255.00 / points: USD 11,017.00 / lender: USD 11,017.00
Delivery copy for Example Party 504",1098,4,1098,fdc-c0607953511e3a44ac43747d,synthetic-form-layout-05,original,2024,fte-fee27c7c78314e84922b37fd,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2025
mortgage interest received: USD 11,100.00 / principal: USD 166,500.00 / points: USD 11,100.00 / lender: USD 11,100.00
Delivery copy for Example Party 505",1098,4,1098,fdc-7533633534493ef35b8e5d5d,synthetic-form-layout-05,original,2025,fte-7e343df6b752e5952746c1f6,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2023
mortgage interest received: USD 11,183.00 / principal: USD 167,745.00 / points: USD 11,183.00 / lender: USD 11,183.00
Delivery copy for Example Party 506",1098,4,1098,fdc-6a95eb0cb9f11f8ffd09c5cf,synthetic-form-layout-05,original,2023,fte-6577c37f1981ea4027217635,synthetic_AI_labeled,v1_template,top,False,
"Form 1098: Mortgage Interest Statement -- reporting year 2024
mortgage interest received: USD 11,266.00 / principal: USD 168,990.00 / points: USD 11,266.00 / lender: USD 11,266.00
Delivery copy for Example Party 507",1098,4,1098,fdc-98859df776b5b9e8d01354b4,synthetic-form-layout-05,original,2024,fte-7eccd99487c76fd62226f90d,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2023
Statement issued to Example Person 0.
payments received for tuition: USD 10,000.00
scholarships: USD 10,000.00
student: Example Entity 0-0-2",1098,4,1098,fdc-6ee584b9e6f3c97fb0690281,synthetic-form-layout-00,original,2023,fte-51dc671726e7fc9e011e7c74,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2024
Statement issued to Example Person 1.
payments received for tuition: USD 10,083.00
scholarships: USD 10,083.00
student: Example Entity 0-1-2",1098,4,1098,fdc-34315db5606c28e97dca3b4f,synthetic-form-layout-00,original,2024,fte-e54433351835171545a476e1,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2025
Statement issued to Example Person 2.
payments received for tuition: USD 10,166.00
scholarships: USD 10,166.00
student: Example Entity 0-2-2",1098,4,1098,fdc-44d4d2467a80d9f0fb059010,synthetic-form-layout-00,original,2025,fte-1453b1ed5c9a8a83e4c756fa,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2023
Statement issued to Example Person 3.
payments received for tuition: USD 10,249.00
scholarships: USD 10,249.00
student: Example Entity 0-3-2",1098,4,1098,fdc-cc4d0fc2b769c656f6d4dad2,synthetic-form-layout-00,original,2023,fte-3c58842587f4cee93212b811,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2024
Statement issued to Example Person 4.
payments received for tuition: USD 10,332.00
scholarships: USD 10,332.00
student: Example Entity 0-4-2",1098,4,1098,fdc-b6e2ec21ef6370d40f5bde5a,synthetic-form-layout-00,original,2024,fte-733359b5c5676dc04c4884bd,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2025
Statement issued to Example Person 5.
payments received for tuition: USD 10,415.00
scholarships: USD 10,415.00
student: Example Entity 0-5-2",1098,4,1098,fdc-86965ae40f7c0836e0c6b5ea,synthetic-form-layout-00,original,2025,fte-8100e0b1c1539afbd947a038,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2023
Statement issued to Example Person 6.
payments received for tuition: USD 10,498.00
scholarships: USD 10,498.00
student: Example Entity 0-6-2",1098,4,1098,fdc-f90658ed6d3543fead612abd,synthetic-form-layout-00,original,2023,fte-509b49f93770db2c7c43e0e4,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Calendar year: 2024
Statement issued to Example Person 7.
payments received for tuition: USD 10,581.00
scholarships: USD 10,581.00
student: Example Entity 0-7-2",1098,4,1098,fdc-3dd695ba2a14c1a39a9940cb,synthetic-form-layout-00,original,2024,fte-c758535f9d0bf2ffc615f7df,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-T: Tuition Statement
Recipient record: Example Person 100
payments received for tuition: USD 10,137.00 | scholarships: USD 10,137.00 | student: Example Entity 1-0-2",1098,4,1098,fdc-38783cf8418502e9bf006be1,synthetic-form-layout-01,original,2023,fte-7249c7b52a1dde4e07be11e0,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-T: Tuition Statement
Recipient record: Example Person 101
payments received for tuition: USD 10,220.00 | scholarships: USD 10,220.00 | student: Example Entity 1-1-2",1098,4,1098,fdc-1e15f0c12a5dc4bdeb2ae72f,synthetic-form-layout-01,original,2024,fte-46c95b066ed8150704fb2570,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098-T: Tuition Statement
Recipient record: Example Person 102
payments received for tuition: USD 10,303.00 | scholarships: USD 10,303.00 | student: Example Entity 1-2-2",1098,4,1098,fdc-7a266c3d0dd5e29c8ed6c409,synthetic-form-layout-01,original,2025,fte-0f69a5b954ad0401145b9450,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-T: Tuition Statement
Recipient record: Example Person 103
payments received for tuition: USD 10,386.00 | scholarships: USD 10,386.00 | student: Example Entity 1-3-2",1098,4,1098,fdc-ee830dbb69e313c0bccd3998,synthetic-form-layout-01,original,2023,fte-1a1098d9e3ad24e381035790,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-T: Tuition Statement
Recipient record: Example Person 104
payments received for tuition: USD 10,469.00 | scholarships: USD 10,469.00 | student: Example Entity 1-4-2",1098,4,1098,fdc-047c524a78ad747fbc930d49,synthetic-form-layout-01,original,2024,fte-2b49a7e9e7a05e15c66902ca,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098-T: Tuition Statement
Recipient record: Example Person 105
payments received for tuition: USD 10,552.00 | scholarships: USD 10,552.00 | student: Example Entity 1-5-2",1098,4,1098,fdc-596352f01d9b26c326ed9da0,synthetic-form-layout-01,original,2025,fte-71bf4cb0d47898a3ac41a689,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-T: Tuition Statement
Recipient record: Example Person 106
payments received for tuition: USD 10,635.00 | scholarships: USD 10,635.00 | student: Example Entity 1-6-2",1098,4,1098,fdc-5304048e212acee401bafad1,synthetic-form-layout-01,original,2023,fte-006747bc58c34863bfe67d43,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-T: Tuition Statement
Recipient record: Example Person 107
payments received for tuition: USD 10,718.00 | scholarships: USD 10,718.00 | student: Example Entity 1-7-2",1098,4,1098,fdc-f4810d58e2fcd67b5141d74c,synthetic-form-layout-01,original,2024,fte-0151242b7b10ff59fe0df16d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,274.00; scholarships: USD 10,274.00; student: Example Entity 2-0-2. Recipient: Example Household 200.",1098,4,1098,fdc-c0e7d1c2a64dc6f25aa8c1a0,synthetic-form-layout-02,original,2023,fte-d0cd07d658694a379b464b3c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,357.00; scholarships: USD 10,357.00; student: Example Entity 2-1-2. Recipient: Example Household 201.",1098,4,1098,fdc-525e59f8cdadae2e3eeadcb6,synthetic-form-layout-02,original,2024,fte-9ff83392a91af19866aa3e70,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,440.00; scholarships: USD 10,440.00; student: Example Entity 2-2-2. Recipient: Example Household 202.",1098,4,1098,fdc-72a86fbd7fcc0b631c313d2c,synthetic-form-layout-02,original,2025,fte-becdfc27aedf03bf738a9778,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,523.00; scholarships: USD 10,523.00; student: Example Entity 2-3-2. Recipient: Example Household 203.",1098,4,1098,fdc-b35d407e21dfc4f0d486fce3,synthetic-form-layout-02,original,2023,fte-875927636b471014ba944c61,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,606.00; scholarships: USD 10,606.00; student: Example Entity 2-4-2. Recipient: Example Household 204.",1098,4,1098,fdc-1354115dcb9cafb3810d1c1c,synthetic-form-layout-02,original,2024,fte-73b0621445538f34be99c31c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,689.00; scholarships: USD 10,689.00; student: Example Entity 2-5-2. Recipient: Example Household 205.",1098,4,1098,fdc-151320ea599da1cef29073b1,synthetic-form-layout-02,original,2025,fte-ccf7544ba9571d9fd4c76236,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,772.00; scholarships: USD 10,772.00; student: Example Entity 2-6-2. Recipient: Example Household 206.",1098,4,1098,fdc-f217fd157be2c1dcb2a15226,synthetic-form-layout-02,original,2023,fte-4193c132f6c60f60687a1712,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-T: Tuition Statement.
payments received for tuition: USD 10,855.00; scholarships: USD 10,855.00; student: Example Entity 2-7-2. Recipient: Example Household 207.",1098,4,1098,fdc-cf59e1b47ebfc5edbb8f3072,synthetic-form-layout-02,original,2024,fte-b7887ac853c5e38ee2bf9ecb,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2023.
Details: payments received for tuition: USD 10,411.00, scholarships: USD 10,411.00, student: Example Entity 3-0-2. Account holder: Example Person 300.",1098,4,1098,fdc-5d7cc0114395c71b69ed1335,synthetic-form-layout-03,original,2023,fte-e7a7f8790d9f3afd05daee30,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2024.
Details: payments received for tuition: USD 10,494.00, scholarships: USD 10,494.00, student: Example Entity 3-1-2. Account holder: Example Person 301.",1098,4,1098,fdc-5fa4ff4d70084414eeae0542,synthetic-form-layout-03,original,2024,fte-679aebdac4a4550f0589478c,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2025.
Details: payments received for tuition: USD 10,577.00, scholarships: USD 10,577.00, student: Example Entity 3-2-2. Account holder: Example Person 302.",1098,4,1098,fdc-bda72c7dfe3d439a787b2974,synthetic-form-layout-03,original,2025,fte-f69decefb436ef2dbb9cc852,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2023.
Details: payments received for tuition: USD 10,660.00, scholarships: USD 10,660.00, student: Example Entity 3-3-2. Account holder: Example Person 303.",1098,4,1098,fdc-aa74c0efb2faedd7a476cb37,synthetic-form-layout-03,original,2023,fte-78ed04edbe4e955db85e42f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2024.
Details: payments received for tuition: USD 10,743.00, scholarships: USD 10,743.00, student: Example Entity 3-4-2. Account holder: Example Person 304.",1098,4,1098,fdc-e124537e086681342d1bfb10,synthetic-form-layout-03,original,2024,fte-6be8beecec0e7e3822d10b2b,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2025.
Details: payments received for tuition: USD 10,826.00, scholarships: USD 10,826.00, student: Example Entity 3-5-2. Account holder: Example Person 305.",1098,4,1098,fdc-bf279d4d134af56d1fd27ce3,synthetic-form-layout-03,original,2025,fte-b399a654f32763ebe7f3d683,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2023.
Details: payments received for tuition: USD 10,909.00, scholarships: USD 10,909.00, student: Example Entity 3-6-2. Account holder: Example Person 306.",1098,4,1098,fdc-e297c93d36c922ec95c28af4,synthetic-form-layout-03,original,2023,fte-cfde1cb0bf654b14ef3bba0c,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement
Reporting period ended 12/31/2024.
Details: payments received for tuition: USD 10,992.00, scholarships: USD 10,992.00, student: Example Entity 3-7-2. Account holder: Example Person 307.",1098,4,1098,fdc-c4c726b781873664b781f594,synthetic-form-layout-03,original,2024,fte-aada464cd245f2cac1a004d2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2023
student: Example Entity 4-0-2
scholarships: USD 10,548.00
payments received for tuition: USD 10,548.00
Named party: Example Person 400",1098,4,1098,fdc-528f662f69101f11f72b2779,synthetic-form-layout-04,original,2023,fte-c6a99aaa4cbcf7e30ba0d649,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2024
student: Example Entity 4-1-2
scholarships: USD 10,631.00
payments received for tuition: USD 10,631.00
Named party: Example Person 401",1098,4,1098,fdc-3c4aed4b6f61b410e0ad3e59,synthetic-form-layout-04,original,2024,fte-5fa2640809c9e295a7950128,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2025
student: Example Entity 4-2-2
scholarships: USD 10,714.00
payments received for tuition: USD 10,714.00
Named party: Example Person 402",1098,4,1098,fdc-1e32cc57574c90ce8418ade9,synthetic-form-layout-04,original,2025,fte-3b8d2ceba1cd2f22bf71feec,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2023
student: Example Entity 4-3-2
scholarships: USD 10,797.00
payments received for tuition: USD 10,797.00
Named party: Example Person 403",1098,4,1098,fdc-61afdf5153affbda34203949,synthetic-form-layout-04,original,2023,fte-98587787e917b5cdc81bacb3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2024
student: Example Entity 4-4-2
scholarships: USD 10,880.00
payments received for tuition: USD 10,880.00
Named party: Example Person 404",1098,4,1098,fdc-ffc0a6a57e9de017a1246632,synthetic-form-layout-04,original,2024,fte-6f77b34f03491b80acafe773,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2025
student: Example Entity 4-5-2
scholarships: USD 10,963.00
payments received for tuition: USD 10,963.00
Named party: Example Person 405",1098,4,1098,fdc-68be62ad96127f86c3f9d5dc,synthetic-form-layout-04,original,2025,fte-c9a4c7b764771844493c3328,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2023
student: Example Entity 4-6-2
scholarships: USD 11,046.00
payments received for tuition: USD 11,046.00
Named party: Example Person 406",1098,4,1098,fdc-8131ab08e3a7422948d9d2fa,synthetic-form-layout-04,original,2023,fte-aeaa23f48b4eba2cfb9ade05,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-T: Tuition Statement
Tax reporting year 2024
student: Example Entity 4-7-2
scholarships: USD 11,129.00
payments received for tuition: USD 11,129.00
Named party: Example Person 407",1098,4,1098,fdc-ffd3bd7eea4750567cffeca5,synthetic-form-layout-04,original,2024,fte-060eb7986a339f53a5b40e4e,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2023
payments received for tuition: USD 10,685.00 / scholarships: USD 10,685.00 / student: Example Entity 5-0-2
Delivery copy for Example Party 500",1098,4,1098,fdc-a0db8ef27e07ecaa1bb18c01,synthetic-form-layout-05,original,2023,fte-1a56fffd55d281e702d1f3f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2024
payments received for tuition: USD 10,768.00 / scholarships: USD 10,768.00 / student: Example Entity 5-1-2
Delivery copy for Example Party 501",1098,4,1098,fdc-c38c21505e55ee3fc60d6f4d,synthetic-form-layout-05,original,2024,fte-7960ba7f845edb4366b78e4d,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2025
payments received for tuition: USD 10,851.00 / scholarships: USD 10,851.00 / student: Example Entity 5-2-2
Delivery copy for Example Party 502",1098,4,1098,fdc-4167089540da024cdff9c1a4,synthetic-form-layout-05,original,2025,fte-80f01b1b9c0d9819831062d6,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2023
payments received for tuition: USD 10,934.00 / scholarships: USD 10,934.00 / student: Example Entity 5-3-2
Delivery copy for Example Party 503",1098,4,1098,fdc-3d18c8986487b7b28cc286f2,synthetic-form-layout-05,original,2023,fte-a4648207978202948c89ad17,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2024
payments received for tuition: USD 11,017.00 / scholarships: USD 11,017.00 / student: Example Entity 5-4-2
Delivery copy for Example Party 504",1098,4,1098,fdc-c5ce28bcc3bd719b6f881d0c,synthetic-form-layout-05,original,2024,fte-f4171ce50fb4dcb6459e9653,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2025
payments received for tuition: USD 11,100.00 / scholarships: USD 11,100.00 / student: Example Entity 5-5-2
Delivery copy for Example Party 505",1098,4,1098,fdc-592927815435427fdfa50efa,synthetic-form-layout-05,original,2025,fte-779741a2658b43d23241d191,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2023
payments received for tuition: USD 11,183.00 / scholarships: USD 11,183.00 / student: Example Entity 5-6-2
Delivery copy for Example Party 506",1098,4,1098,fdc-e016333c2e19a36a36afb07c,synthetic-form-layout-05,original,2023,fte-04405875f503b2e71757434e,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-T: Tuition Statement -- reporting year 2024
payments received for tuition: USD 11,266.00 / scholarships: USD 11,266.00 / student: Example Entity 5-7-2
Delivery copy for Example Party 507",1098,4,1098,fdc-44dd05289e275afd83c60945,synthetic-form-layout-05,original,2024,fte-a79316ad240534d4ab6c486d,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2023
Statement issued to Example Person 0.
student loan interest received: Example Entity 0-0-0
lender: USD 10,000.00
borrower: USD 10,000.00",1098,4,1098,fdc-b64e1aac2b41ea588d2ea6bf,synthetic-form-layout-00,original,2023,fte-a52ab72011175b9d323ddefb,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2024
Statement issued to Example Person 1.
student loan interest received: Example Entity 0-1-0
lender: USD 10,083.00
borrower: USD 10,083.00",1098,4,1098,fdc-972728470f21c024082974f2,synthetic-form-layout-00,original,2024,fte-7a526b9705d23074e9a00502,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2025
Statement issued to Example Person 2.
student loan interest received: Example Entity 0-2-0
lender: USD 10,166.00
borrower: USD 10,166.00",1098,4,1098,fdc-f6135158813d59b03d2c8117,synthetic-form-layout-00,original,2025,fte-01920f0a87067151bffb8e4d,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2023
Statement issued to Example Person 3.
student loan interest received: Example Entity 0-3-0
lender: USD 10,249.00
borrower: USD 10,249.00",1098,4,1098,fdc-1e1f9bdede63fe855f09731d,synthetic-form-layout-00,original,2023,fte-7212b86f2426c7073ea6ef1f,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2024
Statement issued to Example Person 4.
student loan interest received: Example Entity 0-4-0
lender: USD 10,332.00
borrower: USD 10,332.00",1098,4,1098,fdc-bbecd6396cac1891967feb5b,synthetic-form-layout-00,original,2024,fte-7b00e861a48aca5e21fb68a3,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2025
Statement issued to Example Person 5.
student loan interest received: Example Entity 0-5-0
lender: USD 10,415.00
borrower: USD 10,415.00",1098,4,1098,fdc-b115ec8ad3534d7014979781,synthetic-form-layout-00,original,2025,fte-4713e838d198f897e8caaa2c,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2023
Statement issued to Example Person 6.
student loan interest received: Example Entity 0-6-0
lender: USD 10,498.00
borrower: USD 10,498.00",1098,4,1098,fdc-a3f2cffab1262f666c82001e,synthetic-form-layout-00,original,2023,fte-fbc0602bf011f7354dfc3a89,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Calendar year: 2024
Statement issued to Example Person 7.
student loan interest received: Example Entity 0-7-0
lender: USD 10,581.00
borrower: USD 10,581.00",1098,4,1098,fdc-6986d0f567241628c93ca484,synthetic-form-layout-00,original,2024,fte-4f42d5186a6c3a52a00795e5,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 100
student loan interest received: Example Entity 1-0-0 | lender: USD 10,137.00 | borrower: USD 10,137.00",1098,4,1098,fdc-3f1ea31a52fe728d8eb34511,synthetic-form-layout-01,original,2023,fte-6012abf3891f5eee44f905eb,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 101
student loan interest received: Example Entity 1-1-0 | lender: USD 10,220.00 | borrower: USD 10,220.00",1098,4,1098,fdc-fc5f690c863eabc9e4d7fff7,synthetic-form-layout-01,original,2024,fte-7d594164663ff74138836d20,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 102
student loan interest received: Example Entity 1-2-0 | lender: USD 10,303.00 | borrower: USD 10,303.00",1098,4,1098,fdc-9e680a134c7e2e53091b9434,synthetic-form-layout-01,original,2025,fte-8e6de00d2b876ed735fbb7a9,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 103
student loan interest received: Example Entity 1-3-0 | lender: USD 10,386.00 | borrower: USD 10,386.00",1098,4,1098,fdc-1a372241b32f8bbb85836ebe,synthetic-form-layout-01,original,2023,fte-6db6227b381e7c6b5a263833,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 104
student loan interest received: Example Entity 1-4-0 | lender: USD 10,469.00 | borrower: USD 10,469.00",1098,4,1098,fdc-d3699cb407606e4bd28e24eb,synthetic-form-layout-01,original,2024,fte-45ce86001712ad146912bfec,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 105
student loan interest received: Example Entity 1-5-0 | lender: USD 10,552.00 | borrower: USD 10,552.00",1098,4,1098,fdc-4fb32d58dd145e53f0db2fe4,synthetic-form-layout-01,original,2025,fte-7ca045fd69fe0e4ad7c4d410,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 106
student loan interest received: Example Entity 1-6-0 | lender: USD 10,635.00 | borrower: USD 10,635.00",1098,4,1098,fdc-250e0dad8701fb67a8fe0e44,synthetic-form-layout-01,original,2023,fte-815668b3bffc18947a902210,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-E: Student Loan Interest Statement
Recipient record: Example Person 107
student loan interest received: Example Entity 1-7-0 | lender: USD 10,718.00 | borrower: USD 10,718.00",1098,4,1098,fdc-4fd6040a399259361941788e,synthetic-form-layout-01,original,2024,fte-d83c35a86f936f008241e1fd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-0-0; lender: USD 10,274.00; borrower: USD 10,274.00. Recipient: Example Household 200.",1098,4,1098,fdc-c097efdcd27c0e889ef7929b,synthetic-form-layout-02,original,2023,fte-d5ce30a402123bfd113cac7b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-1-0; lender: USD 10,357.00; borrower: USD 10,357.00. Recipient: Example Household 201.",1098,4,1098,fdc-4377b36d699d633d48212221,synthetic-form-layout-02,original,2024,fte-6cc0d85a015efc4604fc5cc6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-2-0; lender: USD 10,440.00; borrower: USD 10,440.00. Recipient: Example Household 202.",1098,4,1098,fdc-be3e0207603666fe7511673c,synthetic-form-layout-02,original,2025,fte-b5c5278b20a040aaae5400aa,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-3-0; lender: USD 10,523.00; borrower: USD 10,523.00. Recipient: Example Household 203.",1098,4,1098,fdc-ecb3d792a26503d047e13f90,synthetic-form-layout-02,original,2023,fte-58509dffbb195c14b50ea2dd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-4-0; lender: USD 10,606.00; borrower: USD 10,606.00. Recipient: Example Household 204.",1098,4,1098,fdc-deed681f7277fecf1de3ccc0,synthetic-form-layout-02,original,2024,fte-3abf4536c7473b064e49c4d1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-5-0; lender: USD 10,689.00; borrower: USD 10,689.00. Recipient: Example Household 205.",1098,4,1098,fdc-2444a8d63440d7b6db42c649,synthetic-form-layout-02,original,2025,fte-99fd45ad41991e43c11f1ebd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-6-0; lender: USD 10,772.00; borrower: USD 10,772.00. Recipient: Example Household 206.",1098,4,1098,fdc-d08996404466068c048a9689,synthetic-form-layout-02,original,2023,fte-eb4508e068699d784151c01a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-E: Student Loan Interest Statement.
student loan interest received: Example Entity 2-7-0; lender: USD 10,855.00; borrower: USD 10,855.00. Recipient: Example Household 207.",1098,4,1098,fdc-6d67737c3a7bf6821520d6ed,synthetic-form-layout-02,original,2024,fte-949e5852ba9c990b197f2884,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2023.
Details: student loan interest received: Example Entity 3-0-0, lender: USD 10,411.00, borrower: USD 10,411.00. Account holder: Example Person 300.",1098,4,1098,fdc-59160dfed64413d14fd7bc69,synthetic-form-layout-03,original,2023,fte-082cc595108e936316082b28,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2024.
Details: student loan interest received: Example Entity 3-1-0, lender: USD 10,494.00, borrower: USD 10,494.00. Account holder: Example Person 301.",1098,4,1098,fdc-b07a7b74a08e3e9d9243b1ce,synthetic-form-layout-03,original,2024,fte-5d4d719b5a039b6f17b9e968,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2025.
Details: student loan interest received: Example Entity 3-2-0, lender: USD 10,577.00, borrower: USD 10,577.00. Account holder: Example Person 302.",1098,4,1098,fdc-916b04578908d65cd9765cfd,synthetic-form-layout-03,original,2025,fte-d7eb876e20dafb6589ba6c0e,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2023.
Details: student loan interest received: Example Entity 3-3-0, lender: USD 10,660.00, borrower: USD 10,660.00. Account holder: Example Person 303.",1098,4,1098,fdc-c818a3ca2eefcec620b628e1,synthetic-form-layout-03,original,2023,fte-c38e62631890e83e34252a68,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2024.
Details: student loan interest received: Example Entity 3-4-0, lender: USD 10,743.00, borrower: USD 10,743.00. Account holder: Example Person 304.",1098,4,1098,fdc-625f1a84dca22ed793399de1,synthetic-form-layout-03,original,2024,fte-05649f24a48d40168171968e,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2025.
Details: student loan interest received: Example Entity 3-5-0, lender: USD 10,826.00, borrower: USD 10,826.00. Account holder: Example Person 305.",1098,4,1098,fdc-5d5aec2bf08a89925e61c8d2,synthetic-form-layout-03,original,2025,fte-2bd4db666b24461c2904d3b7,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2023.
Details: student loan interest received: Example Entity 3-6-0, lender: USD 10,909.00, borrower: USD 10,909.00. Account holder: Example Person 306.",1098,4,1098,fdc-e3618147be7d9d79693c0ff3,synthetic-form-layout-03,original,2023,fte-8b3ed92040617a66ab7c56c2,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement
Reporting period ended 12/31/2024.
Details: student loan interest received: Example Entity 3-7-0, lender: USD 10,992.00, borrower: USD 10,992.00. Account holder: Example Person 307.",1098,4,1098,fdc-6cc3c971d684a89f8753a576,synthetic-form-layout-03,original,2024,fte-856d6e33632d667240cac594,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2023
borrower: USD 10,548.00
lender: USD 10,548.00
student loan interest received: Example Entity 4-0-0
Named party: Example Person 400",1098,4,1098,fdc-f43506c6546a6646c973230c,synthetic-form-layout-04,original,2023,fte-50a7801ea886818ca9b7acae,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2024
borrower: USD 10,631.00
lender: USD 10,631.00
student loan interest received: Example Entity 4-1-0
Named party: Example Person 401",1098,4,1098,fdc-547df2be8ea9ccebdeb91ccf,synthetic-form-layout-04,original,2024,fte-b2ddc7b9c277aa51c632ffb9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2025
borrower: USD 10,714.00
lender: USD 10,714.00
student loan interest received: Example Entity 4-2-0
Named party: Example Person 402",1098,4,1098,fdc-061d1879184ea9f25ff281a3,synthetic-form-layout-04,original,2025,fte-a6fa25eaf7dedbefa476d3cb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2023
borrower: USD 10,797.00
lender: USD 10,797.00
student loan interest received: Example Entity 4-3-0
Named party: Example Person 403",1098,4,1098,fdc-ee43d6e903c9920fcd4260e5,synthetic-form-layout-04,original,2023,fte-632a5374559e05ec62a6d8da,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2024
borrower: USD 10,880.00
lender: USD 10,880.00
student loan interest received: Example Entity 4-4-0
Named party: Example Person 404",1098,4,1098,fdc-f22daa87d5775aeaf61beb57,synthetic-form-layout-04,original,2024,fte-6046564d5ec784608fe08e52,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2025
borrower: USD 10,963.00
lender: USD 10,963.00
student loan interest received: Example Entity 4-5-0
Named party: Example Person 405",1098,4,1098,fdc-4b5dac3a5a5d2a2d8f0ac3d8,synthetic-form-layout-04,original,2025,fte-d2e340930b72e1c3d40ce96c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2023
borrower: USD 11,046.00
lender: USD 11,046.00
student loan interest received: Example Entity 4-6-0
Named party: Example Person 406",1098,4,1098,fdc-d67f579a94d4e2c1882ada7e,synthetic-form-layout-04,original,2023,fte-b9bf3482d97f79e466b32544,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-E: Student Loan Interest Statement
Tax reporting year 2024
borrower: USD 11,129.00
lender: USD 11,129.00
student loan interest received: Example Entity 4-7-0
Named party: Example Person 407",1098,4,1098,fdc-cc9ec31bc738cd2c4ea8fbef,synthetic-form-layout-04,original,2024,fte-647903666930b293f8a46cda,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2023
student loan interest received: Example Entity 5-0-0 / lender: USD 10,685.00 / borrower: USD 10,685.00
Delivery copy for Example Party 500",1098,4,1098,fdc-ec968de16e865a1f16147d8b,synthetic-form-layout-05,original,2023,fte-ddd4ee44f417aa7efc01433c,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2024
student loan interest received: Example Entity 5-1-0 / lender: USD 10,768.00 / borrower: USD 10,768.00
Delivery copy for Example Party 501",1098,4,1098,fdc-627c8dc8b4d56d8b6170e162,synthetic-form-layout-05,original,2024,fte-4853fdf616f1416de19826bb,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2025
student loan interest received: Example Entity 5-2-0 / lender: USD 10,851.00 / borrower: USD 10,851.00
Delivery copy for Example Party 502",1098,4,1098,fdc-e55039209dc778cd7d61f26c,synthetic-form-layout-05,original,2025,fte-0653b5d5b97a270e16374d75,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2023
student loan interest received: Example Entity 5-3-0 / lender: USD 10,934.00 / borrower: USD 10,934.00
Delivery copy for Example Party 503",1098,4,1098,fdc-9e1003f6a3284904bccb7826,synthetic-form-layout-05,original,2023,fte-480bf46e5a7c892defd73839,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2024
student loan interest received: Example Entity 5-4-0 / lender: USD 11,017.00 / borrower: USD 11,017.00
Delivery copy for Example Party 504",1098,4,1098,fdc-7db3d3c8cd634c62f08825ec,synthetic-form-layout-05,original,2024,fte-07e44b1e1ef9c3d28b449cb9,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2025
student loan interest received: Example Entity 5-5-0 / lender: USD 11,100.00 / borrower: USD 11,100.00
Delivery copy for Example Party 505",1098,4,1098,fdc-abfcc1c15bd19ab290e7dcdb,synthetic-form-layout-05,original,2025,fte-523dbcdb991f2a18e6a98884,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2023
student loan interest received: Example Entity 5-6-0 / lender: USD 11,183.00 / borrower: USD 11,183.00
Delivery copy for Example Party 506",1098,4,1098,fdc-bf2e3cde1133f9e395784a2a,synthetic-form-layout-05,original,2023,fte-a202b403c1da6b789204a296,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-E: Student Loan Interest Statement -- reporting year 2024
student loan interest received: Example Entity 5-7-0 / lender: USD 11,266.00 / borrower: USD 11,266.00
Delivery copy for Example Party 507",1098,4,1098,fdc-e94a2a1a0ce3e0687a9f279b,synthetic-form-layout-05,original,2024,fte-a70521e1996a7589239fcd1f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2023
Statement issued to Example Person 0.
gross distribution: USD 10,000.00
earnings: USD 10,000.00
basis: USD 7,000.00
recipient: Example Entity 0-0-3",1099,5,1099,fdc-86573ce8ed99a7ed28ccd254,synthetic-form-layout-00,original,2023,fte-17b9ccdfb78a3caf724a46ce,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2024
Statement issued to Example Person 1.
gross distribution: USD 10,083.00
earnings: USD 10,083.00
basis: USD 7,058.10
recipient: Example Entity 0-1-3",1099,5,1099,fdc-4bf1646baa719b0dbbf54b1e,synthetic-form-layout-00,original,2024,fte-1b9780c141b4ec58256ccbc5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2025
Statement issued to Example Person 2.
gross distribution: USD 10,166.00
earnings: USD 10,166.00
basis: USD 7,116.20
recipient: Example Entity 0-2-3",1099,5,1099,fdc-e231ff0131e6aaef63f363c9,synthetic-form-layout-00,original,2025,fte-2a7e46633ac8324a00a3a8d2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2023
Statement issued to Example Person 3.
gross distribution: USD 10,249.00
earnings: USD 10,249.00
basis: USD 7,174.30
recipient: Example Entity 0-3-3",1099,5,1099,fdc-4cf57131fa2420c8c3c30788,synthetic-form-layout-00,original,2023,fte-f6c703ed1fb402a9ab18a3ad,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2024
Statement issued to Example Person 4.
gross distribution: USD 10,332.00
earnings: USD 10,332.00
basis: USD 7,232.40
recipient: Example Entity 0-4-3",1099,5,1099,fdc-e87e7fa777fc0a880753c08d,synthetic-form-layout-00,original,2024,fte-ad1ce969d8cba4c0a90929e7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2025
Statement issued to Example Person 5.
gross distribution: USD 10,415.00
earnings: USD 10,415.00
basis: USD 7,290.50
recipient: Example Entity 0-5-3",1099,5,1099,fdc-475ea0fce72bbe0562c04a92,synthetic-form-layout-00,original,2025,fte-166d90b228b2abe1d4e02b48,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2023
Statement issued to Example Person 6.
gross distribution: USD 10,498.00
earnings: USD 10,498.00
basis: USD 7,348.60
recipient: Example Entity 0-6-3",1099,5,1099,fdc-a044880b1df177e252cf5947,synthetic-form-layout-00,original,2023,fte-d669087ae1ef70484e83185a,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Calendar year: 2024
Statement issued to Example Person 7.
gross distribution: USD 10,581.00
earnings: USD 10,581.00
basis: USD 7,406.70
recipient: Example Entity 0-7-3",1099,5,1099,fdc-df23da3131a39cec653b9817,synthetic-form-layout-00,original,2024,fte-2af32b22ea44d81fb43538d4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 100
gross distribution: USD 10,137.00 | earnings: USD 10,137.00 | basis: USD 7,095.90 | recipient: Example Entity 1-0-3",1099,5,1099,fdc-314a9198217f33fd51b72cf0,synthetic-form-layout-01,original,2023,fte-56828e2844493b6fcbd4f8d3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 101
gross distribution: USD 10,220.00 | earnings: USD 10,220.00 | basis: USD 7,154.00 | recipient: Example Entity 1-1-3",1099,5,1099,fdc-608610fc22790bc2f5be916f,synthetic-form-layout-01,original,2024,fte-37f8c080a367275bc890cebd,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 102
gross distribution: USD 10,303.00 | earnings: USD 10,303.00 | basis: USD 7,212.10 | recipient: Example Entity 1-2-3",1099,5,1099,fdc-45a352ad62a3ef446bb20d84,synthetic-form-layout-01,original,2025,fte-dfd50f4c2b4914c40660e615,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 103
gross distribution: USD 10,386.00 | earnings: USD 10,386.00 | basis: USD 7,270.20 | recipient: Example Entity 1-3-3",1099,5,1099,fdc-67c615bcc8a92b721c060ab7,synthetic-form-layout-01,original,2023,fte-bca97c66e3af21f6f603da39,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 104
gross distribution: USD 10,469.00 | earnings: USD 10,469.00 | basis: USD 7,328.30 | recipient: Example Entity 1-4-3",1099,5,1099,fdc-9f86cb6a683a4cd07c49a1bc,synthetic-form-layout-01,original,2024,fte-276d2b5ce6113024c2222a38,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 105
gross distribution: USD 10,552.00 | earnings: USD 10,552.00 | basis: USD 7,386.40 | recipient: Example Entity 1-5-3",1099,5,1099,fdc-f488dad99ad44f7b1255bed3,synthetic-form-layout-01,original,2025,fte-2a74976b21ccf32d054e3029,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 106
gross distribution: USD 10,635.00 | earnings: USD 10,635.00 | basis: USD 7,444.50 | recipient: Example Entity 1-6-3",1099,5,1099,fdc-e641197e3f441866a6ed07a4,synthetic-form-layout-01,original,2023,fte-655ffc0d78be9cefe42dfeb8,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-Q: Payments From Qualified Education Programs
Recipient record: Example Person 107
gross distribution: USD 10,718.00 | earnings: USD 10,718.00 | basis: USD 7,502.60 | recipient: Example Entity 1-7-3",1099,5,1099,fdc-102f45f495cc22eee11131ad,synthetic-form-layout-01,original,2024,fte-297890b81276518e0e40e943,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,274.00; earnings: USD 10,274.00; basis: USD 7,191.80; recipient: Example Entity 2-0-3. Recipient: Example Household 200.",1099,5,1099,fdc-41cddb3e5d47823aea72dec4,synthetic-form-layout-02,original,2023,fte-4cd84df8a87a484a67cb7763,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,357.00; earnings: USD 10,357.00; basis: USD 7,249.90; recipient: Example Entity 2-1-3. Recipient: Example Household 201.",1099,5,1099,fdc-b2198c8425c7dd7dcc4098ce,synthetic-form-layout-02,original,2024,fte-8d1c96bd1739ba34b6286871,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,440.00; earnings: USD 10,440.00; basis: USD 7,308.00; recipient: Example Entity 2-2-3. Recipient: Example Household 202.",1099,5,1099,fdc-26637ec6f6dd0c51c5e6aeab,synthetic-form-layout-02,original,2025,fte-4ab5ac5dc67c5a8226a6fc7b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,523.00; earnings: USD 10,523.00; basis: USD 7,366.10; recipient: Example Entity 2-3-3. Recipient: Example Household 203.",1099,5,1099,fdc-93cebcf02290fce77f5c403a,synthetic-form-layout-02,original,2023,fte-53e299949507a2c0f50ac567,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,606.00; earnings: USD 10,606.00; basis: USD 7,424.20; recipient: Example Entity 2-4-3. Recipient: Example Household 204.",1099,5,1099,fdc-987f0ac185ff68c0ca513e6c,synthetic-form-layout-02,original,2024,fte-652d72bfc4c98f480ea0c705,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,689.00; earnings: USD 10,689.00; basis: USD 7,482.30; recipient: Example Entity 2-5-3. Recipient: Example Household 205.",1099,5,1099,fdc-cfaed18b73b8bb1c0137e77a,synthetic-form-layout-02,original,2025,fte-ee63ac170df4d516b1217d97,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,772.00; earnings: USD 10,772.00; basis: USD 7,540.40; recipient: Example Entity 2-6-3. Recipient: Example Household 206.",1099,5,1099,fdc-49aa221fdd8e6c954517fed2,synthetic-form-layout-02,original,2023,fte-dc3a9aa9dc8cd7f0cbaa6344,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-Q: Payments From Qualified Education Programs.
gross distribution: USD 10,855.00; earnings: USD 10,855.00; basis: USD 7,598.50; recipient: Example Entity 2-7-3. Recipient: Example Household 207.",1099,5,1099,fdc-7adba0bbf1f4aafdf4981894,synthetic-form-layout-02,original,2024,fte-44154023855670688c054e98,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,411.00, earnings: USD 10,411.00, basis: USD 7,287.70, recipient: Example Entity 3-0-3. Account holder: Example Person 300.",1099,5,1099,fdc-6bd40b87b211aa155aa24f8a,synthetic-form-layout-03,original,2023,fte-02be819a0fffff9da578ffd4,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,494.00, earnings: USD 10,494.00, basis: USD 7,345.80, recipient: Example Entity 3-1-3. Account holder: Example Person 301.",1099,5,1099,fdc-226a577608ecb14a7bec7ddb,synthetic-form-layout-03,original,2024,fte-18550ddcbb36d6bd114028d5,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2025.
Details: gross distribution: USD 10,577.00, earnings: USD 10,577.00, basis: USD 7,403.90, recipient: Example Entity 3-2-3. Account holder: Example Person 302.",1099,5,1099,fdc-d5a2b161bcc37266339936ca,synthetic-form-layout-03,original,2025,fte-423f01367d66d9281cae2d92,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,660.00, earnings: USD 10,660.00, basis: USD 7,462.00, recipient: Example Entity 3-3-3. Account holder: Example Person 303.",1099,5,1099,fdc-a8da7da5d0323a4b039ef439,synthetic-form-layout-03,original,2023,fte-78e8cb227b367cc4ed97df8d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,743.00, earnings: USD 10,743.00, basis: USD 7,520.10, recipient: Example Entity 3-4-3. Account holder: Example Person 304.",1099,5,1099,fdc-9bbbe2a29e5f79c97ab7e64b,synthetic-form-layout-03,original,2024,fte-0961a18a13c4e345f6c40b79,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2025.
Details: gross distribution: USD 10,826.00, earnings: USD 10,826.00, basis: USD 7,578.20, recipient: Example Entity 3-5-3. Account holder: Example Person 305.",1099,5,1099,fdc-0648f12e9734220eca6ccddf,synthetic-form-layout-03,original,2025,fte-0370b0c2b7cd39e7a95c7664,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,909.00, earnings: USD 10,909.00, basis: USD 7,636.30, recipient: Example Entity 3-6-3. Account holder: Example Person 306.",1099,5,1099,fdc-0c4b79f97d9fadc0ece1db09,synthetic-form-layout-03,original,2023,fte-18fb43034ef745ddedb421b0,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,992.00, earnings: USD 10,992.00, basis: USD 7,694.40, recipient: Example Entity 3-7-3. Account holder: Example Person 307.",1099,5,1099,fdc-f9b3584a92a3f6d26e75007f,synthetic-form-layout-03,original,2024,fte-e3d10876d183f2370548b3e9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2023
recipient: Example Entity 4-0-3
basis: USD 7,383.60
earnings: USD 10,548.00
gross distribution: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-ee27afabf16b367710aa1895,synthetic-form-layout-04,original,2023,fte-758a627f1bf95e3509833357,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2024
recipient: Example Entity 4-1-3
basis: USD 7,441.70
earnings: USD 10,631.00
gross distribution: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-d0489794a164970169a5a69a,synthetic-form-layout-04,original,2024,fte-3b107dd8c3ec644d32466b9d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2025
recipient: Example Entity 4-2-3
basis: USD 7,499.80
earnings: USD 10,714.00
gross distribution: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-186b9ec4f0907bbaf78c5e3f,synthetic-form-layout-04,original,2025,fte-e6568bbd6566cef8685f1f08,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2023
recipient: Example Entity 4-3-3
basis: USD 7,557.90
earnings: USD 10,797.00
gross distribution: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-3ed3d1ca209e45b8ddfaf54b,synthetic-form-layout-04,original,2023,fte-3216ede7b94dd58533195911,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2024
recipient: Example Entity 4-4-3
basis: USD 7,616.00
earnings: USD 10,880.00
gross distribution: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-03535329322ec1979a696deb,synthetic-form-layout-04,original,2024,fte-d075f5de6da93352f0408006,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2025
recipient: Example Entity 4-5-3
basis: USD 7,674.10
earnings: USD 10,963.00
gross distribution: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-10d85601dd4540a5332f9125,synthetic-form-layout-04,original,2025,fte-0517b425907cb2488ec03c5a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2023
recipient: Example Entity 4-6-3
basis: USD 7,732.20
earnings: USD 11,046.00
gross distribution: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-f1ddfb7379ed7eb9ddaf1997,synthetic-form-layout-04,original,2023,fte-7f9ba433c56b9221f707b3a1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-Q: Payments From Qualified Education Programs
Tax reporting year 2024
recipient: Example Entity 4-7-3
basis: USD 7,790.30
earnings: USD 11,129.00
gross distribution: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-687aa747a05d14047b7d2295,synthetic-form-layout-04,original,2024,fte-9ae371303ce0c1c386913143,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2023
gross distribution: USD 10,685.00 / earnings: USD 10,685.00 / basis: USD 7,479.50 / recipient: Example Entity 5-0-3
Delivery copy for Example Party 500",1099,5,1099,fdc-8ac18ef98723cb7c622beb7f,synthetic-form-layout-05,original,2023,fte-61ccb97702f09059c5770151,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2024
gross distribution: USD 10,768.00 / earnings: USD 10,768.00 / basis: USD 7,537.60 / recipient: Example Entity 5-1-3
Delivery copy for Example Party 501",1099,5,1099,fdc-3959a1dcee29eddf138b278a,synthetic-form-layout-05,original,2024,fte-9b9e2e29c5d82b00c46d81a7,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2025
gross distribution: USD 10,851.00 / earnings: USD 10,851.00 / basis: USD 7,595.70 / recipient: Example Entity 5-2-3
Delivery copy for Example Party 502",1099,5,1099,fdc-1659c9594f6099a22c5db7f4,synthetic-form-layout-05,original,2025,fte-07f7bbfbc6c15b18bb1c0597,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2023
gross distribution: USD 10,934.00 / earnings: USD 10,934.00 / basis: USD 7,653.80 / recipient: Example Entity 5-3-3
Delivery copy for Example Party 503",1099,5,1099,fdc-00acff2759e36bfe3a7fffb8,synthetic-form-layout-05,original,2023,fte-35a0523e4bb31d629ad95580,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2024
gross distribution: USD 11,017.00 / earnings: USD 11,017.00 / basis: USD 7,711.90 / recipient: Example Entity 5-4-3
Delivery copy for Example Party 504",1099,5,1099,fdc-472038e04dc5388d1485f212,synthetic-form-layout-05,original,2024,fte-eaa6594cffaf932ec7b6a970,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2025
gross distribution: USD 11,100.00 / earnings: USD 11,100.00 / basis: USD 7,770.00 / recipient: Example Entity 5-5-3
Delivery copy for Example Party 505",1099,5,1099,fdc-d3e50aa97d9e517adefe8b93,synthetic-form-layout-05,original,2025,fte-b07b2e6bd7582a1c8af1528c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2023
gross distribution: USD 11,183.00 / earnings: USD 11,183.00 / basis: USD 7,828.10 / recipient: Example Entity 5-6-3
Delivery copy for Example Party 506",1099,5,1099,fdc-af684fa75427959a93df9101,synthetic-form-layout-05,original,2023,fte-7915ce7b610861f1c7cb3b36,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-Q: Payments From Qualified Education Programs -- reporting year 2024
gross distribution: USD 11,266.00 / earnings: USD 11,266.00 / basis: USD 7,886.20 / recipient: Example Entity 5-7-3
Delivery copy for Example Party 507",1099,5,1099,fdc-319519a205d7bb8948c3c86c,synthetic-form-layout-05,original,2024,fte-87db67f38d4a0d36fd077cb8,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2023
Statement issued to Example Person 0.
Coverdell ESA contributions: USD 10,000.00
rollover contributions: USD 10,000.00
beneficiary: Example Entity 0-0-2",5498,14,5498,fdc-9f0c0e67bdebabcc3d32fcdd,synthetic-form-layout-00,original,2023,fte-c991454409ce03fffa6dc8a4,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2024
Statement issued to Example Person 1.
Coverdell ESA contributions: USD 10,083.00
rollover contributions: USD 10,083.00
beneficiary: Example Entity 0-1-2",5498,14,5498,fdc-199d63a672303972bbe0add5,synthetic-form-layout-00,original,2024,fte-93f410ec79b106af75a52406,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2025
Statement issued to Example Person 2.
Coverdell ESA contributions: USD 10,166.00
rollover contributions: USD 10,166.00
beneficiary: Example Entity 0-2-2",5498,14,5498,fdc-39eb244687844dcbb9c104cb,synthetic-form-layout-00,original,2025,fte-dc7c6c9d4a84891e6fe91a9a,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2023
Statement issued to Example Person 3.
Coverdell ESA contributions: USD 10,249.00
rollover contributions: USD 10,249.00
beneficiary: Example Entity 0-3-2",5498,14,5498,fdc-1df0470e21d0dab906306ef9,synthetic-form-layout-00,original,2023,fte-8e86db95ff7a4755658beab3,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2024
Statement issued to Example Person 4.
Coverdell ESA contributions: USD 10,332.00
rollover contributions: USD 10,332.00
beneficiary: Example Entity 0-4-2",5498,14,5498,fdc-eb9622d9dd9500fba5cbf696,synthetic-form-layout-00,original,2024,fte-729f590681be2ab03980c582,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2025
Statement issued to Example Person 5.
Coverdell ESA contributions: USD 10,415.00
rollover contributions: USD 10,415.00
beneficiary: Example Entity 0-5-2",5498,14,5498,fdc-519a8c4fc42dad8ab74d4aab,synthetic-form-layout-00,original,2025,fte-c458f3d35a9d5c74eed0d80b,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2023
Statement issued to Example Person 6.
Coverdell ESA contributions: USD 10,498.00
rollover contributions: USD 10,498.00
beneficiary: Example Entity 0-6-2",5498,14,5498,fdc-b278def0833b5e050744ad7b,synthetic-form-layout-00,original,2023,fte-d015c20fb440dc0ba69325b4,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Calendar year: 2024
Statement issued to Example Person 7.
Coverdell ESA contributions: USD 10,581.00
rollover contributions: USD 10,581.00
beneficiary: Example Entity 0-7-2",5498,14,5498,fdc-e3721141d99a641d5e3a6e34,synthetic-form-layout-00,original,2024,fte-6144073ca014cf1a822f0449,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 100
Coverdell ESA contributions: USD 10,137.00 | rollover contributions: USD 10,137.00 | beneficiary: Example Entity 1-0-2",5498,14,5498,fdc-a707736cfe3a2c3be77f4d14,synthetic-form-layout-01,original,2023,fte-7c21cfbfb740c4b27712d4a6,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 101
Coverdell ESA contributions: USD 10,220.00 | rollover contributions: USD 10,220.00 | beneficiary: Example Entity 1-1-2",5498,14,5498,fdc-01b6d104c10c3222191c1f55,synthetic-form-layout-01,original,2024,fte-1961978d37f45edc64520f1a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 102
Coverdell ESA contributions: USD 10,303.00 | rollover contributions: USD 10,303.00 | beneficiary: Example Entity 1-2-2",5498,14,5498,fdc-d90f10aeb862c44929f1dccf,synthetic-form-layout-01,original,2025,fte-80cd6f70083f191cf80b02d4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 103
Coverdell ESA contributions: USD 10,386.00 | rollover contributions: USD 10,386.00 | beneficiary: Example Entity 1-3-2",5498,14,5498,fdc-858206b17798191fbd3a027f,synthetic-form-layout-01,original,2023,fte-6808507dabbdfad8477aaf38,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 104
Coverdell ESA contributions: USD 10,469.00 | rollover contributions: USD 10,469.00 | beneficiary: Example Entity 1-4-2",5498,14,5498,fdc-ab2ae7bf7608099e99746e41,synthetic-form-layout-01,original,2024,fte-d0331ffb5e952d5b9a09feae,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 105
Coverdell ESA contributions: USD 10,552.00 | rollover contributions: USD 10,552.00 | beneficiary: Example Entity 1-5-2",5498,14,5498,fdc-19ddae0bd7ef270cc44ece3f,synthetic-form-layout-01,original,2025,fte-0fdca316eac123cc489eb560,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 106
Coverdell ESA contributions: USD 10,635.00 | rollover contributions: USD 10,635.00 | beneficiary: Example Entity 1-6-2",5498,14,5498,fdc-2f76888bf2151943166f1185,synthetic-form-layout-01,original,2023,fte-f529af10911b3af6b1333c37,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498-ESA: Coverdell ESA Contribution Information
Recipient record: Example Person 107
Coverdell ESA contributions: USD 10,718.00 | rollover contributions: USD 10,718.00 | beneficiary: Example Entity 1-7-2",5498,14,5498,fdc-fd1e8a0672506af0f04eddb7,synthetic-form-layout-01,original,2024,fte-97d561071516b1a8b85c997a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,274.00; rollover contributions: USD 10,274.00; beneficiary: Example Entity 2-0-2. Recipient: Example Household 200.",5498,14,5498,fdc-101148fdcdeae2f743788954,synthetic-form-layout-02,original,2023,fte-3ea5263b9620c700bed30f6f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,357.00; rollover contributions: USD 10,357.00; beneficiary: Example Entity 2-1-2. Recipient: Example Household 201.",5498,14,5498,fdc-cf0a4eb973c09a8e1d1ce854,synthetic-form-layout-02,original,2024,fte-e77690af5b832c3d8195e161,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,440.00; rollover contributions: USD 10,440.00; beneficiary: Example Entity 2-2-2. Recipient: Example Household 202.",5498,14,5498,fdc-cd87a38a10aff03e6a05d0b6,synthetic-form-layout-02,original,2025,fte-ece0b145ea1e25702a474d9b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,523.00; rollover contributions: USD 10,523.00; beneficiary: Example Entity 2-3-2. Recipient: Example Household 203.",5498,14,5498,fdc-79de9c7101481c1ebad3756b,synthetic-form-layout-02,original,2023,fte-5e0ccac335dab60edf83bc52,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,606.00; rollover contributions: USD 10,606.00; beneficiary: Example Entity 2-4-2. Recipient: Example Household 204.",5498,14,5498,fdc-60d195569905c87302fee251,synthetic-form-layout-02,original,2024,fte-ed736d5e6098998ed00e3db9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,689.00; rollover contributions: USD 10,689.00; beneficiary: Example Entity 2-5-2. Recipient: Example Household 205.",5498,14,5498,fdc-1145a01acf6e779fefc45093,synthetic-form-layout-02,original,2025,fte-9b0c40df01481025f9187bfa,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,772.00; rollover contributions: USD 10,772.00; beneficiary: Example Entity 2-6-2. Recipient: Example Household 206.",5498,14,5498,fdc-ea71aeb8cb1dd9ae1233f2e3,synthetic-form-layout-02,original,2023,fte-8ec441fbedf220ea86cb1763,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498-ESA: Coverdell ESA Contribution Information.
Coverdell ESA contributions: USD 10,855.00; rollover contributions: USD 10,855.00; beneficiary: Example Entity 2-7-2. Recipient: Example Household 207.",5498,14,5498,fdc-bc4ef7f05d80586108bc586b,synthetic-form-layout-02,original,2024,fte-633896c915cc1406cfb8cb68,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2023.
Details: Coverdell ESA contributions: USD 10,411.00, rollover contributions: USD 10,411.00, beneficiary: Example Entity 3-0-2. Account holder: Example Person 300.",5498,14,5498,fdc-d9ed443abf5a57695c2687b0,synthetic-form-layout-03,original,2023,fte-4906169a813c4d48f99ccfd8,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2024.
Details: Coverdell ESA contributions: USD 10,494.00, rollover contributions: USD 10,494.00, beneficiary: Example Entity 3-1-2. Account holder: Example Person 301.",5498,14,5498,fdc-a2c527d62ad2721177ab4375,synthetic-form-layout-03,original,2024,fte-2188dd327a2b140d75fcdbe6,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2025.
Details: Coverdell ESA contributions: USD 10,577.00, rollover contributions: USD 10,577.00, beneficiary: Example Entity 3-2-2. Account holder: Example Person 302.",5498,14,5498,fdc-28af5e1605c7c2830275e884,synthetic-form-layout-03,original,2025,fte-c2a4d64180010058103f9204,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2023.
Details: Coverdell ESA contributions: USD 10,660.00, rollover contributions: USD 10,660.00, beneficiary: Example Entity 3-3-2. Account holder: Example Person 303.",5498,14,5498,fdc-4fd6dc294655d9c362d7360b,synthetic-form-layout-03,original,2023,fte-a2b135a02b11003982dcee05,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2024.
Details: Coverdell ESA contributions: USD 10,743.00, rollover contributions: USD 10,743.00, beneficiary: Example Entity 3-4-2. Account holder: Example Person 304.",5498,14,5498,fdc-a3b5899ac13f4453f5a7af2e,synthetic-form-layout-03,original,2024,fte-6415fca5d69482fa5aa6a1b8,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2025.
Details: Coverdell ESA contributions: USD 10,826.00, rollover contributions: USD 10,826.00, beneficiary: Example Entity 3-5-2. Account holder: Example Person 305.",5498,14,5498,fdc-20914f66266585735436385c,synthetic-form-layout-03,original,2025,fte-65428ee9839a91700341accf,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2023.
Details: Coverdell ESA contributions: USD 10,909.00, rollover contributions: USD 10,909.00, beneficiary: Example Entity 3-6-2. Account holder: Example Person 306.",5498,14,5498,fdc-5688b8e6f2354125dbe31544,synthetic-form-layout-03,original,2023,fte-0f65825a3904c6ed5c72924b,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information
Reporting period ended 12/31/2024.
Details: Coverdell ESA contributions: USD 10,992.00, rollover contributions: USD 10,992.00, beneficiary: Example Entity 3-7-2. Account holder: Example Person 307.",5498,14,5498,fdc-12a8c7ed380da4366ed17cf5,synthetic-form-layout-03,original,2024,fte-6adf8bf94def321b5b7e6ac5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2023
beneficiary: Example Entity 4-0-2
rollover contributions: USD 10,548.00
Coverdell ESA contributions: USD 10,548.00
Named party: Example Person 400",5498,14,5498,fdc-1f79301cdcb130572b833730,synthetic-form-layout-04,original,2023,fte-1b515af1d5c1eebf864b50e3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2024
beneficiary: Example Entity 4-1-2
rollover contributions: USD 10,631.00
Coverdell ESA contributions: USD 10,631.00
Named party: Example Person 401",5498,14,5498,fdc-8362193a9f3ded904e100b0e,synthetic-form-layout-04,original,2024,fte-383d3a2f32b4e039c25d4532,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2025
beneficiary: Example Entity 4-2-2
rollover contributions: USD 10,714.00
Coverdell ESA contributions: USD 10,714.00
Named party: Example Person 402",5498,14,5498,fdc-76fb3824daaa7ac33e9e1b17,synthetic-form-layout-04,original,2025,fte-efc52ce2673c86dc0e0775f9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2023
beneficiary: Example Entity 4-3-2
rollover contributions: USD 10,797.00
Coverdell ESA contributions: USD 10,797.00
Named party: Example Person 403",5498,14,5498,fdc-2fd3be1684383e4c41ef3732,synthetic-form-layout-04,original,2023,fte-84d6564c73842650930de453,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2024
beneficiary: Example Entity 4-4-2
rollover contributions: USD 10,880.00
Coverdell ESA contributions: USD 10,880.00
Named party: Example Person 404",5498,14,5498,fdc-e109a4f98003c52a917b56d2,synthetic-form-layout-04,original,2024,fte-a32052726f7ade32b6fe93ff,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2025
beneficiary: Example Entity 4-5-2
rollover contributions: USD 10,963.00
Coverdell ESA contributions: USD 10,963.00
Named party: Example Person 405",5498,14,5498,fdc-e140fcb773972223460e2e99,synthetic-form-layout-04,original,2025,fte-46a03693195377a43e4bd75d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2023
beneficiary: Example Entity 4-6-2
rollover contributions: USD 11,046.00
Coverdell ESA contributions: USD 11,046.00
Named party: Example Person 406",5498,14,5498,fdc-665a84ba6fd1ad551865d46e,synthetic-form-layout-04,original,2023,fte-e4c19495a065eaa5618cff48,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-ESA: Coverdell ESA Contribution Information
Tax reporting year 2024
beneficiary: Example Entity 4-7-2
rollover contributions: USD 11,129.00
Coverdell ESA contributions: USD 11,129.00
Named party: Example Person 407",5498,14,5498,fdc-d7db9427f4f2c1c65fcf371c,synthetic-form-layout-04,original,2024,fte-54d961071c40b2b3cb4307fb,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2023
Coverdell ESA contributions: USD 10,685.00 / rollover contributions: USD 10,685.00 / beneficiary: Example Entity 5-0-2
Delivery copy for Example Party 500",5498,14,5498,fdc-6f3f3cb6365283560dc69f49,synthetic-form-layout-05,original,2023,fte-58c6599fc7b4e069183cfe39,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2024
Coverdell ESA contributions: USD 10,768.00 / rollover contributions: USD 10,768.00 / beneficiary: Example Entity 5-1-2
Delivery copy for Example Party 501",5498,14,5498,fdc-69d33043047c1314184d9ded,synthetic-form-layout-05,original,2024,fte-2f95811dca0a4a18f30a6604,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2025
Coverdell ESA contributions: USD 10,851.00 / rollover contributions: USD 10,851.00 / beneficiary: Example Entity 5-2-2
Delivery copy for Example Party 502",5498,14,5498,fdc-5c5510fcbafd069a87840ffd,synthetic-form-layout-05,original,2025,fte-e720567b53d95fd15240488e,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2023
Coverdell ESA contributions: USD 10,934.00 / rollover contributions: USD 10,934.00 / beneficiary: Example Entity 5-3-2
Delivery copy for Example Party 503",5498,14,5498,fdc-ee49171ca19c9ec72f457e24,synthetic-form-layout-05,original,2023,fte-a19639aa81c27668d35087be,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2024
Coverdell ESA contributions: USD 11,017.00 / rollover contributions: USD 11,017.00 / beneficiary: Example Entity 5-4-2
Delivery copy for Example Party 504",5498,14,5498,fdc-951ea1370a95a4796f233bc4,synthetic-form-layout-05,original,2024,fte-e620aa4893e0609b29ae7799,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2025
Coverdell ESA contributions: USD 11,100.00 / rollover contributions: USD 11,100.00 / beneficiary: Example Entity 5-5-2
Delivery copy for Example Party 505",5498,14,5498,fdc-c74bea64d5db3f1e4dfdbd0c,synthetic-form-layout-05,original,2025,fte-91eeab0b7fc5b4bc1991ad85,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2023
Coverdell ESA contributions: USD 11,183.00 / rollover contributions: USD 11,183.00 / beneficiary: Example Entity 5-6-2
Delivery copy for Example Party 506",5498,14,5498,fdc-816ae682d1db70db8dfd3563,synthetic-form-layout-05,original,2023,fte-af3a2c77c01a39081ad78e23,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-ESA: Coverdell ESA Contribution Information -- reporting year 2024
Coverdell ESA contributions: USD 11,266.00 / rollover contributions: USD 11,266.00 / beneficiary: Example Entity 5-7-2
Delivery copy for Example Party 507",5498,14,5498,fdc-c105affa453635570ce4f55f,synthetic-form-layout-05,original,2024,fte-5db202a64e2e742b5104ffbe,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2023
Statement issued to Example Person 0.
monthly enrollment premiums: USD 10,000.00
advance premium tax credit: USD 10,000.00
covered individuals: USD 10,000.00",1095,3,1095,fdc-87adcb9348da6489ec224966,synthetic-form-layout-00,original,2023,fte-caf9082fe975642c948ff8c4,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2024
Statement issued to Example Person 1.
monthly enrollment premiums: USD 10,083.00
advance premium tax credit: USD 10,083.00
covered individuals: USD 10,083.00",1095,3,1095,fdc-5e309d3367b02c05733e00cb,synthetic-form-layout-00,original,2024,fte-345b89e9cf1680442d8a9763,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2025
Statement issued to Example Person 2.
monthly enrollment premiums: USD 10,166.00
advance premium tax credit: USD 10,166.00
covered individuals: USD 10,166.00",1095,3,1095,fdc-85a3b7cfcac3f73bd39e0007,synthetic-form-layout-00,original,2025,fte-1da63d487f39f980ea26345e,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2023
Statement issued to Example Person 3.
monthly enrollment premiums: USD 10,249.00
advance premium tax credit: USD 10,249.00
covered individuals: USD 10,249.00",1095,3,1095,fdc-2f6a05cd47d2da0eca0221ca,synthetic-form-layout-00,original,2023,fte-0ea9c05aee014e57879e4e07,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2024
Statement issued to Example Person 4.
monthly enrollment premiums: USD 10,332.00
advance premium tax credit: USD 10,332.00
covered individuals: USD 10,332.00",1095,3,1095,fdc-494f373a36a6772d49dab99d,synthetic-form-layout-00,original,2024,fte-119693b6f9b1439cdde8b0fd,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2025
Statement issued to Example Person 5.
monthly enrollment premiums: USD 10,415.00
advance premium tax credit: USD 10,415.00
covered individuals: USD 10,415.00",1095,3,1095,fdc-f32cc0a036cdc95e31b2dc1d,synthetic-form-layout-00,original,2025,fte-322f43690b6e2a8eaac2d51f,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2023
Statement issued to Example Person 6.
monthly enrollment premiums: USD 10,498.00
advance premium tax credit: USD 10,498.00
covered individuals: USD 10,498.00",1095,3,1095,fdc-aaf8aaa4367820d09a4d52e7,synthetic-form-layout-00,original,2023,fte-eb16ad39b66913ec6538c8af,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Calendar year: 2024
Statement issued to Example Person 7.
monthly enrollment premiums: USD 10,581.00
advance premium tax credit: USD 10,581.00
covered individuals: USD 10,581.00",1095,3,1095,fdc-bc199bf4a1c8848cf5e06e0c,synthetic-form-layout-00,original,2024,fte-531eaf3d5daae0dc6227421a,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 100
monthly enrollment premiums: USD 10,137.00 | advance premium tax credit: USD 10,137.00 | covered individuals: USD 10,137.00",1095,3,1095,fdc-6e321753824806ed569827e4,synthetic-form-layout-01,original,2023,fte-2ffde6fd620422b3007e233a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 101
monthly enrollment premiums: USD 10,220.00 | advance premium tax credit: USD 10,220.00 | covered individuals: USD 10,220.00",1095,3,1095,fdc-bd573a6c8e18d2f1aca43f47,synthetic-form-layout-01,original,2024,fte-ce35fb82edfa66cf1a576259,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 102
monthly enrollment premiums: USD 10,303.00 | advance premium tax credit: USD 10,303.00 | covered individuals: USD 10,303.00",1095,3,1095,fdc-2f1e973adf3a5d545ed57ac0,synthetic-form-layout-01,original,2025,fte-3fb2c9c52650e03eb0f880db,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 103
monthly enrollment premiums: USD 10,386.00 | advance premium tax credit: USD 10,386.00 | covered individuals: USD 10,386.00",1095,3,1095,fdc-aeb94dd3a33ca3df0d9c6a7f,synthetic-form-layout-01,original,2023,fte-315efa1ee24b98841661eb04,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 104
monthly enrollment premiums: USD 10,469.00 | advance premium tax credit: USD 10,469.00 | covered individuals: USD 10,469.00",1095,3,1095,fdc-85144d921447b3ceaa1d930b,synthetic-form-layout-01,original,2024,fte-2b8f9e4b5956a5007b2b0996,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 105
monthly enrollment premiums: USD 10,552.00 | advance premium tax credit: USD 10,552.00 | covered individuals: USD 10,552.00",1095,3,1095,fdc-859f39c2c0235c95ddf8add9,synthetic-form-layout-01,original,2025,fte-9af7e08b530c6b7f64070632,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 106
monthly enrollment premiums: USD 10,635.00 | advance premium tax credit: USD 10,635.00 | covered individuals: USD 10,635.00",1095,3,1095,fdc-154efe3e4e59377f7f0ccca9,synthetic-form-layout-01,original,2023,fte-65a75c1fbb4d44bafc71ae5a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-A: Health Insurance Marketplace Statement
Recipient record: Example Person 107
monthly enrollment premiums: USD 10,718.00 | advance premium tax credit: USD 10,718.00 | covered individuals: USD 10,718.00",1095,3,1095,fdc-6b6268257be69c437a721791,synthetic-form-layout-01,original,2024,fte-9469e4520ec6094ab6fb18c5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,274.00; advance premium tax credit: USD 10,274.00; covered individuals: USD 10,274.00. Recipient: Example Household 200.",1095,3,1095,fdc-b4a4434fbbf3d3130dde93e0,synthetic-form-layout-02,original,2023,fte-6f322991e95c0533fdb5636d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,357.00; advance premium tax credit: USD 10,357.00; covered individuals: USD 10,357.00. Recipient: Example Household 201.",1095,3,1095,fdc-21856fb9624787f51f4943b0,synthetic-form-layout-02,original,2024,fte-e2becf438c7c1328a31ea743,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,440.00; advance premium tax credit: USD 10,440.00; covered individuals: USD 10,440.00. Recipient: Example Household 202.",1095,3,1095,fdc-f9ae6836fadee81e6de309eb,synthetic-form-layout-02,original,2025,fte-6820cf9fd1104915a97211f6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,523.00; advance premium tax credit: USD 10,523.00; covered individuals: USD 10,523.00. Recipient: Example Household 203.",1095,3,1095,fdc-9263fe53051afb1490be6856,synthetic-form-layout-02,original,2023,fte-f3252c0860d56d48d1d83474,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,606.00; advance premium tax credit: USD 10,606.00; covered individuals: USD 10,606.00. Recipient: Example Household 204.",1095,3,1095,fdc-02ab601c7ffb080514de52b8,synthetic-form-layout-02,original,2024,fte-b816092aacb9a86b2b87661a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,689.00; advance premium tax credit: USD 10,689.00; covered individuals: USD 10,689.00. Recipient: Example Household 205.",1095,3,1095,fdc-3beb5ed858734ac7bd8cda95,synthetic-form-layout-02,original,2025,fte-7e92eccb83fc56596d609442,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,772.00; advance premium tax credit: USD 10,772.00; covered individuals: USD 10,772.00. Recipient: Example Household 206.",1095,3,1095,fdc-1a554444f542406fec927bff,synthetic-form-layout-02,original,2023,fte-3fec98e8e59610e8c1f4de3e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-A: Health Insurance Marketplace Statement.
monthly enrollment premiums: USD 10,855.00; advance premium tax credit: USD 10,855.00; covered individuals: USD 10,855.00. Recipient: Example Household 207.",1095,3,1095,fdc-e85cf1f9d62ac57484ba169c,synthetic-form-layout-02,original,2024,fte-ad78ed9a42b9788b3a920f24,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2023.
Details: monthly enrollment premiums: USD 10,411.00, advance premium tax credit: USD 10,411.00, covered individuals: USD 10,411.00. Account holder: Example Person 300.",1095,3,1095,fdc-e5626fb4f5a8a8b5740dc565,synthetic-form-layout-03,original,2023,fte-fc10a04d55011a981fd7b5bf,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2024.
Details: monthly enrollment premiums: USD 10,494.00, advance premium tax credit: USD 10,494.00, covered individuals: USD 10,494.00. Account holder: Example Person 301.",1095,3,1095,fdc-351cd86867955bb842958b54,synthetic-form-layout-03,original,2024,fte-70e32709bb5825e057a3ad40,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2025.
Details: monthly enrollment premiums: USD 10,577.00, advance premium tax credit: USD 10,577.00, covered individuals: USD 10,577.00. Account holder: Example Person 302.",1095,3,1095,fdc-b468770b35dd58f677e7e00e,synthetic-form-layout-03,original,2025,fte-bb78a3a35be08440888ff520,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2023.
Details: monthly enrollment premiums: USD 10,660.00, advance premium tax credit: USD 10,660.00, covered individuals: USD 10,660.00. Account holder: Example Person 303.",1095,3,1095,fdc-ac8dce7886b28e85606a8bf3,synthetic-form-layout-03,original,2023,fte-66a80d4be7aad43025bd5cdc,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2024.
Details: monthly enrollment premiums: USD 10,743.00, advance premium tax credit: USD 10,743.00, covered individuals: USD 10,743.00. Account holder: Example Person 304.",1095,3,1095,fdc-4845ccef80187b1ed4f2738f,synthetic-form-layout-03,original,2024,fte-acf79818265cb50ffabf328e,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2025.
Details: monthly enrollment premiums: USD 10,826.00, advance premium tax credit: USD 10,826.00, covered individuals: USD 10,826.00. Account holder: Example Person 305.",1095,3,1095,fdc-60c42b40c24e3b556480ae90,synthetic-form-layout-03,original,2025,fte-37681780a872b3ca5a1e3fb8,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2023.
Details: monthly enrollment premiums: USD 10,909.00, advance premium tax credit: USD 10,909.00, covered individuals: USD 10,909.00. Account holder: Example Person 306.",1095,3,1095,fdc-6da65f2dbc77b905c012b469,synthetic-form-layout-03,original,2023,fte-e9c07d5ee2fe79b1a8b3c6d0,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement
Reporting period ended 12/31/2024.
Details: monthly enrollment premiums: USD 10,992.00, advance premium tax credit: USD 10,992.00, covered individuals: USD 10,992.00. Account holder: Example Person 307.",1095,3,1095,fdc-4def81519339490ebe4ad9ef,synthetic-form-layout-03,original,2024,fte-d21edea970374a57983aa353,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2023
covered individuals: USD 10,548.00
advance premium tax credit: USD 10,548.00
monthly enrollment premiums: USD 10,548.00
Named party: Example Person 400",1095,3,1095,fdc-4ed9c9b3f7d3029588471c64,synthetic-form-layout-04,original,2023,fte-7d9844ddf117b5d8b78295bb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2024
covered individuals: USD 10,631.00
advance premium tax credit: USD 10,631.00
monthly enrollment premiums: USD 10,631.00
Named party: Example Person 401",1095,3,1095,fdc-6e468f20b8b9d7022673ef0d,synthetic-form-layout-04,original,2024,fte-8b149e503ffb3148265507db,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2025
covered individuals: USD 10,714.00
advance premium tax credit: USD 10,714.00
monthly enrollment premiums: USD 10,714.00
Named party: Example Person 402",1095,3,1095,fdc-fd13a36b236689da519928fd,synthetic-form-layout-04,original,2025,fte-2750b3c7819a8cd0700f62f8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2023
covered individuals: USD 10,797.00
advance premium tax credit: USD 10,797.00
monthly enrollment premiums: USD 10,797.00
Named party: Example Person 403",1095,3,1095,fdc-379775e50cb3e843399aa7ae,synthetic-form-layout-04,original,2023,fte-a5436a8be1305fed2a0d0fe7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2024
covered individuals: USD 10,880.00
advance premium tax credit: USD 10,880.00
monthly enrollment premiums: USD 10,880.00
Named party: Example Person 404",1095,3,1095,fdc-31dc4add442aac7c579dbd4c,synthetic-form-layout-04,original,2024,fte-6369459f2c8d4bca793610db,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2025
covered individuals: USD 10,963.00
advance premium tax credit: USD 10,963.00
monthly enrollment premiums: USD 10,963.00
Named party: Example Person 405",1095,3,1095,fdc-bb1cebd8977ac8a9f870ed04,synthetic-form-layout-04,original,2025,fte-a6de0580d8c5010e8bd4aee0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2023
covered individuals: USD 11,046.00
advance premium tax credit: USD 11,046.00
monthly enrollment premiums: USD 11,046.00
Named party: Example Person 406",1095,3,1095,fdc-56f3865fb92af9f9b2a3451a,synthetic-form-layout-04,original,2023,fte-625d546996242980042476b5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-A: Health Insurance Marketplace Statement
Tax reporting year 2024
covered individuals: USD 11,129.00
advance premium tax credit: USD 11,129.00
monthly enrollment premiums: USD 11,129.00
Named party: Example Person 407",1095,3,1095,fdc-d45de13392dc6c3d743b147c,synthetic-form-layout-04,original,2024,fte-640b6a50ff846f28aadd861b,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2023
monthly enrollment premiums: USD 10,685.00 / advance premium tax credit: USD 10,685.00 / covered individuals: USD 10,685.00
Delivery copy for Example Party 500",1095,3,1095,fdc-64945372691d6afbf6adacbd,synthetic-form-layout-05,original,2023,fte-bc96377496962452f1cbf6e6,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2024
monthly enrollment premiums: USD 10,768.00 / advance premium tax credit: USD 10,768.00 / covered individuals: USD 10,768.00
Delivery copy for Example Party 501",1095,3,1095,fdc-2f3d8471777ce16a79caeb2d,synthetic-form-layout-05,original,2024,fte-c8b9690c1f42af5bfd67eeef,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2025
monthly enrollment premiums: USD 10,851.00 / advance premium tax credit: USD 10,851.00 / covered individuals: USD 10,851.00
Delivery copy for Example Party 502",1095,3,1095,fdc-ae4e0949eb5aeb23a22fa9dd,synthetic-form-layout-05,original,2025,fte-03461c0faad97478f9bb383b,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2023
monthly enrollment premiums: USD 10,934.00 / advance premium tax credit: USD 10,934.00 / covered individuals: USD 10,934.00
Delivery copy for Example Party 503",1095,3,1095,fdc-105ad72faa95b25734bcb69f,synthetic-form-layout-05,original,2023,fte-84bd397b633b079daaf68766,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2024
monthly enrollment premiums: USD 11,017.00 / advance premium tax credit: USD 11,017.00 / covered individuals: USD 11,017.00
Delivery copy for Example Party 504",1095,3,1095,fdc-7210a989c3b05396932dee51,synthetic-form-layout-05,original,2024,fte-febacaf45a14675267b3c9b8,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2025
monthly enrollment premiums: USD 11,100.00 / advance premium tax credit: USD 11,100.00 / covered individuals: USD 11,100.00
Delivery copy for Example Party 505",1095,3,1095,fdc-121060a96962ad71db681213,synthetic-form-layout-05,original,2025,fte-f036f0716bb588483ddf15f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2023
monthly enrollment premiums: USD 11,183.00 / advance premium tax credit: USD 11,183.00 / covered individuals: USD 11,183.00
Delivery copy for Example Party 506",1095,3,1095,fdc-fff1fdcd1eb06f509846c962,synthetic-form-layout-05,original,2023,fte-7994eee294ef71e49030dea3,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-A: Health Insurance Marketplace Statement -- reporting year 2024
monthly enrollment premiums: USD 11,266.00 / advance premium tax credit: USD 11,266.00 / covered individuals: USD 11,266.00
Delivery copy for Example Party 507",1095,3,1095,fdc-477faf3a935750b6083badb0,synthetic-form-layout-05,original,2024,fte-b9c14309c66918b1de5b8659,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2023
Statement issued to Example Person 0.
responsible individual: USD 10,000.00
covered individuals: USD 10,000.00
months of coverage: January through December",1095,3,1095,fdc-bf77b3b3c4df78a54c0f9a64,synthetic-form-layout-00,original,2023,fte-0058c350076f12fc1b63595c,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2024
Statement issued to Example Person 1.
responsible individual: USD 10,083.00
covered individuals: USD 10,083.00
months of coverage: January through December",1095,3,1095,fdc-e30588f5087fc835ba104587,synthetic-form-layout-00,original,2024,fte-5384ddd149f3d94af11248a0,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2025
Statement issued to Example Person 2.
responsible individual: USD 10,166.00
covered individuals: USD 10,166.00
months of coverage: January through December",1095,3,1095,fdc-6f4cd55ced2f1d24b5b6627c,synthetic-form-layout-00,original,2025,fte-cc0e2c0018c124ab9163530d,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2023
Statement issued to Example Person 3.
responsible individual: USD 10,249.00
covered individuals: USD 10,249.00
months of coverage: January through December",1095,3,1095,fdc-813115a2b12361f9b579b3d5,synthetic-form-layout-00,original,2023,fte-51eb5be5d8c5df410ef35cea,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2024
Statement issued to Example Person 4.
responsible individual: USD 10,332.00
covered individuals: USD 10,332.00
months of coverage: January through December",1095,3,1095,fdc-13c49b3c539d1e47d764a718,synthetic-form-layout-00,original,2024,fte-ba40509ada7e569928c4ce63,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2025
Statement issued to Example Person 5.
responsible individual: USD 10,415.00
covered individuals: USD 10,415.00
months of coverage: January through December",1095,3,1095,fdc-34bfcc31c4d94afb16a08b59,synthetic-form-layout-00,original,2025,fte-e9cb612d2cb61d9fed2db5bb,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2023
Statement issued to Example Person 6.
responsible individual: USD 10,498.00
covered individuals: USD 10,498.00
months of coverage: January through December",1095,3,1095,fdc-9bd7e6c5bf898ab54ce96847,synthetic-form-layout-00,original,2023,fte-6732efddfa88a3460737ddce,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Calendar year: 2024
Statement issued to Example Person 7.
responsible individual: USD 10,581.00
covered individuals: USD 10,581.00
months of coverage: January through December",1095,3,1095,fdc-d51f4247f172e7743c9e7ef5,synthetic-form-layout-00,original,2024,fte-4d096928d7414cfde8557d95,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-B: Health Coverage
Recipient record: Example Person 100
responsible individual: USD 10,137.00 | covered individuals: USD 10,137.00 | months of coverage: January through December",1095,3,1095,fdc-a49915a3ae176cfc0ebcfb86,synthetic-form-layout-01,original,2023,fte-2a17390a0e5b893c886b14fe,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-B: Health Coverage
Recipient record: Example Person 101
responsible individual: USD 10,220.00 | covered individuals: USD 10,220.00 | months of coverage: January through December",1095,3,1095,fdc-6ac8c59beea9caecc5e7a289,synthetic-form-layout-01,original,2024,fte-d07a720e5fc88b6c1632e20c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1095-B: Health Coverage
Recipient record: Example Person 102
responsible individual: USD 10,303.00 | covered individuals: USD 10,303.00 | months of coverage: January through December",1095,3,1095,fdc-d914c16ac567c933dfd528fb,synthetic-form-layout-01,original,2025,fte-5b829d138fc42fa2f766a6d1,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-B: Health Coverage
Recipient record: Example Person 103
responsible individual: USD 10,386.00 | covered individuals: USD 10,386.00 | months of coverage: January through December",1095,3,1095,fdc-56193c75e8dd88251ed02709,synthetic-form-layout-01,original,2023,fte-05a5b914048cd0fd392cd3fb,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-B: Health Coverage
Recipient record: Example Person 104
responsible individual: USD 10,469.00 | covered individuals: USD 10,469.00 | months of coverage: January through December",1095,3,1095,fdc-51514ef5009020c06f530540,synthetic-form-layout-01,original,2024,fte-5203fa65ba3236265aedcdf5,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1095-B: Health Coverage
Recipient record: Example Person 105
responsible individual: USD 10,552.00 | covered individuals: USD 10,552.00 | months of coverage: January through December",1095,3,1095,fdc-be235a9c54a9aa975a79f42e,synthetic-form-layout-01,original,2025,fte-4a5592008a6086d74be4e2eb,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-B: Health Coverage
Recipient record: Example Person 106
responsible individual: USD 10,635.00 | covered individuals: USD 10,635.00 | months of coverage: January through December",1095,3,1095,fdc-62b33cbe361f6bfca37713a7,synthetic-form-layout-01,original,2023,fte-af6e833f24883130c940fdba,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-B: Health Coverage
Recipient record: Example Person 107
responsible individual: USD 10,718.00 | covered individuals: USD 10,718.00 | months of coverage: January through December",1095,3,1095,fdc-1965931fd4994a9cb20adf2b,synthetic-form-layout-01,original,2024,fte-d7830ee54740d86860b90737,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-B: Health Coverage.
responsible individual: USD 10,274.00; covered individuals: USD 10,274.00; months of coverage: January through December. Recipient: Example Household 200.",1095,3,1095,fdc-498d7a79414ed8225a296ca8,synthetic-form-layout-02,original,2023,fte-b789edad70063d1562c05cd8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-B: Health Coverage.
responsible individual: USD 10,357.00; covered individuals: USD 10,357.00; months of coverage: January through December. Recipient: Example Household 201.",1095,3,1095,fdc-7e6dd7c4e38322c224313b21,synthetic-form-layout-02,original,2024,fte-91390c39b67d08d4931b4a78,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1095-B: Health Coverage.
responsible individual: USD 10,440.00; covered individuals: USD 10,440.00; months of coverage: January through December. Recipient: Example Household 202.",1095,3,1095,fdc-f3314537ee057de18a56a1f1,synthetic-form-layout-02,original,2025,fte-38d9c10448478d36b99f7329,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-B: Health Coverage.
responsible individual: USD 10,523.00; covered individuals: USD 10,523.00; months of coverage: January through December. Recipient: Example Household 203.",1095,3,1095,fdc-d04ed5c94a1c4695e24b8394,synthetic-form-layout-02,original,2023,fte-4e7aaf20910de6e1f580dcdf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-B: Health Coverage.
responsible individual: USD 10,606.00; covered individuals: USD 10,606.00; months of coverage: January through December. Recipient: Example Household 204.",1095,3,1095,fdc-88753deaaed7126d3fb02532,synthetic-form-layout-02,original,2024,fte-6afee64eae15378e719ee74e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1095-B: Health Coverage.
responsible individual: USD 10,689.00; covered individuals: USD 10,689.00; months of coverage: January through December. Recipient: Example Household 205.",1095,3,1095,fdc-b4e9bcb10297f48867cde429,synthetic-form-layout-02,original,2025,fte-d092ea70c80b111dd67a7a98,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-B: Health Coverage.
responsible individual: USD 10,772.00; covered individuals: USD 10,772.00; months of coverage: January through December. Recipient: Example Household 206.",1095,3,1095,fdc-e855457f9a71fd5ece12e266,synthetic-form-layout-02,original,2023,fte-c81a7209933a2ed8e638b2f2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-B: Health Coverage.
responsible individual: USD 10,855.00; covered individuals: USD 10,855.00; months of coverage: January through December. Recipient: Example Household 207.",1095,3,1095,fdc-67e6ae0df065d5b895852e37,synthetic-form-layout-02,original,2024,fte-bb079a082dd7f9cccedf54f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2023.
Details: responsible individual: USD 10,411.00, covered individuals: USD 10,411.00, months of coverage: January through December. Account holder: Example Person 300.",1095,3,1095,fdc-3a6a441593f6628fbba8176d,synthetic-form-layout-03,original,2023,fte-d5a3875b10bda9d0394ba2c3,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2024.
Details: responsible individual: USD 10,494.00, covered individuals: USD 10,494.00, months of coverage: January through December. Account holder: Example Person 301.",1095,3,1095,fdc-2f04a69f0de8055e123635d2,synthetic-form-layout-03,original,2024,fte-2c7254b79bdecae3c66b747c,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2025.
Details: responsible individual: USD 10,577.00, covered individuals: USD 10,577.00, months of coverage: January through December. Account holder: Example Person 302.",1095,3,1095,fdc-1921e3709d510a2fb0a0a385,synthetic-form-layout-03,original,2025,fte-3df4960e7956ba0e556aa24e,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2023.
Details: responsible individual: USD 10,660.00, covered individuals: USD 10,660.00, months of coverage: January through December. Account holder: Example Person 303.",1095,3,1095,fdc-8098b19f2415b5cbde079dfb,synthetic-form-layout-03,original,2023,fte-4f181da9df0a07196f4da0f0,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2024.
Details: responsible individual: USD 10,743.00, covered individuals: USD 10,743.00, months of coverage: January through December. Account holder: Example Person 304.",1095,3,1095,fdc-770af0f409916daf2e2c99a7,synthetic-form-layout-03,original,2024,fte-771dd0d72b3520529bc9e648,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2025.
Details: responsible individual: USD 10,826.00, covered individuals: USD 10,826.00, months of coverage: January through December. Account holder: Example Person 305.",1095,3,1095,fdc-27413ef8147bbf73bc533a89,synthetic-form-layout-03,original,2025,fte-e8655aebe32d68be4d1ef737,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2023.
Details: responsible individual: USD 10,909.00, covered individuals: USD 10,909.00, months of coverage: January through December. Account holder: Example Person 306.",1095,3,1095,fdc-72880b3c843657123419195b,synthetic-form-layout-03,original,2023,fte-8cc0347560e7eccfc281f321,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage
Reporting period ended 12/31/2024.
Details: responsible individual: USD 10,992.00, covered individuals: USD 10,992.00, months of coverage: January through December. Account holder: Example Person 307.",1095,3,1095,fdc-56745587b513b1d38d3ba4df,synthetic-form-layout-03,original,2024,fte-a3fedf19aa8f0992bd14ff8f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2023
months of coverage: January through December
covered individuals: USD 10,548.00
responsible individual: USD 10,548.00
Named party: Example Person 400",1095,3,1095,fdc-cb1a436e17bb88e855876738,synthetic-form-layout-04,original,2023,fte-5cd19761dda2817a66056562,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2024
months of coverage: January through December
covered individuals: USD 10,631.00
responsible individual: USD 10,631.00
Named party: Example Person 401",1095,3,1095,fdc-9f0d1ca3c0565b7dfbc80b85,synthetic-form-layout-04,original,2024,fte-3f9b0f391c69f02ce193939e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2025
months of coverage: January through December
covered individuals: USD 10,714.00
responsible individual: USD 10,714.00
Named party: Example Person 402",1095,3,1095,fdc-3c48559f443155b176a4e80d,synthetic-form-layout-04,original,2025,fte-dc6600ae7a7c7f91591a6661,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2023
months of coverage: January through December
covered individuals: USD 10,797.00
responsible individual: USD 10,797.00
Named party: Example Person 403",1095,3,1095,fdc-9b5d465382b07a62ea14bec9,synthetic-form-layout-04,original,2023,fte-bd0e47b18be085ba74b23323,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2024
months of coverage: January through December
covered individuals: USD 10,880.00
responsible individual: USD 10,880.00
Named party: Example Person 404",1095,3,1095,fdc-bdd41375bd1e9e4777c60ed9,synthetic-form-layout-04,original,2024,fte-d87d895c18598a22b1d8571b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2025
months of coverage: January through December
covered individuals: USD 10,963.00
responsible individual: USD 10,963.00
Named party: Example Person 405",1095,3,1095,fdc-8b959f30810f92f90d47b3d5,synthetic-form-layout-04,original,2025,fte-268e00681a2c73a490ad24e4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2023
months of coverage: January through December
covered individuals: USD 11,046.00
responsible individual: USD 11,046.00
Named party: Example Person 406",1095,3,1095,fdc-a6e29bf5d70c87392f288e93,synthetic-form-layout-04,original,2023,fte-25b6b274ba21ed3972b5995a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-B: Health Coverage
Tax reporting year 2024
months of coverage: January through December
covered individuals: USD 11,129.00
responsible individual: USD 11,129.00
Named party: Example Person 407",1095,3,1095,fdc-a0cae274d70cf2ce1c02f9e0,synthetic-form-layout-04,original,2024,fte-9490b17447428367e5a9b6d4,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2023
responsible individual: USD 10,685.00 / covered individuals: USD 10,685.00 / months of coverage: January through December
Delivery copy for Example Party 500",1095,3,1095,fdc-0510e859634e76872533f051,synthetic-form-layout-05,original,2023,fte-de8e31e082136f9e7fd0163a,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2024
responsible individual: USD 10,768.00 / covered individuals: USD 10,768.00 / months of coverage: January through December
Delivery copy for Example Party 501",1095,3,1095,fdc-dec9f8db63a9d52b7a74d38b,synthetic-form-layout-05,original,2024,fte-42587781783bf118f412bcb5,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2025
responsible individual: USD 10,851.00 / covered individuals: USD 10,851.00 / months of coverage: January through December
Delivery copy for Example Party 502",1095,3,1095,fdc-9dceba68a89ab81773634b87,synthetic-form-layout-05,original,2025,fte-39b7e12137165235c530fc80,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2023
responsible individual: USD 10,934.00 / covered individuals: USD 10,934.00 / months of coverage: January through December
Delivery copy for Example Party 503",1095,3,1095,fdc-41aa3855df871dd8750c049d,synthetic-form-layout-05,original,2023,fte-7f8cb7ca88b740623450e4ed,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2024
responsible individual: USD 11,017.00 / covered individuals: USD 11,017.00 / months of coverage: January through December
Delivery copy for Example Party 504",1095,3,1095,fdc-3843eaa2fbae3443b321a307,synthetic-form-layout-05,original,2024,fte-16df5c119e8b7884e777fb73,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2025
responsible individual: USD 11,100.00 / covered individuals: USD 11,100.00 / months of coverage: January through December
Delivery copy for Example Party 505",1095,3,1095,fdc-bf7144300c814d8689747d9a,synthetic-form-layout-05,original,2025,fte-17d41c8f07aeafc61c011f00,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2023
responsible individual: USD 11,183.00 / covered individuals: USD 11,183.00 / months of coverage: January through December
Delivery copy for Example Party 506",1095,3,1095,fdc-c8775bd057a5e866d2a50151,synthetic-form-layout-05,original,2023,fte-0a273bf64b7b1136c4bb104a,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-B: Health Coverage -- reporting year 2024
responsible individual: USD 11,266.00 / covered individuals: USD 11,266.00 / months of coverage: January through December
Delivery copy for Example Party 507",1095,3,1095,fdc-cd40b4327458a6319dfa9add,synthetic-form-layout-05,original,2024,fte-96142862c437851cb511e2e8,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2023
Statement issued to Example Person 0.
employee: Example Entity 0-0-0
employer: Example Entity 0-0-1
offer of coverage: USD 10,000.00
monthly contribution: USD 10,000.00",1095,3,1095,fdc-df83316e71c570f812984724,synthetic-form-layout-00,original,2023,fte-040d43bc2b5bd078667d1ca0,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2024
Statement issued to Example Person 1.
employee: Example Entity 0-1-0
employer: Example Entity 0-1-1
offer of coverage: USD 10,083.00
monthly contribution: USD 10,083.00",1095,3,1095,fdc-560d3de1a7d4b31df6e3afbb,synthetic-form-layout-00,original,2024,fte-547de9c6deb74b4b97437f34,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2025
Statement issued to Example Person 2.
employee: Example Entity 0-2-0
employer: Example Entity 0-2-1
offer of coverage: USD 10,166.00
monthly contribution: USD 10,166.00",1095,3,1095,fdc-6cf3d7092b4efb7285ae5ba9,synthetic-form-layout-00,original,2025,fte-adf377e4e456a1d30e5d4e7d,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2023
Statement issued to Example Person 3.
employee: Example Entity 0-3-0
employer: Example Entity 0-3-1
offer of coverage: USD 10,249.00
monthly contribution: USD 10,249.00",1095,3,1095,fdc-f0d4326d3e0d973a7ff72e70,synthetic-form-layout-00,original,2023,fte-160936bb39127c8bda5b85f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2024
Statement issued to Example Person 4.
employee: Example Entity 0-4-0
employer: Example Entity 0-4-1
offer of coverage: USD 10,332.00
monthly contribution: USD 10,332.00",1095,3,1095,fdc-bc72b8a3345a62ec37924432,synthetic-form-layout-00,original,2024,fte-02976455e364a91444fb1ce8,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2025
Statement issued to Example Person 5.
employee: Example Entity 0-5-0
employer: Example Entity 0-5-1
offer of coverage: USD 10,415.00
monthly contribution: USD 10,415.00",1095,3,1095,fdc-7f66b103a59e3b8a2878b911,synthetic-form-layout-00,original,2025,fte-fb3eaa875f00c8bb7d0d7226,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2023
Statement issued to Example Person 6.
employee: Example Entity 0-6-0
employer: Example Entity 0-6-1
offer of coverage: USD 10,498.00
monthly contribution: USD 10,498.00",1095,3,1095,fdc-cd124df77895f58ba8491635,synthetic-form-layout-00,original,2023,fte-b1aaffb7318474c3017bb526,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Calendar year: 2024
Statement issued to Example Person 7.
employee: Example Entity 0-7-0
employer: Example Entity 0-7-1
offer of coverage: USD 10,581.00
monthly contribution: USD 10,581.00",1095,3,1095,fdc-9ec6cb145f698873746ec63a,synthetic-form-layout-00,original,2024,fte-d8ba5110abf9798e3d53492a,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 100
employee: Example Entity 1-0-0 | employer: Example Entity 1-0-1 | offer of coverage: USD 10,137.00 | monthly contribution: USD 10,137.00",1095,3,1095,fdc-41bbdb8e99570a73e5f2d3e9,synthetic-form-layout-01,original,2023,fte-014590989462e2b23e87e0e7,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 101
employee: Example Entity 1-1-0 | employer: Example Entity 1-1-1 | offer of coverage: USD 10,220.00 | monthly contribution: USD 10,220.00",1095,3,1095,fdc-414b2d60ad4f2b101f0e7c6b,synthetic-form-layout-01,original,2024,fte-5d2a1d0145d59f95b9e5b9a7,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 102
employee: Example Entity 1-2-0 | employer: Example Entity 1-2-1 | offer of coverage: USD 10,303.00 | monthly contribution: USD 10,303.00",1095,3,1095,fdc-de6e6b7338ee0cd32a0e5525,synthetic-form-layout-01,original,2025,fte-05aa9f2332f8007d129d48b3,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 103
employee: Example Entity 1-3-0 | employer: Example Entity 1-3-1 | offer of coverage: USD 10,386.00 | monthly contribution: USD 10,386.00",1095,3,1095,fdc-85e8867b57f7726bb92d9ef6,synthetic-form-layout-01,original,2023,fte-6c938bab6a1c733895fee7e3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 104
employee: Example Entity 1-4-0 | employer: Example Entity 1-4-1 | offer of coverage: USD 10,469.00 | monthly contribution: USD 10,469.00",1095,3,1095,fdc-40c9db0ef3fb72c627aff7a7,synthetic-form-layout-01,original,2024,fte-d17a1eb9ab82f609b9d3f141,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 105
employee: Example Entity 1-5-0 | employer: Example Entity 1-5-1 | offer of coverage: USD 10,552.00 | monthly contribution: USD 10,552.00",1095,3,1095,fdc-c132463debf511764fe98ca6,synthetic-form-layout-01,original,2025,fte-f45fe54c8faf3668f639adf4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 106
employee: Example Entity 1-6-0 | employer: Example Entity 1-6-1 | offer of coverage: USD 10,635.00 | monthly contribution: USD 10,635.00",1095,3,1095,fdc-de834f843d5a8a0891962772,synthetic-form-layout-01,original,2023,fte-503421c233aaa44187a540ff,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Recipient record: Example Person 107
employee: Example Entity 1-7-0 | employer: Example Entity 1-7-1 | offer of coverage: USD 10,718.00 | monthly contribution: USD 10,718.00",1095,3,1095,fdc-d1fd29ed860d11d2f7b0bc64,synthetic-form-layout-01,original,2024,fte-bddb6f8ca97375ca2b7680c6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-0-0; employer: Example Entity 2-0-1; offer of coverage: USD 10,274.00; monthly contribution: USD 10,274.00. Recipient: Example Household 200.",1095,3,1095,fdc-e8e80f060242c8205757bf29,synthetic-form-layout-02,original,2023,fte-b3e80d4b962c5f68d3bad19a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-1-0; employer: Example Entity 2-1-1; offer of coverage: USD 10,357.00; monthly contribution: USD 10,357.00. Recipient: Example Household 201.",1095,3,1095,fdc-30e3619a2b680ea8430e5c53,synthetic-form-layout-02,original,2024,fte-7996abeaa2830d0342bc0ad2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-2-0; employer: Example Entity 2-2-1; offer of coverage: USD 10,440.00; monthly contribution: USD 10,440.00. Recipient: Example Household 202.",1095,3,1095,fdc-2a2b5ba7244b91c731bc7829,synthetic-form-layout-02,original,2025,fte-43200ddd513c8c766c081164,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-3-0; employer: Example Entity 2-3-1; offer of coverage: USD 10,523.00; monthly contribution: USD 10,523.00. Recipient: Example Household 203.",1095,3,1095,fdc-b6e1c961df7aa477c440ba92,synthetic-form-layout-02,original,2023,fte-86f5723a2a237d9a16402c44,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-4-0; employer: Example Entity 2-4-1; offer of coverage: USD 10,606.00; monthly contribution: USD 10,606.00. Recipient: Example Household 204.",1095,3,1095,fdc-d6ea419ad4d73e44f1ed6db2,synthetic-form-layout-02,original,2024,fte-b08964db87e2c5bf19d1011a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-5-0; employer: Example Entity 2-5-1; offer of coverage: USD 10,689.00; monthly contribution: USD 10,689.00. Recipient: Example Household 205.",1095,3,1095,fdc-8c8aa1e73b1275f7b5384376,synthetic-form-layout-02,original,2025,fte-892b35ed2b88561b0fad134c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-6-0; employer: Example Entity 2-6-1; offer of coverage: USD 10,772.00; monthly contribution: USD 10,772.00. Recipient: Example Household 206.",1095,3,1095,fdc-bf57cb637bcce2b163158ba4,synthetic-form-layout-02,original,2023,fte-58e76d44febb63e9e94c890b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1095-C: Employer-Provided Health Insurance Offer and Coverage.
employee: Example Entity 2-7-0; employer: Example Entity 2-7-1; offer of coverage: USD 10,855.00; monthly contribution: USD 10,855.00. Recipient: Example Household 207.",1095,3,1095,fdc-20981d5d50a872d898bfcc5f,synthetic-form-layout-02,original,2024,fte-d6d53e8d1099f1600a21153a,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2023.
Details: employee: Example Entity 3-0-0, employer: Example Entity 3-0-1, offer of coverage: USD 10,411.00, monthly contribution: USD 10,411.00. Account holder: Example Person 300.",1095,3,1095,fdc-fd458263b6d478aaf02250d6,synthetic-form-layout-03,original,2023,fte-e05f7dd5c9ee9797dcf9ca28,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2024.
Details: employee: Example Entity 3-1-0, employer: Example Entity 3-1-1, offer of coverage: USD 10,494.00, monthly contribution: USD 10,494.00. Account holder: Example Person 301.",1095,3,1095,fdc-8e53c878626ba865bac36903,synthetic-form-layout-03,original,2024,fte-ee52ee140e14db650db88a60,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2025.
Details: employee: Example Entity 3-2-0, employer: Example Entity 3-2-1, offer of coverage: USD 10,577.00, monthly contribution: USD 10,577.00. Account holder: Example Person 302.",1095,3,1095,fdc-e5d04a0ac7427d3f2f78357d,synthetic-form-layout-03,original,2025,fte-831f241ae89b8610e070423b,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2023.
Details: employee: Example Entity 3-3-0, employer: Example Entity 3-3-1, offer of coverage: USD 10,660.00, monthly contribution: USD 10,660.00. Account holder: Example Person 303.",1095,3,1095,fdc-6d73f9b6b83cb255cd0da331,synthetic-form-layout-03,original,2023,fte-8fd810ffafed4177fa293a44,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2024.
Details: employee: Example Entity 3-4-0, employer: Example Entity 3-4-1, offer of coverage: USD 10,743.00, monthly contribution: USD 10,743.00. Account holder: Example Person 304.",1095,3,1095,fdc-fb8c270c507dfa0d66e96aa9,synthetic-form-layout-03,original,2024,fte-12da1486b7e94db188b91187,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2025.
Details: employee: Example Entity 3-5-0, employer: Example Entity 3-5-1, offer of coverage: USD 10,826.00, monthly contribution: USD 10,826.00. Account holder: Example Person 305.",1095,3,1095,fdc-141687cd3818ea0b0f28fdab,synthetic-form-layout-03,original,2025,fte-61901d19d2f3e95a1b02f82e,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2023.
Details: employee: Example Entity 3-6-0, employer: Example Entity 3-6-1, offer of coverage: USD 10,909.00, monthly contribution: USD 10,909.00. Account holder: Example Person 306.",1095,3,1095,fdc-418935dc46c544f77dbf2dfb,synthetic-form-layout-03,original,2023,fte-554f4f64620fd5d3167d9b0a,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Reporting period ended 12/31/2024.
Details: employee: Example Entity 3-7-0, employer: Example Entity 3-7-1, offer of coverage: USD 10,992.00, monthly contribution: USD 10,992.00. Account holder: Example Person 307.",1095,3,1095,fdc-eec14dca634731b1a518dc09,synthetic-form-layout-03,original,2024,fte-a3d3cb92d47e7b57871acb65,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2023
monthly contribution: USD 10,548.00
offer of coverage: USD 10,548.00
employer: Example Entity 4-0-1
employee: Example Entity 4-0-0
Named party: Example Person 400",1095,3,1095,fdc-54b05879434c794d02f87c6a,synthetic-form-layout-04,original,2023,fte-23af906578027fd11f21ddde,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2024
monthly contribution: USD 10,631.00
offer of coverage: USD 10,631.00
employer: Example Entity 4-1-1
employee: Example Entity 4-1-0
Named party: Example Person 401",1095,3,1095,fdc-d763132470f360a03759c291,synthetic-form-layout-04,original,2024,fte-4408be1ec9abc58f2af7f012,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2025
monthly contribution: USD 10,714.00
offer of coverage: USD 10,714.00
employer: Example Entity 4-2-1
employee: Example Entity 4-2-0
Named party: Example Person 402",1095,3,1095,fdc-e8ca0f02002ffd732e75bd1c,synthetic-form-layout-04,original,2025,fte-d882ce9d71f12a812ad9756b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2023
monthly contribution: USD 10,797.00
offer of coverage: USD 10,797.00
employer: Example Entity 4-3-1
employee: Example Entity 4-3-0
Named party: Example Person 403",1095,3,1095,fdc-456ed9217464f9d0a75feba6,synthetic-form-layout-04,original,2023,fte-4bd7a2d9abd6bb2be27de5c9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2024
monthly contribution: USD 10,880.00
offer of coverage: USD 10,880.00
employer: Example Entity 4-4-1
employee: Example Entity 4-4-0
Named party: Example Person 404",1095,3,1095,fdc-9fcabce207d3acdea19d9083,synthetic-form-layout-04,original,2024,fte-58fb1157dc7123d8567ef21f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2025
monthly contribution: USD 10,963.00
offer of coverage: USD 10,963.00
employer: Example Entity 4-5-1
employee: Example Entity 4-5-0
Named party: Example Person 405",1095,3,1095,fdc-c27dc1ab0ba3003e86e00fd6,synthetic-form-layout-04,original,2025,fte-e4e0d9c9e2d066fc64711d06,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2023
monthly contribution: USD 11,046.00
offer of coverage: USD 11,046.00
employer: Example Entity 4-6-1
employee: Example Entity 4-6-0
Named party: Example Person 406",1095,3,1095,fdc-7d46bc191a741f3342d7e9b4,synthetic-form-layout-04,original,2023,fte-bef84d343af1f1393467ef51,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
Tax reporting year 2024
monthly contribution: USD 11,129.00
offer of coverage: USD 11,129.00
employer: Example Entity 4-7-1
employee: Example Entity 4-7-0
Named party: Example Person 407",1095,3,1095,fdc-aba31ea87687effb20abadfc,synthetic-form-layout-04,original,2024,fte-c13487d202f160ebf064e119,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2023
employee: Example Entity 5-0-0 / employer: Example Entity 5-0-1 / offer of coverage: USD 10,685.00 / monthly contribution: USD 10,685.00
Delivery copy for Example Party 500",1095,3,1095,fdc-c18747a47fe4a817019f2326,synthetic-form-layout-05,original,2023,fte-4f24525395da96bce8140179,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2024
employee: Example Entity 5-1-0 / employer: Example Entity 5-1-1 / offer of coverage: USD 10,768.00 / monthly contribution: USD 10,768.00
Delivery copy for Example Party 501",1095,3,1095,fdc-e0e0dc43bf68e3fb91d38903,synthetic-form-layout-05,original,2024,fte-cf97463ece28e4e50270b383,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2025
employee: Example Entity 5-2-0 / employer: Example Entity 5-2-1 / offer of coverage: USD 10,851.00 / monthly contribution: USD 10,851.00
Delivery copy for Example Party 502",1095,3,1095,fdc-2b465b438c6714288d579e90,synthetic-form-layout-05,original,2025,fte-38294bf753388d07fb2a55c2,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2023
employee: Example Entity 5-3-0 / employer: Example Entity 5-3-1 / offer of coverage: USD 10,934.00 / monthly contribution: USD 10,934.00
Delivery copy for Example Party 503",1095,3,1095,fdc-22bfbc9cd573d0a8fd0ced4d,synthetic-form-layout-05,original,2023,fte-c8a89764a02ef1ab7d9ff74f,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2024
employee: Example Entity 5-4-0 / employer: Example Entity 5-4-1 / offer of coverage: USD 11,017.00 / monthly contribution: USD 11,017.00
Delivery copy for Example Party 504",1095,3,1095,fdc-d3038c83fb1eecc4c718ba2d,synthetic-form-layout-05,original,2024,fte-c3ae98a5250e374b5982cf93,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2025
employee: Example Entity 5-5-0 / employer: Example Entity 5-5-1 / offer of coverage: USD 11,100.00 / monthly contribution: USD 11,100.00
Delivery copy for Example Party 505",1095,3,1095,fdc-4bba55841778bc14020aa634,synthetic-form-layout-05,original,2025,fte-a942732b91bc3d77b5c66ea6,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2023
employee: Example Entity 5-6-0 / employer: Example Entity 5-6-1 / offer of coverage: USD 11,183.00 / monthly contribution: USD 11,183.00
Delivery copy for Example Party 506",1095,3,1095,fdc-b2835139964b2bde6bf05f36,synthetic-form-layout-05,original,2023,fte-736074c0e11d906eba8925e4,synthetic_AI_labeled,v1_template,top,False,
"Form 1095-C: Employer-Provided Health Insurance Offer and Coverage -- reporting year 2024
employee: Example Entity 5-7-0 / employer: Example Entity 5-7-1 / offer of coverage: USD 11,266.00 / monthly contribution: USD 11,266.00
Delivery copy for Example Party 507",1095,3,1095,fdc-87aadd89d9231716673b5764,synthetic-form-layout-05,original,2024,fte-b3ad0f5e403370d4dc81dbc9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2023
Statement issued to Example Person 0.
gross distribution: USD 10,000.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-97d970ad51e8eadfc7033900,synthetic-form-layout-00,original,2023,fte-aea957ffa13a4e55b158995e,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2024
Statement issued to Example Person 1.
gross distribution: USD 10,083.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-b26a59541ffde9f913244b07,synthetic-form-layout-00,original,2024,fte-65ac8d5de6f9016a058878db,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2025
Statement issued to Example Person 2.
gross distribution: USD 10,166.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-0b0c8af35c7d815959fac590,synthetic-form-layout-00,original,2025,fte-463176ae9320d48defff29d9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2023
Statement issued to Example Person 3.
gross distribution: USD 10,249.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-cd564442d025c20eb859aad2,synthetic-form-layout-00,original,2023,fte-1a95db6704f68e0c737580da,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2024
Statement issued to Example Person 4.
gross distribution: USD 10,332.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-cce44ba61d7c386cb5ad3dd4,synthetic-form-layout-00,original,2024,fte-1d67154c05f87a78131d125d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2025
Statement issued to Example Person 5.
gross distribution: USD 10,415.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-8e4cd8cfee6296dffe373ccf,synthetic-form-layout-00,original,2025,fte-50f28434f6308a057722dcb0,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2023
Statement issued to Example Person 6.
gross distribution: USD 10,498.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-2e6caa5b0d472bad4c507247,synthetic-form-layout-00,original,2023,fte-afadbfa3dc13acbad91f1011,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Calendar year: 2024
Statement issued to Example Person 7.
gross distribution: USD 10,581.00
distribution code: 7
account type: HSA",1099,5,1099,fdc-2db617b71f6aef6c7c37f7f7,synthetic-form-layout-00,original,2024,fte-71eb810f10312f852ff4ad43,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 100
gross distribution: USD 10,137.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-dd34b8fabcdfb9a868b9f060,synthetic-form-layout-01,original,2023,fte-5cba2e676a5dfa4b8f3fa5e0,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 101
gross distribution: USD 10,220.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-3535c0355668a8fcc96da06f,synthetic-form-layout-01,original,2024,fte-e181670711c576c347d58e67,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 102
gross distribution: USD 10,303.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-c795c05e83b9aad7596c60b9,synthetic-form-layout-01,original,2025,fte-296b98137af1342151d51f0d,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 103
gross distribution: USD 10,386.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-8815c11e6be70aa57b424c19,synthetic-form-layout-01,original,2023,fte-137b994afb28ab326adbdf0c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 104
gross distribution: USD 10,469.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-ec622ccf972a6cded0bce8d2,synthetic-form-layout-01,original,2024,fte-4dd9b2cf43edc2baa888441b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 105
gross distribution: USD 10,552.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-88c36c61d9a4857952d2964f,synthetic-form-layout-01,original,2025,fte-f11df5867ef4d19e0ecf096c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 106
gross distribution: USD 10,635.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-57fe5443984cdf8180a03729,synthetic-form-layout-01,original,2023,fte-f981112bf11b4745cbaa14db,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Recipient record: Example Person 107
gross distribution: USD 10,718.00 | distribution code: 7 | account type: HSA",1099,5,1099,fdc-efda99063ee455f4141d59ef,synthetic-form-layout-01,original,2024,fte-bc85afab791f5884c151aa0a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,274.00; distribution code: 7; account type: HSA. Recipient: Example Household 200.",1099,5,1099,fdc-5b130756993644a8ca412a6e,synthetic-form-layout-02,original,2023,fte-a5c34a4abd0a7c4d5fd9f6d6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,357.00; distribution code: 7; account type: HSA. Recipient: Example Household 201.",1099,5,1099,fdc-a4cb8127a7c655f793e8adc1,synthetic-form-layout-02,original,2024,fte-15ffddd816cfd19a7665ca76,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,440.00; distribution code: 7; account type: HSA. Recipient: Example Household 202.",1099,5,1099,fdc-a74a81f7a10acec02940896f,synthetic-form-layout-02,original,2025,fte-7f9406e1be12adefcde2ceb6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,523.00; distribution code: 7; account type: HSA. Recipient: Example Household 203.",1099,5,1099,fdc-7eca14942105c675c176e7ee,synthetic-form-layout-02,original,2023,fte-3f328cb6c17c562d8857bcc1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,606.00; distribution code: 7; account type: HSA. Recipient: Example Household 204.",1099,5,1099,fdc-36a118d51b4f248080c3e588,synthetic-form-layout-02,original,2024,fte-f88394e65b30c04abe20711e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,689.00; distribution code: 7; account type: HSA. Recipient: Example Household 205.",1099,5,1099,fdc-92a6f549002d260f1834cdb2,synthetic-form-layout-02,original,2025,fte-af75c7f81cfa92afe8e187b1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,772.00; distribution code: 7; account type: HSA. Recipient: Example Household 206.",1099,5,1099,fdc-c45bdf8e26d88e99cdaa679a,synthetic-form-layout-02,original,2023,fte-46caefb1e8b96727368e9720,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA.
gross distribution: USD 10,855.00; distribution code: 7; account type: HSA. Recipient: Example Household 207.",1099,5,1099,fdc-8f29b6432dd0375e7b057855,synthetic-form-layout-02,original,2024,fte-d7454ff7c0d780b96774aa1f,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,411.00, distribution code: 7, account type: HSA. Account holder: Example Person 300.",1099,5,1099,fdc-68eef1be1019d33bff878964,synthetic-form-layout-03,original,2023,fte-a4f372ddc969dad1e9c2f65d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,494.00, distribution code: 7, account type: HSA. Account holder: Example Person 301.",1099,5,1099,fdc-ce85cbd4b0fac8ac23f47e2c,synthetic-form-layout-03,original,2024,fte-8452be6a391f5ddee700544b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2025.
Details: gross distribution: USD 10,577.00, distribution code: 7, account type: HSA. Account holder: Example Person 302.",1099,5,1099,fdc-e88f146850ebee597290495b,synthetic-form-layout-03,original,2025,fte-e984f2eb26240de87ec4f29c,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,660.00, distribution code: 7, account type: HSA. Account holder: Example Person 303.",1099,5,1099,fdc-e80386e5a081ecc6a4454ec9,synthetic-form-layout-03,original,2023,fte-3a61f71679388d9dbd60d94d,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,743.00, distribution code: 7, account type: HSA. Account holder: Example Person 304.",1099,5,1099,fdc-54171ca1f2cc4d830d0e6692,synthetic-form-layout-03,original,2024,fte-8d898e3ccec5c280a2de3269,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2025.
Details: gross distribution: USD 10,826.00, distribution code: 7, account type: HSA. Account holder: Example Person 305.",1099,5,1099,fdc-e4b61ee73c879d3dd3f3aa90,synthetic-form-layout-03,original,2025,fte-9955ad8b956b8d7e4f434230,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2023.
Details: gross distribution: USD 10,909.00, distribution code: 7, account type: HSA. Account holder: Example Person 306.",1099,5,1099,fdc-dec6ba998db62af8958b97c2,synthetic-form-layout-03,original,2023,fte-6933c6d370e73238417739c2,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Reporting period ended 12/31/2024.
Details: gross distribution: USD 10,992.00, distribution code: 7, account type: HSA. Account holder: Example Person 307.",1099,5,1099,fdc-167d31ac30e16056c79e51b9,synthetic-form-layout-03,original,2024,fte-3f060448dfcdb0aea292a94d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2023
account type: HSA
distribution code: 7
gross distribution: USD 10,548.00
Named party: Example Person 400",1099,5,1099,fdc-dd83d35b43b072d9f05322e9,synthetic-form-layout-04,original,2023,fte-d8eb7bea6a24724b93ec8efc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2024
account type: HSA
distribution code: 7
gross distribution: USD 10,631.00
Named party: Example Person 401",1099,5,1099,fdc-ff833ea77e37a69a60676d6b,synthetic-form-layout-04,original,2024,fte-2c0d0dfc2d07150fbb149983,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2025
account type: HSA
distribution code: 7
gross distribution: USD 10,714.00
Named party: Example Person 402",1099,5,1099,fdc-bda2ffcf488676a311f24c39,synthetic-form-layout-04,original,2025,fte-33640b6c50f1243e27303480,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2023
account type: HSA
distribution code: 7
gross distribution: USD 10,797.00
Named party: Example Person 403",1099,5,1099,fdc-48773da0f00154b7376200d2,synthetic-form-layout-04,original,2023,fte-972a7c90aba1217203501ba3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2024
account type: HSA
distribution code: 7
gross distribution: USD 10,880.00
Named party: Example Person 404",1099,5,1099,fdc-6e90845461898a851d27b59b,synthetic-form-layout-04,original,2024,fte-2473f638ae39658dcc0de738,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2025
account type: HSA
distribution code: 7
gross distribution: USD 10,963.00
Named party: Example Person 405",1099,5,1099,fdc-6e354cfd0016559ab0aa3bfc,synthetic-form-layout-04,original,2025,fte-8cb3016994d0107e30a53fcf,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2023
account type: HSA
distribution code: 7
gross distribution: USD 11,046.00
Named party: Example Person 406",1099,5,1099,fdc-9a569d38a78688c7bd6c6b5f,synthetic-form-layout-04,original,2023,fte-b9d596353f795e2a0a0922c4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA
Tax reporting year 2024
account type: HSA
distribution code: 7
gross distribution: USD 11,129.00
Named party: Example Person 407",1099,5,1099,fdc-ac7670c475775eb34bd0955e,synthetic-form-layout-04,original,2024,fte-8849201da8c1d794d7206745,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2023
gross distribution: USD 10,685.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 500",1099,5,1099,fdc-719d7ecc36db79a69f8c85fc,synthetic-form-layout-05,original,2023,fte-1789e9df74ef4fd75e796c13,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2024
gross distribution: USD 10,768.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 501",1099,5,1099,fdc-656a74ff4ddacf7d8e4914b8,synthetic-form-layout-05,original,2024,fte-ceacbda4ab154f1c5ef9c81b,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2025
gross distribution: USD 10,851.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 502",1099,5,1099,fdc-f4063898f73deb0f81d55f47,synthetic-form-layout-05,original,2025,fte-a652ed8e1df0a1c71a3b14b0,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2023
gross distribution: USD 10,934.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 503",1099,5,1099,fdc-83c97829892a01f0ec363964,synthetic-form-layout-05,original,2023,fte-ab8841c8437879d956c00ab3,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2024
gross distribution: USD 11,017.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 504",1099,5,1099,fdc-60f6106870704efe4e709441,synthetic-form-layout-05,original,2024,fte-425e3c2e00ea934122d73b67,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2025
gross distribution: USD 11,100.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 505",1099,5,1099,fdc-cae7a7cbcca327c91eeb6047,synthetic-form-layout-05,original,2025,fte-722b4e381c04fd333b79c6d9,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2023
gross distribution: USD 11,183.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 506",1099,5,1099,fdc-19f4969e3121716ec7d649af,synthetic-form-layout-05,original,2023,fte-579b6af11012072b7ba63905,synthetic_AI_labeled,v1_template,top,False,
"Form 1099-SA: Distributions From an HSA Archer MSA or Medicare Advantage MSA -- reporting year 2024
gross distribution: USD 11,266.00 / distribution code: 7 / account type: HSA
Delivery copy for Example Party 507",1099,5,1099,fdc-3dda9c8f6b27ab614068dc6c,synthetic-form-layout-05,original,2024,fte-2d121928de8c045a56aa9ce9,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2023
Statement issued to Example Person 0.
contributions: USD 10,000.00
rollover contributions: USD 10,000.00
fair market value: USD 10,000.00",5498,14,5498,fdc-a70df26a3ffc8b7f4257de46,synthetic-form-layout-00,original,2023,fte-70b16346b5878b710e1c27e2,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2024
Statement issued to Example Person 1.
contributions: USD 10,083.00
rollover contributions: USD 10,083.00
fair market value: USD 10,083.00",5498,14,5498,fdc-e5919605b4ac8417c6c53144,synthetic-form-layout-00,original,2024,fte-bd9bfff05b3e523db3dfe0a1,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2025
Statement issued to Example Person 2.
contributions: USD 10,166.00
rollover contributions: USD 10,166.00
fair market value: USD 10,166.00",5498,14,5498,fdc-4d53fbcb663deb3fd82e368b,synthetic-form-layout-00,original,2025,fte-d79cea163124031cdd92a10b,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2023
Statement issued to Example Person 3.
contributions: USD 10,249.00
rollover contributions: USD 10,249.00
fair market value: USD 10,249.00",5498,14,5498,fdc-534942484cac6ace5bf0683f,synthetic-form-layout-00,original,2023,fte-c34fd3c08e036f145baf4e16,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2024
Statement issued to Example Person 4.
contributions: USD 10,332.00
rollover contributions: USD 10,332.00
fair market value: USD 10,332.00",5498,14,5498,fdc-5127790cc4d704d343ec2ba0,synthetic-form-layout-00,original,2024,fte-8b2083a5e176049e425ceca4,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2025
Statement issued to Example Person 5.
contributions: USD 10,415.00
rollover contributions: USD 10,415.00
fair market value: USD 10,415.00",5498,14,5498,fdc-a09643741ffdc838dea71082,synthetic-form-layout-00,original,2025,fte-b265a7ac6e6a35b641fe11b5,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2023
Statement issued to Example Person 6.
contributions: USD 10,498.00
rollover contributions: USD 10,498.00
fair market value: USD 10,498.00",5498,14,5498,fdc-0a5e626990806584495041b0,synthetic-form-layout-00,original,2023,fte-4e0fc0142b9ecbfbc3aea2a1,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Calendar year: 2024
Statement issued to Example Person 7.
contributions: USD 10,581.00
rollover contributions: USD 10,581.00
fair market value: USD 10,581.00",5498,14,5498,fdc-fff046205dffa05ef8120e17,synthetic-form-layout-00,original,2024,fte-7f52e4cfd4f4ebf5f2ed4592,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 100
contributions: USD 10,137.00 | rollover contributions: USD 10,137.00 | fair market value: USD 10,137.00",5498,14,5498,fdc-f0d382b7791afaa3272f4663,synthetic-form-layout-01,original,2023,fte-41afea9e912a111dfec1996c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 101
contributions: USD 10,220.00 | rollover contributions: USD 10,220.00 | fair market value: USD 10,220.00",5498,14,5498,fdc-cd35355d47276742e14dc8bb,synthetic-form-layout-01,original,2024,fte-e6099b11ee8aa4dff67261c8,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 102
contributions: USD 10,303.00 | rollover contributions: USD 10,303.00 | fair market value: USD 10,303.00",5498,14,5498,fdc-bc0dbd2c412d3ca0a0cae709,synthetic-form-layout-01,original,2025,fte-8a2728c588579058cda5a3e1,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 103
contributions: USD 10,386.00 | rollover contributions: USD 10,386.00 | fair market value: USD 10,386.00",5498,14,5498,fdc-588c4d6ce01dc554a205f3e9,synthetic-form-layout-01,original,2023,fte-caf25d30d3789f1e8b843554,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 104
contributions: USD 10,469.00 | rollover contributions: USD 10,469.00 | fair market value: USD 10,469.00",5498,14,5498,fdc-51b586742672087c4ee5ef2d,synthetic-form-layout-01,original,2024,fte-ea067a9f8891bcdc7e52c688,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 105
contributions: USD 10,552.00 | rollover contributions: USD 10,552.00 | fair market value: USD 10,552.00",5498,14,5498,fdc-2b7b57f0306d88536586454b,synthetic-form-layout-01,original,2025,fte-01ac43d33284804ba47a434e,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 106
contributions: USD 10,635.00 | rollover contributions: USD 10,635.00 | fair market value: USD 10,635.00",5498,14,5498,fdc-52f2ac96cdb096ab0ad7da58,synthetic-form-layout-01,original,2023,fte-e908e4d124c4de015dc0fe45,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Recipient record: Example Person 107
contributions: USD 10,718.00 | rollover contributions: USD 10,718.00 | fair market value: USD 10,718.00",5498,14,5498,fdc-1dcb5f20e33369ca00f24ba9,synthetic-form-layout-01,original,2024,fte-220d416473a077fe8d68f814,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,274.00; rollover contributions: USD 10,274.00; fair market value: USD 10,274.00. Recipient: Example Household 200.",5498,14,5498,fdc-09c8ca85c27b2afdf066de02,synthetic-form-layout-02,original,2023,fte-3833c6766252173952de8ec3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,357.00; rollover contributions: USD 10,357.00; fair market value: USD 10,357.00. Recipient: Example Household 201.",5498,14,5498,fdc-e3f6f9bdcf9830fc0e15926e,synthetic-form-layout-02,original,2024,fte-4cd23dbe9cd3edc8a64e4690,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,440.00; rollover contributions: USD 10,440.00; fair market value: USD 10,440.00. Recipient: Example Household 202.",5498,14,5498,fdc-396dfe0f67b09e2c5a520a2d,synthetic-form-layout-02,original,2025,fte-123340f6df349fbf22c3b839,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,523.00; rollover contributions: USD 10,523.00; fair market value: USD 10,523.00. Recipient: Example Household 203.",5498,14,5498,fdc-760eb7c4a59600b90ed89566,synthetic-form-layout-02,original,2023,fte-bf17762566411ce0433cc68b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,606.00; rollover contributions: USD 10,606.00; fair market value: USD 10,606.00. Recipient: Example Household 204.",5498,14,5498,fdc-0f6334da6269a833bdc48941,synthetic-form-layout-02,original,2024,fte-6a8f76e4f44cd214e7355f64,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,689.00; rollover contributions: USD 10,689.00; fair market value: USD 10,689.00. Recipient: Example Household 205.",5498,14,5498,fdc-a9243f6a5d6192ee95ef0607,synthetic-form-layout-02,original,2025,fte-35db8e3b97f5d77ff732c0e5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,772.00; rollover contributions: USD 10,772.00; fair market value: USD 10,772.00. Recipient: Example Household 206.",5498,14,5498,fdc-56e4a22f69d8f866c6cd1502,synthetic-form-layout-02,original,2023,fte-05e803a9d1c49cc980588f91,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information.
contributions: USD 10,855.00; rollover contributions: USD 10,855.00; fair market value: USD 10,855.00. Recipient: Example Household 207.",5498,14,5498,fdc-0c01ba7d6760632a94951ffd,synthetic-form-layout-02,original,2024,fte-d4996adc1a9314917011856d,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2023.
Details: contributions: USD 10,411.00, rollover contributions: USD 10,411.00, fair market value: USD 10,411.00. Account holder: Example Person 300.",5498,14,5498,fdc-ae407129f557abb8e6b02de7,synthetic-form-layout-03,original,2023,fte-bc59f76605e77355abd5149c,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2024.
Details: contributions: USD 10,494.00, rollover contributions: USD 10,494.00, fair market value: USD 10,494.00. Account holder: Example Person 301.",5498,14,5498,fdc-0e2b7f0ea9f742d8046b7c87,synthetic-form-layout-03,original,2024,fte-dc8614a39318bad4372645dc,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2025.
Details: contributions: USD 10,577.00, rollover contributions: USD 10,577.00, fair market value: USD 10,577.00. Account holder: Example Person 302.",5498,14,5498,fdc-6b145ce351056c701cfefad9,synthetic-form-layout-03,original,2025,fte-c2d53ed4b1b340aa86e001a9,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2023.
Details: contributions: USD 10,660.00, rollover contributions: USD 10,660.00, fair market value: USD 10,660.00. Account holder: Example Person 303.",5498,14,5498,fdc-0d67e01aefc14175340a9a3d,synthetic-form-layout-03,original,2023,fte-07afe15d5e62babbc95bc376,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2024.
Details: contributions: USD 10,743.00, rollover contributions: USD 10,743.00, fair market value: USD 10,743.00. Account holder: Example Person 304.",5498,14,5498,fdc-6ee1572320562397938950ec,synthetic-form-layout-03,original,2024,fte-ae9d267a843994d03320a569,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2025.
Details: contributions: USD 10,826.00, rollover contributions: USD 10,826.00, fair market value: USD 10,826.00. Account holder: Example Person 305.",5498,14,5498,fdc-3b7b259ecb9ded945b850120,synthetic-form-layout-03,original,2025,fte-7e05aa2f2d76fd033a90da72,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2023.
Details: contributions: USD 10,909.00, rollover contributions: USD 10,909.00, fair market value: USD 10,909.00. Account holder: Example Person 306.",5498,14,5498,fdc-9f1bd74870143659a289b2d1,synthetic-form-layout-03,original,2023,fte-5e1934eced7575ed543ca219,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Reporting period ended 12/31/2024.
Details: contributions: USD 10,992.00, rollover contributions: USD 10,992.00, fair market value: USD 10,992.00. Account holder: Example Person 307.",5498,14,5498,fdc-c1cbf776a4738a767f65009d,synthetic-form-layout-03,original,2024,fte-85e42c59a360cd1190879950,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2023
fair market value: USD 10,548.00
rollover contributions: USD 10,548.00
contributions: USD 10,548.00
Named party: Example Person 400",5498,14,5498,fdc-407b06d2d5f53660957cd1bc,synthetic-form-layout-04,original,2023,fte-b3def81c33d7bf6f9fac8e8b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2024
fair market value: USD 10,631.00
rollover contributions: USD 10,631.00
contributions: USD 10,631.00
Named party: Example Person 401",5498,14,5498,fdc-be150128a0eef2b82f2b875a,synthetic-form-layout-04,original,2024,fte-0c6be51f70f38e142686d462,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2025
fair market value: USD 10,714.00
rollover contributions: USD 10,714.00
contributions: USD 10,714.00
Named party: Example Person 402",5498,14,5498,fdc-09568ede7c64792830eebb6e,synthetic-form-layout-04,original,2025,fte-2880e3650e8ebeaedc9286e1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2023
fair market value: USD 10,797.00
rollover contributions: USD 10,797.00
contributions: USD 10,797.00
Named party: Example Person 403",5498,14,5498,fdc-f96b947ec00340139897ef6d,synthetic-form-layout-04,original,2023,fte-73741c7ce38f5e1afcb68936,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2024
fair market value: USD 10,880.00
rollover contributions: USD 10,880.00
contributions: USD 10,880.00
Named party: Example Person 404",5498,14,5498,fdc-eb3468d12558a87724351733,synthetic-form-layout-04,original,2024,fte-f54ee66a7ff5824f6276a4d2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2025
fair market value: USD 10,963.00
rollover contributions: USD 10,963.00
contributions: USD 10,963.00
Named party: Example Person 405",5498,14,5498,fdc-b7ed3e4929b2cb8a2d7ce3dd,synthetic-form-layout-04,original,2025,fte-8269f6a1c43999c628e7b465,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2023
fair market value: USD 11,046.00
rollover contributions: USD 11,046.00
contributions: USD 11,046.00
Named party: Example Person 406",5498,14,5498,fdc-c3e34769c66ae898669de87f,synthetic-form-layout-04,original,2023,fte-3136a85bd9a0d5dbdb541f71,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information
Tax reporting year 2024
fair market value: USD 11,129.00
rollover contributions: USD 11,129.00
contributions: USD 11,129.00
Named party: Example Person 407",5498,14,5498,fdc-17bf431ece2edd61c6bae327,synthetic-form-layout-04,original,2024,fte-851fec3638e821f2b6fb7967,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2023
contributions: USD 10,685.00 / rollover contributions: USD 10,685.00 / fair market value: USD 10,685.00
Delivery copy for Example Party 500",5498,14,5498,fdc-a8b825f642167cb21fa2b71c,synthetic-form-layout-05,original,2023,fte-e13805bbb5e4415046f951fb,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2024
contributions: USD 10,768.00 / rollover contributions: USD 10,768.00 / fair market value: USD 10,768.00
Delivery copy for Example Party 501",5498,14,5498,fdc-cddbdd4ac9bce77c7ed75729,synthetic-form-layout-05,original,2024,fte-46a9fd1b8c47a7b2c349d1ef,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2025
contributions: USD 10,851.00 / rollover contributions: USD 10,851.00 / fair market value: USD 10,851.00
Delivery copy for Example Party 502",5498,14,5498,fdc-e25408c42359fd2b3ab2df0e,synthetic-form-layout-05,original,2025,fte-2801f407ad203d22a7146bbb,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2023
contributions: USD 10,934.00 / rollover contributions: USD 10,934.00 / fair market value: USD 10,934.00
Delivery copy for Example Party 503",5498,14,5498,fdc-f29dc96ecea7872987e2404d,synthetic-form-layout-05,original,2023,fte-03e02cea12d45f5faa8f5b77,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2024
contributions: USD 11,017.00 / rollover contributions: USD 11,017.00 / fair market value: USD 11,017.00
Delivery copy for Example Party 504",5498,14,5498,fdc-1d8be38c4a1e6d425d222297,synthetic-form-layout-05,original,2024,fte-3daa106ee4f4c33725d9e3f6,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2025
contributions: USD 11,100.00 / rollover contributions: USD 11,100.00 / fair market value: USD 11,100.00
Delivery copy for Example Party 505",5498,14,5498,fdc-0aaf200a62b64f14cff35ca7,synthetic-form-layout-05,original,2025,fte-84bd2f3576ecb21f9420417b,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2023
contributions: USD 11,183.00 / rollover contributions: USD 11,183.00 / fair market value: USD 11,183.00
Delivery copy for Example Party 506",5498,14,5498,fdc-5c4b79de25f365b440c78178,synthetic-form-layout-05,original,2023,fte-832611043fdf2bbe256555dc,synthetic_AI_labeled,v1_template,top,False,
"Form 5498-SA: HSA Archer MSA or Medicare Advantage MSA Information -- reporting year 2024
contributions: USD 11,266.00 / rollover contributions: USD 11,266.00 / fair market value: USD 11,266.00
Delivery copy for Example Party 507",5498,14,5498,fdc-c6567745e3485a3e7fa0d1e7,synthetic-form-layout-05,original,2024,fte-94427ce258fe94e40090bc59,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2023
Statement issued to Example Person 0.
HSA contributions: USD 10,000.00
distributions: USD 10,000.00
qualified medical expenses: USD 10,000.00",8889,19,8889,fdc-c6db4629a6c987d5ab488347,synthetic-form-layout-00,original,2023,fte-5af79b531a71585009e0e443,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2024
Statement issued to Example Person 1.
HSA contributions: USD 10,083.00
distributions: USD 10,083.00
qualified medical expenses: USD 10,083.00",8889,19,8889,fdc-09c395137be6d7cad44abe64,synthetic-form-layout-00,original,2024,fte-ab3a01308730808b9b595368,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2025
Statement issued to Example Person 2.
HSA contributions: USD 10,166.00
distributions: USD 10,166.00
qualified medical expenses: USD 10,166.00",8889,19,8889,fdc-c2625541ab96596145e0cdbb,synthetic-form-layout-00,original,2025,fte-03b2273ed93fdce6fe752442,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2023
Statement issued to Example Person 3.
HSA contributions: USD 10,249.00
distributions: USD 10,249.00
qualified medical expenses: USD 10,249.00",8889,19,8889,fdc-980c95ffebbb9027d2f73285,synthetic-form-layout-00,original,2023,fte-b59896c7719a6abbe940cfe4,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2024
Statement issued to Example Person 4.
HSA contributions: USD 10,332.00
distributions: USD 10,332.00
qualified medical expenses: USD 10,332.00",8889,19,8889,fdc-59b137602ee132f027aaf918,synthetic-form-layout-00,original,2024,fte-9f911e554e1587b1a2267a5f,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2025
Statement issued to Example Person 5.
HSA contributions: USD 10,415.00
distributions: USD 10,415.00
qualified medical expenses: USD 10,415.00",8889,19,8889,fdc-3fc3d945847ea8a4a0c455a1,synthetic-form-layout-00,original,2025,fte-5a623b8b799367756277d538,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2023
Statement issued to Example Person 6.
HSA contributions: USD 10,498.00
distributions: USD 10,498.00
qualified medical expenses: USD 10,498.00",8889,19,8889,fdc-abd9d4f33bf0b6be08394fa8,synthetic-form-layout-00,original,2023,fte-ecc49ec55285ca11852bcf3a,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Calendar year: 2024
Statement issued to Example Person 7.
HSA contributions: USD 10,581.00
distributions: USD 10,581.00
qualified medical expenses: USD 10,581.00",8889,19,8889,fdc-8dc17981bc79204796c16132,synthetic-form-layout-00,original,2024,fte-d3e4d1aad5f9e7b9409f6be7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8889: Health Savings Accounts
Recipient record: Example Person 100
HSA contributions: USD 10,137.00 | distributions: USD 10,137.00 | qualified medical expenses: USD 10,137.00",8889,19,8889,fdc-5c538db2ea86a9937fcaf7da,synthetic-form-layout-01,original,2023,fte-d8553924627bb5eb13b23ef5,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8889: Health Savings Accounts
Recipient record: Example Person 101
HSA contributions: USD 10,220.00 | distributions: USD 10,220.00 | qualified medical expenses: USD 10,220.00",8889,19,8889,fdc-088fa918c66d473bf274e1d6,synthetic-form-layout-01,original,2024,fte-947240dff4e7ce2058ee2e6f,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8889: Health Savings Accounts
Recipient record: Example Person 102
HSA contributions: USD 10,303.00 | distributions: USD 10,303.00 | qualified medical expenses: USD 10,303.00",8889,19,8889,fdc-7be8136a3f58e22613fb0764,synthetic-form-layout-01,original,2025,fte-8fb7e29c5790c9bcb324c708,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8889: Health Savings Accounts
Recipient record: Example Person 103
HSA contributions: USD 10,386.00 | distributions: USD 10,386.00 | qualified medical expenses: USD 10,386.00",8889,19,8889,fdc-716ece5ed3f5a856ae621443,synthetic-form-layout-01,original,2023,fte-cc739280505a2e54d556db7c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8889: Health Savings Accounts
Recipient record: Example Person 104
HSA contributions: USD 10,469.00 | distributions: USD 10,469.00 | qualified medical expenses: USD 10,469.00",8889,19,8889,fdc-c26f95ce93e2a2ff4355fb50,synthetic-form-layout-01,original,2024,fte-142d5fa12f5d27731ac57379,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8889: Health Savings Accounts
Recipient record: Example Person 105
HSA contributions: USD 10,552.00 | distributions: USD 10,552.00 | qualified medical expenses: USD 10,552.00",8889,19,8889,fdc-7224966a238892252b7f3b4d,synthetic-form-layout-01,original,2025,fte-5908c284fbbc5589470abb58,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8889: Health Savings Accounts
Recipient record: Example Person 106
HSA contributions: USD 10,635.00 | distributions: USD 10,635.00 | qualified medical expenses: USD 10,635.00",8889,19,8889,fdc-6c88528ede432d0c87ce8ae4,synthetic-form-layout-01,original,2023,fte-bb622e3545dabd7dc34e9179,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8889: Health Savings Accounts
Recipient record: Example Person 107
HSA contributions: USD 10,718.00 | distributions: USD 10,718.00 | qualified medical expenses: USD 10,718.00",8889,19,8889,fdc-41b8f9585407134f474abc55,synthetic-form-layout-01,original,2024,fte-9d446083f9add77257eccf4c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,274.00; distributions: USD 10,274.00; qualified medical expenses: USD 10,274.00. Recipient: Example Household 200.",8889,19,8889,fdc-c413cfe129b82eef9489a709,synthetic-form-layout-02,original,2023,fte-41bf0d4f50a4279855eb2fdd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,357.00; distributions: USD 10,357.00; qualified medical expenses: USD 10,357.00. Recipient: Example Household 201.",8889,19,8889,fdc-8cc4aedd839ef87b763636fe,synthetic-form-layout-02,original,2024,fte-7280b4a380c855de959a98d5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,440.00; distributions: USD 10,440.00; qualified medical expenses: USD 10,440.00. Recipient: Example Household 202.",8889,19,8889,fdc-b8cd46f813fa2f7b1ac52fa5,synthetic-form-layout-02,original,2025,fte-b97e7aade3cd42dff4bbaa14,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,523.00; distributions: USD 10,523.00; qualified medical expenses: USD 10,523.00. Recipient: Example Household 203.",8889,19,8889,fdc-92becae7aad7ae8943490e71,synthetic-form-layout-02,original,2023,fte-939575d5234b61bcf6f8e355,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,606.00; distributions: USD 10,606.00; qualified medical expenses: USD 10,606.00. Recipient: Example Household 204.",8889,19,8889,fdc-439f5f81b911dd6432d9dc01,synthetic-form-layout-02,original,2024,fte-19d3a902dd2eb3fd0b856517,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,689.00; distributions: USD 10,689.00; qualified medical expenses: USD 10,689.00. Recipient: Example Household 205.",8889,19,8889,fdc-cd67adbb94617a29dc9407dc,synthetic-form-layout-02,original,2025,fte-eb76d55d92668b51b94089fe,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,772.00; distributions: USD 10,772.00; qualified medical expenses: USD 10,772.00. Recipient: Example Household 206.",8889,19,8889,fdc-2181604f6a76b44cc31b8efa,synthetic-form-layout-02,original,2023,fte-03f46ea86510b4570e5939d5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8889: Health Savings Accounts.
HSA contributions: USD 10,855.00; distributions: USD 10,855.00; qualified medical expenses: USD 10,855.00. Recipient: Example Household 207.",8889,19,8889,fdc-3f86d046d8b2653c35c4cb11,synthetic-form-layout-02,original,2024,fte-61d57c63c718d2fc7489cdfd,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2023.
Details: HSA contributions: USD 10,411.00, distributions: USD 10,411.00, qualified medical expenses: USD 10,411.00. Account holder: Example Person 300.",8889,19,8889,fdc-b22bde00f28abdc3dc0a1ea4,synthetic-form-layout-03,original,2023,fte-786e725c89b3b736573be682,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2024.
Details: HSA contributions: USD 10,494.00, distributions: USD 10,494.00, qualified medical expenses: USD 10,494.00. Account holder: Example Person 301.",8889,19,8889,fdc-b0eab29fcd2ee38dcfeeccd7,synthetic-form-layout-03,original,2024,fte-138e7aa214efe885879252ec,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2025.
Details: HSA contributions: USD 10,577.00, distributions: USD 10,577.00, qualified medical expenses: USD 10,577.00. Account holder: Example Person 302.",8889,19,8889,fdc-da521cd8937810ab94e3ab72,synthetic-form-layout-03,original,2025,fte-1b7349d880ab09e985e666b3,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2023.
Details: HSA contributions: USD 10,660.00, distributions: USD 10,660.00, qualified medical expenses: USD 10,660.00. Account holder: Example Person 303.",8889,19,8889,fdc-6b7cf28bf4b8368b58f64e76,synthetic-form-layout-03,original,2023,fte-3da32127ca750b1dad79b8b6,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2024.
Details: HSA contributions: USD 10,743.00, distributions: USD 10,743.00, qualified medical expenses: USD 10,743.00. Account holder: Example Person 304.",8889,19,8889,fdc-2464a3ff4e2e3547416578aa,synthetic-form-layout-03,original,2024,fte-6d24159ee1af76b6f6e764f8,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2025.
Details: HSA contributions: USD 10,826.00, distributions: USD 10,826.00, qualified medical expenses: USD 10,826.00. Account holder: Example Person 305.",8889,19,8889,fdc-b74b92dc62f8be952446a7b6,synthetic-form-layout-03,original,2025,fte-f0f6b845f85c294db4c4d9bf,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2023.
Details: HSA contributions: USD 10,909.00, distributions: USD 10,909.00, qualified medical expenses: USD 10,909.00. Account holder: Example Person 306.",8889,19,8889,fdc-b5a8da55ffa1943a69f5589f,synthetic-form-layout-03,original,2023,fte-46162e6c60f7913904864a62,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts
Reporting period ended 12/31/2024.
Details: HSA contributions: USD 10,992.00, distributions: USD 10,992.00, qualified medical expenses: USD 10,992.00. Account holder: Example Person 307.",8889,19,8889,fdc-14e2745fa4b18481e63c4f33,synthetic-form-layout-03,original,2024,fte-87fbb8e2bb8edbd574e3dd94,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2023
qualified medical expenses: USD 10,548.00
distributions: USD 10,548.00
HSA contributions: USD 10,548.00
Named party: Example Person 400",8889,19,8889,fdc-efc66d63b84185d83f4d211e,synthetic-form-layout-04,original,2023,fte-760e5cbe87029900b5a5a704,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2024
qualified medical expenses: USD 10,631.00
distributions: USD 10,631.00
HSA contributions: USD 10,631.00
Named party: Example Person 401",8889,19,8889,fdc-3d2c084ad703939913d9ef14,synthetic-form-layout-04,original,2024,fte-3027d748598aac2e953dad04,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2025
qualified medical expenses: USD 10,714.00
distributions: USD 10,714.00
HSA contributions: USD 10,714.00
Named party: Example Person 402",8889,19,8889,fdc-8f9df7d7784a12d1b6fd1f4b,synthetic-form-layout-04,original,2025,fte-86009a6b1456b204d5a053df,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2023
qualified medical expenses: USD 10,797.00
distributions: USD 10,797.00
HSA contributions: USD 10,797.00
Named party: Example Person 403",8889,19,8889,fdc-2d1e28658bdd74d66e2d11d4,synthetic-form-layout-04,original,2023,fte-f870d610ed9e3b6eed980eea,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2024
qualified medical expenses: USD 10,880.00
distributions: USD 10,880.00
HSA contributions: USD 10,880.00
Named party: Example Person 404",8889,19,8889,fdc-b27b7d498b33d1c30b78e0bb,synthetic-form-layout-04,original,2024,fte-8a45eca616d03093e18926ec,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2025
qualified medical expenses: USD 10,963.00
distributions: USD 10,963.00
HSA contributions: USD 10,963.00
Named party: Example Person 405",8889,19,8889,fdc-5474eab2737d0a6676d2d956,synthetic-form-layout-04,original,2025,fte-1ec7f2a37703ec9680fff76d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2023
qualified medical expenses: USD 11,046.00
distributions: USD 11,046.00
HSA contributions: USD 11,046.00
Named party: Example Person 406",8889,19,8889,fdc-0f6a517447128903f67176c4,synthetic-form-layout-04,original,2023,fte-590978f0d8f4dc7663aafdd2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8889: Health Savings Accounts
Tax reporting year 2024
qualified medical expenses: USD 11,129.00
distributions: USD 11,129.00
HSA contributions: USD 11,129.00
Named party: Example Person 407",8889,19,8889,fdc-a758e6bed8cb0dd98b2f4114,synthetic-form-layout-04,original,2024,fte-7e58b36d6ac78a44ea5ed285,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2023
HSA contributions: USD 10,685.00 / distributions: USD 10,685.00 / qualified medical expenses: USD 10,685.00
Delivery copy for Example Party 500",8889,19,8889,fdc-82d03e4a366ea4bb7ad2935c,synthetic-form-layout-05,original,2023,fte-17a2ef124eae64ed4fd79795,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2024
HSA contributions: USD 10,768.00 / distributions: USD 10,768.00 / qualified medical expenses: USD 10,768.00
Delivery copy for Example Party 501",8889,19,8889,fdc-3decc2a6c676f76790e45f35,synthetic-form-layout-05,original,2024,fte-6a5be50b70ebee852d48c357,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2025
HSA contributions: USD 10,851.00 / distributions: USD 10,851.00 / qualified medical expenses: USD 10,851.00
Delivery copy for Example Party 502",8889,19,8889,fdc-50bd70fdb4beecd3b2eb3691,synthetic-form-layout-05,original,2025,fte-b629466b084f94f6e90d36e7,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2023
HSA contributions: USD 10,934.00 / distributions: USD 10,934.00 / qualified medical expenses: USD 10,934.00
Delivery copy for Example Party 503",8889,19,8889,fdc-477c62b8ff4dc12f826aa0d9,synthetic-form-layout-05,original,2023,fte-4ca974d231766c3eb3395eb4,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2024
HSA contributions: USD 11,017.00 / distributions: USD 11,017.00 / qualified medical expenses: USD 11,017.00
Delivery copy for Example Party 504",8889,19,8889,fdc-9f43374e0118d88c04850562,synthetic-form-layout-05,original,2024,fte-29236667265cd666edfbe6a6,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2025
HSA contributions: USD 11,100.00 / distributions: USD 11,100.00 / qualified medical expenses: USD 11,100.00
Delivery copy for Example Party 505",8889,19,8889,fdc-fe107a9224a3a12f2a15a877,synthetic-form-layout-05,original,2025,fte-323fd9714461ff93f987fa12,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2023
HSA contributions: USD 11,183.00 / distributions: USD 11,183.00 / qualified medical expenses: USD 11,183.00
Delivery copy for Example Party 506",8889,19,8889,fdc-6d9e93b55b6f13d0a2f88cb1,synthetic-form-layout-05,original,2023,fte-f74d39011c5c0ba662a8da9e,synthetic_AI_labeled,v1_template,top,False,
"Form 8889: Health Savings Accounts -- reporting year 2024
HSA contributions: USD 11,266.00 / distributions: USD 11,266.00 / qualified medical expenses: USD 11,266.00
Delivery copy for Example Party 507",8889,19,8889,fdc-1b286bf8acd8f6f46a8237cd,synthetic-form-layout-05,original,2024,fte-af8d3504984bdc9b8c66eb77,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2023
Statement issued to Example Person 0.
family size: 2
household income: USD 10,000.00
premium tax credit reconciliation: USD 10,000.00",8962,23,8962,fdc-fa206fedb3ceff2d08508b71,synthetic-form-layout-00,original,2023,fte-f73069167da1f22cade72197,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2024
Statement issued to Example Person 1.
family size: 2
household income: USD 10,083.00
premium tax credit reconciliation: USD 10,083.00",8962,23,8962,fdc-e7dea9ec39900bbabc63a4c4,synthetic-form-layout-00,original,2024,fte-ac5736159c19b300e41b6e77,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2025
Statement issued to Example Person 2.
family size: 2
household income: USD 10,166.00
premium tax credit reconciliation: USD 10,166.00",8962,23,8962,fdc-829f33260565d4d41e4836bb,synthetic-form-layout-00,original,2025,fte-47acda8399609bf5912924af,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2023
Statement issued to Example Person 3.
family size: 2
household income: USD 10,249.00
premium tax credit reconciliation: USD 10,249.00",8962,23,8962,fdc-f66bce65274c82658a27f0e8,synthetic-form-layout-00,original,2023,fte-5669f4b26403b16c54e67c36,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2024
Statement issued to Example Person 4.
family size: 2
household income: USD 10,332.00
premium tax credit reconciliation: USD 10,332.00",8962,23,8962,fdc-071dc3b6c8329b8461b84551,synthetic-form-layout-00,original,2024,fte-87cd1a52f8b7b2a341ae0c3e,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2025
Statement issued to Example Person 5.
family size: 2
household income: USD 10,415.00
premium tax credit reconciliation: USD 10,415.00",8962,23,8962,fdc-a66f698aee1d2dd112b2a1b4,synthetic-form-layout-00,original,2025,fte-07b959bbd4fee894ba942c4b,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2023
Statement issued to Example Person 6.
family size: 2
household income: USD 10,498.00
premium tax credit reconciliation: USD 10,498.00",8962,23,8962,fdc-82b77d798878fcf249fb6e18,synthetic-form-layout-00,original,2023,fte-7c70f65373c6330f706cc98d,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Calendar year: 2024
Statement issued to Example Person 7.
family size: 2
household income: USD 10,581.00
premium tax credit reconciliation: USD 10,581.00",8962,23,8962,fdc-3f2438a6673fb58381f852fe,synthetic-form-layout-00,original,2024,fte-c8f88abe8cd62882a84d5486,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8962: Premium Tax Credit
Recipient record: Example Person 100
family size: 2 | household income: USD 10,137.00 | premium tax credit reconciliation: USD 10,137.00",8962,23,8962,fdc-5f2965964b2db3420f433a70,synthetic-form-layout-01,original,2023,fte-fdd4f57ab1fd2a8c1ff6dd0a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8962: Premium Tax Credit
Recipient record: Example Person 101
family size: 2 | household income: USD 10,220.00 | premium tax credit reconciliation: USD 10,220.00",8962,23,8962,fdc-5b2140bb4020b6192269fdc6,synthetic-form-layout-01,original,2024,fte-bfcfac51d8c6e5f10061f64c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8962: Premium Tax Credit
Recipient record: Example Person 102
family size: 2 | household income: USD 10,303.00 | premium tax credit reconciliation: USD 10,303.00",8962,23,8962,fdc-572d30b1dcd0a3026d4a78ad,synthetic-form-layout-01,original,2025,fte-9a2f25594323395e7e91cc8c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8962: Premium Tax Credit
Recipient record: Example Person 103
family size: 2 | household income: USD 10,386.00 | premium tax credit reconciliation: USD 10,386.00",8962,23,8962,fdc-b2e6b2725383f140c3ed6bf4,synthetic-form-layout-01,original,2023,fte-1a771f34b0cbee70956aa4d5,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8962: Premium Tax Credit
Recipient record: Example Person 104
family size: 2 | household income: USD 10,469.00 | premium tax credit reconciliation: USD 10,469.00",8962,23,8962,fdc-4d66acc3ab3f422bd27db8cd,synthetic-form-layout-01,original,2024,fte-5a223dcd8a81e8af4dbfde26,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8962: Premium Tax Credit
Recipient record: Example Person 105
family size: 2 | household income: USD 10,552.00 | premium tax credit reconciliation: USD 10,552.00",8962,23,8962,fdc-50a4bd103838a198caf98edb,synthetic-form-layout-01,original,2025,fte-97ad922e697dca661d7633dc,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8962: Premium Tax Credit
Recipient record: Example Person 106
family size: 2 | household income: USD 10,635.00 | premium tax credit reconciliation: USD 10,635.00",8962,23,8962,fdc-4b266b1284a0b4d1b343bed2,synthetic-form-layout-01,original,2023,fte-44a413d46fd05034bd620214,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8962: Premium Tax Credit
Recipient record: Example Person 107
family size: 2 | household income: USD 10,718.00 | premium tax credit reconciliation: USD 10,718.00",8962,23,8962,fdc-3eb9fa1c8944376a2adee441,synthetic-form-layout-01,original,2024,fte-10b407d85e7335b350bc4ab7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,274.00; premium tax credit reconciliation: USD 10,274.00. Recipient: Example Household 200.",8962,23,8962,fdc-a6ff3f10abffafec47244ec7,synthetic-form-layout-02,original,2023,fte-892e1152d42155fee0df0798,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,357.00; premium tax credit reconciliation: USD 10,357.00. Recipient: Example Household 201.",8962,23,8962,fdc-f348ead48c29068500ccde9d,synthetic-form-layout-02,original,2024,fte-798d79bebe92a8e34bdfebb0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,440.00; premium tax credit reconciliation: USD 10,440.00. Recipient: Example Household 202.",8962,23,8962,fdc-d04b8c8e9e4719c2c50b5acb,synthetic-form-layout-02,original,2025,fte-e140bf2b53190e68aa16624e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,523.00; premium tax credit reconciliation: USD 10,523.00. Recipient: Example Household 203.",8962,23,8962,fdc-8a9d6c1e2de138e6938ccb74,synthetic-form-layout-02,original,2023,fte-076a53abb3442cbd9b4cdb09,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,606.00; premium tax credit reconciliation: USD 10,606.00. Recipient: Example Household 204.",8962,23,8962,fdc-eb9cefafff77258ae74ca349,synthetic-form-layout-02,original,2024,fte-bd2fd8ce3268ef5731edc001,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,689.00; premium tax credit reconciliation: USD 10,689.00. Recipient: Example Household 205.",8962,23,8962,fdc-1acb4a9e4084d57552934db2,synthetic-form-layout-02,original,2025,fte-1bc0d2b49b956a4a0763759f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,772.00; premium tax credit reconciliation: USD 10,772.00. Recipient: Example Household 206.",8962,23,8962,fdc-ea3778ea80b9e63d55c13449,synthetic-form-layout-02,original,2023,fte-8b2d7d91067c43c9628ccd1a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8962: Premium Tax Credit.
family size: 2; household income: USD 10,855.00; premium tax credit reconciliation: USD 10,855.00. Recipient: Example Household 207.",8962,23,8962,fdc-b8c6c44045c330ff2788918a,synthetic-form-layout-02,original,2024,fte-048758d59bbc2c6eb58fb0cb,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2023.
Details: family size: 2, household income: USD 10,411.00, premium tax credit reconciliation: USD 10,411.00. Account holder: Example Person 300.",8962,23,8962,fdc-47a5f438117f83ca4d908c86,synthetic-form-layout-03,original,2023,fte-29511a7a7352d1eaf0517be6,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2024.
Details: family size: 2, household income: USD 10,494.00, premium tax credit reconciliation: USD 10,494.00. Account holder: Example Person 301.",8962,23,8962,fdc-f711788cfdef8beea516547f,synthetic-form-layout-03,original,2024,fte-037979a47b0fd8a561882af6,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2025.
Details: family size: 2, household income: USD 10,577.00, premium tax credit reconciliation: USD 10,577.00. Account holder: Example Person 302.",8962,23,8962,fdc-5379f6d9581b55250b1f0c52,synthetic-form-layout-03,original,2025,fte-f02af91b1b1636bdd597d752,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2023.
Details: family size: 2, household income: USD 10,660.00, premium tax credit reconciliation: USD 10,660.00. Account holder: Example Person 303.",8962,23,8962,fdc-0d9a9925092006b01109433a,synthetic-form-layout-03,original,2023,fte-62c279ec89158a4e150357c6,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2024.
Details: family size: 2, household income: USD 10,743.00, premium tax credit reconciliation: USD 10,743.00. Account holder: Example Person 304.",8962,23,8962,fdc-b6a3d895ea4c0cd45cb521b6,synthetic-form-layout-03,original,2024,fte-1bccf4581a08f315165d40c2,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2025.
Details: family size: 2, household income: USD 10,826.00, premium tax credit reconciliation: USD 10,826.00. Account holder: Example Person 305.",8962,23,8962,fdc-cd89eebfbbc30b06afa01cfa,synthetic-form-layout-03,original,2025,fte-386b2c24a8da602b171d426c,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2023.
Details: family size: 2, household income: USD 10,909.00, premium tax credit reconciliation: USD 10,909.00. Account holder: Example Person 306.",8962,23,8962,fdc-6e279992b3c691f9e4587429,synthetic-form-layout-03,original,2023,fte-364d5f814fb49cfef81365e2,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit
Reporting period ended 12/31/2024.
Details: family size: 2, household income: USD 10,992.00, premium tax credit reconciliation: USD 10,992.00. Account holder: Example Person 307.",8962,23,8962,fdc-3ba1ea4261274db21d29e37b,synthetic-form-layout-03,original,2024,fte-91ed4e36ec7566f247ec41dd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2023
premium tax credit reconciliation: USD 10,548.00
household income: USD 10,548.00
family size: 2
Named party: Example Person 400",8962,23,8962,fdc-dddf1d04ea51ca5dff55fd36,synthetic-form-layout-04,original,2023,fte-3691ef40a66753e580727f16,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2024
premium tax credit reconciliation: USD 10,631.00
household income: USD 10,631.00
family size: 2
Named party: Example Person 401",8962,23,8962,fdc-0732e452c04bd87d42f903ee,synthetic-form-layout-04,original,2024,fte-feeb320a65a06ec72d36bea4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2025
premium tax credit reconciliation: USD 10,714.00
household income: USD 10,714.00
family size: 2
Named party: Example Person 402",8962,23,8962,fdc-468b0589aa533e4b389a474d,synthetic-form-layout-04,original,2025,fte-a44374fe4c530384cc566de8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2023
premium tax credit reconciliation: USD 10,797.00
household income: USD 10,797.00
family size: 2
Named party: Example Person 403",8962,23,8962,fdc-c633fdcc4350a15aa9b411a4,synthetic-form-layout-04,original,2023,fte-c1db605dfe68a6c4070a5679,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2024
premium tax credit reconciliation: USD 10,880.00
household income: USD 10,880.00
family size: 2
Named party: Example Person 404",8962,23,8962,fdc-26243360f51e44dc162f30b6,synthetic-form-layout-04,original,2024,fte-0a733a1f8a0934f38ce8ac2f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2025
premium tax credit reconciliation: USD 10,963.00
household income: USD 10,963.00
family size: 2
Named party: Example Person 405",8962,23,8962,fdc-5a819cb49595dabfa405ddb4,synthetic-form-layout-04,original,2025,fte-14d9639523e57730e71ca8c8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2023
premium tax credit reconciliation: USD 11,046.00
household income: USD 11,046.00
family size: 2
Named party: Example Person 406",8962,23,8962,fdc-3898be8fb22f36f21c9f72b1,synthetic-form-layout-04,original,2023,fte-080b3cb25b0a5d504314bcb6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8962: Premium Tax Credit
Tax reporting year 2024
premium tax credit reconciliation: USD 11,129.00
household income: USD 11,129.00
family size: 2
Named party: Example Person 407",8962,23,8962,fdc-7b53bc240bfbd845ae2e3afb,synthetic-form-layout-04,original,2024,fte-186a4146f9a846adf2f0397f,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2023
family size: 2 / household income: USD 10,685.00 / premium tax credit reconciliation: USD 10,685.00
Delivery copy for Example Party 500",8962,23,8962,fdc-87d23202a8a918e303f8967c,synthetic-form-layout-05,original,2023,fte-9c35ecd43db1bce15f953f17,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2024
family size: 2 / household income: USD 10,768.00 / premium tax credit reconciliation: USD 10,768.00
Delivery copy for Example Party 501",8962,23,8962,fdc-68b115d55e16005ccf2b2007,synthetic-form-layout-05,original,2024,fte-964fd47e01b807a35173f93b,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2025
family size: 2 / household income: USD 10,851.00 / premium tax credit reconciliation: USD 10,851.00
Delivery copy for Example Party 502",8962,23,8962,fdc-b028cee052874d50e3cdfa14,synthetic-form-layout-05,original,2025,fte-203f9eeac6541bd91e24ec6a,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2023
family size: 2 / household income: USD 10,934.00 / premium tax credit reconciliation: USD 10,934.00
Delivery copy for Example Party 503",8962,23,8962,fdc-bd3af1d28c95dffaf97632b7,synthetic-form-layout-05,original,2023,fte-df4ae9f4e51832be3b4578bf,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2024
family size: 2 / household income: USD 11,017.00 / premium tax credit reconciliation: USD 11,017.00
Delivery copy for Example Party 504",8962,23,8962,fdc-208252d0edcf5dc36cb6c59d,synthetic-form-layout-05,original,2024,fte-7bc643c6a6a2d74419d0a7f8,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2025
family size: 2 / household income: USD 11,100.00 / premium tax credit reconciliation: USD 11,100.00
Delivery copy for Example Party 505",8962,23,8962,fdc-50d049d8056715589e31e343,synthetic-form-layout-05,original,2025,fte-5c0858f106979103adc14168,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2023
family size: 2 / household income: USD 11,183.00 / premium tax credit reconciliation: USD 11,183.00
Delivery copy for Example Party 506",8962,23,8962,fdc-eac34e3053851a393de8a41c,synthetic-form-layout-05,original,2023,fte-5aa16dbccf075c109da44e21,synthetic_AI_labeled,v1_template,top,False,
"Form 8962: Premium Tax Credit -- reporting year 2024
family size: 2 / household income: USD 11,266.00 / premium tax credit reconciliation: USD 11,266.00
Delivery copy for Example Party 507",8962,23,8962,fdc-f1a722ad55966b220a062d8a,synthetic-form-layout-05,original,2024,fte-2a5be7378dbe74b7824130d2,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2023
Statement issued to Example Person 0.
date of contribution: 2023-03-01
vehicle: Example Entity 0-0-1
gross proceeds: USD 10,000.00
goods or services: USD 10,000.00",1098,4,1098,fdc-7c3b53e80167a9eee58e82a2,synthetic-form-layout-00,original,2023,fte-f5654b3110ee33e7aa0ca6ea,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2024
Statement issued to Example Person 1.
date of contribution: 2024-03-02
vehicle: Example Entity 0-1-1
gross proceeds: USD 10,083.00
goods or services: USD 10,083.00",1098,4,1098,fdc-28f4419cdffb1680dbde5929,synthetic-form-layout-00,original,2024,fte-d390ff5c4fffaf499c1c3d46,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2025
Statement issued to Example Person 2.
date of contribution: 2025-03-03
vehicle: Example Entity 0-2-1
gross proceeds: USD 10,166.00
goods or services: USD 10,166.00",1098,4,1098,fdc-427a3dc134da34361568acd7,synthetic-form-layout-00,original,2025,fte-32be2ba580ae966de901810b,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2023
Statement issued to Example Person 3.
date of contribution: 2023-03-04
vehicle: Example Entity 0-3-1
gross proceeds: USD 10,249.00
goods or services: USD 10,249.00",1098,4,1098,fdc-6718826a894a3b586110df52,synthetic-form-layout-00,original,2023,fte-eb083e44cfea463ab53786d5,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2024
Statement issued to Example Person 4.
date of contribution: 2024-03-05
vehicle: Example Entity 0-4-1
gross proceeds: USD 10,332.00
goods or services: USD 10,332.00",1098,4,1098,fdc-f7e63f38c474ec36fa8a60a8,synthetic-form-layout-00,original,2024,fte-768064656753fb3a7d37041d,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2025
Statement issued to Example Person 5.
date of contribution: 2025-03-06
vehicle: Example Entity 0-5-1
gross proceeds: USD 10,415.00
goods or services: USD 10,415.00",1098,4,1098,fdc-412477d8bc2cd8e9be2b9521,synthetic-form-layout-00,original,2025,fte-48258f9a0d9b8e1ed377cf26,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2023
Statement issued to Example Person 6.
date of contribution: 2023-03-07
vehicle: Example Entity 0-6-1
gross proceeds: USD 10,498.00
goods or services: USD 10,498.00",1098,4,1098,fdc-e91cf339a3907de0f03de17f,synthetic-form-layout-00,original,2023,fte-ac413868257e181943c58d05,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Calendar year: 2024
Statement issued to Example Person 7.
date of contribution: 2024-03-08
vehicle: Example Entity 0-7-1
gross proceeds: USD 10,581.00
goods or services: USD 10,581.00",1098,4,1098,fdc-bb05047b9f7a94ebb5ba90b3,synthetic-form-layout-00,original,2024,fte-f20f84885f4414268accd3c4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 100
date of contribution: 2023-03-01 | vehicle: Example Entity 1-0-1 | gross proceeds: USD 10,137.00 | goods or services: USD 10,137.00",1098,4,1098,fdc-65e05daa3a18ccabfb4b384a,synthetic-form-layout-01,original,2023,fte-5dbd5779019896843fad1d7c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 101
date of contribution: 2024-03-02 | vehicle: Example Entity 1-1-1 | gross proceeds: USD 10,220.00 | goods or services: USD 10,220.00",1098,4,1098,fdc-398fb20ea29950b51b2b46b6,synthetic-form-layout-01,original,2024,fte-a5de07a23b464b61cdac8697,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 102
date of contribution: 2025-03-03 | vehicle: Example Entity 1-2-1 | gross proceeds: USD 10,303.00 | goods or services: USD 10,303.00",1098,4,1098,fdc-f92b276f56a3eb72b1022cf1,synthetic-form-layout-01,original,2025,fte-4ecbe995e57f2045d052e9a5,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 103
date of contribution: 2023-03-04 | vehicle: Example Entity 1-3-1 | gross proceeds: USD 10,386.00 | goods or services: USD 10,386.00",1098,4,1098,fdc-44d510cead947a44260330ac,synthetic-form-layout-01,original,2023,fte-2b50a46137bcaa7d3046668a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 104
date of contribution: 2024-03-05 | vehicle: Example Entity 1-4-1 | gross proceeds: USD 10,469.00 | goods or services: USD 10,469.00",1098,4,1098,fdc-e7f2949866116f9978a9b66a,synthetic-form-layout-01,original,2024,fte-7b6d0b0b3274da917676acaa,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 105
date of contribution: 2025-03-06 | vehicle: Example Entity 1-5-1 | gross proceeds: USD 10,552.00 | goods or services: USD 10,552.00",1098,4,1098,fdc-3dd6b6b0092dac158aebd60b,synthetic-form-layout-01,original,2025,fte-2f3e3e4f9b121d686c85093c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 106
date of contribution: 2023-03-07 | vehicle: Example Entity 1-6-1 | gross proceeds: USD 10,635.00 | goods or services: USD 10,635.00",1098,4,1098,fdc-0cb96ec2d92f3cb0d5dabcb7,synthetic-form-layout-01,original,2023,fte-25f2891f9ce50be9609286cf,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Recipient record: Example Person 107
date of contribution: 2024-03-08 | vehicle: Example Entity 1-7-1 | gross proceeds: USD 10,718.00 | goods or services: USD 10,718.00",1098,4,1098,fdc-3e37e584f0dfadf0eaa93237,synthetic-form-layout-01,original,2024,fte-1ada7a416bc8c765a29ab172,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2023-03-01; vehicle: Example Entity 2-0-1; gross proceeds: USD 10,274.00; goods or services: USD 10,274.00. Recipient: Example Household 200.",1098,4,1098,fdc-9f3e8c25692200bebfc48a09,synthetic-form-layout-02,original,2023,fte-93f240c5f830a23c584921d4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2024-03-02; vehicle: Example Entity 2-1-1; gross proceeds: USD 10,357.00; goods or services: USD 10,357.00. Recipient: Example Household 201.",1098,4,1098,fdc-98d34d286a0428b57836e4c5,synthetic-form-layout-02,original,2024,fte-d58882204367d4237ab61bae,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2025-03-03; vehicle: Example Entity 2-2-1; gross proceeds: USD 10,440.00; goods or services: USD 10,440.00. Recipient: Example Household 202.",1098,4,1098,fdc-5aa4afcb66dbe29254a2775b,synthetic-form-layout-02,original,2025,fte-cd0f193e1ec68376884ddfc5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2023-03-04; vehicle: Example Entity 2-3-1; gross proceeds: USD 10,523.00; goods or services: USD 10,523.00. Recipient: Example Household 203.",1098,4,1098,fdc-1e14e3470d95492d0e9404b8,synthetic-form-layout-02,original,2023,fte-38d595c0524bd9e365972341,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2024-03-05; vehicle: Example Entity 2-4-1; gross proceeds: USD 10,606.00; goods or services: USD 10,606.00. Recipient: Example Household 204.",1098,4,1098,fdc-cc51902e112196063682a1ba,synthetic-form-layout-02,original,2024,fte-59562f9f5a9c01db21f5a2cb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2025-03-06; vehicle: Example Entity 2-5-1; gross proceeds: USD 10,689.00; goods or services: USD 10,689.00. Recipient: Example Household 205.",1098,4,1098,fdc-a54a3754e2c1dec7feaaccad,synthetic-form-layout-02,original,2025,fte-cd337e74c9445abfc3e23dde,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2023-03-07; vehicle: Example Entity 2-6-1; gross proceeds: USD 10,772.00; goods or services: USD 10,772.00. Recipient: Example Household 206.",1098,4,1098,fdc-f14391dea9230d70e22a1556,synthetic-form-layout-02,original,2023,fte-4b61cb501c23dedfb3488fd1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes.
date of contribution: 2024-03-08; vehicle: Example Entity 2-7-1; gross proceeds: USD 10,855.00; goods or services: USD 10,855.00. Recipient: Example Household 207.",1098,4,1098,fdc-d1b7dcdb66321759d7cd67bb,synthetic-form-layout-02,original,2024,fte-a768b0287744e0f27b980426,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2023.
Details: date of contribution: 2023-03-01, vehicle: Example Entity 3-0-1, gross proceeds: USD 10,411.00, goods or services: USD 10,411.00. Account holder: Example Person 300.",1098,4,1098,fdc-44b8e4573d3c6d2259d2357f,synthetic-form-layout-03,original,2023,fte-025b8bc9be8b5c1deca83a57,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2024.
Details: date of contribution: 2024-03-02, vehicle: Example Entity 3-1-1, gross proceeds: USD 10,494.00, goods or services: USD 10,494.00. Account holder: Example Person 301.",1098,4,1098,fdc-55304b217fa5dfc9e96f2777,synthetic-form-layout-03,original,2024,fte-7d78edd6cfe8332a11852797,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2025.
Details: date of contribution: 2025-03-03, vehicle: Example Entity 3-2-1, gross proceeds: USD 10,577.00, goods or services: USD 10,577.00. Account holder: Example Person 302.",1098,4,1098,fdc-282661e879d4190b9dd7e765,synthetic-form-layout-03,original,2025,fte-15c22f4cc243158790488408,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2023.
Details: date of contribution: 2023-03-04, vehicle: Example Entity 3-3-1, gross proceeds: USD 10,660.00, goods or services: USD 10,660.00. Account holder: Example Person 303.",1098,4,1098,fdc-d648f931db6613a592a92246,synthetic-form-layout-03,original,2023,fte-24621006b95da8ddce347e28,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2024.
Details: date of contribution: 2024-03-05, vehicle: Example Entity 3-4-1, gross proceeds: USD 10,743.00, goods or services: USD 10,743.00. Account holder: Example Person 304.",1098,4,1098,fdc-e5b60b62bf0d22cdff4ff861,synthetic-form-layout-03,original,2024,fte-41a7764da7de02bd08da9da1,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2025.
Details: date of contribution: 2025-03-06, vehicle: Example Entity 3-5-1, gross proceeds: USD 10,826.00, goods or services: USD 10,826.00. Account holder: Example Person 305.",1098,4,1098,fdc-6068250e4d386b6d191fa8a4,synthetic-form-layout-03,original,2025,fte-483a2ada60496ca6e4efe67c,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2023.
Details: date of contribution: 2023-03-07, vehicle: Example Entity 3-6-1, gross proceeds: USD 10,909.00, goods or services: USD 10,909.00. Account holder: Example Person 306.",1098,4,1098,fdc-562a61b43c3737b355242375,synthetic-form-layout-03,original,2023,fte-c9cf403a227981f174a35d33,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Reporting period ended 12/31/2024.
Details: date of contribution: 2024-03-08, vehicle: Example Entity 3-7-1, gross proceeds: USD 10,992.00, goods or services: USD 10,992.00. Account holder: Example Person 307.",1098,4,1098,fdc-072972f6b439ef398f6c2048,synthetic-form-layout-03,original,2024,fte-2b4f2e5e4786dd2cf7e71f1a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2023
goods or services: USD 10,548.00
gross proceeds: USD 10,548.00
vehicle: Example Entity 4-0-1
date of contribution: 2023-03-01
Named party: Example Person 400",1098,4,1098,fdc-103e4db5fa2f8b36cdf2edac,synthetic-form-layout-04,original,2023,fte-989d26e5289d3e1e00c825c4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2024
goods or services: USD 10,631.00
gross proceeds: USD 10,631.00
vehicle: Example Entity 4-1-1
date of contribution: 2024-03-02
Named party: Example Person 401",1098,4,1098,fdc-d363c00e484dc21ec8d4c1f5,synthetic-form-layout-04,original,2024,fte-c4b5da1f926e5382ebcdd351,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2025
goods or services: USD 10,714.00
gross proceeds: USD 10,714.00
vehicle: Example Entity 4-2-1
date of contribution: 2025-03-03
Named party: Example Person 402",1098,4,1098,fdc-2bdacfb0524cccb7eb1cee8b,synthetic-form-layout-04,original,2025,fte-218fac5d88ea41ab34f6f73f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2023
goods or services: USD 10,797.00
gross proceeds: USD 10,797.00
vehicle: Example Entity 4-3-1
date of contribution: 2023-03-04
Named party: Example Person 403",1098,4,1098,fdc-79acd2bf54b8880b6fd61a8f,synthetic-form-layout-04,original,2023,fte-26c2a1d34dd4fa57c0988e36,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2024
goods or services: USD 10,880.00
gross proceeds: USD 10,880.00
vehicle: Example Entity 4-4-1
date of contribution: 2024-03-05
Named party: Example Person 404",1098,4,1098,fdc-496afba5f21747a452e72604,synthetic-form-layout-04,original,2024,fte-63dcc45792ce1168b2825130,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2025
goods or services: USD 10,963.00
gross proceeds: USD 10,963.00
vehicle: Example Entity 4-5-1
date of contribution: 2025-03-06
Named party: Example Person 405",1098,4,1098,fdc-03479620f1036c5599c94495,synthetic-form-layout-04,original,2025,fte-3208e5aba7379293dbf0c58d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2023
goods or services: USD 11,046.00
gross proceeds: USD 11,046.00
vehicle: Example Entity 4-6-1
date of contribution: 2023-03-07
Named party: Example Person 406",1098,4,1098,fdc-08ff3a19c47caabdab6cd143,synthetic-form-layout-04,original,2023,fte-018fc222b0d599e6fa2f2c29,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes
Tax reporting year 2024
goods or services: USD 11,129.00
gross proceeds: USD 11,129.00
vehicle: Example Entity 4-7-1
date of contribution: 2024-03-08
Named party: Example Person 407",1098,4,1098,fdc-a79835afda03a6858b0262dc,synthetic-form-layout-04,original,2024,fte-bb57ccc72a800d1251a39c60,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2023
date of contribution: 2023-03-01 / vehicle: Example Entity 5-0-1 / gross proceeds: USD 10,685.00 / goods or services: USD 10,685.00
Delivery copy for Example Party 500",1098,4,1098,fdc-7b439f4fc072f76ba3cab351,synthetic-form-layout-05,original,2023,fte-be5c0c0d98f953bdd9aadccf,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2024
date of contribution: 2024-03-02 / vehicle: Example Entity 5-1-1 / gross proceeds: USD 10,768.00 / goods or services: USD 10,768.00
Delivery copy for Example Party 501",1098,4,1098,fdc-1ff9ed5c4117b42065d5de96,synthetic-form-layout-05,original,2024,fte-700279785821cb87219c4b4f,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2025
date of contribution: 2025-03-03 / vehicle: Example Entity 5-2-1 / gross proceeds: USD 10,851.00 / goods or services: USD 10,851.00
Delivery copy for Example Party 502",1098,4,1098,fdc-77d420367b0617e232a3d288,synthetic-form-layout-05,original,2025,fte-206d8101dee89da2821288a2,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2023
date of contribution: 2023-03-04 / vehicle: Example Entity 5-3-1 / gross proceeds: USD 10,934.00 / goods or services: USD 10,934.00
Delivery copy for Example Party 503",1098,4,1098,fdc-b38187c6b98c23ec4e9d5c4a,synthetic-form-layout-05,original,2023,fte-851e2132b46d051ad950a57c,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2024
date of contribution: 2024-03-05 / vehicle: Example Entity 5-4-1 / gross proceeds: USD 11,017.00 / goods or services: USD 11,017.00
Delivery copy for Example Party 504",1098,4,1098,fdc-e570bb073aa14fb702c98f7e,synthetic-form-layout-05,original,2024,fte-1a5dfe253d652ea11796014e,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2025
date of contribution: 2025-03-06 / vehicle: Example Entity 5-5-1 / gross proceeds: USD 11,100.00 / goods or services: USD 11,100.00
Delivery copy for Example Party 505",1098,4,1098,fdc-09a82590f6c5a6d5bf3a358d,synthetic-form-layout-05,original,2025,fte-913d50b464b6eb80760941b2,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2023
date of contribution: 2023-03-07 / vehicle: Example Entity 5-6-1 / gross proceeds: USD 11,183.00 / goods or services: USD 11,183.00
Delivery copy for Example Party 506",1098,4,1098,fdc-6c8af6006028e63d76edd366,synthetic-form-layout-05,original,2023,fte-03d38041648e3731d8f1217f,synthetic_AI_labeled,v1_template,top,False,
"Form 1098-C: Contributions of Motor Vehicles Boats and Airplanes -- reporting year 2024
date of contribution: 2024-03-08 / vehicle: Example Entity 5-7-1 / gross proceeds: USD 11,266.00 / goods or services: USD 11,266.00
Delivery copy for Example Party 507",1098,4,1098,fdc-8d42f81016b885b0c7758fc6,synthetic-form-layout-05,original,2024,fte-5cfd0a832d33d1360dbf0881,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2023
Statement issued to Example Person 0.
donated property description: Example Entity 0-0-0
acquisition date: 2023-03-01
donor basis: Example Entity 0-0-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-c9966c0885a6d37945a1fb52,synthetic-form-layout-00,original,2023,fte-ccef76746ac0c54e7e371666,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2024
Statement issued to Example Person 1.
donated property description: Example Entity 0-1-0
acquisition date: 2024-03-02
donor basis: Example Entity 0-1-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-9d859a00e3fabda716eb30f6,synthetic-form-layout-00,original,2024,fte-9114379c80e86f53953a4a60,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2025
Statement issued to Example Person 2.
donated property description: Example Entity 0-2-0
acquisition date: 2025-03-03
donor basis: Example Entity 0-2-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-fa7d3b22b74c22f22e437a22,synthetic-form-layout-00,original,2025,fte-d72a79f9ed4fec2067b19865,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2023
Statement issued to Example Person 3.
donated property description: Example Entity 0-3-0
acquisition date: 2023-03-04
donor basis: Example Entity 0-3-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-a30f655a558f93eb8ada8735,synthetic-form-layout-00,original,2023,fte-80a6aae29340f5d97ca988ee,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2024
Statement issued to Example Person 4.
donated property description: Example Entity 0-4-0
acquisition date: 2024-03-05
donor basis: Example Entity 0-4-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-71c406c077b9ea86715520b6,synthetic-form-layout-00,original,2024,fte-5128e64a30af22d568707016,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2025
Statement issued to Example Person 5.
donated property description: Example Entity 0-5-0
acquisition date: 2025-03-06
donor basis: Example Entity 0-5-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-816e7faad13f9486d95812a9,synthetic-form-layout-00,original,2025,fte-c880b508543ef74ddf293d94,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2023
Statement issued to Example Person 6.
donated property description: Example Entity 0-6-0
acquisition date: 2023-03-07
donor basis: Example Entity 0-6-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-f39b0cc91e43e50e33f29833,synthetic-form-layout-00,original,2023,fte-31a0061af765aac03a8962d5,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Calendar year: 2024
Statement issued to Example Person 7.
donated property description: Example Entity 0-7-0
acquisition date: 2024-03-08
donor basis: Example Entity 0-7-2
appraiser declaration: Example named signer; signed",8283,17,8283,fdc-167e5ce04dc4300500951eea,synthetic-form-layout-00,original,2024,fte-4226264980223a10be60b726,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 100
donated property description: Example Entity 1-0-0 | acquisition date: 2023-03-01 | donor basis: Example Entity 1-0-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-4435d0844f61a6f4ddfdbf55,synthetic-form-layout-01,original,2023,fte-3aaf4a5aae9ffa1874d22fc3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 101
donated property description: Example Entity 1-1-0 | acquisition date: 2024-03-02 | donor basis: Example Entity 1-1-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-6d0b73e10f2ca135b480c48e,synthetic-form-layout-01,original,2024,fte-b15dbd36419ae51aea1dce1b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 102
donated property description: Example Entity 1-2-0 | acquisition date: 2025-03-03 | donor basis: Example Entity 1-2-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-feda9d00f0c483ae82a3a954,synthetic-form-layout-01,original,2025,fte-397d5c60c606c23acd182797,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 103
donated property description: Example Entity 1-3-0 | acquisition date: 2023-03-04 | donor basis: Example Entity 1-3-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-8c14f2815d5c1d001b6284a4,synthetic-form-layout-01,original,2023,fte-f2f5d2b8389f0d0abbfd074c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 104
donated property description: Example Entity 1-4-0 | acquisition date: 2024-03-05 | donor basis: Example Entity 1-4-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-3c054b319e25f4c3de9b6c90,synthetic-form-layout-01,original,2024,fte-2f903b3e366bdc1845a2c653,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 105
donated property description: Example Entity 1-5-0 | acquisition date: 2025-03-06 | donor basis: Example Entity 1-5-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-802cc0bb6b3b87c919a87556,synthetic-form-layout-01,original,2025,fte-de5887eb9a14a09dc61417d0,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 106
donated property description: Example Entity 1-6-0 | acquisition date: 2023-03-07 | donor basis: Example Entity 1-6-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-28dac24d3712cc138290b9af,synthetic-form-layout-01,original,2023,fte-e17a25d41731efbb1fee4e12,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8283: Noncash Charitable Contributions
Recipient record: Example Person 107
donated property description: Example Entity 1-7-0 | acquisition date: 2024-03-08 | donor basis: Example Entity 1-7-2 | appraiser declaration: Example named signer; signed",8283,17,8283,fdc-1ff616014bb31d5a1ce3632e,synthetic-form-layout-01,original,2024,fte-71e313cb711fc92b33fca633,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-0-0; acquisition date: 2023-03-01; donor basis: Example Entity 2-0-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 200.",8283,17,8283,fdc-999aff6970640ff3f629c06b,synthetic-form-layout-02,original,2023,fte-e2c0608be41bb4b4405761a0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-1-0; acquisition date: 2024-03-02; donor basis: Example Entity 2-1-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 201.",8283,17,8283,fdc-53c31f080b13839f6eafe8bf,synthetic-form-layout-02,original,2024,fte-96f177974709da716a64b664,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-2-0; acquisition date: 2025-03-03; donor basis: Example Entity 2-2-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 202.",8283,17,8283,fdc-22e3c74e7bcbd693b79e9827,synthetic-form-layout-02,original,2025,fte-0833d2936f6f11b95e740e9b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-3-0; acquisition date: 2023-03-04; donor basis: Example Entity 2-3-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 203.",8283,17,8283,fdc-64f33b1d71d9ef2ee041146e,synthetic-form-layout-02,original,2023,fte-393ca8a84e77c2ecbac7e09e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-4-0; acquisition date: 2024-03-05; donor basis: Example Entity 2-4-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 204.",8283,17,8283,fdc-440b03be749a64157f23e83d,synthetic-form-layout-02,original,2024,fte-096840c175d922d2b6722090,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-5-0; acquisition date: 2025-03-06; donor basis: Example Entity 2-5-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 205.",8283,17,8283,fdc-ff544cb01e7f86b1ae147750,synthetic-form-layout-02,original,2025,fte-a17e11dfcfeeba2aaf892fa8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-6-0; acquisition date: 2023-03-07; donor basis: Example Entity 2-6-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 206.",8283,17,8283,fdc-beef74e591356771e2555d14,synthetic-form-layout-02,original,2023,fte-3fa09a05565b2cd854bbefcf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8283: Noncash Charitable Contributions.
donated property description: Example Entity 2-7-0; acquisition date: 2024-03-08; donor basis: Example Entity 2-7-2; appraiser declaration: Example named signer; signed. Recipient: Example Household 207.",8283,17,8283,fdc-d7665c049a139b630a78aa2e,synthetic-form-layout-02,original,2024,fte-ea22a87838c449964aa8dd9b,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2023.
Details: donated property description: Example Entity 3-0-0, acquisition date: 2023-03-01, donor basis: Example Entity 3-0-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 300.",8283,17,8283,fdc-7428f68ea24d1b15cb4a0028,synthetic-form-layout-03,original,2023,fte-10a381495c0bc8ac9cf2f672,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2024.
Details: donated property description: Example Entity 3-1-0, acquisition date: 2024-03-02, donor basis: Example Entity 3-1-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 301.",8283,17,8283,fdc-434cab7133b07b2600fa978b,synthetic-form-layout-03,original,2024,fte-4bfea8f00ba949238f778f69,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2025.
Details: donated property description: Example Entity 3-2-0, acquisition date: 2025-03-03, donor basis: Example Entity 3-2-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 302.",8283,17,8283,fdc-27c5ba4a829b39c7a784f112,synthetic-form-layout-03,original,2025,fte-e4eef469d5ddd9c44e0d0bd0,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2023.
Details: donated property description: Example Entity 3-3-0, acquisition date: 2023-03-04, donor basis: Example Entity 3-3-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 303.",8283,17,8283,fdc-53205283246efab335df740e,synthetic-form-layout-03,original,2023,fte-bf999d71a55d528417425781,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2024.
Details: donated property description: Example Entity 3-4-0, acquisition date: 2024-03-05, donor basis: Example Entity 3-4-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 304.",8283,17,8283,fdc-8d3f73d5e6f20b678d8b39e8,synthetic-form-layout-03,original,2024,fte-352dde1a1add635a5ecee348,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2025.
Details: donated property description: Example Entity 3-5-0, acquisition date: 2025-03-06, donor basis: Example Entity 3-5-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 305.",8283,17,8283,fdc-ca11592fc711878f7894682c,synthetic-form-layout-03,original,2025,fte-d2dcb165d87d6c61034fb377,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2023.
Details: donated property description: Example Entity 3-6-0, acquisition date: 2023-03-07, donor basis: Example Entity 3-6-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 306.",8283,17,8283,fdc-35b561ffbbd524086f536dab,synthetic-form-layout-03,original,2023,fte-35810157f6960386de00e06a,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions
Reporting period ended 12/31/2024.
Details: donated property description: Example Entity 3-7-0, acquisition date: 2024-03-08, donor basis: Example Entity 3-7-2, appraiser declaration: Example named signer; signed. Account holder: Example Person 307.",8283,17,8283,fdc-25eedb14024673701ad652ab,synthetic-form-layout-03,original,2024,fte-ad560a315f9988dd758f8555,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2023
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-0-2
acquisition date: 2023-03-01
donated property description: Example Entity 4-0-0
Named party: Example Person 400",8283,17,8283,fdc-9b8411f860ec1f19a1c7eade,synthetic-form-layout-04,original,2023,fte-bf82eeccee59d387e3274cae,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2024
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-1-2
acquisition date: 2024-03-02
donated property description: Example Entity 4-1-0
Named party: Example Person 401",8283,17,8283,fdc-d7e123654695f77425a9feb8,synthetic-form-layout-04,original,2024,fte-95ffa5ad2dcf902d5da06679,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2025
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-2-2
acquisition date: 2025-03-03
donated property description: Example Entity 4-2-0
Named party: Example Person 402",8283,17,8283,fdc-68f3dc493f8978eaa1ebaec1,synthetic-form-layout-04,original,2025,fte-d2d700560230a8c8c7d22ebd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2023
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-3-2
acquisition date: 2023-03-04
donated property description: Example Entity 4-3-0
Named party: Example Person 403",8283,17,8283,fdc-2452624216e384b721839018,synthetic-form-layout-04,original,2023,fte-d0ab1cc1bece17ce8ef5d52b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2024
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-4-2
acquisition date: 2024-03-05
donated property description: Example Entity 4-4-0
Named party: Example Person 404",8283,17,8283,fdc-e6a146348f2e556e50965823,synthetic-form-layout-04,original,2024,fte-393883ccc58df64285f1d693,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2025
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-5-2
acquisition date: 2025-03-06
donated property description: Example Entity 4-5-0
Named party: Example Person 405",8283,17,8283,fdc-c74fb85a0ee3c647293e5b33,synthetic-form-layout-04,original,2025,fte-18c9defb332e908ca7947a8d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2023
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-6-2
acquisition date: 2023-03-07
donated property description: Example Entity 4-6-0
Named party: Example Person 406",8283,17,8283,fdc-73f84ac94596ab1dece86405,synthetic-form-layout-04,original,2023,fte-da71deaf25ad1a320d91dab3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8283: Noncash Charitable Contributions
Tax reporting year 2024
appraiser declaration: Example named signer; signed
donor basis: Example Entity 4-7-2
acquisition date: 2024-03-08
donated property description: Example Entity 4-7-0
Named party: Example Person 407",8283,17,8283,fdc-372016877ba18bb172927bd1,synthetic-form-layout-04,original,2024,fte-ed03768bbc59e809fc39f992,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2023
donated property description: Example Entity 5-0-0 / acquisition date: 2023-03-01 / donor basis: Example Entity 5-0-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 500",8283,17,8283,fdc-76a5b536e7d80e1c623aaa7c,synthetic-form-layout-05,original,2023,fte-664aac31d7356e8da41b73be,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2024
donated property description: Example Entity 5-1-0 / acquisition date: 2024-03-02 / donor basis: Example Entity 5-1-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 501",8283,17,8283,fdc-4fd6412d24bd91ba644d1d1f,synthetic-form-layout-05,original,2024,fte-0f9bd55960563a2bd3a334c2,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2025
donated property description: Example Entity 5-2-0 / acquisition date: 2025-03-03 / donor basis: Example Entity 5-2-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 502",8283,17,8283,fdc-bfda8e5673b5659e2071c099,synthetic-form-layout-05,original,2025,fte-cc1c34503599abcb4de41269,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2023
donated property description: Example Entity 5-3-0 / acquisition date: 2023-03-04 / donor basis: Example Entity 5-3-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 503",8283,17,8283,fdc-ba1417429d384d123a4a1fc3,synthetic-form-layout-05,original,2023,fte-7af5060b39c39223ec12e97f,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2024
donated property description: Example Entity 5-4-0 / acquisition date: 2024-03-05 / donor basis: Example Entity 5-4-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 504",8283,17,8283,fdc-bc2b5bfa46001f27e0b698fb,synthetic-form-layout-05,original,2024,fte-1652ed686be6284537d4aaab,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2025
donated property description: Example Entity 5-5-0 / acquisition date: 2025-03-06 / donor basis: Example Entity 5-5-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 505",8283,17,8283,fdc-16bf11608d58f16c6b07a6db,synthetic-form-layout-05,original,2025,fte-45619427c33d591563fa2d03,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2023
donated property description: Example Entity 5-6-0 / acquisition date: 2023-03-07 / donor basis: Example Entity 5-6-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 506",8283,17,8283,fdc-00bf0a4e7f161d1c25c1a8ea,synthetic-form-layout-05,original,2023,fte-b55bc1913a1d75fa1a195108,synthetic_AI_labeled,v1_template,top,False,
"Form 8283: Noncash Charitable Contributions -- reporting year 2024
donated property description: Example Entity 5-7-0 / acquisition date: 2024-03-08 / donor basis: Example Entity 5-7-2 / appraiser declaration: Example named signer; signed
Delivery copy for Example Party 507",8283,17,8283,fdc-6e3bd4793c12ccb8e9fc9c35,synthetic-form-layout-05,original,2024,fte-1c7dc2a527326728c837c934,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2023
Statement issued to Example Person 0.
donor: Example Entity 0-0-0
donee: Example Entity 0-0-1
description of gift: Example Entity 0-0-2
date of gift: 2023-03-01
value: USD 10,000.00",709,16,709,fdc-b495a38fc2c58d94e44363d8,synthetic-form-layout-00,original,2023,fte-5f2e4a53fb4863fd0522b346,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2024
Statement issued to Example Person 1.
donor: Example Entity 0-1-0
donee: Example Entity 0-1-1
description of gift: Example Entity 0-1-2
date of gift: 2024-03-02
value: USD 10,083.00",709,16,709,fdc-725be2558061668979d1142a,synthetic-form-layout-00,original,2024,fte-87a83170275ef06c84a0b62e,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2025
Statement issued to Example Person 2.
donor: Example Entity 0-2-0
donee: Example Entity 0-2-1
description of gift: Example Entity 0-2-2
date of gift: 2025-03-03
value: USD 10,166.00",709,16,709,fdc-ab6e22d23616049a63a360b1,synthetic-form-layout-00,original,2025,fte-7fdcf098cd5a3378cfad33b7,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2023
Statement issued to Example Person 3.
donor: Example Entity 0-3-0
donee: Example Entity 0-3-1
description of gift: Example Entity 0-3-2
date of gift: 2023-03-04
value: USD 10,249.00",709,16,709,fdc-273541820845242effba58bb,synthetic-form-layout-00,original,2023,fte-c5beb3b252379172dd275a7b,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2024
Statement issued to Example Person 4.
donor: Example Entity 0-4-0
donee: Example Entity 0-4-1
description of gift: Example Entity 0-4-2
date of gift: 2024-03-05
value: USD 10,332.00",709,16,709,fdc-7567071fa1a4164bcc561a1a,synthetic-form-layout-00,original,2024,fte-ad444295164ad2cd7d466c9f,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2025
Statement issued to Example Person 5.
donor: Example Entity 0-5-0
donee: Example Entity 0-5-1
description of gift: Example Entity 0-5-2
date of gift: 2025-03-06
value: USD 10,415.00",709,16,709,fdc-2295c4a4f1cc85565cae9b1a,synthetic-form-layout-00,original,2025,fte-3ce94d9eef4cc52be437a830,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2023
Statement issued to Example Person 6.
donor: Example Entity 0-6-0
donee: Example Entity 0-6-1
description of gift: Example Entity 0-6-2
date of gift: 2023-03-07
value: USD 10,498.00",709,16,709,fdc-7c2132330da8d2a45dc71aab,synthetic-form-layout-00,original,2023,fte-903809f737786a708738a0ad,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Calendar year: 2024
Statement issued to Example Person 7.
donor: Example Entity 0-7-0
donee: Example Entity 0-7-1
description of gift: Example Entity 0-7-2
date of gift: 2024-03-08
value: USD 10,581.00",709,16,709,fdc-988af297e219d8bf35aee941,synthetic-form-layout-00,original,2024,fte-8ca882644ab8ccef882225a7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 100
donor: Example Entity 1-0-0 | donee: Example Entity 1-0-1 | description of gift: Example Entity 1-0-2 | date of gift: 2023-03-01 | value: USD 10,137.00",709,16,709,fdc-cc93de11052807a0ed5b0764,synthetic-form-layout-01,original,2023,fte-23d322ee5d1e0f29c7625292,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 101
donor: Example Entity 1-1-0 | donee: Example Entity 1-1-1 | description of gift: Example Entity 1-1-2 | date of gift: 2024-03-02 | value: USD 10,220.00",709,16,709,fdc-7eb1b2853f72936ead60d3c4,synthetic-form-layout-01,original,2024,fte-5c762e682fd7a5368f937708,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 102
donor: Example Entity 1-2-0 | donee: Example Entity 1-2-1 | description of gift: Example Entity 1-2-2 | date of gift: 2025-03-03 | value: USD 10,303.00",709,16,709,fdc-736e3d318afc1f01bdfc76a4,synthetic-form-layout-01,original,2025,fte-5dd0bcad8e9d54f82ca2ccce,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 103
donor: Example Entity 1-3-0 | donee: Example Entity 1-3-1 | description of gift: Example Entity 1-3-2 | date of gift: 2023-03-04 | value: USD 10,386.00",709,16,709,fdc-e29e573295487fd85f790fc6,synthetic-form-layout-01,original,2023,fte-58f830fd780657e0e0fefb75,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 104
donor: Example Entity 1-4-0 | donee: Example Entity 1-4-1 | description of gift: Example Entity 1-4-2 | date of gift: 2024-03-05 | value: USD 10,469.00",709,16,709,fdc-f27c449b1f100b9314ab1633,synthetic-form-layout-01,original,2024,fte-3b7b48b28ae8ca4632048fc9,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 105
donor: Example Entity 1-5-0 | donee: Example Entity 1-5-1 | description of gift: Example Entity 1-5-2 | date of gift: 2025-03-06 | value: USD 10,552.00",709,16,709,fdc-7f4d4f335efe86e98fbabef9,synthetic-form-layout-01,original,2025,fte-c14c0b3871e42fe75e15c5d5,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 106
donor: Example Entity 1-6-0 | donee: Example Entity 1-6-1 | description of gift: Example Entity 1-6-2 | date of gift: 2023-03-07 | value: USD 10,635.00",709,16,709,fdc-421e7251f4b6e442e13e0723,synthetic-form-layout-01,original,2023,fte-bb11f97ac9d1205c76bf7b57,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Recipient record: Example Person 107
donor: Example Entity 1-7-0 | donee: Example Entity 1-7-1 | description of gift: Example Entity 1-7-2 | date of gift: 2024-03-08 | value: USD 10,718.00",709,16,709,fdc-d6cc8a9d071a678b7bda2673,synthetic-form-layout-01,original,2024,fte-13fa3108d571b0991ad8517c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-0-0; donee: Example Entity 2-0-1; description of gift: Example Entity 2-0-2; date of gift: 2023-03-01; value: USD 10,274.00. Recipient: Example Household 200.",709,16,709,fdc-91b13a8b84657a9532be4d46,synthetic-form-layout-02,original,2023,fte-379ff59c9e0cd06279d75a0d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-1-0; donee: Example Entity 2-1-1; description of gift: Example Entity 2-1-2; date of gift: 2024-03-02; value: USD 10,357.00. Recipient: Example Household 201.",709,16,709,fdc-bcb23f0484573c53942ce977,synthetic-form-layout-02,original,2024,fte-72177ae28d917edb7322ca91,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-2-0; donee: Example Entity 2-2-1; description of gift: Example Entity 2-2-2; date of gift: 2025-03-03; value: USD 10,440.00. Recipient: Example Household 202.",709,16,709,fdc-f326e89051537eb056ded13c,synthetic-form-layout-02,original,2025,fte-e428d52cf76aff1a16a3d489,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-3-0; donee: Example Entity 2-3-1; description of gift: Example Entity 2-3-2; date of gift: 2023-03-04; value: USD 10,523.00. Recipient: Example Household 203.",709,16,709,fdc-e089c48d7b37faff35e7d69b,synthetic-form-layout-02,original,2023,fte-03dec2eae5772a1b0f39ab25,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-4-0; donee: Example Entity 2-4-1; description of gift: Example Entity 2-4-2; date of gift: 2024-03-05; value: USD 10,606.00. Recipient: Example Household 204.",709,16,709,fdc-e5a0f0ec5fc656b2e47473fc,synthetic-form-layout-02,original,2024,fte-676805419287283bda968316,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-5-0; donee: Example Entity 2-5-1; description of gift: Example Entity 2-5-2; date of gift: 2025-03-06; value: USD 10,689.00. Recipient: Example Household 205.",709,16,709,fdc-2dc946fd5724f75d6e0d0521,synthetic-form-layout-02,original,2025,fte-1511d3dd1a2e3deea45db281,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-6-0; donee: Example Entity 2-6-1; description of gift: Example Entity 2-6-2; date of gift: 2023-03-07; value: USD 10,772.00. Recipient: Example Household 206.",709,16,709,fdc-910b1f089b851deafcefbd1e,synthetic-form-layout-02,original,2023,fte-d480db44ac25dd4b5b2ba989,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 709: United States Gift and Generation-Skipping Transfer Tax Return.
donor: Example Entity 2-7-0; donee: Example Entity 2-7-1; description of gift: Example Entity 2-7-2; date of gift: 2024-03-08; value: USD 10,855.00. Recipient: Example Household 207.",709,16,709,fdc-6ba88581fc519cc11d80ac3e,synthetic-form-layout-02,original,2024,fte-ffaa80766045c1cd6a372a8b,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2023.
Details: donor: Example Entity 3-0-0, donee: Example Entity 3-0-1, description of gift: Example Entity 3-0-2, date of gift: 2023-03-01, value: USD 10,411.00. Account holder: Example Person 300.",709,16,709,fdc-47b4a96e3ce8f3431b5d0827,synthetic-form-layout-03,original,2023,fte-1a5453128dc95e78d39e5a5d,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2024.
Details: donor: Example Entity 3-1-0, donee: Example Entity 3-1-1, description of gift: Example Entity 3-1-2, date of gift: 2024-03-02, value: USD 10,494.00. Account holder: Example Person 301.",709,16,709,fdc-3cfd2ed74704c4dcc0e5e4df,synthetic-form-layout-03,original,2024,fte-6cf352097cefe5518e7f2d4f,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2025.
Details: donor: Example Entity 3-2-0, donee: Example Entity 3-2-1, description of gift: Example Entity 3-2-2, date of gift: 2025-03-03, value: USD 10,577.00. Account holder: Example Person 302.",709,16,709,fdc-f558a16fd3cd27bfd8b721e4,synthetic-form-layout-03,original,2025,fte-1dbb9f56820c275866cafe0d,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2023.
Details: donor: Example Entity 3-3-0, donee: Example Entity 3-3-1, description of gift: Example Entity 3-3-2, date of gift: 2023-03-04, value: USD 10,660.00. Account holder: Example Person 303.",709,16,709,fdc-d6e73a00b5c648eaa88e7591,synthetic-form-layout-03,original,2023,fte-3c7b4e2c16857325e6e93fd1,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2024.
Details: donor: Example Entity 3-4-0, donee: Example Entity 3-4-1, description of gift: Example Entity 3-4-2, date of gift: 2024-03-05, value: USD 10,743.00. Account holder: Example Person 304.",709,16,709,fdc-ee7bb21d26b327d15d898266,synthetic-form-layout-03,original,2024,fte-d0eac167e52308c88efe5087,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2025.
Details: donor: Example Entity 3-5-0, donee: Example Entity 3-5-1, description of gift: Example Entity 3-5-2, date of gift: 2025-03-06, value: USD 10,826.00. Account holder: Example Person 305.",709,16,709,fdc-9fd83027cd4d2a5351d753c7,synthetic-form-layout-03,original,2025,fte-9aea98c34daa79c70db4f42d,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2023.
Details: donor: Example Entity 3-6-0, donee: Example Entity 3-6-1, description of gift: Example Entity 3-6-2, date of gift: 2023-03-07, value: USD 10,909.00. Account holder: Example Person 306.",709,16,709,fdc-179f9c134e4de603adbe8d7d,synthetic-form-layout-03,original,2023,fte-78000b29b597807e61f3e4ed,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Reporting period ended 12/31/2024.
Details: donor: Example Entity 3-7-0, donee: Example Entity 3-7-1, description of gift: Example Entity 3-7-2, date of gift: 2024-03-08, value: USD 10,992.00. Account holder: Example Person 307.",709,16,709,fdc-06b53dd2d58741684ca314cc,synthetic-form-layout-03,original,2024,fte-4227a5ca4c68c8e7a2c21cc8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2023
value: USD 10,548.00
date of gift: 2023-03-01
description of gift: Example Entity 4-0-2
donee: Example Entity 4-0-1
donor: Example Entity 4-0-0
Named party: Example Person 400",709,16,709,fdc-12a3be105a5dd21f9f7fb304,synthetic-form-layout-04,original,2023,fte-df35749d3fa8fd9dd1fbaa3f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2024
value: USD 10,631.00
date of gift: 2024-03-02
description of gift: Example Entity 4-1-2
donee: Example Entity 4-1-1
donor: Example Entity 4-1-0
Named party: Example Person 401",709,16,709,fdc-9a12b0457e4cd19e0e06d0a5,synthetic-form-layout-04,original,2024,fte-80e295e601ed233c85821acc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2025
value: USD 10,714.00
date of gift: 2025-03-03
description of gift: Example Entity 4-2-2
donee: Example Entity 4-2-1
donor: Example Entity 4-2-0
Named party: Example Person 402",709,16,709,fdc-06d5fb6cd5c790bfc2eba159,synthetic-form-layout-04,original,2025,fte-b0c5723422a6af8b70e90ffd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2023
value: USD 10,797.00
date of gift: 2023-03-04
description of gift: Example Entity 4-3-2
donee: Example Entity 4-3-1
donor: Example Entity 4-3-0
Named party: Example Person 403",709,16,709,fdc-3da160cc129bf9d9ed420039,synthetic-form-layout-04,original,2023,fte-c2187c1f045cb8b83e3b969b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2024
value: USD 10,880.00
date of gift: 2024-03-05
description of gift: Example Entity 4-4-2
donee: Example Entity 4-4-1
donor: Example Entity 4-4-0
Named party: Example Person 404",709,16,709,fdc-e575f99bc69d5c2d98094d9c,synthetic-form-layout-04,original,2024,fte-e60a4e9813be535b468d136f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2025
value: USD 10,963.00
date of gift: 2025-03-06
description of gift: Example Entity 4-5-2
donee: Example Entity 4-5-1
donor: Example Entity 4-5-0
Named party: Example Person 405",709,16,709,fdc-60c9261233b9d4907e1b2694,synthetic-form-layout-04,original,2025,fte-85cc30cbe21d92a9d05c10d4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2023
value: USD 11,046.00
date of gift: 2023-03-07
description of gift: Example Entity 4-6-2
donee: Example Entity 4-6-1
donor: Example Entity 4-6-0
Named party: Example Person 406",709,16,709,fdc-31be0f5a8e1e1e50e75d3d2d,synthetic-form-layout-04,original,2023,fte-80bca98c1c0607e0b44f26e2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709: United States Gift and Generation-Skipping Transfer Tax Return
Tax reporting year 2024
value: USD 11,129.00
date of gift: 2024-03-08
description of gift: Example Entity 4-7-2
donee: Example Entity 4-7-1
donor: Example Entity 4-7-0
Named party: Example Person 407",709,16,709,fdc-4be1b367a23843309dd9a443,synthetic-form-layout-04,original,2024,fte-5829f3829ef256ac762af559,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2023
donor: Example Entity 5-0-0 / donee: Example Entity 5-0-1 / description of gift: Example Entity 5-0-2 / date of gift: 2023-03-01 / value: USD 10,685.00
Delivery copy for Example Party 500",709,16,709,fdc-418bb9c3f369337d39cc33a0,synthetic-form-layout-05,original,2023,fte-32cfffc6d569710b64a3d490,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2024
donor: Example Entity 5-1-0 / donee: Example Entity 5-1-1 / description of gift: Example Entity 5-1-2 / date of gift: 2024-03-02 / value: USD 10,768.00
Delivery copy for Example Party 501",709,16,709,fdc-65801add342d36b5b9dfeed2,synthetic-form-layout-05,original,2024,fte-976f2d6154318be01d068e79,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2025
donor: Example Entity 5-2-0 / donee: Example Entity 5-2-1 / description of gift: Example Entity 5-2-2 / date of gift: 2025-03-03 / value: USD 10,851.00
Delivery copy for Example Party 502",709,16,709,fdc-b8c53349885159059dbe23b4,synthetic-form-layout-05,original,2025,fte-4f60bede8560519f447e1d4b,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2023
donor: Example Entity 5-3-0 / donee: Example Entity 5-3-1 / description of gift: Example Entity 5-3-2 / date of gift: 2023-03-04 / value: USD 10,934.00
Delivery copy for Example Party 503",709,16,709,fdc-0a61ffc0a6c5ea88bf886339,synthetic-form-layout-05,original,2023,fte-ce7d574b151ba3de140a75e5,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2024
donor: Example Entity 5-4-0 / donee: Example Entity 5-4-1 / description of gift: Example Entity 5-4-2 / date of gift: 2024-03-05 / value: USD 11,017.00
Delivery copy for Example Party 504",709,16,709,fdc-992b2e7c301874aabfa7acb6,synthetic-form-layout-05,original,2024,fte-b6defb81a57bb9034df6d207,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2025
donor: Example Entity 5-5-0 / donee: Example Entity 5-5-1 / description of gift: Example Entity 5-5-2 / date of gift: 2025-03-06 / value: USD 11,100.00
Delivery copy for Example Party 505",709,16,709,fdc-4cbbf8d719e8f6f3450f682a,synthetic-form-layout-05,original,2025,fte-320199eb4cce562a21456064,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2023
donor: Example Entity 5-6-0 / donee: Example Entity 5-6-1 / description of gift: Example Entity 5-6-2 / date of gift: 2023-03-07 / value: USD 11,183.00
Delivery copy for Example Party 506",709,16,709,fdc-b4825a2271c131d7cfa37803,synthetic-form-layout-05,original,2023,fte-52dee9f35f15c9d00a37658a,synthetic_AI_labeled,v1_template,top,False,
"Form 709: United States Gift and Generation-Skipping Transfer Tax Return -- reporting year 2024
donor: Example Entity 5-7-0 / donee: Example Entity 5-7-1 / description of gift: Example Entity 5-7-2 / date of gift: 2024-03-08 / value: USD 11,266.00
Delivery copy for Example Party 507",709,16,709,fdc-d2a97f9d115d9f949390d14c,synthetic-form-layout-05,original,2024,fte-db8ff2d0cbb9981f8b32c7b4,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2023
Statement issued to Example Person 0.
nonresident donor: Example Entity 0-0-0
property: Example Entity 0-0-1
donee: Example Entity 0-0-2
date of gift: 2023-03-01",709,16,709,fdc-ad8045a2a961f06eb0b008aa,synthetic-form-layout-00,original,2023,fte-d48bf870770cd5c5b1d405c1,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2024
Statement issued to Example Person 1.
nonresident donor: Example Entity 0-1-0
property: Example Entity 0-1-1
donee: Example Entity 0-1-2
date of gift: 2024-03-02",709,16,709,fdc-362094e11ad6f050908ba0f7,synthetic-form-layout-00,original,2024,fte-79e9c257594f664e85c344cd,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2025
Statement issued to Example Person 2.
nonresident donor: Example Entity 0-2-0
property: Example Entity 0-2-1
donee: Example Entity 0-2-2
date of gift: 2025-03-03",709,16,709,fdc-ca22617b9fdf63b563e475f9,synthetic-form-layout-00,original,2025,fte-89b95e567e74f430ca824da0,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2023
Statement issued to Example Person 3.
nonresident donor: Example Entity 0-3-0
property: Example Entity 0-3-1
donee: Example Entity 0-3-2
date of gift: 2023-03-04",709,16,709,fdc-01e7d1b9910e0de2843d321b,synthetic-form-layout-00,original,2023,fte-5f79546a4d61031c0f6cda64,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2024
Statement issued to Example Person 4.
nonresident donor: Example Entity 0-4-0
property: Example Entity 0-4-1
donee: Example Entity 0-4-2
date of gift: 2024-03-05",709,16,709,fdc-54af0c0b990118f67da9a3d7,synthetic-form-layout-00,original,2024,fte-76c3d80ac9418c0d5f9e6098,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2025
Statement issued to Example Person 5.
nonresident donor: Example Entity 0-5-0
property: Example Entity 0-5-1
donee: Example Entity 0-5-2
date of gift: 2025-03-06",709,16,709,fdc-0cd936580184731e2683c2ca,synthetic-form-layout-00,original,2025,fte-dad794c948932ad9b96d3d84,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2023
Statement issued to Example Person 6.
nonresident donor: Example Entity 0-6-0
property: Example Entity 0-6-1
donee: Example Entity 0-6-2
date of gift: 2023-03-07",709,16,709,fdc-7f4e39639aae22e23473cefd,synthetic-form-layout-00,original,2023,fte-a2354bb43b8f1962a3e8e659,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Calendar year: 2024
Statement issued to Example Person 7.
nonresident donor: Example Entity 0-7-0
property: Example Entity 0-7-1
donee: Example Entity 0-7-2
date of gift: 2024-03-08",709,16,709,fdc-4cdb6b622855470a5d6bde3c,synthetic-form-layout-00,original,2024,fte-23ded4146f9ac48599cd305a,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 100
nonresident donor: Example Entity 1-0-0 | property: Example Entity 1-0-1 | donee: Example Entity 1-0-2 | date of gift: 2023-03-01",709,16,709,fdc-f0fa5945a01d3bdb2bf1bc10,synthetic-form-layout-01,original,2023,fte-e3eb8072940bd44a21a99b7f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 101
nonresident donor: Example Entity 1-1-0 | property: Example Entity 1-1-1 | donee: Example Entity 1-1-2 | date of gift: 2024-03-02",709,16,709,fdc-351f1de4f2389eb7213be215,synthetic-form-layout-01,original,2024,fte-344bd8e5318f58e30fa1e544,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 102
nonresident donor: Example Entity 1-2-0 | property: Example Entity 1-2-1 | donee: Example Entity 1-2-2 | date of gift: 2025-03-03",709,16,709,fdc-7dd1c3fb464ba4ea7ef8d54f,synthetic-form-layout-01,original,2025,fte-957cead4f04dbc8293f2b1ef,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 103
nonresident donor: Example Entity 1-3-0 | property: Example Entity 1-3-1 | donee: Example Entity 1-3-2 | date of gift: 2023-03-04",709,16,709,fdc-ecec87d8f835f6a8d983df45,synthetic-form-layout-01,original,2023,fte-422a9aa75b6d76b81c498788,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 104
nonresident donor: Example Entity 1-4-0 | property: Example Entity 1-4-1 | donee: Example Entity 1-4-2 | date of gift: 2024-03-05",709,16,709,fdc-0d1dfd711b9b13e5058656b2,synthetic-form-layout-01,original,2024,fte-122ad097ca995bc6efb69c65,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 105
nonresident donor: Example Entity 1-5-0 | property: Example Entity 1-5-1 | donee: Example Entity 1-5-2 | date of gift: 2025-03-06",709,16,709,fdc-ce1da657502356634877b19a,synthetic-form-layout-01,original,2025,fte-4ecc90ef72b2c7f73a5c1ff7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 106
nonresident donor: Example Entity 1-6-0 | property: Example Entity 1-6-1 | donee: Example Entity 1-6-2 | date of gift: 2023-03-07",709,16,709,fdc-d7b43a6366cfe9d8545f2349,synthetic-form-layout-01,original,2023,fte-f9defcf09a2e5fe729787a10,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Recipient record: Example Person 107
nonresident donor: Example Entity 1-7-0 | property: Example Entity 1-7-1 | donee: Example Entity 1-7-2 | date of gift: 2024-03-08",709,16,709,fdc-ab614aa5a3474cb444c0578f,synthetic-form-layout-01,original,2024,fte-51c090a6b17d3c7514837172,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-0-0; property: Example Entity 2-0-1; donee: Example Entity 2-0-2; date of gift: 2023-03-01. Recipient: Example Household 200.",709,16,709,fdc-51196008f773e702156db988,synthetic-form-layout-02,original,2023,fte-ccd937df6dbc4826d6442dc3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-1-0; property: Example Entity 2-1-1; donee: Example Entity 2-1-2; date of gift: 2024-03-02. Recipient: Example Household 201.",709,16,709,fdc-30490196de15e816c902b0b7,synthetic-form-layout-02,original,2024,fte-4b706bec30ed0ff4b5f1d7e6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-2-0; property: Example Entity 2-2-1; donee: Example Entity 2-2-2; date of gift: 2025-03-03. Recipient: Example Household 202.",709,16,709,fdc-aa74f6c5280ef5d6ea2f00b3,synthetic-form-layout-02,original,2025,fte-db72f5fc17410d377c0e77a2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-3-0; property: Example Entity 2-3-1; donee: Example Entity 2-3-2; date of gift: 2023-03-04. Recipient: Example Household 203.",709,16,709,fdc-649b9cd92ff7e60f35ca8ba9,synthetic-form-layout-02,original,2023,fte-19af6a4a8f76d1c140422566,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-4-0; property: Example Entity 2-4-1; donee: Example Entity 2-4-2; date of gift: 2024-03-05. Recipient: Example Household 204.",709,16,709,fdc-b21061c11ec677609b23f189,synthetic-form-layout-02,original,2024,fte-662357e823ddb6aa1fd88cdb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-5-0; property: Example Entity 2-5-1; donee: Example Entity 2-5-2; date of gift: 2025-03-06. Recipient: Example Household 205.",709,16,709,fdc-82541258806e5fa9250960d4,synthetic-form-layout-02,original,2025,fte-5b7a7444504a5e840b52ced5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-6-0; property: Example Entity 2-6-1; donee: Example Entity 2-6-2; date of gift: 2023-03-07. Recipient: Example Household 206.",709,16,709,fdc-869c4e1de3b9af3cb3bf6908,synthetic-form-layout-02,original,2023,fte-bd978a54c7cb422fb579370f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen.
nonresident donor: Example Entity 2-7-0; property: Example Entity 2-7-1; donee: Example Entity 2-7-2; date of gift: 2024-03-08. Recipient: Example Household 207.",709,16,709,fdc-96354aec70492ee5ecf1bfa5,synthetic-form-layout-02,original,2024,fte-7b9ad176aae7bf1a0dcdbee5,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2023.
Details: nonresident donor: Example Entity 3-0-0, property: Example Entity 3-0-1, donee: Example Entity 3-0-2, date of gift: 2023-03-01. Account holder: Example Person 300.",709,16,709,fdc-f34bb4c84f477d7cdf35bcec,synthetic-form-layout-03,original,2023,fte-7228fd320e7a1a81b6c107a3,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2024.
Details: nonresident donor: Example Entity 3-1-0, property: Example Entity 3-1-1, donee: Example Entity 3-1-2, date of gift: 2024-03-02. Account holder: Example Person 301.",709,16,709,fdc-01f10651c5d6ee03bcfaa7d6,synthetic-form-layout-03,original,2024,fte-587d59bf9b09dacdcb2ee676,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2025.
Details: nonresident donor: Example Entity 3-2-0, property: Example Entity 3-2-1, donee: Example Entity 3-2-2, date of gift: 2025-03-03. Account holder: Example Person 302.",709,16,709,fdc-81e73a4f115fffc74951abb6,synthetic-form-layout-03,original,2025,fte-5250a806db6b9fe043f461a9,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2023.
Details: nonresident donor: Example Entity 3-3-0, property: Example Entity 3-3-1, donee: Example Entity 3-3-2, date of gift: 2023-03-04. Account holder: Example Person 303.",709,16,709,fdc-fb339217ec28e5a9304c76c4,synthetic-form-layout-03,original,2023,fte-c9622572b04e7206b2885776,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2024.
Details: nonresident donor: Example Entity 3-4-0, property: Example Entity 3-4-1, donee: Example Entity 3-4-2, date of gift: 2024-03-05. Account holder: Example Person 304.",709,16,709,fdc-7623377e2627a1e3a926348e,synthetic-form-layout-03,original,2024,fte-efd441eaa6b11e709a12bceb,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2025.
Details: nonresident donor: Example Entity 3-5-0, property: Example Entity 3-5-1, donee: Example Entity 3-5-2, date of gift: 2025-03-06. Account holder: Example Person 305.",709,16,709,fdc-7047f5db59b659b146bb9768,synthetic-form-layout-03,original,2025,fte-bc82c26fb1aa4003764ed32b,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2023.
Details: nonresident donor: Example Entity 3-6-0, property: Example Entity 3-6-1, donee: Example Entity 3-6-2, date of gift: 2023-03-07. Account holder: Example Person 306.",709,16,709,fdc-86672d9f652686f237db7537,synthetic-form-layout-03,original,2023,fte-d59a23404de49b2f5c13c20d,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Reporting period ended 12/31/2024.
Details: nonresident donor: Example Entity 3-7-0, property: Example Entity 3-7-1, donee: Example Entity 3-7-2, date of gift: 2024-03-08. Account holder: Example Person 307.",709,16,709,fdc-c0fba7ec3f93da78b11e785f,synthetic-form-layout-03,original,2024,fte-d1bdd2be04275b4815cecfb6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2023
date of gift: 2023-03-01
donee: Example Entity 4-0-2
property: Example Entity 4-0-1
nonresident donor: Example Entity 4-0-0
Named party: Example Person 400",709,16,709,fdc-01332fb1af29f620e4cde16a,synthetic-form-layout-04,original,2023,fte-fa90ce6bbbe32c278b5784f9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2024
date of gift: 2024-03-02
donee: Example Entity 4-1-2
property: Example Entity 4-1-1
nonresident donor: Example Entity 4-1-0
Named party: Example Person 401",709,16,709,fdc-1a18f17bb668af4cf4ac276d,synthetic-form-layout-04,original,2024,fte-0416f2e1dbeb90f7cea72989,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2025
date of gift: 2025-03-03
donee: Example Entity 4-2-2
property: Example Entity 4-2-1
nonresident donor: Example Entity 4-2-0
Named party: Example Person 402",709,16,709,fdc-3b539ec08b2bab9cc069ac3c,synthetic-form-layout-04,original,2025,fte-405b1c6098128b85c820f4fa,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2023
date of gift: 2023-03-04
donee: Example Entity 4-3-2
property: Example Entity 4-3-1
nonresident donor: Example Entity 4-3-0
Named party: Example Person 403",709,16,709,fdc-0d70cb41ce7e499a0cefdfdd,synthetic-form-layout-04,original,2023,fte-79029b6d853512eeea096a5c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2024
date of gift: 2024-03-05
donee: Example Entity 4-4-2
property: Example Entity 4-4-1
nonresident donor: Example Entity 4-4-0
Named party: Example Person 404",709,16,709,fdc-17a928b92625d0472b86b03e,synthetic-form-layout-04,original,2024,fte-155ae0d79c21e3619ffb5e92,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2025
date of gift: 2025-03-06
donee: Example Entity 4-5-2
property: Example Entity 4-5-1
nonresident donor: Example Entity 4-5-0
Named party: Example Person 405",709,16,709,fdc-c49310ca39a57f7eaa53621f,synthetic-form-layout-04,original,2025,fte-406095de353d82c98c999a07,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2023
date of gift: 2023-03-07
donee: Example Entity 4-6-2
property: Example Entity 4-6-1
nonresident donor: Example Entity 4-6-0
Named party: Example Person 406",709,16,709,fdc-572bea1afc435efc9eb3da7b,synthetic-form-layout-04,original,2023,fte-83bcd7b64933d4b5e1771c68,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen
Tax reporting year 2024
date of gift: 2024-03-08
donee: Example Entity 4-7-2
property: Example Entity 4-7-1
nonresident donor: Example Entity 4-7-0
Named party: Example Person 407",709,16,709,fdc-59a7a11053cefd1d70e8d0ac,synthetic-form-layout-04,original,2024,fte-1b1d72fa667fdebfb4bdc94e,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2023
nonresident donor: Example Entity 5-0-0 / property: Example Entity 5-0-1 / donee: Example Entity 5-0-2 / date of gift: 2023-03-01
Delivery copy for Example Party 500",709,16,709,fdc-d8a326659a1955fd54a8d20e,synthetic-form-layout-05,original,2023,fte-185d4378f31691156cb02d4d,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2024
nonresident donor: Example Entity 5-1-0 / property: Example Entity 5-1-1 / donee: Example Entity 5-1-2 / date of gift: 2024-03-02
Delivery copy for Example Party 501",709,16,709,fdc-4421ce0b8bf2b90742059417,synthetic-form-layout-05,original,2024,fte-113e84bc31ad879c7c4e78c7,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2025
nonresident donor: Example Entity 5-2-0 / property: Example Entity 5-2-1 / donee: Example Entity 5-2-2 / date of gift: 2025-03-03
Delivery copy for Example Party 502",709,16,709,fdc-baf34cb55efdf9166eab2efe,synthetic-form-layout-05,original,2025,fte-590a5532b282b27988f0139d,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2023
nonresident donor: Example Entity 5-3-0 / property: Example Entity 5-3-1 / donee: Example Entity 5-3-2 / date of gift: 2023-03-04
Delivery copy for Example Party 503",709,16,709,fdc-e80d72ba06d828671d51adcd,synthetic-form-layout-05,original,2023,fte-63903a4a63bbe5bba1931083,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2024
nonresident donor: Example Entity 5-4-0 / property: Example Entity 5-4-1 / donee: Example Entity 5-4-2 / date of gift: 2024-03-05
Delivery copy for Example Party 504",709,16,709,fdc-2ebb6edd626e0cddf07a9cc0,synthetic-form-layout-05,original,2024,fte-2061017f8901c5dcd2fe4c7c,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2025
nonresident donor: Example Entity 5-5-0 / property: Example Entity 5-5-1 / donee: Example Entity 5-5-2 / date of gift: 2025-03-06
Delivery copy for Example Party 505",709,16,709,fdc-2cf85b3b346bf3467e314216,synthetic-form-layout-05,original,2025,fte-d57522be13fdf8ef9cdafa01,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2023
nonresident donor: Example Entity 5-6-0 / property: Example Entity 5-6-1 / donee: Example Entity 5-6-2 / date of gift: 2023-03-07
Delivery copy for Example Party 506",709,16,709,fdc-fc20b87f033d3d31d6b89bc4,synthetic-form-layout-05,original,2023,fte-4415e16f47499b8bf0558a16,synthetic_AI_labeled,v1_template,top,False,
"Form 709-NA: United States Gift and Generation-Skipping Transfer Tax Return of Nonresident Not a Citizen -- reporting year 2024
nonresident donor: Example Entity 5-7-0 / property: Example Entity 5-7-1 / donee: Example Entity 5-7-2 / date of gift: 2024-03-08
Delivery copy for Example Party 507",709,16,709,fdc-cf7d714a5bbcf311bf116b86,synthetic-form-layout-05,original,2024,fte-df9cdca40498471bc6770b50,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2023
Statement issued to Example Person 0.
foreign donor: Example Entity 0-0-0
recipient: Example Entity 0-0-1
foreign gifts: USD 10,000.00
trust transactions: USD 10,000.00",3520,11,3520,fdc-62750a8fd6f2908704f18339,synthetic-form-layout-00,original,2023,fte-4d7bdab442b80751a6ddf6a9,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2024
Statement issued to Example Person 1.
foreign donor: Example Entity 0-1-0
recipient: Example Entity 0-1-1
foreign gifts: USD 10,083.00
trust transactions: USD 10,083.00",3520,11,3520,fdc-4e91edc98023cca560cc93db,synthetic-form-layout-00,original,2024,fte-2d065944af18fd18d6f6319b,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2025
Statement issued to Example Person 2.
foreign donor: Example Entity 0-2-0
recipient: Example Entity 0-2-1
foreign gifts: USD 10,166.00
trust transactions: USD 10,166.00",3520,11,3520,fdc-ca847c959b2de078480dcbd8,synthetic-form-layout-00,original,2025,fte-1123c7d13aa498cde199ba77,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2023
Statement issued to Example Person 3.
foreign donor: Example Entity 0-3-0
recipient: Example Entity 0-3-1
foreign gifts: USD 10,249.00
trust transactions: USD 10,249.00",3520,11,3520,fdc-81b5ef5a935c03699ca5a1a9,synthetic-form-layout-00,original,2023,fte-6ba517c5c86bea811389efb5,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2024
Statement issued to Example Person 4.
foreign donor: Example Entity 0-4-0
recipient: Example Entity 0-4-1
foreign gifts: USD 10,332.00
trust transactions: USD 10,332.00",3520,11,3520,fdc-3017038704d58767865897fa,synthetic-form-layout-00,original,2024,fte-d817837e89c64036b4e7f878,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2025
Statement issued to Example Person 5.
foreign donor: Example Entity 0-5-0
recipient: Example Entity 0-5-1
foreign gifts: USD 10,415.00
trust transactions: USD 10,415.00",3520,11,3520,fdc-4e38f6cc820997c40f0519d5,synthetic-form-layout-00,original,2025,fte-1bbd7fea8ace999656308184,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2023
Statement issued to Example Person 6.
foreign donor: Example Entity 0-6-0
recipient: Example Entity 0-6-1
foreign gifts: USD 10,498.00
trust transactions: USD 10,498.00",3520,11,3520,fdc-22ad5baf216e3423ee23369a,synthetic-form-layout-00,original,2023,fte-19e08763a80690adab16ebe4,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Calendar year: 2024
Statement issued to Example Person 7.
foreign donor: Example Entity 0-7-0
recipient: Example Entity 0-7-1
foreign gifts: USD 10,581.00
trust transactions: USD 10,581.00",3520,11,3520,fdc-8933c619af59cdcf882042de,synthetic-form-layout-00,original,2024,fte-a253ac1609288128e9f03415,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 100
foreign donor: Example Entity 1-0-0 | recipient: Example Entity 1-0-1 | foreign gifts: USD 10,137.00 | trust transactions: USD 10,137.00",3520,11,3520,fdc-f036d820be0e9824bcc02ad1,synthetic-form-layout-01,original,2023,fte-3497dae409c56b38bdf6f3ac,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 101
foreign donor: Example Entity 1-1-0 | recipient: Example Entity 1-1-1 | foreign gifts: USD 10,220.00 | trust transactions: USD 10,220.00",3520,11,3520,fdc-49816e8b7b66414ec0267e16,synthetic-form-layout-01,original,2024,fte-ff562b9dca8d326f2d6f4c3e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 102
foreign donor: Example Entity 1-2-0 | recipient: Example Entity 1-2-1 | foreign gifts: USD 10,303.00 | trust transactions: USD 10,303.00",3520,11,3520,fdc-6d00aaa76c6de044671b9fd4,synthetic-form-layout-01,original,2025,fte-8e5f0a8c70b0c6909a1616d6,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 103
foreign donor: Example Entity 1-3-0 | recipient: Example Entity 1-3-1 | foreign gifts: USD 10,386.00 | trust transactions: USD 10,386.00",3520,11,3520,fdc-bba04ccb61db56daf486e200,synthetic-form-layout-01,original,2023,fte-9591ea37642f3af7a7429fe4,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 104
foreign donor: Example Entity 1-4-0 | recipient: Example Entity 1-4-1 | foreign gifts: USD 10,469.00 | trust transactions: USD 10,469.00",3520,11,3520,fdc-a5c15a17c1084fca6ded5c54,synthetic-form-layout-01,original,2024,fte-82558be97921450d789f0fee,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 105
foreign donor: Example Entity 1-5-0 | recipient: Example Entity 1-5-1 | foreign gifts: USD 10,552.00 | trust transactions: USD 10,552.00",3520,11,3520,fdc-47a7d4492bc52faad7febc87,synthetic-form-layout-01,original,2025,fte-7a6aa4c12fdae468435d5cc6,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 106
foreign donor: Example Entity 1-6-0 | recipient: Example Entity 1-6-1 | foreign gifts: USD 10,635.00 | trust transactions: USD 10,635.00",3520,11,3520,fdc-d1077af96682feafa124bf25,synthetic-form-layout-01,original,2023,fte-c92ec4ac20fe4740ace83872,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Recipient record: Example Person 107
foreign donor: Example Entity 1-7-0 | recipient: Example Entity 1-7-1 | foreign gifts: USD 10,718.00 | trust transactions: USD 10,718.00",3520,11,3520,fdc-f418e9780af3e60d5e42e7f3,synthetic-form-layout-01,original,2024,fte-843d17438e1c5d741f4c09d3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-0-0; recipient: Example Entity 2-0-1; foreign gifts: USD 10,274.00; trust transactions: USD 10,274.00. Recipient: Example Household 200.",3520,11,3520,fdc-788e68de956c7f48c73dfb92,synthetic-form-layout-02,original,2023,fte-76b67026d3adb25883b95457,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-1-0; recipient: Example Entity 2-1-1; foreign gifts: USD 10,357.00; trust transactions: USD 10,357.00. Recipient: Example Household 201.",3520,11,3520,fdc-0859b7b896ff33aef5493085,synthetic-form-layout-02,original,2024,fte-3c196155705cac963b87fd44,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-2-0; recipient: Example Entity 2-2-1; foreign gifts: USD 10,440.00; trust transactions: USD 10,440.00. Recipient: Example Household 202.",3520,11,3520,fdc-2c41cb803e04654532e43c9e,synthetic-form-layout-02,original,2025,fte-ffc9729455ada5afe58f098a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-3-0; recipient: Example Entity 2-3-1; foreign gifts: USD 10,523.00; trust transactions: USD 10,523.00. Recipient: Example Household 203.",3520,11,3520,fdc-ba4a47b0d072eb2f6cc40339,synthetic-form-layout-02,original,2023,fte-01cb8d5e3cd53e1681ab8cf5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-4-0; recipient: Example Entity 2-4-1; foreign gifts: USD 10,606.00; trust transactions: USD 10,606.00. Recipient: Example Household 204.",3520,11,3520,fdc-522c5349d6e00934eaeb5fde,synthetic-form-layout-02,original,2024,fte-fe1d8daf63fa06df41f4ce52,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-5-0; recipient: Example Entity 2-5-1; foreign gifts: USD 10,689.00; trust transactions: USD 10,689.00. Recipient: Example Household 205.",3520,11,3520,fdc-c59f5505aedc4b55eeba6c47,synthetic-form-layout-02,original,2025,fte-9956ea05f0ef4420aae8d456,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-6-0; recipient: Example Entity 2-6-1; foreign gifts: USD 10,772.00; trust transactions: USD 10,772.00. Recipient: Example Household 206.",3520,11,3520,fdc-19b056cfeb20d784ace54080,synthetic-form-layout-02,original,2023,fte-59eb17d4500dff04c53600f6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.
foreign donor: Example Entity 2-7-0; recipient: Example Entity 2-7-1; foreign gifts: USD 10,855.00; trust transactions: USD 10,855.00. Recipient: Example Household 207.",3520,11,3520,fdc-ff612c90b33275cafdfe2043,synthetic-form-layout-02,original,2024,fte-f110170497e41d2397f7e50b,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2023.
Details: foreign donor: Example Entity 3-0-0, recipient: Example Entity 3-0-1, foreign gifts: USD 10,411.00, trust transactions: USD 10,411.00. Account holder: Example Person 300.",3520,11,3520,fdc-d540488b686624007533ea65,synthetic-form-layout-03,original,2023,fte-bc391096b490e240db61ff9c,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2024.
Details: foreign donor: Example Entity 3-1-0, recipient: Example Entity 3-1-1, foreign gifts: USD 10,494.00, trust transactions: USD 10,494.00. Account holder: Example Person 301.",3520,11,3520,fdc-df8c520fce3e2784ec00041c,synthetic-form-layout-03,original,2024,fte-8278a794dfd5fb90fe36dcbc,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2025.
Details: foreign donor: Example Entity 3-2-0, recipient: Example Entity 3-2-1, foreign gifts: USD 10,577.00, trust transactions: USD 10,577.00. Account holder: Example Person 302.",3520,11,3520,fdc-827dfff7838e57c307ca9611,synthetic-form-layout-03,original,2025,fte-8c7b6a5558ad65ef0d7a45a7,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2023.
Details: foreign donor: Example Entity 3-3-0, recipient: Example Entity 3-3-1, foreign gifts: USD 10,660.00, trust transactions: USD 10,660.00. Account holder: Example Person 303.",3520,11,3520,fdc-f9e57e5aceb19377cf611e3e,synthetic-form-layout-03,original,2023,fte-de65be0a6e81e12890e30b49,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2024.
Details: foreign donor: Example Entity 3-4-0, recipient: Example Entity 3-4-1, foreign gifts: USD 10,743.00, trust transactions: USD 10,743.00. Account holder: Example Person 304.",3520,11,3520,fdc-9e415fddc8537caa13440e6f,synthetic-form-layout-03,original,2024,fte-70aca1817520d67ce637d663,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2025.
Details: foreign donor: Example Entity 3-5-0, recipient: Example Entity 3-5-1, foreign gifts: USD 10,826.00, trust transactions: USD 10,826.00. Account holder: Example Person 305.",3520,11,3520,fdc-9ef4d435475325eabb920c31,synthetic-form-layout-03,original,2025,fte-87be401ba11410534c44ef64,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2023.
Details: foreign donor: Example Entity 3-6-0, recipient: Example Entity 3-6-1, foreign gifts: USD 10,909.00, trust transactions: USD 10,909.00. Account holder: Example Person 306.",3520,11,3520,fdc-51b2d1b6f853702680a79f1d,synthetic-form-layout-03,original,2023,fte-baf083b15f710bfd8bc303d7,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Reporting period ended 12/31/2024.
Details: foreign donor: Example Entity 3-7-0, recipient: Example Entity 3-7-1, foreign gifts: USD 10,992.00, trust transactions: USD 10,992.00. Account holder: Example Person 307.",3520,11,3520,fdc-5f955f7d06bdd5e151c00f09,synthetic-form-layout-03,original,2024,fte-229c4c0ed6219b4f5b6396e5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2023
trust transactions: USD 10,548.00
foreign gifts: USD 10,548.00
recipient: Example Entity 4-0-1
foreign donor: Example Entity 4-0-0
Named party: Example Person 400",3520,11,3520,fdc-1349f791e38fa3f553a5b00a,synthetic-form-layout-04,original,2023,fte-d57008f7b80b1cb0a2f49e05,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2024
trust transactions: USD 10,631.00
foreign gifts: USD 10,631.00
recipient: Example Entity 4-1-1
foreign donor: Example Entity 4-1-0
Named party: Example Person 401",3520,11,3520,fdc-ec7388f255e75af016328b96,synthetic-form-layout-04,original,2024,fte-7e06096a59c0166326dc8301,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2025
trust transactions: USD 10,714.00
foreign gifts: USD 10,714.00
recipient: Example Entity 4-2-1
foreign donor: Example Entity 4-2-0
Named party: Example Person 402",3520,11,3520,fdc-e32d962640c70a33b71f2163,synthetic-form-layout-04,original,2025,fte-e26347742e4142d27f8ae893,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2023
trust transactions: USD 10,797.00
foreign gifts: USD 10,797.00
recipient: Example Entity 4-3-1
foreign donor: Example Entity 4-3-0
Named party: Example Person 403",3520,11,3520,fdc-42ceb772800cafdae7b255ed,synthetic-form-layout-04,original,2023,fte-cf919f6f41cbe17871ac1c66,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2024
trust transactions: USD 10,880.00
foreign gifts: USD 10,880.00
recipient: Example Entity 4-4-1
foreign donor: Example Entity 4-4-0
Named party: Example Person 404",3520,11,3520,fdc-47d1d39ced977cb52d628276,synthetic-form-layout-04,original,2024,fte-b3b2f11bc5f4ce7801b10727,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2025
trust transactions: USD 10,963.00
foreign gifts: USD 10,963.00
recipient: Example Entity 4-5-1
foreign donor: Example Entity 4-5-0
Named party: Example Person 405",3520,11,3520,fdc-4b68373034e73dfa18ea0ba0,synthetic-form-layout-04,original,2025,fte-928fc92485105754fc227441,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2023
trust transactions: USD 11,046.00
foreign gifts: USD 11,046.00
recipient: Example Entity 4-6-1
foreign donor: Example Entity 4-6-0
Named party: Example Person 406",3520,11,3520,fdc-a4dc93d3a9f4b6fb5d73f927,synthetic-form-layout-04,original,2023,fte-698083f839e53e7b2db4d612,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts
Tax reporting year 2024
trust transactions: USD 11,129.00
foreign gifts: USD 11,129.00
recipient: Example Entity 4-7-1
foreign donor: Example Entity 4-7-0
Named party: Example Person 407",3520,11,3520,fdc-c5f20b2a01ed18117f35dd8b,synthetic-form-layout-04,original,2024,fte-73c09c8c95985381776cc5e9,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2023
foreign donor: Example Entity 5-0-0 / recipient: Example Entity 5-0-1 / foreign gifts: USD 10,685.00 / trust transactions: USD 10,685.00
Delivery copy for Example Party 500",3520,11,3520,fdc-e6319ceb5a60292643128423,synthetic-form-layout-05,original,2023,fte-61eebbccad72cd11790fc358,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2024
foreign donor: Example Entity 5-1-0 / recipient: Example Entity 5-1-1 / foreign gifts: USD 10,768.00 / trust transactions: USD 10,768.00
Delivery copy for Example Party 501",3520,11,3520,fdc-700f6b674e11d29b6e2819c9,synthetic-form-layout-05,original,2024,fte-dcd2fd07c5dd2ded9dbefb66,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2025
foreign donor: Example Entity 5-2-0 / recipient: Example Entity 5-2-1 / foreign gifts: USD 10,851.00 / trust transactions: USD 10,851.00
Delivery copy for Example Party 502",3520,11,3520,fdc-892bee4547b2a81eb06ff7d5,synthetic-form-layout-05,original,2025,fte-b8bbbf8d113b3d00524fd75c,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2023
foreign donor: Example Entity 5-3-0 / recipient: Example Entity 5-3-1 / foreign gifts: USD 10,934.00 / trust transactions: USD 10,934.00
Delivery copy for Example Party 503",3520,11,3520,fdc-281b4b1bbebe60f1dca40297,synthetic-form-layout-05,original,2023,fte-ba650519d1cf4a9744847225,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2024
foreign donor: Example Entity 5-4-0 / recipient: Example Entity 5-4-1 / foreign gifts: USD 11,017.00 / trust transactions: USD 11,017.00
Delivery copy for Example Party 504",3520,11,3520,fdc-33ed7742e5ba52addc65907b,synthetic-form-layout-05,original,2024,fte-4413370e96bdd957e957e5a9,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2025
foreign donor: Example Entity 5-5-0 / recipient: Example Entity 5-5-1 / foreign gifts: USD 11,100.00 / trust transactions: USD 11,100.00
Delivery copy for Example Party 505",3520,11,3520,fdc-2f96e53c88690c49fafb9123,synthetic-form-layout-05,original,2025,fte-5f261f5e3957fdcc1841b418,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2023
foreign donor: Example Entity 5-6-0 / recipient: Example Entity 5-6-1 / foreign gifts: USD 11,183.00 / trust transactions: USD 11,183.00
Delivery copy for Example Party 506",3520,11,3520,fdc-59fada0d362be76dc373a30d,synthetic-form-layout-05,original,2023,fte-0ba37f0ac769758e1d8aad94,synthetic_AI_labeled,v1_template,top,False,
"Form 3520: Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts -- reporting year 2024
foreign donor: Example Entity 5-7-0 / recipient: Example Entity 5-7-1 / foreign gifts: USD 11,266.00 / trust transactions: USD 11,266.00
Delivery copy for Example Party 507",3520,11,3520,fdc-a482d73116daeb72490397b6,synthetic-form-layout-05,original,2024,fte-45fe6f32f63bba837a01fad1,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 0.
filing status: Single
total income: USD 10,000.00
adjusted gross income: USD 9,000.00
payments: USD 10,000.00",1040,0,1040,fdc-3cee83613a8de118b3b60e76,synthetic-form-layout-00,original,2023,fte-5212cfbd75e0353007b0ee97,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 1.
filing status: Single
total income: USD 10,083.00
adjusted gross income: USD 9,074.70
payments: USD 10,083.00",1040,0,1040,fdc-485dcae8cffce819408bd275,synthetic-form-layout-00,original,2024,fte-001d1cc2ec5a750c4eb9d44e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2025
Statement issued to Example Person 2.
filing status: Single
total income: USD 10,166.00
adjusted gross income: USD 9,149.40
payments: USD 10,166.00",1040,0,1040,fdc-192f9277527bf8bd8530138f,synthetic-form-layout-00,original,2025,fte-21eec824e3efb518a93d17a9,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 3.
filing status: Single
total income: USD 10,249.00
adjusted gross income: USD 9,224.10
payments: USD 10,249.00",1040,0,1040,fdc-3569a86840afbf3f64dc1f0a,synthetic-form-layout-00,original,2023,fte-d9a9d9e44c8767ac5654d802,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 4.
filing status: Single
total income: USD 10,332.00
adjusted gross income: USD 9,298.80
payments: USD 10,332.00",1040,0,1040,fdc-f9aabe2f8737868accb55d30,synthetic-form-layout-00,original,2024,fte-db73f3d6b842cf6ed0caebc9,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2025
Statement issued to Example Person 5.
filing status: Single
total income: USD 10,415.00
adjusted gross income: USD 9,373.50
payments: USD 10,415.00",1040,0,1040,fdc-d4065dcdced638d7d6679e8e,synthetic-form-layout-00,original,2025,fte-1e05438ec4619d6b38afb550,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 6.
filing status: Single
total income: USD 10,498.00
adjusted gross income: USD 9,448.20
payments: USD 10,498.00",1040,0,1040,fdc-24e4b93983a8bc63788ce861,synthetic-form-layout-00,original,2023,fte-48ae85a0a8bdcbb2124bff03,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 7.
filing status: Single
total income: USD 10,581.00
adjusted gross income: USD 9,522.90
payments: USD 10,581.00",1040,0,1040,fdc-0635dbb3bb24b94173b5ff76,synthetic-form-layout-00,original,2024,fte-8c0c6b9422acdd32ae749884,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 100
filing status: Single | total income: USD 10,137.00 | adjusted gross income: USD 9,123.30 | payments: USD 10,137.00",1040,0,1040,fdc-686aa2b3b378eaab212f39da,synthetic-form-layout-01,original,2023,fte-b6df10c0916c60166a53b473,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 101
filing status: Single | total income: USD 10,220.00 | adjusted gross income: USD 9,198.00 | payments: USD 10,220.00",1040,0,1040,fdc-f0ba5b7ece09081249c72e6e,synthetic-form-layout-01,original,2024,fte-0ec2301b898e31a4112547ad,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 102
filing status: Single | total income: USD 10,303.00 | adjusted gross income: USD 9,272.70 | payments: USD 10,303.00",1040,0,1040,fdc-93fb9c78c83fecc369943ddb,synthetic-form-layout-01,original,2025,fte-0bdf64a930caec10f68b688c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 103
filing status: Single | total income: USD 10,386.00 | adjusted gross income: USD 9,347.40 | payments: USD 10,386.00",1040,0,1040,fdc-99da771178c158e5d810d8ec,synthetic-form-layout-01,original,2023,fte-60dfde5425631b7edcd54442,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 104
filing status: Single | total income: USD 10,469.00 | adjusted gross income: USD 9,422.10 | payments: USD 10,469.00",1040,0,1040,fdc-d28d4c119dda23cf4b39042b,synthetic-form-layout-01,original,2024,fte-17e4ec14696e89a2fb2c9b49,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 105
filing status: Single | total income: USD 10,552.00 | adjusted gross income: USD 9,496.80 | payments: USD 10,552.00",1040,0,1040,fdc-589e01aabd068ed2f1968656,synthetic-form-layout-01,original,2025,fte-a305b7afebaadaf3c9eefa84,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 106
filing status: Single | total income: USD 10,635.00 | adjusted gross income: USD 9,571.50 | payments: USD 10,635.00",1040,0,1040,fdc-567e2419ee0cd0b28ffb78fa,synthetic-form-layout-01,original,2023,fte-d728858a56c738f3e1bbbc78,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040: US Individual Income Tax Return
Recipient record: Example Person 107
filing status: Single | total income: USD 10,718.00 | adjusted gross income: USD 9,646.20 | payments: USD 10,718.00",1040,0,1040,fdc-281cd2fa846e286af16987da,synthetic-form-layout-01,original,2024,fte-24df3cab3adf678e1c18e924,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,274.00; adjusted gross income: USD 9,246.60; payments: USD 10,274.00. Recipient: Example Household 200.",1040,0,1040,fdc-e35d5017bca290b7c19254e1,synthetic-form-layout-02,original,2023,fte-2b9b3e9df9dd7cbd1f55696e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,357.00; adjusted gross income: USD 9,321.30; payments: USD 10,357.00. Recipient: Example Household 201.",1040,0,1040,fdc-26d7ecfcac55e76d49e47e8b,synthetic-form-layout-02,original,2024,fte-109c671c49a6d73789e4becc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,440.00; adjusted gross income: USD 9,396.00; payments: USD 10,440.00. Recipient: Example Household 202.",1040,0,1040,fdc-2cb9f33b3caaafbd113c5ed6,synthetic-form-layout-02,original,2025,fte-428cb3c169d97ac8366021ca,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,523.00; adjusted gross income: USD 9,470.70; payments: USD 10,523.00. Recipient: Example Household 203.",1040,0,1040,fdc-bd01f7eb78af0d9d21cb164d,synthetic-form-layout-02,original,2023,fte-15db841ae2b121b30ff80f16,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,606.00; adjusted gross income: USD 9,545.40; payments: USD 10,606.00. Recipient: Example Household 204.",1040,0,1040,fdc-58d63a43ffce2243e823a84e,synthetic-form-layout-02,original,2024,fte-cf88da240752b1afc06448ab,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,689.00; adjusted gross income: USD 9,620.10; payments: USD 10,689.00. Recipient: Example Household 205.",1040,0,1040,fdc-47703eb2374649cb6d5958e9,synthetic-form-layout-02,original,2025,fte-312b95c0b9998205bc78988d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,772.00; adjusted gross income: USD 9,694.80; payments: USD 10,772.00. Recipient: Example Household 206.",1040,0,1040,fdc-9603ccf6d97fbaffce8286c6,synthetic-form-layout-02,original,2023,fte-ea5557794e721f66e0612960,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040: US Individual Income Tax Return.
filing status: Single; total income: USD 10,855.00; adjusted gross income: USD 9,769.50; payments: USD 10,855.00. Recipient: Example Household 207.",1040,0,1040,fdc-4031411ec6c911215ea02fbc,synthetic-form-layout-02,original,2024,fte-7601d534821e510d8e7118a0,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: filing status: Single, total income: USD 10,411.00, adjusted gross income: USD 9,369.90, payments: USD 10,411.00. Account holder: Example Person 300.",1040,0,1040,fdc-631f91421d5d38f82fea8a5a,synthetic-form-layout-03,original,2023,fte-4fd2479cd4f12674e18559df,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: filing status: Single, total income: USD 10,494.00, adjusted gross income: USD 9,444.60, payments: USD 10,494.00. Account holder: Example Person 301.",1040,0,1040,fdc-d745eacc3916f5ba458fcd7b,synthetic-form-layout-03,original,2024,fte-a68f0edbde50eddbac11f5ce,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2025.
Details: filing status: Single, total income: USD 10,577.00, adjusted gross income: USD 9,519.30, payments: USD 10,577.00. Account holder: Example Person 302.",1040,0,1040,fdc-192a86cc040d88d04246dc26,synthetic-form-layout-03,original,2025,fte-61b3a9a4bb5a382ae172e3f5,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: filing status: Single, total income: USD 10,660.00, adjusted gross income: USD 9,594.00, payments: USD 10,660.00. Account holder: Example Person 303.",1040,0,1040,fdc-a692fbea49c5c76b64de1c0e,synthetic-form-layout-03,original,2023,fte-54d025fd54e96650cb0b9e33,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: filing status: Single, total income: USD 10,743.00, adjusted gross income: USD 9,668.70, payments: USD 10,743.00. Account holder: Example Person 304.",1040,0,1040,fdc-c31aa4f02af81bc65bf6bd98,synthetic-form-layout-03,original,2024,fte-dde99e5f75a4d174f2091d2e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2025.
Details: filing status: Single, total income: USD 10,826.00, adjusted gross income: USD 9,743.40, payments: USD 10,826.00. Account holder: Example Person 305.",1040,0,1040,fdc-b4ae4f9918cb7890bfe758fc,synthetic-form-layout-03,original,2025,fte-9fb7f2d0f2086da9e4c9126d,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: filing status: Single, total income: USD 10,909.00, adjusted gross income: USD 9,818.10, payments: USD 10,909.00. Account holder: Example Person 306.",1040,0,1040,fdc-62101d26923bedbd7b105be1,synthetic-form-layout-03,original,2023,fte-52ffc9e9ab76dcf4a407fd1a,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: filing status: Single, total income: USD 10,992.00, adjusted gross income: USD 9,892.80, payments: USD 10,992.00. Account holder: Example Person 307.",1040,0,1040,fdc-0ceecd4cd998eedf21bf44ef,synthetic-form-layout-03,original,2024,fte-777f10d4779a0bed611fc76e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2023
payments: USD 10,548.00
adjusted gross income: USD 9,493.20
total income: USD 10,548.00
filing status: Single
Named party: Example Person 400",1040,0,1040,fdc-0bafcfc263f7d5a6d60e85a9,synthetic-form-layout-04,original,2023,fte-1dcbe53398c19e59ff74e7b3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2024
payments: USD 10,631.00
adjusted gross income: USD 9,567.90
total income: USD 10,631.00
filing status: Single
Named party: Example Person 401",1040,0,1040,fdc-f339fafeb28dbe75f6025580,synthetic-form-layout-04,original,2024,fte-e7abc0da2ddddc4ca3721f43,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2025
payments: USD 10,714.00
adjusted gross income: USD 9,642.60
total income: USD 10,714.00
filing status: Single
Named party: Example Person 402",1040,0,1040,fdc-7e439546dbdf058a418717a1,synthetic-form-layout-04,original,2025,fte-f131b34be037b773baa6783f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2023
payments: USD 10,797.00
adjusted gross income: USD 9,717.30
total income: USD 10,797.00
filing status: Single
Named party: Example Person 403",1040,0,1040,fdc-804e8e92027383dd71658749,synthetic-form-layout-04,original,2023,fte-1ae80b67ff95d575ed7877eb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2024
payments: USD 10,880.00
adjusted gross income: USD 9,792.00
total income: USD 10,880.00
filing status: Single
Named party: Example Person 404",1040,0,1040,fdc-743dfa34191a8264ff0ac0d4,synthetic-form-layout-04,original,2024,fte-2245a65974d002659acf60d5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2025
payments: USD 10,963.00
adjusted gross income: USD 9,866.70
total income: USD 10,963.00
filing status: Single
Named party: Example Person 405",1040,0,1040,fdc-caec77eddb2ba65b5be92027,synthetic-form-layout-04,original,2025,fte-a864d5b57ef5b02a407f22f9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2023
payments: USD 11,046.00
adjusted gross income: USD 9,941.40
total income: USD 11,046.00
filing status: Single
Named party: Example Person 406",1040,0,1040,fdc-a58a2bd141f67109aee9d9df,synthetic-form-layout-04,original,2023,fte-022a5ce0ee4bfc7e41653f8c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040: US Individual Income Tax Return
Tax reporting year 2024
payments: USD 11,129.00
adjusted gross income: USD 10,016.10
total income: USD 11,129.00
filing status: Single
Named party: Example Person 407",1040,0,1040,fdc-e8c22458296475af98b8830d,synthetic-form-layout-04,original,2024,fte-efe696f78951140028d32d62,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2023
filing status: Single / total income: USD 10,685.00 / adjusted gross income: USD 9,616.50 / payments: USD 10,685.00
Delivery copy for Example Party 500",1040,0,1040,fdc-68d4c910512c9c486e03c2d7,synthetic-form-layout-05,original,2023,fte-4f726bd9b291b404b2494b3a,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2024
filing status: Single / total income: USD 10,768.00 / adjusted gross income: USD 9,691.20 / payments: USD 10,768.00
Delivery copy for Example Party 501",1040,0,1040,fdc-3edcd4f9e2687ecb84ce2b24,synthetic-form-layout-05,original,2024,fte-df61ead58f1b096dac671e07,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2025
filing status: Single / total income: USD 10,851.00 / adjusted gross income: USD 9,765.90 / payments: USD 10,851.00
Delivery copy for Example Party 502",1040,0,1040,fdc-42bf013dae8e65d14df565fe,synthetic-form-layout-05,original,2025,fte-63a07f8e7d9287ea31bf709b,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2023
filing status: Single / total income: USD 10,934.00 / adjusted gross income: USD 9,840.60 / payments: USD 10,934.00
Delivery copy for Example Party 503",1040,0,1040,fdc-61bfc81261da2a3eb09fd37e,synthetic-form-layout-05,original,2023,fte-c1bf85028140b876df50e168,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2024
filing status: Single / total income: USD 11,017.00 / adjusted gross income: USD 9,915.30 / payments: USD 11,017.00
Delivery copy for Example Party 504",1040,0,1040,fdc-2524f57484016a5c811f2f89,synthetic-form-layout-05,original,2024,fte-0419b69c270356d9671080d0,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2025
filing status: Single / total income: USD 11,100.00 / adjusted gross income: USD 9,990.00 / payments: USD 11,100.00
Delivery copy for Example Party 505",1040,0,1040,fdc-045cd555bb2085f9391dc92b,synthetic-form-layout-05,original,2025,fte-fbd8df174823fe4f8c5c1592,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2023
filing status: Single / total income: USD 11,183.00 / adjusted gross income: USD 10,064.70 / payments: USD 11,183.00
Delivery copy for Example Party 506",1040,0,1040,fdc-be25f89f6ab7ac7dafa11bac,synthetic-form-layout-05,original,2023,fte-9f79fe75ff737541306b513b,synthetic_AI_labeled,v1_template,top,False,
"Form 1040: US Individual Income Tax Return -- reporting year 2024
filing status: Single / total income: USD 11,266.00 / adjusted gross income: USD 10,139.40 / payments: USD 11,266.00
Delivery copy for Example Party 507",1040,0,1040,fdc-d20de0c8dbb96dc16541ae72,synthetic-form-layout-05,original,2024,fte-c9b778693504a0e54a56103c,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2023
Statement issued to Example Person 0.
filing status: Single
total income: USD 10,000.00
adjusted gross income: USD 9,000.00
payments: USD 10,000.00",1040,0,1040,fdc-8690d7a2eba450ad4afe8ed7,synthetic-form-layout-00,original,2023,fte-fe8bdebe9e640e70cb78184d,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2024
Statement issued to Example Person 1.
filing status: Single
total income: USD 10,083.00
adjusted gross income: USD 9,074.70
payments: USD 10,083.00",1040,0,1040,fdc-bcabf7c9fed11604255fa5ca,synthetic-form-layout-00,original,2024,fte-cd06b358b4218aaa9f810b1a,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2025
Statement issued to Example Person 2.
filing status: Single
total income: USD 10,166.00
adjusted gross income: USD 9,149.40
payments: USD 10,166.00",1040,0,1040,fdc-9e74798004f403bcff4d4b81,synthetic-form-layout-00,original,2025,fte-2b3699924f1ccf4231c95e13,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2023
Statement issued to Example Person 3.
filing status: Single
total income: USD 10,249.00
adjusted gross income: USD 9,224.10
payments: USD 10,249.00",1040,0,1040,fdc-be8901b0ae945149f7106b24,synthetic-form-layout-00,original,2023,fte-24fb83aec2525ff7e25beaff,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2024
Statement issued to Example Person 4.
filing status: Single
total income: USD 10,332.00
adjusted gross income: USD 9,298.80
payments: USD 10,332.00",1040,0,1040,fdc-469ca9fa278924232b5ad304,synthetic-form-layout-00,original,2024,fte-f663c6b69d108f87f4f2f462,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2025
Statement issued to Example Person 5.
filing status: Single
total income: USD 10,415.00
adjusted gross income: USD 9,373.50
payments: USD 10,415.00",1040,0,1040,fdc-c3d6f6bd5a5cfcf1999432c6,synthetic-form-layout-00,original,2025,fte-adc5b2388f550da50019a5ff,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2023
Statement issued to Example Person 6.
filing status: Single
total income: USD 10,498.00
adjusted gross income: USD 9,448.20
payments: USD 10,498.00",1040,0,1040,fdc-fbe8b5b3c1ace3679cd55af6,synthetic-form-layout-00,original,2023,fte-d96281c73a48bc9cb9b95bfe,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Calendar year: 2024
Statement issued to Example Person 7.
filing status: Single
total income: USD 10,581.00
adjusted gross income: USD 9,522.90
payments: USD 10,581.00",1040,0,1040,fdc-396aabcea20638aa3e64f517,synthetic-form-layout-00,original,2024,fte-47ff58929e4932d089470655,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 100
filing status: Single | total income: USD 10,137.00 | adjusted gross income: USD 9,123.30 | payments: USD 10,137.00",1040,0,1040,fdc-66fabdccedfc26d7112ce3ee,synthetic-form-layout-01,original,2023,fte-e6f9bae910720507c38c4d87,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 101
filing status: Single | total income: USD 10,220.00 | adjusted gross income: USD 9,198.00 | payments: USD 10,220.00",1040,0,1040,fdc-65e8c3fe152caabf368bbb82,synthetic-form-layout-01,original,2024,fte-062efdee597e1e7fbec03da0,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 102
filing status: Single | total income: USD 10,303.00 | adjusted gross income: USD 9,272.70 | payments: USD 10,303.00",1040,0,1040,fdc-2f945d4f7c03da2fff90dde8,synthetic-form-layout-01,original,2025,fte-cb23a752dbb404a69902905d,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 103
filing status: Single | total income: USD 10,386.00 | adjusted gross income: USD 9,347.40 | payments: USD 10,386.00",1040,0,1040,fdc-cf0a43485eae6dd4d05c23cc,synthetic-form-layout-01,original,2023,fte-9a091bf264ce66fbb99268ca,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 104
filing status: Single | total income: USD 10,469.00 | adjusted gross income: USD 9,422.10 | payments: USD 10,469.00",1040,0,1040,fdc-d5731df0c442b2c4b01a182c,synthetic-form-layout-01,original,2024,fte-01e888acdb66334e58359595,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 105
filing status: Single | total income: USD 10,552.00 | adjusted gross income: USD 9,496.80 | payments: USD 10,552.00",1040,0,1040,fdc-c7dee53fbe9851aa02e4ac52,synthetic-form-layout-01,original,2025,fte-90bf150898e870c7330819d6,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 106
filing status: Single | total income: USD 10,635.00 | adjusted gross income: USD 9,571.50 | payments: USD 10,635.00",1040,0,1040,fdc-e6252bccfa8deae9e1479acd,synthetic-form-layout-01,original,2023,fte-30529bf7cbc382dff603853d,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-SR: US Tax Return for Seniors
Recipient record: Example Person 107
filing status: Single | total income: USD 10,718.00 | adjusted gross income: USD 9,646.20 | payments: USD 10,718.00",1040,0,1040,fdc-e11207ae2d7c642b23a919b1,synthetic-form-layout-01,original,2024,fte-d35909f294c0b1840c266652,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,274.00; adjusted gross income: USD 9,246.60; payments: USD 10,274.00. Recipient: Example Household 200.",1040,0,1040,fdc-6902a3d1bccf98d477a5d5c2,synthetic-form-layout-02,original,2023,fte-4770f396ffb93b02f4bb536b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,357.00; adjusted gross income: USD 9,321.30; payments: USD 10,357.00. Recipient: Example Household 201.",1040,0,1040,fdc-2d8f5863e2a0e3ba27239eaa,synthetic-form-layout-02,original,2024,fte-f3f736c9075f5d2218171f58,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,440.00; adjusted gross income: USD 9,396.00; payments: USD 10,440.00. Recipient: Example Household 202.",1040,0,1040,fdc-299f00a53de284d17c1db91a,synthetic-form-layout-02,original,2025,fte-9207101578d9ea533f478c86,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,523.00; adjusted gross income: USD 9,470.70; payments: USD 10,523.00. Recipient: Example Household 203.",1040,0,1040,fdc-ca79682452ef9c4baeeabed9,synthetic-form-layout-02,original,2023,fte-30ba72cb370c2e5e6e11769b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,606.00; adjusted gross income: USD 9,545.40; payments: USD 10,606.00. Recipient: Example Household 204.",1040,0,1040,fdc-7de3e8e3f8609d7af63ad10f,synthetic-form-layout-02,original,2024,fte-be6b801797b981c07763fcf6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,689.00; adjusted gross income: USD 9,620.10; payments: USD 10,689.00. Recipient: Example Household 205.",1040,0,1040,fdc-0bde4ca950bbb170e426026c,synthetic-form-layout-02,original,2025,fte-6b3b893490ebb5e5a7c1938d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,772.00; adjusted gross income: USD 9,694.80; payments: USD 10,772.00. Recipient: Example Household 206.",1040,0,1040,fdc-177b02725dc9480218854a28,synthetic-form-layout-02,original,2023,fte-839e2b8ec54576d3310692bd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-SR: US Tax Return for Seniors.
filing status: Single; total income: USD 10,855.00; adjusted gross income: USD 9,769.50; payments: USD 10,855.00. Recipient: Example Household 207.",1040,0,1040,fdc-7c768a66cd31e483a2aa5823,synthetic-form-layout-02,original,2024,fte-7db27759cc3196b62e97f41c,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2023.
Details: filing status: Single, total income: USD 10,411.00, adjusted gross income: USD 9,369.90, payments: USD 10,411.00. Account holder: Example Person 300.",1040,0,1040,fdc-2e5224622747ab32f4f47f0b,synthetic-form-layout-03,original,2023,fte-3c116c9a07cf5c7bf7432eb3,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2024.
Details: filing status: Single, total income: USD 10,494.00, adjusted gross income: USD 9,444.60, payments: USD 10,494.00. Account holder: Example Person 301.",1040,0,1040,fdc-fe1913b9b469076739ab1e46,synthetic-form-layout-03,original,2024,fte-2049ea311abf586a724ea36f,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2025.
Details: filing status: Single, total income: USD 10,577.00, adjusted gross income: USD 9,519.30, payments: USD 10,577.00. Account holder: Example Person 302.",1040,0,1040,fdc-0c1f047d4abc699394f6fc35,synthetic-form-layout-03,original,2025,fte-72723d6cca258c29bb5f0dab,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2023.
Details: filing status: Single, total income: USD 10,660.00, adjusted gross income: USD 9,594.00, payments: USD 10,660.00. Account holder: Example Person 303.",1040,0,1040,fdc-54727ea93d341d04e6d32e92,synthetic-form-layout-03,original,2023,fte-165dbc6b373b025dac298d61,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2024.
Details: filing status: Single, total income: USD 10,743.00, adjusted gross income: USD 9,668.70, payments: USD 10,743.00. Account holder: Example Person 304.",1040,0,1040,fdc-fd06c091590fc9463b1bf80c,synthetic-form-layout-03,original,2024,fte-a113392750d196eef61a3798,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2025.
Details: filing status: Single, total income: USD 10,826.00, adjusted gross income: USD 9,743.40, payments: USD 10,826.00. Account holder: Example Person 305.",1040,0,1040,fdc-f77b3254db121dc7cf6e7a71,synthetic-form-layout-03,original,2025,fte-a8d7a0bc04979d7af11143e5,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2023.
Details: filing status: Single, total income: USD 10,909.00, adjusted gross income: USD 9,818.10, payments: USD 10,909.00. Account holder: Example Person 306.",1040,0,1040,fdc-c122a2cfadeff13c8a1245ce,synthetic-form-layout-03,original,2023,fte-60cf4d9121ee451f1325a8b0,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors
Reporting period ended 12/31/2024.
Details: filing status: Single, total income: USD 10,992.00, adjusted gross income: USD 9,892.80, payments: USD 10,992.00. Account holder: Example Person 307.",1040,0,1040,fdc-42882ef178b6b20d0f7721bd,synthetic-form-layout-03,original,2024,fte-eed7436e9b530280c83832a8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2023
payments: USD 10,548.00
adjusted gross income: USD 9,493.20
total income: USD 10,548.00
filing status: Single
Named party: Example Person 400",1040,0,1040,fdc-087c0a087162272f62c3918e,synthetic-form-layout-04,original,2023,fte-cceddc051113451dcb5cbf70,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2024
payments: USD 10,631.00
adjusted gross income: USD 9,567.90
total income: USD 10,631.00
filing status: Single
Named party: Example Person 401",1040,0,1040,fdc-26c7d51d37191fb0efeb112c,synthetic-form-layout-04,original,2024,fte-278b3e5ec7c4e4bc3935c92b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2025
payments: USD 10,714.00
adjusted gross income: USD 9,642.60
total income: USD 10,714.00
filing status: Single
Named party: Example Person 402",1040,0,1040,fdc-cc347f6935a02f034f74987f,synthetic-form-layout-04,original,2025,fte-7fdfda7ef5281436daeec24d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2023
payments: USD 10,797.00
adjusted gross income: USD 9,717.30
total income: USD 10,797.00
filing status: Single
Named party: Example Person 403",1040,0,1040,fdc-19b697c1ff5dea4284e4a6c1,synthetic-form-layout-04,original,2023,fte-93a21f2c8fe1246b75022183,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2024
payments: USD 10,880.00
adjusted gross income: USD 9,792.00
total income: USD 10,880.00
filing status: Single
Named party: Example Person 404",1040,0,1040,fdc-25d355275f4acd0d436e78c8,synthetic-form-layout-04,original,2024,fte-12844fd33445a18f472404d2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2025
payments: USD 10,963.00
adjusted gross income: USD 9,866.70
total income: USD 10,963.00
filing status: Single
Named party: Example Person 405",1040,0,1040,fdc-1356021cc590397684def9c0,synthetic-form-layout-04,original,2025,fte-7632e57721a3dbb861d15975,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2023
payments: USD 11,046.00
adjusted gross income: USD 9,941.40
total income: USD 11,046.00
filing status: Single
Named party: Example Person 406",1040,0,1040,fdc-53c51d4a72a591f4c9cc659a,synthetic-form-layout-04,original,2023,fte-be19a5fbec3f78e60c910121,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-SR: US Tax Return for Seniors
Tax reporting year 2024
payments: USD 11,129.00
adjusted gross income: USD 10,016.10
total income: USD 11,129.00
filing status: Single
Named party: Example Person 407",1040,0,1040,fdc-0103cc190a69e7c27b3c7047,synthetic-form-layout-04,original,2024,fte-148c7d15d45aa0b130b2af94,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2023
filing status: Single / total income: USD 10,685.00 / adjusted gross income: USD 9,616.50 / payments: USD 10,685.00
Delivery copy for Example Party 500",1040,0,1040,fdc-d3a29726c71fa3c56aa8028c,synthetic-form-layout-05,original,2023,fte-2b616e968be8c9add7dbeec2,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2024
filing status: Single / total income: USD 10,768.00 / adjusted gross income: USD 9,691.20 / payments: USD 10,768.00
Delivery copy for Example Party 501",1040,0,1040,fdc-b9a38cbe0aca82f0acd1a6d1,synthetic-form-layout-05,original,2024,fte-37f15b0cf56c5779bde21fb0,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2025
filing status: Single / total income: USD 10,851.00 / adjusted gross income: USD 9,765.90 / payments: USD 10,851.00
Delivery copy for Example Party 502",1040,0,1040,fdc-e1a813bf1b1a32f22df438ef,synthetic-form-layout-05,original,2025,fte-a3ce00bf9ac53d93a6308e8e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2023
filing status: Single / total income: USD 10,934.00 / adjusted gross income: USD 9,840.60 / payments: USD 10,934.00
Delivery copy for Example Party 503",1040,0,1040,fdc-91b91ae263cdc7c7c8d55ad6,synthetic-form-layout-05,original,2023,fte-6b40247a043c245dfa798d7c,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2024
filing status: Single / total income: USD 11,017.00 / adjusted gross income: USD 9,915.30 / payments: USD 11,017.00
Delivery copy for Example Party 504",1040,0,1040,fdc-2237f2cfe7bddbe02891c6bb,synthetic-form-layout-05,original,2024,fte-3da5d31735e478f132747010,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2025
filing status: Single / total income: USD 11,100.00 / adjusted gross income: USD 9,990.00 / payments: USD 11,100.00
Delivery copy for Example Party 505",1040,0,1040,fdc-fcb62398683a6d43f6d1478b,synthetic-form-layout-05,original,2025,fte-5fb681b16c62342fb9534c8a,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2023
filing status: Single / total income: USD 11,183.00 / adjusted gross income: USD 10,064.70 / payments: USD 11,183.00
Delivery copy for Example Party 506",1040,0,1040,fdc-242739960dc9f7a249ac986c,synthetic-form-layout-05,original,2023,fte-b6410b385ec7bc2ed1521bef,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-SR: US Tax Return for Seniors -- reporting year 2024
filing status: Single / total income: USD 11,266.00 / adjusted gross income: USD 10,139.40 / payments: USD 11,266.00
Delivery copy for Example Party 507",1040,0,1040,fdc-5821f715bb63c179cc08ad6d,synthetic-form-layout-05,original,2024,fte-fa4e352d181998667b5070bc,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2023
Statement issued to Example Person 0.
filing status: Single
effectively connected income: USD 10,000.00
payments: USD 10,000.00",1040,0,1040,fdc-2f39f02c448277c13b86fec8,synthetic-form-layout-00,original,2023,fte-6aca33324a3ce935f4d85cde,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2024
Statement issued to Example Person 1.
filing status: Single
effectively connected income: USD 10,083.00
payments: USD 10,083.00",1040,0,1040,fdc-c4053b02640b1c0d5fc939b6,synthetic-form-layout-00,original,2024,fte-9c508ea45740ee48a42511a0,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2025
Statement issued to Example Person 2.
filing status: Single
effectively connected income: USD 10,166.00
payments: USD 10,166.00",1040,0,1040,fdc-01d64a9220d346e7e24e2741,synthetic-form-layout-00,original,2025,fte-bc8678c87d24412208483b17,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2023
Statement issued to Example Person 3.
filing status: Single
effectively connected income: USD 10,249.00
payments: USD 10,249.00",1040,0,1040,fdc-59b9b36605199a01505f0128,synthetic-form-layout-00,original,2023,fte-a9c7519d2cb606f8538d59cc,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2024
Statement issued to Example Person 4.
filing status: Single
effectively connected income: USD 10,332.00
payments: USD 10,332.00",1040,0,1040,fdc-a73f9073d41b44c3a396ce01,synthetic-form-layout-00,original,2024,fte-60dfa32f465e650d20d7a9a8,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2025
Statement issued to Example Person 5.
filing status: Single
effectively connected income: USD 10,415.00
payments: USD 10,415.00",1040,0,1040,fdc-34e52c197bd1a6d4adb8d07e,synthetic-form-layout-00,original,2025,fte-d4254a9538bccb27e6f5cb70,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2023
Statement issued to Example Person 6.
filing status: Single
effectively connected income: USD 10,498.00
payments: USD 10,498.00",1040,0,1040,fdc-43ba84fe00fa75860b7d89ee,synthetic-form-layout-00,original,2023,fte-b8472b1027da7d12fddf24dc,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Calendar year: 2024
Statement issued to Example Person 7.
filing status: Single
effectively connected income: USD 10,581.00
payments: USD 10,581.00",1040,0,1040,fdc-b1de7c0cd9054b22b5d44dff,synthetic-form-layout-00,original,2024,fte-52feb26e5dc354b6d3e041a3,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 100
filing status: Single | effectively connected income: USD 10,137.00 | payments: USD 10,137.00",1040,0,1040,fdc-0cd25e0c916fd1f15c6b9ac0,synthetic-form-layout-01,original,2023,fte-d14a14f23c93841a3ef28f4a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 101
filing status: Single | effectively connected income: USD 10,220.00 | payments: USD 10,220.00",1040,0,1040,fdc-fee80dfcba38825ff6b38d3b,synthetic-form-layout-01,original,2024,fte-49bde64f083fe17e4a828a96,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 102
filing status: Single | effectively connected income: USD 10,303.00 | payments: USD 10,303.00",1040,0,1040,fdc-8605b7fb4a417db594583eb9,synthetic-form-layout-01,original,2025,fte-c33a1e6b407005e0462eed85,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 103
filing status: Single | effectively connected income: USD 10,386.00 | payments: USD 10,386.00",1040,0,1040,fdc-ffa739c8bdb9fc9502fb8609,synthetic-form-layout-01,original,2023,fte-9efd01a6059d8752cf862701,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 104
filing status: Single | effectively connected income: USD 10,469.00 | payments: USD 10,469.00",1040,0,1040,fdc-4db2a7c21fae841212a75310,synthetic-form-layout-01,original,2024,fte-d9c064252fd2d10e026d91cd,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 105
filing status: Single | effectively connected income: USD 10,552.00 | payments: USD 10,552.00",1040,0,1040,fdc-80d6b76f7ec4b2c8c54f6ddb,synthetic-form-layout-01,original,2025,fte-c97940fb41dc3df3ba25f4cc,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 106
filing status: Single | effectively connected income: USD 10,635.00 | payments: USD 10,635.00",1040,0,1040,fdc-af4026de7b2530acba527a84,synthetic-form-layout-01,original,2023,fte-cf1b71bf593eb1f66c588152,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-NR: US Nonresident Alien Income Tax Return
Recipient record: Example Person 107
filing status: Single | effectively connected income: USD 10,718.00 | payments: USD 10,718.00",1040,0,1040,fdc-98521caf0db934d99e567588,synthetic-form-layout-01,original,2024,fte-ff0a7a58fbff9a4b6e0c8bfe,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,274.00; payments: USD 10,274.00. Recipient: Example Household 200.",1040,0,1040,fdc-3853128886414881d69aebe4,synthetic-form-layout-02,original,2023,fte-8f155e7f1bd5af67b99b68dd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,357.00; payments: USD 10,357.00. Recipient: Example Household 201.",1040,0,1040,fdc-faf31759dc893082fa11d693,synthetic-form-layout-02,original,2024,fte-59926416122e7984b3d5d981,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,440.00; payments: USD 10,440.00. Recipient: Example Household 202.",1040,0,1040,fdc-d3b29f097751d85186ea92d2,synthetic-form-layout-02,original,2025,fte-34a881475f7c25e2f3965206,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,523.00; payments: USD 10,523.00. Recipient: Example Household 203.",1040,0,1040,fdc-2e3ccf16f20f500fb63ebd51,synthetic-form-layout-02,original,2023,fte-78cc05fa56faafdea1f6519a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,606.00; payments: USD 10,606.00. Recipient: Example Household 204.",1040,0,1040,fdc-f27a934013258d94b3604e5a,synthetic-form-layout-02,original,2024,fte-a85ace2b8ef81bf4a965ccd6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,689.00; payments: USD 10,689.00. Recipient: Example Household 205.",1040,0,1040,fdc-b8807a6e86847c1ebe341fc7,synthetic-form-layout-02,original,2025,fte-92dad4ddbf1f5e8e0a59a65b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,772.00; payments: USD 10,772.00. Recipient: Example Household 206.",1040,0,1040,fdc-6a813a6767e5bfcad8b27c38,synthetic-form-layout-02,original,2023,fte-94c282af0c18c648ef264242,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-NR: US Nonresident Alien Income Tax Return.
filing status: Single; effectively connected income: USD 10,855.00; payments: USD 10,855.00. Recipient: Example Household 207.",1040,0,1040,fdc-cd1828d3bd07d9722d220491,synthetic-form-layout-02,original,2024,fte-d394ee6c0c6a01d800fb63b2,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2023.
Details: filing status: Single, effectively connected income: USD 10,411.00, payments: USD 10,411.00. Account holder: Example Person 300.",1040,0,1040,fdc-e1684888cbfb0774985301df,synthetic-form-layout-03,original,2023,fte-71a6620504d8110cb913ff5e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2024.
Details: filing status: Single, effectively connected income: USD 10,494.00, payments: USD 10,494.00. Account holder: Example Person 301.",1040,0,1040,fdc-62e57f0906c44908848e6794,synthetic-form-layout-03,original,2024,fte-fe53c0a40cf7aa8a355e77af,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2025.
Details: filing status: Single, effectively connected income: USD 10,577.00, payments: USD 10,577.00. Account holder: Example Person 302.",1040,0,1040,fdc-48541ebeaa3869bbe11be369,synthetic-form-layout-03,original,2025,fte-184a3f2b7ffcb09f7225c067,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2023.
Details: filing status: Single, effectively connected income: USD 10,660.00, payments: USD 10,660.00. Account holder: Example Person 303.",1040,0,1040,fdc-35adcb3aef9aa1ef1bc44d55,synthetic-form-layout-03,original,2023,fte-d3b0a155672ac78e87cc51ce,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2024.
Details: filing status: Single, effectively connected income: USD 10,743.00, payments: USD 10,743.00. Account holder: Example Person 304.",1040,0,1040,fdc-af19c9db885fa47d5e324eca,synthetic-form-layout-03,original,2024,fte-5136baa986a469937db54934,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2025.
Details: filing status: Single, effectively connected income: USD 10,826.00, payments: USD 10,826.00. Account holder: Example Person 305.",1040,0,1040,fdc-e0708dd1a555aab97608eec8,synthetic-form-layout-03,original,2025,fte-81ad2f075c59ebd1eb9495a6,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2023.
Details: filing status: Single, effectively connected income: USD 10,909.00, payments: USD 10,909.00. Account holder: Example Person 306.",1040,0,1040,fdc-f821b1fe78acf0344949dea7,synthetic-form-layout-03,original,2023,fte-6cc44736a1a8c1d65ce338eb,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return
Reporting period ended 12/31/2024.
Details: filing status: Single, effectively connected income: USD 10,992.00, payments: USD 10,992.00. Account holder: Example Person 307.",1040,0,1040,fdc-9609ce40c19966426badd85d,synthetic-form-layout-03,original,2024,fte-07a05a24dc1baa176ac76002,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2023
payments: USD 10,548.00
effectively connected income: USD 10,548.00
filing status: Single
Named party: Example Person 400",1040,0,1040,fdc-d9ef3de04d62ed08bdcdf465,synthetic-form-layout-04,original,2023,fte-f07723898a9a84751517e6dc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2024
payments: USD 10,631.00
effectively connected income: USD 10,631.00
filing status: Single
Named party: Example Person 401",1040,0,1040,fdc-bb0e6cf16829fc6cd55e73a9,synthetic-form-layout-04,original,2024,fte-121db5c4b33db7fde6b52d18,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2025
payments: USD 10,714.00
effectively connected income: USD 10,714.00
filing status: Single
Named party: Example Person 402",1040,0,1040,fdc-b0a12296a7d856275a20aad4,synthetic-form-layout-04,original,2025,fte-edf540c0278a2a8488bcbe52,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2023
payments: USD 10,797.00
effectively connected income: USD 10,797.00
filing status: Single
Named party: Example Person 403",1040,0,1040,fdc-b73efb6308d8bc949185cd8f,synthetic-form-layout-04,original,2023,fte-25a621ad42b1994fc780033e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2024
payments: USD 10,880.00
effectively connected income: USD 10,880.00
filing status: Single
Named party: Example Person 404",1040,0,1040,fdc-0e9f28ddba2e9d99f5a8bf74,synthetic-form-layout-04,original,2024,fte-3e7876ae63552c49a8cd8ba7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2025
payments: USD 10,963.00
effectively connected income: USD 10,963.00
filing status: Single
Named party: Example Person 405",1040,0,1040,fdc-57acfde6065521dc1d17423d,synthetic-form-layout-04,original,2025,fte-bb96fc6f29b9e42f1e18b0f9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2023
payments: USD 11,046.00
effectively connected income: USD 11,046.00
filing status: Single
Named party: Example Person 406",1040,0,1040,fdc-3d5714fa0d0e38ab9d3ab06c,synthetic-form-layout-04,original,2023,fte-374e593fa8404a5872d2e91f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-NR: US Nonresident Alien Income Tax Return
Tax reporting year 2024
payments: USD 11,129.00
effectively connected income: USD 11,129.00
filing status: Single
Named party: Example Person 407",1040,0,1040,fdc-b28b440a7d15d0bb744118d0,synthetic-form-layout-04,original,2024,fte-42927255ab92e3b31bc2cc4e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2023
filing status: Single / effectively connected income: USD 10,685.00 / payments: USD 10,685.00
Delivery copy for Example Party 500",1040,0,1040,fdc-66b39ae8edde8556f4d2c590,synthetic-form-layout-05,original,2023,fte-c52b897e60127f281cf8a01e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2024
filing status: Single / effectively connected income: USD 10,768.00 / payments: USD 10,768.00
Delivery copy for Example Party 501",1040,0,1040,fdc-5e50d6395022291e809e7c54,synthetic-form-layout-05,original,2024,fte-48412ca584c36cbe515156dd,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2025
filing status: Single / effectively connected income: USD 10,851.00 / payments: USD 10,851.00
Delivery copy for Example Party 502",1040,0,1040,fdc-df1080da73269b541aa590db,synthetic-form-layout-05,original,2025,fte-4ec91d5b67be1ba76310cc05,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2023
filing status: Single / effectively connected income: USD 10,934.00 / payments: USD 10,934.00
Delivery copy for Example Party 503",1040,0,1040,fdc-54d67b55f3a930a01de74605,synthetic-form-layout-05,original,2023,fte-5409b9aa56068ecc37aa9e06,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2024
filing status: Single / effectively connected income: USD 11,017.00 / payments: USD 11,017.00
Delivery copy for Example Party 504",1040,0,1040,fdc-2999c9799d7b32217683f234,synthetic-form-layout-05,original,2024,fte-3acdc268e3ac6580e340895e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2025
filing status: Single / effectively connected income: USD 11,100.00 / payments: USD 11,100.00
Delivery copy for Example Party 505",1040,0,1040,fdc-0aef812eecef8f7c14f1eddf,synthetic-form-layout-05,original,2025,fte-9e2bba0e9417ee4641f04977,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2023
filing status: Single / effectively connected income: USD 11,183.00 / payments: USD 11,183.00
Delivery copy for Example Party 506",1040,0,1040,fdc-69972aa032809ce37720396b,synthetic-form-layout-05,original,2023,fte-bb11a136dd90069c667d2c70,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-NR: US Nonresident Alien Income Tax Return -- reporting year 2024
filing status: Single / effectively connected income: USD 11,266.00 / payments: USD 11,266.00
Delivery copy for Example Party 507",1040,0,1040,fdc-93e0e25e1c6c1a822719c76e,synthetic-form-layout-05,original,2024,fte-f2a7339ed07cc51f07d6e732,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 0.
original amount: USD 10,000.00
net change: USD 10,000.00
correct amount: USD 10,000.00
explanation of changes: USD 10,000.00",1040,0,1040,fdc-32be1eda4dd211784a1ffbaa,synthetic-form-layout-00,original,2023,fte-f59046e21f0cad2438c1299d,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 1.
original amount: USD 10,083.00
net change: USD 10,083.00
correct amount: USD 10,083.00
explanation of changes: USD 10,083.00",1040,0,1040,fdc-73c3a902a40f6f4faccb80e5,synthetic-form-layout-00,original,2024,fte-d50e483c1e956e04d971dc82,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2025
Statement issued to Example Person 2.
original amount: USD 10,166.00
net change: USD 10,166.00
correct amount: USD 10,166.00
explanation of changes: USD 10,166.00",1040,0,1040,fdc-cc171b1cd1f35f85dcb8b035,synthetic-form-layout-00,original,2025,fte-c87f336b26e179d4cc66f6e6,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 3.
original amount: USD 10,249.00
net change: USD 10,249.00
correct amount: USD 10,249.00
explanation of changes: USD 10,249.00",1040,0,1040,fdc-b20d7250ce032afe88e5f67c,synthetic-form-layout-00,original,2023,fte-02b5331e320f0b10193c979d,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 4.
original amount: USD 10,332.00
net change: USD 10,332.00
correct amount: USD 10,332.00
explanation of changes: USD 10,332.00",1040,0,1040,fdc-65d22e1fdeea06d4c934e7fc,synthetic-form-layout-00,original,2024,fte-83dfede52473f02a75eaa31e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2025
Statement issued to Example Person 5.
original amount: USD 10,415.00
net change: USD 10,415.00
correct amount: USD 10,415.00
explanation of changes: USD 10,415.00",1040,0,1040,fdc-f273a51e898c9dadb8e87500,synthetic-form-layout-00,original,2025,fte-2690df224eb065bcda0c3bc9,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 6.
original amount: USD 10,498.00
net change: USD 10,498.00
correct amount: USD 10,498.00
explanation of changes: USD 10,498.00",1040,0,1040,fdc-a9e48692015a208aa374558b,synthetic-form-layout-00,original,2023,fte-849ca45ee478b9d758d889ea,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 7.
original amount: USD 10,581.00
net change: USD 10,581.00
correct amount: USD 10,581.00
explanation of changes: USD 10,581.00",1040,0,1040,fdc-d7d6c27b44d8ae9430c16a7b,synthetic-form-layout-00,original,2024,fte-60984cc77af69976f5ec6513,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 100
original amount: USD 10,137.00 | net change: USD 10,137.00 | correct amount: USD 10,137.00 | explanation of changes: USD 10,137.00",1040,0,1040,fdc-9dd3d33f2a294ba32883c79d,synthetic-form-layout-01,original,2023,fte-a4739c98ec56b8f7bf2bff21,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 101
original amount: USD 10,220.00 | net change: USD 10,220.00 | correct amount: USD 10,220.00 | explanation of changes: USD 10,220.00",1040,0,1040,fdc-0a5a1f8639e72794e9682b08,synthetic-form-layout-01,original,2024,fte-6bcbf32e083c2f8b87d096b4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 102
original amount: USD 10,303.00 | net change: USD 10,303.00 | correct amount: USD 10,303.00 | explanation of changes: USD 10,303.00",1040,0,1040,fdc-0aaadf5de2a6cbd579865df1,synthetic-form-layout-01,original,2025,fte-c4520dd7868456540dd84c57,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 103
original amount: USD 10,386.00 | net change: USD 10,386.00 | correct amount: USD 10,386.00 | explanation of changes: USD 10,386.00",1040,0,1040,fdc-d103bea94dd8f87c10e51ff7,synthetic-form-layout-01,original,2023,fte-2573e850d1782e0622165e6e,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 104
original amount: USD 10,469.00 | net change: USD 10,469.00 | correct amount: USD 10,469.00 | explanation of changes: USD 10,469.00",1040,0,1040,fdc-58d89815cfbb9fec40b0fc74,synthetic-form-layout-01,original,2024,fte-6c70f4607b4b9435c999a785,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 105
original amount: USD 10,552.00 | net change: USD 10,552.00 | correct amount: USD 10,552.00 | explanation of changes: USD 10,552.00",1040,0,1040,fdc-78d4f3d31013a5b675739ece,synthetic-form-layout-01,original,2025,fte-02b78adb4d98a4a7bf7312ee,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 106
original amount: USD 10,635.00 | net change: USD 10,635.00 | correct amount: USD 10,635.00 | explanation of changes: USD 10,635.00",1040,0,1040,fdc-b89639a76cca9ec0c3c9e850,synthetic-form-layout-01,original,2023,fte-643820e526c40de2e5316be8,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-X: Amended US Individual Income Tax Return
Recipient record: Example Person 107
original amount: USD 10,718.00 | net change: USD 10,718.00 | correct amount: USD 10,718.00 | explanation of changes: USD 10,718.00",1040,0,1040,fdc-d50f947f9df36d21d5c926c3,synthetic-form-layout-01,original,2024,fte-9556c7127dfc1c67d86ba769,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,274.00; net change: USD 10,274.00; correct amount: USD 10,274.00; explanation of changes: USD 10,274.00. Recipient: Example Household 200.",1040,0,1040,fdc-4618910ee6a6d63ace227670,synthetic-form-layout-02,original,2023,fte-44ceb976f909b3d0f551f66f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,357.00; net change: USD 10,357.00; correct amount: USD 10,357.00; explanation of changes: USD 10,357.00. Recipient: Example Household 201.",1040,0,1040,fdc-60f1c2a21abbab1d0f8eb3c1,synthetic-form-layout-02,original,2024,fte-3297e5e39e2e75485dd57caf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,440.00; net change: USD 10,440.00; correct amount: USD 10,440.00; explanation of changes: USD 10,440.00. Recipient: Example Household 202.",1040,0,1040,fdc-167020355f02753c1d451d5a,synthetic-form-layout-02,original,2025,fte-2a0d5104e35b9a401000ede8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,523.00; net change: USD 10,523.00; correct amount: USD 10,523.00; explanation of changes: USD 10,523.00. Recipient: Example Household 203.",1040,0,1040,fdc-e01224aa566887d621b2c07a,synthetic-form-layout-02,original,2023,fte-0b2f56b8435a120d036938fe,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,606.00; net change: USD 10,606.00; correct amount: USD 10,606.00; explanation of changes: USD 10,606.00. Recipient: Example Household 204.",1040,0,1040,fdc-dcce543b67d141ede10bf377,synthetic-form-layout-02,original,2024,fte-ab9b74ff0b087a811452607d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,689.00; net change: USD 10,689.00; correct amount: USD 10,689.00; explanation of changes: USD 10,689.00. Recipient: Example Household 205.",1040,0,1040,fdc-07e907dbbde8c5122d1af118,synthetic-form-layout-02,original,2025,fte-4e1367f6304acc3a14ac11d2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,772.00; net change: USD 10,772.00; correct amount: USD 10,772.00; explanation of changes: USD 10,772.00. Recipient: Example Household 206.",1040,0,1040,fdc-7aa198578e791d469918809e,synthetic-form-layout-02,original,2023,fte-bf60b51224a8cb0556d7eaee,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-X: Amended US Individual Income Tax Return.
original amount: USD 10,855.00; net change: USD 10,855.00; correct amount: USD 10,855.00; explanation of changes: USD 10,855.00. Recipient: Example Household 207.",1040,0,1040,fdc-efebe608b41adce9d0de764a,synthetic-form-layout-02,original,2024,fte-d9fbaa44837450019757bebc,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: original amount: USD 10,411.00, net change: USD 10,411.00, correct amount: USD 10,411.00, explanation of changes: USD 10,411.00. Account holder: Example Person 300.",1040,0,1040,fdc-de14ef08da3b9779a5753984,synthetic-form-layout-03,original,2023,fte-d2ffc550fa7b3517ac43f002,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: original amount: USD 10,494.00, net change: USD 10,494.00, correct amount: USD 10,494.00, explanation of changes: USD 10,494.00. Account holder: Example Person 301.",1040,0,1040,fdc-34d15ed40c66006a5b0f4b87,synthetic-form-layout-03,original,2024,fte-d9392757ba6720ac3cf989af,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2025.
Details: original amount: USD 10,577.00, net change: USD 10,577.00, correct amount: USD 10,577.00, explanation of changes: USD 10,577.00. Account holder: Example Person 302.",1040,0,1040,fdc-a37d1b3850cf6b77f5e73918,synthetic-form-layout-03,original,2025,fte-bb9f6399c04f4926c0dece08,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: original amount: USD 10,660.00, net change: USD 10,660.00, correct amount: USD 10,660.00, explanation of changes: USD 10,660.00. Account holder: Example Person 303.",1040,0,1040,fdc-a75f3ac6146a70057e3d9ff4,synthetic-form-layout-03,original,2023,fte-de6fb1b4da273271803d3eaa,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: original amount: USD 10,743.00, net change: USD 10,743.00, correct amount: USD 10,743.00, explanation of changes: USD 10,743.00. Account holder: Example Person 304.",1040,0,1040,fdc-dbadc99026ab3d96293a226e,synthetic-form-layout-03,original,2024,fte-36b3e4c7794ccbecac3168bb,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2025.
Details: original amount: USD 10,826.00, net change: USD 10,826.00, correct amount: USD 10,826.00, explanation of changes: USD 10,826.00. Account holder: Example Person 305.",1040,0,1040,fdc-a0cb40a42f15961a95f25d9b,synthetic-form-layout-03,original,2025,fte-7cdb2922342564d9dd36a7e7,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: original amount: USD 10,909.00, net change: USD 10,909.00, correct amount: USD 10,909.00, explanation of changes: USD 10,909.00. Account holder: Example Person 306.",1040,0,1040,fdc-da4597b286e5d84d930b5525,synthetic-form-layout-03,original,2023,fte-cc3d8888a7d732f7a954597c,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: original amount: USD 10,992.00, net change: USD 10,992.00, correct amount: USD 10,992.00, explanation of changes: USD 10,992.00. Account holder: Example Person 307.",1040,0,1040,fdc-f6e80813c1200cc786e0cb8b,synthetic-form-layout-03,original,2024,fte-d2634dc28261d3a7bfa6da2e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2023
explanation of changes: USD 10,548.00
correct amount: USD 10,548.00
net change: USD 10,548.00
original amount: USD 10,548.00
Named party: Example Person 400",1040,0,1040,fdc-0d727c44179fa5398a162270,synthetic-form-layout-04,original,2023,fte-8f0f18100ac5b0940cea6769,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2024
explanation of changes: USD 10,631.00
correct amount: USD 10,631.00
net change: USD 10,631.00
original amount: USD 10,631.00
Named party: Example Person 401",1040,0,1040,fdc-f880a93c001174e769853108,synthetic-form-layout-04,original,2024,fte-a69aa65f2abe7ad22e6cfd80,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2025
explanation of changes: USD 10,714.00
correct amount: USD 10,714.00
net change: USD 10,714.00
original amount: USD 10,714.00
Named party: Example Person 402",1040,0,1040,fdc-57d6dfc8bb29bf6a4c71b20c,synthetic-form-layout-04,original,2025,fte-cac1200d5679f65dd9306d26,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2023
explanation of changes: USD 10,797.00
correct amount: USD 10,797.00
net change: USD 10,797.00
original amount: USD 10,797.00
Named party: Example Person 403",1040,0,1040,fdc-744754a160172a6c9480fcbe,synthetic-form-layout-04,original,2023,fte-75f38045a62eff92d9683d0e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2024
explanation of changes: USD 10,880.00
correct amount: USD 10,880.00
net change: USD 10,880.00
original amount: USD 10,880.00
Named party: Example Person 404",1040,0,1040,fdc-f84997608ba23b51185c1635,synthetic-form-layout-04,original,2024,fte-de0f91af566ccf962fdd8d8b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2025
explanation of changes: USD 10,963.00
correct amount: USD 10,963.00
net change: USD 10,963.00
original amount: USD 10,963.00
Named party: Example Person 405",1040,0,1040,fdc-e5245d28c839d986dbb93e91,synthetic-form-layout-04,original,2025,fte-7266e4f3d459485836d842ce,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2023
explanation of changes: USD 11,046.00
correct amount: USD 11,046.00
net change: USD 11,046.00
original amount: USD 11,046.00
Named party: Example Person 406",1040,0,1040,fdc-5499a1606e221eaf392170e6,synthetic-form-layout-04,original,2023,fte-2cd7dfb8fdb292e82cd6fdc2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-X: Amended US Individual Income Tax Return
Tax reporting year 2024
explanation of changes: USD 11,129.00
correct amount: USD 11,129.00
net change: USD 11,129.00
original amount: USD 11,129.00
Named party: Example Person 407",1040,0,1040,fdc-0ece6f0ec8d4188abadb06d0,synthetic-form-layout-04,original,2024,fte-a8da39a00ed96b1dd2d84af6,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2023
original amount: USD 10,685.00 / net change: USD 10,685.00 / correct amount: USD 10,685.00 / explanation of changes: USD 10,685.00
Delivery copy for Example Party 500",1040,0,1040,fdc-f3af223b1118562eeeb11c64,synthetic-form-layout-05,original,2023,fte-4327c332cfd430c9a44f97fb,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2024
original amount: USD 10,768.00 / net change: USD 10,768.00 / correct amount: USD 10,768.00 / explanation of changes: USD 10,768.00
Delivery copy for Example Party 501",1040,0,1040,fdc-92a6e2cdaa92d065cc3ab389,synthetic-form-layout-05,original,2024,fte-59620f7944460340c4ae2fba,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2025
original amount: USD 10,851.00 / net change: USD 10,851.00 / correct amount: USD 10,851.00 / explanation of changes: USD 10,851.00
Delivery copy for Example Party 502",1040,0,1040,fdc-43f563056d6b233343a64196,synthetic-form-layout-05,original,2025,fte-2fbce24e90b24b9f612a3afa,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2023
original amount: USD 10,934.00 / net change: USD 10,934.00 / correct amount: USD 10,934.00 / explanation of changes: USD 10,934.00
Delivery copy for Example Party 503",1040,0,1040,fdc-7536b758f737644132552db8,synthetic-form-layout-05,original,2023,fte-75cbbcf18281d016ef31c009,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2024
original amount: USD 11,017.00 / net change: USD 11,017.00 / correct amount: USD 11,017.00 / explanation of changes: USD 11,017.00
Delivery copy for Example Party 504",1040,0,1040,fdc-3ca44496ede4d9026edfdffa,synthetic-form-layout-05,original,2024,fte-7d5d06e012e9c7e6ad31b5cf,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2025
original amount: USD 11,100.00 / net change: USD 11,100.00 / correct amount: USD 11,100.00 / explanation of changes: USD 11,100.00
Delivery copy for Example Party 505",1040,0,1040,fdc-b3f3714a36960cbb0902bd72,synthetic-form-layout-05,original,2025,fte-e3527ce910568c7c8728e970,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2023
original amount: USD 11,183.00 / net change: USD 11,183.00 / correct amount: USD 11,183.00 / explanation of changes: USD 11,183.00
Delivery copy for Example Party 506",1040,0,1040,fdc-c1ba5d3eae1248edac3a6026,synthetic-form-layout-05,original,2023,fte-de7b34b052695cb8421b9b9d,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-X: Amended US Individual Income Tax Return -- reporting year 2024
original amount: USD 11,266.00 / net change: USD 11,266.00 / correct amount: USD 11,266.00 / explanation of changes: USD 11,266.00
Delivery copy for Example Party 507",1040,0,1040,fdc-6c5cdc64cfe6958c897c850e,synthetic-form-layout-05,original,2024,fte-4a48efa8f283bc21e892352a,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2023
Statement issued to Example Person 0.
estimated tax worksheet: USD 10,000.00
payment voucher: USD 10,000.00
taxpayer: Example Entity 0-0-2",1040,0,1040,fdc-8f18dfaa83da3c4fd34acb29,synthetic-form-layout-00,original,2023,fte-74e0fc38d8cfb9b6ce1d3ef8,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2024
Statement issued to Example Person 1.
estimated tax worksheet: USD 10,083.00
payment voucher: USD 10,083.00
taxpayer: Example Entity 0-1-2",1040,0,1040,fdc-9ecef61d1124bf08765b0dc5,synthetic-form-layout-00,original,2024,fte-e3aaadca6e68049f315bb7a3,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2025
Statement issued to Example Person 2.
estimated tax worksheet: USD 10,166.00
payment voucher: USD 10,166.00
taxpayer: Example Entity 0-2-2",1040,0,1040,fdc-5ff845c087fe10749b93179a,synthetic-form-layout-00,original,2025,fte-1c9734cbeea5d8c3407854d1,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2023
Statement issued to Example Person 3.
estimated tax worksheet: USD 10,249.00
payment voucher: USD 10,249.00
taxpayer: Example Entity 0-3-2",1040,0,1040,fdc-0ee5dacec25444128a43eca0,synthetic-form-layout-00,original,2023,fte-c977578c1f3673eb2b2682bc,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2024
Statement issued to Example Person 4.
estimated tax worksheet: USD 10,332.00
payment voucher: USD 10,332.00
taxpayer: Example Entity 0-4-2",1040,0,1040,fdc-4442c917ff70dc94e946a2d2,synthetic-form-layout-00,original,2024,fte-22b5cec1147e6519deb10db0,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2025
Statement issued to Example Person 5.
estimated tax worksheet: USD 10,415.00
payment voucher: USD 10,415.00
taxpayer: Example Entity 0-5-2",1040,0,1040,fdc-fff9d459fb399b23a75963b5,synthetic-form-layout-00,original,2025,fte-f367274a52257eaf48b7fc8e,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2023
Statement issued to Example Person 6.
estimated tax worksheet: USD 10,498.00
payment voucher: USD 10,498.00
taxpayer: Example Entity 0-6-2",1040,0,1040,fdc-5febf0cd8984b4a3fd860a6e,synthetic-form-layout-00,original,2023,fte-03c996615a8a25d16d3ea845,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Calendar year: 2024
Statement issued to Example Person 7.
estimated tax worksheet: USD 10,581.00
payment voucher: USD 10,581.00
taxpayer: Example Entity 0-7-2",1040,0,1040,fdc-c6109de73f6b72a7d5764baf,synthetic-form-layout-00,original,2024,fte-7122513de1638c15b9bda3cd,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 100
estimated tax worksheet: USD 10,137.00 | payment voucher: USD 10,137.00 | taxpayer: Example Entity 1-0-2",1040,0,1040,fdc-3ae931f81c72b42360867dda,synthetic-form-layout-01,original,2023,fte-439d6d2f274cf39ef2dee768,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 101
estimated tax worksheet: USD 10,220.00 | payment voucher: USD 10,220.00 | taxpayer: Example Entity 1-1-2",1040,0,1040,fdc-81f0692b577fe0f389667e0a,synthetic-form-layout-01,original,2024,fte-f5c5c3200f50ab5942ea5318,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 102
estimated tax worksheet: USD 10,303.00 | payment voucher: USD 10,303.00 | taxpayer: Example Entity 1-2-2",1040,0,1040,fdc-ada400f3330a5dba3e1dcd8a,synthetic-form-layout-01,original,2025,fte-14c57bf800c53406601b3be2,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 103
estimated tax worksheet: USD 10,386.00 | payment voucher: USD 10,386.00 | taxpayer: Example Entity 1-3-2",1040,0,1040,fdc-caeedf8443e30f5810805023,synthetic-form-layout-01,original,2023,fte-154c56eabd6bdb49ffa195d2,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 104
estimated tax worksheet: USD 10,469.00 | payment voucher: USD 10,469.00 | taxpayer: Example Entity 1-4-2",1040,0,1040,fdc-1a3abb7058d27d2121688fe0,synthetic-form-layout-01,original,2024,fte-f9c718b7fa4822eeda01e485,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 105
estimated tax worksheet: USD 10,552.00 | payment voucher: USD 10,552.00 | taxpayer: Example Entity 1-5-2",1040,0,1040,fdc-5f76a25cd4799d2d132e511b,synthetic-form-layout-01,original,2025,fte-e2bf0cb64406d977c814f199,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 106
estimated tax worksheet: USD 10,635.00 | payment voucher: USD 10,635.00 | taxpayer: Example Entity 1-6-2",1040,0,1040,fdc-63ab463a334759992b48070a,synthetic-form-layout-01,original,2023,fte-9ad6dfdbf726f7f901c7b176,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1040-ES: Estimated Tax for Individuals
Recipient record: Example Person 107
estimated tax worksheet: USD 10,718.00 | payment voucher: USD 10,718.00 | taxpayer: Example Entity 1-7-2",1040,0,1040,fdc-c6a54fa9ef1c30e83da5c8ef,synthetic-form-layout-01,original,2024,fte-dfa09b0079adfba6425268ea,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,274.00; payment voucher: USD 10,274.00; taxpayer: Example Entity 2-0-2. Recipient: Example Household 200.",1040,0,1040,fdc-98fe2d5e73e9bc0ae6739864,synthetic-form-layout-02,original,2023,fte-ef7576ab9a1989bb5f53d716,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,357.00; payment voucher: USD 10,357.00; taxpayer: Example Entity 2-1-2. Recipient: Example Household 201.",1040,0,1040,fdc-5c69c55ccb6fb88700d5b655,synthetic-form-layout-02,original,2024,fte-98004857dc64e9f4238f501b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,440.00; payment voucher: USD 10,440.00; taxpayer: Example Entity 2-2-2. Recipient: Example Household 202.",1040,0,1040,fdc-733d7c5ea3849adfc74dbebb,synthetic-form-layout-02,original,2025,fte-f432ca0f788df6e41813b281,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,523.00; payment voucher: USD 10,523.00; taxpayer: Example Entity 2-3-2. Recipient: Example Household 203.",1040,0,1040,fdc-59219b483dfd1698c0bd909a,synthetic-form-layout-02,original,2023,fte-2cc1f6c44b3aa721a1174847,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,606.00; payment voucher: USD 10,606.00; taxpayer: Example Entity 2-4-2. Recipient: Example Household 204.",1040,0,1040,fdc-34e33d2c8026c98e63e7dd4d,synthetic-form-layout-02,original,2024,fte-9de7c4d2a3760e7a411807cb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,689.00; payment voucher: USD 10,689.00; taxpayer: Example Entity 2-5-2. Recipient: Example Household 205.",1040,0,1040,fdc-b82a6513da5a4ab668b356b8,synthetic-form-layout-02,original,2025,fte-9e12b0cdf6b9cc9eec00575b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,772.00; payment voucher: USD 10,772.00; taxpayer: Example Entity 2-6-2. Recipient: Example Household 206.",1040,0,1040,fdc-0247732e0497524c53904955,synthetic-form-layout-02,original,2023,fte-ec6ec5014271e18841e80e4e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1040-ES: Estimated Tax for Individuals.
estimated tax worksheet: USD 10,855.00; payment voucher: USD 10,855.00; taxpayer: Example Entity 2-7-2. Recipient: Example Household 207.",1040,0,1040,fdc-78029cad7af33b3a9a499b18,synthetic-form-layout-02,original,2024,fte-c083a1de2a05033a19654483,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2023.
Details: estimated tax worksheet: USD 10,411.00, payment voucher: USD 10,411.00, taxpayer: Example Entity 3-0-2. Account holder: Example Person 300.",1040,0,1040,fdc-75c0a6daca02964a824e5ec6,synthetic-form-layout-03,original,2023,fte-8d8260828f9b4e44ea8ebead,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2024.
Details: estimated tax worksheet: USD 10,494.00, payment voucher: USD 10,494.00, taxpayer: Example Entity 3-1-2. Account holder: Example Person 301.",1040,0,1040,fdc-caa027261cb2f67c32b1d1dc,synthetic-form-layout-03,original,2024,fte-9102bcc4fd2dfcf62f21f258,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2025.
Details: estimated tax worksheet: USD 10,577.00, payment voucher: USD 10,577.00, taxpayer: Example Entity 3-2-2. Account holder: Example Person 302.",1040,0,1040,fdc-3e51b0a9f15585e1fdb29faa,synthetic-form-layout-03,original,2025,fte-5bd695bf2834902f79b77a04,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2023.
Details: estimated tax worksheet: USD 10,660.00, payment voucher: USD 10,660.00, taxpayer: Example Entity 3-3-2. Account holder: Example Person 303.",1040,0,1040,fdc-a17b7409710b443b18436cce,synthetic-form-layout-03,original,2023,fte-e078b7d6f9a507fb774f0699,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2024.
Details: estimated tax worksheet: USD 10,743.00, payment voucher: USD 10,743.00, taxpayer: Example Entity 3-4-2. Account holder: Example Person 304.",1040,0,1040,fdc-e5a7663897189ba6616e1ea8,synthetic-form-layout-03,original,2024,fte-87f6beceb76a820d372c41f4,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2025.
Details: estimated tax worksheet: USD 10,826.00, payment voucher: USD 10,826.00, taxpayer: Example Entity 3-5-2. Account holder: Example Person 305.",1040,0,1040,fdc-9c3451547915f66b879e7463,synthetic-form-layout-03,original,2025,fte-7cdddf39ecdfb8516ae09a07,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2023.
Details: estimated tax worksheet: USD 10,909.00, payment voucher: USD 10,909.00, taxpayer: Example Entity 3-6-2. Account holder: Example Person 306.",1040,0,1040,fdc-ef23fe6da051fb807304bf9e,synthetic-form-layout-03,original,2023,fte-6f3e0d8363933eddbe70df1f,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals
Reporting period ended 12/31/2024.
Details: estimated tax worksheet: USD 10,992.00, payment voucher: USD 10,992.00, taxpayer: Example Entity 3-7-2. Account holder: Example Person 307.",1040,0,1040,fdc-b2cf7f875bbe5db2496af7ab,synthetic-form-layout-03,original,2024,fte-c144264eb39114b3da9fee68,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2023
taxpayer: Example Entity 4-0-2
payment voucher: USD 10,548.00
estimated tax worksheet: USD 10,548.00
Named party: Example Person 400",1040,0,1040,fdc-57975cfc78229ed024444cca,synthetic-form-layout-04,original,2023,fte-f1c6dcacc0544f1ec5068c1e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2024
taxpayer: Example Entity 4-1-2
payment voucher: USD 10,631.00
estimated tax worksheet: USD 10,631.00
Named party: Example Person 401",1040,0,1040,fdc-6395a1f47df38c163c00248c,synthetic-form-layout-04,original,2024,fte-32cb20f2d009012356113e0b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2025
taxpayer: Example Entity 4-2-2
payment voucher: USD 10,714.00
estimated tax worksheet: USD 10,714.00
Named party: Example Person 402",1040,0,1040,fdc-2213ef7cb7740775b67c4788,synthetic-form-layout-04,original,2025,fte-4173eb6a1ecd6f3232a6d30f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2023
taxpayer: Example Entity 4-3-2
payment voucher: USD 10,797.00
estimated tax worksheet: USD 10,797.00
Named party: Example Person 403",1040,0,1040,fdc-9345c18fef6a583f6cf32fa5,synthetic-form-layout-04,original,2023,fte-f629b280a0d863c70407724e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2024
taxpayer: Example Entity 4-4-2
payment voucher: USD 10,880.00
estimated tax worksheet: USD 10,880.00
Named party: Example Person 404",1040,0,1040,fdc-4a3569d9eb81ffdbbdbb787e,synthetic-form-layout-04,original,2024,fte-664a070b3ad2e9f9fc092537,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2025
taxpayer: Example Entity 4-5-2
payment voucher: USD 10,963.00
estimated tax worksheet: USD 10,963.00
Named party: Example Person 405",1040,0,1040,fdc-0973c1d491e662bdc168e0d3,synthetic-form-layout-04,original,2025,fte-0e01f466ffb4d143d279664c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2023
taxpayer: Example Entity 4-6-2
payment voucher: USD 11,046.00
estimated tax worksheet: USD 11,046.00
Named party: Example Person 406",1040,0,1040,fdc-ad2031d8e564f5948cef2a30,synthetic-form-layout-04,original,2023,fte-2cf14eeb5d8038039d7d8243,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1040-ES: Estimated Tax for Individuals
Tax reporting year 2024
taxpayer: Example Entity 4-7-2
payment voucher: USD 11,129.00
estimated tax worksheet: USD 11,129.00
Named party: Example Person 407",1040,0,1040,fdc-7e35bde654f035e7b5074cb5,synthetic-form-layout-04,original,2024,fte-9e8f917f5f6106e96ddf7c45,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2023
estimated tax worksheet: USD 10,685.00 / payment voucher: USD 10,685.00 / taxpayer: Example Entity 5-0-2
Delivery copy for Example Party 500",1040,0,1040,fdc-76945e883990004e19b60a97,synthetic-form-layout-05,original,2023,fte-1e3eeb17a37a170d6b4b871a,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2024
estimated tax worksheet: USD 10,768.00 / payment voucher: USD 10,768.00 / taxpayer: Example Entity 5-1-2
Delivery copy for Example Party 501",1040,0,1040,fdc-6b8df3f95be67f1c719be86b,synthetic-form-layout-05,original,2024,fte-e290ffcaef11aa0c1e8ddd03,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2025
estimated tax worksheet: USD 10,851.00 / payment voucher: USD 10,851.00 / taxpayer: Example Entity 5-2-2
Delivery copy for Example Party 502",1040,0,1040,fdc-5b891613bc9d7a2dfed1ec6a,synthetic-form-layout-05,original,2025,fte-780eacaa1773d63efb5f1019,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2023
estimated tax worksheet: USD 10,934.00 / payment voucher: USD 10,934.00 / taxpayer: Example Entity 5-3-2
Delivery copy for Example Party 503",1040,0,1040,fdc-e0c952f1b3cfd2b1f1ab4203,synthetic-form-layout-05,original,2023,fte-a369affda0cf0b43f717d2cf,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2024
estimated tax worksheet: USD 11,017.00 / payment voucher: USD 11,017.00 / taxpayer: Example Entity 5-4-2
Delivery copy for Example Party 504",1040,0,1040,fdc-421f0bdd752fe7fc38e510a9,synthetic-form-layout-05,original,2024,fte-a4f244401a9960437b34d884,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2025
estimated tax worksheet: USD 11,100.00 / payment voucher: USD 11,100.00 / taxpayer: Example Entity 5-5-2
Delivery copy for Example Party 505",1040,0,1040,fdc-5e6719eb79e68d751bd13b1e,synthetic-form-layout-05,original,2025,fte-7690aa6569ad19123dfe973c,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2023
estimated tax worksheet: USD 11,183.00 / payment voucher: USD 11,183.00 / taxpayer: Example Entity 5-6-2
Delivery copy for Example Party 506",1040,0,1040,fdc-8e7a1f9ace6e4c97b89da163,synthetic-form-layout-05,original,2023,fte-704942163bacc505b13965e1,synthetic_AI_labeled,v1_template,top,False,
"Form 1040-ES: Estimated Tax for Individuals -- reporting year 2024
estimated tax worksheet: USD 11,266.00 / payment voucher: USD 11,266.00 / taxpayer: Example Entity 5-7-2
Delivery copy for Example Party 507",1040,0,1040,fdc-fbe7595facb81eeec38c558f,synthetic-form-layout-05,original,2024,fte-8f3ee018ee2c0aa02f863b26,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 0.
estimate of total tax liability: USD 10,000.00
payments: USD 10,000.00
balance due: USD 10,000.00",4868,13,4868,fdc-925393793e8414037a3503d4,synthetic-form-layout-00,original,2023,fte-52e21f2c3559b55d7d3c4acd,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 1.
estimate of total tax liability: USD 10,083.00
payments: USD 10,083.00
balance due: USD 10,083.00",4868,13,4868,fdc-0a4bb9b69e7241d98ec145eb,synthetic-form-layout-00,original,2024,fte-3b3a5936594059c5ff9a5fd4,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2025
Statement issued to Example Person 2.
estimate of total tax liability: USD 10,166.00
payments: USD 10,166.00
balance due: USD 10,166.00",4868,13,4868,fdc-d774d478dfcf3be9af6900a0,synthetic-form-layout-00,original,2025,fte-eb81fdb49720ab01920072ae,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 3.
estimate of total tax liability: USD 10,249.00
payments: USD 10,249.00
balance due: USD 10,249.00",4868,13,4868,fdc-e9c069636f5c815d71da42fd,synthetic-form-layout-00,original,2023,fte-951b1e87e7da7b80ea2b5738,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 4.
estimate of total tax liability: USD 10,332.00
payments: USD 10,332.00
balance due: USD 10,332.00",4868,13,4868,fdc-2d7334fbca94f4bdb478d1c8,synthetic-form-layout-00,original,2024,fte-f970291591062289f626242f,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2025
Statement issued to Example Person 5.
estimate of total tax liability: USD 10,415.00
payments: USD 10,415.00
balance due: USD 10,415.00",4868,13,4868,fdc-6dd0634235b65f6a9bb1d6a2,synthetic-form-layout-00,original,2025,fte-de675fc26be18a3988751784,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2023
Statement issued to Example Person 6.
estimate of total tax liability: USD 10,498.00
payments: USD 10,498.00
balance due: USD 10,498.00",4868,13,4868,fdc-9c15bbf7b80de8a92abe7b29,synthetic-form-layout-00,original,2023,fte-fe545a61888c95c2356e184b,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Calendar year: 2024
Statement issued to Example Person 7.
estimate of total tax liability: USD 10,581.00
payments: USD 10,581.00
balance due: USD 10,581.00",4868,13,4868,fdc-25fcbc51868ea6ada7b56ae9,synthetic-form-layout-00,original,2024,fte-2fcddaeeb10af72b7f81aef2,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 100
estimate of total tax liability: USD 10,137.00 | payments: USD 10,137.00 | balance due: USD 10,137.00",4868,13,4868,fdc-00fbb306fe3acbe1cad5ab23,synthetic-form-layout-01,original,2023,fte-546ccac867230ac02ffc9ad2,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 101
estimate of total tax liability: USD 10,220.00 | payments: USD 10,220.00 | balance due: USD 10,220.00",4868,13,4868,fdc-7dade5d4d2d6627853fc6718,synthetic-form-layout-01,original,2024,fte-d117b5d36b0f4d4b91b15574,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 102
estimate of total tax liability: USD 10,303.00 | payments: USD 10,303.00 | balance due: USD 10,303.00",4868,13,4868,fdc-0fb4dc254d18c85161f170c3,synthetic-form-layout-01,original,2025,fte-f4edc48cf09acfcf85a42065,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 103
estimate of total tax liability: USD 10,386.00 | payments: USD 10,386.00 | balance due: USD 10,386.00",4868,13,4868,fdc-570d882613a30eec5b719d30,synthetic-form-layout-01,original,2023,fte-223d91b48098e0a4b0b44998,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 104
estimate of total tax liability: USD 10,469.00 | payments: USD 10,469.00 | balance due: USD 10,469.00",4868,13,4868,fdc-8ed83c90925930a46f980ddf,synthetic-form-layout-01,original,2024,fte-b2b3170830347c1de8fd0954,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 105
estimate of total tax liability: USD 10,552.00 | payments: USD 10,552.00 | balance due: USD 10,552.00",4868,13,4868,fdc-ba1a913e8550be6545026177,synthetic-form-layout-01,original,2025,fte-d3e84f2500771ba09f332a49,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 106
estimate of total tax liability: USD 10,635.00 | payments: USD 10,635.00 | balance due: USD 10,635.00",4868,13,4868,fdc-529d5d07a1f5547dfd73bd63,synthetic-form-layout-01,original,2023,fte-ad0807ca82cb6150120fba4b,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Recipient record: Example Person 107
estimate of total tax liability: USD 10,718.00 | payments: USD 10,718.00 | balance due: USD 10,718.00",4868,13,4868,fdc-be43a1638f5e7134eb761e83,synthetic-form-layout-01,original,2024,fte-280cd7bc6a600dc8d7d1e13f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,274.00; payments: USD 10,274.00; balance due: USD 10,274.00. Recipient: Example Household 200.",4868,13,4868,fdc-4e8c880167e3ebc40af10d88,synthetic-form-layout-02,original,2023,fte-618a79248204214603ae69b1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,357.00; payments: USD 10,357.00; balance due: USD 10,357.00. Recipient: Example Household 201.",4868,13,4868,fdc-951a63d85db242b8735dabc4,synthetic-form-layout-02,original,2024,fte-b1d8525afe5712a39618bfcc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,440.00; payments: USD 10,440.00; balance due: USD 10,440.00. Recipient: Example Household 202.",4868,13,4868,fdc-82b20bff8b803b0252b8318f,synthetic-form-layout-02,original,2025,fte-4cdad1e584b9294d1ed5b6ec,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,523.00; payments: USD 10,523.00; balance due: USD 10,523.00. Recipient: Example Household 203.",4868,13,4868,fdc-477eec38d2972a3de2f762fa,synthetic-form-layout-02,original,2023,fte-2568abe172781297ff8077ef,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,606.00; payments: USD 10,606.00; balance due: USD 10,606.00. Recipient: Example Household 204.",4868,13,4868,fdc-80521d8a1a8a056e5c020afd,synthetic-form-layout-02,original,2024,fte-6db2b7597621b9073756ca78,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,689.00; payments: USD 10,689.00; balance due: USD 10,689.00. Recipient: Example Household 205.",4868,13,4868,fdc-e13c04392a0724e8f25de07d,synthetic-form-layout-02,original,2025,fte-e82ea34f7dd6f8819a9e6fc2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,772.00; payments: USD 10,772.00; balance due: USD 10,772.00. Recipient: Example Household 206.",4868,13,4868,fdc-ef509b55fd36eeac85507296,synthetic-form-layout-02,original,2023,fte-457d8c92e551a390ad803982,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return.
estimate of total tax liability: USD 10,855.00; payments: USD 10,855.00; balance due: USD 10,855.00. Recipient: Example Household 207.",4868,13,4868,fdc-ad70be9d1286d99097abb93d,synthetic-form-layout-02,original,2024,fte-4ba91684a9911b723a8585db,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: estimate of total tax liability: USD 10,411.00, payments: USD 10,411.00, balance due: USD 10,411.00. Account holder: Example Person 300.",4868,13,4868,fdc-fbf79946fbed214b0afcdc39,synthetic-form-layout-03,original,2023,fte-7e704aa5dfd80d464e9e8fdd,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: estimate of total tax liability: USD 10,494.00, payments: USD 10,494.00, balance due: USD 10,494.00. Account holder: Example Person 301.",4868,13,4868,fdc-2716537e59815e3a52c30962,synthetic-form-layout-03,original,2024,fte-e59625224e2bdb45d789e368,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2025.
Details: estimate of total tax liability: USD 10,577.00, payments: USD 10,577.00, balance due: USD 10,577.00. Account holder: Example Person 302.",4868,13,4868,fdc-6bb461b6470e1a870ad52b20,synthetic-form-layout-03,original,2025,fte-49a574b90a02788824e91f51,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: estimate of total tax liability: USD 10,660.00, payments: USD 10,660.00, balance due: USD 10,660.00. Account holder: Example Person 303.",4868,13,4868,fdc-20521b3f9271eb4f23bd3bd6,synthetic-form-layout-03,original,2023,fte-6b64d35ca998b5adeaead751,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: estimate of total tax liability: USD 10,743.00, payments: USD 10,743.00, balance due: USD 10,743.00. Account holder: Example Person 304.",4868,13,4868,fdc-8b840cff9a073269aac7ca03,synthetic-form-layout-03,original,2024,fte-df44d092b0ecd285fd666eaf,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2025.
Details: estimate of total tax liability: USD 10,826.00, payments: USD 10,826.00, balance due: USD 10,826.00. Account holder: Example Person 305.",4868,13,4868,fdc-4e72c2a290add93df81245f6,synthetic-form-layout-03,original,2025,fte-93d38284807975bbd838b615,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2023.
Details: estimate of total tax liability: USD 10,909.00, payments: USD 10,909.00, balance due: USD 10,909.00. Account holder: Example Person 306.",4868,13,4868,fdc-f364fdcce14b38f6462a659e,synthetic-form-layout-03,original,2023,fte-4dcac60b2aefe8f505fd56eb,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Reporting period ended 12/31/2024.
Details: estimate of total tax liability: USD 10,992.00, payments: USD 10,992.00, balance due: USD 10,992.00. Account holder: Example Person 307.",4868,13,4868,fdc-376a535dd7d0c40c4cb75e43,synthetic-form-layout-03,original,2024,fte-ec20687300aca1256d0d9343,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2023
balance due: USD 10,548.00
payments: USD 10,548.00
estimate of total tax liability: USD 10,548.00
Named party: Example Person 400",4868,13,4868,fdc-838ff23513cea184b9c1090c,synthetic-form-layout-04,original,2023,fte-58a1fe16f2c81d7634ecf1a8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2024
balance due: USD 10,631.00
payments: USD 10,631.00
estimate of total tax liability: USD 10,631.00
Named party: Example Person 401",4868,13,4868,fdc-18fa2d7ec30488d86c096683,synthetic-form-layout-04,original,2024,fte-b6633c0798a4b1c7aa3101ef,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2025
balance due: USD 10,714.00
payments: USD 10,714.00
estimate of total tax liability: USD 10,714.00
Named party: Example Person 402",4868,13,4868,fdc-0bb71b1f88af655f5678ea0a,synthetic-form-layout-04,original,2025,fte-6a9060a638bc6b212ce39930,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2023
balance due: USD 10,797.00
payments: USD 10,797.00
estimate of total tax liability: USD 10,797.00
Named party: Example Person 403",4868,13,4868,fdc-9e8eb9f742bd1ac0af10d496,synthetic-form-layout-04,original,2023,fte-07ebdbce7fce3fbcb3ebfa79,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2024
balance due: USD 10,880.00
payments: USD 10,880.00
estimate of total tax liability: USD 10,880.00
Named party: Example Person 404",4868,13,4868,fdc-59a05c99591ea59b7cecfb86,synthetic-form-layout-04,original,2024,fte-272dce49a3e0c5c255500fac,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2025
balance due: USD 10,963.00
payments: USD 10,963.00
estimate of total tax liability: USD 10,963.00
Named party: Example Person 405",4868,13,4868,fdc-b7acb899d6ddf416c37c381c,synthetic-form-layout-04,original,2025,fte-d4dbfc7844fc92b40cd841c9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2023
balance due: USD 11,046.00
payments: USD 11,046.00
estimate of total tax liability: USD 11,046.00
Named party: Example Person 406",4868,13,4868,fdc-13b461ec1383d2e35c4e340d,synthetic-form-layout-04,original,2023,fte-3774b6ee5b5cf51448f8e3d8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return
Tax reporting year 2024
balance due: USD 11,129.00
payments: USD 11,129.00
estimate of total tax liability: USD 11,129.00
Named party: Example Person 407",4868,13,4868,fdc-7fba1878f09125cec8ba4760,synthetic-form-layout-04,original,2024,fte-933953faadb0e9c6e8f8077d,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2023
estimate of total tax liability: USD 10,685.00 / payments: USD 10,685.00 / balance due: USD 10,685.00
Delivery copy for Example Party 500",4868,13,4868,fdc-d6a4bb1cb7a162b1792a4cd4,synthetic-form-layout-05,original,2023,fte-d1fc2d36dda890f1bf1126b7,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2024
estimate of total tax liability: USD 10,768.00 / payments: USD 10,768.00 / balance due: USD 10,768.00
Delivery copy for Example Party 501",4868,13,4868,fdc-600f9c280c0f835eae40c0af,synthetic-form-layout-05,original,2024,fte-909031227d665b1a869e4f7b,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2025
estimate of total tax liability: USD 10,851.00 / payments: USD 10,851.00 / balance due: USD 10,851.00
Delivery copy for Example Party 502",4868,13,4868,fdc-c2f9a9ac7ea5ec2a327a2575,synthetic-form-layout-05,original,2025,fte-6653c8b335d339805269d650,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2023
estimate of total tax liability: USD 10,934.00 / payments: USD 10,934.00 / balance due: USD 10,934.00
Delivery copy for Example Party 503",4868,13,4868,fdc-65d27aad240391feb98d944e,synthetic-form-layout-05,original,2023,fte-ee929b2753f6780c784c40c3,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2024
estimate of total tax liability: USD 11,017.00 / payments: USD 11,017.00 / balance due: USD 11,017.00
Delivery copy for Example Party 504",4868,13,4868,fdc-b2dcd14b6881f2765af7aa55,synthetic-form-layout-05,original,2024,fte-72020a4f45923090f4f4356b,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2025
estimate of total tax liability: USD 11,100.00 / payments: USD 11,100.00 / balance due: USD 11,100.00
Delivery copy for Example Party 505",4868,13,4868,fdc-02b3066ae0465ac5d7ce94e9,synthetic-form-layout-05,original,2025,fte-ba03e17d4fb8ac12fda92c37,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2023
estimate of total tax liability: USD 11,183.00 / payments: USD 11,183.00 / balance due: USD 11,183.00
Delivery copy for Example Party 506",4868,13,4868,fdc-c1b7174bf6ec0a33adc7c735,synthetic-form-layout-05,original,2023,fte-06559af0a3c2d0e1ae051402,synthetic_AI_labeled,v1_template,top,False,
"Form 4868: Application for Automatic Extension of Time To File US Individual Income Tax Return -- reporting year 2024
estimate of total tax liability: USD 11,266.00 / payments: USD 11,266.00 / balance due: USD 11,266.00
Delivery copy for Example Party 507",4868,13,4868,fdc-9b19af85eabc70331f879e25,synthetic-form-layout-05,original,2024,fte-35f61e80223caf708a14e1ab,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2023
Statement issued to Example Person 0.
partnership: Example Entity 0-0-0
ordinary business income: USD 10,000.00
deductions: USD 10,000.00
partners: Example Entity 0-0-3",1065,2,1065,fdc-b9b086c34cf9c222db54f217,synthetic-form-layout-00,original,2023,fte-e6d0060b2f2d7f28f9257690,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2024
Statement issued to Example Person 1.
partnership: Example Entity 0-1-0
ordinary business income: USD 10,083.00
deductions: USD 10,083.00
partners: Example Entity 0-1-3",1065,2,1065,fdc-20e223cb1d6d02208713558a,synthetic-form-layout-00,original,2024,fte-664357bc20fd9943b6776dc3,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2025
Statement issued to Example Person 2.
partnership: Example Entity 0-2-0
ordinary business income: USD 10,166.00
deductions: USD 10,166.00
partners: Example Entity 0-2-3",1065,2,1065,fdc-ef46ea307fc9668b45ad1c93,synthetic-form-layout-00,original,2025,fte-9fda6c4d3c6104c9e7a79e5c,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2023
Statement issued to Example Person 3.
partnership: Example Entity 0-3-0
ordinary business income: USD 10,249.00
deductions: USD 10,249.00
partners: Example Entity 0-3-3",1065,2,1065,fdc-e26ed959a5187c9b07604e21,synthetic-form-layout-00,original,2023,fte-8b086bc376d367a72957a78b,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2024
Statement issued to Example Person 4.
partnership: Example Entity 0-4-0
ordinary business income: USD 10,332.00
deductions: USD 10,332.00
partners: Example Entity 0-4-3",1065,2,1065,fdc-5131994c45bdfc0a6963f338,synthetic-form-layout-00,original,2024,fte-d5da05f8269fdc43eba4de58,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2025
Statement issued to Example Person 5.
partnership: Example Entity 0-5-0
ordinary business income: USD 10,415.00
deductions: USD 10,415.00
partners: Example Entity 0-5-3",1065,2,1065,fdc-feadfa06b5dd3b55fae7ab7d,synthetic-form-layout-00,original,2025,fte-863c2ba1ba69596c1762259e,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2023
Statement issued to Example Person 6.
partnership: Example Entity 0-6-0
ordinary business income: USD 10,498.00
deductions: USD 10,498.00
partners: Example Entity 0-6-3",1065,2,1065,fdc-90762451d75980d24e1f4103,synthetic-form-layout-00,original,2023,fte-2716e2d696e1c62bf0f312cb,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Calendar year: 2024
Statement issued to Example Person 7.
partnership: Example Entity 0-7-0
ordinary business income: USD 10,581.00
deductions: USD 10,581.00
partners: Example Entity 0-7-3",1065,2,1065,fdc-47e21d4b2c756199c5a9385e,synthetic-form-layout-00,original,2024,fte-fdcdcdd499331e5d6887e616,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 100
partnership: Example Entity 1-0-0 | ordinary business income: USD 10,137.00 | deductions: USD 10,137.00 | partners: Example Entity 1-0-3",1065,2,1065,fdc-a4fec6b9c7933656617fac00,synthetic-form-layout-01,original,2023,fte-fb92346c0fa92408b196c6bd,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 101
partnership: Example Entity 1-1-0 | ordinary business income: USD 10,220.00 | deductions: USD 10,220.00 | partners: Example Entity 1-1-3",1065,2,1065,fdc-ccf2346a5d061cf7c4b957f5,synthetic-form-layout-01,original,2024,fte-5e32fad4a305bc5755602de6,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 102
partnership: Example Entity 1-2-0 | ordinary business income: USD 10,303.00 | deductions: USD 10,303.00 | partners: Example Entity 1-2-3",1065,2,1065,fdc-d8fecc34522d0e710e57b56d,synthetic-form-layout-01,original,2025,fte-a4468bbb3538b1535a61f837,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 103
partnership: Example Entity 1-3-0 | ordinary business income: USD 10,386.00 | deductions: USD 10,386.00 | partners: Example Entity 1-3-3",1065,2,1065,fdc-9804943273be2d5ddc09ce73,synthetic-form-layout-01,original,2023,fte-7f3fee53fe4b217961e23c70,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 104
partnership: Example Entity 1-4-0 | ordinary business income: USD 10,469.00 | deductions: USD 10,469.00 | partners: Example Entity 1-4-3",1065,2,1065,fdc-3a810ea8f8d7efc6c060330a,synthetic-form-layout-01,original,2024,fte-fc6f09b25518850672533d2a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 105
partnership: Example Entity 1-5-0 | ordinary business income: USD 10,552.00 | deductions: USD 10,552.00 | partners: Example Entity 1-5-3",1065,2,1065,fdc-bc16606e2a9c1e4f66c55fa2,synthetic-form-layout-01,original,2025,fte-a9fea978b91a98e2912a745c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 106
partnership: Example Entity 1-6-0 | ordinary business income: USD 10,635.00 | deductions: USD 10,635.00 | partners: Example Entity 1-6-3",1065,2,1065,fdc-a70e5cf64ab5f33d41bf0bac,synthetic-form-layout-01,original,2023,fte-7d319cfd1a08436c4ad389a3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1065: US Return of Partnership Income
Recipient record: Example Person 107
partnership: Example Entity 1-7-0 | ordinary business income: USD 10,718.00 | deductions: USD 10,718.00 | partners: Example Entity 1-7-3",1065,2,1065,fdc-c5cfcad064ca25c52cd6020c,synthetic-form-layout-01,original,2024,fte-dbbb28134a64ea34b8c24d14,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-0-0; ordinary business income: USD 10,274.00; deductions: USD 10,274.00; partners: Example Entity 2-0-3. Recipient: Example Household 200.",1065,2,1065,fdc-328f500913db95a7eb61f014,synthetic-form-layout-02,original,2023,fte-c1f8b99a317686edbdb5c6c2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-1-0; ordinary business income: USD 10,357.00; deductions: USD 10,357.00; partners: Example Entity 2-1-3. Recipient: Example Household 201.",1065,2,1065,fdc-95fa6a53ea835ab67ffd8c05,synthetic-form-layout-02,original,2024,fte-b437c2cc5e852888441229d9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-2-0; ordinary business income: USD 10,440.00; deductions: USD 10,440.00; partners: Example Entity 2-2-3. Recipient: Example Household 202.",1065,2,1065,fdc-2f36399c5b95bc8558cc2e16,synthetic-form-layout-02,original,2025,fte-68bf01dabeec262e28ce7b27,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-3-0; ordinary business income: USD 10,523.00; deductions: USD 10,523.00; partners: Example Entity 2-3-3. Recipient: Example Household 203.",1065,2,1065,fdc-e0c2b4cefd2711696070303c,synthetic-form-layout-02,original,2023,fte-1169fe84002d2f6d1e7b1da1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-4-0; ordinary business income: USD 10,606.00; deductions: USD 10,606.00; partners: Example Entity 2-4-3. Recipient: Example Household 204.",1065,2,1065,fdc-17b2a63f4bfe99790846400a,synthetic-form-layout-02,original,2024,fte-b36f9404c11cd64e710efadf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-5-0; ordinary business income: USD 10,689.00; deductions: USD 10,689.00; partners: Example Entity 2-5-3. Recipient: Example Household 205.",1065,2,1065,fdc-f76d76ed84fbaa23cd6ec369,synthetic-form-layout-02,original,2025,fte-ca5e8ec3f0d5d8d66a2337e4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-6-0; ordinary business income: USD 10,772.00; deductions: USD 10,772.00; partners: Example Entity 2-6-3. Recipient: Example Household 206.",1065,2,1065,fdc-66c4706a808d33f1c0d94f67,synthetic-form-layout-02,original,2023,fte-4d389923d1feec4b1c2689d7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1065: US Return of Partnership Income.
partnership: Example Entity 2-7-0; ordinary business income: USD 10,855.00; deductions: USD 10,855.00; partners: Example Entity 2-7-3. Recipient: Example Household 207.",1065,2,1065,fdc-e84e938ecd9860721c930935,synthetic-form-layout-02,original,2024,fte-ffff59865c4154ab58f6ac30,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2023.
Details: partnership: Example Entity 3-0-0, ordinary business income: USD 10,411.00, deductions: USD 10,411.00, partners: Example Entity 3-0-3. Account holder: Example Person 300.",1065,2,1065,fdc-96606625a37b0834d2f88bc8,synthetic-form-layout-03,original,2023,fte-cb133ecaba91f92aa16ccdb2,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2024.
Details: partnership: Example Entity 3-1-0, ordinary business income: USD 10,494.00, deductions: USD 10,494.00, partners: Example Entity 3-1-3. Account holder: Example Person 301.",1065,2,1065,fdc-d8d304a17670cc84004f0126,synthetic-form-layout-03,original,2024,fte-213d1dc614804590ae48b654,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2025.
Details: partnership: Example Entity 3-2-0, ordinary business income: USD 10,577.00, deductions: USD 10,577.00, partners: Example Entity 3-2-3. Account holder: Example Person 302.",1065,2,1065,fdc-eda3b0409e4cd10902c0d505,synthetic-form-layout-03,original,2025,fte-c86abb1dbc0d6255c7158c4e,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2023.
Details: partnership: Example Entity 3-3-0, ordinary business income: USD 10,660.00, deductions: USD 10,660.00, partners: Example Entity 3-3-3. Account holder: Example Person 303.",1065,2,1065,fdc-48d0e5bd9e28916fd9cf256a,synthetic-form-layout-03,original,2023,fte-170de5b48028aaac8ae55d0e,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2024.
Details: partnership: Example Entity 3-4-0, ordinary business income: USD 10,743.00, deductions: USD 10,743.00, partners: Example Entity 3-4-3. Account holder: Example Person 304.",1065,2,1065,fdc-216664b40d9ce0186118c1e6,synthetic-form-layout-03,original,2024,fte-fbe646c2378fc1af333a0f22,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2025.
Details: partnership: Example Entity 3-5-0, ordinary business income: USD 10,826.00, deductions: USD 10,826.00, partners: Example Entity 3-5-3. Account holder: Example Person 305.",1065,2,1065,fdc-93389d27a49d4bc06d1b4ebf,synthetic-form-layout-03,original,2025,fte-fe20ef926631ac3a5fcd7a7a,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2023.
Details: partnership: Example Entity 3-6-0, ordinary business income: USD 10,909.00, deductions: USD 10,909.00, partners: Example Entity 3-6-3. Account holder: Example Person 306.",1065,2,1065,fdc-f6a63df012d6d64942524721,synthetic-form-layout-03,original,2023,fte-87d2672b928f622a394fdff8,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income
Reporting period ended 12/31/2024.
Details: partnership: Example Entity 3-7-0, ordinary business income: USD 10,992.00, deductions: USD 10,992.00, partners: Example Entity 3-7-3. Account holder: Example Person 307.",1065,2,1065,fdc-a3400294914a925bf5fabd65,synthetic-form-layout-03,original,2024,fte-f98e05bd0cbbd9b123815b69,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2023
partners: Example Entity 4-0-3
deductions: USD 10,548.00
ordinary business income: USD 10,548.00
partnership: Example Entity 4-0-0
Named party: Example Person 400",1065,2,1065,fdc-4a431494d3b999b96346106e,synthetic-form-layout-04,original,2023,fte-f1d1550a89bb05146d818def,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2024
partners: Example Entity 4-1-3
deductions: USD 10,631.00
ordinary business income: USD 10,631.00
partnership: Example Entity 4-1-0
Named party: Example Person 401",1065,2,1065,fdc-44115e02ccf8a3a5ccaf73ce,synthetic-form-layout-04,original,2024,fte-2b2aedd514ffcbbcee0dfdcd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2025
partners: Example Entity 4-2-3
deductions: USD 10,714.00
ordinary business income: USD 10,714.00
partnership: Example Entity 4-2-0
Named party: Example Person 402",1065,2,1065,fdc-7469a3b94cd9cead435ac6a4,synthetic-form-layout-04,original,2025,fte-79e586490fb5e8ccd07425de,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2023
partners: Example Entity 4-3-3
deductions: USD 10,797.00
ordinary business income: USD 10,797.00
partnership: Example Entity 4-3-0
Named party: Example Person 403",1065,2,1065,fdc-d09560f4c59e8c2a337cf52d,synthetic-form-layout-04,original,2023,fte-ea267c984212b5054844c239,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2024
partners: Example Entity 4-4-3
deductions: USD 10,880.00
ordinary business income: USD 10,880.00
partnership: Example Entity 4-4-0
Named party: Example Person 404",1065,2,1065,fdc-6c14b6ead1d974695762d9b1,synthetic-form-layout-04,original,2024,fte-f6e91ff2a2bb22663966ca4f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2025
partners: Example Entity 4-5-3
deductions: USD 10,963.00
ordinary business income: USD 10,963.00
partnership: Example Entity 4-5-0
Named party: Example Person 405",1065,2,1065,fdc-ddc260d07cbd088037a9eac4,synthetic-form-layout-04,original,2025,fte-b6d851b7cd14ec358f77d6a3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2023
partners: Example Entity 4-6-3
deductions: USD 11,046.00
ordinary business income: USD 11,046.00
partnership: Example Entity 4-6-0
Named party: Example Person 406",1065,2,1065,fdc-b94dc2a6d0fbbaa097d121e5,synthetic-form-layout-04,original,2023,fte-cc02f2c61a52c31fcb17dfbb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1065: US Return of Partnership Income
Tax reporting year 2024
partners: Example Entity 4-7-3
deductions: USD 11,129.00
ordinary business income: USD 11,129.00
partnership: Example Entity 4-7-0
Named party: Example Person 407",1065,2,1065,fdc-9e7aca73376de93e0a21e356,synthetic-form-layout-04,original,2024,fte-c14d5e8ee685cd03f79a71ed,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2023
partnership: Example Entity 5-0-0 / ordinary business income: USD 10,685.00 / deductions: USD 10,685.00 / partners: Example Entity 5-0-3
Delivery copy for Example Party 500",1065,2,1065,fdc-4521272cae1d1018f780804e,synthetic-form-layout-05,original,2023,fte-85ede1a9cef6f204d484e24d,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2024
partnership: Example Entity 5-1-0 / ordinary business income: USD 10,768.00 / deductions: USD 10,768.00 / partners: Example Entity 5-1-3
Delivery copy for Example Party 501",1065,2,1065,fdc-0daec12eb686931659b262cf,synthetic-form-layout-05,original,2024,fte-b547788905e22c64d934891f,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2025
partnership: Example Entity 5-2-0 / ordinary business income: USD 10,851.00 / deductions: USD 10,851.00 / partners: Example Entity 5-2-3
Delivery copy for Example Party 502",1065,2,1065,fdc-a3bc22305a34550c8dd68359,synthetic-form-layout-05,original,2025,fte-5383efe7859a1dd9f93fbada,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2023
partnership: Example Entity 5-3-0 / ordinary business income: USD 10,934.00 / deductions: USD 10,934.00 / partners: Example Entity 5-3-3
Delivery copy for Example Party 503",1065,2,1065,fdc-76111a23c57d3d4ccf6e2bab,synthetic-form-layout-05,original,2023,fte-6aad94618c9516af48558c03,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2024
partnership: Example Entity 5-4-0 / ordinary business income: USD 11,017.00 / deductions: USD 11,017.00 / partners: Example Entity 5-4-3
Delivery copy for Example Party 504",1065,2,1065,fdc-f7a87531d567d8c3757cb2e2,synthetic-form-layout-05,original,2024,fte-8e92bb62bb81b5a29bdeed28,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2025
partnership: Example Entity 5-5-0 / ordinary business income: USD 11,100.00 / deductions: USD 11,100.00 / partners: Example Entity 5-5-3
Delivery copy for Example Party 505",1065,2,1065,fdc-6938bf50a661e5fa7060226b,synthetic-form-layout-05,original,2025,fte-9ca71caa15d6d39e4e473122,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2023
partnership: Example Entity 5-6-0 / ordinary business income: USD 11,183.00 / deductions: USD 11,183.00 / partners: Example Entity 5-6-3
Delivery copy for Example Party 506",1065,2,1065,fdc-d3a06fb5e3e07137823e9db6,synthetic-form-layout-05,original,2023,fte-af47c6c643ce3b5001e595bf,synthetic_AI_labeled,v1_template,top,False,
"Form 1065: US Return of Partnership Income -- reporting year 2024
partnership: Example Entity 5-7-0 / ordinary business income: USD 11,266.00 / deductions: USD 11,266.00 / partners: Example Entity 5-7-3
Delivery copy for Example Party 507",1065,2,1065,fdc-2500334a76112599dbbaed7b,synthetic-form-layout-05,original,2024,fte-53443cdedb07771eaa742df9,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2023
Statement issued to Example Person 0.
corporation: USD 10,000.00
ordinary business income: USD 10,000.00
deductions: USD 10,000.00
shareholders: Example Entity 0-0-3",1120-S,7,1120-S,fdc-34eec559bbbf67f8fdcc03e7,synthetic-form-layout-00,original,2023,fte-76a79d677084a53d176c7ba2,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2024
Statement issued to Example Person 1.
corporation: USD 10,083.00
ordinary business income: USD 10,083.00
deductions: USD 10,083.00
shareholders: Example Entity 0-1-3",1120-S,7,1120-S,fdc-34429adb6a9fbb9f427beb77,synthetic-form-layout-00,original,2024,fte-2e05ebe4bbd96e47125c1a2e,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2025
Statement issued to Example Person 2.
corporation: USD 10,166.00
ordinary business income: USD 10,166.00
deductions: USD 10,166.00
shareholders: Example Entity 0-2-3",1120-S,7,1120-S,fdc-ec5653f445e06e9198f19f23,synthetic-form-layout-00,original,2025,fte-8a3eb03391ef05c7a34641cc,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2023
Statement issued to Example Person 3.
corporation: USD 10,249.00
ordinary business income: USD 10,249.00
deductions: USD 10,249.00
shareholders: Example Entity 0-3-3",1120-S,7,1120-S,fdc-55d2a8bffd5464918ba364d4,synthetic-form-layout-00,original,2023,fte-994108a61b1d85c58ee9c72f,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2024
Statement issued to Example Person 4.
corporation: USD 10,332.00
ordinary business income: USD 10,332.00
deductions: USD 10,332.00
shareholders: Example Entity 0-4-3",1120-S,7,1120-S,fdc-9ea314343e888dd83b94e60e,synthetic-form-layout-00,original,2024,fte-5e0cfaba782e0aaacd5553ad,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2025
Statement issued to Example Person 5.
corporation: USD 10,415.00
ordinary business income: USD 10,415.00
deductions: USD 10,415.00
shareholders: Example Entity 0-5-3",1120-S,7,1120-S,fdc-5bef0a30dd15377d1541ec27,synthetic-form-layout-00,original,2025,fte-cf1ccc6483bffcec988665e8,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2023
Statement issued to Example Person 6.
corporation: USD 10,498.00
ordinary business income: USD 10,498.00
deductions: USD 10,498.00
shareholders: Example Entity 0-6-3",1120-S,7,1120-S,fdc-13b17453301deb70b918279c,synthetic-form-layout-00,original,2023,fte-b98ba2adc87c48d918a32c51,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Calendar year: 2024
Statement issued to Example Person 7.
corporation: USD 10,581.00
ordinary business income: USD 10,581.00
deductions: USD 10,581.00
shareholders: Example Entity 0-7-3",1120-S,7,1120-S,fdc-e0103e1fe50f18b486b58f29,synthetic-form-layout-00,original,2024,fte-4c02aa86071476ff5f32a0fa,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 100
corporation: USD 10,137.00 | ordinary business income: USD 10,137.00 | deductions: USD 10,137.00 | shareholders: Example Entity 1-0-3",1120-S,7,1120-S,fdc-c4f1fb67ec91e36ce405051e,synthetic-form-layout-01,original,2023,fte-653959f16c745792ac23f2a6,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 101
corporation: USD 10,220.00 | ordinary business income: USD 10,220.00 | deductions: USD 10,220.00 | shareholders: Example Entity 1-1-3",1120-S,7,1120-S,fdc-bda7cfbdf933db4375ef606f,synthetic-form-layout-01,original,2024,fte-6195e545021e88ab7137fcfa,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 102
corporation: USD 10,303.00 | ordinary business income: USD 10,303.00 | deductions: USD 10,303.00 | shareholders: Example Entity 1-2-3",1120-S,7,1120-S,fdc-b5d1dd31e3a7ca2050893c02,synthetic-form-layout-01,original,2025,fte-1a54a76d95df179320913ebc,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 103
corporation: USD 10,386.00 | ordinary business income: USD 10,386.00 | deductions: USD 10,386.00 | shareholders: Example Entity 1-3-3",1120-S,7,1120-S,fdc-ef7392740888f4be70f7eb2a,synthetic-form-layout-01,original,2023,fte-7443f29e409b4c0de5520eaa,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 104
corporation: USD 10,469.00 | ordinary business income: USD 10,469.00 | deductions: USD 10,469.00 | shareholders: Example Entity 1-4-3",1120-S,7,1120-S,fdc-75e3e77bbcf4bc828b77d3e6,synthetic-form-layout-01,original,2024,fte-8ed17f0d5c1260f943e3db89,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 105
corporation: USD 10,552.00 | ordinary business income: USD 10,552.00 | deductions: USD 10,552.00 | shareholders: Example Entity 1-5-3",1120-S,7,1120-S,fdc-2f7ba2afd1af43d950c4ae5d,synthetic-form-layout-01,original,2025,fte-5e5ec886185e425a54a340d0,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 106
corporation: USD 10,635.00 | ordinary business income: USD 10,635.00 | deductions: USD 10,635.00 | shareholders: Example Entity 1-6-3",1120-S,7,1120-S,fdc-5f0ecdba9836663a97c4a6b6,synthetic-form-layout-01,original,2023,fte-4be0a959e6aa668e028a460a,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1120-S: US Income Tax Return for an S Corporation
Recipient record: Example Person 107
corporation: USD 10,718.00 | ordinary business income: USD 10,718.00 | deductions: USD 10,718.00 | shareholders: Example Entity 1-7-3",1120-S,7,1120-S,fdc-9bffd7222b3bfefda9054934,synthetic-form-layout-01,original,2024,fte-54f8e9f8cb1721937aac6d58,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,274.00; ordinary business income: USD 10,274.00; deductions: USD 10,274.00; shareholders: Example Entity 2-0-3. Recipient: Example Household 200.",1120-S,7,1120-S,fdc-2c30b30c3b9ff3a78cd1d482,synthetic-form-layout-02,original,2023,fte-6d22687ea21ab3f3789c9080,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,357.00; ordinary business income: USD 10,357.00; deductions: USD 10,357.00; shareholders: Example Entity 2-1-3. Recipient: Example Household 201.",1120-S,7,1120-S,fdc-4cf314d4cd56a05f0db970e6,synthetic-form-layout-02,original,2024,fte-8cf41b38e850cabaec4bcf7d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,440.00; ordinary business income: USD 10,440.00; deductions: USD 10,440.00; shareholders: Example Entity 2-2-3. Recipient: Example Household 202.",1120-S,7,1120-S,fdc-895bfeeea667ad6a25d91233,synthetic-form-layout-02,original,2025,fte-b0fc7c1089dcc81a515ad2e7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,523.00; ordinary business income: USD 10,523.00; deductions: USD 10,523.00; shareholders: Example Entity 2-3-3. Recipient: Example Household 203.",1120-S,7,1120-S,fdc-e947fd7b2abc378eac0271da,synthetic-form-layout-02,original,2023,fte-a0efb3594afdcadba7562342,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,606.00; ordinary business income: USD 10,606.00; deductions: USD 10,606.00; shareholders: Example Entity 2-4-3. Recipient: Example Household 204.",1120-S,7,1120-S,fdc-a85cf05a68479de331c424f1,synthetic-form-layout-02,original,2024,fte-afa51905690ddca4906f68f0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,689.00; ordinary business income: USD 10,689.00; deductions: USD 10,689.00; shareholders: Example Entity 2-5-3. Recipient: Example Household 205.",1120-S,7,1120-S,fdc-02401553cbcd053c73e44c47,synthetic-form-layout-02,original,2025,fte-573967e99bc18fa2b8e2fecf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,772.00; ordinary business income: USD 10,772.00; deductions: USD 10,772.00; shareholders: Example Entity 2-6-3. Recipient: Example Household 206.",1120-S,7,1120-S,fdc-63367cdaa4d8d0044d02aafd,synthetic-form-layout-02,original,2023,fte-4c69af6c9e32bf14b45f30e8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1120-S: US Income Tax Return for an S Corporation.
corporation: USD 10,855.00; ordinary business income: USD 10,855.00; deductions: USD 10,855.00; shareholders: Example Entity 2-7-3. Recipient: Example Household 207.",1120-S,7,1120-S,fdc-794c718b33c782e44bfaa846,synthetic-form-layout-02,original,2024,fte-352d8832915307c9a26b1905,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2023.
Details: corporation: USD 10,411.00, ordinary business income: USD 10,411.00, deductions: USD 10,411.00, shareholders: Example Entity 3-0-3. Account holder: Example Person 300.",1120-S,7,1120-S,fdc-3296780b6624d3748d806557,synthetic-form-layout-03,original,2023,fte-0149dfdafbbaa93396b3245f,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2024.
Details: corporation: USD 10,494.00, ordinary business income: USD 10,494.00, deductions: USD 10,494.00, shareholders: Example Entity 3-1-3. Account holder: Example Person 301.",1120-S,7,1120-S,fdc-57a892a0e1912d8a89bd26a4,synthetic-form-layout-03,original,2024,fte-17770b822b8f87d55fe59465,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2025.
Details: corporation: USD 10,577.00, ordinary business income: USD 10,577.00, deductions: USD 10,577.00, shareholders: Example Entity 3-2-3. Account holder: Example Person 302.",1120-S,7,1120-S,fdc-d919fb0aad2edcf00e83e672,synthetic-form-layout-03,original,2025,fte-feb2c8f9a85e155d42ca7ee8,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2023.
Details: corporation: USD 10,660.00, ordinary business income: USD 10,660.00, deductions: USD 10,660.00, shareholders: Example Entity 3-3-3. Account holder: Example Person 303.",1120-S,7,1120-S,fdc-9fb7fdc4d3a635a469d70921,synthetic-form-layout-03,original,2023,fte-ce474405dbdd8bcc60f8bbad,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2024.
Details: corporation: USD 10,743.00, ordinary business income: USD 10,743.00, deductions: USD 10,743.00, shareholders: Example Entity 3-4-3. Account holder: Example Person 304.",1120-S,7,1120-S,fdc-994dfcdb55b233a9a344e7b2,synthetic-form-layout-03,original,2024,fte-e317f0ddb74432cbe784d6e9,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2025.
Details: corporation: USD 10,826.00, ordinary business income: USD 10,826.00, deductions: USD 10,826.00, shareholders: Example Entity 3-5-3. Account holder: Example Person 305.",1120-S,7,1120-S,fdc-f7a9d65a5d9df50b470815be,synthetic-form-layout-03,original,2025,fte-847a9a5ded6ff5ee54f500fa,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2023.
Details: corporation: USD 10,909.00, ordinary business income: USD 10,909.00, deductions: USD 10,909.00, shareholders: Example Entity 3-6-3. Account holder: Example Person 306.",1120-S,7,1120-S,fdc-4091a504a84735d0b792c092,synthetic-form-layout-03,original,2023,fte-35e2ca1d5070d529109d2dc7,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation
Reporting period ended 12/31/2024.
Details: corporation: USD 10,992.00, ordinary business income: USD 10,992.00, deductions: USD 10,992.00, shareholders: Example Entity 3-7-3. Account holder: Example Person 307.",1120-S,7,1120-S,fdc-53fa654fbc30044d8c90667e,synthetic-form-layout-03,original,2024,fte-1cf334f2e675735c152504e2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2023
shareholders: Example Entity 4-0-3
deductions: USD 10,548.00
ordinary business income: USD 10,548.00
corporation: USD 10,548.00
Named party: Example Person 400",1120-S,7,1120-S,fdc-fe71f29345de8bb24c828807,synthetic-form-layout-04,original,2023,fte-0f96a23ca521578a4c70cf6c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2024
shareholders: Example Entity 4-1-3
deductions: USD 10,631.00
ordinary business income: USD 10,631.00
corporation: USD 10,631.00
Named party: Example Person 401",1120-S,7,1120-S,fdc-dbc36d1bf28f0542e6a12904,synthetic-form-layout-04,original,2024,fte-ac569b88453fc9a49cec4f8e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2025
shareholders: Example Entity 4-2-3
deductions: USD 10,714.00
ordinary business income: USD 10,714.00
corporation: USD 10,714.00
Named party: Example Person 402",1120-S,7,1120-S,fdc-651d625cdfd960c2c279f3ef,synthetic-form-layout-04,original,2025,fte-f680fa6c3ae0a3313e640a4f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2023
shareholders: Example Entity 4-3-3
deductions: USD 10,797.00
ordinary business income: USD 10,797.00
corporation: USD 10,797.00
Named party: Example Person 403",1120-S,7,1120-S,fdc-afd46915c5ee186fbeb4fc74,synthetic-form-layout-04,original,2023,fte-2df7447938adec1ccb6a2a7f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2024
shareholders: Example Entity 4-4-3
deductions: USD 10,880.00
ordinary business income: USD 10,880.00
corporation: USD 10,880.00
Named party: Example Person 404",1120-S,7,1120-S,fdc-2583bb0f6723cbc05fa07109,synthetic-form-layout-04,original,2024,fte-011c193fe9d9064e99707282,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2025
shareholders: Example Entity 4-5-3
deductions: USD 10,963.00
ordinary business income: USD 10,963.00
corporation: USD 10,963.00
Named party: Example Person 405",1120-S,7,1120-S,fdc-bf5ccf95246f773077cebb18,synthetic-form-layout-04,original,2025,fte-c67255c404472b6c16fb0616,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2023
shareholders: Example Entity 4-6-3
deductions: USD 11,046.00
ordinary business income: USD 11,046.00
corporation: USD 11,046.00
Named party: Example Person 406",1120-S,7,1120-S,fdc-e25105389ce081aff0db1943,synthetic-form-layout-04,original,2023,fte-0d3d49bd3ab15f207ce842d0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1120-S: US Income Tax Return for an S Corporation
Tax reporting year 2024
shareholders: Example Entity 4-7-3
deductions: USD 11,129.00
ordinary business income: USD 11,129.00
corporation: USD 11,129.00
Named party: Example Person 407",1120-S,7,1120-S,fdc-fa974d8b2a646eb279c408dc,synthetic-form-layout-04,original,2024,fte-46d63279de4983d8567a0f6c,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2023
corporation: USD 10,685.00 / ordinary business income: USD 10,685.00 / deductions: USD 10,685.00 / shareholders: Example Entity 5-0-3
Delivery copy for Example Party 500",1120-S,7,1120-S,fdc-f326eaa1d7e704a89f2eb102,synthetic-form-layout-05,original,2023,fte-28f036907d197492f1421cc7,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2024
corporation: USD 10,768.00 / ordinary business income: USD 10,768.00 / deductions: USD 10,768.00 / shareholders: Example Entity 5-1-3
Delivery copy for Example Party 501",1120-S,7,1120-S,fdc-de39370084e0841ca73a2786,synthetic-form-layout-05,original,2024,fte-1eb038e75708558d37adc020,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2025
corporation: USD 10,851.00 / ordinary business income: USD 10,851.00 / deductions: USD 10,851.00 / shareholders: Example Entity 5-2-3
Delivery copy for Example Party 502",1120-S,7,1120-S,fdc-2135f4f57b77095e9117e84c,synthetic-form-layout-05,original,2025,fte-835f83c5518e8ea5df745451,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2023
corporation: USD 10,934.00 / ordinary business income: USD 10,934.00 / deductions: USD 10,934.00 / shareholders: Example Entity 5-3-3
Delivery copy for Example Party 503",1120-S,7,1120-S,fdc-dabbecaf6ddade9cdaf9a848,synthetic-form-layout-05,original,2023,fte-0bc38f1eccb5367468d31940,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2024
corporation: USD 11,017.00 / ordinary business income: USD 11,017.00 / deductions: USD 11,017.00 / shareholders: Example Entity 5-4-3
Delivery copy for Example Party 504",1120-S,7,1120-S,fdc-d1db52dce9a3978a1aafd818,synthetic-form-layout-05,original,2024,fte-aa1b72b7985f9a1b3c58f950,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2025
corporation: USD 11,100.00 / ordinary business income: USD 11,100.00 / deductions: USD 11,100.00 / shareholders: Example Entity 5-5-3
Delivery copy for Example Party 505",1120-S,7,1120-S,fdc-773e7def2d31476deb8382be,synthetic-form-layout-05,original,2025,fte-80114aebc41100df069e9039,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2023
corporation: USD 11,183.00 / ordinary business income: USD 11,183.00 / deductions: USD 11,183.00 / shareholders: Example Entity 5-6-3
Delivery copy for Example Party 506",1120-S,7,1120-S,fdc-6b2522985499905c3724597c,synthetic-form-layout-05,original,2023,fte-bea08a7676205741d3f64b54,synthetic_AI_labeled,v1_template,top,False,
"Form 1120-S: US Income Tax Return for an S Corporation -- reporting year 2024
corporation: USD 11,266.00 / ordinary business income: USD 11,266.00 / deductions: USD 11,266.00 / shareholders: Example Entity 5-7-3
Delivery copy for Example Party 507",1120-S,7,1120-S,fdc-a7aef55bfad3792eb2616918,synthetic-form-layout-05,original,2024,fte-a7ac29a27508d17ec411833a,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2023
Statement issued to Example Person 0.
estate or trust: USD 10,000.00
fiduciary: Example Entity 0-0-1
income: USD 10,000.00
distributions: USD 10,000.00",1041,1,1041,fdc-30c3a94ee70f0f81cd69d2f2,synthetic-form-layout-00,original,2023,fte-85309dde7307fdb2200eeefb,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2024
Statement issued to Example Person 1.
estate or trust: USD 10,083.00
fiduciary: Example Entity 0-1-1
income: USD 10,083.00
distributions: USD 10,083.00",1041,1,1041,fdc-efcc93c86d08f085a8c666c5,synthetic-form-layout-00,original,2024,fte-7d68a2234fd4882d1c44e871,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2025
Statement issued to Example Person 2.
estate or trust: USD 10,166.00
fiduciary: Example Entity 0-2-1
income: USD 10,166.00
distributions: USD 10,166.00",1041,1,1041,fdc-d34240f3deb409039010a34f,synthetic-form-layout-00,original,2025,fte-322a633dabc7f5a641f3f01e,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2023
Statement issued to Example Person 3.
estate or trust: USD 10,249.00
fiduciary: Example Entity 0-3-1
income: USD 10,249.00
distributions: USD 10,249.00",1041,1,1041,fdc-ef05a1d4c880243a90ae94ed,synthetic-form-layout-00,original,2023,fte-29761e56a0c86568412cbadd,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2024
Statement issued to Example Person 4.
estate or trust: USD 10,332.00
fiduciary: Example Entity 0-4-1
income: USD 10,332.00
distributions: USD 10,332.00",1041,1,1041,fdc-097ecc13ce94c9a8aea02e01,synthetic-form-layout-00,original,2024,fte-68c2718944b3870aed4be7fe,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2025
Statement issued to Example Person 5.
estate or trust: USD 10,415.00
fiduciary: Example Entity 0-5-1
income: USD 10,415.00
distributions: USD 10,415.00",1041,1,1041,fdc-290ab0d0dbe8c58a3321d7b5,synthetic-form-layout-00,original,2025,fte-026bbfce1e2d1ed3f809d044,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2023
Statement issued to Example Person 6.
estate or trust: USD 10,498.00
fiduciary: Example Entity 0-6-1
income: USD 10,498.00
distributions: USD 10,498.00",1041,1,1041,fdc-eab5e65ff3b8701541d1e947,synthetic-form-layout-00,original,2023,fte-6ec7894b9e9afa8212f7203e,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Calendar year: 2024
Statement issued to Example Person 7.
estate or trust: USD 10,581.00
fiduciary: Example Entity 0-7-1
income: USD 10,581.00
distributions: USD 10,581.00",1041,1,1041,fdc-d50d9577e7652a341661afd9,synthetic-form-layout-00,original,2024,fte-5eae4cd8ec30e8034da7386c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 100
estate or trust: USD 10,137.00 | fiduciary: Example Entity 1-0-1 | income: USD 10,137.00 | distributions: USD 10,137.00",1041,1,1041,fdc-5c18924e6e5aa3f04373403a,synthetic-form-layout-01,original,2023,fte-f46309b192fc4db9ef62933c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 101
estate or trust: USD 10,220.00 | fiduciary: Example Entity 1-1-1 | income: USD 10,220.00 | distributions: USD 10,220.00",1041,1,1041,fdc-4f8944328aaba05a320a6f56,synthetic-form-layout-01,original,2024,fte-a581ad893670cf29ffb41cd2,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 102
estate or trust: USD 10,303.00 | fiduciary: Example Entity 1-2-1 | income: USD 10,303.00 | distributions: USD 10,303.00",1041,1,1041,fdc-8e5364bc4cf8ee45cda833d3,synthetic-form-layout-01,original,2025,fte-edbe539144de910757681849,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 103
estate or trust: USD 10,386.00 | fiduciary: Example Entity 1-3-1 | income: USD 10,386.00 | distributions: USD 10,386.00",1041,1,1041,fdc-7c35d458e2e6f59610766f5d,synthetic-form-layout-01,original,2023,fte-095840dc92e00d089a767495,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 104
estate or trust: USD 10,469.00 | fiduciary: Example Entity 1-4-1 | income: USD 10,469.00 | distributions: USD 10,469.00",1041,1,1041,fdc-1734c813e327cdd66d5ea9b0,synthetic-form-layout-01,original,2024,fte-7cb3da013253f8f2cb46fe77,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 105
estate or trust: USD 10,552.00 | fiduciary: Example Entity 1-5-1 | income: USD 10,552.00 | distributions: USD 10,552.00",1041,1,1041,fdc-34f22db6246091d60f0b3f29,synthetic-form-layout-01,original,2025,fte-656b42f3dca26c20892afe21,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 106
estate or trust: USD 10,635.00 | fiduciary: Example Entity 1-6-1 | income: USD 10,635.00 | distributions: USD 10,635.00",1041,1,1041,fdc-e23ce9eedb85fe4fa1facfb3,synthetic-form-layout-01,original,2023,fte-ed757b8227feb41deab19acb,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1041: US Income Tax Return for Estates and Trusts
Recipient record: Example Person 107
estate or trust: USD 10,718.00 | fiduciary: Example Entity 1-7-1 | income: USD 10,718.00 | distributions: USD 10,718.00",1041,1,1041,fdc-2f389822b0761d2090b400fd,synthetic-form-layout-01,original,2024,fte-7746ad1c7bcefb5e4dea0ca3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,274.00; fiduciary: Example Entity 2-0-1; income: USD 10,274.00; distributions: USD 10,274.00. Recipient: Example Household 200.",1041,1,1041,fdc-6dc0507404b96875d9173562,synthetic-form-layout-02,original,2023,fte-9ed12a7a5541001dc7f7ee82,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,357.00; fiduciary: Example Entity 2-1-1; income: USD 10,357.00; distributions: USD 10,357.00. Recipient: Example Household 201.",1041,1,1041,fdc-2422d75f69cba543eb52c750,synthetic-form-layout-02,original,2024,fte-232f85c5f884c5027d6f5876,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,440.00; fiduciary: Example Entity 2-2-1; income: USD 10,440.00; distributions: USD 10,440.00. Recipient: Example Household 202.",1041,1,1041,fdc-e4be2cd608d89ab37f68c0b9,synthetic-form-layout-02,original,2025,fte-9ca7900b1c977e2346e7b0d4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,523.00; fiduciary: Example Entity 2-3-1; income: USD 10,523.00; distributions: USD 10,523.00. Recipient: Example Household 203.",1041,1,1041,fdc-11a919eca3637a819cc96462,synthetic-form-layout-02,original,2023,fte-91fa12e47d760042537257ac,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,606.00; fiduciary: Example Entity 2-4-1; income: USD 10,606.00; distributions: USD 10,606.00. Recipient: Example Household 204.",1041,1,1041,fdc-3a70e98a73bddbad063353ef,synthetic-form-layout-02,original,2024,fte-6aa6df9a88b9f0737744c1b8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,689.00; fiduciary: Example Entity 2-5-1; income: USD 10,689.00; distributions: USD 10,689.00. Recipient: Example Household 205.",1041,1,1041,fdc-f5974cbcb0329f8f26ac40df,synthetic-form-layout-02,original,2025,fte-9d6a44521a3880da9920eb9a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,772.00; fiduciary: Example Entity 2-6-1; income: USD 10,772.00; distributions: USD 10,772.00. Recipient: Example Household 206.",1041,1,1041,fdc-bca8fd4554d1a3e803dd21db,synthetic-form-layout-02,original,2023,fte-6041d3da673929345f092d56,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1041: US Income Tax Return for Estates and Trusts.
estate or trust: USD 10,855.00; fiduciary: Example Entity 2-7-1; income: USD 10,855.00; distributions: USD 10,855.00. Recipient: Example Household 207.",1041,1,1041,fdc-4a1d78f215998a98d9e8c66f,synthetic-form-layout-02,original,2024,fte-2d42ff770977a492371cd021,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2023.
Details: estate or trust: USD 10,411.00, fiduciary: Example Entity 3-0-1, income: USD 10,411.00, distributions: USD 10,411.00. Account holder: Example Person 300.",1041,1,1041,fdc-b070f5b38df5e9ace754f5d8,synthetic-form-layout-03,original,2023,fte-80e209042d65b7a1008a1285,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2024.
Details: estate or trust: USD 10,494.00, fiduciary: Example Entity 3-1-1, income: USD 10,494.00, distributions: USD 10,494.00. Account holder: Example Person 301.",1041,1,1041,fdc-bbf7b8483008635c31d4dcb9,synthetic-form-layout-03,original,2024,fte-c1cc96d7ef63d3d604de7e12,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2025.
Details: estate or trust: USD 10,577.00, fiduciary: Example Entity 3-2-1, income: USD 10,577.00, distributions: USD 10,577.00. Account holder: Example Person 302.",1041,1,1041,fdc-a78793a93496e3a09728c361,synthetic-form-layout-03,original,2025,fte-494d58941296fe3f548a322b,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2023.
Details: estate or trust: USD 10,660.00, fiduciary: Example Entity 3-3-1, income: USD 10,660.00, distributions: USD 10,660.00. Account holder: Example Person 303.",1041,1,1041,fdc-ceeecd354a74faed197867fd,synthetic-form-layout-03,original,2023,fte-cb031dc976ad1da4412e2ed5,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2024.
Details: estate or trust: USD 10,743.00, fiduciary: Example Entity 3-4-1, income: USD 10,743.00, distributions: USD 10,743.00. Account holder: Example Person 304.",1041,1,1041,fdc-afc7856a9f4a9a8df73bffe5,synthetic-form-layout-03,original,2024,fte-eaa3b449fbd014b25d288a00,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2025.
Details: estate or trust: USD 10,826.00, fiduciary: Example Entity 3-5-1, income: USD 10,826.00, distributions: USD 10,826.00. Account holder: Example Person 305.",1041,1,1041,fdc-b4449e2cbe1639d9f51cd10e,synthetic-form-layout-03,original,2025,fte-e2a151611d47f4ed949b19c5,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2023.
Details: estate or trust: USD 10,909.00, fiduciary: Example Entity 3-6-1, income: USD 10,909.00, distributions: USD 10,909.00. Account holder: Example Person 306.",1041,1,1041,fdc-0c3dab66208bd623548d7ba1,synthetic-form-layout-03,original,2023,fte-aaef011e961a641721989cd8,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts
Reporting period ended 12/31/2024.
Details: estate or trust: USD 10,992.00, fiduciary: Example Entity 3-7-1, income: USD 10,992.00, distributions: USD 10,992.00. Account holder: Example Person 307.",1041,1,1041,fdc-eaa4cfa2a2d625042c71b131,synthetic-form-layout-03,original,2024,fte-60eccc0db966948f084669b5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2023
distributions: USD 10,548.00
income: USD 10,548.00
fiduciary: Example Entity 4-0-1
estate or trust: USD 10,548.00
Named party: Example Person 400",1041,1,1041,fdc-8ca07e84fc69f4d016bb2d9d,synthetic-form-layout-04,original,2023,fte-84bce58ec4f8e4167169653d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2024
distributions: USD 10,631.00
income: USD 10,631.00
fiduciary: Example Entity 4-1-1
estate or trust: USD 10,631.00
Named party: Example Person 401",1041,1,1041,fdc-4a0642698e78cee85d75c611,synthetic-form-layout-04,original,2024,fte-f4e20a8cb301867857be6e97,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2025
distributions: USD 10,714.00
income: USD 10,714.00
fiduciary: Example Entity 4-2-1
estate or trust: USD 10,714.00
Named party: Example Person 402",1041,1,1041,fdc-77403bb27e3d5af0e44ff1a1,synthetic-form-layout-04,original,2025,fte-dad36d7a987498422299600b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2023
distributions: USD 10,797.00
income: USD 10,797.00
fiduciary: Example Entity 4-3-1
estate or trust: USD 10,797.00
Named party: Example Person 403",1041,1,1041,fdc-01a2ec684ccb9e89d0f8830b,synthetic-form-layout-04,original,2023,fte-f39562a481ddf75102e5a455,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2024
distributions: USD 10,880.00
income: USD 10,880.00
fiduciary: Example Entity 4-4-1
estate or trust: USD 10,880.00
Named party: Example Person 404",1041,1,1041,fdc-064bd0112dd32c17aad095bf,synthetic-form-layout-04,original,2024,fte-601027c29515fd98e8f2e659,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2025
distributions: USD 10,963.00
income: USD 10,963.00
fiduciary: Example Entity 4-5-1
estate or trust: USD 10,963.00
Named party: Example Person 405",1041,1,1041,fdc-1567c2e2dfb66dd26e47e2ca,synthetic-form-layout-04,original,2025,fte-3b6290c06f766bb4e0fb1c92,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2023
distributions: USD 11,046.00
income: USD 11,046.00
fiduciary: Example Entity 4-6-1
estate or trust: USD 11,046.00
Named party: Example Person 406",1041,1,1041,fdc-d2761f4dcda530393f0d21b1,synthetic-form-layout-04,original,2023,fte-21d3c9c310f9709fc4fa288f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1041: US Income Tax Return for Estates and Trusts
Tax reporting year 2024
distributions: USD 11,129.00
income: USD 11,129.00
fiduciary: Example Entity 4-7-1
estate or trust: USD 11,129.00
Named party: Example Person 407",1041,1,1041,fdc-f71baf0bf1d9e908121f10a1,synthetic-form-layout-04,original,2024,fte-0c7a3633d8007d74625247a6,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2023
estate or trust: USD 10,685.00 / fiduciary: Example Entity 5-0-1 / income: USD 10,685.00 / distributions: USD 10,685.00
Delivery copy for Example Party 500",1041,1,1041,fdc-21529150531d43f2e46cf797,synthetic-form-layout-05,original,2023,fte-d4ca1eac2f414fddd3248b4a,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2024
estate or trust: USD 10,768.00 / fiduciary: Example Entity 5-1-1 / income: USD 10,768.00 / distributions: USD 10,768.00
Delivery copy for Example Party 501",1041,1,1041,fdc-c0ae142416f9e9a33a6f21d2,synthetic-form-layout-05,original,2024,fte-bfaa5a7d38b1116251eeb486,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2025
estate or trust: USD 10,851.00 / fiduciary: Example Entity 5-2-1 / income: USD 10,851.00 / distributions: USD 10,851.00
Delivery copy for Example Party 502",1041,1,1041,fdc-b47051cbfedeeea550c35428,synthetic-form-layout-05,original,2025,fte-a6fb3a8598ea87cb0259a8c1,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2023
estate or trust: USD 10,934.00 / fiduciary: Example Entity 5-3-1 / income: USD 10,934.00 / distributions: USD 10,934.00
Delivery copy for Example Party 503",1041,1,1041,fdc-efb6118c82439112e9c7eda0,synthetic-form-layout-05,original,2023,fte-fc8a45e94269590876606262,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2024
estate or trust: USD 11,017.00 / fiduciary: Example Entity 5-4-1 / income: USD 11,017.00 / distributions: USD 11,017.00
Delivery copy for Example Party 504",1041,1,1041,fdc-463e88565cc39a326fc9f238,synthetic-form-layout-05,original,2024,fte-efe586bdbf7f90abdee97a92,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2025
estate or trust: USD 11,100.00 / fiduciary: Example Entity 5-5-1 / income: USD 11,100.00 / distributions: USD 11,100.00
Delivery copy for Example Party 505",1041,1,1041,fdc-42bd2fcf7370ae8b144d3ad4,synthetic-form-layout-05,original,2025,fte-ddce6d29f7f40310cc80ffb3,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2023
estate or trust: USD 11,183.00 / fiduciary: Example Entity 5-6-1 / income: USD 11,183.00 / distributions: USD 11,183.00
Delivery copy for Example Party 506",1041,1,1041,fdc-eb10ab0980a3da4a91f2688e,synthetic-form-layout-05,original,2023,fte-af5b33ba0f55626781a00f5d,synthetic_AI_labeled,v1_template,top,False,
"Form 1041: US Income Tax Return for Estates and Trusts -- reporting year 2024
estate or trust: USD 11,266.00 / fiduciary: Example Entity 5-7-1 / income: USD 11,266.00 / distributions: USD 11,266.00
Delivery copy for Example Party 507",1041,1,1041,fdc-04c39e4a0625cfcbe44c77e9,synthetic-form-layout-05,original,2024,fte-28162a423f46f0dad854e67a,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 0.
partnership: Example Entity 0-0-0
partner: Example Entity 0-0-1
ordinary business income: USD 10,000.00
distributions: USD 10,000.00",K-1,30,K-1,fdc-d2c1de90542ff02b427dc3b3,synthetic-form-layout-00,original,2023,fte-d6f269159bf8d0321b06ecf0,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 1.
partnership: Example Entity 0-1-0
partner: Example Entity 0-1-1
ordinary business income: USD 10,083.00
distributions: USD 10,083.00",K-1,30,K-1,fdc-9ad22a51f6c35b0c5aeac8a9,synthetic-form-layout-00,original,2024,fte-2ef9e0015e0973d2635424ac,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2025
Statement issued to Example Person 2.
partnership: Example Entity 0-2-0
partner: Example Entity 0-2-1
ordinary business income: USD 10,166.00
distributions: USD 10,166.00",K-1,30,K-1,fdc-ffc3fd60c53ac219adec18eb,synthetic-form-layout-00,original,2025,fte-b24b3f5677a12c7b6c02c786,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 3.
partnership: Example Entity 0-3-0
partner: Example Entity 0-3-1
ordinary business income: USD 10,249.00
distributions: USD 10,249.00",K-1,30,K-1,fdc-f44e84515523c36fa3987257,synthetic-form-layout-00,original,2023,fte-088bd11c945340a172b4e6dd,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 4.
partnership: Example Entity 0-4-0
partner: Example Entity 0-4-1
ordinary business income: USD 10,332.00
distributions: USD 10,332.00",K-1,30,K-1,fdc-110f26b03e86b3c4201cfdcc,synthetic-form-layout-00,original,2024,fte-a1428094e027f8111a8e6420,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2025
Statement issued to Example Person 5.
partnership: Example Entity 0-5-0
partner: Example Entity 0-5-1
ordinary business income: USD 10,415.00
distributions: USD 10,415.00",K-1,30,K-1,fdc-15206ec44db11dd74566e9c7,synthetic-form-layout-00,original,2025,fte-a01b8237f3794e45a5cc2f40,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 6.
partnership: Example Entity 0-6-0
partner: Example Entity 0-6-1
ordinary business income: USD 10,498.00
distributions: USD 10,498.00",K-1,30,K-1,fdc-56ebc420a09e283517a7ba6f,synthetic-form-layout-00,original,2023,fte-4ed388741beea8d7bc91663e,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 7.
partnership: Example Entity 0-7-0
partner: Example Entity 0-7-1
ordinary business income: USD 10,581.00
distributions: USD 10,581.00",K-1,30,K-1,fdc-9417e9f2e3dd592a3223e2e1,synthetic-form-layout-00,original,2024,fte-b070453e843f3642614e9b20,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 100
partnership: Example Entity 1-0-0 | partner: Example Entity 1-0-1 | ordinary business income: USD 10,137.00 | distributions: USD 10,137.00",K-1,30,K-1,fdc-65bcbc7cc79a529e6319de1f,synthetic-form-layout-01,original,2023,fte-26c62573bdb3db96c64f2cc1,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 101
partnership: Example Entity 1-1-0 | partner: Example Entity 1-1-1 | ordinary business income: USD 10,220.00 | distributions: USD 10,220.00",K-1,30,K-1,fdc-dcf3f9ecb2bedd52d34c2f43,synthetic-form-layout-01,original,2024,fte-8154527f093a2ffbae04537f,synthetic_AI_labeled,v1_template,top,False,
"2025 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 102
partnership: Example Entity 1-2-0 | partner: Example Entity 1-2-1 | ordinary business income: USD 10,303.00 | distributions: USD 10,303.00",K-1,30,K-1,fdc-01accfa6c126c4157f177a18,synthetic-form-layout-01,original,2025,fte-e27b93e85e3afe5d8841dd4f,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 103
partnership: Example Entity 1-3-0 | partner: Example Entity 1-3-1 | ordinary business income: USD 10,386.00 | distributions: USD 10,386.00",K-1,30,K-1,fdc-fc55837e915b8f98c997bda2,synthetic-form-layout-01,original,2023,fte-7fbcf48a39c3055cf072f519,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 104
partnership: Example Entity 1-4-0 | partner: Example Entity 1-4-1 | ordinary business income: USD 10,469.00 | distributions: USD 10,469.00",K-1,30,K-1,fdc-34298925ae55d94bea7c1ccb,synthetic-form-layout-01,original,2024,fte-8ed3e8e0eb08c69e0c77bc1d,synthetic_AI_labeled,v1_template,top,False,
"2025 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 105
partnership: Example Entity 1-5-0 | partner: Example Entity 1-5-1 | ordinary business income: USD 10,552.00 | distributions: USD 10,552.00",K-1,30,K-1,fdc-c8f4075857018a1163e9d0da,synthetic-form-layout-01,original,2025,fte-ec9fa166c4d9b42f7ac60a2b,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 106
partnership: Example Entity 1-6-0 | partner: Example Entity 1-6-1 | ordinary business income: USD 10,635.00 | distributions: USD 10,635.00",K-1,30,K-1,fdc-780140ac7300ef45c4d63ab0,synthetic-form-layout-01,original,2023,fte-955b02609becbd43ce699f2a,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Recipient record: Example Person 107
partnership: Example Entity 1-7-0 | partner: Example Entity 1-7-1 | ordinary business income: USD 10,718.00 | distributions: USD 10,718.00",K-1,30,K-1,fdc-236b18b39e784251bb62869a,synthetic-form-layout-01,original,2024,fte-2805c22ec72365e8d3d79885,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-0-0; partner: Example Entity 2-0-1; ordinary business income: USD 10,274.00; distributions: USD 10,274.00. Recipient: Example Household 200.",K-1,30,K-1,fdc-208044e81b2ac6a5ccf8598a,synthetic-form-layout-02,original,2023,fte-45b58d2af36845eecdc53a64,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-1-0; partner: Example Entity 2-1-1; ordinary business income: USD 10,357.00; distributions: USD 10,357.00. Recipient: Example Household 201.",K-1,30,K-1,fdc-78a2bfb0dd90ad7343a35a91,synthetic-form-layout-02,original,2024,fte-1341602aba14635197b2d64e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-2-0; partner: Example Entity 2-2-1; ordinary business income: USD 10,440.00; distributions: USD 10,440.00. Recipient: Example Household 202.",K-1,30,K-1,fdc-568f69e066ce30626dd5f169,synthetic-form-layout-02,original,2025,fte-c6b8236d5e4067f14250ddc8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-3-0; partner: Example Entity 2-3-1; ordinary business income: USD 10,523.00; distributions: USD 10,523.00. Recipient: Example Household 203.",K-1,30,K-1,fdc-96dd7f7db9e2a96dac791115,synthetic-form-layout-02,original,2023,fte-b1c16162bd9fcc195f1ef47b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-4-0; partner: Example Entity 2-4-1; ordinary business income: USD 10,606.00; distributions: USD 10,606.00. Recipient: Example Household 204.",K-1,30,K-1,fdc-2e544da53ddda5d93a6788cd,synthetic-form-layout-02,original,2024,fte-de2b2d32bc3deb5d478ab866,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-5-0; partner: Example Entity 2-5-1; ordinary business income: USD 10,689.00; distributions: USD 10,689.00. Recipient: Example Household 205.",K-1,30,K-1,fdc-0e70e4d46ca0b34b2ddcd963,synthetic-form-layout-02,original,2025,fte-08d79f317c13b7e3e4c86748,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-6-0; partner: Example Entity 2-6-1; ordinary business income: USD 10,772.00; distributions: USD 10,772.00. Recipient: Example Household 206.",K-1,30,K-1,fdc-ec38cecf3b31027229c2305d,synthetic-form-layout-02,original,2023,fte-7b754f2b104ff7bf6e40a0a7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits.
partnership: Example Entity 2-7-0; partner: Example Entity 2-7-1; ordinary business income: USD 10,855.00; distributions: USD 10,855.00. Recipient: Example Household 207.",K-1,30,K-1,fdc-5f4c11ffde2be48d6ca2fe9d,synthetic-form-layout-02,original,2024,fte-03836fbc1adc7a01853054ae,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: partnership: Example Entity 3-0-0, partner: Example Entity 3-0-1, ordinary business income: USD 10,411.00, distributions: USD 10,411.00. Account holder: Example Person 300.",K-1,30,K-1,fdc-186248410ebf3600ce8627fa,synthetic-form-layout-03,original,2023,fte-b2cab5a30aa09e353445c5ae,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: partnership: Example Entity 3-1-0, partner: Example Entity 3-1-1, ordinary business income: USD 10,494.00, distributions: USD 10,494.00. Account holder: Example Person 301.",K-1,30,K-1,fdc-98af6ca2e8d3e2b5db3eedaf,synthetic-form-layout-03,original,2024,fte-f56c0cf25454ceb8c815df91,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2025.
Details: partnership: Example Entity 3-2-0, partner: Example Entity 3-2-1, ordinary business income: USD 10,577.00, distributions: USD 10,577.00. Account holder: Example Person 302.",K-1,30,K-1,fdc-a984b344d7680071aa4521fa,synthetic-form-layout-03,original,2025,fte-807645336a22bce0fd452f2b,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: partnership: Example Entity 3-3-0, partner: Example Entity 3-3-1, ordinary business income: USD 10,660.00, distributions: USD 10,660.00. Account holder: Example Person 303.",K-1,30,K-1,fdc-b95734124bba59dc30ba9e82,synthetic-form-layout-03,original,2023,fte-b43046957dbca9f41c16d916,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: partnership: Example Entity 3-4-0, partner: Example Entity 3-4-1, ordinary business income: USD 10,743.00, distributions: USD 10,743.00. Account holder: Example Person 304.",K-1,30,K-1,fdc-08987f3e51ca2654a662b8f3,synthetic-form-layout-03,original,2024,fte-93bd3177046b457e451290c5,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2025.
Details: partnership: Example Entity 3-5-0, partner: Example Entity 3-5-1, ordinary business income: USD 10,826.00, distributions: USD 10,826.00. Account holder: Example Person 305.",K-1,30,K-1,fdc-70a005c8672f9fd882fc36dc,synthetic-form-layout-03,original,2025,fte-fddf44515e26a1a34d92b4ce,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: partnership: Example Entity 3-6-0, partner: Example Entity 3-6-1, ordinary business income: USD 10,909.00, distributions: USD 10,909.00. Account holder: Example Person 306.",K-1,30,K-1,fdc-34f8349f1ad1edf7686f55b2,synthetic-form-layout-03,original,2023,fte-4129ffb718a7e4be2074db91,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: partnership: Example Entity 3-7-0, partner: Example Entity 3-7-1, ordinary business income: USD 10,992.00, distributions: USD 10,992.00. Account holder: Example Person 307.",K-1,30,K-1,fdc-fa296da0ae12f0a4806fa048,synthetic-form-layout-03,original,2024,fte-ffa74c3a5bcc75ac1ec4800b,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2023
distributions: USD 10,548.00
ordinary business income: USD 10,548.00
partner: Example Entity 4-0-1
partnership: Example Entity 4-0-0
Named party: Example Person 400",K-1,30,K-1,fdc-218d839050eeb8587c0a7486,synthetic-form-layout-04,original,2023,fte-a5272c6bd6afbb5c95135169,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2024
distributions: USD 10,631.00
ordinary business income: USD 10,631.00
partner: Example Entity 4-1-1
partnership: Example Entity 4-1-0
Named party: Example Person 401",K-1,30,K-1,fdc-e9cb9c5b7e9ffe0029fce28c,synthetic-form-layout-04,original,2024,fte-1f726827ec4122aba5f6a515,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2025
distributions: USD 10,714.00
ordinary business income: USD 10,714.00
partner: Example Entity 4-2-1
partnership: Example Entity 4-2-0
Named party: Example Person 402",K-1,30,K-1,fdc-2738a6a2294f2dc0abd0b9ec,synthetic-form-layout-04,original,2025,fte-65965160e66198f02f9a9ff0,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2023
distributions: USD 10,797.00
ordinary business income: USD 10,797.00
partner: Example Entity 4-3-1
partnership: Example Entity 4-3-0
Named party: Example Person 403",K-1,30,K-1,fdc-88978e346e3de6383d65d605,synthetic-form-layout-04,original,2023,fte-9b7415c9d2d46b308f4b6511,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2024
distributions: USD 10,880.00
ordinary business income: USD 10,880.00
partner: Example Entity 4-4-1
partnership: Example Entity 4-4-0
Named party: Example Person 404",K-1,30,K-1,fdc-86a7d8da8f512252eabdb9f9,synthetic-form-layout-04,original,2024,fte-99507efdffa03c35fe45d816,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2025
distributions: USD 10,963.00
ordinary business income: USD 10,963.00
partner: Example Entity 4-5-1
partnership: Example Entity 4-5-0
Named party: Example Person 405",K-1,30,K-1,fdc-cf2be0e15fbb44feb97dc23b,synthetic-form-layout-04,original,2025,fte-a2f340f462f6be4f573eb457,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2023
distributions: USD 11,046.00
ordinary business income: USD 11,046.00
partner: Example Entity 4-6-1
partnership: Example Entity 4-6-0
Named party: Example Person 406",K-1,30,K-1,fdc-96dda578d145ee6644f716b4,synthetic-form-layout-04,original,2023,fte-2c0215ee276b6b6cccfe3722,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits
Tax reporting year 2024
distributions: USD 11,129.00
ordinary business income: USD 11,129.00
partner: Example Entity 4-7-1
partnership: Example Entity 4-7-0
Named party: Example Person 407",K-1,30,K-1,fdc-dc1477644812d5ac949c8d79,synthetic-form-layout-04,original,2024,fte-95b838bcaa8c6496ae372f69,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2023
partnership: Example Entity 5-0-0 / partner: Example Entity 5-0-1 / ordinary business income: USD 10,685.00 / distributions: USD 10,685.00
Delivery copy for Example Party 500",K-1,30,K-1,fdc-02886ef7be7d2a96b93e106e,synthetic-form-layout-05,original,2023,fte-12d0e4db99cafc04c79585c2,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2024
partnership: Example Entity 5-1-0 / partner: Example Entity 5-1-1 / ordinary business income: USD 10,768.00 / distributions: USD 10,768.00
Delivery copy for Example Party 501",K-1,30,K-1,fdc-5409b84c912acc3e0f327437,synthetic-form-layout-05,original,2024,fte-0f27285bf054979fe25682d3,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2025
partnership: Example Entity 5-2-0 / partner: Example Entity 5-2-1 / ordinary business income: USD 10,851.00 / distributions: USD 10,851.00
Delivery copy for Example Party 502",K-1,30,K-1,fdc-deaf034e1f0dd133083fd8db,synthetic-form-layout-05,original,2025,fte-909ece623a9458a184cf4c05,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2023
partnership: Example Entity 5-3-0 / partner: Example Entity 5-3-1 / ordinary business income: USD 10,934.00 / distributions: USD 10,934.00
Delivery copy for Example Party 503",K-1,30,K-1,fdc-40a9c14f8461a554cf7a3f21,synthetic-form-layout-05,original,2023,fte-ef0b87190f2971edeb6673d5,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2024
partnership: Example Entity 5-4-0 / partner: Example Entity 5-4-1 / ordinary business income: USD 11,017.00 / distributions: USD 11,017.00
Delivery copy for Example Party 504",K-1,30,K-1,fdc-795db7290ea32d885a29c3ea,synthetic-form-layout-05,original,2024,fte-41259ad026e18981cfb4b382,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2025
partnership: Example Entity 5-5-0 / partner: Example Entity 5-5-1 / ordinary business income: USD 11,100.00 / distributions: USD 11,100.00
Delivery copy for Example Party 505",K-1,30,K-1,fdc-8906db0052e2a2972c3730e6,synthetic-form-layout-05,original,2025,fte-fde411504986e779ffeaacd4,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2023
partnership: Example Entity 5-6-0 / partner: Example Entity 5-6-1 / ordinary business income: USD 11,183.00 / distributions: USD 11,183.00
Delivery copy for Example Party 506",K-1,30,K-1,fdc-ae5a9f3209463bea81ea3b38,synthetic-form-layout-05,original,2023,fte-82f44691ecb70cb06617b87e,synthetic_AI_labeled,v1_template,top,False,
"K-1-1065: Schedule K-1 Form 1065 Partner Share of Income Deductions Credits -- reporting year 2024
partnership: Example Entity 5-7-0 / partner: Example Entity 5-7-1 / ordinary business income: USD 11,266.00 / distributions: USD 11,266.00
Delivery copy for Example Party 507",K-1,30,K-1,fdc-f894598ed6583f7b82749190,synthetic-form-layout-05,original,2024,fte-0e15e1861a3b5cf9849b1dff,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 0.
corporation: USD 10,000.00
shareholder: Example Entity 0-0-1
ordinary business income: USD 10,000.00
distributions: USD 10,000.00",K-1,30,K-1,fdc-70f39b0ea6839b18553712e0,synthetic-form-layout-00,original,2023,fte-aed5af95ace9aa69233641d3,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 1.
corporation: USD 10,083.00
shareholder: Example Entity 0-1-1
ordinary business income: USD 10,083.00
distributions: USD 10,083.00",K-1,30,K-1,fdc-a0e7b285ba4c1c743884d705,synthetic-form-layout-00,original,2024,fte-c8038db8012b67e1677b77f9,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2025
Statement issued to Example Person 2.
corporation: USD 10,166.00
shareholder: Example Entity 0-2-1
ordinary business income: USD 10,166.00
distributions: USD 10,166.00",K-1,30,K-1,fdc-d34fc0d6be969b5567bd3506,synthetic-form-layout-00,original,2025,fte-80a41ffdb9012f2af449efb8,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 3.
corporation: USD 10,249.00
shareholder: Example Entity 0-3-1
ordinary business income: USD 10,249.00
distributions: USD 10,249.00",K-1,30,K-1,fdc-07ee490308e21489872d071e,synthetic-form-layout-00,original,2023,fte-4ba8f6e7f639bbc1b3a4e354,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 4.
corporation: USD 10,332.00
shareholder: Example Entity 0-4-1
ordinary business income: USD 10,332.00
distributions: USD 10,332.00",K-1,30,K-1,fdc-f6698aaeaab9b89d275d8115,synthetic-form-layout-00,original,2024,fte-abf2853be80275a9ac11f398,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2025
Statement issued to Example Person 5.
corporation: USD 10,415.00
shareholder: Example Entity 0-5-1
ordinary business income: USD 10,415.00
distributions: USD 10,415.00",K-1,30,K-1,fdc-d5ea3f52d11788d1130ff3f2,synthetic-form-layout-00,original,2025,fte-b115faa8b3c92b5b74fa4ae1,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 6.
corporation: USD 10,498.00
shareholder: Example Entity 0-6-1
ordinary business income: USD 10,498.00
distributions: USD 10,498.00",K-1,30,K-1,fdc-98af42b76d2c725128cf5f63,synthetic-form-layout-00,original,2023,fte-8a335b2807b737d5e6ff5fee,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 7.
corporation: USD 10,581.00
shareholder: Example Entity 0-7-1
ordinary business income: USD 10,581.00
distributions: USD 10,581.00",K-1,30,K-1,fdc-fcbb0ffd3de6cb2b50b1c3c7,synthetic-form-layout-00,original,2024,fte-ea4bb5dbe571804a50ccef70,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 100
corporation: USD 10,137.00 | shareholder: Example Entity 1-0-1 | ordinary business income: USD 10,137.00 | distributions: USD 10,137.00",K-1,30,K-1,fdc-819046e5d7f8e1ccae0289a0,synthetic-form-layout-01,original,2023,fte-5e1b3023d9cbb3fce3ef5651,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 101
corporation: USD 10,220.00 | shareholder: Example Entity 1-1-1 | ordinary business income: USD 10,220.00 | distributions: USD 10,220.00",K-1,30,K-1,fdc-9d8d52cc5b593c9fb9ef49f9,synthetic-form-layout-01,original,2024,fte-1f590b39ad62aa378e9b87b5,synthetic_AI_labeled,v1_template,top,False,
"2025 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 102
corporation: USD 10,303.00 | shareholder: Example Entity 1-2-1 | ordinary business income: USD 10,303.00 | distributions: USD 10,303.00",K-1,30,K-1,fdc-bd742a0178c673bdb1fa4323,synthetic-form-layout-01,original,2025,fte-b55288ac0ec59ba2a05e191d,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 103
corporation: USD 10,386.00 | shareholder: Example Entity 1-3-1 | ordinary business income: USD 10,386.00 | distributions: USD 10,386.00",K-1,30,K-1,fdc-ed39f702785c0022bedc102d,synthetic-form-layout-01,original,2023,fte-40b78b600d2868fbb6a62300,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 104
corporation: USD 10,469.00 | shareholder: Example Entity 1-4-1 | ordinary business income: USD 10,469.00 | distributions: USD 10,469.00",K-1,30,K-1,fdc-ab312b73831c36ef7e197a66,synthetic-form-layout-01,original,2024,fte-b2573a30d618d9ed23a23c26,synthetic_AI_labeled,v1_template,top,False,
"2025 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 105
corporation: USD 10,552.00 | shareholder: Example Entity 1-5-1 | ordinary business income: USD 10,552.00 | distributions: USD 10,552.00",K-1,30,K-1,fdc-929c50d83968047ee69687e0,synthetic-form-layout-01,original,2025,fte-498ef5a1e60b54946d7da6d3,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 106
corporation: USD 10,635.00 | shareholder: Example Entity 1-6-1 | ordinary business income: USD 10,635.00 | distributions: USD 10,635.00",K-1,30,K-1,fdc-9dee05de0ebcdeb5b23f8cda,synthetic-form-layout-01,original,2023,fte-e03ae5369ff9975c6ecdf583,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Recipient record: Example Person 107
corporation: USD 10,718.00 | shareholder: Example Entity 1-7-1 | ordinary business income: USD 10,718.00 | distributions: USD 10,718.00",K-1,30,K-1,fdc-bad5586e84be70b7fcf03bb1,synthetic-form-layout-01,original,2024,fte-8f5940bf92dc1b4338f97b64,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,274.00; shareholder: Example Entity 2-0-1; ordinary business income: USD 10,274.00; distributions: USD 10,274.00. Recipient: Example Household 200.",K-1,30,K-1,fdc-c1b767faa8250417cd4d5ed2,synthetic-form-layout-02,original,2023,fte-d62df79999d5ebce68cc391a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,357.00; shareholder: Example Entity 2-1-1; ordinary business income: USD 10,357.00; distributions: USD 10,357.00. Recipient: Example Household 201.",K-1,30,K-1,fdc-d1d6f41edc7fad6587cce25c,synthetic-form-layout-02,original,2024,fte-3d8216fd535c8fa3ca42d10d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,440.00; shareholder: Example Entity 2-2-1; ordinary business income: USD 10,440.00; distributions: USD 10,440.00. Recipient: Example Household 202.",K-1,30,K-1,fdc-5530336d763ef42f78b22306,synthetic-form-layout-02,original,2025,fte-0bd0bdf572cc1854983fd962,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,523.00; shareholder: Example Entity 2-3-1; ordinary business income: USD 10,523.00; distributions: USD 10,523.00. Recipient: Example Household 203.",K-1,30,K-1,fdc-60d5b8e2f56ad92115d7ce72,synthetic-form-layout-02,original,2023,fte-dee6c431aedce05ad924c0b3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,606.00; shareholder: Example Entity 2-4-1; ordinary business income: USD 10,606.00; distributions: USD 10,606.00. Recipient: Example Household 204.",K-1,30,K-1,fdc-a8ade036cf6d6b2d2d253581,synthetic-form-layout-02,original,2024,fte-5afc0bd3f29927d66afd719c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,689.00; shareholder: Example Entity 2-5-1; ordinary business income: USD 10,689.00; distributions: USD 10,689.00. Recipient: Example Household 205.",K-1,30,K-1,fdc-6be8d43e7d2910ea1454e399,synthetic-form-layout-02,original,2025,fte-1b4e5a3eeba9d2c7911f86ef,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,772.00; shareholder: Example Entity 2-6-1; ordinary business income: USD 10,772.00; distributions: USD 10,772.00. Recipient: Example Household 206.",K-1,30,K-1,fdc-3baba97fc492f8d34a8f2916,synthetic-form-layout-02,original,2023,fte-0ba7cc0a89e24b061630f30e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits.
corporation: USD 10,855.00; shareholder: Example Entity 2-7-1; ordinary business income: USD 10,855.00; distributions: USD 10,855.00. Recipient: Example Household 207.",K-1,30,K-1,fdc-cf78628061d758350d8b508a,synthetic-form-layout-02,original,2024,fte-5c4f37dc64dc94ffa0815fc5,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: corporation: USD 10,411.00, shareholder: Example Entity 3-0-1, ordinary business income: USD 10,411.00, distributions: USD 10,411.00. Account holder: Example Person 300.",K-1,30,K-1,fdc-fd3804c9e43ce092364f16d1,synthetic-form-layout-03,original,2023,fte-4dc84a4a2972ad2f097bf581,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: corporation: USD 10,494.00, shareholder: Example Entity 3-1-1, ordinary business income: USD 10,494.00, distributions: USD 10,494.00. Account holder: Example Person 301.",K-1,30,K-1,fdc-cea73c50781d3b74696cb912,synthetic-form-layout-03,original,2024,fte-08085fca97d58f2c1fa1db65,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2025.
Details: corporation: USD 10,577.00, shareholder: Example Entity 3-2-1, ordinary business income: USD 10,577.00, distributions: USD 10,577.00. Account holder: Example Person 302.",K-1,30,K-1,fdc-625766d6118aec218736f568,synthetic-form-layout-03,original,2025,fte-5c368d428270e2495d8da5c1,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: corporation: USD 10,660.00, shareholder: Example Entity 3-3-1, ordinary business income: USD 10,660.00, distributions: USD 10,660.00. Account holder: Example Person 303.",K-1,30,K-1,fdc-c166bff4ecbbd5012f8fc005,synthetic-form-layout-03,original,2023,fte-cff45064a78faae23ec9f4eb,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: corporation: USD 10,743.00, shareholder: Example Entity 3-4-1, ordinary business income: USD 10,743.00, distributions: USD 10,743.00. Account holder: Example Person 304.",K-1,30,K-1,fdc-9cbd934df0f481b006aa2572,synthetic-form-layout-03,original,2024,fte-7c6fad57e65d704d8c773888,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2025.
Details: corporation: USD 10,826.00, shareholder: Example Entity 3-5-1, ordinary business income: USD 10,826.00, distributions: USD 10,826.00. Account holder: Example Person 305.",K-1,30,K-1,fdc-90409610ea98c9d72d6d374a,synthetic-form-layout-03,original,2025,fte-deb2b38e46091f6abcea51ab,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: corporation: USD 10,909.00, shareholder: Example Entity 3-6-1, ordinary business income: USD 10,909.00, distributions: USD 10,909.00. Account holder: Example Person 306.",K-1,30,K-1,fdc-14ff58d7f7f24fa816ad5304,synthetic-form-layout-03,original,2023,fte-2049aab303e505b7a11cac30,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: corporation: USD 10,992.00, shareholder: Example Entity 3-7-1, ordinary business income: USD 10,992.00, distributions: USD 10,992.00. Account holder: Example Person 307.",K-1,30,K-1,fdc-e7e171b276d754ad2e316c4a,synthetic-form-layout-03,original,2024,fte-a504f210db20334dd0ff9603,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2023
distributions: USD 10,548.00
ordinary business income: USD 10,548.00
shareholder: Example Entity 4-0-1
corporation: USD 10,548.00
Named party: Example Person 400",K-1,30,K-1,fdc-b5096f5a37b441efc0ddd0a9,synthetic-form-layout-04,original,2023,fte-a62e54ac0258c7cd0dfdb176,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2024
distributions: USD 10,631.00
ordinary business income: USD 10,631.00
shareholder: Example Entity 4-1-1
corporation: USD 10,631.00
Named party: Example Person 401",K-1,30,K-1,fdc-a651c3bd9b17e135af96bb48,synthetic-form-layout-04,original,2024,fte-8911966a7220fa11fc060b6e,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2025
distributions: USD 10,714.00
ordinary business income: USD 10,714.00
shareholder: Example Entity 4-2-1
corporation: USD 10,714.00
Named party: Example Person 402",K-1,30,K-1,fdc-95524b354196f4c875d01ad2,synthetic-form-layout-04,original,2025,fte-990881acac4d4ae40e9725af,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2023
distributions: USD 10,797.00
ordinary business income: USD 10,797.00
shareholder: Example Entity 4-3-1
corporation: USD 10,797.00
Named party: Example Person 403",K-1,30,K-1,fdc-90a1833f6f12a185f89fa9d5,synthetic-form-layout-04,original,2023,fte-b4f2b03d75d77daaac2c6b97,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2024
distributions: USD 10,880.00
ordinary business income: USD 10,880.00
shareholder: Example Entity 4-4-1
corporation: USD 10,880.00
Named party: Example Person 404",K-1,30,K-1,fdc-69a989de0052894dec8e71ee,synthetic-form-layout-04,original,2024,fte-212c77a0ad835477c849a5c6,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2025
distributions: USD 10,963.00
ordinary business income: USD 10,963.00
shareholder: Example Entity 4-5-1
corporation: USD 10,963.00
Named party: Example Person 405",K-1,30,K-1,fdc-4a47ded2dfd352f8cee4b301,synthetic-form-layout-04,original,2025,fte-0f17ce089d74d7008111c731,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2023
distributions: USD 11,046.00
ordinary business income: USD 11,046.00
shareholder: Example Entity 4-6-1
corporation: USD 11,046.00
Named party: Example Person 406",K-1,30,K-1,fdc-c64e0fa7f7c826666c23a2c1,synthetic-form-layout-04,original,2023,fte-f6d4c6ca2574facf15289f34,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits
Tax reporting year 2024
distributions: USD 11,129.00
ordinary business income: USD 11,129.00
shareholder: Example Entity 4-7-1
corporation: USD 11,129.00
Named party: Example Person 407",K-1,30,K-1,fdc-fcfd9559450a14d7c693e9e9,synthetic-form-layout-04,original,2024,fte-497e32695ed2d7c1a1044c4a,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2023
corporation: USD 10,685.00 / shareholder: Example Entity 5-0-1 / ordinary business income: USD 10,685.00 / distributions: USD 10,685.00
Delivery copy for Example Party 500",K-1,30,K-1,fdc-11c002bc7f08d0d4e78519dc,synthetic-form-layout-05,original,2023,fte-82bf5fc08b2ae56f3ff92834,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2024
corporation: USD 10,768.00 / shareholder: Example Entity 5-1-1 / ordinary business income: USD 10,768.00 / distributions: USD 10,768.00
Delivery copy for Example Party 501",K-1,30,K-1,fdc-0a7ebc9969d0869c7e0b4db5,synthetic-form-layout-05,original,2024,fte-cfb836a280b0d0673285274f,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2025
corporation: USD 10,851.00 / shareholder: Example Entity 5-2-1 / ordinary business income: USD 10,851.00 / distributions: USD 10,851.00
Delivery copy for Example Party 502",K-1,30,K-1,fdc-b60130179641e7db480a51c0,synthetic-form-layout-05,original,2025,fte-d68fed078d5a78fce52a7ac4,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2023
corporation: USD 10,934.00 / shareholder: Example Entity 5-3-1 / ordinary business income: USD 10,934.00 / distributions: USD 10,934.00
Delivery copy for Example Party 503",K-1,30,K-1,fdc-a60ad8b8485f58e3144db0f5,synthetic-form-layout-05,original,2023,fte-d4a2adf953ebeb4c135e799c,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2024
corporation: USD 11,017.00 / shareholder: Example Entity 5-4-1 / ordinary business income: USD 11,017.00 / distributions: USD 11,017.00
Delivery copy for Example Party 504",K-1,30,K-1,fdc-901ec3d3298af70c270f2e5d,synthetic-form-layout-05,original,2024,fte-8ff7479c98e861455c004602,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2025
corporation: USD 11,100.00 / shareholder: Example Entity 5-5-1 / ordinary business income: USD 11,100.00 / distributions: USD 11,100.00
Delivery copy for Example Party 505",K-1,30,K-1,fdc-270111d6f3b291fa023974ac,synthetic-form-layout-05,original,2025,fte-5eab6de2f00867953fe52cd6,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2023
corporation: USD 11,183.00 / shareholder: Example Entity 5-6-1 / ordinary business income: USD 11,183.00 / distributions: USD 11,183.00
Delivery copy for Example Party 506",K-1,30,K-1,fdc-1fb5bf390cc97fc954283d93,synthetic-form-layout-05,original,2023,fte-4a25bdbf9c79594cffcb0465,synthetic_AI_labeled,v1_template,top,False,
"K-1-1120-S: Schedule K-1 Form 1120-S Shareholder Share of Income Deductions Credits -- reporting year 2024
corporation: USD 11,266.00 / shareholder: Example Entity 5-7-1 / ordinary business income: USD 11,266.00 / distributions: USD 11,266.00
Delivery copy for Example Party 507",K-1,30,K-1,fdc-1c39c0aa4ff015b582388cf9,synthetic-form-layout-05,original,2024,fte-c96f52ca01e3ada93feb6898,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 0.
estate or trust: USD 10,000.00
beneficiary: Example Entity 0-0-1
income: USD 10,000.00
deductions: USD 10,000.00",K-1,30,K-1,fdc-4c3dabab43cc6199944ead4f,synthetic-form-layout-00,original,2023,fte-dcd61cff0b0d643a62942ee3,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 1.
estate or trust: USD 10,083.00
beneficiary: Example Entity 0-1-1
income: USD 10,083.00
deductions: USD 10,083.00",K-1,30,K-1,fdc-81914d38d9b69d9557d85420,synthetic-form-layout-00,original,2024,fte-db0a9776ea05ad9c024a9125,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2025
Statement issued to Example Person 2.
estate or trust: USD 10,166.00
beneficiary: Example Entity 0-2-1
income: USD 10,166.00
deductions: USD 10,166.00",K-1,30,K-1,fdc-0bd9d59e7a22121d331c30ca,synthetic-form-layout-00,original,2025,fte-73d80cbcddbab6cc74e1515b,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 3.
estate or trust: USD 10,249.00
beneficiary: Example Entity 0-3-1
income: USD 10,249.00
deductions: USD 10,249.00",K-1,30,K-1,fdc-42f504e636b3e2504b90d032,synthetic-form-layout-00,original,2023,fte-414fd2df61e04d06c6d0bfcf,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 4.
estate or trust: USD 10,332.00
beneficiary: Example Entity 0-4-1
income: USD 10,332.00
deductions: USD 10,332.00",K-1,30,K-1,fdc-ea3413b7109e3732d168c067,synthetic-form-layout-00,original,2024,fte-463fc5995c38ad29b6fd63d1,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2025
Statement issued to Example Person 5.
estate or trust: USD 10,415.00
beneficiary: Example Entity 0-5-1
income: USD 10,415.00
deductions: USD 10,415.00",K-1,30,K-1,fdc-edb1c995362ac8bf334f4e5f,synthetic-form-layout-00,original,2025,fte-12626d3ce4778652e73f8c29,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2023
Statement issued to Example Person 6.
estate or trust: USD 10,498.00
beneficiary: Example Entity 0-6-1
income: USD 10,498.00
deductions: USD 10,498.00",K-1,30,K-1,fdc-3d9c8973c448e6a5d587e436,synthetic-form-layout-00,original,2023,fte-bdb74cf2d8f7f72b45fc9fe2,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Calendar year: 2024
Statement issued to Example Person 7.
estate or trust: USD 10,581.00
beneficiary: Example Entity 0-7-1
income: USD 10,581.00
deductions: USD 10,581.00",K-1,30,K-1,fdc-f88467d9dd2f73cddfa4fb29,synthetic-form-layout-00,original,2024,fte-bc859aa93c150fbb6ae99f6c,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 100
estate or trust: USD 10,137.00 | beneficiary: Example Entity 1-0-1 | income: USD 10,137.00 | deductions: USD 10,137.00",K-1,30,K-1,fdc-d1d16b6bb4346cb45dd10570,synthetic-form-layout-01,original,2023,fte-f0e4559c13ed598f97e81b5e,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 101
estate or trust: USD 10,220.00 | beneficiary: Example Entity 1-1-1 | income: USD 10,220.00 | deductions: USD 10,220.00",K-1,30,K-1,fdc-9c1d8a92654634daee6dde6c,synthetic-form-layout-01,original,2024,fte-15a2e07a9de1823aacda3acc,synthetic_AI_labeled,v1_template,top,False,
"2025 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 102
estate or trust: USD 10,303.00 | beneficiary: Example Entity 1-2-1 | income: USD 10,303.00 | deductions: USD 10,303.00",K-1,30,K-1,fdc-41acd8a876cad2bfada87b2c,synthetic-form-layout-01,original,2025,fte-4fff26461445983f62b3d22f,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 103
estate or trust: USD 10,386.00 | beneficiary: Example Entity 1-3-1 | income: USD 10,386.00 | deductions: USD 10,386.00",K-1,30,K-1,fdc-df1c3c3e4e9dc24ee5cd968a,synthetic-form-layout-01,original,2023,fte-a3f321f2fab0202317d4195c,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 104
estate or trust: USD 10,469.00 | beneficiary: Example Entity 1-4-1 | income: USD 10,469.00 | deductions: USD 10,469.00",K-1,30,K-1,fdc-f6ab4cad2f1377f2ed8e7cee,synthetic-form-layout-01,original,2024,fte-689877bf13b2297b05cfca69,synthetic_AI_labeled,v1_template,top,False,
"2025 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 105
estate or trust: USD 10,552.00 | beneficiary: Example Entity 1-5-1 | income: USD 10,552.00 | deductions: USD 10,552.00",K-1,30,K-1,fdc-bac04d83fcb0563678c9b9a5,synthetic-form-layout-01,original,2025,fte-6b25d191c4cca66e33e3108a,synthetic_AI_labeled,v1_template,top,False,
"2023 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 106
estate or trust: USD 10,635.00 | beneficiary: Example Entity 1-6-1 | income: USD 10,635.00 | deductions: USD 10,635.00",K-1,30,K-1,fdc-6fd2428600b530ba78219a78,synthetic-form-layout-01,original,2023,fte-1b225854d41ce9a6c5428320,synthetic_AI_labeled,v1_template,top,False,
"2024 | K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Recipient record: Example Person 107
estate or trust: USD 10,718.00 | beneficiary: Example Entity 1-7-1 | income: USD 10,718.00 | deductions: USD 10,718.00",K-1,30,K-1,fdc-f973bd3671ee2070dc567921,synthetic-form-layout-01,original,2024,fte-3dd4fa06c98fa8a50ac513ac,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,274.00; beneficiary: Example Entity 2-0-1; income: USD 10,274.00; deductions: USD 10,274.00. Recipient: Example Household 200.",K-1,30,K-1,fdc-5d80a80a79f9edaaf981585a,synthetic-form-layout-02,original,2023,fte-e5a6b8e84169a724fd70edd2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,357.00; beneficiary: Example Entity 2-1-1; income: USD 10,357.00; deductions: USD 10,357.00. Recipient: Example Household 201.",K-1,30,K-1,fdc-2b8381414642e053c6a3457f,synthetic-form-layout-02,original,2024,fte-8b1fd7fa64e4ddb7a1dd7b77,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,440.00; beneficiary: Example Entity 2-2-1; income: USD 10,440.00; deductions: USD 10,440.00. Recipient: Example Household 202.",K-1,30,K-1,fdc-337cd386547aff71dcd2df2c,synthetic-form-layout-02,original,2025,fte-e65525ba03883c75bdbdea09,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,523.00; beneficiary: Example Entity 2-3-1; income: USD 10,523.00; deductions: USD 10,523.00. Recipient: Example Household 203.",K-1,30,K-1,fdc-706c72fa3abc96aabea70f6a,synthetic-form-layout-02,original,2023,fte-e1c7876a15ea6f4dce04f5fe,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,606.00; beneficiary: Example Entity 2-4-1; income: USD 10,606.00; deductions: USD 10,606.00. Recipient: Example Household 204.",K-1,30,K-1,fdc-e3d34d78f2640ef0c31a9cf0,synthetic-form-layout-02,original,2024,fte-0fcf7b41073014b73c919777,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,689.00; beneficiary: Example Entity 2-5-1; income: USD 10,689.00; deductions: USD 10,689.00. Recipient: Example Household 205.",K-1,30,K-1,fdc-49799f54cd9170f66c2b6c8d,synthetic-form-layout-02,original,2025,fte-5555b5dbb625771cb4ee85b8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,772.00; beneficiary: Example Entity 2-6-1; income: USD 10,772.00; deductions: USD 10,772.00. Recipient: Example Household 206.",K-1,30,K-1,fdc-0413658f55e34352478f9446,synthetic-form-layout-02,original,2023,fte-90d4363587f768898bf6f341,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits.
estate or trust: USD 10,855.00; beneficiary: Example Entity 2-7-1; income: USD 10,855.00; deductions: USD 10,855.00. Recipient: Example Household 207.",K-1,30,K-1,fdc-ae4ed2e19f9308d226616a83,synthetic-form-layout-02,original,2024,fte-729070777c815c4da678a0af,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: estate or trust: USD 10,411.00, beneficiary: Example Entity 3-0-1, income: USD 10,411.00, deductions: USD 10,411.00. Account holder: Example Person 300.",K-1,30,K-1,fdc-9600941c446e06d729e1071e,synthetic-form-layout-03,original,2023,fte-f7dca691182beccbe54fe98b,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: estate or trust: USD 10,494.00, beneficiary: Example Entity 3-1-1, income: USD 10,494.00, deductions: USD 10,494.00. Account holder: Example Person 301.",K-1,30,K-1,fdc-f927eb28cbae1bf1552d252c,synthetic-form-layout-03,original,2024,fte-c6ab952d5c6c7bd80daba20b,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2025.
Details: estate or trust: USD 10,577.00, beneficiary: Example Entity 3-2-1, income: USD 10,577.00, deductions: USD 10,577.00. Account holder: Example Person 302.",K-1,30,K-1,fdc-b863cc3382013e218a59b93b,synthetic-form-layout-03,original,2025,fte-711460fff25f17d5407a3739,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: estate or trust: USD 10,660.00, beneficiary: Example Entity 3-3-1, income: USD 10,660.00, deductions: USD 10,660.00. Account holder: Example Person 303.",K-1,30,K-1,fdc-53ad2e0319b78fb33523252e,synthetic-form-layout-03,original,2023,fte-b460f9e25b317c573107cde4,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: estate or trust: USD 10,743.00, beneficiary: Example Entity 3-4-1, income: USD 10,743.00, deductions: USD 10,743.00. Account holder: Example Person 304.",K-1,30,K-1,fdc-de22e4bfcb89d1b45229588d,synthetic-form-layout-03,original,2024,fte-a2564fc415bd566e909074c1,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2025.
Details: estate or trust: USD 10,826.00, beneficiary: Example Entity 3-5-1, income: USD 10,826.00, deductions: USD 10,826.00. Account holder: Example Person 305.",K-1,30,K-1,fdc-ce3dc15ae0dabe8baa29c30d,synthetic-form-layout-03,original,2025,fte-2032cb245130f168fe6a1f2b,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2023.
Details: estate or trust: USD 10,909.00, beneficiary: Example Entity 3-6-1, income: USD 10,909.00, deductions: USD 10,909.00. Account holder: Example Person 306.",K-1,30,K-1,fdc-315a148c301515dfe2bbbf01,synthetic-form-layout-03,original,2023,fte-fca1d9b7ebe84488f002d87a,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Reporting period ended 12/31/2024.
Details: estate or trust: USD 10,992.00, beneficiary: Example Entity 3-7-1, income: USD 10,992.00, deductions: USD 10,992.00. Account holder: Example Person 307.",K-1,30,K-1,fdc-4e468992b1846d83df13c956,synthetic-form-layout-03,original,2024,fte-9af40eddaf971686d3b560fa,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2023
deductions: USD 10,548.00
income: USD 10,548.00
beneficiary: Example Entity 4-0-1
estate or trust: USD 10,548.00
Named party: Example Person 400",K-1,30,K-1,fdc-57900e1c029b849bdee75acf,synthetic-form-layout-04,original,2023,fte-506b437b1f6cdfb12f6635b3,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2024
deductions: USD 10,631.00
income: USD 10,631.00
beneficiary: Example Entity 4-1-1
estate or trust: USD 10,631.00
Named party: Example Person 401",K-1,30,K-1,fdc-302dcf744d333139fa09e2d2,synthetic-form-layout-04,original,2024,fte-436e2be89e9c6bcc722e0c9e,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2025
deductions: USD 10,714.00
income: USD 10,714.00
beneficiary: Example Entity 4-2-1
estate or trust: USD 10,714.00
Named party: Example Person 402",K-1,30,K-1,fdc-5d81b38838aba4a12a9b18d7,synthetic-form-layout-04,original,2025,fte-ec4a0e8d518267e52ccb4c88,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2023
deductions: USD 10,797.00
income: USD 10,797.00
beneficiary: Example Entity 4-3-1
estate or trust: USD 10,797.00
Named party: Example Person 403",K-1,30,K-1,fdc-21199b2b9f2e0a0216296380,synthetic-form-layout-04,original,2023,fte-6253b28cd4e2a56e874b91a3,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2024
deductions: USD 10,880.00
income: USD 10,880.00
beneficiary: Example Entity 4-4-1
estate or trust: USD 10,880.00
Named party: Example Person 404",K-1,30,K-1,fdc-8a3f6c93fa47d88a271a9cc9,synthetic-form-layout-04,original,2024,fte-419a064b62ce558c2a0ffe35,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2025
deductions: USD 10,963.00
income: USD 10,963.00
beneficiary: Example Entity 4-5-1
estate or trust: USD 10,963.00
Named party: Example Person 405",K-1,30,K-1,fdc-75c32a8e066c4d8235d8ae1e,synthetic-form-layout-04,original,2025,fte-d767c3e27a1856fb683eb01b,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2023
deductions: USD 11,046.00
income: USD 11,046.00
beneficiary: Example Entity 4-6-1
estate or trust: USD 11,046.00
Named party: Example Person 406",K-1,30,K-1,fdc-9938e6edefbcb4181db2eaa3,synthetic-form-layout-04,original,2023,fte-bf342d930a4149d9f90f6fc9,synthetic_AI_labeled,v1_template,top,False,
"Document header: K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits
Tax reporting year 2024
deductions: USD 11,129.00
income: USD 11,129.00
beneficiary: Example Entity 4-7-1
estate or trust: USD 11,129.00
Named party: Example Person 407",K-1,30,K-1,fdc-6a544cf5c0952c51af8196d8,synthetic-form-layout-04,original,2024,fte-31c1317fd42db8d3af16705f,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2023
estate or trust: USD 10,685.00 / beneficiary: Example Entity 5-0-1 / income: USD 10,685.00 / deductions: USD 10,685.00
Delivery copy for Example Party 500",K-1,30,K-1,fdc-264885a67ba6f1a32e38d777,synthetic-form-layout-05,original,2023,fte-b2f3248704708dd2f1682d26,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2024
estate or trust: USD 10,768.00 / beneficiary: Example Entity 5-1-1 / income: USD 10,768.00 / deductions: USD 10,768.00
Delivery copy for Example Party 501",K-1,30,K-1,fdc-c69cb170c6937103bb051d21,synthetic-form-layout-05,original,2024,fte-9d8617e9e6a589c47419bbd7,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2025
estate or trust: USD 10,851.00 / beneficiary: Example Entity 5-2-1 / income: USD 10,851.00 / deductions: USD 10,851.00
Delivery copy for Example Party 502",K-1,30,K-1,fdc-cbe0da875d88d41a0d65e23c,synthetic-form-layout-05,original,2025,fte-63ca53755aee0a4adbc5cad1,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2023
estate or trust: USD 10,934.00 / beneficiary: Example Entity 5-3-1 / income: USD 10,934.00 / deductions: USD 10,934.00
Delivery copy for Example Party 503",K-1,30,K-1,fdc-f052b699544b7775bd5fb9b2,synthetic-form-layout-05,original,2023,fte-3ecfa6c30e46519096b7da34,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2024
estate or trust: USD 11,017.00 / beneficiary: Example Entity 5-4-1 / income: USD 11,017.00 / deductions: USD 11,017.00
Delivery copy for Example Party 504",K-1,30,K-1,fdc-ff8ebfab61dc6502e9adfc4c,synthetic-form-layout-05,original,2024,fte-265c5504dd56c9bc6068d75c,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2025
estate or trust: USD 11,100.00 / beneficiary: Example Entity 5-5-1 / income: USD 11,100.00 / deductions: USD 11,100.00
Delivery copy for Example Party 505",K-1,30,K-1,fdc-f0c823cecbad27fe88049c52,synthetic-form-layout-05,original,2025,fte-849c6b1551559976e94a74c7,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2023
estate or trust: USD 11,183.00 / beneficiary: Example Entity 5-6-1 / income: USD 11,183.00 / deductions: USD 11,183.00
Delivery copy for Example Party 506",K-1,30,K-1,fdc-f7c87be4e50a821b61e56fdf,synthetic-form-layout-05,original,2023,fte-5500d6a1a67e5465acc82111,synthetic_AI_labeled,v1_template,top,False,
"K-1-1041: Schedule K-1 Form 1041 Beneficiary Share of Income Deductions Credits -- reporting year 2024
estate or trust: USD 11,266.00 / beneficiary: Example Entity 5-7-1 / income: USD 11,266.00 / deductions: USD 11,266.00
Delivery copy for Example Party 507",K-1,30,K-1,fdc-b3ab77d23183e8b488f83ca8,synthetic-form-layout-05,original,2024,fte-bfc7b579dd9436b2aec3f848,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2023
Statement issued to Example Person 0.
medical expenses: USD 10,000.00
taxes paid: USD 10,000.00
interest: USD 10,000.00
gifts to charity: USD 10,000.00",SCHEDULE,34,SCHEDULE,fdc-f6ce56686c95eddb8163f3fd,synthetic-form-layout-00,original,2023,fte-5fabb1d258515ec303e7129f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2024
Statement issued to Example Person 1.
medical expenses: USD 10,083.00
taxes paid: USD 10,083.00
interest: USD 10,083.00
gifts to charity: USD 10,083.00",SCHEDULE,34,SCHEDULE,fdc-59df548343329e1b4f329d38,synthetic-form-layout-00,original,2024,fte-77f85e2864d0484b973b9a2a,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2025
Statement issued to Example Person 2.
medical expenses: USD 10,166.00
taxes paid: USD 10,166.00
interest: USD 10,166.00
gifts to charity: USD 10,166.00",SCHEDULE,34,SCHEDULE,fdc-1bfddc9625cd403fdc94fc52,synthetic-form-layout-00,original,2025,fte-45e188bccea790c2ebca7a84,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2023
Statement issued to Example Person 3.
medical expenses: USD 10,249.00
taxes paid: USD 10,249.00
interest: USD 10,249.00
gifts to charity: USD 10,249.00",SCHEDULE,34,SCHEDULE,fdc-382242b097b75e581c446836,synthetic-form-layout-00,original,2023,fte-c1ac93b77a3801ae5428f839,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2024
Statement issued to Example Person 4.
medical expenses: USD 10,332.00
taxes paid: USD 10,332.00
interest: USD 10,332.00
gifts to charity: USD 10,332.00",SCHEDULE,34,SCHEDULE,fdc-bfdd6b19d00ca1891082b90a,synthetic-form-layout-00,original,2024,fte-8bc1c988c45b8ef22cb65b5f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2025
Statement issued to Example Person 5.
medical expenses: USD 10,415.00
taxes paid: USD 10,415.00
interest: USD 10,415.00
gifts to charity: USD 10,415.00",SCHEDULE,34,SCHEDULE,fdc-54f814e4d7795821f7f39f81,synthetic-form-layout-00,original,2025,fte-648cd5420f6c67dcb65b3c85,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2023
Statement issued to Example Person 6.
medical expenses: USD 10,498.00
taxes paid: USD 10,498.00
interest: USD 10,498.00
gifts to charity: USD 10,498.00",SCHEDULE,34,SCHEDULE,fdc-9323ad81de51ee3dc980e716,synthetic-form-layout-00,original,2023,fte-a474e04bec069540f3591764,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Calendar year: 2024
Statement issued to Example Person 7.
medical expenses: USD 10,581.00
taxes paid: USD 10,581.00
interest: USD 10,581.00
gifts to charity: USD 10,581.00",SCHEDULE,34,SCHEDULE,fdc-4b0092a6a1778313d926c27e,synthetic-form-layout-00,original,2024,fte-55639d2d5c3b83a481b16087,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 100
medical expenses: USD 10,137.00 | taxes paid: USD 10,137.00 | interest: USD 10,137.00 | gifts to charity: USD 10,137.00",SCHEDULE,34,SCHEDULE,fdc-4785624eddd8989418b29db9,synthetic-form-layout-01,original,2023,fte-0424d61d2229bbbf84e1cb3e,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 101
medical expenses: USD 10,220.00 | taxes paid: USD 10,220.00 | interest: USD 10,220.00 | gifts to charity: USD 10,220.00",SCHEDULE,34,SCHEDULE,fdc-63f1cb5599fe0e93ec8b2203,synthetic-form-layout-01,original,2024,fte-112d7cea300304201d26964e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 102
medical expenses: USD 10,303.00 | taxes paid: USD 10,303.00 | interest: USD 10,303.00 | gifts to charity: USD 10,303.00",SCHEDULE,34,SCHEDULE,fdc-3cc1895649b249e3594ad3cd,synthetic-form-layout-01,original,2025,fte-8b5d25a8942660ce76fffa7b,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 103
medical expenses: USD 10,386.00 | taxes paid: USD 10,386.00 | interest: USD 10,386.00 | gifts to charity: USD 10,386.00",SCHEDULE,34,SCHEDULE,fdc-59fa3d5c4984e25f5c50a280,synthetic-form-layout-01,original,2023,fte-c8b55a5653f14eca9e7fa1ca,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 104
medical expenses: USD 10,469.00 | taxes paid: USD 10,469.00 | interest: USD 10,469.00 | gifts to charity: USD 10,469.00",SCHEDULE,34,SCHEDULE,fdc-c3654aa40fd3069431a6a67d,synthetic-form-layout-01,original,2024,fte-192f2116db45c28332d36e4d,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 105
medical expenses: USD 10,552.00 | taxes paid: USD 10,552.00 | interest: USD 10,552.00 | gifts to charity: USD 10,552.00",SCHEDULE,34,SCHEDULE,fdc-ab989032362c01169e489190,synthetic-form-layout-01,original,2025,fte-a689751aea59be3f3dda435e,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 106
medical expenses: USD 10,635.00 | taxes paid: USD 10,635.00 | interest: USD 10,635.00 | gifts to charity: USD 10,635.00",SCHEDULE,34,SCHEDULE,fdc-668f4b4a959bfdd8f50529de,synthetic-form-layout-01,original,2023,fte-e56715e8f3a06f7027a85be0,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-A: Schedule A Itemized Deductions
Recipient record: Example Person 107
medical expenses: USD 10,718.00 | taxes paid: USD 10,718.00 | interest: USD 10,718.00 | gifts to charity: USD 10,718.00",SCHEDULE,34,SCHEDULE,fdc-4bd0ca8eeb6bf9c4498ae517,synthetic-form-layout-01,original,2024,fte-3c2dbfc262f5e5ed1046e747,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,274.00; taxes paid: USD 10,274.00; interest: USD 10,274.00; gifts to charity: USD 10,274.00. Recipient: Example Household 200.",SCHEDULE,34,SCHEDULE,fdc-14f74cac7593c1a6176cfaf6,synthetic-form-layout-02,original,2023,fte-86d2d55d33dc57468961fa23,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,357.00; taxes paid: USD 10,357.00; interest: USD 10,357.00; gifts to charity: USD 10,357.00. Recipient: Example Household 201.",SCHEDULE,34,SCHEDULE,fdc-c8c8651ae36851321792af28,synthetic-form-layout-02,original,2024,fte-c83aa7133c592441e4ad0777,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,440.00; taxes paid: USD 10,440.00; interest: USD 10,440.00; gifts to charity: USD 10,440.00. Recipient: Example Household 202.",SCHEDULE,34,SCHEDULE,fdc-f559fb9c7862c1f7f8b675b3,synthetic-form-layout-02,original,2025,fte-a4e892a3046482bcc77ecb20,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,523.00; taxes paid: USD 10,523.00; interest: USD 10,523.00; gifts to charity: USD 10,523.00. Recipient: Example Household 203.",SCHEDULE,34,SCHEDULE,fdc-904059748c76f4ccc2461beb,synthetic-form-layout-02,original,2023,fte-bf7a9c3bb70787453f17661e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,606.00; taxes paid: USD 10,606.00; interest: USD 10,606.00; gifts to charity: USD 10,606.00. Recipient: Example Household 204.",SCHEDULE,34,SCHEDULE,fdc-a2e490d8ac82378a4ca2f38a,synthetic-form-layout-02,original,2024,fte-a1ddcc53efd39a8466401296,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,689.00; taxes paid: USD 10,689.00; interest: USD 10,689.00; gifts to charity: USD 10,689.00. Recipient: Example Household 205.",SCHEDULE,34,SCHEDULE,fdc-b042dbfb1d575e9e69c87704,synthetic-form-layout-02,original,2025,fte-f8c4a9119612d72122ddd8cf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,772.00; taxes paid: USD 10,772.00; interest: USD 10,772.00; gifts to charity: USD 10,772.00. Recipient: Example Household 206.",SCHEDULE,34,SCHEDULE,fdc-efb5e4e0319d029e38a2642f,synthetic-form-layout-02,original,2023,fte-09a9fde72f2e2ebf4de9361f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-A: Schedule A Itemized Deductions.
medical expenses: USD 10,855.00; taxes paid: USD 10,855.00; interest: USD 10,855.00; gifts to charity: USD 10,855.00. Recipient: Example Household 207.",SCHEDULE,34,SCHEDULE,fdc-85db9a9ab6748ad1cb6940be,synthetic-form-layout-02,original,2024,fte-589c524e8f0425f559847545,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2023.
Details: medical expenses: USD 10,411.00, taxes paid: USD 10,411.00, interest: USD 10,411.00, gifts to charity: USD 10,411.00. Account holder: Example Person 300.",SCHEDULE,34,SCHEDULE,fdc-82f549b8e73298e5e2f054c3,synthetic-form-layout-03,original,2023,fte-f5df5dd6880957485ec19c5d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2024.
Details: medical expenses: USD 10,494.00, taxes paid: USD 10,494.00, interest: USD 10,494.00, gifts to charity: USD 10,494.00. Account holder: Example Person 301.",SCHEDULE,34,SCHEDULE,fdc-8302c7eaa2f4321c1877a396,synthetic-form-layout-03,original,2024,fte-acc7c12e770d9ddf5c992e87,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2025.
Details: medical expenses: USD 10,577.00, taxes paid: USD 10,577.00, interest: USD 10,577.00, gifts to charity: USD 10,577.00. Account holder: Example Person 302.",SCHEDULE,34,SCHEDULE,fdc-5dbef99e6ada9bdf583a9697,synthetic-form-layout-03,original,2025,fte-65ce4c09d4f31e55c13fb8d2,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2023.
Details: medical expenses: USD 10,660.00, taxes paid: USD 10,660.00, interest: USD 10,660.00, gifts to charity: USD 10,660.00. Account holder: Example Person 303.",SCHEDULE,34,SCHEDULE,fdc-a1ac1784037a551cb8b11696,synthetic-form-layout-03,original,2023,fte-e2a24e93a83c4707c06db33e,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2024.
Details: medical expenses: USD 10,743.00, taxes paid: USD 10,743.00, interest: USD 10,743.00, gifts to charity: USD 10,743.00. Account holder: Example Person 304.",SCHEDULE,34,SCHEDULE,fdc-6176081745103b9f6a16f55d,synthetic-form-layout-03,original,2024,fte-57a25a9633d716fbbe2e4e0d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2025.
Details: medical expenses: USD 10,826.00, taxes paid: USD 10,826.00, interest: USD 10,826.00, gifts to charity: USD 10,826.00. Account holder: Example Person 305.",SCHEDULE,34,SCHEDULE,fdc-a9411930c96befe71066c85e,synthetic-form-layout-03,original,2025,fte-24058a7a478b5a604e2313fb,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2023.
Details: medical expenses: USD 10,909.00, taxes paid: USD 10,909.00, interest: USD 10,909.00, gifts to charity: USD 10,909.00. Account holder: Example Person 306.",SCHEDULE,34,SCHEDULE,fdc-4ea037f12e1b7a4f50c7827a,synthetic-form-layout-03,original,2023,fte-bff35a133561d71ded85a6a4,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions
Reporting period ended 12/31/2024.
Details: medical expenses: USD 10,992.00, taxes paid: USD 10,992.00, interest: USD 10,992.00, gifts to charity: USD 10,992.00. Account holder: Example Person 307.",SCHEDULE,34,SCHEDULE,fdc-3c1c4bf051ed6796c340d62e,synthetic-form-layout-03,original,2024,fte-4e18c0bcd42d6ce2182d6317,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2023
gifts to charity: USD 10,548.00
interest: USD 10,548.00
taxes paid: USD 10,548.00
medical expenses: USD 10,548.00
Named party: Example Person 400",SCHEDULE,34,SCHEDULE,fdc-df4159a401f34b4e790a2116,synthetic-form-layout-04,original,2023,fte-70636d1a138ad054c4f5daff,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2024
gifts to charity: USD 10,631.00
interest: USD 10,631.00
taxes paid: USD 10,631.00
medical expenses: USD 10,631.00
Named party: Example Person 401",SCHEDULE,34,SCHEDULE,fdc-4bef1991dffee885dc7c4df6,synthetic-form-layout-04,original,2024,fte-5566ddd589b35ac054ce3a3f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2025
gifts to charity: USD 10,714.00
interest: USD 10,714.00
taxes paid: USD 10,714.00
medical expenses: USD 10,714.00
Named party: Example Person 402",SCHEDULE,34,SCHEDULE,fdc-c9497038ceeea0f394cd3f25,synthetic-form-layout-04,original,2025,fte-cb1c298be3d18271404b404f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2023
gifts to charity: USD 10,797.00
interest: USD 10,797.00
taxes paid: USD 10,797.00
medical expenses: USD 10,797.00
Named party: Example Person 403",SCHEDULE,34,SCHEDULE,fdc-603b81f163345e6c6a170aba,synthetic-form-layout-04,original,2023,fte-29acf7e3f7e91c7df18ea9da,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2024
gifts to charity: USD 10,880.00
interest: USD 10,880.00
taxes paid: USD 10,880.00
medical expenses: USD 10,880.00
Named party: Example Person 404",SCHEDULE,34,SCHEDULE,fdc-61ef9e4da545aae283175e0f,synthetic-form-layout-04,original,2024,fte-bee279537dcce18129815e8d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2025
gifts to charity: USD 10,963.00
interest: USD 10,963.00
taxes paid: USD 10,963.00
medical expenses: USD 10,963.00
Named party: Example Person 405",SCHEDULE,34,SCHEDULE,fdc-76e21cf761d2373966520e92,synthetic-form-layout-04,original,2025,fte-0cbd07cd17d4f3a101586937,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2023
gifts to charity: USD 11,046.00
interest: USD 11,046.00
taxes paid: USD 11,046.00
medical expenses: USD 11,046.00
Named party: Example Person 406",SCHEDULE,34,SCHEDULE,fdc-f838716880355f8e365f8fb2,synthetic-form-layout-04,original,2023,fte-56a89157fa2eee016ecf6245,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-A: Schedule A Itemized Deductions
Tax reporting year 2024
gifts to charity: USD 11,129.00
interest: USD 11,129.00
taxes paid: USD 11,129.00
medical expenses: USD 11,129.00
Named party: Example Person 407",SCHEDULE,34,SCHEDULE,fdc-f363be486ea9c065ecf8d9b0,synthetic-form-layout-04,original,2024,fte-fde8e97b81c88afceacca2df,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2023
medical expenses: USD 10,685.00 / taxes paid: USD 10,685.00 / interest: USD 10,685.00 / gifts to charity: USD 10,685.00
Delivery copy for Example Party 500",SCHEDULE,34,SCHEDULE,fdc-318737584767f9762bef3e7e,synthetic-form-layout-05,original,2023,fte-12ecb2c109e63718dff590c2,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2024
medical expenses: USD 10,768.00 / taxes paid: USD 10,768.00 / interest: USD 10,768.00 / gifts to charity: USD 10,768.00
Delivery copy for Example Party 501",SCHEDULE,34,SCHEDULE,fdc-770c0d8d0f3457da918b3aa5,synthetic-form-layout-05,original,2024,fte-890171f190afd37bebe966f9,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2025
medical expenses: USD 10,851.00 / taxes paid: USD 10,851.00 / interest: USD 10,851.00 / gifts to charity: USD 10,851.00
Delivery copy for Example Party 502",SCHEDULE,34,SCHEDULE,fdc-07602811dffe9cbd5d19ffaa,synthetic-form-layout-05,original,2025,fte-2fa2a01a250a16fbfba8f6b2,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2023
medical expenses: USD 10,934.00 / taxes paid: USD 10,934.00 / interest: USD 10,934.00 / gifts to charity: USD 10,934.00
Delivery copy for Example Party 503",SCHEDULE,34,SCHEDULE,fdc-241265c4e68002f5f16f61e3,synthetic-form-layout-05,original,2023,fte-bc96ffaa823e86b304d009d8,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2024
medical expenses: USD 11,017.00 / taxes paid: USD 11,017.00 / interest: USD 11,017.00 / gifts to charity: USD 11,017.00
Delivery copy for Example Party 504",SCHEDULE,34,SCHEDULE,fdc-b92dc5046d42ce25db63b6cc,synthetic-form-layout-05,original,2024,fte-2626ad48391b8cd23136c145,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2025
medical expenses: USD 11,100.00 / taxes paid: USD 11,100.00 / interest: USD 11,100.00 / gifts to charity: USD 11,100.00
Delivery copy for Example Party 505",SCHEDULE,34,SCHEDULE,fdc-bebaa565ad13b82f93982a43,synthetic-form-layout-05,original,2025,fte-5e66264f0b19ceddf4abb26e,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2023
medical expenses: USD 11,183.00 / taxes paid: USD 11,183.00 / interest: USD 11,183.00 / gifts to charity: USD 11,183.00
Delivery copy for Example Party 506",SCHEDULE,34,SCHEDULE,fdc-fbef844a5534bcb7f0bf8624,synthetic-form-layout-05,original,2023,fte-a5d0aca2c7db9cfb13085711,synthetic_AI_labeled,v1_template,top,False,
"Schedule-A: Schedule A Itemized Deductions -- reporting year 2024
medical expenses: USD 11,266.00 / taxes paid: USD 11,266.00 / interest: USD 11,266.00 / gifts to charity: USD 11,266.00
Delivery copy for Example Party 507",SCHEDULE,34,SCHEDULE,fdc-29ec7537c675976091975e45,synthetic-form-layout-05,original,2024,fte-7eb6345cb7d0de5d9af7ccd7,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2023
Statement issued to Example Person 0.
interest payer: Example Entity 0-0-0
ordinary dividends: USD 10,000.00
foreign accounts: USD 10,000.00",SCHEDULE,34,SCHEDULE,fdc-0185b81e1874df8c7526c867,synthetic-form-layout-00,original,2023,fte-bda45c73e0a3c8f5c012789f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2024
Statement issued to Example Person 1.
interest payer: Example Entity 0-1-0
ordinary dividends: USD 10,083.00
foreign accounts: USD 10,083.00",SCHEDULE,34,SCHEDULE,fdc-9320f79910925b23ab35e516,synthetic-form-layout-00,original,2024,fte-fdac64f3a61d613a7d34decd,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2025
Statement issued to Example Person 2.
interest payer: Example Entity 0-2-0
ordinary dividends: USD 10,166.00
foreign accounts: USD 10,166.00",SCHEDULE,34,SCHEDULE,fdc-0c4d26c7336273e4843f6742,synthetic-form-layout-00,original,2025,fte-11a54472d7376270a6b78c2d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2023
Statement issued to Example Person 3.
interest payer: Example Entity 0-3-0
ordinary dividends: USD 10,249.00
foreign accounts: USD 10,249.00",SCHEDULE,34,SCHEDULE,fdc-5e90fb3a37a367503750e52a,synthetic-form-layout-00,original,2023,fte-7b212ef788261e9769e23820,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2024
Statement issued to Example Person 4.
interest payer: Example Entity 0-4-0
ordinary dividends: USD 10,332.00
foreign accounts: USD 10,332.00",SCHEDULE,34,SCHEDULE,fdc-27b2eb7291e2dfe64dad1a55,synthetic-form-layout-00,original,2024,fte-af8ddbdaf75ae6804a42d0cc,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2025
Statement issued to Example Person 5.
interest payer: Example Entity 0-5-0
ordinary dividends: USD 10,415.00
foreign accounts: USD 10,415.00",SCHEDULE,34,SCHEDULE,fdc-0bfeae0301f2ba52a88dc004,synthetic-form-layout-00,original,2025,fte-bab29d7f5f958f68a652e5e0,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2023
Statement issued to Example Person 6.
interest payer: Example Entity 0-6-0
ordinary dividends: USD 10,498.00
foreign accounts: USD 10,498.00",SCHEDULE,34,SCHEDULE,fdc-ed5f6cdbbe9ddb3dee29b756,synthetic-form-layout-00,original,2023,fte-485afad5be744afbb01c5fe0,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Calendar year: 2024
Statement issued to Example Person 7.
interest payer: Example Entity 0-7-0
ordinary dividends: USD 10,581.00
foreign accounts: USD 10,581.00",SCHEDULE,34,SCHEDULE,fdc-afe91bfa22c6d35dfdd477eb,synthetic-form-layout-00,original,2024,fte-d4ef658dea620358f895c497,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 100
interest payer: Example Entity 1-0-0 | ordinary dividends: USD 10,137.00 | foreign accounts: USD 10,137.00",SCHEDULE,34,SCHEDULE,fdc-ba9f199315035b341c17a57d,synthetic-form-layout-01,original,2023,fte-95a1d5b86553d5daaca3eab5,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 101
interest payer: Example Entity 1-1-0 | ordinary dividends: USD 10,220.00 | foreign accounts: USD 10,220.00",SCHEDULE,34,SCHEDULE,fdc-0425c3470959268eb430f683,synthetic-form-layout-01,original,2024,fte-73dc9122351d15a3e464e4a2,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 102
interest payer: Example Entity 1-2-0 | ordinary dividends: USD 10,303.00 | foreign accounts: USD 10,303.00",SCHEDULE,34,SCHEDULE,fdc-656076de270fa23f4f0cfd89,synthetic-form-layout-01,original,2025,fte-5bccf4d47d7a0b6c53c292c5,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 103
interest payer: Example Entity 1-3-0 | ordinary dividends: USD 10,386.00 | foreign accounts: USD 10,386.00",SCHEDULE,34,SCHEDULE,fdc-025b1ee5bb9a4725dee0d97d,synthetic-form-layout-01,original,2023,fte-b5363bfcfcd1e72136dbf3b6,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 104
interest payer: Example Entity 1-4-0 | ordinary dividends: USD 10,469.00 | foreign accounts: USD 10,469.00",SCHEDULE,34,SCHEDULE,fdc-af25f7bef8ce5c975363dca0,synthetic-form-layout-01,original,2024,fte-788dce1df1b616b36bc0b686,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 105
interest payer: Example Entity 1-5-0 | ordinary dividends: USD 10,552.00 | foreign accounts: USD 10,552.00",SCHEDULE,34,SCHEDULE,fdc-8a942eccb7b43fa940c7058f,synthetic-form-layout-01,original,2025,fte-595e8d762b381dfdb502ff6d,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 106
interest payer: Example Entity 1-6-0 | ordinary dividends: USD 10,635.00 | foreign accounts: USD 10,635.00",SCHEDULE,34,SCHEDULE,fdc-45d0973c95881d3a19dc5afc,synthetic-form-layout-01,original,2023,fte-aa975d37b990a4fcdab24c09,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-B: Schedule B Interest and Ordinary Dividends
Recipient record: Example Person 107
interest payer: Example Entity 1-7-0 | ordinary dividends: USD 10,718.00 | foreign accounts: USD 10,718.00",SCHEDULE,34,SCHEDULE,fdc-be9b02bf56aee2d7f777daa6,synthetic-form-layout-01,original,2024,fte-eea75be2e376362fd4e4d4a8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-0-0; ordinary dividends: USD 10,274.00; foreign accounts: USD 10,274.00. Recipient: Example Household 200.",SCHEDULE,34,SCHEDULE,fdc-5ab8cd6f8b99fa2df8754faa,synthetic-form-layout-02,original,2023,fte-40f8595fad8d2672dcdf4316,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-1-0; ordinary dividends: USD 10,357.00; foreign accounts: USD 10,357.00. Recipient: Example Household 201.",SCHEDULE,34,SCHEDULE,fdc-752070bb5a26da5b89ffbc8b,synthetic-form-layout-02,original,2024,fte-207cc6f818b5637cfd4dc535,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-2-0; ordinary dividends: USD 10,440.00; foreign accounts: USD 10,440.00. Recipient: Example Household 202.",SCHEDULE,34,SCHEDULE,fdc-176cf9b3d238e4a934f0bac2,synthetic-form-layout-02,original,2025,fte-0155e5f2d139f326bbc87664,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-3-0; ordinary dividends: USD 10,523.00; foreign accounts: USD 10,523.00. Recipient: Example Household 203.",SCHEDULE,34,SCHEDULE,fdc-b19f15be24bce3684cce1090,synthetic-form-layout-02,original,2023,fte-913880bb04d976b7bbf58d71,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-4-0; ordinary dividends: USD 10,606.00; foreign accounts: USD 10,606.00. Recipient: Example Household 204.",SCHEDULE,34,SCHEDULE,fdc-26e80f2b148937516c362fd2,synthetic-form-layout-02,original,2024,fte-d080350aa0527f66f2b7dfcc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-5-0; ordinary dividends: USD 10,689.00; foreign accounts: USD 10,689.00. Recipient: Example Household 205.",SCHEDULE,34,SCHEDULE,fdc-64f92936d625ded9181145c8,synthetic-form-layout-02,original,2025,fte-31c48e8b23715b6de18f273a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-6-0; ordinary dividends: USD 10,772.00; foreign accounts: USD 10,772.00. Recipient: Example Household 206.",SCHEDULE,34,SCHEDULE,fdc-858b090b812711d3806f9ca5,synthetic-form-layout-02,original,2023,fte-ddf81ec194210aa02c842a6b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-B: Schedule B Interest and Ordinary Dividends.
interest payer: Example Entity 2-7-0; ordinary dividends: USD 10,855.00; foreign accounts: USD 10,855.00. Recipient: Example Household 207.",SCHEDULE,34,SCHEDULE,fdc-00078e4366e323c1e7a300d7,synthetic-form-layout-02,original,2024,fte-9e9c0028de5384db3f9057de,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2023.
Details: interest payer: Example Entity 3-0-0, ordinary dividends: USD 10,411.00, foreign accounts: USD 10,411.00. Account holder: Example Person 300.",SCHEDULE,34,SCHEDULE,fdc-5bd8755bec0793f009794fe3,synthetic-form-layout-03,original,2023,fte-2786cc74e4df24f31932cf78,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2024.
Details: interest payer: Example Entity 3-1-0, ordinary dividends: USD 10,494.00, foreign accounts: USD 10,494.00. Account holder: Example Person 301.",SCHEDULE,34,SCHEDULE,fdc-9e34cb9b36b2a048fe96a1f8,synthetic-form-layout-03,original,2024,fte-ea5a6726bd0e5ca9d49d0885,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2025.
Details: interest payer: Example Entity 3-2-0, ordinary dividends: USD 10,577.00, foreign accounts: USD 10,577.00. Account holder: Example Person 302.",SCHEDULE,34,SCHEDULE,fdc-da57929823089d19bd3a3479,synthetic-form-layout-03,original,2025,fte-f119ea97cc611443d1e424dc,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2023.
Details: interest payer: Example Entity 3-3-0, ordinary dividends: USD 10,660.00, foreign accounts: USD 10,660.00. Account holder: Example Person 303.",SCHEDULE,34,SCHEDULE,fdc-d60e0c0b859af2698ddc862d,synthetic-form-layout-03,original,2023,fte-a689526bfd1466c5ae8aaed5,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2024.
Details: interest payer: Example Entity 3-4-0, ordinary dividends: USD 10,743.00, foreign accounts: USD 10,743.00. Account holder: Example Person 304.",SCHEDULE,34,SCHEDULE,fdc-1a94a00b3ce9dd1563b48ea9,synthetic-form-layout-03,original,2024,fte-9abba885dc0c43280fccf337,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2025.
Details: interest payer: Example Entity 3-5-0, ordinary dividends: USD 10,826.00, foreign accounts: USD 10,826.00. Account holder: Example Person 305.",SCHEDULE,34,SCHEDULE,fdc-fd4489fa7a560db15ef587d0,synthetic-form-layout-03,original,2025,fte-7c7ac6bf598c18e207cbe41b,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2023.
Details: interest payer: Example Entity 3-6-0, ordinary dividends: USD 10,909.00, foreign accounts: USD 10,909.00. Account holder: Example Person 306.",SCHEDULE,34,SCHEDULE,fdc-1395b770f2a96cf670de4746,synthetic-form-layout-03,original,2023,fte-9af2b1c359e9dc95b83a04d0,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends
Reporting period ended 12/31/2024.
Details: interest payer: Example Entity 3-7-0, ordinary dividends: USD 10,992.00, foreign accounts: USD 10,992.00. Account holder: Example Person 307.",SCHEDULE,34,SCHEDULE,fdc-0f03b8302b2cff3a4cd4f575,synthetic-form-layout-03,original,2024,fte-85a522b8ae6481cadd8aa46d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2023
foreign accounts: USD 10,548.00
ordinary dividends: USD 10,548.00
interest payer: Example Entity 4-0-0
Named party: Example Person 400",SCHEDULE,34,SCHEDULE,fdc-d08ce88bc2c7b0cac81a3813,synthetic-form-layout-04,original,2023,fte-4fa4f96c851f1f7e36269d8d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2024
foreign accounts: USD 10,631.00
ordinary dividends: USD 10,631.00
interest payer: Example Entity 4-1-0
Named party: Example Person 401",SCHEDULE,34,SCHEDULE,fdc-a894dde1762ce81bfbba0d70,synthetic-form-layout-04,original,2024,fte-729db0736000870960076c2d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2025
foreign accounts: USD 10,714.00
ordinary dividends: USD 10,714.00
interest payer: Example Entity 4-2-0
Named party: Example Person 402",SCHEDULE,34,SCHEDULE,fdc-39ffdd7ae16a21a5a69b6d58,synthetic-form-layout-04,original,2025,fte-1e0604d6b68e40748aeb49df,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2023
foreign accounts: USD 10,797.00
ordinary dividends: USD 10,797.00
interest payer: Example Entity 4-3-0
Named party: Example Person 403",SCHEDULE,34,SCHEDULE,fdc-41e302cba60fd3435eef38d1,synthetic-form-layout-04,original,2023,fte-e40b0f1ac6aba6f50692306d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2024
foreign accounts: USD 10,880.00
ordinary dividends: USD 10,880.00
interest payer: Example Entity 4-4-0
Named party: Example Person 404",SCHEDULE,34,SCHEDULE,fdc-7badf4b1b38ecc55d021ae2b,synthetic-form-layout-04,original,2024,fte-c27eb4d923caf5b0437fdfdd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2025
foreign accounts: USD 10,963.00
ordinary dividends: USD 10,963.00
interest payer: Example Entity 4-5-0
Named party: Example Person 405",SCHEDULE,34,SCHEDULE,fdc-df380d89ac0e50d27bf27020,synthetic-form-layout-04,original,2025,fte-e3b44679cbf5dc0918b2fbdc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2023
foreign accounts: USD 11,046.00
ordinary dividends: USD 11,046.00
interest payer: Example Entity 4-6-0
Named party: Example Person 406",SCHEDULE,34,SCHEDULE,fdc-bbfbc40c02334abd4b9a8498,synthetic-form-layout-04,original,2023,fte-151b49c8a1a6ffa91daa67a7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-B: Schedule B Interest and Ordinary Dividends
Tax reporting year 2024
foreign accounts: USD 11,129.00
ordinary dividends: USD 11,129.00
interest payer: Example Entity 4-7-0
Named party: Example Person 407",SCHEDULE,34,SCHEDULE,fdc-937f58bf8722f4a51f53c00f,synthetic-form-layout-04,original,2024,fte-15463b6742f62e4c86d3cc2e,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2023
interest payer: Example Entity 5-0-0 / ordinary dividends: USD 10,685.00 / foreign accounts: USD 10,685.00
Delivery copy for Example Party 500",SCHEDULE,34,SCHEDULE,fdc-d5576e84a35e60f035c83b38,synthetic-form-layout-05,original,2023,fte-3b5501d2893fc64f1cdc8947,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2024
interest payer: Example Entity 5-1-0 / ordinary dividends: USD 10,768.00 / foreign accounts: USD 10,768.00
Delivery copy for Example Party 501",SCHEDULE,34,SCHEDULE,fdc-63318cb0b97c7db0f3c6231e,synthetic-form-layout-05,original,2024,fte-71e3512b088f99f011b9dd5b,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2025
interest payer: Example Entity 5-2-0 / ordinary dividends: USD 10,851.00 / foreign accounts: USD 10,851.00
Delivery copy for Example Party 502",SCHEDULE,34,SCHEDULE,fdc-53abea1e162347ae77f4e150,synthetic-form-layout-05,original,2025,fte-bb9db1c7d86ab99eb9bc84b2,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2023
interest payer: Example Entity 5-3-0 / ordinary dividends: USD 10,934.00 / foreign accounts: USD 10,934.00
Delivery copy for Example Party 503",SCHEDULE,34,SCHEDULE,fdc-b2021a98d6b89decb38d06f1,synthetic-form-layout-05,original,2023,fte-41de4e0c39a010a2a392db4a,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2024
interest payer: Example Entity 5-4-0 / ordinary dividends: USD 11,017.00 / foreign accounts: USD 11,017.00
Delivery copy for Example Party 504",SCHEDULE,34,SCHEDULE,fdc-9655d06c0e14120397e85e63,synthetic-form-layout-05,original,2024,fte-d3bfa33fe0d8f2bbb41631e8,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2025
interest payer: Example Entity 5-5-0 / ordinary dividends: USD 11,100.00 / foreign accounts: USD 11,100.00
Delivery copy for Example Party 505",SCHEDULE,34,SCHEDULE,fdc-994e61dd1dbf9cd980d6cc07,synthetic-form-layout-05,original,2025,fte-3f2c7d6ffd0c48a5d4fd3dba,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2023
interest payer: Example Entity 5-6-0 / ordinary dividends: USD 11,183.00 / foreign accounts: USD 11,183.00
Delivery copy for Example Party 506",SCHEDULE,34,SCHEDULE,fdc-ca10876b88bfe3a3cb66be1f,synthetic-form-layout-05,original,2023,fte-7fc4df50f5d920950e77c2b6,synthetic_AI_labeled,v1_template,top,False,
"Schedule-B: Schedule B Interest and Ordinary Dividends -- reporting year 2024
interest payer: Example Entity 5-7-0 / ordinary dividends: USD 11,266.00 / foreign accounts: USD 11,266.00
Delivery copy for Example Party 507",SCHEDULE,34,SCHEDULE,fdc-6f5a1805291865de7d8fa5bf,synthetic-form-layout-05,original,2024,fte-c84da1258e6af3a7952e3020,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2023
Statement issued to Example Person 0.
business name: Example Entity 0-0-0
gross receipts: USD 10,000.00
expenses: USD 10,000.00
net profit: USD 10,000.00",SCHEDULE,34,SCHEDULE,fdc-a6ae87d37b0774e6a4aa83a9,synthetic-form-layout-00,original,2023,fte-1b6e0af809aba6145cbdf563,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2024
Statement issued to Example Person 1.
business name: Example Entity 0-1-0
gross receipts: USD 10,083.00
expenses: USD 10,083.00
net profit: USD 10,083.00",SCHEDULE,34,SCHEDULE,fdc-7c463eb73fc147881248aa82,synthetic-form-layout-00,original,2024,fte-51a02c3793acfc95a67b754e,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2025
Statement issued to Example Person 2.
business name: Example Entity 0-2-0
gross receipts: USD 10,166.00
expenses: USD 10,166.00
net profit: USD 10,166.00",SCHEDULE,34,SCHEDULE,fdc-41ffb4779e0a8b54f275f66b,synthetic-form-layout-00,original,2025,fte-11ed8b95845ba889fa66dbc4,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2023
Statement issued to Example Person 3.
business name: Example Entity 0-3-0
gross receipts: USD 10,249.00
expenses: USD 10,249.00
net profit: USD 10,249.00",SCHEDULE,34,SCHEDULE,fdc-7d92a74002ac35835dbfaff8,synthetic-form-layout-00,original,2023,fte-f5d9b68c50813f4a97a52944,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2024
Statement issued to Example Person 4.
business name: Example Entity 0-4-0
gross receipts: USD 10,332.00
expenses: USD 10,332.00
net profit: USD 10,332.00",SCHEDULE,34,SCHEDULE,fdc-9ac67d70669fd98e1d01c12d,synthetic-form-layout-00,original,2024,fte-20cd66ee2bdf38f14bfd4276,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2025
Statement issued to Example Person 5.
business name: Example Entity 0-5-0
gross receipts: USD 10,415.00
expenses: USD 10,415.00
net profit: USD 10,415.00",SCHEDULE,34,SCHEDULE,fdc-b2680363009bd7cd5f3c6fbe,synthetic-form-layout-00,original,2025,fte-b1e83f946439d272572b28f0,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2023
Statement issued to Example Person 6.
business name: Example Entity 0-6-0
gross receipts: USD 10,498.00
expenses: USD 10,498.00
net profit: USD 10,498.00",SCHEDULE,34,SCHEDULE,fdc-a7d97e45f0354da122d619a2,synthetic-form-layout-00,original,2023,fte-f42adffee237abb827886738,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Calendar year: 2024
Statement issued to Example Person 7.
business name: Example Entity 0-7-0
gross receipts: USD 10,581.00
expenses: USD 10,581.00
net profit: USD 10,581.00",SCHEDULE,34,SCHEDULE,fdc-c727c59b5114415863194dcb,synthetic-form-layout-00,original,2024,fte-84ee89b06f49d0b57310b31c,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 100
business name: Example Entity 1-0-0 | gross receipts: USD 10,137.00 | expenses: USD 10,137.00 | net profit: USD 10,137.00",SCHEDULE,34,SCHEDULE,fdc-5d9e6f114b5d3b34c32866b5,synthetic-form-layout-01,original,2023,fte-486008fa753421829ff9788c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 101
business name: Example Entity 1-1-0 | gross receipts: USD 10,220.00 | expenses: USD 10,220.00 | net profit: USD 10,220.00",SCHEDULE,34,SCHEDULE,fdc-0c700e335546a5f9c15263d2,synthetic-form-layout-01,original,2024,fte-2180dfff08db04a7b805f9ce,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 102
business name: Example Entity 1-2-0 | gross receipts: USD 10,303.00 | expenses: USD 10,303.00 | net profit: USD 10,303.00",SCHEDULE,34,SCHEDULE,fdc-e0cdd5ab5539ca8a3c319564,synthetic-form-layout-01,original,2025,fte-5982968190a3233a2f9efae7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 103
business name: Example Entity 1-3-0 | gross receipts: USD 10,386.00 | expenses: USD 10,386.00 | net profit: USD 10,386.00",SCHEDULE,34,SCHEDULE,fdc-305f3f9ccadbc6fd38648dbc,synthetic-form-layout-01,original,2023,fte-f2147774f389609548823260,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 104
business name: Example Entity 1-4-0 | gross receipts: USD 10,469.00 | expenses: USD 10,469.00 | net profit: USD 10,469.00",SCHEDULE,34,SCHEDULE,fdc-6d211e34768d3c5f7d1abba7,synthetic-form-layout-01,original,2024,fte-078e74dfdb67dd90f26fc702,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 105
business name: Example Entity 1-5-0 | gross receipts: USD 10,552.00 | expenses: USD 10,552.00 | net profit: USD 10,552.00",SCHEDULE,34,SCHEDULE,fdc-cea3ec9e2597c25b1c8a057c,synthetic-form-layout-01,original,2025,fte-57de105073735ce70c221808,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 106
business name: Example Entity 1-6-0 | gross receipts: USD 10,635.00 | expenses: USD 10,635.00 | net profit: USD 10,635.00",SCHEDULE,34,SCHEDULE,fdc-19f7d409f4ba3413b90a8662,synthetic-form-layout-01,original,2023,fte-b762b5fee7894afa5e8cd074,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-C: Schedule C Profit or Loss From Business
Recipient record: Example Person 107
business name: Example Entity 1-7-0 | gross receipts: USD 10,718.00 | expenses: USD 10,718.00 | net profit: USD 10,718.00",SCHEDULE,34,SCHEDULE,fdc-786a7ed7cacce4f2aeee6ed5,synthetic-form-layout-01,original,2024,fte-5925189aa0747d0086f28f8c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-0-0; gross receipts: USD 10,274.00; expenses: USD 10,274.00; net profit: USD 10,274.00. Recipient: Example Household 200.",SCHEDULE,34,SCHEDULE,fdc-4a9f07b26d0ce01970d157ef,synthetic-form-layout-02,original,2023,fte-35d260513c882f245fdbdce7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-1-0; gross receipts: USD 10,357.00; expenses: USD 10,357.00; net profit: USD 10,357.00. Recipient: Example Household 201.",SCHEDULE,34,SCHEDULE,fdc-3c515c375aceb2168382fffc,synthetic-form-layout-02,original,2024,fte-ce7ba6ebe67dc9af9121cb67,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-2-0; gross receipts: USD 10,440.00; expenses: USD 10,440.00; net profit: USD 10,440.00. Recipient: Example Household 202.",SCHEDULE,34,SCHEDULE,fdc-a78008a37bf0bdc891255fb8,synthetic-form-layout-02,original,2025,fte-b074d2c82c6475e36d5645db,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-3-0; gross receipts: USD 10,523.00; expenses: USD 10,523.00; net profit: USD 10,523.00. Recipient: Example Household 203.",SCHEDULE,34,SCHEDULE,fdc-8d4c45a04b4bd3ef8f7245f5,synthetic-form-layout-02,original,2023,fte-cc3dc768b9b83147195759ac,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-4-0; gross receipts: USD 10,606.00; expenses: USD 10,606.00; net profit: USD 10,606.00. Recipient: Example Household 204.",SCHEDULE,34,SCHEDULE,fdc-5bace94be20fd1bb99c4b091,synthetic-form-layout-02,original,2024,fte-ca0f4cae593c293ea03fa6c7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-5-0; gross receipts: USD 10,689.00; expenses: USD 10,689.00; net profit: USD 10,689.00. Recipient: Example Household 205.",SCHEDULE,34,SCHEDULE,fdc-3fe50ea0f78b3442a788b991,synthetic-form-layout-02,original,2025,fte-9aa3ea70525477006fd7e681,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-6-0; gross receipts: USD 10,772.00; expenses: USD 10,772.00; net profit: USD 10,772.00. Recipient: Example Household 206.",SCHEDULE,34,SCHEDULE,fdc-473bc40e8d7ea3ea7a164ff7,synthetic-form-layout-02,original,2023,fte-e4cd2d3fffdde883efae4fee,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-C: Schedule C Profit or Loss From Business.
business name: Example Entity 2-7-0; gross receipts: USD 10,855.00; expenses: USD 10,855.00; net profit: USD 10,855.00. Recipient: Example Household 207.",SCHEDULE,34,SCHEDULE,fdc-f2fc8e2a668adfeea7f671a1,synthetic-form-layout-02,original,2024,fte-08cfb47e076d186f1ccabdc5,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2023.
Details: business name: Example Entity 3-0-0, gross receipts: USD 10,411.00, expenses: USD 10,411.00, net profit: USD 10,411.00. Account holder: Example Person 300.",SCHEDULE,34,SCHEDULE,fdc-7073bfd6666f3aee391adab3,synthetic-form-layout-03,original,2023,fte-26abd36155a25d7b0ff4d4e8,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2024.
Details: business name: Example Entity 3-1-0, gross receipts: USD 10,494.00, expenses: USD 10,494.00, net profit: USD 10,494.00. Account holder: Example Person 301.",SCHEDULE,34,SCHEDULE,fdc-9499d683c019b7fe1ab7e334,synthetic-form-layout-03,original,2024,fte-68994e40553dc34e839911e0,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2025.
Details: business name: Example Entity 3-2-0, gross receipts: USD 10,577.00, expenses: USD 10,577.00, net profit: USD 10,577.00. Account holder: Example Person 302.",SCHEDULE,34,SCHEDULE,fdc-3bedfe3c64d2c3d864019013,synthetic-form-layout-03,original,2025,fte-1fffd184541f49bb90315726,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2023.
Details: business name: Example Entity 3-3-0, gross receipts: USD 10,660.00, expenses: USD 10,660.00, net profit: USD 10,660.00. Account holder: Example Person 303.",SCHEDULE,34,SCHEDULE,fdc-934717ae570685e3a7bb860b,synthetic-form-layout-03,original,2023,fte-7a039f93ffe06dfacdaeee24,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2024.
Details: business name: Example Entity 3-4-0, gross receipts: USD 10,743.00, expenses: USD 10,743.00, net profit: USD 10,743.00. Account holder: Example Person 304.",SCHEDULE,34,SCHEDULE,fdc-0af6626bb10c0701ea92553f,synthetic-form-layout-03,original,2024,fte-0a3713a3e5f7970ee5c6e34f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2025.
Details: business name: Example Entity 3-5-0, gross receipts: USD 10,826.00, expenses: USD 10,826.00, net profit: USD 10,826.00. Account holder: Example Person 305.",SCHEDULE,34,SCHEDULE,fdc-01b1de1d4af1f2a7491a61de,synthetic-form-layout-03,original,2025,fte-013602b62fef0ab03b40c54f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2023.
Details: business name: Example Entity 3-6-0, gross receipts: USD 10,909.00, expenses: USD 10,909.00, net profit: USD 10,909.00. Account holder: Example Person 306.",SCHEDULE,34,SCHEDULE,fdc-10d17fa15a6cb97caafa14de,synthetic-form-layout-03,original,2023,fte-e3fb0a1120b776a78570e7a6,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business
Reporting period ended 12/31/2024.
Details: business name: Example Entity 3-7-0, gross receipts: USD 10,992.00, expenses: USD 10,992.00, net profit: USD 10,992.00. Account holder: Example Person 307.",SCHEDULE,34,SCHEDULE,fdc-d1a977c8f80f7065d9d58121,synthetic-form-layout-03,original,2024,fte-81dfa28992bb1f660d630b14,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2023
net profit: USD 10,548.00
expenses: USD 10,548.00
gross receipts: USD 10,548.00
business name: Example Entity 4-0-0
Named party: Example Person 400",SCHEDULE,34,SCHEDULE,fdc-e6d251231af8f7afd9103b96,synthetic-form-layout-04,original,2023,fte-02305efec4fdc1752b5d82fc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2024
net profit: USD 10,631.00
expenses: USD 10,631.00
gross receipts: USD 10,631.00
business name: Example Entity 4-1-0
Named party: Example Person 401",SCHEDULE,34,SCHEDULE,fdc-f293972380dd186c50e6d9e8,synthetic-form-layout-04,original,2024,fte-00b2fb029440ce7664a9b4a0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2025
net profit: USD 10,714.00
expenses: USD 10,714.00
gross receipts: USD 10,714.00
business name: Example Entity 4-2-0
Named party: Example Person 402",SCHEDULE,34,SCHEDULE,fdc-49750e964079111646a69744,synthetic-form-layout-04,original,2025,fte-333a2ed99d2b0f6f02063a62,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2023
net profit: USD 10,797.00
expenses: USD 10,797.00
gross receipts: USD 10,797.00
business name: Example Entity 4-3-0
Named party: Example Person 403",SCHEDULE,34,SCHEDULE,fdc-acb6698598a7f348f0756b6f,synthetic-form-layout-04,original,2023,fte-f9af8c5f8f5a47637ac8bfea,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2024
net profit: USD 10,880.00
expenses: USD 10,880.00
gross receipts: USD 10,880.00
business name: Example Entity 4-4-0
Named party: Example Person 404",SCHEDULE,34,SCHEDULE,fdc-2e6aae82cb6744e68049eb27,synthetic-form-layout-04,original,2024,fte-cb54f16a3e316f1c09ddbdc7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2025
net profit: USD 10,963.00
expenses: USD 10,963.00
gross receipts: USD 10,963.00
business name: Example Entity 4-5-0
Named party: Example Person 405",SCHEDULE,34,SCHEDULE,fdc-f4a8fd1ae7a1537633976809,synthetic-form-layout-04,original,2025,fte-971f92d1b5c4611fb343cfb9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2023
net profit: USD 11,046.00
expenses: USD 11,046.00
gross receipts: USD 11,046.00
business name: Example Entity 4-6-0
Named party: Example Person 406",SCHEDULE,34,SCHEDULE,fdc-6004ecb406ac193e3af73699,synthetic-form-layout-04,original,2023,fte-b76d6410b3ffaa5a71d85033,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-C: Schedule C Profit or Loss From Business
Tax reporting year 2024
net profit: USD 11,129.00
expenses: USD 11,129.00
gross receipts: USD 11,129.00
business name: Example Entity 4-7-0
Named party: Example Person 407",SCHEDULE,34,SCHEDULE,fdc-42ee237d9431d84e93bd8271,synthetic-form-layout-04,original,2024,fte-db50dc6501b392938a8e01b2,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2023
business name: Example Entity 5-0-0 / gross receipts: USD 10,685.00 / expenses: USD 10,685.00 / net profit: USD 10,685.00
Delivery copy for Example Party 500",SCHEDULE,34,SCHEDULE,fdc-dd54d5b879329350c7557a17,synthetic-form-layout-05,original,2023,fte-07d86a4af16cb060e1a77845,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2024
business name: Example Entity 5-1-0 / gross receipts: USD 10,768.00 / expenses: USD 10,768.00 / net profit: USD 10,768.00
Delivery copy for Example Party 501",SCHEDULE,34,SCHEDULE,fdc-8683d03d0c2ecab4ab0644fc,synthetic-form-layout-05,original,2024,fte-127d220bac6230cde16697ba,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2025
business name: Example Entity 5-2-0 / gross receipts: USD 10,851.00 / expenses: USD 10,851.00 / net profit: USD 10,851.00
Delivery copy for Example Party 502",SCHEDULE,34,SCHEDULE,fdc-f6f17929f8d07e8ce2e9828e,synthetic-form-layout-05,original,2025,fte-a0eaa2dcd09efd8e5979feba,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2023
business name: Example Entity 5-3-0 / gross receipts: USD 10,934.00 / expenses: USD 10,934.00 / net profit: USD 10,934.00
Delivery copy for Example Party 503",SCHEDULE,34,SCHEDULE,fdc-581a5bd64a90c31da9582f73,synthetic-form-layout-05,original,2023,fte-10e674663ef4b34c8b69b3d9,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2024
business name: Example Entity 5-4-0 / gross receipts: USD 11,017.00 / expenses: USD 11,017.00 / net profit: USD 11,017.00
Delivery copy for Example Party 504",SCHEDULE,34,SCHEDULE,fdc-49f179498583e63d2ed39b9f,synthetic-form-layout-05,original,2024,fte-64e5631d94e780123362d29f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2025
business name: Example Entity 5-5-0 / gross receipts: USD 11,100.00 / expenses: USD 11,100.00 / net profit: USD 11,100.00
Delivery copy for Example Party 505",SCHEDULE,34,SCHEDULE,fdc-f6d0cc2981f4ac28d24951ca,synthetic-form-layout-05,original,2025,fte-45e65384712e94e5307d0eb3,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2023
business name: Example Entity 5-6-0 / gross receipts: USD 11,183.00 / expenses: USD 11,183.00 / net profit: USD 11,183.00
Delivery copy for Example Party 506",SCHEDULE,34,SCHEDULE,fdc-fd25ab8ed5a3f252af386510,synthetic-form-layout-05,original,2023,fte-56586aee9fd0b1c65a6c2916,synthetic_AI_labeled,v1_template,top,False,
"Schedule-C: Schedule C Profit or Loss From Business -- reporting year 2024
business name: Example Entity 5-7-0 / gross receipts: USD 11,266.00 / expenses: USD 11,266.00 / net profit: USD 11,266.00
Delivery copy for Example Party 507",SCHEDULE,34,SCHEDULE,fdc-f860a9a0e1111105b0352451,synthetic-form-layout-05,original,2024,fte-2d6739572226990ba4901851,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2023
Statement issued to Example Person 0.
short term gains: USD 10,000.00
long term gains: USD 10,000.00
carryover: USD 10,000.00",SCHEDULE,34,SCHEDULE,fdc-a3dd622fc233870086b9d4ef,synthetic-form-layout-00,original,2023,fte-efcb4485002a481e32598c80,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2024
Statement issued to Example Person 1.
short term gains: USD 10,083.00
long term gains: USD 10,083.00
carryover: USD 10,083.00",SCHEDULE,34,SCHEDULE,fdc-f77f0e044998afcf3d575bf2,synthetic-form-layout-00,original,2024,fte-b585aef939b9cc796848f007,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2025
Statement issued to Example Person 2.
short term gains: USD 10,166.00
long term gains: USD 10,166.00
carryover: USD 10,166.00",SCHEDULE,34,SCHEDULE,fdc-2756fe263806d2b32c72e3d9,synthetic-form-layout-00,original,2025,fte-4e45223132e1f41ced1ccd4f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2023
Statement issued to Example Person 3.
short term gains: USD 10,249.00
long term gains: USD 10,249.00
carryover: USD 10,249.00",SCHEDULE,34,SCHEDULE,fdc-c6f01ca38858121776f008c1,synthetic-form-layout-00,original,2023,fte-22373ece293d298d7ace6472,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2024
Statement issued to Example Person 4.
short term gains: USD 10,332.00
long term gains: USD 10,332.00
carryover: USD 10,332.00",SCHEDULE,34,SCHEDULE,fdc-338a5b04b4d021c1776858a8,synthetic-form-layout-00,original,2024,fte-7a8b74f9f7b82ba768eda611,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2025
Statement issued to Example Person 5.
short term gains: USD 10,415.00
long term gains: USD 10,415.00
carryover: USD 10,415.00",SCHEDULE,34,SCHEDULE,fdc-920164cd0711e14cb88cfd80,synthetic-form-layout-00,original,2025,fte-e7ee298f9a536ac4b9200972,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2023
Statement issued to Example Person 6.
short term gains: USD 10,498.00
long term gains: USD 10,498.00
carryover: USD 10,498.00",SCHEDULE,34,SCHEDULE,fdc-4ee8f63fb1dff692b91eb0ef,synthetic-form-layout-00,original,2023,fte-b3d2ca515ed9b571b8b46fff,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Calendar year: 2024
Statement issued to Example Person 7.
short term gains: USD 10,581.00
long term gains: USD 10,581.00
carryover: USD 10,581.00",SCHEDULE,34,SCHEDULE,fdc-b193b6e2844c1c9af3ba990c,synthetic-form-layout-00,original,2024,fte-461c4c407a72de2b282067ce,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 100
short term gains: USD 10,137.00 | long term gains: USD 10,137.00 | carryover: USD 10,137.00",SCHEDULE,34,SCHEDULE,fdc-86af84d258f0d86ba7e6b7ed,synthetic-form-layout-01,original,2023,fte-7fca195837078480f09eda17,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 101
short term gains: USD 10,220.00 | long term gains: USD 10,220.00 | carryover: USD 10,220.00",SCHEDULE,34,SCHEDULE,fdc-f10aa756178266a35399760b,synthetic-form-layout-01,original,2024,fte-d30d43e0da7905edd331b25e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 102
short term gains: USD 10,303.00 | long term gains: USD 10,303.00 | carryover: USD 10,303.00",SCHEDULE,34,SCHEDULE,fdc-a0799c9ef38b93cffc2788f6,synthetic-form-layout-01,original,2025,fte-e03e6d4e06494859db9eb924,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 103
short term gains: USD 10,386.00 | long term gains: USD 10,386.00 | carryover: USD 10,386.00",SCHEDULE,34,SCHEDULE,fdc-6f0cbe6cf6c93bc27fc4c73b,synthetic-form-layout-01,original,2023,fte-3bfd5826971acdc7445dd5a4,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 104
short term gains: USD 10,469.00 | long term gains: USD 10,469.00 | carryover: USD 10,469.00",SCHEDULE,34,SCHEDULE,fdc-dd118f02ba31f186613ad7ab,synthetic-form-layout-01,original,2024,fte-f0611f34dbac3179b607012f,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 105
short term gains: USD 10,552.00 | long term gains: USD 10,552.00 | carryover: USD 10,552.00",SCHEDULE,34,SCHEDULE,fdc-503719e1d990ed1ad3832741,synthetic-form-layout-01,original,2025,fte-a12dca40a3f97bca0e079aac,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 106
short term gains: USD 10,635.00 | long term gains: USD 10,635.00 | carryover: USD 10,635.00",SCHEDULE,34,SCHEDULE,fdc-6ccd915e42307e28776b3516,synthetic-form-layout-01,original,2023,fte-45bc771c5e6fe7ffabd12c23,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-D: Schedule D Capital Gains and Losses
Recipient record: Example Person 107
short term gains: USD 10,718.00 | long term gains: USD 10,718.00 | carryover: USD 10,718.00",SCHEDULE,34,SCHEDULE,fdc-b550448b0ff663d5c8a30f26,synthetic-form-layout-01,original,2024,fte-68103261f7dbb623ead88496,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,274.00; long term gains: USD 10,274.00; carryover: USD 10,274.00. Recipient: Example Household 200.",SCHEDULE,34,SCHEDULE,fdc-c483ec61bca5128883f64c12,synthetic-form-layout-02,original,2023,fte-5a01289a031235c8ab432c79,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,357.00; long term gains: USD 10,357.00; carryover: USD 10,357.00. Recipient: Example Household 201.",SCHEDULE,34,SCHEDULE,fdc-56e18be3405705a48ac2c5cc,synthetic-form-layout-02,original,2024,fte-f3acb9df34a18497ace1d26c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,440.00; long term gains: USD 10,440.00; carryover: USD 10,440.00. Recipient: Example Household 202.",SCHEDULE,34,SCHEDULE,fdc-bd9932bea7edbf54ae1000fd,synthetic-form-layout-02,original,2025,fte-ba9a42900239d400f845cab6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,523.00; long term gains: USD 10,523.00; carryover: USD 10,523.00. Recipient: Example Household 203.",SCHEDULE,34,SCHEDULE,fdc-e06b6200eed2ab132a4ec00d,synthetic-form-layout-02,original,2023,fte-3c84b971a95263a158dc1030,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,606.00; long term gains: USD 10,606.00; carryover: USD 10,606.00. Recipient: Example Household 204.",SCHEDULE,34,SCHEDULE,fdc-0de59a458ac0d39343d66e64,synthetic-form-layout-02,original,2024,fte-91a712c7d91ef33331fc0192,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,689.00; long term gains: USD 10,689.00; carryover: USD 10,689.00. Recipient: Example Household 205.",SCHEDULE,34,SCHEDULE,fdc-836b263ebc24c767e24103bb,synthetic-form-layout-02,original,2025,fte-e90dca5bd83fa266d3bc4f23,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,772.00; long term gains: USD 10,772.00; carryover: USD 10,772.00. Recipient: Example Household 206.",SCHEDULE,34,SCHEDULE,fdc-7974cabaf3951114033699f6,synthetic-form-layout-02,original,2023,fte-9e3e3461a77245be6b452c4f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-D: Schedule D Capital Gains and Losses.
short term gains: USD 10,855.00; long term gains: USD 10,855.00; carryover: USD 10,855.00. Recipient: Example Household 207.",SCHEDULE,34,SCHEDULE,fdc-fe61876f6f72df05d80ff2ea,synthetic-form-layout-02,original,2024,fte-8ae1a169656c0c43ee96a81c,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2023.
Details: short term gains: USD 10,411.00, long term gains: USD 10,411.00, carryover: USD 10,411.00. Account holder: Example Person 300.",SCHEDULE,34,SCHEDULE,fdc-b024d2a17565772440556b43,synthetic-form-layout-03,original,2023,fte-374cd59b9b2e100339251eed,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2024.
Details: short term gains: USD 10,494.00, long term gains: USD 10,494.00, carryover: USD 10,494.00. Account holder: Example Person 301.",SCHEDULE,34,SCHEDULE,fdc-7fde64a526c8b3df0f7a0466,synthetic-form-layout-03,original,2024,fte-852713e8b812e418e194f376,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2025.
Details: short term gains: USD 10,577.00, long term gains: USD 10,577.00, carryover: USD 10,577.00. Account holder: Example Person 302.",SCHEDULE,34,SCHEDULE,fdc-836b93975032000515858e1b,synthetic-form-layout-03,original,2025,fte-635f2c8aa140a2b2a4f6aaf1,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2023.
Details: short term gains: USD 10,660.00, long term gains: USD 10,660.00, carryover: USD 10,660.00. Account holder: Example Person 303.",SCHEDULE,34,SCHEDULE,fdc-9420f4837afe7c11a52a0dd3,synthetic-form-layout-03,original,2023,fte-8aa81815e6eba43c60dc70fc,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2024.
Details: short term gains: USD 10,743.00, long term gains: USD 10,743.00, carryover: USD 10,743.00. Account holder: Example Person 304.",SCHEDULE,34,SCHEDULE,fdc-1614fc755bdd2b62d6de2457,synthetic-form-layout-03,original,2024,fte-7602d5e3bd2a29ef8ee3e1ee,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2025.
Details: short term gains: USD 10,826.00, long term gains: USD 10,826.00, carryover: USD 10,826.00. Account holder: Example Person 305.",SCHEDULE,34,SCHEDULE,fdc-f452ff78776cb7902763691c,synthetic-form-layout-03,original,2025,fte-025c55dbcb8909cf85d2bf4e,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2023.
Details: short term gains: USD 10,909.00, long term gains: USD 10,909.00, carryover: USD 10,909.00. Account holder: Example Person 306.",SCHEDULE,34,SCHEDULE,fdc-495b959c4aa96045d801787c,synthetic-form-layout-03,original,2023,fte-904a64f585e411e3fabde06b,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses
Reporting period ended 12/31/2024.
Details: short term gains: USD 10,992.00, long term gains: USD 10,992.00, carryover: USD 10,992.00. Account holder: Example Person 307.",SCHEDULE,34,SCHEDULE,fdc-f912f10b856d0dd8e801e270,synthetic-form-layout-03,original,2024,fte-940174e2adee3ccdb1f9cc79,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2023
carryover: USD 10,548.00
long term gains: USD 10,548.00
short term gains: USD 10,548.00
Named party: Example Person 400",SCHEDULE,34,SCHEDULE,fdc-de0d46b776bb30e39f547005,synthetic-form-layout-04,original,2023,fte-18401b56b1deac1c7fd4c0ec,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2024
carryover: USD 10,631.00
long term gains: USD 10,631.00
short term gains: USD 10,631.00
Named party: Example Person 401",SCHEDULE,34,SCHEDULE,fdc-de388a208c28fb42e17410c7,synthetic-form-layout-04,original,2024,fte-35a20355e3d8ffa87da08dd7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2025
carryover: USD 10,714.00
long term gains: USD 10,714.00
short term gains: USD 10,714.00
Named party: Example Person 402",SCHEDULE,34,SCHEDULE,fdc-5693a0e4e68f1d9afc9c510b,synthetic-form-layout-04,original,2025,fte-07db2fdd00693d607a31daee,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2023
carryover: USD 10,797.00
long term gains: USD 10,797.00
short term gains: USD 10,797.00
Named party: Example Person 403",SCHEDULE,34,SCHEDULE,fdc-fc2baa0dd77690b58f3a90d1,synthetic-form-layout-04,original,2023,fte-e776ad55d551c97689d1e0f1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2024
carryover: USD 10,880.00
long term gains: USD 10,880.00
short term gains: USD 10,880.00
Named party: Example Person 404",SCHEDULE,34,SCHEDULE,fdc-da3e582b9285b902f91ebfea,synthetic-form-layout-04,original,2024,fte-c44d025aaff49404edb48fc1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2025
carryover: USD 10,963.00
long term gains: USD 10,963.00
short term gains: USD 10,963.00
Named party: Example Person 405",SCHEDULE,34,SCHEDULE,fdc-06f60e3f0392695833a5a24a,synthetic-form-layout-04,original,2025,fte-72d15a6114a79bed4a71d472,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2023
carryover: USD 11,046.00
long term gains: USD 11,046.00
short term gains: USD 11,046.00
Named party: Example Person 406",SCHEDULE,34,SCHEDULE,fdc-c3b09b18131c964ed11b63d1,synthetic-form-layout-04,original,2023,fte-8e70bdb0d98cec67201c4011,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-D: Schedule D Capital Gains and Losses
Tax reporting year 2024
carryover: USD 11,129.00
long term gains: USD 11,129.00
short term gains: USD 11,129.00
Named party: Example Person 407",SCHEDULE,34,SCHEDULE,fdc-44422f1106f1b4e4fc88eb83,synthetic-form-layout-04,original,2024,fte-ab97f6d871a511d6a9aa191d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2023
short term gains: USD 10,685.00 / long term gains: USD 10,685.00 / carryover: USD 10,685.00
Delivery copy for Example Party 500",SCHEDULE,34,SCHEDULE,fdc-3cbaf358248fb731dfac16f2,synthetic-form-layout-05,original,2023,fte-c2234e169ffdc1bda95f7610,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2024
short term gains: USD 10,768.00 / long term gains: USD 10,768.00 / carryover: USD 10,768.00
Delivery copy for Example Party 501",SCHEDULE,34,SCHEDULE,fdc-d0008657edbf2dcf41053fa9,synthetic-form-layout-05,original,2024,fte-c2e1010a7266ae08cc0cf6d7,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2025
short term gains: USD 10,851.00 / long term gains: USD 10,851.00 / carryover: USD 10,851.00
Delivery copy for Example Party 502",SCHEDULE,34,SCHEDULE,fdc-dba880dae497738a63535e3d,synthetic-form-layout-05,original,2025,fte-e68902245437f5397c0e8fbd,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2023
short term gains: USD 10,934.00 / long term gains: USD 10,934.00 / carryover: USD 10,934.00
Delivery copy for Example Party 503",SCHEDULE,34,SCHEDULE,fdc-5c21e0a710233e4f0ae00cfd,synthetic-form-layout-05,original,2023,fte-83e718174571e692f153992f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2024
short term gains: USD 11,017.00 / long term gains: USD 11,017.00 / carryover: USD 11,017.00
Delivery copy for Example Party 504",SCHEDULE,34,SCHEDULE,fdc-72fc4b0657575066c3fba73a,synthetic-form-layout-05,original,2024,fte-ea661df28758eadee1329bbf,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2025
short term gains: USD 11,100.00 / long term gains: USD 11,100.00 / carryover: USD 11,100.00
Delivery copy for Example Party 505",SCHEDULE,34,SCHEDULE,fdc-fe0ad8aec1437aed2a658c58,synthetic-form-layout-05,original,2025,fte-26819a7978f8e3dcc16b9982,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2023
short term gains: USD 11,183.00 / long term gains: USD 11,183.00 / carryover: USD 11,183.00
Delivery copy for Example Party 506",SCHEDULE,34,SCHEDULE,fdc-670c19ad68174ba77ac07419,synthetic-form-layout-05,original,2023,fte-922ccc07883ed2d344e5b801,synthetic_AI_labeled,v1_template,top,False,
"Schedule-D: Schedule D Capital Gains and Losses -- reporting year 2024
short term gains: USD 11,266.00 / long term gains: USD 11,266.00 / carryover: USD 11,266.00
Delivery copy for Example Party 507",SCHEDULE,34,SCHEDULE,fdc-b8e37e5b8677e00d56e1d597,synthetic-form-layout-05,original,2024,fte-0f002427ec27095a2af09cec,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2023
Statement issued to Example Person 0.
rental property: Example Entity 0-0-0
royalties: USD 10,000.00
partnerships: Example Entity 0-0-2
income: USD 10,000.00
expenses: USD 10,000.00",SCHEDULE,34,SCHEDULE,fdc-4985b27790417b54a8e1eb7a,synthetic-form-layout-00,original,2023,fte-167605bed331d3f0d676848a,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2024
Statement issued to Example Person 1.
rental property: Example Entity 0-1-0
royalties: USD 10,083.00
partnerships: Example Entity 0-1-2
income: USD 10,083.00
expenses: USD 10,083.00",SCHEDULE,34,SCHEDULE,fdc-6df1ed690a81ce04cd7318b5,synthetic-form-layout-00,original,2024,fte-484ba15ed3c14f2f33430593,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2025
Statement issued to Example Person 2.
rental property: Example Entity 0-2-0
royalties: USD 10,166.00
partnerships: Example Entity 0-2-2
income: USD 10,166.00
expenses: USD 10,166.00",SCHEDULE,34,SCHEDULE,fdc-c1a5690151e8bbbf2615a8b8,synthetic-form-layout-00,original,2025,fte-bae9355b9500e7b6d9cc4142,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2023
Statement issued to Example Person 3.
rental property: Example Entity 0-3-0
royalties: USD 10,249.00
partnerships: Example Entity 0-3-2
income: USD 10,249.00
expenses: USD 10,249.00",SCHEDULE,34,SCHEDULE,fdc-098198b0db5c328603bc9e9a,synthetic-form-layout-00,original,2023,fte-bc90ca8dfbea5d40389261f1,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2024
Statement issued to Example Person 4.
rental property: Example Entity 0-4-0
royalties: USD 10,332.00
partnerships: Example Entity 0-4-2
income: USD 10,332.00
expenses: USD 10,332.00",SCHEDULE,34,SCHEDULE,fdc-5b079e8dd8c4b77ba6762386,synthetic-form-layout-00,original,2024,fte-7a9c3adfe7369595b509609a,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2025
Statement issued to Example Person 5.
rental property: Example Entity 0-5-0
royalties: USD 10,415.00
partnerships: Example Entity 0-5-2
income: USD 10,415.00
expenses: USD 10,415.00",SCHEDULE,34,SCHEDULE,fdc-bbe89a41a410bd7a3f43594b,synthetic-form-layout-00,original,2025,fte-05aac1eefc213e76f025b68d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2023
Statement issued to Example Person 6.
rental property: Example Entity 0-6-0
royalties: USD 10,498.00
partnerships: Example Entity 0-6-2
income: USD 10,498.00
expenses: USD 10,498.00",SCHEDULE,34,SCHEDULE,fdc-de3d00c2794432a84da5f35f,synthetic-form-layout-00,original,2023,fte-65d9145bc0b57501469d7185,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Calendar year: 2024
Statement issued to Example Person 7.
rental property: Example Entity 0-7-0
royalties: USD 10,581.00
partnerships: Example Entity 0-7-2
income: USD 10,581.00
expenses: USD 10,581.00",SCHEDULE,34,SCHEDULE,fdc-db262bbc25ca1475da21d44b,synthetic-form-layout-00,original,2024,fte-cd9b8629530bb2bfab3f8583,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 100
rental property: Example Entity 1-0-0 | royalties: USD 10,137.00 | partnerships: Example Entity 1-0-2 | income: USD 10,137.00 | expenses: USD 10,137.00",SCHEDULE,34,SCHEDULE,fdc-d8f9bf44bf071318d7cbded2,synthetic-form-layout-01,original,2023,fte-40190517801a747f11c808a3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 101
rental property: Example Entity 1-1-0 | royalties: USD 10,220.00 | partnerships: Example Entity 1-1-2 | income: USD 10,220.00 | expenses: USD 10,220.00",SCHEDULE,34,SCHEDULE,fdc-45f96e864588e2d5455003a6,synthetic-form-layout-01,original,2024,fte-fb524578a335b4b99c003961,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 102
rental property: Example Entity 1-2-0 | royalties: USD 10,303.00 | partnerships: Example Entity 1-2-2 | income: USD 10,303.00 | expenses: USD 10,303.00",SCHEDULE,34,SCHEDULE,fdc-acea2f1372cb57cd5305f9ac,synthetic-form-layout-01,original,2025,fte-37d5f2ae7bf041d686241643,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 103
rental property: Example Entity 1-3-0 | royalties: USD 10,386.00 | partnerships: Example Entity 1-3-2 | income: USD 10,386.00 | expenses: USD 10,386.00",SCHEDULE,34,SCHEDULE,fdc-6dfcc5d93f8a032bd7b0247e,synthetic-form-layout-01,original,2023,fte-318c466b449a12bd9b4e69a0,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 104
rental property: Example Entity 1-4-0 | royalties: USD 10,469.00 | partnerships: Example Entity 1-4-2 | income: USD 10,469.00 | expenses: USD 10,469.00",SCHEDULE,34,SCHEDULE,fdc-a94f0d59f075fc571a6114eb,synthetic-form-layout-01,original,2024,fte-356c929aa437fc4bb5ccc467,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 105
rental property: Example Entity 1-5-0 | royalties: USD 10,552.00 | partnerships: Example Entity 1-5-2 | income: USD 10,552.00 | expenses: USD 10,552.00",SCHEDULE,34,SCHEDULE,fdc-7d3fbe73b1899e0ec73b17bd,synthetic-form-layout-01,original,2025,fte-090b075b6b25fe62657136f6,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 106
rental property: Example Entity 1-6-0 | royalties: USD 10,635.00 | partnerships: Example Entity 1-6-2 | income: USD 10,635.00 | expenses: USD 10,635.00",SCHEDULE,34,SCHEDULE,fdc-86f4725eab67c80b85474e13,synthetic-form-layout-01,original,2023,fte-69bc67e4bcd273063a8ce5f2,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-E: Schedule E Supplemental Income and Loss
Recipient record: Example Person 107
rental property: Example Entity 1-7-0 | royalties: USD 10,718.00 | partnerships: Example Entity 1-7-2 | income: USD 10,718.00 | expenses: USD 10,718.00",SCHEDULE,34,SCHEDULE,fdc-2dc81c174dba47190e58a3ab,synthetic-form-layout-01,original,2024,fte-2281a3ca71e37351a0a7d0e5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-0-0; royalties: USD 10,274.00; partnerships: Example Entity 2-0-2; income: USD 10,274.00; expenses: USD 10,274.00. Recipient: Example Household 200.",SCHEDULE,34,SCHEDULE,fdc-50d60c69ce723e482ceb83d5,synthetic-form-layout-02,original,2023,fte-72f13821702b71e50ea7cc4b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-1-0; royalties: USD 10,357.00; partnerships: Example Entity 2-1-2; income: USD 10,357.00; expenses: USD 10,357.00. Recipient: Example Household 201.",SCHEDULE,34,SCHEDULE,fdc-bee1c6448afd37c16cf1e791,synthetic-form-layout-02,original,2024,fte-e3e0412a2f0ed0f4dd00fd98,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-2-0; royalties: USD 10,440.00; partnerships: Example Entity 2-2-2; income: USD 10,440.00; expenses: USD 10,440.00. Recipient: Example Household 202.",SCHEDULE,34,SCHEDULE,fdc-b276c6810f40ee23710633b1,synthetic-form-layout-02,original,2025,fte-466267aa9f2ae16c696bd98e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-3-0; royalties: USD 10,523.00; partnerships: Example Entity 2-3-2; income: USD 10,523.00; expenses: USD 10,523.00. Recipient: Example Household 203.",SCHEDULE,34,SCHEDULE,fdc-7e479d65057e0a29b8912977,synthetic-form-layout-02,original,2023,fte-28993a6db49aec152244ca09,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-4-0; royalties: USD 10,606.00; partnerships: Example Entity 2-4-2; income: USD 10,606.00; expenses: USD 10,606.00. Recipient: Example Household 204.",SCHEDULE,34,SCHEDULE,fdc-1f114dbc2b585ecffa814ed2,synthetic-form-layout-02,original,2024,fte-f7b79c73a9cc1e101a2f55fe,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-5-0; royalties: USD 10,689.00; partnerships: Example Entity 2-5-2; income: USD 10,689.00; expenses: USD 10,689.00. Recipient: Example Household 205.",SCHEDULE,34,SCHEDULE,fdc-92c2bdc46c9c8c9d4becdd07,synthetic-form-layout-02,original,2025,fte-b5244d09d77ca71ef8fdfdcb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-6-0; royalties: USD 10,772.00; partnerships: Example Entity 2-6-2; income: USD 10,772.00; expenses: USD 10,772.00. Recipient: Example Household 206.",SCHEDULE,34,SCHEDULE,fdc-c3c44fcb031faa2950669b91,synthetic-form-layout-02,original,2023,fte-d81eef1eb634c6e833460581,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-E: Schedule E Supplemental Income and Loss.
rental property: Example Entity 2-7-0; royalties: USD 10,855.00; partnerships: Example Entity 2-7-2; income: USD 10,855.00; expenses: USD 10,855.00. Recipient: Example Household 207.",SCHEDULE,34,SCHEDULE,fdc-caca60c222b5018886b0910d,synthetic-form-layout-02,original,2024,fte-9453786a0834d8c44e6c4995,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2023.
Details: rental property: Example Entity 3-0-0, royalties: USD 10,411.00, partnerships: Example Entity 3-0-2, income: USD 10,411.00, expenses: USD 10,411.00. Account holder: Example Person 300.",SCHEDULE,34,SCHEDULE,fdc-a2617ac456641193b204497a,synthetic-form-layout-03,original,2023,fte-57696e5656a50f100b46e9b2,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2024.
Details: rental property: Example Entity 3-1-0, royalties: USD 10,494.00, partnerships: Example Entity 3-1-2, income: USD 10,494.00, expenses: USD 10,494.00. Account holder: Example Person 301.",SCHEDULE,34,SCHEDULE,fdc-07526c462dbe681380ed79de,synthetic-form-layout-03,original,2024,fte-b53cdb6668dff1aa5410824d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2025.
Details: rental property: Example Entity 3-2-0, royalties: USD 10,577.00, partnerships: Example Entity 3-2-2, income: USD 10,577.00, expenses: USD 10,577.00. Account holder: Example Person 302.",SCHEDULE,34,SCHEDULE,fdc-574c625b4f4608f88d582284,synthetic-form-layout-03,original,2025,fte-78f2993351b0146c688f21cc,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2023.
Details: rental property: Example Entity 3-3-0, royalties: USD 10,660.00, partnerships: Example Entity 3-3-2, income: USD 10,660.00, expenses: USD 10,660.00. Account holder: Example Person 303.",SCHEDULE,34,SCHEDULE,fdc-8bb686d1f9e7f6a7e32dc6c0,synthetic-form-layout-03,original,2023,fte-e39c832655c850fbbc97ba4d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2024.
Details: rental property: Example Entity 3-4-0, royalties: USD 10,743.00, partnerships: Example Entity 3-4-2, income: USD 10,743.00, expenses: USD 10,743.00. Account holder: Example Person 304.",SCHEDULE,34,SCHEDULE,fdc-07668058836211ac8cda2ee3,synthetic-form-layout-03,original,2024,fte-48128d55c4080afaa62d0f0f,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2025.
Details: rental property: Example Entity 3-5-0, royalties: USD 10,826.00, partnerships: Example Entity 3-5-2, income: USD 10,826.00, expenses: USD 10,826.00. Account holder: Example Person 305.",SCHEDULE,34,SCHEDULE,fdc-93962a18082813b60ab5edc2,synthetic-form-layout-03,original,2025,fte-fdb3600e8a299a69c8028e61,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2023.
Details: rental property: Example Entity 3-6-0, royalties: USD 10,909.00, partnerships: Example Entity 3-6-2, income: USD 10,909.00, expenses: USD 10,909.00. Account holder: Example Person 306.",SCHEDULE,34,SCHEDULE,fdc-8fd65de9ee5619d03f20022d,synthetic-form-layout-03,original,2023,fte-00720dfddba3b580c4cd82eb,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss
Reporting period ended 12/31/2024.
Details: rental property: Example Entity 3-7-0, royalties: USD 10,992.00, partnerships: Example Entity 3-7-2, income: USD 10,992.00, expenses: USD 10,992.00. Account holder: Example Person 307.",SCHEDULE,34,SCHEDULE,fdc-f0cf96cf44e216aef9478f42,synthetic-form-layout-03,original,2024,fte-6622d523aafc062f1f71e733,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2023
expenses: USD 10,548.00
income: USD 10,548.00
partnerships: Example Entity 4-0-2
royalties: USD 10,548.00
rental property: Example Entity 4-0-0
Named party: Example Person 400",SCHEDULE,34,SCHEDULE,fdc-0c8bafcccf9193383e1042c2,synthetic-form-layout-04,original,2023,fte-400ef26fa63a7e59ce80f6d4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2024
expenses: USD 10,631.00
income: USD 10,631.00
partnerships: Example Entity 4-1-2
royalties: USD 10,631.00
rental property: Example Entity 4-1-0
Named party: Example Person 401",SCHEDULE,34,SCHEDULE,fdc-5561462b3112edf9a7e28502,synthetic-form-layout-04,original,2024,fte-4121de35c9a9e0249100e4ef,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2025
expenses: USD 10,714.00
income: USD 10,714.00
partnerships: Example Entity 4-2-2
royalties: USD 10,714.00
rental property: Example Entity 4-2-0
Named party: Example Person 402",SCHEDULE,34,SCHEDULE,fdc-2f41266148b78bcae675d800,synthetic-form-layout-04,original,2025,fte-0a3b96d088c2798ee431c2d7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2023
expenses: USD 10,797.00
income: USD 10,797.00
partnerships: Example Entity 4-3-2
royalties: USD 10,797.00
rental property: Example Entity 4-3-0
Named party: Example Person 403",SCHEDULE,34,SCHEDULE,fdc-5c1536a1d950cf3f519b37f5,synthetic-form-layout-04,original,2023,fte-af242f16f8f94760a4ffc648,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2024
expenses: USD 10,880.00
income: USD 10,880.00
partnerships: Example Entity 4-4-2
royalties: USD 10,880.00
rental property: Example Entity 4-4-0
Named party: Example Person 404",SCHEDULE,34,SCHEDULE,fdc-d2ddf1e21da76e5c02fcee0c,synthetic-form-layout-04,original,2024,fte-52b6582a5bcb0272c0bbc664,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2025
expenses: USD 10,963.00
income: USD 10,963.00
partnerships: Example Entity 4-5-2
royalties: USD 10,963.00
rental property: Example Entity 4-5-0
Named party: Example Person 405",SCHEDULE,34,SCHEDULE,fdc-fdeb769c0d9cc6f71c08c692,synthetic-form-layout-04,original,2025,fte-56eed6505c39513142dad0d7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2023
expenses: USD 11,046.00
income: USD 11,046.00
partnerships: Example Entity 4-6-2
royalties: USD 11,046.00
rental property: Example Entity 4-6-0
Named party: Example Person 406",SCHEDULE,34,SCHEDULE,fdc-ae93cdc0f1a546e571818213,synthetic-form-layout-04,original,2023,fte-c6ac6325711b049d4120e048,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-E: Schedule E Supplemental Income and Loss
Tax reporting year 2024
expenses: USD 11,129.00
income: USD 11,129.00
partnerships: Example Entity 4-7-2
royalties: USD 11,129.00
rental property: Example Entity 4-7-0
Named party: Example Person 407",SCHEDULE,34,SCHEDULE,fdc-3010fdaea63cd1b0ac2294ce,synthetic-form-layout-04,original,2024,fte-b70d830c4207d8a8e0b1947b,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2023
rental property: Example Entity 5-0-0 / royalties: USD 10,685.00 / partnerships: Example Entity 5-0-2 / income: USD 10,685.00 / expenses: USD 10,685.00
Delivery copy for Example Party 500",SCHEDULE,34,SCHEDULE,fdc-31004eca190bd758bfca0581,synthetic-form-layout-05,original,2023,fte-b3053fe564866ecef4800cc5,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2024
rental property: Example Entity 5-1-0 / royalties: USD 10,768.00 / partnerships: Example Entity 5-1-2 / income: USD 10,768.00 / expenses: USD 10,768.00
Delivery copy for Example Party 501",SCHEDULE,34,SCHEDULE,fdc-5e97a0e08e7684ae111245d0,synthetic-form-layout-05,original,2024,fte-0619fd0057c7a6800dfcb713,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2025
rental property: Example Entity 5-2-0 / royalties: USD 10,851.00 / partnerships: Example Entity 5-2-2 / income: USD 10,851.00 / expenses: USD 10,851.00
Delivery copy for Example Party 502",SCHEDULE,34,SCHEDULE,fdc-b232c89e4dbe8ac71c8ba42f,synthetic-form-layout-05,original,2025,fte-b954a68832ee59a9658781f3,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2023
rental property: Example Entity 5-3-0 / royalties: USD 10,934.00 / partnerships: Example Entity 5-3-2 / income: USD 10,934.00 / expenses: USD 10,934.00
Delivery copy for Example Party 503",SCHEDULE,34,SCHEDULE,fdc-4649aede5525e48c5b41f2c7,synthetic-form-layout-05,original,2023,fte-5c44509ab35419966cc563e6,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2024
rental property: Example Entity 5-4-0 / royalties: USD 11,017.00 / partnerships: Example Entity 5-4-2 / income: USD 11,017.00 / expenses: USD 11,017.00
Delivery copy for Example Party 504",SCHEDULE,34,SCHEDULE,fdc-5f2ea443d9af53ba5785e551,synthetic-form-layout-05,original,2024,fte-8f1f03a18402f325c6eab348,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2025
rental property: Example Entity 5-5-0 / royalties: USD 11,100.00 / partnerships: Example Entity 5-5-2 / income: USD 11,100.00 / expenses: USD 11,100.00
Delivery copy for Example Party 505",SCHEDULE,34,SCHEDULE,fdc-c9dd410c252d0eceadf03b22,synthetic-form-layout-05,original,2025,fte-e9268530c55e83955d6a3d7d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2023
rental property: Example Entity 5-6-0 / royalties: USD 11,183.00 / partnerships: Example Entity 5-6-2 / income: USD 11,183.00 / expenses: USD 11,183.00
Delivery copy for Example Party 506",SCHEDULE,34,SCHEDULE,fdc-1e825a6871fa5fd2b77e7238,synthetic-form-layout-05,original,2023,fte-774b7a3bdd792b6273b046eb,synthetic_AI_labeled,v1_template,top,False,
"Schedule-E: Schedule E Supplemental Income and Loss -- reporting year 2024
rental property: Example Entity 5-7-0 / royalties: USD 11,266.00 / partnerships: Example Entity 5-7-2 / income: USD 11,266.00 / expenses: USD 11,266.00
Delivery copy for Example Party 507",SCHEDULE,34,SCHEDULE,fdc-608e575f3e7d9b37a028aa45,synthetic-form-layout-05,original,2024,fte-980d4b22a4a1948571c1f9fc,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2023
Statement issued to Example Person 0.
farm income: USD 10,000.00
farm expenses: USD 10,000.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-96d16ea2bd2796f2490baaad,synthetic-form-layout-00,original,2023,fte-7255c4f027f5f0fa23cf740d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2024
Statement issued to Example Person 1.
farm income: USD 10,083.00
farm expenses: USD 10,083.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-42c805acc300752042d0a730,synthetic-form-layout-00,original,2024,fte-32ddcff3c4cef241273f95f5,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2025
Statement issued to Example Person 2.
farm income: USD 10,166.00
farm expenses: USD 10,166.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-3a8339c3310132516bade44e,synthetic-form-layout-00,original,2025,fte-feac7b07d20f5ef30da4a619,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2023
Statement issued to Example Person 3.
farm income: USD 10,249.00
farm expenses: USD 10,249.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-5ef5fcd3af7aa2a41dbcb741,synthetic-form-layout-00,original,2023,fte-8c51bc975523535b1a9cd8b1,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2024
Statement issued to Example Person 4.
farm income: USD 10,332.00
farm expenses: USD 10,332.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-bd86d5625d77b040344f74db,synthetic-form-layout-00,original,2024,fte-a28b2209d80148b8edfbf05c,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2025
Statement issued to Example Person 5.
farm income: USD 10,415.00
farm expenses: USD 10,415.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-5cb8c4a68500f7c8ea6e5a7b,synthetic-form-layout-00,original,2025,fte-69df8c8256453f5bab30db24,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2023
Statement issued to Example Person 6.
farm income: USD 10,498.00
farm expenses: USD 10,498.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-86bf77f548fa63a64410be7b,synthetic-form-layout-00,original,2023,fte-b2c6b3f151439a5fb52dcab1,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Calendar year: 2024
Statement issued to Example Person 7.
farm income: USD 10,581.00
farm expenses: USD 10,581.00
accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-4768396032e109008c867389,synthetic-form-layout-00,original,2024,fte-f705cc09d57bc2475bf54e47,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 100
farm income: USD 10,137.00 | farm expenses: USD 10,137.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-5569bdb0654a4906818b3f5b,synthetic-form-layout-01,original,2023,fte-13f67f755dfedf575dc74045,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 101
farm income: USD 10,220.00 | farm expenses: USD 10,220.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-c7250744e754178c1de94327,synthetic-form-layout-01,original,2024,fte-cbc34922d4443a0a5d3c4d8e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 102
farm income: USD 10,303.00 | farm expenses: USD 10,303.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-8b2d29b911912f94818c52b8,synthetic-form-layout-01,original,2025,fte-818b33cbc56a9da3d62df603,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 103
farm income: USD 10,386.00 | farm expenses: USD 10,386.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-647f733b3595c5642276d88e,synthetic-form-layout-01,original,2023,fte-3b31a631de15e4354808d4d8,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 104
farm income: USD 10,469.00 | farm expenses: USD 10,469.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-0abbf36b05d79472e129da4b,synthetic-form-layout-01,original,2024,fte-d4ff784f880de65d2b62808c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 105
farm income: USD 10,552.00 | farm expenses: USD 10,552.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-1636b7e52027a7fd7ce7cf25,synthetic-form-layout-01,original,2025,fte-db35af97bdac9ac00c3ba5b5,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 106
farm income: USD 10,635.00 | farm expenses: USD 10,635.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-42d41528dca178b108eb9e1b,synthetic-form-layout-01,original,2023,fte-4d7c16b8f0db58282680d7fe,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-F: Schedule F Profit or Loss From Farming
Recipient record: Example Person 107
farm income: USD 10,718.00 | farm expenses: USD 10,718.00 | accounting method: Cash method",SCHEDULE,34,SCHEDULE,fdc-919109d520968472d568659c,synthetic-form-layout-01,original,2024,fte-d8b8386b4a53cbc2c8c48994,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,274.00; farm expenses: USD 10,274.00; accounting method: Cash method. Recipient: Example Household 200.",SCHEDULE,34,SCHEDULE,fdc-5530ca9dbbd7d6e762bd5c04,synthetic-form-layout-02,original,2023,fte-ab4d448b2b783db8c037511c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,357.00; farm expenses: USD 10,357.00; accounting method: Cash method. Recipient: Example Household 201.",SCHEDULE,34,SCHEDULE,fdc-5bb8bd0a936dcdc20a573bc4,synthetic-form-layout-02,original,2024,fte-f98b440dfca64a93816d7d7f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,440.00; farm expenses: USD 10,440.00; accounting method: Cash method. Recipient: Example Household 202.",SCHEDULE,34,SCHEDULE,fdc-e1071d3b77848fe1ee537e5b,synthetic-form-layout-02,original,2025,fte-316b00b4d23d0286ad0507f2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,523.00; farm expenses: USD 10,523.00; accounting method: Cash method. Recipient: Example Household 203.",SCHEDULE,34,SCHEDULE,fdc-c36dec5ba035b86cebc99d60,synthetic-form-layout-02,original,2023,fte-37de2be023b9a3ef664b7fac,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,606.00; farm expenses: USD 10,606.00; accounting method: Cash method. Recipient: Example Household 204.",SCHEDULE,34,SCHEDULE,fdc-8bb1d7703b1ef30a647ef80c,synthetic-form-layout-02,original,2024,fte-cf002957d5b95abf6b60c31a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,689.00; farm expenses: USD 10,689.00; accounting method: Cash method. Recipient: Example Household 205.",SCHEDULE,34,SCHEDULE,fdc-ac4f04ce58027cc58b57bdb0,synthetic-form-layout-02,original,2025,fte-e69fc56536d51c33a20fbc4c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,772.00; farm expenses: USD 10,772.00; accounting method: Cash method. Recipient: Example Household 206.",SCHEDULE,34,SCHEDULE,fdc-a67c688294c3b6229c49aef2,synthetic-form-layout-02,original,2023,fte-93415f45b24ce3f74ea5dcc3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-F: Schedule F Profit or Loss From Farming.
farm income: USD 10,855.00; farm expenses: USD 10,855.00; accounting method: Cash method. Recipient: Example Household 207.",SCHEDULE,34,SCHEDULE,fdc-89f3b8e892adaef2b2989b96,synthetic-form-layout-02,original,2024,fte-1b872df810bf4007e9a20a0e,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2023.
Details: farm income: USD 10,411.00, farm expenses: USD 10,411.00, accounting method: Cash method. Account holder: Example Person 300.",SCHEDULE,34,SCHEDULE,fdc-70cacc2df43d4c1b8b48308f,synthetic-form-layout-03,original,2023,fte-4027fdd552f7b6e25e4e8c88,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2024.
Details: farm income: USD 10,494.00, farm expenses: USD 10,494.00, accounting method: Cash method. Account holder: Example Person 301.",SCHEDULE,34,SCHEDULE,fdc-4d17dcdf40264ec7ccd2935e,synthetic-form-layout-03,original,2024,fte-2e93b26e6eb8abfe99e382d0,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2025.
Details: farm income: USD 10,577.00, farm expenses: USD 10,577.00, accounting method: Cash method. Account holder: Example Person 302.",SCHEDULE,34,SCHEDULE,fdc-efee89c7a57cef7243096aab,synthetic-form-layout-03,original,2025,fte-3e177f166b869b15b4e03c18,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2023.
Details: farm income: USD 10,660.00, farm expenses: USD 10,660.00, accounting method: Cash method. Account holder: Example Person 303.",SCHEDULE,34,SCHEDULE,fdc-c6b5aa645bf5fed9a176a5bd,synthetic-form-layout-03,original,2023,fte-f3280c6befeb4178fbabd922,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2024.
Details: farm income: USD 10,743.00, farm expenses: USD 10,743.00, accounting method: Cash method. Account holder: Example Person 304.",SCHEDULE,34,SCHEDULE,fdc-90ea65ab03d33bcf8856fb4b,synthetic-form-layout-03,original,2024,fte-51fc4866f8d76b656f16d101,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2025.
Details: farm income: USD 10,826.00, farm expenses: USD 10,826.00, accounting method: Cash method. Account holder: Example Person 305.",SCHEDULE,34,SCHEDULE,fdc-2d8de8ed46c4e3d252034aef,synthetic-form-layout-03,original,2025,fte-62738fa113801794b9866ded,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2023.
Details: farm income: USD 10,909.00, farm expenses: USD 10,909.00, accounting method: Cash method. Account holder: Example Person 306.",SCHEDULE,34,SCHEDULE,fdc-a583edb64b615b3fbb5ca29e,synthetic-form-layout-03,original,2023,fte-7949d3e3bd7c5ed071ccd5a6,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming
Reporting period ended 12/31/2024.
Details: farm income: USD 10,992.00, farm expenses: USD 10,992.00, accounting method: Cash method. Account holder: Example Person 307.",SCHEDULE,34,SCHEDULE,fdc-7bf11ac097d9540bcdc9b156,synthetic-form-layout-03,original,2024,fte-83c371a85727bb00be07f101,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2023
accounting method: Cash method
farm expenses: USD 10,548.00
farm income: USD 10,548.00
Named party: Example Person 400",SCHEDULE,34,SCHEDULE,fdc-d00070caaf168b97902e7c27,synthetic-form-layout-04,original,2023,fte-5c6a287844be13a0da64bf30,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2024
accounting method: Cash method
farm expenses: USD 10,631.00
farm income: USD 10,631.00
Named party: Example Person 401",SCHEDULE,34,SCHEDULE,fdc-3bc07a3cd096ca6169fee0f7,synthetic-form-layout-04,original,2024,fte-666e5a759ce07e6e697fa8f3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2025
accounting method: Cash method
farm expenses: USD 10,714.00
farm income: USD 10,714.00
Named party: Example Person 402",SCHEDULE,34,SCHEDULE,fdc-27388a395eaccc7313f054fa,synthetic-form-layout-04,original,2025,fte-342af5286ac2f479cf1fd071,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2023
accounting method: Cash method
farm expenses: USD 10,797.00
farm income: USD 10,797.00
Named party: Example Person 403",SCHEDULE,34,SCHEDULE,fdc-87e93570a5341afed8a3e0dd,synthetic-form-layout-04,original,2023,fte-2ef8bc7b81646fac7fb11fcc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2024
accounting method: Cash method
farm expenses: USD 10,880.00
farm income: USD 10,880.00
Named party: Example Person 404",SCHEDULE,34,SCHEDULE,fdc-4d8df2662ed68938894f350b,synthetic-form-layout-04,original,2024,fte-032430dddb489a74cfbe5527,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2025
accounting method: Cash method
farm expenses: USD 10,963.00
farm income: USD 10,963.00
Named party: Example Person 405",SCHEDULE,34,SCHEDULE,fdc-f2cf00246ec9115e3254f77c,synthetic-form-layout-04,original,2025,fte-2a80867c161a8e2585178f4c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2023
accounting method: Cash method
farm expenses: USD 11,046.00
farm income: USD 11,046.00
Named party: Example Person 406",SCHEDULE,34,SCHEDULE,fdc-7a2443bfc255742b8a59905f,synthetic-form-layout-04,original,2023,fte-f25b342c08304b42f51a9529,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-F: Schedule F Profit or Loss From Farming
Tax reporting year 2024
accounting method: Cash method
farm expenses: USD 11,129.00
farm income: USD 11,129.00
Named party: Example Person 407",SCHEDULE,34,SCHEDULE,fdc-016f906482e33e7401df44ce,synthetic-form-layout-04,original,2024,fte-c4352650bd9316e081fc3917,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2023
farm income: USD 10,685.00 / farm expenses: USD 10,685.00 / accounting method: Cash method
Delivery copy for Example Party 500",SCHEDULE,34,SCHEDULE,fdc-d5b254fbe0c8765182709a1b,synthetic-form-layout-05,original,2023,fte-2afa4dc95b4ec64afb43f591,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2024
farm income: USD 10,768.00 / farm expenses: USD 10,768.00 / accounting method: Cash method
Delivery copy for Example Party 501",SCHEDULE,34,SCHEDULE,fdc-578c4d7ffe0e38b98ecbd918,synthetic-form-layout-05,original,2024,fte-3ca8ab69f48fc14e288eb788,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2025
farm income: USD 10,851.00 / farm expenses: USD 10,851.00 / accounting method: Cash method
Delivery copy for Example Party 502",SCHEDULE,34,SCHEDULE,fdc-d94d11f2ebe70b44ed778e12,synthetic-form-layout-05,original,2025,fte-95c01e6edf8dd85a91bb3b2d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2023
farm income: USD 10,934.00 / farm expenses: USD 10,934.00 / accounting method: Cash method
Delivery copy for Example Party 503",SCHEDULE,34,SCHEDULE,fdc-59cf25ad7488fcc3940fa03c,synthetic-form-layout-05,original,2023,fte-52f12ad47a96b4355cbb99ec,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2024
farm income: USD 11,017.00 / farm expenses: USD 11,017.00 / accounting method: Cash method
Delivery copy for Example Party 504",SCHEDULE,34,SCHEDULE,fdc-89d9837caa01d28f6274aec2,synthetic-form-layout-05,original,2024,fte-cad534f9c72d8c754f21d2ed,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2025
farm income: USD 11,100.00 / farm expenses: USD 11,100.00 / accounting method: Cash method
Delivery copy for Example Party 505",SCHEDULE,34,SCHEDULE,fdc-7ebe62086a63836cccdca098,synthetic-form-layout-05,original,2025,fte-1d2afcb554506708dda685c1,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2023
farm income: USD 11,183.00 / farm expenses: USD 11,183.00 / accounting method: Cash method
Delivery copy for Example Party 506",SCHEDULE,34,SCHEDULE,fdc-e8757400ffbe2f9ab9435426,synthetic-form-layout-05,original,2023,fte-cbb66d36ccdbe6eb38d1e78a,synthetic_AI_labeled,v1_template,top,False,
"Schedule-F: Schedule F Profit or Loss From Farming -- reporting year 2024
farm income: USD 11,266.00 / farm expenses: USD 11,266.00 / accounting method: Cash method
Delivery copy for Example Party 507",SCHEDULE,34,SCHEDULE,fdc-4c87f74ff6d7b6bebf211b7f,synthetic-form-layout-05,original,2024,fte-4ff1792aa2e21d917ea08d2b,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2023
Statement issued to Example Person 0.
net earnings: USD 10,000.00
self employment tax: USD 10,000.00
adjustment: USD 10,000.00",SCHEDULE,34,SCHEDULE,fdc-9409919d57b499285592025e,synthetic-form-layout-00,original,2023,fte-1bdd262e369513215ee9c753,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2024
Statement issued to Example Person 1.
net earnings: USD 10,083.00
self employment tax: USD 10,083.00
adjustment: USD 10,083.00",SCHEDULE,34,SCHEDULE,fdc-217eeb5f11c7500b1f172ac1,synthetic-form-layout-00,original,2024,fte-d54cbaff7f205e9874059ffd,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2025
Statement issued to Example Person 2.
net earnings: USD 10,166.00
self employment tax: USD 10,166.00
adjustment: USD 10,166.00",SCHEDULE,34,SCHEDULE,fdc-e9e2e04bff872761bb95839b,synthetic-form-layout-00,original,2025,fte-bdf1b5e50394d49fca785d55,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2023
Statement issued to Example Person 3.
net earnings: USD 10,249.00
self employment tax: USD 10,249.00
adjustment: USD 10,249.00",SCHEDULE,34,SCHEDULE,fdc-d53c7053c8d2d0cae3d7e821,synthetic-form-layout-00,original,2023,fte-f28cf5850454ac8644bc13ba,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2024
Statement issued to Example Person 4.
net earnings: USD 10,332.00
self employment tax: USD 10,332.00
adjustment: USD 10,332.00",SCHEDULE,34,SCHEDULE,fdc-224c125bc0af5674e00d9cdc,synthetic-form-layout-00,original,2024,fte-7f1d073653e55f7960fac537,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2025
Statement issued to Example Person 5.
net earnings: USD 10,415.00
self employment tax: USD 10,415.00
adjustment: USD 10,415.00",SCHEDULE,34,SCHEDULE,fdc-645cb1519793291ce5d6f9f3,synthetic-form-layout-00,original,2025,fte-579e7c9de68abb67d2a59ba4,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2023
Statement issued to Example Person 6.
net earnings: USD 10,498.00
self employment tax: USD 10,498.00
adjustment: USD 10,498.00",SCHEDULE,34,SCHEDULE,fdc-c3635afcf4284433449b2a06,synthetic-form-layout-00,original,2023,fte-d26a7d31018bb3f53d7520c7,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Calendar year: 2024
Statement issued to Example Person 7.
net earnings: USD 10,581.00
self employment tax: USD 10,581.00
adjustment: USD 10,581.00",SCHEDULE,34,SCHEDULE,fdc-e82df8836eb234274836ce9b,synthetic-form-layout-00,original,2024,fte-9cf3d5f705b47c4d02c1b3c0,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 100
net earnings: USD 10,137.00 | self employment tax: USD 10,137.00 | adjustment: USD 10,137.00",SCHEDULE,34,SCHEDULE,fdc-3253233130749e6583f42f39,synthetic-form-layout-01,original,2023,fte-4f887608a9a0172f897bee61,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 101
net earnings: USD 10,220.00 | self employment tax: USD 10,220.00 | adjustment: USD 10,220.00",SCHEDULE,34,SCHEDULE,fdc-09479be6eeea1cbaf5084d02,synthetic-form-layout-01,original,2024,fte-a0c864fdb004ced4f7cfb8ef,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 102
net earnings: USD 10,303.00 | self employment tax: USD 10,303.00 | adjustment: USD 10,303.00",SCHEDULE,34,SCHEDULE,fdc-e6d72018d4c233ae429780ba,synthetic-form-layout-01,original,2025,fte-ef54e77dde5b935bdfc0000d,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 103
net earnings: USD 10,386.00 | self employment tax: USD 10,386.00 | adjustment: USD 10,386.00",SCHEDULE,34,SCHEDULE,fdc-1460bb614c6f76ef4588c7f4,synthetic-form-layout-01,original,2023,fte-519c271bf902d5e4a380f5cc,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 104
net earnings: USD 10,469.00 | self employment tax: USD 10,469.00 | adjustment: USD 10,469.00",SCHEDULE,34,SCHEDULE,fdc-71d055af8d60e391e8915719,synthetic-form-layout-01,original,2024,fte-df5ca07ddea92f00df3d2335,synthetic_AI_labeled,v1_template,top,False,
"2025 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 105
net earnings: USD 10,552.00 | self employment tax: USD 10,552.00 | adjustment: USD 10,552.00",SCHEDULE,34,SCHEDULE,fdc-a5aa779f1f7e3f7e45ddb93e,synthetic-form-layout-01,original,2025,fte-e3b0e7d10dc9e758654d5ec2,synthetic_AI_labeled,v1_template,top,False,
"2023 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 106
net earnings: USD 10,635.00 | self employment tax: USD 10,635.00 | adjustment: USD 10,635.00",SCHEDULE,34,SCHEDULE,fdc-f7117ca007e52d0e24f4f9a6,synthetic-form-layout-01,original,2023,fte-4a4622f13990da289869861f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Schedule-SE: Schedule SE Self-Employment Tax
Recipient record: Example Person 107
net earnings: USD 10,718.00 | self employment tax: USD 10,718.00 | adjustment: USD 10,718.00",SCHEDULE,34,SCHEDULE,fdc-4eb1b299d68552dc52d9daca,synthetic-form-layout-01,original,2024,fte-9ca1a530d7b2bbfaf85e2557,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,274.00; self employment tax: USD 10,274.00; adjustment: USD 10,274.00. Recipient: Example Household 200.",SCHEDULE,34,SCHEDULE,fdc-dffb41aeccc01bb298efb33e,synthetic-form-layout-02,original,2023,fte-d7cae52782f11a6b352900e5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,357.00; self employment tax: USD 10,357.00; adjustment: USD 10,357.00. Recipient: Example Household 201.",SCHEDULE,34,SCHEDULE,fdc-afba6c0662abaf453c624d82,synthetic-form-layout-02,original,2024,fte-4dbfc4d0bc601a40d57c6353,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,440.00; self employment tax: USD 10,440.00; adjustment: USD 10,440.00. Recipient: Example Household 202.",SCHEDULE,34,SCHEDULE,fdc-c0267891e1bea5a969a1f154,synthetic-form-layout-02,original,2025,fte-31beeeb62d2e40368532b8cc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,523.00; self employment tax: USD 10,523.00; adjustment: USD 10,523.00. Recipient: Example Household 203.",SCHEDULE,34,SCHEDULE,fdc-b90371bd35f1f6c1c8fedf5f,synthetic-form-layout-02,original,2023,fte-9dd707371d935cc1cd8db26c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,606.00; self employment tax: USD 10,606.00; adjustment: USD 10,606.00. Recipient: Example Household 204.",SCHEDULE,34,SCHEDULE,fdc-1a6b22043e5568e0e0ad878a,synthetic-form-layout-02,original,2024,fte-8f793c1b48f293ab693fab82,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,689.00; self employment tax: USD 10,689.00; adjustment: USD 10,689.00. Recipient: Example Household 205.",SCHEDULE,34,SCHEDULE,fdc-45e3cc465fed17ff806ecb86,synthetic-form-layout-02,original,2025,fte-f98848148ea04e18e26e394b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,772.00; self employment tax: USD 10,772.00; adjustment: USD 10,772.00. Recipient: Example Household 206.",SCHEDULE,34,SCHEDULE,fdc-a9ec72091e924f3ebbf30927,synthetic-form-layout-02,original,2023,fte-f1161fe1e7a7aa0647e5b853,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Schedule-SE: Schedule SE Self-Employment Tax.
net earnings: USD 10,855.00; self employment tax: USD 10,855.00; adjustment: USD 10,855.00. Recipient: Example Household 207.",SCHEDULE,34,SCHEDULE,fdc-364c32c08777233c010d91f8,synthetic-form-layout-02,original,2024,fte-774ca72963ac7331d0f5b40d,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2023.
Details: net earnings: USD 10,411.00, self employment tax: USD 10,411.00, adjustment: USD 10,411.00. Account holder: Example Person 300.",SCHEDULE,34,SCHEDULE,fdc-51b338702be2adf5a34c3d87,synthetic-form-layout-03,original,2023,fte-b8f83a5b9b0069e77067899c,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2024.
Details: net earnings: USD 10,494.00, self employment tax: USD 10,494.00, adjustment: USD 10,494.00. Account holder: Example Person 301.",SCHEDULE,34,SCHEDULE,fdc-7c9fb7fbf5a9f4e376547381,synthetic-form-layout-03,original,2024,fte-c44feb6ec790d752f552d401,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2025.
Details: net earnings: USD 10,577.00, self employment tax: USD 10,577.00, adjustment: USD 10,577.00. Account holder: Example Person 302.",SCHEDULE,34,SCHEDULE,fdc-9a44a5ef30f72776f58e4a84,synthetic-form-layout-03,original,2025,fte-a57bcf243ff82296920fe0ef,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2023.
Details: net earnings: USD 10,660.00, self employment tax: USD 10,660.00, adjustment: USD 10,660.00. Account holder: Example Person 303.",SCHEDULE,34,SCHEDULE,fdc-7e3ccb4cfa774c2fac242ea2,synthetic-form-layout-03,original,2023,fte-fc992d2ca94baa8371240d90,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2024.
Details: net earnings: USD 10,743.00, self employment tax: USD 10,743.00, adjustment: USD 10,743.00. Account holder: Example Person 304.",SCHEDULE,34,SCHEDULE,fdc-3c8b671c6b1d38c387230786,synthetic-form-layout-03,original,2024,fte-af7bf0d8af1d92fffba24511,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2025.
Details: net earnings: USD 10,826.00, self employment tax: USD 10,826.00, adjustment: USD 10,826.00. Account holder: Example Person 305.",SCHEDULE,34,SCHEDULE,fdc-ada5c2e85ab53c82f07b062f,synthetic-form-layout-03,original,2025,fte-925b3fa4e7e489e6c05088d4,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2023.
Details: net earnings: USD 10,909.00, self employment tax: USD 10,909.00, adjustment: USD 10,909.00. Account holder: Example Person 306.",SCHEDULE,34,SCHEDULE,fdc-c967ac73042e20ab598ff115,synthetic-form-layout-03,original,2023,fte-af8aac7ff15eabac6380e09a,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax
Reporting period ended 12/31/2024.
Details: net earnings: USD 10,992.00, self employment tax: USD 10,992.00, adjustment: USD 10,992.00. Account holder: Example Person 307.",SCHEDULE,34,SCHEDULE,fdc-e536508877da696b6884ccaf,synthetic-form-layout-03,original,2024,fte-a7aab1a1fffdc6d4ee7b7903,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2023
adjustment: USD 10,548.00
self employment tax: USD 10,548.00
net earnings: USD 10,548.00
Named party: Example Person 400",SCHEDULE,34,SCHEDULE,fdc-443b6947e102ace027b1f30f,synthetic-form-layout-04,original,2023,fte-98560e444560ba09b56556c0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2024
adjustment: USD 10,631.00
self employment tax: USD 10,631.00
net earnings: USD 10,631.00
Named party: Example Person 401",SCHEDULE,34,SCHEDULE,fdc-63cf68ba1408272ed2a85093,synthetic-form-layout-04,original,2024,fte-91778396aa319273035ae42f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2025
adjustment: USD 10,714.00
self employment tax: USD 10,714.00
net earnings: USD 10,714.00
Named party: Example Person 402",SCHEDULE,34,SCHEDULE,fdc-c3f443f9001af70771d57806,synthetic-form-layout-04,original,2025,fte-5fd86cf6f55108519fafc16e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2023
adjustment: USD 10,797.00
self employment tax: USD 10,797.00
net earnings: USD 10,797.00
Named party: Example Person 403",SCHEDULE,34,SCHEDULE,fdc-fe493e18a712c4b0a191df87,synthetic-form-layout-04,original,2023,fte-e8e5bdbfc7d3559790f92ec8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2024
adjustment: USD 10,880.00
self employment tax: USD 10,880.00
net earnings: USD 10,880.00
Named party: Example Person 404",SCHEDULE,34,SCHEDULE,fdc-80985d5f82f7246128781811,synthetic-form-layout-04,original,2024,fte-f70ba827f9b191aa2586a636,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2025
adjustment: USD 10,963.00
self employment tax: USD 10,963.00
net earnings: USD 10,963.00
Named party: Example Person 405",SCHEDULE,34,SCHEDULE,fdc-2757c53390e3e6e5887e4a71,synthetic-form-layout-04,original,2025,fte-43cf4524b2886ab85c7f94a9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2023
adjustment: USD 11,046.00
self employment tax: USD 11,046.00
net earnings: USD 11,046.00
Named party: Example Person 406",SCHEDULE,34,SCHEDULE,fdc-d58af1f0bed69a99d9aead8d,synthetic-form-layout-04,original,2023,fte-1a8f63c14f3c1b208ec8bf30,synthetic_AI_labeled,v1_template,top,False,
"Document header: Schedule-SE: Schedule SE Self-Employment Tax
Tax reporting year 2024
adjustment: USD 11,129.00
self employment tax: USD 11,129.00
net earnings: USD 11,129.00
Named party: Example Person 407",SCHEDULE,34,SCHEDULE,fdc-fc7e649b281ab2929aa67159,synthetic-form-layout-04,original,2024,fte-b62f1ff0f659e39e0ffe5e7e,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2023
net earnings: USD 10,685.00 / self employment tax: USD 10,685.00 / adjustment: USD 10,685.00
Delivery copy for Example Party 500",SCHEDULE,34,SCHEDULE,fdc-4d95b8199c8a69bb56364cf7,synthetic-form-layout-05,original,2023,fte-a33151e264c316c077657cd4,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2024
net earnings: USD 10,768.00 / self employment tax: USD 10,768.00 / adjustment: USD 10,768.00
Delivery copy for Example Party 501",SCHEDULE,34,SCHEDULE,fdc-32faaab54ba0f14a564d61af,synthetic-form-layout-05,original,2024,fte-1b32a203b74f0aaaea1e2336,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2025
net earnings: USD 10,851.00 / self employment tax: USD 10,851.00 / adjustment: USD 10,851.00
Delivery copy for Example Party 502",SCHEDULE,34,SCHEDULE,fdc-3d7e3cf26c73c5b3609df0f7,synthetic-form-layout-05,original,2025,fte-097e0aae3606624131c091db,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2023
net earnings: USD 10,934.00 / self employment tax: USD 10,934.00 / adjustment: USD 10,934.00
Delivery copy for Example Party 503",SCHEDULE,34,SCHEDULE,fdc-e2f128c3ff300960c05e5f8a,synthetic-form-layout-05,original,2023,fte-cccc1e21a7c2a1fbd3631191,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2024
net earnings: USD 11,017.00 / self employment tax: USD 11,017.00 / adjustment: USD 11,017.00
Delivery copy for Example Party 504",SCHEDULE,34,SCHEDULE,fdc-f0b22497749ed3208f0a408d,synthetic-form-layout-05,original,2024,fte-d66f2b1894c4f4e98d199e07,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2025
net earnings: USD 11,100.00 / self employment tax: USD 11,100.00 / adjustment: USD 11,100.00
Delivery copy for Example Party 505",SCHEDULE,34,SCHEDULE,fdc-08fa648df45af5d9608448de,synthetic-form-layout-05,original,2025,fte-5f28e4102c892c8d6bbc816b,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2023
net earnings: USD 11,183.00 / self employment tax: USD 11,183.00 / adjustment: USD 11,183.00
Delivery copy for Example Party 506",SCHEDULE,34,SCHEDULE,fdc-415a4f6eba2b3099e31b4382,synthetic-form-layout-05,original,2023,fte-910bb2a56ad599dad67e51b7,synthetic_AI_labeled,v1_template,top,False,
"Schedule-SE: Schedule SE Self-Employment Tax -- reporting year 2024
net earnings: USD 11,266.00 / self employment tax: USD 11,266.00 / adjustment: USD 11,266.00
Delivery copy for Example Party 507",SCHEDULE,34,SCHEDULE,fdc-3c7b45d5b0f0b5a30548cd3c,synthetic-form-layout-05,original,2024,fte-83ad9eab778362054d596a65,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2023
Statement issued to Example Person 0.
name: Example Entity 0-0-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-0-2
certification: Example named signer; signed",W-9,41,W-9,fdc-b5e0f04c0da5bda3a9b7b564,synthetic-form-layout-00,original,2023,fte-4d90ed697c64cdbc5c7432e5,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2024
Statement issued to Example Person 1.
name: Example Entity 0-1-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-1-2
certification: Example named signer; signed",W-9,41,W-9,fdc-ba9ca708eac10c2febf34bf8,synthetic-form-layout-00,original,2024,fte-04e9e698c387041d2d2e0ddc,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2025
Statement issued to Example Person 2.
name: Example Entity 0-2-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-2-2
certification: Example named signer; signed",W-9,41,W-9,fdc-c33c3b60ac9f06fc5f65860e,synthetic-form-layout-00,original,2025,fte-ed228ba58122b040f3d07091,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2023
Statement issued to Example Person 3.
name: Example Entity 0-3-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-3-2
certification: Example named signer; signed",W-9,41,W-9,fdc-7c38538a7cbc7d825bfa2bba,synthetic-form-layout-00,original,2023,fte-86117c1ab3014283251bb649,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2024
Statement issued to Example Person 4.
name: Example Entity 0-4-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-4-2
certification: Example named signer; signed",W-9,41,W-9,fdc-6d5c1f92ceaf6dad5ffb5451,synthetic-form-layout-00,original,2024,fte-30d3ac314f839c5c61de6a5d,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2025
Statement issued to Example Person 5.
name: Example Entity 0-5-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-5-2
certification: Example named signer; signed",W-9,41,W-9,fdc-8824f6308005512270f8f714,synthetic-form-layout-00,original,2025,fte-0690c4404446bb0653fec560,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2023
Statement issued to Example Person 6.
name: Example Entity 0-6-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-6-2
certification: Example named signer; signed",W-9,41,W-9,fdc-cde631d26dec9072b554856e,synthetic-form-layout-00,original,2023,fte-0d9e53b0a43e7470d0697594,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Calendar year: 2024
Statement issued to Example Person 7.
name: Example Entity 0-7-0
tax classification: Individual or sole proprietor
taxpayer identification number: Example Entity 0-7-2
certification: Example named signer; signed",W-9,41,W-9,fdc-ccbaae9e3c10a52f0914b6be,synthetic-form-layout-00,original,2024,fte-70afa73fcd6625ce72471739,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 100
name: Example Entity 1-0-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-0-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-beb7d2466f10e6676ffb7c0e,synthetic-form-layout-01,original,2023,fte-4b65c400dcd600e94065f298,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 101
name: Example Entity 1-1-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-1-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-9eae016abd4f040192b52e17,synthetic-form-layout-01,original,2024,fte-b01bd1374d1347158299321d,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 102
name: Example Entity 1-2-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-2-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-aba99ba3efbfbb19737343fc,synthetic-form-layout-01,original,2025,fte-097bf94bac2ed2e6e12bc189,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 103
name: Example Entity 1-3-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-3-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-443a9afb1faf6ebe9edebf95,synthetic-form-layout-01,original,2023,fte-72f38a149adc34950bd777d5,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 104
name: Example Entity 1-4-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-4-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-3a3010f1c2873a895cb5a0b1,synthetic-form-layout-01,original,2024,fte-270e8164333415ba90d4291a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 105
name: Example Entity 1-5-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-5-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-5d49617ccd1185d0ddf50d02,synthetic-form-layout-01,original,2025,fte-7fdb98dc1d81511d1b0d0cdc,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 106
name: Example Entity 1-6-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-6-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-8d84929000292b52d75095c3,synthetic-form-layout-01,original,2023,fte-f1b4f5753020f047717664eb,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-9: Request for Taxpayer Identification Number and Certification
Recipient record: Example Person 107
name: Example Entity 1-7-0 | tax classification: Individual or sole proprietor | taxpayer identification number: Example Entity 1-7-2 | certification: Example named signer; signed",W-9,41,W-9,fdc-6e8bf56c108112799296c71a,synthetic-form-layout-01,original,2024,fte-e34718e59a6701433ce66c5f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-0-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-0-2; certification: Example named signer; signed. Recipient: Example Household 200.",W-9,41,W-9,fdc-21d28ebcafc7636b4b9189cc,synthetic-form-layout-02,original,2023,fte-7d3e25316a24f8a21ddd2285,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-1-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-1-2; certification: Example named signer; signed. Recipient: Example Household 201.",W-9,41,W-9,fdc-d6a42db4d85a16e84783c87b,synthetic-form-layout-02,original,2024,fte-a064e94cf3566e5d09b6c57f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-2-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-2-2; certification: Example named signer; signed. Recipient: Example Household 202.",W-9,41,W-9,fdc-d545656781fa224966468c87,synthetic-form-layout-02,original,2025,fte-d977461d4aa5b5067dbf7250,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-3-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-3-2; certification: Example named signer; signed. Recipient: Example Household 203.",W-9,41,W-9,fdc-5a68e3caac03010696fe0cff,synthetic-form-layout-02,original,2023,fte-2d510f1b47431a95a4495f64,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-4-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-4-2; certification: Example named signer; signed. Recipient: Example Household 204.",W-9,41,W-9,fdc-a7b8c3128c96f2d519a55c01,synthetic-form-layout-02,original,2024,fte-ce277b9bc923ba4e36978e5a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-5-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-5-2; certification: Example named signer; signed. Recipient: Example Household 205.",W-9,41,W-9,fdc-db93e9afa66a029271184492,synthetic-form-layout-02,original,2025,fte-7ef564be60d71d28b8266b4f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-6-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-6-2; certification: Example named signer; signed. Recipient: Example Household 206.",W-9,41,W-9,fdc-cf267f36801b81b5aa008bdc,synthetic-form-layout-02,original,2023,fte-72cfef573446cc8332cde760,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-9: Request for Taxpayer Identification Number and Certification.
name: Example Entity 2-7-0; tax classification: Individual or sole proprietor; taxpayer identification number: Example Entity 2-7-2; certification: Example named signer; signed. Recipient: Example Household 207.",W-9,41,W-9,fdc-de6d16b302ce38a6491328a5,synthetic-form-layout-02,original,2024,fte-0b07aebf02f1624d56d301c9,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2023.
Details: name: Example Entity 3-0-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-0-2, certification: Example named signer; signed. Account holder: Example Person 300.",W-9,41,W-9,fdc-d339b573065092312648cf9f,synthetic-form-layout-03,original,2023,fte-052215bcc0c045a0b79b2725,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2024.
Details: name: Example Entity 3-1-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-1-2, certification: Example named signer; signed. Account holder: Example Person 301.",W-9,41,W-9,fdc-6dbe62ef7ba9edd692a4a4f1,synthetic-form-layout-03,original,2024,fte-13c3cd0ed2792f8972abd16f,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2025.
Details: name: Example Entity 3-2-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-2-2, certification: Example named signer; signed. Account holder: Example Person 302.",W-9,41,W-9,fdc-3be68c6950ab1bf8e3b7ea68,synthetic-form-layout-03,original,2025,fte-2a1f6c0058952c61c0d213d3,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2023.
Details: name: Example Entity 3-3-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-3-2, certification: Example named signer; signed. Account holder: Example Person 303.",W-9,41,W-9,fdc-8727972933e36e137d5150a6,synthetic-form-layout-03,original,2023,fte-3ba88e4eeb5fcded18166094,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2024.
Details: name: Example Entity 3-4-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-4-2, certification: Example named signer; signed. Account holder: Example Person 304.",W-9,41,W-9,fdc-b64bdb2a58dee686d911b93d,synthetic-form-layout-03,original,2024,fte-151943e78a1cc1548d219981,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2025.
Details: name: Example Entity 3-5-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-5-2, certification: Example named signer; signed. Account holder: Example Person 305.",W-9,41,W-9,fdc-82be390410e2a35723927f93,synthetic-form-layout-03,original,2025,fte-d1b43ba1781ba4f57cf11bd8,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2023.
Details: name: Example Entity 3-6-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-6-2, certification: Example named signer; signed. Account holder: Example Person 306.",W-9,41,W-9,fdc-d32f18aca5a1ac42ff14d6cd,synthetic-form-layout-03,original,2023,fte-a9ed71e0588a93aa0886bc42,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification
Reporting period ended 12/31/2024.
Details: name: Example Entity 3-7-0, tax classification: Individual or sole proprietor, taxpayer identification number: Example Entity 3-7-2, certification: Example named signer; signed. Account holder: Example Person 307.",W-9,41,W-9,fdc-73b5f63c9876e2fe7365ff9d,synthetic-form-layout-03,original,2024,fte-f317ef6797aa55c84911d17e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2023
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-0-2
tax classification: Individual or sole proprietor
name: Example Entity 4-0-0
Named party: Example Person 400",W-9,41,W-9,fdc-5a53c129955657a80d4a79b1,synthetic-form-layout-04,original,2023,fte-d0a11f9b29f855b1fad99b28,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2024
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-1-2
tax classification: Individual or sole proprietor
name: Example Entity 4-1-0
Named party: Example Person 401",W-9,41,W-9,fdc-8b7fbb3581887412f1a3a579,synthetic-form-layout-04,original,2024,fte-579a13b1d1f214ad463b6f50,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2025
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-2-2
tax classification: Individual or sole proprietor
name: Example Entity 4-2-0
Named party: Example Person 402",W-9,41,W-9,fdc-b3d762ebb9e589d74585e335,synthetic-form-layout-04,original,2025,fte-58f25c27ee7fa06f9966a0a7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2023
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-3-2
tax classification: Individual or sole proprietor
name: Example Entity 4-3-0
Named party: Example Person 403",W-9,41,W-9,fdc-9441a93ce87aa042bcb9a4bb,synthetic-form-layout-04,original,2023,fte-8f2751d1173dc159d8106359,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2024
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-4-2
tax classification: Individual or sole proprietor
name: Example Entity 4-4-0
Named party: Example Person 404",W-9,41,W-9,fdc-be78f5586aee5db8adde5d94,synthetic-form-layout-04,original,2024,fte-2b0a9d5e234c7d5886c3848b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2025
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-5-2
tax classification: Individual or sole proprietor
name: Example Entity 4-5-0
Named party: Example Person 405",W-9,41,W-9,fdc-769c6d91b9bddf5a47dd7a0d,synthetic-form-layout-04,original,2025,fte-172754c8146d796f81495516,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2023
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-6-2
tax classification: Individual or sole proprietor
name: Example Entity 4-6-0
Named party: Example Person 406",W-9,41,W-9,fdc-37599a71cecb01b22800cd42,synthetic-form-layout-04,original,2023,fte-5b14ceacaa92bfe766e14f4a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-9: Request for Taxpayer Identification Number and Certification
Tax reporting year 2024
certification: Example named signer; signed
taxpayer identification number: Example Entity 4-7-2
tax classification: Individual or sole proprietor
name: Example Entity 4-7-0
Named party: Example Person 407",W-9,41,W-9,fdc-d820642e4179fef6ab9ace08,synthetic-form-layout-04,original,2024,fte-27e08195f949908622fb9c90,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2023
name: Example Entity 5-0-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-0-2 / certification: Example named signer; signed
Delivery copy for Example Party 500",W-9,41,W-9,fdc-1ab0a6b4ae289dd38899c8ea,synthetic-form-layout-05,original,2023,fte-b7fe9226dff63cd23b1f5236,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2024
name: Example Entity 5-1-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-1-2 / certification: Example named signer; signed
Delivery copy for Example Party 501",W-9,41,W-9,fdc-c804416106c2f92acbd2a1cb,synthetic-form-layout-05,original,2024,fte-bfa9ac80456a78fe15fdb8b6,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2025
name: Example Entity 5-2-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-2-2 / certification: Example named signer; signed
Delivery copy for Example Party 502",W-9,41,W-9,fdc-c386bd707426b1e1365d6a70,synthetic-form-layout-05,original,2025,fte-79bc329ca377165cc04bfe54,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2023
name: Example Entity 5-3-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-3-2 / certification: Example named signer; signed
Delivery copy for Example Party 503",W-9,41,W-9,fdc-ff003960ec73feb37d31a4de,synthetic-form-layout-05,original,2023,fte-655c4b530dd2d31d13ab358b,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2024
name: Example Entity 5-4-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-4-2 / certification: Example named signer; signed
Delivery copy for Example Party 504",W-9,41,W-9,fdc-6b180efcf5835e61214e61d4,synthetic-form-layout-05,original,2024,fte-bc38fcbefaa1be40104c49ec,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2025
name: Example Entity 5-5-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-5-2 / certification: Example named signer; signed
Delivery copy for Example Party 505",W-9,41,W-9,fdc-0714038b073d7365356f1061,synthetic-form-layout-05,original,2025,fte-85907fccc273a12aef64c62d,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2023
name: Example Entity 5-6-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-6-2 / certification: Example named signer; signed
Delivery copy for Example Party 506",W-9,41,W-9,fdc-22e539cfdbba81a6b20d3010,synthetic-form-layout-05,original,2023,fte-1fafc63ad410087edfbd23b0,synthetic_AI_labeled,v1_template,top,False,
"Form W-9: Request for Taxpayer Identification Number and Certification -- reporting year 2024
name: Example Entity 5-7-0 / tax classification: Individual or sole proprietor / taxpayer identification number: Example Entity 5-7-2 / certification: Example named signer; signed
Delivery copy for Example Party 507",W-9,41,W-9,fdc-72abdebab7961149dfef0450,synthetic-form-layout-05,original,2024,fte-b622f29bf41e44056f455132,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2023
Statement issued to Example Person 0.
filing status: Single
dependents: USD 10,000.00
other adjustments: USD 10,000.00
signature: Example named signer; signed",W-4,40,W-4,fdc-553107948e8923fe98f66063,synthetic-form-layout-00,original,2023,fte-fbd1cdb4f36f10b377136516,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2024
Statement issued to Example Person 1.
filing status: Single
dependents: USD 10,083.00
other adjustments: USD 10,083.00
signature: Example named signer; signed",W-4,40,W-4,fdc-d2c9d8b9f0d0b45efeea72be,synthetic-form-layout-00,original,2024,fte-65acfec115c2d12bf8dfd358,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2025
Statement issued to Example Person 2.
filing status: Single
dependents: USD 10,166.00
other adjustments: USD 10,166.00
signature: Example named signer; signed",W-4,40,W-4,fdc-e54c38645d18777aa0bfba66,synthetic-form-layout-00,original,2025,fte-67b57353c2f8e613fd66dfbf,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2023
Statement issued to Example Person 3.
filing status: Single
dependents: USD 10,249.00
other adjustments: USD 10,249.00
signature: Example named signer; signed",W-4,40,W-4,fdc-1142093136170bcf7d396a1a,synthetic-form-layout-00,original,2023,fte-e0edaa5293f6ecf6f0d8c98f,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2024
Statement issued to Example Person 4.
filing status: Single
dependents: USD 10,332.00
other adjustments: USD 10,332.00
signature: Example named signer; signed",W-4,40,W-4,fdc-9fbd06b9f40f8e51f4b74a3c,synthetic-form-layout-00,original,2024,fte-6167ff9c99d0aa6a37c343a0,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2025
Statement issued to Example Person 5.
filing status: Single
dependents: USD 10,415.00
other adjustments: USD 10,415.00
signature: Example named signer; signed",W-4,40,W-4,fdc-756cfde52082ccb6b4ca62b5,synthetic-form-layout-00,original,2025,fte-b0f8697252b510e2cafa3917,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2023
Statement issued to Example Person 6.
filing status: Single
dependents: USD 10,498.00
other adjustments: USD 10,498.00
signature: Example named signer; signed",W-4,40,W-4,fdc-7f27fc049279f70f52db5c4c,synthetic-form-layout-00,original,2023,fte-335119fec840c80752d4a652,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Calendar year: 2024
Statement issued to Example Person 7.
filing status: Single
dependents: USD 10,581.00
other adjustments: USD 10,581.00
signature: Example named signer; signed",W-4,40,W-4,fdc-301bc02de3856ceb2dbc0d29,synthetic-form-layout-00,original,2024,fte-c69e93b7980ae6fda1cabfcd,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 100
filing status: Single | dependents: USD 10,137.00 | other adjustments: USD 10,137.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-9a6297cd71ab69c5365b0229,synthetic-form-layout-01,original,2023,fte-b2cff540eae8b5b3379916ed,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 101
filing status: Single | dependents: USD 10,220.00 | other adjustments: USD 10,220.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-fd0b0a92003936998f3ea9d0,synthetic-form-layout-01,original,2024,fte-2d16f9aba8402a59a49a68d0,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 102
filing status: Single | dependents: USD 10,303.00 | other adjustments: USD 10,303.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-6f5f9f06736da2d6239d2ddc,synthetic-form-layout-01,original,2025,fte-d7e4178d99bf0a5cecf92759,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 103
filing status: Single | dependents: USD 10,386.00 | other adjustments: USD 10,386.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-9a2b46183817d4809fe0d24b,synthetic-form-layout-01,original,2023,fte-5eb715983b7121fd88d702ed,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 104
filing status: Single | dependents: USD 10,469.00 | other adjustments: USD 10,469.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-f3456ff4c73c6d5101405b85,synthetic-form-layout-01,original,2024,fte-70c3aa8ac9f7973f359f9329,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 105
filing status: Single | dependents: USD 10,552.00 | other adjustments: USD 10,552.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-1bcc4a2e794e54f5b58b1ef7,synthetic-form-layout-01,original,2025,fte-83a0b9d5583ffdde556b7bd7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 106
filing status: Single | dependents: USD 10,635.00 | other adjustments: USD 10,635.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-17e9bad239d7826aa19dc90f,synthetic-form-layout-01,original,2023,fte-8259d988ad58d05306b7949f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form W-4: Employee Withholding Certificate
Recipient record: Example Person 107
filing status: Single | dependents: USD 10,718.00 | other adjustments: USD 10,718.00 | signature: Example named signer; signed",W-4,40,W-4,fdc-f96c86a7ce5775cf80c8ba1c,synthetic-form-layout-01,original,2024,fte-a1db47a683e6e591dfaa5072,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,274.00; other adjustments: USD 10,274.00; signature: Example named signer; signed. Recipient: Example Household 200.",W-4,40,W-4,fdc-cf7030169518082241b39e72,synthetic-form-layout-02,original,2023,fte-13c70e12ae494562f4a903ab,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,357.00; other adjustments: USD 10,357.00; signature: Example named signer; signed. Recipient: Example Household 201.",W-4,40,W-4,fdc-1286a29ff096f520d44ede5e,synthetic-form-layout-02,original,2024,fte-f0049a9c7cdb27a818601a69,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,440.00; other adjustments: USD 10,440.00; signature: Example named signer; signed. Recipient: Example Household 202.",W-4,40,W-4,fdc-bf07ce05c0a1bdcdb059a2d6,synthetic-form-layout-02,original,2025,fte-879c23542ef6d280dd9c3be0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,523.00; other adjustments: USD 10,523.00; signature: Example named signer; signed. Recipient: Example Household 203.",W-4,40,W-4,fdc-7c675cb1f8a4ae715a80fb98,synthetic-form-layout-02,original,2023,fte-28cd827e7637cd700efa935b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,606.00; other adjustments: USD 10,606.00; signature: Example named signer; signed. Recipient: Example Household 204.",W-4,40,W-4,fdc-e7d857091ccf9f900e9fee93,synthetic-form-layout-02,original,2024,fte-bc46bb84aef8014807bfebbf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,689.00; other adjustments: USD 10,689.00; signature: Example named signer; signed. Recipient: Example Household 205.",W-4,40,W-4,fdc-29bb1e9385ff2714c83baab0,synthetic-form-layout-02,original,2025,fte-4be5373320c69a0bbae0dd9c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,772.00; other adjustments: USD 10,772.00; signature: Example named signer; signed. Recipient: Example Household 206.",W-4,40,W-4,fdc-6c67dd5699276a67c2b62d50,synthetic-form-layout-02,original,2023,fte-78d258b701e383897f832880,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form W-4: Employee Withholding Certificate.
filing status: Single; dependents: USD 10,855.00; other adjustments: USD 10,855.00; signature: Example named signer; signed. Recipient: Example Household 207.",W-4,40,W-4,fdc-a50bda76e22298a1f8cbb702,synthetic-form-layout-02,original,2024,fte-f3146b4b061da32eddd6526f,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2023.
Details: filing status: Single, dependents: USD 10,411.00, other adjustments: USD 10,411.00, signature: Example named signer; signed. Account holder: Example Person 300.",W-4,40,W-4,fdc-9bcb290342bee052ccdf18d6,synthetic-form-layout-03,original,2023,fte-a8d12cb3b7d1faa315d87253,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2024.
Details: filing status: Single, dependents: USD 10,494.00, other adjustments: USD 10,494.00, signature: Example named signer; signed. Account holder: Example Person 301.",W-4,40,W-4,fdc-4c2926e38218ab36b5072d57,synthetic-form-layout-03,original,2024,fte-9a90e1595c49c2a160d8ae5d,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2025.
Details: filing status: Single, dependents: USD 10,577.00, other adjustments: USD 10,577.00, signature: Example named signer; signed. Account holder: Example Person 302.",W-4,40,W-4,fdc-531e1cac42556400ee8b347f,synthetic-form-layout-03,original,2025,fte-c524084daec62ac7c7601ea2,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2023.
Details: filing status: Single, dependents: USD 10,660.00, other adjustments: USD 10,660.00, signature: Example named signer; signed. Account holder: Example Person 303.",W-4,40,W-4,fdc-acd610f9a68562e7d4267f8e,synthetic-form-layout-03,original,2023,fte-efff5b22de325bcc1087ba39,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2024.
Details: filing status: Single, dependents: USD 10,743.00, other adjustments: USD 10,743.00, signature: Example named signer; signed. Account holder: Example Person 304.",W-4,40,W-4,fdc-543251053b7476638b727f6b,synthetic-form-layout-03,original,2024,fte-64191542f7ec9b9e4a56142c,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2025.
Details: filing status: Single, dependents: USD 10,826.00, other adjustments: USD 10,826.00, signature: Example named signer; signed. Account holder: Example Person 305.",W-4,40,W-4,fdc-a51c9eb65e58b01993a2dd3f,synthetic-form-layout-03,original,2025,fte-e427e5b0d4e070328eaa2f73,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2023.
Details: filing status: Single, dependents: USD 10,909.00, other adjustments: USD 10,909.00, signature: Example named signer; signed. Account holder: Example Person 306.",W-4,40,W-4,fdc-48608eeff1470c60522c7302,synthetic-form-layout-03,original,2023,fte-7240c0ade43e377e3a9e2d6c,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate
Reporting period ended 12/31/2024.
Details: filing status: Single, dependents: USD 10,992.00, other adjustments: USD 10,992.00, signature: Example named signer; signed. Account holder: Example Person 307.",W-4,40,W-4,fdc-ffa755cbd19cee19d9fd3ea7,synthetic-form-layout-03,original,2024,fte-9921a9e56d36adfe374b96a7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2023
signature: Example named signer; signed
other adjustments: USD 10,548.00
dependents: USD 10,548.00
filing status: Single
Named party: Example Person 400",W-4,40,W-4,fdc-1f74f5c54e71415710171c1d,synthetic-form-layout-04,original,2023,fte-b572a149ee91cc6715f29b2d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2024
signature: Example named signer; signed
other adjustments: USD 10,631.00
dependents: USD 10,631.00
filing status: Single
Named party: Example Person 401",W-4,40,W-4,fdc-d30a594c92378d71696b45e5,synthetic-form-layout-04,original,2024,fte-cf77b7786c37a329f0f1b70c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2025
signature: Example named signer; signed
other adjustments: USD 10,714.00
dependents: USD 10,714.00
filing status: Single
Named party: Example Person 402",W-4,40,W-4,fdc-64e0326bd17af756abdd3b2d,synthetic-form-layout-04,original,2025,fte-96092faecb75ddfcc3772e60,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2023
signature: Example named signer; signed
other adjustments: USD 10,797.00
dependents: USD 10,797.00
filing status: Single
Named party: Example Person 403",W-4,40,W-4,fdc-1ecdc58dfbcc6224813adb2f,synthetic-form-layout-04,original,2023,fte-be92060e0d5456aee9a64af6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2024
signature: Example named signer; signed
other adjustments: USD 10,880.00
dependents: USD 10,880.00
filing status: Single
Named party: Example Person 404",W-4,40,W-4,fdc-960c7bceca03ca2372a1a416,synthetic-form-layout-04,original,2024,fte-1a01b3a34be29aeca5e8d7d7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2025
signature: Example named signer; signed
other adjustments: USD 10,963.00
dependents: USD 10,963.00
filing status: Single
Named party: Example Person 405",W-4,40,W-4,fdc-50886d92fd7419e1635b515b,synthetic-form-layout-04,original,2025,fte-19e2d1164ac01562ced5a1ed,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2023
signature: Example named signer; signed
other adjustments: USD 11,046.00
dependents: USD 11,046.00
filing status: Single
Named party: Example Person 406",W-4,40,W-4,fdc-5dba77c7d4171beeec115dd9,synthetic-form-layout-04,original,2023,fte-fcc67cfd914ead1daa620510,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form W-4: Employee Withholding Certificate
Tax reporting year 2024
signature: Example named signer; signed
other adjustments: USD 11,129.00
dependents: USD 11,129.00
filing status: Single
Named party: Example Person 407",W-4,40,W-4,fdc-74bde40dc0b5acdd8af27cfa,synthetic-form-layout-04,original,2024,fte-7a3dc1eda5e7c79834386888,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2023
filing status: Single / dependents: USD 10,685.00 / other adjustments: USD 10,685.00 / signature: Example named signer; signed
Delivery copy for Example Party 500",W-4,40,W-4,fdc-515ed38c35378ee12507e657,synthetic-form-layout-05,original,2023,fte-f8080fd43e3a46cb12f45216,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2024
filing status: Single / dependents: USD 10,768.00 / other adjustments: USD 10,768.00 / signature: Example named signer; signed
Delivery copy for Example Party 501",W-4,40,W-4,fdc-5ae1553152702ae4d775028a,synthetic-form-layout-05,original,2024,fte-dc65eeb8d158328738b1fea2,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2025
filing status: Single / dependents: USD 10,851.00 / other adjustments: USD 10,851.00 / signature: Example named signer; signed
Delivery copy for Example Party 502",W-4,40,W-4,fdc-8aae15145f1d463a0caf24ff,synthetic-form-layout-05,original,2025,fte-c638c0bd7661bfe9afd05aaf,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2023
filing status: Single / dependents: USD 10,934.00 / other adjustments: USD 10,934.00 / signature: Example named signer; signed
Delivery copy for Example Party 503",W-4,40,W-4,fdc-8f07980c4d68585ccd131560,synthetic-form-layout-05,original,2023,fte-0efda0ce6276d6b2446f60f8,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2024
filing status: Single / dependents: USD 11,017.00 / other adjustments: USD 11,017.00 / signature: Example named signer; signed
Delivery copy for Example Party 504",W-4,40,W-4,fdc-176f43324f635a86e42fb994,synthetic-form-layout-05,original,2024,fte-c14ce0dc3d90931257549582,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2025
filing status: Single / dependents: USD 11,100.00 / other adjustments: USD 11,100.00 / signature: Example named signer; signed
Delivery copy for Example Party 505",W-4,40,W-4,fdc-ec10000c5a48bfe6f3018644,synthetic-form-layout-05,original,2025,fte-174b810f9d8ab882467d2612,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2023
filing status: Single / dependents: USD 11,183.00 / other adjustments: USD 11,183.00 / signature: Example named signer; signed
Delivery copy for Example Party 506",W-4,40,W-4,fdc-d5a9d908f6ab13762167999b,synthetic-form-layout-05,original,2023,fte-16029ef727e022d8984d2f6a,synthetic_AI_labeled,v1_template,top,False,
"Form W-4: Employee Withholding Certificate -- reporting year 2024
filing status: Single / dependents: USD 11,266.00 / other adjustments: USD 11,266.00 / signature: Example named signer; signed
Delivery copy for Example Party 507",W-4,40,W-4,fdc-0f18540890bfc7c78b9eef44,synthetic-form-layout-05,original,2024,fte-38c096201fe6e04cc370d8eb,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2023
Statement issued to Example Person 0.
taxpayer: Example Entity 0-0-0
return transcript: USD 10,000.00
tax year: 2023
signature: Example named signer; signed",4506-T,12,4506-T,fdc-3f6897114a77ef1e7c2e4f55,synthetic-form-layout-00,original,2023,fte-3dd84335213561bedbc667fd,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2024
Statement issued to Example Person 1.
taxpayer: Example Entity 0-1-0
return transcript: USD 10,083.00
tax year: 2024
signature: Example named signer; signed",4506-T,12,4506-T,fdc-adadd562a76326cf5b22d2dc,synthetic-form-layout-00,original,2024,fte-7206e3e125849f0d43e52299,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2025
Statement issued to Example Person 2.
taxpayer: Example Entity 0-2-0
return transcript: USD 10,166.00
tax year: 2025
signature: Example named signer; signed",4506-T,12,4506-T,fdc-b2992bd497571de8195436fc,synthetic-form-layout-00,original,2025,fte-b0580b0a625861c6d8e713fe,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2023
Statement issued to Example Person 3.
taxpayer: Example Entity 0-3-0
return transcript: USD 10,249.00
tax year: 2023
signature: Example named signer; signed",4506-T,12,4506-T,fdc-56a28a9395b58cb784a849b9,synthetic-form-layout-00,original,2023,fte-a9b9b0d77c799c709b7fcbd6,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2024
Statement issued to Example Person 4.
taxpayer: Example Entity 0-4-0
return transcript: USD 10,332.00
tax year: 2024
signature: Example named signer; signed",4506-T,12,4506-T,fdc-533a4ca9d608a2049d00f984,synthetic-form-layout-00,original,2024,fte-ad27a30aa326d1708447f8b3,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2025
Statement issued to Example Person 5.
taxpayer: Example Entity 0-5-0
return transcript: USD 10,415.00
tax year: 2025
signature: Example named signer; signed",4506-T,12,4506-T,fdc-efbfc4ae6b716e182c854e0a,synthetic-form-layout-00,original,2025,fte-f7008eb0dfde26ce5b883778,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2023
Statement issued to Example Person 6.
taxpayer: Example Entity 0-6-0
return transcript: USD 10,498.00
tax year: 2023
signature: Example named signer; signed",4506-T,12,4506-T,fdc-7bd973c9b4748830359c9ef7,synthetic-form-layout-00,original,2023,fte-2d4f396edffb60c72f41da4c,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Calendar year: 2024
Statement issued to Example Person 7.
taxpayer: Example Entity 0-7-0
return transcript: USD 10,581.00
tax year: 2024
signature: Example named signer; signed",4506-T,12,4506-T,fdc-20e2b1cdd1be6560e15d17c5,synthetic-form-layout-00,original,2024,fte-2d05495298412b66b0700237,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 100
taxpayer: Example Entity 1-0-0 | return transcript: USD 10,137.00 | tax year: 2023 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-e21cdef0a6014ff478a92e1c,synthetic-form-layout-01,original,2023,fte-e6708f9a251a08e2be22223d,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 101
taxpayer: Example Entity 1-1-0 | return transcript: USD 10,220.00 | tax year: 2024 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-093b2491eb559df04e531cb6,synthetic-form-layout-01,original,2024,fte-cb1c05d7eccd100c77032428,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 102
taxpayer: Example Entity 1-2-0 | return transcript: USD 10,303.00 | tax year: 2025 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-a98f8f56bc3fc0914a40427d,synthetic-form-layout-01,original,2025,fte-cd1deb722e7fc46cc1e97ca4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 103
taxpayer: Example Entity 1-3-0 | return transcript: USD 10,386.00 | tax year: 2023 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-c9d3dc688a38030c3718ca64,synthetic-form-layout-01,original,2023,fte-a6c7f52709e73b407bbc4af0,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 104
taxpayer: Example Entity 1-4-0 | return transcript: USD 10,469.00 | tax year: 2024 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-46d59e17a7f2e50c6d624cd1,synthetic-form-layout-01,original,2024,fte-6bc709f5389e0216cdd65379,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 105
taxpayer: Example Entity 1-5-0 | return transcript: USD 10,552.00 | tax year: 2025 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-80f262de9f430d47fbd8aae8,synthetic-form-layout-01,original,2025,fte-3838c58b730407cd6367b749,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 106
taxpayer: Example Entity 1-6-0 | return transcript: USD 10,635.00 | tax year: 2023 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-52529a286041384d0f6afe4d,synthetic-form-layout-01,original,2023,fte-7b29f1467fd32fcb2dcf81a1,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 4506-T: Request for Transcript of Tax Return
Recipient record: Example Person 107
taxpayer: Example Entity 1-7-0 | return transcript: USD 10,718.00 | tax year: 2024 | signature: Example named signer; signed",4506-T,12,4506-T,fdc-1ffd6f80e938f42f3df96a2e,synthetic-form-layout-01,original,2024,fte-c5fc076ce91ad50849181b9a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-0-0; return transcript: USD 10,274.00; tax year: 2023; signature: Example named signer; signed. Recipient: Example Household 200.",4506-T,12,4506-T,fdc-8ec71cc5e77e06411f3e0c7d,synthetic-form-layout-02,original,2023,fte-e5d2ca2114f1c0572412214f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-1-0; return transcript: USD 10,357.00; tax year: 2024; signature: Example named signer; signed. Recipient: Example Household 201.",4506-T,12,4506-T,fdc-d99a624f4c7ab7d88be54cf5,synthetic-form-layout-02,original,2024,fte-7c028dab5112fdd34051f8cb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-2-0; return transcript: USD 10,440.00; tax year: 2025; signature: Example named signer; signed. Recipient: Example Household 202.",4506-T,12,4506-T,fdc-3e9c138f748a676fdc5ecfba,synthetic-form-layout-02,original,2025,fte-2ad0f422f6a68cf7c7a48245,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-3-0; return transcript: USD 10,523.00; tax year: 2023; signature: Example named signer; signed. Recipient: Example Household 203.",4506-T,12,4506-T,fdc-9045585d8f4e0ed625da4afd,synthetic-form-layout-02,original,2023,fte-d614281a76953da9f70e580f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-4-0; return transcript: USD 10,606.00; tax year: 2024; signature: Example named signer; signed. Recipient: Example Household 204.",4506-T,12,4506-T,fdc-4ec680fa7964b32a5c419d05,synthetic-form-layout-02,original,2024,fte-d2e96de0b84aed4789803b46,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-5-0; return transcript: USD 10,689.00; tax year: 2025; signature: Example named signer; signed. Recipient: Example Household 205.",4506-T,12,4506-T,fdc-ca7f47db9a1ec1899f5aee0d,synthetic-form-layout-02,original,2025,fte-6c58d10c48de933fc756bb17,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-6-0; return transcript: USD 10,772.00; tax year: 2023; signature: Example named signer; signed. Recipient: Example Household 206.",4506-T,12,4506-T,fdc-a97c13903c2e2d5a826ebcee,synthetic-form-layout-02,original,2023,fte-434d9df31a194dd9b5aae1dd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 4506-T: Request for Transcript of Tax Return.
taxpayer: Example Entity 2-7-0; return transcript: USD 10,855.00; tax year: 2024; signature: Example named signer; signed. Recipient: Example Household 207.",4506-T,12,4506-T,fdc-c3e10904dad31f1a8c8277f1,synthetic-form-layout-02,original,2024,fte-fafaef5d67620a571552e8ad,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2023.
Details: taxpayer: Example Entity 3-0-0, return transcript: USD 10,411.00, tax year: 2023, signature: Example named signer; signed. Account holder: Example Person 300.",4506-T,12,4506-T,fdc-f9235c479c94c277528b1867,synthetic-form-layout-03,original,2023,fte-ac1f52bebca2d71e1c134bc8,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2024.
Details: taxpayer: Example Entity 3-1-0, return transcript: USD 10,494.00, tax year: 2024, signature: Example named signer; signed. Account holder: Example Person 301.",4506-T,12,4506-T,fdc-ba8fcd1e524d008aa15c9b90,synthetic-form-layout-03,original,2024,fte-309eccba9a34a03f9f431db9,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2025.
Details: taxpayer: Example Entity 3-2-0, return transcript: USD 10,577.00, tax year: 2025, signature: Example named signer; signed. Account holder: Example Person 302.",4506-T,12,4506-T,fdc-432c19eced4e7c7364eaa286,synthetic-form-layout-03,original,2025,fte-b7b5b9eec1189b5f4bae6640,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2023.
Details: taxpayer: Example Entity 3-3-0, return transcript: USD 10,660.00, tax year: 2023, signature: Example named signer; signed. Account holder: Example Person 303.",4506-T,12,4506-T,fdc-e593af96aa4e78e8c9c587f6,synthetic-form-layout-03,original,2023,fte-c21c1eb154e91ae9deb05c28,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2024.
Details: taxpayer: Example Entity 3-4-0, return transcript: USD 10,743.00, tax year: 2024, signature: Example named signer; signed. Account holder: Example Person 304.",4506-T,12,4506-T,fdc-5fc116e91df46e216522b894,synthetic-form-layout-03,original,2024,fte-5eaed7adcb4b095d8c4bdcf1,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2025.
Details: taxpayer: Example Entity 3-5-0, return transcript: USD 10,826.00, tax year: 2025, signature: Example named signer; signed. Account holder: Example Person 305.",4506-T,12,4506-T,fdc-67d1a2f4e77a5412d26e5793,synthetic-form-layout-03,original,2025,fte-b136d72a3098fb1a839f71e9,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2023.
Details: taxpayer: Example Entity 3-6-0, return transcript: USD 10,909.00, tax year: 2023, signature: Example named signer; signed. Account holder: Example Person 306.",4506-T,12,4506-T,fdc-e2cbba7b35372f2185a4c321,synthetic-form-layout-03,original,2023,fte-4711868370574412658d94d3,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return
Reporting period ended 12/31/2024.
Details: taxpayer: Example Entity 3-7-0, return transcript: USD 10,992.00, tax year: 2024, signature: Example named signer; signed. Account holder: Example Person 307.",4506-T,12,4506-T,fdc-c4fe87ca3d0106f917e7af9a,synthetic-form-layout-03,original,2024,fte-58b57d20acd84f353ca2275e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2023
signature: Example named signer; signed
tax year: 2023
return transcript: USD 10,548.00
taxpayer: Example Entity 4-0-0
Named party: Example Person 400",4506-T,12,4506-T,fdc-1699b42f9f2bebdc1e9cfd1f,synthetic-form-layout-04,original,2023,fte-eccfa6e0d1abc0a2721544cd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2024
signature: Example named signer; signed
tax year: 2024
return transcript: USD 10,631.00
taxpayer: Example Entity 4-1-0
Named party: Example Person 401",4506-T,12,4506-T,fdc-42d0f2cdbeb9258500e14376,synthetic-form-layout-04,original,2024,fte-71b6546e4116b61de4aaa378,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2025
signature: Example named signer; signed
tax year: 2025
return transcript: USD 10,714.00
taxpayer: Example Entity 4-2-0
Named party: Example Person 402",4506-T,12,4506-T,fdc-d643c2e871d5923e038db322,synthetic-form-layout-04,original,2025,fte-1b3aad554ed3d8dbc27a7537,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2023
signature: Example named signer; signed
tax year: 2023
return transcript: USD 10,797.00
taxpayer: Example Entity 4-3-0
Named party: Example Person 403",4506-T,12,4506-T,fdc-9b6cf6c8989c524c5fe7783f,synthetic-form-layout-04,original,2023,fte-08c5b5fe19c69f4b29fbdfde,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2024
signature: Example named signer; signed
tax year: 2024
return transcript: USD 10,880.00
taxpayer: Example Entity 4-4-0
Named party: Example Person 404",4506-T,12,4506-T,fdc-2aa508fa2023a89d1575c3b5,synthetic-form-layout-04,original,2024,fte-3fa09d00a378446d81cf1b25,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2025
signature: Example named signer; signed
tax year: 2025
return transcript: USD 10,963.00
taxpayer: Example Entity 4-5-0
Named party: Example Person 405",4506-T,12,4506-T,fdc-09505ee543940850eeee6155,synthetic-form-layout-04,original,2025,fte-c6a684418a584076cbf3588b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2023
signature: Example named signer; signed
tax year: 2023
return transcript: USD 11,046.00
taxpayer: Example Entity 4-6-0
Named party: Example Person 406",4506-T,12,4506-T,fdc-d6f7c3aef2e42feab285e57d,synthetic-form-layout-04,original,2023,fte-4260305490e7fa384136d337,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 4506-T: Request for Transcript of Tax Return
Tax reporting year 2024
signature: Example named signer; signed
tax year: 2024
return transcript: USD 11,129.00
taxpayer: Example Entity 4-7-0
Named party: Example Person 407",4506-T,12,4506-T,fdc-edb0a77ab5c766617474c072,synthetic-form-layout-04,original,2024,fte-f051df75557591d23f08b439,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2023
taxpayer: Example Entity 5-0-0 / return transcript: USD 10,685.00 / tax year: 2023 / signature: Example named signer; signed
Delivery copy for Example Party 500",4506-T,12,4506-T,fdc-4b8420fbcf419210615c1f90,synthetic-form-layout-05,original,2023,fte-4e717af2e395c74ea8820c59,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2024
taxpayer: Example Entity 5-1-0 / return transcript: USD 10,768.00 / tax year: 2024 / signature: Example named signer; signed
Delivery copy for Example Party 501",4506-T,12,4506-T,fdc-9cce4401bc4bfca4fb975a8e,synthetic-form-layout-05,original,2024,fte-270dc98319312c663b420d15,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2025
taxpayer: Example Entity 5-2-0 / return transcript: USD 10,851.00 / tax year: 2025 / signature: Example named signer; signed
Delivery copy for Example Party 502",4506-T,12,4506-T,fdc-e43c7340d4dc46ab939baf5c,synthetic-form-layout-05,original,2025,fte-f71be0289ad0b26a97fc2d88,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2023
taxpayer: Example Entity 5-3-0 / return transcript: USD 10,934.00 / tax year: 2023 / signature: Example named signer; signed
Delivery copy for Example Party 503",4506-T,12,4506-T,fdc-bd59dd9c159984c009ff13af,synthetic-form-layout-05,original,2023,fte-5d6caa3bab1d3334b11f15f7,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2024
taxpayer: Example Entity 5-4-0 / return transcript: USD 11,017.00 / tax year: 2024 / signature: Example named signer; signed
Delivery copy for Example Party 504",4506-T,12,4506-T,fdc-c74589ced736d30c486858af,synthetic-form-layout-05,original,2024,fte-deb41a734b9be0ba29c93a39,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2025
taxpayer: Example Entity 5-5-0 / return transcript: USD 11,100.00 / tax year: 2025 / signature: Example named signer; signed
Delivery copy for Example Party 505",4506-T,12,4506-T,fdc-e2309b25d89617175d7da9cb,synthetic-form-layout-05,original,2025,fte-3c8ba79ca12469e4b190b919,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2023
taxpayer: Example Entity 5-6-0 / return transcript: USD 11,183.00 / tax year: 2023 / signature: Example named signer; signed
Delivery copy for Example Party 506",4506-T,12,4506-T,fdc-67297a6290c39c50922dd22a,synthetic-form-layout-05,original,2023,fte-5023c836e0bec69074420542,synthetic_AI_labeled,v1_template,top,False,
"Form 4506-T: Request for Transcript of Tax Return -- reporting year 2024
taxpayer: Example Entity 5-7-0 / return transcript: USD 11,266.00 / tax year: 2024 / signature: Example named signer; signed
Delivery copy for Example Party 507",4506-T,12,4506-T,fdc-2c3b722864a739f372b0335a,synthetic-form-layout-05,original,2024,fte-6eedbadd3ed38c87905af8ed,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2023
Statement issued to Example Person 0.
taxpayer: Example Entity 0-0-0
representative: Example Entity 0-0-1
tax matters: USD 10,000.00
authorization: USD 10,000.00",2848,10,2848,fdc-d4195f2e10c8bdb485391279,synthetic-form-layout-00,original,2023,fte-4c0950d1b7b3d48005dd2097,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2024
Statement issued to Example Person 1.
taxpayer: Example Entity 0-1-0
representative: Example Entity 0-1-1
tax matters: USD 10,083.00
authorization: USD 10,083.00",2848,10,2848,fdc-bd342a23b96c50806b4e055e,synthetic-form-layout-00,original,2024,fte-049b912b8de8f578dfcbd41e,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2025
Statement issued to Example Person 2.
taxpayer: Example Entity 0-2-0
representative: Example Entity 0-2-1
tax matters: USD 10,166.00
authorization: USD 10,166.00",2848,10,2848,fdc-8cb26e9b8d098640ea24149a,synthetic-form-layout-00,original,2025,fte-c79500a5ea3b6d7a30cbb4f0,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2023
Statement issued to Example Person 3.
taxpayer: Example Entity 0-3-0
representative: Example Entity 0-3-1
tax matters: USD 10,249.00
authorization: USD 10,249.00",2848,10,2848,fdc-1b8fae0d4516247af6240a67,synthetic-form-layout-00,original,2023,fte-a2d9d0ccbea760248ef21d5b,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2024
Statement issued to Example Person 4.
taxpayer: Example Entity 0-4-0
representative: Example Entity 0-4-1
tax matters: USD 10,332.00
authorization: USD 10,332.00",2848,10,2848,fdc-26067c92cf77211cdeef1e39,synthetic-form-layout-00,original,2024,fte-e54bd685c6eac108d4a163d4,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2025
Statement issued to Example Person 5.
taxpayer: Example Entity 0-5-0
representative: Example Entity 0-5-1
tax matters: USD 10,415.00
authorization: USD 10,415.00",2848,10,2848,fdc-b6355cee87c0024a93dc2f29,synthetic-form-layout-00,original,2025,fte-6f9c116b90fc68ec13d1191e,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2023
Statement issued to Example Person 6.
taxpayer: Example Entity 0-6-0
representative: Example Entity 0-6-1
tax matters: USD 10,498.00
authorization: USD 10,498.00",2848,10,2848,fdc-dca242b79db3e5331f5cc225,synthetic-form-layout-00,original,2023,fte-e4bf993ce6e61255505345b1,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Calendar year: 2024
Statement issued to Example Person 7.
taxpayer: Example Entity 0-7-0
representative: Example Entity 0-7-1
tax matters: USD 10,581.00
authorization: USD 10,581.00",2848,10,2848,fdc-e4d2c869d0cfb338e9aae56a,synthetic-form-layout-00,original,2024,fte-649d3c34eeaaf145a6cd0f16,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 100
taxpayer: Example Entity 1-0-0 | representative: Example Entity 1-0-1 | tax matters: USD 10,137.00 | authorization: USD 10,137.00",2848,10,2848,fdc-9f1573f82403773135b53ab8,synthetic-form-layout-01,original,2023,fte-b9cdcc86c391651931091173,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 101
taxpayer: Example Entity 1-1-0 | representative: Example Entity 1-1-1 | tax matters: USD 10,220.00 | authorization: USD 10,220.00",2848,10,2848,fdc-d52d9bd092596963a8d1b493,synthetic-form-layout-01,original,2024,fte-0cdc5da57e38b283658ebffc,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 102
taxpayer: Example Entity 1-2-0 | representative: Example Entity 1-2-1 | tax matters: USD 10,303.00 | authorization: USD 10,303.00",2848,10,2848,fdc-a08392905529da02d69b5cdf,synthetic-form-layout-01,original,2025,fte-9be2c4a385b7144102bf5db7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 103
taxpayer: Example Entity 1-3-0 | representative: Example Entity 1-3-1 | tax matters: USD 10,386.00 | authorization: USD 10,386.00",2848,10,2848,fdc-7734c30f662fb78328daa991,synthetic-form-layout-01,original,2023,fte-a86a5f414080d91da593722f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 104
taxpayer: Example Entity 1-4-0 | representative: Example Entity 1-4-1 | tax matters: USD 10,469.00 | authorization: USD 10,469.00",2848,10,2848,fdc-479c8ea0d653608a0b73034d,synthetic-form-layout-01,original,2024,fte-33e8c32c30c2b6cea04f264d,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 105
taxpayer: Example Entity 1-5-0 | representative: Example Entity 1-5-1 | tax matters: USD 10,552.00 | authorization: USD 10,552.00",2848,10,2848,fdc-b93de2060355501293efd628,synthetic-form-layout-01,original,2025,fte-c1b284451af09b99e2727fbb,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 106
taxpayer: Example Entity 1-6-0 | representative: Example Entity 1-6-1 | tax matters: USD 10,635.00 | authorization: USD 10,635.00",2848,10,2848,fdc-71f974ab629dfe5fb103a802,synthetic-form-layout-01,original,2023,fte-cf0213c62785b7157887035b,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2848: Power of Attorney and Declaration of Representative
Recipient record: Example Person 107
taxpayer: Example Entity 1-7-0 | representative: Example Entity 1-7-1 | tax matters: USD 10,718.00 | authorization: USD 10,718.00",2848,10,2848,fdc-2899b3cae4bd4e5026215854,synthetic-form-layout-01,original,2024,fte-9d35202e04b6f5da07354e72,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-0-0; representative: Example Entity 2-0-1; tax matters: USD 10,274.00; authorization: USD 10,274.00. Recipient: Example Household 200.",2848,10,2848,fdc-f4c4072a30c8d588b6313c45,synthetic-form-layout-02,original,2023,fte-3394a234534b239242af0f71,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-1-0; representative: Example Entity 2-1-1; tax matters: USD 10,357.00; authorization: USD 10,357.00. Recipient: Example Household 201.",2848,10,2848,fdc-cd85e7c3264a782b49c0d82c,synthetic-form-layout-02,original,2024,fte-7cc0eee2ea970bf3ec4832f6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-2-0; representative: Example Entity 2-2-1; tax matters: USD 10,440.00; authorization: USD 10,440.00. Recipient: Example Household 202.",2848,10,2848,fdc-f6a3f9d8df264d9b191e1b02,synthetic-form-layout-02,original,2025,fte-224756cfd3f7134a963b3ffb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-3-0; representative: Example Entity 2-3-1; tax matters: USD 10,523.00; authorization: USD 10,523.00. Recipient: Example Household 203.",2848,10,2848,fdc-3375519aafb9036d56f61a0e,synthetic-form-layout-02,original,2023,fte-64f4b3c37d4b2007462e15ac,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-4-0; representative: Example Entity 2-4-1; tax matters: USD 10,606.00; authorization: USD 10,606.00. Recipient: Example Household 204.",2848,10,2848,fdc-5ecd08aee66cfaa9ee8aaa41,synthetic-form-layout-02,original,2024,fte-bce28e9494b6642748506751,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-5-0; representative: Example Entity 2-5-1; tax matters: USD 10,689.00; authorization: USD 10,689.00. Recipient: Example Household 205.",2848,10,2848,fdc-81fb254ef9cdba5e7d678a12,synthetic-form-layout-02,original,2025,fte-77b4fe82621dd9123e38275d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-6-0; representative: Example Entity 2-6-1; tax matters: USD 10,772.00; authorization: USD 10,772.00. Recipient: Example Household 206.",2848,10,2848,fdc-37c7174c1d0977f94051a377,synthetic-form-layout-02,original,2023,fte-cd7b6770e99530dd3c7408fb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2848: Power of Attorney and Declaration of Representative.
taxpayer: Example Entity 2-7-0; representative: Example Entity 2-7-1; tax matters: USD 10,855.00; authorization: USD 10,855.00. Recipient: Example Household 207.",2848,10,2848,fdc-347cc30122b8da937a9afc81,synthetic-form-layout-02,original,2024,fte-5af61b084aaf08343ccc526e,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2023.
Details: taxpayer: Example Entity 3-0-0, representative: Example Entity 3-0-1, tax matters: USD 10,411.00, authorization: USD 10,411.00. Account holder: Example Person 300.",2848,10,2848,fdc-622f9d9a130310b672f802af,synthetic-form-layout-03,original,2023,fte-9aff9e052281b61b7c4eaffc,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2024.
Details: taxpayer: Example Entity 3-1-0, representative: Example Entity 3-1-1, tax matters: USD 10,494.00, authorization: USD 10,494.00. Account holder: Example Person 301.",2848,10,2848,fdc-e6f3b7506e1a07357700ab09,synthetic-form-layout-03,original,2024,fte-758dad8d81cd518287ff47bb,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2025.
Details: taxpayer: Example Entity 3-2-0, representative: Example Entity 3-2-1, tax matters: USD 10,577.00, authorization: USD 10,577.00. Account holder: Example Person 302.",2848,10,2848,fdc-97cfd5793865c268af9eaaad,synthetic-form-layout-03,original,2025,fte-016b6ce3eeaca4af55e67c26,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2023.
Details: taxpayer: Example Entity 3-3-0, representative: Example Entity 3-3-1, tax matters: USD 10,660.00, authorization: USD 10,660.00. Account holder: Example Person 303.",2848,10,2848,fdc-e05d743d0567a8a41762906c,synthetic-form-layout-03,original,2023,fte-6426691b4231acf51fa9979b,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2024.
Details: taxpayer: Example Entity 3-4-0, representative: Example Entity 3-4-1, tax matters: USD 10,743.00, authorization: USD 10,743.00. Account holder: Example Person 304.",2848,10,2848,fdc-5e4d659e6688f035f30381fa,synthetic-form-layout-03,original,2024,fte-f696a8da2c31d870a8882d09,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2025.
Details: taxpayer: Example Entity 3-5-0, representative: Example Entity 3-5-1, tax matters: USD 10,826.00, authorization: USD 10,826.00. Account holder: Example Person 305.",2848,10,2848,fdc-9b3f222305d12b290d2c9082,synthetic-form-layout-03,original,2025,fte-c1125961d4902ac5ecd66753,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2023.
Details: taxpayer: Example Entity 3-6-0, representative: Example Entity 3-6-1, tax matters: USD 10,909.00, authorization: USD 10,909.00. Account holder: Example Person 306.",2848,10,2848,fdc-4895f7a7be2e28d556cbd962,synthetic-form-layout-03,original,2023,fte-4f297a24c6ee346b523c8d90,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative
Reporting period ended 12/31/2024.
Details: taxpayer: Example Entity 3-7-0, representative: Example Entity 3-7-1, tax matters: USD 10,992.00, authorization: USD 10,992.00. Account holder: Example Person 307.",2848,10,2848,fdc-f3c0cb28c598bfb702b98c4a,synthetic-form-layout-03,original,2024,fte-23bce6ee6589541fdc28f486,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2023
authorization: USD 10,548.00
tax matters: USD 10,548.00
representative: Example Entity 4-0-1
taxpayer: Example Entity 4-0-0
Named party: Example Person 400",2848,10,2848,fdc-69fa503ec330d6fd9aa3a599,synthetic-form-layout-04,original,2023,fte-643123d5fffeb22b16c18357,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2024
authorization: USD 10,631.00
tax matters: USD 10,631.00
representative: Example Entity 4-1-1
taxpayer: Example Entity 4-1-0
Named party: Example Person 401",2848,10,2848,fdc-bc357fd7362e90bede7add10,synthetic-form-layout-04,original,2024,fte-b4e520508df7f4050216f04f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2025
authorization: USD 10,714.00
tax matters: USD 10,714.00
representative: Example Entity 4-2-1
taxpayer: Example Entity 4-2-0
Named party: Example Person 402",2848,10,2848,fdc-9104947112378cc8b4892ddb,synthetic-form-layout-04,original,2025,fte-c733eab569d6857ec4add28d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2023
authorization: USD 10,797.00
tax matters: USD 10,797.00
representative: Example Entity 4-3-1
taxpayer: Example Entity 4-3-0
Named party: Example Person 403",2848,10,2848,fdc-f511e43ada869e8542cb78bc,synthetic-form-layout-04,original,2023,fte-03ff9dd7fb7981f70d59ac99,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2024
authorization: USD 10,880.00
tax matters: USD 10,880.00
representative: Example Entity 4-4-1
taxpayer: Example Entity 4-4-0
Named party: Example Person 404",2848,10,2848,fdc-7976cd148ab678cad4a133ce,synthetic-form-layout-04,original,2024,fte-f8ca1d9037cd1c3355fd4921,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2025
authorization: USD 10,963.00
tax matters: USD 10,963.00
representative: Example Entity 4-5-1
taxpayer: Example Entity 4-5-0
Named party: Example Person 405",2848,10,2848,fdc-e0f97338b896041b46807ef5,synthetic-form-layout-04,original,2025,fte-7085e5965bf6a412f88199ab,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2023
authorization: USD 11,046.00
tax matters: USD 11,046.00
representative: Example Entity 4-6-1
taxpayer: Example Entity 4-6-0
Named party: Example Person 406",2848,10,2848,fdc-8eda4b7da3299d866df00dd2,synthetic-form-layout-04,original,2023,fte-604259011a16d00705c8cb3e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2848: Power of Attorney and Declaration of Representative
Tax reporting year 2024
authorization: USD 11,129.00
tax matters: USD 11,129.00
representative: Example Entity 4-7-1
taxpayer: Example Entity 4-7-0
Named party: Example Person 407",2848,10,2848,fdc-17821e6e86a86c7a0745f9fb,synthetic-form-layout-04,original,2024,fte-b092be30d5c6d3af0b5a3a23,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2023
taxpayer: Example Entity 5-0-0 / representative: Example Entity 5-0-1 / tax matters: USD 10,685.00 / authorization: USD 10,685.00
Delivery copy for Example Party 500",2848,10,2848,fdc-764f26405f6fe5ebe111b798,synthetic-form-layout-05,original,2023,fte-f7157ceead43f68f6115fa43,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2024
taxpayer: Example Entity 5-1-0 / representative: Example Entity 5-1-1 / tax matters: USD 10,768.00 / authorization: USD 10,768.00
Delivery copy for Example Party 501",2848,10,2848,fdc-bda627c7761641434dcc9aa2,synthetic-form-layout-05,original,2024,fte-156594a9c550a8ea775b7f8d,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2025
taxpayer: Example Entity 5-2-0 / representative: Example Entity 5-2-1 / tax matters: USD 10,851.00 / authorization: USD 10,851.00
Delivery copy for Example Party 502",2848,10,2848,fdc-8edd41ee9ea9627d9b9b2ffb,synthetic-form-layout-05,original,2025,fte-96dec52bfd67ea4916498092,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2023
taxpayer: Example Entity 5-3-0 / representative: Example Entity 5-3-1 / tax matters: USD 10,934.00 / authorization: USD 10,934.00
Delivery copy for Example Party 503",2848,10,2848,fdc-de795873ad6a4a28017b92c2,synthetic-form-layout-05,original,2023,fte-3a0ba4657409df40d4d02138,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2024
taxpayer: Example Entity 5-4-0 / representative: Example Entity 5-4-1 / tax matters: USD 11,017.00 / authorization: USD 11,017.00
Delivery copy for Example Party 504",2848,10,2848,fdc-60f751ecbc205268c789caf6,synthetic-form-layout-05,original,2024,fte-8618cb523e5fa910fa2e8cab,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2025
taxpayer: Example Entity 5-5-0 / representative: Example Entity 5-5-1 / tax matters: USD 11,100.00 / authorization: USD 11,100.00
Delivery copy for Example Party 505",2848,10,2848,fdc-1676e5eed4df0c7fd1fd50f0,synthetic-form-layout-05,original,2025,fte-4b449c713cfcf7aeb85e0c28,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2023
taxpayer: Example Entity 5-6-0 / representative: Example Entity 5-6-1 / tax matters: USD 11,183.00 / authorization: USD 11,183.00
Delivery copy for Example Party 506",2848,10,2848,fdc-0bb76172babb76a4b5ddb597,synthetic-form-layout-05,original,2023,fte-260605cd3cfd6f8963baddd8,synthetic_AI_labeled,v1_template,top,False,
"Form 2848: Power of Attorney and Declaration of Representative -- reporting year 2024
taxpayer: Example Entity 5-7-0 / representative: Example Entity 5-7-1 / tax matters: USD 11,266.00 / authorization: USD 11,266.00
Delivery copy for Example Party 507",2848,10,2848,fdc-6887d023cabd5b6e6047158f,synthetic-form-layout-05,original,2024,fte-d13bc1a354e4c6cb6c006a40,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2023
Statement issued to Example Person 0.
child: USD 10,000.00
custodial parent: USD 10,000.00
noncustodial parent: USD 10,000.00
release: USD 10,000.00",8332,18,8332,fdc-cb863dfa8692a0244c225c35,synthetic-form-layout-00,original,2023,fte-ad7abd56680f46dea8e7f3bb,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2024
Statement issued to Example Person 1.
child: USD 10,083.00
custodial parent: USD 10,083.00
noncustodial parent: USD 10,083.00
release: USD 10,083.00",8332,18,8332,fdc-465e621f9b5c27aad190bb87,synthetic-form-layout-00,original,2024,fte-66afdf56507d15f93d6eb40f,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2025
Statement issued to Example Person 2.
child: USD 10,166.00
custodial parent: USD 10,166.00
noncustodial parent: USD 10,166.00
release: USD 10,166.00",8332,18,8332,fdc-b0b0b61dfa0104fdfd4ad54a,synthetic-form-layout-00,original,2025,fte-769404da91504ebd25563c3d,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2023
Statement issued to Example Person 3.
child: USD 10,249.00
custodial parent: USD 10,249.00
noncustodial parent: USD 10,249.00
release: USD 10,249.00",8332,18,8332,fdc-55cb1573203ddfe8b5433607,synthetic-form-layout-00,original,2023,fte-3acc59fe1bdef3af1068e318,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2024
Statement issued to Example Person 4.
child: USD 10,332.00
custodial parent: USD 10,332.00
noncustodial parent: USD 10,332.00
release: USD 10,332.00",8332,18,8332,fdc-4493dbef1aa94022a459b4cf,synthetic-form-layout-00,original,2024,fte-b8357115006e115b6bfcb800,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2025
Statement issued to Example Person 5.
child: USD 10,415.00
custodial parent: USD 10,415.00
noncustodial parent: USD 10,415.00
release: USD 10,415.00",8332,18,8332,fdc-946cb4da0189b0cca44b361d,synthetic-form-layout-00,original,2025,fte-0f39b7aecb5e530b17072c73,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2023
Statement issued to Example Person 6.
child: USD 10,498.00
custodial parent: USD 10,498.00
noncustodial parent: USD 10,498.00
release: USD 10,498.00",8332,18,8332,fdc-c7ec110770e5174c13d756e1,synthetic-form-layout-00,original,2023,fte-017f4ee4ec9fa96f619c5830,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Calendar year: 2024
Statement issued to Example Person 7.
child: USD 10,581.00
custodial parent: USD 10,581.00
noncustodial parent: USD 10,581.00
release: USD 10,581.00",8332,18,8332,fdc-ad38be475807c3cba16c3b7d,synthetic-form-layout-00,original,2024,fte-d01f039b50c09f61a5e46111,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 100
child: USD 10,137.00 | custodial parent: USD 10,137.00 | noncustodial parent: USD 10,137.00 | release: USD 10,137.00",8332,18,8332,fdc-d2f5e5b9bf25e32e9a15ea66,synthetic-form-layout-01,original,2023,fte-0a7b4c9ef7bdb77fbd81982f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 101
child: USD 10,220.00 | custodial parent: USD 10,220.00 | noncustodial parent: USD 10,220.00 | release: USD 10,220.00",8332,18,8332,fdc-b5d064165624754144c84491,synthetic-form-layout-01,original,2024,fte-4639c4f3b81ceb6341e92ec9,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 102
child: USD 10,303.00 | custodial parent: USD 10,303.00 | noncustodial parent: USD 10,303.00 | release: USD 10,303.00",8332,18,8332,fdc-e6924bf8f52881b38f1f3467,synthetic-form-layout-01,original,2025,fte-7742ca50bde673a5b43fbbcb,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 103
child: USD 10,386.00 | custodial parent: USD 10,386.00 | noncustodial parent: USD 10,386.00 | release: USD 10,386.00",8332,18,8332,fdc-8e1b411af7036493a8fd20fc,synthetic-form-layout-01,original,2023,fte-dd76c1cedd83e9840dd3989f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 104
child: USD 10,469.00 | custodial parent: USD 10,469.00 | noncustodial parent: USD 10,469.00 | release: USD 10,469.00",8332,18,8332,fdc-b80a2db41c12aed55cbfc015,synthetic-form-layout-01,original,2024,fte-139e90683e45976c01b705b4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 105
child: USD 10,552.00 | custodial parent: USD 10,552.00 | noncustodial parent: USD 10,552.00 | release: USD 10,552.00",8332,18,8332,fdc-2eb1aa4963d6e53ab44676f2,synthetic-form-layout-01,original,2025,fte-b5e8c2671db96c245e3d5129,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 106
child: USD 10,635.00 | custodial parent: USD 10,635.00 | noncustodial parent: USD 10,635.00 | release: USD 10,635.00",8332,18,8332,fdc-1f366415f1ccfc4fdfa594d5,synthetic-form-layout-01,original,2023,fte-d7d8c2d289def6a87e72b5f5,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Recipient record: Example Person 107
child: USD 10,718.00 | custodial parent: USD 10,718.00 | noncustodial parent: USD 10,718.00 | release: USD 10,718.00",8332,18,8332,fdc-c8f9a8248b4ae187ed1f349e,synthetic-form-layout-01,original,2024,fte-076d8901e576321ba430fcaf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,274.00; custodial parent: USD 10,274.00; noncustodial parent: USD 10,274.00; release: USD 10,274.00. Recipient: Example Household 200.",8332,18,8332,fdc-26761024b6be63b9bfa21e09,synthetic-form-layout-02,original,2023,fte-35ed0d8a43cdf2663c1219da,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,357.00; custodial parent: USD 10,357.00; noncustodial parent: USD 10,357.00; release: USD 10,357.00. Recipient: Example Household 201.",8332,18,8332,fdc-80f697c980cf6d88bb7e8d9d,synthetic-form-layout-02,original,2024,fte-49fec9c4e25d530b701d90a9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,440.00; custodial parent: USD 10,440.00; noncustodial parent: USD 10,440.00; release: USD 10,440.00. Recipient: Example Household 202.",8332,18,8332,fdc-8028f6ef7256dca88486fa53,synthetic-form-layout-02,original,2025,fte-6f1bb3963cedd64213c03e4e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,523.00; custodial parent: USD 10,523.00; noncustodial parent: USD 10,523.00; release: USD 10,523.00. Recipient: Example Household 203.",8332,18,8332,fdc-b369f4667ad074d3d5e17bf1,synthetic-form-layout-02,original,2023,fte-d95a1bebd1227216c930de24,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,606.00; custodial parent: USD 10,606.00; noncustodial parent: USD 10,606.00; release: USD 10,606.00. Recipient: Example Household 204.",8332,18,8332,fdc-6a9781293593c753b1fbdbd5,synthetic-form-layout-02,original,2024,fte-96355a0e44f3e504c98e8620,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,689.00; custodial parent: USD 10,689.00; noncustodial parent: USD 10,689.00; release: USD 10,689.00. Recipient: Example Household 205.",8332,18,8332,fdc-5a86cbdb7c6885f5e760fe3c,synthetic-form-layout-02,original,2025,fte-487a4957e17b0bd1d384635f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,772.00; custodial parent: USD 10,772.00; noncustodial parent: USD 10,772.00; release: USD 10,772.00. Recipient: Example Household 206.",8332,18,8332,fdc-33d334ee06ba53ca328be870,synthetic-form-layout-02,original,2023,fte-684ae37ae5305de3806fde5a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent.
child: USD 10,855.00; custodial parent: USD 10,855.00; noncustodial parent: USD 10,855.00; release: USD 10,855.00. Recipient: Example Household 207.",8332,18,8332,fdc-73dabeec902399c48f478e35,synthetic-form-layout-02,original,2024,fte-e17de39aa14c42445ef9f697,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2023.
Details: child: USD 10,411.00, custodial parent: USD 10,411.00, noncustodial parent: USD 10,411.00, release: USD 10,411.00. Account holder: Example Person 300.",8332,18,8332,fdc-205c457ee4335e4b8895d11f,synthetic-form-layout-03,original,2023,fte-fe021c5b5f190d39a4c27666,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2024.
Details: child: USD 10,494.00, custodial parent: USD 10,494.00, noncustodial parent: USD 10,494.00, release: USD 10,494.00. Account holder: Example Person 301.",8332,18,8332,fdc-66a827fcceabadecd8e3bd86,synthetic-form-layout-03,original,2024,fte-960684e4318aa191f3cf51fd,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2025.
Details: child: USD 10,577.00, custodial parent: USD 10,577.00, noncustodial parent: USD 10,577.00, release: USD 10,577.00. Account holder: Example Person 302.",8332,18,8332,fdc-bd023fda722ed4525c7f3658,synthetic-form-layout-03,original,2025,fte-8562f9d39673fdabefcb1605,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2023.
Details: child: USD 10,660.00, custodial parent: USD 10,660.00, noncustodial parent: USD 10,660.00, release: USD 10,660.00. Account holder: Example Person 303.",8332,18,8332,fdc-7ee333306c3581101a5746f4,synthetic-form-layout-03,original,2023,fte-4dfc9676b8058f24c5938b6b,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2024.
Details: child: USD 10,743.00, custodial parent: USD 10,743.00, noncustodial parent: USD 10,743.00, release: USD 10,743.00. Account holder: Example Person 304.",8332,18,8332,fdc-e36705da6f0071d30d2fdf94,synthetic-form-layout-03,original,2024,fte-f570c7d1bab92563c7211203,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2025.
Details: child: USD 10,826.00, custodial parent: USD 10,826.00, noncustodial parent: USD 10,826.00, release: USD 10,826.00. Account holder: Example Person 305.",8332,18,8332,fdc-c3249df46a1d383579fdafa2,synthetic-form-layout-03,original,2025,fte-c62f1c3cc02f300cc665e334,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2023.
Details: child: USD 10,909.00, custodial parent: USD 10,909.00, noncustodial parent: USD 10,909.00, release: USD 10,909.00. Account holder: Example Person 306.",8332,18,8332,fdc-a370c4598e3a0303c08d5db3,synthetic-form-layout-03,original,2023,fte-847a5bcf2352d5b15d9dcf55,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Reporting period ended 12/31/2024.
Details: child: USD 10,992.00, custodial parent: USD 10,992.00, noncustodial parent: USD 10,992.00, release: USD 10,992.00. Account holder: Example Person 307.",8332,18,8332,fdc-70432202ab5f38192df5e948,synthetic-form-layout-03,original,2024,fte-07546f6dfe243f124987dbe4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2023
release: USD 10,548.00
noncustodial parent: USD 10,548.00
custodial parent: USD 10,548.00
child: USD 10,548.00
Named party: Example Person 400",8332,18,8332,fdc-89bcbe5756d6a43e722d7528,synthetic-form-layout-04,original,2023,fte-94f102dc8b8ef7ef84511f66,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2024
release: USD 10,631.00
noncustodial parent: USD 10,631.00
custodial parent: USD 10,631.00
child: USD 10,631.00
Named party: Example Person 401",8332,18,8332,fdc-52c17b9e57361a94eca309d2,synthetic-form-layout-04,original,2024,fte-24301506be599313c1079472,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2025
release: USD 10,714.00
noncustodial parent: USD 10,714.00
custodial parent: USD 10,714.00
child: USD 10,714.00
Named party: Example Person 402",8332,18,8332,fdc-be1a7f86531c207dbbca96c3,synthetic-form-layout-04,original,2025,fte-60214a8b66bdaeccfc017456,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2023
release: USD 10,797.00
noncustodial parent: USD 10,797.00
custodial parent: USD 10,797.00
child: USD 10,797.00
Named party: Example Person 403",8332,18,8332,fdc-6ab440a85c11371931ae2d3b,synthetic-form-layout-04,original,2023,fte-f3f72d4b6f5cf9d1d91e616c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2024
release: USD 10,880.00
noncustodial parent: USD 10,880.00
custodial parent: USD 10,880.00
child: USD 10,880.00
Named party: Example Person 404",8332,18,8332,fdc-ae15ecbc8686c71dda198bd6,synthetic-form-layout-04,original,2024,fte-afa95f4de435e364bf3b846e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2025
release: USD 10,963.00
noncustodial parent: USD 10,963.00
custodial parent: USD 10,963.00
child: USD 10,963.00
Named party: Example Person 405",8332,18,8332,fdc-de9c7d841509955f0f4256cb,synthetic-form-layout-04,original,2025,fte-bdec520a8999a74b000ce530,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2023
release: USD 11,046.00
noncustodial parent: USD 11,046.00
custodial parent: USD 11,046.00
child: USD 11,046.00
Named party: Example Person 406",8332,18,8332,fdc-a6261fde4598dbda60f0e06e,synthetic-form-layout-04,original,2023,fte-b3e004ccebb0669b5e412812,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent
Tax reporting year 2024
release: USD 11,129.00
noncustodial parent: USD 11,129.00
custodial parent: USD 11,129.00
child: USD 11,129.00
Named party: Example Person 407",8332,18,8332,fdc-0cac84926419287265d3e35b,synthetic-form-layout-04,original,2024,fte-9f6a0881bd3aeeac13cc31e6,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2023
child: USD 10,685.00 / custodial parent: USD 10,685.00 / noncustodial parent: USD 10,685.00 / release: USD 10,685.00
Delivery copy for Example Party 500",8332,18,8332,fdc-b03c213894a7f36a4ed7c922,synthetic-form-layout-05,original,2023,fte-e3012ffe4f664a0b3c13cac7,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2024
child: USD 10,768.00 / custodial parent: USD 10,768.00 / noncustodial parent: USD 10,768.00 / release: USD 10,768.00
Delivery copy for Example Party 501",8332,18,8332,fdc-8c550185446f442efc6eaf3c,synthetic-form-layout-05,original,2024,fte-095d13ab4a7459bf3fc081b8,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2025
child: USD 10,851.00 / custodial parent: USD 10,851.00 / noncustodial parent: USD 10,851.00 / release: USD 10,851.00
Delivery copy for Example Party 502",8332,18,8332,fdc-1714c3b55a92b38a641df854,synthetic-form-layout-05,original,2025,fte-5b58678d2e26e45c938ddd7b,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2023
child: USD 10,934.00 / custodial parent: USD 10,934.00 / noncustodial parent: USD 10,934.00 / release: USD 10,934.00
Delivery copy for Example Party 503",8332,18,8332,fdc-70c382c23118d158e0c680ca,synthetic-form-layout-05,original,2023,fte-f96e757db70408397824fffd,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2024
child: USD 11,017.00 / custodial parent: USD 11,017.00 / noncustodial parent: USD 11,017.00 / release: USD 11,017.00
Delivery copy for Example Party 504",8332,18,8332,fdc-42b275ea511ff2cddab1f866,synthetic-form-layout-05,original,2024,fte-6f4ca4f75bb58b07fb1608ad,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2025
child: USD 11,100.00 / custodial parent: USD 11,100.00 / noncustodial parent: USD 11,100.00 / release: USD 11,100.00
Delivery copy for Example Party 505",8332,18,8332,fdc-e79714d92b2c7b3c492e2223,synthetic-form-layout-05,original,2025,fte-f9d727155f4777fadf862fbf,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2023
child: USD 11,183.00 / custodial parent: USD 11,183.00 / noncustodial parent: USD 11,183.00 / release: USD 11,183.00
Delivery copy for Example Party 506",8332,18,8332,fdc-2a0415fb5ec7571b90cf3f73,synthetic-form-layout-05,original,2023,fte-9018d249aaf802df002f597e,synthetic_AI_labeled,v1_template,top,False,
"Form 8332: Release Revocation of Release of Claim to Exemption for Child by Custodial Parent -- reporting year 2024
child: USD 11,266.00 / custodial parent: USD 11,266.00 / noncustodial parent: USD 11,266.00 / release: USD 11,266.00
Delivery copy for Example Party 507",8332,18,8332,fdc-04bbbdc5dcb338ec920cfe99,synthetic-form-layout-05,original,2024,fte-49e4a1df1b5ab87419d45e87,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2023
Statement issued to Example Person 0.
care provider: Example Entity 0-0-0
qualifying person: USD 10,000.00
care expenses: USD 10,000.00",2441,8,2441,fdc-a431088f5c8e8b92af98f924,synthetic-form-layout-00,original,2023,fte-0cdab5c12f3061582e4c98df,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2024
Statement issued to Example Person 1.
care provider: Example Entity 0-1-0
qualifying person: USD 10,083.00
care expenses: USD 10,083.00",2441,8,2441,fdc-4ba4a559d9ec593bc7ad0e5a,synthetic-form-layout-00,original,2024,fte-6eb1b088e81cb2282e73371a,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2025
Statement issued to Example Person 2.
care provider: Example Entity 0-2-0
qualifying person: USD 10,166.00
care expenses: USD 10,166.00",2441,8,2441,fdc-3f207edd8d0bf7f9e59d705e,synthetic-form-layout-00,original,2025,fte-019333bf73f1a96e20de039e,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2023
Statement issued to Example Person 3.
care provider: Example Entity 0-3-0
qualifying person: USD 10,249.00
care expenses: USD 10,249.00",2441,8,2441,fdc-d6a404b49948a9b8a1d88cf7,synthetic-form-layout-00,original,2023,fte-83cd71c42b371127cac0f830,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2024
Statement issued to Example Person 4.
care provider: Example Entity 0-4-0
qualifying person: USD 10,332.00
care expenses: USD 10,332.00",2441,8,2441,fdc-0cd0bd7debe7334bbbadf2ee,synthetic-form-layout-00,original,2024,fte-b870a8642072bc83468916c9,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2025
Statement issued to Example Person 5.
care provider: Example Entity 0-5-0
qualifying person: USD 10,415.00
care expenses: USD 10,415.00",2441,8,2441,fdc-9d1e221461d30e2df7c4049d,synthetic-form-layout-00,original,2025,fte-5afbb6bca0dbadef499f01d3,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2023
Statement issued to Example Person 6.
care provider: Example Entity 0-6-0
qualifying person: USD 10,498.00
care expenses: USD 10,498.00",2441,8,2441,fdc-31e8ac840f321627f5954ef4,synthetic-form-layout-00,original,2023,fte-e5df86a32c0bc5fd6cb53574,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Calendar year: 2024
Statement issued to Example Person 7.
care provider: Example Entity 0-7-0
qualifying person: USD 10,581.00
care expenses: USD 10,581.00",2441,8,2441,fdc-0cc3645de64454784c16a656,synthetic-form-layout-00,original,2024,fte-6fbf7623889d0ad63d1c0aa1,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 100
care provider: Example Entity 1-0-0 | qualifying person: USD 10,137.00 | care expenses: USD 10,137.00",2441,8,2441,fdc-0de6e39f758434fd28fed71d,synthetic-form-layout-01,original,2023,fte-1efeaba622793850ff212d3c,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 101
care provider: Example Entity 1-1-0 | qualifying person: USD 10,220.00 | care expenses: USD 10,220.00",2441,8,2441,fdc-382cac36c83c4c7a4cb36088,synthetic-form-layout-01,original,2024,fte-c1897ece976fff6ad4619c88,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 102
care provider: Example Entity 1-2-0 | qualifying person: USD 10,303.00 | care expenses: USD 10,303.00",2441,8,2441,fdc-f63f78211b2c9819429e41a9,synthetic-form-layout-01,original,2025,fte-bf6010e2a514bf57039127b3,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 103
care provider: Example Entity 1-3-0 | qualifying person: USD 10,386.00 | care expenses: USD 10,386.00",2441,8,2441,fdc-57bc70645d8d239ac6c35f61,synthetic-form-layout-01,original,2023,fte-4efa6e8aee92b43c75eaddb4,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 104
care provider: Example Entity 1-4-0 | qualifying person: USD 10,469.00 | care expenses: USD 10,469.00",2441,8,2441,fdc-4a67db55f73924e2b4252b8e,synthetic-form-layout-01,original,2024,fte-99f52785bfb7571501ea40a3,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 105
care provider: Example Entity 1-5-0 | qualifying person: USD 10,552.00 | care expenses: USD 10,552.00",2441,8,2441,fdc-fcb283f381660f3f9851baa3,synthetic-form-layout-01,original,2025,fte-c3419d3d1f622a2466cae93d,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 106
care provider: Example Entity 1-6-0 | qualifying person: USD 10,635.00 | care expenses: USD 10,635.00",2441,8,2441,fdc-44ff417f073b68a40fd1ff4c,synthetic-form-layout-01,original,2023,fte-2019f88289884515dbb57758,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2441: Child and Dependent Care Expenses
Recipient record: Example Person 107
care provider: Example Entity 1-7-0 | qualifying person: USD 10,718.00 | care expenses: USD 10,718.00",2441,8,2441,fdc-b100c833f333f54d044ca4ed,synthetic-form-layout-01,original,2024,fte-131d5524b48b58b578b908bf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-0-0; qualifying person: USD 10,274.00; care expenses: USD 10,274.00. Recipient: Example Household 200.",2441,8,2441,fdc-4ce52ce934147bdce2d573dc,synthetic-form-layout-02,original,2023,fte-6a676583635f45f5d40db403,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-1-0; qualifying person: USD 10,357.00; care expenses: USD 10,357.00. Recipient: Example Household 201.",2441,8,2441,fdc-0792fde724510f32104a9c1b,synthetic-form-layout-02,original,2024,fte-0097c79a704df2608fa98218,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-2-0; qualifying person: USD 10,440.00; care expenses: USD 10,440.00. Recipient: Example Household 202.",2441,8,2441,fdc-7adee285382b5d11fea83b48,synthetic-form-layout-02,original,2025,fte-ba218c86d7b262d6d908be75,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-3-0; qualifying person: USD 10,523.00; care expenses: USD 10,523.00. Recipient: Example Household 203.",2441,8,2441,fdc-d04d534fa510475e7f2a6358,synthetic-form-layout-02,original,2023,fte-e565c87e15f56f429f23f05e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-4-0; qualifying person: USD 10,606.00; care expenses: USD 10,606.00. Recipient: Example Household 204.",2441,8,2441,fdc-141a0fde8df8137266580b7f,synthetic-form-layout-02,original,2024,fte-fd953130f8bb7957b2fcc8d7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-5-0; qualifying person: USD 10,689.00; care expenses: USD 10,689.00. Recipient: Example Household 205.",2441,8,2441,fdc-d543cb6d0661e7a934fe22f1,synthetic-form-layout-02,original,2025,fte-716b4b506d0c75fff3a08429,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-6-0; qualifying person: USD 10,772.00; care expenses: USD 10,772.00. Recipient: Example Household 206.",2441,8,2441,fdc-5ef75ff8262b3c68116d31e4,synthetic-form-layout-02,original,2023,fte-6a3b8033a19015c47ec76822,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2441: Child and Dependent Care Expenses.
care provider: Example Entity 2-7-0; qualifying person: USD 10,855.00; care expenses: USD 10,855.00. Recipient: Example Household 207.",2441,8,2441,fdc-b2db4d931788df484654bd30,synthetic-form-layout-02,original,2024,fte-ed85e8abc93ffa28e0f6a692,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2023.
Details: care provider: Example Entity 3-0-0, qualifying person: USD 10,411.00, care expenses: USD 10,411.00. Account holder: Example Person 300.",2441,8,2441,fdc-e8ce79220dd7f8e9a2a49f5f,synthetic-form-layout-03,original,2023,fte-f464615859e103359eee73c8,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2024.
Details: care provider: Example Entity 3-1-0, qualifying person: USD 10,494.00, care expenses: USD 10,494.00. Account holder: Example Person 301.",2441,8,2441,fdc-09df5b9b9d50b7bb43e0d128,synthetic-form-layout-03,original,2024,fte-d251452379e05257e58a06f5,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2025.
Details: care provider: Example Entity 3-2-0, qualifying person: USD 10,577.00, care expenses: USD 10,577.00. Account holder: Example Person 302.",2441,8,2441,fdc-7417ef29a7e1e7b8e92df902,synthetic-form-layout-03,original,2025,fte-75d2611fa1363ba0b71b789f,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2023.
Details: care provider: Example Entity 3-3-0, qualifying person: USD 10,660.00, care expenses: USD 10,660.00. Account holder: Example Person 303.",2441,8,2441,fdc-2dc60eb37f46213a9dda08e4,synthetic-form-layout-03,original,2023,fte-b42e00f3891e20a7b51cfebb,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2024.
Details: care provider: Example Entity 3-4-0, qualifying person: USD 10,743.00, care expenses: USD 10,743.00. Account holder: Example Person 304.",2441,8,2441,fdc-f74dc7ea942352b4ef7a11d9,synthetic-form-layout-03,original,2024,fte-a55307b14d5b34560f82bf63,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2025.
Details: care provider: Example Entity 3-5-0, qualifying person: USD 10,826.00, care expenses: USD 10,826.00. Account holder: Example Person 305.",2441,8,2441,fdc-d8fee48baf03af0e139edd68,synthetic-form-layout-03,original,2025,fte-b7561a343321eb9ad9ffc0d2,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2023.
Details: care provider: Example Entity 3-6-0, qualifying person: USD 10,909.00, care expenses: USD 10,909.00. Account holder: Example Person 306.",2441,8,2441,fdc-bdb6b5f9151785a65d7a8fa2,synthetic-form-layout-03,original,2023,fte-125c6f74bcb928d081557a1e,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses
Reporting period ended 12/31/2024.
Details: care provider: Example Entity 3-7-0, qualifying person: USD 10,992.00, care expenses: USD 10,992.00. Account holder: Example Person 307.",2441,8,2441,fdc-72c807b51bf4f34816f341df,synthetic-form-layout-03,original,2024,fte-ab1f49837b8c1a9f613f6504,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2023
care expenses: USD 10,548.00
qualifying person: USD 10,548.00
care provider: Example Entity 4-0-0
Named party: Example Person 400",2441,8,2441,fdc-1ee8af27dd669a34cd1e5fe2,synthetic-form-layout-04,original,2023,fte-407db92a972cf8a0f3fd32fd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2024
care expenses: USD 10,631.00
qualifying person: USD 10,631.00
care provider: Example Entity 4-1-0
Named party: Example Person 401",2441,8,2441,fdc-402015ce7746fbc55188a720,synthetic-form-layout-04,original,2024,fte-def9658bcf00bbca247643be,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2025
care expenses: USD 10,714.00
qualifying person: USD 10,714.00
care provider: Example Entity 4-2-0
Named party: Example Person 402",2441,8,2441,fdc-869b306cf07e07081527a0eb,synthetic-form-layout-04,original,2025,fte-a2bc7ad982b5f2bb37ae19b4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2023
care expenses: USD 10,797.00
qualifying person: USD 10,797.00
care provider: Example Entity 4-3-0
Named party: Example Person 403",2441,8,2441,fdc-94ea1ae0d6d06eeb2947380b,synthetic-form-layout-04,original,2023,fte-ca2fa2c5be94f879e722077d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2024
care expenses: USD 10,880.00
qualifying person: USD 10,880.00
care provider: Example Entity 4-4-0
Named party: Example Person 404",2441,8,2441,fdc-74d85ae551cee128c5af0f0c,synthetic-form-layout-04,original,2024,fte-79b8f84690cdc25e76809e65,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2025
care expenses: USD 10,963.00
qualifying person: USD 10,963.00
care provider: Example Entity 4-5-0
Named party: Example Person 405",2441,8,2441,fdc-8ce7e2b9e53b846ba70e8c18,synthetic-form-layout-04,original,2025,fte-b094fc6f9f1bf0316ec4deca,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2023
care expenses: USD 11,046.00
qualifying person: USD 11,046.00
care provider: Example Entity 4-6-0
Named party: Example Person 406",2441,8,2441,fdc-29631665903d261a1521f8f7,synthetic-form-layout-04,original,2023,fte-c468b2bc46324ffb59a91531,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2441: Child and Dependent Care Expenses
Tax reporting year 2024
care expenses: USD 11,129.00
qualifying person: USD 11,129.00
care provider: Example Entity 4-7-0
Named party: Example Person 407",2441,8,2441,fdc-3e6873b963b53ab7a7f66612,synthetic-form-layout-04,original,2024,fte-705fbbbce4ecc8b3dd3e7e54,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2023
care provider: Example Entity 5-0-0 / qualifying person: USD 10,685.00 / care expenses: USD 10,685.00
Delivery copy for Example Party 500",2441,8,2441,fdc-872ecbbebdbc16df2791ed09,synthetic-form-layout-05,original,2023,fte-4906fbcff8a6f1b96d096785,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2024
care provider: Example Entity 5-1-0 / qualifying person: USD 10,768.00 / care expenses: USD 10,768.00
Delivery copy for Example Party 501",2441,8,2441,fdc-94d3a3492082b0b6f877130a,synthetic-form-layout-05,original,2024,fte-3dc2904dca6b78352e15fb0d,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2025
care provider: Example Entity 5-2-0 / qualifying person: USD 10,851.00 / care expenses: USD 10,851.00
Delivery copy for Example Party 502",2441,8,2441,fdc-f248c99da6c5699e13c25b03,synthetic-form-layout-05,original,2025,fte-ff6fc63a95e60dcd9a100ac4,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2023
care provider: Example Entity 5-3-0 / qualifying person: USD 10,934.00 / care expenses: USD 10,934.00
Delivery copy for Example Party 503",2441,8,2441,fdc-ac8dcafdb96c39a2ff758c78,synthetic-form-layout-05,original,2023,fte-229fd5a0fe410aa662b0afff,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2024
care provider: Example Entity 5-4-0 / qualifying person: USD 11,017.00 / care expenses: USD 11,017.00
Delivery copy for Example Party 504",2441,8,2441,fdc-c058176abb707f16e2b8c74a,synthetic-form-layout-05,original,2024,fte-0e3cdfa7fe365ddc6561896a,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2025
care provider: Example Entity 5-5-0 / qualifying person: USD 11,100.00 / care expenses: USD 11,100.00
Delivery copy for Example Party 505",2441,8,2441,fdc-3bf9b3f7ba5d14bb68b442d1,synthetic-form-layout-05,original,2025,fte-65a5b69d316468892087f003,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2023
care provider: Example Entity 5-6-0 / qualifying person: USD 11,183.00 / care expenses: USD 11,183.00
Delivery copy for Example Party 506",2441,8,2441,fdc-77d5dad4f4931abc528a051d,synthetic-form-layout-05,original,2023,fte-8130d007d69be6d51a5a2f39,synthetic_AI_labeled,v1_template,top,False,
"Form 2441: Child and Dependent Care Expenses -- reporting year 2024
care provider: Example Entity 5-7-0 / qualifying person: USD 11,266.00 / care expenses: USD 11,266.00
Delivery copy for Example Party 507",2441,8,2441,fdc-f7689dd6a6c234b941a0c224,synthetic-form-layout-05,original,2024,fte-12732dc058d0022ea1fdc2fc,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2023
Statement issued to Example Person 0.
residential clean energy: USD 10,000.00
energy efficient home improvements: USD 10,000.00",5695,15,5695,fdc-803392a5749d7c835449a84a,synthetic-form-layout-00,original,2023,fte-bf59c9abdc81aa605b00dc41,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2024
Statement issued to Example Person 1.
residential clean energy: USD 10,083.00
energy efficient home improvements: USD 10,083.00",5695,15,5695,fdc-1abfbeaf5cbe3ab928f3baa6,synthetic-form-layout-00,original,2024,fte-989e88d6a66742f9cf311f0b,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2025
Statement issued to Example Person 2.
residential clean energy: USD 10,166.00
energy efficient home improvements: USD 10,166.00",5695,15,5695,fdc-f36d6d7b4c5c3f2c228aa97e,synthetic-form-layout-00,original,2025,fte-d5813c58da58ecf50d3cf56e,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2023
Statement issued to Example Person 3.
residential clean energy: USD 10,249.00
energy efficient home improvements: USD 10,249.00",5695,15,5695,fdc-7f71e59366bd59ac496dd346,synthetic-form-layout-00,original,2023,fte-57baaa838d51892f12e1bef0,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2024
Statement issued to Example Person 4.
residential clean energy: USD 10,332.00
energy efficient home improvements: USD 10,332.00",5695,15,5695,fdc-8ae61d5f6a0242aac9cb23a2,synthetic-form-layout-00,original,2024,fte-79f5f44a7393a502e73c9f2f,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2025
Statement issued to Example Person 5.
residential clean energy: USD 10,415.00
energy efficient home improvements: USD 10,415.00",5695,15,5695,fdc-0d77a5166c2f725b50194950,synthetic-form-layout-00,original,2025,fte-37da9b92965ce0481d8277f8,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2023
Statement issued to Example Person 6.
residential clean energy: USD 10,498.00
energy efficient home improvements: USD 10,498.00",5695,15,5695,fdc-e0055dfc4d1f2710db67a2fd,synthetic-form-layout-00,original,2023,fte-0d1010c75ab9fb680fcf363a,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Calendar year: 2024
Statement issued to Example Person 7.
residential clean energy: USD 10,581.00
energy efficient home improvements: USD 10,581.00",5695,15,5695,fdc-b7767cf41cfdcd8fb48e181f,synthetic-form-layout-00,original,2024,fte-5d5ba2dff7580a0b451a42a0,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5695: Residential Energy Credits
Recipient record: Example Person 100
residential clean energy: USD 10,137.00 | energy efficient home improvements: USD 10,137.00",5695,15,5695,fdc-19d04fc4f895564fe7b4721d,synthetic-form-layout-01,original,2023,fte-1d1eb8c234a807f37dcf82b3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5695: Residential Energy Credits
Recipient record: Example Person 101
residential clean energy: USD 10,220.00 | energy efficient home improvements: USD 10,220.00",5695,15,5695,fdc-881dce73d627e4ba38116128,synthetic-form-layout-01,original,2024,fte-a51112655352da678d76aa7a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5695: Residential Energy Credits
Recipient record: Example Person 102
residential clean energy: USD 10,303.00 | energy efficient home improvements: USD 10,303.00",5695,15,5695,fdc-2196b2f70e16cc585b4b8368,synthetic-form-layout-01,original,2025,fte-087895118a61e2404d94ac5e,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5695: Residential Energy Credits
Recipient record: Example Person 103
residential clean energy: USD 10,386.00 | energy efficient home improvements: USD 10,386.00",5695,15,5695,fdc-cb1f139a396108301dc3603e,synthetic-form-layout-01,original,2023,fte-8105b47b267c81e6cd92a546,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5695: Residential Energy Credits
Recipient record: Example Person 104
residential clean energy: USD 10,469.00 | energy efficient home improvements: USD 10,469.00",5695,15,5695,fdc-0745d9bada619cf5a960fa6e,synthetic-form-layout-01,original,2024,fte-a76a164bda0cebbd373ea197,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 5695: Residential Energy Credits
Recipient record: Example Person 105
residential clean energy: USD 10,552.00 | energy efficient home improvements: USD 10,552.00",5695,15,5695,fdc-dd1912cf6bd2e4658f954295,synthetic-form-layout-01,original,2025,fte-b394c0ecd13914a4b98dd2d3,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 5695: Residential Energy Credits
Recipient record: Example Person 106
residential clean energy: USD 10,635.00 | energy efficient home improvements: USD 10,635.00",5695,15,5695,fdc-6f40bed484b6d4fe6f5d689c,synthetic-form-layout-01,original,2023,fte-112401aa9ba76ce5eca9c3f9,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 5695: Residential Energy Credits
Recipient record: Example Person 107
residential clean energy: USD 10,718.00 | energy efficient home improvements: USD 10,718.00",5695,15,5695,fdc-e3414de312206d9f6169d50e,synthetic-form-layout-01,original,2024,fte-2d4098f3124902ba7c963081,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,274.00; energy efficient home improvements: USD 10,274.00. Recipient: Example Household 200.",5695,15,5695,fdc-c68bfd5a3efbf012c2d64fb8,synthetic-form-layout-02,original,2023,fte-75122c4f475a7003cbed3206,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,357.00; energy efficient home improvements: USD 10,357.00. Recipient: Example Household 201.",5695,15,5695,fdc-66e3c92a65be9d2a5570aa04,synthetic-form-layout-02,original,2024,fte-36998dd5e10d1f94a7b86ddf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,440.00; energy efficient home improvements: USD 10,440.00. Recipient: Example Household 202.",5695,15,5695,fdc-9a96be4d27dba4ce130d397e,synthetic-form-layout-02,original,2025,fte-e48be387987550e89161b38e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,523.00; energy efficient home improvements: USD 10,523.00. Recipient: Example Household 203.",5695,15,5695,fdc-9d9ac2fd0bb24e4c1745a64c,synthetic-form-layout-02,original,2023,fte-6f09d02be31fa0160a4a28aa,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,606.00; energy efficient home improvements: USD 10,606.00. Recipient: Example Household 204.",5695,15,5695,fdc-b9c4f092a7e5cfa1cedef5ff,synthetic-form-layout-02,original,2024,fte-831b9e380e2af19e91f1f1da,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,689.00; energy efficient home improvements: USD 10,689.00. Recipient: Example Household 205.",5695,15,5695,fdc-720315d4b038c2b4f68d18e8,synthetic-form-layout-02,original,2025,fte-58af6b5b1c1e1abe454ee060,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,772.00; energy efficient home improvements: USD 10,772.00. Recipient: Example Household 206.",5695,15,5695,fdc-61fb1c8aac7f44865c654cc1,synthetic-form-layout-02,original,2023,fte-9fd9b5e0f1c1f76aecf5e3ea,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 5695: Residential Energy Credits.
residential clean energy: USD 10,855.00; energy efficient home improvements: USD 10,855.00. Recipient: Example Household 207.",5695,15,5695,fdc-4602c3b53eb689bb60ccb742,synthetic-form-layout-02,original,2024,fte-a2c27cf3c22878187112c9bd,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2023.
Details: residential clean energy: USD 10,411.00, energy efficient home improvements: USD 10,411.00. Account holder: Example Person 300.",5695,15,5695,fdc-4f16d05e61f9e8f5735f762c,synthetic-form-layout-03,original,2023,fte-a7e5744f7234aedeacdfbcdc,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2024.
Details: residential clean energy: USD 10,494.00, energy efficient home improvements: USD 10,494.00. Account holder: Example Person 301.",5695,15,5695,fdc-5c598eef22fce0f718611fcc,synthetic-form-layout-03,original,2024,fte-c1fe4563cd315fda29b34d8d,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2025.
Details: residential clean energy: USD 10,577.00, energy efficient home improvements: USD 10,577.00. Account holder: Example Person 302.",5695,15,5695,fdc-1e6c5c0e5a9ab269537f9c52,synthetic-form-layout-03,original,2025,fte-58af64df842bcc9fa83d76dc,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2023.
Details: residential clean energy: USD 10,660.00, energy efficient home improvements: USD 10,660.00. Account holder: Example Person 303.",5695,15,5695,fdc-888f091fc134731de8a17eab,synthetic-form-layout-03,original,2023,fte-84a12e300b769d053fcdf120,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2024.
Details: residential clean energy: USD 10,743.00, energy efficient home improvements: USD 10,743.00. Account holder: Example Person 304.",5695,15,5695,fdc-d149888a62816ba426bfc04d,synthetic-form-layout-03,original,2024,fte-dbd179f708d31b1162f7c9dc,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2025.
Details: residential clean energy: USD 10,826.00, energy efficient home improvements: USD 10,826.00. Account holder: Example Person 305.",5695,15,5695,fdc-a73a6b63b1c8d2871dd5f1f8,synthetic-form-layout-03,original,2025,fte-cf947d1ae12ae30a8a6ffb92,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2023.
Details: residential clean energy: USD 10,909.00, energy efficient home improvements: USD 10,909.00. Account holder: Example Person 306.",5695,15,5695,fdc-0b6a268f585e33d83c587138,synthetic-form-layout-03,original,2023,fte-bdf92282db2d8e07bb8d592d,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits
Reporting period ended 12/31/2024.
Details: residential clean energy: USD 10,992.00, energy efficient home improvements: USD 10,992.00. Account holder: Example Person 307.",5695,15,5695,fdc-f3711847a67a78bcc06360c6,synthetic-form-layout-03,original,2024,fte-969f02bedcdfcc4a320be46d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2023
energy efficient home improvements: USD 10,548.00
residential clean energy: USD 10,548.00
Named party: Example Person 400",5695,15,5695,fdc-0db0c077eee300be6c029619,synthetic-form-layout-04,original,2023,fte-64d15d2b74e24fdaefd302b3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2024
energy efficient home improvements: USD 10,631.00
residential clean energy: USD 10,631.00
Named party: Example Person 401",5695,15,5695,fdc-b37f5c13db193c54f170cafa,synthetic-form-layout-04,original,2024,fte-5a768659268885691ef2dca8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2025
energy efficient home improvements: USD 10,714.00
residential clean energy: USD 10,714.00
Named party: Example Person 402",5695,15,5695,fdc-009ec34910490fd79224c26c,synthetic-form-layout-04,original,2025,fte-12877055a586adcac6999910,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2023
energy efficient home improvements: USD 10,797.00
residential clean energy: USD 10,797.00
Named party: Example Person 403",5695,15,5695,fdc-c2edd8004666527643b876b0,synthetic-form-layout-04,original,2023,fte-c47fe199815d4746fb7643a6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2024
energy efficient home improvements: USD 10,880.00
residential clean energy: USD 10,880.00
Named party: Example Person 404",5695,15,5695,fdc-a635bf54adb97cfb126ac273,synthetic-form-layout-04,original,2024,fte-55cdb3deabe0f6206e72c918,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2025
energy efficient home improvements: USD 10,963.00
residential clean energy: USD 10,963.00
Named party: Example Person 405",5695,15,5695,fdc-b8a1b9934ff4083cf6491acc,synthetic-form-layout-04,original,2025,fte-b3fb27cec8871124525701a0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2023
energy efficient home improvements: USD 11,046.00
residential clean energy: USD 11,046.00
Named party: Example Person 406",5695,15,5695,fdc-9c3dc2680b8c53e11ab71bd7,synthetic-form-layout-04,original,2023,fte-703b3c89a9a7795072665fdf,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 5695: Residential Energy Credits
Tax reporting year 2024
energy efficient home improvements: USD 11,129.00
residential clean energy: USD 11,129.00
Named party: Example Person 407",5695,15,5695,fdc-f42847b4b35fdc85cb5fd42a,synthetic-form-layout-04,original,2024,fte-877f68dc6942ca3a6cfa6644,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2023
residential clean energy: USD 10,685.00 / energy efficient home improvements: USD 10,685.00
Delivery copy for Example Party 500",5695,15,5695,fdc-65dda48740a0f16bfef1d1de,synthetic-form-layout-05,original,2023,fte-a4a474c9990a30dbe461b16f,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2024
residential clean energy: USD 10,768.00 / energy efficient home improvements: USD 10,768.00
Delivery copy for Example Party 501",5695,15,5695,fdc-9935d334f47a2bf5eb30b480,synthetic-form-layout-05,original,2024,fte-b8f6cc648c49dfdbe24151e9,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2025
residential clean energy: USD 10,851.00 / energy efficient home improvements: USD 10,851.00
Delivery copy for Example Party 502",5695,15,5695,fdc-7779bf3f17baa6b16450e3e6,synthetic-form-layout-05,original,2025,fte-59f5674581692e7dbab5cf23,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2023
residential clean energy: USD 10,934.00 / energy efficient home improvements: USD 10,934.00
Delivery copy for Example Party 503",5695,15,5695,fdc-86fa6ea4c1a79e5fc373acf1,synthetic-form-layout-05,original,2023,fte-a8e1c46a2f719ad2cea073db,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2024
residential clean energy: USD 11,017.00 / energy efficient home improvements: USD 11,017.00
Delivery copy for Example Party 504",5695,15,5695,fdc-0c4c4e1d68b98efe9c2e78eb,synthetic-form-layout-05,original,2024,fte-ed34ba99825681e98839a0c6,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2025
residential clean energy: USD 11,100.00 / energy efficient home improvements: USD 11,100.00
Delivery copy for Example Party 505",5695,15,5695,fdc-fb25801607cc6404218f1a6d,synthetic-form-layout-05,original,2025,fte-2505413c8d1f799c727a5f76,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2023
residential clean energy: USD 11,183.00 / energy efficient home improvements: USD 11,183.00
Delivery copy for Example Party 506",5695,15,5695,fdc-77224d499db6dafa5107afef,synthetic-form-layout-05,original,2023,fte-b9712ce183fac6d44a7619f0,synthetic_AI_labeled,v1_template,top,False,
"Form 5695: Residential Energy Credits -- reporting year 2024
residential clean energy: USD 11,266.00 / energy efficient home improvements: USD 11,266.00
Delivery copy for Example Party 507",5695,15,5695,fdc-c8f4a8a12fceeab9bfda42a7,synthetic-form-layout-05,original,2024,fte-755343c7c0a1a37415f92660,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2023
Statement issued to Example Person 0.
vehicle: Example Entity 0-0-0
date placed in service: 2023-03-01
credit limitation: USD 10,000.00",8936,20,8936,fdc-46325fa63c95cad5116ed744,synthetic-form-layout-00,original,2023,fte-3fdabfc72f994922d53d44b5,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2024
Statement issued to Example Person 1.
vehicle: Example Entity 0-1-0
date placed in service: 2024-03-02
credit limitation: USD 10,083.00",8936,20,8936,fdc-4f1f57b6dca23b5f2ca16cc1,synthetic-form-layout-00,original,2024,fte-dd1f26d58a5cfedd6f9f65b2,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2025
Statement issued to Example Person 2.
vehicle: Example Entity 0-2-0
date placed in service: 2025-03-03
credit limitation: USD 10,166.00",8936,20,8936,fdc-43880bcc5ddf5699082e0b83,synthetic-form-layout-00,original,2025,fte-5b313721205115cd60f16b5a,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2023
Statement issued to Example Person 3.
vehicle: Example Entity 0-3-0
date placed in service: 2023-03-04
credit limitation: USD 10,249.00",8936,20,8936,fdc-e7885c3eacf61064ed9151a4,synthetic-form-layout-00,original,2023,fte-efe1e43746bfb7a65787fb12,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2024
Statement issued to Example Person 4.
vehicle: Example Entity 0-4-0
date placed in service: 2024-03-05
credit limitation: USD 10,332.00",8936,20,8936,fdc-d5eb7fbb3bfddd3caa08090e,synthetic-form-layout-00,original,2024,fte-09c0f8a4f24378238c3df552,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2025
Statement issued to Example Person 5.
vehicle: Example Entity 0-5-0
date placed in service: 2025-03-06
credit limitation: USD 10,415.00",8936,20,8936,fdc-1e73fb94c3d4fdaf64ca8a6f,synthetic-form-layout-00,original,2025,fte-7301f8a4f2a62c7600e93ed2,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2023
Statement issued to Example Person 6.
vehicle: Example Entity 0-6-0
date placed in service: 2023-03-07
credit limitation: USD 10,498.00",8936,20,8936,fdc-003a96061d0fd2595016da12,synthetic-form-layout-00,original,2023,fte-88d921240f61c039b8fb6260,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Calendar year: 2024
Statement issued to Example Person 7.
vehicle: Example Entity 0-7-0
date placed in service: 2024-03-08
credit limitation: USD 10,581.00",8936,20,8936,fdc-3558096c0382feb9e6e7f9d5,synthetic-form-layout-00,original,2024,fte-3f1690047c18707851243ec2,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 100
vehicle: Example Entity 1-0-0 | date placed in service: 2023-03-01 | credit limitation: USD 10,137.00",8936,20,8936,fdc-9bd662cddb46e5db53428c05,synthetic-form-layout-01,original,2023,fte-40fbfe9ebc55f699ba8fd173,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 101
vehicle: Example Entity 1-1-0 | date placed in service: 2024-03-02 | credit limitation: USD 10,220.00",8936,20,8936,fdc-f857004a023fd74652019322,synthetic-form-layout-01,original,2024,fte-337658166d89ec3446d2b668,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 102
vehicle: Example Entity 1-2-0 | date placed in service: 2025-03-03 | credit limitation: USD 10,303.00",8936,20,8936,fdc-baeec54baaa52edcad099d48,synthetic-form-layout-01,original,2025,fte-26d08dbc9d91e049422a7625,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 103
vehicle: Example Entity 1-3-0 | date placed in service: 2023-03-04 | credit limitation: USD 10,386.00",8936,20,8936,fdc-0acfceca0cf7689f55b0df38,synthetic-form-layout-01,original,2023,fte-e3279100f765ea5c2ea26743,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 104
vehicle: Example Entity 1-4-0 | date placed in service: 2024-03-05 | credit limitation: USD 10,469.00",8936,20,8936,fdc-eca46cad5b578424a134c906,synthetic-form-layout-01,original,2024,fte-08b0751c5237c91954517540,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 105
vehicle: Example Entity 1-5-0 | date placed in service: 2025-03-06 | credit limitation: USD 10,552.00",8936,20,8936,fdc-a63bc4805557ab023e244288,synthetic-form-layout-01,original,2025,fte-7aa6e8d8e07de4a00935ae5f,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 106
vehicle: Example Entity 1-6-0 | date placed in service: 2023-03-07 | credit limitation: USD 10,635.00",8936,20,8936,fdc-b0dd438ea2f2d500df0e4b5b,synthetic-form-layout-01,original,2023,fte-22f2fe34ce3a0b5644236363,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8936: Clean Vehicle Credits
Recipient record: Example Person 107
vehicle: Example Entity 1-7-0 | date placed in service: 2024-03-08 | credit limitation: USD 10,718.00",8936,20,8936,fdc-6b20d270a91cdfb960ef5981,synthetic-form-layout-01,original,2024,fte-6cab0305bbd2398575a47e12,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-0-0; date placed in service: 2023-03-01; credit limitation: USD 10,274.00. Recipient: Example Household 200.",8936,20,8936,fdc-cda6e6f8a89ee55a21eab9cd,synthetic-form-layout-02,original,2023,fte-45af2b349dd9a85e61bddc09,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-1-0; date placed in service: 2024-03-02; credit limitation: USD 10,357.00. Recipient: Example Household 201.",8936,20,8936,fdc-b25301e673e1071a95a89ebc,synthetic-form-layout-02,original,2024,fte-ac673b920e72ac5438036c28,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-2-0; date placed in service: 2025-03-03; credit limitation: USD 10,440.00. Recipient: Example Household 202.",8936,20,8936,fdc-25c30e2c609fd507474b8ede,synthetic-form-layout-02,original,2025,fte-5f3e4eb9452f0e315132fb98,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-3-0; date placed in service: 2023-03-04; credit limitation: USD 10,523.00. Recipient: Example Household 203.",8936,20,8936,fdc-bb7ab6527c3068df320bd70e,synthetic-form-layout-02,original,2023,fte-61cc723c12438e6b88a9cedf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-4-0; date placed in service: 2024-03-05; credit limitation: USD 10,606.00. Recipient: Example Household 204.",8936,20,8936,fdc-a5f50c627c9780153f77cc95,synthetic-form-layout-02,original,2024,fte-557f7218be016800a2526393,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-5-0; date placed in service: 2025-03-06; credit limitation: USD 10,689.00. Recipient: Example Household 205.",8936,20,8936,fdc-3e9d958f3ca5350e0fad9d85,synthetic-form-layout-02,original,2025,fte-90fd0e2dc065fc8fba5546b0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-6-0; date placed in service: 2023-03-07; credit limitation: USD 10,772.00. Recipient: Example Household 206.",8936,20,8936,fdc-31061a56367c477eb13f8a37,synthetic-form-layout-02,original,2023,fte-48ce3d6d74c6ce5c5c240035,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8936: Clean Vehicle Credits.
vehicle: Example Entity 2-7-0; date placed in service: 2024-03-08; credit limitation: USD 10,855.00. Recipient: Example Household 207.",8936,20,8936,fdc-811b82060825ebd76e1c9a6b,synthetic-form-layout-02,original,2024,fte-76adc90a0999cae7772df5f5,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2023.
Details: vehicle: Example Entity 3-0-0, date placed in service: 2023-03-01, credit limitation: USD 10,411.00. Account holder: Example Person 300.",8936,20,8936,fdc-6b17f112a7a286a53bd7e738,synthetic-form-layout-03,original,2023,fte-bda8db297cd2805f7a90aada,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2024.
Details: vehicle: Example Entity 3-1-0, date placed in service: 2024-03-02, credit limitation: USD 10,494.00. Account holder: Example Person 301.",8936,20,8936,fdc-0084fb21c2014af0e288dec6,synthetic-form-layout-03,original,2024,fte-ea2444f60093e427efe3dfa1,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2025.
Details: vehicle: Example Entity 3-2-0, date placed in service: 2025-03-03, credit limitation: USD 10,577.00. Account holder: Example Person 302.",8936,20,8936,fdc-5bc5d27b6b2b092ddfed7d47,synthetic-form-layout-03,original,2025,fte-f1fe3c40bab24a769705c433,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2023.
Details: vehicle: Example Entity 3-3-0, date placed in service: 2023-03-04, credit limitation: USD 10,660.00. Account holder: Example Person 303.",8936,20,8936,fdc-dfbd35fe790876a19b26d7bb,synthetic-form-layout-03,original,2023,fte-41eae12ce85d2b7f96689356,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2024.
Details: vehicle: Example Entity 3-4-0, date placed in service: 2024-03-05, credit limitation: USD 10,743.00. Account holder: Example Person 304.",8936,20,8936,fdc-2b8fe2dd10debd577766db84,synthetic-form-layout-03,original,2024,fte-028c4506b3369d139df7ebaa,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2025.
Details: vehicle: Example Entity 3-5-0, date placed in service: 2025-03-06, credit limitation: USD 10,826.00. Account holder: Example Person 305.",8936,20,8936,fdc-a2a6021818f96020e064be65,synthetic-form-layout-03,original,2025,fte-5fa6127344be263b66b87102,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2023.
Details: vehicle: Example Entity 3-6-0, date placed in service: 2023-03-07, credit limitation: USD 10,909.00. Account holder: Example Person 306.",8936,20,8936,fdc-1d2663529f3cc83aef9d6ee1,synthetic-form-layout-03,original,2023,fte-53b3deaaeb02ef31fd1de694,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits
Reporting period ended 12/31/2024.
Details: vehicle: Example Entity 3-7-0, date placed in service: 2024-03-08, credit limitation: USD 10,992.00. Account holder: Example Person 307.",8936,20,8936,fdc-9d6161d31c1188f5f21cba17,synthetic-form-layout-03,original,2024,fte-d877bfc9547ebfb81f7d31f9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2023
credit limitation: USD 10,548.00
date placed in service: 2023-03-01
vehicle: Example Entity 4-0-0
Named party: Example Person 400",8936,20,8936,fdc-6c95d690793091e574371601,synthetic-form-layout-04,original,2023,fte-4ba2301112abe60bbec3cf4f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2024
credit limitation: USD 10,631.00
date placed in service: 2024-03-02
vehicle: Example Entity 4-1-0
Named party: Example Person 401",8936,20,8936,fdc-4b71d7b92f7b7091bfcbfcf3,synthetic-form-layout-04,original,2024,fte-f7d06635d528dc2a6b7277cb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2025
credit limitation: USD 10,714.00
date placed in service: 2025-03-03
vehicle: Example Entity 4-2-0
Named party: Example Person 402",8936,20,8936,fdc-98f7dbfb69d8233986ee5853,synthetic-form-layout-04,original,2025,fte-ce3c36346bcd4d3828f68cbd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2023
credit limitation: USD 10,797.00
date placed in service: 2023-03-04
vehicle: Example Entity 4-3-0
Named party: Example Person 403",8936,20,8936,fdc-d963dc51c44a26caa64866ee,synthetic-form-layout-04,original,2023,fte-5f9ce975843a7dbf3386f080,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2024
credit limitation: USD 10,880.00
date placed in service: 2024-03-05
vehicle: Example Entity 4-4-0
Named party: Example Person 404",8936,20,8936,fdc-32299c7bb999116217efb89f,synthetic-form-layout-04,original,2024,fte-3544517459025dabb8d936cd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2025
credit limitation: USD 10,963.00
date placed in service: 2025-03-06
vehicle: Example Entity 4-5-0
Named party: Example Person 405",8936,20,8936,fdc-ce6550bf7114c310f78999da,synthetic-form-layout-04,original,2025,fte-cc425a61adfd6e2c21dc0637,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2023
credit limitation: USD 11,046.00
date placed in service: 2023-03-07
vehicle: Example Entity 4-6-0
Named party: Example Person 406",8936,20,8936,fdc-5fcc50ad3596018162f3d954,synthetic-form-layout-04,original,2023,fte-c402035b48fe1c9bd36a5e39,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8936: Clean Vehicle Credits
Tax reporting year 2024
credit limitation: USD 11,129.00
date placed in service: 2024-03-08
vehicle: Example Entity 4-7-0
Named party: Example Person 407",8936,20,8936,fdc-8d84674ff27ccede267e1cc3,synthetic-form-layout-04,original,2024,fte-3ecd6009353ff1e78f48ad35,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2023
vehicle: Example Entity 5-0-0 / date placed in service: 2023-03-01 / credit limitation: USD 10,685.00
Delivery copy for Example Party 500",8936,20,8936,fdc-ce0c56835774914e16340cde,synthetic-form-layout-05,original,2023,fte-17cabcb16a1d4176d77aa82b,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2024
vehicle: Example Entity 5-1-0 / date placed in service: 2024-03-02 / credit limitation: USD 10,768.00
Delivery copy for Example Party 501",8936,20,8936,fdc-94d51e9c6f132c7a08f84ba5,synthetic-form-layout-05,original,2024,fte-4d3c7850554a9f57c328c74e,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2025
vehicle: Example Entity 5-2-0 / date placed in service: 2025-03-03 / credit limitation: USD 10,851.00
Delivery copy for Example Party 502",8936,20,8936,fdc-2cf73789db1554b27a250b24,synthetic-form-layout-05,original,2025,fte-cf59966b8445c30faf6a66e1,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2023
vehicle: Example Entity 5-3-0 / date placed in service: 2023-03-04 / credit limitation: USD 10,934.00
Delivery copy for Example Party 503",8936,20,8936,fdc-8da250a711616f18147fb7ac,synthetic-form-layout-05,original,2023,fte-b9b7385c40c81c8a375898c3,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2024
vehicle: Example Entity 5-4-0 / date placed in service: 2024-03-05 / credit limitation: USD 11,017.00
Delivery copy for Example Party 504",8936,20,8936,fdc-8ee439717bd019d7923cce09,synthetic-form-layout-05,original,2024,fte-a9a8309d502f0c1bb521499d,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2025
vehicle: Example Entity 5-5-0 / date placed in service: 2025-03-06 / credit limitation: USD 11,100.00
Delivery copy for Example Party 505",8936,20,8936,fdc-306dbbfa4059988edce978cd,synthetic-form-layout-05,original,2025,fte-d9b4d8577d4ddd10e0effe67,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2023
vehicle: Example Entity 5-6-0 / date placed in service: 2023-03-07 / credit limitation: USD 11,183.00
Delivery copy for Example Party 506",8936,20,8936,fdc-6f84b455a9c67db292d460e0,synthetic-form-layout-05,original,2023,fte-3edf3c67f386afab29cdda0e,synthetic_AI_labeled,v1_template,top,False,
"Form 8936: Clean Vehicle Credits -- reporting year 2024
vehicle: Example Entity 5-7-0 / date placed in service: 2024-03-08 / credit limitation: USD 11,266.00
Delivery copy for Example Party 507",8936,20,8936,fdc-a528e32a6083aa7725d8e6cb,synthetic-form-layout-05,original,2024,fte-3039a91d1d6f7443da2dd5b0,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2023
Statement issued to Example Person 0.
foreign source income: USD 10,000.00
foreign taxes paid: USD 10,000.00
credit limitation: USD 10,000.00",1116,6,1116,fdc-c52348be096e7c30161d700c,synthetic-form-layout-00,original,2023,fte-6f187dfe82f9f7a422e35461,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2024
Statement issued to Example Person 1.
foreign source income: USD 10,083.00
foreign taxes paid: USD 10,083.00
credit limitation: USD 10,083.00",1116,6,1116,fdc-deec93e7ade3f0d4ade27a1b,synthetic-form-layout-00,original,2024,fte-f4364fd606572cf3d376f893,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2025
Statement issued to Example Person 2.
foreign source income: USD 10,166.00
foreign taxes paid: USD 10,166.00
credit limitation: USD 10,166.00",1116,6,1116,fdc-81778faa88986ea656e2a830,synthetic-form-layout-00,original,2025,fte-a9f7f79e7665b8f0379bdc34,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2023
Statement issued to Example Person 3.
foreign source income: USD 10,249.00
foreign taxes paid: USD 10,249.00
credit limitation: USD 10,249.00",1116,6,1116,fdc-98c24c8d8a290a117b520c8b,synthetic-form-layout-00,original,2023,fte-f549154b0bf62773fa3b7bec,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2024
Statement issued to Example Person 4.
foreign source income: USD 10,332.00
foreign taxes paid: USD 10,332.00
credit limitation: USD 10,332.00",1116,6,1116,fdc-7c5133a878acc5fe5f7bc219,synthetic-form-layout-00,original,2024,fte-5dafdd93524734ceef3cdfe7,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2025
Statement issued to Example Person 5.
foreign source income: USD 10,415.00
foreign taxes paid: USD 10,415.00
credit limitation: USD 10,415.00",1116,6,1116,fdc-1cb2c8b3f512503deb25628d,synthetic-form-layout-00,original,2025,fte-88f25d1f7e4bbd08ba11defe,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2023
Statement issued to Example Person 6.
foreign source income: USD 10,498.00
foreign taxes paid: USD 10,498.00
credit limitation: USD 10,498.00",1116,6,1116,fdc-74bb4153fa5e2958d6cf1859,synthetic-form-layout-00,original,2023,fte-fd94cfb056fbeb8b61263c3a,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Calendar year: 2024
Statement issued to Example Person 7.
foreign source income: USD 10,581.00
foreign taxes paid: USD 10,581.00
credit limitation: USD 10,581.00",1116,6,1116,fdc-f8f5ca9952ff9ade8e064fc2,synthetic-form-layout-00,original,2024,fte-84dbef608794dc4a2dad6ed7,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 100
foreign source income: USD 10,137.00 | foreign taxes paid: USD 10,137.00 | credit limitation: USD 10,137.00",1116,6,1116,fdc-4c9198daa580d0d8d617ef11,synthetic-form-layout-01,original,2023,fte-cabb3fbb735ae2497a398f75,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 101
foreign source income: USD 10,220.00 | foreign taxes paid: USD 10,220.00 | credit limitation: USD 10,220.00",1116,6,1116,fdc-fda5ccd9f854e4bab1456eeb,synthetic-form-layout-01,original,2024,fte-650fc59aa21fccc1f2f70263,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 102
foreign source income: USD 10,303.00 | foreign taxes paid: USD 10,303.00 | credit limitation: USD 10,303.00",1116,6,1116,fdc-cc5105ad69af02be60ba09a0,synthetic-form-layout-01,original,2025,fte-01fa59c18cc47cc76604d4a4,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 103
foreign source income: USD 10,386.00 | foreign taxes paid: USD 10,386.00 | credit limitation: USD 10,386.00",1116,6,1116,fdc-f0875bdf9c5c6d7a0d5e5914,synthetic-form-layout-01,original,2023,fte-01addfda3ef809888247955e,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 104
foreign source income: USD 10,469.00 | foreign taxes paid: USD 10,469.00 | credit limitation: USD 10,469.00",1116,6,1116,fdc-3a8b4f61f5980f046fbc72e6,synthetic-form-layout-01,original,2024,fte-875efed0520b7118e537980a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 105
foreign source income: USD 10,552.00 | foreign taxes paid: USD 10,552.00 | credit limitation: USD 10,552.00",1116,6,1116,fdc-1b9086aaab0345e79ecbb731,synthetic-form-layout-01,original,2025,fte-55bee4e0e34fc34082a95adb,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 106
foreign source income: USD 10,635.00 | foreign taxes paid: USD 10,635.00 | credit limitation: USD 10,635.00",1116,6,1116,fdc-ad4a443f23ff8fca314341ac,synthetic-form-layout-01,original,2023,fte-fab876dacb5e2474e424a1bd,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 1116: Foreign Tax Credit
Recipient record: Example Person 107
foreign source income: USD 10,718.00 | foreign taxes paid: USD 10,718.00 | credit limitation: USD 10,718.00",1116,6,1116,fdc-46f533a2df7273fad4113e89,synthetic-form-layout-01,original,2024,fte-a308439d41ed9bea639f35d9,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,274.00; foreign taxes paid: USD 10,274.00; credit limitation: USD 10,274.00. Recipient: Example Household 200.",1116,6,1116,fdc-c1e392089bdaf87f54ce7a85,synthetic-form-layout-02,original,2023,fte-aa2c41515606a975d951d32f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,357.00; foreign taxes paid: USD 10,357.00; credit limitation: USD 10,357.00. Recipient: Example Household 201.",1116,6,1116,fdc-5fdcef0c21a72f499f7f54d0,synthetic-form-layout-02,original,2024,fte-f6b7ffa18a0d4099d7114c40,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,440.00; foreign taxes paid: USD 10,440.00; credit limitation: USD 10,440.00. Recipient: Example Household 202.",1116,6,1116,fdc-622732c68e5f236d59cd2716,synthetic-form-layout-02,original,2025,fte-b0728c4f4c0436b5504276e8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,523.00; foreign taxes paid: USD 10,523.00; credit limitation: USD 10,523.00. Recipient: Example Household 203.",1116,6,1116,fdc-6cb63693b2e4d9105049d050,synthetic-form-layout-02,original,2023,fte-d60a8688cfd3b84dc523b2bc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,606.00; foreign taxes paid: USD 10,606.00; credit limitation: USD 10,606.00. Recipient: Example Household 204.",1116,6,1116,fdc-92f49e521b8003b6856db458,synthetic-form-layout-02,original,2024,fte-001799d91b4ca8a8c60bc1db,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,689.00; foreign taxes paid: USD 10,689.00; credit limitation: USD 10,689.00. Recipient: Example Household 205.",1116,6,1116,fdc-6ee18e2b3e0d41bdba5d416d,synthetic-form-layout-02,original,2025,fte-d80d8c34f8178cf8109bbad4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,772.00; foreign taxes paid: USD 10,772.00; credit limitation: USD 10,772.00. Recipient: Example Household 206.",1116,6,1116,fdc-078f984c5750a730388c273c,synthetic-form-layout-02,original,2023,fte-ef6abd6a600fd76b7c03816a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 1116: Foreign Tax Credit.
foreign source income: USD 10,855.00; foreign taxes paid: USD 10,855.00; credit limitation: USD 10,855.00. Recipient: Example Household 207.",1116,6,1116,fdc-7cabf4e6fbe4aadcfe57b28b,synthetic-form-layout-02,original,2024,fte-fb65830808d549b1450d1097,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2023.
Details: foreign source income: USD 10,411.00, foreign taxes paid: USD 10,411.00, credit limitation: USD 10,411.00. Account holder: Example Person 300.",1116,6,1116,fdc-00234f8004ba08b8407b026d,synthetic-form-layout-03,original,2023,fte-87606eb1b42f423b5db900f6,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2024.
Details: foreign source income: USD 10,494.00, foreign taxes paid: USD 10,494.00, credit limitation: USD 10,494.00. Account holder: Example Person 301.",1116,6,1116,fdc-f9b22ecf7a266942c3f81529,synthetic-form-layout-03,original,2024,fte-9bad7775ea4f3b4cdd08cf56,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2025.
Details: foreign source income: USD 10,577.00, foreign taxes paid: USD 10,577.00, credit limitation: USD 10,577.00. Account holder: Example Person 302.",1116,6,1116,fdc-dab70b2e7b9edc53c7f87631,synthetic-form-layout-03,original,2025,fte-562cc1d2e8c1777dd85cc1f8,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2023.
Details: foreign source income: USD 10,660.00, foreign taxes paid: USD 10,660.00, credit limitation: USD 10,660.00. Account holder: Example Person 303.",1116,6,1116,fdc-981447652f92d3791d21ed21,synthetic-form-layout-03,original,2023,fte-ffcb25ae9b1e9fd60a49bbb8,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2024.
Details: foreign source income: USD 10,743.00, foreign taxes paid: USD 10,743.00, credit limitation: USD 10,743.00. Account holder: Example Person 304.",1116,6,1116,fdc-84b5b8340adfe06e009ccefa,synthetic-form-layout-03,original,2024,fte-51c3e390380ff51005820b8b,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2025.
Details: foreign source income: USD 10,826.00, foreign taxes paid: USD 10,826.00, credit limitation: USD 10,826.00. Account holder: Example Person 305.",1116,6,1116,fdc-1d953ca16652320ecd297972,synthetic-form-layout-03,original,2025,fte-9fffe46fa37a547046f970a9,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2023.
Details: foreign source income: USD 10,909.00, foreign taxes paid: USD 10,909.00, credit limitation: USD 10,909.00. Account holder: Example Person 306.",1116,6,1116,fdc-efe858e72179b74d7af8ed0a,synthetic-form-layout-03,original,2023,fte-175e14464b4fcc62f53820f6,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit
Reporting period ended 12/31/2024.
Details: foreign source income: USD 10,992.00, foreign taxes paid: USD 10,992.00, credit limitation: USD 10,992.00. Account holder: Example Person 307.",1116,6,1116,fdc-c50e3f4181eeb951c017dd8a,synthetic-form-layout-03,original,2024,fte-650d665b3a244804ff99fe0d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2023
credit limitation: USD 10,548.00
foreign taxes paid: USD 10,548.00
foreign source income: USD 10,548.00
Named party: Example Person 400",1116,6,1116,fdc-d26a604a36c79613ef80293f,synthetic-form-layout-04,original,2023,fte-0793b88c0abba2bb08620758,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2024
credit limitation: USD 10,631.00
foreign taxes paid: USD 10,631.00
foreign source income: USD 10,631.00
Named party: Example Person 401",1116,6,1116,fdc-9858a935db9693b0e8174acc,synthetic-form-layout-04,original,2024,fte-596616791856c9bd8020edc7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2025
credit limitation: USD 10,714.00
foreign taxes paid: USD 10,714.00
foreign source income: USD 10,714.00
Named party: Example Person 402",1116,6,1116,fdc-f36acf1f9d960637d4afb3e9,synthetic-form-layout-04,original,2025,fte-dae2c07582798129b9ff2ece,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2023
credit limitation: USD 10,797.00
foreign taxes paid: USD 10,797.00
foreign source income: USD 10,797.00
Named party: Example Person 403",1116,6,1116,fdc-59ab075a8a2ed8e20c9a71ba,synthetic-form-layout-04,original,2023,fte-02ba332a081a267bfe2498d4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2024
credit limitation: USD 10,880.00
foreign taxes paid: USD 10,880.00
foreign source income: USD 10,880.00
Named party: Example Person 404",1116,6,1116,fdc-c0600370c471dc63c4789ffe,synthetic-form-layout-04,original,2024,fte-a65ef908da429e6b14ad467d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2025
credit limitation: USD 10,963.00
foreign taxes paid: USD 10,963.00
foreign source income: USD 10,963.00
Named party: Example Person 405",1116,6,1116,fdc-9dba9011c8df30e2bd5bbecf,synthetic-form-layout-04,original,2025,fte-3e93c434a7f4cc74b6b8236a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2023
credit limitation: USD 11,046.00
foreign taxes paid: USD 11,046.00
foreign source income: USD 11,046.00
Named party: Example Person 406",1116,6,1116,fdc-a7cc2765ddc2cedbed6f0888,synthetic-form-layout-04,original,2023,fte-bdfb4a88b42211ca504993db,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 1116: Foreign Tax Credit
Tax reporting year 2024
credit limitation: USD 11,129.00
foreign taxes paid: USD 11,129.00
foreign source income: USD 11,129.00
Named party: Example Person 407",1116,6,1116,fdc-3c6d0d6d81a10191b5f983ae,synthetic-form-layout-04,original,2024,fte-8b50efb9d5fdbe971d124fd9,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2023
foreign source income: USD 10,685.00 / foreign taxes paid: USD 10,685.00 / credit limitation: USD 10,685.00
Delivery copy for Example Party 500",1116,6,1116,fdc-08cbce08531d0e3aae5cffec,synthetic-form-layout-05,original,2023,fte-529dc8c2aedad75cf57e79b6,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2024
foreign source income: USD 10,768.00 / foreign taxes paid: USD 10,768.00 / credit limitation: USD 10,768.00
Delivery copy for Example Party 501",1116,6,1116,fdc-d6380997a90776c65c7f7748,synthetic-form-layout-05,original,2024,fte-67f7633f128292da058217a5,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2025
foreign source income: USD 10,851.00 / foreign taxes paid: USD 10,851.00 / credit limitation: USD 10,851.00
Delivery copy for Example Party 502",1116,6,1116,fdc-8dacfedffcb4514a27a536cc,synthetic-form-layout-05,original,2025,fte-3d603c055458fc503449f67c,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2023
foreign source income: USD 10,934.00 / foreign taxes paid: USD 10,934.00 / credit limitation: USD 10,934.00
Delivery copy for Example Party 503",1116,6,1116,fdc-c64cf111a2df52ed28345d8b,synthetic-form-layout-05,original,2023,fte-e29ea14f72ff0ffcbe2f604c,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2024
foreign source income: USD 11,017.00 / foreign taxes paid: USD 11,017.00 / credit limitation: USD 11,017.00
Delivery copy for Example Party 504",1116,6,1116,fdc-92ad8fd8c83b441f7825417d,synthetic-form-layout-05,original,2024,fte-441879ad2138dba3489893a7,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2025
foreign source income: USD 11,100.00 / foreign taxes paid: USD 11,100.00 / credit limitation: USD 11,100.00
Delivery copy for Example Party 505",1116,6,1116,fdc-5eed4eef0e7a42642136c453,synthetic-form-layout-05,original,2025,fte-2c33cb3aabdffc883b4d6278,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2023
foreign source income: USD 11,183.00 / foreign taxes paid: USD 11,183.00 / credit limitation: USD 11,183.00
Delivery copy for Example Party 506",1116,6,1116,fdc-056693be4e251ed96f765c4a,synthetic-form-layout-05,original,2023,fte-dacf69306d770d42e7c62569,synthetic_AI_labeled,v1_template,top,False,
"Form 1116: Foreign Tax Credit -- reporting year 2024
foreign source income: USD 11,266.00 / foreign taxes paid: USD 11,266.00 / credit limitation: USD 11,266.00
Delivery copy for Example Party 507",1116,6,1116,fdc-8a31143cf6fd5d4d6dee6baa,synthetic-form-layout-05,original,2024,fte-c97b4241b0289ea2353ade57,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2023
Statement issued to Example Person 0.
foreign address: Example Entity 0-0-0
physical presence: USD 10,000.00
foreign earned income: USD 10,000.00",2555,9,2555,fdc-5fccaf9b97abdca6c8ec52b3,synthetic-form-layout-00,original,2023,fte-058fc656f9525a1e2fb2c462,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2024
Statement issued to Example Person 1.
foreign address: Example Entity 0-1-0
physical presence: USD 10,083.00
foreign earned income: USD 10,083.00",2555,9,2555,fdc-9d57da1197cd834cf9aec261,synthetic-form-layout-00,original,2024,fte-0f1fe302235acbc36ff8aa0b,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2025
Statement issued to Example Person 2.
foreign address: Example Entity 0-2-0
physical presence: USD 10,166.00
foreign earned income: USD 10,166.00",2555,9,2555,fdc-778b370ebdf00a60a7be2aeb,synthetic-form-layout-00,original,2025,fte-853cda9a9e7809e28fe80e0b,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2023
Statement issued to Example Person 3.
foreign address: Example Entity 0-3-0
physical presence: USD 10,249.00
foreign earned income: USD 10,249.00",2555,9,2555,fdc-aa59429177a8285e20fb47ee,synthetic-form-layout-00,original,2023,fte-f9005c6f854a6550dc5bf840,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2024
Statement issued to Example Person 4.
foreign address: Example Entity 0-4-0
physical presence: USD 10,332.00
foreign earned income: USD 10,332.00",2555,9,2555,fdc-c211de4b171dd3096f460115,synthetic-form-layout-00,original,2024,fte-5e0f4758dc350090bb7848f2,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2025
Statement issued to Example Person 5.
foreign address: Example Entity 0-5-0
physical presence: USD 10,415.00
foreign earned income: USD 10,415.00",2555,9,2555,fdc-7b067ab128f31ebaaaa80a40,synthetic-form-layout-00,original,2025,fte-68e37a13d87b8d116455fcb3,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2023
Statement issued to Example Person 6.
foreign address: Example Entity 0-6-0
physical presence: USD 10,498.00
foreign earned income: USD 10,498.00",2555,9,2555,fdc-0fdf941f96f676fae8cc1acf,synthetic-form-layout-00,original,2023,fte-874d73d07fffdab37fe8d93d,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Calendar year: 2024
Statement issued to Example Person 7.
foreign address: Example Entity 0-7-0
physical presence: USD 10,581.00
foreign earned income: USD 10,581.00",2555,9,2555,fdc-a775bc7ec09dccd65bf8a3db,synthetic-form-layout-00,original,2024,fte-7c1d9e3fa1718f5c91bf3069,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2555: Foreign Earned Income
Recipient record: Example Person 100
foreign address: Example Entity 1-0-0 | physical presence: USD 10,137.00 | foreign earned income: USD 10,137.00",2555,9,2555,fdc-97e3129e74170e291a2730b1,synthetic-form-layout-01,original,2023,fte-c209d93bb19c52aaf2160b76,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2555: Foreign Earned Income
Recipient record: Example Person 101
foreign address: Example Entity 1-1-0 | physical presence: USD 10,220.00 | foreign earned income: USD 10,220.00",2555,9,2555,fdc-91d220dbcec3e653f186411f,synthetic-form-layout-01,original,2024,fte-c117b0eedc14b32e74bb148c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 2555: Foreign Earned Income
Recipient record: Example Person 102
foreign address: Example Entity 1-2-0 | physical presence: USD 10,303.00 | foreign earned income: USD 10,303.00",2555,9,2555,fdc-0853e5ffa0e8d9c2c6c6e750,synthetic-form-layout-01,original,2025,fte-d05de3b5fb793142bcce0318,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2555: Foreign Earned Income
Recipient record: Example Person 103
foreign address: Example Entity 1-3-0 | physical presence: USD 10,386.00 | foreign earned income: USD 10,386.00",2555,9,2555,fdc-fab09e69ecc62e4b4db38d68,synthetic-form-layout-01,original,2023,fte-8397d07e51991979e2e5371f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2555: Foreign Earned Income
Recipient record: Example Person 104
foreign address: Example Entity 1-4-0 | physical presence: USD 10,469.00 | foreign earned income: USD 10,469.00",2555,9,2555,fdc-ae3fdeffbd65a25b35344f30,synthetic-form-layout-01,original,2024,fte-95c75e0431fcba39de6a26de,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 2555: Foreign Earned Income
Recipient record: Example Person 105
foreign address: Example Entity 1-5-0 | physical presence: USD 10,552.00 | foreign earned income: USD 10,552.00",2555,9,2555,fdc-5d7e96a56801a30e2c41ac80,synthetic-form-layout-01,original,2025,fte-486e3bdebd51f83cc92f6740,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 2555: Foreign Earned Income
Recipient record: Example Person 106
foreign address: Example Entity 1-6-0 | physical presence: USD 10,635.00 | foreign earned income: USD 10,635.00",2555,9,2555,fdc-93aec851f3922995afb13efb,synthetic-form-layout-01,original,2023,fte-cfd636211761f8ea6a14fc3f,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 2555: Foreign Earned Income
Recipient record: Example Person 107
foreign address: Example Entity 1-7-0 | physical presence: USD 10,718.00 | foreign earned income: USD 10,718.00",2555,9,2555,fdc-1a8b9ea1d45fd8ff98dbc738,synthetic-form-layout-01,original,2024,fte-743655a4f8c7843164d91a5a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-0-0; physical presence: USD 10,274.00; foreign earned income: USD 10,274.00. Recipient: Example Household 200.",2555,9,2555,fdc-2bfdb53fbd9207b18a940d26,synthetic-form-layout-02,original,2023,fte-e1410d8d97d4b33404542eaa,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-1-0; physical presence: USD 10,357.00; foreign earned income: USD 10,357.00. Recipient: Example Household 201.",2555,9,2555,fdc-a84ba2245ed7cfd2904175ba,synthetic-form-layout-02,original,2024,fte-270403bf84278d2c33305650,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-2-0; physical presence: USD 10,440.00; foreign earned income: USD 10,440.00. Recipient: Example Household 202.",2555,9,2555,fdc-84e4683e3a540e55caf17fa0,synthetic-form-layout-02,original,2025,fte-be244e66a0e110f63c385110,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-3-0; physical presence: USD 10,523.00; foreign earned income: USD 10,523.00. Recipient: Example Household 203.",2555,9,2555,fdc-01d985ac4ce6a6a5c223d19d,synthetic-form-layout-02,original,2023,fte-3229b8a29c37b380ea8e7bab,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-4-0; physical presence: USD 10,606.00; foreign earned income: USD 10,606.00. Recipient: Example Household 204.",2555,9,2555,fdc-f02c90b6ba79dccd6b1e5103,synthetic-form-layout-02,original,2024,fte-1e4880ad8616f82e9907327b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-5-0; physical presence: USD 10,689.00; foreign earned income: USD 10,689.00. Recipient: Example Household 205.",2555,9,2555,fdc-80c7a465debf1682a2dc1a64,synthetic-form-layout-02,original,2025,fte-232c82df0a2045f13064f97a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-6-0; physical presence: USD 10,772.00; foreign earned income: USD 10,772.00. Recipient: Example Household 206.",2555,9,2555,fdc-dfe41ec90c8642df659b272d,synthetic-form-layout-02,original,2023,fte-70dde995f3a8381883179195,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 2555: Foreign Earned Income.
foreign address: Example Entity 2-7-0; physical presence: USD 10,855.00; foreign earned income: USD 10,855.00. Recipient: Example Household 207.",2555,9,2555,fdc-a585d8550b08a9d561c65a6d,synthetic-form-layout-02,original,2024,fte-1c1e0c4090a7b8cf2394bc54,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2023.
Details: foreign address: Example Entity 3-0-0, physical presence: USD 10,411.00, foreign earned income: USD 10,411.00. Account holder: Example Person 300.",2555,9,2555,fdc-bccc73443f0878820d024a1f,synthetic-form-layout-03,original,2023,fte-25ef2707c182a9612ec0c174,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2024.
Details: foreign address: Example Entity 3-1-0, physical presence: USD 10,494.00, foreign earned income: USD 10,494.00. Account holder: Example Person 301.",2555,9,2555,fdc-089d788af242890a2e323d4d,synthetic-form-layout-03,original,2024,fte-d58e2c5ec6ec9bd000b86fb1,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2025.
Details: foreign address: Example Entity 3-2-0, physical presence: USD 10,577.00, foreign earned income: USD 10,577.00. Account holder: Example Person 302.",2555,9,2555,fdc-4f04ce8c0f291d6154888369,synthetic-form-layout-03,original,2025,fte-407773a43be7949509a91d1f,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2023.
Details: foreign address: Example Entity 3-3-0, physical presence: USD 10,660.00, foreign earned income: USD 10,660.00. Account holder: Example Person 303.",2555,9,2555,fdc-906214f0af3c9d986cb975e8,synthetic-form-layout-03,original,2023,fte-240b6b2f5be51fc48bf4aba4,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2024.
Details: foreign address: Example Entity 3-4-0, physical presence: USD 10,743.00, foreign earned income: USD 10,743.00. Account holder: Example Person 304.",2555,9,2555,fdc-f5436d289a238e2588d693aa,synthetic-form-layout-03,original,2024,fte-0cc393376c3180b8d15da3ef,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2025.
Details: foreign address: Example Entity 3-5-0, physical presence: USD 10,826.00, foreign earned income: USD 10,826.00. Account holder: Example Person 305.",2555,9,2555,fdc-201564c881d39028e5de203e,synthetic-form-layout-03,original,2025,fte-133f50f9f99bef71a7536d85,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2023.
Details: foreign address: Example Entity 3-6-0, physical presence: USD 10,909.00, foreign earned income: USD 10,909.00. Account holder: Example Person 306.",2555,9,2555,fdc-29c4b107dffd7d67eae3eb57,synthetic-form-layout-03,original,2023,fte-4a6b228d7d3d9c7b6e125a2f,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income
Reporting period ended 12/31/2024.
Details: foreign address: Example Entity 3-7-0, physical presence: USD 10,992.00, foreign earned income: USD 10,992.00. Account holder: Example Person 307.",2555,9,2555,fdc-4e559ca42929dac71d99fd9a,synthetic-form-layout-03,original,2024,fte-a3da993a02c8ea18307cee1e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2023
foreign earned income: USD 10,548.00
physical presence: USD 10,548.00
foreign address: Example Entity 4-0-0
Named party: Example Person 400",2555,9,2555,fdc-0022a578dfeea56c9feb7451,synthetic-form-layout-04,original,2023,fte-059ea2e0fe764c5ae8de0eb7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2024
foreign earned income: USD 10,631.00
physical presence: USD 10,631.00
foreign address: Example Entity 4-1-0
Named party: Example Person 401",2555,9,2555,fdc-a9f58751873dbf85d396914d,synthetic-form-layout-04,original,2024,fte-86c5d08b5b50a9bd40c1c3a4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2025
foreign earned income: USD 10,714.00
physical presence: USD 10,714.00
foreign address: Example Entity 4-2-0
Named party: Example Person 402",2555,9,2555,fdc-d0ef670a5d2b3fc4db01ff79,synthetic-form-layout-04,original,2025,fte-8ef11d537237198476a8afc4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2023
foreign earned income: USD 10,797.00
physical presence: USD 10,797.00
foreign address: Example Entity 4-3-0
Named party: Example Person 403",2555,9,2555,fdc-926e61254ba4852c892c5d99,synthetic-form-layout-04,original,2023,fte-18d1ae0ab9f848dc50a8456b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2024
foreign earned income: USD 10,880.00
physical presence: USD 10,880.00
foreign address: Example Entity 4-4-0
Named party: Example Person 404",2555,9,2555,fdc-0d4396a00be9853dddb9dab3,synthetic-form-layout-04,original,2024,fte-23e4f0e330f9395cc0007397,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2025
foreign earned income: USD 10,963.00
physical presence: USD 10,963.00
foreign address: Example Entity 4-5-0
Named party: Example Person 405",2555,9,2555,fdc-8e882e0e151cf1ca1ba9f34a,synthetic-form-layout-04,original,2025,fte-f7eaf63e972d1d7c1daa45be,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2023
foreign earned income: USD 11,046.00
physical presence: USD 11,046.00
foreign address: Example Entity 4-6-0
Named party: Example Person 406",2555,9,2555,fdc-62b4667ffa1753c10ee21a68,synthetic-form-layout-04,original,2023,fte-2bd97828705bca966373f989,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 2555: Foreign Earned Income
Tax reporting year 2024
foreign earned income: USD 11,129.00
physical presence: USD 11,129.00
foreign address: Example Entity 4-7-0
Named party: Example Person 407",2555,9,2555,fdc-60e8223a78ca7ef2743c32c5,synthetic-form-layout-04,original,2024,fte-d748d29ed33849646e1991d8,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2023
foreign address: Example Entity 5-0-0 / physical presence: USD 10,685.00 / foreign earned income: USD 10,685.00
Delivery copy for Example Party 500",2555,9,2555,fdc-88117d5943e92a8550cf2efa,synthetic-form-layout-05,original,2023,fte-caac6de81ae69bc545179fe9,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2024
foreign address: Example Entity 5-1-0 / physical presence: USD 10,768.00 / foreign earned income: USD 10,768.00
Delivery copy for Example Party 501",2555,9,2555,fdc-688af721649a9d095a2d36b6,synthetic-form-layout-05,original,2024,fte-5f8897b1ad55370bf1bbef87,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2025
foreign address: Example Entity 5-2-0 / physical presence: USD 10,851.00 / foreign earned income: USD 10,851.00
Delivery copy for Example Party 502",2555,9,2555,fdc-7f771267937bb0a723836763,synthetic-form-layout-05,original,2025,fte-9548b5cca490aa0acd0ee1f3,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2023
foreign address: Example Entity 5-3-0 / physical presence: USD 10,934.00 / foreign earned income: USD 10,934.00
Delivery copy for Example Party 503",2555,9,2555,fdc-7ec021384739eb3c1a651d6d,synthetic-form-layout-05,original,2023,fte-bdc71553f84976af47f36f0b,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2024
foreign address: Example Entity 5-4-0 / physical presence: USD 11,017.00 / foreign earned income: USD 11,017.00
Delivery copy for Example Party 504",2555,9,2555,fdc-2e2f68204e3dc5e5b1c1797c,synthetic-form-layout-05,original,2024,fte-8447546d709638f29fcf258e,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2025
foreign address: Example Entity 5-5-0 / physical presence: USD 11,100.00 / foreign earned income: USD 11,100.00
Delivery copy for Example Party 505",2555,9,2555,fdc-ae35225b74d40338ba7fd196,synthetic-form-layout-05,original,2025,fte-ccf791f34db9c3777aa8eac0,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2023
foreign address: Example Entity 5-6-0 / physical presence: USD 11,183.00 / foreign earned income: USD 11,183.00
Delivery copy for Example Party 506",2555,9,2555,fdc-9dc983aa013e30f06f9d9225,synthetic-form-layout-05,original,2023,fte-f5fe95469387d7a65828bf30,synthetic_AI_labeled,v1_template,top,False,
"Form 2555: Foreign Earned Income -- reporting year 2024
foreign address: Example Entity 5-7-0 / physical presence: USD 11,266.00 / foreign earned income: USD 11,266.00
Delivery copy for Example Party 507",2555,9,2555,fdc-f83872c0fae41359896fa7de,synthetic-form-layout-05,original,2024,fte-1f49989907b389afa47e94d2,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2023
Statement issued to Example Person 0.
foreign accounts: USD 10,000.00
assets: USD 10,000.00
maximum value: USD 10,000.00
income: USD 10,000.00",8938,21,8938,fdc-6ce6946fbac96c142273f0af,synthetic-form-layout-00,original,2023,fte-4c7e95268fa710e0a0a5bf74,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2024
Statement issued to Example Person 1.
foreign accounts: USD 10,083.00
assets: USD 10,083.00
maximum value: USD 10,083.00
income: USD 10,083.00",8938,21,8938,fdc-07706c6ac2e265e5e3964b1e,synthetic-form-layout-00,original,2024,fte-37efe84d4bd9eca705970c05,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2025
Statement issued to Example Person 2.
foreign accounts: USD 10,166.00
assets: USD 10,166.00
maximum value: USD 10,166.00
income: USD 10,166.00",8938,21,8938,fdc-21df1ad3fca39c58acdcb44d,synthetic-form-layout-00,original,2025,fte-5bb91ed7aa7c3f2daafc788e,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2023
Statement issued to Example Person 3.
foreign accounts: USD 10,249.00
assets: USD 10,249.00
maximum value: USD 10,249.00
income: USD 10,249.00",8938,21,8938,fdc-fc143dc7c7b6e1ae58f748cb,synthetic-form-layout-00,original,2023,fte-271f27b5cd92c4efacbee674,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2024
Statement issued to Example Person 4.
foreign accounts: USD 10,332.00
assets: USD 10,332.00
maximum value: USD 10,332.00
income: USD 10,332.00",8938,21,8938,fdc-934140245e03807815376e10,synthetic-form-layout-00,original,2024,fte-61eaeb26e69abe0a432b38b4,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2025
Statement issued to Example Person 5.
foreign accounts: USD 10,415.00
assets: USD 10,415.00
maximum value: USD 10,415.00
income: USD 10,415.00",8938,21,8938,fdc-77fca5a46a875d900b3f16aa,synthetic-form-layout-00,original,2025,fte-b5112ae3a7201ea036c0b8f7,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2023
Statement issued to Example Person 6.
foreign accounts: USD 10,498.00
assets: USD 10,498.00
maximum value: USD 10,498.00
income: USD 10,498.00",8938,21,8938,fdc-839091156a15f30dd1747de8,synthetic-form-layout-00,original,2023,fte-6725586a56556f3e25b81b5d,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Calendar year: 2024
Statement issued to Example Person 7.
foreign accounts: USD 10,581.00
assets: USD 10,581.00
maximum value: USD 10,581.00
income: USD 10,581.00",8938,21,8938,fdc-e5643f4d939832103d1f545a,synthetic-form-layout-00,original,2024,fte-d51da2d8db0b774131d021a3,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 100
foreign accounts: USD 10,137.00 | assets: USD 10,137.00 | maximum value: USD 10,137.00 | income: USD 10,137.00",8938,21,8938,fdc-243d5427b6d43941aa112d3b,synthetic-form-layout-01,original,2023,fte-4ec2aedb289fc86d359634a3,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 101
foreign accounts: USD 10,220.00 | assets: USD 10,220.00 | maximum value: USD 10,220.00 | income: USD 10,220.00",8938,21,8938,fdc-5660d3538c9ba36083dcc8ec,synthetic-form-layout-01,original,2024,fte-9685e8e56aa58e575d24643e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 102
foreign accounts: USD 10,303.00 | assets: USD 10,303.00 | maximum value: USD 10,303.00 | income: USD 10,303.00",8938,21,8938,fdc-4204de3d4d5403d963fb2e8d,synthetic-form-layout-01,original,2025,fte-6f20366beec7d828673992e1,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 103
foreign accounts: USD 10,386.00 | assets: USD 10,386.00 | maximum value: USD 10,386.00 | income: USD 10,386.00",8938,21,8938,fdc-bc23fcdcac304678f433c413,synthetic-form-layout-01,original,2023,fte-087d2e8e13fd98317f812945,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 104
foreign accounts: USD 10,469.00 | assets: USD 10,469.00 | maximum value: USD 10,469.00 | income: USD 10,469.00",8938,21,8938,fdc-68888eb363a864cefca4316a,synthetic-form-layout-01,original,2024,fte-4a92353eff2b70eb87279d73,synthetic_AI_labeled,v1_template,top,False,
"2025 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 105
foreign accounts: USD 10,552.00 | assets: USD 10,552.00 | maximum value: USD 10,552.00 | income: USD 10,552.00",8938,21,8938,fdc-82e7e978ab8dbb8eb898561b,synthetic-form-layout-01,original,2025,fte-3337471123a16462b8ad49d8,synthetic_AI_labeled,v1_template,top,False,
"2023 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 106
foreign accounts: USD 10,635.00 | assets: USD 10,635.00 | maximum value: USD 10,635.00 | income: USD 10,635.00",8938,21,8938,fdc-49c0e9ab0e2fa6c43de9e990,synthetic-form-layout-01,original,2023,fte-1b88dbaf32634b9e8ddb7c6e,synthetic_AI_labeled,v1_template,top,False,
"2024 | Form 8938: Statement of Specified Foreign Financial Assets
Recipient record: Example Person 107
foreign accounts: USD 10,718.00 | assets: USD 10,718.00 | maximum value: USD 10,718.00 | income: USD 10,718.00",8938,21,8938,fdc-9d1b4f152f5a2b3589d999cc,synthetic-form-layout-01,original,2024,fte-9280c4ccff30bfaf53cd5119,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,274.00; assets: USD 10,274.00; maximum value: USD 10,274.00; income: USD 10,274.00. Recipient: Example Household 200.",8938,21,8938,fdc-66e6ed554f9f6a8d2585e616,synthetic-form-layout-02,original,2023,fte-51c8152fc24ed9f9b7f8f609,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,357.00; assets: USD 10,357.00; maximum value: USD 10,357.00; income: USD 10,357.00. Recipient: Example Household 201.",8938,21,8938,fdc-d8bb17515137406d8c3d98d4,synthetic-form-layout-02,original,2024,fte-7a39c054ac12320b38c9de6e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,440.00; assets: USD 10,440.00; maximum value: USD 10,440.00; income: USD 10,440.00. Recipient: Example Household 202.",8938,21,8938,fdc-86f5047a0e04d66f59aa4f23,synthetic-form-layout-02,original,2025,fte-4f7084b693a7e4e1b85250cd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,523.00; assets: USD 10,523.00; maximum value: USD 10,523.00; income: USD 10,523.00. Recipient: Example Household 203.",8938,21,8938,fdc-5b159f1932265f8d6c54cc3f,synthetic-form-layout-02,original,2023,fte-dea2c369f96b509bb60e2f3c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,606.00; assets: USD 10,606.00; maximum value: USD 10,606.00; income: USD 10,606.00. Recipient: Example Household 204.",8938,21,8938,fdc-d961e8ed1b36f7dacb3c3c13,synthetic-form-layout-02,original,2024,fte-5f87a2c07777eda13e15ddc4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,689.00; assets: USD 10,689.00; maximum value: USD 10,689.00; income: USD 10,689.00. Recipient: Example Household 205.",8938,21,8938,fdc-61205b42d9c195326d81a1e0,synthetic-form-layout-02,original,2025,fte-7a9c7eeb699daf2f7540868b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2023. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,772.00; assets: USD 10,772.00; maximum value: USD 10,772.00; income: USD 10,772.00. Recipient: Example Household 206.",8938,21,8938,fdc-684807a9a50d5cd69113713a,synthetic-form-layout-02,original,2023,fte-926f219dc3a5ae667a88e201,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2024. Form 8938: Statement of Specified Foreign Financial Assets.
foreign accounts: USD 10,855.00; assets: USD 10,855.00; maximum value: USD 10,855.00; income: USD 10,855.00. Recipient: Example Household 207.",8938,21,8938,fdc-1b531fc476b1a4a41ec27f57,synthetic-form-layout-02,original,2024,fte-0f293873caddd68416d9f971,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2023.
Details: foreign accounts: USD 10,411.00, assets: USD 10,411.00, maximum value: USD 10,411.00, income: USD 10,411.00. Account holder: Example Person 300.",8938,21,8938,fdc-2bd7b1f5ab0639fac1786fe3,synthetic-form-layout-03,original,2023,fte-ce4b9532f958db3e7a24e468,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2024.
Details: foreign accounts: USD 10,494.00, assets: USD 10,494.00, maximum value: USD 10,494.00, income: USD 10,494.00. Account holder: Example Person 301.",8938,21,8938,fdc-d2e4666ae7980e9754ff736e,synthetic-form-layout-03,original,2024,fte-5b699c7a5196546b9f3e7ee4,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2025.
Details: foreign accounts: USD 10,577.00, assets: USD 10,577.00, maximum value: USD 10,577.00, income: USD 10,577.00. Account holder: Example Person 302.",8938,21,8938,fdc-7b28b5e84127b22bebf607fb,synthetic-form-layout-03,original,2025,fte-16a883f4f70f4e93a7c635b5,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2023.
Details: foreign accounts: USD 10,660.00, assets: USD 10,660.00, maximum value: USD 10,660.00, income: USD 10,660.00. Account holder: Example Person 303.",8938,21,8938,fdc-f640ae68a7c25239cf104329,synthetic-form-layout-03,original,2023,fte-8c094d355cb58da048ef9c9f,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2024.
Details: foreign accounts: USD 10,743.00, assets: USD 10,743.00, maximum value: USD 10,743.00, income: USD 10,743.00. Account holder: Example Person 304.",8938,21,8938,fdc-192e6313686f71446162de11,synthetic-form-layout-03,original,2024,fte-2e3f325d24c5c05e42b8cf65,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2025.
Details: foreign accounts: USD 10,826.00, assets: USD 10,826.00, maximum value: USD 10,826.00, income: USD 10,826.00. Account holder: Example Person 305.",8938,21,8938,fdc-be78bced9ee9c5b836c9b4db,synthetic-form-layout-03,original,2025,fte-7055d26f1afd8b01bfcb1aca,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2023.
Details: foreign accounts: USD 10,909.00, assets: USD 10,909.00, maximum value: USD 10,909.00, income: USD 10,909.00. Account holder: Example Person 306.",8938,21,8938,fdc-36bbed14b39f450e58e0bc2e,synthetic-form-layout-03,original,2023,fte-7efe40ba424b6b3be41aeaba,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets
Reporting period ended 12/31/2024.
Details: foreign accounts: USD 10,992.00, assets: USD 10,992.00, maximum value: USD 10,992.00, income: USD 10,992.00. Account holder: Example Person 307.",8938,21,8938,fdc-742118119e62f3f462aee6fd,synthetic-form-layout-03,original,2024,fte-1f3988d51da0b222f4061fc6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2023
income: USD 10,548.00
maximum value: USD 10,548.00
assets: USD 10,548.00
foreign accounts: USD 10,548.00
Named party: Example Person 400",8938,21,8938,fdc-3e601a97a23bfbdeedbfdae1,synthetic-form-layout-04,original,2023,fte-fc18908809c9b77ebc57f42a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2024
income: USD 10,631.00
maximum value: USD 10,631.00
assets: USD 10,631.00
foreign accounts: USD 10,631.00
Named party: Example Person 401",8938,21,8938,fdc-55c5bb1b07b8364bc12a22c5,synthetic-form-layout-04,original,2024,fte-89f7a5d60deb2165b8ecad6b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2025
income: USD 10,714.00
maximum value: USD 10,714.00
assets: USD 10,714.00
foreign accounts: USD 10,714.00
Named party: Example Person 402",8938,21,8938,fdc-88ad70902546fdab13c11a92,synthetic-form-layout-04,original,2025,fte-1addb15b90c6625b67a56045,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2023
income: USD 10,797.00
maximum value: USD 10,797.00
assets: USD 10,797.00
foreign accounts: USD 10,797.00
Named party: Example Person 403",8938,21,8938,fdc-3cef4d252c2432e5a68e9458,synthetic-form-layout-04,original,2023,fte-2ab4636fe0d1ef4111275548,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2024
income: USD 10,880.00
maximum value: USD 10,880.00
assets: USD 10,880.00
foreign accounts: USD 10,880.00
Named party: Example Person 404",8938,21,8938,fdc-f375514f29d2f7c1e260fb5c,synthetic-form-layout-04,original,2024,fte-e80a9f5c15b42d5f047ccc30,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2025
income: USD 10,963.00
maximum value: USD 10,963.00
assets: USD 10,963.00
foreign accounts: USD 10,963.00
Named party: Example Person 405",8938,21,8938,fdc-5dff3f009d34daa5b45cc874,synthetic-form-layout-04,original,2025,fte-48318809afa529b697f3e836,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2023
income: USD 11,046.00
maximum value: USD 11,046.00
assets: USD 11,046.00
foreign accounts: USD 11,046.00
Named party: Example Person 406",8938,21,8938,fdc-5609ae4c928d8ac1e9d701ec,synthetic-form-layout-04,original,2023,fte-c34197a7d6a2548b5e13cdaf,synthetic_AI_labeled,v1_template,top,False,
"Document header: Form 8938: Statement of Specified Foreign Financial Assets
Tax reporting year 2024
income: USD 11,129.00
maximum value: USD 11,129.00
assets: USD 11,129.00
foreign accounts: USD 11,129.00
Named party: Example Person 407",8938,21,8938,fdc-cdf16a9cecac820844002e03,synthetic-form-layout-04,original,2024,fte-d936638a08f07c6fe7851407,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2023
foreign accounts: USD 10,685.00 / assets: USD 10,685.00 / maximum value: USD 10,685.00 / income: USD 10,685.00
Delivery copy for Example Party 500",8938,21,8938,fdc-37e1d559740206929dcb2d97,synthetic-form-layout-05,original,2023,fte-d78139de233d370ee38a9b65,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2024
foreign accounts: USD 10,768.00 / assets: USD 10,768.00 / maximum value: USD 10,768.00 / income: USD 10,768.00
Delivery copy for Example Party 501",8938,21,8938,fdc-6050ae546b166dd9da00a334,synthetic-form-layout-05,original,2024,fte-455fca080c937a298476300b,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2025
foreign accounts: USD 10,851.00 / assets: USD 10,851.00 / maximum value: USD 10,851.00 / income: USD 10,851.00
Delivery copy for Example Party 502",8938,21,8938,fdc-776540ee06f5b8294ca92f0e,synthetic-form-layout-05,original,2025,fte-aeaa48d3066de69a9ab9e6db,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2023
foreign accounts: USD 10,934.00 / assets: USD 10,934.00 / maximum value: USD 10,934.00 / income: USD 10,934.00
Delivery copy for Example Party 503",8938,21,8938,fdc-77e0999da55d73860690589a,synthetic-form-layout-05,original,2023,fte-d32f999f53320e14be5ad992,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2024
foreign accounts: USD 11,017.00 / assets: USD 11,017.00 / maximum value: USD 11,017.00 / income: USD 11,017.00
Delivery copy for Example Party 504",8938,21,8938,fdc-4db9e02aaed47f7f6576875a,synthetic-form-layout-05,original,2024,fte-cbc6e9f3a66de1bc5c3a5272,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2025
foreign accounts: USD 11,100.00 / assets: USD 11,100.00 / maximum value: USD 11,100.00 / income: USD 11,100.00
Delivery copy for Example Party 505",8938,21,8938,fdc-210c23d3bd999b82fd856d4e,synthetic-form-layout-05,original,2025,fte-65ee4ef8d9acf4397578d987,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2023
foreign accounts: USD 11,183.00 / assets: USD 11,183.00 / maximum value: USD 11,183.00 / income: USD 11,183.00
Delivery copy for Example Party 506",8938,21,8938,fdc-42584ff0b7d3bcd4d57aac00,synthetic-form-layout-05,original,2023,fte-f518ebfd76cd8428decdf617,synthetic_AI_labeled,v1_template,top,False,
"Form 8938: Statement of Specified Foreign Financial Assets -- reporting year 2024
foreign accounts: USD 11,266.00 / assets: USD 11,266.00 / maximum value: USD 11,266.00 / income: USD 11,266.00
Delivery copy for Example Party 507",8938,21,8938,fdc-e07ea7707af1b4ef207346c7,synthetic-form-layout-05,original,2024,fte-143427f0cb263bc8f63eedc5,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 0.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 300.00",DONATION_RECORD,28,DONATION_RECORD,fdc-71717926ad2de13804cd584a,synthetic-nonform-layout-00,original,2025,fte-6d720f0877ed249e4c0b319c,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 1.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 319.00",DONATION_RECORD,28,DONATION_RECORD,fdc-2f07d6e2d0030ac208e49baa,synthetic-nonform-layout-00,original,2025,fte-fc1329beccd829c2e73f1e1e,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 2.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 338.00",DONATION_RECORD,28,DONATION_RECORD,fdc-cc6d64de492044e535749a0e,synthetic-nonform-layout-00,original,2025,fte-81f4a6631ed10759cc953a1d,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 3.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 357.00",DONATION_RECORD,28,DONATION_RECORD,fdc-9e052056b6c91ab64d0af183,synthetic-nonform-layout-00,original,2025,fte-2c2ed64a7c08797560cd5a0f,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 4.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 376.00",DONATION_RECORD,28,DONATION_RECORD,fdc-5c507a805b51f565544a329d,synthetic-nonform-layout-00,original,2025,fte-4fe803516f45da20cc00b26c,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 5.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 395.00",DONATION_RECORD,28,DONATION_RECORD,fdc-bcf74ef6f533a4cee7ef9089,synthetic-nonform-layout-00,original,2025,fte-fed0b75e8cd203ea10a8db8a,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 6.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 414.00",DONATION_RECORD,28,DONATION_RECORD,fdc-e869d3a9fc4337c765f476d2,synthetic-nonform-layout-00,original,2025,fte-fab010b826cd144dfdc9199f,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Calendar year: 2025
Statement issued to Example Person 7.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Reference amount: 433.00",DONATION_RECORD,28,DONATION_RECORD,fdc-8e1b7fec9919aa3a69b5d846,synthetic-nonform-layout-00,original,2025,fte-a08d112fcd0cb9b6dc4d3cf7,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 100
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 323.00",DONATION_RECORD,28,DONATION_RECORD,fdc-96d4a1e260023b3982f99eb3,synthetic-nonform-layout-01,original,2025,fte-2be158b9423997c243c0c49b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 101
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 342.00",DONATION_RECORD,28,DONATION_RECORD,fdc-6ed79104f96c501e620cd2f0,synthetic-nonform-layout-01,original,2025,fte-e0819a77670cb95d0ab15a6b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 102
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 361.00",DONATION_RECORD,28,DONATION_RECORD,fdc-f9538a43426eac976f01ecea,synthetic-nonform-layout-01,original,2025,fte-634b5ef772fd110b23534da4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 103
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 380.00",DONATION_RECORD,28,DONATION_RECORD,fdc-7c69eb8f6d46fa969a287e8b,synthetic-nonform-layout-01,original,2025,fte-af978ff56d575ea565878a59,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 104
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 399.00",DONATION_RECORD,28,DONATION_RECORD,fdc-88d24d95d51165f670eaa824,synthetic-nonform-layout-01,original,2025,fte-e771e9edde59c18e7f424f70,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 105
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 418.00",DONATION_RECORD,28,DONATION_RECORD,fdc-2ac17c3580c1a0b1f40c8e57,synthetic-nonform-layout-01,original,2025,fte-768323acb54a01e9af1691b4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 106
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 437.00",DONATION_RECORD,28,DONATION_RECORD,fdc-39e2b7e082043cb91151056f,synthetic-nonform-layout-01,original,2025,fte-28639642746b644e9d220757,synthetic_AI_labeled,v1_template,top,False,
"2025 | Annual charitable giving statement
Recipient record: Example Person 107
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named | Reference amount: 456.00",DONATION_RECORD,28,DONATION_RECORD,fdc-0fd037fc425598f1f92ecd79,synthetic-nonform-layout-01,original,2025,fte-c82477603835d25a88ab0ac0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 346.00. Recipient: Example Household 200.",DONATION_RECORD,28,DONATION_RECORD,fdc-b9a5a05d7601893a2f76559f,synthetic-nonform-layout-02,original,2025,fte-708e8b891358c3beef938444,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 365.00. Recipient: Example Household 201.",DONATION_RECORD,28,DONATION_RECORD,fdc-8337a92f19e86879a56b43bd,synthetic-nonform-layout-02,original,2025,fte-c16ff4d68ed304f78f637706,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 384.00. Recipient: Example Household 202.",DONATION_RECORD,28,DONATION_RECORD,fdc-953b022ac3cbe7b22db7455e,synthetic-nonform-layout-02,original,2025,fte-d883b311a84c134821c2a9a1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 403.00. Recipient: Example Household 203.",DONATION_RECORD,28,DONATION_RECORD,fdc-9d4b13898150fe5bfd524b21,synthetic-nonform-layout-02,original,2025,fte-b88f8b7c68f3563802042f99,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 422.00. Recipient: Example Household 204.",DONATION_RECORD,28,DONATION_RECORD,fdc-1c7cdd3938f5bcab7149bb81,synthetic-nonform-layout-02,original,2025,fte-0d3c73eeae7da16d5a696f53,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 441.00. Recipient: Example Household 205.",DONATION_RECORD,28,DONATION_RECORD,fdc-2c9ba0035fa6777f9d945550,synthetic-nonform-layout-02,original,2025,fte-190292ff699054a379e0103d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 460.00. Recipient: Example Household 206.",DONATION_RECORD,28,DONATION_RECORD,fdc-950c9c05d5c3d351e8630616,synthetic-nonform-layout-02,original,2025,fte-ac2efdf03cc61480fc391b18,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Annual charitable giving statement.
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named; Reference amount: 479.00. Recipient: Example Household 207.",DONATION_RECORD,28,DONATION_RECORD,fdc-1277c6d60cf18dc5fdf690b7,synthetic-nonform-layout-02,original,2025,fte-5f2c97b22637cbe703304be7,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 369.00. Account holder: Example Person 300.",DONATION_RECORD,28,DONATION_RECORD,fdc-38f6fee81ae239d57ca01744,synthetic-nonform-layout-03,original,2025,fte-c4bdbe25285e1efe65d97c7e,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 388.00. Account holder: Example Person 301.",DONATION_RECORD,28,DONATION_RECORD,fdc-1d4bf5064ab00a5b2c0bc0ce,synthetic-nonform-layout-03,original,2025,fte-0a3a12f0bb66dd9d87fb35dd,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 407.00. Account holder: Example Person 302.",DONATION_RECORD,28,DONATION_RECORD,fdc-26d5b1cd7ffae850cfe8cae9,synthetic-nonform-layout-03,original,2025,fte-029fb72ab5a96f911ac2f0b4,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 426.00. Account holder: Example Person 303.",DONATION_RECORD,28,DONATION_RECORD,fdc-342ea1f0c83a0faf109740fa,synthetic-nonform-layout-03,original,2025,fte-0812e7b4e4cad5b13fa7fb90,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 445.00. Account holder: Example Person 304.",DONATION_RECORD,28,DONATION_RECORD,fdc-c557e117a983ad86c5697e96,synthetic-nonform-layout-03,original,2025,fte-e1b8fd847e2638e1c8353186,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 464.00. Account holder: Example Person 305.",DONATION_RECORD,28,DONATION_RECORD,fdc-cb10302065ad1911504b3fb2,synthetic-nonform-layout-03,original,2025,fte-6c2c4e5806c116d1c0cb2b71,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 483.00. Account holder: Example Person 306.",DONATION_RECORD,28,DONATION_RECORD,fdc-95aec00f1e557348887879fd,synthetic-nonform-layout-03,original,2025,fte-3f4bcdc4560857204de47af2,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement
Reporting period ended 12/31/2025.
Details: Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named, Reference amount: 502.00. Account holder: Example Person 307.",DONATION_RECORD,28,DONATION_RECORD,fdc-b0a086a3246bca460e086b23,synthetic-nonform-layout-03,original,2025,fte-b28ded7c5c04e84b3e872be7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 392.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 400",DONATION_RECORD,28,DONATION_RECORD,fdc-c78763d5981b824af7dceac9,synthetic-nonform-layout-04,original,2025,fte-794f5b22ac6c504caecf418f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 411.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 401",DONATION_RECORD,28,DONATION_RECORD,fdc-2f4a38658858d5997f7d820e,synthetic-nonform-layout-04,original,2025,fte-fc4d0eac0144f7fecd29df7f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 430.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 402",DONATION_RECORD,28,DONATION_RECORD,fdc-ecfc57c979ce708f1e0f8943,synthetic-nonform-layout-04,original,2025,fte-89257b6c860cd491093db2a1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 449.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 403",DONATION_RECORD,28,DONATION_RECORD,fdc-27752f178efe0eb757e911cb,synthetic-nonform-layout-04,original,2025,fte-e96a6f1810a6b226c1867d10,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 468.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 404",DONATION_RECORD,28,DONATION_RECORD,fdc-fc44da1faa289e54ca2ff887,synthetic-nonform-layout-04,original,2025,fte-840e098996479edc5cbf599a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 487.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 405",DONATION_RECORD,28,DONATION_RECORD,fdc-00aabe2a83c9f22ffdbedc43,synthetic-nonform-layout-04,original,2025,fte-d0594905e5f0de556a59e4ec,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 506.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 406",DONATION_RECORD,28,DONATION_RECORD,fdc-a571771498c4e827c2955d92,synthetic-nonform-layout-04,original,2025,fte-7a48c90b7ff774174d04e0ab,synthetic_AI_labeled,v1_template,top,False,
"Document header: Annual charitable giving statement
Tax reporting year 2025
Reference amount: 525.00
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named
Named party: Example Person 407",DONATION_RECORD,28,DONATION_RECORD,fdc-5e4dfdc3308dbaea02bf087c,synthetic-nonform-layout-04,original,2025,fte-eebb16503b9f8f833c11b88c,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 415.00
Delivery copy for Example Party 500",DONATION_RECORD,28,DONATION_RECORD,fdc-d13fbbcf5c43556a1b6aafe5,synthetic-nonform-layout-05,original,2025,fte-89473acbcc5f2deebfc0b979,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 434.00
Delivery copy for Example Party 501",DONATION_RECORD,28,DONATION_RECORD,fdc-13600b6176d609ec4ddf78ba,synthetic-nonform-layout-05,original,2025,fte-29e0a740969e7085dc586ad4,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 453.00
Delivery copy for Example Party 502",DONATION_RECORD,28,DONATION_RECORD,fdc-3a6b8f3ecb184935767cbbef,synthetic-nonform-layout-05,original,2025,fte-5d1a4db84449edf046e0d54e,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 472.00
Delivery copy for Example Party 503",DONATION_RECORD,28,DONATION_RECORD,fdc-eda48e85f7e46c1dcb3898f0,synthetic-nonform-layout-05,original,2025,fte-182f047ad494d1b95514e915,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 491.00
Delivery copy for Example Party 504",DONATION_RECORD,28,DONATION_RECORD,fdc-6a7ab1047d72b4f6a46ba0af,synthetic-nonform-layout-05,original,2025,fte-68aed69826b2f11a6092b423,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 510.00
Delivery copy for Example Party 505",DONATION_RECORD,28,DONATION_RECORD,fdc-ba425e3be6e0bc9e40b97190,synthetic-nonform-layout-05,original,2025,fte-243dfb46a8dc225a3728368b,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 529.00
Delivery copy for Example Party 506",DONATION_RECORD,28,DONATION_RECORD,fdc-12e45e485a4cd8ddd32487cb,synthetic-nonform-layout-05,original,2025,fte-eb32e4ddaf99f6343209fcad,synthetic_AI_labeled,v1_template,top,False,
"Annual charitable giving statement -- reporting year 2025
Individual gifts and dates; completed cash payments; no goods or services provided; donor and organization named / Reference amount: 548.00
Delivery copy for Example Party 507",DONATION_RECORD,28,DONATION_RECORD,fdc-cdb37f14d71a0622750aca67,synthetic-nonform-layout-05,original,2025,fte-c7ef848bf7b46cf6a7fec08e,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 0.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 300.00",DONATION_RECORD,28,DONATION_RECORD,fdc-b605b7b43c96f12c4092f8e2,synthetic-nonform-layout-00,original,2025,fte-0d2d18c9b16b82229d9657cf,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 1.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 319.00",DONATION_RECORD,28,DONATION_RECORD,fdc-ba38126e4ef397d2cede38be,synthetic-nonform-layout-00,original,2025,fte-c580288700807a3c94959a6a,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 2.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 338.00",DONATION_RECORD,28,DONATION_RECORD,fdc-d703ff063b5a90be3de22abe,synthetic-nonform-layout-00,original,2025,fte-ca3e797f3a2c38ef761ab5c5,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 3.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 357.00",DONATION_RECORD,28,DONATION_RECORD,fdc-35d318b4e87c5b264da68588,synthetic-nonform-layout-00,original,2025,fte-dbd9201eb12b8e5097317707,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 4.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 376.00",DONATION_RECORD,28,DONATION_RECORD,fdc-8baa275411662bccfe29ecf4,synthetic-nonform-layout-00,original,2025,fte-eab94c4a56a63c8dcaff6c8f,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 5.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 395.00",DONATION_RECORD,28,DONATION_RECORD,fdc-bbd19474a48e21f2ba435d32,synthetic-nonform-layout-00,original,2025,fte-6eeadb951ef9965f79828615,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 6.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 414.00",DONATION_RECORD,28,DONATION_RECORD,fdc-99e103689690464ca5e1ab16,synthetic-nonform-layout-00,original,2025,fte-a69c40df02783009fd87887f,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 7.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Reference amount: 433.00",DONATION_RECORD,28,DONATION_RECORD,fdc-e7fe4a113f0d4841a9df50ef,synthetic-nonform-layout-00,original,2025,fte-442067875fc228005b268b26,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 100
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 323.00",DONATION_RECORD,28,DONATION_RECORD,fdc-4a297fa35a407632918b063e,synthetic-nonform-layout-01,original,2025,fte-46860e05c5b6abbfed0b245c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 101
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 342.00",DONATION_RECORD,28,DONATION_RECORD,fdc-f6fa2fbf1edf2b764cace6f2,synthetic-nonform-layout-01,original,2025,fte-d3f9101fc98eadc7f75acc0a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 102
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 361.00",DONATION_RECORD,28,DONATION_RECORD,fdc-74330916c17feedd4769ce1c,synthetic-nonform-layout-01,original,2025,fte-26bfaf5d8aac7743d329576c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 103
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 380.00",DONATION_RECORD,28,DONATION_RECORD,fdc-fd0669ae9e12bf7141e0b29c,synthetic-nonform-layout-01,original,2025,fte-f637ea63d6bdca82fa51cb5c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 104
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 399.00",DONATION_RECORD,28,DONATION_RECORD,fdc-4a6ec00b1732475d8f66f946,synthetic-nonform-layout-01,original,2025,fte-3fad31eb18594371d5f0204a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 105
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 418.00",DONATION_RECORD,28,DONATION_RECORD,fdc-2d3192f4f8df503a8c428c2d,synthetic-nonform-layout-01,original,2025,fte-030cd816a93027ca61f27772,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 106
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 437.00",DONATION_RECORD,28,DONATION_RECORD,fdc-4058c673bb155101668b85e4,synthetic-nonform-layout-01,original,2025,fte-c258ff8b6a030b8dee9c01fb,synthetic_AI_labeled,v1_template,top,False,
"2025 | Noncash donation acknowledgment
Recipient record: Example Person 107
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied | Reference amount: 456.00",DONATION_RECORD,28,DONATION_RECORD,fdc-0c92e4ff088a77ccd6a3ff63,synthetic-nonform-layout-01,original,2025,fte-7dee6961300ae348c40ff4bb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 346.00. Recipient: Example Household 200.",DONATION_RECORD,28,DONATION_RECORD,fdc-08545b0a0d4b8fe8fb644468,synthetic-nonform-layout-02,original,2025,fte-787a42487835a91a780d0800,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 365.00. Recipient: Example Household 201.",DONATION_RECORD,28,DONATION_RECORD,fdc-f985f2607f81de3e72463a64,synthetic-nonform-layout-02,original,2025,fte-eaf6263ffc304f65a0a129f3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 384.00. Recipient: Example Household 202.",DONATION_RECORD,28,DONATION_RECORD,fdc-c2c9906d6da8c35b4b8e8842,synthetic-nonform-layout-02,original,2025,fte-a610f521d7d4fd437e43cf93,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 403.00. Recipient: Example Household 203.",DONATION_RECORD,28,DONATION_RECORD,fdc-b3ab37591c2ab25e56d1d81f,synthetic-nonform-layout-02,original,2025,fte-6576c483518a580bd3138381,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 422.00. Recipient: Example Household 204.",DONATION_RECORD,28,DONATION_RECORD,fdc-a402607cdac62dd7a268e6c0,synthetic-nonform-layout-02,original,2025,fte-1a46f5bbf0941739393b66fa,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 441.00. Recipient: Example Household 205.",DONATION_RECORD,28,DONATION_RECORD,fdc-cb002f958f17ad8d31f96542,synthetic-nonform-layout-02,original,2025,fte-ac21c0e8bb00b84c04eef8b3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 460.00. Recipient: Example Household 206.",DONATION_RECORD,28,DONATION_RECORD,fdc-b72e3c546c96e373af3ddeea,synthetic-nonform-layout-02,original,2025,fte-99fb6d0ff83643180efe84a1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Noncash donation acknowledgment.
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied; Reference amount: 479.00. Recipient: Example Household 207.",DONATION_RECORD,28,DONATION_RECORD,fdc-e6d4a7de64a0855eb305e3e0,synthetic-nonform-layout-02,original,2025,fte-35fe0ca2ec30e3fdbd9a1ea5,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 369.00. Account holder: Example Person 300.",DONATION_RECORD,28,DONATION_RECORD,fdc-32924144610479ec28738384,synthetic-nonform-layout-03,original,2025,fte-7b1c89e90768bb32ded6e939,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 388.00. Account holder: Example Person 301.",DONATION_RECORD,28,DONATION_RECORD,fdc-e082d0b8d999c44cf52dbd7d,synthetic-nonform-layout-03,original,2025,fte-a30aa6eaf08318c13dafad75,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 407.00. Account holder: Example Person 302.",DONATION_RECORD,28,DONATION_RECORD,fdc-86391e2b17ccbd37dcad8a62,synthetic-nonform-layout-03,original,2025,fte-afa679b983290b5d11ed0c3f,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 426.00. Account holder: Example Person 303.",DONATION_RECORD,28,DONATION_RECORD,fdc-428b07aad2e4f67b98d730a8,synthetic-nonform-layout-03,original,2025,fte-546674f8efd851b31797646b,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 445.00. Account holder: Example Person 304.",DONATION_RECORD,28,DONATION_RECORD,fdc-69989c68cd6a73842a50e30c,synthetic-nonform-layout-03,original,2025,fte-be514089d9a28d8793beae20,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 464.00. Account holder: Example Person 305.",DONATION_RECORD,28,DONATION_RECORD,fdc-8de41fd50e9f0b1e38474ea2,synthetic-nonform-layout-03,original,2025,fte-54f499b68b2aef2afefcca73,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 483.00. Account holder: Example Person 306.",DONATION_RECORD,28,DONATION_RECORD,fdc-c4cc03f2c0a5b29ae7fb9364,synthetic-nonform-layout-03,original,2025,fte-91390793ecd32dea58f2be95,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied, Reference amount: 502.00. Account holder: Example Person 307.",DONATION_RECORD,28,DONATION_RECORD,fdc-a3138e447d69ac309f354e66,synthetic-nonform-layout-03,original,2025,fte-78c6f043c6d53bf41262c6ef,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 392.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 400",DONATION_RECORD,28,DONATION_RECORD,fdc-75b066d6d581745650c6b2dd,synthetic-nonform-layout-04,original,2025,fte-cd2c4bd5eaea86a3a8606b9e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 411.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 401",DONATION_RECORD,28,DONATION_RECORD,fdc-4573cbad389d1caaac90d7e3,synthetic-nonform-layout-04,original,2025,fte-6f532a86822a275d956864c4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 430.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 402",DONATION_RECORD,28,DONATION_RECORD,fdc-d738c9f2f4dd22c83d7b4461,synthetic-nonform-layout-04,original,2025,fte-4ecaf93fb92e795437fa73e2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 449.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 403",DONATION_RECORD,28,DONATION_RECORD,fdc-39fe059fa649c3889e000f52,synthetic-nonform-layout-04,original,2025,fte-6c4808d9b6c06e7284cff28b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 468.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 404",DONATION_RECORD,28,DONATION_RECORD,fdc-d466f7d1107fabb59905f753,synthetic-nonform-layout-04,original,2025,fte-9e41ca6ce73a679f74739d77,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 487.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 405",DONATION_RECORD,28,DONATION_RECORD,fdc-43c41977d7d29e930a18d500,synthetic-nonform-layout-04,original,2025,fte-e5561b5d9edc58a2d24d492d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 506.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 406",DONATION_RECORD,28,DONATION_RECORD,fdc-539b084481ad85772fdaa59a,synthetic-nonform-layout-04,original,2025,fte-a1949ad1380ef525f454684b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Noncash donation acknowledgment
Tax reporting year 2025
Reference amount: 525.00
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied
Named party: Example Person 407",DONATION_RECORD,28,DONATION_RECORD,fdc-8091ac427c7f104c269e66a6,synthetic-nonform-layout-04,original,2025,fte-dec59fd554db4810afbd2c0f,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 415.00
Delivery copy for Example Party 500",DONATION_RECORD,28,DONATION_RECORD,fdc-7ddf0bcb28b3f4813e15d40f,synthetic-nonform-layout-05,original,2025,fte-57a4e6361557e099b65cf9aa,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 434.00
Delivery copy for Example Party 501",DONATION_RECORD,28,DONATION_RECORD,fdc-a7a5a6a07110159c2ced14de,synthetic-nonform-layout-05,original,2025,fte-061f0ce28a4bb02b952e2e6b,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 453.00
Delivery copy for Example Party 502",DONATION_RECORD,28,DONATION_RECORD,fdc-5884d4037089b3c5ae3f44b7,synthetic-nonform-layout-05,original,2025,fte-e882c1d8ff3c71c0029728a8,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 472.00
Delivery copy for Example Party 503",DONATION_RECORD,28,DONATION_RECORD,fdc-e2307a1e9745acac7f423a20,synthetic-nonform-layout-05,original,2025,fte-4320460c0e5c39136f77bb7e,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 491.00
Delivery copy for Example Party 504",DONATION_RECORD,28,DONATION_RECORD,fdc-cbaf7c6966784d45de646583,synthetic-nonform-layout-05,original,2025,fte-ea8f4f2d9c800c2a8d6ff421,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 510.00
Delivery copy for Example Party 505",DONATION_RECORD,28,DONATION_RECORD,fdc-ecad627aa2e754fb480ed5b5,synthetic-nonform-layout-05,original,2025,fte-1c547abcaae8d0b88518551e,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 529.00
Delivery copy for Example Party 506",DONATION_RECORD,28,DONATION_RECORD,fdc-8836bc79dfd94c7c2bc456dd,synthetic-nonform-layout-05,original,2025,fte-56d81945cda215aa189c60aa,synthetic_AI_labeled,v1_template,top,False,
"Noncash donation acknowledgment -- reporting year 2025
Donated household property described; charity confirms receipt; no value assigned by charity; goods and services statement supplied / Reference amount: 548.00
Delivery copy for Example Party 507",DONATION_RECORD,28,DONATION_RECORD,fdc-325fd8df8b8b72d0fd6877ea,synthetic-nonform-layout-05,original,2025,fte-27df4ca5fad2ab6bb5778557,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 0.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 300.00",DONATION_RECORD,28,DONATION_RECORD,fdc-f8233f5ad5155a3f1441c883,synthetic-nonform-layout-00,original,2025,fte-0c671a9a57f5532a74a1379d,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 1.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 319.00",DONATION_RECORD,28,DONATION_RECORD,fdc-61108bb69734b7caf2f41530,synthetic-nonform-layout-00,original,2025,fte-bf72921f8b9c433b7da627af,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 2.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 338.00",DONATION_RECORD,28,DONATION_RECORD,fdc-c7a5291a40b8ca4dfef88d4e,synthetic-nonform-layout-00,original,2025,fte-48c65e4a0c5523fd4b1c5e53,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 3.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 357.00",DONATION_RECORD,28,DONATION_RECORD,fdc-9e7c774955450f4fcbc50dea,synthetic-nonform-layout-00,original,2025,fte-6064b9e6046f9b09e1d3bc78,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 4.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 376.00",DONATION_RECORD,28,DONATION_RECORD,fdc-3db6c67b3d95301f1dba9775,synthetic-nonform-layout-00,original,2025,fte-cc956a667bdb7bd957933245,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 5.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 395.00",DONATION_RECORD,28,DONATION_RECORD,fdc-065708df7b4435cdd57ea3da,synthetic-nonform-layout-00,original,2025,fte-571d0e5fc9e904bff2211781,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 6.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 414.00",DONATION_RECORD,28,DONATION_RECORD,fdc-b6cf28c86430eb1a7ef64716,synthetic-nonform-layout-00,original,2025,fte-a25ff2d3b7fe63d4b8865b0c,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Calendar year: 2025
Statement issued to Example Person 7.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Reference amount: 433.00",DONATION_RECORD,28,DONATION_RECORD,fdc-339e3d4a8d7d339f549497b5,synthetic-nonform-layout-00,original,2025,fte-2409a36db3d6bc8a25ecfc03,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 100
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 323.00",DONATION_RECORD,28,DONATION_RECORD,fdc-251bc2f724420e72f2184b04,synthetic-nonform-layout-01,original,2025,fte-591feb73c39cdc1c5c606fbe,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 101
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 342.00",DONATION_RECORD,28,DONATION_RECORD,fdc-35b104b0982004a1f877072c,synthetic-nonform-layout-01,original,2025,fte-f3cfad6bf65f6b6673f83e3e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 102
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 361.00",DONATION_RECORD,28,DONATION_RECORD,fdc-9a726aaf4cf99da2b71b5732,synthetic-nonform-layout-01,original,2025,fte-d928411e638599a4fb90d66e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 103
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 380.00",DONATION_RECORD,28,DONATION_RECORD,fdc-c6e345f3ad4049daa1be7727,synthetic-nonform-layout-01,original,2025,fte-bfbf0d72558632903b1ad27e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 104
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 399.00",DONATION_RECORD,28,DONATION_RECORD,fdc-4ef8b5dde91ea0153a4cb740,synthetic-nonform-layout-01,original,2025,fte-c90b39e99f99df26aedaf3bd,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 105
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 418.00",DONATION_RECORD,28,DONATION_RECORD,fdc-170744d872145dfe96b41180,synthetic-nonform-layout-01,original,2025,fte-dadd25ff345fb5d601fae7d6,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 106
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 437.00",DONATION_RECORD,28,DONATION_RECORD,fdc-535c8142632b8aed9f82aa53,synthetic-nonform-layout-01,original,2025,fte-cb0b9dc2d006248c9c5aa9ce,synthetic_AI_labeled,v1_template,top,False,
"2025 | Vehicle donation acknowledgment
Recipient record: Example Person 107
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C | Reference amount: 456.00",DONATION_RECORD,28,DONATION_RECORD,fdc-a6eca2165b78519e157b75ab,synthetic-nonform-layout-01,original,2025,fte-64544f22a31819f2ff040ee6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 346.00. Recipient: Example Household 200.",DONATION_RECORD,28,DONATION_RECORD,fdc-d655afe3ba5f89b8f8688e2d,synthetic-nonform-layout-02,original,2025,fte-24f1c6b04f83bda32c564a82,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 365.00. Recipient: Example Household 201.",DONATION_RECORD,28,DONATION_RECORD,fdc-9eb60e4f9ecf2f393e0f43ec,synthetic-nonform-layout-02,original,2025,fte-dd966effdd52f92870387956,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 384.00. Recipient: Example Household 202.",DONATION_RECORD,28,DONATION_RECORD,fdc-d62794cc595660c8bf4de4a0,synthetic-nonform-layout-02,original,2025,fte-91e362919a5574024bd4af30,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 403.00. Recipient: Example Household 203.",DONATION_RECORD,28,DONATION_RECORD,fdc-975a7cea296ac0019062dc98,synthetic-nonform-layout-02,original,2025,fte-f77c0f02c0be37bf6b6337b6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 422.00. Recipient: Example Household 204.",DONATION_RECORD,28,DONATION_RECORD,fdc-9c8d9f1fb0a2d534ddf8a21d,synthetic-nonform-layout-02,original,2025,fte-12edd8b00388729aecfcd43f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 441.00. Recipient: Example Household 205.",DONATION_RECORD,28,DONATION_RECORD,fdc-fbcb058a88cc45e0835b043a,synthetic-nonform-layout-02,original,2025,fte-75465ee7ae003ae687bbde60,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 460.00. Recipient: Example Household 206.",DONATION_RECORD,28,DONATION_RECORD,fdc-42a8164dda35c4c195050be3,synthetic-nonform-layout-02,original,2025,fte-4c55b3bc11b73fd12de3f636,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Vehicle donation acknowledgment.
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C; Reference amount: 479.00. Recipient: Example Household 207.",DONATION_RECORD,28,DONATION_RECORD,fdc-51df2ef8fa4899dd78611870,synthetic-nonform-layout-02,original,2025,fte-1ed8bbd1c5a717d9299145da,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 369.00. Account holder: Example Person 300.",DONATION_RECORD,28,DONATION_RECORD,fdc-29ebb908525740e8dbc0d422,synthetic-nonform-layout-03,original,2025,fte-55599015b1f31a79c07ce74e,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 388.00. Account holder: Example Person 301.",DONATION_RECORD,28,DONATION_RECORD,fdc-643b66d3d886fcb764c4d149,synthetic-nonform-layout-03,original,2025,fte-1fc2906ace99a88e12a6b1de,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 407.00. Account holder: Example Person 302.",DONATION_RECORD,28,DONATION_RECORD,fdc-a434b061107862dd4328376c,synthetic-nonform-layout-03,original,2025,fte-c1fc551a2a0bd9fd46edb6b9,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 426.00. Account holder: Example Person 303.",DONATION_RECORD,28,DONATION_RECORD,fdc-88c44a86fb26013dd8a1be0b,synthetic-nonform-layout-03,original,2025,fte-070e2f19cb721e7e7f36bfc0,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 445.00. Account holder: Example Person 304.",DONATION_RECORD,28,DONATION_RECORD,fdc-18f2abe39cae182146c078aa,synthetic-nonform-layout-03,original,2025,fte-98505bea8a26af0ebcf5c29b,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 464.00. Account holder: Example Person 305.",DONATION_RECORD,28,DONATION_RECORD,fdc-4e16feafd0948023215fedc2,synthetic-nonform-layout-03,original,2025,fte-6e426eedf843bbb28cbcf929,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 483.00. Account holder: Example Person 306.",DONATION_RECORD,28,DONATION_RECORD,fdc-d9427f4e4a96de305b18e9d8,synthetic-nonform-layout-03,original,2025,fte-3a1b24f06a8a2b2a51130f31,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment
Reporting period ended 12/31/2025.
Details: Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C, Reference amount: 502.00. Account holder: Example Person 307.",DONATION_RECORD,28,DONATION_RECORD,fdc-6fef667ce6a265fe83871cbc,synthetic-nonform-layout-03,original,2025,fte-264a6ca26fbb54f7b7fa2629,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 392.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 400",DONATION_RECORD,28,DONATION_RECORD,fdc-06e73b5736f744d4b0f53e81,synthetic-nonform-layout-04,original,2025,fte-ec806e81ab45da7e0e46f6c6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 411.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 401",DONATION_RECORD,28,DONATION_RECORD,fdc-3b2559a7373dace2b637bef7,synthetic-nonform-layout-04,original,2025,fte-f58d6107314c61683fed3428,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 430.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 402",DONATION_RECORD,28,DONATION_RECORD,fdc-898d6ad05d7aec44cb6d2dfc,synthetic-nonform-layout-04,original,2025,fte-d865c1bcc7cd55e1ff71e04a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 449.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 403",DONATION_RECORD,28,DONATION_RECORD,fdc-768880616dae1ccc9fbc1c2a,synthetic-nonform-layout-04,original,2025,fte-6d0a1c8b9722b66122ce56a5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 468.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 404",DONATION_RECORD,28,DONATION_RECORD,fdc-cd89b069e82a6028bef603cb,synthetic-nonform-layout-04,original,2025,fte-c4d1cc251a7bb8f25e825eb6,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 487.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 405",DONATION_RECORD,28,DONATION_RECORD,fdc-f08efec49f90fe509306b6e2,synthetic-nonform-layout-04,original,2025,fte-323b78f677e48e4aa0f1a552,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 506.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 406",DONATION_RECORD,28,DONATION_RECORD,fdc-53db98c327172324c3990fce,synthetic-nonform-layout-04,original,2025,fte-68d85ea9714bf9e4341d937f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Vehicle donation acknowledgment
Tax reporting year 2025
Reference amount: 525.00
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C
Named party: Example Person 407",DONATION_RECORD,28,DONATION_RECORD,fdc-2004d3f40696b53738be3663,synthetic-nonform-layout-04,original,2025,fte-a242a345cbb8718b4b8bb312,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 415.00
Delivery copy for Example Party 500",DONATION_RECORD,28,DONATION_RECORD,fdc-b7b7c309d01973af4b23bed6,synthetic-nonform-layout-05,original,2025,fte-d8a11e938bcd661a9dee39ce,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 434.00
Delivery copy for Example Party 501",DONATION_RECORD,28,DONATION_RECORD,fdc-3aa549c8fd13471e82993bd9,synthetic-nonform-layout-05,original,2025,fte-93885f81efdce105362fd6fc,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 453.00
Delivery copy for Example Party 502",DONATION_RECORD,28,DONATION_RECORD,fdc-bdc1f5743897973148ed84a0,synthetic-nonform-layout-05,original,2025,fte-ab19195817cf1b2d500b58de,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 472.00
Delivery copy for Example Party 503",DONATION_RECORD,28,DONATION_RECORD,fdc-fdeda72dd897f3dfab2c2f65,synthetic-nonform-layout-05,original,2025,fte-09efaddec908f86a4f10b49c,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 491.00
Delivery copy for Example Party 504",DONATION_RECORD,28,DONATION_RECORD,fdc-8f4294d2f592db54122c3cf8,synthetic-nonform-layout-05,original,2025,fte-7ddc9235cec37c8e74490e7d,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 510.00
Delivery copy for Example Party 505",DONATION_RECORD,28,DONATION_RECORD,fdc-8d41707f4332dd74919a4811,synthetic-nonform-layout-05,original,2025,fte-8a97128906609c63ecd79c87,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 529.00
Delivery copy for Example Party 506",DONATION_RECORD,28,DONATION_RECORD,fdc-8103836d9ccc5f39a00f5354,synthetic-nonform-layout-05,original,2025,fte-be6d0cb5b1ea40ae6e02675e,synthetic_AI_labeled,v1_template,top,False,
"Vehicle donation acknowledgment -- reporting year 2025
Donor vehicle contribution recorded; sale proceeds and recipient organization shown; verify related 1098-C / Reference amount: 548.00
Delivery copy for Example Party 507",DONATION_RECORD,28,DONATION_RECORD,fdc-b07357aca622b6c359a791df,synthetic-nonform-layout-05,original,2025,fte-5765eee8a8332dfa8e6d3cf7,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 0.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 300.00",GIFT_RECORD,29,GIFT_RECORD,fdc-01a446eaa86615305a0f7c8e,synthetic-nonform-layout-00,original,2025,fte-0b3668be1f3e207ef193ce24,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 1.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 319.00",GIFT_RECORD,29,GIFT_RECORD,fdc-1d7f7010a8d49d1dc25cd013,synthetic-nonform-layout-00,original,2025,fte-3b29ea324d1a3cbccf0e0b90,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 2.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 338.00",GIFT_RECORD,29,GIFT_RECORD,fdc-98d164e0f6b50583d6052d88,synthetic-nonform-layout-00,original,2025,fte-ad03350d86bdc010d031517b,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 3.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 357.00",GIFT_RECORD,29,GIFT_RECORD,fdc-160c9127df53cbd3b138f85a,synthetic-nonform-layout-00,original,2025,fte-4018dfa22dee7017aba354a4,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 4.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 376.00",GIFT_RECORD,29,GIFT_RECORD,fdc-2a14360bf66809e403d84229,synthetic-nonform-layout-00,original,2025,fte-9924cfbf5e5db28273d2903c,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 5.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 395.00",GIFT_RECORD,29,GIFT_RECORD,fdc-1cbde9cd6d1db949bed1274e,synthetic-nonform-layout-00,original,2025,fte-a39d93ceb3369dd6c8e2f13f,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 6.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 414.00",GIFT_RECORD,29,GIFT_RECORD,fdc-8e6aa7000ef0658f984a5d87,synthetic-nonform-layout-00,original,2025,fte-0773c4b2eab8854019bc8f75,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Calendar year: 2025
Statement issued to Example Person 7.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Reference amount: 433.00",GIFT_RECORD,29,GIFT_RECORD,fdc-46e4bbf062e49a05e8f94a70,synthetic-nonform-layout-00,original,2025,fte-ba42908c2e3f181292117e20,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 100
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 323.00",GIFT_RECORD,29,GIFT_RECORD,fdc-a698d6724b973e77ce2e6398,synthetic-nonform-layout-01,original,2025,fte-e84a00e519e3b860d7bd8887,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 101
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 342.00",GIFT_RECORD,29,GIFT_RECORD,fdc-64a9b9a6b20e5d42f3b44c0d,synthetic-nonform-layout-01,original,2025,fte-7ae49cf0a9c3eaf8f9b70dc3,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 102
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 361.00",GIFT_RECORD,29,GIFT_RECORD,fdc-6becc97ad21123742ba5ea15,synthetic-nonform-layout-01,original,2025,fte-9ec5a5af0f5283de01e29ed8,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 103
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 380.00",GIFT_RECORD,29,GIFT_RECORD,fdc-5e337066f2eab20848107bf5,synthetic-nonform-layout-01,original,2025,fte-bfe08a40a8ab8e86926fe1e5,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 104
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 399.00",GIFT_RECORD,29,GIFT_RECORD,fdc-c53b42fed1a8ac1ac1093416,synthetic-nonform-layout-01,original,2025,fte-e4f1ad5a2717dea3e76f5783,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 105
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 418.00",GIFT_RECORD,29,GIFT_RECORD,fdc-7f42b921f5d61cbbca85ceb8,synthetic-nonform-layout-01,original,2025,fte-580a171d2780b015170df035,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 106
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 437.00",GIFT_RECORD,29,GIFT_RECORD,fdc-e441c2448216cbe56345b6f7,synthetic-nonform-layout-01,original,2025,fte-55e4613454dd8b2a39d23916,synthetic_AI_labeled,v1_template,top,False,
"2025 | Personal gift letter
Recipient record: Example Person 107
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation | Reference amount: 456.00",GIFT_RECORD,29,GIFT_RECORD,fdc-296e2b9f1ca470f2791cdac8,synthetic-nonform-layout-01,original,2025,fte-ff398e6a7d448d2ee20a8724,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 346.00. Recipient: Example Household 200.",GIFT_RECORD,29,GIFT_RECORD,fdc-49d4cb34d9ff6615a7fd0bd2,synthetic-nonform-layout-02,original,2025,fte-ba1ab4129ba8371f73c85aed,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 365.00. Recipient: Example Household 201.",GIFT_RECORD,29,GIFT_RECORD,fdc-59aac3bfcb977293de8f7744,synthetic-nonform-layout-02,original,2025,fte-0bedc015812b9948b732e434,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 384.00. Recipient: Example Household 202.",GIFT_RECORD,29,GIFT_RECORD,fdc-1e227885f45c6440323a3af2,synthetic-nonform-layout-02,original,2025,fte-fe56f004ecf21d2cf139cf18,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 403.00. Recipient: Example Household 203.",GIFT_RECORD,29,GIFT_RECORD,fdc-6eb23b5590cfc0bef3b1d2b8,synthetic-nonform-layout-02,original,2025,fte-3ed87f561bbcbcfa15163caf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 422.00. Recipient: Example Household 204.",GIFT_RECORD,29,GIFT_RECORD,fdc-0dc92725d94ae61c27d9bad1,synthetic-nonform-layout-02,original,2025,fte-8555efc24969ff33b3bf5dd6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 441.00. Recipient: Example Household 205.",GIFT_RECORD,29,GIFT_RECORD,fdc-f3f79039d418044e5dae15a4,synthetic-nonform-layout-02,original,2025,fte-85c063ca0eee266da4f075a8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 460.00. Recipient: Example Household 206.",GIFT_RECORD,29,GIFT_RECORD,fdc-db8122429064408fb666ea8f,synthetic-nonform-layout-02,original,2025,fte-193e9b688c056617072d59a7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Personal gift letter.
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation; Reference amount: 479.00. Recipient: Example Household 207.",GIFT_RECORD,29,GIFT_RECORD,fdc-1eadf0b3d08a281ca48047b8,synthetic-nonform-layout-02,original,2025,fte-dee87c29dcabf4c6ab6ad13e,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 369.00. Account holder: Example Person 300.",GIFT_RECORD,29,GIFT_RECORD,fdc-8eaa35c30d27de70e816f372,synthetic-nonform-layout-03,original,2025,fte-076c4f0ae13bce2c3023e4c1,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 388.00. Account holder: Example Person 301.",GIFT_RECORD,29,GIFT_RECORD,fdc-b1091a306b649353a9de21cb,synthetic-nonform-layout-03,original,2025,fte-fd6e857e7d42179550491bec,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 407.00. Account holder: Example Person 302.",GIFT_RECORD,29,GIFT_RECORD,fdc-7825ed595b91f420d33f56eb,synthetic-nonform-layout-03,original,2025,fte-4a0b56e2115d6cfb0ba7e165,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 426.00. Account holder: Example Person 303.",GIFT_RECORD,29,GIFT_RECORD,fdc-c784fef7140206c9a7fd60a8,synthetic-nonform-layout-03,original,2025,fte-d0b405c381b024eb34675a23,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 445.00. Account holder: Example Person 304.",GIFT_RECORD,29,GIFT_RECORD,fdc-f508fef3b7a72870549b1967,synthetic-nonform-layout-03,original,2025,fte-5b1e568d05465f3d84ee83b6,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 464.00. Account holder: Example Person 305.",GIFT_RECORD,29,GIFT_RECORD,fdc-643c0657c5e740962c5b8a16,synthetic-nonform-layout-03,original,2025,fte-2ab532b4244cd33b85181302,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 483.00. Account holder: Example Person 306.",GIFT_RECORD,29,GIFT_RECORD,fdc-9003747a6ca003888cbfbca7,synthetic-nonform-layout-03,original,2025,fte-dad10ab1ee41373029ae4446,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter
Reporting period ended 12/31/2025.
Details: Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation, Reference amount: 502.00. Account holder: Example Person 307.",GIFT_RECORD,29,GIFT_RECORD,fdc-d8efde818df999a389753c93,synthetic-nonform-layout-03,original,2025,fte-cb580a21e7a4282581ff1c37,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 392.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 400",GIFT_RECORD,29,GIFT_RECORD,fdc-842da733fc19a0b74abf1a50,synthetic-nonform-layout-04,original,2025,fte-be2fdc44caec874d5d61b8c0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 411.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 401",GIFT_RECORD,29,GIFT_RECORD,fdc-d72ec2617994541d6b5636d6,synthetic-nonform-layout-04,original,2025,fte-b15bbc9a7efd222ed2420b98,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 430.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 402",GIFT_RECORD,29,GIFT_RECORD,fdc-5c7b7a04c1a02ed000c12595,synthetic-nonform-layout-04,original,2025,fte-035767ba3f5a453452045f13,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 449.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 403",GIFT_RECORD,29,GIFT_RECORD,fdc-d35f488ef3d0258c3c1628b1,synthetic-nonform-layout-04,original,2025,fte-b6a4132297e5f42b6429ad94,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 468.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 404",GIFT_RECORD,29,GIFT_RECORD,fdc-bf9d8fe6a073a99dbbe12733,synthetic-nonform-layout-04,original,2025,fte-e838726d78b4d49b19018b88,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 487.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 405",GIFT_RECORD,29,GIFT_RECORD,fdc-db48a70f044056fada275bf6,synthetic-nonform-layout-04,original,2025,fte-87bb8af1a729a2a3aa12c49e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 506.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 406",GIFT_RECORD,29,GIFT_RECORD,fdc-77649950f8193ea31bb092e4,synthetic-nonform-layout-04,original,2025,fte-bdad35488c9b546ad7727910,synthetic_AI_labeled,v1_template,top,False,
"Document header: Personal gift letter
Tax reporting year 2025
Reference amount: 525.00
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation
Named party: Example Person 407",GIFT_RECORD,29,GIFT_RECORD,fdc-e7c3d9abc3cc5d6ab026500a,synthetic-nonform-layout-04,original,2025,fte-6a6067f4833fffd91f9f8d37,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 415.00
Delivery copy for Example Party 500",GIFT_RECORD,29,GIFT_RECORD,fdc-b1098cfd0ba0200e9d69b326,synthetic-nonform-layout-05,original,2025,fte-5604fbdda4298a972e30a833,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 434.00
Delivery copy for Example Party 501",GIFT_RECORD,29,GIFT_RECORD,fdc-fcbbb8f2ceedb9137d98abfe,synthetic-nonform-layout-05,original,2025,fte-fc3f153cb3e6079ff4e2b905,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 453.00
Delivery copy for Example Party 502",GIFT_RECORD,29,GIFT_RECORD,fdc-889a00de4e380ac4525b526a,synthetic-nonform-layout-05,original,2025,fte-90b60ffa7f93f696a2219e19,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 472.00
Delivery copy for Example Party 503",GIFT_RECORD,29,GIFT_RECORD,fdc-d2b3c015fbcf51d139744396,synthetic-nonform-layout-05,original,2025,fte-d81d09e5d582c9d7e36e2863,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 491.00
Delivery copy for Example Party 504",GIFT_RECORD,29,GIFT_RECORD,fdc-b17ad0adb4ccc328ec442cd5,synthetic-nonform-layout-05,original,2025,fte-e557832902356d8b8cbdc564,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 510.00
Delivery copy for Example Party 505",GIFT_RECORD,29,GIFT_RECORD,fdc-332ceeeadce51a8f9a7b27a0,synthetic-nonform-layout-05,original,2025,fte-cf66cdfb37e05c51ef76296d,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 529.00
Delivery copy for Example Party 506",GIFT_RECORD,29,GIFT_RECORD,fdc-170cb5ca4809ec280e5309b2,synthetic-nonform-layout-05,original,2025,fte-ff4d4c9697ceacfac34554fd,synthetic_AI_labeled,v1_template,top,False,
"Personal gift letter -- reporting year 2025
Family donor states transfer is a completed personal gift, with no services, sale or repayment obligation / Reference amount: 548.00
Delivery copy for Example Party 507",GIFT_RECORD,29,GIFT_RECORD,fdc-7cd389934f6a16c56daff563,synthetic-nonform-layout-05,original,2025,fte-d821f583f4ebe79f0ba4d495,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 0.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 300.00",GIFT_RECORD,29,GIFT_RECORD,fdc-e7cc31d177e04d2c87041984,synthetic-nonform-layout-00,original,2025,fte-559aedf1a2129db73faf788d,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 1.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 319.00",GIFT_RECORD,29,GIFT_RECORD,fdc-fb9385a1dc25989df2e05f56,synthetic-nonform-layout-00,original,2025,fte-6762169dc585ce53e46e3f79,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 2.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 338.00",GIFT_RECORD,29,GIFT_RECORD,fdc-a52899107e15c7bb93aac391,synthetic-nonform-layout-00,original,2025,fte-f58edda1eb5a827c668e6a4e,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 3.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 357.00",GIFT_RECORD,29,GIFT_RECORD,fdc-191737bbadeba825a8c55c65,synthetic-nonform-layout-00,original,2025,fte-3f8c5839cb39a7a6d94e7724,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 4.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 376.00",GIFT_RECORD,29,GIFT_RECORD,fdc-cf8afc2b0bf79c2818ddd557,synthetic-nonform-layout-00,original,2025,fte-a20e835d2c4ea4c7a37c00c5,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 5.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 395.00",GIFT_RECORD,29,GIFT_RECORD,fdc-2912e1bd3b3db48c44bc648d,synthetic-nonform-layout-00,original,2025,fte-24e04f7762e557af399e7131,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 6.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 414.00",GIFT_RECORD,29,GIFT_RECORD,fdc-a3db54c8ad5abfe0c439dd2d,synthetic-nonform-layout-00,original,2025,fte-593bc1a015dbcb329629e4d7,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Calendar year: 2025
Statement issued to Example Person 7.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Reference amount: 433.00",GIFT_RECORD,29,GIFT_RECORD,fdc-3fed5d1dd51d477d2338ce7d,synthetic-nonform-layout-00,original,2025,fte-628729b69842f03f27f5e84b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 100
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 323.00",GIFT_RECORD,29,GIFT_RECORD,fdc-21e81e09bfc7d9df8b2ae155,synthetic-nonform-layout-01,original,2025,fte-9d1c3f5be4dd836281c2a6ea,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 101
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 342.00",GIFT_RECORD,29,GIFT_RECORD,fdc-b6f3f4dbc4f687823576039d,synthetic-nonform-layout-01,original,2025,fte-c73da48560c7c223bb3f7869,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 102
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 361.00",GIFT_RECORD,29,GIFT_RECORD,fdc-69bd003a33f89ab0350a12d1,synthetic-nonform-layout-01,original,2025,fte-66159cbd85456393a86dea0b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 103
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 380.00",GIFT_RECORD,29,GIFT_RECORD,fdc-67aafa564b04c8a1951262b3,synthetic-nonform-layout-01,original,2025,fte-c1af522b57d8f9fd9ad91875,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 104
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 399.00",GIFT_RECORD,29,GIFT_RECORD,fdc-12be8b05dc666511503680f2,synthetic-nonform-layout-01,original,2025,fte-1cde2c149002a546ed477a2d,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 105
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 418.00",GIFT_RECORD,29,GIFT_RECORD,fdc-9a7040bbd3373d79ea0bd3c2,synthetic-nonform-layout-01,original,2025,fte-ed08eaa5550b4d072de1bc35,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 106
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 437.00",GIFT_RECORD,29,GIFT_RECORD,fdc-f3ce682cf6cb25b66b8bb01f,synthetic-nonform-layout-01,original,2025,fte-6d91cbdc38bbbd0220ec9324,synthetic_AI_labeled,v1_template,top,False,
"2025 | Foreign gift evidence
Recipient record: Example Person 107
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review | Reference amount: 456.00",GIFT_RECORD,29,GIFT_RECORD,fdc-9def2e8cc282647878645a35,synthetic-nonform-layout-01,original,2025,fte-4700fbee089632a04aea13c6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 346.00. Recipient: Example Household 200.",GIFT_RECORD,29,GIFT_RECORD,fdc-717b6754e38f567fe212856f,synthetic-nonform-layout-02,original,2025,fte-e3c5087fac267ddb85f6c607,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 365.00. Recipient: Example Household 201.",GIFT_RECORD,29,GIFT_RECORD,fdc-b03aa8c03ae206db579a2206,synthetic-nonform-layout-02,original,2025,fte-179fd891d8c4776d3b44039b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 384.00. Recipient: Example Household 202.",GIFT_RECORD,29,GIFT_RECORD,fdc-5687b6bd705105f929fe893c,synthetic-nonform-layout-02,original,2025,fte-327c05f3bea447c2641ab894,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 403.00. Recipient: Example Household 203.",GIFT_RECORD,29,GIFT_RECORD,fdc-1e5e257bf4ba6fec20d4b22f,synthetic-nonform-layout-02,original,2025,fte-7643dd93e7c2cae9ead442c2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 422.00. Recipient: Example Household 204.",GIFT_RECORD,29,GIFT_RECORD,fdc-9e5285d15d69adaefe31608a,synthetic-nonform-layout-02,original,2025,fte-baae277cbf31ba496eac3caa,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 441.00. Recipient: Example Household 205.",GIFT_RECORD,29,GIFT_RECORD,fdc-1cee1c5199e4e67dea08d7b7,synthetic-nonform-layout-02,original,2025,fte-038a6218e5af4ab1776bbac4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 460.00. Recipient: Example Household 206.",GIFT_RECORD,29,GIFT_RECORD,fdc-db1cbc9495d17d23a78dc967,synthetic-nonform-layout-02,original,2025,fte-0557842d67e9fae069e204d5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Foreign gift evidence.
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review; Reference amount: 479.00. Recipient: Example Household 207.",GIFT_RECORD,29,GIFT_RECORD,fdc-c0a8cb2e920cd2d55b814a51,synthetic-nonform-layout-02,original,2025,fte-1171900741e94808e8cdd0f2,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 369.00. Account holder: Example Person 300.",GIFT_RECORD,29,GIFT_RECORD,fdc-e915435d07d5fb526b3d5df1,synthetic-nonform-layout-03,original,2025,fte-65bf1f61e0fd946ce3bfaead,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 388.00. Account holder: Example Person 301.",GIFT_RECORD,29,GIFT_RECORD,fdc-d120e0f591d1a59ccc4a6af3,synthetic-nonform-layout-03,original,2025,fte-7ba098275e56784fff4f7064,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 407.00. Account holder: Example Person 302.",GIFT_RECORD,29,GIFT_RECORD,fdc-a0d2238c7eb36ca7c0d0442c,synthetic-nonform-layout-03,original,2025,fte-c66d2d5dccf85500a188cd4e,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 426.00. Account holder: Example Person 303.",GIFT_RECORD,29,GIFT_RECORD,fdc-6f2cec0e67dafc2769103ae6,synthetic-nonform-layout-03,original,2025,fte-b402fae4bf2696ce61c649c3,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 445.00. Account holder: Example Person 304.",GIFT_RECORD,29,GIFT_RECORD,fdc-595b01030df202fa732104e6,synthetic-nonform-layout-03,original,2025,fte-1c9434fe0ace3e3b304f43bc,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 464.00. Account holder: Example Person 305.",GIFT_RECORD,29,GIFT_RECORD,fdc-ad50f12917b008f572266ee7,synthetic-nonform-layout-03,original,2025,fte-1947c18ac246b45de19347ed,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 483.00. Account holder: Example Person 306.",GIFT_RECORD,29,GIFT_RECORD,fdc-f256a4568c7f0630c64791e5,synthetic-nonform-layout-03,original,2025,fte-80b88c6673047feec6594b74,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence
Reporting period ended 12/31/2025.
Details: Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review, Reference amount: 502.00. Account holder: Example Person 307.",GIFT_RECORD,29,GIFT_RECORD,fdc-f6a9c86ff51245f50e493649,synthetic-nonform-layout-03,original,2025,fte-82e015385b18e4191e668b26,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 392.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 400",GIFT_RECORD,29,GIFT_RECORD,fdc-a39c7f6822c8ad05ef6de1e8,synthetic-nonform-layout-04,original,2025,fte-318da5459ecd6c1c08425cdd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 411.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 401",GIFT_RECORD,29,GIFT_RECORD,fdc-e400654952dc0a62696c91b0,synthetic-nonform-layout-04,original,2025,fte-e93a26c2723bdc956346978a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 430.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 402",GIFT_RECORD,29,GIFT_RECORD,fdc-78422caa216706b877aeeff0,synthetic-nonform-layout-04,original,2025,fte-7cd04755a6398ed2c2598742,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 449.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 403",GIFT_RECORD,29,GIFT_RECORD,fdc-0a22927236ff101a0e35ff8f,synthetic-nonform-layout-04,original,2025,fte-3db6315246284b6332f537dd,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 468.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 404",GIFT_RECORD,29,GIFT_RECORD,fdc-e86c17d50aefe4c5ec7e12e8,synthetic-nonform-layout-04,original,2025,fte-2c8c19b2d5d101feb008a3c8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 487.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 405",GIFT_RECORD,29,GIFT_RECORD,fdc-1d6a33aecad357f5d0f8798b,synthetic-nonform-layout-04,original,2025,fte-96dc03fc0bab08e5d24796c7,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 506.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 406",GIFT_RECORD,29,GIFT_RECORD,fdc-cd0d1cb4058fa1c78a0eb1ef,synthetic-nonform-layout-04,original,2025,fte-15f1567bcce8930f3d0508ac,synthetic_AI_labeled,v1_template,top,False,
"Document header: Foreign gift evidence
Tax reporting year 2025
Reference amount: 525.00
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review
Named party: Example Person 407",GIFT_RECORD,29,GIFT_RECORD,fdc-cb930424e688bd90ae28fd94,synthetic-nonform-layout-04,original,2025,fte-d407e29a4a2fcdb974e299de,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 415.00
Delivery copy for Example Party 500",GIFT_RECORD,29,GIFT_RECORD,fdc-132d3d038fce813adbd001ba,synthetic-nonform-layout-05,original,2025,fte-9fef352b0f2828e717c80785,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 434.00
Delivery copy for Example Party 501",GIFT_RECORD,29,GIFT_RECORD,fdc-84e5088de43a40285654d80e,synthetic-nonform-layout-05,original,2025,fte-8d9922a43868e26ee5557e56,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 453.00
Delivery copy for Example Party 502",GIFT_RECORD,29,GIFT_RECORD,fdc-66d43c09e9f3e999976f8261,synthetic-nonform-layout-05,original,2025,fte-ac5c340e8942d07a90cf98b8,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 472.00
Delivery copy for Example Party 503",GIFT_RECORD,29,GIFT_RECORD,fdc-186ca6cfbdd5b0d8f1a62a76,synthetic-nonform-layout-05,original,2025,fte-f54d7f0d204a704ec0211a3d,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 491.00
Delivery copy for Example Party 504",GIFT_RECORD,29,GIFT_RECORD,fdc-2a2102b2611c4939b490198a,synthetic-nonform-layout-05,original,2025,fte-c7faf2fa804ef25e48edc5a4,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 510.00
Delivery copy for Example Party 505",GIFT_RECORD,29,GIFT_RECORD,fdc-48f08d93e2cae782724b644a,synthetic-nonform-layout-05,original,2025,fte-8284acfc5a2c63f6134b0856,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 529.00
Delivery copy for Example Party 506",GIFT_RECORD,29,GIFT_RECORD,fdc-035a60c13206531b2baf9140,synthetic-nonform-layout-05,original,2025,fte-32a0ac9dc33d42ec5e4630f4,synthetic_AI_labeled,v1_template,top,False,
"Foreign gift evidence -- reporting year 2025
Letter identifies foreign donor and US recipient; no services; foreign information reporting requires specialist review / Reference amount: 548.00
Delivery copy for Example Party 507",GIFT_RECORD,29,GIFT_RECORD,fdc-ff42686040d63f8cdaae1fbc,synthetic-nonform-layout-05,original,2025,fte-0bfc54a3cc60a136002813d9,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 0.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 300.00",GIFT_RECORD,29,GIFT_RECORD,fdc-91e561e3b41d83ddfa16f90f,synthetic-nonform-layout-00,original,2025,fte-1c1eed48bb46b8e386c4d11f,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 1.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 319.00",GIFT_RECORD,29,GIFT_RECORD,fdc-1d60469a0c2bd3c2c05983d0,synthetic-nonform-layout-00,original,2025,fte-f891c2d553e673c970ece48a,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 2.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 338.00",GIFT_RECORD,29,GIFT_RECORD,fdc-046f70f973b54dff34bb4ddf,synthetic-nonform-layout-00,original,2025,fte-f54b8c14647307c9253f7a82,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 3.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 357.00",GIFT_RECORD,29,GIFT_RECORD,fdc-04b48ce34bb0ee4c26396f12,synthetic-nonform-layout-00,original,2025,fte-ddaf5975e61fd36ae9f03428,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 4.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 376.00",GIFT_RECORD,29,GIFT_RECORD,fdc-dba5d8196bfd96ba67b7a404,synthetic-nonform-layout-00,original,2025,fte-57da92c2ec78fac666111f39,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 5.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 395.00",GIFT_RECORD,29,GIFT_RECORD,fdc-2dd215820a4ccb97a99344b3,synthetic-nonform-layout-00,original,2025,fte-1161110f74724119e022199e,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 6.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 414.00",GIFT_RECORD,29,GIFT_RECORD,fdc-a8eda16078b9418a0ea2e2c2,synthetic-nonform-layout-00,original,2025,fte-5b158cba1d23a8df50382595,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Calendar year: 2025
Statement issued to Example Person 7.
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Reference amount: 433.00",GIFT_RECORD,29,GIFT_RECORD,fdc-0cbc668242767aab5f4957d5,synthetic-nonform-layout-00,original,2025,fte-a23149e5758eaf356ed88fb3,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 100
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 323.00",GIFT_RECORD,29,GIFT_RECORD,fdc-0675d2f87c43438d9712c7f2,synthetic-nonform-layout-01,original,2025,fte-43cba068bc534892782620ab,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 101
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 342.00",GIFT_RECORD,29,GIFT_RECORD,fdc-e984106cf63a0644300a387e,synthetic-nonform-layout-01,original,2025,fte-d5d80127057095e7bdd0375c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 102
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 361.00",GIFT_RECORD,29,GIFT_RECORD,fdc-bf58d2b7c73226e667a8817e,synthetic-nonform-layout-01,original,2025,fte-27fd6aa5e805327ac5162efd,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 103
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 380.00",GIFT_RECORD,29,GIFT_RECORD,fdc-f6b4dc5f1305954398d121e2,synthetic-nonform-layout-01,original,2025,fte-3459edf18aa6a821051bbdb4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 104
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 399.00",GIFT_RECORD,29,GIFT_RECORD,fdc-3fec8078af657c3608b77d07,synthetic-nonform-layout-01,original,2025,fte-966e7eaa0ffb6dbf6dc6cb7e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 105
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 418.00",GIFT_RECORD,29,GIFT_RECORD,fdc-512fa4512706c9cf22d61ab3,synthetic-nonform-layout-01,original,2025,fte-66c7facf1a93bcba7f5cf5c1,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 106
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 437.00",GIFT_RECORD,29,GIFT_RECORD,fdc-df6c83178669d0656ada2f5a,synthetic-nonform-layout-01,original,2025,fte-f93cf4127da41a15ae745c34,synthetic_AI_labeled,v1_template,top,False,
"2025 | Gift transfer agreement
Recipient record: Example Person 107
Donor and donee identified; property transferred without consideration; gift reporting facts require review | Reference amount: 456.00",GIFT_RECORD,29,GIFT_RECORD,fdc-79d6390d47600c9b0cc60c03,synthetic-nonform-layout-01,original,2025,fte-2131fbefee2528bffbbefec5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 346.00. Recipient: Example Household 200.",GIFT_RECORD,29,GIFT_RECORD,fdc-9943c19b74ebfae83f5eaa8b,synthetic-nonform-layout-02,original,2025,fte-69cba44a3f210df1aec0ac18,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 365.00. Recipient: Example Household 201.",GIFT_RECORD,29,GIFT_RECORD,fdc-be53aefeb3b775c88a291436,synthetic-nonform-layout-02,original,2025,fte-3cea04905cff1bebdc58ff22,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 384.00. Recipient: Example Household 202.",GIFT_RECORD,29,GIFT_RECORD,fdc-a2705592345c618178ba43a2,synthetic-nonform-layout-02,original,2025,fte-45e4affd62c331c68e795f2f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 403.00. Recipient: Example Household 203.",GIFT_RECORD,29,GIFT_RECORD,fdc-fda8637059d824a5d5441c80,synthetic-nonform-layout-02,original,2025,fte-3b780154ea697bf15e3de848,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 422.00. Recipient: Example Household 204.",GIFT_RECORD,29,GIFT_RECORD,fdc-fc0a130010070acb854f6092,synthetic-nonform-layout-02,original,2025,fte-0346b64e85ab3a2e371a14f1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 441.00. Recipient: Example Household 205.",GIFT_RECORD,29,GIFT_RECORD,fdc-7ad5d3fff06656ddba07b0ba,synthetic-nonform-layout-02,original,2025,fte-31cc09e5a3a5e8afdb276cba,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 460.00. Recipient: Example Household 206.",GIFT_RECORD,29,GIFT_RECORD,fdc-77b22c92e326374843be690a,synthetic-nonform-layout-02,original,2025,fte-52fd84b2fc3216d449444e0e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Gift transfer agreement.
Donor and donee identified; property transferred without consideration; gift reporting facts require review; Reference amount: 479.00. Recipient: Example Household 207.",GIFT_RECORD,29,GIFT_RECORD,fdc-f0bffaa04c7dd6dc5b7bd943,synthetic-nonform-layout-02,original,2025,fte-488d4e602baaf28901bcd6e9,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 369.00. Account holder: Example Person 300.",GIFT_RECORD,29,GIFT_RECORD,fdc-e973545f943e549539c2f874,synthetic-nonform-layout-03,original,2025,fte-550811b0bfc3c35726545672,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 388.00. Account holder: Example Person 301.",GIFT_RECORD,29,GIFT_RECORD,fdc-e0f457531935c4f81dc8c60a,synthetic-nonform-layout-03,original,2025,fte-161e0189d94d9bc0e07efaa9,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 407.00. Account holder: Example Person 302.",GIFT_RECORD,29,GIFT_RECORD,fdc-71e580eaee9aad4e1e64318f,synthetic-nonform-layout-03,original,2025,fte-3c2243beaeabdea5a2394dc5,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 426.00. Account holder: Example Person 303.",GIFT_RECORD,29,GIFT_RECORD,fdc-f15e025ea7960d9ecec1b1f4,synthetic-nonform-layout-03,original,2025,fte-96f94b98204bd204847b009d,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 445.00. Account holder: Example Person 304.",GIFT_RECORD,29,GIFT_RECORD,fdc-78666ab241891c6cea73273e,synthetic-nonform-layout-03,original,2025,fte-b846ff3819a2e5e3e1b93121,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 464.00. Account holder: Example Person 305.",GIFT_RECORD,29,GIFT_RECORD,fdc-108250ca80ed0e115aa73146,synthetic-nonform-layout-03,original,2025,fte-1584cc20c58b4f1c618225d2,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 483.00. Account holder: Example Person 306.",GIFT_RECORD,29,GIFT_RECORD,fdc-25de9335efdf5d02382328a4,synthetic-nonform-layout-03,original,2025,fte-795038112c05487ca041b174,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement
Reporting period ended 12/31/2025.
Details: Donor and donee identified; property transferred without consideration; gift reporting facts require review, Reference amount: 502.00. Account holder: Example Person 307.",GIFT_RECORD,29,GIFT_RECORD,fdc-478107735c85d05f93fd5f9f,synthetic-nonform-layout-03,original,2025,fte-4c0213aba65493faf5b95056,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 392.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 400",GIFT_RECORD,29,GIFT_RECORD,fdc-9d103d33f677fb50779982c0,synthetic-nonform-layout-04,original,2025,fte-5fb0324dac29ee51c9799234,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 411.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 401",GIFT_RECORD,29,GIFT_RECORD,fdc-325f641a58ccc226220bb59d,synthetic-nonform-layout-04,original,2025,fte-bee260d32984e09888d6ae53,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 430.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 402",GIFT_RECORD,29,GIFT_RECORD,fdc-ccc9f4138307f6b69a50a9a7,synthetic-nonform-layout-04,original,2025,fte-c3ac64fc71851873f6f49fac,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 449.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 403",GIFT_RECORD,29,GIFT_RECORD,fdc-5dd9febf3b2139d349310d4b,synthetic-nonform-layout-04,original,2025,fte-17be79a4e3809c4cf3de5280,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 468.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 404",GIFT_RECORD,29,GIFT_RECORD,fdc-966f295dd3f74b104f2dc410,synthetic-nonform-layout-04,original,2025,fte-86f22a273305400cd3c925af,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 487.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 405",GIFT_RECORD,29,GIFT_RECORD,fdc-c769af8dcf989050702bbf96,synthetic-nonform-layout-04,original,2025,fte-bb778cf40cd1e9a21004680f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 506.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 406",GIFT_RECORD,29,GIFT_RECORD,fdc-76c1e63e63844d4199b9b2c4,synthetic-nonform-layout-04,original,2025,fte-989c7e3c19989e0b0af8f2aa,synthetic_AI_labeled,v1_template,top,False,
"Document header: Gift transfer agreement
Tax reporting year 2025
Reference amount: 525.00
Donor and donee identified; property transferred without consideration; gift reporting facts require review
Named party: Example Person 407",GIFT_RECORD,29,GIFT_RECORD,fdc-3b4cf581d8fe02fd864c9de6,synthetic-nonform-layout-04,original,2025,fte-be912537d3f7dbc4827a6acd,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 415.00
Delivery copy for Example Party 500",GIFT_RECORD,29,GIFT_RECORD,fdc-4d3656f7d0ea97ce1129017c,synthetic-nonform-layout-05,original,2025,fte-bf6cf5a025d724ec71739186,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 434.00
Delivery copy for Example Party 501",GIFT_RECORD,29,GIFT_RECORD,fdc-df810922fff95d86c99a3c7d,synthetic-nonform-layout-05,original,2025,fte-1ebb435be50246e17d0ef379,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 453.00
Delivery copy for Example Party 502",GIFT_RECORD,29,GIFT_RECORD,fdc-47f67eb3d6564b79145e2837,synthetic-nonform-layout-05,original,2025,fte-75a6fd610ae1ede9686e6557,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 472.00
Delivery copy for Example Party 503",GIFT_RECORD,29,GIFT_RECORD,fdc-18ee8851e98c181999541d90,synthetic-nonform-layout-05,original,2025,fte-dd2a6e3507b81e7befbe40e7,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 491.00
Delivery copy for Example Party 504",GIFT_RECORD,29,GIFT_RECORD,fdc-0d732d053e9d7cd6517d03ce,synthetic-nonform-layout-05,original,2025,fte-20ca9c493568af647a28f151,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 510.00
Delivery copy for Example Party 505",GIFT_RECORD,29,GIFT_RECORD,fdc-ed260701f9e92617f68f4653,synthetic-nonform-layout-05,original,2025,fte-92ede7ccf47d20c56d656ca5,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 529.00
Delivery copy for Example Party 506",GIFT_RECORD,29,GIFT_RECORD,fdc-a170eb38626d1d72589652a4,synthetic-nonform-layout-05,original,2025,fte-6abd2065ffe6c89ac71bcdcf,synthetic_AI_labeled,v1_template,top,False,
"Gift transfer agreement -- reporting year 2025
Donor and donee identified; property transferred without consideration; gift reporting facts require review / Reference amount: 548.00
Delivery copy for Example Party 507",GIFT_RECORD,29,GIFT_RECORD,fdc-e529c3e57eabb3fd2858e493,synthetic-nonform-layout-05,original,2025,fte-fff706504f352d6d4e7a76cc,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 0.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 300.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-3d408354ccf981aa58a3c24b,synthetic-nonform-layout-00,original,2025,fte-703b3e91618898fee2fbf02d,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 1.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 319.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b91ee29b0c955c32a1a8c5b7,synthetic-nonform-layout-00,original,2025,fte-fafebf0ee3ab9b4b5f415753,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 2.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 338.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-39696018bcd0de4e708f40cd,synthetic-nonform-layout-00,original,2025,fte-9f9ef1c15b786cf8df57bdea,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 3.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 357.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-4dec97c0733cf612a6481cc0,synthetic-nonform-layout-00,original,2025,fte-b5bd553ab8c1cdcc636ac65e,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 4.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 376.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-5442c804dc039d918343f17d,synthetic-nonform-layout-00,original,2025,fte-50c8c5420840eebc3314386a,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 5.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 395.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-cba247a51a629bc9dcfa1822,synthetic-nonform-layout-00,original,2025,fte-2226a3f1f8879d647c50990d,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 6.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 414.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-a1709e19fb5ee230216ed4d4,synthetic-nonform-layout-00,original,2025,fte-179d7f23a723851e1cac0d23,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Calendar year: 2025
Statement issued to Example Person 7.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Reference amount: 433.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-ba5b21c882efcd5169af6ca3,synthetic-nonform-layout-00,original,2025,fte-f67ad1911afb4fec568725fd,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 100
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 323.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d1a01f7aff4c312022f1e4c5,synthetic-nonform-layout-01,original,2025,fte-b2d53301301a278dbabeb802,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 101
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 342.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-43d2ae5011e2ba037ede6990,synthetic-nonform-layout-01,original,2025,fte-8a843fa4ece6bdfa7cbca6b4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 102
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 361.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-0faf0cb880a6af693850ea5f,synthetic-nonform-layout-01,original,2025,fte-3004011a8afc53cc178c1432,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 103
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 380.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b31882654a9d4a0f994d99c5,synthetic-nonform-layout-01,original,2025,fte-e956ad2e318e5f3e0f23cffd,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 104
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 399.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-2817b1fbb24f88248e7700a0,synthetic-nonform-layout-01,original,2025,fte-9425ab104153cde3a5695f9c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 105
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 418.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b5b040f4ea67fbd56956e071,synthetic-nonform-layout-01,original,2025,fte-93103aac4165c01904ee2964,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 106
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 437.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-7c1ba77721a04d26ec274c8d,synthetic-nonform-layout-01,original,2025,fte-3c004231170b58fd4f443f5f,synthetic_AI_labeled,v1_template,top,False,
"2025 | Credit card account statement
Recipient record: Example Person 107
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed | Reference amount: 456.00",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-96e76375ccd0a9e6f94ad088,synthetic-nonform-layout-01,original,2025,fte-8b356ddb948cbcab2c0dcba2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 346.00. Recipient: Example Household 200.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-ecd1c9d8e5b66beab2d16703,synthetic-nonform-layout-02,original,2025,fte-1e7ec6014531e5b271f9f33b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 365.00. Recipient: Example Household 201.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-85797b15b74be7cbfc91a757,synthetic-nonform-layout-02,original,2025,fte-c93528924b310a7ede870485,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 384.00. Recipient: Example Household 202.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-fd4acd3918d66110fdf495e8,synthetic-nonform-layout-02,original,2025,fte-3407f4a01563146d551fe97a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 403.00. Recipient: Example Household 203.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-5b3db04f61b050b8d17f0f0c,synthetic-nonform-layout-02,original,2025,fte-7d2a9ce001c60e6408dc885f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 422.00. Recipient: Example Household 204.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-110cf1055209fce90095c7f7,synthetic-nonform-layout-02,original,2025,fte-5a97f24eaa5bf916f10bec9a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 441.00. Recipient: Example Household 205.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f14040e039317f86d0544f1b,synthetic-nonform-layout-02,original,2025,fte-d69ddf8a64030b52f1f4e8c5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 460.00. Recipient: Example Household 206.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-71190248c989c10a11bcb8b5,synthetic-nonform-layout-02,original,2025,fte-51c2ecad519d69e30c33cb17,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Credit card account statement.
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed; Reference amount: 479.00. Recipient: Example Household 207.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-bf00764acb54015bb120147b,synthetic-nonform-layout-02,original,2025,fte-f37aaeaa007dd671d04fed2b,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 369.00. Account holder: Example Person 300.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-85219b80de2d683bf06deee7,synthetic-nonform-layout-03,original,2025,fte-3615c4569e9c5ad7e05fb3b2,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 388.00. Account holder: Example Person 301.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9f02263abf028e601727f343,synthetic-nonform-layout-03,original,2025,fte-290c7de03ce25dbdb7f151cc,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 407.00. Account holder: Example Person 302.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-1955b840cd8a00facfc45009,synthetic-nonform-layout-03,original,2025,fte-7d1eb03066d178162896b038,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 426.00. Account holder: Example Person 303.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-109d415ca2930ea2b730d5fc,synthetic-nonform-layout-03,original,2025,fte-2d11c04175a156abc25e78e1,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 445.00. Account holder: Example Person 304.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-70339dfe32b91987146c423e,synthetic-nonform-layout-03,original,2025,fte-fee0b14f505715063e7f5840,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 464.00. Account holder: Example Person 305.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d9cd1d5761447088269f1b8d,synthetic-nonform-layout-03,original,2025,fte-1e092bcbfb292600b10d5b3f,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 483.00. Account holder: Example Person 306.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-cd6a6d0788a3accc2545e21f,synthetic-nonform-layout-03,original,2025,fte-21ac50c2788b10af76bc4417,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement
Reporting period ended 12/31/2025.
Details: Purchases, payments and merchant credits are reported separately; no income tax form is enclosed, Reference amount: 502.00. Account holder: Example Person 307.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-fcb6835d435f0b51eccec84b,synthetic-nonform-layout-03,original,2025,fte-38905f00f498628fa5132317,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 392.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 400",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-78302919881118977f2ed8b2,synthetic-nonform-layout-04,original,2025,fte-001b32da11d31488818ce783,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 411.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 401",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-3b412056d17daf24ef6419b3,synthetic-nonform-layout-04,original,2025,fte-a479418af2d17bfc8a231154,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 430.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 402",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-dd2769d59e3776199af45aab,synthetic-nonform-layout-04,original,2025,fte-1e0fff9654ac915ddb7cf27e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 449.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 403",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b977d07d95eee26c95fc1c65,synthetic-nonform-layout-04,original,2025,fte-f578cd4057efbed966fae45a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 468.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 404",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f73dc72718d6153014484f24,synthetic-nonform-layout-04,original,2025,fte-472e527861ad9eaa28ce0b24,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 487.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 405",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-a4f21ab588ef1b0a15d76051,synthetic-nonform-layout-04,original,2025,fte-43824196d995e5aedb33021b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 506.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 406",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-0b7e8663e5355674529f9cbb,synthetic-nonform-layout-04,original,2025,fte-0c63bbacc49fa96db27616b2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Credit card account statement
Tax reporting year 2025
Reference amount: 525.00
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed
Named party: Example Person 407",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-086fe95a66f7196c10350280,synthetic-nonform-layout-04,original,2025,fte-aeb2d678dbac51a86571b8a5,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 415.00
Delivery copy for Example Party 500",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f4922138ce3ffe7a7799a669,synthetic-nonform-layout-05,original,2025,fte-45db329c207497dd69eed17f,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 434.00
Delivery copy for Example Party 501",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-c7bb3acb28886f671c889b50,synthetic-nonform-layout-05,original,2025,fte-8ff176d297ce8f4c1b4281ac,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 453.00
Delivery copy for Example Party 502",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-36ed60dbbb9035dd0d7b0c59,synthetic-nonform-layout-05,original,2025,fte-4c3b491d517d8f6aeaf0b34f,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 472.00
Delivery copy for Example Party 503",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-91cc89403812d59091f8d34b,synthetic-nonform-layout-05,original,2025,fte-429a291adb93c42976bb45f4,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 491.00
Delivery copy for Example Party 504",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-884ae663fa591e9059bc0eb2,synthetic-nonform-layout-05,original,2025,fte-8f318cdedcca59dd17fd4266,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 510.00
Delivery copy for Example Party 505",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-e976c7bdc33cb9004db22bec,synthetic-nonform-layout-05,original,2025,fte-f2bb4d493682f4a0fb116570,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 529.00
Delivery copy for Example Party 506",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-54e3050242ac88c1ce4e7557,synthetic-nonform-layout-05,original,2025,fte-d1e86a212b13f54e7f5b1474,synthetic_AI_labeled,v1_template,top,False,
"Credit card account statement -- reporting year 2025
Purchases, payments and merchant credits are reported separately; no income tax form is enclosed / Reference amount: 548.00
Delivery copy for Example Party 507",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-0263f4b086e56432b90ac12a,synthetic-nonform-layout-05,original,2025,fte-45ed455ec63b0d31bd1da79a,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 0.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 300.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-154b12ff5249882fbf078714,synthetic-nonform-layout-00,original,2025,fte-917df65e7fcb10786696c5bf,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 1.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 319.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4abc9c1c4401f1dafc32644c,synthetic-nonform-layout-00,original,2025,fte-ff107116d3ba143e14381d09,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 2.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 338.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-97eed9bacfd835e829708104,synthetic-nonform-layout-00,original,2025,fte-3d09bb911320be3c2c0e635f,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 3.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 357.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-19487b980ddfb2dcd5fd7632,synthetic-nonform-layout-00,original,2025,fte-3b168640d5a9df831f15adab,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 4.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 376.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-aae8eb211e39da62a6b2e49a,synthetic-nonform-layout-00,original,2025,fte-e237e7805e1d9583356ca1ba,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 5.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 395.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f76df45bd15114ca478559ec,synthetic-nonform-layout-00,original,2025,fte-1609065d2d36d780a2e2cba7,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 6.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 414.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-8e1e2aef1b1a252786e33d87,synthetic-nonform-layout-00,original,2025,fte-49c603d2298495e7543d9d0f,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Calendar year: 2025
Statement issued to Example Person 7.
Deposits and withdrawals shown; account ownership and source direction convention printed
Reference amount: 433.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-333f8ce1d3b17705f959fb18,synthetic-nonform-layout-00,original,2025,fte-e3909cd0e840fdcec7157356,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 100
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 323.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a5fe3d5d51dd161e43a4c2e4,synthetic-nonform-layout-01,original,2025,fte-929186ea2855dea510bd7d7f,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 101
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 342.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-2bbc24dd6f7763e900711643,synthetic-nonform-layout-01,original,2025,fte-0ae23dfaf7ce52ec25f16c3e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 102
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 361.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5cceeb8535638349a34deabc,synthetic-nonform-layout-01,original,2025,fte-07b298d6dcb23148b9e0f55e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 103
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 380.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f421fa0a6aae0509b2950508,synthetic-nonform-layout-01,original,2025,fte-d3aafab4ab0b8b50339d4521,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 104
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 399.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-7da6bdf373a4a53c89b9a464,synthetic-nonform-layout-01,original,2025,fte-2de2c474b5761f1f3e4fc21c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 105
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 418.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ecf1ef7d1795e809066996c2,synthetic-nonform-layout-01,original,2025,fte-15939e6beaf52d937d4b2562,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 106
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 437.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-975cc6d46c450da06c9c2c7e,synthetic-nonform-layout-01,original,2025,fte-98e91738daa33902edad6187,synthetic_AI_labeled,v1_template,top,False,
"2025 | Checking account activity
Recipient record: Example Person 107
Deposits and withdrawals shown; account ownership and source direction convention printed | Reference amount: 456.00",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ea964fb9f36a3c379d540c7c,synthetic-nonform-layout-01,original,2025,fte-0c094b3a966532f322913108,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 346.00. Recipient: Example Household 200.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5f546e050a92c68525edaded,synthetic-nonform-layout-02,original,2025,fte-e0b8133ad54a91fd03404cbb,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 365.00. Recipient: Example Household 201.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-589a9bcee2c0532ecd578340,synthetic-nonform-layout-02,original,2025,fte-c9030c1a13bc4b8586eb1439,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 384.00. Recipient: Example Household 202.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-253ec288035d206bd9c73ca4,synthetic-nonform-layout-02,original,2025,fte-c832f63a6facca6cb11835db,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 403.00. Recipient: Example Household 203.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-20f437febab8345a825cb172,synthetic-nonform-layout-02,original,2025,fte-fa6917f74e3feab258c0e1bc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 422.00. Recipient: Example Household 204.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-0b56e043f8891aafda1f907c,synthetic-nonform-layout-02,original,2025,fte-43a2bd94d980e6cffb6cdf18,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 441.00. Recipient: Example Household 205.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ad7726126f369fcd50cb9cc9,synthetic-nonform-layout-02,original,2025,fte-575037daeb22c48591730251,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 460.00. Recipient: Example Household 206.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-103a0f0b193bb406aa8fb7d4,synthetic-nonform-layout-02,original,2025,fte-33f6e8f634e378b9b2d72e41,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Checking account activity.
Deposits and withdrawals shown; account ownership and source direction convention printed; Reference amount: 479.00. Recipient: Example Household 207.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-922303489f326d646609c234,synthetic-nonform-layout-02,original,2025,fte-2b623f58e25a807cc61047fc,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 369.00. Account holder: Example Person 300.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-30357781e2a9ff7bdae12214,synthetic-nonform-layout-03,original,2025,fte-aa73a0e82eb47f3c2629391c,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 388.00. Account holder: Example Person 301.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-c5db8247d8dea7f7cd878bf4,synthetic-nonform-layout-03,original,2025,fte-c96a3b44c1ee49aefff9abe4,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 407.00. Account holder: Example Person 302.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ba4ecc76b25f14dc18738777,synthetic-nonform-layout-03,original,2025,fte-41aeed3f3c6a4922eaed74dc,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 426.00. Account holder: Example Person 303.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b90f62abdd536d2b3b0807e3,synthetic-nonform-layout-03,original,2025,fte-feb0192a47bad4a1dde7a2cd,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 445.00. Account holder: Example Person 304.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-acf0daf66c8976b880e89375,synthetic-nonform-layout-03,original,2025,fte-3526ab756673b20a39f064c7,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 464.00. Account holder: Example Person 305.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-8f229d5ba921c377e0b42698,synthetic-nonform-layout-03,original,2025,fte-309b8269ae12d118c00ede51,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 483.00. Account holder: Example Person 306.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4f1a4bb32effadacf132a2d3,synthetic-nonform-layout-03,original,2025,fte-1a7c30e8d831304c49376d85,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity
Reporting period ended 12/31/2025.
Details: Deposits and withdrawals shown; account ownership and source direction convention printed, Reference amount: 502.00. Account holder: Example Person 307.",BANK_STATEMENT,24,BANK_STATEMENT,fdc-fa101b2209759931586874eb,synthetic-nonform-layout-03,original,2025,fte-c38550c2c2bf81f820632d89,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 392.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 400",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ec745f34bdd7c08f8d89e7e9,synthetic-nonform-layout-04,original,2025,fte-edeb59e50cf36c309ddad13d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 411.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 401",BANK_STATEMENT,24,BANK_STATEMENT,fdc-c11e9cefcfa3ce383b558825,synthetic-nonform-layout-04,original,2025,fte-8456a27de1f5b18b5f6159b5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 430.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 402",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f5cb558ead627b971f439993,synthetic-nonform-layout-04,original,2025,fte-3112c67b97aff864abbab21e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 449.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 403",BANK_STATEMENT,24,BANK_STATEMENT,fdc-79253910bb6edff4352bb136,synthetic-nonform-layout-04,original,2025,fte-df37bf70cf9dbf9f6b90b61d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 468.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 404",BANK_STATEMENT,24,BANK_STATEMENT,fdc-30c6de7cc46b46716fba9de4,synthetic-nonform-layout-04,original,2025,fte-d8e49a22ce66b7be31d52f6e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 487.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 405",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5ac3daed287ebba5f0c74b09,synthetic-nonform-layout-04,original,2025,fte-242d2e9d0f8907f6d2f96370,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 506.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 406",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f2568849cf51f7a1eb2ac958,synthetic-nonform-layout-04,original,2025,fte-5cff61ade7ca160afda6c33b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Checking account activity
Tax reporting year 2025
Reference amount: 525.00
Deposits and withdrawals shown; account ownership and source direction convention printed
Named party: Example Person 407",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ac5eb121f247e22611450ba5,synthetic-nonform-layout-04,original,2025,fte-96159c60b97633170e4d9171,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 415.00
Delivery copy for Example Party 500",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b9170362acfbaac3dda14704,synthetic-nonform-layout-05,original,2025,fte-44a13aed3c3ccc7c4929c6e2,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 434.00
Delivery copy for Example Party 501",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f40d16c209eeedeb386c2c23,synthetic-nonform-layout-05,original,2025,fte-6aac95c2935666a0afb8d7b5,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 453.00
Delivery copy for Example Party 502",BANK_STATEMENT,24,BANK_STATEMENT,fdc-55642976bbbb9b539e0de08a,synthetic-nonform-layout-05,original,2025,fte-1b4091b287ac1de74d477a4a,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 472.00
Delivery copy for Example Party 503",BANK_STATEMENT,24,BANK_STATEMENT,fdc-43ab6064e90b5e14599e066e,synthetic-nonform-layout-05,original,2025,fte-96fc6a8889322348eba5cc68,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 491.00
Delivery copy for Example Party 504",BANK_STATEMENT,24,BANK_STATEMENT,fdc-83a2953e07931f3f65f39b25,synthetic-nonform-layout-05,original,2025,fte-73d94a80d88aeab563f18ff3,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 510.00
Delivery copy for Example Party 505",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e419a73bd5f203722367c501,synthetic-nonform-layout-05,original,2025,fte-5b80fe0527e512b59ed8eca5,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 529.00
Delivery copy for Example Party 506",BANK_STATEMENT,24,BANK_STATEMENT,fdc-6d487a5d3f2ebcf828c7ae69,synthetic-nonform-layout-05,original,2025,fte-0eba843999087b537e2b6711,synthetic_AI_labeled,v1_template,top,False,
"Checking account activity -- reporting year 2025
Deposits and withdrawals shown; account ownership and source direction convention printed / Reference amount: 548.00
Delivery copy for Example Party 507",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5c8fed986723eeebf17c6fc9,synthetic-nonform-layout-05,original,2025,fte-c1e9bcbd3043fab062a93f7d,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 0.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 300.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-876eef12f16d72335e9a8fdc,synthetic-nonform-layout-00,original,2025,fte-3d45732629951ea713bae81b,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 1.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 319.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-7b06e91fddaba9d7b94e4347,synthetic-nonform-layout-00,original,2025,fte-5208326df69b74dee22353ad,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 2.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 338.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-0e015c81aea881776735cd9d,synthetic-nonform-layout-00,original,2025,fte-338f615a145481316baea7aa,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 3.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 357.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-c60bc3130f69c79122d8ab57,synthetic-nonform-layout-00,original,2025,fte-3269cb42688753442589edbe,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 4.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 376.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-70ccff21e90a53e23ea80b4a,synthetic-nonform-layout-00,original,2025,fte-89020fe01799572bb2448553,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 5.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 395.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-79ec23586fa82a24088df712,synthetic-nonform-layout-00,original,2025,fte-328e3e96d7d2463811b4019a,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 6.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 414.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8fc06c340625fe17ccf9f79b,synthetic-nonform-layout-00,original,2025,fte-a1f004ec6d1a03aaa7deda92,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Calendar year: 2025
Statement issued to Example Person 7.
Goods purchased for personal use; paid by card; seller and purchase amount shown
Reference amount: 433.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-894941da48b5a7367743f462,synthetic-nonform-layout-00,original,2025,fte-754339b8b098dee55c5dc83b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 100
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 323.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-d12f80978cc7989bafc97986,synthetic-nonform-layout-01,original,2025,fte-3e64d288355979a14c4b8b92,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 101
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 342.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8627bdc3ff4680df65c8493f,synthetic-nonform-layout-01,original,2025,fte-fd5d4162be2eaa85805e8523,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 102
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 361.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-9a68e9274766746c32652eba,synthetic-nonform-layout-01,original,2025,fte-59786e8c551b7de4603ee81a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 103
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 380.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-cd0aa76018106f8efa285a89,synthetic-nonform-layout-01,original,2025,fte-9d115814d6d057a3184fed95,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 104
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 399.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-a1d88456afb11419481a3f21,synthetic-nonform-layout-01,original,2025,fte-f1b963ae0288dfce4bb61be4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 105
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 418.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-17c0f235958378ce18454d68,synthetic-nonform-layout-01,original,2025,fte-1ccb385119f78cb8cd10e7ed,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 106
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 437.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-6c69e9bcdfc2d2e67c660418,synthetic-nonform-layout-01,original,2025,fte-e0d1f6fdbc5a4a433d54a3ab,synthetic_AI_labeled,v1_template,top,False,
"2025 | Retail purchase receipt
Recipient record: Example Person 107
Goods purchased for personal use; paid by card; seller and purchase amount shown | Reference amount: 456.00",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-388db0e1c686f5fd45cc9bd2,synthetic-nonform-layout-01,original,2025,fte-270b2ea80bbf221fcf9c8297,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 346.00. Recipient: Example Household 200.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-43b6cf342fa6fe6e7ba0a60f,synthetic-nonform-layout-02,original,2025,fte-e8a70a59204713536335d2dd,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 365.00. Recipient: Example Household 201.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-5718304e7e2b481c35546aa1,synthetic-nonform-layout-02,original,2025,fte-142160e66ab4e2ecc16bd53b,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 384.00. Recipient: Example Household 202.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-ae3d6c1ba515e12a1861f228,synthetic-nonform-layout-02,original,2025,fte-a7e08e31c40a5de3952f71bc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 403.00. Recipient: Example Household 203.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-16c98ff0a61ba3a553ad7e5d,synthetic-nonform-layout-02,original,2025,fte-3ec51743dc24514f231e9c32,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 422.00. Recipient: Example Household 204.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-a963cd5cd91dfb47049faa96,synthetic-nonform-layout-02,original,2025,fte-3928657ba3b25fc4b5148367,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 441.00. Recipient: Example Household 205.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-38aeaf88f8f44570ba27bd92,synthetic-nonform-layout-02,original,2025,fte-3b670c4ce66a0f9b3354283d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 460.00. Recipient: Example Household 206.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-c0d2c1c1ef147a49061c58b6,synthetic-nonform-layout-02,original,2025,fte-5083ff32ed7a95644f67dbae,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Retail purchase receipt.
Goods purchased for personal use; paid by card; seller and purchase amount shown; Reference amount: 479.00. Recipient: Example Household 207.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-246ce21d14efd86b2f5ef1f8,synthetic-nonform-layout-02,original,2025,fte-ebd9dba53114fd8e0d97e352,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 369.00. Account holder: Example Person 300.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8b2f0264e46a4cc537dbcecf,synthetic-nonform-layout-03,original,2025,fte-615f93814c9c0e34b11bb452,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 388.00. Account holder: Example Person 301.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-c78426b4a67d4ea29e4ef829,synthetic-nonform-layout-03,original,2025,fte-d154dee839b9dc2de84e2cfc,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 407.00. Account holder: Example Person 302.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-96f92ea9c0e30665f8200ef5,synthetic-nonform-layout-03,original,2025,fte-e1c8da82e274f7d2abc42f19,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 426.00. Account holder: Example Person 303.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-df3348d7e0565bbceb052824,synthetic-nonform-layout-03,original,2025,fte-d2c1f662103e3cbd7e40493c,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 445.00. Account holder: Example Person 304.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-089e7bef9f03dd2766ba9475,synthetic-nonform-layout-03,original,2025,fte-d837a6d28985e03ff993251f,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 464.00. Account holder: Example Person 305.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-ffd2f8083c6ad90f75d88571,synthetic-nonform-layout-03,original,2025,fte-4dbf6bbde61328285769d1e8,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 483.00. Account holder: Example Person 306.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8f7f8b9bae25b906191a065e,synthetic-nonform-layout-03,original,2025,fte-f05a7561f58a9c64bb035b39,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt
Reporting period ended 12/31/2025.
Details: Goods purchased for personal use; paid by card; seller and purchase amount shown, Reference amount: 502.00. Account holder: Example Person 307.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-3ab3ec1b58b943254f79e973,synthetic-nonform-layout-03,original,2025,fte-c73a6f4a17082d7c917d546d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 392.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 400",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-0e5ca9569731436ff168cf59,synthetic-nonform-layout-04,original,2025,fte-f6ef58b07041ad38009906ba,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 411.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 401",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-0fa11f5f1b0568cce7775cb3,synthetic-nonform-layout-04,original,2025,fte-eca1c76ef584e59037c75e3a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 430.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 402",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-31e2e196a17e2d61d037c2a3,synthetic-nonform-layout-04,original,2025,fte-514e7df26ca0c7a56204b94f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 449.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 403",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-f5f709633bb23044043fc05a,synthetic-nonform-layout-04,original,2025,fte-4711b09e410014131e5a18f1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 468.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 404",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-23af2ee036056d0c2beea8a5,synthetic-nonform-layout-04,original,2025,fte-8604ff75104bf7f4a06badd3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 487.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 405",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-2dcbb1db6e974de341c542b3,synthetic-nonform-layout-04,original,2025,fte-6f6df4e8fdf5eb6b97e6fbb5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 506.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 406",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-54c4c90a94f2c6d644f4031f,synthetic-nonform-layout-04,original,2025,fte-1d5e1d83973c94037eb0ad19,synthetic_AI_labeled,v1_template,top,False,
"Document header: Retail purchase receipt
Tax reporting year 2025
Reference amount: 525.00
Goods purchased for personal use; paid by card; seller and purchase amount shown
Named party: Example Person 407",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8b427bb198b68ff584d682ff,synthetic-nonform-layout-04,original,2025,fte-cf469cc28853174af4173485,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 415.00
Delivery copy for Example Party 500",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-1865f928602b32d2e04a8a03,synthetic-nonform-layout-05,original,2025,fte-eca754f96293be062c53889a,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 434.00
Delivery copy for Example Party 501",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-803ab3b53c97124cb5db681e,synthetic-nonform-layout-05,original,2025,fte-954170d87b81c1b48b2da950,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 453.00
Delivery copy for Example Party 502",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-3a10ba6df31f02e57e997214,synthetic-nonform-layout-05,original,2025,fte-cb7429764c8e1721b96f729b,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 472.00
Delivery copy for Example Party 503",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-521b3003bd084dc376438351,synthetic-nonform-layout-05,original,2025,fte-b6e5df4b765a195a8caeff6d,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 491.00
Delivery copy for Example Party 504",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-86f8f137148549f1d6c6e256,synthetic-nonform-layout-05,original,2025,fte-1c469ef9e7231338aef3b2d8,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 510.00
Delivery copy for Example Party 505",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-ff175da23006ed176b815ea9,synthetic-nonform-layout-05,original,2025,fte-55f7dbffcaa4cf6b763c1995,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 529.00
Delivery copy for Example Party 506",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-7d5ad974e216f8550cab9053,synthetic-nonform-layout-05,original,2025,fte-7a13958fb2c89f47f033108e,synthetic_AI_labeled,v1_template,top,False,
"Retail purchase receipt -- reporting year 2025
Goods purchased for personal use; paid by card; seller and purchase amount shown / Reference amount: 548.00
Delivery copy for Example Party 507",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-f2d5e5ea3103a5bc44b7af1b,synthetic-nonform-layout-05,original,2025,fte-16d7ca28164c3a06d8a98a2d,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 0.
Promise of a future contribution; payment has not been received
Reference amount: 300.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-7261586ca8411cd08eb45232,synthetic-nonform-layout-00,original,2025,fte-e6eeff02b694c14feb36d68a,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 1.
Promise of a future contribution; payment has not been received
Reference amount: 319.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-a0f94b2ea47d3f1bd0a6b392,synthetic-nonform-layout-00,original,2025,fte-b63a0aec5f2f933de81c9e25,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 2.
Promise of a future contribution; payment has not been received
Reference amount: 338.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-077184937c94cb6f30a96330,synthetic-nonform-layout-00,original,2025,fte-251c347bacb0f3264aea9df4,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 3.
Promise of a future contribution; payment has not been received
Reference amount: 357.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-792d4d945c8b5450cc8fba00,synthetic-nonform-layout-00,original,2025,fte-21a6b957f79eae0bcba43ea9,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 4.
Promise of a future contribution; payment has not been received
Reference amount: 376.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-5ec79fdd6bb88bf467b89245,synthetic-nonform-layout-00,original,2025,fte-f18533a1df27954a666832ff,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 5.
Promise of a future contribution; payment has not been received
Reference amount: 395.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-c39e6c9dffb001acfb4fa9e6,synthetic-nonform-layout-00,original,2025,fte-540ecbfa4f82ae9a59413faf,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 6.
Promise of a future contribution; payment has not been received
Reference amount: 414.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-69fa621172169b1f716e2bb9,synthetic-nonform-layout-00,original,2025,fte-6a25f5165eb140633f5f7b59,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Calendar year: 2025
Statement issued to Example Person 7.
Promise of a future contribution; payment has not been received
Reference amount: 433.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-d6cbef8e2a6d945ff6dea98a,synthetic-nonform-layout-00,original,2025,fte-6afa7a2eaefb265ae3f75031,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 100
Promise of a future contribution; payment has not been received | Reference amount: 323.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-2dac736fb4eb6488c41b8a14,synthetic-nonform-layout-01,original,2025,fte-966b542d487726a87916c483,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 101
Promise of a future contribution; payment has not been received | Reference amount: 342.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-b3e3b6d2509b599d7d987339,synthetic-nonform-layout-01,original,2025,fte-4fc1a3bcaba9eaa653bce9e0,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 102
Promise of a future contribution; payment has not been received | Reference amount: 361.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-ffbe65e1c28e6ea9af0f17ee,synthetic-nonform-layout-01,original,2025,fte-d99678ca1ccdc165bbabe3f5,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 103
Promise of a future contribution; payment has not been received | Reference amount: 380.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-cf913eb391b1d9e04d71d5aa,synthetic-nonform-layout-01,original,2025,fte-6e47ece81edd076b39385795,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 104
Promise of a future contribution; payment has not been received | Reference amount: 399.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-112d200d4b55b2363d7b4abd,synthetic-nonform-layout-01,original,2025,fte-c4ffc0734d966907e4562412,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 105
Promise of a future contribution; payment has not been received | Reference amount: 418.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-d44bbf29e7092b19fa001da2,synthetic-nonform-layout-01,original,2025,fte-248e8953f3f1b7af22a2a1ed,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 106
Promise of a future contribution; payment has not been received | Reference amount: 437.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-6e70b97a021538d7041a09c9,synthetic-nonform-layout-01,original,2025,fte-68ab7c695fa611337f4b29bc,synthetic_AI_labeled,v1_template,top,False,
"2025 | Charitable pledge reminder
Recipient record: Example Person 107
Promise of a future contribution; payment has not been received | Reference amount: 456.00",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-223a715f9387f5fa6f2e9d1b,synthetic-nonform-layout-01,original,2025,fte-426565d6c149ae06904eba0d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 346.00. Recipient: Example Household 200.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-13f93342daa7a09e4c0c0d07,synthetic-nonform-layout-02,original,2025,fte-5b406d7e47b870dad384ef66,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 365.00. Recipient: Example Household 201.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-f6072c7de0db65f955a74fcb,synthetic-nonform-layout-02,original,2025,fte-d803a3c4d79763e5bcfcd080,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 384.00. Recipient: Example Household 202.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-e168bec55e1cbcb55a460f74,synthetic-nonform-layout-02,original,2025,fte-da4bf687387df24a3a7c1464,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 403.00. Recipient: Example Household 203.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-18a1ed5e0f506699291c8363,synthetic-nonform-layout-02,original,2025,fte-1a1d262917712f057fd96539,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 422.00. Recipient: Example Household 204.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-6823ac20229ae02dfc321439,synthetic-nonform-layout-02,original,2025,fte-06afaac965ae48ef6364f409,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 441.00. Recipient: Example Household 205.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-1f47f30d793ec0a63499101c,synthetic-nonform-layout-02,original,2025,fte-821ab32bb27a7ddc4aef29ba,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 460.00. Recipient: Example Household 206.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-f635b128de2dea264023af78,synthetic-nonform-layout-02,original,2025,fte-39c52bf008ba63e97010513a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Charitable pledge reminder.
Promise of a future contribution; payment has not been received; Reference amount: 479.00. Recipient: Example Household 207.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-96422ca9193bd4de7a0a8e7c,synthetic-nonform-layout-02,original,2025,fte-91dc3ea18401f86934745b4d,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 369.00. Account holder: Example Person 300.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-0034942d4b8453832612b145,synthetic-nonform-layout-03,original,2025,fte-71656a0d855911aec2ed365b,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 388.00. Account holder: Example Person 301.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-829323c79d8dbf889ee90557,synthetic-nonform-layout-03,original,2025,fte-36c289ee6f550010712c4588,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 407.00. Account holder: Example Person 302.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-c4ecebe8fffc03d1593e8ec8,synthetic-nonform-layout-03,original,2025,fte-8adc761c1e11dbfe1fd9e22b,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 426.00. Account holder: Example Person 303.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-1ba004283f8c43b1fb424213,synthetic-nonform-layout-03,original,2025,fte-99b142010ac8ad4d105a5e8f,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 445.00. Account holder: Example Person 304.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-0ee76e48eb227f66b0b51b7b,synthetic-nonform-layout-03,original,2025,fte-90fe6e4d0d26a0e29538d0a0,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 464.00. Account holder: Example Person 305.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-0aa7a0340490094b13a13a7b,synthetic-nonform-layout-03,original,2025,fte-2d666e35d9fa7d3046cc2423,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 483.00. Account holder: Example Person 306.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-5fc098ba0e037365155d537c,synthetic-nonform-layout-03,original,2025,fte-4cdde056fda0d9ca8eff8c96,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder
Reporting period ended 12/31/2025.
Details: Promise of a future contribution; payment has not been received, Reference amount: 502.00. Account holder: Example Person 307.",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-a36f80a75071b8a7099339c7,synthetic-nonform-layout-03,original,2025,fte-b92e58dbaaf0b4ba116e12b0,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 392.00
Promise of a future contribution; payment has not been received
Named party: Example Person 400",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-13a9fa68b574fe9146a0c729,synthetic-nonform-layout-04,original,2025,fte-2e30e60e352a8670bd9f6b98,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 411.00
Promise of a future contribution; payment has not been received
Named party: Example Person 401",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-0580826cc2ddcac590df1500,synthetic-nonform-layout-04,original,2025,fte-97df1f274b5652002f355305,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 430.00
Promise of a future contribution; payment has not been received
Named party: Example Person 402",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-386a3f8ad20e93a3d8f13410,synthetic-nonform-layout-04,original,2025,fte-04d6d60fd0d3e0b0fa6bf816,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 449.00
Promise of a future contribution; payment has not been received
Named party: Example Person 403",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-1f8601a4628393623e94cd43,synthetic-nonform-layout-04,original,2025,fte-500e4e9b075cb46b9bc5f490,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 468.00
Promise of a future contribution; payment has not been received
Named party: Example Person 404",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-17cd2ef0ec2bab3130dd3fd6,synthetic-nonform-layout-04,original,2025,fte-21836bf857c2f69768431b71,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 487.00
Promise of a future contribution; payment has not been received
Named party: Example Person 405",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-f0ff1501fbc79780c8efcdbf,synthetic-nonform-layout-04,original,2025,fte-54da22caa09c7be51edbb9a4,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 506.00
Promise of a future contribution; payment has not been received
Named party: Example Person 406",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-6460ca4b45b16165aff349fd,synthetic-nonform-layout-04,original,2025,fte-e962e2037d05bb93833d1c87,synthetic_AI_labeled,v1_template,top,False,
"Document header: Charitable pledge reminder
Tax reporting year 2025
Reference amount: 525.00
Promise of a future contribution; payment has not been received
Named party: Example Person 407",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-1431d35f644387f2658f083f,synthetic-nonform-layout-04,original,2025,fte-d04d8dd6e6f01aeaf5f78dc1,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 415.00
Delivery copy for Example Party 500",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-b1d49c196eed19d7a3c2fd38,synthetic-nonform-layout-05,original,2025,fte-fa31179694464b7078966353,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 434.00
Delivery copy for Example Party 501",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-761c78d71e61853d2deb1d98,synthetic-nonform-layout-05,original,2025,fte-2369e816a62b2569dcaee5df,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 453.00
Delivery copy for Example Party 502",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-df7efe09f864c200b87ec657,synthetic-nonform-layout-05,original,2025,fte-0af1c5c20234c36f97d57834,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 472.00
Delivery copy for Example Party 503",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-f6bc89e52a94d37863d25c28,synthetic-nonform-layout-05,original,2025,fte-9af42a8c49d30e44592e4e1e,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 491.00
Delivery copy for Example Party 504",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-4ecbf09e94bd4899fc89c357,synthetic-nonform-layout-05,original,2025,fte-8d51a1d7f639c1e00fafaf13,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 510.00
Delivery copy for Example Party 505",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-c5c5fa6b2e1b12d8a885e888,synthetic-nonform-layout-05,original,2025,fte-d2776fe009e5a59abd3341a1,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 529.00
Delivery copy for Example Party 506",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-64a91d5e905ac092b0674801,synthetic-nonform-layout-05,original,2025,fte-4d0c836d275181d1ed0a36a1,synthetic_AI_labeled,v1_template,top,False,
"Charitable pledge reminder -- reporting year 2025
Promise of a future contribution; payment has not been received / Reference amount: 548.00
Delivery copy for Example Party 507",PLEDGE_NOTICE,32,PLEDGE_NOTICE,fdc-b1fba51cf7e7ee8590576729,synthetic-nonform-layout-05,original,2025,fte-6756e594d43f54be7a11ca06,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 0.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 300.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-55a39dfb7acea2ff1b6a88b5,synthetic-nonform-layout-00,instruction,2025,fte-23d2d9e9f58d73a26ab128a8,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 1.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 319.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-5536d900e558aecbeb44aa51,synthetic-nonform-layout-00,instruction,2025,fte-b9f3d48189b583b5bec7048f,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 2.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 338.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-164c423daa99280949cfd788,synthetic-nonform-layout-00,instruction,2025,fte-a04f5b13d92f30d52fc56555,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 3.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 357.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-f7e7dbb3fe16ac65b415f10d,synthetic-nonform-layout-00,instruction,2025,fte-391179fd372732a6ce84ba5d,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 4.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 376.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-428467c7255e56abebd1edae,synthetic-nonform-layout-00,instruction,2025,fte-c24fd63b38d288d072fae085,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 5.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 395.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b62601a5d24d7f0fb00bfdd8,synthetic-nonform-layout-00,instruction,2025,fte-496bdb1a84e5db2c6efec0bf,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 6.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 414.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-6cdd4e3beda353ab5dd8c486,synthetic-nonform-layout-00,instruction,2025,fte-e5179b761eea6c55c5655099,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Calendar year: 2025
Statement issued to Example Person 7.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Reference amount: 433.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-9f887fbc2fbe62eeb7855ba3,synthetic-nonform-layout-00,instruction,2025,fte-524bb5f74cd4d386f8d41b45,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 100
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 323.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-ff10e0e38f279d541d081222,synthetic-nonform-layout-01,instruction,2025,fte-bc0d4f426a29ff4ea8eb8fa5,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 101
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 342.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-03b0196bdf90b5d95d8fbd4c,synthetic-nonform-layout-01,instruction,2025,fte-220ec3f35855f9c0fb3939b8,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 102
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 361.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-1cbeeade09e60d778e351f73,synthetic-nonform-layout-01,instruction,2025,fte-227481a169e35ef3aa276aa4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 103
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 380.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-fe0671510ff6e60f1f643734,synthetic-nonform-layout-01,instruction,2025,fte-e9333ec72852d95c20ce132b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 104
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 399.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-f8aefaaac11c65916030209c,synthetic-nonform-layout-01,instruction,2025,fte-bc965716e7680b0ba16a1d11,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 105
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 418.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-e8c6f1113cb14298e5709382,synthetic-nonform-layout-01,instruction,2025,fte-0743965ed8dfe6456e391f0b,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 106
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 437.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-ff85b16211ce4c3ad1d07054,synthetic-nonform-layout-01,instruction,2025,fte-09b96540c987f6f7b3e83726,synthetic_AI_labeled,v1_template,top,False,
"2025 | Blank tax form instructions
Recipient record: Example Person 107
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation | Reference amount: 456.00",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-926b8c3fedfb2220343529a7,synthetic-nonform-layout-01,instruction,2025,fte-8db469c68d305fa0480969f6,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 346.00. Recipient: Example Household 200.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-68fb888578fe8a217c95863e,synthetic-nonform-layout-02,instruction,2025,fte-36602bf328046330bb67389e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 365.00. Recipient: Example Household 201.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-5c746a8ec343abea084fb0d2,synthetic-nonform-layout-02,instruction,2025,fte-19645f9beb37cec286170297,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 384.00. Recipient: Example Household 202.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b6035d884d1b0cc125259abd,synthetic-nonform-layout-02,instruction,2025,fte-24781edf294f4e11a5daccca,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 403.00. Recipient: Example Household 203.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-43277159c18e8591b75385f6,synthetic-nonform-layout-02,instruction,2025,fte-5aabcaf9af85003958089a40,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 422.00. Recipient: Example Household 204.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-6539689f3f31659c607d9262,synthetic-nonform-layout-02,instruction,2025,fte-b0cf71c8cfeec228a73bbd9e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 441.00. Recipient: Example Household 205.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-0a920992c1a27ed60c63fb4e,synthetic-nonform-layout-02,instruction,2025,fte-c61e14f53703b031ca73f482,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 460.00. Recipient: Example Household 206.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-a496cc4c1888fbb927a65eef,synthetic-nonform-layout-02,instruction,2025,fte-7288bb5c1079d3eb7c5372a0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Blank tax form instructions.
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation; Reference amount: 479.00. Recipient: Example Household 207.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-72c0e1c2e06c820b71ae4808,synthetic-nonform-layout-02,instruction,2025,fte-9851b40d38078f0155b7586a,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 369.00. Account holder: Example Person 300.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-3f8c6310dc28029b652d52f4,synthetic-nonform-layout-03,instruction,2025,fte-9e3b91ce6f9ca418293f326f,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 388.00. Account holder: Example Person 301.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-7a4c6f4848b6f9712811dfe6,synthetic-nonform-layout-03,instruction,2025,fte-2c3d97a5a380b4d2d461c67c,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 407.00. Account holder: Example Person 302.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-88dd4b708f54f2f07c912776,synthetic-nonform-layout-03,instruction,2025,fte-7a2c8116bb02d7c369a7a13b,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 426.00. Account holder: Example Person 303.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-e4ce29769c2413d3930e3fba,synthetic-nonform-layout-03,instruction,2025,fte-11072617347ccb06dbebd14c,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 445.00. Account holder: Example Person 304.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-2b95e33a0d09a19475820030,synthetic-nonform-layout-03,instruction,2025,fte-61a7080bca74b191c8840f70,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 464.00. Account holder: Example Person 305.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-cfd5fcf9e16ffbd54647d190,synthetic-nonform-layout-03,instruction,2025,fte-aa0b02266acf64c69f044e4b,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 483.00. Account holder: Example Person 306.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-6e04d04c068bba5de1ac9275,synthetic-nonform-layout-03,instruction,2025,fte-401a0ebb832519cde6b502f5,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions
Reporting period ended 12/31/2025.
Details: General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation, Reference amount: 502.00. Account holder: Example Person 307.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b30c346516e157785ff8eeb3,synthetic-nonform-layout-03,instruction,2025,fte-561e002d707b549e9cc77e5f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 392.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 400",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-853abeb4a1cc67f71ff957a9,synthetic-nonform-layout-04,instruction,2025,fte-5ed863125f83fa8bd8461059,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 411.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 401",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-ef56b8099dcde5aff74cab76,synthetic-nonform-layout-04,instruction,2025,fte-73104dcc03551be78db15e3c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 430.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 402",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-e437989466fcd497dd1303b7,synthetic-nonform-layout-04,instruction,2025,fte-f302a38503fadd08ef35dc3c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 449.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 403",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-033f9fa8c4eeb1148a7a7a5f,synthetic-nonform-layout-04,instruction,2025,fte-825bebb534994e0d6e2754a9,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 468.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 404",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-20c102523c9992191dcf0afd,synthetic-nonform-layout-04,instruction,2025,fte-1b86ae4ed98384448d46e94d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 487.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 405",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-690eab967fd8b7e64e3f62d4,synthetic-nonform-layout-04,instruction,2025,fte-eee1efe79331320d9f78d2b8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 506.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 406",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-61455bd53fe9fa7032561f7d,synthetic-nonform-layout-04,instruction,2025,fte-cea899b1331a8f26abf67290,synthetic_AI_labeled,v1_template,top,False,
"Document header: Blank tax form instructions
Tax reporting year 2025
Reference amount: 525.00
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation
Named party: Example Person 407",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-0d0c6bd61d36e2a602a19b23,synthetic-nonform-layout-04,instruction,2025,fte-b19e8c96a60f7fba261ec0b4,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 415.00
Delivery copy for Example Party 500",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-fec2d1ab00210cd1e5d8ab8d,synthetic-nonform-layout-05,instruction,2025,fte-a6cca514fab3b3dd0d4b6bcb,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 434.00
Delivery copy for Example Party 501",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-3e60f53887048638d8454cbe,synthetic-nonform-layout-05,instruction,2025,fte-b0a77f89b93017669f7cbe04,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 453.00
Delivery copy for Example Party 502",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-66a682b42e6b2e172d12cd30,synthetic-nonform-layout-05,instruction,2025,fte-282f728a932448325f603900,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 472.00
Delivery copy for Example Party 503",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-e3a839fc68c9329563b72d6a,synthetic-nonform-layout-05,instruction,2025,fte-0c3c81d48d088757b57392aa,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 491.00
Delivery copy for Example Party 504",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-1c135e7cf706c56927bb6a46,synthetic-nonform-layout-05,instruction,2025,fte-317e8a02005bb7bb331d852b,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 510.00
Delivery copy for Example Party 505",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-1b7d576066f102e3e60193e1,synthetic-nonform-layout-05,instruction,2025,fte-eead4c4acb0dc9485d4b4e20,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 529.00
Delivery copy for Example Party 506",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-3eb6ed9ad3d54c6342bbf896,synthetic-nonform-layout-05,instruction,2025,fte-d539570cb59181bf97976261,synthetic_AI_labeled,v1_template,top,False,
"Blank tax form instructions -- reporting year 2025
General directions mentioning W-2 and 1099-NEC; no completed payer statement or reported compensation / Reference amount: 548.00
Delivery copy for Example Party 507",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-7ded0908bc2b146394d1fcae,synthetic-nonform-layout-05,instruction,2025,fte-159e315e4b6c2f249ede21b8,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 0.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 300.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-691115f724995667f5baa1ab,synthetic-nonform-layout-00,original,2025,fte-57b941d56b6a612060d7b9b7,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 1.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 319.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-96545dcb47116d7fd827b775,synthetic-nonform-layout-00,original,2025,fte-ea59748a0a79c181e77429bc,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 2.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 338.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-6404f6179dfad7c47a0b8a2e,synthetic-nonform-layout-00,original,2025,fte-85ae77998634c56aeac1532d,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 3.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 357.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-141b2e4d39e1d20900abf9f3,synthetic-nonform-layout-00,original,2025,fte-882dda72ce49618d00293012,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 4.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 376.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-16e8aeba399e778a1084257f,synthetic-nonform-layout-00,original,2025,fte-7b7d86c92129f4eeab7cce87,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 5.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 395.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-470a489b19b3605c6eb92ce2,synthetic-nonform-layout-00,original,2025,fte-2b6d772a3b9f61ae2f3c03a4,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 6.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 414.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-ec3b4a88c15f46a820c67129,synthetic-nonform-layout-00,original,2025,fte-6de9a657dd2ecd65b103be54,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Calendar year: 2025
Statement issued to Example Person 7.
Request for future support; no completed donation or donor acknowledgment
Reference amount: 433.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-af6d9877a65eef6036676b99,synthetic-nonform-layout-00,original,2025,fte-4c8f2cef0f48535d791a505c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 100
Request for future support; no completed donation or donor acknowledgment | Reference amount: 323.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-765ed34fbe11af98c42e7a08,synthetic-nonform-layout-01,original,2025,fte-f4323327d98111438b000154,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 101
Request for future support; no completed donation or donor acknowledgment | Reference amount: 342.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-258ea306a67a8e8fa903c5dc,synthetic-nonform-layout-01,original,2025,fte-c38b9309431dcf91c3a30f77,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 102
Request for future support; no completed donation or donor acknowledgment | Reference amount: 361.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-c2c3114f8ec16920fd6da9f7,synthetic-nonform-layout-01,original,2025,fte-eb404602e6a3f1f1c7a4a9ee,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 103
Request for future support; no completed donation or donor acknowledgment | Reference amount: 380.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-6159a753d0a5d8b51424f64b,synthetic-nonform-layout-01,original,2025,fte-e99693bd83ac61017cfce18d,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 104
Request for future support; no completed donation or donor acknowledgment | Reference amount: 399.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-02276847e4fd338899f44947,synthetic-nonform-layout-01,original,2025,fte-3cf4bb0c27521234a72e54b8,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 105
Request for future support; no completed donation or donor acknowledgment | Reference amount: 418.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-df55083c3fbf7ee2a8e1aaa5,synthetic-nonform-layout-01,original,2025,fte-a464911b3155f65f14a9a273,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 106
Request for future support; no completed donation or donor acknowledgment | Reference amount: 437.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-df9f141504fd88a3f8836a8d,synthetic-nonform-layout-01,original,2025,fte-4d2a748e7b333d48ac56db11,synthetic_AI_labeled,v1_template,top,False,
"2025 | Donation appeal
Recipient record: Example Person 107
Request for future support; no completed donation or donor acknowledgment | Reference amount: 456.00",DONATION_APPEAL,27,DONATION_APPEAL,fdc-9ef52327b03aeea23c328578,synthetic-nonform-layout-01,original,2025,fte-58fc1b003ca1eef124b6b9dc,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 346.00. Recipient: Example Household 200.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-e8533ed281808716ad7ac23d,synthetic-nonform-layout-02,original,2025,fte-94913ee13d9c8945b8631cb1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 365.00. Recipient: Example Household 201.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-20d71218ab3df5375498b2e4,synthetic-nonform-layout-02,original,2025,fte-65b9554208faf4a978fdbd64,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 384.00. Recipient: Example Household 202.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-4368d49d6530928e2d602100,synthetic-nonform-layout-02,original,2025,fte-da96be3b78d07c0b179c971a,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 403.00. Recipient: Example Household 203.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-4c549f8ef0e54c8c46ceed01,synthetic-nonform-layout-02,original,2025,fte-44533f5ce6eae5c95db13c38,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 422.00. Recipient: Example Household 204.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-a02cb54edb82863e538e0fb0,synthetic-nonform-layout-02,original,2025,fte-8813651bcfc41ef7b4ac45f2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 441.00. Recipient: Example Household 205.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-01fcd9a74665f38245e78971,synthetic-nonform-layout-02,original,2025,fte-82a2ae19df3ccb667b949c75,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 460.00. Recipient: Example Household 206.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-602fb82607434cee930a09d7,synthetic-nonform-layout-02,original,2025,fte-c4004b7df27a6a9916d4e9e1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Donation appeal.
Request for future support; no completed donation or donor acknowledgment; Reference amount: 479.00. Recipient: Example Household 207.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-6ff0771e516f595abba7fdaa,synthetic-nonform-layout-02,original,2025,fte-96c568e68d084669753217c5,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 369.00. Account holder: Example Person 300.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-1960b6b59ae7ebeb0aff8710,synthetic-nonform-layout-03,original,2025,fte-a4b2fd6af7048f4b5cd424b1,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 388.00. Account holder: Example Person 301.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-08a2bfc4b42229a6dacd6d2c,synthetic-nonform-layout-03,original,2025,fte-ad2b7b6ac7a743da78354355,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 407.00. Account holder: Example Person 302.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-dcf05bcb55a0523799751fa0,synthetic-nonform-layout-03,original,2025,fte-0e0592bb0277a7834b49b407,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 426.00. Account holder: Example Person 303.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-0f984706b0d2c50dc6f41e1f,synthetic-nonform-layout-03,original,2025,fte-6ab5c8086f2318f9d323c111,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 445.00. Account holder: Example Person 304.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-dbcdc6ec12757e29dd2afe69,synthetic-nonform-layout-03,original,2025,fte-0002cf5508e24cc267645aa2,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 464.00. Account holder: Example Person 305.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-0869e291ac5e11c83cd0d00d,synthetic-nonform-layout-03,original,2025,fte-48b7b56a19624ef2c0f0d9c2,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 483.00. Account holder: Example Person 306.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-5058cb07c21ea41dfdf617e3,synthetic-nonform-layout-03,original,2025,fte-408320ac07ffaae81c667698,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal
Reporting period ended 12/31/2025.
Details: Request for future support; no completed donation or donor acknowledgment, Reference amount: 502.00. Account holder: Example Person 307.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-2c256910cb601a2832e0bae1,synthetic-nonform-layout-03,original,2025,fte-00ef9fbe82ccfac1dc092f9d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 392.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 400",DONATION_APPEAL,27,DONATION_APPEAL,fdc-57d12e93064dceeab5f12076,synthetic-nonform-layout-04,original,2025,fte-aba0d709e7b0b0c61a7af85d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 411.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 401",DONATION_APPEAL,27,DONATION_APPEAL,fdc-2beba3b262caf7a748e1adee,synthetic-nonform-layout-04,original,2025,fte-b20f2a7a9d0619aa74d751ac,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 430.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 402",DONATION_APPEAL,27,DONATION_APPEAL,fdc-da73e988a48fa5d3c58d6921,synthetic-nonform-layout-04,original,2025,fte-05f1f019f12be75c30956eb3,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 449.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 403",DONATION_APPEAL,27,DONATION_APPEAL,fdc-18415eb2ad3182149bd67f09,synthetic-nonform-layout-04,original,2025,fte-b8254d96648f675c675d4150,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 468.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 404",DONATION_APPEAL,27,DONATION_APPEAL,fdc-52e2eea88b617868b268dee0,synthetic-nonform-layout-04,original,2025,fte-bcdb1c284656d2a61367fc24,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 487.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 405",DONATION_APPEAL,27,DONATION_APPEAL,fdc-d8238362705edf4d11159650,synthetic-nonform-layout-04,original,2025,fte-4591daba894cef8b6e6c7d2c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 506.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 406",DONATION_APPEAL,27,DONATION_APPEAL,fdc-7a5061069424d971e339a079,synthetic-nonform-layout-04,original,2025,fte-a8da5688b5753b083796c91b,synthetic_AI_labeled,v1_template,top,False,
"Document header: Donation appeal
Tax reporting year 2025
Reference amount: 525.00
Request for future support; no completed donation or donor acknowledgment
Named party: Example Person 407",DONATION_APPEAL,27,DONATION_APPEAL,fdc-ef2272a138dfd5036b28da47,synthetic-nonform-layout-04,original,2025,fte-eae1cb3fc04f8c03647ac969,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 415.00
Delivery copy for Example Party 500",DONATION_APPEAL,27,DONATION_APPEAL,fdc-9a557127f1895fd5fda35277,synthetic-nonform-layout-05,original,2025,fte-2c8a0c9e45d8353b5f0f858f,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 434.00
Delivery copy for Example Party 501",DONATION_APPEAL,27,DONATION_APPEAL,fdc-0c12e04967fd5862b4ac25e2,synthetic-nonform-layout-05,original,2025,fte-26124afbc8079a3b39493f12,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 453.00
Delivery copy for Example Party 502",DONATION_APPEAL,27,DONATION_APPEAL,fdc-909fb3ef9dc7d496e9e92bd7,synthetic-nonform-layout-05,original,2025,fte-749ad44c123f92658c7cd762,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 472.00
Delivery copy for Example Party 503",DONATION_APPEAL,27,DONATION_APPEAL,fdc-d0b2097b1f2b3c61a4da8650,synthetic-nonform-layout-05,original,2025,fte-da288184e653b3450d895f2d,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 491.00
Delivery copy for Example Party 504",DONATION_APPEAL,27,DONATION_APPEAL,fdc-a1ac728261c48ac5a132d5d7,synthetic-nonform-layout-05,original,2025,fte-26af081601167c2e632dfb0c,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 510.00
Delivery copy for Example Party 505",DONATION_APPEAL,27,DONATION_APPEAL,fdc-4467c7c8be8a219c841f1c4d,synthetic-nonform-layout-05,original,2025,fte-a9afb6973775628510e113ba,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 529.00
Delivery copy for Example Party 506",DONATION_APPEAL,27,DONATION_APPEAL,fdc-43250172742bb620a1c0ad69,synthetic-nonform-layout-05,original,2025,fte-9b5dd9642d69c36af3c739f1,synthetic_AI_labeled,v1_template,top,False,
"Donation appeal -- reporting year 2025
Request for future support; no completed donation or donor acknowledgment / Reference amount: 548.00
Delivery copy for Example Party 507",DONATION_APPEAL,27,DONATION_APPEAL,fdc-8ca9287834ad640e1f62496a,synthetic-nonform-layout-05,original,2025,fte-2520b3e2bf0f14840931ad07,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 0.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 300.00",DONATION_RECORD,28,DONATION_RECORD,fdc-aa726d95f5fdc18bf1fad10f,synthetic-nonform-layout-00,original,2025,fte-de50c6e9f0a4b21794972b6e,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 1.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 319.00",DONATION_RECORD,28,DONATION_RECORD,fdc-88abc1194b45095c1bec5b4d,synthetic-nonform-layout-00,original,2025,fte-44a65a5e6c3e9eca854f071f,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 2.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 338.00",DONATION_RECORD,28,DONATION_RECORD,fdc-79227968621a62ba38f8342a,synthetic-nonform-layout-00,original,2025,fte-c8cac11e446495cd7ae0226e,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 3.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 357.00",DONATION_RECORD,28,DONATION_RECORD,fdc-d75712d23a57ad2fec6c0f37,synthetic-nonform-layout-00,original,2025,fte-20ec90c3d0b09734b7a9bf48,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 4.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 376.00",DONATION_RECORD,28,DONATION_RECORD,fdc-84136cfdebf6dfb94abf79ab,synthetic-nonform-layout-00,original,2025,fte-2962f89b8c1b380e6c31a715,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 5.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 395.00",DONATION_RECORD,28,DONATION_RECORD,fdc-deed0b85d846a5aa88d87b6b,synthetic-nonform-layout-00,original,2025,fte-d98a34eb5d3f1424c67d36f9,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 6.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 414.00",DONATION_RECORD,28,DONATION_RECORD,fdc-005e1d640b6527ac06b18157,synthetic-nonform-layout-00,original,2025,fte-45d46eafc29595f57bd695af,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Calendar year: 2025
Statement issued to Example Person 7.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Reference amount: 433.00",DONATION_RECORD,28,DONATION_RECORD,fdc-35373d39312afe54fa41a734,synthetic-nonform-layout-00,original,2025,fte-1906d7ea5bc8f6fa00128b36,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 100
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 323.00",DONATION_RECORD,28,DONATION_RECORD,fdc-3df611bba6b8a6d74cc521f9,synthetic-nonform-layout-01,original,2025,fte-19dec5f76e25bd607f61edc7,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 101
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 342.00",DONATION_RECORD,28,DONATION_RECORD,fdc-f26426a1b3be2aa6f4e58282,synthetic-nonform-layout-01,original,2025,fte-a4127137b7ff6b446ccc24ba,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 102
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 361.00",DONATION_RECORD,28,DONATION_RECORD,fdc-8fcf28e3b27206a7e1240928,synthetic-nonform-layout-01,original,2025,fte-1dd8fc282a284fddd08f8c15,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 103
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 380.00",DONATION_RECORD,28,DONATION_RECORD,fdc-7bbe76fca1d3252e86015b3d,synthetic-nonform-layout-01,original,2025,fte-9634aeca2d797c54871beace,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 104
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 399.00",DONATION_RECORD,28,DONATION_RECORD,fdc-a8f430d20444f9e3dbf18931,synthetic-nonform-layout-01,original,2025,fte-8fc321768c1ae063161eaac4,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 105
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 418.00",DONATION_RECORD,28,DONATION_RECORD,fdc-748d0d8cc4d741cc68561f82,synthetic-nonform-layout-01,original,2025,fte-8f08db4f040f6baa9fed7484,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 106
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 437.00",DONATION_RECORD,28,DONATION_RECORD,fdc-95f91e0d6de18b548e72f47f,synthetic-nonform-layout-01,original,2025,fte-4b11ca2327aa87a9cf868683,synthetic_AI_labeled,v1_template,top,False,
"2025 | Fundraising dinner receipt
Recipient record: Example Person 107
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction | Reference amount: 456.00",DONATION_RECORD,28,DONATION_RECORD,fdc-b53e590a46dcd7711f0a58a7,synthetic-nonform-layout-01,original,2025,fte-76555599b249d9cf5e45faff,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 346.00. Recipient: Example Household 200.",DONATION_RECORD,28,DONATION_RECORD,fdc-165105a3e74e6ec3f56151a6,synthetic-nonform-layout-02,original,2025,fte-77cc77a82db2c75d8e3d7ba1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 365.00. Recipient: Example Household 201.",DONATION_RECORD,28,DONATION_RECORD,fdc-2fa9b6511af70895b1c4eadc,synthetic-nonform-layout-02,original,2025,fte-d1638b7de1fc4c01210f1789,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 384.00. Recipient: Example Household 202.",DONATION_RECORD,28,DONATION_RECORD,fdc-9ae16c31ec01a9b6361ef071,synthetic-nonform-layout-02,original,2025,fte-9ca7394005c9d64e1946fbca,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 403.00. Recipient: Example Household 203.",DONATION_RECORD,28,DONATION_RECORD,fdc-7c7b79acf11043f48af2e862,synthetic-nonform-layout-02,original,2025,fte-1423d56006dd7b54ed140b9c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 422.00. Recipient: Example Household 204.",DONATION_RECORD,28,DONATION_RECORD,fdc-b68e1f92973ddc27df2956a6,synthetic-nonform-layout-02,original,2025,fte-58a5f93b2b9a25968218e0f7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 441.00. Recipient: Example Household 205.",DONATION_RECORD,28,DONATION_RECORD,fdc-9e3fdbeb66cc4f569913775e,synthetic-nonform-layout-02,original,2025,fte-7fd9b9f5897ff41b1af1d4f0,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 460.00. Recipient: Example Household 206.",DONATION_RECORD,28,DONATION_RECORD,fdc-dbbe1005b8f7c892a9e3f76b,synthetic-nonform-layout-02,original,2025,fte-3c14f6cf1d61b7a4f5e6c451,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Fundraising dinner receipt.
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction; Reference amount: 479.00. Recipient: Example Household 207.",DONATION_RECORD,28,DONATION_RECORD,fdc-d18dcb82654e0033a1ba039b,synthetic-nonform-layout-02,original,2025,fte-1ebdd6d9847a73eca344d748,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 369.00. Account holder: Example Person 300.",DONATION_RECORD,28,DONATION_RECORD,fdc-00f13a6370e442afdacf81fc,synthetic-nonform-layout-03,original,2025,fte-5a8eef580f1ae7394d499db8,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 388.00. Account holder: Example Person 301.",DONATION_RECORD,28,DONATION_RECORD,fdc-797eea1762b72d08f381e005,synthetic-nonform-layout-03,original,2025,fte-efd2bec51dc3c09ca14aaa17,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 407.00. Account holder: Example Person 302.",DONATION_RECORD,28,DONATION_RECORD,fdc-a8d5ed4f420f3bb520ce30ac,synthetic-nonform-layout-03,original,2025,fte-de0148f16ef2826696cc1a9e,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 426.00. Account holder: Example Person 303.",DONATION_RECORD,28,DONATION_RECORD,fdc-2a43648fd9ff72f62c0ea61c,synthetic-nonform-layout-03,original,2025,fte-cd2e15b7d90cd617b1fc82a9,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 445.00. Account holder: Example Person 304.",DONATION_RECORD,28,DONATION_RECORD,fdc-7c61feaac6baaf85237207dc,synthetic-nonform-layout-03,original,2025,fte-b8917d7900608ed2a1e1cf24,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 464.00. Account holder: Example Person 305.",DONATION_RECORD,28,DONATION_RECORD,fdc-adcb579ae06327f28085ebb2,synthetic-nonform-layout-03,original,2025,fte-deec2a25b601feeeb5883e9a,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 483.00. Account holder: Example Person 306.",DONATION_RECORD,28,DONATION_RECORD,fdc-3e9aedc321f42c72d1e2dc43,synthetic-nonform-layout-03,original,2025,fte-db55a462a59526a30e7f8ec8,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt
Reporting period ended 12/31/2025.
Details: Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction, Reference amount: 502.00. Account holder: Example Person 307.",DONATION_RECORD,28,DONATION_RECORD,fdc-ed48a251e5c3cad3035847d9,synthetic-nonform-layout-03,original,2025,fte-250f3903d525c4bb4d4cf712,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 392.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 400",DONATION_RECORD,28,DONATION_RECORD,fdc-c4c07618bbd45a9f1854aab8,synthetic-nonform-layout-04,original,2025,fte-cf098e0548905c1387a1ae60,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 411.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 401",DONATION_RECORD,28,DONATION_RECORD,fdc-8d182fa50922490230348377,synthetic-nonform-layout-04,original,2025,fte-5ae83a1c0df830211b8c739a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 430.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 402",DONATION_RECORD,28,DONATION_RECORD,fdc-a1ee3150083d3e9ff6bcd52a,synthetic-nonform-layout-04,original,2025,fte-31897dab6312c7b558f179ec,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 449.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 403",DONATION_RECORD,28,DONATION_RECORD,fdc-562feb24c2cd2d6af8939ac4,synthetic-nonform-layout-04,original,2025,fte-ec545c33a89d187e3c14a6dc,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 468.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 404",DONATION_RECORD,28,DONATION_RECORD,fdc-9f2dc7728956e32962c68128,synthetic-nonform-layout-04,original,2025,fte-c71734875c295cd64774362f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 487.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 405",DONATION_RECORD,28,DONATION_RECORD,fdc-6d9798554c3888ae655ebe2f,synthetic-nonform-layout-04,original,2025,fte-d93c24a8dd184ed024ea41f2,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 506.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 406",DONATION_RECORD,28,DONATION_RECORD,fdc-956e723dedf822ed7b6c1cac,synthetic-nonform-layout-04,original,2025,fte-330f40e43ba4d6703cd3fb96,synthetic_AI_labeled,v1_template,top,False,
"Document header: Fundraising dinner receipt
Tax reporting year 2025
Reference amount: 525.00
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction
Named party: Example Person 407",DONATION_RECORD,28,DONATION_RECORD,fdc-38f90a90750773ed2b6a1e7d,synthetic-nonform-layout-04,original,2025,fte-e596c5d4ef4a716ac96180e8,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 415.00
Delivery copy for Example Party 500",DONATION_RECORD,28,DONATION_RECORD,fdc-fb40aca984e2e4f4b816adc8,synthetic-nonform-layout-05,original,2025,fte-d6ca42f0a19c5b5e7e57c212,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 434.00
Delivery copy for Example Party 501",DONATION_RECORD,28,DONATION_RECORD,fdc-e907a263fcd130a7c2400ee7,synthetic-nonform-layout-05,original,2025,fte-f0d5476fa1b07fbd9dea154b,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 453.00
Delivery copy for Example Party 502",DONATION_RECORD,28,DONATION_RECORD,fdc-5a883ca6c383c751bc9346df,synthetic-nonform-layout-05,original,2025,fte-803c1efdfa56b07841317de0,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 472.00
Delivery copy for Example Party 503",DONATION_RECORD,28,DONATION_RECORD,fdc-00dba7f1679991b881b067c8,synthetic-nonform-layout-05,original,2025,fte-2a964f39d54a251a2a5a5a80,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 491.00
Delivery copy for Example Party 504",DONATION_RECORD,28,DONATION_RECORD,fdc-294cdd27a9522659eb9e6c7b,synthetic-nonform-layout-05,original,2025,fte-d7fe884190843c3c042bfd56,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 510.00
Delivery copy for Example Party 505",DONATION_RECORD,28,DONATION_RECORD,fdc-a8be9f65c58229b1fe0ba662,synthetic-nonform-layout-05,original,2025,fte-2d5afaa9c3e9a29e07f5c758,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 529.00
Delivery copy for Example Party 506",DONATION_RECORD,28,DONATION_RECORD,fdc-2b5e9fc09195265f806ea785,synthetic-nonform-layout-05,original,2025,fte-1e6753fb6bc834eae3354293,synthetic_AI_labeled,v1_template,top,False,
"Fundraising dinner receipt -- reporting year 2025
Payment and fair value of dinner benefits separately stated; do not equate gross payment with deduction / Reference amount: 548.00
Delivery copy for Example Party 507",DONATION_RECORD,28,DONATION_RECORD,fdc-083d6a4120615b1a936adad3,synthetic-nonform-layout-05,original,2025,fte-803a043c475bfaa43dd7a1d8,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 0.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 300.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-6d435ed0d4e5bc5c25659914,synthetic-nonform-layout-00,original,2025,fte-9e4ac86453fdf0e69a1cce48,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 1.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 319.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-8552a202a93f4d96d818559b,synthetic-nonform-layout-00,original,2025,fte-b2c9172ef4d8948362be4d61,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 2.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 338.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-b2f36a999af3e04d3826cf7c,synthetic-nonform-layout-00,original,2025,fte-14a85887f2c3ba7797bc3eb1,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 3.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 357.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-cd54b8aa5db9e6a96bee6035,synthetic-nonform-layout-00,original,2025,fte-58b9eb86443f2ac8f956f033,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 4.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 376.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-f6519baa897dfc23333429da,synthetic-nonform-layout-00,original,2025,fte-ff58deb342c17d7f1a1bb569,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 5.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 395.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-ec5adb7484e2ad49037a03c2,synthetic-nonform-layout-00,original,2025,fte-0114c7debf35b2d6e7bdaf54,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 6.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 414.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-cd30a93f982d56facfc3d8dc,synthetic-nonform-layout-00,original,2025,fte-545ebdb755aebf2202554de8,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Calendar year: 2025
Statement issued to Example Person 7.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Reference amount: 433.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-2e2537de38a85ee3537167eb,synthetic-nonform-layout-00,original,2025,fte-dae350e750dc2b37cc77e5a2,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 100
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 323.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-b0466901668d0a4abc9b512f,synthetic-nonform-layout-01,original,2025,fte-11582e34db2ddac618865d39,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 101
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 342.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-ac05860c24de669941b48544,synthetic-nonform-layout-01,original,2025,fte-37c05ffb2bf68b14023d7029,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 102
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 361.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-042e99520d2e5d5e4e58a2a9,synthetic-nonform-layout-01,original,2025,fte-c24ffcb39c8ae7e2e310faef,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 103
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 380.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-064b2e765372e6d482e1a76a,synthetic-nonform-layout-01,original,2025,fte-7b2417420c44218a785d2ee3,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 104
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 399.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-2c7bae4b0acd79a8b27126ec,synthetic-nonform-layout-01,original,2025,fte-d686876de340e44b9d44c042,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 105
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 418.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-826c8bea51fa9374dd15f5d3,synthetic-nonform-layout-01,original,2025,fte-17b46118d55e4bdc87354251,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 106
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 437.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-402a1e072b0a13d22ba27116,synthetic-nonform-layout-01,original,2025,fte-b912a05553b79e74a0422439,synthetic_AI_labeled,v1_template,top,False,
"2025 | Medical expense receipt
Recipient record: Example Person 107
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification | Reference amount: 456.00",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-a5760e3f09d1eb629c8c60d8,synthetic-nonform-layout-01,original,2025,fte-40c49b8d8c534e14a26717ca,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 346.00. Recipient: Example Household 200.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-768a8ca04d176c7358d5efd6,synthetic-nonform-layout-02,original,2025,fte-b1e8a5732ff787f110a59304,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 365.00. Recipient: Example Household 201.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-50229e9207cbe99b5402e810,synthetic-nonform-layout-02,original,2025,fte-6d21774ebd84894841e9e66c,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 384.00. Recipient: Example Household 202.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-c1d48fff1c94736868701249,synthetic-nonform-layout-02,original,2025,fte-e3a0ec9023a852533318ecc3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 403.00. Recipient: Example Household 203.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-f98f11ff1ad390d35f2c4fee,synthetic-nonform-layout-02,original,2025,fte-e05f4a428fea63512dae8bc2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 422.00. Recipient: Example Household 204.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-24e71a34301d3a7bf9053671,synthetic-nonform-layout-02,original,2025,fte-faf53b77f05963a81ba0caf7,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 441.00. Recipient: Example Household 205.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-0fbeee325c6f780a1d758625,synthetic-nonform-layout-02,original,2025,fte-44f129de4671b63aeee5fe84,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 460.00. Recipient: Example Household 206.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-760dd42ca944f9ebcbfde9b9,synthetic-nonform-layout-02,original,2025,fte-db11fbe89d40ad03b63c0791,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Medical expense receipt.
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification; Reference amount: 479.00. Recipient: Example Household 207.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-4686d4cba6dbed4a00535c86,synthetic-nonform-layout-02,original,2025,fte-e9451fd99b9006c2e9078d5a,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 369.00. Account holder: Example Person 300.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-24e5cd2b6dc6a636660c44bc,synthetic-nonform-layout-03,original,2025,fte-822e7a901c6130071762a92d,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 388.00. Account holder: Example Person 301.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-e26c00456eeefb915c224beb,synthetic-nonform-layout-03,original,2025,fte-4c9a838a546c880b0373e8d4,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 407.00. Account holder: Example Person 302.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-d69bbc0476b1e6dade32cd16,synthetic-nonform-layout-03,original,2025,fte-b7d7f77eca36c1a00c71f141,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 426.00. Account holder: Example Person 303.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-c810a42487f08e12d3bec95f,synthetic-nonform-layout-03,original,2025,fte-722206a1aa1d6e7aa97d5fd3,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 445.00. Account holder: Example Person 304.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-235d060768ae0479da0eb1e4,synthetic-nonform-layout-03,original,2025,fte-47d6bc1bd222410f8acee290,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 464.00. Account holder: Example Person 305.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-fae5405815dd154279878818,synthetic-nonform-layout-03,original,2025,fte-1c1cdcd27637de3980809241,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 483.00. Account holder: Example Person 306.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-b5700618618df638a4a2d0d4,synthetic-nonform-layout-03,original,2025,fte-a60cb7b900f0e303daf07ff8,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt
Reporting period ended 12/31/2025.
Details: Patient paid for treatment; insurance reimbursement and qualified expense facts require verification, Reference amount: 502.00. Account holder: Example Person 307.",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-668fa64ccfe9b8fd77823a0e,synthetic-nonform-layout-03,original,2025,fte-0a129ea6d26537b7619acb14,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 392.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 400",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-d29cd8f5c1425fdd652f7523,synthetic-nonform-layout-04,original,2025,fte-ec74d6fd579916a2acf5a9a5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 411.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 401",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-e0ee82bfdbd8ce0fec34ad47,synthetic-nonform-layout-04,original,2025,fte-5d002fd475863b6dc2cd2ed8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 430.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 402",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-b68d2858074f0a10d3d5fa56,synthetic-nonform-layout-04,original,2025,fte-24a1f4823e4caefda32cd052,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 449.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 403",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-b7558b590b5c0e0d1b8036c2,synthetic-nonform-layout-04,original,2025,fte-36880767b9e6110f28eaab9f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 468.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 404",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-d3bea81823dcecf5dc2b135b,synthetic-nonform-layout-04,original,2025,fte-cc4de026614299641d01be82,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 487.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 405",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-ecc527dbaaade661409ec3a5,synthetic-nonform-layout-04,original,2025,fte-5acd6606161a576b11cccaea,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 506.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 406",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-0007474135472f3354f08909,synthetic-nonform-layout-04,original,2025,fte-b072577d961809a90710c960,synthetic_AI_labeled,v1_template,top,False,
"Document header: Medical expense receipt
Tax reporting year 2025
Reference amount: 525.00
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification
Named party: Example Person 407",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-e5bf607ef1afd698c1504861,synthetic-nonform-layout-04,original,2025,fte-cb764efc5b63214ba62729cf,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 415.00
Delivery copy for Example Party 500",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-f4a09e3f0d66b4ad359fed5e,synthetic-nonform-layout-05,original,2025,fte-cb715d024f55c9c85b2b4ecb,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 434.00
Delivery copy for Example Party 501",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-1800ecdbf5ef9348d3a25453,synthetic-nonform-layout-05,original,2025,fte-d5ad0b55dca56ee1bd2649d3,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 453.00
Delivery copy for Example Party 502",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-3e51f9ef958b93e7d796afd3,synthetic-nonform-layout-05,original,2025,fte-d9cf73e77db6876b88526f9e,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 472.00
Delivery copy for Example Party 503",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-5e850f7233a4bcb834e815e3,synthetic-nonform-layout-05,original,2025,fte-5922aff19e833f85539cc25f,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 491.00
Delivery copy for Example Party 504",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-2dcc680dc7f44df1a98e86bc,synthetic-nonform-layout-05,original,2025,fte-8a188c337c8c75e4e2200274,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 510.00
Delivery copy for Example Party 505",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-87139c45c376311fd0d9bc84,synthetic-nonform-layout-05,original,2025,fte-fe3d2602182a1bf7a6b127df,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 529.00
Delivery copy for Example Party 506",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-2d73c142e2f4232af69bbff7,synthetic-nonform-layout-05,original,2025,fte-b4453f5ee275afdeee6bc1d6,synthetic_AI_labeled,v1_template,top,False,
"Medical expense receipt -- reporting year 2025
Patient paid for treatment; insurance reimbursement and qualified expense facts require verification / Reference amount: 548.00
Delivery copy for Example Party 507",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-a32a8bec2515453bfa396d8f,synthetic-nonform-layout-05,original,2025,fte-aedcac8db231d6c37dc754a3,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 0.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 300.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-672fffd6921d0115ec5374a8,synthetic-nonform-layout-00,original,2025,fte-b7ecbecac18529620a7083c0,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 1.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 319.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-2c83120651bdef6f050a7bfb,synthetic-nonform-layout-00,original,2025,fte-33a6b4c4ac338b8680a08e67,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 2.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 338.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-33074ac3e356ac9db24fd38b,synthetic-nonform-layout-00,original,2025,fte-25d738a0031b0b1dce0f5985,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 3.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 357.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f9d347f090c758f02467c7db,synthetic-nonform-layout-00,original,2025,fte-e22cff99c78629f72fda520c,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 4.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 376.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ad2f75a8f7f1ef987d4ece99,synthetic-nonform-layout-00,original,2025,fte-e9bf9014cad64972dab5ca53,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 5.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 395.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-5761e24d4cd5a48ba398fd7d,synthetic-nonform-layout-00,original,2025,fte-927630f88cae0cbf34421ae5,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 6.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 414.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-510b5e2246e02d97e97c5ea8,synthetic-nonform-layout-00,original,2025,fte-bcdd58328f84d7c7a065bf45,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Calendar year: 2025
Statement issued to Example Person 7.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Reference amount: 433.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-987f13eda4a04f2b261694a2,synthetic-nonform-layout-00,original,2025,fte-446a4c3e158abc498f21794d,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 100
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 323.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-e10da843956ec88f72adf046,synthetic-nonform-layout-01,original,2025,fte-32ac10276d4a1dc87415e523,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 101
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 342.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-8549dea87b56db485a28170c,synthetic-nonform-layout-01,original,2025,fte-e8cfaf567259f0cfe61c2cda,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 102
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 361.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ba55233e1a7506c63f58c164,synthetic-nonform-layout-01,original,2025,fte-4d6fbffb9e3933e27112b96e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 103
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 380.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-6e606ee6b483cb9c3af37ed8,synthetic-nonform-layout-01,original,2025,fte-67c80659fb09f8944764a7cb,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 104
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 399.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-b0761eb6aaba5790fdb2637d,synthetic-nonform-layout-01,original,2025,fte-cb6ccb19836bf6a62c423a9e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 105
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 418.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f3e6ae8fb736c9529b7d3f84,synthetic-nonform-layout-01,original,2025,fte-6ae719f42cb8d6de7bc94a50,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 106
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 437.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-dd8df33081e28475ca12fae5,synthetic-nonform-layout-01,original,2025,fte-56635f8085f86b1bd9e8ef3e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Estimated tax payment confirmation
Recipient record: Example Person 107
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher | Reference amount: 456.00",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-b0f873bc9e0fa86ad7335de8,synthetic-nonform-layout-01,original,2025,fte-18d29ccd08af914a0ce5c174,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 346.00. Recipient: Example Household 200.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-22faa7cc556b737ae94cb553,synthetic-nonform-layout-02,original,2025,fte-2abd0f7bf8cb36511ea3de97,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 365.00. Recipient: Example Household 201.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-d45e0f4a52dc24b03d30fbdb,synthetic-nonform-layout-02,original,2025,fte-882cb827bf219f192ea046be,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 384.00. Recipient: Example Household 202.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f03b7b8e8f8812e0ecb40f45,synthetic-nonform-layout-02,original,2025,fte-51a54d4bd41e15c18438ad6e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 403.00. Recipient: Example Household 203.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-3173dbcabc4ac0dace5c0654,synthetic-nonform-layout-02,original,2025,fte-cf8a2c186f8776fc8892db2d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 422.00. Recipient: Example Household 204.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-2a7f722995934ca363446a67,synthetic-nonform-layout-02,original,2025,fte-58626397a8ee03259fc3e583,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 441.00. Recipient: Example Household 205.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-bb8e332f610a78a6985c838e,synthetic-nonform-layout-02,original,2025,fte-33fe7b7a2ed7983196c6eb79,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 460.00. Recipient: Example Household 206.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-21c7373d2f164b3de554ec23,synthetic-nonform-layout-02,original,2025,fte-5c2f6f114f812f2a6d077e83,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Estimated tax payment confirmation.
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher; Reference amount: 479.00. Recipient: Example Household 207.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-e41165610106e1ed9429eda8,synthetic-nonform-layout-02,original,2025,fte-cdc7284725afff10f07e8370,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 369.00. Account holder: Example Person 300.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-d5238818ddcaa49b022fb3ee,synthetic-nonform-layout-03,original,2025,fte-ef0d6c05f6f117325ef8af4d,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 388.00. Account holder: Example Person 301.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-7c9a09ed0188f1d1983cb28c,synthetic-nonform-layout-03,original,2025,fte-c30e84d7f96884bbdfb946ad,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 407.00. Account holder: Example Person 302.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-1d46c0b7e328ba32c8d514ad,synthetic-nonform-layout-03,original,2025,fte-3b11cf2be243646c4815dfb3,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 426.00. Account holder: Example Person 303.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-73129e0dfee32a77a383560e,synthetic-nonform-layout-03,original,2025,fte-b2da2483bb6636ab7e16ad33,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 445.00. Account holder: Example Person 304.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-c4b388da373c3f4411092b30,synthetic-nonform-layout-03,original,2025,fte-a91145797359685887564900,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 464.00. Account holder: Example Person 305.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-bf0a32b9f642269c5c17b252,synthetic-nonform-layout-03,original,2025,fte-6cd5e8cc058b9008d1f2e9c2,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 483.00. Account holder: Example Person 306.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-46dacb58e37b638789c70c4c,synthetic-nonform-layout-03,original,2025,fte-3dd5f733bc7a522aaa054bed,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation
Reporting period ended 12/31/2025.
Details: Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher, Reference amount: 502.00. Account holder: Example Person 307.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-652659adc51bf0085bdc0e38,synthetic-nonform-layout-03,original,2025,fte-557a4da0c2e711c1de9d7d67,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 392.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 400",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-1dbbe040d0764baaa4c4bfca,synthetic-nonform-layout-04,original,2025,fte-4446c0c377478a68e20af3ec,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 411.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 401",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ddbb4c3d975ab9a39c576f9b,synthetic-nonform-layout-04,original,2025,fte-c5a46224a3d8f3c63e91a19f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 430.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 402",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-46d14290e6ed2b96025b2dbb,synthetic-nonform-layout-04,original,2025,fte-2b3409826fbee14b38eeb31d,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 449.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 403",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-d15e5393d901e0cf4d174a89,synthetic-nonform-layout-04,original,2025,fte-66507d1e633b5b27ed2cd619,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 468.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 404",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-9d08d14fcc37ddda1033a34c,synthetic-nonform-layout-04,original,2025,fte-7a2275749d642ead9d199108,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 487.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 405",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f693ad82cd42aa2bc5c956e8,synthetic-nonform-layout-04,original,2025,fte-5229ebff2a104924d913bc92,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 506.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 406",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-59fa97b097f66f1dd092ca26,synthetic-nonform-layout-04,original,2025,fte-1ff42e18895666b06e5dc572,synthetic_AI_labeled,v1_template,top,False,
"Document header: Estimated tax payment confirmation
Tax reporting year 2025
Reference amount: 525.00
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher
Named party: Example Person 407",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-e2d4d88edcc6df07e26503b1,synthetic-nonform-layout-04,original,2025,fte-8e04b29aa7851b82cb62d165,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 415.00
Delivery copy for Example Party 500",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-b762a25a377e5662f9222320,synthetic-nonform-layout-05,original,2025,fte-dd99df1a4b0153ad6a259f67,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 434.00
Delivery copy for Example Party 501",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-929a2cb934a37a4bc0c3bb8d,synthetic-nonform-layout-05,original,2025,fte-a69411545f2cc808c1cc58df,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 453.00
Delivery copy for Example Party 502",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-7e98f6f52179005e4c5503d5,synthetic-nonform-layout-05,original,2025,fte-897a157f84fa3239ab892d0e,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 472.00
Delivery copy for Example Party 503",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-a6c774a0d18cf51fd9092f95,synthetic-nonform-layout-05,original,2025,fte-cf7dd4dbed2da9591201951f,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 491.00
Delivery copy for Example Party 504",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f94b3f0cba472dec23452988,synthetic-nonform-layout-05,original,2025,fte-6efe272439c0f6ba34ccb96a,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 510.00
Delivery copy for Example Party 505",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-8db2a9db489d5316cb163b6d,synthetic-nonform-layout-05,original,2025,fte-d5e9a4ba244ce5885ce0613b,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 529.00
Delivery copy for Example Party 506",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f4c9c9b10f0942520fe9866f,synthetic-nonform-layout-05,original,2025,fte-3fc59e32f7345c9466f6b71c,synthetic_AI_labeled,v1_template,top,False,
"Estimated tax payment confirmation -- reporting year 2025
Payment completed; tax year and federal authority identified; this is not an unsubmitted voucher / Reference amount: 548.00
Delivery copy for Example Party 507",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-cb0257d2d471edf2e486b457,synthetic-nonform-layout-05,original,2025,fte-d64d8a98dd347bd50a6e13c1,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 0.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 300.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-956d1f7ad622b0a5ad5881dd,synthetic-nonform-layout-00,original,2025,fte-7d4b56a8faec1645201f0e39,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 1.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 319.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ec5db743a48b3af78836e890,synthetic-nonform-layout-00,original,2025,fte-05562ae0122bdc5ab77676f3,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 2.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 338.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1a37cf40a83dd8a017da0424,synthetic-nonform-layout-00,original,2025,fte-27072375120130604536a6cd,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 3.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 357.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-5800611888ec3ba300529503,synthetic-nonform-layout-00,original,2025,fte-7260cba3352923427b224a0f,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 4.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 376.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-083b7c1a75bb2e1a52a05415,synthetic-nonform-layout-00,original,2025,fte-efc54e787964e0cdfacd507d,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 5.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 395.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-b71f721d1fecc1b2088ce6ea,synthetic-nonform-layout-00,original,2025,fte-313fd1e6966b1f55464a9497,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 6.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 414.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-cfef8db37adfcb28313883a1,synthetic-nonform-layout-00,original,2025,fte-83b57f27a51b299837077fde,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Calendar year: 2025
Statement issued to Example Person 7.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Reference amount: 433.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1aaae5e97c508771fea4c013,synthetic-nonform-layout-00,original,2025,fte-97fd58d64ad08b4ac7df976a,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 100
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 323.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-15ba24138cb6b20fd4b27982,synthetic-nonform-layout-01,original,2025,fte-cd2a9515c2ed08b8eefe6e72,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 101
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 342.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-d516a862dc1bedabe1c2cc58,synthetic-nonform-layout-01,original,2025,fte-c6ea649ba08729662691c0a0,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 102
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 361.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-3f6739afdb2ef7714f699a54,synthetic-nonform-layout-01,original,2025,fte-df19ce861226b7f679cb2215,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 103
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 380.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-c5d26378912f89d0a74e1a71,synthetic-nonform-layout-01,original,2025,fte-3a9be2d9cd39dabd3d415b86,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 104
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 399.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-509accfe73a95df7e12fc229,synthetic-nonform-layout-01,original,2025,fte-f54cd8291d4d3cf47c759bf2,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 105
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 418.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-5a859cf613d2143f13f716bc,synthetic-nonform-layout-01,original,2025,fte-212f900c7eb906ab8472da42,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 106
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 437.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-97fed4a7f76477aaef97edfc,synthetic-nonform-layout-01,original,2025,fte-4d66c2777e8b44286bb03545,synthetic_AI_labeled,v1_template,top,False,
"2025 | Business sales ledger
Recipient record: Example Person 107
Customer sales and processing fees shown separately; reconciliation needed to gross receipts | Reference amount: 456.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f2ed427aca85bae96cb039a9,synthetic-nonform-layout-01,original,2025,fte-f0fe7f2de35546861b34fba8,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 346.00. Recipient: Example Household 200.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-48afc124010ef94997ee69ee,synthetic-nonform-layout-02,original,2025,fte-e99f9442d731d14f4f8bdcc4,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 365.00. Recipient: Example Household 201.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-c9beb0b28e42216fc05b4b6c,synthetic-nonform-layout-02,original,2025,fte-b59cf0fa8bb6ca45d6ab49be,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 384.00. Recipient: Example Household 202.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-138a4c5710bb9aa80a4e6338,synthetic-nonform-layout-02,original,2025,fte-bd6df00e913728f56c5f175f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 403.00. Recipient: Example Household 203.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-5c5df2d9936eecc633a770c8,synthetic-nonform-layout-02,original,2025,fte-a13c8b041b46347d2dc24bd3,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 422.00. Recipient: Example Household 204.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-6131c66c420aee4399d9178b,synthetic-nonform-layout-02,original,2025,fte-be0074410dcfd7358c7ee90d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 441.00. Recipient: Example Household 205.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-063bfcf9e1258412aca02073,synthetic-nonform-layout-02,original,2025,fte-d6277c98753b97daae0e404f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 460.00. Recipient: Example Household 206.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-6e038e2d1d098ce74a5b7fdb,synthetic-nonform-layout-02,original,2025,fte-7a31321f9cd312f0351a691e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Business sales ledger.
Customer sales and processing fees shown separately; reconciliation needed to gross receipts; Reference amount: 479.00. Recipient: Example Household 207.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-a8cc11cbb593f4fe7b84b359,synthetic-nonform-layout-02,original,2025,fte-7705642d700c604438304e2d,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 369.00. Account holder: Example Person 300.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-b61f41086e9853fc3f3849ad,synthetic-nonform-layout-03,original,2025,fte-76ac3f7e577d0d5618c7190f,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 388.00. Account holder: Example Person 301.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4647a2ab1c0a21215d6640d3,synthetic-nonform-layout-03,original,2025,fte-cfd29d9e1310fd1a548fcfb6,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 407.00. Account holder: Example Person 302.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e6b595f67bf3b2e57187ec3e,synthetic-nonform-layout-03,original,2025,fte-fb963de1991101b483e453d6,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 426.00. Account holder: Example Person 303.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bbe6ef7644a277cc7052d9e7,synthetic-nonform-layout-03,original,2025,fte-71289671325fe0d6c9cf37e4,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 445.00. Account holder: Example Person 304.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e1cf9af036f9a298aaf22790,synthetic-nonform-layout-03,original,2025,fte-0dd524f59e1f833d89f6d396,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 464.00. Account holder: Example Person 305.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-875186c944e7f1ae2cefb938,synthetic-nonform-layout-03,original,2025,fte-4f491ceaca8132d04b75c719,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 483.00. Account holder: Example Person 306.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-30371263458ff36882f153e7,synthetic-nonform-layout-03,original,2025,fte-b2434a3a4ecace7a94b772a5,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger
Reporting period ended 12/31/2025.
Details: Customer sales and processing fees shown separately; reconciliation needed to gross receipts, Reference amount: 502.00. Account holder: Example Person 307.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e7d58942feb5962d391c32de,synthetic-nonform-layout-03,original,2025,fte-4819048f0e5409e6da582ff5,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 392.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 400",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2dd78f34c35116c785f9958f,synthetic-nonform-layout-04,original,2025,fte-a71119555286852c455343f1,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 411.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 401",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2a1e20ad73c75be9cd61d6be,synthetic-nonform-layout-04,original,2025,fte-c9142ef181aef0cc3d5e89a8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 430.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 402",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-909cb0c8855370fe78d4ef46,synthetic-nonform-layout-04,original,2025,fte-7c8dab8ae0c0a9da0a7280cf,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 449.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 403",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4c35d7807d085f890c11c164,synthetic-nonform-layout-04,original,2025,fte-2c446ba769da92a61d485688,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 468.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 404",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-a559ef318871b486686ed658,synthetic-nonform-layout-04,original,2025,fte-65780bd0a515f217866985fb,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 487.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 405",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-efaa15a178238e50d0b3a834,synthetic-nonform-layout-04,original,2025,fte-d917ab368896dead423dc57a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 506.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 406",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-6b79f816beb83736e4090e66,synthetic-nonform-layout-04,original,2025,fte-5b7ff3eb28b3321280bc5a57,synthetic_AI_labeled,v1_template,top,False,
"Document header: Business sales ledger
Tax reporting year 2025
Reference amount: 525.00
Customer sales and processing fees shown separately; reconciliation needed to gross receipts
Named party: Example Person 407",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-36344e1e0446c5675670f5de,synthetic-nonform-layout-04,original,2025,fte-21e53439e821b8c02b14d65b,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 415.00
Delivery copy for Example Party 500",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-acc788307ddab16e27374a6f,synthetic-nonform-layout-05,original,2025,fte-190eb6923a6d9200c33e0df5,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 434.00
Delivery copy for Example Party 501",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0aaacac1fc4096c41dba51ac,synthetic-nonform-layout-05,original,2025,fte-940c3177332b2adaf8521db8,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 453.00
Delivery copy for Example Party 502",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-79c5a7a3379383a4e2badce2,synthetic-nonform-layout-05,original,2025,fte-0094c4101ca0611ead69b2c5,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 472.00
Delivery copy for Example Party 503",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8188cdfb4290deb008d0b492,synthetic-nonform-layout-05,original,2025,fte-67d31375d1c8ea50d425eccb,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 491.00
Delivery copy for Example Party 504",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0a34ca1d7cc16d54ddc268d2,synthetic-nonform-layout-05,original,2025,fte-76a2ec20e8bea948f6182986,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 510.00
Delivery copy for Example Party 505",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-3f0166e49adb8cdf7c4636ee,synthetic-nonform-layout-05,original,2025,fte-abac4bfee27020ae1803c53e,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 529.00
Delivery copy for Example Party 506",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-a1f994a1dd7a83e8a358c31c,synthetic-nonform-layout-05,original,2025,fte-7e263e86248657a735cba6c6,synthetic_AI_labeled,v1_template,top,False,
"Business sales ledger -- reporting year 2025
Customer sales and processing fees shown separately; reconciliation needed to gross receipts / Reference amount: 548.00
Delivery copy for Example Party 507",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-9641d6fb6eae8a7bc3da8d9c,synthetic-nonform-layout-05,original,2025,fte-54f4a2545c4a98b1c60739dd,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 0.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 300.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-39630c845f8b3cc85c6d0b9e,synthetic-nonform-layout-00,original,2025,fte-de5e358e720dc138241345bd,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 1.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 319.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f380ea1f8d1790bc33a0919d,synthetic-nonform-layout-00,original,2025,fte-0caecbaf44fdf2778e2b5150,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 2.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 338.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-c2a4c37fb71981adbd35086b,synthetic-nonform-layout-00,original,2025,fte-7bee1de5080b792678ef1390,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 3.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 357.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-fb4ebe9b1b5ab49bab2edfac,synthetic-nonform-layout-00,original,2025,fte-12b40c371ec2f2257b161112,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 4.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 376.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0549562df4586717fc540d4d,synthetic-nonform-layout-00,original,2025,fte-b5cca020d74d7e909f81454c,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 5.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 395.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ba6931301f8569a3435794c1,synthetic-nonform-layout-00,original,2025,fte-f038f1a9b1732acc61d89b99,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 6.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 414.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f9326ee332c6e68db4cb54c3,synthetic-nonform-layout-00,original,2025,fte-229a8090756464ddc84a004a,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Calendar year: 2025
Statement issued to Example Person 7.
Tenant rent and security deposit listed separately; expense records attached
Reference amount: 433.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-6a03978c3a0d6ae682053ab4,synthetic-nonform-layout-00,original,2025,fte-cdf7996006052636e2cf692e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 100
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 323.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-37f40466004fe91c7801d8d8,synthetic-nonform-layout-01,original,2025,fte-55d5cac2a761e549978bc5c7,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 101
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 342.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-7b2078004fc056613bd5c611,synthetic-nonform-layout-01,original,2025,fte-b5d49f98694b11c746f604ba,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 102
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 361.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ad8ae13181dbf9c77c5422bd,synthetic-nonform-layout-01,original,2025,fte-658037d3d14ab813b12cdd6d,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 103
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 380.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-5e2939b6004265864d4ad748,synthetic-nonform-layout-01,original,2025,fte-94cafb742128d993658fa806,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 104
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 399.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e042f7bc712a9d94782841d1,synthetic-nonform-layout-01,original,2025,fte-058d5a3d02b04b81b35175cf,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 105
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 418.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1235b6d8bcfd5cfb1e1a506d,synthetic-nonform-layout-01,original,2025,fte-63e829f45d454a6c844e9524,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 106
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 437.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-cf84cae00314d1f69670a77d,synthetic-nonform-layout-01,original,2025,fte-131f840341f5686466467405,synthetic_AI_labeled,v1_template,top,False,
"2025 | Rental property income record
Recipient record: Example Person 107
Tenant rent and security deposit listed separately; expense records attached | Reference amount: 456.00",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-45f814bbbc257e90f3f6abc2,synthetic-nonform-layout-01,original,2025,fte-b13c02f45b8af81f199eb125,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 346.00. Recipient: Example Household 200.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ae947c976810923b9c44435e,synthetic-nonform-layout-02,original,2025,fte-bce2ad0df3bc2bbc39ce48d1,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 365.00. Recipient: Example Household 201.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-fbd9ed01f27d55079d8f65f9,synthetic-nonform-layout-02,original,2025,fte-534ad4de280a1e3c1ef05319,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 384.00. Recipient: Example Household 202.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-284782a2dcfe730b5d990a53,synthetic-nonform-layout-02,original,2025,fte-eb624fc9ae7c5a8d189d186d,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 403.00. Recipient: Example Household 203.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-887ce16d81c653310eb19c88,synthetic-nonform-layout-02,original,2025,fte-e570bcd6332c2e1f40a3790f,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 422.00. Recipient: Example Household 204.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ff67cfdce5a70a1bc58c0af2,synthetic-nonform-layout-02,original,2025,fte-dc9c508db0abdb17ebcecb96,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 441.00. Recipient: Example Household 205.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-55a40cd92808d0aae3b1fc76,synthetic-nonform-layout-02,original,2025,fte-4ed447904c287481f7f6af70,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 460.00. Recipient: Example Household 206.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-3e799736daecc072c86ce7c4,synthetic-nonform-layout-02,original,2025,fte-7b7c6a0ccf70ee669924ccbf,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Rental property income record.
Tenant rent and security deposit listed separately; expense records attached; Reference amount: 479.00. Recipient: Example Household 207.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-93e6e01a147ecb6857f4b480,synthetic-nonform-layout-02,original,2025,fte-0d5bb7bf0929cb7f75f9ecb3,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 369.00. Account holder: Example Person 300.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-d4a822d3e952dbe8038be4c1,synthetic-nonform-layout-03,original,2025,fte-d8cd7727a6be1098a6eaa43b,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 388.00. Account holder: Example Person 301.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-fcae119440af9b9ed040b383,synthetic-nonform-layout-03,original,2025,fte-bab70e0ba5a9644678b5e999,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 407.00. Account holder: Example Person 302.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-862aac8c5d2f4ab7340e102c,synthetic-nonform-layout-03,original,2025,fte-bbe3e22efd06d2b20502c407,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 426.00. Account holder: Example Person 303.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8958e533ddcb4ed8730f5382,synthetic-nonform-layout-03,original,2025,fte-a4901ca9101d59e87c37e983,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 445.00. Account holder: Example Person 304.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-9d63733a1dc697aa571df86c,synthetic-nonform-layout-03,original,2025,fte-0e0d89c1f7dda1cd8ed676fd,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 464.00. Account holder: Example Person 305.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-a66e79bce2b1b550ddc539d8,synthetic-nonform-layout-03,original,2025,fte-df022ef1e5907621989fe399,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 483.00. Account holder: Example Person 306.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-c804593569d1cb5dff3c1470,synthetic-nonform-layout-03,original,2025,fte-8dacb5e7a5d5ae847584612e,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record
Reporting period ended 12/31/2025.
Details: Tenant rent and security deposit listed separately; expense records attached, Reference amount: 502.00. Account holder: Example Person 307.",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-b01f0e8b53d1f5445d4ef2b3,synthetic-nonform-layout-03,original,2025,fte-c0d821c4d1061517e9a87c3c,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 392.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 400",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-80e577db5c4a3824589d3fc3,synthetic-nonform-layout-04,original,2025,fte-ce49a601029020f10fcd5b3a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 411.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 401",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-5220f8741695b180ef351688,synthetic-nonform-layout-04,original,2025,fte-6d06fd0c06c246471419c014,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 430.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 402",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-30788139184635a102608c3f,synthetic-nonform-layout-04,original,2025,fte-5144989347ddaa17e80bc3db,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 449.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 403",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-490252c57428ab1e8fd3a3aa,synthetic-nonform-layout-04,original,2025,fte-ca51d63c64cb40453b623f1f,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 468.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 404",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-aed34f1ed1a7ee98a9cb48dd,synthetic-nonform-layout-04,original,2025,fte-f4d4c83e4e0c98968853cb39,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 487.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 405",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-9d2e8245bca73badb587b84f,synthetic-nonform-layout-04,original,2025,fte-73524694aa77e07df817209e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 506.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 406",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bb6e287b02fdd838326972b2,synthetic-nonform-layout-04,original,2025,fte-c19ff5b4501faa60dd8c76bf,synthetic_AI_labeled,v1_template,top,False,
"Document header: Rental property income record
Tax reporting year 2025
Reference amount: 525.00
Tenant rent and security deposit listed separately; expense records attached
Named party: Example Person 407",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-84042f3339e331e5b5597bb7,synthetic-nonform-layout-04,original,2025,fte-8f7b5879689986c3606055e8,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 415.00
Delivery copy for Example Party 500",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2f4078447b5d5c71d7f46d78,synthetic-nonform-layout-05,original,2025,fte-60fe00e32bb2eee895fe3d13,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 434.00
Delivery copy for Example Party 501",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-78c5e232bb0a4417535ab0bb,synthetic-nonform-layout-05,original,2025,fte-5946877fb76d9bc9f7c29dfb,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 453.00
Delivery copy for Example Party 502",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-28a0f0a2bd591d9b8d446dbe,synthetic-nonform-layout-05,original,2025,fte-6e6f71a09fd4386fd67a2529,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 472.00
Delivery copy for Example Party 503",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4fd395a5298ac903b449e2f9,synthetic-nonform-layout-05,original,2025,fte-3a3c738d43b3834642076abe,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 491.00
Delivery copy for Example Party 504",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-80a1f94a98ff1c5eaaf0fee7,synthetic-nonform-layout-05,original,2025,fte-0d39b9679e1c9f8aa1575d68,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 510.00
Delivery copy for Example Party 505",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bdc18cadd3a718964af43f3b,synthetic-nonform-layout-05,original,2025,fte-227d6cfcc1cae0c37194e727,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 529.00
Delivery copy for Example Party 506",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2e6d08eccacfb5246807182d,synthetic-nonform-layout-05,original,2025,fte-d05eea002cc7ce738b2dabd5,synthetic_AI_labeled,v1_template,top,False,
"Rental property income record -- reporting year 2025
Tenant rent and security deposit listed separately; expense records attached / Reference amount: 548.00
Delivery copy for Example Party 507",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-cbe50c5bffa32b95073f1ff0,synthetic-nonform-layout-05,original,2025,fte-b64fd8adda359b16e117d740,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 0.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 300.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-de5c6586019f6d3c936ef2d8,synthetic-nonform-layout-00,unknown,,fte-79d0b7b63ba2948049a275ec,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 1.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 319.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-811eba61ecc2c0728adc8fdb,synthetic-nonform-layout-00,unknown,,fte-0ac38203902e85df4a9d83d2,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 2.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 338.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-fc8fd7f05cb50fafd8b99ecd,synthetic-nonform-layout-00,unknown,,fte-35b7d954506d26ad352da140,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 3.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 357.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d05dd5f83567d56ac7f98251,synthetic-nonform-layout-00,unknown,,fte-7eeb8f0e99d683383cb8798f,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 4.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 376.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-25f12af22818df2b6226d312,synthetic-nonform-layout-00,unknown,,fte-3d9793933d7669a078f0d45f,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 5.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 395.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e0dc95644a36879e56bac9f5,synthetic-nonform-layout-00,unknown,,fte-d75231884ffdcdc9e8dc77f6,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 6.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 414.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-8f55596293be3fa0453b246f,synthetic-nonform-layout-00,unknown,,fte-b80001190b5dc23fbfeb5a2e,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Calendar year: 2025
Statement issued to Example Person 7.
Unusable cropped fragment; document title and tax year cannot be read
Reference amount: 433.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1e25a2df265d58e7f8a28cc1,synthetic-nonform-layout-00,unknown,,fte-c5b4ed94efb531a713117950,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 100
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 323.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-76c9a851d59325083abbf079,synthetic-nonform-layout-01,unknown,,fte-a9ff76561e2ae5d1c5f5f0da,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 101
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 342.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ee6a123a914ba78ca81a6cf1,synthetic-nonform-layout-01,unknown,,fte-8f3d9d258b7c6017afcaefde,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 102
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 361.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-9725a4673239bcf68ef3769c,synthetic-nonform-layout-01,unknown,,fte-7dbc2ece9a8977b5d02a915e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 103
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 380.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-bd1de25cbaab32bedd90a351,synthetic-nonform-layout-01,unknown,,fte-19112f4f2c05ee1cbdd1f31c,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 104
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 399.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-6c0c95c1c7b9935dc8178eef,synthetic-nonform-layout-01,unknown,,fte-e2262af96b970bcba36d427e,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 105
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 418.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-261ff01e71dc3e7ea28fec57,synthetic-nonform-layout-01,unknown,,fte-4853e19b09aca32c456ee460,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 106
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 437.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b3089f5eef2ed21cf3032bec,synthetic-nonform-layout-01,unknown,,fte-a310b7706c722c6398cb77c8,synthetic_AI_labeled,v1_template,top,False,
"2025 | Illegible record fragment
Recipient record: Example Person 107
Unusable cropped fragment; document title and tax year cannot be read | Reference amount: 456.00",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ffd9b2aafdf58dbc9925ec14,synthetic-nonform-layout-01,unknown,,fte-0bc946bdf08a54e860c53131,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 346.00. Recipient: Example Household 200.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-bac659b9573875b780cf6bda,synthetic-nonform-layout-02,unknown,,fte-2d9febc49704ba366a0602d2,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 365.00. Recipient: Example Household 201.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2d460e7539fb0f2be567c486,synthetic-nonform-layout-02,unknown,,fte-ed57e952a45e950a9d817b15,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 384.00. Recipient: Example Household 202.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7341e7ac288710955ec32b58,synthetic-nonform-layout-02,unknown,,fte-ae320196b4f4e799c8e91173,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 403.00. Recipient: Example Household 203.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7e59f15481cf2a0b32f6c824,synthetic-nonform-layout-02,unknown,,fte-fddbc74a1b099550ab63a9d5,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 422.00. Recipient: Example Household 204.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-bb4f65f0c287396cd1e97938,synthetic-nonform-layout-02,unknown,,fte-916f084fb1af3d8879cdc58e,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 441.00. Recipient: Example Household 205.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1abb1b6c630e9df8ecda0d24,synthetic-nonform-layout-02,unknown,,fte-341eac13cc7cd6fb38ae6f51,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 460.00. Recipient: Example Household 206.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2a6f5150c1a926b8413b44fd,synthetic-nonform-layout-02,unknown,,fte-ac0908e3c79015403cb472ae,synthetic_AI_labeled,v1_template,top,False,
"Annual reporting document for 2025. Illegible record fragment.
Unusable cropped fragment; document title and tax year cannot be read; Reference amount: 479.00. Recipient: Example Household 207.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d4a75c989e53b72f6896a1c8,synthetic-nonform-layout-02,unknown,,fte-6cb639559016abe942472bca,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 369.00. Account holder: Example Person 300.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ece09734274fb0c6695c2b8f,synthetic-nonform-layout-03,unknown,,fte-f28a84d07d827b1a1dfd609c,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 388.00. Account holder: Example Person 301.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f53cc94182d40f1b62428d31,synthetic-nonform-layout-03,unknown,,fte-bae3b23c4a712f70a08a1943,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 407.00. Account holder: Example Person 302.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b7af5cabd6bc360edeedccc2,synthetic-nonform-layout-03,unknown,,fte-b6c155b3459e469e92970366,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 426.00. Account holder: Example Person 303.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4915f6f1f9337e2e566057b6,synthetic-nonform-layout-03,unknown,,fte-b46772622dbcbec5649ec245,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 445.00. Account holder: Example Person 304.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-37c4b308ec789b9d5c559a3b,synthetic-nonform-layout-03,unknown,,fte-1fc8969d7612237d75e6a62e,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 464.00. Account holder: Example Person 305.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-9459abbaaf6a74130d84f60f,synthetic-nonform-layout-03,unknown,,fte-59cd3eeab0732f92c43a4509,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 483.00. Account holder: Example Person 306.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-9a505a00fb0071805cffb89f,synthetic-nonform-layout-03,unknown,,fte-35ed224f26638d3756a1cae6,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment
Reporting period ended 12/31/2025.
Details: Unusable cropped fragment; document title and tax year cannot be read, Reference amount: 502.00. Account holder: Example Person 307.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f3ada28cf9de8c8bb13f4df0,synthetic-nonform-layout-03,unknown,,fte-f38910af0419f7a9d7b0dbdf,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 392.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 400",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b63e01d870827f5e0b84c1c7,synthetic-nonform-layout-04,unknown,,fte-2e8b49b78e1b6eda568bc1c8,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 411.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 401",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ec38df9a3b20bc1b6c1bcb16,synthetic-nonform-layout-04,unknown,,fte-fe961d400f7286516af2689e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 430.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 402",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-262e1494e17b3acb35479354,synthetic-nonform-layout-04,unknown,,fte-e0ff95b90e0c7bee0ecd3995,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 449.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 403",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-cd3843eab8392fdf95d2c71e,synthetic-nonform-layout-04,unknown,,fte-9d722a7ff66e48d84f90b86a,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 468.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 404",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7ae7c769209613980ef1c70d,synthetic-nonform-layout-04,unknown,,fte-cc734931bd28958cfee15e59,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 487.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 405",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-70bd38cdddb72c3b41da587e,synthetic-nonform-layout-04,unknown,,fte-fbbe555beccd2f086d560a6e,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 506.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 406",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2b88c8922ca6e6c5a518e103,synthetic-nonform-layout-04,unknown,,fte-356e0709634d0a3286efa241,synthetic_AI_labeled,v1_template,top,False,
"Document header: Illegible record fragment
Tax reporting year 2025
Reference amount: 525.00
Unusable cropped fragment; document title and tax year cannot be read
Named party: Example Person 407",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-276d78d2fae39527c2b65a6a,synthetic-nonform-layout-04,unknown,,fte-b6975277b657ee2f3890c28b,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 415.00
Delivery copy for Example Party 500",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-18b39ad5bccea7382755dd33,synthetic-nonform-layout-05,unknown,,fte-cc5919887ea4392faf64590b,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 434.00
Delivery copy for Example Party 501",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c232425f7efef089a48f63ea,synthetic-nonform-layout-05,unknown,,fte-a0dd64e056939f26091e2875,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 453.00
Delivery copy for Example Party 502",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2e2f10afbbb6ffbecad5c285,synthetic-nonform-layout-05,unknown,,fte-cf4927879db22237da1df6e5,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 472.00
Delivery copy for Example Party 503",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2ae873b72d9737686025fb62,synthetic-nonform-layout-05,unknown,,fte-98e3c5e57a4c16ec130007bb,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 491.00
Delivery copy for Example Party 504",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-5dd7af79b2eff2ce2749e4e2,synthetic-nonform-layout-05,unknown,,fte-37beb87a50fc3c1bebc0fbb7,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 510.00
Delivery copy for Example Party 505",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f8c97fffb285d4a8d65a66bb,synthetic-nonform-layout-05,unknown,,fte-963a8c29def8da72d326e063,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 529.00
Delivery copy for Example Party 506",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0a97534065ed8bc0b3f09db4,synthetic-nonform-layout-05,unknown,,fte-ea21497b801e65a6cee20179,synthetic_AI_labeled,v1_template,top,False,
"Illegible record fragment -- reporting year 2025
Unusable cropped fragment; document title and tax year cannot be read / Reference amount: 548.00
Delivery copy for Example Party 507",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-50393aeb6c92775227b1b15c,synthetic-nonform-layout-05,unknown,,fte-afe09d112602f5a34475605b,synthetic_AI_labeled,v1_template,top,False,
"VOID  CORRECTED
Form 1040
U.S. Individual Income Tax Return
For calendar year 2024
Department of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Hiro Kowalski
8509 Willow Bend Way Fairview, OH 95337
XXX-XX-5300
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
100,240.02
7,912.73
$2,971.25
93,330.08
$29,813.37
$8,648.46
1,069.46
5,577.00",1040,0,1040,fdc-aa916017b69c7245446ce8bc,v11-1040-columns,original,2024,fgen-1f63be5555842ad38731e95e,synthetic_programmatic_template,columns,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2026
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Wei Larsen
2597 Willow Bend Way Pinecrest, GA 84598
XXX-XX-4034
Filing Status
1a Total amount from Form(s) W-2, box 1
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
$58,441.18
108,329.41
122,548.01
$23,973.91
49,488.18
5,089.55
$356.25
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-35625a6d4e19a64383687eb3,v11-1040-columns,original,2026,fgen-6a568399e5e5b185d8b187dd,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1040
U.S. Individual Income Tax Return
For calendar year 2024
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Olivia D. Brennan
1802 Willow Bend Way Pinecrest, GA 56921
XXX-XX-7441
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
$55,566.88
5,185.80
2,471.28
111,372.74
111,689.46
$12,695.51
$2,854.47
$5,185.84
4,943.52",1040,0,1040,fdc-789ae45053441f40c64427ea,v11-1040-columns,original,2024,fgen-b0e05328a780229ba3589c5e,synthetic_programmatic_template,columns,top,False,
"Form 1040 U.S. Individual Income Tax Return 2025
Name:
11 Subtract line 10 from line 9. This is your adjusted gross income
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
33 Add lines 25d, 26, and 32. These are your total payments
Kwame A. Rivera
$90,758.99
52,687.89
$4,701.20",1040,0,1040,fdc-9b71bef6de6be28ada49fd24,v11-1040-columns,original,2025,fgen-386c8ff703c61164f5ff8b3c,synthetic_programmatic_template,columns,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2024
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Wei J. Brennan
8809 Granite St Lakewood, CO 75754
XXXXX9138
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
$72,918.47
5,817.44
2,702.61
11,962.67
$28,614.70
134,490.83
$23,011.04
$4,284.67
$6,307.49
5,684.69",1040,0,1040,fdc-79b2bb2a0c1162816744f020,v11-1040-columns,original,2024,fgen-0d9d647d6d65158ee8ba014e,synthetic_programmatic_template,columns,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2022
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Servíce
Your first namc and middle initial  Lastname
Home address (number and street)
Your social security number
Amara Larsen
8234 Sample Street 0ak Grove, TX 58212
***-**-9844
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b 0rdinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 5tandard deduction or itemized deductions (from Schcdule A)
15 Subtract line 14 from line 11.If zero or less, enter -0-. This is your taxab1e income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d,26, and 32. Theseare your total payments
$55,404.42
$6,435.19
$3,563.79
106,235.43
20,559.93
102,193.43
113,707.60
5,550.57
8,553.43",1040,0,1040,fdc-fa7969d274c6c8ac4cdca0aa,v11-1040-columns,original,2022,fgen-f0d1b3acc01036b70c182756,synthetic_programmatic_template,columns,top,True,
"Form 1040
U.S. Individual Income Tax Return
OMB No. 1545-0074
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Priya C. Testcase
6095 Maple Ridge Dr Bayside, WA 54161
****8082
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
37 Subtract line 33 from line 24. This is the amount you owe
76,411.16
6,224.00
$8,058.12
7,987.21
125,440.49
133,348.33
$42,327.61
765.70
$8,644.14
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-b51f6680678e1b1eda320e43,v11-1040-columns,original,2026,fgen-236dce9e2fa88b1c09a0af42,synthetic_programmatic_template,columns,top,False,
"2021
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Lena Castillo
4737 Oak Hollow Ct Maplewood, MN 52826
ending in 0365
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
115,208.02
5,194.13
117,935.64
$118,647.10
3,076.11
$108,793.81
1,710.12
$4,973.96
$5,413.59",1040,0,1040,fdc-a79d74e9d4225d8faf3e0425,v11-1040-columns,original,2021,fgen-f7327a6c957ceb8d1706e186,synthetic_programmatic_template,columns,none,False,
"☐ CORRECTED
Form 1040
U.S. Individual Income Tax Return
For calendar year 2022
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Jamie Adeyemi
8836 Sample Street Brookhaven, PA 45029
***-**-9947
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
33 Add lines 25d, 26, and 32. These are your total payments
34,878.96
990.11
$5,632.69
$78,393.70
54,758.66
116,063.75
$3,806.45",1040,0,1040,fdc-190aa52eefe1eede603f67ea,v11-1040-columns,original,2022,fgen-2049a012f830a2ee880814eb,synthetic_programmatic_template,columns,top,False,
"Form 1040
U.S. Individual Income Tax Return
2023
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Casey Haddad
6448 Maple Ridge Dr Testville, IL 10838
ending in 4499
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
37 Subtract line 33 from line 24. This is the amount you owe
$100,530.33
7,703.63
1,716.88
$133,368.40
$113,439.02
$78,882.25
26,911.85
$1,712.30
$2,706.92",1040,0,1040,fdc-1547f38ce3550d8f9eace6b3,v11-1040-columns,original,2023,fgen-e2bbe14122ed6012d2ad95ff,synthetic_programmatic_template,columns,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2026
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Riley Haddad
3297 Sample Street Cedar Falls, IA 30781
XXXXX6046
Filing Status
1a Total amount from Form(s) W-2, box 1
3b Ordinary dividends
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
24 Add lines 22 and 23. This is your total tax
37 Subtract line 33 from line 24. This is the amount you owe
41,565.91
$6,376.33
$56,851.38
72,760.59
$3,109.65
$518.29",1040,0,1040,fdc-a0dce60a74bfbb0776114ad3,v11-1040-columns,original,2026,fgen-c78a014af3bdda01bb59563c,synthetic_programmatic_template,columns,top,False,
"Form 1040
U.S. Individual Incomc Tax Return
OMB No. 1545-O074
IR5 Use Only—Do not writc or staple in thisspace.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Avery Fischer
1429 Elm Park P1 Bayside, WA 69038
XXXXX7963
Filing 5tatus
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is yourtotal income
11 Subtract line 10 from line 9. This is your adjusted grossíncome
12 Standarddeduction or itemized deductíons (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -O-. This isyour taxable income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
S9,055.l0
$625.13
134,893.98
$108,574.87
$137,563.22
$29,011.39
$4,256.40
4,927.83
$7,844.75",1040,0,1040,fdc-bf0305af63d0e33fe138e69c,v11-1040-columns,original,2023,fgen-528c7654ffad7821c268587c,synthetic_programmatic_template,columns,top,True,
"CORRECTED (if checked)
Form 1040
U.S. Individual Income Tax Return
For calendar year 2026
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Jordan K. Haddad
4797 Cedar Ln Maplewood, MN 21375
****5456
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
33 Add lines 25d, 26, and 32. These are your total payments
$129,986.21
5,687.53
4,816.49
$114,757.30
73,270.01
135,099.62
8,960.92
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-0accf7e0619144c396e2f939,v11-1040-columns,original,2026,fgen-547245cf8911c7f1c002bab8,synthetic_programmatic_template,columns,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2023
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Kwame Walsh
7870 Maple Ridge Dr Testville, IL 72338
ending in 4269
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
13,939.12
5,763.83
$2,560.31
$131,649.39
$28,414.74
$75,209.31
112,236.01
7,527.67
$4,815.21",1040,0,1040,fdc-e71efb349d0a3184fa389c01,v11-1040-columns,original,2023,fgen-1bfe1d804e32b57939526d60,synthetic_programmatic_template,columns,top,False,
"2022
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Jamie Romero
4638 Elm Park Pl Testville, IL 38785
***-**-8950
Filing Status
1a Total amount from Form(s) W-2, box 1
2b Taxable interest
3b Ordinary dividends
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
93,873.18
8,119.51
$4,599.96
$124,267.59
$113,970.13
$7,424.34
$28,050.87
$3,509.64
$7,724.74
$161.23",1040,0,1040,fdc-3b0cd333de55049a962a939b,v11-1040-columns,original,2022,fgen-2e91f795429cba262eaac974,synthetic_programmatic_template,columns,none,False,
"For calendar year 2023
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name
Home address (number and street)
Your social security number
Wei Patel
3842 Oak Hollow Ct Oak Grove, TX 69800
ending in 2883
Filing Status
2b Taxable interest
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
11 Subtract line 10 from line 9. This is your adjusted gross income
12 Standard deduction or itemized deductions (from Schedule A)
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income
24 Add lines 22 and 23. This is your total tax
33 Add lines 25d, 26, and 32. These are your total payments
37 Subtract line 33 from line 24. This is the amount you owe
$2,602.85
123,320.87
76,468.87
$114,066.81
$127,941.72
$328.62
4,673.35
$5,872.27
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-d8b18fa31f3823a9b3dbce5f,v11-1040-columns,original,2023,fgen-23869cb59e00e72730c889fb,synthetic_programmatic_template,columns,none,False,
"Name:: Olivia Lindqvist
2b Taxable interest: 8,148.96
33 Add lines 25d, 26, and 32. These are your total payments:2,720.05
Form 1040 U.S. Individual Incomc Tax Retum 2022",1040,0,1040,fdc-6b7891860949d8f928d6aa90,v11-1040-boxed,original,2022,fgen-15c23e79440b33c8c9e73a06,synthetic_programmatic_template,boxed,bottom,True,
"Form 1040 U.S. Individual Income Tax Return 2022
Name:: Avery D. Moreau
Box 37 Subtract line 33 from line 24. This is the amount you owe: $5,544.55
Box 1a Total amount from Form(s) W-2, box 1: $19,556.74
Box 3b Ordinary dividends: $581.94",1040,0,1040,fdc-d5c16e13582e7a7a3d02f014,v11-1040-boxed,original,2022,fgen-e354531bc188117ac8623bbb,synthetic_programmatic_template,boxed,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2021
OMB No. 1545-0074
Your first name and middle initial  Last name: Alex E. Lindqvist
Home address (number and street): 4933 Oak Hollow Ct Brookhaven, PA 36513
Your social security number: XXX-XX-7092
Filing Status
Line 1a Total amount from Form(s) W-2, box 1: $122,556.95
Line 2b Taxable interest: $8,555.79
Line 3b Ordinary dividends: $1,227.20
Line 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: $12,865.02
Line 11 Subtract line 10 from line 9. This is your adjusted gross income: $77,856.77
Line 12 Standard deduction or itemized deductions (from Schedule A): 130,171.18
Line 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: 59,313.02
Line 24 Add lines 22 and 23. This is your total tax: $4,486.95
Line 33 Add lines 25d, 26, and 32. These are your total payments: $5,662.82
Line 37 Subtract line 33 from line 24. This is the amount you owe: 4,958.15",1040,0,1040,fdc-dcdc05bf5c15e7e81cf919e7,v11-1040-boxed,original,2021,fgen-aa4fab16cf9ef27443ee4dcc,synthetic_programmatic_template,boxed,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2025
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name: Riley R. Rivera
Home address (number and street): 2827 Lakeshore Blvd Brookhaven, PA 36960
Your social security number: ****5289
Filing Status
1a Total amount from Form(s) W-2, box 1: $72,795.95
2b Taxable interest: 1,984.30
3b Ordinary dividends: $2,230.14
11 Subtract line 10 from line 9. This is your adjusted gross income: 57,873.35
12 Standard deduction or itemized deductions (from Schedule A): 101,935.40
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: $89,654.45
24 Add lines 22 and 23. This is your total tax: $8,091.72
33 Add lines 25d, 26, and 32. These are your total payments: $8,020.57
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-b14fa36e920c14af698c212d,v11-1040-boxed,original,2025,fgen-260089ec629fdc15043348a9,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
2021
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name: Taylor Okafor
Home address (number and street): 4480 Willow Bend Way Testville, IL 75054
Your social security number: ending in 0642
Filing Status
1a Total amount from Form(s) W-2, box 1: $63,463.05
2b Taxable interest: $7,544.84
11 Subtract line 10 from line 9. This is your adjusted gross income: $66,342.13
12 Standard deduction or itemized deductions (from Schedule A): 50,237.68
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: 105,370.23
24 Add lines 22 and 23. This is your total tax: $8,502.57
33 Add lines 25d, 26, and 32. These are your total payments: 704.69
37 Subtract line 33 from line 24. This is the amount you owe: 2,794.32",1040,0,1040,fdc-7a560d402b659cfb95e174cc,v11-1040-boxed,original,2021,fgen-a442cdea582bae580a46fd04,synthetic_programmatic_template,boxed,none,False,
"☐ CORRECTED
Form 1040
U.S. Individual Income Tax Return
For calendar year 2024
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name: Casey Lindqvist
Home address (number and street): 3489 Willow Bend Way Brookhaven, PA 22560
Your social security number: XXXXX8178
Filing Status
Line 1a Total amount from Form(s) W-2, box 1: $126,709.79
Line 3b Ordinary dividends: $6,159.84
Line 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: 130,445.06
Line 11 Subtract line 10 from line 9. This is your adjusted gross income: 73,391.09
Line 12 Standard deduction or itemized deductions (from Schedule A): 43,540.65
Line 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: 45,139.87
Line 24 Add lines 22 and 23. This is your total tax: 9,496.32
Line 33 Add lines 25d, 26, and 32. These are your total payments: $787.28
Line 37 Subtract line 33 from line 24. This is the amount you owe: $561.33
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-8b548529b1e30a6bd909fe73,v11-1040-boxed,original,2024,fgen-3d8e6d54fd597c7a8ae6a3b1,synthetic_programmatic_template,boxed,top,False,
"Form 1040 U.S. Individual Income Tax Return 2023
Name:: Jordan R. Walsh
Line 33 Add lines 25d,26, and 32. These are your total payments: 7,491.53
Líne 3b Ordinary dividends: $5,054.71
Line 37 Subtract line 33 from line 24. This is the amount you owe: 4,971.89
Line 2b Taxable interest: $6,055.09",1040,0,1040,fdc-8d135f35f7019c435cfd5f49,v11-1040-boxed,original,2023,fgen-8ea43571fd0617206bbb52c1,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
For calendar year 2024
OMB No. 1545-0074
Your first name and middle initial  Last name: Kwame A. Fischer
Home address (number and street): 5918 Cedar Ln Testville, IL 58768
Your social security number: ending in 0567
Filing Status
Line 2b Taxable interest: 3,718.40
Line 3b Ordinary dividends: $3,081.93
Line 11 Subtract line 10 from line 9. This is your adjusted gross income: $107,292.05
Line 12 Standard deduction or itemized deductions (from Schedule A): $9,246.74
Line 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: 44,733.70
Line 24 Add lines 22 and 23. This is your total tax: $4,665.55
Line 37 Subtract line 33 from line 24. This is the amount you owe: $7,044.62
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-9711a569dc630211042ebf3e,v11-1040-boxed,original,2024,fgen-79e71da278d81fe025a42f51,synthetic_programmatic_template,boxed,none,False,
"Form 1040
U.S. Individual Income Tax Return
2023
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name: Jamie L. Brennan
Home address (number and street): 5533 Oak Hollow Ct Cedar Falls, IA 38661
Your social security number: ***-**-4737
Filing Status
1a Total amount from Form(s) W-2, box 1: $15,758.53
2b Taxable interest: $4,458.36
3b Ordinary dividends: 5,058.78
9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: $39,251.43
12 Standard deduction or itemized deductions (from Schedule A): $108,176.66
15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: 125,713.07
24 Add lines 22 and 23. This is your total tax: $7,854.10
33 Add lines 25d, 26, and 32. These are your total payments: 548.52
37 Subtract line 33 from line 24. This is the amount you owe: $4,781.60
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-69c48cdf276fbcd06738b8e8,v11-1040-boxed,original,2023,fgen-3cd1111c6cfd516bb043ba53,synthetic_programmatic_template,boxed,top,False,
"Form 1040 U.S. Individual Income Tax Return
Name:: Morgan E. Romero
Line 33 Add lines 25d, 26, and 32. These are your total payments: 5,698.02
Line 11 Subtract line 10 from line 9. This is your adjusted gross income: $83,786.46
Line 24 Add lines 22 and 23. This is your total tax: $9,413.22
Line 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: $35,009.84",1040,0,1040,fdc-d9dd7af84d7fa690303049a7,v11-1040-boxed,original,2025,fgen-398375c9308f2229aad61a7d,synthetic_programmatic_template,boxed,top,False,
"2024
Your first name and middle initial  Last name: Hiro Kowalski
Home address (number and street): 487 Elm Park Pl Brookhaven, PA 62441
Your social security number: ***-**-5683
Filing Status
Line 1a Total amount from Form(s) W-2, box 1: $28,998.91
Line 2b Taxable interest: 8,580.87
Line 3b Ordinary dividends: $7,610.94
Line 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: $60,233.87
Line 11 Subtract line 10 from line 9. This is your adjusted gross income: 130,881.56
Line 12 Standard deduction or itemized deductions (from Schedule A): $119,009.98
Line 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: 76,545.11
Line 33 Add lines 25d, 26, and 32. These are your total payments: 9,074.33
Line 37 Subtract line 33 from line 24. This is the amount you owe: 7,484.32
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-56ceade96dc96823bdb6e830,v11-1040-boxed,original,2024,fgen-f0eb705853eb3bbe83780073,synthetic_programmatic_template,boxed,none,False,
"VOID  CORRECTED
For calendar year 2026
Department of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name: Casey J. Romero
Home address (number and street): 9122 Harbor View Rd Brookhaven, PA 17595
Your social security number: ending in 3776
Filing Status
Line 1a Total amount from Form(s) W-2, box 1: 129,046.57
Line 2b Taxable interest: 6,308.92
Line 3b Ordinary dividends: 7,000.15
Line 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: 96,983.49
Line 11 Subtract line 10 from line 9. This is your adjusted gross income: $136,646.96
Line 12 Standard deduction or itemized deductions (from Schedule A): $66,342.48
Line 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: 98,402.09
Line 24 Add lines 22 and 23. This is your total tax: 1,153.51
Line 33 Add lines 25d, 26, and 32. These are your total payments: $7,564.50
Line 37 Subtract line 33 from line 24. This is the amount you owe: 4,429.84
Department of the Treasury - Internal Revenue Service
Form 1040
U.S. Individual Income Tax Return
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-a2eda3c5158930f067fa787d,v11-1040-boxed,original,2026,fgen-bacb88df4ab7c78b882dd086,synthetic_programmatic_template,boxed,bottom,False,
"Form 1040 U.S. Individual Income Tax Return 2021
Name:: Hiro D. Nguyen
Box 12 Standard deduction or itemized deductions (from Schedule A): $124,826.20
Box 3b Ordinary dividends: $2,947.76",1040,0,1040,fdc-5ecfa8194d32d76c468aa7c3,v11-1040-boxed,original,2021,fgen-9d36df275028ed488aa3adcb,synthetic_programmatic_template,boxed,top,False,
"2024
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name: Kwame S. Larsen
Home address (number and street): 8689 Oak Hollow Ct Oak Grove, TX 13989
Your social security number: ***-**-7197
Filing Status
Box 1a Total amount from Form(s) W-2, box 1: $102,418.93
Box 2b Taxable interest: 8,568.37
Box 3b Ordinary dividends: 6,206.99
Box 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: 124,990.81
Box 11 Subtract line 10 from line 9. This is your adjusted gross income: 45,686.65
Box 12 Standard deduction or itemized deductions (from Schedule A): 78,356.37
Box 24 Add lines 22 and 23. This is your total tax: $5,005.22
Box 33 Add lines 25d, 26, and 32. These are your total payments: $2,540.75
Box 37 Subtract line 33 from line 24. This is the amount you owe: $3,705.71
Department of the Treasury - Internal Revenue Service
Form 1040
U.S. Individual Income Tax Return
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-f3a1909bf439cd14b8483dbb,v11-1040-boxed,original,2024,fgen-abde3adbd571d48ba9015ef9,synthetic_programmatic_template,boxed,bottom,False,
"Form 1040
U.S. Individual Income Tax Return
2021
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
Your first name and middle initial  Last name: Mateo J. Kowalski
Home address (number and street): 6765 Willow Bend Way Bayside, WA 26260
Your social security number: XXX-XX-9362
Filing Status
Line 1a Total amount from Form(s) W-2, box 1: $94,241.49
Line 2b Taxable interest: $2,278.95
Line 3b Ordinary dividends: 4,672.69
Line 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income: $47,066.06
Line 11 Subtract line 10 from line 9. This is your adjusted gross income: $136,607.63
Line 12 Standard deduction or itemized deductions (from Schedule A): 71,014.27
Line 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income: $75,495.73
Line 24 Add lines 22 and 23. This is your total tax: $7,339.00
Line 33 Add lines 25d, 26, and 32. These are your total payments: $1,563.97
Line 37 Subtract line 33 from line 24. This is the amount you owe: $7,458.37
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-a5ce556eafbe0001e8703d25,v11-1040-boxed,original,2021,fgen-2f361f83f07ae4eda34ccbc6,synthetic_programmatic_template,boxed,top,False,
"Form 1040
U.S. Individual Income Tax Return
For calendar year 2022
OMB No. 1545-0074
IRS Usc Only—Do not write or staplein this space.
Your first name and middle initial  Last name: AveryPatel
Home address (number and street): 3374 WillowBend Way Testville, IL 969l8
Your social security number: ****2957
Filing 5tatus
Box 1a Total amount from Form(s)W-2, box 1: $1,349.62
Box 2b Taxable interest: $2,447.98
Box 3b 0rdinary dividends: $630.44
Box 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is yourtotal income: $116,011.68
Box 11 Subtract line 10 from line 9. Thisis your adjusted gross income: $77,204.35
Box 12 Standard deduction or itemized deductions (from Schedule A): 5l,877.62
Box 24 Add lines 22 and 23. This is your total tax: $915.24
Box 33 Add lines 25d, 26, and 32. Thcse are your tota1 payments: $1,337.52
Box 37 5ubtract line 33 from line 24. This is the amount you owe: 1,988.45
Department of the Treasury - Interna1 Revenue Servíce
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-7b1ffd40e603df9b79dd6d1e,v11-1040-boxed,original,2022,fgen-16288051305f040e96d2d845,synthetic_programmatic_template,boxed,top,True,
"Name: Alex Lindqvist 15 Subtract line 14 from line 11. If zero or less, enter -0-. This
is your taxable income S12,841.51 33 Add lines 25d, 26,and 32.
These are your total payments 491.96",1040,0,1040,fdc-dd345033d0321b99d45cd961,v11-1040-flat,original,2025,fgen-9af571a2a6d7d1827ef9a316,synthetic_programmatic_template,flat,none,True,
"Form 1040 U.S. Individual Income Tax Return For calendar year 2024 OMB No. 1545-0074 Department of the Treasury—Internal Revenue Service Your
first name and middle initial Last name Lena B. Larsen Home address (number and street) 1433 Willow Bend Way Lakewood, CO 82373 Your social security number ****3063 Filing Status 1a Total amount from Form(s) W-2, box 1 $117,040.20 2b Taxable interest $8,741.96 3b Ordinary dividends $4,464.89 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income $77,486.14 11 Subtract line 10 from line 9. This is your adjusted gross income 91,455.62 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income 2,522.22 24 Add lines 22 and 23. This is your total tax
1,245.04 33 Add lines 25d, 26, and 32. These are your total payments $7,402.56 37 Subtract line 33 from line 24. This is the amount you owe $8,304.04",1040,0,1040,fdc-3fa20ab89e73bc41b986de29,v11-1040-flat,original,2024,fgen-d50ed1fc9a7ee34c0b642353,synthetic_programmatic_template,flat,top,False,
"Form 1040 U.S. Individual Income Tax Return For calendar year 2021 OMB No. 1545-0074 Department of the Treasury—Internal Revenue Service Your first name and middle initial Last name Kwame Patel Home address (number and street) 9345 Harbor View Rd Riverton, WI 46475 Your social security number XXXXX1494 Filing Status 2b Taxable interest 2,090.28 3b Ordinary dividends 871.69 9
Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income $86,240.51 11 Subtract line 10 from line 9. This is your adjusted gross income 137,186.20 12
Standard deduction or itemized deductions (from Schedule A) $12,162.99 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income $99,460.93 24 Add lines 22 and 23. This is your total tax $5,361.58 33 Add lines 25d, 26, and 32. These are your total payments 7,152.18 37 Subtract line 33 from line 24. This is the amount you owe 8,634.79",1040,0,1040,fdc-4b1e94e4f5c0c76f201015e2,v11-1040-flat,original,2021,fgen-9d7bdae453754343cf27bf05,synthetic_programmatic_template,flat,top,False,
"2023 Department of the Treasury—Internal Revenue Service IRS Use
Only—Do not write or staple in this space. Your first name and middle initial Last name Riley L. Okafor Home
address (number and street) 2894 Oak Hollow Ct Riverton, WI 61646 Your social security number ***-**-6258 Filing Status 1a Total amount from Form(s) W-2, box 1 $25,384.11 3b Ordinary dividends $5,770.25 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income 40,537.44 11 Subtract line 10 from line 9. This is your adjusted gross income 48,273.13 12 Standard deduction or itemized deductions (from Schedule A) $119,016.19 24 Add lines 22 and 23. This is your total tax $5,041.14 33 Add lines 25d, 26, and 32. These are your total payments $2,668.90 37 Subtract line 33 from line 24. This is the amount you owe 6,435.45 Form 1040 U.S. Individual Income Tax Return",1040,0,1040,fdc-63e9f95905c3e4fa4237b689,v11-1040-flat,original,2023,fgen-0242893178d5338e3973cca0,synthetic_programmatic_template,flat,bottom,False,
"Form 1040 U.S. Individual Income Tax Return Department of the Treasury—Internal Revenue Service Your first name and middle initial Last name Hiro C. Adeyemi Home address (number and street) 3236 Elm Park Pl Lakewood, CO 90258 Your social security number XXXXX3218 Filing Status 1a Total amount
from Form(s) W-2, box 1 $100,507.69 2b Taxable interest
$9,096.03 3b Ordinary dividends $1,563.86 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income 32,850.16 12 Standard deduction or itemized deductions (from Schedule A) $16,150.95 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income $5,672.64 24 Add lines 22 and 23. This is your total tax $2,628.82 33 Add lines 25d, 26, and 32. These are your total payments 401.05 37 Subtract line 33 from line 24. This is the amount you owe 6,755.11 Department of the Treasury - Internal Revenue Service Form 1040 (keep for your records) www.irs.gov/Form1040",1040,0,1040,fdc-91f53f82021fc984000be855,v11-1040-flat,original,2025,fgen-c49d4e308e0da8fa50c67402,synthetic_programmatic_template,flat,top,False,
"For calendar year 2021 IRS Use Only—Do not writeor staple in this space. Your first name and middle initial Last name Noah Castillo Home address (number and street)4834 Prairie Ave Testvi1le,IL 84820 Your social security number ***-**-4672 Filing Status la Total amount from Form(s) W-2, box 1 $16,084.95 2b Taxable interest 3,447.78 3b 0rdinary dividends 8,687.39 11 Subtract line l0 from line 9. This is your adjusted gross income 1O6,078.41 15 Subtract line 14 from line 11. If zero or less, enter -0-.This is your taxable income 23,808.29 24 Add lines 22 and 23. This is your total tax 3,688.75 33 Add lines 25d, 26, and 32. These are your total payments $4,699.32 37 Subtract line 33 from line 24. This is
theamount you owe
2,648.83 Department of the Treasury - Intema1 Revenue Service Form 1040 U.S. Indívidual Income Tax Retum Form 1040(keep for your records) www.irs.gov/Forml040",1040,0,1040,fdc-88586e6973eeaea1736d79e5,v11-1040-flat,original,2021,fgen-005199a61b84268dfaa8a157,synthetic_programmatic_template,flat,bottom,True,
"Name:
Jamie Haddad 33 Add lines 25d, 26, and 32. These are your total
payments 3,135.86",1040,0,1040,fdc-469e992452f227f57c45bafd,v11-1040-flat,original,2026,fgen-0d1f2f765ecd15c9cdfc489c,synthetic_programmatic_template,flat,none,False,
"OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. Your first name and middle initial Last name Mateo E. Romero Home address (number and street) 9751 Elm Park Pl Fairview, OH 57175 Your social security number ****3275 Filing
Status 1a Total amount from Form(s) W-2, box 1 130,284.38 2b Taxable interest $6,226.12 3b Ordinary dividends 2,121.20 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income $74,728.97 11 Subtract line 10 from line 9. This is your adjusted gross income $3,891.09 12 Standard deduction or itemized deductions (from Schedule A) $28,264.95 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income $35,567.21 24 Add lines 22 and 23. This is your total tax 4,211.46
33 Add lines 25d, 26, and 32. These are your total payments 7,140.63 37 Subtract line 33 from line 24. This is the amount you owe 6,206.57",1040,0,1040,fdc-f5174e6856b4fb3e0bb33369,v11-1040-flat,original,2024,fgen-947add7be1b864813310c5d2,synthetic_programmatic_template,flat,none,False,
"Form 1040 U.S. Individual Income Tax Return 2024 Name: Hiro Castillo 11 Subtract line 10 from line 9. This is your adjusted gross income$33,266.689 Add línes
1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income 87,179.16 15 Subtract line 14 from line 11. If zero or less, enter -0-. This
is your taxable income $73,425.59",1040,0,1040,fdc-c127ad3ffc8416356f4df502,v11-1040-flat,original,2024,fgen-eb9203f3823cb78a84aca20b,synthetic_programmatic_template,flat,top,True,
"CORRECTED (if checked) Form 1040 U.S. Individual Income Tax Return OMB No. 1545-0074 Department of the Treasury—Internal Revenue Service IRS Use Only—Do not write or staple in this space. Your first name and middle initial Last name Noah Walsh Home address (number and street) 4721 Willow Bend Way Bayside, WA 51687 Your social security number ending in 3582 Filing Status 1a Total amount from Form(s) W-2, box 1 948.14 2b Taxable interest $3,497.69 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
$67,797.88 11 Subtract line
10 from line 9. This is your adjusted gross income 22,305.83 12 Standard deduction or itemized deductions (from Schedule A) 46,888.90 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income 89,989.95 24 Add lines 22 and 23. This is your total tax 5,117.80 33 Add lines 25d, 26, and 32. These are your total payments $8,972.32 37 Subtract line 33 from line 24. This is the amount you owe 2,805.05",1040,0,1040,fdc-db4edf55efbc8d3793792cf7,v11-1040-flat,original,2025,fgen-441f3d36cf759c1efc502bbf,synthetic_programmatic_template,flat,top,False,
"2022 OMB No. 1545-0074 Your first name and middle initial Last name Riley Castillo Home address (number and street) 4832 Oak Hollow Ct Fairview, OH 48765 Your social security number XXXXX2842 Filing Status 1a Total amount from Form(s) W-2,
box 1 $41,473.57 3b Ordinary dividends 2,087.36 11 Subtract line 10 from line 9. This is your adjusted gross income 61,305.98 12
Standard deduction or itemized deductions (from Schedule A) 20,505.86 33 Add lines 25d, 26, and 32. These are your total payments $8,840.25 37 Subtract line 33 from line 24. This is the amount you owe 6,935.37 Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-ee1f2c5e9ee27a9a5ae25bfe,v11-1040-flat,original,2022,fgen-1e28c141cd985827e027e2a2,synthetic_programmatic_template,flat,none,False,
"Form 1040 U.S. Individual Income Tax Return 2025 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. Your first name and middle initial Last name Wei E. Testcase Home address (number and street) 5355 Elm Park Pl Oak Grove, TX 56164 Your social security number XXX-XX-9032 Filing Status 2b Taxable interest 7,864.67 3b Ordinary dividends 2,529.90 9
Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income 14,466.69 11 Subtract line 10 from line 9. This is your adjusted gross income $61,336.24 12
Standard deduction or itemized deductions (from Schedule A) 43,090.37 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income $11,259.71 37 Subtract line 33 from line 24. This is the amount you owe 5,645.59",1040,0,1040,fdc-836207ab9a4831072aacf324,v11-1040-flat,original,2025,fgen-87e4b4a66348647b80a4ad64,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) For calendar year 2025 OMB No. 1545-0074 Department of the
Treasury—Internal Revenue Service Your first name and middle initial Last name Olivia Brennan Home address (number and street) 6651 Elm Park Pl Riverton, WI 21946 Your social security number ****5604 Filing Status 1a Total amount from Form(s) W-2, box 1 61,545.03 3b Ordinary dividends 7,024.98 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total
income $13,914.68 11 Subtract line 10 from line 9. This is your adjusted gross income 13,271.49 12 Standard deduction or itemized deductions (from Schedule A) $70,819.78 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income $68,625.84 24 Add lines 22 and 23. This is your total tax 7,136.46 33 Add lines 25d, 26, and 32. These are your total payments $9,225.00 37 Subtract line 33 from line 24. This is the amount you owe $5,997.01 Department of the Treasury - Internal Revenue Service Form 1040 U.S. Individual Income Tax Return Form 1040 (keep for your records) www.irs.gov/Form1040",1040,0,1040,fdc-a5f1fb9bf4d7393ba019c18d,v11-1040-flat,original,2025,fgen-69f8621fc376f936b08affac,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2024 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. Your first name and middle initial Last name Morgan B. Tanaka Home address (number and street) 9718 Cedar Ln Riverton, WI 36322 Your social security number XXXXX9442 Filing Status 1a Total amount
from Form(s) W-2, box 1 68,009.25 3b Ordinary
dividends 9,279.95 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income $43,697.45 11 Subtract line 10 from line 9. This is your adjusted gross income $91,257.96 12 Standard deduction or itemized deductions (from Schedule A) 110,231.07 24 Add lines 22 and 23. This is your total tax 6,765.73 37 Subtract line 33 from line 24. This is the amount you owe $252.46 Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-28724bba3d6096ac9c7cc1fb,v11-1040-flat,original,2024,fgen-5fdf4301efcdc9ae38cd3917,synthetic_programmatic_template,flat,none,False,
"OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. Your first name and middle initial Last
nameHiro Tanaka Home address (number and street)8l16 Granite St Riverton, WI 66774 Your social sccurity number XXX-XX-5080 Filing Status
1a Total amount from Form(s) W-2, box 1 56,528.73 2b Taxable interest $6,041.75 3b Ordinary dividends 4,167.09 11 Subtract line 10from line 9. This is youradjusted gross income 83,168.58 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income $40,734.94 24 Add línes 22 and 23. This is your total tax 3,951.16 33 Addlines 25d, 26, and 32. These are your total payments 1,844.22 37 Subtract line 33 from line 24. This is the amount you owe 2,534.95 Department of the Treasury - Intemal Revenue Service",1040,0,1040,fdc-43062a6e8fae53c86af20662,v11-1040-flat,original,2025,fgen-2525902007217703706196d2,synthetic_programmatic_template,flat,none,True,
"CORRECTED (if checked) Form 1040 U.S.
Individual Income Tax Return 2023 OMB No. 1545-0074 Department of the Treasury—Internal Revenue Service IRS Use Only—Do not write or staple in this space. Your first name and middle initial Last name Lena Fischer Home
address (number and street) 4024 Prairie Ave Maplewood, MN 65356 Your social security number ending in 7132 Filing Status 1a Total amount from Form(s) W-2, box 1 $64,385.69 2b Taxable interest 2,200.64 3b Ordinary dividends $6,092.70 11 Subtract line 10 from line 9. This is your adjusted gross income $111,175.50 12 Standard deduction or itemized deductions (from Schedule A) 136,749.23 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income 2,124.31 24 Add lines 22 and 23. This is your total tax 6,752.25 33 Add lines 25d, 26, and 32. These are your total payments $8,348.15 37 Subtract line 33 from line 24. This is the amount you owe 2,034.29",1040,0,1040,fdc-a817c45520062f728377ce52,v11-1040-flat,original,2023,fgen-98c6a8c80eb67bbd5160c34c,synthetic_programmatic_template,flat,top,False,
"## 2021
Department of the Treasury—Internal Revenue Service
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Kwame Lindqvist |
| Home address (number and street) | 6181 Harbor View Rd Fairview, OH 82425 |
| Your social security number | ***-**-5979 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | 39,265.00 |
| 2b Taxable interest | 9,324.22 |
| 3b Ordinary dividends | 2,760.53 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | $110,977.99 |
| 12 Standard deduction or itemized deductions (from Schedule A) | $54,751.89 |
| 24 Add lines 22 and 23. This is your total tax | 6,025.92 |
| 33 Add lines 25d, 26, and 32. These are your total payments | 8,820.39 |
| 37 Subtract line 33 from line 24. This is the amount you owe | $2,445.30 |
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-f1fcd0fdeb42e3ead1f899df,v11-1040-markdown,original,2021,fgen-b1eab8e3e8a86e465d54091b,synthetic_programmatic_template,markdown,none,False,
"☐ CORRECTED
Form 1040
U.S. Individual Income Tax Return
2024
## OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Kwame Adeyemi |
| Home address (number and street) | 2156 Maple Ridge Dr Maplewood, MN 54991 |
| Your social security number | ***-**-1067 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | $24,179.84 |
| 2b Taxable interest | 6,132.23 |
| 3b Ordinary dividends | 5,955.53 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | 56,215.54 |
| 12 Standard deduction or itemized deductions (from Schedule A) | $97,551.07 |
| 24 Add lines 22 and 23. This is your total tax | $3,781.45 |
| 33 Add lines 25d, 26, and 32. These are your total payments | 4,318.29 |
| 37 Subtract line 33 from line 24. This is the amount you owe | $2,872.73 |
## Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-b40e2bcdb30c18062e0cea20,v11-1040-markdown,original,2024,fgen-f4093198e5c2539d01900a97,synthetic_programmatic_template,markdown,top,False,
"Form 1040
U.S. Individual Income Tax Return
## For calendar year 2023
OMB No. 1545-0074
## Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Priya Tanaka |
| Home address (number and street) | 227lE1m Park Pl Brookhaven, PA 51801|
|Your socíal securíty number | XXX-XX-9946 |
Filing Status
| Field | Value |
| --- | --- |
| 2b Taxable interest | S2,663.55 |
| 3b Ordinary dividends | 7,84l.63 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. Thís is your total income | $48,5O8.09 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | $8,908.94 |
| l2 Standarddeduction or itemized deductions (from Schedule A) | 108,666.76 |
| 15 Subtract line 14 fromline 11. If zero or less, enter -0-. This is your taxable income | $l36,501.81 |
| 24Add lines 22 and 23. This is your total tax | $2,002.58 |
| 33 Add lines 25d, 26, and 32. These are your total payments | 6,708.14 |
| 37 5ubtractline 33 from line24. This is the amount you owe | $9,465.33 |
Department of the Treasury - Intemal Revenue Service
## Form l040 (kcep for your records)  www.irs.gov/Forml040",1040,0,1040,fdc-143f1ada51e0f29d2df4f0c0,v11-1040-markdown,original,2023,fgen-57bf3d5ef28ced26bb8894ee,synthetic_programmatic_template,markdown,top,True,
"CORRECTED (ifchecked)
## Form 1040
U.S. Individual Income Tax Return
## For calendar year 2024
IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial Last name | Noah Romero |
| Home address (number and street) | 2728 Maple Ridge Dr Fairview, OH 47066 |
| Your social security number |ending in 6055 |
## Filing Status
| Field | Value |
| --- | --- |
| 1a Total amountfrom Form(s) W-2, box 1 | S1O5,850.24|
| 2b Taxable interest | 8,638.94 |
| 3b Ordinary dividends | $8,141.89 |
| 11 Subtract linc 1O from line 9. This is your adjusted gross income| 109,091.57 |
| 12Standard deduction or itemized deductions (from Schedule A) | 75,822.89 |
| 15 Subtract líne 14 from line 11. If zero or less, enter -0-. This is your taxable income | $136,100.00 |
| 24 Add 1ines 22 and 23. This is your tota1 tax | 560.07 |
| 33 Add 1ínes 25d, 26, and 32. These are your total payments | $954.83 |
| 37 Subtract line 33 from line 24. This is the amount you owe | $5,696.07 |",1040,0,1040,fdc-e9c3990b08b3c3d48689da89,v11-1040-markdown,original,2024,fgen-c9eebcfe8140580c67594441,synthetic_programmatic_template,markdown,top,True,
"2023
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Hiro Moreau |
| Home address (number and street) | 9151 Harbor View Rd Oak Grove, TX 29361 |
| Your social security number | ***-**-9661 |
## Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | $79,770.54 |
| 2b Taxable interest | 5,813.58 |
| 3b Ordinary dividends | 2,789.78 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | 51,109.37 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | $47,039.17 |
| 12 Standard deduction or itemized deductions (from Schedule A) | $133,656.90 |
| 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income | $80,221.85 |
| 24 Add lines 22 and 23. This is your total tax | 9,065.64 |
| 33 Add lines 25d, 26, and 32. These are your total payments | 1,629.34 |
| 37 Subtract line 33 from line 24. This is the amount you owe | 8,086.29 |
## Form 1040
U.S. Individual Income Tax Return",1040,0,1040,fdc-27cee8b26363b4fafc43f30b,v11-1040-markdown,original,2023,fgen-c4a9616a8c9589fb9d0641ca,synthetic_programmatic_template,markdown,bottom,False,
"## Form 1040
U.S. Individual Income Tax Return
2026
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
## IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Olivia Adeyemi |
| Home address (number and street) | 7985 Lakeshore Blvd Pinecrest, GA 64891 |
| Your social security number | ****6945 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | $84,181.50 |
| 3b Ordinary dividends | $7,408.83 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | 126,470.68 |
| 12 Standard deduction or itemized deductions (from Schedule A) | 86,608.21 |
| 24 Add lines 22 and 23. This is your total tax | $5,643.12 |
| 33 Add lines 25d, 26, and 32. These are your total payments | $7,099.45 |
| 37 Subtract line 33 from line 24. This is the amount you owe | $1,376.74 |
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-348ff0ceca8530d490ee42d9,v11-1040-markdown,original,2026,fgen-dc8812aa8c689503b622f06f,synthetic_programmatic_template,markdown,top,False,
"Form 1040
## U.S.Individual Income Tax Return
2024
## Department of the Treasury—Intemal Revenue Service
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Riley S. Kowalski |
| Homc address (number and street) | 8993 Willow Bend Way Fairview, OH 26523 |
| Your social security number | XXXXX4783 |
Fíling 5tatus
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | 11O,010.67 |
| 2b Taxable interest | 3,268.55 |
| 3b Ordinary dividends | 7,399.46 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | 61,316.75|
| 11 5ubtract line 10 from line 9. This is your adjusted grossincome | 38,135.18 |
|15 Subtract line 14 from line 11. If zero or less, enter -0-. This isyour taxable income | 119,553.23 |
| 24 Add lines 22 and 23. This isyour total tax | 1,970.45 |
## Department of the Treasury- Intemal Revenue Servíce
## Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-89e77de6d8dac30df11b10ea,v11-1040-markdown,original,2024,fgen-06973f189ff3ca4381455427,synthetic_programmatic_template,markdown,top,True,
"Form 1040
U.S. Individual Income Tax Return
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Alex Patel |
| Home address (number and street) | 6842 Harbor View Rd Cedar Falls, IA 24331 |
| Your social security number | XXXXX9507 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | $96,104.55 |
| 3b Ordinary dividends | 3,425.66 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | $84,102.34 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | $137,662.65 |
| 12 Standard deduction or itemized deductions (from Schedule A) | 47,828.63 |
| 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income | $26,454.17 |
| 24 Add lines 22 and 23. This is your total tax | $3,627.63 |
| 33 Add lines 25d, 26, and 32. These are your total payments | 503.68 |
| 37 Subtract line 33 from line 24. This is the amount you owe | $6,238.44 |",1040,0,1040,fdc-3144ecf211c8cc9c65e04f71,v11-1040-markdown,original,2024,fgen-287769be2976a38534765e75,synthetic_programmatic_template,markdown,top,False,
"## CORRECTED (if checked)
Form 1040
U.S. Individual Income Tax Return
## 2026
## Department of the Treasury—Internal Revenue Service
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Sofia Larsen |
| Home address (number and street) | 5871 Granite St Pinecrest, GA 86733 |
| Your social security number | XXX-XX-0301 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | 6,483.67 |
| 2b Taxable interest | 6,481.36 |
| 3b Ordinary dividends | 9,422.33 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | 66,267.20 |
| 12 Standard deduction or itemized deductions (from Schedule A) | 62,831.67 |
| 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income | $114,352.60 |
| 24 Add lines 22 and 23. This is your total tax | $7,786.14 |
| 33 Add lines 25d, 26, and 32. These are your total payments | 6,774.68 |
| 37 Subtract line 33 from line 24. This is the amount you owe | 1,624.38 |
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-5ca226e45f0b6a4cc9e5f0c8,v11-1040-markdown,original,2026,fgen-1d41ade327f9d92dd9e1147c,synthetic_programmatic_template,markdown,top,False,
"## 2023
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Jamie Fischer |
| Home address (number and street) | 1238 Harbor View Rd Maplewood, MN 83257 |
| Your social security number | ****4075 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | $122,516.79 |
| 2b Taxable interest | 750.92 |
| 3b Ordinary dividends | $6,110.52 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | $64,631.15 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | $55,038.17 |
| 12 Standard deduction or itemized deductions (from Schedule A) | $40,783.12 |
| 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income | 15,742.53 |
| 24 Add lines 22 and 23. This is your total tax | $5,192.73 |
| 33 Add lines 25d, 26, and 32. These are your total payments | $6,970.18 |
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-04a16cb6e0847cac1c6fdfaa,v11-1040-markdown,original,2023,fgen-8d9a4cf5750b4cd7c9f36c8e,synthetic_programmatic_template,markdown,none,False,
"CORRECTED (if checked)
Form 1040
## U.S. Individual Income Tax Return
2026
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Noah Moreau |
| Home address (number and street) | 6179 Cedar Ln Testville, IL 79105 |
| Your social security number | XXX-XX-2294 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | 83,397.99 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | 55,504.98 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | $1,333.15 |
| 12 Standard deduction or itemized deductions (from Schedule A) | 5,018.38 |
| 37 Subtract line 33 from line 24. This is the amount you owe | $3,728.76 |
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-044aaf00ac2881c06772eda8,v11-1040-markdown,original,2026,fgen-0745a7bab3646488b492ddc2,synthetic_programmatic_template,markdown,top,False,
"Form 1040
## U.S. Individual Income Tax Return
2026
## OMB No. 1545-0074
## Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Sofia S. Fischer |
| Home address (number and street) | 8625 Cedar Ln Brookhaven, PA 12038 |
| Your social security number | ***-**-2462 |
## Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | 87,287.59 |
| 2b Taxable interest | $8,451.61 |
| 3b Ordinary dividends | 7,409.04 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | $23,377.92 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | 25,537.19 |
| 12 Standard deduction or itemized deductions (from Schedule A) | 28,047.76 |
| 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income | $90,992.80 |
| 24 Add lines 22 and 23. This is your total tax | 2,268.12 |
| 33 Add lines 25d, 26, and 32. These are your total payments | $2,018.13 |
Department of the Treasury - Internal Revenue Service
Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-00341ebfceabe705ae0c1b1d,v11-1040-markdown,original,2026,fgen-8837b29584834d8fd5159918,synthetic_programmatic_template,markdown,top,False,
"Form 1040
U.S. Individual Income Tax Return
2024
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Fatima Larsen |
| Home address (number and street) | 4943 Sample Street Lakewood, CO 59189 |
| Your social security number | XXX-XX-1360 |
Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | $39,156.76 |
| 2b Taxable interest | $4,242.64 |
| 3b Ordinary dividends | 8,961.53 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | $20,843.47 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | 67,177.38 |
| 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income | 71,820.07 |
| 24 Add lines 22 and 23. This is your total tax | 1,826.23 |
| 33 Add lines 25d, 26, and 32. These are your total payments | $5,612.39 |
| 37 Subtract line 33 from line 24. This is the amount you owe | $6,428.80 |",1040,0,1040,fdc-9e669ed86416644718228a33,v11-1040-markdown,original,2024,fgen-4de5017409fd77cc3a63833d,synthetic_programmatic_template,markdown,top,False,
"Form 1040 U.S. Individual Income Tax Return 2024
| Fie1d | Value |
| --- | --- |
| Namc: | Olivia C. Lindqvist |
|11 5ubtract line 10 from line 9. This is your adjusted gross income | $49,172.91 |",1040,0,1040,fdc-4b26bb4041e21eb65d83ca78,v11-1040-markdown,original,2024,fgen-87677a79e0170a08d11a1b39,synthetic_programmatic_template,markdown,top,True,
"## Form 1040
U.S. Individual Income Tax Return
For calendar year 2026
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Jordan Brennan |
| Home address (number and street) | 6028 Lakeshore Blvd Fairview, OH 44449 |
| Your social security number | XXXXX7370 |
## Filing Status
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | $139,478.05 |
| 2b Taxable interest | 5,139.82 |
| 3b Ordinary dividends | 2,922.85 |
| 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income | $139,934.37 |
| 11 Subtract line 10 from line 9. This is your adjusted gross income | $20,118.69 |
| 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income | 84,461.75 |
| 33 Add lines 25d, 26, and 32. These are your total payments | $2,530.51 |
| 37 Subtract line 33 from line 24. This is the amount you owe | 9,348.90 |
Department of the Treasury - Internal Revenue Service
## Form 1040 (keep for your records)  www.irs.gov/Form1040",1040,0,1040,fdc-425e974cb207134ac867036b,v11-1040-markdown,original,2026,fgen-83302b393b164605f00f4b41,synthetic_programmatic_template,markdown,top,False,
"## VOID  CORRECTED
Form 1040
U.S. Individual Income Tax Return
## For calendar year 2026
## OMB No. 1545-0074
IRS Use Only—Donot write or staple in this space.
| Field | Value |
|--- | --- |
| Your first name and middle initial  Last name | Jamie C. Moreau |
| Home address (number and street) | 470 Willow Bend Way Brookhaven, PA 87852|
| Your social sccurity numbcr | ending in 2813 |
Filing 5tatus
| Field | Value |
| --- | --- |
| 1a Total amount from Form(s) W-2, box 1 | 45,235.43|
| 2b Taxablc intcrest | 6,202.93|
| 3b Ordinary dividends | $8,117.59 |
| 9 Add lines 1z, 2b, 3b,4b, 5b, 6b, 7, and 8. This is your total incomc | 57,855.52 |
| 11 Subtract 1ine 10 from line 9. This is your adjusted gross income | 35,714.74 |
| 12 Standard deduction or itemized deductions (from Schedule A) | l9,534.72 |
| 15 Subtract line l4 from line 11. If zero or less, enter -0-. This is your taxable income | $21,218.29 |
| 24 Add lines 22 and 23. This is your total tax | 385.67|
| 33 Add lines 25d, 26, and 32. These are your total payments | 3,224.67 |
| 37 Subtract líne 33 from line 24. This is the amount you owe | $5,592.58 |
## Department of the Treasury - Internal RevenueService
Form 1040 (keep foryour records)  www.irs.gov/Form1040",1040,0,1040,fdc-6f5149c29d2a187e440ee238,v11-1040-markdown,original,2026,fgen-3fe5470a739df37df081e406,synthetic_programmatic_template,markdown,top,True,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2023
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
Your first name and middle initial  Your last name
Riley Larsen
Address (number, street, and apt. no.)
2571 Harbor View Rd Riverton, WI 18320
Your social security number
XXXXX0669
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
4,407.60
Voucher
4
Calendar year—Due
Jan. 15, 2024
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-f954a6acb437485e6b3efb3e,v11-1040-ES-stacked,original,2023,fgen-7b2bce02e13a5abfe7106218,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
Your first name and middle initial  Your last name
Diego R. Nguyen
Address (number, street, and apt. no.)
2624 Willow Bend Way Pinecrest, GA 64370
Your social security number
***-**-4600
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
$5,681.54
Voucher
1
Calendar year—Due
Jan. 15, 2023
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-4bf29edbed2b5a0cda8bc965,v11-1040-ES-stacked,original,2022,fgen-c358bd17c303ce31118a3f36,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2023
File only if you are making a payment of estimated tax by check or money order.
Your first name and middle initial  Your last name
Casey Testcase
Address (number, street, and apt. no.)
5019 Oak Hollow Ct Brookhaven, PA 71279
Your social security number
XXXXX1008
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
5,160.22
Voucher
4
Calendar year—Due
April 15, 2023",1040,0,1040,fdc-af1c212049769190b82dd66d,v11-1040-ES-stacked,original,2023,fgen-d5d30b320ed014bd6226a5e9,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
Avery Lindqvist
Address (number, street, and apt. no.)
9184 Willow Bend Way Lakewood, CO 11863
Your social security number
XXXXX2672
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
8,053.90
Calendar year—Due
June 15, 2026",1040,0,1040,fdc-ba80abd6eeec4f7cbba377dd,v11-1040-ES-stacked,original,2026,fgen-c6b2f06fe1c6a727d8513fa2,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2026
File only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
Jordan Castillo
Address (number, street, and apt. no.)
3669 Lakeshore Blvd Fairview, OH 46167
Your social security number
****5391
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
6,607.18
Voucher
2
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher",1040,0,1040,fdc-987cff54fd93e413a7752217,v11-1040-ES-stacked,original,2026,fgen-3ee91dc00ee488a029249a53,synthetic_programmatic_template,stacked,bottom,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2022
File only if you are making a payment of estimated tax by check or money order.
Your first name and middle initial  Your last name
Jordan Patel
Address (number, street, and apt. no.)
3061 Willow Bend Way Pinecrest, GA 92113
Your social security number
ending in 7636
Calendar year—Due
Voucher
3
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-c647c7a0f729004f5ff01a87,v11-1040-ES-stacked,original,2022,fgen-a7e33a868f93aa5f7ecd1c10,synthetic_programmatic_template,stacked,top,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2026
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
Morgan Sato
Address (number, street, and apt. no.)
767 Oak Hollow Ct Pinecrest, GA 95647
Your social security number
ending in 4439
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
2,807.82
Voucher
4
Calendar year—Due
Jan. 15, 2027
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-99b87e02ce99613f74a88009,v11-1040-ES-stacked,original,2026,fgen-3255ccb32b445eb38dc847f9,synthetic_programmatic_template,stacked,top,False,
"2021
OMB No. 1545-0074
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
5ofia B. Moreau
Address (number, street, and apt. no.)
4529 5ample Street Cedar Falls, IA 82l93
Your social security number
****6829
Calendar year—Due
Amount of estimated tax you are paying by check ormoney order.
2,215.96
Voucher
3
Calendar year—Due
Jan. 15, 2022
Department of the Treasury - Internal RevenueService",1040,0,1040,fdc-bb747392441abbe8b9c59f14,v11-1040-ES-stacked,original,2021,fgen-3daf8bc30a2341899a41c367,synthetic_programmatic_template,stacked,none,True,
"Name:
Kwame Haddad
Calendar year—Due
Jan. 15, 2026
Amount of estimatedtax you are paying by check or money order.
$5,O48.O7
Voucher
2
Form 1040-ES Estimated Tax for Individuals",1040,0,1040,fdc-3b29f96b4a873659e9e82e4c,v11-1040-ES-stacked,original,2025,fgen-461fc2b627f9376aca578710,synthetic_programmatic_template,stacked,bottom,True,
"Form 1040-ES
Estimated Taxfor Individuals
Payment Voucher
2026
OMB No. 1545-0074
Fíle only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money order payable to ""United 5tates Treasury.""
Your first name and middle initial  Your last name
Noah D. Haddad
Address (number, street, and apt. no.)
300 Maple Ridge Dr Oak Grove, TX 863l8
Yoursocial security number
****9603
Calendar year—Due
Amount of estímated tax you are paying by check or moneyorder.
$8,96l.77
Voucher
2
Calendar year—Due
June l5, 2O26",1040,0,1040,fdc-5e4a7ad5bfc4f2b0215deff2,v11-1040-ES-stacked,original,2026,fgen-ae0f68769e825010d953f869,synthetic_programmatic_template,stacked,top,True,
"File only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
Fatima Brennan
Address (number, street, and apt. no.)
8584 Maple Ridge Dr Cedar Falls, IA 77558
Your social security number
****8946
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
3,400.15
Voucher
4
Calendar year—Due
Jan. 15, 2026
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-ed9e68fa230bbafb324daed6,v11-1040-ES-stacked,original,2025,fgen-83c97b9196790d5aca7a35b8,synthetic_programmatic_template,stacked,none,False,
"VOID  CORRECTED
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2022
OMB No. 1545-0074
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
Fatima Okafor
Address (number, street, and apt. no.)
4845 Prairie Ave Testville, IL 66767
Your social security number
****1880
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
$7,582.78
Calendar year—Due
Sept. 15, 2022",1040,0,1040,fdc-880e107b307186f9e7dd9938,v11-1040-ES-stacked,original,2022,fgen-7c2f51144208f5a7bc25a0d1,synthetic_programmatic_template,stacked,top,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
OMB No. 1545-0074
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
Wei Lindqvist
Address (number, street, and apt. no.)
16 Cedar Ln Cedar Falls, IA 37407
Your social security number
XXX-XX-9046
Calendar year—Due
Voucher
4
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-89b7108158b2a004521f8e7c,v11-1040-ES-stacked,original,2023,fgen-162ee37b4b2a14de08f8a95b,synthetic_programmatic_template,stacked,top,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
Mail this voucher with your check or money order payable to ""United 5tates Treasury.""
Your first name and middle initial  Your lastname
Priya Okafor
Address (number, street, and apt. no.)
934 Oak Hollow Ct Maplewood, MN l5139
Your social security number
***-**-0366
Calendar year—Due
Amount of cstimated taxyou are paying by chcck or money order.
5,797.84
Voucher
2
Calendar ycar—Due
April 15, 2024
Department of the Treasury - Intemal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-1706f23c88d60c83176ef2fb,v11-1040-ES-stacked,original,2024,fgen-5c419443f156a046b6fd75fc,synthetic_programmatic_template,stacked,top,True,
"VOID  CORRECTED
2023
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name
Sofia Testcase
Address (number, street, and apt. no.)
2592 Granite St Testville, IL 73826
Your social security number
XXXXX6844
Calendar year—Due
Amount of estimated tax you are paying by check or money order.
4,935.43
Voucher
3
Calendar year—Due
Sept. 15, 2023",1040,0,1040,fdc-44fb73e59d9ef94d4df2b6f3,v11-1040-ES-stacked,original,2023,fgen-3b827e88546c9c5430f5f9d6,synthetic_programmatic_template,stacked,none,False,
"Form 1040-ES Estimated Tax for Individuals
Name:
Riley Okafor
Amount of estimated tax you are paying by check or money order.
1,514.08
Voucher
2
Calendar year—Due
April 15, 2025",1040,0,1040,fdc-65d4bca75395680a053cf2ca,v11-1040-ES-stacked,original,2025,fgen-746bdc51010743a78b9bdb7a,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
For calendar year 2024
OMB No. 1545-0074
Your first name and middle initial  Your last name: Lena Okafor
Address (number, street, and apt. no.): 7218 Maple Ridge Dr Cedar Falls, IA 95895
Your social security number: XXX-XX-7755
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: $1,923.02
Voucher: 4
Calendar year—Due: Sept. 15, 2024",1040,0,1040,fdc-da6208e78b2f99ab82db0c34,v11-1040-ES-boxed,original,2024,fgen-bc5fa122062f629fe5685b2e,synthetic_programmatic_template,boxed,none,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2023
OMB No. 1545-0074
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name: Mateo Adeyemi
Address (number, street, and apt. no.): 215 Maple Ridge Dr Oak Grove, TX 89873
Your social security number: ***-**-8259
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: $814.75
Voucher: 3",1040,0,1040,fdc-2fe480f123250b67d8bc3fb0,v11-1040-ES-boxed,original,2023,fgen-70b366670b61464a1525cfc8,synthetic_programmatic_template,boxed,top,False,
"Form 1040-ES Estimated Tax for Individuals
Name:: Alex Kowalski
Amount of estimated tax you are paying by check or money order.: 5,266.88
Voucher: 3",1040,0,1040,fdc-3af0dd9a1cb56e9e34ae1463,v11-1040-ES-boxed,original,2021,fgen-b55f2c56fdd496dee8fc54d6,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
For calendar year 2023
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name: Mateo B. Romero
Address (number, street, and apt. no.): 4313 Granite St Lakewood, CO 15570
Your social security number: ****9834
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: 4,231.17
Voucher: 3
Calendar year—Due: Sept. 15, 2023
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-2a6f9fb29cb397569422e496,v11-1040-ES-boxed,original,2023,fgen-4b5b7ccb0aaede94912e2676,synthetic_programmatic_template,boxed,none,False,
"☐ CORRECTED
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2021
File only if you are making a payment of estimated tax by check or money order.
Your first name and middle initial  Your last name: Wei Romero
Address (number, street, and apt. no.): 1450 Cedar Ln Testville, IL 79335
Your social security number: XXXXX1362
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: 9,178.85
Voucher: 1
Calendar year—Due: April 15, 2021
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-8ffe99d5af1f7d7f0c8c2a62,v11-1040-ES-boxed,original,2021,fgen-6838e889d73fb158cf401b03,synthetic_programmatic_template,boxed,top,False,
"OMB No. 1545-0074
Mail this voucher with yourcheck or money order payable to ""United States Treasury.""
Your first name and middleinitial  Your last name: Fatima C. Testcase
Address (number, street, and apt. no.): 4306 Elm Park Pl Brookhaven, PA l0244
Your social security number: XXX-XX-4683
Calendar year—Due
Voucher: 4
Calendar year—Due: Jan. l5, 2023",1040,0,1040,fdc-2edfed7c22b1fc3d295a59f1,v11-1040-ES-boxed,original,2022,fgen-125315b8827e4eef19d85b70,synthetic_programmatic_template,boxed,none,True,
"CORRECTED (if checked)
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2025
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
Your first name and middle initial  Your last name: Hiro Castillo
Address (number, street, and apt. no.): 4861 Prairie Ave Maplewood, MN 20452
Your social security number: ***-**-1000
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: $5,701.94
Calendar year—Due: June 15, 2025
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-d57c7a0add5f7368a435090a,v11-1040-ES-boxed,original,2025,fgen-cb8bf6e67f5df942dcd81f03,synthetic_programmatic_template,boxed,top,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2021
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
Your first name and middle initial  Your last name: Sofia A. Patel
Address (number, street, and apt. no.): 1201 Cedar Ln Brookhaven, PA 83622
Your social security number: ***-**-0404
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: $6,027.99
Calendar year—Due: Jan. 15, 2022",1040,0,1040,fdc-6132b81a83a7e59593a46aeb,v11-1040-ES-boxed,original,2021,fgen-a3777f18347aacee94b28f46,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form l040-ES
Estimated Tax for Individuals
Payment Voucher
2021
OMB No. 1545-0074
Fi1e only if you are making a payment of estimated taxby check or money order.
Mail this voucher with your check or money order payable to ""Uníted States Treasury.""
Your firstname and middle initial  Your last name: Wei Testcase
Address (number, street, and apt. no.): 7109 Lakeshore Blvd 0ak Grovc, TX 89356
Your social security number: ending in 7574
Calcndar year—Due
Amount of estimated tax you are paying by check or money order.: $1,598.71
Voucher: 1
Calendar year—Due: Jan. 15, 2022
Department of the Treasury - InternalRevenue Service
Form 1040-E5 (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-1ca2881d1ddd71fad1656790,v11-1040-ES-boxed,original,2021,fgen-fed012caec0f51180ae6562e,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked)
2025
OMB No. l545-0074
Your firstname and middle initial  Your last name: Priya Moreau
Address (number, street, and apt. no.): 105 E1m Park PlCedar Falls, IA 94993
Your social security number: XXXXX7764
Ca1endar year—Due
Amount of estimated tax you are paying by check or money order.: 4,059.11
Voucher: 3
Calendar year—Due: Jan. 15, 2026
Department of the Treasury - Intemal Revenue Service
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-b95121f873fc42bc338f5d74,v11-1040-ES-boxed,original,2025,fgen-3ca54a4b2c77800a037b34e0,synthetic_programmatic_template,boxed,bottom,True,
"☐ CORRECTED
For calendar year 2022
File only if you are making a payment of estimated tax by chcck or money order.
Your first name and middle initial  Your last name: Morgan J. Patel
Address (number, street, and apt. no.): 108 Cedar Ln Maplewood, MN 11743
Your social security number: ***-**-8604
Calendar year—Due
Amount of estimated taxyou are paying by chcck or money order.:$2,457.91
Voucher: 2
Calendar ycar—Due: Jan. 15, 2023",1040,0,1040,fdc-65acb18d059459da0c80357e,v11-1040-ES-boxed,original,2022,fgen-3c106e97530798ea0310b761,synthetic_programmatic_template,boxed,none,True,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2021
File only if you are making a payment of estimatedtax by check or moneyordcr.
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name: Jamie C. Fischer
Address (number, street, and apt. no.): 1213 Prairie Ave Testville, IL 53443
Your socia1 sccurity number: ***-**-9030
Calendar year—Due
Voucher: 1
Calendar year—Due: Jan. 15, 2022",1040,0,1040,fdc-c9ce01c7427e5639038a03c6,v11-1040-ES-boxed,original,2021,fgen-ca424460e404d7857a52708a,synthetic_programmatic_template,boxed,top,True,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2023
OMB No. 1545-0074
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name: Hiro Lindqvist
Address (number, street, and apt. no.): 1741 Cedar Ln Riverton, WI 93992
Your social security number: ending in 4612
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: 2,483.58
Voucher: 3
Calendar year—Due: April 15, 2023",1040,0,1040,fdc-bd1b3451dd055acadf600824,v11-1040-ES-boxed,original,2023,fgen-f42ad5145f19e996c671530a,synthetic_programmatic_template,boxed,top,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2025
OMB No. 1545-0074
Your first name and middle initial  Your last name: Wei C. Testcase
Address (number, street, and apt. no.): 9499 Elm Park Pl Brookhaven, PA 21533
Your social security number: ***-**-4339
Calendar year—Due
Amount of estimated tax you are paying by check or money order.: 3,743.46
Calendar year—Due: Sept. 15, 2025
Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-719673f9ca7df39aef1e366c,v11-1040-ES-boxed,original,2025,fgen-c228e9da92d31d1798cef042,synthetic_programmatic_template,boxed,top,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2023
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money order payable to ""United States Treasury.""
Your first name and middle initial  Your last name: Wei R. Patel
Address (number, street, and apt. no.): 736 Prairie Ave Bayside, WA 14045
Your social security number: ***-**-1891
Calendar year—Due
Voucher: 2
Calendar year—Due: Sept. 15, 2023",1040,0,1040,fdc-3dbaab5ebd7caf6d77c155a3,v11-1040-ES-boxed,original,2023,fgen-56b3efa1e8d4d0cfe364093c,synthetic_programmatic_template,boxed,top,False,
"Form 1040-ES Estimated Tax for Individuals 2022
Name:: Mateo Fischer
Amount of estimated tax you are paying by check or money order.: 4,058.66
Voucher: 1
Calendar year—Due: Jan. 15, 2023",1040,0,1040,fdc-17540cecfe3ad596c6623d7a,v11-1040-ES-boxed,original,2022,fgen-43c2c09dc8cebf4322aadb1d,synthetic_programmatic_template,boxed,top,False,
"Form 1040-ES Estimated Tax for Individuals Name: Mateo Castillo Voucher 4
Amount of estimated tax
you are paying by check or money order. 5,621.58 Calendar year—Due April 15, 2025",1040,0,1040,fdc-b837524a2797e2dc498f9725,v11-1040-ES-flat,original,2025,fgen-f3bd0d80846cb344d2420f6c,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 1040-ES Estimated Tax for Individuals Payment Voucher 2021 OMB No.
1545-0074 File only if you are making a payment of estimated tax by check or money order. Mail this voucher
with your check or money order payable to ""United States Treasury."" Your first name and middle initial Your last name Morgan Moreau Address (number, street, and apt. no.) 4759 Willow Bend Way Riverton, WI 84459 Your social security number ****2288 Calendar year—Due Amount of estimated tax you are paying by check or money order. $7,970.21 Voucher 4 Calendar year—Due Sept. 15, 2021 Department of the Treasury - Internal Revenue Service Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-316c074a974da4cad6733177,v11-1040-ES-flat,original,2021,fgen-c2c13ba21b6c4081729cb17e,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 1040-ES Estimated Taxfor Individuals Payment Voucher 2O26 OMB No. 1545-O074 File only if you are making a payment
of estimated tax by check or
money order. Your first name and middle initial Your last name Avery Adeyemi Address (number, street, and apt. no.) 1056Elm Park Pl Brookhaven, PA 23220 Your social security number ****0061 Calendar year—Due Amount of estimated tax you are paying by check or money order. 4,225.27 Voucher 3 Ca1endar year—Due June 15, 2026 Department of theTreasury - Intemal Revenue Service Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-7b8f3c77b301e728f3000b93,v11-1040-ES-flat,original,2026,fgen-8439d9ad6479b87e2e4d43ab,synthetic_programmatic_template,flat,top,True,
"Form 1040-ES Estimated Tax for Individuals Name: Noah C. Nguyen Amount of estimated tax
you are paying by check or money order.
2,562.14 Calendar year—Due April 15, 2022 Voucher 3",1040,0,1040,fdc-772c42113f89ece8062c9d3f,v11-1040-ES-flat,original,2022,fgen-70b2f9684c41996417d6da83,synthetic_programmatic_template,flat,top,False,
"Form 1040-ES Estimated Tax for Individuals Payment Voucher 2021 OMB No. 1545-0074 File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to ""United States Treasury."" Your first name and middle initial Your last name Kwame
B. Kowalski Address (number, street, and apt. no.) 6486 Sample Street Testville, IL 67534 Your
social security number ***-**-6764 Calendar year—Due Voucher 1 Calendar year—Due April 15, 2021",1040,0,1040,fdc-6fdb8f5a05cbc499e543ab75,v11-1040-ES-flat,original,2021,fgen-8c5d4e01b5ef25b5eab4e493,synthetic_programmatic_template,flat,top,False,
"Form 1040-ES Estimated Tax for Individuals Payment Voucher File only if you are making a payment of estimated tax by check or moneyorder. Your first name and middle initial Your last name Diego Brennan Address (number, street, and apt. no.) 6431 Elm Park Pl Maplewood,
MN 75032 Your socia1 security number XXX-XX-2723 Calendar year—Due Amount of
estimated tax you arepaying by check or money order. $5,586.34 Voucher 3 Calendar year—Due 5ept. l5, 2023",1040,0,1040,fdc-e244bb8191072178e0398a6e,v11-1040-ES-flat,original,2023,fgen-7d2b0ab28fbf637f68623434,synthetic_programmatic_template,flat,top,True,
"CORRECTED
(if checked) Form 1040-ES Estimated Tax for Individuals Payment Voucher 2024 File only if you are making a payment of estimated tax by check or money order. Your first name and middle initial Your last name Noah D. Fischer Address (number, street, and apt. no.) 5854 Granite St Lakewood, CO 13765 Your social security number ending in 5521 Calendar year—Due Amount of
estimated tax you are paying by check or money order. 9,149.80 Voucher 1 Calendar year—Due June 15, 2024 Department of the Treasury - Internal Revenue Service Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-36a644a1a43e37101b4e58af,v11-1040-ES-flat,original,2024,fgen-6778b7089b4f1e807d377bed,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 1040-ES Estimated Tax for Individuals Payment Voucher For calendar year 2021 OMB No. 1545-0074 Your first name and middle initial Your last name0livia KowalskiAddress (number, street, and apt. no.) 8649 Cedar Ln Brookhaven, PA 29092 Your socia1 security number ***-**-2005
Ca1endar year—Due Amount of estimated tax you are paying by check or money
order.$3,416.51 Vouchcr 3 Calendar year—Due Jan. 15, 2022 Department of the Treasury - Internal Revenue Service Form 1040-ES (keep for your records) www.írs.gov/Form1040ES",1040,0,1040,fdc-b20cc78aed71a1d856fd79aa,v11-1040-ES-flat,original,2021,fgen-7195b84ed4ccdd440dea5e95,synthetic_programmatic_template,flat,top,True,
"2021 OMB No. 1545-0074 Yourfirst name andmiddle initial Your last name Mateo Lindqvist Address (number, street, and apt. no.) 8034 Prairie Ave Riverton, WI 63679 Your social security number XXXXX4004 Calendar year—Due Amount of estimated tax you
are paying by check or money order. $7,464.01 Voucher
1 Calendar year—Due June 15, 2021 Department of the Trcasury - Intemal Revenue Service",1040,0,1040,fdc-0acd95ad44fd7261f5c4b106,v11-1040-ES-flat,original,2021,fgen-823af9728d60f17e1145bd35,synthetic_programmatic_template,flat,none,True,
"2026 OMB No. 1545-0074 File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to ""United States Treasury."" Your first name and middle initial Your last name Riley Patel Address (number, street, and apt. no.) 4459 Elm Park Pl Cedar Falls, IA
91413 Your social security number ***-**-9374 Calendar year—Due Amount of estimated tax you are paying by check or money order. 3,610.64 Voucher 1 Department of the Treasury - Internal Revenue Service Form 1040-ES Estimated Tax for Individuals
Payment Voucher Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-4c67fb2a6f62b1f5425c998b,v11-1040-ES-flat,original,2026,fgen-1a0c95668fd17dbf32f5a6e3,synthetic_programmatic_template,flat,bottom,False,
"Form 1040-ES Estimated Tax for Individuals Payment Voucher OMB No.
1545-0074 Mail this voucher with your check or money order payable to ""United States
Treasury."" Your first name and middle initial Your last name Casey J. Sato Address (number, street, and apt. no.) 6671 Granite St Testville, IL 55216 Your social security number ***-**-7379 Calendar year—Due Amount of estimated tax you are paying by check or money order. 621.98 Voucher 3 Calendar year—Due June 15, 2025 Department of the Treasury - Internal Revenue Service Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-b45e4538dd8a5765bc98f0b8,v11-1040-ES-flat,original,2025,fgen-f25a0f70e421533f0326329e,synthetic_programmatic_template,flat,top,False,
"Form 1040-ES Estimated Tax for Individuals Payment
Voucher OMB No. 1545-0074 File only if you are making a payment of estimated tax by check or money order. Your first name and middle initial Your last name Jordan Adeyemi Address (number, street, and apt. no.) 7821 Elm Park Pl Bayside, WA 28952 Your social security number ****6170 Calendar year—Due Amount of estimated tax you are paying by check or money order. 5,738.67 Voucher 2 Department of the Treasury -
Internal Revenue Service Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-9bd884e1a1ab18251e0b5851,v11-1040-ES-flat,original,2024,fgen-7cb442641a5052b29678ea3d,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED For calendar year 2022 OMB No. 1545-0074 Mail this voucher
with your check or money order payable to ""United States Treasury."" Your first name and middle initial Your last name Hiro Moreau Address (number, street, and apt. no.) 2405 Oak Hollow Ct Pinecrest, GA 49150 Your social security number XXXXX1719 Calendar year—Due Amount of
estimated tax you are paying by check or money order. $6,401.64 Calendar year—Due Sept. 15, 2022 Department of the Treasury - Internal Revenue Service Form 1040-ES Estimated Tax for Individuals Payment Voucher Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-25ba2b680348d9c8df4871b5,v11-1040-ES-flat,original,2022,fgen-de3c73b1c938a8db47220557,synthetic_programmatic_template,flat,bottom,False,
"Form 1040-ES Estimated Tax for
Individuals
Payment Voucher For calendar year 2025 OMB No. 1545-0074 Mail this voucher with your check or money order payable to ""United States Treasury."" Your first name and middle initial Your last name Riley Romero Address (number, street, and apt. no.) 3689 Prairie Ave Maplewood, MN 56348 Your social security number ****7090 Calendar year—Due Amount of estimated tax you are paying by check or money order. $6,509.80 Voucher 4 Calendar year—Due April 15, 2025",1040,0,1040,fdc-5a1e350d4efb79213c1105a4,v11-1040-ES-flat,original,2025,fgen-8c448b3efb5b4ca91af5dcfe,synthetic_programmatic_template,flat,top,False,
"Form 1040-ES Estimated Tax for Individuals Payment Voucher File only if you are making a payment of estimated tax by check or money order. Mail this voucher
with your check or money order payable to ""United States Treasury."" Your first name
and middle initial Your last name Olivia Nguyen Address (number, street, and apt. no.) 6279 Lakeshore Blvd Brookhaven, PA 70085 Your social security number ending in 7257 Calendar year—Due Amount of estimated tax you are paying by check or money order. 2,240.30 Voucher 4 Calendar year—Due Sept. 15, 2025 Department of the Treasury - Internal Revenue Service Form 1040-ES (keep for your records) www.irs.gov/Form1040ES",1040,0,1040,fdc-90cce0a19012cf319d1d231f,v11-1040-ES-flat,original,2025,fgen-50a8a83ea0156007b955a399,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) For calendar year 2021 OMB No. 1545-0074 File only if you are making a payment of estimated tax by check or money order. Your first name and middle initial Your last name Taylor D. Lindqvist Address (number, street, and apt. no.) 8337 Sample Street Fairview, OH 13825 Your social security number ***-**-4963 Calendar year—Due Amount of estimated tax you
are paying by
check or money order. $2,942.03 Voucher 1 Calendar year—Due Jan. 15, 2022 Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-b30d364f17e33a3533467235,v11-1040-ES-flat,original,2021,fgen-d00b624765ef45a4ea2943d3,synthetic_programmatic_template,flat,none,False,
"VOID  CORRECTED
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2024
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Sofia L. Rivera |
| Address (number, street, and apt. no.) | 1124 Oak Hollow Ct Bayside, WA 78593 |
| Your social security number | ****8622 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | $5,879.55 |
| Voucher | 2 |
| Calendar year—Due | April 15, 2024 |",1040,0,1040,fdc-58ff6b168d8da908d84c5e06,v11-1040-ES-markdown,original,2024,fgen-0ab5c57e186a094e0d634d48,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
## Form 1040-ES
## Estimated Tax for Individuals
PaymentVoucher
## 2025
0MB No. l545-0074
File only if you are making a payment ofestimated taxby check or money order.
| Field | Value |
| --- | --- |
| Your first name and midd1e initial  Your last name | Noah Wa1sh |
| Address (number, street, and apt. no.) | 6482 LakeshoreBlvd Riverton, WI 99354 |
| Your socíal security number | XXX-XX-7057 |
## Calendar year—Due
| Fie1d | Value |
| --- | --- |
| Amount of estímated tax you are paying by check or money order. | 5,828.76 |
| Voucher | 1 |
| Calendar year—Due | Jan. 15, 2026 |",1040,0,1040,fdc-7125d569c535689fa3a41869,v11-1040-ES-markdown,original,2025,fgen-6831c552f6df3d4a34e502ff,synthetic_programmatic_template,markdown,top,True,
"## Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
## For calendar year 2023
OMB No. 1545-0074
## File only if you are making a payment of estimated tax by check or money order.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Diego Larsen |
| Address (number, street, and apt. no.) | 3029 Willow Bend Way Cedar Falls, IA 61607 |
| Your social security number | ***-**-3465 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | $8,763.47 |
## Department of the Treasury - Internal Revenue Service
## Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-078274510b8cb022082669f7,v11-1040-ES-markdown,original,2023,fgen-ac1dde7c8527c5201e3f91ee,synthetic_programmatic_template,markdown,top,False,
"2021
OMB No. 1545-0074
## File only if you are making a payment of estimated tax by check or money order.
## Mail this voucher with your check or money order payable to ""United States Treasury.""
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Noah S. Testcase |
| Address (number, street, and apt. no.) | 54 Willow Bend Way Pinecrest, GA 38066 |
| Your social security number | XXX-XX-6910 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | 480.63 |
| Calendar year—Due | April 15, 2021 |
Department of the Treasury - Internal Revenue Service
Form 1040-ES
Estimated Tax for Individuals
## Payment Voucher
## Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-d6cb1ce15fbb13c992efd097,v11-1040-ES-markdown,original,2021,fgen-7be80e3594fce59d08709c2c,synthetic_programmatic_template,markdown,bottom,False,
"Form 1040-ES Estimated Tax forIndividuals 2026
| Field | Value |
| --- | --- |
| Name: | Hiro B. Nguyen |
| Calendar year—Due | June l5, 2026 |
| Voucher | 3 |
| Amount of estimated tax you are payíng by check or money order. | 9,O25.00 |",1040,0,1040,fdc-b7a2f56231b86f4600c990f6,v11-1040-ES-markdown,original,2026,fgen-cdbf194d745ec769f68c62db,synthetic_programmatic_template,markdown,top,True,
"## 2023
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Olivia Sato |
| Address (number, street, and apt. no.) | 8209 Sample Street Oak Grove, TX 30755 |
| Your social security number | ****2529 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | $3,951.69 |
| Voucher | 4 |
| Calendar year—Due | June 15, 2023 |
## Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-1bab8840d49c653ad82ae8f2,v11-1040-ES-markdown,original,2023,fgen-7be2ad14483422c147a9b934,synthetic_programmatic_template,markdown,none,False,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
2025
OMB No. 1545-0074
## File only if you are making a payment of estimated tax by check or money order.
## Mail this voucher with your check or money order payable to ""United States Treasury.""
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Sofia Adeyemi |
| Address (number, street, and apt. no.) | 3193 Harbor View Rd Oak Grove, TX 88110 |
| Your social security number | ending in 9215 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | 8,548.54 |
| Voucher | 4 |
| Calendar year—Due | June 15, 2025 |",1040,0,1040,fdc-0fb274841d3a23857d44a011,v11-1040-ES-markdown,original,2025,fgen-250145cf5e1df93116e9dfb5,synthetic_programmatic_template,markdown,top,False,
"## Form 1040-ES Estimated Tax for Individuals
| Field | Value |
| --- | --- |
| Name: | Hiro S. Nguyen |
| Voucher | 1 |",1040,0,1040,fdc-bbf470209a7fcd0038a20fd5,v11-1040-ES-markdown,original,2026,fgen-6a0c4c125ea9609007e39db5,synthetic_programmatic_template,markdown,top,False,
"Forcalendar year2022
OMB No. 1545-0074
Fi1e only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money ordcr payable to ""United StatesTreasury.""
|Field | Value |
| --- | --- |
| Your first namc and middle initial  Your last name | Mateo Okafor |
| Address (number, street, and apt. no.) | 6593 Lakeshore Blvd Fairview, OH 97985 |
| Your social security number | ending in 76O7 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Calendar year—Due | Jan. l5, 2023 |
## Form l040-E5
Estimated Tax for Individuals
Payment Voucher",1040,0,1040,fdc-9e3ba91f4590fbe53fb8f259,v11-1040-ES-markdown,original,2022,fgen-426f0c6161f914380040f250,synthetic_programmatic_template,markdown,bottom,True,
"Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2025
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
## Mail this voucher with your check or money order payable to ""United States Treasury.""
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Sofia Lindqvist |
| Address (number, street, and apt. no.) | 367 Prairie Ave Oak Grove, TX 40424 |
| Your social security number | ending in 1996 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | $1,883.87 |
| Calendar year—Due | Sept. 15, 2025 |",1040,0,1040,fdc-aa9cf1e36579a1273e3b953a,v11-1040-ES-markdown,original,2025,fgen-aac0b56ce3a86ba7c68c5015,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
Form 1040-ES
Estimated Tax for Individuals
Payment Voucher
For calendar year 2025
OMB No. 1545-0074
## File only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money order payable to ""United States Treasury.""
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Kwame Sato |
| Address (number, street, and apt. no.) | 5650 Maple Ridge Dr Lakewood, CO 58779 |
| Your social security number | XXXXX7839 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Voucher | 2 |
| Calendar year—Due | Jan. 15, 2026 |
## Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-8909a8113fdf0ea2e366185e,v11-1040-ES-markdown,original,2025,fgen-35da92ab9bbe57d842b346ec,synthetic_programmatic_template,markdown,top,False,
"Form 1040-ES
Estimated Tax for Individuals
## Payment Voucher
For calendar year 2024
## File only if you are making a payment of estimated tax by check or money order.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Wei Romero |
| Address (number, street, and apt. no.) | 8640 Cedar Ln Maplewood, MN 45182 |
| Your social security number | ****2764 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | $7,329.40 |
| Voucher | 1 |
| Calendar year—Due | Sept. 15, 2024 |
## Department of the Treasury - Internal Revenue Service
Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-66c7f0a099236e9bba11c969,v11-1040-ES-markdown,original,2024,fgen-9ecf2eca9d37a5bd7da2df73,synthetic_programmatic_template,markdown,top,False,
"Form 1040-ES
Estimated Tax for Individuals
## Payment Voucher
For calendar year 2025
OMB No. 1545-0074
Mail this voucher with your check or money order payable to ""United States Treasury.""
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Sofia Kowalski |
| Address (number, street, and apt. no.) | 7038 Oak Hollow Ct Bayside, WA 84220 |
| Your social security number | XXX-XX-9739 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | 5,327.59 |
| Voucher | 2 |
| Calendar year—Due | April 15, 2025 |
## Department of the Treasury - Internal Revenue Service
## Form 1040-ES (keep for your records)  www.irs.gov/Form1040ES",1040,0,1040,fdc-b67a5075e2e1417cf0d0dd2b,v11-1040-ES-markdown,original,2025,fgen-38ab5ff2d87e8335aa98c6ce,synthetic_programmatic_template,markdown,top,False,
"Form 1040-ES
## Estimated Tax for Individuals
Payment Voucher
For calendar year 2022
File only if you are making a payment of estimated tax by check or money order.
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Wei Fischer |
| Address (number, street, and apt. no.) | 7979 Maple Ridge Dr Cedar Falls, IA 20519 |
| Your social security number | ending in 7376 |
## Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | $5,456.49 |
| Voucher | 4 |
| Calendar year—Due | June 15, 2022 |",1040,0,1040,fdc-05b057e305286292a4458e6b,v11-1040-ES-markdown,original,2022,fgen-2214a056f603bbfdea2acb19,synthetic_programmatic_template,markdown,top,False,
"2021
OMB No. 1545-0074
File only if you are making a payment of estimated tax by check or money order.
Mail this voucher with your check or money order payable to ""United States Treasury.""
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Sofia S. Rivera |
| Address (number, street, and apt. no.) | 2279 Maple Ridge Dr Maplewood, MN 13038 |
| Your social security number | ****1393 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | 2,648.12 |
| Voucher | 2 |
| Calendar year—Due | Jan. 15, 2022 |
## Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-a718876eb0b2c8f130dfa501,v11-1040-ES-markdown,original,2021,fgen-4936b18a50227140f218cfb4,synthetic_programmatic_template,markdown,none,False,
"2022
## OMB No. 1545-0074
Mail this voucher with your check or money order payable to ""United States Treasury.""
| Field | Value |
| --- | --- |
| Your first name and middle initial  Your last name | Jamie Adeyemi |
| Address (number, street, and apt. no.) | 5998 Willow Bend Way Maplewood, MN 15640 |
| Your social security number | XXX-XX-8196 |
Calendar year—Due
| Field | Value |
| --- | --- |
| Amount of estimated tax you are paying by check or money order. | $6,781.35 |
| Voucher | 2 |
| Calendar year—Due | Sept. 15, 2022 |
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-b853284c48e528d277e4c144,v11-1040-ES-markdown,original,2022,fgen-0125722c9279bf5cee117053,synthetic_programmatic_template,markdown,none,False,
"2025
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name
Wei Moreau
Home address (number and street)
9321 Maple Ridge Dr Brookhaven, PA 51941
Your social security number
XXX-XX-5554
Filing status
1 B. Net change
$4,981.56
1 C. Correct amount
118,669.59
5 Taxable income
134,173.35
6 Tax liability
3,053.92
Part II Explanation of Changes
Reported omitted interest income.
Department of the Treasury - Internal Revenue Service
Form 1040-X
Amended U.S. Individual Income Tax Return
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-8b9e341955b9610d14ba401e,v11-1040-X-stacked,original,2025,fgen-b86b9389d4a80450e8f1a0ee,synthetic_programmatic_template,stacked,bottom,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2024
OMB No. 1545-0074
This return is for calendar year
Your first name and middle initial  Last name
Noah L. Testcase
Home address (number and street)
131 Oak Hollow Ct Cedar Falls, IA 98617
Your social security number
XXXXX5346
Filing status
1 Adjusted gross income  A. Original amount
$134,227.27
1 B. Net change
$7,242.60
1 C. Correct amount
96,476.58
5 Taxable income
88,925.11
6 Tax liability
8,127.24
Part II Explanation of Changes
Reported omitted interest income.",1040,0,1040,fdc-0789e9ae4ec6c44a12079237,v11-1040-X-stacked,original,2024,fgen-35671c148c08d43004aec5db,synthetic_programmatic_template,stacked,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
OMB No. 1545-0074
Your first name and middle initial  Last name
Wei Rivera
Home address (number and street)
2019 Prairie Ave Maplewood, MN 11786
Your social security number
ending in 8844
Filing status
1 C. Correct amount
98,428.04
5 Taxable income
$135,482.12
6 Tax liability
$641.41
Part II Explanation of Changes
Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-0be7920e4818fc5fd910f25a,v11-1040-X-stacked,original,2023,fgen-8a5835567274f1a8653319b5,synthetic_programmatic_template,stacked,top,False,
"Form 1040-X Amended U.S. Individual Income Tax Return
Name:
Riley Fischer
1 C. Correct amount
23,383.68
6 Tax liability
495.66",1040,0,1040,fdc-f8ace96aa0e5c521d5fed9c0,v11-1040-X-stacked,original,2026,fgen-e9b77ccd6f261add85e78462,synthetic_programmatic_template,stacked,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
For calendar year 2026
Your first name and middle inítial  Last name
Hiro Testcase
Home address (number and street)
4158 Elm Park Pl Maplewood, MN 12018
Your socíal security number
****1229
Filing status
1 Adjustcd gross íncome  A.Original amount
$58,444.l3
1 B. Net change
$6,378.58
1 C. Correct amount
130,890.17
5 Taxable íncome
98,330.30
6Tax liability
5,845.57
Part II Explanation of Changes
Claimed a missed education credit.",1040,0,1040,fdc-8dc3bbb1aceee0050eed61c3,v11-1040-X-stacked,original,2026,fgen-495b472a9fa9b5d38a662496,synthetic_programmatic_template,stacked,top,True,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2022
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name
Riley Patel
Home address (number and street)
805 Cedar Ln Fairview, OH 35286
Your social security number
XXX-XX-3781
Filing status
1 Adjusted gross income  A. Original amount
47,779.55
1 B. Net change
$2,760.87
1 C. Correct amount
$94,167.59
5 Taxable income
125,469.50
6 Tax liability
6,448.81
Part II Explanation of Changes
Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-a1f4c6151431889996975611,v11-1040-X-stacked,original,2022,fgen-c8bbefdcf6cd8a9ad5572903,synthetic_programmatic_template,stacked,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
For calendar year 2021
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name
Sofia M. Tanaka
Home address (number and street)
1288 Prairie Ave Oak Grove, TX 42912
Your social security number
XXX-XX-7331
Filing status
1 Adjusted gross income  A. Original amount
$21,257.28
1 B. Net change
$7,253.65
1 C. Correct amount
126,005.48
5 Taxable income
$102,798.99
6 Tax liability
4,265.03
Part II Explanation of Changes
Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-1d28cb34401b0a70f10a7d82,v11-1040-X-stacked,original,2021,fgen-6897ca16dc1af62f1d207c35,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2022
Department of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name
Sofia J. Sato
Home address (number and street)
1722 Sample Street Bayside, WA 33582
Your social security number
XXXXX3391
Filing status
1 Adjusted gross income  A. Original amount
14,156.96
1 B. Net change
8,915.26
5 Taxable income
5,659.02
6 Tax liability
3,370.35
Part II Explanation of Changes
Reported omitted interest income.",1040,0,1040,fdc-bff52d08b2e5ccb7cb397a0e,v11-1040-X-stacked,original,2022,fgen-98adda53231506af253d1e61,synthetic_programmatic_template,stacked,none,False,
"Form 1040-X Amended U.S. Individual Income Tax Return
Name:
Morgan Moreau
1 Adjusted gross income  A. Original amount
139,057.26
1 B. Net change
8,027.54
6 Tax liability
$3,187.84
Part II Explanation of Changes
Claimed a missed education credit.",1040,0,1040,fdc-7c8b7b8d657154c8e6ab2ae1,v11-1040-X-stacked,original,2021,fgen-c96480a993fce6cbb6b30129,synthetic_programmatic_template,stacked,top,False,
"Name:
Morgan Walsh
6 Tax liability
6,374.33
5 Taxable income
$135,095.56
1 C. Correct amount
132,851.65",1040,0,1040,fdc-164bb5797abfc92384d991c1,v11-1040-X-stacked,original,2026,fgen-83b4c4f9368efa707af112f5,synthetic_programmatic_template,stacked,none,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
For calendar year 2023
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name
Olivia Castillo
Home address (number and street)
6656 Granite St Lakewood, CO 73928
Your social security number
ending in 9622
Filing status
1 Adjusted gross income  A. Original amount
71,450.50
1 B. Net change
$9,247.41
1 C. Correct amount
77,413.71
5 Taxable income
$32,879.28
6 Tax liability
4,478.59
Part II Explanation of Changes
Reported omitted interest income.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-14f9e2751cc5d5fbb77a1efc,v11-1040-X-stacked,original,2023,fgen-147577d69eacadef24dfb1a7,synthetic_programmatic_template,stacked,top,False,
"Form 1040-X Amended U.S. Individual Income Tax Return
Name:
Amara Sato
6 Tax liability
8,578.06
1 Adjusted gross income  A. Original amount
$19,811.93
1 B. Net change
6,912.11",1040,0,1040,fdc-83e0cf6dffa37080b1898578,v11-1040-X-stacked,original,2023,fgen-928ea032f845df89d802381d,synthetic_programmatic_template,stacked,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2024
OMB No. 1545-0074
Your first name and middle initial  Last name
Jordan Adeyemi
Home address (number and street)
4472 Elm Park Pl Pinecrest, GA 78081
Your social security number
***-**-8053
Filing status
1 Adjusted gross income  A. Original amount
$51,653.57
1 B. Net change
7,430.53
1 C. Correct amount
72,414.83
5 Taxable income
$26,778.16
6 Tax liability
3,182.87
Part II Explanation of Changes
Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-29dc5a8630763402bc9b4480,v11-1040-X-stacked,original,2024,fgen-440eb70b32bc99b2636a46be,synthetic_programmatic_template,stacked,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2023
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name
Priya Castillo
Home address (number and street)
5610 Sample Street Fairview, OH 51126
Your social security number
XXX-XX-8321
Filing status
1 Adjusted gross income  A. Original amount
$66,044.49
1 B. Net change
6,819.39
1 C. Correct amount
$132,513.18
5 Taxable income
75,477.98
6 Tax liability
3,640.63",1040,0,1040,fdc-0ba96e219a67bf09e07f0bf3,v11-1040-X-stacked,original,2023,fgen-1d11ed1cd3982d6556e45476,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
2025
This return is for calendar year
Your first name and middle initial  Last name
Wei J. Kowalski
Home address (number and street)
8264 Elm Park Pl Pinecrest, GA 46194
Your social security number
***-**-1085
Filing status
1 Adjusted gross income  A. Original amount
$78,447.19
1 B. Net change
4,422.33
1 C. Correct amount
$89,983.00
6 Tax liability
$8,263.95
Part II Explanation of Changes
Claimed a missed education credit.
Form 1040-X
Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-83c3f424f5e86836d9df23bc,v11-1040-X-stacked,original,2025,fgen-21e60f6321b9190788145883,synthetic_programmatic_template,stacked,bottom,False,
"2026
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name
Priya Kowalski
Home address (number and street)
9089 Harbor View Rd Testville, IL 72736
Your social security number
***-**-2887
Filing status
1 Adjusted gross income  A. Original amount
102,922.74
1 B. Net change
$5,892.62
1 C. Correct amount
$69,211.90
5 Taxable income
89,255.43
Part II Explanation of Changes
Claimed a missed education credit.
Form 1040-X
Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-9d94cd11927f3b52dca96d40,v11-1040-X-stacked,original,2026,fgen-6488bf614d1a325a1c2bbcf2,synthetic_programmatic_template,stacked,bottom,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name      Riley Rivera
Home address (number and street)   8698 Willow Bend Way Riverton, WI 15592
Your social security number      ****0199
Filing status
1 Adjusted gross income  A. Original amount   $27,404.65
1 B. Net change  7,966.41
1 C. Correct amount      35,698.84
5 Taxable income 10,295.65
6 Tax liability      $3,176.58
Part II Explanation of Changes  Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-ad09c38a176bf9a85c726d99,v11-1040-X-inline,original,2025,fgen-4da4f7a02c05dc4e9b36436c,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form 1040-X
Amended U.S. Individual Income Tax Return
2026
OMB No. 1545-0074
This return is for calendar year
Your first name and middle initial  Last name      Avery Adeyemi
Home address (number and street)  5941 Granite St Oak Grove, TX 42696
Your social security number ***-**-9198
Filing status
1 Adjusted gross income  A. Original amount   $24,417.13
1 B. Net change $8,972.14
1 C. Correct amount $64,740.09
5 Taxable income  78,664.72
6 Tax liability 8,182.43
Part II Explanation of Changes Reported omitted interest income.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-3d747ceb31ada241923605b3,v11-1040-X-inline,original,2026,fgen-5893b3cea0dd311ab31892ef,synthetic_programmatic_template,inline,top,False,
"Form 1040-X Amended U.S. Individual Income Tax Return 2024
Name:      Olivia Rivera
1 C. Correct amount $1,504.49
Part II Explanation of Changes Claimed a missed education credit.
5 Taxable income   117,913.47
1 Adjusted gross income  A. Original amount  71,224.10",1040,0,1040,fdc-bade1c16f700970a9b13175c,v11-1040-X-inline,original,2024,fgen-d731ab0d15d040189156910e,synthetic_programmatic_template,inline,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2026
Your first name and middle initial  Last name  Jordan Patel
Home address (number and street) 2971 Harbor View Rd Maplewood, MN 60451
Your social security number ***-**-0616
Filing status
1 B. Net change      $1,715.47
1 C. Correct amount 135,844.77
5 Taxable income $97,273.56
6 Tax liability   $1,549.02
Part II Explanation of Changes   Claimed a missed education credit.",1040,0,1040,fdc-1c0bec1f34f4ac2b9e9d90d7,v11-1040-X-inline,original,2026,fgen-491d5ab46dbf2aa704096f5c,synthetic_programmatic_template,inline,top,False,
"For calendar year 2023
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name Jordan Moreau
Home address (number and street)      8981 Harbor View Rd Oak Grove, TX 52723
Your social security number   XXXXX6124
Filing status
1 Adjusted gross income  A. Original amount      $25,277.95
1 B. Net change  $1,337.74
1 C. Correct amount      123,160.70
5 Taxable income      134,785.89
6 Tax liability      5,776.53
Part II Explanation of Changes Claimed a missed education credit.
Form 1040-X
Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-d09df9cadba044e44e625dd5,v11-1040-X-inline,original,2023,fgen-69ff7ea3488b437988fbdf47,synthetic_programmatic_template,inline,bottom,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2021
OMB No. 1545-0074
Dcpartment of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name Lena Sato
Home address (number and street)   397l Maple Ridge Dr Brookhaven, PA 89990
Your social security number endingin 4598
Filing status
1 Adjusted gross incomc  A. Oríginal amount 73,922.65
1 B. Nct changc   $3,740.64
1 C. Correct amount      $114,438.31
5 Taxable income  125,373.09
6 Tax liability 291.28
Departmentof the Treasury - Intemal RevenueService
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-1d70ce0986c80a52df74a560,v11-1040-X-inline,original,2021,fgen-8ab2e2b536bd873b4334db0a,synthetic_programmatic_template,inline,top,True,
"Form 1040-X
Amended U.S. Individual Income Tax Return
OMB No. 1545-0074
This return is for calendar year
Your first name and midd1e initial  Last name Casey Tanaka
Home address(number andstreet) 6920 Lakeshore Blvd Testville, IL 35675
Your social security number XXX-XX-2174
Filing status
1 Adjusted gross income  A. Original amount  7O,561.76
1 B. Net change      $9,318.85
1 C. Correct amount     $121,357.28
5 Taxab1e income  8,694.17
6 Tax liability  5,2O8.49
Part II Explanation of Changes Receíved a corrected Form 1099-DIV after filing.
Department of the Treasury - Intemal Revenue 5ervice
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-d5acaead7f94d418cae7a85f,v11-1040-X-inline,original,2024,fgen-ecb21b65bd2b9084c6fb57a6,synthetic_programmatic_template,inline,top,True,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2024
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name   Amara J. Castillo
Home address (number and street)  1508 Cedar Ln Fairview, OH 81714
Your social security number XXXXX2402
Filing status
1 Adjusted gross income  A. Original amount   $55,718.71
1 B. Net change 1,932.46
1 C. Correct amount      78,400.26
5 Taxable income  $106,827.18
6 Tax liability  6,636.15
Part II Explanation of Changes Received a corrected Form 1099-DIV after filing.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-99f1dbd1e7e2501012ce1d5f,v11-1040-X-inline,original,2024,fgen-87d2da7b7c498d7ac72b1f13,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1040-X
Amended U.S. Individual Income Tax Return
2026
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
Your first name and middle initial  Last name   Noah C. Walsh
Home address (number and street)      4325 Harbor View Rd Testville, IL 49731
Your social security number      XXX-XX-7576
Filing status
1 Adjusted gross income  A. Original amount   40,848.26
1 B. Net change $2,071.02
6 Tax liability 3,051.93
Part II Explanation of Changes   Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-571ac747e0a89a079a5b4daf,v11-1040-X-inline,original,2026,fgen-55c450712c89059cd8a2e7a4,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1040-X
Amended U.S. Individua1 Income TaxReturn
For calendar year 2024
0MB No. 1545-0074
Department of the Trcasury—Internal RevenueService
Your first name and middle initial  Last name      Jamie Adeyemi
Home address (number and street) 1174 Willow Bend Way Cedar Falls, IA 40781
Yoursocíal security number   ***-**-4406
Filing status
l Adjusted gross income  A. 0riginal amount  l34,770.97
1 B. Net change 655.15
1 C. Correct amount  $46,073.58
5 Taxable income  $84,623.26
6 Tax liability  7,862.29
Part II Explanation of Changes   Claimed a missed education credit.",1040,0,1040,fdc-cd4009e8a94d8c20534d0d56,v11-1040-X-inline,original,2024,fgen-a340b786783ffc0c9d25099c,synthetic_programmatic_template,inline,top,True,
"CORRECTED (if checked)
Form 1040-X
Amended U.S. Individual Income Tax Return
Your first name and middle initial  Last name   Taylor A. Sato
Home address (number and street)      2471 Harbor View Rd Fairview, OH 59688
Your social security number  XXXXX7101
Filing status
1 Adjusted gross income  A. Original amount  $94,687.98
1 B. Net change 5,741.87
1 C. Correct amount 30,353.07
5 Taxable income 95,015.45
6 Tax liability $1,460.43
Part II Explanation of Changes Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-a499b098fbdf2a85d3363923,v11-1040-X-inline,original,2023,fgen-0743aa8e02f25ea2fc5e0c87,synthetic_programmatic_template,inline,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
2022
Department of the Treasury—Interna1 Revenue Servíce
Your first name and midd1e initial  Last name     Kwame Haddad
Home address (number and street) 844 Harbor View Rd Oak Grove, TX 73984
Your social security number      ***-**-8899
Filing status
l Adjusted gross income  A. Original amount   Sl27,298.84
1 B. Net change  6,717.55
5 Taxable income   50,659.26
6 Tax liability  1,830.81
Part II Explanation of Changcs Received a corrected Form 1099-DIV after filing.
Department of the Trcasury - InternalRevenue5ervice
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-6d2c23b4a8d1d495816727bd,v11-1040-X-inline,original,2022,fgen-a14d2b663528837186b1058d,synthetic_programmatic_template,inline,top,True,
"2026
OMB No. 1545-0074
Your first name and middle initial  Last name Jamie Moreau
Home address (number and street) 9397 Granite St Oak Grove, TX 47099
Your social security number ***-**-9091
Filing status
1 Adjusted gross income  A. Original amount      $26,808.79
1 B. Net change   7,494.95
1 C. Correct amount   $131,376.19
5 Taxable income 50,183.00
Department of the Treasury - Internal Revenue Service
Form 1040-X
Amended U.S. Individual Income Tax Return
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-19b77132c3f787e221350561,v11-1040-X-inline,original,2026,fgen-2efc13562a0bb2f2217e5540,synthetic_programmatic_template,inline,bottom,False,
"2022
OMB No. 1545-0074
Your first name and middle initial  Last name   Olivia Romero
Home address (number and street)  7543 Oak Hollow Ct Maplewood, MN 30716
Your social security number      ***-**-9241
Filing status
1 Adjusted gross income  A. Original amount 63,672.71
1 B. Net change      2,169.53
5 Taxable income  $113,456.96
6 Tax liability  $7,327.07
Part II Explanation of Changes Claimed a missed education credit.
Department of the Treasury - Internal Revenue Service
Form 1040-X
Amended U.S. Individual Income Tax Return
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-65a27d863dc9a7f41215ac06,v11-1040-X-inline,original,2022,fgen-07716170d2af2074f12f0e85,synthetic_programmatic_template,inline,bottom,False,
"VOID  CORRECTED
Form 1040-X
Amended U.S. Individual Income Tax Return
2026
Department of the Treasury—Internal Revenue Service
This return is for calendar year
Your first name and middle initial  Last name      Kwame Romero
Home address (number and street)   1924 Sample Street Lakewood, CO 30366
Your social security number ****7652
Filing status
1 B. Net change  $2,774.80
1 C. Correct amount   120,150.26
5 Taxable income $110,575.32
6 Tax liability      $7,799.19
Part II Explanation of Changes   Reported omitted interest income.",1040,0,1040,fdc-0204efe8a9e5ccc03b4073c0,v11-1040-X-inline,original,2026,fgen-6fff6e71a7988debb685cdab,synthetic_programmatic_template,inline,top,False,
"Name: Olivia Larsen
1 C. Correct amount  71,394.74",1040,0,1040,fdc-6d863ffe1fb1b4a9c8f4e5d1,v11-1040-X-inline,original,2021,fgen-e5dfcbe3c59c89d144a029cd,synthetic_programmatic_template,inline,none,False,
"Name: Casey Castillo 6 Tax liability $3,169.33 1 C. Correct amount $86,886.55 1 B. Net
change 2,009.06 1 Adjusted gross income A. Original
amount 110,170.56 Form 1040-X Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-6c5f3f24cdf8bdc0b7c599ff,v11-1040-X-flat,original,2024,fgen-ffe4c0320347805b5c54576b,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2026 Department of the Treasury—Internal
Revenue Service This return is for calendar year Your first name and middle initial Last name Casey Sato Home
address (number and street) 507 Harbor View Rd Brookhaven, PA 13167 Your social security number ***-**-7636 Filing status 1 Adjusted gross income A. Original amount $82,088.90 1 B. Net change $3,672.54 1 C. Correct amount 25,161.55 5 Taxable income 16,155.07 6 Tax liability $4,505.26 Part II Explanation of Changes Reported omitted interest income. Department of the Treasury - Internal Revenue Service Form 1040-X Amended U.S. Individual Income Tax Return Form 1040-X (keep for your records) www.irs.gov/Form1040X",1040,0,1040,fdc-fdb78cfc338884106b6ebb5d,v11-1040-X-flat,original,2026,fgen-b39e92ad7314dc7646d92283,synthetic_programmatic_template,flat,bottom,False,
"Form 1040-X Amended U.S. Individual Income Tax Return 2022 OMB No. 1545-0074 Department of the Treasury—Internal Revenue Service Your first name and middle initial Last name Mateo Castillo Home address (number and street) 2197 Cedar Ln Testville, IL 65297 Your social security number XXX-XX-9298
Filing status 1 Adjusted gross income A. Original amount $56,212.17 1 C. Correct amount 7,213.72 5 Taxable income 98,325.15 Part II Explanation
of Changes Claimed a missed education credit.",1040,0,1040,fdc-d4128a189905b24c93e4a0a1,v11-1040-X-flat,original,2022,fgen-6b88bd809c46f0710dddf732,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked)
Form 1040-X Amended U.S. Individual Income Tax Return For calendar year 2022 OMB No. 1545-0074 This return is for calendar year Your first name and middle initial Last name Taylor Lindqvist Home address (number and street) 7846 Lakeshore Blvd Brookhaven, PA 27851 Your social security number ***-**-8303 Filing status 1 Adjusted gross income A. Original amount 41,025.55 1 B. Net change $9,089.47
1 C. Correct amount $29,210.66 5 Taxable income 46,957.45 6 Tax liability 3,459.46 Part II Explanation of Changes Claimed a missed education credit.",1040,0,1040,fdc-4f69f00ec06d45d776bb54e7,v11-1040-X-flat,original,2022,fgen-de4ba5cd4be7b4eedb954e2e,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 1040-X Amended U.S. Individual Income Tax
Return For calendar year 2021 OMB No. 1545-0074 Department of the Treasury—Internal Revenue Service This return is for calendar year Your first name and middle initial Last name Amara M.
Testcase Home address (number and street) 5280 Prairie Ave Fairview, OH 36576 Your social security number ***-**-7661 Filing status 1 Adjusted gross income A. Original amount $80,254.16 1 B. Net change $2,264.34 1 C. Correct amount 92,040.59 5 Taxable income $44,486.75 6 Tax liability 4,670.61 Part II Explanation of Changes Reported omitted interest income. Department of the Treasury - Internal Revenue Service Form 1040-X (keep for your records) www.irs.gov/Form1040X",1040,0,1040,fdc-a6cd6edb4f432a16aaebd2cc,v11-1040-X-flat,original,2021,fgen-685dfe95df50acc537c31781,synthetic_programmatic_template,flat,top,False,
"Form 1040-X Amended U.S. Individual Income Tax Return 2025 Name:
Kwame L. Kowalski Part II
Explanation of Changes Received a corrected Form 1099-DIV after filing. 5 Taxable income 61,102.76 1 Adjusted gross income A. Original amount 103,415.55 1 C. Correct amount $54,655.03",1040,0,1040,fdc-9349332a93916005b0e0dfc1,v11-1040-X-flat,original,2025,fgen-4262d73722d423d680573d8e,synthetic_programmatic_template,flat,top,False,
"Name: Wei D. Moreau Part II Explanation of Changes Claimed a missed
education credit. 1 C. Correct
amount 22,168.56",1040,0,1040,fdc-5aad1670e6e313b115e02fb6,v11-1040-X-flat,original,2021,fgen-83dd689ea8aca3e27cc74d80,synthetic_programmatic_template,flat,none,False,
"Department of the Treasury—Internal Revenue Service This return is for calendar year Your first name and middle initial Last name Alex Haddad Home address (number and street) 2600 Granite St Oak Grove,
TX 49777 Your social security number ending in 4049 Filing status 1 Adjusted gross income A. Original amount 92,146.19 1 B. Net
change $5,378.33 1 C. Correct amount 47,563.49 5 Taxable income $65,937.80 6 Tax liability 8,398.24 Part II Explanation of Changes Reported omitted interest income. Department of the Treasury - Internal Revenue Service Form 1040-X Amended U.S. Individual Income Tax Return Form 1040-X (keep for your records) www.irs.gov/Form1040X",1040,0,1040,fdc-6966c13c59b07cdc8d8fe522,v11-1040-X-flat,original,2025,fgen-9bd2aaa9773da0523439d56c,synthetic_programmatic_template,flat,bottom,False,
"VOID CORRECTED Form 1040-X Amended U.S. Individual Income Tax Return 2025 OMB No. 1545-0074 Department of the Treasury—Internal Revenue Service This return is for calendar year Your first name and middle initial Last name Morgan Patel Home address (number and street) 3300 Willow Bend Way Testville, IL 70502 Your social security number ***-**-1198 Filing status 1 Adjusted gross income A. Original amount $20,710.71 1 B. Net change $9,288.22 1 C. Correct amount
26,938.32 5 Taxable income 20,946.24 6 Tax liability 6,905.60 Part II Explanation of Changes Reported omitted interest income. Department of the Treasury - Internal Revenue Service Form 1040-X
(keep for your records) www.irs.gov/Form1040X",1040,0,1040,fdc-65e55b56f814d9cbcb7ead0d,v11-1040-X-flat,original,2025,fgen-d4883e3b7677beb36cc366f9,synthetic_programmatic_template,flat,top,False,
"Name:
Sofia Nguyen Part II Explanation of Changes Received a
corrected Form 1099-DIV after filing.",1040,0,1040,fdc-88d6706a2ccbf405fb051a16,v11-1040-X-flat,original,2021,fgen-c9bc5aa2b44324efd1ad7dd6,synthetic_programmatic_template,flat,none,False,
"2026 OMB No. 1545-0074 This return is for calendar year Your first name and middle initial Last name Wei Romero Home address (number and street) 1501 Elm Park Pl Riverton, WI
93255 Your social security number ***-**-2241 Filing status 1 Adjusted gross income A. Original amount $47,834.45 1 B. Net change $6,220.78 1 C.
Correct amount 137,268.09 5 Taxable income $112,034.37 6 Tax liability $6,330.71 Part II Explanation of Changes Reported omitted interest income. Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-5d385fb4d7988ea88847d26d,v11-1040-X-flat,original,2026,fgen-881581b15581f8fe78cfa735,synthetic_programmatic_template,flat,none,False,
"2025 This return is for calendar year Your first name and middle initial Last name Wei E. Romero Home address (number and street) 5802 Cedar Ln Riverton, WI 65569 Your social security number
XXXXX1890 Filing status 1 Adjusted gross income A. Original amount 129,104.72 1 B. Net change $6,676.39 1 C. Correct amount 37,682.29 6 Tax liability 8,393.09 Part II Explanation of Changes Received a corrected Form 1099-DIV after filing.
Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-83bcc65986bf3a43d09e5692,v11-1040-X-flat,original,2025,fgen-332a6b1370c0c534d3a38978,synthetic_programmatic_template,flat,none,False,
"Form 1040-X Amended U.S. Individual Income Tax Return For calendar year 2026 OMB No. 1545-0074 This return is for
calendar year Your first name and middle initial Last name Morgan Testcase Home address (number and street) 9174 Oak Hollow Ct Oak Grove, TX 12226 Your social security number
XXX-XX-9000 Filing status 1 Adjusted gross income A. Original amount $36,020.30 1 B. Net change 870.17 1 C. Correct amount 125,496.09 5 Taxable income 128,014.33 6 Tax liability $926.76 Part II Explanation of Changes Claimed a missed education credit.",1040,0,1040,fdc-b2998aab0228a4637798952c,v11-1040-X-flat,original,2026,fgen-a48fd1fc723d2dee35219156,synthetic_programmatic_template,flat,top,False,
"2026 OMB No. 1545-0074 This return is for calendar year Your first name and middle initial Last name Noah Haddad
Home address (number and street) 7610 Granite St Fairview, OH 61235 Your social security number ending in 9539 Filing status 1 Adjusted gross income A. Original amount
$106,344.19 1 C. Correct amount 79,836.50 5 Taxable income $93,143.06 6 Tax liability 7,735.83 Part II Explanation of Changes Received a corrected Form 1099-DIV after filing. Department of the Treasury - Internal Revenue Service Form 1040-X Amended U.S. Individual Income Tax Return Form 1040-X (keep for your records) www.irs.gov/Form1040X",1040,0,1040,fdc-6dfbcf8a321dec613d4b89b6,v11-1040-X-flat,original,2026,fgen-6684f0a8561bd30443ca7075,synthetic_programmatic_template,flat,bottom,False,
"2026 OMB No. 1545-0074 Your first name and middle initial Last name Priya Larsen Home address (number and street)
9231 Sample Street Brookhaven, PA 61175 Your social security number ending in 0252 Filing status 1 Adjusted gross income A. Original amount 124,006.66 1 C. Correct amount 99,285.59 5 Taxable income 86,468.92
6 Tax liability $338.50 Part II Explanation of Changes Claimed a missed education credit. Department of the Treasury - Internal Revenue Service",1040,0,1040,fdc-cdb5c954b6ce8bc4955f7f65,v11-1040-X-flat,original,2026,fgen-8e30b0844cde7cccda3750b1,synthetic_programmatic_template,flat,none,False,
"Form 1040-X Amended U.S. Individual Income Tax Return Name: Morgan Adeyemi
6 Tax liability $6,746.33 Part
II Explanation of Changes Reported omitted interest income.",1040,0,1040,fdc-28378615a14e6e77b04f2215,v11-1040-X-flat,original,2024,fgen-411848907140b65b6ccbaf46,synthetic_programmatic_template,flat,top,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
## Department of the Treasury—Internal Revenue Service
This return is for calendar year
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Kwame Adeyemi |
| Home address (number and street) | 3807 Lakeshore Blvd Testville, IL 34320 |
| Your social security number | XXX-XX-1862 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $29,278.59 |
| 1 B. Net change | $4,055.42 |
| 1 C. Correct amount | 36,659.93 |
| 5 Taxable income | $21,671.85 |
| 6 Tax liability | 668.30 |
| Part II Explanation of Changes | Claimed a missed education credit. |",1040,0,1040,fdc-c1c3c08bcb715214b2b4cd3b,v11-1040-X-markdown,original,2021,fgen-179255949045fedfce6bf375,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| Name: |Noah Rivera |
| Part II Explanatíon of Changes | Claimed a missed education credit. |
Form l040-X Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-b975bf2eb846dbdadde6bc73,v11-1040-X-markdown,original,2022,fgen-7c37350896b8627c8c830806,synthetic_programmatic_template,markdown,bottom,True,
"2022
| Field | Value |
| --- | --- |
| Your first name and midd1e initial  Last name | Diego E. Sato |
|Home address (number and street) | 533O Oak Hollow Ct Riverton, WI 85899 |
| Your social security number | ***-**-3456 |
## Filing status
| Ficld |Value |
| --- | --- |
| lAdjusted gross income  A. Original amount | S25,045.92 |
| 1 B. Net change | $3,301.88 |
| 1 C. Correctamount | 77,992.20 |
| 5 Taxable income | $114,898.45 |
| 6 Tax liability | 2,208.71 |
| Part II Explanation of Changes | Received a corrected Form 1O99-DIV aftcr fíling. |
Department of the Treasury - Intemal Revenue Service",1040,0,1040,fdc-14f13905c7f1f1c881526325,v11-1040-X-markdown,original,2022,fgen-0e4d8da7b3b55ec240aea39c,synthetic_programmatic_template,markdown,none,True,
"## For calendar year2023
OMB No. l545-0074
This rcturn is for ca1endar year
| Field | Value |
| --- | --- |
| Your first name and middleinitial  Last name | Kwame Haddad |
| Home address (number and street) |7026 Oak Hollow Ct Lakewood, CO 68861 |
| Your socíal security number | ending in 3027 |
Filing status
| Field | Value |
| --- | --- |
|1 Adjusted gross income  A. Original amount | 134,003.39 |
| l B. Net change | $8,615.61 |
| 5 Taxable íncome | 68,477.31 |
| Part II Explanation of Changes | Claimed a missed education credit. |",1040,0,1040,fdc-a1a9672f026b94eb34293be0,v11-1040-X-markdown,original,2023,fgen-af0bb528d36949600114b7ce,synthetic_programmatic_template,markdown,none,True,
"| Field | Value |
| --- | --- |
| Name: | Casey Lindqvist |
| Part II Explanation of Changes | Received a corrected Form 1099-DIV after filing. |
| 6 Tax liability | 3,525.47 |
| 1 B. Net change | 4,245.51 |
Form 1040-X Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-af87d9b81834af07bb045429,v11-1040-X-markdown,original,2023,fgen-966640b4816c9543e4bf0a6d,synthetic_programmatic_template,markdown,bottom,False,
"Form 1040-X
Amended U.S. Individual Income Tax Return
## 2022
## OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
## This return is for calendar year
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Fatima J. Sato |
| Home address (number and street) | 7202 Harbor View Rd Pinecrest, GA 18072 |
| Your social security number | ****5272 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $22,084.32 |
| 1 B. Net change | $9,072.00 |
| 1 C. Correct amount | $97,483.29 |
| 5 Taxable income | 94,215.43 |
| 6 Tax liability | 113.22 |
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-9f499a36fb82ce93e034cebc,v11-1040-X-markdown,original,2022,fgen-063567694f06f93f21d9f845,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
For calendar year 2021
OMB No. 1545-0074
Department of the Treasury—Internal Revenue Service
This return is for calendar year
| Field| Value |
| --- | --- |
| Your first nameand middle initial  Last name | Jamie R. Lindqvist |
| Home address (number and street) | 3148 Cedar Ln Testville,IL 54772 |
| Your socia1 security number | XXX-XX-7153 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. 0riginal amount | 78,427.75 |
| 1 B. Net change | 7,673.14 |
| 1 C. Correct amount | 61,193.83 |
| 5 Taxable income | $10O,345.20 |
| 6 Tax liability | $1,443.59 |
| Part II Exp1anation of Changes |Claimed a missed education credit. |
Form 1040-X
##Amended U.5. Individual Income Tax Retum",1040,0,1040,fdc-fd1b0a61dd25b61accc80849,v11-1040-X-markdown,original,2021,fgen-7c247426adf49c0699ef8186,synthetic_programmatic_template,markdown,bottom,True,
"## 2025
OMB No. 1545-0074
This return is for calendar year
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Amara Rivera |
| Home address (number and street) | 6851 Willow Bend Way Bayside, WA 17338 |
| Your social security number | ****6914 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $16,255.42 |
| 1 B. Net change | $4,351.45 |
| 1 C. Correct amount | $113,574.82 |
| 5 Taxable income | $99,536.80 |
| 6 Tax liability | 1,238.55 |
| Part II Explanation of Changes | Claimed a missed education credit. |
Form 1040-X
Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-2c71eb54a52f083ef63e71ea,v11-1040-X-markdown,original,2025,fgen-257e7a6937b9ff04fc048a63,synthetic_programmatic_template,markdown,bottom,False,
"For calendar year 2022
OMB No. 1545-0074
This return is for calendar year
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Wei Haddad |
| Home address (number and street) | 8658 Cedar Ln Testville, IL 89124 |
| Your social security number | XXXXX7166 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $69,274.85 |
| 1 B. Net change | $7,376.63 |
| 1 C. Correct amount | $133,089.78 |
| 5 Taxable income | $117,245.97 |
| 6 Tax liability | 3,757.24 |
| Part II Explanation of Changes | Received a corrected Form 1099-DIV after filing. |
Department of the Treasury - Internal Revenue Service
Form 1040-X
## Amended U.S. Individual Income Tax Return
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-358017b1185e91745ad249bc,v11-1040-X-markdown,original,2022,fgen-2008962b75f25438a47adc13,synthetic_programmatic_template,markdown,bottom,False,
"CORRECTED (if checked)
## Form 1040-X
Amended U.S. Individual Income Tax Return
2023
## Department of the Treasury—Internal Revenue Service
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Noah Moreau |
| Home address (number and street) | 4764 Lakeshore Blvd Cedar Falls, IA 69459 |
| Your social security number | ***-**-6941 |
## Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $93,453.71 |
| 1 B. Net change | 2,874.90 |
| 1 C. Correct amount | 53,953.27 |
| 5 Taxable income | $8,239.70 |
| 6 Tax liability | 5,283.78 |
| Part II Explanation of Changes | Reported omitted interest income. |
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-c1758022f601655a848c64e4,v11-1040-X-markdown,original,2023,fgen-c9164c52ace1fe108b7e5b4d,synthetic_programmatic_template,markdown,top,False,
"Form 1040-X
## Amended U.S. Individual Income Tax Return
For calendar year 2021
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Fatima B. Adeyemi |
| Home address (number and street) | 6545 Maple Ridge Dr Pinecrest, GA 22508 |
| Your social security number | ***-**-2335 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $138,398.74 |
| 1 B. Net change | 1,588.68 |
| 1 C. Correct amount | $86,548.20 |
| 5 Taxable income | 104,329.92 |
| 6 Tax liability | 1,163.07 |
| Part II Explanation of Changes | Received a corrected Form 1099-DIV after filing. |
Department of the Treasury - Internal Revenue Service
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-fd8342601a7d086a13ba6288,v11-1040-X-markdown,original,2021,fgen-b58428cdde40878c37714335,synthetic_programmatic_template,markdown,top,False,
"## Form 1040-X
Amended U.S. Individual Income Tax Return
2024
## OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Wei D. Adeyemi |
| Home address (number and street) | 1649 Elm Park Pl Maplewood, MN 42999 |
| Your social security number | ending in 9858 |
## Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $35,841.31 |
| 1 C. Correct amount | $70,955.54 |
| 6 Tax liability | 5,208.14 |
| Part II Explanation of Changes | Reported omitted interest income. |",1040,0,1040,fdc-54729df1f67859a575398de1,v11-1040-X-markdown,original,2024,fgen-e9fb5c42e33074222ddd27eb,synthetic_programmatic_template,markdown,top,False,
"For calendar year 2022
OMB No. 1545-0074
## Department of the Treasury—Internal Revenue Service
This return is for calendar year
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Kwame Sato |
| Home address (number and street) | 1708 Harbor View Rd Testville, IL 86722 |
| Your social security number | ***-**-9096 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $123,673.11 |
| 1 B. Net change | 7,255.61 |
| 1 C. Correct amount | $69,364.13 |
| 5 Taxable income | 64,591.14 |
| 6 Tax liability | $5,986.06 |
| Part II Explanation of Changes | Reported omitted interest income. |
Department of the Treasury - Internal Revenue Service
Form 1040-X
Amended U.S. Individual Income Tax Return
Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-595205491059b32f5295a1b9,v11-1040-X-markdown,original,2022,fgen-cc6463b49484fb85fcce55de,synthetic_programmatic_template,markdown,bottom,False,
"| Field | Value |
| --- | --- |
| Name: | Casey Testcase |
| 1 C. Correct amount | 38,564.27 |
| 1 B. Net change | $1,378.81 |
| 5 Taxable income | 77,970.50 |
| Part II Explanation of Changes | Reported omitted interest income. |",1040,0,1040,fdc-422a728eea27c8294336240a,v11-1040-X-markdown,original,2023,fgen-90368fb0e2f2eddc98ab80f7,synthetic_programmatic_template,markdown,none,False,
"## CORRECTED (if checked)
Form 1040-X
Amended U.S. Individual Income Tax Return
## 2021
OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Mateo Sato |
| Home address (number and street) | 7653 Willow Bend Way Pinecrest, GA 46113 |
| Your social security number | XXX-XX-8396 |
## Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | $104,637.37 |
| 1 B. Net change | 2,106.97 |
| 1 C. Correct amount | 106,359.21 |
| 6 Tax liability | $6,996.38 |
| Part II Explanation of Changes | Reported omitted interest income. |
Department of the Treasury - Internal Revenue Service
## Form 1040-X (keep for your records)  www.irs.gov/Form1040X",1040,0,1040,fdc-77376e910479ac976027fa6c,v11-1040-X-markdown,original,2021,fgen-ed66b8d2688ffa304ca55764,synthetic_programmatic_template,markdown,top,False,
"Department of the Treasury—Internal Revenue Service
This return is for calendar year
| Field | Value |
| --- | --- |
| Your first name and middle initial  Last name | Amara Nguyen |
| Home address (number and street) | 7502 Sample Street Oak Grove, TX 65147 |
| Your social security number | XXXXX0800 |
Filing status
| Field | Value |
| --- | --- |
| 1 Adjusted gross income  A. Original amount | 62,306.00 |
| 1 C. Correct amount | $5,953.24 |
| 5 Taxable income | $108,685.79 |
| 6 Tax liability | 7,886.73 |
| Part II Explanation of Changes | Claimed a missed education credit. |
## Form 1040-X
Amended U.S. Individual Income Tax Return",1040,0,1040,fdc-644db5f4bd81e8721374b203,v11-1040-X-markdown,original,2025,fgen-ddf16bb9538af37307fd9d56,synthetic_programmatic_template,markdown,bottom,False,
"Form 1095-A Health Insurance Marketplace Statement 2023
Part I Recipient Information'S name:
Evergreen Health Plan
Recipient's name:
Priya Tanaka
33 Annual Totals
13,399.49
21 C. Monthly advance payment of premium tax credit
$1,432.43",1095,3,1095,fdc-aa1b7f5e2d952c1201d09060,v11-1095-A-stacked,original,2023,fgen-9535a4f8d16d9f6000ba66fb,synthetic_programmatic_template,stacked,top,False,
"Form 1095-A Health Insurance Marketplace Statement 2021
Part I Recipient Information'S name:
Sample Mutual Insurance
To:
Taylor A. Rivera
21 C. Monthly advance payment of premium tax credit
$567.84",1095,3,1095,fdc-944eacbbe2c40316f252679c,v11-1095-A-stacked,original,2021,fgen-0f95a9562eff28d959570a05,synthetic_programmatic_template,stacked,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
OMB No. l545-2232
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
Granite Auto Insurance Co. 2375 Samp1c Street Fairview, 0H 6O979
2 Marketplace-assigned policy number
88-1O09821
1 Marketplaceidentifier
Riley Haddad
3 Policy issuer's name
XXX-XX-1842
Street address (íncluding apt. no.)
4834Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 28690
Account number (see instructions)
ending in 528710
Part III Coverage Information
21 January  A. Monthly enrollment premiums
$2,873.68
21 C. Monthly advance payment of premium tax credit
7,549.84
33 Annual Totals
68,447.68
Departmcnt of the Treasury -Internal Revenue 5ervice
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-896885e7b9060038d02ad283,v11-1095-A-stacked,original,2025,fgen-48ef2aa96b93c65478f56770,synthetic_programmatic_template,stacked,top,True,
"☐ CORRECTED
Form 1095-A
Health Insurance Marketplace Statement
2025
VOID  CORRECTED
Part I Recipient Information
Harbor Life Assurance 8589 Sample Street Lakewood, CO 50332
2 Marketplace-assigned policy number
45-1500079
1 Marketplace identifier
Jordan D. Okafor
3 Policy issuer's name
****4418
Street address (including apt. no.)
5998 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 47976
Part III Coverage Information
21 January  A. Monthly enrollment premiums
$414.73
21 B. Monthly second lowest cost silver plan (SLCSP) premium
6,009.35
21 C. Monthly advance payment of premium tax credit
$433.82
33 Annual Totals
$122,946.74
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-49abdef648412b29387be186,v11-1095-A-stacked,original,2025,fgen-85c1a87d53051f9b46ed641f,synthetic_programmatic_template,stacked,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
For calendar year 2023
Part I Recipient Information
Evergreen Health Plan 2329 Willow Bend Way Fairview, OH 61907
2 Marketplace-assigned policy number
71-9953968
1 Marketplace identifier
Wei Nguyen
3 Policy issuer's name
****2775
Part III Coverage Information
21 B. Monthly second lowest cost silver plan (SLCSP) premium
$1,239.34
21 C. Monthly advance payment of premium tax credit
6,827.20",1095,3,1095,fdc-2f4018a28f334084f69f2284,v11-1095-A-stacked,original,2023,fgen-8e4659a4f45b1f006a1a271b,synthetic_programmatic_template,stacked,top,False,
"Form 1095-A Health Insurance Marketplace Statement
Part I Recipient Information:
Sample Mutual Insurance
Recipient's name:
Diego Tanaka
21 B. Monthly second lowest cost silver plan (SLCSP) premium
3,863.19
21 January  A. Monthly enrollment premiums
4,917.65",1095,3,1095,fdc-9c8b3d35bf279466fe99ca94,v11-1095-A-stacked,original,2021,fgen-a8fe9328bda1d1519815d9f4,synthetic_programmatic_template,stacked,top,False,
"OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
Harbor Life Assurance 8722 Maple Ridge Dr Pinecrest, GA 39381
2 Marketplace-assigned policy number
86-7400605
1 Marketplace identifier
Wei Lindqvist
3 Policy issuer's name
***-**-4597
Street address (including apt. no.)
1576 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 30920
Account number (see instructions)
ending in 083977
Part III Coverage Information
21 January  A. Monthly enrollment premiums
7,656.12
21 B. Monthly second lowest cost silver plan (SLCSP) premium
8,424.21
21 C. Monthly advance payment of premium tax credit
$4,490.20
33 Annual Totals
50,872.99
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-caef3a60485a3a68d84d1edb,v11-1095-A-stacked,original,2022,fgen-6a588a6ff172ab2c30582375,synthetic_programmatic_template,stacked,none,False,
"Form 1095-A
Health Insurance Marketplace Statement
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
Sample Mutual Insurance 404 Elm Park Pl Bayside, WA 27661
2 Marketplace-assigned policy number
34-1333976
1 Marketplace identifier
Wei Lindqvist
3 Policy issuer's name
XXX-XX-6776
Street address (including apt. no.)
6759 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 19512
21 January  A. Monthly enrollment premiums
$2,017.84
21 B. Monthly second lowest cost silver plan (SLCSP) premium
$7,355.19
21 C. Monthly advance payment of premium tax credit
$6,530.94
33 Annual Totals
$43,968.93",1095,3,1095,fdc-76324d113e5208e4dc40ba9e,v11-1095-A-stacked,original,2024,fgen-c1303a7e8492b9626a1f1270,synthetic_programmatic_template,stacked,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
Granite Auto Insurance Co. 5200 Prairie Ave Cedar Falls, IA 77892
2 Marketplace-assigned policy number
78-6664321
1 Marketplace identifier
Wei Rivera
3 Policy issuer's name
XXXXX9596
Part III Coverage Information
21 January  A. Monthly enrollment premiums
$8,254.72
21 B. Monthly second lowest cost silver plan (SLCSP) premium
2,862.90
21 C. Monthly advance payment of premium tax credit
$1,852.85
33 Annual Totals
$62,137.27",1095,3,1095,fdc-dfd0e39a27e7336416ca696e,v11-1095-A-stacked,original,2025,fgen-b0512b7049dd1f16566e1a18,synthetic_programmatic_template,stacked,top,False,
"Part I Recipient Information:
Evergreen Health Plan
To:
Riley Adeyemi
33 Annual Totals
13,672.60",1095,3,1095,fdc-b2d783be81ff577315433b3c,v11-1095-A-stacked,original,2025,fgen-8339be1fba1b56296b84a239,synthetic_programmatic_template,stacked,none,False,
"Form 1095-A
Health Insurance Marketplace Statement
For calendar year 2022
OMB No. 1545-2232
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
Evergreen Health Plan 9629 Maple Ridge Dr Maplewood, MN 24462
2 Marketplace-assigned policy number
83-8358080
1 Marketplace identifier
Sofia S. Moreau
3 Policy issuer's name
XXXXX8106
Street address (including apt. no.)
8135 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 95585
Account number (see instructions)
****605486
Part III Coverage Information
21 January  A. Monthly enrollment premiums
$3,785.67
21 C. Monthly advance payment of premium tax credit
$6,718.99
33 Annual Totals
131,054.80
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-6a07e09a0f51ea68df24bc20,v11-1095-A-stacked,original,2022,fgen-174c6e409c6bd978ea292ff3,synthetic_programmatic_template,stacked,top,False,
"Form 1095-A Health Insurance Marketplace Statement 2026
Part I Recipient Information'S name:
Granite Auto Insurance Co.
Recipient's name:
Avery Romero
21 January  A. Monthly enrollment premiums
$6,636.78
21 B. Monthly second lowest cost silver plan (SLCSP) premium
5,921.64
33 Annual Totals
$130,729.46",1095,3,1095,fdc-1d614a1f30fe6e9dd811a408,v11-1095-A-stacked,original,2026,fgen-d1adda0f5ab36a90a0d547c7,synthetic_programmatic_template,stacked,top,False,
"Form 1095-A
Health InsuranceMarketplace Statemcnt
For calendar year 2023
OMB No. 1545-2232
VOID  CORRECTED
Do notattach to your tax return. Keep for your records.
Part I Recipient Information
Granite Auto Insurance Co. 3482 Harbor Víew Rd Brookhaven, PA 92839
2 Marketplace-assigned policy number
36-l04l166
1 Marketplace identifier
Priya Adeyemí
3 Policy issuer's name
****252O
Street address (including apt. no.)
4910 Maple Ridge Dr
City or town, stateor province, country, and ZIP or foreign postal code
Bayside, WA 21371
Part III Coverage Information
21 January  A. Monthly enrollment premiums
5,063.34
21 B. Monthly second lowest cost silver plan (SLCSP) premium
526.16
21 C. Monthly advance payment of premium tax credit
$9,159.89
33 Annual Totals
$114,8O5.16",1095,3,1095,fdc-37d26f98f68c2205157c3a37,v11-1095-A-stacked,original,2023,fgen-109f3690a53cb6553b65ea05,synthetic_programmatic_template,stacked,top,True,
"Form 1095-A Health Insurance Marketplace Statement
Part I Recipient Information:
Sample Mutua1Insurance
RECIPIENT:
Olivia Tanaka
33 Annual Totals
$129,665.36
21 B. Monthly second lowest cost silver plan (SLCSP) premium
2,l18.50",1095,3,1095,fdc-adf282742045270ab43c4a10,v11-1095-A-stacked,original,2026,fgen-99d5a6e2a2b7f27ff207cc07,synthetic_programmatic_template,stacked,top,True,
"Form 1095-A Health Insurance Marketplace Statement 2024
Part I Recipient Information'S name:
Evergreen Health Plan
RECIPIENT:
Lena Testcase
33 Annual Totals
34,757.47
21 C. Monthly advance payment of premium tax credit
$1,532.66
21 January  A. Monthly enrollment premiums
1,917.93",1095,3,1095,fdc-510b65c1a0f3a26d700d8dbb,v11-1095-A-stacked,original,2024,fgen-f92d0641ef95b67b50368c99,synthetic_programmatic_template,stacked,top,False,
"From:
SampleMutual Insurance
Recipient's name:
Morgan L. Testcase
2l January  A. Monthly enrollment premiums
1,481.28",1095,3,1095,fdc-a4a54f9721d2e7584b391ee2,v11-1095-A-stacked,original,2025,fgen-c410ef948bc3662788119f3e,synthetic_programmatic_template,stacked,none,True,
"☐ CORRECTED
Form 1095-A
Health Insurance Marketplace Statement
For calendar year 2026
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information   Harbor Life Assurance 9837 Oak Hollow Ct Brookhaven, PA 15062
2 Marketplace-assigned policy number      75-2931941
1 Marketplace identifier      Mateo A. Romero
3 Policy issuer's name      XXX-XX-9040
Street address (including apt. no.)   4875 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 77683
Part III Coverage Information
21 January  A. Monthly enrollment premiums 7,117.60
21 B. Monthly second lowest cost silver plan (SLCSP) premium 5,580.07
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-a4b4788cff534ebd6ab0b164,v11-1095-A-inline,original,2026,fgen-789182cfa3b6568caa41ef9c,synthetic_programmatic_template,inline,top,False,
"2022
OMB No. 1545-2232
Part I Recipient Information Sample Mutual Insurance 1869 Cedar Ln Riverton, WI 35974
2 Marketplace-assigned policy number   78-7794244
1 Marketplace identifier Alex Rivera
3 Policy issuer's name ending in 2336
Street address (including apt. no.) 3735 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code   Oak Grove, TX 95376
Part III Coverage Information
21 January  A. Monthly enrollment premiums      $2,738.07
21 B. Monthly second lowest cost silver plan (SLCSP) premium      $644.30
21 C. Monthly advance payment of premium tax credit $1,980.16
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-85bd11e7fd7681eead39f4e7,v11-1095-A-inline,original,2022,fgen-3eb379d4c5efb2e91391be49,synthetic_programmatic_template,inline,none,False,
"Form 1095-A Health Insurance Marketplace Statement 2023
Part I Recipient Information:   Harbor Life Assurance
Recipient's name:      Noah Rivera
21 C. Monthly advance payment of premium tax credit 3,584.75
21 January  A. Monthly enrollment premiums  $634.60
33 Annual Totals      26,902.51
21 B. Monthly second lowest cost silver plan (SLCSP) premium $5,096.23",1095,3,1095,fdc-fe4e151f47c58aba3fb00ee5,v11-1095-A-inline,original,2023,fgen-62556170517d431eb5025cd4,synthetic_programmatic_template,inline,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
OMB No. 1545-2232
VOID  CORRECTED
Part I Recipient Information Harbor Life Assurance 5121 Harbor View Rd Brookhaven, PA 54880
2 Marketplace-assigned policy number   18-6641500
1 Marketplace identifier Kwame Lindqvist
3 Policy issuer's name   ***-**-6230
Part III Coverage Information
21 January  A. Monthly enrollment premiums  7,877.19
21 B. Monthly second lowest cost silver plan (SLCSP) premium      4,093.69
21 C. Monthly advance payment of premium tax credit      7,280.69
33 Annual Totals  39,303.69",1095,3,1095,fdc-26b5b99eb4685bedb97d463d,v11-1095-A-inline,original,2022,fgen-3cb9fb33f22ddf605446275d,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
For calendar year 2022
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information   Evergreen Health Plan 1838 Harbor View Rd Cedar Falls, IA 36545
2 Marketplace-assigned policy number 68-8371574
1 Marketplace identifier      Riley Sato
3 Policy issuer's name ending in 4654
Street address (including apt. no.) 974 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code  Testville, IL 62676
Part III Coverage Information
21 January  A. Monthly enrollment premiums   $5,719.45
21 C. Monthly advance payment of premium tax credit 1,653.33
33 Annual Totals   43,868.04
Department of the Treasury - Internal Revenue Service
Form 1095-A
Health Insurance Marketplace Statement
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-0d5827e41b6ddcac092927b2,v11-1095-A-inline,original,2022,fgen-4d0af35db2cdd30d77a768a9,synthetic_programmatic_template,inline,bottom,False,
"From:   Granite Auto Insurance Co.
Recipient's name:      Kwame Romero
33 Annual Totals 55,359.71
21B. Monthly second lowest cost sílver plan (5LCSP) premium   5,030.00",1095,3,1095,fdc-a8090a96e0db414f226296d7,v11-1095-A-inline,original,2022,fgen-dea5c7dab7dccc3cacfb9383,synthetic_programmatic_template,inline,none,True,
"Form 1095-A Health Insurance Marketplace 5tatement 2022
Part I Recipient Information'S name: Evergreen Health Plan
Recipient's name:Jamie Fischer
21 January  A. Month1y enrollment premiums $9,244.54",1095,3,1095,fdc-5ef39d26d32dd8128b482c9d,v11-1095-A-inline,original,2022,fgen-32a437c0014e66d58a63ce21,synthetic_programmatic_template,inline,top,True,
"Form 1095-A Health Insurance Marketplace Statement 2022
From:  Sample Mutual Insurance
RECIPIENT: Casey Fischer
2l January  A. Monthly enrollment premiums      8,234.77
21 B. Monthly second lowest cost silver plan (SLCSP) premium S6,934.63
2l C.Month1y advance payment of premium tax crcdit   $1,604.38",1095,3,1095,fdc-5c4426e9457e515037091744,v11-1095-A-inline,original,2022,fgen-ad4f0009b956d181fb93b178,synthetic_programmatic_template,inline,top,True,
"2024
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information Granite Auto Insurance Co. 7314 Willow Bend Way Brookhaven, PA 22575
2 Marketplace-assigned policy number      89-6277809
1 Marketplace identifier Jordan Nguyen
3 Policy issuer's name ****7376
Street address (including apt. no.)   5926 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 72123
Part III Coverage Information
21 January  A. Monthly enrollment premiums 4,147.67
21 B. Monthly second lowest cost silver plan (SLCSP) premium  3,093.90
21 C. Monthly advance payment of premium tax credit   $5,437.44
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-c131b8f99be3f24f42444b36,v11-1095-A-inline,original,2024,fgen-3f9021572163978b16e729cb,synthetic_programmatic_template,inline,none,False,
"CORRECTED (if checked)
Form 1095-A
Health Insurance Marketplace Statement
2021
OMB No. 1545-2232
Do not attach to your tax return. Keep for your records.
Part I Recipient Information Evergreen Health Plan 5520 Elm Park Pl Riverton, WI 57270
2 Marketplace-assigned policy number 93-3163524
1 Marketplace identifier  Jamie D. Okafor
3 Policy issuer's name      ***-**-9998
Street address (including apt. no.) 4480 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 67641
Part III Coverage Information
21 January  A. Monthly enrollment premiums $3,366.31
21 B. Monthly second lowest cost silver plan (SLCSP) premium $96.21
21 C. Monthly advance payment of premium tax credit 274.51
33 Annual Totals $22,248.28",1095,3,1095,fdc-a9cb0e4b86f4d59dd3eb5c47,v11-1095-A-inline,original,2021,fgen-59039bce496f45555bc298a7,synthetic_programmatic_template,inline,top,False,
"Form 1095-A Health Insurance Marketplace Statement 2023
Part I Recipient Information'S name:   Evergreen Health Plan
To:  Casey A. Kowalski
21 January  A. Monthly enrollment premiums $5,046.07",1095,3,1095,fdc-caab1736d267eafcd5fb8ddf,v11-1095-A-inline,original,2023,fgen-bfe85833deb57e596c5a9783,synthetic_programmatic_template,inline,top,False,
"Part I Recipient Information'S name:  Sample Mutual Insurance
Recipient's name:      Mateo Okafor
33 Annual Totals  $102,256.58
21 January  A. Monthly enrollment premiums      $9,425.47
Form 1095-A Health Insurance Marketplace Statement",1095,3,1095,fdc-cf43d679ac0861e04f4852b1,v11-1095-A-inline,original,2022,fgen-f60358974854275c065d6d57,synthetic_programmatic_template,inline,bottom,False,
"Form 1095-A
Health Insurance Marketplace Statement
OMB No. 1545-2232
VOID  CORRECTED
Part I Recipient Information  Samp1e Mutual Insurance 8639 Maple Ridge Dr Map1ewood, MN 44806
2 Marketp1ace-assigned policy number 32-4698133
1 Marketplace identifier  5ofia Nguyen
3 Policy issuer's nameXXX-XX-7476
5treet address (including apt. no.)  9475 Prairie Ave
Cityor town, state or province, country, and ZIP or foreign posta1 code      Brookhaven, PA l4976
Part III CoverageInformation
21 January  A. Monthly enrollment premiums      4,195.91
21 B. Monthly second lowest cost silver plan (SLCSP) premium  S8,608.05
21 C. Monthly advance paymentof premium tax credit   3,297.76
33 Annual Totals 114,212.27",1095,3,1095,fdc-34e163647aef67ee04bbea31,v11-1095-A-inline,original,2025,fgen-384e7c19f27cb0a2e5a6b471,synthetic_programmatic_template,inline,top,True,
"Form 1095-A
Hcalth Insurance Marketplace Statement
Forcalendaryear 2026
OMB No. 1545-2232
Do not attach toyour tax rcturn. Keep for your records.
Part I Recipient Information Harbor Life Assurance 9185 Sample Street Maplewood, MN 79649
2 Marketplace-assigned policy number  84-9795l93
1 Marketplace identifier   Avery B. Tcstcase
3 Policy issuer's name      ****0483
Street address (including apt. no.)   2678 Maple Ridge Dr
City or town, state or province, country, and ZIPor foreign postal code      Lakewood, C0 30057
Part III Coverage Information
21 January  A. Month1y enrollment premiums  3,8O3.19
21 B. Monthly sccond lowest cost silver p1an (5LCSP) premium   827.61
21C. Monthly advance payment of premium tax credit   6,538.25
33 Annual Totals  S33,l96.58
Department of the Treasury - Internal Revenue 5ervice
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-7afe94b42529e164577a66ed,v11-1095-A-inline,original,2026,fgen-2f985f96b617b5c284f736f0,synthetic_programmatic_template,inline,top,True,
"For calendar year 2021
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information      Harbor Life Assurance 5988 Granite St Brookhaven, PA 12780
2 Marketplace-assigned policy number  18-9525457
1 Marketplace identifier Priya Lindqvist
3 Policy issuer's name ending in 3734
Street address (including apt. no.) 6284 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code   Riverton, WI 69028
Account number (see instructions) XXX-XX-586318
Part III Coverage Information
21 January  A. Monthly enrollment premiums   237.03
21 B. Monthly second lowest cost silver plan (SLCSP) premium  $4,604.75
21 C. Monthly advance payment of premium tax credit $4,496.68
33 Annual Totals $70,431.47
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-2749bfcb7e62d9fd85fc1dc8,v11-1095-A-inline,original,2021,fgen-5401f18bc1512f87ff389520,synthetic_programmatic_template,inline,none,False,
"☐ CORRECTED
Form 1095-A
Health Insurance Marketplace Statement
2021
OMB No. 1545-2232
Do not attach to your tax return. Keep for your records.
Part I Recipient Information Evergreen Health Plan 4928 Elm Park Pl Pinecrest, GA 69658
2 Marketplace-assigned policy number  43-8759653
1 Marketplace identifier Noah Romero
3 Policy issuer's name   ****4639
Part III Coverage Information
21 January  A. Monthly enrollment premiums      1,274.93
21 B. Monthly second lowest cost silver plan (SLCSP) premium      $9,359.27
21 C. Monthly advance payment of premium tax credit      2,785.75
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-4441c9138eb31974b59348f2,v11-1095-A-inline,original,2021,fgen-1005f2f7c7bf25e901a5aed2,synthetic_programmatic_template,inline,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
For calendar year 2023
OMB No. 1545-2232
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Account number (see instructions)
Part III Coverage Information
21 January  A. Monthly enrollment premiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
33 Annual Totals
Granite Auto Insurance Co. 3667 Prairie Ave Oak Grove, TX 91622
20-9688898
Avery E. Testcase
XXX-XX-9976
****610051
$4,912.20
7,396.32
8,057.56
$104,982.96",1095,3,1095,fdc-df34a6785533dba0d8b51e54,v11-1095-A-columns,original,2023,fgen-b1fe8517172e6d04dd6ed2ab,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Form 1095-A
Health Insurance Marketplace Statement
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Part III Coverage Information
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
33 Annual Totals
Granite Auto Insurance Co. 6191 Granite St Brookhaven, PA 63511
11-5831614
Lena B. Walsh
***-**-6870
7604 Maple Ridge Dr
Riverton, WI 87273
***-**-534122
5,594.30
$3,301.24
5,308.93
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-97e1ff14a8ec39f0db50fc6f,v11-1095-A-columns,original,2021,fgen-e1efa4063db61c6a0b0d9af5,synthetic_programmatic_template,columns,top,False,
"2023
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Part III Coverage Information
21 January  A. Monthly enrollment premiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
33 Annual Totals
Granite Auto Insurance Co. 2017 Maple Ridge Dr Riverton, WI 74257
77-1849003
Hiro Sato
ending in 7114
829 Harbor View Rd
Bayside, WA 60040
XXXXX637137
$7,259.42
7,792.73
7,963.38
$80,696.72
Form 1095-A
Health Insurance Marketplace Statement",1095,3,1095,fdc-1d9c8af70cc7389652cd0048,v11-1095-A-columns,original,2023,fgen-f1dc6e99c199a1b2055409c8,synthetic_programmatic_template,columns,bottom,False,
"Form 1095-A Health Insurance Marketplace Statement 2024
Part I Recipient Information:
To:
33 Annual Totals
21 January  A. Monthly enrollment premiums
21 C. Monthly advance payment of premium tax credit
21 B. Monthly second lowest cost silver plan (SLCSP) premium
Evergreen Health Plan
Hiro B. Patel
101,678.86
$2,161.17
$703.70
$951.27",1095,3,1095,fdc-497eef78ba4021c45b6062e2,v11-1095-A-columns,original,2024,fgen-c1da179db171cc7088080d82,synthetic_programmatic_template,columns,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
2022
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Part III Coverage Information
21 January  A. Monthly enrollment premiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
Granite Auto Insurance Co. 5292 Oak Hollow Ct Pinecrest, GA 47339
67-3221124
Morgan Larsen
ending in 5026
6906 Maple Ridge Dr
Fairview, OH 17807
$8,301.19
1,348.95
37.41
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-45a60d68966f67039a25a96a,v11-1095-A-columns,original,2022,fgen-aad99ce00190820e42b24b1d,synthetic_programmatic_template,columns,top,False,
"Form 1095-A Health Insurance Marketplace Statement 2023
Part I Recipient Information:
RECIPIENT:
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 January  A. Monthly enrollment premiums
Harbor Life Assurance
Fatima Rivera
$8,315.60
$4,054.42",1095,3,1095,fdc-92a4b2d87223db5e3a78855e,v11-1095-A-columns,original,2023,fgen-a7a58786ad6c9243006d3b1e,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1095-A
Health Insurance Marketplace Statement
2023
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
21 January  A. Monthly enrollment premiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
Harbor Life Assurance 4225 Sample Street Oak Grove, TX 59419
30-9180242
Morgan Walsh
***-**-0031
3,001.72
$2,954.11
1,482.14
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-e63298a92938fdebf0f64acd,v11-1095-A-columns,original,2023,fgen-dae2be0cc23b3736e26d2489,synthetic_programmatic_template,columns,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
2025
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Part III Coverage Information
21 January  A. Monthly enrollment premiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
33 Annual Totals
Granite Auto Insurance Co. 7743 Prairie Ave Cedar Falls, IA 30258
20-5910482
Amara Patel
***-**-5557
$7,773.06
1,292.96
$6,293.63
21,110.88
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-d502ede43b29a2d64a69b95b,v11-1095-A-columns,original,2025,fgen-22d5c202f13e47b7096039f6,synthetic_programmatic_template,columns,top,False,
"Form 1095-A Health Insurance Marketplace Statement
From:
RECIPIENT:
21 January  A. Monthly enrollment premiums
21 C. Monthly advance payment of premium tax credit
Sample Mutual Insurance
Jamie Romero
1,208.84
$4,750.88",1095,3,1095,fdc-a64b593592b9c2ba98d1ba6f,v11-1095-A-columns,original,2021,fgen-6067c75e0b8fb817877ba8a9,synthetic_programmatic_template,columns,top,False,
"For calendar year 2024
VOID  CORRECTED
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Account number (see instructions)
Part III Coverage Information
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
33 Annual Totals
Granite Auto Insurance Co. 2689 Cedar Ln Oak Grove, TX 52709
33-8490962
Fatima Rivera
XXX-XX-2764
****536848
$487.29
$4,237.02
$72,252.10
Department of the Treasury - Internal Revenue Service
Form 1095-A
Health Insurance Marketplace Statement
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-ed2cffb58923808b214b854b,v11-1095-A-columns,original,2024,fgen-0260d3b4edb5e4213fcbde24,synthetic_programmatic_template,columns,bottom,False,
"Form 1095-A
Health Insurance Marketplace Statement
2022
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Part III Coverage Information
21 January  A. Monthly enrollment premiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
33 Annual Totals
Sample Mutual Insurance 9485 Elm Park Pl Fairview, OH 81816
28-6906135
Avery Lindqvist
XXXXX9496
1536 Elm Park Pl
Fairview, OH 48855
$3,107.19
4,231.46
5,806.06
67,310.64",1095,3,1095,fdc-c447078547bb243613c1a477,v11-1095-A-columns,original,2022,fgen-f4a53fa4946230d5fb7782f6,synthetic_programmatic_template,columns,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
For calendar year 2024
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Part III Coverage Information
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
33 Annual Totals
Evergreen Health Plan 7393 Elm Park Pl Bayside, WA 39949
68-1398386
Jordan R. Brennan
****1830
4673 Granite St
Fairview, OH 86946
ending in 173095
$7,564.58
3,265.01
$35,018.32",1095,3,1095,fdc-f6ea89fcdd64adcff50d5a82,v11-1095-A-columns,original,2024,fgen-e194b7b939f71dbb54c0ab72,synthetic_programmatic_template,columns,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part IRecipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Part III Coverage Information
21 January  A. Monthly enrollmentpremiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advancc payment of premium tax credit
33 Annual Totals
Granite Auto Insurance Co. 3758 Prairie Ave Baysíde, WA 40365
55-799l804
Wei Lindqvist
XXX-XX-1373
S521.53
2,134.08
$6,752.39
1,014.77
Department of the Treasury -Interna1 Revenue 5ervice
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-d3f07d55e9dc42198fcdf2a0,v11-1095-A-columns,original,2021,fgen-e8a7ff5fa014e020715336a2,synthetic_programmatic_template,columns,top,True,
"Form 1095-A Health Insurance Marketplace Statement
Part I Recipient Information'S name:
RECIPIENT:
33 Annual Totals
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 January  A. Monthly enrollment premiums
21 C. Monthly advance payment of premium tax credit
Sample Mutual Insurance
Hiro Fischer
130,108.26
$2,339.43
$7,162.22
3,678.00",1095,3,1095,fdc-baf5fb1879f02ed7cb06d71b,v11-1095-A-columns,original,2024,fgen-4f0660e19b9245823d7ef478,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1095-A
Health Insurance Marketplace Statement
2023
OMB No. 1545-2232
VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
Part I Recipient Information
2 Marketplace-assigned policy number
1 Marketplace identifier
3 Policy issuer's name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Part III Coverage Information
21 January  A. Monthly enrollment premiums
21 B. Monthly second lowest cost silver plan (SLCSP) premium
21 C. Monthly advance payment of premium tax credit
Granite Auto Insurance Co. 5113 Sample Street Riverton, WI 72833
54-4032660
Jordan Moreau
****3011
5541 Cedar Ln
Fairview, OH 53096
XXXXX923492
9,067.56
5,602.91
$3,537.18
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-d87a2ccb96e37459b3806bf1,v11-1095-A-columns,original,2023,fgen-3e882750f534e7aea3d74acc,synthetic_programmatic_template,columns,top,False,
"Form 1095-A Health Insurance Marketplace Statement 2024
Part I Recipient Information'S name:
Recipient's name:
21 C. Monthly advancc payment of premium tax credit
33 Annual Totals
Evergreen Health Plan
RileyNguyen
$6,200.85
56,l71.87",1095,3,1095,fdc-91d20e361c3e70d8620ca3f6,v11-1095-A-columns,original,2024,fgen-b813d975998a66c5d0817bbd,synthetic_programmatic_template,columns,top,True,
"## VOID  CORRECTED
Form 1095-A
Health Insurance Marketplace Statcment
Do not attach to your tax return. Keep for your records.
| Field | Value |
| --- | --- |
| Part I Recipient Informatíon| Granite Auto Insurance Co. 2901 Prairie AveLakewood, C0 84893 |
| 2 Marketplace-assigned policy number | 76-5182656 |
| 1 Marketplace identificr |Diego K. Sato |
| 3 Policy issuer's name | ***-**-9642 |
| Account number (see instructions) | XXX-XX-518428 |
| 21January  A. Monthly enrollment premiums | $6,862.62 |
| 21 B. Monthly second lowest cost sílver plan (SLCSP) premium | $6,768.92 |
| 21 C. Month1y advance payment of premium tax credit | $2,664.58 |
| 33 Annual Totals | 137,410.90 |
Departmentof the Treasury - Intemal Revenue Service
Form 1095-A (keep for your records)  www.írs.gov/Form1095A",1095,3,1095,fdc-c6c2b6c14d904ce20fb6504f,v11-1095-A-markdown,original,2024,fgen-b515c41d7816a7c069a20c29,synthetic_programmatic_template,markdown,top,True,
"Form 1095-A Health Insurance Marketplace Statement
| Field | Value |
| --- | --- |
| From: | Granite Auto Insurance Co. |
| To: | Olivia Sato |
| 33 Annual Totals | $84,930.49 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | $2,662.18 |
| 21 C. Monthly advance payment of premium tax credit | $8,437.21 |",1095,3,1095,fdc-c25f277595fc8268b36db872,v11-1095-A-markdown,original,2022,fgen-fa94b29160c958f1309d04e0,synthetic_programmatic_template,markdown,top,False,
"Form 1095-A
Health Insurance Marketplace Statement
OMB No. 1545-2232
## Do not attach to your tax return. Keep for your records.
| Field | Value |
| --- | --- |
| Part I Recipient Information | Harbor Life Assurance 7974 Sample Street Fairview, OH 94715 |
| 2 Marketplace-assigned policy number | 87-5082536 |
| 1 Marketplace identifier | Casey M. Lindqvist |
| 3 Policy issuer's name | XXX-XX-8934 |
| Street address (including apt. no.) | 9513 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 73855 |
| Part III Coverage Information |  |
| 21 January  A. Monthly enrollment premiums | 3,196.10 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | $4,232.37 |
| 21 C. Monthly advance payment of premium tax credit | $6,552.37 |
| 33 Annual Totals | 75,922.84 |
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-25beb54c0b5301a483fceb05,v11-1095-A-markdown,original,2023,fgen-99f48317430a9793d61b340c,synthetic_programmatic_template,markdown,top,False,
"Form 1095-A Health Insurance Marketplace Statement 2026
| Field | Value |
| --- | --- |
| Part I Recipient Information'S name: | Evergreen Health Plan |
| Recipient's name: | Diego Rivera |
| 21 January  A. Monthly enrollment premiums | 2,851.83 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | 4,664.69 |
| 33 Annual Totals | 60,774.45 |
| 21 C. Monthly advance payment of premium tax credit | $5,983.26 |",1095,3,1095,fdc-708d8a6cb0d25d493237dc72,v11-1095-A-markdown,original,2026,fgen-afb7e2bc32f7a0d786354cc4,synthetic_programmatic_template,markdown,top,False,
"## ☐ CORRECTED
## OMB No. 1545-2232
## Do not attach to your tax return. Keep for your records.
| Field | Value |
| --- | --- |
| Part I Recipient Information | Sample Mutual Insurance 8232 Cedar Ln Oak Grove, TX 16429 |
| 2 Marketplace-assigned policy number | 93-1803364 |
| 1 Marketplace identifier | Olivia Patel |
| 3 Policy issuer's name | XXXXX9826 |
| Street address (including apt. no.) | 1503 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 52678 |
| Account number (see instructions) | XXXXX866346 |
| Part III Coverage Information |  |
| 21 January  A. Monthly enrollment premiums | 2,518.16 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | 6,931.05 |
| 33 Annual Totals | $51,797.00 |
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-262749ca51b0751217c044c8,v11-1095-A-markdown,original,2026,fgen-d0dced435e2faf73299c8429,synthetic_programmatic_template,markdown,none,False,
"## ☐ CORRECTED
## Form 1095-A
Health Insurance Marketplace Statement
For calendar year 2022
VOID  CORRECTED
| Field | Value |
| --- | --- |
| Part I Recipient Information | Evergreen Health Plan 6179 Granite St Brookhaven, PA 21574 |
| 2 Marketplace-assigned policy number | 75-3625389 |
| 1 Marketplace identifier | Sofia Okafor |
| 3 Policy issuer's name | ending in 6025 |
| Street address (including apt. no.) | 2628 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 21117 |
| Account number (see instructions) | ***-**-075270 |
| Part III Coverage Information |  |
| 21 January  A. Monthly enrollment premiums | 715.53 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | 7,972.10 |
| 21 C. Monthly advance payment of premium tax credit | $7,499.74 |
| 33 Annual Totals | $116,937.67 |
## Department of the Treasury - Internal Revenue Service
## Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-a6ca07278efa7a2c97776265,v11-1095-A-markdown,original,2022,fgen-a238cd1c4013311676dfff02,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
## 2021
VOID  CORRECTED
| Field | Value |
| --- | --- |
| Part I Recipient Information | Evergreen Health Plan 601 Harbor View Rd Pinecrest, GA 26039 |
| 2 Marketplace-assigned policy number | 94-8385574 |
| 1 Marketplace identifier | Avery M. Castillo |
| 3 Policy issuer's name | XXXXX5505 |
| Street address (including apt. no.) | 5673 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 76366 |
| 21 January  A. Monthly enrollment premiums | $3,868.85 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | 4,868.36 |
| 33 Annual Totals | 76,347.01 |
Department of the Treasury - Internal Revenue Service
Form 1095-A
## Health Insurance Marketplace Statement
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-e260ec039a37cc6b7b797a6f,v11-1095-A-markdown,original,2021,fgen-e5ad46ce7c2755ae4a273bf9,synthetic_programmatic_template,markdown,bottom,False,
"## ☐ CORRECTED
2023
OMB No. 1545-2232
## Do not attach to your taxreturn. Keep for your records.
| Field | Value |
| --- | --- |
| Part I Recipient Information | 5ample Mutual Insurance 5973 Harbor View Rd Pinecrest, GA 33874 |
| 2 Marketplace-assignedpolicy number | 93-3834720 |
| l Marketplace identifier | Lena Adeyemi |
| 3 Policy issuer's name | ending in l232 |
| Part III Coverage Information |  |
| 2l January  A. Monthly enrollment premiums | S70l.40 |
| 21 B. Monthly second lowest costsilver plan (SLCSP) premium | 2,239.19|
| 21 C. Monthly advance payment of premium tax crcdit | 6,990.48 |
Department of the Treasury -Intema1 Revenue Service
Form 1095-A
## Health Insurance Marketplacc Statement
## Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-c4c4425b23a901be567e1de1,v11-1095-A-markdown,original,2023,fgen-a911c872018a3bbeb9adf5a1,synthetic_programmatic_template,markdown,bottom,True,
"CORRECTED (if checked)
## Form 1095-A
## Health Insurance Marketplace Statement
For calendar year 2023
OMB No. 1545-2232
## VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
| Field | Value |
| --- | --- |
| Part I Recipient Information | Evergreen Health Plan 8371 Prairie Ave Brookhaven, PA 15162 |
| 2 Marketplace-assigned policy number | 32-7133628 |
| 1 Marketplace identifier | Morgan M. Lindqvist |
| 3 Policy issuer's name | XXX-XX-7120 |
| Street address (including apt. no.) | 7201 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 97530 |
| Part III Coverage Information |  |
| 21 January  A. Monthly enrollment premiums | 1,873.67 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | 4,070.35 |
| 33 Annual Totals | $103,014.62 |
Department of the Treasury - Internal Revenue Service
Form 1095-A (keep for your records)  www.irs.gov/Form1095A",1095,3,1095,fdc-9b1faeacd5d592880143d4cd,v11-1095-A-markdown,original,2023,fgen-2de5afac01f26e6cb3ff873d,synthetic_programmatic_template,markdown,top,False,
"Form 1095-A Health Insurance Marketplace Statement 2024
| Field | Value |
| --- | --- |
| From: | Evergreen Health Plan |
| RECIPIENT: | Avery Okafor |
| 21 C. Monthly advance payment of premium tax credit | 3,092.05 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | $6,410.02 |",1095,3,1095,fdc-0395257cff75462dfa8f87b2,v11-1095-A-markdown,original,2024,fgen-650b3a1110a6eb67e3eff1b0,synthetic_programmatic_template,markdown,top,False,
"## Form 1095-A Health Insurance Marketplace Statement 2022
| Field | Value |
| --- | --- |
| Part I Recipient Information: | Sample Mutual Insurance |
| Recipient's name: | Jamie J. Brennan |
| 33 Annual Totals | 2,463.32 |",1095,3,1095,fdc-2dae642990249ba99d72ff27,v11-1095-A-markdown,original,2022,fgen-a26ac813665c5140978acc6f,synthetic_programmatic_template,markdown,top,False,
"2023
## OMB No. 1545-2232
## VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
| Field | Value |
| --- | --- |
| Part I Recipient Information | Evergreen Health Plan 1989 Lakeshore Blvd Cedar Falls, IA 56699 |
| 2 Marketplace-assigned policy number | 27-6673332 |
| 1 Marketplace identifier | Wei Castillo |
| 3 Policy issuer's name | XXXXX3854 |
| Account number (see instructions) | XXXXX095973 |
| Part III Coverage Information |  |
| 21 January  A. Monthly enrollment premiums | 3,923.55 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | $2,881.39 |
| 21 C. Monthly advance payment of premium tax credit | 6,683.10 |
| 33 Annual Totals | $7,542.85 |",1095,3,1095,fdc-5675f34cf2f1a7f823a12ea7,v11-1095-A-markdown,original,2023,fgen-41c1d1fe83c3b1c35d886fe2,synthetic_programmatic_template,markdown,none,False,
"Form 1095-A
Health Insurance Marketplace Statement
For calendar year 2023
OMB No. 1545-2232
## VOID  CORRECTED
Do not attach to your tax return. Keep for your records.
| Field | Value |
| --- | --- |
| Part I Recipient Information | Harbor Life Assurance 5138 Sample Street Bayside, WA 96843 |
| 2 Marketplace-assigned policy number | 60-7007034 |
| 1 Marketplace identifier | Wei R. Larsen |
| 3 Policy issuer's name | ending in 6217 |
| Street address (including apt. no.) | 1933 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 62714 |
| Account number (see instructions) | ***-**-993456 |
| Part III Coverage Information |  |
| 21 January  A. Monthly enrollment premiums | 5,300.23 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | 2,083.05 |",1095,3,1095,fdc-65ceed04cada85b0014ce150,v11-1095-A-markdown,original,2023,fgen-3fcabe895491b8e5904ab48a,synthetic_programmatic_template,markdown,top,False,
"Form 1095-A Health Insurance Marketplace Statement
| Field | Value |
| --- | --- |
| Part I Recipient Information'S name: | Evergreen Health Plan |
| To: | Fatima D. Lindqvist |
| 21 C. Monthly advance payment of premium tax credit | 2,305.55 |
| 21 January  A. Monthly enrollment premiums | 4,259.48 |
| 33 Annual Totals | 70,379.02 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | $4,272.38 |",1095,3,1095,fdc-07cd0961bfc36d31f0e1194e,v11-1095-A-markdown,original,2024,fgen-9947d8d383e447d0477fcef5,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| Part I Recipient Information'S name: | Evergreen Health Plan |
| To: | Olivia Nguyen |
| 21 C. Monthly advance payment of premium tax credit | 8,816.98 |
| 33 Annual Totals | 104,914.66 |",1095,3,1095,fdc-654ee8add1039c9a5050e15a,v11-1095-A-markdown,original,2026,fgen-6f9bc63e41f4b9b350405a9b,synthetic_programmatic_template,markdown,none,False,
"Form 1095-A
## Health Insurance Marketplace Statement
## For calendar year 2023
OMB No. 1545-2232
| Field | Value |
| --- | --- |
| Part I Recipient Information | Evergreen Health Plan 6884 Prairie Ave Brookhaven, PA 71960 |
| 2 Marketplace-assigned policy number | 84-4039370 |
| 1 Marketplace identifier | Wei Lindqvist |
| 3 Policy issuer's name | XXX-XX-3636 |
| Street address (including apt. no.) | 2426 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 93957 |
| Account number (see instructions) | ****834440 |
| Part III Coverage Information |  |
| 21 January  A. Monthly enrollment premiums | 5,004.43 |
| 21 B. Monthly second lowest cost silver plan (SLCSP) premium | $811.34 |
| 21 C. Monthly advance payment of premium tax credit | 6,409.72 |",1095,3,1095,fdc-15985bfd01b2f7f7ab779068,v11-1095-A-markdown,original,2023,fgen-a9c4c65d41a6209f5f80d182,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
Form 1095-B
Health Coverage
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
Granite Auto Insurance Co. 337 Granite St Lakewood, CO 67620
16 Name
41-7235021
Part III Issuer or Other Coverage Provider
Casey Lindqvist
17 Employer identification number (EIN)
XXX-XX-6471
Street address (including apt. no.)
4703 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 14802
8 Enter letter identifying Origin of the Health Coverage
B
Part IV Covered Individuals  (a) Name of covered individual(s)
Olivia Sato
(d) Covered all 12 months
☐",1095,3,1095,fdc-5d720f0bbdadf5ff6692cebc,v11-1095-B-stacked,original,2024,fgen-ec26a221c0f362459a598167,synthetic_programmatic_template,stacked,top,False,
"Form 1095-B Health Coverage
Part I Responsible Individual'S name:
Granite Auto Insurance Co.
Recipient's name:
Morgan Fischer
(d) Covered all 12 months
☐
Part IV Covered Individuals  (a) Name of covered individual(s)
Diego Adeyemi",1095,3,1095,fdc-149f92322defdecd3b8f05a0,v11-1095-B-stacked,original,2025,fgen-894bde87c942a953a95334b2,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1095-B
Health Coverage
For calendar year 2026
OMB No. 1545-2252
VOID  CORRECTED
Part I Responsible Individual
Granite Auto Insurance Co. 8809 Prairie Ave Cedar Falls, IA 31788
16 Name
18-1954892
Part III Issuer or Other Coverage Provider
Kwame Tanaka
17 Employer identification number (EIN)
ending in 7834
Street address (including apt. no.)
1896 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 48796
Account number (see instructions)
ending in 401470
8 Enter letter identifying Origin of the Health Coverage
D
Part IV Covered Individuals  (a) Name of covered individual(s)
Priya Walsh
(d) Covered all 12 months
☒
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-fcc2f4f9d7299c7aea0e8c53,v11-1095-B-stacked,original,2026,fgen-754525ecc1b21335708315c0,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1095-B
Health Coverage
For calendar year 2024
OMB No. 1545-2252
Part I Responsible Individual
Sample Mutual Insurance 4896 Elm Park Pl Bayside, WA 64082
16 Name
23-3555792
Part III Issuer or Other Coverage Provider
Olivia Moreau
17 Employer identification number (EIN)
ending in 6963
Street address (including apt. no.)
2374 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 56348
Account number (see instructions)
***-**-237973
8 Enter letter identifying Origin of the Health Coverage
B
(d) Covered all 12 months
[X]",1095,3,1095,fdc-6feba7c57a5f11550bd28a67,v11-1095-B-stacked,original,2024,fgen-8be2b5d623b7c878f3ca0e80,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1095-B
Health Coverage
2026
Part I Responsible Individual
Sample Mutual Insurance 6048 Maple Ridge Dr Maplewood, MN 91470
16 Name
59-5385276
Part III Issuer or Other Coverage Provider
Amara Patel
17 Employer identification number (EIN)
****6871
8 Enter letter identifying Origin of the Health Coverage
D
Part IV Covered Individuals  (a) Name of covered individual(s)
Jordan Lindqvist
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-5a5d9cb27d0b5032b51b4284,v11-1095-B-stacked,original,2026,fgen-b4eef1f21648ee494bda6ae5,synthetic_programmatic_template,stacked,top,False,
"Form 1095-B
Health Coverage
OMB No. 1545-2252
Part I Responsible Individual
Evergreen Health Plan 9185 Oak Hollow Ct Lakewood, CO 31245
16 Name
34-5421930
Part III Issuer or Other Coverage Provider
Morgan K. Walsh
17 Employer identification number (EIN)
***-**-1963
8 Enter letter identifying Origin of the Health Coverage
B
Part IV Covered Individuals  (a) Name of covered individual(s)
Wei Brennan
(d) Covered all 12 months
X
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-35eb6d64e32bed7bab4f415d,v11-1095-B-stacked,original,2026,fgen-0e941cf8f66506537b7921a7,synthetic_programmatic_template,stacked,top,False,
"2024
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
Granite Auto Insurance Co. 2368 Granite St Maplewood, MN 32708
16 Name
72-9428524
Part III Issuer or Other Coverage Provider
Wei Kowalski
17 Employer identification number (EIN)
ending in 1676
Street address (including apt. no.)
7503 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 84437
Account number (see instructions)
ending in 871892
8 Enter letter identifying Origin of the Health Coverage
D
Part IV Covered Individuals  (a) Name of covered individual(s)
Lena S. Testcase
(d) Covered all 12 months
[X]
Department of the Treasury - Internal Revenue Service
Form 1095-B
Health Coverage
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-34cc6454346873e34e4d27d5,v11-1095-B-stacked,original,2024,fgen-707f263ec971f9be24b12105,synthetic_programmatic_template,stacked,bottom,False,
"Form 1095-B
Health Coverage
For calendar year 2023
VOID  CORRECTED
Part I Responsible Individual
Granite Auto Insurance Co. 6441 Elm Park Pl Brookhaven, PA 43533
16 Name
54-4966378
Part III Issuer or Other Coverage Provider
Jordan Larsen
17 Employer identification number (EIN)
***-**-5976
Street address (including apt. no.)
5469 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 35595
Account number (see instructions)
***-**-574340
8 Enter letter identifying Origin of the Health Coverage
D
Part IV Covered Individuals  (a) Name of covered individual(s)
Fatima Brennan
(d) Covered all 12 months
☒
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-3be86634aac913ea11df7969,v11-1095-B-stacked,original,2023,fgen-624172c14d297ff278329d38,synthetic_programmatic_template,stacked,top,False,
"Form 1095-B
Health Coverage
2025
OMB No. l545-2252
VOID  CORRECTED
Part I Responsible Individual
Harbor Life Assurance 8270 Willow Bend Way Riverton,WI 29833
16 Name
98-3749699
Part III Issueror 0ther Coverage Províder
Kwame R. Rivera
17 Emp1oyer identification number (EIN)
****0490
8 Enter letter identifying 0rigin of the Health Coverage
C
Part IV Covered Individuals  (a) Name of covered individua1(s)
Noah R. Moreau
Department of the Treasury - Intemal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-03d9f1f6ed853cd394e8bc23,v11-1095-B-stacked,original,2025,fgen-8d7cd76495fd9923a479cc7d,synthetic_programmatic_template,stacked,top,True,
"Form 1095-B Health Coverage 2025
From:
Sample Mutual Insurance
Recipient's name:
Hiro Castillo
8 Enter letter identifying Origin of the Health Coverage
D
Part IV Covered Individuals  (a) Name of covered individual(s)
Kwame J. Haddad",1095,3,1095,fdc-3bf7ea67da3ee0b9d6a6774a,v11-1095-B-stacked,original,2025,fgen-e4aa4beb9f533b4c5e5d6013,synthetic_programmatic_template,stacked,top,False,
"Form 1095-B
Health Coverage
2022
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
Evergreen Health Plan 7956 Willow Bend Way Brookhaven, PA 61891
16 Name
33-2005233
Part III Issuer or Other Coverage Provider
Taylor Kowalski
17 Employer identification number (EIN)
***-**-5682
Street address (including apt. no.)
7320 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 70313
Account number (see instructions)
XXXXX820393
8 Enter letter identifying Origin of the Health Coverage
D
Part IV Covered Individuals  (a) Name of covered individual(s)
Mateo A. Tanaka
(d) Covered all 12 months
X
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-c5cd44287794b8c60d965000,v11-1095-B-stacked,original,2022,fgen-f4d933f12b84d476c83da56b,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2021
OMB No. 1545-2252
Part I Responsible Individual
Harbor Life Assurance 685 Elm Park Pl Fairview, OH 94293
16 Name
42-6411794
Part III Issuer or Other Coverage Provider
Diego Brennan
17 Employer identification number (EIN)
***-**-4921
Street address (including apt. no.)
737 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 33498
Account number (see instructions)
****382725
8 Enter letter identifying Origin of the Health Coverage
B
Part IV Covered Individuals  (a) Name of covered individual(s)
Sofia A. Moreau
(d) Covered all 12 months
X
Department of the Treasury - Internal Revenue Service
Form 1095-B
Health Coverage
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-6cc5a65bb06b5193edc07c28,v11-1095-B-stacked,original,2021,fgen-ad90436e235edaeebcb42200,synthetic_programmatic_template,stacked,bottom,False,
"Form 1095-B
Health Coverage
2024
OMB No. 1545-2252
VOID  CORRECTED
Part I Responsible Individual
Sample Mutual Insurance 6326 Granite St Riverton, WI 25062
16 Name
38-7941658
Part III Issuer or Other Coverage Provider
Morgan L. Moreau
17 Employer identification number (EIN)
ending in 8368
Street address (including apt. no.)
3228 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 76872
8 Enter letter identifying Origin of the Health Coverage
D
Part IV Covered Individuals  (a) Name of covered individual(s)
Diego Testcase
(d) Covered all 12 months",1095,3,1095,fdc-1e5718600ce9f765525d004d,v11-1095-B-stacked,original,2024,fgen-41ec23c5a3a6b87c6fca1ff4,synthetic_programmatic_template,stacked,top,False,
"Form 1095-B
Health Coverage
2022
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
Granite Auto Insurance Co. 3327 Oak Hollow Ct Riverton, WI 14975
16 Name
21-3071030
Part III Issuer or Other Coverage Provider
Amara J. Moreau
17 Employer identification number (EIN)
XXX-XX-0862
Street address (including apt. no.)
3003 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 44181
8 Enter letter identifying Origin of the Health Coverage
D
(d) Covered all 12 months
☐",1095,3,1095,fdc-1dc88ecf28bb1c8074deec7e,v11-1095-B-stacked,original,2022,fgen-eab5cb778faf6264dfee1891,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1095-B
Health Coverage
For calendar year 2023
VOID  CORRECTED
Part I Responsible Individual
Granite Auto Insurance Co. 8216 Granite St Testville, IL 88948
16 Name
58-8479961
Part III Issuer or Other Coverage Provider
Jordan Testcase
17 Employer identification number (EIN)
XXXXX4216
Street address (including apt. no.)
3625 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 62412
Account number (see instructions)
***-**-258345
8 Enter letter identifying Origin of the Health Coverage
C
Part IV Covered Individuals  (a) Name of covered individual(s)
Morgan Patel
(d) Covered all 12 months
X
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-b313baf76325191a149abe40,v11-1095-B-stacked,original,2023,fgen-90bef0efa265ad079a153671,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1095-B
Health Coverage
For calendar year 2022
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
Evergreen Health Plan 7789 Prairie Ave Lakewood, CO 28351
16 Name
83-8316374
Part III Issuer or Other Coverage Provider
Morgan S. Haddad
17 Employer identification number (EIN)
XXXXX9446
Street address (including apt. no.)
9633 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 52015
8 Enter letter identifying Origin of the Health Coverage
D
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-0449cc0836c2138a2eab5402,v11-1095-B-stacked,original,2022,fgen-946b737a9de52d6b83f7754e,synthetic_programmatic_template,stacked,top,False,
"Form 1095-B
Health Coverage
For calendar year 2025
OMB No. 1545-2252
VOID  CORRECTED
Part I Responsible Individual Granite Auto Insurance Co. 1481 Willow Bend Way Pinecrest, GA 56188
16 Name 95-5618307
Part III Issuer or Other Coverage Provider  Riley K. Patel
17 Employer identification number (EIN)   ending in 8756
Street address (including apt. no.)  3277 Sample Street
City or town, state or province, country, and ZIP or foreign postal code  Brookhaven, PA 95834
Account number (see instructions)      XXX-XX-442520
8 Enter letter identifying Origin of the Health Coverage  C
(d) Covered all 12 months   X",1095,3,1095,fdc-bf4c64f284b2365d48faed3d,v11-1095-B-inline,original,2025,fgen-30b322e5b51422b4ef71b3b7,synthetic_programmatic_template,inline,top,False,
"Form 1095-B
Health Coverage
2023
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual  Granite Auto Insurance Co. 551 Cedar Ln Oak Grove, TX 53273
16 Name   39-5749767
Part III Issuer or Other Coverage Provider Riley Okafor
17 Employer identification number (EIN)   ending in 0713
8 Enter letter identifying Origin of the Health Coverage D
Part IV Covered Individuals  (a) Name of covered individual(s) Amara Sato
(d) Covered all 12 months   ☒
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-511586189794e5708f93544b,v11-1095-B-inline,original,2023,fgen-4d8278368c3b04786560f731,synthetic_programmatic_template,inline,top,False,
"Form 1095-B Health Coverage 2026
From:  Evergreen Health Plan
Recipient's name:  Olivia R. Castillo
(d) Covered all 12 months   [X]
Part IV Covered Individuals  (a) Name of covered individual(s) Noah Testcase
8 Enter letter identifying Origin of the Health Coverage   A",1095,3,1095,fdc-462cd319a40c0fad3f2c0bd2,v11-1095-B-inline,original,2026,fgen-17458e02afa8a09d32139399,synthetic_programmatic_template,inline,top,False,
"For calendar year 2026
OMB No. 1545-2252
VOID  CORRECTED
Part I Responsible Individual  Evergreen Health Plan 1208 Oak Hollow Ct Maplewood, MN 73830
16 Name  60-8192522
Part III Issuer or Other Coverage Provider Alex R. Kowalski
17 Employer identification number (EIN) ****3172
Street address (including apt. no.) 4640 Granite St
City or town, state or province, country, and ZIP or foreign postal code   Maplewood, MN 81036
8 Enter letter identifying Origin of the Health Coverage   C
Part IV Covered Individuals  (a) Name of covered individual(s)   Fatima Haddad
(d) Covered all 12 months      X
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-1142b5c182208e54f83de5c2,v11-1095-B-inline,original,2026,fgen-a49f091c113c3ade68deb0fa,synthetic_programmatic_template,inline,none,False,
"Form 1095-B Health Coverage
From:   Sample Mutual Insurance
RECIPIENT: Morgan Castillo
8 Enter letter identifying Origin of the Health Coverage B
(d) Covered all 12 months ☐
Part IV Covered Individuals  (a) Name of covered individual(s) Casey Okafor",1095,3,1095,fdc-d16ab1880ab0971b065e54eb,v11-1095-B-inline,original,2026,fgen-acac151b0147c7c4096d9e60,synthetic_programmatic_template,inline,top,False,
"Form 1095-B
Health Coverage
For calendar year 2026
OMB No. 1545-2252
VOID  CORRECTED
Dcpartment ofthe Treasury Internal Revenue Servíce
Part I Responsible Individual      Harbor Life Assurance 5358 Elm Park Pl Oak Grove, TX 39128
16 Name 19-26369O9
PartIII Issuer or Other Coverage Provider Amara Patd
17 Employer identification number (EIN)     ****86O5
Account number (see instructions) ending in 278545
8 Enter 1etter ídentifying Origin of the Health Coverage B
(d) Covered all 12 months
Departmcnt of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-86b1cc166f3848c47bbfb910,v11-1095-B-inline,original,2026,fgen-16d416100b69f433643f6cdf,synthetic_programmatic_template,inline,top,True,
"Form 1095-B Health Coverage2025
Part I Responsible Individual'5 name:  Sample Mutual Insurance
To: Diego Haddad
Part IV Covered Individuals  (a) Name of covered individua1(s) Sofia Patel",1095,3,1095,fdc-b6e352124a2722a836517c89,v11-1095-B-inline,original,2025,fgen-8eae72a7efceff40ec13c9e1,synthetic_programmatic_template,inline,top,True,
"Form 1095-B Health Coverage 2021
Part I Responsible Individual'S name:      Granite Auto Insurance Co.
To:      Morgan Moreau
8 Enter letter identifying Origin of the Health Coverage A
Part IV Covered Individuals  (a) Name of covered individual(s)  Priya Romero
(d) Covered all 12 months X",1095,3,1095,fdc-767ffca36f0f8eaec240d1f8,v11-1095-B-inline,original,2021,fgen-bf01359c74e6706bd03206a6,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1095-B
Health Coverage
For calendar year 2023
VOID  CORRECTED
Part I Responsible Individual Harbor Life Assurance 3308 Harbor View Rd Lakewood, CO 54010
16 Name 14-5080002
Part III Issuer or Other Coverage Provider   Jordan Castillo
17 Employer identification number (EIN) XXX-XX-9950
Street address (including apt. no.)      4195 Granite St
City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 14450
8 Enter letter identifying Origin of the Health Coverage   B
(d) Covered all 12 months ☐",1095,3,1095,fdc-f67553b8b0a29b3d8ad0a6df,v11-1095-B-inline,original,2023,fgen-cc035a742388e36ba9f3b0d4,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
2023
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual Evergreen Health Plan 229 Harbor View Rd Maplewood, MN 81866
16 Name   88-2239065
Part III Issuer or Other Coverage Provider Jamie A. Okafor
17 Employer identification number (EIN)   ending in 0319
Street address (including apt. no.) 320 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code  Maplewood, MN 72196
Part IV Covered Individuals  (a) Name of covered individual(s) Alex C. Nguyen
(d) Covered all 12 months      X
Form 1095-B
Health Coverage",1095,3,1095,fdc-b6d964bc68a7471d97fe0acc,v11-1095-B-inline,original,2023,fgen-98e4ad6abcf3f704e313d751,synthetic_programmatic_template,inline,bottom,False,
"Form 1095-B Health Coverage 2021
From:  Evergreen Health Plan
Recipient's name:      Lena M. Walsh
8 Enter letter identifying Origin of the Health Coverage      C
(d) Covered all 12 months [X]
Part IV Covered Individuals  (a) Name of covered individual(s)   Mateo Moreau",1095,3,1095,fdc-6e2938d694838bffba27ef72,v11-1095-B-inline,original,2021,fgen-732d05d4fc561d30bd89f0d1,synthetic_programmatic_template,inline,top,False,
"Form 1095-B Health Coverage 2023
From:   Evergreen Health Plan
RECIPIENT: Jordan Lindqvist
Part IV Covered Individuals  (a) Name of covered individual(s) Priya Brennan
8 Enter letter identifying Origin of the Health Coverage   A
(d) Covered all 12 months      [X]",1095,3,1095,fdc-acf184e0ff9b12ddb0bfa5cd,v11-1095-B-inline,original,2023,fgen-1c3eaaec9ea9ebffabfbc653,synthetic_programmatic_template,inline,top,False,
"Form 1095-B Health Coverage 2022
From: Graníte Auto Insurance Co.
Recipient's name:  Amara Kowa1ski
Part IV Covered Individuals  (a) Name of covered individual(s) Alex Sato
8 Enter letter identifying Originof the Health Coverage  C",1095,3,1095,fdc-479b127724313545558c5f1b,v11-1095-B-inline,original,2022,fgen-e28f54bdeab096395994a5d8,synthetic_programmatic_template,inline,top,True,
"Form 1095-B
Health Coverage
2024
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual      Granite Auto Insurance Co.61 Maple Ridge Dr Maplewood, MN 70854
16 Name 27-99743l7
PartIII Issuer or Other Coverage Províder  Avery Moreau
17 Employer identification number (EIN)  XXX-XX-4985
5treet address (induding apt. no.) 9620 Willow Bend Way
Cíty or town, state or province, country, and ZIP or foreign postalcode  Oak Grove, TX 89640
8 Enter letter identifying Origin of the Health Coverage   B
Part IV Covered Individuals  (a) Name of covered individual(s) Fatima Okafor
(d) Covered all 12 months
Department of the Treasury - Intcmal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-cbfb7ad7cf44a0c3c28a65f3,v11-1095-B-inline,original,2024,fgen-a71515f314030306a28b338d,synthetic_programmatic_template,inline,top,True,
"Form 1095-B
Health Coverage
2022
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual Granite Auto Insurance Co. 3144 Harbor View Rd Fairview, OH 18834
16 Name      66-3982378
Part III Issuer or Other Coverage Provider   Priya Testcase
17 Employer identification number (EIN) ending in 8119
8 Enter letter identifying Origin of the Health Coverage  A
Part IV Covered Individuals  (a) Name of covered individual(s)      Lena Okafor
(d) Covered all 12 months  X",1095,3,1095,fdc-3dedc8381f7a97519a3a6529,v11-1095-B-inline,original,2022,fgen-5f0b32e21e140445cd008481,synthetic_programmatic_template,inline,top,False,
"Form 1095-B
Health Coverage
2025
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual Granite Auto Insurance Co. 7072 Harbor View Rd Cedar Falls, IA 52864
16 Name      98-4948440
Part III Issuer or Other Coverage Provider      Sofia D. Haddad
17 Employer identification number (EIN)   ****0837
Street address (including apt. no.)   7260 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 93591
8 Enter letter identifying Origin of the Health Coverage  D
Part IV Covered Individuals  (a) Name of covered individual(s)   Lena B. Lindqvist
(d) Covered all 12 months  X
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-ba888da12cd01417c852758e,v11-1095-B-inline,original,2025,fgen-2c661af0ad67c3c875321c8b,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1095-B
Health Coverage
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
8 Enter letter identifying Origin of the Health Coverage
(d) Covered all 12 months
Granite Auto Insurance Co. 352 Willow Bend Way Maplewood, MN 48989
67-8672101
Sofia Okafor
ending in 3966
8703 Willow Bend Way
Brookhaven, PA 86522
B
X",1095,3,1095,fdc-80721df623b181435403f6ee,v11-1095-B-columns,original,2022,fgen-7ea54d8c4689df646808db80,synthetic_programmatic_template,columns,top,False,
"Form 1095-B
Health Coverage
For calendar year 2021
OMB No. 1545-2252
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Granite Auto Insurance Co. 9588 Willow Bend Way Riverton, WI 67709
42-6474069
Amara Adeyemi
XXX-XX-1120
1521 Willow Bend Way
Cedar Falls, IA 49556
XXX-XX-527430
A
Olivia Tanaka
X
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-38e5f3315ba1319356323df0,v11-1095-B-columns,original,2021,fgen-3c9a41772ce2586b82040f91,synthetic_programmatic_template,columns,top,False,
"Form 1095-B
Health Coverage
2026
VOID  C0RRECTED
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Províder
17 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
8 Enter letter identifying Origin of theHealth Coverage
(d) Covered all l2 months
Granite Auto Insurance Co. 9145 Prairie Ave Riverton, WI 51O13
81-9831958
Casey Haddad
***-**-2233
62l3Maple Ridge Dr
Testville, IL 55371
***-**-144083
B
X",1095,3,1095,fdc-c2357019a1a7855419268690,v11-1095-B-columns,original,2026,fgen-36edacd646e9abf519139943,synthetic_programmatic_template,columns,top,True,
"Form 1095-B Health Coverage 2022
Part I Responsible Individual'S name:
Recipient's name:
(d) Covered all 12 months
Harbor Life Assurance
Avery Romero
0.00",1095,3,1095,fdc-f70577372b45d28d85f4cb07,v11-1095-B-columns,original,2022,fgen-9d0006c68ad46918129393c1,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1095-B
Health Coverage
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Granite Auto Insurance Co. 2403 Granite St Testville, IL 40478
67-2727278
Casey Moreau
XXXXX9297
B
Kwame Castillo
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-2303472c74975dcf5c6eae15,v11-1095-B-columns,original,2023,fgen-a6e81a775e3b97ce392d85f5,synthetic_programmatic_template,columns,top,False,
"2025
OMB No. 1545-2252
VOID  CORRECTED
Part IResponsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number(EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign posta1 code
8 Enter letter identifying Origin ofthe Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Granite Auto Insurance Co. 2336 Cedar Ln Riverton, WI 65lO4
45-9142017
Riley D. Walsh
XXXXX8131
4129 Harbor View Rd
Lakewood, CO 6964O
A
Priya Castillo
☐
Dcpartment of the Treasury - Internal Revenue 5ervice
Form l095-B
Health Coverage
Form l095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-c4b50b88906a4eab39a5bcde,v11-1095-B-columns,original,2025,fgen-c94bb2c76c7d619f829e4fc4,synthetic_programmatic_template,columns,bottom,True,
"VOID  CORRECTED
Form 1095-B
Health Coverage
For calendar year 2021
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Evergreen Health Plan 2564 Willow Bend Way Lakewood, CO 11245
44-3427119
Morgan Patel
ending in 8897
9766 Maple Ridge Dr
Cedar Falls, IA 78255
D
Casey Romero
☐
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-90db09163f0bf278585a6772,v11-1095-B-columns,original,2021,fgen-d89bca0b8d99031a04774afc,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
2026
OMB No. 1545-2252
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Sample Mutual Insurance 9327 Sample Street Brookhaven, PA 99375
26-8026112
Lena L. Sato
XXX-XX-5333
8474 Elm Park Pl
Riverton, WI 93297
XXXXX726559
A
Sofia Okafor
☒",1095,3,1095,fdc-601301db3de07877097da8d6,v11-1095-B-columns,original,2026,fgen-cc35de305ffec0333a8b046b,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
Form 1095-B
Health Coverage
2021
OMB No. 1545-2252
VOID  CORRECTED
Department of the Treasury Internal Revenue 5ervice
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employcr identification numbcr (EIN)
Account number (see instructions)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals (a) Name of coveredindividual(s)
Harbor Life Assurance 3115 Sample Street Oak Grove, TX 93684
75-72O2318
Mateo Moreau
XXX-XX-6136
XXX-XX-8859OO
B
Avery Adeyemi",1095,3,1095,fdc-559d9627c4dc8548a860fc2f,v11-1095-B-columns,original,2021,fgen-b3286f944f21bee92aba17f6,synthetic_programmatic_template,columns,top,True,
"VOID  CORRECTED
Form 1095-B
Health Coverage
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
Account number (see instructions)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Evergreen Health Plan 362 Willow Bend Way Bayside, WA 19658
60-8743467
Casey Lindqvist
XXXXX9885
***-**-675638
B
Casey R. Nguyen
☐
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-71ab1e0469a3aacf2a6be939,v11-1095-B-columns,original,2023,fgen-d9a77725923767b32bc9f5fe,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Form 1095-B
Health Coverage
For calendar year 2025
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Sample Mutual Insurance 8868 Elm Park Pl Cedar Falls, IA 42487
44-6977634
Alex L. Patel
***-**-7651
8877 Granite St
Lakewood, CO 24673
D
Hiro Romero
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-0fce5bac16d6a5fc6dc0112b,v11-1095-B-columns,original,2025,fgen-2d283414c830191cb565b97f,synthetic_programmatic_template,columns,top,False,
"Form 1095-B
Health Coverage
2026
OMB No. 1545-2252
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Evergreen Health Plan 1140 Elm Park Pl Oak Grove, TX 90835
47-6425972
Casey Brennan
ending in 8866
A
Kwame C. Haddad
☒",1095,3,1095,fdc-00a184f996206eab31254393,v11-1095-B-columns,original,2026,fgen-88a759cbc2ea5e7aa6c8f508,synthetic_programmatic_template,columns,top,False,
"Form 1095-B
Health Coverage
2023
Department of the Treasury Internal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Coverage Provider
17 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
(d) Covered all 12 months
Evergreen Health Plan 3736 Elm Park Pl Cedar Falls, IA 91859
39-6730836
Noah L. Lindqvist
ending in 3026
358 Granite St
Fairview, OH 42470
A
Avery K. Moreau
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-b4f360ab38f4710c39554a71,v11-1095-B-columns,original,2023,fgen-9be272d611db5177828de1ee,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1095-B
Health Coverage
For calendar year 2026
VOID  CORRECTED
Department of the Treasury Internal Revenue Servíce
Part I Responsible Individual
l6 Name
Part III Issuer or Other Coverage Provider
17 Emp1oyer identification number(EIN)
5treet address (including apt. no.)
City or town, state or province, country, and ZIP or foreign posta1 code
Accountnumber (see instructions)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Indívidua1s  (a) Name of covered individual(s)
(d) Covered all 12 months
Evergreen Health Plan 939O Maple Ridge Dr Maplewood, MN 51200
24-3223179
OliviaJ. Haddad
ending in 1136
2038 Willow Bend Way
Maplewood, MN 9785O
XXX-XX-207962
A
Hiro J. Fischer
☐",1095,3,1095,fdc-52b6813fe80e2d57fc3e1fe1,v11-1095-B-columns,original,2026,fgen-38ddb48e4f3c1cd006e3f570,synthetic_programmatic_template,columns,top,True,
"Form 1095-B
Health Coverage
2025
OMB No. 1545-2252
Department of the Treasury Intemal Revenue Service
Part I Responsible Individual
16 Name
Part III Issuer or Other Covcrage Provider
17 Employer identification number (EIN)
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a)Name of covered individual(s)
(d) Covered all l2 months
Evergreen Hea1th Plan 1676 Elm Park Pl Lakcwood,CO 62377
61-3063820
Avery 5. Moreau
ending in 3594
B
Olivia Kowalski
X",1095,3,1095,fdc-22c0549680d14986d37c51a2,v11-1095-B-columns,original,2025,fgen-71f5906ae5ab4cc241e80da3,synthetic_programmatic_template,columns,top,True,
"Part I Responsible Individual:
RECIPIENT:
(d) Covered all 12 months
8 Enter letter identifying Origin of the Health Coverage
Part IV Covered Individuals  (a) Name of covered individual(s)
Harbor Life Assurance
Fatima Adeyemi
[X]
B
Lena Adeyemi",1095,3,1095,fdc-6c5f1271cc512ac59fe4f878,v11-1095-B-columns,original,2025,fgen-5f62faac021d75225a71ce2b,synthetic_programmatic_template,columns,none,False,
"Form 1095-B
Health Coverage
For calendar year 2026
Part I Responsible Individual: Sample Mutual Insurance 2175 Oak Hollow Ct Lakewood, CO 99859
Line 16 Name: 52-7333111
Part III Issuer or Other Coverage Provider: Diego Tanaka
Line 17 Employer identification number (EIN): ****0719
Account number (see instructions): XXX-XX-009693
Line 8 Enter letter identifying Origin of the Health Coverage: A
(d) Covered all 12 months: ☐",1095,3,1095,fdc-60c07d067f4a71e177c6f6e2,v11-1095-B-boxed,original,2026,fgen-d94574b4855a2f965caedd49,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1095-B
Health Coverage
2024
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual: Sample Mutual Insurance 9475 Harbor View Rd Fairview, OH 67692
Box 16 Name: 83-2969698
Part III Issuer or Other Coverage Provider: Hiro Kowalski
Box 17 Employer identification number (EIN): ***-**-7666
Street address (including apt. no.): 2582 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 50586
Box 8 Enter letter identifying Origin of the Health Coverage: A
Part IV Covered Individuals  (a) Name of covered individual(s): Priya J. Rivera",1095,3,1095,fdc-e3e886749f86660a01fbb517,v11-1095-B-boxed,original,2024,fgen-b35bd0ae52aea5fa3b018f1d,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 1095-B
Health Coverage
For calendar year 2025
OMB No. 1545-2252
Part I Responsible Individual: Granite Auto Insurance Co. 6723 Lakeshore Blvd Pinecrest, GA 68018
Box 16 Name: 78-8278796
Part III Issuer or Other Coverage Provider: Wei Walsh
Box 17 Employer identification number (EIN): ***-**-7397
Street address (including apt. no.): 4321 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 62871
Account number (see instructions): XXX-XX-882260
Box 8 Enter letter identifying Origin of the Health Coverage: A
Part IV Covered Individuals  (a) Name of covered individual(s): Casey D. Sato
(d) Covered all 12 months: [X]
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-58820817e60ad9d31954a2bc,v11-1095-B-boxed,original,2025,fgen-09fcab9e8c0fc0a0d336be77,synthetic_programmatic_template,boxed,top,False,
"From:: Granite Auto Insurance Co.
RECIPIENT:: Alex Moreau
Part IV Covered Individuals  (a) Name of covered individual(s): Mateo Sato
8 Enter letter identifying Origin of the Health Coverage: D",1095,3,1095,fdc-9f7442c52a4277cdba7e5659,v11-1095-B-boxed,original,2024,fgen-12fb156fc1e7d0b45d427459,synthetic_programmatic_template,boxed,none,False,
"Form 1095-B
Health Coverage
OMB No. 1545-2252
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual: Sample Mutual Insurance 9172 Maple Ridge Dr Riverton, WI 83260
Line 16 Name: 74-7339806
Part III Issuer or Other Coverage Provider: Jordan E. Nguyen
Line 17 Employer identification number (EIN): ending in 4957
Street address (including apt. no.): 9162 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 70748
Line 8 Enter letter identifying Origin of the Health Coverage: B
Part IV Covered Individuals  (a) Name of covered individual(s): Casey Sato
(d) Covered all 12 months: ☒
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-dc33ffc04ad3f0a9c94eb6b8,v11-1095-B-boxed,original,2026,fgen-eb89e612e4822ef511167c1c,synthetic_programmatic_template,boxed,top,False,
"Form 1095-B
Health Coverage
2021
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part IResponsible Individual: Evergreen Health Plan 7489 Oak Hollow Ct Baysíde, WA 50208
Line l6 Name: 66-3640699
Part III Issuer or Other Coverage Provider: Taylor Fischcr
Line 17 Employer identification number (EIN): XXXXX5809
Street address (índuding apt. no.): 6028 Samplc Street
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 81521
Account numbcr (seeinstructions): XXX-XX-290570
Linc 8 Enter letter identifying Origin of the Health Coverage: D
Part IV Covered Individuals  (a) Name of covered individual(s):Taylor Kowalski
(d) Covered all l2 months: [X]
Department of the Treasury - Internal Revenue 5ervíce
Form 1095-B (keep for yourrecords)  www.irs.gov/Form1095B",1095,3,1095,fdc-cedc7fc29ecf37a4de123c07,v11-1095-B-boxed,original,2021,fgen-312b23aeca1400ec0a8c65b6,synthetic_programmatic_template,boxed,top,True,
"Form 1095-B
Health Coverage
For calendar year 2023
OMB No. 1545-2252
VOID  CORRECTED
Part I Responsible Individual: Granite Auto Insurance Co. 341 Harbor View Rd Riverton, WI 34520
Box 16 Name: 82-8506458
Part III Issuer or Other Coverage Provider: Hiro A. Okafor
Box 17 Employer identification number (EIN): ***-**-0272
Street address (including apt. no.): 6645 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 32243
Box 8 Enter letter identifying Origin of the Health Coverage: B
Part IV Covered Individuals  (a) Name of covered individual(s): Kwame Castillo
(d) Covered all 12 months: ☐",1095,3,1095,fdc-de74ba9c61a8d7bf8a609f60,v11-1095-B-boxed,original,2023,fgen-0e6dfcf24f97b074824d419a,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1095-B
Health Coverage
2026
OMB No. 1545-2252
Department of the Treasury Internal Revenue Service
Part I Responsible Individual: Evergreen Health Plan 5917 Willow Bend Way Pinecrest, GA 82202
Line 16 Name: 42-3442065
Part III Issuer or Other Coverage Provider: Lena J. Okafor
Line 17 Employer identification number (EIN): XXXXX3303
Line 8 Enter letter identifying Origin of the Health Coverage: A
Part IV Covered Individuals  (a) Name of covered individual(s): Hiro Adeyemi
(d) Covered all 12 months: [X]
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-5c0adeeb0550943d92478546,v11-1095-B-boxed,original,2026,fgen-f298b09eb2cd281f785bf687,synthetic_programmatic_template,boxed,top,False,
"OMB No. 1545-2252
Department of the Treasury InternalRevenue Service
Part I Responsible Individual: Harbor Life Assurance 7166 Prairic Ave Testville, IL 62952
l6 Name: 17-4905915
Part III Issuer or Other Coverage Provider:Hiro Walsh
l7 Employer identification number(EIN): XXX-XX-3l77
Street address (íncluding apt. no.): 572 Granite St
City or town, state or province, country, and ZIP or foreign posta1 code: Maplewood, MN 98O88
8 Enter letter identifying Origin of the Health Coverage: A
Part IV Covered Individuals  (a) Name of covered individual(s): Noah Testcase
(d) Covered all 12 months: ☐
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-f0c44e76b0846791f350baad,v11-1095-B-boxed,original,2022,fgen-ed24a19265fe896de2b74bea,synthetic_programmatic_template,boxed,none,True,
"2022
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual: Granite Auto Insurance Co. 2668 Maple Ridge Dr Bayside, WA 50013
Box 16 Name: 75-5103112
Part III Issuer or Other Coverage Provider: Priya Lindqvist
Box 17 Employer identification number (EIN): ending in 7858
Street address (including apt. no.): 8657 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 97730
Account number (see instructions): ending in 927140
Box 8 Enter letter identifying Origin of the Health Coverage: C
Part IV Covered Individuals  (a) Name of covered individual(s): Fatima Patel
(d) Covered all 12 months: ☒
Form 1095-B
Health Coverage",1095,3,1095,fdc-b1dfc32226dec92783562c9b,v11-1095-B-boxed,original,2022,fgen-2e35e754ffd23a93ebc66243,synthetic_programmatic_template,boxed,bottom,False,
"2025
OMB No. 1545-2252
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual: Harbor Life Assurance 4878 Elm Park Pl Fairview, OH 54773
Line 16 Name: 98-7367623
Part III Issuer or Other Coverage Provider: Taylor L. Patel
Line 17 Employer identification number (EIN): XXX-XX-3964
Street address (including apt. no.): 6508 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 95946
Account number (see instructions): XXXXX728011
Part IV Covered Individuals  (a) Name of covered individual(s): Avery Brennan
(d) Covered all 12 months: ☐
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-0bb6a6f4d0fa4c86bf0bab9d,v11-1095-B-boxed,original,2025,fgen-2fc365f8d45bd322a5439426,synthetic_programmatic_template,boxed,none,False,
"Form 1095-B Health Coverage 2025
Part I Responsible Individual'S name:: Sample Mutual Insurance
RECIPIENT:: Noah Lindqvist
(d) Covered all 12 months: [X]
Part IV Covered Individuals  (a) Name of covered individual(s): Alex R. Tanaka
8 Enter letter identifying Origin of the Health Coverage: B",1095,3,1095,fdc-aaa2648f52b113151e94ed16,v11-1095-B-boxed,original,2025,fgen-e941ea5c065d33fce2bc4c73,synthetic_programmatic_template,boxed,top,False,
"Form 1095-B
Health Coverage
For calendar year 2023
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Responsible Individual: Sample Mutual Insurance 8996 Maple Ridge Dr Pinecrest, GA 72690
Box 16 Name: 33-3480196
Part III Issuer or Other Coverage Provider: Olivia Lindqvist
Box 17 Employer identification number (EIN): XXXXX3877
Account number (see instructions): XXXXX808768
Box 8 Enter letter identifying Origin of the Health Coverage: C
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-9a4f1199dab2eab912c90ad9,v11-1095-B-boxed,original,2023,fgen-7055f4c088476bcc3c94931a,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 1095-B
Health Coverage
Department of the Treasury Internal Revenue Service
Part I Responsible Individual: Evergreen Health Plan 4758 Maple Ridge Dr Maplewood, MN 35925
16 Name: 74-7209460
Part III Issuer or Other Coverage Provider: Amara Patel
17 Employer identification number (EIN): ***-**-5061
Street address (including apt. no.): 2871 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 66790
Account number (see instructions): ***-**-075711
8 Enter letter identifying Origin of the Health Coverage: D
(d) Covered all 12 months: [X]
Department of the Treasury - Internal Revenue Service
Form 1095-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-25ae8190eb19c8c89b0640e6,v11-1095-B-boxed,original,2025,fgen-13d84bf5be6fcdf72fb433dc,synthetic_programmatic_template,boxed,top,False,
"Form 1095-B
Health Coverage
2025
Department of the Treasury Internal Revenue Service
Part I Responsible Individua1: Sample Mutual Insurance8573 0ak Hollow Ct Oak Grove, TX 91101
Line 16 Name: 68-9477678
Part III Issuer or Other Coverage Províder: Taylor B. Haddad
Line 17 Employer identification number (EIN): ****5938
Street address (includíng apt. no.): 1842 Prairie Ave
City or town, stateor province, country, and ZIP or foreign postal code: Cedar Falls, IA 95326
Line 8 Enterletter ídentifying Origin of the Health Coverage: D
Department of thc Treasury - Intemal Revenue Service
Form 1O95-B (keep for your records)  www.irs.gov/Form1095B",1095,3,1095,fdc-46c8043b2be351c3db0fb0e8,v11-1095-B-boxed,original,2025,fgen-07e0e5de90e5da504d716141,synthetic_programmatic_template,boxed,top,True,
"Form 1095-B Health Coverage 2025
Part I Responsible Individual'S name:: Sample Mutual Insurance
To:: Sofia Tanaka
(d) Covered all 12 months: ☒
Line 8 Enter letter identifying Origin of the Health Coverage: C",1095,3,1095,fdc-7e7b2e8243e941e8bf6556dc,v11-1095-B-boxed,original,2025,fgen-e46b5b4658ca0f384fed822e,synthetic_programmatic_template,boxed,top,False,
"For calendar year 2021
OMB No. 1545-2251
Department of the Treasury Internal Revenue Service
Part I Employee Granite Peak Manufacturing Co. 9122 Cedar Ln Oak Grove, TX 45925
7 Name of employer      94-8175504
Applicable Large Employer Member (Employer)  Jamie M. Brennan
8 Employer identification number (EIN) XXX-XX-5449
Street address (including apt. no.)      8955 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code  Lakewood, CO 85745
14 Offer of Coverage (enter required code)  All 12 Months      1E
15 Employee Required Contribution (see instructions)      $8,023.52
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2D
Plan Start Month (enter 2-digit number) 01
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-e7921771ece957d9d4736f67,v11-1095-C-inline,original,2021,fgen-1c2539156bfc6875c72876c0,synthetic_programmatic_template,inline,none,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage
Part I Employee'S name:      Copperline Softwarc Inc.
Recipient's name: Avery Nguyen
PlanStart Month (enter 2-digit number) 10",1095,3,1095,fdc-4c83e7a95db5361d27d1d74f,v11-1095-C-inline,original,2026,fgen-b9bb298765cdb3bfc39d6651,synthetic_programmatic_template,inline,top,True,
"Part I Employee:  Copperline Software Inc.
Recipient's name: Alex Moreau
Plan Start Month (enter 2-digit number)   04
15 Employee Required Contribution (see instructions) 3,598.94
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)      2C
14 Offer of Coverage (enter required code)  All 12 Months      1E
Form 1095-C Employer-Provided Health Insurance Offer and Coverage",1095,3,1095,fdc-ac1f3a9d7106c629a57a5363,v11-1095-C-inline,original,2024,fgen-a06a2e092375554b3caa01bd,synthetic_programmatic_template,inline,bottom,False,
"Part I Employee'S name:  Blue Heron Logistics LLC
To:   Lena Okafor
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)  2C
14 Offer of Coverage (enter required code)  All 12 Months 1A
15 Employee Required Contribution (see instructions) $3,902.44
Form 1095-C Employer-Provided Health Insurance Offer and Coverage",1095,3,1095,fdc-f74754698c0f8da402021d2f,v11-1095-C-inline,original,2023,fgen-27407793251822e75b5baf98,synthetic_programmatic_template,inline,bottom,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2022
OMB No. 1545-2251
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Employee      Acme Test Corp 8091 Sample Street Oak Grove, TX 64855
7 Name of employer      22-5453633
Applicable Large Employer Member (Employer)  Jordan Lindqvist
8 Employer identification number (EIN) ****7014
Street address (including apt. no.)   9286 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code      Lakewood, CO 70166
Account number (see instructions) ***-**-194114
14 Offer of Coverage (enter required code)  All 12 Months  1E
15 Employee Required Contribution (see instructions)  $4,592.03
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)  2H
Plan Start Month (enter 2-digit number) 03
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-0b88447f928bb72cce4abde5,v11-1095-C-inline,original,2022,fgen-dc761fdd0e8062f1f0f73511,synthetic_programmatic_template,inline,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage
Part I Employee:  Riverside Regional Hospital
RECIPIENT:   Riley L. Haddad
15 Employee Required Contribution (see instructions) 7,173.13",1095,3,1095,fdc-801017dba3fa329bd4ee6587,v11-1095-C-inline,original,2022,fgen-603e9df0e20badebf11520c1,synthetic_programmatic_template,inline,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage
Part I Employee:  Acme Test Corp
To:  Avery L. Adeyemi
l6Section 4980H Safc Harbor and Other Relief (enter code, if applicable)  2C",1095,3,1095,fdc-069982467d164f899e446546,v11-1095-C-inline,original,2024,fgen-cdd47dfb3efed7303141a191,synthetic_programmatic_template,inline,top,True,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
Part I Employee      Tri-County School District 9655 Harbor View Rd Fairview, OH 47247
7 Name of employer  67-9266391
Applicable Large Employer Member (Employer) Morgan Tanaka
8 Employer identification number (EIN)   ***-**-9222
Account number (see instructions)  ****516646
14 Offer of Coverage (enter required code)  All 12 Months      1E
15 Employee Required Contribution (see instructions)      $4,762.41
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)  2C
Plan Start Month (enter 2-digit number) 10
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-937dcb61bc4f3a8ce91bf28c,v11-1095-C-inline,original,2024,fgen-8d9ba0cefbe2e36fb4b581e0,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
For calendar year 2026
OMB No. 1545-2251
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Employee   Maple Street Dental PC 1923 Granite St Fairview, OH 60488
7 Name of employer  26-6101137
Applicable Large Employer Member (Employer) Alex Moreau
8 Employer identification number (EIN) XXX-XX-3692
Street address (including apt. no.)   6342 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code  Brookhaven, PA 24995
14 Offer of Coverage (enter required code)  All 12 Months 1H
15 Employee Required Contribution (see instructions)  $4,850.91
Plan Start Month (enter 2-digit number)      05",1095,3,1095,fdc-9bf3444e8791a7c3d7d6f7c4,v11-1095-C-inline,original,2026,fgen-8c88f54f6bde7fe7603634b1,synthetic_programmatic_template,inline,none,False,
"VOID  CORRECTED
2022
OMB No. 1545-2251
VOID  CORRECTED
Part I Employee Maple Street Dental PC 605 Willow Bend Way Oak Grove, TX 27499
7 Name of employer   44-9867008
Applicable Large Employer Member (Employer)      Riley Moreau
8 Employer identification number (EIN) ending in 9172
Street address (including apt. no.)   5822 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 40788
Account number (see instructions)      XXX-XX-012614
14 Offer of Coverage (enter required code)  All 12 Months 1H
15 Employee Required Contribution (see instructions) 8,527.75
Plan Start Month (enter 2-digit number) 05
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage",1095,3,1095,fdc-52f4e9466cd8d821f2fa747f,v11-1095-C-inline,original,2022,fgen-a0028eaf7263cfb85ddafdf1,synthetic_programmatic_template,inline,bottom,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2023
OMB No. 1545-2251
Department of the Treasury Internal Revenue Service
Part I Employee      Riverside Regional Hospital 3822 Harbor View Rd Lakewood, C0 11099
7 Name ofemployer  32-8462122
Applicab1e Large Employer Member (Employcr)      Mateo Kowalskí
8 Employer identification number (EIN) ending in 0323
Street address (including apt. no.)   835 Elm Park Pl
Cityor town, state or province, country, and ZIP or foreign posta1 code  0ak Grove, TX 86073
140ffer of Coverage (enter required code)  All 12 Months  1A
15 Employee Required Contribution (see instructions) Sl,461.03
Plan Start Month (enter 2-digit number)   11",1095,3,1095,fdc-a2c4ac398ee039b4812d46b5,v11-1095-C-inline,original,2023,fgen-61d586b61801e64744a994bc,synthetic_programmatic_template,inline,top,True,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage
Part I Employee:   Maple Street Dental PC
Recipient's name:   Casey S. Patel
15 Employee Required Contribution (see instructions)   $1,057.12
Plan Start Month (enter 2-digit number) 09",1095,3,1095,fdc-c391fa24b5c87b38ce4d0e2f,v11-1095-C-inline,original,2023,fgen-222d9b7f5bcbc3bfde2c5cc3,synthetic_programmatic_template,inline,top,False,
"From:  Acme Test Corp
To: Kwame Castillo
15 Employee Required Contribution (see instructions)      $4,540.04
16 Section 4980H Safe Harbor and Other Relief (enter code, ifapplicable)   2H
Plan 5tart Month (enter 2-digit number)   06",1095,3,1095,fdc-5b3f7fb93e4516b3e41047c7,v11-1095-C-inline,original,2021,fgen-dbd0db4ec7364c820aa4c29e,synthetic_programmatic_template,inline,none,True,
"2024
OMB No. l545-2251
Department of the Treasury Internal Revenue Service
Part I Employee Riverside Regional Hospital 1925 Lakeshore Blvd Maplewood, MN 62931
7 Name of employer   78-5263637
Applicable Large Employer Member (Employer)      Riley E. Romero
8 Employer identification number (EIN)   XXX-XX-8470
5treet address (induding apt. no.)  2515 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code  Pinecrest, GA 52336
Account number (see instructions) XXXXX476324
14 0ffer of Covcrage (enter required code) All 12 Months  1H
16 Section 4980H Safe Harbor and 0ther Relief (enter code, ifapp1icable) 2D
Department ofthe Treasury- Interna1 Revenue Service
Form 1095-C
Employer-Provided Health Insurancc Offer and Coverage
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-f4ab772bb0bc5821e6863d7e,v11-1095-C-inline,original,2024,fgen-144b1a3c0540d8342a65bfed,synthetic_programmatic_template,inline,bottom,True,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2024
OMB No. 1545-2251
Part I Employee Tri-County School District 9548 Oak Hollow Ct Fairview, OH 66888
7 Name of employer   52-4680999
Applicable Large Employer Member (Employer)  Casey Castillo
8 Employer identification number (EIN) XXXXX7867
Street address (including apt. no.) 7024 Granite St
City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 59761
14 Offer of Coverage (enter required code)  All 12 Months 1E
15 Employee Required Contribution (see instructions) $5,243.28
Plan Start Month (enter 2-digit number) 02
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-4638e625fa7b7919a61ff5b9,v11-1095-C-inline,original,2024,fgen-52369cee1feb096e024b4bcf,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
OMB No. 1545-2251
VOID  CORRECTED
Department of the Treasury Interna1 Revenue Service
Part I Employee   Blue Heron Logistics LLC547 Oak Ho1low Ct Lakewood,CO 22027
7 Name of employer      22-9614249
Applícable Large Employer Member (Employer) Hiro Nguycn
8 Employer identification number (EIN)  XXXXX0982
Street address (induding apt. no.) 8455 Harbor View Rd
City or town, stateor province, country, and ZIP or foreign postal code  Oak Grove, TX 92614
Account number (see instructions)  ****868229
14 Offer of Coverage (enterrequired code)  All 12 Months     1E
15 Employee Requircd Contribution (see instructions)   $1,554.10
16 5ection 4980H Safe Harbor and Other Rdief (enter code, if app1icable)  2H
Department of the Treasury - Intemal Revenue 5ervice
Form 1O95-C (keep for your records)  www.irs.gov/Forml095C",1095,3,1095,fdc-321fa171be4fd1b292404c39,v11-1095-C-inline,original,2021,fgen-c0103123108d824193867c01,synthetic_programmatic_template,inline,top,True,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage
From:
RECIPIENT:
14 Offer of Coverage (enter required code)  All 12 Months
Plan Start Month (enter 2-digit number)
Maple Street Dental PC
Kwame Kowalski
1A
10",1095,3,1095,fdc-deb6fddc139e9d381d561380,v11-1095-C-columns,original,2022,fgen-f00af24634c15661cb24bd0c,synthetic_programmatic_template,columns,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2023
OMB No. 1545-2251
VOID  CORRECTED
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Plan Start Month (enter 2-digit number)
Maple Street Dental PC 1587 Prairie Ave Brookhaven, PA 32486
52-8615337
Riley A. Brennan
XXX-XX-4581
1H
$6,707.27
2C
08
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-880f143a3bfbb9f52666eb0e,v11-1095-C-columns,original,2023,fgen-fa6f210b659bcae45c15455b,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2026
OMB No. 1545-2251
Department of the Treasury Internal Revenue Service
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Plan Start Month (enter 2-digit number)
Copperline Software Inc. 233 Sample Street Riverton, WI 23289
98-4340210
Wei A. Tanaka
****0108
9155 Maple Ridge Dr
Maplewood, MN 16534
1H
183.53
2D
08",1095,3,1095,fdc-444af9964b64c4c2c3f0087e,v11-1095-C-columns,original,2026,fgen-85b79eefa59086fa5033657a,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2026
VOID  CORRECTED
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Plan Start Month (enter 2-digit number)
Blue Heron Logistics LLC 862 Cedar Ln Lakewood, CO 77461
87-2391789
Lena R. Walsh
XXX-XX-1631
1A
6,862.54
2D
09",1095,3,1095,fdc-f30f13854a6dee3ef307df5f,v11-1095-C-columns,original,2026,fgen-1d8e22c1677a22aa1f9ed2a5,synthetic_programmatic_template,columns,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2023
OMB No. 1545-2251
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8Employer identification number (EIN)
Streetaddress (including apt. no.)
City or town, state or province,country, and ZIP or foreign postal code
15 Employee Required Contribution (see instructions)
16 Section 498OH Safe Harbor and Other Relief (enter code, if applicable)
Plan 5tart Month (cnter 2-digit number)
Rivcrside Regional Hospital 3445 Elm Park Pl Fairview, OH 24O62
67-3357969
Olivia Romero
ending in 6757
9669 Elm Park Pl
Bayside, WA 62726
6,831.67
2D
O4
Department of the Treasury - Intemal Revenue 5ervice
Form 1095-C (keep for your records)  www.írs.gov/Form1095C",1095,3,1095,fdc-7c359aa0e17b35dead0d7680,v11-1095-C-columns,original,2023,fgen-b37454d17c3fe7607a65953b,synthetic_programmatic_template,columns,top,True,
"☐ CORRECTED
Form 1095-C
Employer-Provided HealthInsurance 0ffer and Coverage
2026
OMB No. 1545-2251
VOID  CORRECTED
Part I Employee
7 Name of employer
ApplicableLarge Employer Member (Employer)
8 Employer identification number (EIN)
14 0ffer of Coverage (enter requíred codc)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 498OH Safe Harbor and Other Relíef (enter code, if applicable)
Plan Start Month (enter 2-digit number)
AcmeTest Corp 8380 Lakeshore Blvd Oak Grove, TX 38093
66-6679290
Mateo Sato
XXX-XX-3042
1A
$6,950.61
2D
10
Department of the Treasury - Intemal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-56c50199a5d61f129414c47b,v11-1095-C-columns,original,2026,fgen-b6202b1768a132beb59e7e21,synthetic_programmatic_template,columns,top,True,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2026
OMB No. 1545-2251
VOID  CORRECTED
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Plan Start Month (enter 2-digit number)
Tri-County School District 862 Cedar Ln Brookhaven, PA 35468
28-3433783
Amara Testcase
XXXXX0938
1E
$7,888.35
2D
05
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-e958731c5c7a16c26d4612d2,v11-1095-C-columns,original,2026,fgen-03a06af7f42ed3e60f0f6f86,synthetic_programmatic_template,columns,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
OMB No. 1545-2251
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Granite Peak Manufacturing Co. 5457 Cedar Ln Maplewood, MN 33786
44-2229389
Wei Patel
XXX-XX-1838
8645 Prairie Ave
Fairview, OH 12840
1E
3,145.99
2H",1095,3,1095,fdc-2de85234cec7149ba5a81afa,v11-1095-C-columns,original,2023,fgen-0e919bfea16a6ac9423c1b1c,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2023
OMB No. 1545-2251
Department of the Treasury Internal Revenue Service
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Plan Start Month (enter 2-digit number)
Copperline Software Inc. 5296 Harbor View Rd Bayside, WA 94659
74-1689048
Sofia Romero
XXXXX7082
1H
$7,034.65
2H
09",1095,3,1095,fdc-7874380000e48fd9701b93f5,v11-1095-C-columns,original,2023,fgen-d325f9c043c0705c8a732818,synthetic_programmatic_template,columns,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
OMB No. 1545-2251
VOID  CORRECTED
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Plan Start Month (enter 2-digit number)
Riverside Regional Hospital 6335 Oak Hollow Ct Testville, IL 49122
75-6343045
Riley D. Fischer
****7569
8830 Oak Hollow Ct
Brookhaven, PA 10142
XXXXX222585
1A
3,008.22
2H
10",1095,3,1095,fdc-aceb3c81116db40ac007e3fa,v11-1095-C-columns,original,2026,fgen-849ec0895714665cb9773239,synthetic_programmatic_template,columns,top,False,
"OMB No. 1545-2251
VOID  CORRECTED
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
Plan Start Month (enter 2-digit number)
Copperline Software Inc. 2639 Cedar Ln Bayside, WA 73177
85-1050758
Avery D. Haddad
***-**-2435
6043 Sample Street
Fairview, OH 85876
1H
$5,693.72
03
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-c7791ddf9d1e21e8d8078175,v11-1095-C-columns,original,2022,fgen-c54b2571ea655a1826296974,synthetic_programmatic_template,columns,none,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
OMB No. 1545-2251
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Blue Heron Logistics LLC 7675 Prairie Ave Oak Grove, TX 29046
91-4522188
Noah Patel
XXXXX0292
1E
9,275.95
2D
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-bad02b10558f2ec834d6a237,v11-1095-C-columns,original,2024,fgen-dfe78dd4c158c1af90f98dfd,synthetic_programmatic_template,columns,top,False,
"For calendar year 2021
VOID  CORRECTED
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
Plan Start Month (enter 2-digit number)
Copperline Software Inc. 7849 Willow Bend Way Pinecrest, GA 51984
39-2999654
Alex Moreau
XXXXX2324
2911 Oak Hollow Ct
Fairview, OH 58879
1A
2,147.14
02
Department of the Treasury - Internal Revenue Service",1095,3,1095,fdc-56074d6d89d599e202a74cd7,v11-1095-C-columns,original,2021,fgen-4773236ceca923f16b95646c,synthetic_programmatic_template,columns,none,False,
"Part I Employee'S name:
To:
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
15 Employee Required Contribution (see instructions)
Plan Start Month (enter 2-digit number)
Riverside Regional Hospital
Noah Sato
2H
5,999.00
11
Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2024",1095,3,1095,fdc-b34aef09b65d66a685e8cedf,v11-1095-C-columns,original,2024,fgen-8fa49a54f104d3988cdd4a85,synthetic_programmatic_template,columns,bottom,False,
"Form1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2022
OMB No. 1545-2251
VOID  CORRECTED
Department ofthe Treasury Internal Revenue Service
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Emp1oyer identification number (EIN)
5treet address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
14 0ffer of Coverage (enterrequired code)  All 12 Months
15 Employee Required Contribution (see instructions)
l6 5ection 4980H Safc Harbor and Other Relief (enter code, if applicable)
Plan 5tart Month (enter 2-digit number)
Granite Peak Manufacturing Co. 7238 Lakeshore Blvd Cedar Falls, IA 971O6
63-9043287
Taylor Rívera
XXX-XX-6561
4818 Willow Bend Way
Testville, IL 64713
XXX-XX-977528
1E
$148.43
2C
O5",1095,3,1095,fdc-af7751882ed8387da00eab09,v11-1095-C-columns,original,2022,fgen-6ed69c140c798bc11f85b7c2,synthetic_programmatic_template,columns,top,True,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
Part I Employee
7 Name of employer
Applicable Large Employer Member (Employer)
8 Employer identification number (EIN)
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
14 Offer of Coverage (enter required code)  All 12 Months
15 Employee Required Contribution (see instructions)
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
Plan Start Month (enter 2-digit number)
Granite Peak Manufacturing Co. 4424 Cedar Ln Maplewood, MN 56214
75-6466303
Alex Larsen
****4845
748 Prairie Ave
Cedar Falls, IA 98993
1E
6,454.21
2H
03
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-580535f01aeff0b319bfd83d,v11-1095-C-columns,original,2024,fgen-91ed6f9839006030f1a49a70,synthetic_programmatic_template,columns,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2022
Part I Employee'S name:: Tri-County School District
RECIPIENT:: Mateo Rivera
Box 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2H
Box 14 Offer of Coverage (enter required code)  All 12 Months: 1H
Plan Start Month (enter 2-digit number): 05
Box 15 Employee Required Contribution (see instructions): $4,148.00",1095,3,1095,fdc-ad046502792bd395ef535ac6,v11-1095-C-boxed,original,2022,fgen-d294e6bfaec13d11749c5903,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage
Part I Employee'S name:: Riverside Regional Hospital
Recipient's name:: Jordan Patel
Line 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2D
Line 14 Offer of Coverage (enter required code)  All 12 Months: 1H",1095,3,1095,fdc-01ae3b7083328273a05e9fda,v11-1095-C-boxed,original,2023,fgen-bff9d4f5f72755045077b60b,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2026
OMB No. 1545-2251
Department of the Treasury Internal Revenue Service
Part I Employee: Acme Test Corp 3169 Prairie Ave Riverton, WI 14441
Line 7 Name of employer: 40-7257241
Applicable Large Employer Member (Employer): Diego Adeyemi
Line 8 Employer identification number (EIN): XXXXX8578
Street address (including apt. no.): 3237 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 32972
Account number (see instructions): ending in 325702
Line 14 Offer of Coverage (enter required code)  All 12 Months: 1E
Line 15 Employee Required Contribution (see instructions): 6,640.92
Plan Start Month (enter 2-digit number): 09",1095,3,1095,fdc-4cc8600c85dbbcf9b08c2c80,v11-1095-C-boxed,original,2026,fgen-ee09d02e430049abf8dece6e,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2023
VOID  CORRECTED
Part I Employee: Maple Street Dental PC 9244 Prairie Ave Lakewood, CO 37575
Box 7 Name of employer: 63-3010772
Applicable Large Employer Member (Employer): Taylor M. Castillo
Box 8 Employer identification number (EIN): ****5934
Box 14 Offer of Coverage (enter required code)  All 12 Months: 1A
Plan Start Month (enter 2-digit number): 11
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-8e693006bc3364731f44fd0d,v11-1095-C-boxed,original,2023,fgen-5b5071daebcc0dec1ab4f3b0,synthetic_programmatic_template,boxed,top,False,
"Part I Employee'S name:: Riverside Regional Hospital
RECIPIENT:: Sofia K. Okafor
Box 16 Sectíon4980H Safe Harbor and Other Relief (enter code, if applicable): 2C
Box 14 Offer of Coverage (enter required code)  All 12 Months: 1E
Plan Start Month (enter 2-digit number): 03
Box 15 Employee Required Contribution (see instructions): 223.01",1095,3,1095,fdc-710e9c5e94b8e7e37764b813,v11-1095-C-boxed,original,2025,fgen-396025267863fff063f83a5a,synthetic_programmatic_template,boxed,none,True,
"VOID  CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
Part I Employee: Maple Street Dental PC 1530 Oak Hollow Ct Lakewood, CO 31841
Line 7 Name of employer: 56-8504747
Applicable Large Employer Member (Employer): Jamie J. Romero
Line 8 Employer identification number (EIN): ending in 4621
Line 14 Offer of Coverage (enter required code)  All 12 Months: 1E
Line 15 Employee Required Contribution (see instructions): 499.10
Line 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2H
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-45b7b3bb133a78f6a050b71c,v11-1095-C-boxed,original,2024,fgen-985ebe6f36b816e61e554186,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
Part I Employee: Granite Peak Manufacturing Co. 9550 Granite St Cedar Falls, IA 36876
7 Name of employer: 95-4743216
Applicable Large Employer Member (Employer): Noah Nguyen
8 Employer identification number (EIN): ending in 2309
15 Employee Required Contribution (see instructions): $1,121.20
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2H
Plan Start Month (enter 2-digit number): 10
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-4c24e663108e4120d9e0962c,v11-1095-C-boxed,original,2022,fgen-25a77b9d34c509304c110fed,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
OMB No. 1545-2251
VOID  CORRECTED
Part I Employee: Riverside Regional Hospital 7221 Elm Park Pl Oak Grove, TX 85455
Line 7 Name of employer: 28-6867929
Applicable Large Employer Member (Employer): Hiro Romero
Line 8 Employer identification number (EIN): XXXXX5444
Street address (including apt. no.): 922 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 16604
Line 14 Offer of Coverage (enter required code)  All 12 Months: 1E
Line 15 Employee Required Contribution (see instructions): 7,507.54
Line 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2D
Plan Start Month (enter 2-digit number): 05
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-b4dee4d88417670ad8908f67,v11-1095-C-boxed,original,2021,fgen-f2390ea872ccfb12a0be6ecb,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2026
OMB No. 1545-2251
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Employee: Granite Peak Manufacturing Co. 3500 Willow Bend Way Pinecrest, GA 71875
7 Name of employer: 22-6764610
Applicable Large Employer Member (Employer): Avery Patel
8 Employer identification number (EIN): ***-**-0754
Street address (including apt. no.): 5695 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 88166
15 Employee Required Contribution (see instructions): $6,018.99
16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2C",1095,3,1095,fdc-5021b5dba958909c806042ab,v11-1095-C-boxed,original,2026,fgen-69d3b14175de2ebce37ed9fb,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2025
OMB No. 1545-2251
Part I Employee: Riverside Regional Hospital 9709 Harbor View Rd Brookhaven, PA 91302
Box 7 Name of employer: 20-7658575
Applicable Large Employer Member (Employer): Priya Lindqvist
Box 8 Employer identification number (EIN): ****3922
Account number (see instructions): ***-**-039122
Box 15 Employee Required Contribution (see instructions): 5,376.43
Box 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2H
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-fe261a335daf7a9e9dfaa781,v11-1095-C-boxed,original,2025,fgen-4ff993e3acc0b974fa04e1e7,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
OMB No. 1545-2251
VOID  CORRECTED
Part I Employee: Tri-County School District 1301 Sample Street Brookhaven, PA 78732
Box 7 Name of employer: 65-4219398
Applicable Large Employer Member (Employer): Hiro Romero
Box 8 Employer identification number (EIN): XXX-XX-5722
Box 14 Offer of Coverage (enter required code)  All 12 Months: 1A
Box 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2H
Plan Start Month (enter 2-digit number): 09
Department of the Treasury - Internal Revenue Service
Form 1095-C (keep for your records)  www.irs.gov/Form1095C",1095,3,1095,fdc-e52913cd9acf1f21d54e1ba4,v11-1095-C-boxed,original,2024,fgen-b823ddc47c91c70b496ec373,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
2026
OMB No. 1545-2251
Department of the Treasury Internal Revenue Service
Part I Employee: Tri-County School District 9190 Harbor View Rd Cedar Falls, IA 47812
Line 7 Name of employer: 54-6019700
Applicable Large Employer Member (Employer): Priya Testcase
Line 8 Employer identification number (EIN): XXX-XX-9847
Street address (including apt. no.): 2774 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 20948
Account number (see instructions): ****037907
Line 14 Offer of Coverage (enter required code)  All 12 Months: 1E
Line 15 Employee Required Contribution (see instructions): $1,827.83
Line 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2D
Plan Start Month (enter 2-digit number): 03",1095,3,1095,fdc-211a4387f95208ce1f334188,v11-1095-C-boxed,original,2026,fgen-f95ecac15127afc4192bbf7e,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
For calendar year 2023
OMB No. 1545-2251
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Employee: Copperline Software Inc. 8292 Oak Hollow Ct Oak Grove, TX 60527
Box 7 Name of employer: 67-5305770
Applicable Large Employer Member (Employer): Taylor Sato
Box 8 Employer identification number (EIN): ***-**-0860
Street address (including apt. no.): 1144 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 86732
Box 15 Employee Required Contribution (see instructions): $3,292.31
Box 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2H
Plan Start Month (enter 2-digit number): 01",1095,3,1095,fdc-41bf837615f5ca11b6cfdc98,v11-1095-C-boxed,original,2023,fgen-c21fdee775df055b9eeca496,synthetic_programmatic_template,boxed,none,False,
"VOID  CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer andCoverage
For calendar year 2O23
VOID  CORRECTED
Part I Employee: Acme Test Corp 9040 Elm Park Pl Maplewood, MN 99748
Box 7 Name of employer: 88-8676648
ApplicableLarge Employer Member (Employer):Morgan C. Brennan
Box 8 Employer identification number(EIN): XXXXX2357
Street address (induding apt. no.): 7794 Prairie Ave
City or town, state or province, country, and ZIP or foreign posta1 code: Fairview, OH 96049
Box 14 Offer of Coverage (enter required code)  A1l 12 Months: 1E
Box 15 Employee Requíred Contríbution (see instructions): $7,897.95
Plan Start Month (enter 2-digit number): 06
Department of the Treasury - Intema1 Revenue Service
Form l095-C (keep for your records)  www.irs.gov/Form1O95C",1095,3,1095,fdc-c56cb127bb450f087538585c,v11-1095-C-boxed,original,2023,fgen-6e63ab4d27ebccf45aeb149e,synthetic_programmatic_template,boxed,top,True,
"VOID  CORRECTED
Form 1095-C
Employer-Provided Health Insurance Offer and Coverage
For calendar year 2026
OMB No. 1545-2251
VOID  CORRECTED
Department of the Treasury Internal Revenue Service
Part I Employee: Granite Peak Manufacturing Co. 1904 Harbor View Rd Fairview, OH 80314
Box 7 Name of employer: 26-9820691
Applicable Large Employer Member (Employer): Sofia Rivera
Box 8 Employer identification number (EIN): XXX-XX-0824
Street address (including apt. no.): 7892 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 84443
Box 14 Offer of Coverage (enter required code)  All 12 Months: 1H
Box 15 Employee Required Contribution (see instructions): $116.55
Box 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable): 2H
Plan Start Month (enter 2-digit number): 07",1095,3,1095,fdc-6c96b96f2b2c70fe49ac16b8,v11-1095-C-boxed,original,2026,fgen-88ecb00bcb2a50312a51b4ad,synthetic_programmatic_template,boxed,top,False,
"Form 1095-C
Employer-Províded Health Insurance Offer and Coverage
For calendar year2022
OMBNo. 1545-2251
VOID  CORRECTED
Part I Emp1oyee: Blue Heron Logistics LLC 8009 Granitc St Testville, IL 15286
Line 7 Name of employer: 30-7869466
Applicable Large Employer Member (Employer): Amara Larsen
Line 8 Employer identification number (EIN): ****6458
Street address (including apt. no.): 6945 Harbor Vícw Rd
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 79854
Line 14 Offer of Coverage (enter required code)  A1l 12 Months: 1A
Linc 15 Employee Required Contribution (see instructions): 6,6O3.81
Line 16 Section 4980H Safe Harbor and Other Relief(enter code, if applicable): 2C",1095,3,1095,fdc-b79b3908bb2efabeb55f52f8,v11-1095-C-boxed,original,2022,fgen-7b76e6b5acc92e746b84dc5f,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked) Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2026 OMB No. 1545-2251 VOID CORRECTED Part I Employee Riverside Regional Hospital 4865 Willow Bend Way Lakewood, CO 83200
7 Name of employer 15-6400936 Applicable Large Employer Member (Employer) Taylor
Larsen 8 Employer identification number (EIN) XXXXX4265 Street address (including apt. no.) 4505 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 21267 14 Offer of Coverage (enter required code) All 12 Months 1E 15 Employee Required Contribution (see instructions) $7,127.67 Plan Start Month (enter 2-digit number) 11",1095,3,1095,fdc-226be6a6b892d73fd3dd9d9f,v11-1095-C-flat,original,2026,fgen-6e15441d8809ff5ab4cdf1b0,synthetic_programmatic_template,flat,top,False,
"Part I Employee'S name: Riverside Regional Hospital To: Kwame
Okafor 14 Offer of Coverage (enter required code) All 12 Months
1E 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2D 15 Employee Required Contribution (see instructions) 2,157.63 Form 1095-C Employer-Provided Health Insurance Offer and Coverage",1095,3,1095,fdc-23c42161d172b52f9f78511a,v11-1095-C-flat,original,2024,fgen-549cefece1b0d8676576ea96,synthetic_programmatic_template,flat,bottom,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage OMB No. 1545-2251 VOID CORRECTED Part I Employee Blue Heron Logistics LLC 4595 Elm Park Pl Cedar Falls, IA 15182 7 Name of employer 53-9192574 Applicable Large Employer Member (Employer) Morgan B. Adeyemi 8 Employer identification number (EIN) ending in 4579 Street address (including apt. no.) 2027 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 62549 15 Employee Required Contribution (see
instructions) $3,068.26 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable)
2D Plan Start Month (enter 2-digit number) 01 Department of the Treasury - Internal Revenue Service Form 1095-C (keep for your records) www.irs.gov/Form1095C",1095,3,1095,fdc-39dfc1ba18a3553fbe7f3f3b,v11-1095-C-flat,original,2026,fgen-b3e5bd72507fd977b57b6c28,synthetic_programmatic_template,flat,top,False,
"Part
I Employee'S name: Acme Test Corp To: Kwame Moreau 16 Section 4980H Safe Harbor and Other Relief (enter code, if
applicable) 2C Plan Start Month (enter 2-digit number) 12 15 Employee Required Contribution (see instructions) 1,683.08 14 Offer of Coverage (enter required code) All 12 Months 1A",1095,3,1095,fdc-ba0153e2ccec3ed03b98b2ad,v11-1095-C-flat,original,2024,fgen-07a634e50511b749094c3295,synthetic_programmatic_template,flat,none,False,
"2026 VOID CORRECTED Part I Employee Tri-County School District 1089 Maple Ridge Dr Maplewood, MN 53566 7
Name of employer 52-1614467 Applicable Large Employer Member (Employer) Morgan Sato 8 Employer identification number
(EIN) ***-**-0619 Account number (see instructions) ending in 013437 14 Offer of Coverage (enter required code) All 12 Months 1A 15 Employee Required Contribution (see instructions) 3,154.89 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2C Department of the Treasury - Internal Revenue Service Form 1095-C Employer-Provided Health Insurance Offer and Coverage Form 1095-C (keep for your records) www.irs.gov/Form1095C",1095,3,1095,fdc-7081e29c75907975c2bdf319,v11-1095-C-flat,original,2026,fgen-c06c8df1d9e549521fdb30f0,synthetic_programmatic_template,flat,bottom,False,
"Form 1095-C Employer-Provided Health
Insurance Offer and Coverage Part I Employee'S name: Maple Street Dental PC RECIPIENT: Sofia Rivera 14 Offer of Coverage (enter required code) All 12 Months 1A 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2D 15 Employee Required Contribution (see instructions) 3,128.09 Plan Start
Month (enter 2-digit number) 07",1095,3,1095,fdc-4f2b94e1cf26130a724936e1,v11-1095-C-flat,original,2022,fgen-ba26fedf462307c76f12ddd1,synthetic_programmatic_template,flat,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2022 OMB No. 1545-2251 VOID CORRECTED
Department of the Treasury Internal Revenue Service Part I Employee Riverside Regional Hospital 2432 Sample Street Riverton, WI 61927 7 Name of employer 37-2973045 Applicable Large Employer Member (Employer) Taylor S. Kowalski 8 Employer identification number (EIN) ending in 6268 Street address (including apt. no.) 4639 Oak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Testville, IL 92434 Account number (see instructions) XXXXX350540 15 Employee Required Contribution (see instructions) $1,426.42 16 Section 4980H Safe Harbor and Other Relief (enter code, if
applicable) 2H Plan Start Month (enter 2-digit number) 02 Department of the Treasury - Internal Revenue Service Form 1095-C (keep for your records) www.irs.gov/Form1095C",1095,3,1095,fdc-243a94a6f283afd3e7b9af1b,v11-1095-C-flat,original,2022,fgen-648ba675d1bfb377179756e4,synthetic_programmatic_template,flat,top,False,
"Form 1095-C Employer-Provided
Health Insurance Offer and Coverage Part I Employee: BlueHeron
Logistics LLC RECIPIENT: Taylor A. Kowalski 14 Offer of Coverage (enter required code) All 12 Months 1E",1095,3,1095,fdc-84a7558e71b33f93808f9c54,v11-1095-C-flat,original,2024,fgen-00501db0f2fc0e1ad0f5892a,synthetic_programmatic_template,flat,top,True,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2022 Part I Employee Granite Peak Manufacturing Co. 1001 Sample Street Testville, IL 44604 7 Name of employer 63-5076491 Applicable Large Employer Member (Employer) Wei L. Sato
8 Employer identification
number (EIN) XXXXX1129 14 Offer of Coverage (enter required code) All 12 Months 1A",1095,3,1095,fdc-8385dcd196d06d5242ca2a36,v11-1095-C-flat,original,2022,fgen-67bdc2fd395283cfe4a1d6e2,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED 2025 OMB No. 1545-2251 Department of the Treasury Internal Revenue Service Part
I Employee Acme Test Corp 7506 Maple Ridge Dr Cedar Falls, IA 80775 7 Name of employer 38-3762637 Applicable Large Employer Member (Employer) Fatima A. Okafor 8 Employer identification number (EIN) ****7697 Street address (including apt. no.) 1912 Lakeshore Blvd City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 66588 Account number (see instructions) ending in 011183 14 Offer of Coverage (enter required code) All 12 Months 1E 15 Employee Required Contribution (see instructions) 2,050.29 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2D Plan Start Month (enter 2-digit number) 03 Department of
the Treasury - Internal Revenue Service Form 1095-C Employer-Provided Health Insurance Offer and Coverage Form 1095-C (keep for your records) www.irs.gov/Form1095C",1095,3,1095,fdc-d1e8c0f519c7d73599a6e7ab,v11-1095-C-flat,original,2025,fgen-987181a5b74182ef2dcbc967,synthetic_programmatic_template,flat,bottom,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2023 Part I Employee:
Copperline Software Inc. Recipient's name: Amara Moreau Plan
Start Month (enter 2-digit number) 01 14 Offer of Coverage (enter required code) All 12 Months 1E",1095,3,1095,fdc-6db0277561414ab0e527d68e,v11-1095-C-flat,original,2023,fgen-7d7817c54e87c26a182e2e0c,synthetic_programmatic_template,flat,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage For calendar year 2023 OMB No. 1545-2251 VOID CORRECTED Department of the Treasury Internal Revenue Service Part I Employee Tri-County School District 2718 Granite St Bayside, WA 22276 7 Name of employer 60-3186838 Applicable Large Employer Member (Employer) Priya Moreau 8
Employer identification number (EIN) XXXXX8702 Street address (including apt. no.) 10 Willow Bend
Way City or town, state or province, country, and ZIP or foreign postal code Testville, IL 47566 14 Offer of Coverage (enter required code) All 12 Months 1E 15 Employee Required Contribution (see instructions) 6,757.80 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2D Plan Start Month (enter 2-digit number) 11 Department of the Treasury - Internal Revenue Service Form 1095-C (keep for your records) www.irs.gov/Form1095C",1095,3,1095,fdc-4a1a2fa18e9d40565f850d1a,v11-1095-C-flat,original,2023,fgen-5743a65d655ca7529fa71be3,synthetic_programmatic_template,flat,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and
Coverage 2021 Part I Employee: Granite Peak Manufacturing Co. To: Amara Romero 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2D 14 Offer of Coverage (enter required code) All 12 Months 1A Plan Start Month
(enter 2-digit number) 10",1095,3,1095,fdc-76bf28bfc72b3e8fca12e40b,v11-1095-C-flat,original,2021,fgen-f1608effa188aebca7a99ec2,synthetic_programmatic_template,flat,top,False,
"Form 1095-C Employer-Provided Health Insurance Offer and Coverage OMB No. 1545-2251 VOID CORRECTED Part I Employee Blue Heron Logistics LLC 4597 Cedar Ln Brookhaven, PA 12857 7 Name of employer 30-6617023 Applicable Large Employer Member (Employer) Wei S. Adeyemi 8 Employer identification number (EIN) XXXXX3154 Account number (see instructions) ***-**-915732 14 Offer of Coverage (enter required code) All 12 Months 1A 15 Employee Required Contribution (see instructions) $420.73 16 Section 4980H Safe Harbor and Other Relief (enter code, if applicable) 2D Plan
Start Month (enter 2-digit number) 04 Department of the Treasury
- Internal Revenue Service Form 1095-C (keep for your records) www.irs.gov/Form1095C",1095,3,1095,fdc-9ba4370d3736f4a22e6b74ed,v11-1095-C-flat,original,2022,fgen-f38e3031706bea4b4ea7ebef,synthetic_programmatic_template,flat,top,False,
"Form 1095-C Employer-ProvidedHealth Insurance Offer and Coverage 2O21 Department of the Treasury Intemal Revenue Service Part IEmployee Maple Street Dental PC 4302 Oak Hollow Ct Baysíde, WA 30790 7 Name of employer 56-l066688 Applicable
Large Employer Member (Employer)
Taylor C. Haddad 8 Employer identíficationnumber (EIN) ***-**-1136 Street address (including apt. no.) 8266 Granite St City or town, state or province, country, and ZIPor foreign postal code Riverton, WI 76381 14 0ffer of Coverage (enter required code) A1l 12 Months 1E 15 Employee Required Contribution (see instructions) $5,381.24 16 5ection 498OH Safe Harbor and Other Relief (enter code, if applicable) 2D",1095,3,1095,fdc-bd4373b21912b3ef85ff7ddc,v11-1095-C-flat,original,2021,fgen-c7205f6d2a9020aa51ff42fc,synthetic_programmatic_template,flat,top,True,
"Form
1095-C Employer-Providcd Health Insurance Offer and Coverage 2022 Part I Employee: Blue Heron Logistics LLC Recipient's name: Taylor S. Patel 14 0ffer of Coverage (enter required code) All 12 Months 1E 15Employce Required Contribution (see instructions) 3,799.70
Plan Start Month (enter 2-digit number) 04",1095,3,1095,fdc-b45763cc882301d4107fe1f7,v11-1095-C-flat,original,2022,fgen-a8bb94017a00acc782fef84b,synthetic_programmatic_template,flat,top,True,
"Form 1098 Mortgage Interest Statement 2021
RECIPIENT:
RECIPIENT:
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
2 Outstanding mortgage principal
1 Mortgage interest received from payer(s)/borrower(s)
Riverbend Mortgage Servicing
Hiro Patel
1841 Elm Park Pl Brookhaven, PA 42856
1
197,790.45
$70,145.75",1098,4,1098,fdc-e7f3fae9eda06472a725c1a5,v11-1098-columns,original,2021,fgen-c6a750cd03550e1a9bd8f80f,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1098
Mortgage Interest Statement
For calendar year 2026
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
4 Refund of overpaid interest
6 Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
10 Other
11 Mortgage acquisition date
Lakeshore Home Lending 2731 Lakeshore Blvd Oak Grove, TX 23889
91-6413258
Lena Haddad
****0934
362 Granite St
Cedar Falls, IA 55593
$36,936.88
112,977.92
12/8/25
9568 Harbor View Rd Bayside, WA 86546
1
2,911.96
07/12/2026
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-7d459101d804b37904e8857b,v11-1098-columns,original,2026,fgen-6793dd8bb43f986229c14a5e,synthetic_programmatic_template,columns,top,False,
"Form 1098
Mortgage Interest Statement
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
4 Refund of overpaid interest
6 Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
10 Other
11 Mortgage acquisition date
Bluewater Loan Servicing 4824 Elm Park Pl Cedar Falls, IA 46819
13-4174850
Morgan Patel
XXXXX7040
8557 Granite St
Maplewood, MN 22830
$15,908.25
$502,507.49
August 2, 2021
8227 Harbor View Rd Pinecrest, GA 15409
1
3,285.42
2019-01-28
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-d2d9175280c6b6bf43c1b787,v11-1098-columns,original,2022,fgen-98903a507504c89bce015592,synthetic_programmatic_template,columns,top,False,
"Form 1098
Mortgage Interest Statement
2023
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
4 Refund of overpaid interest
6 Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
10 Other
11 Mortgage acquisition date
Bluewater Loan Servicing 2113 Lakeshore Blvd Brookhaven, PA 49567
90-2086662
Riley Walsh
***-**-3382
7823 Harbor View Rd
Lakewood, CO 44624
ending in 251684
$107,879.13
403,220.71
9/8/22
3841 Oak Hollow Ct Cedar Falls, IA 97804
1
4,395.87
2023-04-05
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-fd8bc6911f454aab76e85bec,v11-1098-columns,original,2023,fgen-9b445d7e1c4b1c235130b291,synthetic_programmatic_template,columns,top,False,
"2026
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
5 Mortgage insurance premiums
6 Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
10 Other
Riverbend Mortgage Servicing 3213 Maple Ridge Dr Lakewood, CO 35517
62-2056545
Taylor Okafor
ending in 8569
1335 Lakeshore Blvd
Riverton, WI 88288
ending in 388536
89,093.47
$339,077.24
03/05/2026
$0.00
7104 Harbor View Rd Cedar Falls, IA 61953
1
$9,242.33
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-62eb48ebedfe4faee85c0ee5,v11-1098-columns,original,2026,fgen-26ef6e48542a357f9eeefe40,synthetic_programmatic_template,columns,none,False,
"Form 1098
Mortgage Interest Statement
Copy B For Payer/Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
4 Refund of overpaid interest
5 Mortgage insurance premiums
6 Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
10 Other
11 Mortgage acquisition date
Riverbend Mortgage Servicing 3448 Harbor View Rd Pinecrest, GA 53783
94-8603511
Casey Romero
****6243
1648 Prairie Ave
Riverton, WI 53484
XXX-XX-676373
68,270.16
$405,663.03
10/21/2022
$0.00
$0.00
$0.00
8155 Willow Bend Way Pinecrest, GA 13147
1
4,593.45
2021-02-02
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-d3ed8f658e56c95b4547ce84,v11-1098-columns,original,2022,fgen-4c09b693e7c78e6c8a64d4a0,synthetic_programmatic_template,columns,top,False,
"Form 1098 Mortgage Interest Statement
From:
Recípient's name:
1 Mortgageinterest received from payer(s)/borrower(s)
1O Other
Riverbend Mortgage Servicing
Kwame K. Okafor
118,338.67
$987.61",1098,4,1098,fdc-49745a6ca217e40aa9ee76f5,v11-1098-columns,original,2025,fgen-e961c0f84ff445eed35a277f,synthetic_programmatic_template,columns,top,True,
"Form 1098
Mortgage Interest Statement
2026
OMB No. 1545-1380
Copy B For Payer/Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
Account number (see instructions)
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
4 Refund of overpaid interest
5 Mortgage insurance premiums
6 Points paid on purchase of principal residence
9 Number of properties securing the mortgage
10 Other
11 Mortgage acquisition date
Lakeshore Home Lending 3862 Granite St Oak Grove, TX 46619
34-9201309
Wei R. Lindqvist
XXXXX9606
XXXXX752605
19,984.64
543,689.16
9/5/23
1
9,128.19
2026-12-05",1098,4,1098,fdc-b0cad1baea06639c128259ab,v11-1098-columns,original,2026,fgen-dfbd47981cec304e248e4aa8,synthetic_programmatic_template,columns,top,False,
"Form 1098 Mortgage Interest Statement
RECIPIENT'S name:
Recipient's name:
11 Mortgage acquisition date
3 Mortgage origination date
9 Number of properties securing the mortgage
10 Other
Pinecrest Mortgage Company
Sofia Nguyen
November 12, 2025
12/11/2025
1
$1,542.47",1098,4,1098,fdc-45de019f5fb2814384a33a9b,v11-1098-columns,original,2025,fgen-f85888ed10eafc7382fbfc38,synthetic_programmatic_template,columns,top,False,
"Form 1098
Mortgage Interest Statement
For calendar year 2025
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
4 Refund of overpaid interest
5 Mortgage insurance premiums
6 Points paid on purchase of principal residence
9 Number of properties securing the mortgage
10 Other
11 Mortgage acquisition date
Lakeshore Home Lending 5150 Cedar Ln Testville, IL 37247
81-2789610
Fatima Patel
XXX-XX-4875
120,239.28
115,844.73
2025-05-21
$0.00
1
$1,791.36
2025-07-10
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-7b1d69da83ed438efac3efe5,v11-1098-columns,original,2025,fgen-f2bdd0b67707f3b9d6870353,synthetic_programmatic_template,columns,top,False,
"Form 1098
Mortgage Interest Statement
2024
OMB No. 1545-1380
Copy B For Payer/Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principal
3 Mortgage origination date
4 Refund of overpaid interest
5 Mortgage insurance premiums
6 Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
10 Other
Keystone Home Loans 4347 Elm Park Pl Pinecrest, GA 74780
84-6589937
Avery Castillo
XXXXX7841
$104,956.19
$559,256.17
11/6/24
0.00
4648 Sample Street Bayside, WA 27197
1
9,382.34",1098,4,1098,fdc-ca76e837396b2a07aa5c2e3a,v11-1098-columns,original,2024,fgen-394494cca3e30393015e338e,synthetic_programmatic_template,columns,top,False,
"Form 1098
Mortgage Interest Statement
For calendar year 2025
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Outstanding mortgage principal
4 Refund of overpaid interest
6 Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
10 Other
11 Mortgage acquisition date
Riverbend Mortgage Servicing 4895 Lakeshore Blvd Fairview, OH 32639
60-5173229
Noah Sato
XXXXX8659
5622 Elm Park Pl
Riverton, WI 20164
267,139.23
0.00
6792 Sample Street Oak Grove, TX 23147
1
$5,992.74
01/06/2022
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-abf56f746f8c2316a6b9c3f5,v11-1098-columns,original,2025,fgen-abc692ed3ad0aaafd0c04c12,synthetic_programmatic_template,columns,top,False,
"RECIPIENT:
Recipient's name:
10 0ther
8 Address or description of property securing mortgage
3 Mortgage origination date
2 Outstanding mortgage principa1
Bluewater Loan Servicing
Fatima Haddad
$4,255.28
576 Harbor ViewRd Oak Grove, TX 13O19
08/17/2025
466,835.14",1098,4,1098,fdc-33273168fe27996a741df0fe,v11-1098-columns,original,2026,fgen-28a2d9b974a4b4d57f618425,synthetic_programmatic_template,columns,none,True,
"RECIPIENT'S name:
RECIPIENT:
3 Mortgage origination date
11 Mortgage acquisition date
Lakeshore Home Lending
Amara Adeyemi
12/06/2024
March 8, 2021
Form 1098 Mortgage Interest Statement",1098,4,1098,fdc-5accf34c293d5feb725ea820,v11-1098-columns,original,2024,fgen-5732bd39ad70123d8631651c,synthetic_programmatic_template,columns,bottom,False,
"Form 1098
Mortgage Interest Statement
OMB No. 1545-1380
Copy B ForPayer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being fumished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town,state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/B0RR0WER'S name
PAYER'S/BORROWER'S TIN
Account number (see ínstructions)
1 Mortgage interest received from payer(s)/borrower(s)
2 Outstanding mortgage principa1
3 Mortgage origination date
4 Refund of overpaid interest
5 Mortgage insurance premiums
6Points paid on purchase of principal residence
8 Address or description of property securing mortgage
9 Number of properties securing the mortgage
lO Other
11 Mortgage acquisition date
Keystone Home Loans 8202 5ample 5treet Fairview, OH 15010
18-2471988
Noah Testcase
****3464
ending in 501916
34,913.48
590,619.06
March 3, 2022
$0.00
8868 5ample Street Oak Grove, TX 26677
1
2,883.34
2022-01-04
Department of the Treasury - Intema1 Revenue Servíce
Form lO98 (keepforyour records)  www.irs.gov/Form1098",1098,4,1098,fdc-02830ac9ec7f075079ceb4fa,v11-1098-columns,original,2025,fgen-0474fa915db37858dd79a8b2,synthetic_programmatic_template,columns,top,True,
"2025
OMB No. 1545-1380
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S namc, street address, city or town, stateor province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S TIN
PAYER'S/BORROWER'S name
PAYER'S/BORROWER'S TIN
1 Mortgage interest received from payer(s)/borrower(s)
3 Mortgage origination date
4 Refund of overpaid interest
5 Mortgage insurance premiums
6 Points paid on purchasc of principal rcsidence
8 Address ordescription of property securing mortgage
9 Number of properties securing the mortgage
lO Other
l1 Mortgage acquisition date
B1uewater Loan 5ervicing 1164 Maple Ridge Dr Fairview, OH 58285
32-6664085
Amara Brennan
ending in 6500
S104,839.51
2022-10-02
$0.00
3506Maple Ridge Dr Oak Grove, TX 12748
1
$16.84
l2/26/24
Department ofthe Treasury - Intemal Revenue 5ervice
Form 1O98
Mortgage Interest 5tatement
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-7fa743b4345fbd86f0824af9,v11-1098-columns,original,2025,fgen-479aae25624992655fc74540,synthetic_programmatic_template,columns,bottom,True,
"For calendar year 2022
OMB No. 1545-1380
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Keystone Home Loans 3510 Oak Hollow Ct Fairview, OH 89725
RECIPIENT'S/LENDER'S TIN: 84-4090640
PAYER'S/BORROWER'S name: Fatima Brennan
PAYER'S/BORROWER'S TIN: ***-**-1977
Street address (including apt. no.): 5834 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 44648
Line 1 Mortgage interest received from payer(s)/borrower(s): 56,141.56
Line 2 Outstanding mortgage principal: $126,563.38
Line 3 Mortgage origination date: 09/26/2021
Line 4 Refund of overpaid interest: $0.00
Line 5 Mortgage insurance premiums
Line 6 Points paid on purchase of principal residence
Line 9 Number of properties securing the mortgage: 1
Line 10 Other: $9,095.31
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-5bfe09ed521dc9fb86fcbf26,v11-1098-boxed,original,2022,fgen-199edcdf7c8f91cfff692ca8,synthetic_programmatic_template,boxed,none,False,
"Form 1098
Mortgage Interest Statement
2025
OMBNo. 1545-l380
Thc ínformation in boxes 1 through 9 and 11 is important tax information and is being furnished tothe IRS.
RECIPIENT'S/LENDER'S name, street address, cíty or town, state or provínce, country, ZIPor foreign postal code, and telephone no.: Riverbend Mortgage 5ervicing 4730 Prairie Ave Testville, IL 46071
RECIPIENT'S/LENDER'S TIN: 93-7840433
PAYER'S/B0RROWER'S name: Wei Okafor
PAYER'S/BORROWER'S TIN: XXX-XX-5974
1 Mortgage interest received from payer(s)/borrower(s): 93,027.03
2 Outstanding mortgagc principa1: 614,362.39
3 Mortgage origination date: 2025-02-10
5 Mortgage insurance premiums
6 Points paid on purchase of príncipalresidence
8 Address or description of property securing mortgage: 7094 Willow Bend Way Bayside, WA 21295
9 Number of properties securing the mortgage: 1
10 0ther: $8,180.07
11 Mortgage acquisition date: 8/8/22
Department of the Treasury - Intema1 Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1O98",1098,4,1098,fdc-7430358ca204b863389b4854,v11-1098-boxed,original,2025,fgen-33a0216f63bb28e97f1b9003,synthetic_programmatic_template,boxed,top,True,
"Form 1098
Mortgagc Interest Statement
OMB No. 1545-1380
The ínformation in boxes 1 through 9 and 11 is important tax information and is bcing furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no.: Bluewater Loan Servicing 5638 Cedar Ln Cedar Falls, IA 25107
RECIPIENT'S/LENDER'S TIN: 31-1287169
PAYER'S/B0RROWER'S name: Hiro Fischer
PAYER'5/BORROWER'S TIN:ending in 6499
Account number (see instructions): endingin 765933
Line l Mortgage interest received from payer(s)/borrower(s): l3O,174.08
Line 2 Outstanding mortgage principal: S177,O74.57
Line 3 Mortgage origination date: 2021-01-06
Line4 Refundof overpaid interest: 0.00
Line 5 Mortgage insurance premiums
Line 6 Points paid on purchase of principal residence
Line 10 0ther: 270.08
Line 11 Mortgage acquisition date: 11/12/21
Department of the Treasury -Intema1 Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-894f33003e71d3a593864fcb,v11-1098-boxed,original,2021,fgen-ebec4ede24e58f7d8483c088,synthetic_programmatic_template,boxed,top,True,
"2024
OMB No. 1545-1380
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Keystone Home Loans 2935 Lakeshore Blvd Riverton, WI 96564
RECIPIENT'S/LENDER'S TIN: 85-7626950
PAYER'S/BORROWER'S name: Noah Kowalski
PAYER'S/BORROWER'S TIN: ending in 9408
Line 2 Outstanding mortgage principal: $567,885.10
Line 3 Mortgage origination date: October 25, 2021
Line 4 Refund of overpaid interest: 0.00
Line 5 Mortgage insurance premiums
Line 8 Address or description of property securing mortgage: 3003 Harbor View Rd Bayside, WA 38141
Line 9 Number of properties securing the mortgage: 1
Line 10 Other: $6,135.94
Line 11 Mortgage acquisition date: 2024-11-19
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-8d9108994535393a82654fc4,v11-1098-boxed,original,2024,fgen-02aa98b38577729ba52382c6,synthetic_programmatic_template,boxed,none,False,
"Form 1098
Mortgage Interest Statement
Copy B For Payer/Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bluewater Loan Servicing 5138 Sample Street Bayside, WA 26095
RECIPIENT'S/LENDER'S TIN: 31-5442371
PAYER'S/BORROWER'S name: Wei M. Adeyemi
PAYER'S/BORROWER'S TIN: XXX-XX-0708
Street address (including apt. no.): 7144 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 10695
Box 1 Mortgage interest received from payer(s)/borrower(s): 106,590.22
Box 2 Outstanding mortgage principal: 513,611.41
Box 3 Mortgage origination date: 11/18/18
Box 4 Refund of overpaid interest
Box 5 Mortgage insurance premiums
Box 6 Points paid on purchase of principal residence
Box 8 Address or description of property securing mortgage: 424 Prairie Ave Maplewood, MN 79952
Box 9 Number of properties securing the mortgage: 1
Box 11 Mortgage acquisition date: 2018-06-25
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-7cdbb527c6fbfcc3b13523ad,v11-1098-boxed,original,2021,fgen-6ede0fc77aca38bd4f21b35e,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
For calendar year 2025
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Lakeshore Home Lending 2318 Sample Street Pinecrest, GA 86574
RECIPIENT'S/LENDER'S TIN: 52-9308641
PAYER'S/BORROWER'S name: Wei K. Haddad
PAYER'S/BORROWER'S TIN: XXXXX6957
Street address (including apt. no.): 196 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 43004
Box 1 Mortgage interest received from payer(s)/borrower(s): $123,243.20
Box 2 Outstanding mortgage principal: 541,057.90
Box 4 Refund of overpaid interest: 0.00
Box 5 Mortgage insurance premiums: 0.00
Box 6 Points paid on purchase of principal residence
Box 8 Address or description of property securing mortgage: 4658 Harbor View Rd Bayside, WA 84767
Box 9 Number of properties securing the mortgage: 1
Box 10 Other: 4,239.56
Box 11 Mortgage acquisition date: 2022-08-16
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-1c118135927976af7612f7f7,v11-1098-boxed,original,2025,fgen-8376bc030cc2d87adbf5eb55,synthetic_programmatic_template,boxed,none,False,
"Form 1098
Mortgage Interest Statement
2022
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Lakeshore Home Lending 3396 Oak Hollow Ct Testville, IL 86640
RECIPIENT'S/LENDER'S TIN: 47-2787213
PAYER'S/BORROWER'S name: Riley Haddad
PAYER'S/BORROWER'S TIN: XXXXX9359
Street address (including apt. no.): 6586 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 16251
Line 1 Mortgage interest received from payer(s)/borrower(s): $18,164.96
Line 3 Mortgage origination date: 05/01/2019
Line 4 Refund of overpaid interest
Line 5 Mortgage insurance premiums
Line 6 Points paid on purchase of principal residence
Line 8 Address or description of property securing mortgage: 940 Harbor View Rd Testville, IL 83113
Line 9 Number of properties securing the mortgage: 1
Line 10 Other: $289.13
Line 11 Mortgage acquisition date: 2022-06-28
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-07aa804c364dc8d3cff3aa84,v11-1098-boxed,original,2022,fgen-4a8dae081abd7f035a09704d,synthetic_programmatic_template,boxed,top,False,
"Form 1098 Mortgage Interest Statement
From:: Riverbend Mortgage Servicing
RECIPIENT:: Wei Fischer
1 Mortgage interest received from payer(s)/borrower(s): $7,847.30
2 Outstanding mortgage principal: 599,550.93",1098,4,1098,fdc-813d8bcfd7ced6ebf1dc6260,v11-1098-boxed,original,2026,fgen-7dcee7457cba8f93b4b87be7,synthetic_programmatic_template,boxed,top,False,
"For calendar year 2025
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IR5.
RECIPIENT'S/LENDER'S namc, street address, cíty or town, state or province, country, ZIP or foreign postal code, and telephone no.: Keystone Home Loans 5667 Cedar Ln Oak Grove, TX 38291
RECIPIENT'S/LENDER'S TIN: 1O-4274723
PAYER'S/BORROWER'S name:Priya Tanaka
PAYER'S/B0RROWER'S TIN: ending in O519
Street address (inc1uding apt. no.): 6867 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 33962
Account number (see instructions): ending in 621248
Box lMortgage interest reccived frompayer(s)/borrower(s): S5,079.37
Box 2 0utstanding mortgage principal: 613,792.25
Box 3 Mortgage origination date: 8/17/25
Box 4 Refund of overpaid interest: $0.00
Box 5 Mortgage insurance premiums
Box 6 Points paid on purchaseof principal residence: $0.00
Box 8 Address ordescríption of property securing mortgage: 4575 Willow Bend WayBayside, WA 10495
Box 9 Number of properties securing the mortgage: l
Box 10 Other: 7,705.13
Box 11 Mortgage acquísitiondate: March 14, 2O24
Department of thc Treasury - Intemal Revenue 5ervice
Form 1098
Mortgage Interest Statement
Form 1098 (keep for your records)  www.írs.gov/Form1098",1098,4,1098,fdc-631bdbf2b9126f9529df5ab2,v11-1098-boxed,original,2025,fgen-1bc007e6484dc60229a06f3d,synthetic_programmatic_template,boxed,bottom,True,
"CORRECTED (if checked)
Form 1098
Mortgage Interest Statement
For calendar year 2024
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bluewater Loan Servicing 870 Sample Street Brookhaven, PA 20033
RECIPIENT'S/LENDER'S TIN: 46-3958247
PAYER'S/BORROWER'S name: Taylor Haddad
PAYER'S/BORROWER'S TIN: ending in 5402
Line 1 Mortgage interest received from payer(s)/borrower(s): 90,838.83
Line 2 Outstanding mortgage principal: 96,118.25
Line 5 Mortgage insurance premiums
Line 6 Points paid on purchase of principal residence: $0.00
Line 8 Address or description of property securing mortgage: 6679 Cedar Ln Testville, IL 22105
Line 9 Number of properties securing the mortgage: 1
Line 10 Other: $4,864.99
Line 11 Mortgage acquisition date: 2024-07-22
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-2f7a364a974c6e9cf3c4fbfb,v11-1098-boxed,original,2024,fgen-771a4d63670cc62244d6b516,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
Form 1098
Mortgage Interest Statement
For calendar year 2023
OMB No. 1545-1380
Copy B For Payer/Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Keystone Home Loans 8040 Sample Street Testville, IL 10860
RECIPIENT'S/LENDER'S TIN: 51-2490861
PAYER'S/BORROWER'S name: Kwame K. Rivera
PAYER'S/BORROWER'S TIN: ****5199
Line 1 Mortgage interest received from payer(s)/borrower(s): $139,086.07
Line 2 Outstanding mortgage principal: $443,342.64
Line 4 Refund of overpaid interest: 0.00
Line 5 Mortgage insurance premiums: $0.00
Line 8 Address or description of property securing mortgage: 4822 Elm Park Pl Lakewood, CO 11335
Line 9 Number of properties securing the mortgage: 1
Line 10 Other: 6,233.70
Line 11 Mortgage acquisition date: 3/19/20
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-87a9dc993a4a379190b543bb,v11-1098-boxed,original,2023,fgen-4c540842db3a81edc28ba94a,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 1098
Mortgage Interest Statement
For calendar year 2026
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Mortgage Servicing 110 Oak Hollow Ct Pinecrest, GA 24077
RECIPIENT'S/LENDER'S TIN: 24-2991037
PAYER'S/BORROWER'S name: Amara Adeyemi
PAYER'S/BORROWER'S TIN: XXX-XX-4810
Line 1 Mortgage interest received from payer(s)/borrower(s): $30,352.16
Line 2 Outstanding mortgage principal: $623,119.52
Line 3 Mortgage origination date: May 1, 2023
Line 4 Refund of overpaid interest
Line 5 Mortgage insurance premiums: 0.00
Line 6 Points paid on purchase of principal residence
Line 8 Address or description of property securing mortgage: 2279 Harbor View Rd Lakewood, CO 59375
Line 10 Other: $471.18
Line 11 Mortgage acquisition date: 02/13/2023",1098,4,1098,fdc-ed56a7c958d358f0f440c734,v11-1098-boxed,original,2026,fgen-80490149da177cccb0d2e412,synthetic_programmatic_template,boxed,top,False,
"Form 1098 Mortgage Interest Statement
From:: Bluewater Loan Servicing
RECIPIENT:: Fatima Patel
Box 11 Mortgage acquisition date: 12/21/2024
Box 8 Address or description of property securing mortgage: 6292 Granite St Bayside, WA 54422",1098,4,1098,fdc-b688523267c1faac8d23b8a9,v11-1098-boxed,original,2024,fgen-fb3a88b261dbf59647f43f0f,synthetic_programmatic_template,boxed,top,False,
"Form 1098
Mortgage Interest Statement
OMB No. 1545-1380
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Pinecrest Mortgage Company 9362 Granite St Bayside, WA 70808
RECIPIENT'S/LENDER'S TIN: 18-5927185
PAYER'S/BORROWER'S name: Wei Sato
PAYER'S/BORROWER'S TIN: XXXXX7228
Street address (including apt. no.): 1502 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 82427
Line 1 Mortgage interest received from payer(s)/borrower(s): 135,653.74
Line 2 Outstanding mortgage principal: 465,115.47
Line 3 Mortgage origination date: 2/6/23
Line 4 Refund of overpaid interest
Line 5 Mortgage insurance premiums: 0.00
Line 6 Points paid on purchase of principal residence
Line 8 Address or description of property securing mortgage: 8435 Elm Park Pl Bayside, WA 63034
Line 9 Number of properties securing the mortgage: 1
Line 11 Mortgage acquisition date: January 8, 2023
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-2d60aebc6f4bce21f398438d,v11-1098-boxed,original,2023,fgen-0f5f3fffc0434654fc209455,synthetic_programmatic_template,boxed,top,False,
"Form 1098
Mortgage Interest Statement
For calendar year 2025
OMB No. 1545-1380
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Keystone Home Loans 1303 Willow Bend Way Cedar Falls, IA 76945
RECIPIENT'S/LENDER'S TIN: 95-4066842
PAYER'S/BORROWER'S name: Wei Rivera
PAYER'S/BORROWER'S TIN: ****6043
Street address (including apt. no.): 7795 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 50444
Account number (see instructions): ending in 440001
1 Mortgage interest received from payer(s)/borrower(s): 40,942.98
2 Outstanding mortgage principal: $277,564.98
3 Mortgage origination date: 06/25/2025
4 Refund of overpaid interest: $0.00
5 Mortgage insurance premiums: 0.00
8 Address or description of property securing mortgage: 4925 Maple Ridge Dr Oak Grove, TX 16622
9 Number of properties securing the mortgage: 1
10 Other: 276.78
11 Mortgage acquisition date: 9/12/22",1098,4,1098,fdc-d7baf64e492a1152aff04ba1,v11-1098-boxed,original,2025,fgen-d6f99fe2309329c1a82b8f4a,synthetic_programmatic_template,boxed,top,False,
"Form 1098
Mortgage Interest Statement
2021
OMB No. 1545-1380
Copy B For Payer/Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bluewater Loan Servicing 5486 Lakeshore Blvd Maplewood, MN 22253
RECIPIENT'S/LENDER'S TIN: 71-8358740
PAYER'S/BORROWER'S name: Amara Walsh
PAYER'S/BORROWER'S TIN: XXX-XX-0123
1 Mortgage interest received from payer(s)/borrower(s): 133,504.05
2 Outstanding mortgage principal: $493,390.87
5 Mortgage insurance premiums: 0.00
6 Points paid on purchase of principal residence: 0.00
8 Address or description of property securing mortgage: 2267 Oak Hollow Ct Brookhaven, PA 65816
9 Number of properties securing the mortgage: 1
10 Other: $5,998.84
11 Mortgage acquisition date: October 4, 2021",1098,4,1098,fdc-9073b0bbfe7d2eedb07106bc,v11-1098-boxed,original,2021,fgen-161e4c58f5b881d48e06acb8,synthetic_programmatic_template,boxed,top,False,
"Form 1098 Mortgage Interest Statement RECIPIENT:
Bluewater Loan Servicing To:
Kwame Patel 2 Outstanding mortgage principal $381,639.48",1098,4,1098,fdc-343938a61532375d0b17893c,v11-1098-flat,original,2023,fgen-0758c264e70ca4b6e429aaed,synthetic_programmatic_template,flat,top,False,
"Form 1098 Mortgage Interest Statement 2026 RECIPIENT: Pinecrest Mortgage Company Recipient's name: Avery Adeyemi 2 Outstanding mortgage principal 350,214.71 9 Number of properties securing
the
mortgage 1",1098,4,1098,fdc-bb572546fa1abe38231b8c27,v11-1098-flat,original,2026,fgen-f1a332b53e8cc7bc61a80d6c,synthetic_programmatic_template,flat,top,False,
"Form 1098 Mortgage Interest Statement 2021 OMB No. 1545-1380 The information in boxes 1 through 9
and 11 is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Lakeshore Home Lending 311 Cedar Ln Fairview, OH 23395 RECIPIENT'S/LENDER'S TIN 88-9357040 PAYER'S/BORROWER'S name Lena K. Larsen PAYER'S/BORROWER'S TIN ****7572 Account number (see instructions) ****786028 1 Mortgage interest received from payer(s)/borrower(s) $10,753.60 2 Outstanding mortgage principal $424,047.73 4 Refund of overpaid interest 5 Mortgage insurance premiums 6 Points paid on purchase of principal residence 0.00 8 Address or description of property securing mortgage 5530 Maple Ridge Dr
Maplewood, MN 85788 9 Number of properties securing the mortgage 1 10 Other $2,691.43 11 Mortgage acquisition date 2/17/18 Department of the Treasury - Internal Revenue Service Form 1098 (keep for your records) www.irs.gov/Form1098",1098,4,1098,fdc-82dc2cf6270c9f28785f1be7,v11-1098-flat,original,2021,fgen-862c6d1447dc7ba6dad81e91,synthetic_programmatic_template,flat,top,False,
"2023 OMB No. 1545-1380 RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Lakeshore Home Lending 2196 Elm Park Pl Pinecrest, GA 49645 RECIPIENT'S/LENDER'S TIN 18-2535735 PAYER'S/BORROWER'S name Wei Haddad PAYER'S/BORROWER'S TIN XXXXX3304 Street address (including apt. no.) 1042 Lakeshore Blvd City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 67716 Account number (see instructions) ****370735 1
Mortgage interest received from payer(s)/borrower(s) $56,462.30 2 Outstanding mortgage principal $226,683.37 3 Mortgage origination date June 22, 2020 4 Refund of overpaid interest 5 Mortgage insurance premiums 6 Points paid on purchase of principal residence 0.00
8 Address or description of property securing mortgage 3916 Elm Park Pl Lakewood, CO 36803 9 Number of properties securing the mortgage 1 10 Other 5,181.94 Department of the Treasury - Internal Revenue Service Form 1098 Mortgage Interest Statement Form 1098 (keep for your records) www.irs.gov/Form1098",1098,4,1098,fdc-046e76a7ef923a50cded3a56,v11-1098-flat,original,2023,fgen-96cc9860ad67965e08643e23,synthetic_programmatic_template,flat,bottom,False,
"Form 1098 Mortgage Interest Statement RECIPIENT: Bluewater Loan Servicing To:
Jamie A. Walsh 9 Number of properties securing the mortgage 1 11 Mortgage acquisition date 10/23/2022 3 Mortgage origination date
2022-11-08",1098,4,1098,fdc-b56eb13c596170e40e64b31d,v11-1098-flat,original,2022,fgen-bfe29ccaa525f935a965f178,synthetic_programmatic_template,flat,top,False,
"Form 1098 Mortgage Interest Statement 2025 From: Lakeshore Home Lending Recipient's name: Casey Larsen 8 Address or description of property securing mortgage 7106 Cedar Ln Testville, IL 32754 11 Mortgage acquisition
date 5/14/25 3 Mortgage origination date 4/5/22 2 Outstanding
mortgage principal 326,234.72",1098,4,1098,fdc-0cf24a624a5be14db56dd2d4,v11-1098-flat,original,2025,fgen-1a4fd2e1049f91e8aeeacd10,synthetic_programmatic_template,flat,top,False,
"RECIPIENT'S name: Riverbend Mortgage Servicing RECIPIENT: Avery Fischer 1 Mortgage interest received from payer(s)/borrower(s)
96,348.65 Form 1098 Mortgage
Interest Statement",1098,4,1098,fdc-83001ab7f0ccf3190276c937,v11-1098-flat,original,2023,fgen-87e41f73d495f27fb4c8eb14,synthetic_programmatic_template,flat,bottom,False,
"From: Riverbend Mortgage Servicing To:
Alex Patel 11 Mortgage acquisition date 9/8/24 3 Mortgage origination date 10/18/2021
9 Number of properties securing the mortgage 1 2 Outstanding mortgage principal $422,166.57",1098,4,1098,fdc-1f163bf58d741231291c70f5,v11-1098-flat,original,2024,fgen-e1e7b93f62758e718cbb564b,synthetic_programmatic_template,flat,none,False,
"Form 1098 Mortgage Interest Statement 2024 OMB No. 1545-1380 The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Mortgage Servicing 8614 Maple Ridge Dr Testville, IL 47793 RECIPIENT'S/LENDER'S TIN 68-8122592 PAYER'S/BORROWER'S name Riley Tanaka PAYER'S/BORROWER'S TIN XXX-XX-9825 Street address (including apt. no.) 5421 Granite St City or town, state or province, country, and ZIP
or foreign postal code Maplewood, MN 69503 Account number (see instructions) ***-**-170792 2 Outstanding mortgage principal 198,482.88 3 Mortgage origination date 12/08/2024 4 Refund of overpaid interest $0.00 6 Points paid on purchase of principal residence $0.00 9 Number
of properties securing the mortgage 1 10 Other $2,037.81 11 Mortgage acquisition date 5/28/24 Department of the Treasury - Internal Revenue Service Form 1098 (keep for your records) www.irs.gov/Form1098",1098,4,1098,fdc-a86c58249becc4dda81ee511,v11-1098-flat,original,2024,fgen-fe4f8710ec01ac092a69a7db,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 1098 Mortgage Interest Statement OMB No. 1545-1380
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Pinecrest Mortgage Company 1840 Sample Street Testville, IL 85792 RECIPIENT'S/LENDER'S TIN 26-3475228 PAYER'S/BORROWER'S name Avery Testcase PAYER'S/BORROWER'S TIN ****1290 Street address (including apt. no.) 7515
Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 77498 Account number (see instructions) XXXXX538068 1 Mortgage interest received from payer(s)/borrower(s) $95,144.79 2 Outstanding mortgage principal 439,547.86 3 Mortgage origination date 1/8/25 4 Refund of overpaid interest 5 Mortgage insurance premiums $0.00 6 Points paid on purchase of principal residence 8 Address or description of property securing mortgage 8597 Lakeshore Blvd Cedar Falls, IA 13702 9 Number of properties securing the mortgage 1 10 Other $4,012.03 11 Mortgage acquisition date 11/21/25",1098,4,1098,fdc-c11836392e6a2b75a14c62e1,v11-1098-flat,original,2025,fgen-436bc3a1cdecc5ab22544fa3,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 1098 Mortgage Interest Statement 2026 OMB No. 1545-1380 Copy B For Payer/Borrower RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Mortgage Servicing 4895 Elm Park Pl Testville, IL 48414 RECIPIENT'S/LENDER'S TIN 30-6746194 PAYER'S/BORROWER'S name Taylor Sato PAYER'S/BORROWER'S TIN ending in 9426
Account number (see instructions) ***-**-337541 1 Mortgage interest received from payer(s)/borrower(s) 128,820.28 2 Outstanding mortgage principal $393,650.11 5 Mortgage insurance premiums 6 Points paid on purchase of principal residence 9 Number of properties securing the mortgage 1 10 Other 5,911.09 11 Mortgage acquisition date
07/26/2023 Department of the Treasury - Internal Revenue Service Form 1098 (keep for your records) www.irs.gov/Form1098",1098,4,1098,fdc-a0dc1e0b42872210e206d7c0,v11-1098-flat,original,2026,fgen-a36e78cbca0d1d58f352f385,synthetic_programmatic_template,flat,top,False,
"2026 Copy B For Payer/Borrower The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or
province, country, ZIP or foreign postal code, and telephone no. Bluewater Loan Servicing 3703 Elm Park Pl Bayside, WA 78556 RECIPIENT'S/LENDER'S TIN 66-8447971 PAYER'S/BORROWER'S name Alex E. Castillo PAYER'S/BORROWER'S TIN ending in 8561 3 Mortgage origination date 2023-01-28 4 Refund of overpaid interest $0.00 5 Mortgage insurance premiums $0.00 6 Points paid on purchase of principal residence 8 Address or description of property securing mortgage 1603 Sample
Street Maplewood, MN 35522 9 Number of properties securing the mortgage 1 11 Mortgage acquisition date 05/08/2026 Form 1098 Mortgage Interest Statement",1098,4,1098,fdc-4e5d60da6b5d9b5faaf56e34,v11-1098-flat,original,2026,fgen-61786a53ba2c7c46128ead1b,synthetic_programmatic_template,flat,bottom,False,
"Form 1098 Mortgage Interest Statement
2022 RECIPIENT: Bluewater
Loan Servicing Recipient's name: Olivia S. Adeyemi 8 Address or description of property securing mortgage 9301 Oak Hollow Ct Bayside, WA 19131 9 Number of properties securing the mortgage 1 1 Mortgage interest received from payer(s)/borrower(s) 114,566.31 10 Other 4,424.11",1098,4,1098,fdc-a9a7d661abd9e952afeb5caa,v11-1098-flat,original,2022,fgen-358db9869169d9b623016e1b,synthetic_programmatic_template,flat,top,False,
"Form 1098 Mortgage Interest Statement The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Keystone Home Loans 9003 Cedar Ln Riverton, WI 71375 RECIPIENT'S/LENDER'S TIN 52-1956374 PAYER'S/BORROWER'S name Lena Patel PAYER'S/BORROWER'S TIN XXXXX9292 Street address (including apt. no.)
2327 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Oak
Grove, TX 75373 1 Mortgage interest received from payer(s)/borrower(s) 51,873.81 2 Outstanding mortgage principal $543,682.42 3 Mortgage origination date 5/22/22 4 Refund of overpaid interest 0.00 5 Mortgage insurance premiums 8 Address or description of property securing mortgage 6429 Lakeshore Blvd Riverton, WI 90918 9 Number of properties securing the mortgage 1 10 Other 200.89",1098,4,1098,fdc-2392abe5f33b05f2d8b2f2a7,v11-1098-flat,original,2023,fgen-d2e9626e7b717d135bab50fb,synthetic_programmatic_template,flat,top,False,
"For calendar year 2021 OMB No. 1545-1380 The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Pinecrest Mortgage Company 4026 Sample Street Maplewood, MN 72061 RECIPIENT'S/LENDER'S TIN 44-9253799 PAYER'S/BORROWER'S name Sofia Moreau PAYER'S/BORROWER'S TIN ****5978 Street address (including apt. no.) 89 Oak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 20774 1 Mortgage interest received from payer(s)/borrower(s) 71,896.52 2 Outstanding mortgage principal $260,475.09 3 Mortgage origination date 08/13/2018 4 Refund of overpaid interest 5
Mortgage insurance premiums 6 Points paid on purchase of principal residence 8 Address or description of property securing
mortgage 9540 Oak Hollow Ct Bayside, WA 33944 9 Number of properties securing the mortgage 1 10 Other 8,674.56 Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-2dc63d9a5eda57612e2391c3,v11-1098-flat,original,2021,fgen-f138e4b425efd15e35b62897,synthetic_programmatic_template,flat,none,False,
"☐ CORRECTED Form 1098
Mortgage Interest Statement For calendar year 2022 OMB No. 1545-1380 Copy B For Payer/Borrower RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Lakeshore Home Lending 8001 Cedar Ln Cedar Falls, IA 28790 RECIPIENT'S/LENDER'S TIN 33-7667496 PAYER'S/BORROWER'S name Hiro Haddad PAYER'S/BORROWER'S TIN XXXXX0996 1 Mortgage interest received from payer(s)/borrower(s) 119,157.44 3 Mortgage origination date 2/15/19 4 Refund of overpaid interest $0.00 5 Mortgage insurance premiums 0.00 6 Points paid on purchase of principal
residence 8 Address or description of property securing mortgage 3626 Sample Street Lakewood, CO 77850 9 Number of properties securing the mortgage 1 10 Other 1,364.28 11 Mortgage acquisition date 09/11/2022 Department of the Treasury - Internal Revenue Service Form 1098 (keep for your records) www.irs.gov/Form1098",1098,4,1098,fdc-9775e8e08749d896da6b3151,v11-1098-flat,original,2022,fgen-43e43ab3cfe24e71103c0700,synthetic_programmatic_template,flat,top,False,
"2021
OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes1 through 9 and 11 is important tax information andis being furnished to the IRS.
| Fie1d | Value |
| --- | --- |
| RECIPIENT'S/LENDER'Sname, street address, cíty or town, state or province, country, ZIP or forcign postal code, and telephone no. | Keystone Home Loans 9l44 Cedar Ln Testville, IL 89587 |
| RECIPIENT'S/LENDER'S TIN | 53-9932113 |
|PAYER'S/B0RROWER'S name | Fatima Lindqvist |
| PAYER'5/BORROWER'S TIN | XXX-XX-6182 |
| Street address (induding apt. no.) | 6O1 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 655O7 |
| 1Mortgage interest received from payer(s)/borrower(s) | $74,728.36 |
| 3 Mortgage origination date | June 26, 2020 |
|4 Refund of overpaid interest |  |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of príncipa1 residence | 0.00 |
| 8 Address or descriptionof property securing mortgage | 9449 Harbor View Rd Brookhaven, PA 94311 |
| 9 Number of properties securing the mortgage | l |
| 10 0ther | 6,060.27 |
| 11 Mortgage acquisition datc | 8/28/21 |
Department of the Treasury - Intemal Revenue 5ervice",1098,4,1098,fdc-daad4c7f922d2bf55f463503,v11-1098-markdown,original,2021,fgen-e2a21ae08e41ddedb589f352,synthetic_programmatic_template,markdown,none,True,
"The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Keystone Home Loans 6418 Oak Hollow Ct Testville, IL 57084 |
| RECIPIENT'S/LENDER'S TIN | 26-5443083 |
| PAYER'S/BORROWER'S name | Morgan Larsen |
| PAYER'S/BORROWER'S TIN | ending in 3904 |
| Street address (including apt. no.) | 4249 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 94276 |
| 2 Outstanding mortgage principal | $510,118.00 |
| 3 Mortgage origination date | 05/23/2025 |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of principal residence | $0.00 |
| 8 Address or description of property securing mortgage | 4871 Granite St Bayside, WA 44016 |
| 10 Other | $6,290.75 |",1098,4,1098,fdc-9b6171b6d2b4a705776cdf7d,v11-1098-markdown,original,2025,fgen-b3049546962094a837383bf6,synthetic_programmatic_template,markdown,none,False,
"2023
## The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Keystone Home Loans 7875 Oak Hollow Ct Cedar Falls, IA 18602 |
| RECIPIENT'S/LENDER'S TIN | 58-8849842 |
| PAYER'S/BORROWER'S name | Avery Haddad |
| PAYER'S/BORROWER'S TIN | ***-**-1235 |
| Street address (including apt. no.) | 5227 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 16873 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 128,416.20 |
| 2 Outstanding mortgage principal | 465,578.11 |
| 3 Mortgage origination date | 12/26/22 |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of principal residence |  |
| 8 Address or description of property securing mortgage | 2760 Granite St Lakewood, CO 75215 |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | $5,436.64 |
| 11 Mortgage acquisition date | October 15, 2023 |",1098,4,1098,fdc-0dfaeaed765868797d61b281,v11-1098-markdown,original,2023,fgen-fe305654332a1749868a8841,synthetic_programmatic_template,markdown,none,False,
"## Form 1098
Mortgage Interest Statement
2025
## OMB No. 1545-1380
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Keystone Home Loans 7262 Lakeshore Blvd Riverton, WI 25964 |
| RECIPIENT'S/LENDER'S TIN | 88-1484822 |
| PAYER'S/BORROWER'S name | Fatima Brennan |
| PAYER'S/BORROWER'S TIN | XXX-XX-3199 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 92,136.17 |
| 2 Outstanding mortgage principal | $428,733.99 |
| 4 Refund of overpaid interest | 0.00 |
| 6 Points paid on purchase of principal residence | 0.00 |
| 8 Address or description of property securing mortgage | 4810 Sample Street Maplewood, MN 22776 |
| 10 Other | 2,468.11 |
| 11 Mortgage acquisition date | 10/17/22 |
## Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-f61dd1657eb8bcb7f8df4d8a,v11-1098-markdown,original,2025,fgen-53fc9b796389a8a0495978dd,synthetic_programmatic_template,markdown,top,False,
"Form 1098
Mortgage Interest Statement
OMB No. 1545-1380
Copy B For Payer/Borrower
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Pinecrest Mortgage Company 6681 Granite St Fairview, OH 57998 |
| RECIPIENT'S/LENDER'S TIN | 30-9319985 |
| PAYER'S/BORROWER'S name | Wei Adeyemi |
| PAYER'S/BORROWER'S TIN | XXX-XX-3454 |
| Street address (including apt. no.) | 6578 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 51579 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 63,074.08 |
| 2 Outstanding mortgage principal | 106,951.86 |
| 3 Mortgage origination date | 10/11/20 |
| 4 Refund of overpaid interest | 0.00 |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of principal residence |  |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | $4,659.30 |
| 11 Mortgage acquisition date | 2020-01-18 |
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-db5485642be640210c448f73,v11-1098-markdown,original,2023,fgen-aa15cabfcd0b646887eb58f7,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
## Form 1098
Mortgage Interest Statement
For calendar year 2026
## Copy B For Payer/Borrower
## The informatíon in boxes 1 through 9 and 11 is important tax information and is being fumished to the IRS.
|Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, cíty or town, state or province, country, ZIP orforeign postal code, and telephone no. | Bluewater Loan Servicing 922 Elm Park Pl 0ak Grove,TX 66153 |
| RECIPIENT'S/LENDER'S TIN | 69-6524535 |
| PAYER'S/BORROWER'S name | Lena Nguyen |
| PAYER'S/BORROWER'S TIN | ****O398 |
| 2 Outstandíng mortgage principal | $649,490.79 |
|3 Mortgagc orígínation date | February 16, 2023 |
| 5 Mortgage insurance premiums | 0.00 |
| 6 Points paid on purchase of principa1 residence |  |
| 9 Number of properties securing the mortgage | 1 |
|10 0ther | $3,889.51 |
| 11 Mortgage acquisition date | March 14, 2025 |",1098,4,1098,fdc-33a17ad54944b284f4f38e94,v11-1098-markdown,original,2026,fgen-e581c4fa02a333ba76db8a01,synthetic_programmatic_template,markdown,top,True,
"VOID  CORRECTED
Form 1098
## Mortgage Interest Statement
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Keystone Home Loans 4054 Elm Park Pl Brookhaven, PA 34954 |
| RECIPIENT'S/LENDER'S TIN | 95-9960394 |
| PAYER'S/BORROWER'S name | Amara K. Brennan |
| PAYER'S/BORROWER'S TIN | ****5709 |
| Street address (including apt. no.) | 4040 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 82043 |
| 1 Mortgage interest received from payer(s)/borrower(s) | $38,953.35 |
| 2 Outstanding mortgage principal | $167,632.64 |
| 3 Mortgage origination date | 12/10/2025 |
| 4 Refund of overpaid interest |  |
| 6 Points paid on purchase of principal residence |  |
| 8 Address or description of property securing mortgage | 5330 Prairie Ave Cedar Falls, IA 21333 |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | 5,418.23 |
| 11 Mortgage acquisition date | January 9, 2023 |
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-df3d35ccb7eaaa9d8ff31999,v11-1098-markdown,original,2026,fgen-7599c55ceb66799e14396d5e,synthetic_programmatic_template,markdown,top,False,
"## Form 1098 Mortgage Interest Statement
| Field | Value |
| --- | --- |
| From: | Pinecrest Mortgage Company |
| RECIPIENT: | Taylor D. Nguyen |
| 10 Other | 691.23 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 81,461.13 |
| 2 Outstanding mortgage principal | 360,945.51 |
| 9 Number of properties securing the mortgage | 1 |",1098,4,1098,fdc-cacc04cb2130443908463cd4,v11-1098-markdown,original,2021,fgen-6e62539b287803a9aaf6058f,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
Form 1098
Mortgage Interest Statement
## OMB No. 1545-1380
Copy B For Payer/Borrower
## The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Bluewater Loan Servicing 7385 Sample Street Brookhaven, PA 89237 |
| RECIPIENT'S/LENDER'S TIN | 25-2779251 |
| PAYER'S/BORROWER'S name | Noah Fischer |
| PAYER'S/BORROWER'S TIN | ***-**-2873 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 87,802.71 |
| 2 Outstanding mortgage principal | $251,995.11 |
| 3 Mortgage origination date | September 11, 2024 |
| 4 Refund of overpaid interest | $0.00 |
| 5 Mortgage insurance premiums | $0.00 |
| 6 Points paid on purchase of principal residence | 0.00 |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | 4,539.51 |
| 11 Mortgage acquisition date | 2021-11-24 |
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-e2388666cdd50de1ae764ced,v11-1098-markdown,original,2024,fgen-38151d7b59078e193e9993f4,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| RECIPIENT'S name: | Pinecrest Mortgage Company |
| Recipient's name: | Morgan Romero |
| 2 Outstanding mortgage principal | 150,062.15 |
| 10 Other | $667.72 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 125,030.18 |
Form 1098 Mortgage Interest Statement 2025",1098,4,1098,fdc-3b8d8720752a53a61c86ac04,v11-1098-markdown,original,2025,fgen-d76cad9259822cb29592ab48,synthetic_programmatic_template,markdown,bottom,False,
"☐ CORRECTED
## Copy B For Payer/Borrower
| Field | Value |
| --- | --- |
| RECIPIENT'5/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no. | Riverbend Mortgage Servicing 1320 Granitc St Pinecrest, GA 88651 |
| RECIPIENT'S/LENDER'S TIN| 53-3427771 |
| PAYER'S/B0RROWER'S name | Weí Testcase |
| PAYER'S/BORROWER'S TIN |****3267 |
| Street address (induding apt. no.) | 8412 Elm Park Pl |
| Cityor town, state or province, country, andZIP or foreign posta1 code | Fairview, OH 94678 |
| Account number (see instructions) | ending in 072645 |
| 1 Mortgage interest received from payer(s)/borrower(s) | S133,239.79 |
| 2 Outstanding mortgageprincipa1 | 27l,601.39 |
| 4 Refund of overpaid interest| $0.00 |
| 5 Mortgage insurance premiums | $0.00 |
| 6 Points paid on purchase of principal residence |  |
| 8 Addrcss or description of property securing mortgage | 2451 Lakeshore Blvd Brookhaven, PA 62283 |
| 9 Number of properties securing the mortgage | 1 |
| 10 0ther | 1,232.72 |
| 11 Mortgage acquisition date | 2021-03-22 |
## Department of the Treasury - Intemal Revenue 5ervice
Form 1098
## Mortgage Interest 5tatement
Form 1098 (keep for yourrecords)  www.irs.gov/Form1098",1098,4,1098,fdc-e2b5bbdf608905a1c7060746,v11-1098-markdown,original,2024,fgen-171d5354fbf7e4629a2c805e,synthetic_programmatic_template,markdown,bottom,True,
"Form 1098 Mortgage Interest Statement
| Field | Value |
| --- | --- |
| RECIPIENT'S name: | Riverbend Mortgage Servicing |
| To: | Mateo Rivera |
| 1 Mortgage interest received from payer(s)/borrower(s) | 46,625.64 |",1098,4,1098,fdc-e232425a26f940d944c90a60,v11-1098-markdown,original,2024,fgen-fca1b6fd33e6845e513dfaad,synthetic_programmatic_template,markdown,top,False,
"## ☐ CORRECTED
For calendar year 2025
OMB No. 1545-1380
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Lakeshore Home Lending 5720 Lakeshore Blvd Oak Grove, TX 15121 |
| RECIPIENT'S/LENDER'S TIN | 40-5847669 |
| PAYER'S/BORROWER'S name | Morgan Rivera |
| PAYER'S/BORROWER'S TIN | ***-**-2298 |
| Street address (including apt. no.) | 6980 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 12514 |
| 2 Outstanding mortgage principal | 210,978.65 |
| 3 Mortgage origination date | 6/12/24 |
| 4 Refund of overpaid interest | 0.00 |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of principal residence |  |
| 8 Address or description of property securing mortgage | 3558 Sample Street Brookhaven, PA 12816 |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | 5,064.50 |
| 11 Mortgage acquisition date | 07/04/2025 |
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-d657941f222fa8e8706a1a47,v11-1098-markdown,original,2025,fgen-f086711391ae36e337a8b984,synthetic_programmatic_template,markdown,none,False,
"Form 1098
Mortgage Interest Statement
For calendar year 2024
## OMB No. 1545-1380
Copy B For Payer/Borrower
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Bluewater Loan Servicing 2152 Lakeshore Blvd Lakewood, CO 99039 |
| RECIPIENT'S/LENDER'S TIN | 54-6645484 |
| PAYER'S/BORROWER'S name | Amara Brennan |
| PAYER'S/BORROWER'S TIN | ending in 0760 |
| Street address (including apt. no.) | 5238 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 57938 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 96,841.42 |
| 2 Outstanding mortgage principal | 647,913.65 |
| 3 Mortgage origination date | November 2, 2024 |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of principal residence |  |
| 8 Address or description of property securing mortgage | 9561 Sample Street Testville, IL 59038 |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | $3,865.80 |
| 11 Mortgage acquisition date | 9/3/24 |",1098,4,1098,fdc-cde8996e91fd1f67164a6b94,v11-1098-markdown,original,2024,fgen-3186b0e27b560718930688e4,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
Form 1098
Mortgage Interest Statement
For calendar year 2022
## OMB No. 1545-1380
Copy B For Payer/Borrower
## The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Pinecrest Mortgage Company 2471 Maple Ridge Dr Cedar Falls, IA 78203 |
| RECIPIENT'S/LENDER'S TIN | 26-5470057 |
| PAYER'S/BORROWER'S name | Amara Larsen |
| PAYER'S/BORROWER'S TIN | ***-**-1479 |
| Street address (including apt. no.) | 3913 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 46587 |
| 1 Mortgage interest received from payer(s)/borrower(s) | 34,032.26 |
| 4 Refund of overpaid interest |  |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of principal residence |  |
| 8 Address or description of property securing mortgage | 9469 Willow Bend Way Cedar Falls, IA 24840 |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | $6,071.08 |
| 11 Mortgage acquisition date | 2022-01-26 |",1098,4,1098,fdc-0391c2880da36ad8fff004df,v11-1098-markdown,original,2022,fgen-a037e170ee94c3edc618bcdd,synthetic_programmatic_template,markdown,top,False,
"## Form 1098
Mortgage Interest Statement
2021
Copy B For Payer/Borrower
The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Pinecrest Mortgage Company 8402 Maple Ridge Dr Lakewood, CO 23594 |
| RECIPIENT'S/LENDER'S TIN | 20-5391516 |
| PAYER'S/BORROWER'S name | Noah Castillo |
| PAYER'S/BORROWER'S TIN | ****1191 |
| Street address (including apt. no.) | 2959 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 30675 |
| 4 Refund of overpaid interest |  |
| 5 Mortgage insurance premiums |  |
| 6 Points paid on purchase of principal residence | $0.00 |
| 8 Address or description of property securing mortgage | 8630 Granite St Maplewood, MN 79573 |
| 9 Number of properties securing the mortgage | 1 |
| 10 Other | 4,927.78 |
| 11 Mortgage acquisition date | 12/21/21 |
Department of the Treasury - Internal Revenue Service
Form 1098 (keep for your records)  www.irs.gov/Form1098",1098,4,1098,fdc-0c3a5651d407f62f504e2bb6,v11-1098-markdown,original,2021,fgen-5e0f1394abfa3b51f8152603,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
2022
OMB No. 1545-1959
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Hope Harbor Shelter 2244 Harbor View Rd Cedar Falls, IA 62900
DONEE'S TIN
84-9586571
DONOR'S name
Alex Moreau
DONOR'S TIN
***-**-3509
Street address (including apt. no.)
5333 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 95518
1 Date of contribution
11/24/22
2a Odometer mileage
866
2b Year
2022
2c Make
Subaru
2d Model
Corolla
4c Gross proceeds from sale
$578.62
6a Did you provide goods or services in exchange for the vehicle?
No
Department of the Treasury - Internal Revenue Service
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-85a7b7474e0b762dea2e672f,v11-1098-C-stacked,original,2022,fgen-f150825e062458f9de5ff227,synthetic_programmatic_template,stacked,bottom,False,
"CORRECTED (if checked)
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2022
OMB No. 1545-1959
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Riverbend Public Library Foundation 6381 Elm Park Pl Lakewood, CO 75948
DONEE'S TIN
41-6062514
DONOR'S name
Lena B. Okafor
DONOR'S TIN
ending in 4513
Account number (see instructions)
ending in 933008
1 Date of contribution
2/20/19
2a Odometer mileage
270
2b Year
2022
2d Model
F-150
3 Vehicle or other identification number
TB36EUH046XE4L4FW
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
☒
4c Gross proceeds from sale
7,285.00
6a Did you provide goods or services in exchange for the vehicle?
No
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-555e32a8285898044d797a0c,v11-1098-C-stacked,original,2022,fgen-fdbe6c884d6bd743686e53f7,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2023
OMB No. 1545-1959
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
St. Brendan Parish 8716 Harbor View Rd Fairview, OH 54198
DONEE'S TIN
63-6354319
DONOR'S name
Diego Moreau
DONOR'S TIN
XXXXX3974
Street address (including apt. no.)
2163 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 91361
1 Date of contribution
2020-01-12
2a Odometer mileage
838
2b Year
2023
2c Make
Subaru
2d Model
F-150
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
☒
4c Gross proceeds from sale
$9,342.95
6a Did you provide goods or services in exchange for the vehicle?
No
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-e475b6a8b3b84dcfb35b3005,v11-1098-C-stacked,original,2023,fgen-4353dd19085735b2a78e1cc5,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2021
OMB No. 1545-1959
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Greenway Animal Rescue 9188 Maple Ridge Dr Pinecrest, GA 59722
DONEE'S TIN
52-6671134
DONOR'S name
Riley Sato
DONOR'S TIN
XXXXX7187
Street address (including apt. no.)
9053 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 80407
1 Date of contribution
December 8, 2018
2b Year
2021
2c Make
Ford
3 Vehicle or other identification number
6K0YCA91PJTU1LBWN
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
X
6a Did you provide goods or services in exchange for the vehicle?
No
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-8e330bd1be0638610c2cecb1,v11-1098-C-stacked,original,2021,fgen-ebed313f523a00ef7bb21c53,synthetic_programmatic_template,stacked,none,False,
"VOID  CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2022
OMB No. 1545-1959
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
St. Brendan Parish 3280 Harbor View Rd Lakewood, CO 74456
DONEE'S TIN
30-1272454
DONOR'S name
Jordan Rivera
DONOR'S TIN
***-**-7618
Account number (see instructions)
****296114
1 Date of contribution
August 16, 2022
2a Odometer mileage
58
2b Year
2022
2c Make
Honda
3 Vehicle or other identification number
R5UVHDBLJU4UHZMVY
4c Gross proceeds from sale
6,095.78
6a Did you provide goods or services in exchange for the vehicle?
Yes ☐  No ☒
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-f5356b61d06850906f7e7c20,v11-1098-C-stacked,original,2022,fgen-4f9147c59accb53830efc6d4,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2024
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Sample Community Food Bank 6321 Lakeshore Blvd Fairview, OH 37520
DONEE'S TIN
73-8654688
DONOR'S name
Avery M. Lindqvist
DONOR'S TIN
XXXXX7549
Street address (including apt. no.)
6138 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 93175
1 Date of contribution
05/07/2024
2a Odometer mileage
781
2b Year
2024
2d Model
F-150
3 Vehicle or other identification number
P2MUZYKCM63CE0KGV
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
☒
4c Gross proceeds from sale
$8,448.62
Department of the Treasury - Internal Revenue Service
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-66edf13c55c254884ed2c0ec,v11-1098-C-stacked,original,2024,fgen-b7d4b1251a0fd80780b18bc5,synthetic_programmatic_template,stacked,bottom,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2025
DONEE'S name:
St. Brendan Parish
RECIPIENT:
Fatima Walsh
3 Vehicle or other identification number
X6TZCTPKUTNG312EJ
2a Odometer mileage
618
6a Did you provide goods or services in exchange for the vehicle?
Yes ☐  No ☒
2d Model
Outback",1098,4,1098,fdc-fac630d06bb524c086eda1f8,v11-1098-C-stacked,original,2025,fgen-8f9b7cf6819e120e2ead1d0e,synthetic_programmatic_template,stacked,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2022
OMB No. 1545-1959
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Greenway Animal Rescue 7757 Cedar Ln Pinecrest, GA 24585
DONEE'S TIN
89-7585288
DONOR'S name
Olivia Adeyemi
DONOR'S TIN
XXX-XX-5647
1 Date of contribution
07/10/2019
2b Year
2022
3 Vehicle or other identification number
VF8054XMLH8ZKBKXF
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
☒
4c Gross proceeds from sale
2,582.88
6a Did you provide goods or services in exchange for the vehicle?
No",1098,4,1098,fdc-6368ce78d9f310eaf4f6e44e,v11-1098-C-stacked,original,2022,fgen-c7f3bd7225b9d2b682a7d9fe,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
OMB No. l545-1959
DONEE'5 name, street address, city or town, state orprovince, country, ZIP or foreign postal code, and telephone no.
Sample Community Food Bank 6254 Elm Park Pl Riverton, WI 56239
DONEE'S TIN
7l-288897O
DONOR'S name
Sofia Kowalski
DONOR'S TIN
endingin 3802
1 Date of contribution
July 11, 2020
2a Odometer mileage
926
2b Year
2021
2c Make
5ubaru
2d Model
F-150
3 Vehícle or other identification number
FY3TCRBTXML5HAE4H
4a Donee certifies that vehide was sold inarm's length transaction to unrelated party
☒
4c Gross proceeds from sale
101.16
6a Did you provide goods or scrvices in exchange for the vehicle?
Yes ☐  No ☒",1098,4,1098,fdc-4b6fa4e32a8d8d8a60f2ed47,v11-1098-C-stacked,original,2021,fgen-f4ea7b5746128b3c9e837dd8,synthetic_programmatic_template,stacked,top,True,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2021
OMB No. 1545-1959
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Riverbend Public Library Foundation 9892 Prairie Ave Oak Grove, TX 61702
DONEE'S TIN
84-9858069
DONOR'S name
Fatima C. Okafor
DONOR'S TIN
XXX-XX-0482
Street address (including apt. no.)
5422 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 45478
2a Odometer mileage
827
2b Year
2021
2c Make
Honda
2d Model
F-150
3 Vehicle or other identification number
SWBHM1NKUJKXSAN2P
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
☒
4c Gross proceeds from sale
$3,524.29
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-5096c6a176d71ab4082c1af4,v11-1098-C-stacked,original,2021,fgen-345e547aeadaaf4dfb4cb2b2,synthetic_programmatic_template,stacked,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2025
OMB No. 1545-1959
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Sample Community Food Bank 5151 Elm Park Pl Bayside, WA 58608
DONEE'S TIN
12-5233740
DONOR'S name
Avery C. Tanaka
DONOR'S TIN
ending in 8343
Street address (including apt. no.)
8603 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 82286
Account number (see instructions)
XXX-XX-424366
1 Date of contribution
June 5, 2025
2a Odometer mileage
229
2b Year
2025
2c Make
Toyota
2d Model
Civic
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
X
4c Gross proceeds from sale
9,227.57
6a Did you provide goods or services in exchange for the vehicle?
No",1098,4,1098,fdc-75a1b105422d2a1719c6cd4c,v11-1098-C-stacked,original,2025,fgen-66466c4ae697b32ede5ddcff,synthetic_programmatic_template,stacked,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes
DONEE:
Riverbend Public Library Foundation
Recipient's name:
Lena R. Romero
3 Vehicle or other identification number
ZMSJPT3N460BUH00Z
6a Did you provide goods or services in exchange for the vehicle?
Yes ☐  No ☒
4c Gross proceeds from sale
$407.72",1098,4,1098,fdc-39109760583559d3bddecc02,v11-1098-C-stacked,original,2024,fgen-29a8f8ec6b11446664dddad0,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2023
OMB No. 1545-1959
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Riverbend Public Library Foundation 2883 Lakeshore Blvd Lakewood, CO 25632
DONEE'S TIN
75-5743127
DONOR'S name
Priya Adeyemi
DONOR'S TIN
****8840
Street address (including apt. no.)
1152 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 19031
1 Date of contribution
December 24, 2023
2a Odometer mileage
507
2b Year
2023
2c Make
Honda
2d Model
Corolla
3 Vehicle or other identification number
ERS6EXM6DWYTEDWJJ
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
☐
4c Gross proceeds from sale
$8,130.86
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-cab479bd2a30a9e99e056bdc,v11-1098-C-stacked,original,2023,fgen-86192530a463ab85cce6d0f4,synthetic_programmatic_template,stacked,none,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
OMB No. 1545-1959
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Greenway Animal Rescue 1488 Oak Hollow Ct Testville, IL 43721
DONEE'S TIN
94-7737614
DONOR'S name
Jamie Castillo
DONOR'S TIN
***-**-9427
Street address (including apt. no.)
6921 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 57807
Account number (see instructions)
****097127
1 Date of contribution
6/22/23
2a Odometer mileage
751
2b Year
2023
2c Make
Subaru
3 Vehicle or other identification number
98HB48L6VJ0S2HG9S
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
☒
4c Gross proceeds from sale
3,983.68
6a Did you provide goods or services in exchange for the vehicle?
No
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-e0d51532baec286b845a8019,v11-1098-C-stacked,original,2023,fgen-6d03d198e4f4834ef08ebb0c,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2021
OMB No. 1545-1959
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Hope Harbor Shelter 9588 Prairie Ave Riverton, WI 16843
DONEE'S TIN
74-2680251
DONOR'S name
Mateo Kowalski
DONOR'S TIN
XXX-XX-1846
1 Date of contribution
11/24/20
2a Odometer mileage
248
2b Year
2021
2c Make
Honda
3 Vehicle or other identification number
LXVGEM00CVEUH4SV3
4c Gross proceeds from sale
$6,088.07
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-9801e6112d5d7ddd2912318c,v11-1098-C-stacked,original,2021,fgen-a092ad62ffce009ecee7acca,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
OMB No. 1545-1959
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Greenway Animal Rescue 7450 Harbor View Rd Riverton, WI 43459
DONEE'S TIN
15-6596305
DONOR'S name
Morgan Nguyen
DONOR'S TIN
XXX-XX-3393
Street address (including apt. no.)
5691 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 13645
Account number (see instructions)
****476792
1 Date of contribution
11/3/26
2a Odometer mileage
678
2b Year
2026
2c Make
Honda
2d Model
Civic
3 Vehicle or other identification number
P71ZESV96MG41ZT89
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party
[X]
4c Gross proceeds from sale
7,488.26
6a Did you provide goods or services in exchange for the vehicle?
No",1098,4,1098,fdc-854d96962facbe96a6fcac87,v11-1098-C-stacked,original,2026,fgen-c56d51b4562905c8c17a8eb2,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2023
Copy B For Donor
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: St. Brendan Parish 3396 Sample Street Pinecrest, GA 73851
DONEE'S TIN: 62-3993641
DONOR'S name: Mateo Adeyemi
DONOR'S TIN: ****3584
Street address (including apt. no.): 7649 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 19752
Account number (see instructions): XXX-XX-839474
1 Date of contribution: 8/2/20
2a Odometer mileage: 640
2b Year: 2023
2c Make: Subaru
2d Model: Civic
3 Vehicle or other identification number: C80GEFYSJKA8JTPN7
4c Gross proceeds from sale: 8,728.43
6a Did you provide goods or services in exchange for the vehicle?: Yes ☐  No ☒
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-4b2789a26edeacee79e73d8e,v11-1098-C-boxed,original,2023,fgen-e15762b0fdf04f36df63e32d,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2024
OMB No. 1545-1959
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Hope Harbor Shelter 4798 Harbor View Rd Lakewood, CO 94374
DONEE'S TIN: 91-4111893
DONOR'S name: Fatima Okafor
DONOR'S TIN: XXX-XX-6905
Account number (see instructions): ****326481
2a Odometer mileage: 607
2b Year: 2024
2c Make: Subaru
2d Model: Civic
3 Vehicle or other identification number: AYK59XDUCB57YKWWL
6a Did you provide goods or services in exchange for the vehicle?: No
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-a32729c7520fd4d405a6aae4,v11-1098-C-boxed,original,2024,fgen-947c1c70bbf3241b24245d20,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2024
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Greenway Animal Rescue 4224 Maple Ridge Dr Riverton, WI 18901
DONEE'S TIN: 83-8288891
DONOR'S name: Priya Moreau
DONOR'S TIN: XXX-XX-8047
Street address (including apt. no.): 9224 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 12409
Account number (see instructions): ****484887
1 Date of contribution: 1/25/23
2a Odometer mileage: 991
2b Year: 2024
2c Make: Ford
2d Model: Outback
3 Vehicle or other identification number: 435SJKHK8CBZF0JP0
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party: [X]
4c Gross proceeds from sale: $8,540.15
6a Did you provide goods or services in exchange for the vehicle?: No
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-d307c304f0dca36d31aec931,v11-1098-C-boxed,original,2024,fgen-e6ddf6d4613f81e1fcf6c8cb,synthetic_programmatic_template,boxed,top,False,
"From:: Hope Harbor Shelter
RECIPIENT:: Alex R. Fischer
2b Year: 2026
2d Model: F-150
2a Odometer mileage: 333",1098,4,1098,fdc-be87a585487a7e73ca7dbf4c,v11-1098-C-boxed,original,2026,fgen-b3294fc761c0ad1314314412,synthetic_programmatic_template,boxed,none,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2023
DONEE:: St. Brendan Parish
To:: Mateo A. Larsen
Box 6a Did you provide goods or services in exchange for the vehicle?: Yes ☐  No ☒",1098,4,1098,fdc-d4053d3e3d7e04aa9758bee3,v11-1098-C-boxed,original,2023,fgen-759431d6af850ff6a0261fa8,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
OMB No.1545-1959
This is important tax information and is bcingfurnished to the IRS.
DONEE'S name, street address, city or town, state or province, country,ZIP or foreign postal codc, and telephone no.: Hope Harbor Shelter 2277 Prairie Ave Lakewood, CO 2l507
DONEE'5 TIN: 44-6447081
DONOR'S name: A1ex R. Adeyemi
DONOR'S TIN: XXXXX9346
Account number (see instructions): ending in l22761
1 Date of contribution: 2025-07-03
2d Model: Outback
3 Vehide or other identification number: 1XLV6EL10KS477BH4
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party: X
4c Gross proceeds from sa1e: 553.53",1098,4,1098,fdc-aa38df1e0617d51467d7e3bd,v11-1098-C-boxed,original,2025,fgen-732258a8bc56733bef40a188,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
Form1098-C
Contributionsof Motor Vehicles, Boats, and Airplanes
0MB No. 1545-l959
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Sample Community Food Bank 9755 WillowBend Way Lakewood, CO 74453
DONEE'5 TIN: 88-667O780
DONOR'S name: TaylorWalsh
DONOR'S TIN: XXX-XX-5214
Street address (índuding apt. no.): 7057 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 83670
Box l Date of contribution: 2026-06-13
Box 2a Odometer míleage: 124
Box 2b Year: 2026
Box 2c Make: Honda
Box 2d Model: Outback
Box 3Vehide or other identification number: 59LCRSB8L64P4RY2D
Box 4a Donee certifies that vehide was sold ín arm's length transaction to unrelated party: ☐
Box 4c Gross proceeds from sale: $615.52
Box 6a Did you provide goods or services in exchange for the vehicle?: No
Department of the Treasury - Intemal Revenue 5ervice
Form 1098-C (keepfor your records)  www.irs.gov/Forml098C",1098,4,1098,fdc-815febff71a860ab68f060e8,v11-1098-C-boxed,original,2026,fgen-35cf5ab73ad3a9db0df4a1a4,synthetic_programmatic_template,boxed,top,True,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2022
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: St. Brendan Parish 7235 Sample Street Fairview, OH 37121
DONEE'S TIN: 67-8008140
DONOR'S name: Lena Moreau
DONOR'S TIN: ****1695
Street address (including apt. no.): 4649 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 76186
Account number (see instructions): ending in 368281
Box 1 Date of contribution: 2022-03-18
Box 2a Odometer mileage: 69
Box 2b Year: 2022
Box 2c Make: Toyota
Box 2d Model: Outback
Box 3 Vehicle or other identification number: UWPGV1FAH6E1Z8CS8
Box 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party: ☒
Box 6a Did you provide goods or services in exchange for the vehicle?: Yes ☐  No ☒
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-7095833a4b4c4e78f6ad38b8,v11-1098-C-boxed,original,2022,fgen-e7cdec2995babc6f48218e10,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes
DONEE:: Sample Community Food Bank
To:: Jamie Tanaka
3 Vehicle or other identification number: FB65Z88KDJENBF8UJ
6a Did you provide goods or services in exchange for the vehicle?: No
2b Year: 2022
4c Gross proceeds from sale: $7,125.78",1098,4,1098,fdc-ea31ab191da6fb28f1d72ac8,v11-1098-C-boxed,original,2022,fgen-d149fb4dd3cb10114be8b607,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2022
OMB No. 1545-1959
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Public Library Foundation 2423 Granite St Cedar Falls, IA 75900
DONEE'S TIN: 41-8807256
DONOR'S name: Lena R. Nguyen
DONOR'S TIN: XXX-XX-8436
Account number (see instructions): ***-**-473018
1 Date of contribution: 03/07/2019
2b Year: 2022
2c Make: Honda
3 Vehicle or other identification number: Z2V8986JG2RTJK1L5
4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party: ☐
4c Gross proceeds from sale: $6,704.71
6a Did you provide goods or services in exchange for the vehicle?: Yes ☐  No ☒",1098,4,1098,fdc-1a097a8ace059667b7e0d0fe,v11-1098-C-boxed,original,2022,fgen-21ac44722b757b1ea660f0d5,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2023
OMB No. 1545-1959
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Sample Community Food Bank 8133 Granite St Maplewood, MN 23987
DONEE'S TIN: 78-1628016
DONOR'S name: Jamie Adeyemi
DONOR'S TIN: ending in 6546
Box 2a Odometer mileage: 504
Box 2c Make: Toyota
Box 3 Vehicle or other identification number: X1VH8CCB76DKLB7VP
Box 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party: [X]
Box 4c Gross proceeds from sale: $6,970.99
Box 6a Did you provide goods or services in exchange for the vehicle?: Yes ☐  No ☒",1098,4,1098,fdc-d12e2631cc17662542e45d41,v11-1098-C-boxed,original,2023,fgen-3995a2ec1579cc67f95e9c64,synthetic_programmatic_template,boxed,top,False,
"DONEE'S name:: St. Brendan Parish
Recipient's name:: Jordan K. Rivera
Box 3 Vehicle or other identification number: RVR3YMLR5LCEC3R1P
Box 2c Make: Ford",1098,4,1098,fdc-2256b918ff71d48f25b86ee1,v11-1098-C-boxed,original,2021,fgen-defc586b4c39d53f515b5414,synthetic_programmatic_template,boxed,none,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2023
OMB No. 1545-1959
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Hope Harbor Shelter 2962 Elm Park Pl Riverton, WI 60686
DONEE'S TIN: 29-9458020
DONOR'S name: Jordan Fischer
DONOR'S TIN: ****4848
Street address (including apt. no.): 6640 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 95783
Account number (see instructions): ending in 021768
Box 1 Date of contribution: October 2, 2022
Box 2a Odometer mileage: 333
Box 2b Year: 2023
Box 2c Make: Toyota
Box 2d Model: Civic
Box 4c Gross proceeds from sale: $5,005.26
Box 6a Did you provide goods or services in exchange for the vehicle?: No
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-c5b402fb21eb85da16ad417c,v11-1098-C-boxed,original,2023,fgen-ef2ab94649e0db28867e6142,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2026
DONEE:: Greenway Animal Rescue
To:: Taylor Haddad
2d Model: Corolla
2a Odometer mileage: 650",1098,4,1098,fdc-3747be57283766a5abd58604,v11-1098-C-boxed,original,2026,fgen-bb6eb89b92ceb04cfc325e3d,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2025
Copy B For Donor
This is important tax information and is being furnished to the IRS.
DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Sample Community Food Bank 76 Lakeshore Blvd Oak Grove, TX 18774
DONEE'S TIN: 31-3821625
DONOR'S name: Taylor Nguyen
DONOR'S TIN: ending in 1278
Street address (including apt. no.): 7052 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 29833
Line 1 Date of contribution: April 25, 2022
Line 2a Odometer mileage: 815
Line 2b Year: 2025
Line 2d Model: Civic
Line 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party: [X]
Line 4c Gross proceeds from sale: 2,201.36
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-2d0c97adba900ce11900758e,v11-1098-C-boxed,original,2025,fgen-242eb580bd347e0842b07b72,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes
DONEE'S name:: Hope Harbor Shelter
Recipient's name:: Priya D. Adeyemi
Box 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party: ☒",1098,4,1098,fdc-cb837cb7b97819a96f5f152d,v11-1098-C-boxed,original,2025,fgen-5b8ad1473a615c24bd0d487c,synthetic_programmatic_template,boxed,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2022 DONEE: Hope
Harbor Shelter RECIPIENT: Lena R. Rivera 2a
Odometer mileage 276 2c Make Honda 4c Gross proceeds from sale $1,330.14",1098,4,1098,fdc-f24ce74314c806f2b1382c88,v11-1098-C-flat,original,2022,fgen-29bb6508557262eb329c5947,synthetic_programmatic_template,flat,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2026 Copy B For Donor This
is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. St. Brendan Parish 8110 Elm Park Pl Maplewood, MN 68028 DONEE'S TIN 31-7666958
DONOR'S name Diego L. Patel DONOR'S TIN XXX-XX-7235 Account number (see instructions) XXX-XX-140514 2b Year 2026 2c Make Toyota 2d Model Corolla 3 Vehicle or other identification number 0Z3LMMJ7RRPLPXXF5 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party ☒ 4c Gross proceeds from sale $3,884.04 Department of the Treasury - Internal Revenue Service Form 1098-C (keep for your records) www.irs.gov/Form1098C",1098,4,1098,fdc-e6d31c33269623f5eed4ce2a,v11-1098-C-flat,original,2026,fgen-1172e2b9b48f75147a30abea,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes OMB No. 1545-1959 This is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state
or province, country, ZIP or foreign postal code, and telephone no. Riverbend Public Library Foundation 7114 Harbor View Rd Lakewood, CO 22852 DONEE'S TIN 92-4489797 DONOR'S name Morgan Moreau DONOR'S TIN XXXXX3642 1 Date of contribution 02/24/2021 2a Odometer mileage 251 2c Make Honda 2d Model Civic 3 Vehicle or other identification number HJYNGZY5TU921NZZD 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party X 4c Gross proceeds from sale $2,659.71 6a Did you provide goods or services in exchange for the vehicle? Yes ☐ No ☒
Department of the Treasury - Internal Revenue Service Form 1098-C (keep for your records) www.irs.gov/Form1098C",1098,4,1098,fdc-0ddc23a2c37e6d99f78d0057,v11-1098-C-flat,original,2021,fgen-2944d3f7a78e0060f27a4b7c,synthetic_programmatic_template,flat,top,False,
"Form 1098-C Contributions of Motor Vehicles,
Boats, and Airplanes 2022 DONEE'S name: Sample Community Food Bank To: Olivia Testcase 4a Donee
certifies that vehicle was sold in arm's length transaction to unrelated party ☒",1098,4,1098,fdc-38ce15e3e9ab4be9c3317c78,v11-1098-C-flat,original,2022,fgen-d2847f26ac8e972c133d37f3,synthetic_programmatic_template,flat,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes For calendar year 2023 OMB No. 1545-1959 Copy B For Donor This is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Hope Harbor Shelter 8268 Prairie Ave Fairview, OH 45764 DONEE'S TIN 94-2311376 DONOR'S name Avery Nguyen DONOR'S TIN XXXXX1516 1 Date of contribution 7/16/23 2a Odometer mileage
518 2c Make Subaru 3 Vehicle or other identification number BFGB672ETRG2L22ZX 4c Gross proceeds from sale $6,994.03 6a Did you provide goods or services in exchange for the vehicle? No Department of the Treasury - Internal Revenue Service Form
1098-C (keep for your records) www.irs.gov/Form1098C",1098,4,1098,fdc-b894f287a2ab55a96f361a5e,v11-1098-C-flat,original,2023,fgen-f757c187d60a01ddea347947,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2021 Copy B For Donor This is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Sample Community Food Bank 3406 Elm Park Pl Oak Grove, TX 85711 DONEE'S
TIN 21-7416117 DONOR'S name Mateo B. Kowalski DONOR'S TIN XXX-XX-1224 1 Date of contribution 09/23/2021 2a Odometer mileage 247 2b Year 2021 2c Make Ford 2d Model F-150 3 Vehicle or other identification number J7Z60N90AU17JB1A3 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party [X] 4c Gross proceeds from sale 8,793.69 6a Did you provide goods or services in exchange for the vehicle? No Department of the Treasury - Internal Revenue Service Form 1098-C (keep for
your records) www.irs.gov/Form1098C",1098,4,1098,fdc-46c6592fa32f4ac127936df8,v11-1098-C-flat,original,2021,fgen-d5258e65595104fd22d720b6,synthetic_programmatic_template,flat,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2026 Copy B For Donor DONEE'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no. Riverbend Public Library Foundation 6332 Willow Bend Way Bayside, WA 75896 DONEE'S TIN 14-2641063 DONOR'S name Olivia K. Brennan DONOR'S TIN ending in 8443 Street address (including apt. no.) 850 Oak
Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 59411 1 Date of contribution 09/18/2026 2a Odometer mileage 927 2b Year 2026 2c Make Ford 3 Vehicle or other identification number DC1MPPYVJH7EMFVDK 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party X 4c Gross proceeds from sale $1,807.49 Department of the Treasury - Internal Revenue Service Form 1098-C (keep for your records) www.irs.gov/Form1098C",1098,4,1098,fdc-e771976907daf5a311948c0f,v11-1098-C-flat,original,2026,fgen-3498e72d894c95cef41860fc,synthetic_programmatic_template,flat,top,False,
"DONEE'S name: Sample Community Food Bank Recipient's name: Fatima Brennan 2d Model Civic 1 Date of contribution December 12, 2025 Form 1098-C Contributions of Motor Vehicles, Boats, and
Airplanes
2025",1098,4,1098,fdc-f6bb0917bdbfb91e8d64e9f4,v11-1098-C-flat,original,2025,fgen-99b05025905d4e3685625cbc,synthetic_programmatic_template,flat,bottom,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes OMB No. 1545-1959 This is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state
or province, country, ZIP or foreign postal code, and telephone no. Sample Community Food Bank 6467 Maple Ridge Dr Pinecrest, GA 86525 DONEE'S TIN 19-5038427 DONOR'S name Olivia Fischer DONOR'S TIN XXXXX5774 Street address (including
apt. no.) 1372 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 58423 1 Date of contribution September 4, 2024 2a Odometer mileage 29 2b Year 2024 2c Make Toyota 2d Model Civic 3 Vehicle or other identification number 1UEGLPASELHR5F0RG 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party ☒ 6a Did you provide goods or services in exchange for the vehicle? Yes ☐ No ☒",1098,4,1098,fdc-36e63898c265518818460d11,v11-1098-C-flat,original,2024,fgen-32e8b8d73eb65d29134e971e,synthetic_programmatic_template,flat,top,False,
"DONEE'S
name: Sample Community Food Bank To:
Mateo Larsen 2b Year 2025 6a Did you provide goods or services in exchange for the vehicle? No 2d Model F-150",1098,4,1098,fdc-a062676548e468c327af2a3a,v11-1098-C-flat,original,2025,fgen-9a10089f79291eaf3d71b326,synthetic_programmatic_template,flat,none,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes For calendar year 2026 OMB No. 1545-1959 Copy B For Donor This is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no. Riverbend Public Library Foundation 5682 Cedar Ln Brookhaven, PA 93737 DONEE'S TIN 71-4802508 DONOR'S name
Mateo Patel DONOR'S TIN ending in 0518 Street address (including apt. no.) 4162 Oak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 86094 1 Date of contribution 07/04/2025 2c Make Honda 2d Model Corolla 3 Vehicle or other identification number YMHB66B4G8EP5AEVX 4c Gross proceeds from sale 4,148.80 Department of the Treasury - Internal Revenue Service Form 1098-C (keep for your records) www.irs.gov/Form1098C",1098,4,1098,fdc-ed2440a9388dd46eaf2ce3d8,v11-1098-C-flat,original,2026,fgen-62473b68e51b6d89db7c175c,synthetic_programmatic_template,flat,top,False,
"For calendar year 2026 OMB No. 1545-1959 Copy B For Donor This is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Hope Harbor Shelter 5438 Maple Ridge Dr Brookhaven, PA 54126 DONEE'S TIN 57-1244547 DONOR'S name Priya Moreau DONOR'S TIN ****9278 Street address
(including apt. no.) 6336 Granite St City or town, state or province, country, and
ZIP or foreign postal code Brookhaven, PA 65162 Account number (see instructions) ending in 549487 2a Odometer mileage 414 2b Year 2026 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party 4c Gross proceeds from sale $6,798.11 6a Did you provide goods or services in exchange for the vehicle? No Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-650e99bf13fa106904f28cf7,v11-1098-C-flat,original,2026,fgen-3593d32764b204bf513fc66b,synthetic_programmatic_template,flat,none,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes For calendar year 2022 OMB No. 1545-1959 DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. St. Brendan Parish 5123 Prairie Ave Fairview, OH 86664 DONEE'S TIN 71-7369466 DONOR'S name Hiro Moreau DONOR'S TIN ***-**-5224 Street address (including apt. no.) 9386 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 68202 Account number
(see instructions) XXXXX247530 2a Odometer mileage 390 2b Year 2022 2c Make Ford 2d Model Civic 3 Vehicle or other identification number UCSZRXWD6BWEKAR2C 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party ☐ 4c Gross proceeds from sale $9,161.00 6a Did you provide goods or services in exchange for the vehicle? Yes ☐ No ☒ Department of the Treasury - Internal Revenue Service Form 1098-C
(keep for your records) www.irs.gov/Form1098C",1098,4,1098,fdc-30e50a0e71cae255a2e236b3,v11-1098-C-flat,original,2022,fgen-e513c0d2444bc7c7c556af4d,synthetic_programmatic_template,flat,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes OMB No. 1545-1959 This is important
tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Public Library Foundation 8646 Harbor View Rd Bayside, WA 74182 DONEE'S TIN 14-4750374 DONOR'S name Diego Moreau DONOR'S
TIN ****3155 Street address (including apt. no.) 6938 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 55774 Account number (see instructions) ****266230 1 Date of contribution 12/20/23 2b Year 2026 2c Make Toyota 2d Model F-150 3 Vehicle or other identification number B7KL9P7D5P6BMYLVL 6a Did you provide goods or services in exchange for the vehicle? Yes ☐ No ☒",1098,4,1098,fdc-a09a43ef28200648267dbef7,v11-1098-C-flat,original,2026,fgen-aa972f8d1062bcc2d4f541a6,synthetic_programmatic_template,flat,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes For calendar year 2024 This is important tax information and is being furnished to the IRS. DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. St. Brendan
Parish 1495 Lakeshore Blvd Bayside, WA 96453 DONEE'S TIN 38-4646989 DONOR'S name Casey Romero DONOR'S TIN ****1198 Street address (including apt. no.) 4310 Oak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 65862 Account number (see instructions)
XXX-XX-018353 2a Odometer mileage 726 2b Year 2024 2c Make Ford 2d Model Civic 3 Vehicle or other identification number AT6F4YY9RXEV792LF 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party 4c Gross proceeds from sale 5,078.02 6a Did you provide goods or services in exchange for the vehicle? No Department of the Treasury - Internal Revenue Service Form 1098-C (keep for your records) www.irs.gov/Form1098C",1098,4,1098,fdc-7c19757da261f8ab864cdd61,v11-1098-C-flat,original,2024,fgen-f2a7ba02184b3e9d29ab89d6,synthetic_programmatic_template,flat,top,False,
"Form 1098-C Contributions
of Motor Vehicles, Boats, and Airplanes From: Greenway Animal Rescue
To: Riley Castillo 2b Year 2026",1098,4,1098,fdc-ef4bd086ee2a614d846833a8,v11-1098-C-flat,original,2026,fgen-61ea96e842491ad34530c7d5,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked)
## Form 1098-C
Contributions of Motor Vehides, Boats, and Airplanes
2025
OMB No. 1545-1959
| Field | Value |
| --- | --- |
| DONEE'5 name, street address, city or town, state or provincc, country, ZIP or foreign postal code, and telephone no. | GreenwayAnimal Rescue 3389 Sample Street Bayside, WA 58434 |
| DONEE'S TIN | 56-9935l15 |
| DONOR'S name | Olivia E. Testcase |
|DONOR'S TIN |XXXXX6785 |
| Street address (induding apt. no.)| 3983 Prairie Ave |
| City or town, state or province, country, and ZIP or foreígn postal code | Cedar Falls, IA 19963 |
| Account number (see ínstructions) | XXX-XX-644590 |
| l Date of contribution | 6/11/25 |
| 2a Odometer mileage | 64 |
|2b Year | 2025 |
| 2c Make | Honda |
| 2d Model | Outback |
| 3 Vehíde or other identification number | YVCVEUY4OMDZ41NMN |
| 4a Donee certífies that vehide was sold in arm's length transaction to unrelated party | [X] |
| 4c Gross proceeds from sale | $4,890.50 |
| 6a Did you provide goods or services in exchangefor the vehide? | No |
## Dcpartment of the Treasury - Intemal Revenue5ervice
## Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-bdf0df493ea885489c3a3ab4,v11-1098-C-markdown,original,2025,fgen-4f335d86457b7c2a69b13544,synthetic_programmatic_template,markdown,top,True,
"☐ CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2024
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Sample Community Food Bank 3760 Elm Park Pl Maplewood, MN 31501 |
| DONEE'S TIN | 98-5223661 |
| DONOR'S name | Kwame K. Castillo |
| DONOR'S TIN | ending in 7680 |
| Street address (including apt. no.) | 2770 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 80642 |
| 1 Date of contribution | 2021-11-10 |
| 2a Odometer mileage | 533 |
| 2b Year | 2024 |
| 2c Make | Subaru |
| 3 Vehicle or other identification number | WMKMHGSP8MCJCRAT9 |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party |  |
| 4c Gross proceeds from sale | 1,217.66 |
| 6a Did you provide goods or services in exchange for the vehicle? | Yes ☐  No ☒ |",1098,4,1098,fdc-cee3e786cc89699264583123,v11-1098-C-markdown,original,2024,fgen-12187375b4fc7b706dea976e,synthetic_programmatic_template,markdown,top,False,
"## Form 1098-C
Contríbutions of Motor Vchides, Boats, and Airplanes
## For calendar year 2O23
Copy B For Donor
| Field | Value |
| --- | --- |
| DONEE'S namc, street address, city or town, state or province, country, ZIP or foreígn posta1 code, and telephone no. | Hope Harbor Shelter 3436 Harbor View Rd Riverton, WI 31168 |
| DONEE'STIN | 83-1088759 |
| DONOR'S name | Mateo Kowalski |
| DONOR'S TIN | ending in 3150 |
| Account number (see instructions) | XXXXX761292 |
| 1 Date of contribution | 8/19/23|
| 2a Odometer mi1eage | 20 |
| 2b Year | 2023 |
| 2c Make | Honda |
| 2d Model | F-150 |
| 4a Donee certífies that vehicle was sold in arm's length transaction to unrdatcd party |  |
| 6a Didyou providc goods or services in exchange for thevehicle? |No |
Department of the Treasury - Internal Revenue 5ervice
Form 1098-C(keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-21402aeef721d6459a6341d5,v11-1098-C-markdown,original,2023,fgen-e1badab7561cbe09f7e993d0,synthetic_programmatic_template,markdown,top,True,
"☐ CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
OMB No. 1545-1959
Copy B For Donor
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Hope Harbor Shelter 2223 Maple Ridge Dr Fairview, OH 15189 |
| DONEE'S TIN | 57-7760857 |
| DONOR'S name | Sofia Romero |
| DONOR'S TIN | XXXXX7071 |
| Street address (including apt. no.) | 8384 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 13798 |
| 1 Date of contribution | 6/23/18 |
| 2a Odometer mileage | 861 |
| 2b Year | 2021 |
| 2c Make | Subaru |
| 2d Model | Corolla |
| 3 Vehicle or other identification number | 2MGSATLPTVVNCV2WL |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party | ☒ |
| 4c Gross proceeds from sale | 6,635.18 |
| 6a Did you provide goods or services in exchange for the vehicle? | Yes ☐  No ☒ |
## Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-86a1f22e213c1d00c0437781,v11-1098-C-markdown,original,2021,fgen-6dab4a891e502fde287161f5,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
Form 1098-C
## Contributions of Motor Vehicles, Boats, and Airplanes
## 2021
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Greenway Animal Rescue 2074 Cedar Ln Testville, IL 32531 |
| DONEE'S TIN | 50-9605521 |
| DONOR'S name | Sofia Fischer |
| DONOR'S TIN | ***-**-3688 |
| 1 Date of contribution | April 18, 2021 |
| 2a Odometer mileage | 270 |
| 2b Year | 2021 |
| 2d Model | Civic |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party |  |
| 4c Gross proceeds from sale | 3,214.60 |
| 6a Did you provide goods or services in exchange for the vehicle? | No |
Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-f640da4f5caed074f0ecfff5,v11-1098-C-markdown,original,2021,fgen-8fe8d7f2dcccb5bcf20f1bdb,synthetic_programmatic_template,markdown,top,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2025
OMB No. 1545-1959
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Sample Community Food Bank 9705 Elm Park Pl Bayside, WA 57330 |
| DONEE'S TIN | 91-5584749 |
| DONOR'S name | Diego Adeyemi |
| DONOR'S TIN | ***-**-5994 |
| Account number (see instructions) | XXXXX297832 |
| 1 Date of contribution | 12/19/22 |
| 2a Odometer mileage | 887 |
| 2b Year | 2025 |
| 2c Make | Honda |
| 2d Model | Corolla |
| 3 Vehicle or other identification number | R9R4WD1VGED4JASG6 |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party | X |
| 4c Gross proceeds from sale | $5,439.89 |
| 6a Did you provide goods or services in exchange for the vehicle? | No |",1098,4,1098,fdc-62228ef8bf3b92942d9a6e5e,v11-1098-C-markdown,original,2025,fgen-bfad88ce3cf6591feeefb527,synthetic_programmatic_template,markdown,top,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes 2026
| Field | Value |
| --- | --- |
| DONEE: | Hope Harbor Shelter |
| RECIPIENT: | Mateo Walsh |
| 2c Make | Toyota |
| 3 Vehicle or other identification number | HMPS15E5MRL05N3JC |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party | ☐ |",1098,4,1098,fdc-e521cce9724696c8562b4f4d,v11-1098-C-markdown,original,2026,fgen-4ee795fde07b2aeaf0a1135e,synthetic_programmatic_template,markdown,top,False,
"## ☐ CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2021
## OMB No. 1545-1959
Copy B For Donor
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Sample Community Food Bank 1165 Oak Hollow Ct Brookhaven, PA 22890 |
| DONEE'S TIN | 85-2272891 |
| DONOR'S name | Sofia C. Castillo |
| DONOR'S TIN | XXXXX8570 |
| Street address (including apt. no.) | 496 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 74671 |
| Account number (see instructions) | ****590719 |
| 1 Date of contribution | 2021-05-20 |
| 2a Odometer mileage | 574 |
| 2b Year | 2021 |
| 2c Make | Toyota |
| 2d Model | Corolla |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party |  |
| 4c Gross proceeds from sale | 774.47 |
| 6a Did you provide goods or services in exchange for the vehicle? | No |
## Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-f3f45ae86dd8d66ff010f229,v11-1098-C-markdown,original,2021,fgen-03ece08af84ae1f2cbd62793,synthetic_programmatic_template,markdown,top,False,
"For calendar year 2024
## Copy B For Donor
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Riverbend Public Library Foundation 7389 Oak Hollow Ct Brookhaven, PA 41463 |
| DONEE'S TIN | 41-9179108 |
| DONOR'S name | Alex Kowalski |
| DONOR'S TIN | ****5366 |
| 1 Date of contribution | 2023-02-11 |
| 2b Year | 2024 |
| 2c Make | Honda |
| 2d Model | F-150 |
| 3 Vehicle or other identification number | 4US367MMY6BYNK5CD |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party | ☐ |
| 4c Gross proceeds from sale | 3,814.13 |
| 6a Did you provide goods or services in exchange for the vehicle? | No |",1098,4,1098,fdc-aa5d418f86a365c293ce6207,v11-1098-C-markdown,original,2024,fgen-7f9385cde754498ab5fdfde9,synthetic_programmatic_template,markdown,none,False,
"For calendar year 2025
OMB No. 1545-1959
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Hope Harbor Shelter 6759 Lakeshore Blvd Bayside, WA 51197 |
| DONEE'S TIN | 46-5090533 |
| DONOR'S name | Noah J. Tanaka |
| DONOR'S TIN | XXXXX9991 |
| Account number (see instructions) | ****925685 |
| 1 Date of contribution | June 28, 2022 |
| 2a Odometer mileage | 234 |
| 2b Year | 2025 |
| 2c Make | Ford |
| 2d Model | Corolla |
| 3 Vehicle or other identification number | 9SCHKMUCLHVM0RA6C |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party | ☐ |
Department of the Treasury - Internal Revenue Service
## Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
## Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-a159db0d053afe08d91a37e2,v11-1098-C-markdown,original,2025,fgen-2570df817f66e7b488072435,synthetic_programmatic_template,markdown,bottom,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
For calendar year 2021
## OMB No. 1545-1959
## Copy B For Donor
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Greenway Animal Rescue 4864 Elm Park Pl Fairview, OH 89339 |
| DONEE'S TIN | 46-3471420 |
| DONOR'S name | Mateo Adeyemi |
| DONOR'S TIN | XXX-XX-4465 |
| Street address (including apt. no.) | 1011 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 97157 |
| 1 Date of contribution | 2/16/21 |
| 2a Odometer mileage | 662 |
| 2b Year | 2021 |
| 2c Make | Ford |
| 2d Model | Corolla |
| 3 Vehicle or other identification number | 6Y45HCRZ27RV9J18F |
| 6a Did you provide goods or services in exchange for the vehicle? | No |
## Department of the Treasury - Internal Revenue Service
Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-e6bbde452f6de43baaaf2783,v11-1098-C-markdown,original,2021,fgen-60c829e380617061812f91f0,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
2024
OMB No. 1545-1959
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | St. Brendan Parish 3490 Maple Ridge Dr Maplewood, MN 68681 |
| DONEE'S TIN | 34-7658377 |
| DONOR'S name | Riley A. Lindqvist |
| DONOR'S TIN | XXX-XX-2697 |
| Street address (including apt. no.) | 9289 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 88938 |
| 1 Date of contribution | November 24, 2024 |
| 2a Odometer mileage | 349 |
| 2b Year | 2024 |
| 2c Make | Ford |
| 2d Model | Outback |
| 3 Vehicle or other identification number | EZM6ENR7FF0WHFKHB |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party | [X] |
| 4c Gross proceeds from sale | 4,208.34 |
| 6a Did you provide goods or services in exchange for the vehicle? | No |
Department of the Treasury - Internal Revenue Service
## Form 1098-C (keep for your records)  www.irs.gov/Form1098C",1098,4,1098,fdc-c6c4b1d9dccc148d0fcada03,v11-1098-C-markdown,original,2024,fgen-e9f5fc8f582b2e2a51595e77,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
For calendar year 2025
## OMB No. 1545-1959
Copy B For Donor
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| DONEE'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Greenway Animal Rescue 1136 Sample Street Maplewood, MN 91176 |
| DONEE'S TIN | 75-1397329 |
| DONOR'S name | Priya Rivera |
| DONOR'S TIN | XXX-XX-0033 |
| Street address (including apt. no.) | 9710 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 42182 |
| 1 Date of contribution | 9/17/22 |
| 2b Year | 2025 |
| 2c Make | Toyota |
| 2d Model | Outback |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party |  |
| 4c Gross proceeds from sale | $4,387.33 |",1098,4,1098,fdc-1420d2ac8abf5abc16283571,v11-1098-C-markdown,original,2025,fgen-a26b9174cbe10f34ed725522,synthetic_programmatic_template,markdown,none,False,
"Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes
| Field | Value |
| --- | --- |
|DONEE: | Riverbend Public Library Foundation |
| RECIPIENT: | Rilcy R. Nguycn |
| 2b Year | 2022 |",1098,4,1098,fdc-625a176b97526a4bf3689c14,v11-1098-C-markdown,original,2022,fgen-3b7ccf9ce5c6a6e503657f93,synthetic_programmatic_template,markdown,top,True,
"| Field | Value |
| --- | --- |
| From: | Hope Harbor Shelter |
| RECIPIENT: | Morgan Romero |
| 4c Gross proceeds from sale | 5,701.44 |
Form 1098-C Contributions of Motor Vehicles, Boats, and Airplanes",1098,4,1098,fdc-ae5ea40fb1554c36c8242888,v11-1098-C-markdown,original,2022,fgen-61559fbe879ee37e3ffb306d,synthetic_programmatic_template,markdown,bottom,False,
"Form 1098-C
Contributions of Motor Vehicles, Boats, and Airplanes
## 2O25
| Field | Value |
| --- | --- |
| DONEE'5 name, street address, city or town, state or province, country, ZIP orforeignposta1 code, and telephone no. | Greenway Animal Rescue 3525 Oak Hollow Ct Riverton, WI 328O5 |
| DONEE'S TIN | 51-512O445 |
| DONOR'S name | Diego Testcasc |
|DONOR'S TIN | ****5427 |
| Account number (see instructions) |***-**-274971 |
|1 Date of contribution | 2024-10-09 |
| 2a Odometer mileage | 255 |
| 2b Year | 2025 |
| 2c Make | Ford |
| 2d Model | F-150 |
|3 Vehicle or other ídentification number | AW0045J1JEXKRAVH6 |
| 4a Donee certifies that vehicle was sold in arm's length transaction to unrelated party | [X] |
| 4c Gross proceeds from sale | $6,5O3.93 |
| 6a Did you provide goods or services in exchange for the vehide? | No |
Department of the Treasury - Internal Revenue Service
Form 1O98-C (keep for your records)  www.irs.gov/Forml098C",1098,4,1098,fdc-914ad3bc0cebd0f85642535f,v11-1098-C-markdown,original,2025,fgen-b1027e20c1a745f49b230c47,synthetic_programmatic_template,markdown,top,True,
"Form 1098-E
Student Loan Interest Statement
2022
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Northwind Auto Credit 2786 Cedar Ln Oak Grove, TX 66737
RECIPIENT'S TIN
83-5412486
BORROWER'S name
Sofia Sato
BORROWER'S TIN
***-**-0390
1 Student loan interest received by lender
227.46
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
[X]
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-0f14cbac4256cf58d6619902,v11-1098-E-stacked,original,2022,fgen-69fe9744bb09b2840c94a44e,synthetic_programmatic_template,stacked,top,False,
"Form 1098-E Student Loan Interest Statement
RECIPIENT:
Summit Student Loan Servicing
RECIPIENT:
Sofia R. Sato
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
0.00",1098,4,1098,fdc-54b214f6404c6cef4f3eabdf,v11-1098-E-stacked,original,2022,fgen-bfdcb886a44fb2db468b3b23,synthetic_programmatic_template,stacked,top,False,
"2022
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Summit Student Loan Servicing 299 Prairie Ave Pinecrest, GA 59492
RECIPIENT'S TIN
71-5292156
BORROWER'S name
Diego K. Haddad
BORROWER'S TIN
XXXXX2104
Street address (including apt. no.)
5468 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 77646
1 Student loan interest received by lender
$8,927.68
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
Form 1098-E
Student Loan Interest Statement",1098,4,1098,fdc-38e13421877a9fe0e71acf4e,v11-1098-E-stacked,original,2022,fgen-b06cd5b6615581d0a72a6cd6,synthetic_programmatic_template,stacked,bottom,False,
"Form 1098-E
Student Loan Interest Statement
2022
OMB No. 1545-1576
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Granite Auto Finance 5383 Sample Street Pinecrest, GA 93829
RECIPIENT'S TIN
19-6306666
BORROWER'S name
Riley E. Lindqvist
BORROWER'S TIN
****7535
Street address (including apt. no.)
6400 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 28315
Account number (see instructions)
****318926
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
☒
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-3f05871bcd595ece869dc8ca,v11-1098-E-stacked,original,2022,fgen-aced721a07c449c562254720,synthetic_programmatic_template,stacked,top,False,
"Form 1098-E Student Loan Interest Statement
From:
Summit Student Loan Servicing
Recipient's name:
Noah Brennan
1 Student loan interest received by lender
7,962.94
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
☒",1098,4,1098,fdc-b6fa10f2b045695e4eef119b,v11-1098-E-stacked,original,2023,fgen-8bf59a2eaf1772b2429c806b,synthetic_programmatic_template,stacked,top,False,
"2026
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Cedar Valley Credit Union 6821 Maple Ridge Dr Riverton, WI 99149
RECIPIENT'S TIN
37-2120372
BORROWER'S name
Wei D. Patel
BORROWER'S TIN
***-**-2754
Street address (including apt. no.)
3334 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 53665
1 Student loan interest received by lender
8,329.08
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
☐
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-ca11d18ef55f17e07b465338,v11-1098-E-stacked,original,2026,fgen-747c1a121e8e44623d2ae879,synthetic_programmatic_template,stacked,none,False,
"VOID  CORRECTED
For calendar year 2021
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Harbor Personal Lending 2022 Elm Park Pl Maplewood, MN 73055
RECIPIENT'S TIN
23-7927319
BORROWER'S name
Lena Brennan
BORROWER'S TIN
****7409
Street address (including apt. no.)
6837 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 30320
Account number (see instructions)
****900246
1 Student loan interest received by lender
$4,236.53
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
☐
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-8acadad74c712040757e395d,v11-1098-E-stacked,original,2021,fgen-781870171464f7e17a425a70,synthetic_programmatic_template,stacked,none,False,
"2022
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Summit Student Loan Servicing 7463 Elm Park Pl Riverton, WI 24272
RECIPIENT'S TIN
24-9207935
BORROWER'S name
Amara D. Fischer
BORROWER'S TIN
****9694
Street address (including apt. no.)
743 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 13800
Account number (see instructions)
***-**-405822
1 Student loan interest received by lender
$1,321.72
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
Department of the Treasury - Internal Revenue Service
Form 1098-E
Student Loan Interest Statement
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-fe26daef77c76457802a96a8,v11-1098-E-stacked,original,2022,fgen-b23ed92578733bd7f1b34452,synthetic_programmatic_template,stacked,bottom,False,
"Form 1098-E
Student Loan Interest Statement
For calendar year 2024
OMB No. 1545-1576
Copy B For Borrower
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Granite Auto Finance 8058 Lakeshore Blvd Fairview, OH 32394
RECIPIENT'S TIN
75-6685154
BORROWER'S name
Olivia K. Romero
BORROWER'S TIN
ending in 8949
Street address (including apt. no.)
9648 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 96406
1 Student loan interest received by lender
$8,804.48
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004",1098,4,1098,fdc-40772e53ed3237184d99643f,v11-1098-E-stacked,original,2024,fgen-e9fa40b1524d59da87d8ef9b,synthetic_programmatic_template,stacked,top,False,
"Form 1098-E
Student Loan Interest Statement
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Granite Auto Finance 5201 Maple Ridge Dr Lakewood, CO 91417
RECIPIENT'S TIN
93-1118548
BORROWER'S name
Noah Fischer
BORROWER'S TIN
XXXXX5510
Street address (including apt. no.)
3505 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 96883
1 Student loan interest received by lender
5,098.06
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004",1098,4,1098,fdc-6fc1dcb075b112a571b865f5,v11-1098-E-stacked,original,2026,fgen-8e37b83f5923a4ac5062f7f8,synthetic_programmatic_template,stacked,top,False,
"Form 1098-E
Student Loan Interest Statement
For calendar year 2021
OMB No. 1545-1576
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Summit Student Loan Servicing 9169 Sample Street Bayside, WA 33674
RECIPIENT'S TIN
24-9176620
BORROWER'S name
Avery Haddad
BORROWER'S TIN
XXXXX7947
Street address (including apt. no.)
5545 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 97786
1 Student loan interest received by lender
$3,763.41
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-4e517a8e41b151fa99ef5ff9,v11-1098-E-stacked,original,2021,fgen-6ab9d4391d3590361a94ae7b,synthetic_programmatic_template,stacked,top,False,
"OMB No. 1545-1576
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Harbor Personal Lending 1290 Lakeshore Blvd Oak Grove, TX 42561
RECIPIENT'S TIN
37-1359376
BORROWER'S name
Lena B. Tanaka
BORROWER'S TIN
XXXXX4176
Account number (see instructions)
XXX-XX-921344
1 Student loan interest received by lender
$539.97
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
X
Department of the Treasury - Internal Revenue Service
Form 1098-E
Student Loan Interest Statement
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-9546d1b882616b362873b334,v11-1098-E-stacked,original,2023,fgen-c3eb82f45a6d38cae92c561d,synthetic_programmatic_template,stacked,bottom,False,
"For calendar year2021
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Granite Auto Finance 5924 Oak Hollow Ct Pinecrest, GA 52649
RECIPIENT'STIN
91-6475317
BORROWER'S name
O1ivia Haddad
BORROWER'S TIN
XXXXX8876
Street address (including apt. no.)
7O72 Prairie Ave
City or town, state or province, country, and ZIP or forcign postal code
Bayside, WA 45689
l Student loan interest received by lender
4,889.39
2 If checked, box l does not ínclude loan origination fces and/or capitalized interest for loans made before September 1, 2004
Departmentof the Treasury - Intemal Revenue Service
Form l098-E
Student Loan Interest Statement
Form 1098-E (keepfor your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-54360fcc29cc646ad816c363,v11-1098-E-stacked,original,2021,fgen-a0d4bfcf8c24547978d869f1,synthetic_programmatic_template,stacked,bottom,True,
"Form 1098-E
Student Loan Interest Statement
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Harbor Personal Lending 246 Oak Hollow Ct Fairview, OH 87864
RECIPIENT'S TIN
35-1304810
BORROWER'S name
Casey Fischer
BORROWER'S TIN
ending in 7761
Account number (see instructions)
XXX-XX-906301
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-df1d756fa22b7672608ec113,v11-1098-E-stacked,original,2021,fgen-772a78695111ab3796784230,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1098-E
Student Loan Interest Statement
For calendar year 2025
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Summit Student Loan Servicing 1226 Granite St Bayside, WA 93276
RECIPIENT'S TIN
51-1183675
BORROWER'S name
Priya Rivera
BORROWER'S TIN
ending in 8243
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-2de0ef061522f87286de1a00,v11-1098-E-stacked,original,2025,fgen-a810fcc72769fcd29d1b95e4,synthetic_programmatic_template,stacked,top,False,
"Form 1098-E Student Loan Interest Statement 2026
From:
Northwind Auto Credit
Recipient's name:
Kwame Rivera
1 Student loan interest received by lender
$802.75
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
☐",1098,4,1098,fdc-838ccc1405539272739ffd58,v11-1098-E-stacked,original,2026,fgen-72ec710daea0fe4ca0340df6,synthetic_programmatic_template,stacked,top,False,
"Form 1098-E
Student Loan Interest Statement
For calendar year 2026
OMB No. 1545-1576
Copy B For Borrower
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number   Summit Student Loan Servicing 9384 Elm Park Pl Fairview, OH 33490
RECIPIENT'S TIN 93-6641653
BORROWER'S name Casey Lindqvist
BORROWER'S TIN      ****7381
1 Student loan interest received by lender $1,447.77
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 X
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-39296c81514279e053934d06,v11-1098-E-inline,original,2026,fgen-4abdfafe6056282c708cae94,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1098-E
Student Loan Interest Statement
For calendar year 2022
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number   Harbor Personal Lending 4655 Cedar Ln Oak Grove, TX 88000
RECIPIENT'S TIN 66-5965873
BORROWER'S name Priya Moreau
BORROWER'S TIN ***-**-3511
1 Student loan interest received by lender $3,007.17
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 ☐",1098,4,1098,fdc-a150b9b134f268727c249dc7,v11-1098-E-inline,original,2022,fgen-663ca3b181516d93c22c8141,synthetic_programmatic_template,inline,top,False,
"For calendar year 2023
OMB No. 1545-1576
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number  Cedar Valley Credit Union 369 Elm Park Pl Maplewood, MN 27240
RECIPIENT'S TIN 74-7952471
BORROWER'S name      Diego Kowalski
BORROWER'S TIN   ****3701
Street address (including apt. no.)   6829 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code      Cedar Falls, IA 16835
1 Student loan interest received by lender 9,060.51
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 X",1098,4,1098,fdc-5e9f50ac93c6e4120ca2f327,v11-1098-E-inline,original,2023,fgen-27ef7d41e97e4f0975eb469e,synthetic_programmatic_template,inline,none,False,
"CORRECTED (if checked)
Form 1098-E
Student Loan Interest Statement
OMB No. 1545-1576
Copy B For Borrower
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Granite Auto Financc 8l99 Prairie Ave Pinecrest, GA17444
RECIPIENT'S TIN   42-7302473
BORROWER'S name Lena L. Romero
BORROWER'S TIN ****4486
Street address (including apt. no.)6355 Cedar Ln
City ortown, stateor province, country, and ZIP or foreign postal code 0ak Grove, TX 8592l
1 5tudent loan interest received by lender $7,580.72
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before 5eptember l, 2004      X
Department ofthe Treasury - Internal Revenue Servíce
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-1b6eb3b36f6fcd5cd97783d0,v11-1098-E-inline,original,2025,fgen-bf68d87ef24eba76184ea19a,synthetic_programmatic_template,inline,top,True,
"Form 1098-E
Student Loan Interest Statement
2024
OMB No. 1545-1576
Copy B For Borrower
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number      Northwind Auto Credit 6863 Oak Hollow Ct Fairview, OH 27807
RECIPIENT'S TIN 83-2781098
BORROWER'S name Amara Rivera
BORROWER'S TIN ***-**-0136
Street address (including apt. no.)      4103 Sample Street
City or town, state or province, country, and ZIP or foreign postal code      Bayside, WA 89029
Account number (see instructions)      XXX-XX-742856
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004   ☐
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-ef049b96a057708c536bc38d,v11-1098-E-inline,original,2024,fgen-e713fe3b81f4f3b69ca9b030,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1098-E
Student Loan Interest Statement
For calendar year 2026
OMB No. 1545-1576
Copy B For Borrower
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Harbor Personal Lending 3653 Oak Hollow Ct Maplewood, MN 81367
RECIPIENT'S TIN 16-1945496
BORROWER'S name  Sofia S. Castillo
BORROWER'S TIN ***-**-1454
Account number (see instructions)   XXX-XX-259104
1 Student loan interest received by lender      553.93
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004  X
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-fbec0e3ce8d111838c5e0fb2,v11-1098-E-inline,original,2026,fgen-dc65efb342c7afe8756bbcb0,synthetic_programmatic_template,inline,top,False,
"Form 1098-E Student Loan Interest Statement
From: Harbor Personal Lending
Recipient's name: Diego J. Brennan
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004  0.00",1098,4,1098,fdc-d2b2f13cfb7bead7b909e6ab,v11-1098-E-inline,original,2025,fgen-7e4cf464be933900e040f008,synthetic_programmatic_template,inline,top,False,
"RECIPIENT'S name:  Summit Student Loan Servicing
Recipient's name:  Taylor D. Rivera
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 0.00
1 Student loan interest received by lender $77.46
Form 1098-E Student Loan Interest Statement 2026",1098,4,1098,fdc-f5b4fbbad1a96ec968311ce5,v11-1098-E-inline,original,2026,fgen-c09bd25b475f01d3475a9c71,synthetic_programmatic_template,inline,bottom,False,
"Form 1098-E
Student Loan Interest Statement
For calendar year 2023
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Cedar Valley Credit Union 3002 Sample Street Testville, IL 83001
RECIPIENT'S TIN  51-2516579
BORROWER'S name Mateo R. Nguyen
BORROWER'S TIN   XXX-XX-7632
1 Student loan interest received by lender $1,562.76",1098,4,1098,fdc-d3834387b502e13873f784b8,v11-1098-E-inline,original,2023,fgen-ffdbb4904bc0da3677221962,synthetic_programmatic_template,inline,top,False,
"Form 1098-E
Student Loan Interest Statement
For calendar year 2023
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Granite Auto Finance 8673 Willow Bend Way Testville, IL 93748
RECIPIENT'S TIN 73-5940735
BORROWER'S name Sofia Rivera
BORROWER'S TIN      ****6203
Street address (including apt. no.)   2680 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code   Pinecrest, GA 28451
Account number (see instructions)  XXX-XX-255997
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 [X]
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-fe26393cce851c085095a2e4,v11-1098-E-inline,original,2023,fgen-647cc5d2c8275eb11c8a211b,synthetic_programmatic_template,inline,top,False,
"Form 1098-E
Student Loan Interest Statement
2021
OMB No. 1545-1576
Copy B For Borrower
This is important tax information and is being furnished to the IRS.
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Harbor Personal Lending 1292 Prairie Ave Lakewood, CO 38567
RECIPIENT'S TIN 32-4490619
BORROWER'S name Fatima Kowalski
BORROWER'S TIN XXX-XX-9002
Street address (including apt. no.) 2520 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code      Bayside, WA 65727
1 Student loan interest received by lender 1,155.80
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 X
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-2f3cd12c6641966a00dad234,v11-1098-E-inline,original,2021,fgen-04cd24f2391a08cf0daa3744,synthetic_programmatic_template,inline,top,False,
"Form 1098-E Student Loan Interest Statement
RECIPIENT'S name: Granite Auto Finance
RECIPIENT: Fatima Moreau
1 Student loan interest received by lender  $8,251.77
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004      ☒",1098,4,1098,fdc-bfe87af28f6472ca07d3d2f2,v11-1098-E-inline,original,2025,fgen-80b3fef98ca070766e6a424f,synthetic_programmatic_template,inline,top,False,
"Form 1098-E Student Loan Interest Statement
RECIPIENT'S name: Harbor Personal Lending
Recipient's name: Alex Haddad
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004      0.00",1098,4,1098,fdc-1ca2181770e7f09eba00c1ff,v11-1098-E-inline,original,2026,fgen-0634814ce88bc71a44239e0d,synthetic_programmatic_template,inline,top,False,
"Form 1098-E
Student Loan Interest Statement
OMB No. 1545-1576
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Summit Student Loan Servicing 751 Oak Hollow Ct Pinecrest, GA 37704
RECIPIENT'S TIN  61-1115463
BORROWER'S name Noah Testcase
BORROWER'S TIN  ***-**-3123
Street address (including apt. no.)   5403 Sample Street
City or town, state or province, country, and ZIP or foreign postal code  Pinecrest, GA 42133
1 Student loan interest received by lender   $4,212.40
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 X
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-f1069b805cd9379fcd9944f6,v11-1098-E-inline,original,2022,fgen-dc0a414bb9347af6b08571b7,synthetic_programmatic_template,inline,top,False,
"Form 1098-E
Student Loan Interest Statement
2023
OMB No. 1545-1576
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number  Harbor Personal Lending 8366 Elm Park Pl Pinecrest, GA 43425
RECIPIENT'S TIN 39-6258259
BORROWER'S name Lena Rivera
BORROWER'S TIN   ***-**-3673
Street address (including apt. no.)   8087 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code      Brookhaven, PA 20196
1 Student loan interest received by lender $2,274.46
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004   ☒",1098,4,1098,fdc-7053b3f986b253e93be01b2d,v11-1098-E-inline,original,2023,fgen-2a94c74223d3d50849a39ca7,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1098-E
Student Loan Interest Statement
For calendar year 2026
Copy B For Borrower
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number      Summit Student Loan Servicing 795 Willow Bend Way Oak Grove, TX 25661
RECIPIENT'S TIN 47-2739084
BORROWER'S name   Taylor Sato
BORROWER'S TIN   ***-**-9957
Account number (see instructions) XXX-XX-839042
1 Student loan interest received by lender  $2,614.45
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-4a6658d08b7ec3c737762aba,v11-1098-E-inline,original,2026,fgen-12e6ee42b62f812e049839ad,synthetic_programmatic_template,inline,top,False,
"From: Northwind Auto Credit RECIPIENT: Jamie Adeyemi 1 Student loan interest received by lender $9,099.16
2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before
September 1, 2004 0.00 Form 1098-E Student Loan Interest Statement 2022",1098,4,1098,fdc-eaec6d389c2b5646eab35c84,v11-1098-E-flat,original,2022,fgen-b0f5b7246686b080c984a595,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2024 OMB No. 1545-1576 This is important tax
information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Granite Auto Finance 9301 Willow Bend Way Brookhaven, PA 49381 RECIPIENT'S TIN 69-5239641 BORROWER'S name Alex Adeyemi BORROWER'S TIN XXX-XX-9196 Account number (see instructions) ***-**-677090
1 Student loan interest received by lender 4,060.19 Department of the Treasury - Internal Revenue Service Form 1098-E Student Loan Interest Statement Form 1098-E (keep for your records) www.irs.gov/Form1098E",1098,4,1098,fdc-61dbe4959e3f116e5996602e,v11-1098-E-flat,original,2024,fgen-0857f6230d762e0dfa33da46,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2021 OMB No. 1545-1576 This is important tax information and is
being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Summit Student Loan Servicing 2149 Elm Park Pl Lakewood, CO 30064 RECIPIENT'S TIN 84-3198726 BORROWER'S name Casey Sato
BORROWER'S TIN ****5873 1 Student loan interest received by lender 3,394.77 Department of the Treasury - Internal Revenue Service Form 1098-E Student Loan Interest Statement Form 1098-E (keep for your records) www.irs.gov/Form1098E",1098,4,1098,fdc-08927718b5de6fc0c02ae8c5,v11-1098-E-flat,original,2021,fgen-c0aee318c4487fd781aaed7b,synthetic_programmatic_template,flat,bottom,False,
"Form 1098-E Student Loan Interest Statement For calendar year 2023 OMB No. 1545-1576 Copy B For Borrower RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Harbor Personal Lending 3351 Elm Park Pl Lakewood, CO 16828 RECIPIENT'S TIN 70-7986198 BORROWER'S
name Taylor Moreau BORROWER'S TIN ending in 9354 Street address (including apt. no.) 888 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 49038 Account number (see instructions) XXXXX869121 1 Student loan interest received by lender $5,666.43 2 If checked, box 1 does not include loan origination fees and/or capitalized
interest for loans made before September 1, 2004 Department of the Treasury - Internal Revenue Service Form 1098-E (keep for your records) www.irs.gov/Form1098E",1098,4,1098,fdc-2635cee6c67c7a594b0fd77e,v11-1098-E-flat,original,2023,fgen-26fd7adc51b8e910285e319c,synthetic_programmatic_template,flat,top,False,
"Form l098-E Student
Loan Interest Statement 2024 RECIPIENT'S name:Harbor Personal Lending
To: Fatima Romero 1 Student loan interest received by lender 3,487.83",1098,4,1098,fdc-0c51796ad5e6d1c359534298,v11-1098-E-flat,original,2024,fgen-e01eb6fa522f9bb9190767f9,synthetic_programmatic_template,flat,top,True,
"Form 1098-E Student Loan Interest Statement For ca1endar year 2023 OMB No. 1545-1576 RECIPIENT'S/LENDER'S name, street address, city or town, statc or province, country, ZIP orforeignpostal code, and telephone number Cedar Valley Credit Union 7623 Cedar Ln Maplewood, MN 34657 RECIPIENT'5 TIN 11-7749838 B0RROWER'S name Casey R. Sato BORROWER'5 TIN XXX-XX-7729 Street address (íncluding apt. no.) 3373
Oak Hollow CtCity or town, stateor provínce, country, and ZIP or foreign posta1 code Pinecrest, GA 69850 l Student loan interest received by lender 6,163.97 2 If checked, box 1 does not indude
loan origination fees and/or capitalized interest for loans made before September 1, 20O4 [X] Department of the Treasury - Internal Revenue Service Form 1098-E (keep for your records) www.irs.gov/Form1098E",1098,4,1098,fdc-5dcf8373ae7052dfcbd53726,v11-1098-E-flat,original,2023,fgen-99a966a3607bde6d98e99043,synthetic_programmatic_template,flat,top,True,
"Form 1098-E Student Loan Interest Statement From: Harbor Personal Lending RECIPIENT: Kwame Castillo
1 Student loan interest received by lender 6,095.67 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004
0.00",1098,4,1098,fdc-24ed27d229102b959695f363,v11-1098-E-flat,original,2026,fgen-30ce9511d8cb38527cf7aa78,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 1098-E Student Loan Interest Statement For calendar year 2022 OMB No. 1545-1576 Copy B For Borrower This
is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address,
city or town, state or province, country, ZIP or foreign postal code, and telephone number Granite Auto Finance 8855 Granite St Maplewood, MN 50278 RECIPIENT'S TIN 86-3034133 BORROWER'S name Wei Tanaka BORROWER'S TIN XXX-XX-1160 Street address (including apt. no.) 89 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 89900 1 Student loan interest received by lender $8,508.20 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 X Department of the Treasury - Internal Revenue Service Form 1098-E (keep for your records) www.irs.gov/Form1098E",1098,4,1098,fdc-93b6407ef5a84ea765930669,v11-1098-E-flat,original,2022,fgen-133df5f4581d45a0a0de9dcd,synthetic_programmatic_template,flat,top,False,
"Form 1098-E Student Loan Interest Statement For calendar year 2022 OMB No. 1545-1576 Copy B For Borrower RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Northwind Auto Credit 4631 Harbor View Rd Riverton, WI 70085 RECIPIENT'S
TIN 46-8027370 BORROWER'S name Kwame B. Castillo BORROWER'S TIN ***-**-9740 Street address (including apt. no.) 2023 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 36080 Account number (see instructions) ***-**-529409 1
Student loan interest received by lender $1,759.97 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004",1098,4,1098,fdc-72149f1a08b3b759c25c16b7,v11-1098-E-flat,original,2022,fgen-fdae32ab6d4bb33fb79b6cae,synthetic_programmatic_template,flat,top,False,
"Form 1098-E Student Loan Interest Statement 2023 OMB No. 1545-1576 Copy B For Borrower RECIPIENT'S/LENDER'S name, street address, city or town, state
or province, country, ZIP or foreign postal code, and telephone number
Harbor Personal Lending 8944 Lakeshore Blvd Oak Grove, TX 54304 RECIPIENT'S TIN 95-3971635 BORROWER'S name Avery Walsh BORROWER'S TIN XXX-XX-8530 1 Student loan interest received by lender 8,958.42",1098,4,1098,fdc-f1d8ec9c8a1c9ffe905bfb8f,v11-1098-E-flat,original,2023,fgen-a853ec16a97f817316c25eb8,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Form 1098-E Student Loan Interest Statement 2022 Copy B For Borrower RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Granite Auto Finance 93 Sample Street Testville, IL 11243 RECIPIENT'S TIN 47-3131172 BORROWER'S name Wei A. Lindqvist BORROWER'S
TIN ending in 0854 Street address (including apt. no.) 2269 Prairie Ave City or
town, state or province, country, and ZIP or foreign postal code Testville, IL 60927 1 Student loan interest received by lender $7,169.65 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 X Department of the Treasury - Internal Revenue Service Form 1098-E (keep for your records) www.irs.gov/Form1098E",1098,4,1098,fdc-8d723d06b1c804f5985dbd12,v11-1098-E-flat,original,2022,fgen-468f5db446f43e93fb354a8c,synthetic_programmatic_template,flat,top,False,
"2025 This is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Summit Student Loan Servicing 3231 Sample Street Bayside, WA 72033 RECIPIENT'S TIN 30-3764759 BORROWER'S
name Alex L. Larsen BORROWER'S TIN XXXXX9113 Street address (including apt. no.) 5547
Sample Street City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 46580 1 Student loan interest received by lender $3,327.88 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 Form 1098-E Student Loan Interest Statement",1098,4,1098,fdc-4339d6c1676a86be30ba1f1f,v11-1098-E-flat,original,2025,fgen-502cb43cac8da35daecde042,synthetic_programmatic_template,flat,bottom,False,
"☐ CORRECTED Form 1098-E Student
Loan Interest Statement 2021 OMB No. 1545-1576 Copy B For Borrower This is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Granite Auto Finance 7257 MapleRidge Dr Brookhaven, PA 2865O RECIPIENT'S TIN 77-227960l BORROWER'S name Sofia S. Haddad BORROWER'S TIN ****3888 2 If checked,box l does not indudeloan origination fees and/or capitalized interest for loans made before September l, 2O04 ☒ Department of the Treasury - Intemal
Revenue Service Form 1098-E (kcep foryour records) www.irs.gov/Form1O98E",1098,4,1098,fdc-013c13c94ef7e23f8acf901b,v11-1098-E-flat,original,2021,fgen-b4b449d0969a755a4272a823,synthetic_programmatic_template,flat,top,True,
"Form 1098-E Student Loan Interest Statement Copy B For Borrower RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Harbor Personal Lending 2650 Sample Street Lakewood, CO 99754 RECIPIENT'S TIN 71-1079728 BORROWER'S name Riley Romero BORROWER'S TIN ***-**-5635 Street address (including apt. no.) 6818 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 21071 1 Student loan interest received by lender
$3,328.91 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 ☒ Department of the Treasury - Internal Revenue Service Form 1098-E (keep for
your records) www.irs.gov/Form1098E",1098,4,1098,fdc-c40c031883ede1372f41b545,v11-1098-E-flat,original,2022,fgen-82a431ac97d8830ae49543f3,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED For calendar year 2025 OMB No. 1545-1576 This is important tax information and is being furnished to the IRS. RECIPIENT'S/LENDER'S name, street address, city
or town, state or province, country, ZIP or foreign postal code, and telephone number Northwind Auto Credit 7955 Sample Street Testville, IL 71828 RECIPIENT'S TIN 28-1068125 BORROWER'S name Amara R. Fischer BORROWER'S TIN XXX-XX-3519 Street address (including apt. no.) 2284 Sample Street City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 86229 1 Student loan interest received by lender 1,258.30 2 If checked, box 1 does not include
loan origination fees and/or capitalized interest for loans made before September 1, 2004 X Form 1098-E Student Loan Interest Statement",1098,4,1098,fdc-d5e148f2dc2f9a60645fbf2c,v11-1098-E-flat,original,2025,fgen-f80a9a5126f683170d4f1df5,synthetic_programmatic_template,flat,bottom,False,
"☐ CORRECTED Form 1098-E Student Loan Interest Statement For calendar year 2022 OMB No. 1545-1576 RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Granite Auto Finance 4484 Harbor View Rd Pinecrest, GA 30496 RECIPIENT'S TIN 89-7775820 BORROWER'S name Riley Rivera BORROWER'S TIN ***-**-2923 Street address (including apt.
no.) 5018 Willow
Bend Way City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 17566 Account number (see instructions) XXX-XX-917514 1 Student loan interest received by lender $7,714.29 Department of the Treasury - Internal Revenue Service Form 1098-E (keep for your records) www.irs.gov/Form1098E",1098,4,1098,fdc-28a0e523b4dd03f9c7ff2d5a,v11-1098-E-flat,original,2022,fgen-186da25b748a1db6113b3cdd,synthetic_programmatic_template,flat,top,False,
"## Form 1098-E Student Loan Interest Statement 2021
| Field | Value |
| --- | --- |
| RECIPIENT: | Cedar Valley Credit Union |
| To: | Hiro Okafor |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | X |",1098,4,1098,fdc-9dc4875c46689cb2b03c8504,v11-1098-E-markdown,original,2021,fgen-77d7c86903b310a10e4cd9d7,synthetic_programmatic_template,markdown,top,False,
"Form 1098-E
Student Loan Interest Statement
2025
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Granite Auto Finance 6034 Willow Bend Way Fairview, OH 86375 |
| RECIPIENT'S TIN | 68-3012406 |
| BORROWER'S name | Mateo E. Rivera |
| BORROWER'S TIN | ***-**-0337 |
| Account number (see instructions) | ***-**-811773 |
| 1 Student loan interest received by lender | $4,015.27 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | [X] |
## Department of the Treasury - Internal Revenue Service
## Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-b6dd5de527a5f62539250c77,v11-1098-E-markdown,original,2025,fgen-014425573618e6e9b3c0af6f,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
## Form 1098-E
## Student Loan Interest Statement
For calendar year 2025
## OMB No. 1545-1576
Copy B For Borrower
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Granite Auto Finance 6948 Cedar Ln Bayside, WA 34073 |
| RECIPIENT'S TIN | 70-4110706 |
| BORROWER'S name | Alex Patel |
| BORROWER'S TIN | XXX-XX-7243 |
| Street address (including apt. no.) | 1414 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 78814 |
| Account number (see instructions) | ****568164 |
| 1 Student loan interest received by lender | 8,511.35 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | X |
Department of the Treasury - Internal Revenue Service
## Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-0d644e78dcaf1056904461e1,v11-1098-E-markdown,original,2025,fgen-222d48bdc1b8c1d9f73cf149,synthetic_programmatic_template,markdown,top,False,
"Copy B For Borrower
| Field | Value |
| ---| --- |
| RECIPIENT'S/LENDER'S name, street address, city or town,state or province, country, ZIP or foreígn postal code, and telephonc number | Northwind Auto Credit 627 Prairie Ave Fairview, 0H 49038 |
|RECIPIENT'5 TIN | 37-7082678 |
| BORROWER'S name | Wei S. Patel |
| BORROWER'S TIN | XXX-XX-9849 |
| Street address (including apt.no.) | 7016 0ak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 42182 |
| Account number (see instructions) | ****412659 |
| 1 5tudent loan interestreceived by lender | $1,547.58 |
| 2 If checked, box 1 does not ínc1ude loan origination fees and/or capitalized interest for loans made before September 1, 2004 | X |
Department of the Treasury - Intemal Rcvenue Service",1098,4,1098,fdc-d7830034c50f410a220e3283,v11-1098-E-markdown,original,2021,fgen-d5c625eabaa5109600871b4e,synthetic_programmatic_template,markdown,none,True,
"Form 1098-E
Student Loan Interest Statement
For calendar year 2025
OMB No. 1545-1576
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Summit Student Loan Servicing 5081 Granite St Pinecrest, GA 12762 |
| RECIPIENT'S TIN | 25-4516809 |
| BORROWER'S name | Olivia B. Patel |
| BORROWER'S TIN | ending in 3371 |
| Account number (see instructions) | ending in 780878 |
| 1 Student loan interest received by lender | 6,308.13 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | [X] |
Department of the Treasury - Internal Revenue Service
Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-01c474e3f3a38ab42dcd3bb7,v11-1098-E-markdown,original,2025,fgen-1eb499c313bf2829cc1778d9,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
OMB No. 1545-1576
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Summit Student Loan Servicing 1452 Maple Ridge Dr Cedar Falls, IA 89726 |
| RECIPIENT'S TIN | 10-9316408 |
| BORROWER'S name | Riley Okafor |
| BORROWER'S TIN | ***-**-2286 |
| Street address (including apt. no.) | 2716 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 11730 |
| Account number (see instructions) | ****009781 |
| 1 Student loan interest received by lender | 5,161.22 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 |  |",1098,4,1098,fdc-e63f3b9603086960de8ab14e,v11-1098-E-markdown,original,2021,fgen-45079981bd1b9390f6634b51,synthetic_programmatic_template,markdown,none,False,
"Form 1098-E Student Loan Interest Statement
| Field | Value |
| --- | --- |
| From: | Summit Student Loan Servicing |
| RECIPIENT: | Jordan Sato |
| 1 Student loan interest received by lender | $2,493.75 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | X |",1098,4,1098,fdc-def2358ecd591db2b1718ed0,v11-1098-E-markdown,original,2025,fgen-780294ff998b112b17c9854e,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| RECIPIENT'S name: | Northwind Auto Credit |
| Recipient's name: | Kwame Patel |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | X |
| 1 Student loan interest received by lender | $1,455.80 |",1098,4,1098,fdc-a6812c8ea24295ef94c33d3b,v11-1098-E-markdown,original,2022,fgen-78455265bf2a2e229eadbdff,synthetic_programmatic_template,markdown,none,False,
"☐ CORRECTED
2024
OMB No. 1545-1576
## Copy B For Borrower
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Summit Student Loan Servicing 2229 Cedar Ln Cedar Falls, IA 93738 |
| RECIPIENT'S TIN | 44-4644692 |
| BORROWER'S name | Amara Haddad |
| BORROWER'S TIN | ****4269 |
| 1 Student loan interest received by lender | 3,145.67 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | ☐ |
Department of the Treasury - Internal Revenue Service
Form 1098-E
Student Loan Interest Statement
## Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-ffbbfd52c98c361a42d65e43,v11-1098-E-markdown,original,2024,fgen-14a98bef8f48d69711dbe3dd,synthetic_programmatic_template,markdown,bottom,False,
"## For calendar year 2022
OMB No. 1545-1576
Copy B For Borrower
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Granite Auto Finance 2399 Oak Hollow Ct Riverton, WI 67721 |
| RECIPIENT'S TIN | 32-3307492 |
| BORROWER'S name | Fatima J. Romero |
| BORROWER'S TIN | ***-**-3824 |
| Account number (see instructions) | XXX-XX-611326 |
| 1 Student loan interest received by lender | 1,585.88 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 |  |",1098,4,1098,fdc-47ebeec5844224cdc63eb0e7,v11-1098-E-markdown,original,2022,fgen-12e080806f100dbe5d0bd96b,synthetic_programmatic_template,markdown,none,False,
"☐ CORRECTED
## Form 1O98-E
Student Loan Interest Statement
## 2021
OMB No.1545-1576
This is important tax information and is being furnished tothe IRS.
| Ficld | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP orforeign postal code, and telephone number | Summit Student Loan Servicing 6830 Lakeshore Blvd 0ak Grove, TX 46853 |
| RECIPIENT'5 TIN | 94-4934653 |
| B0RROWER'S name | Priya S. Haddad |
| BORROWER'S TIN | ***-**-484l |
| Street address (induding apt. no.) | 6277 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign posta1 code | Baysíde, WA 32811 |
Department of theTreasury - Internal Revenue 5ervice
Form 1O98-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-05a5cb2e8a97ea84e529be64,v11-1098-E-markdown,original,2021,fgen-661d8bd4652b5250691a0e36,synthetic_programmatic_template,markdown,top,True,
"Form 1098-E Student Loan Interest Statement 2025
| Field | Value |
| --- | --- |
| From: | Cedar Valley Credit Union |
| Recipient's name: | Taylor L. Patel |
| 1 Student loan interest received by lender | $1,428.28 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | [X] |",1098,4,1098,fdc-292936608d2c68d0ea6c029d,v11-1098-E-markdown,original,2025,fgen-4a4d02da56f0c7c81c963ae1,synthetic_programmatic_template,markdown,top,False,
"Form 1098-E Student Loan Interest Statement
| Field | Value |
| --- | --- |
| RECIPIENT: | Cedar Valley Credit Union |
| RECIPIENT: | Avery Lindqvist |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | [X] |",1098,4,1098,fdc-70f1ee8c27846b39fcdd3be8,v11-1098-E-markdown,original,2024,fgen-4116c296afc20d3e3921afb5,synthetic_programmatic_template,markdown,top,False,
"## Form 1098-E Student Loan Interest Statement 2021
| Field | Value |
| --- | --- |
| RECIPIENT: | Cedar Valley Credit Union |
| RECIPIENT: | Priya Sato |
| 1 Student loan interest received by lender | 6,023.41 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | ☐ |",1098,4,1098,fdc-7ff68cefe7cd8d0419e2075c,v11-1098-E-markdown,original,2021,fgen-bd74618d6dba9a2daf8020f3,synthetic_programmatic_template,markdown,top,False,
"Form 1098-E
## Student Loan Interest Statement
2025
OMB No. 1545-1576
## Copy B For Borrower
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Cedar Valley Credit Union 9550 Harbor View Rd Cedar Falls, IA 55762 |
| RECIPIENT'S TIN | 31-4360100 |
| BORROWER'S name | Casey K. Patel |
| BORROWER'S TIN | XXXXX7682 |
| Street address (including apt. no.) | 5998 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 32189 |
| 1 Student loan interest received by lender | 6,706.31 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | ☐ |
## Department of the Treasury - Internal Revenue Service
## Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-9e17fb1b30c303b7f0224ac4,v11-1098-E-markdown,original,2025,fgen-8db203709308aea92587c08c,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
Form 1098-E
Student Loan Interest Statement
For calendar year 2022
| Field | Value |
| --- | --- |
| RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Cedar Valley Credit Union 8622 Cedar Ln Brookhaven, PA 35468 |
| RECIPIENT'S TIN | 98-4272256 |
| BORROWER'S name | Riley B. Okafor |
| BORROWER'S TIN | XXXXX9383 |
| 1 Student loan interest received by lender | $2,487.28 |
| 2 If checked, box 1 does not include loan origination fees and/or capitalized interest for loans made before September 1, 2004 | ☒ |
Department of the Treasury - Internal Revenue Service
## Form 1098-E (keep for your records)  www.irs.gov/Form1098E",1098,4,1098,fdc-8d494b02a9d644ff9eac1e59,v11-1098-E-markdown,original,2022,fgen-ae4555e5b47d4a943a165dc4,synthetic_programmatic_template,markdown,top,False,
"Form 1098-T TuitionStatement 2023
FILER:
Lakeshore State University
Rccipient's name:
Avery M. Testcase
5 Scholarships or grants
8,486.66",1098,4,1098,fdc-feb4c8af29c79d3dbb2911bb,v11-1098-T-stacked,original,2023,fgen-7440eed3689dd648bc425e91,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
Form 1098-T
Tuition Statement
2025
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Lakeshore State University 1120 Cedar Ln Brookhaven, PA 51953
FILER'S employer identification no.
18-3194182
STUDENT'S name
Olivia Fischer
STUDENT'S TIN
XXXXX6026
Street address (including apt. no.)
5973 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 28242
Account number (see instructions)
ending in 062929
1 Payments received for qualified tuition and related expenses
129,696.20
4 Adjustments made for a prior year
$0.00
5 Scholarships or grants
7,941.42
6 Adjustments to scholarships or grants for a prior year
9 Checked if a graduate student
☒
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-871f6ac0eccf255fe2818867,v11-1098-T-stacked,original,2025,fgen-c92aea4456778ef84accd55a,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1098-T
Tuition Statement
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreignpostal code, and telephone number
Riverside Community College 8l6 Oak Hollow Ct Fairview, OH 55377
FILER'S employer identification no.
47-1748O47
5TUDENT'S name
Riley Haddad
STUDENT'S TIN
XXX-XX-9467
Street address (including apt. no.)
573 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 18225
1Payments received for qualified tuition and related expenses
5l,190.52
4 Adjustments made for a prior year
S0.00
5 Scholarships or grants
2,390.22
6 Adjustments to scholarships or grants for a prior year
8Checked if at least half-time student
☒
9 Checked if a graduate student
☐
Department of the Treasury -Intemal Revenue Servíce
Form 1O98-T (keep for your records)  www.irs.gov/Form1O98T",1098,4,1098,fdc-d7f56cea4e206ccb79fbc285,v11-1098-T-stacked,original,2022,fgen-26c3a0dea586578a377372f5,synthetic_programmatic_template,stacked,top,True,
"FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Lakeshore State University 2078 Sample Street Fairview, OH 33496
FILER'S employer identification no.
19-2985313
STUDENT'S name
Noah C. Haddad
STUDENT'S TIN
****0303
Street address (including apt. no.)
829 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 56739
Account number (see instructions)
****820357
1 Payments received for qualified tuition and related expenses
$12,625.50
4 Adjustments made for a prior year
6 Adjustments to scholarships or grants for a prior year
9 Checked if a graduate student
[X]
Department of the Treasury - Internal Revenue Service
Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-8afedfbaabb11a815ce6cd16,v11-1098-T-stacked,original,2023,fgen-a9ff61c7e5a108b37ca303ff,synthetic_programmatic_template,stacked,bottom,False,
"FILER:
Riverside Community College
Recipient's name:
Amara Testcase
8 Checked if at 1east half-time student
[X]
5 Scholarships or grants
l34.56
1 Payments received forqualified tuition and related expenses
$101,762.53",1098,4,1098,fdc-7bee33843259b673e38adb33,v11-1098-T-stacked,original,2026,fgen-1537300f158f25494df40391,synthetic_programmatic_template,stacked,none,True,
"CORRECTED (if checked)
For calendar year 2026
OMB No. 1545-1574
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Riverside Community College 5218 Harbor View Rd Pinecrest, GA 22391
FILER'S employer identification no.
26-2329062
STUDENT'S name
Sofia J. Rivera
STUDENT'S TIN
***-**-3908
Account number (see instructions)
***-**-282037
1 Payments received for qualified tuition and related expenses
$101,302.08
4 Adjustments made for a prior year
5 Scholarships or grants
8,065.44
6 Adjustments to scholarships or grants for a prior year
$0.00
9 Checked if a graduate student",1098,4,1098,fdc-2dcaf3428c0e1f4e4485f427,v11-1098-T-stacked,original,2026,fgen-742351fb8362710ee267a9e1,synthetic_programmatic_template,stacked,none,False,
"Form l098-T
Tuition Statement
2024
OMB No. 1545-1574
Copy B ForStudent
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone number
Lakeshore State University 8645 Maple Ridge Dr Maplewood, MN 74633
FILER'S employer identification no.
84-9874477
5TUDENT'S name
Fatima Moreau
STUDENT'S TIN
***-**-514O
Street address (induding apt. no.)
7458 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 14368
1 Payments received for qualified tuition and re1ated expenses
27,138.O3
4 Adjustments made for a prior year
SO.00
5 Scholarships or grants
2,530.80
6 Adjustments to scholarships or grants for a prior year
$0.00
8 Checked íf at leasthalf-time student
X
9Checked if a graduate student
☒
Department of the Treasury - Intema1 Revenue Service
Form 1098-T (keep foryour records)  www.irs.gov/Form1098T",1098,4,1098,fdc-8e0abb1e5f89fa89f102c7be,v11-1098-T-stacked,original,2024,fgen-b981bcef18c1bcfd27125758,synthetic_programmatic_template,stacked,top,True,
"For calendar year 2021
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Lakeshore State University 8406 Lakeshore Blvd Maplewood, MN 57876
FILER'S employer identification no.
22-9281845
STUDENT'S name
Casey S. Walsh
STUDENT'S TIN
XXX-XX-4224
Street address (including apt. no.)
7998 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 42236
Account number (see instructions)
***-**-563317
1 Payments received for qualified tuition and related expenses
$111,266.12
5 Scholarships or grants
$7,568.69
8 Checked if at least half-time student
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-ce5626a3859bf531dd343bcd,v11-1098-T-stacked,original,2021,fgen-da2fabd0eb0beb3a5ae780fa,synthetic_programmatic_template,stacked,none,False,
"Form 1098-T
Tuition Statement
For calendar year 2022
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Riverside Community College 5572 Maple Ridge Dr Lakewood, CO 49840
FILER'S employer identification no.
92-7102640
STUDENT'S name
Jordan Haddad
STUDENT'S TIN
***-**-9586
Street address (including apt. no.)
6848 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 46259
1 Payments received for qualified tuition and related expenses
111,061.75
4 Adjustments made for a prior year
$0.00
5 Scholarships or grants
1,208.21
6 Adjustments to scholarships or grants for a prior year
0.00
8 Checked if at least half-time student
X",1098,4,1098,fdc-7c9a4fbfc6a884ea5a372006,v11-1098-T-stacked,original,2022,fgen-24a62f17ff79b34d0cc1b0a8,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2022
OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Lakeshore State University 6021 Maple Ridge Dr Oak Grove, TX 40645
FILER'S employer identification no.
94-3051871
STUDENT'S name
Lena Adeyemi
STUDENT'S TIN
****7529
1 Payments received for qualified tuition and related expenses
$66,499.68
4 Adjustments made for a prior year
5 Scholarships or grants
6,041.24
6 Adjustments to scholarships or grants for a prior year
$0.00
8 Checked if at least half-time student
X
9 Checked if a graduate student
☒
Department of the Treasury - Internal Revenue Service
Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-ea7eb799d6893ebff20fc8d8,v11-1098-T-stacked,original,2022,fgen-0d82eefa59dbf4b0c38b86a6,synthetic_programmatic_template,stacked,bottom,False,
"Form 1098-T
Tuition Statement
For calendar year 2025
OMB No. 1545-1574
Copy B For Student
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Lakeshore State University 1952 Maple Ridge Dr Fairview, OH 67296
FILER'S employer identification no.
94-5192872
STUDENT'S name
Fatima Haddad
STUDENT'S TIN
XXXXX9398
Street address (including apt. no.)
5281 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 71911
1 Payments received for qualified tuition and related expenses
$105,200.83
4 Adjustments made for a prior year
9 Checked if a graduate student
X
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-c47e934e0bccf9a83373c5f1,v11-1098-T-stacked,original,2025,fgen-aefffa1bb76e135ce50ff654,synthetic_programmatic_template,stacked,top,False,
"Form 1098-T
Tuition Statement
For calendar year 2023
OMB No. 1545-1574
Copy B For Student
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Riverside Community College 1793 Lakeshore Blvd Lakewood, CO 70801
FILER'S employer identification no.
36-5894257
STUDENT'S name
Lena Okafor
STUDENT'S TIN
ending in 6684
Account number (see instructions)
XXXXX462005
1 Payments received for qualified tuition and related expenses
$94,819.47
4 Adjustments made for a prior year
0.00
5 Scholarships or grants
1,729.43
6 Adjustments to scholarships or grants for a prior year
$0.00
8 Checked if at least half-time student
☒
9 Checked if a graduate student
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-13a898542c7c27861c7d95f9,v11-1098-T-stacked,original,2023,fgen-45fc8f20d7568e836a791e26,synthetic_programmatic_template,stacked,top,False,
"FILER'S name:
Northwind Technical Institute
RECIPIENT:
Jamie M. Tanaka
8 Checked if at least half-time student
☐
5 Scholarships or grants
1,449.15
9 Checked if a graduate student
0.00",1098,4,1098,fdc-eedff96e158cb7b7ede9cbcc,v11-1098-T-stacked,original,2026,fgen-d5c1b78ea8dc3f1cbb6f662b,synthetic_programmatic_template,stacked,none,False,
"Form 1098-T
Tuition Statement
OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Lakeshore State University 2582 Lakeshore Blvd Lakewood, CO 53084
FILER'S employer identification no.
90-2845344
STUDENT'S name
Morgan C. Haddad
STUDENT'S TIN
ending in 2565
Street address (including apt. no.)
3332 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 24960
1 Payments received for qualified tuition and related expenses
$96,192.92
4 Adjustments made for a prior year
5 Scholarships or grants
$1,741.59
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
[X]
9 Checked if a graduate student
☒",1098,4,1098,fdc-1ca9f8ea99e34c520279cc8a,v11-1098-T-stacked,original,2024,fgen-4190c7b0adaa6eb98b215895,synthetic_programmatic_template,stacked,top,False,
"Form 1098-T
Tuition Statement
For calendar year 2024
OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
Riverside Community College 6851 Sample Street Fairview, OH 96606
FILER'S employer identification no.
17-6923476
STUDENT'S name
Alex D. Castillo
STUDENT'S TIN
****4646
1 Payments received for qualified tuition and related expenses
$58,831.57
4 Adjustments made for a prior year
5 Scholarships or grants
6,242.27
6 Adjustments to scholarships or grants for a prior year
0.00
8 Checked if at least half-time student
☒
9 Checked if a graduate student
[X]
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-0e16ee02559566877abc3ff8,v11-1098-T-stacked,original,2024,fgen-6614d7fb41718ddfd7ae2644,synthetic_programmatic_template,stacked,top,False,
"Form 1098-T Tuition Statement
FILER'S name:
Lakeshore State University
Recipient's name:
Olivia Brennan
5 5cholarships or grants
7,9O2.58
9 Checked ifa graduate student
0.00",1098,4,1098,fdc-53b835190aa4787cfa1d852b,v11-1098-T-stacked,original,2023,fgen-f541aa023be08091344039de,synthetic_programmatic_template,stacked,top,True,
"Form 1098-T Tuition Statement
From:   NorthwindTechnical Institute
RECIPIENT:      Fatima Moreau
8 Checked if at least half-time student ☐
1 Payments received for qua1ified tuition and related expenses $51,675.82",1098,4,1098,fdc-0adc738ca2ff3300fd86ee27,v11-1098-T-inline,original,2026,fgen-f769f627b0bc098e7b53fbd4,synthetic_programmatic_template,inline,top,True,
"Form 1098-T
Tuition Statement
2024
OMBNo. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, cíty or town, state or province, country, ZIP or foreign postal code, and telephone number Lakeshore State University 5871Prairic Ave Faírview, OH 67348
FILER'5 employer identification no.   89-2179359
STUDENT'S name Casey Haddad
STUDENT'S TIN     ****4372
5treet address (induding apt. no.) 13O9 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 68833
1 Payments received for qualified tuition and related expenses   64,O85.30
4 Adjustmentsmade for a prior year
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student",1098,4,1098,fdc-ee93a4a794fc0085d5a04519,v11-1098-T-inline,original,2024,fgen-a84fc89b1ecb1c018afb932b,synthetic_programmatic_template,inline,top,True,
"Form 1098-T
Tuition Statement
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number  Riverside Community College 1399 Maple Ridge Dr Pinecrest, GA 15096
FILER'S employer identification no. 75-4202119
STUDENT'S name Taylor Fischer
STUDENT'S TIN XXXXX9579
Street address (including apt. no.) 3470 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code      Lakewood, CO 93332
1 Payments received for qualified tuition and related expenses 100,721.34
4 Adjustments made for a prior year
5 Scholarships or grants      $2,844.13
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student   ☒
9 Checked if a graduate student ☐",1098,4,1098,fdc-11c0635b106806b563b2b50d,v11-1098-T-inline,original,2024,fgen-97d9ec420704964b774d661d,synthetic_programmatic_template,inline,top,False,
"Form 1098-T
Tuition Statement
For calendar year 2025
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number  Lakeshore State University 8527 Elm Park Pl Maplewood, MN 84589
FILER'S employer identification no. 22-1359128
STUDENT'S name   Riley Okafor
STUDENT'S TIN  ***-**-7526
Street address (including apt. no.) 8981 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 48771
1 Payments received for qualified tuition and related expenses $60,529.35
4 Adjustments made for a prior year      0.00
9 Checked if a graduate student  X
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-821a2d234c459c280c46df88,v11-1098-T-inline,original,2025,fgen-8d460ae851cc353aa04e3cb8,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
2025
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Northwind Technical Institute 2712 Sample Street Oak Grove, TX 51211
FILER'S employer identification no.   67-8761096
STUDENT'S name      Lena E. Romero
STUDENT'S TIN  ***-**-3783
Street address (including apt. no.) 8985 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code   Oak Grove, TX 20606
Account number (see instructions)   XXXXX924736
1 Payments received for qualified tuition and related expenses 118,827.52
4 Adjustments made for a prior year
5 Scholarships or grants   3,240.00
6 Adjustments to scholarships or grants for a prior year   0.00
8 Checked if at least half-time student   ☐
9 Checked if a graduate student [X]
Department of the Treasury - Internal Revenue Service
Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-2b044bd33d4f2b26dbd8f9cc,v11-1098-T-inline,original,2025,fgen-e9d885f206541810ea2e67e2,synthetic_programmatic_template,inline,bottom,False,
"For calendar year 2024
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Northwind Technical Institute 1729 Sample Street Bayside, WA 53228
FILER'S employer identification no.   50-5213562
STUDENT'S name      Hiro Tanaka
STUDENT'S TIN ***-**-9777
1 Payments received for qualified tuition and related expenses $61,336.24
4 Adjustments made for a prior year      $0.00
5 Scholarships or grants   $9,269.82
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student   ☒",1098,4,1098,fdc-2d10687e16f772fc990a9521,v11-1098-T-inline,original,2024,fgen-4483c8f62c6a7f74b6ebb1b3,synthetic_programmatic_template,inline,none,False,
"Form 1098-T
Tuition Statement
2024
OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number   Lakeshore State University 741 Granite St Lakewood, CO 56138
FILER'S employer identification no.  77-9890274
STUDENT'S name  Hiro J. Okafor
STUDENT'S TIN  XXX-XX-0573
Street address (including apt. no.) 8349 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code  Riverton, WI 42880
4 Adjustments made for a prior year
5 Scholarships or grants   $759.82
8 Checked if at least half-time student
9 Checked if a graduate student      ☐
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-de89bfb548f80ab3a783432b,v11-1098-T-inline,original,2024,fgen-d7350493c2a694d920ec63f7,synthetic_programmatic_template,inline,top,False,
"Form 1098-T
Tuition Statement
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Northwind Technical Institute 2095 Cedar Ln Lakewood, CO 93272
FILER'S employer identification no. 35-8706273
STUDENT'S name   Lena Rivera
STUDENT'S TIN      ***-**-9380
1 Payments received for qualified tuition and related expenses   $36,147.07
4 Adjustments made for a prior year   0.00
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student      X
9 Checked if a graduate student   [X]",1098,4,1098,fdc-552a81b4bb4c3044711f22a8,v11-1098-T-inline,original,2026,fgen-cfc66f81edc574d9b2252faf,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
2021
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number   Riverside Community College 6219 Oak Hollow Ct Riverton, WI 13021
FILER'S employer identification no.  41-9317401
STUDENT'S name Avery Testcase
STUDENT'S TIN  XXXXX8005
Street address (including apt. no.)  7272 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code   Brookhaven, PA 55932
5 Scholarships or grants 449.61
6 Adjustments to scholarships or grants for a prior year   $0.00
8 Checked if at least half-time student      X
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-ad4553b77c6542bc27a1d04d,v11-1098-T-inline,original,2021,fgen-cdea8880ea5d2d498bc476b8,synthetic_programmatic_template,inline,none,False,
"Form 1098-T
Tuition Statement
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number      Northwind Technical Institute 7869 5ample Street Pinecrest, GA 84l90
FILER'Semployer identifícation no. 21-2063780
STUDENT'S name   Jamie M. Romero
STUDENT'STIN  ***-**-2484
Street address (including apt. no.)   5557 Wi1low Bend Way
City or town, state or province, country, andZIP or foreígn postal code Brookhaven, PA 69624
l Payments received for qualified tuition and related expenses $82,674.66
5 Scho1arships or grants $8,579.11
6 Adjustments to scho1arships or grants fora prior year O.00
8 Checked if at least half-time student   X
9 Checked if a graduate student",1098,4,1098,fdc-89fb299ba4cc52a7624b24f2,v11-1098-T-inline,original,2024,fgen-e0f84b6c2f06b7e6abeedfd9,synthetic_programmatic_template,inline,top,True,
"Form 1098-T
Tuition Statement
For calendar year 2023
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number Lakeshore State University 6991 Elm Park Pl Pinecrest, GA 94431
FILER'S employer identification no. 73-9873254
STUDENT'S name   Riley M. Fischer
STUDENT'S TIN ****5645
Street address (including apt. no.) 8399 Granite St
City or town, state or province, country, and ZIP or foreign postal code      Lakewood, CO 59895
Account number (see instructions)   ****369030
1 Payments received for qualified tuition and related expenses   $35,996.90
4 Adjustments made for a prior year 0.00
5 Scholarships or grants 2,724.14
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student  ☒
9 Checked if a graduate student      ☐",1098,4,1098,fdc-e10c6d448c15ba1882a5d733,v11-1098-T-inline,original,2023,fgen-09fa7212921443a18f8a76c4,synthetic_programmatic_template,inline,top,False,
"Form 1098-T
Tuition Statement
For calendar year 2026
Copy B For Student
Thís is important taxinformation and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIPor foreign posta1 code, and telephone number  Lakeshore State University l43l Oak Hollow Ct Riverton, WI 94243
FILER'5 employeridentificationno.      81-656O782
STUDENT'S name KwameRomero
STUDENT'S TIN XXXXX0735
Street address (induding apt. no.)      7028 5ample Street
City or town, state or province, country, and ZIP or foreign postal code      Riverton, WI 85721
1 Payments received for qua1ified tuition and related expenses  87,O79.17
4 Adjustments made for a prior year   SO.00
5 Scholarships or grants $857.44
6 Adjustmcnts to scholarships or grants for a prior year   0.00
8 Checked if at least half-time student X
9 Checked if a graduate student [X]",1098,4,1098,fdc-cdf9f358980570c3e0e03cbc,v11-1098-T-inline,original,2026,fgen-508bc6d6d72280aef6b39dc9,synthetic_programmatic_template,inline,top,True,
"Form 1098-T
Tuition Statement
2023
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number   Northwind Technical Institute 9165 Maple Ridge Dr Cedar Falls, IA 22771
FILER'S employer identification no. 44-1981162
STUDENT'S name Priya E. Adeyemi
STUDENT'S TIN      ****1982
Account number (see instructions)      XXXXX877840
1 Payments received for qualified tuition and related expenses      $26,318.48
4 Adjustments made for a prior year
5 Scholarships or grants $881.46
8 Checked if at least half-time student  ☐
9 Checked if a graduate student  ☐",1098,4,1098,fdc-dc094d49e79bab4f53b94f82,v11-1098-T-inline,original,2023,fgen-7c67efee238713559d595553,synthetic_programmatic_template,inline,top,False,
"OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number  Lakeshore State University 3444 Willow Bend Way Testville, IL 55535
FILER'S employer identification no.      76-8331630
STUDENT'S name      Wei E. Larsen
STUDENT'S TIN  XXXXX9439
Street address (including apt. no.)  4027 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 62259
Account number (see instructions)      ***-**-445026
5 Scholarships or grants $4,727.30
8 Checked if at least half-time student ☐
9 Checked if a graduate student  [X]
Department of the Treasury - Internal Revenue Service
Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-4603bae060a430ec9333f67c,v11-1098-T-inline,original,2021,fgen-5502c7d32aa9d89d88809791,synthetic_programmatic_template,inline,bottom,False,
"VOID  CORRECTED
Form 1098-T
Tuition Statement
2024
This is important tax information and is bcing furnished to the IR5.
FILER'S name, street addrcss, city or town, stateor province, country, ZIP or foreign postal code, and telephone number   Lakeshore State University 2742Oak Hollow Ct CedarFa1ls, IA 87911
FILER'S employer identification no.   65-4787852
STUDENT'S name Híro Rivera
STUDENT'S TIN  XXX-XX-4574
l Payments received for qualified tuition and related expenses $46,602.l6
4 Adjustments made for a prior year  0.00
5 Scholarships or grants  $5,544.99
6 Adjustments to scholarshíps or grants for a prior year
8 Checked if at lcast half-time student ☐
9 Checked if a graduate student  ☒
Department of the Treasury - Intemal Revenue Servíce
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-1518c21692b60166927dcebc,v11-1098-T-inline,original,2024,fgen-47f23369881d64ee6761f439,synthetic_programmatic_template,inline,top,True,
"Form 1098-T Tuition Statement 2024
FILER'S name: Northwind Technical Institute
Recipient's name: Mateo Rivera
9 Checked if a graduate student  [X]
8 Checked if at least half-time student ☒
1 Payments received for qualified tuition and related expenses      $33,125.28",1098,4,1098,fdc-3638d617dea984bbcb73657b,v11-1098-T-inline,original,2024,fgen-2d40cce36c4de7976ed39b12,synthetic_programmatic_template,inline,top,False,
"Form 1098-T Tuition Statement 2025
FILER'S name:
RECIPIENT:
8 Checked if at least half-time student
1 Paymentsreceived for qualified tuition and related expenses
9 Checked if a graduate student
Riverside Community College
Lena Brennan
X
79,464.04
[X]",1098,4,1098,fdc-411883a865ca3bbb883b840e,v11-1098-T-columns,original,2025,fgen-7481a0e46efc03bc718d11f1,synthetic_programmatic_template,columns,top,True,
"VOID  CORRECTED
2023
OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Account number (see instructions)
4 Adjustments made for a prior year
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Riverside Community College 828 Sample Street Fairview, OH 14637
65-6869543
Sofia Nguyen
XXXXX5381
XXX-XX-512457
0.00
☐
X
Department of the Treasury - Internal Revenue Service
Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-a82a479b7c5887b84c515932,v11-1098-T-columns,original,2023,fgen-579bbf680d3e73145bff432c,synthetic_programmatic_template,columns,bottom,False,
"CORRECTED (if checked)
Form 1098-T
Tuition Statement
2023
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Payments received for qualified tuition and related expenses
4 Adjustments made for a prior year
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Riverside Community College 4663 Oak Hollow Ct Brookhaven, PA 84870
50-3974872
Jamie Tanaka
***-**-7212
726 Sample Street
Riverton, WI 61127
74,353.96
$0.00
☒
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-ca93277ce984fe888cc63fa2,v11-1098-T-columns,original,2023,fgen-744cad1a719f9d3526d5affd,synthetic_programmatic_template,columns,top,False,
"2026
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
4 Adjustments made for a prior year
5 Scholarships or grants
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Northwind Technical Institute 3196 Oak Hollow Ct Brookhaven, PA 41275
34-7231076
Olivia E. Tanaka
XXXXX3273
8562 Elm Park Pl
Pinecrest, GA 53003
$0.00
3,843.42
☒
X
Department of the Treasury - Internal Revenue Service
Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-557d15e143448798c718e901,v11-1098-T-columns,original,2026,fgen-b6923c4311e0e92cd8800d05,synthetic_programmatic_template,columns,bottom,False,
"From:
To:
8 Checked if at least half-time student
1 Payments received for qualified tuition and related expenses
5 Scholarships or grants
Riverside Community College
Mateo Castillo
X
$21,498.69
9,363.40",1098,4,1098,fdc-105be09829eef2c38ed98161,v11-1098-T-columns,original,2021,fgen-259155d5dda6cf55ce278465,synthetic_programmatic_template,columns,none,False,
"Form 1098-T
Tuition Statement
2025
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Account number (see instructions)
4 Adjustments made for a prior year
5 Scholarships or grants
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Northwind Technical Institute 1535 Willow Bend Way Bayside, WA 14924
48-3254810
Jordan Rivera
XXX-XX-6024
XXX-XX-196494
$3,586.52
[X]
X",1098,4,1098,fdc-5fc9612453897f6f4f16b68d,v11-1098-T-columns,original,2025,fgen-129124ba9a5ca79625087fda,synthetic_programmatic_template,columns,top,False,
"OMB No. 1545-1574
Copy B ForStudent
This is important tax informationand is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Account number (see instructions)
l Payments received for qualified tuition and related expenses
4Adjustments made for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Lakeshore 5tate University 54O E1m Park P1 Pinecrest, GA 52611
42-5503243
5ofia Moreau
****1473
ending in 261505
1O9,058.03
☒
☒
Form 1098-T
Tuition Statement",1098,4,1098,fdc-7e751f1c08cea44beb7b7a96,v11-1098-T-columns,original,2025,fgen-9b3700903709572d9e14ac54,synthetic_programmatic_template,columns,bottom,True,
"Form 1098-T Tuition Statement 2026
FILER'S name:
Recipient's name:
8 Checked if at least half-time student
Lakeshore State University
Sofia S. Lindqvist
☐",1098,4,1098,fdc-b7f7115d4a555e4047c3dc72,v11-1098-T-columns,original,2026,fgen-883bb9d90346d858ee29f270,synthetic_programmatic_template,columns,top,False,
"Form 1098-T Tuition Statement
FILER'S name:
RECIPIENT:
5 Scholarships or grants
8 Checked if at least half-time student
9 Checked if a graduate student
Northwind Technical Institute
Avery Adeyemi
$4,725.13
[X]
☐",1098,4,1098,fdc-4fbf3a6584d245277da6e865,v11-1098-T-columns,original,2025,fgen-aa84a5cb59d375bba817956e,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1098-T
Tuition Statement
2024
OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Payments received for qualified tuition and related expenses
4 Adjustments made for a prior year
5 Scholarships or grants
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Northwind Technical Institute 6940 Lakeshore Blvd Brookhaven, PA 73462
91-3273720
Priya K. Brennan
ending in 6910
8421 Elm Park Pl
Oak Grove, TX 33751
$25,338.13
8,227.82
☒
[X]
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-bcd5d3ebe796d5ed3793b083,v11-1098-T-columns,original,2024,fgen-a5d0828949e0ce5d5d2c1336,synthetic_programmatic_template,columns,top,False,
"Form 1098-T Tuition Statement 2023
FILER:
To:
9 Checked if a graduate student
5 Scholarships or grants
Lakeshore State University
Lena Okafor
[X]
5,698.36",1098,4,1098,fdc-ad45b3e3310d69bbf5e7498f,v11-1098-T-columns,original,2023,fgen-be2f4d1c380f237335283a93,synthetic_programmatic_template,columns,top,False,
"Form 1098-T
Tuition Statement
2023
Copy B For Student
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Payments received for qualified tuition and related expenses
4 Adjustments made for a prior year
5 Scholarships or grants
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Lakeshore State University 8693 Elm Park Pl Pinecrest, GA 17398
34-7380485
Priya Nguyen
****7715
4777 Elm Park Pl
Riverton, WI 85147
104,316.56
618.71
$0.00
☒
☒",1098,4,1098,fdc-1204aaf56111cf50e2d8d34b,v11-1098-T-columns,original,2023,fgen-7ca82d1f8d827a0c713e5b90,synthetic_programmatic_template,columns,top,False,
"Form 1098-T
Tuition Statement
2025
OMB No. 1545-1574
Copy B For Student
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
5 Scholarships or grants
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
9 Checked if a graduate student
Northwind Technical Institute 1179 Cedar Ln Oak Grove, TX 40419
39-3494065
Wei Adeyemi
XXX-XX-4305
43 Harbor View Rd
Brookhaven, PA 54916
$3,100.04
$0.00
☒
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-893ae156694f014d8373fc04,v11-1098-T-columns,original,2025,fgen-964d14b9deb97e200117e166,synthetic_programmatic_template,columns,top,False,
"From:
To:
5 Scholarships or grants
1 Payments received for qualified tuition and related expenses
Northwind Technical Institute
Kwame Fischer
89.01
$41,481.82
Form 1098-T Tuition Statement",1098,4,1098,fdc-1cb8763fb58736afac116b2e,v11-1098-T-columns,original,2021,fgen-5082c0c49386c259659a6f9d,synthetic_programmatic_template,columns,bottom,False,
"CORRECTED (if checked)
Form 1098-T
Tuition Statement
OMB No. 1545-1574
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Payments received for qualified tuition and related expenses
4 Adjustments made for a prior year
5 Scholarships or grants
6 Adjustments to scholarships or grants for a prior year
9 Checked if a graduate student
Lakeshore State University 504 Maple Ridge Dr Fairview, OH 65420
18-9040921
Kwame Walsh
ending in 2745
144 Prairie Ave
Lakewood, CO 68162
39,474.48
$0.00
$2,776.48
0.00
X
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-21981c67ebe19465502d5540,v11-1098-T-columns,original,2025,fgen-ae0ec196561112009c201636,synthetic_programmatic_template,columns,top,False,
"Form 1098-T
Tuition Statement
2023
OMB No. 1545-1574
Copy B For Student
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
FILER'S employer identification no.
STUDENT'S name
STUDENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Payments received for qualified tuition and related expenses
4 Adjustments made for a prior year
6 Adjustments to scholarships or grants for a prior year
8 Checked if at least half-time student
Lakeshore State University 7479 Willow Bend Way Riverton, WI 13566
11-9367218
Taylor Kowalski
XXXXX8312
664 Oak Hollow Ct
Testville, IL 73444
$76,245.60
X
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-3004a1ca84d193502a856ad4,v11-1098-T-columns,original,2023,fgen-0fb3d7fe1e1860396b2a0424,synthetic_programmatic_template,columns,top,False,
"## Form 1098-T
## Tuition Statement
## 2026
Copy B For Student
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Riverside Community College 7178 Prairie Ave Pinecrest, GA 28225 |
| FILER'S employer identification no. | 86-7164966 |
| STUDENT'S name | Mateo Testcase |
| STUDENT'S TIN | ****9805 |
| 1 Payments received for qualified tuition and related expenses | 65,512.92 |
| 5 Scholarships or grants | $4,212.34 |
| 6 Adjustments to scholarships or grants for a prior year |  |
| 8 Checked if at least half-time student | X |
| 9 Checked if a graduate student | [X] |",1098,4,1098,fdc-f95999feeb418401e6ff1450,v11-1098-T-markdown,original,2026,fgen-e5193e71e31ce89187cf056c,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| FILER'S name: | Riverside Community College |
| RECIPIENT: | Diego Brennan |
| 9 Checked if a graduate student | X |",1098,4,1098,fdc-edc2f49d8dd4e7d11ce13c28,v11-1098-T-markdown,original,2024,fgen-82160d07259df49b38e16065,synthetic_programmatic_template,markdown,none,False,
"## CORRECTED (if checked)
2026
## OMB No. 1545-1574
This is important tax informationand is bcing fumished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Riverside Community College 1783 Oak Hollow Ct Brookhaven, PA 94936 |
|FILER'S employer ídentificationno. | 84-6548338 |
| STUDENT'S name | Hiro Nguyen |
| STUDENT'S TIN | XXX-XX-6137 |
| Streetaddress (including apt. no.) | 355 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign posta1 code | Maplewood, MN 4511O |
| Account number (see instructions) | ****377419 |
| 4 Adjustments made for a prior year |  |
| 5 Scholarshíps or grants | 7,O99.96 |
| 6Adjustments to scholarshipsor grants for a prior year |O.00 |
| 8 Checked if at least half-time student | [X] |
| 9 Checked if a graduate student | ☐ |
## Department of the Treasury - Intemal Revenue 5ervíce
Form l098-T
Tuition Statement
## Form 1098-T (keep for your records)  www.irs.gov/Forml098T",1098,4,1098,fdc-702c389e41c2eafa4b35e8ed,v11-1098-T-markdown,original,2026,fgen-56cdcb95bb17f671d89470c0,synthetic_programmatic_template,markdown,bottom,True,
"CORRECTED (if checked)
2021
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Riverside Community College 4755 Prairie Ave Cedar Falls, IA 92807 |
| FILER'S employer identification no. | 66-1901413 |
| STUDENT'S name | Morgan Romero |
| STUDENT'S TIN | ending in 0526 |
| Street address (including apt. no.) | 4458 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 76622 |
| Account number (see instructions) | ending in 643962 |
| 1 Payments received for qualified tuition and related expenses | $112,821.68 |
| 4 Adjustments made for a prior year |  |
| 5 Scholarships or grants | 2,453.64 |
| 6 Adjustments to scholarships or grants for a prior year |  |
| 8 Checked if at least half-time student | ☒ |
| 9 Checked if a graduate student | ☒ |
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-7cc21eb902e7eb0a84bff08e,v11-1098-T-markdown,original,2021,fgen-661056af7b4881ecd40afdd1,synthetic_programmatic_template,markdown,none,False,
"## VOID  CORRECTED
Form 1098-T
Tuition Statement
2023
OMB No. 1545-1574
## Copy B For Student
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Northwind Technical Institute 7002 Maple Ridge Dr Pinecrest, GA 33386 |
| FILER'S employer identification no. | 34-1043783 |
| STUDENT'S name | Morgan Haddad |
| STUDENT'S TIN | ****0632 |
| Street address (including apt. no.) | 3268 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 53025 |
| Account number (see instructions) | ***-**-240899 |
| 1 Payments received for qualified tuition and related expenses | 128,101.36 |
| 6 Adjustments to scholarships or grants for a prior year |  |
| 8 Checked if at least half-time student | [X] |
| 9 Checked if a graduate student | [X] |
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-562e131ed40950243762e476,v11-1098-T-markdown,original,2023,fgen-e602a3222ddc4e595d7b0fa1,synthetic_programmatic_template,markdown,top,False,
"## Form 1098-T
Tuition Statement
2025
OMB No. 1545-1574
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Lakeshore State University 8845 Granite St Bayside, WA 37719 |
| FILER'S employer identification no. | 79-1029429 |
| STUDENT'S name | Fatima Walsh |
| STUDENT'S TIN | ending in 5284 |
| Account number (see instructions) | XXXXX146873 |
| 4 Adjustments made for a prior year | $0.00 |
| 5 Scholarships or grants | 1,563.12 |
| 6 Adjustments to scholarships or grants for a prior year |  |
| 8 Checked if at least half-time student | [X] |
| 9 Checked if a graduate student | ☒ |
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-60d5b088efd241fcefbcea89,v11-1098-T-markdown,original,2025,fgen-16b771d7bf2ecb9b3c2a7030,synthetic_programmatic_template,markdown,top,False,
"2021
| Field | Value |
| --- | --- |
| FILER'5 name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone numbcr | Ríverside Community College 8618 Maple Ridge Dr Riverton, WI 50055 |
| FILER'S employer identification no. | 45-6586002 |
| STUDENT'S name | Jamie L. Romero |
| STUDENT'S TIN | ***-**-7678 |
| Street address (induding apt. no.) | 1459 Granite St |
| City or town, state or provincc, country, and ZIPor foreign postalcode | Riverton, WI 67925 |
| Account number(see instructions)| ****293432 |
| 1 Payments received for qualified tuition andrelated expenses | 110,443.88 |
| 4 Adjustments madc for a príor year | 0.00 |
| 5 Scho1arships or grants | 6,980.74 |
|6 Adjustments to scholarships or grants for a prior year | $0.00 |
| 8 Checked if at least half-time student | ☒ |
| 9 Checked if a graduate student |  |
Department of the Treasury - Intemal Revenue Service
Form l098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-7d02025ea511f6d813086cc6,v11-1098-T-markdown,original,2021,fgen-fe9d30dfa5b9ef76b75f29df,synthetic_programmatic_template,markdown,bottom,True,
"VOID  CORRECTED
## OMB No. 1545-1574
## Copy B For Student
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Lakeshore State University 6237 Lakeshore Blvd Lakewood, CO 35356 |
| FILER'S employer identification no. | 64-2313772 |
| STUDENT'S name | Kwame Romero |
| STUDENT'S TIN | ***-**-3088 |
| 1 Payments received for qualified tuition and related expenses | 49,428.65 |
| 5 Scholarships or grants | 2,737.82 |
| 8 Checked if at least half-time student | [X] |
| 9 Checked if a graduate student | [X] |",1098,4,1098,fdc-b128ed34faa1041689be6797,v11-1098-T-markdown,original,2025,fgen-fa90df72ab8ca34b4e2bfd24,synthetic_programmatic_template,markdown,none,False,
"Form 1098-T
Tuition Statement
OMB No. 1545-1574
Copy B For Student
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Lakeshore State University 5474 Harbor View Rd Bayside, WA 72340 |
| FILER'S employer identification no. | 49-5924596 |
| STUDENT'S name | Jordan J. Larsen |
| STUDENT'S TIN | ****6309 |
| Street address (including apt. no.) | 8166 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 38863 |
| 1 Payments received for qualified tuition and related expenses | 93,681.99 |
| 6 Adjustments to scholarships or grants for a prior year |  |
| 8 Checked if at least half-time student | ☐ |
| 9 Checked if a graduate student | ☒ |
## Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-b78c7242efad9b1fd8c54c04,v11-1098-T-markdown,original,2022,fgen-b5619023b473567189cae1cd,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-1574
Copy B For Student
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Riverside Community College 6278 Lakeshore Blvd Bayside, WA 46362 |
| FILER'S employer identification no. | 12-4138426 |
| STUDENT'S name | Diego Okafor |
| STUDENT'S TIN | ending in 2024 |
| Street address (including apt. no.) | 1134 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 59072 |
| 1 Payments received for qualified tuition and related expenses | 131,180.67 |
| 4 Adjustments made for a prior year | 0.00 |
| 6 Adjustments to scholarships or grants for a prior year | 0.00 |
| 8 Checked if at least half-time student | ☒ |
| 9 Checked if a graduate student | ☐ |
## Department of the Treasury - Internal Revenue Service
Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-29e78f0bae3e906540bf5768,v11-1098-T-markdown,original,2022,fgen-56ee32bab0b06d71c9ef49ef,synthetic_programmatic_template,markdown,bottom,False,
"VOID  CORRECTED
Form 1098-T
Tuition Statement
2023
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Lakeshore State University 3050 Willow Bend Way Maplewood, MN 63908 |
| FILER'S employer identification no. | 84-6241737 |
| STUDENT'S name | Hiro R. Kowalski |
| STUDENT'S TIN | XXX-XX-6308 |
| Account number (see instructions) | ending in 556794 |
| 1 Payments received for qualified tuition and related expenses | 108,136.11 |
| 4 Adjustments made for a prior year | $0.00 |
| 5 Scholarships or grants | 3,582.95 |
| 6 Adjustments to scholarships or grants for a prior year |  |
| 9 Checked if a graduate student | X |
Department of the Treasury - Internal Revenue Service
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-a0b5674d8ac81c857d1fd51f,v11-1098-T-markdown,original,2023,fgen-959b743536c1f850d60fa044,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| FILER'S name: | Riverside Community College |
| RECIPIENT: | Priya Romero |
| 5 Scholarships or grants | 3,212.71 |
| 9 Checked if a graduate student | ☒ |
| 1 Payments received for qualified tuition and related expenses | 83,052.85 |
| 8 Checked if at least half-time student | 0.00 |",1098,4,1098,fdc-9aec577e7e446d3c13e36c53,v11-1098-T-markdown,original,2025,fgen-0b521c91f19efca1d9ac7192,synthetic_programmatic_template,markdown,none,False,
"Form 1098-T Tuition Statement
| Field | Value |
| --- | --- |
| From: | Northwind Technical Institute |
| To: | Jordan K. Rivera |
| 5 Scholarships or grants | 5,961.20 |
| 1 Payments received for qualified tuition and related expenses | $22,384.86 |
| 9 Checked if a graduate student | ☐ |
| 8 Checked if at least half-time student | X |",1098,4,1098,fdc-126a1a6e972a32061292e60e,v11-1098-T-markdown,original,2024,fgen-b39aed6ec4ff355381ecaa68,synthetic_programmatic_template,markdown,top,False,
"Form 1098-T
Tuition Statement
2023
Copy B For Student
| Field | Value |
| --- |--- |
| FILER'5 name, street address, cíty or town, state or province, country, ZIP or foreign postal code, andtelephone number | Lakeshore 5tate University 5820 Oak Hollow Ct Lakewood, CO 47010 |
| FILER'S employer identification no.| 55-265O440 |
| STUDENT'S name | Jordan Kowalskí |
| 5TUDENT'S TIN | XXXXX2647 |
| Strcet address (induding apt. no.) | 4836Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code| Lakewood, CO 79225 |
| 1 Payments received for qualified tuition and related expenses | 52,O81.16 |
| 4 Adjustmcnts made for a prior year| 0.00 |
| 5 Scholarships or grants | 539.28 |
| 6 Adjustments to scholarships or grants for a prior year | $0.00 |
| 8 Checked if at 1east half-time student | X |
| 9 Checked if a graduate student | X |
## Department of the Treasury - Intema1 Revenue Service
Form l098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-a243f3d5a24e7c31806c01eb,v11-1098-T-markdown,original,2023,fgen-3f402def413f9ae696760601,synthetic_programmatic_template,markdown,top,True,
"CORRECTED (if checked)
2021
OMB No. 1545-1574
## Copy B For Student
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Riverside Community College 1820 Elm Park Pl Bayside, WA 69277 |
| FILER'S employer identification no. | 23-3203656 |
| STUDENT'S name | Avery Rivera |
| STUDENT'S TIN | ***-**-2399 |
| Street address (including apt. no.) | 2133 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 83864 |
| Account number (see instructions) | XXX-XX-543645 |
| 1 Payments received for qualified tuition and related expenses | $21,589.82 |
| 4 Adjustments made for a prior year |  |
| 5 Scholarships or grants | $1,019.81 |
| 6 Adjustments to scholarships or grants for a prior year | 0.00 |
| 8 Checked if at least half-time student |  |
| 9 Checked if a graduate student | ☐ |
Department of the Treasury - Internal Revenue Service",1098,4,1098,fdc-dd9e5c5f4e2f132de6860e30,v11-1098-T-markdown,original,2021,fgen-49c3e04366678d40934f2533,synthetic_programmatic_template,markdown,none,False,
"## VOID  CORRECTED
## For calendar year 2023
OMB No. 1545-1574
## Copy B For Student
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number | Lakeshore State University 5400 Lakeshore Blvd Maplewood, MN 77866 |
| FILER'S employer identification no. | 92-2652016 |
| STUDENT'S name | Sofia B. Moreau |
| STUDENT'S TIN | ending in 4081 |
| Street address (including apt. no.) | 6834 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Lakewood, CO 49459 |
| 1 Payments received for qualified tuition and related expenses | $100,621.14 |
| 4 Adjustments made for a prior year | 0.00 |
| 5 Scholarships or grants | 606.28 |
| 6 Adjustments to scholarships or grants for a prior year | $0.00 |
| 8 Checked if at least half-time student |  |
| 9 Checked if a graduate student | X |
Department of the Treasury - Internal Revenue Service
## Form 1098-T
Tuition Statement
Form 1098-T (keep for your records)  www.irs.gov/Form1098T",1098,4,1098,fdc-4f760d54cc9402aa9c955ae8,v11-1098-T-markdown,original,2023,fgen-3c00a2efcf2855763c5871c7,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2021
From:
Clearwater Investing
Recipient's name:
Taylor Testcase
1d Proceeds
$37,070.38
2 Short-term gain or loss / Long-term gain or loss
Long-term
1b Date acquired
2021-11-11
1a Description of property
VOO",1099,5,1099,fdc-9e9e63de106e45f182d6b3df,v11-1099-B-stacked,original,2021,fgen-96a2c09235d6dd4b545a4eab,synthetic_programmatic_template,stacked,top,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2021
PAYER'S name:
Clearwater Investing
To:
Fatima Brennan
1dProceeds
128,199.65
5 Check if noncovered security
☐
1b Date acquired
2O18-07-06
6 Reported to IRS: Gross proceeds
0.00",1099,5,1099,fdc-24abb90474eba8fae53dec1e,v11-1099-B-stacked,original,2021,fgen-f57ff994cdf51d93166d44d1,synthetic_programmatic_template,stacked,top,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2021
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Brokerage Services 3213 Cedar Ln Fairview, OH 90227
PAYER'S TIN
71-8619955
RECIPIENT'S name
Noah Moreau
RECIPIENT'S TIN
XXX-XX-6671
1b Date acquired
December 25, 2020
1c Date sold or disposed
November 28, 2018
1d Proceeds
88,377.25
1e Cost or other basis
$44,453.06
1g Wash sale loss disallowed
5 Check if noncovered security
[X]",1099,5,1099,fdc-f8272011e614a4e25f9e5644,v11-1099-B-stacked,original,2021,fgen-809894e5d0db47451d90e4bc,synthetic_programmatic_template,stacked,top,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2023
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and isbeing furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country,and ZIP or forcign posta1 code
Clearwater Investing 8584 Sample Street Lakewood, CO l4124
PAYER'S TIN
49-6449426
RECIPIENT'S name
Fatíma D. Lindqvist
RECIPIENT'S TIN
XXX-XX-7188
Street address (inc1uding apt. no.)
388 Praírie Ave
City or town, state orprovince,country, and ZIP or foreígn postal code
Bayside, WA 48009
Account number (see instructions)
****625042
la Description of property
VOO
1b Date acquired
February 15, 2022
1c Date sold or dísposed
2023-12-27
1d Proceeds
121,825.86
1e Cost or other basis
$133,924.77
1g Wash sale loss disallowed
$0.00
2 Short-term gain or loss / Long-term gain or 1oss
X Short-term
4 Federal income tax withheld
$0.00
5 Check if noncovered security
X
6 Reported to IRS:Gross proceeds
☐
Department of the Treasury - Intema1 Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-e18b1c145419192d1758a757,v11-1099-B-stacked,original,2023,fgen-37ffbe8259bdd46ed98b8685,synthetic_programmatic_template,stacked,top,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2026
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Ironwood Wealth Partners 2156 Harbor View Rd Riverton, WI 51700
PAYER'S TIN
77-7627249
RECIPIENT'S name
Casey J. Lindqvist
RECIPIENT'S TIN
***-**-5456
Account number (see instructions)
***-**-144169
1a Description of property
50 SH NORTHWIND INC
1b Date acquired
2026-06-17
1c Date sold or disposed
07/16/2026
1d Proceeds
$126,760.40
1e Cost or other basis
72,358.33
1g Wash sale loss disallowed
0.00
2 Short-term gain or loss / Long-term gain or loss
Long-term
4 Federal income tax withheld
5 Check if noncovered security
☐
6 Reported to IRS: Gross proceeds
X
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-8cd07421e41446142a8b359b,v11-1099-B-stacked,original,2026,fgen-b99ddc7b1e19c9c19f83acb1,synthetic_programmatic_template,stacked,top,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2022
PAYER'S name:
Summit Investments
RECIPIENT:
Casey Nguyen
6 Reported to IRS: Gross proceeds
0.00
5 Check if noncovered security
☐
1c Date sold or disposed
01/13/2022
1a Description of property
FXAIX",1099,5,1099,fdc-54401687250e60751393c744,v11-1099-B-stacked,original,2022,fgen-2f59afe6993562327e9fb616,synthetic_programmatic_template,stacked,top,False,
"PAYER:
Summit Investments
RECIPIENT:
Wei Brennan
6 Reported to IRS: Gross proceeds
X
Form 1099-B Proceeds From Broker and Barter Exchange Transactions",1099,5,1099,fdc-2df1742cb2572f9032855275,v11-1099-B-stacked,original,2023,fgen-ec07a8755c895f0cbfd436c9,synthetic_programmatic_template,stacked,bottom,False,
"CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2022
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Ironwood Wealth Partners 4379 Harbor View Rd Brookhaven, PA 18503
PAYER'S TIN
31-5328882
RECIPIENT'S name
Jordan C. Nguyen
RECIPIENT'S TIN
XXXXX9891
Street address (including apt. no.)
3673 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 54226
Account number (see instructions)
ending in 464470
1a Description of property
AAPL
1b Date acquired
December 16, 2022
1c Date sold or disposed
11/05/2022
1e Cost or other basis
24,795.85
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
X Short-term
4 Federal income tax withheld
0.00
5 Check if noncovered security
[X]
6 Reported to IRS: Gross proceeds",1099,5,1099,fdc-52f747210e1d4f62c08af348,v11-1099-B-stacked,original,2022,fgen-228a9df1903178ff2b551306,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
For calendar year 2O23
OMB No. 1545-0715
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Clearwater Investing 676l Granite St Cedar Falls, IA 99442
PAYER'S TIN
72-3254780
RECIPIENT'S name
Jamie Moreau
RECIPIENT'S TIN
***-**-4789
Street address (induding apt. no.)
71O7 Granitc St
City or town, state or province, country, and ZIPor foreígnpostal code
Testvi1le, IL 93483
1a Description of property
100 SH ACME CORP
1b Date acquired
2022-11-05
1c Date soldor disposed
2023-l0-10
1d Proceeds
$20,467.63
1e Cost or other basis
$86,127.86
1g Wash sale loss disallowed
5 Check íf noncovered security
☒
6 Reported to IR5: Gross proceeds
X
Departmentof the Treasury - Intemal Revenue Service
Form 1O99-B
Proceeds From Broker and Barter Exchange Transactions
Form 1O99-B (keep for your records)  www.irs.gov/Form1O99B",1099,5,1099,fdc-e84890131c4b128f9694383f,v11-1099-B-stacked,original,2023,fgen-415dac45376bb40258950e2d,synthetic_programmatic_template,stacked,bottom,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2021
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Clearwater Investing 6430 Willow Bend Way Lakewood, CO 79073
PAYER'S TIN
77-8598915
RECIPIENT'S name
Riley E. Sato
RECIPIENT'S TIN
****9566
Account number (see instructions)
****214887
1a Description of property
BND
1b Date acquired
06/25/2021
1c Date sold or disposed
October 10, 2018
1d Proceeds
$98,026.80
1e Cost or other basis
$55,181.15
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
X Long-term
4 Federal income tax withheld
5 Check if noncovered security
X
6 Reported to IRS: Gross proceeds
[X]
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-b64e532ea6d776cb2c00d53a,v11-1099-B-stacked,original,2021,fgen-5aa2626ee213d69b5de2235d,synthetic_programmatic_template,stacked,top,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2025
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Ironwood Wealth Partners 7009 Prairie Ave Maplewood, MN 98585
PAYER'S TIN
18-4231081
RECIPIENT'S name
Jamie Rivera
RECIPIENT'S TIN
XXXXX3200
Account number (see instructions)
****675275
1a Description of property
FXAIX
1b Date acquired
1/22/24
1d Proceeds
11,473.00
1e Cost or other basis
$72,470.12
1g Wash sale loss disallowed
0.00
2 Short-term gain or loss / Long-term gain or loss
Long-term
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-cbcd2bdad44ae47e022a5b90,v11-1099-B-stacked,original,2025,fgen-e59dcbdd27764b58f5950e38,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
OMB No. 1545-0715
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northstar Securities 4174 Harbor View Rd Riverton, WI 57854
PAYER'S TIN
72-4514723
RECIPIENT'S name
Lena Adeyemi
RECIPIENT'S TIN
***-**-4092
Street address (including apt. no.)
9006 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 38913
1a Description of property
VTI
1b Date acquired
7/10/21
1c Date sold or disposed
2021-12-28
1d Proceeds
6,032.39
1e Cost or other basis
106,716.37
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
Long-term
4 Federal income tax withheld
5 Check if noncovered security
X
6 Reported to IRS: Gross proceeds
X
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-443eab0f56b21a9d2363b7c3,v11-1099-B-stacked,original,2021,fgen-7060bde9560f6abd8a9466d7,synthetic_programmatic_template,stacked,none,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2021
PAYER'S name:
Evergreen Brokerage Services
RECIPIENT:
Jamie Nguyen
5 Check if noncovered security
0.00
1d Proceeds
40,600.95",1099,5,1099,fdc-09921bc0665c123b3d67e67e,v11-1099-B-stacked,original,2021,fgen-38f51581ee387c50a97f9ac6,synthetic_programmatic_template,stacked,top,False,
"Form 1099-B ProceedsFrom Broker and Barter Exchange Transactions 2023
PAYER'S name:
Summít Investments
To:
Mateo Kowalski
1c Date sold or disposed
January 4, 2023
5 Check if noncovered security
[X]",1099,5,1099,fdc-b6c631d12182dcdd3de1c634,v11-1099-B-stacked,original,2023,fgen-fef67fc87fb874a842e11a4b,synthetic_programmatic_template,stacked,top,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2024
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Brokerage Services 1879 Willow Bend Way Cedar Falls, IA 93779
PAYER'S TIN
57-9222708
RECIPIENT'S name
Wei L. Testcase
RECIPIENT'S TIN
ending in 8563
Street address (including apt. no.)
8897 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 15454
Account number (see instructions)
***-**-170900
1a Description of property
SCHD
1b Date acquired
6/16/24
1c Date sold or disposed
03/20/2024
1d Proceeds
$116,409.64
1e Cost or other basis
41,451.38
1g Wash sale loss disallowed
0.00
2 Short-term gain or loss / Long-term gain or loss
X Short-term
4 Federal income tax withheld
5 Check if noncovered security
[X]
6 Reported to IRS: Gross proceeds
☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-b7a38bb68d488d0f55298609,v11-1099-B-stacked,original,2024,fgen-0926685794c8453975af8bb1,synthetic_programmatic_template,stacked,top,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2023
PAYER:
Clearwater Investing
Recipient's name:
Priya Fischer
1a Description of property
MSFT
1c Date sold or disposed
9/4/20
1e Cost or other basis
$71,966.74",1099,5,1099,fdc-8fe985afa990280f34a32e9b,v11-1099-B-stacked,original,2023,fgen-fb93942fbf8dd3f3953076a6,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
2022
OMB No. 1545-0715
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Clearwater Investing 7184 Maple Ridge Dr Riverton, WI 52629
PAYER'S TIN   91-5875099
RECIPIENT'S name   Fatima Okafor
RECIPIENT'S TIN      XXXXX5197
Street address (including apt. no.)      3204 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 15919
Account number (see instructions)      ***-**-805695
1a Description of property 50 SH NORTHWIND INC
1b Date acquired   08/19/2022
1c Date sold or disposed 12/11/22
1e Cost or other basis 54,570.94
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss  Short-term
4 Federal income tax withheld
5 Check if noncovered security ☒
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-ba236f4ef97c74eb039dc4a2,v11-1099-B-inline,original,2022,fgen-04c9da56c8b602e4012f1498,synthetic_programmatic_template,inline,none,False,
"2021
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished tothe IRS.
PAYER'S name, strect address, city or town, state or province, country, and ZIP or foreign posta1 code Northstar Securities 3923 Granite StBrookhaven, PA l8981
PAYER'S TIN   73-7513383
RECIPIENT'S name Kwame Testcase
RECIPIENT'5 TIN  ending in 8O96
Street address (including apt. no.)  9425 Elm Park Pl
Cityor town, state or province, country, and ZIP or foreign postal code  Brookhaven, PA 857l4
Account number (see instructions)  ****930701
1a Description of property  VTI
1b Date acquired  2021-08-22
1c Date so1d or disposed  2/3/21
1d Proceeds 47,942.88
1e Cost or other basis      42,437.99
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss Short-term
5 Check if noncovered security
6 Reported to IRS: Gross proceeds ☒
Department of the Treasury - Intemal Revenue Service",1099,5,1099,fdc-60814d9bf0bce404b256cb59,v11-1099-B-inline,original,2021,fgen-ebb9cb3fa215a775452f1001,synthetic_programmatic_template,inline,none,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2025
OMB No. 1545-0715
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Evergreen Brokerage Services 8743 Maple Ridge Dr Riverton, WI 10564
PAYER'S TIN      43-4644205
RECIPIENT'S name   Noah J. Okafor
RECIPIENT'S TIN   ending in 2289
1a Description of property      50 SH NORTHWIND INC
1b Date acquired  5/11/22
1c Date sold or disposed 12/07/2022
1d Proceeds 41,473.61
1e Cost or other basis   $59,492.53
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss      Short-term
5 Check if noncovered security   ☐
6 Reported to IRS: Gross proceeds  X",1099,5,1099,fdc-85388c67ecb4d1782fd8a594,v11-1099-B-inline,original,2025,fgen-95913aa247d5852fd31d5ba6,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
2026
OMB No. 1545-0715
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 4513 Elm Park Pl Bayside, WA 91477
PAYER'S TIN   21-4680355
RECIPIENT'S name      Priya Castillo
RECIPIENT'S TIN ***-**-6535
1a Description of property SCHD
1b Date acquired 2026-03-22
1c Date sold or disposed  9/14/23
1d Proceeds $121,405.82
1e Cost or other basis 136,109.85
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss      Long-term
4 Federal income tax withheld
5 Check if noncovered security ☐
6 Reported to IRS: Gross proceeds
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-df934cf43ab61fefb8759ec7,v11-1099-B-inline,original,2026,fgen-36f6276ff9b897d8699dca31,synthetic_programmatic_template,inline,none,False,
"CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2021
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Ironwood Wealth Partners 2217 Lakeshore Blvd Bayside, WA 11001
PAYER'S TIN   55-9941852
RECIPIENT'S name   Morgan Walsh
RECIPIENT'S TIN XXXXX9072
Street address (including apt. no.)  955 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 67178
Account number (see instructions)  XXXXX337912
1a Description of property SCHD
1b Date acquired 2021-12-01
1c Date sold or disposed  February 1, 2018
1d Proceeds 79,748.48
1e Cost or other basis      51,604.23
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss X Short-term
6 Reported to IRS: Gross proceeds      [X]",1099,5,1099,fdc-a8dc174c2f0deb2b86d92787,v11-1099-B-inline,original,2021,fgen-134c59d7cf1383199c95993a,synthetic_programmatic_template,inline,top,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2024
0MB No. 1545-0715
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal codc Clearwater Investing 2753 5ample Street Testville, IL 70730
PAYER'S TIN  51-7122261
RECIPIENT'S name  Casey Haddad
RECIPIENT'S TIN ****2989
Street address (ínc1uding apt. no.)  13O2 0ak Hollow Ct
City or town, state or province,country, and ZIP or foreign postal code Oak Grove, TX 86589
1b Date acquired   November 6, 2024
lc Date sold or disposed08/l0/2021
1d Proceeds  $91,1O4.12
1g Wash sale loss disallowed
2 5hort-term gainor loss / Long-term gain or loss Short-term
4 Federalincome tax withheld  $0.00
5 Check if noncovered security  ☐
6 Reported to IRS: Gross proceeds X",1099,5,1099,fdc-a423849a87ef4de723466eb6,v11-1099-B-inline,original,2024,fgen-77e8418e4846e4e245ed1160,synthetic_programmatic_template,inline,top,True,
"CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2021
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Ironwood Wealth Partners 9465 Oak Hollow Ct Lakewood, CO 58854
PAYER'S TIN      29-1879852
RECIPIENT'S name  Alex Patel
RECIPIENT'S TIN ****9159
Street address (including apt. no.)      1011 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 78271
1b Date acquired  10/21/21
1c Date sold or disposed April 10, 2020
1e Cost or other basis $54,631.33
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss Long-term
4 Federal income tax withheld $0.00
5 Check if noncovered security X
6 Reported to IRS: Gross proceeds X
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-586b66b7dd76aabb680a1259,v11-1099-B-inline,original,2021,fgen-a1a3d41fab9e34b47ac1aa52,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2026
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Northstar Securities 3722 Maple Ridge Dr Maplewood, MN 73895
PAYER'S TIN 14-8823406
RECIPIENT'S name Riley L. Fischer
RECIPIENT'S TIN      XXXXX4501
Street address (including apt. no.) 7623 Sample Street
City or town, state or province, country, and ZIP or foreign postal code  Maplewood, MN 48597
1a Description of property  FXAIX
1b Date acquired  10/20/25
1d Proceeds  79,426.72
1e Cost or other basis  59,805.35
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss   Short-term
4 Federal income tax withheld
5 Check if noncovered security   [X]
6 Reported to IRS: Gross proceeds   ☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-8aaced0dc2e467ee9259c2fa,v11-1099-B-inline,original,2026,fgen-19265fbefdf00ea672fbd1f9,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
For calendar year 2022
OMB No. 1545-0715
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Ironwood Wealth Partners 4169 Oak Hollow Ct Pinecrest, GA 15369
PAYER'S TIN   36-4484274
RECIPIENT'S name  Morgan Adeyemi
RECIPIENT'S TIN ***-**-7603
Street address (including apt. no.)   8427 Granite St
City or town, state or province, country, and ZIP or foreign postal code  Brookhaven, PA 96182
1b Date acquired      August 21, 2019
1d Proceeds $94,761.31
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss X Short-term
5 Check if noncovered security  X
6 Reported to IRS: Gross proceeds
Department of the Treasury - Internal Revenue Service
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-ee2d6fd8e26afcc28753ff60,v11-1099-B-inline,original,2022,fgen-415323ae25261b6ed7303493,synthetic_programmatic_template,inline,bottom,False,
"CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2026
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 713 Prairie Ave Maplewood, MN 98908
PAYER'S TIN 70-6565226
RECIPIENT'S name      Diego Walsh
RECIPIENT'S TIN XXXXX6671
Street address (including apt. no.) 7307 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code  Lakewood, CO 27842
1a Description of property   FXAIX
1b Date acquired  10/25/2023
1c Date sold or disposed 06/17/2026
1d Proceeds   $136,077.74
1e Cost or other basis $96,663.34
1g Wash sale loss disallowed      $0.00
4 Federal income tax withheld
5 Check if noncovered security ☐
6 Reported to IRS: Gross proceeds      ☒
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-dc6bddfb56cb71b4192c8a01,v11-1099-B-inline,original,2026,fgen-3ed7f962ed762ce5a9ceb1d0,synthetic_programmatic_template,inline,top,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions
PAYER'S name:      Northstar Securities
Recipient's name: Riley Romero
6 Reported to IRS: Gross proceeds X
1c Date sold or disposed      2022-11-22
1e Cost or other basis $48,710.49",1099,5,1099,fdc-830b1c6599c6c4fb95df2228,v11-1099-B-inline,original,2025,fgen-9e6825d386578d0ad2090f72,synthetic_programmatic_template,inline,top,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2022
OMB No. 1545-0715
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 4841 Harbor View Rd Maplewood, MN 48298
PAYER'S TIN      51-5413267
RECIPIENT'S name      Noah Adeyemi
RECIPIENT'S TIN XXXXX7650
Street address (including apt. no.)  9316 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 51944
1a Description of property   VOO
1b Date acquired 03/09/2022
1c Date sold or disposed   9/20/22
1d Proceeds  $132,188.20
1e Cost or other basis  $85,761.86
2 Short-term gain or loss / Long-term gain or loss  X Short-term
4 Federal income tax withheld      $0.00
5 Check if noncovered security      [X]
6 Reported to IRS: Gross proceeds ☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-d7af4e310ccb5803b0d231ab,v11-1099-B-inline,original,2022,fgen-c1061e8311aa75569241aeb3,synthetic_programmatic_template,inline,top,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactíons
For calendar year 2021
OMB No.1545-0715
Thís is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 9380 Oak HollowCt Fairvicw, OH 13227
PAYER'S TIN      31-6876953
RECIPIENT'S name      Kwame M. Okafor
RECIPIENT'S TIN   ****4750
Street address (ínc1uding apt. no.)     8359 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreígn postal code   Lakewood, C0 18899
Account number(see instructions)   ****596747
1a Dcscríption of property   BND
1b Date acquired     02/09/2020
1e Cost or other basis      129,985.84
1gWash sa1e 1oss disallowed
4 Federal income tax withheld 0.00
5 Check if noncovered security  X
6 Reported to IRS: Gross proceeds  X",1099,5,1099,fdc-b72a3c30363e1304e9fcbdb1,v11-1099-B-inline,original,2021,fgen-0a2ca5ef8db0cd75ef8b13c7,synthetic_programmatic_template,inline,top,True,
"VOID  CORRECTED
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
OMB No. 1545-0715
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 8139 Cedar Ln Riverton, WI 34563
PAYER'S TIN   49-5418720
RECIPIENT'S name   Jamie Tanaka
RECIPIENT'S TIN ****0693
Street address (including apt. no.)      2230 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code   Brookhaven, PA 46977
Account number (see instructions)      ****765307
1b Date acquired 2020-10-01
1c Date sold or disposed 2020-04-09
1d Proceeds 103,036.80
1e Cost or other basis  115,830.55
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss   Long-term
4 Federal income tax withheld
5 Check if noncovered security ☐
6 Reported to IRS: Gross proceeds   X
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-e01f14c7abd659dd374dd9b9,v11-1099-B-inline,original,2023,fgen-2be02ec271170afad9aa705b,synthetic_programmatic_template,inline,top,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions
PAYER'S name:      Clearwater Investing
Recipient's name: Olivia R. Brennan
6 Reported to IRS: Gross proceeds  X
1e Cost or other basis $1,727.01
2 Short-term gain or loss / Long-term gain or loss  X Long-term
1b Date acquired 04/10/2024",1099,5,1099,fdc-5b5ff84120e36eacea3f2fc1,v11-1099-B-inline,original,2024,fgen-631b90f4345a18cbf24a800f,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
For calendar year 2026
OMB No. 1545-0715
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 8690 Lakeshore Blvd Lakewood, CO 65454
PAYER'S TIN 57-6979254
RECIPIENT'S name Priya S. Fischer
RECIPIENT'S TIN XXX-XX-6910
Street address (including apt. no.)   7415 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code  Maplewood, MN 76019
Account number (see instructions)   XXXXX163768
1b Date acquired  11/14/2025
1c Date sold or disposed  2023-08-15
1d Proceeds  $26,044.55
1e Cost or other basis      55,793.60
1g Wash sale loss disallowed 0.00
4 Federal income tax withheld
5 Check if noncovered security      ☒
Department of the Treasury - Internal Revenue Service
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-461d295c8e196c4ab650ab99,v11-1099-B-inline,original,2026,fgen-23c7302a15dbfdefb2b56f9a,synthetic_programmatic_template,inline,bottom,False,
"From:
To:
1d Proceeds
Ironwood Wealth Partners
Kwame Moreau
84,312.23
Form 1099-B Proceeds From Broker and Barter Exchange Transactions",1099,5,1099,fdc-8cd186e5c22d15533dc878bd,v11-1099-B-columns,original,2024,fgen-fd15fec309a4cc790380aed2,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2023
OMB No. 1545-0715
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1a Description of property
1b Date acquired
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
6 Reported to IRS: Gross proceeds
Clearwater Investing 6417 Harbor View Rd Maplewood, MN 49301
23-3964676
Lena Walsh
XXXXX4809
****750364
SCHD
February 4, 2022
06/02/2023
28,055.36
109,464.62
Long-term
0.00",1099,5,1099,fdc-0e518c083a5304dc6103d79e,v11-1099-B-columns,original,2023,fgen-d8d9a78f25eed50fa19f5230,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
2025
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1a Description of property
1b Date acquired
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Clearwater Investing 2440 Elm Park Pl Pinecrest, GA 36461
31-6719055
Casey Patel
***-**-8119
****339938
50 SH NORTHWIND INC
7/2/25
6/20/25
99,449.36
$66,112.92
Long-term
0.00
☒",1099,5,1099,fdc-446ed8dd8b60424f705c4ae1,v11-1099-B-columns,original,2025,fgen-d1a321db5e7e66284903580a,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2024
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Description of property
1c Date sold or disposed
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Ironwood Wealth Partners 3366 Elm Park Pl Lakewood, CO 56203
64-1479106
Morgan Larsen
****6854
2723 Lakeshore Blvd
Fairview, OH 62347
***-**-675601
SCHD
April 18, 2021
$47,844.42
Long-term
☒
☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-9dc281fdce68e1082d09428c,v11-1099-B-columns,original,2024,fgen-884ac0403b4447d072bdf981,synthetic_programmatic_template,columns,top,False,
"For calendar year 2023
OMB No. 1545-0715
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Description of property
1b Date acquired
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Northstar Securities 9557 Sample Street Testville, IL 91880
30-1238822
Kwame Testcase
***-**-3780
9085 Sample Street
Testville, IL 84902
XXX-XX-853550
BND
2022-02-07
3/23/23
6,691.00
134,448.26
Long-term
☐
Department of the Treasury - Internal Revenue Service
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-fc8c27afa440c4b67ea7422b,v11-1099-B-columns,original,2023,fgen-632f5f734e39cc84efd4962d,synthetic_programmatic_template,columns,bottom,False,
"2024
OMB No. 1545-0715
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1b Date acquired
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Summit Investments 5007 Prairie Ave Fairview, OH 53392
73-8995970
Lena A. Haddad
ending in 6423
8109 Cedar Ln
Testville, IL 40054
****664068
2023-06-10
11/10/2024
112,942.01
131,496.47
X Long-term
[X]
Department of the Treasury - Internal Revenue Service
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-f09c524269a790883b9d571f,v11-1099-B-columns,original,2024,fgen-bf88ef64703b3e39814bc14e,synthetic_programmatic_template,columns,bottom,False,
"☐ CORRECTED
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2023
OMB No. 1545-0715
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1a Description of property
1b Date acquired
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Northstar Securities 180 Sample Street Cedar Falls, IA 42535
80-3694255
Wei Sato
***-**-3829
3271 Oak Hollow Ct
Riverton, WI 21821
MSFT
09/13/2023
08/16/2022
112,288.23
$78,265.18
Short-term
$0.00
☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-3378e3243878232842bcbbc4,v11-1099-B-columns,original,2023,fgen-3be3c8a1b751269d8d6f725f,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2026
OMB No. 1545-0715
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
1a Description of property
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Clearwater Investing 5717 Sample Street Pinecrest, GA 79927
10-2435117
Lena R. Kowalski
****2656
VTI
07/04/2023
74,908.89
9,610.03
X Short-term
$0.00
[X]
[X]
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-6b571bf7b9d3698e70e10d71,v11-1099-B-columns,original,2026,fgen-b05650c053580db504f513eb,synthetic_programmatic_template,columns,top,False,
"PAYER'S name:
Recipient's name:
2 Short-term gain or loss / Long-term gain or loss
6 Reported to IRS: Gross proceeds
1a Description of property
Evergreen Brokerage Services
Jamie Rivera
X Short-term
0.00
VTI
Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2025",1099,5,1099,fdc-7067d62ee79cb0d3e6b6dcbb,v11-1099-B-columns,original,2025,fgen-ff2e520baae61655b5b2b749,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-B
Procceds From Broker andBarter Exchange Transactíons
OMBNo. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreignpostalcode
PAYER'5 TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (induding apt. no.)
City or town, state or province, country, andZIP or foreign postal code
la Description of property
1b Datc acquired
1c Date sold or disposed
1d Proceeds
1g Wash sale loss disallowed
2 Short-term gaín or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Summit Investments 5282 Wi1low Bend Way Lakewood, CO 59259
18-2653046
Sofia D. Haddad
ending in 5564
19l6 Granite 5t
Testville, IL 64605
SCHD
10/27/2021
2021-04-19
$113,262.95
X Short-term
☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1O99B",1099,5,1099,fdc-c7c1f7bd4c5f256a915b5af8,v11-1099-B-columns,original,2021,fgen-b08ce785de850ca36cae07d7,synthetic_programmatic_template,columns,top,True,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions
From:
RECIPIENT:
1b Date acquired
1d Proceeds
Ironwood Wealth Partners
Alex Patel
2020-05-17
$48,247.06",1099,5,1099,fdc-fe5243058ed6c2922828446e,v11-1099-B-columns,original,2021,fgen-18e1896313c47ee25fefc8f0,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1a Description of property
1b Date acquired
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Ironwood Wealth Partners 884 Lakeshore Blvd Testville, IL 53810
97-7625989
Lena Testcase
***-**-0858
XXX-XX-024092
FXAIX
10/12/25
2024-12-02
122,747.10
$7,424.92
X Long-term
$0.00
☐
X
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions",1099,5,1099,fdc-4a9d16c3d0a15ea4538b3947,v11-1099-B-columns,original,2025,fgen-df183f3e8e54a7bf7236d43c,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2026
PAYER'S name:
To:
1e Cost or other basis
Northstar Securities
Mateo S. Adeyemi
49,344.27",1099,5,1099,fdc-068e5eebf100c8a1d4a0ee65,v11-1099-B-columns,original,2026,fgen-545e2fa372e97e6453712c44,synthetic_programmatic_template,columns,top,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2023
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1a Description of property
1c Date sold or disposed
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Summit Investments 6152 Granite St Pinecrest, GA 50073
33-4305211
Jamie Castillo
****2030
XXXXX304517
100 SH ACME CORP
11/02/2023
$67,588.71
$0.00
X Short-term
☒
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-5f4acb9df48802ccd3c6263d,v11-1099-B-columns,original,2023,fgen-417c51ac5152442d62216306,synthetic_programmatic_template,columns,top,False,
"2021
OMB No. 1545-0715
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1a Description of property
1c Date sold or disposed
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Summit Investments 7574 Maple Ridge Dr Pinecrest, GA 25009
96-3729718
Kwame Kowalski
ending in 9239
5292 Maple Ridge Dr
Testville, IL 19507
VTI
9/20/18
$82,227.92
2,580.44
X Short-term
☐
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions",1099,5,1099,fdc-a17e0bb99d247fb932d242ae,v11-1099-B-columns,original,2021,fgen-57340e45a0e91298b5cf344f,synthetic_programmatic_template,columns,bottom,False,
"For calendar year 2024
PAYER'S name, street address, city or town, state or province, country, and ZIP or forcignpostal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Streetaddress (induding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Description of property
lc Datesold or disposcd
1d Proceeds
1e Cost or other basis
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss
4 Federal income tax withheld
5 Check if noncovered security
6 Reported to IRS: Gross proceeds
Ironwood Wealth Partners 653l Oak Hollow Ct Lakewood, CO 10128
80-2240207
Avery Romero
***-**-6428
6426 Harbor View Rd
Testville, IL 71659
XXXXX831815
FXAIX
May 3, 2023
$109,677.30
69,794.74
X Long-term
0.00
X
☐
Form 1099-B
Proceeds From Broker and Barter ExchangeTransactions",1099,5,1099,fdc-f8dbb4c95c841bbacf3fca53,v11-1099-B-columns,original,2024,fgen-3d8555db1abfaf42e427427f,synthetic_programmatic_template,columns,bottom,True,
"2024
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 9758 Maple Ridge Dr Cedar Falls, IA 25075
PAYER'S TIN: 96-3112879
RECIPIENT'S name: Jordan Nguyen
RECIPIENT'S TIN: ****6348
Street address (including apt. no.): 7505 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 44794
Account number (see instructions): ****788838
1a Description of property: VOO
1b Date acquired: 11/16/24
1c Date sold or disposed: 6/22/24
1d Proceeds: $18,614.21
1e Cost or other basis: 49,369.78
1g Wash sale loss disallowed: $0.00
2 Short-term gain or loss / Long-term gain or loss: Long-term
4 Federal income tax withheld: $0.00
5 Check if noncovered security: [X]
6 Reported to IRS: Gross proceeds: [X]
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-b5f456e24a43b22308639572,v11-1099-B-boxed,original,2024,fgen-4e1c10d4c4c645bfe5790f43,synthetic_programmatic_template,boxed,none,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2024
PAYER:: Ironwood Wealth Partners
To:: Casey Nguyen
Box 1e Cost or other basis: $97,776.76",1099,5,1099,fdc-cfd3697bcfbd9f8dd5fa04ee,v11-1099-B-boxed,original,2024,fgen-b4a12e6ecf923bf66b73e863,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2023
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 8962 Elm Park Pl Lakewood, CO 15273
PAYER'S TIN: 95-2560451
RECIPIENT'S name: Morgan Okafor
RECIPIENT'S TIN: ****3328
Street address (including apt. no.): 3408 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 75568
1b Date acquired: 01/23/2023
1c Date sold or disposed: June 24, 2023
1d Proceeds: 71,101.97
1g Wash sale loss disallowed
2 Short-term gain or loss / Long-term gain or loss: Short-term
5 Check if noncovered security: X
6 Reported to IRS: Gross proceeds: ☐
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-669522cbe01567570d7d4674,v11-1099-B-boxed,original,2023,fgen-5d5222b9021eee0d936092a2,synthetic_programmatic_template,boxed,top,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions
PAYER'S name:: Ironwood Wealth Partners
Recipient's name:: Morgan D. Nguyen
Box 1d Proceeds: 65,736.35",1099,5,1099,fdc-889632ff2c30c3b5859e49fc,v11-1099-B-boxed,original,2021,fgen-6f50d6f15d6feff4c12254d6,synthetic_programmatic_template,boxed,top,False,
"Form 1099-B Proceeds From Broker and Barter Exchange Transactions 2026
PAYER:: Evergreen Brokerage Services
To:: Hiro L. Okafor
1b Date acquired: 6/9/23
1d Proceeds: $37,877.19
5 Check if noncovered security: 0.00
1c Date sold or disposed: 8/17/26",1099,5,1099,fdc-0e79d6a17c2a3589672fcd72,v11-1099-B-boxed,original,2026,fgen-b36362872470b7f5b6960477,synthetic_programmatic_template,boxed,top,False,
"From:: Evergreen Brokerage Services
RECIPIENT:: Amara Moreau
Box 1d Proceeds: $104,448.13
Box 6 Reported to IRS: Gross proceeds: [X]
Box 5 Check if noncovered security:0.00",1099,5,1099,fdc-87984047322b41f62ffb901d,v11-1099-B-boxed,original,2024,fgen-4c962351e113bb8a9892de7b,synthetic_programmatic_template,boxed,none,True,
"Form 1099-B
Proceeds From Broker and BarterExchange Transactions
2022
OMB No. 1545-0715
CopyB ForRecipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 5753 Granite St Bayside, WA 44385
PAYER'5 TIN: 41-2401738
RECIPIENT'S namc: Sofia 0kafor
RECIPIENT'S TIN: ***-**-0472
Account number (see instructions): ***-**-710628
Linc 1a Description of property: V0O
Line 1c Date sold or disposed: 01/24/2022
Line 1e Cost or other basis: S83,800.21
Line 1g Wash sale loss disallowed
Line 2 Short-term gain or loss / Long-term gain or loss: Short-term
Line 4 Federal income tax withheld
Line 5 Check if noncovcred security: ☐
Line 6 Reported to IRS: Gross proceeds: ☐",1099,5,1099,fdc-42da90c7fd8c0a362680c807,v11-1099-B-boxed,original,2022,fgen-06ad2fb8eec31198e950428c,synthetic_programmatic_template,boxed,top,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 2064 Maple Ridge Dr Cedar Falls, IA 34602
PAYER'S TIN: 16-5532571
RECIPIENT'S name: Avery R. Rivera
RECIPIENT'S TIN: ***-**-9515
Street address (including apt. no.): 8591 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 14898
Line 1a Description of property: MSFT
Line 1b Date acquired: 2/12/20
Line 1c Date sold or disposed: 2020-09-24
Line 1e Cost or other basis: $56,836.26
Line 1g Wash sale loss disallowed
Line 2 Short-term gain or loss / Long-term gain or loss: Short-term
Line 4 Federal income tax withheld
Line 5 Check if noncovered security: ☐
Line 6 Reported to IRS: Gross proceeds",1099,5,1099,fdc-4a3d9e3a9e7b073aaaf013f7,v11-1099-B-boxed,original,2023,fgen-de1594f09e4ecc81412f358e,synthetic_programmatic_template,boxed,top,False,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2026
OMB No. 1545-0715
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 9188 Elm Park Pl Bayside, WA 33116
PAYER'S TIN: 90-8660374
RECIPIENT'S name: Taylor J. Kowalski
RECIPIENT'S TIN: XXX-XX-3371
Street address (including apt. no.): 6954 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 66061
Account number (see instructions): XXXXX583248
1a Description of property: SCHD
1b Date acquired: 2023-04-16
1c Date sold or disposed: 10/23/23
1d Proceeds: $64,357.88
1e Cost or other basis: $34,389.24
1g Wash sale loss disallowed: $0.00
2 Short-term gain or loss / Long-term gain or loss: X Long-term
4 Federal income tax withheld
5 Check if noncovered security: [X]",1099,5,1099,fdc-55b52ce35e9a715b03f53b0d,v11-1099-B-boxed,original,2026,fgen-0caefa00d5b7b06f0cfee5f5,synthetic_programmatic_template,boxed,top,False,
"From:: Ironwood Wealth Partners
To:: Avery Rivera
1a Description of property: VOO",1099,5,1099,fdc-a74a9784019fc7a3e42d1240,v11-1099-B-boxed,original,2026,fgen-73e363d41816cee612cd6dbd,synthetic_programmatic_template,boxed,none,False,
"2023
OMB No. 1545-07l5
Copy B For Recipient
PAYER'5 name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 6474 Maple Ridge Dr Ríverton, WI 37676
PAYER'S TIN: 29-9477101
RECIPIENT'S name: Jordan D. Larsen
RECIPIENT'S TIN: ***-**-6462
Street address (ínc1uding apt. no.): 4421 Sample Street
City or town, state or province, country, and ZIPor foreign postal code: Testville, IL 48O32
Account number (seeinstructions): XXX-XX-793632
Box 1a Description of property: 1005H ACME CORP
Box 1b Date acquired: 7/9/22
Box 1c Date sold or disposed:2023-12-05
Box 1d Proceeds: $19,859.26
Box 1e Cost or other basis: 123,205.91
Box 1g Wash sale loss disallowed
Box 2 5hort-term gain or loss / Long-term gain or loss: X Long-term
Box 4 Federal income tax withheld: $O.00
Box 6 Reported to IRS: Gross proceeds: X
Department ofthe Treasury - Intemal Revenue 5ervice",1099,5,1099,fdc-62f32a2e1ce95ee008f10b56,v11-1099-B-boxed,original,2023,fgen-14d8dabfa1b22d4363e11ccc,synthetic_programmatic_template,boxed,none,True,
"☐ CORRECTED
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
2021
0MB No. 1545-0715
This is important tax information and is bcing furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign posta1 code: C1earwater Investing 505 Granite St Bayside, WA 6770l
PAYER'S TIN: 45-9932419
RECIPIENT'S namc: DiegoTestcase
RECIPIENT'5 TIN: XXXXX1077
Street address (including apt. no.): 1684 Lakeshore Blvd
City or town, state or province, country, and ZIP or forcign postal code: Pinecrest, GA 47394
Accountnumber (see instructions): XXXXX695l82
Line 1a Description of property: FXAIX
Line 1b Date acquired: December 6, 2021
Line 1c Date so1d or disposed:2021-06-22
Line 1dProceeds: 40,312.43
Line 1g Wash sa1e loss disallowed
Line 2 Short-term gain or loss/ Long-term gain or loss: Long-term
Line 4 Federal income tax withheld
Line 5 Check if noncovered security: X
Line 6 Reported to IR5: Gross proceeds: ☒
Department of the Treasury - Intemal Revenue Service
Form l099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-8e4a9eef010938fe82d724d1,v11-1099-B-boxed,original,2021,fgen-0d509f7a8e1e59cd5a090af2,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2022
Copy B For Recipient
PAYER'5 name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities5994 Elm Park Pl Brookhaven, PA 68565
PAYER'S TIN: 77-744348l
RECIPIENT'S name: Wei R. Rivera
RECIPIENT'S TIN: XXXXX5772
Street address (including apt. no.): 8786 Harbor Víew Rd
City or town, state or province, country, and ZIP or foreignpostal code: Cedar Falls, IA 68O39
Box 1a Description of property: MSFT
Box 1b Date acquired: O9/21/2021
Box 1c Date sold or dísposed: 03/21/2021
Box 1d Proceeds: S81,166.56
Box 1e Cost or other basís: 111,129.82
Box 1g Wash sale loss disallowed
Box 2 5hort-term gain or loss / Long-term gain or loss: X Long-term
Box 4Federal income tax withheld
Box 5 Chcck if noncovered security: [X]
Box 6 Reported to IRS: Gross proceeds: ☒
Department of the Treasury - InternalRevenue 5ervíce
Form l099-B (keepfor your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-7bad618563d69558195b77c3,v11-1099-B-boxed,original,2022,fgen-26e5ae7c6baabcb08c89d225,synthetic_programmatic_template,boxed,top,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
For calendar year 2026
OMB No. 1545-0715
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Clearwater Investing 9257 Willow Bend Way Pinecrest, GA 42046
PAYER'S TIN: 28-2861657
RECIPIENT'S name: Hiro Larsen
RECIPIENT'S TIN: ****6314
Account number (see instructions): ***-**-774218
1a Description of property: VOO
1b Date acquired: August 26, 2026
1c Date sold or disposed: 06/20/2025
1d Proceeds: 136,385.87
1e Cost or other basis: 11,817.22
1g Wash sale loss disallowed: $0.00
2 Short-term gain or loss / Long-term gain or loss: Long-term
5 Check if noncovered security
6 Reported to IRS: Gross proceeds: ☒
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-e89392f0a3e4be13ba5724e0,v11-1099-B-boxed,original,2026,fgen-c571144d2b14c23e802c651c,synthetic_programmatic_template,boxed,top,False,
"Form 1099-B
Proceeds From Broker and Barter ExchangeTransactions
For calendar year 2025
0MB No. 1545-0715
Thís is important tax information and is being furnished to the IR5.
PAYER'S name, street address, city or town, state orprovince, country,and ZIP or foreign posta1 code: Ironwood Wealth Partners 5597 Maple Ridge Dr Riverton, WI 25833
PAYER'5 TIN: 49-5654747
RECIPIENT'5 name: Alex Sato
RECIPIENT'S TIN: ending in 9620
Street address (inc1uding apt. no.): 260 Lakeshore Blvd
Cíty or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 48701
Box 1a Description of property: VTI
Box 1b Date acquired: 5/20/25
Box 1c Date sold or dísposed: June 22, 2025
Box 1d Proceeds: 109,764.62
Box 1e Cost or other basis: 107,801.49
Box1g Wash sa1e loss disallowed: $0.00
Box2 Short-term gain or loss / Long-term gain or loss: X Long-term
Box 4 Federal income tax withheld
Box 5 Check if noncovered security: ☒
Box 6 Reported to IRS: Gross proceeds: ☒
Department of the Treasury- Internal Revenue Service
Form 1O99-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-2fc6e3172ddec2f4d1166a8e,v11-1099-B-boxed,original,2025,fgen-9fea9eeaca381f2f74c30c15,synthetic_programmatic_template,boxed,top,True,
"Form 1099-B
Proceeds From Broker and Barter Exchange Transactions
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 9618 Harbor View Rd Riverton, WI 43478
PAYER'S TIN: 14-5918033
RECIPIENT'S name: Jamie Testcase
RECIPIENT'S TIN: XXXXX8600
Street address (including apt. no.): 6843 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 64543
1a Description of property: VOO
1b Date acquired: 04/15/2019
1d Proceeds: 102,365.67
1e Cost or other basis: 62,744.18
1g Wash sale loss disallowed: $0.00
2 Short-term gain or loss / Long-term gain or loss: X Short-term
4 Federal income tax withheld
5 Check if noncovered security: X
6 Reported to IRS: Gross proceeds
Department of the Treasury - Internal Revenue Service
Form 1099-B (keep for your records)  www.irs.gov/Form1099B",1099,5,1099,fdc-01cb21af1f49fed1add92a5a,v11-1099-B-boxed,original,2022,fgen-8b4c511782ac71669332fd27,synthetic_programmatic_template,boxed,top,False,
"From:   Harbor Card Services
Recipient's name: Jordan Haddad
3 Interest, if included in box 2  3,177.88
2 Amount of debt discharged      9,983.29
4 Debt description   Auto loan deficiency
6 Identifiable event code  F
Form 1099-C Cancellation of Debt",1099,5,1099,fdc-982bad80cc3eb9329718eff6,v11-1099-C-inline,original,2022,fgen-1001d36db2c3fde2f879d133,synthetic_programmatic_template,inline,bottom,False,
"Form 1099-C Cancellation of Debt 2023
CREDITOR: Atlas Card Services
Recipient's name: Taylor R. Sato
5 If checked, the debtor was personally liable for repayment of the debt      0.00
2 Amount of debt discharged   17,104.24
3 Interest, if included in box 2   $9,027.21",1099,5,1099,fdc-f62d82aeafc8ef87b0d4110d,v11-1099-C-inline,original,2023,fgen-41b7dc00c8aa9fc9bbb82d7d,synthetic_programmatic_template,inline,top,False,
"Form 1099-C Cancellation of Debt 2022
From:   Bluewater Bank Card Center
To:  Alex B. Walsh
6 Identifiable event code F",1099,5,1099,fdc-9a44c8e62349cde2b01da713,v11-1099-C-inline,original,2022,fgen-93af6061e22385ff4f6bf3cc,synthetic_programmatic_template,inline,top,False,
"2024
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Atlas Card Services 6835 Sample Street Bayside, WA 26721
CREDITOR'S TIN  17-1768998
DEBTOR'S name  Alex Romero
DEBTOR'S TIN   XXXXX0303
Street address (including apt. no.)      6108 Granite St
City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 59464
Account number (see instructions) ***-**-403423
1 Date of identifiable event   09/04/2021
2 Amount of debt discharged   48,213.78
3 Interest, if included in box 2 $2,113.71
5 If checked, the debtor was personally liable for repayment of the debt [X]
6 Identifiable event code 2
7 Fair market value of property
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-222cea725cc9a603fead49e4,v11-1099-C-inline,original,2024,fgen-dbfc61a390f7140193acb7ab,synthetic_programmatic_template,inline,none,False,
"From:      Harbor Card Services
To:      Riley D. Romero
2 Amount of debt discharged 122,200.00
3 Interest, if included in box 2 $684.94
Form 1099-C Cancellation of Debt",1099,5,1099,fdc-5e62bedb49a9ef81cc22aece,v11-1099-C-inline,original,2026,fgen-738fcf39477e54b8740b834c,synthetic_programmatic_template,inline,bottom,False,
"Form 1099-C
Cancellation of Debt
2022
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.      Atlas Card Services 8160 Willow Bend Way Fairview, OH 46636
CREDITOR'S TIN  88-9157233
DEBTOR'S name   Priya Larsen
DEBTOR'S TIN      XXX-XX-4864
Street address (including apt. no.) 3462 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 84841
Account number (see instructions) ***-**-903377
1 Date of identifiable event September 15, 2021
2 Amount of debt discharged   60,518.32
3 Interest, if included in box 2   $7,072.23
4 Debt description Auto loan deficiency
6 Identifiable event code 1
7 Fair market value of property",1099,5,1099,fdc-b4404b4582e564ead0b193e7,v11-1099-C-inline,original,2022,fgen-70cf03706d449f3f31538292,synthetic_programmatic_template,inline,top,False,
"Form 1099-C
Cancellation of Debt
2023
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Harbor Card Services 574 Lakeshore Blvd Riverton, WI 62192
CREDITOR'S TIN 98-4599220
DEBTOR'S name   Priya D. Testcase
DEBTOR'S TIN  XXX-XX-6945
Street address (including apt. no.) 5515 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code      Cedar Falls, IA 13713
2 Amount of debt discharged 13,289.84
3 Interest, if included in box 2 174.56
4 Debt description  Auto loan deficiency
5 If checked, the debtor was personally liable for repayment of the debt      X
6 Identifiable event code   A
7 Fair market value of property
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-fe0b0bd3d1ffdd91cc7dd5d1,v11-1099-C-inline,original,2023,fgen-220bd4eda3204d98d0214660,synthetic_programmatic_template,inline,top,False,
"Form 1099-C
Cancellation of Debt
2024
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Card Member Services 7289 Elm Park Pl Brookhaven, PA 24680
CREDITOR'S TIN  77-5772270
DEBTOR'S name Riley D. Haddad
DEBTOR'S TIN XXX-XX-6921
2 Amount of debt discharged      $41,113.17
3 Interest, if included in box 2 7,657.14
4 Debt description  Credit card
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code      F
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-3325624a2ab5dfeb01b67332,v11-1099-C-inline,original,2024,fgen-4ba5c8176f77859490e24345,synthetic_programmatic_template,inline,top,False,
"Form 1099-C
Cancellation of Debt
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Northwind Card Member Services 2060 Sample Street Lakewood, CO 92696
CREDITOR'S TIN 31-1207921
DEBTOR'S name   Avery C. Fischer
DEBTOR'S TIN   ****7632
Street address (including apt. no.)  1952 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code   Oak Grove, TX 45157
Account number (see instructions)  ***-**-840855
1 Date of identifiable event September 19, 2021
2 Amount of debt discharged      $9,159.20
3 Interest, if included in box 2  8,231.80
4 Debt description      Personal loan
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code F
7 Fair market value of property",1099,5,1099,fdc-66e060b1f2c39d844d087926,v11-1099-C-inline,original,2021,fgen-974e68d586ca2e79c6b179db,synthetic_programmatic_template,inline,top,False,
"Form 1099-C
Cancellation of Debt
For calendar year 2023
OMB No. 1545-1424
Copy B For Debtor
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Atlas Card Services 6975 Oak Hollow Ct Testville, IL 89397
CREDITOR'S TIN 30-9569543
DEBTOR'S name Amara A. Haddad
DEBTOR'S TIN      ***-**-5774
Street address (including apt. no.)      5215 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code  Testville, IL 55094
1 Date of identifiable event  2023-08-09
2 Amount of debt discharged 14,637.11
3 Interest, if included in box 2 1,569.83
4 Debt description      Auto loan deficiency
5 If checked, the debtor was personally liable for repayment of the debt   X
6 Identifiable event code A
7 Fair market value of property $0.00
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-df80bf261bcfdb846a126a6a,v11-1099-C-inline,original,2023,fgen-84472dad4d755cd46b023658,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
For calendar year 2026
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Harbor Card Services 3568 Elm Park Pl Testville, IL 61520
CREDITOR'S TIN 92-6413244
DEBTOR'S name Kwame Tanaka
DEBTOR'S TIN      XXXXX7269
Street address (including apt. no.)   8785 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 94343
Account number (see instructions)   XXXXX516149
1 Date of identifiable event 2025-07-13
2 Amount of debt discharged      60,274.46
3 Interest, if included in box 2 $5,086.59
4 Debt description Credit card
5 If checked, the debtor was personally liable for repayment of the debt ☒
6 Identifiable event code   F
7 Fair market value of property
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-75ea06415cfa6ba1a0aed3e6,v11-1099-C-inline,original,2026,fgen-d84ddce0966bc4e8c91cb71e,synthetic_programmatic_template,inline,none,False,
"Form 1099-C Cancellation of Debt 2026
CREDITOR'S name: Harbor Card Services
To: Casey Lindqvist
4 Debt description Auto loan deficiency
1 Date of identifiable event 02/16/2025",1099,5,1099,fdc-d9f749052bb2c5934d760b4e,v11-1099-C-inline,original,2026,fgen-ea0c5ef2a2a48381d611e0ae,synthetic_programmatic_template,inline,top,False,
"Form 1099-C Cancellation of Debt 2023
From: Summit Card Services
RECIPIENT: Mateo Okafor
1 Date of identifiable event  02/28/2020
5 If checked, the debtor was personally liable for repayment of the debt  ☒
2 Amount of debt discharged $5,202.64
4 Debt description   Credit card",1099,5,1099,fdc-470be552cc0f3bec8f801349,v11-1099-C-inline,original,2023,fgen-425ea344ef58c63f87bf1a24,synthetic_programmatic_template,inline,top,False,
"Form 1099-C
Cancellation of Debt
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Summit Card Services 4174 Maple Ridge Dr Oak Grove, TX 17581
CREDITOR'S TIN  13-7943872
DEBTOR'S name   Riley Adeyemi
DEBTOR'S TIN      XXXXX8313
2 Amount of debt discharged $65,056.86
3 Interest, if included in box 2   2,868.01
4 Debt description      Auto loan deficiency
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code  G
7 Fair market value of property      $0.00
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-dfa639e70c77e0648bfa21bf,v11-1099-C-inline,original,2026,fgen-6b026d8f800838886e73f68f,synthetic_programmatic_template,inline,top,False,
"2021
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Card Member Services 2898 Harbor View Rd Pinecrest, GA 54529
CREDITOR'S TIN 69-3537164
DEBTOR'S name   Noah Haddad
DEBTOR'S TIN   ****7454
1 Date of identifiable event 2018-09-23
2 Amount of debt discharged   52,045.29
3 Interest, if included in box 2 $3,188.70
4 Debt description  Personal loan
5 If checked, the debtor was personally liable for repayment of the debt   ☒
6 Identifiable event code      F
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-81c2fe5f1abd55dbde889270,v11-1099-C-inline,original,2021,fgen-602380228ce64a53e70489f7,synthetic_programmatic_template,inline,none,False,
"Form 1099-C
Cancellation of Debt
For calendar year 2021
OMB No. 1545-1424
Copy B For Debtor
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Summit Card Services 3199 Willow Bend Way Riverton, WI 95364
CREDITOR'S TIN 41-9843497
DEBTOR'S name Amara Kowalski
DEBTOR'S TIN ending in 4398
Account number (see instructions)      XXXXX869175
2 Amount of debt discharged $87,968.40
3 Interest, if included in box 2      8,649.23
4 Debt description  Credit card
6 Identifiable event code 2
7 Fair market value of property 0.00
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-b65ea07d3151ab5ad7ffbe1b,v11-1099-C-inline,original,2021,fgen-6139406ce6b04233b77babe8,synthetic_programmatic_template,inline,top,False,
"Form 1099-C
Cancellation of Debt
For calendar year 2021
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identifiable event
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
Harbor Card Services 6810 Oak Hollow Ct Fairview, OH 52695
82-5821723
Riley Romero
***-**-2276
228 Oak Hollow Ct
Oak Grove, TX 72479
ending in 165915
07/09/2021
69,441.10
$4,352.01
Credit card
[X]
G
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-83e73b535a117b476168f91a,v11-1099-C-columns,original,2021,fgen-fb48c4db0498f10d56efdcc6,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1099-C
Cancellation of Debt
For calendar year 2021
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Date of identifiable event
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Summit Card Services 5887 Granite St Maplewood, MN 61756
86-6135869
Riley Haddad
***-**-6411
2796 Lakeshore Blvd
Maplewood, MN 69013
March 24, 2018
Personal loan
[X]
F
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-5c391d24c8a84a484fefbc79,v11-1099-C-columns,original,2021,fgen-99dece3491e714f23f2e8070,synthetic_programmatic_template,columns,top,False,
"Form 1099-C
Cancellation of Debt
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Date of identifiable event
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Northwind Card Member Services 9644 Oak Hollow Ct Cedar Falls, IA 68349
94-8959464
Casey Brennan
ending in 5647
8778 Granite St
Testville, IL 28408
February 22, 2022
$44,640.39
8,947.10
Personal loan
X
A
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-812d8f818313fee40e91f728,v11-1099-C-columns,original,2023,fgen-0857729cbf2fce80a0e5a999,synthetic_programmatic_template,columns,top,False,
"Form 1099-C Cancellation of Debt
CREDITOR:
To:
2 Amount of debt discharged
5 If checked, the debtorwas personally liable for repayment of the debt
Atlas Card Servíces
Amara B. Kowalski
96,710.34
X",1099,5,1099,fdc-c0c302f14e4628c51cf445ab,v11-1099-C-columns,original,2023,fgen-e1e66fea61b895bc4673d53b,synthetic_programmatic_template,columns,top,True,
"Form 1099-C
Cancellation of Debt
2026
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Account number (see instructions)
1 Date of identifiable event
3 Interest, if included in box 2
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
Summit Card Services 3953 Oak Hollow Ct Fairview, OH 10000
12-6854696
Kwame R. Adeyemi
***-**-0253
ending in 183044
12/20/2023
$2,747.55
X
A",1099,5,1099,fdc-9c0076db4d1213ee8a0cb6d6,v11-1099-C-columns,original,2026,fgen-1037396018e03f50f0f39027,synthetic_programmatic_template,columns,top,False,
"Form 1099-C
Cancellation of Debt
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Summit Card Services 9635 Willow Bend Way Fairview, OH 18584
72-9522891
Jamie C. Moreau
XXXXX6085
67,349.65
1,028.83
Personal loan
☐
2",1099,5,1099,fdc-e27e6fa20daedf9f2e1a442c,v11-1099-C-columns,original,2021,fgen-d30163146568297f7b5f13ee,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Form 1099-C
Cancellation of Debt
2023
Copy B For Debtor
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identifiable event
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Northwind Card Member Services 179 Maple Ridge Dr Cedar Falls, IA 52229
17-2743201
Olivia Nguyen
****1641
5091 Oak Hollow Ct
Bayside, WA 94183
ending in 845311
2/21/20
57,773.41
3,177.84
Credit card
X
G
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-1420c8a32ee581c209195f61,v11-1099-C-columns,original,2023,fgen-85ee8c822e3a18357c341c19,synthetic_programmatic_template,columns,top,False,
"Form 1099-C
Cancellation of Debt
For calendar year 2023
OMB No. 1545-1424
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
1 Date of identifiable event
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Harbor Card Services 2864 Sample Street Cedar Falls, IA 63283
48-4370578
Amara Adeyemi
****1899
2022-12-17
$48,912.94
7,904.17
Auto loan deficiency
☒
F
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-7c62395870b73048bf739ac9,v11-1099-C-columns,original,2023,fgen-cda13d1edd50dbe92766787e,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1099-C
Cancellation of Debt
2023
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identifiable event
2 Amount of debt discharged
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
7 Fair market value of property
Atlas Card Services 7973 Cedar Ln Oak Grove, TX 91924
79-5643259
Mateo Okafor
****5389
6824 Elm Park Pl
Pinecrest, GA 56924
***-**-013944
5/3/22
$8,623.41
Credit card
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-8c6e027135f16c78e9d2052c,v11-1099-C-columns,original,2023,fgen-8b5be946ff3c563c7e97f14d,synthetic_programmatic_template,columns,top,False,
"2026
OMB No. 1545-1424
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Date of identifiable event
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Harbor Card Services 6227 Granite St Testville, IL 74031
39-5198440
Amara M. Rivera
XXXXX4053
3485 Oak Hollow Ct
Lakewood, CO 38919
September 26, 2026
11,040.47
$4,410.13
Credit card
[X]
G
Form 1099-C
Cancellation of Debt",1099,5,1099,fdc-3c34be5d7d4d8923128198b9,v11-1099-C-columns,original,2026,fgen-05976e3be0bfd708f3b12b45,synthetic_programmatic_template,columns,bottom,False,
"CORRECTED (if checked)
Form 1099-C
Cancellation of Debt
For calendar year 2022
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identifiable event
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Bluewater Bank Card Center 2642 Willow Bend Way Pinecrest, GA 13846
81-8795927
Jordan Rivera
XXXXX7549
8813 Maple Ridge Dr
Maplewood, MN 63198
ending in 902250
2022-11-20
52,163.53
$3,022.73
Auto loan deficiency
[X]
A",1099,5,1099,fdc-69874a3bcd8f04ba9bbf0dad,v11-1099-C-columns,original,2022,fgen-1ca6565b4de50f6906d7a839,synthetic_programmatic_template,columns,top,False,
"Form 1099-C Cancellation of Debt 2025
CREDIT0R:
Recipient's name:
5 If checked, thedebtor was pcrsonally liable for repayment of thc debt
2 Amount of debt discharged
4 Debt description
Atlas Card Servíces
Alex E. Lindqvist
[X]
$35,626.40
Credit card",1099,5,1099,fdc-7c96dacb81c0cfff4cc7ddb4,v11-1099-C-columns,original,2025,fgen-653b7e661b5b29ccf533c319,synthetic_programmatic_template,columns,top,True,
"VOID  CORRECTED
2021
Copy B For Debtor
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Northwind Card Member Services 53 Prairie Ave Cedar Falls, IA 18368
56-5123608
Jordan Adeyemi
XXX-XX-4143
3227 Maple Ridge Dr
Cedar Falls, IA 65443
$10,144.65
8,219.76
Credit card
[X]
1
$0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-d3c1f86be43b3435850142a8,v11-1099-C-columns,original,2021,fgen-06adc23d46037f0c80ee68de,synthetic_programmatic_template,columns,none,False,
"OMB No. 1545-1424
CREDITOR'S name, street address, city or town, state or provínce, country, ZIP orforeign postal code,and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
Account number (see instructions)
1 Date of identífiable event
2 Amount of debt discharged
3 Interest, if inc1uded in box 2
4 Debt description
5 If checked, the debtor was personally líable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Harbor Card 5ervices615O Prairie Ave Fairview, 0H 47019
95-9550008
Morgan Haddad
***-**-0l38
ending in 671985
2022-06-15
$135,999.52
7,503.99
Personal loan
☒
2
Department of the Treasury - Intemal Revenue Service
Form l099-C
Cancellation of Debt
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-2fd5585842fa862dd94d55e9,v11-1099-C-columns,original,2023,fgen-cae66ee005e694765677b8b2,synthetic_programmatic_template,columns,bottom,True,
"Form 1099-C Cancellation of Debt
From:
RECIPIENT:
2 Amount of debt discharged
5 If checked, the debtor was personally liable for repayment of the debt
Bluewater Bank Card Center
Kwame Kowalski
$19,200.80
0.00",1099,5,1099,fdc-aa2762d49b475c2a8cec3848,v11-1099-C-columns,original,2023,fgen-069395180469512623080c9f,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 1099-C
Cancellation of Debt
For calendar year 2025
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S TIN
DEBTOR'S name
DEBTOR'S TIN
1 Date of identifiable event
2 Amount of debt discharged
3 Interest, if included in box 2
4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt
6 Identifiable event code
7 Fair market value of property
Atlas Card Services 5425 Harbor View Rd Brookhaven, PA 30450
81-5129819
Wei B. Nguyen
****8577
2022-10-14
69,657.88
6,142.49
Auto loan deficiency
X
1
$0.00",1099,5,1099,fdc-b1603b5ec458e619eae74704,v11-1099-C-columns,original,2025,fgen-ea05f2994c178c627607d1e6,synthetic_programmatic_template,columns,top,False,
"For calendar year 2022
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address,city or town, state or province, country, ZIP or foreign posta1 codc, and telephone no.: AtlasCardServices 3982 Prairie Ave Pinecrest, GA 8252O
CREDITOR'S TIN: 62-9758933
DEBT0R'S name: Morgan Casti1lo
DEBTOR'S TIN: XXX-XX-1570
Account numbcr (see instructions): XXX-XX-940720
2 Amount of debt discharged: 59,082.00
3 Interest, if induded in box 2: 4,716.O5
4 Debt description: Personal loan
6 Identifiable event code: 1
7 Fair markct value of property
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-86c8aecb5245d14ab8c88246,v11-1099-C-boxed,original,2022,fgen-ec7e4a9f2d0eeda6efb4fb7c,synthetic_programmatic_template,boxed,none,True,
"CORRECTED (if checked)
Form 1099-C
Cancellation of Debt
2024
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bluewater Bank Card Center 3326 Maple Ridge Dr Testville, IL 44043
CREDITOR'S TIN: 35-8699613
DEBTOR'S name: Jordan M. Haddad
DEBTOR'S TIN: ***-**-3411
Street address (including apt. no.): 892 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 81035
1 Date of identifiable event: September 28, 2021
2 Amount of debt discharged: 24,410.12
3 Interest, if included in box 2: 2,565.83
5 If checked, the debtor was personally liable for repayment of the debt: ☐
6 Identifiable event code: F
7 Fair market value of property
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-db7a78137639c3881689cc83,v11-1099-C-boxed,original,2024,fgen-3458e032c4da9ffe7e4c44ef,synthetic_programmatic_template,boxed,top,False,
"Form 1099-C
Cancellation of Debt
OMB No. 1545-1424
Copy B For Debtor
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northwind Card Member Services 5258 Oak Hollow Ct Testville, IL 20831
CREDITOR'S TIN: 96-2635659
DEBTOR'S name: Wei Okafor
DEBTOR'S TIN: XXX-XX-0480
Street address (including apt. no.): 3140 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 16255
Account number (see instructions): ending in 446153
Line 1 Date of identifiable event: 1/13/22
Line 2 Amount of debt discharged: $65,519.26
Line 3 Interest, if included in box 2: 2,449.64
Line 4 Debt description: Auto loan deficiency
Line 5 If checked, the debtor was personally liable for repayment of the debt: ☒
Line 6 Identifiable event code: F
Line 7 Fair market value of property: $0.00",1099,5,1099,fdc-3d56382ea3c5a7e12b799d67,v11-1099-C-boxed,original,2025,fgen-4bed23ac523a4c3f09b58a22,synthetic_programmatic_template,boxed,top,False,
"Form1099-C
Cancellation of Debt
For calendar year 2O24
This is important tax information and is beingfurnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country,ZIP or foreign posta1 code, and telephone no.: Bluewater Bank Card Center 5112 Sample Street Cedar Falls, IA 44625
CREDIT0R'S TIN: 75-9939329
DEBTOR'S namc: Mateo L. Patel
DEBTOR'S TIN: ending in 3767
Line 2 Amount of debt discharged: $106,927.90
Line 3 Interest, if induded in box 2: 9,484.14
Line 4 Debt description: Persona1 loan
Line 5 If checked, the debtor was personally liable for repayment of the debt
Line6 Identifiable event code: 2
Line 7 Fair market value of propcrty
Department of the Treasury - Intemal Revenue 5ervice
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-988f6b5c7f5aede7fb2e61e4,v11-1099-C-boxed,original,2024,fgen-53197e9df10d1f5fa69056fe,synthetic_programmatic_template,boxed,top,True,
"VOID  CORRECTED
2023
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northwind Card Member Services 9485 Lakeshore Blvd Brookhaven, PA 48535
CREDITOR'S TIN: 33-8856807
DEBTOR'S name: Hiro C. Haddad
DEBTOR'S TIN: ending in 1910
Street address (including apt. no.): 4834 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 68351
1 Date of identifiable event: July 21, 2023
3 Interest, if included in box 2: $8,502.29
4 Debt description: Auto loan deficiency
7 Fair market value of property
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-a7742fe8056ed13baca60bc3,v11-1099-C-boxed,original,2023,fgen-eeb03aec69101dc500e46bc7,synthetic_programmatic_template,boxed,none,False,
"Form 1099-C
Cancellation of Debt
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Harbor Card Services 963 Willow Bend Way Maplewood, MN 37997
CREDITOR'S TIN: 44-6138353
DEBTOR'S name: Riley M. Kowalski
DEBTOR'S TIN: ***-**-0366
Street address (including apt. no.): 1098 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 28612
1 Date of identifiable event: 3/25/21
2 Amount of debt discharged: $4,782.13
3 Interest, if included in box 2: 8,131.02
4 Debt description: Credit card
5 If checked, the debtor was personally liable for repayment of the debt: [X]
7 Fair market value of property",1099,5,1099,fdc-6adb7d910de87bb0fcfba012,v11-1099-C-boxed,original,2021,fgen-18562b2f48a33afdb106d516,synthetic_programmatic_template,boxed,top,False,
"Form 1099-C Cancellation of Debt 2024
CREDITOR'S name:: Northwind Card Member Services
Recipient's name:: Priya Okafor
Box 3 Interest, if included in box 2: $5,680.96
Box 1 Date of identifiable event: 2/17/24
Box 5 If checked, the debtor was personally liable for repayment of the debt: ☐",1099,5,1099,fdc-13ca3ae42a97e7e575d26a20,v11-1099-C-boxed,original,2024,fgen-b773f665f380c108ff8d9a7f,synthetic_programmatic_template,boxed,top,False,
"Form 1099-C
Cancellationof Debt
OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town,statc or province, country, ZIP or foreign posta1 code, andtelephone no.: Atlas Card Services 6299 Maple Ridge Dr Testville, IL 27562
CREDITOR'S TIN: 96-53474l9
DEBTOR'S name: Amara Rivera
DEBTOR'S TIN: XXXXX8873
Box 1 Date of identifiable event: 06/28/2022
Box3 Interest, if included in box 2: $232.79
Box 4 Debt description: Auto loan defíciency
Box 5 If checked, the debtor was personally liable for repayment of the debt: X
Box 6 Identífiable cvent code: G
Box 7 Fair market value of propcrty
Department of the Treasury - Intemal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-de2dcb9b3e256cbc7c5d0415,v11-1099-C-boxed,original,2022,fgen-d756aa612ff1c4bfebe41ee7,synthetic_programmatic_template,boxed,top,True,
"2025
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Harbor Card Services 4811 Oak Hollow Ct Brookhaven, PA 42838
CREDITOR'S TIN: 21-9049464
DEBTOR'S name: Amara Brennan
DEBTOR'S TIN: ***-**-5203
Box 2 Amount of debt discharged: 60,340.96
Box 3 Interest, if included in box 2: $4,321.23
Box 4 Debt description: Personal loan
Box 5 If checked, the debtor was personally liable for repayment of the debt: X
Box 6 Identifiable event code: A
Box 7 Fair market value of property: 0.00",1099,5,1099,fdc-8baf54d7656866611d12ce36,v11-1099-C-boxed,original,2025,fgen-21803b41f1bbf0b93b793be9,synthetic_programmatic_template,boxed,none,False,
"VOID  CORRECTED
Form 1099-C
Cancellation of Debt
OMB No. 1545-1424
Copy B For Debtor
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Harbor Card Services 6754 Prairie Ave Riverton, WI 84442
CREDITOR'S TIN: 85-5974760
DEBTOR'S name: Casey Nguyen
DEBTOR'S TIN: ****0106
Street address (including apt. no.): 5240 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 39432
Account number (see instructions): ***-**-900295
Line 1 Date of identifiable event: 12/16/25
Line 2 Amount of debt discharged: $90,366.40
Line 3 Interest, if included in box 2: $1,677.02
Line 4 Debt description: Auto loan deficiency
Line 5 If checked, the debtor was personally liable for repayment of the debt: ☒
Line 6 Identifiable event code: 1
Line 7 Fair market value of property",1099,5,1099,fdc-dc8f54471b94d4222372cf3c,v11-1099-C-boxed,original,2025,fgen-13228646ca1cd5236dbb3851,synthetic_programmatic_template,boxed,top,False,
"OMB No. 1545-1424
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Atlas Card Services 4230 Granite St Brookhaven, PA 12537
CREDITOR'S TIN: 21-7475544
DEBTOR'S name: Riley Tanaka
DEBTOR'S TIN: XXX-XX-8100
1 Date of identifiable event: May 2, 2024
2 Amount of debt discharged: 44,334.09
3 Interest, if included in box 2: 7,056.25
4 Debt description: Auto loan deficiency
5 If checked, the debtor was personally liable for repayment of the debt: [X]
6 Identifiable event code: 1
7 Fair market value of property
Department of the Treasury - Internal Revenue Service
Form 1099-C
Cancellation of Debt
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-b32155448dab1029973ed952,v11-1099-C-boxed,original,2024,fgen-093641638de8d74276ba76f9,synthetic_programmatic_template,boxed,bottom,False,
"Form 1099-C Cancellation of Debt 2022
CREDITOR:: Bluewater Bank Card Center
RECIPIENT:: Avery R. Patel
2 Amount of debt discharged: $5,058.57",1099,5,1099,fdc-a5717bf82552affd38d1eb84,v11-1099-C-boxed,original,2022,fgen-e9ae00ac52742478ed0b8601,synthetic_programmatic_template,boxed,top,False,
"Form 1099-C Cancellation of Debt
From:: Bluewater Bank Card Center
Recipient's name:: Taylor Castillo
Line 1 Date of identifiable event: 10/4/23
Line 6Identifiable event code: A
Line 3 Interest, if included in box 2: 1,O85.54",1099,5,1099,fdc-caa0cd125fc0ab3d4142970d,v11-1099-C-boxed,original,2026,fgen-f9301419bc45adda33998fce,synthetic_programmatic_template,boxed,top,True,
"Form 1099-C
Cancellation of Debt
For calendar year 2025
OMB No. 1545-1424
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Summit Card Services 3355 Prairie Ave Bayside, WA 91042
CREDITOR'S TIN: 80-3070241
DEBTOR'S name: Alex Brennan
DEBTOR'S TIN: XXX-XX-0216
Street address (including apt. no.): 3189 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 70607
Account number (see instructions): XXX-XX-229264
Line 1 Date of identifiable event: 08/04/2025
Line 2 Amount of debt discharged: 113,484.49
Line 3 Interest, if included in box 2: $4,254.16
Line 4 Debt description: Personal loan
Line 5 If checked, the debtor was personally liable for repayment of the debt: ☒
Line 6 Identifiable event code: F
Line 7 Fair market value of property: $0.00
Department of the Treasury - Internal Revenue Service
Form 1099-C (keep for your records)  www.irs.gov/Form1099C",1099,5,1099,fdc-aa4d5621ad0f8c244c5fd355,v11-1099-C-boxed,original,2025,fgen-d9b60a82c3ebe52a8e142b6c,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
OMBNo.1545-1424
Thís is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.:Summit Card Services 9027 Lakeshore B1vd Testvillc, IL 53465
CREDITOR'S TIN: 98-8998928
DEBTOR'S name: Mateo Pate1
DEBTOR'S TIN: ***-**-2872
Line 1 Dateof identifiable event: January 13, 2022
Line 2 Amount of debt discharged: $34,981.63
Line 3 Interest, íf induded in box 2: $1,407.46
Line 4 Debt description: Auto loan deficiency
Line 5 If checked, the debtor was pcrsonally líable for repayment of the debt: [X]
Line 6 Identifiable event code: G
Line 7 Faír market value of property: $0.00",1099,5,1099,fdc-aefa578f8036b828ed2f7094,v11-1099-C-boxed,original,2022,fgen-8d4151afcb3e1f5106c24238,synthetic_programmatic_template,boxed,none,True,
"CORRECTED (if checked)
Form 1099-C
Cancellation of Debt
2024
OMB No. 1545-1424
Copy B For Debtor
This is important tax information and is being furnished to the IRS.
CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Atlas Card Services 9386 Sample Street Testville, IL 38820
CREDITOR'S TIN: 58-7385611
DEBTOR'S name: Casey A. Walsh
DEBTOR'S TIN: ending in 7735
Street address (including apt. no.): 2698 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 59699
Box 2 Amount of debt discharged: 57,489.97
Box 3 Interest, if included in box 2: 1,833.56
Box 4 Debt description: Personal loan
Box 5 If checked, the debtor was personally liable for repayment of the debt: ☒
Box 6 Identifiable event code: A",1099,5,1099,fdc-8fe31ee77dab31b91d072570,v11-1099-C-boxed,original,2024,fgen-f1d4aebdd9bcab6951691502,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked) Form 1099-C Cancellation of Debt For calendar year 2021 OMB No. 1545-1424 Copy B For Debtor This is
important tax information and is being furnished to the IRS. CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Bluewater Bank Card Center 2301 Oak Hollow Ct Brookhaven, PA 23851 CREDITOR'S TIN 34-2819929 DEBTOR'S name Priya K. Moreau DEBTOR'S TIN XXX-XX-5967 Street address (including apt. no.) 1277 Granite St City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 37311 1 Date of identifiable event 04/17/2020 2 Amount of debt discharged 124,577.95 3 Interest, if included
in box 2 5,844.12 5 If checked, the debtor was personally liable for repayment of the debt [X] 6 Identifiable event code 2 7 Fair market value of property 0.00",1099,5,1099,fdc-97be126b6b3f1b33498ccea4,v11-1099-C-flat,original,2021,fgen-9002c598b28369cc73a33220,synthetic_programmatic_template,flat,top,False,
"Form 1099-C Cancellation of Debt OMB No. 1545-1424 Copy B
For Debtor This is important tax information and is being furnished to the IRS. CREDITOR'S name, street address, city
or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Card Member Services 5208 Granite St Bayside, WA 59254 CREDITOR'S TIN 71-1817626 DEBTOR'S name Casey Patel DEBTOR'S TIN ***-**-3290 Street address (including apt. no.) 5870 Maple Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 15242 Account number (see instructions) XXX-XX-302964 1 Date of identifiable event 2022-07-19 2 Amount of debt discharged 101,424.94 3 Interest, if included in box 2 $6,560.86 5 If checked, the debtor was personally liable for repayment of the debt X 7 Fair market value of property $0.00 Department of the Treasury - Internal Revenue Service Form 1099-C (keep for your records) www.irs.gov/Form1099C",1099,5,1099,fdc-4d5d81177983bd2461b92b75,v11-1099-C-flat,original,2023,fgen-8e1f63a17eddd1403e3b268d,synthetic_programmatic_template,flat,top,False,
"Form 1099-C Cancellation of Debt 2026 CREDITOR'S
name: Bluewater Bank
Card Center To: Lena Romero 1 Date of identifiable event 03/18/2023 3 Interest, if included in box 2 3,565.42 2 Amount of debt discharged 28,126.58",1099,5,1099,fdc-46c57f85990652b13be03ce6,v11-1099-C-flat,original,2026,fgen-267326794783211bdbf58e73,synthetic_programmatic_template,flat,top,False,
"Form 1099-C Cancellation of Debt 2025 CREDITOR: Atlas Card
Services Recipient's name: Avery J.
Fischer 1 Date of identifiable event 9/28/25",1099,5,1099,fdc-976d135e44fb1da9dee5ee53,v11-1099-C-flat,original,2025,fgen-e8baecea0dacca85ac69f7e8,synthetic_programmatic_template,flat,top,False,
"CREDITOR: Harbor Card Services RECIPIENT: Olivia Patel
3 Interest, if included in box 2 8,816.72 2 Amount of debt
discharged S131,599.55 1 Date of identifiab1e event 11/03/2020 Form 1099-CCancellation of Debt 2023",1099,5,1099,fdc-aedf8c6dda282961f034acb3,v11-1099-C-flat,original,2023,fgen-c9902cbbbad8d263cf70bb8a,synthetic_programmatic_template,flat,bottom,True,
"2025 OMB No. 1545-1424 Copy B For Debtor CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign
postal code, and telephone no. Northwind Card Member Services 1970 Maple Ridge Dr Riverton, WI 16413 CREDITOR'S TIN 74-1975510 DEBTOR'S name Casey Sato DEBTOR'S TIN XXXXX9105 Street address (including apt. no.) 4199 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 80675 1 Date of identifiable event 2022-04-03 2 Amount of debt discharged $37,809.79 3 Interest, if included in box 2 $6,637.96 4 Debt description Auto loan deficiency 5 If checked, the debtor was personally liable
for repayment of the debt ☒ 7 Fair market value of property Form 1099-C Cancellation of Debt",1099,5,1099,fdc-45ad53f2ea176b9ef08052b1,v11-1099-C-flat,original,2025,fgen-3621f15db8bc4e42817d0b33,synthetic_programmatic_template,flat,bottom,False,
"VOID CORRECTED Form 1099-C Cancellation of Debt For calendar year 2023 This is important tax information and is being furnished
to the IRS. CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Card Member Services 8823 Willow Bend Way Pinecrest, GA 83994 CREDITOR'S TIN 31-8032813 DEBTOR'S name Morgan R. Kowalski DEBTOR'S TIN ****4873 Street address (including apt. no.) 5204
Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 36938 2 Amount of debt discharged 129,778.58 3 Interest, if included in box 2 $8,234.89 4 Debt description Credit card 6 Identifiable event code A 7 Fair market value of property $0.00",1099,5,1099,fdc-4f01f8b082f8da023e37be95,v11-1099-C-flat,original,2023,fgen-432c931d8861552adbb1d897,synthetic_programmatic_template,flat,top,False,
"Form 1099-C Cancellation of Debt 2024 OMB No. 1545-1424 Copy B For Debtor CREDITOR'S name, street address, city or town,
state or province, country, ZIP or foreign postal code, and telephone no. Atlas Card Services 7690 Harbor View Rd Cedar Falls, IA 64074 CREDITOR'S TIN 14-9432825 DEBTOR'S name Avery Romero DEBTOR'S TIN ***-**-5641 1 Date of identifiable event 11/06/2024 3 Interest, if included
in box 2 $8,400.88 4 Debt description Personal loan 5 If checked, the debtor was personally liable for repayment of the debt [X] 6 Identifiable event code 2 7 Fair market value of property 0.00 Department of the Treasury - Internal Revenue Service Form 1099-C (keep for your records) www.irs.gov/Form1099C",1099,5,1099,fdc-d6c7b871efe4020619e1f23d,v11-1099-C-flat,original,2024,fgen-9d73cc4207a8a5dce130ed48,synthetic_programmatic_template,flat,top,False,
"2021 OMB No. 1545-1424 Copy B For
Debtor This is important tax information and is being furnished to the IRS. CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Card Member Services 7982 Harbor View Rd Pinecrest, GA 76365 CREDITOR'S TIN 39-2936346 DEBTOR'S name Riley K. Romero DEBTOR'S TIN ****4765 1 Date of identifiable event August 13, 2021 2 Amount of debt
discharged 14,853.26 3 Interest, if included in box 2 5,475.75 4 Debt description Auto loan deficiency 5 If checked, the debtor was personally liable for repayment of the debt [X] 6 Identifiable event code A 7 Fair market value of property Form 1099-C Cancellation of Debt",1099,5,1099,fdc-b2b6d0cf8decc0452afd7bcb,v11-1099-C-flat,original,2021,fgen-802c5bf9d4edc222f3655c19,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-C Cancellation of Debt For calendar year 2022 OMB No. 1545-1424 This is important tax information and is being furnished to the IRS. CREDITOR'S name, street address, city
or town, state or province, country, ZIP or foreign postal code, and telephone no. Summit Card Services 7426 Willow
Bend Way Pinecrest, GA 77772 CREDITOR'S TIN 49-7811874 DEBTOR'S name Fatima Patel DEBTOR'S TIN XXXXX6994 Account number (see instructions) ***-**-672684 1 Date of identifiable event February 20, 2021 2 Amount of debt discharged 138,355.89 4 Debt description Personal loan 5 If checked, the debtor was personally liable for repayment of the debt 6 Identifiable event code G 7 Fair market value of property Department of the Treasury - Internal Revenue Service Form 1099-C (keep for your records) www.irs.gov/Form1099C",1099,5,1099,fdc-1268f687a7794e3fbe13ef90,v11-1099-C-flat,original,2022,fgen-217d6b751520b6d432f2ab9a,synthetic_programmatic_template,flat,top,False,
"Form 1099-C Cancellation of Debt
2022 CREDITOR:
Northwind Card Member Services RECIPIENT: Riley Patel 4 Debt description Auto loan deficiency 2 Amount of debt discharged 137,834.26",1099,5,1099,fdc-d631a65a46102c7d8bbb52fb,v11-1099-C-flat,original,2022,fgen-e23c6cb97d6eaa7554d90136,synthetic_programmatic_template,flat,top,False,
"CREDITOR: Harbor Card
Services
RECIPIENT: Alex Adeyemi 4 Debt description Personal loan Form 1099-C Cancellation of Debt 2022",1099,5,1099,fdc-73b863703fbba60f3a708d1d,v11-1099-C-flat,original,2022,fgen-ac6bfbb2b610319d4b1d32ed,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-C Cancellation of Debt 2024 OMB No. 1545-1424 Copy B For Debtor
This is important tax information and is being furnished to the IRS. CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Card Member Services 5611 Oak Hollow Ct Bayside, WA 51477 CREDITOR'S TIN 41-1802439 DEBTOR'S name Morgan Brennan DEBTOR'S TIN ending in 3089 Street address (including
apt. no.) 6033 Granite St City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 67878 1 Date of identifiable event 2021-03-07 3 Interest, if included in box 2 2,007.97 5 If checked, the debtor was personally liable for repayment of the debt 6 Identifiable event code A 7 Fair market value of property",1099,5,1099,fdc-90ce7406138836fd0308cb52,v11-1099-C-flat,original,2024,fgen-880534827867acba8ca37eab,synthetic_programmatic_template,flat,top,False,
"Form 1099-C Cancellation of Debt 2026 OMB No. 1545-1424 This is important tax information and is being furnished to the IRS. CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code,
and telephone no. Summit Card Services 510 Elm Park Pl Bayside, WA 62104 CREDITOR'S TIN 24-1929274 DEBTOR'S name Kwame E. Haddad DEBTOR'S TIN XXX-XX-4203 Street address (including apt. no.) 1158 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 35653 1 Date of identifiable
event 12/17/2023 2 Amount of debt discharged 127,627.50 3 Interest, if included in box 2 $7,396.37 4 Debt description Personal loan 5 If checked, the debtor was personally liable for repayment of the debt ☐ 7 Fair market value of property Department of the Treasury - Internal Revenue Service Form 1099-C (keep for your records) www.irs.gov/Form1099C",1099,5,1099,fdc-c790f7bcadb4afe52ce571c5,v11-1099-C-flat,original,2026,fgen-3fcf3eb7fa7ef6fc181b28ac,synthetic_programmatic_template,flat,top,False,
"Form 1099-C Cancellation of Debt 2022 CREDITOR'S name: Northwind Card
Member Services RECIPIENT: Casey Brennan 1 Date of identifiable event December 18, 2021 5 If checked, the debtor was personally
liable for repayment of the debt ☒ 6 Identifiable event code 2",1099,5,1099,fdc-6c55c0c3d23a46c92f0611b2,v11-1099-C-flat,original,2022,fgen-1f03700196593c8a0c1126d3,synthetic_programmatic_template,flat,top,False,
"2021 OMB No. 1545-1424 Copy B For Debtor CREDITOR'S name, street address, city or
town, state or province, country, ZIP or foreign postal code, and telephone no. Harbor Card Services 4405 Harbor View Rd Bayside, WA 48310 CREDITOR'S TIN 72-2244204 DEBTOR'S name Diego Adeyemi DEBTOR'S TIN ending in 8439 Street address (including apt. no.) 4406 Sample Street City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 46521 1 Date of identifiable event 03/12/2020 2 Amount
of debt discharged 135,968.39 3 Interest, if included in box 2 $2,354.00 4 Debt description Auto loan deficiency 5 If checked, the debtor was personally liable for repayment of the debt X 6 Identifiable event code 2 7 Fair market value of property Form 1099-C Cancellation of Debt",1099,5,1099,fdc-79e3a2110fbb4cdb56c21562,v11-1099-C-flat,original,2021,fgen-fd06c1d228e9778522245867,synthetic_programmatic_template,flat,bottom,False,
"2023
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Digital asset name
Number of units
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
BitMeadow 9406 Willow Bend Way Fairview, OH 67600
52-5978941
Olivia Castillo
****6429
4518 Oak Hollow Ct
Brookhaven, PA 18887
Solana (SOL)
10.689262
December 16, 2022
2020-12-14
48,961.33
$93,617.42
0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-6b9b428aaae4b15e728b4fa6,v11-1099-DA-columns,original,2023,fgen-c4c17e0e3163f03fd0abfbd2,synthetic_programmatic_template,columns,none,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
For calendar year 2025
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Digital asset name
Number of units
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
LedgerPeak Markets 8988 Granite St Oak Grove, TX 47070
97-6139278
Wei B. Adeyemi
XXXXX4117
1129 Harbor View Rd
Oak Grove, TX 99883
Solana (SOL)
0.434863
9/16/22
2025-09-07
$127,315.76
106,876.80
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-c0ebb52121e99a37fc1c433f,v11-1099-DA-columns,original,2025,fgen-12bc0a9eb2f2404219e390e7,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
2022
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Digital asset name
Date sold or disposed
Proceeds
Federal income tax withheld
BitMeadow 7400 Willow Bend Way Lakewood, CO 20299
50-8917488
Kwame Adeyemi
XXXXX5295
7765 Prairie Ave
Oak Grove, TX 26913
Solana (SOL)
November 21, 2022
37,993.66
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-d2f043690f99a80fb5d6431c,v11-1099-DA-columns,original,2022,fgen-64d258724458cac6ce33d567,synthetic_programmatic_template,columns,top,False,
"For calendar year 2026
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Digital asset name
Date acquired
Date sold or disposed
Cost or other basis
LedgerPeak Markets 9111 Sample Street Maplewood, MN 97607
74-1218197
Casey Larsen
XXXXX0055
4208 Elm Park Pl
Brookhaven, PA 72765
USD Coin (USDC)
March 9, 2026
04/09/2026
$75,734.51
Department of the Treasury - Internal Revenue Service
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-f6c4cb687da726f1b31575e8,v11-1099-DA-columns,original,2026,fgen-b882223865498d0bb1d37a2b,synthetic_programmatic_template,columns,bottom,False,
"CORRECTED (if checked)
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'5 name
RECIPIENT'S TIN
Streetaddress (induding apt. no.)
City or town,state or province, country, and ZIP or foreign postal code
Digital asset name
Number ofunits
Date acquired
Date so1d or disposcd
Cost or other basis
Federal income tax withheld
CoinHarbor Exchange 9397 Maple Ridge Dr Fairview, OH 8642O
43-824O829
Lena S. Nguyen
XXX-XX-7526
4739 Maple Ridge Dr
Brookhaven, PA 74685
Solana (S0L)
9.891803
2025-09-06
04/26/2024
S82,708.41",1099,5,1099,fdc-20c759b68b5da07ca2cd9334,v11-1099-DA-columns,original,2025,fgen-01cec5430201a4e0b375137f,synthetic_programmatic_template,columns,top,True,
"For calendar year 2023
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code,and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Dígital asset name
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
LedgerPeak Markets 342 5ample Street Pínecrest, GA 54746
64-6030756
Jamie Romero
XXX-XX-5905
Ethereum (ETH)
l2/26/23
06/l8/2023
4,824.17
$44,463.48
Form 1099-DA
Digital Asset Proceeds From Broker Transactions",1099,5,1099,fdc-86cbcf8b32fc304c7e9496aa,v11-1099-DA-columns,original,2023,fgen-f0f7a56060430a97633c8b4b,synthetic_programmatic_template,columns,bottom,True,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions 2022
BROKER:
RECIPIENT:
Cost or other basis
Number of units
CoinHarbor Exchange
Alex Testcase
$137,960.33
19.534692",1099,5,1099,fdc-7255c36ea8302614af38b51b,v11-1099-DA-columns,original,2022,fgen-439bed318c8fd5150a479535,synthetic_programmatic_template,columns,top,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
For calendar year 2025
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Digital asset name
Number of units
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
BitMeadow 3006 Maple Ridge Dr Lakewood, CO 52150
23-5934370
Jamie R. Adeyemi
****8829
5846 Oak Hollow Ct
Bayside, WA 29872
USD Coin (USDC)
27.992789
April 26, 2025
2024-06-12
116,238.69
$35,318.27
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-87014988aa635c4358aaeaf7,v11-1099-DA-columns,original,2025,fgen-b745b720c4e13c9a18040cfb,synthetic_programmatic_template,columns,top,False,
"2025
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Digital asset name
Number of units
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
BitMeadow 9176 Cedar Ln Riverton, WI 85963
75-8076130
Riley Kowalski
XXX-XX-9237
7826 Oak Hollow Ct
Fairview, OH 28857
***-**-762386
Ethereum (ETH)
14.752046
2024-02-09
July 22, 2025
$105,738.05
$60,067.52
Form 1099-DA
Digital Asset Proceeds From Broker Transactions",1099,5,1099,fdc-da404d71e4cda9c1c861dad1,v11-1099-DA-columns,original,2025,fgen-555ae69edf1c871e4fe985fe,synthetic_programmatic_template,columns,bottom,False,
"VOID  CORRECTED
Form 1099-DA
Digital Asset Proceeds FromBroker Transactions
For calendar year 2026
Copy B For Recipient
This is important tax information and is being furnished to the IR5.
BR0KER'S name, street address, city or town, state or province, country,ZIP or foreign postal code, and telephone no.
BR0KER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
Number of units
Date sold or disposed
Proceeds
Cost or other basís
Federal income tax withheld
CoinHarbor Exchange 4O69Granite St Riverton, WI 92724
23-6l73454
Taylor B. Brennan
***-**-O591
****000897
4.520811
5/8/26
48,175.60
48,268.55
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.írs.gov/Form1099DA",1099,5,1099,fdc-bc232268cb077c98f1302bae,v11-1099-DA-columns,original,2026,fgen-910e6841fcede57f5658e24e,synthetic_programmatic_template,columns,top,True,
"Copy B For Recipient
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Digital asset name
Date acquired
Date sold or disposed
Proceeds
Federal income tax withheld
LedgerPeak Markets 3102 Elm Park Pl Lakewood, CO 38571
59-6323168
Jordan Walsh
XXXXX5400
4527 Maple Ridge Dr
Lakewood, CO 47150
USD Coin (USDC)
2024-10-13
October 16, 2021
130,010.71",1099,5,1099,fdc-fdca19b6a5748a6a8a7e90f9,v11-1099-DA-columns,original,2024,fgen-23b8eff6b31d6d657f36db0c,synthetic_programmatic_template,columns,none,False,
"Form 1099-DA
Digital Asset Proceeds FromBroker Transactions
2022
Copy B For Recipient
Thís isimportant tax information and is bcing fumishedto the IR5.
BROKER'S name, street address, cíty or town, stateor province, country, ZIP or foreign postal code, and telephone no.
BROKER'5 TIN
RECIPIENT'5 name
RECIPIENT'S TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Digital asset name
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
CoinHarbor Exchange 8899 Lakeshore Blvd Oak Grove, TX 78252
60-2631587
Riley Tanaka
ending in 3176
4635 Prairie Ave
Lakewood, C0 53140
Bitcoin (BTC)
01/04/2019
8/10/21
42,063.34
$32,333.05
O.00
Departmcnt of the Treasury - Intemal Revenue 5ervice
Form 1099-DA (keep for your records)  www.irs.gov/Form1O99DA",1099,5,1099,fdc-53931151c68b5e722e39a1b4,v11-1099-DA-columns,original,2022,fgen-1fa098dff0443bbf29c20434,synthetic_programmatic_template,columns,top,True,
"BROKER'S name:
Recipient's name:
Cost or other basis
Date sold or disposed
BitMeadow
Kwame Okafor
$23,720.22
01/14/2022",1099,5,1099,fdc-a52e85fa2b898ad84794ef07,v11-1099-DA-columns,original,2022,fgen-7d06cf1cd6fa95000abf9502,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
For calendar year 2022
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
Digital asset name
Number of units
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
LedgerPeak Markets 4985 Elm Park Pl Maplewood, MN 71357
73-7685436
Jamie S. Adeyemi
XXX-XX-8966
XXXXX845250
Solana (SOL)
22.324653
2021-03-27
03/27/2022
$100,641.83
64,758.54
0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-4809c6283546c5abfe6f8b66,v11-1099-DA-columns,original,2022,fgen-d63d990d1bc7bd26ae41cd85,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
For calendar year 2025
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Digital asset name
Number of units
Date acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
BitMeadow 7753 Harbor View Rd Pinecrest, GA 47972
81-9625687
Mateo Larsen
ending in 4124
USD Coin (USDC)
39.776529
2025-07-12
August 3, 2022
62,912.66
$107,771.37
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-f80aa6f08b49e43ab64f67c2,v11-1099-DA-columns,original,2025,fgen-99bd57ba0e82a033c3f7af34,synthetic_programmatic_template,columns,top,False,
"Thisis important tax information and is being fumished to the IRS.
BROKER'S name, street address, city or town,state or province, country, ZIP or foreign postal code, and telephone no.
BROKER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (induding apt. no.)
City or town, statc or province, country, and ZIP or foreign postal code
Digital asset name
Number of units
Datc acquired
Date sold or disposed
Proceeds
Cost or other basis
Federal income tax withheld
LedgerPeak Markets 2671 Granite 5t Map1ewood, MN 58793
45-4872663
Noah Fischer
XXX-XX-4861
17O2 Lakeshore B1vd
Fairview, OH 82378
Bitcoin (BTC)
21.746401
5/3/18
June 9, 2021
9,608.02
S59,410.75
Department of the Treasury - Internal Revenue 5ervice
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
Form 1099-DA (keep foryour records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-684b4693fad9475cced9a1ae,v11-1099-DA-columns,original,2021,fgen-498649df2b0449b770483a12,synthetic_programmatic_template,columns,bottom,True,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions 2026
BROKER'S name:: LedgerPeak Markets
Recipient's name:: Sofia Castillo
Date sold or disposed: 2025-07-21",1099,5,1099,fdc-6bdbee90cf5cf5f3141dfe2d,v11-1099-DA-boxed,original,2026,fgen-9883d2d7cc987a1a19bdd865,synthetic_programmatic_template,boxed,top,False,
"BROKER'S name:: LedgerPeak Markets
To:: Wei S. Adeyemi
Number of units: 16.042795
Date sold or disposed: 07/19/2024
Form 1099-DA Digital Asset Proceeds From Broker Transactions 2025",1099,5,1099,fdc-80635e3aa8465ad45ffe62cc,v11-1099-DA-boxed,original,2025,fgen-461990c3e6eb63d7194150bd,synthetic_programmatic_template,boxed,bottom,False,
"VOID  CORRECTED
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and te1ephone no.: LedgerPeakMarkcts 8574 Willow Bend Way Cedar Falls, IA 86299
BR0KER'5 TIN: 62-9181568
RECIPIENT'S name: Sofia Patel
RECIPIENT'S TIN: XXXXX77O6
Digital asset name: Solana (SOL)
Number ofunits: 0.792256
Date acquired: September 28, 2021
Date sold or dísposed: April 7, 2O18
Cost or other basis: 118,485.60
Federal income tax withheld:",1099,5,1099,fdc-d835749269da8282c73f1816,v11-1099-DA-boxed,original,2021,fgen-d0db2598184675307559db1a,synthetic_programmatic_template,boxed,none,True,
"VOID  CORRECTED
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
2025
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: LedgerPeak Markets 1641 Oak Hollow Ct Testville, IL 50260
BROKER'S TIN: 18-2680495
RECIPIENT'S name: Riley Brennan
RECIPIENT'S TIN: ***-**-1497
Street address (including apt. no.): 3337 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 46914
Digital asset name: Solana (SOL)
Number of units: 37.307340
Date sold or disposed: 05/21/2025
Proceeds: $70,184.02
Cost or other basis: 127,474.39
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-f91bdf2842698c43c4f63fc8,v11-1099-DA-boxed,original,2025,fgen-6df518e21292743288390ff6,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1099-DA
Dígital Asset Proceeds FromBroker Transactions
For calendar ycar 2026
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: LedgerPeak Markets 7708 Harbor View Rd Riverton, WI 40l96
BR0KER'S TIN: 71-3772375
RECIPIENT'S name: Amara Brennan
RECIPIENT'S TIN: ****2801
Streetaddress (ínc1uding apt. no.): 5403 Elm Park Pl
City or town, state or province, country, and ZIPor foreign postal code: Riverton, WI 68423
Account number (see instructions): XXX-XX-9336l5
Digital asset name: USD Coin (USDC)
Number of units: l1.541374
Date acquired: April 21, 2023
Date sold or disposed: 08/l0/2026
Cost or other basis: 118,301.79",1099,5,1099,fdc-6fad2d2d196566197968583c,v11-1099-DA-boxed,original,2026,fgen-501d20b917ca75c22af5eb05,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked)
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
2026
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: BitMeadow 677 Granite St Pinecrest, GA 25641
BROKER'S TIN: 26-2198619
RECIPIENT'S name: Casey Testcase
RECIPIENT'S TIN: ending in 4095
Digital asset name: Bitcoin (BTC)
Number of units: 35.041228
Date acquired: 06/26/2025
Date sold or disposed: 3/10/26
Proceeds: 112,936.82
Federal income tax withheld:",1099,5,1099,fdc-b56d56e0ebfe07a7cbdb8251,v11-1099-DA-boxed,original,2026,fgen-e2442572b4bde1f6923cde53,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
For calendar year 2024
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: LedgerPeak Markets 3308 Prairie Ave Lakewood, CO 12878
BROKER'S TIN: 47-3000750
RECIPIENT'S name: Fatima Sato
RECIPIENT'S TIN: ***-**-3874
Street address (including apt. no.): 2704 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 84258
Digital asset name: Solana (SOL)
Number of units: 25.712022
Date acquired: 07/17/2021
Date sold or disposed: 1/13/23
Proceeds: $76,232.38
Cost or other basis: 127,528.85
Federal income tax withheld: 
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-5d7b3d05698d5f040d4d7957,v11-1099-DA-boxed,original,2024,fgen-564ffc7bef4a96fa5f6081b5,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
For calendar year 2023
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: CoinHarbor Exchange 3549 Willow Bend Way Testville, IL 33847
BROKER'S TIN: 15-3352590
RECIPIENT'S name: Mateo Castillo
RECIPIENT'S TIN: ending in 5593
Street address (including apt. no.): 5033 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 49808
Digital asset name: Bitcoin (BTC)
Number of units: 0.504772
Date acquired: 10/18/2020
Proceeds: 105,096.53
Cost or other basis: 17,879.99
Federal income tax withheld: 
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-2ca16caef69e5a00a7a9b3e0,v11-1099-DA-boxed,original,2023,fgen-8d11ca90a460012825effc0a,synthetic_programmatic_template,boxed,top,False,
"2021
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: CoinHarbor Exchange 8914 Harbor View Rd Oak Grove, TX 74837
BROKER'S TIN: 82-8194154
RECIPIENT'S name: Lena Haddad
RECIPIENT'S TIN: ending in 0781
Street address (including apt. no.): 1207 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 85072
Account number (see instructions): ending in 860255
Digital asset name: USD Coin (USDC)
Number of units: 15.008752
Date acquired: January 11, 2020
Date sold or disposed: 7/20/20
Proceeds: $52,147.14
Form 1099-DA
Digital Asset Proceeds From Broker Transactions",1099,5,1099,fdc-03a60bad253b23b31f457504,v11-1099-DA-boxed,original,2021,fgen-6418d7d776bcd7b614505c48,synthetic_programmatic_template,boxed,bottom,False,
"BROKER:: LedgerPeak Markets
To:: Amara Nguyen
Cost or other basis: 22,720.51
Date sold or disposed: November 14, 2020
Date acquired: 01/12/2021",1099,5,1099,fdc-ad5ddaae1e1dceaed3526d7e,v11-1099-DA-boxed,original,2021,fgen-c9cf56f426b61d15b739eba9,synthetic_programmatic_template,boxed,none,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
2022
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: CoinHarbor Exchange 7133 Willow Bend Way Testville, IL 56758
BROKER'S TIN: 52-6529754
RECIPIENT'S name: Jordan Rivera
RECIPIENT'S TIN: ending in 4326
Street address (including apt. no.): 3706 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 68566
Account number (see instructions): ***-**-121533
Digital asset name: Bitcoin (BTC)
Number of units: 12.182230
Date acquired: 07/23/2021
Date sold or disposed: 10/22/22
Proceeds: $17,699.68
Cost or other basis: 121,861.37
Federal income tax withheld: 
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-ed1463dd26ba7a28ea5c08b9,v11-1099-DA-boxed,original,2022,fgen-20ee1df97a256997a5f4f6f0,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions 2021
BROKER'S name:: BitMeadow
RECIPIENT:: Lena L. Walsh
Proceeds: $44,934.73
Number of units: 1.438412
Date sold or disposed: 1/1/21
Digital asset name: Bitcoin (BTC)",1099,5,1099,fdc-e039d4374bd144f35c2caa4e,v11-1099-DA-boxed,original,2021,fgen-1e3e421770c5f5f355cf3430,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: LedgerPeak Markets 4595 Willow Bend Way Riverton, WI 50139
BROKER'S TIN: 43-5100456
RECIPIENT'S name: Mateo L. Patel
RECIPIENT'S TIN: XXX-XX-6178
Account number (see instructions): ****798662
Digital asset name: Bitcoin (BTC)
Date acquired: 9/27/23
Date sold or disposed: July 27, 2023
Proceeds: 120,760.94
Cost or other basis: 41,387.47
Federal income tax withheld: 
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-3970fd40c54b553a6ff6e0a4,v11-1099-DA-boxed,original,2026,fgen-05a462cf474e909a48b15b2d,synthetic_programmatic_template,boxed,top,False,
"2022
Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: LedgerPeak Markets 4581 Granite St Lakewood, CO 12924
BROKER'S TIN: 44-4331654
RECIPIENT'S name: Jordan Patel
RECIPIENT'S TIN: ****3168
Street address (including apt. no.): 1540 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 30525
Number of units: 13.981843
Date acquired: 2019-01-25
Date sold or disposed: 2/4/21
Proceeds: 125,196.90
Federal income tax withheld: $0.00",1099,5,1099,fdc-08703a2071b86ff8242585d9,v11-1099-DA-boxed,original,2022,fgen-645e93c17b303636a3e32fde,synthetic_programmatic_template,boxed,none,False,
"CORRECTED (if checked)
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
BROKER'Sname, street address, cíty or town, state or province, country, ZIP or foreign postal code, and te1ephone no.: CoinHarbor Exchange 9565 Elm Park Pl Cedar Falls, IA 25485
BROKER'S TIN: 82-674929l
RECIPIENT'S name: Mateo S. Moreau
RECIPIENT'S TIN: endíng in 782O
Digital asset name: Ethereum(ETH)
Number of units: 7.692918
Date acquired: 1/16/24
Proceeds: 54,519.98
Cost or other basís: 24,760.15
Federal income taxwithheld: 
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.írs.gov/Form1O99DA",1099,5,1099,fdc-ef8c8b7470c21e08bbed9cf5,v11-1099-DA-boxed,original,2024,fgen-28c4d88c20c202ad45c2ad9e,synthetic_programmatic_template,boxed,top,True,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
For calendar year 2022
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: BitMeadow 3079 Maple Ridge Dr Testville, IL 49141
BROKER'S TIN: 59-5499934
RECIPIENT'S name: Taylor Nguyen
RECIPIENT'S TIN: ***-**-1032
Street address (including apt. no.): 4539 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 30043
Digital asset name: USD Coin (USDC)
Number of units: 2.848287
Date acquired: June 19, 2022
Date sold or disposed: 04/05/2022
Proceeds: 118,040.33
Cost or other basis: $52,974.34
Federal income tax withheld: 
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-4b17a5581cde57722b68bdb1,v11-1099-DA-boxed,original,2022,fgen-0cf7503e22d4772252182c49,synthetic_programmatic_template,boxed,top,False,
"Form
1099-DA Digital Asset Proceeds
From Broker Transactions 2026 From: CoinHarbor Exchange Recipient's name: Wei Okafor Proceeds $34,554.14 Date sold or disposed 2023-08-09",1099,5,1099,fdc-e8acfd0247403dc3ad4b5d2c,v11-1099-DA-flat,original,2026,fgen-b9ba7cd1e8516d56e92b745f,synthetic_programmatic_template,flat,top,False,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions 2026 Copy B For
Recipient BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. CoinHarbor Exchange 1054 Oak Hollow Ct Cedar Falls, IA 32319 BROKER'S TIN 41-9815009 RECIPIENT'S name Noah K. Sato RECIPIENT'S TIN XXXXX3556 Street address (including apt. no.) 2309 Lakeshore Blvd City or town, state or province, country, and ZIP or foreign postal code Fairview, OH
32921 Account number (see instructions) XXXXX304514 Digital asset name Solana (SOL) Date acquired April 14, 2026 Date sold or disposed 2026-01-08 Cost or other basis $123,050.02 Federal income tax withheld",1099,5,1099,fdc-16d5e692a7133d374390530b,v11-1099-DA-flat,original,2026,fgen-4e655f349c9fa52264d3baff,synthetic_programmatic_template,flat,top,False,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions 2023 BROKER: CoinHarbor
Exchange Recipient's name: Wei J. Patel Number of units
32.824970 Proceeds $11,841.79",1099,5,1099,fdc-a4e9e9d6c6bb031a41090807,v11-1099-DA-flat,original,2023,fgen-27e4fe7e29124537d44118f4,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Copy B For Recipient This is important tax information and is being furnishedto the IRS.
BR0KER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no. LedgerPeak Markets 6164 Cedar Ln Brookhaven, PA 14554 BR0KER'5 TIN 94-3813364 RECIPIENT'S name Fatima J. Kowalski RECIPIENT'S TIN ***-**-7607 Street address (includingapt. no.) 2176Willow Bend Way City or town, state or province, country, and ZIP or foreígn postal code Bayside, WA 451O6 Account number (see instructions)
XXXXX263053 Digital asset name Solana (S0L) Number of units l5.250155 Date acquired October 26, 2021 Date sold or disposed 12/17/21 Proceeds $101,326.70 Cost or other basís 49,081.19 Federalincome tax withheld Department of the Treasury - Intemal Revenue Service",1099,5,1099,fdc-9dce425e82af4189232b1c5e,v11-1099-DA-flat,original,2021,fgen-76f9aa48da5a038471226be7,synthetic_programmatic_template,flat,none,True,
"VOID CORRECTED 2021 BROKER'S name, street address, city or town, state
or province, country, ZIP or foreign postal code, and telephone no. LedgerPeak Markets 1526 Lakeshore Blvd Cedar Falls, IA 69909 BROKER'S TIN 43-9801109 RECIPIENT'S name Jamie A. Kowalski RECIPIENT'S
TIN XXXXX6500 Street address (including apt. no.) 2007 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Testville, IL 98272 Digital asset name Solana (SOL) Date sold or disposed 2021-07-27 Proceeds 115,160.79 Federal income tax withheld",1099,5,1099,fdc-ff3452afc396097f1f5c30cf,v11-1099-DA-flat,original,2021,fgen-3331120530a3636aed012b12,synthetic_programmatic_template,flat,none,False,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions From: BitMeadow RECIPIENT: Kwame S. Larsen Proceeds $104,692.60 Number of units
33.000310 Cost or other
basis 17,897.69",1099,5,1099,fdc-619b90faad0c02560c6d3e1a,v11-1099-DA-flat,original,2022,fgen-dd09e9c3f3a0f8530af0f629,synthetic_programmatic_template,flat,top,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactíons For calendar year 2023 Copy B For Recipient BROKER'S name, street address, city
or town, state or province, country, ZIP or foreign posta1 code, and telephone no. LedgerPeak Markets 8l35 Granite St Riverton, WI 63904 BR0KER'S TIN11-9801587 RECIPIENT'Sname MateoR. Romero RECIPIENT'S TIN XXXXXl528 Street address (including apt. no.) 9279 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Lakewood, C0 57202 Digital asset namc Ethereum (ETH) Number of units32.286263 Date acquired 10/15/2023 Date sold or disposed April 24, 2020 Proceeds S19,373.51 Cost or other basis $44,175.49 Federal income tax withheld 0.00 Department of the Treasury - Internal Revenue 5ervice Form 1099-DA (keep for your records) www.irs.gov/Form1099DA",1099,5,1099,fdc-3260a0ecf7bbff9040ad092a,v11-1099-DA-flat,original,2023,fgen-0baf81b08c5e6f03dfbed9e5,synthetic_programmatic_template,flat,top,True,
"VOID CORRECTED Form 1099-DA Digital Asset Proceeds From Broker
Transactions For calendar year 2026 This is important tax information and is being furnished to the IRS. BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. CoinHarbor Exchange 7406 Willow Bend Way Lakewood, CO 69598 BROKER'S TIN 11-6342264 RECIPIENT'S name Morgan Patel RECIPIENT'S TIN XXXXX1505 Digital asset name Solana (SOL) Number of units 16.230758 Date acquired 2026-10-06 Date sold or disposed 07/24/2023 Proceeds 115,615.63 Cost
or other basis $18,584.88 Federal income tax withheld $0.00",1099,5,1099,fdc-4985487e303c17a390e2c28d,v11-1099-DA-flat,original,2026,fgen-e14ab5849f5fed5657070450,synthetic_programmatic_template,flat,top,False,
"For calendar year 2022 Copy B For Recipient
BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. BitMeadow 4922 Maple Ridge Dr Lakewood, CO 69183 BROKER'S TIN 67-3054624 RECIPIENT'S name Olivia B. Patel RECIPIENT'S TIN ending in 5059 Street address (including apt. no.) 6492 Prairie Ave City
or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 67192 Digital asset name Bitcoin (BTC) Number of units 10.557656 Date acquired 11/17/2022 Date sold or disposed 2019-01-12 Cost or other basis 115,583.89 Federal income tax withheld $0.00",1099,5,1099,fdc-926976af0dc10fca28c458b2,v11-1099-DA-flat,original,2022,fgen-72411e77e3f6a3762a0eeccb,synthetic_programmatic_template,flat,none,False,
"For calendar year 2023 This is important tax information and is being furnished to the IRS. BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. LedgerPeak Markets 8918 Prairie Ave Pinecrest, GA 62535 BROKER'S TIN 42-5344946 RECIPIENT'S name Jamie Moreau RECIPIENT'S TIN
***-**-4639 Street address (including apt. no.) 1017 Elm
Park Pl City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 95335 Account number (see instructions) ****768590 Digital asset name Ethereum (ETH) Number of units 24.698869 Date acquired 2022-09-09 Date sold or disposed February 21, 2020 Proceeds 79,584.74 Cost or other basis $37,793.36 Federal income tax withheld Department of the Treasury - Internal Revenue Service Form 1099-DA Digital Asset Proceeds From Broker Transactions Form 1099-DA (keep for your records) www.irs.gov/Form1099DA",1099,5,1099,fdc-b04bcd41f2997d08532e9608,v11-1099-DA-flat,original,2023,fgen-46f97cd1db130115d7852372,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-DA Digital Asset Proceeds From Broker
Transactions 2023 From: CoinHarbor Exchange RECIPIENT: Riley
Patel Cost or other basis $50,134.66 Proceeds 123,435.82 Date acquired 8/5/23 Digital asset name USD Coin (USDC)",1099,5,1099,fdc-881c9651f7a06e0cbc5145f4,v11-1099-DA-flat,original,2023,fgen-dd824ec61febaa3bd9e98b14,synthetic_programmatic_template,flat,top,False,
"Copy B For Recipient BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. CoinHarbor Exchange 1858 Cedar Ln Pinecrest, GA 67195 BROKER'S TIN 43-6528796 RECIPIENT'S name Taylor Kowalski RECIPIENT'S TIN XXXXX9192 Street address (including apt. no.) 1186 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 71433
Number of units 3.623033 Date acquired 12/10/21 Date sold or disposed 2018-03-28 Proceeds $1,481.02 Cost or other basis 21,891.84 Federal income
tax withheld Department of the Treasury - Internal Revenue Service Form 1099-DA Digital Asset Proceeds From Broker Transactions Form 1099-DA (keep for your records) www.irs.gov/Form1099DA",1099,5,1099,fdc-48ec0da82b01cb7cbaf18477,v11-1099-DA-flat,original,2021,fgen-e4536279e06cd5fc8704c8cf,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions Copy B For Recipient This is important tax information and is being furnished to the IRS. BROKER'S name, street address, city
or town, state or province, country, ZIP or foreign postal code, and telephone no. LedgerPeak Markets 5245 Prairie Ave Bayside, WA 36715 BROKER'S TIN 52-9072858 RECIPIENT'S name Fatima Walsh RECIPIENT'S TIN ending in 5430 Digital asset name Ethereum (ETH) Number of units 30.491764 Date acquired March 15, 2022 Date sold or disposed 3/16/19 Cost
or other basis 23,116.57 Federal income tax withheld $0.00",1099,5,1099,fdc-5d64e2cdc688b1b7291d5700,v11-1099-DA-flat,original,2022,fgen-609db979bf4619379f1d901f,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Form 1099-DA Dígíta1 Asset ProceedsFromBroker Transactions For calendar year 2022 This is important tax information and is being furnishedto the IR5. BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. LedgerPeak Markets 2363 Oak Hollow Ct Fairview, OH 46O59 BROKER'5 TIN 44-2717789RECIPIENT'S name Avery Adeyemí RECIPIENT'S TIN ****6302 Street address (including apt. no.) 3461 Harbor Vicw Rd City or town, state or province, country, and ZIP or foreígn postal
code Testville, IL 63293 Account number (see instructions) ****960409 Digital asset name Bitcoin (BTC)
Number of units 8.387226 Date acquired 01/21/2021 Date sold or disposcd 5/15/19 Proceeds $37,146.75 Cost or other basis 113,794.99 Federal incometax withheld Departmcnt of the Treasury - Interna1 Revenue Service Form 1099-DA (keep for your records) www.irs.gov/Form1099DA",1099,5,1099,fdc-8e2ba0aeb392a05ebe90af73,v11-1099-DA-flat,original,2022,fgen-a40a5d2ad30372757b5ddd9a,synthetic_programmatic_template,flat,top,True,
"CORRECTED (if checked) Form 1099-DA DigitalAsset Proceeds From Broker Transactions 2026 Copy B For Recipient This is important tax information and is being furnished to the IRS. BR0KER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and
telephone no. LedgerPeak Markets 841 Elm Park Pl Oak Grove, TX 66342 BROKER'S TIN 18-2611911 RECIPIENT'S namc Lena S. Larsen RECIPIENT'S TIN ***-**-4329 Street address (ínc1udíng apt. no.) 2736 Graníte St City or town, state or province,country, and ZIP or foreign postal code Bayside, WA 6118O Account number(see instructions) ending in 685955 Digital asset name Solana (SOL) Number of units
1O.506853 Proceeds $42,184.89Cost or other basis 24,218.71 Federal income tax withheld",1099,5,1099,fdc-a2160f22dbba4835bfadc03d,v11-1099-DA-flat,original,2026,fgen-1ea6a05990d848163425365a,synthetic_programmatic_template,flat,top,True,
"BROKER'S name: BitMeadow RECIPIENT: Kwame L. Patel Cost or other
basis 55,348.20 Number of units 13.889288 Date sold or disposed 12/5/21 Date
acquired 2022-08-26",1099,5,1099,fdc-b9d01370ffd4ab7c1af7df0a,v11-1099-DA-flat,original,2022,fgen-51658551ea6b11ef59be512c,synthetic_programmatic_template,flat,none,False,
"Form 1099-DA Digital Asset Proceeds From Broker Transactions 2023
| Field | Value |
| --- | --- |
| From: | CoinHarbor Exchange |
| RECIPIENT: | Hiro Nguyen |
| Proceeds | $104,225.13 |",1099,5,1099,fdc-db91fb4d3e2f17abe770a152,v11-1099-DA-markdown,original,2023,fgen-c0b7030cd1d9927cd7e7191f,synthetic_programmatic_template,markdown,top,False,
"For calendar year 2023
## Copy B For Recipient
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | CoinHarbor Exchange 7734 Maple Ridge Dr Lakewood, CO 79759 |
| BROKER'S TIN | 64-7664342 |
| RECIPIENT'S name | Lena Walsh |
| RECIPIENT'S TIN | XXX-XX-2860 |
| Street address (including apt. no.) | 5736 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 93512 |
| Digital asset name | Ethereum (ETH) |
| Number of units | 4.435392 |
| Date acquired | June 9, 2023 |
| Date sold or disposed | 7/28/22 |
| Proceeds | 81,946.56 |
| Federal income tax withheld | 0.00 |
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-e1cd73e5591c214b59847c5f,v11-1099-DA-markdown,original,2023,fgen-846ee7fd9b6ca70b141bbab8,synthetic_programmatic_template,markdown,none,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
2025
## Copy B For Recipient
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | CoinHarbor Exchange 6000 Willow Bend Way Maplewood, MN 82765 |
| BROKER'S TIN | 75-5791013 |
| RECIPIENT'S name | Riley Kowalski |
| RECIPIENT'S TIN | XXXXX2698 |
| Street address (including apt. no.) | 3849 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 84043 |
| Digital asset name | USD Coin (USDC) |
| Number of units | 10.907094 |
| Date acquired | 10/5/24 |
| Proceeds | 29,301.78 |
| Cost or other basis | $40,975.58 |
| Federal income tax withheld |  |",1099,5,1099,fdc-71ee1d53f5b8cbbb9a48e9c3,v11-1099-DA-markdown,original,2025,fgen-5caf9d2a66c26581e3bb3d69,synthetic_programmatic_template,markdown,top,False,
"## Form l099-DA
Digital AssctProcceds From Broker Transactions
For calendar year 2022
## Copy B For Recipient
This is important tax informationand is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postalcode, and telephone no. | CoinHarbor Exchange 9361 Cedar Ln Riverton, WI 86725 |
| BROKER'S TIN | 75-4O14654 |
| RECIPIENT'S name | Lena Fischer |
| RECIPIENT'S TIN | XXXXX4307 |
| Street address (induding apt. no.) | 1753 Samp1e Street |
| City or town, state or province, country, and ZIP or foreign posta1 code | Brookhaven, PA 73075 |
| Account number (see ínstructions) | XXX-XX-548082 |
| Digitalasset name | Ethereum (ETH) |
| Number of uníts | 3.529840 |
| Date acquired | 09/24/2019 |
| Date sold or dísposed | 03/25/2022 |
| Proceeds | $76,967.85|
| Cost or other basis| $36,397.12 |
## Department of the Treasury - Intemal Revenue 5ervice
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-8fc94462051704338bb228fa,v11-1099-DA-markdown,original,2022,fgen-cc10a554d159a4ea6674c2a7,synthetic_programmatic_template,markdown,top,True,
"Form 1099-DA
## Digital Asset Proceeds From Broker Transactions
## For calendar year 2021
## Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | BitMeadow 2516 Sample Street Testville, IL 52153 |
| BROKER'S TIN | 42-8893944 |
| RECIPIENT'S name | Sofia Moreau |
| RECIPIENT'S TIN | XXX-XX-4796 |
| Digital asset name | USD Coin (USDC) |
| Number of units | 35.535075 |
| Date acquired | 07/02/2021 |
| Date sold or disposed | 2020-12-12 |
| Proceeds | $1,321.58 |
| Cost or other basis | $104,472.08 |
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-c358039ea586eb139125da6c,v11-1099-DA-markdown,original,2021,fgen-b58c999f5e0bbeb84b88e41a,synthetic_programmatic_template,markdown,top,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
## For calendar year 2021
## Copy B For Recipient
## Thisis important tax information and is being furnished to the IRS.
| Field | Value |
|--- |--- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no. | LedgerPeak Markets 627 Map1e Ridge Dr Maplewood, MN 1O273 |
| BROKER'S TIN | 58-2989933 |
| RECIPIENT'S name | Lena J. Testcase |
| RECIPIENT'S TIN | ****l202 |
| Dígita1 asset name | Solana (S0L) |
| Number of units | l3.742160 |
| Date sold or disposed | 02/18/2020 |
| Proceeds | S85,598.59 |
|Cost or other basis | $47,128.88 |
| Federal income tax withheld|  |
Department of the Treasury - Intemal Revenue 5ervice
Form l099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-1eddec81c6e3c259cd8d9cca,v11-1099-DA-markdown,original,2021,fgen-daca6b276b72f6c208c6bbc0,synthetic_programmatic_template,markdown,top,True,
"VOID  CORRECTED
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
2025
Copy B For Recipient
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | LedgerPeak Markets 5426 Prairie Ave Fairview, OH 25964 |
| BROKER'S TIN | 36-6842056 |
| RECIPIENT'S name | Kwame C. Castillo |
| RECIPIENT'S TIN | XXXXX5780 |
| Street address (including apt. no.) | 2436 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 17316 |
| Number of units | 8.971300 |
| Date acquired | 2025-04-27 |
| Date sold or disposed | 2025-04-16 |
| Proceeds | $24,953.86 |
| Cost or other basis | 104,308.06 |
| Federal income tax withheld |  |",1099,5,1099,fdc-0bdd03d750bea896b38e11fb,v11-1099-DA-markdown,original,2025,fgen-5f4d2834d54577407b554e47,synthetic_programmatic_template,markdown,top,False,
"For calendar year 2025
| Fíeld | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIPor foreígn postal code, andtelephone no. | LedgerPeak Markets 4699 Map1e Ridge Dr Testville, IL 8265l |
| BROKER'S TIN | 14-7O1599O |
| RECIPIENT'S name | Casey Líndqvist |
| RECIPIENT'S TIN | ***-**-7668 |
| Accountnumber (see ínstructions) | XXX-XX-805054 |
| Digital asset name | Solana (SOL) |
| Number of units | 32.717169 |
| Date acquired | March 22, 2025 |
| Datesold or disposed | 08/09/2022 |
| Proceeds | l34,071.95 |
| Federal income tax withheld | $0.00 |
Department of the Treasury - Intemal Revenue Service",1099,5,1099,fdc-ac7865c399834365fec217bb,v11-1099-DA-markdown,original,2025,fgen-9f6e316aaa5ddf1e13b93986,synthetic_programmatic_template,markdown,none,True,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | CoinHarbor Exchange 9653 Harbor View Rd Pinecrest, GA 77921 |
| BROKER'S TIN | 39-1558418 |
| RECIPIENT'S name | Avery Okafor |
| RECIPIENT'S TIN | XXXXX6181 |
| Digital asset name | Bitcoin (BTC) |
| Number of units | 38.021953 |
| Date acquired | 2023-06-02 |
| Date sold or disposed | 02/16/2025 |
| Cost or other basis | $6,479.93 |
| Federal income tax withheld | $0.00 |",1099,5,1099,fdc-b9eaa03a9d70f1bdca298d4a,v11-1099-DA-markdown,original,2026,fgen-a44fc062eeefa852ecfed215,synthetic_programmatic_template,markdown,top,False,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
For calendar year 2023
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | LedgerPeak Markets 5563 Oak Hollow Ct Cedar Falls, IA 91799 |
| BROKER'S TIN | 49-3667653 |
| RECIPIENT'S name | Lena Walsh |
| RECIPIENT'S TIN | ending in 8710 |
| Street address (including apt. no.) | 1236 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 13136 |
| Account number (see instructions) | ****158967 |
| Digital asset name | Bitcoin (BTC) |
| Number of units | 21.404372 |
| Date acquired | 2023-06-19 |
| Date sold or disposed | 2020-05-25 |
| Proceeds | $96,043.36 |
| Cost or other basis | $11,588.44 |
| Federal income tax withheld |  |
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-8351ca998d6b866a569a1e8c,v11-1099-DA-markdown,original,2023,fgen-edd97bb440efd46ade3d875c,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
## Copy B For Recipient
| Field |Value|
| --- | --- |
| BR0KER'S namc, street address, city or town, state or province, country, ZIP or foreign postal code, and telephoneno. | BitMeadow 9768 Prairie Ave Fairview, 0H 61323 |
| BROKER'S TIN | 10-1996332 |
| RECIPIENT'S name | Kwame Testcase |
| RECIPIENT'S TIN | ***-**-7117 |
| Street address (índuding apt. no.) | 398 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 95925 |
| Digital asset name | USD Coin (USDC) |
| Number of units | l1.265747 |
| Date acquired | 04/04/2024 |
| Proceeds | 110,694.37|
| Cost or other basís | $18,494.90 |
| Federal income tax withheld |  |",1099,5,1099,fdc-be999dd4bc0da0e46f7afe44,v11-1099-DA-markdown,original,2025,fgen-a8f088d49290484bdf528ac6,synthetic_programmatic_template,markdown,none,True,
"## VOID  C0RRECTED
2022
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Fíeld | Value |
| --- | --- |
| BR0KER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no. | LedgerPeak Markets 5869 Lakeshore Blvd Pínecrest, GA 38585 |
| BROKER'S TIN | 93-5250056 |
| RECIPIENT'S namc | Kwame Moreau |
| RECIPIENT'S TIN |XXXXX0894 |
| Street address (including apt. no.) | 7308 Cedar Ln |
|City or town, stateor province, country, and ZIP or foreign posta1 code| Riverton, WI l7553 |
| Digital asset name | Bitcoin (BTC) |
| Number of units | 20.878565 |
| Date acquired | 2022-01-10 |
| Date soldor disposed | 2022-11-12 |
| Proceeds | 55,511.78 |
| Cost or other basis | $l15,052.83 |
## Department of the Treasury - Intemal Revenue 5ervice",1099,5,1099,fdc-8b137d22fdef1101b39b381a,v11-1099-DA-markdown,original,2022,fgen-3dcf7e075c8c5b9048d34a12,synthetic_programmatic_template,markdown,none,True,
"Form 1099-DA
Digital Asset Proceeds From Broker Transactions
2024
## Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | LedgerPeak Markets 7243 Cedar Ln Fairview, OH 78212 |
| BROKER'S TIN | 75-4265216 |
| RECIPIENT'S name | Casey S. Rivera |
| RECIPIENT'S TIN | XXX-XX-0780 |
| Street address (including apt. no.) | 7988 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 40234 |
| Account number (see instructions) | XXXXX548818 |
| Digital asset name | Bitcoin (BTC) |
| Number of units | 25.752034 |
| Date acquired | 08/06/2024 |
| Date sold or disposed | 01/24/2023 |
| Proceeds | 116,973.82 |
| Cost or other basis | 68,277.88 |
| Federal income tax withheld |  |",1099,5,1099,fdc-1bb98ae4f63a45a0aad14678,v11-1099-DA-markdown,original,2024,fgen-4f4171577ad982438dce883c,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
Form 1099-DA
Digital Asset Proceeds From Broker Transactions
## 2023
## Copy B For Recipient
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | CoinHarbor Exchange 2877 Harbor View Rd Bayside, WA 44074 |
| BROKER'S TIN | 32-3349567 |
| RECIPIENT'S name | Diego Brennan |
| RECIPIENT'S TIN | XXXXX8566 |
| Street address (including apt. no.) | 3331 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 93349 |
| Digital asset name | Bitcoin (BTC) |
| Number of units | 18.300611 |
| Date acquired | 5/17/22 |
| Date sold or disposed | 10/07/2022 |
| Proceeds | 70,167.73 |
| Cost or other basis | 130,854.66 |
| Federal income tax withheld | 0.00 |
Department of the Treasury - Internal Revenue Service
Form 1099-DA (keep for your records)  www.irs.gov/Form1099DA",1099,5,1099,fdc-1e90c371f888311b5284f3c3,v11-1099-DA-markdown,original,2023,fgen-76a709d9c265fc842b128116,synthetic_programmatic_template,markdown,top,False,
"## 2022
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | CoinHarbor Exchange 8241 Maple Ridge Dr Testville, IL 90537 |
| BROKER'S TIN | 52-8522766 |
| RECIPIENT'S name | Amara Nguyen |
| RECIPIENT'S TIN | ****7771 |
| Street address (including apt. no.) | 7812 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 16490 |
| Digital asset name | USD Coin (USDC) |
| Number of units | 4.562860 |
| Date sold or disposed | June 18, 2022 |
| Cost or other basis | 75,011.79 |
| Federal income tax withheld |  |
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-6c9ed3025372b890cd5dda72,v11-1099-DA-markdown,original,2022,fgen-63df77ba3afd3fc2021cbd10,synthetic_programmatic_template,markdown,none,False,
"## Form 1099-DA
## Digital Asset Proceeds From Broker Transactions
For calendar year 2024
Copy B For Recipient
| Field | Value |
| --- | --- |
| BROKER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | LedgerPeak Markets 5654 Prairie Ave Testville, IL 26558 |
| BROKER'S TIN | 38-1535546 |
| RECIPIENT'S name | Fatima Lindqvist |
| RECIPIENT'S TIN | XXXXX0984 |
| Street address (including apt. no.) | 3336 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 91191 |
| Account number (see instructions) | XXX-XX-444298 |
| Digital asset name | USD Coin (USDC) |
| Number of units | 20.998331 |
| Date sold or disposed | 10/3/24 |
| Proceeds | $10,740.96 |
| Cost or other basis | $113,611.91 |
| Federal income tax withheld |  |",1099,5,1099,fdc-c2f00bdc49f00a5395b380a9,v11-1099-DA-markdown,original,2024,fgen-480ef7ea80a52b3fe220be2b,synthetic_programmatic_template,markdown,top,False,
"Form 1099-DIV
Dividends and Distributions
For calendar year 2024
OMB No. 1545-0110
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Evergreen Brokerage Services 5351 Willow Bend Way Lakewood, CO 12600
PAYER'S TIN
36-5233452
RECIPIENT'S name
Morgan Walsh
RECIPIENT'S TIN
ending in 5551
1a Total ordinary dividends
$1,186.13
1b Qualified dividends
$4,450.51
2a Total capital gain distr.
$4,614.98
2b Unrecap. Sec. 1250 gain
3 Nondividend distributions
4 Federal income tax withheld
5 Section 199A dividends
9,431.37
7 Foreign tax paid
6,045.22
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-4737997fbbd462ecbd2edc28,v11-1099-DIV-stacked,original,2024,fgen-998ef66198d4dbc7552bd424,synthetic_programmatic_template,stacked,top,False,
"Form 1099-DIV
Dividends and Distributions
2023
OMB No. 1545-0110
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northstar Securities 5120 Elm Park Pl Maplewood, MN 44252
PAYER'S TIN
52-1259495
RECIPIENT'S name
Olivia Rivera
RECIPIENT'S TIN
***-**-7743
1a Total ordinary dividends
7,275.20
1b Qualified dividends
340.14
2a Total capital gain distr.
7,208.51
2b Unrecap. Sec. 1250 gain
0.00
4 Federal income tax withheld
5 Section 199A dividends
$7,823.55
7 Foreign tax paid
3,081.82",1099,5,1099,fdc-2192418279e0754b284d3cc6,v11-1099-DIV-stacked,original,2023,fgen-d41abbcae37b26b883fa7187,synthetic_programmatic_template,stacked,top,False,
"Form l099-DIV
Dividends and Distributions
For calendar year 2026
OMB No. l545-0110
This is important tax information and isbeing furnished to the IR5.
PAYER'5 name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and te1ephone no.
Clearwater Investing 1685 Willow Bend Way Maplewood, MN 65632
PAYER'S TIN
74-5874O27
RECIPIENT'S name
Riley Nguyen
RECIPIENT'S TIN
****2908
Street address (including apt. no.)
9537 Cedar Ln
City or town, state or province, country,and ZIP or foreign postal code
Bayside, WA 80711
Accountnumber (see instructions)
XXXXX042504
1a Total ordinary dividends
$6,128.96
1bQualified dividends
6,204.05
2a Total capital gain distr.
4,067.69
2b Unrecap. 5ec. 1250 gain
0.00
3 Nondividend distributions
4 Federal income tax withheld
$0.00
5 5ection 199A dividends
5,483.71
7 Foreign tax paid
1,361.42
12 Exempt-interest dividends
O.00",1099,5,1099,fdc-d758b3179496aa54fd5b1ef1,v11-1099-DIV-stacked,original,2026,fgen-bf8e84f58b9ce6e5ab9e44c1,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
For calendar year 2023
OMB No. 1545-0110
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Clearwater Investing 819 Harbor View Rd Riverton, WI 49752
PAYER'S TIN
27-6993265
RECIPIENT'S name
Lena Haddad
RECIPIENT'S TIN
ending in 5384
Street address (including apt. no.)
7064 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 15161
1a Total ordinary dividends
4,914.85
2a Total capital gain distr.
8,268.72
2b Unrecap. Sec. 1250 gain
0.00
3 Nondividend distributions
0.00
4 Federal income tax withheld
5 Section 199A dividends
$3,488.74
12 Exempt-interest dividends
Department of the Treasury - Internal Revenue Service
Form 1099-DIV
Dividends and Distributions
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-c626971dde2ce05dce608f78,v11-1099-DIV-stacked,original,2023,fgen-6b8e2bc44231e3ccf8f2b7cf,synthetic_programmatic_template,stacked,bottom,False,
"For calendar year 2026
OMB No. 1545-0110
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northstar Securities 8428 Lakeshore Blvd Lakewood, CO 71717
PAYER'S TIN
90-5194008
RECIPIENT'S name
Wei R. Nguyen
RECIPIENT'S TIN
XXX-XX-5153
Street address (including apt. no.)
7642 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 72788
1a Total ordinary dividends
4,507.40
1b Qualified dividends
$8,571.11
2a Total capital gain distr.
$1,122.85
3 Nondividend distributions
$0.00
4 Federal income tax withheld
5 Section 199A dividends
7,306.37
7 Foreign tax paid
4,079.03
12 Exempt-interest dividends
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DIV
Dividends and Distributions
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-8caf163bcad877aa6854aadb,v11-1099-DIV-stacked,original,2026,fgen-8cb9aa92e1724625c8d2bb6d,synthetic_programmatic_template,stacked,bottom,False,
"VOID  CORRECTED
Form 1099-DIV
Dividends and Distributions
For calendar year 2026
OMB No. 1545-0110
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Clearwater Investing 8308 Sample Street Lakewood, CO 35758
PAYER'S TIN
97-1845202
RECIPIENT'S name
Noah Adeyemi
RECIPIENT'S TIN
****9474
Street address (including apt. no.)
6736 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 53986
Account number (see instructions)
***-**-503659
1a Total ordinary dividends
$4,672.15
1b Qualified dividends
8,876.16
2a Total capital gain distr.
$9,420.75
2b Unrecap. Sec. 1250 gain
4 Federal income tax withheld
5 Section 199A dividends
$1,811.17
7 Foreign tax paid
962.26
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-a2a0f27876eff76aa9f51de6,v11-1099-DIV-stacked,original,2026,fgen-f127cd548120a3892caf8d86,synthetic_programmatic_template,stacked,top,False,
"Form 1099-DIV
Dividends and Distributions
2025
OMB No. 1545-0110
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northstar Securities 1338 Prairie Ave Fairview, OH 91782
PAYER'S TIN
61-9247822
RECIPIENT'S name
Avery A. Lindqvist
RECIPIENT'S TIN
***-**-2161
Street address (including apt. no.)
681 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 17428
1a Total ordinary dividends
3,935.31
1b Qualified dividends
836.35
2a Total capital gain distr.
5,447.78
2b Unrecap. Sec. 1250 gain
0.00
3 Nondividend distributions
4 Federal income tax withheld
5 Section 199A dividends
$250.76
12 Exempt-interest dividends
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-2ff96342beff57741261eaa9,v11-1099-DIV-stacked,original,2025,fgen-701f7e149b5c802d23bd347a,synthetic_programmatic_template,stacked,top,False,
"Form 1099-DIV Dividends and Distributions 2024
PAYER'S name:
Evergreen Brokerage Services
To:
Casey M. Adeyemi
1a Total ordinary dividends
5,533.37
7 Foreígntax paid
$817.20",1099,5,1099,fdc-d454d3b5032ca29945bbf3bf,v11-1099-DIV-stacked,original,2024,fgen-761e0284a3d9d4565150d3b6,synthetic_programmatic_template,stacked,top,True,
"Form 1099-DIVDividends and Distributions
PAYER:
Ironwood Wealth Partners
RECIPIENT:
Casey Lindqvíst
1b Qualified dividends
479.58",1099,5,1099,fdc-11d63d145797415f099a4347,v11-1099-DIV-stacked,original,2021,fgen-6329fc552a94488e34f6a9e5,synthetic_programmatic_template,stacked,top,True,
"VOID  CORRECTED
Form 1099-DIV
Dividends and Distributions
For calendar year 2026
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Summit Investments 2928 Cedar Ln Bayside, WA 71858
PAYER'S TIN
36-6050084
RECIPIENT'S name
Amara Brennan
RECIPIENT'S TIN
ending in 4299
Street address (including apt. no.)
1617 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 39343
1a Total ordinary dividends
$762.97
1b Qualified dividends
3,828.55
2b Unrecap. Sec. 1250 gain
3 Nondividend distributions
4 Federal income tax withheld
5 Section 199A dividends
7,939.58
7 Foreign tax paid
$6,254.74
12 Exempt-interest dividends
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-8fc8967251f866f9107b044c,v11-1099-DIV-stacked,original,2026,fgen-63cbdb4ac4de2e2344db4d83,synthetic_programmatic_template,stacked,top,False,
"Form 1099-DIV Dividendsand Distributions
PAYER'S name:
Summit Investments
RECIPIENT:
Hiro Larsen
7 Foreign tax paid
S2,948.47
5 5ection l99A dividends
4,931.74
1b Qualified dividends
3,306.48",1099,5,1099,fdc-d2e85c7684cb78dca829da9e,v11-1099-DIV-stacked,original,2025,fgen-23d8ba661875e31d0421df8f,synthetic_programmatic_template,stacked,top,True,
"Form 1099-DIV
Dividends and Distributions
2O23
Copy B For Recipient
This is important tax information and isbeing furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Evergreen Brokerage 5crvices 7361 Maple Ridge Dr Oak Grove, TX 61144
PAYER'S TIN
93-917O759
RECIPIENT'S name
Priya Romero
RECIPIENT'S TIN
***-**-6355
Street address (inc1uding apt. no.)
8273 Cedar Ln
City or town, state or province, country, and ZIP or foreign postalcode
Cedar Falls, IA58611
Account number (see instructions)
****4O1848
1a Total ordinary dividends
8,940.96
1b Qualified dividends
8,245.59
2a Total capital gain distr.
7,l80.90
3 Nondividend distributions
4 Federal income tax withheld
$0.00
5 5ection 199A dividends
$4,435.30
12 Exempt-interest dividends
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (kcep for your records) www.irs.gov/Form1099DIV",1099,5,1099,fdc-0697e08c23ab718a37968e11,v11-1099-DIV-stacked,original,2023,fgen-1d878c2aec625bfb53b52f9a,synthetic_programmatic_template,stacked,top,True,
"Form 1099-DIV Dividends and Distributions 2022
PAYER'S name:
Summit Investments
To:
Jordan Romero
7 Foreign tax paid
7,799.99
5 Section 199A dividends
$6,499.10
1b Qualified dividends
521.68",1099,5,1099,fdc-166221d203f949b7ed81fba7,v11-1099-DIV-stacked,original,2022,fgen-994f58d87da249352e160c02,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1099-DIV
Dividends and Distributions
2024
OMB No. 1545-0110
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Summit Investments 8207 Oak Hollow Ct Pinecrest, GA 24652
PAYER'S TIN
12-2388709
RECIPIENT'S name
Taylor Patel
RECIPIENT'S TIN
***-**-6824
Account number (see instructions)
XXX-XX-790585
1a Total ordinary dividends
$538.19
1b Qualified dividends
$9,021.35
2a Total capital gain distr.
$1,866.71
2b Unrecap. Sec. 1250 gain
$0.00
3 Nondividend distributions
4 Federal income tax withheld
5 Section 199A dividends
$2,168.09
7 Foreign tax paid
$9,300.04
12 Exempt-interest dividends
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-2d1c47640713cddc7a1c8aaa,v11-1099-DIV-stacked,original,2024,fgen-2caf802149fbdb9f94f5acd8,synthetic_programmatic_template,stacked,top,False,
"From:
Northstar Securities
RECIPIENT:
AveryPatel
7 Foreign tax paid
$6,l37.82
1a Total ordinary dividends
3,014.71
5 Section 199A dividends
8,295.66
2a Total capital gain distr.
6,668.37
Form 1099-DIV Dividends and Distributions",1099,5,1099,fdc-e04e68142a6a81092bd83987,v11-1099-DIV-stacked,original,2023,fgen-4d7834a1b6b502520bc6a978,synthetic_programmatic_template,stacked,bottom,True,
"CORRECTED (if checked)
Form 1099-DIV
Dividends and Distributions
2024
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northstar Securities 4103 Willow Bend Way Oak Grove, TX 22045
PAYER'S TIN
65-2064704
RECIPIENT'S name
Noah K. Haddad
RECIPIENT'S TIN
ending in 8276
1a Total ordinary dividends
7,297.25
2a Total capital gain distr.
$7,946.28
2b Unrecap. Sec. 1250 gain
3 Nondividend distributions
4 Federal income tax withheld
5 Section 199A dividends
4,594.17
7 Foreign tax paid
$8,427.96
12 Exempt-interest dividends
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-796db65b628c65a58b5fac25,v11-1099-DIV-stacked,original,2024,fgen-a796fbf1ffb5d762f7e78ed7,synthetic_programmatic_template,stacked,top,False,
"Form 1099-DIV
Dividends and Distributions
OMB No. 1545-0110
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Ironwood Wealth Partners 2468 Granite St Cedar Falls, IA 39350
PAYER'S TIN: 24-5084094
RECIPIENT'S name: Morgan Haddad
RECIPIENT'S TIN: XXX-XX-4125
Street address (including apt. no.): 3668 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 43822
Account number (see instructions): XXX-XX-477105
Box 1a Total ordinary dividends: $4,847.66
Box 1b Qualified dividends: $7,093.83
Box 2a Total capital gain distr.: 1,193.17
Box 2b Unrecap. Sec. 1250 gain: $0.00
Box 3 Nondividend distributions: 0.00
Box 4 Federal income tax withheld: $0.00
Box 5 Section 199A dividends: $1,824.75
Box 7 Foreign tax paid: $7,922.68
Box 12 Exempt-interest dividends: 0.00
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-b25e983a54c2bae9cac66cd8,v11-1099-DIV-boxed,original,2025,fgen-6cb092b34d2b4564423adae9,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 1099-DIV
Dividends and Distributions
2025
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Summit Investments 5034 Cedar Ln Brookhaven, PA 54179
PAYER'S TIN: 27-6849119
RECIPIENT'S name: Jordan S. Testcase
RECIPIENT'S TIN: ***-**-5472
Street address (including apt. no.): 6319 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 59442
Account number (see instructions): XXXXX169828
Line 1b Qualified dividends: 4,708.61
Line 2a Total capital gain distr.: $4,222.04
Line 2b Unrecap. Sec. 1250 gain
Line 3 Nondividend distributions: 0.00
Line 4 Federal income tax withheld: 0.00
Line 5 Section 199A dividends: 8,582.88
Line 7 Foreign tax paid: 7,722.21
Line 12 Exempt-interest dividends: $0.00",1099,5,1099,fdc-2a4df2491d0aa89028499210,v11-1099-DIV-boxed,original,2025,fgen-ce576041a3035549d09b34bc,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
2022
OMB No. 1545-0110
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Clearwater Investing 8570 Prairie Ave Oak Grove, TX 92244
PAYER'S TIN: 48-8952988
RECIPIENT'S name: Olivia Rivera
RECIPIENT'S TIN: XXX-XX-1730
Street address (including apt. no.): 4818 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 12118
Box 1a Total ordinary dividends: 5,195.30
Box 1b Qualified dividends: $7,588.39
Box 2a Total capital gain distr.: 6,812.73
Box 2b Unrecap. Sec. 1250 gain
Box 3 Nondividend distributions
Box 4 Federal income tax withheld: 0.00
Box 5 Section 199A dividends: $2,104.30
Box 7 Foreign tax paid: 5,645.80
Box 12 Exempt-interest dividends
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-49abbc52acdf5e135b1e754f,v11-1099-DIV-boxed,original,2022,fgen-dee49fa7cea016bda3f50d1c,synthetic_programmatic_template,boxed,none,False,
"Form 1099-DIV
Dividends and Distributions
For calendar year 2023
OMB No. 1545-0110
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northstar Securities 2656 Cedar Ln Riverton, WI 29922
PAYER'S TIN: 80-9098329
RECIPIENT'S name: Wei Fischer
RECIPIENT'S TIN: ****3126
Street address (including apt. no.): 6646 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 72038
2a Total capital gain distr.: 2,824.72
4 Federal income tax withheld
5 Section 199A dividends: $4,728.17
7 Foreign tax paid: 6,779.70
12 Exempt-interest dividends
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-15f8e4eccd462889f5c5c006,v11-1099-DIV-boxed,original,2023,fgen-eb90edf3b78df1e0ffa81111,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DIV Dividends and Distributions 2024
From:: Evergreen Brokerage Services
To:: Mateo Lindqvist
Line 5 Section 199A dividends: $6,775.40
Line 7 Foreign tax paid: $3,862.66
Line 2a Total capital gain distr.: 8,450.84",1099,5,1099,fdc-4a8ca32f72367f9653df649d,v11-1099-DIV-boxed,original,2024,fgen-dac0949cb2abfe1e613f28eb,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DIV Dividends and Distributions
PAYER:: Ironwood Wealth Partners
Recipient's name:: Morgan L. Moreau
Box 5 Section 199A dividends: 7,893.05
Box 7 Foreign tax paid: 1,157.31
Box 1b Qualified dividends: 3,386.65
Box 2a Total capital gain distr.: 8,070.28",1099,5,1099,fdc-1065b3d644fc2cae0cfaef99,v11-1099-DIV-boxed,original,2026,fgen-01c984d04b9fc6bc3f34b0bf,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DIV
Dividends and Distributions
For calendar year 2025
OMB No. 1545-0110
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephoneno.:Northstar Securities 9053 Granite St Oak Grove, TX 35156
PAYER'STIN: 29-8769368
RECIPIENT'S name: Jordan Nguyen
RECIPIENT'S TIN: XXX-XX-73O0
Street address (índuding apt. no.): 9592 Granite St
Cíty or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 33799
Account number (see instructions): ending in 090258
la Total ordinary dividends: 2,825.45
lb Qualified dividends: $3,287.85
2b Unrecap. Sec. 1250 gain: $0.00
3 Nondividend distributions: 0.00
4Federal income tax withheld
5 Section 199A dividends: $3,115.72
7 Foreign tax paid: $4,065.21
12 Exempt-interest dividends",1099,5,1099,fdc-e1250cc6b26b1a1325af3319,v11-1099-DIV-boxed,original,2025,fgen-9cbd301942bece9c833c512b,synthetic_programmatic_template,boxed,top,True,
"Form 1099-DIV
Dividends and Distributions
2024
OMB No. 1545-0110
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Clearwater Investing 7278 Lakeshore Blvd Bayside, WA 74836
PAYER'S TIN: 43-8052831
RECIPIENT'S name: Olivia Patel
RECIPIENT'S TIN: XXXXX3459
Account number (see instructions): ****846332
Line 1a Total ordinary dividends: $3,283.66
Line 1b Qualified dividends: 8,612.27
Line 2b Unrecap. Sec. 1250 gain
Line 3 Nondividend distributions
Line 4 Federal income tax withheld: 0.00
Line 5 Section 199A dividends: 7,039.13
Line 7 Foreign tax paid: $334.25
Line 12 Exempt-interest dividends: 0.00",1099,5,1099,fdc-44b2292b671dfdd1db21ada3,v11-1099-DIV-boxed,original,2024,fgen-d9537f406641490f6c98acd0,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DIV
Dividends and Distributions
OMB No. 1545-0110
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Evergreen Brokerage Services 7374 Oak Hollow Ct Fairview, OH 74982
PAYER'S TIN: 92-9995971
RECIPIENT'S name: Priya Sato
RECIPIENT'S TIN: ***-**-6059
Account number (see instructions): XXX-XX-555502
Box 1a Total ordinary dividends: $2,048.94
Box 1b Qualified dividends: $5,257.20
Box 2a Total capital gain distr.: 5,427.71
Box 3 Nondividend distributions: 0.00
Box 4 Federal income tax withheld
Box 5 Section 199A dividends: 7,043.43
Box 7 Foreign tax paid: 3,837.70
Box 12 Exempt-interest dividends",1099,5,1099,fdc-ed3e77477e192a936000c3a9,v11-1099-DIV-boxed,original,2024,fgen-92b2f2569887a00b5c79ef56,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DIV
Dividends and Distributions
2025
OMB No. 1545-0110
PAYER'5 name, street address, city or town,state or province, country, ZIP or foreign postal code, and telephone no.: Evergrcen Brokerage Services l877 Prairie Ave Maplewood,MN 23039
PAYER'S TIN: 23-1465569
RECIPIENT'S name: Morgan Moreau
RECIPIENT'S TIN: ****6095
Box 1a Total ordinary dividends: 3,851.24
Box 2bUnrecap. Sec. 1250 gain
Box 3 Nondividend distributions
Box 4 Federal income tax withheld: $0.00
Box 5 5ection 199A dividends: $3,603.13
Box 7 Foreign tax paíd: 7,194.66
Box 12 Exempt-interest dividends: $0.00
Dcpartment of the Treasury - Intemal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-54b69047a1bd1593d9b707ea,v11-1099-DIV-boxed,original,2025,fgen-5ec5b50def944c99b3fbc08d,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
Form 1099-DIV
Dividends and Distributions
2021
OMB No. 1545-0110
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Ironwood Wealth Partners 7209 Oak Hollow Ct Brookhaven, PA 71735
PAYER'S TIN: 12-6798101
RECIPIENT'S name: Riley Testcase
RECIPIENT'S TIN: XXXXX5049
Street address (including apt. no.): 7214 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 24161
Box 1a Total ordinary dividends: $5,705.48
Box 1b Qualified dividends: $8,451.32
Box 2a Total capital gain distr.: $3,036.13
Box 2b Unrecap. Sec. 1250 gain: $0.00
Box 3 Nondividend distributions
Box 4 Federal income tax withheld
Box 5 Section 199A dividends: $991.18
Box 12 Exempt-interest dividends",1099,5,1099,fdc-d07ad13e5d8d2e9be11ae4c1,v11-1099-DIV-boxed,original,2021,fgen-0387c5c66e82d61e31cbd7fa,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
OMB No. 1545-0110
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Ironwood Wealth Partners 2172 Maple Ridge Dr Pinecrest, GA 76120
PAYER'S TIN: 64-9720690
RECIPIENT'S name: Casey Castillo
RECIPIENT'S TIN: XXXXX5094
Street address (including apt. no.): 2681 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 54155
Account number (see instructions): ****219813
1a Total ordinary dividends: $8,521.48
1b Qualified dividends: $3,246.32
2a Total capital gain distr.: 8,291.31
2b Unrecap. Sec. 1250 gain
3 Nondividend distributions
4 Federal income tax withheld
5 Section 199A dividends: 5,467.89
7 Foreign tax paid: $5,952.25
12 Exempt-interest dividends: $0.00",1099,5,1099,fdc-04b5d744eba19b3b52571645,v11-1099-DIV-boxed,original,2022,fgen-71d2fa81eb4bbdaf9556de52,synthetic_programmatic_template,boxed,none,False,
"Form 1099-DIV
Dividends and Distributions
2021
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Clearwater Investing 1814 Harbor View Rd Cedar Falls, IA 44336
PAYER'S TIN: 46-3517561
RECIPIENT'S name: Avery A. Fischer
RECIPIENT'S TIN: XXXXX8162
Account number (see instructions): ending in 935607
1a Total ordinary dividends: 930.22
1b Qualified dividends: 7,424.93
2a Total capital gain distr.: $8,815.90
2b Unrecap. Sec. 1250 gain
3 Nondividend distributions: 0.00
5 Section 199A dividends: 7,646.72
12 Exempt-interest dividends
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-0417bdbda11a9c3a90d25910,v11-1099-DIV-boxed,original,2021,fgen-b2e4915980c7e26b061dce08,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DIV
Dividends and Distributions
For calendar year 2022
OMB No. 1545-0110
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Evergreen Brokerage Services 8588 Prairie Ave Lakewood, CO 89020
PAYER'S TIN: 32-5067454
RECIPIENT'S name: Fatima K. Adeyemi
RECIPIENT'S TIN: ***-**-5560
Street address (including apt. no.): 2811 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 77888
Account number (see instructions): ***-**-078103
Box 1a Total ordinary dividends: 8,552.60
Box 1b Qualified dividends: 8,546.37
Box 2a Total capital gain distr.: 4,131.76
Box 2b Unrecap. Sec. 1250 gain: 0.00
Box 3 Nondividend distributions
Box 4 Federal income tax withheld
Box 5 Section 199A dividends: 6,488.81
Box 12 Exempt-interest dividends
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-8ee75626efd1895a22daec0f,v11-1099-DIV-boxed,original,2022,fgen-f533dd288af01606464a7e24,synthetic_programmatic_template,boxed,top,False,
"Form 1099-DIV
Dividends and Distributions
For calendar year 2024
OMB No. 1545-0110
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Clearwater Investing 7152 Maple Ridge Dr Cedar Falls, IA 59838
PAYER'S TIN: 11-8845424
RECIPIENT'S name: Avery M. Tanaka
RECIPIENT'S TIN: XXX-XX-6004
Street address (including apt. no.): 4169 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 80374
Line 1a Total ordinary dividends: $6,241.07
Line 2a Total capital gain distr.: 9,160.47
Line 2b Unrecap. Sec. 1250 gain
Line 3 Nondividend distributions
Line 4 Federal income tax withheld: 0.00
Line 5 Section 199A dividends: $587.02
Line 7 Foreign tax paid: $4,814.96
Line 12 Exempt-interest dividends",1099,5,1099,fdc-5c28cc962159123e6b3700de,v11-1099-DIV-boxed,original,2024,fgen-2a2d09779d0505b2da908e79,synthetic_programmatic_template,boxed,top,False,
"Form 1O99-DIV Dividends and Distributions2025
From:: Summit Investments
RECIPIENT:: Alex Testcase
Line 7 Foreign tax paid: 4,411.05",1099,5,1099,fdc-be697b0647e4e50da64e3ff0,v11-1099-DIV-boxed,original,2025,fgen-ff3f2f49844d6434355357e6,synthetic_programmatic_template,boxed,top,True,
"Form 1099-DIV Dividends and Distributions OMB No. 1545-0110 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northstar Securities 8144 Oak Hollow Ct Cedar Falls, IA 11376 PAYER'S TIN 33-9128106 RECIPIENT'S name Jordan C. Adeyemi RECIPIENT'S TIN ****2156 Street address (including apt. no.) 1261 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 26242 Account number (see instructions) ***-**-374020
1a
Total ordinary dividends 7,275.55 1b Qualified dividends 2,589.19 2a Total capital gain distr. $5,319.35 2b Unrecap. Sec. 1250 gain 3 Nondividend distributions 4 Federal income tax withheld 5 Section 199A dividends 6,303.74 7 Foreign tax paid 7,051.53 12 Exempt-interest dividends $0.00",1099,5,1099,fdc-b20cbd39720bb4d9f8300958,v11-1099-DIV-flat,original,2024,fgen-b94b005a8fd2e87fd0dca0b8,synthetic_programmatic_template,flat,top,False,
"2021 OMB No. 1545-O110Copy B For Recipient This is important tax information and is being furnished to the
IRS. PAYER'S name, street address, city or town,state or province, country, ZIP or foreign postal code, and telephone no. Summit Investments 5782 Sample Street Pinecrest, GA 23929 PAYER'S TIN 93-l738721RECIPIENT'S name
Amara S.Nguyen RECIPIENT'S TIN ***-**-l569 Account number (see instructions) XXX-XX-5283O3 la Total ordinary dividends $3,303.44 1b Qualified dividends 580.59 2a Total capital gain distr. 3,737.50 2b Unrecap. 5ec. 1250 gain 3 Nondividend distributions 4 Federal income tax withheld 5 Section 199A dividends $5,363.61 7 Foreign tax paid 1,077.98 12 Exempt-interest dividends $0.00 Department of the Treasury - Intema1 Revenue Service",1099,5,1099,fdc-ad67dcecb5cd35b57bf65dec,v11-1099-DIV-flat,original,2021,fgen-92a543b158159b6da8da4309,synthetic_programmatic_template,flat,none,True,
"Form 1099-DIV Dividends and Distributions 2021 From: Evergreen Brokerage Services To: Taylor Rivera 5 Section
199A dividends 5,613.25 1b Qualified
dividends 2,127.70",1099,5,1099,fdc-b41fb174908bfd8290690337,v11-1099-DIV-flat,original,2021,fgen-1c8981feb2f0de4fdfba3467,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 1099-DIV Dividends and Distributions For calendar year 2024 OMB No. 1545-0110 Copy B For Recipient PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northstar Securities 9896 Granite St Testville, IL 29830 PAYER'S TIN 76-9702222 RECIPIENT'S name Wei Rivera RECIPIENT'S TIN ending in 0976 Street address (including apt. no.) 9724 Elm Park Pl City or
town, state or province, country,
and ZIP or foreign postal code Oak Grove, TX 93150 1a Total ordinary dividends 3,458.28 1b Qualified dividends $565.78 2a Total capital gain distr. $3,204.00 2b Unrecap. Sec. 1250 gain 3 Nondividend distributions 0.00 4 Federal income tax withheld 7 Foreign tax paid $4,857.26 12 Exempt-interest dividends",1099,5,1099,fdc-f66a542a78640d0b6ab6abc7,v11-1099-DIV-flat,original,2024,fgen-3ce1946196511674be75a2f8,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 1099-DIV Dividends and Distributions 2022 OMB No. 1545-0110 PAYER'S name,
street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Clearwater Investing 7069 Granite St Oak Grove, TX 22619 PAYER'S TIN 53-1342591 RECIPIENT'S name Diego
B. Lindqvist RECIPIENT'S TIN ending in 5639 1a Total ordinary dividends 6,095.49 1b Qualified dividends 6,545.40 2a Total capital gain distr. $7,810.77 3 Nondividend distributions 4 Federal income tax withheld 5 Section 199A dividends $8,314.24 7 Foreign tax paid $7,038.92 12 Exempt-interest dividends Department of the Treasury - Internal Revenue Service Form 1099-DIV (keep for your records) www.irs.gov/Form1099DIV",1099,5,1099,fdc-b916c2cd606acb774be1dc6a,v11-1099-DIV-flat,original,2022,fgen-e5763d88ba7ce0b8b1f9503d,synthetic_programmatic_template,flat,top,False,
"Form 1099-DIV Dividends and Distributions PAYER: Evergreen Brokerage Services
RECIPIENT: Lena A. Nguyen 2a Total capital gain distr.
1,315.00 1a Total ordinary dividends $5,476.82",1099,5,1099,fdc-98b0b1a2e682949f41710deb,v11-1099-DIV-flat,original,2024,fgen-e835f611471c612c0736ddcd,synthetic_programmatic_template,flat,top,False,
"Form
1099-DIV Dividends and Distributions 2025 Copy B For Recipient PAYER'S name, street
address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Ironwood Wealth Partners 4341 Harbor View Rd Maplewood, MN 69763 PAYER'S TIN 91-3576777 RECIPIENT'S name Noah Kowalski RECIPIENT'S TIN ****2762 Street address (including apt. no.) 2765 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 29341 1a Total ordinary dividends 4,078.72 1b Qualified dividends $1,030.75 2a Total capital gain distr. $6,554.55 2b Unrecap. Sec. 1250 gain 3 Nondividend distributions 4 Federal income tax withheld 0.00 5 Section 199A dividends 5,533.67 7 Foreign tax paid $2,353.92",1099,5,1099,fdc-0d97a94484ded1ab5a2e32a3,v11-1099-DIV-flat,original,2025,fgen-76f3852b31cea1f78b32cc99,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked)Form 1099-DIV Dividends and Distributions For
ca1endar year 2021 Copy B For Recipient PAYER'S name, streetaddress, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Ironwood Wea1th Partners 7292 Oak Hollow Ct Brookhavcn, PA 64996 PAYER'5 TIN 47-3840389 RECIPIENT'S name Hiro L. FischerRECIPIENT'S TIN XXXXX3738 Street addrcss (includingapt. no.) 7325 Lakeshore Blvd City or town, statc or provínce, country, and ZIP or foreign postal code Maplewood, MN 7583l Account number (see instructions) XXX-XX-1736O8 1a Total ordinary dividends 1,733.13 1b
Qualified dividends 4,514.O2 2a Total capital gain distr. S2,895.O5 2b Unrecap. Sec. 125O gain 3 Nondividenddistributions $0.00 4 Federal income tax withheld 5 Section 199A dividends 4,254.O6 7 Foreign tax paid $555.26 12 Exempt-interest dividends",1099,5,1099,fdc-44801d8dcdd233b6e7cab648,v11-1099-DIV-flat,original,2021,fgen-ec3136aed871d8b5a3f406b8,synthetic_programmatic_template,flat,top,True,
"Form 1099-DIV Dividends and Distributions OMB No. 1545-0110 Copy B For Rccipient
This is important tax information and is being furnished to the IR5. PAYER'S name, street address, city or town, state or province, country, ZIP or foreígn postal codc, and telephone no. Northstar Securities 6613 Lakeshore BlvdRívcrton, WI 55382 PAYER'S TIN 25-1036881 RECIPIENT'S name Amara Haddad RECIPIENT'S TIN XXXXX6444 Street address(induding apt. no.) 4610 0ak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 50426 1a Total ordinary dividends $6,020.08 1b Qualified dividends 8,081.89 2a Total capital gain distr. 8,442.87 2b Unrecap.
Sec. 1250 gain 3 Nondividend distributions4Federal income taxwithheld $0.00 5 Section l99A dividends 226.02 7 Foreígn tax paid $922.54 12 Exempt-interest dividends Department of the Treasury - Intema1 Revenue 5ervice Form 1099-DIV (keep for your records) www.irs.gov/Form1099DIV",1099,5,1099,fdc-4ed9c2158e6ae91ec72869c1,v11-1099-DIV-flat,original,2022,fgen-58c4db715f55ff6d98ac1596,synthetic_programmatic_template,flat,top,True,
"From: Northstar Securíties RECIPIENT: Hiro Fischer 7 Foreign tax paid S1,400.09 1b
Qualifieddividends 6,857.78 la
Total ordinary dividends $1,760.23 Form 1099-DIV Dividcnds and Distributions",1099,5,1099,fdc-ec28ead45fa2dc82a380aead,v11-1099-DIV-flat,original,2021,fgen-80d33c63d10ee072d606ff18,synthetic_programmatic_template,flat,bottom,True,
"☐ CORRECTED Form 1099-DIV Dividends and Distributions 2024
OMB No. 1545-0110 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northstar Securities 1135 Willow Bend Way Maplewood, MN 19785 PAYER'S TIN 54-3212618 RECIPIENT'S name Mateo Testcase RECIPIENT'S TIN ***-**-1137 Street address (including apt. no.) 8035 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 59136 1a Total ordinary dividends 3,613.15 1b Qualified dividends $4,744.90 2a Total capital gain distr. 4,661.43 2b Unrecap. Sec. 1250 gain 3 Nondividend distributions 4 Federal income tax withheld 0.00
5 Section 199A dividends 7,461.18 7 Foreign tax paid 6,155.68 12 Exempt-interest dividends Department of the Treasury - Internal Revenue Service Form 1099-DIV (keep for your records) www.irs.gov/Form1099DIV",1099,5,1099,fdc-45c15e84b8e7d17a4d22935b,v11-1099-DIV-flat,original,2024,fgen-ce5f19a6b5c0523eb816a1ff,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED For calendar year 2021 OMB No. 1545-0110 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign
postal code, and telephone no. Summit Investments 2799 Granite St Testville, IL 95728 PAYER'S TIN 90-3582507 RECIPIENT'S name Riley Walsh RECIPIENT'S TIN ****1105 Account number (see instructions) XXXXX641764
1a Total ordinary dividends 8,597.59 1b Qualified dividends 3,094.80 2a Total capital gain distr. 4,897.01 4 Federal income tax withheld 0.00 5 Section 199A dividends $6,885.47 7 Foreign tax paid $5,259.19 12 Exempt-interest dividends Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-d8fb9eee346dc8999b05a0e8,v11-1099-DIV-flat,original,2021,fgen-b987988a522e76f1181a8997,synthetic_programmatic_template,flat,none,False,
"PAYER: Clearwater Investing RECIPIENT: Amara Patel
1b Qualified dividends
4,713.33 Form 1099-DIV Dividends and Distributions 2024",1099,5,1099,fdc-d4173dbb1e91f854242baa0c,v11-1099-DIV-flat,original,2024,fgen-f8ecaa0d2f0984b78fac5db2,synthetic_programmatic_template,flat,bottom,False,
"PAYER'S name: Ironwood Wealth PartnersRecipient's name:
Lena C.
Sato 7 Foreign tax paid 1,765.96",1099,5,1099,fdc-c42e023dda1cb877b2a41c6c,v11-1099-DIV-flat,original,2025,fgen-71d4258ce78812e8b769eb53,synthetic_programmatic_template,flat,none,True,
"2022 OMB No. 1545-0110 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Evergreen Brokerage Services 1329 Prairie Ave Lakewood, CO 10396 PAYER'S TIN 44-8515310 RECIPIENT'S name Sofia Sato RECIPIENT'S TIN XXX-XX-0128 1a Total ordinary dividends $7,634.23 1b Qualified dividends $3,431.11 2a Total capital gain distr. $1,775.12 2b Unrecap. Sec. 1250 gain $0.00 3 Nondividend
distributions 5 Section 199A dividends 5,727.16 7 Foreign tax paid 3,296.64 12 Exempt-interest
dividends",1099,5,1099,fdc-c61e68a34ec1165a1d6a2d8c,v11-1099-DIV-flat,original,2022,fgen-900903fd612cdc0af361cbef,synthetic_programmatic_template,flat,none,False,
"PAYER'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no. Northstar Securities 6471 Cedar Ln
Riverton, WI 11898 PAYER'S TIN 69-6531118 RECIPIENT'S name Lena Adeyemi RECIPIENT'S TIN ****2930 Street address (including apt. no.) 1474 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 64016 1a Total ordinary dividends $5,944.09 1b Qualified dividends $2,022.74 2a Total capital gain distr. 6,806.28 2b Unrecap. Sec. 1250 gain 3 Nondividend distributions 4 Federal income tax withheld 5 Section 199A dividends 3,019.90 7 Foreign tax paid 2,142.68 12 Exempt-interest dividends $0.00 Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-89c46303656d425d988238a9,v11-1099-DIV-flat,original,2025,fgen-e2626724c3184fd4bb856fbc,synthetic_programmatic_template,flat,none,False,
"For calendar year 2023
OMB No. 1545-0110
Copy B For Recipient
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Northstar Securities 2829 Harbor View Rd Cedar Falls, IA 62562 |
| PAYER'S TIN | 19-1719155 |
| RECIPIENT'S name | Sofia C. Testcase |
| RECIPIENT'S TIN | ****3361 |
| Street address (including apt. no.) | 9686 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 18165 |
| Account number (see instructions) | XXXXX494506 |
| 1a Total ordinary dividends | 7,216.99 |
| 1b Qualified dividends | $2,007.30 |
| 2a Total capital gain distr. | 7,581.29 |
| 2b Unrecap. Sec. 1250 gain |  |
| 3 Nondividend distributions |  |
| 4 Federal income tax withheld | 0.00 |
| 5 Section 199A dividends | 2,240.72 |
| 7 Foreign tax paid | $6,680.24 |
| 12 Exempt-interest dividends | 0.00 |
## Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-dee2b32abbb40b742d36ca82,v11-1099-DIV-markdown,original,2023,fgen-c285cafd59fa81c2efbcd088,synthetic_programmatic_template,markdown,none,False,
"## Form 1099-DIV
Dividends and Distributions
## 2021
OMB No. 1545-0110
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Clearwater Investing 4608 Maple Ridge Dr Brookhaven, PA 50997 |
| PAYER'S TIN | 98-1349898 |
| RECIPIENT'S name | Morgan Patel |
| RECIPIENT'S TIN | ***-**-6707 |
| Street address (including apt. no.) | 3936 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 23766 |
| 1a Total ordinary dividends | 1,854.23 |
| 1b Qualified dividends | $1,417.79 |
| 2a Total capital gain distr. | $8,018.06 |
| 2b Unrecap. Sec. 1250 gain |  |
| 3 Nondividend distributions |  |
| 4 Federal income tax withheld |  |
| 7 Foreign tax paid | 1,024.92 |
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-0da6b69cd8cc73792e0a0efb,v11-1099-DIV-markdown,original,2021,fgen-80436b307107db96e302d23f,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
## Form 1099-DIV
Dividends and Distributions
2023
OMB No. 1545-0110
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Northstar Securities 1106 Elm Park Pl Pinecrest, GA 66155 |
| PAYER'S TIN | 34-9916141 |
| RECIPIENT'S name | Jordan Patel |
| RECIPIENT'S TIN | ending in 3466 |
| Street address (including apt. no.) | 8292 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 15161 |
| 1a Total ordinary dividends | $4,976.88 |
| 1b Qualified dividends | $8,230.14 |
| 2a Total capital gain distr. | $7,926.70 |
| 2b Unrecap. Sec. 1250 gain |  |
| 4 Federal income tax withheld |  |
| 5 Section 199A dividends | $6,744.92 |
| 12 Exempt-interest dividends |  |
Department of the Treasury - Internal Revenue Service
Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-2ef03319923615ac5645d5e2,v11-1099-DIV-markdown,original,2023,fgen-e7865c6b4ce77d56956f2244,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| PAYER: | Northstar Securities |
| To: | Taylor K. Okafor |
| 5 Section 199A dividends | $3,830.99 |
| 2a Total capital gain distr. | 6,045.84 |
| 7 Foreign tax paid | $4,982.63 |",1099,5,1099,fdc-842711f56b6ab45ae5a38ede,v11-1099-DIV-markdown,original,2022,fgen-4920fcd11ee3e4a9312580e2,synthetic_programmatic_template,markdown,none,False,
"CORRECTED (if checked)
## Form 1099-DIV
Dividends and Distributions
For calendar year 2023
OMB No. 1545-0110
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Summit Investments 7448 Lakeshore Blvd Pinecrest, GA 40185 |
| PAYER'S TIN | 79-7212205 |
| RECIPIENT'S name | Riley C. Tanaka |
| RECIPIENT'S TIN | XXXXX5394 |
| Street address (including apt. no.) | 3539 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Lakewood, CO 24265 |
| Account number (see instructions) | XXXXX648863 |
| 1a Total ordinary dividends | $8,512.91 |
| 2a Total capital gain distr. | 3,935.43 |
| 3 Nondividend distributions |  |
| 7 Foreign tax paid | 7,035.81 |
| 12 Exempt-interest dividends |  |",1099,5,1099,fdc-43a6e4e1eff9f32fd6e256b8,v11-1099-DIV-markdown,original,2023,fgen-310527bb1686e162cd30c611,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| PAYER'S name: | Evergreen Brokerage Services |
| RECIPIENT: | Jamie K. Fischer |
| 2a Total capital gain distr. | 5,969.98 |
| 1b Qualified dividends | $1,940.21 |",1099,5,1099,fdc-ff07b2c613b074584dedfc9e,v11-1099-DIV-markdown,original,2022,fgen-d85060e7d4f95b06b4381a2c,synthetic_programmatic_template,markdown,none,False,
"This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Evergreen Brokerage Services 3084 Maple Ridge Dr Oak Grove, TX 92237 |
| PAYER'S TIN | 87-2160153 |
| RECIPIENT'S name | Taylor R. Nguyen |
| RECIPIENT'S TIN | ending in 2253 |
| 1a Total ordinary dividends | $3,828.36 |
| 1b Qualified dividends | 5,148.29 |
| 2b Unrecap. Sec. 1250 gain | 0.00 |
| 3 Nondividend distributions | 0.00 |
| 4 Federal income tax withheld |  |
| 5 Section 199A dividends | $893.77 |
| 7 Foreign tax paid | $6,000.21 |
| 12 Exempt-interest dividends | $0.00 |
Form 1099-DIV
Dividends and Distributions",1099,5,1099,fdc-c071d8447fefe6ba88d3f899,v11-1099-DIV-markdown,original,2022,fgen-586a9e84824802e23e7be8a0,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-DIV Dividends and Distributions 2022
| Field | Value |
| --- | --- |
|PAYER: | Ironwood Wealth Partners |
| Recipient's name: | Lena Sato |
| la Total ordinary dividends | $431.47 |",1099,5,1099,fdc-695e2bdbc88fc629f29c4394,v11-1099-DIV-markdown,original,2022,fgen-7b704b931799e4741d2a2d91,synthetic_programmatic_template,markdown,top,True,
"Form 1099-DIV
Dividends and Distributions
## For calendar year 2023
OMB No. 1545-0110
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Clearwater Investing 6654 Elm Park Pl Riverton, WI 63328 |
| PAYER'S TIN | 94-8542329 |
| RECIPIENT'S name | Alex K. Brennan |
| RECIPIENT'S TIN | XXX-XX-7178 |
| Street address (including apt. no.) | 7015 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 33645 |
| 1a Total ordinary dividends | 984.20 |
| 1b Qualified dividends | 4,935.67 |
| 2a Total capital gain distr. | $8,348.47 |
| 2b Unrecap. Sec. 1250 gain |  |
| 3 Nondividend distributions |  |
| 4 Federal income tax withheld | $0.00 |
| 5 Section 199A dividends | $8,186.50 |
| 7 Foreign tax paid | $1,876.91 |
| 12 Exempt-interest dividends |  |",1099,5,1099,fdc-a46f0a57fe65a5077374a12c,v11-1099-DIV-markdown,original,2023,fgen-ffb6be4a58f7564b1141b119,synthetic_programmatic_template,markdown,top,False,
"## ☐ CORRECTED
## Form 1099-DIV
Dividends andDistributions
For calcndar year 2021
## This is importanttax information and is being fumished to the IR5.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, cityor town, state or province, country, ZIP or foreign postal code, and telephone no. | Northstar Securities 1632 Willow Bend Way Fairview, OH 51745 |
| PAYER'S TIN | 5O-8659468 |
| RECIPIENT'S name | Avery Nguyen |
| RECIPIENT'S TIN | ***-**-6888 |
| Account numbcr (see instructions) | ****97O340 |
| 1a Total ordinary dividends |$5,0l0.38 |
| 1b Qualified dividends | 7,224.39 |
| 2a Total capital gain distr. | 2,181.13 |
| 2b Unrecap. Sec. 1250 gain |  |
| 3 Nondividend distributions |  |
| 4 Federal income tax withheld | 0.00 |
| 5 Section 199A dividends | 1,764.00|
| 7 Foreign tax paid | $8,607.06 |
| 12 Exempt-interest dividends | 0.00 |
Departmentof the Treasury - Intemal Revenue Service
Form l099-DIV (keep for your records)  www.irs.gov/Forml099DIV",1099,5,1099,fdc-a6a076c173c1768f4de65e80,v11-1099-DIV-markdown,original,2021,fgen-c16dfd84ad92684f0ee94dab,synthetic_programmatic_template,markdown,top,True,
"| Field | Value |
| --- | --- |
| From: | Evergreen Brokerage Services |
| Recipient's name: | Fatima Tanaka |
| 1b Qualified dividends | 9,155.83 |
| 7 Foreign tax paid | 5,658.64 |
| 2a Total capital gain distr. | 7,518.13 |",1099,5,1099,fdc-fca3b3cacbc67e01fda98293,v11-1099-DIV-markdown,original,2025,fgen-6093ac18b2636779de4f2b52,synthetic_programmatic_template,markdown,none,False,
"Form 1099-DIV
## Dividends and Distributions
## 2021
Copy B For Recipient
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Northstar Securities 2437 Cedar Ln Pinecrest, GA 39901 |
| PAYER'S TIN | 64-1840159 |
| RECIPIENT'S name | Amara S. Fischer |
| RECIPIENT'S TIN | XXX-XX-2031 |
| Street address (including apt. no.) | 4133 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 53016 |
| 1a Total ordinary dividends | $2,327.17 |
| 1b Qualified dividends | $4,034.80 |
| 2a Total capital gain distr. | 1,856.24 |
| 2b Unrecap. Sec. 1250 gain |  |
| 3 Nondividend distributions |  |
| 4 Federal income tax withheld | $0.00 |
| 7 Foreign tax paid | $2,820.55 |
| 12 Exempt-interest dividends | $0.00 |
Department of the Treasury - Internal Revenue Service
## Form 1099-DIV (keep for your records)  www.irs.gov/Form1099DIV",1099,5,1099,fdc-7d734d12385338bbdf985a06,v11-1099-DIV-markdown,original,2021,fgen-5694290e438de53f14f8e743,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| PAYER'S name: | Northstar Securities |
| To: | Fatima Lindqvist |
| 5 Section 199A dividends | $3,679.63 |
| 2a Total capital gain distr. | $2,165.48 |
| 1a Total ordinary dividends | 3,464.19 |
| 1b Qualified dividends | 6,295.25 |
## Form 1099-DIV Dividends and Distributions 2023",1099,5,1099,fdc-3a02f1fa9759f80d0ee26980,v11-1099-DIV-markdown,original,2023,fgen-3ecfed916be2d6b0dd941165,synthetic_programmatic_template,markdown,bottom,False,
"CORRECTED (if checked)
## Form 1099-DIV
Dividends and Distributions
For calendar year 2025
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Ironwood Wealth Partners 8969 Granite St Riverton, WI 66608 |
| PAYER'S TIN | 15-9874311 |
| RECIPIENT'S name | Jamie S. Walsh |
| RECIPIENT'S TIN | ***-**-2177 |
| Street address (including apt. no.) | 6761 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 80208 |
| 1a Total ordinary dividends | $1,937.82 |
| 1b Qualified dividends | $2,304.83 |
| 2a Total capital gain distr. | $8,432.76 |
| 2b Unrecap. Sec. 1250 gain | $0.00 |
| 3 Nondividend distributions |  |
| 4 Federal income tax withheld |  |
| 7 Foreign tax paid | 1,602.34 |
| 12 Exempt-interest dividends | 0.00 |",1099,5,1099,fdc-344dfa56118ab159624ca895,v11-1099-DIV-markdown,original,2025,fgen-77009d24752f3f99aecd5ab1,synthetic_programmatic_template,markdown,top,False,
"Form 1099-DIV
## Dividends and Distributions
## 2026
OMB No. 1545-0110
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Northstar Securities 7156 Prairie Ave Pinecrest, GA 21028 |
| PAYER'S TIN | 71-7605451 |
| RECIPIENT'S name | Casey Moreau |
| RECIPIENT'S TIN | ***-**-4495 |
| Street address (including apt. no.) | 94 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 60342 |
| Account number (see instructions) | ***-**-136384 |
| 1a Total ordinary dividends | 7,433.70 |
| 1b Qualified dividends | $4,285.64 |
| 2a Total capital gain distr. | $210.67 |
| 2b Unrecap. Sec. 1250 gain | $0.00 |
| 4 Federal income tax withheld |  |
| 5 Section 199A dividends | $7,213.68 |
| 7 Foreign tax paid | $2,747.33 |
| 12 Exempt-interest dividends | 0.00 |",1099,5,1099,fdc-8fd4e14a6ee5338aebc6abed,v11-1099-DIV-markdown,original,2026,fgen-ae6a776874bed758fb3e0b3f,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
For calendar year 2025
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Ironwood Wealth Partners 5582 Cedar Ln Testville, IL 31106 |
| PAYER'S TIN | 83-7075760 |
| RECIPIENT'S name | Jordan Okafor |
| RECIPIENT'S TIN | XXX-XX-2049 |
| Street address (including apt. no.) | 6819 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 12869 |
| 1a Total ordinary dividends | 8,989.33 |
| 1b Qualified dividends | 7,790.73 |
| 2a Total capital gain distr. | 8,481.89 |
| 2b Unrecap. Sec. 1250 gain | $0.00 |
| 3 Nondividend distributions |  |
| 4 Federal income tax withheld |  |
| 5 Section 199A dividends | 7,971.05 |
| 7 Foreign tax paid | 5,984.31 |
| 12 Exempt-interest dividends |  |
Form 1099-DIV
## Dividends and Distributions",1099,5,1099,fdc-a17f6e7e4be0f9aa9af40163,v11-1099-DIV-markdown,original,2025,fgen-b88d1adea0ac08141d89195b,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-G
Certain Government Payments
OMB No. 1545-0120
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Illinois Department of Employment Security 7412 Lakeshore Blvd Maplewood, MN 29493
PAYER'S TIN
77-1821557
RECIPIENT'S name
Casey Okafor
RECIPIENT'S TIN
****9356
Account number (see instructions)
XXX-XX-212917
1 Unemployment compensation
104,936.03
2 State or local income tax refunds, credits, or offsets
9,160.47
3 Box 2 amount is for tax year
2021
4 Federal income tax withheld
5,201.98
6 Taxable grants
$0.00
10a State
IL 2760914
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-956bced4700d9249f0a544ae,v11-1099-G-stacked,original,2021,fgen-687aded4da00c9967ac16307,synthetic_programmatic_template,stacked,top,False,
"Form 1099-G Certain Government Payments 2023
PAYER:
State of Ohio Department of Taxation
RECIPIENT:
Diego Patel
3 Box2 amount is for tax year
2023
10a State
MN 8082183
1 Uncmployment compensatíon
101,860.91",1099,5,1099,fdc-4fd1fa36bacf7061ad978f0a,v11-1099-G-stacked,original,2023,fgen-47edfc6ac69c0c66c388bbd7,synthetic_programmatic_template,stacked,top,True,
"VOID  CORRECTED
Form 1099-G
Certain Government Payments
For calendar year 2024
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
State of Ohio Department of Taxation 3207 Lakeshore Blvd Brookhaven, PA 11997
PAYER'S TIN
91-6645521
RECIPIENT'S name
Jordan Patel
RECIPIENT'S TIN
***-**-7957
Street address (including apt. no.)
8405 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 71704
1 Unemployment compensation
81,967.05
2 State or local income tax refunds, credits, or offsets
$6,026.96
4 Federal income tax withheld
$5,191.34
6 Taxable grants
0.00
10a State
OH 6372862
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-e3a7caf004f7345502bb7ef3,v11-1099-G-stacked,original,2024,fgen-de1c651bdf8f0bb4dfc5c344,synthetic_programmatic_template,stacked,top,False,
"Form 1099-G
Certain Government Payments
For calendar year 2024
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Wisconsin Department of Revenue 8536 Lakeshore Blvd Fairview, OH 61037
PAYER'S TIN
30-6291646
RECIPIENT'S name
Amara L. Testcase
RECIPIENT'S TIN
****9724
Street address (including apt. no.)
3877 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 13865
2 State or local income tax refunds, credits, or offsets
$788.06
3 Box 2 amount is for tax year
2024
4 Federal income tax withheld
6,060.38
6 Taxable grants
7 Agriculture payments
10a State
TX 7984814
11 State income tax withheld
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-3230e0ebd546adb31c7ca4d6,v11-1099-G-stacked,original,2024,fgen-26a4b58124d0092d9461fa1a,synthetic_programmatic_template,stacked,top,False,
"Form 1099-G Certain Government Payments
From:
State of Ohio Department of Taxation
To:
Taylor Brennan
1 Unemployment compensation
$126,910.63
4 Federal income tax withheld
1,184.21",1099,5,1099,fdc-b26e410944f40db34cec3f5f,v11-1099-G-stacked,original,2026,fgen-c3ab146f1384144a967a66a4,synthetic_programmatic_template,stacked,top,False,
"PAYER'S name:
State of Ohio Department of Taxation
Recipient's name:
Casey Tanaka
4 Federal income tax withheld
2,587.61
2 State or local income tax refunds, credits, or offsets
7,207.38
1 Unemployment compensation
$123,921.48
3 Box 2 amount is for tax year
2026
Form 1099-G Certain Government Payments 2026",1099,5,1099,fdc-71dccbeb06a542e52db77e66,v11-1099-G-stacked,original,2026,fgen-e34e15a718aab092edbb0e42,synthetic_programmatic_template,stacked,bottom,False,
"Form 1099-G Certain Government Payments 2024
From:
State of Ohio Department of Taxation
Recipient's name:
Lena Romero
3 Box 2 amount is for tax year
2024
1 Unemployment compensation
$48,355.66",1099,5,1099,fdc-4c840303e589690878c232cb,v11-1099-G-stacked,original,2024,fgen-140a4a036b170bf461ee4921,synthetic_programmatic_template,stacked,top,False,
"Form 1099-G
Certain Government Payments
2022
OMB No. 1545-0120
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
State of Ohio Department of Taxation 3279 Harbor View Rd Riverton, WI 69044
PAYER'S TIN
49-9213510
RECIPIENT'S name
Morgan J. Walsh
RECIPIENT'S TIN
ending in 6754
Account number (see instructions)
XXXXX394772
1 Unemployment compensation
55,352.39
2 State or local income tax refunds, credits, or offsets
$8,842.10
3 Box 2 amount is for tax year
2022
6 Taxable grants
$0.00
7 Agriculture payments
$0.00
11 State income tax withheld
0.00",1099,5,1099,fdc-f007612f07e65818d5fad467,v11-1099-G-stacked,original,2022,fgen-03f0344c6a013f5628b2eaba,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1099-G
Certain Government Payments
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
State of Ohio Department of Taxation 4146 Lakeshore Blvd Brookhaven, PA 25994
PAYER'S TIN
96-6398249
RECIPIENT'S name
Morgan Fischer
RECIPIENT'S TIN
XXX-XX-0083
Street address (including apt. no.)
1328 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 37349
Account number (see instructions)
****453619
1 Unemployment compensation
$44,199.92
2 State or local income tax refunds, credits, or offsets
3,638.75
4 Federal income tax withheld
3,170.39
6 Taxable grants
7 Agriculture payments
11 State income tax withheld
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-14c39c3af394cb90e804b7d7,v11-1099-G-stacked,original,2022,fgen-a17f7ddadb9dc066dbfc9392,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2023
OMB No. 1545-0120
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Wisconsin Department of Revenue 8040 Cedar Ln Cedar Falls, IA 48199
PAYER'S TIN
68-2084260
RECIPIENT'S name
Taylor Romero
RECIPIENT'S TIN
***-**-1853
Street address (including apt. no.)
4091 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 24781
1 Unemployment compensation
86,016.66
4 Federal income tax withheld
$384.94
6 Taxable grants
$0.00
7 Agriculture payments
0.00
10a State
CO 2999477
11 State income tax withheld",1099,5,1099,fdc-7e598477afd8f1d26e838b78,v11-1099-G-stacked,original,2023,fgen-fb30b0ab3113d068472e684b,synthetic_programmatic_template,stacked,none,False,
"☐ CORRECTED
Form 1099-G
Certain Government Payments
For calendar year 2023
OMB No. 1545-0120
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Wisconsin Department of Revenue 6108 Maple Ridge Dr Cedar Falls, IA 14134
PAYER'S TIN
62-8827077
RECIPIENT'S name
Lena Nguyen
RECIPIENT'S TIN
***-**-7797
1 Unemployment compensation
$42,227.04
2 State or local income tax refunds, credits, or offsets
$2,060.13
3 Box 2 amount is for tax year
2023
4 Federal income tax withheld
7,757.77
6 Taxable grants
7 Agriculture payments
10a State
CO 7813922
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-fe6589ad8f296378a594c26e,v11-1099-G-stacked,original,2023,fgen-2d5fc432bd2ea3e1eae094f1,synthetic_programmatic_template,stacked,top,False,
"Form 1099-G
Certain Government Payments
For calendar year 2024
OMB No. 1545-0120
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Wisconsin Department of Revenue 4010 Elm Park Pl Cedar Falls, IA 45272
PAYER'S TIN
43-6139596
RECIPIENT'S name
Diego Testcase
RECIPIENT'S TIN
XXXXX4325
Street address (including apt. no.)
3261 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 20477
1 Unemployment compensation
$109,024.75
4 Federal income tax withheld
2,587.77
6 Taxable grants
7 Agriculture payments
0.00
10a State
IL 3781762
11 State income tax withheld
$0.00",1099,5,1099,fdc-2f8e2410366b9bb078d1095c,v11-1099-G-stacked,original,2024,fgen-5be013a25589eb9dcec33aae,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1099-G
Certain Government Payments
2026
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Wisconsin Department of Revenue 5609 Willow Bend Way Riverton, WI 33327
PAYER'S TIN
75-5581366
RECIPIENT'S name
Lena B. Moreau
RECIPIENT'S TIN
XXX-XX-2578
Street address (including apt. no.)
8802 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 96104
Account number (see instructions)
XXXXX282839
1 Unemployment compensation
$118,656.12
2 State or local income tax refunds, credits, or offsets
7,051.72
3 Box 2 amount is for tax year
2026
6 Taxable grants
0.00
7 Agriculture payments
10a State
PA 9773715
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-33de3c7683dbe9a9b2dc8b2d,v11-1099-G-stacked,original,2026,fgen-3857a6a8c068fc5efbb60e06,synthetic_programmatic_template,stacked,top,False,
"Form 1099-G
Certain Government Payments
For calendar year 2024
This is important tax information and is bcing fumished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Illinois Department of Employment Security 2817 Willow Bend Way Cedar Falls, IA 95028
PAYER'S TIN
88-4390998
RECIPIENT'S name
Morgan K. Patel
RECIPIENT'S TIN
XXX-XX-3693
Account number (see ínstructions)
XXX-XX-0027l2
l Unemploymentcompensatíon
$98,202.43
2 State orlocal income tax refunds,credits, or offsets
$4,158.62
3 Box 2 amount is for tax year
2024
4 Federal income tax withheld
$6,341.32
6 Taxable grants
10a State
IL 8746999
Department of the Treasury - Intemal Revenue Service
Form 1O99-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-d9d4bedcd710119ab73049a3,v11-1099-G-stacked,original,2024,fgen-3874b1c83411f73eef15a025,synthetic_programmatic_template,stacked,top,True,
"Form 1099-G Certain Government Payments
From:
State of Ohio Department of Taxation
RECIPIENT:
Fatima L. Sato
1 Unemployment compensation
$30,236.86
2 State or local income tax refunds, credits, or offsets
1,649.00",1099,5,1099,fdc-ce767192602d04e14b8c50d8,v11-1099-G-stacked,original,2022,fgen-7fa66a4fa1d214d643e7ea5a,synthetic_programmatic_template,stacked,top,False,
"PAYER:
Illinois Department of Employment Security
To:
Avery Brennan
4Federal income tax withheld
$5,714.26
2 State or local income tax refunds, credits, or offsets
$5,227.95
10a 5tate
TX 3308581
Form 1099-G Certain Govemment Payments 2025",1099,5,1099,fdc-5649d7b8c70d570a4d68eb76,v11-1099-G-stacked,original,2025,fgen-3cfa1a45d5e1f618f6e96bd3,synthetic_programmatic_template,stacked,bottom,True,
"VOID  CORRECTED
Form 1099-G
Certain Government Payments
2022
OMB No. 1545-0120
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Wisconsin Department of Revenue 3033 Maple Ridge Dr Bayside, WA 17176
PAYER'S TIN      90-6284536
RECIPIENT'S name      Morgan Haddad
RECIPIENT'S TIN  ending in 3475
Street address (including apt. no.)  448 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 82020
Account number (see instructions)  XXX-XX-921419
1 Unemployment compensation  50,874.50
2 State or local income tax refunds, credits, or offsets      $408.35
4 Federal income tax withheld $1,782.86
7 Agriculture payments      0.00
10a State OH 8759715
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-2a0f9dd13a747cf8365acf55,v11-1099-G-inline,original,2022,fgen-60368ca37666e364d4c1f4f2,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1099-G
Certain Government Payments
For calendar year 2025
OMB No. 1545-0120
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Illinois Department of Employment Security 639 Willow Bend Way Lakewood, CO 82555
PAYER'S TIN  69-5408974
RECIPIENT'S name Taylor Rivera
RECIPIENT'S TIN      ***-**-7013
Street address (including apt. no.) 1700 Sample Street
City or town, state or province, country, and ZIP or foreign postal code      Brookhaven, PA 81507
1 Unemployment compensation  $66,392.11
3 Box 2 amount is for tax year      2025
4 Federal income tax withheld $3,539.86
7 Agriculture payments
10a State   OH 9090056
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-3554260826b7f6232eacc8fa,v11-1099-G-inline,original,2025,fgen-4d7bc78650e5b3d56f34d366,synthetic_programmatic_template,inline,top,False,
"Form 1099-G Certain Government Payments
PAYER:   Illinois Department of Employment Security
RECIPIENT:      Sofia Fischer
3 Box 2 amount is for tax year 2023
4 Federal income tax withheld 8,285.14",1099,5,1099,fdc-691c12d5b9192b6630b17c54,v11-1099-G-inline,original,2023,fgen-fd97146c553f918358c685c8,synthetic_programmatic_template,inline,top,False,
"Form 1099-G
Certain Government Payments
2021
0MB No. 1545-0120
Copy B For Recipient
PAYER'5 name, street address, cíty or town, state or province, country, ZIP or foreign postal code, and telephone no.      State of Ohio Department of Taxation4534 Harbor View Rd Fairview, OH 545O3
PAYER'S TIN 88-3853690
RECIPIENT'S name      Lena Adeyemi
RECIPIENT'S TIN ***-**-953l
Street address (induding apt. no.) 9167Harbor Vicw Rd
City or town, state or province, country, andZIP or forcign postal code Cedar Falls, IA 43087
1 Unemployment compensation  S54,300.13
2 State or local income tax refunds, credits, or offsets $7,745.29
3 Box 2 amount is fortax year      2021
4 Federal income tax withheld   9,104.62
6 Taxab1e grants
7 Agricu1ture payments     $0.00
11 5tate income tax withheld
Department of the Treasury - Internal Revenue 5ervice
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-d2890687bcd6cb6863d9a447,v11-1099-G-inline,original,2021,fgen-9a34fcb628585daf130c7869,synthetic_programmatic_template,inline,top,True,
"For calendar year 2024
OMB No. 1545-0120
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Illinois Department of Employment Security 5209 Sample Street Lakewood, CO 97890
PAYER'S TIN      19-2111209
RECIPIENT'S name Taylor Sato
RECIPIENT'S TIN ****5564
Street address (including apt. no.)      6667 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code  Fairview, OH 48894
Account number (see instructions) ending in 309444
1 Unemployment compensation $8,839.02
2 State or local income tax refunds, credits, or offsets      1,333.29
3 Box 2 amount is for tax year  2024
4 Federal income tax withheld 7,520.94
6 Taxable grants
7 Agriculture payments      $0.00
10a State CO 5508014
11 State income tax withheld      0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-6089af525014e42c51044a4f,v11-1099-G-inline,original,2024,fgen-4a26451e847041c6bfafddf5,synthetic_programmatic_template,inline,none,False,
"Form 1099-G
Certain Government Payments
OMB No. 1545-0120
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Wisconsin Department of Revenue 5555 Cedar Ln Riverton, WI 33957
PAYER'S TIN  40-9654978
RECIPIENT'S name      Jordan E. Nguyen
RECIPIENT'S TIN  ending in 7043
Street address (including apt. no.)   2083 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code      Riverton, WI 39383
1 Unemployment compensation 27,598.39
2 State or local income tax refunds, credits, or offsets  3,602.37
3 Box 2 amount is for tax year 2022
4 Federal income tax withheld 2,018.90
6 Taxable grants   0.00
7 Agriculture payments   $0.00
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-b62cdff5ce6103adfcbdfebc,v11-1099-G-inline,original,2022,fgen-8dd69c9bc5bfd285bfe23c66,synthetic_programmatic_template,inline,top,False,
"From: State of Ohio Department of Taxation
RECIPIENT: Jamie Moreau
10a State OH 6868935
1 Unemp1oyment compensation$57,014.00",1099,5,1099,fdc-55e1a56a48ebb01b607a33ae,v11-1099-G-inline,original,2025,fgen-a35d27c7a8cf25bca3148a48,synthetic_programmatic_template,inline,none,True,
"Form 1099-G Certain Government Payments 2021
PAYER: Illinois Department of Employment Security
RECIPIENT: Wei Tanaka
10a State PA 8348297",1099,5,1099,fdc-db25dacf9f6354be4c7da8f9,v11-1099-G-inline,original,2021,fgen-7f52387da382b1ea89dcf869,synthetic_programmatic_template,inline,top,False,
"Form 1099-G
Certain Government Payments
2022
OMB No. 1545-0120
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Illinois Department of Employment Security 6955 Granite St Lakewood, CO 95226
PAYER'S TIN 59-2830071
RECIPIENT'S name Taylor B. Adeyemi
RECIPIENT'S TIN ****8703
Account number (see instructions)      XXX-XX-235919
1 Unemployment compensation 87,952.35
2 State or local income tax refunds, credits, or offsets      $7,208.49
3 Box 2 amount is for tax year      2022
4 Federal income tax withheld  $9,201.46
6 Taxable grants      $0.00
7 Agriculture payments
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-3ef741fc4940d9bcde7b911f,v11-1099-G-inline,original,2022,fgen-42e13ef648bc621c3be0b7b9,synthetic_programmatic_template,inline,top,False,
"Form 1099-G
Certain Government Payments
2021
OMB No. 1545-0120
PAYER'S name, street address, city or town, state or province,country, ZIP orforeígn postal code, and telephone no. Illinois Department of Employment Security 7046 Lakeshore Blvd Pinecrest, GA 40564
PAYER'5 TIN   60-2017386
RECIPIENT'S name Alex M. Brennan
RECIPIENT'S TIN XXX-XX-6642
Streetaddress (including apt. no.)   391 Elm Park Pl
City or town, state or province, country, and ZIP or foreign posta1 code Fairview, OH 26883
1 Unemployment compensation   53,856.12
2 State or local income tax refunds, credits, oroffsets   $3,181.74
4 Federal íncome tax withheld  6,647.15
6 Taxable grants
7 Agriculture payments
1Oa Statc TX 2592821
11 State income tax withheld",1099,5,1099,fdc-5a24d07564d77df73a2bf7e7,v11-1099-G-inline,original,2021,fgen-cbea55a1070fdf2350f16666,synthetic_programmatic_template,inline,top,True,
"Form 1099-G Certain Govemment Payments
PAYER'S name:      Illinois Department of Employment Security
RECIPIENT:Riley Testcase
4 Federal incomc tax withhe1d      344.24
l Unemployment compensation $4,586.00
2 State or local income tax refunds, credits, or offsets  5,018.99",1099,5,1099,fdc-121835fe604ac000138189a4,v11-1099-G-inline,original,2024,fgen-5f579968dcabc657473df829,synthetic_programmatic_template,inline,top,True,
"VOID  CORRECTED
Form 1099-G
Certain Government Payments
For calendar year 2025
OMB No. 1545-0120
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Illinois Department of Employment Security 8697 Elm Park Pl Oak Grove, TX 13376
PAYER'S TIN   39-1228485
RECIPIENT'S name   Taylor M. Okafor
RECIPIENT'S TIN XXXXX1471
Account number (see instructions) ***-**-975827
2 State or local income tax refunds, credits, or offsets 7,387.26
3 Box 2 amount is for tax year      2025
4 Federal income tax withheld  1,766.79
6 Taxable grants
7 Agriculture payments      0.00
10a State IL 5342614
11 State income tax withheld 0.00
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-47151e8e1515720997146efc,v11-1099-G-inline,original,2025,fgen-44cbd1aa32ddb79f66917da1,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1099-G
Certain Government Payments
2021
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Illinois Department of Employment Security 6937 Harbor View Rd Cedar Falls, IA 66766
PAYER'S TIN  68-2827115
RECIPIENT'S name Riley K. Fischer
RECIPIENT'S TIN  ****4754
1 Unemployment compensation  $93,498.82
2 State or local income tax refunds, credits, or offsets 7,502.63
4 Federal income tax withheld 3,021.25
6 Taxable grants
7 Agriculture payments
10a State OH 1861143
11 State income tax withheld",1099,5,1099,fdc-ca2c0f7ceec940c652a481e3,v11-1099-G-inline,original,2021,fgen-c2691587c8ecb76eb6ee171c,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
For calendar year 2023
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Wisconsin Department of Revenue 7494 Cedar Ln Cedar Falls, IA 97236
PAYER'S TIN      32-9422199
RECIPIENT'S name   Taylor Rivera
RECIPIENT'S TIN XXXXX1138
Street address (including apt. no.) 7075 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code   Fairview, OH 91008
1 Unemployment compensation      42,184.77
2 State or local income tax refunds, credits, or offsets      2,887.28
3 Box 2 amount is for tax year  2023
4 Federal income tax withheld   $9,378.73
6 Taxable grants   0.00
7 Agriculture payments      $0.00
10a State WI 3301204
11 State income tax withheld $0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-96f253ae50b46cbd905896ee,v11-1099-G-inline,original,2023,fgen-4918779c44d1a3d2700b6ad5,synthetic_programmatic_template,inline,none,False,
"☐ CORRECTED
Form 1099-G
Certain Government Payments
2026
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.      Illinois Department of Employment Security 3340 Cedar Ln Oak Grove, TX 77114
PAYER'S TIN   85-9816580
RECIPIENT'S name   Alex Rivera
RECIPIENT'S TIN   XXXXX7798
Street address (including apt. no.) 8762 Granite St
City or town, state or province, country, and ZIP or foreign postal code      Oak Grove, TX 42031
Account number (see instructions)  XXX-XX-543438
1 Unemployment compensation 103,475.52
2 State or local income tax refunds, credits, or offsets 8,772.17
3 Box 2 amount is for tax year  2026
4 Federal income tax withheld  5,296.05
6 Taxable grants
7 Agriculture payments
10a State TX 7578203
11 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-c5e53478f3267bcb2f3b3384,v11-1099-G-inline,original,2026,fgen-15c1e08d1b48defae8961af4,synthetic_programmatic_template,inline,top,False,
"Form 1099-G
Certaín Government Payments
For calendar year 2O25
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIPor foreign postal code, and telephone no. State of Ohio Department of Taxation 6977 Prairie Ave Lakewood, CO 25538
PAYER'S TIN  76-7757l06
RECIPIENT'S name Sofia Romero
RECIPIENT'S TIN ****8298
1 Unemploymcnt compensation $20,421.84
4 Federal income tax withheld $7,848.l4
7 Agriculture payments
10aState IL 3231954
11 State incometax withheld  $0.00
Department of the Treasury - Interna1 Revenue 5ervice
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-034cf3a64f5bd3664391b9d3,v11-1099-G-inline,original,2025,fgen-bdbf10e4b8b797fb2813814c,synthetic_programmatic_template,inline,top,True,
"CORRECTED (if checked) Form 1099-G Certain Government
Payments For calendar year 2026 OMB No. 1545-0120 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Wisconsin Department of Revenue 7937 Sample Street Fairview, OH 62625 PAYER'S TIN 56-5797787 RECIPIENT'S name Wei B. Moreau RECIPIENT'S TIN XXXXX8391 1 Unemployment compensation 123,651.54 2 State or local income tax refunds, credits, or offsets 1,892.62 3 Box 2 amount is for tax year 2026 4 Federal income tax withheld $5,455.95 6 Taxable grants 0.00 7 Agriculture payments 10a State PA 9703761 11 State
income tax withheld Department of the Treasury - Internal Revenue Service Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-0ff8368e69c9fdbc1c301bb2,v11-1099-G-flat,original,2026,fgen-7ee806f10a42767db2e9383b,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED OMB No. 1545-0120 Copy B For Recipient This is important tax
information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. State of Ohio Department of Taxation 7320 Granite St Lakewood, CO 15830 PAYER'S TIN 10-3104855 RECIPIENT'S name Lena Nguyen RECIPIENT'S TIN ending in 6820 Street address (including apt. no.) 9673 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 74179 1 Unemployment compensation 113,604.96 2 State or local income tax refunds,
credits, or offsets 3,384.93 3 Box 2 amount is for tax year 2021 4 Federal income tax withheld 7,312.75 6 Taxable grants 10a State MN 5528329 11 State income tax withheld 0.00 Form 1099-G Certain Government Payments",1099,5,1099,fdc-b54a6921d8a3d07ab84764ba,v11-1099-G-flat,original,2021,fgen-dceee17396c0d827d9d6ceeb,synthetic_programmatic_template,flat,bottom,False,
"PAYER: Illinois Department of Employment Security Recipient's name: Priya Okafor 4 Federal income tax withheld $7,900.25 3 Box 2 amount is for tax year 2026 10a State
CO 2506585 2 State or local income tax refunds, credits, or offsets
6,610.93",1099,5,1099,fdc-303751c190078b8c8c12c178,v11-1099-G-flat,original,2026,fgen-881636855e77bbacc5fdd814,synthetic_programmatic_template,flat,none,False,
"For calendar year 2025 OMB No. 1545-0120 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. State of Ohio Department of Taxation 6059 Lakeshore Blvd Pinecrest, GA 66212 PAYER'S TIN 36-8991165 RECIPIENT'S name Riley Brennan RECIPIENT'S TIN ****1809 Street address (including
apt. no.) 9334 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Fairview, OH
37813 1 Unemployment compensation 36,893.07 2 State or local income tax refunds, credits, or offsets $891.02 4 Federal income tax withheld $2,877.12 6 Taxable grants 7 Agriculture payments $0.00 11 State income tax withheld 0.00 Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-f4374bf4ab1d6377005ee0db,v11-1099-G-flat,original,2025,fgen-3203cc5318e73e616ae7f03c,synthetic_programmatic_template,flat,none,False,
"☐ CORRECTED Form 1099-G Certain Government Payments For calendar year2023 OMB No. 1545-0120 Copy B For Rccípient PAYER'S name, street address, cityor town, state or province, country, ZIP or foreígn postal codc, and telephoneno. State of Ohio Department of Taxation 7478 ElmPark Pl Maplewood, MN 37116 PAYER'S TIN 70-6173702 RECIPIENT'S name Morgan Tanaka
RECIPIENT'S TIN ****2048 Street address (including apt. no.) 6266 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Riverton, WI
88843 Account number (see instructions) XXXXX31O880 1 Unemployment compensation 15,908.37 2 State or local income tax refunds, credits, or offsets S2,337.l5 3 Box 2 amount is for tax year 2023 4 Federa1 income tax withhe1d 8,194.11 7 Agriculture payments$0.00 10a State CO 9954702 11 State income tax wíthhe1d",1099,5,1099,fdc-dcfd62da5d811e6c58d6754b,v11-1099-G-flat,original,2023,fgen-27ba12e2627eaf47f337c691,synthetic_programmatic_template,flat,top,True,
"Form 1099-G Certain Government Payments For calendar year 2025 OMB No. 1545-0120 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name,
street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Illinois Department of Employment Security 453 Sample Street Bayside, WA 58754 PAYER'S TIN 16-2390264 RECIPIENT'S name Olivia Walsh RECIPIENT'S TIN ****1491 Street address (including apt. no.) 5037 Maple
Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 61282 1 Unemployment compensation 86,598.34 2 State or local income tax refunds, credits, or offsets 2,068.42 3 Box 2 amount is for tax year 2025 4 Federal income tax withheld $6,683.36 7 Agriculture payments 10a State OH 8446258 11 State income tax withheld 0.00 Department of the Treasury - Internal Revenue Service Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-1396d639ed9f276297c5434f,v11-1099-G-flat,original,2025,fgen-3f9a7b71d564de943ebc9652,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) For calendar year 2022 This is important tax information and is being furnished to the IRS. PAYER'S name, street address,
city or town, state or province, country, ZIP or foreign postal code, and telephone no. State of Ohio Department of Taxation 9562 Prairie Ave Lakewood, CO 86697 PAYER'S TIN 10-4922234 RECIPIENT'S name Morgan Fischer RECIPIENT'S TIN XXX-XX-2781 Street address (including apt. no.) 5911 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 75151 Account number (see instructions) ***-**-256828 1 Unemployment compensation 41,253.06 2 State or local income tax refunds, credits, or offsets $4,123.25 4 Federal income
tax withheld $6,332.94 7 Agriculture payments $0.00 10a State CO 3079807 Department of the Treasury - Internal Revenue Service Form 1099-G Certain Government Payments Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-048a4b5dbdb138735d5802d7,v11-1099-G-flat,original,2022,fgen-f1c97dcd0d60f5506fb1f2d3,synthetic_programmatic_template,flat,bottom,False,
"CORRECTED (if checked) Form 1099-G Ccrtain Government Payments Copy B ForRecipient PAYER'S name,street address, city or town, state or province, country, ZIP or foreignpostal code, and telephonc no. State of 0hio Department of
Taxation 7342 Oak Hollow Ct Brookhaven, PA 47844 PAYER'S TIN 73-4628915 RECIPIENT'S name Taylor Moreau RECIPIENT'S TIN ending in 8979
Street address (including apt. no.) 4025 Granite St City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 4l088 l Unemployment compensation 89,369.70 2 State or local income tax refunds, credits,or offsets $l,210.67 3 Box 2 amount is for tax ycar 2021 4 Federal income tax withheld 9,416.25 6 Taxable grants7 Agriculture payments 1Oa State WI 4203173 11 State íncome tax withheld $0.00 Department of the Treasury - Internal Revenue 5ervice Form l099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-2da5d8635b145e7c4fb2fe99,v11-1099-G-flat,original,2021,fgen-a793b528f7b90df6d4e4076e,synthetic_programmatic_template,flat,top,True,
"☐ CORRECTED Form
1099-G Certain Government Payments OMB No. 1545-0120 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Wisconsin Department of Revenue 4205 Oak Hollow Ct Bayside, WA 29227
PAYER'S TIN 35-9521834 RECIPIENT'S name Fatima Adeyemi RECIPIENT'S TIN XXX-XX-8716 Account number (see instructions) ***-**-999037 1 Unemployment compensation $139,843.12 2 State or local income tax refunds, credits, or offsets $5,507.71 3 Box 2 amount is for tax year 2025 4 Federal income tax withheld 6,681.96 6 Taxable grants 0.00 7 Agriculture payments 0.00 10a State IL 8722193 11 State income tax withheld",1099,5,1099,fdc-80fb002db776698a2f02884d,v11-1099-G-flat,original,2025,fgen-09a64cfab9f86a6fec13cd89,synthetic_programmatic_template,flat,top,False,
"Form 1099-G Certain Government Payments PAYER: State of Ohio Department of Taxation RECIPIENT: Lena Sato 10a State CO 3700518 4 Federal income tax withheld $1,855.22 1
Unemployment compensation 66,619.83 3 Box 2
amount is for tax year 2026",1099,5,1099,fdc-cb43195153e5680be5a2efb5,v11-1099-G-flat,original,2026,fgen-4ec19308e37a90ffada1ff69,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED OMB No. 1545-0120 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Illinois Department of Employment Security 3510 Lakeshore Blvd Riverton, WI 81022 PAYER'S TIN 63-2523738 RECIPIENT'S name Avery
K. Adeyemi RECIPIENT'S TIN ****1547 Street address (including apt. no.) 4104 Oak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 22454 1 Unemployment compensation $136,107.95 2 State or local
income tax refunds, credits, or offsets 2,080.52 3 Box 2 amount is for tax year 2025 4 Federal income tax withheld 3,893.67 6 Taxable grants 7 Agriculture payments $0.00 10a State CO 8933319 Department of the Treasury - Internal Revenue Service Form 1099-G Certain Government Payments Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-3e0fc75297d47d42de2f5743,v11-1099-G-flat,original,2025,fgen-b8be342cb60b6148fd553dc3,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-G Certain Government Payments 2022 Copy B For Recipient PAYER'S name, street address, city or
town, state or province, country, ZIP or foreign postal code, and telephone no. State of Ohio Department of Taxation 4921 Granite St Riverton, WI 64148 PAYER'S TIN 40-8373132 RECIPIENT'S name Casey Okafor RECIPIENT'S TIN ****0402 Street address (including apt. no.) 4476 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 24805 Account number (see instructions) XXXXX193449 1 Unemployment compensation
$129,810.82 2 State or local income tax refunds, credits, or offsets $3,199.64 3 Box 2 amount is for tax year 2022 4 Federal income tax withheld $4,438.46 6 Taxable grants 7 Agriculture payments 0.00 10a State OH 8266381 11 State income tax withheld 0.00 Department of the Treasury - Internal Revenue Service Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-f23bb001edb5bce34692a53e,v11-1099-G-flat,original,2022,fgen-c2670b0d4114f80e462968d8,synthetic_programmatic_template,flat,top,False,
"Form 1099-G Certain Government Payments PAYER'S name, streetaddress, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Wisconsin Department of Revenue5493
Oak Hollow Ct Riverton, WI 7O269 PAYER'S TIN 46-2498545 RECIPIENT'S name Morgan Testcase RECIPIENT'S TIN ending in 6800 5treet address (including apt. no.) 4184 Map1e Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Testville, IL 104191 Unemployment compensation S3,221.43 2 State
or local income tax refunds, credits, or offsets $1,795.95 3 Box 2 amount is for tax ycar 2023 4Federal íncome tax withheld $8,420.13 6 Taxablegrants 7 Agrículture payments 0.00 10a State MN 8310960 11 State income tax withheld $0.00 Department of the Treasury - Intemal Revenue 5ervice Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-7c4432dc072845dec2e8f628,v11-1099-G-flat,original,2023,fgen-53c747dc459ed01f54dd55fc,synthetic_programmatic_template,flat,top,True,
"2024
OMB No. 1545-0120 Copy B For Recipient PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Wisconsin Department of Revenue 6116 Oak Hollow Ct Oak Grove, TX 70853 PAYER'S TIN 44-3483109 RECIPIENT'S name Lena Adeyemi RECIPIENT'S TIN XXXXX4299 1 Unemployment compensation $24,445.34 2 State or local income tax refunds, credits, or offsets 523.22 4 Federal income tax withheld $850.39 6 Taxable grants 7 Agriculture payments 0.00 10a State PA 9916941 11
State income tax withheld Department of the Treasury - Internal Revenue Service Form 1099-G Certain Government Payments Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-1acda93e68e1bfb298660e11,v11-1099-G-flat,original,2024,fgen-62f22a5168043e122c019a42,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-G Certain Government Payments For
calendar year 2022 This is important tax information and isbeing furnished to the IRS. PAYER'S name, street address, city or town, state orprovince, country, ZIP or foreign postal code, and telephone no. State of Ohio Department of Taxatíon 5588 Lakeshore Blvd Riverton, WI 65592 PAYER'S TIN 33-4379235
RECIPIENT'S name Diego Lindqvist RECIPIENT'S TIN ****56l5 1 Unemployment compensation $73,519.88 2 State or 1ocal income tax refunds, credits, or offsets $456.693 Box 2 amount ís for tax year 2O22 4 Federa1 income tax wíthheld $7,982.29 6 Taxable grants $0.00 7 Agriculture payments 1Oa State GA 58l964211 State income tax withheld",1099,5,1099,fdc-60359abfb3c95cd9576ff39c,v11-1099-G-flat,original,2022,fgen-57ec999cbf6caa0d982ed192,synthetic_programmatic_template,flat,top,True,
"CORRECTED(if checked) Form 1099-G Ccrtain Government Payments OMB No. 1545-0120 Copy B For Recipient PAYER'S name,street address, city ortown, state or province, country, ZIP or forcign postal code, and telephone no. Illinois Department of Employment Security 4062 Elm
Park Pl Bayside, WA 69838 PAYER'S TIN 77-8609096 RECIPIENT'S name Noah Fischer
RECIPIENT'S TIN ****6745 1 Unemployment compensatíon 96,995.53 2 State or local íncome tax refunds, credits,or offsets $5,806.84 3 Box 2 amount is for tax year 2021 4 Federal income tax withheld $484.14 7 Agriculture payments 11 State income tax withheld Department of the Treasury - Intema1 Revenue Service Form 1099-G (keep for your records) www.irs.gov/Form1099G",1099,5,1099,fdc-1f02f4bb19bb0275646dc181,v11-1099-G-flat,original,2021,fgen-46e519e3a034cafa08cee6c9,synthetic_programmatic_template,flat,top,True,
"2022
## OMB No.1545-0120
| Field | Value |
| --- | --- |
|PAYER'S name, street address, cíty or town, state or province, country, ZIP or foreign postal code, and telephone no. | Wisconsin Department of Revenue 4131 Elm Park Pl Testville, IL 86547 |
| PAYER'S TIN | 11-7867863 |
| RECIPIENT'S name | MorganBrennan |
| RECIPIENT'S TIN | ***-**-9498|
| Street address (induding apt. no.) | 7160 Oak Hollow Ct |
| City or town,state or province, country, and ZIP or foreign posta1 code | Cedar Falls, IA 59696 |
| 2 State or local income tax refunds, credits, or offsets | 2,032.06 |
| 3Box 2 amount is for tax year | 2022 |
| 4 Federal income tax withheld | 2,265.6l |
| 7 Agriculture payments |  |
| 10a State | OH 7686472 |
| l1 State income tax withhe1d | $0.00 |
## Department of the Treasury - Intemal Revenue Service
Form 1099-G
## Certain Govemment Payments
Form 1099-G (kcep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-9d276b0011d4a9eb24a5f0b8,v11-1099-G-markdown,original,2022,fgen-00df5eac686c0ba4d4c691d8,synthetic_programmatic_template,markdown,bottom,True,
"Form 1099-G
Certain Government Payments
## For calendar year 2026
OMB No. 1545-0120
Copy B For Recipient
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Wisconsin Department of Revenue 9453 Sample Street Fairview, OH 18285 |
| PAYER'S TIN | 61-5488325 |
| RECIPIENT'S name | Riley Lindqvist |
| RECIPIENT'S TIN | ending in 6696 |
| Account number (see instructions) | ****789287 |
| 2 State or local income tax refunds, credits, or offsets | 5,608.00 |
| 3 Box 2 amount is for tax year | 2026 |
| 4 Federal income tax withheld | 2,516.49 |
| 6 Taxable grants | 0.00 |
| 10a State | GA 9939620 |
| 11 State income tax withheld |  |
Department of the Treasury - Internal Revenue Service
## Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-7527e1c524e2e5fc20b9dbf7,v11-1099-G-markdown,original,2026,fgen-fdb1bc8721c73571876aaa06,synthetic_programmatic_template,markdown,top,False,
"Form 1099-G Certain Government Payments
| Field | Value |
| --- | --- |
| From: | State of Ohio Department of Taxation |
| To: | Riley A. Fischer |
| 3 Box 2 amount is for tax year | 2021 |",1099,5,1099,fdc-8cf9b383498265f8d29eb794,v11-1099-G-markdown,original,2021,fgen-e46e4882ceebaf650e9b8e96,synthetic_programmatic_template,markdown,top,False,
"## Form 1099-G
## Certain Government Payments
2026
## OMB No. 1545-0120
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Illinois Department of Employment Security 2443 Cedar Ln Riverton, WI 36334 |
| PAYER'S TIN | 79-5332189 |
| RECIPIENT'S name | Mateo E. Okafor |
| RECIPIENT'S TIN | XXX-XX-9107 |
| Street address (including apt. no.) | 2892 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 69489 |
| 1 Unemployment compensation | $125,901.24 |
| 2 State or local income tax refunds, credits, or offsets | $3,553.39 |
| 4 Federal income tax withheld | $8,360.03 |
| 6 Taxable grants | 0.00 |
| 7 Agriculture payments |  |
| 10a State | CO 1900256 |
Department of the Treasury - Internal Revenue Service
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-254def9b5e7ed918e1f9a829,v11-1099-G-markdown,original,2026,fgen-6251b1bcab078f2da4dd9949,synthetic_programmatic_template,markdown,top,False,
"Form 1099-G
Certain Government Payments
## 2023
OMB No. 1545-0120
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | State of Ohio Department of Taxation 4887 Lakeshore Blvd Pinecrest, GA 70841 |
| PAYER'S TIN | 72-7556617 |
| RECIPIENT'S name | Lena B. Adeyemi |
| RECIPIENT'S TIN | ****0592 |
| Street address (including apt. no.) | 9899 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 51096 |
| 1 Unemployment compensation | 126,209.33 |
| 2 State or local income tax refunds, credits, or offsets | $4,113.08 |
| 4 Federal income tax withheld | $1,654.59 |
| 6 Taxable grants |  |
| 7 Agriculture payments |  |
| 10a State | IL 8019317 |",1099,5,1099,fdc-cdc340fe86dc6c950bdf6a74,v11-1099-G-markdown,original,2023,fgen-b0375f17f7b48310ecbff5de,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-0120
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Wisconsin Department of Revenue 7567 Lakeshore Blvd Testville, IL 56791 |
| PAYER'S TIN | 59-6608751 |
| RECIPIENT'S name | Casey Castillo |
| RECIPIENT'S TIN | XXX-XX-8670 |
| Street address (including apt. no.) | 4581 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Lakewood, CO 31882 |
| Account number (see instructions) | ending in 820476 |
| 1 Unemployment compensation | $101,938.21 |
| 2 State or local income tax refunds, credits, or offsets | $6,224.42 |
| 3 Box 2 amount is for tax year | 2023 |
| 4 Federal income tax withheld | 180.13 |
| 6 Taxable grants |  |
| 7 Agriculture payments | 0.00 |
| 10a State | GA 4221841 |
| 11 State income tax withheld |  |",1099,5,1099,fdc-c6a3265a6e9ff727b269474c,v11-1099-G-markdown,original,2023,fgen-70bfe133267c5b16cd95e6ae,synthetic_programmatic_template,markdown,none,False,
"VOID  CORRECTED
## Form 1099-G
Certain Government Payments
## OMB No. 1545-0120
Copy B For Rccipient
|Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | IllinoisDepartment of Employment 5ecurity 936 Lakeshore Blvd Brookhaven, PA 36740 |
| PAYER'S TIN | 90-4792765 |
| RECIPIENT'S name | Olivia Moreau |
| RECIPIENT'S TIN | XXXXX8867 |
| 1 Unemployment compensation | 135,986.62 |
| 2 State or local income tax refunds, credits, oroffsets | $8,72l.66 |
| 3 Box 2 amount isfor tax year | 2021 |
| 4 Federa1 íncomc tax withhdd | $l,758.82 |
| 6 Taxable grants | 0.00 |
| l0a State | OH 1345304 |
| 11 Statcincome tax withheld |  |",1099,5,1099,fdc-23d8c796b9fece6a45b4c61b,v11-1099-G-markdown,original,2021,fgen-c0595f51db9e94e94dfabdb8,synthetic_programmatic_template,markdown,top,True,
"## Form 1099-G
## Certain Government Payments
For calendar year 2022
OMB No. 1545-0120
## Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Illinois Department of Employment Security 3217 Willow Bend Way Cedar Falls, IA 24923 |
| PAYER'S TIN | 81-4890342 |
| RECIPIENT'S name | Kwame B. Patel |
| RECIPIENT'S TIN | XXXXX7599 |
| 1 Unemployment compensation | 22,372.20 |
| 3 Box 2 amount is for tax year | 2022 |
| 4 Federal income tax withheld | 4,615.05 |
| 6 Taxable grants |  |
| 7 Agriculture payments |  |
| 10a State | OH 2057630 |
| 11 State income tax withheld | 0.00 |",1099,5,1099,fdc-c3649c28b85baea4ff8cd4cc,v11-1099-G-markdown,original,2022,fgen-91c1aca3d9be8515bc77f6e4,synthetic_programmatic_template,markdown,top,False,
"## Form 1099-G
Certain Government Payments
OMB No. 1545-0120
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Illinois Department of Employment Security 4312 Oak Hollow Ct Cedar Falls, IA 94224 |
| PAYER'S TIN | 35-8025048 |
| RECIPIENT'S name | Avery Tanaka |
| RECIPIENT'S TIN | ***-**-0337 |
| Account number (see instructions) | XXX-XX-111816 |
| 3 Box 2 amount is for tax year | 2022 |
| 4 Federal income tax withheld | $7,498.78 |
| 6 Taxable grants | $0.00 |
| 10a State | GA 9958170 |",1099,5,1099,fdc-1903c971ea0a67c06b6e861f,v11-1099-G-markdown,original,2022,fgen-f6334ce0ad5d8dec8de410dd,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-0120
## Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'5 name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Wisconsin Department of Revenue 3074 Maple Ridge Dr Lakewood, CO 10360 |
| PAYER'5 TIN | 23-4320829 |
| RECIPIENT'S namc | Wei C. Haddad |
| RECIPIENT'S TIN | ending in 4299 |
| Street address (induding apt. no.) | 9505 Samplc Strcet |
| City ortown, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 72285 |
| Account number (see instructions) | ***-**-325079 |
| 1 Unemployment compensation | 88,l33.72 |
| 2 State or local income tax refunds, credits, or offsets | $4,290.15 |
| 3 Box 2 amount is fortax ycar | 2024 |
| 4 Federal íncome tax withheld | $2,636.26 |
| 6 Taxablegrants |  |
| 7 Agriculturepayments | 0.00 |
| 115tateincome tax withheld | $0.00 |
## Form 1099-G
## Certain Govemment Payments",1099,5,1099,fdc-2d3bb479638b6a258f1a1ee7,v11-1099-G-markdown,original,2024,fgen-4c6bb5817bbf03caf9e3d83e,synthetic_programmatic_template,markdown,bottom,True,
"Form 1099-G
Certain Government Payments
2023
## OMB No. 1545-0120
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | State of Ohio Department of Taxation 2194 Elm Park Pl Lakewood, CO 16090 |
| PAYER'S TIN | 25-2365623 |
| RECIPIENT'S name | Amara D. Patel |
| RECIPIENT'S TIN | ending in 8756 |
| Street address (including apt. no.) | 3740 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 68843 |
| 1 Unemployment compensation | 102,487.75 |
| 2 State or local income tax refunds, credits, or offsets | $4,164.83 |
| 3 Box 2 amount is for tax year | 2023 |
| 6 Taxable grants | $0.00 |
| 7 Agriculture payments |  |
| 10a State | IL 9001989 |
| 11 State income tax withheld | $0.00 |",1099,5,1099,fdc-a1b7655f46ace07c05f0d079,v11-1099-G-markdown,original,2023,fgen-4d0614938e9507c652521b9c,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
## Form 1099-G
## Certain Government Payments
##OMB No. l545-0120
Copy B For Recipient
| Fie1d | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | State of 0hio Department of Taxation 2347 Granite St Lakewood, CO 27473 |
| PAYER'S TIN | 36-748O768 |
| RECIPIENT'S name | Priya Moreau|
| RECIPIENT'STIN| ****4464 |
| Street address (induding apt. no.) | 6480 E1m Park Pl|
| City or town, state or provínce, country, and ZIP or foreign postal code | Maplewood, MN 6042l |
| l Unemployment compensation | S124,248.93 |
| 2 State or local income tax refunds, credits, or offsets | 430.50 |
| 4 Federal income tax withheld | $3,999.74 |
| 6 Taxable grants |  |
| 7 Agriculture payments | 0.00 |
| 10a State | WI 6481363 |
| 11 Statc income taxwithheld |  |
## Department of the Treasury - Interna1 Revenue Servíce
Form 1099-G (keep for your records)  www.irs.gov/Form1099G",1099,5,1099,fdc-a61e851b0ad7a8b14dfa603f,v11-1099-G-markdown,original,2023,fgen-1fec8e4d8ba5154d768830e7,synthetic_programmatic_template,markdown,top,True,
"For calendar year 2022
## OMB No. 1545-0120
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Wisconsin Department of Revenue 8649 Cedar Ln Lakewood, CO 27263 |
| PAYER'S TIN | 40-5928155 |
| RECIPIENT'S name | Taylor Nguyen |
| RECIPIENT'S TIN | ending in 0036 |
| Street address (including apt. no.) | 390 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 89587 |
| Account number (see instructions) | XXX-XX-752453 |
| 1 Unemployment compensation | 27,323.65 |
| 2 State or local income tax refunds, credits, or offsets | 1,895.22 |
| 3 Box 2 amount is for tax year | 2022 |
| 4 Federal income tax withheld | $6,769.37 |
| 6 Taxable grants | 0.00 |
| 10a State | OH 8708533 |
| 11 State income tax withheld | 0.00 |
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-7c88faedf6f2f5cef2579027,v11-1099-G-markdown,original,2022,fgen-2f31e8b6e99054cea2e87abe,synthetic_programmatic_template,markdown,none,False,
"## Form 1099-G Certain Government Payments
| Field | Value |
| --- | --- |
| PAYER'S name: | State of Ohio Department of Taxation |
| RECIPIENT: | Olivia Romero |
| 3 Box 2 amount is for tax year | 2021 |
| 1 Unemployment compensation | 34,358.65 |
| 4 Federal income tax withheld | 2,458.12 |
| 2 State or local income tax refunds, credits, or offsets | $4,696.91 |",1099,5,1099,fdc-58a81c6120f3f5e4587900cf,v11-1099-G-markdown,original,2021,fgen-4a7eff80853a00c73a92cb15,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| From: | Illinois Departmentof Employment Security |
| Recipient's name: | Mateo Okafor |
| 4 Federal income tax withheld | 4,742.7O|
| 2 5tate or 1ocal income tax refunds, credits, or offsets | $1,067.36 |
| 10a State | OH 4150592 |
Form 1099-G Certain Govemment Payments",1099,5,1099,fdc-093c66af50f968e62ace1747,v11-1099-G-markdown,original,2022,fgen-d090936e0cb36c62e24e7ad4,synthetic_programmatic_template,markdown,bottom,True,
"| Field | Value |
| --- | --- |
| From: | State of Ohio Department of Taxation |
| To: | Jamie Patel |
| 4 Federal income tax withheld | 1,673.79 |
| 10a State | WI 6608874 |
| 1 Unemployment compensation | $25,117.20 |
| 3 Box 2 amount is for tax year | 2024 |
Form 1099-G Certain Government Payments 2024",1099,5,1099,fdc-190d4aa6ea2a71134e268664,v11-1099-G-markdown,original,2024,fgen-3abfbfdb8c88e1e3d6a8d47f,synthetic_programmatic_template,markdown,bottom,False,
"PAYER'S name:
Granite Peak Bank
To:
Mateo Nguyen
15 State
CO 1678655
1 Interest income
$8,388.15",1099,5,1099,fdc-bf1d448a8c9b66deb1eb2f5b,v11-1099-INT-stacked,original,2026,fgen-817cf5406295bb7ba456992b,synthetic_programmatic_template,stacked,none,False,
"Form 1099-INT Interest Income 2025
From:
Cedar Va1ley Credit Union
Recipient's name:
Priya Rivera
1 Interest income
2,474.07
155tate
MN 5803417",1099,5,1099,fdc-f7c0e464d4a8aa7b290e0a91,v11-1099-INT-stacked,original,2025,fgen-47f97a16b3c2ee5995a7e189,synthetic_programmatic_template,stacked,top,True,
"Form 1099-INT
Interest Income
For calendar year 2022
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Summit Ridge Bank 3319 Lakeshore Blvd Bayside, WA 63542
PAYER'S TIN
95-7867287
RECIPIENT'S name
Sofia E. Larsen
RECIPIENT'S TIN
XXXXX1072
Account number (see instructions)
****548502
1 Interest income
$8,289.44
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
$0.00
11 Bond premium
$0.00
15 State
CO 4388366
17 State tax withheld
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-61d6ef807af8d131e85e3e12,v11-1099-INT-stacked,original,2022,fgen-8141e550054d36a65726346a,synthetic_programmatic_template,stacked,top,False,
"Form 1099-INT
Interest Income
For calendar year 2023
OMB No. 1545-0112
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town,state or province, country, ZIP or foreign postal code, and telephone no.
Bayview Community Bank 76l5 Sample Street Baysíde, WA 57561
PAYER'S TIN
51-45O6346
RECIPIENT'5name
Fatima C. Kowalski
RECIPIENT'S TIN
ending in 9449
Street address (inc1uding apt. no.)
7326 Prairie Ave
City or town, state or province, country, and ZIP or forcign postal code
Lakewood,C0 54190
Account number (see instructions)
XXXXX273180
1 Interest íncome
2,941.35
2 Early withdrawal penalty
0.00
3 Interest onU.5. 5avings Bonds and Treasury obligations
$0.00
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
0.00
11 Bond premium
$0.00
15 State
0H 9562166
17 State tax withhe1d",1099,5,1099,fdc-cc7fc54682b3f4e2556c1c62,v11-1099-INT-stacked,original,2023,fgen-63a88b7a49ee2d6e8bd576fa,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
Form 1099-INT
Interest Income
2026
OMB No. 1545-0112
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Harbor Federal Credit Union 6041 Elm Park Pl Pinecrest, GA 20140
PAYER'S TIN
12-7082005
RECIPIENT'S name
Sofia Romero
RECIPIENT'S TIN
ending in 0391
Account number (see instructions)
****229980
1 Interest income
$472.20
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
$0.00
5 Investment expenses
11 Bond premium
$0.00
17 State tax withheld
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-f468156621f5b87dba5aa6b0,v11-1099-INT-stacked,original,2026,fgen-58b7e58cc4e4c33307cd75c9,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2023
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Cedar Valley Credit Union 6708 Granite St Testville, IL 73397
PAYER'S TIN
81-6883286
RECIPIENT'S name
Mateo Larsen
RECIPIENT'S TIN
ending in 2641
Street address (including apt. no.)
2840 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 72502
Account number (see instructions)
***-**-576440
1 Interest income
$1,382.98
2 Early withdrawal penalty
4 Federal income tax withheld
0.00
11 Bond premium
15 State
MN 8916106
17 State tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-INT
Interest Income
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-b063124b4251c4f08554646f,v11-1099-INT-stacked,original,2023,fgen-56d4508537cd31a6fc6c609c,synthetic_programmatic_template,stacked,bottom,False,
"Form 1099-INT Interest Income 2023
From:
Meadowlark Savings Bank
RECIPIENT:
Jordan A. Haddad
1 Interest income
$4,751.23
15 State
MN7681229",1099,5,1099,fdc-39c054a32026b71c308fc305,v11-1099-INT-stacked,original,2023,fgen-322512eef818713b2b751609,synthetic_programmatic_template,stacked,top,True,
"Form 1099-INT
Interest Income
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northwind Financial 6261 Willow Bend Way Brookhaven, PA 10912
PAYER'S TIN
34-9392632
RECIPIENT'S name
Riley R. Testcase
RECIPIENT'S TIN
XXX-XX-2012
Street address (including apt. no.)
6955 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 47515
Account number (see instructions)
XXX-XX-652626
1 Interest income
5,621.71
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
0.00
4 Federal income tax withheld
5 Investment expenses
0.00
8 Tax-exempt interest
15 State
PA 5210043
17 State tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-58d4ec18f6ba64cf3f875bb3,v11-1099-INT-stacked,original,2026,fgen-cccfd9e8fd4b9f31896b31a5,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1099-INT
Interest Income
2022
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Granite Peak Bank 5516 Maple Ridge Dr Pinecrest, GA 37785
PAYER'S TIN
94-9042084
RECIPIENT'S name
Wei C. Lindqvist
RECIPIENT'S TIN
***-**-2902
1 Interest income
7,054.41
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
$0.00
11 Bond premium
0.00
15 State
PA 3368086
17 State tax withheld",1099,5,1099,fdc-a64abf62c7b9758a8aec0082,v11-1099-INT-stacked,original,2022,fgen-bcdd2255d6e30663f8b19145,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
For calendar year 2026
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northwind Financial 3716 Cedar Ln Lakewood, CO 66865
PAYER'S TIN
78-4984900
RECIPIENT'S name
Kwame Romero
RECIPIENT'S TIN
XXXXX9158
Street address (including apt. no.)
8053 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 24250
1 Interest income
4,117.21
2 Early withdrawal penalty
0.00
3 Interest on U.S. Savings Bonds and Treasury obligations
0.00
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
0.00
15 State
OH 3136302
17 State tax withheld
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-9c342da57300e4ff9cd50eda,v11-1099-INT-stacked,original,2026,fgen-f1913ea73c5d5ef73bbbeaab,synthetic_programmatic_template,stacked,none,False,
"Form 1099-INT Interest Income
PAYER'S name:
Cedar Valley Credit Union
RECIPIENT:
Taylor Nguyen
15 State
MN 8971062
1 Interest income
5,319.47",1099,5,1099,fdc-970b8118cda38493ccefb891,v11-1099-INT-stacked,original,2026,fgen-1995d6cff4cfdb9d198df6a6,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
2025
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Riverbend Bank & Trust 1823 Elm Park Pl Brookhaven, PA 98752
PAYER'S TIN
74-3679206
RECIPIENT'S name
Taylor E. Moreau
RECIPIENT'S TIN
****8164
Street address (including apt. no.)
5746 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 20855
Account number (see instructions)
****875783
1 Interest income
$5,521.88
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
$0.00
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State
IL 8931252
17 State tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-INT
Interest Income
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-d7fb9a2001fc5c73d8b0dd58,v11-1099-INT-stacked,original,2025,fgen-f39107821092e1efbbb43418,synthetic_programmatic_template,stacked,bottom,False,
"CORRECTED (if checked)
Form 1099-INT
Interest Income
2023
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Granite Peak Bank 8685 Granite St Brookhaven, PA 35606
PAYER'S TIN
63-9600635
RECIPIENT'S name
Priya Patel
RECIPIENT'S TIN
***-**-2857
Street address (including apt. no.)
2004 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 60137
Account number (see instructions)
****072952
1 Interest income
3,447.49
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
$0.00
4 Federal income tax withheld
5 Investment expenses
0.00
11 Bond premium
15 State
IL 4801753
17 State tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-6c6d1ce6189af1b5050216f3,v11-1099-INT-stacked,original,2023,fgen-f95dd084feedbfd1c9b7be51,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2025
OMB No. 1545-0112
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Meadowlark Savings Bank 7159 Willow Bend Way Cedar Falls, IA 93899
PAYER'S TIN
59-6271540
RECIPIENT'S name
Lena Patel
RECIPIENT'S TIN
****7604
Street address (including apt. no.)
5059 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 13980
Account number (see instructions)
XXXXX251594
1 Interest income
9,356.44
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
0.00
8 Tax-exempt interest
11 Bond premium
$0.00
15 State
GA 7187367
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-b22e252ebdd14ce009db57a1,v11-1099-INT-stacked,original,2025,fgen-83384ab4ed4b3444d84076ac,synthetic_programmatic_template,stacked,none,False,
"☐ CORRECTED
Form 1099-INT
Interest Income
2026
OMB No. 1545-0112
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Lakeshore National Bank 3098 Oak Hollow Ct Riverton, WI 70130
PAYER'S TIN
15-5663182
RECIPIENT'S name
Taylor Sato
RECIPIENT'S TIN
XXX-XX-1536
Account number (see instructions)
ending in 905239
1 Interest income
3,073.04
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
$0.00
15 State
MN 9342332
17 State tax withheld",1099,5,1099,fdc-57e8ca4b2a2d18ce135d70f8,v11-1099-INT-stacked,original,2026,fgen-1a9b18e0287e29121a604178,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
2021
OMB No. 1545-0112
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Summit Ridge Bank 1320 Prairie Ave Testville, IL 55614
PAYER'S TIN
20-4796206
RECIPIENT'S name
Taylor Sato
RECIPIENT'S TIN
***-**-7394
Street address (including apt. no.)
778 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 36085
1 Interest income
5,296.64
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
$0.00
5 Investment expenses
8 Tax-exempt interest
$0.00
11 Bond premium
0.00
15 State
TX 7377702
17 State tax withheld
0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-a561f0a37d5e286ad900613e,v11-1099-INT-stacked,original,2021,fgen-7a43cfa205b99e59a14e17e8,synthetic_programmatic_template,stacked,none,False,
"CORRECTED (if checked)
Form 1099-INT
Interest Income
For calendar year 2025
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Lakeshore National Bank 2251 Granite St Bayside, WA 11080
PAYER'S TIN 76-3256174
RECIPIENT'S name   Jordan Patel
RECIPIENT'S TIN      XXX-XX-7027
1 Interest income 5,845.89
2 Early withdrawal penalty  0.00
3 Interest on U.S. Savings Bonds and Treasury obligations   0.00
4 Federal income tax withheld $0.00
5 Investment expenses
8 Tax-exempt interest
11 Bond premium      0.00
15 State OH 3149433
17 State tax withheld  0.00
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-55f1c36e6d1ab4e749f5dd80,v11-1099-INT-inline,original,2025,fgen-a39ea8628100eef9f7b24f03,synthetic_programmatic_template,inline,top,False,
"Form 1099-INT
Interest Income
2025
OMB No. 1545-0112
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Bank & Trust 6953 Oak Hollow Ct Testville, IL 75024
PAYER'S TIN      82-4300473
RECIPIENT'S name   Fatima Okafor
RECIPIENT'S TIN      XXX-XX-8003
Street address (including apt. no.)   9444 Granite St
City or town, state or province, country, and ZIP or foreign postal code   Oak Grove, TX 67512
1 Interest income  6,312.56
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld $0.00
5 Investment expenses
8 Tax-exempt interest 0.00
15 State GA 6500470
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-40c8951b15253ccd55a63e1f,v11-1099-INT-inline,original,2025,fgen-85af22a41bcd7cc53138bf7b,synthetic_programmatic_template,inline,top,False,
"Form 1099-INT Interest Income 2023
PAYER: Harbor Federal Credit Union
To: Olivia Rivera
15 State WI 2231946",1099,5,1099,fdc-53594abc924542838ca8af1c,v11-1099-INT-inline,original,2023,fgen-96c81518fc07de80c088dd7a,synthetic_programmatic_template,inline,top,False,
"Form 1099-INT Interest Income 2024
From:      Meadowlark Savings Bank
To:  Casey Moreau
1 Interest income 1,098.45
15 State  OH 9039324",1099,5,1099,fdc-d58f1b19b2031fdbdc2ae50b,v11-1099-INT-inline,original,2024,fgen-908de579b4c87cd13959316a,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
For calendar year 2022
OMB No. 1545-0112
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.      Granite Peak Bank 3511 Lakeshore Blvd Fairview, OH 97066
PAYER'S TIN  58-9538186
RECIPIENT'S name   Avery Nguyen
RECIPIENT'S TIN      XXX-XX-2738
Street address (including apt. no.) 7094 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 23983
1 Interest income 3,740.76
3 Interest on U.S. Savings Bonds and Treasury obligations
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State   MN 6525288
17 State tax withheld  0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-c082269c3b630179703327d8,v11-1099-INT-inline,original,2022,fgen-b48116acf1e2a4da700f54a0,synthetic_programmatic_template,inline,none,False,
"PAYER:      Summit Ridge Bank
RECIPIENT: Fatima Kowalski
1 Interest income   $6,870.90
15 State      IL 1603461",1099,5,1099,fdc-2d36b3c9b66abcb5d088dc65,v11-1099-INT-inline,original,2023,fgen-a73973e08d65c7c88b3e022c,synthetic_programmatic_template,inline,none,False,
"Form 1099-INT
Interest Income
OMB No. 1545-0112
CopyB For Rccipient
PAYER'S name, street address, city or town, state or province, country, ZIP or forcign postal code, and tdephone no.   Summit Ridge Bank 4745 Elm Park PlMaplewood, MN 2O411
PAYER'S TIN 74-9048754
RECIPIENT'S name  Avery Adeyemi
RECIPIENT'S TIN  XXX-XX-2516
Account number (see instructions)  XXXXX725425
lInterest income   5,822.61
2 Early withdrawal penalty
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium   $0.00
15 5tate   IL 3383946
17 State tax withheld  0.00
Department of the Treasury - Internal Revenue 5ervice
Form 1O99-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-55f9d126314666c238233040,v11-1099-INT-inline,original,2023,fgen-7efb78246ac377f396532d89,synthetic_programmatic_template,inline,top,True,
"Form 1099-INT
Interest Income
OMB No. 1545-0112
Copy B For Recipient
This isimportant tax informationand is bcing furnished to the IRS.
PAYER'S name, street address, city or town, state or provínce, country, ZIP or foreign postal code, and telephone no. Granite Peak Bank 8888 Oak Hollow Ct Cedar Falls, IA 67613
PAYER'S TIN35-7O83409
RECIPIENT'S name      Amara Rivera
RECIPIENT'S TIN   ****3877
Strcet address (induding apt. no.)      6272 OakHollow Ct
City or town, state or province, country,and ZIP or foreign postal code   Maplewood, MN 46O46
1 Interest income      S5,592.77
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 5tate MN 7444434
17 State tax withheld   $O.00
Department of the Trcasury - Intcmal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-ff84363928fa0fcc4de21121,v11-1099-INT-inline,original,2026,fgen-5950fa9a2907084ac2488912,synthetic_programmatic_template,inline,top,True,
"Form 1099-INT
Interest Income
2026
OMB No. 1545-0112
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Lakeshore National Bank 6041 Granite St Maplewood, MN 35813
PAYER'S TIN 33-3773885
RECIPIENT'S name Jamie Nguyen
RECIPIENT'S TIN      ending in 2811
Street address (including apt. no.) 9686 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code  Fairview, OH 16249
1 Interest income  7,726.74
2 Early withdrawal penalty  0.00
3 Interest on U.S. Savings Bonds and Treasury obligations $0.00
4 Federal income tax withheld
5 Investment expenses   0.00
8 Tax-exempt interest $0.00
11 Bond premium $0.00
15 State      MN 2985480
17 State tax withheld      $0.00
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-39b2f339f1ddc3a96c94e49f,v11-1099-INT-inline,original,2026,fgen-fe8c5edfb87f5eb189ab2b00,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1099-INT
Interest Income
For calendar year 2026
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Northwind Financial 908 Prairie Ave Bayside, WA 57698
PAYER'S TIN  60-4150046
RECIPIENT'S name      Jordan Rivera
RECIPIENT'S TIN   XXXXX1978
1 Interest income   8,198.33
2 Early withdrawal penalty 0.00
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld      $0.00
5 Investment expenses
8 Tax-exempt interest 0.00
11 Bond premium
15 State TX 2018898
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-4969dc9b893549ec863ec50d,v11-1099-INT-inline,original,2026,fgen-2ec0b012a780dd7cafabdfbe,synthetic_programmatic_template,inline,top,False,
"Form 1099-INT
Interest Income
For calendar year 2023
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Lakeshore National Bank 6588 Prairie Ave Bayside, WA 40561
PAYER'S TIN 81-7635402
RECIPIENT'S name      Olivia E. Fischer
RECIPIENT'S TIN XXX-XX-8450
Street address (including apt. no.) 5104 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 99931
1 Interest income      6,330.01
3 Interest on U.S. Savings Bonds and Treasury obligations
5 Investment expenses
8 Tax-exempt interest $0.00
11 Bond premium
15 State      GA 7801839
17 State tax withheld",1099,5,1099,fdc-9af219e80fdd055ee57243f7,v11-1099-INT-inline,original,2023,fgen-86bd518772464382ad2adc07,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Summit Ridge Bank 7546 Harbor View Rd Oak Grove, TX 16242
PAYER'S TIN      52-2790174
RECIPIENT'S name Kwame Adeyemi
RECIPIENT'S TIN  ***-**-3611
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations $0.00
4 Federal income tax withheld
5 Investment expenses      0.00
8 Tax-exempt interest      $0.00
11 Bond premium
15 State      WI 7498194
17 State tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-INT
Interest Income
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-d823f77378d348d52a2669ca,v11-1099-INT-inline,original,2024,fgen-2010ed2a23116ad778a86163,synthetic_programmatic_template,inline,bottom,False,
"☐ CORRECTED
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.      Harbor Federal Credit Union 8973 Granite St Lakewood, CO 63078
PAYER'S TIN  68-9122980
RECIPIENT'S name   Casey Lindqvist
RECIPIENT'S TIN   ***-**-8782
Street address (including apt. no.)   3470 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code  Riverton, WI 64743
1 Interest income  2,943.34
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium   0.00
15 State   WI 6225848
17 State tax withheld
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-f090d457b7dc9de5deab55e2,v11-1099-INT-inline,original,2023,fgen-51ab2aa783c2375ee8656047,synthetic_programmatic_template,inline,none,False,
"Form 1099-INT Interest Income
PAYER:      Lakeshore National Bank
To:      Noah Tanaka
15 State   TX 2141249
1 Interest income   $7,521.20",1099,5,1099,fdc-a2594da2e4ae7f6a7a4644b2,v11-1099-INT-inline,original,2024,fgen-28966d10852ccaaad190fbd3,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
2023
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Lakeshore National Bank 325 Willow Bend Way Testville, IL 83036
PAYER'S TIN 86-1272352
RECIPIENT'S name   Kwame Adeyemi
RECIPIENT'S TIN   XXXXX9035
1 Interest income $9,001.17
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations 0.00
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State   IL 6686476
17 State tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-INT
Interest Income
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-56d94fef87794313cc6d7af7,v11-1099-INT-inline,original,2023,fgen-0a47d890d7df54fd7269b6c5,synthetic_programmatic_template,inline,bottom,False,
"Form 1099-INT Interest Income 2021
PAYER:  Granite Peak Bank
RECIPIENT:  Alex B. Castillo
1 Interest income  7,874.75
15 State IL 7337524",1099,5,1099,fdc-f2aaaa8e558f6bb52f1d61aa,v11-1099-INT-inline,original,2021,fgen-9dbeef76157a5c3618e35565,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
For calendar year 2024
OMB No. 1545-0112
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, cíty or town, state or province, country, ZIP or foreign posta1 code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federa1 incometax withheld
5Investmentexpenses
8 Tax-exempt interest
11 Bond premium
15 State
17 State tax withhe1d
Lakeshore National Bank 2856 Oak Hollow Ct Fairview, OH 45871
73-4453811
Diego Nguyen
****1551
9436 Lakeshore Blvd
Riverton, WI 3498O
6,963.45
0.00
0.00
IL 4149647
Department of the Treasury - Intemal Revenue Service",1099,5,1099,fdc-e74f31374ad1b118940929e3,v11-1099-INT-columns,original,2024,fgen-57c84770207bf7891494ffad,synthetic_programmatic_template,columns,none,True,
"Form 1099-INT Interest Income
From:
Recipient's name:
1 Interest income
15 State
Summit Ridge Bank
Lena C. Sato
$8,374.91
PA 6984274",1099,5,1099,fdc-4988231f99dc7a606c12ea91,v11-1099-INT-columns,original,2025,fgen-8d9bf7d7c8983d646983ea0b,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1099-INT
Interest Income
2024
OMB No. 1545-0112
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
2 Early withdrawal pcnalty
4 Federal income tax withheld
5Investment expenses
11 Bond premium
15 5tate
17State tax withheld
Cedar Valley Credit Union 1529 Elm Park Pl Bayside, WA 61736
52-4419647
Wei Kowalski
***-**-9591
$0.00
0.00
0.00
PA 4984598",1099,5,1099,fdc-1ebe5409bc816ec5b95f3315,v11-1099-INT-columns,original,2024,fgen-399f37820d83b30127b2cc9d,synthetic_programmatic_template,columns,top,True,
"Form 1099-INT
Interest Income
For calendar year 2023
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State
Northwind Financial 5102 Lakeshore Blvd Maplewood, MN 60961
35-8957353
Lena Rivera
ending in 8021
5410 Prairie Ave
Bayside, WA 65472
$6,320.17
$0.00
0.00
OH 9610716
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-3d5fdb468f577df1b860a326,v11-1099-INT-columns,original,2023,fgen-ef1750be42d8434d4860f0dc,synthetic_programmatic_template,columns,top,False,
"For calendar year 2021
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State
17 State tax withheld
Bayview Community Bank 9823 Lakeshore Blvd Oak Grove, TX 67233
85-6446175
Amara J. Lindqvist
****8777
1515 Cedar Ln
Bayside, WA 58658
$0.00
0.00
IL 3140324
Form 1099-INT
Interest Income",1099,5,1099,fdc-ca07caf24520aba346e2474c,v11-1099-INT-columns,original,2021,fgen-0dc4b12240275a9d3e292671,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-INT
Interest Income
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
8 Tax-exempt interest
15 State
Prairie State Savings 8649 Maple Ridge Dr Brookhaven, PA 90404
31-8192951
Mateo K. Brennan
XXXXX0321
2054 Maple Ridge Dr
Cedar Falls, IA 36029
$2,569.58
MN 1894404",1099,5,1099,fdc-ba9b463f0af44b6dc53d44e4,v11-1099-INT-columns,original,2025,fgen-59b10049d4dea50405bd0bba,synthetic_programmatic_template,columns,top,False,
"Form 1099-INT
Interest Income
202l
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (inc1uding apt. no.)
City or town, stateor province, country, and ZIP or foreígn postal code
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury oblígations
4 Federal íncome tax withheld
5 Investment expenses
8 Tax-exemptinterest
11 Bond premium
15 State
17 State tax withhe1d
Summit Ridge Bank 1586 Harbor View Rd Bayside,WA 68377
94-9349348
Rilcy B. Kowalski
XXXXX7l14
9820 Oak Hollow Ct
Fairview, OH 70203
$6,l20.88
0.00
CO 4966932
0.00
Department of the Treasury -Intema1 Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-9bb67ea30e6d1327144c2387,v11-1099-INT-columns,original,2021,fgen-043ce5929ce92ca65449d495,synthetic_programmatic_template,columns,top,True,
"Form 1099-INT
Interest Income
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State
17 State tax withheld
Northwind Financial 2894 Sample Street Lakewood, CO 89328
80-3298839
Kwame Larsen
XXX-XX-7466
XXXXX222478
$4,969.70
$0.00
$0.00
0.00
0.00
0.00
PA 9723497
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-5a7f75ea0e4f8ac68bb652e1,v11-1099-INT-columns,original,2024,fgen-efe0ba0e3171793df3673dd0,synthetic_programmatic_template,columns,top,False,
"Form 1099-INT
Interest Income
For calendar year 2026
OMB No. 1545-0112
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
8 Tax-exempt interest
11 Bond premium
15 State
17 State tax withheld
Granite Peak Bank 8112 Cedar Ln Maplewood, MN 32673
30-5549180
Taylor Patel
****8456
9657 Maple Ridge Dr
Lakewood, CO 83291
7,259.73
$0.00
$0.00
0.00
0.00
CO 9210647
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-e495c0f5e5e2bd4af177dc62,v11-1099-INT-columns,original,2026,fgen-9999fa56a46cf1a672074757,synthetic_programmatic_template,columns,top,False,
"For calendar year 2022
OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State
17 State tax withheld
Cedar Valley Credit Union 1576 Harbor View Rd Lakewood, CO 22477
12-8760275
Amara Lindqvist
XXXXX3825
ending in 742114
516.98
0.00
0.00
0.00
MN 7191719
0.00
Form 1099-INT
Interest Income",1099,5,1099,fdc-679d9cfd97a3795dbd6f42c3,v11-1099-INT-columns,original,2022,fgen-e2152629a2e42ae8de23a797,synthetic_programmatic_template,columns,bottom,False,
"From:
To:
15 State
1 Interest income
RiverbendBank & Trust
Mateo Castillo
MN 6370561
9,337.32",1099,5,1099,fdc-6cea804b1f4b83986f97a979,v11-1099-INT-columns,original,2025,fgen-2702208d714aa12eed114b55,synthetic_programmatic_template,columns,none,True,
"Form 1099-INT
Interest Income
For calendar year 2023
OMB No. 1545-0112
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
8 Tax-exempt interest
11 Bond premium
15 State
Prairie State Savings 7171 Granite St Maplewood, MN 14362
81-1659470
Amara Adeyemi
ending in 9506
2078 Sample Street
Cedar Falls, IA 28368
2,596.24
$0.00
TX 4296057
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-0b1d91721217f7de5213e206,v11-1099-INT-columns,original,2023,fgen-d35b1b1a09e44a9fcebf300f,synthetic_programmatic_template,columns,top,False,
"Form 1099-INT Interest Income 2023
PAYER'S name:
RECIPIENT:
15 State
1 Interest income
Cedar Valley Credit Union
Alex Moreau
PA 9708744
$5,661.19",1099,5,1099,fdc-e8283a83d996b1ddb8ef94cd,v11-1099-INT-columns,original,2023,fgen-6cc75f2dcc59e9793f81f9ee,synthetic_programmatic_template,columns,top,False,
"Form 1099-INT
Interest Income
2025
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld
11 Bond premium
15 State
17 State tax withheld
Northwind Financial 9818 Lakeshore Blvd Brookhaven, PA 32292
55-9245539
Priya Testcase
ending in 1404
$4,055.91
0.00
IL 3577721
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-40cd07b61336ae27f63460d7,v11-1099-INT-columns,original,2025,fgen-85bba05f046d867de05b65b9,synthetic_programmatic_template,columns,top,False,
"Form 1099-INT Interest Income
From:
RECIPIENT:
1 Interest income
15 State
Cedar Valley Credit Union
Fatima J. Haddad
$6,127.14
GA 2815274",1099,5,1099,fdc-efea96132e856472318ec743,v11-1099-INT-columns,original,2024,fgen-c641b119b1f26374f4cfde52,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 1099-INT
Interest Income
For calendar year 2022
OMB No. 1545-0112
This isimportant tax information and is being furnished to the IRS.
PAYER'Sname, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S namc
RECIPIENT'S TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Interest income
2 Early withdrawal penalty
3 Interest on U.5. Savings Bonds and Treasury obligations
4 Federal income tax withheld
5 Investment expenses
ll Bond premium
15 State
17State tax withheld
Prairie State Savings3263 Granite St Brookhaven, PA 96017
83-3613804
Amara Kowa1skí
XXX-XX-1361
3028 Maple Ridge Dr
Brookhaven, PA 73267
ending in 814128
4,042.92
0.00
0.00
0H 5176504
Department of the Treasury - Intemal Revenue Service
Form 1099-INT (keep for your records)  www.írs.gov/Form1099INT",1099,5,1099,fdc-b828672c653ed0f170176a1f,v11-1099-INT-columns,original,2022,fgen-343a737bca01fdba57e243c1,synthetic_programmatic_template,columns,top,True,
"## Form 1099-INT Interest Income 2023
| Field | Value |
| --- | --- |
| PAYER: | Lakeshore National Bank |
| RECIPIENT: | Lena L. Haddad |
| 1 Interest income | 4,238.67 |
| 15 State | GA 4637063 |",1099,5,1099,fdc-f314fc4d5a13b9d1ecc32488,v11-1099-INT-markdown,original,2023,fgen-f15085f06df61fd7e15ee397,synthetic_programmatic_template,markdown,top,False,
"Form 1099-INT
Interest Income
Forcalendar year 2023
OMB No. 1545-0112
Copy B For Recípient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, cityor town, state or province, country, ZIP or foreign postal code, and telephone no. | Riverbend Bank & Trust 8975 Granite StBayside, WA 65354|
| PAYER'S TIN | 36-9622097 |
| RECIPIENT'S namc | Morgan J. Kowa1ski |
| RECIPIENT'S TIN | XXXXX7270 |
| 5treet address (including apt. no.) | 5289 Prairic Ave |
| City or town,state or provincc, country, and ZIP or foreign postal code | Pinecrest, GA 53900 |
| Account number (see instructions) | ***-**-2564l9 |
| 1 Interest íncome | $1,194.92 |
| 2 Early withdrawal penalty | 0.00 |
| 4 Federal income tax withheld |  |
| 5 Investment expenses |  |
|8 Tax-exempt interest | $0.00 |
| l1 Bond premium | $0.00 |
| 15 State | IL 5124740 |
| 17 State tax withheld | 0.00 |",1099,5,1099,fdc-a5b45ed743b25182e5a4093e,v11-1099-INT-markdown,original,2023,fgen-45c27b3d54a09e9108bdd9da,synthetic_programmatic_template,markdown,top,True,
"2025
## Copy BFor Recipient
This is important tax information and isbeing furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and tclephone no. | Riverbend Bank & Trust 6195 Willow Bend Way Bayside, WA 77352 |
| PAYER'S TIN | 14-3105540 |
| RECIPIENT'5 name | Casey K. Romero |
| RECIPIENT'S TIN | ****7149 |
| Street address (induding apt. no.)| 3175 Cedar Ln |
| City or town, stateor province, country, and ZIP or foreign postal code | Riverton, WI 83336 |
| Account number (see instructions) | ***-**-991148 |
| 1 Interest income | 2,5O1.19 |
| 3 Interest on U.5. Savings Bondsand Treasuryob1igations | $O.00 |
| 4 Federal income tax withheld |  |
| 5 Investment expenses | 0.00 |
| 8 Tax-exempt interest | $0.00 |
| 11 Bond premium |  |
| 15 State | GA 4O90404 |
Department of the Treasury - Intemal Revenue Servíce
Form 1099-INT
Interest Income
Form 1099-INT (keep for your records)  www.írs.gov/Form1099INT",1099,5,1099,fdc-104e7dc927d8486fcbcd044f,v11-1099-INT-markdown,original,2025,fgen-b8b9efd2ecff5769f89ede7e,synthetic_programmatic_template,markdown,bottom,True,
"For calendar year 2022
This is important tax information and is being furnished to the IRS.
| Field | Value |
| ---| --- |
| PAYER'S name, streetaddress, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Northwind Financial 6869 Sample Street Fairview,OH 595O8 |
| PAYER'S TIN | 63-35348l3 |
| RECIPIENT'S name | Amara Fischer |
| RECIPIENT'S TIN | XXXXX7835 |
| Street address (inc1uding apt. no.) | 4035 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign posta1 code | Oak Grove, TX 4O872 |
| l Interest income |119.72 |
| 2 Early withdrawal penalty |O.00 |
| 3 Interest on U.5. Savings Bonds and Treasuryobligations |  |
| 4 Federal income tax withheld |  |
| 5 Investment expenses | S0.00 |
| 8 Tax-exempt interest |  |
| 11 Bond premium | 0.00 |
| 15 State | MN 9135394 |",1099,5,1099,fdc-ff2ea6985625fe21ebf14476,v11-1099-INT-markdown,original,2022,fgen-0b7c95bf27daaefb4961c5de,synthetic_programmatic_template,markdown,none,True,
"CORRECTED (if checked)
Form 1099-INT
Interest Income
## 2022
## OMB No. 1545-0112
| Field| Value |
| --- | --- |
|PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal codc, and telephone no. | Summit Ridge Bank 9067 Elm Park Pl Baysidc, WA 4504l|
| PAYER'S TIN | 84-1008474 |
| RECIPIENT'S name | Wei Moreau |
| RECIPIENT'S TIN | XXX-XX-9O45 |
| Streetaddress (including apt. no.) | 2488 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 23l93 |
| Account number (see instructions) | ending in 625246|
| 1 Interest income |$3,975.35 |
| 2 Early withdrawal penalty | 0.00 |
| 4 Federal income tax withhcld |  |
| 5 Investment expenses |  |
| 8 Tax-exempt interest | 0.00 |
| 11 Bond premium |  |
| 15 5tate | CO 8229628 |
| 17 5tate tax withheld |  |
Department of the Treasury - Intema1 Revenue 5ervíce
Form lO99-INT (keep for your records)  www.irs.gov/Form1O99INT",1099,5,1099,fdc-e47845639f35723f581ac7e2,v11-1099-INT-markdown,original,2022,fgen-edd46ffac27a2f246c3bfb61,synthetic_programmatic_template,markdown,top,True,
"For calendar year 2026
OMB No. 1545-0112
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Cedar Valley Credit Union 3867 Granite St Brookhaven, PA 97766 |
| PAYER'S TIN | 12-3461718 |
| RECIPIENT'S name | Lena A. Larsen |
| RECIPIENT'S TIN | ***-**-5517 |
| 1 Interest income | 953.49 |
| 2 Early withdrawal penalty | $0.00 |
| 3 Interest on U.S. Savings Bonds and Treasury obligations | 0.00 |
| 4 Federal income tax withheld |  |
| 8 Tax-exempt interest | 0.00 |
| 11 Bond premium | $0.00 |
| 15 State | GA 6945041 |
| 17 State tax withheld |  |",1099,5,1099,fdc-c0a4c03b641aefa9dc28892e,v11-1099-INT-markdown,original,2026,fgen-6c85e16399cbf3e5d22652af,synthetic_programmatic_template,markdown,none,False,
"VOID  CORRECTED
Form 1099-INT
Interest Income
OMB No. 1545-0112
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Granite Peak Bank 2196 Willow Bend Way Brookhaven, PA 58662 |
| PAYER'S TIN | 64-4034607 |
| RECIPIENT'S name | Wei Adeyemi |
| RECIPIENT'S TIN | XXXXX8301 |
| 1 Interest income | $2,106.81 |
| 2 Early withdrawal penalty |  |
| 3 Interest on U.S. Savings Bonds and Treasury obligations |  |
| 4 Federal income tax withheld |  |
| 8 Tax-exempt interest |  |
| 11 Bond premium | 0.00 |
| 15 State | TX 5157786 |
| 17 State tax withheld | 0.00 |
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-b13f5341680662f0cea1850f,v11-1099-INT-markdown,original,2024,fgen-9b0c1195e939320d12cf1bd6,synthetic_programmatic_template,markdown,top,False,
"Form 1099-INT
## Interest Income
## OMB No. 1545-0112
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Meadowlark Savings Bank 8254 Granite St Testville, IL 85928 |
| PAYER'S TIN | 73-3040382 |
| RECIPIENT'S name | Priya Kowalski |
| RECIPIENT'S TIN | ending in 1820 |
| Street address (including apt. no.) | 4901 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 97891 |
| 1 Interest income | 335.26 |
| 2 Early withdrawal penalty | 0.00 |
| 3 Interest on U.S. Savings Bonds and Treasury obligations |  |
| 4 Federal income tax withheld |  |
| 5 Investment expenses | $0.00 |
| 11 Bond premium |  |
| 15 State | MN 5791369 |
| 17 State tax withheld | 0.00 |
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-3235c075fefa14b1f3a976b8,v11-1099-INT-markdown,original,2023,fgen-82b31350bc577dbe1cac9d23,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| PAYER: | Northwind Financial |
| Recipient's name: | Alex M. Larsen |
| 15 State | GA 7037109 |
## Form 1099-INT Interest Income",1099,5,1099,fdc-77481513dcef3a516941bbc9,v11-1099-INT-markdown,original,2021,fgen-ecfdbebb34751761b1b2d0bf,synthetic_programmatic_template,markdown,bottom,False,
"## Form 1099-INT
Interest Income
2023
OMB No. 1545-0112
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Summit Ridge Bank 3622 Maple Ridge Dr Oak Grove, TX 32772 |
| PAYER'S TIN | 66-6243301 |
| RECIPIENT'S name | Morgan Romero |
| RECIPIENT'S TIN | ****0191 |
| Street address (including apt. no.) | 3654 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 80335 |
| 1 Interest income | $7,158.57 |
| 3 Interest on U.S. Savings Bonds and Treasury obligations | $0.00 |
| 4 Federal income tax withheld | $0.00 |
| 5 Investment expenses |  |
| 8 Tax-exempt interest |  |
| 11 Bond premium | 0.00 |
| 15 State | PA 2434349 |
| 17 State tax withheld |  |",1099,5,1099,fdc-1072baada7cc6c7f720f24af,v11-1099-INT-markdown,original,2023,fgen-1e07a563ff2edddf825503fe,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
Form 1099-INT
Interest Income
## 2023
OMB No. 1545-0112
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Cedar Valley Credit Union 1170 Granite St Pinecrest, GA 23323 |
| PAYER'S TIN | 47-6535568 |
| RECIPIENT'S name | Lena Castillo |
| RECIPIENT'S TIN | ****8023 |
| Street address (including apt. no.) | 5552 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 46934 |
| 1 Interest income | 7,068.52 |
| 2 Early withdrawal penalty |  |
| 3 Interest on U.S. Savings Bonds and Treasury obligations |  |
| 4 Federal income tax withheld |  |
| 5 Investment expenses | 0.00 |
| 8 Tax-exempt interest |  |
| 11 Bond premium |  |
| 15 State | CO 4548847 |
| 17 State tax withheld | $0.00 |
Department of the Treasury - Internal Revenue Service
Form 1099-INT (keep for your records)  www.irs.gov/Form1099INT",1099,5,1099,fdc-6fd71a785642896b21d847ee,v11-1099-INT-markdown,original,2023,fgen-6a0d6e3db7620ede84cbe57b,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
Form 1099-INT
## Interest Income
2021
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Harbor Federal Credit Union 933 Cedar Ln Riverton, WI 36320 |
| PAYER'S TIN | 64-4354689 |
| RECIPIENT'S name | Taylor M. Okafor |
| RECIPIENT'S TIN | XXXXX2048 |
| Street address (including apt. no.) | 9282 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Lakewood, CO 45766 |
| 1 Interest income | 2,378.79 |
| 3 Interest on U.S. Savings Bonds and Treasury obligations |  |
| 4 Federal income tax withheld | $0.00 |
| 5 Investment expenses |  |
| 8 Tax-exempt interest |  |
| 11 Bond premium |  |
| 17 State tax withheld |  |",1099,5,1099,fdc-5f8a07a87848eb41077be174,v11-1099-INT-markdown,original,2021,fgen-66636f0cb43d1ec43f72fe90,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-0112
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Riverbend Bank & Trust 9702 Granite St Testville, IL 23348 |
| PAYER'S TIN | 54-2833920 |
| RECIPIENT'S name | Diego D. Moreau |
| RECIPIENT'S TIN | XXXXX1057 |
| Street address (including apt. no.) | 4820 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 65915 |
| 1 Interest income | $3,162.65 |
| 2 Early withdrawal penalty |  |
| 4 Federal income tax withheld |  |
| 5 Investment expenses |  |
| 8 Tax-exempt interest |  |
| 11 Bond premium |  |
| 15 State | GA 4995198 |
| 17 State tax withheld |  |
## Form 1099-INT
Interest Income",1099,5,1099,fdc-2d30ac23601e5cf05bf5a8b1,v11-1099-INT-markdown,original,2022,fgen-533787cca20592d7a5f5c54d,synthetic_programmatic_template,markdown,bottom,False,
"Copy B For Recipient
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Cedar Valley Credit Union 1637 Willow Bend Way Oak Grove, TX 85751 |
| PAYER'S TIN | 94-1156337 |
| RECIPIENT'S name | Jamie Nguyen |
| RECIPIENT'S TIN | ***-**-4259 |
| 1 Interest income | 2,128.38 |
| 2 Early withdrawal penalty |  |
| 3 Interest on U.S. Savings Bonds and Treasury obligations | 0.00 |
| 5 Investment expenses | $0.00 |
| 8 Tax-exempt interest |  |
| 11 Bond premium | 0.00 |
| 15 State | TX 9993147 |
| 17 State tax withheld |  |",1099,5,1099,fdc-6fd519af2303889e251c7a5a,v11-1099-INT-markdown,original,2023,fgen-ba97bddffcfa6277dfe47672,synthetic_programmatic_template,markdown,none,False,
"Form 1099-INT Interest Income
| Field | Value |
| --- | --- |
| PAYER'S name: | Riverbend Bank & Trust |
| Recipient's name: | Taylor R. Nguyen |
| 15 State | CO 9944982 |
| 1 Interest income | $238.72 |",1099,5,1099,fdc-7f97b772165602291dd47137,v11-1099-INT-markdown,original,2021,fgen-33d16465fd6f5f897e1d3575,synthetic_programmatic_template,markdown,top,False,
"For calendar year 2021
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Lakeshore National Bank 3455 Granite St Pinecrest, GA 44553 |
| PAYER'S TIN | 57-1874757 |
| RECIPIENT'S name | Kwame Rivera |
| RECIPIENT'S TIN | XXX-XX-6245 |
| Street address (including apt. no.) | 1020 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 40975 |
| Account number (see instructions) | ending in 802297 |
| 1 Interest income | $2,920.35 |
| 2 Early withdrawal penalty |  |
| 3 Interest on U.S. Savings Bonds and Treasury obligations |  |
| 5 Investment expenses |  |
| 8 Tax-exempt interest |  |
| 11 Bond premium |  |
| 15 State | TX 2413580 |
| 17 State tax withheld | $0.00 |
Form 1099-INT
## Interest Income",1099,5,1099,fdc-ce72b691b5228aae5761834e,v11-1099-INT-markdown,original,2021,fgen-f9f09c57999b09e406dc63b2,synthetic_programmatic_template,markdown,bottom,False,
"CORRECTED (if checked)
Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2025
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PayStream Networks Inc. 6840 Cedar Ln Brookhaven, PA 12290
FILER'S TIN
74-9925884
PAYEE'S name
Priya Haddad
PAYEE'S TIN
XXXXX2759
1a Gross amount of payment card/third party network transactions
$104,192.67
1b Card Not Present transactions
$29,704.63
2 Merchant category code
523
3 Number of payment transactions
42
4 Federal income tax withheld
$0.00
5a January
6,205.77
5b February
6,074.38
6 State
TX 5463582
8 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-6d38cd734ce5f101e5c1a375,v11-1099-K-stacked,original,2025,fgen-c3736a620a4267b536566d91,synthetic_programmatic_template,stacked,top,False,
"Form 1099-K Payment Card and Third Party Network Transactions
FILER'S name:
Harbor Merchant Services
Recipient's name:
Kwame Walsh
1a Gross amount of payment card/third party network transactions
104,401.24
1b Card Not Present transactions
$139,077.99
5b February
$8,453.46",1099,5,1099,fdc-1ff3e6f9bd4e74f4e95a9e8a,v11-1099-K-stacked,original,2021,fgen-6c9b16ef1f940d7d260439b0,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1099-K
Payment Card and Third Party Network Transactions
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northwind Payments LLC 1485 Harbor View Rd Riverton, WI 37908
FILER'S TIN
82-6243459
PAYEE'S name
Jamie E. Nguyen
PAYEE'S TIN
XXX-XX-3707
Street address (including apt. no.)
5667 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 45090
1a Gross amount of payment card/third party network transactions
$85,492.61
1b Card Not Present transactions
28,417.63
2 Merchant category code
214
3 Number of payment transactions
412
4 Federal income tax withheld
0.00
5a January
$9,183.57
5b February
$7,437.67
5c March
$7,279.17
6 State
PA 9777522
8 State income tax withheld
0.00
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-9ba8647e86cad8df9a413849,v11-1099-K-stacked,original,2026,fgen-f4cba189864a37a58dd1a00b,synthetic_programmatic_template,stacked,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
2023
OMB No. 1545-2205
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PayStream Networks Inc. 8872 Granite St Fairview, OH 83639
FILER'S TIN
33-6911887
PAYEE'S name
Amara Romero
PAYEE'S TIN
****1019
Street address (including apt. no.)
7818 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 43361
1b Card Not Present transactions
101,640.36
2 Merchant category code
100
3 Number of payment transactions
363
4 Federal income tax withheld
$0.00
5a January
$863.26
5b February
$6,620.17
5c March
$3,889.07
6 State
MN 3770506
8 State income tax withheld
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-8b780010dd2f6748b5cabb19,v11-1099-K-stacked,original,2023,fgen-7ad178340ea44c84344ec558,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2023
OMB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northwind Payments LLC 9210 Sample Street Cedar Falls, IA 31677
FILER'S TIN
22-8069566
PAYEE'S name
Casey Brennan
PAYEE'S TIN
****3978
Street address (including apt. no.)
5254 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 37180
1a Gross amount of payment card/third party network transactions
68,247.56
1b Card Not Present transactions
80,614.22
2 Merchant category code
757
3 Number of payment transactions
805
4 Federal income tax withheld
5a January
$7,815.12
5b February
$7,632.94
5c March
$2,495.55
6 State
TX 9247193",1099,5,1099,fdc-39b27f71c0becaf18965b245,v11-1099-K-stacked,original,2023,fgen-b9e414f6b2f4a697326eecf9,synthetic_programmatic_template,stacked,none,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
2021
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PayStream Networks Inc. 4631 Cedar Ln Pinecrest, GA 35716
FILER'S TIN
43-1190993
PAYEE'S name
Noah Fischer
PAYEE'S TIN
XXX-XX-0792
Street address (including apt. no.)
1475 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 81286
Account number (see instructions)
****564664
1a Gross amount of payment card/third party network transactions
$60,936.20
1b Card Not Present transactions
91,906.50
2 Merchant category code
235
4 Federal income tax withheld
0.00
5a January
5,056.92
5b February
2,604.99
5c March
8,815.76
6 State
PA 9618491
8 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-5f14ea8cf9cbd761e99a5682,v11-1099-K-stacked,original,2021,fgen-bb80baff899db53a4539fca4,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2021
OMB No. 1545-2205
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PayStream Networks Inc. 3989 Granite St Brookhaven, PA 95856
FILER'S TIN
80-3290221
PAYEE'S name
Lena Sato
PAYEE'S TIN
****6012
Street address (including apt. no.)
7542 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 69108
1a Gross amount of payment card/third party network transactions
$46,966.51
2 Merchant category code
544
3 Number of payment transactions
886
5a January
2,826.57
5c March
363.23
6 State
WI 8940194
8 State income tax withheld
0.00",1099,5,1099,fdc-bb8f8c220523f401b8e0af64,v11-1099-K-stacked,original,2021,fgen-0ff1e954d5112e3f8c8edf98,synthetic_programmatic_template,stacked,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
2023
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PayStream Networks Inc. 6472 Sample Street Riverton, WI 33802
FILER'S TIN
49-1804727
PAYEE'S name
Amara S. Nguyen
PAYEE'S TIN
XXXXX1959
Street address (including apt. no.)
5566 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 88343
1a Gross amount of payment card/third party network transactions
70,097.00
1b Card Not Present transactions
$138,599.97
2 Merchant category code
242
3 Number of payment transactions
697
4 Federal income tax withheld
0.00
5a January
$9,232.85
5b February
2,982.81
5c March
$5,232.80
6 State
PA 2094225",1099,5,1099,fdc-77cdfc741d00ff67a68cf1f2,v11-1099-K-stacked,original,2023,fgen-06421766787298df26429d35,synthetic_programmatic_template,stacked,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
OMB No. 1545-2205
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northwind Payments LLC 3797 Harbor View Rd Cedar Falls, IA 77820
FILER'S TIN
95-2526701
PAYEE'S name
Priya M. Testcase
PAYEE'S TIN
ending in 9407
1a Gross amount of payment card/third party network transactions
130,021.95
1b Card Not Present transactions
26,985.82
2 Merchant category code
348
3 Number of payment transactions
705
4 Federal income tax withheld
5a January
$4,401.73
5b February
7,439.39
6 State
IL 3388425
8 State income tax withheld",1099,5,1099,fdc-c58b6e526e03d36af4eaf6b4,v11-1099-K-stacked,original,2024,fgen-9ab49522076d02f0c18e3634,synthetic_programmatic_template,stacked,top,False,
"FILER:
Harbor Merchant Services
To:
Diego Larsen
1b Card Not Present transactions
$10,433.36
Form 1099-K Payment Card and Third Party Network Transactions 2024",1099,5,1099,fdc-d0b60b93b9b2146887203db0,v11-1099-K-stacked,original,2024,fgen-05913f6dd9bc71a97f5c07e0,synthetic_programmatic_template,stacked,bottom,False,
"Form 1099-K Payment Card and Third Party Network Transactions 2021
From:
Harbor Merchant Services
Recipient's name:
Amara Adeyemi
5c March
$4,848.33
1a Gross amount of payment card/third party network transactions
$2,131.08
3 Number of payment transactions
699
5b February
$6,143.50",1099,5,1099,fdc-5599bb82daa9e6b587b4bf3d,v11-1099-K-stacked,original,2021,fgen-a8dbdbe115c405b52f5b5043,synthetic_programmatic_template,stacked,top,False,
"Form 1099-K Payment Card and Third Party Network Transactions 2023
From:
PayStream Networks Inc.
RECIPIENT:
O1ivia Lindqvist
3Number of payment transactions
322
5c March
4,283.96",1099,5,1099,fdc-97767504d7bf3ab68fb98d54,v11-1099-K-stacked,original,2023,fgen-3dc30db0fd7b6c71596666b5,synthetic_programmatic_template,stacked,top,True,
"Form 1099-K Payment Card and Third PartyNetwork Transactions 2025
FILER'S name:
Northwind Payments LLC
RECIPIENT:
Ríley Romero
3 Number of payment transactions
352
5c March
9,199.99",1099,5,1099,fdc-4db0becce67ee33fda490238,v11-1099-K-stacked,original,2025,fgen-802dfee55bfe1974e94bac8b,synthetic_programmatic_template,stacked,top,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
2021
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PayStream Networks Inc. 3046 Lakeshore Blvd Cedar Falls, IA 29404
FILER'S TIN
82-7690731
PAYEE'S name
Avery R. Adeyemi
PAYEE'S TIN
XXX-XX-7542
Street address (including apt. no.)
7958 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 68938
1a Gross amount of payment card/third party network transactions
68,577.38
2 Merchant category code
284
3 Number of payment transactions
68
4 Federal income tax withheld
5a January
$2,267.70
5b February
5,483.30
6 State
OH 2615656
8 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-5d9b0b5054a91fdcbf141977,v11-1099-K-stacked,original,2021,fgen-5c0689c3af90f724ca7e71d7,synthetic_programmatic_template,stacked,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2026
OMB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Northwind Payments LLC 7777 Harbor View Rd Oak Grove, TX 25713
FILER'S TIN
65-1742573
PAYEE'S name
Jamie L. Kowalski
PAYEE'S TIN
XXXXX1052
Street address (including apt. no.)
2207 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 85054
1a Gross amount of payment card/third party network transactions
91,233.18
1b Card Not Present transactions
$16,624.30
2 Merchant category code
630
4 Federal income tax withheld
0.00
5a January
$4,052.70
5b February
$6,785.27
5c March
$7,234.04
6 State
IL 7876823
8 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-e0cdca8d3356cb8975077dea,v11-1099-K-stacked,original,2026,fgen-6558e10b0b214dbdac914889,synthetic_programmatic_template,stacked,top,False,
"Form1099-K
Payment Card and Third Party Network Transactions
2026
OMB No. 1545-2205
Copy B For Payee
Thís is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no.
Harbor Merchant Servíces 5226 Harbor View Rd Fairview, 0H 46723
FILER'STIN
78-9216277
PAYEE'S namc
Kwame Patel
PAYEE'S TIN
XXXXX0720
Street address(induding apt. no.)
7505 Lakeshore Blvd
City or town, stateor province, country, and ZIP or foreign postal code
Oak Grove, TX 85266
1a Gross amount of payment card/third party network transactions
69,274.86
1b Card Not Present transactions
8,310.76
2 Merchant category code
480
3 Number of payment transactions
7l7
4 Federal income tax withheld
5a January
$781.O7
5b February
5,611.77
5c March
5,295.24
6 State
IL 8727401
8 State income tax withheld",1099,5,1099,fdc-9919241de3859d48e27d93c3,v11-1099-K-stacked,original,2026,fgen-a3504e376e609b92703a8a1e,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
2021
OMB No. 1545-2205
This is important tax information and is being furnished to theIRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Pay5tream Networks Inc. 5312 Sample Street Pinecrest, GA 70543
FILER'S TIN  97-3479080
PAYEE'S name Jamie Walsh
PAYEE'STIN XXX-XX-1953
1b Card Not Present transactions      60,640.86
2 Merchant category code 354
3 Number of payment transactions     297
5a January      4,901.87
5b February $1,845.16
5c March $4,466.48
6 5tate C0 8173294
8 State income tax withheld
Department of the Treasury - Internal RevenueService",1099,5,1099,fdc-a2aefbe05dda6ea8e6a470e8,v11-1099-K-inline,original,2021,fgen-1e0507bf35102ae68b853913,synthetic_programmatic_template,inline,none,True,
"Form 1099-K Payment Card and Third Party Network Transactions 2026
From:  Harbor Merchant Services
To:  Diego R. Nguyen
5a January 4,451.50",1099,5,1099,fdc-84764814d9089ef87426d658,v11-1099-K-inline,original,2026,fgen-996fb5584677e892a6bf41a3,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2021
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.      PayStream Networks Inc. 7745 Harbor View Rd Cedar Falls, IA 25216
FILER'S TIN   71-8656263
PAYEE'S name   Hiro Larsen
PAYEE'S TIN      ****3449
1a Gross amount of payment card/third party network transactions  $94,722.82
1b Card Not Present transactions  38,069.56
2 Merchant category code   430
3 Number of payment transactions 20
5a January      1,571.04
5b February $8,678.59
5c March  3,032.39
6 State GA 5797679
8 State income tax withheld   $0.00",1099,5,1099,fdc-9b4e15ff7fb64b35d1213a5d,v11-1099-K-inline,original,2021,fgen-f1fd4752e54349a288ae237a,synthetic_programmatic_template,inline,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Harbor Merchant Services 7946 Sample Street Pinecrest, GA 39169
FILER'S TIN 53-6968714
PAYEE'S name  Casey Lindqvist
PAYEE'S TIN XXXXX2828
Street address (including apt. no.)      2093 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code  Lakewood, CO 28848
1b Card Not Present transactions   $4,395.32
3 Number of payment transactions  24
4 Federal income tax withheld
5a January   $5,437.86
5b February $523.95
5c March   $6,136.69
6 State      CO 6438586
8 State income tax withheld",1099,5,1099,fdc-c010bff17e8359d1ffb3066a,v11-1099-K-inline,original,2024,fgen-758f11765976eac9219d2619,synthetic_programmatic_template,inline,top,False,
"FILER:   Northwind Payments LLC
RECIPIENT: Olivia Brennan
5c March $2,593.44",1099,5,1099,fdc-7617d7be3a57ec9397fa5869,v11-1099-K-inline,original,2024,fgen-925f3c9cae905fdae169f945,synthetic_programmatic_template,inline,none,False,
"From:      PayStream Networks Inc.
Recipient's name:   Jamie Larsen
5b February 760.15",1099,5,1099,fdc-57c5372b3b5255f4e5e063fb,v11-1099-K-inline,original,2025,fgen-15767ca898e170457d0eb70c,synthetic_programmatic_template,inline,none,False,
"☐ CORRECTED
For calendar year 2026
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Harbor Merchant Services 4331 Elm Park Pl Lakewood, CO 61826
FILER'S TIN   38-8769093
PAYEE'S name  Sofia Okafor
PAYEE'S TIN      ending in 8931
Street address (including apt. no.) 4533 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code   Lakewood, CO 73397
1a Gross amount of payment card/third party network transactions  $106,120.02
2 Merchant category code   653
4 Federal income tax withheld
5a January 6,403.45
5b February  9,322.89
5c March  $3,851.27
6 State TX 3267679",1099,5,1099,fdc-e984cee5be9fbca28277c2da,v11-1099-K-inline,original,2026,fgen-51ec1865dcf9e15d13b880d7,synthetic_programmatic_template,inline,none,False,
"Form 1099-K
Payment Card andThird Party Network Transactions
2025
OMB No. 1545-2205
Copy B For Payee
Thisis important tax information and is being furnishedto the IR5.
FILER'S namc, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Payments LLC 4220 Harbor View Rd 0ak Grove, TX 60178
FILER'S TIN      66-5523611
PAYEE'S name Amara C. Walsh
PAYEE'S TIN XXXXX5843
1a Gross amount of payment card/third partynetwork transactions  56,067.99
1b Card Not Present transactions  $74,394.09
2 Merchant category code      964
3 Number of payment transactions  106
4 Federal incomc tax withheld
5a January  3,898.50
5b February $545.00
5c March $6,337.04
6 State  WI 8473003
8 State income tax withhe1d
Departmentof the Treasury - Intemal Revenue 5ervice
Form l099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-0f35a3bcb9b8ea82de94a934,v11-1099-K-inline,original,2025,fgen-8f7c01546a772d3ee4b0c80c,synthetic_programmatic_template,inline,top,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2025
FILER'5 name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   PayStream Networks Inc. 8452 GraniteSt Maplewood, MN 72874
FILER'S TIN  32-8292843
PAYEE'S namc      Casey A. Tanaka
PAYEE'S TIN ****7352
Street address (induding apt. no.)   957 0ak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code   Testville, IL 54324
la Gross amount of payment card/third party network transactions $1O6,978.33
1b Card Not Present transactions      2,251.59
4 Federal income tax withheld    0.00
5b February 2,916.58
5c March $5,445.59
6 5tate   OH4681277",1099,5,1099,fdc-6d2fa25a7d27f058850b5940,v11-1099-K-inline,original,2025,fgen-2449c57bb4f2a71b7f91f612,synthetic_programmatic_template,inline,top,True,
"From:      Harbor Merchant Services
RECIPIENT: Alex Larsen
2 Merchant category code   898
5c March $2,363.63
3 Number of payment transactions 893
6 State MN 9145463
Form 1099-K Payment Card and Third Party Network Transactions",1099,5,1099,fdc-cb80f659d9be8af91f46b168,v11-1099-K-inline,original,2023,fgen-ff2598f22f64ee9198baa761,synthetic_programmatic_template,inline,bottom,False,
"VOID  CORRECTED
Form 1099-K
Payment Card and Third Party Network Transactions
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Harbor Merchant Services 6204 Maple Ridge Dr Oak Grove, TX 30142
FILER'S TIN 21-5175209
PAYEE'S name   Jordan Nguyen
PAYEE'S TIN  ending in 9118
1a Gross amount of payment card/third party network transactions  $21,214.44
1b Card Not Present transactions   $52,627.99
2 Merchant category code 24
3 Number of payment transactions 971
4 Federal income tax withheld
5a January   $288.48
5b February 2,423.35
5c March   $4,452.80",1099,5,1099,fdc-f5748626be9a923555cb8e08,v11-1099-K-inline,original,2025,fgen-3ea9af1dbb6a23bb0209cd58,synthetic_programmatic_template,inline,top,False,
"2023
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Northwind Payments LLC 1186 Willow Bend Way Lakewood, CO 72157
FILER'S TIN  68-4631314
PAYEE'S name Lena Larsen
PAYEE'S TIN   XXX-XX-7991
1a Gross amount of payment card/third party network transactions  23,070.16
2 Merchant category code  452
3 Number of payment transactions   112
5a January 2,268.76
5b February      $1,237.87
5c March $7,190.10
6 State OH 1582002
8 State income tax withheld
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-86ed4299633bc49c337ce209,v11-1099-K-inline,original,2023,fgen-2d24902e5da383e845d47761,synthetic_programmatic_template,inline,none,False,
"VOID  CORRECTED
Form 1099-K
Payment Card and Third Party Network Transactions
OMB No. 1545-2205
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Northwind Payments LLC 2297 Prairie Ave Testville, IL 56447
FILER'S TIN 55-5461259
PAYEE'S name  Sofia Nguyen
PAYEE'S TIN XXX-XX-1220
Account number (see instructions) ending in 852900
1a Gross amount of payment card/third party network transactions 80,300.31
1b Card Not Present transactions      31,143.41
2 Merchant category code  832
3 Number of payment transactions   546
5a January $7,977.43
5b February  1,498.00
5c March   $7,580.85
6 State  GA 7879317
8 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-1c9e38348b6ad6b566c9305f,v11-1099-K-inline,original,2025,fgen-72637b9a634e8c3830cd5962,synthetic_programmatic_template,inline,top,False,
"FILER:  Northwind Payments LLC
Recipient's name: Avery Castillo
5a January 8,174.74
5b February  8,912.28
2 Merchant category code 212
1b Card Not Present transactions 6,228.39
Form 1099-K Payment Card and Third Party Network Transactions 2023",1099,5,1099,fdc-0e06ca9adb774ee63b21fa87,v11-1099-K-inline,original,2023,fgen-e8b6adf9caedfd3188f2585e,synthetic_programmatic_template,inline,bottom,False,
"FILER'S name:      Northwind Payments LLC
Recipient's name:      Amara M. Adeyemi
2 Merchant category code 940
5a January $8,985.92
Form 1099-K Payment Card and Third Party Network Transactions 2024",1099,5,1099,fdc-242ca7ab18aa000f562b5b6a,v11-1099-K-inline,original,2024,fgen-4c620dcf27654d357212a126,synthetic_programmatic_template,inline,bottom,False,
"From: Northwind Payments LLC
RECIPIENT: Casey Lindqvist
3 Number of payment transactions 767
1a Gross amount of payment card/third party network transactions      16,206.20
5a January  859.8l
5b February     $2,318.09",1099,5,1099,fdc-416701a433ce839e2231eb9d,v11-1099-K-inline,original,2025,fgen-a5e4652448886430882f7332,synthetic_programmatic_template,inline,none,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2025
OMB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Gross amount of payment card/third party network transactions
1b Card Not Present transactions
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
5a January
5b February
6 State
PayStream Networks Inc. 308 Granite St Pinecrest, GA 42197
85-5189480
Amara Larsen
XXXXX9903
6306 Elm Park Pl
Bayside, WA 45054
ending in 326794
$133,948.19
$77,378.19
508
506
$2,278.90
5,179.57
OH 8452661",1099,5,1099,fdc-f94f5ca34d8d1293ff54740e,v11-1099-K-columns,original,2025,fgen-d94848e1537a1c7f174e7607,synthetic_programmatic_template,columns,top,False,
"From:
Recipient's name:
5a January
6 State
3 Number of payment transactions
Northwind Payments LLC
Jordan Tanaka
6,399.72
OH 2374857
677",1099,5,1099,fdc-24717903ac71e33ffc1d4ffa,v11-1099-K-columns,original,2024,fgen-87ddc4c553021b0385180bb1,synthetic_programmatic_template,columns,none,False,
"For calendar year 2026
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1a Gross amount of payment card/third party network transactions
1b Card Not Present transactions
2 Merchant category code
5a January
5c March
8 State income tax withheld
Harbor Merchant Services 2613 Harbor View Rd Riverton, WI 10254
90-9396267
Jordan Moreau
XXXXX7028
7186 Granite St
Lakewood, CO 62394
42,870.11
45,564.14
929
7,270.95
2,346.81",1099,5,1099,fdc-2292ee3273b483da889a1771,v11-1099-K-columns,original,2026,fgen-f81f6690c64d829da02e61cb,synthetic_programmatic_template,columns,none,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
2022
OMB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Gross amount of payment card/third party network transactions
1b Card Not Present transactions
2 Merchant category code
3 Number of payment transactions
5a January
5c March
Harbor Merchant Services 8305 Elm Park Pl Lakewood, CO 58573
64-5332311
Jordan Brennan
****8192
6731 Granite St
Testville, IL 28770
***-**-627639
136,907.05
99,690.20
281
327
8,889.56
4,059.25
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-482c011212b17f8beb07f1fd,v11-1099-K-columns,original,2022,fgen-927fd7b88bf737fb780186de,synthetic_programmatic_template,columns,top,False,
"FILER:
To:
5b February
3 Number of payment transactions
2 Merchant category code
6 State
Northwind Payments LLC
Kwame Walsh
117.04
932
876
MN 3384006
Form 1099-K Payment Card and Third Party Network Transactions",1099,5,1099,fdc-19d65b8002f77acda9c0e862,v11-1099-K-columns,original,2026,fgen-5554ed37f062e241aa32f574,synthetic_programmatic_template,columns,bottom,False,
"For calendar year 2021
OMB No. 1545-2205
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Gross amount of payment card/third party network transactions
1b Card Not Present transactions
2 Merchant category code
4 Federal income tax withheld
5c March
6 State
8 State income tax withheld
PayStream Networks Inc. 4974 Maple Ridge Dr Maplewood, MN 26916
12-2142604
Hiro L. Moreau
***-**-6592
9107 Cedar Ln
Pinecrest, GA 41294
ending in 531638
47,507.95
104,637.26
889
7,169.75
MN 8882850",1099,5,1099,fdc-bb794e4801c84af6e9b88b3e,v11-1099-K-columns,original,2021,fgen-e1b7157c2743d09fa1ae0752,synthetic_programmatic_template,columns,none,False,
"Form 1099-K Payment Card and Third Party Network Transactions
FILER'S name:
To:
1b Card Not Present transactions
Northwind Payments LLC
Taylor Fischer
23,273.62",1099,5,1099,fdc-63175d217ae83fbcea319f64,v11-1099-K-columns,original,2024,fgen-8bc3040b2227a343fbe85be0,synthetic_programmatic_template,columns,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2024
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1a Gross amount of payment card/third party network transactions
1b Card Not Present transactions
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
5a January
5b February
5c March
6 State
Harbor Merchant Services 2352 Maple Ridge Dr Brookhaven, PA 89697
74-7923842
Amara Moreau
ending in 3759
1712 Maple Ridge Dr
Riverton, WI 94404
53,755.97
$101,591.58
502
734
$0.00
$8,763.04
$1,658.21
$5,002.68
GA 1865128",1099,5,1099,fdc-a5252de2277061162be23ee6,v11-1099-K-columns,original,2024,fgen-5b997b113cbdf14415f83bd7,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Form 1099-K
Payment Card and Third Party Network Transactions
2022
OMB No. 1545-2205
Copy B For Paycc
This is important tax informationand is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S namc
PAYEE'S TIN
1a Gross amount of payment card/thírd party network transactions
1b Card Not Present transactions
2 Merchant category code
4 Federa1 income tax withheld
5a January
5b February
5c March
6 5tate
8 Stateincome tax withheld
Northwind Payments LLC 322l ElmPark Pl Maplewood, MN 81002
52-3048428
Taylor J. Kowalski
XXXXX1757
7,925.35
$104,018.53
337
0.00
1,635.52
2,465.82
7,709.50
IL 2065274",1099,5,1099,fdc-c48d7562256384a08782d997,v11-1099-K-columns,original,2022,fgen-cda219983254312e2f1ad76f,synthetic_programmatic_template,columns,top,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
2021
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Gross amount of payment card/third party network transactions
1b Card Not Present transactions
3 Number of payment transactions
4 Federal income tax withheld
5a January
5b February
5c March
6 State
8 State income tax withheld
Harbor Merchant Services 9787 Elm Park Pl Testville, IL 38365
82-1313630
Amara Moreau
****4730
2014 Prairie Ave
Fairview, OH 10173
ending in 286985
$29,565.19
50,377.26
258
4,169.27
8,507.63
$3,448.26
CO 9384011",1099,5,1099,fdc-590e5a065dc376cb22014410,v11-1099-K-columns,original,2021,fgen-db0f751697f7123dbdaed3a9,synthetic_programmatic_template,columns,top,False,
"2021
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1a Gross amount of payment card/third party network transactions
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
5a January
5b February
6 State
8 State income tax withheld
Harbor Merchant Services 6046 Harbor View Rd Cedar Falls, IA 13274
97-1382073
Amara Okafor
XXXXX7824
5061 Sample Street
Oak Grove, TX 19349
***-**-820881
87,075.08
898
719
$0.00
$1,401.34
8,204.15
WI 3172216
Form 1099-K
Payment Card and Third Party Network Transactions",1099,5,1099,fdc-addd237701af8bd364bf1666,v11-1099-K-columns,original,2021,fgen-a97c91a76d99e139ae58b2ff,synthetic_programmatic_template,columns,bottom,False,
"FILER'S name:
Recipient'sname:
5c March
PayStream Networks Inc.
Olivia Kowalski
$2,163.03",1099,5,1099,fdc-2222895961ea738b82c3ddfd,v11-1099-K-columns,original,2025,fgen-8e8925f8f0b56d3a1c93e917,synthetic_programmatic_template,columns,none,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
OMB No. 1545-2205
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1a Gross amount of payment card/third party network transactions
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
5a January
5b February
5c March
6 State
8 State income tax withheld
PayStream Networks Inc. 4337 Lakeshore Blvd Bayside, WA 80247
29-2078471
Alex Kowalski
****2249
8563 Willow Bend Way
Cedar Falls, IA 94002
7,008.82
974
415
$46.25
7,561.19
1,706.56
WI 2174421
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-6fed62367f33c090030e8172,v11-1099-K-columns,original,2025,fgen-29e5338673513e689b9ec6f7,synthetic_programmatic_template,columns,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2025
0MB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'5 TIN
PAYEE'S name
PAYEE'S TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
la Gross amount of payment card/third party network transactions
1bCard Not Present transactions
4 Federa1 income tax withhe1d
5a January
5b February
5c March
6 5tate
8 State income taxwithheld
Harbor Merchant Services9531 Granite St Riverton, WI 83686
44-19O3691
Fatima Nguyen
****1598
51O7 Maple Ridge Dr
Lakewood, CO 76966
XXX-XX-311496
S7O,974.86
$134,532.45
$0.00
$5,616.31
$365.94
5,512.92
OH 6888891
O.00",1099,5,1099,fdc-912af2d438503103e15604f6,v11-1099-K-columns,original,2025,fgen-61e38407c525b4d5963a08ed,synthetic_programmatic_template,columns,top,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2024
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'S TIN
PAYEE'S name
PAYEE'S TIN
1a Gross amount of payment card/third party network transactions
1b Card Not Present transactions
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
5b February
5c March
6 State
8 State income tax withheld
PayStream Networks Inc. 7461 Granite St Bayside, WA 46558
96-9565016
Alex Fischer
***-**-6633
$115,036.22
18,295.45
169
681
$0.00
9,351.70
$8,950.29
PA 1733125
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-2682d7c16e7a98301dd2cbc4,v11-1099-K-columns,original,2024,fgen-8be9b4cf4501e0881be64190,synthetic_programmatic_template,columns,top,False,
"OMB No. 1545-2205
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
FILER'5 TIN
PAYEE'S namc
PAYEE'S TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
la Grossamount of payment card/third party network transactions
lb Card Not Present transactions
2 Merchant category code
3 Numberof payment transactions
5a January
5c March
Northwind Payments LLC 4647 Elm Park Pl Cedar Falls, IA 20086
51-6113746
Diego Romero
XXX-XX-3110
1875 Prairic Ave
Lakewood,C0 32535
***-**-392982
52,964.57
126,370.72
891
897
$4,262.60
7,558.31",1099,5,1099,fdc-2367f6ace51e555cb986cd26,v11-1099-K-columns,original,2023,fgen-f0c1826a0d7ed5f6c8934132,synthetic_programmatic_template,columns,none,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
2023
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northwind Payments LLC 7255 Granite St Testville, IL 64334
FILER'S TIN: 43-5914950
PAYEE'S name: Avery S. Okafor
PAYEE'S TIN: ***-**-4116
Account number (see instructions): ending in 927536
Line 1a Gross amount of payment card/third party network transactions: $45,319.57
Line 2 Merchant category code: 34
Line 4 Federal income tax withheld: 0.00
Line 5a January: $6,733.02
Line 5c March: $6,852.93
Line 6 State: OH 3425331
Line 8 State income tax withheld",1099,5,1099,fdc-2c3615f6b661d6747dcb5d5c,v11-1099-K-boxed,original,2023,fgen-86a49de7ea491844e2dfb938,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
Form 1099-K
Payment Card and Third Party Network Transactions
OMB No. 1545-2205
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northwind Payments LLC 5317 Maple Ridge Dr Testville, IL 70852
FILER'S TIN: 64-7774229
PAYEE'S name: Sofia A. Castillo
PAYEE'S TIN: ending in 6633
1b Card Not Present transactions: 38,929.40
2 Merchant category code: 825
3 Number of payment transactions: 11
4 Federal income tax withheld: $0.00
5a January: $8,696.39
5c March: $4,184.42
6 State: OH 7917636
8 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-f660592e963f40111423ebde,v11-1099-K-boxed,original,2023,fgen-dae7cd503e1876d4669f9316,synthetic_programmatic_template,boxed,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
OMB No. 1545-2205
Copy B For Payee
FILER'5 name,street address, city or town, statc or provincc, country, ZIP or foreign posta1 code, and telephone no.: PayStream Networks Inc. 84O Sample Street Riverton, WI 67468
FILER'S TIN: 72-8476539
PAYEE'S name: Noah Testcase
PAYEE'S TIN: XXXXX577l
Street address (induding apt. no.):5283 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 51778
1a Gross amount of payment card/third party network transactions: 119,199.85
1b Card Not Present transactíons: $43,135.82
2 Merchant category code: 391
3 Number of payment transactions: 376
4 Federal income tax withheld: $0.00
5a January: $3,604.97
5b February: 4,541.85
5c March:2,853.25
6 5tate:TX 4300658
8 State income tax withheld",1099,5,1099,fdc-b162ced3181c36cc36f35e0f,v11-1099-K-boxed,original,2025,fgen-db3b5b1d9854653ca4e735a2,synthetic_programmatic_template,boxed,top,True,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2023
OMB No. 1545-22O5
Copy B For Payee
This is important tax information and is being furnished to the IRS.
FILER'Sname, street address, cíty or town, state or province, country,ZIP or foreign postal code, and telephone no.: Northwind Payments LLC 3226 Map1e Ridge Dr Lakewood, CO 69l79
FILER'S TIN: 92-2844263
PAYEE'S name: Amara Lindqvist
PAYEE'S TIN: XXX-XX-5328
Street address (induding apt. no.): 2840 Cedar Ln
City or town, state or province, country, andZIP or foreign postal code: Bayside, WA 49521
Account number (see instructions): XXX-XX-332980
Box 1b Card Not Present transactions: S21,641.75
Box 2 Merchant category code: 603
Box 3 Number of payment transactions: 314
Box 4 Federal income tax withheld
Box 5b Fcbruary: 8,577.24
Box 6 5tate: GA 719441O
Box 8 State income tax withheld
Department of the Treasury -Intemal Revenue Servíce
Form1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-c3645b1d7bfe8a67104a7598,v11-1099-K-boxed,original,2023,fgen-98ead34c9b7ec14f6fbfe1bf,synthetic_programmatic_template,boxed,top,True,
"Form 1099-K Payment Card and Third Party Network Transactions 2023
FILER'S name:: PayStream Networks Inc.
Recipient's name:: Lena J. Castillo
Line 1a Gross amount of payment card/third party network transactions: 21,172.27
Line 6 State: IL 8651261",1099,5,1099,fdc-3b0e727664b8ddb5423e83f8,v11-1099-K-boxed,original,2023,fgen-a1ef77f2c068fdf2892faac7,synthetic_programmatic_template,boxed,top,False,
"Form 1099-K Payment Card and Third Party Network Transactions 2021
FILER:: PayStream Networks Inc.
To:: Priya Nguyen
2 Merchant category code: 528
3 Number of payment transactions: 576
5c March: $4,641.98
5a January: 6,189.68",1099,5,1099,fdc-8d4e18633a4d05921cb231c6,v11-1099-K-boxed,original,2021,fgen-814f361c6b5f329c786377f2,synthetic_programmatic_template,boxed,top,False,
"2022
OMB No. 1545-2205
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northwind Payments LLC 2711 Elm Park Pl Oak Grove, TX 86392
FILER'S TIN: 20-8175293
PAYEE'S name: Fatima Okafor
PAYEE'S TIN: XXXXX9831
Street address (including apt. no.): 7218 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 81897
Account number (see instructions): ***-**-655862
1a Gross amount of payment card/third party network transactions: $19,361.00
1b Card Not Present transactions: $137,493.95
2 Merchant category code: 848
3 Number of payment transactions: 686
4 Federal income tax withheld: 0.00
5a January: $7,938.95
5b February: 9,446.49
5c March: $521.73
6 State: IL 6302091
8 State income tax withheld
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-0565f873db369d2a198ce835,v11-1099-K-boxed,original,2022,fgen-3b1b778eaa8cb69fb815caf9,synthetic_programmatic_template,boxed,none,False,
"For calendar year 2025
OMB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Harbor Merchant Services 2999 Lakeshore Blvd Oak Grove, TX 27589
FILER'S TIN: 50-2665802
PAYEE'S name: Amara A. Okafor
PAYEE'S TIN: ***-**-1995
Street address (including apt. no.): 8210 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 33210
Account number (see instructions): XXXXX377709
1a Gross amount of payment card/third party network transactions: 128,038.28
1b Card Not Present transactions: 127,315.56
2 Merchant category code: 707
4 Federal income tax withheld: 0.00
5b February: 8,790.62
5c March: 4,479.60
6 State: GA 8736816
8 State income tax withheld: $0.00
Form 1099-K
Payment Card and Third Party Network Transactions",1099,5,1099,fdc-3d0e5d95830d21ae981b6956,v11-1099-K-boxed,original,2025,fgen-fe71e7f5420e8795dd0afce1,synthetic_programmatic_template,boxed,bottom,False,
"☐ CORRECTED
Form 1099-K
Payment Card and Third Party Network Transactions
OMB No. 1545-2205
This is important tax information and is being furnished to the IR5.
FILER'S name, street address, city or town, state or province, country,ZIP or foreign posta1 code, and te1ephone no.: Harbor Merchant Services 63O0 Granite St Brookhaven, PA48205
FILER'S TIN: 70-9892200
PAYEE'S name: O1ívia L. Kowalski
PAYEE'5 TIN: XXX-XX-9638
Account number (see instructions): XXXXX628179
Line 1a Gross amount of payment card/third party network transactions: $50,350.69
Line 1b Card Not Presenttransactions: $138,219.56
Líne2 Merchant category code: 21
Line 3 Number of payment transactions: 943
Line 4 Federal income tax withheld: 0.00
Line 5a January: 6,806.73
Line 5b February: $5,664.54
Line 6 State: C0 37l0509
Line 8 State income tax withheld",1099,5,1099,fdc-7c6a318c0c327ba897d7a70b,v11-1099-K-boxed,original,2026,fgen-9e379a459eb3dff14dca57b5,synthetic_programmatic_template,boxed,top,True,
"Form 1099-K Payment Card and Third Party Network Transactions 2024
FILER'S name:: Harbor Merchant Services
Recipient's name:: Diego Castillo
Box 1b Card Not Present transactions: $90,947.82
Box 2 Merchant category code: 443",1099,5,1099,fdc-213e2e242d03d3face488c64,v11-1099-K-boxed,original,2024,fgen-e8a6d37a081846efdde3623b,synthetic_programmatic_template,boxed,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
2023
OMB No. 1545-2205
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: PayStream Networks Inc. 4410 Willow Bend Way Bayside, WA 74185
FILER'S TIN: 69-5164002
PAYEE'S name: Sofia A. Rivera
PAYEE'S TIN: ***-**-0145
Street address (including apt. no.): 1596 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 67563
Account number (see instructions): ****981697
Box 1a Gross amount of payment card/third party network transactions: $62,384.88
Box 1b Card Not Present transactions: 27,996.47
Box 2 Merchant category code: 317
Box 3 Number of payment transactions: 946
Box 4 Federal income tax withheld
Box 5a January: $7,627.66
Box 5b February: $2,570.03
Box 5c March: $5,168.36
Box 6 State: CO 5064010
Box 8 State income tax withheld",1099,5,1099,fdc-3b40a9478d06797542fcc31d,v11-1099-K-boxed,original,2023,fgen-9f1df77337bf5019e842e7e0,synthetic_programmatic_template,boxed,top,False,
"Form 1099-K
Payment Card and Third Party Network Transactions
For calendar year 2021
OMB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, statc or province, country, ZIP or foreign postal code, and tclephone no.: Harbor Merchant Services 7750 Willow Bend Way Fairview, OH 48l52
FILER'S TIN: 54-8019422
PAYEE'S name: Jordan Castillo
PAYEE'S TIN: XXX-XX-5631
Streetaddress (including apt. no.): 9611 Willow Bend Way
City or town, state or province, country, and ZIP or foreignpostal code: Maplewood, MN 45745
Line 2 Merchant category code: 73l
Line 5b February: 8,4O8.51
Line 5c March: $7,841.29
Line 6 5tate: PA3860383
Line 8 State income tax withheld",1099,5,1099,fdc-9093c10025cabebebb1cc73e,v11-1099-K-boxed,original,2021,fgen-5076cde10a19f46b309dd9c3,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
For calendar year 2024
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northwind Payments LLC 5415 Oak Hollow Ct Testville, IL 93031
FILER'S TIN: 91-9660960
PAYEE'S name: Alex K. Testcase
PAYEE'S TIN: ending in 3259
Street address (including apt. no.): 2039 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 26254
Account number (see instructions): ending in 052950
Line 1a Gross amount of payment card/third party network transactions: 111,912.10
Line 1b Card Not Present transactions: $73,082.62
Line 2 Merchant category code: 891
Line 3 Number of payment transactions: 395
Line 4 Federal income tax withheld
Line 5b February: 1,329.03
Line 5c March: 2,975.87
Line 6 State: TX 4651075
Line 8 State income tax withheld
Department of the Treasury - Internal Revenue Service
Form 1099-K
Payment Card and Third Party Network Transactions
Form 1099-K (keep for your records)  www.irs.gov/Form1099K",1099,5,1099,fdc-534322fe6e281ce48641a5b1,v11-1099-K-boxed,original,2024,fgen-1429290d784e65a97dd23f61,synthetic_programmatic_template,boxed,bottom,False,
"CORRECTED (if checked)
For calendar year 2026
OMB No. 1545-2205
Copy B For Payee
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Northwind Payments LLC 4739 Harbor View Rd Brookhaven, PA 45384
FILER'S TIN: 54-1632448
PAYEE'S name: Avery Walsh
PAYEE'S TIN: XXXXX5674
Box 1a Gross amount of payment card/third party network transactions: $22,683.20
Box 1b Card Not Present transactions: $135,090.26
Box 2 Merchant category code: 505
Box 3 Number of payment transactions: 767
Box 4 Federal income tax withheld: 0.00
Box 5a January: 4,637.84
Box 5b February: 899.21
Box 6 State: OH 6782935
Box 8 State income tax withheld",1099,5,1099,fdc-f97254414f9bc5f841a69d30,v11-1099-K-boxed,original,2026,fgen-f65d17a406eb19a552666ffd,synthetic_programmatic_template,boxed,none,False,
"FILER:: PayStream Networks Inc.
Recipient's name:: Noah Walsh
Line 6 State: TX 1283429
Line 5a January: 9,279.33
Line 5b February: 5,090.16
Line 1b Card Not Present transactions: 97,654.06",1099,5,1099,fdc-0fb31842ed80cbcfa96e6e95,v11-1099-K-boxed,original,2026,fgen-b3b95c6d35301f5ae56fa015,synthetic_programmatic_template,boxed,none,False,
"FILER'S name:: PayStream Networks Inc.
Recipient's name:: Jordan Sato
Line 1a Gross amount of payment card/third party network transactions: 19,245.03
Line 5a January: 154.43
Line 3 Number of payment transactions: 285",1099,5,1099,fdc-969e334c59785f346cee0715,v11-1099-K-boxed,original,2024,fgen-a762f2c1465f7f8e04f3e2a5,synthetic_programmatic_template,boxed,none,False,
"For calendar year 2026
OMB No. 1545-0115
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Riverbend Landscaping 2444 Maple Ridge Dr Bayside, WA 56991
PAYER'S TIN  55-9502225
RECIPIENT'S name      Sofia Adeyemi
RECIPIENT'S TIN      XXXXX5966
Street address (including apt. no.) 8756 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code   Cedar Falls, IA 64057
Account number (see instructions)      XXX-XX-938174
1 Rents  87,876.52
2 Royalties   0.00
3 Other income $6,216.92
4 Federal income tax withheld   0.00
6 Medical and health care payments
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income  $129,840.05
Department of the Treasury - Internal Revenue Service
Form 1099-MISC
Miscellaneous Information
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-c7eb1ea9f0f2eddf7a5f2f93,v11-1099-MISC-inline,original,2026,fgen-34d1674ef2514489460bc7b5,synthetic_programmatic_template,inline,bottom,False,
"Form 1099-MISC
Miscellaneous Information
2024
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Copperline Consulting 8590 Maple Ridge Dr Fairview, OH 43370
PAYER'S TIN  95-9763964
RECIPIENT'S name Lena S. Rivera
RECIPIENT'S TIN XXX-XX-8701
1 Rents   49,456.00
3 Other income   $2,877.31
4 Federal income tax withheld
10 Gross proceeds paid to an attorney   $0.00
16 State tax withheld      0.00
18 State income   128,898.04",1099,5,1099,fdc-585190dd7bb0a9d7a91fd2b7,v11-1099-MISC-inline,original,2024,fgen-3129f3a591c68e113eebf665,synthetic_programmatic_template,inline,top,False,
"Form 1099-MISC Miscellaneous Information 2022
From:   Copperline Consulting
To: Mateo Rivera
3 Other income  7,214.69",1099,5,1099,fdc-017b071bd10111fb1c137e08,v11-1099-MISC-inline,original,2022,fgen-161b31bc912fd95c0a8d69e5,synthetic_programmatic_template,inline,top,True,
"Form 1099-MISC
Miscellaneous Information
For calendar year 2021
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Copperline Consulting 8595 Prairie Ave Pinecrest, GA 38381
PAYER'S TIN   33-2558096
RECIPIENT'S name Mateo Larsen
RECIPIENT'S TIN      ****0581
Street address (including apt. no.) 2620 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 62793
Account number (see instructions)   ****504860
1 Rents 113,290.25
2 Royalties
3 Other income 2,458.75
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney 0.00
16 State tax withheld
18 State income      $15,655.47
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-88e070bfda97d86ddbc0268f,v11-1099-MISC-inline,original,2021,fgen-78b0671b31834376c5b16fca,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1099-MISC
Miscellaneous Information
For calendar year 2026
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Bright Pixel Design LLC 5385 Oak Hollow Ct Maplewood, MN 97185
PAYER'S TIN  52-8150218
RECIPIENT'S name   Casey Testcase
RECIPIENT'S TIN   XXX-XX-1421
Street address (including apt. no.) 4999 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 73272
Account number (see instructions) ending in 017920
1 Rents $49,803.81
2 Royalties
4 Federal income tax withheld      0.00
6 Medical and health care payments   0.00
10 Gross proceeds paid to an attorney  0.00
16 State tax withheld
18 State income  72,581.67
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-4ecca117ad6535d6424b4165,v11-1099-MISC-inline,original,2026,fgen-bd9ffede1fceeb79a4123d1c,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
2023
OMB No. 1545-0115
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.      Bright Pixel Design LLC 3895 Cedar Ln Fairview, OH 93708
PAYER'S TIN 85-6679407
RECIPIENT'S name   Mateo E. Testcase
RECIPIENT'S TIN  ending in 0828
Street address (including apt. no.)      5152 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 13002
1 Rents $45,629.88
2 Royalties      0.00
3 Other income   $3,267.13
4 Federal income tax withheld   $0.00
6 Medical and health care payments   $0.00
10 Gross proceeds paid to an attorney
16 State tax withheld 0.00
Department of the Treasury - Internal Revenue Service
Form 1099-MISC
Miscellaneous Information
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-0b53f0043cd19e2c6947cc1b,v11-1099-MISC-inline,original,2023,fgen-f1096830e8435aaeb2d1a18c,synthetic_programmatic_template,inline,bottom,False,
"Form 1099-MISC Miscellaneous Information 2021
PAYER'S name:   Maple Street Bakery
RECIPIENT: Amara J. Tanaka
1 Rents   $127,353.51
18 State income  98,210.05
3 Other income 3,574.78",1099,5,1099,fdc-8536e6900deb95b875d5023f,v11-1099-MISC-inline,original,2021,fgen-3fa37d209e34f677c330e0e4,synthetic_programmatic_template,inline,top,False,
"Form 1099-MISC
Miscellaneous Information
2026
OMB No.1545-0115
Copy B For Rccípient
This is important tax information and is being fumished to the IR5.
PAYER'S name, street address, city or town,state or province, country, ZIP or foreign posta1 code, and telephone no.      Copperlíne Consulting 8462 Lakeshore Blvd Cedar Falls, IA 57716
PAYER'S TIN 44-5135193
RECIPIENT'Sname   01ivia Patel
RECIPIENT'S TIN ***-**-2008
Street address (including apt. no.)     4420 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign posta1 code      Ríverton, WI 47529
Account number (see instructions) XXX-XX-551373
1 Rents 139,315.69
2 Royalties
3 Other income l,990.40
4 Federal income tax withheld
6 Medical and health care payments $0.00
10 Gross proceeds paid toan attomey  0.00
16 5tate tax withheld
Department of the Treasury - Intemal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-de40ea42adbd5e76f581ffef,v11-1099-MISC-inline,original,2026,fgen-4542f2f3a9ed0447bffa156e,synthetic_programmatic_template,inline,top,True,
"Form 1099-MISC Miscellaneous Information 2026
From: Riverbend Landscaping
To: Sofia Nguycn
3Other income      $3,O59.98
18 State income      $64,234.79",1099,5,1099,fdc-f83a1ee213a71107ff733504,v11-1099-MISC-inline,original,2026,fgen-6961ec5645d077bdd16499e8,synthetic_programmatic_template,inline,top,True,
"Form 1099-MISC
Miscellaneous Information
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Riverbend Landscaping 5510 Lakeshore Blvd Cedar Falls, IA 58586
PAYER'S TIN 30-9420784
RECIPIENT'S name  Amara B. Tanaka
RECIPIENT'S TIN   XXXXX4358
Street address (including apt. no.) 2485 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code   Brookhaven, PA 78546
1 Rents   60,801.05
2 Royalties  $0.00
3 Other income  1,459.71
4 Federal income tax withheld  $0.00
6 Medical and health care payments   0.00
10 Gross proceeds paid to an attorney 0.00
16 State tax withheld      $0.00
18 State income      $25,629.74",1099,5,1099,fdc-29c9dfa88455c9ca3101c441,v11-1099-MISC-inline,original,2026,fgen-4a4db28910bcbafb8887be08,synthetic_programmatic_template,inline,top,False,
"Form 1099-MISC Miscellaneous Information 2021
PAYER'S name: Copperline Consulting
Recipient's name: Amara M. Walsh
1 Rents      111,293.70
18 State income   72,922.51
3 Other income $2,713.87",1099,5,1099,fdc-ada27b93b5223205c47114dc,v11-1099-MISC-inline,original,2021,fgen-92886b1beb69f1f3e1fcfbf3,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form 1099-MISC
Miscellaneous Information
For calendar year 2023
OMB No. 1545-0115
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.  Maple Street Bakery 5971 Harbor View Rd Lakewood, CO 37381
PAYER'S TIN 56-4361040
RECIPIENT'S name Riley R. Lindqvist
RECIPIENT'S TIN   ***-**-7810
Street address (including apt. no.)      1418 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code      Oak Grove, TX 32745
Account number (see instructions)      XXX-XX-556903
1 Rents      $122,146.54
3 Other income 5,102.24
4 Federal income tax withheld      0.00
6 Medical and health care payments  $0.00
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income 94,446.15
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-2fa4ca143072671d3ca19c5c,v11-1099-MISC-inline,original,2023,fgen-fbd08980932d0a8f38c2ec54,synthetic_programmatic_template,inline,top,False,
"Form 1099-MISC
Miscellaneous Information
OMB No. 1545-0115
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Maple Street Bakery 6849 Granite St Bayside, WA 42561
PAYER'S TIN 88-4091587
RECIPIENT'S name   Lena C. Kowalski
RECIPIENT'S TIN   XXXXX3797
Street address (including apt. no.) 9300 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code  Brookhaven, PA 20544
1 Rents $22,105.84
2 Royalties
3 Other income $6,759.02
4 Federal income tax withheld
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income 25,375.46",1099,5,1099,fdc-98327c984767d312fc1f9979,v11-1099-MISC-inline,original,2026,fgen-33e92bc7173751bec41e050d,synthetic_programmatic_template,inline,top,False,
"PAYER: Riverbend Landscaping
To:      Lena Okafor
3 Other income  8,187.61
18 State income 38,400.59
1 Rents 23,311.93",1099,5,1099,fdc-b3f6eee7723cb65d66338be8,v11-1099-MISC-inline,original,2026,fgen-9e3a1fecf78ec8f77cfc0cdd,synthetic_programmatic_template,inline,none,False,
"Form 1099-MISC
Miscellaneous Information
For calendar year 2025
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.   Bright Pixel Design LLC 4337 Sample Street Maplewood, MN 77747
PAYER'S TIN 10-1561735
RECIPIENT'S name Lena J. Fischer
RECIPIENT'S TIN XXXXX6537
Account number (see instructions)   ending in 452773
1 Rents 22,199.36
3 Other income      $9,169.44
4 Federal income tax withheld   $0.00
10 Gross proceeds paid to an attorney      $0.00
16 State tax withheld",1099,5,1099,fdc-7906dab121909f6bafe59ef1,v11-1099-MISC-inline,original,2025,fgen-2786e9bb159f33c51d99edab,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
2022
OMB No. 1545-0115
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 7675 Maple Ridge Dr Pinecrest, GA 87865
PAYER'S TIN 88-6483372
RECIPIENT'S name Taylor Nguyen
RECIPIENT'S TIN ending in 8062
Street address (including apt. no.) 7762 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code  Brookhaven, PA 90117
Account number (see instructions) ***-**-267697
1 Rents   25,854.22
2 Royalties
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney  $0.00
16 State tax withheld 0.00
18 State income $124,942.25
Form 1099-MISC
Miscellaneous Information",1099,5,1099,fdc-74164999ca14dbe8b9d00467,v11-1099-MISC-inline,original,2022,fgen-fa7c6c5ea177871dfb36decd,synthetic_programmatic_template,inline,bottom,False,
"VOID  CORRECTED
Form 1099-MISC
Miscellaneous Information
2025
OMB No. 1545-0115
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Rents
2 Royalties
3 Other income
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income
Maple Street Bakery 8669 Sample Street Oak Grove, TX 40326
93-8828508
Lena L. Castillo
****1499
9393 Sample Street
Maplewood, MN 66985
76,217.45
$5,618.06
0.00
0.00
107,774.40
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-0d16b285f46db87bec4a606c,v11-1099-MISC-columns,original,2025,fgen-8fe42ccad69799ad478b5738,synthetic_programmatic_template,columns,top,False,
"Form 1099-MISC
Miscellaneous Information
2021
OMB No. 1545-0115
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1 Rents
2 Royalties
3 Other income
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
16 State tax withheld
Copperline Consulting 670 Oak Hollow Ct Maplewood, MN 20868
55-5898696
Priya R. Larsen
ending in 4658
***-**-454688
$89,703.35
$0.00
$7,881.11
0.00",1099,5,1099,fdc-0082662bc8f3d9903dd54f8a,v11-1099-MISC-columns,original,2021,fgen-e192fb41981d0ddfec76bbea,synthetic_programmatic_template,columns,top,False,
"For calendar year 2025
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city ortown, stateor province, country, ZIP or foreign posta1 code, and te1ephonc no.
PAYER'STIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign posta1 code
2 Royalties
3 0ther income
4 Federal income tax withheld
6 Medical and health care payments
1O Gross proceeds paid to anattorney
16 State tax withheld
18 State income
Riverbend Landscaping 4711 Granite St Riverton, WI 36999
75-1137189
Jordan Tanaka
****2872
6542 0ak Ho1low Ct
Riverton, WI 21232
S9,O77.67
0.00
66,5l8.63
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-cba38754c72ac8c429023017,v11-1099-MISC-columns,original,2025,fgen-13edcb54115c284e54175aa7,synthetic_programmatic_template,columns,none,True,
"VOID  CORRECTED
For calendar year 2026
OMB No. 1545-0115
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Rents
2 Royalties
3 Other income
4 Federal income tax withheld
6 Medical and health care payments
16 State tax withheld
18 State income
Maple Street Bakery 9458 Harbor View Rd Testville, IL 75946
12-6659675
Hiro Testcase
XXXXX2385
1830 Maple Ridge Dr
Brookhaven, PA 87153
60,673.90
$0.00
$167.27
96,555.40
Department of the Treasury - Internal Revenue Service
Form 1099-MISC
Miscellaneous Information
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-715bd82026ef5c76a7c4d2de,v11-1099-MISC-columns,original,2026,fgen-f21f88fe8415b3845b35a3e0,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-MISC
Miscellaneous Information
For calendar year 2026
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
1 Rents
2 Royalties
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income
Bright Pixel Design LLC 1624 Willow Bend Way Riverton, WI 83545
42-8747046
Morgan S. Brennan
ending in 5744
72,851.67
0.00
79,155.97
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-6fb5cfbcd29635228c2e60c8,v11-1099-MISC-columns,original,2026,fgen-d3c744aa8f64012e7288a26e,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
For calendar year 2025
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Rents
2 Royalties
3 Other income
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
16 State tax withheld
Riverbend Landscaping 2869 Granite St Pinecrest, GA 62822
27-3622792
Lena Walsh
XXXXX0635
2491 Granite St
Brookhaven, PA 57305
47,627.39
2,504.55
$0.00
$0.00",1099,5,1099,fdc-2da73a90a74a871d5707050f,v11-1099-MISC-columns,original,2025,fgen-789fa4d4c028d721e48e2d98,synthetic_programmatic_template,columns,none,False,
"Form 1099-MISC
Miscellaneous Information
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Rents
2 Royalties
3 Other income
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
18 State income
Maple Street Bakery 4146 Willow Bend Way Riverton, WI 34459
13-7705527
Jamie A. Patel
****6544
250 Willow Bend Way
Fairview, OH 50096
***-**-107550
56,664.50
0.00
$3,881.52
$0.00
0.00
53,302.20
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-a8786bbe2702b9d5a84a6cf3,v11-1099-MISC-columns,original,2023,fgen-00de3164871976640f34df49,synthetic_programmatic_template,columns,top,False,
"Form 1099-MISC
Miscellaneous Information
For calcndar year 2025
OMB No. 1545-0115
This is important tax information and is being furnished to theIRS.
PAYER'S name,street address, city or town, state or province, country, ZIP or foreign posta1 code, and tc1ephone no.
PAYER'5 TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
3 0ther incomc
4 Federal income tax withheld
6 Medical and healthcare payments
16 State tax withheld
18 State income
Bright Pixe1 Design LLC 596 Prairie Ave Pinecrest, GA 65325
17-6467132
Morgan Adeyemi
****1087
***-**-015067
S5,873.60
$0.00
0.00
1,468.82
Department of the Treasury - Intemal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-eb76ad35f510b0e5e4618563,v11-1099-MISC-columns,original,2025,fgen-0f196edd95998ad9ed25cf58,synthetic_programmatic_template,columns,top,True,
"Form 1099-MISC Miscellaneous Information 2024
From:
RECIPIENT:
18 State income
3 Other income
Copperline Consulting
Sofia Kowalski
36,474.86
7,086.03",1099,5,1099,fdc-438c1953e95eefdb463cff83,v11-1099-MISC-columns,original,2024,fgen-49491292e0f34b1cb1dc049c,synthetic_programmatic_template,columns,top,False,
"PAYER:
RECIPIENT:
18 State income
3 Other income
1 Rents
Bright Pixel Design LLC
Riley Patel
$128,128.54
$1,275.86
$78,544.47
Form 1099-MISC Miscellaneous Information 2021",1099,5,1099,fdc-23944341c15066a2badd31e8,v11-1099-MISC-columns,original,2021,fgen-4798d1e0d6b4c3f613f4c33b,synthetic_programmatic_template,columns,bottom,False,
"From:
RECIPIENT:
1 Rents
Riverbend Landscaping
Fatima Kowalski
$53,335.23",1099,5,1099,fdc-e3abfc869f46fcb5e39fdd78,v11-1099-MISC-columns,original,2022,fgen-0fd81fc6db3ddf89ac0caf42,synthetic_programmatic_template,columns,none,False,
"Form 1099-MISC Miscellaneous Information 2025
From:
RECIPIENT:
3 Other income
18 State income
1 Rents
Riverbend Landscaping
Morgan Castillo
$3,512.09
$28,131.50
$129,904.03",1099,5,1099,fdc-2059f08c98c7c2dd8c478b9a,v11-1099-MISC-columns,original,2025,fgen-6170c67f1ff14f896b5c96a7,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1099-MISC
Miscellaneous Information
2026
OMB No. 1545-0115
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
2 Royalties
3 Other income
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income
Riverbend Landscaping 7829 Willow Bend Way Bayside, WA 73658
96-4413243
Noah Moreau
ending in 3800
XXX-XX-861533
$3,076.57
25,529.95
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-62d91131ec3f730168ba4c65,v11-1099-MISC-columns,original,2026,fgen-b84ef9535a394ac806cd68f7,synthetic_programmatic_template,columns,top,False,
"Form 1099-MISC
Miscellaneous Information
For calendar year 2026
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Rents
3 Other income
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income
Bright Pixel Design LLC 8299 Sample Street Maplewood, MN 25297
27-1866289
Avery Castillo
XXXXX6769
143 Willow Bend Way
Bayside, WA 90581
29,263.04
1,071.53
0.00
$0.00
63,044.14
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-baa099f61bedbfc063d2f86b,v11-1099-MISC-columns,original,2026,fgen-e739994cfd43cba6d9c394e6,synthetic_programmatic_template,columns,top,False,
"From:
To:
3 Other income
18 State income
1 Rents
Riverbend Landscaping
Fatima D.Patel
3,O58.90
$112,992.59
125,949.77
Form 1099-MISC Miscellaneous Information",1099,5,1099,fdc-39ccd4ee6d3a6e3025ebb6da,v11-1099-MISC-columns,original,2026,fgen-8bc98d00decf0645d4e2fae3,synthetic_programmatic_template,columns,bottom,True,
"Form 1099-MISC
Miscellaneous Information
2021
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
1 Rents
2 Royalties
3 Other income
4 Federal income tax withheld
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income
Riverbend Landscaping 4982 Willow Bend Way Brookhaven, PA 76600
20-8816632
Mateo Larsen
XXXXX9915
106,174.02
7,081.29
131,276.14
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-913d6b5573c460f7bcb5d91f,v11-1099-MISC-columns,original,2021,fgen-4b2a0ba05983814ef2c3253f,synthetic_programmatic_template,columns,top,False,
"PAYER:: Riverbend Landscaping
To:: Wei S. Nguyen
1 Rents: 129,748.90
3 Other income: $1,971.06",1099,5,1099,fdc-4f0fbffc9995233fb1ec4f09,v11-1099-MISC-boxed,original,2023,fgen-21da283af88df3319551944a,synthetic_programmatic_template,boxed,none,False,
"2022
OMB No. 1545-0115
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Maple Street Bakery 2958 Granite St Riverton, WI 52082
PAYER'S TIN: 31-9020267
RECIPIENT'S name: Alex Castillo
RECIPIENT'S TIN: XXX-XX-8215
Street address (including apt. no.): 8898 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 85493
Box 1 Rents: $122,572.47
Box 2 Royalties
Box 3 Other income: $4,599.90
Box 4 Federal income tax withheld
Box 6 Medical and health care payments: 0.00
Box 10 Gross proceeds paid to an attorney: $0.00
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-dc228e8bbe167a9f9ae75391,v11-1099-MISC-boxed,original,2022,fgen-ec94592c347a403a32ad7b77,synthetic_programmatic_template,boxed,none,False,
"Form 1099-MISC
Miscellaneous Information
For calendar year 2025
0MB No. l545-0115
Copy B For Recipient
This is important tax information and is being fumished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreígn posta1 code, and telephone no.: Copperline Consulting l60 Sample Street Oak Grove, TX 19890
PAYER'S TIN: 48-5392749
RECIPIENT'5 name: Noah Patel
RECIPIENT'S TIN: ***-**-8296
Account number (see ínstructions): XXXXXO45781
Box 1 Rents: $28,151.90
Box 3 Other income: 8,639.54
Box 4 Federal income taxwithheld:0.00
Box 6 Medical andhealth care payments
Box l0 Gross proceeds paid to an attorney
Box 16 State tax withheld
Box 18 State income: $120,906.43",1099,5,1099,fdc-4131a30246b3ebc57ea2d046,v11-1099-MISC-boxed,original,2025,fgen-8e413951e413096330b53b62,synthetic_programmatic_template,boxed,top,True,
"Form 1099-MISC
Miscellaneous Information
For calendar year 2024
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Landscaping 3548 Maple Ridge Dr Oak Grove, TX 68024
PAYER'S TIN: 94-3534800
RECIPIENT'S name: Amara A. Rivera
RECIPIENT'S TIN: ending in 8690
Box 1 Rents: $120,817.00
Box 2 Royalties: 0.00
Box 6 Medical and health care payments: $0.00
Box 10 Gross proceeds paid to an attorney: 0.00
Box 16 State tax withheld
Box 18 State income: 59,290.74
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-f936f01ff404a032f7cc6120,v11-1099-MISC-boxed,original,2024,fgen-9c1a00a6bcbb5b6fc52bc1e6,synthetic_programmatic_template,boxed,top,False,
"Form 1099-MISC
Miscellaneous Information
2021
OMB No. 1545-0115
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Landscaping 1307 Cedar Ln Brookhaven, PA 17894
PAYER'S TIN: 40-1822734
RECIPIENT'S name: Lena Testcase
RECIPIENT'S TIN: XXX-XX-1850
Street address (including apt. no.): 674 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 65247
Box 1 Rents: 40,287.82
Box 2 Royalties
Box 3 Other income: 2,104.33
Box 4 Federal income tax withheld
Box 6 Medical and health care payments: $0.00
Box 10 Gross proceeds paid to an attorney
Box 16 State tax withheld: 0.00
Box 18 State income: 71,130.89
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-bc2b553d292c31040b3f2bcd,v11-1099-MISC-boxed,original,2021,fgen-65e074f98aa0fabd9f290667,synthetic_programmatic_template,boxed,top,False,
"Form 1099-MISC
Miscellaneous Information
2023
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Landscaping 6547 Sample Street Maplewood, MN 21933
PAYER'S TIN: 62-8812804
RECIPIENT'S name: Jamie E. Sato
RECIPIENT'S TIN: ****8338
Street address (including apt. no.): 414 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 62439
Box 1 Rents: $87,234.53
Box 2 Royalties
Box 3 Other income: 5,718.91
Box 4 Federal income tax withheld: 0.00
Box 10 Gross proceeds paid to an attorney: $0.00
Box 16 State tax withheld: 0.00
Box 18 State income: 61,993.66
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-c2671e044a51afe974222096,v11-1099-MISC-boxed,original,2023,fgen-3184a1ac0c82b6345b25ba16,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
2022
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bright Pixel Design LLC 4974 Prairie Ave Bayside, WA 35912
PAYER'S TIN: 47-1191796
RECIPIENT'S name: Alex E. Nguyen
RECIPIENT'S TIN: XXX-XX-3788
Street address (including apt. no.): 7039 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 72070
Box 1 Rents: 115,067.59
Box 2 Royalties
Box 3 Other income: $1,771.49
Box 4 Federal income tax withheld: $0.00
Box 6 Medical and health care payments: 0.00
Box 10 Gross proceeds paid to an attorney
Box 16 State tax withheld
Box 18 State income: $39,620.96
Form 1099-MISC
Miscellaneous Information",1099,5,1099,fdc-df03ad5f5437b9f00c732c1c,v11-1099-MISC-boxed,original,2022,fgen-d46c7556889e80d98e209fe2,synthetic_programmatic_template,boxed,bottom,False,
"☐ CORRECTED
Form 1099-MISC
Miscellaneous Information
For calendar year 2025
OMB No. 1545-0115
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Copperline Consulting 2450 Maple Ridge Dr Maplewood, MN 22363
PAYER'S TIN: 75-4029865
RECIPIENT'S name: Hiro Sato
RECIPIENT'S TIN: ****6183
Street address (including apt. no.): 8173 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 19447
1 Rents: $75,420.54
2 Royalties: $0.00
3 Other income: $2,937.11
4 Federal income tax withheld
10 Gross proceeds paid to an attorney
16 State tax withheld
18 State income: $78,229.39",1099,5,1099,fdc-2552ae07ed97bdbc7cb37bc0,v11-1099-MISC-boxed,original,2025,fgen-95d3d898750034f3b1d3c9f9,synthetic_programmatic_template,boxed,top,False,
"From:: Riverbend Landscaping
RECIPIENT:: Priya Moreau
Line 18 State income: 122,305.39
Line 1 Rents: 23,390.41
Form 1099-MISC Miscellaneous Information 2022",1099,5,1099,fdc-1bab06e312a6e67f051a2031,v11-1099-MISC-boxed,original,2022,fgen-d9b4841bfb2910d730865679,synthetic_programmatic_template,boxed,bottom,False,
"Form 1099-MISC
Miscellaneous Information
2022
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Maple Street Bakery 7189 Elm Park Pl Cedar Falls, IA 86963
PAYER'S TIN: 30-8119697
RECIPIENT'S name: Amara Haddad
RECIPIENT'S TIN: ending in 1786
Street address (including apt. no.): 3894 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 21289
Box 1 Rents: $59,331.80
Box 2 Royalties
Box 3 Other income: 463.93
Box 4 Federal income tax withheld
Box 6 Medical and health care payments
Box 10 Gross proceeds paid to an attorney
Box 16 State tax withheld
Box 18 State income: $23,348.95
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-debc0a1292cef1c286df7b0d,v11-1099-MISC-boxed,original,2022,fgen-6f7d87c871b16d1861b84a28,synthetic_programmatic_template,boxed,top,False,
"Form 1099-MISC Miscellaneous Information
PAYER:: Bright Pixel Design LLC
Recipient's name:: Jamie C. Okafor
Line 1 Rents: $26,342.79
Line 3 Other income: $4,779.93
Line 18 State income: 47,015.41",1099,5,1099,fdc-80a3b28f0011d9bd4ef47a14,v11-1099-MISC-boxed,original,2023,fgen-35b87525a0e6ef01338dc70c,synthetic_programmatic_template,boxed,top,False,
"Form 1099-MISC
Miscellaneous Information
2022
OMB No. 1545-0115
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Maple Street Bakery 513 Prairie Ave Oak Grove, TX 28707
PAYER'S TIN: 14-1065106
RECIPIENT'S name: Avery Testcase
RECIPIENT'S TIN: XXXXX5111
2 Royalties
3 Other income: 8,563.63
4 Federal income tax withheld
6 Medical and health care payments
10 Gross proceeds paid to an attorney
18 State income: 21,176.37
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records)  www.irs.gov/Form1099MISC",1099,5,1099,fdc-f0cb3ca364bcb3bcf095db84,v11-1099-MISC-boxed,original,2022,fgen-f0b8252e7e6cbdfbe2063c9d,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1099-MISC
Miscellaneous Information
For calendar year 2021
OMB No. 1545-0115
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code,and telephone no.: Copperline Consulting 8665 Sample Street Brookhaven, PA 36414
PAYER'S TIN: 52-7O76386
RECIPIENT'S name: Lena Nguyen
RECIPIENT'S TIN: XXX-XX-5589
Street address (including apt. no.): 4O21 Harbor View Rd
City or town,state or province, country, and ZIP or foreígn posta1 code: Testville, IL 41071
Line 1 Rents: $139,422.41
Line 2 Royalties
Line 3 0thcr income: $5,949.87
Line 4 Federal income tax withheld: $0.00
Line 6 Medicaland healthcare payments
Line 10 Gross proceeds paid to an attorney
Line 16 5tate tax withhe1d
Line 18 State income: $126,492.28",1099,5,1099,fdc-2f38993ecd7e4945dd053c55,v11-1099-MISC-boxed,original,2021,fgen-ccc0fc2c6727a2e2459499d1,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked)
Form 1099-MISC
Miscellaneous Information
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Landscaping 9406 Willow Bend Way Cedar Falls, IA 38020
PAYER'S TIN: 14-6890090
RECIPIENT'S name: Diego M. Romero
RECIPIENT'S TIN: ****1924
Street address (including apt. no.): 4025 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 99508
1 Rents: $27,621.44
2 Royalties: 0.00
4 Federal income tax withheld
6 Medical and health care payments: $0.00
10 Gross proceeds paid to an attorney: 0.00
16 State tax withheld
18 State income: $125,443.11",1099,5,1099,fdc-c173c0e01490a53755146b95,v11-1099-MISC-boxed,original,2024,fgen-056740d064b53aa69d3f6cec,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
2024
OMB No. 1545-0115
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Copperline Consulting 6585 Cedar Ln Cedar Falls, IA 31509
PAYER'S TIN: 91-8602203
RECIPIENT'S name: Morgan Nguyen
RECIPIENT'S TIN: ending in 4400
Account number (see instructions): ***-**-622419
Box 2 Royalties
Box 3 Other income: 295.69
Box 4 Federal income tax withheld
Box 10 Gross proceeds paid to an attorney: 0.00
Box 16 State tax withheld
Box 18 State income: $123,213.00
Form 1099-MISC
Miscellaneous Information",1099,5,1099,fdc-2b8aeefdfe039ba5ed26328f,v11-1099-MISC-boxed,original,2024,fgen-bb9440e89d9ee7ed533089f4,synthetic_programmatic_template,boxed,bottom,False,
"CORRECTED (if checked)
Form 1099-MI5C
Miscellaneous Information
For calendar year 2021
Copy B For Recipient
This is important tax information and is being furnishcd to the IR5.
PAYER'S name, street address, city or town, state or province,country, ZIP or foreign postal code, and telephone no.: Copperline Consulting 2l78 Lakeshore Blvd Riverton, WI 13302
PAYER'S TIN: 23-3572854
RECIPIENT'S name: Morgan K. Testcase
RECIPIENT'S TIN: ***-**-4038
Street address (induding apt. no.): 3278 Cedar Ln
City or town, state or province, country, and ZIP or foreign posta1 code: Brookhaven, PA68876
Account number (see instructions): XXX-XX-705032
1 Rents: 57,853.71
2 Royalties
3 0ther income: S4,683.05
4Federal incomc tax withheld: $0.00
10 Gross proceeds paid to an attorney: $0.00
16 State tax wíthheld: 0.00
18 Statc income: $87,100.65
Department of the Treasury - Internal Revenue Service
Form 1099-MISC (keep for your records) www.irs.gov/Form1099MISC",1099,5,1099,fdc-560923e077421db0bd468a44,v11-1099-MISC-boxed,original,2021,fgen-749533191162c5d00deaa443,synthetic_programmatic_template,boxed,top,True,
"Form 1099-MISC Miscellaneous Information 2025 From:
Bright Pixel Design LLC To:
Jordan Adeyemi 3 Other income 8,594.38 18 State income 6,033.86 1 Rents $94,554.78",1099,5,1099,fdc-5dce547aa1662826dcccc864,v11-1099-MISC-flat,original,2025,fgen-a0092ac93d8f225d657a6e00,synthetic_programmatic_template,flat,top,False,
"From: Riverbend Landscaping
To: Sofia Haddad 18 State income 71,736.25 1
Rents 101,905.60 3 Other income 1,672.02",1099,5,1099,fdc-e8edb578bb332c1c6c5cdc20,v11-1099-MISC-flat,original,2025,fgen-579aacc65e0f7c393529a891,synthetic_programmatic_template,flat,none,False,
"Form 1099-MISC Miscellaneous Information For calendar year 2021 OMB No. 1545-0115 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Copperline Consulting 827 Oak Hollow Ct Oak
Grove, TX 68059 PAYER'S TIN 72-6926445 RECIPIENT'S name Mateo Walsh RECIPIENT'S TIN ***-**-9238 Account number (see instructions) ***-**-786530 1 Rents 87,943.38 2 Royalties 3 Other income 2,593.52 4 Federal income tax withheld 6 Medical and health care payments 10 Gross proceeds paid to an
attorney 16 State tax withheld 18 State income $135,464.05 Department of the Treasury - Internal Revenue Service Form 1099-MISC (keep for your records) www.irs.gov/Form1099MISC",1099,5,1099,fdc-8c60659d3769f48c5beb8956,v11-1099-MISC-flat,original,2021,fgen-367b94984b9bb0a33f94a35f,synthetic_programmatic_template,flat,top,False,
"Form 1099-MISC Miscellaneous
Information PAYER: Bright Pixel
Design LLC To: Mateo Sato 1 Rents 32,741.64",1099,5,1099,fdc-2615faf35f5fefab1dbd65e1,v11-1099-MISC-flat,original,2023,fgen-dae12fc0d003c04678255f8f,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if
checked) OMB No. 1545-0115 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code,
and telephone no. Riverbend Landscaping 8605 Cedar Ln Oak Grove, TX 12156 PAYER'S TIN 35-6834544 RECIPIENT'S name Mateo Brennan RECIPIENT'S TIN ending in 5830 1 Rents 88,266.14 2 Royalties 3 Other income $7,140.09 4 Federal income tax withheld 6 Medical and health care payments 10 Gross proceeds paid to an attorney 16 State tax withheld 18 State income $76,118.65 Department of the Treasury - Internal Revenue Service Form 1099-MISC Miscellaneous Information Form 1099-MISC (keep for your records) www.irs.gov/Form1099MISC",1099,5,1099,fdc-0fed12cc28e8dcfbe9dd3131,v11-1099-MISC-flat,original,2025,fgen-1456aef0ab69969cafe8680f,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2022 Copy B For Recipient This is important tax information and is being furnished
to the IRS. PAYER'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 399 Sample Street Pinecrest, GA 53961 PAYER'S TIN 97-4481397 RECIPIENT'S name Avery Lindqvist RECIPIENT'S TIN XXX-XX-2279 1 Rents $74,760.65 2 Royalties 4 Federal income tax withheld 0.00 6 Medical and health care payments 10 Gross proceeds paid to an attorney 16 State tax withheld",1099,5,1099,fdc-8f05332d23b36feb615a8152,v11-1099-MISC-flat,original,2022,fgen-c913f1487b72b073b051b6d5,synthetic_programmatic_template,flat,none,False,
"PAYER: Maple Street Bakery Recipient's name:
Casey Haddad 18 State income 49,998.70 3 Other income $4,220.61 1
Rents 51,079.79 Form 1099-MISC Miscellaneous Information",1099,5,1099,fdc-121b29f10aa65dff7405b57b,v11-1099-MISC-flat,original,2023,fgen-cd8d139cc67ac1c6b052bb3b,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-MISC Miscellaneous Information 2023 OMB No. 1545-0115 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Bright Pixel Design LLC 8100 Maple Ridge Dr Testville, IL 78798 PAYER'S TIN 55-7658476 RECIPIENT'S name Wei Testcase RECIPIENT'S TIN ***-**-1716 Street address (including apt. no.) 5966 Elm Park Pl City
or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 16648 3 Other income $2,174.46 4 Federal income tax withheld 6 Medical and health care payments $0.00 10 Gross proceeds paid to an attorney $0.00 16 State tax withheld
0.00 18 State income 107,607.94",1099,5,1099,fdc-a2efa47c445489b46fa9d52b,v11-1099-MISC-flat,original,2023,fgen-80a17e63bc943dbe29b1936b,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form l099-MISC Miscellaneous Information 2024 OMB No. 1545-0115 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S namc, street address, cíty or town, state
or province, country, ZIPor foreign postal code, and telephone no.Bright PixelDesign LLC
8571 0ak Hollow Ct Bayside, WA 59179 PAYER'5 TIN 62-3443411 RECIPIENT'S name Sofia M. Haddad RECIPIENT'S TIN ending in0325 Account number (see instructions) XXXXX798549 1 Rents 108,534.60 2 Roya1tíes $0.00 4 Federal income tax withheld $0.00 6 Medical and health care payments 10 Gross proceeds paid to an attorney 18 5tate income $114,485.05",1099,5,1099,fdc-f1ef556f1e770f2bed7b924b,v11-1099-MISC-flat,original,2024,fgen-a5b39bb3d9c53e7d69f4769d,synthetic_programmatic_template,flat,top,True,
"Form 1099-MISC Miscellaneous
Information From: Maple
Street Bakery RECIPIENT: Sofia Larsen 18Statc income 65,144.01",1099,5,1099,fdc-d5c315b6753bcedcc020d8c9,v11-1099-MISC-flat,original,2023,fgen-3ba0c57e5ebb0822ac97c407,synthetic_programmatic_template,flat,top,True,
"Form 1099-MISC Miscellaneous Information 2025 OMB No. 1545-0115 This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 1458
Lakeshore Blvd Fairview, OH 45650 PAYER'S TIN 84-6484261 RECIPIENT'S name Casey Rivera
RECIPIENT'S TIN ****0220 Account number (see instructions) ****261362 1 Rents $18,598.46 3 Other income $1,024.62 4 Federal income tax withheld $0.00 6 Medical and health care payments 10 Gross proceeds paid to an attorney 16 State tax withheld",1099,5,1099,fdc-94e5c581443a040b797e6340,v11-1099-MISC-flat,original,2025,fgen-d48cc7871a99e9a975dd3991,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED 2023 OMB No. 1545-0115 Copy B For Recipient PAYER'S name, street address, city or town, state or
province, country, ZIP or foreign postal code, and telephone no. Maple Street Bakery 9152 Willow Bend Way Testville, IL 38437 PAYER'S TIN 32-9704780 RECIPIENT'S name Hiro A. Castillo RECIPIENT'S TIN ****1099 1 Rents $26,277.48 2 Royalties 3 Other income 6,506.71 4 Federal income tax
withheld 10 Gross proceeds paid to an attorney 0.00 Form 1099-MISC Miscellaneous Information",1099,5,1099,fdc-746a215969d9ba736a97f5a9,v11-1099-MISC-flat,original,2023,fgen-8bd5bd5db43552d1dc929ffd,synthetic_programmatic_template,flat,bottom,False,
"2023 OMB No. 1545-0115 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 7718
Willow Bend Way Oak Grove, TX 22636 PAYER'S TIN 44-3300519 RECIPIENT'S name Jamie Walsh RECIPIENT'S TIN ending in 4654 Street address (including apt. no.) 5665 Oak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 45228 1 Rents 119,087.26 2 Royalties
0.00 3 Other income $8,788.70 4 Federal income tax withheld 6 Medical and health care payments 10 Gross proceeds paid to an attorney 16 State tax withheld $0.00 18 State income $132,442.58 Form 1099-MISC Miscellaneous Information",1099,5,1099,fdc-0384d289aabaf0b1bcd145cc,v11-1099-MISC-flat,original,2023,fgen-c8ef4a62d7ce5e10af62720b,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-MISC
Miscellaneous Information 2025 From: Copperline Consulting Recipient's name: Jamie
Moreau 18 State income $110,626.85 1 Rents 79,752.94 3 Other income $4,662.40",1099,5,1099,fdc-6bb8125a7b8ef4ebcad84b94,v11-1099-MISC-flat,original,2025,fgen-f36485581a6ed1c44f22b39f,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED For calendar year 2026
This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 3330 Prairie Ave Maplewood, MN
86466 PAYER'S TIN 88-4690269 RECIPIENT'S name Riley D. Patel RECIPIENT'S TIN XXX-XX-4142 Street address (including apt. no.) 9790 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 88121 Account number (see instructions) ****055258 1 Rents 18,834.51 2 Royalties 0.00 3 Other income 2,429.57 4 Federal income tax withheld 0.00 6 Medical and health care payments 10 Gross proceeds paid to an attorney 16 State tax withheld $0.00 18 State income 19,021.15 Form 1099-MISC Miscellaneous Information",1099,5,1099,fdc-7776302c0593889d2cb26048,v11-1099-MISC-flat,original,2026,fgen-acf5d348f9fb4edf337436a1,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2024 OMB No. 1545-0115 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Copperline Consulting 971 Maple Ridge Dr Lakewood, CO 75198 PAYER'S TIN
30-8814232 RECIPIENT'S name Mateo C. Nguyen RECIPIENT'S TIN XXXXX7372 Street address (including apt. no.) 9584 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 54740 1 Rents 91,484.57 2 Royalties $0.00 4 Federal income tax withheld 6 Medical and health care payments 10 Gross proceeds paid to an attorney 16
State tax withheld Department of the Treasury - Internal Revenue Service Form 1099-MISC Miscellaneous Information Form 1099-MISC (keep for your records) www.irs.gov/Form1099MISC",1099,5,1099,fdc-3f7b13ac3178a4037431fd50,v11-1099-MISC-flat,original,2024,fgen-765c4314ef95ec69eef84883,synthetic_programmatic_template,flat,bottom,False,
"Form 1099-NEC
Nonemployee Compensation
For calendar year 2024
OMB No. 1545-0116
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
7 State income
Maple Street Bakery 5956 Harbor View Rd Pinecrest, GA 88122
62-1240702
Olivia Rivera
XXXXX4014
1709 Oak Hollow Ct
Maplewood, MN 99696
[X]
0.00
$25,487.85",1099,5,1099,fdc-5653aeb3d0e7e25129d0d830,v11-1099-NEC-columns,original,2024,fgen-33687e0a9db5e2d62795dd54,synthetic_programmatic_template,columns,top,False,
"Form 1099-NEC Nonemployee Compensation
PAYER:
To:
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
1 Nonemployee compensation
6 State/Payer's state no.
Maple Street Bakery
Mateo R. Adeyemi
☐
93,015.65
IL 1904789",1099,5,1099,fdc-de66ea297301eb303931b55f,v11-1099-NEC-columns,original,2022,fgen-9ff276438d515168b7e90589,synthetic_programmatic_template,columns,top,False,
"Form 1099-NEC Nonemployee Compensation
PAYER'S name:
RECIPIENT:
7 State income
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
6 State/Payer's state no.
1 Nonemployee compensation
Copperline Consulting
Priya K. Sato
123,662.57
☐
IL 4561680
70,881.38",1099,5,1099,fdc-948fc4055ea54903d4c9202a,v11-1099-NEC-columns,original,2021,fgen-a66c7959469d15570af7b11e,synthetic_programmatic_template,columns,top,False,
"PAYER'S name:
RECIPIENT:
2 Payer made direct sales totaling S5,000 or moreof consumer products to recipient for resale
Bright Pixel Design LLC
Riley Tanaka
☐
Form l099-NEC Nonemployee Compensation",1099,5,1099,fdc-fe95fa3c89d96ac81c5d91e3,v11-1099-NEC-columns,original,2025,fgen-b2126aa90415d63b90624632,synthetic_programmatic_template,columns,bottom,True,
"OMB No. 1545-0116
Copy B For Recipient
This is importanttax information and is bcing furnished to the IRS.
PAYER'S name, street address, city or town, state or provínce, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S namc
RECIPIENT'S TIN
1 Nonemployee compensation
2 Payer made direct sales totaling$5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 Stateincome
Maple Street Bakery 5O15 Willow Bend Way Bayside, WA 97152
95-3O83475
Casey Kowalski
****8002
$41,431.12
[X]
$0.00
0.00
IL 4054570
38,321.15
Form 1099-NEC
Nonemployee Compensation",1099,5,1099,fdc-974d325551e74eabbcf5cfc5,v11-1099-NEC-columns,original,2021,fgen-33f8d4433dc3b3a369a84d87,synthetic_programmatic_template,columns,bottom,True,
"Form 1099-NEC
Nonemployee Compensation
For calendar year 2025
OMB No. 1545-0116
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP orforeign postal code
Account number (see instructions)
1 Nonemployee compensation
4Federal income tax withheld
6 State/Payer's state no.
7 5tate income
Riverbend Landscaping 6543 Elm Park Pl Lakewood, C0 82339
92-9l48150
Noah Fischer
XXXXX1630
6511 Lakeshore Blvd
Maplewood, MN 49498
****766944
14,875.63
0.00
MN 5849105
13,794.67
Department of the Treasury - Intemal Revenue Servíce
Form 1099-NEC(keep for your records)  www.írs.gov/Form1099NEC",1099,5,1099,fdc-fab19493e98e95a3e0d0c725,v11-1099-NEC-columns,original,2025,fgen-ed92247f908911a40a6521b7,synthetic_programmatic_template,columns,top,True,
"VOID  CORRECTED
2022
OMB No. 1545-0116
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Maple Street Bakery 980 Granite St Brookhaven, PA 85961
27-3013042
Avery Larsen
***-**-9507
1681 Elm Park Pl
Oak Grove, TX 81302
56,933.84
☐
$0.00
WI 2320705
$55,523.16
Form 1099-NEC
Nonemployee Compensation",1099,5,1099,fdc-5611cccdf0e1c7419e5b86c3,v11-1099-NEC-columns,original,2022,fgen-166a83774ea462deee9709d9,synthetic_programmatic_template,columns,bottom,False,
"☐ CORRECTED
Form 1099-NEC
Nonemployee Compensation
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Riverbend Landscaping 63 Prairie Ave Fairview, OH 97238
78-7441263
Casey E. Brennan
ending in 0920
9520 Maple Ridge Dr
Cedar Falls, IA 28650
$99,258.71
TX 1776617
$45,295.09
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-e4759147a7d4a882dfc8b27f,v11-1099-NEC-columns,original,2025,fgen-8f1e6370e5b7b7c575a2a4de,synthetic_programmatic_template,columns,top,False,
"Form 1099-NEC
Nonemployee Compensation
For calendar year 2022
0MB No. 1545-0116
Copy B For Recipient
Thisis important tax information and is being furnished to the IRS.
PAYER'S name, street address,city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Nonemployee compensation
4 Federalincome tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Copper1ine Consulting 6032 Maple Ridge Dr Cedar Falls, IA 98683
72-17681O3
Jordan Larsen
XXX-XX-7484
711O Wi1low Bend Way
Maplewood, MN 55842
****389437
114,402.18
IL 9486169
S13,158.85",1099,5,1099,fdc-ace63cfc9bf22fe97e243445,v11-1099-NEC-columns,original,2022,fgen-b57b1e3234c01119f45fe7b5,synthetic_programmatic_template,columns,top,True,
"CORRECTED (ifchecked)
Form 1O99-NEC
Nonemployee Compensation
For calendar year 2024
PAYER'S name, street address, city or town, stateor province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (índuding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
l Nonemployee compensation
2 Payermade direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Bright Pixel Design LLC 3926 Sample Street 0ak Grove, TX 10807
19-8426749
Jordan Castillo
XXXXX6643
6822 Maple Ridge Dr
Lakewood, CO 37325
80,299.03
☒
GA 1609443
5,151.30",1099,5,1099,fdc-7b0a04a301e37997e5bc0888,v11-1099-NEC-columns,original,2024,fgen-ed091bb887321b07c18667eb,synthetic_programmatic_template,columns,top,True,
"☐ CORRECTED
For calendar year 2025
OMB No. 1545-0116
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
Bright Pixel Design LLC 615 Lakeshore Blvd Maplewood, MN 99998
50-8047979
Jamie Sato
****1944
6351 Sample Street
Brookhaven, PA 72602
XXXXX900011
119,960.14
X
Department of the Treasury - Internal Revenue Service
Form 1099-NEC
Nonemployee Compensation
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-d43462fbc3dc195984cb308c,v11-1099-NEC-columns,original,2025,fgen-ffaa0f1b1d9066f4fcfeba0d,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-NEC
Nonemployee Compensation
2025
OMB No. 1545-0116
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
5 State tax withheld
6 State/Payer's state no.
7 State income
Riverbend Landscaping 2826 Prairie Ave Maplewood, MN 82853
31-8683479
Jamie Castillo
XXXXX3399
7330 Prairie Ave
Pinecrest, GA 74707
73,233.66
☐
MN 9066928
$129,409.32",1099,5,1099,fdc-d005d88c0ac6a76657f85322,v11-1099-NEC-columns,original,2025,fgen-03337d52787312840a7271a9,synthetic_programmatic_template,columns,top,False,
"Form 1099-NEC
Nonemployee Compensation
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Account number (see instructions)
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Maple Street Bakery 8381 Oak Hollow Ct Fairview, OH 10100
95-9696604
Diego M. Haddad
XXX-XX-9699
***-**-689476
$68,705.21
☒
0.00
0.00
GA 9251298
78,639.21
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-ae5472200f11fff40531b795,v11-1099-NEC-columns,original,2022,fgen-0efa14c31f515f4d4b5351b4,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Bright Pixel Design LLC 9878 Lakeshore Blvd Lakewood, CO 43806
18-6573820
Amara Walsh
XXX-XX-4897
4501 Cedar Ln
Testville, IL 73299
***-**-572214
$3,878.32
☐
0.00
TX 2395390
$112,400.74
Form 1099-NEC
Nonemployee Compensation",1099,5,1099,fdc-964e66d74bad86f745ec6d5b,v11-1099-NEC-columns,original,2023,fgen-4dba3516e07407b1178e6124,synthetic_programmatic_template,columns,bottom,False,
"CORRECTED (if checked)
Form 1099-NEC
Nonemployee Compensation
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Bright Pixel Design LLC 8660 Maple Ridge Dr Brookhaven, PA 29360
17-2679431
Morgan A. Patel
XXXXX6343
2693 Sample Street
Maplewood, MN 61486
80,655.22
[X]
$0.00
CO 6689011
$10,017.38
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-d61abfac41e7bec02eedef57,v11-1099-NEC-columns,original,2026,fgen-8f9f2f2ba1df7228f3f03a99,synthetic_programmatic_template,columns,top,False,
"Form 1099-NEC
Nonemployee Compensation
2021
OMB No. 1545-0116
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
1 Nonemployee compensation
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
4 Federal income tax withheld
5 State tax withheld
6 State/Payer's state no.
7 State income
Maple Street Bakery 7062 Cedar Ln Fairview, OH 26779
59-8768039
Noah K. Nguyen
***-**-7010
110,609.91
MN 3310451
$81,694.47",1099,5,1099,fdc-065eeafd14c1b9f873b11736,v11-1099-NEC-columns,original,2021,fgen-6303a43958aa1b4c15c2281b,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Form 1099-NEC
Nonemployee Compensation
2021
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Landscaping 6189 Willow Bend Way Riverton, WI 20699
PAYER'S TIN: 44-9648715
RECIPIENT'S name: Olivia R. Castillo
RECIPIENT'S TIN: XXX-XX-1246
Street address (including apt. no.): 7507 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 43743
Account number (see instructions): ****176767
1 Nonemployee compensation: 11,781.43
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: [X]
4 Federal income tax withheld: $0.00
5 State tax withheld: $0.00
7 State income: $40,249.38
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-b4aa750ee231709aa16b1d04,v11-1099-NEC-boxed,original,2021,fgen-eaa8db803997fadb77187df1,synthetic_programmatic_template,boxed,top,False,
"OMB No. 1545-0116
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Copperline Consulting 2436 Lakeshore Blvd Fairview, OH 11987
PAYER'S TIN: 65-5736714
RECIPIENT'S name: Hiro Testcase
RECIPIENT'S TIN: XXX-XX-3598
Street address (including apt. no.): 6239 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 31155
Account number (see instructions): ****930446
Box 1 Nonemployee compensation: $98,857.99
Box 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: ☒
Box 6 State/Payer's state no.: CO 5334077
Box 7 State income: $6,109.70
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-3b284ec5774cb89147660301,v11-1099-NEC-boxed,original,2026,fgen-1b4130d0bbbce0a85fb098c5,synthetic_programmatic_template,boxed,none,False,
"CORRECTED (if checked)
OMB No. 1545-0116
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bright Pixel Design LLC 4704 Lakeshore Blvd Pinecrest, GA 21924
PAYER'S TIN: 27-4471406
RECIPIENT'S name: Noah Patel
RECIPIENT'S TIN: ****5774
Street address (including apt. no.): 9669 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 49544
Line 1 Nonemployee compensation: $64,995.81
Line 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: ☒
Line 4 Federal income tax withheld
Line 5 State tax withheld
Line 6 State/Payer's state no.: PA 9524298
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-90cbfaa001b543e97734977d,v11-1099-NEC-boxed,original,2022,fgen-c8d19c96a39eed1d4993f5de,synthetic_programmatic_template,boxed,none,False,
"☐ CORRECTED
Form 1099-NEC
Nonemployee Compensation
For calendar year 2022
OMB No. 1545-0116
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Copperline Consulting 5690 Maple Ridge Dr Testville, IL 43853
PAYER'S TIN: 34-9680836
RECIPIENT'S name: Diego Moreau
RECIPIENT'S TIN: ending in 7977
Street address (including apt. no.): 1047 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 75158
Account number (see instructions): ****231059
Line 1 Nonemployee compensation: $37,384.45
Line 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: ☐
Line 4 Federal income tax withheld
Line 5 State tax withheld
Line 7 State income: 119,609.60
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-b8ca82c737ae8ea17657c59a,v11-1099-NEC-boxed,original,2022,fgen-303b882f4050eac653c9574f,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
For calendar year 2026
OMB No. 1545-0116
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Copperline Consulting 7414 Willow Bend Way Maplewood, MN 80114
PAYER'S TIN: 46-2026207
RECIPIENT'S name: Hiro Moreau
RECIPIENT'S TIN: ***-**-2123
Street address (including apt. no.): 2710 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 12747
Account number (see instructions): XXX-XX-339001
Line 1 Nonemployee compensation: 103,133.42
Line 4 Federal income tax withheld: $0.00
Line 5 State tax withheld
Line 6 State/Payer's state no.: MN 2308990
Line 7 State income: $25,401.82
Department of the Treasury - Internal Revenue Service
Form 1099-NEC
Nonemployee Compensation
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-95f474dbb1ee4a1e74119565,v11-1099-NEC-boxed,original,2026,fgen-8179f10dcaaab75f37228a3a,synthetic_programmatic_template,boxed,bottom,False,
"VOID  CORRECTED
2023
OMB No. 1545-0116
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Maple Street Bakery 5034 Sample Street Testville, IL 35222
PAYER'S TIN: 40-9571641
RECIPIENT'S name: Hiro Moreau
RECIPIENT'S TIN: XXX-XX-9923
Street address (including apt. no.): 894 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 93015
1 Nonemployee compensation: 42,647.95
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: [X]
6 State/Payer's state no.: WI 3743351",1099,5,1099,fdc-4bad8e61b6fbf8f8c2eb8619,v11-1099-NEC-boxed,original,2023,fgen-f22818e49e35255746680ff3,synthetic_programmatic_template,boxed,none,False,
"Form 1099-NEC Nonemployee Compensation
From:: BrightPixcl Design LLC
Recipient's name:: Diego Patel
1 Nonemployee compensation: $119,78O.55
6 State/Payer's state no.: TX 5847356
7 State income: $73,180.39
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: X",1099,5,1099,fdc-2386626131a77a9e0976516a,v11-1099-NEC-boxed,original,2024,fgen-3904f052889bbc4832cf0715,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked)
Form 1099-NEC
Nonemployee Compensation
2022
OMB No. 1545-0116
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bright Pixel Design LLC 3807 Sample Street Oak Grove, TX 42895
PAYER'S TIN: 40-4686283
RECIPIENT'S name: Jordan Lindqvist
RECIPIENT'S TIN: ending in 0796
Street address (including apt. no.): 1537 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 97785
1 Nonemployee compensation: $84,879.21
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
5 State tax withheld: 0.00
6 State/Payer's state no.: GA 7477053
7 State income: 8,622.78",1099,5,1099,fdc-84fc4640bd0e0a9788ad3cf8,v11-1099-NEC-boxed,original,2022,fgen-fd0dc4b38bb4aa08f0f258a0,synthetic_programmatic_template,boxed,top,False,
"Form 1099-NEC Nonemployee Compensation
From:: Map1e5treet Bakery
Recipient's name:: Lena Rivera
Line 1 Nonemployee compensation: $73,186.53
Line 2 Payer made direct sales totaling $5,O00 or more of consumer products to recipient for resale: X",1099,5,1099,fdc-d1e362f6d7034612354b9435,v11-1099-NEC-boxed,original,2023,fgen-0d0d675799e347dcf2649596,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
For calendar year 2021
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Copperline Consulting 5846 Oak Hollow Ct Testville, IL 76575
PAYER'S TIN: 54-8110853
RECIPIENT'S name: Fatima Adeyemi
RECIPIENT'S TIN: ****8681
Street address (including apt. no.): 770 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 37762
Box 1 Nonemployee compensation: 116,648.83
Box 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: [X]
Box 4 Federal income tax withheld
Box 6 State/Payer's state no.: OH 5363742
Box 7 State income: 58,526.62
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-41a5ac2f8df9e480db1906f8,v11-1099-NEC-boxed,original,2021,fgen-2866dad08d2eff774e3356fd,synthetic_programmatic_template,boxed,none,False,
"Form 1099-NEC
Nonemployee Compensation
For calendar year 2026
OMB No. 1545-0116
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Riverbend Landscaping 1529 Sample Street Bayside, WA 33794
PAYER'S TIN: 39-8989904
RECIPIENT'S name: Sofia A. Rivera
RECIPIENT'S TIN: XXX-XX-9365
Street address (including apt. no.): 8156 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 14609
Account number (see instructions): XXXXX476881
Box 1 Nonemployee compensation: $119,231.64
Box 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: [X]
Box 4 Federal income tax withheld: 0.00
Box 5 State tax withheld: $0.00
Box 6 State/Payer's state no.: GA 7457853
Box 7 State income: 80,231.42",1099,5,1099,fdc-ada910146595f8e2df33eb10,v11-1099-NEC-boxed,original,2026,fgen-59d6b267b3f0aff49211eb25,synthetic_programmatic_template,boxed,top,False,
"Form 1099-NEC
Nonemployee Compensation
For calendar year 2023
OMB No. 1545-0116
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bright Pixel Design LLC 1621 Oak Hollow Ct Pinecrest, GA 39928
PAYER'S TIN: 61-7474571
RECIPIENT'S name: Sofia Lindqvist
RECIPIENT'S TIN: ending in 2769
Street address (including apt. no.): 4649 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 36258
1 Nonemployee compensation: $15,968.07
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: X
5 State tax withheld: $0.00
6 State/Payer's state no.: GA 7473736
7 State income: $90,257.27",1099,5,1099,fdc-c72322f114916d675c1b45eb,v11-1099-NEC-boxed,original,2023,fgen-c0583202988eaf080a0fdc38,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1099-NEC
Nonemployee Compensation
2026
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Maple Street Bakery 3168 Maple Ridge Dr Testville, IL 34287
PAYER'S TIN: 16-3715722
RECIPIENT'S name: Lena A. Walsh
RECIPIENT'S TIN: XXX-XX-1529
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: ☒
4 Federal income tax withheld
5 State tax withheld: $0.00
6 State/Payer's state no.: WI 1045468
7 State income: 56,259.54
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-479618137505aa72165fa35e,v11-1099-NEC-boxed,original,2026,fgen-2a2a5b50a9f957c8269feab2,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1099-NEC
Nonemployee Compensation
For calendar year 2022
Copy B For Recipient
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.: Bright Pixel Design LLC 3154 Lakeshore Blvd Lakewood, CO 13722
PAYER'S TIN: 21-1589815
RECIPIENT'S name: Kwame E. Adeyemi
RECIPIENT'S TIN: ***-**-8922
Street address (including apt. no.): 9610 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 56087
1 Nonemployee compensation: 1,192.77
2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: [X]
4 Federal income tax withheld
5 State tax withheld: $0.00
6 State/Payer's state no.: WI 9367244
7 State income: $110,057.33
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-24a91799427084be6f64f64c,v11-1099-NEC-boxed,original,2022,fgen-f86223921bf2e448ee2ab464,synthetic_programmatic_template,boxed,top,False,
"Form 1099-NEC
Nonemployee Compensation
For calendar year 2025
PAYER'S name, street address, cíty or town,state or province, country, ZIP or foreign postal code, and telephone no.: Maple StreetBakery 183O Maple Ridge Dr Oak Grove, TX 42125
PAYER'S TIN: 11-3043110
RECIPIENT'S name: PriyaAdeyemí
RECIPIENT'S TIN: ending in 4416
Strcct address (induding apt. no.): 2334 Willow Bend Way
Cíty or town, state or province, country, and ZIP or foreign postal code:Bayside, WA 42347
Box l Nonemployee compensation: 84,489.21
Box 2 Payer made direct sales totaling $5,O00 or morc of consumer products to recipient for resale
Box 5 State tax withheld
Box 6 State/Payer's state no.: OH 271O560
Box 7 State income: 58,065.26
Department of the Treasury - Intema1 Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-fc52986af90d51604a7b6864,v11-1099-NEC-boxed,original,2025,fgen-9c8b871823acef9976e6379a,synthetic_programmatic_template,boxed,top,True,
"Form 1099-NEC Nonemployee Compensation 2022
PAYER'S name:: Copperline Consulting
To:: Fatima C. Rivera
Line 7 State income: 129,971.91
Line 1 Nonemployee compensation: 96,113.85
Line 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale: X",1099,5,1099,fdc-1e22493aa234640cf1e5c99d,v11-1099-NEC-boxed,original,2022,fgen-df8b0642ab7457f6f021574e,synthetic_programmatic_template,boxed,top,False,
"Form 1099-NEC Nonemployee Compensation For calendar year 2022 OMB No. 1545-0116 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Maple Street Bakery 5503 Cedar Ln Maplewood, MN 99377 PAYER'S TIN 50-5379458 RECIPIENT'S name Alex Romero RECIPIENT'S TIN ****6541 Account number (see instructions) ***-**-652379 1 Nonemployee compensation $74,235.28 2 Payer made
direct sales totaling $5,000 or more of consumer products to recipient for resale X 4 Federal income tax withheld $0.00 5 State tax withheld 0.00 6 State/Payer's state no. MN 2271608 7 State income 70,637.21 Department of the Treasury - Internal Revenue Service Form 1099-NEC (keep for
your records) www.irs.gov/Form1099NEC",1099,5,1099,fdc-c579672549dde7e51c8221d8,v11-1099-NEC-flat,original,2022,fgen-21cd84ddf5a174ec8f636b10,synthetic_programmatic_template,flat,top,False,
"Form 1099-NEC Nonemployee Compensation For calendar year 2024 OMB No. 1545-0116 Copy B For Recipient PAYER'S
name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 2059 Prairie Ave Brookhaven, PA 16381 PAYER'S TIN 57-7636749 RECIPIENT'S name Priya Brennan RECIPIENT'S TIN XXXXX3362
1 Nonemployee compensation 70,139.38 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale [X] 5 State tax withheld 0.00 6 State/Payer's state no. TX 1086243 7 State income $98,644.82",1099,5,1099,fdc-1da625c1794d25923dca03d7,v11-1099-NEC-flat,original,2024,fgen-8e3c3ca15a079c71778412a8,synthetic_programmatic_template,flat,top,False,
"Form 1099-NEC
Nonemployee
Compensation PAYER'S name: Bright Pixel Design LLC RECIPIENT: Avery Larsen 7 State income 105,375.03 1 Nonemployee compensation 40,290.05 6 State/Payer's state no. IL 3780758",1099,5,1099,fdc-25146cf26c1bb710c6994cdd,v11-1099-NEC-flat,original,2025,fgen-e75a01b5a948d09c7aa11a88,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 1099-NEC Nonemployee Compensation
For calendar year 2026 OMB No. 1545-0116 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or
town, state or province, country, ZIP or foreign postal code, and telephone no. Maple Street Bakery 261 Willow Bend Way Cedar Falls, IA 21521 PAYER'S TIN 50-4052690 RECIPIENT'S name Wei Castillo RECIPIENT'S TIN XXXXX6313 1 Nonemployee compensation 75,748.74 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale ☒ 4 Federal income tax withheld $0.00 5 State tax withheld 6 State/Payer's state no. TX 2061146 7 State income 131,123.03",1099,5,1099,fdc-a3b8bcce1f8c4fb8aab4eaa3,v11-1099-NEC-flat,original,2026,fgen-d59f639d6c8c129ae14b65f5,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 1099-NEC Nonemployee Compensation For calendar year 2026 OMB No. 1545-0116 Copy B For Recipient This is important tax information
and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 519 Granite St Oak Grove, TX 88617 PAYER'S TIN 54-7749154 RECIPIENT'S name Lena L. Adeyemi RECIPIENT'S TIN XXXXX5501 1 Nonemployee compensation 90,283.20 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale ☒ 4 Federal income tax withheld 0.00 5 State tax withheld 6 State/Payer's state no. IL 1483350 7 State income 81,260.52 Department of the Treasury - Internal Revenue Service Form 1099-NEC (keep for your records) www.irs.gov/Form1099NEC",1099,5,1099,fdc-a26ad7f9facae3133fbb0729,v11-1099-NEC-flat,original,2026,fgen-0f4e18b3a50923b4e58fe0ef,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Form 1099-NEC Nonemp1oyee Compensation 2025 Copy B For Recipient PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 5458 Maple Ridge Dr Brookhaven, PA 9O766 PAYER'S TIN 69-5541435 RECIPIENT'S name Diego R.Romero RECIPIENT'S TIN ***-**-4948
Street address (induding
apt. no.)2605 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Brookhaven,PA 93100 1 Nonemployee compensation $30,467.62 2 Payer made direct sales totaling $5,000 or more of consumer products to recípient for resale 4 Federal income tax withheld 55tate tax withheld 6 State/Payer's state no. OH 9646289 7 State income 63,933.49",1099,5,1099,fdc-b527cbb0befd5dfc96c87a43,v11-1099-NEC-flat,original,2025,fgen-509d78cfad58a14c45a0a701,synthetic_programmatic_template,flat,top,True,
"Form 1099-NEC Nonemployee Compensation For calendar year 2023 This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 5779 Harbor View Rd Riverton, WI 82775 PAYER'S TIN 15-6208681 RECIPIENT'S name Taylor Okafor RECIPIENT'S TIN ending in 1886
Account number (see instructions) ending in 613049 1 Nonemployee compensation 134,943.79 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale ☐ 4 Federal income tax withheld $0.00 6 State/Payer's state no. CO
4122953 7 State income 42,383.34 Department of the Treasury - Internal Revenue Service Form 1099-NEC (keep for your records) www.irs.gov/Form1099NEC",1099,5,1099,fdc-d33a3a0aae2a7d0760347817,v11-1099-NEC-flat,original,2023,fgen-ebe07f37c270ce8e1c2b2892,synthetic_programmatic_template,flat,top,False,
"Form 1099-NEC Nonemployee Compensation OMB No. 1545-0116 Copy B For Recipient PAYER'S name, street address, city or town,
state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 5668 Elm Park Pl Oak Grove, TX 16541 PAYER'S TIN 64-3443995 RECIPIENT'S name Amara Fischer RECIPIENT'S TIN XXX-XX-3855 Street address (including apt. no.) 1064 Sample Street City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 40496 1 Nonemployee compensation 135,873.50 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale [X] 4 Federal income tax withheld $0.00 6 State/Payer's state no.
WI 8265733 7 State income 39,364.50",1099,5,1099,fdc-ad5234ceb8804d39411746f5,v11-1099-NEC-flat,original,2021,fgen-b09669d1621479ea0b9488ca,synthetic_programmatic_template,flat,top,False,
"Form 1099-NEC Nonemployee Compensation 2022 PAYER'S name:
Copperline Consulting To: Wei Walsh 1 Nonemployee compensation 63,076.82 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale
X",1099,5,1099,fdc-56227a7928dd88c96c15c53f,v11-1099-NEC-flat,original,2022,fgen-62463861b1d54a4c83380a92,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Riverbend Landscaping 9624 Sample Street Riverton, WI 75504 PAYER'S TIN 15-7978660 RECIPIENT'S name Jamie E. Nguyen RECIPIENT'S TIN XXX-XX-5381 Account number (see instructions) ending
in 830693 1 Nonemployee compensation $10,625.51 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale ☐ 5 State tax withheld 6 State/Payer's state no. PA 7276198 7 State income 132,515.91 Department of the Treasury - Internal Revenue Service Form 1099-NEC Nonemployee Compensation Form 1099-NEC (keep for your records)
www.irs.gov/Form1099NEC",1099,5,1099,fdc-9d4fabc89a68248c88665614,v11-1099-NEC-flat,original,2021,fgen-c0f063e3f2c8a132d70bd5af,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2023 OMB No. 1545-0116 PAYER'S name, street address, city or town, state or province, country,
ZIP or foreign postal code, and telephone no. Bright Pixel Design LLC 5697 Harbor View Rd Oak Grove, TX 50941 PAYER'S TIN 47-1797687 RECIPIENT'S name Jordan Castillo RECIPIENT'S TIN XXX-XX-9175 1 Nonemployee compensation 65,015.02 2 Payer made direct sales totaling
$5,000 or more of consumer products to recipient for resale 5 State tax withheld 7 State income $4,378.25",1099,5,1099,fdc-6474d6590eb2740b9ae7a834,v11-1099-NEC-flat,original,2023,fgen-93c7f2887d836314c63f2479,synthetic_programmatic_template,flat,none,False,
"Form 1099-NEC Nonemployee Compensation 2026 OMB No. 1545-0116 Copy B For Recipient PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Maple Street
Bakery 3098 Sample Street Riverton,
WI 65973 PAYER'S TIN 26-8948715 RECIPIENT'S name Jordan Okafor RECIPIENT'S TIN XXX-XX-9945 Street address (including apt. no.) 5705 Granite St City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 75958 1 Nonemployee compensation $17,033.06 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale X 6 State/Payer's state no. CO 9617397 7 State income 127,846.41",1099,5,1099,fdc-f11c38353a8512df043866a2,v11-1099-NEC-flat,original,2026,fgen-68bd8acd256154842ab561a3,synthetic_programmatic_template,flat,top,False,
"For calendar year 2026 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Maple Street Bakery 2712 Granite St Lakewood, CO 44213 PAYER'S TIN 24-1787607 RECIPIENT'S name Olivia Adeyemi RECIPIENT'S TIN XXX-XX-5795 2 Payer made direct sales
totaling $5,000 or more of consumer products to
recipient for resale ☐ 4 Federal income tax withheld 5 State tax withheld 6 State/Payer's state no. CO 9524274 7 State income $66,951.25",1099,5,1099,fdc-1b994583135680ff6bfbebff,v11-1099-NEC-flat,original,2026,fgen-5a69f4fe96a45f1b707b07df,synthetic_programmatic_template,flat,none,False,
"☐ CORRECTED For calendar year 2026 OMB No. 1545-0116 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Bright Pixel Design LLC 4602 Lakeshore Blvd Fairview, OH 49405 PAYER'S TIN 71-3165074 RECIPIENT'S name Olivia Testcase
RECIPIENT'S TIN ending in 6252 Street address (including apt. no.) 3195 Granite St City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 26885 Account number (see instructions) ending in 065086 1 Nonemployee compensation $51,813.16 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale ☒ 6 State/Payer's state
no. TX 5410347 7 State income $86,790.62 Department of the Treasury - Internal Revenue Service Form 1099-NEC Nonemployee Compensation Form 1099-NEC (keep for your records) www.irs.gov/Form1099NEC",1099,5,1099,fdc-7d38f2a4f659f54b1cca6075,v11-1099-NEC-flat,original,2026,fgen-9472d07e2839081eef6e4144,synthetic_programmatic_template,flat,bottom,False,
"Form
1099-NEC Nonemployee Compensation 2026 PAYER'S name: Copperline Consulting To: Noah Lindqvist 7 State income $32,193.53
6 State/Payer's state no. GA 2873326 2 Payermade direct sales totaling $5,000 or more of consumer products to recipient for resale X",1099,5,1099,fdc-c55a76f09e414f1b7828d4a7,v11-1099-NEC-flat,original,2026,fgen-c2daa3c4e0d77247cf6c5fe3,synthetic_programmatic_template,flat,top,True,
"☐ CORRECTED
For calendar year 2021 This is important tax information and is being furnished to the IRS. PAYER'S name, street address, city or town, state or
province, country, ZIP or foreign postal code, and telephone no. Copperline Consulting 9383 Lakeshore Blvd Oak Grove, TX 96568 PAYER'S TIN 90-4378926 RECIPIENT'S name Hiro Walsh RECIPIENT'S TIN ***-**-3012 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale [X] 5 State tax withheld 6 State/Payer's state no. WI 3664704 7 State income 951.90 Department of the Treasury - Internal Revenue Service Form 1099-NEC Nonemployee Compensation Form 1099-NEC (keep for your records) www.irs.gov/Form1099NEC",1099,5,1099,fdc-23a8fff5530ad18872e56275,v11-1099-NEC-flat,original,2021,fgen-c30d427cf0b17279698d02e7,synthetic_programmatic_template,flat,bottom,False,
"## Form 1099-NEC
Nonemployee Compensation
## For calendar year 2026
OMB No. 1545-0116
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Maple Street Bakery 7848 Oak Hollow Ct Oak Grove, TX 52027 |
| PAYER'S TIN | 65-4275612 |
| RECIPIENT'S name | Mateo Walsh |
| RECIPIENT'S TIN | ending in 4769 |
| Street address (including apt. no.) | 7967 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Lakewood, CO 63925 |
| 1 Nonemployee compensation | 60,085.48 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale | ☒ |
| 4 Federal income tax withheld |  |
| 5 State tax withheld | $0.00 |
| 6 State/Payer's state no. | IL 4823132 |
| 7 State income | $59,663.62 |
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-44913ad073e63b4f4be98a8f,v11-1099-NEC-markdown,original,2026,fgen-e52b82c878f7f78d58417ded,synthetic_programmatic_template,markdown,top,False,
"Form 1099-NEC
## Nonemployee Compensation
2022
OMB No. 1545-0116
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Riverbend Landscaping 5552 Prairie Ave Riverton, WI 48473 |
| PAYER'S TIN | 38-7222359 |
| RECIPIENT'S name | Fatima Kowalski |
| RECIPIENT'S TIN | ***-**-2848 |
| Street address (including apt. no.) | 441 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 52460 |
| Account number (see instructions) | ending in 115255 |
| 1 Nonemployee compensation | $128,626.92 |
| 4 Federal income tax withheld | 0.00 |
| 6 State/Payer's state no. | TX 1269743 |
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-bf85e81a1a84e3db48b6e1dd,v11-1099-NEC-markdown,original,2022,fgen-144094472bd0e985e6e86423,synthetic_programmatic_template,markdown,top,False,
"Form 1099-NEC
Nonemployee Compensation
## 2024
## OMB No. 1545-0116
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Maple Street Bakery 6405 Lakeshore Blvd Brookhaven, PA 16550 |
| PAYER'S TIN | 11-3981526 |
| RECIPIENT'S name | Riley Tanaka |
| RECIPIENT'S TIN | XXXXX6871 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale |  |
| 5 State tax withheld |  |
| 6 State/Payer's state no. | MN 4772123 |
| 7 State income | 66,781.46 |
## Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-6604b5eff920650ced627233,v11-1099-NEC-markdown,original,2024,fgen-a7ae097ac458c5a7545b5556,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| PAYER'S name: | Riverbend Landscaping |
| Recipient's name: | Jamie K. Haddad |
| 7 State income | 19,117.81 |
## Form 1099-NEC Nonemployee Compensation 2025",1099,5,1099,fdc-e4a33c04bf010b9d89b647ad,v11-1099-NEC-markdown,original,2025,fgen-12c5381c46723f156be3b19e,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-NEC
Nonemployee Compensation
## For calendar year 2026
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Maple Street Bakery 990 Sample Street Cedar Falls, IA 24152 |
| PAYER'S TIN | 43-6449089 |
| RECIPIENT'S name | Alex Haddad |
| RECIPIENT'S TIN | ending in 8961 |
| Street address (including apt. no.) | 1613 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 90903 |
| Account number (see instructions) | XXXXX164289 |
| 1 Nonemployee compensation | $934.65 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale |  |
| 4 Federal income tax withheld | 0.00 |
| 6 State/Payer's state no. | PA 4601517 |
| 7 State income | $37,248.87 |
## Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-ae7f4c4fc0007db2fa1a350e,v11-1099-NEC-markdown,original,2026,fgen-40c689cceeb065a5f9523b05,synthetic_programmatic_template,markdown,top,False,
"Form 1099-NEC
Nonemployee Compensation
2021
OMB No. 1545-0116
## Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Riverbend Landscaping 8682 Willow Bend Way Pinecrest, GA 82815 |
| PAYER'S TIN | 98-8334451 |
| RECIPIENT'S name | Hiro C. Castillo |
| RECIPIENT'S TIN | ***-**-8780 |
| 1 Nonemployee compensation | $81,012.89 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale | X |
| 4 Federal income tax withheld | 0.00 |
| 5 State tax withheld | $0.00 |
| 6 State/Payer's state no. | IL 1096827 |
| 7 State income | $62,133.49 |
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-a47c7178f85039e5fc6ff698,v11-1099-NEC-markdown,original,2021,fgen-15b9b446899c1714d30bd98d,synthetic_programmatic_template,markdown,top,False,
"Form 1099-NEC
## Nonemployee Compensation
2022
OMB No. 1545-0116
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Bright Pixel Design LLC 6047 Granite St Cedar Falls, IA 29410 |
| PAYER'S TIN | 49-4340598 |
| RECIPIENT'S name | Diego Moreau |
| RECIPIENT'S TIN | ***-**-4531 |
| Street address (including apt. no.) | 5784 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 68044 |
| Account number (see instructions) | ending in 747702 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale |  |
| 4 Federal income tax withheld |  |
| 5 State tax withheld | 0.00 |
| 6 State/Payer's state no. | OH 1871425 |
| 7 State income | $99,181.84 |",1099,5,1099,fdc-2019593c84def50e2141986e,v11-1099-NEC-markdown,original,2022,fgen-9d67b6c89c77fcb049a08d47,synthetic_programmatic_template,markdown,top,False,
"Form 1099-NEC
Nonemployee Compensation
## 2022
## OMB No. 1545-0116
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Maple Street Bakery 8409 Cedar Ln Maplewood, MN 96813 |
| PAYER'S TIN | 14-5706889 |
| RECIPIENT'S name | Morgan K. Rivera |
| RECIPIENT'S TIN | ****1324 |
| Street address (including apt. no.) | 2795 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 98744 |
| 1 Nonemployee compensation | $72,410.33 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale |  |
| 4 Federal income tax withheld | $0.00 |
| 5 State tax withheld | $0.00 |
| 6 State/Payer's state no. | GA 9979989 |",1099,5,1099,fdc-493e304a08be73ef7b7bb479,v11-1099-NEC-markdown,original,2022,fgen-82d913f56ecfc170abc5f8ba,synthetic_programmatic_template,markdown,top,False,
"Form 1099-NEC Nonemployee Compensation 2022
| Field | Value |
| --- | --- |
| PAYER: | Maple Street Bakery |
| Recipient's name: | Casey R. Kowalski |
| 1 Nonemployee compensation | $125,947.31 |
| 6 State/Payer's state no. | WI 3584090 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale | ☐ |
| 7 State income | $96,327.33 |",1099,5,1099,fdc-39ca4474c2f3a5718e0009f0,v11-1099-NEC-markdown,original,2022,fgen-fa9c23d8daa8234a660aaac9,synthetic_programmatic_template,markdown,top,False,
"## 2022
OMB No. 1545-0116
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Copperline Consulting 6105 Maple Ridge Dr Testville, IL 20790 |
| PAYER'S TIN | 42-2016260 |
| RECIPIENT'S name | Priya Haddad |
| RECIPIENT'S TIN | ****7951 |
| Street address (including apt. no.) | 7720 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 65063 |
| 1 Nonemployee compensation | $59,695.92 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale | X |
| 4 Federal income tax withheld | $0.00 |
| 5 State tax withheld |  |
| 6 State/Payer's state no. | CO 6383787 |
| 7 State income | 107,721.13 |
Department of the Treasury - Internal Revenue Service
Form 1099-NEC
Nonemployee Compensation
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-4259a3182d03fceb00fb2fee,v11-1099-NEC-markdown,original,2022,fgen-1004a018f56215ae3f23f709,synthetic_programmatic_template,markdown,bottom,False,
"CORRECTED (if checked)
Form 1099-NEC
Nonemployee Compensation
2026
OMB No. 1545-0116
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Maple Street Bakery 9457 Lakeshore Blvd Oak Grove, TX 27964 |
| PAYER'S TIN | 61-8920093 |
| RECIPIENT'S name | Casey A. Fischer |
| RECIPIENT'S TIN | ****7649 |
| Street address (including apt. no.) | 1437 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 84289 |
| 1 Nonemployee compensation | $116,517.81 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale |  |
| 4 Federal income tax withheld |  |
| 5 State tax withheld |  |
| 6 State/Payer's state no. | IL 6644993 |
| 7 State income | 117,826.39 |",1099,5,1099,fdc-bea463ba417ddd340313f7f3,v11-1099-NEC-markdown,original,2026,fgen-577dd2ef72b904849daadc54,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
## Form 1099-NEC
Nonemp1oyee Compensation
## OMB No. 1545-0116
This is important tax information and is being furnished to theIR5.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Bright Pixel Design LLC 8112 Prairie Ave Testville, IL 60163 |
| PAYER'S TIN| 98-5704604 |
| RECIPIENT'S name | Sofia Kowalski |
| RECIPIENT'S TIN | ****4316 |
| Strcetaddress (induding apt. no.)|7058 Granite St |
| City or town, state or province, country, and ZIP or foreign posta1 code | Ríverton, WI 41939 |
| 1 Nonemployee compensation | 28,292.27 |
| 5 State tax wíthheld |  |
| 6 State/Payer's state no. | TX 5143668 |
| 7 State income | S53,806.08 |
Department of the Treasury - Internal Revenue 5ervice
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-ec63eb83a4e89d907e4d53b8,v11-1099-NEC-markdown,original,2023,fgen-366e8fceb22e11834f30af28,synthetic_programmatic_template,markdown,top,True,
"## CORRECTED (if checked)
## 2026
OMB No. 1545-0116
## Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Bright Pixel Design LLC 6581 Prairie Ave Testville, IL 88504 |
| PAYER'S TIN | 76-8504675 |
| RECIPIENT'S name | Mateo C. Castillo |
| RECIPIENT'S TIN | ending in 9095 |
| Street address (including apt. no.) | 3403 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 63201 |
| Account number (see instructions) | ending in 587006 |
| 1 Nonemployee compensation | 19,443.11 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale | ☐ |
| 4 Federal income tax withheld | $0.00 |
| 5 State tax withheld |  |
| 6 State/Payer's state no. | OH 1394309 |
| 7 State income | 32,903.11 |
Form 1099-NEC
Nonemployee Compensation",1099,5,1099,fdc-58c16be4f4e8011b53aaf6b7,v11-1099-NEC-markdown,original,2026,fgen-fe551458a0cd747d7bd15e11,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-NEC
## Nonemployee Compensation
2022
OMB No. 1545-0116
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Maple Street Bakery 4864 Maple Ridge Dr Lakewood, CO 92025 |
| PAYER'S TIN | 39-9485610 |
| RECIPIENT'S name | Alex Testcase |
| RECIPIENT'S TIN | XXXXX1725 |
| 1 Nonemployee compensation | $56,198.10 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale | [X] |
| 5 State tax withheld | $0.00 |
| 6 State/Payer's state no. | WI 2903008 |
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-7a327b756ad2357e5f340eab,v11-1099-NEC-markdown,original,2022,fgen-c4a73a1ea14ed1dde8646e4f,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
Form 1099-NEC
## Nonemployee Compensation
For calendar year 2021
## Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. | Bright Pixel Design LLC 7394 Willow Bend Way Oak Grove, TX 46078 |
| PAYER'S TIN | 17-9888602 |
| RECIPIENT'S name | Amara J. Nguyen |
| RECIPIENT'S TIN | XXXXX2220 |
| 1 Nonemployee compensation | 57,797.12 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale | ☒ |
| 4 Federal income tax withheld |  |
| 5 State tax withheld | $0.00 |
| 6 State/Payer's state no. | GA 4896931 |
| 7 State income | $17,981.44 |
Department of the Treasury - Internal Revenue Service
Form 1099-NEC (keep for your records)  www.irs.gov/Form1099NEC",1099,5,1099,fdc-282f3e75891fec3e6d472542,v11-1099-NEC-markdown,original,2021,fgen-24c9861706d7f5508165022f,synthetic_programmatic_template,markdown,top,False,
"Form 1099-NEC
Nonemployee Compensatíon
## For calendar year 2024
OMB No. 1545-0116
## This is important tax information and is being furnished to the IRS.
| Fie1d |Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, and telephone no. | Riverbend Landscaping 8827 Harbor ViewRd Bayside, WA 51152 |
| PAYER'S TIN | 50-9354495 |
| RECIPIENT'5 name | Kwamc Sato |
| RECIPIENT'S TIN | ending in 5497|
| Street address (induding apt. no.) | 2180 Willow Bend Way |
| City or town, state or province, country, and ZIP orforeign postal code | Brookhaven, PA 14749 |
| 1 Nonemployee compensatíon | 4O,993.49 |
| 2 Payer made direct sales totaling $5,000 or more of consumer products to recipient for resale |  |
| 4 Federal income taxwithheld |  |",1099,5,1099,fdc-037c3b5840c2bc756365b40a,v11-1099-NEC-markdown,original,2024,fgen-4f2f5f614779a330ed0612e9,synthetic_programmatic_template,markdown,top,True,
"Form 1099-Q Payments FromQualified Education Programs (Under Sections 529 and 530) 2022
From:
Summit Investments
To:
Hiro Pate1
5 Qualified tuition program—Private or State / Coverdell ESA
☐
2 Earnings
4,66l.59
4 Trustee-to-trustee transfer
[X]",1099,5,1099,fdc-a8da67fc39fe64fdbb41a34a,v11-1099-Q-stacked,original,2022,fgen-6c2a86783a6ea98d084833c4,synthetic_programmatic_template,stacked,top,True,
"☐ CORRECTED
Form 1099-Q
Payments From Qualificd Education Programs (Under Sections 529 and 530)
202l
Copy B For Recipient
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign posta1 code
Summit Investments 4l21 Granite St Lakewood, C0 56538
PAYER'S/TRUSTEE'S TIN
85-4062605
RECIPIENT'S name
Morgan Patel
RECIPIENT'S TIN
***-**-9216
Street address (induding apt. no.)
6543 Prairie Ave
City or town, stateor province, country, and ZIP or foreign postal code
Lakewood, CO 26742
1 Gross distribution
$1O7,748.85
2 Earnings
$3,136.49
3 Basis
$92,8O5.94
5 Qualified tuition program—Private or State / CoverdellESA
☐
Department of the Treasury - Internal RevenueService
Form 1O99-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-3233404f55a6a4de2b1875be,v11-1099-Q-stacked,original,2021,fgen-d1480ca686f1af5791227d6f,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2022
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Brokerage Services 8511 Lakeshore Blvd Pinecrest, GA 75555
PAYER'S/TRUSTEE'S TIN
38-3679866
RECIPIENT'S name
Taylor Adeyemi
RECIPIENT'S TIN
XXX-XX-4254
Street address (including apt. no.)
9515 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 47433
1 Gross distribution
87,922.47
2 Earnings
$4,563.46
3 Basis
17,634.85
4 Trustee-to-trustee transfer
6 If this box is checked, the recipient is not the designated beneficiary
☐
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-d9e1cda76319471168a7d8ea,v11-1099-Q-stacked,original,2022,fgen-90be1d25bc3cd5b1d839910d,synthetic_programmatic_template,stacked,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
PAYER:
Clearwater Investing
Recipient's name:
Kwame Larsen
4 Trustee-to-trustee transfer
☒",1099,5,1099,fdc-0a0e4221c795e5a45d5aafa8,v11-1099-Q-stacked,original,2025,fgen-4f9a51f73da3b852a789f03b,synthetic_programmatic_template,stacked,top,False,
"PAYER:
Northstar Securities
Recipient's name:
Olivia D. Okafor
3 Basis
$111,316.29
Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)",1099,5,1099,fdc-38f142f3d5f023ea8b5830e4,v11-1099-Q-stacked,original,2021,fgen-32b9ba00185c58ac0fd8af6f,synthetic_programmatic_template,stacked,bottom,False,
"☐ CORRECTED
2025
OMB No. 1545-1760
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Summit Investments 7578 Willow Bend Way Bayside, WA 53854
PAYER'S/TRUSTEE'S TIN
62-3859820
RECIPIENT'S name
Lena Patel
RECIPIENT'S TIN
XXX-XX-3873
Street address (including apt. no.)
1463 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 30196
Account number (see instructions)
XXXXX426487
1 Gross distribution
$40,975.63
2 Earnings
$3,259.57
3 Basis
100,414.14
4 Trustee-to-trustee transfer
[X]
5 Qualified tuition program—Private or State / Coverdell ESA
☒
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-4a19d2de5927915db0ab72c6,v11-1099-Q-stacked,original,2025,fgen-31c177067cccb32bd8fc2b30,synthetic_programmatic_template,stacked,none,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2021
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Clearwater Investing 7478 Maple Ridge Dr Pinecrest, GA 42974
PAYER'S/TRUSTEE'S TIN
79-5420658
RECIPIENT'S name
Riley S. Walsh
RECIPIENT'S TIN
****7137
Street address (including apt. no.)
2649 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 20640
1 Gross distribution
$92,818.75
2 Earnings
5,392.02
3 Basis
12,374.77
4 Trustee-to-trustee transfer
5 Qualified tuition program—Private or State / Coverdell ESA
☐
6 If this box is checked, the recipient is not the designated beneficiary
[X]",1099,5,1099,fdc-3f3e5b0e51787d4706bd26c7,v11-1099-Q-stacked,original,2021,fgen-744bbb279942d85da5fb4cb8,synthetic_programmatic_template,stacked,top,False,
"PAYER'S name:
Ironwood Wealth Partners
Recipient's name:
Alex Nguyen
2 Earnings
$2,911.99
Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2021",1099,5,1099,fdc-d513f5a9190e0f7d1f520353,v11-1099-Q-stacked,original,2021,fgen-b31c84ef176f8aaf1b358233,synthetic_programmatic_template,stacked,bottom,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
OMB No. 1545-1760
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Clearwater Investing 9773 Cedar Ln Brookhaven, PA 89261
PAYER'S/TRUSTEE'S TIN
71-1956558
RECIPIENT'S name
Riley Adeyemi
RECIPIENT'S TIN
XXXXX9343
Street address (including apt. no.)
6282 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 86132
1 Gross distribution
$97,196.28
2 Earnings
$6,812.10
3 Basis
$88,339.32
4 Trustee-to-trustee transfer
☐
6 If this box is checked, the recipient is not the designated beneficiary
☐
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-9613b0e5ad2886e64d437f66,v11-1099-Q-stacked,original,2026,fgen-9c7e0363ca8dbdeaf47c7ff3,synthetic_programmatic_template,stacked,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2022
PAYER:
Summit Investments
Recipient's name:
Riley Adeyemi
1 Gross distribution
134,971.43
2 Earnings
$304.44",1099,5,1099,fdc-42dbe01e17729f32310a7138,v11-1099-Q-stacked,original,2022,fgen-fec8195a410b56ef23445826,synthetic_programmatic_template,stacked,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
PAYER'S name:
Ironwood Wealth Partners
RECIPIENT:
Riley J. Walsh
1 Gross distribution
$78,137.30
4 Trustee-to-trustee transfer
☒
6 If this box is checked, the recipient is not the designated beneficiary
0.00
3 Basis
120,815.13",1099,5,1099,fdc-74f35feb6649b5c256074bbf,v11-1099-Q-stacked,original,2023,fgen-7f274cd2bdf66ddac3031249,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2022
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Ironwood Wealth Partners 2572 Lakeshore Blvd Pinecrest, GA 45114
PAYER'S/TRUSTEE'S TIN
38-5728403
RECIPIENT'S name
Taylor Patel
RECIPIENT'S TIN
ending in 3080
Street address (including apt. no.)
2917 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 23900
1 Gross distribution
$137,178.47
2 Earnings
4,937.60
3 Basis
48,141.25
4 Trustee-to-trustee transfer
5 Qualified tuition program—Private or State / Coverdell ESA
6 If this box is checked, the recipient is not the designated beneficiary
[X]
Department of the Treasury - Internal Revenue Service
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-7f10c6003db6bfe270fc7b23,v11-1099-Q-stacked,original,2022,fgen-801dcc3eb47438ef14a35179,synthetic_programmatic_template,stacked,bottom,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2023
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Ironwood Wealth Partners 8457 Cedar Ln Brookhaven, PA 74064
PAYER'S/TRUSTEE'S TIN
11-9536825
RECIPIENT'S name
Mateo Sato
RECIPIENT'S TIN
XXX-XX-2167
Street address (including apt. no.)
9640 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 24634
1 Gross distribution
$29,967.46
2 Earnings
$6,235.57
3 Basis
118,452.64
4 Trustee-to-trustee transfer
5 Qualified tuition program—Private or State / Coverdell ESA
[X]
6 If this box is checked, the recipient is not the designated beneficiary
X
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-abc8493a19a5112f364890a7,v11-1099-Q-stacked,original,2023,fgen-bfb1a9ba11ffd5be1c145846,synthetic_programmatic_template,stacked,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2023
PAYER'S name:
Ironwood Wealth Partners
Recipient's name:
Riley Moreau
1 Gross distribution
27,291.10
6 If this box is checked, the recipient is not the designated beneficiary
[X]
2 Earnings
8,875.62",1099,5,1099,fdc-caaf43c249c2dea32b4ee5d1,v11-1099-Q-stacked,original,2023,fgen-0faf10b52fe43625c1b242aa,synthetic_programmatic_template,stacked,top,False,
"OMB No. 1545-1760
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Clearwater Investing 1506 Willow Bend Way Brookhaven, PA 31297
PAYER'S/TRUSTEE'S TIN
92-8547068
RECIPIENT'S name
Jordan Romero
RECIPIENT'S TIN
ending in 1081
Street address (including apt. no.)
1792 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 53757
1 Gross distribution
53,647.00
2 Earnings
$4,616.10
3 Basis
92,306.67
4 Trustee-to-trustee transfer
X
5 Qualified tuition program—Private or State / Coverdell ESA
☒
6 If this box is checked, the recipient is not the designated beneficiary
☒
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)",1099,5,1099,fdc-0853804dc4b229bb1993efc3,v11-1099-Q-stacked,original,2024,fgen-8a1bf6fec14a5be5380885b2,synthetic_programmatic_template,stacked,bottom,False,
"For calendar year 2025
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Brokerage Services 3463 Granite St Bayside, WA 67789
PAYER'S/TRUSTEE'S TIN
11-3480718
RECIPIENT'S name
Jordan Brennan
RECIPIENT'S TIN
ending in 4070
Street address (including apt. no.)
9348 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 94933
Account number (see instructions)
XXXXX913151
1 Gross distribution
$74,304.66
2 Earnings
5,350.65
3 Basis
38,065.89
4 Trustee-to-trustee transfer
☐
6 If this box is checked, the recipient is not the designated beneficiary
X
Department of the Treasury - Internal Revenue Service
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-f03051b8b4729f3decf9098c,v11-1099-Q-stacked,original,2025,fgen-19844a92d1ba4ab1223fe3a0,synthetic_programmatic_template,stacked,bottom,False,
"For calendar year 2024
Copy B For Recipient
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Ironwood Wealth Partners 8275 Maple Ridge Dr Testville, IL 91023
PAYER'S/TRUSTEE'S TIN: 70-7931931
RECIPIENT'S name: Fatima E. Brennan
RECIPIENT'S TIN: ***-**-8677
Street address (including apt. no.): 8975 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 36489
Account number (see instructions): ***-**-937605
Line 1 Gross distribution: 59,227.34
Line 2 Earnings: $6,521.52
Line 3 Basis: $135,074.40
Line 4 Trustee-to-trustee transfer: ☐
Line 5 Qualified tuition program—Private or State / Coverdell ESA: X
Line 6 If this box is checked, the recipient is not the designated beneficiary: X",1099,5,1099,fdc-66fd07da07316682bb49f0ee,v11-1099-Q-boxed,original,2024,fgen-ebce0998664f56c3525b596f,synthetic_programmatic_template,boxed,none,False,
"VOID  CORRECTED
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2024
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 9824 Elm Park Pl Cedar Falls, IA 56262
PAYER'S/TRUSTEE'S TIN: 25-8411304
RECIPIENT'S name: Riley Rivera
RECIPIENT'S TIN: ***-**-0514
Street address (including apt. no.): 2492 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 33160
Line 1 Gross distribution: 21,045.06
Line 2 Earnings: $4,648.85
Line 3 Basis: 99,494.20
Line 4 Trustee-to-trustee transfer: ☒
Line 5 Qualified tuition program—Private or State / Coverdell ESA: [X]
Line 6 If this box is checked, the recipient is not the designated beneficiary: [X]
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-0a06b96c9e0c1177adff21b1,v11-1099-Q-boxed,original,2024,fgen-1411c577372ac7b65c3337c0,synthetic_programmatic_template,boxed,top,False,
"OMB No. 1545-1760
Copy B For Rccipient
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postalcode: Northstar Securities l744 Harbor Vicw Rd Lakewood, CO 496O5
PAYER'S/TRUSTEE'S TIN: 57-733l552
RECIPIENT'S name: Sofia Rivera
RECIPIENT'S TIN: XXXXX5167
Street address (induding apt. no.): 5443Willow Bend Way
City or town,state or province, country, and ZIP or foreign postal code: Lakewood, C0 82982
Box 6 If this box is checked, the recipient is not the designated beneficiary
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-820ec4a118f05903dbe23bdf,v11-1099-Q-boxed,original,2024,fgen-b866e866e57a33c4fd8987e5,synthetic_programmatic_template,boxed,none,True,
"PAYER:: Ironwood Wealth Partners
To:: Jordan B. Sato
Line 4 Trustee-to-trustee transfer: 0.00
Line 6 If this box is checked, the recipient is not the designated beneficiary: 0.00
Line 1 Gross distribution: 109,885.08
Line 2 Earnings: $854.91
Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2026",1099,5,1099,fdc-24cab2cf79dd25c599579c0d,v11-1099-Q-boxed,original,2026,fgen-9fb047fc63ed5db7f8c72116,synthetic_programmatic_template,boxed,bottom,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
PAYER:: Ironwood WealthPartners
To:: Avery D. Moreau
3 Basis: $76,597.17",1099,5,1099,fdc-04c966efc7a7b27e90eb6b83,v11-1099-Q-boxed,original,2023,fgen-fb03760038d2ada3fa0e56e9,synthetic_programmatic_template,boxed,top,True,
"VOID  CORRECTED
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
OMB No. 1545-1760
Copy B For Recipient
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 5855 Lakeshore Blvd Pinecrest, GA 50354
PAYER'S/TRUSTEE'S TIN: 25-8551320
RECIPIENT'S name: Lena Romero
RECIPIENT'S TIN: ***-**-2247
Street address (including apt. no.): 6972 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 80874
Account number (see instructions): XXX-XX-403227
1 Gross distribution: $69,509.17
2 Earnings: 5,426.61
4 Trustee-to-trustee transfer: [X]
5 Qualified tuition program—Private or State / Coverdell ESA: X
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-b3688f27c0a6199ee72caaba,v11-1099-Q-boxed,original,2025,fgen-44421483fe5d65146f815735,synthetic_programmatic_template,boxed,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2023
OMB No. l545-l760
Copy BFor Recipient
PAYER'S/TRUSTEE'S name,street address, city or town, statc or province, country, and ZIP or foreign postal code: Northstar Securities 4281 ElmPark Pl Riverton, WI 86321
PAYER'S/TRUSTEE'S TIN: 78-2642363
RECIPIENT'S name: Mateo Lindqvist
RECIPIENT'S TIN: XXX-XX-3951
Line 1 Gross distribution: $58,083.32
Line 2 Eamings: $6,914.40
Line 3 Basis: $39,655.57
Líne 4 Trustce-to-trustee transfer: X
Line 5 Qualified tuition program—Private or State / Coverdell ESA
Line 6 If this box is checked, the recipient is not the designated beneficiary: [X]
Department of the Treasury - Intemal Revenue Service
Form lO99-Q (keep for your records)  www.irs.gov/Forml099Q",1099,5,1099,fdc-1412d5154c751b002c950c51,v11-1099-Q-boxed,original,2023,fgen-89d998a866433c9b5622c021,synthetic_programmatic_template,boxed,top,True,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
PAYER:: Clearwater Investing
To:: Avery Castillo
1 Gross distribution: 3,571.87",1099,5,1099,fdc-3e55d54a47a00162830e6a38,v11-1099-Q-boxed,original,2026,fgen-6d6bb65addcaac9c0264f131,synthetic_programmatic_template,boxed,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2024
OMB No. 1545-1760
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 1614 Lakeshore Blvd Riverton, WI 85305
PAYER'S/TRUSTEE'S TIN: 39-7319872
RECIPIENT'S name: Casey Larsen
RECIPIENT'S TIN: ****1866
Street address (including apt. no.): 1605 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 21200
Box 1 Gross distribution: $25,391.80
Box 2 Earnings: $3,376.75
Box 3 Basis: $117,383.76
Box 4 Trustee-to-trustee transfer: X
Box 6 If this box is checked, the recipient is not the designated beneficiary
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-28d389088cc07a712aad7db1,v11-1099-Q-boxed,original,2024,fgen-ef9f11647ee9dd2dc4eef6c6,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 1O99-Q
Payments From Qualified Education Programs (UnderSections 529 and 53O)
2026
OMB No. 1545-1760
Copy BFor Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreígn postal code: Ironwood Wealth Partners 862 Sample Street Fairview, OH 23783
PAYER'S/TRUSTEE'S TIN: 28-5973922
RECIPIENT'S name:Fatima C. Haddad
RECIPIENT'STIN: XXXXX4656
1 Gross distribution: 115,528.16
2 Earnings: $5,71O.67
3 Basis: $6,054.06
4 Trustee-to-trustee transfer: ☐
5 Qualified tuition program—Private or State / Coverdell ESA
6 If this box is checked, the recipient is not the designated beneficiary
Department of the Treasury - Internal Revenue Service
Form l099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-d04b9fcbe231c06d1c0ed685,v11-1099-Q-boxed,original,2026,fgen-7d16603676d9a39a641d78c9,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 7957 Sample Street Testville, IL 44318
PAYER'S/TRUSTEE'S TIN: 45-7045794
RECIPIENT'S name: Jordan D. Walsh
RECIPIENT'S TIN: XXXXX5707
Box 1 Gross distribution: $77,838.88
Box 3 Basis: $132,627.70
Box 4 Trustee-to-trustee transfer
Box 5 Qualified tuition program—Private or State / Coverdell ESA: ☒
Box 6 If this box is checked, the recipient is not the designated beneficiary: ☐
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-db65f4ae85f35d7d41016ba1,v11-1099-Q-boxed,original,2025,fgen-2150f315558185d8148ae02e,synthetic_programmatic_template,boxed,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2021
From:: Summit Investments
Recipient's name:: Casey Brennan
Box 5 Qualified tuition program—Private or State / Coverdell ESA: ☐
Box 3 Basis: $80,625.57",1099,5,1099,fdc-7f910a54d6e8140b6b8d2d38,v11-1099-Q-boxed,original,2021,fgen-de4ff31d5738c95637809190,synthetic_programmatic_template,boxed,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2025
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Ironwood Wealth Partners 5248 Sample Street Pinecrest, GA 65134
PAYER'S/TRUSTEE'S TIN: 65-4602314
RECIPIENT'S name: Sofia Kowalski
RECIPIENT'S TIN: ending in 2445
Account number (see instructions): ****921044
Box 1 Gross distribution: $85,805.72
Box 2 Earnings: $8,681.66
Box 3 Basis: 50,004.30
Box 4 Trustee-to-trustee transfer: ☒
Box 5 Qualified tuition program—Private or State / Coverdell ESA
Box 6 If this box is checked, the recipient is not the designated beneficiary: ☒
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-d88aa9c785ec07c9992d68b3,v11-1099-Q-boxed,original,2025,fgen-651642188d60a0578d3f3edf,synthetic_programmatic_template,boxed,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2025
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 3349 Granite St Cedar Falls, IA 47947
PAYER'S/TRUSTEE'S TIN: 30-1429548
RECIPIENT'S name: Riley Nguyen
RECIPIENT'S TIN: ***-**-5373
1 Gross distribution: 76,133.21
2 Earnings: 194.96
3 Basis: 1,996.47
4 Trustee-to-trustee transfer: ☒
5 Qualified tuition program—Private or State / Coverdell ESA
6 If this box is checked, the recipient is not the designated beneficiary
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-33eac98b6f66f6dd25447bca,v11-1099-Q-boxed,original,2025,fgen-1adebe09c5c153984c078e30,synthetic_programmatic_template,boxed,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2023
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 1100 Willow Bend Way Oak Grove, TX 24985
PAYER'S/TRUSTEE'S TIN: 30-4021690
RECIPIENT'S name: Jamie Haddad
RECIPIENT'S TIN: ***-**-0123
Street address (including apt. no.): 5331 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 76802
Account number (see instructions): ****805359
Box 1 Gross distribution: $123,589.31
Box 2 Earnings: $1,668.58
Box 3 Basis: $113,230.53
Box 5 Qualified tuition program—Private or State / Coverdell ESA: [X]
Box 6 If this box is checked, the recipient is not the designated beneficiary: ☐
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-22348ada7f3c42a0633b9c2b,v11-1099-Q-boxed,original,2023,fgen-269bf633c30e8071bb6e42b5,synthetic_programmatic_template,boxed,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2025
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Ironwood Wealth Partners 5354 Granite St Oak Grove, TX 33824
PAYER'S/TRUSTEE'S TIN: 79-3522865
RECIPIENT'S name: Mateo Castillo
RECIPIENT'S TIN: ***-**-8401
Line 1 Gross distribution: $34,124.99
Line 2 Earnings: 667.99
Line 3 Basis: 29,959.32
Line 4 Trustee-to-trustee transfer: X
Line 6 If this box is checked, the recipient is not the designated beneficiary: ☐
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-ccc6f583af90499368b7bf18,v11-1099-Q-boxed,original,2025,fgen-f976ebdb8581835d7a49fee0,synthetic_programmatic_template,boxed,top,False,
"For calendar year 2026 PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 4264 Cedar Ln Pinecrest, GA 29099 PAYER'S/TRUSTEE'S TIN 13-1882371 RECIPIENT'S name Priya Romero RECIPIENT'S TIN XXX-XX-9913 Street address (including apt. no.) 741 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 72006 Account number (see instructions) XXXXX420020 1
Gross
distribution 85,899.19 3 Basis 105,314.66 4 Trustee-to-trustee transfer [X] 5 Qualified tuition program—Private or State / Coverdell ESA ☒ 6 If this box is checked, the recipient is not the designated beneficiary [X] Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-4afd760dd9e58be71001629b,v11-1099-Q-flat,original,2026,fgen-0fbabfca045ed26ef7a6adf1,synthetic_programmatic_template,flat,none,False,
"VOID CORRECTED Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2026 OMB No. 1545-1760 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code Clearwater
Investing 7009 Maple Ridge Dr Maplewood, MN 22634 PAYER'S/TRUSTEE'S TIN 71-2473673 RECIPIENT'S name Noah Testcase RECIPIENT'S TIN XXX-XX-1711 Street address (including apt. no.) 9741 Lakeshore Blvd City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 16861 2 Earnings $948.47 3 Basis 118,913.76 4 Trustee-to-trustee transfer ☒ 5 Qualified tuition program—Private or State / Coverdell ESA ☒ 6 If this box is checked, the recipient is not the designated beneficiary [X]",1099,5,1099,fdc-0e1ca351089b08b2feb28c42,v11-1099-Q-flat,original,2026,fgen-b2d459f439d9749f8e142746,synthetic_programmatic_template,flat,top,False,
"For calendar year 2021 OMB No. 1545-1760 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Ironwood Wealth Partners 1206 Willow Bend Way Fairview, OH 12611 PAYER'S/TRUSTEE'S TIN 91-6365574 RECIPIENT'S name Taylor Tanaka RECIPIENT'S TIN ****2954 1 Gross distribution 38,766.88 2 Earnings 6,940.94 3 Basis $17,197.78 4 Trustee-to-trustee transfer ☐ 5 Qualified tuition program—Private or State / Coverdell ESA 6 If this box is checked, the recipient is not the designated beneficiary [X] Form 1099-Q Payments From Qualified Education Programs (Under
Sections 529 and
530)",1099,5,1099,fdc-12bd1051ccb11ce460afee36,v11-1099-Q-flat,original,2021,fgen-287b073120245078052b90eb,synthetic_programmatic_template,flat,bottom,False,
"CORRECTED
(if checked) Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2022 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments
4806 Elm Park Pl Oak Grove, TX 85712 PAYER'S/TRUSTEE'S TIN 25-1685594 RECIPIENT'S name Amara Sato RECIPIENT'S TIN ****4331 1 Gross distribution $127,539.38 2 Earnings $9,016.64 3 Basis 95,114.32 4 Trustee-to-trustee transfer 5 Qualified tuition program—Private or State / Coverdell ESA ☒ 6 If this box is checked, the recipient is not the designated beneficiary Department of the Treasury - Internal Revenue Service Form 1099-Q (keep for your records) www.irs.gov/Form1099Q",1099,5,1099,fdc-4f472b286e2bd22c43c75a5d,v11-1099-Q-flat,original,2022,fgen-50a2d89d611bbcacaf53ba4a,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED OMB No.
1545-1760 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 5714 Elm Park Pl Maplewood, MN 38579 PAYER'S/TRUSTEE'S TIN 26-4399160 RECIPIENT'S name Kwame Fischer RECIPIENT'S TIN XXX-XX-4437 Street address (including apt. no.) 5730 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 37335 Account number (see instructions) XXXXX129608 2 Earnings 3,311.77 3 Basis $104,109.45 5 Qualified tuition program—Private or State / Coverdell ESA [X] 6 If this box is checked, the recipient is not the designated beneficiary ☐ Department of the Treasury - Internal Revenue
Service",1099,5,1099,fdc-4b3c523d98125994181bfd7b,v11-1099-Q-flat,original,2023,fgen-3b9aa0f28182728aa96b834b,synthetic_programmatic_template,flat,none,False,
"CORRECTED (if checked) 2023 OMB No. 1545-1760 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 1828 Oak Hollow Ct Riverton, WI 73450 PAYER'S/TRUSTEE'S TIN 11-6785280 RECIPIENT'S name Fatima Castillo
RECIPIENT'S TIN XXXXX5983 1 Gross distribution 96,128.40 2 Earnings $1,407.58 3 Basis 137,876.68 4 Trustee-to-trustee transfer ☒ 5 Qualified tuition program—Private or State / Coverdell ESA [X] 6 If this box is checked,
the recipient is not the designated beneficiary [X] Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-90abc791b4e2e4eb12b78661,v11-1099-Q-flat,original,2023,fgen-7d55aa030db76b2d0670c7aa,synthetic_programmatic_template,flat,none,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) For calendar year 2022 OMB No. 1545-1760 This is important tax information and is being furnished to the IRS. PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Brokerage Services 9221 Harbor View Rd
Cedar Falls, IA 50844 PAYER'S/TRUSTEE'S TIN
84-5400787 RECIPIENT'S name Jordan Lindqvist RECIPIENT'S TIN ***-**-9701 Account number (see instructions) ending in 273376 1 Gross distribution $128,793.87 2 Earnings 9,083.98 3 Basis $77,496.85 4 Trustee-to-trustee transfer X 5 Qualified tuition program—Private or State / Coverdell ESA ☐ Department of the Treasury - Internal Revenue Service Form 1099-Q (keep for your records) www.irs.gov/Form1099Q",1099,5,1099,fdc-a8e3955fea699e3042a83627,v11-1099-Q-flat,original,2022,fgen-114f90ae37f170dfe4202f4f,synthetic_programmatic_template,flat,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) OMB No. 1545-1760 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northstar Securities 5735 Prairie Ave Lakewood, CO 15314 PAYER'S/TRUSTEE'S TIN 89-7506893 RECIPIENT'S name Riley Patel RECIPIENT'S TIN XXX-XX-2838 Street address (including apt. no.) 383 Harbor View Rd City or town, state or province, country, and ZIP or
foreign postal code Brookhaven, PA 99096 1 Gross distribution $6,651.89 2 Earnings 4,144.33 3 Basis $89,742.55 4 Trustee-to-trustee transfer ☐ 5 Qualified tuition program—Private or State / Coverdell ESA ☒ 6 If this box is
checked, the recipient is not the designated beneficiary [X] Department of the Treasury - Internal Revenue Service Form 1099-Q (keep for your records) www.irs.gov/Form1099Q",1099,5,1099,fdc-30edcffc57d66c0a6e2a72e4,v11-1099-Q-flat,original,2021,fgen-14fe4c6cd9adbdd35c3ff9f4,synthetic_programmatic_template,flat,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or forcign postal code Northstar Securities8711 Elm ParkPl Lakewood, C0 73618 PAYER'S/TRUSTEE'S TIN 28-9493606 RECIPIENT'S name AmaraB. Castillo RECIPIENT'S TIN ending in 3000 Street address (induding apt. no.) 5l1
0ak Hollow Ct City or town, stateor province, country, and ZIP orforcign postal code Riverton,
WI 29452 l Gross distribution $112,748.43 2 Earnings $2,207.43 4 Trustee-to-trustee transfer ☐ 5 Qualified tuition program—Private or State / Coverdell ESA ☐ 6 If this box is checked, the recipient is not the designated beneficiary Department of the Treasury - Internal Revenue 5ervice Form 1099-Q (keep for your records) www.irs.gov/Form1099Q",1099,5,1099,fdc-2ccf6e2cb1d3d3550caebaa9,v11-1099-Q-flat,original,2024,fgen-6976b526b30aa95b8cb67b1e,synthetic_programmatic_template,flat,top,True,
"For calendar year 2024 OMB No. 1545-1760 Copy B For Recipient This is important tax information and is being furnished to the IRS. PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northstar Securities 1341 Elm Park Pl Riverton, WI 59675 PAYER'S/TRUSTEE'S TIN 49-6592611 RECIPIENT'S name Amara Kowalski RECIPIENT'S TIN ending in 9479 Street address (including apt. no.) 7441 Maple Ridge Dr City or town, state
or province, country, and ZIP or foreign postal code Maplewood,
MN 77853 1 Gross distribution 22,522.34 2 Earnings 8,321.19 3 Basis $35,862.79 5 Qualified tuition program—Private or State / Coverdell ESA ☐ 6 If this box is checked, the recipient is not the designated beneficiary [X] Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)",1099,5,1099,fdc-04698ecac318db65758b59e0,v11-1099-Q-flat,original,2024,fgen-ea2e87fe10c6a6f817088cae,synthetic_programmatic_template,flat,bottom,False,
"CORRECTED (if checked) Copy B For Recipient PAYER'S/TRUSTEE'Sname, street address, city or town, state or province,
country, and ZIP or foreígn posta1 code Summit Investments 6511 Maple Ridge Dr Brookhaven, PA 37593 PAYER'S/TRUSTEE'S TIN 68-1O20607 RECIPIENT'S name Jordan A.Castíllo RECIPIENT'S TIN XXX-XX-8674 Street address (induding apt. no.) 4317 Elm Park Pl City or town, state
or province, country, and ZIP or foreign posta1 code Brookhaven, PA 48112 1 Gross distribution S45,927.05 2 Earnings 8,912.02 3 Basis 50,876.62 5 Qua1ifiedtuition program—Private or 5tate /Coverdell ESA X 6 If this box is checked, the recipient is not the designated beneficiary Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-ede295f547a6d1c3cab7fac6,v11-1099-Q-flat,original,2025,fgen-6e7f6bb68645282238fef675,synthetic_programmatic_template,flat,none,True,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2026 OMB No. 1545-1760 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 393 Oak Hollow Ct Oak Grove, TX 45202 PAYER'S/TRUSTEE'S TIN 43-9202661 RECIPIENT'S name Hiro R. Tanaka RECIPIENT'S TIN ***-**-3206 Street address (including apt. no.) 1459 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 43441 Account number (see instructions) ending in 120024 1 Gross distribution $59,849.32 2 Earnings 2,745.81 3 Basis $6,710.94 4 Trustee-to-trustee transfer ☐ 5 Qualified tuition program—Private or State / Coverdell ESA [X] 6 If this box is checked, the recipient is not the designated beneficiary [X] Department
of the Treasury
- Internal Revenue Service Form 1099-Q (keep for your records) www.irs.gov/Form1099Q",1099,5,1099,fdc-b31fd2da6833276e4b2e99cd,v11-1099-Q-flat,original,2026,fgen-2dd11bea95149aa4b3edbf3e,synthetic_programmatic_template,flat,top,False,
"PAYER: Evergreen Brokerage Services To: Alex Nguyen 4 Trustee-to-trustee transfer ☐ 3 Basis 46,734.12 1 Gross distribution $88,897.43 Form
1099-Q Payments From Qualified Education
Programs (Under Sections 529 and 530) 2026",1099,5,1099,fdc-daac4866e49978d367fd5537,v11-1099-Q-flat,original,2026,fgen-39de9594928f32c09c055208,synthetic_programmatic_template,flat,bottom,False,
"☐ CORRECTED Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) For
calendar year 2022 Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province,
country, and ZIP or foreign postal code Evergreen Brokerage Services 6735 Cedar Ln Maplewood, MN 36239 PAYER'S/TRUSTEE'S TIN 37-7022344 RECIPIENT'S name Wei Patel RECIPIENT'S TIN ***-**-1267 2 Earnings 5,696.76 3 Basis 63,327.98 5 Qualified tuition program—Private or State / Coverdell ESA X 6 If this box is checked, the recipient is not the designated beneficiary [X] Department of the Treasury - Internal Revenue Service Form 1099-Q (keep for your records) www.irs.gov/Form1099Q",1099,5,1099,fdc-7d6a9968bdc56148683dbc7b,v11-1099-Q-flat,original,2022,fgen-bdd527f36efbb734a6a734d3,synthetic_programmatic_template,flat,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2023 OMB No. 1545-1760 This is important tax information and is being furnished to the IRS. PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Ironwood Wealth Partners 9348 Oak Hollow Ct Fairview, OH 40059 PAYER'S/TRUSTEE'S TIN 64-3108979 RECIPIENT'S name Jordan L. Larsen RECIPIENT'S TIN ending in 4635 Account number (see instructions) ending in
537861 1 Gross distribution 3,547.86 2 Earnings $9,366.49 3 Basis $85,197.62 4 Trustee-to-trustee transfer ☐ 6 If this box is checked, the recipient
is not the designated beneficiary [X] Department of the Treasury - Internal Revenue Service Form 1099-Q (keep for your records) www.irs.gov/Form1099Q",1099,5,1099,fdc-da27b8c8ed111173508a7423,v11-1099-Q-flat,original,2023,fgen-9ad066405abfb0212a30c98e,synthetic_programmatic_template,flat,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) Copy B For Recipient PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 8801 Elm Park Pl Lakewood, CO 85915 PAYER'S/TRUSTEE'S TIN 95-3201850 RECIPIENT'S name Amara Walsh RECIPIENT'S TIN
ending in 1449 Street address (including apt. no.) 8345
Maple Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 23158 1 Gross distribution $9,119.14 2 Earnings $8,684.46 3 Basis $113,751.66 4 Trustee-to-trustee transfer 5 Qualified tuition program—Private or State / Coverdell ESA 6 If this box is checked, the recipient is not the designated beneficiary ☒",1099,5,1099,fdc-a39d1f21a6510a734e920319,v11-1099-Q-flat,original,2021,fgen-2488012f5ed06457c6dcc1f8,synthetic_programmatic_template,flat,top,False,
"Form 1099-Q
## Payments From Qualified Education Programs (Under Sections 529 and 530)
## For calendar year 2025
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Clearwater Investing 6127 Oak Hollow Ct Testville, IL 80274 |
| PAYER'S/TRUSTEE'S TIN | 93-4309221 |
| RECIPIENT'S name | Jamie B. Haddad |
| RECIPIENT'S TIN | XXXXX5067 |
| Street address (including apt. no.) | 3518 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 17927 |
| Account number (see instructions) | XXXXX924468 |
| 1 Gross distribution | $119,947.60 |
| 2 Earnings | $331.96 |
| 3 Basis | 10,294.42 |
| 4 Trustee-to-trustee transfer | [X] |
| 5 Qualified tuition program—Private or State / Coverdell ESA | ☐ |
| 6 If this box is checked, the recipient is not the designated beneficiary | ☐ |
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-1fcc87e3fca8d11b3d726597,v11-1099-Q-markdown,original,2025,fgen-a477c33fc226c98a93a40ffe,synthetic_programmatic_template,markdown,top,False,
"Form1099-QPayments From Qualified Education Programs (Under Sections 529 and 530) 2025
| Field | Value |
| --- | --- |
| PAYER'S name: | Northstar Securities |
| Recipient's name: | Casey Moreau |
| 2 Earnings | $2,O57.l6 |
| 5 Qualified tuition program—Private or State / Coverdell ESA | X |",1099,5,1099,fdc-bb301c8893b0a104fb7c40ed,v11-1099-Q-markdown,original,2025,fgen-e40e284fc74494ceaba75c9e,synthetic_programmatic_template,markdown,top,True,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2026
Copy B ForRecipient
This is important tax information and is being fumished to the IRS.
| Field |Value |
| --- |--- |
| PAYER'5/TRUSTEE'S name, street address, cíty or town, state or provincc, country, and ZIP or foreign postal code | 5ummit Investments 6688 Granite St Riverton, WI 2577O |
| PAYER'S/TRUSTEE'S TIN |8l-7320382 |
| RECIPIENT'S name | Jordan M. Okafor |
| RECIPIENT'S TIN | ****7292 |
| Strcet address (induding apt. no.) | 2574 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 85967 |
| Account number (see instructions) | XXXXX986ll5 |
| lGross distribution | 58,211.90 |
| 2 Eamings | 8,804.22 |
| 3 Basis | 72,418.11 |
| 4 Trustee-to-trustee transfer | ☐ |
Department of the Treasury - Internal Revenue Service
## Form l099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-71903ac6ea6fe76fe89d8ccd,v11-1099-Q-markdown,original,2026,fgen-bf292a35ee3bfaa7ccfdf028,synthetic_programmatic_template,markdown,top,True,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2026
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Clearwater Investing 8280 Willow Bend Way Pinecrest, GA 62508 |
| PAYER'S/TRUSTEE'S TIN | 79-8729430 |
| RECIPIENT'S name | Noah Walsh |
| RECIPIENT'S TIN | ***-**-9384 |
| 1 Gross distribution | 106,089.06 |
| 2 Earnings | $9,193.68 |
| 3 Basis | 75,411.75 |
| 4 Trustee-to-trustee transfer | [X] |
| 5 Qualified tuition program—Private or State / Coverdell ESA |  |
| 6 If this box is checked, the recipient is not the designated beneficiary | [X] |",1099,5,1099,fdc-bcd7eeccecc223eb6ef682ca,v11-1099-Q-markdown,original,2026,fgen-abafbb6dc9e7ef64bccb54b1,synthetic_programmatic_template,markdown,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
| Field | Value |
| --- | --- |
| PAYER: | Summit Investments |
| Recipient's name: | Avery M. Lindqvist |
| 6 If this box is checked, the recipient is not the designated beneficiary | ☐ |
| 4 Trustee-to-trustee transfer | 0.00 |",1099,5,1099,fdc-b789363b15cdf8beedd08e16,v11-1099-Q-markdown,original,2023,fgen-59a3741d7ebe633eb6f9cd7e,synthetic_programmatic_template,markdown,top,False,
"## VOID  CORRECTED
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2023
OMB No. 1545-1760
Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'5/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | EvergreenBrokerage Services 1887 Maple Ridge Dr Pinecrest, GA 192O4 |
| PAYER'S/TRUSTEE'5 TIN | 29-2927573 |
| RECIPIENT'5 namc |Taylor Castillo |
| RECIPIENT'S TIN | cnding in 9279 |
| Street address (induding apt. no.) |7896 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 95395 |
| Account number (see instructions) | ****220695 |
| 2 Eamings | S3,680.89 |
| 3 Basis| 95,294.26 |
| 5 Qualified tuition program—Private or State / Coverdell ESA| [X] |
| 6 If this box is checked, the recipient is not the designated benefíciary | ☐ |
Department of the Treasury - Intemal Revenue Service
Form 1099-Q (keep for yourrecords)  www.irs.gov/Form1099Q",1099,5,1099,fdc-b9e44e2d944476c8b28aa001,v11-1099-Q-markdown,original,2023,fgen-3bc3d935d9e148cb4560f1fe,synthetic_programmatic_template,markdown,top,True,
"| Field | Value |
| ---| --- |
| PAYER: | Northstar Securities |
| To:| Avery Testcase |
| 6 If this box is checked, the recipient is not the designated beneficiary | ☐ |
| 1 Gross distribution | 115,431.27 |
| 4 Trustee-to-trustee transfer | 0.00 |
| 2 Eamings | S1,687.46 |
Form 1099-Q Payments From Qua1ified Education Programs (Under 5ections 529 and 530) 2026",1099,5,1099,fdc-a4a869c77795a16ebd195370,v11-1099-Q-markdown,original,2026,fgen-f999c299d2c058fb159fe71a,synthetic_programmatic_template,markdown,bottom,True,
"## Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
## OMB No. 1545-1760
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Clearwater Investing 1471 Willow Bend Way Brookhaven, PA 61374 |
| PAYER'S/TRUSTEE'S TIN | 41-6070898 |
| RECIPIENT'S name | Noah E. Tanaka |
| RECIPIENT'S TIN | ending in 1980 |
| Street address (including apt. no.) | 5416 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 66766 |
| 1 Gross distribution | 89,869.75 |
| 2 Earnings | $7,575.87 |
| 3 Basis | 11,905.05 |
| 4 Trustee-to-trustee transfer |  |
| 5 Qualified tuition program—Private or State / Coverdell ESA | ☒ |
| 6 If this box is checked, the recipient is not the designated beneficiary | ☒ |",1099,5,1099,fdc-caa3c415e8d344e174cac14c,v11-1099-Q-markdown,original,2026,fgen-5ac71a15fbdf41d76c76e1d5,synthetic_programmatic_template,markdown,top,False,
"## Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2025
OMB No. 1545-1760
| Field | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Ironwood Wealth Partners 8711 Elm Park Pl Fairview, OH 69077 |
| PAYER'S/TRUSTEE'S TIN | 48-5809482 |
| RECIPIENT'S name | Kwame Okafor |
| RECIPIENT'S TIN | ****5346 |
| Street address (including apt. no.) | 8920 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 25970 |
| 1 Gross distribution | 110,078.51 |
| 2 Earnings | 6,365.27 |
| 3 Basis | 133,986.13 |
| 4 Trustee-to-trustee transfer | ☐ |
| 5 Qualified tuition program—Private or State / Coverdell ESA | [X] |
| 6 If this box is checked, the recipient is not the designated beneficiary | [X] |",1099,5,1099,fdc-9b9a8f6058421789ed6a841e,v11-1099-Q-markdown,original,2025,fgen-c871204effa857975c2b9700,synthetic_programmatic_template,markdown,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2021
OMB No. 1545-1760
Copy B For Recipient
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Northstar Securities 2465 Oak Hollow Ct Oak Grove, TX 70993 |
| PAYER'S/TRUSTEE'S TIN | 70-9124271 |
| RECIPIENT'S name | Noah Castillo |
| RECIPIENT'S TIN | ***-**-4503 |
| 1 Gross distribution | 90,937.52 |
| 2 Earnings | $124.13 |
| 3 Basis | $25,661.98 |
| 4 Trustee-to-trustee transfer | X |
| 5 Qualified tuition program—Private or State / Coverdell ESA |  |
| 6 If this box is checked, the recipient is not the designated beneficiary | X |
Department of the Treasury - Internal Revenue Service
Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-8cd057111794bbf269f4f921,v11-1099-Q-markdown,original,2021,fgen-22a0078ad6adcd54fa7ffea5,synthetic_programmatic_template,markdown,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
| Field | Value |
| --- | --- |
| PAYER: | Northstar Securities |
| To: | Wei Brennan |
| 6 If this box is checked, the recipient is not the designated beneficiary | 0.00 |",1099,5,1099,fdc-e67b1bc35fd1ed5b7aed13c2,v11-1099-Q-markdown,original,2022,fgen-b4b5ce7035bde75268100280,synthetic_programmatic_template,markdown,top,False,
"Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2023
## OMB No.1545-1760
This is important tax information and is being furnished to the IRS.
| Fie1d | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or provínce, country, and ZIP or foreign posta1 code |Summit Investments 5343 Maple Ridge Dr Testville, IL35206|
| PAYER'S/TRUSTEE'S TIN | 18-5568940 |
| RECIPIENT'S name | Noah Sato |
| RECIPIENT'S TIN | ****3798 |
| Strcet address (inc1uding apt. no.) | 9149 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 71235 |
| l Gross distribution | $124,597.19 |
| 2 Earnings | $1O5.17 |
| 3 Basis | 131,104.15 |
| 5 Qua1ified tuition program—Private or State / Coverdell ESA | X |
|6 If this box is checked, the recipient is not the designated beneficiary | ☐|
## Department of the Treasury - Intemal Revenue Service
## Form 1099-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-44c5e76f80d3a2fe089a6c14,v11-1099-Q-markdown,original,2023,fgen-94142b6864c2496f7b68d7fe,synthetic_programmatic_template,markdown,top,True,
"CORRECTED (if checked)
Form 1099-Q
Payments From Qualified Education Programs (Under Sections 529 and 530)
2021
OMB No. 1545-1760
## Copy B For Recipient
| Field | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Ironwood Wealth Partners 6759 Sample Street Maplewood, MN 96122 |
| PAYER'S/TRUSTEE'S TIN | 32-2168542 |
| RECIPIENT'S name | Taylor Patel |
| RECIPIENT'S TIN | ***-**-3553 |
| Street address (including apt. no.) | 6652 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 48512 |
| Account number (see instructions) | ****800465 |
| 2 Earnings | $3,022.13 |
| 4 Trustee-to-trustee transfer |  |
| 6 If this box is checked, the recipient is not the designated beneficiary | X |",1099,5,1099,fdc-b031b6efbbe05ebcd6c19de1,v11-1099-Q-markdown,original,2021,fgen-d7c2e71821038963bccfff7d,synthetic_programmatic_template,markdown,top,False,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
| Field | Value |
| --- | --- |
| PAYER'S name: | Clearwater Investing |
| Recipient's name: | Morgan Rivera |
| 1 Gross distribution | 27,805.06 |",1099,5,1099,fdc-813ca2a236bf4a9135840361,v11-1099-Q-markdown,original,2023,fgen-06db24da80c04b399561daf6,synthetic_programmatic_template,markdown,top,False,
"## CORRECTED (if checked)
Form 1099-Q
## Payments From Qualified Education Programs (Under Sections 529 and 530)
For calendar year 2023
OMB No. 1545-1760
This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| PAYER'S/TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign posta1 code | Ironwood Wealth Partners 9084 Granite St Bayside, WA 6l959 |
| PAYER'S/TRUSTEE'S TIN | 61-4473733|
| RECIPIENT'Snamc| Fatima Nguyen |
| RECIPIENT'S TIN | XXX-XX-0119 |
| Street address (induding apt. no.) | 5626 Harbor Vicw Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 81911 |
| 1 Gross distribution | $96,145.86 |
| 2 Eamings | $1,887.86 |
| 3 Basis | 127,578.67 |
| 4 Trustee-to-trustee transfer | ☐ |
| 5 Qua1ified tuitionprogram—Private or 5tate / Coverdell ESA | ☐|
## Department ofthe Treasury - Intemal Revenue Service
## Form 1O99-Q (keep for your records)  www.irs.gov/Form1099Q",1099,5,1099,fdc-446e5da93abe585d8800b686,v11-1099-Q-markdown,original,2023,fgen-2f7fbb6c9e5cbe0f2e3a7df8,synthetic_programmatic_template,markdown,top,True,
"Form 1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530) 2023
| Field | Value |
| --- | --- |
| From: | Evergreen Brokerage Services |
| To: | Alex Testcase |
| 2 Earnings | $5,231.42 |
| 1 Gross distribution | 114,607.61 |
| 6 If this box is checked, the recipient is not the designated beneficiary | X |",1099,5,1099,fdc-5236f81511ff886d1f5b168c,v11-1099-Q-markdown,original,2023,fgen-c8909f607c07637af6923547,synthetic_programmatic_template,markdown,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2026
OMB No. 1545-0119
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Evergreen Retirement Services 7503 Granite St Riverton, WI 26434
PAYER'S TIN
82-4996832
RECIPIENT'S name
Jordan Castillo
RECIPIENT'S TIN
ending in 3096
Account number (see instructions)
***-**-671983
1 Gross distribution
85,833.48
2b Taxable amount not determined
☒
4 Federal income tax withheld
$1,044.79
5 Employee contributions/Designated Roth contributions or insurance premiums
7 Distribution code(s)
4
7 IRA/SEP/SIMPLE
[X]
14 State tax withheld
$5,584.31
16 State distribution
8,538.21
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-886e25c3822cdf50231e9d53,v11-1099-R-stacked,original,2026,fgen-5ab2b9795132801bd47f48ab,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Forcalcndar year 2022
OMB No. 1545-0119
Copy B Reportthis income on your federal tax retum.
PAYER'S name, street addrcss, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Clearwater 401(k) Administration 2502 Willow Bend Way Brookhaven, PA 97052
PAYER'S TIN
45-3016007
RECIPIENT'S namc
Fatima Larscn
RECIPIENT'5 TIN
***-**-0015
1 Gross distribution
78,210.10
2a Taxablc amount
46,764.35
2b Taxable amount not determined
X
4 Federal income tax withheld
256.20
5Employee contributions/Designated Roth contributions or insurance premíums
7 Distribution code(s)
1
7 IRA/SEP/SIMPLE
X
14 Statc tax withhe1d
6,254.85
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.",1099,5,1099,fdc-f86c9ed048ac5795fd144664,v11-1099-R-stacked,original,2022,fgen-137521b0de26257ca16dda88,synthetic_programmatic_template,stacked,bottom,True,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
From:
Evergreen Retirement Services
RECIPIENT:
Wei Rivera
4 Federal income tax withheld
7,082.22
7 Distribution code(s)
G
2a Taxable amount
76,734.99
2b Taxable amount not determined
X",1099,5,1099,fdc-97c1e6e6846ab2d6184464aa,v11-1099-R-stacked,original,2024,fgen-2d26689f4b716d88e82ea747,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2023
OMB No. 1545-0119
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Summit Retirement Trust 4841 Maple Ridge Dr Pinecrest, GA 31896
PAYER'S TIN
90-1376522
RECIPIENT'S name
Jordan M. Okafor
RECIPIENT'S TIN
XXXXX2354
Street address (including apt. no.)
2143 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 92687
Account number (see instructions)
***-**-937779
1 Gross distribution
$38,664.85
2a Taxable amount
93,783.08
2b Taxable amount not determined
4 Federal income tax withheld
$7,097.78
5 Employee contributions/Designated Roth contributions or insurance premiums
7 Distribution code(s)
1
7 IRA/SEP/SIMPLE
☐
14 State tax withheld
$7,722.36
16 State distribution
$19,361.76
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-a81f971a7408326187d2185f,v11-1099-R-stacked,original,2023,fgen-8588fbb88a44c54be2cf3627,synthetic_programmatic_template,stacked,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2023
OMB No. 1545-0119
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Evergreen Retirement Services 7656 Cedar Ln Lakewood, CO 37678
PAYER'S TIN
15-4778901
RECIPIENT'S name
Hiro Okafor
RECIPIENT'S TIN
XXX-XX-0741
Street address (including apt. no.)
4925 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 78224
1 Gross distribution
$47,880.36
2a Taxable amount
$115,339.23
2b Taxable amount not determined
☐
4 Federal income tax withheld
4,181.00
5 Employee contributions/Designated Roth contributions or insurance premiums
7 Distribution code(s)
7D
7 IRA/SEP/SIMPLE
☒
14 State tax withheld
$6,888.25
16 State distribution
59,568.77
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-f503743cdd8158fb130c97d6,v11-1099-R-stacked,original,2023,fgen-a1996b780c6c66778f53d74b,synthetic_programmatic_template,stacked,top,False,
"2026
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code, andphone no.
Summit Retirement Trust 478 Elm Park Pl Oak Grove, TX 2l469
PAYER'S TIN
15-4323153
RECIPIENT'S name
Olivia D. Brennan
RECIPIENT'S TIN
***-**-771O
Strcet address (índuding apt. no.)
6984 Lakeshore Blvd
City or town, statc or province, country, and ZIP or foreign postal code
Fairview, OH 56991
1 Gross distribution
69,943.23
2a Taxable amount
8O,351.17
4 Federal income taxwithheld
$2,873.71
5 Employeecontributions/Designated Roth contributions or insurance premiums
$O.00
7 Distribution code(s)
G
7 IRA/5EP/SIMPLE
14 State tax wíthheld
544.72
Form1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.",1099,5,1099,fdc-2f925904d8c48302ac258978,v11-1099-R-stacked,original,2026,fgen-d4d648caab932837adbcdc3d,synthetic_programmatic_template,stacked,bottom,True,
"VOID  CORRECTED
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2021
OMB No. 1545-0119
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Evergreen Retirement Services 2731 Sample Street Brookhaven, PA 20317
PAYER'S TIN
54-4130391
RECIPIENT'S name
Fatima M. Walsh
RECIPIENT'S TIN
***-**-6525
2a Taxable amount
$129,022.96
2b Taxable amount not determined
☒
4 Federal income tax withheld
$7,067.70
5 Employee contributions/Designated Roth contributions or insurance premiums
$0.00
7 Distribution code(s)
4
7 IRA/SEP/SIMPLE
[X]
14 State tax withheld
$6,996.61
16 State distribution
59,619.36",1099,5,1099,fdc-f7a353c58a6e04559b75b8b2,v11-1099-R-stacked,original,2021,fgen-4a04bfedb56f7c4202bff076,synthetic_programmatic_template,stacked,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2023
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Summit Retirement Trust 6314 Sample Street Riverton, WI 10212
PAYER'S TIN
75-6230404
RECIPIENT'S name
Noah Sato
RECIPIENT'S TIN
***-**-4995
Street address (including apt. no.)
5478 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 59394
2a Taxable amount
16,049.80
2b Taxable amount not determined
☐
7 Distribution code(s)
7
7 IRA/SEP/SIMPLE
☒
14 State tax withheld
$8,828.02
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-f8c085e30ef7ae444ae4410a,v11-1099-R-stacked,original,2023,fgen-bf07d70f8c283a9e42eb39b2,synthetic_programmatic_template,stacked,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurancc Contracts, etc. 2023
PAYER:
Clearwater 401(k) Administration
RECIPIENT:
Mateo Moreau
2bTaxable amount not determined
☒
1 Gross distribution
44,051.08
4 Federal income tax withheld
9,413.42",1099,5,1099,fdc-46203ead406ddbf6145fd6eb,v11-1099-R-stacked,original,2023,fgen-a3576a5c9187da29598d0909,synthetic_programmatic_template,stacked,top,True,
"For calendar year2021
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign posta1 code,and phone no.
Northstar Retirement Plan Services 7443 Prairie Ave Pinecrest, GA 20036
PAYER'S TIN
65-26l3932
RECIPIENT'5 name
Lena Walsh
RECIPIENT'S TIN
XXX-XX-7860
Street address (including apt. no.)
9402 Oak Ho1low Ct
City or town, state or province, country, andZIP or foreign postal code
Maplewood, MN 94791
Account number (see instructions)
ending in 307705
1 Gross distribution
52,409.37
2a Taxable amount
$38,121.64
2b Taxable amount not determined
☒
4 Federal income tax withheld
1,575.16
5Employee contributions/Designated Roth contributions or insurance premiums
O.00
7 Distribution code(s)
7D
7 IRA/5EP/SIMPLE
X
14 State tax withhe1d
$8,428.49
16 5tate distribution
10,605.93",1099,5,1099,fdc-e2ce9497783f6882461f5f53,v11-1099-R-stacked,original,2021,fgen-a73471c2cb12d843e31cbc72,synthetic_programmatic_template,stacked,none,True,
"Form 1099-R
Distributions From Pensions,Annuities, Retirement or Profit-Sharing P1ans, IRAs, Insurance Contracts, etc.
For calendar year 2O22
OMB No. 1545-O119
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province,country, ZIP or foreign postal code, and phone no.
Northstar Retirement Plan 5ervices 8005 Prairie Ave 0ak Grove, TX 95317
PAYER'5 TIN
92-9819296
RECIPIENT'Sname
Casey M. Larsen
RECIPIENT'S TIN
****1752
1 Gross distribution
$38,891.13
2a Taxable amount
$52,815.55
2b Taxable amount not determíned
[X]
4 Federal income tax withheld
$4,231.98
5 Employee contributions/Designated Roth contributions or insurance premiums
7 Distribution code(s)
1
7 IRA/SEP/SIMPLE
☐
14 State tax withheld
6,779.45
16 State distribution
14,511.44
Department of the Treasury - Intemal Revenue 5ervice
Form 1O99-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-c8b63d94c74fa68675d4175b,v11-1099-R-stacked,original,2022,fgen-d2230beb4fbf819661ae7df6,synthetic_programmatic_template,stacked,top,True,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
From:
Summit Retirement Trust
Recipient's name:
Mateo A. Romero
2b Taxable amount not determined
☐
2a Taxable amount
20,485.28
7 Distribution code(s)
2
4 Federal income tax withheld
$6,046.83",1099,5,1099,fdc-245fc4132095db344a356874,v11-1099-R-stacked,original,2026,fgen-331cc66573ed407171ff0d45,synthetic_programmatic_template,stacked,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
OMB No. 1545-0119
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Evergreen Retirement Services 4943 Oak Hollow Ct Maplewood, MN 59182
PAYER'S TIN
15-5784491
RECIPIENT'S name
Hiro K. Fischer
RECIPIENT'S TIN
***-**-1650
Account number (see instructions)
****044861
1 Gross distribution
$42,293.75
2a Taxable amount
$70,212.19
2b Taxable amount not determined
☐
4 Federal income tax withheld
$6,076.02
7 IRA/SEP/SIMPLE
16 State distribution
$44,381.75
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-f7fe9c31047f4b430f40b33b,v11-1099-R-stacked,original,2026,fgen-bea5a65600614d60254b6507,synthetic_programmatic_template,stacked,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-SharingP1ans, IRAs, Insurance Contracts, etc.
For calendar year 2022
OMB No. l545-0119
CopyB Report this income on your federal tax return.
PAYER'S name, street address, city or town, state or provínce, country, ZIP or foreign posta1 code, and phone no.
Northstar Retírement Plan Services 2820 Elm Park PlTestville, IL 77178
PAYER'S TIN
11-7499631
RECIPIENT'S name
Alex A. Kowalski
RECIPIENT'S TIN
XXXXX0424
Street address (induding apt. no.)
9329 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign posta1 codc
Bayside, WA 6l181
1 Gross distribution
26,877.73
2a Taxable amount
$120,421.36
2b Taxable amount not determined
[X]
4 Federalincome tax withheld
7,l45.48
5 Employee contributions/Designated Roth contributions or insurance premiums
7 Distribution code(s)
1
14 State tax withheld
3,6O5.27
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-962f8efb7afb245d75e8d57a,v11-1099-R-stacked,original,2022,fgen-3edf0de10614f308428d5a68,synthetic_programmatic_template,stacked,top,True,
"Form 1099-RDistributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
PAYER'S name:
Summít Retirement Trust
To:
Sofia Brennan
16 State distribution
$25,955.94
7 IRA/5EP/SIMPLE
0.00
7 Distribution code(s)
4",1099,5,1099,fdc-3b4780ebe19b5953b913b730,v11-1099-R-stacked,original,2023,fgen-acb470f9faa18d29e44471ab,synthetic_programmatic_template,stacked,top,True,
"VOID  CORRECTED
2021
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.
Clearwater 401(k) Administration 3780 Harbor View Rd Brookhaven, PA 34758
PAYER'S TIN
44-7434333
RECIPIENT'S name
Jordan Haddad
RECIPIENT'S TIN
XXXXX9626
Street address (including apt. no.)
1082 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 72087
2a Taxable amount
$99,120.20
2b Taxable amount not determined
[X]
4 Federal income tax withheld
6,088.43
5 Employee contributions/Designated Roth contributions or insurance premiums
$0.00
7 Distribution code(s)
G
7 IRA/SEP/SIMPLE
☒
14 State tax withheld
$617.25
16 State distribution
99,391.64
Department of the Treasury - Internal Revenue Service
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-d24a31e5ce6eb81da7052ae0,v11-1099-R-stacked,original,2021,fgen-ff013c81504cd6ef59232332,synthetic_programmatic_template,stacked,bottom,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2023
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Evergreen Retirement Services 980 Willow Bend Way Bayside, WA 31965
PAYER'S TIN  94-8326655
RECIPIENT'S name   Hiro Tanaka
RECIPIENT'S TIN      XXX-XX-7425
Street address (including apt. no.)      2767 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code      Lakewood, CO 65999
Account number (see instructions) ****597478
1 Gross distribution  $64,711.39
2a Taxable amount   $122,500.70
2b Taxable amount not determined
4 Federal income tax withheld  $7,755.09
5 Employee contributions/Designated Roth contributions or insurance premiums 0.00
7 Distribution code(s) 7D
14 State tax withheld   3,110.36
16 State distribution $96,184.07
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-a28f7a06bfa91e4dcc24b3c4,v11-1099-R-inline,original,2023,fgen-5ce456184d93714c5fd54171,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
For calendar year 2023
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.      Evergreen Retirement Services 5706 Elm Park Pl Testville, IL 92271
PAYER'S TIN 26-3120103
RECIPIENT'S name Riley E. Patel
RECIPIENT'S TIN ending in 7411
Street address (including apt. no.) 556 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code   Riverton, WI 13603
1 Gross distribution  54,934.39
2a Taxable amount $73,110.83
2b Taxable amount not determined   [X]
4 Federal income tax withheld $2,593.28
5 Employee contributions/Designated Roth contributions or insurance premiums 0.00
7 Distribution code(s) 4
7 IRA/SEP/SIMPLE ☒
14 State tax withheld   4,895.20
16 State distribution $21,136.03
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-6efb079c375d60e5ce8d4d56,v11-1099-R-inline,original,2023,fgen-8b1d4c4cbc01ce8240b9fc81,synthetic_programmatic_template,inline,none,False,
"OMB No. 1545-0l19
Copy B Report this income on your federal taxreturn.
Copy C For Recipient's Records
PAYER'S name, street address, city or town,state or province, country, ZIP or foreign postal code, and phone no. Summit Retirement Trust 2001 Lakeshore Blvd Bayside, WA 12309
PAYER'S TIN  35-4291431
RECIPIENT'S namc  Casey D. Fischer
RECIPIENT'S TIN ****1994
Street address (induding apt. no.)   6181 PrairieAve
City or town, state or province, country, and ZIP orforeign postal code Oak Grove, TX 84884
l Gross dístribution 93,226.50
2a Taxab1e amount   9l,793.37
2b Taxable amount not dctermined  X
4 Federal income tax withheld S1,251.68
7 Distribution code(s)  7
7 IRA/SEP/SIMPLE
Department of the Treasury - Intemal Revenue Servíce
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-4dfa27af8587f7981130f496,v11-1099-R-inline,original,2023,fgen-80015f8def3c08e2a5b8ff8f,synthetic_programmatic_template,inline,bottom,True,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2024
OMB No. 1545-0119
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Clearwater 401(k) Administration 660 Elm Park Pl Cedar Falls, IA 65279
PAYER'S TIN   47-2368884
RECIPIENT'S name Kwame J. Romero
RECIPIENT'S TIN   ending in 4679
Street address (including apt. no.)      3004 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 42177
1 Gross distribution   37,663.20
2a Taxable amount  122,855.35
2b Taxable amount not determined   [X]
5 Employee contributions/Designated Roth contributions or insurance premiums  $0.00
7 Distribution code(s) 7D
7 IRA/SEP/SIMPLE   ☒
14 State tax withheld      $7,702.09
16 State distribution $69,445.04
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-411aed2f898159903015225b,v11-1099-R-inline,original,2024,fgen-8dfb34e77844c6be88de7a31,synthetic_programmatic_template,inline,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing P1ans, IRAs, Insurance Contracts, etc.
2024
OMB No. 1545-0119
PAYER'S name, street address, cíty or town, state or province, country, ZIP or foreignpostalcode, and phone no.   Summit Retirement Trust 3186 Elm Park Pl Cedar Falls, IA 3504l
PAYER'S TIN      88-6624773
RECIPIENT'S name  Jordan Fischer
RECIPIENT'S TIN      XXXXX5988
Street address (inc1uding apt. no.)  5702 Maplc Ridge Dr
City or town,state or provínce, country, and ZIP or foreign postal code      Testville, IL66608
1 Gross distribution   $47,638.84
2a Taxable amount   $85,380.23
2b Taxable amount not determined   ☐
4 Federal income tax withheld  $2,248.58
7 Distribution code(s)   G
7 IRA/5EP/SIMPLE
14 State tax withheld   1,723.38
Department of the Treasury -Intemal Revenue 5ervice
Form 1099-R (keep for your records)  www.irs.gov/Form1O99R",1099,5,1099,fdc-78a79f227dd274ff2903f154,v11-1099-R-inline,original,2024,fgen-c0f0db3d83df27bd301f63e1,synthetic_programmatic_template,inline,top,True,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
PAYER'S name:      Evergreen Retirement Services
RECIPIENT: Jamie Testcase
1 Gross distribution  67,203.08
14 State tax withheld 6,256.38",1099,5,1099,fdc-2ee278dc5ca1f92e55c165cf,v11-1099-R-inline,original,2023,fgen-d74fc2ff58962d50f555f743,synthetic_programmatic_template,inline,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2023
PAYER: Northstar Retirement Plan Services
RECIPIENT:   Jamie Adeyemi
1 Gross distribution 116,945.71
2a Taxable amount   36,221.08",1099,5,1099,fdc-1a0dd7cfda87fe49c25434c8,v11-1099-R-inline,original,2023,fgen-b02d4f4eda58bedc9eba308b,synthetic_programmatic_template,inline,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2023
PAYER'S name:   Northstar Retirement Plan Services
To:      Lena Testcase
2a Taxable amount   $49,872.17",1099,5,1099,fdc-fdfc554aebde8a049cfe1b23,v11-1099-R-inline,original,2023,fgen-78b5aa8bc4649e935fa8c0f9,synthetic_programmatic_template,inline,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2021
PAYER'S name:   Evergreen Retirement Services
Recipient's name:  Fatima Patel
4 Federal income tax withheld 902.54
16 State distribution 31,022.06
14 State tax withheld $4,994.04",1099,5,1099,fdc-17fee1fab0c1b7727aa15c89,v11-1099-R-inline,original,2021,fgen-e9119219d55c4d697ba02382,synthetic_programmatic_template,inline,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2023
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.  Summit Retirement Trust 4846 Granite St Oak Grove, TX 94861
PAYER'S TIN   37-5687547
RECIPIENT'S name      Fatima Brennan
RECIPIENT'S TIN   ***-**-5941
Street address (including apt. no.) 4801 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code  Brookhaven, PA 84576
1 Gross distribution  $103,789.47
2a Taxable amount $118,699.38
2b Taxable amount not determined      ☐
4 Federal income tax withheld $8,696.49
5 Employee contributions/Designated Roth contributions or insurance premiums
7 Distribution code(s)      1
7 IRA/SEP/SIMPLE      ☐
14 State tax withheld   $5,069.19
16 State distribution $51,005.36",1099,5,1099,fdc-5b8dfe72801831fc90e5bf27,v11-1099-R-inline,original,2023,fgen-db96b7fef92c242bc38a924b,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2022
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.      Clearwater 401(k) Administration 9742 Cedar Ln Brookhaven, PA 70060
PAYER'S TIN  54-8108353
RECIPIENT'S name      Jordan B. Okafor
RECIPIENT'S TIN  ***-**-8891
Street address (including apt. no.)   9777 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code  Bayside, WA 27905
1 Gross distribution 67,822.85
2b Taxable amount not determined [X]
4 Federal income tax withheld 2,415.43
5 Employee contributions/Designated Roth contributions or insurance premiums
7 Distribution code(s)   7
14 State tax withheld $5,095.90
16 State distribution 50,625.81
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-052b4449cc8c8c5fa745fa78,v11-1099-R-inline,original,2022,fgen-795fb934f8a0fd14b50100a1,synthetic_programmatic_template,inline,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Northstar Retirement Plan Services 1570 Lakeshore Blvd Bayside, WA 53668
PAYER'S TIN 28-7169336
RECIPIENT'S name  Casey B. Lindqvist
RECIPIENT'S TIN  ending in 9355
Street address (including apt. no.)  4681 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 71924
1 Gross distribution  $105,584.66
2a Taxable amount  $68,998.03
2b Taxable amount not determined
4 Federal income tax withheld 5,864.25
5 Employee contributions/Designated Roth contributions or insurance premiums $0.00
7 Distribution code(s) 1
7 IRA/SEP/SIMPLE  ☐
14 State tax withheld   $2,331.50
16 State distribution $131,019.39",1099,5,1099,fdc-81ac7c8c2027baaece149858,v11-1099-R-inline,original,2022,fgen-b8a57091df5bf77777100815,synthetic_programmatic_template,inline,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2026
PAYER: Evergreen Retirement Services
RECIPIENT: Alex Haddad
4 Federal income tax withheld 9,175.54
1 Gross distribution 102,304.25
2a Taxable amount  95,139.48",1099,5,1099,fdc-6b8d1d681818bf4cfba738e2,v11-1099-R-inline,original,2026,fgen-1a2af66e5fb54a570f90138c,synthetic_programmatic_template,inline,top,False,
"For calendar year 2026
OMB No. 1545-0119
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Clearwater 401(k) Administration 4584 Granite St Testville, IL 61542
PAYER'S TIN 87-7580838
RECIPIENT'S name  Taylor Lindqvist
RECIPIENT'S TIN  ending in 5014
Street address (including apt. no.)      9263 Granite St
City or town, state or province, country, and ZIP or foreign postal code  Riverton, WI 69527
2a Taxable amount   38,435.81
2b Taxable amount not determined ☐
4 Federal income tax withheld      5,703.47
7 Distribution code(s) 7
7 IRA/SEP/SIMPLE   [X]
14 State tax withheld $3,812.26
Department of the Treasury - Internal Revenue Service
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-5e59ed15c5c96c820c73175d,v11-1099-R-inline,original,2026,fgen-460f1228799a7d94c8fc5e25,synthetic_programmatic_template,inline,bottom,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2021
From:  Clearwater 401(k) Administration
To: Noah Moreau
1 Gross distribution 63,274.41
4 Federal income tax withheld $4,705.73
2b Taxable amount not determined [X]",1099,5,1099,fdc-dff5d62a9705cc6849cb6eeb,v11-1099-R-inline,original,2021,fgen-a73b8c0d7f91d9c7c7eb2881,synthetic_programmatic_template,inline,top,False,
"2024
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Summit Retirement Trust 1361 Cedar Ln Pinecrest, GA 26207
PAYER'S TIN   38-2612744
RECIPIENT'S name Morgan B. Haddad
RECIPIENT'S TIN ****4215
Street address (including apt. no.)      9326 Granite St
City or town, state or province, country, and ZIP or foreign postal code      Riverton, WI 36695
Account number (see instructions) XXX-XX-639355
1 Gross distribution      $75,501.37
4 Federal income tax withheld 2,574.06
5 Employee contributions/Designated Roth contributions or insurance premiums      $0.00
7 Distribution code(s)  7D
7 IRA/SEP/SIMPLE
14 State tax withheld   $3,396.56
16 State distribution      $83,352.58",1099,5,1099,fdc-dbc393c19602c6ecd1669ca0,v11-1099-R-inline,original,2024,fgen-7559f2063a414f2d02ed92b6,synthetic_programmatic_template,inline,none,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2026 From: Summit Retirement Trust
Recipient's name: Hiro Moreau 2a
Taxable amount $39,795.54",1099,5,1099,fdc-279233c31dff8758bc019fcd,v11-1099-R-flat,original,2026,fgen-ca9302eec3f0841a4c45f4b0,synthetic_programmatic_template,flat,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2021 OMB No. 1545-0119 Copy B Report this income on your federal tax return. PAYER'S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and phone no. Clearwater 401(k) Administration 9541 Granite St Maplewood, MN 17664 PAYER'S TIN 72-8299236 RECIPIENT'S name Amara B. Rivera RECIPIENT'S TIN ending in 7274 1 Gross distribution 38,992.98 2a Taxable amount 5,790.94 2b Taxable amount not determined ☒ 4 Federal income tax withheld $6,221.03 5 Employee contributions/Designated Roth contributions or insurance premiums 7 Distribution code(s) G 14
State tax withheld 4,007.60 16 State distribution 932.54 Department of the Treasury - Internal Revenue Service Form 1099-R (keep for your records) www.irs.gov/Form1099R",1099,5,1099,fdc-ca105df3e1585c344049d2de,v11-1099-R-flat,original,2021,fgen-2463fdb7702134f57f775660,synthetic_programmatic_template,flat,top,False,
"Form 1099-R Distributions
From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. PAYER: Northstar Retirement Plan Services To: Morgan Adeyemi 7 IRA/SEP/SIMPLE X 4 Federal income
tax withheld $209.48",1099,5,1099,fdc-d2f24dab40b3c868283dcbd4,v11-1099-R-flat,original,2021,fgen-89f658da040325caf854037a,synthetic_programmatic_template,flat,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement
or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2021 PAYER'S name: Evergreen Retirement Services
Recipient's name: Wei Okafor 2b Taxable amount not determined ☒ 1 Gross distribution 84,272.00",1099,5,1099,fdc-fe1f4fdb6f23c9292e13c0df,v11-1099-R-flat,original,2021,fgen-8078c0c3262ccf0994e639aa,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED For calendar year 2022 Copy B Report this income on your federal tax return. Copy C For Recipient's Records PAYER'S name, street address, cíty or town, state or province, country, ZIPor foreign postal code, and phone no. NorthstarRetirement P1an 5ervices 5646 Harbor View Rd Brookhaven, PA 6l479 PAYER'S TIN 48-8026049 RECIPIENT'S name
Sofia K. Rivera RECIPIENT'S TIN ****1285 1 Gross distribution 81,700.73 2a Taxable amount 83,O84.11 2b Taxable amount not determined ☒ 4 Federal income tax withheld2,728.7O 5 Employee contributions/Designated Roth contributions or insurancepremiums 7 Distribution code(s)
G 7 IRA/SEP/SIMPLE 14 State tax withheld $1,577.68 16 State distribution $52,730.28 Department of the Treasury - Intema1 Revenue Service",1099,5,1099,fdc-30fc4db9bbfe03e7fe4a2884,v11-1099-R-flat,original,2022,fgen-f34ac7e4cd577dddad9fdc7a,synthetic_programmatic_template,flat,none,True,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. For calendar year 2025 OMB No. 1545-0119 PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Summit Retirement Trust 7009 Lakeshore Blvd Maplewood, MN 16835 PAYER'S TIN 11-8701175 RECIPIENT'S name Mateo L.
Adeyemi RECIPIENT'S TIN ending in 5284 1 Gross distribution $132,073.30 2b Taxable
amount not determined X 4 Federal income tax withheld 8,960.10 5 Employee contributions/Designated Roth contributions or insurance premiums 0.00 7 Distribution code(s) 7D 7 IRA/SEP/SIMPLE 14 State tax withheld $4,403.70 Department of the Treasury - Internal Revenue Service Form 1099-R (keep for your records) www.irs.gov/Form1099R",1099,5,1099,fdc-79780e07a7d95e8377a221fe,v11-1099-R-flat,original,2025,fgen-e069330ca6934020b46125b6,synthetic_programmatic_template,flat,top,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. OMB No. 1545-0119 Copy C For Recipient's Records PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Northstar Retirement Plan Services 6732 Harbor View Rd Bayside, WA 60352 PAYER'S TIN
52-4707873 RECIPIENT'S name Casey Brennan RECIPIENT'S TIN ***-**-8834 Street address (including apt. no.) 2266 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 15016 Account number (see instructions) XXX-XX-807141 1 Gross distribution $127,686.64 2a Taxable amount $6,428.87 2b Taxable amount not determined X 4 Federal income
tax withheld 5,825.89 5 Employee contributions/Designated Roth contributions or insurance premiums 7 Distribution code(s) 7D 14 State tax withheld $2,239.75 16 State distribution 120,524.92",1099,5,1099,fdc-c443437b91538a431e0718f3,v11-1099-R-flat,original,2023,fgen-f6f8d64ec0e07b9eaa00510a,synthetic_programmatic_template,flat,top,False,
"Form 1099-R Distributions From Pensions,Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2026 Copy C For Recipient's Records PAYER'S name, street address, city or town, stateor province, country, ZIP or foreign postal code,and phone no. Northstar
Retirement Plan 5ervices 2797 Willow Bcnd Way Pinecrest, GA 80449 PAYER'S TIN 90-7262084RECIPIENT'5 name Diego D. Rivera RECIPIENT'S TIN XXX-XX-973lStreetaddress (including apt. no.) 4102 Granite St City or town, state or province, country, and ZIP or foreign postal code Pínecrest, GA 97684 Account number (see instructions) ending in 611710 1 Gross distribution 22,449.83 2a Taxablc amount S25,680.81 2b Taxable amount not determíned ☐ 4 Federal income tax withheld $4,281.93 5 Employee contributions/Designated Roth contributions or insurance premiums $0.00 7 Distribution code(s) G 7 IRA/SEP/SIMPLE ☒ l4 State tax withhe1d $9,217.91 16 State distribution $63,067.92 Department of the Treasury - Intema1 Revenue Service Form 1099-R (keep for your records) www.irs.gov/Forml099R",1099,5,1099,fdc-7603102406732ce34279bae9,v11-1099-R-flat,original,2026,fgen-a23cba48621712bb4330aacf,synthetic_programmatic_template,flat,top,True,
"☐ CORRECTED Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. For calendar year 2021 OMB No. 1545-0119 Copy B Report this income on your federal tax return. Copy C For Recipient's Records PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Summit Retirement Trust 9553 Sample Street Testville, IL 87335 PAYER'S TIN 75-3131514 RECIPIENT'S name Sofia Moreau RECIPIENT'S TIN ****5564 1 Gross
distribution 1,602.51 2a Taxable amount 32,136.69 2b Taxable amount not determined ☒ 4 Federal income tax withheld 487.25 5 Employee contributions/Designated Roth contributions or insurance premiums 0.00 7 Distribution code(s) 7 7 IRA/SEP/SIMPLE ☐ 14 State tax withheld $5,138.26 16 State distribution 21,026.76 Department of the Treasury -
Internal Revenue Service Form 1099-R (keep for your records) www.irs.gov/Form1099R",1099,5,1099,fdc-5f5b81a664a1a1503024bd57,v11-1099-R-flat,original,2021,fgen-21573804626ac71a3e3db744,synthetic_programmatic_template,flat,top,False,
"2023 OMB No. 1545-0119 Copy C For Recipient's Records PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Evergreen Retirement Services 4481
Elm Park Pl Oak Grove, TX 83422 PAYER'S TIN 33-3335280 RECIPIENT'S name Taylor E. Moreau RECIPIENT'S TIN ending in 5691 Street address (including apt. no.) 5252 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 53262 Account number (see instructions) XXX-XX-372154 1 Gross distribution $126,743.78 2a Taxable amount $84,156.41 2b Taxable amount not determined [X] 4 Federal income tax withheld $2,201.69 5 Employee contributions/Designated Roth contributions or insurance premiums 7 Distribution code(s) 4 7 IRA/SEP/SIMPLE [X] 14 State
tax withheld $7,990.34 Department of the Treasury - Internal Revenue Service Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Form 1099-R (keep for your records) www.irs.gov/Form1099R",1099,5,1099,fdc-6b262d596efb9d643938de3c,v11-1099-R-flat,original,2023,fgen-26e20f42ce1bef1215d872f4,synthetic_programmatic_template,flat,bottom,False,
"☐ CORRECTED Copy B Report this income on your federal tax return. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Northstar Retirement Plan Services 2764 Oak Hollow Ct Brookhaven, PA 81422 PAYER'S TIN 80-4203983 RECIPIENT'S name Diego Castillo RECIPIENT'S TIN XXXXX1793 Street address (including apt. no.) 715 Sample Street City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 37373 1 Gross distribution 96,403.77 2a Taxable amount 99,538.66 2b Taxable amount not determined ☒ 4 Federal income tax withheld 2,244.07 5 Employee
contributions/Designated Roth contributions or insurance premiums 0.00 7 Distribution code(s) 7 7 IRA/SEP/SIMPLE ☐ 14 State tax withheld
5,738.51 16 State distribution $37,532.75",1099,5,1099,fdc-8fc4b1aea336ca55f693cacb,v11-1099-R-flat,original,2022,fgen-8dec32e210f59059deaec1d0,synthetic_programmatic_template,flat,none,False,
"Form 1099-R Distributions From
Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2025 PAYER:
Clearwater 401(k) Administration To: Fatima A. Patel 2a Taxable amount $125,549.67 7 Distribution code(s) 1",1099,5,1099,fdc-14591295814b63615fa66bc6,v11-1099-R-flat,original,2025,fgen-723f604fa4b0468e725d809f,synthetic_programmatic_template,flat,top,False,
"Form 1099-R Distributions From
Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. For calendar year 2025 0MBNo. l545-0119 Copy B Report this incomeon your federal tax return. Copy C For Recipicnt's Records PAYER'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and phone no. Northstar Retirement Plan Services 7952 0ak Hollow Ct Maplewood, MN 11877 PAYER'5 TIN 29-9537986 RECIPIENT'S name Hiro Tanaka RECIPIENT'S TIN ****4772 Street address (including apt. no.) 6744 Harbor View Rd City or town, state or province, country, and ZIP or foreign posta1 code Maplewood, MN 30605 Account number (see instructions) ****862666 l Gross distribution $1,856.90 2a Taxab1e amount $105,123.06 2b Taxable amount not determined X 4Federal income tax withheld 1,641.04 5 Employee contributions/Designated Roth contributions or insurance premiums 0.00 7 Distribution code(s) 77 IRA/5EP/SIMPLE ☒ 14State tax withheld $8,656.20 16 State dístribution $22,560.25",1099,5,1099,fdc-d2829ca62530aa69aa0985fd,v11-1099-R-flat,original,2025,fgen-66449dc70c7330e1c70e6a09,synthetic_programmatic_template,flat,top,True,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2025 OMB No. 1545-0119 Copy B Report this income on your federal tax return. Copy C For Recipient's Records PAYER'S name, street
address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Summit Retirement Trust 1051 Lakeshore Blvd Testville, IL 49084
PAYER'S TIN 58-1924303 RECIPIENT'S name Lena Rivera RECIPIENT'S TIN ****7601 1 Gross distribution 28,668.54 2a Taxable amount 70,380.72 2b Taxable amount not determined ☐ 4 Federal income tax withheld 1,477.44 7 Distribution code(s) 7 7 IRA/SEP/SIMPLE [X] 14 State tax withheld 3,161.62 16 State distribution 83,649.26 Department of the Treasury - Internal Revenue Service Form 1099-R (keep for your records) www.irs.gov/Form1099R",1099,5,1099,fdc-f44700e30c11f7777b065ddd,v11-1099-R-flat,original,2025,fgen-88e27300b1ab4283c3907de5,synthetic_programmatic_template,flat,top,False,
"For
calendar year 2026 OMB No. 1545-0119 Copy B Report this income on your federal tax return. PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Northstar Retirement Plan Services 1668 Oak Hollow Ct Testville, IL 24360 PAYER'S TIN 78-7710135 RECIPIENT'S name Alex Haddad RECIPIENT'S TIN ending in 2100 1 Gross distribution $40,006.87 2a Taxable amount 85,374.13 2b Taxable amount not determined ☐ 4 Federal income tax withheld $4,398.29 5 Employee contributions/Designated Roth contributions or insurance premiums 0.00 7 Distribution code(s) G 7 IRA/SEP/SIMPLE [X]
14 State tax withheld 5,536.53 16 State distribution $130,943.65 Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-f5ce3ddd74e93209d8aecca9,v11-1099-R-flat,original,2026,fgen-65b220c874f3c6b7d27056b5,synthetic_programmatic_template,flat,none,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2022 From: Northstar Retirement Plan Services
To: Alex
B. Patel 16 State distribution 79,791.40 2b Taxable amount not determined ☐ 14 State tax withheld 4,899.35 4 Federal income tax withheld 957.76",1099,5,1099,fdc-0dfacb4d86593ce05d4f8fb1,v11-1099-R-flat,original,2022,fgen-88032402700b768327c4aea5,synthetic_programmatic_template,flat,top,False,
"## Form 1099-R
## Distributions From Pcnsions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendaryear 2023
OMB No. 1545-0l19
Copy B Report thís income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, stateor province, country, ZIP or foreign posta1 code, and phone no. | Summit Retirement Trust 2758 Oak Hollow Ct Ríverton, WI 97531 |
| PAYER'5 TIN | 85-3470298 |
| RECIPIENT'5 name | Casey Kowalskí |
| RECIPIENT'S TIN | ****2686 |
| Street address (including apt. no.)| 9212 Maple RidgeDr |
| City or town, state or province, country, and ZIP or foreígn postal code| Bayside, WA 27949 |
| 1 Gross dístribution | $71,988.67 |
| 2a Taxable amount | $139,117.66 |
| 2b Taxable amount not determined | X |
| 4 Federal income tax withheld | 3,210.98 |
| 7 Distribution code(s) |7|
| 7 IRA/SEP/SIMPLE |  |
| 14 Statc tax withheld | $5,025.89 |
| 16 State distribution | $34,164.94 |
Department of the Treasury - Internal Revenue Service
## Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-8cc6decdb6165018bd543012,v11-1099-R-markdown,original,2023,fgen-d56c9d0138c1b6c24c7c78f6,synthetic_programmatic_template,markdown,top,True,
"For calendar year 2023
## OMB No. 1545-0119
Copy B Report this income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Evergreen Retirement Services 2267 Elm Park Pl Lakewood, CO 46162 |
| PAYER'S TIN | 80-7776634 |
| RECIPIENT'S name | Olivia K. Patel |
| RECIPIENT'S TIN | ****7016 |
| Street address (including apt. no.) | 9562 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 38916 |
| 1 Gross distribution | 120,622.53 |
| 2a Taxable amount | 115,715.72 |
| 2b Taxable amount not determined | X |
| 4 Federal income tax withheld | 1,727.74 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums |  |
| 7 IRA/SEP/SIMPLE | [X] |",1099,5,1099,fdc-9f9bafd1e2c52cdbd9d1a52c,v11-1099-R-markdown,original,2023,fgen-fcc3e1cec0af82e760f4ee29,synthetic_programmatic_template,markdown,none,False,
"CORRECTED (if checked)
## Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
2024
OMB No. 1545-0119
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Summit Retirement Trust 1322 Sample Street Cedar Falls, IA 78635 |
| PAYER'S TIN | 70-4053436 |
| RECIPIENT'S name | Jordan Lindqvist |
| RECIPIENT'S TIN | XXX-XX-4507 |
| Street address (including apt. no.) | 5020 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 52668 |
| 1 Gross distribution | $69,398.90 |
| 2a Taxable amount | $3,474.37 |
| 4 Federal income tax withheld | 7,871.94 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums | $0.00 |
| 7 Distribution code(s) | 7D |
| 7 IRA/SEP/SIMPLE | ☒ |
| 14 State tax withheld | 7,950.95 |
| 16 State distribution | $79,447.65 |
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-ea182e0b9eedae5e0ff4cc2b,v11-1099-R-markdown,original,2024,fgen-d69a1fa8e70ddebeaab97653,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2023
## OMB No. 1545-0119
Copy B Report this income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Northstar Retirement Plan Services 2514 Prairie Ave Riverton, WI 20871 |
| PAYER'S TIN | 61-8974150 |
| RECIPIENT'S name | Avery B. Sato |
| RECIPIENT'S TIN | XXX-XX-8471 |
| Account number (see instructions) | ending in 262391 |
| 1 Gross distribution | 20,492.18 |
| 2a Taxable amount | $102,270.31 |
| 2b Taxable amount not determined | X |
| 4 Federal income tax withheld | $4,137.33 |
| 7 IRA/SEP/SIMPLE | ☒ |
| 14 State tax withheld | 9,223.82 |
| 16 State distribution | 38,294.42 |
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-84be537ca1c69b153375a018,v11-1099-R-markdown,original,2023,fgen-c6c2a6c9cb162b0346c2243e,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-0119
## Copy C For Recipient's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Summit Retirement Trust 4513 Willow Bend Way Bayside, WA 27806 |
| PAYER'S TIN | 45-8433698 |
| RECIPIENT'S name | Olivia Castillo |
| RECIPIENT'S TIN | ***-**-2856 |
| Street address (including apt. no.) | 6447 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 67413 |
| 1 Gross distribution | 91,161.87 |
| 2a Taxable amount | 100,850.10 |
| 4 Federal income tax withheld | $5,437.95 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums |  |
| 7 Distribution code(s) | 2 |
| 7 IRA/SEP/SIMPLE | ☐ |
| 14 State tax withheld | 3,241.14 |
## Department of the Treasury - Internal Revenue Service
## Form 1099-R
## Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-c738812c0e14dc936690c726,v11-1099-R-markdown,original,2026,fgen-67b2a8a00c5817e89841afb5,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
| Field | Value |
| --- | --- |
| PAYER'S name: | Evergreen Retirement Services |
| To: | Avery Lindqvist |
| 2a Taxable amount | 20,961.72 |",1099,5,1099,fdc-b03e3a1d94a82a05a53993b0,v11-1099-R-markdown,original,2025,fgen-33a4dc0d43660f75ecdf057c,synthetic_programmatic_template,markdown,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Evergreen Retirement Services 332 Harbor View Rd Cedar Falls, IA 21560 |
| PAYER'S TIN | 26-1985247 |
| RECIPIENT'S name | Kwame Patel |
| RECIPIENT'S TIN | ***-**-3799 |
| Street address (including apt. no.) | 1290 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 26617 |
| Account number (see instructions) | ****684728 |
| 1 Gross distribution | 43,892.35 |
| 2a Taxable amount | 43,949.15 |
| 2b Taxable amount not determined | ☐ |
| 5 Employee contributions/Designated Roth contributions or insurance premiums |  |
| 7 Distribution code(s) | G |
| 7 IRA/SEP/SIMPLE | ☒ |
| 14 State tax withheld | 451.55 |
| 16 State distribution | $136,997.84 |",1099,5,1099,fdc-5c761a4b8b08f89ec3068151,v11-1099-R-markdown,original,2023,fgen-1f9912ee6782843eefb10bc0,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| PAYER: | Northstar Retirement Plan Services |
| RECIPIENT: | Fatima Walsh |
| 1 Gross distribution | 99,670.54 |
| 14 State tax withheld | $5,969.43 |
## Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.",1099,5,1099,fdc-d9473ca8eb19f0c7c2a6908c,v11-1099-R-markdown,original,2026,fgen-3a7acc6021770cbea0651f9f,synthetic_programmatic_template,markdown,bottom,False,
"| Field | Value |
| --- | --- |
| PAYER: | Clearwater 401(k) Administration |
| RECIPIENT: | Hiro Kowalski |
| 4 Federal income tax withheld | $7,480.57 |
| 14 State tax withheld | $8,370.19 |",1099,5,1099,fdc-fb3563e0f00eb801d26002ba,v11-1099-R-markdown,original,2025,fgen-330a0396c42dd5195f070d38,synthetic_programmatic_template,markdown,none,False,
"2024
OMB No. 1545-0119
Copy B Report this income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Summit Retirement Trust 3296 Harbor View Rd Lakewood, CO 13164 |
| PAYER'S TIN | 49-2972646 |
| RECIPIENT'S name | Alex Sato |
| RECIPIENT'S TIN | ****2225 |
| Street address (including apt. no.) | 3037 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 35431 |
| Account number (see instructions) | XXX-XX-474693 |
| 2a Taxable amount | 103,071.79 |
| 2b Taxable amount not determined | [X] |
| 4 Federal income tax withheld | $4,407.01 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums | 0.00 |
| 7 Distribution code(s) | 2 |
| 7 IRA/SEP/SIMPLE | ☒ |
| 14 State tax withheld | $7,493.19 |
| 16 State distribution | 94,678.87 |
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.",1099,5,1099,fdc-5286b11cd47b73a53756f693,v11-1099-R-markdown,original,2024,fgen-add7cc173b8ff1997eb17003,synthetic_programmatic_template,markdown,bottom,False,
"VOID  CORRECTED
## Form 1099-R
## Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2021
OMB No. 1545-0119
## Copy B Report this income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Summit Retirement Trust 8678 Elm Park Pl Bayside, WA 77148 |
| PAYER'S TIN | 82-3783175 |
| RECIPIENT'S name | Taylor D. Lindqvist |
| RECIPIENT'S TIN | XXX-XX-2461 |
| 1 Gross distribution | 111,878.32 |
| 2a Taxable amount | 51,980.53 |
| 2b Taxable amount not determined |  |
| 5 Employee contributions/Designated Roth contributions or insurance premiums | $0.00 |
| 7 Distribution code(s) | 7D |
| 7 IRA/SEP/SIMPLE | X |
| 14 State tax withheld | 4,917.79 |
| 16 State distribution | $127,392.65 |",1099,5,1099,fdc-779cc0ca4aae2e66bcede5cb,v11-1099-R-markdown,original,2021,fgen-2555310858b322b4752656ba,synthetic_programmatic_template,markdown,top,False,
"## 2021
OMB No. 1545-0119
## Copy B Report this income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Northstar Retirement Plan Services 9284 Maple Ridge Dr Brookhaven, PA 12980 |
| PAYER'S TIN | 92-7341780 |
| RECIPIENT'S name | Morgan Brennan |
| RECIPIENT'S TIN | ***-**-9164 |
| Street address (including apt. no.) | 9003 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 42678 |
| 1 Gross distribution | 33,736.02 |
| 2b Taxable amount not determined |  |
| 4 Federal income tax withheld | 7,863.32 |
| 7 Distribution code(s) | G |
| 7 IRA/SEP/SIMPLE |  |
| 14 State tax withheld | $5,830.25 |
| 16 State distribution | $56,599.18 |
Department of the Treasury - Internal Revenue Service
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-8d957452a3d2e54ddb0a00fc,v11-1099-R-markdown,original,2021,fgen-ef873d52fbea14d9cf624c7f,synthetic_programmatic_template,markdown,bottom,False,
"## CORRECTED (if checked)
Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2025
OMB No. 1545-0119
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Evergreen Retirement Services 6225 Cedar Ln Oak Grove, TX 33599 |
| PAYER'S TIN | 59-2922048 |
| RECIPIENT'S name | Noah Moreau |
| RECIPIENT'S TIN | ****3426 |
| Street address (including apt. no.) | 190 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 88516 |
| 1 Gross distribution | $25,972.02 |
| 2a Taxable amount | $104,154.33 |
| 2b Taxable amount not determined | ☐ |
| 4 Federal income tax withheld | 9,489.46 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums | 0.00 |
| 7 Distribution code(s) | G |
| 7 IRA/SEP/SIMPLE | [X] |
| 14 State tax withheld | $2,215.26 |
| 16 State distribution | 122,019.47 |
Department of the Treasury - Internal Revenue Service
Form 1099-R (keep for your records)  www.irs.gov/Form1099R",1099,5,1099,fdc-e09866d7a46e90d32d1053ed,v11-1099-R-markdown,original,2025,fgen-725fe894b9abf23f4eb9f1f0,synthetic_programmatic_template,markdown,top,False,
"Form 1099-R
## Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2022
OMB No. 1545-0119
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Summit Retirement Trust 4191 Cedar Ln Cedar Falls, IA 19470 |
| PAYER'S TIN | 15-2737180 |
| RECIPIENT'S name | Avery Brennan |
| RECIPIENT'S TIN | ****9385 |
| Street address (including apt. no.) | 7926 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 74908 |
| 1 Gross distribution | 71,406.48 |
| 2b Taxable amount not determined |  |
| 4 Federal income tax withheld | $1,095.26 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums | $0.00 |
| 7 Distribution code(s) | 7D |
| 7 IRA/SEP/SIMPLE | X |
| 14 State tax withheld | 8,498.12 |",1099,5,1099,fdc-3c352246995c0aaa90f91761,v11-1099-R-markdown,original,2022,fgen-bb06ce41b059da0dc3123b5b,synthetic_programmatic_template,markdown,top,False,
"Form 1099-R
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
For calendar year 2023
Copy B Report this income on your federal tax return.
Copy C For Recipient's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Evergreen Retirement Services 3378 Cedar Ln Brookhaven, PA 45511 |
| PAYER'S TIN | 74-3531374 |
| RECIPIENT'S name | Casey Testcase |
| RECIPIENT'S TIN | ****6493 |
| 1 Gross distribution | 105,521.64 |
| 2b Taxable amount not determined | ☒ |
| 4 Federal income tax withheld | $5,604.33 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums | 0.00 |
| 7 Distribution code(s) | 1 |
| 7 IRA/SEP/SIMPLE | ☒ |
| 14 State tax withheld | $8,900.12 |
| 16 State distribution | $55,289.91 |",1099,5,1099,fdc-0acc940d64292c3fa46bc545,v11-1099-R-markdown,original,2023,fgen-f1c00d3399c6f4f23eb8994d,synthetic_programmatic_template,markdown,top,False,
"## VOID  CORRECTED
For calendar year 2022
OMB No. 1545-0119
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. | Summit Retirement Trust 2897 Prairie Ave Pinecrest, GA 20289 |
| PAYER'S TIN | 77-6055425 |
| RECIPIENT'S name | Kwame S. Romero |
| RECIPIENT'S TIN | XXX-XX-2027 |
| Street address (including apt. no.) | 6181 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 32881 |
| 1 Gross distribution | $55,234.27 |
| 2a Taxable amount | 54,543.88 |
| 2b Taxable amount not determined | ☐ |
| 4 Federal income tax withheld | $9,160.39 |
| 5 Employee contributions/Designated Roth contributions or insurance premiums | 0.00 |
| 7 IRA/SEP/SIMPLE | ☐ |
| 14 State tax withheld | $4,927.56 |
| 16 State distribution | $86,716.69 |
## Form 1099-R
## Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.",1099,5,1099,fdc-ada9dcba2bce3a1b09b0e38d,v11-1099-R-markdown,original,2022,fgen-9a1bac53ca34cf61335f3b08,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2023
OMB No. 1545-0997
This is importanttax informationand is bcing fumished to the IRS.
FILER'S name, street address,city or town, state or province, country, and ZIP or foreign postal code
Lakeshore Closing Services 3773 Granite St Maplewood, MN 83540
FILER'S TIN
43-3803294
TRANSFEROR'S name
Jamie K. Haddad
TRANSFEROR'S TIN
ending in 0853
Account number (see instructions)
ending in 267578
l Date of dosing
July 26, 2023
2 Gross proceeds
$40l,987.31
3 Address orlegal description (induding city, statc, and ZIP code)
2442 Oak Hollow Ct Fairview, OH 46648
4 Check here if the transferor received or will rcceive property or services as part of the consideration
☒
5 Check here if the transferor is a foreign person
[X]
6 Buyer's part of real estate tax
6,708.83
Department of the Treasury - Intemal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-3293cef2e7282ab579a21ac5,v11-1099-S-stacked,original,2023,fgen-5300b58d070757a540a6a982,synthetic_programmatic_template,stacked,top,True,
"For calendar year 2026
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Cedar Title & Escrow 4163 Prairie Ave Pinecrest, GA 27843
FILER'S TIN
29-2094932
TRANSFEROR'S name
Priya Fischer
TRANSFEROR'S TIN
***-**-7155
Street address (including apt. no.)
8964 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 96662
2 Gross proceeds
240,481.70
3 Address or legal description (including city, state, and ZIP code)
8369 Sample Street Testville, IL 99833
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
X
6 Buyer's part of real estate tax
9,037.24
Department of the Treasury - Internal Revenue Service
Form 1099-S
Proceeds From Real Estate Transactions
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-764c2933201fbae2fabb8a5d,v11-1099-S-stacked,original,2026,fgen-fd6243f595339edcffe7e489,synthetic_programmatic_template,stacked,bottom,False,
"CORRECTED (if checked)
For calendar year 2025
0MB No. 1545-0997
Copy B For Transferor
FILER'5 name, street address, city or town, state or province, country, and ZIP or foreignpostal code
Summit Land Title Co. 1477 Prairie Ave Cedar Falls, IA 11728
FILER'S TIN
91-7458100
TRANSFEROR'S namc
Lena S. Romero
TRANSFEROR'S TIN
ending in 2078
Account number (see instructions)
ending in 376699
1 Date of dosing
2O25-06-15
2 Grossproceeds
$315,488.98
3 Address or legal descríption(including city, state, and ZIP code)
6551 Elm Park Pl Cedar Falls, IA 95411
4 Check here if the transferor received or will rcceive property or scrvices as part of the consideration
X
5Check here if the transferor is a foreign person
☒
6 Buyer's part of real estate tax
475.18
Department of the Treasury - Intemal Revenue 5ervice
Form 1O99-S
Proceeds From Real Estate Transactions
Form 1099-5 (keep for your records)  www.irs.gov/Forml099S",1099,5,1099,fdc-58c96b2fb6ca1e0da0303134,v11-1099-S-stacked,original,2025,fgen-b8c68dafbe599a688d786156,synthetic_programmatic_template,stacked,bottom,True,
"VOID  CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2026
Copy B For Transferor
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Lakeshore Closing Services 4959 Sample Street Oak Grove, TX 65419
FILER'S TIN
39-3307396
TRANSFEROR'S name
Taylor J. Walsh
TRANSFEROR'S TIN
****0808
Street address (including apt. no.)
2955 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 94669
Account number (see instructions)
XXXXX624099
1 Date of closing
1/16/26
2 Gross proceeds
$566,847.92
3 Address or legal description (including city, state, and ZIP code)
5480 Granite St Brookhaven, PA 72249
4 Check here if the transferor received or will receive property or services as part of the consideration
☒
5 Check here if the transferor is a foreign person
☒
6 Buyer's part of real estate tax
$3,703.88
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-e760ae5ada6c3096dfcec93f,v11-1099-S-stacked,original,2026,fgen-0ac9700e9d5d11b9a43938f0,synthetic_programmatic_template,stacked,top,False,
"Form 1099-S
Proceeds From Rea1 Estate Transactions
OMBNo. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street addrcss, city or town, state or provincc, country, and ZIP or foreign postal code
Lakeshore Closing Services l900Prairie Ave Testville, IL 85916
FILER'S TIN
79-5O35553
TRAN5FER0R'5name
Jamie E. Larsen
TRANSFEROR'S TIN
XXXXX1978
Street address (induding apt. no.)
6680 Prairie Ave
City or town, statc or province, country, and ZIP or foreign postalcode
Lakewood, CO 91624
1Date of dosing
12/08/2023
2 Gross proceeds
$586,145.47
3 Address or legal description (includíng city, state, and ZIP code)
7763 Harbor View Rd Oak Grove, TX 97157
4 Check here if the transferor received or will receive property or services as part of the consideration
[X]
5 Check here if the transferor is a foreign person
☐
6 Buyer's part of real estate tax
4,629.90",1099,5,1099,fdc-ecebdb0effcc230b185ea72e,v11-1099-S-stacked,original,2023,fgen-8d17fce7fb765440ed93a109,synthetic_programmatic_template,stacked,top,True,
"Form 1099-S
Proceeds From Real Estate Transactions
2026
OMB No. 1545-O997
Copy B For Transferor
FILER'S name, street address, city ortown, state or provínce, country, and ZIP or foreign postal code
Summit Land TitleCo. 9508 0ak Hollow Ct Pinecrest, GA 57739
FILER'S TIN
68-9484509
TRANSFEROR'S namc
Hiro M. Testcase
TRANSFEROR'S TIN
ending in 6754
Street address (including apt. no.)
1626 E1m Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 47351
1 Date of closíng
12/14/23
4 Check hereíf the transferor received or will receive property or services as part of the consideration
☒
5 Check here if the transferor is a foreignperson
[X]
6 Buyer's part of real estate tax
$3,498.l3
Department of the Treasury - Internal Revenue 5ervice
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-5e5bea78b9ccd927d0b1d7e7,v11-1099-S-stacked,original,2026,fgen-a8bed8ff166d3650a76bc0d6,synthetic_programmatic_template,stacked,top,True,
"Form 1099-S
Proceeds From Real Estate Transactions
2026
OMB No. 1545-0997
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Lakeshore Closing Services 5279 Granite St Cedar Falls, IA 13461
FILER'S TIN
44-7661351
TRANSFEROR'S name
Kwame Fischer
TRANSFEROR'S TIN
XXXXX6791
Street address (including apt. no.)
5035 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 76243
1 Date of closing
February 13, 2026
2 Gross proceeds
$174,099.97
3 Address or legal description (including city, state, and ZIP code)
5744 Maple Ridge Dr Riverton, WI 99079
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
[X]
6 Buyer's part of real estate tax
$5,717.13",1099,5,1099,fdc-f6c9af4be61e4a47242a76e3,v11-1099-S-stacked,original,2026,fgen-b3e7dc0749a9296b37824831,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Summit Land Title Co. 5701 Oak Hollow Ct Bayside, WA 18745
FILER'S TIN
78-5992512
TRANSFEROR'S name
Morgan E. Castillo
TRANSFEROR'S TIN
XXX-XX-7171
Street address (including apt. no.)
4360 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 67779
1 Date of closing
June 20, 2021
2 Gross proceeds
351,760.03
3 Address or legal description (including city, state, and ZIP code)
157 Harbor View Rd Brookhaven, PA 99795
4 Check here if the transferor received or will receive property or services as part of the consideration
[X]
5 Check here if the transferor is a foreign person
X
6 Buyer's part of real estate tax
49.21",1099,5,1099,fdc-c9f57ebd738130df26458d2d,v11-1099-S-stacked,original,2021,fgen-3dfe4e21b0a9a683be1d3c3f,synthetic_programmatic_template,stacked,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2O22
Copy B For Transferor
FILER'5 name, street address, cíty ortown, state or province, country, and ZIP or foreign postal code
Summit Land Títle Co. 7175 Maple Ridge Dr Maplewood,MN 75281
FILER'S TIN
67-7165083
TRANSFEROR'S name
Priya Kowalski
TRANSFEROR'S TIN
***-**-2385
Street address (including apt. no.)
6435 Maple Ridge Dr
City or town, state or province, country, and ZIPor foreign postal code
Pinecrest, GA 18757
Account number (see instructions)
XXXXX712581
1 Date of closing
2022-07-26
2 Gross procceds
178,750.82
4 Check here íf the transferor received or wi1l receive property or services as part of the consideration
[X]
Department of the Treasury -Intemal Revenue Servíce
Form lO99-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-22410c67ae38217a110b0922,v11-1099-S-stacked,original,2022,fgen-f306194bdaf878e55c833a9d,synthetic_programmatic_template,stacked,top,True,
"From:
Cedar Title & Escrow
To:
Taylor L. Sato
4 Check here if the transferor received or will receíve property or services as part of the consíderation
☐
3 Address or legal description (including city,state, and ZIP code)
3059 Sample Street Brookhaven, PA 979l9
1 Date of closing
August 14, 2O23",1099,5,1099,fdc-44fb8fe847d779346c660f06,v11-1099-S-stacked,original,2026,fgen-c65e3085de41d81d77fdc916,synthetic_programmatic_template,stacked,none,True,
"Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2025
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Summit Land Title Co. 4039 Oak Hollow Ct Bayside, WA 38773
FILER'S TIN
63-4332592
TRANSFEROR'S name
Avery C. Patel
TRANSFEROR'S TIN
***-**-6411
Street address (including apt. no.)
6419 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 13865
1 Date of closing
01/18/2025
2 Gross proceeds
$155,455.51
3 Address or legal description (including city, state, and ZIP code)
2183 Cedar Ln Brookhaven, PA 97551
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
[X]
6 Buyer's part of real estate tax
2,048.18
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-fe30146021a85acdc7fdf226,v11-1099-S-stacked,original,2025,fgen-a38aa372937196db2bd1cc40,synthetic_programmatic_template,stacked,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2026
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Summit Land Title Co. 5274 Elm Park Pl Lakewood, CO 18138
FILER'S TIN
16-8289460
TRANSFEROR'S name
Jordan Sato
TRANSFEROR'S TIN
ending in 1623
Street address (including apt. no.)
3396 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 98756
1 Date of closing
2023-03-16
2 Gross proceeds
411,392.20
3 Address or legal description (including city, state, and ZIP code)
8418 Elm Park Pl Riverton, WI 61346
4 Check here if the transferor received or will receive property or services as part of the consideration
☒
5 Check here if the transferor is a foreign person
☒
6 Buyer's part of real estate tax
$8,036.61",1099,5,1099,fdc-3a1acb073e65f65791997085,v11-1099-S-stacked,original,2026,fgen-e845d3ff6d765e1a6701f7de,synthetic_programmatic_template,stacked,top,False,
"Form 1099-S Proceeds From Real Estate Transactions 2026
FILER:
Lakeshore Closing Services
Recipient's name:
Diego Castillo
5 Check here if the transferor is a foreign person
X
6 Buyer's part of real estate tax
$4,934.80
1 Date of closing
February 9, 2023
2 Gross proceeds
165,395.13",1099,5,1099,fdc-749acb3455fa241a0709f197,v11-1099-S-stacked,original,2026,fgen-fd1e6d7c490f791bab81fd12,synthetic_programmatic_template,stacked,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2025
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Summit Land Title Co. 268 Sample Street Oak Grove, TX 88599
FILER'S TIN
86-5649318
TRANSFEROR'S name
Priya E. Sato
TRANSFEROR'S TIN
XXX-XX-1644
Street address (including apt. no.)
3925 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 60465
Account number (see instructions)
***-**-045187
3 Address or legal description (including city, state, and ZIP code)
1742 Elm Park Pl Bayside, WA 93288
4 Check here if the transferor received or will receive property or services as part of the consideration
☐
5 Check here if the transferor is a foreign person",1099,5,1099,fdc-de5d71a51b95e9b318af62b1,v11-1099-S-stacked,original,2025,fgen-231b0b43ea36b2cbb88b5b09,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 1099-S
Proceeds From Real Estate Transactions
2023
OMB No. 1545-0997
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Summit Land Title Co. 9884 Elm Park Pl Testville, IL 31139
FILER'S TIN
92-1159475
TRANSFEROR'S name
Amara S. Sato
TRANSFEROR'S TIN
***-**-2334
Street address (including apt. no.)
3539 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 48878
Account number (see instructions)
XXX-XX-429950
1 Date of closing
2023-01-15
2 Gross proceeds
$158,773.12
5 Check here if the transferor is a foreign person
X
6 Buyer's part of real estate tax
5,083.26
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-845ff2ae8edba8b281f912bb,v11-1099-S-stacked,original,2023,fgen-9f77f9a78c7387f5ea196ce7,synthetic_programmatic_template,stacked,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2023
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Summit Land Title Co. 5909 Maple Ridge Dr Lakewood, CO 93482
FILER'S TIN
42-4190448
TRANSFEROR'S name
Morgan Castillo
TRANSFEROR'S TIN
XXX-XX-1510
Street address (including apt. no.)
6887 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 87672
Account number (see instructions)
ending in 846001
2 Gross proceeds
$100,649.45
3 Address or legal description (including city, state, and ZIP code)
8673 Willow Bend Way Pinecrest, GA 34524
4 Check here if the transferor received or will receive property or services as part of the consideration
X
5 Check here if the transferor is a foreign person
X
6 Buyer's part of real estate tax
8,745.87
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-b639557ed8f89f35773f50f8,v11-1099-S-stacked,original,2023,fgen-aae500cf962a96f9606171c9,synthetic_programmatic_template,stacked,top,False,
"Form 1099-S Proceeds From Real Estate Transactions
FILER'S name: Summit Land Title Co.
RECIPIENT:  Diego R. Haddad
6 Buyer's part of real estate tax   1,307.83",1099,5,1099,fdc-11966d14e869c3ebc41b4bfd,v11-1099-S-inline,original,2022,fgen-d3437f7c0d026d1a1109cac9,synthetic_programmatic_template,inline,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2024
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Land Title Co. 1510 Cedar Ln Testville, IL 86814
FILER'S TIN      21-7192979
TRANSFEROR'S name   Jamie Tanaka
TRANSFEROR'S TIN      XXX-XX-8423
1 Date of closing 2021-07-10
2 Gross proceeds $451,357.67
3 Address or legal description (including city, state, and ZIP code)  4456 Prairie Ave Testville, IL 22136
4 Check here if the transferor received or will receive property or services as part of the consideration   [X]
5 Check here if the transferor is a foreign person [X]
6 Buyer's part of real estate tax      $3,606.01",1099,5,1099,fdc-40bcb4c256aacb4566ebf336,v11-1099-S-inline,original,2024,fgen-36d4beefc8929b06c5aa9c9c,synthetic_programmatic_template,inline,top,False,
"OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Lakeshore Closing Services 6406 Granite St Oak Grove, TX 17068
FILER'S TIN   50-9808550
TRANSFEROR'S name      Lena Kowalski
TRANSFEROR'S TIN      XXX-XX-2550
Street address (including apt. no.)      2794 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Testville, IL 98757
1 Date of closing 2023-09-14
2 Gross proceeds  261,798.73
3 Address or legal description (including city, state, and ZIP code)  4328 Lakeshore Blvd Lakewood, CO 67367
4 Check here if the transferor received or will receive property or services as part of the consideration      ☐
5 Check here if the transferor is a foreign person   ☒
6 Buyer's part of real estate tax   5,846.90
Department of the Treasury - Internal Revenue Service
Form 1099-S
Proceeds From Real Estate Transactions
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-31cf1af72edf7baa264fcd90,v11-1099-S-inline,original,2023,fgen-73b60117f63eb29ecfc05503,synthetic_programmatic_template,inline,bottom,False,
"☐ CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2022
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Lakeshore Closing Services 2222 Elm Park Pl Lakewood, CO 20101
FILER'S TIN      28-3280517
TRANSFEROR'S name  Olivia Castillo
TRANSFEROR'S TIN  ***-**-0114
Street address (including apt. no.)  1975 Sample Street
City or town, state or province, country, and ZIP or foreign postal code  Testville, IL 36223
Account number (see instructions)   ****367217
1 Date of closing 1/3/22
2 Gross proceeds 333,240.58
4 Check here if the transferor received or will receive property or services as part of the consideration  [X]
5 Check here if the transferor is a foreign person      [X]
6 Buyer's part of real estate tax 4,669.80",1099,5,1099,fdc-630ebe9efd1544fe20d9798d,v11-1099-S-inline,original,2022,fgen-3fbf33c28a013adb55966b4e,synthetic_programmatic_template,inline,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2026
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Summit Land Title Co. 4929 Harbor View Rd Oak Grove, TX 67956
FILER'S TIN 24-7927039
TRANSFEROR'S name Lena Okafor
TRANSFEROR'S TIN  ***-**-0908
Account number (see instructions)  ending in 155063
1 Date of closing      7/18/26
2 Gross proceeds   $254,426.32
3 Address or legal description (including city, state, and ZIP code) 7081 Lakeshore Blvd Fairview, OH 43586
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax 498.38",1099,5,1099,fdc-891833017cb2b6395223fc2d,v11-1099-S-inline,original,2026,fgen-c7486273cd240148e5570016,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
2026
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Land Title Co. 116 Cedar Ln Bayside, WA 69772
FILER'S TIN 86-1095275
TRANSFEROR'S name Avery S. Sato
TRANSFEROR'S TIN ending in 9839
Street address (including apt. no.)  3556 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code   Pinecrest, GA 62043
2 Gross proceeds $475,944.38
3 Address or legal description (including city, state, and ZIP code) 3750 Prairie Ave Pinecrest, GA 36789
4 Check here if the transferor received or will receive property or services as part of the consideration  X
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax  8,263.31
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-cf17991f1857693e06c781f5,v11-1099-S-inline,original,2026,fgen-1fc2de1f67168fa924fdd8f4,synthetic_programmatic_template,inline,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy B For Transferor
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Summit Land Title Co. 5412 Harbor View Rd Lakewood, CO 81083
FILER'S TIN      54-9186580
TRANSFEROR'S name      Sofia Adeyemi
TRANSFEROR'S TIN      ***-**-5205
2 Gross proceeds 290,654.76
3 Address or legal description (including city, state, and ZIP code)  9419 Maple Ridge Dr Brookhaven, PA 70025
4 Check here if the transferor received or will receive property or services as part of the consideration  X
6 Buyer's part of real estate tax 4,728.12
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-f2b05c7611d1af1ab5e1049e,v11-1099-S-inline,original,2021,fgen-a466659233f8fd7f2aba8393,synthetic_programmatic_template,inline,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2021
OMB No. 1545-0997
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Lakeshore Closing Services 3181 Oak Hollow Ct Riverton, WI 96512
FILER'S TIN 47-2453548
TRANSFEROR'S name  Taylor Castillo
TRANSFEROR'S TIN      ending in 6542
Street address (including apt. no.)  2726 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code  Pinecrest, GA 89986
Account number (see instructions)   XXX-XX-893350
1 Date of closing May 24, 2021
2 Gross proceeds $382,508.24",1099,5,1099,fdc-b681c767ac7533ef8e8b1f40,v11-1099-S-inline,original,2021,fgen-aafc27633b98a0d2f62a7575,synthetic_programmatic_template,inline,top,False,
"From:   Cedar Title & Escrow
Recipient's name:      Jamie A. Moreau
3 Address or legal description (including city, state, and ZIP code)   3729 Cedar Ln Lakewood, CO 72369
2 Gross proceeds 204,855.27
5 Check here if the transferor is a foreign person 0.00
4 Check here if the transferor received or will receive property or services as part of the consideration  ☒",1099,5,1099,fdc-3bdeaf8ba173f2c2900858ff,v11-1099-S-inline,original,2021,fgen-5f223deee72acc4ddf210382,synthetic_programmatic_template,inline,none,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2021
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Cedar Title & Escrow 2083 Granite St Brookhaven, PA 90726
FILER'S TIN   88-3187176
TRANSFEROR'S name  Kwame Testcase
TRANSFEROR'S TIN      XXXXX8553
Street address (including apt. no.)   2956 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 31882
Account number (see instructions)  ***-**-875279
1 Date of closing  05/06/2021
2 Gross proceeds   88,057.55
3 Address or legal description (including city, state, and ZIP code) 6220 Sample Street Oak Grove, TX 28146
4 Check here if the transferor received or will receive property or services as part of the consideration      ☐
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax 1,791.15",1099,5,1099,fdc-0fc7ebb7d66b141bce00ec0f,v11-1099-S-inline,original,2021,fgen-eb85d563e4aea84cea247f50,synthetic_programmatic_template,inline,top,False,
"Form 1099-S Proceeds From Real Estate Transactions 2025
From:  Lakeshore Closing Services
Recipient's name: Lena Moreau
3 Address or legal description (including city, state, and ZIP code)      5420 Willow Bend Way Riverton, WI 83330
1 Date of closing      03/10/2025
4 Check here if the transferor received or will receive property or services as part of the consideration ☒",1099,5,1099,fdc-f7f42afd29e629c3169891b7,v11-1099-S-inline,original,2025,fgen-1b2f1aab0c2dd00203333e35,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Cedar Title & Escrow 9670 Cedar Ln Fairview, OH 50145
FILER'S TIN  80-2270238
TRANSFEROR'S name Sofia Larsen
TRANSFEROR'S TIN ***-**-0669
Account number (see instructions)      ****938763
1 Date of closing      2023-05-20
2 Gross proceeds   $413,322.99
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person ☒
6 Buyer's part of real estate tax      $3,990.76
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-58a26d9c27172306d4cb3f45,v11-1099-S-inline,original,2023,fgen-211f332832f12f32369797a3,synthetic_programmatic_template,inline,none,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2021
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Land Title Co. 1145 Oak Hollow Ct Fairview, OH 56442
FILER'S TIN   95-8244905
TRANSFEROR'S name Hiro R. Brennan
TRANSFEROR'S TIN XXX-XX-7308
Account number (see instructions) ending in 729603
1 Date of closing  9/4/21
2 Gross proceeds  $140,137.16
4 Check here if the transferor received or will receive property or services as part of the consideration      ☒
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax  7,710.10",1099,5,1099,fdc-d1ca7decab9a4cb3969743c5,v11-1099-S-inline,original,2021,fgen-24bfceb297a618db96384fa4,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2024
OMB No. 1545-0997
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Lakeshore Closing Services 8616 Lakeshore Blvd Oak Grove, TX 17573
FILER'S TIN   51-1312606
TRANSFEROR'S name   Hiro Haddad
TRANSFEROR'S TIN ****1017
Street address (including apt. no.)   3889 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code   Lakewood, CO 73207
1 Date of closing      2024-12-14
2 Gross proceeds  141,701.57
3 Address or legal description (including city, state, and ZIP code)  6422 Sample Street Fairview, OH 56323
4 Check here if the transferor received or will receive property or services as part of the consideration  ☒
5 Check here if the transferor is a foreign person   [X]
6 Buyer's part of real estate tax  $8,187.37
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-bacd3bd1f50be4b12ab92372,v11-1099-S-inline,original,2024,fgen-5b05667ce991bb4423c7b0f3,synthetic_programmatic_template,inline,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2024
OMB No. 1545-0997
Copy B For Transferor
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Cedar Title & Escrow 3500 Lakeshore Blvd Pinecrest, GA 25834
FILER'S TIN 40-4727752
TRANSFEROR'S name  Jordan Kowalski
TRANSFEROR'S TIN XXXXX9151
1 Date of closing 06/03/2023
2 Gross proceeds 348,884.26
3 Address or legal description (including city, state, and ZIP code) 5981 Lakeshore Blvd Cedar Falls, IA 71618
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person ☐
6 Buyer's part of real estate tax  $1,053.43",1099,5,1099,fdc-5549142f24333928502f8232,v11-1099-S-inline,original,2024,fgen-5d6a25c61891e710c3409b4d,synthetic_programmatic_template,inline,top,False,
"Form 1099-S Proceeds From Real Estate Transactions
FILER'S name: Lakeshore Closing Services
RECIPIENT:  Morgan A. Lindqvist
5 Check here if the transferor is a foreign person  0.00
2 Gross proceeds      $559,661.56
4 Check here if the transferor received or will receive property or services as part of the consideration   ☐",1099,5,1099,fdc-238bc6276ccbd9496edfab61,v11-1099-S-inline,original,2023,fgen-844b58281cd2910b45ab8258,synthetic_programmatic_template,inline,top,False,
"FILER'S name:
Recipient's name:
4 Check here if the transferor received or will receive property or services as part of the consideration
3 Address or legal description (including city, state, and ZIP code)
Lakeshore Closing Services
Kwame Brennan
[X]
2512 Maple Ridge Dr Maplewood, MN 89766
Form 1099-S Proceeds From Real Estate Transactions",1099,5,1099,fdc-6ee1043866f6d26b6b000194,v11-1099-S-columns,original,2023,fgen-e2554cae78bd28d898265720,synthetic_programmatic_template,columns,bottom,False,
"☐ CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
2024
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
1 Date of closing
2 Gross proceeds
3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Lakeshore Closing Services 4881 Prairie Ave Fairview, OH 14868
82-4984584
Jordan Testcase
***-**-6868
09/19/2024
$466,705.33
7981 Sample Street Maplewood, MN 89073
☒
1,724.04
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-0d658a227cc66f8b557f3761,v11-1099-S-columns,original,2024,fgen-df8b83b874591e2bf264442f,synthetic_programmatic_template,columns,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
2022
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
1 Date of closing
2 Gross proceeds
3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Lakeshore Closing Services 3628 Granite St Brookhaven, PA 62551
15-8334804
Priya D. Rivera
XXXXX2304
5/2/22
$176,967.07
4854 Elm Park Pl Lakewood, CO 81383
☐
[X]
$5,029.53
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-cc6a3280bfaaeda9af5e3225,v11-1099-S-columns,original,2022,fgen-d75b49da63652b7ad824d093,synthetic_programmatic_template,columns,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of closing
2 Gross proceeds
3 Address or legal description (including city, state, and ZIP code)
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Cedar Title & Escrow 9496 Elm Park Pl Cedar Falls, IA 67753
88-3488664
Avery Romero
****9110
1949 Lakeshore Blvd
Bayside, WA 15345
ending in 550147
July 14, 2023
$343,475.93
680 Maple Ridge Dr Cedar Falls, IA 67866
☐
6,636.53",1099,5,1099,fdc-937b30cdaad1647f10746e47,v11-1099-S-columns,original,2026,fgen-36a5d937938df6d644cc6ea0,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
OMB No. 1545-0997
Copy B For Transferor
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Date of closing
2 Gross proceeds
3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Summit Land Title Co. 9570 Sample Street Riverton, WI 44487
92-4139218
Olivia Sato
XXXXX2426
9530 Lakeshore Blvd
Maplewood, MN 97716
03/28/2025
$430,691.34
2665 Granite St Maplewood, MN 76116
X
☐
685.99
Department of the Treasury - Internal Revenue Service
Form 1099-S
Proceeds From Real Estate Transactions
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-2668fb1522ab3041e6a070c1,v11-1099-S-columns,original,2025,fgen-26738f52320b728eb7bc42d2,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-S ProceedsFrom Real Estate Transactions 2023
FILER:
To:
1 Date of closing
3 Address or legal description (including city, state, and ZIP code)
5 Check here ifthe transferor is a foreign person
4 Check here if the transferor received or will receivc property or services as part of the consideration
Cedar Title & Escrow
Priya Adeyemi
2022-04-28
3776 Cedar Ln Faírview, OH 58590
X
0.00",1099,5,1099,fdc-c397e49842ea8f9031a5e460,v11-1099-S-columns,original,2023,fgen-a123a4f4bf8394e8643cee6d,synthetic_programmatic_template,columns,top,True,
"Form 1099-S Proceeds From Real Estate Transactions 2025
FILER:
Recipient's name:
2 Gross proceeds
1 Date of closing
Lakeshore Closing Services
Sofia M. Patel
$341,294.46
June 7, 2024",1099,5,1099,fdc-b18c0fc26bfbc09231a31b42,v11-1099-S-columns,original,2025,fgen-754eaee72687f8d38c4474c4,synthetic_programmatic_template,columns,top,False,
"Form 1099-S Proceeds From Real Estate Transactions 2023
From:
Recipient's name:
2 Gross proceeds
1 Date of closing
3 Address or legal description (including city, state, and ZIP code)
Cedar Title & Escrow
Casey R. Romero
$467,262.76
2022-01-07
461 Lakeshore Blvd Bayside, WA 26656",1099,5,1099,fdc-ff7b4aeb8739b3674a46e1c5,v11-1099-S-columns,original,2023,fgen-aa7ed0f830b949d02a1f7347,synthetic_programmatic_template,columns,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Date of closing
2 Gross proceeds
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Lakeshore Closing Services 318 Granite St Testville, IL 51220
40-7807811
Kwame Romero
XXXXX1827
401 Maple Ridge Dr
Fairview, OH 55430
March 19, 2024
$257,860.50
☒
☒
7,519.55",1099,5,1099,fdc-bd880602f4ae394b90b9f5ae,v11-1099-S-columns,original,2024,fgen-4bf475a34e3dcc467c690602,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
2025
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
2 Gross proceeds
3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
Lakeshore Closing Services 811 Granite St Bayside, WA 55187
57-1808832
Amara D. Kowalski
XXXXX5421
607,559.51
9869 Granite St Maplewood, MN 98319
☒
☐
Department of the Treasury - Internal Revenue Service
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-01924e938099a640b6f5c1e3,v11-1099-S-columns,original,2025,fgen-d4ad33bc4b9ab67cda48569c,synthetic_programmatic_template,columns,top,False,
"For calendar year 2023
OMB No. 1545-0997
Copy B For Transferor
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Gross proceeds
3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Summit Land Title Co. 829 Granite St Brookhaven, PA 24092
68-5765554
Riley Brennan
ending in 3714
6551 Granite St
Fairview, OH 60286
$534,672.96
1810 Cedar Ln Oak Grove, TX 99035
X
☐
$3,942.30
Department of the Treasury - Internal Revenue Service
Form 1099-S
Proceeds From Real Estate Transactions
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-5ae018dde614c297489cc14c,v11-1099-S-columns,original,2023,fgen-70753722626f06f3aa9723fd,synthetic_programmatic_template,columns,bottom,False,
"For calendar year 2026
OMB No. 1545-0997
This is important tax information and is being furnished to the IRS.
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of closing
2 Gross proceeds
3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Cedar Title & Escrow 4719 Oak Hollow Ct Cedar Falls, IA 44566
31-4281176
Jamie Okafor
XXX-XX-0920
6821 Prairie Ave
Riverton, WI 30908
***-**-502919
December 4, 2025
$456,466.15
2962 Oak Hollow Ct Testville, IL 21122
$1,609.33
Department of the Treasury - Internal Revenue Service
Form 1099-S
Proceeds From Real Estate Transactions
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-10abaf64a3e13d99c495453d,v11-1099-S-columns,original,2026,fgen-e438280e7f93004cafd85e24,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-S Proceeds From Real Estate Transactions 2O23
From:
Recipicnt's name:
3 Address or legal description (including city, state, and ZIP code)
Cedar Title &Escrow
Alex Haddad
145 Lakeshore Blvd Fairview, OH 50443",1099,5,1099,fdc-e9b70296b83a7a999ad22c5a,v11-1099-S-columns,original,2023,fgen-56166f571892ab407a1b5288,synthetic_programmatic_template,columns,top,True,
"FILER'S name:
RECIPIENT:
4 Check here if the transferor received or will receive property or services as part of the consideration
6 Buyer's part of real estate tax
2 Gross proceeds
Summit Land Title Co.
Noah Okafor
[X]
8,737.45
246,418.26
Form 1099-S Proceeds From Real Estate Transactions 2023",1099,5,1099,fdc-a5529a5ba847016019836d88,v11-1099-S-columns,original,2023,fgen-53093a724395a70eb1f11e4e,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-S Proceeds From Real Estate Transactions 2023
FILER'S name:
RECIPIENT:
3 Address or 1egal descríption (including city, state, and ZIP code)
CedarTitle & Escrow
Mateo 5. Adeyemi
4358 Cedar Ln Maplewood, MN 76928",1099,5,1099,fdc-d61e171b1642b44df3007ebd,v11-1099-S-columns,original,2023,fgen-aa2b24e30f34fd979c52b208,synthetic_programmatic_template,columns,top,True,
"2023
FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
FILER'S TIN
TRANSFEROR'S name
TRANSFEROR'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Date of closing
3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Check here if the transferor is a foreign person
6 Buyer's part of real estate tax
Summit Land Title Co. 7108 Sample Street Brookhaven, PA 15977
69-1875581
Noah Rivera
***-**-3956
2745 Granite St
Pinecrest, GA 18464
05/09/2023
9349 Prairie Ave Riverton, WI 96849
[X]
$6,050.28
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-14fc88ebaa0728dfb71a6835,v11-1099-S-columns,original,2023,fgen-cf19e010664149d8a84e8fd6,synthetic_programmatic_template,columns,none,False,
"VOID  CORRECTED
Form 1099-S
Proceeds From Real EstateTransactíons
## For calcndar year 2026
## OMB No. 1545-0997
## Copy B For Transferor
|Field | Value |
|--- | --- |
| FILER'S name, street address, cíty or town, state or province, country, and ZIP or foreign posta1 code | Cedar Tit1e & Escrow 3024 Harbor View Rd Lakewood, CO 53572 |
| FILER'S TIN | 63-6652800 |
| TRANSFEROR'S name | Morgan A. Adeyemi |
| TRANSFEROR'S TIN |XXXXX3527 |
| Street address (including apt. no.) | 9800 Lakeshore Blvd |
| Cíty or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 40l78 |
| Account number (see instructions) | XXXXX742480 |
| l Date ofclosing | December 1, 2026 |
| 2 Gross proceeds | $435,212.34 |
| 3 Address or legal description(including city, state, and ZIP code) | 8030 Praírie Ave Bayside, WA 55427 |
| 4 Check here if the transferor receivedor will receive property or services as part of the consideration | [X] |
| 5 Check here if the transferor is a foreign person |  |
| 6 Buyer's part of real estate tax | $8,172.34 |",1099,5,1099,fdc-cec40fc9c6d71f20c5e872bb,v11-1099-S-markdown,original,2026,fgen-5b096159df6c3a9b46b592f9,synthetic_programmatic_template,markdown,top,True,
"CORRECTED (if checked)
Form 1099-S
## Proceeds From Real Estate Transactions
2026
## OMB No. 1545-0997
Copy B For Transferor
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Lakeshore Closing Services 4855 Elm Park Pl Maplewood, MN 81688 |
| FILER'S TIN | 43-5416687 |
| TRANSFEROR'S name | Priya B. Moreau |
| TRANSFEROR'S TIN | XXX-XX-5770 |
| Street address (including apt. no.) | 7138 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 22504 |
| 1 Date of closing | 1/25/23 |
| 3 Address or legal description (including city, state, and ZIP code) | 5781 Prairie Ave Cedar Falls, IA 36566 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | X |
| 5 Check here if the transferor is a foreign person | X |
| 6 Buyer's part of real estate tax | $7,793.14 |",1099,5,1099,fdc-cefba7571ab8a1f1db646ea2,v11-1099-S-markdown,original,2026,fgen-466fd058d49a1c4cd738161d,synthetic_programmatic_template,markdown,top,False,
"## Form 1099-S Proceeds From Real Estate Transactions 2023
| Field | Value |
| --- | --- |
| From: | Lakeshore Closíng Servíces |
|To: | Avery C. Moreau |
| 1 Dateof closing | 2O22-11-2O |
| 3 Address or legal description (including city, state, and ZIP code) | 6327 Oak Hollow Ct Testville, IL 80572 |",1099,5,1099,fdc-cc3bc156f32f2142b07d5581,v11-1099-S-markdown,original,2023,fgen-1d0a89fe4b4bb6e2597ac550,synthetic_programmatic_template,markdown,top,True,
"☐ CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
| Field | Value |
| --- | --- |
| FILER'5 name, street address, city or town, state or province, country,and ZIPor foreign postal code | Lakeshore Closing Services 8093 Maple Ridge Dr Testville, IL l0408 |
| FILER'5 TIN| 35-9543224 |
| TRANSFEROR'S name | Jordan Testcase |
| TRANSFEROR'S TIN | ***-**-8682 |
| Street address (ínc1uding apt. no.) | 7662 Willow Bend Way|
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 57605|
| Account number (see instructions) | XXX-XX-08l814 |
| 1 Date of closing | 08/03/2019 |
| 2 Gross proceeds |$456,105.51 |
| 3 Address or legal descríption (including city, state, and ZIP code) | 1398 Elm Park Pl Oak Grove, TX 66333 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration |  |
| 6 Buyer's part of real estate tax | 6,381.06 |",1099,5,1099,fdc-259b9f59ad30eea7f0643649,v11-1099-S-markdown,original,2022,fgen-23ead26e07d92eb4dbc02d94,synthetic_programmatic_template,markdown,top,True,
"2025
Copy B For Transferor
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Cedar Title & Escrow 2284 Oak Hollow Ct Pinecrest, GA 75427 |
| FILER'S TIN | 37-2188207 |
| TRANSFEROR'S name | Amara Tanaka |
| TRANSFEROR'S TIN | XXXXX4956 |
| Street address (including apt. no.) | 4231 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Lakewood, CO 91710 |
| Account number (see instructions) | ****909550 |
| 1 Date of closing | September 14, 2022 |
| 2 Gross proceeds | $303,505.13 |
| 3 Address or legal description (including city, state, and ZIP code) | 4225 Willow Bend Way Cedar Falls, IA 91929 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | [X] |
| 5 Check here if the transferor is a foreign person | X |
| 6 Buyer's part of real estate tax | 2,868.96 |
Department of the Treasury - Internal Revenue Service
Form 1099-S
Proceeds From Real Estate Transactions
Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-bfc9b2705f517a701cd222f9,v11-1099-S-markdown,original,2025,fgen-7c22ee4f862868bafb11c816,synthetic_programmatic_template,markdown,bottom,False,
"Form 1099-S
Proceeds From Real Estate Transactíons
## 2O25
Copy B For Transferor
## This is important tax information and is being furnished to the IRS.
| Field | Value |
| --- | --- |
| FILER'S namc, street address, city or town, state or province, country, andZIP or foreign postal code | Summit Land Title Co. 8262 Lakeshore Blvd 0ak Grove, TX 32973 |
| FILER'S TIN | 38-6423829 |
| TRANSFEROR'S name | Morgan B. Rivcra |
| TRANSFER0R'S TIN | XXX-XX-6799 |
| Account number(seeinstructions) | endingin 05593l |
| 1 Date of dosing | 1/6/24 |
| 4 Check here if the transferor received or will receive property or services aspart of the consideration | ☒ |
| 5 Check here if the transferor is a foreign person | [X] |
| 6 Buyer's part of rea1 estate tax | 7,9O7.55 |
Department of the Treasury -Interna1 Revenue Service
Form 1O99-S (keep for your records)  www.irs.gov/Forml099S",1099,5,1099,fdc-be38dad2a3b290517c18bc8e,v11-1099-S-markdown,original,2025,fgen-bc5a421802166449ac24b03d,synthetic_programmatic_template,markdown,top,True,
"☐ CORRECTED
Form 1099-S
## Proceeds From Real Estate Transactions
For calendar year 2024
Copy B For Transferor
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Cedar Title & Escrow 3361 Maple Ridge Dr Maplewood, MN 11014 |
| FILER'S TIN | 29-9818185 |
| TRANSFEROR'S name | Riley Okafor |
| TRANSFEROR'S TIN | ****1229 |
| Street address (including apt. no.) | 7628 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 70758 |
| 1 Date of closing | 8/28/24 |
| 2 Gross proceeds | 431,988.21 |
| 3 Address or legal description (including city, state, and ZIP code) | 2077 Maple Ridge Dr Maplewood, MN 17497 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | ☒ |
| 5 Check here if the transferor is a foreign person | X |
| 6 Buyer's part of real estate tax | 7,835.19 |",1099,5,1099,fdc-da348bdcae83506955f5c650,v11-1099-S-markdown,original,2024,fgen-f57fa47fa19b767263674b2f,synthetic_programmatic_template,markdown,top,False,
"## Form 1099-S
Proceeds From Real Estate Transactions
## 0MB No. 1545-0997
## Copy BFor Transferor
| Field | Value|
| --- | --- |
| FILER'S name,street address, city or town, state or province, country, andZIP or foreign postal code | Cedar Title & Escrow 79 Willow Bend Way Fairview, OH 40714 |
| FILER'5 TIN | 33-6538247 |
| TRANSFEROR'S name | Casey Castillo |
| TRANSFEROR'S TIN | XXXXX3693 |
| 1 Date of dosing | March 20, 2022 |
| 3 Address or legal description (including city, state, and ZIP code) | 9539 Oak Hollow Ct Pínecrest, GA 34l33 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | ☒ |
| 5 Check here if the transferor is a foreign person | [X] |
| 6 Buyer's part of real cstate tax |5,227.4O |",1099,5,1099,fdc-04ec28a7b6a7db96531c4eda,v11-1099-S-markdown,original,2022,fgen-abba63fa9ba874a05f5fd1cd,synthetic_programmatic_template,markdown,top,True,
"Form 1099-S Proceeds From Real Estate Transactions 2021
| Field | Value |
| --- | --- |
| FILER: | Cedar Title & Escrow |
| To: | Alex Romero |
| 6 Buyer's part of real estate tax | $4,004.13 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | X |
| 2 Gross proceeds | 242,969.16 |",1099,5,1099,fdc-0a1f7da2d9f7ee8bc582df45,v11-1099-S-markdown,original,2021,fgen-1d2bac055d198fc792f3235d,synthetic_programmatic_template,markdown,top,False,
"Form 1099-S Proceeds From Real Estate Transactions 2025
| Field | Va1ue |
| --- | --- |
| From: | 5ummit Land Title Co. |
| Recipient's name: | Riley L. Romero |
| 5 Check here if the transferor is a foreign person | O.00 |
| 2 Gross proceeds | $166,819.63|
| 4 Check here if the transferor received or will receive propertyor services as part of the consideration | O.00 |",1099,5,1099,fdc-ab8da6324b79a8f515c9ecc3,v11-1099-S-markdown,original,2025,fgen-9ed067eb8dd47c41b07d1009,synthetic_programmatic_template,markdown,top,True,
"For calendar year 2021
Copy B For Transferor
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Cedar Title & Escrow 4631 Cedar Ln Brookhaven, PA 79866 |
| FILER'S TIN | 39-6955792 |
| TRANSFEROR'S name | Hiro Walsh |
| TRANSFEROR'S TIN | XXX-XX-8159 |
| Street address (including apt. no.) | 1837 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 49628 |
| 1 Date of closing | 2020-02-10 |
| 2 Gross proceeds | 556,578.74 |
| 3 Address or legal description (including city, state, and ZIP code) | 1250 Elm Park Pl Riverton, WI 58440 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | [X] |
| 5 Check here if the transferor is a foreign person | [X] |
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-ea15d294f4d6100d4ddd5915,v11-1099-S-markdown,original,2021,fgen-f2439ea5ba46396214434f41,synthetic_programmatic_template,markdown,none,False,
"VOID  CORRECTED
Form 1099-S
Proceeds From Real Estate Transactions
## For calendar year 2025
## OMB No. 1545-0997
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Summit Land Title Co. 3204 Elm Park Pl Oak Grove, TX 56971 |
| FILER'S TIN | 79-9159511 |
| TRANSFEROR'S name | Olivia Tanaka |
| TRANSFEROR'S TIN | XXXXX0411 |
| Account number (see instructions) | XXX-XX-181256 |
| 1 Date of closing | 10/09/2025 |
| 2 Gross proceeds | 490,976.44 |
| 3 Address or legal description (including city, state, and ZIP code) | 4370 Lakeshore Blvd Bayside, WA 74489 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | ☐ |
| 5 Check here if the transferor is a foreign person | ☒ |
| 6 Buyer's part of real estate tax | $7,257.18 |",1099,5,1099,fdc-52f15713ff068824f2f95d2e,v11-1099-S-markdown,original,2025,fgen-4c2b8def9d44cb64e1d77a7f,synthetic_programmatic_template,markdown,top,False,
"2021
## Copy B For Transferor
This is important tax information and is being furnished to the IRS.
| Field | Value|
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreígn postal code | Cedar Title & Escrow 2459 Willow Bend Way Bayside, WA 67526 |
| FILER'5 TIN | 79-5001810 |
| TRANSFEROR'S name | Amara Nguyen |
| TRANSFEROR'S TIN |endíng in 7541 |
| Street address (including apt. no.)| 5359 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code |Bayside, WA 82824 |
| 2Gross proceeds |S179,992.31 |
| 3 Address or legal description (including city, state, and ZIP code) | 8926 Elm Park Pl Maplewood, MN 29760 |
| 5 Check here if the transferor is a foreign person | X |
| 6 Buyer's part of real estate tax | $5,479.85 |
Department of the Treasury - Intemal Revenue 5ervíce",1099,5,1099,fdc-4b3d478e7ff8e5e1ae36d9e0,v11-1099-S-markdown,original,2021,fgen-a3daed02412bba3b48469ad7,synthetic_programmatic_template,markdown,none,True,
"## ☐ CORRECTED
Form 1099-S
## Proceeds From Real Estate Transactions
## For calendar year 2024
OMB No. 1545-0997
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Lakeshore Closing Services 6070 Cedar Ln Cedar Falls, IA 19689 |
| FILER'S TIN | 33-5916924 |
| TRANSFEROR'S name | Kwame S. Lindqvist |
| TRANSFEROR'S TIN | ending in 8364 |
| Street address (including apt. no.) | 2498 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 81841 |
| 1 Date of closing | 7/25/23 |
| 2 Gross proceeds | 510,948.56 |
| 3 Address or legal description (including city, state, and ZIP code) | 4969 Cedar Ln Cedar Falls, IA 49669 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | ☒ |
| 6 Buyer's part of real estate tax | $5,151.23 |",1099,5,1099,fdc-95c03a32b1df828912c5b8a7,v11-1099-S-markdown,original,2024,fgen-3544f6cb692baef2fa4d52bc,synthetic_programmatic_template,markdown,top,False,
"Form 1099-S
Proceeds From Real Estate Transactions
For calendar year 2021
OMB No. 1545-0997
Copy B For Transferor
| Field | Value |
| --- | --- |
| FILER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Lakeshore Closing Services 3171 Lakeshore Blvd Riverton, WI 81321 |
| FILER'S TIN | 79-2713294 |
| TRANSFEROR'S name | Morgan Okafor |
| TRANSFEROR'S TIN | XXX-XX-3356 |
| Street address (including apt. no.) | 6216 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 69212 |
| Account number (see instructions) | XXXXX705544 |
| 1 Date of closing | 5/4/21 |
| 2 Gross proceeds | 596,011.00 |
| 3 Address or legal description (including city, state, and ZIP code) | 5818 Harbor View Rd Pinecrest, GA 42643 |
| 4 Check here if the transferor received or will receive property or services as part of the consideration | ☐ |
| 5 Check here if the transferor is a foreign person | [X] |
| 6 Buyer's part of real estate tax | 4,098.16 |
Department of the Treasury - Internal Revenue Service
## Form 1099-S (keep for your records)  www.irs.gov/Form1099S",1099,5,1099,fdc-442a0bbb4e992d52b93ade06,v11-1099-S-markdown,original,2021,fgen-70f47cdc30346ad2d8e10b65,synthetic_programmatic_template,markdown,top,False,
"Form 1099-S Proceeds From Real Estate Transactions 2021
| Field | Value |
| --- | --- |
| FILER'S name: | Lakeshore Closing Services |
| RECIPIENT: | Alex S. Sato |
| 2 Gross proceeds | 623,590.41 |
| 3 Address or legal description (including city, state, and ZIP code) | 7511 Elm Park Pl Testville, IL 51062 |
| 6 Buyer's part of real estate tax | $1,299.16 |
| 1 Date of closing | June 27, 2021 |",1099,5,1099,fdc-e1fa7c33a6433b1471fad5d2,v11-1099-S-markdown,original,2021,fgen-ef1bb7032ea35018eedd2d18,synthetic_programmatic_template,markdown,top,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, orMedicare Advantage MSA
TRUSTEE:
Sample HSA Bank
To:
Avery Tanaka
1 Gross distribution
4,820.45
5 HSA / Archcr MSA / MA MSA
HSA ☒
3 Distribution codc
1",1099,5,1099,fdc-992029f1f9d1e06208541fd4,v11-1099-SA-stacked,original,2021,fgen-19f597e82f28388527086273,synthetic_programmatic_template,stacked,top,True,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2024
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northwind HSA Custodian 756 Sample Street Pinecrest, GA 23713
PAYER'S TIN
13-7162693
RECIPIENT'S name
Sofia Romero
RECIPIENT'S TIN
****0126
Street address (including apt. no.)
5801 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 59487
Account number (see instructions)
XXXXX202769
1 Gross distribution
$6,212.92
2 Earnings on excess cont.
3 Distribution code
A
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-31985058712f126b5eb5c85a,v11-1099-SA-stacked,original,2024,fgen-e4bf2380949064fbe2070e49,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 1099-SA
DistributionsFrom an HSA, Archer MSA, or Medicare Advantage MSA
2022
This information is being fumished to the IRS.
TRUSTEE'S/PAYER'S name, street address,city or town, state or province, country, and ZIP or foreign posta1 code
Northwind HSA Custodian 2574 Ccdar Ln Cedar Falls, IA 89546
PAYER'S TIN
42-5898668
RECIPIENT'S name
Mateo J. Kowalski
RECIPIENT'S TIN
ending in 8867
Street address (induding apt. no.)
5294 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 331O6
Account number (see instructions)
***-**-592967
1 Gross distribution
$613.61
2 Eamings onexcess cont.
$0.00
3 Distribution code
A
4 FMV on date of death
0.00
5 H5A / Archer MSA / MA MSA
HSA☒
Department of the Treasury - Intema1 Revenue 5ervice
Form lO99-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-abdeed613034afca2146156f,v11-1099-SA-stacked,original,2022,fgen-f3179515ec754836f066a023,synthetic_programmatic_template,stacked,top,True,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2025
Copy B For Recipient
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Sample HSA Bank 9494 Prairie Ave Lakewood, CO 55533
PAYER'S TIN
87-5949307
RECIPIENT'S name
Sofia Larsen
RECIPIENT'S TIN
***-**-5609
Street address (including apt. no.)
8681 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 79561
1 Gross distribution
5,092.97
2 Earnings on excess cont.
3 Distribution code
1
4 FMV on date of death
0.00
5 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-013a7eb28f0f6dd253b764c8,v11-1099-SA-stacked,original,2025,fgen-55a5c614752c48dea702d5af,synthetic_programmatic_template,stacked,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2025
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northwind HSA Custodian 7147 Sample Street Testville, IL 77350
PAYER'S TIN
34-5095771
RECIPIENT'S name
Noah Haddad
RECIPIENT'S TIN
ending in 5283
Account number (see instructions)
XXXXX324721
1 Gross distribution
$664.76
3 Distribution code
F
5 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-8d5c8618172fc4ca2b6a5384,v11-1099-SA-stacked,original,2025,fgen-73f0376c9b3cc22e05b85591,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
2026
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Health Savings 7845 Maplc Ridge Dr Maplewood, MN 78753
PAYER'S TIN
67-1O95379
RECIPIENT'S namc
Kwame Tanaka
RECIPIENT'S TIN
****9355
Street address (including apt. no.)
8312Oak Hollow Ct
City or town, state or províncc, country, and ZIP or foreign postal code
Lakewood, CO 52O96
Account number (see instructions)
***-**-3l2167
1 Gross distribution
$3,941.51
3 Distribution code
A
4 FMV ondate of death
0.00
5 H5A / Archer MSA / MA MSA
HSA ☒",1099,5,1099,fdc-3301daa79be563fa90b85c47,v11-1099-SA-stacked,original,2026,fgen-ea1d6bad4b3a397730cc38ff,synthetic_programmatic_template,stacked,none,True,
"TRUSTEE'S name:
Sample HSA Bank
Recipient's name:
Mateo Brennan
3 Distribution code
A
5 HSA / Archer MSA / MA MSA
HSA ☒",1099,5,1099,fdc-3ea0718b10c5a3f40735e40e,v11-1099-SA-stacked,original,2024,fgen-3a817493585b7dd8ce6677cc,synthetic_programmatic_template,stacked,none,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA 2021
From:
Evergreen Health Savings
To:
Kwame Haddad
5 HSA / Archer MSA / MA MSA
HSA ☒
1 Gross distribution
$7,372.85
3 Distribution code
2",1099,5,1099,fdc-ea68f1cb77c3501c95e70122,v11-1099-SA-stacked,original,2021,fgen-03f07b9b759ac3849e30cfae,synthetic_programmatic_template,stacked,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2024
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Sample HSA Bank 6442 Lakeshore Blvd Cedar Falls, IA 69463
PAYER'S TIN
93-5832663
RECIPIENT'S name
Priya Castillo
RECIPIENT'S TIN
ending in 3113
Street address (including apt. no.)
2607 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 25071
1 Gross distribution
$3,907.65
2 Earnings on excess cont.
0.00
3 Distribution code
1
4 FMV on date of death
$0.00
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-ce23da4d8659a51a98f72ab9,v11-1099-SA-stacked,original,2024,fgen-f53773ffe82461e36f20202a,synthetic_programmatic_template,stacked,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2021
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northwind HSA Custodian 9803 Sample Street Oak Grove, TX 64098
PAYER'S TIN
44-4904661
RECIPIENT'S name
Olivia A. Testcase
RECIPIENT'S TIN
XXX-XX-9440
1 Gross distribution
$8,014.32
3 Distribution code
1
4 FMV on date of death
5 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-0084c5697a7e86cd78cf77b8,v11-1099-SA-stacked,original,2021,fgen-bf79540c20133fd40ee264d4,synthetic_programmatic_template,stacked,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2023
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northwind HSA Custodian 2217 Harbor View Rd Maplewood, MN 10587
PAYER'S TIN
53-5841396
RECIPIENT'S name
Mateo M. Fischer
RECIPIENT'S TIN
XXXXX3281
Account number (see instructions)
XXXXX812946
1 Gross distribution
6,737.20
2 Earnings on excess cont.
4 FMV on date of death
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-5c475b785e2e2d91cbd97c7e,v11-1099-SA-stacked,original,2023,fgen-3b79a0e4b8408a1b8458354a,synthetic_programmatic_template,stacked,top,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
TRUSTEE:
Evergreen Health Savings
RECIPIENT:
Taylor Sato
1 Gross distribution
$4,028.09",1099,5,1099,fdc-e561ef69e856864f80e96bbb,v11-1099-SA-stacked,original,2022,fgen-804ec07c8757875956801958,synthetic_programmatic_template,stacked,top,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
From:
Evergreen Health Savings
Recipient's name:
Morgan Lindqvist
1 Gross distribution
730.48",1099,5,1099,fdc-d95933cf44591c09494ba455,v11-1099-SA-stacked,original,2023,fgen-af3f00ca3ba625789e5d0db5,synthetic_programmatic_template,stacked,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2024
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Health Savings 8008 Maple Ridge Dr Oak Grove, TX 58975
PAYER'S TIN
27-5978955
RECIPIENT'S name
Jordan Rivera
RECIPIENT'S TIN
XXXXX9342
Street address (including apt. no.)
2632 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 46868
Account number (see instructions)
XXXXX072381
1 Gross distribution
648.42
2 Earnings on excess cont.
3 Distribution code
F
4 FMV on date of death
0.00
5 HSA / Archer MSA / MA MSA
HSA ☒",1099,5,1099,fdc-66980d7e05d8b9365bf9fbe7,v11-1099-SA-stacked,original,2024,fgen-a042c4c65f12ddb3ffdab2ee,synthetic_programmatic_template,stacked,top,False,
"TRUSTEE'S name:
Northwind HSA Custodian
To:
Riley Kowalski
3 Distribution code
F
1 Gross distribution
5,977.30",1099,5,1099,fdc-4dea062ae133756ee8015b92,v11-1099-SA-stacked,original,2022,fgen-21d0953a862aca0b06a4a3a9,synthetic_programmatic_template,stacked,none,False,
"☐ CORRECTED
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2021
OMB No. 1545-1517
Copy B For Rccipient
This information is being fumished to the IR5.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province,country, and ZIP or foreign posta1 codc
Evergreen Health Savings 310 Maple Ridge Dr Pínecrest, GA 90002
PAYER'S TIN
32-8500845
RECIPIENT'S name
Wei Pate1
RECIPIENT'S TIN
XXXXX4837
Streetaddress (íncludingapt. no.)
5084 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, C0 3l889
Account number (see instructions)
ending in 049539
1 Gross distribution
5,479.04
2 Earnings on excess cont.
4FMV on date of death
5 H5A / Archer M5A / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form10995A",1099,5,1099,fdc-7408321dfd89061c5c8f9584,v11-1099-SA-stacked,original,2021,fgen-1a693b4bd2eada4103a7a4a2,synthetic_programmatic_template,stacked,top,True,
"For calendar year 2021
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northwind H5A Custodian 5l74 Prairic Ave Testville, IL 59188
PAYER'S TIN 53-4335428
RECIPIENT'S name Avery Walsh
RECIPIENT'S TIN endingin 9392
1 Gross distribution 2,662.71
3 Distribution code  l
4 FMV on datc of death
5 HSA / Archer MSA / MA MSA   HSA ☒",1099,5,1099,fdc-385c0a4187a1770ce6332823,v11-1099-SA-inline,original,2021,fgen-32bb0dec845022e586a22c9c,synthetic_programmatic_template,inline,none,True,
"CORRECTED (if checked)
Form l099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2026
OMB No. 1545-1517
Copy B For Recipient
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Northwind H5A Custodian 9314 Willow Bend Way Testville, IL 4863O
PAYER'S TIN 4l-2539824
RECIPIENT'Sname Sofia Testcase
RECIPIENT'S TIN      ****8941
Street address (induding apt. no.)      3773 Sample Street
City or town, state or province, country,and ZIP or foreign postal code Lakewood, CO 66774
1 Gross distribution   $3,O28.97
2 Eamings on excess cont.
3Distribution code      G
4 FMV on date of death
5 HSA / Archer MSA/ MA MSA      HSA ☒",1099,5,1099,fdc-ea9ab4d460037af1587d13a2,v11-1099-SA-inline,original,2026,fgen-6bf2b3fb6b8ffa3336cfc701,synthetic_programmatic_template,inline,top,True,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2022
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Sample HSA Bank 5051 Willow Bend Way Brookhaven, PA 11323
PAYER'S TIN  32-5087140
RECIPIENT'S name  Fatima Testcase
RECIPIENT'S TIN  XXX-XX-3708
3 Distribution code   2
4 FMV on date of death $0.00
5 HSA / Archer MSA / MA MSA HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-d3e735feeec61bfd2c5c7877,v11-1099-SA-inline,original,2022,fgen-fd1003a3f015d0f4f2a2f745,synthetic_programmatic_template,inline,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Evergreen Health Savings 7057 Sample Street Cedar Falls, IA 48497
PAYER'S TIN 32-9924263
RECIPIENT'S name   Wei Tanaka
RECIPIENT'S TIN  ending in 0120
Street address (including apt. no.)   6516 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 71751
1 Gross distribution 7,253.56
2 Earnings on excess cont.
3 Distribution code   G
4 FMV on date of death   0.00
5 HSA / Archer MSA / MA MSA HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-0f244a59be87b14dfcd5b7f6,v11-1099-SA-inline,original,2021,fgen-40692e543a1b9701962b6174,synthetic_programmatic_template,inline,top,False,
"From: Evergreen Hea1th Savings
To:   AlexTanaka
1 Gross distribution S3,038.05
Form 1099-5A Distributions From an HSA, Archer MSA, or Medicare Advantage MSA",1099,5,1099,fdc-cfc8a4c042584eaa60433992,v11-1099-SA-inline,original,2026,fgen-a29512b251fee508d09c0eef,synthetic_programmatic_template,inline,bottom,True,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2025
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Health Savings 2740 Lakeshore Blvd Cedar Falls, IA 22840
PAYER'S TIN   42-5993827
RECIPIENT'S name Noah Adeyemi
RECIPIENT'S TIN   ending in 6526
Street address (including apt. no.)   393 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code  Cedar Falls, IA 63968
1 Gross distribution      3,616.14
2 Earnings on excess cont.
3 Distribution code A
5 HSA / Archer MSA / MA MSA      HSA ☒",1099,5,1099,fdc-7e4c90eecbcfa4149d72b532,v11-1099-SA-inline,original,2025,fgen-48a035d4e8db61e80a0bbb9f,synthetic_programmatic_template,inline,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2021
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Sample HSA Bank 61 Oak Hollow Ct Fairview, OH 93172
PAYER'S TIN   88-9684707
RECIPIENT'S name  Avery L. Walsh
RECIPIENT'S TIN  XXX-XX-7641
Street address (including apt. no.)      7001 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code Testville, IL 40685
1 Gross distribution   $1,917.11
2 Earnings on excess cont. 0.00
3 Distribution code F
5 HSA / Archer MSA / MA MSA HSA ☒",1099,5,1099,fdc-3aa9dd0940ddb45c755d42d2,v11-1099-SA-inline,original,2021,fgen-30ad169f8dd6fb76c9540ee0,synthetic_programmatic_template,inline,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2023
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Sample HSA Bank 6867 Willow Bend Way Pinecrest, GA 38259
PAYER'S TIN 42-5192695
RECIPIENT'S name Casey Nguyen
RECIPIENT'S TIN ending in 9320
Street address (including apt. no.)      6430 Granite St
City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 46559
Account number (see instructions)   ending in 175520
1 Gross distribution $4,574.91
2 Earnings on excess cont.      0.00
4 FMV on date of death
5 HSA / Archer MSA / MA MSA   HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-e30a27a4de7c5c895cef6370,v11-1099-SA-inline,original,2023,fgen-b93d321b44fcbf8c45dae8cc,synthetic_programmatic_template,inline,top,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA 2026
From: Evergreen Health Savings
Recipient's name:      Wei Larsen
5 HSA / Archer MSA / MA MSA      HSA ☒",1099,5,1099,fdc-8897f4922cb49d7ac2791f7a,v11-1099-SA-inline,original,2026,fgen-c11563162dc62a1802f43a43,synthetic_programmatic_template,inline,top,False,
"For calendar year 2026
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Northwind HSA Custodian 8843 Harbor View Rd Oak Grove, TX 91576
PAYER'S TIN   97-5641657
RECIPIENT'S name   Jordan Testcase
RECIPIENT'S TIN      ***-**-1705
Street address (including apt. no.)   4693 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code  Testville, IL 99560
Account number (see instructions) ***-**-222636
1 Gross distribution  602.06
2 Earnings on excess cont.
3 Distribution code F
4 FMV on date of death
5 HSA / Archer MSA / MA MSA      HSA ☒
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-df1ff6dc07bb5bd98a181f19,v11-1099-SA-inline,original,2026,fgen-9a15304d2e25c4e5adcbf3c2,synthetic_programmatic_template,inline,none,False,
"VOID  CORRECTED
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2026
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Health Savings 6764 Sample Street Testville, IL 19778
PAYER'S TIN 95-9053169
RECIPIENT'S name  Mateo Lindqvist
RECIPIENT'S TIN ****6740
Street address (including apt. no.)  4631 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 93363
Account number (see instructions)      XXXXX210003
1 Gross distribution $7,574.35
2 Earnings on excess cont.
3 Distribution code F
4 FMV on date of death   0.00
5 HSA / Archer MSA / MA MSA   HSA ☒",1099,5,1099,fdc-e2a6284799a60a088b27acad,v11-1099-SA-inline,original,2026,fgen-d3f2a47e190e6fc971672ca9,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2022
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Sample HSA Bank 4346 Maple Ridge Dr Cedar Falls, IA 45868
PAYER'S TIN 91-8117073
RECIPIENT'S name Wei A. Larsen
RECIPIENT'S TIN      XXXXX9935
Street address (including apt. no.) 9567 Granite St
City or town, state or province, country, and ZIP or foreign postal code      Brookhaven, PA 61811
1 Gross distribution      9,169.85
2 Earnings on excess cont.      $0.00
4 FMV on date of death
5 HSA / Archer MSA / MA MSA HSA ☒",1099,5,1099,fdc-85a79515e924475d217cc002,v11-1099-SA-inline,original,2022,fgen-5083984ea9140f181e08c24d,synthetic_programmatic_template,inline,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2021
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Evergreen Health Savings 7909 Granite St Bayside, WA 55293
PAYER'S TIN  85-8203247
RECIPIENT'S name Olivia Moreau
RECIPIENT'S TIN      ending in 3744
Street address (including apt. no.)  8088 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code      Maplewood, MN 23422
1 Gross distribution  $5,334.32
3 Distribution code 1
4 FMV on date of death
5 HSA / Archer MSA / MA MSA  HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-f0560068a61884dde22ee858,v11-1099-SA-inline,original,2021,fgen-5285aed37ab5cb941cfdcabf,synthetic_programmatic_template,inline,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2021
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Health Savings 3257 Oak Hollow Ct Cedar Falls, IA 31231
PAYER'S TIN   63-7226325
RECIPIENT'S name  Sofia Rivera
RECIPIENT'S TIN XXXXX1226
Street address (including apt. no.)      822 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 63230
Account number (see instructions) XXXXX771043
1 Gross distribution   $5,760.81
2 Earnings on excess cont. 0.00
3 Distribution code 2
4 FMV on date of death      0.00
5 HSA / Archer MSA / MA MSA  HSA ☒",1099,5,1099,fdc-84aa0bc34e9af054c52d8f55,v11-1099-SA-inline,original,2021,fgen-092b18e5f29f8452f9d29f20,synthetic_programmatic_template,inline,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2026
Copy B For Recipient
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northwind HSA Custodian 330 Harbor View Rd Pinecrest, GA 44482
PAYER'S TIN 88-4406962
RECIPIENT'S name Wei E. Fischer
RECIPIENT'S TIN   ****4378
Street address (including apt. no.) 4965 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 37346
1 Gross distribution $6,505.39
3 Distribution code  A
4 FMV on date of death
5 HSA / Archer MSA / MA MSA      HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-c1ec029196f65627c9a98a53,v11-1099-SA-inline,original,2026,fgen-49fe0abc9d499a872fc7221e,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northwind HSA Custodian 8015 Maple Ridge Dr Bayside, WA 71544
PAYER'S TIN 63-7887660
RECIPIENT'S name Avery Rivera
RECIPIENT'S TIN ****2389
Street address (including apt. no.)  7640 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 62094
Account number (see instructions)   ending in 788248
1 Gross distribution      $8,623.59
2 Earnings on excess cont.  0.00
3 Distribution code  2
4 FMV on date of death   0.00
5 HSA / Archer MSA / MA MSA HSA ☒",1099,5,1099,fdc-6f4037ee59503aab63dff788,v11-1099-SA-inline,original,2024,fgen-81c6b7bddc1d92d725e14943,synthetic_programmatic_template,inline,top,False,
"For calendar year 2025
OMB No. 1545-1517
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
2 Earnings on excess cont.
3 Distribution code
4 FMV on date of death
5 HSA / Archer MSA / MA MSA
Evergreen Health Savings 6183 Elm Park Pl Fairview, OH 21550
26-8073906
Mateo J. Castillo
***-**-3342
709 Oak Hollow Ct
Maplewood, MN 69220
XXX-XX-655087
$7,211.30
A
HSA ☒",1099,5,1099,fdc-41085b2aa19f028c6c6e5cd6,v11-1099-SA-columns,original,2025,fgen-d5687d2cd819400eb0c9800f,synthetic_programmatic_template,columns,none,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
2 Earnings on excess cont.
3 Distribution code
4 FMV on date of death
5 HSA / Archer MSA / MA MSA
Sample HSA Bank 1911 Granite St Riverton, WI 29223
42-7241972
Fatima Sato
***-**-9436
4801 Oak Hollow Ct
Oak Grove, TX 38301
XXXXX175906
1
$0.00
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-7f6745059572040d5cbb0c47,v11-1099-SA-columns,original,2021,fgen-f599dcc47dade9e4d64624f1,synthetic_programmatic_template,columns,top,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA 2021
From:
To:
3 Distribution code
5 HSA / Archer MSA / MA MSA
1 Gross distribution
Northwind HSA Custodian
Noah M. Tanaka
A
HSA ☒
1,232.82",1099,5,1099,fdc-1b74f6c13a7face8181ec711,v11-1099-SA-columns,original,2021,fgen-58ed29e1aff14ef1f36636d6,synthetic_programmatic_template,columns,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2025
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
1 Gross distribution
3 Distribution code
4 FMV on date of death
5 HSA / Archer MSA / MA MSA
Northwind HSA Custodian 7417 Maple Ridge Dr Riverton, WI 53039
53-1707306
Sofia Adeyemi
XXXXX4435
4,192.44
F
0.00
HSA ☒",1099,5,1099,fdc-87deea6935c2ab5e1221eff6,v11-1099-SA-columns,original,2025,fgen-24dc95e3bfc1e3fa22375bfa,synthetic_programmatic_template,columns,top,False,
"TRUSTEE'S name:
RECIPIENT:
1 Gross distribution
Evergreen Health Savings
Avery Fischer
$8,164.98",1099,5,1099,fdc-712432a4b8360a4043bc1d76,v11-1099-SA-columns,original,2022,fgen-f162bdfdd12de0eb61da3586,synthetic_programmatic_template,columns,none,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medícare Advantage MSA
For calendar year 2021
Copy B For Recípient
This information is being fumished to the IRS.
TRUSTEE'S/PAYER'Sname, street address, city or town, state or province, country, and ZIP or foreign posta1 code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (inc1uding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Gross distribution
2 Eamings on excess cont.
3 Distribution code
4 FMV on date of death
5 HSA / ArcherMSA / MA MSA
Evergreen Health Savings 9O79 Sample Street Brookhaven, PA 71O10
20-3376126
Sofia Walsh
XXXXX8633
8053Lakeshore Blvd
Cedar Fa1ls, IA 64792
$8,243.83
0.00
2
HSA ☒",1099,5,1099,fdc-23efedaf81eb037a6232c211,v11-1099-SA-columns,original,2021,fgen-2735b07aa731046e4d68954c,synthetic_programmatic_template,columns,top,True,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2023
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
2 Earnings on excess cont.
3 Distribution code
4 FMV on date of death
5 HSA / Archer MSA / MA MSA
Northwind HSA Custodian 7675 Harbor View Rd Fairview, OH 94176
19-6158892
Priya Patel
XXX-XX-7590
7079 Maple Ridge Dr
Bayside, WA 40034
XXX-XX-099737
$4,684.57
0.00
G
$0.00
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-81869e80a8edf5f56ee2eb9a,v11-1099-SA-columns,original,2023,fgen-55baefba6c3aea2433e06357,synthetic_programmatic_template,columns,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2021
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Gross distribution
2 Earnings on excess cont.
4 FMV on date of death
5 HSA / Archer MSA / MA MSA
Sample HSA Bank 8325 Elm Park Pl Bayside, WA 81778
65-6229046
Lena Tanaka
***-**-7683
6285 Granite St
Cedar Falls, IA 85876
4,836.02
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-47d9678f4dc1cc136f8c66be,v11-1099-SA-columns,original,2021,fgen-bd6635066499556afd024af2,synthetic_programmatic_template,columns,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendaryear2026
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
2 Earnings on cxcess cont.
3 Distribution code
4 FMV on datc of death
5 H5A / Archer MSA / MA MSA
Northwind HSA Custodian 2720 Granite St Riverton, WI 99739
94-8543979
Fatima Haddad
****0972
8258 Harbor View Rd
Brookhaven, PA 24975
***-**-414542
1,128.71
2
H5A ☒
Department of the Treasury - Interna1Revenue Servíce
Form 1099-SA (keepfor your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-c8f4c3d42c3dbed5afdbcdeb,v11-1099-SA-columns,original,2026,fgen-e3b8d5ff8d8722cc13df7bfe,synthetic_programmatic_template,columns,top,True,
"TRUSTEE'S name:
To:
5 HSA / Archer MSA / MA MSA
1 Gross distribution
3 Distribution code
Evergreen Health Savings
Lena M. Rivera
HSA ☒
9,212.64
2
Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA 2024",1099,5,1099,fdc-4b86f0c70878c74223a96099,v11-1099-SA-columns,original,2024,fgen-34db4d55f4792f051b3df525,synthetic_programmatic_template,columns,bottom,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA 2021
TRUSTEE:
RECIPIENT:
1Gross distribution
5 HSA / Archer MSA / MA MSA
Samp1e H5A Bank
Hiro Fischer
8,675.48
H5A ☒",1099,5,1099,fdc-e977e0c24b80716bba886f06,v11-1099-SA-columns,original,2021,fgen-c607e22fef45ca9117f3da75,synthetic_programmatic_template,columns,top,True,
"VOID  CORRECTED
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2025
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Gross distribution
2 Earnings on excess cont.
3 Distribution code
5 HSA / Archer MSA / MA MSA
Evergreen Health Savings 6148 Sample Street Testville, IL 67490
78-2884335
Fatima Romero
XXXXX2942
8047 Prairie Ave
Cedar Falls, IA 41752
$7,423.01
1
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-39f57510ee06c3b76e8fc5b4,v11-1099-SA-columns,original,2025,fgen-ba8f374b106d90c22bed4999,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2022
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Gross distribution
2 Earnings on excess cont.
3 Distribution code
4 FMV on date of death
5 HSA / Archer MSA / MA MSA
Northwind HSA Custodian 2424 Oak Hollow Ct Maplewood, MN 43199
30-6887757
Mateo Adeyemi
ending in 5998
7689 Willow Bend Way
Maplewood, MN 67367
6,224.67
G
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-5efda7ef5e1f9c597a57fafc,v11-1099-SA-columns,original,2022,fgen-ca631176b98e4f7c348d7a7b,synthetic_programmatic_template,columns,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Gross distribution
2 Earnings on excess cont.
3 Distribution code
5 HSA / Archer MSA / MA MSA
Sample HSA Bank 6359 Sample Street Bayside, WA 43706
63-7215958
Avery S. Lindqvist
ending in 3475
9805 Elm Park Pl
Pinecrest, GA 51641
****843079
7,376.92
0.00
G
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-783e33bf6adfe9e0c5d99ee0,v11-1099-SA-columns,original,2024,fgen-e1a52c64c9fd53d6bbf3290f,synthetic_programmatic_template,columns,top,False,
"TRUSTEE:
To:
1 Gross distribution
3 Distribution code
5 HSA / Archer MSA / MA MSA
Evergreen Health Savings
Lena Testcase
9,094.50
A
HSA ☒",1099,5,1099,fdc-9629e15e713bfaa4a7328741,v11-1099-SA-columns,original,2021,fgen-257b9db7dbbeed86fb4257d3,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2021
Copy B For Recipient
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER'S TIN
RECIPIENT'S name
RECIPIENT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Gross distribution
2 Earnings on excess cont.
3 Distribution code
4 FMV on date of death
Sample HSA Bank 1160 Elm Park Pl Lakewood, CO 42432
29-5657268
Taylor D. Patel
XXXXX9713
6020 Lakeshore Blvd
Fairview, OH 32124
$2,353.04
0.00
1",1099,5,1099,fdc-927777d45ef562feddf947b9,v11-1099-SA-columns,original,2021,fgen-38552a214fc82889d45bd6d6,synthetic_programmatic_template,columns,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2025
OMB No. 1545-1517
Copy B For Recipient
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Health Savings 7961 Oak Hollow Ct Brookhaven, PA 62351
PAYER'S TIN: 82-3772040
RECIPIENT'S name: Diego Larsen
RECIPIENT'S TIN: XXXXX3090
Street address (including apt. no.): 1027 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 52491
Account number (see instructions): ending in 347422
1 Gross distribution: 3,637.42
2 Earnings on excess cont.
3 Distribution code: G
5 HSA / Archer MSA / MA MSA: HSA ☒",1099,5,1099,fdc-aa2f34da5be6c1f1e77a9bbb,v11-1099-SA-boxed,original,2025,fgen-5136e813864611e971418d4b,synthetic_programmatic_template,boxed,top,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
TRUSTEE:: Evergreen Health Savings
Recipient's name:: Jamie E. Testcase
5 HSA / Archer MSA / MA MSA: HSA ☒",1099,5,1099,fdc-8c55c8975e32f0d527fd4c8d,v11-1099-SA-boxed,original,2025,fgen-92159f4b8e88ebd17f6de7ad,synthetic_programmatic_template,boxed,top,False,
"Form 1099-SA Dístributions From an HSA, Archer MSA, or Medicare Advantage M5A
TRUSTEE:: Evergreen Hea1th Savings
Recipient's name:: Avery Rivera
Box 5HSA / Archer MSA / MA MSA: HSA ☒
Box 3 Distribution code: F
Box l Gross distribution: $7,906.94",1099,5,1099,fdc-be7cdd278e16ee4c9549019e,v11-1099-SA-boxed,original,2021,fgen-1e18f5a7834ea939ac89f364,synthetic_programmatic_template,boxed,top,True,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2023
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 987 Sample Street Oak Grove, TX 28196
PAYER'S TIN: 87-7029484
RECIPIENT'S name: Alex Larsen
RECIPIENT'S TIN: ***-**-5572
Box 1 Gross distribution: 835.16
Box 2 Earnings on excess cont.
Box 3 Distribution code: G
Box 4 FMV on date of death
Box 5 HSA / Archer MSA / MA MSA: HSA ☒",1099,5,1099,fdc-5e71e6d989b5a41a632cd984,v11-1099-SA-boxed,original,2023,fgen-e1dd982edec6e7aa14b4d643,synthetic_programmatic_template,boxed,top,False,
"2025
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Health Savings 9555 Lakeshore Blvd Testville, IL 34153
PAYER'S TIN: 62-1055373
RECIPIENT'S name: Avery Okafor
RECIPIENT'S TIN: XXX-XX-1725
Street address (including apt. no.): 9028 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 79569
Account number (see instructions): ending in 097281
Box 1 Gross distribution: 4,533.56
Box 2 Earnings on excess cont.
Box 3 Distribution code: 2
Box 4 FMV on date of death
Box 5 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-176e810c183d2b40f6a62e1a,v11-1099-SA-boxed,original,2025,fgen-6470c82b23d22cd92b536288,synthetic_programmatic_template,boxed,none,False,
"For calendar year 2021
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Sample HSA Bank 2165 Sample Street Testville, IL 26701
PAYER'S TIN: 21-6118447
RECIPIENT'S name: Casey Testcase
RECIPIENT'S TIN: ending in 3063
Street address (including apt. no.): 8068 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 46724
Account number (see instructions): ***-**-850469
1 Gross distribution: 219.43
2 Earnings on excess cont.
3 Distribution code: G
4 FMV on date of death
5 HSA / Archer MSA / MA MSA: HSA ☒",1099,5,1099,fdc-d76985f7cf3c304b11f26cf7,v11-1099-SA-boxed,original,2021,fgen-b7168dd20df8a9ce4f238fb6,synthetic_programmatic_template,boxed,none,False,
"TRUSTEE'S name:: Evergreen Health Savings
RECIPIENT:: Riley Patel
Box 3 Distribution code: G
Form1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA",1099,5,1099,fdc-5b05ac4d00d9aa67a988ef19,v11-1099-SA-boxed,original,2026,fgen-3f4e2441c2ad2d57fbcce1a3,synthetic_programmatic_template,boxed,bottom,True,
"☐ CORRECTED
OMB No. 1545-1517
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Health Savings 3208 Cedar Ln Cedar Falls, IA 39927
PAYER'S TIN: 66-1457591
RECIPIENT'S name: Alex S. Lindqvist
RECIPIENT'S TIN: XXXXX2228
Street address (including apt. no.): 3688 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 52476
Account number (see instructions): XXX-XX-413444
Line 1 Gross distribution: $1,106.00
Line 2 Earnings on excess cont.: 0.00
Line 3 Distribution code: A
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA",1099,5,1099,fdc-43278c4659e826bbfcb9c435,v11-1099-SA-boxed,original,2025,fgen-1744b26aa6f075adbca0ba82,synthetic_programmatic_template,boxed,bottom,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2023
OMB No. 1545-1517
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 6803 Maple Ridge Dr Pinecrest, GA 88039
PAYER'S TIN: 64-1581576
RECIPIENT'S name: Olivia D. Tanaka
RECIPIENT'S TIN: ***-**-5729
Street address (including apt. no.): 2683 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 26179
Account number (see instructions): ending in 250121
1 Gross distribution: $4,435.98
2 Earnings on excess cont.: $0.00
3 Distribution code: 2
4 FMV on date of death
5 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-7c2bc8bd56ab8d339706d272,v11-1099-SA-boxed,original,2023,fgen-9f63731b447fe956f86688f3,synthetic_programmatic_template,boxed,top,False,
"Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 5859 Elm Park Pl Fairview, OH 56435
PAYER'S TIN: 89-5292466
RECIPIENT'S name: Taylor Tanaka
RECIPIENT'S TIN: ***-**-5674
Street address (including apt. no.): 1822 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 30088
Account number (see instructions): XXXXX934041
Box 1 Gross distribution: 8,075.73
Box 2 Earnings on excess cont.: 0.00
Box 3 Distribution code: F
Box 4 FMV on date of death
Box 5 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-78f04016d8910711ae2ecced,v11-1099-SA-boxed,original,2022,fgen-c98be1fafdc6742b04a67ec7,synthetic_programmatic_template,boxed,bottom,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
Copy B For Recipient
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 2821 Sample Street Cedar Falls, IA 69136
PAYER'S TIN: 52-4656717
RECIPIENT'S name: Hiro R. Lindqvist
RECIPIENT'S TIN: ending in 8231
Box 1 Gross distribution: 5,758.70
Box 2 Earnings on excess cont.
Box 3 Distribution code: F
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-092efd1315b4ac0c0693119e,v11-1099-SA-boxed,original,2026,fgen-05bff647bdfb6efe9710de4e,synthetic_programmatic_template,boxed,top,False,
"For calendar year 2023
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Sample HSA Bank 8766 Elm Park Pl Brookhaven, PA 15750
PAYER'S TIN: 81-4112069
RECIPIENT'S name: Avery Okafor
RECIPIENT'S TIN: ****5340
Street address (including apt. no.): 3496 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 46937
Line 1 Gross distribution: 6,968.42
Line 2 Earnings on excess cont.: 0.00
Line 3 Distribution code: G
Line 4 FMV on date of death
Line 5 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service",1099,5,1099,fdc-f987b93958c7b5477e44815f,v11-1099-SA-boxed,original,2023,fgen-0e613f9b26b6aebb0a1e5d13,synthetic_programmatic_template,boxed,none,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
OMB No. 1545-1517
Copy B For Recipient
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 7816 Granite St Bayside, WA 52905
PAYER'S TIN: 90-4568752
RECIPIENT'S name: Jordan Testcase
RECIPIENT'S TIN: ***-**-3453
Account number (see instructions): XXXXX482891
1 Gross distribution: $3,479.75
3 Distribution code: A
4 FMV on date of death",1099,5,1099,fdc-6c61d7387bb42430929398f8,v11-1099-SA-boxed,original,2024,fgen-836c13b9c5b64bc99d6e6ae8,synthetic_programmatic_template,boxed,top,False,
"Form 1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA 2026
TRUSTEE:: Northwind HSA Custodian
RECIPIENT:: Diego B. Adeyemi
1 Gross distribution: $3,056.21
3 Distribution code: 1
5 HSA / Archer MSA / MA MSA: HSA ☒",1099,5,1099,fdc-89300009338c476a37b810c5,v11-1099-SA-boxed,original,2026,fgen-afd56aae5530cd1a2c852e74,synthetic_programmatic_template,boxed,top,False,
"Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
For calendar year 2022
OMB No. 1545-1517
Copy B For Recipient
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 5277 Elm Park Pl Bayside, WA 57280
PAYER'S TIN: 95-9626110
RECIPIENT'S name: Morgan Romero
RECIPIENT'S TIN: XXXXX6793
Street address (including apt. no.): 5849 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 32391
Line 1 Gross distribution: $7,289.81
Line 2 Earnings on excess cont.
Line 3 Distribution code: 1
Line 4 FMV on date of death
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-931fcc05c7fa8b2490d4fbea,v11-1099-SA-boxed,original,2022,fgen-0bf4320bc21d87ab85e33202,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 1099-SA
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
2023
This information is being furnished to the IRS.
TRUSTEE'S/PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Health Savings 9458 Prairie Ave Lakewood, CO 59329
PAYER'S TIN: 82-2621700
RECIPIENT'S name: Jordan Nguyen
RECIPIENT'S TIN: ****7555
Street address (including apt. no.): 3331 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 26944
Account number (see instructions): ***-**-263390
Box 1 Gross distribution: 6,296.71
Box 4 FMV on date of death
Box 5 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service
Form 1099-SA (keep for your records)  www.irs.gov/Form1099SA",1099,5,1099,fdc-54feb3428bb96dcf31389283,v11-1099-SA-boxed,original,2023,fgen-ebff700603af2e9d7f85b925,synthetic_programmatic_template,boxed,top,False,
"Form 5498
IRA Contribution Information
OMB No. 1545-0747
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Ironwood Wealth Partners 4482 Prairie Ave Lakewood, CO 50198
TRUSTEE'S or ISSUER'S TIN  91-3083622
PARTICIPANT'S name Kwame Rivera
PARTICIPANT'S TIN  XXXXX5460
Street address (including apt. no.)      7208 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code  Riverton, WI 52820
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $8,602.65
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account      241,603.61
10 Roth IRA contributions 5,418.71
11 Check if RMD for next year      ☐",5498,14,5498,fdc-c7a39b5e9618506c597db5d6,v11-5498-inline,original,2025,fgen-88464afab4d911a0d555c3fe,synthetic_programmatic_template,inline,top,False,
"Form 5498
IRA Contribution Information
OMB No. 1545-0747
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Ironwood Wealth Partners 190 Prairie Ave Fairview, OH 87656
TRUSTEE'S or ISSUER'S TIN 77-5592143
PARTICIPANT'S name   Morgan Patel
PARTICIPANT'S TIN   ending in 3652
Account number (see instructions)   XXX-XX-324582
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)  6,954.75
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account      $360,517.85
7 IRA / SEP / SIMPLE / Roth IRA  Roth IRA ☒
10 Roth IRA contributions      7,108.67
11 Check if RMD for next year
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-7ce9bd529542aa0f83468dd4,v11-5498-inline,original,2023,fgen-7ab05aef04803573e89cf44e,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form 5498
IRA Contribution Information
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 4546 Prairie Ave Pinecrest, GA 73313
TRUSTEE'S or ISSUER'S TIN 19-1780283
PARTICIPANT'S name  Fatima C. Haddad
PARTICIPANT'S TIN ****5038
Street address (including apt. no.)  5393 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code  Cedar Falls, IA 80501
Account number (see instructions) XXX-XX-249076
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)      1,601.39
3 Roth IRA conversion amount
5 Fair market value of account  457,478.00
7 IRA / SEP / SIMPLE / Roth IRA      Roth IRA ☒
11 Check if RMD for next year      ☐
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-08f46df3c50674fbd8a1f893,v11-5498-inline,original,2025,fgen-12f946f344869ff8552987f0,synthetic_programmatic_template,inline,top,False,
"Form 5498
IRA Contribution Information
For calendar year 2021
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Evergreen Brokerage Services 2372 Elm Park Pl Lakewood, CO 13493
TRUSTEE'S or ISSUER'S TIN  83-2077911
PARTICIPANT'S name   Mateo Fischer
PARTICIPANT'S TIN      ending in 3267
Account number (see instructions) ****631514
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $1,027.47
2 Rollover contributions   0.00
3 Roth IRA conversion amount   0.00
5 Fair market value of account 171,174.99
7 IRA / SEP / SIMPLE / Roth IRA   SEP ☒
10 Roth IRA contributions      $4,004.27",5498,14,5498,fdc-226905ce9158cbfcd71cde6f,v11-5498-inline,original,2021,fgen-dd11363e348acec6c4c47f3a,synthetic_programmatic_template,inline,top,False,
"Form 5498
IRA Contribution Information
2025
OMB No. 1545-0747
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Ironwood Wealth Partners 2633 Cedar Ln Brookhaven, PA 74427
TRUSTEE'S or ISSUER'S TIN      31-6863024
PARTICIPANT'S name  Fatima M. Rivera
PARTICIPANT'S TIN  ***-**-6439
Street address (including apt. no.) 8776 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 81718
Account number (see instructions) ***-**-462784
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)  2,370.89
2 Rollover contributions $0.00
3 Roth IRA conversion amount $0.00
5 Fair market value of account  $521,192.41
7 IRA / SEP / SIMPLE / Roth IRA  IRA ☒
10 Roth IRA contributions  5,989.51
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-1798e6eb34ffd84128ee803b,v11-5498-inline,original,2025,fgen-e65c4976cf36c0e589103c1c,synthetic_programmatic_template,inline,top,False,
"TRUSTEE:   Northstar Securities
RECIPIENT: Sofia Lindqvist
7 IRA / SEP / SIMPLE / Roth IRA IRA ☒",5498,14,5498,fdc-fe4b950a6d1ee4cbfa9d00e4,v11-5498-inline,original,2022,fgen-1c44b8c72eaa0867c5c8e669,synthetic_programmatic_template,inline,none,True,
"Form 5498
IRA Contribution Information
For calendar year 2022
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northstar Securities 4399 Lakeshore Blvd Fairview, OH 26285
TRUSTEE'S or ISSUER'S TIN 35-6468161
PARTICIPANT'S name  Riley Sato
PARTICIPANT'S TIN      ****2327
Street address (including apt. no.) 7689 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 73227
Account number (see instructions) ****516824
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $4,207.40
2 Rollover contributions   $0.00
3 Roth IRA conversion amount
5 Fair market value of account  537,390.36
7 IRA / SEP / SIMPLE / Roth IRA   IRA ☒
10 Roth IRA contributions      $9,062.14
11 Check if RMD for next year   X
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-507424336d4447a12cbdc633,v11-5498-inline,original,2022,fgen-7a3c0e597ed46de179bf209b,synthetic_programmatic_template,inline,top,False,
"Form 5498 IRA Contribution Information 2026
TRUSTEE'S name:      Northstar Securities
Recipient's name:      Olivia Rivera
7 IRA / SEP / SIMPLE / Roth IRA  Roth IRA ☒
5 Fair market value of account 541,108.56
10 Roth IRA contributions      $483.03",5498,14,5498,fdc-6883d95d1ca0de0d6967d0b4,v11-5498-inline,original,2026,fgen-f5c2194f8c3501c9b09eca9f,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form 5498
IRA Contribution Information
2022
OMB No. 1545-0747
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code  Evergreen Brokerage Services 9664 Granite St Brookhaven, PA 64315
TRUSTEE'S or ISSUER'S TIN 46-6331597
PARTICIPANT'S name Jordan Haddad
PARTICIPANT'S TIN  ending in 2495
Street address (including apt. no.) 4822 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 94504
Account number (see instructions)   ***-**-656019
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) 1,435.50
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account  $398,145.89
7 IRA / SEP / SIMPLE / Roth IRA   SEP ☒
10 Roth IRA contributions      8,253.39
11 Check if RMD for next year
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-6c929b9509d57cd234a2c092,v11-5498-inline,original,2022,fgen-497458adff07af2270f60623,synthetic_programmatic_template,inline,top,False,
"Form 5498
IRA Contribution Information
OMB No. 1545-0747
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Evergreen Brokerage Services 8141 Prairie Ave Fairview, OH 64127
TRUSTEE'S or ISSUER'S TIN 53-2398693
PARTICIPANT'S name Noah Moreau
PARTICIPANT'S TIN      XXXXX5773
Street address (including apt. no.) 5406 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code      Bayside, WA 65377
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)  8,219.19
2 Rollover contributions
3 Roth IRA conversion amount 0.00
5 Fair market value of account   458,012.34
7 IRA / SEP / SIMPLE / Roth IRA  IRA ☒
10 Roth IRA contributions   $1,231.61
11 Check if RMD for next year
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-98ecdae182efa21d4ed27752,v11-5498-inline,original,2026,fgen-26b15f35e97b9b5ba0b3a582,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form 5498
IRA Contribution Information
2023
OMB No. 1545-0747
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Clearwater Investing 9392 Sample Street Testville, IL 36101
TRUSTEE'S or ISSUER'S TIN      12-8988444
PARTICIPANT'S name Priya Walsh
PARTICIPANT'S TIN   XXX-XX-9048
Street address (including apt. no.)   9421 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Testville, IL 43506
Account number (see instructions) ending in 585969
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account $626,080.50
7 IRA / SEP / SIMPLE / Roth IRA      SEP ☒
10 Roth IRA contributions $2,718.32
11 Check if RMD for next year",5498,14,5498,fdc-80d44cf8952273a0edff99e6,v11-5498-inline,original,2023,fgen-02fc960023edf48d2f3696ac,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Form 5498
IRA Contribution Information
For calendar year 2021
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Clearwater Investing 2342 Prairie Ave Oak Grove, TX 24612
TRUSTEE'S or ISSUER'S TIN 14-4758225
PARTICIPANT'S name Wei Adeyemi
PARTICIPANT'S TIN      ***-**-0063
Street address (including apt. no.) 2613 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 31949
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)      $2,606.98
2 Rollover contributions 0.00
3 Roth IRA conversion amount
5 Fair market value of account      $325,902.15
10 Roth IRA contributions      $570.22
11 Check if RMD for next year      ☒
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-2a138dd6b9218eec8ba29092,v11-5498-inline,original,2021,fgen-83f6b0bb6edfbbf261f55e88,synthetic_programmatic_template,inline,top,False,
"Form 5498 IRA Contribution Information
TRUSTEE:      Summit Investments
Recipient's name:   Noah Larsen
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)  $6,106.98
5 Fair market value of account   642,140.93",5498,14,5498,fdc-c0e4b5bced754386bb281305,v11-5498-inline,original,2026,fgen-b9e513737624b89039cd1569,synthetic_programmatic_template,inline,top,False,
"Form 5498
IRA Contribution Information
2021
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code      Summit Investments 7009 Elm Park Pl Fairview, OH 14734
TRUSTEE'S or ISSUER'S TIN 86-2056765
PARTICIPANT'S name      Amara Moreau
PARTICIPANT'S TIN      ending in 9484
Street address (including apt. no.)  2127 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code  Riverton, WI 84163
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)      $6,700.70
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account  110,066.25
7 IRA / SEP / SIMPLE / Roth IRA IRA ☒
10 Roth IRA contributions 1,468.90
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-ece0b8b97c2803f8cf847fbb,v11-5498-inline,original,2021,fgen-d728217d3581a238cc69e16b,synthetic_programmatic_template,inline,top,False,
"Form 5498 IRA Contribution Information
From: Ironwood Wealth Partners
To:     Lena Haddad
11 Check if RMD for next year 0.00
7 IRA / SEP / SIMPLE /Roth IRA   SEP ☒
1 IRA contributíons (other than amounts in boxes 2–4, 8–1O, 13a, 14a, and 15a) $3,493.22
10 Roth IRA contributions   $7,246.53",5498,14,5498,fdc-60c764c11a68f8aa9ef3a2c6,v11-5498-inline,original,2021,fgen-201337444ccd2a3d04cdbde5,synthetic_programmatic_template,inline,top,True,
"Form 5498
IRA Contribution Information
For calendar year 2024
OMB No. 1545-0747
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code   Clearwater Investing 5796 Granite St Lakewood, CO 64657
TRUSTEE'S or ISSUER'S TIN  70-4111298
PARTICIPANT'S name  Casey B. Adeyemi
PARTICIPANT'S TIN   XXXXX6123
Street address (including apt. no.)   7317 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 61720
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $4,565.82
2 Rollover contributions $0.00
3 Roth IRA conversion amount
5 Fair market value of account  $611,074.99
7 IRA / SEP / SIMPLE / Roth IRA SEP ☒
10 Roth IRA contributions  3,744.34
11 Check if RMD for next year
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-3d7f55559184e42c0a7cae53,v11-5498-inline,original,2024,fgen-a5e2b8e1e4df3ed1213b3ef8,synthetic_programmatic_template,inline,top,False,
"For calendar year 2025
OMB No. 1545-0747
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
10 Roth IRA contributions
11 Check if RMD for next year
Ironwood Wealth Partners 8356 Elm Park Pl Cedar Falls, IA 86358
42-4403973
Olivia D. Lindqvist
****0807
1853 Sample Street
Lakewood, CO 17090
$0.00
317,616.11
4,658.45
☒
Form 5498
IRA Contribution Information",5498,14,5498,fdc-de850771c97f43ae92555624,v11-5498-columns,original,2025,fgen-7dc6ddcb9d57f38edf415cfb,synthetic_programmatic_template,columns,bottom,False,
"Form 5498 IRA Contribution Information
From:
To:
11 Check if RMD for next year
5 Fair market value of account
10 Roth IRA contributions
Summit Investments
Morgan Walsh
[X]
$349,787.46
$9,089.33",5498,14,5498,fdc-1a820529c8088ac1628433e6,v11-5498-columns,original,2022,fgen-73597286f138f28b7fc02cd9,synthetic_programmatic_template,columns,top,False,
"Form 5498
IRA Contribution Information
For calendar year 2022
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
2 Rollover contributions
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
10 Roth IRA contributions
Northstar Securities 6386 Oak Hollow Ct Testville, IL 26496
14-4855088
Jamie Testcase
***-**-5109
1333 Cedar Ln
Testville, IL 63978
XXXXX345464
2,819.17
$320,314.27
Roth IRA ☒
$4,530.79",5498,14,5498,fdc-56f3bdda1d7cde56c4932237,v11-5498-columns,original,2022,fgen-52f6efdd9002bdc892279af7,synthetic_programmatic_template,columns,top,False,
"OMB No. 1545-0747
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
2 Rollover contributions
3 Roth IRA conversion amount
11 Check if RMD for next year
Ironwood Wealth Partners 789 Granite St Riverton, WI 63647
38-6314233
Noah S. Walsh
****4090
876 Lakeshore Blvd
Riverton, WI 19730
XXXXX804889
$4,382.31
$0.00
$0.00
X
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-0a92d9f285b629a4b46e948a,v11-5498-columns,original,2022,fgen-a2ccd47c851883a78f770149,synthetic_programmatic_template,columns,none,False,
"Form 5498 IRA Contribution Information
From:
To:
1 IRA contributions (other than amounts in boxes 2–4, 8–lO, l3a, 14a, and15a)
Evergreen Brokerage Services
Olivia Tanaka
$5,635.76",5498,14,5498,fdc-631a138708619b07a82c8925,v11-5498-columns,original,2023,fgen-a0a03c7ecf31f87b2f1fda01,synthetic_programmatic_template,columns,top,True,
"Form 5498 IRA Contribution Information
TRUSTEE'S name:
Recipient's name:
10 Roth IRA contributions
Summit Investments
KwameB. Wa1sh
$1,153.55",5498,14,5498,fdc-9fc549b809ed593617c79618,v11-5498-columns,original,2026,fgen-8f4d9291112f1dbe9db60301,synthetic_programmatic_template,columns,top,True,
"For calendar year 2026
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
11 Check if RMD for next year
Summit Investments 87 Sample Street Cedar Falls, IA 69478
49-4199148
Hiro Kowalski
XXXXX8471
731 Oak Hollow Ct
Oak Grove, TX 40553
XXX-XX-202921
$553,114.67
SEP ☒
☒
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-33c345f139bdd2214cd2e502,v11-5498-columns,original,2026,fgen-ac578c3c8c4ee1e371ce56b2,synthetic_programmatic_template,columns,none,False,
"Form 5498 IRA Contribution Information 2025
From:
Recipient's name:
5 Fair market value of account
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
10 Roth IRA contributions
11 Check if RMD for next year
Summit Investments
Morgan Nguyen
573,340.83
5,481.25
9,240.00
0.00",5498,14,5498,fdc-6640c315f6d264655ec06677,v11-5498-columns,original,2025,fgen-44a68b6f9b150254c0745174,synthetic_programmatic_template,columns,top,False,
"Form 5498
IRA Contribution Information
2021
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
10 Roth IRA contributions
11 Check if RMD for next year
Summit Investments 2656 Maple Ridge Dr Oak Grove, TX 67131
55-5811974
Sofia Adeyemi
ending in 4317
2133 Sample Street
Oak Grove, TX 10927
$0.00
$201,953.12
IRA ☒
$3,031.37
☒
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-8831c23aaceba69e648ff2ef,v11-5498-columns,original,2021,fgen-c3d33c50d0a44bd350923d60,synthetic_programmatic_template,columns,top,False,
"Form 5498 IRA Contribution Information
From:
To:
10 Roth IRA contributions
11 Check if RMD for next year
Summit Investments
Amara Nguyen
$3,924.68
0.00",5498,14,5498,fdc-84ef65c7731a1262ac09b537,v11-5498-columns,original,2023,fgen-d156d9632403c5b56ce8c438,synthetic_programmatic_template,columns,top,False,
"2021
OMB No. 1545-0747
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
10 Roth IRA contributions
11 Check if RMD for next year
Northstar Securities 1967 Oak Hollow Ct Brookhaven, PA 83001
89-6625643
Hiro C. Patel
****4432
$4,192.51
$0.00
0.00
344,244.35
IRA ☒
$9,147.18
X
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-38e54c2902ed24a0a8152d5e,v11-5498-columns,original,2021,fgen-0220ed7834b4c10f8d1ca61b,synthetic_programmatic_template,columns,none,False,
"2025
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
11 Check if RMD for next year
Summit Investments 3474 Sample Street Fairview, OH 21417
48-7324753
Diego Moreau
****1655
4983 Oak Hollow Ct
Riverton, WI 80612
$3,492.14
194,788.84
SEP ☒
☒",5498,14,5498,fdc-a9f12db7c3a5c777f2bdbbb7,v11-5498-columns,original,2025,fgen-6503f66b1869a266993dc898,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
Form 5498
IRA Contribution Information
For calendar year 2025
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
10 Roth IRA contributions
11 Check if RMD for next year
Evergreen Brokerage Services 5865 Maple Ridge Dr Fairview, OH 90964
52-7056269
Morgan Romero
XXX-XX-6190
5078 Oak Hollow Ct
Bayside, WA 50505
472,548.27
$710.38
☐
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-5993131df69b4bae9c42399c,v11-5498-columns,original,2025,fgen-672d24dba3fce70e2a8dce31,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 5498
IRA Contribution Information
2025
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Account number (see instructions)
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
10 Roth IRA contributions
Northstar Securities 9613 Sample Street Riverton, WI 90439
10-1233526
Noah Nguyen
****9336
XXXXX282266
5,030.87
$328,954.75
Roth IRA ☒
7,899.59
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-698f7b6ecb839f0ef1a6b275,v11-5498-columns,original,2025,fgen-c6b68589c092d75ebc151a93,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 5498
IRA Contribution Information
For calendar year 2021
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Account number (see instructions)
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
2 Rollover contributions
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
10 Roth IRA contributions
11 Check if RMD for next year
Ironwood Wealth Partners 693 Maple Ridge Dr Cedar Falls, IA 24040
65-6592844
Noah Moreau
XXXXX1690
XXXXX309517
$5,880.98
574,116.23
IRA ☒
2,638.25
☐",5498,14,5498,fdc-efe640bde9a369e981068b8c,v11-5498-columns,original,2021,fgen-8c295780f1a9cdbd486411f5,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 5498
IRA Contribution Information
For calendar year 2025
OMB No. 1545-0747
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S or ISSUER'S TIN
PARTICIPANT'S name
PARTICIPANT'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
2 Rollover contributions
3 Roth IRA conversion amount
5 Fair market value of account
7 IRA / SEP / SIMPLE / Roth IRA
10 Roth IRA contributions
Ironwood Wealth Partners 1552 Harbor View Rd Bayside, WA 73328
13-1549798
Sofia Patel
***-**-0736
7700 Granite St
Pinecrest, GA 39373
$4,891.25
0.00
270,015.88
IRA ☒
$468.31
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-d53867a43d4ab8e9d61c58d0,v11-5498-columns,original,2025,fgen-c65fe160423adbaa4ab262df,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 5498
IRA Contribution Information
2023
Copy B For Participant
Thisinformation is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, statc or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 6897 Lakeshore Blvd Lakewood, CO 75952
TRUSTEE'S or ISSUER'S TIN: 95-55l5Ol1
PARTICIPANT'Sname: Casey Larsen
PARTICIPANT'S TIN: XXXXX4773
Account number (see instructions): ****723953
Box l IRA contributions (other thanamounts in boxcs 2–4, 8–1O, 13a, 14a, and 15a): S4,456.16
Box 2 Ro1lover contributions: O.00
Box 3 Roth IRA conversion amount
Box 5 Faír market value of account: $269,367.16
Box 11 Check if RMD for next year",5498,14,5498,fdc-a33ed48068f09aa6fb16cd7b,v11-5498-boxed,original,2023,fgen-f879334d4c8079a40d28fbeb,synthetic_programmatic_template,boxed,top,True,
"2024
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 2856 Oak Hollow Ct Oak Grove, TX 38746
TRUSTEE'S or ISSUER'S TIN: 40-4010658
PARTICIPANT'S name: Mateo Rivera
PARTICIPANT'S TIN: ****7413
Account number (see instructions): ***-**-633517
Box 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): 2,949.46
Box 2 Rollover contributions
Box 3 Roth IRA conversion amount
Box 5 Fair market value of account: $448,240.83
Box 7 IRA / SEP / SIMPLE / Roth IRA: Roth IRA ☒
Box 10 Roth IRA contributions: $8,083.16
Box 11 Check if RMD for next year: [X]
Department of the Treasury - Internal Revenue Service
Form 5498
IRA Contribution Information
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-166b12ef8a5fe7505b8618ba,v11-5498-boxed,original,2024,fgen-ab531c63dd0851bfc5e56530,synthetic_programmatic_template,boxed,bottom,False,
"Form 5498
IRA Contribution Information
2021
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 9216 Cedar Ln Brookhaven, PA 62676
TRUSTEE'S or ISSUER'S TIN: 91-6164440
PARTICIPANT'S name: Olivia Tanaka
PARTICIPANT'S TIN: ****6521
Street address (including apt. no.): 5669 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 85399
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): 1,405.51
2 Rollover contributions
3 Roth IRA conversion amount: $0.00
5 Fair market value of account: 91,646.87
7 IRA / SEP / SIMPLE / Roth IRA: IRA ☒
10 Roth IRA contributions: 7,912.25
11 Check if RMD for next year: ☐",5498,14,5498,fdc-9aa316a77823bc503bc81f22,v11-5498-boxed,original,2021,fgen-0782d78571dc545ecf06b0e9,synthetic_programmatic_template,boxed,top,False,
"Form 5498
IRA Contribution Information
2025
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 4962 Willow Bend Way Fairview, OH 96730
TRUSTEE'S or ISSUER'S TIN: 43-6179768
PARTICIPANT'S name: Mateo Okafor
PARTICIPANT'S TIN: XXX-XX-7611
Street address (including apt. no.): 2333 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 89931
Account number (see instructions): ***-**-273791
Line 2 Rollover contributions
Line 3 Roth IRA conversion amount: $0.00
Line 5 Fair market value of account: 246,521.98
Line 7 IRA / SEP / SIMPLE / Roth IRA: IRA ☒
Line 10 Roth IRA contributions: 6,814.51
Line 11 Check if RMD for next year: ☒
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-2e9f7031278d22cd69156333,v11-5498-boxed,original,2025,fgen-e6a07320dafb57659057c43e,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
2024
OMB No. 1545-0747
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 8907 Prairie Ave Lakewood, CO 48251
TRUSTEE'S or ISSUER'S TIN: 76-8173073
PARTICIPANT'S name: Wei Walsh
PARTICIPANT'S TIN: ***-**-0894
Account number (see instructions): ****006652
Line 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): 8,877.59
Line 2 Rollover contributions
Line 5 Fair market value of account: $322,121.60
Line 7 IRA / SEP / SIMPLE / Roth IRA: SEP ☒
Line 10 Roth IRA contributions: 3,754.98
Line 11 Check if RMD for next year: X
Department of the Treasury - Internal Revenue Service
Form 5498
IRA Contribution Information
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-c86e99b5e44864331a5617c6,v11-5498-boxed,original,2024,fgen-98e765a468469f276e363b03,synthetic_programmatic_template,boxed,bottom,False,
"Form 5498 IRA Contribution Information 2024
TRUSTEE:: Ironwood Wealth Partners
To:: Noah C. Fischer
Line 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): $5,859.37
Line 11 Check if RMD for next year: ☐
Line 5 Fair market value of account: 493,399.23",5498,14,5498,fdc-8ff18c8c8ee5c4550a7cd643,v11-5498-boxed,original,2024,fgen-555bece1b47c95f72fcea5f6,synthetic_programmatic_template,boxed,top,False,
"Form 5498 IRA Contribution Information 2022
TRUSTEE'S name:: Summit Investments
Recipient's name:: Hiro Moreau
Box 7 IRA / SEP / SIMPLE / Roth IRA: SEP ☒
Box 11 Check if RMD for next year: ☒
Box 5 Fair market value of account: $529,698.94
Box 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): 998.31",5498,14,5498,fdc-c829357ee4929ade1fa2d1e9,v11-5498-boxed,original,2022,fgen-b8d4220edc0507dd547ed2c8,synthetic_programmatic_template,boxed,top,False,
"Form 5498
IRA Contribution Information
2022
OMB No. 1545-0747
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 3512 Elm Park Pl Pinecrest, GA 15921
TRUSTEE'S or ISSUER'S TIN: 35-8048582
PARTICIPANT'S name: Mateo Walsh
PARTICIPANT'S TIN: XXXXX2169
Street address (including apt. no.): 9352 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 94037
Account number (see instructions): ***-**-932984
Box 5 Fair market value of account: $491,879.44
Box 7 IRA / SEP / SIMPLE / Roth IRA: SEP ☒
Box 10 Roth IRA contributions: 1,563.74
Box 11 Check if RMD for next year: ☐
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-73ca1e328a562941db30a871,v11-5498-boxed,original,2022,fgen-1e7df6beb809c3d4826b0fe9,synthetic_programmatic_template,boxed,top,False,
"TRUSTEE'S name:: Summit Investments
To:: Jordan Sato
Box 7 IRA / SEP / SIMPLE / Roth IRA: SEP ☒
Box 5 Fair market value of account: 238,583.88
Box 10 Roth IRA contributions: $552.73
Box 11 Check if RMD for next year: ☒",5498,14,5498,fdc-d22c75363775342998b38600,v11-5498-boxed,original,2021,fgen-8c29ff9a028b130f69d9f636,synthetic_programmatic_template,boxed,none,False,
"Form 5498
IRA Contribution Information
For calendar year 2021
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Clearwater Investing 3412 Granite St Testville, IL 25171
TRUSTEE'S or ISSUER'S TIN: 85-8990713
PARTICIPANT'S name: Olivia Testcase
PARTICIPANT'S TIN: XXXXX7727
Account number (see instructions): ending in 518487
Line 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): 2,624.09
Line 3 Roth IRA conversion amount: 0.00
Line 5 Fair market value of account: $602,798.49
Line 7 IRA / SEP / SIMPLE / Roth IRA: SEP ☒
Line 10 Roth IRA contributions: $9,187.37
Line 11 Check if RMD for next year: ☐",5498,14,5498,fdc-78d3da782c951f6d2224ef40,v11-5498-boxed,original,2021,fgen-ef87de2b61182228a69c8d33,synthetic_programmatic_template,boxed,top,False,
"Form 5498
IRA Contribution Information
For calendar year 2026
OMB No. 1545-0747
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Clearwater Investing 8334 Cedar Ln Testville, IL 11380
TRUSTEE'S or ISSUER'S TIN: 21-7925213
PARTICIPANT'S name: Morgan Brennan
PARTICIPANT'S TIN: ***-**-4611
Street address (including apt. no.): 6791 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 54133
Account number (see instructions): ending in 816562
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): $6,734.23
3 Roth IRA conversion amount
5 Fair market value of account: 242,668.88
10 Roth IRA contributions: $6,723.95
11 Check if RMD for next year: X",5498,14,5498,fdc-1cea999b78cf7e6ba089479c,v11-5498-boxed,original,2026,fgen-0242006a89cc9edb67724755,synthetic_programmatic_template,boxed,top,False,
"Form 5498
IRA Contribution Information
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 3510 Prairie Ave Bayside, WA 31430
TRUSTEE'S or ISSUER'S TIN: 90-1806055
PARTICIPANT'S name: Amara Walsh
PARTICIPANT'S TIN: XXX-XX-5269
Street address (including apt. no.): 1682 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 76445
Line 2 Rollover contributions
Line 3 Roth IRA conversion amount
Line 5 Fair market value of account: 446,198.10
Line 7 IRA / SEP / SIMPLE / Roth IRA: IRA ☒
Line 10 Roth IRA contributions: $7,547.20
Line 11 Check if RMD for next year: X
Department of the Treasury - Internal Revenue Service
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-07130c5eb2fe2119cfc8078d,v11-5498-boxed,original,2024,fgen-a0c67166fe7cca1bb815cce7,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
For calendar year 2021
OMB No. 1545-0747
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 7410 Prairie Ave Riverton, WI 81813
TRUSTEE'S or ISSUER'S TIN: 60-7058614
PARTICIPANT'S name: Olivia D. Lindqvist
PARTICIPANT'S TIN: ****1194
Account number (see instructions): XXXXX526818
Line 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): $6,735.66
Line 2 Rollover contributions
Line 3 Roth IRA conversion amount
Line 5 Fair market value of account: 203,273.67
Line 7 IRA / SEP / SIMPLE / Roth IRA: SEP ☒
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-ea0a4240053a871f9f34bcd7,v11-5498-boxed,original,2021,fgen-e8a5cbdc641ffe5d7ada9861,synthetic_programmatic_template,boxed,none,False,
"VOID  CORRECTED
For calendar year 2026
OMB No. 1545-0747
This information is being furnished to the IRS.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 8259 Lakeshore Blvd Bayside, WA 52919
TRUSTEE'S or ISSUER'S TIN: 34-1246084
PARTICIPANT'S name: Jordan Testcase
PARTICIPANT'S TIN: XXX-XX-7750
Street address (including apt. no.): 8048 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 51561
Line 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): $8,958.86
Line 2 Rollover contributions: 0.00
Line 3 Roth IRA conversion amount: $0.00
Line 5 Fair market value of account: 263,060.71
Line 7 IRA / SEP / SIMPLE / Roth IRA: Roth IRA ☒
Line 10 Roth IRA contributions: $1,658.84
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-37b3bcf62a02b2a3b05ad521,v11-5498-boxed,original,2026,fgen-340897385c2b01b2ccf5358c,synthetic_programmatic_template,boxed,none,False,
"For calendar year 2021
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Clearwater Investing 489 Elm Park Pl Oak Grove, TX 88031
TRUSTEE'S or ISSUER'S TIN: 67-5067289
PARTICIPANT'S name: Jamie R. Okafor
PARTICIPANT'S TIN: ****6797
Street address (including apt. no.): 3465 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 66307
1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): 6,163.04
2 Rollover contributions: $0.00
3 Roth IRA conversion amount
5 Fair market value of account: $623,184.42
7 IRA / SEP / SIMPLE / Roth IRA: Roth IRA ☒
10 Roth IRA contributions: 5,621.56
11 Check if RMD for next year: ☒
Department of the Treasury - Internal Revenue Service
Form 5498
IRA Contribution Information
Form 5498 (keep for your records)  www.irs.gov/Form5498",5498,14,5498,fdc-783fd97ae04970a4cee94bdc,v11-5498-boxed,original,2021,fgen-063d6fd38b964a3c40930f21,synthetic_programmatic_template,boxed,bottom,False,
"Form 5498
IRA Contribution Information
For calendar year 2025
OMB No. 1545-0747
Copy B For Participant
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 6240 Oak Hollow Ct Riverton, WI 51034
TRUSTEE'S or ISSUER'S TIN: 95-7917969
PARTICIPANT'S name: Kwame K. Moreau
PARTICIPANT'S TIN: XXXXX4594
Street address (including apt. no.): 549 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 68142
Account number (see instructions): XXXXX285901
Box 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a): $5,966.03
Box 2 Rollover contributions: 0.00
Box 3 Roth IRA conversion amount
Box 5 Fair market value of account: $124,672.11
Box 7 IRA / SEP / SIMPLE / Roth IRA: SEP ☒
Box 10 Roth IRA contributions: $8,760.47",5498,14,5498,fdc-c439671c4b49c9c7f146ae51,v11-5498-boxed,original,2025,fgen-3debe242c51a2c4228aadbb8,synthetic_programmatic_template,boxed,top,False,
"Form 5498 IRA
Contribution Information 2026 From: Clearwater Investing RECIPIENT: Olivia E. Moreau 11 Check if RMD for ncxt year ☐ 7 IRA / SEP / SIMPLE /
Roth IRA SEP ☒ 5 Fair market value of account 441,309.90 1 IRA contributions (other than amountsinboxes 2–4, 8–10, 13a, 14a, and 15a) S1,040.65",5498,14,5498,fdc-5d22eb0d8fe18b22dc0ad399,v11-5498-flat,original,2026,fgen-63349158cc3b471ecc04199e,synthetic_programmatic_template,flat,top,True,
"TRUSTEE'S name: Evergreen Brokerage
Services To: Jordan J. Lindqvist 7 IRA / SEP / SIMPLE / Roth IRA SEP ☒ 5 Fair market value of account $411,612.43 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) 8,369.64
11 Check if RMD for next year ☐ Form 5498 IRA Contribution Information 2025",5498,14,5498,fdc-25beb5e2fa12d16758ec14bc,v11-5498-flat,original,2025,fgen-1355154dc737ecc95e457190,synthetic_programmatic_template,flat,bottom,False,
"Form 5498 IRA Contribution
Information TRUSTEE'S name: Northstar Securities RECIPIENT: Jordan A. Moreau 5 Fair market value of
account 541,460.43 7 IRA / SEP / SIMPLE / Roth IRA SEP ☒ 10 Roth IRA contributions $4,431.71",5498,14,5498,fdc-26b064acd609137818fa307f,v11-5498-flat,original,2024,fgen-1d4822591b24040fc13ef53f,synthetic_programmatic_template,flat,top,False,
"2023 This information is being furnished to the IRS. TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 5137 Cedar Ln Bayside, WA 95022 TRUSTEE'S or ISSUER'S TIN 20-1773487 PARTICIPANT'S name Hiro Walsh PARTICIPANT'S TIN XXXXX3957 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) 1,855.59 3 Roth IRA conversion amount 5 Fair market value of account $216,673.88 7 IRA / SEP / SIMPLE /
Roth IRA Roth IRA ☒
10 Roth IRA contributions 5,616.11 11 Check if RMD for next year [X] Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-2ce6e7fb452df18c38062c4b,v11-5498-flat,original,2023,fgen-dabef5ca71c3f15d000e3547,synthetic_programmatic_template,flat,none,False,
"Form 5498 IRA Contribution Information 2022 From: Clearwater Investing Recipient's name: Morgan Rivera 5 Fair
market value of account $620,329.87 7 IRA / SEP / SIMPLE / Roth
IRA Roth IRA ☒ 10 Roth IRA contributions 609.37 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) 3,184.76",5498,14,5498,fdc-45b2d3abf5ad0b42022ca8b4,v11-5498-flat,original,2022,fgen-36c0715d2d05098bcf83b177,synthetic_programmatic_template,flat,top,False,
"Form 5498 IRA Contribution Information 2025 OMB No. 1545-0747 Copy B For Participant This information is being furnished to the IRS. TRUSTEE'S or ISSUER'S
name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 4187 Sample Street Pinecrest, GA 26943 TRUSTEE'S or ISSUER'S TIN 36-2123172 PARTICIPANT'S name Sofia J. Romero PARTICIPANT'S TIN ***-**-0134 Street address (including apt. no.) 4337 Lakeshore Blvd City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 29860 Account number (see instructions) XXX-XX-522739 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) 7,221.40 2 Rollover contributions $0.00 3
Roth IRA conversion amount 5 Fair market value of account $582,770.07 7 IRA / SEP / SIMPLE / Roth IRA Roth IRA ☒ 10 Roth IRA contributions $5,493.24",5498,14,5498,fdc-22d6d8b238d24c65cfd06570,v11-5498-flat,original,2025,fgen-e631eebe2784d9bbaaff4ca2,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED 2024 OMB No. 1545-0747 Copy B For Participant TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Ironwood Wealth
Partners 8002 Sample Street Cedar Falls, IA 54990 TRUSTEE'S or ISSUER'S TIN 44-1373662 PARTICIPANT'S name Jordan Okafor PARTICIPANT'S TIN ****7904 Street address (including apt. no.) 3739 Sample Street City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 93530 1 IRA contributions (other than
amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $440.36 2 Rollover contributions 0.00 5 Fair market value of account 646,181.50 7 IRA / SEP / SIMPLE / Roth IRA IRA ☒ 10 Roth IRA contributions $2,534.36",5498,14,5498,fdc-0b080bc973f29e1f52e05d78,v11-5498-flat,original,2024,fgen-10061207a707a80b13749f2c,synthetic_programmatic_template,flat,none,False,
"TRUSTEE:
Summit Investments Recipient's name: Wei Castillo
7 IRA / SEP / SIMPLE / Roth IRA Roth IRA ☒ 10 Roth IRA contributions 3,158.43 5 Fair market value of account 85,284.93 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $5,577.68",5498,14,5498,fdc-ad3bd0d810ce87418965b54c,v11-5498-flat,original,2026,fgen-209a88ae163565e508d63d1b,synthetic_programmatic_template,flat,none,False,
"Form 5498 IRA Contribution Information For calendar year 2025 OMB No. 1545-0747 Copy B For Participant This information is being furnished to the IRS. TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 9572 Oak Hollow Ct Cedar Falls, IA 50627 TRUSTEE'S or ISSUER'S TIN 21-4632057 PARTICIPANT'S name Olivia Kowalski PARTICIPANT'S TIN XXX-XX-1070 1 IRA contributions (other
than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $9,487.87 2 Rollover contributions 0.00 3 Roth IRA conversion amount 0.00 5 Fair market value of account $440,650.64 7 IRA / SEP / SIMPLE / Roth IRA SEP ☒ 11 Check if RMD for next year X Department of the Treasury
- Internal Revenue Service Form 5498 (keep for your records) www.irs.gov/Form5498",5498,14,5498,fdc-1a6a72951ac0cc7d2576cf73,v11-5498-flat,original,2025,fgen-67f69462299034bc56b9fb26,synthetic_programmatic_template,flat,top,False,
"Form 5498IRA Contribution Information OMB No. 1545-0747 TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Ironwood Wealth Partners 5585 Prairie Ave Bayside, WA 55796 TRUSTEE'S or ISSUER'S TIN 64-7919332 PARTICIPANT'S namc Avery Nguyen PARTICIPANT'S TIN XXXXX1828 Street address(índuding
apt. no.) 7144 Samplc Street City or town,
state or province, country, and ZIP or foreign posta1 code Maplewood, MN 99659 Account number (see instructions) XXX-XX-O26414 2Rollover contributions 3Roth IRA conversion amount 5 Fair market value of account 454,O49.64 7 IRA / SEP / SIMPLE / Roth IRA Roth IRA ☒ l1 Check íf RMD for nextyear ☐ Department of the Treasury - Internal Revenue 5ervíce Form 5498 (keep for your records) www.irs.gov/Form5498",5498,14,5498,fdc-a52305541ea043a98e334542,v11-5498-flat,original,2026,fgen-ad63924042f1283573d1c4f7,synthetic_programmatic_template,flat,top,True,
"Form 5498 IRA Contribution
Information 2025 From: Evergreen Brokerage Services Recipient's name: Amara Larsen 5 Fair market
value of account $528,719.68 7 IRA / SEP / SIMPLE / Roth IRA SEP ☒ 11 Check if RMD for next year ☒ 10 Roth IRA contributions 921.38",5498,14,5498,fdc-588111b63e28d4a73b1d3978,v11-5498-flat,original,2025,fgen-865885550d2ca56059c15d63,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED 2026 Copy B
For Participant This information is being furnished to the IRS. TRUSTEE'S
or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 1405 Elm Park Pl Cedar Falls, IA 43069 TRUSTEE'S or ISSUER'S TIN 66-5999121 PARTICIPANT'S name Casey Rivera PARTICIPANT'S TIN ***-**-7669 Street address (including apt. no.) 5900 Sample Street City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 14407 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $934.51 2 Rollover contributions 3 Roth IRA conversion amount 0.00 7 IRA / SEP / SIMPLE / Roth IRA IRA ☒ 10 Roth IRA contributions $3,550.26 11 Check if RMD for next year ☒ Form 5498 IRA Contribution Information",5498,14,5498,fdc-cba788fe56231afbf4148e39,v11-5498-flat,original,2026,fgen-f95b6994e9ab76db50a59535,synthetic_programmatic_template,flat,bottom,False,
"CORRECTED (if checked) 2023 OMB No. 1545-0747 This information is being furnished to the IRS. TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Brokerage Services 9721 Lakeshore Blvd Testville, IL 50415 TRUSTEE'S or ISSUER'S TIN 56-3008306 PARTICIPANT'S name Diego Fischer
PARTICIPANT'S TIN ending in 1610 Street address (including apt. no.) 3082 Sample Street City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 14368 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and
15a) 4,603.07 2 Rollover contributions 3 Roth IRA conversion amount 5 Fair market value of account 234,402.92 7 IRA / SEP / SIMPLE / Roth IRA IRA ☒ 10 Roth IRA contributions 12.91 11 Check if RMD for next year ☒ Department of the Treasury - Internal Revenue Service Form 5498 IRA Contribution Information Form 5498 (keep for your records) www.irs.gov/Form5498",5498,14,5498,fdc-3efa6cee82f75960dd22f11d,v11-5498-flat,original,2023,fgen-120af6326fd7d8a2689f72b0,synthetic_programmatic_template,flat,bottom,False,
"From: IronwoodWealth Partners Recipient's namc: Priya A. Lindqvist
5 Fair market value of account
$359,176.87",5498,14,5498,fdc-4c0dd669090b40d453154294,v11-5498-flat,original,2023,fgen-0304837ea550262aa79d9a6c,synthetic_programmatic_template,flat,none,True,
"Form 5498 IRA Contribution Information OMB No. 1545-0747 Copy B For Participant This information is being furnished to the IRS. TRUSTEE'S or ISSUER'S name, street address, city or town, state or province,
country, and ZIP or foreign postal code Clearwater Investing 338 Sample Street Bayside, WA 60515 TRUSTEE'S or ISSUER'S TIN 42-7414471 PARTICIPANT'S name
Morgan Sato PARTICIPANT'S TIN ***-**-0988 Street address (including apt. no.) 6953 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 93964 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a) $3,733.74 2 Rollover contributions $0.00 3 Roth IRA conversion amount 5 Fair market value of account $485,211.88 7 IRA / SEP / SIMPLE / Roth IRA Roth IRA ☒ 10 Roth IRA contributions $2,154.19 11 Check if RMD for next year ☐ Department of the Treasury - Internal Revenue Service Form 5498 (keep for your records) www.irs.gov/Form5498",5498,14,5498,fdc-df71d4f1d4e82750187dc08c,v11-5498-flat,original,2021,fgen-e99300c01e966e4bb76e7d65,synthetic_programmatic_template,flat,top,False,
"Form5498 IRA Contribution Informatíon 2022 OMB No. 1545-0747 Copy B For Participant This information is being furnished to the IR5.
TRUSTEE'S or ISSUER'S name, street address, city or town, state or province, country, andZIP or foreign posta1 code Clearwater Investing 94O3 Willow Bend Way Lakewood, C0 74303 TRUSTEE'S or ISSUER'S TIN 86-4726l00 PARTICIPANT'S name Príya FischerPARTICIPANT'S TIN XXX-XX-7103 Street address (inc1uding apt. no.) 3635 Sample Street City or town, state or province, country, and ZIP or foreign posta1 code Pinecrest, GA 40766 Account number (see instructions) XXXXX705195 1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, 14a, and 15a)
$484.65 2 Rollovercontributions 3 Roth IRA conversion amount 5 Fairmarket value of account 469,304.62 7 IRA / 5EP / SIMPLE / Roth IRA SEP ☒",5498,14,5498,fdc-a7bcac04e9b05a4c4e48f32e,v11-5498-flat,original,2022,fgen-7361551edf7fa53e64bb4e14,synthetic_programmatic_template,flat,top,True,
"Form 5498-ESA
Coverdell ESA ContributionInformation
OMB No. 1545-1815
Copy B For Beneficiary
TRUSTEE'S name, streetaddress, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
l Coverdell E5A contributions
2 Rollover contributions
Ironwood Wealth Partners 5311 Oak Hollow Ct Testville, IL 37525
6O-1938841
Priya Brennan
XXXXX5O86
7162 Prairie Ave
Cedar Falls, IA 85834
7,461.35",5498,14,5498,fdc-0e3f3ef4d274d94a39a4b121,v11-5498-ESA-columns,original,2025,fgen-ca1ec06f749036b5f47dfea8,synthetic_programmatic_template,columns,top,True,
"Form 5498-ESA
Coverdell ESA Contribution Information
For calendar year 2026
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Coverdell ESA contributions
2 Rollover contributions
Evergreen Brokerage Services 7174 Granite St Pinecrest, GA 87335
37-6703903
Kwame B. Castillo
XXXXX0186
9788 Maple Ridge Dr
Pinecrest, GA 25059
5,459.06
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-d449d8dffd780d8b3b73d0a5,v11-5498-ESA-columns,original,2026,fgen-5270b021a647421aa03af15e,synthetic_programmatic_template,columns,top,False,
"Form 5498-ESA
Coverdell ESA Contribution Information
For calendar year 2021
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Coverdell ESA contributions
2 Rollover contributions
Summit Investments 8590 Cedar Ln Lakewood, CO 10067
20-9359582
Avery D. Larsen
XXXXX6725
4811 Prairie Ave
Brookhaven, PA 69783
$2,847.66",5498,14,5498,fdc-c9d3aea99359d383a8a3578c,v11-5498-ESA-columns,original,2021,fgen-fd6a552897ae9485dc7f9ebe,synthetic_programmatic_template,columns,top,False,
"Form5498-ESA Coverdell ESA Contribution Information
TRUSTEE:
To:
1 Coverdell ESA contributions
Northstar Securities
Priya J. Adeyemi
6,429.70",5498,14,5498,fdc-fbc02dc5bf98a355fc2ffede,v11-5498-ESA-columns,original,2021,fgen-0513f65ba61b1c175b8380e3,synthetic_programmatic_template,columns,top,True,
"Form 5498-ESA
Coverdell ESA Contribution Information
2022
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
2 Rollover contributions
Clearwater Investing 8955 Sample Street Oak Grove, TX 18105
28-9685017
Amara K. Castillo
XXX-XX-4471
7098 Prairie Ave
Fairview, OH 42679
XXX-XX-933660",5498,14,5498,fdc-db11f8279ba4fd21f1094e18,v11-5498-ESA-columns,original,2022,fgen-c6072daf8a9d47d94fee1b5c,synthetic_programmatic_template,columns,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information 2025
TRUSTEE:
RECIPIENT:
1 Coverdell ESA contributions
Northstar Securities
Hiro Castillo
3,507.14",5498,14,5498,fdc-e2e881d01a1ebb3ced9f1d93,v11-5498-ESA-columns,original,2025,fgen-a1ad29c1cfcfcae33b8bc944,synthetic_programmatic_template,columns,top,False,
"For calendar year 2026
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Account number (see instructions)
1 Coverdell ESA contributions
Ironwood Wealth Partners 6188 Elm Park Pl Cedar Falls, IA 36472
39-3331982
Mateo Fischer
XXXXX0857
****164291
8,751.02
Form 5498-ESA
Coverdell ESA Contribution Information",5498,14,5498,fdc-d468867ae445d5dd04297a5f,v11-5498-ESA-columns,original,2026,fgen-07e994bef466488c4a5b96cf,synthetic_programmatic_template,columns,bottom,False,
"VOID  CORRECTED
2021
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Coverdell ESA contributions
Evergreen Brokerage Services 6758 Willow Bend Way Oak Grove, TX 54423
12-5252736
Sofia C. Nguyen
ending in 1452
338 Oak Hollow Ct
Cedar Falls, IA 91035
$7,705.82
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-3e926053d9902ba561016679,v11-5498-ESA-columns,original,2021,fgen-b765dc6ffd4238d31381f91b,synthetic_programmatic_template,columns,none,False,
"☐ CORRECTED
For calendar year 2021
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Rollover contributions
Summit Investments 5158 Lakeshore Blvd Lakewood, CO 11837
81-7140301
Lena Haddad
****8701
3207 Willow Bend Way
Brookhaven, PA 62072
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-57ec45fe9abf99aff5cb4e68,v11-5498-ESA-columns,original,2021,fgen-2f5804d262f04f41d820e4cf,synthetic_programmatic_template,columns,none,False,
"Form 5498-ESA Coverdell ESA Contribution Information
TRUSTEE'S name:
RECIPIENT:
1 Coverdell ESA contributions
Summit Investments
Alex Testcase
$7,809.52",5498,14,5498,fdc-7e06bcb8efc7820cc42e41dd,v11-5498-ESA-columns,original,2025,fgen-5622f74ac024643b99e626d2,synthetic_programmatic_template,columns,top,False,
"Form 5498-ESA Coverde1l ESA ContributionInformation 2023
TRUSTEE:
Recipient's name:
1 Coverdell ESA contributions
Northstar Securities
Alex Rivera
$5,858.58",5498,14,5498,fdc-c9613de6531857d4556b54a0,v11-5498-ESA-columns,original,2023,fgen-ff9ede157b2149ae6f2a345e,synthetic_programmatic_template,columns,top,True,
"Form 5498-ESA Coverdell ESA Contribution Information 2024
TRUSTEE:
Recipient's name:
1 Coverdell ESA contributions
Clearwater Investing
Sofia B. Moreau
4,872.33",5498,14,5498,fdc-667f9b3e93a589bf4cb5a1de,v11-5498-ESA-columns,original,2024,fgen-391631a77aaa3857745265e6,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 5498-ESA
Coverdell ESA Contribution Information
2021
OMB No. 1545-1815
Copy B For Beneficiary
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Account number (see instructions)
1 Coverdell ESA contributions
Northstar Securities 749 Elm Park Pl Pinecrest, GA 92098
23-6752348
Jordan Testcase
****4080
XXX-XX-135174
8,430.12",5498,14,5498,fdc-b630e96cb68fd883428a2f2a,v11-5498-ESA-columns,original,2021,fgen-afb93183e692358550bd6f10,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Form 5498-ESA
Coverdell ESA Contribution Information
2023
OMB No. 1545-1815
Copy B For Bcneficiary
This information isbeing furnished to the IRS.
TRUSTEE'S name,street address, city or town, state or provínce, country, and ZIP or foreign postal code
TRU5TEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
Account number (see instructions)
1 Coverdell ESA contributions
2 Rollover contributions
Summit Investments 6837 Lakeshore Blvd Maplewood, MN 13795
23-8927174
Kwame J. Lindqvist
****5O02
XXXXX999876
7,523.80
Department of the Treasury - Intemal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498E5A",5498,14,5498,fdc-c8b6f95915c04e5706f4b8ea,v11-5498-ESA-columns,original,2023,fgen-7911aac42dd4f9d522776e56,synthetic_programmatic_template,columns,top,True,
"Form 5498-ESA
Coverdell ESA Contribution Information
2O25
OMB No. 1545-1815
Copy B For Beneficiary
TRU5TEE'S name, street address, city or town, statc or province, country, and ZIP orforeign postal code
TRUSTEE'S TIN
BENEFICIARY'S name
BENEFICIARY'S TIN
1 Coverdell ESA contributions
2 Rollover contributions
Ironwood Wealth Partners 3130 Elm Park Pl Fairview, OH76715
55-2648784
Hiro Fischer
ending in 6499
$248.90
$0.00
Dcpartment of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.írs.gov/Form5498ESA",5498,14,5498,fdc-1fe52a5c14ebc47225c8c588,v11-5498-ESA-columns,original,2025,fgen-43105fa881d2119ca47f792b,synthetic_programmatic_template,columns,top,True,
"Form 5498-ESA Coverdell ESA Contribution Information
TRUSTEE'S name:
Recipient's name:
1 Coverdell ESA contributions
Northstar Securities
Casey Patel
$1,261.39",5498,14,5498,fdc-7796e5576b295103b62ea698,v11-5498-ESA-columns,original,2023,fgen-8521c2866115bd2fa4263071,synthetic_programmatic_template,columns,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information 2022
TRUSTEE'S name:: Ironwood Wealth Partners
To:: Avery Patel
Box 1 Coverdell ESA contributions: 4,482.01",5498,14,5498,fdc-756e6be3d342b3197cb03936,v11-5498-ESA-boxed,original,2022,fgen-b4e8481164017a179086e698,synthetic_programmatic_template,boxed,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information
TRUSTEE:: Ironwood Wealth Partners
RECIPIENT:: Olivia Patel
Box 1 Coverdell ESA contributions: $7,383.17",5498,14,5498,fdc-1ab6e969b86e3501ec475997,v11-5498-ESA-boxed,original,2024,fgen-edf9bb0542a43d17f5466eb3,synthetic_programmatic_template,boxed,top,False,
"Form 5498-ESA
Coverdell ESA Contribution Information
For calendar year 2023
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 386 Cedar Ln Oak Grove, TX 68475
TRUSTEE'S TIN: 16-4943502
BENEFICIARY'S name: Riley Tanaka
BENEFICIARY'S TIN: XXX-XX-0322
Account number (see instructions): XXXXX569714
Box 1 Coverdell ESA contributions: $7,694.96
Box 2 Rollover contributions",5498,14,5498,fdc-8290d2d57d9543a914298c5e,v11-5498-ESA-boxed,original,2023,fgen-ffda7de7279a20edcb605e59,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
Form 5498-ESA
Coverdell ESA Contribution Information
2023
OMB No. 1545-1815
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Clearwater Investing 6297 Prairie Ave Lakewood, CO 29927
TRUSTEE'S TIN: 19-9839851
BENEFICIARY'S name: Diego Castillo
BENEFICIARY'S TIN: XXX-XX-0070
Street address (including apt. no.): 5597 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 63823
Box 1 Coverdell ESA contributions: $6,123.79
Box 2 Rollover contributions: $0.00
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-419b581b4400ec9df11fbb54,v11-5498-ESA-boxed,original,2023,fgen-0d4438d8e71e15cca69e3ef5,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 5498-ESA
Coverdell ESA Contribution Information
2026
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 2380 Oak Hollow Ct Oak Grove, TX 68276
TRUSTEE'S TIN: 44-2877112
BENEFICIARY'S name: Amara Tanaka
BENEFICIARY'S TIN: ***-**-2688
Street address (including apt. no.): 6169 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 47296
1 Coverdell ESA contributions: 8,471.44
2 Rollover contributions: 0.00
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-8fcf4ee097b105536f43e90d,v11-5498-ESA-boxed,original,2026,fgen-8e8c4d36cca466b9b963887f,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form5498-ESA
Coverdell ESA Contribution Information
2022
0MB No. l545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Brokerage Services 3l59 Lakeshore Blvd Riverton, WI 32756
TRUSTEE'5 TIN: 24-3601146
BENEFICIARY'S name: Wei M. Wa1sh
BENEFICIARY'S TIN: XXXXX7521
1 Coverdell ESA contributions: 3,639.70
2 Rollover contributions:$0.00
Department of the Treasury - Interna1 Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-3126a7743888298a214e06d5,v11-5498-ESA-boxed,original,2022,fgen-d36d31fc9e0a612787b6d13f,synthetic_programmatic_template,boxed,top,True,
"Form 5498-ESA
Coverdell ESA Contribution Information
For calendar year 2023
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northstar Securities 8889 Harbor View Rd Brookhaven, PA 77149
TRUSTEE'S TIN: 37-9232112
BENEFICIARY'S name: Fatima S. Rivera
BENEFICIARY'S TIN: ***-**-2620
Street address (including apt. no.): 593 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 77402
1 Coverdell ESA contributions: $459.37
2 Rollover contributions: $0.00
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-423d328002e038a190a95ac1,v11-5498-ESA-boxed,original,2023,fgen-3d1e942149c5401bef435fc0,synthetic_programmatic_template,boxed,top,False,
"From:: Clearwater Investing
To:: Diego D. Larsen
Box 1 Coverdell ESA contributions: 474.26
Form 5498-ESA Coverdell ESA Contribution Information 2025",5498,14,5498,fdc-eef8b04b347df3a4c41fc7c9,v11-5498-ESA-boxed,original,2025,fgen-7fbf52dea92577512091ea8a,synthetic_programmatic_template,boxed,bottom,False,
"2025
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Clearwater Investing 3982 Prairie Ave Fairview, OH 99540
TRUSTEE'S TIN: 51-2216830
BENEFICIARY'S name: Amara Haddad
BENEFICIARY'S TIN: ****4344
Street address (including apt. no.): 3273 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 81526
Account number (see instructions): ending in 491108
1 Coverdell ESA contributions: $8,213.90
2 Rollover contributions
Form 5498-ESA
Coverdell ESA Contribution Information",5498,14,5498,fdc-c26db87e35c97d8f2f95fd96,v11-5498-ESA-boxed,original,2025,fgen-0794fd610d38f98361c2752d,synthetic_programmatic_template,boxed,bottom,False,
"2026
OMB No. 1545-1815
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 4679 Maple Ridge Dr Oak Grove, TX 73619
TRUSTEE'S TIN: 64-4951437
BENEFICIARY'S name: Lena Testcase
BENEFICIARY'S TIN: ****0212
Line 1 Coverdell ESA contributions: $2,245.77
Line 2 Rollover contributions
Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-32f0d5c6b564b000af62ce80,v11-5498-ESA-boxed,original,2026,fgen-c98f08872cf34846a6570cc1,synthetic_programmatic_template,boxed,none,False,
"Form 5498-ESA
Coverdell ESA Contribution Information
2025
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 5013 Prairie Ave Lakewood, CO 66933
TRUSTEE'S TIN: 16-2280461
BENEFICIARY'S name: Taylor Kowalski
BENEFICIARY'S TIN: ****9800
Street address (including apt. no.): 4066 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 35607
Account number (see instructions): ending in 760328
1 Coverdell ESA contributions: 9,355.49
2 Rollover contributions: 0.00
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-9349bd5e06c1468b3b62694b,v11-5498-ESA-boxed,original,2025,fgen-a8f8458f4fe81c1b31b2a151,synthetic_programmatic_template,boxed,top,False,
"Form 5498-ESA
Coverdell ESA Contribution Information
2023
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Clearwater Investing 8516 Elm Park Pl Fairview, OH 72239
TRUSTEE'S TIN: 75-6636741
BENEFICIARY'S name: Amara Adeyemi
BENEFICIARY'S TIN: XXX-XX-5883
Street address (including apt. no.): 3252 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 56833
1 Coverdell ESA contributions: $2,383.45
2 Rollover contributions",5498,14,5498,fdc-6d033cb76f007e80add3ae1f,v11-5498-ESA-boxed,original,2023,fgen-004fcab196a49c9d95dc4d2f,synthetic_programmatic_template,boxed,top,False,
"For calendar year 2025
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 5933 Cedar Ln Riverton, WI 84162
TRUSTEE'S TIN: 44-2906070
BENEFICIARY'S name: Amara Nguyen
BENEFICIARY'S TIN: ****0739
Street address (including apt. no.): 3539 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 79370
Line 1 Coverdell ESA contributions: $7,161.89
Form 5498-ESA
Coverdell ESA Contribution Information",5498,14,5498,fdc-64dd325961ce76ffe1d9b276,v11-5498-ESA-boxed,original,2025,fgen-997b1404b47c2de3a04797a5,synthetic_programmatic_template,boxed,bottom,False,
"VOID  CORRECTED
Form 5498-ESA
Coverde1l ESA Contribution Information
OMB No. 1545-1815
Copy B For Beneficiary
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: SummitInvestments 9868 Lakeshore Blvd Brookhaven, PA 15394
TRUSTEE'S TIN: 51-8934123
BENEFICIARY'S name: Díego D. Adeyemi
BENEFICIARY'S TIN: XXXXX3164
Street address (induding apt. no.): 8598 Ccdar Ln
City ortown, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 26467
1 Coverdell ESA contributions: 572.91
2 Rollover contributions: O.O0
Department of the Treasury - Internal Revenue 5ervice
Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-27471e5c0bd0fcfdca6a8927,v11-5498-ESA-boxed,original,2024,fgen-1cb74388b45628e46cf261a8,synthetic_programmatic_template,boxed,top,True,
"Form 5498-ESA
Coverdell ESA Contribution Information
2024
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Summit Investments 9423 Willow Bend Way Bayside, WA 75055
TRUSTEE'S TIN: 17-4509594
BENEFICIARY'S name: Lena Romero
BENEFICIARY'S TIN: XXXXX7830
Street address (including apt. no.): 4818 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 44805
Account number (see instructions): XXX-XX-317089
1 Coverdell ESA contributions: $2,662.08
2 Rollover contributions
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-09d2f6882348f4b90f82fa8f,v11-5498-ESA-boxed,original,2024,fgen-d44013a8786eb5c2fe918a47,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form 5498-ESA
Coverdell ESA Contribution Information
2023
OMB No. 1545-1815
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Ironwood Wealth Partners 6038 Maple Ridge Dr Brookhaven, PA 17456
TRUSTEE'S TIN: 59-6822859
BENEFICIARY'S name: Sofia Brennan
BENEFICIARY'S TIN: ***-**-0796
Account number (see instructions): XXXXX659202
Box 1 Coverdell ESA contributions: 3,104.15
Box 2 Rollover contributions",5498,14,5498,fdc-bd6281f79cdd684b6501def6,v11-5498-ESA-boxed,original,2023,fgen-6e508f7929d40ddfbe941f26,synthetic_programmatic_template,boxed,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information 2023 CopyB For Beneficiary This information is being fumished to the IRS. TRUSTEE'S name, street address, city or town, statc or province, country, and ZIP or foreign postal code Northstar Securities l015 Prairie Ave Oak Grove, TX 97792 TRU5TEE'S TIN 15-1419050 BENEFICIARY'Snamc Noah Brennan BENEFICIARY'5 TINXXX-XX-8412 Account
number (see ínstructions) XXXXX497791 1 Coverdell ESA contributions $6,231.26 2 Ro1lover contributions Department of the
Treasury - Internal Revenue Service Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-43a09499a3b704e9cc574d37,v11-5498-ESA-flat,original,2023,fgen-4dadca2c572bb1fbe71921c3,synthetic_programmatic_template,flat,top,True,
"☐ CORRECTED Form 5498-ESA Coverdell ESA Contribution Information 2022 OMB No. 1545-1815 Copy B For Beneficiary This information is being
furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP
or foreign postal code Clearwater Investing 9802 Prairie Ave Pinecrest, GA 28378 TRUSTEE'S TIN 20-7528749 BENEFICIARY'S name Lena S. Fischer BENEFICIARY'S TIN XXXXX5804 Street address (including apt. no.) 6579 Elm Park Pl City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 52436 1 Coverdell ESA contributions $3,516.89 2 Rollover contributions Department of the Treasury - Internal Revenue Service Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-0c43c4854ee2c16b2f879217,v11-5498-ESA-flat,original,2022,fgen-7767eefe5895bb352581d846,synthetic_programmatic_template,flat,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information OMB No.
1545-1815 This information
is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Summit Investments 271 Willow Bend Way Fairview, OH 48831 TRUSTEE'S TIN 20-8096806 BENEFICIARY'S name Riley B. Brennan BENEFICIARY'S TIN ending in 0674 2 Rollover contributions $0.00",5498,14,5498,fdc-391feac00f46b5d58f654184,v11-5498-ESA-flat,original,2022,fgen-40a6094215132f812512784b,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 5498-ESA Coverdell ESA Contribution Information For calendar year 2021 OMB No. 1545-1815 Copy B For Beneficiary This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province,
country, and ZIP or foreign postal code Clearwater Investing 2427 Sample Street Oak Grove, TX 35415 TRUSTEE'S TIN
30-7158208 BENEFICIARY'S name Avery Kowalski BENEFICIARY'S TIN ****4231 Street address (including apt. no.) 3499 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 32578 2 Rollover contributions $0.00",5498,14,5498,fdc-96a2bd299a53e7d22a1e1f5f,v11-5498-ESA-flat,original,2021,fgen-6ca3ad02e01f151d08c14fd2,synthetic_programmatic_template,flat,top,False,
"Form 5498-ESA Coverdell ESA Contribution
Information TRUSTEE: Clearwater Investing Recipient's name: Amara D.
Kowalski 1 Coverdell ESA contributions 7,214.84",5498,14,5498,fdc-3b0fd896848fa6ef50833595,v11-5498-ESA-flat,original,2024,fgen-d7506c90cda2411253416d82,synthetic_programmatic_template,flat,top,False,
"Form 5498-ESA Coverdell ESA Contribution
Information TRUSTEE'S name:
Evergreen Brokerage Services RECIPIENT: Priya Lindqvist 1 Coverdell ESA contributions 902.99",5498,14,5498,fdc-b0eef984da735f00b557d10f,v11-5498-ESA-flat,original,2022,fgen-f8a210fd5911c2740665268e,synthetic_programmatic_template,flat,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information 2024 From: Ironwood
Wealth Partners RECIPIENT: Taylor Adeyemi 1 Coverdell ESA
contributions 9,414.20",5498,14,5498,fdc-01ff7697327949f623b0dbd2,v11-5498-ESA-flat,original,2024,fgen-cd54ffa9dcec197e5fea1653,synthetic_programmatic_template,flat,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information For calendar year 2026 Copy B For Beneficiary This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country,
and ZIP or foreign postal code Evergreen Brokerage Services 4543 Prairie Ave Maplewood, MN 74208 TRUSTEE'S TIN 81-6638221 BENEFICIARY'S name Hiro Kowalski BENEFICIARY'S TIN XXXXX8661 Street address (including apt. no.) 7455 Granite St City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA
18971 Account number (see instructions) ending in 071234 1 Coverdell ESA contributions 7,395.45 2 Rollover contributions Department of the Treasury - Internal Revenue Service Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-772a7d5bdc25fef4509191ad,v11-5498-ESA-flat,original,2026,fgen-00a44d4f8357df208929df6c,synthetic_programmatic_template,flat,top,False,
"Form 5498-ESA
Coverdell ESA Contribution Information From: Summit Investments To: Alex L. Nguyen
1 Coverdell ESA contributions $1,119.37",5498,14,5498,fdc-566505e3b99d5e928197227a,v11-5498-ESA-flat,original,2022,fgen-ed26734c26be4bcd87d60ad0,synthetic_programmatic_template,flat,top,False,
"OMB No. 1545-1815 This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northstar Securities 9076 Sample Street Fairview, OH 78282 TRUSTEE'S TIN 22-3833386 BENEFICIARY'S name Alex M.
Sato BENEFICIARY'S TIN XXX-XX-8423 Street address (including apt. no.) 6815 Maple Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 17824 Account number (see instructions) XXX-XX-466739 1 Coverdell ESA
contributions $215.57 2 Rollover contributions $0.00",5498,14,5498,fdc-39a24a4a0d5e511b7ced0fc6,v11-5498-ESA-flat,original,2023,fgen-b08663705fdba29bcb20b691,synthetic_programmatic_template,flat,none,False,
"Form 5498-ESA Coverdell ESA Contribution Information 2024 OMB
No. l545-1815 Copy B ForBeneficiary Thisinformation is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 7l49 Willow Bend Way Maplewood, MN 64925 TRUSTEE'S TIN 25-1292857 BENEFICIARY'S name Casey Tanaka BENEFICIARY'S TIN ending in 8301 Account number (see instructions) ***-**-754958 1 Coverdell ESA contributions 1,386.05 2 Rollovcr contributions Department of the Treasury- Intemal
Rcvenue Service Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-05864fb1f4d5e73c9428e7e5,v11-5498-ESA-flat,original,2024,fgen-66a82fca83d97168d381e1c1,synthetic_programmatic_template,flat,top,True,
"For calendar year 2022 Copy B For Beneficiary TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Ironwood Wealth Partners 6661 Harbor View Rd Pinecrest, GA 97670 TRUSTEE'S TIN 97-7215548 BENEFICIARY'S name Amara Larsen BENEFICIARY'S TIN ending in 1203 Street address (including apt. no.) 3869 Maple Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 87287 Account number
(see instructions) XXX-XX-538550 2 Rollover contributions Department of
the Treasury - Internal Revenue Service Form 5498-ESA Coverdell ESA Contribution Information Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-861134becc67ecd25afe3b58,v11-5498-ESA-flat,original,2022,fgen-fbfb3e822b6151cd0fe33c62,synthetic_programmatic_template,flat,bottom,False,
"TRUSTEE: Clearwater Investing Recipient's name: Kwame Lindqvist 1 Coverdell
ESA contributions $4,355.40 Form 5498-ESA
Coverdell ESA Contribution Information",5498,14,5498,fdc-ff150b5880995620899ab642,v11-5498-ESA-flat,original,2024,fgen-4939f7db9188e4bf7cac6f00,synthetic_programmatic_template,flat,bottom,False,
"OMB No. 1545-1815 Copy B For Beneficiary This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state
or province, country, and ZIP or foreign postal code Clearwater Investing 8585 Maple Ridge Dr Riverton, WI 92816 TRUSTEE'S TIN 20-7622549 BENEFICIARY'S
name Amara Brennan BENEFICIARY'S TIN ending in 5823 1 Coverdell ESA contributions $7,997.78 Form 5498-ESA Coverdell ESA Contribution Information",5498,14,5498,fdc-31d7a4131b707a2a31d6c1d8,v11-5498-ESA-flat,original,2022,fgen-8aa023c5bb266dae338a9351,synthetic_programmatic_template,flat,bottom,False,
"☐ CORRECTED Form 5498-ESA Coverdell ESA
Contribution Information For calendar year 2022 OMB No. 1545-1815 TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 2775 Cedar Ln Cedar Falls, IA 49180 TRUSTEE'S TIN 48-2610120 BENEFICIARY'S name Jamie Tanaka BENEFICIARY'S TIN XXXXX5083 Street address (including apt. no.) 7026 Prairie Ave City or town, state or province, country, and
ZIP or foreign postal code Riverton, WI 74129 Account number (see instructions) XXXXX152439 1 Coverdell ESA contributions $4,287.02 Department of the Treasury - Internal Revenue Service Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-3a539c10e375ee97ccd33fc8,v11-5498-ESA-flat,original,2022,fgen-a1053262691641694142d3e3,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 5498-ESA Coverdell ESA Contribution Information For calendar year 2023 OMB No. 1545-1815 Copy B For
Beneficiary This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Clearwater Investing 7181 Oak
Hollow Ct Maplewood, MN 32506 TRUSTEE'S TIN 65-2163713 BENEFICIARY'S name Priya Tanaka BENEFICIARY'S TIN ending in 0284 Street address (including apt. no.) 487 Sample Street City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 95182 Account number (see instructions) ending in 100248 1 Coverdell ESA contributions $6,227.24 Department of the Treasury - Internal Revenue Service Form 5498-ESA (keep for your records) www.irs.gov/Form5498ESA",5498,14,5498,fdc-420beefc5ed5377fa5470277,v11-5498-ESA-flat,original,2023,fgen-559000957d0be23ee2254e6c,synthetic_programmatic_template,flat,top,False,
"## Form 5498-ESA Coverdell ESA Contribution Information
| Field | Value |
| --- | --- |
| From: | Clearwater Investing |
| To: | Taylor Moreau |
| 1 Coverdell ESA contributions | $1,538.57 |",5498,14,5498,fdc-03e28a0758850c1e3c45e5d4,v11-5498-ESA-markdown,original,2024,fgen-3d214bdd35f6588ab0a6f796,synthetic_programmatic_template,markdown,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information
| Field | Value |
| --- | --- |
| TRUSTEE: | Ironwood Wealth Partners |
| RECIPIENT: | Hiro Haddad |
| 1 Coverdell ESA contributions | $5,945.44 |",5498,14,5498,fdc-16f47048014a215fdaf64fe9,v11-5498-ESA-markdown,original,2024,fgen-fe0af54c6058d0e722323a0e,synthetic_programmatic_template,markdown,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information
| Field | Value |
| --- | --- |
| TRUSTEE'S name: | Northstar Securities |
| To: | Jamie D. Brennan |
| 1 Coverdell ESA contributions | $6,881.61 |",5498,14,5498,fdc-cf356e35b57563b548a8897c,v11-5498-ESA-markdown,original,2021,fgen-5ac4ac78ce35d31d2188f3dc,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| TRUSTEE'S name: | Evergreen Brokerage Services |
| To: | Sofia Tanaka |
| 1 Coverdell ESA contributions | $269.42 |
## Form 5498-ESA Coverdell ESA Contribution Information 2022",5498,14,5498,fdc-748bcfcb86f480b71bb772c5,v11-5498-ESA-markdown,original,2022,fgen-2e25f3c22a4789d607a044b8,synthetic_programmatic_template,markdown,bottom,False,
"| Field | Value |
| --- | --- |
| TRUSTEE: | Ironwood Wealth Partners |
| RECIPIENT: | Jordan R. Romero |
| 1 Coverdell ESA contributions | $8.94 |
Form 5498-ESA Coverdell ESA Contribution Information 2023",5498,14,5498,fdc-71233b937c6226e7910f8e7a,v11-5498-ESA-markdown,original,2023,fgen-04782a6c2f0956db9e97fb4c,synthetic_programmatic_template,markdown,bottom,False,
"## Form 5498-ESA
Coverdell ESA Contribution Information
## For calendar year 2025
OMB No. 1545-1815
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Evergreen Brokerage Services 9244 Cedar Ln Fairview, OH 20561 |
| TRUSTEE'S TIN | 45-3963863 |
| BENEFICIARY'S name | Lena Lindqvist |
| BENEFICIARY'S TIN | XXX-XX-9476 |
| Street address (including apt. no.) | 1481 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 55422 |
| 1 Coverdell ESA contributions | 2,370.66 |
| 2 Rollover contributions |  |
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-dc992a7fa642ec15df9f2850,v11-5498-ESA-markdown,original,2025,fgen-e67f49f7c644caa0fd04179f,synthetic_programmatic_template,markdown,top,False,
"## Form 5498-ESA
Coverdell ESA Contribution Information
Copy B For Beneficiary
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Summit Investments 846 Maple Ridge Dr Brookhaven, PA 51145 |
| TRUSTEE'S TIN | 52-4728548 |
| BENEFICIARY'S name | Sofia Adeyemi |
| BENEFICIARY'S TIN | ****7565 |
| Account number (see instructions) | XXX-XX-902373 |
| 1 Coverdell ESA contributions | 2,514.53 |
| 2 Rollover contributions | $0.00 |
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-0828cb73de04f81d11ee3e23,v11-5498-ESA-markdown,original,2025,fgen-a6f60016794cd3bb1d5e766c,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-1815
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Summit Investments 3714 Lakeshore Blvd Testville, IL 29873 |
| TRUSTEE'S TIN | 24-6818733 |
| BENEFICIARY'S name | Morgan Kowalski |
| BENEFICIARY'S TIN | ***-**-5283 |
| Street address (including apt. no.) | 4247 Willow Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 84713 |
| Account number (see instructions) | ending in 855714 |
| 2 Rollover contributions |  |
## Form 5498-ESA
Coverdell ESA Contribution Information",5498,14,5498,fdc-aa9c3eb607d0c28cc82a82df,v11-5498-ESA-markdown,original,2023,fgen-30951af01bfbc730e7a4915d,synthetic_programmatic_template,markdown,bottom,False,
"☐ CORRECTED
For calendar year 2026
## Copy B ForBeneficiary
| Field | Value |
| --- | --- |
| TRUSTEE'S name, streetaddress, city or town, state or province, country, and ZIP or foreign postal code | Evergreen Brokerage Servíces 1690 Granite St Pinecrest, GA 35575 |
| TRUSTEE'S TIN | 57-2010050 |
| BENEFICIARY'S name | Sofia Brennan |
| BENEFICIARY'STIN |ending in 5806 |
| Street address (including apt. no.) | 5393 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreígn postal codc | Lakewood, CO 42646 |
| Account number (see ínstructions) | ***-**-76932l |
| 1 Coverdell ESA contributions | 4,416.33 |
| 2 Rollovcr contributions |  |
Department of the Treasury - Intemal Revenue Service",5498,14,5498,fdc-b8285d8e9f98eb3ff3d4b550,v11-5498-ESA-markdown,original,2026,fgen-d6616a1ff20d5cb508ec2f29,synthetic_programmatic_template,markdown,none,True,
"OMB No. 1545-1815
| Fie1d | Value |
| --- | --- |
|TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Evergreen Brokerage Services 1183 Granite St Riverton, WI 36180 |
| TRUSTEE'S TIN | 56-6114748 |
| BENEFICIARY'S name | Fatima Pate1 |
| BENEFICIARY'STIN | ending in 2686 |
| Strcet address (induding apt. no.) | 4235 Map1e RidgeDr |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 33021 |
| 2 Rollover contributions |  |
Department of the Treasury - Intemal Revenue Service",5498,14,5498,fdc-ff4e62273f9c78eea5d36dbd,v11-5498-ESA-markdown,original,2022,fgen-df7f94c8a4667884ce0378ee,synthetic_programmatic_template,markdown,none,True,
"Form 5498-ESA
Coverdell ESA Contribution Information
For calendar year 2023
OMB No. 1545-1815
Copy B For Beneficiary
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Ironwood Wealth Partners 2509 Oak Hollow Ct Bayside, WA 44326 |
| TRUSTEE'S TIN | 43-1955708 |
| BENEFICIARY'S name | Hiro Adeyemi |
| BENEFICIARY'S TIN | XXX-XX-6601 |
| Street address (including apt. no.) | 7171 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 91110 |
| Account number (see instructions) | XXX-XX-348202 |
| 1 Coverdell ESA contributions | 4,411.90 |
| 2 Rollover contributions |  |
Department of the Treasury - Internal Revenue Service
## Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-b2d0534d0cbb5725b926f9c3,v11-5498-ESA-markdown,original,2023,fgen-9f0ee5d38884ec140d484c66,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
## Form 5498-ESA
Coverdell ESA Contribution Information
For calendar year 2021
Copy B For Beneficiary
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Northstar Securities 443 Lakeshore Blvd Lakewood, CO 64354 |
| TRUSTEE'S TIN | 94-5048111 |
| BENEFICIARY'S name | Amara Brennan |
| BENEFICIARY'S TIN | XXXXX9427 |
| Street address (including apt. no.) | 6946 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 22150 |
| Account number (see instructions) | XXXXX812789 |
| 1 Coverdell ESA contributions | $3,195.53 |
| 2 Rollover contributions |  |
## Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-1a9740167a2335d07252530e,v11-5498-ESA-markdown,original,2021,fgen-f3e1133db32196bcea2244c5,synthetic_programmatic_template,markdown,top,False,
"Form 5498-ESA Coverdell ESA Contribution Information
| Field | Value |
| --- | --- |
| TRUSTEE'S name: | Clearwater Investing |
| Recipient's name: | Fatima K. Sato |
| 1 Coverdell ESA contributions | $2,662.13 |",5498,14,5498,fdc-60c9b430de767be89bf9b9eb,v11-5498-ESA-markdown,original,2024,fgen-a5cfeeb5148ec3f80bdb13b5,synthetic_programmatic_template,markdown,top,False,
"Form 5498-ESA
Coverdell ESA Contribution Information
For calendar year 2022
OMB No. 1545-1815
Copy B For Beneficiary
## This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Summit Investments 3555 Willow Bend Way Bayside, WA 58620 |
| TRUSTEE'S TIN | 42-6588581 |
| BENEFICIARY'S name | Hiro E. Romero |
| BENEFICIARY'S TIN | ***-**-0245 |
| Street address (including apt. no.) | 2632 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 18642 |
| Account number (see instructions) | ***-**-111214 |
| 1 Coverdell ESA contributions | 8,575.34 |
| 2 Rollover contributions | $0.00 |
Department of the Treasury - Internal Revenue Service
Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-fae7ceac0fd3bd5fb7061c72,v11-5498-ESA-markdown,original,2022,fgen-516263f723457414283b9a08,synthetic_programmatic_template,markdown,top,False,
"## Form 5498-ESA
## Coverdell ESA Contribution Information
2026
Copy B For Beneficiary
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Ironwood Wealth Partners 6417 Cedar Ln Testville, IL 74611 |
| TRUSTEE'S TIN | 49-9422468 |
| BENEFICIARY'S name | Jamie Lindqvist |
| BENEFICIARY'S TIN | ****2704 |
| Street address (including apt. no.) | 6557 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 10997 |
| Account number (see instructions) | ***-**-241151 |
| 1 Coverdell ESA contributions | 6,585.05 |
| 2 Rollover contributions |  |
## Department of the Treasury - Internal Revenue Service
## Form 5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-6388662d81f8e9864efb6361,v11-5498-ESA-markdown,original,2026,fgen-8591a98422d4b3dec507885c,synthetic_programmatic_template,markdown,top,False,
"## Form 5498-ESA
Coverdell ESA Contribution Information
## 2023
Copy B For Beneficiary
| Field | Value |
| --- | --- |
| TRU5TEE'S name, street address, cityor town, state or province, country, and ZIP or foreign postal codc | Clearwater Investing 4318 Prairie Ave 0ak Grove, TX 73988 |
| TRUSTEE'S TIN | 44-4613197 |
| BENEFICIARY'S name | Wei D. Patel |
| BENEFICIARY'S TIN | XXX-XX-4242 |
| Street address (índuding apt. no.) | 8540Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 98564 |
| l Coverdell ESA contributions | S2,734.74 |
| 2 Rollover contributions | 0.00|
Department of the Treasury - Internal Revenue Service
Form5498-ESA (keep for your records)  www.irs.gov/Form5498ESA",5498,14,5498,fdc-6a3b20bc77ba13a861172c8f,v11-5498-ESA-markdown,original,2023,fgen-4a6bc4657193e8d813caa97c,synthetic_programmatic_template,markdown,top,True,
"2022
OMB No. 1545-1518
Copy B For Participant
This information is being fumished to the IR5.
TRUSTEE'S name, street address,city or town, state or province, country, andZIP or foreign posta1 code
5ample HSA Bank 9055 Harbor View Rd Oak Grove, TX 28378
TRUSTEE'S TIN
64-4022025
PARTICIPANT'S name
Kwame Moreau
PARTICIPANT'S TIN
XXXXX6235
Street address (induding apt. no.)
1382 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 15763
1 Emp1oyce orself-employed person's Archer MSA contributions
$0.00
2 Total contributions made in the tax year
$317.80
3 Total HSA or Archer MSA contributions made in the following year for the tax year
0.00
6 HSA / Archer M5A / MA MSA
HSA ☒
Department of the Treasury -Intemal Revenue Servíce",5498,14,5498,fdc-56c09ccb55c39494343461ab,v11-5498-SA-stacked,original,2022,fgen-497513451d40e2ccd346ff2f,synthetic_programmatic_template,stacked,none,True,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2024
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Sample HSA Bank 8489 Granite St Testville, IL 33243
TRUSTEE'S TIN
56-9072631
PARTICIPANT'S name
Riley Moreau
PARTICIPANT'S TIN
****9419
Account number (see instructions)
***-**-322863
1 Employee or self-employed person's Archer MSA contributions
2 Total contributions made in the tax year
3,197.06
3 Total HSA or Archer MSA contributions made in the following year for the tax year
4 Rollover contributions
5 Fair market value of HSA, Archer MSA, or MA MSA
70,853.77
6 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-7c28c129d15b35a2de08b45f,v11-5498-SA-stacked,original,2024,fgen-25ece244a3afa52c5d109811,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2026
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Health Savings 2000 Elm Park Pl Bayside, WA 22214
TRUSTEE'S TIN
27-7621407
PARTICIPANT'S name
Jordan Testcase
PARTICIPANT'S TIN
***-**-9968
Street address (including apt. no.)
7519 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 88269
Account number (see instructions)
XXXXX069194
1 Employee or self-employed person's Archer MSA contributions
$0.00
3 Total HSA or Archer MSA contributions made in the following year for the tax year
4 Rollover contributions
0.00
5 Fair market value of HSA, Archer MSA, or MA MSA
7,475.79
6 HSA / Archer MSA / MA MSA
HSA ☒
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information",5498,14,5498,fdc-8e4d43e20021d0bf3f132c3f,v11-5498-SA-stacked,original,2026,fgen-212457bbc30e92b7aee860ff,synthetic_programmatic_template,stacked,bottom,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information
From:
Evergreen Health Savings
Recipient's name:
Avery Walsh
6 HSA / Archer MSA / MA MSA
HSA ☒",5498,14,5498,fdc-6f02cc32e4c90dd2fdd5ce58,v11-5498-SA-stacked,original,2025,fgen-ecd99144a8fb51746dc27f25,synthetic_programmatic_template,stacked,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
2024
OMB No. 1545-1518
Copy B For Participant
TRU5TEE'S name, street address, city or town, state orprovince, country, and ZIP or foreign postal code
Sample H5A Bank 35O4 0ak Hollow Ct Maplewood, MN 87908
TRUSTEE'S TIN
35-76O8353
PARTICIPANT'S name
Avery Nguyen
PARTICIPANT'S TIN
****3932
l Employeeor self-employed person's Archer MSA contributions
3 Total HSA or Archer MSA contributions made in the following year forthe tax year
S0.00
4 Ro1lover contributions
5 Fair market value of HSA, Archer MSA, or MA MSA
$2,842.11
6 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-99f5c3c843509a01453e8c30,v11-5498-SA-stacked,original,2024,fgen-c2259bd4ba7c60fc5c1594b9,synthetic_programmatic_template,stacked,top,True,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information
TRUSTEE:
Sample HSA Bank
To:
Taylor Tanaka
5 Fair market value of HSA, Archer MSA, or MA MSA
$32,921.36",5498,14,5498,fdc-783473cb1ecfcc86710542e2,v11-5498-SA-stacked,original,2025,fgen-b8da33c79d9a6c8de729ff18,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
2026
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northwind HSA Custodian 9367 Prairie Ave Brookhaven, PA 17174
TRUSTEE'S TIN
22-3243243
PARTICIPANT'S name
Mateo Sato
PARTICIPANT'S TIN
***-**-9719
Account number (see instructions)
XXXXX324886
1 Employee or self-employed person's Archer MSA contributions
3 Total HSA or Archer MSA contributions made in the following year for the tax year
4 Rollover contributions
$0.00
5 Fair market value of HSA, Archer MSA, or MA MSA
84,539.09
6 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-01c4f4c31802761ee6ca43c3,v11-5498-SA-stacked,original,2026,fgen-3b12b2d6b25e457974445d92,synthetic_programmatic_template,stacked,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
OMB No. l545-1518
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northwind HSA Custodian 256O Sample Street Brookhaven, PA 85847
TRUSTEE'S TIN
80-3539911
PARTICIPANT'S name
Fatima Nguyen
PARTICIPANT'S TIN
***-**-5942
Street address (including apt. no.)
254 Maplc Ridge Dr
Cíty or town, state or province, country,and ZIP or foreign postal code
Brookhaven, PA 96655
2 Total contributions made in the tax year
6,448.85
3 TotalHSA or Archer MSAcontributions made in the following year for the tax year
4 Rollover contributions
6 HSA / ArcherMSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Servíce
Form 5498-SA (keep for your records)  www.írs.gov/Form5498SA",5498,14,5498,fdc-5a6b0e99572bfcde3be482a8,v11-5498-SA-stacked,original,2023,fgen-7447e1e3e506f8d7920d855a,synthetic_programmatic_template,stacked,top,True,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2026
TRUSTEE:
Evergreen Health Savings
To:
Wei M. Kowalski
2 Total contributions made in the tax year
6,789.45
5 Fair market value of HSA, Archer MSA, or MA MSA
$82,368.56",5498,14,5498,fdc-2be6a0bab7c27dc7cdf201c0,v11-5498-SA-stacked,original,2026,fgen-5fbd6bea48f8caa4357c8f1b,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2023
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Health Savings 1496 Cedar Ln Brookhaven, PA 74874
TRUSTEE'S TIN
56-5135279
PARTICIPANT'S name
Noah Castillo
PARTICIPANT'S TIN
ending in 0851
Street address (including apt. no.)
6922 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 46856
1 Employee or self-employed person's Archer MSA contributions
2 Total contributions made in the tax year
5,495.82
3 Total HSA or Archer MSA contributions made in the following year for the tax year
4 Rollover contributions
5 Fair market value of HSA, Archer MSA, or MA MSA
59,573.50
6 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-2ff68c3376b06be5bf52ebe4,v11-5498-SA-stacked,original,2023,fgen-143d5cf0135611b86703f3bf,synthetic_programmatic_template,stacked,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2025
TRUSTEE:
Sample HSA Bank
To:
Kwame Testcase
6 HSA / Archer MSA / MA MSA
HSA ☒
5 Fair market value of HSA, Archer MSA, or MA MSA
$107,294.40
2 Total contributions made in the tax year
$686.75",5498,14,5498,fdc-e833b5c9ca8f09e44a115aa0,v11-5498-SA-stacked,original,2025,fgen-1c2ee62ecd9b0cb55df90479,synthetic_programmatic_template,stacked,top,False,
"TRUSTEE'S name:
Sample HSA Bank
RECIPIENT:
Amara A. Romero
2 Total contributions made in the tax year
$8,343.92
5 Fair market value of HSA, Archer MSA, or MA MSA
$108,575.38
6 HSA / Archer MSA / MA MSA
HSA ☒",5498,14,5498,fdc-ad61c45c0df56e853f4f093b,v11-5498-SA-stacked,original,2026,fgen-86d7e606d3c928377e734884,synthetic_programmatic_template,stacked,none,False,
"Form 5498-SA
H5A, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2022
OMB No. 1545-1518
This information is being fumished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Sample HSA Bank 57l6 Prairie Ave Lakewood, CO 5O273
TRUSTEE'S TIN
9l-2390119
PARTICIPANT'S name
Jamie Adeyemi
PARTICIPANT'S TIN
ending in 9536
Streetaddress (induding apt. no.)
4257 Elm Park Pl
City or town, state or province, country, and ZIP orforeign postal code
Brookhaven, PA 83796
Account number (see instructions)
ending in 77616O
1 Emp1oyee or sclf-employed person's Archer M5A contributions
2 Tota1 contributions made in the tax year
5,562.79
3 Total HSA or Archcr MSA contributions made in the followingyear forthe tax year
4 Rollover contributions
$0.00
6 HSA / Archer MSA / MAMSA
H5A ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-377fcb3172409d1c0dd567ac,v11-5498-SA-stacked,original,2022,fgen-fc5129c18de3545e99525828,synthetic_programmatic_template,stacked,top,True,
"☐ CORRECTED
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2025
OMB No. 1545-1518
Copy B For Participant
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Northwind HSA Custodian 7376 Harbor View Rd Bayside, WA 58640
TRUSTEE'S TIN
37-3149999
PARTICIPANT'S name
Amara Adeyemi
PARTICIPANT'S TIN
ending in 8119
Account number (see instructions)
****851449
1 Employee or self-employed person's Archer MSA contributions
0.00
2 Total contributions made in the tax year
$3,035.89
3 Total HSA or Archer MSA contributions made in the following year for the tax year
$0.00
4 Rollover contributions
5 Fair market value of HSA, Archer MSA, or MA MSA
63,887.59
6 HSA / Archer MSA / MA MSA
HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-7431648923bc35e6cfca9dc8,v11-5498-SA-stacked,original,2025,fgen-7ba6988927377ed221ed1f61,synthetic_programmatic_template,stacked,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2025
OMB No. 1545-1518
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Health Savings 8242 Sample Street Lakewood, CO 80660
TRUSTEE'S TIN
53-6815997
PARTICIPANT'S name
Sofia K. Fischer
PARTICIPANT'S TIN
XXXXX4199
Street address (including apt. no.)
4856 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 95908
2 Total contributions made in the tax year
6,193.68
3 Total HSA or Archer MSA contributions made in the following year for the tax year
4 Rollover contributions
5 Fair market value of HSA, Archer MSA, or MA MSA
$82,630.56",5498,14,5498,fdc-316dca1cfe2e0fe20072bdd3,v11-5498-SA-stacked,original,2025,fgen-3a95ac53e589586d9a7badd0,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage M5A Information
2025
OMB No. 1545-1518
Copy BFor Participant
This information is beingfumished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Evergreen Health Savings 39O3 Harbor ViewRd Pinecrest, GA 38167
TRUSTEE'S TIN
15-1752389
PARTICIPANT'S name
Ri1ey Brennan
PARTICIPANT'S TIN
***-**-5721
Street address (induding apt. no.)
884 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 4O762
1 Employee or self-employed person's Archer MSA contributions
0.00
2 Total contributions made in the tax year
7,937.45
3 Total HSA or Archer MSA contributions madein the following year for the tax year
4 Rollover contributions
5 Fair market value of HSA, Archer MSA, or MA MSA
65,034.16
6 HSA / Archer MSA / MAMSA
HSA ☒
Department of the Treasury - Intemal Revenue Service
Form 5498-5A (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-a59aed3e0f47c8adfb5113ed,v11-5498-SA-stacked,original,2025,fgen-a5dc6bdfd3264aded949a312,synthetic_programmatic_template,stacked,top,True,
"☐ CORRECTED
OMB No. 1545-1518
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Health Savings 9l81 Harbor View Rd Testville, IL 4O065
TRUSTEE'S TIN: 52-4574l33
PARTICIPANT'S name: Mateo Okafor
PARTICIPANT'STIN: XXX-XX-7461
Street address (inc1uding apt. no.): 1782 Graníte St
City or town, state or province, country, and ZIP or foreígn postalcode: Bayside, WA 79557
Account number(see instructíons): XXXXX584536
Linc l Employee or self-employed person's Archer M5A contributions: O.00
Line 2 Total contributions made in the tax year: 5,925.46
Line 3 Total HSA or Archer MSA contributions made in the following year for the tax year: S0.00
Line 4 Rollover contributions
Line5 Fair market value ofHSA, Archer MSA, or MA MSA: 46,490.48
Department of the Treasury - Internal Revenue Servicc
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-2731398d5ffc2c82ea58cd11,v11-5498-SA-boxed,original,2025,fgen-f64617f060f7fde9a331e919,synthetic_programmatic_template,boxed,bottom,True,
"TRUSTEE:: Northwind HSA Custodian
Recipient's name:: Avery Okafor
Box 2 Total contributions made in the tax year: $5,699.67
Box 6 HSA / Archer MSA / MA MSA: HSA ☒",5498,14,5498,fdc-6f7daedd0045d1a1cd009256,v11-5498-SA-boxed,original,2025,fgen-adaaadeaa6b1f6ef1d1391e4,synthetic_programmatic_template,boxed,none,False,
"For calendar year 2023
OMB No. 1545-1518
This information is being fumished to the IRS.
TRUSTEE'S name,street address, city or town, state or province, country, and ZIP or foreign postal code: Sample HSA Bank 9004 Lakeshore Blvd Maplewood, MN 78845
TRU5TEE'S TIN: 89-8017556
PARTICIPANT'S namc: Morgan Sato
PARTICIPANT'S TIN: ****4876
Street address (including apt. no.): 8248 Harbor Vicw Rd
City or town, state or province, country, and ZIP or foreign posta1 code: Oak Grove, TX 12724
Box 1 Employeeor self-employed person's Archer M5A contributions: 0.00
Box 2Total contributions made in the tax year: $7,981.44
Box 3 Total HSA or Archer MSA contributions made in the followíng year for the tax year: O.00
Box 4 Rollover contributions
Box 6 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Intemal Revenue Service
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
Form 5498-SA (keep foryour records) www.irs.gov/Form5498SA",5498,14,5498,fdc-feeaf9857da4946cd908f5e6,v11-5498-SA-boxed,original,2023,fgen-41b2f734cd08908b30be5d77,synthetic_programmatic_template,boxed,bottom,True,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2025
TRUSTEE'S name:: Evergreen Health Savings
RECIPIENT:: Olivia Lindqvist
Box 5 Fair market value of HSA, Archer MSA, or MA MSA: $5,905.77
Box 2 Total contributions made in the tax year: 7,853.06
Box 6 HSA / Archer MSA / MA MSA: HSA ☒",5498,14,5498,fdc-547f5cb2b4437d1dddeadd42,v11-5498-SA-boxed,original,2025,fgen-bc0fed5ec72dcbed0fb6fb86,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
2021
OMB No. 1545-1518
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 4294 Lakeshore Blvd Riverton, WI 94686
TRUSTEE'S TIN: 75-5740767
PARTICIPANT'S name: Jordan K. Tanaka
PARTICIPANT'S TIN: XXX-XX-7729
Street address (including apt. no.): 7351 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Fairview, OH 26336
Box 1 Employee or self-employed person's Archer MSA contributions
Box 2 Total contributions made in the tax year: $7,052.11
Box 3 Total HSA or Archer MSA contributions made in the following year for the tax year
Box 4 Rollover contributions
Box 5 Fair market value of HSA, Archer MSA, or MA MSA: $65,698.23
Box 6 HSA / Archer MSA / MA MSA: HSA ☒",5498,14,5498,fdc-1c4af84857af80d72944e95a,v11-5498-SA-boxed,original,2021,fgen-833e7809a09d1701e1204b8c,synthetic_programmatic_template,boxed,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2026
TRUSTEE'S name:: Northwind HSA Custodian
Recipient's name:: Wei S. Lindqvist
Line 5 Fair market value of HSA, Archer MSA, or MA MSA: 133,618.33",5498,14,5498,fdc-50c549b7afd87a10167cb68c,v11-5498-SA-boxed,original,2026,fgen-561df05796a6486229e2054a,synthetic_programmatic_template,boxed,top,False,
"TRUSTEE'S name:: Sample HSA Bank
Recipient's name:: Mateo Nguyen
Line 6 HSA / Archer MSA / MA MSA: HSA ☒
Line 2 Total contributions made in the tax year: 5,238.00
Line 5 Fair market value of HSA, Archer MSA, or MA MSA: $120,502.43
Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2024",5498,14,5498,fdc-c2600f98598e1b675dcf2735,v11-5498-SA-boxed,original,2024,fgen-34bc258e6fc2c1a2ba80d93a,synthetic_programmatic_template,boxed,bottom,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 6927 Cedar Ln Bayside, WA 15861
TRUSTEE'S TIN: 38-8632137
PARTICIPANT'S name: Lena R. Nguyen
PARTICIPANT'S TIN: XXX-XX-9599
Street address (including apt. no.): 2045 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 40069
2 Total contributions made in the tax year: $4,771.99
3 Total HSA or Archer MSA contributions made in the following year for the tax year: 0.00
6 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-02d3767b3abadba5759cac22,v11-5498-SA-boxed,original,2025,fgen-5de2573c9aa78d1d7f0cc7a2,synthetic_programmatic_template,boxed,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
2024
OMB No. 1545-1518
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 810 Sample Street Pinecrest, GA 93871
TRUSTEE'S TIN: 16-6294173
PARTICIPANT'S name: Taylor K. Sato
PARTICIPANT'S TIN: XXXXX9521
Street address (including apt. no.): 5479 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 37146
Account number (see instructions): XXX-XX-977497
3 Total HSA or Archer MSA contributions made in the following year for the tax year: 0.00
4 Rollover contributions: $0.00
5 Fair market value of HSA, Archer MSA, or MA MSA: $115,803.53
6 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-2ea832ad8683321e1f4dccdf,v11-5498-SA-boxed,original,2024,fgen-5fbba5754b700719d16a476e,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2025
OMB No. 1545-1518
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Sample HSA Bank 5581 Maple Ridge Dr Fairview, OH 59630
TRUSTEE'S TIN: 32-4389271
PARTICIPANT'S name: Diego J. Patel
PARTICIPANT'S TIN: ***-**-5852
Street address (including apt. no.): 5222 Granite St
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 32534
Line 1 Employee or self-employed person's Archer MSA contributions: 0.00
Line 2 Total contributions made in the tax year: 5,011.96
Line 3 Total HSA or Archer MSA contributions made in the following year for the tax year
Line 4 Rollover contributions: 0.00
Line 5 Fair market value of HSA, Archer MSA, or MA MSA: $82,215.85
Line 6 HSA / Archer MSA / MA MSA: HSA ☒",5498,14,5498,fdc-53acefa4c1c12b4d05d486dc,v11-5498-SA-boxed,original,2025,fgen-7096236282ee4f800145deac,synthetic_programmatic_template,boxed,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information
TRUSTEE'S name:: Evergreen Health Savings
To:: Wei Castillo
Box 5 Fair market value of HSA, Archer MSA, or MA MSA: $88,532.50
Box 6 HSA / Archer MSA / MA MSA: HSA ☒
Box 2 Total contributions made in the tax year: 6,384.81",5498,14,5498,fdc-adadb681c30cf87831b5326d,v11-5498-SA-boxed,original,2023,fgen-6cbdee1fcf749c3943f52c3d,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
OMB No. 1545-1518
Copy B For Participant
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 1593 Cedar Ln Bayside, WA 31647
TRUSTEE'S TIN: 91-4694221
PARTICIPANT'S name: Olivia Nguyen
PARTICIPANT'S TIN: ***-**-4951
Street address (including apt. no.): 2514 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 96652
1 Employee or self-employed person's Archer MSA contributions: $0.00
2 Total contributions made in the tax year: 6,686.18
3 Total HSA or Archer MSA contributions made in the following year for the tax year
5 Fair market value of HSA, Archer MSA, or MA MSA: 83,193.50
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-556e1d106cd15a6fdd09291b,v11-5498-SA-boxed,original,2023,fgen-a9f603ff86634a2b66e00d60,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
For calendar year 2026
OMB No. 1545-1518
CopyB For Partícipant
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 7859 Willow Bcnd Way Bayside, WA 76951
TRUSTEE'S TIN: 35-5473958
PARTICIPANT'S name: Casey B. Tanaka
PARTICIPANT'S TIN: XXXXX8896
Street address (including apt. no.): 4862 Harbor ViewRd
City or town, state or province, country, and ZIP or foreignpostal code:Riverton, WI 94506
1 Employee or self-employed person's Archer M5A contributions
2 Total contributions made in the tax year: $3,267.46
4 Rollover contributions
5 Fair market value of H5A, Archer MSA, or MA MSA: 121,O9O.20
6 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Intemal Revenue Servíce",5498,14,5498,fdc-bb4324e1ce5dd927b31606f3,v11-5498-SA-boxed,original,2026,fgen-ce1e2854bcab93fc5050f5b0,synthetic_programmatic_template,boxed,none,True,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
2026
OMB No. 1545-1518
Copy B For Participant
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Northwind HSA Custodian 8382 Sample Street Pinecrest, GA 55092
TRUSTEE'S TIN: 71-5291569
PARTICIPANT'S name: Priya M. Castillo
PARTICIPANT'S TIN: ****4917
Street address (including apt. no.): 1265 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Maplewood, MN 62916
Box 1 Employee or self-employed person's Archer MSA contributions
Box 2 Total contributions made in the tax year: $1,543.65
Box 4 Rollover contributions
Box 5 Fair market value of HSA, Archer MSA, or MA MSA: 29,187.00
Box 6 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-cc524038e4b91d04f4b0ed5e,v11-5498-SA-boxed,original,2026,fgen-8cc830b7db60b1e46eb64580,synthetic_programmatic_template,boxed,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
2026
This information is being furnished to the IRS.
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Evergreen Health Savings 4105 Cedar Ln Testville, IL 45123
TRUSTEE'S TIN: 80-3095938
PARTICIPANT'S name: Noah Romero
PARTICIPANT'S TIN: ***-**-2581
Account number (see instructions): ending in 145198
1 Employee or self-employed person's Archer MSA contributions
2 Total contributions made in the tax year: $4,021.43
3 Total HSA or Archer MSA contributions made in the following year for the tax year: $0.00
4 Rollover contributions: 0.00
6 HSA / Archer MSA / MA MSA: HSA ☒
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-1dbb6e5df41766788c4f3979,v11-5498-SA-boxed,original,2026,fgen-748db24471668bb1023a95c9,synthetic_programmatic_template,boxed,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
2021
OMB No. 1545-1518
TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code: Sample HSA Bank 6656 Lakeshore Blvd Cedar Falls, IA 71874
TRUSTEE'S TIN: 69-1125575
PARTICIPANT'S name: Jamie Rivera
PARTICIPANT'S TIN: XXXXX7282
Street address (including apt. no.): 9225 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 90555
Account number (see instructions): XXX-XX-624877
Box 2 Total contributions made in the tax year: 298.98
Box 4 Rollover contributions
Box 5 Fair market value of HSA, Archer MSA, or MA MSA: $23,502.51
Box 6 HSA / Archer MSA / MA MSA: HSA ☒",5498,14,5498,fdc-ad285daff56c7f31c4dffebd,v11-5498-SA-boxed,original,2021,fgen-851518eb17c904750c653d82,synthetic_programmatic_template,boxed,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information OMB No. 1545-1518 Copy B For Participant This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northwind HSA Custodian 9851 Granite St Brookhaven, PA 90885 TRUSTEE'S TIN 58-5784681 PARTICIPANT'S name Jamie Patel PARTICIPANT'S TIN ****9761 Street address (including apt. no.) 3804 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 93634 1 Employee or self-employed person's Archer MSA contributions $0.00 2 Total contributions made in the tax year $713.54 3 Total HSA or Archer MSA contributions made in the following year for the tax year 4 Rollover contributions 5 Fair market value of HSA, Archer
MSA, or MA MSA $80,924.91 6 HSA / Archer MSA / MA MSA HSA ☒ Department of the Treasury - Internal Revenue Service Form 5498-SA (keep for your records) www.irs.gov/Form5498SA",5498,14,5498,fdc-f19b1915ceb47d8dc44a3870,v11-5498-SA-flat,original,2026,fgen-8de67a47a867c65b4143c973,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form 5498-SAHSA, Archer MSA, or Medicare Advantage MSA Information 2022 OMB No. l545-1518 Copy B For Participant TRU5TEE'S name, streetaddress, city or town, state or
provincc, country, and ZIP or foreign postal code Northwind HSA Custodian 469 Willow Bend Way Pinecrest, GA 65456 TRU5TEE'S TIN90-6072307 PARTICIPANT'S name Amara Pate1 PARTICIPANT'S TIN ****1232 Street address (induding apt. no.) 2395 Oak Hollow Ct City or town,state or province, country, and ZIP or foreign postal code 0ak Grove, TX 53348 Account number (see instructions) XXXXX377250 1 Employee or self-employed person's Archer M5A contributions 2 Totalcontributions made in the tax year 1,380.78 3 Total HSA or Archer MSA contríbutions made in
the fo1lowing year for the tax year 4 Rollover contributions Department of the Treasury - Intemal Revenue Service Form 5498-SA (keep for your records) www.irs.gov/Form54985A",5498,14,5498,fdc-cadde7cd69c36ca724480db3,v11-5498-SA-flat,original,2022,fgen-8c2117303fd6786d60b4afe0,synthetic_programmatic_template,flat,top,True,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information For calendar year 2026 Copy B For Participant TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Sample HSA Bank 8185 Cedar Ln Lakewood, CO 21004 TRUSTEE'S TIN 20-4440707 PARTICIPANT'S name Amara Adeyemi PARTICIPANT'S TIN ***-**-5151 2 Total contributions made in the tax year $8,762.49 3 Total HSA or Archer MSA
contributions made in the following year for the tax year 4 Rollover contributions $0.00 5 Fair market value of HSA, Archer MSA, or
MA MSA $126,454.10 Department of the Treasury - Internal Revenue Service Form 5498-SA (keep for your records) www.irs.gov/Form5498SA",5498,14,5498,fdc-92022d2673df3adca9b1b1c3,v11-5498-SA-flat,original,2026,fgen-081dccbb5a78951aa6868bdb,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Form 5498-SA HSA, Archer
MSA, or Medicare Advantage MSA Information Copy B For Participant TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Health Savings 6268 Granite St Brookhaven, PA 71463 TRUSTEE'S TIN 15-4509979 PARTICIPANT'S name Taylor Rivera PARTICIPANT'S TIN XXXXX6058 1 Employee or self-employed person's
Archer MSA contributions $0.00 2 Total contributions made in the tax year 5,605.82 3 Total HSA or Archer MSA contributions made in the following year for the tax year 4 Rollover contributions 5 Fair market value of HSA, Archer MSA, or MA MSA 95,410.26 Department of the Treasury - Internal Revenue Service Form 5498-SA (keep for your records) www.irs.gov/Form5498SA",5498,14,5498,fdc-b53dfb30e7f58709eb68eb8f,v11-5498-SA-flat,original,2025,fgen-5537ea03278ef85d82a5bc00,synthetic_programmatic_template,flat,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information For calendar year 2026 Copy B For Participant TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Health Savings 301 Maple Ridge Dr Riverton, WI 37002 TRUSTEE'S TIN 96-4286864 PARTICIPANT'S name Diego C. Castillo PARTICIPANT'S TIN XXXXX3530 Street address (including apt. no.) 5946 Willow Bend Way City or town, state
or province, country, and ZIP or foreign postal code Maplewood, MN
57708 Account number (see instructions) ****898878 1 Employee or self-employed person's Archer MSA contributions $0.00 3 Total HSA or Archer MSA contributions made in the following year for the tax year $0.00 4 Rollover contributions $0.00 5 Fair market value of HSA, Archer MSA, or MA MSA 65,285.42 6 HSA / Archer MSA / MA MSA HSA ☒ Department of the Treasury - Internal Revenue Service Form 5498-SA (keep for your records) www.irs.gov/Form5498SA",5498,14,5498,fdc-637bab5cebdb1e1b2af12649,v11-5498-SA-flat,original,2026,fgen-83f204bea67ecd2b8f184364,synthetic_programmatic_template,flat,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2023
TRUSTEE: Sample
HSA Bank To: Jordan Sato 5 Fair market value of HSA, Archer MSA, or MA MSA $66,011.26 6 HSA / Archer MSA / MA MSA HSA ☒",5498,14,5498,fdc-024d6d4f8f22d5165d870055,v11-5498-SA-flat,original,2023,fgen-bd902368163ce5e8aaa51b5c,synthetic_programmatic_template,flat,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2024 OMB No. 1545-1518 Copy B For Participant TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Northwind HSA
Custodian 5252 Cedar Ln Fairview, OH 45889 TRUSTEE'S TIN 77-7337553 PARTICIPANT'S name Jordan A. Adeyemi PARTICIPANT'S TIN ***-**-4249 2 Total contributions made in the tax year 7,796.87
3 Total HSA or Archer MSA contributions made in the following year for the tax year 0.00 5 Fair market value of HSA, Archer MSA, or MA MSA $75,527.05 6 HSA / Archer MSA / MA MSA HSA ☒",5498,14,5498,fdc-e3171c592078f2368a63e972,v11-5498-SA-flat,original,2024,fgen-63ed7c7f094c51ff2c82c1a7,synthetic_programmatic_template,flat,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information From: Northwind HSA Custodian
Recipient's name: Diego Haddad 5 Fair market value of HSA, Archer MSA, or MA MSA 21,521.73 2 Total
contributions made in the tax year $7.49 6 HSA / Archer MSA / MA MSA HSA ☒",5498,14,5498,fdc-c49109b78d56e4290e0041b6,v11-5498-SA-flat,original,2022,fgen-44dd870b5052ec42101fd5b0,synthetic_programmatic_template,flat,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information2026 From: Evergreen Health Savings Recipient's name: Hiro Romero 2 Total contributions made in the tax year $1,863.57 6 H5A / Archer MSA / MA MSA
HSA ☒ 5 Fair market value of HSA,
Archer MSA, or MA MSA $3,820.65",5498,14,5498,fdc-2614bf5e4ba23c824dc3d77f,v11-5498-SA-flat,original,2026,fgen-9407e8941db8f76595101d69,synthetic_programmatic_template,flat,top,True,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information Copy B For Participant TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Evergreen Health Savings 6210 Willow Bend Way Pinecrest, GA 70324 TRUSTEE'S TIN 97-4491188 PARTICIPANT'S name Avery L. Testcase PARTICIPANT'S TIN ****8769 Street address (including apt. no.) 4170 Granite St City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 88770
Account number (see instructions) ****901875 2 Total contributions made in the tax year $8,298.14 3 Total HSA or Archer MSA contributions made in the following year
for the tax year 4 Rollover contributions 5 Fair market value of HSA, Archer MSA, or MA MSA 138,311.70 6 HSA / Archer MSA / MA MSA HSA ☒ Department of the Treasury - Internal Revenue Service Form 5498-SA (keep for your records) www.irs.gov/Form5498SA",5498,14,5498,fdc-2998793446addbd7cc9099d9,v11-5498-SA-flat,original,2021,fgen-4fe3e52d914ab20d6f712574,synthetic_programmatic_template,flat,top,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2024 Copy B For Participant TRUSTEE'S name, street address, city or town, state or province,
country, and ZIP or foreign postal code Sample HSA Bank 9562 Lakeshore Blvd Pinecrest, GA 84370 TRUSTEE'S TIN 67-9582492 PARTICIPANT'S name Taylor B. Walsh PARTICIPANT'S TIN ****1736 Account number (see instructions) ****491213 1 Employee or self-employed person's Archer MSA contributions 2 Total contributions made in the tax year $6,660.16
3 Total HSA or Archer MSA contributions made in the following year for the tax year 5 Fair market value of HSA, Archer MSA, or MA MSA $33,243.26",5498,14,5498,fdc-0d5300100e696b609e5de74c,v11-5498-SA-flat,original,2024,fgen-4b544f1e00dbf16ac9626c67,synthetic_programmatic_template,flat,top,False,
"From: Evergreen Health Savings To: Hiro Castillo 5 Fair market value of HSA, Archer MSA, or MA MSA 73,727.76 2 Total contributions made in the tax year $633.73 6 HSA
/ Archer MSA / MA
MSA HSA ☒",5498,14,5498,fdc-f3e8f7eb12cf6d1ade6e24a1,v11-5498-SA-flat,original,2025,fgen-7beb2968f50bafba4e7ff053,synthetic_programmatic_template,flat,none,False,
"2026 Copy B For Participant This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Sample HSA Bank 1371 Willow Bend Way Oak Grove, TX 53152 TRUSTEE'S TIN 55-3054415 PARTICIPANT'S name Wei Fischer PARTICIPANT'S TIN ****0823 Street address (including apt. no.) 4788 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Testville,
IL 75131 1 Employee or self-employed person's Archer MSA contributions 0.00 2 Total contributions made in the tax year $9,279.11 3 Total HSA or Archer MSA contributions made in the following year for the tax year
4 Rollover contributions $0.00 6 HSA / Archer MSA / MA MSA HSA ☒ Department of the Treasury - Internal Revenue Service",5498,14,5498,fdc-5797662021fd79bcd3e92caa,v11-5498-SA-flat,original,2026,fgen-148b79586beb9e3d990187a0,synthetic_programmatic_template,flat,none,False,
"Form 5498-SA
HSA, Archer MSA,or Mcdicare Advantage MSA Information 2025 From: Northwind HSA Custodian RECIPIENT: Morgan K. Lindqvist 2 Total contributions made in
the tax year $4,407.78",5498,14,5498,fdc-0a9e785e59111acb5f1329ae,v11-5498-SA-flat,original,2025,fgen-f15ff1ee0a4a7dbace2bd0fc,synthetic_programmatic_template,flat,top,True,
"2022 OMB No. 1545-1518 This information is being furnished to the IRS. TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Sample HSA Bank 7541 Sample Street Brookhaven, PA 94320 TRUSTEE'S TIN 37-7494215 PARTICIPANT'S name Casey Kowalski
PARTICIPANT'S TIN ending in 3310 Street address (including apt. no.) 3046 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 22571 Account number (see instructions) ***-**-121897 1 Employee or self-employed person's Archer MSA contributions 2 Total
contributions made in the tax year 2,628.44 3 Total HSA or Archer MSA contributions made in the following year for the tax year 4 Rollover contributions $0.00 6 HSA / Archer MSA / MA MSA HSA ☒ Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information",5498,14,5498,fdc-21c83017df08ebd50b3d738c,v11-5498-SA-flat,original,2022,fgen-b6dfe4cd8264b09e5acde691,synthetic_programmatic_template,flat,bottom,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2021 TRUSTEE: Sample
HSA Bank RECIPIENT: Taylor Fischer 2 Total contributions made in the tax year 1,486.63 5 Fair market value of HSA, Archer MSA, or
MA MSA $43,972.79",5498,14,5498,fdc-474b88ce4eafee50b667c11b,v11-5498-SA-flat,original,2021,fgen-cbfbd6eebaf36c41b20951ac,synthetic_programmatic_template,flat,top,False,
"## Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information
| Field | Value |
| --- | --- |
| TRUSTEE'S name: | Northwind HSA Custodian |
| RECIPIENT: | Olivia Tanaka |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |",5498,14,5498,fdc-c2d042c1f6f3f176a6130b99,v11-5498-SA-markdown,original,2021,fgen-7f6d148e78c0e5f2dd8dc7c6,synthetic_programmatic_template,markdown,top,False,
"## Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
OMB No. 1545-1518
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Sample HSA Bank 1978 Granite St Bayside, WA 16762 |
| TRUSTEE'S TIN | 52-2173889 |
| PARTICIPANT'S name | Morgan Moreau |
| PARTICIPANT'S TIN | XXXXX7473 |
| Street address (including apt. no.) | 2800 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 66648 |
| Account number (see instructions) | XXX-XX-750986 |
| 1 Employee or self-employed person's Archer MSA contributions |  |
| 2 Total contributions made in the tax year | 5,537.73 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year | $0.00 |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 5,923.76 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-1285bea03daea9ad8f71655e,v11-5498-SA-markdown,original,2021,fgen-fd21b941fcdebc0f66534c47,synthetic_programmatic_template,markdown,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2022
OMB No. 1545-1518
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Evergreen Health Savings 9175 Harbor View Rd Testville, IL 93507 |
| TRUSTEE'S TIN | 55-8780559 |
| PARTICIPANT'S name | Alex C. Nguyen |
| PARTICIPANT'S TIN | XXX-XX-1415 |
| Account number (see instructions) | ****986176 |
| 1 Employee or self-employed person's Archer MSA contributions | $0.00 |
| 2 Total contributions made in the tax year | $7,067.38 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year | $0.00 |
| 4 Rollover contributions |  |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 123,698.38 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-914ff8bcb3759abdb9983462,v11-5498-SA-markdown,original,2022,fgen-380f5af75e92998bc0a6476c,synthetic_programmatic_template,markdown,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
## For calendar year 2022
OMB No. 1545-1518
## Copy B For Participant
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Sample HSA Bank 6510 Maple Ridge Dr Fairview, OH 14290 |
| TRUSTEE'S TIN | 79-2346600 |
| PARTICIPANT'S name | Avery C. Nguyen |
| PARTICIPANT'S TIN | XXX-XX-6091 |
| 1 Employee or self-employed person's Archer MSA contributions |  |
| 2 Total contributions made in the tax year | $2,895.48 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year |  |
| 4 Rollover contributions | 0.00 |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | $72,838.92 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
## Department of the Treasury - Internal Revenue Service
## Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-32c630ffa7240f4ff69f265f,v11-5498-SA-markdown,original,2022,fgen-1852c5fca11e2d2e7ae59192,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2026
## Copy B For Participant
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Sample HSA Bank 9373 Granite St Fairview, OH 35833 |
| TRUSTEE'S TIN | 60-2257316 |
| PARTICIPANT'S name | Sofia Rivera |
| PARTICIPANT'S TIN | ***-**-0174 |
| Street address (including apt. no.) | 9060 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 81202 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year |  |
| 4 Rollover contributions |  |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 116,085.00 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-9441bf8fc10bee37d2789375,v11-5498-SA-markdown,original,2026,fgen-6d9e4460f308cbb04a99c6eb,synthetic_programmatic_template,markdown,top,False,
"Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
For calendar year 2023
Copy B For Participant
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Northwind HSA Custodian 3355 Lakeshore Blvd Pinecrest, GA 96120 |
| TRUSTEE'S TIN | 17-6235887 |
| PARTICIPANT'S name | Wei Romero |
| PARTICIPANT'S TIN | ****7179 |
| Street address (including apt. no.) | 9700 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Lakewood, CO 55622 |
| Account number (see instructions) | ending in 298684 |
| 1 Employee or self-employed person's Archer MSA contributions |  |
| 2 Total contributions made in the tax year | $7,150.67 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year | 0.00 |
| 4 Rollover contributions | $0.00 |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 65,508.61 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |",5498,14,5498,fdc-259cd2cdbb7ea059abb6bae8,v11-5498-SA-markdown,original,2023,fgen-c0166b5b994401a42f0ecf2c,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| TRUSTEE: | Northwind HSA Custodian |
| Recipient's name: | Avery Okafor |
| 2 Total contributions made in the tax year | 4,077.72 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
## Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2023",5498,14,5498,fdc-2b161d5572150ffc7522b3b4,v11-5498-SA-markdown,original,2023,fgen-e95f41c51380ff272feab602,synthetic_programmatic_template,markdown,bottom,False,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2025
| Field | Value |
| --- | --- |
| TRUSTEE: | Sample HSA Bank |
| Recipient's name: | Diego Sato |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | $12,873.65 |
| 2 Total contributions made in the tax year | $1,868.55 |",5498,14,5498,fdc-51c70848829785bf2ea11be3,v11-5498-SA-markdown,original,2025,fgen-03490dbceb279ab5eb551e3c,synthetic_programmatic_template,markdown,top,False,
"2025
OMB No. 1545-1518
## Copy B For Participant
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Evergreen Health Savings 4690 Oak Hollow Ct Riverton, WI 46184 |
| TRUSTEE'S TIN | 92-4715005 |
| PARTICIPANT'S name | Lena Larsen |
| PARTICIPANT'S TIN | ****8399 |
| Street address (including apt. no.) | 3830 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 92512 |
| Account number (see instructions) | ending in 281520 |
| 1 Employee or self-employed person's Archer MSA contributions |  |
| 2 Total contributions made in the tax year | 4,789.70 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year | $0.00 |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | $79,926.66 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |",5498,14,5498,fdc-6ab3924d9d8dd9ab203f0a4b,v11-5498-SA-markdown,original,2025,fgen-3211278b6789cf99c27ed4d2,synthetic_programmatic_template,markdown,none,False,
"VOID  CORRECTED
OMB No. 1545-1518
## Copy B For Participant
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Evergreen Health Savings 2727 Elm Park Pl Oak Grove, TX 80327 |
| TRUSTEE'S TIN | 23-8149997 |
| PARTICIPANT'S name | Casey Larsen |
| PARTICIPANT'S TIN | XXXXX2456 |
| Street address (including apt. no.) | 8504 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 72972 |
| Account number (see instructions) | ****749263 |
| 1 Employee or self-employed person's Archer MSA contributions | $0.00 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year |  |
| 4 Rollover contributions | 0.00 |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | $53,643.71 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
## Department of the Treasury - Internal Revenue Service
Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-5ad38ca89c10c1e390ff35bf,v11-5498-SA-markdown,original,2026,fgen-d4f836129107d1f57cf90b84,synthetic_programmatic_template,markdown,bottom,False,
"Form 5498-SA HSA, Archer MSA, or MedicareAdvantage MSA Information 2021
| Fie1d | Value |
| --- | --- |
| TRUSTEE: | Northwind HSA Custodian |
| Recipient's name: | Wei Tanaka |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | S115,531.73 |",5498,14,5498,fdc-fc148fcdb9acbc580e127f80,v11-5498-SA-markdown,original,2021,fgen-fae822ef27833d5d46d95530,synthetic_programmatic_template,markdown,top,True,
"## Form 5498-SA
## HSA, Archer MSA, or Medicare Advantage MSA Information
2024
OMB No. 1545-1518
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Northwind HSA Custodian 9619 Maple Ridge Dr Oak Grove, TX 87763 |
| TRUSTEE'S TIN | 16-5677455 |
| PARTICIPANT'S name | Alex Rivera |
| PARTICIPANT'S TIN | ***-**-4417 |
| Street address (including apt. no.) | 9429 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 54976 |
| 1 Employee or self-employed person's Archer MSA contributions | 0.00 |
| 2 Total contributions made in the tax year | 4,609.35 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year |  |
| 4 Rollover contributions |  |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 82,983.46 |
Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-9c71f80bdd45a815822ce3ff,v11-5498-SA-markdown,original,2024,fgen-910071d5fe770ff80dbfc37e,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
## Form 5498-SA
HSA, Archer MSA, or Medicare Advantage MSA Information
## OMB No. 1545-1518
This information is being furnished to the IRS.
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Sample HSA Bank 4058 Maple Ridge Dr Riverton, WI 74688 |
| TRUSTEE'S TIN | 33-6443524 |
| PARTICIPANT'S name | Casey Fischer |
| PARTICIPANT'S TIN | ending in 4454 |
| Street address (including apt. no.) | 9107 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 26332 |
| Account number (see instructions) | ***-**-973914 |
| 1 Employee or self-employed person's Archer MSA contributions |  |
| 2 Total contributions made in the tax year | 3,499.25 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year | $0.00 |
| 4 Rollover contributions |  |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 50,893.59 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |
## Department of the Treasury - Internal Revenue Service
Form 5498-SA (keep for your records)  www.irs.gov/Form5498SA",5498,14,5498,fdc-0b4b8cf108ab250afef75e14,v11-5498-SA-markdown,original,2023,fgen-04a6b9288ef645b6c62fa93f,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
## Form 5498-SA
## HSA, Archer MSA, or Medicare Advantage MSA Information
2022
## OMB No. 1545-1518
| Field | Value |
| --- | --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign postal code | Sample HSA Bank 777 Harbor View Rd Maplewood, MN 68999 |
| TRUSTEE'S TIN | 36-9479690 |
| PARTICIPANT'S name | Kwame C. Testcase |
| PARTICIPANT'S TIN | XXXXX3213 |
| Street address (including apt. no.) | 6164 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 91823 |
| 1 Employee or self-employed person's Archer MSA contributions |  |
| 2 Total contributions made in the tax year | 7,249.41 |
| 3 Total HSA or Archer MSA contributions made in the following year for the tax year |  |
| 4 Rollover contributions | 0.00 |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 133,446.90 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |",5498,14,5498,fdc-d6e9ca769c44a2747452f520,v11-5498-SA-markdown,original,2022,fgen-4327dbcf966bdb2cd7eb3aab,synthetic_programmatic_template,markdown,top,False,
"Form5498-SA
## HSA, Archer MSA, or Medicare Advantage MSA Information
## For calendar year 2025
## OMB No. 1545-1518
This information is being furnished to theIRS.
| Field | Value |
| ---| --- |
| TRUSTEE'S name, street address, city or town, state or province, country, and ZIP or foreign posta1 code | Northwind H5A Custodian 9280 Cedar Ln Testville, IL 44294 |
| TRUSTEE'S TIN| 52-3075l07 |
| PARTICIPANT'S name | Riley 0kafor |
| PARTICIPANT'S TIN | ****7032 |
| Street address (induding apt. no.) | 3009 Willow Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 48734 |
| l Employee or self-employed person's Archer MSA contributions | 0.00 |
| 3 Total HSA or Archer MSA contributions made in the following year for the taxyear |  |
| 4 Rollover contributions | 0.00 |
| 5Fair market value of HSA, Archer MSA, or MA MSA | 87,425.l0 |",5498,14,5498,fdc-0d8d8d8229eaf0b402c4b0e8,v11-5498-SA-markdown,original,2025,fgen-ad43a8ce3f8482d4936d14a3,synthetic_programmatic_template,markdown,top,True,
"Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 2021
| Field | Value |
| --- | --- |
| TRUSTEE'S name: | Evergreen Health Savings |
| To: | Alex Sato |
| 5 Fair market value of HSA, Archer MSA, or MA MSA | 44,037.89 |
| 2 Total contributions made in the tax year | 2,169.97 |
| 6 HSA / Archer MSA / MA MSA | HSA ☒ |",5498,14,5498,fdc-869060c38be0f9be2100b0d7,v11-5498-SA-markdown,original,2021,fgen-6ae6d241b4e0d40a270ca2bc,synthetic_programmatic_template,markdown,top,False,
"Name(s) shown on your income tax return
Sample Community Food Bank 1408 Elm Park Pl Maplewood, MN 38606
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
16-8716455
Identifying number
Diego Moreau
(a) Name and address of the donee organization
ending in 0545
Street address (including apt. no.)
2141 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 26771
Account number (see instructions)
XXX-XX-108048
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Clothing, 6 bags, good used
(d) Date of the contribution
January 7, 2024
(f) How acquired by donor
Inheritance
(g) Donor's cost or adjusted basis
$2,962.34
(h) Fair market value (see instructions)
$9,229.77
Department of the Treasury - Internal Revenue Service",8283,17,8283,fdc-67b5a90038c8fea41e4a07c9,v11-8283-stacked,original,2025,fgen-f4d42f1defcc0ad2f8636e5b,synthetic_programmatic_template,stacked,none,False,
"CORRECTED (if checked)
Form 8283
Noncash Charitable Contributions
2022
OMB No. 1545-0074
Name(s) shown on your income tax return
St. Brendan Parish 7691 Sample Street Pinecrest, GA 10824
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
97-6085159
Identifying number
Hiro B. Fischer
(a) Name and address of the donee organization
****2831
Street address (including apt. no.)
6538 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 55162
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Household furniture, good condition
(d) Date of the contribution
11/07/2021
(e) Date acquired by donor (mo., yr.)
2022-10-27
(f) How acquired by donor
Purchase
(g) Donor's cost or adjusted basis
$2,010.58
(h) Fair market value (see instructions)
4,689.25
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-c318274decdf7cd539db63af,v11-8283-stacked,original,2022,fgen-be7d05c01f5510b6dabf806f,synthetic_programmatic_template,stacked,top,False,
"2023
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Name(s) shown on your income tax return
Greenway Animal Rescue 7960 Granite St Pinecrest, GA 48573
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
45-7266896
Identifying number
Amara Adeyemi
(a) Name and address of the donee organization
XXXXX7140
Street address (including apt. no.)
5730 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 96232
Account number (see instructions)
ending in 976787
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Clothing, 6 bags, good used
(d) Date of the contribution
November 27, 2022
(e) Date acquired by donor (mo., yr.)
September 21, 2023
(f) How acquired by donor
Gift
(g) Donor's cost or adjusted basis
7,482.95
(i) Method used to determine the fair market value
Thrift shop value
Form 8283
Noncash Charitable Contributions",8283,17,8283,fdc-84770317b0dd867c674f23a4,v11-8283-stacked,original,2023,fgen-6f7ae1e461975d40a3210b97,synthetic_programmatic_template,stacked,bottom,False,
"Form 8283 Noncash Charitable Contributíons2022
Name(s) shown on your income tax return'S name:
Sample Community Food Bank
To:
Noah Castillo
(f) How acquired by donor
Purchase
(g) Donor's cost or adjusted basis
$3,799.53
(e) Date acquired by donor (mo., yr.)
l0/11/2019
(h) Faír market va1ue (see instructions)
4,849.87",8283,17,8283,fdc-6723cc7bfdb2c005dc444b80,v11-8283-stacked,original,2022,fgen-9f8582133d895b52ab45acea,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
Form 8283
Noncash Charitable Contributions
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Name(s) shown on your income tax return
Sample Community Food Bank 7192 Prairie Ave Pinecrest, GA 70956
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
26-3458713
Identifying number
Kwame A. Kowalski
(a) Name and address of the donee organization
****7174
Street address (including apt. no.)
266 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 53810
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Clothing, 6 bags, good used
(d) Date of the contribution
09/13/2020
(f) How acquired by donor
Purchase
(g) Donor's cost or adjusted basis
$8,662.24
(i) Method used to determine the fair market value
Appraisal",8283,17,8283,fdc-6ee94ff421c4f27113e7fb36,v11-8283-stacked,original,2021,fgen-e2a5db1e37f720d1b3acc47e,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form 8283
Noncash Charitable Contributions
2026
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return
Greenway Animal Rescue 6239 Prairie Ave Cedar Falls, IA 38176
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
43-7028802
Identifying number
Noah Adeyemi
(a) Name and address of the donee organization
****5918
Street address (including apt. no.)
6847 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 93500
(c) Description and condition of donated property
Household furniture, good condition
(d) Date of the contribution
2025-11-02
(e) Date acquired by donor (mo., yr.)
01/10/2025
(f) How acquired by donor
Inheritance
(g) Donor's cost or adjusted basis
7,522.82
(h) Fair market value (see instructions)
$7,817.47
(i) Method used to determine the fair market value
Comparable sales
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-037102870474fb71627238b4,v11-8283-stacked,original,2026,fgen-336fa6c75ce59440006d94fb,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form 8283
Noncash Charitable Contributions
2022
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Name(s) shown on your income tax return
Sample Community Food Bank 6473 Sample Street Maplewood, MN 34086
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
83-8146884
Identifying number
Fatima Sato
(a) Name and address of the donee organization
XXXXX9521
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Laptop computer, fair
(d) Date of the contribution
2021-01-03
(e) Date acquired by donor (mo., yr.)
9/17/21
(f) How acquired by donor
Inheritance
(g) Donor's cost or adjusted basis
$1,998.66
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-bb3352c91992ae46d3095029,v11-8283-stacked,original,2022,fgen-c35b92ff130e9ff2a72f9b99,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2024
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Name(s) shown on your income tax return
St. Brendan Parish 3798 Oak Hollow Ct Riverton, WI 98009
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
56-2624638
Identifying number
Kwame Nguyen
(a) Name and address of the donee organization
ending in 9457
Street address (including apt. no.)
7793 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 65942
Account number (see instructions)
XXX-XX-744724
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Clothing, 6 bags, good used
(d) Date of the contribution
12/27/2024
(e) Date acquired by donor (mo., yr.)
10/13/24
(f) How acquired by donor
Inheritance
(h) Fair market value (see instructions)
$1,289.58
Department of the Treasury - Internal Revenue Service
Form 8283
Noncash Charitable Contributions
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-30a6ed9e2ede88bd497fbe7a,v11-8283-stacked,original,2024,fgen-38666fa3b1950ca4bb15e55b,synthetic_programmatic_template,stacked,bottom,False,
"Form 8283
Noncash Charitable Contributions
For calendar year 2021
OMB No. 1545-0074
Department of the Treasury Intemal Revenue 5ervice
Name(s) shown on your incometax rcturn
Sample CommunityFood Bank392 Sample Street Brookhaven, PA 63175
Section A. Donated Property of $5,O00 or Less and Publicly Traded Securities
6O-8928136
Identifying number
Wei Tanaka
(a)Name and address of the donee organization
ending in 5058
(b) If donated property is a vehide (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Household fumiture, good condition
(d) Date of the contribution
February l9, 2020
(e) Date acquíred by donor (mo., yr.)
March 19, 2021
(f) How acquired by donor
Purchase
(g) Donor's cost or adjusted basis
$1,225.38
(h) Faír market value (see instructions)
$392.90
Department of the Treasury - Internal Revenue 5ervice
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-350a346ae2a19e5e2a7fc1ef,v11-8283-stacked,original,2021,fgen-11efd03567b1e3693a776f3b,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
Form 8283
Noncash Charitable Contributions
2026
Name(s) shown on your income tax return
Sample Community Food Bank 3100 Harbor View Rd Cedar Falls, IA 81575
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
35-4449075
Identifying number
Jamie B. Sato
(a) Name and address of the donee organization
XXXXX1085
Street address (including apt. no.)
7730 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 52557
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Clothing, 6 bags, good used
(d) Date of the contribution
2026-08-12
(e) Date acquired by donor (mo., yr.)
May 27, 2025
(f) How acquired by donor
Purchase
(g) Donor's cost or adjusted basis
2,016.66
(h) Fair market value (see instructions)
4,649.54
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-a7f00dbfb8067a14108e0120,v11-8283-stacked,original,2026,fgen-73bc1e68c473cbd475f1e95d,synthetic_programmatic_template,stacked,top,False,
"2022
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return
Sample Community Food Bank 5053 Lakeshore Blvd Brookhaven, PA 12538
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
14-5053388
Identifying number
Kwame L. Testcase
(a) Name and address of the donee organization
XXXXX4761
Street address (including apt. no.)
2488 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 91285
(c) Description and condition of donated property
Clothing, 6 bags, good used
(d) Date of the contribution
2021-06-10
(e) Date acquired by donor (mo., yr.)
2021-02-16
(h) Fair market value (see instructions)
$7,989.93
Department of the Treasury - Internal Revenue Service
Form 8283
Noncash Charitable Contributions
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-373e20d47f2df9ded99c88d6,v11-8283-stacked,original,2022,fgen-110ee34d0b9161e206fd160e,synthetic_programmatic_template,stacked,bottom,False,
"Form 8283
Noncash Charitable Contributions
For calendar year 2022
OMB No. 1545-0074
Name(s) shown on your income tax return
Sample Community Food Bank 5992 Prairie Ave Fairview, OH 94755
Section A. Donated Property of $5,O00 or Less and Publicly Traded Securities
51-7973248
Identífying number
Lena L. Kowalski
(a) Name and address of the donee organization
****416O
Street address (including apt. no.)
7362 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 47382
Accountnumber (see instructions)
XXX-XX-130090
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehide identification numbcr
(c) Description and condition of donated property
Clothing, 6 bags, good used
(d) Date of the contríbution
2022-11-02
(e) Date acquired by donor (mo., yr.)
7/17/22
(f) How acquired by donor
Purchase
(g) Donor's cost or adjusted basis
$7,515.60
(h)Fair marketva1ue (see instructions)
9,268.6l
(i) Method used to determinethe fair market value
Appraisal
Department of the Treasury - Intemal Revenue Service
Form 8283 (keep for yourrecords)  www.irs.gov/Form8283",8283,17,8283,fdc-5179eb2c049630348d2fdb27,v11-8283-stacked,original,2022,fgen-0775fc10b9b543740b8fd120,synthetic_programmatic_template,stacked,top,True,
"Form 8283
Noncash Charitable Contributions
For calendar year 2024
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return
Hope Harbor Shelter 2106 Cedar Ln Brookhaven, PA 79807
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
29-5136038
Identifying number
Wei Nguyen
(a) Name and address of the donee organization
XXXXX7496
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Laptop computer, fair
(e) Date acquired by donor (mo., yr.)
November 25, 2023
(f) How acquired by donor
Purchase
(h) Fair market value (see instructions)
2,227.93
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-76488e74d68abdbbb797b08b,v11-8283-stacked,original,2024,fgen-3b515df385834dd5f511018d,synthetic_programmatic_template,stacked,top,False,
"Form 8283 Noncash Charitable Contributions 2025
Name(s) shown on your income tax return'S name:
St. Brendan Parish
Recipient's name:
Amara Tanaka
(i) Method used to determine the fair market value
Appraisal",8283,17,8283,fdc-670dddba1eef2fd64c3b8eab,v11-8283-stacked,original,2025,fgen-d11264e182b071c6f84eb4a8,synthetic_programmatic_template,stacked,top,False,
"2021
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return
Riverbend Public Library Foundation 4928 Cedar Ln Fairview, OH 67479
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
55-2944402
Identifying number
Wei R. Testcase
(a) Name and address of the donee organization
ending in 3680
Account number (see instructions)
***-**-213294
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Laptop computer, fair
(d) Date of the contribution
September 3, 2021
(f) How acquired by donor
Purchase
(g) Donor's cost or adjusted basis
$4,739.20",8283,17,8283,fdc-3218fa43f023c4e44d5d0a25,v11-8283-stacked,original,2021,fgen-a7d04c9e42d3ee1379cdd5b0,synthetic_programmatic_template,stacked,none,False,
"Form 8283
Noncash Charitable Contributions
2025
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return
St. Brendan Parish 4807 Oak Hollow Ct Cedar Falls, IA 80857
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities
97-8911842
Identifying number
Priya Haddad
(a) Name and address of the donee organization
****3391
Street address (including apt. no.)
4409 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 76244
Account number (see instructions)
****440625
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property
Household furniture, good condition
(d) Date of the contribution
5/9/22
(f) How acquired by donor
Gift
(g) Donor's cost or adjusted basis
4,626.86
(i) Method used to determine the fair market value
Comparable sales",8283,17,8283,fdc-f7b0530bf57ef9a9ea304db7,v11-8283-stacked,original,2025,fgen-0f9f46a3c7350bd21fe2ce78,synthetic_programmatic_template,stacked,top,False,
"OMB No.1545-0074
Attach onc or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Name(s) shown onyour income tax return   St. Brcndan Parish 4229 Lakeshore Blvd Fairview, 0H 43798
Section A. Donated Property of $5,O00 or Lessand Publidy Traded 5ecurities      80-4307647
Identifying number Avery Walsh
(a) Name and address of the donee organization  ending in 9794
(b) If donated property is a vehide (see instructions), checkthe box. Also enter the vehide identification number
(c) Descríption and condition of donated property Clothing, 6 bags, good used
(d) Date of the contribution April 21, 2O24
(e) Date acquired by donor (mo., yr.)   12/02/2024
(f) How acquired by donor      Purchase
(g) Donor's cost or adjusted basis5,615.30
(i) Method used to determine the fair marketvalue  Thrift shop value
Department of the Treasury - Intema1 Revenue Service
Form 8283
Noncash Charitable Contributions
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-5b876cb69bce6b0c494a1eea,v11-8283-inline,original,2024,fgen-f8e085241767443845c450df,synthetic_programmatic_template,inline,bottom,True,
"For calendar year 2025
OMB No. 1545-0074
Name(s) shown on yourincome tax return  5t. Brendan Parish 9327 Lakeshore B1vd Bayside, WA14766
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities  61-3210301
Identifying number      Jamie Testcase
(a) Name and address of the donee organization XXX-XX-3096
(b) If donatedproperty is a vehicle (see instructions), checkthe box. Also enter the vehicle identification number
(c) Description and condition of donated property  Laptop computer, fair
(e) Date acquired by donor (mo., yr.)      1/4/25
(h) Fair market value (see instructions)   6,747.03
(i) Method used to determine the fair market value Thrift shop value",8283,17,8283,fdc-62da03b5d0922cdb091e447e,v11-8283-inline,original,2025,fgen-9eba72acc3797fe9df203b75,synthetic_programmatic_template,inline,none,True,
"VOID  CORRECTED
Form 8283
Noncash Charitable Contributions
For calendar year 2024
OMB No. 1545-0074
Name(s) shown on your income tax return St. Brendan Parish 1532 Maple Ridge Dr Testville, IL 92810
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities  92-2991354
Identifying number   Amara Adeyemi
(a) Name and address of the donee organization XXX-XX-2910
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property Laptop computer, fair
(f) How acquired by donor  Purchase
(g) Donor's cost or adjusted basis $6,690.07
(h) Fair market value (see instructions) $7,771.45
(i) Method used to determine the fair market value      Comparable sales
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-c2a5bbd9359dca5773e63026,v11-8283-inline,original,2024,fgen-676a096979f481bef8e95c6c,synthetic_programmatic_template,inline,top,False,
"Form 8283 Noncash Charitable Contributions 2026
Name(s) shown on your income tax return: Hope Harbor Shelter
Recipient's name:   Amara Brennan
(g) Donor's cost or adjusted basis $3,470.17
(f) How acquired by donor Gift
(e) Date acquired by donor (mo., yr.) 2026-12-19
(d) Date of the contribution  January 11, 2026",8283,17,8283,fdc-ba4335b3e4a276cbe890ece6,v11-8283-inline,original,2026,fgen-d95f2b92f941a99c744eb9a9,synthetic_programmatic_template,inline,top,False,
"Form 8283
Noncash Charitable Contributions
For calendar year 2022
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return Sample Community Food Bank 1062 Sample Street Cedar Falls, IA 74694
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 84-2716912
Identifying number  Jamie K. Haddad
(a) Name and address of the donee organization XXX-XX-9027
Street address (including apt. no.)      4943 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code      Brookhaven, PA 97186
Account number (see instructions)   ***-**-490537
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property Laptop computer, fair
(d) Date of the contribution 7/27/22
(e) Date acquired by donor (mo., yr.)   2019-02-24
(f) How acquired by donor  Inheritance
(g) Donor's cost or adjusted basis $6,529.83
(h) Fair market value (see instructions) $416.02
(i) Method used to determine the fair market value Appraisal
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-c0478fa40568de2746db1f48,v11-8283-inline,original,2022,fgen-224a8a2087f208200d03cc0a,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
For calendar year 2024
OMB No. 1545-0074
Name(s) shown on your income tax return  Greenway Animal Rescue 4076 Oak Hollow Ct Oak Grove, TX 65062
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities   21-9617300
Identifying number      Taylor Sato
(a) Name and address of the donee organization   ending in 1835
Street address (including apt. no.)   3660 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code      Fairview, OH 19529
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property   Laptop computer, fair
(d) Date of the contribution  2021-08-04
(e) Date acquired by donor (mo., yr.)  8/25/23
(f) How acquired by donor Gift
(g) Donor's cost or adjusted basis   $2,457.61
(h) Fair market value (see instructions)  2,406.72
(i) Method used to determine the fair market value   Appraisal",8283,17,8283,fdc-359f2992c266352cac827d26,v11-8283-inline,original,2024,fgen-57cb7d1937f8b3747cb2ac38,synthetic_programmatic_template,inline,none,False,
"Form 8283 Noncash Charitable Contributions 2O24
Name(s) shown on your income tax return: Greenway Animal Rescue
Recipient's name: Jordan J. Lindqvist
(i) Method used to determine the fair market value  Appraisal
(d) Date of the contribution O2/20/2023
(h)Fair market value (see instructions) 1,13O.44",8283,17,8283,fdc-ec550f6a07202f28c651ddd2,v11-8283-inline,original,2024,fgen-981346f0f1288a7966f57efe,synthetic_programmatic_template,inline,top,True,
"For calendar year 2025
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return íf you claimed a tota1 deduction ofover $500 for all contributed property.
Name(s)shown on your income tax return      RivcrbendPublic Library Foundation 7645 Maple Ridge Dr Cedar Falls, IA 17881
Section A. Donated Property of $5,000 or Less andPublicly Traded Securities 74-7916347
Identifying number      Morgan Castillo
(a) Name andaddress of the donee organization ***-**-1912
Account number(see instructions) ending in 131504
(e) Date acquired by donor (mo., yr.)      2/19/25
(f) How acquired by donor      Inheritance
(g) Donor's cost or adjusted basis $7,514.65
(h) Fair market va1ue (see instructions)      7,898.32
(i) Method used to determine the fair market value Appraísal
Department of the Treasury - Internal Revenue 5ervice
Form 8283
Noncash Charitable Contributions
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-bd0472c9180571d4ad79d742,v11-8283-inline,original,2025,fgen-7eb8045a48693fc7c0e24f52,synthetic_programmatic_template,inline,bottom,True,
"For calendar year 2025
Name(s) shown on your income tax return Sample Community Food Bank 1062 Granite St Testville, IL 44380
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 84-2734238
Identifying number   Jamie Patel
(a) Name and address of the donee organization   XXX-XX-8907
Account number (see instructions) ending in 453940
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property Household furniture, good condition
(d) Date of the contribution 02/14/2022
(e) Date acquired by donor (mo., yr.)      2022-12-18
(f) How acquired by donor Gift
(g) Donor's cost or adjusted basis   $6,868.49
(h) Fair market value (see instructions) $33.57
Department of the Treasury - Internal Revenue Service",8283,17,8283,fdc-64f85cc7080aaafc82268725,v11-8283-inline,original,2025,fgen-b0515be92435ec21ff452b90,synthetic_programmatic_template,inline,none,False,
"Form 8283
NoncashCharitable Contributions
0MB No. 1545-0074
Attach onc or more Forms 8283 to your tax return if you claimed a total deduction of over S500 for all contributed property.
Department of the Treasury Internal Revenue 5ervice
Name(s) shown on your income tax return Sample Community Food Bank 2240 Willow Bend Way Testville,IL 11959
Section A. Donated Property of $5,O00 or Less and Publídy Traded Securities  78-l015061
Idcntifying number  Amara Castillo
(a) Name and address of the donee organization   ****6818
5treet address (induding apt. no.) 4831 Maple Ridge Dr
City ortown, state or province, country,and ZIP or foreign postal code Pinecrest, GA 64155
(b) If donated property isa vehide (see instructions), check the box. A1so enter the vehide identification number
(c) Description and condition of donated property   C1othing, 6 bags, good used
(d) Date of the contribution  8/26/20
(f)How acquired by donor      Inheritance
(g) Donor's cost or adjusted basis 7,497.93
(i) Method used to determine the fair market value   Appraisal",8283,17,8283,fdc-d3028bb248bcedf559d1a31c,v11-8283-inline,original,2021,fgen-f8d4405c66b86fdd55e7c607,synthetic_programmatic_template,inline,top,True,
"Name(s) shown on your income tax return'Sname:  Riverbend Public Líbrary Foundation
To: Sofia Testcase
(d) Date of the contribution 03/26/2022",8283,17,8283,fdc-773bb26d980bf7323d771738,v11-8283-inline,original,2022,fgen-6959210dbce045910680bfb6,synthetic_programmatic_template,inline,none,True,
"2021
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return      Hope Harbor Shelter 107 Oak Hollow Ct Cedar Falls, IA 41414
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 45-3221737
Identifying number Casey Nguyen
(a) Name and address of the donee organization      ***-**-9970
Street address (including apt. no.) 1935 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code  Maplewood, MN 63694
Account number (see instructions)      ***-**-497440
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(d) Date of the contribution January 4, 2021
(e) Date acquired by donor (mo., yr.) 01/28/2021
(g) Donor's cost or adjusted basis 1,109.97
(h) Fair market value (see instructions) 8,254.43
(i) Method used to determine the fair market value  Comparable sales
Department of the Treasury - Internal Revenue Service",8283,17,8283,fdc-b24233017be9dab42273110d,v11-8283-inline,original,2021,fgen-0906be0f4c7c0690836fd04d,synthetic_programmatic_template,inline,none,False,
"Form 8283 Noncash Charitablc Contributions
From:      Sample Community Food Bank
To: KwameD. Tanaka
(g) Donor's cost or adjusted basis  3,874.27",8283,17,8283,fdc-dba4c39bacd70c5cbf8c9042,v11-8283-inline,original,2025,fgen-299588db1ca7c0f7dcabba97,synthetic_programmatic_template,inline,top,True,
"Form 8283
Noncash Charitable Contributions
For calendar year 2023
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Name(s) shown on your income tax return St. Brendan Parish 9021 Sample Street Fairview, OH 75422
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 67-6435738
Identifying number Jamie L. Castillo
(a) Name and address of the donee organization      ending in 1302
Street address (including apt. no.)   3342 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code      Cedar Falls, IA 49896
(d) Date of the contribution 2023-10-04
(e) Date acquired by donor (mo., yr.)   April 14, 2023
(f) How acquired by donor   Gift
(g) Donor's cost or adjusted basis  7,599.12
(h) Fair market value (see instructions)  $2,123.35
(i) Method used to determine the fair market value  Appraisal
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-b0a352787a5f214a3b5697e2,v11-8283-inline,original,2023,fgen-0835fd53a6b56b6aa8f90684,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Form 8283
Noncash Charitable Contributions
2023
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on your income tax return      Hope Harbor Shelter 2026 Sample Street Bayside, WA 24218
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 30-1217454
Identifying number   Hiro Fischer
(a) Name and address of the donee organization ***-**-9968
Street address (including apt. no.) 8300 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code   Cedar Falls, IA 38737
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(c) Description and condition of donated property Laptop computer, fair
(d) Date of the contribution  2023-09-19
(e) Date acquired by donor (mo., yr.)      September 23, 2023
(f) How acquired by donor Purchase
(g) Donor's cost or adjusted basis  1,327.32
(i) Method used to determine the fair market value      Thrift shop value
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-ad7143ecd9d80895fb7c6419,v11-8283-inline,original,2023,fgen-a6592ab411686995b1bff1f4,synthetic_programmatic_template,inline,top,False,
"For calendar year 2025
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Name(s) shown on your income tax return Sample Community Food Bank 7414 Granite St Riverton, WI 52503
Section A. Donated Property of $5,000 or Less and Publicly Traded Securities  46-4465732
Identifying number   Riley L. Patel
(a) Name and address of the donee organization ***-**-8502
Street address (including apt. no.) 4324 Sample Street
City or town, state or province, country, and ZIP or foreign postal code  Bayside, WA 17155
Account number (see instructions)   ending in 579555
(b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number
(d) Date of the contribution      3/9/25
(e) Date acquired by donor (mo., yr.)  October 23, 2022
(f) How acquired by donor   Gift
(g) Donor's cost or adjusted basis 7,469.47
(h) Fair market value (see instructions) $2,645.44
Form 8283
Noncash Charitable Contributions",8283,17,8283,fdc-95bef43cacb0e1a55949f197,v11-8283-inline,original,2025,fgen-5397e67ec34a5bb1c2e2949b,synthetic_programmatic_template,inline,bottom,False,
"Form 8283 Noncash Charitable Contributions OMB No. 1545-0074 Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed
property. Department of the Treasury Internal Revenue Service Name(s) shown on your income tax return St. Brendan Parish 4924 Granite St Pinecrest, GA 92283 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 54-5646340 Identifying number Morgan Kowalski (a) Name and address of the donee organization ***-**-8484 Street address (including apt.
no.) 524 Maple Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Testville, IL 15360 Account number (see instructions) ***-**-678352 (c) Description and condition of donated property Laptop computer, fair (d) Date of the contribution February 10, 2022 (e) Date acquired by donor (mo., yr.) 8/7/23 (f) How acquired by donor Purchase (g) Donor's cost or adjusted basis $5,439.25 (h) Fair market value (see instructions) 7,423.43 (i) Method used to determine the fair market value Thrift shop value",8283,17,8283,fdc-55624887d965de899f648f75,v11-8283-flat,original,2023,fgen-8b03f9838dab6cf19ebb9e9c,synthetic_programmatic_template,flat,top,False,
"Form 8283 Noncash Charitable Contributions 2025 OMB No. 1545-0074 Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property. Department of the Treasury Internal Revenue Service Name(s) shown on your income tax return Hope Harbor Shelter 6389 Willow Bend Way Riverton, WI 95286 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 64-2269617 Identifying number Priya Kowalski (a) Name and address of the donee organization ****9668 Account number (see instructions) ending in 380157 (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number (c) Description and condition of donated property Clothing, 6 bags, good used (d) Date of the contribution 07/09/2025
(e) Date acquired by donor (mo., yr.) 7/14/24 (f) How acquired by donor Purchase (g) Donor's cost or adjusted basis $3,702.34 (h) Fair market value (see instructions) 1,432.26
(i) Method used to determine the fair market value Thrift shop value Department of the Treasury - Internal Revenue Service Form 8283 (keep for your records) www.irs.gov/Form8283",8283,17,8283,fdc-4042308dcff046ff0c272275,v11-8283-flat,original,2025,fgen-7fb76f4fa6306d8761f5a1ac,synthetic_programmatic_template,flat,top,False,
"Form 8283
Noncash Charitable Contributions From: Greenway Animal Rescue RECIPIENT: JordanFischer (i) Method used to
determine the fair market value Thrift shop value",8283,17,8283,fdc-e675cfa5de2da355324ded7d,v11-8283-flat,original,2021,fgen-836962099cc52c4b325e168f,synthetic_programmatic_template,flat,top,True,
"Form 8283 Noncash Charitable Contributions For calendar year 2025 OMB No. 1545-0074 Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property. Department of the Treasury Internal Revenue Service Name(s) shown on your income tax return Greenway Animal Rescue 6029 Elm Park Pl Maplewood, MN 67217 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 80-5139163 Identifying number Riley Larsen (a) Name and address of the donee organization ending in 6400 Street address (including apt. no.) 8249 Sample Street City or town, state or province, country, and ZIP or foreign postal code Brookhaven,
PA 53530 (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number (c) Description and condition of donated property Clothing, 6 bags, good used (d) Date of the contribution 04/09/2025 (e) Date acquired by donor (mo., yr.) May 5, 2025 (f) How acquired by donor Gift (g) Donor's cost or adjusted basis 2,518.95 (h) Fair market value (see instructions) 6,866.56 Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records) www.irs.gov/Form8283",8283,17,8283,fdc-a8463f1fdd267eb5f1b7574a,v11-8283-flat,original,2025,fgen-e30320e16547d4a0b73f1647,synthetic_programmatic_template,flat,top,False,
"Form 8283 Noncash Charitable Contributions 2026 Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property. Department of the Treasury Internal Revenue Service Name(s) shown on your income tax return Sample Community Food Bank 5732 Cedar Ln Bayside, WA 65604 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 79-8097011 Identifying number Lena Testcase (a) Name and address of the donee organization ending in 4984 Account number (see instructions) ending in 355487 (c) Description and condition of donated property Clothing, 6 bags, good used (d) Date
of the contribution October 27, 2026 (e) Date acquired by donor (mo., yr.) 2/19/25 (f) How acquired by donor Inheritance (g) Donor's cost or adjusted basis 7,531.53 (h) Fair market value (see instructions) 1,605.31 (i)
Method used to determine the fair market value Comparable sales Department of the Treasury - Internal Revenue Service Form 8283 (keep for your records) www.irs.gov/Form8283",8283,17,8283,fdc-778b73999a00ca77d5665ada,v11-8283-flat,original,2026,fgen-47565893f139556539f1e12e,synthetic_programmatic_template,flat,top,False,
"Name(s) shown on your income tax return: Sample
Community Food Bank RECIPIENT: Fatima
Walsh (i) Method used to determine the fair market value Comparable sales",8283,17,8283,fdc-673edf996baf648bfacf7e33,v11-8283-flat,original,2025,fgen-d3a70d31dfa20a01d9c56204,synthetic_programmatic_template,flat,none,False,
"☐ CORRECTED Form 8283 Noncash Charitable Contributions 2023 OMB No. 1545-0074 Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property. Department of the Treasury Internal Revenue Service Name(s) shown on your income tax return Sample Community Food Bank 306 Maple Ridge Dr Lakewood, CO 48406 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 14-6174257 Identifying number Sofia Moreau (a) Name and address of the donee organization ending in 2001 Street address (including apt. no.) 9017 Lakeshore Blvd City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 28262 (b) If donated property is a vehicle (see instructions), check the box. Also enter
the vehicle
identification number (c) Description and condition of donated property Clothing, 6 bags, good used (d) Date of the contribution 2023-02-04 (e) Date acquired by donor (mo., yr.) June 19, 2022 (f) How acquired by donor Inheritance (g) Donor's cost or adjusted basis $8,845.21 (h) Fair market value (see instructions) 6,674.53",8283,17,8283,fdc-bb72804bb5b352cf70e18efe,v11-8283-flat,original,2023,fgen-1545583f0703e34cdb7f21ab,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Form 8283 Noncash Charitable Contributions 2026 OMB No. 1545-0074 Attach one or more Forms 8283 to your tax return if you daimed a total deduction of
over S500 for all contributed property. Department of the Treasury Internal Revenue Service Name(s) shown on your income tax returnGreenway Animal Rescue 9570 Lakeshore Blvd Maplewood, MN 69l14 Section A. Donated Property of $5,000 or Less and Publidy Traded Securities 24-1927986 Identifying number Jordan Romero (a) Name and address of the donee organization ***-**-3948 5treet address (induding apt. no.) 5594 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 33014 Accountnumber (see instructions) XXX-XX-76296l (c) Description and condition of donated propcrty Household fumiture, good condition (d) Date of the contribution August 5, 2023(e) Date
acquíred bydonor (mo., yr.) 12/4/23 (f) How acquired by donor Inheritance (g) Donor's costor adjusted basis $2,353.23 (h) Fair market value (see instructíons) $4,515.25 (i)Method used to determine the fair market value Comparable sales",8283,17,8283,fdc-9911d6b06f7b5c04ae890d39,v11-8283-flat,original,2026,fgen-dffa0fae9a8d4e0a87ffd9c0,synthetic_programmatic_template,flat,top,True,
"Form 8283 Noncash Charitable Contributions For calendar year 2025 OMB No. 1545-0074 Department of the Treasury Internal Revenue Service Name(s) shown on your income tax return St. Brendan Parish 6968 Lakeshore Blvd Cedar
Falls, IA 51861 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 72-6566955 Identifying number Kwame Brennan (a) Name and address of the donee organization ****4762 Account number (see instructions) ****614645 (b) If donated property is a vehicle (see instructions), check
the box. Also enter the vehicle identification number (c) Description and condition of donated property Laptop computer, fair (d) Date of the contribution 2025-08-12 (e) Date acquired by donor (mo., yr.) 2025-01-26 (f) How acquired by donor Inheritance (g) Donor's cost or adjusted basis $7,867.08 (i) Method used to determine the fair market value Appraisal Department of the Treasury - Internal Revenue Service Form 8283 (keep for your records) www.irs.gov/Form8283",8283,17,8283,fdc-ab6da51fd1d2cecf45aa748f,v11-8283-flat,original,2025,fgen-067f92abf0e4b8ae85e2ab6c,synthetic_programmatic_template,flat,top,False,
"Form 8283 Noncash Charitable Contributions 2024 From: Greenway Animal Rescue Recipient's name:
Taylor Romero (d) Date of the contribution 2024-08-03 (e) Date acquired by
donor (mo., yr.) February 23, 2023",8283,17,8283,fdc-abb4413997d8d2b09f74b301,v11-8283-flat,original,2024,fgen-1c4aff831f4c9444dbe860fb,synthetic_programmatic_template,flat,top,False,
"Name(s) shown on your income tax return'S name:
St. Brendan Parish To:
Kwame M. Sato (i) Method used to determine the fair market value Appraisal (e) Date acquired by donor (mo., yr.) 05/25/2023",8283,17,8283,fdc-4372a26cec4b370003d140d4,v11-8283-flat,original,2023,fgen-7eb0715641be64fa9df7ec1a,synthetic_programmatic_template,flat,none,False,
"VOID CORRECTED For calendar year 2023 Attach one or more Forms 8283 to your tax return
if you claimed a total deduction of over $500 for all contributed property. Department of the Treasury
Internal Revenue Service Name(s) shown on your income tax return St. Brendan Parish 850 Maple Ridge Dr Testville, IL 27414 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 33-6279009 Identifying number Diego Walsh (a) Name and address of the donee organization ending in 5764 (c) Description and condition of donated property Clothing, 6 bags, good used (d) Date of the contribution 2022-10-03 (e) Date acquired by donor (mo., yr.) September 9, 2023 (f) How acquired by donor Inheritance (g) Donor's cost or adjusted basis $52.28 (h) Fair market value (see instructions) $8,861.34 (i) Method used to determine the fair market value Appraisal Department of the Treasury - Internal Revenue Service Form 8283 Noncash Charitable Contributions Form 8283 (keep for your records) www.irs.gov/Form8283",8283,17,8283,fdc-1c2207406e18c54bfbf81e5a,v11-8283-flat,original,2023,fgen-c3a878c4c9bd072eeb3968df,synthetic_programmatic_template,flat,bottom,False,
"☐ CORRECTED Form 8283 Noncash Charitable Contributions For
calendar year 2021 OMB No. 1545-0074 Name(s) shown on your income tax return Greenway Animal Rescue 2092 Oak Hollow Ct Riverton, WI 75081 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 64-4133154 Identifying number Noah Rivera (a) Name and address of the donee organization ***-**-6655 Street address (including apt. no.) 6824 Maple Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 72096 Account number (see instructions) ****665094 (b)
If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number (c) Description and condition of donated property Household furniture, good condition (d) Date of the contribution 03/19/2021 (e) Date acquired by donor (mo., yr.) 02/15/2020 (f) How acquired by donor Gift (g) Donor's cost or adjusted basis $2,018.01 (h) Fair market value (see instructions) $9,082.32 (i) Method used to determine the fair market value Comparable sales Department of the Treasury - Internal Revenue Service Form 8283 (keep for your records) www.irs.gov/Form8283",8283,17,8283,fdc-3830733c1a410b132fe27f76,v11-8283-flat,original,2021,fgen-f193f332fe657cace1a4b59e,synthetic_programmatic_template,flat,top,False,
"Name(s) shown on your income tax return: Riverbend Public Library Foundation Recipient's name: Amara Testcase (f) How acquired by donor Purchase (i) Method used
to determine the fair market value Comparable sales (g) Donor's cost or adjusted basis $7,362.52 (c) Description and condition of
donated property Laptop computer, fair",8283,17,8283,fdc-e79566e53078379ab639e04d,v11-8283-flat,original,2021,fgen-bdcd210e60b2d986a35d59c6,synthetic_programmatic_template,flat,none,False,
"Form 8283 Noncash Charitable Contributions 2026 Name(s) shown on your income tax return'S name: Sample Community Food Bank RECIPIENT: Alex C. Moreau (g) Donor's cost or adjusted basis 5,383.48 (f) How acquired by donor Gift (c) Description and condition of donated property Household furniture, good condition (d) Date of the
contribution May 15,
2026",8283,17,8283,fdc-d06bfeb9331bfa26c1b0921f,v11-8283-flat,original,2026,fgen-9128b4a1eb21fd9a8bf560a2,synthetic_programmatic_template,flat,top,False,
"Form 8283 Noncash Charitable Contributions 2026 Department of the Treasury Internal Revenue Service Name(s) shown on your income tax return
Hope Harbor Shelter 4204 Granite St Fairview, OH 87049 Section A. Donated Property of $5,000 or Less and Publicly Traded Securities 49-2587175 Identifying number Amara Nguyen (a) Name and address of the donee organization ***-**-6351 Street address (including apt. no.) 6402 Sample Street City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 72841 (c) Description and condition of donated property Laptop computer, fair (d) Date of the contribution November 13, 2023 (e) Date acquired by donor (mo., yr.) 3/5/25 (f) How acquired by donor Purchase (g) Donor's cost or adjusted basis $788.55 (h) Fair
market value (see instructions) 2,765.84 (i) Method used to determine the fair market value Comparable sales Department of the Treasury - Internal Revenue Service Form 8283 (keep for your records) www.irs.gov/Form8283",8283,17,8283,fdc-963401d619a6af75ce3b50b1,v11-8283-flat,original,2026,fgen-19288e884d790b680d39d976,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED
For calendar year 2025
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | Riverbend Public Library Foundation 374 Lakeshore Blvd Riverton, WI 39918 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 96-5996855 |
| Identifying number | Amara J. Sato |
| (a) Name and address of the donee organization | XXXXX0301 |
| Street address (including apt. no.) | 8085 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 50968 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Clothing, 6 bags, good used |
| (d) Date of the contribution | August 22, 2025 |
| (f) How acquired by donor | Inheritance |
| (g) Donor's cost or adjusted basis | 3,349.67 |
| (h) Fair market value (see instructions) | $2,321.38 |
| (i) Method used to determine the fair market value | Comparable sales |
## Form 8283
Noncash Charitable Contributions",8283,17,8283,fdc-f7f2a81e8e6d4e291116aa06,v11-8283-markdown,original,2025,fgen-e68322b854869d87b9264fc8,synthetic_programmatic_template,markdown,bottom,False,
"## Form 8283
Noncash Charitable Contributions
## For calendar year 2022
OMB No. 1545-0074
Attach onc or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for allcontributed property.
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | Sample Community Food Bank 4483Sample Street Pinecrest, GA 17208 |
| Section A. Donated Property of $5,000 or Less and Pub1idy Traded Securities | 74-4464795 |
| Identífying number| Jordan Sato |
| (a) Name and address of the donee organization | ****7506 |
| Strcet address (inc1uding apt. no.) | 8409 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside,WA 92578 |
| (b) If donatcd property is a vehide (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Househo1d fumiture, good condition |
| (d) Date of the contributíon | 1/9/22 |
|(f) How acquired by donor |Gift |
| (g) Donor's cost or adjusted basis | 6,831.47 |
| (h) Fair market va1ue (see instructions) | 7,808.49 |
|(i) Mcthod used to determine the fair market value | Comparablesales |
## Department of the Treasury - Intemal Rcvenue 5ervice
Form 8283 (keep for your records)  www.írs.gov/Form8283",8283,17,8283,fdc-c89e911eba2e3e6a66265b2a,v11-8283-markdown,original,2022,fgen-134cc0b1e9b82d2495582a1a,synthetic_programmatic_template,markdown,top,True,
"Form 8283
Noncash Charitable Contributions
OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | St. Brendan Parish 5661 Elm Park Pl Maplewood, MN 41556 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 22-7931455 |
| Identifying number | Sofia Nguyen |
| (a) Name and address of the donee organization | XXX-XX-9217 |
| Street address (including apt. no.) | 316 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 76526 |
| Account number (see instructions) | ending in 505958 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Clothing, 6 bags, good used |
| (d) Date of the contribution | October 27, 2021 |
| (e) Date acquired by donor (mo., yr.) | 10/15/2020 |
| (f) How acquired by donor | Inheritance |
| (g) Donor's cost or adjusted basis | $7,435.75 |
| (h) Fair market value (see instructions) | $1,656.38 |
| (i) Method used to determine the fair market value | Appraisal |
Department of the Treasury - Internal Revenue Service
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-a5e8527fcc376f55c2f5a5cf,v11-8283-markdown,original,2021,fgen-5c8fe00bf98579bec95817dd,synthetic_programmatic_template,markdown,top,False,
"Form 8283
## Noncash Charitable Contributions
## 2024
OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | Riverbend Public Library Foundation 4043 Oak Hollow Ct Testville, IL 80665 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 64-1155681 |
| Identifying number | Jordan R. Sato |
| (a) Name and address of the donee organization | ***-**-2054 |
| Account number (see instructions) | XXX-XX-419896 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Household furniture, good condition |
| (d) Date of the contribution | 8/28/23 |
| (e) Date acquired by donor (mo., yr.) | December 6, 2021 |
| (f) How acquired by donor | Gift |
| (g) Donor's cost or adjusted basis | $3,940.22 |
| (h) Fair market value (see instructions) | $3,962.73 |
| (i) Method used to determine the fair market value | Appraisal |",8283,17,8283,fdc-ed3ccc43d65c964d304dcf17,v11-8283-markdown,original,2024,fgen-89d906e2f22edbdc001e8090,synthetic_programmatic_template,markdown,top,False,
"Form 8283
Noncash Charitable Contributions
For calendar year 2021
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | ---|
| Name(s) shown on your income tax return | 5t. Brendan Parish 4412Prairie Ave Lakewood, C0 19159 |
| Section A. Donated Property of S5,000 or Less and Publicly Traded Securities | 30-977593l |
| Identifying number | Taylor S. Adeyemi |
| (a) Name and address of the donee organization | XXX-XX-3171 |
| Street address (includingapt. no.) | 2669 Willow Bend Way |
| City or town, state or province, country, and ZIPor foreign postal code | 0ak Grove, TX 43278 |
| (b) If donated property is a vchide (see instructions), check the box. A1so enter the vehicle identification number |  |
| (c) Description and condition of donated property | C1othing, 6 bags, good used |
| (d)Date of the contribution | O1/23/2O18 |
| (e) Date acquircd by donor (mo., yr.) | December 26, 2021 |
| (f) How acquiredby donor | Gift |
| (g) Donor's cost or adjusted basis | $8,644.45 |
| (i) Method usedto determine the fair market va1ue |Appraisal |
## Department of the Treasury - Intemal Revenue 5ervice
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-1b56f85774582218b01e850f,v11-8283-markdown,original,2021,fgen-6c8dbd83f2497712c4a7a3e3,synthetic_programmatic_template,markdown,top,True,
"## Form 8283
## Noncash Charitable Contributions
2O25
OMB No. 1545-0074
## Attach one or more Forms 8283 to your tax rcturn if you daimed a total deductíon of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on yourincome tax retum | St.BrendanParish 4950 Elm Park PlBayside, WA 42511 |
| Section A. DonatedProperty of $5,000 or Less and Publicly Traded Securities | 39-6420l74 |
|Identifying number | Lena K. Patel |
| (a) Name and address of the donee organization | XXXXX6884 |
| Street address (induding apt. no.) | 9681 Sample Street |
| Cíty or town, state or province, country, and ZIP or foreign postal code | Testvílle, IL 45736 |
| Account number (see ínstructions) | ***-**-72l998 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehide identification number |  |
| (c) Descriptíon and condition of donated property | Clothing, 6 bags, good used |
| (e) Date acquired by donor (mo., yr.) | 2024-03-25 |
| (g) Donor's cost or adjusted basis| $l,190.60 |
| (h) Fair market va1ue (see instructions) | $9,078.87 |
| (i) Methodused to determine the fair market va1ue | Thrift shop value |
Department of the Treasury - Internal Revenue 5ervice
## Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-f1fbdbe4fcf089c5ed9b3aca,v11-8283-markdown,original,2025,fgen-f7fb5d7e18b28a363c57a291,synthetic_programmatic_template,markdown,top,True,
"For calendar year 2022
OMB No. 1545-0074
## Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | Greenway Animal Rescue 4804 Elm Park Pl Bayside, WA 10164 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 21-6100841 |
| Identifying number | Mateo Lindqvist |
| (a) Name and address of the donee organization | XXX-XX-9237 |
| Street address (including apt. no.) | 8657 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 40849 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Clothing, 6 bags, good used |
| (d) Date of the contribution | 10/04/2022 |
| (e) Date acquired by donor (mo., yr.) | 07/27/2019 |
| (f) How acquired by donor | Inheritance |
| (g) Donor's cost or adjusted basis | 1,000.83 |
| (h) Fair market value (see instructions) | 2,899.38 |
| (i) Method used to determine the fair market value | Appraisal |
Department of the Treasury - Internal Revenue Service
Form 8283
Noncash Charitable Contributions
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-dfce637a987c17833b23a5ff,v11-8283-markdown,original,2022,fgen-e363fa691c3fca0f8bd185c3,synthetic_programmatic_template,markdown,bottom,False,
"Form 8283
Noncash Charitable Contributions
## For calendar year 2021
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | St. Brendan Parish 1175 Willow Bend Way Cedar Falls, IA 46129 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 73-5925541 |
| Identifying number | Jordan Nguyen |
| (a) Name and address of the donee organization | ****4219 |
| Street address (including apt. no.) | 2266 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 53234 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Clothing, 6 bags, good used |
| (e) Date acquired by donor (mo., yr.) | 1/3/21 |
| (f) How acquired by donor | Purchase |
| (g) Donor's cost or adjusted basis | $7,621.76 |
| (h) Fair market value (see instructions) | $1,220.79 |
| (i) Method used to determine the fair market value | Appraisal |",8283,17,8283,fdc-a4fccaa0b7abc0509b1b1d35,v11-8283-markdown,original,2021,fgen-984b0704105612cb71a13979,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-0074
Attach one or more Forms 8283 to your tax return if you claimed a total deduction of over $500 for all contributed property.
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | Riverbend Public Library Foundation 4785 Cedar Ln Bayside, WA 32109 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 58-2895161 |
| Identifying number | Jamie Romero |
| (a) Name and address of the donee organization | XXXXX8454 |
| Street address (including apt. no.) | 889 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 15809 |
| Account number (see instructions) | ending in 818729 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Clothing, 6 bags, good used |
| (d) Date of the contribution | June 15, 2023 |
| (e) Date acquired by donor (mo., yr.) | 2023-05-01 |
| (f) How acquired by donor | Gift |
| (g) Donor's cost or adjusted basis | 3,619.34 |
| (i) Method used to determine the fair market value | Appraisal |
## Department of the Treasury - Internal Revenue Service
Form 8283
Noncash Charitable Contributions
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-2768b683214705a1cfae60ea,v11-8283-markdown,original,2024,fgen-98e9efa67eb4eff7b7c647f4,synthetic_programmatic_template,markdown,bottom,False,
"Form 8283
## Noncash Charitable Contributions
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | Greenway Animal Rescue 9667 Prairie Ave Maplewood, MN 66410 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 14-2932059 |
| Identifying number | Hiro Nguyen |
| (a) Name and address of the donee organization | XXX-XX-3519 |
| Street address (including apt. no.) | 6589 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 62754 |
| Account number (see instructions) | ending in 300052 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (d) Date of the contribution | 05/27/2021 |
| (e) Date acquired by donor (mo., yr.) | May 1, 2018 |
| (g) Donor's cost or adjusted basis | $7,867.79 |
| (h) Fair market value (see instructions) | 5,221.45 |
| (i) Method used to determine the fair market value | Appraisal |",8283,17,8283,fdc-c6a2fc089b9a3a1f93cbbc47,v11-8283-markdown,original,2021,fgen-6c551081f8c46d5090fc5298,synthetic_programmatic_template,markdown,top,False,
"2025
## OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | Riverbend Public Library Foundation 6983 Sample Street Cedar Falls, IA 46333 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 61-3008088 |
| Identifying number | Noah Moreau |
| (a) Name and address of the donee organization | ***-**-5853 |
| Street address (including apt. no.) | 2030 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 25300 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Laptop computer, fair |
| (e) Date acquired by donor (mo., yr.) | 07/26/2022 |
| (f) How acquired by donor | Inheritance |
| (g) Donor's cost or adjusted basis | 8,178.84 |
| (h) Fair market value (see instructions) | 5,356.01 |
| (i) Method used to determine the fair market value | Comparable sales |
Department of the Treasury - Internal Revenue Service
Form 8283
## Noncash Charitable Contributions
## Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-d52f7a34e439c9dc23a4626c,v11-8283-markdown,original,2025,fgen-27eb918605f804ae7216727e,synthetic_programmatic_template,markdown,bottom,False,
"Form 8283
Noncash Charitable Contributions
2025
## 0MB No. 1545-0074
## Attach one or more Forms 8283 to your tax return if you daimed a total deduction of over S500 forall contributed property.
Department of the TreasuryInternal Revenue Service
| Field | Value |
|--- | --- |
| Namc(s) shown on your income tax return | Samplc Community Food Bank 6345 Harbor View Rd Lakewood, CO 60624 |
| Section A. Donatcd Property of $5,000 or Less and Publidy Tradcd Securities |65-6966554 |
| Idcntifying number | Amara Rivera |
| (a) Name and address of the donee organization | ending in 8010 |
| 5treet address (induding apt. no.) | l579 Willow Bend Way |
| City or town, state or province, country, and ZIP or forcign postal code| Riverton, WI 60742 |
| Account number (see instructions) | ***-**-468464 |
| (c) Description and condition of donated property | Clothíng, 6 bags, good used |
| (d) Date of the contribution |2/10/24 |
| (e) Date acquired by donor (mo., yr.) | 5/13/22 |
| (f) How acquired by donor | Gift |
| (g) Donor's cost or adjusted basis | $1,496.85 |
| (h) Faír marketvalue (see instructíons) | $1,559.80 |
| (i) Methodused to determine the fair market value | Comparable sales |",8283,17,8283,fdc-c659c5e73681a3b681df2975,v11-8283-markdown,original,2025,fgen-592bc4000fce99e33a407b37,synthetic_programmatic_template,markdown,top,True,
"Form 8283
Noncash Charitable Contributions
## Department of the Treasury Interna1 Revenue Service
| Field | Value|
| --- | --- |
| Name(s) shown on your income tax retum | Hope Harbor Shelter 156Sample Street Pinecrest, GA 42481 |
| Section A. Donated Property of S5,000 or Less and Publicly Traded Securities | 18-8966705 |
|Identifying numbcr | Alex Fischer |
| (a) Name and address of the donee organization | ending in 9460 |
|Account number (see instructions) | XXXXX9890l9 |
| (b) If donated property is a vehicle (see instructions), check thebox. A1so enter the vehicle identificationnumber |  |
| (c) Description and condítion of donated property | Clothing, 6 bags, good used |
| (d) Date of the contribution | 04/04/20l9 |
| (e) Date acquired by donor (mo., yr.) | 06/22/20l9 |
| (f) How acquired by donor | Gift |
|(g) Donor's cost or adjusted basis | $8,363.27 |
| (h) Fair market value (see instructions) | 2,103.84 |
| (i) Method used to determine the fair market value | Thrift shop value |
Department of the Treasury - Intemal Revenue 5ervice
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-013c903558c0605ef2540f47,v11-8283-markdown,original,2022,fgen-712b22cebb9c7c5e83db4ec8,synthetic_programmatic_template,markdown,top,True,
"| Field | Value |
| --- | --- |
| From: | Hope Harbor Shelter |
| RECIPIENT: | Jordan Castillo |
| (d) Date of the contribution | 12/15/22 |
Form 8283 Noncash Charitable Contributions",8283,17,8283,fdc-fd345c90782ea506a16ab73f,v11-8283-markdown,original,2022,fgen-139842fd5862c26ed5e5aa14,synthetic_programmatic_template,markdown,bottom,False,
"Form 8283 Noncash Charitable Contributions
| Field | Value |
| --- | --- |
| From: | St. Brendan Parish |
| Recipient's name: | Amara L. Rivera |
| (d) Date of the contribution | 2025-05-07 |",8283,17,8283,fdc-5937fd57e391baf154fb1841,v11-8283-markdown,original,2026,fgen-b45a1866ead4dc7033fb8dcc,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
2025
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on your income tax return | St. Brendan Parish 4293 Sample Street Bayside, WA 23515 |
| Section A. Donated Property of $5,000 or Less and Publicly Traded Securities | 74-7509211 |
| Identifying number | Olivia A. Walsh |
| (a) Name and address of the donee organization | ending in 8978 |
| Account number (see instructions) | XXXXX192062 |
| (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle identification number |  |
| (c) Description and condition of donated property | Laptop computer, fair |
| (d) Date of the contribution | February 4, 2025 |
| (e) Date acquired by donor (mo., yr.) | 10/28/2024 |
| (f) How acquired by donor | Inheritance |
| (g) Donor's cost or adjusted basis | $8,165.65 |
| (h) Fair market value (see instructions) | 4,939.56 |
| (i) Method used to determine the fair market value | Comparable sales |
## Department of the Treasury - Internal Revenue Service
Form 8283
## Noncash Charitable Contributions
Form 8283 (keep for your records)  www.irs.gov/Form8283",8283,17,8283,fdc-ddd2a0eab4b30a73b1612406,v11-8283-markdown,original,2025,fgen-f735ef966e482921ab00fae0,synthetic_programmatic_template,markdown,bottom,False,
"CORRECTED (if checked)
2023
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Avery Larsen
Social security number or taxpayer identification number
4019 Maple Ridge Dr Bayside, WA 51034
Part I Short-Term.
***-**-7839
Part II Long-Term.
(a) Description of property
VOO
(b) Date acquired
2023-10-21
(c) Date sold or disposed of
12/11/2023
(d) Proceeds (sales price)
5,590.93
(e) Cost or other basis
129,663.56",8949,22,8949,fdc-7f78c958610fbf63abb7e174,v11-8949-stacked,original,2023,fgen-79c90655d2f9863a2b75d7b0,synthetic_programmatic_template,stacked,none,False,
"VOID  CORRECTED
For calendar year 2021
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Kwame Kowalski
Social security number or taxpayer identification number
9008 Elm Park Pl Maplewood, MN 97507
Part I Short-Term.
***-**-0882
Part II Long-Term.
(a) Description of property
VTI
(b) Date acquired
11/26/21
(c) Date sold or disposed of
August 26, 2021
(d) Proceeds (sales price)
$104,793.51
(e) Cost or other basis
$23,237.15
Department of the Treasury - Internal Revenue Service",8949,22,8949,fdc-368fca6eff2b3e420880df85,v11-8949-stacked,original,2021,fgen-e7a6dfd7eb53fb6eb7c54060,synthetic_programmatic_template,stacked,none,False,
"VOID  CORRECTED
Form 8949
Sales and Other Dispositions of Capital Assets
2025
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Priya A. Adeyemi
Social security number or taxpayer identification number
1641 Elm Park Pl Pinecrest, GA 76961
Part I Short-Term.
***-**-0903
Part II Long-Term.
(a) Description of property
MSFT
(b) Date acquired
2024-04-09
(c) Date sold or disposed of
1/15/25
(e) Cost or other basis
12,774.85
(h) Gain or (loss)
(6,837.44)
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-1482b8f32e3a7e4722a176e6,v11-8949-stacked,original,2025,fgen-a4f3ea05f0a29584059bcd85,synthetic_programmatic_template,stacked,top,False,
"Form8949
Sales and Other Dispositions of Capital Assets
2024
Attach toyour Schedu1e D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of 5chedule D.
Department of the Treasury Internal Revenue Servíce
Name(s) shown on return
Avery Walsh
Social security numberor taxpayer identification number
2604 Cedar Ln Cedar Falls, IA 19828
Part I Short-Term.
***-**-3437
Part II Long-Term.
(a) Description of property
VOO
(b) Date acquired
June 24, 2O21
(c) Date sold or disposed of
2024-03-07
(d) Proceeds (sales price)
S50,194.94
(e) Cost or other basis
38,190.02
(h) Gain or (loss)
13,010.48
Department of the Treasury - Internal Revenue 5ervice
Form 8949 (keep for your rccords)  www.irs.gov/Form8949",8949,22,8949,fdc-1842d6596ed8f032c53661ee,v11-8949-stacked,original,2024,fgen-bc6059a6be2463ad9c25d67c,synthetic_programmatic_template,stacked,top,True,
"Form 8949
Sales and Other Dispositions of Capital Assets
2026
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Lena M. Castillo
Social security number or taxpayer identification number
639 Harbor View Rd Pinecrest, GA 45977
Part I Short-Term.
ending in 4041
Part II Long-Term.
(b) Date acquired
February 1, 2026
(c) Date sold or disposed of
2025-02-17
(e) Cost or other basis
$3,848.46
(h) Gain or (loss)
10,630.98",8949,22,8949,fdc-72726aea517f4509f0353455,v11-8949-stacked,original,2026,fgen-dd32d535aa3aed2ec9052d3f,synthetic_programmatic_template,stacked,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
2024
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return
Priya Testcase
Social security number or taxpayer identification number
8461 Granite St Riverton, WI 54719
Part I Short-Term.
ending in 3552
Part II Long-Term.
(a) Description of property
SCHD
(b) Date acquired
2/14/24
(c) Date sold or disposed of
2023-07-27
(d) Proceeds (sales price)
$97,060.44
(e) Cost or other basis
56,541.18
(h) Gain or (loss)
23,586.57
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-fabe089dd599607ac8fbfb19,v11-8949-stacked,original,2024,fgen-9d8aa213ae2cdca73a2ecff3,synthetic_programmatic_template,stacked,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2023
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Wei B. Fischer
Social security number or taxpayer identification number
1770 Cedar Ln Testville, IL 93423
Part I Short-Term.
XXX-XX-2942
Part II Long-Term.
(a) Description of property
50 SH NORTHWIND INC
(b) Date acquired
06/07/2023
(c) Date sold or disposed of
01/11/2020
(d) Proceeds (sales price)
66,514.45
(e) Cost or other basis
$101,546.32
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-4d07bd08c6d4bb7f69dc1f01,v11-8949-stacked,original,2023,fgen-ed1e6a534d838b37a3a3bbc7,synthetic_programmatic_template,stacked,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2024
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Taylor Nguyen
Social security number or taxpayer identification number
524 Cedar Ln Oak Grove, TX 26890
Part I Short-Term.
****2866
Part II Long-Term.
(a) Description of property
VTI
(b) Date acquired
2/3/21
(d) Proceeds (sales price)
$91,649.26
(e) Cost or other basis
$126,888.43
(h) Gain or (loss)
25,442.77
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-5d9994c988b6a4fd4c0368f9,v11-8949-stacked,original,2024,fgen-890995a50a9a9951d52a6c25,synthetic_programmatic_template,stacked,top,False,
"Form 8949 Sales and Other Dispositions of Capital Assets
Name:
Noah Haddad
(c) Date sold or disposed of
3/23/21
(b) Date acquired
April 19, 2019",8949,22,8949,fdc-424dbf9226df730e5fb8d554,v11-8949-stacked,original,2022,fgen-bd08f5280d11ea6d4fbb364e,synthetic_programmatic_template,stacked,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2025
OMB No. 1545-0074
Name(s) shown on return
Wei Romero
Social security number or taxpayer identification number
5576 Oak Hollow Ct Testville, IL 30263
Part I Short-Term.
XXX-XX-4707
Part II Long-Term.
(a) Description of property
100 SH ACME CORP
(b) Date acquired
June 6, 2022
(c) Date sold or disposed of
10/3/25
(e) Cost or other basis
$135,870.29
(h) Gain or (loss)
3,185.43
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-e4044512710b4483fe738e81,v11-8949-stacked,original,2025,fgen-1304e11985e4ff06f51c797c,synthetic_programmatic_template,stacked,top,False,
"2025
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Amara Romero
Social security number or taxpayer identification number
9246 Granite St Bayside, WA 31967
Part I Short-Term.
XXX-XX-9967
Part II Long-Term.
(a) Description of property
VOO
(b) Date acquired
2025-04-08
(c) Date sold or disposed of
04/20/2024
(e) Cost or other basis
$136,019.22
(h) Gain or (loss)
7,000.84
Department of the Treasury - Internal Revenue Service
Form 8949
Sales and Other Dispositions of Capital Assets
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-f9f9c065fe210bee29613c09,v11-8949-stacked,original,2025,fgen-c1a003adac989af0630807eb,synthetic_programmatic_template,stacked,bottom,False,
"CORRECTED (if checked)
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return
Diego Okafor
Social security number or taxpayer identification number
452 Harbor View Rd Bayside, WA 83174
Part I Short-Term.
****3721
Part II Long-Term.
(a) Description of property
100 SH ACME CORP
(b) Date acquired
2023-05-18
(c) Date sold or disposed of
04/03/2023
(h) Gain or (loss)
15,737.83
Department of the Treasury - Internal Revenue Service
Form 8949
Sales and Other Dispositions of Capital Assets
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-7dab6138cb672713c8945485,v11-8949-stacked,original,2026,fgen-8009e5b46feb6f0f7112d082,synthetic_programmatic_template,stacked,bottom,False,
"Form 8949 Sales and Other Dispositions of Capital Assets
Name:
Sofia Nguycn
(a) Description of property
50 SH NORTHWINDINC
(e) Cost or other basis
S101,932.38",8949,22,8949,fdc-56aa24c7bc9b2ad54d91b1f6,v11-8949-stacked,original,2026,fgen-06d40b085e49b3c02dda93db,synthetic_programmatic_template,stacked,top,True,
"Form 8949
Sales and Other Dispositions of Capital Assets
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return
Diego Okafor
Social security number or taxpayer identification number
8984 Oak Hollow Ct Testville, IL 49873
Part I Short-Term.
XXXXX1157
Part II Long-Term.
(a) Description of property
MSFT
(b) Date acquired
September 6, 2022
(c) Date sold or disposed of
10/14/21
(d) Proceeds (sales price)
$9,019.37
(e) Cost or other basis
$114,476.91
(h) Gain or (loss)
(247.00)",8949,22,8949,fdc-2432f7785737ce60b6e29a9c,v11-8949-stacked,original,2022,fgen-93f03329781394a263506618,synthetic_programmatic_template,stacked,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
2022
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Hiro C. Sato
Social security number or taxpayer identification number
237 Oak Hollow Ct Pinecrest, GA 40051
Part I Short-Term.
XXX-XX-7052
Part II Long-Term.
(a) Description of property
AAPL
(b) Date acquired
2021-11-18
(c) Date sold or disposed of
11/15/2019
(d) Proceeds (sales price)
$98,634.44
(e) Cost or other basis
$10,423.64
(h) Gain or (loss)
5,476.07
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-d64519398ca72921d8214db5,v11-8949-stacked,original,2022,fgen-d9e51be260a094aaa41b2f3e,synthetic_programmatic_template,stacked,top,False,
"Name:
Mateo Larsen
(h) Gain or (loss)
5,876.75
(d) Proceeds (sales price)
$70,969.40
(c) Date sold or disposed of
06/08/2023
(b)Date acquired
June 7, 2026",8949,22,8949,fdc-2a660538384b230e8d7df9ed,v11-8949-stacked,original,2026,fgen-979fbdc9af3b1b303ca79f98,synthetic_programmatic_template,stacked,none,True,
"Form 8949 Sales and Other Dispositions of Capital Assets 2025
Name:   Hiro Moreau
(d) Proceeds (sales price)  50,116.62
(a) Description of property      VTI
(e) Cost or other basis      $67,148.35",8949,22,8949,fdc-d4fdcb84ed3139f28997a938,v11-8949-inline,original,2025,fgen-5750737111553f6e2282cea3,synthetic_programmatic_template,inline,top,False,
"For calendar year 2026
OMB No. 1545-0074
Attach to your Schedule D to líst your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on retum      Riley A. Romero
Social security number or taxpayer identification number 3595 Maple Ridge Dr Bayside, WA45728
Part I 5hort-Term. endingin 84l2
Part II Long-Term.
(a) Description of property   5CHD
(b) Date acquired      O8/l3/2O23
(c) Date sold or disposedof      February 19, 2026
(d) Proceeds (sa1es price) $17,328.47
(e) Cost or other basis      101,838.91
(h) Gain or (loss)     29,282.24
Department of the Treasury - Internal Revenue Service",8949,22,8949,fdc-3898f18ef74a083945279b5d,v11-8949-inline,original,2026,fgen-8bcbfd724642d27397631e2d,synthetic_programmatic_template,inline,none,True,
"Form 8949 Sales and Other Dispositions of Capital Assets 2022
Name:      Taylor D. Fischer
(a) Description of property   MSFT
(c) Date sold or disposed of   2022-07-04
(e) Cost or other basis 43,463.27
(d) Proceeds (sales price) 4,480.44",8949,22,8949,fdc-0a8293ec82da86d64056a55b,v11-8949-inline,original,2022,fgen-da717f4034a662232520338d,synthetic_programmatic_template,inline,top,False,
"2026
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return      Kwame Brennan
Social security number or taxpayer identification number      4942 Cedar Ln Cedar Falls, IA 61736
Part I Short-Term.   ending in 5670
Part II Long-Term.
(a) Description of property MSFT
(b) Date acquired   2025-05-09
(c) Date sold or disposed of      6/2/25
(e) Cost or other basis   82,653.24
(h) Gain or (loss) 20,452.15",8949,22,8949,fdc-8432768a8fbeadc8e1d3cb92,v11-8949-inline,original,2026,fgen-ab6d2f6072e7f093b6bd01e4,synthetic_programmatic_template,inline,none,False,
"☐ CORRECTED
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return Diego Rivera
Social security number or taxpayer identification number   6820 Oak Hollow Ct Bayside, WA 91573
Part I Short-Term.      ***-**-2389
Part II Long-Term.
(a) Description of property   BND
(b) Date acquired      2018-07-09
(c) Date sold or disposed of      03/28/2021
(d) Proceeds (sales price)  25,159.07
(e) Cost or other basis   62,979.03
(h) Gain or (loss)   -6,934.82
Form 8949
Sales and Other Dispositions of Capital Assets",8949,22,8949,fdc-f2789b1dd6ef8dc0530b61da,v11-8949-inline,original,2021,fgen-0b6cfcaa37428c96fc58609d,synthetic_programmatic_template,inline,bottom,False,
"Form 8949 Sales and Other Dispositions of Capital Assets 2025
Name:  Hiro Rivera
(e) Cost or other basis  $51,978.31
(h) Gain or (loss)   18,633.20",8949,22,8949,fdc-ec28adf28b38e95542d35d10,v11-8949-inline,original,2025,fgen-845402215cd8dc77ca1082c9,synthetic_programmatic_template,inline,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
2024
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on return      Kwame R. Moreau
Social security number or taxpayer identification number  2371 Sample Street Bayside, WA 31127
Part I Short-Term. ending in 7357
Part II Long-Term.
(a) Description of property VTI
(b) Date acquired   November 7, 2023
(c) Date sold or disposed of   2023-06-08
(d) Proceeds (sales price)  82,299.35
(e) Cost or other basis      $95,686.48
(h) Gain or (loss)   (4,860.60)
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-ab49c72a237de8089e61e8c2,v11-8949-inline,original,2024,fgen-2de8c6ba4499308dad128bc4,synthetic_programmatic_template,inline,top,False,
"Name:      Príya Larsen
(h) Gain or (loss)   2,854.95
(a) Description of property 50 SH NORTHWIND INC
(d) Proceeds (sales price)   $93,313.08
Form 8949 Sales and Other Díspositions of CapitalAssets",8949,22,8949,fdc-d5c75c874dd626ee8109ce4c,v11-8949-inline,original,2026,fgen-1f650ccdce0abda5eb52f55d,synthetic_programmatic_template,inline,bottom,True,
"☐ CORRECTED
Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2023
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return  Avery Okafor
Social security number or taxpayer identification number 837 Oak Hollow Ct Lakewood, CO 84549
Part I Short-Term.      ending in 9352
Part II Long-Term.
(b) Date acquired      06/03/2020
(c) Date sold or disposed of   2022-05-27
(e) Cost or other basis  $36,757.15
(h) Gain or (loss)  -142.42",8949,22,8949,fdc-3b2187a1460a10830064820f,v11-8949-inline,original,2023,fgen-78f0b93381dc12874e11ac0d,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
For calendar year 202l
Attach to your Schedule D to list your transactionsfor lines lb, 2, 3, 8b, 9, and 1O of Schedule D.
Name(s) shown on retum Wei Lindqvist
Social security number or taxpayer identification number  8086 Lakeshore Blvd Lakewood, CO 10554
Part I Short-Term.      ***-**-3102
Part II Long-Term.
(a) Descríptíon of property      SCHD
(b) Date acquired September 8, 2Ol8
(c) Date sold or disposed of  9/26/21
(d) Proceeds (sales price) $86,682.95
(e) Cost or other basis $l16,628.74
(h) Gain or (loss) 26,16O.59
Department of the Treasury -Internal Revenue Service
Form 8949
Sales and OtherDispositions of Capital Assets
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-02e701e79f8e7e80811bb1bc,v11-8949-inline,original,2021,fgen-ad617ac3dc0a368381276308,synthetic_programmatic_template,inline,bottom,True,
"CORRECTED (if checked)
Form 8949
Sales and Other Dispositions of Capital Assets
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return      Jordan Adeyemi
Social security number or taxpayer identification number  7106 Elm Park Pl Oak Grove, TX 63943
Part I Short-Term.   XXX-XX-7307
Part II Long-Term.
(b) Date acquired      03/12/2025
(c) Date sold or disposed of   December 25, 2025
(e) Cost or other basis  $33,571.58
(h) Gain or (loss)   (5,064.84)",8949,22,8949,fdc-2d9cfbac5fe0ad931520627c,v11-8949-inline,original,2025,fgen-74b7adfeca730e869e18cf59,synthetic_programmatic_template,inline,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
2022
Name(s) shown on return  Mateo Haddad
Social security number or taxpayer identification number 3803 Elm Park Pl Lakewood, CO 38486
Part I Short-Term.      ***-**-8088
Part II Long-Term.
(a) Description of property BND
(b) Date acquired   January 1, 2021
(c) Date sold or disposed of      2019-11-08
(d) Proceeds (sales price)   $128,502.38
(e) Cost or other basis  $72,065.55
(h) Gain or (loss)   29,612.37
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-66837f061d19b29ff68f6829,v11-8949-inline,original,2022,fgen-31caf2fe9798645117ba1138,synthetic_programmatic_template,inline,top,False,
"Form 8949 Sales and Other Dispositions of Capital Assets 2021
Name:      Sofia A. Sato
(c) Date soldor disposed of      0ctober 4, 2020
(a) Description of property      VOO
(d) Proceeds (sa1es price) S111,692.73",8949,22,8949,fdc-a07764f16fff0216d59b9c9e,v11-8949-inline,original,2021,fgen-4362ce2982a9bd1fd80a9da8,synthetic_programmatic_template,inline,top,True,
"☐ CORRECTED
Form 8949
Sales and Other Dispositions of Capital Assets
2022
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return Hiro Tanaka
Social security number or taxpayer identification number 8303 Lakeshore Blvd Riverton, WI 99372
Part I Short-Term.  XXXXX2337
Part II Long-Term.
(a) Description of property FXAIX
(b) Date acquired 11/15/19
(c) Date sold or disposed of  4/5/19
(d) Proceeds (sales price) $58,106.35
(e) Cost or other basis $74,020.14
(h) Gain or (loss)  1,094.76
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-dda089ec29985311e0052928,v11-8949-inline,original,2022,fgen-9cf45f574605570022105298,synthetic_programmatic_template,inline,top,False,
"Name:   Noah Lindqvist
(d) Proceeds (sales price)      $30,758.77
(e) Cost or other basis   29,704.72",8949,22,8949,fdc-3abd0043766b0993e1893415,v11-8949-inline,original,2025,fgen-9072e984a7c7adfd2dbf3536,synthetic_programmatic_template,inline,none,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2021
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return      Olivia B. Tanaka
Social security number or taxpayer identification number 177 Maple Ridge Dr Brookhaven, PA 73107
Part I Short-Term. ending in 7056
Part II Long-Term.
(a) Description of property SCHD
(b) Date acquired March 14, 2021
(c) Date sold or disposed of   2021-12-10
(d) Proceeds (sales price)      $16,967.14
(h) Gain or (loss)      10,298.06",8949,22,8949,fdc-4839f6e77da3c4ad04a4f3a2,v11-8949-inline,original,2021,fgen-319c368fce1496acc6ee0a0d,synthetic_programmatic_template,inline,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2025
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Morgan Lindqvist
994 Sample Street Oak Grove, TX 13463
XXX-XX-8977
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Date sold or disposed of
(e) Cost or other basis
(h) Gain or (loss)
VOO
10/24/22
09/15/2025
20,781.23
6,622.75
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-55f9fe3871bed5340728b1aa,v11-8949-columns,original,2025,fgen-da02d6cc32f2998360b71db2,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
2026
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Jamíe Haddad
3332 Granite St Riverton, WI 24653
ending in l444
Part II Long-Term.
(b) Date acquired
(c) Date so1d or disposed of
(d) Proceeds (sales price)
(e) Cost or othcr basis
(h) Gain or (loss)
O6/26/2026
11/20/2023
9,206.36
88,265.03
16,815.29
Dcpartment of the Treasury - Internal Revenue Service
Form 8949
Sales and Other Dispositions of Capital Assets
Form8949 (keepfor your records)  www.irs.gov/Form8949",8949,22,8949,fdc-6adcc38cb68a1518b50fac96,v11-8949-columns,original,2026,fgen-2dad98c1a81ff5c099952a97,synthetic_programmatic_template,columns,bottom,True,
"Form 8949
Sales and Other Dispositionsof Capital Assets
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedu1e D.
Name(s) shown on return
5ocial security number or taxpayer identification number
Part I 5hort-Term.
Olivia B. Sato
8O57 Granite St Cedar Falls, IA 63238
****4230
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Datesold or disposed of
(d) Proceeds (sales príce)
(e) Cost or other basis
(h) Gain or (loss)
50 SH NORTHWIND INC
02/05/2024
09/l1/2025
74,830.90
77,351.90
11,250.13",8949,22,8949,fdc-6481d2d494f0c5b96c715f31,v11-8949-columns,original,2025,fgen-52ff439d6bd53573ffc99dac,synthetic_programmatic_template,columns,top,True,
"Form 8949
Sales and Other Dispositions of Capital Assets
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Noah Tanaka
9763 Lakeshore Blvd Pinecrest, GA 86973
****9648
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Date sold or disposed of
(d) Proceeds (sales price)
(e) Cost or other basis
(h) Gain or (loss)
FXAIX
March 4, 2022
7/20/25
136,242.01
$85,739.61
3,762.00
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-024575e54380bce6b5bdbaf9,v11-8949-columns,original,2025,fgen-17c37f53597998d9731b8dcd,synthetic_programmatic_template,columns,top,False,
"Name:
(a) Description of property
Lena Testcase
AAPL
Form 8949Sales and Other Dispositions of Capital Assets 2O22",8949,22,8949,fdc-f3dbbf92bbfbf5830f560645,v11-8949-columns,original,2022,fgen-642179f3163ac87b66bace99,synthetic_programmatic_template,columns,bottom,True,
"☐ CORRECTED
Form 8949
Sales and Other Dispositions of Capital Assets
2021
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Avery Kowalski
2689 Granite St Testville, IL 69859
XXX-XX-3426
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Date sold or disposed of
(e) Cost or other basis
(h) Gain or (loss)
VTI
09/22/2018
July 19, 2018
122,869.96
-8,146.66
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-ddfea63186b16582eec5ac25,v11-8949-columns,original,2021,fgen-487e34ac9bdeb8f0644b8cdb,synthetic_programmatic_template,columns,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2026
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Jamie L. Fischer
2087 Oak Hollow Ct Brookhaven, PA 13114
ending in 1316
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Date sold or disposed of
(d) Proceeds (sales price)
(h) Gain or (loss)
50 SH NORTHWIND INC
August 14, 2026
11/11/25
$15,142.85
(5,236.74)
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-91bab9a27e876c30e653288b,v11-8949-columns,original,2026,fgen-f4e34abaed727e620ca6bfe7,synthetic_programmatic_template,columns,top,False,
"Name:
(a) Description of property
(e) Cost or other basis
Morgan M. Fischer
VTI
$84,827.79
Form 8949 Sales and Other Dispositions of Capital Assets",8949,22,8949,fdc-257f11f583d6eeac291639d3,v11-8949-columns,original,2023,fgen-e500fe6db3d5ef4f1d3121f6,synthetic_programmatic_template,columns,bottom,False,
"☐ CORRECTED
Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2022
OMB No. 1545-0074
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Morgan Sato
9572 Cedar Ln Bayside, WA 52854
ending in 2949
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Date sold or disposed of
(d) Proceeds (sales price)
(e) Cost or other basis
(h) Gain or (loss)
MSFT
11/14/22
2019-07-02
$107,477.57
$103,125.40
(3,825.56)",8949,22,8949,fdc-f2eee2588260ee60ae834635,v11-8949-columns,original,2022,fgen-5e07dac2923c87017f89372b,synthetic_programmatic_template,columns,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Taylor Sato
7190 Oak Hollow Ct Bayside, WA 60293
XXX-XX-4828
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Date sold or disposed of
(d) Proceeds (sales price)
(h) Gain or (loss)
BND
06/23/2024
2025-09-14
24,962.49
7,045.70",8949,22,8949,fdc-d8d95984f5ee9bcc8c15b8ae,v11-8949-columns,original,2025,fgen-9ce532c0fec59a40c99211f1,synthetic_programmatic_template,columns,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
2023
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Sofia D. Patel
1588 Maple Ridge Dr Maplewood, MN 93599
ending in 7473
Part II Long-Term.
(a) Description of property
(c) Date sold or disposed of
(d) Proceeds (sales price)
(e) Cost or other basis
(h) Gain or (loss)
100 SH ACME CORP
04/02/2022
54,412.05
63,384.04
15,407.01
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-e7054536b4641ecf32282788,v11-8949-columns,original,2023,fgen-ffe99832e18b1ec1b6fe4756,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Form 8949
Sales and Other Dispositions of Capital Assets
2021
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Wei Sato
2116 Willow Bend Way Bayside, WA 15426
****3897
Part II Long-Term.
(a) Description of property
(b) Date acquired
(c) Date sold or disposed of
(d) Proceeds (sales price)
(e) Cost or other basis
(h) Gain or (loss)
SCHD
2018-08-02
2/22/18
126,027.12
113,887.93
28,599.87
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-3cdf4727b827147518e062aa,v11-8949-columns,original,2021,fgen-6de06ff307088a33eb7d3111,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form 8949
Sales and Other Dispositions of Capital Assets
2021
OMB No. 1545-0074
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Jamie L. Larsen
569 Oak Hollow Ct Cedar Falls, IA 92432
ending in 2364
Part II Long-Term.
(b) Date acquired
(c) Date sold or disposed of
(d) Proceeds (sales price)
(e) Cost or other basis
(h) Gain or (loss)
August 20, 2018
August 16, 2021
63,342.05
18,000.12
-333.26
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-2bc208b66cbd10f1d306b9eb,v11-8949-columns,original,2021,fgen-17d281959c107f13253316fb,synthetic_programmatic_template,columns,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2024
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Jamie Nguyen
4958 Oak Hollow Ct Maplewood, MN 63543
****7796
Part II Long-Term.
(a) Description of property
(b) Date acquired
(e) Cost or other basis
BND
2023-05-18
121,708.15
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-ed2ce560b40ab2c26c8e3cf2,v11-8949-columns,original,2024,fgen-6c29c1bc5b92cea175bba2c9,synthetic_programmatic_template,columns,top,False,
"2026
OMB No. 1545-0074
Attach to your ScheduleD to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of 5chedule D.
Name(s) shown onreturn
Social security number or taxpayer identification number
Part I Short-Term.
Mateo E. Haddad
4143 Sample Street Fairview, 0H 63553
***-**-1153
Part II Long-Term.
(a) Description of property
(c) Date so1d or disposed of
(d) Proceeds (sales price)
(e) Cost or other basis
(h) Gain or (loss)
VOO
2O23-O9-02
99,875.87
96,581.47
29,08l.76
Department of the Treasury - Internal Revenue 5ervice",8949,22,8949,fdc-ea9f7859164b81975565b6d9,v11-8949-columns,original,2026,fgen-0723ce873ec9a49312f944d3,synthetic_programmatic_template,columns,none,True,
"Form 8949
Sales and Other Dispositions of Capital Assets
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name(s) shown on return
Social security number or taxpayer identification number
Part I Short-Term.
Riley Brennan
989 Lakeshore Blvd Maplewood, MN 66927
***-**-7828
Part II Long-Term.
(a) Description of property
(d) Proceeds (sales price)
(e) Cost or other basis
(h) Gain or (loss)
VOO
89,416.12
109,223.08
21,881.96",8949,22,8949,fdc-f783cecc325e87aeb2225407,v11-8949-columns,original,2025,fgen-f00b8adea72512dd731ed169,synthetic_programmatic_template,columns,top,False,
"For calendar year 2025
## OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Name(s) shown on retum | Jordan E. Adeyemi |
| 5ocial security number or taxpaycr ídentification number | 2841 Cedar Ln Fairview, OH 28379 |
| Part I 5hort-Term. | ****7O09 |
Part II Long-Term.
| Field | Value|
| --- | --- |
| (a) Description of property | 5CHD |
| (b) Date acquired | 06/03/2025 |
| (c) Date soldor disposed of | 2025-02-27 |
| (d) Proceeds (sales price) | $105,758.24 |
| (e) Cost or other basis | $82,620.06 |
| (h) Gain or(loss) | -5,577.15 |
Dcpartmentof the Treasury - Intemal Revenue Service",8949,22,8949,fdc-e90a1643e03e648446474a08,v11-8949-markdown,original,2025,fgen-b43a8e66d2632e998489e605,synthetic_programmatic_template,markdown,none,True,
"## VOID  CORRECTED
## Form 8949
Sales and Other Dispositions of Capital Assets
## For calendar year 2026
OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Name(s) shown on return | Olivia Patel |
| Social security number or taxpayer identification number | 248 Sample Street Brookhaven, PA 45741 |
| Part I Short-Term. | ****4931 |
Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | SCHD |
| (b) Date acquired | 02/12/2025 |
| (c) Date sold or disposed of | 2025-12-04 |
| (d) Proceeds (sales price) | $34,456.73 |
| (e) Cost or other basis | $101,222.19 |
| (h) Gain or (loss) | -8,058.21 |
Department of the Treasury - Internal Revenue Service
## Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-dd76506e7e1c52b844852d98,v11-8949-markdown,original,2026,fgen-3cb3c7716a707c2256800e34,synthetic_programmatic_template,markdown,top,False,
"2022
Attach to your Schedule D to list your transactions forlines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Department of the Treasury Intemal Revenue 5ervice
| Field | Value |
| --- | --- |
| Name(s) shown on return | Jamie Testcase |
| Social security number or taxpayer identification number |7469 Harbor View Rd Brookhaven, PA 9l426 |
| Part I 5hort-Term. | ****4215 |
Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | 1OO SH ACMEC0RP |
| (b) Datc acquired | 03/16/2022 |
| (c) Date sold or disposed of | 5/7/22 |
| (d) Proceeds (sales price) | 45,582.54 |
| (e) Cost or other basis | $103,017.02 |
| (h) Gain or (loss)| 10,919.33 |
## Form 8949
Salcs andOthcr Dispositions of Capital Assets",8949,22,8949,fdc-4f9167c1a45578667fae2cd5,v11-8949-markdown,original,2022,fgen-0ca2d76d9cf68a21f67463ba,synthetic_programmatic_template,markdown,bottom,True,
"☐ CORRECTED
Form 8949
## Sales and Other Dispositions of Capital Assets
2021
| Field | Value |
| --- | --- |
| Name(s) shown on return | Morgan Adeyemi |
| Social security number or taxpayer identification number | 623 Oak Hollow Ct Testville, IL 70871 |
| Part I Short-Term. | ending in 1787 |
Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | VTI |
| (c) Date sold or disposed of | 4/6/20 |
| (e) Cost or other basis | 27,687.16 |
| (h) Gain or (loss) | 27,529.74 |",8949,22,8949,fdc-cc3c3b42329b42a493922b8f,v11-8949-markdown,original,2021,fgen-4d8c88cdb9b3ae1da7efbd41,synthetic_programmatic_template,markdown,top,False,
"## Form 8949 Sales and Other Dispositions of Capital Assets 2021
| Field | Value |
| --- | --- |
| Name: | Riley Okafor |
| (c) Date sold or disposed of | 7/25/18 |
| (e) Cost or other basis | 72,979.15 |
| (d) Proceeds (sales price) | $101,582.92 |",8949,22,8949,fdc-03ee9d747325f82ea259e121,v11-8949-markdown,original,2021,fgen-18c5a0160daa0ce7f4656c4a,synthetic_programmatic_template,markdown,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
## For calendar year 2026
OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Name(s) shown on return | Casey Moreau |
| Social security number or taxpayer identification number | 8129 Willow Bend Way Bayside, WA 17456 |
| Part I Short-Term. | ****6635 |
## Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | FXAIX |
| (b) Date acquired | 07/23/2026 |
| (c) Date sold or disposed of | 2026-03-25 |
| (d) Proceeds (sales price) | 86,806.68 |
| (e) Cost or other basis | 65,050.98 |
| (h) Gain or (loss) | 11,010.62 |
Department of the Treasury - Internal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-bc67bd7eb968391baa4c9180,v11-8949-markdown,original,2026,fgen-01904f0f5ead87065b15d375,synthetic_programmatic_template,markdown,top,False,
"## Form 8949
## Sales and Other Dispositions of Capital Assets
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
| Field | Value |
| --- | --- |
| Name(s) shown on return | Hiro Castillo |
| Social security number or taxpayer identification number | 4519 Granite St Brookhaven, PA 59180 |
| Part I Short-Term. | ****7558 |
Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | VOO |
| (c) Date sold or disposed of | March 22, 2023 |
| (d) Proceeds (sales price) | $5,100.55 |
| (e) Cost or other basis | $67,464.58 |
| (h) Gain or (loss) | -6,930.53 |
Department of the Treasury - Internal Revenue Service
## Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-775d46a90d44567ddb0a0daa,v11-8949-markdown,original,2023,fgen-71e27b16a3f06c510433cd0c,synthetic_programmatic_template,markdown,top,False,
"2021
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on return| Kwame Castillo |
| Social security number or taxpayer identification number | 2978 Willow Bend Way Lakewood, CO 74l75 |
|Part I Short-Term. | ending in O904 |
Part II Long-Term.
| Fie1d | Value |
| --- |--- |
| (a) Description of property | SCHD |
| (b) Date acquired | October 6, 20l8 |
| (c) Date sold or disposed of | l/22/21 |
| (d) Proceeds (sales price) | 73,364.37 |
| (e) Cost or other basis | S122,879.19 |
|(h) Gain or (loss) | (8,O40.65) |
Department of the Treasury - Internal Revenue Service",8949,22,8949,fdc-0c283abda77daed7da5e4a10,v11-8949-markdown,original,2021,fgen-5f63b51d610b5620cb9ed00e,synthetic_programmatic_template,markdown,none,True,
"## Form 8949 Sales and Other Dispositions of Capital Assets 2024
| Field | Value |
| --- | --- |
| Name: | Hiro R. Okafor |
| (b) Date acquired | 7/15/21 |",8949,22,8949,fdc-c8b71aba36288c8bb040eaba,v11-8949-markdown,original,2024,fgen-69418fe06e7eebf93dc00b3c,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
Form 8949
Sales and Other Dispositions of Capital Assets
For calendar year 2O26
## OMB No. 1545-0074
## Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 ofSchedule D.
Department of the Treasury Intemal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on return | Alex A.Castillo |
| Social securitynumber or taxpayer identification number | 39l5 Prairie Ave Maplewood, MN 73748 |
| Part I Short-Tcrm. | ***-**-1874 |
## Part II Long-Term.
| Fíe1d | Value |
| ---| --- |
| (a) Description of property | FXAIX |
| (b) Date acquired | 4/24/26 |
| (c) Date sold or disposed of|2023-l0-l7 |
| (d) Proceeds (sales price) | $92,910.05 |
| (e) Cost or other basis | $54,024.90 |
| (h) Gain or (1oss) | (4,384.76) |
Department of the Treasury - Intemal Revenue Service
Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-fa0344ea6252d543bbdab391,v11-8949-markdown,original,2026,fgen-76f93d093d82b0ec6b2a138b,synthetic_programmatic_template,markdown,top,True,
"Form 8949 Sales and Other Dispositions of Capital Assets 2021
| Field | Value |
| --- | --- |
| Name: | Noah Fischer |
| (a) Description of property | AAPL |
| (c) Date sold or disposed of | January 8, 2021 |
| (b) Date acquired | 2018-01-04 |",8949,22,8949,fdc-73d954865eef6101884344e5,v11-8949-markdown,original,2021,fgen-0b77a20bb2c841b4d365d1ed,synthetic_programmatic_template,markdown,top,False,
"## OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on return | Amara Lindqvist |
| Social security number or taxpayer identification number | 1681 Harbor View Rd Lakewood, CO 64547 |
| Part I Short-Term. | ***-**-5368 |
## Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | AAPL |
| (b) Date acquired | 4/19/22 |
| (c) Date sold or disposed of | March 22, 2022 |
| (d) Proceeds (sales price) | 14,544.49 |
## Department of the Treasury - Internal Revenue Service
Form 8949
Sales and Other Dispositions of Capital Assets
## Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-4f1e75cce6a13dd4274b95bb,v11-8949-markdown,original,2022,fgen-743cadb99a373119edee72f3,synthetic_programmatic_template,markdown,bottom,False,
"Form 8949 Sales and Other Dispositions of Capital Assets
| Field | Value |
| --- | --- |
| Name: | Avery D. Adeyemi |
| (d) Proceeds (sales price) | $80,639.43 |
| (a) Description of property | AAPL |",8949,22,8949,fdc-702fcea2574926866b90dd85,v11-8949-markdown,original,2022,fgen-d83695fe9171b68e401177ac,synthetic_programmatic_template,markdown,top,False,
"Form 8949
Sales and Other Dispositions of Capital Assets
| Field | Value |
| --- | --- |
| Name(s) shown on return | Fatima Moreau |
| Social security number or taxpayer identification number | 8521 Willow Bend Way Riverton, WI 60006 |
| Part I Short-Term. | XXX-XX-3758 |
Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | BND |
| (b) Date acquired | 02/27/2022 |
| (c) Date sold or disposed of | March 7, 2023 |
| (d) Proceeds (sales price) | 60,305.72 |
| (e) Cost or other basis | 32,279.27 |
| (h) Gain or (loss) | (1,332.34) |
Department of the Treasury - Internal Revenue Service
## Form 8949 (keep for your records)  www.irs.gov/Form8949",8949,22,8949,fdc-4eda49dc6dcea22ab28397a1,v11-8949-markdown,original,2023,fgen-658dd884b20c62b6279891fb,synthetic_programmatic_template,markdown,top,False,
"Form 8949
## Sales and Other Dispositions of Capital Assets
2021
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name(s) shown on return | Olivia J. Tanaka |
| Social security number or taxpayer identification number | 2307 Elm Park Pl Fairview, OH 27887 |
| Part I Short-Term. | XXX-XX-3368 |
Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | BND |
| (b) Date acquired | 9/10/18 |
| (c) Date sold or disposed of | 5/5/20 |
| (e) Cost or other basis | $18,110.95 |
| (h) Gain or (loss) | 20,130.52 |",8949,22,8949,fdc-3d21cef3b0597a0dafb8c04c,v11-8949-markdown,original,2021,fgen-f244cebf5584d1a99a1c195e,synthetic_programmatic_template,markdown,top,False,
"Form 8949
## Sales and Other Dispositions of Capital Assets
2024
OMB No. 1545-0074
Attach to your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
| Field | Value |
| --- | --- |
| Name(s) shown on return | Wei Okafor |
| Social security number or taxpayer identification number | 6625 Harbor View Rd Lakewood, CO 46269 |
| Part I Short-Term. | ending in 2467 |
## Part II Long-Term.
| Field | Value |
| --- | --- |
| (a) Description of property | 100 SH ACME CORP |
| (d) Proceeds (sales price) | $56,110.98 |
| (e) Cost or other basis | 132,674.71 |
| (h) Gain or (loss) | (2,791.08) |",8949,22,8949,fdc-b0b93562c135b54922c1b723,v11-8949-markdown,original,2024,fgen-3ebe587bdacf4cf1740a7120,synthetic_programmatic_template,markdown,top,False,
"Contribution Statement for 2022
Riverbend Public Library Foundation
Tax ID 90-4990767  A 501(c)(3) organization
Dear Lena R. Fischer,
Thank you for your generous support this year.
Date  Method  Amount
06/11/2022
Stock transfer
926.37
December 11, 2022
Check #8780
595.27
2022-08-28
Cash
1,230.29
July 19, 2022
Cash
1,869.54
2022-10-05
Online gift
2,244.99
12/09/2022
Stock transfer
517.65
8/25/22
Stock transfer
597.65
Total contributions
$7,981.76
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-d09a70ed02ab02996f167ce2,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2022,fgen-2f4291159b5998c288158e10,synthetic_programmatic_template,stacked,top,False,daf_grant_summary
"2023 Annual Giving Statement
Riverbend Public Library Foundation
Tax ID 13-1842914  A 501(c)(3) organization
Dear Olivia Larsen,
Thank you for your generous support this year.
Date  Method  Amount
07/07/2023
Online gift
2,236.48
10/20/2023
Stock transfer
1,922.53
June 10, 2023
Online gift
834.62
9/17/23
Stock transfer
1,603.88
11/1/23
Stock transfer
1,531.89
2023-01-21
Online gift
1,465.59
December 8, 2023
Check #1174
2,010.37
Total contributions
$11,605.36
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-afc4f2d9c9908a9597274e42,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2023,fgen-b5b39c560764c8751620cadb,synthetic_programmatic_template,stacked,top,False,daf_grant_summary
"Contribution Statement for 2022
Sample Community Food Bank
Tax ID 43-4373571  A 501(c)(3) organization
Dear Hiro J. Kowalski,
Thank you for your generous support this year.
Date  Method  Amount
3/3/22
Check #9303
1,407.59
06/12/2022
Stock transfer
2,361.38
2022-11-18
Cash
1,368.15
Total contributions
$5,137.12
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-9e3a632502fdcbaad4f68142,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2022,fgen-45c4cfe25ef0690b9a0a438a,synthetic_programmatic_template,stacked,top,False,church
"Year-End Giving Summary
Hope Harbor Shelter
Tax ID 12-8365220  A 501(c)(3) organization
Dear Morgan Patel,
Thank you for your generous support this year.
Date  Method  Amount
2026-05-15
Check #1742
1,671.28
July 25, 2026
Online gift
1,280.10
05/25/2026
Cash
1,833.17
December 10, 2026
Cash
1,211.59
Total contributions
$5,996.14
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-1293d353a0ccfdb958b05dfb,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2026,fgen-bb441d48fb612e0341a7e12f,synthetic_programmatic_template,stacked,top,False,church
"St. Brendan Parish
Tax ID 88-3437202  A 501(c)(3) organization
Dear Sofia Nguyen,
Thank you for your generous support this year.
Date  Method  Amount
11/08/2023
Stock transfer
2,313.01
June 18, 2023
Check #8635
454.70
01/07/2023
Check #3026
2,135.10
December 25, 2023
Stock transfer
1,041.80
2023-07-28
Online gift
1,992.95
Total contributions
$7,937.56
No goods or services were provided in exchange for these contributions.
Year-End Giving Summary",DONATION_RECORD,28,DONATION_RECORD,fdc-31ed197c613ffb5711162893,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2023,fgen-8c8251564efdf14b4a3d37d8,synthetic_programmatic_template,stacked,bottom,False,church
"Year-End Giving Summary
Sample Community Food Bank
Tax ID 72-7234423  A 501(c)(3) organization
Dear HiroKowalski,
Thank you for your generous support this year.
Date  Method  Amount
04/24/2022
Stock transfer
120.72
2022-07-l0
Online gift
76.54
December 25, 2022
Online gift
961.65
10/27/2022
Check #8647
1,501.77
6/18/22
Check #8125
673.87
l0/03/2022
Check #4766
513.06
Total contributions
S3,847.61
No goods or scrviccs were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-e702b74fecb84ef7d7389b00,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2022,fgen-d622ea4fd643194a6e825a43,synthetic_programmatic_template,stacked,top,True,daf_grant_summary
"Year-End Giving Summary
Greenway Animal Rescue
Tax ID 72-1136101  A 501(c)(3)organization
Dear Lena Okafor,
Thank you for your generous support this year.
Date  Method  Amount
08/11/2023
Stock transfer
1,068.66
9/2/23
Stock transfer
762.94
4/2/23
Cash
2,315.22
08/28/2023
Check #7581
1,619.93
2023-11-05
Online gift
2,181.75
2023-02-07
Stock transfer
1,398.98
07/21/2023
Stock transfer
2,389.13
Tota1 contributions
$11,736.61
No goods or scrvices were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-42070ab33cd856d072d17e88,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2023,fgen-2a6788adba2f83a471ad029e,synthetic_programmatic_template,stacked,top,True,daf_grant_summary
"Year-End Giving Summary
Sample Community Food Bank
Tax ID 58-2822000  A 501(c)(3) organization
Dear Kwame S. Patel,
Thank you for your generous support this year.
Date  Method  Amount
03/20/2022
Online gift
535.01
03/10/2022
Stock transfer
58.69
05/22/2022
Online gift
2,275.23
February 6, 2022
Stock transfer
396.52
2022-10-05
Online gift
1,644.76
2022-09-17
Online gift
689.83
November 28, 2022
Cash
2,342.85
Total contributions
$7,942.89
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-4ddeca941b63a45b0ea4a686,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2022,fgen-70f8a10f3c37ec65d27dd371,synthetic_programmatic_template,stacked,top,False,church
"2021 Annual Giving Statement
Greenway Animal Rescue
Tax ID 24-3017035  A 501(c)(3) organization
Dear Diego A. Nguyen,
Thank you for your generous support this year.
Date  Method  Amount
11/2/21
Online gift
1,184.02
2021-02-05
Stock transfer
1,462.99
January 26, 2021
Stock transfer
2,212.53
10/5/21
Online gift
1,898.48
4/22/21
Check #5144
1,693.50
April 28, 2021
Check #3029
1,543.00
2021-12-25
Online gift
1,661.74
10/06/2021
Online gift
982.14
Total contributions
$12,638.40
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-f077e6df66326a1b35060f52,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2021,fgen-e512e486b5ccc705ce1626da,synthetic_programmatic_template,stacked,top,False,nonprofit
"Year-End Giving Summary
St. Brendan Parish
Tax ID 34-9756914  A 501(c)(3) organization
Dear Jordan Rivera,
Thank you for your generous support this year.
Date  Method  Amount
11/16/24
Online gift
1,308.34
December 23, 2024
Cash
539.98
March 5, 2024
Stock transfer
1,067.00
2024-09-05
Check #1883
1,837.22
December 5, 2024
Check #8867
2,378.90
Total contributions
$7,131.44
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-1ed2629faa9710ad4f9ff80e,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2024,fgen-14aa3f767e4559a0ef4b7481,synthetic_programmatic_template,stacked,top,False,church
"Riverbend Public Library Foundation
Tax ID 85-8247011  A 501(c)(3) organization
Dear Olivia Okafor,
Thank you for your generous support this year.
Date  Method  Amount
9/27/23
Stock transfer
2,457.32
01/05/2023
Online gift
611.58
2023-11-21
Cash
1,255.51
2023-07-28
Check #5378
204.92
Total contributions
$4,529.33
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-f6012eccf611d71f513dae7b,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2023,fgen-33942823685f9b1b54a8ebef,synthetic_programmatic_template,stacked,none,False,church
"Riverbend Public Library Foundation
Tax ID 52-1153378  A 501(c)(3) organization
Dear Mateo Castillo,
Thank you for your generous support this year.
Date  Method  Amount
5/5/26
Check #6396
1,130.31
12/15/26
Stock transfer
2,043.72
03/18/2026
Online gift
39.66
12/19/2026
Online gift
1,715.18
December 24, 2026
Online gift
98.72
06/21/2026
Online gift
2,209.02
Total contributions
$7,236.61
No goods or services were provided in exchange for these contributions.
Contribution Statement for 2026",DONATION_RECORD,28,DONATION_RECORD,fdc-dbdbb13c995c4e74f2ca3158,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2026,fgen-1c7a1b4d77f972550d70c3ef,synthetic_programmatic_template,stacked,bottom,False,nonprofit
"Year-End Giving Summary
Hope Harbor Shelter
Tax ID 54-1200572  A 501(c)(3) organization
Dear Riley A. Brennan,
Thank you for your generous support this year.
Date  Method  Amount
August 10, 2022
Cash
2,103.80
November 2, 2022
Online gift
667.57
July 17, 2022
Check #1358
142.32
2022-12-15
Cash
948.64
2022-09-15
Stock transfer
1,468.96
2022-05-15
Cash
965.31
Total contributions
$6,296.60
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-c576f07722a1ae15b1589f7e,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2022,fgen-52a8f7fa09b571c7fe582e34,synthetic_programmatic_template,stacked,top,False,nonprofit
"2022 Annual Giving Statement
Riverbend Public Library Foundation
Tax ID 15-8649549  A 501(c)(3) organization
Dear Jordan Nguyen,
Thank you for your generous support this year.
Date  Method  Amount
May 1, 2022
Check #8346
1,561.97
June 24, 2022
Cash
1,186.34
July 18, 2022
Cash
2,360.74
07/22/2022
Online gift
626.42
7/17/22
Check #7746
89.34
12/21/2022
Cash
461.93
03/21/2022
Check #8515
1,861.48
2022-04-21
Check #2239
882.89
Total contributions
$9,031.11
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-1741225ebe1ccada2fa43523,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2022,fgen-730271eb1c8c1799113f2c9b,synthetic_programmatic_template,stacked,top,False,nonprofit
"Hope Harbor Shelter
Tax ID 53-7065942  A 501(c)(3) organization
Dear Riley Castillo,
Thank you for your generous support this year.
Date  Method  Amount
06/15/2025
Online gift
1,103.76
May 24, 2025
Stock transfer
1,635.88
2025-04-08
Stock transfer
2,079.14
8/12/25
Stock transfer
505.34
08/24/2025
Cash
176.36
3/16/25
Online gift
1,840.76
6/10/25
Cash
2,342.99
Total contributions
$9,684.23
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-b7ee256288756bf61c2a9422,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2025,fgen-f204f642802cf448dfd02fee,synthetic_programmatic_template,stacked,none,False,church
"Greenway Animal Rescue
Tax ID 80-6183334  A 501(c)(3) organization
Dear Jordan Larsen,
Thank you for your generous support this year.
Date  Method  Amount
02/25/2022
Check #4898
1,598.07
2022-10-04
Stock transfer
460.95
December 15, 2022
Online gift
1,070.82
06/25/2022
Stock transfer
436.02
2022-09-11
Cash
528.76
2022-09-23
Stock transfer
964.17
2022-06-04
Check #4631
2,116.94
December 24, 2022
Stock transfer
1,003.35
Total contributions
$8,179.08
Only intangible religious benefits were provided in exchange for your gifts.
Year-End Giving Summary",DONATION_RECORD,28,DONATION_RECORD,fdc-d38a57b42cf068d90d3526e8,v11-ANNUAL_GIVING_STATEMENT-stacked,original,2022,fgen-12c510139699933ed252c1f9,synthetic_programmatic_template,stacked,bottom,False,daf_grant_summary
"2026 Annual Giving Statement
Riverbend Public Library Foundation
Tax ID 56-8979119  A 501(c)(3) organization
Dear Priya Okafor,
Thank you for your generous support this year.
Date Method Amount
2026-05-23   Online gift   904.55
January 27, 2026  Online gift  899.44
08/21/2026   Cash   628.42
March 19, 2026  Stock transfer  1,650.42
4/20/26 Check #4552 2,168.57
2026-03-23  Cash  1,706.03
Total contributions   $7,957.43
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-311db4082b2a51370d9be1a6,v11-ANNUAL_GIVING_STATEMENT-inline,original,2026,fgen-64969ecb3a22a19df6860e09,synthetic_programmatic_template,inline,top,False,nonprofit
"Contribution Statement for 2024
Greenway Animal Rescue
Tax ID 60-9184836  A 501(c)(3) organization
Dear Jamie Patel,
Thank you for your generous support this year.
Date   Method   Amount
January 25, 2024      Online gift      1,830.06
2024-12-14 Cash 2,167.72
May 18, 2024   Check #2679   1,014.65
03/12/2024      Check #3418      1,368.46
2024-12-18      Check #2003      2,380.34
2024-07-14 Stock transfer 117.27
2024-09-15 Cash 1,749.01
2024-12-24  Stock transfer  1,075.43
Total contributions      $11,702.94
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-ef63892500de5230e269a375,v11-ANNUAL_GIVING_STATEMENT-inline,original,2024,fgen-869a43865248a5d21a92d979,synthetic_programmatic_template,inline,top,False,nonprofit
"Sample Community Food Bank
Tax ID 46-4411323  A 501(c)(3) organization
Dear Priya Patel,
Thank you for your generous support this year.
Date  Method  Amount
2025-09-12  Stock transfer  1,952.55
3/25/25      Online gift      209.97
12/04/2025   Cash   2,255.45
Total contributions $4,417.97
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-3d5c4d40c38c0f3ad5852ee2,v11-ANNUAL_GIVING_STATEMENT-inline,original,2025,fgen-1b998b349f919bf4207a5fb3,synthetic_programmatic_template,inline,none,False,church
"2022 Annual Giving Statement
St. Brendan Parish
Tax ID 30-5365704  A 501(c)(3) organization
Dear Sofia Moreau,
Thank you for your generous support this year.
Date Method Amount
June 16, 2022   Stock transfer   1,607.92
7/11/22   Check #4702   204.74
November 5, 2022 Check #8020 2,441.50
7/6/22      Stock transfer      307.01
2022-07-08 Check #1462 2,496.98
September 23, 2022      Check #4244      1,073.22
Total contributions $8,131.37
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-7f40d4b228fa578abca0b526,v11-ANNUAL_GIVING_STATEMENT-inline,original,2022,fgen-4eb1c9489ebc3a057b14d5ac,synthetic_programmatic_template,inline,top,False,daf_grant_summary
"Contribution Statement for 2024
Hope Harbor Shelter
Tax ID 73-7241989  A 501(c)(3) organization
Dear Olivia D. Sato,
Thank you for your generous support this year.
Date Method Amount
11/10/2024   Online gift   1,421.48
February 13, 2024   Cash   1,668.92
08/22/2024 Cash 87.54
5/8/24      Online gift      667.22
Total contributions $3,845.16
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-3442f653ba93ce0578e9e2d8,v11-ANNUAL_GIVING_STATEMENT-inline,original,2024,fgen-25d7b8225d445df28b79436c,synthetic_programmatic_template,inline,top,False,daf_grant_summary
"Contribution Statement for 2022
Greenway Animal Rescue
Tax ID 42-6774161  A 501(c)(3) organization
Dear Diego J. Rivera,
Thank you for your generous support this year.
Date Method Amount
02/13/2022      Online gift      1,939.92
09/13/2022 Online gift 715.92
2022-06-19  Cash  1,315.04
2022-07-18   Check #5422   510.15
2022-10-17      Online gift      441.70
06/02/2022  Online gift  805.42
Total contributions $5,728.15
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-39f9a901bbe164a9ac1a7f2f,v11-ANNUAL_GIVING_STATEMENT-inline,original,2022,fgen-e6d2e8e35693b4f030953e63,synthetic_programmatic_template,inline,top,False,church
"Contribution Statement for 2026
St. Brendan Parish
Tax ID 63-3579706  A 501(c)(3) organization
Dear Alex Sato,
Thank you for your generous support this year.
Date Method Amount
February 24, 2026 Stock transfer 2,062.87
2026-01-09   Online gift   1,869.22
06/27/2026 Online gift 1,646.12
04/03/2026      Cash      736.71
January 9, 2026  Online gift  1,719.71
Total contributions $8,034.63
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-a240087897758e701a15988a,v11-ANNUAL_GIVING_STATEMENT-inline,original,2026,fgen-d257b423beacb3be8d832b83,synthetic_programmatic_template,inline,top,False,nonprofit
"Sample Community Food Bank
Tax ID 15-2906203  A 501(c)(3) organization
Dear Amara J. Castillo,
Thank you for your generous support this year.
Date Method Amount
February 23, 2023  Online gift  1,218.66
2/27/23      Cash      645.57
August 25, 2023   Stock transfer   1,027.62
11/5/23 Online gift 417.88
Total contributions   $3,309.73
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-f9dbe02da35de026c6585f09,v11-ANNUAL_GIVING_STATEMENT-inline,original,2023,fgen-cecf282a773feb1799cbb17a,synthetic_programmatic_template,inline,none,False,church
"Contribution Statement for 2022
Hope Harbor Shelter
Tax ID 22-4291353  A 501(c)(3) organization
Dear Priya D. Romero,
Thank you for your generous support this year.
Date      Method      Amount
7/15/22 Check #7544 202.29
07/05/2022  Stock transfer  2,182.90
November 27, 2022   Online gift   387.85
07/12/2022 Stock transfer 19.50
1/11/22 Online gift 704.85
2022-08-09   Cash   2,428.11
July 27, 2022 Cash 339.08
Total contributions   $6,264.58
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-dc51185b31834fbb3aa8fb47,v11-ANNUAL_GIVING_STATEMENT-inline,original,2022,fgen-6dc3b99612d3ade2f4a7ee17,synthetic_programmatic_template,inline,top,False,nonprofit
"Year-End Giving Summary
Sample Community Food Bank
Tax ID 90-4807426  A 501(c)(3) organization
Dear Avery R. Adeyemi,
Thank you for your generous support this year.
Date   Method   Amount
11/8/23 Cash 356.32
2023-07-21      Online gift      1,813.02
06/14/2023      Online gift      711.65
10/10/2023      Check #9504      974.27
2023-06-25   Stock transfer   279.67
Total contributions $4,134.93
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-77b0818e3aeb3c10b75e4170,v11-ANNUAL_GIVING_STATEMENT-inline,original,2023,fgen-983b825a7120d478c702771c,synthetic_programmatic_template,inline,top,False,church
"2025 Annual Giving Statement
Greenway Animal Rescue
Tax ID 32-6465170  A 501(c)(3) organization
Dear Sofia Fischer,
Thank you for your generous support this year.
Date   Method   Amount
08/13/2025 Stock transfer 2,264.23
January 15, 2025      Stock transfer      270.19
10/4/25      Cash      2,147.38
2025-05-23 Check #7928 2,196.29
02/01/2025  Check #5688  2,207.23
2025-03-08  Online gift  756.55
Total contributions   $9,841.87
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-c8ded69c471e6db5125a5640,v11-ANNUAL_GIVING_STATEMENT-inline,original,2025,fgen-e77f245269d0f12d5a37c1f0,synthetic_programmatic_template,inline,top,False,church
"2026 Annual Giving Statement
Hope Harbor Shelter
Tax ID 40-9174846  A 501(c)(3) organization
Dear Kwame Larsen,
Thank you for your generous support this year.
Date Method Amount
2026-11-05      Stock transfer      2,367.50
05/11/2026 Stock transfer 2,406.14
11/06/2026      Online gift      1,637.98
Total contributions  $6,411.62
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-41828c847a40b2a8dfc77b8c,v11-ANNUAL_GIVING_STATEMENT-inline,original,2026,fgen-fec659cbc9b97bb02661f70d,synthetic_programmatic_template,inline,top,False,church
"Contribution Statement for 2025
Sample Community Food Bank
Tax ID 81-9298594  A 501(c)(3) organization
Dear Fatima Fischer,
Thank you for your generous support this year.
Date   Method   Amount
February 3, 2025  Online gift  1,722.96
09/20/2025  Stock transfer  739.20
1/25/25  Stock transfer  524.02
Total contributions      $2,986.18
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-1884416ae95dbaf76eef36bf,v11-ANNUAL_GIVING_STATEMENT-inline,original,2025,fgen-de37228618e4cdc6ad93d394,synthetic_programmatic_template,inline,top,False,daf_grant_summary
"Hope Harbor Shelter
Tax ID 74-2496025  A 501(c)(3) organization
Dear Avery Testcase,
Thank you for your generous support this year.
Date Method Amount
2025-09-09      Check #4478      1,961.65
9/11/25  Check #4053  767.97
03/22/2025 Online gift 1,392.65
6/11/25      Cash      1,502.55
2025-04-05      Online gift      2,114.47
February 11, 2025   Cash   1,759.38
2025-11-14  Stock transfer  2,463.19
Total contributions   $11,961.86
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-f97f9219dbfc692a2a319aaf,v11-ANNUAL_GIVING_STATEMENT-inline,original,2025,fgen-6588793b48591084721ddcbd,synthetic_programmatic_template,inline,none,False,church
"Contribution Statement for 2026
Riverbend Public Library Foundation
Tax ID 62-7184489  A 501(c)(3) organization
Dear Jordan Adeyemi,
Thank you for your generous support this year.
Date Method Amount
11/14/2026 Stock transfer 1,781.05
February 9, 2026 Cash 2,380.10
November 24, 2026 Cash 2,261.79
10/23/26 Stock transfer 2,269.40
2026-07-16   Stock transfer   1,671.19
2026-07-08  Cash  1,230.34
10/5/26 Check #6596 474.10
December 18, 2026 Cash 1,850.48
Total contributions $13,918.45
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-9fb6c97b1f93c3d8cdfbaf87,v11-ANNUAL_GIVING_STATEMENT-inline,original,2026,fgen-4514cb6dbe6d5e4cc5d41978,synthetic_programmatic_template,inline,top,False,nonprofit
"Year-End Giving Summary
St. Brendan Parish
Tax ID 93-4265943  A 501(c)(3) organization
Dear Kwame Adeyemi,
Thank you for your generous support this year.
Date Method Amount
1/8/23  Online gift  1,847.04
November 18, 2023      Online gift      1,211.70
2023-01-16   Cash   1,635.86
09/03/2023   Online gift   1,343.71
July 26, 2023  Cash  357.77
Total contributions $6,396.08
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-ac4b91f0816e099018784dcf,v11-ANNUAL_GIVING_STATEMENT-inline,original,2023,fgen-9ad74f2b0786748d4b32540d,synthetic_programmatic_template,inline,top,False,nonprofit
"Year-End Giving Summary
Sample Community Food Bank
Tax ID 45-2148575  A 501(c)(3) organization
Dear Morgan Brennan,
Thank you for your generous support this year.
Date
Method
Amount
08/05/2021
Cash
540.88
08/08/2021
Cash
516.22
September 26, 2021
Stock transfer
64.57
02/16/2021
Online gift
1,266.62
11/26/2021
Online gift
1,768.24
2021-08-01
Stock transfer
1,405.70
10/12/21
Check #8962
2,275.05
Total contributions
$7,837.28
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-0bc281a820686604ba1d9aa8,v11-ANNUAL_GIVING_STATEMENT-columns,original,2021,fgen-93612aafbd48b6d6c07109a2,synthetic_programmatic_template,columns,top,False,daf_grant_summary
"Year-End Giving Summary
Sample Community Food Bank
Tax ID 33-4908669  A 501(c)(3) organization
Dear Amara Walsh,
Thank you for your generous support this year.
Date
Method
Amount
05/10/2026
Stock transfer
880.36
December 23, 2026
Check #1211
759.49
2026-08-09
Stock transfer
881.00
2026-02-26
Stock transfer
1,536.71
1/1/26
Check #1473
2,173.78
3/8/26
Check #7437
2,400.38
2026-12-14
Stock transfer
1,149.20
Total contributions
$9,780.92
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-a55d8807be63cecb5a2a2cc2,v11-ANNUAL_GIVING_STATEMENT-columns,original,2026,fgen-00ace2edaf53c00267876269,synthetic_programmatic_template,columns,top,False,church
"2023 Annual Giving Statement
Sample Community Food Bank
Tax ID 17-7921921  A 501(c)(3) organization
Dear Taylor Patel,
Thank you for your generous support this year.
Date
Method
Amount
4/4/23
Check #8481
1,462.40
8/5/23
Online gift
195.97
2023-08-21
Online gift
1,651.22
Total contributions
$3,309.59
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-e7d4789290de67c1ec63e9ca,v11-ANNUAL_GIVING_STATEMENT-columns,original,2023,fgen-7a81bd662baff58c4dafcc22,synthetic_programmatic_template,columns,top,False,daf_grant_summary
"Sample Community Food Bank
Tax ID 31-1462616  A 501(c)(3) organization
Dear Sofia Patel,
Thank you for your generous support this year.
Date
Method
Amount
2026-05-13
Cash
2,336.88
9/10/26
Cash
354.44
2026-11-11
Check #6012
2,411.61
06/01/2026
Check #8302
750.23
Total contributions
$5,853.16
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-a0074eaa0319c7b197f1b9dd,v11-ANNUAL_GIVING_STATEMENT-columns,original,2026,fgen-834214b7d6d96f7dc2e5496f,synthetic_programmatic_template,columns,none,False,church
"Year-End Giving Summary
Hope Harbor Shelter
Tax ID 30-4132361  A 501(c)(3) organization
Dear Hiro Larsen,
Thank you for your generous support this year.
Date
Method
Amount
June 1, 2026
Stock transfer
943.35
02/06/2026
Check #5810
1,268.15
2026-06-07
Online gift
2,064.82
August 20, 2026
Check #1839
417.56
July 13, 2026
Check #2305
2,272.90
7/28/26
Cash
2,330.27
12/21/26
Check #4119
1,714.19
06/05/2026
Online gift
1,207.42
Total contributions
$12,218.66
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-5938961ea7495e7bbb1d9603,v11-ANNUAL_GIVING_STATEMENT-columns,original,2026,fgen-8bdd4e8d2c52576d3e33de78,synthetic_programmatic_template,columns,top,False,daf_grant_summary
"Sample Community Food Bank
TaxID 30-3O76025  A 501(c)(3) organízation
Dear Diego Romero,
Thank you for your generous support this year.
Date
Method
Amount
11/4/24
Stock transfer
1,971.26
6/7/24
Online gift
1,438.95
2024-02-01
Stock transfer
2,062.18
October 13, 2024
Check #4058
1,100.46
Tota1 contributions
$6,572.85
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-80306320439543fd86778497,v11-ANNUAL_GIVING_STATEMENT-columns,original,2024,fgen-aa6c42dbff058fc2f61a73b0,synthetic_programmatic_template,columns,none,True,daf_grant_summary
"Year-End Giving Summary
Sample Community Food Bank
Tax ID 59-3421712  A 501(c)(3) organization
Dear Olivia Moreau,
Thank you for your generous support this year.
Date
Method
Amount
2021-05-04
Cash
2,422.68
05/07/2021
Cash
508.98
December 26, 2021
Check #1051
1,627.02
10/11/2021
Stock transfer
1,141.93
Total contributions
$5,700.61
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-5fa63f556f544cebd86cc35f,v11-ANNUAL_GIVING_STATEMENT-columns,original,2021,fgen-e277e3b00fb068e8e97d54b5,synthetic_programmatic_template,columns,top,False,church
"Sample Communíty Food Bank
Tax ID 25-4410929  A 501(c)(3) organization
Dear AveryLarsen,
Thank you for your generous support this year.
Date
Method
Amount
3/26/24
Stock transfer
1,619.14
October 9, 2O24
Cash
2,005.15
09/20/2024
Check #5798
1,407.52
08/23/2024
Cash
24.97
Tota1 contríbutíons
$5,056.78
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-a7b283bcade0764d4146949d,v11-ANNUAL_GIVING_STATEMENT-columns,original,2024,fgen-a104db10b7a2cd320c81397b,synthetic_programmatic_template,columns,none,True,nonprofit
"Year-End GivingSummary
Hope Harbor Shelter
Tax ID 13-2931130  A 501(c)(3) organization
Dear Priya Castillo,
Thank you for your generous support this year.
Date
Method
Amount
2026-05-21
Cash
94.80
March 18, 2026
Stock transfer
589.60
03/01/2026
Cash
1,121.73
2026-07-07
Check #5122
200.47
September 10, 2026
0n1ine gift
456.33
Total contributions
$2,462.93
Only intangiblc religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-b5b36a27089a9cac0f94abe1,v11-ANNUAL_GIVING_STATEMENT-columns,original,2026,fgen-1ecdb26692816cb039143909,synthetic_programmatic_template,columns,top,True,daf_grant_summary
"Contribution Statement for 2023
Sample Community Food Bank
Tax ID 25-8018366  A 501(c)(3) organization
Dear Hiro Larsen,
Thank you for your generous support this year.
Date
Method
Amount
2023-09-16
Check #6691
1,368.28
2023-02-23
Online gift
429.12
July 23, 2023
Cash
464.66
9/8/23
Online gift
2,072.28
2023-08-15
Online gift
1,714.70
July 15, 2023
Online gift
848.76
July 13, 2023
Online gift
50.09
Total contributions
$6,947.89
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-18272f205d552c58455309fb,v11-ANNUAL_GIVING_STATEMENT-columns,original,2023,fgen-cbbfe11644fa2b2b3a210cf9,synthetic_programmatic_template,columns,top,False,church
"2022 Annual Giving Statement
Hope Harbor 5helter
Tax ID 94-3537048  A 501(c)(3) organization
Dear Morgan Castillo,
Thank you for your generous support this year.
Date
Method
Amount
August 15, 2022
Stock transfer
705.88
1/16/22
Check#8575
1,801.47
March 28, 2022
Cash
1,105.41
08/09/2022
Check #6664
2,O53.84
12/21/22
Check #5691
2,383.83
03/23/2022
Stock transfer
1,962.84
Tota1 contributions
$10,013.27
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-eb238199dcd7c728092814e5,v11-ANNUAL_GIVING_STATEMENT-columns,original,2022,fgen-f3fd96e33eade1bbcb6d5dce,synthetic_programmatic_template,columns,top,True,nonprofit
"2021 Annua1 Giving Statement
Riverbend Public Library Foundation
Tax ID 81-1474035  A 501(c)(3) organization
Dear Kwame C. Brennan,
Thank you for your generous support this year.
Date
Method
Amount
August 3, 2021
0nline gift
2,226.07
4/5/21
Check #6506
1,121.03
11/25/21
Check #9441
474.72
4/4/21
Online gift
1,710.45
2021-09-24
Check#6646
1,753.96
Total contributions
$7,286.23
Only intangiblc religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-d0558d7df3375ed53c4c76c9,v11-ANNUAL_GIVING_STATEMENT-columns,original,2021,fgen-3bcd005bf76afd560b1a8589,synthetic_programmatic_template,columns,top,True,nonprofit
"Contribution Statement for 2022
Hope Harbor Shelter
Tax ID 78-6784652  A 501(c)(3) organization
Dear Taylor E. Adeyemi,
Thank you for your generous support this year.
Date
Method
Amount
May 21, 2022
Check #1343
1,872.30
2022-04-02
Online gift
2,113.43
2022-04-22
Online gift
983.14
5/21/22
Cash
1,804.77
06/14/2022
Cash
2,160.92
2022-08-28
Check #1866
1,531.37
08/19/2022
Check #6268
1,841.84
07/20/2022
Cash
447.55
Total contributions
$12,755.32
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-0b27225d0d35f7f410d7e3fd,v11-ANNUAL_GIVING_STATEMENT-columns,original,2022,fgen-3b93fabde933de02e053fb85,synthetic_programmatic_template,columns,top,False,church
"2023 Annual Giving Statement
Hope Harbor Shelter
Tax ID 23-9278309  A 501(c)(3) organization
Dear Alex A. Testcase,
Thank you for your generous support this year.
Date
Method
Amount
March 1, 2023
Stock transfer
1,452.61
11/19/23
Stock transfer
208.00
9/26/23
Cash
1,579.29
05/01/2023
Stock transfer
1,909.56
Total contributions
$5,149.46
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-7087356b7a4176008d078b84,v11-ANNUAL_GIVING_STATEMENT-columns,original,2023,fgen-c6c549349ad91c259eeeb082,synthetic_programmatic_template,columns,top,False,nonprofit
"Contribution Statement for 2026
Sample Community Food Bank
Tax ID 89-9761496  A 501(c)(3) organization
Dear Morgan Romero,
Thank you for your generous support this year.
Date
Method
Amount
2026-05-07
Check #4170
592.26
2026-08-25
Cash
414.91
10/26/26
Cash
208.62
July 4, 2026
Cash
1,700.19
July 24, 2026
Stock transfer
2,179.39
2026-08-28
Check #8794
1,518.63
June 27, 2026
Online gift
1,401.25
2026-09-23
Online gift
368.75
Total contributions
$8,384.00
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-6c80f9e4ad705ccc9d3b7d22,v11-ANNUAL_GIVING_STATEMENT-columns,original,2026,fgen-4ec9d60ee333d32abcd0cdfb,synthetic_programmatic_template,columns,top,False,daf_grant_summary
"Greenway Animal Rescue
Tax ID 41-7270186  A 501(c)(3) organization
Dear Jordan Brennan,
Thank you for your generous support this year.
Date
Method
Amount
2025-10-15
Check #1543
678.75
2025-12-24
Onlíne gift
1,79O.59
June 20, 2025
5tock transfer
185.05
12/15/2025
Cash
560.23
Fcbruary 6, 2025
Chcck #7254
2,195.47
July 4, 2025
Onlíne gift
1,205.36
February 4, 2025
Check #8310
2,077.38
Total contributions
$8,692.83
No goods orservices were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-fdc210f6f4024bb060afd1ca,v11-ANNUAL_GIVING_STATEMENT-columns,original,2025,fgen-42dd2e249a7092a997cda326,synthetic_programmatic_template,columns,none,True,church
"Hope Harbor Shelter
Tax ID 88-2884339  A 501(c)(3) organization
Dear Wei Adeyemi,
Thank you for your generous support this year.
Date,Method,Amount
3/7/21,Check #1473,""2,410.89""
2021-02-01,Check #2652,""1,576.57""
2021-06-11,Check #9037,""1,322.95""
""November 6, 2021"",Online gift,90.30
""March 21, 2021"",Stock transfer,""1,423.60""
11/8/21,Online gift,57.52
""March 13, 2021"",Check #5364,813.09
2021-10-19,Online gift,""1,567.41""
Total contributions,""$9,262.33""
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-8fd12bce0e57c5f3ea118ea3,v11-ANNUAL_GIVING_STATEMENT-csv,original,2021,fgen-70d1f2daae7d514b55d96b78,synthetic_programmatic_template,csv,none,False,church
"Year-End Giving Summary
Greenway Animal Rescue
Tax ID 77-9321534  A 501(c)(3) organization
Dear Riley Okafor,
Thank you for your generous support this year.
Date,Method,Amount
10/15/2021,Stock transfer,""1,100.16""
10/12/21,Stock transfer,148.53
2021-01-02,Cash,""1,333.48""
01/18/2021,Stock transfer,""2,279.77""
""September 3, 2021"",Online gift,730.15
11/4/21,Online gift,""2,451.47""
6/20/21,Stock transfer,""1,440.83""
3/6/21,Check #4267,994.34
Total contributions,""$10,478.73""
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-b230d3788fd2adb1f95fbeb7,v11-ANNUAL_GIVING_STATEMENT-csv,original,2021,fgen-6f3e2d07c627790a706f95d1,synthetic_programmatic_template,csv,top,False,daf_grant_summary
"2024 Annual Giving Statement
Sample Community Food Bank
Tax ID 72-3423078  A 501(c)(3) organization
Dear Alex D. Okafor,
Thank you for your generous support this year.
Date,Method,Amount
""August 19, 2024"",Cash,41.20
""December 27, 2024"",Cash,""2,197.22""
""December 3, 2024"",Cash,814.00
1/14/24,Cash,89.80
2024-10-20,Check #3667,421.99
2024-11-28,Stock transfer,932.80
6/2/24,Stock transfer,""2,379.17""
2024-09-12,Check #5729,""1,016.65""
Total contributions,""$7,892.83""
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-90c822cd2922baa1d43b17eb,v11-ANNUAL_GIVING_STATEMENT-csv,original,2024,fgen-8701c762b188313c05a21768,synthetic_programmatic_template,csv,top,False,daf_grant_summary
"Sample Community Food Bank
Tax ID 86-6445444  A 501(c)(3) organization
Dear Taylor Adeyemi,
Thank you for your generous support this year.
Date,Method,Amount
10/15/23,Stock transfer,""2,210.01""
3/26/23,Check #2808,""1,416.48""
05/21/2023,Stock transfer,""2,060.16""
10/4/23,Cash,10.06
""February 23, 2023"",Check #5453,430.08
7/9/23,Online gift,272.24
12/5/23,Cash,""2,231.97""
08/15/2023,Check #2138,419.78
Total contributions,""$9,050.78""
Only intangible religious benefits were provided in exchange for your gifts.
Contribution Statement for 2023",DONATION_RECORD,28,DONATION_RECORD,fdc-724bf0838717dfcaf19c7e24,v11-ANNUAL_GIVING_STATEMENT-csv,original,2023,fgen-2e7960418c39ac865e7dd778,synthetic_programmatic_template,csv,bottom,False,nonprofit
"Riverbend Public Library Foundation
Tax ID 57-6379054  A 501(c)(3) organization
Dear Diego Haddad,
Thank you for your generous support this year.
Date,Method,Amount
12/18/2025,Online gift,""1,476.62""
2025-03-06,Online gift,""2,115.00""
12/12/25,Online gift,""1,111.74""
2025-12-18,Online gift,""1,175.59""
Total contributions,""$5,878.95""
No goods or services were provided in exchange for these contributions.
Contribution Statement for 2025",DONATION_RECORD,28,DONATION_RECORD,fdc-8dd5cd6ccfb27221edf11874,v11-ANNUAL_GIVING_STATEMENT-csv,original,2025,fgen-371a4fc9377ba7782488856e,synthetic_programmatic_template,csv,bottom,False,daf_grant_summary
"Year-End Giving Summary
St. Brendan Parish
Tax ID 62-6503212  A 501(c)(3) organization
Dear Casey Walsh,
Thank you for your generous support this year.
Date,Method,Amount
5/10/25,Cash,""2,065.56""
2025-04-18,Check #4983,""2,498.67""
2025-08-16,Stock transfer,740.23
Total contributions,""$5,304.46""
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-19cf64e00362d078dbcceb85,v11-ANNUAL_GIVING_STATEMENT-csv,original,2025,fgen-e92f97cbbe8243eaf85292c9,synthetic_programmatic_template,csv,top,False,nonprofit
"Contribution Statement for 2025
St. Brendan Parish
Tax ID 74-7057111  A 501(c)(3) organization
Dear Diego Tanaka,
Thank you for your generous support this year.
Date,Method,Amount
06/27/2025,Stock transfer,""1,466.24""
09/09/2025,Cash,""1,296.65""
""May 28, 2025"",Online gift,59.86
Total contributions,""$2,822.75""
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-f388c828d0233ec435f4aad4,v11-ANNUAL_GIVING_STATEMENT-csv,original,2025,fgen-187e4bdcd2f655d9eed324a5,synthetic_programmatic_template,csv,top,False,daf_grant_summary
"St. Brendan Parish
Tax ID 77-7368037  A 501(c)(3) organization
Dear Lena Fischer,
Thank you for your generous support this year.
Date,Method,Amount
1/17/22,Cash,""1,956.61""
4/18/22,Check #7576,985.67
2/20/22,Stock transfer,""2,427.97""
9/18/22,Stock transfer,""1,479.28""
""November 3, 2022"",Online gift,""2,331.67""
9/23/22,Cash,341.44
2022-01-07,Online gift,941.78
Total contributions,""$10,464.42""
Only intangible religious benefits were provided in exchange for your gifts.
Contribution Statement for 2022",DONATION_RECORD,28,DONATION_RECORD,fdc-b5d25a6b09d5ca7de43d47a2,v11-ANNUAL_GIVING_STATEMENT-csv,original,2022,fgen-e10fa308d80d3716734b6f41,synthetic_programmatic_template,csv,bottom,False,church
"Year-End Giving Summary
Hope Harbor Shelter
Tax ID 13-1264250  A 501(c)(3) organization
Dear Wei Larsen,
Thank you for your generous support this year.
Date,Method,Amount
8/15/25,Check #3127,""1,762.93""
""November 19, 2025"",Check #8615,251.68
2025-08-02,Check #4596,966.26
9/28/25,Online gift,""2,473.65""
Total contributions,""$5,454.52""
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-e443c60785d44444353f22d2,v11-ANNUAL_GIVING_STATEMENT-csv,original,2025,fgen-f82943b604221e0e139d434e,synthetic_programmatic_template,csv,top,False,daf_grant_summary
"Year-End Giving Summary
Riverbend Public Library Foundation
Tax ID 55-4533453  A 501(c)(3) organization
Dear Fatima Adeyemi,
Thank you for your generous support this year.
Date,Method,Amount
2026-04-03,Stock transfer,460.05
""March 2, 2026"",Cash,""2,146.56""
05/14/2026,Online gift,""2,330.79""
11/3/26,5tock transfer,""2,472.84""
11/21/2026,0nline gift,""2,269.88""
9/16/26,On1ine gift,869.71
Total contributions,""$10,549.83""
No goods or services were provided inexchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-1efffb3b7a354ac4ed3b1f6c,v11-ANNUAL_GIVING_STATEMENT-csv,original,2026,fgen-d5b4143a25a08a4526ce1698,synthetic_programmatic_template,csv,top,True,nonprofit
"Contribution Statement for 2026
Greenway Animal Rescue
Tax ID 49-5805300  A 501(c)(3) organization
Dear Alex Walsh,
Thank you for your generous support this year.
Date,Method,Amount
05/03/2026,Stock transfer,""1,689.36""
06/04/2026,Check #5089,652.90
""November 13, 2026"",Cash,""1,670.29""
04/02/2026,Stock transfer,158.75
05/01/2026,Check #1298,914.53
12/8/26,Online gift,""2,439.57""
Total contributions,""$7,525.40""
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-6bee95d9a7254ac9b26f62d4,v11-ANNUAL_GIVING_STATEMENT-csv,original,2026,fgen-65f73c1c14e2c74afb16e482,synthetic_programmatic_template,csv,top,False,church
"2022 Annual Giving Statement
Sample Community Food Bank
Tax ID 47-1089902  A 501(c)(3) organization
Dear Hiro M. Tanaka,
Thank you for your generous support this year.
Date,Method,Amount
2022-06-11,Stock transfer,""2,273.74""
2022-09-26,Cash,""1,380.43""
2022-10-15,Cash,769.20
07/06/2022,Online gift,""1,227.00""
04/28/2022,Stock transfer,93.57
10/16/2022,Stock transfer,162.39
2022-11-13,Check #8912,""2,192.31""
Total contributions,""$8,098.64""
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-df49e69af708c32348212195,v11-ANNUAL_GIVING_STATEMENT-csv,original,2022,fgen-14179c8882be7936298b7e93,synthetic_programmatic_template,csv,top,False,nonprofit
"2025 Annual Giving Statement
Hope Harbor Shelter
Tax ID 46-7897205  A 501(c)(3) organization
Dear Kwame Tanaka,
Thank you for your generous support this year.
Date,Method,Amount
""August 19, 2025"",Cash,""1,199.99""
2025-01-09,Cash,257.26
""January 20, 2025"",Stock transfer,546.99
""July 9, 2025"",Check #8848,""1,515.42""
Total contributions,""$3,519.66""
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-56b57e314124ba967617fde6,v11-ANNUAL_GIVING_STATEMENT-csv,original,2025,fgen-413404fd2730045eacac6515,synthetic_programmatic_template,csv,top,False,daf_grant_summary
"2025 Annual Giving Statement
Riverbend Public Library Foundation
Tax ID 78-6480510  A 501(c)(3) organization
Dear Sofia Okafor,
Thank you for your generous support this year.
Date,Method,Amount
10/25/25,Check #1761,""1,142.58""
8/17/25,Stock transfer,779.86
11/22/25,Cash,333.84
2025-08-21,Online gift,""2,319.05""
2025-02-28,Stock transfer,175.37
Total contributions,""$4,750.70""
Only intangible religious benefits were provided in exchange for your gifts.",DONATION_RECORD,28,DONATION_RECORD,fdc-12a70a6572d2832f93181de9,v11-ANNUAL_GIVING_STATEMENT-csv,original,2025,fgen-75825737b071f07c84a62c24,synthetic_programmatic_template,csv,top,False,daf_grant_summary
"2023 Annual Giving Statement
Greenway Animal Rescue
Tax ID 61-1098629  A 501(c)(3) organization
Dear Wei Haddad,
Thank you for your generous support this year.
Date,Method,Amount
2023-08-20,Stock transfer,""1,487.38""
10/9/23,Stock transfer,80.03
""January 18, 2023"",Stock transfer,""2,031.98""
1/26/23,Stock transfer,987.21
01/18/2023,Cash,249.94
2023-11-18,Stock transfer,34.10
09/24/2023,Stock transfer,262.44
Total contributions,""$5,133.08""
No goods or services were provided in exchange for these contributions.",DONATION_RECORD,28,DONATION_RECORD,fdc-2aee6ab561711cacf45f8fcc,v11-ANNUAL_GIVING_STATEMENT-csv,original,2023,fgen-c84dc509f998a7430597d3b4,synthetic_programmatic_template,csv,top,False,church
"Sample Community Food Bank
Tax ID 77-4276630  A 501(c)(3) organization
Dear Mateo Walsh,
Thank you for your generous support this year.
Date,Method,Amount
6/22/23,Check #8680,572.28
07/21/2023,Stock transfer,""1,507.32""
2023-09-27,Cash,77.21
Total contributions,""$2,156.81""
No goods or services were provided in exchange for these contributions.
2023 Annual Giving Statement",DONATION_RECORD,28,DONATION_RECORD,fdc-d1c434f45f8b4e5dc51eba24,v11-ANNUAL_GIVING_STATEMENT-csv,original,2023,fgen-12103bcf0cb9c9371a344e40,synthetic_programmatic_template,csv,bottom,False,church
"Transaction Date   Transaction Description   Debit   Credit   Balance
2021-08-28 MOBILE DEPOSIT 672.28  18052.46
22/02/2021     AMAZON MKTPLACE      147.94            20571.08
04/03/2021  DELTA AIR LINES  542.20    1406O.00
2021-06-22   WHOLE FOODS #1021   522.76      22031.78
01/01/2021  COSTCOWHSE #412  601.40  2123.17 1495.51
07/06/2021 NETFLIX.COM 632.24 1939.27 13618.44
2021-05-23 TARGET T-2231 888.48  9425.50
02/20/2021  WHOLE FOODS #1021  602.06    2387.94",BANK_STATEMENT,24,BANK_STATEMENT,fdc-91ffaeb94ea3438e83d070f4,v11-BANK_STATEMENT-inline,original,2021,fgen-1b60f18a5d2dbfde9bd15b71,synthetic_programmatic_template,inline,top,True,raw_export
"Checking Account Statement
Cedar Valley Credit Union
Account number      ending in 7576
Statement period   10/01/2023 - 10/28/2023
Kwame Patel
1985 Elm Park Pl Testville, IL 39253
Account summary
Beginning balance $38,190.45
Deposits and other credits $6,681.20
Withdrawals and other debits -$2,831.91
Ending balance $42,039.73
Interest paid this period $31.01
Interest paid year-to-date      205.18
Annual percentage yield earned   3.92%
Date      Description      Amount
05/19   NETFLIX.COM   -492.63
05/03      SHELL OIL 5741      -322.67
10/28 AMAZON MKTPLACE 103.68
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b1cd5d0c54dc36461223c6d1,v11-BANK_STATEMENT-inline,original,2023,fgen-aebf8d964e36152c44da55cf,synthetic_programmatic_template,inline,top,False,checking
"Cedar Valley Credit Union
Account number  XXX-XX-5535
Statement period   07/01/2023 - 07/30/2023
Sofia Kowalski
8470 Sample Street Cedar Falls, IA 92765
Account summary
Beginning balance   $7,465.53
Deposits and other credits $5,271.61
Withdrawals and other debits   -$942.67
Ending balance $11,794.47
Interest paid this period $33.67
Interest paid year-to-date  475.09
Annual percentage yield earned   3.16%
Tax reminder: amounts on this statement may differ from your Form 1099-INT.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-595682dff3594c95e5507892,v11-BANK_STATEMENT-inline,original,2023,fgen-9e08335d9a3113493680a7ea,synthetic_programmatic_template,inline,none,False,year_end
"Checking Account Statement
Granite Peak Bank
Account number   ending in 8843
Statement period      06/01/2026 - 06/30/2026
Taylor Rivera
9491 Elm Park Pl Fairview, OH 48125
Account summary
Beginning balance      $2,680.10
Deposits and other credits      $4,728.08
Withdrawals and other debits   -$5,807.44
Ending balance  $1,600.75
Interest paid this period  44.67
Interest paid year-to-date 728.89
Annual percentage yield earned 3.16%
Date      Description      Amount
02/08 COSTCO WHSE #412 -322.82
01/28 HOME DEPOT 0612 -518.17
08/19 AMAZON MKTPLACE -762.39
Tax reminder: amounts on this statement may differ from your Form 1099-INT.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e65c81aa83717d77cf63dd3d,v11-BANK_STATEMENT-inline,original,2026,fgen-3958f0d49993ab720c21d9b4,synthetic_programmatic_template,inline,top,False,checking
"Summit Ridge Bank
Account number ***-**-7524
5tatement períod 11/01/2021 - 11/28/2021
Kwame Testcase
9625 Sample Street Bayside, WA 32078
Account summary
Beginning balance $23,562.86
Deposits and othercredits   $8,995.77
Wíthdrawals and other debits  -$3,686.47
Ending balance   $28,872.16
Interest paíd this period   $2.89
Interest paid year-to-date   673.81
Annua1 percentage yield eamed  3.44%
This statement isnot a Form 1099-INT. Keep it for your records.
Equal Housing Lcnder",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ed18a7f5c9f37faab5736dcf,v11-BANK_STATEMENT-inline,original,2021,fgen-ac3c51448555eaa2724c93b2,synthetic_programmatic_template,inline,none,True,year_end
"Transaction Date  Transaction Description  Debit  Credit  Balance
04/08/2024 NETFLIX.COM   29665.37
11/11/2024 UBER TRIP 172.16 2455.77 9421.78
08/10/2024 COSTCO WHSE #412 479.95  3257.48
03/26/2024      AMAZON MKTPLACE            850.37      7517.87
08/12/2024 WHOLE FOODS #1021   4552.98
04/27/2024  MOBILE DEPOSIT      16288.36
10/18/2024   UBER TRIP      2158.42   11856.12
02/09/2024 SHELL OIL 5741   27297.24",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e115b68febce8f5c349b1db9,v11-BANK_STATEMENT-inline,original,2024,fgen-2db3b974654e784dab1d8405,synthetic_programmatic_template,inline,top,False,raw_export
"Checking Account Statement
Harbor Federal Credit Union
Account number      XXXXX6419
Statement period  07/01/2024 - 07/31/2024
Wei M. Castillo
5701 Harbor View Rd Bayside, WA 77386
Account summary
Beginning balance $3,723.05
Deposits and other credits $6,684.26
Withdrawals and other debits -$7,957.11
Ending balance   $2,450.20
Interest paid this period 59.33
Interest paid year-to-date   336.74
Annual percentage yield earned  3.80%
Date   Description   Amount
06/25      AMAZON MKTPLACE      -628.27
11/10      COSTCO WHSE #412      -379.28
10/19   NETFLIX.COM   -142.22
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-cf2263e212402986b5a81132,v11-BANK_STATEMENT-inline,original,2024,fgen-b55d077b30791abbc69d9efe,synthetic_programmatic_template,inline,top,False,checking
"Checking Account Statement
Meadowlark Savings Bank
Account number      ending in 0900
Statement period 10/01/2025 - 10/28/2025
Lena Larsen
5907 Harbor View Rd Oak Grove, TX 88153
Account summary
Beginning balance $36,349.34
Deposits and other credits $4,939.03
Withdrawals and other debits -$5,172.17
Ending balance      $36,116.19
Date   Description   Amount
01/15 COSTCO WHSE #412 -544.25
11/28 SHELL OIL 5741 765.58
11/23 COSTCO WHSE #412 -600.13
01/28 TARGET T-2231 83.54
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-7315e577fb37d52af1739f6f,v11-BANK_STATEMENT-inline,original,2025,fgen-2b6bc859e90feabef92b69cf,synthetic_programmatic_template,inline,top,False,checking
"Checking Account Statement
Granite Peak Bank
Account number XXX-XX-6669
Statement period 07/01/2022 - 07/31/2022
Diego Brennan
740 Prairie Ave Fairview, OH 69326
Account summary
Beginning balance $51,987.58
Deposits and other credits      $973.70
Withdrawals and other debits  -$2,328.87
Ending balance $50,632.42
Interest paid this period  $8.83
Interest paid year-to-date      $445.80
Annual percentage yield earned 3.91%
Date   Description   Amount
09/13   AMAZON MKTPLACE   -391.69
05/05 TARGET T-2231 -817.80
02/02 HOME DEPOT 0612 -314.06
06/01   COSTCO WHSE #412   -627.50
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-daec565078f08a21f03b6e9b,v11-BANK_STATEMENT-inline,original,2022,fgen-fee3256c27903f81a5189469,synthetic_programmatic_template,inline,top,False,checking
"Transaction Date Transaction Description Debit Credit Balance
05/12/2022 CVS/PHARMACY 0832 651.30  18642.77
12/21/2022 CVS/PHARMACY 0832  454.76 2290.89
22/06/2022   INTEREST PAYMENT   417.27   881.22   28215.15
19/09/2022  MOBILE DEPOSIT      13461.96
2022-06-23 TARGET T-2231 699.44 455.04 21783.40
06/25/2022   UBER TRIP      1391.95   3946.84
2022-05-12 HOME DEPOT 0612  2169.82 29951.32",BANK_STATEMENT,24,BANK_STATEMENT,fdc-42e7350c8a023de13b38c33f,v11-BANK_STATEMENT-inline,original,2022,fgen-eedd4c5fa112ad3126217bfc,synthetic_programmatic_template,inline,top,False,raw_export
"Granite Peak Bank
Account number  XXX-XX-4032
Statement period   03/01/2025 -03/31/2025
Jamie S. Rivera
8275 Granite St Faírview,OH 1583O
Account summary
Beginning balance  $32,832.08
Deposits and other credits $626.50
Withdrawals and other debits   -$3,441.99
Ending balance $30,016.59
Interest paid thisperiod 6.24
Interest paid year-to-date      $226.05
Annual percentage yield eamed      1.33%
Date Description Amount
07/21 DELTA AIR LINES 763.97
05/04 WH0LE FOODS #1021 830.18
08/12 AMAZON MKTPLACE 204.11
Your 2025 Form 1099-INT will be available online by January 31, 2026.
Member FDIC
Money Market Account 5tatement",BANK_STATEMENT,24,BANK_STATEMENT,fdc-863c179db1363fae9adb6f7a,v11-BANK_STATEMENT-inline,original,2025,fgen-c757830dfb6e2870a3762185,synthetic_programmatic_template,inline,bottom,True,money_market
"Checking Account Statement
Bayview Community Bank
Account number      ****8142
Statement period 08/01/2025 - 08/31/2025
Olivia Fischer
2481 Oak Hollow Ct Bayside, WA 59983
Account summary
Beginning balance $52,071.97
Deposits and other credits      $3,747.00
Withdrawals and other debits -$3,073.56
Ending balance   $52,745.41
Interest paid this period  16.65
Interest paid year-to-date  $145.20
Annual percentage yield earned 0.43%
Date  Description  Amount
07/08      AMAZON MKTPLACE      878.23
09/13 TARGET T-2231 560.08
04/28   SHELL OIL 5741   -897.85
05/04 AMAZON MKTPLACE -117.64
02/15      CVS/PHARMACY 0832      -44.77
12/15   TARGET T-2231   -453.89
11/24  NETFLIX.COM  863.22
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f0db8f7454bff2b2e2d20b73,v11-BANK_STATEMENT-inline,original,2025,fgen-6bd0b757ac0737540de7e6f8,synthetic_programmatic_template,inline,top,False,checking
"Date   Payee   Memo   Withdrawal   Deposit   Balance
07/01/2021      NETFLIX.COM            410.58            14324.18
2021-06-20 STARBUCKS #11872 utilities 812.78  28751.59
02/10/2021 COSTCO WHSE #412  664.41  25048.10
21/05/2021 CVS/PHARMACY 0832 utilities 692.00  18805.15
2021-09-25  STARBUCKS #11872  groceries  290.56    24173.12
09/12/2021      COSTCO WHSE #412      rent      709.86            11980.32",BANK_STATEMENT,24,BANK_STATEMENT,fdc-0e4b996a8538194722f43b05,v11-BANK_STATEMENT-inline,original,2021,fgen-d5566023b53c865b650b386f,synthetic_programmatic_template,inline,none,False,raw_export
"2026 Year-End AccountSummary
Summit Ridge Bank
Account number XXXXX2703
Statement period 11/01/2026 - 11/28/2026
Avery Testcase
6743 HarborView Rd Lakewood, CO 76418
Account summary
Beginning balance   $33,257.66
Deposíts and other credits $535.81
Withdrawals and other debits  -$4,192.7O
Ending balance $29,600.78
Interest paid this period  $51.44
Interest paid year-to-date  199.99
Annua1 percentage yield earned 1.18%
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-0778d2784d4d627f42c32fb3,v11-BANK_STATEMENT-inline,original,2026,fgen-4f0049b474c3ebdfbb40c5bd,synthetic_programmatic_template,inline,top,True,year_end
"Checking Account Statement
Summit Ridge Bank
Account number   ****8627
Statement period   04/01/2024 - 04/28/2024
Diego Testcase
6990 Sample Street Oak Grove, TX 44599
Account summary
Beginning balance $19,378.42
Deposits and other credits      $5,284.52
Withdrawals and other debits -$7,556.27
Ending balance $17,106.67
Interest paid this period      $0.88
Interest paid year-to-date      $31.97
Annual percentage yield earned 3.68%
Date Description Amount
02/16 AMAZON MKTPLACE -191.29
03/07   DELTA AIR LINES   -364.68
05/16      WHOLE FOODS #1021      -726.89
12/23      NETFLIX.COM      -898.78
03/10      NETFLIX.COM      -291.91
09/21  HOME DEPOT 0612  -51.74
This statement is not a Form 1099-INT. Keep it for your records.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ff1f232b03d9bb307368e992,v11-BANK_STATEMENT-inline,original,2024,fgen-ca16f6beb16b13992d7588ea,synthetic_programmatic_template,inline,top,False,checking
"Account History: Checking
Date Description Amount Running Bal.
07/21/2026   ZELLE FROM J SMITH   1992.63   23429.11
2026-11-07 HOME DEPOT 0612 -473.12 1595.95
2026-01-06  UBER TRIP  -2488.40  15389.83
2026-07-24   PAYROLL DIRECT DEP   -849.28   12295.67",BANK_STATEMENT,24,BANK_STATEMENT,fdc-11a043fc8ed988c53677c6e4,v11-BANK_STATEMENT-inline,original,2026,fgen-c78a1f94ec25c2d62b8f2451,synthetic_programmatic_template,inline,top,False,raw_export
"Checking Account Statement
Harbor Federal Credit Union
Account number  XXX-XX-2467
Statement period 10/01/2024 - l0/28/2024
Casey Haddad
8522 PrairieAve Bayside, WA 70920
Account summary
Beginningba1ancc $33,846.31
Dcposíts and other credits   $8,774.37
Withdrawals and other debits -$5,315.54
Ending balance $37,3O5.14
Interest paid this period     19.57
Interest paid ycar-to-date      $768.44
Annual percentage yield earned 1.09%
Date      Description      Amount
06/09  5TARBUCKS #l1872  -29.97
12/11  H0ME DEPOT 0612  -223.45
04/17      UBER TRIP      -682.99
01/22   UBER TRIP   582.17
07/14 DELTA AIR LINES -210.67
Your 2024Form 1099-INT wíll be available online by January 31, 2025.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-8c560938e921c9827bf2a433,v11-BANK_STATEMENT-inline,original,2024,fgen-e0bbe117ed9fec8e2bf7d63a,synthetic_programmatic_template,inline,top,True,checking
"Money Market Account Statement
Riverbend Bank & Trust
Account number XXX-XX-5413
Statement period  12/01/2024 - 12/28/2024
Sofia L. Okafor
3421 Granite St Maplewood, MN 88191
Account summary
Beginning balance  $7,041.64
Deposits and other credits  $3,961.24
Withdrawals and other debits -$4,943.43
Ending balance  $6,059.46
Interest paid this period 37.51
Interest paid year-to-date   $548.31
Annual percentage yield earned 2.29%
Date  Description  Amount
02/23 UBER TRIP -468.79
03/15   NETFLIX.COM   -816.60
05/07 WHOLE FOODS #1021 -434.55
12/01 SHELL OIL 5741 -56.03
Your 2024 Form 1099-INT will be available online by January 31, 2025.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-73d2ca5eff61cd6ce38b64ad,v11-BANK_STATEMENT-inline,original,2024,fgen-bbd52edf919275b39bab5bd0,synthetic_programmatic_template,inline,top,False,money_market
"Checking Account Statement
Cedar Vallcy Credit Union
Account number XXX-XX-0108
Statement period 06/01/2022 - 06/31/2022
Priya Castillo
2750 Prairie Ave Maplewood, MN 49396
Account summary
Beginningbalance $4,756.72
Deposits and other credits   $7,504.41
Withdrawa1s and other debits   -$836.80
Ending balancc  $11,424.33
Interest paid thís period  $4.57
Interest paid year-to-date   $228.25
Annual percentage yield earned    2.60%
Datc Description Amount
07/13  NETFLIX.COM  -72.04
11/03      AMAZON MKTPLACE      -673.84
04/13   WHOLE FOOD5 #1021  -194.28
01/10 DELTA AIR LINE5 824.08
01/20   NETFLIX.COM   -626.62
IRS Form 1099-INT information for 2022 will be mailed separately.
Equa1 Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b8ba4cef58e6e93e489f0fda,v11-BANK_STATEMENT-inline,original,2022,fgen-911c3cb5b23af440b7fbfb19,synthetic_programmatic_template,inline,top,True,checking
"Bayview Community Bank
Account number ending in 6867
Statement period 12/01/2026 - 12/31/2026
Lena Okafor
665 Lakeshore Blvd Pinecrest, GA 65394
Account summary
Beginning balance      $30,827.41
Deposits and other credits      $244.78
Withdrawals and other debits  -$2,955.70
Ending balance  $28,116.48
Date   Description   Amount
03/25 AMAZON MKTPLACE 519.62
06/21      COSTCO WHSE #412      -276.41
12/10 STARBUCKS #11872 -530.74
09/14  STARBUCKS #11872  -223.18
07/22      HOME DEPOT 0612      -122.61
This statement is not a Form 1099-INT. Keep it for your records.
Member FDIC
Checking Account Statement",BANK_STATEMENT,24,BANK_STATEMENT,fdc-d2db0982b354da9933c6695b,v11-BANK_STATEMENT-inline,original,2026,fgen-5f74d076f6ef578b023ed8b6,synthetic_programmatic_template,inline,bottom,False,checking
"Bayview Community Bank
Account number      ending in 0023
Statement period 08/01/2021 - 08/28/2021
Taylor Moreau
5232 Elm Park Pl 0ak Grove, TX 20750
Account summary
Beginning balance $46,313.16
Deposíts and other credits $6,604.28
Withdrawa1s and other debits   -$1,740.84
Endíng balance  $51,176.60
Interest paid this period   35.42
Interest paid year-to-date      $622.l9
Annual percentage yield eamed 3.31%
Date   Description  Amount
1O/14  DELTA AIR LINES -563.05
04/04 STARBUCKS #11872 743.56
07/15  WHOLE FOODS #1021  -527.62
07/20  NETFLIX.COM  -256.56
This statement is not a Form 1099-INT. Keep it for your records.
Equal Housing Lender
Savings Statement",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e76dca133824b7c70286176d,v11-BANK_STATEMENT-inline,original,2021,fgen-1915d7cdd2779c48921927db,synthetic_programmatic_template,inline,bottom,True,savings
"Cedar Valley Credit Union
Account number  ***-**-7692
Statement period   06/01/2022 - 06/30/2022
Kwame Kowalski
1961 Granite St Riverton, WI 53152
Account summary
Beginning balance  $54,435.60
Deposits and other credits      $1,368.64
Withdrawals and other debits -$3,980.50
Ending balance $51,823.74
Interest paid this period 27.66
Interest paid year-to-date 738.41
Annual percentage yield earned   2.91%
Date Description Amount
03/28  NETFLIX.COM  -413.06
01/08 STARBUCKS #11872 -112.59
03/26      SHELL OIL 5741      688.93
10/04 WHOLE FOODS #1021 -200.70
This statement is not a Form 1099-INT. Keep it for your records.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5e05cb07994f5040b7abf24b,v11-BANK_STATEMENT-inline,original,2022,fgen-ac2460350274e716416e5c3f,synthetic_programmatic_template,inline,none,False,money_market
"Savings Statement
Northwind Financial
Account number ***-**-3574
Statement period  12/01/2024 - 12/31/2024
Olivia K. Morcau
2698 Elm Park P1 0ak Grove, TX 77305
Account summary
Beginning balance $54,069.89
Deposits and other credits  $7,015.13
Withdrawals and other debits -$7,777.87
Ending balancc   $53,307.15
Interest paid this period$3.52
Interest paid year-to-date   365.48
Annual percentage yield earned 2.28%
Date Description Amount
O8/12  WHOLE FOODS #1021  110.99
02/06      SHELL OIL 5741      -213.72
01/21      SHELL 0IL 5741      -24.56
04/20   DELTA AIR LINE5   -579.37
Equal HousingLender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-8acd8dc240d2b7621e5d4eb4,v11-BANK_STATEMENT-inline,original,2024,fgen-7e62c8d7725c789d4bf332ee,synthetic_programmatic_template,inline,top,True,savings
"Checking Account Statement
Cedar Valley Credit Union
Account number ending in 1841
Statement period   06/01/2025 - 06/30/2025
Noah A. Patel
8125 Harbor View Rd Cedar Falls, IA 70428
Account summary
Beginning balance      $51,368.65
Deposits and other credits $7,667.77
Withdrawals and other debits  -$4,828.21
Ending balance  $54,208.21
Interest paid this period 45.67
Interest paid year-to-date $73.29
Annual percentage yield earned 4.19%
Date  Description  Amount
05/04 COSTCO WHSE #412 -127.89
07/04   WHOLE FOODS #1021   -472.58
09/09  COSTCO WHSE #412  -330.76
07/14 HOME DEPOT 0612 266.72
04/10 NETFLIX.COM 751.68
04/19 HOME DEPOT 0612 228.60
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-cc1a8355f26924fa0019ef63,v11-BANK_STATEMENT-inline,original,2025,fgen-64f69c6d893e9676bd79eba9,synthetic_programmatic_template,inline,top,False,checking
"Lakeshore National Bank
Account number  XXX-XX-5712
Statement period      06/01/2025 - 06/31/2025
Mateo Pate1
3115 Willow BendWay Testville, IL 61987
Account summary
Beginning balance $39,387.1O
Deposits and other credits $2,734.49
Withdrawa1s and other debits -$1,029.99
Endíng balance      $41,091.59
Interest paid this period 59.61
Interest paid year-to-date     $473.45
Annual percentage yield eamed  1.00%
Member FDIC
2025 Year-End Account 5ummary",BANK_STATEMENT,24,BANK_STATEMENT,fdc-96b76828129d6cf7ade9180c,v11-BANK_STATEMENT-inline,original,2025,fgen-7b3f81cd6c15c2eb3343a092,synthetic_programmatic_template,inline,bottom,True,year_end
"Lakeshore National Bank
Account number XXX-XX-9352
Statement period   07/01/2024 - 07/28/2024
Mateo Haddad
2808 Prairie Ave Brookhaven, PA 64545
Account summary
Beginning balance $59,941.00
Deposits and other credits      $2,303.47
Withdrawals and other debits -$1,728.71
Ending balance   $60,515.76
Date Description Amount
06/24  NETFLIX.COM  -289.92
07/12      UBER TRIP      -543.29
04/09  NETFLIX.COM  -527.68
09/06 CVS/PHARMACY 0832 -272.87
11/01 AMAZON MKTPLACE -226.15
02/13 HOME DEPOT 0612 -407.44
08/01   WHOLE FOODS #1021   -592.08
IRS Form 1099-INT information for 2024 will be mailed separately.
Federally insured by NCUA
Checking Account Statement",BANK_STATEMENT,24,BANK_STATEMENT,fdc-acb50b0c750a33b1a7b75db0,v11-BANK_STATEMENT-inline,original,2024,fgen-b9e0dfcb5d8a929c766179a3,synthetic_programmatic_template,inline,bottom,False,checking
"Harbor Federal Credit Union
Account numbcr   ***-**-1415
Statement period  12/01/2024 - 12/30/2024
Amara Patel
7304 Lakeshore Blvd Testville, IL 93626
Account summary
Beginning balance   $20,161.85
Deposíts and other credits $4,193.76
Withdrawals and other debits-$1,153.97
Ending balance $23,201.63
Interest paid this period $42.39
Interest paid year-to-date 846.10
Annua1 percentage yield earned3.81%
Date Description Amount
10/10      AMAZ0N MKTPLACE     -224.00
05/15      5HELL OIL 5741      -21.67
07/21 DELTA AIR LINES -438.18
06/15  NETFLIX.COM   -889.18
01/16      HOME DEPOT 0612      -372.92
Fcdera1ly ínsured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b752e67de022b37fccb08b2e,v11-BANK_STATEMENT-inline,original,2024,fgen-699dc4d9b5b6324a14edd8ca,synthetic_programmatic_template,inline,none,True,savings
"Checking Account Statement
Prairie State Savings
Account number   XXXXX2674
Statement period   06/01/2023 - 06/30/2023
Casey Kowalski
6753 Granite St Brookhaven, PA 10486
Account summary
Beginning balance      $58,784.41
Deposits and other credits   $4,950.99
Withdrawals and other debits      -$3,023.11
Ending balance      $60,712.29
Interest paid this period  23.24
Interest paid year-to-date   $409.05
Annual percentage yield earned 1.46%
Date Description Amount
12/12 WHOLE FOODS #1021 689.59
02/05 HOME DEPOT 0612 -610.88
05/01  COSTCO WHSE #412  -461.59
03/12 COSTCO WHSE #412 -808.49
01/19      STARBUCKS #11872      -53.00
01/21   AMAZON MKTPLACE   -894.09
09/11  STARBUCKS #11872  -665.14
Tax reminder: amounts on this statement may differ from your Form 1099-INT.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-6c6e351aa245678c5576a2df,v11-BANK_STATEMENT-inline,original,2023,fgen-4732aded45bb9956b1ccb868,synthetic_programmatic_template,inline,top,False,checking
"Money Market Account Statement
Harbor Federal Credit Union
Account number  ****2762
Statement period      11/01/2025 - 11/31/2025
Hiro C. Adeyemi
6489 Sample Street Riverton, WI 73485
Account summary
Beginning balance   $34,712.45
Deposits and other credits      $7,893.24
Withdrawals and other debits -$3,775.27
Ending balance      $38,830.41
Interest paid this period  18.43
Interest paid year-to-date      312.26
Annual percentage yield earned      0.84%
Date  Description  Amount
07/27      SHELL OIL 5741      -171.34
11/04 NETFLIX.COM 796.76
12/12 WHOLE FOODS #1021 473.61
01/27      UBER TRIP      -686.64
12/27   TARGET T-2231   -379.01
05/14  TARGET T-2231  -580.45
10/14      TARGET T-2231      793.79
Tax reminder: amounts on this statement may differ from your Form 1099-INT.
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-fe25fc2041b3f1277e157d90,v11-BANK_STATEMENT-inline,original,2025,fgen-65b20f70659253ee4a88b544,synthetic_programmatic_template,inline,top,False,money_market
"2021 Year-End Account Summary
Lakeshore National Bank
Account number      ****5011
Statement period   12/01/2021 - 12/30/2021
Wei Testcase
4497 Sample Street Riverton, WI 19542
Account summary
Beginning balance   $21,260.55
Deposits and other credits  $1,085.71
Withdrawals and other debits -$4,882.29
Ending balance   $17,463.96
Interest paid this period      23.08
Interest paid year-to-date  258.49
Annual percentage yield earned  3.94%
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-0b2c944d6f759c4521429957,v11-BANK_STATEMENT-inline,original,2021,fgen-1960754e2e40fb08b973d937,synthetic_programmatic_template,inline,top,False,year_end
"Summit Ridge Bank
Account number   ****2137
Statement period      03/01/2022 - 03/31/2022
Casey K. Walsh
9582 Oak Hollow Ct Brookhaven, PA 15550
Account summary
Beginning balance $46,755.66
Deposits and other credits $4,719.05
Withdrawals and other debits  -$6,506.86
Ending balance   $44,967.85
Interest paid this period $55.36
Interest paid year-to-date      $6.95
Annual percentage yield earned  0.08%
Date Description Amount
12/22      TARGET T-2231      634.50
03/20 AMAZON MKTPLACE -435.07
04/18   CVS/PHARMACY 0832   -396.23
01/07      AMAZON MKTPLACE      419.73
07/14      SHELL OIL 5741      -695.60
04/24   DELTA AIR LINES   -516.18
Your 2022 Form 1099-INT will be available online by January 31, 2023.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-dd864c811e5d674bfe49a603,v11-BANK_STATEMENT-inline,original,2022,fgen-918e283bd28804f7082eff2f,synthetic_programmatic_template,inline,none,False,savings
"Account History: Checking
Downloaded 2022-08-03
Date Payee Memo Withdrawal Deposit Balance
16/06/2022  AMAZON MKTPLACE  utilities  565.00    2241.75
02/07/2022  TARGET T-2231  groceries  553.95    23495.10
2022-05-20   COSTCO WHSE #412      731.53      23079.64
12/11/2022 AMAZON MKTPLACE rent 264.59  22454.42
17/05/2022 STARBUCKS #11872 utilities 604.77  7973.21
09/05/2022  NETFLIX.COM  groceries  127.55    17356.57",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e5e77f8198f4ccabfdd61aa2,v11-BANK_STATEMENT-inline,original,2022,fgen-1e53666df98f6efa3aeb1a89,synthetic_programmatic_template,inline,top,False,raw_export
"Savings Statement
Summit Ridge Bank
Account number
Statement period
ending in 6721
10/01/2023 - 10/31/2023
Taylor Castillo
3086 Prairie Ave Fairview, OH 37166
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$50,624.12
$1,319.74
-$985.17
$50,958.69
$59.38
742.42
1.13%
Date
Description
Amount
02/09
UBER TRIP
-229.60
06/01
DELTA AIR LINES
-766.94
07/23
CVS/PHARMACY 0832
-229.52
09/23
UBER TRIP
-32.35
08/24
WHOLE FOODS #1021
211.33
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-c56666251b565d11f9adb563,v11-BANK_STATEMENT-columns,original,2023,fgen-3454bdd05e33938fd70d4eb6,synthetic_programmatic_template,columns,top,False,savings
"Bayview Community Bank
Account number
Statement period
XXX-XX-5394
08/01/2023 - 08/31/2023
Jamie Fischer
9833 Maple Ridge Dr Riverton, WI 26543
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$42,740.52
$8,919.72
-$4,276.32
$47,383.91
$59.78
143.96
1.14%
IRS Form 1099-INT information for 2023 will be mailed separately.
Equal Housing Lender
2023 Year-End Account Summary",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a35f1856e2f94e5e01db4cae,v11-BANK_STATEMENT-columns,original,2023,fgen-4e3224ddec011a1f89bb36c3,synthetic_programmatic_template,columns,bottom,False,year_end
"Savings Statement
Summit Ridge Bank
Account number
Statement period
***-**-7811
10/01/2024 - 10/31/2024
Noah R. Brennan
9659 Willow Bend Way Riverton, WI 22631
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$16,883.78
$167.65
-$5,168.31
$11,883.12
51.75
285.59
3.40%
Date
Description
Amount
11/22
SHELL OIL 5741
-387.25
07/24
SHELL OIL 5741
-724.74
10/18
UBER TRIP
-479.01
09/21
WHOLE FOODS #1021
-22.07
08/18
AMAZON MKTPLACE
-90.32
This statement is not a Form 1099-INT. Keep it for your records.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-2d73ff6e45bd0fda567aef03,v11-BANK_STATEMENT-columns,original,2024,fgen-00aefc721ecfe2bcf417d4bd,synthetic_programmatic_template,columns,top,False,savings
"Everyday Checking ...5359
Downloaded 06/28/2024
Date
Description
Amount
RunningBal.
2024-12-28
C0STCO WHSE #412
-1960.43
15229.41
28/01/2024
NETFLIX.COM
1564.75
1578.22
08/05/2024
H0ME DEPOT 0612
114.53
7714.52",BANK_STATEMENT,24,BANK_STATEMENT,fdc-d5b7a21e5b6ae743ab26e3fb,v11-BANK_STATEMENT-columns,original,2024,fgen-a0d50fb8d4ba8751a597a48d,synthetic_programmatic_template,columns,top,True,raw_export
"Everyday Checking ...9654
Date
Payee
Memo
Withdrawal
Deposit
Balance
2026-07-06
STARBUCKS #11872

19.63

18285.36
10/08/2026
COSTCO WHSE #412
rent
55.74

1181.73
02/06/2026
WHOLE FOODS #1021

439.14

14095.85
2026-01-16
UBER TRIP
utilities
49.91

6434.86
09/12/2026
TARGET T-2231
rent
665.09

8447.52
12/06/2026
COSTCO WHSE #412
rent
637.58

8821.80
12/06/2026
NETFLIX.COM
utilities
650.61

15526.95
2026-04-24
UBER TRIP
groceries
501.23

28742.70
2026-03-22
HOME DEPOT 0612
groceries
858.48

2520.65",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ae4b638eba8c3c281dac4863,v11-BANK_STATEMENT-columns,original,2026,fgen-639dab1b6606175058c934f7,synthetic_programmatic_template,columns,top,False,raw_export
"2023 Year-End Account Summary
Bayview Community Bank
Account number
Statement period
***-**-3399
12/01/2023 - 12/30/2023
Amara M. Fischer
9005 Elm Park Pl Fairview, OH 37870
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$43,699.82
$7,785.99
-$7,676.48
$43,809.33
19.38
$575.25
1.38%
IRS Form 1099-INT information for 2023 will be mailed separately.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-434423f77fa3462ba9724b9c,v11-BANK_STATEMENT-columns,original,2023,fgen-3a5c316e0c44ccdbd6817eef,synthetic_programmatic_template,columns,top,False,year_end
"Date
Payee
Memo
Withdrawal
Deposit
Balance
16/01/2021
WHOLE FOODS #1021
groceries
676.89

10514.97
2021-10-11
CVS/PHARMACY 0832
groceries
728.59

25539.34
03/02/2021
COSTCO WHSE #412
rent
122.72

27358.05
2021-04-04
CVS/PHARMACY 0832
utilities
853.31

21049.69",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b5880544f5838947f4ad935d,v11-BANK_STATEMENT-columns,original,2021,fgen-34edfb858430f6cdc04ad2b5,synthetic_programmatic_template,columns,top,False,raw_export
"Date
Payee
Memo
Withdrawal
Deposit
Balance
02/08/2025
UBER TRIP

895.57

15832.11
2025-03-26
WHOLE FOODS #1021
rent
215.87

8638.53
12/09/2025
SHELL OIL 5741
utilities
177.86

21066.88
2025-06-02
HOME DEPOT 0612

668.90

3684.21",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ed87600ebe75ef73814402af,v11-BANK_STATEMENT-columns,original,2025,fgen-bb66f873847856cc91e0e59d,synthetic_programmatic_template,columns,top,False,raw_export
"Savings Statement
Prairie State Savings
Account number
Statement period
XXXXX4758
08/01/2024 - 08/30/2024
Jamie Walsh
9073 Elm Park Pl Riverton, WI 57991
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$47,061.35
$1,742.94
-$4,966.61
$43,837.69
8.00
$775.59
1.92%
Date
Description
Amount
05/28
SHELL OIL 5741
-139.71
01/09
NETFLIX.COM
-104.13
08/09
NETFLIX.COM
-730.80
02/17
NETFLIX.COM
-310.20
02/01
DELTA AIR LINES
203.07
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4ad633377b11a16ab78e9480,v11-BANK_STATEMENT-columns,original,2024,fgen-f1c9baf0b6aa98d0dd3b49c1,synthetic_programmatic_template,columns,top,False,savings
"Granite Peak Bank
Account number
Statement period
****2748
07/01/2021 - 07/31/2021
Mateo R. Moreau
3068 Prairie Ave Fairview, OH 38735
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$20,240.55
$6,310.44
-$2,392.58
$24,158.41
$9.41
$101.00
4.55%
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-bae3adeb4b8ed92a93694bda,v11-BANK_STATEMENT-columns,original,2021,fgen-ef604058e2fa55a0e84b571e,synthetic_programmatic_template,columns,none,False,year_end
"Date
Payee
Memo
Withdrawal
Deposit
Balance
2024-05-02
COSTCO WHSE #412

425.73

23201.72
2024-05-12
UBER TRIP
groceries
26.02

11685.72
2024-04-27
AMAZON MKTPLACE
groceries
541.91

4812.68
02/18/2024
DELTA AIR LINES
groceries
507.71

16277.36
03/05/2024
SHELL OIL 5741

216.74

23409.53",BANK_STATEMENT,24,BANK_STATEMENT,fdc-45098a2c84515f50ee74e042,v11-BANK_STATEMENT-columns,original,2024,fgen-421e92ba204e66a880fd7db9,synthetic_programmatic_template,columns,top,False,raw_export
"2021 Year-End Account Summary
Meadowlark Savings Bank
Account number
Statement period
XXX-XX-3159
04/01/2021 - 04/31/2021
Noah Adeyemi
71 Granite St Brookhaven, PA 14359
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$9,996.26
$4,312.09
-$2,295.03
$12,013.31
$0.90
$199.08
4.62%
This statement is not a Form 1099-INT. Keep it for your records.
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a3eb1bae72ecec0307a4114e,v11-BANK_STATEMENT-columns,original,2021,fgen-893d69e2e7b37681738eedef,synthetic_programmatic_template,columns,top,False,year_end
"Checking Account Statement
Bayview Community Bank
Account number
Statement period
XXX-XX-6783
05/01/2023 - 05/30/2023
Casey L. Lindqvist
6225 Prairie Ave Cedar Falls, IA 88023
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$36,069.03
$8,601.77
-$7,206.69
$37,464.11
16.38
$177.43
3.11%
Date
Description
Amount
10/05
NETFLIX.COM
477.31
10/25
UBER TRIP
-138.90
05/16
HOME DEPOT 0612
202.64
06/01
UBER TRIP
-175.09
Tax reminder: amounts on this statement may differ from your Form 1099-INT.
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a4b4b1e825fb3c008b001cbd,v11-BANK_STATEMENT-columns,original,2023,fgen-3afd176f1f70fdf907235c5f,synthetic_programmatic_template,columns,top,False,checking
"Checking Account Statement
Northwind Financial
Account number
Statement period
****0030
02/01/2021 - 02/28/2021
Avery Kowalski
3627 Lakeshore Blvd Fairview, OH 96501
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
$23,211.98
$6,624.08
-$4,324.23
$25,511.82
Date
Description
Amount
07/03
STARBUCKS #11872
-396.01
05/23
DELTA AIR LINES
-333.10
05/01
WHOLE FOODS #1021
-826.29
07/08
TARGET T-2231
760.68
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e97f9d04e9d7a38992c497e3,v11-BANK_STATEMENT-columns,original,2021,fgen-2908d56678b452f49ec4751a,synthetic_programmatic_template,columns,top,False,checking
"Money Market Account Statement
Prairie State Savings
Account number
Statement period
ending in 1971
05/01/2022 - 05/30/2022
Jordan Rivera
9861 Oak Hollow Ct Maplewood, MN 71399
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$33,995.87
$2,138.88
-$3,130.06
$33,004.70
46.18
353.72
2.94%
Date
Description
Amount
01/14
CVS/PHARMACY 0832
-351.93
03/01
SHELL OIL 5741
-108.62
07/10
TARGET T-2231
-428.92
11/19
DELTA AIR LINES
-223.85
04/28
AMAZON MKTPLACE
-677.89
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-19b3fb9c5890440f10cf825b,v11-BANK_STATEMENT-columns,original,2022,fgen-ca63bf0fdc56d5edb8ac83be,synthetic_programmatic_template,columns,top,False,money_market
"Checking Account Statement
Bayview Community Bank
Account number
Statement period
***-**-9197
09/01/2026 - 09/31/2026
Morgan Brennan
5196 Granite St Oak Grove, TX 33245
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
$38,532.01
$2,986.96
-$7,863.93
$33,655.04
Date
Description
Amount
06/17
AMAZON MKTPLACE
-569.01
04/22
CVS/PHARMACY 0832
-232.21
11/06
UBER TRIP
-781.06
12/11
COSTCO WHSE #412
-18.90
05/09
AMAZON MKTPLACE
-77.13
12/25
NETFLIX.COM
-624.83
Your 2026 Form 1099-INT will be available online by January 31, 2027.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5e2024455d5380206395d107,v11-BANK_STATEMENT-columns,original,2026,fgen-39cd8f9fec1907276658d982,synthetic_programmatic_template,columns,top,False,checking
"Transaction Date
Transaction Description
Debit
Credit
Balance
02/15/2025
SHELL OIL 5741
887.46

25716.00
11/09/2025
TARGET T-2231


5640.75
2025-07-26
TARGET T-2231
898.36
411.02
4106.02
09/18/2025
AMAZON MKTPLACE


27280.35
12/03/2025
CVS/PHARMACY 0832
834.30
2808.52
24248.39
10/08/2025
UBER TRIP

1556.87
10210.34
09/21/2025
TARGET T-2231
227.57

8867.35",BANK_STATEMENT,24,BANK_STATEMENT,fdc-6fffd757ef4bf549fc1adadf,v11-BANK_STATEMENT-columns,original,2025,fgen-0a4d7f62ef89d742fa77238f,synthetic_programmatic_template,columns,none,False,raw_export
"Checking Account Statement
Riverbend Bank & Trust
Account number
Statement period
ending in 6397
06/01/2023 - 06/30/2023
Alex Brennan
3622 Sample Street Pinecrest, GA 58039
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$38,083.02
$4,917.46
-$6,661.27
$36,339.20
22.82
739.48
4.20%
Date
Description
Amount
05/02
UBER TRIP
-380.48
10/23
NETFLIX.COM
-175.61
08/19
CVS/PHARMACY 0832
-105.61
03/15
CVS/PHARMACY 0832
-541.36
11/11
DELTA AIR LINES
74.75
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e99abed419ac4f430f450c22,v11-BANK_STATEMENT-columns,original,2023,fgen-3c2044bad6a0cd758943d06c,synthetic_programmatic_template,columns,top,False,checking
"Savings Statement
Meadowlark Savings Bank
Account number
Statement period
XXX-XX-2503
l0/01/2022 - 10/31/2022
Olivia Adeyemi
4594 Granite St Testville, IL 84374
Accountsummary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$8,4ll.36
$7,483.89
-$5,395.58
$10,499.67
$16.99
656.73
3.64%
Datc
Description
Amount
07/16
WH0LE FOODS #1O21
779.49
09/21
AMAZ0N MKTPLACE
-300.21
11/14
SHELL OIL 5741
-51.98
09/08
UBER TRIP
-322.95
10/21
UBER TRIP
-724.54
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-0c741df6ba49b9d09bb18363,v11-BANK_STATEMENT-columns,original,2022,fgen-e43d78cf4635894ce776659e,synthetic_programmatic_template,columns,top,True,savings
"2023 Year-End Account Summary
Lakeshore National Bank
Account number
Statement period
ending in 1692
05/01/2023 - 05/31/2023
Kwame Moreau
8829 Cedar Ln Bayside, WA 10599
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$48,098.35
$1,711.91
-$6,855.85
$42,954.41
17.07
$356.25
2.86%
IRS Form 1099-INT information for 2023 will be mailed separately.
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-70225bdb6e5bd8125f5b7189,v11-BANK_STATEMENT-columns,original,2023,fgen-0bd389e7c4f47b32e57c8f02,synthetic_programmatic_template,columns,top,False,year_end
"Savings Statement
Riverbend Bank & Trust
Account number
Statement period
ending in 4389
02/01/2024 - 02/28/2024
Wei Rivera
7250 Willow Bend Way Bayside, WA 66877
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$29,805.81
$1,230.40
-$3,321.73
$27,714.48
3.11
155.79
4.60%
Date
Description
Amount
07/18
AMAZON MKTPLACE
-62.35
09/11
TARGET T-2231
-879.69
12/07
TARGET T-2231
-532.00
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-3986f063062776d95f25b6d5,v11-BANK_STATEMENT-columns,original,2024,fgen-daa0f5ba9792f9d1f60e9ea4,synthetic_programmatic_template,columns,top,False,savings
"Checking Account Statement
Bayview Community Bank
Account number
Statement period
ending in 0513
12/01/2026 - 12/28/2026
Wei Lindqvist
8262 Cedar Ln Fairview, OH 76146
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$54,254.79
$3,776.68
-$2,668.50
$55,362.96
22.70
475.22
1.83%
Date
Description
Amount
05/06
CVS/PHARMACY 0832
-810.01
08/12
STARBUCKS #11872
-529.57
03/19
DELTA AIR LINES
-467.24
09/20
TARGET T-2231
235.79
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-afdc0ea047561a226c1c2b80,v11-BANK_STATEMENT-columns,original,2026,fgen-b27ee1e4530c2b10e6588753,synthetic_programmatic_template,columns,top,False,checking
"Savings Statement
Meadowlark Savings Bank
Account number
Statement period
ending in 4866
08/01/2026 - 08/30/2026
Taylor R. Moreau
2383 Oak Hollow Ct Bayside, WA 21308
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$45,757.77
$7,839.66
-$6,461.39
$47,136.03
$46.56
682.09
3.78%
Date
Description
Amount
04/02
UBER TRIP
711.08
02/17
COSTCO WHSE #412
-135.19
07/03
CVS/PHARMACY 0832
-664.33
03/22
TARGET T-2231
-721.47
02/11
AMAZON MKTPLACE
-306.63
01/20
DELTA AIR LINES
73.52
03/12
WHOLE FOODS #1021
-674.65
IRS Form 1099-INT information for 2026 will be mailed separately.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-adce5cc5a595c7177d4a93f7,v11-BANK_STATEMENT-columns,original,2026,fgen-273e76df5782653eb32caf43,synthetic_programmatic_template,columns,top,False,savings
"Posting Date
Description
Amount
Type
Balance
Check or Slip #
28/06/2026
STARBUCKS #11872
-248.86
ACH_CREDIT
12126.36

2026-01-10
CHECK 1043
1696.02
ACH_CREDIT
15981.95

02/23/2026
STARBUCKS #11872
1097.95
ATM
8705.00

11/22/2026
UBER TRIP
-932.56
CHECK_PAID
1139.09
1043
07/17/2026
WHOLE FOODS #1021
-622.91
DEBIT_CARD
26103.60

07/22/2026
COSTCO WHSE #412
-1353.96
ACH_CREDIT
14187.98

2026-02-19
TARGET T-2231
-514.39
ATM
21040.26",BANK_STATEMENT,24,BANK_STATEMENT,fdc-dbe453ee679ff2712419b384,v11-BANK_STATEMENT-columns,original,2026,fgen-55efd7834e0ce4e0307a775b,synthetic_programmatic_template,columns,top,False,raw_export
"Money Market Account Statement
Summit Ridge Bank
Account number
Statement period
XXXXX1789
07/01/2024 - 07/31/2024
Casey Brennan
1642 Sample Street Pinecrest, GA 56181
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$48,127.44
$3,108.47
-$597.65
$50,638.26
26.21
$714.79
0.07%
Date
Description
Amount
08/13
STARBUCKS #11872
-470.46
02/25
AMAZON MKTPLACE
-506.68
10/06
NETFLIX.COM
897.41
IRS Form 1099-INT information for 2024 will be mailed separately.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-89b8531c9870008d84677882,v11-BANK_STATEMENT-columns,original,2024,fgen-7aaa514315d8e3d4f5759abd,synthetic_programmatic_template,columns,top,False,money_market
"Everyday Checking ...1011
Posting Date
Description
Amount
Type
Balance
Check or Slip #
O6/10/2023
HOME DEPOT 0612
-2083.24
ATM
29506.14
1043
04/06/2023
CHECK 1043
-2279.75
ATM
8286.69

2O23-02-07
COSTCO WHSE #412
1712.14
ATM
19225.79

2023-03-19
CVS/PHARMACY 0832
790.24
DEBIT_CARD
9755.06
1043
2023-O7-28
AMAZON MKTPLACE
2341.36
DEBIT_CARD
22470.80

2O23-07-11
AMAZONMKTPLACE
-658.97
DEBIT_CARD
14438.22",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4184fd5fb80045ef5f40c466,v11-BANK_STATEMENT-columns,original,2023,fgen-adeafe177a9dc774db37c527,synthetic_programmatic_template,columns,top,True,raw_export
"Date
Description
Amount
Running Bal.
2022-03-13
DELTA AIR LINES
2035.82
25331.63
17/07/2022
UBER TRIP
-995.31
22436.63
21/02/2022
UBER TRIP
-1391.01
29412.89
2022-08-06
HOME DEPOT 0612
1960.74
17700.61
2022-12-07
SHELL OIL 5741
1213.88
2406.19
05/13/2022
WHOLE FOODS #1021
1484.59
3832.31
2022-09-08
CVS/PHARMACY 0832
-409.95
3658.32
23/02/2022
UBER TRIP
972.12
15885.92
2022-04-23
ZELLE FROM J SMITH
-415.96
4132.59
Account History: Checking",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5a642142f9e7c9ab1b9e1e95,v11-BANK_STATEMENT-columns,original,2022,fgen-fdde4b41e9680e49bc81c2a4,synthetic_programmatic_template,columns,bottom,False,raw_export
"2021 Year-End Account Summary
Granite Peak Bank
Account number
Statement period
***-**-3794
07/01/2021 - 07/30/2021
Amara Walsh
5570 Harbor View Rd Brookhaven, PA 46557
Account summary
Beginning balance
Deposits and other credits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$13,262.25
$139.87
-$6,923.01
$6,479.10
$0.99
23.93
2.91%
This statement is not a Form 1099-INT. Keep it for your records.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-6836d45301918f04e67255b2,v11-BANK_STATEMENT-columns,original,2021,fgen-c5eed9a087cb20522cf234fb,synthetic_programmatic_template,columns,top,False,year_end
"Money Market Account Statement
Harbor Federal CreditUnion
Account number
Statement period
XXXXX9686
0l/01/2025 - 01/28/2025
Tay1or Sato
8936 Willow Bend Way Lakewood, CO 59914
Account summary
Bcginning balance
Deposits and other credits
Withdrawals and other dcbits
Ending balance
Interest paid this period
Interest paid year-to-date
Annualpercentage yield earned
S2l,607.88
$5,530.08
-$543.33
$26,594.62
$56.73
$ll1.09
1.96%
Date
Description
Amount
12/03
SHELL OIL 5741
-511.32
09/21
SHELL OIL 5741
265.92
12/16
NETFLIX.COM
-845.84
04/23
COSTCO WHSE #412
-760.90
01/10
AMAZON MKTPLACE
-350.60
02/28
TARGET T-2231
-452.73
07/02
COSTCO WHSE #412
-179.48
Tax remínder: amounts on thís statement may differ from your Form 1099-INT.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-82907b4445d951bb476c3e0f,v11-BANK_STATEMENT-columns,original,2025,fgen-cbd57c43d0781ded380be0f1,synthetic_programmatic_template,columns,top,True,money_market
"Northwind Financial
Account number
Statement period
XXXXX6180
06/01/2025 - 06/28/2025
Avery Líndqvist
3336 Samp1e Street Lakewood, C0 72288
Account summary
Beginning balance
Deposits and othercredits
Withdrawals and other debits
Ending balance
Interest paid this period
Interest paid year-to-date
Annual percentage yield earned
$21,401.93
$6,394.59
-$3,451.87
$24,344.65
32.42
874.53
3.94%
Tax reminder: amounts on this statement may differ from your Form l099-INT.
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-d9b3ad60caed6a4e17f1c837,v11-BANK_STATEMENT-columns,original,2025,fgen-193421c60371217dd2529144,synthetic_programmatic_template,columns,none,True,year_end
"Downloaded 11/14/2022
Transaction Date
Transaction Description
Debit
Credit
Balance
09/25/2022
NETFLIX.COM

2359.33
7678.02
2022-04-08
INTEREST PAYMENT
66.37

20491.43
24/02/2022
UBER TRIP
634.64

7161.60
06/01/2022
TARGET T-2231


23589.85
17/05/2022
DELTA AIR LINES

1731.23
1237.81
12/01/2022
INTEREST PAYMENT

544.97
27579.77
07/22/2022
CVS/PHARMACY 0832


9688.39
2022-02-28
AMAZON MKTPLACE
95.61
2885.19
22203.67
2022-10-28
COSTCO WHSE #412

892.21
20380.64",BANK_STATEMENT,24,BANK_STATEMENT,fdc-e679b1092c816a33e0aa2183,v11-BANK_STATEMENT-columns,original,2022,fgen-d41b47cdadfa5ea0461911cb,synthetic_programmatic_template,columns,top,False,raw_export
"Savings Statement
Summit Ridge Bank
Account number
Statement period
XXX-XX-9240
12/01/2021 - 12/28/2021
Tay1or L. Moreau
7217 Harbor View Rd Bayside, WA 15660
Account summary
Beginning ba1ance
Deposits and other credits
Withdrawa1s and other debits
Ending balance
Interest paid this period
Interestpaid year-to-date
Annual percentage yíeld earned
$l0,578.93
$2,906.16
-$3,174.35
$10,310.73
$6.30
59.97
2.54%
Date
Description
Amount
09/20
WH0LE FOOD5 #1021
-638.13
02/02
WHOLE FOODS #1021
-114.59
12/16
H0ME DEPOT 0612
-371.52
04/04
TARGET T-2231
-587.14
05/22
DELTA AIR LINES
667.32
11/11
NETFLIX.COM
-718.75
Fcderally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-6eebacb5a171a5df7b2a7dd5,v11-BANK_STATEMENT-columns,original,2021,fgen-2661851b514b3c979dc2a020,synthetic_programmatic_template,columns,top,True,savings
"Money Market Account Statement
Bayview Community Bank
Account number,****7360
Statement period,07/01/2023 - 07/30/2023
Lena C. Rivera
6399 Cedar Ln Oak Grove, TX 42604
Account summary
Beginning balance,""$35,293.70""
Deposits and other credits,""$5,705.97""
Withdrawals and other debits,""-$3,431.30""
Ending balance,""$37,568.37""
Interest paid this period,13.32
Interest paid year-to-date,$47.76
Annual percentage yield earned,1.08%
Date,Description,Amount
05/12,CVS/PHARMACY 0832,-609.10
08/01,HOME DEPOT 0612,519.88
06/22,TARGET T-2231,-667.55
03/27,WHOLE FOODS #1021,-809.84
03/18,TARGET T-2231,-204.48
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-bb645e6c297fe1e09fc5aa1c,v11-BANK_STATEMENT-csv,original,2023,fgen-1483f5d6e47f12fb5fc70d33,synthetic_programmatic_template,csv,top,False,money_market
"Checking Account Statement
Riverbend Bank & Trust
Account number,ending in 4110
Statement period,02/01/2025 - 02/28/2025
Jordan R. Okafor
3661 Granitc St Maplewood, MN 34757
Account summary
Beginning balancc,""$l4,644.51""
Deposits and othcr credits,""$7,246.71""
Withdrawals and other debits,""-$3,140.63""
Ending balance,""$18,750.59""
Date,Description,Amount
02/11,UBER TRIP,248.03
03/05,NETFLIX.C0M,-766.33
03/26,CVS/PHARMACY O832,-126.83
06/06,HOME DEPOT 0612,-626.21
03/15,TARGETT-2231,-877.50
08/01,COSTCO WHSE #412,-607.10
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-388ae0805973c692c458a431,v11-BANK_STATEMENT-csv,original,2025,fgen-b96b0fe8b59a275f7681eb4a,synthetic_programmatic_template,csv,top,True,checking
"Savings Statement
Prairie State 5avings
Account number,XXX-XX-4788
5tatement period,07/0l/2026 - 07/3l/2026
Amara R. Rivera
4854 Sample Street Pinecrest, GA 38350
Account summary
Beginningbalance,""S2,102.55""
Deposits and other credits,""$5,478.88""
Withdrawals and other debits,""-$6,787.40""
Ending balance,$794.03
Interest paid this period,$9.13
Interest paid year-to-date,$562.43
Annua1 percentage yield eamed,4.09%
Date,Description,Amount
08/08,WHOLE FOOD5 #1021,74.25
04/22,NETFLIX.COM,-678.36
07/26,HOME DEPOT 0612,-11.09
03/13,COSTCO WHSE #412,-463.71
07/15,HOME DEPOT 0612,610.17
05/25,HOME DEPOT 0612,502.96
05/13,HOME DEPOT 0612,-820.90
Your 2026 Form 1099-INTwill be available online by January 31, 2027.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a7b95f6d0a055fb52d420cb9,v11-BANK_STATEMENT-csv,original,2026,fgen-a20f3eaebbff3bf700dac893,synthetic_programmatic_template,csv,top,True,savings
"Money Market Account Statement
Riverbend Bank & Trust
Account number,XXX-XX-2585
Statement period,08/01/2022 - 08/31/2022
Fatima R. Brennan
6021 Lakeshore Blvd Fairview, OH 86524
Account summary
Beginning balance,""$9,336.40""
Deposits and other credits,""$5,934.88""
Withdrawals and other debits,""-$6,018.31""
Ending balance,""$9,252.97""
Interest paid this period,$4.31
Interest paid year-to-date,$570.25
Annual percentage yield earned,2.06%
Date,Description,Amount
04/21,COSTCO WHSE #412,257.97
06/24,STARBUCKS #11872,-658.20
11/25,DELTA AIR LINES,-295.62
10/12,NETFLIX.COM,-157.88
11/10,HOME DEPOT 0612,118.07
Your 2022 Form 1099-INT will be available online by January 31, 2023.
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-015f92d326df349326493d95,v11-BANK_STATEMENT-csv,original,2022,fgen-3a10b2c437bdf8e60b745a3b,synthetic_programmatic_template,csv,top,False,money_market
"Checking Account Statement
Granite Peak Bank
Account number,XXXXX8876
Statement period,11/01/2023 - 11/28/2023
Avery Moreau
2215 Prairie Ave Lakewood, CO 33446
Account summary
Beginning balance,""$59,114.52""
Deposits and other credits,""$1,105.57""
Withdrawals and other debits,""-$1,093.86""
Ending balance,""$59,126.23""
Date,Description,Amount
09/17,COSTCO WHSE #412,-500.39
01/02,SHELL OIL 5741,332.70
01/27,TARGET T-2231,-487.46
02/22,STARBUCKS #11872,787.90
12/13,WHOLE FOODS #1021,-447.77
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-69788635296e07ce59abc5db,v11-BANK_STATEMENT-csv,original,2023,fgen-b7f7ff0acef800eb3d1f434b,synthetic_programmatic_template,csv,top,False,checking
"Checking Account Statement
Riverbend Bank & Trust
Account number,****9795
Statement period,07/01/2021 - 07/30/2021
Hiro Castillo
127 Willow Bend Way Brookhaven, PA 37552
Account summary
Beginning balance,""$8,933.95""
Deposits and other credits,""$2,547.33""
Withdrawals and other debits,""-$6,598.43""
Ending balance,""$4,882.85""
Date,Description,Amount
03/12,WHOLE FOODS #1021,-639.39
05/03,DELTA AIR LINES,-744.66
02/20,DELTA AIR LINES,-764.93
03/16,STARBUCKS #11872,-183.40
02/09,COSTCO WHSE #412,423.44
09/13,SHELL OIL 5741,-595.46
01/19,SHELL OIL 5741,892.57
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-2687af0a58c9964050b5da90,v11-BANK_STATEMENT-csv,original,2021,fgen-daf772b38a1e4c64e98d68f3,synthetic_programmatic_template,csv,top,False,checking
"Money Market Account Statement
Granite Peak Bank
Account number,XXXXX7541
Statement period,05/01/2025 - 05/28/2025
Riley Brennan
1581 Oak Hollow Ct Oak Grove, TX 38208
Account summary
Beginning balance,""$32,947.97""
Deposits and other credits,""$7,191.89""
Withdrawals and other debits,""-$1,075.52""
Ending balance,""$39,064.34""
Interest paid this period,$50.88
Interest paid year-to-date,$358.38
Annual percentage yield earned,3.00%
Date,Description,Amount
10/10,HOME DEPOT 0612,-441.10
06/24,UBER TRIP,-722.30
08/01,WHOLE FOODS #1021,-640.67
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-75579a0c18079506751151d9,v11-BANK_STATEMENT-csv,original,2025,fgen-daf7b657cd1a06f02ca78206,synthetic_programmatic_template,csv,top,False,money_market
"Checking Account Statement
Harbor Federal Credit Union
Account number,****9561
Statement period,07/01/2024 - 07/31/2024
Avery Brennan
8606 Cedar Ln Bayside, WA 61886
Account summary
Beginning balance,""$11,469.15""
Deposits and other credits,""$1,618.37""
Withdrawals and other debits,""-$3,843.82""
Ending balance,""$9,243.70""
Interest paid this period,$6.04
Interest paid year-to-date,$375.59
Annual percentage yield earned,0.18%
Date,Description,Amount
01/12,CVS/PHARMACY 0832,-68.17
09/20,TARGET T-2231,-296.62
07/10,TARGET T-2231,-558.08
10/03,TARGET T-2231,-742.97
08/22,COSTCO WHSE #412,-147.82
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-05fa625e9ff699f5cd1f0411,v11-BANK_STATEMENT-csv,original,2024,fgen-3fa2e77f4b984325d91b3254,synthetic_programmatic_template,csv,top,False,checking
"Cedar Valley Credit Union
Account number,XXX-XX-6737
Statement period,05/01/2022 - 05/31/2022
Sofia Nguyen
6665 Lakeshore Blvd Cedar Falls, IA 18646
Account summary
Beginning balance,""$23,759.67""
Deposits and other credits,""$4,677.16""
Withdrawals and other debits,""-$6,304.25""
Ending balance,""$22,132.58""
Interest paid this period,25.57
Interest paid year-to-date,$723.43
Annual percentage yield earned,1.31%
Tax reminder: amounts on this statement may differ from your Form 1099-INT.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a0b9093f793eb475df910e16,v11-BANK_STATEMENT-csv,original,2022,fgen-266b7597512d50969edb1528,synthetic_programmatic_template,csv,none,False,year_end
"Savings Account XXXX3490 - transactions
Downloaded 08/27/2023
Date,Payee,Memo,Withdrawal,Deposit,Balance
2023-07-26,UBER TRIP,groceries,695.17,,18407.73
04/09/2023,STARBUCKS #11872,rent,817.96,,25815.22
02/10/2023,CVS/PHARMACY 0832,rent,830.78,,26681.96
2023-08-26,COSTCO WHSE #412,groceries,471.08,,11624.70
01/15/2023,AMAZON MKTPLACE,,530.28,,22361.87
02/12/2023,DELTA AIR LINES,utilities,652.46,,18758.95",BANK_STATEMENT,24,BANK_STATEMENT,fdc-c776c639041752dfa88d6603,v11-BANK_STATEMENT-csv,original,2023,fgen-c17a0c89449eb29fdbccdf0e,synthetic_programmatic_template,csv,top,False,raw_export
"2023 Year-End Account Summary
Bayview Community Bank
Account number,***-**-5824
Statement period,08/01/2023 - 08/30/2023
Olivia Adeyemi
3890 Maple Ridge Dr Pinecrest, GA 39062
Account summary
Beginning balance,""$59,151.83""
Deposits and other credits,$229.68
Withdrawa1s and otherdebits,""-$7,147.93""
Ending balance,""$52,233.58""
Interest paid this period,25.63
Interest paid year-to-date,631.22
Annual percentage yield eamed,4.71%
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-9869416277a4906e25987cf7,v11-BANK_STATEMENT-csv,original,2023,fgen-83c8588197878d540934d8ac,synthetic_programmatic_template,csv,top,True,year_end
"Meadowlark Savings Bank
Account number,****0295
Statement period,10/01/2026 - 10/28/2026
Fatima Haddad
7635 HarborView Rd Testville, IL 74575
Account summary
Beginning balance,""$56,185.21""
Deposits and other credíts,""$5,067.04""
Withdrawals and other debits,""-$3,l61.09""
Ending balance,""$58,091.16""
Interest paid this period,39.48
Interest paid year-to-date,717.17
Annua1 percentage yield eamed,4.43%
Date,Description,Amount
05/26,CVS/PHARMACY 0832,-225.83
01/20,AMAZ0N MKTPLACE,195.15
02/07,C0STCO WHSE #412,461.12
03/27,UBER TRIP,370.59
03/20,WHOLE FOODS #1021,401.14
Equa1 Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-7daedbf1e0bc10d3bf6c3202,v11-BANK_STATEMENT-csv,original,2026,fgen-18f964f5afb02f0bd86b0d01,synthetic_programmatic_template,csv,none,True,money_market
"Checking Account Statement
Riverbend Bank & Trust
Account number,XXXXX0065
Statement period,01/01/2024 - 01/31/2024
Olivia B. Romero
5257 Granite St Fairview, OH 39051
Account summary
Beginning balance,""$55,635.47""
Deposits and other credits,$249.29
Withdrawals and other debits,""-$4,532.40""
Ending balance,""$51,352.35""
Date,Description,Amount
05/05,AMAZON MKTPLACE,-703.76
09/13,WHOLE FOODS #1021,-287.17
01/09,NETFLIX.COM,-790.65
11/23,STARBUCKS #11872,-204.79
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5160a5f074a34334f332f94b,v11-BANK_STATEMENT-csv,original,2024,fgen-c0c22bfb519ab001cfe2a0c0,synthetic_programmatic_template,csv,top,False,checking
"EverydayChecking ...4973
Date,Description,Amount,Running Bal.
23/05/2021,ZELLE FROM J SMITH,-1189.47,18926.04
03/25/2O21,COSTCO WHSE #412,-246.54,l8430.67
03/10/2021,CVS/PHARMACY 0832,911.77,17409.49
09/10/2021,COSTCO WHSE #412,2257.42,25709.73
07/01/2021,ONLINE TRANSFER TO SAV,-1402.70,20447.79
2021-05-26,TARGET T-2231,-755.88,9956.63
06/08/2021,NETFLIX.COM,-83.10,22646.90
20/09/2021,ONLINE TRAN5FER TO SAV,-372.78,18368.39
2021-11-26,STARBUCKS #11872,-415.36,6221.74",BANK_STATEMENT,24,BANK_STATEMENT,fdc-98a38106d618f2312439f7c1,v11-BANK_STATEMENT-csv,original,2021,fgen-3412cca3bf443913238bc03f,synthetic_programmatic_template,csv,top,True,raw_export
"Everyday Checking ...2711
Posting Date,Description,Amount,Type,Balance,Check or Slip #
25/03/2024,UBER TRIP,-911.81,ATM,2449.68,
19/11/2024,STARBUCKS #11872,-402.94,DEBIT_CARD,5098.92,
24/02/2024,DELTA AIR LINES,-2003.15,CHECK_PAID,22966.59,",BANK_STATEMENT,24,BANK_STATEMENT,fdc-cb2901f4d7be119152f1e59a,v11-BANK_STATEMENT-csv,original,2024,fgen-37bf7473c4e5ed1201f2e997,synthetic_programmatic_template,csv,top,False,raw_export
"Money Market Account Statement
Northwind Financial
Account number,***-**-3736
Statement period,01/01/2022 - 01/31/2022
Avery Walsh
5907 Elm Park Pl Lakewood, CO 35501
Account summary
Beginning balance,""$41,254.91""
Deposits and other credits,""$4,478.92""
Withdrawals and other debits,""-$6,279.87""
Ending balance,""$39,453.96""
Interest paid this period,$11.69
Interest paid year-to-date,$817.26
Annual percentage yield earned,1.44%
Date,Description,Amount
08/08,UBER TRIP,-497.90
10/13,SHELL OIL 5741,-144.47
05/02,HOME DEPOT 0612,-477.51
03/07,TARGET T-2231,-470.49
02/19,CVS/PHARMACY 0832,-466.14
03/21,AMAZON MKTPLACE,-725.28
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-031bce2de5b4916f2b30f6b6,v11-BANK_STATEMENT-csv,original,2022,fgen-02924d38901e88e27c33a4cb,synthetic_programmatic_template,csv,top,False,money_market
"Downloaded 01/02/2022
Date,Payee,Memo,Withdrawal,Deposit,Balance
20/04/2022,HOME DEPOT 0612,rent,721.18,,5365.30
10/11/2022,WHOLE FOODS #1021,groceries,431.18,,7919.95
2022-10-20,UBER TRIP,,478.35,,11764.95
06/04/2022,TARGET T-2231,groceries,728.06,,22680.14
01/14/2022,WHOLE FOODS #1021,rent,175.95,,15991.75
2022-03-12,NETFLIX.COM,utilities,419.91,,25862.18
09/16/2022,STARBUCKS #11872,rent,865.46,,15479.73",BANK_STATEMENT,24,BANK_STATEMENT,fdc-edd10053d2ee397df52ecbe0,v11-BANK_STATEMENT-csv,original,2022,fgen-564e1249023e08a007aa0f38,synthetic_programmatic_template,csv,top,False,raw_export
"Granite Peak Bank
Account number,ending in 8415
Statement period,09/01/2026 - 09/28/2026
Jamie Romero
5637 Oak Hollow Ct Riverton, WI 82649
Account summary
Beginning balance,""$7,274.09""
Deposits and other credits,""$5,244.07""
Withdrawals and other debits,""-$5,321.45""
Ending balance,""$7,196.71""
Interest paid this period,9.63
Interest paid year-to-date,128.28
Annual percentage yield earned,0.81%
Date,Description,Amount
08/12,NETFLIX.COM,274.66
10/28,STARBUCKS #11872,-627.34
11/06,DELTA AIR LINES,-659.86
03/18,COSTCO WHSE #412,-819.29
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-34561f9d328ee6bc521e9e1e,v11-BANK_STATEMENT-csv,original,2026,fgen-d7834e17bd56d422f699ccd3,synthetic_programmatic_template,csv,none,False,savings
"Money Market Account Statement
Riverbend Bank & Trust
Account number,XXX-XX-4334
Statement period,12/01/2026 - 12/28/2026
Jamie Castillo
883 Cedar Ln Brookhaven, PA 36520
Account summary
Beginning balance,""$23,821.40""
Deposits and other credits,""$5,625.67""
Withdrawals and other debits,""-$5,411.64""
Ending balance,""$24,035.42""
Interest paid this period,42.54
Interest paid year-to-date,562.44
Annual percentage yield earned,0.92%
Date,Description,Amount
11/12,STARBUCKS #11872,-784.09
07/02,NETFLIX.COM,68.24
11/28,CVS/PHARMACY 0832,-853.38
11/08,HOME DEPOT 0612,-26.12
02/26,CVS/PHARMACY 0832,-420.75
02/03,COSTCO WHSE #412,-806.19
10/22,STARBUCKS #11872,-351.59
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5d6288dd0c8ba75b1f655122,v11-BANK_STATEMENT-csv,original,2026,fgen-ccfedee688526c35cc554933,synthetic_programmatic_template,csv,top,False,money_market
"Money Market Account Statement
Lakeshore National Bank
Account number,ending in 2872
Statement period,02/01/2024 - 02/28/2024
Lena Moreau
4049 Harbor View Rd Brookhaven, PA 54655
Account summary
Beginning balance,""$23,343.54""
Deposits and other credits,""$5,941.90""
Withdrawals and other debits,""-$7,338.21""
Ending balance,""$21,947.24""
Interest paid this period,$8.54
Interest paid year-to-date,$534.27
Annual percentage yield earned,1.74%
Date,Description,Amount
02/14,DELTA AIR LINES,-722.83
11/14,WHOLE FOODS #1021,-740.28
08/25,NETFLIX.COM,649.17
10/16,COSTCO WHSE #412,-605.06
02/14,COSTCO WHSE #412,664.98
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5bcc58999b5e448349223623,v11-BANK_STATEMENT-csv,original,2024,fgen-d3200cbf7b65b16d52b1bd75,synthetic_programmatic_template,csv,top,False,money_market
"Harbor Federal Credit Union
Account number,XXX-XX-2917
Statement period,04/01/2024 - 04/30/2024
Mateo B. Fischer
8498 Harbor View Rd Oak Grove, TX 81487
Account summary
Beginning balance,""$14,520.46""
Deposits and other credits,""$3,745.22""
Withdrawals and other debits,""-$5,050.34""
Ending balance,""$13,215.34""
Interest paid this period,$12.30
Interest paid year-to-date,326.27
Annual percentage yield earned,3.40%
Date,Description,Amount
10/20,TARGET T-2231,-365.62
10/18,UBER TRIP,-51.93
02/20,DELTA AIR LINES,-35.86
IRS Form 1099-INT information for 2024 will be mailed separately.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-40f0ccfd640695aea675bb26,v11-BANK_STATEMENT-csv,original,2024,fgen-ac2854443ce267db59641ca8,synthetic_programmatic_template,csv,none,False,savings
"Cedar Valley Credit Union
Account number,XXXXX0926
Statement period,02/01/2021 - 02/28/2021
Taylor Walsh
5714 Elm Park Pl Lakewood, CO 22245
Account summary
Beginning balance,""$29,793.52""
Deposits and other credits,$211.73
Withdrawals and other debits,""-$2,978.06""
Ending balance,""$27,027.18""
Interest paid this period,58.09
Interest paid year-to-date,$420.06
Annual percentage yield earned,4.59%
Date,Description,Amount
04/08,STARBUCKS #11872,-404.93
06/18,WHOLE FOODS #1021,-243.47
02/10,DELTA AIR LINES,-615.17
07/04,SHELL OIL 5741,-203.07
03/15,DELTA AIR LINES,-242.69
This statement is not a Form 1099-INT. Keep it for your records.
Member FDIC
Money Market Account Statement",BANK_STATEMENT,24,BANK_STATEMENT,fdc-44ec00522d1e70151f3683e6,v11-BANK_STATEMENT-csv,original,2021,fgen-921b23fd7cff56402adab3c6,synthetic_programmatic_template,csv,bottom,False,money_market
"Checking Account Statement
Harbor Federal Credit Union
Account number,XXX-XX-0760
5tatement period,09/01/2023 - 09/30/2023
Olivia Sato
9655 Oak Hollow Ct Maplewood, MN 73310
Account summary
Begínning balance,""$35,302.33""
Deposits and other credits,""$7,64l.83""
Withdrawals and other debits,""-$5,314.O8""
Ending balance,""$37,63O.08""
Interest paid this period,53.53
Interest paid year-to-date,388.10
Annual percentage yield earned,0.67%
Date,Description,Amount
10/05,WHOLE FOOD5 #l021,-682.33
09/28,NETFLIX.COM,-139.45
02/20,DELTAAIR LINES,-294.78
02/09,HOME DEPOT 0612,-327.89
09/25,HOME DEPOT 0612,-7.64
Equa1 Housing Lcnder",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b727ea12b972c469cc996361,v11-BANK_STATEMENT-csv,original,2023,fgen-4f03b75f15b4cb8ba8138988,synthetic_programmatic_template,csv,top,True,checking
"Savings Statement
Granite Peak Bank
Account number,XXXXX5538
Statement period,10/01/2022 - 10/30/2022
Diego Walsh
4849 Prairie Ave Cedar Falls, IA 13927
Account summary
Beginning balance,""$8,637.86""
Deposits and other credits,$308.07
Withdrawals and other debits,""-$4,134.88""
Ending balance,""$4,811.05""
Interest paid this period,$48.08
Interest paid year-to-date,527.53
Annual percentage yield earned,0.10%
Date,Description,Amount
11/01,COSTCO WHSE #412,-625.10
11/24,AMAZON MKTPLACE,-477.58
09/16,WHOLE FOODS #1021,-582.40
03/05,STARBUCKS #11872,-817.30
11/22,WHOLE FOODS #1021,687.29
04/16,HOME DEPOT 0612,-70.19
IRS Form 1099-INT information for 2022 will be mailed separately.
Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-2ea163d3c90da4de0efad34d,v11-BANK_STATEMENT-csv,original,2022,fgen-471ff78083701a83d3efc3da,synthetic_programmatic_template,csv,top,False,savings
"Date,Payee,Memo,Withdrawal,Deposit,Balance
2025-07-20,WHOLE FOODS #1021,groceries,15.70,,526.27
01/04/2025,CVS/PHARMACY 0832,rent,492.26,,7363.17
2025-12-10,SHELL OIL 5741,,348.99,,14459.96
06/23/2025,WHOLE FOODS #1021,utilities,760.19,,27366.46
2025-10-11,NETFLIX.COM,,448.15,,28020.50
26/11/2025,HOME DEPOT 0612,utilities,343.22,,23602.12
13/10/2025,UBER TRIP,groceries,797.12,,26333.60
2025-06-26,COSTCO WHSE #412,utilities,854.81,,16566.07
2025-05-19,DELTA AIR LINES,utilities,586.92,,26490.82
Account History: Checking",BANK_STATEMENT,24,BANK_STATEMENT,fdc-14a599b0c862641997824519,v11-BANK_STATEMENT-csv,original,2025,fgen-ec0da91fbf7b43feb2165a0a,synthetic_programmatic_template,csv,bottom,False,raw_export
"Lakeshore National Bank
Account number,***-**-1270
Statement period,12/01/2026 - 12/30/2026
Avery Walsh
279 Elm Park Pl Lakewood, CO 58364
Account summary
Beginning balance,""$19,343.94""
Deposits and other credits,$584.22
Withdrawals and other debits,""-$2,167.04""
Ending balance,""$17,761.11""
Interest paid this period,$31.26
Interest paid year-to-date,$338.24
Annual percentage yield earned,3.03%
Date,Description,Amount
12/15,UBER TRIP,-263.96
01/24,UBER TRIP,-88.99
05/17,DELTA AIR LINES,-116.70
09/22,WHOLE FOODS #1021,-350.81
09/19,CVS/PHARMACY 0832,-432.01
03/19,SHELL OIL 5741,-709.47
02/23,NETFLIX.COM,275.55
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-359abd0fcb63cb592e5b2173,v11-BANK_STATEMENT-csv,original,2026,fgen-0dd462a5845b0990208a04b4,synthetic_programmatic_template,csv,none,False,money_market
"2022 Year-End Account Summary
Northwind Financial
Account number,endíng in 67O8
Statementperiod,01/01/2022 - 01/28/2022
Alex L. Walsh
3081 Harbor View Rd 0ak Grove, TX 70257
Account summary
Beginning balance,""S52,036.40""
Deposits and other credits,""$3,197.27""
Withdrawals and othcrdebits,""-$1,775.45""
Ending balance,""$53,458.21""
Interest paid this period,29.28
Interest paid year-to-date,478.48
Annual percentage yield eamed,1.59%
Tax reminder: amounts on this statement may differ from your Form l099-INT.
Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-872dbe1a6a760ee50f73d052,v11-BANK_STATEMENT-csv,original,2022,fgen-63abf393938e116f514b1f59,synthetic_programmatic_template,csv,top,True,year_end
"Prairie State Savings
Account number,****7642
Statementperiod,03/01/2023 - 03/30/2O23
Jamie Haddad
2053 SampleStreet Pinecrest, GA 39837
Account summary
Beginning balance,""$50,786.25""
Deposits and other credits,""$6,532.92""
Wíthdrawals and other debits,""-$3,596.42""
Ending balance,""$53,722.75""
Interest paíd this period,$20.l2
Interest paid year-to-date,$401.36
Annual percentage yield earned,0.96%
Date,Description,Amount
05/04,DELTA AIR LINE5,-599.12
03/04,H0ME DEPOT 0612,148.76
03/06,DELTA AIR LINE5,-818.65
Tax rcminder: amounts on this statement may differ from your Form 1099-INT.
Equal Housing Lender
Checking Account Statement",BANK_STATEMENT,24,BANK_STATEMENT,fdc-b9140acb59aa1b5a2a7e7c99,v11-BANK_STATEMENT-csv,original,2023,fgen-514d19d1b1de0fe7b1aa74bb,synthetic_programmatic_template,csv,bottom,True,checking
"Money Market Account Statement
Northwind Financial
Account number,XXXXX1839
Statement period,11/01/2025 - 11/28/2025
Taylor Testcase
8900 Willow Bend Way Bayside, WA 43749
Account summary
Beginning balance,""$50,646.21""
Deposits and other credits,""$4,775.67""
Withdrawals and other debits,-$481.30
Ending balance,""$54,940.57""
Interest paid this period,12.06
Interest paid year-to-date,455.26
Annual percentage yield earned,3.71%
Date,Description,Amount
07/13,AMAZON MKTPLACE,-261.76
09/18,STARBUCKS #11872,-859.72
12/13,HOME DEPOT 0612,-643.69
Tax reminder: amounts on this statement may differ from your Form 1099-INT.
Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-bb586688f4a205789d844508,v11-BANK_STATEMENT-csv,original,2025,fgen-d66b32251a1059c5debd0ed1,synthetic_programmatic_template,csv,top,False,money_market
"Account History: Checking
Transaction Date,Transaction Description,Debit,Credit,Balance
19/07/2026,COSTCO WHSE #412,,897.63,1480.66
2026-05-27,TARGET T-2231,,2437.58,26751.31
10/26/2026,INTEREST PAYMENT,,2177.27,13850.38
01/23/2026,MOBILE DEPOSIT,393.30,,8897.65
17/10/2026,TARGET T-2231,,,13127.16
2026-04-15,CVS/PHARMACY 0832,57.98,,25737.99
06/03/2026,NETFLIX.COM,106.00,,119.30
08/07/2026,INTEREST PAYMENT,420.53,,2586.01
2026-09-03,COSTCO WHSE #412,856.53,1300.95,9295.38",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4e22f2ea933d086e059b794d,v11-BANK_STATEMENT-csv,original,2026,fgen-682d36faff23aa1f95d5e2aa,synthetic_programmatic_template,csv,top,False,raw_export
"Date,Description,Amount,Running Bal.
2026-03-03,PAYROLL DIRECT DEP,-244.40,7770.92
04/18/2026,NETFLIX.COM,-1640.56,28788.46
17/05/2026,TARGET T-2231,-1711.03,29496.42
2026-04-12,STARBUCKS #11872,2330.50,3255.04",BANK_STATEMENT,24,BANK_STATEMENT,fdc-be7d75fe413fce2625d21ecb,v11-BANK_STATEMENT-csv,original,2026,fgen-646009421161bdf0407c3511,synthetic_programmatic_template,csv,none,False,raw_export
"Date,Description,Amount,Running Bal.
06/07/2026,ONLINE TRANSFER TO SAV,1632.58,21477.77
06/03/2026,TARGET T-2231,1811.08,11255.48
11/14/2026,NETFLIX.COM,-1062.87,9154.17
07/08/2026,SHELL OIL 5741,-1430.61,3424.45
06/19/2026,TARGET T-2231,-967.95,16312.91
10/11/2026,PAYROLL DIRECT DEP,-793.32,22340.60
Account History: Checking",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ee9618fced005245a91d234e,v11-BANK_STATEMENT-csv,original,2026,fgen-290c51948c654c92350801db,synthetic_programmatic_template,csv,bottom,False,raw_export
"Summit Ridge Bank Account number ***-**-9033 Statement period 03/01/2021 - 03/28/2021 Taylor C. Testcase 81 Willow Bend Way Oak Grove, TX 75312 Account summary Beginning balance $32,487.07
Deposits and other credits $7,906.96
Withdrawals and other debits -$3,755.03 Ending balance $36,639.00 Date Description Amount 10/10 COSTCO WHSE #412 -605.58 02/07 COSTCO WHSE #412 -122.96 05/27 TARGET T-2231 -258.12 04/09 HOME DEPOT 0612 -229.27 01/05 UBER TRIP 36.89 Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a08173147c0b35205faac5c2,v11-BANK_STATEMENT-flat,original,2021,fgen-eb71484eb9fa1cc2ee2e9581,synthetic_programmatic_template,flat,none,False,checking
"Transaction Date Transaction Description Debit Credit Balance 2023-09-16 SHELL OIL 5741 23852.62 12/24/2023 COSTCO WHSE #412 746.27 1770.97 19318.40 2023-02-08
STARBUCKS #11872 3566.22 2023-05-24 STARBUCKS #11872 579.04
19520.62",BANK_STATEMENT,24,BANK_STATEMENT,fdc-695641d241d07870b290cf91,v11-BANK_STATEMENT-flat,original,2023,fgen-89bec254e13f28d22aafceea,synthetic_programmatic_template,flat,top,False,raw_export
"Riverbend Bank & Trust Account number ending in 4953 Statement period 09/01/2025 - 09/31/2025 Alex K. Fischer 2063 Harbor View Rd Fairview, OH 35274 Account summary Beginning balance $48,137.72 Deposits and other credits $2,718.00
Withdrawals and other debits -$999.42 Ending balance $49,856.30 Interest paid this period 59.86 Interest paid year-to-date $344.77 Annual percentage yield
earned 2.88% Date Description Amount 01/27 DELTA AIR LINES -834.34 01/28 TARGET T-2231 -283.67 02/09 AMAZON MKTPLACE -431.60 Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-fcf4f0f9f1b529dddaf1eeaf,v11-BANK_STATEMENT-flat,original,2025,fgen-5c928ea3fc07b0cddc2f133f,synthetic_programmatic_template,flat,none,False,money_market
"Checking Account Statement Harbor Federal Credit Union Account number XXX-XX-1287 Statement period 04/01/2023 - 04/30/2023 Hiro Castillo 3159 Sample Street Bayside, WA 24878 Account summary Beginning balance $42,103.07 Deposits and other credits $7,592.07 Withdrawals and other debits -$7,623.57 Ending balance
$42,071.58 Date Description Amount 08/07 STARBUCKS
#11872 -576.28 02/12 SHELL OIL 5741 -6.02 02/28 NETFLIX.COM -305.48 08/21 NETFLIX.COM -810.56 Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-5cdf889cc61b7a154b935d48,v11-BANK_STATEMENT-flat,original,2023,fgen-1bc8f098d0ddc96e6abf418d,synthetic_programmatic_template,flat,top,False,checking
"Checking Account Statement Granite Peak Bank Account number ****8091 Statement
period 01/01/2025 - 01/28/2025 Taylor Nguyen 7451 Lakeshore Blvd Maplewood, MN 53933 Account summary Beginning balance $57,945.38 Deposits and other credits $5,611.02 Withdrawals and other debits -$4,199.37 Ending balance $59,357.03 Interest paid this period 42.94 Interest paid year-to-date 396.08 Annual percentage yield earned 3.78% Date Description Amount 08/12 TARGET T-2231 -336.64 08/14 TARGET T-2231 -328.02 09/19 COSTCO WHSE #412 -431.68 07/09 CVS/PHARMACY 0832 -894.06 07/26 AMAZON
MKTPLACE -828.95 Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-3448d7fc47c6f04e3d2de2e7,v11-BANK_STATEMENT-flat,original,2025,fgen-8f2bc301455d89ce21116239,synthetic_programmatic_template,flat,top,False,checking
"Downloaded 07/19/2021 Transaction Date Transaction Description Debit Credit Balance
11/17/2021 WHOLE FOODS #1021 495.16 29740.41 26/11/2021 CVS/PHARMACY 0832 868.37 1331.11 9017.15
2021-04-02 AMAZON MKTPLACE 2402.69 17434.78",BANK_STATEMENT,24,BANK_STATEMENT,fdc-eb6a379b67e88abd6fd4cc68,v11-BANK_STATEMENT-flat,original,2021,fgen-bb6788edceae7aa89bd2162e,synthetic_programmatic_template,flat,top,False,raw_export
"Northwind Financial Account number ending in 8435 Statement period 12/01/2023 - 12/28/2023 Alex J. Fischer 1463 Lakeshore Blvd Cedar Falls, IA 83970 Account summary Begínning balance $8,813.90 Deposits and other credits $5,791.55 Withdrawals and other debits
-$263.0l Endingbalance $14,342.43 Intcrest paid this period $12.71 Interest paid ycar-to-date $868.45 Annual percentage yield earned 0.02% Date Description Amount 11/26 HOME DEPOT0612 738.50 04/24 COSTCO WHSE #412 -698.7101/06 STARBUCKS #11872 848.36 03/27 SHELL OIL 5741 298.17 07/11 COSTCO WHSE
#412 -254.22 Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f59b63df6debdb90de2ca5d4,v11-BANK_STATEMENT-flat,original,2023,fgen-c3bcdb9450512af72a8d6fce,synthetic_programmatic_template,flat,none,True,savings
"Date Description Amount RunningBal. 07/15/2022 WHOLE FOODS #1021 1648.48 13658.68
03/08/2022 NETFLIX.COM
1114.22 17542.84 08/11/2022 TARGET T-2231 -1723.18 29912.51",BANK_STATEMENT,24,BANK_STATEMENT,fdc-16663b20273803a5db77b752,v11-BANK_STATEMENT-flat,original,2022,fgen-9d910899e093c993a0e70f39,synthetic_programmatic_template,flat,top,True,raw_export
"2021 Year-End Account Summary Meadowlark Savings Bank Account number XXXXX5684 Statement period 03/01/2021 - 03/28/2021 Hiro C. Walsh 1824 Cedar Ln Cedar Falls, IA 76423 Account summary Beginning balance $52,281.44 Deposits and other credits $1,277.38 Withdrawals and other debits -$4,903.19 Ending balance $48,655.63 Interest paid this period 36.18
Interest paid year-to-date $747.42 Annual percentage
yield earned 3.76% IRS Form 1099-INT information for 2021 will be mailed separately. Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-cfdb39cfd9d19447b0cfb176,v11-BANK_STATEMENT-flat,original,2021,fgen-293b3e5c3d7d1b679c08a4b7,synthetic_programmatic_template,flat,top,False,year_end
"Date Description Amount Running Bal. 03/07/2022 TARGET T-2231 -1775.86
10607.25 2022-08-22 SHELL OIL 5741 -2070.48 1010.38 25/05/2022 SHELL OIL 5741 -199.45 26808.99 12/12/2022 ZELLE FROM J SMITH -2418.87 13529.71 19/01/2022 HOME
DEPOT 0612 -2110.78 29579.67 12/12/2022 UBER TRIP 1979.00 13164.02",BANK_STATEMENT,24,BANK_STATEMENT,fdc-de84a03825fad44d5ca956f8,v11-BANK_STATEMENT-flat,original,2022,fgen-1458c8a51f5c40665dda2a2f,synthetic_programmatic_template,flat,top,False,raw_export
"Money Market Account Statement Summit Ridge Bank Account number ****4026 Statement period 10/01/2022 - 10/28/2022 Casey Walsh 6429 Harbor View Rd Fairview, OH
54169 Account summary Beginning balance $17,027.27 Deposits and other credits $1,194.96 Withdrawals and other debits -$2,711.80 Ending balance $15,510.43 Interest paid this period 20.45 Interest paid year-to-date 505.53 Annual percentage yield earned 0.04% Date Description
Amount 08/25 SHELL OIL 5741 -870.09 06/27 COSTCO WHSE #412 -799.59 11/22 NETFLIX.COM -334.24 10/03 TARGET T-2231 76.06 03/10 TARGET T-2231 -632.31 Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-0e8cc0617a01e1e0bdf58628,v11-BANK_STATEMENT-flat,original,2022,fgen-aa9ee3555cec58293d9285cd,synthetic_programmatic_template,flat,top,False,money_market
"Account History: Checking Date Description Amount Running Bal. 04/12/2026 HOME DEPOT
0612 -266.21 1374.62 06/18/2026 COSTCO WHSE #412 -787.43 10412.69 01/04/2026 ONLINE TRANSFER TO SAV -698.87 7263.30 10/12/2026 ONLINE TRANSFER
TO SAV -1495.82 17264.05 09/12/2026 NETFLIX.COM 1368.71 10639.89",BANK_STATEMENT,24,BANK_STATEMENT,fdc-1b79ac93d25bb61e35c6d47e,v11-BANK_STATEMENT-flat,original,2026,fgen-4ea04f28b08a9e53cad987c9,synthetic_programmatic_template,flat,top,False,raw_export
"Everyday Checking ...8095 Date Description Amount
Running Bal. 2021-01-01 PAYROLL DIRECT DEP -1062.65 9980.73
20/12/2021 STARBUCKS #11872 1169.26 9675.24 10/15/2021 UBER TRIP -596.59 15990.54 09/24/2021 PAYROLL DIRECT DEP -2079.98 7458.50 2021-03-09 HOME DEPOT 0612 129.39 5135.41",BANK_STATEMENT,24,BANK_STATEMENT,fdc-2f9aa453f949d82e38c6f8af,v11-BANK_STATEMENT-flat,original,2021,fgen-b28da3e0b77234c546f52c0a,synthetic_programmatic_template,flat,top,False,raw_export
"Checking Account Statement Prairie State Savings Account number XXXXX5524 Statement period
07/01/2025 - 07/28/2025 Jamie Tanaka 6313 Oak Hollow Ct Bayside, WA 14032 Account
summary Beginning balance $56,418.36 Deposits and other credits $1,805.27 Withdrawals and other debits -$6,920.41 Ending balance $51,303.22 Interest paid this period 59.48 Interest paid year-to-date 614.64 Annual percentage yield earned 3.62% Date Description Amount 04/26 DELTA AIR LINES 26.35 12/07 UBER TRIP -855.83 03/22 COSTCO WHSE #412 75.62 12/15 STARBUCKS #11872 -27.72 09/04 UBER TRIP -601.81 12/01 COSTCO WHSE #412 -395.15 IRS Form 1099-INT information for 2025 will be mailed separately. Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4aee19c7a8814c80c427e5a0,v11-BANK_STATEMENT-flat,original,2025,fgen-faae71a6ecec748bf6cc9f5d,synthetic_programmatic_template,flat,top,False,checking
"Checking Account Statement Prairie State Savings Account number XXXXX8204 Statement period 06/01/2023 - 06/28/2023 Amara A. Lindqvist 4610 Prairie Ave Oak
Grove, TX 15250 Account summary Beginning balance $12,687.41 Deposits and other credits $4,160.18 Withdrawals and other debits -$5,225.30 Ending balance $11,622.29 Date Description Amount 04/26 AMAZON MKTPLACE -527.71 11/21 DELTA AIR LINES -454.82 03/14 TARGET T-2231 -838.95 12/19 DELTA AIR LINES -710.30 Your 2023 Form 1099-INT will
be available online by January 31, 2024. Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4811422a685a37032f4d1e8b,v11-BANK_STATEMENT-flat,original,2023,fgen-6b71d8c1b13ee436d988fa50,synthetic_programmatic_template,flat,top,False,checking
"Account History: Checking Date Payee Memo Withdrawal Deposit Balance 11/20/2023 STARBUCKS #11872 rent 169.79 23131.87 16/03/2023 SHELL OIL 5741 utilities 662.76
9465.80 06/01/2023 CVS/PHARMACY 0832
856.24 7318.71 12/09/2023 DELTA AIR LINES rent 775.79 29887.13 13/01/2023 UBER TRIP utilities 478.10 24654.98 07/25/2023 UBER TRIP groceries 86.17 1758.66",BANK_STATEMENT,24,BANK_STATEMENT,fdc-80848c5308da721af6922d9b,v11-BANK_STATEMENT-flat,original,2023,fgen-941d899d6d5886213b86f03b,synthetic_programmatic_template,flat,top,False,raw_export
"Posting Date Description Amount Type Balance Checkor
5lip # 07/27/2023 UBER TRIP -83.40 ATM 18463.5l 04/05/2023 DELTA AIR LINES -1571.06 DEBIT_CARD 17084.16 2023-10-09 TARGET T-2231 -238.04
DEBIT_CARD 4037.17",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f48d81c3be4a4a6f36056420,v11-BANK_STATEMENT-flat,original,2023,fgen-1330e276c1fe24cf6f437f6d,synthetic_programmatic_template,flat,bottom,True,raw_export
"Everyday Checking
...7860 Date Description Amount Running Bal. 2021-11-14 ONLINE TRANSFER TO SAV -1073.36 25657.32 03/07/2021 COSTCO WHSE #412 2496.36 5575.01 2021-07-16 ONLINE TRANSFER TO SAV 1897.86 18451.27 01/06/2021 HOME DEPOT 0612 2162.08 21909.42 2021-03-04 UBER TRIP 2140.92 18574.10 2021-07-26 DELTA AIR LINES -1929.60 18556.61
2021-09-18 AMAZON MKTPLACE 1015.95 8500.62 14/10/2021 TARGET T-2231 -1207.22 14714.01 10/02/2021 TARGET T-2231 -2209.19 11172.09",BANK_STATEMENT,24,BANK_STATEMENT,fdc-3765ec2c4dc0b9c7365de343,v11-BANK_STATEMENT-flat,original,2021,fgen-127025a22a163501c5ec57d2,synthetic_programmatic_template,flat,top,False,raw_export
"Cedar Valley Credit Union Account number ending in 9470
Statement period 09/01/2024 - 09/30/2024 Kwame Romero 2604 Willow Bend Way Lakewood, CO 83419 Account summary Beginning balance $26,035.27 Deposits and other credits $2,274.44 Withdrawals and other debits -$4,453.75 Ending balance $23,855.96 Date Description Amount 08/21 SHELL OIL 5741 -628.29 03/21 HOME DEPOT 0612 -288.80 08/11 HOME DEPOT 0612 -429.62 08/10 STARBUCKS #11872 261.97 07/15 HOME DEPOT 0612 -131.84 IRS Form 1099-INT information for 2024 will be mailed separately. Federally insured
by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-1ab731c2b74596a76af7f2d9,v11-BANK_STATEMENT-flat,original,2024,fgen-0a271ad16c13ce2875b76958,synthetic_programmatic_template,flat,none,False,checking
"2025 Year-End Account Summary Prairie State Savings Account number XXXXX2136 Statement period 04/01/2025 - 04/30/2025 Fatima Brennan 5725 Cedar Ln Cedar Falls, IA 96905 Account summary Beginning balance $31,657.01 Deposits and other credits $5,550.11
Withdrawals and other debits -$3,023.61 Ending balance $34,183.51 Interest paid this period $6.41 Interest paid year-to-date 160.37 Annual percentage yield earned
3.97% Your 2025 Form 1099-INT will be available online by January 31, 2026. Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-f9d7979341460dceffb3fe9c,v11-BANK_STATEMENT-flat,original,2025,fgen-d47a104e7be555a95d1de73e,synthetic_programmatic_template,flat,top,False,year_end
"Harbor Federal Credit Union Account number XXXXX9190 Statement period 12/01/2023 - 12/31/2023 Sofia Haddad 425 Harbor View Rd Maplewood, MN 23150 Account summary Beginning balance $49,507.69 Deposits and other credits $7,916.72 Withdrawals and other debits -$5,194.19
Ending balance $52,230.23 Interest
paid this period $24.25 Interest paid year-to-date $366.23 Annual percentage yield earned 2.10% Federally insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-45098390d3576fc97dae0a80,v11-BANK_STATEMENT-flat,original,2023,fgen-99f02dd18c5e5e35ec7ddc04,synthetic_programmatic_template,flat,none,False,year_end
"Date Description Amount Running Bal. 2023-07-05
SHELL OIL 5741 -2076.95 5162.24 2023-10-20
ONLINE TRANSFER TO SAV -750.68 1254.79 01/13/2023 COSTCO WHSE #412 -1367.78 3677.21 2023-03-25 DELTA AIR LINES -780.86 5097.57 2023-05-03 ONLINE TRANSFER TO SAV -2241.76 12626.29 06/07/2023 CVS/PHARMACY 0832 745.33 659.41 08/11/2023 AMAZON MKTPLACE 1131.75 17408.67 12/03/2023 SHELL OIL 5741 -1975.15 23783.34",BANK_STATEMENT,24,BANK_STATEMENT,fdc-48a06ef0a6c37b7c1bc9b4e3,v11-BANK_STATEMENT-flat,original,2023,fgen-712e4d3d038bc4dcb42728e8,synthetic_programmatic_template,flat,top,False,raw_export
"Money Market Account Statement Riverbend Bank & Trust Account number ending in 8308 Statementperiod 09/01/2025
- 09/28/2025 Sofia Lindqvist 5953 Harbor View Rd Brookhaven, PA 76390 Account summary Beginning balance $23,470.23 Deposits and other credits $4,245.53 Withdrawa1s and other debits -$3,165.77 Ending balance $24,549.99 Interestpaid this period $52.32 Interest paid year-to-date $152.84 Annua1 percentage yield eamed 2.34% Date Description Amount O5/07 TARGET T-2231 -736.23 02/08 H0ME DEP0T 0612 -166.47 O3/20 HOME DEPOT 0612 -319.29 03/05 CO5TCO WHSE #412 -749.7810/07 NETFLIX.COM -55O.13 Federally
insured by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-dc1ecd3a050a54f082767978,v11-BANK_STATEMENT-flat,original,2025,fgen-ad0972d36afe26d88ef350e2,synthetic_programmatic_template,flat,top,True,money_market
"2021 Year-End Account Summary Harbor Federal Credit Union Account number XXXXX4360 Statement period 10/01/2021 - 10/28/2021 Jordan Testcase 1573 Harbor View Rd Testville, IL 88963
Account summary Beginning balance $41,052.15 Deposits and other credits $6,862.94 Withdrawals and other debits -$4,958.73 Ending balance $42,956.35 Interest paid
this period 25.90 Interest paid year-to-date 614.47 Annual percentage yield earned 2.16% Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-8ae66e5a6212f9136c525b25,v11-BANK_STATEMENT-flat,original,2021,fgen-8ce9846eb1d73e44f73d200a,synthetic_programmatic_template,flat,top,False,year_end
"Bayview Community Bank Account number ending in 3850 Statement period 08/01/2021 - 08/28/2021 Avery Rivera 9273
Granite St Maplewood, MN 28945 Account summary Beginning balance $13,612.93 Deposits and other credits $5,763.58 Withdrawals and other debits -$4,799.20 Ending balance $14,577.32 Interest paid this period $38.79 Interest paid year-to-date $412.64 Annual percentage yield earned 1.92% Date Description Amount 01/24 SHELL OIL 5741 -326.10 12/03 NETFLIX.COM -779.55 09/07 HOME DEPOT 0612 -402.39 05/16 WHOLE FOODS #1021 -160.68 11/13 CVS/PHARMACY 0832 -49.28 05/18 HOME DEPOT 0612 -217.62 Your 2021 Form 1099-INT will be available online by January 31, 2022. Equal Housing Lender Savings
Statement",BANK_STATEMENT,24,BANK_STATEMENT,fdc-bb8b1c9156410a76df5fc378,v11-BANK_STATEMENT-flat,original,2021,fgen-a5f35bd128242794f67103d9,synthetic_programmatic_template,flat,bottom,False,savings
"Checking Account Statement Prairie State Savings Account number XXX-XX-5266 Statement period 06/01/2022 - 06/28/2022
Amara Lindqvist 7692 Prairie Ave Bayside, WA 10476 Account summary Beginning balance $3,743.51 Deposits and other credits $936.40 Withdrawals and other debits -$5,230.53 Ending balance
$0.00 Date Description Amount 12/14 TARGET T-2231 -668.21 03/18 HOME DEPOT 0612 -123.64 08/08 SHELL OIL 5741 -207.10 06/13 NETFLIX.COM -486.90 03/13 STARBUCKS #11872 -697.51 12/25 WHOLE FOODS #1021 -265.22 11/06 SHELL OIL 5741 -114.09 Tax reminder: amounts on this statement may differ from your Form 1099-INT. Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-6dd02f255fce6e2b08829048,v11-BANK_STATEMENT-flat,original,2022,fgen-7a9bc991bb28f2703d04283e,synthetic_programmatic_template,flat,top,False,checking
"Money MarketAccount Statement Harbor Federal Credit Union Account number ****3429 Statement period 07/0l/2025 - 07/31/2025 Casey Walsh 4897 Harbor View Rd Maplewood, MN 85570 Account summary Beginning balance $57,O39.9l Deposits and other credits $2,338.70 Withdrawals and othcr debits -$744.17 Ending balance $58,634.44 Interest paid thisperiod $44.85 Interest paid year-to-datc 399.58 Annua1 percentage yield earned 0.54%
Datc Description Amount 02/02 NETFLIX.C0M -176.78 02/01 NETFLIX.COM -285.54 11/18 CV5/PHARMACY0832 -710.41 11/08 WHOLE FOODS #1021 -192.81 11/05 WHOLE FOODS #1021 -336.47 This statcment is not a Form 1099-INT. Keep it for your records. Federally insured
by NCUA",BANK_STATEMENT,24,BANK_STATEMENT,fdc-ee00f0e014c9581ebe4949ce,v11-BANK_STATEMENT-flat,original,2025,fgen-ad445895f285da49818226d1,synthetic_programmatic_template,flat,top,True,money_market
"Savings Account XXXX5386 - transactions Transaction Date
Transaction Description Debit Credit Balance 2021-04-18 WHOLE FOODS #1021 2296.08 15702.52 07/07/2021 HOME DEPOT 0612 9764.77 14/02/2021 UBER TRIP 639.84 14005.13 01/21/2021 AMAZON MKTPLACE 70.97 5066.90 10/02/2021 CVS/PHARMACY 0832 80.06 875.03 12583.02 2021-06-11 DELTA AIR LINES 393.03
865.46 1435.08 2021-12-08 AMAZON MKTPLACE 459.94 15437.63",BANK_STATEMENT,24,BANK_STATEMENT,fdc-94ba2d6de3838c9850382f07,v11-BANK_STATEMENT-flat,original,2021,fgen-213f7a3aacd1b8c4c768c927,synthetic_programmatic_template,flat,top,False,raw_export
"Transaction Date Transaction Description Debit Credit Balance 2021-09-07 NETFLIX.COM 230.53 20392.47 2021-05-25 WHOLE FOODS #1021 566.40
8525.02 06/19/2021 STARBUCKS #11872 561.35
1967.78 5319.84",BANK_STATEMENT,24,BANK_STATEMENT,fdc-a855ff06f8f5f2adeeaabf12,v11-BANK_STATEMENT-flat,original,2021,fgen-185013cb56b461a8e2812346,synthetic_programmatic_template,flat,none,False,raw_export
"Meadowlark Savings Bank Account number XXXXX1976 Statement period 07/01/2022 - 07/28/2022 Jordan D. Okafor 1042 Harbor View Rd Brookhaven, PA 78195 Account summary Beginning balance $59,098.18 Deposits and other credits $1,711.50 Withdrawals and other debits -$4,762.38 Ending
balance $56,047.30 Interest paid this period 27.19 Interest paid year-to-date $198.62 Annual percentage yield earned
2.39% Member FDIC",BANK_STATEMENT,24,BANK_STATEMENT,fdc-4535279dfc7015f5dea24d40,v11-BANK_STATEMENT-flat,original,2022,fgen-fdc0212b74a2fc9b9d07304f,synthetic_programmatic_template,flat,none,False,year_end
"Downloaded 2022-06-10 Transaction
Date Transaction Description Debit
Credit Balance 2022-07-28 WHOLE FOODS #1021 14083.52 13/01/2022 SHELL OIL 5741 19798.33 2022-07-18 HOME DEPOT 0612 696.90 10068.20",BANK_STATEMENT,24,BANK_STATEMENT,fdc-528149d7e2584bc201d9a75e,v11-BANK_STATEMENT-flat,original,2022,fgen-1900df81d94743eec1611306,synthetic_programmatic_template,flat,top,False,raw_export
"Money Market Account Statement Meadowlark Savings Bank Account number ending in 0664 Statement period 11/01/2022 -
11/30/2022 Hiro Haddad 878 Cedar Ln Pinecrest, GA 83066 Account summary Beginning balance $24,664.28 Deposits and other credits $105.00 Withdrawals and other debits -$6,608.41 Ending balance
$18,160.87 Interest paid this period $55.58 Interest paid year-to-date $848.45 Annual percentage yield earned 4.09% Date Description Amount 07/17 SHELL OIL 5741 844.02 04/13 NETFLIX.COM -627.38 11/22 SHELL OIL 5741 317.51 Equal Housing Lender",BANK_STATEMENT,24,BANK_STATEMENT,fdc-cfc743d4abb9a449960fe478,v11-BANK_STATEMENT-flat,original,2022,fgen-a168f93cb5711cea45521e6f,synthetic_programmatic_template,flat,top,False,money_market
"AccountNumber
Account Name
5ymbol
Description
Quantity
Last Price
Current Value
Total Gain/Loss Dollar
Percent Of Account
Z13385146
Individual
FXAIX
FIDELITY 500 INDEX
139.74
513.78
75348.16
454.91
29.46%
Z46173888
Individual
AMZN
FIDELITY 500 INDEX
207.99
339.71
27748.09
3869.80
21.54%
Z31162955
Individual
AMZN
FIDELITY 500 INDEX
42.51
306.60
14591.21
-333.31
7.92%
Z14518444
Individual
AMZN
NVIDIA CORP
397.56
675.45
86174.11
-2409.55
53.12%
Z23228745
Individual
NVDA
FIDELITY 500 INDEX
232.85
831.91
57478.32
-685.66
8.83%
Z24487277
Individual
NVDA
FIDELITY 500 INDEX
382.87
108.63
24742.86
2910.32
33.21%
Z89606905
Individual
FXAIX
NVIDIA C0RP
70.46
100.81
59471.71
2864.56
42.98%
Z85302476
Individual
NVDA
NVIDIA C0RP
37.87
879.50
26530.2l
-6317.80
43.96%
Z57131210
Individual
V0O
VANGUARD 5&P 500 ETF
90.30
616.21
32930.61
-579.91
32.36%",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a408056e4e3efc19409917e0,v11-BROKERAGE_STATEMENT-columns,original,2024,fgen-1445d5516aa173c8e89579ec,synthetic_programmatic_template,columns,top,True,raw_export
"Positions as of 01/03/2023
Run Date
Action
Symbol
Security Description
Quantity
Price
Amount
Settlement Date
2023-09-07
YOU SOLD
VTI
APPLE INC
67.13
496.86
-7211.48
16/08/2023
04/09/2023
REINVESTMENT
SCHD
APPLE INC
29.81
95.47
-2268.33
06/01/2023
06/11/2023
YOU SOLD
SCHD
VANGUARD INDEX FDS
99.91
177.31
-3245.11
07/08/2023
2023-04-09
REINVESTMENT
VTI
APPLE INC
44.91
81.00
-1542.46
16/01/2023
27/12/2023
INTEREST EARNED
SCHD
VANGUARD INDEX FDS
93.40
382.83
-6710.63
05/03/2023
04/06/2023
INTEREST EARNED
VTI
SCHWAB US DIVIDEND EQUITY ETF
47.89
103.40
-3809.88
06/14/2023
2023-06-28
DIVIDEND RECEIVED
AAPL
SCHWAB US DIVIDEND EQUITY ETF
45.41
75.33
-1083.94
25/09/2023",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ed8ca4f2870196e15cf2c834,v11-BROKERAGE_STATEMENT-columns,original,2023,fgen-097a1bdcfc58a630dc96cc64,synthetic_programmatic_template,columns,top,False,raw_export
"Symbol
Description
Quantity
Price
Market Value
Cost Basis
Gain/Loss
SPAXX**
APPLE INC
62.78
318.39
77175.25
24886.82
-241.94
VTI
APPLE INC
196.65
151.90
38059.81
53941.52
4089.48
VTI
MONEY MARKET
176.74
27.63
16348.84
69885.92
-8318.31
SCHD
VANGUARD TOTAL STOCK MKT ETF
77.37
424.16
40854.11
43903.60
-7317.28
SPAXX**
APPLE INC
283.37
114.07
29893.58
25031.09
828.06
MSFT
VANGUARD TOTAL STOCK MKT ETF
284.49
466.60
42805.53
77756.75
6382.02
QQQ
VANGUARD TOTAL STOCK MKT ETF
297.14
413.36
86467.59
59288.78
1925.94",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-49a22a45524c6c9f374e3d86,v11-BROKERAGE_STATEMENT-columns,original,2025,fgen-9c992ef7c1a082b2442301cb,synthetic_programmatic_template,columns,none,False,raw_export
"Positions
Summit Investments
Account
Statement period
Individual Brokerage Account ****3028
11/01/2022 - 11/30/2022
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
357.677
290.66
103,963.14
6,921.62
VTI
75.157
159.31
11,973.06
-1,013.17
SCHB
281.819
443.78
125,066.32
4,810.91
QQQ
380.069
274.80
104,443.92
849.37
IRS Form 1099 information for 2022 will be mailed separately.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bbb1beec6234b76f51215df2,v11-BROKERAGE_STATEMENT-columns,original,2022,fgen-15ba9dc124baa3d947466b1c,synthetic_programmatic_template,columns,top,False,holdings_export
"Account Number
Account Name
Symbol
Description
Quantity
Last Price
Current Value
Total Gain/Loss Dollar
Percent Of Account
Z18826175
Individual
VOO
NVIDIA CORP
232.01
63.11
56868.74
-6011.00
45.27%
Z37458039
Individual
FXAIX
VANGUARD S&P 500 ETF
353.62
790.78
33202.19
-8353.40
59.69%
Z60280645
Individual
AMZN
VANGUARD S&P 500 ETF
77.95
448.35
63923.95
7764.54
52.19%
Z22749341
Individual
FXAIX
NVIDIA CORP
164.02
64.47
42278.37
-907.64
50.79%
Z73002714
Individual
AMZN
NVIDIA CORP
389.35
717.68
32168.10
4460.98
17.88%
Z13468324
Individual
AMZN
FIDELITY 500 INDEX
276.84
42.11
20547.72
46.77
4.02%",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f4d928febcfd94008ced0ae0,v11-BROKERAGE_STATEMENT-columns,original,2026,fgen-67fb0367b8c3474f502ce9a1,synthetic_programmatic_template,columns,top,False,raw_export
"Investment Report
Northstar Securities
Account
Statement period
Beginning account value
Ending account value
Joint WROS XXXXX9088
05/01/2026 - 05/30/2026
$88,006.85
$95,960.33
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
431.75  2,490.10
22.97  490.46
8,751.00
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
VTI
19.442
126.41
2,457.52
7,944.26
AAPL
165.930
473.21
78,519.26
2,622.70
QQQ
48.168
352.89
16,997.93
8,648.92
VOO
64.881
129.55
8,405.47
-1,170.74
IRS Form 1099 information for 2026 will be mailed separately.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-44b3130fbf348b7902623b36,v11-BROKERAGE_STATEMENT-columns,original,2026,fgen-81fa397e3af355f23ef98ee0,synthetic_programmatic_template,columns,top,False,monthly
"Investment Report
Clearwater Investing
Account
Statement period
Beginning account value
Ending account value
Individual Brokerage Account XXXXX7491
06/01/2026 - 06/30/2026
$432,707.54
$395,046.26
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
608.68  3,708.10
21.63  398.11
4,331.20
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
VOO
112.922
385.86
43,571.59
140.24
SCHD
87.657
452.86
39,696.31
928.94
VTI
175.902
495.79
87,209.60
3,670.98
BND
49.535
332.70
16,480.36
-540.80
This statement is not a Form 1099. Keep it for your records.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-89447969442d95d4ff7b90ef,v11-BROKERAGE_STATEMENT-columns,original,2026,fgen-f77ba73f849faab0c3a0e0f0,synthetic_programmatic_template,columns,top,False,monthly
"Evergreen Brokerage Services
Account
Statement period
Beginning account value
Ending account value
Joint WROS XXX-XX-9421
03/01/2022 - 03/28/2022
$174,962.44
$188,322.84
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
275.08  5,867.55
65.29  316.13
1,575.49
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
AAPL
282.922
495.53
140,195.44
1,724.33
VTI
391.745
307.42
120,432.22
7,508.94
QQQ
161.867
359.91
58,257.66
4,347.66
BND
372.501
450.10
167,664.53
8,112.08
This statement is not a Form 1099. Keep it for your records.
Quarterly Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-45cdf6a0bd2f644b95df1189,v11-BROKERAGE_STATEMENT-columns,original,2022,fgen-d2da6876de8ccc3d9c8f55a8,synthetic_programmatic_template,columns,bottom,False,quarterly
"Ironwood Wealth Partners
Account
Statement period
Individual - TOD ending in 8600
12/01/2024 - 12/31/2024
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
IVV
359.145
245.11
88,030.69
-1,051.94
VOO
70.607
143.94
10,163.44
-1,813.59
BND
266.113
407.87
108,540.38
6,476.12
MSFT
134.292
107.54
14,442.14
6,036.47
Your 2024 Form 1099 will be available online by January 31, 2025.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Positions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-476ef2f4a32782e975ed5d16,v11-BROKERAGE_STATEMENT-columns,original,2024,fgen-8678b30b3b40fe4594e66f51,synthetic_programmatic_template,columns,bottom,False,holdings_export
"Positions
Summit Investments
Account
Statement period
Individual Brokerage Account ***-**-3869
11/01/2025 - 11/30/2025
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
QQQ
214.787
99.35
21,338.20
5,177.44
SCHB
238.906
102.60
24,511.31
6,732.38
AAPL
249.790
252.14
62,983.07
8,391.42
SCHD
289.743
21.05
6,098.77
8,570.77
IRS Form 1099 information for 2025 will be mailed separately.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d6330f6b5a2e6c2e503ba446,v11-BROKERAGE_STATEMENT-columns,original,2025,fgen-5a997a4fd2f0087db9972d9b,synthetic_programmatic_template,columns,top,False,holdings_export
"Evergreen Brokerage Services
Account
Statement period
Beginning account value
Ending account value
Individual Brokerage Account ***-**-9683
10/01/2021 - 10/30/2021
$860,219.11
$876,824.82
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
493.43  7,398.58
77.94  496.34
-1,923.31
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
AAPL
27.938
381.06
10,646.02
-318.20
BND
152.173
424.84
64,649.69
1,925.76
SCHB
110.705
270.80
29,978.88
4,564.84
SCHD
319.008
63.30
20,191.86
699.91
Tax reminder: amounts on this statement may differ from your Form 1099.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a573b8b37b2a97a74530f5cc,v11-BROKERAGE_STATEMENT-columns,original,2021,fgen-7b0d48dff1d5c5a5260fe34c,synthetic_programmatic_template,columns,none,False,monthly
"Downloaded 19/01/2026
Account Number
Account Name
Symbol
Description
Quantity
Last Price
Current Value
Total Gain/Loss Dollar
Percent Of Account
Z41327847
Individual
FXAIX
VANGUARD S&P 500 ETF
188.16
827.39
45778.07
6642.31
31.32%
Z87646203
Individual
FXAIX
VANGUARD S&P 500 ETF
206.36
836.80
77772.52
-1844.87
42.95%
Z15179286
Individual
FXAIX
VANGUARD S&P 500 ETF
232.08
305.99
52681.63
1257.17
51.48%
Z39833813
Individual
NVDA
NVIDIA CORP
334.23
661.78
4801.68
-4430.05
22.34%
Z62692066
Individual
AMZN
FIDELITY 500 INDEX
242.76
116.85
47266.51
850.50
59.07%
Z46281070
Individual
AMZN
FIDELITY 500 INDEX
105.78
592.66
49956.17
5201.02
15.91%
Z35454737
Individual
NVDA
NVIDIA CORP
386.10
34.72
76471.29
5999.28
55.02%
Z97912820
Individual
VOO
NVIDIA CORP
88.92
259.66
28521.39
7914.71
45.74%
Z89436848
Individual
FXAIX
FIDELITY 500 INDEX
350.58
234.77
45796.54
4993.73
26.16%",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b6fcb75e3a518913fdbdf132,v11-BROKERAGE_STATEMENT-columns,original,2026,fgen-7a020e3f5b6c5d69c5ff170f,synthetic_programmatic_template,columns,none,False,raw_export
"Clearwater Investing
Account
Statement period
Beginning account value
Ending account value
Individual - TOD XXXXX2164
03/01/2023 - 03/30/2023
$783,036.79
$836,399.94
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
525.48  6,875.00
58.03  40.21
4,233.54
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
BND
51.265
281.92
14,452.48
-751.86
VOO
275.378
73.76
20,312.76
4,849.70
VTI
176.359
103.03
18,171.08
6,079.52
SCHB
318.480
398.83
127,020.56
2,470.48
Tax reminder: amounts on this statement may differ from your Form 1099.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Quarterly Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-32cc5f0dcdcae3a0c3aa3fb5,v11-BROKERAGE_STATEMENT-columns,original,2023,fgen-b5f8b2d7b10afe6d1b4af4f4,synthetic_programmatic_template,columns,bottom,False,quarterly
"Quarterly Account Statement
Northstar Securities
Account
Statement period
Beginning account value
Ending account value
Individual - TOD XXX-XX-2941
07/01/2023 - 07/30/2023
$854,748.89
$906,882.17
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
719.54  2,741.27
60.34  150.10
332.55
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
VOO
156.962
376.28
59,061.77
3,812.17
MSFT
8.628
191.18
1,649.50
2,451.19
SCHB
78.654
276.53
21,750.44
-347.97
VTI
332.951
327.34
108,987.78
7,223.54
This statement is not a Form 1099. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-873216acf4411afc2a36de7e,v11-BROKERAGE_STATEMENT-columns,original,2023,fgen-e467410b560c8d0c57c2ea74,synthetic_programmatic_template,columns,top,False,quarterly
"Investment Report
Northstar Securities
Account
Statement period
Beginning account value
Ending account value
Individual - TOD ***-**-4834
11/01/2023 - 11/28/2023
$873,692.40
$802,261.69
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
658.63  2,325.50
34.24  51.34
-1,402.60
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
BND
249.297
437.06
108,956.67
-1,354.71
VTI
199.446
253.79
50,618.03
7,058.16
SCHD
56.862
62.46
3,551.73
4,148.43
AAPL
206.714
247.93
51,251.20
3,098.67
IRS Form 1099 information for 2023 will be mailed separately.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a892d8b6a6be8d473818c306,v11-BROKERAGE_STATEMENT-columns,original,2023,fgen-22b0c1009b8e1ac7f2f5d069,synthetic_programmatic_template,columns,top,False,monthly
"Investment Report
NorthstarSecurities
Account
Statement period
Beginning account value
Ending account value
Joint WR05 ****2145
01/01/2023 - 01/28/2023
$14,032.86
$14,517.76
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
162.10  143.42
31.51  94.50
-1,727.23
5ymbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
326.250
135.13
44,086.65
3,054.94
AAPL
89.546
122.41
10,961.06
8,251.18
MSFT
126.332
460.56
58,183.63
5,135.45
V00
51.966
448.50
23,306.73
6,222.21
Tax reminder: amounts on this statement may diffcr from your Form 1099.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8821600c08b1bed99a1f8a1c,v11-BROKERAGE_STATEMENT-columns,original,2023,fgen-82609d1d50674b187fa83dbd,synthetic_programmatic_template,columns,top,True,monthly
"Quarterly Account Statement
Northstar Securities
Account
Statement period
Beginning account value
Ending account value
Individual - T0D XXX-XX-3208
12/01/2022 - 12/31/2022
S82,458.58
$86,824.11
Income summary  Thís period  Yearto date
Dividends
Interest
Realized gain/loss
509.73  289.60
29.26  500.61
4,098.23
5ymbol
Quantity
Last Price
Current Value
Total Gain/Loss
IVV
386.884
45.26
17,511.48
3,040.03
BND
13.188
130.17
1,716.75
5,760.48
AAPL
235.093
409.06
96,166.87
345.70
QQQ
134.293
444.35
59,672.98
347.78
Sccurítíes offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-348b9365e1e6eceb4c4d4e17,v11-BROKERAGE_STATEMENT-columns,original,2022,fgen-7ef96453e464286b7781d867,synthetic_programmatic_template,columns,top,True,quarterly
"Quarterly Account Statement
Clearwater Investing
Account
Statement period
Beginning account value
Ending account value
Individual - TOD XXXXX9587
10/01/2026 - 10/31/2026
$659,619.35
$641,347.73
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
536.79  7,376.05
88.99  70.20
2,518.85
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
300.267
218.20
65,518.47
3,553.49
VTI
135.223
111.47
15,073.69
318.50
BND
261.735
355.31
92,997.76
6,363.00
QQQ
383.743
341.68
131,115.94
5,330.54",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b9ad96839637410cb8f88f8c,v11-BROKERAGE_STATEMENT-columns,original,2026,fgen-755ff1018824721ba8039bb6,synthetic_programmatic_template,columns,top,False,quarterly
"Evergreen Brokerage Services
Account
Statement period
Beginning account value
Ending account value
Individual Brokerage Account ***-**-3503
01/01/2021 - 01/28/2021
$164,902.59
$172,550.35
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
440.08  4,873.81
35.14  134.42
4,653.60
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
VTI
123.478
214.89
26,534.35
4,016.69
IVV
298.701
428.24
127,915.05
572.44
MSFT
36.089
422.52
15,247.95
7,687.54
VOO
289.876
35.38
10,254.42
-374.65
Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-01f27c3ba4507cd13400369d,v11-BROKERAGE_STATEMENT-columns,original,2021,fgen-cfa8cb76858363668ad99767,synthetic_programmatic_template,columns,bottom,False,monthly
"Investment Report
Northstar Securities
Account
Statement period
Beginning account value
Ending account value
Individual - TOD XXX-XX-3938
04/01/2024 - 04/31/2024
$358,168.57
$377,681.07
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
599.91  618.45
83.14  433.55
-2,726.45
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
IVV
19.874
327.52
6,508.94
4,886.66
SCHD
18.735
219.23
4,107.30
2,072.96
BND
138.737
180.97
25,107.53
3,494.91
QQQ
366.587
185.06
67,840.77
7,333.25
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f0399475925d2b9ef6894a59,v11-BROKERAGE_STATEMENT-columns,original,2024,fgen-8dadf172b8fb69c51c416f2b,synthetic_programmatic_template,columns,top,False,monthly
"Downloaded 03/07/2024
Run Date
Action
Symbol
Security Description
Quantity
Price
Amount
Settlement Date
2024-12-21
INTEREST EARNED
SCHD
SCHWAB US DIVIDEND EQUITY ETF
84.26
73.18
8984.87
2024-09-26
24/08/2024
YOU BOUGHT
VTI
VANGUARD INDEX FDS
23.76
383.20
-8940.67
11/05/2024
24/03/2024
REINVESTMENT
SCHD
VANGUARD INDEX FDS
45.62
221.16
-5545.02
2024-01-21
04/14/2024
REINVESTMENT
AAPL
APPLE INC
12.64
194.36
-4067.57
04/01/2024
21/08/2024
REINVESTMENT
SCHD
VANGUARD INDEX FDS
92.75
67.46
2920.89
2024-01-24
10/10/2024
REINVESTMENT
SCHD
SCHWAB US DIVIDEND EQUITY ETF
6.74
304.29
-482.45
2024-07-16
12/01/2024
DIVIDEND RECEIVED
AAPL
VANGUARD INDEX FDS
27.36
307.33
8797.53
2024-01-02
2024-05-24
DIVIDEND RECEIVED
VTI
VANGUARD INDEX FDS
55.69
191.62
-3044.76
15/06/2024",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d3e11ae1fd5c3b32863abe60,v11-BROKERAGE_STATEMENT-columns,original,2024,fgen-85035dd89762ddcbda8b51af,synthetic_programmatic_template,columns,top,False,raw_export
"Quarterly Account Statement
Summit Investments
Account
Statement period
Beginning account value
Ending account value
Joint WROS ending in 6455
12/01/2021 - 12/30/2021
$267,246.06
$249,504.76
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
695.90  150.84
77.33  290.24
6,600.92
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHB
288.790
225.51
65,124.24
1,854.06
SCHD
368.888
457.03
168,594.26
1,405.77
AAPL
67.499
183.84
12,409.26
-1,673.22
VTI
398.944
384.96
153,578.00
7,042.78
Your 2021 Form 1099 will be available online by January 31, 2022.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-004e6425a9f247903621500d,v11-BROKERAGE_STATEMENT-columns,original,2021,fgen-16f375e2c8b177b90bc31775,synthetic_programmatic_template,columns,top,False,quarterly
"Evergreen Brokerage Services
Account
Statement period
Individual - TOD ***-**-5919
09/01/2024 - 09/28/2024
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
153.871
84.50
13,001.85
569.89
QQQ
260.956
204.70
53,417.60
2,817.42
VTI
42.255
290.83
12,289.13
4,377.93
AAPL
206.160
26.10
5,381.27
5,905.09
This statement is not a Form 1099. Keep it for your records.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6e86041dafd494fcd6781dc7,v11-BROKERAGE_STATEMENT-columns,original,2024,fgen-b487f26b1cbd20c49c4fafd0,synthetic_programmatic_template,columns,none,False,holdings_export
"Positions
Ironwood Wealth Partners
Account
Statement period
Individual - TOD XXXXX6650
12/01/2024 - 12/31/2024
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
QQQ
219.260
372.07
81,580.07
4,692.27
SCHD
176.213
382.87
67,467.61
764.67
AAPL
288.548
78.43
22,632.16
3,382.32
VTI
224.043
372.08
83,362.31
2,287.55",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ff1b799a7695e3f819a2b324,v11-BROKERAGE_STATEMENT-columns,original,2024,fgen-465bb3e7676204ca82d895a7,synthetic_programmatic_template,columns,top,False,holdings_export
"Brokerage Account ...7435 -Actívity
5ymbol
Description
Quantity
Pricc
Market Value
Cost Basis
Gain/Loss
SCHD
VANGUARD TOTAL STOCK MKT ETF
85.6l
396.89
37349.87
40178.27
7953.97
QQQ
VANGUARD TOTAL STOCK MKT ETF
8.93
374.08
65292.21
12782.92
-1588.41
MSFT
APPLE INC
293.09
365.63
89624.34
74689.18
1152.74
BND
APPLE INC
395.66
404.64
54545.92
13365.24
-6267.72
SPAXX**
APPLE INC
269.43
378.92
66338.33
20742.3l
6951.67
QQQ
APPLE INC
21.93
303.09
56287.66
70228.77
8929.98",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4880071fe1e9342293a8645d,v11-BROKERAGE_STATEMENT-columns,original,2021,fgen-e30dc46183efff9696763c2d,synthetic_programmatic_template,columns,top,True,raw_export
"Quarterly Account Statement
Summit Investments
Account
Statement period
Beginning account value
Ending account value
Individual - TOD ending in 2224
02/01/2021 - 02/28/2021
$33,457.79
$33,908.14
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
428.57  3,203.87
21.91  67.48
4,290.40
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
148.675
176.50
26,240.93
242.35
AAPL
232.781
61.55
14,327.70
8,013.39
QQQ
157.543
413.06
65,074.90
6,298.21
VOO
319.957
381.05
121,921.25
4,295.79
Tax reminder: amounts on this statement may differ from your Form 1099.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7c6efeb0a50d12e93c880e75,v11-BROKERAGE_STATEMENT-columns,original,2021,fgen-2752622bd9620e9d75598555,synthetic_programmatic_template,columns,top,False,quarterly
"Investment Report
Ironwood Wealth Partners
Account
Statement period
Beginning account value
Ending account value
Individual - TOD ****4208
10/01/2025 - 10/28/2025
$432,384.72
$396,678.19
Income summary  This period  Year to date
Dividends
Interest
Realized gain/loss
535.52  2,383.55
35.15  289.92
2,933.46
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
152.881
152.90
23,376.22
2,202.13
VTI
268.278
63.39
17,004.93
5,882.22
AAPL
328.505
243.17
79,882.75
-1,619.49
SCHB
164.018
130.18
21,352.40
2,165.50
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1d0996c996be110988a8ec07,v11-BROKERAGE_STATEMENT-columns,original,2025,fgen-804d720f2b906b6ffc3cef96,synthetic_programmatic_template,columns,top,False,monthly
"Positions
Evergreen Brokerage Services
Account
Statement period
Joint WROS XXXXX2429
05/01/2026 - 05/28/2026
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
136.522
475.36
64,897.41
6,716.18
QQQ
149.118
204.16
30,443.55
7,623.38
BND
386.595
254.99
98,576.06
5,034.25
VOO
195.633
358.67
70,167.07
-1,426.93
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7907bd7a156f7d19135644e3,v11-BROKERAGE_STATEMENT-columns,original,2026,fgen-44ab74ae1fc14acf51edf18f,synthetic_programmatic_template,columns,top,False,holdings_export
"Northstar Securities
Account
Statement period
Beginning account value
Ending account value
Joint WR0S ****0700
07/01/2024 - 07/30/2024
$730,672.32
$765,883.73
Income summary  This period  Year to date
Dividends
Interest
Rea1ized gain/1oss
33.71  829.64
79.40 485.70
4,934.84
Symbol
Quantity
Last Price
Current Value
Total Gain/Loss
SCHD
15O.791
271.60
40,954.37
3,718.56
SCHB
309.277
447.12
138,284.72
-1,026.87
QQQ
132.641
120.79
16,021.26
3,572.67
VTI
197.391
28.57
5,640.21
6,507.95
Tax reminder: amounts on this statement may differ from your Form 1099.
5ecurities offered through a member of FINRA/5IPC. Not FDIC insured.
Invcstment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7073f8e09ae6eb9bedcb5d78,v11-BROKERAGE_STATEMENT-columns,original,2024,fgen-ca8ec79029f8c80138dd6925,synthetic_programmatic_template,columns,bottom,True,monthly
"Evergreen Brokerage Services
Account
Statement period
Individual Brokerage Account ****6705
08/01/2025 -08/30/2025
Symbo1
Quantity
Last Price
Current Value
Total Gain/Loss
MSFT
207.219
442.88
91,772.15
7,134.54
IVV
213.429
165.63
35,349.57
8,857.6O
VTI
300.124
375.60
112,726.30
408.22
VOO
317.596
231.62
73,560.03
8,677.59
Your 2025 Form 1099 will be available online by January 31, 2O26.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-9e95a7708e200ba869df4a5a,v11-BROKERAGE_STATEMENT-columns,original,2025,fgen-b0960f7b6650c75341206834,synthetic_programmatic_template,columns,none,True,holdings_export
"Brokerage Account ...4805 - Activity
Trade Date
Transaction Type
Investment Name
Shares
Share Price
Net Amount
05/14/2023
Buy
500 Index Admiral
93.0l
78.02
-5665.48
01/23/2023
Buy
Tota1Stock Market Index Admiral
1.86
257.59
-7988.07
01/10/2023
Sell
Total Stock Market Index Admiral
7l.58
333.92
7851.44
09/24/2023
Capital gain (LT)
Total Bond Markct ETF
3.85
420.75
-7867.20
2023-08-02
Dividend
500 Indcx Admira1
58.62
109.68
1834.52
2023-04-11
Dividend
Total Bond Market ETF
57.18
448.66
8773.91
22/03/2023
Capital gain (LT)
Total Stock Market Index Admiral
92.88
338.69
-3491.84
10/16/2023
Buy
Total Bond Market ETF
85.9l
82.83
-2798.22",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-15e67d89d69d57c1f45f79b8,v11-BROKERAGE_STATEMENT-columns,original,2023,fgen-4d23e406e3944fcc9622562c,synthetic_programmatic_template,columns,top,True,raw_export
"Brokerage Account ...9850- Activity
Downloaded 2023-11-24
Symbol
Description
Quantity
Price
Market Value
Cost Basis
Gain/Loss
QQQ
VANGUARD TOTAL STOCK MKT ETF
l95.19
133.51
71393.38
249O8.07
7425.72
SPAXX**
MONEY MARKET
166.98
359.39
15378.60
56691.13
-5203.l2
QQQ
MONEY MARKET
159.11
141.49
36147.28
7633.87
2758.34
QQQ
ISHARES CORE 5&P 500
8.34
362.01
70116.17
678.33
-1239.20
MSFT
APPLE INC
285.09
305.24
88118.96
43426.02
7488.60",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-96ae82aeb93df6c714a64b8e,v11-BROKERAGE_STATEMENT-columns,original,2023,fgen-371e1ae78dd1fc8b3c553db9,synthetic_programmatic_template,columns,top,True,raw_export
"Positions
Ironwood Wealth Partners
Account,Individual Brokerage Account ending in 5387
Statement period,12/01/2026 - 12/31/2026
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
SCHD,225.073,268.84,""60,508.53"",""3,145.19""
QQQ,84.883,444.66,""37,743.72"",""6,137.81""
VTI,105.330,432.92,""45,599.38"",""8,366.50""
MSFT,146.106,55.17,""8,060.74"",-39.24",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f4671ff1272b4f45fc81c550,v11-BROKERAGE_STATEMENT-csv,original,2026,fgen-00129f8df36b30a0b5dcdc72,synthetic_programmatic_template,csv,top,False,holdings_export
"Positions
Evergreen Brokerage Services
Account,Individua1 Brokerage Account XXX-XX-9357
Statement period,11/01/2021 - 11/30/2021
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
SCHB,348.676,33.4l,""11,65O.79"",""8,441.35""
QQQ,60.995,100.38,""6,122.34"",765.64
AAPL,287.726,102.95,""29,620.90"",-371.93
SCHD,216.465,288.30,""62,407.09"",""1,927.35""
Securities offered through amember of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cfd1b8fd1a9012fc3c8e34ac,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-00bf7f49042e4d33c9bc0c9b,synthetic_programmatic_template,csv,top,True,holdings_export
"Account Number,Account Name,Symbol,Description,Quantity,Last Price,Current Value,Total Gain/Loss Dollar,Percent Of Account
Z82034639,Individual,NVDA,VANGUARD S&P 500 ETF,89.21,93.32,61552.36,6519.73,4.30%
Z57586015,Individual,NVDA,NVIDIA CORP,169.16,832.19,59685.29,6149.20,55.66%
Z84361781,Individual,AMZN,NVIDIA CORP,75.39,138.26,77355.23,8288.82,21.38%
Z39478903,Individual,VOO,NVIDIA CORP,57.29,571.51,50015.31,2888.43,39.95%
Z88204423,Individual,VOO,FIDELITY 500 INDEX,206.75,82.59,54261.70,1569.57,42.42%
Z25778251,Individual,AMZN,VANGUARD S&P 500 ETF,378.06,760.78,23619.51,5041.55,26.00%
Z37973988,Individual,VOO,NVIDIA CORP,239.20,472.78,69927.35,1103.44,40.08%
Z10591382,Individual,FXAIX,FIDELITY 500 INDEX,338.62,690.94,49245.56,4959.84,9.67%",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d9b5d90fc39633ba55ecd26b,v11-BROKERAGE_STATEMENT-csv,original,2025,fgen-41915c0110fd7e3fd0d673a8,synthetic_programmatic_template,csv,top,False,raw_export
"Clearwater Investing
Account,Joint WROS XXX-XX-746O
Statement períod,09/01/2025 - 09/31/2025
Beginning account value,""$713,902.33""
Ending account value,""$683,483.50""
Income summary  This period  Year to date
Dividends,""896.54  5,719.44""
Interest,17.29  383.80
Realized gain/loss,""4,595.54""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
IVV,307.859,359.51,""110,677.08"",-128.20
BND,258.573,221.74,""57,336.93"",-250.59
5CHD,23.088,487.70,""11,259.72"",956.77
MSFT,122.954,32.38,""3,980.65"",""6,574.77""
Securíties offered through a member of FINRA/SIPC. Not FDIC insured.
InvestmentReport",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e43bc89e3039a4abe73e30ff,v11-BROKERAGE_STATEMENT-csv,original,2025,fgen-4ecabeb754b17b65ff2fe4f8,synthetic_programmatic_template,csv,bottom,True,monthly
"Ironwood Wealth Partners
Account,Joint WROS XXXXX4992
Statement period,04/01/2021 - 04/28/2021
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
QQQ,2.171,241.86,524.96,""-1,275.l0""
VTI,145.048,80.67,""11,701.58"",""7,757.06""
MSFT,343.700,201.20,""69,152.58"",""-1,525.42""
V0O,255.120,58.88,""15,022.50"",""2,706.42""
Thís statement is not a Form 1099. Keep itfor your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-053029fa994a5946c55309cb,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-8905ce11210a475deff8ec6a,synthetic_programmatic_template,csv,none,True,holdings_export
"Summit Investments
Account,Individual Brokerage Account XXX-XX-9970
Statement period,02/01/2021 - 02/28/2021
Beginning account value,""S40,458.09""
Ending account value,""$44,441.13""
Income summary  This period  Year to date
Dividends,480.71  166.44
Interest,5.77  77.03
Rea1ized gain/loss,""4,330.49""
5ymbol,Quantity,Last Price,Current Value,Total Gain/Loss
QQQ,53.839,321.84,""17,327.71"",""1,352.44""
BND,392.351,437.49,""171,649.32"",""2,932.O6""
IVV,2.206,232.44,512.66,-83.52
AAPL,374.130,411.90,""154,105.40"",122.01
Securíties offered through amember of FINRA/SIPC. Not FDIC insured.
Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-eb7d7494408661ad26d7d877,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-6b078c37093b1b9a4334ada2,synthetic_programmatic_template,csv,bottom,True,monthly
"Investment Report
Ironwood Wealth Partners
Account,Individual - TOD ****6507
Statement period,01/01/2021 - 01/30/2021
Beginning account value,""$227,932.88""
Ending account value,""$250,017.92""
Income summary  This period  Year to date
Dividends,""651.57  1,607.96""
Interest,64.90  360.07
Realized gain/loss,""5,339.12""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
MSFT,184.507,198.25,""36,578.10"",295.74
SCHB,178.069,443.44,""78,962.65"",""1,248.64""
QQQ,150.713,65.28,""9,838.62"",""-1,186.39""
BND,304.636,454.37,""138,417.61"",""1,406.61""",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f7d6518dd3c0608599f792c9,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-51e8822bc9fd7c4e8f4a458f,synthetic_programmatic_template,csv,top,False,monthly
"Investment Report
Northstar Securities
Account,Individual - TOD ****9705
Statement period,03/01/2024 - 03/30/2024
Beginning account value,""$197,730.25""
Ending account value,""$190,133.92""
Income summary  This period  Year to date
Dividends,""799.55  3,891.49""
Interest,14.22  48.02
Realized gain/loss,""1,994.25""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
VOO,126.917,359.30,""45,600.97"",""2,299.10""
MSFT,350.799,434.97,""152,585.93"",""3,008.33""
SCHD,183.102,147.75,""27,052.72"",""5,150.48""
IVV,185.367,384.87,""71,341.84"",""8,293.90""
This statement is not a Form 1099. Keep it for your records.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-54e2056b70b4bdffdc6b49dc,v11-BROKERAGE_STATEMENT-csv,original,2024,fgen-b03680bb17fa8f0eb9efa2cc,synthetic_programmatic_template,csv,top,False,monthly
"Investment Report
Ironwood Wealth Partners
Account,Individual - TOD ***-**-3759
5tatement period,01/01/2023 - 01/31/2023
Beginning account value,""$602,430.36""
Ending account value,""$665,910.95""
Income summary This period  Year to datc
Dividends,""89.99  6,426.59""
Interest,76.40  170.51
Realized gain/loss,""-1,865.14""
Symbol,Quantity,Last Price,Current Valuc,Total Gain/Loss
MSFT,14.616,391.92,""5,728.19"",""7,811.71""
BND,333.315,226.36,""75,449.48"",947.13
5CHB,19.5O4,197.28,""3,847.80"",""-1,720.62""
VOO,17.955,191.80,""3,443.80"",""-1,146.11""
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0469a9dc654791e5cd3b2b1b,v11-BROKERAGE_STATEMENT-csv,original,2023,fgen-8746d0e33c798c28803edd37,synthetic_programmatic_template,csv,top,True,monthly
"Downloaded 2025-05-09
Symbol,Description,Quantity,Price,Market Value,Cost Basis,Gain/Loss
VTI,VANGUARD TOTAL STOCK MKT ETF,309.92,271.67,13231.05,52148.06,126.15
SCHD,MONEY MARKET,391.28,159.78,89552.02,37656.20,7693.00
MSFT,APPLE INC,216.43,132.28,78066.68,46764.13,-5493.18
SCHD,ISHARES CORE S&P 500,168.54,210.98,5585.46,33589.21,-7410.91
AAPL,ISHARES CORE S&P 500,86.79,79.69,78190.15,63472.17,7112.11
SCHD,VANGUARD TOTAL STOCK MKT ETF,353.32,469.44,65466.23,43827.72,6718.68
SPAXX**,APPLE INC,172.57,309.92,13809.65,65231.01,4119.12
SPAXX**,MONEY MARKET,285.69,251.73,59527.54,58276.40,-4297.38
SCHD,MONEY MARKET,282.91,90.66,3806.37,24669.26,7429.53",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d39cbd8c74990e2e5e2823e6,v11-BROKERAGE_STATEMENT-csv,original,2025,fgen-6b6dd339958a98d9c6c903e2,synthetic_programmatic_template,csv,bottom,False,raw_export
"Evergreen Brokerage Services
Account,Individual Brokerage Account ***-**-0751
Statement period,08/01/2022 - 08/28/2022
Beginning account value,""$130,975.31""
Ending account value,""$124,681.48""
Income summary  This period  Year to date
Dividends,""246.48  5,484.86""
Interest,60.44  218.74
Realized gain/loss,""7,773.63""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
QQQ,258.931,127.47,""33,006.58"",""2,894.00""
VTI,238.068,249.18,""59,321.80"",21.29
SCHD,143.107,350.24,""50,122.41"",""6,981.53""
BND,326.065,411.36,""134,128.32"",""6,462.08""
Quarterly Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b4aab98abace3b4b89fb2f15,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-fe1f727e255ee1db7d9256b5,synthetic_programmatic_template,csv,bottom,False,quarterly
"Ironwood Wealth Partners
Account,Individual Brokerage Account XXX-XX-2543
Statement period,05/01/2025 - 05/31/2025
Beginning account value,""$563,221.98""
Ending account value,""$541,5O4.82""
Income summary  This period  Year to date
Dividends,""379.81  6,000.80""
Intcrest,33.81  382.41
Realized gain/loss,""3,521.20""
Symbol,Quantity,Last Price,Current Value,TotalGain/Loss
M5FT,349.849,34.O5,""11,911.81"",-89.79
SCHB,392.O10,73.31,""28,738.38"",""3,976.18""
AAPL,255.955,181.66,""46,497.39"",""1,344.52""
QQQ,335.353,132.31,""44,369.37"",374.93",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-134f6848374f130cfe688d0d,v11-BROKERAGE_STATEMENT-csv,original,2025,fgen-d82aa3420d918c856e51ae53,synthetic_programmatic_template,csv,none,True,quarterly
"Clearwater Investing
Account,Joint WROS ****2694
Statement period,10/01/2024 - 10/31/2024
Beginning account value,""$37,932.90""
Ending account value,""$37,227.11""
Income summary  This period  Year to date
Dividends,""604.87  6,561.76""
Interest,88.75  477.94
Realized gain/loss,""8,521.66""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
MSFT,315.464,452.65,""142,794.72"",""2,947.62""
QQQ,385.113,424.85,""163,613.94"",-376.31
VOO,68.270,147.08,""10,041.31"",""-1,582.45""
VTI,385.733,171.89,""66,302.06"",""4,429.13""
IRS Form 1099 information for 2024 will be mailed separately.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-9e196ec943698261c63e87ba,v11-BROKERAGE_STATEMENT-csv,original,2024,fgen-768632a62b3089f88bdffba4,synthetic_programmatic_template,csv,bottom,False,monthly
"Positions
Evergreen Brokerage Services
Account,Joint WROS XXX-XX-5864
Statement period,O2/Ol/2021 - 02/28/2021
5ymbol,Quantity,Last Price,Current Value,Total Gain/Loss
SCHB,335.921,101.08,""33,955.25"",""2,005.35""
AAPL,279.488,394.23,""110,182.90"",""2,641.33""
IVV,167.048,489.97,""81,847.65"",-418.32
VTI,342.354,483.56,""165,547.76"",""5,610.18""
Tax reminder:amounts on this statement may differ from your Form l099.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ae227259ac7e7715f44d88c5,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-c629d826206201523c677a64,synthetic_programmatic_template,csv,top,True,holdings_export
"NorthstarSecurities
Account,Joint WROS ending in 0433
Statement period,02/01/2022 - 02/28/2022
5ymbol,Quantity,Last Price,Current Va1ue,Total Gain/Loss
BND,183.173,250.50,""45,885.24"",""8,387.35""
MSFT,44.564,88.72,""3,953.72"",""4,945.63""
AAPL,142.729,337.8O,""48,213.67"",-604.33
SCHB,62.244,186.61,""11,615.64"",-264.71
Positions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a5cef994bf7b0d9c16ff68ee,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-dd2a9fd2ba69966bd02d4c01,synthetic_programmatic_template,csv,bottom,True,holdings_export
"Downloaded 21/06/2021
Symbol,Description,Quantity,Price,Market Value,Cost Basis,Gain/Loss
SCHD,APPLE INC,236.82,166.88,81472.06,66473.33,5742.35
MSFT,ISHARES CORE S&P 500,65.72,159.58,11454.19,79792.17,860.90
AAPL,MONEY MARKET,51.59,383.37,17068.91,17762.62,-4271.20",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4a6a2de79dadc13b562e8305,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-1f6cfb90fc53dc4bd685401b,synthetic_programmatic_template,csv,top,False,raw_export
"Positions
Summit Investments
Account,Joint WROS ***-**-8978
Statement period,05/01/2026 - 05/30/2026
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
BND,361.798,459.92,""166,399.73"",""4,278.60""
SCHB,53.805,443.41,""23,857.71"",""3,476.91""
QQQ,100.341,451.51,""45,305.25"",""8,212.41""
MSFT,70.332,58.45,""4,111.06"",""-1,084.29""
Tax rcminder: amounts on this statement may differ fromyour Form 1099.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ce60f6423a9281b93585f3be,v11-BROKERAGE_STATEMENT-csv,original,2026,fgen-17b204188fb8a2bd0e98a665,synthetic_programmatic_template,csv,top,True,holdings_export
"Ironwood Wealth Partners
Account,Joint WROS ending in 3046
Statement period,09/01/2025 - 09/28/2025
Beginning account value,""$173,288.84""
Ending account value,""$164,590.17""
Income summary  This period  Year to date
Dividends,647.99  637.10
Interest,54.51  488.83
Realized gain/loss,""-1,550.51""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
SCHD,297.906,203.29,""60,562.61"",""3,025.79""
VOO,190.006,286.02,""54,345.06"",-873.21
SCHB,386.002,336.93,""130,056.96"",""8,338.17""
MSFT,242.075,86.12,""20,847.93"",""4,100.77""",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2f35e3aaf2a944dfada8110d,v11-BROKERAGE_STATEMENT-csv,original,2025,fgen-c3b55f3ee2f21330478c8fea,synthetic_programmatic_template,csv,none,False,quarterly
"Ironwood Wealth Partners
Account,Individual Brokerage Account XXXXX5393
Statement period,11/01/2023 - 11/30/2023
Beginning account value,""$490,493.25""
Ending account value,""$524,473.53""
Income summary  This period  Year to date
Dividends,""810.01  7,304.84""
Interest,41.72  189.73
Realized gain/loss,""5,114.10""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
VTI,380.156,81.22,""30,877.57"",254.36
AAPL,141.340,422.11,""59,660.54"",""2,384.87""
QQQ,158.737,73.35,""11,643.00"",""-1,382.03""
MSFT,384.553,150.50,""57,873.60"",""7,820.08""
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-efa2811009472469fc6a7dc2,v11-BROKERAGE_STATEMENT-csv,original,2023,fgen-a4e1ceddd566fe0f98b88669,synthetic_programmatic_template,csv,none,False,monthly
"Investment Report
Summit Investments
Account,Joint WROS XXXXX1703
Statement period,04/01/2022 - 04/31/2022
Beginning account value,""$429,927.60""
Ending account value,""$432,894.47""
Income summary  This period  Year to date
Dividends,""383.36  2,119.55""
Interest,39.03  292.24
Realized gain/loss,""1,183.19""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
VTI,227.987,204.33,""46,583.97"",111.94
BND,153.819,414.81,""63,806.44"",-598.61
QQQ,345.224,350.19,""120,893.20"",""-1,121.96""
IVV,93.839,203.21,""19,069.12"",""5,370.97""
IRS Form 1099 information for 2022 will be mailed separately.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-af07b4b49d7ecbccc6952e97,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-4c002620b212be7d1b16c4e7,synthetic_programmatic_template,csv,top,False,monthly
"Investment Report
Evergreen Brokerage Services
Account,Joint WROS ***-**-3163
Statement period,07/01/2023 - 07/31/2023
Beginning account value,""$790,814.60""
Ending account value,""$791,608.07""
Income summary  This period  Year to date
Dividends,""222.84  6,068.41""
Interest,18.75  504.19
Realized gain/loss,""2,121.74""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
MSFT,185.337,493.44,""91,452.27"",117.12
VOO,132.553,486.50,""64,486.83"",""8,960.53""
QQQ,33.499,354.47,""11,874.37"",""3,622.42""
BND,73.486,60.81,""4,468.67"",""1,588.39""
This statement is not a Form 1099. Keep it for your records.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b1e4816a6786f241e47dd155,v11-BROKERAGE_STATEMENT-csv,original,2023,fgen-6047517c8e386489451230c2,synthetic_programmatic_template,csv,top,False,monthly
"Clearwater Investing
Account,Individual Brokerage Account ending in 9657
Statement period,10/01/2022 - 10/28/2022
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
SCHB,81.105,96.46,""7,823.63"",""3,785.00""
VOO,90.167,195.37,""17,615.96"",""5,155.89""
SCHD,196.717,83.71,""16,467.06"",""6,620.60""
BND,31.845,44.84,""1,428.01"",""8,615.04""
Your 2022 Form 1099 will be available online by January 31, 2023.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a6028e268b059681fd8e0128,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-93f9f8d07fcce3327ea24c14,synthetic_programmatic_template,csv,none,False,holdings_export
"Ironwood Wealth Partners
Account,Joint WROS ending in 2350
Statement period,02/01/2022 - 02/28/2022
Beginning account value,""$484,029.90""
Ending account value,""$494,630.15""
Income summary  This period  Year to date
Dividends,""821.68  3,258.71""
Interest,64.56  271.80
Realized gain/loss,""8,566.97""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
SCHB,86.705,340.41,""29,514.88"",""3,665.71""
VOO,269.442,74.10,""19,964.47"",""7,448.01""
SCHD,213.671,37.93,""8,104.64"",""-1,460.78""
VTI,262.356,26.87,""7,050.42"",""5,357.50""
This statement is not a Form 1099. Keep it for your records.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Quarterly Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7f89fce0065b5e8f049eb6ef,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-6280bf6498b8558072013947,synthetic_programmatic_template,csv,bottom,False,quarterly
"Clearwater Investing
Account,Individual Brokerage Account ***-**-2589
Statement period,08/01/2022 - 08/28/2022
Beginningaccount value,""S344,368.89""
Ending account value,""$324,919.38""
Income summary  This period  Year to date
Dividends,""618.23  7,685.47""
Interest,35.10  226.31
Realized gain/loss,""-1,898.91""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
AAPL,139.254,372.88,""51,925.26"",""4,845.65""
VOO,363.648,29l.15,""105,876.97"",""4,566.21""
MSFT,217.470,487.02,""105,911.82"",""6,545.75""
SCHB,156.001,25.52,""3,981.10"",""4,154.78""
Sccuríties offered through a member of FINRA/SIPC. Not FDIC insurcd.
Quarterly Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-dd0a046f9e1201a625efc6b4,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-416218a22f2ffc99d05edabc,synthetic_programmatic_template,csv,bottom,True,quarterly
"Symbol,Description,Quantity,Price,Market Value,Cost Basis,Gain/Loss
SCHD,APPLE INC,264.75,326.50,2833.76,37303.70,6845.63
SPAXX**,ISHARES CORE S&P 500,1.78,323.25,10935.05,71250.74,-6430.19
SPAXX**,APPLE INC,82.01,104.81,37918.26,54629.43,-3648.46
SCHD,VANGUARD TOTAL STOCK MKT ETF,103.09,253.62,75490.46,25407.55,7199.62
QQQ,MONEY MARKET,251.08,483.88,40566.73,45704.70,6021.99
AAPL,VANGUARD TOTAL STOCK MKT ETF,309.86,115.81,54604.52,38520.31,8677.26
BND,MONEY MARKET,70.95,366.18,86773.39,27145.95,4723.00
SCHD,APPLE INC,351.83,223.39,68144.76,14715.96,915.00",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0ab7273176c87563c7f84b23,v11-BROKERAGE_STATEMENT-csv,original,2023,fgen-acc2a516f16ad20a88cc7eb9,synthetic_programmatic_template,csv,top,False,raw_export
"Evergreen Brokerage Services
Account,Individual Brokerage Account XXXXX2617
Statement period,03/01/2024 - 03/28/2024
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
AAPL,59.746,188.25,""11,246.95"",""2,407.24""
SCHB,56.140,248.49,""13,950.11"",""7,434.72""
QQQ,213.050,467.37,""99,573.88"",""2,991.94""
IVV,324.644,339.46,""110,202.50"",880.56
This statement is not a Form 1099. Keep it for your records.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Positions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-9a5c1a0788319c93fb089df3,v11-BROKERAGE_STATEMENT-csv,original,2024,fgen-7f45cd82e9d9f285171f8b3d,synthetic_programmatic_template,csv,bottom,False,holdings_export
"Clearwater Investing
Account,Individual Brokerage Account ending in 5952
Statement period,06/01/2021 - 06/31/2021
Beginning account value,""$340,627.76""
Ending account value,""$375,653.77""
Income summary  This period  Year to date
Dividends,""371.81  3,541.83""
Interest,74.98  77.17
Realized gain/loss,""1,410.31""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
MSFT,332.304,412.62,""137,114.57"",""1,924.30""
BND,357.228,236.94,""84,640.38"",""3,440.08""
VTI,188.458,334.94,""63,121.96"",670.94
QQQ,296.085,127.34,""37,704.00"",578.77
Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-65d8318baf6579ce94f06579,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-1faf04bbe2eb310685d6ccfc,synthetic_programmatic_template,csv,bottom,False,monthly
"Investment Report
Northstar Securities
Account,Individual - TOD ending in 1819
Statement period,04/01/2022 - 04/30/2022
Beginning account value,""$152,142.14""
Ending account value,""$148,172.81""
Income summary  This period  Year to date
Dividends,197.30  427.01
Interest,68.48  64.73
Realized gain/loss,""7,057.61""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
QQQ,321.107,89.39,""28,703.62"",""-1,089.62""
VTI,358.027,129.19,""46,254.88"",""5,876.70""
MSFT,175.916,331.41,""58,300.35"",""3,667.93""
AAPL,90.874,337.09,""30,633.03"",-35.46
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ecf9512d79e52dfc0dc608d6,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-fc0ec4222d072f46b0cfb7f3,synthetic_programmatic_template,csv,top,False,monthly
"Investment Report
Ironwood Wealth Partners
Account,Joint WROS ****3980
Statement period,12/01/2022 - 12/28/2022
Beginning account value,""$122,673.03""
Ending account value,""$121,064.53""
Income summary  This period  Year to date
Dividends,745.12  858.25
Interest,53.24  551.37
Realized gain/loss,""8,693.34""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
VTI,23.940,214.56,""5,136.73"",170.69
SCHD,155.883,74.65,""11,636.72"",""8,045.31""
MSFT,306.961,352.84,""108,309.54"",""5,130.26""
QQQ,123.086,108.12,""13,308.08"",""5,114.03""
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b3950c7ccdf31865f81cb070,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-06c1b68fc311766153c2a983,synthetic_programmatic_template,csv,top,False,monthly
"Positions as of22/05/2022
Downloaded 10/22/2022
Run Date,Action,Symbol,Security Description,Quantity,Price,Amount,Settlement Date
2O22-10-28,REINVESTMENT,SCHD,SCHWAB US DIVIDEND EQUITY ETF,35.33,496.07,1351.81,17/03/2022
2022-03-23,DIVIDEND RECEIVED,AAPL,APPLE INC,57.54,430.89,-6604.93,07/08/2022
10/12/2022,REINVESTMENT,AAPL,SCHWAB US DIVIDEND EQUITY ETF,52.34,29.66,3752.22,O7/13/2022
25/05/2022,DIVIDEND RECEIVED,VTI,5CHWAB US DIVIDEND EQUITY ETF,50.36,266.74,612.46,2022-02-21
05/04/2022,Y0U BOUGHT,VTI,APPLE INC,84.00,304.07,-3268.53,28/05/2022
28/06/2022,YOU SOLD,AAPL,APPLE INC,6.31,418.94,-2326.47,01/01/2022",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4ea4938b2b50485a4bbb0e25,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-af217a8a215d9fc3e2e51a2b,synthetic_programmatic_template,csv,top,True,raw_export
"Clearwater Investing
Account,Individual Brokerage Account XXX-XX-4108
Statement period,01/01/2021 - 01/30/2021
Beginning account value,""$787,898.60""
Ending account value,""$748,321.52""
Income summary  This period  Year to date
Dividends,""123.60  6,468.88""
Interest,10.55  150.93
Realized gain/loss,-29.91
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
BND,332.178,477.64,""158,661.19"",""1,255.31""
VTI,151.561,109.04,""16,525.99"",""2,114.26""
SCHD,249.324,198.25,""49,428.12"",""-1,768.73""
AAPL,192.033,94.53,""18,152.18"",""2,229.66""
Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d0868179c003bce90643530d,v11-BROKERAGE_STATEMENT-csv,original,2021,fgen-ec9f58b2c65170c1e1d9f6b9,synthetic_programmatic_template,csv,bottom,False,monthly
"Evergreen Brokerage Services
Account,Joint WROS ****4905
Statement period,11/01/2022 - 11/28/2022
Beginning account value,""$419,084.47""
Ending account value,""$381,080.02""
Income summary  This period  Year to date
Dividends,""849.41  7,959.45""
Interest,36.74  420.44
Realized gain/loss,""8,477.14""
Symbol,Quantity,Last Price,Current Value,Total Gain/Loss
VTI,58.618,377.49,""22,127.95"",-971.42
SCHB,349.092,419.59,""146,474.01"",""5,642.27""
IVV,304.480,267.69,""81,504.93"",928.51
SCHD,356.525,321.95,""114,781.60"",""6,454.48""
This statement is not a Form 1099. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ce86cf93489f0dd17a5bc16a,v11-BROKERAGE_STATEMENT-csv,original,2022,fgen-919b1582338e2a68e465fb5a,synthetic_programmatic_template,csv,none,False,quarterly
"Downloaded 20/09/2021 Symbol Description Quantity Price Market Value Cost Basis Gain/Loss SCHD ISHARES CORE S&P 500 284.43 414.28
69510.07 48544.19 6878.48 VTI MONEY MARKET 57.67 282.16 45068.78 23161.46 -2126.52 SPAXX** MONEY MARKET 329.23 317.20 38527.93 63949.85 4574.40 SCHD ISHARES CORE
S&P 500 398.06 457.33 76336.74 64927.36 -4980.49 AAPL VANGUARD TOTAL STOCK MKT ETF 280.00 294.18 79186.03 76603.60 4557.02 VTI ISHARES CORE S&P 500 197.71 377.37 1378.39 43661.93 8877.19 BND APPLE INC 48.94 310.21 59915.39 50609.40 -6051.78",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6ccd39c991238bfe95697acf,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-05678b6acacff6025cbebdf9,synthetic_programmatic_template,flat,top,False,raw_export
"Quarterly Account Statement Northstar Securities Account Individual - TOD ***-**-5905 Statement period 05/01/2026 - 05/31/2026 Beginning account value $253,192.39 Ending account value $256,277.74 Income summary This period Year to date Dividends 473.11 3,401.54 Interest 40.35 42.69 Realized gain/loss 8,131.28 Symbol Quantity
Last Price Current Value Total Gain/Loss IVV 236.635 432.92 102,444.14 2,682.46 VOO 81.201 279.74 22,715.21 2,008.39 BND 268.844 175.67 47,227.21 6,802.40 VTI 54.488 57.00
3,106.04 3,212.70",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-700630644ad2785811bd2ab4,v11-BROKERAGE_STATEMENT-flat,original,2026,fgen-b9b8d1ce3344ebbc62c78043,synthetic_programmatic_template,flat,top,False,quarterly
"Account Number Account Name Symbol Description Quantity Last Price Current Value Total Gain/Loss Dollar Percent Of Account Z96347530 Individual AMZN FIDELITY 500 INDEX 153.44 260.18 31360.73 7385.80 13.31%
Z51985101 Individual NVDA VANGUARD S&P 500 ETF 144.31 849.96 86337.05 8097.69 23.17% Z92724750 Individual AMZN NVIDIA CORP 200.28
823.52 70459.73 3113.02 56.16% Z73197047 Individual AMZN FIDELITY 500 INDEX 260.21 700.00 77703.34 6406.26 7.75% Z20133766 Individual AMZN VANGUARD S&P 500 ETF 33.65 26.26 47269.52 -3618.30 12.35% Positions as of 2022-09-25",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0c5adf097a44cc2a43c277bc,v11-BROKERAGE_STATEMENT-flat,original,2022,fgen-788adafdb4e26811d5cf45f5,synthetic_programmatic_template,flat,bottom,False,raw_export
"Evergreen Brokerage Services Account Individual - TOD XXX-XX-2842 Statement period 02/01/2026 - 02/28/2026 Beginning account value $488,278.15 Ending account value $524,603.07 Income summary This period Year
to date
Dividends 148.39 6,576.36 Interest 2.65 464.80 Realized gain/loss 1,049.51 Symbol Quantity Last Price Current Value Total Gain/Loss BND 225.564 204.93 46,225.21 346.61 VOO 155.674 295.22 45,958.21 -1,531.06 MSFT 398.555 189.54 75,540.79 4,727.97 IVV 261.846 386.56 101,218.92 -121.24 Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e2b78f67946993100597ff69,v11-BROKERAGE_STATEMENT-flat,original,2026,fgen-66c2743decb858761615486d,synthetic_programmatic_template,flat,bottom,False,monthly
"Quarterly Account Statement Summit Investments Account Individual - TOD ***-**-2582 Statement period 10/01/2025 - 10/28/2025 Beginning account value $184,743.39 Ending account value $198,507.55 Income summary This period Year to date Dividends 577.82 5,125.75 Interest 75.07 356.45 Realized gain/loss 8,647.23 Symbol Quantity Last Price Current
Value Total Gain/Loss SCHD 22.181 255.30 5,662.90 7,005.06 QQQ 304.501 353.86
107,751.92 7,147.68 VTI 86.370 266.98 23,058.85 7,604.00 VOO 162.126 427.11 69,245.23 3,478.27 Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c79cc27f1474024d058c25f1,v11-BROKERAGE_STATEMENT-flat,original,2025,fgen-202aea8383f3305ef2b0f1da,synthetic_programmatic_template,flat,top,False,quarterly
"Positions Summit Investments Account
Individual - TOD ending in 6588 Statement period 11/01/2022 - 11/28/2022 Symbol Quantity Last Price Current Value Total
Gain/Loss QQQ 82.741 271.48 22,462.52 8,916.23 VTI 67.924 321.38 21,829.26 11.92 IVV 170.366 340.76 58,053.59 1,909.02 SCHD 76.146 475.15 36,180.54 246.13 Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5d96fcd27e071f32b3fa716f,v11-BROKERAGE_STATEMENT-flat,original,2022,fgen-2ab412b66da0da3e0f41670b,synthetic_programmatic_template,flat,top,False,holdings_export
"Quarterly Account Statement Ironwood Wealth Partners Account Individual -
TOD
ending in 3076 Statement period 02/01/2021 - 02/28/2021 Beginning account value $667,284.13 Ending account value $652,722.81 Income summary This period Year to date Dividends 610.17 4,513.12 Interest 49.31 110.95 Realized gain/loss -2,299.20 Symbol Quantity Last Price Current Value Total Gain/Loss IVV 4.544 418.17 1,899.96 8,362.79 MSFT 168.060 372.14 62,541.55 1,950.70 VTI 12.349 448.93 5,543.69 4,896.50 AAPL 117.182 163.30 19,136.01 4,180.60 This statement is not a Form 1099. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6bf8858336fa39d51a10dbc8,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-74c67ecbf4f7759790e5928c,synthetic_programmatic_template,flat,top,False,quarterly
"Downloaded 10/15/2025 Symbol Description Quantity Price Market Value
Cost Basis Gain/Loss AAPL APPLE INC 87.60 126.55 13827.7O 2149.16 -8913.60 BND MONEY MARKET 135.74 157.96 81782.14 28740.98 681.47 AAPL ISHARES CORE S&P 500 l52.61 130.9416610.59 53261.91 7095.35 BND APPLE INC 197.19 99.50 15370.07 74733.52 6086.93 VTI VANGUARD TOTAL STOCK MKT ETF 252.2l 342.84 44128.10 34123.73 3925.42 VTIAPPLE INC 305.02 499.87 70182.21 8368.54 5753.92 SCHDISHARES CORE S&P 500 103.97 496.77 70049.27 78747.13 2640.84 BND ISHARES CORE S&P 500 182.71 3.72 37681.82 29275.90
-6001.17 BND ISHARES CORE S&P 500 133.10 482.61 44978.15 46601.44 -6248.05",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-872860cfbb2144db8cb33059,v11-BROKERAGE_STATEMENT-flat,original,2025,fgen-307ff6770fb44c69270632a9,synthetic_programmatic_template,flat,top,True,raw_export
"Ironwood Wealth Partners Account Individual - TOD ****9167 Statement period 11/01/2022 - 11/30/2022 Symbol Quantity Last Price Current Value Total Gain/Loss VTI 124.273 88.14 10,953.73 -1,030.64 AAPL 264.014 404.57 106,812.77 6,899.55 VOO 293.691 496.04 145,682.50
5,101.79 QQQ 206.497 413.80 85,448.71 4,565.98 This statement is not a Form 1099. Keep it for your records. Securities offered through a member of FINRA/SIPC. Not FDIC
insured. Positions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3b1b04f7fff27a55507f0511,v11-BROKERAGE_STATEMENT-flat,original,2022,fgen-404f750470e4391c09a2777f,synthetic_programmatic_template,flat,bottom,False,holdings_export
"Portfolio Positions Run Date Action Symbol Security Description Quantity Price Amount Settlement Date 2024-05-20 REINVESTMENT
VTI APPLE INC 53.24 188.90 7258.89 10/11/2024 03/09/2024 DIVIDEND RECEIVED AAPL VANGUARD INDEX FDS 28.85 193.13 3830.62 17/01/2024 06/05/2024 REINVESTMENT AAPL VANGUARD INDEX FDS 89.06 239.18 -3750.40 2024-04-20 2024-11-21 REINVESTMENT SCHD APPLE INC 78.28 367.69 6415.49 01/12/2024 03/17/2024 DIVIDEND RECEIVED VTI VANGUARD INDEX FDS 38.14 447.45 6629.29 2024-01-17 10/23/2024 YOU SOLD AAPL SCHWAB US DIVIDEND EQUITY ETF 16.78 207.85 -2613.42 18/09/2024 07/03/2024 DIVIDEND RECEIVED AAPL VANGUARD INDEX FDS 58.78 347.26 4089.51
24/01/2024 2024-05-08 DIVIDEND RECEIVED VTI APPLE INC 8.13 180.98 1833.41 24/09/2024 2024-06-21 DIVIDEND RECEIVED VTI APPLE INC 6.51 13.50 -4689.57 2024-02-23",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3a91d57eb351d3a9081a3ada,v11-BROKERAGE_STATEMENT-flat,original,2024,fgen-d54923a6526e998a556f9348,synthetic_programmatic_template,flat,top,False,raw_export
"Quarterly AccountStatement Northstar Securities Account Individual - TOD ending in 2022
Statement period 04/01/2026 - 04/30/2026 Beginning account va1ue $60,428.55 Ending account value$67,645.34 Income summary This period Year to date Dividends171.77 3,797.22 Interest 46.09 559.22 Realized gain/loss 4,796.66 Symbol
Quantity Last Price Current Value Total Gain/Loss BND 257.823 277.13 71,449.70 4,820.73 QQQ 390.302 4l0.65 160,279.16 1,836.70 IVV 396.976 229.96 91,289.68 5,665.94 SCHB 70.894 147.34 10,445.54 587.11 IRS Form 1099 ínformatíon for 2026 wíll bc mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-62edd9df1001c49d8aec8035,v11-BROKERAGE_STATEMENT-flat,original,2026,fgen-1e255e30bd9febb33de8afac,synthetic_programmatic_template,flat,top,True,quarterly
"Symbol Description Quantity Price Market Value Cost Basis
Gain/Loss VTI MONEY MARKET 373.84 185.27 15899.36 47530.14 -53l7.52 AAPL VANGUARD TOTAL STOCK MKT ETF 1O4.12 312.35 82027.04 44088.15 1192.91SCHD VANGUARD TOTAL STOCK MKT ETF 316.10 33.27 84141.65 38135.16
8660.07",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c5865a986c35f159ff2cffe4,v11-BROKERAGE_STATEMENT-flat,original,2026,fgen-c37155d5c4a15e72960e7ea4,synthetic_programmatic_template,flat,none,True,raw_export
"Clearwater Investing Account Individual Brokerage Account ***-**-3253 Statement period 08/01/2021 - 08/28/2021 Beginning account
value $580,624.33 Ending account value $541,576.90 Income summary This period Year to date Dividends 814.90 4,680.11 Interest 36.55 18.30 Realized gain/loss -2,449.78 Symbol Quantity Last Price Current Value Total Gain/Loss BND 231.234 229.14 52,986.04
3,279.26 SCHB 124.073 274.43 34,049.52 948.57 MSFT 261.926 288.17 75,480.01 5,798.01 VTI 72.024 35.57 2,561.62 -898.75 This statement is not a Form 1099. Keep it for your records. Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3cb573c5638be0556f15aa8a,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-1580fdcf20226276528f2757,synthetic_programmatic_template,flat,none,False,monthly
"Positions Evergreen Brokerage Services Account Individual Brokerage Account ending
in 5874 Statement period 08/01/2022 - 08/28/2022 Symbol Quantity Last Price Current Value Total Gain/Loss VTI 54.895 29.71 1,630.83 5,433.35 QQQ
333.910 268.69 89,718.83 4,800.05 IVV 264.802 195.60 51,796.23 4,925.36 SCHB 204.804 486.67 99,672.87 -221.53 Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f89a382ef76788e0875554de,v11-BROKERAGE_STATEMENT-flat,original,2022,fgen-8602ce86c67cfc6584d314d0,synthetic_programmatic_template,flat,top,False,holdings_export
"Evergreen Brokerage Services Account Individual Brokerage Account XXX-XX-6422 Statement period 12/01/2024 - 12/28/2024 Beginning account value $556,533.33 Ending account value $575,643.39 Income
summary This period Year to date Dividends 566.70
3,440.65 Interest 74.53 490.50 Realized gain/loss 869.09 Symbol Quantity Last Price Current Value Total Gain/Loss SCHD 145.745 106.23 15,482.56 7,360.88 MSFT 208.321 175.35 36,529.75 7,311.79 IVV 376.642 414.94 156,285.64 4,289.03 AAPL 46.655 111.30 5,192.49 1,364.13 IRS Form 1099 information for 2024 will be mailed separately. Quarterly Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2e10d6e1470160be899eb5a3,v11-BROKERAGE_STATEMENT-flat,original,2024,fgen-ad1f47b57c621308e050be59,synthetic_programmatic_template,flat,bottom,False,quarterly
"Investment Report Northstar Securities Account Individual - TOD ****1943 Statement period 03/01/2021 - 03/30/2021 Beginning account value $413,693.52 Ending account value $377,312.20 Income summary This period Year to date Dividends 453.30 5,603.45 Interest 64.00 306.55 Realized gain/loss -1,234.43
Symbol Quantity Last Price Current Value Total Gain/Loss BND 227.198 481.20 109,327.21 5,627.98
QQQ 359.249 426.40 153,185.04 6,201.19 VTI 177.153 205.19 36,349.95 1,002.15 MSFT 172.642 97.85 16,892.63 4,941.60 Tax reminder: amounts on this statement may differ from your Form 1099. Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8b02b60edef03f01f9b2c18e,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-a40f99b8923066b653c3469b,synthetic_programmatic_template,flat,top,False,monthly
"Trade Date Transaction Type Investment Name Shares Share Price
Net Amount 2026-02-21 Reinvestment 500 Index Admiral 18.78 223.11 -5949.26 2026-01-10 Capital gain (LT) Total Stock Market Index Admiral 36.62 450.44 -2584.21 2026-07-10 Reinvestment Total Stock Market Index Admiral 99.23 74.91 596.22 23/09/2026
Capital gain (LT) 500 Index Admiral 15.53 475.93 3059.49 20/08/2026 Reinvestment Total Bond Market ETF 87.20 264.19 -3321.81 08/15/2026 Dividend 500 Index Admiral 75.51 25.37 8648.96 06/12/2026 Reinvestment Total Bond Market ETF 57.78 427.21 3911.48 2026-12-05 Buy Total Stock Market Index Admiral 66.91 309.00 -7630.50 15/04/2026 Sell 500 Index Admiral 38.24 229.73 3108.40",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d5c6f14bcf57dbe5fa71f335,v11-BROKERAGE_STATEMENT-flat,original,2026,fgen-b79111ff815345d3de2cefa8,synthetic_programmatic_template,flat,top,False,raw_export
"Evergreen Brokerage Services Account Joint WROS ***-**-4159 Statement period 11/01/2021 - 11/31/2021 Beginning account
value $898,985.13 Ending account value $904,507.04 Income summary This period Year to date
Dividends 749.69 2,169.12 Interest 65.13 568.98 Realized gain/loss -1,779.03 Symbol Quantity Last Price Current Value Total Gain/Loss IVV 186.113 31.64 5,888.33 8,970.61 BND 76.968 453.36 34,894.35 1,966.23 SCHB 205.257 247.76 50,854.99 6,136.71 VOO 2.150 34.79 74.78 2,888.76 IRS Form 1099 information for 2021 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b588791f0d0053a28c5fe195,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-d8a494bc09f37ffd9a23245f,synthetic_programmatic_template,flat,none,False,quarterly
"Account Number Account Name Symbol Description Quantity Last Price Current
Value Total Gain/Loss Dollar Percent Of Account Z67883090 Individual AMZN VANGUARD S&P 500 ETF 143.79 147.00 74907.76 -457.12 19.56% Z53186942 Individual VOO NVIDIA CORP 71.26 773.48 51954.78
5775.47 7.20% Z49200936 Individual AMZN NVIDIA CORP 93.94 894.94 10363.57 3244.91 8.47% Z38365287 Individual NVDA NVIDIA CORP 52.79 582.17 31149.46 -6859.18 20.22% Z88043547 Individual AMZN VANGUARD S&P 500 ETF 244.93 21.80 88712.46 -3303.41 18.76% Z10682772 Individual VOO NVIDIA CORP 146.00 840.02 6518.88 -1655.09 35.35% Z69371270 Individual AMZN NVIDIA CORP 392.51 483.58 57899.89 8664.36 4.80%",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-544a243b1520cff987d108c7,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-038a2917c719485e3065cede,synthetic_programmatic_template,flat,top,False,raw_export
"Positions Evergreen Brokerage Services Account Individual Brokerage Account ending in 6737 Statement period 01/01/2024 -
01/30/2024 Symbol Quantity Last Price Current Value Total Gain/Loss VTI 238.915 491.64 117,460.08 7,437.38 SCHB 170.624 314.00 53,575.09 2,317.83 VOO 33.702 236.28 7,963.08 8,841.97 BND 61.304 236.08 14,472.88 -1,739.96 IRS Form
1099 information for 2024 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d458d2c3527a300958b9c1b5,v11-BROKERAGE_STATEMENT-flat,original,2024,fgen-4f878907038e9464b888b3ac,synthetic_programmatic_template,flat,top,False,holdings_export
"Northstar Securities Account Individual
- TOD ****1O32 Statcment period 03/01/2025 - 03/30/2025 Bcginning account value $793,419.19 Ending account value $884,139.82 Incomesummary This period Year to date Dividends 387.54 1,365.13 Interest85.00 564.31 Realized gain/loss 2,602.91 Symbol Quantity Last Price Current Value Total Gain/Loss AAPL 284.009 148.67 42,224.49 8,380.17 VOO 24.844 112.55 2,796.19 1,392.68 5CHB 29.255 381.51 11,160.93 -1,579.20 VTI 143.030 180.11 25,761.33 2,223.46 This statcment is not
a Form 1099. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e596095bfab79c4309889eb6,v11-BROKERAGE_STATEMENT-flat,original,2025,fgen-216b3afb0c1eac91be7b0808,synthetic_programmatic_template,flat,none,True,quarterly
"Quarterly Account Statement Ironwood Wealth Partners Account Joint
WROS ending in 6957 Statement period 04/01/2026 - 04/31/2026 Beginning account value $239,921.93 Ending account value $256,046.94 Income summary This period
Year to date Dividends 54.89 2,152.83 Interest 34.96 375.59 Realized gain/loss 2,794.52 Symbol Quantity Last Price Current Value Total Gain/Loss MSFT 15.459 293.51 4,537.47 6,463.73 SCHB 338.279 41.89 14,168.87 3,065.99 AAPL 104.594 50.34 5,265.56 8,740.15 IVV 20.076 373.62 7,500.75 6,535.38",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f42cac2b7b64db088d6ce8f6,v11-BROKERAGE_STATEMENT-flat,original,2026,fgen-75c7fed632d38aef9d0c1487,synthetic_programmatic_template,flat,top,False,quarterly
"Investment Report Summit Investments Account Individual Brokerage Account ***-**-1879 5tatement period 09/01/2026 - 09/31/2026 Beginning account value S556,168.80 Ending account value $517,354.15 Income summary This períod Year to date Dividcnds 526.54 6,767.81 Interest 12.04 457.36 Rea1ized gain/loss 6,896.67 Symbol Quantity Last Price CurrentValue Total Gain/Loss MSFT 385.473 495.55 l91,019.67 1,004.62 VOO 217.874 31.576,878.50 -766.39 IVV l57.731 186.10 29,353.54 6,145.88 QQQ 54.959 450.80 24,775.29
3,755.61 Your 2026 Form 1099 wíll be available online by January31,
2027.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a2a4f9194f4552dee5a5cd6e,v11-BROKERAGE_STATEMENT-flat,original,2026,fgen-2a6286d78e6f0e4d5af48b66,synthetic_programmatic_template,flat,top,True,monthly
"Clearwater Investing Account Individual - TOD ***-**-6181 Statement period 04/01/2023 - 04/28/2023 Beginning account value $376,738.71 Ending account value $368,565.63 Income summary This period Year to date Dividends 352.26 2,565.79 Interest 25.14 379.14 Realized gain/loss 3,345.16
Symbol Quantity Last Price Current Value Total Gain/Loss SCHD 269.455
200.02 53,895.44 1,672.08 VTI 146.650 245.42 35,990.63 2,943.23 MSFT 290.156 294.01 85,308.30 837.92 BND 222.377 472.84 105,148.59 5,673.77 Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0c266e8e6c7b401e5b4e14b1,v11-BROKERAGE_STATEMENT-flat,original,2023,fgen-56797dca0e86fff9cf20845a,synthetic_programmatic_template,flat,bottom,False,monthly
"Positions Clearwater Investing Account Individual Brokerage Account ****7745 Statement period 04/01/2024 - 04/28/2024 Symbol Quantity Last Price Current Value Total Gain/Loss BND 255.935 259.74 66,477.15 3,878.53 MSFT 1.325 298.43 395.45 2,964.19 AAPL 110.488 320.76 35,439.69 -332.22
SCHB 8.288 408.02 3,381.81 1,580.34 IRS Form 1099
information for 2024 will be mailed separately. Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-068c9f5d0a6274c6324f41f3,v11-BROKERAGE_STATEMENT-flat,original,2024,fgen-f0415371a640bdb56e54a7c3,synthetic_programmatic_template,flat,top,False,holdings_export
"Positions Evergreen Brokerage Services Account Individual - TOD XXXXX3868 5tatement period 12/O1/2024 - 12/31/2024 Symbo1
Quantity
Last Price Current Value Tota1 Gain/Loss QQQ 375.293 40.77 15,302.46 2,018.48 AAPL 94.182 135.09 12,723.32 -1,901.85 SCHB 128.683 69.61 8,958.19 6,665.52 V0O377.579 339.47 128,177.70 8,175.93 IRS Form 1099 information for 2024 wi1l bemailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-090360acb688cc3bb0cdb866,v11-BROKERAGE_STATEMENT-flat,original,2024,fgen-61fb931f6e48a7fd0198496c,synthetic_programmatic_template,flat,top,True,holdings_export
"Portfolio Positions Symbol Description Quantity Price
Market Value Cost Basis Gain/Loss SCHD VANGUARD TOTAL STOCK MKT ETF 11.91 9.64 81099.59 52365.67 4613.99 BND ISHARES CORE S&P 500 204.31 468.83 52617.69 9075.89 461.96 MSFT APPLE INC 225.68 152.38 30978.94 53664.15 4217.41 SCHD APPLE INC 121.70 291.19 43760.50 18052.06 3914.86 MSFT APPLE INC 158.32 300.00 40251.82 62296.00 6798.53 MSFT VANGUARD TOTAL STOCK MKT ETF 75.81 172.23 71062.63 68521.00 -2644.23 SCHD MONEY MARKET 275.86 22.20 85861.76
43315.87 -1897.51",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-04cf53e34eaf0ac2c8203e68,v11-BROKERAGE_STATEMENT-flat,original,2022,fgen-e4fa64a766b7efccaba1d316,synthetic_programmatic_template,flat,top,False,raw_export
"Quarterly
Account Statement Evergreen Brokerage Services Account Individual Brokerage Account XXXXX1692 Statement period 09/01/2021 - 09/30/2021 Beginning account value $790,806.42 Ending account value $827,468.69 Income summary This period Year to date Dividends 696.75 2,050.70 Interest 26.98 225.41 Realized gain/loss 5,336.04 Symbol Quantity Last Price Current Value Total Gain/Loss QQQ 182.063 225.15 40,991.75 8,965.78 BND 233.690 233.50 54,565.76 -204.59 MSFT 264.222 178.06 47,047.41 995.95
VOO 84.074 397.75 33,440.63 6,765.84 This statement is not a Form 1099. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d9c6f911e0dd8b48980a4da6,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-b54237dbbbfd72657495f6a3,synthetic_programmatic_template,flat,top,False,quarterly
"Northstar Securities Account Individual - TOD XXXXX4675 Statement period 03/01/2025 - 03/30/2025 Beginning account value $135,062.34 Ending account value $123,491.34 Income summary This period Year to date Dividends 12.36 6,029.13 Interest 65.52 40.81 Realized gain/loss 3,433.89 Symbol Quantity Last Price Current Value Total Gain/Loss MSFT 396.731 359.89 142,777.78 3,958.79 BND 36.059 316.28 11,404.74 5,693.52 SCHD 385.945 337.39 130,214.36 7,190.22 VTI 71.530 413.18 29,554.62 7,757.37
Quarterly
Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8a4fd391a444334407b61027,v11-BROKERAGE_STATEMENT-flat,original,2025,fgen-05407365218733fc1c00021c,synthetic_programmatic_template,flat,bottom,False,quarterly
"Clearwater
Investing Account Individual
- TOD ***-**-8297 Statement period 09/01/2023 - 09/28/2023 Beginning account value S292,8O6.22 Ending account value $301,654.62 Income summary This period Year to date Dividends705.63 6,638.25 Interest 69.77 159.64 Realized gaín/loss 395.37Symbol Quantity Last Price Current Value Total Gain/Loss MSFT 88.959 372.29 33,118.27 4,339.40 SCHD 336.728 489.86 164,948.18 513.08 IVV 132.588 103.36 13,703.93 -14.45 AAPL 110.724 161.12 17,839.71 8,494.96 Quartcr1y Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cecb9ceff08af255ca12ea85,v11-BROKERAGE_STATEMENT-flat,original,2023,fgen-751b90fb11d35457e4b451ab,synthetic_programmatic_template,flat,bottom,True,quarterly
"Positions as of 2O21-05-2l Downloaded 2021-06-28 Symbol Description Quantity Price Market Value CostBasis Gain/Loss MSFT MONEY MARKET 232.54 270.l0 88393.21 69303.65 -5896.88 VTI APPLE INC 134.04 312.07 72410.79 79100.83 2346.94 BND APPLE INC 94.05
389.57 55613.31 68171.10 8360.15 MSFT MONEYMARKET 150.46 279.67 44698.78 42691.57
-8415.7O QQQ ISHARES CORE S&P 500 268.98 259.88 15162.89 21726.40 1178.07 SCHD ISHARES CORE S&P 500 92.38 469.14 15684.16 51878.24 1482.01 SCHD APPLE INC 229.92 262.89 43523.67 51437.70 4699.16",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-dc48a8abe3938e7a8f3443e1,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-fc2797b7929c50fdd2f4e39b,synthetic_programmatic_template,flat,top,True,raw_export
"Investment Report Northstar Securities Account Individual - TOD XXXXX5917 Statement period 09/01/2021 - 09/28/2021 Beginning account value $255,450.14 Ending account value $238,210.82 Income summary This period Year to date Dividends 494.27
5,260.29 Interest 62.59 149.51 Realized gain/loss 4,318.83 Symbol Quantity Last Price
Current Value Total Gain/Loss VOO 173.713 383.37 66,595.85 6,284.41 BND 262.421 397.56 104,327.00 1,700.87 IVV 351.043 351.85 123,515.70 5,689.11 AAPL 311.330 85.75 26,695.84 -1,669.50 Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d9fe1b62ba1a0c73c8257673,v11-BROKERAGE_STATEMENT-flat,original,2021,fgen-3d8798b3fed6ec68ccf689e5,synthetic_programmatic_template,flat,top,False,monthly
"Quarterly Account Statement
## Evergreen Brokerage Services
| Field | Value |
| --- | --- |
| Account | Joint WROS XXX-XX-7035 |
| Statement period | 01/01/2025 - 01/30/2025 |
| Beginning account value | $810,224.10 |
| Ending account value | $811,750.86 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 470.49  1,686.71 |
| Interest | 19.36  539.04 |
| Realized gain/loss | -712.32 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| BND | 173.439 | 110.20 | 19,113.22 | -343.51 |
| MSFT | 187.080 | 86.31 | 16,146.10 | 8,349.43 |
| SCHB | 316.698 | 193.81 | 61,378.16 | 4,009.39 |
| SCHD | 17.147 | 81.40 | 1,395.84 | -238.07 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-92c903a6153e9064fb140a4a,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-a468fcdfabe1eaf2e2ee91ad,synthetic_programmatic_template,markdown,top,False,quarterly
"Evergreen Brokerage Services
| Field | Value |
| --- | --- |
| Account | Individual - TOD ****9542 |
| Statement period | 06/01/2025 - 06/30/2025 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| VOO | 79.995 | 477.95 | 38,233.62 | 2,705.72 |
| SCHD | 209.611 | 316.61 | 66,364.21 | 3,027.71 |
| QQQ | 43.455 | 206.11 | 8,956.37 | 8,111.47 |
| BND | 320.800 | 78.24 | 25,098.09 | 8,949.02 |
IRS Form 1099 information for 2025 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bacb14e86275798149eee9df,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-89785dfc74ef24dac8bc89b8,synthetic_programmatic_template,markdown,none,False,holdings_export
"Positions
## Summit Investments
| Field | Value |
| --- | --- |
| Account | Joint WROS ****0479 |
| Statement period | 02/O1/2021 - 02/28/2021 |
| Symbo1 | Quantity |Last Price | Current Va1ue | Total Gain/Loss|
| --- | --- | --- | --- | --- |
| IVV| 122.634 | 57.95 | 7,106.56 | 1,831.46 |
| VOO | 81.853 | 186.16 | 15,237.85 | 5,541.99 |
| MSFT | 236.270 | 213.92 | 50,543.31 | 6,907.93 |
| BND | 345.862 | 42.64 | 14,747.03 | 6,866.52 |
Tax remínder: amounts on thís statement may differ from your Form lO99.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d7bb79674ecbd3f3a2aefc10,v11-BROKERAGE_STATEMENT-markdown,original,2021,fgen-f05f51be058e91a739140513,synthetic_programmatic_template,markdown,top,True,holdings_export
"## Clearwater Investing
| Field | Value |
| --- | --- |
| Account | Individual Brokerage Account ****6315 |
| Statement period | 02/01/2021 - 02/28/2021 |
| Beginning account value | $347,496.80 |
| Ending account value | $327,752.07 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 215.58  6,168.72 |
| Interest | 20.24  245.75 |
| Realized gain/loss | 6,779.35 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| AAPL | 167.699 | 209.48 | 35,128.80 | 5,186.92 |
| VOO | 94.357 | 327.69 | 30,919.41 | 8,653.34 |
| BND | 146.534 | 145.20 | 21,277.29 | -1,407.87 |
| IVV | 35.300 | 125.40 | 4,426.80 | 1,259.92 |
## Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-9c6f3c170cd6656ff3e7d51e,v11-BROKERAGE_STATEMENT-markdown,original,2021,fgen-1df8dde8cb1c5a0a7bc803cd,synthetic_programmatic_template,markdown,none,False,monthly
"Evergreen Brokerage Services
| Field | Value |
| --- | --- |
| Account | Individual - TOD ending in 2073 |
| Statement period | 08/01/2025 - 08/28/2025 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| BND | 37.587 | 246.51 | 9,265.56 | 6,404.36 |
| SCHB | 244.548 | 382.00 | 93,416.98 | 2,055.87 |
| QQQ | 123.307 | 371.74 | 45,838.16 | 2,477.05 |
| SCHD | 147.995 | 292.30 | 43,258.79 | 5,558.33 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d9373acdbdd6c6d2dbd5980b,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-caeda042c16398863e1ae975,synthetic_programmatic_template,markdown,none,False,holdings_export
"## Investment Report
Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account | Joint WROS ending in 4105 |
| Statement period | 06/01/2023 - 06/30/2023 |
| Beginning account value | $125,245.11 |
| Ending account value | $139,975.34 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 177.64  5,663.02 |
| Interest | 66.57  305.42 |
| Realized gain/loss | -1,621.07 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| QQQ | 214.709 | 117.05 | 25,131.92 | 2,492.43 |
| MSFT | 173.818 | 481.60 | 83,709.98 | 498.97 |
| AAPL | 292.724 | 133.14 | 38,974.02 | 1,705.62 |
| VOO | 163.448 | 415.23 | 67,868.67 | 6,350.56 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0e180d4e260731048f44d6da,v11-BROKERAGE_STATEMENT-markdown,original,2023,fgen-1249b88edcc589aab5dd88f5,synthetic_programmatic_template,markdown,top,False,monthly
"Investment Report
Northstar Securities
| Field | Value |
| --- | --- |
| Account | Joint WROS XXXXX1110 |
| Statement period | 11/01/2026 - 11/28/2026 |
| Beginning account value | $548,673.64 |
| Ending account value | $518,639.26 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 486.37  4,795.92 |
| Interest | 69.05  189.50 |
| Realized gain/loss | -1,042.00 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| QQQ | 286.250 | 184.66 | 52,858.53 | 6,502.38 |
| BND | 186.178 | 384.59 | 71,602.07 | 6,240.10 |
| AAPL | 239.870 | 119.94 | 28,771.07 | 7,993.62 |
| VTI | 248.442 | 356.52 | 88,574.08 | 2,140.57 |
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e66dd39f40f3ae4f1e980690,v11-BROKERAGE_STATEMENT-markdown,original,2026,fgen-adcb2f60084ff96d34056ef0,synthetic_programmatic_template,markdown,top,False,monthly
"Positions
## Clearwater Investing
| Field | Value |
| --- | --- |
| Account | Joint WROS ending in 1761 |
| Statement period | 07/01/2024 - 07/28/2024 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| VTI | 342.235 | 254.18 | 86,990.01 | 6,590.69 |
| SCHB | 315.219 | 110.17 | 34,727.47 | 542.83 |
| QQQ | 114.273 | 147.98 | 16,910.51 | 528.83 |
| MSFT | 188.274 | 72.68 | 13,683.83 | 2,073.80 |
Your 2024 Form 1099 will be available online by January 31, 2025.
## Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-49fd801d4b5ce245c713ecc2,v11-BROKERAGE_STATEMENT-markdown,original,2024,fgen-c7bfacb3ebebef75e0691b66,synthetic_programmatic_template,markdown,top,False,holdings_export
"## Quarterly Account Statement
## Clearwater Investing
| Field | Value |
| --- | --- |
| Account | Joint WROS ending in 9124 |
| Statement period | 01/01/2024 - 01/30/2024 |
| Beginning account value | $422,571.66 |
| Ending account value | $469,415.08 |
## Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 137.52  527.98 |
| Interest | 19.15  478.90 |
| Realized gain/loss | 8,280.12 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| VTI | 275.073 | 158.82 | 43,687.63 | 1,584.76 |
| SCHB | 186.294 | 167.05 | 31,119.66 | 7,701.55 |
| MSFT | 317.990 | 420.67 | 133,768.16 | 3,167.69 |
| AAPL | 384.072 | 167.66 | 64,393.04 | 3,526.56 |
IRS Form 1099 information for 2024 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-76e8c503daa786382b83a00a,v11-BROKERAGE_STATEMENT-markdown,original,2024,fgen-80809fe02f0eb2912d66bf69,synthetic_programmatic_template,markdown,top,False,quarterly
"Downloaded 26/04/2024
| Trade Date | Transaction Type | Investment Name | Shares | Share Price | Net Amount |
| --- | --- | --- | --- | --- | --- |
| 20/04/2024 | Reinvestment | 500 Index Admiral | 35.66 | 186.39 | 6342.11 |
| 06/09/2024 | Sell | Total Stock Market Index Admiral | 3.61 | 362.55 | 2648.10 |
| 2024-09-11 | Buy | 500 Index Admiral | 61.32 | 335.52 | 5329.29 |
| 02/02/2024 | Reinvestment | Total Bond Market ETF | 95.90 | 60.97 | -7487.82 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b6a3d62531c75a8e8d6796d0,v11-BROKERAGE_STATEMENT-markdown,original,2024,fgen-8d8ebedb3376b69d9fd4d7c6,synthetic_programmatic_template,markdown,top,False,raw_export
"Northstar Securities
| Field | Value |
| --- | --- |
| Account | Individual - TOD ****0794 |
| Statement period | 02/01/2026 - 02/28/2026 |
| Beginning account value | $495,950.92 |
| Ending account value | $448,465.86 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 52.32  2,266.07 |
| Interest | 63.74  452.97 |
| Realized gain/loss | -91.93 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| MSFT | 206.516 | 284.91 | 58,838.26 | 1,943.74 |
| IVV | 190.814 | 272.49 | 51,994.37 | 2,022.15 |
| SCHB | 157.497 | 325.01 | 51,187.86 | 8,888.98 |
| SCHD | 223.572 | 124.02 | 27,726.99 | 7,174.23 |
IRS Form 1099 information for 2026 will be mailed separately.
## Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Quarterly Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6424da8e5e42b90ed3bbeea2,v11-BROKERAGE_STATEMENT-markdown,original,2026,fgen-bf4c98f18a5368ed22f5f171,synthetic_programmatic_template,markdown,bottom,False,quarterly
"Brokerage Account ...839l - Activity
| Trade Date | Transaction Type | Investment Name | Shares | Share Price | Net Amount |
| --- | --- | --- |--- | --- | --- |
| 17/10/2024 | 5cll | Total Stock Market Index Admiral| 23.34 | 256.71 | 14.65 |
| 2024-06-09 | Capital gain (LT) | Total Bond Market ETF |64.93 | 400.23 | -7500.42 |
| 10/05/2024 | Sell | Total Stock Market Index Admíral | 67.28 | 226.16 | 15l2.07 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-26aee6ffa1e1b269652c8a3b,v11-BROKERAGE_STATEMENT-markdown,original,2024,fgen-39181750710a702aacfa0597,synthetic_programmatic_template,markdown,top,True,raw_export
"Summit Investments
| Field | Value |
| --- | --- |
| Account | Individual - TOD XXXXX5972 |
| Statement period | 10/01/2025 - 10/28/2025 |
| Symbol | Quantíty | Last Pricc | Current Value | Total Gain/Loss |
| --- | --- | ---| --- | --- |
| BND | 68.770 | 491.23 | 33,782.29 | 879.67 |
| SCHB | 104.124 | 135.78 | 14,137.65 | 8,556.01 |
| V0O | 154.606 | 384.40 | 59,429.71| 8,164.96 |
| QQQ |305.341 | 194.94 | 59,524.17 | -744.92 |
Sccurities offered through a member of FINRA/SIPC. Not FDIC ínsured.
Positions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-aa6afce4ceb392ccd64d30ed,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-e11ff1b632b8ef2db4ac4f33,synthetic_programmatic_template,markdown,bottom,True,holdings_export
"| Symbol | Description | Quantity | Pricc | Market Value | Cost Basis | Gain/Loss |
|--- | --- | --- | --- | --- | --- | --- |
| BND | VANGUARD TOTAL STOCK MKT ETF | 101.82 | 180.76 | 54535.36 | 57806.70 | 2581.02 |
| AAPL | APPLE INC |179.14 | 273.23 | 49513.51 | 66655.50 | -6803.44 |
| QQQ| MONEY MARKET | 395.41 | 285.93 | 71430.32 | 69641.64 | 6355.41 |
| M5FT | ISHARES CORE S&P 500 | 248.24 | 313.61 | 3O838.14 | 58378.98 | 177.17 |
| MSFT | ISHARES C0RE S&P 5O0| 105.42 | 68.62 | 87175.O1 | 27023.42 | 8102.18 |
| MSFT | APPLE INC |362.57 | 67.77 | 26785.37 | 45883.32 | -5758.01 |
| QQQ | ISHARES C0RE S&P 500 | 26.48 | 234.23 | 65498.29 | 57982.92 | -4586.38 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-320b0454571558ccb8cf9ae7,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-bbb0c22c466370122543c93b,synthetic_programmatic_template,markdown,none,True,raw_export
"## Downloaded 2026-08-08
| Trade Date | Transaction Type | Investment Name | Shares | Share Price | Net Amount |
| --- | --- | --- | --- | --- | --- |
| 2026-01-07 | Buy | Total Stock Market Index Admiral | 23.30 | 418.51 | -6618.85 |
| 04/28/2026 | Capital gain (LT) | Total Stock Market Index Admiral | 70.95 | 271.97 | -1352.34 |
| 02/01/2026 | Capital gain (LT) | 500 Index Admiral | 28.67 | 135.20 | 6269.05 |
| 17/02/2026 | Dividend | Total Stock Market Index Admiral | 25.66 | 81.23 | 3179.02 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f9f3d81de0e9ca67bc8d4262,v11-BROKERAGE_STATEMENT-markdown,original,2026,fgen-477896dc1c4a126a7b6ab6b3,synthetic_programmatic_template,markdown,bottom,False,raw_export
"Northstar 5ecuritics
| Field | Value |
| ---| --- |
| Account| Joint WROS XXXXX2242 |
| Statement period | O7/01/2021 - 07/30/2021|
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| BND | 65.550 | 405.36 | 26,571.00 | -1,876.48 |
| MSFT | 302.149 | 416.85 | 125,951.84 | 403.15 |
| AAPL | 186.312 | 71.82 | 13,381.55 | 3,288.73 |
| V0O | 61.78O | 480.13 | 29,662.51 | 2,366.25 |
Positions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2b9ec6c4afc1770d5c43e531,v11-BROKERAGE_STATEMENT-markdown,original,2021,fgen-4ae6600454ab3461e44e2950,synthetic_programmatic_template,markdown,bottom,True,holdings_export
"Investment Report
Northstar Securities
| Field | Value |
| --- | --- |
| Account | Individual - TOD ***-**-1467 |
| Statement period | 12/01/2022 - 12/28/2022 |
| Beginning account value | $29,307.98 |
| Ending account value | $27,293.37 |
## Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 354.74  1,733.29 |
| Interest | 73.71  306.03 |
| Realized gain/loss | -179.13 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| IVV | 39.371 | 358.42 | 14,111.26 | -619.67 |
| VTI | 66.592 | 263.26 | 17,531.33 | 3,839.72 |
| VOO | 64.746 | 412.89 | 26,733.32 | 4,659.61 |
| SCHD | 319.796 | 138.63 | 44,333.84 | 8,873.53 |
This statement is not a Form 1099. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1ceec7975e3e6087c3dc7bc7,v11-BROKERAGE_STATEMENT-markdown,original,2022,fgen-80eccf5c3ee5cf5e22851173,synthetic_programmatic_template,markdown,top,False,monthly
"Portfolio Positions
| Run Date | Action | Symbol | Security Description | Quantity | Price | Amount | Settlement Date |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 01/07/2024 | REINVESTMENT | SCHD | VANGUARD INDEX FDS | 30.16 | 51.19 | 2427.88 | 27/11/2024 |
| 2024-12-02 | REINVESTMENT | SCHD | VANGUARD INDEX FDS | 32.32 | 368.74 | -1455.29 | 05/19/2024 |
| 01/12/2024 | YOU SOLD | SCHD | VANGUARD INDEX FDS | 12.36 | 359.20 | -7697.44 | 2024-09-28 |
| 2024-12-07 | REINVESTMENT | SCHD | VANGUARD INDEX FDS | 60.50 | 97.37 | 1394.97 | 02/18/2024 |
| 11/12/2024 | YOU BOUGHT | SCHD | SCHWAB US DIVIDEND EQUITY ETF | 80.56 | 444.59 | -1183.72 | 02/05/2024 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-07e69d509f86921ea97b4ba7,v11-BROKERAGE_STATEMENT-markdown,original,2024,fgen-d41c51fdbedd6f86cc04914b,synthetic_programmatic_template,markdown,top,False,raw_export
"Positions
Evergreen Brokerage Services
| Fie1d | Value |
| --- | --- |
| Account | Joint WROS ***-**-9449 |
| 5tatement period| 03/01/2026 - 03/28/2026 |
| Symbol |Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| VOO | 3O9.720 | 498.83 | 154,496.95 | 3,468.94 |
| AAPL| 172.555 | 232.00 | 40,033.29 | 5,391.73 |
| SCHD | 356.635 | 185.21 | 66,054.14 | 3,783.32 |
| MSFT | 281.809 | 225.17 | 63,455.65 | 8,040.81 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4c4cf7bd69fb1c2c6cc373b4,v11-BROKERAGE_STATEMENT-markdown,original,2026,fgen-1f73f44a49aaabe43802b3da,synthetic_programmatic_template,markdown,top,True,holdings_export
"Downloaded 2024-07-23
| Account Number | AccountName | 5ymbol | Description | Quantity | LastPrice | Current Value | Total Gain/Loss Dollar | Percent Of Account |
| --- | --- | --- |--- | --- | --- | --- | --- | --- |
| Z14536585 | Individual | FXAIX | FIDELITY 5O0 INDEX |63.04 | 476.97 | 48887.79 | -6400.06 | 45.99% |
| Z20299167 | Indívídual |V0O | VANGUARD 5&P 500 ETF | 135.65 | 285.67 | 63082.98 | 3069.25 | 38.07% |
| Z11937531 | Individual | AMZN | VANGUARD S&P 500 ETF | 142.44 | 661.98 | 15067.33 | -4491.88 | 30.87% |
| Z87757357 | Individual | AMZN | NVIDIA CORP | 395.63 | 64.10 | 37374.82 | 880.88 | 14.91% |
| Z77550245 | Individual | VOO | FIDELITY 500 INDEX | 2.31 | 303.37 | 10616.48 | 3976.11 | 3.56% |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-22336dd35e0ae95ccb54f88d,v11-BROKERAGE_STATEMENT-markdown,original,2024,fgen-18b70a438c464eea70ec7f51,synthetic_programmatic_template,markdown,bottom,True,raw_export
"QuarterlyAccount Statement
## Northstar Securities
| Fíeld | Value |
| --- | --- |
| Account | JointWROS ***-**-893l |
| Statement period| 06/01/2021 - 06/28/2021 |
| Beginning account va1ue | S94,481.88 |
| Ending account value | $90,659.53 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 483.08  5,945.29 |
| Interest | 86.60  428.21 |
| Realized gain/loss | 4,471.95 |
| 5ymbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- |--- | --- | --- | --- |
| VTI | 67.450 | 55.96| 3,774.43 | 6,668.17 |
| IVV | 379.860 | 263.50 | 100,094.55 | 467.85 |
| BND | 19.620 | 302.12 | 5,927.66 | 8,682.42 |
| 5CHB | 117.869 | 361.11 | 42,563.49 | 6,171.20 |
## IRS Form 1099 information for 2021 will bc mailed separately.
5ecuritiesoffered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bcf13c644a4482962670ec8e,v11-BROKERAGE_STATEMENT-markdown,original,2021,fgen-d060a3244967ca3a2358dcae,synthetic_programmatic_template,markdown,top,True,quarterly
"Quarterly Account Statement
ClearwaterInvesting
| Field | Value |
|--- | --- |
| Account | Individual - TOD ending in 1880 |
| Statement period | 11/01/2022 - 11/31/2022 |
| Beginning account value | $466,977.95 |
| Ending account valuc | $483,814.21 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 817.55  5,555.84 |
| Interest | 47.73  408.69 |
| Realized gain/loss | 6l8.89 |
| 5ymbol | Quantity | Last Pricc| Current Value | TotalGaín/Loss |
| --- | ---| --- | --- | --- |
| QQQ | 360.l18 | 233.81 | 84,2O0.12 | 8,548.81 |
| BND | 255.509 | 71.17 | 18,184.51 | 4,540.77 |
| IVV | 199.076 | 494.64 | 98,471.21 | 2,021.38 |
| MSFT | 240.767 | 360.50 | 86,795.89 | 6,763.69 |
This statcment isnot a Form l099. Keep it for your records.
5ecurities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5beb05d4b0503bd4f048cbcc,v11-BROKERAGE_STATEMENT-markdown,original,2022,fgen-8d0db9544a59a0adec5466d9,synthetic_programmatic_template,markdown,top,True,quarterly
"Positions
## Summit Investments
| Field | Value |
| --- | --- |
| Account | Individual - TOD ending in 3775 |
| Statement period | 06/01/2026 - 06/31/2026 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| VTI | 369.119 | 184.94 | 68,263.39 | 8,274.21 |
| VOO | 377.562 | 325.33 | 122,831.23 | 4,160.75 |
| AAPL | 298.079 | 383.04 | 114,174.96 | 8,463.91 |
| BND | 283.711 | 356.85 | 101,240.98 | 1,591.52 |
Tax reminder: amounts on this statement may differ from your Form 1099.
Securities offered through a member of FINRA/SIPC. Not FDIC insured.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a89d5b60f99bff914be98446,v11-BROKERAGE_STATEMENT-markdown,original,2026,fgen-2b23b3fbf2fcf7b149370084,synthetic_programmatic_template,markdown,top,False,holdings_export
"Investment Report
Summit Investments
| Field | Value |
| --- | --- |
| Account | Individual Brokerage Account XXX-XX-9308 |
| Statement period | 10/01/2021 - 10/30/2021 |
| Beginning account value | $672,943.87 |
| Ending account value | $633,213.42 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 759.32  4,034.50 |
| Interest | 26.62  250.91 |
| Realized gain/loss | -406.33 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| AAPL | 261.571 | 162.60 | 42,532.69 | 7,189.57 |
| SCHB | 66.160 | 490.50 | 32,451.36 | 1,251.00 |
| MSFT | 236.532 | 84.47 | 19,979.98 | -1,836.37 |
| VTI | 245.181 | 440.45 | 107,990.33 | 3,335.76 |
## IRS Form 1099 information for 2021 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-83c098722c884efab2f25d8a,v11-BROKERAGE_STATEMENT-markdown,original,2021,fgen-7a1324fd658cb7818f26407c,synthetic_programmatic_template,markdown,top,False,monthly
"| Run Date | Action | Symbol | Security Description | Quantity | Price | Amount | Settlement Date |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 2025-12-19 | YOU SOLD | SCHD | VANGUARD INDEX FDS | 85.84 | 216.47 | -8148.96 | 2025-04-24 |
| 22/08/2025 | INTEREST EARNED | AAPL | SCHWAB US DIVIDEND EQUITY ETF | 23.61 | 151.36 | -22.55 | 03/09/2025 |
| 19/07/2025 | DIVIDEND RECEIVED | AAPL | APPLE INC | 27.39 | 187.75 | 1386.39 | 09/09/2025 |
| 25/08/2025 | INTEREST EARNED | VTI | SCHWAB US DIVIDEND EQUITY ETF | 70.03 | 162.42 | 7670.62 | 2025-12-19 |
| 10/16/2025 | DIVIDEND RECEIVED | SCHD | APPLE INC | 79.69 | 338.37 | -1620.86 | 2025-12-01 |
| 09/04/2025 | INTEREST EARNED | VTI | VANGUARD INDEX FDS | 41.21 | 133.45 | 4231.58 | 06/09/2025 |
| 08/07/2025 | YOU SOLD | SCHD | APPLE INC | 11.23 | 97.94 | -5963.14 | 28/07/2025 |
| 06/12/2025 | REINVESTMENT | VTI | APPLE INC | 85.28 | 61.64 | -8635.45 | 08/06/2025 |
| 09/24/2025 | INTEREST EARNED | VTI | SCHWAB US DIVIDEND EQUITY ETF | 67.71 | 441.88 | 1068.56 | 21/10/2025 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e9c09e45d43fb7d97dd8eb39,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-583f5398d9ed9b70dd483921,synthetic_programmatic_template,markdown,none,False,raw_export
"| Run Date | Action | Symbol | Security Description | Quantity | Price | Amount | Settlement Date |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 2022-11-23 | YOU SOLD | AAPL | VANGUARD INDEX FDS | 38.92 | 148.15 | 7515.72 | 01/23/2022 |
| 21/09/2022 | YOU BOUGHT | AAPL | SCHWAB US DIVIDEND EQUITY ETF | 49.09 | 32.01 | -6450.62 | 05/02/2022 |
| 12/03/2022 | DIVIDEND RECEIVED | AAPL | SCHWAB US DIVIDEND EQUITY ETF | 26.00 | 57.71 | 815.25 | 25/01/2022 |
| 10/04/2022 | YOU SOLD | VTI | APPLE INC | 12.70 | 162.91 | -2208.04 | 10/03/2022 |
| 2022-01-28 | REINVESTMENT | AAPL | APPLE INC | 43.44 | 384.84 | -2949.79 | 03/08/2022 |
| 06/10/2022 | YOU BOUGHT | VTI | VANGUARD INDEX FDS | 75.22 | 190.90 | -407.10 | 21/08/2022 |
| 2022-03-04 | INTEREST EARNED | SCHD | SCHWAB US DIVIDEND EQUITY ETF | 32.85 | 344.89 | 4161.88 | 02/08/2022 |
Portfolio Positions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bedcb908397e0384814ec24c,v11-BROKERAGE_STATEMENT-markdown,original,2022,fgen-5498ec9e97853ae9a551d2e7,synthetic_programmatic_template,markdown,bottom,False,raw_export
"## Quarterly Account Statement
## Northstar Securities
| Field | Value |
| --- | --- |
| Account | Individual - TOD XXXXX9253 |
| Statement period | 05/01/2025 - 05/30/2025 |
| Beginning account value | $372,826.04 |
| Ending account value | $415,672.75 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 383.48  306.60 |
| Interest | 1.20  545.03 |
| Realized gain/loss | 2,220.57 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| AAPL | 84.188 | 122.20 | 10,287.74 | 328.80 |
| SCHB | 233.504 | 155.89 | 36,400.46 | 4,714.27 |
| QQQ | 300.510 | 233.30 | 70,110.26 | 7,481.03 |
| SCHD | 222.386 | 229.06 | 50,938.85 | 2,585.27 |
## Your 2025 Form 1099 will be available online by January 31, 2026.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5906713458ee7e1892f0dbcf,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-212536ae39051ab7256a34e0,synthetic_programmatic_template,markdown,top,False,quarterly
"| Trade Date | Transaction Type |Investment Name | Shares | Share Price | Net Amount |
| --- | --- | --- | --- | ---| --- |
| 2022-07-19 | Reínvestment | 500 Index Admiral | 2l.78 | 355.25 | 8337.92 |
| 2022-09-26 | Capital gain (LT) | Total Stock Market IndexAdmiral | 6.68 | 352.67 | 2552.59 |
| ll/15/2022 | Buy |Total Bond Markct ETF | 42.37 | 439.61 | 4487.67 |
| 2022-09-13 | Dividend | Tota1 Bond Market ETF | 66.68 | 71.43 | 739.79 |
| 20/10/2022| Buy | Total Bond Market ETF | 73.99 | 465.74 | 1029.19 |
| 02/13/2022 | Sell | 500 Index Admiral | 79.41 | 385.25 | 98.16 |
| 07/11/2022 | Capital gain (LT) | Total Stock Market Index Admiral | 35.33 | 138.03 | -2462.11 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-993322fb9d9d977871f1b7ec,v11-BROKERAGE_STATEMENT-markdown,original,2022,fgen-1b660bd80a334f18f443dd25,synthetic_programmatic_template,markdown,bottom,True,raw_export
"## Positions
Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account | Individual - TOD ending in 2023 |
| Statement period | 01/01/2023 - 01/31/2023 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| SCHD | 6.186 | 34.38 | 212.65 | -538.66 |
| BND | 159.887 | 58.86 | 9,410.79 | 3,080.44 |
| SCHB | 65.484 | 45.49 | 2,978.86 | 8,892.54 |
| AAPL | 211.405 | 55.40 | 11,711.79 | -668.65 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7507633f3b0b6ff7ac84b9b1,v11-BROKERAGE_STATEMENT-markdown,original,2023,fgen-520af0d8c470dcd4ff8eb658,synthetic_programmatic_template,markdown,top,False,holdings_export
"Summit Investments
| Field | Value |
| --- | --- |
| Account | Joint WROS XXXXX1793 |
| Statement period | 11/01/2025 - 11/28/2025 |
| Beginning account value | $899,360.32 |
| Ending account value | $817,815.66 |
## Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 53.34  4,589.41 |
| Interest | 51.36  357.79 |
| Realized gain/loss | -1,145.28 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| VTI | 121.724 | 301.78 | 36,733.74 | 4,228.68 |
| AAPL | 210.261 | 356.62 | 74,982.74 | 4,199.24 |
| SCHD | 370.722 | 254.36 | 94,297.15 | 7,891.24 |
| BND | 364.179 | 441.05 | 160,622.14 | 8,359.63 |
Securities offered through a member of FINRA/SIPC. Not FDIC insured.
Investment Report",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4956374ec23607b0ebc8e2f6,v11-BROKERAGE_STATEMENT-markdown,original,2025,fgen-5e3d156b37a9599620c47bb2,synthetic_programmatic_template,markdown,bottom,False,monthly
"## Summit Investments
| Field | Value |
| --- | --- |
| Account | Joint WROS ending in 8946 |
| Statement period | 06/01/2021 - 06/28/2021 |
| Beginning account value | $288,688.08 |
| Ending account value | $268,187.88 |
Income summary  This period  Year to date
| Field | Value |
| --- | --- |
| Dividends | 196.94  7,262.44 |
| Interest | 52.57  254.24 |
| Realized gain/loss | 4,015.35 |
| Symbol | Quantity | Last Price | Current Value | Total Gain/Loss |
| --- | --- | --- | --- | --- |
| SCHD | 129.023 | 196.49 | 25,351.26 | 8,989.92 |
| AAPL | 281.208 | 206.75 | 58,138.85 | 4,609.66 |
| MSFT | 181.243 | 440.48 | 79,833.48 | 7,539.31 |
| IVV | 146.150 | 281.46 | 41,134.70 | -1,267.79 |
Tax reminder: amounts on this statement may differ from your Form 1099.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f71fb35cca60bf8b6601d8ac,v11-BROKERAGE_STATEMENT-markdown,original,2021,fgen-1b4c1984013853d3e6bdc2e3,synthetic_programmatic_template,markdown,none,False,quarterly
"Brokerage Account ...3355 - Activity
Downloaded 24/10/2021
| Run Date | Action | Symbol | Security Description | Quantity | Price | Amount | Settlement Date |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 28/12/2021 | DIVIDEND RECEIVED | VTI | VANGUARD INDEX FDS | 83.73 | 424.24 | -8573.05 | 11/21/2021 |
| 12/12/2021 | YOU BOUGHT | SCHD | VANGUARD INDEX FDS | 9.75 | 321.34 | 3909.86 | 17/05/2021 |
| 2021-10-22 | YOU BOUGHT | VTI | SCHWAB US DIVIDEND EQUITY ETF | 59.63 | 468.05 | 4479.58 | 2021-07-05 |
| 09/15/2021 | YOU SOLD | SCHD | VANGUARD INDEX FDS | 31.69 | 191.52 | -6929.84 | 06/10/2021 |
| 2021-05-27 | INTEREST EARNED | SCHD | SCHWAB US DIVIDEND EQUITY ETF | 20.47 | 141.94 | -6682.65 | 2021-06-01 |
| 23/10/2021 | REINVESTMENT | AAPL | APPLE INC | 44.13 | 341.59 | -5827.42 | 2021-10-17 |
| 18/12/2021 | YOU SOLD | AAPL | APPLE INC | 79.50 | 139.78 | -147.35 | 07/10/2021 |
| 2021-09-08 | DIVIDEND RECEIVED | AAPL | APPLE INC | 10.30 | 144.59 | -7398.15 | 2021-10-05 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-760020f8030eecb59a8621d2,v11-BROKERAGE_STATEMENT-markdown,original,2021,fgen-64235defd1d348b39facbdb6,synthetic_programmatic_template,markdown,top,False,raw_export
"Gala Ticket Receipt
Hope Harbor Shelter
Attendee
Riley S. Romero
Event date
2026-02-22
Amount paid
$290.25
Fair market value of dinner and entertainment
$129.37
Deductible portion
$160.87
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-e1efd99b0062f8e4aac9f10f,v11-CHARITY_EVENT_RECEIPT-stacked,original,2026,fgen-24614319392bc90c94601983,synthetic_programmatic_template,stacked,top,False,event
"Event Registration Receipt
Greenway Animal Rescue
Attendee
Noah Brennan
Event date
O7/03/2025
Amount paid
$211.75
Fair markct value of dinner and entertainment
$103.61
Deductible portion
$108.15
Thedeductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-428a77581e78e4c5d4a92c33,v11-CHARITY_EVENT_RECEIPT-stacked,original,2025,fgen-104f7cfe4456a84d33a2a5f1,synthetic_programmatic_template,stacked,top,True,event
"Charity Auction Receipt
St. Brendan Parish
Attendee
Noah Larsen
Event date
7/28/21
Amount paid
$79.48
Fair market value of dinner and entertainment
$22.95
Deductible portion
$56.53
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-1287940d50f403d9883e1400,v11-CHARITY_EVENT_RECEIPT-stacked,original,2021,fgen-3319b96a761b83715a3dcc8b,synthetic_programmatic_template,stacked,top,False,event
"Gala Ticket Receipt
St. Brendan Parish
Attendee
Lena J. Sato
Event date
10/11/2024
Amount paid
$390.30
Fair market value of dinner and entertainment
$197.37
Deductible portion
$192.93
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-ed98c0bdd465359b03370bac,v11-CHARITY_EVENT_RECEIPT-stacked,original,2024,fgen-844709d6bbb060460477d573,synthetic_programmatic_template,stacked,top,False,event
"Event Registration Receipt
St. Brendan Parish
Attendee
Lena Walsh
Event date
8/12/22
Amount paid
$202.42
Fair market value of dinner andentertainment
$42.41
Deductible portion
$160.01
The deductíble amount is limited to thc excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-f9506811e7337314414224f7,v11-CHARITY_EVENT_RECEIPT-stacked,original,2022,fgen-94a08e493f4121bd4efba7bf,synthetic_programmatic_template,stacked,top,True,event
"Gala Ticket Receipt
Greenway Animal Rescue
Attendee
Mateo K. Tanaka
Evcntdate
2022-08-03
Amount paid
S144.87
Fair market value of dinner and entertainment
$30.37
Deductible portion
$114.50
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-9ac978832b28924e1bd2d9c5,v11-CHARITY_EVENT_RECEIPT-stacked,original,2022,fgen-b7ff07b350d97d394e84dad8,synthetic_programmatic_template,stacked,top,True,event
"Charity Auction Receipt
Riverbend Public Library Foundation
Attendee
Olivia Sato
Event date
2022-06-14
Amount paid
$408.46
Fair market value of dinner and entertainment
$123.25
Deductible portion
$285.21
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-a080d13252acfa2152368a02,v11-CHARITY_EVENT_RECEIPT-stacked,original,2022,fgen-044f9dbd4a96f0ccb5ef3a31,synthetic_programmatic_template,stacked,top,False,event
"Charity Auction Receipt
Hope Harbor Shelter
Attendee
Amara Tanaka
Event date
07/02/2024
Amount paid
$391.62
Fair market value of dinner and entertainment
$186.60
Deductible portion
$205.02
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-5f4c8cbb8e064db03bdc5638,v11-CHARITY_EVENT_RECEIPT-stacked,original,2024,fgen-9bbbeb446967e05b7772c4b7,synthetic_programmatic_template,stacked,top,False,event
"Gala Ticket Receipt
Greenway Animal Rescue
Attendee
Riley E. Lindqvist
Event date
2024-04-07
Amount paid
$245.69
Fair market value of dinner and entertainment
$133.40
Deductible portion
$112.29
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-4692d4505ad4a2f6ad48ccf4,v11-CHARITY_EVENT_RECEIPT-stacked,original,2024,fgen-13a953f222958de9b4d8df67,synthetic_programmatic_template,stacked,top,False,event
"Event Registration Receipt
Riverbend Public Library Foundation
Attendee
Diego Fischer
Event date
10/3/26
Amount paid
$202.03
Fair market value of dinner and entertainment
$44.44
Deductible portion
$157.59
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-754d7d8600cda2916ec8952f,v11-CHARITY_EVENT_RECEIPT-stacked,original,2026,fgen-68896be0c023d38118b25bff,synthetic_programmatic_template,stacked,top,False,event
"Charity Auction Receipt
Sample Community Food Bank
Attendee
Avery Fischer
Event date
3/8/24
Amount paid
$186.98
Fair market value of dinner and entertainment
$70.53
Deductible portion
$116.45
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-5e566ad9d0cacf87c8268995,v11-CHARITY_EVENT_RECEIPT-stacked,original,2024,fgen-4fab8c11e5bac806e2244ec0,synthetic_programmatic_template,stacked,top,False,event
"Riverbend Public Library Foundation
Attendee
Hiro Brennan
Event date
11/08/2021
Amount paid
$108.26
Fair market value of dinner and entertainment
$61.16
Deductible portion
$47.11
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-6f974d47eac2e12fdbcdfaf8,v11-CHARITY_EVENT_RECEIPT-stacked,original,2021,fgen-262c329739a5839744d377b1,synthetic_programmatic_template,stacked,none,False,event
"Gala Ticket Receipt
St. Brendan Parish
Attendee
Avery Romero
Event date
September 10, 2024
Amount paid
S467.40
Fair market value of dinner and entertainment
$145.39
Deductible portion
$322.00
The deductíble amount is limited to the excess of your payment over the value of goods and servicesreceived.",DONATION_RECORD,28,DONATION_RECORD,fdc-b4b2521987bceacdad9c5c93,v11-CHARITY_EVENT_RECEIPT-stacked,original,2024,fgen-07ad88cf7365acf73270c5b4,synthetic_programmatic_template,stacked,top,True,event
"Event Registration Receipt
Greenway Animal Rescue
Attendee
Fatima Larsen
Event date
2023-09-18
Amount paid
$429.41
Fair market value of dinner and entertainment
$184.73
Deductible portion
$244.68
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-05964d2694e531326403308b,v11-CHARITY_EVENT_RECEIPT-stacked,original,2023,fgen-08e9cad2098c7bd730a86a86,synthetic_programmatic_template,stacked,top,False,event
"Event Registration Receipt
Riverbend Public Library Foundation
Attendee
Wei Walsh
Event date
2021-04-24
Amount paid
$318.00
Fair market value of dinner and entertainment
$79.72
Deductible portion
$238.28
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-0498e36c8f7d561d03dd318b,v11-CHARITY_EVENT_RECEIPT-stacked,original,2021,fgen-0833fb72fd10051bf040e7d2,synthetic_programmatic_template,stacked,top,False,event
"Riverbend Public Library Foundation
Attendee
Hiro Larsen
Event date
5/8/23
Amount paid
$427.78
Fair market value of dinner and entertainment
$242.69
Deductible portion
$l85.08
The deductible amount is limitedto the excess of your payment over the value of goods and servíces receíved.",DONATION_RECORD,28,DONATION_RECORD,fdc-0ab990a044a88044bc00b012,v11-CHARITY_EVENT_RECEIPT-stacked,original,2023,fgen-0dc61c1f6b565fa756c9afcc,synthetic_programmatic_template,stacked,none,True,event
"Event Registration Receipt
Sample Community Food Bank
Attendee,Noah Nguyen
Event date,09/24/2023
Amount paid,$248.23
Fair market value of dinner and entertainment,$113.19
Deductible portion,$135.03
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-ef1597952533ff83492041fb,v11-CHARITY_EVENT_RECEIPT-csv,original,2023,fgen-98c23607fc0d197cc9e5394a,synthetic_programmatic_template,csv,top,False,event
"Event Registration Receipt
Riverbend Public Library Foundation
Attendee,Olívia Adeyemi
Event date,""February 28, 202l""
Amount paid,$316.O8
Fair market value of dinner andentertainment,$104.39
Deductible portion,$211.69
The deductíble amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-30f56d77b8214a42732ff051,v11-CHARITY_EVENT_RECEIPT-csv,original,2021,fgen-b11d45e4c7e14e09440aa037,synthetic_programmatic_template,csv,top,True,event
"Gala Ticket Receipt
St. Brendan Parish
Attendee,Hiro Tanaka
Event date,""July 25, 2024""
Amount paid,$239.58
Fair market value of dinner and entertainment,$53.19
Deductible portion,$186.39
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-c2f17051227abffa685f5afc,v11-CHARITY_EVENT_RECEIPT-csv,original,2024,fgen-d703b59aa7a008411cd61e80,synthetic_programmatic_template,csv,top,False,event
"Greenway Animal Rescue
Attendee,Alex M. Testcase
Event date,10/14/23
Amount paid,$324.00
Fair market value of dinner and entertainment,$144.93
Deductible portion,$179.08
The deductible amount is limited to the excess of your payment over the value of goods and services received.
Gala Ticket Receipt",DONATION_RECORD,28,DONATION_RECORD,fdc-2deff085e3d2890b41d53753,v11-CHARITY_EVENT_RECEIPT-csv,original,2023,fgen-16b3fec472764599c7e3126a,synthetic_programmatic_template,csv,bottom,False,event
"Charity Auction Receipt
Hope Harbor Shelter
Attendee,Lena K. Kowalski
Event date,2022-06-l1
Amount paid,$247.99
Fair markct value of dinner and entertainment,$93.81
Deductible portion,$154.18
Thedeductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-88463e8efe4cc9b019d28604,v11-CHARITY_EVENT_RECEIPT-csv,original,2022,fgen-e38e8fed5fdfb776372feb35,synthetic_programmatic_template,csv,top,True,event
"St. Brendan Parish
Attendee,Alex D. Walsh
Event date,""January 1, 2024""
Amount paid,$260.97
Fair market value of dinner and entertainment,$109.03
Deductible portion,$151.95
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-c9677733b04e38812cac6588,v11-CHARITY_EVENT_RECEIPT-csv,original,2024,fgen-6d8e57813e39a23a0ba1d17d,synthetic_programmatic_template,csv,none,False,event
"Greenway Animal Rescue
Attendee,Casey Testcase
Event date,4/8/22
Amount paid,$228.54
Fair market value of dinner and entertainment,$103.53
Deductible portion,$125.01
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-c01ba1a360a09014a45e5d89,v11-CHARITY_EVENT_RECEIPT-csv,original,2022,fgen-01e437e47afb35bb91b88064,synthetic_programmatic_template,csv,none,False,event
"Riverbend Public Library Foundation
Attendee,Casey S. Walsh
Event date,2024-10-07
Amount paid,$187.05
Fair market value of dinner and entertainment,$72.91
Deductible portion,$114.15
The deductible amount is limited to the excess of your payment over the value of goods and services received.
Charity Auction Receipt",DONATION_RECORD,28,DONATION_RECORD,fdc-543442a890ee8bef15118d14,v11-CHARITY_EVENT_RECEIPT-csv,original,2024,fgen-418b18347e161cd1229e6b35,synthetic_programmatic_template,csv,bottom,False,event
"Gala Ticket Receipt
Hope Harbor Shelter
Attendee,Diego Nguyen
Event date,02/26/2021
Amount paid,$356.70
Fairmarket value of dinner and entertainment,$154.40
Deductible portion,$202.30
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-53938a356afa0f32fdea8a82,v11-CHARITY_EVENT_RECEIPT-csv,original,2021,fgen-d3e9283cbf161bffc5f901e4,synthetic_programmatic_template,csv,top,True,event
"Charity Auction Receipt
Hope Harbor Shelter
Attendee,Casey Walsh
Event date,l2/03/2024
Amount paid,$276.01
Fair market value of dinner and entertainment,$162.68
Deductible portion,$113.32
The deductible amount is limited to the excess of yourpayment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-d2c2e3290816924427e1df99,v11-CHARITY_EVENT_RECEIPT-csv,original,2024,fgen-c3355bfed0751947a975263e,synthetic_programmatic_template,csv,top,True,event
"Hope Harbor Shelter
Attendee,Alex Larsen
Event date,2/14/22
Amount paid,$192.14
Fair market value of dinner and entertainment,$67.67
Deductible portion,$124.47
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-7fb392726dea9d978fac3051,v11-CHARITY_EVENT_RECEIPT-csv,original,2022,fgen-81dc9f6f6974767885c62e1a,synthetic_programmatic_template,csv,none,False,event
"Event Registration Receipt
St. Brendan Parish
Attendee,Avery Romero
Event date,""June 19, 2022""
Amount paid,$341.22
Fair market value of dinner and entertainment,$150.32
Deductible portion,$190.91
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-333ce326fb56c0e14da91d0e,v11-CHARITY_EVENT_RECEIPT-csv,original,2022,fgen-36170ef221f4109c668a7d6a,synthetic_programmatic_template,csv,top,False,event
"Event Registration Receipt
St. Brendan Parish
Attendee,Avery E. Rivera
Event date,""August 22, 2021""
Amount paid,$266.70
Fair market value of dinner and entertainment,$131.30
Deductible portion,$135.40
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-30b64cbd1ae5f240383f3703,v11-CHARITY_EVENT_RECEIPT-csv,original,2021,fgen-7639bef7ff1054925329e37b,synthetic_programmatic_template,csv,top,False,event
"Gala Ticket Receipt
St. Brendan Parish
Attendee,Kwame Larsen
Event date,""December 20, 2021""
Amount paid,S315.49
Fair market value of dinner and entertainment,$155.96
Deductible portion,$159.54
The deductible amount is limited to the excess of your payment over the value ofgoods and servíces received.",DONATION_RECORD,28,DONATION_RECORD,fdc-eb66619a8d3c6bc5d2262523,v11-CHARITY_EVENT_RECEIPT-csv,original,2021,fgen-6b0991ffcc57d69b771ddcbe,synthetic_programmatic_template,csv,top,True,event
"Sample Community Food Bank
Attendee,Hiro Larsen
Event date,""August 10, 2025""
Amount paid,$396.94
Fair market value of dinner and entertainment,$93.39
Deductible portion,$303.55
The deductible amount is limited to the excess of your payment over the value of goods and services received.
Event Registration Receipt",DONATION_RECORD,28,DONATION_RECORD,fdc-7364a4d7a6fb98b330545304,v11-CHARITY_EVENT_RECEIPT-csv,original,2025,fgen-353bce3ff2a5dd000a7677a6,synthetic_programmatic_template,csv,bottom,False,event
"Charity Auction Receipt
Hope Harbor Shelter
Attendee,Sofia Haddad
Event date,01/01/2022
Amount paid,$208.31
Fair market value of dinner and entertainment,$110.78
Deductible portion,$97.53
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-015b727283345f056ab67566,v11-CHARITY_EVENT_RECEIPT-csv,original,2022,fgen-8a31a86a675f1fd3d27176f5,synthetic_programmatic_template,csv,top,False,event
"Sample Community Food Bank Attendee Morgan A. Romero Event date June 23, 2023 Amount paid $309.62 Fair market
value of dinner and entertainment $120.14 Deductible portion $189.48 The deductible amount is limited to the excess
of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-a62050c002fb9e64e3fa8d89,v11-CHARITY_EVENT_RECEIPT-flat,original,2023,fgen-bebaa80734387c139db8c760,synthetic_programmatic_template,flat,none,False,event
"St. Brendan Parish
Attendee DíegoOkafor Event date 02/05/2023 Amount paid $337.09 Fair market va1ue of dinner and entertainment $121.38 Deductible portion $215.72 The deductible amount is 1imited to the excess of your payment over the
value of goods and services received. Gala Ticket Receipt",DONATION_RECORD,28,DONATION_RECORD,fdc-71403f66de965db2988caa52,v11-CHARITY_EVENT_RECEIPT-flat,original,2023,fgen-91e5695cad79772542605d97,synthetic_programmatic_template,flat,bottom,True,event
"Event Registration Receipt Riverbend Public Library Foundation Attendee Alex Lindqvist
Event date February 5, 2021 Amount paid $356.70 Fair market value of dinner and entertainment $129.41 Deductible portion $227.28 The deductible amount is
limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-a09d9fa60351d025ecee7a9f,v11-CHARITY_EVENT_RECEIPT-flat,original,2021,fgen-5596f4274f8aa19c0a4e3453,synthetic_programmatic_template,flat,top,False,event
"Event Registration Receipt Sample
Community Food Bank Attendee Mateo Walsh Event date
05/15/2023 Amount paid $328.02 Fair market value of dinner and entertainment $178.15 Deductible portion $149.87 The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-a85966f7c6fe8bad47296516,v11-CHARITY_EVENT_RECEIPT-flat,original,2023,fgen-16aab008c07c41ccd44c011a,synthetic_programmatic_template,flat,top,False,event
"Charity Auction Receipt Sample Community Food Bank Attendee Jamie Haddad Event date 4/18/25 Amount paid $486.95 Fair market value of dinner and entertainment $212.62
Deductible portion
$274.33 The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-45f5c24944baa6dd42dbe8b1,v11-CHARITY_EVENT_RECEIPT-flat,original,2025,fgen-726b13da779412b3a005218b,synthetic_programmatic_template,flat,top,False,event
"Gala Ticket Receipt Riverbend Public Library Foundation Attendee Jordan C. PatelEvent date 2024-06-07 Amount paid $136.36 Fair market value of dinner
and entertainment $60.61 Deductible
portion $75.74 The deductible amount is limited to the excess of your paymcnt over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-ee756616f90bd3e5f0e69142,v11-CHARITY_EVENT_RECEIPT-flat,original,2024,fgen-07158fd722887382adc3e1b2,synthetic_programmatic_template,flat,top,True,event
"Event Registration Receipt Sample Community Food Bank Attendee Fatima Haddad Event
date 07/13/2024 Amount paid $181.50 Fair market value of dinner
and entertainment $82.97 Deductible portion $98.53 The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-e84624bc116f4e6ac05652aa,v11-CHARITY_EVENT_RECEIPT-flat,original,2024,fgen-da72aa376f42880bd2fa2365,synthetic_programmatic_template,flat,top,False,event
"Sample Community Food Bank Attendee Priya Sato Event date 08/08/2026 Amount paid $410.61 Fair market value of dinner and cntertainment $161.26
Deductible portion
$249.35 The deductible amount is limited to the excess of your payment over the value of goods andservices received. Gala Ticket Receipt",DONATION_RECORD,28,DONATION_RECORD,fdc-1fa3721c4dccd6f10d8cd833,v11-CHARITY_EVENT_RECEIPT-flat,original,2026,fgen-88c8f29ad9ade3e8a572f13e,synthetic_programmatic_template,flat,bottom,True,event
"Charity Auction Receipt
Riverbend Public Library Foundation Attendee Jordan B. Romero Event date October 20, 2024 Amount paid
$439.99 Fair market value of dinner and entertainment $190.68 Deductible portion $249.31 The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-41365ee4ca94d333cd3b5cbd,v11-CHARITY_EVENT_RECEIPT-flat,original,2024,fgen-df3110cd56f6d1def9d765cf,synthetic_programmatic_template,flat,top,False,event
"Charity Auction Receipt Riverbend Public Library
Foundation Attendee Amara Larsen Event date 5/5/21 Amount paid $169.90 Fair market value of dinner and entertainment $50.45 Deductible portion $119.45
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-cced78c30083e70cdb9b1aa5,v11-CHARITY_EVENT_RECEIPT-flat,original,2021,fgen-788792d4fe16d7af304a5d20,synthetic_programmatic_template,flat,top,False,event
"Gala Ticket Receipt Riverbend Public Library Foundation Attendee Casey Brennan
Event date 02/10/2023 Amount paid $323.02 Fair market value of dinner and entertainment $149.65 Deductible portion $173.37 The
deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-0fe3e1cf5c4d152b9cffedcf,v11-CHARITY_EVENT_RECEIPT-flat,original,2023,fgen-fdbd7fdbf4b6f9f3fa2e960d,synthetic_programmatic_template,flat,top,False,event
"Greenway Animal Rescue Attendee Noah Fischer Event date 02/19/2022 Amount paid $467.58 Fair market
value of dinner and entertainment
$126.73 Deductible portion $340.85 The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-b85531383304ea164880b871,v11-CHARITY_EVENT_RECEIPT-flat,original,2022,fgen-de73ecc95db85ad6e23e6a27,synthetic_programmatic_template,flat,none,False,event
"Riverbend Public Library Foundation Attendee MorganNguyen Event date 11/27/25 Amount paid $166.05 Fair market value of dinner and entertainment $65.84 Deductible portion $1O0.21
The deductible amount is limited to the excess of your payment over the value of goods and services
received.",DONATION_RECORD,28,DONATION_RECORD,fdc-bb4c19937e2c6bdb3e83153a,v11-CHARITY_EVENT_RECEIPT-flat,original,2025,fgen-ee37a13b60be1b9870335187,synthetic_programmatic_template,flat,none,True,event
"St. Brendan Parish
Attendee Casey Brennan Event date 11/12/2023 Amount
paid $99.55 Fair market value of dinner and entertainment $34.65 Deductible portion $64.90 The deductible amount is limited to the excess of your payment over the value of goods and services received. Event Registration Receipt",DONATION_RECORD,28,DONATION_RECORD,fdc-4fc5fd273a13114b9f9b60f1,v11-CHARITY_EVENT_RECEIPT-flat,original,2023,fgen-eaa1f085f364ba1afdd4cbf1,synthetic_programmatic_template,flat,bottom,False,event
"Sample Community Food Bank Attendee Jamie Romero Event date 12/23/2023 Amount paid $136.03 Fair market value of dinner and entertainment $29.25 Deductible
portion $106.78 The deductible amount is limited to the excess of your payment over the value of goods and services
received.",DONATION_RECORD,28,DONATION_RECORD,fdc-a1e940771950d47b942c6a26,v11-CHARITY_EVENT_RECEIPT-flat,original,2023,fgen-cf9361e934c9016e80cd05e1,synthetic_programmatic_template,flat,none,False,event
"Charity Auction Receipt Greenway Animal Rescue
Attendee Wei A. Larsen Event date 2024-05-15 Amount paid $454.06 Fair market value of dinner and entertainment $198.89 Deductible portion $255.17 The deductible amount is limited to the excess of your payment over the value of goods and
services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-28420bacc827fda7813480ad,v11-CHARITY_EVENT_RECEIPT-flat,original,2024,fgen-05d5398f0fec6b60093a0ac8,synthetic_programmatic_template,flat,top,False,event
"## Event Registration Receipt
Sample Community Food Bank
| Field | Value |
| --- | --- |
| Attendee | Avery L. Moreau |
| Event date | 2025-05-15 |
| Amount paid | $361.18 |
| Fair market value of dinner and entertainment | $154.11 |
| Deductible portion | $207.07 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-180effec791600612ea2937e,v11-CHARITY_EVENT_RECEIPT-markdown,original,2025,fgen-33597e2906f20910d1df846b,synthetic_programmatic_template,markdown,top,False,event
"Event Registration Receipt
St. Brendan Parish
| Field | Value |
| --- | --- |
| Attendee | Avery Testcase |
| Event date | August 23, 2026 |
| Amount paid | $202.65 |
| Fair market value of dinner and entertainment | $49.39 |
| Deductible portion | $153.26 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-874fbc5affbfb5caee5c9515,v11-CHARITY_EVENT_RECEIPT-markdown,original,2026,fgen-cc8f0cac8a781ee491d0adbd,synthetic_programmatic_template,markdown,top,False,event
"Event Registration Receipt
Riverbend Public Library Foundation
| Field | Value |
| --- | --- |
| Attendee | Amara Okafor |
| Event date | 2023-05-16 |
| Amount paid | $236.70 |
| Fair market value of dinner and entertainment | $114.67 |
| Deductible portion | $122.03 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-ebc5107ed00aec1519dfa54b,v11-CHARITY_EVENT_RECEIPT-markdown,original,2023,fgen-fa372f4f53582cd125669c2b,synthetic_programmatic_template,markdown,top,False,event
"## Gala Ticket Receipt
St. Brendan Parish
| Field | Value|
| --- | --- |
| Attendee | Priya Haddad |
| Event date | 2026-02-l8 |
| Amount paid | S109.40 |
| Faír market value of dinner and entertainment | $22.13 |
| Deductible portion | $87.27 |
## The deductible amount is limited to the excess of yourpayment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-e9b4c3a72ef7b23d9157667d,v11-CHARITY_EVENT_RECEIPT-markdown,original,2026,fgen-826994d27455ee335c56b52a,synthetic_programmatic_template,markdown,top,True,event
"Gala Ticket Receipt
Sample Community Food Bank
| Field | Value |
| --- | --- |
| Attendee | Priya M. Haddad |
| Event date | 2024-12-14 |
| Amount paid | $399.21 |
| Fair market value of dinner and entertainment | $149.81 |
| Deductible portion | $249.39 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-c61cbcb67d01cabd181f2bd8,v11-CHARITY_EVENT_RECEIPT-markdown,original,2024,fgen-99a4087842cea1cfe3f861fe,synthetic_programmatic_template,markdown,top,False,event
"Gala Ticket Receipt
St. Brendan Parish
| Field | Value |
| --- | --- |
| Attendee | Diego Haddad |
| Event date | June 27, 2025 |
| Amount paid | $300.16 |
| Fair market value of dinner and entertainment | $102.15 |
| Deductible portion | $198.01 |
## The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-8d2c6a324488b4a67ffbc06f,v11-CHARITY_EVENT_RECEIPT-markdown,original,2025,fgen-21b3ad316dbd85b62d607c07,synthetic_programmatic_template,markdown,top,False,event
"Charity Auction Receipt
St. Brendan Parish
| Field | Value |
| --- | --- |
| Attendee | Olivia Rivera |
| Event date | 7/22/25 |
| Amount paid | $128.97 |
| Fair market value of dinner and entertainment | $38.24 |
| Deductible portion | $90.74 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-1be40a14492df7c9e4d3681b,v11-CHARITY_EVENT_RECEIPT-markdown,original,2025,fgen-dea28c3bc2e4c17efed9b15d,synthetic_programmatic_template,markdown,top,False,event
"Charity Auction Receipt
Greenway Animal Rescue
| Field | Value |
| --- | --- |
| Attendee | Priya E. Sato |
| Event date | 8/22/24 |
| Amount paid | $464.35 |
| Fair market value of dinner and entertainment | $106.18 |
| Deductible portion | $358.17 |
## The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-e236cb172f2ffd3657198b14,v11-CHARITY_EVENT_RECEIPT-markdown,original,2024,fgen-7827056e293ba341a6474989,synthetic_programmatic_template,markdown,top,False,event
"Gala Ticket Receipt
Sample Community Food Bank
| Field | Value |
| --- | --- |
| Attendee | Mateo Okafor |
| Event date | 4/6/23 |
| Amount paid | $434.32 |
| Fair market value of dinner and entertainment | $201.11 |
| Deductible portion | $233.21 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-862e705d5fe6da4d4e7df8a1,v11-CHARITY_EVENT_RECEIPT-markdown,original,2023,fgen-eb23b5960fb03be490ad9ab6,synthetic_programmatic_template,markdown,top,False,event
"Greenway Animal Rescue
| Field | Value |
| --- | --- |
| Attendee | Alex Rivera |
| Event date | December 13, 2024 |
| Amount paid | $232.59 |
| Fair market value of dinner and entertainment | $63.61 |
| Deductible portion | $168.98 |
## The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-34a9a47315c7274ac263996b,v11-CHARITY_EVENT_RECEIPT-markdown,original,2024,fgen-3ecc33c6d1dccc9aff438ff7,synthetic_programmatic_template,markdown,none,False,event
"Charity Auction Receipt
## Hope Harbor Shelter
| Field | Value |
| --- | --- |
| Attendee | Jordan Larsen |
| Event date | August 28, 2025 |
| Amount paid | $112.55 |
| Fair market value of dinner and entertainment | $29.97 |
| Deductible portion | $82.58 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-45d37552c0a8c78203cb608d,v11-CHARITY_EVENT_RECEIPT-markdown,original,2025,fgen-00e60f6fa318f999f91557d3,synthetic_programmatic_template,markdown,top,False,event
"## Event Registration Receipt
Hope Harbor Shelter
| Field | Value |
| --- | --- |
| Attendee | Diego Haddad |
| Event date | 02/06/2021 |
| Amount paid | $100.50 |
| Fair market value of dinner and entertainment | $23.73 |
| Deductible portion | $76.77 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-f2a5667f20d1bd2efbada32b,v11-CHARITY_EVENT_RECEIPT-markdown,original,2021,fgen-b791782e1eef18e3a87600fb,synthetic_programmatic_template,markdown,top,False,event
"Charity Auction Receipt
Riverbend Public Library Foundation
| Field | Value |
| --- | --- |
| Attendee | Fatima A. Tanaka |
| Event date | 2021-05-08 |
| Amount paid | $427.06 |
| Fair market value of dinner and entertainment | $241.44 |
| Deductible portion | $185.62 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-dfdcce4e4e36a14da95e2f8d,v11-CHARITY_EVENT_RECEIPT-markdown,original,2021,fgen-09b7cb26a62ce897f9c26992,synthetic_programmatic_template,markdown,top,False,event
"Event Registration Receipt
## Hope Harbor Shelter
| Field | Value |
| --- | --- |
| Attendee | Fatima Walsh |
| Event date | 11/24/23 |
| Amount paid | $469.00 |
| Fair market value of dinner and entertainment | $250.54 |
| Deductible portion | $218.46 |
The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-9dcfb4a7dec0a68ba95624c3,v11-CHARITY_EVENT_RECEIPT-markdown,original,2023,fgen-b52b1d3050cf7e9d18b0bbb2,synthetic_programmatic_template,markdown,top,False,event
"Event Rcgístration Receipt
St. Brendan Parish
| Field | Value |
| --- | --- |
| Attendee | Lena Larsen |
| Eventdate | November 7, 2023 |
| Amount paid | $108.91 |
| Fair market value of dinner and entertainment | $52.08 |
| Deductible portion| $56.82 |
## The deductible amount is limited to the excess of your payment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-c9410bec3418b54de414389a,v11-CHARITY_EVENT_RECEIPT-markdown,original,2023,fgen-ef87f31fa3ddba6b67464e6b,synthetic_programmatic_template,markdown,top,True,event
"## Gala Ticket Receipt
## Greenway Animal Rescue
| Field | Value |
| --- | --- |
| Attendee | Riley Moreau |
| Event date | 08/06/2023 |
| Amount paid | $362.73 |
| Fair market valueof dinner and entertainment | $160.09 |
| Deductib1e portion | $202.64 |
The deductíb1e amount is limited to the excess of yourpayment over the value of goods and services received.",DONATION_RECORD,28,DONATION_RECORD,fdc-fc3daa513734f0cfac0dd931,v11-CHARITY_EVENT_RECEIPT-markdown,original,2023,fgen-c0152be4678d8810c305ea9a,synthetic_programmatic_template,markdown,top,True,event
"2025 Tax Information Statement
Ironwood Wealth Partners
Account
XXXXX9840
Recipient
Olivia B. Haddad
Payer's Federal ID number
36-2552365
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 15
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
2,745.65
1b Qualified dividends
2,346.74
2a Total capital gain distributions
490.78
1099-INT  Interest Income
1 Interest income
852.76
1099-MISC  Miscellaneous Information
3 Other income
137.56
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
42,419.91
31,853.98
0.00
-4,105.39
Long
D (basis reported to the IRS)
78,509.30
44,925.67
0.00
26,235.08
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-563368689b2e9efeb900dd47,v11-CONSOLIDATED_1099-stacked,original,2025,fgen-8902eba22daccd1fa5a467eb,synthetic_programmatic_template,stacked,top,False,summary_page
"Evergreen Brokerage Services
Account
****0420
Recipient
Priya Romero
Payer's Federal ID number
14-1771666
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 21
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
8,320.40
1b Qualified dividends
5,568.15
2a Total capital gain distributions
1,108.36
1099-INT  Interest Income
1 Interest income
780.99
1099-MISC  Miscellaneous Information
3 Other income
71.98
This is important tax information and is being furnished to the Internal Revenue Service.
Tax Reporting Statement",1099,5,1099,fdc-c601115e3e637f84fc126d80,v11-CONSOLIDATED_1099-stacked,original,2022,fgen-a6b90913f1a7c2f32147d79b,synthetic_programmatic_template,stacked,bottom,False,div_int_detail
"2021 Consolidated Form 1099
Northstar Securities
Account
***-**-6202
Recipient
Morgan D. Kowa1ski
Payer's Federal ID number
29-8434348
Copy B for Recipient  OMB No. 1545-O715
Page 3 of 15
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
7,676.28
1b Qualified dividends
1,025.41
2a Total capítal gain distributions
2,967.01
1099-INT Interest Income
1 Interest income
587.49
1099-MISC  Miscellaneous Information
30ther income
174.99
This is important tax information and ís being fumished to the Intemal Revenue Service.",1099,5,1099,fdc-89c706fec63313ae775c8cd9,v11-CONSOLIDATED_1099-stacked,original,2021,fgen-5ca014074c1f421fbb8cd49a,synthetic_programmatic_template,stacked,top,True,div_int_detail
"Summit Investments
Account
***-**-2691
Recipient
Morgan Patel
Payer's Federal ID number
62-7087960
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 10
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
921.20
1b Qualified dividends
1,260.28
2a Total capital gain distributions
2,106.81
1099-INT  Interest Income
1 Interest income
43.92
1099-MISC  Miscellaneous Information
3 Other income
17.59
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-7f249ac3d98caf95521a1c3b,v11-CONSOLIDATED_1099-stacked,original,2026,fgen-3790e3de122ae1b420087918,synthetic_programmatic_template,stacked,none,False,div_int_detail
"Summit Investments
Account
XXX-XX-0606
Recipient
Avery Okafor
Payer's FederalID number
96-634666l
Copy Bfor Recipient  OMB No. 1545-0715
Page 1 of 19
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss dísallowed  Net gain or loss
5hort
A (basis reported to the IRS)
14,465.24
54,O65.03
0.00
-3,016.70
Long
D (basis reported to the IR5)
46,888.86
41,501.18
0.00
101.02
This is important tax information and is bcing furnished to the Intemal Revenue Service.
Form l099 Composite & Year-End Summary",1099,5,1099,fdc-0e5bbfd2ec3e3dd33cb5b319,v11-CONSOLIDATED_1099-stacked,original,2022,fgen-22314b2264eb88b40da8fb9d,synthetic_programmatic_template,stacked,bottom,True,b_detail
"Ironwood Wealth Partners
Account
***-**-8004
Recipient
Noah L. Patel
Payer's Federal ID number
53-3304699
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 18
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
8,533.89
1b Qualified dividends
7,779.53
2a Total capital gain distributions
2,644.07
1099-INT  Interest Income
1 Interest income
368.76
1099-MISC  Miscellaneous Information
3 Other income
135.15
This is important tax information and is being furnished to the Internal Revenue Service.
Tax Reporting Statement",1099,5,1099,fdc-2da1c3145c2e3fe988fd3ce9,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-6591432fbfc8afd2842ffeef,synthetic_programmatic_template,stacked,bottom,False,div_int_detail
"Evergreen Brokerage Servíces
Account
***-**-4644
Recipient
Casey A. Larsen
Payer's Federal ID number
17-3699838
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 23
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 typc  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
74,505.41
23,723.82
0.00
-3,999.77
Long
D (basisreported to the IRS)
38,086.79
4,596.23
0.00
52.17
This is important tax information and is being fumished to the Intema1 Revenue Service.",1099,5,1099,fdc-40cb8e2af1638b9120223b12,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-5d02fcbe7536e6f33c8b1fc9,synthetic_programmatic_template,stacked,none,True,b_detail
"2024 Consolidated Form 1099
Ironwood Wealth Partners
Account
****5490
Recipient
Sofia Adeyemi
Payer's Federal ID number
89-9418919
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 18
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
292.77
1b Qualified dividends
549.97
2a Total capital gain distributions
410.63
1099-INT  Interest Income
1 Interest income
560.13
1099-MISC  Miscellaneous Information
3 Other income
54.92
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-5347cca981115593ffc73dc0,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-8cdfdd599da84a5903adfe3c,synthetic_programmatic_template,stacked,top,False,div_int_detail
"2024 Tax Information Statement
Ironwood WealthPartners
Account
***-**-4724
Recipient
Riley Haddad
Payer's Federal ID number
91-7117533
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 28
1099-B  Summary of Proceeds, Gains &Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gaín or loss
5hort
A (basis reported to the IRS)
38,824.56
89,485.25
0.00
-4,692.l0
Long
D (basis reported to the IRS)
54,4l5.41
58,656.97
0.00
27,847.90
This is important tax information and is being fumished to the Internal Revenue 5ervice.",1099,5,1099,fdc-05d2d1d1d713880d70d20f75,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-0d2ae5b67da2b39cf199f722,synthetic_programmatic_template,stacked,top,True,b_detail
"Northstar Securities
Account
ending in 6228
Recipient
Hiro Nguyen
Payer's Federal ID number
77-5536859
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 8
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
10,803.10
71,055.66
0.00
-4,308.12
Long
D (basis reported to the IRS)
24,039.19
14,317.89
0.00
20,078.89
This is important tax information and is being furnished to the Internal Revenue Service.
Tax Reporting Statement",1099,5,1099,fdc-796a4e4d7f4335156665fd4d,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-f305f0f4d26f294178c71a74,synthetic_programmatic_template,stacked,bottom,False,b_detail
"Northstar Securities
Account
***-**-4908
Recipient
Jamie Fischer
Payer's Federal ID number
69-9142701
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 10
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
1,770.16
13,254.82
0.00
4,638.08
Long
D (basis reported to the IRS)
16,821.69
5,727.38
0.00
24,280.65
This is important tax information and is being furnished to the Internal Revenue Service.
Tax Reporting Statement",1099,5,1099,fdc-babbec3d4774b0016cbca09c,v11-CONSOLIDATED_1099-stacked,original,2023,fgen-acb3c05f2bed6b226a77bfe3,synthetic_programmatic_template,stacked,bottom,False,b_detail
"2023 Tax Information Statement
Evergreen Brokerage Services
Account
****5987
Recipient
Priya M. Romero
Payer's Federal ID number
84-6436913
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 9
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
8,689.53
1b Qualified dividends
6,845.33
2a Total capital gain distributions
1,945.22
1099-INT  Interest Income
1 Interest income
122.98
1099-MISC  Miscellaneous Information
3 Other income
190.13
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-3146ed38abf7cf58bf8a5b6d,v11-CONSOLIDATED_1099-stacked,original,2023,fgen-6afc28241da3df3b14f93537,synthetic_programmatic_template,stacked,top,False,div_int_detail
"Clearwater Investing
Account
XXXXX3231
Recipient
Olivia Walsh
Payer's Federal ID number
90-2121934
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 28
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
7,069.84
1b Qualified dividends
4,293.25
2a Total capital gain distributions
1,495.01
1099-INT  Interest Income
1 Interest income
562.06
1099-MISC  Miscellaneous Information
3 Other income
57.89
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-2cb1b5c7d02071939de56048,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-2a9cebefd59546d89415ce39,synthetic_programmatic_template,stacked,none,False,div_int_detail
"Tax Reporting Statement
Summit Investments
Account
ending in 3738
Recipient
Amara L. Larsen
Payer's Federal ID number
49-3378501
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 9
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
8,642.61
1b Qualified dividends
3,079.74
2a Total capital gain distributions
2,968.75
1099-INT  Interest Income
1 Interest income
451.57
1099-MISC  Miscellaneous Information
3 Other income
106.52
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-71eb1c5aa0f8085c167d2ef5,v11-CONSOLIDATED_1099-stacked,original,2025,fgen-ae93449c1833a34564e1d012,synthetic_programmatic_template,stacked,top,False,div_int_detail
"2023 Tax Information Statement
Clearwater Investing
Account
***-**-1665
Recipient
Sofia Castillo
Payer's Federal ID number
96-6746140
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 8
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
6,882.55
1b Qualified dividends
3,056.06
2a Total capital gain distributions
1,137.87
1099-INT  Interest Income
1 Interest income
106.76
1099-MISC  Miscellaneous Information
3 Other income
66.21
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
49,354.81
19,981.93
0.00
1,036.85
Long
D (basis reported to the IRS)
43,437.45
44,380.65
0.00
25,540.46
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-e8a8558b1552dedcda23f6b6,v11-CONSOLIDATED_1099-stacked,original,2023,fgen-3e6d44690e56009ddc311fbb,synthetic_programmatic_template,stacked,top,False,summary_page
"Form 1099 Composite & Year-End Summary
Clearwater Investing
Account
***-**-8678
Recipient
Avery B. Patel
Payer's Federal ID number
27-1975607
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 21
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
5,925.58
1b Qualified dividends
4,877.21
2a Total capital gain distributions
525.62
1099-INT  Interest Income
1 Interest income
439.81
1099-MISC  Miscellaneous Information
3 Other income
144.86
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-deff2147f28ec37af0856564,v11-CONSOLIDATED_1099-stacked,original,2021,fgen-3bf7ce1bb815f6be76db6ab8,synthetic_programmatic_template,stacked,top,False,div_int_detail
"2026 Consolidated Form 1099
Northstar Securities
Account
***-**-7515
Recipient
Olivia K. Testcase
Payer's Federal ID number
89-3195365
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 25
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
7,984.09
1b Qualified dividends
6,876.99
2a Total capital gain distributions
126.85
1099-INT  Interest Income
1 Interest income
656.84
1099-MISC  Miscellaneous Information
3 Other income
1.51
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
12,292.53
40,387.22
0.00
8,647.24
Long
D (basis reported to the IRS)
85,738.73
72,756.69
0.00
26,685.85
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-40d43f88f4ef9d42ee7e6396,v11-CONSOLIDATED_1099-stacked,original,2026,fgen-f74e6da756406f76fd656d41,synthetic_programmatic_template,stacked,top,False,summary_page
"Tax Reporting Statement
Ironwood Wealth Partners
Account
XXX-XX-2079
Recipient
Mateo A. Moreau
Payer's Federal ID number
50-8566713
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 23
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
5,400.62
1b Qualified dividends
7,333.99
2a Total capital gain distributions
2,623.05
1099-INT  Interest Income
1 Interest income
462.88
1099-MISC  Miscellaneous Information
3 Other income
59.37
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-f2c36ebb695a4bc036d3a187,v11-CONSOLIDATED_1099-stacked,original,2023,fgen-65e329e4e5304d4100b79dc8,synthetic_programmatic_template,stacked,top,False,div_int_detail
"2026 Tax Information Statement
Summit Investments
Account
****1545
Recipient
Lena R. Lindqvist
Payer's Federal ID number
93-7874498
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 21
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
80,544.54
21,964.37
0.00
8,740.85
Long
D (basis reported to the IRS)
47,202.85
41,481.92
0.00
25,158.23
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-533eb1ba461e22e8d71ee97d,v11-CONSOLIDATED_1099-stacked,original,2026,fgen-52a9f88a86878dd96f85578e,synthetic_programmatic_template,stacked,top,False,b_detail
"2022 Tax Information Statcment
Summit Investments
Account
XXXXX3480
Recipient
Avery Larsen
Payer's Federal ID number
96-4508668
Copy B for Recipient  0MB No. 1545-O715
Pagc 1 of 9
1099-DIV  Dividendsand Distributions
1a Total ordinary dividends
5,777.15
1b Qualified dividends
2,463.88
2a Total capital gain distributions
1,985.05
1099-INT  Interest Income
1Interest income
92.63
1099-MISC  Miscellaneous Information
3 0ther income
14O.78
This is important tax information and is being fumished to the Intemal Revenue Service.",1099,5,1099,fdc-049e11c1d61f15103e8505b0,v11-CONSOLIDATED_1099-stacked,original,2022,fgen-a909d6ddf8fdcc08df484f14,synthetic_programmatic_template,stacked,top,True,div_int_detail
"2026 Consolidated Form 1099
Summit Investments
Account
XXX-XX-2474
Recipient
Noah Romero
Payer's Federal ID number
82-3788904
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 22
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
35,844.86
4,045.80
0.00
-3,404.49
Long
D (basis reported to the IRS)
56,612.86
34,755.24
0.00
29,986.67
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-acd1679283f1117662bcfa9d,v11-CONSOLIDATED_1099-stacked,original,2026,fgen-a82a889f6d2bcdaac447601c,synthetic_programmatic_template,stacked,top,False,b_detail
"Form 1099 Composite & Year-End Summary
Clearwater Investing
Account
****2209
Recipient
Wei B. Okafor
Payer's Federal ID number
74-3853626
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 28
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
40,538.92
66,980.17
0.00
6,273.07
Long
D (basis reported to the IRS)
63,286.34
43,236.81
0.00
16,066.89
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-ef60c331065a2236271bd177,v11-CONSOLIDATED_1099-stacked,original,2022,fgen-f16e8d8cc5d4cfb68af06100,synthetic_programmatic_template,stacked,top,False,b_detail
"Tax Reporting Statement
Ironwood Wealth Partners
Account
****8470
Recipient
Fatima K. Lindqvist
Payer's Federal ID number
30-2857297
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 10
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
8,183.73
1b Qualified dividends
1,217.03
2a Total capital gain distributions
359.00
1099-INT  Interest Income
1 Interest income
896.51
1099-MISC  Miscellaneous Information
3 Other income
151.31
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
56,481.19
89,854.86
0.00
-4,060.13
Long
D (basis reported to the IRS)
11,259.27
6,304.39
0.00
8,385.77
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-647e8209a49446de529c7ab6,v11-CONSOLIDATED_1099-stacked,original,2021,fgen-3739d550b386548c63f6732b,synthetic_programmatic_template,stacked,top,False,summary_page
"Ironwood Wealth Partners
Account
****4193
Recipient
Taylor Testcase
Payer's Federal ID number
94-8139961
Copy B for Recipient OMB No. 1545-O715
Page 1 of 26
1099-DIV  Dividends and Distributions
1a Totalordinary dividends
6,362.25
1b Qualified dividcnds
1,964.93
2a Total capital gain distributions
1,299.00
1099-INT  Interest Income
1 Interest income
881.92
1099-MISC  Miscellaneous Informatíon
3 Other income
188.82
1O99-B  Summary of Proceeds, Gains & Losses, Adjustments and Withho1ding
Term  Form 8949 type Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
84,595.95
77,262.42
0.00
2,929.72
Long
D (basis rcported to the IR5)
63,446.l5
2,378.31
0.00
6,265.10
This is important tax information and is bcing fumished to the Internal Revenue 5ervice.",1099,5,1099,fdc-d7199b4932b32f51393687fc,v11-CONSOLIDATED_1099-stacked,original,2025,fgen-eaa40222d529ff215e3382dd,synthetic_programmatic_template,stacked,none,True,summary_page
"Tax Reporting Statement
Clearwater Investing
Account
XXXXX5221
Recipient
Kwame E. Kowalski
Payer's Federal ID number
43-5575895
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 15
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
840.12
1b Qualified dividends
5,448.00
2a Total capital gain distributions
2,145.34
1099-INT  Interest Income
1 Interest income
728.83
1099-MISC  Miscellaneous Information
3 Other income
83.03
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-8668e815e3b5d5da28157a1d,v11-CONSOLIDATED_1099-stacked,original,2025,fgen-566378f01d6c5829edc5a0aa,synthetic_programmatic_template,stacked,top,False,div_int_detail
"Northstar Securities
Account
ending in 3631
Recipient
Amara Castillo
Payer's Federal ID number
51-7447020
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 29
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
4,884.15
1b Qualified dividends
5,741.91
2a Total capital gain distributions
2,983.11
1099-INT  Interest Income
1 Interest income
760.78
1099-MISC  Miscellaneous Information
3 Other income
21.94
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
46,940.57
35,298.96
0.00
-708.67
Long
D (basis reported to the IRS)
48,422.33
7,525.95
0.00
9,244.61
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-53801fecc8af5bac78e746e2,v11-CONSOLIDATED_1099-stacked,original,2021,fgen-dba2dd9306d54d7b2b66d78a,synthetic_programmatic_template,stacked,none,False,summary_page
"Clearwater Investing
Account
XXX-XX-9649
Rccipient
Hiro Wa1sh
Payer's Federal ID number
47-l62819O
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 30
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
5,317.03
1b Qualified dividends
2,833.94
2a Total capital gain distributions
1,355.28
1099-INT  Interest Income
1 Interest income
494.92
1O99-MI5C  Miscellaneous Informatíon
3 Other income
101.74
1099-B  5ummary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gainor loss
5hort
A(basis reported to the IRS)
67,174.19
38,446.95
0.00
2,025.87
Long
D (basís reportedto the IRS)
60,578.14
19,080.47
0.00
5,909.18
This is important tax information and is bcing fumished to the Internal Revenue Service.
Form 1099 Composite & Year-End Summary",1099,5,1099,fdc-16d54849856ed3b7de643e9d,v11-CONSOLIDATED_1099-stacked,original,2026,fgen-67c8ee19cd63b91ea24b392b,synthetic_programmatic_template,stacked,bottom,True,summary_page
"2024 Tax Information Statement
Summit Investments
Account
***-**-7309
Recipient
Fatima L. Rivera
Payer's Federal ID number
32-9492927
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 25
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
3,474.44
1b Qualified dividends
2,989.84
2a Total capital gain distributions
2,148.87
1099-INT  Interest Income
1 Interest income
587.12
1099-MISC  Miscellaneous Information
3 Other income
86.77
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
50,120.31
72,813.65
0.00
2,183.40
Long
D (basis reported to the IRS)
39,694.06
49,222.79
0.00
303.64
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-0c65c352a354f11b0dbb8a81,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-d3df43bcef05f5f77e45cffd,synthetic_programmatic_template,stacked,top,False,summary_page
"2024 Tax Information Statement
Clearwater Investing
Account
ending in 8532
Recipient
Taylor Romero
Payer's Federal ID number
79-1757209
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 22
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
2,679.56
1bQualified dividends
4,802.70
2a Tota1 capital gain distributions
2,180.65
1099-INT  Interest Income
1 Interest income
53.59
1099-MI5C  Miscellaneous Information
3 0ther income
32.88
1099-B 5ummary of Procceds, Gains &Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
5hort
A (basis reported to the IRS)
83,250.65
62,346.83
0.00
6,401.40
Long
D (basis reported to the IRS)
50,641.53
58,832.36
0.00
10,984.24
This is important tax information and is being fumished to the Intemal Revenue 5ervice.",1099,5,1099,fdc-002a232171fae1596eab673e,v11-CONSOLIDATED_1099-stacked,original,2024,fgen-28363011e83ce1a52dcd00aa,synthetic_programmatic_template,stacked,top,True,summary_page
"Form 1099 Composite & Year-End Summary
Clearwater Investing
Account
***-**-4789
Recipient
Riley Larsen
Payer's Federal ID number
37-6215465
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 14
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
98.23
1b Qualified dividends
4,372.27
2a Total capital gain distributions
2,315.10
1099-INT  Interest Income
1 Interest income
642.42
1099-MISC  Miscellaneous Information
3 Other income
114.96
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
23,884.89
13,510.54
0.00
8,710.06
Long
D (basis reported to the IRS)
78,831.22
26,618.36
0.00
-3,535.60
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-a55c11a103e2cea207fe43a7,v11-CONSOLIDATED_1099-stacked,original,2021,fgen-ad754b4c89455bd76b34b8a4,synthetic_programmatic_template,stacked,top,False,summary_page
"2026 Tax Information Statement
Northstar Securities
Account
ending in 2785
Recipient
Jamie Nguyen
Payer's Federal ID number
16-7411428
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 11
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short
A (basis reported to the IRS)
38,630.60
26,987.09
0.00
7,146.65
Long
D (basis reported to the IRS)
14,245.17
19,690.04
0.00
20,697.68
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-20dda6a6beb522b37d1c9cf1,v11-CONSOLIDATED_1099-stacked,original,2026,fgen-51aed9c3bfd829887ba48939,synthetic_programmatic_template,stacked,top,False,b_detail
"2023 Consolidated Form 1099
Ironwood Wealth Partners
Account
XXXXX0141
Recipient
Amara Nguyen
Payer's Federal ID number
21-5351975
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 11
1099-DIV  Dividends and Distributions
1a Total ordinary dividends
4,991.84
1b Qualified dividends
6,519.23
2a Total capital gain distributions
2,389.89
1099-INT  Interest Income
1 Interest income
102.16
1099-MISC  Miscellaneous Information
3 Other income
5.65
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-386f63e11fb76c0baf947914,v11-CONSOLIDATED_1099-stacked,original,2023,fgen-83eac4ab0d3eea2438bf881c,synthetic_programmatic_template,stacked,top,False,div_int_detail
"Tax Reporting Statement
Evergreen Brokerage 5ervices
Account  ***-**-2156
Recipient  Wei M. Testcase
Payer's Federal ID number  15-5753350
Copy B for Recipient  OMB No. l545-0715
Page 3 of 16
1099-B  Summary of Proceeds,Gains & Losses, Adjustments andWithho1ding
Term Form 8949 type Proceeds Cost basis Wash sa1e loss disallowed Net gain or loss
Short A (basis reported to the IRS) 2,268.01 42,764.92 0.00 4O5.98
Long D (basis reported to the IRS) 3,0l0.86 67,984.74 0.00 15,648.40
This is important tax information and is being fumished to the Interna1 Revenue Service.",1099,5,1099,fdc-ed1edfe363bdae19781ec633,v11-CONSOLIDATED_1099-inline,original,2026,fgen-eaa2795279635c65c8c73381,synthetic_programmatic_template,inline,top,True,b_detail
"Summit Investments
Account   ***-**-6032
Recipient Diego Haddad
Payer's Federal ID number   57-9599487
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 10
1099-DIV  Dividends and Distributions
1a Total ordinary dividends      8,570.36
1b Qualified dividends 5,095.80
2a Total capital gain distributions  1,113.62
1099-INT  Interest Income
1 Interest income      102.42
1099-MISC  Miscellaneous Information
3 Other income      118.15
This is important tax information and is being furnished to the Internal Revenue Service.
Form 1099 Composite & Year-End Summary",1099,5,1099,fdc-9affbe1296e97570010690c3,v11-CONSOLIDATED_1099-inline,original,2024,fgen-00856409fe4034d44f26cb8d,synthetic_programmatic_template,inline,bottom,False,div_int_detail
"Form 1099 Composite & Year-End Summary
Evergreen Brokerage Services
Account      ****4104
Recipient Hiro Patel
Payer's Federal ID number   80-4073339
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 12
1099-DIV  Dividends and Distributions
1a Total ordinary dividends  38.37
1b Qualified dividends 5,374.83
2a Total capital gain distributions 1,253.15
1099-INT  Interest Income
1 Interest income   357.33
1099-MISC  Miscellaneous Information
3 Other income   73.35
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-ef5cd581b2465c015baba462,v11-CONSOLIDATED_1099-inline,original,2024,fgen-da5481484b382550518f3186,synthetic_programmatic_template,inline,top,False,div_int_detail
"2021 Tax Information Statement
Ironwood Wealth Partners
Account   XXXXX5515
Recipient Sofia Romero
Payer's Federal ID number 89-1393590
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 11
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss
Short      A (basis reported to the IRS)      67,302.41      14,068.91      0.00      6,485.94
Long  D (basis reported to the IRS)  55,925.01  28,460.60  0.00  26,189.29
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-ae1f4d3899db5c23422377f3,v11-CONSOLIDATED_1099-inline,original,2021,fgen-53444a6150a3d7c659761bc9,synthetic_programmatic_template,inline,top,False,b_detail
"Form 1099 Composite & Year-End Summary
Evergreen Brokerage Services
Account      XXXXX3393
Recipient Morgan Rivera
Payer's Federal ID number 37-1962702
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 22
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss
Short   A (basis reported to the IRS)   51,069.72   29,209.62   0.00   1,800.64
Long      D (basis reported to the IRS)      36,840.38      18,982.84      0.00      -2,641.51
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-3aedb863acf67ef8d16c93c7,v11-CONSOLIDATED_1099-inline,original,2023,fgen-5ae881340eb5cc897becd7a5,synthetic_programmatic_template,inline,top,False,b_detail
"Clearwater Investing
Account      XXXXX6268
Recipient Priya Brennan
Payer's Federal ID number 21-4925236
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 10
1099-DIV  Dividends and Distributions
1a Total ordinary dividends 6,108.44
1b Qualified dividends  5,612.78
2a Total capital gain distributions   1,474.56
1099-INT  Interest Income
1 Interest income  424.55
1099-MISC  Miscellaneous Information
3 Other income  175.39
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss
Short A (basis reported to the IRS) 15,488.25 51,862.56 0.00 -925.52
Long D (basis reported to the IRS) 34,250.71 60,130.64 0.00 5,196.09
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-57a628a62ebfaa71d9bc068b,v11-CONSOLIDATED_1099-inline,original,2023,fgen-2526aecea3fafb8a0253948a,synthetic_programmatic_template,inline,none,False,summary_page
"2023 Consolidated Form 1099
Ironwood Wealth Partners
Account XXXXX7353
Recípient  Mateo C. Castillo
Payer's Federal ID number 93-6995518
Copy B for Recipient  OMB No. 1545-0715
Page l of 14
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term   Form 8949 type  Proceeds   Cost basis   Wash sa1e 1oss disallowed  Net gain or 1oss
Short A (basis reported to the IRS) 66,583.52 58,091.23 0.00 8,469.91
Long D (basis reported to the IRS) 84,013.90 7,058.78 0.00 8,111.67
This is important tax information and isbeing fumished to the Intemal Revenue Service.",1099,5,1099,fdc-f5641df2a327cf1316b3c1f2,v11-CONSOLIDATED_1099-inline,original,2023,fgen-be77ed33d31d6e33aa7c398a,synthetic_programmatic_template,inline,top,True,b_detail
"Northstar Securities
Account XXX-XX-0920
Recipient      Priya B. Sato
Payer's Federal ID number 70-9676814
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 24
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss
Short A (basis reported to the IRS) 45,585.52 23,330.63 0.00 -4,162.30
Long   D (basis reported to the IRS)   83,972.77   33,417.93   0.00   29,139.61
This is important tax information and is being furnished to the Internal Revenue Service.
2025 Tax Information Statement",1099,5,1099,fdc-52553c98a561fabb6fca2e2e,v11-CONSOLIDATED_1099-inline,original,2025,fgen-cda8108486be805946d0c7f4,synthetic_programmatic_template,inline,bottom,False,b_detail
"Form 1099 Composite & Year-End Summary
Ironwood Wealth Partners
Account XXX-XX-1213
Recipient  Alex Castillo
Payer's Federal ID number   48-4425322
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 17
1099-DIV  Dividends and Distributions
1a Total ordinary dividends 7,489.58
1b Qualified dividends  4,515.34
2a Total capital gain distributions   1,099.36
1099-INT  Interest Income
1 Interest income   573.89
1099-MISC  Miscellaneous Information
3 Other income 20.08
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-a42d4810fc61afc14195a76d,v11-CONSOLIDATED_1099-inline,original,2026,fgen-557693d6179652fb72bba664,synthetic_programmatic_template,inline,top,False,div_int_detail
"2023 Tax Information Statement
Clearwater Investing
Account XXXXX7841
Recipient Riley Walsh
Payer's Federal ID number  27-7320589
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 16
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term      Form 8949 type      Proceeds      Cost basis      Wash sale loss disallowed      Net gain or loss
Short      A (basis reported to the IRS)      13,644.82      76,654.05      0.00      8,562.61
Long D (basis reported to the IRS) 44,362.04 4,156.92 0.00 13,214.05
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-ffe03a65e9aab160f772b80c,v11-CONSOLIDATED_1099-inline,original,2023,fgen-48e36dd856220f59148ad625,synthetic_programmatic_template,inline,top,False,b_detail
"2024 Tax Information Statement
Summit Investments
Account   XXX-XX-0505
Recipient      Wei K. Testcase
Payer's Federal ID number   31-8878519
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 13
1099-DIV  Dividends and Distributions
1a Total ordinary dividends 4,384.66
1b Qualified dividends      6,425.05
2a Total capital gain distributions   266.06
1099-INT  Interest Income
1 Interest income   303.09
1099-MISC  Miscellaneous Information
3 Other income  46.13
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short   A (basis reported to the IRS)   38,893.67   11,920.33   0.00   -1,849.96
Long   D (basis reported to the IRS)   3,632.49   26,828.38   0.00   342.23
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-9d84595e11fa96751708f1b3,v11-CONSOLIDATED_1099-inline,original,2024,fgen-4a29f91c90519a28402ab820,synthetic_programmatic_template,inline,top,False,summary_page
"Tax Reporting Statement
Summit Investments
Account  ending in 0992
Recipient     Priya Testcase
Payer's FederalID number   30-8524875
Copy B for Recípient  OMB No. 1545-0715
Page 3 of 9
1099-DIV  Dividends and Distributions
1a Tota1 ordinary dividends      426.62
1b Qua1ífied dividends      5,365.09
2a Total capital gain distributions  589.23
1099-INT  Interest Income
1 Interest income   681.37
1099-MI5C  Miscellaneous Information
3 0ther income      75.92
1O99-B  5ummary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949type Proceeds Cost basis Wash sale loss disallowed Net gain or loss
Short A (basis reported to the IRS) 40,050.51 57,002.52 0.00 2,847.79
Long  D (basis reported to the IRS)   46,831.79   25,624.49   0.00   13,576.00
Thís is important taxinformation and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-591999eb16dc1522a2c8fc4c,v11-CONSOLIDATED_1099-inline,original,2025,fgen-51b040c24126c50de7ad600d,synthetic_programmatic_template,inline,top,True,summary_page
"2022 Consolidated Form 1099
Ironwood Wealth Partners
Account      ending in 4584
Recipient      Olivia R. Lindqvist
Payer's Federal ID number   31-9419482
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 12
1099-DIV  Dividends and Distributions
1a Total ordinary dividends  7,175.70
1b Qualified dividends  4,737.67
2a Total capital gain distributions 889.47
1099-INT  Interest Income
1 Interest income      171.54
1099-MISC  Miscellaneous Information
3 Other income      109.05
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-5a13269afe57c41320665f3d,v11-CONSOLIDATED_1099-inline,original,2022,fgen-815630cc76b50081e05f40e1,synthetic_programmatic_template,inline,top,False,div_int_detail
"2026 Tax Information Statement
Evergreen Brokerage Services
Account ending in 9411
Recipient Sofia Patel
Payer's Federal ID number   68-9439084
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 10
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss
Short A (basis reported to the IRS) 81,471.65 55,241.54 0.00 194.18
Long D (basis reported to the IRS) 16,940.55 22,910.37 0.00 8,286.28
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-3ffef83ae185a20e01be4102,v11-CONSOLIDATED_1099-inline,original,2026,fgen-47a4f6a2c238b552b4a9aa3e,synthetic_programmatic_template,inline,top,False,b_detail
"2025 Consolidated Form 1099
Clearwater Investing
Account      XXX-XX-6532
Recipient   Alex J. Rivera
Payer's Federal ID number      94-7615177
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 26
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term   Form 8949 type   Proceeds   Cost basis   Wash sale loss disallowed   Net gain or loss
Short      A (basis reported to the IRS)      62,021.80      24,586.93      0.00      -4,981.30
Long   D (basis reported to the IRS)   20,354.07   36,796.60   0.00   18,140.33
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-1384ee33c2cf16c9d8897cb6,v11-CONSOLIDATED_1099-inline,original,2025,fgen-2841ea69951d454884961e28,synthetic_programmatic_template,inline,top,False,b_detail
"2024 Tax Information Statement
Clearwater Investing
Account ending in 9163
Recipient Wei Walsh
Payer's Federal ID number 73-5459807
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 22
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term   Form 8949 type   Proceeds   Cost basis   Wash sale loss disallowed   Net gain or loss
Short  A (basis reported to the IRS)  54,102.13  65,463.66  0.00  -3,523.34
Long D (basis reported to the IRS) 46,132.98 68,846.87 0.00 20,030.09
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-2cc89ccfc9590bb91f8fa6d4,v11-CONSOLIDATED_1099-inline,original,2024,fgen-69a94bed4c1f84ba498d3dae,synthetic_programmatic_template,inline,top,False,b_detail
"Northstar 5ecurities
Account  XXXXX1780
Recipient Wei J. Castillo
Payer's FederalID number 25-2571908
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 17
1099-DIV  Dividends and Distributions
1a Total ordinary dividends  4,574.85
1b Qualified dividends      1,696.15
2a Total capital gain distributions  1,385.04
1099-INT Interest Income
1 Interest income      836.48
1099-MISC  Miscellaneous Informatíon
3 Other íncome 132.93
This is important tax information and is being furnished to the Interna1 Revenue Service.",1099,5,1099,fdc-18569a48f9595e88f2b7679e,v11-CONSOLIDATED_1099-inline,original,2025,fgen-edc33aba123f5eaeb9d9d8d1,synthetic_programmatic_template,inline,none,True,div_int_detail
"2022 Consolidated Form 1099
Evergreen Brokerage Services
Account XXXXX3434
Recipient   Amara Lindqvist
Payer's Federal ID number   31-6655038
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 26
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss
Short A (basis reported to the IRS) 2,938.79 33,104.40 0.00 1,985.83
Long  D (basis reported to the IRS)  71,319.36  67,287.96  0.00  -2,572.69
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-e61cf7e810d20754e82675b1,v11-CONSOLIDATED_1099-inline,original,2022,fgen-875eca47e8f8c28e95b14003,synthetic_programmatic_template,inline,top,False,b_detail
"Form 1099 Composite & Year-End Summary
Evergreen Brokerage Services
Account XXXXX3635
Recipient  Jamie Okafor
Payer's Federal ID number  36-9455626
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 14
1099-DIV  Dividends and Distributions
1a Total ordinary dividends 7,161.38
1b Qualified dividends 4,265.01
2a Total capital gain distributions  2,466.23
1099-INT  Interest Income
1 Interest income   33.51
1099-MISC  Miscellaneous Information
3 Other income      168.63
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-d897e15691730794fdef73ad,v11-CONSOLIDATED_1099-inline,original,2025,fgen-5ae26a667c9d0a2a729fb4fc,synthetic_programmatic_template,inline,top,False,div_int_detail
"Tax Reporting Statement
Clearwater Investing
Account  ***-**-9633
Recipient  Hiro Romero
Payer's Federal ID number      13-3185534
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 10
1099-DIV  Dividends and Distributions
1a Total ordinary dividends  6,065.20
1b Qualified dividends 5,059.24
2a Total capital gain distributions 1,142.14
1099-INT  Interest Income
1 Interest income 379.54
1099-MISC  Miscellaneous Information
3 Other income  189.20
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term   Form 8949 type   Proceeds   Cost basis   Wash sale loss disallowed   Net gain or loss
Short A (basis reported to the IRS) 13,507.74 63,264.52 0.00 7,257.84
Long  D (basis reported to the IRS)  55,186.56  39,724.95  0.00  -815.58
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-336473fabac388d769cd3798,v11-CONSOLIDATED_1099-inline,original,2024,fgen-4f1cbea5e88358ca85fc3ac7,synthetic_programmatic_template,inline,top,False,summary_page
"Ironwood Wealth Partners
Account ending in 8729
Recipient      Lena Tanaka
Payer's Federal ID number 58-9414166
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 26
1099-DIV  Dividends and Distributions
1a Total ordinary dividends      1,131.67
1b Qualified dividends  736.12
2a Total capital gain distributions  1,495.70
1099-INT  Interest Income
1 Interest income 50.99
1099-MISC  Miscellaneous Information
3 Other income   95.78
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-26a6c148879902ffb775ccf9,v11-CONSOLIDATED_1099-inline,original,2021,fgen-0dd2e1a5ae5c935ead22bfde,synthetic_programmatic_template,inline,none,False,div_int_detail
"2024 Consolidated Form 1O99
Summit Investments
Account      ending in 9159
Rccipient Olivia Moreau
Payer's Federal ID number      82-1579257
Copy B for Recipient  0MB No. l545-0715
Page 2 of 19
1099-DIV  Dividcnds and Distributions
1a Total ordinarydividends 3,467.47
1bQualified dividends 3,681.98
2a Total capital gain distributions 499.01
1099-INT  InterestIncome
1 Interest íncome   723.61
1099-MISC  Miscellaneous Information
3 Other income 91.82
1099-B  Summary of Proceeds,Gains & Losses, Adjustments and Withholding
Term     Form 8949 type      Proceeds      Cost basis      Wash sale loss disallowed      Net gain or 1oss
5hort A (basis reported to the IR5) 85,091.25 86,569.63 0.00 -1,036.83
Long D (basis reported to the IRS) 82,087.06 10,081.22 0.00 28,963.97
This is important tax information and is being fumished to the Internal Revenue Service.",1099,5,1099,fdc-45a75b18b3d1976b3f48c1d5,v11-CONSOLIDATED_1099-inline,original,2024,fgen-f07471751a545e58c1161459,synthetic_programmatic_template,inline,top,True,summary_page
"2022 Consolidated Form 1099
Clearwater Investing
Account      XXX-XX-8153
Recipient Diego Nguyen
Payer's Federal ID number  91-2020273
Copy B for Recipient  0MB No. 1545-O7l5
Page 3 of 29
1099-DIV  Dividends and Distributíons
1a Total ordinary dividends   7,585.92
1b Qualified dividends   7,943.9O
2a Total capital gain distributions 1,588.63
1O99-INT  Intcrest Income
1 Interest income 482.9O
1099-MI5C Miscellaneous Information
3 Other income   77.22
1099-B  Summaryof Proceeds, Gains & Losses, Adjustments and Withholding
Term      Form 8949 type     Proceeds      Cost basis      Wash sale loss disallowed      Net gain or loss
Short A (basis reported tothe IRS) 82,030.09 4,273.19 0.00 4,726.62
Long  D (basis reported to thc IRS)  74,364.27  70,609.22  0.00  29,959.25
Thís is important tax information and is bcing fumished to theInternal Revenue Service.",1099,5,1099,fdc-28de776fd73d3b26b280e4b9,v11-CONSOLIDATED_1099-inline,original,2022,fgen-eaa80201105e09194917b716,synthetic_programmatic_template,inline,top,True,summary_page
"2024 Tax Information Statement
Evergreen Brokcrage Services
Account     ending in 3030
Recipient   Casey Fischer
Payer's Federal ID number   77-9485875
Copy B for Rccipient  OMB No. l545-0715
Page 2 of 11
1099-DIV  Dividends and Distributions
1a Total ordinary dividends      3,322.25
1b Qualified dividends      7,154.12
2a Total capital gain distributions 425.6O
1O99-INT  Interest Incomc
1 Interestincome      3.60
1099-MISC  Miscellaneous Information
3 Other income   l44.46
1099-B  5ummary of Proceeds, Gains & Losses, Adjustments and Withholding
Term      Form 8949 type     Proceeds      Cost basis    Wash sale loss disallowed     Net gain or loss
Short A (basis reported to the IRS) 65,813.55 10,393.48 0.00 4,316.37
Long D (basis reported to the IRS) 115.02 11,950.05 0.00 19,211.86
This is important tax information and is being fumished to the Intemal Revenue Servíce.",1099,5,1099,fdc-4bfe42e28a236511cc1eca18,v11-CONSOLIDATED_1099-inline,original,2024,fgen-5fb31ce13d0083675a9aac59,synthetic_programmatic_template,inline,top,True,summary_page
"2022 Tax Information Statement
Summit Investments
Account ****7829
Recipient  Riley Adeyemi
Payer's Federal ID number  13-2076186
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 30
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term   Form 8949 type   Proceeds   Cost basis   Wash sale loss disallowed   Net gain or loss
Short   A (basis reported to the IRS)   19,452.14   13,209.22   0.00   -1,278.60
Long D (basis reported to the IRS) 78,126.21 87,482.71 0.00 24,178.55
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-4bb7840345fbdabdbd821d28,v11-CONSOLIDATED_1099-inline,original,2022,fgen-eb7588c35b3989aaa8b38e7f,synthetic_programmatic_template,inline,top,False,b_detail
"Tax Reporting Statement
Clearwater Investing
Account ****5165
Recipient  Jamie R. Tanaka
Payer's Federal ID number 82-3988837
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 8
1099-DIV  Dividends and Distributions
1a Total ordinary dividends      3,300.31
1b Qualified dividends  736.12
2a Total capital gain distributions 2,240.36
1099-INT  Interest Income
1 Interest income  746.84
1099-MISC  Miscellaneous Information
3 Other income  118.96
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term   Form 8949 type   Proceeds   Cost basis   Wash sale loss disallowed   Net gain or loss
Short   A (basis reported to the IRS)   11,294.72   29,817.75   0.00   -1,374.41
Long D (basis reported to the IRS) 87,568.33 49,645.76 0.00 -3,054.75
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-ca121e34077c3ae947230182,v11-CONSOLIDATED_1099-inline,original,2026,fgen-0886657f948058b58892be62,synthetic_programmatic_template,inline,top,False,summary_page
"2022 Consolidated Form 1099
Summit Investments
Account  ****9894
Recipient Noah K. Haddad
Payer's Federal ID number   94-5701278
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 14
1099-DIV  Dividends and Distributions
1a Total ordinary dividends  2,481.89
1b Qualified dividends  4,871.31
2a Total capital gain distributions 1,509.59
1099-INT  Interest Income
1 Interest income 73.74
1099-MISC  Miscellaneous Information
3 Other income      157.47
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term   Form 8949 type   Proceeds   Cost basis   Wash sale loss disallowed   Net gain or loss
Short A (basis reported to the IRS) 63,684.82 62,024.87 0.00 3,361.08
Long   D (basis reported to the IRS)   86,072.49   57,479.71   0.00   25,029.62
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-44a7bb1589467f312a009338,v11-CONSOLIDATED_1099-inline,original,2022,fgen-5351a55ba57540f3afbbc716,synthetic_programmatic_template,inline,top,False,summary_page
"2023 Consolidated Form 1099
Ironwood Wealth Partners
Account  XXXXX9226
Recipient   Olivia Lindqvist
Payer's Federal ID number 95-6585218
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 28
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term      Form 8949 type      Proceeds      Cost basis      Wash sale loss disallowed      Net gain or loss
Short A (basis reported to the IRS) 12,598.67 77,501.37 0.00 1,302.51
Long   D (basis reported to the IRS)   80,283.99   45,650.04   0.00   8,533.09
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-5f0562111b02e976e89ee4e3,v11-CONSOLIDATED_1099-inline,original,2023,fgen-be5ce7c622e31039b984d6f1,synthetic_programmatic_template,inline,top,False,b_detail
"Form 1099 Composite & Year-End Summary
Summit Investments
Account      XXXXX9458
Recipient Mateo E. Kowalski
Payer's Federal ID number   92-6650986
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 15
1099-DIV  Dividends and Distributions
1a Total ordinary dividends 60.46
1b Qualified dividends      4,151.07
2a Total capital gain distributions      25.71
1099-INT  Interest Income
1 Interest income      620.92
1099-MISC  Miscellaneous Information
3 Other income 189.17
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short      A (basis reported to the IRS)      49,359.29      48,444.55      0.00      7,491.51
Long      D (basis reported to the IRS)      444.15      26,787.07      0.00      28,346.77
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-f682534a26f78ee68dbd3da7,v11-CONSOLIDATED_1099-inline,original,2022,fgen-fabf9199e64c277d22d94684,synthetic_programmatic_template,inline,top,False,summary_page
"Form 1099 Composite & Year-End Summary
Evergreen Brokerage Services
Account XXX-XX-5963
Recipient Jordan Patel
Payer's Federal ID number 19-6539224
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 20
1099-DIV  Dividends and Distributions
1a Total ordinary dividends 6,076.68
1b Qualified dividends 6,549.59
2a Total capital gain distributions      2,992.92
1099-INT  Interest Income
1 Interest income      639.28
1099-MISC  Miscellaneous Information
3 Other income 93.70
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term      Form 8949 type      Proceeds      Cost basis      Wash sale loss disallowed      Net gain or loss
Short  A (basis reported to the IRS)  70,741.60  19,726.04  0.00  -3,681.07
Long D (basis reported to the IRS) 53,009.48 11,936.67 0.00 29,670.35
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-abd14059ed10b3b4efaab154,v11-CONSOLIDATED_1099-inline,original,2025,fgen-e5f0c54d05554fdc710b6add,synthetic_programmatic_template,inline,top,False,summary_page
"Northstar Securities
Account ****1181
Recipient  Priya M. Romero
Payer's Federal ID number 18-8459540
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 8
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
Short  A (basis reported to the IRS)  24,332.61  47,104.56  0.00  -3,105.87
Long  D (basis reported to the IRS)  36,869.23  56,497.71  0.00  5,066.75
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-f248c0113b7d6637852ab8d3,v11-CONSOLIDATED_1099-inline,original,2025,fgen-5df6d9d50d20c4ed36c81309,synthetic_programmatic_template,inline,none,False,b_detail
"Form 1099 Composite & Year-End Summary
Ironwood Wealth Partners
Account  XXXXX6708
Rccipient Mateo Okafor
Payer's Federal ID number  76-2347734
Copy B for Recipient  OMB No. l545-07l5
Page 2 of22
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term  Form 8949 type  Proceeds  Cost basis  Wash sale loss disallowed  Net gain or loss
5hort  A (basis rcported to the IRS)   18,878.59   49,818.79   0.00   3,198.37
Long D (basis rcported tothe IRS) 6,338.98 63,487.08 0.00 -4,172.63
This is important tax information and is being fumished to the Internal Revenue Service.",1099,5,1099,fdc-2fa08ceae440a794f968c990,v11-CONSOLIDATED_1099-inline,original,2021,fgen-36bda450b65aac34dbf537f6,synthetic_programmatic_template,inline,top,True,b_detail
"Evergreen Brokerage Services Account ****4009 Recipient Olivia L. Brennan Payer's Federal ID number 25-8571449 Copy B for Recipient OMB No. 1545-0715 Page 1 of 26 1099-DIV Dividends and Distributions 1a Total ordinary dividends 4,100.54 1b Qualified dividends 6,431.02 2a
Total capital gain distributions 2,093.80 1099-INT
Interest Income 1 Interest income 737.13 1099-MISC Miscellaneous Information 3 Other income 97.45 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-c31ecf5bf9f2fa9a4fd24e08,v11-CONSOLIDATED_1099-flat,original,2021,fgen-ededf350110b3a30ea791a69,synthetic_programmatic_template,flat,none,False,div_int_detail
"2024 Consolidated Form 1099 Summit Investments Account XXXXX8957 Recipient Taylor M. Rivera Payer's Federal ID number
47-3056716 Copy B for Recipient OMB No. 1545-0715 Page 3 of 13 1099-DIV Dividends and
Distributions 1a Total ordinary dividends 8,255.40 1b Qualified dividends 3,468.51 2a Total capital gain distributions 572.48 1099-INT Interest Income 1 Interest income 193.95 1099-MISC Miscellaneous Information 3 Other income 187.29 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-1226d63026c569c88b3b2d7b,v11-CONSOLIDATED_1099-flat,original,2024,fgen-7eba51b3772766587ffbe760,synthetic_programmatic_template,flat,top,False,div_int_detail
"2026 Consolidated Form 1099 Summit Investments Account XXXXX6133 Recipient Jamie D. Patel Payer's Federal ID number 34-5832064 Copy B for Recipient OMB No.
1545-0715 Page 1 of 21 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding
Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 24,973.00 28,808.56 0.00 2,941.63 Long D (basis reported to the IRS) 46,976.02 28,000.07 0.00 11,992.47 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-b21cf45cb05902279cfbda09,v11-CONSOLIDATED_1099-flat,original,2026,fgen-07bb7309422360bd7c113496,synthetic_programmatic_template,flat,top,False,b_detail
"Summit Investments
Account ****0809 Recipient Lena Okafor Payer's Federal ID number 85-3675733 Copy B for Recipient OMB No. 1545-0715 Page 1 of 11 1099-DIV Dividends and Distributions 1a Total ordinary dividends 6,085.84 1b Qualified dividends 1,756.32 2a Total capital gain distributions 2,635.68 1099-INT Interest Income 1 Interest income 181.65 1099-MISC Miscellaneous Information 3 Other income 122.00 This is important tax information and is being furnished to the Internal
Revenue Service.",1099,5,1099,fdc-e90d355a2b72df6986e5fd55,v11-CONSOLIDATED_1099-flat,original,2023,fgen-fd462431da1e35a784c47cc1,synthetic_programmatic_template,flat,none,False,div_int_detail
"2026 Tax Information Statement Evergreen Brokerage Services Account ***-**-8522
Recipient Morgan Rivera Payer's Federal ID number 51-8008472 Copy B for Recipient OMB No. 1545-0715 Page 2 of 28 1099-DIV Dividends and Distributions 1a Total ordinary dividends 6,542.76 1b Qualified dividends 975.41 2a Total capital gain distributions 199.62 1099-INT Interest Income 1 Interest income 328.05 1099-MISC Miscellaneous Information 3 Other income 190.48 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 10,187.64 51,731.63 0.00 1,523.88 Long D (basis reported to the
IRS) 59,755.39 7,155.08 0.00 27,945.00 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-140a429b0023e9a9b75044f6,v11-CONSOLIDATED_1099-flat,original,2026,fgen-9939f5217299f9cad268029c,synthetic_programmatic_template,flat,top,False,summary_page
"Form 1099 Composite
& Year-End Summary Clearwater Investing Account ***-**-6613 Recipient Diego Kowalski Payer's Federal ID number 22-9872451 Copy B for Recipient OMB No. 1545-0715 Page 3 of 27 1099-DIV Dividends and Distributions 1a Total ordinary dividends 3,551.17 1b Qualified dividends 4,431.50 2a Total capital gain distributions 1,523.90 1099-INT Interest Income 1 Interest income 118.43 1099-MISC Miscellaneous Information 3 Other income 30.38 This is important tax information and is being furnished to the
Internal Revenue Service.",1099,5,1099,fdc-bf42069d843057af3bae615b,v11-CONSOLIDATED_1099-flat,original,2023,fgen-f8ef26139c898971e9424eca,synthetic_programmatic_template,flat,top,False,div_int_detail
"Form 1099 Composite & Year-End Summary Clearwater Investing Account ****9442 Recipient Sofia Lindqvist Payer's Federal ID number 34-8567196 Copy B for Recipient OMB No. 1545-0715 Page 3 of 18 1099-DIV Dividends
and Distributions 1a Total ordinary dividends 149.66 1b Qualified dividends 3,612.49 2a
Total capital gain distributions 918.37 1099-INT Interest Income 1 Interest income 673.87 1099-MISC Miscellaneous Information 3 Other income 77.02 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-c637b8d953ae80f7b7de221d,v11-CONSOLIDATED_1099-flat,original,2025,fgen-7c214b96050c63b965bac709,synthetic_programmatic_template,flat,top,False,div_int_detail
"Form 1099 Composite & Year-End Summary Summit Investments Account XXX-XX-6100 Recipient Sofia
Tanaka Payer's Federal ID number 22-7436083 Copy B
for Recipient OMB No. 1545-0715 Page 2 of 21 1099-DIV Dividends and Distributions 1a Total ordinary dividends 6,287.75 1b Qualified dividends 660.64 2a Total capital gain distributions 1,930.37 1099-INT Interest Income 1 Interest income 464.42 1099-MISC Miscellaneous Information 3 Other income 60.43 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-b8910166311f08a7dfb60db9,v11-CONSOLIDATED_1099-flat,original,2022,fgen-967533667ce8b8a2acf68626,synthetic_programmatic_template,flat,top,False,div_int_detail
"Evergreen Brokerage
Services Account XXX-XX-8378 Recipient Priya Larsen Payer's Federal ID number 43-8305535 Copy B for Recipient OMB No. 1545-0715 Page 3 of 13
1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 29,429.96 8,858.18 0.00 -4,987.46 Long D (basis reported to the IRS) 82,680.82 75,746.72 0.00 3,369.32 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-754ed9bd83ebe667204fdb19,v11-CONSOLIDATED_1099-flat,original,2022,fgen-2aec9d5d1b40cc450da42c55,synthetic_programmatic_template,flat,none,False,b_detail
"Tax Reporting Statement Evergreen Brokerage Services Account XXXXX5924 Recipient Morgan
Okafor Paycr's Federal ID number 23-6292636 Copy B for Recipient OMB No. 1545-O715 Page 1 of 17 1099-DIV Dividends and Distributions 1aTotal ordinary dividends 1,545.45 1b Qualified dividends 3,920.71 2a Total capital gain distributions 2,252.46 1099-INT Intcrest Income 1 Interest income 188.O9 1099-MISC Miscellaneous Information 3 0ther income 63.80 1099-B Summaryof Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 33,O78.81 17,609.11 0.00
-2,461.44 Long D (basis reported to the IRS) 50,154.9149,939.21 0.00 24,606.80 Thisis important tax information and is being fumished to the Intemal Revenue Service.",1099,5,1099,fdc-10b7cf60ea6477144e1eabcf,v11-CONSOLIDATED_1099-flat,original,2024,fgen-3afc81fdd3f90124f044539c,synthetic_programmatic_template,flat,top,True,summary_page
"2025 Consolidated Form 1099 Ironwood Wealth Partners Account ***-**-1711 Recipient Olivia D. Haddad Payer's Federal ID number 68-5771065 Copy B for Recipient OMB No. 1545-0715
Page 3 of 24 1099-DIV Dividends and Distributions 1a Total ordinary dividends 5,443.54 1b Qualified dividends 4,527.24 2a Total capital gain distributions 1,617.93 1099-INT Interest Income 1 Interest income 803.96 1099-MISC Miscellaneous Information 3 Other income 92.47 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A
(basis reported to the IRS) 71,216.22 88,507.80 0.00 -4,685.40 Long D (basis reported to the IRS) 34,135.80 28,556.35 0.00 28,045.62 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-4f3b88a0dfc91132292416e8,v11-CONSOLIDATED_1099-flat,original,2025,fgen-d268b5226a06cbd8a2070cf9,synthetic_programmatic_template,flat,top,False,summary_page
"Tax Reporting Statement Ironwood Wealth Partners Account XXXXX4465 Recipient Priya Sato Payer's Federal ID number 52-8784791 Copy B for Recipient OMB No. 1545-0715 Page 3 of 23 1099-DIV Dividends and Distributions 1a Total ordinary dividends 677.44 1b Qualified dividends 7,328.96 2a Total capital gain
distributions 1,763.94 1099-INT Interest Income
1 Interest income 810.37 1099-MISC Miscellaneous Information 3 Other income 61.25 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-d414bece5acc8f94bff92e41,v11-CONSOLIDATED_1099-flat,original,2025,fgen-961209207d6e3dd558a402d9,synthetic_programmatic_template,flat,top,False,div_int_detail
"2025 Tax Information Statement
Evergreen Brokerage Services Account ***-**-5590 Recipient Noah Haddad Payer's Federal ID number 54-8417064 Copy B for Recipient OMB No. 1545-0715 Page 2 of 19 1099-DIV Dividends and Distributions 1a Total ordinary dividends 2,795.40 1b Qualified dividends 5,976.39 2a Total capital gain distributions
2,306.83 1099-INT Interest Income 1 Interest income 349.73 1099-MISC Miscellaneous Information 3 Other income 149.13 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 19,227.85 23,879.20 0.00 -4,924.19 Long D (basis reported to the IRS) 54,869.95 23,086.87 0.00 18,518.40 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-a0640ce8a0805142fd699671,v11-CONSOLIDATED_1099-flat,original,2025,fgen-633c60030a14976c22c3a17e,synthetic_programmatic_template,flat,top,False,summary_page
"2024 Consolidated Form 1099 Summit Investments Account ending in 1022 Recipient Casey B. Moreau Payer's Federal ID number 43-1464004 Copy B for Recipient OMB No. 1545-0715 Page 2 of 27 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or
loss Short A (basis reported to the IRS) 37,334.95 81,257.67 0.00 3,546.33 Long D (basis reported
to the IRS) 77,811.84 38,205.29 0.00 12,399.36 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-ee8122a25ffab15928f04473,v11-CONSOLIDATED_1099-flat,original,2024,fgen-283403397470bed61b42f83d,synthetic_programmatic_template,flat,top,False,b_detail
"Form 1099 Composite & Year-End Summary Ironwood Wealth Partners Account
***-**-4469 Recipient Alex Fischer Payer's Federal ID number 69-9996808 Copy B for Recipient OMB No. 1545-0715 Page 2 of 25 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 52,834.71 79,282.83 0.00 2,667.20 Long D (basis reported to the IRS) 62,413.30 44,859.90 0.00 16,209.15 This is important tax information and is being furnished to the
Internal Revenue Service.",1099,5,1099,fdc-027093a47cb1b06f9cb7c0cd,v11-CONSOLIDATED_1099-flat,original,2025,fgen-5d04984e062f61ea42654a9d,synthetic_programmatic_template,flat,top,False,b_detail
"2024 Tax Information Statement Ironwood Wealth Partners Account ***-**-3754 Recipient Avery Larsen Payer's Federal ID number 72-6186908 Copy B for Recipient OMB No. 1545-0715 Page 2 of 9 1099-DIV Dividends and Distributions 1a Total ordinary dividends 8,828.86 1b Qualified dividends 624.58 2a Total capital gain distributions 29.51 1099-INT Interest Income 1 Interest income 419.14 1099-MISC Miscellaneous Information 3 Other income 133.22 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949
type Proceeds Cost basis Wash sale loss disallowed Net gain
or loss Short A (basis reported to the IRS) 83,975.74 84,239.27 0.00 -1,903.46 Long D (basis reported to the IRS) 8,466.26 23,540.95 0.00 -1,223.54 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-17b5ff018935e36e320b5c99,v11-CONSOLIDATED_1099-flat,original,2024,fgen-6282eae56015ff2830f23adc,synthetic_programmatic_template,flat,top,False,summary_page
"2026 Consolidated Form 1099 Summit Investments Account ****9854 Recipient Lena Fischer Payer's Federal
ID number 47-6401428 Copy B for Recipient OMB No. 1545-0715 Page 3 of 20 1099-B
Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 39,758.55 4,109.95 0.00 8,906.39 Long D (basis reported to the IRS) 1,466.70 59,327.54 0.00 15,574.18 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-2afdf6d221316ffa3d873634,v11-CONSOLIDATED_1099-flat,original,2026,fgen-b87b5ac8f4d1930df656ab2d,synthetic_programmatic_template,flat,top,False,b_detail
"2024 Tax Information Statement Clearwater Investing Account XXXXX5770 Recipient Lena J. Tanaka Payer's
Federal ID number 21-9525213 Copy B for Recipient OMB No. 1545-0715 Page 2 of 15 1099-DIV Dividends and Distributions 1a Total ordinary dividends 3,736.78 1b Qualified dividends 910.63 2a Total capital gain distributions 2,815.69 1099-INT Interest Income 1 Interest income
671.40 1099-MISC Miscellaneous Information 3 Other income 122.01 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-ea50960fd4ac0b82407873a5,v11-CONSOLIDATED_1099-flat,original,2024,fgen-fddf143ec9d02f39c01d5e5b,synthetic_programmatic_template,flat,top,False,div_int_detail
"Tax
Reporting Statement Evergreen Brokerage Services Account ***-**-7784 Recipient Morgan Kowalski Payer's Federal ID number 60-2641310 Copy B for Recipient OMB No. 1545-0715 Page 3 of 28
1099-DIV Dividends and Distributions 1a Total ordinary dividends 96.77 1b Qualified dividends 1,423.52 2a Total capital gain distributions 360.13 1099-INT Interest Income 1 Interest income 895.90 1099-MISC Miscellaneous Information 3 Other income 166.82 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 83,465.82 56,776.09 0.00 8,315.23 Long D (basis reported to the IRS) 942.20 9,680.90 0.00 28,265.17 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-48df45a6df7ec9230c4d363b,v11-CONSOLIDATED_1099-flat,original,2026,fgen-01411f1bf3ac30ffb23d22de,synthetic_programmatic_template,flat,top,False,summary_page
"2024 Tax Information Statement Northstar Securities Account XXXXX8881 Recipient Kwame Patel Payer's Federal ID number 91-8639409 Copy B for Recipient OMB No. 1545-0715 Page 1 of 17 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported
to the IRS) 77,243.42 53,277.55 0.00 5,055.71 Long D (basis reported to the IRS) 75,692.01 32,527.13 0.00 23,120.37 This is important tax information and is being
furnished to the Internal Revenue Service.",1099,5,1099,fdc-ce42e1399cab59aded29f29c,v11-CONSOLIDATED_1099-flat,original,2024,fgen-05b42d23d124c79b6e816120,synthetic_programmatic_template,flat,top,False,b_detail
"Clearwater Investing Account ***-**-9927 Recipient Alex Romero Payer's Federal ID number 48-5684493 Copy B for Recipient OMB No. 1545-0715 Page 1 of 8 1099-DIV
Dividends and Distributions 1a Total ordinary dividends 6,274.81 1b Qualified dividends 1,301.65 2a Total capital gain distributions 1,137.77 1099-INT Interest Income 1 Interest income 297.44 1099-MISC Miscellaneous Information 3 Other income 186.10 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis
reported to the IRS) 2,011.22 66,252.48 0.00 -4,009.17 Long D (basis reported to the IRS) 20,452.26 64,788.89 0.00 621.72 This is important tax information and is being furnished to the Internal Revenue Service. 2023 Tax Information Statement",1099,5,1099,fdc-e95d2e8db45db9c522b18d32,v11-CONSOLIDATED_1099-flat,original,2023,fgen-2ff351d847b4526d76b092f6,synthetic_programmatic_template,flat,bottom,False,summary_page
"Clearwater Investing
Account XXXXX4337 Recipient Riley E. Nguyen Payer's Federal ID number 40-2343020 Copy B for Recipient OMB No. 1545-0715 Page 3 of 8 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 56,376.13 40,763.14 0.00 1,169.87 Long D (basis reported to the IRS) 41,476.29 46,152.56 0.00 13,675.37 This is important tax information and is being furnished to the
Internal Revenue Service. 2021 Consolidated Form 1099",1099,5,1099,fdc-63a3311824e3813dc80827d5,v11-CONSOLIDATED_1099-flat,original,2021,fgen-0ea95501c1ce633449ab2830,synthetic_programmatic_template,flat,bottom,False,b_detail
"Clearwater Investing Account ending in
4029 Recipient Priya B. Patel Payer's Federal ID number 79-6101103 Copy B for Recipient OMB No. 1545-0715 Page 1 of 24 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form
8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 75,253.03 28,408.56 0.00 -1,515.18 Long D (basis reported to the IRS) 81,052.95 56,773.26 0.00 7,581.65 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-bcd9e2098461252cd9bb0cb9,v11-CONSOLIDATED_1099-flat,original,2025,fgen-e52aa8a5811b3fe6ab30f15e,synthetic_programmatic_template,flat,none,False,b_detail
"Tax Reporting Statement Evergreen Brokerage Services Account ****2082 Recipient Jordan Tanaka Payer's Federal ID number 55-8403395 Copy B for Recipient OMB No. 1545-0715 Page 3 of 27 1099-DIV Dividends and Distributions 1a Total ordinary dividends 6,441.67 1b Qualified dividends 4,624.71 2a Total capital
gain distributions 412.46 1099-INT Interest Income 1 Interest income
10.74 1099-MISC Miscellaneous Information 3 Other income 43.90 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-5263dbabed051fb163657f4b,v11-CONSOLIDATED_1099-flat,original,2021,fgen-2377b6c941b0e372ed318a20,synthetic_programmatic_template,flat,top,False,div_int_detail
"Clearwater Investing Account ***-**-9379 Recipient Noah Patel Payer's Federal
ID number 13-9044946 Copy B for Recipient OMB No. 1545-0715 Page 3 of 10 1099-B
Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 44,807.07 87,070.83 0.00 -3,192.38 Long D (basis reported to the IRS) 4,672.88 63,427.73 0.00 -3,098.07 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-6074bc253f5106e975a391f2,v11-CONSOLIDATED_1099-flat,original,2024,fgen-7fa2959c2c9ab1c2628a827a,synthetic_programmatic_template,flat,none,False,b_detail
"2022 Tax Information Statement Summit Investments Account XXX-XX-7362 Recipient Diego Kowalski Payer's Federa1 ID number 54-1310822 Copy B for Recipient OMB No. 1545-0715
Pagc 2 of 29 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withho1ding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS)
81,602.06 78,552.50 0.00 8,302.55 Long D(basís reportedto the IRS) 20,607.97 89,273.09 0.00l9,358.84 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-33ed986409d40725885acbba,v11-CONSOLIDATED_1099-flat,original,2022,fgen-7e6d37e57376b9085c21b0c3,synthetic_programmatic_template,flat,top,True,b_detail
"Clearwater Investing Account ***-**-4019 Recipient
Riley E. Fischer Payer's Federal ID number 62-5158041 Copy B for Recipient OMB No. 1545-0715 Page 2 of 11 1099-DIV Dividends and Distributions 1a Total ordinary dividends 2,974.77
1b Qualified dividends 2,112.96 2a Total capital gain distributions 736.48 1099-INT Interest Income 1 Interest income 264.78 1099-MISC Miscellaneous Information 3 Other income 109.91 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 71,394.27 20,898.32 0.00 5,793.37 Long D (basis reported to the IRS) 46,646.85 18,505.61 0.00 3,663.05 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-d6d331ce851886c07a83aa87,v11-CONSOLIDATED_1099-flat,original,2024,fgen-e3222822568dd2b30e49bb98,synthetic_programmatic_template,flat,none,False,summary_page
"2025 Consolidated Form 1099 Summit Investments Account ***-**-9384 Recipient Mateo Walsh Payer's Federal ID number 98-2357809 Copy B for Recipient OMB No. 1545-0715 Page 1 of 15 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 57,302.89 60,261.32 0.00 -759.00 Long D (basis reported to the IRS) 23,557.65 45,677.84 0.00 -2,161.94 This is important tax information
and is
being furnished to the Internal Revenue Service.",1099,5,1099,fdc-eda06d435c21ac0c394aed09,v11-CONSOLIDATED_1099-flat,original,2025,fgen-e86277ac92aaaf610d3eeb64,synthetic_programmatic_template,flat,top,False,b_detail
"Northstar Securities Account XXX-XX-4317 Recipient Amara Brennan Payer's Federal ID number 96-3524230 Copy B for Recipient OMB No. 1545-0715 Page 2 of 27 1099-DIV Dividends and Distributions 1a Total ordinary dividends
2,887.75 1b Qualified dividends 3,272.64 2a Total capital gain distributions 1,803.83 1099-INT Interest Income 1 Interest income 498.48 1099-MISC Miscellaneous Information 3 Other income 127.05 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short
A (basis reported to the IRS) 63,017.28 26,059.32 0.00 -4,429.36 Long D (basis reported to the IRS) 28,637.73 33,756.17 0.00 7,655.80 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-fb99a06655a842432d4ccb0f,v11-CONSOLIDATED_1099-flat,original,2025,fgen-844ec15c99cc1d3ab3000435,synthetic_programmatic_template,flat,none,False,summary_page
"Tax Reporting Statement Summit Investments Account ending in 8547 Recipient Priya Haddad Payer's Federal ID number 35-5763637 Copy B for Recipient OMB No. 1545-0715 Page 2 of 10 1099-B Summary of Proceeds,
Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 30,058.75 46,895.97 0.00 5,759.55 Long D (basis reported to the IRS) 28,310.64 61,693.73 0.00 16,146.85 This is important tax information and is being furnished
to the Internal Revenue Service.",1099,5,1099,fdc-e4b0d85adcabf643f511508a,v11-CONSOLIDATED_1099-flat,original,2024,fgen-7ddd42b72b5ada7070206333,synthetic_programmatic_template,flat,top,False,b_detail
"Form 1099 Composite & Year-End Summary Summit Investments Account XXXXX5144 Recipient Jordan J. Testcase Payer's Federal ID number 46-3346086 Copy B for Recipient OMB No. 1545-0715 Page 3 of 12 1099-B Summary of Proceeds, Gains & Losses, Adjustments and Withholding Term Form 8949 type Proceeds Cost basis Wash
sale loss disallowed Net gain or loss Short A (basis reported to the IRS) 7,448.74
42,751.00 0.00 -2,133.49 Long D (basis reported to the IRS) 86,713.75 18,829.80 0.00 -1,367.65 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-e3654b2ecd465810147b2641,v11-CONSOLIDATED_1099-flat,original,2025,fgen-1d25904508863821d744306f,synthetic_programmatic_template,flat,top,False,b_detail
"2025 Consolidated Form 1099 Evergreen Brokerage Services Account XXXXX9108 Recipient Wei Patel Payer's Federal ID number 75-5423123 Copy B for Recipient OMB No. 1545-0715 Page 2 of 15 1099-DIV Dividends and Distributions 1a Total ordinary dividends 4,825.58 1b Qualified dividends 2,361.04 2a Total capital gain
distributions 1,929.83 1099-INT Interest Income 1 Interest income 605.18 1099-MISC Miscellaneous
Information 3 Other income 90.34 This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-e56dff249771c57166d7f476,v11-CONSOLIDATED_1099-flat,original,2025,fgen-ee3084c17822b4a165800ead,synthetic_programmatic_template,flat,top,False,div_int_detail
"Form 1099 Composite & Year-End Summary
Northstar Securities
| Fie1d | Value |
| --- | --- |
| Account | ***-**-7102 |
| Recipient | Riley Walsh|
| Payer'sFederal ID number | 75-2839617 |
## Copy B for Recipient  OMB No. 1545-0715
Page 1 of 20
1099-DIV  Dívidends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends |4,380.12 |
| 1b Qualified dividends | 6,732.74 |
| 2a Total capital gain distributions | 2,469.20 |
## l099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 205.39 |
1099-MI5C  Miscellaneous Information
| Fíeld | Value |
| --- | --- |
| 3 Other income | 189.14 |
## This is importanttax information and is being fumished to the Intema1 Revenue 5ervice.",1099,5,1099,fdc-9f93e0e61f0ba3f2cdcee3d3,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-2c570e24e8d6019b7614f45c,synthetic_programmatic_template,markdown,top,True,div_int_detail
"Form 1099 Composite & Year-End Summary
Summit Investments
| Field | Value |
| --- | --- |
| Account | ending in 9057 |
| Recipient | Avery Romero |
| Payer's Federal ID number | 21-7023505 |
Copy B for Recípient  OMB No. 1545-0715
## Page 1of 27
1099-B  Summaryof Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | ---| --- | --- | --- |
| 5hort | A (basis reported to the IR5) | 85,63l.93 | 11,573.79 | 0.00 | 6,092.15|
| Long | D (basis reported to the IRS) | 20,153.66 | 89,296.23 | 0.00 | 10,734.06 |
This is important tax information and is being fumished to the Interna1 Revenue Service.",1099,5,1099,fdc-5871c2df784960b0cb8d1124,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-533744d9897671b2c0a15dad,synthetic_programmatic_template,markdown,top,True,b_detail
"Form 1099 Composite & Year-End Summary
## Evergreen Brokerage Services
| Field | Value |
| --- | --- |
| Account | ending in 2652 |
| Recipient | Hiro Romero |
| Payer's Federal ID number | 59-4078763 |
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 26
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 5,439.77 |
| 1b Qualified dividends | 4,772.54 |
| 2a Total capital gain distributions | 1,951.04 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 341.84 |
## 1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 156.64 |
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 36,711.50 | 5,856.67 | 0.00 | 1,075.24 |
| Long | D (basis reported to the IRS) | 36,354.14 | 17,733.84 | 0.00 | -1,238.04 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-4118d4ec48bc9dcc74b7c0ab,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-21f5d822a000366bad4a5cf5,synthetic_programmatic_template,markdown,top,False,summary_page
"2022 Tax Information Statement
Evergreen Brokerage Services
| Field | Value |
| --- | --- |
| Account | XXXXX6927 |
| Recipient | Noah Brennan |
| Payer's Federal ID number | 33-9141681 |
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 21
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 4,707.15 |
| 1b Qualified dividends | 5,980.37 |
| 2a Total capital gain distributions | 2,159.97 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 707.79 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 43.70 |
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 57,485.65 | 74,369.67 | 0.00 | 1,609.46 |
| Long | D (basis reported to the IRS) | 81,427.58 | 11,217.54 | 0.00 | -1,756.70 |
## This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-05744c0b1e642c6c0c9aad8f,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-ada5d56a112f0835bf77c567,synthetic_programmatic_template,markdown,top,False,summary_page
"2023 Tax Information Statement
Northstar Securities
| Field | Value |
| --- | --- |
| Account | ending in 3310 |
| Recipient | Mateo Rivera |
| Payer's Federal ID number | 93-6168655 |
Copy B for Recipient  OMB No. 1545-0715
## Page 1 of 22
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 6,778.04 |
| 1b Qualified dividends | 2,278.09 |
| 2a Total capital gain distributions | 57.40 |
## 1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 170.03 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 114.84 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-44ca08802786e30cf0aac194,v11-CONSOLIDATED_1099-markdown,original,2023,fgen-0ec4003cb16402473e9dccb4,synthetic_programmatic_template,markdown,top,False,div_int_detail
"Summit Investments
| Field | Value |
| --- | --- |
| Account | XXX-XX-9554 |
| Recipient | Mateo D. Romero |
| Payer's Federal ID number | 45-3090945 |
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 8
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 8,602.56 |
| 1b Qualified dividends | 4,669.43 |
| 2a Total capital gain distributions | 354.50 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 806.42 |
## 1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 130.00 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-4c883d302f3fc159b93e0a33,v11-CONSOLIDATED_1099-markdown,original,2024,fgen-5c0be3c5b5250d8f8c45eb8d,synthetic_programmatic_template,markdown,none,False,div_int_detail
"2022 Tax Information Statement
Northstar Securities
| Field | Value |
| --- | --- |
| Account | ***-**-1442 |
| Recipient | Priya Romero |
| Payer's Federal ID number | 68-8987721 |
## Copy B for Recipient  OMB No. 1545-0715
## Page 2 of 18
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 3,789.02 |
| 1b Qualified dividends | 1,405.78 |
| 2a Total capital gain distributions | 1,361.44 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 159.93 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 4.35 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-4e786e03cee16a6320de7517,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-b18d1ee73b81ce5625ef1ee7,synthetic_programmatic_template,markdown,top,False,div_int_detail
"Form 1099 Composite & Year-EndSummary
C1earwater Investing
| Field | Value |
| --- | --- |
| Account | ****2799 |
| Recipient | Jordan Castillo|
| Payer's Federal ID number | 12-3375O47 |
Copy B for Recipient  OMB No. 1545-O715
Page 2 of 8
1O99-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
|5hort | A (basis reported to theIRS) | 25,959.77 | 52,75O.92 | 0.00 | 4,889.89 |
| Long | D (basis reported to the IRS) | 7l,237.06 | 58,790.13 | 0.00| 11,846.17 |
This is important tax information and is being fumished to the Internal Revenue Service.",1099,5,1099,fdc-6f4dbd534c04bd7363d3b543,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-af487fd6716da3801e9db8a1,synthetic_programmatic_template,markdown,top,True,b_detail
"Clearwater Investing
| Field | Value |
| --- | --- |
| Account | ****2632 |
| Recipient | Noah Castillo |
| Payer's Federal ID number | 87-3977123 |
## Copy B for Recipient  OMB No. 1545-0715
## Page 3 of 12
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 69,815.90 | 82,724.53 | 0.00 | -2,359.83 |
| Long | D (basis reported to the IRS) | 35,986.11 | 77,442.98 | 0.00 | 23,768.32 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-85d6ff691b133d7cbfdd8339,v11-CONSOLIDATED_1099-markdown,original,2021,fgen-f66ed7b70b06d062ed5b6e30,synthetic_programmatic_template,markdown,none,False,b_detail
"2024 Tax Information Statement
## Clearwater Investing
| Field | Value |
| --- | --- |
| Account | ****7393 |
| Recipient | Wei Romero |
| Payer's Federal ID number | 44-5091159 |
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 9
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 6,436.73 |
| 1b Qualified dividends | 4,515.01 |
| 2a Total capital gain distributions | 2,125.69 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 556.64 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 170.43 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-f3fff067fa8910049f5cc17c,v11-CONSOLIDATED_1099-markdown,original,2024,fgen-bc7b0af5c65680948f553015,synthetic_programmatic_template,markdown,top,False,div_int_detail
"2025 Tax Information Statement
Northstar Securities
| Field | Value |
| --- | --- |
| Account | XXX-XX-1404 |
| Recipient | Jamie B. Nguyen |
| Payer's Federal ID number | 59-8993835 |
Copy B for Recipient  OMB No. 1545-0715
## Page 3 of 19
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 5,855.93 |
| 1b Qualified dividends | 830.97 |
| 2a Total capital gain distributions | 1,624.60 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 114.40 |
## 1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 51.00 |
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 51,060.75 | 72,751.56 | 0.00 | 7,111.97 |
| Long | D (basis reported to the IRS) | 47,750.06 | 22,523.44 | 0.00 | 2,437.70 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-a8c463d98e64fa54f7dd0835,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-84bb640208fee88b5bb13cf2,synthetic_programmatic_template,markdown,top,False,summary_page
"Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account | ending in 7833 |
| Recipient | Diego Nguyen |
| Payer's Federal ID number | 90-9110178 |
## Copy B for Recipient  OMB No. 1545-0715
Page 2 of 11
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 31,850.92 | 39,333.62 | 0.00 | 7,626.29 |
| Long | D (basis reported to the IRS) | 62,776.52 | 38,821.07 | 0.00 | 25,037.28 |
## This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-323534087c68c688349d1201,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-d7b18593f9e045034b219aef,synthetic_programmatic_template,markdown,none,False,b_detail
"## Tax Reporting Statement
## Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account | XXXXX3905 |
| Recipient | Priya Brennan |
| Payer's Federal ID number | 65-3181396 |
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 10
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 770.33 |
| 1b Qualified dividends | 4,043.90 |
| 2a Total capital gain distributions | 1,857.31 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 402.82 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 177.93 |
## This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-163e667c5f6406fa83a104ba,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-3f405e8b153dd315621c3d03,synthetic_programmatic_template,markdown,top,False,div_int_detail
"Tax Reporting Statement
## Northstar Securities
| Field | Value |
| --- | --- |
| Account | XXX-XX-2938 |
| Recipient | Casey E. Rivera |
| Payer's Federal ID number | 28-5356018 |
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 20
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 5,545.07 |
| 1b Qualified dividends | 4,379.89 |
| 2a Total capital gain distributions | 650.76 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 831.68 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 188.91 |
## 1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 3,403.37 | 73,890.49 | 0.00 | 1,552.10 |
| Long | D (basis reported to the IRS) | 1,806.17 | 33,939.58 | 0.00 | -2,351.07 |
## This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-90112adaf2a3f23eeff680cc,v11-CONSOLIDATED_1099-markdown,original,2021,fgen-9195737d96016b261df21911,synthetic_programmatic_template,markdown,top,False,summary_page
"Clearwater Investing
| Field | Value |
| --- | --- |
| Account | XXX-XX-6937 |
| Recipient | Casey Testcase |
| Payer's Federal ID number | 10-7583689 |
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 11
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 672.09 |
| 1b Qualified dividends | 5,965.10 |
| 2a Total capital gain distributions | 524.92 |
## 1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 890.54 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 37.90 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-8e62e223887445c446e928ab,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-ff2ac3af5cdba424d42c0d16,synthetic_programmatic_template,markdown,none,False,div_int_detail
"Form 1099 Composite & Year-End Summary
Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account| ending in 3862 |
| Recipient | Lena Okafor |
| Payer's Federal ID number | 43-6370594 |
Copy B for Recípíent  OMB No. 1545-0715
## Page 3 of 22
## 1099-B 5ummary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term| Form8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| 5hort | A (basis reported to the IRS) | 65,182.85 | 33,960.62 | 0.00 |-1,217.72 |
| Long | D (basis reported to the IRS) | 86,428.87 | 44,500.15 | 0.00 | 13,194.99 |
This is important tax information and is being fumished to the Interna1 Revenue 5ervice.",1099,5,1099,fdc-858320d8adf9f41d1ed7a5cb,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-450cbd3cf41455c5f02c334b,synthetic_programmatic_template,markdown,top,True,b_detail
"## Form 1099 Compositc & Year-End Summary
Ironwood Wealth Partners
|Field | Value |
| --- | --- |
| Account | ***-**-6635 |
| Recípient | Priya Testcase |
| Payer's Federa1 ID number | 42-6115421 |
Copy B for Recipient  OMB No. 1545-O715
Page 2 of 22
## 1099-DIV  Dividends and Distributions
|Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 5,466.15 |
| 1b Qualífied dividends | 6,678.90 |
| 2a Total capital gaindistributíons | 940.l5 |
## 1099-INT  Interest Income
| Field | Value|
| --- | --- |
| 1 Interest income | 478.01 |
1099-MI5C  Miscellaneous Information
| Field| Value |
| --- | --- |
| 3 Other income | 103.06 |
1099-B  5ummary of Proceeds, Gains & Losses, Adjustmentsand Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Netgain or loss |
| --- | --- | --- | --- | ---| --- |
| 5hort | A (basis reported to the IR5) | 41,66O.97 | 70,276.34 | 0.00 | 1,363.10 |
| Long | D (basís reported to the IR5) | 86,328.41 | 7,948.87 | 0.00 | 13,744.46 |
## This is important tax information and is being fumished to the Intemal Revenue Service.",1099,5,1099,fdc-dff9f044039051b8b114c984,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-3138fbf75783c3b19ff33d10,synthetic_programmatic_template,markdown,top,True,summary_page
"## 2022 Consolidated Form 1099
## Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account | ending in 7936 |
| Recipient | Fatima R. Castillo |
| Payer's Federal ID number | 76-5501240 |
Copy B for Recipient  OMB No. 1545-0715
## Page 3 of 10
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 4,308.57 |
| 1b Qualified dividends | 7,585.93 |
| 2a Total capital gain distributions | 2,167.27 |
## 1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 19.96 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 92.03 |
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 18,276.99 | 20,298.32 | 0.00 | -146.76 |
| Long | D (basis reported to the IRS) | 47,430.55 | 15,600.43 | 0.00 | 28,636.43 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-672e9ec31d490ab1d301714b,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-986ce77a6bb19ff809547ad0,synthetic_programmatic_template,markdown,top,False,summary_page
"Northstar Securities
| Field | Value |
| --- | --- |
| Account | XXXXX6034 |
|Recipient | Sofia Kowalski |
| Payer's Federal ID number | 40-4343278 |
## Copy B for Recipient  OMB No. l545-07l5
##Page 2 of 16
1099-DIV  Dividends and Distributions
| Field |Va1ue |
| --- | --- |
| 1a Total ordínary dividends | 5,537.12 |
| 1b Qualified dividends | 6,070.79 |
| 2a Total capital gain distributions | 316.62 |
1099-INT  Interest Income
| Field | Value |
| --- |--- |
| 1 Interest income | 322.26 |
1099-MI5C  Miscellaneous Information
|Field | Value |
| --- | --- |
| 3 0ther income | 139.13 |
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 31,715.65 | 5,584.67 | 0.00 | 7,949.74 |
| Long |D (basis reported to the IRS) | 57,892.05 | 3,314.18 | 0.00 | 23,194.64 |
## Thís is important tax ínformation and is being fumishedto the Intema1 Revenue Service.",1099,5,1099,fdc-40fa0a5a6ab698fc51c0c389,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-653b4a485110c0dfd974fd7f,synthetic_programmatic_template,markdown,none,True,summary_page
"Clearwater Investing
| Field | Value |
| --- | --- |
| Account | ***-**-4884 |
| Recipient | Noah Castillo |
| Payer's Federal ID number | 17-7599027 |
Copy B for Recipient  OMB No. 1545-0715
Page 3 of 17
## 1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 2,110.59 |
| 1b Qualified dividends | 6,305.10 |
| 2a Total capital gain distributions | 2,065.78 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 884.52 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 192.86 |
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 11,566.49 | 75,171.16 | 0.00 | 4,477.19 |
| Long | D (basis reported to the IRS) | 47,994.42 | 31,921.68 | 0.00 | -146.79 |
## This is important tax information and is being furnished to the Internal Revenue Service.
Tax Reporting Statement",1099,5,1099,fdc-37943ed1a6afcedf4edb1fa8,v11-CONSOLIDATED_1099-markdown,original,2023,fgen-acc16ba6c17cadbf81f63b79,synthetic_programmatic_template,markdown,bottom,False,summary_page
"Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account | ****6439 |
| Recipient | Noah A. Tanaka |
| Payer's Federal ID number | 60-6817320 |
Copy B for Recipient  OMB No. 1545-0715
## Page 2 of 11
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 4,421.59 |
| 1b Qualified dividends | 7,629.41 |
| 2a Total capital gain distributions | 1,735.63 |
## 1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 267.29 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 42.50 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-5a0c18d7509e90027d760c18,v11-CONSOLIDATED_1099-markdown,original,2024,fgen-5654467a0951a5948c2d5bdc,synthetic_programmatic_template,markdown,none,False,div_int_detail
"## Evergreen BrokerageServices
| Field | Value |
| --- | --- |
| Account | ***-**-6644|
| Rccipient | Morgan Adcyemi |
| Payer's Federal ID number | 75-5347511 |
## Copy B for Recipient  0MB No. 1545-0715
Page 2 of 27
1099-DIV  Dividends and Distributions
| Fie1d | Value |
| --- | --- |
| la Total ordinary dividends | 743.63 |
| 1bQualified dividends | 5,371.69 |
| 2a Total capital gain distributions | 2,402.26 |
1099-INT  Interest Income
| Fíeld | Value |
| --- | --- |
| 1 Interest income | 715.92 |
1099-MISC  Miscellaneous Information
| Field | Value |
| ---| --- |
| 3 0ther income | 75.28 |
This is important tax information and is being fumished to the Interna1 Revenue 5ervice.
2024 Consolidated Form 1099",1099,5,1099,fdc-5364dcd8cd621290c7737462,v11-CONSOLIDATED_1099-markdown,original,2024,fgen-467dddfe45ad41e2139509d7,synthetic_programmatic_template,markdown,bottom,True,div_int_detail
"Tax Reporting Statement
Clearwater Investing
| Field | Value |
| --- | --- |
| Account | ***-**-0007 |
| Recipient | Hiro Tanaka |
| Payer's Federal ID number | 61-7175838 |
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 23
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 2,929.99 |
| 1b Qualified dividends | 2,843.81 |
| 2a Total capital gain distributions | 1,732.47 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 243.16 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 32.38 |
## 1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 85,689.64 | 58,699.76 | 0.00 | 4,656.27 |
| Long | D (basis reported to the IRS) | 34,305.15 | 57,726.05 | 0.00 | 20,611.16 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-b0ac95bc2d840615bcdbbbc1,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-60ed0a8d4562c72b05f5298a,synthetic_programmatic_template,markdown,top,False,summary_page
"## Form 1099 Composite & Year-End Summary
## Clearwater Investing
| Field | Value |
| --- | --- |
| Account | ****1111 |
| Recipient | Wei Larsen |
| Payer's Federal ID number | 40-2649083 |
## Copy B for Recipient  OMB No. 1545-0715
## Page 3 of 29
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 19,922.47 | 70,554.75 | 0.00 | -3,590.52 |
| Long | D (basis reported to the IRS) | 6,853.92 | 61,419.53 | 0.00 | 7,114.36 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-2db51666bf9c3dde6bfe0f2d,v11-CONSOLIDATED_1099-markdown,original,2021,fgen-8ec16de76f044792dd9f0822,synthetic_programmatic_template,markdown,top,False,b_detail
"## Northstar Securities
| Field | Value |
| --- | --- |
| Account | XXXXX7440 |
| Recipient | SofiaOkafor |
| Payer's Federal ID number | 5l-4459303 |
## Copy B for Recipient  OMB No. 1545-0715
## Page 1 of 21
1099-B  Summary of Procceds, Gains & Losses, Adjustments and Withho1ding
|Term | Form 8949 type | Proceeds | Cost basís | Wash sale loss dísallowed | Net gain orloss |
| --- | --- | --- | --- | --- |--- |
| Short | A (basis rcported to the IRS) | l6,911.43 | 79,943.59 | 0.00 | 276.41 |
| Long | D (basis reported to the IRS) | 61,233.87 | 20,781.38 | 0.00 | 29,172.21 |
## This is important tax information and is being furnished tothe Internal Revenue 5ervice.",1099,5,1099,fdc-c328030a086db7263f6f1aea,v11-CONSOLIDATED_1099-markdown,original,2026,fgen-fca09effb910ef402020e8b5,synthetic_programmatic_template,markdown,none,True,b_detail
"Clearwater Investing
| Field | Va1ue |
| --- | --- |
| Account | XXXXX3802 |
| Recipient | Casey Castillo |
| Payer's Federal ID number | 76-3617250 |
Copy B for Recipient  OMB No. 1545-0715
## Page 1 of 14
##1099-DIV Dividends and Distributions
| Fídd | Value |
| --- | --- |
| 1a Total ordinary dividends | 2,814.57 |
| 1b Qualified dividends | 2,206.68 |
| 2aTotal capital gain distributions | 304.99 |
l099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 639.84 |
1O99-MI5C  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 69.30 |
This is important tax information and is being fumíshed to theInterna1 Revenue 5ervice.
Form 1099 Composite & Year-End Summary",1099,5,1099,fdc-64620ed1507f3bb13b5069ff,v11-CONSOLIDATED_1099-markdown,original,2024,fgen-b61bbec0e3a756534ab628e4,synthetic_programmatic_template,markdown,bottom,True,div_int_detail
"2023 Consolidated Form 1099
Northstar Securities
| Field | Value |
| --- | --- |
| Account | ***-**-8824 |
| Recipient | Taylor Sato |
| Payer's Federal ID number | 14-6837972 |
## Copy B for Recipient  OMB No. 1545-0715
## Page 1 of 27
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 12,409.25 | 18,579.06 | 0.00 | -4,458.11 |
| Long | D (basis reported to the IRS) | 50,144.97 | 49,037.81 | 0.00 | 23,457.91 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-d73c58b9a5ce7fcb90921b82,v11-CONSOLIDATED_1099-markdown,original,2023,fgen-8187b8e61bc9601f65a2f239,synthetic_programmatic_template,markdown,top,False,b_detail
"## 2026 Tax Information Statement
Northstar Securities
| Field | Value |
| --- | --- |
| Account | ending in 2399 |
| Recipient | Noah S. Adeyemi |
| Payer's Federal ID number | 84-8755223 |
## Copy B for Recipient  OMB No. 1545-0715
Page 2 of 30
## 1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 59,426.30 | 35,253.43 | 0.00 | -1,663.82 |
| Long | D (basis reported to the IRS) | 74,078.46 | 5,122.64 | 0.00 | 15,667.01 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-8a8bd057ebe390e8b22b6746,v11-CONSOLIDATED_1099-markdown,original,2026,fgen-451212e38bbc31754b17fc5e,synthetic_programmatic_template,markdown,top,False,b_detail
"## Evergreen Brokerage Services
| Field | Value |
| --- | --- |
| Account | XXXXX4986 |
| Recipient | Kwame Castillo |
| Payer's Federal ID number | 87-2818237 |
Copy B for Recipient  OMB No. 1545-0715
## Page 2 of 27
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 7,325.40 |
| 1b Qualified dividends | 3,236.25 |
| 2a Total capital gain distributions | 2,974.83 |
## 1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 404.72 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 149.08 |
## 1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 4,912.64 | 67,438.22 | 0.00 | 4,163.28 |
| Long | D (basis reported to the IRS) | 65,886.69 | 89,793.62 | 0.00 | 7,489.63 |
## This is important tax information and is being furnished to the Internal Revenue Service.
2026 Consolidated Form 1099",1099,5,1099,fdc-44ce00e86ef0e44f548bc7ef,v11-CONSOLIDATED_1099-markdown,original,2026,fgen-3278c944d50b6b5f9dc0a8bf,synthetic_programmatic_template,markdown,bottom,False,summary_page
"## Form 1099 Composite & Year-End Summary
Evergreen Brokerage Services
| Field | Value |
| --- | --- |
| Account | ***-**-1887 |
| Recipient | Noah E. Tanaka |
| Payer's Federal ID number | 31-1556001 |
Copy B for Recipient  OMB No. 1545-0715
Page 1 of 30
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 408.77 |
| 1b Qualified dividends | 3,120.48 |
| 2a Total capital gain distributions | 835.50 |
## 1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 239.46 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 173.92 |
## This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-5d88b763de490f6f77396cf3,v11-CONSOLIDATED_1099-markdown,original,2026,fgen-8a2d94a8d1e6f5b7258e61cb,synthetic_programmatic_template,markdown,top,False,div_int_detail
"Tax Reporting Statement
## Ironwood Wealth Partners
| Field | Value |
| --- | --- |
| Account | ****7333 |
| Recipient | Amara K. Lindqvist |
| Payer's Federal ID number | 56-4040461 |
Copy B for Recipient  OMB No. 1545-0715
Page 2 of 9
1099-DIV  Dividends and Distributions
| Field | Value |
| --- | --- |
| 1a Total ordinary dividends | 4,894.16 |
| 1b Qualified dividends | 1,260.87 |
| 2a Total capital gain distributions | 1,518.52 |
1099-INT  Interest Income
| Field | Value |
| --- | --- |
| 1 Interest income | 374.97 |
1099-MISC  Miscellaneous Information
| Field | Value |
| --- | --- |
| 3 Other income | 162.02 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-82a0c72a03fe206519d1d5b0,v11-CONSOLIDATED_1099-markdown,original,2025,fgen-b4ebdb81d731cfa691915607,synthetic_programmatic_template,markdown,top,False,div_int_detail
"2022 Tax Information Statement
## Summit Investments
| Field | Value |
| --- | --- |
| Account | ending in 6163 |
| Recipient | Lena A. Sato |
| Payer's Federal ID number | 43-1301107 |
Copy B for Recipient  OMB No. 1545-0715
## Page 2 of 11
1099-B  Summary of Proceeds, Gains & Losses, Adjustments and Withholding
| Term | Form 8949 type | Proceeds | Cost basis | Wash sale loss disallowed | Net gain or loss |
| --- | --- | --- | --- | --- | --- |
| Short | A (basis reported to the IRS) | 48,260.32 | 33,381.54 | 0.00 | -3,537.16 |
| Long | D (basis reported to the IRS) | 46,482.28 | 7,699.48 | 0.00 | 19,247.88 |
This is important tax information and is being furnished to the Internal Revenue Service.",1099,5,1099,fdc-39aafe1727b54b670029a116,v11-CONSOLIDATED_1099-markdown,original,2022,fgen-59146aa6d3f077b3f5c41636,synthetic_programmatic_template,markdown,top,False,b_detail
"World Elite Mastercard
2025 Year-End Summary
Harbor Card Services
Category  Transactions  Total
Merchandise
70
5,899.84
Groceries
37
4,360.98
Travel
68
4,228.18
Gas
44
8,876.23
Total purchases this year
$53,233.37
Total interest charged this year
533.24
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9119e3a19283b37bfe66d304,v11-CREDIT_CARD_STATEMENT-stacked,original,2025,fgen-b0e47f05b778c803484d9170,synthetic_programmatic_template,stacked,top,False,year_end_summary
"Everyday Cash Card
2024 Year-End Summary
Atlas Card Servíces
Category  Transactions  Total
Dining
80
4,164.82
Groceries
23
494.46
Services
12
2,004.84
Travel
42
7,920.87
Total purchases this year
56,176.74
Total interest charged thisyear
$205.40
This summary is provided for your records and ís not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-cb310971264b3d6c9f9c3511,v11-CREDIT_CARD_STATEMENT-stacked,original,2024,fgen-88deb35e03499edefab90e6d,synthetic_programmatic_template,stacked,top,True,year_end_summary
"Rewards Visa Signature
Summit Card Services
Account ending in
3983
Opening/Closing Date
04/01/2023 - 04/30/2023
Account Summary
Previous Balance
$1,855.29
Payments, Credits
-$1,855.29
Purchases
$2,997.49
Fees Charged
$0.00
Interest Charged
$13.92
New Balance
$1,994.03
Minimum Payment Due
$121.73
Payment Due Date
12/13/23
Purchase APR
18.56%
Trans Date  Description  Amount
04/02
TARGET T-2231
209.41
10/11
HOME DEPOT 0612
222.17
09/25
AMAZON MKTPLACE
489.31
06/03
SHELL OIL 5741
543.53
08/11
UBER TRIP
574.59
03/03
AMAZON MKTPLACE
183.96
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-db069e9baaba9a7dc1234469,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-3dc18ea332ebe8721df3498c,synthetic_programmatic_template,stacked,top,False,monthly
"Downloaded 03/14/2026
Date  Description  Card Member  Account #  Amount
2026-04-25
COSTCO WHSE #412
PRIYA KOWALSKI
-60887
830.89
2026-10-05
NETFLIX.COM
AMARA L. LINDQVIST
-79192
373.22
07/01/2026
SHELL OIL 5741
FATIMA MOREAU
-74952
663.00
02/05/2026
AMAZON MKTPLACE
LENA BRENNAN
-89973
522.07
2026-07-24
TARGET T-2231
AVERY MOREAU
-35266
577.50
05/06/2026
TARGET T-2231
JAMIE RIVERA
-69790
339.62
03/13/2026
UBER TRIP
NOAH KOWALSKI
-16785
488.37
02/21/2026
AMAZON MKTPLACE
MORGAN NGUYEN
-44251
18.89
2026-08-15
COSTCO WHSE #412
OLIVIA MOREAU
-35291
469.12
Card ending in 4914 - Activity",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-01f0eb0e85d23e9e8efd4c06,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-138757e319c373e166a76b53,synthetic_programmatic_template,stacked,bottom,False,raw_export
"Bluewater Bank Card Center
Account ending in
4583
Opening/Closing Date
10/01/2026 - 10/31/2026
Account Summary
Previous Balance
$5,533.07
Payments, Credits
-$5,533.07
Purchases
$970.09
Fees Charged
$0.00
Interest Charged
$67.89
New Balance
$4,691.62
Minimum Payment Due
$69.88
Payment Due Date
03/03/2026
Purchase APR
28.32%
Trans Date  Description  Amount
02/25
WHOLE FOODS #1021
446.07
12/12
AMAZON MKTPLACE
251.49
03/08
TARGET T-2231
465.76
05/25
NETFLIX.COM
695.69
03/11
HOME DEPOT 0612
218.58
Rewards Visa Signature",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9286d990cde5d957f537b302,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-cf36d37ddfdbc9e8e58a89e2,synthetic_programmatic_template,stacked,bottom,False,monthly
"Cash Back Mastercard
2023 Year-End Summary
Harbor Card Services
Category  Transactions  Total
Dining
56
4,625.18
Groceries
49
7,294.64
Gas
23
8,466.76
Merchandise
27
426.20
Total purchases this year
$23,499.73
Total interest charged thís year
$797.50
This summary is provided for your records and is not atax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-17931750bd84899575640ec6,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-953f2782c399a3ce8dd3929c,synthetic_programmatic_template,stacked,top,True,year_end_summary
"World Elite Mastercard
Atlas Card Services
Account ending in
2250
Opening/Closing Date
05/01/2025 - 05/30/2025
Account Summary
Previous Balance
$7,199.63
Payments, Credits
-$7,199.63
Purchases
$3,397.17
Fees Charged
$0.00
Interest Charged
$39.95
New Balance
$3,710.26
Minimum Payment Due
$27.04
Payment Due Date
10/22/25
Purchase APR
28.62%
Trans Date  Description  Amount
09/27
SHELL OIL 5741
66.77
07/08
AMAZON MKTPLACE
36.99
06/13
CVS/PHARMACY 0832
785.93
11/25
UBER TRIP
505.01
04/07
TARGET T-2231
566.64
08/12
NETFLIX.COM
266.39
07/02
COSTCO WHSE #412
549.29",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-37f26a1be8d56e73ec9c9e3f,v11-CREDIT_CARD_STATEMENT-stacked,original,2025,fgen-0931dbe9c9f6c0583bae8395,synthetic_programmatic_template,stacked,top,False,monthly
"Trans. Date  Post Date  Description Amount  Category
2026-10-27
17/02/2026
AUTOPAY PAYMENT - THANK YOU
198.75
Mcrchandise
2026-07-12
15/09/2026
5HELL OIL 5741
207.25
Payments and Credits
12/21/2026
12/20/2026
AUTOPAY PAYMENT - THANK Y0U
489.88
Merchandíse
09/25/2026
2026-06-26
CVS/PHARMACY 0832
452.86
Restaurants",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-c0038bfa89f16c5880c0dec7,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-42be3d4c5acf575974129d12,synthetic_programmatic_template,stacked,top,True,raw_export
"Downloaded 04/09/2022
Trans. Date  Post Date Description  Amount  Category
2022-07-28
l0/20/2022
NETFLIX.COM
43.46
Merchandise
2022-06-08
07/03/2022
NETFLIX.C0M
271.82
Merchandise
2022-04-19
11/19/2022
AUTOPAY PAYMENT - THANK YOU
265.06
Restaurants
09/23/2022
02/03/2022
COSTCO WHSE #412
527.62
Payments and Credíts
2022-08-23
25/11/2022
AMAZON MKTPLACE
304.90
Merchandise",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-1cbd03dfa370e5ed4a0fa526,v11-CREDIT_CARD_STATEMENT-stacked,original,2022,fgen-ce8621e17e6a9cdd53a0877f,synthetic_programmatic_template,stacked,none,True,raw_export
"Everyday Cash Card
Bluewater Bank Card Center
Account ending in
4680
Opening/Closing Date
06/01/2023 - 06/30/2023
Account Summary
Previous Balance
$6,811.77
Payments, Credits
-$6,811.77
Purchases
$317.96
Fees Charged
$0.00
Interest Charged
$11.53
New Balance
$4,574.08
Minimum Payment Due
$186.28
Payment Due Date
6/10/23
Purchase APR
21.45%
Trans Date  Description  Amount
04/23
SHELL OIL 5741
819.13
02/27
AMAZON MKTPLACE
556.37
09/12
WHOLE FOODS #1021
736.57
03/16
AMAZON MKTPLACE
599.19
09/25
COSTCO WHSE #412
202.41",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-212b31acce4b028fc0187de5,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-ee43a4185baf3e5a1eae9cb1,synthetic_programmatic_template,stacked,top,False,monthly
"Credit Card Transactions
Downloaded 2024-03-06
Trans. Date  Post Date  Description  Amount  Category
02/08/2024
2024-08-10
WHOLE FOODS #1021
141.57
Merchandise
26/02/2024
2024-03-28
COSTCO WHSE #412
816.99
Restaurants
2024-02-07
07/27/2024
NETFLIX.COM
197.43
Payments and Credits
09/09/2024
21/02/2024
HOME DEPOT 0612
48.40
Merchandise
2024-04-10
14/11/2024
STARBUCKS #11872
-268.20
Payments and Credits
2024-06-10
2024-04-19
WHOLE FOODS #1021
392.26
Restaurants
01/05/2024
2024-04-06
TARGET T-2231
447.78
Merchandise
23/11/2024
16/07/2024
AMAZON MKTPLACE
375.96
Restaurants
02/01/2024
02/12/2024
TARGET T-2231
229.22
Merchandise",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-69caaeb796e38e1175b22d5a,v11-CREDIT_CARD_STATEMENT-stacked,original,2024,fgen-d403703b0b160266b9de71f3,synthetic_programmatic_template,stacked,top,False,raw_export
"Rewards Visa Signature
Atlas Card Services
Account ending in
2484
Opening/Closing Date
03/01/2024 - 03/28/2024
Account Summary
Previous Balance
$3,937.79
Payments, Credits
-$3,937.79
Purchases
$2,545.63
Fees Charged
$0.00
Interest Charged
$97.55
New Balance
$2,719.08
Minimum Payment Due
$43.23
Payment Due Date
November 4, 2024
Purchase APR
23.10%
Trans Date  Description  Amount
09/20
TARGET T-2231
476.06
01/23
CVS/PHARMACY 0832
173.25
11/23
NETFLIX.COM
867.96
09/15
COSTCO WHSE #412
66.46
07/09
STARBUCKS #11872
504.40",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-dfc53945c952b6bd650e4426,v11-CREDIT_CARD_STATEMENT-stacked,original,2024,fgen-7c057ba90248be1788c2756d,synthetic_programmatic_template,stacked,top,False,monthly
"Everyday Cash Card
Bluewater Bank Card Center
Account ending in
9002
Opening/Closing Date
06/01/2023 - 06/28/2023
Account Summary
Previous Balance
$5,819.57
Payments, Credits
-$5,819.57
Purchases
$776.20
Fees Charged
$0.00
Interest Charged
$0.68
New Balance
$1,664.67
Minimum Payment Due
$165.90
Payment Due Date
08/10/2023
Purchase APR
29.34%
Trans Date  Description  Amount
08/26
CVS/PHARMACY 0832
458.70
05/19
CVS/PHARMACY 0832
311.56
11/20
SHELL OIL 5741
600.45
03/07
COSTCO WHSE #412
794.48
05/17
TARGET T-2231
209.58
01/23
STARBUCKS #11872
784.30
05/11
DELTA AIR LINES
544.66",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-a96f32806bf5afb886641b04,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-4624f4908d281c20661d73a4,synthetic_programmatic_template,stacked,top,False,monthly
"Bluewater Bank Card Center
Account ending in
6655
Opening/Closing Datc
04/01/2023 - 04/31/2023
Account Summary
Prevíous Balance
S7,149.16
Payments, Credits
-$7,149.16
Purchases
$3,293.04
Fees Charged
$0.00
Interest Charged
$61.74
New Balance
$4,406.86
Minimum Payment Due
$120.80
Payment Due Date
2O23-05-06
Purchasc APR
26.38%
Trans Date  Description  Amount
06/05
5TARBUCKS #11872
369.62
04/12
TARGET T-2231
828.93
08/05
UBER TRIP
125.60
Late PaymentWamíng: If we do not receive your minimum payment by the date listed above, you mayhave to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-0c72689779cc701691f6d740,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-5b094a73f3b36713b360cf27,synthetic_programmatic_template,stacked,none,True,monthly
"Everyday Cash Card
5ummit Card Services
Account ending in
0699
Opening/Closing Date
08/01/2026 - 08/31/2026
Account Summary
Previous Balance
$2,689.71
Payments, Credits
-$2,689.71
Purchases
$2,842.74
Fees Charged
$0.00
Interest Charged
$1.03
New Balance
$893.04
MinimumPayment Due
$99.97
Payment Due Date
03/23/2026
Purchase APR
21.58%
Trans Date  Description  Amount
02/01
H0ME DEPOT0612
79.52
01/2l
CO5TCO WH5E #412
781.81
08/11
COSTCO WHSE #412
754.00
12/12
CVS/PHARMACY 0832
571.22
08/05
CVS/PHARMACY 0832
829.42
04/28
WHOLE FOODS #1021
76.42
Latc Payment Wamíng: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d8f68b7ccbd7509c0b344594,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-6a5fada7a7871dae7a458938,synthetic_programmatic_template,stacked,top,True,monthly
"Bluewater Bank Card Center
Category  Transactions  Total
Gas
23
8,980.22
Merchandise
21
7,946.43
Travel
81
1,427.44
Dining
49
3,086.42
Total purchases this year
4,140.06
Total interest charged this year
342.46
This summary is provided for your records and is not a tax form.
Platinum Card
2026 Year-End Summary",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-fbfb4c7cc08419baa89c7e2f,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-3bcc12f2867f8e3c83676ac8,synthetic_programmatic_template,stacked,bottom,False,year_end_summary
"Rewards Visa ...7144
Date  Description  Card Member  Account #  Amount
O6/O3/2025
TARGET T-2231
MORGAN KOWALSKI
-99132
869.57
25/01/2025
TARGET T-2231
CASEY MOREAU
-90309
656.64
2025-l2-25
HOME DEPOT 0612
RILEY TANAKA
-30526
322.69
2025-05-08
NETFLIX.C0M
WEI J. SATO
-60079
867.01
2025-06-11
TARGET T-2231
SOFIA NGUYEN
-87292
402.19
2025-12-04
AMAZON MKTPLACE
MORGAN K. HADDAD
-15146
204.85
03/06/2025
WHOLE FOODS #1021
TAYLOR TANAKA
-70516
428.91
09/19/2025
DELTA AIR LINES
WEIL. HADDAD
-70719
375.90
04/06/2025
NETFLIX.COM
HIRO ADEYEMI
-42218
220.41",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-99e989057999be41a21e02a7,v11-CREDIT_CARD_STATEMENT-stacked,original,2025,fgen-6fdc9cb92d8cd09491b49d30,synthetic_programmatic_template,stacked,top,True,raw_export
"Travel Rewards Visa
2021 Year-End Summary
Atlas Card Services
Category  Transactions  Total
Gas
32
3,401.81
Merchandise
72
5,091.83
Dining
49
1,651.51
Groceries
39
1,432.83
Total purchases this year
22,828.88
Total interest charged this year
278.50
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-992414aab3adecd52eb807ea,v11-CREDIT_CARD_STATEMENT-stacked,original,2021,fgen-aa073334274a0ef1dd0f0bab,synthetic_programmatic_template,stacked,top,False,year_end_summary
"Transaction Date  Post Date  Description  Category  Type  Amount  Memo
16/02/2021
27/07/2021
UBER TRIP
Travel
Sale
879.32

04/05/2021
2021-04-01
HOME DEPOT 0612
Food & Drink
Return
-687.31

05/25/2021
2021-03-08
TARGET T-2231
Groceries
Sale
-612.83

09/07/2021
21/08/2021
STARBUCKS #11872
Shopping
Sale
-830.05

Rewards Visa ...2500",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-548a740f04139eee0747e3f8,v11-CREDIT_CARD_STATEMENT-stacked,original,2021,fgen-8fda6b088f82f557776963bf,synthetic_programmatic_template,stacked,bottom,False,raw_export
"Everyday Cash Card
Bluewater Bank Card Center
Account ending in
0129
Opening/Closing Date
02/01/2022 - 02/28/2022
Account Summary
Previous Balance
$6,192.86
Payments, Credits
-$6,192.86
Purchases
$71.80
Fees Charged
$0.00
Interest Charged
$57.37
New Balance
$5,826.37
Minimum Payment Due
$134.07
Payment Due Date
April 7, 2022
Purchase APR
27.15%
Trans Date  Description  Amount
06/02
AMAZON MKTPLACE
275.50
06/02
SHELL OIL 5741
105.16
11/19
UBER TRIP
731.69
06/06
WHOLE FOODS #1021
810.44",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-27dfde53a417f625e3fc0da3,v11-CREDIT_CARD_STATEMENT-stacked,original,2022,fgen-5d38c470e1ab8dbb8475db2d,synthetic_programmatic_template,stacked,top,False,monthly
"Everyday Cash Card
Northwind CardMember Services
Account ending in
8141
Opening/Closing Date
08/01/2026 - 08/28/2026
Account Summary
Previous Balance
$6,310.27
Payments, Credits
-$6,310.27
Purchases
$3,279.65
Fees Charged
$0.00
Interest Charged
$34.36
New Balance
$3,253.59
Minimum Payment Due
$l02.96
Payment Due Date
2026-07-28
Purchase APR
24.57%
Trans Date  Descríption  Amount
08/28
UBER TRIP
315.79
06/26
STARBUCKS #l1872
591.14
04/25
SHELL 0IL 5741
605.94
l1/24
H0ME DEPOT 0612
713.65
03/06
HOME DEPOT 0612
774.70
Late Payment Waming: If we do not receive your minimum payment by the date listed above, you may haveto pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d87ad8035b001673c1e2ba9d,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-cae364964ed48157147b2b74,synthetic_programmatic_template,stacked,top,True,monthly
"Transaction Date  Post Date  Description  Category  Type  Amount  Memo
17/01/2022
21/03/2022
NETFLIX.COM
Shopping
Sale
44.36

01/13/2022
19/06/2022
DELTA AIR LINES
Groceries
Sale
-591.89

2022-05-24
2022-12-08
CVS/PHARMACY 0832
Travel
Return
-587.38

2022-10-04
2022-07-08
NETFLIX.COM
Groceries
Return
-316.58",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-8e1a3d99c1e39981cbb31c30,v11-CREDIT_CARD_STATEMENT-stacked,original,2022,fgen-2499bd193b344b45f2f6fa0d,synthetic_programmatic_template,stacked,none,False,raw_export
"Trans. Date  Post Date  Description  Amount  Category
2021-12-17
202l-08-28
INTEREST CHARGE ONPURCHASES
177.08
Payments and Credits
06/02/2021
2021-02-12
INTEREST CHARGE ON PURCHASES
694.11
Restaurants
2021-06-02
2021-01-15
DELTA AIR LINES
293.92
Paymcnts and Credits
04/12/2021
2021-04-09
UBER TRIP
515.77
Restaurants
2021-06-11
02/18/2021
DELTA AIR LINES
547.58
Merchandise
2021-12-08
09/09/2021
NETFLIX.C0M
520.68
Restaurants",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d632aa8d148058d7cfd09414,v11-CREDIT_CARD_STATEMENT-stacked,original,2021,fgen-7e6f1c8d322740117f45c61b,synthetic_programmatic_template,stacked,bottom,True,raw_export
"Harbor Card Services
Account ending in
3296
Opening/Closing Date
O3/01/2022 - 03/31/2022
Account Summary
Previous Balance
$6,858.37
Payments, Credits
-$6,858.37
Purchases
$2,191.41
Fees Charged
$0.00
Interest Charged
$15.79
New Ba1ance
$5,091.72
MinimumPayment Due
$191.71
Payment Due Date
04/24/2022
Purchase APR
21.80%
Trans Date  Description  Amount
l0/03
DELTA AIR LINE5
544.79
12/1O
TARGET T-2231
795.01
10/08
STARBUCKS #l1872
345.27
02/26
C0STCO WHSE #412
621.03
10/02
HOME DEPOT 0612
209.02
04/16
DELTA AIR LINES
401.70
Latc Payment Warning: If we do not receive your minimum payment by the datelisted above, you may have to pay a late fee.
Rewards Visa Signature",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9c9466623414d24613cda3b1,v11-CREDIT_CARD_STATEMENT-stacked,original,2022,fgen-794c86696a3c4816a2303345,synthetic_programmatic_template,stacked,bottom,True,monthly
"Atlas Card Services
Category  Transactions  Total
Services
68
5,067.39
Gas
33
2,224.11
Merchandise
33
2,491.53
Travel
61
8,504.41
Total purchases this year
$48,060.88
Total interest charged this year
760.52
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-7c374ec2438d02d8ee2ae278,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-b8d0bd2ca60ab03ba1d0c90b,synthetic_programmatic_template,stacked,none,False,year_end_summary
"Date  Description  Card Member  Account #  Amount
2023-12-21
HOME DEPOT 0612
PRIYA TESTCASE
-90872
185.05
12/07/2023
HOME DEPOT 0612
JAMIE LARSEN
-97227
868.44
20/12/2023
TARGET T-2231
SOFIA K. SATO
-80371
490.62
01/03/2023
WHOLE FOODS #1021
AMARA RIVERA
-83788
529.46
14/01/2023
DELTA AIR LINES
RILEY OKAFOR
-88866
860.39",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-35d7e9d3affb3329fd8e3333,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-ee6e8569fd5c9b77d7b3065c,synthetic_programmatic_template,stacked,top,False,raw_export
"Credit Card Transactions
Downloaded 27/12/2023
Transaction Date  Post Date  Description  Category  Type  Amount  Memo
08/05/2023
2023-07-01
AMAZON MKTPLACE
Gas
Return
5.75

2023-08-17
19/06/2023
UBER TRIP
Groceries
Sale
-499.31

2023-05-23
11/12/2023
COSTCO WHSE #412
Gas
Payment
-796.15

2023-08-18
05/04/2023
UBER TRIP
Travel
Sale
-835.76

02/08/2023
07/03/2023
SHELL OIL 5741
Shopping
Sale
-12.01

21/06/2023
28/04/2023
WHOLE FOODS #1021
Shopping
Sale
-593.41

2023-04-05
2023-04-04
DELTA AIR LINES
Gas
Sale
508.59

05/08/2023
2023-08-22
HOME DEPOT 0612
Travel
Sale
-513.27

19/12/2023
2023-01-08
UBER TRIP
Gas
Sale
-683.61",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-27e8c1e16200414f48540423,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-f7dc10c21ebe5c2b46be603a,synthetic_programmatic_template,stacked,top,False,raw_export
"Platinum Card
2026 Year-End Summary
Harbor Card Services
Category  Transactions  Total
Services
52
5,351.73
Groceries
56
2,202.25
Dining
25
1,243.58
Travel
65
2,400.38
Total purchases this year
$43,753.38
Total interest charged this year
674.97
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-038d540a8320c0f452981a41,v11-CREDIT_CARD_STATEMENT-stacked,original,2026,fgen-e5c16a4833f472c4007b5979,synthetic_programmatic_template,stacked,top,False,year_end_summary
"Everyday Cash Card
Bluewater Bank Card Center
Account endíng in
5513
Opening/Closing Date
04/01/2025 - 04/28/2025
Account Summary
Previous Balancc
$171.35
Payments, Credíts
-$171.35
Purchascs
$3,318.15
Fces Charged
$0.00
Interest Charged
$84.34
New Balance
$4,034.24
Mínimum Payment Due
$47.76
Payment Due Date
2025-03-26
Purchase APR
25.92%
Trans Date  Description  Amount
12/12
CVS/PHARMACY 0832
90.31
06/24
HOME DEPOT 0612
741.67
07/04
HOME DEPOT 0612
51.32
01/17
UBERTRIP
93.77
07/17
HOME DEPOT 0612
109.61
09/04
COSTCO WHSE #412
476.26
Latc Payment Waming: If we do notreceive your minimum payment by the date 1isted above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-baaf712f5b1efc3e95e76587,v11-CREDIT_CARD_STATEMENT-stacked,original,2025,fgen-778f42c268dc37d3b081bad5,synthetic_programmatic_template,stacked,top,True,monthly
"Bluewater Bank Card Center
Account ending in
8533
Opening/Closing Date
10/01/2023 - 10/30/2023
Account Summary
Previous Balance
$1,718.27
Payments, Credits
-$1,718.27
Purchases
$3,662.89
Fees Charged
$0.00
Interest Charged
$94.09
New Balance
$3,720.96
Minimum Payment Due
$80.89
Payment Due Date
2023-08-17
Purchase APR
29.42%
Trans Date  Description  Amount
03/15
UBER TRIP
668.59
07/26
CVS/PHARMACY 0832
80.69
11/15
CVS/PHARMACY 0832
523.63",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d03a30c83e5190fc38d96066,v11-CREDIT_CARD_STATEMENT-stacked,original,2023,fgen-6b816ffca97b945ef2b2600d,synthetic_programmatic_template,stacked,none,False,monthly
"Card ending in 9850 - Activity
Trans. Date  Post Date  Description  Amount  Category
04/11/2025
11/04/2025
INTEREST CHARGE ON PURCHASES
74.68
Payments and Credits
09/15/2025
2025-06-22
SHELL OIL 5741
361.76
Restaurants
17/03/2025
04/11/2025
STARBUCKS #11872
-225.75
Merchandise
2025-10-07
2025-09-20
WHOLE FOODS #1021
247.35
Merchandise
2025-09-04
12/16/2025
STARBUCKS #11872
699.73
Payments and Credits
04/11/2025
09/04/2025
CVS/PHARMACY 0832
693.31
Merchandise
03/24/2025
13/05/2025
WHOLE FOODS #1021
631.40
Payments and Credits",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-81f7ef4b09929cf22b53f395,v11-CREDIT_CARD_STATEMENT-stacked,original,2025,fgen-199eef6886d54d78530b4492,synthetic_programmatic_template,stacked,top,False,raw_export
"World Elite Mastercard
Bluewater Bank Card Center
Account ending in
0732
Opening/Closing Date
04/01/2025 - 04/31/2025
Account Summary
Previous Balance
$4,368.06
Payments, Credits
-$4,368.06
Purchases
$3,370.89
Fees Charged
$0.00
Interest Charged
$3.21
New Balance
$5,237.80
Minimum Payment Due
$30.09
Payment Due Date
September 2, 2025
Purchase APR
18.93%
Trans Date  Description  Amount
10/25
COSTCO WHSE #412
575.42
04/03
NETFLIX.COM
632.10
04/13
WHOLE FOODS #1021
821.85
08/27
STARBUCKS #11872
549.42",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-16358d07b2a699991c596b73,v11-CREDIT_CARD_STATEMENT-stacked,original,2025,fgen-4f5d9a03bec922a43788329b,synthetic_programmatic_template,stacked,top,False,monthly
"Rewards Visa ...3761
Downloaded 2026-02-16
Date  Description  Card Member  Account #  Amount
2026-07-13  CVS/PHARMACY 0832  AMARA TANAKA  -79329  829.69
2026-03-20      TARGET T-2231      AVERY TANAKA      -86834      826.53
13/11/2026      COSTCO WHSE #412      KWAME J. ROMERO      -79974      103.54
01/06/2026   HOME DEPOT 0612   JAMIE A. ADEYEMI   -39141   880.82
04/13/2026 SHELL OIL 5741 JORDAN TESTCASE -11791 497.17
04/05/2026      HOME DEPOT 0612      NOAH E. CASTILLO      -41621      824.56
10/10/2026   HOME DEPOT 0612   JORDAN PATEL   -86369   88.82",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-16a368651e10c16c1a9d71ea,v11-CREDIT_CARD_STATEMENT-inline,original,2026,fgen-53a74b72a1aeeb69c254312b,synthetic_programmatic_template,inline,top,False,raw_export
"World Elite Mastercard
Harbor Card Services
Account ending in 9775
Opening/Closing Date 05/01/2025 - 05/28/2025
Account Summary
Previous Balance $70.96
Payments, Credits -$70.96
Purchases $1,157.49
Fees Charged      $0.00
Interest Charged   $13.07
New Balance      $5,479.08
Minimum Payment Due  $104.14
Payment Due Date   May 25, 2025
Purchase APR 19.68%
Trans Date  Description  Amount
10/14 STARBUCKS #11872 219.99
09/26 AMAZON MKTPLACE 283.44
07/05 DELTA AIR LINES 369.53
05/26  NETFLIX.COM  832.05",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-269256ea5fe8a6c2eff20c2f,v11-CREDIT_CARD_STATEMENT-inline,original,2025,fgen-78d7c196b8601167849d0b0f,synthetic_programmatic_template,inline,top,False,monthly
"Rewards Visa ...2081
Downloaded 2022-03-11
Transaction Date      Post Date      Description      Category      Type      Amount      Memo
02/23/2022 07/10/2022 HOME DEPOT 0612 Gas Return 195.25 
2022-08-19 2022-07-18 UBER TRIP Travel Sale -290.88 
11/12/2022 05/22/2022 TARGET T-2231 Shopping Payment -17.93 
2022-10-05 07/03/2022 STARBUCKS #11872 Shopping Return -140.62 
12/22/2022 2022-01-22 AMAZON MKTPLACE Travel Payment -825.29 
2022-07-24   2022-03-25   HOME DEPOT 0612   Gas   Return   -560.02   
2022-03-01 2022-03-25 SHELL OIL 5741 Travel Return -425.13 
2022-11-13  08/06/2022  STARBUCKS #11872  Food & Drink  Sale  -881.52",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-ee2f4e46517dde0f9a8ce529,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-3ff2fbd36b9f87e1f2c29a12,synthetic_programmatic_template,inline,top,False,raw_export
"Everyday Cash Card
2026 Year-End Summary
Bluewater Bank Card Center
Category      Transactions     Total
Gas   74   1,300.68
Travel      26     8,362.88
Dining      89      8,862.26
Groceries 90 940.92
Tota1 purchases this year      10,256.30
Tota1 interest charged this year $424.18
This summaryis provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b77290755591a1ca3cb1ceeb,v11-CREDIT_CARD_STATEMENT-inline,original,2026,fgen-a6c1b4a8112307026077cee0,synthetic_programmatic_template,inline,top,True,year_end_summary
"Rewards Visa Signature
Bluewater Bank Card Center
Account ending in  2064
Opening/Closing Date      03/01/2024 - 03/28/2024
Account Summary
Previous Balance $7,918.48
Payments, Credits  -$7,918.48
Purchases  $1,850.47
Fees Charged $0.00
Interest Charged      $5.32
New Balance   $137.36
Minimum Payment Due $30.71
Payment Due Date 07/04/2024
Purchase APR      27.38%
Trans Date Description Amount
09/04   UBER TRIP   562.49
11/13      CVS/PHARMACY 0832      440.97
09/21  STARBUCKS #11872  173.08
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-ab5129026183ede6e8834525,v11-CREDIT_CARD_STATEMENT-inline,original,2024,fgen-084b4b7e753c843f8f58dc46,synthetic_programmatic_template,inline,top,False,monthly
"World Elite Mastercard
2025 Year-End Summary
Harbor Card Services
Category   Transactions   Total
Travel  30  2,289.62
Gas   33   3,485.95
Dining 58 1,757.29
Merchandise      77      8,444.72
Total purchases this year 45,241.93
Total interest charged this year  $400.20
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-7caee73a40504e3f38b80bbe,v11-CREDIT_CARD_STATEMENT-inline,original,2025,fgen-05812c0a87545dc8a33bc0ff,synthetic_programmatic_template,inline,top,False,year_end_summary
"Platinum Card
Bluewater Bank Card Center
Account ending in 2631
Opening/Closing Date  01/01/2021 - 01/30/2021
Account Summary
Previous Balance $1,664.11
Payments, Credits -$1,664.11
Purchases  $2,624.47
Fees Charged      $0.00
Interest Charged $8.91
New Balance  $402.28
Minimum Payment Due   $99.52
Payment Due Date 02/03/2021
Purchase APR      25.87%
Trans Date   Description   Amount
09/22 NETFLIX.COM 812.22
07/22 DELTA AIR LINES 99.72
08/11   STARBUCKS #11872   514.56
05/28  NETFLIX.COM  227.37
07/27 DELTA AIR LINES 573.01
11/09  AMAZON MKTPLACE  695.13
01/01  TARGET T-2231  31.68
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-eb0c5860bf321a4ec6e120f2,v11-CREDIT_CARD_STATEMENT-inline,original,2021,fgen-d39492063e46dece7db0dc76,synthetic_programmatic_template,inline,top,False,monthly
"World Elite Mastercard
Harbor Card Services
Account ending in 2633
Opening/ClosingDate   07/01/2026 - 07/28/2026
Account Summary
Previous Balance $6,890.01
Payments, Credits      -$6,890.01
Purchases  $2,989.36
Fees Charged $0.00
Interest Charged $45.13
New Balance   $3,9l3.59
Minimum Payment Due   $157.61
Payment Due Date  11/17/2026
Purchase APR  29.41%
Trans Date      Description      Amount
03/07 CO5TCO WHSE #412 453.55
11/08  UBER TRIP  283.78
11/04   STARBUCKS #11872   575.12
11/21 CVS/PHARMACY 0832 662.66
l0/15 DELTA AIR LINES 212.32
02/26 DELTA AIR LINES 337.82
07/25 DELTA AIR LINES 611.69",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f3a7e68eb553cbc72cd74a97,v11-CREDIT_CARD_STATEMENT-inline,original,2026,fgen-401a04b62ae9de03bd708ee6,synthetic_programmatic_template,inline,top,True,monthly
"Bluewater Bank Card Center
Account ending in  2092
Opening/Closing Date   O5/01/2022- 05/28/2022
Account Summary
Previous Balance $6,821.29
Payments, Credits  -$6,82l.29
Purchases  $4,O24.59
Fees Charged      $0.00
Interest Charged $0.72
New Balance $5,275.55
Minimum Payment Due $70.32
Payment Due Date   April 24, 2022
Purchase APR  l9.17%
Trans Date      Description      Amount
12/23  WHOLE FOODS #1021  889.50
08/21 AMAZON MKTPLACE 575.73
09/10 AMAZON MKTPLACE 560.89
06/06      STARBUCKS#11872      351.54
O4/16  DELTA AIR LINES  730.49
02/16      STARBUCKS #11872      818.52
09/08      COSTCO WHSE #412      386.86
P1atinumCard",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-3bb1d6d9909a9e08c1ae4752,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-401cc063528b59f97755d18a,synthetic_programmatic_template,inline,bottom,True,monthly
"Trans. Date      Post Date      Description      Amount      Category
2021-07-24 08/20/2021 DELTA AIR LINES 234.56 Restaurants
03/09/2021 24/07/2021 STARBUCKS #11872 708.41 Payments and Credits
10/08/2021 15/04/2021 UBER TRIP 496.23 Merchandise
21/08/2021      05/22/2021      SHELL OIL 5741      640.18      Restaurants
17/08/2021 03/24/2021 AUTOPAY PAYMENT - THANK YOU 623.23 Merchandise",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-219f5118562ebe1b9cbe3bd7,v11-CREDIT_CARD_STATEMENT-inline,original,2021,fgen-01d60eb1ccadf1f104e1938c,synthetic_programmatic_template,inline,none,False,raw_export
"Everyday Cash Card
2022 Year-End Summary
Bluewater Bank Card Center
Category Transactions Total
Dining  64  2,447.51
Travel 51 1,449.72
Services 65 5,621.39
Merchandise 24 2,968.56
Total purchases this year   45,140.73
Total interest charged this year $700.98
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-81306e7308f7feece7a942fd,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-d1b58a4fc42a8fa688e9cdd8,synthetic_programmatic_template,inline,top,False,year_end_summary
"Everyday Cash Card
Atlas Card Services
Account ending in 0603
Opening/Closing Date   05/01/2021 - 05/30/2021
Account Summary
Previous Balance $4,182.91
Payments, Credits  -$4,182.91
Purchases $506.94
Fees Charged      $0.00
Interest Charged   $42.41
New Balance $3,536.12
Minimum Payment Due      $60.17
Payment Due Date 2021-04-12
Purchase APR  29.24%
Trans Date  Description  Amount
04/22  COSTCO WHSE #412  715.02
01/16 SHELL OIL 5741 306.12
04/13  TARGET T-2231  656.18
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-13143adc75cfd735896eeab8,v11-CREDIT_CARD_STATEMENT-inline,original,2021,fgen-1e127229b7b67026d6165864,synthetic_programmatic_template,inline,top,False,monthly
"Harbor Card Services
Account ending in      1184
Opening/Closing Date      02/01/2025 - 02/28/2025
Account Summary
Previous Balance   $1,509.37
Payments, Credits   -$1,509.37
Purchases  $2,546.91
Fees Charged $0.00
Interest Charged      $25.90
New Balance $772.74
Minimum Payment Due      $114.46
Payment Due Date  2025-09-05
Purchase APR 26.04%
Trans Date   Description   Amount
04/26  WHOLE FOODS #1021  887.58
04/18      COSTCO WHSE #412      633.54
03/28  TARGET T-2231  515.93
03/05 AMAZON MKTPLACE 242.05
05/24 COSTCO WHSE #412 896.82
06/14      COSTCO WHSE #412      545.62
09/16 CVS/PHARMACY 0832 691.23
Platinum Card",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9bdcb4386066205314a5baf8,v11-CREDIT_CARD_STATEMENT-inline,original,2025,fgen-ecc2a989bde1d1228d46fafe,synthetic_programmatic_template,inline,bottom,False,monthly
"Rewards Visa Signature
Harbor Card Services
Account ending in  6546
Opening/Closing Date 06/01/2023 - 06/28/2023
Account Summary
Previous Balance    $3,025.44
Payments, Credits   -$3,025.44
Purchases  $508.27
Fees Charged  $0.00
Interest Charged  $52.43
New Balance      $3,440.ll
Minimum Payment Due      $176.04
Payment Due Date November 16, 2023
Purchase APR 24.38%
Trans Date      Description      Amount
10/06   WH0LE F0ODS #1021   327.24
08/10 STARBUCKS #11872 163.84
06/12   STARBUCKS #11872   583.01
09/24 HOME DEPOT 0612 505.59
03/25 TARGET T-2231 651.36
02/12     CVS/PHARMACY 0832      26.57",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-2a5abc29e770f9b0efcf11e2,v11-CREDIT_CARD_STATEMENT-inline,original,2023,fgen-f112be40bffb72cc849f5c77,synthetic_programmatic_template,inline,top,True,monthly
"Everyday Cash Card
2022 Year-End Summary
Atlas Card Services
Category  Transactions  Total
Travel  26  4,551.84
Dining 79 2,905.89
Gas      36      3,026.71
Merchandise  20  3,364.80
Total purchases this year $44,578.43
Total interest charged this year      $680.34
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-6e533dc84b91ec10b107df77,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-208717346fcdf39eec59b9a7,synthetic_programmatic_template,inline,top,False,year_end_summary
"Everyday Cash Card
2022 Year-End Summary
Bluewater Bank Card Center
Category Transactions Total
Travel 45 6,051.71
Merchandise 15 5,028.95
Gas      35      8,152.64
Services   56   8,893.74
Total purchases this year 18,694.47
Total interest charged this year   $368.51
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-854fe463a34ccaab3cf91c8f,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-e234ce0b537809ef84053e14,synthetic_programmatic_template,inline,top,False,year_end_summary
"Platinum Card
2023 Year-End Summary
Summit Card Services
Category   Transactions   Total
Gas 7 1,497.89
Travel   84   6,760.57
Groceries 39 7,218.28
Services 56 4,730.35
Total purchases this year $59,050.35
Total interest charged this year      $432.89
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-286d96109fc8f5c2bd53cad1,v11-CREDIT_CARD_STATEMENT-inline,original,2023,fgen-54237cc84dd9c2f2b8de1705,synthetic_programmatic_template,inline,top,False,year_end_summary
"Cash Back Mastercard
Bluewater Bank Card Center
Account endíng in 8004
Opening/Closing Date 03/0l/2025 - 03/31/2025
Account 5ummary
Previous Balance  $1,023.86
Payments, Credits -$1,023.86
Purchases      $2,194.08
Fees Charged      $0.00
Interest Charged $31.28
New Balance   $3,689.86
Minimum Payment Due   $47.36
Payment Due Date 8/14/25
Purchase APR  22.98%
Trans Date Descríption Amount
04/17 C0STCO WHSE #412 395.26
O8/28     SHELL OIL 5741     330.35
11/21  TARGET T-2231  136.56
Late Payment Warning: If we do not receive your minimum payment bythc date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d4e22fe307b2c29aadf252c5,v11-CREDIT_CARD_STATEMENT-inline,original,2025,fgen-803b6df4d88eaf1803633f8c,synthetic_programmatic_template,inline,top,True,monthly
"Trans. Date  Post Date  Description  Amount  Category
08/05/2024  10/12/2024  STARBUCKS #11872  294.06  Merchandise
13/04/2024 06/04/2024 AMAZON MKTPLACE 695.42 Payments and Credits
04/24/2024      2024-10-25      AUTOPAY PAYMENT - THANK YOU      721.71      Merchandise
2024-01-04  2024-06-07  CVS/PHARMACY 0832  846.05  Restaurants",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f3a024e2686edb61a4796557,v11-CREDIT_CARD_STATEMENT-inline,original,2024,fgen-312cf53f818d141c5173773c,synthetic_programmatic_template,inline,none,False,raw_export
"Rewards Visa ...6709
Trans. Date Post Date Description Amount Category
01/03/2022   09/07/2022   WHOLE FOODS #1021   375.81   Restaurants
10/08/2022      2022-06-21      AMAZON MKTPLACE      178.06      Payments and Credits
2022-03-10  2022-03-17  NETFLIX.COM  -279.82  Payments and Credits
04/07/2022 09/01/2022 COSTCO WHSE #412 40.87 Merchandise
11/01/2022   05/22/2022   INTEREST CHARGE ON PURCHASES   273.81   Restaurants
2022-12-11   2022-04-01   NETFLIX.COM   33.66   Restaurants
01/20/2022  07/12/2022  AMAZON MKTPLACE  -476.97  Payments and Credits
2022-03-05  02/12/2022  SHELL OIL 5741  -586.11  Merchandise
15/04/2022   2022-01-08   TARGET T-2231   229.29   Payments and Credits",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-1a19862ae04c41c0de0ab6e6,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-e9e91a01e41ce3b8545c2589,synthetic_programmatic_template,inline,top,False,raw_export
"Rewards Visa Signature
Northwind Card Member Services
Account ending in 3669
Opening/Closing Date  01/01/2025 - 01/31/2025
Account Summary
Previous Balance $6,615.52
Payments, Credits -$6,615.52
Purchases $744.38
Fees Charged $0.00
Interest Charged  $94.14
New Balance   $4,764.74
Minimum Payment Due   $193.67
Payment Due Date 08/21/2025
Purchase APR      26.23%
Trans Date Description Amount
12/12      TARGET T-2231      773.23
09/08   UBER TRIP   79.28
05/22 COSTCO WHSE #412 350.59
11/03 DELTA AIR LINES 250.18
12/27  AMAZON MKTPLACE  171.69
12/10  STARBUCKS #11872  612.57",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-8bbfa0fa2358592d6db4d7d4,v11-CREDIT_CARD_STATEMENT-inline,original,2025,fgen-455fcc5cb1263626950d4534,synthetic_programmatic_template,inline,top,False,monthly
"Harbor Card Services
Account ending in 3340
Opening/Closing Date 12/01/2021 - 12/30/2021
Account Summary
Previous Balance $7,303.36
Payments, Credits -$7,303.36
Purchases $4,272.93
Fees Charged   $0.00
Interest Charged $29.23
New Balance   $3,248.75
Minimum Payment Due   $163.01
Payment Due Date 08/24/2021
Purchase APR 26.04%
Trans Date      Description      Amount
03/26  DELTA AIR LINES  641.48
06/25 NETFLIX.COM 425.34
05/15  AMAZON MKTPLACE  526.23",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-40b381f7f7389d44761f1c83,v11-CREDIT_CARD_STATEMENT-inline,original,2021,fgen-40ab45c92d0a20ac24db8263,synthetic_programmatic_template,inline,none,False,monthly
"Travel Rewards Visa
Atlas Card Services
Account ending in      2503
Opening/Closing Date 10/01/2024 - 10/30/2024
Account Summary
Previous Balance   $6,917.97
Payments, Credits  -$6,917.97
Purchases  $353.31
Fees Charged      $0.00
Interest Charged $69.49
New Balance  $2,063.53
Minimum Payment Due  $100.80
Payment Due Date  09/19/2024
Purchase APR      20.32%
Trans Date  Description  Amount
06/06 NETFLIX.COM 746.08
02/19  SHELL OIL 5741  621.47
06/14      DELTA AIR LINES      705.69
02/26  DELTA AIR LINES  869.38",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-1bc224b940fb0feef47e6888,v11-CREDIT_CARD_STATEMENT-inline,original,2024,fgen-592dc8d192bef810db08757f,synthetic_programmatic_template,inline,top,False,monthly
"Platinum Card
Atlas Card Services
Account ending in   2958
Opening/Closing Date 05/01/2022 - 05/30/2022
Account Summary
Previous Balance   $1,645.27
Payments, Credits -$1,645.27
Purchases $1,278.80
Fees Charged   $0.00
Interest Charged  $112.78
New Balance      $1,139.55
Minimum Payment Due $91.02
Payment Due Date 2022-02-14
Purchase APR 17.40%
Trans Date Description Amount
11/24   AMAZON MKTPLACE   197.56
12/07 CVS/PHARMACY 0832 704.79
09/03  COSTCO WHSE #412  266.59
02/21   DELTA AIR LINES   36.96
06/14 DELTA AIR LINES 781.63
12/06      CVS/PHARMACY 0832      537.20",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b16ba1d17cf85934ebc0b5f6,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-43e11f1ccdc2949eede64715,synthetic_programmatic_template,inline,top,False,monthly
"Rewards Visa Signature
2023 Year-End Summary
Bluewater Bank Card Center
Category Transactions Total
Services  36  2,031.99
Dining      50      4,113.65
Merchandise  36  5,482.26
Groceries   70   8,998.31
Total purchases this year   29,968.66
Total interest charged this year      237.59
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-e6b06cd5dfde51e1f59f4842,v11-CREDIT_CARD_STATEMENT-inline,original,2023,fgen-398361583ec853892fad5fb2,synthetic_programmatic_template,inline,top,False,year_end_summary
"Rewards Visa Signature
Summit Card Services
Account ending in  4223
Opening/Closing Date 02/01/2024 - 02/28/2024
Account Summary
Previous Balance  $3,397.01
Payments, Credits -$3,397.01
Purchases $2,877.93
Fees Charged   $0.00
Interest Charged      $90.52
New Balance  $2,094.47
Minimum Payment Due  $76.75
Payment Due Date June 9, 2024
Purchase APR  21.83%
Trans Date   Description   Amount
01/23 WHOLE FOODS #1021 650.64
06/24   AMAZON MKTPLACE   449.10
02/08      CVS/PHARMACY 0832      449.82
11/07   SHELL OIL 5741   414.12
03/02  STARBUCKS #11872  210.42
03/26  UBER TRIP  388.50
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-bf600c8c41bd2582d667f0c8,v11-CREDIT_CARD_STATEMENT-inline,original,2024,fgen-6d107f72f072aa6b8ab9b03e,synthetic_programmatic_template,inline,top,False,monthly
"Travel Rewards Visa
2024 Year-End Summary
Summit Card Services
Category  Transactions  Total
Travel   25   5,442.33
Groceries      48      3,684.49
Dining 56 2,767.21
Gas  75  4,941.48
Total purchases this year      18,248.06
Total interest charged this year      779.45
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-674799acd04da61e706d2f09,v11-CREDIT_CARD_STATEMENT-inline,original,2024,fgen-4c2145dd4d249472e2de59a7,synthetic_programmatic_template,inline,top,False,year_end_summary
"Travel Rewards Visa
Harbor Card Services
Account ending in  2100
Opening/Closing Date 10/01/2025 - 10/31/2025
Account Summary
Previous Balance $5,101.67
Payments, Credits  -$5,101.67
Purchases   $437.77
Fees Charged  $0.00
Interest Charged  $22.11
New Balance $2,738.57
Minimum Payment Due  $106.49
Payment Due Date 3/5/25
Purchase APR 28.21%
Trans Date Description Amount
04/03      TARGET T-2231      786.57
11/03 DELTA AIR LINES 78.78
06/14   CVS/PHARMACY 0832   84.79
06/16      AMAZON MKTPLACE      195.14
01/02 NETFLIX.COM 121.27",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-c78b1f612a311ac8733981ec,v11-CREDIT_CARD_STATEMENT-inline,original,2025,fgen-30e9b109a547d72c276c7779,synthetic_programmatic_template,inline,top,False,monthly
"Platinum Card
Atlas Card Services
Accountending in   5225
Opening/Closing Date     08/01/2026 - 08/30/2026
Account Summary
Previous Balance      S7,726.50
Payments,Credits  -$7,726.50
Purchases  $1,108.72
Fees Charged   $0.00
Interest Charged  $15.37
New Balance  $384.15
Mínimum Payment Due      $122.43
Payment Due Date 04/21/2026
Purchase APR 18.63%
Trans Date  Description  Amount
09/28 CO5TCO WH5E#412 381.81
06/23   DELTA AIR LINES   483.57
11/26 NETFLIX.COM 123.89
03/23 SHELL OIL 5741 562.17
03/15  UBER TRIP  760.31
01/22   DELTA AIR LINES   614.51
07/06      TARGET T-2231      500.88",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-6aa691efffe940585d48e64e,v11-CREDIT_CARD_STATEMENT-inline,original,2026,fgen-0aba29fa95175dcfde7b84a0,synthetic_programmatic_template,inline,top,True,monthly
"Downloaded 09/07/2026
Transaction Date Post Date Description Category Type Amount Memo
11/06/2026      2026-05-22      HOME DEPOT 0612      Gas      Sale      498.94      
09/08/2026      28/06/2026      WHOLE FOODS #1021      Groceries      Payment      -448.60      
2026-01-27      2026-07-23      CVS/PHARMACY 0832      Food & Drink      Payment      -705.82      
19/07/2026 13/08/2026 AMAZON MKTPLACE Travel Return -417.67 
2026-07-03  06/16/2026  WHOLE FOODS #1021  Travel  Payment  -777.03",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-01cc066c7acc5d4190209a22,v11-CREDIT_CARD_STATEMENT-inline,original,2026,fgen-d86b54f5ee7b005aa70e4a95,synthetic_programmatic_template,inline,none,False,raw_export
"Platinum Card
Summit Card Scrvices
Account ending in      4365
Opening/ClosingDate  02/01/2022 - 02/28/2022
Account Summary
Prcvious Balance  $5,707.18
Payments, Credits   -$5,7O7.18
Purchases   $3,931.01
Fees Charged   $0.00
Interest Charged  $22.11
New Balance $4,695.73
Minimum Payment Due  $64.85
Payment Due Date  1O/22/22
Purchase APR   22.47%
Trans Date Descríption Amount
09/17      WHOLE FOOD5 #1021     67.03
02/O1  STARBUCKS #11872  375.74
09/19 AMAZON MKTPLACE 260.90
03/16 WHOLE FOODS #1O21 75.64
12/12  HOME DEPOT 0612  402.39
Late Payment Warning: If we donot receive your minimum payment by the date listed above, you may have to paya late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-83e1e7ac1fc3f4822cb19cec,v11-CREDIT_CARD_STATEMENT-inline,original,2022,fgen-b95b4bb4dab60984a55fcc81,synthetic_programmatic_template,inline,top,True,monthly
"Travel Rewards Visa
Summit Card Services
Account ending in 2242
Opening/Closing Date      02/01/2026 - 02/28/2026
Account Summary
Previous Balance $4,470.29
Payments, Credits   -$4,470.29
Purchases $600.91
Fees Charged $0.00
Interest Charged $96.66
New Balance  $4,353.21
Minimum Payment Due $67.66
Payment Due Date   April 22, 2026
Purchase APR   21.82%
Trans Date      Description      Amount
03/03 SHELL OIL 5741 160.39
08/14 STARBUCKS #11872 435.07
06/10   SHELL OIL 5741   467.60
07/06   COSTCO WHSE #412   592.60
02/10  UBER TRIP  169.65
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b731c149cb2ffeb0d034ae92,v11-CREDIT_CARD_STATEMENT-inline,original,2026,fgen-ee82665382804fba91a8d17c,synthetic_programmatic_template,inline,top,False,monthly
"Summit Card Services
Category
Transactions
Total
Dining
16
7,216.50
Travel
16
2,547.14
Groceries
34
8,590.84
Gas
81
8,971.49
Total purchases this year
Total interest charged this year
34,418.85
$634.89
This summary is provided for your records and is not a tax form.
Cash Back Mastercard
2025 Year-End Summary",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-7d3903a2ce4fe79a2160b985,v11-CREDIT_CARD_STATEMENT-columns,original,2025,fgen-8413fd75bdb82e964efbc2d7,synthetic_programmatic_template,columns,bottom,False,year_end_summary
"Date
Description
Card Member
Account #
Amount
05/03/2024
UBER TRIP
NOAH CASTILLO
-81175
108.98
2024-07-01
NETFLIX.COM
AMARA D. BRENNAN
-56892
629.75
06/12/2024
NETFLIX.COM
MATEO L. RIVERA
-72988
435.77
01/15/2024
NETFLIX.COM
JAMIE WALSH
-63848
285.18
12/13/2024
HOME DEPOT 0612
PRIYA E. PATEL
-90987
215.78
15/04/2024
SHELL OIL 5741
AMARA KOWALSKI
-57882
390.63",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-5d84613f312e6dc330609974,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-fed6719da29e55238acc7254,synthetic_programmatic_template,columns,none,False,raw_export
"Travel Rewards Visa
2025 Year-End Summary
Atlas Card Services
Category
Transactions
Total
Gas
11
4,120.34
Dining
15
6,111.40
Merchandise
12
8,170.35
Groceries
74
2,274.15
Total purchases this year
Total interest charged this year
25,265.60
$115.41
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-7fd33d51ed923f7d7a0e1b05,v11-CREDIT_CARD_STATEMENT-columns,original,2025,fgen-1bf7cf0ffc297f4027577973,synthetic_programmatic_template,columns,top,False,year_end_summary
"Summit Card Services
Category
Transactions
Total
Gas
3
1,860.71
Merchandise
56
2,937.26
Groceries
57
5,441.41
Travel
51
5,797.55
Total purchases this year
Total interest charged this year
44,377.96
$365.70
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d06803e7b16aa13a61640c58,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-fe48a0878559a9fa93c43d6b,synthetic_programmatic_template,columns,none,False,year_end_summary
"Harbor Card Services
Account ending in
Opening/Closing Date
7154
07/01/2024 - 07/28/2024
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$5,448.83
-$5,448.83
$1,195.34
$0.00
$83.77
$1,708.39
$85.38
5/7/24
17.61%
Trans Date
Description
Amount
03/23
UBER TRIP
876.25
05/27
AMAZON MKTPLACE
554.48
03/28
SHELL OIL 5741
670.67
10/02
COSTCO WHSE #412
736.33
03/17
WHOLE FOODS #1021
274.66
11/17
STARBUCKS #11872
483.29
09/03
COSTCO WHSE #412
705.99",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-ac9553438c7a6dd1d99e4862,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-5fbc8a45beff01fab47143c1,synthetic_programmatic_template,columns,none,False,monthly
"Trans. Date
Post Date
Description
Amount
Category
26/12/2022
05/15/2022
COSTCO WHSE #412
223.60
Restaurants
20/11/2022
2022-03-22
TARGET T-2231
177.74
Merchandise
07/07/2022
12/21/2022
STARBUCKS #11872
608.18
Merchandise
2022-04-12
07/24/2022
SHELL OIL 5741
798.38
Merchandise
01/13/2022
2022-09-23
SHELL OIL 5741
233.21
Restaurants
12/11/2022
07/12/2022
INTEREST CHARGE ON PURCHASES
242.97
Merchandise
04/10/2022
2022-05-06
INTEREST CHARGE ON PURCHASES
135.33
Payments and Credits",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-ddb28452c4e96321ee8ae71d,v11-CREDIT_CARD_STATEMENT-columns,original,2022,fgen-6e54a3434aadb72af6999a17,synthetic_programmatic_template,columns,top,False,raw_export
"Bluewater Bank Card Center
Account ending in
Opening/Closing Date
2624
07/01/2022 - 07/28/2022
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$5,401.03
-$5,401.03
$1,697.41
$0.00
$116.76
$3,839.18
$141.77
9/4/22
21.13%
Trans Date
Description
Amount
06/20
HOME DEPOT 0612
130.28
10/04
UBER TRIP
743.52
07/01
TARGET T-2231
546.97
04/21
CVS/PHARMACY 0832
23.15
03/16
TARGET T-2231
534.58
World Elite Mastercard",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-10f5e2446fc0aea32931cc75,v11-CREDIT_CARD_STATEMENT-columns,original,2022,fgen-1a4c88f247c1a2fca086c974,synthetic_programmatic_template,columns,bottom,False,monthly
"Downloaded 05/02/2024
Date
Description
Card Member
Account #
Amount
2024-08-27
CVS/PHARMACY 0832
NOAH LARSEN
-66433
237.71
24/01/2024
TARGET T-2231
KWAME OKAFOR
-60008
74.68
15/01/2024
SHELL OIL 5741
JORDAN E. CASTILLO
-70124
71.69
07/22/2024
HOME DEPOT 0612
NOAH FISCHER
-23742
392.91
Card ending in 5646 - Activity",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-6ab127b52470953cc9115ccb,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-a0712a47db80ced5fd0943e7,synthetic_programmatic_template,columns,bottom,False,raw_export
"Travel Rewards Visa
Harbor Card Services
Account ending in
Opening/Closing Date
5804
12/01/2025 - 12/28/2025
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$3,476.92
-$3,476.92
$3,439.33
$0.00
$26.10
$4,130.69
$30.18
10/28/25
29.56%
Trans Date
Description
Amount
12/12
WHOLE FOODS #1021
335.53
10/07
AMAZON MKTPLACE
700.02
08/10
CVS/PHARMACY 0832
654.90
01/26
AMAZON MKTPLACE
386.79",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b47abe4e08e703a5eed0c180,v11-CREDIT_CARD_STATEMENT-columns,original,2025,fgen-07266510ffaa51faa7116e87,synthetic_programmatic_template,columns,top,False,monthly
"Everyday Cash Card
Atlas Card Services
Account ending in
Opening/Closing Date
0977
04/01/2023 - 04/31/2023
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$294.74
-$294.74
$1,217.76
$0.00
$5.75
$5,291.66
$57.56
2023-04-01
22.94%
Trans Date
Description
Amount
12/07
TARGET T-2231
579.36
04/05
UBER TRIP
825.87
08/06
COSTCO WHSE #412
697.74
02/10
NETFLIX.COM
311.36
07/23
STARBUCKS #11872
881.54
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b6a109678cbc82f3639381f5,v11-CREDIT_CARD_STATEMENT-columns,original,2023,fgen-d285968b128b497c8bb914ac,synthetic_programmatic_template,columns,top,False,monthly
"Atlas Card Services
Account ending in
Opening/Closing Date
5967
07/01/2023 - 07/28/2023
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$896.95
-$896.95
$1,263.21
$0.00
$67.62
$2,590.03
$140.20
04/19/2023
18.88%
Trans Date
Description
Amount
10/05
NETFLIX.COM
247.47
06/17
COSTCO WHSE #412
782.05
05/07
TARGET T-2231
767.73
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.
World Elite Mastercard",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-1e552a89cc31c1647d443b46,v11-CREDIT_CARD_STATEMENT-columns,original,2023,fgen-7ed00c6dc5745b4bf73d0afe,synthetic_programmatic_template,columns,bottom,False,monthly
"Trans. Date
Post Date
Description
Amount
Category
11/03/2023
26/04/2023
HOME DEPOT 0612
222.79
Restaurants
2023-09-03
11/23/2023
STARBUCKS #11872
268.65
Payments and Credits
06/07/2023
2023-04-02
STARBUCKS #11872
29.25
Merchandise
06/20/2023
27/03/2023
AMAZON MKTPLACE
463.80
Payments and Credits
04/07/2023
2023-02-22
UBER TRIP
545.55
Restaurants
Credit Card Transactions",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-8f380d78368cf869dd5a0aba,v11-CREDIT_CARD_STATEMENT-columns,original,2023,fgen-2843894e2680d6d8f74e0dce,synthetic_programmatic_template,columns,bottom,False,raw_export
"World Elite Mastercard
Summit Card Services
Account ending in
Opening/Closing Date
0908
02/01/2021 - 02/28/2021
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$1,689.80
-$1,689.80
$218.40
$0.00
$49.82
$67.29
$42.63
10/12/21
24.91%
Trans Date
Description
Amount
07/10
SHELL OIL 5741
655.30
04/13
HOME DEPOT 0612
478.73
01/17
CVS/PHARMACY 0832
687.09
03/01
UBER TRIP
856.33
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-364f710e59ee5a22f64dd4aa,v11-CREDIT_CARD_STATEMENT-columns,original,2021,fgen-c604ba4c7ed4a58a441ed484,synthetic_programmatic_template,columns,top,False,monthly
"Atlas Card Services
Category
Transactions
Total
Groceries
26
8,431.88
Travel
56
178.50
Services
66
6,324.07
Gas
13
4,777.85
Total purchases this year
Total interest charged this year
40,661.40
233.74
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-013fcb57c3edf7c50cb8aace,v11-CREDIT_CARD_STATEMENT-columns,original,2025,fgen-c47753be1ba5d7f84e3b4e04,synthetic_programmatic_template,columns,none,False,year_end_summary
"World EliteMastercard
Bluewater Bank Card Center
Account ending in
Opening/C1osing Date
1904
10/01/2022 - 10/28/2022
Account Summary
Previous Ba1ance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$1,221.62
-$1,221.62
$4,432.56
$O.00
$38.5l
$4,157.17
$160.61
2022-02-09
27.21%
Trans Date
Description
Amount
11/17
SHELL OIL 5741
320.83
12/13
AMAZON MKTPLACE
197.2O
07/01
WHOLE FOODS #1O21
274.35
12/03
AMAZON MKTPLACE
890.44
09/15
CVS/PHARMACY 0832
516.87
06/20
HOME DEPOT 0612
557.90
06/03
SHELL OIL 5741
109.64",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-2e88d0d37c2e75be2271d87a,v11-CREDIT_CARD_STATEMENT-columns,original,2022,fgen-48ff318b18b3f5d3fd947a93,synthetic_programmatic_template,columns,top,True,monthly
"Everyday Cash Card
2022 Year-End Summary
Harbor Card Services
Category
Transactions
Total
Merchandise
81
1,956.31
Dining
28
4,306.91
Travel
66
6,984.01
Services
34
8,074.00
Total purchases this year
Total interest charged this year
$48,435.56
$337.35
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-4514e1136b7481759ca25c40,v11-CREDIT_CARD_STATEMENT-columns,original,2022,fgen-287aa30a02859df598ac0e7a,synthetic_programmatic_template,columns,top,False,year_end_summary
"Trans. Date
Post Date
Description
Amount
Category
2024-02-05
2024-11-05
AUTOPAY PAYMENT - THANK YOU
218.77
Restaurants
2024-01-17
24/03/2024
NETFLIX.COM
378.51
Merchandise
12/12/2024
2024-04-21
STARBUCKS #11872
238.10
Restaurants
2024-01-09
2024-11-03
HOME DEPOT 0612
180.49
Payments and Credits",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-abc500217504714133e2b945,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-d10330f533262b670271fc25,synthetic_programmatic_template,columns,none,False,raw_export
"Summit Card Services
Account ending in
Opening/Closing Date
9853
O1/01/2023 - 01/30/2023
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
NewBalance
Minimum Payment Due
Payment Due Date
PurchaseAPR
$5,578.15
-$5,578.15
$2,534.53
$O.00
$72.63
$591.70
$37.37
2023-11-20
29.75%
Trans Date
Description
Amount
02/06
CVS/PHARMACY 0832
54.03
02/27
UBER TRIP
408.08
02/10
C0STCO WHSE #412
301.91
12/24
STARBUCKS #11872
585.02
09/11
DELTA AIR LINES
716.16
06/03
TARGET T-2231
576.59
Late Paymcnt Warníng: If we do not receive your minimum payment by the date 1isted above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-76431b18ca7f3fa4ac5719c3,v11-CREDIT_CARD_STATEMENT-columns,original,2023,fgen-a0156dc09d5eaba09cde2351,synthetic_programmatic_template,columns,none,True,monthly
"Everyday Cash Card
Northwind Card Member Services
Account ending in
Opening/Closing Date
9866
10/01/2024 - 10/31/2024
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$5,192.22
-$5,192.22
$1,745.29
$0.00
$97.32
$3,065.61
$98.27
January 17, 2024
20.78%
Trans Date
Description
Amount
07/17
AMAZON MKTPLACE
416.90
05/17
STARBUCKS #11872
237.45
04/28
DELTA AIR LINES
860.59
09/11
WHOLE FOODS #1021
462.00
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-e5805389dfd4186a8d978190,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-50a568fcbd9a8cee9c20b67e,synthetic_programmatic_template,columns,top,False,monthly
"Northwind Card Member Services
Account ending in
Opening/Closing Date
8514
03/01/2023 - 03/31/2023
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$4,601.58
-$4,601.58
$2,887.87
$0.00
$46.33
$4,206.73
$157.56
2023-09-01
27.11%
Trans Date
Description
Amount
02/12
NETFLIX.COM
551.10
04/02
NETFLIX.COM
138.30
01/13
COSTCO WHSE #412
270.41
09/12
WHOLE FOODS #1021
497.70
07/01
SHELL OIL 5741
341.29
01/18
STARBUCKS #11872
230.90
Everyday Cash Card",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-6dd4831984b0c8f1c1f01363,v11-CREDIT_CARD_STATEMENT-columns,original,2023,fgen-1858a26ea11405306e70e366,synthetic_programmatic_template,columns,bottom,False,monthly
"World Elite Mastercard
Harbor Card Services
Account ending in
Opening/Closing Date
2014
12/01/2026 - 12/31/2026
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$4,774.45
-$4,774.45
$685.58
$0.00
$58.70
$704.30
$27.18
2026-10-01
23.20%
Trans Date
Description
Amount
12/22
TARGET T-2231
827.73
03/17
STARBUCKS #11872
506.22
03/14
HOME DEPOT 0612
468.33
12/27
UBER TRIP
533.98
03/24
TARGET T-2231
669.61
03/10
CVS/PHARMACY 0832
874.68",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-1c675aed28daf92ec74a6fbd,v11-CREDIT_CARD_STATEMENT-columns,original,2026,fgen-c3f1605ee0a789948d47d4b4,synthetic_programmatic_template,columns,top,False,monthly
"Rewards Visa Signature
2025 Year-End Summary
Bluewater Bank Card Center
Category
Transactions
Total
Merchandise
12
4,894.51
Dining
33
343.75
Gas
18
2,316.26
Groceries
4
2,768.67
Total purchases this year
Total interest charged this year
12,810.15
$781.75
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-414ec3b4ebb4146c58876df6,v11-CREDIT_CARD_STATEMENT-columns,original,2025,fgen-4d7eda8a09db574d63d972be,synthetic_programmatic_template,columns,top,False,year_end_summary
"World Elite Mastercard
Northwind Card Member Services
Account ending in
Opening/Closing Date
3564
12/01/2022 - 12/28/2022
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$7,095.37
-$7,095.37
$4,121.58
$0.00
$97.45
$3,469.35
$94.44
8/10/22
24.26%
Trans Date
Description
Amount
11/21
WHOLE FOODS #1021
527.74
09/24
CVS/PHARMACY 0832
210.98
08/18
TARGET T-2231
894.67
01/25
COSTCO WHSE #412
493.12
07/06
AMAZON MKTPLACE
758.16
06/01
NETFLIX.COM
10.49
02/21
SHELL OIL 5741
898.79
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-e5809cb7465773f5fc49747d,v11-CREDIT_CARD_STATEMENT-columns,original,2022,fgen-8737dee5de6e70348e118d01,synthetic_programmatic_template,columns,top,False,monthly
"Travel Rewards Visa
Harbor Card Services
Account ending in
Opening/Closing Date
4356
04/01/2022 - 04/28/2022
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$4,624.05
-$4,624.05
$2,937.07
$0.00
$65.48
$2,284.60
$85.59
06/14/2022
29.58%
Trans Date
Description
Amount
05/11
DELTA AIR LINES
835.34
08/05
SHELL OIL 5741
404.45
08/26
NETFLIX.COM
401.16
07/03
DELTA AIR LINES
814.48
08/26
COSTCO WHSE #412
393.09
08/12
WHOLE FOODS #1021
856.64
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-64ec5e069a86c7d2fb705a5a,v11-CREDIT_CARD_STATEMENT-columns,original,2022,fgen-c38462590ac046a2828dc85a,synthetic_programmatic_template,columns,top,False,monthly
"Everyday Cash Card
2021 Year-End Summary
Northwind Card Member Services
Category
Transactions
Total
Groceries
21
249.44
Gas
62
7,998.10
Dining
32
8,755.62
Travel
65
548.16
Total purchases this year
Total interest charged this year
$48,688.13
$209.77
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-78a94ae5fe50fac50ecbb2dc,v11-CREDIT_CARD_STATEMENT-columns,original,2021,fgen-cbee7e3857a2ce188242b91f,synthetic_programmatic_template,columns,top,False,year_end_summary
"Credit Card Transactions
Downloaded 03/07/2023
Trans. Date
Post Datc
Description
Amount
Category
02/22/2023
12/10/2023
SHELL OIL 5741
485.64
Paymcnts and Credits
O4/O3/2023
23/07/2023
NETFLIX.COM
404.66
Merchandise
05/01/2023
16/11/2023
CVS/PHARMACY 0832
753.79
Restaurants
2023-07-22
2023-03-03
DELTA AIRLINES
298.58
Mcrchandise",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-071c3568c4c9c971dd42ba8e,v11-CREDIT_CARD_STATEMENT-columns,original,2023,fgen-1be498477aee219afcb669de,synthetic_programmatic_template,columns,top,True,raw_export
"Rewards Visa Signature
Bluewater Bank Card Center
Account ending in
Opening/Closing Date
5252
12/01/2024 - 12/31/2024
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$5,416.20
-$5,416.20
$1,066.07
$0.00
$48.21
$2,591.06
$138.13
June 20, 2024
25.88%
Trans Date
Description
Amount
08/10
CVS/PHARMACY 0832
416.92
08/14
CVS/PHARMACY 0832
214.15
04/20
STARBUCKS #11872
103.74
08/17
HOME DEPOT 0612
304.48
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-5f589ce0f9b8adc6ca359bb7,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-e9d08c041077111ab4ccae40,synthetic_programmatic_template,columns,top,False,monthly
"Travel Rewards Visa
2024 Year-EndSummary
Summit Card Services
Category
Transactions
Total
Dining
29
5,226.98
Travel
17
1,979.73
Groceries
62
5,579.61
Gas
65
659.70
Total purchases this year
Total interest charged this year
51,4O0.27
482.42
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9bf89ab518b81b299744621e,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-273ebfc1deab2a18ac045d7c,synthetic_programmatic_template,columns,top,True,year_end_summary
"Rewards Visa Signature
Bluewater Bank Card Center
Account ending in
Opening/Closing Date
7667
10/01/2024 - 10/28/2024
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$6,666.79
-$6,666.79
$4,054.62
$0.00
$91.62
$5,737.05
$51.71
2024-06-17
21.22%
Trans Date
Description
Amount
10/02
UBER TRIP
644.88
01/14
WHOLE FOODS #1021
39.28
05/20
WHOLE FOODS #1021
811.60
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-bec5215b19371a3830213779,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-0c456ea2739bf8eeb89e504b,synthetic_programmatic_template,columns,top,False,monthly
"Rewards Visa Signature
Bluewater Bank Card Center
Account ending in
Opening/Closing Date
2425
01/01/2024 - 01/30/2024
Account Summary
Previous Balance
Payments, Credits
Purchases
Fees Charged
Interest Charged
New Balance
Minimum Payment Due
Payment Due Date
Purchase APR
$794.57
-$794.57
$3,421.75
$0.00
$23.65
$2,691.94
$27.08
September 6, 2024
29.70%
Trans Date
Description
Amount
10/12
DELTA AIR LINES
795.17
01/26
CVS/PHARMACY 0832
212.58
05/22
TARGET T-2231
833.56
12/23
AMAZON MKTPLACE
463.22
08/27
CVS/PHARMACY 0832
181.24
10/27
CVS/PHARMACY 0832
330.60",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-4a49727bf25b6c19c37ed236,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-02106db07f7c0c9e9ab8d632,synthetic_programmatic_template,columns,top,False,monthly
"Northwind Card Member Services
Category
Transactions
Total
Merchandise
41
623.52
Gas
37
7,004.96
Dining
39
1,718.94
Services
59
8,025.54
Total purchases this year
Total interest charged this year
$47,830.37
255.03
This summary is provided for your records and is not a tax form.
Travel Rewards Visa
2025 Year-End Summary",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-0eeb0bd159462d4b07723edd,v11-CREDIT_CARD_STATEMENT-columns,original,2025,fgen-9f5cc409ceb9391b9eb74c6c,synthetic_programmatic_template,columns,bottom,False,year_end_summary
"Cash Back Mastercard
2024 Year-End Summary
Bluewater Bank Card Center
Category
Transactions
Total
Dining
43
7,211.82
Groceries
58
6,339.36
Services
17
5,989.75
Gas
32
5,126.10
Total purchases this year
Total interest charged this year
$41,194.75
291.73
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-8e9775b2a06aede49ea8437c,v11-CREDIT_CARD_STATEMENT-columns,original,2024,fgen-633458c69a73e203e3526c37,synthetic_programmatic_template,columns,top,False,year_end_summary
"## Northwind Card Member Services
| Field | Value |
| --- | --- |
| Account ending in | 9214 |
| Opening/Closing Date | 03/01/2022 - 03/30/2022 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $7,609.17 |
| Payments, Credits | -$7,609.17 |
| Purchases | $2,148.28 |
| Fees Charged | $0.00 |
| Interest Charged | $115.80 |
| New Balance | $5,078.19 |
| Minimum Payment Due | $108.62 |
| Payment Due Date | 2/2/22 |
| Purchase APR | 29.38% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 08/20 | HOME DEPOT 0612 | 417.34 |
| 09/28 | WHOLE FOODS #1021 | 70.37 |
| 08/25 | STARBUCKS #11872 | 229.39 |
| 10/04 | WHOLE FOODS #1021 | 399.67 |
| 03/16 | WHOLE FOODS #1021 | 677.84 |
| 03/28 | TARGET T-2231 | 836.02 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.
World Elite Mastercard",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-a05751f4523365be485c5de2,v11-CREDIT_CARD_STATEMENT-markdown,original,2022,fgen-b7efc837d2edb5fd8a87afcd,synthetic_programmatic_template,markdown,bottom,False,monthly
"Rewards Visa Signature
## 2022 Year-End Summary
Summit Card Services
| Category | Transactions | Total |
| --- | --- | --- |
| Travel | 61 | 313.59 |
| Groceries | 26 | 5,451.45 |
| Merchandise | 88 | 8,539.47 |
| Services | 47 | 441.84 |
| Field | Value |
| --- | --- |
| Total purchases this year | 54,205.79 |
| Total interest charged this year | $891.05 |
## This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-dd3edf99b78a9e52ea9abb28,v11-CREDIT_CARD_STATEMENT-markdown,original,2022,fgen-05801cbcd637ecf0732b0477,synthetic_programmatic_template,markdown,top,False,year_end_summary
"## Rewards Visa Signature
Harbor Card Services
| Field | Value |
| --- | --- |
| Account ending in | 4258 |
| Opening/Closing Date | 05/01/2024 - 05/30/2024 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $6,469.48 |
| Payments, Credits | -$6,469.48 |
| Purchases | $3,749.79 |
| Fees Charged | $0.00 |
| Interest Charged | $88.04 |
| New Balance | $1,009.97 |
| Minimum Payment Due | $158.70 |
| Payment Due Date | 10/24/2024 |
| Purchase APR | 27.88% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 07/13 | DELTA AIR LINES | 380.86 |
| 10/17 | COSTCO WHSE #412 | 465.92 |
| 03/18 | NETFLIX.COM | 833.87 |
| 01/28 | NETFLIX.COM | 484.05 |
| 07/25 | DELTA AIR LINES | 303.96 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9bc8a3ec3ed421aef7a7af8d,v11-CREDIT_CARD_STATEMENT-markdown,original,2024,fgen-a8b1f398955198e49f617d7f,synthetic_programmatic_template,markdown,top,False,monthly
"## Travel Rewards Visa
## 2026Year-End Summary
Northwind Card Member Services
|Category | Transactions | Total |
| --- |--- | --- |
| 5ervices | 62 | 4,874.41 |
| Groceries | 37 | 2,560.70 |
| Gas | 40 | 8,026.20 |
| Dining | 23 | 1,782.86 |
| Field | Value |
| --- | --- |
| Total purchascs this year | 54,892.83 |
| Total interest chargcd this year | 445.52 |
This summary ís provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f740a17b383bcf06f188fae5,v11-CREDIT_CARD_STATEMENT-markdown,original,2026,fgen-3b4392c9f0fc0e50102e9eea,synthetic_programmatic_template,markdown,top,True,year_end_summary
"World Elite Mastercard
Harbor Card Services
| Field | Value |
| --- | --- |
| Account ending in | 8536 |
| Opening/Closing Date | 07/01/2026 - 07/31/2026 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $7,787.13 |
| Payments, Credits | -$7,787.13 |
| Purchases | $3,607.48 |
| Fees Charged | $0.00 |
| Interest Charged | $61.06 |
| New Balance | $5,657.05 |
| Minimum Payment Due | $82.13 |
| Payment Due Date | 02/20/2026 |
| Purchase APR | 22.05% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 04/28 | UBER TRIP | 529.80 |
| 06/18 | TARGET T-2231 | 387.19 |
| 08/06 | CVS/PHARMACY 0832 | 95.34 |
| 05/14 | NETFLIX.COM | 620.11 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-700a287f7a0576e3af6123e0,v11-CREDIT_CARD_STATEMENT-markdown,original,2026,fgen-c97e349b4f11b9f059c1f02c,synthetic_programmatic_template,markdown,top,False,monthly
"## Everyday Cash Card
Harbor Card Services
| Field | Value |
| --- | --- |
| Account ending in | 2622 |
| Opening/Closing Date | 02/01/2023 - 02/28/2023 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $6,285.57 |
| Payments, Credits | -$6,285.57 |
| Purchases | $2,741.97 |
| Fees Charged | $0.00 |
| Interest Charged | $78.10 |
| New Balance | $3,231.14 |
| Minimum Payment Due | $61.25 |
| Payment Due Date | 08/28/2023 |
| Purchase APR | 18.88% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 08/18 | WHOLE FOODS #1021 | 668.85 |
| 07/01 | DELTA AIR LINES | 273.78 |
| 03/18 | AMAZON MKTPLACE | 266.83 |
| 01/01 | CVS/PHARMACY 0832 | 782.45 |
| 07/07 | HOME DEPOT 0612 | 265.03 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-0f4bee8d4f25776a86145fe7,v11-CREDIT_CARD_STATEMENT-markdown,original,2023,fgen-9bfe44086c8b4943bdc7c24d,synthetic_programmatic_template,markdown,top,False,monthly
"Summit Card Services
| Category | Transactions | Total |
| --- | --- | --- |
| Gas | 43 | 4,178.50 |
| Groceries | 85 | 8,462.64 |
| Dining | 38 | 5,146.20 |
| Merchandise | 75 | 8,626.04 |
| Field | Value |
| --- | --- |
| Total purchases this year | 41,511.11 |
| Total interest charged this year | $392.34 |
## This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f4dc89b3fd73cd87bbd57c46,v11-CREDIT_CARD_STATEMENT-markdown,original,2022,fgen-27e8cd081d51302bfedbb5cf,synthetic_programmatic_template,markdown,none,False,year_end_summary
"Rewards Visa ...2290
| Date | Description | Card Member | Account # | Amount |
| --- | --- | --- | --- | --- |
| 10/01/2025 | COSTCO WHSE #412 | NOAH TANAKA | -33027 | 200.99 |
| 03/27/2025 | AMAZON MKTPLACE | LENA TESTCASE | -92324 | 663.29 |
| 01/25/2025 | DELTA AIR LINES | TAYLOR BRENNAN | -28729 | 704.32 |
| 21/07/2025 | UBER TRIP | CASEY C. MOREAU | -72509 | 107.23 |
| 2025-07-27 | WHOLE FOODS #1021 | DIEGO S. OKAFOR | -41132 | 715.49 |
| 01/03/2025 | UBER TRIP | AMARA B. FISCHER | -16144 | 265.44 |
| 12/13/2025 | AMAZON MKTPLACE | RILEY SATO | -72113 | 778.84 |
| 2025-06-04 | HOME DEPOT 0612 | AMARA M. HADDAD | -23778 | 311.48 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-b8622ff23c7cf299764f218f,v11-CREDIT_CARD_STATEMENT-markdown,original,2025,fgen-c8d640409e00d1d0cab49d61,synthetic_programmatic_template,markdown,top,False,raw_export
"Everyday Cash Card
2026 Year-End Summary
## Bluewater Bank Card Center
| Category | Transactions | Total |
| --- | --- | --- |
| Merchandise | 29 | 3,105.87 |
| Services | 14 | 2,345.63 |
| Gas | 75 | 2,797.81 |
| Dining | 33 | 4,315.46 |
| Field | Value |
| --- | --- |
| Total purchases this year | 37,538.39 |
| Total interest charged this year | 797.11 |
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-dd2757ca4ea76a0adaecd560,v11-CREDIT_CARD_STATEMENT-markdown,original,2026,fgen-d8d73068346be3befe52ccd1,synthetic_programmatic_template,markdown,top,False,year_end_summary
"Northwind Card Member Services
| Field | Value |
| --- | --- |
| Account ending in | 1871 |
| Opening/Closing Date | 11/01/2023 - 11/31/2023 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $2,896.57 |
| Payments, Credits | -$2,896.57 |
| Purchases | $1,009.23 |
| Fees Charged | $0.00 |
| Interest Charged | $56.76 |
| New Balance | $1,919.05 |
| Minimum Payment Due | $83.89 |
| Payment Due Date | 12/26/23 |
| Purchase APR | 17.52% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 10/05 | NETFLIX.COM | 175.01 |
| 11/01 | WHOLE FOODS #1021 | 572.86 |
| 12/19 | UBER TRIP | 96.92 |
## Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d3cd539733331db463382bd9,v11-CREDIT_CARD_STATEMENT-markdown,original,2023,fgen-75a5218d9eeeec8c56c5f8c7,synthetic_programmatic_template,markdown,none,False,monthly
"## Cash Back Mastercard
## Atlas Card Scrvices
| Field | Value |
| --- | --- |
| Account endingin | 7520 |
| 0pening/C1osing Date | 12/01/2024 - 12/31/2024 |
## Account Summary
| Fíeld | Value |
| --- | --- |
| Prcvious Balance | $6,495.82 |
| Payments, Credits | -$6,495.82 |
| Purchascs | $2,574.52 |
| Fees Charged | $0.00 |
| Interest Charged | $97.27 |
| New Balance | $5,310.26 |
| Minimum Payment Due | $84.18 |
| Payment Due Date | O7/06/2024 |
| Purchase APR | 23.01% |
| TransDate | Description | Amount |
| --- | --- | --- |
| 05/07 | TARGET T-2231 | 7.15 |
| 07/05 | WH0LE F0OD5 #1021| 784.88 |
| 11/19 | TARGET T-2231 | 538.85 |
| O5/09 | NETFLIX.COM | 357.20 |
| 01/01 | COSTCO WHSE #412 | 133.39|
| 04/07 | WHOLE FOODS#1021 | 845.19 |
| 06/09 | SHELL OIL 5741 | 189.46 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-438833c2d749628c14c17c1a,v11-CREDIT_CARD_STATEMENT-markdown,original,2024,fgen-cb285233e4894a713ad2e974,synthetic_programmatic_template,markdown,top,True,monthly
"## Travel Rewards Visa
Summit Card Services
| Field | Value |
| --- | --- |
| Account ending in | 5067 |
| Opening/Closing Date | 04/01/2023 - 04/28/2023 |
## Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $2,451.89 |
| Payments, Credits | -$2,451.89 |
| Purchases | $1,917.42 |
| Fees Charged | $0.00 |
| Interest Charged | $105.85 |
| New Balance | $1,372.28 |
| Minimum Payment Due | $28.12 |
| Payment Due Date | 10/18/23 |
| Purchase APR | 27.14% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 01/28 | TARGET T-2231 | 219.62 |
| 10/01 | TARGET T-2231 | 209.12 |
| 06/10 | WHOLE FOODS #1021 | 729.11 |
| 03/14 | SHELL OIL 5741 | 868.77 |
| 12/01 | WHOLE FOODS #1021 | 48.98 |
| 01/15 | TARGET T-2231 | 765.20 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-d3a868cbda185555c4a6bf41,v11-CREDIT_CARD_STATEMENT-markdown,original,2023,fgen-1cd9eec67fdbcb85cf12655b,synthetic_programmatic_template,markdown,top,False,monthly
"## Rewards Visa Signature
2022 Year-End Summary
Northwind Card Member Services
| Category | Transactions | Total |
| --- | --- | --- |
| Groceries | 65 | 7,771.89 |
| Dining | 16 | 5,983.99 |
| Travel | 78 | 7,226.26 |
| Merchandise | 36 | 8,005.57 |
| Field | Value |
| --- | --- |
| Total purchases this year | 41,909.11 |
| Total interest charged this year | $214.11 |
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-6bfe818ec9f54cf8dfb16000,v11-CREDIT_CARD_STATEMENT-markdown,original,2022,fgen-8ce34166ef3788936db5970d,synthetic_programmatic_template,markdown,top,False,year_end_summary
"Everyday Cash Card
## Atlas Card Services
| Field | Value |
| --- | --- |
| Account ending in | 7458 |
| Opening/Closing Date | 09/01/2021 - 09/30/2021 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $3,002.14 |
| Payments, Credits | -$3,002.14 |
| Purchases | $1,908.36 |
| Fees Charged | $0.00 |
| Interest Charged | $109.13 |
| New Balance | $3,349.72 |
| Minimum Payment Due | $155.75 |
| Payment Due Date | 2021-11-17 |
| Purchase APR | 20.17% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 03/09 | WHOLE FOODS #1021 | 437.42 |
| 07/03 | AMAZON MKTPLACE | 463.44 |
| 03/27 | NETFLIX.COM | 652.27 |
| 09/04 | STARBUCKS #11872 | 279.13 |
| 03/04 | UBER TRIP | 763.32 |
| 12/05 | WHOLE FOODS #1021 | 216.22 |
| 03/15 | TARGET T-2231 | 361.96 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-811b31201c65530c3475a740,v11-CREDIT_CARD_STATEMENT-markdown,original,2021,fgen-423da07bb832496d38709936,synthetic_programmatic_template,markdown,top,False,monthly
"Rewards Visa Signature
Summit Card Services
| Field | Value |
| --- | --- |
| Account ending in | 0589 |
| Opening/Closing Date | 02/01/2023 - 02/28/2023 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $5,602.20 |
| Payments, Credits | -$5,602.20 |
| Purchases | $2,542.91 |
| Fees Charged | $0.00 |
| Interest Charged | $102.92 |
| New Balance | $4,060.08 |
| Minimum Payment Due | $84.49 |
| Payment Due Date | 1/13/23 |
| Purchase APR | 23.83% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 05/26 | HOME DEPOT 0612 | 695.47 |
| 12/14 | WHOLE FOODS #1021 | 519.24 |
| 07/05 | DELTA AIR LINES | 595.12 |
| 09/21 | NETFLIX.COM | 839.63 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-ee911d91d73ce8b9031e168f,v11-CREDIT_CARD_STATEMENT-markdown,original,2023,fgen-5bd7b00ca7089967be51b9a8,synthetic_programmatic_template,markdown,top,False,monthly
"| Trans. Date | Post Date | Description | Amount | Category |
| --- | --- | --- | --- | --- |
| 2025-11-18 | 07/25/2025 | NETFLIX.COM | 629.87 | Merchandise |
| 16/07/2025 | 06/10/2025 | AMAZON MKTPLACE | 767.99 | Payments and Credits |
| 26/11/2025 | 04/07/2025 | INTEREST CHARGE ON PURCHASES | 368.09 | Merchandise |
| 01/20/2025 | 2025-08-24 | AMAZON MKTPLACE | 746.75 | Restaurants |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-c0fe7babf2781595ad5bab71,v11-CREDIT_CARD_STATEMENT-markdown,original,2025,fgen-f55d30019feb34c31b30058f,synthetic_programmatic_template,markdown,none,False,raw_export
"Rewards Visa Signature
## Northwind Card Member Services
| Field | Value |
| --- | --- |
| Account ending in | 3200 |
| Opening/Closing Date | 08/01/2026 - 08/30/2026 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $4,511.97 |
| Payments, Credits | -$4,511.97 |
| Purchases | $2,342.04 |
| Fees Charged | $0.00 |
| Interest Charged | $91.87 |
| New Balance | $1,128.27 |
| Minimum Payment Due | $188.16 |
| Payment Due Date | 3/4/26 |
| Purchase APR | 18.19% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 12/27 | HOME DEPOT 0612 | 290.62 |
| 04/04 | STARBUCKS #11872 | 570.99 |
| 06/13 | CVS/PHARMACY 0832 | 135.67 |
| 11/11 | STARBUCKS #11872 | 103.70 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-405c0a8fa700d3fc8a03a589,v11-CREDIT_CARD_STATEMENT-markdown,original,2026,fgen-2aef7eeb78d57be920b50894,synthetic_programmatic_template,markdown,top,False,monthly
"Bluewater Bank Card Center
| Category | Transactions | Total |
| --- | --- | --- |
| Travel | 79 | 1,736.82 |
| Gas | 17 | 6,709.09 |
| Dining | 80 | 6,549.74 |
| Merchandise | 34 | 7,102.68 |
| Field | Value |
| --- | --- |
| Total purchases this year | $46,354.07 |
| Total interest charged this year | $547.04 |
This summary is provided for your records and is not a tax form.
## Rewards Visa Signature
## 2026 Year-End Summary",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-443896dafa22016316dd2d8b,v11-CREDIT_CARD_STATEMENT-markdown,original,2026,fgen-f5a79c1734b7aa1b45a418b7,synthetic_programmatic_template,markdown,bottom,False,year_end_summary
"Harbor Card Services
| Field | Value |
| --- | --- |
| Account ending in | 8064 |
| Opening/Closing Date | 06/01/2023 - 06/28/2023 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $479.00 |
| Payments, Credits | -$479.00 |
| Purchases | $2,083.57 |
| Fees Charged | $0.00 |
| Interest Charged | $28.79 |
| New Balance | $576.20 |
| Minimum Payment Due | $76.24 |
| Payment Due Date | 7/18/23 |
| Purchase APR | 28.00% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 10/12 | HOME DEPOT 0612 | 280.32 |
| 03/26 | NETFLIX.COM | 31.15 |
| 12/03 | STARBUCKS #11872 | 802.30 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.
Travel Rewards Visa",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-9d2557a917799635c5505b53,v11-CREDIT_CARD_STATEMENT-markdown,original,2023,fgen-769331f63cd143ab3a1b202a,synthetic_programmatic_template,markdown,bottom,False,monthly
"## Rewards Visa Signature
Summit Card Services
| Field | Value |
| --- | --- |
| Account ending in | 9292 |
| Opening/Closing Date | 07/01/2021 - 07/31/2021 |
## Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $1,053.25 |
| Payments, Credits | -$1,053.25 |
| Purchases | $4,616.60 |
| Fees Charged | $0.00 |
| Interest Charged | $84.66 |
| New Balance | $577.17 |
| Minimum Payment Due | $82.22 |
| Payment Due Date | 03/12/2021 |
| Purchase APR | 18.90% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 07/02 | NETFLIX.COM | 255.82 |
| 06/14 | HOME DEPOT 0612 | 722.79 |
| 09/02 | UBER TRIP | 147.55 |
| 07/18 | STARBUCKS #11872 | 483.22 |
| 07/17 | DELTA AIR LINES | 674.63 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-f49ed868b34d24fe23bd589d,v11-CREDIT_CARD_STATEMENT-markdown,original,2021,fgen-3f43631dcf432b2ed7b0da48,synthetic_programmatic_template,markdown,top,False,monthly
"Northwind Card Member Services
| Category | Transactions | Total |
| --- | --- | --- |
| Gas | 51 | 4,234.43 |
| Merchandise | 3 | 2,517.55 |
| Groceries | 48 | 2,091.76 |
| Travel | 3 | 5,041.96 |
| Field | Value |
| --- | --- |
| Total purchases this year | $9,167.62 |
| Total interest charged this year | 425.26 |
## This summary is provided for your records and is not a tax form.
## Rewards Visa Signature
## 2025 Year-End Summary",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-49eb21c87c2196da6ebc3b7f,v11-CREDIT_CARD_STATEMENT-markdown,original,2025,fgen-515d7aae6f74085e29b64930,synthetic_programmatic_template,markdown,bottom,False,year_end_summary
"Cash Back Mastercard
Harbor Card Services
| Field | Value |
| --- | --- |
| Account ending in | 9072 |
| Opening/Closing Date | 12/01/2024 - 12/30/2024 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $7,347.26 |
| Payments, Credits | -$7,347.26 |
| Purchases | $1,942.05 |
| Fees Charged | $0.00 |
| Interest Charged | $94.34 |
| New Balance | $1,778.96 |
| Minimum Payment Due | $111.23 |
| Payment Due Date | 11/21/24 |
| Purchase APR | 24.27% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 05/18 | SHELL OIL 5741 | 290.44 |
| 09/23 | WHOLE FOODS #1021 | 197.72 |
| 02/26 | WHOLE FOODS #1021 | 213.31 |
| 05/18 | UBER TRIP | 876.32 |
| 04/08 | AMAZON MKTPLACE | 886.15 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-440a21fd44494bcaa5fad276,v11-CREDIT_CARD_STATEMENT-markdown,original,2024,fgen-b54ca874326bdbc8abcd68d1,synthetic_programmatic_template,markdown,top,False,monthly
"World Elite Mastercard
2021 Year-End Summary
Harbor Card Services
| Category | Transactions | Total |
| --- | --- | --- |
| Dining | 33 | 7,945.48 |
| Travel | 65 | 5,961.54 |
| Merchandise | 78 | 3,193.19 |
| Services | 72 | 3,919.95 |
| Field | Value |
| --- | --- |
| Total purchases this year | 50,075.14 |
| Total interest charged this year | 22.14 |
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-0af5b9a521d4863ab0e7569c,v11-CREDIT_CARD_STATEMENT-markdown,original,2021,fgen-4bb9fefea684a5196401075b,synthetic_programmatic_template,markdown,top,False,year_end_summary
"Downloaded 01/01/2023
| Transaction Date | Post Date | Description | Category | Type | Amount | Memo |
| --- | --- | --- | --- | --- | --- | --- |
| 17/05/2023 | 05/22/2023 | COSTCO WHSE #412 | Gas | Payment | -131.41 |  |
| 05/17/2023 | 10/14/2023 | CVS/PHARMACY 0832 | Gas | Payment | 538.80 |  |
| 28/02/2023 | 04/19/2023 | UBER TRIP | Groceries | Payment | -289.92 |  |
| 03/11/2023 | 2023-01-03 | AMAZON MKTPLACE | Shopping | Sale | -328.44 |  |
| 2023-03-02 | 12/22/2023 | STARBUCKS #11872 | Travel | Sale | -188.54 |  |
| 12/03/2023 | 13/12/2023 | UBER TRIP | Food & Drink | Return | -466.77 |  |
| 09/08/2023 | 04/03/2023 | DELTA AIR LINES | Groceries | Sale | -841.24 |  |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-1e101d3146b6ac5ed84d0a4a,v11-CREDIT_CARD_STATEMENT-markdown,original,2023,fgen-8ea777baefb9d854dc395ee3,synthetic_programmatic_template,markdown,none,False,raw_export
"Rewards Visa Signature
Harbor Card Services
| Field | Value |
| --- | --- |
| Account ending in | 5631 |
| Opening/Closing Date | 07/01/2022 - 07/31/2022 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $7,375.97 |
| Payments, Credits | -$7,375.97 |
| Purchases | $1,912.42 |
| Fees Charged | $0.00 |
| Interest Charged | $26.95 |
| New Balance | $1,906.68 |
| Minimum Payment Due | $26.71 |
| Payment Due Date | July 10, 2022 |
| Purchase APR | 23.88% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 05/24 | COSTCO WHSE #412 | 402.19 |
| 05/28 | CVS/PHARMACY 0832 | 566.54 |
| 03/10 | HOME DEPOT 0612 | 66.55 |
| 11/25 | HOME DEPOT 0612 | 869.85 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-57870164670432f2b4e436ac,v11-CREDIT_CARD_STATEMENT-markdown,original,2022,fgen-c5e9dd84bea8c8b5e3c2e29f,synthetic_programmatic_template,markdown,top,False,monthly
"Card ending in 7972 - Activity
| Transaction Date | Post Date | Description | Category | Type| Amount | Memo |
| --- | --- | ---| --- | --- | --- | --- |
| O6/2O/2O21 | O9/28/2021 | TARGET T-2231 | Groceríes | Retum | 588.75 |  |
| 05/25/2021 | 2021-06-01 | HOME DEPOT 0612 | Gas | Return |-208.30 |  |
| 04/11/2021 | 09/12/2021 | TARGET T-2231| Travcl | Sale | 474.21 |  |
| 20/08/2021 | 2021-12-06 | AMAZON MKTPLACE | Groceries | Return | -159.21 |  |
| 2021-03-16 | 09/26/2021 |AMAZ0N MKTPLACE | Groccries | Sale | -205.38 |  |
| 03/04/2021 | 2021-02-24 | TARGET T-2231 | Groceries | Retum | -837.64 |  |
| 2021-11-04 | 03/24/2021 | C0STCO WHSE #412 | Gas | Sa1e | -829.46 | |
| 2021-11-08 | 2021-06-08| STARBUCKS #11872 | Food & Drink | Payment | -699.62 |  |
| 06/26/2021 | 2021-03-21 | COSTCO WHSE #412 | Trave1 | Sale | -448.76 |  |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-c074d1dc3fd0f1d0c0dc02eb,v11-CREDIT_CARD_STATEMENT-markdown,original,2021,fgen-3571cb5c3295d28950e198d2,synthetic_programmatic_template,markdown,top,True,raw_export
"Rewards Visa Signature
## 2023 Year-End Summary
## Atlas Card Services
| Category | Transactions | Total |
| --- | --- | --- |
| Groceries | 85 | 6,361.22 |
| Merchandise | 47 | 5,101.31 |
| Services | 22 | 4,360.12 |
| Gas | 87 | 4,292.16 |
| Field | Value |
| --- | --- |
| Total purchases this year | $31,926.05 |
| Total interest charged this year | 130.89 |
This summary is provided for your records and is not a tax form.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-111660538976d06f4a7befde,v11-CREDIT_CARD_STATEMENT-markdown,original,2023,fgen-bc2128e7a66ae3575116f00b,synthetic_programmatic_template,markdown,top,False,year_end_summary
"World Elite Mastercard
Northwind Card Member Services
| Field | Value |
| --- | --- |
| Account ending in | 8472 |
| Opening/Closing Date | 12/01/2025 - 12/31/2025 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $3,781.43 |
| Payments, Credits | -$3,781.43 |
| Purchases | $1,405.09 |
| Fees Charged | $0.00 |
| Interest Charged | $34.20 |
| New Balance | $2,285.57 |
| Minimum Payment Due | $86.27 |
| Payment Due Date | 5/4/25 |
| Purchase APR | 28.30% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 10/08 | NETFLIX.COM | 22.19 |
| 10/23 | STARBUCKS #11872 | 532.59 |
| 04/16 | TARGET T-2231 | 618.02 |
| 04/02 | COSTCO WHSE #412 | 182.36 |
| 09/24 | UBER TRIP | 211.91 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-6e626a4e4e2dd4868dbdc771,v11-CREDIT_CARD_STATEMENT-markdown,original,2025,fgen-fadbaff2b5899b601c782226,synthetic_programmatic_template,markdown,top,False,monthly
"| Date | Description | Card Member | Account # | Amount |
| --- | --- | --- | --- |--- |
| 21/02/2025 | STARBUCKS #11872 | PRIYA C. ADEYEMI | -39965 | 712.78|
| 05/06/2025 | HOME DEPOT 0612 | MATEO TANAKA | -45878 | 31.33 |
| 02/02/2025 | WHOLE FOODS #1021 | AMARA A. CA5TILLO | -10180| 552.15 |
|12/26/2025 | SHELL OIL 5741 | PRIYA KOWALSKI | -37121 | 469.57 |
| 24/07/2025 | WHOLE FOODS #1021 | KWAME PATEL | -86789 | 641.30 |
| 2025-11-16 | COSTCO WHSE #412 | AVERY R. LINDQVIST | -40226 | 401.10 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-dfd80a34dd1d1e0e13e77331,v11-CREDIT_CARD_STATEMENT-markdown,original,2025,fgen-4e62f728067e990398aef45e,synthetic_programmatic_template,markdown,top,True,raw_export
"Downloaded 2021-12-06
| Transaction Date | Post Date | Description | Category | Type | Amount | Memo |
| --- | --- | --- | --- | --- | --- | --- |
| 22/07/2021 | 23/08/2021 | COSTCO WHSE #412 | Travel | Sale | -87.46 |  |
| 21/07/2021 | 2021-01-26 | CVS/PHARMACY 0832 | Food & Drink | Return | -354.41 |  |
| 05/09/2021 | 09/02/2021 | UBER TRIP | Gas | Payment | -794.24 |  |
| 12/22/2021 | 03/06/2021 | SHELL OIL 5741 | Food & Drink | Sale | -103.52 |  |
| 2021-11-20 | 08/08/2021 | HOME DEPOT 0612 | Groceries | Sale | -371.72 |  |
| 09/08/2021 | 2021-07-16 | WHOLE FOODS #1021 | Groceries | Sale | -350.09 |  |
| 04/25/2021 | 04/15/2021 | COSTCO WHSE #412 | Shopping | Payment | -879.44 |  |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-55512fa4403683a0836978a6,v11-CREDIT_CARD_STATEMENT-markdown,original,2021,fgen-cd75ef47a19ef03972d4e2bd,synthetic_programmatic_template,markdown,top,False,raw_export
"## Northwind Card Member Services
| Field | Value |
| --- | --- |
| Account ending in | 6842 |
| Opening/Closing Date | 06/01/2025 - 06/30/2025 |
## Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $3,249.83 |
| Payments, Credits | -$3,249.83 |
| Purchases | $2,495.53 |
| Fees Charged | $0.00 |
| Interest Charged | $12.68 |
| New Balance | $1,722.39 |
| Minimum Payment Due | $68.92 |
| Payment Due Date | 3/21/25 |
| Purchase APR | 19.37% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 07/23 | TARGET T-2231 | 321.79 |
| 02/04 | STARBUCKS #11872 | 43.65 |
| 03/11 | SHELL OIL 5741 | 458.96 |
| 07/22 | DELTA AIR LINES | 877.59 |
| 01/17 | WHOLE FOODS #1021 | 467.34 |
Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee.
## Cash Back Mastercard",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-fadc3ca335b36fa8be05cb6e,v11-CREDIT_CARD_STATEMENT-markdown,original,2025,fgen-14c063c72f95940464019e9d,synthetic_programmatic_template,markdown,bottom,False,monthly
"Everyday Cash Card
Harbor Card Services
| Field | Value |
| --- | --- |
| Account ending in | 0329 |
| Opening/Closing Date | 08/01/2021 - 08/31/2021 |
Account Summary
| Field | Value |
| --- | --- |
| Previous Balance | $1,455.68 |
| Payments, Credits | -$1,455.68 |
| Purchases | $4,047.02 |
| Fees Charged | $0.00 |
| Interest Charged | $5.01 |
| New Balance | $4,002.78 |
| Minimum Payment Due | $179.52 |
| Payment Due Date | 09/03/2021 |
| Purchase APR | 20.49% |
| Trans Date | Description | Amount |
| --- | --- | --- |
| 04/27 | HOME DEPOT 0612 | 11.64 |
| 09/23 | NETFLIX.COM | 803.56 |
| 07/19 | DELTA AIR LINES | 356.87 |
| 12/24 | AMAZON MKTPLACE | 793.01 |",CREDIT_CARD_STATEMENT,26,CREDIT_CARD_STATEMENT,fdc-62dcf99ec62496c8ff466b1e,v11-CREDIT_CARD_STATEMENT-markdown,original,2021,fgen-fd489b48b987e61b17e202bb,synthetic_programmatic_template,markdown,top,False,monthly
"Crypto Transaction History Export
CoinLedger-style report
Account
Morgan Fischer
Cost basis method
Specific ID
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
SOL
l8.289116
10/25/24
2024-01-11
4,237.85
2,737.67
ADA
29.129451
10/27/2022
June27, 2024
11,213.91
9,446.52
ADA
24.989844
March 18, 2024
2024-08-01
11,856.22
7,125.86
50L
28.473529
5/2/24
6/14/24
7,387.18
5,631.51
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-e6ed21919155ca32e4dfe204,v11-CRYPTO_TAX_REPORT-stacked,original,2024,fgen-c0a1872a5636d8e55c296b34,synthetic_programmatic_template,stacked,top,True,transaction_history
"2024 Realized Gains and Losses Report
CoinHarbor Exchange
Account
Priya Romero
Cost basis method
Specific ID
Short-term realized gain/loss
-8,925.24
Long-term realized gain/loss
16,241.32
Staking and other income
$569.78
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
USDC
9.453082
07/22/2024
9/5/24
3,709.43
2,670.97
ADA
28.524507
2023-11-20
December 5, 2024
17,144.69
23,621.27
ETH
16.549437
4/24/23
12/20/2024
13,175.24
8,052.39
ETH
26.193974
8/17/23
2024-07-26
8,627.26
6,617.99
ETH
3.865637
08/01/2022
December 22, 2024
15,443.16
19,561.42
ADA
20.453662
October 4, 2024
September 17, 2024
16,535.20
10,704.42
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-a17679522514b0f5c8a63a18,v11-CRYPTO_TAX_REPORT-stacked,original,2024,fgen-dcac80924cc825df1e7cbba0,synthetic_programmatic_template,stacked,top,False,gain_loss
"2023 Crypto Tax Summary
LedgerPeak Markets
Account
Díego K. Walsh
Cost basis method
HIFO
Short-tcrm realized gain/loss
11,528.65
Long-term realized gain/loss
26,648.87
Staking and other income
$2,535.59
Asset  Amount  Date Acquired Date Sold  Proceeds  Cost Basis
BTC
18.287619
8/14/21
2023-06-22
18,780.33
17,376.17
USDC
5.649644
04/15/2023
November 23, 2023
9,075.39
5,030.63
USDC
0.940904
05/09/2021
2023-09-12
5,837.01
4,060.51
S0L
16.447891
09/17/2023
O3/09/2023
l1,780.12
12,207.51
ADA
15.351100
2021-08-24
03/15/2023
3,521.70
4,489.17
ETH
3.316117
2021-09-11
7/20/23
6,393.67
4,352.64
Use this report to prepare Form 8949; it is not a Form lO99-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-dd3bb2c1425a7c092871f581,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-c37671cf76db1b3d17acb524,synthetic_programmatic_template,stacked,top,True,tax_software_summary
"2025 Crypto Tax Summary
LedgerPeak Markets
Account
Kwame Patel
Cost basis method
HIFO
Short-term realized gain/loss
4,093.68
Long-term realized gain/loss
12,515.41
Staking and other income
$1,705.65
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ADA
11.910321
May 15, 2025
2025-06-08
17,022.09
19,798.89
SOL
5.097561
May 20, 2025
1/11/25
5,526.94
6,302.72
SOL
23.531156
1/15/24
10/27/25
907.63
1,087.58
ADA
6.695430
July 22, 2025
11/07/2025
19,853.96
25,023.04
USDC
5.750470
2023-02-19
5/26/25
9,082.11
10,999.96
ADA
9.759811
2025-10-23
02/05/2025
12,560.97
9,458.16
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d0f1b2244bd30ca679d7bfea,v11-CRYPTO_TAX_REPORT-stacked,original,2025,fgen-8f5acd0f3b0fe8967e49d41e,synthetic_programmatic_template,stacked,top,False,tax_software_summary
"Crypto Transaction History Export
BitMeadow
Account
Jordan Haddad
Cost basis method
HIFO
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
SOL
1.128773
03/14/2020
August 24, 2022
15,468.67
17,582.58
SOL
17.969699
2020-06-26
10/12/2022
12,277.09
10,138.63
BTC
27.013436
2022-05-06
9/22/22
3,943.22
3,317.40
ADA
1.175407
March 10, 2022
2/4/22
16,269.05
8,324.59
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-2dd64cfd4793e0440bb84bf7,v11-CRYPTO_TAX_REPORT-stacked,original,2022,fgen-c24c96854779aaa1f1993404,synthetic_programmatic_template,stacked,top,False,transaction_history
"Crypto Transaction History Export
TaxBit-style report
Account
Riley B. Sato
Cost basis method
HIFO
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
USDC
24.007874
2022-11-21
August 10, 2024
1,907.60
1,795.61
ETH
17.986253
10/28/2022
2024-06-02
1,851.90
953.06
SOL
11.512727
2022-06-07
05/18/2024
12,106.09
11,447.64
USDC
10.164977
8/21/23
January 20, 2024
9,243.56
6,035.24
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-e3d355294c3b0006be4bdb16,v11-CRYPTO_TAX_REPORT-stacked,original,2024,fgen-c507cd2ef19d363ad913628b,synthetic_programmatic_template,stacked,top,False,transaction_history
"2022 Realized Gains and Losses Report
TaxBit-style report
Account
Hiro Nguyen
Cost basis method
Specific ID
Short-term realized gain/loss
8,312.56
Long-term realized gain/loss
34,365.56
Staking and other income
1,606.19
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
USDC
24.502786
2021-12-25
July 5, 2022
17,596.00
11,304.64
BTC
23.542032
2022-10-12
4/22/22
6,632.93
6,252.26
BTC
17.247077
09/21/2022
05/24/2022
9,459.75
8,012.40
BTC
22.908106
06/11/2022
12/20/22
9,544.24
5,701.85
BTC
9.934767
June 6, 2021
10/5/22
15,939.30
22,207.78
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-5eb8b6614c41d276c347438e,v11-CRYPTO_TAX_REPORT-stacked,original,2022,fgen-782adbaf307c6b5354d62fb6,synthetic_programmatic_template,stacked,top,False,gain_loss
"2024 Crypto Tax Summary
LedgerPeak Markets
Account
Olivia Fischer
Cost basis method
HIFO
Short-term realized gain/loss
17,891.20
Long-term realized gain/loss
30,115.97
Staking and other income
$713.72
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
USDC
21.965988
9/9/23
8/8/24
17,595.68
13,392.24
USDC
4.013900
9/22/22
April 15, 2024
664.98
732.40
USDC
25.357178
7/5/23
9/2/24
13,371.99
9,809.84
SOL
5.466344
June 6, 2023
7/24/24
4,960.69
2,896.45
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-0535fe437e8b047683a6ae9a,v11-CRYPTO_TAX_REPORT-stacked,original,2024,fgen-56f4a650e983b8e5e8992e16,synthetic_programmatic_template,stacked,top,False,tax_software_summary
"Asset  Date Acquired  Date Sold  Proceeds  Cost Basis  Gain (Loss)  Holding Period
ETH
2021-11-14
2022-04-04
1280.42
18921.98
7616.48
Short-term
ETH
2021-05-19
2022-01-18
10186.65
17073.46
-5636.04
Long-term
BTC
06/23/2021
23/04/2022
9848.70
11109.87
2238.20
Long-term
SOL
04/04/2021
2022-02-18
12094.52
17030.57
-2816.94
Short-term
SOL
12/14/2021
04/05/2022
8176.11
1138.47
-6359.95
Short-term
SOL
07/03/2021
03/25/2022
7485.81
1853.51
-1737.58
Short-term
BTC
15/01/2021
08/08/2022
15873.98
4653.80
3283.82
Long-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-93d96971a350ad9a13fdd326,v11-CRYPTO_TAX_REPORT-stacked,original,2022,fgen-2ab13251863cb8818f1a20d3,synthetic_programmatic_template,stacked,top,False,raw_export
"Timestamp  Transaction Type  Asset  Quantity Transacted  Spot Price at Transaction  Subtotal  Total (inclusive of fees)  Fees
2023-07-28T04:27:00Z
Staking Income
USDC
7.689787
43045.03
8668.20
1970.34
10.93
05/04/2023T13:14:00Z
Buy
USDC
16.989337
10685.61
5445.73
4690.69
4.44
10/15/2023T05:43:00Z
Sell
ETH
18.107179
8906.42
5387.87
1503.85
38.51
26/01/2023T15:45:00Z
Receive
BTC
2.399197
38964.08
1256.25
7140.58
31.96
2023-04-05T15:40:00Z
Send
USDC
11.578564
60288.52
2651.08
8584.53
1.01",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-b8afa3e426862bc3daccf1fd,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-ffc97e269929e65538d61e4f,synthetic_programmatic_template,stacked,bottom,False,raw_export
"CoinHarbor Exchange
Account
Sofia S. Adeyemi
Cost basis method
HIFO
Short-term realized gain/loss
10,525.85
Long-term realized gain/loss
7,923.78
Staking and otherincome
2,224.18
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
SOL
8.855524
July 15, 2025
2026-10-28
15,727.64
19,085.42
ETH
22.752363
3/19/25
2026-02-12
8,573.09
9,528.38
S0L
l4.154107
2024-05-12
10/28/2026
14,642.30
14,132.50
ETH
5.213438
2026-02-01
5eptember 2, 2026
1,347.39
1,110.99
S0L
10.583762
11/1/26
2026-11-04
18,933.35
10,521.70
ETH
28.298803
05/17/2024
12/12/26
17,243.82
12,088.90
Gcnerated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-2ca6083dd760a045b2b52ad3,v11-CRYPTO_TAX_REPORT-stacked,original,2026,fgen-bb59042b7ab5ceecccc2f58a,synthetic_programmatic_template,stacked,none,True,gain_loss
"BitMeadow
Account
Amara Rivera
Cost basis method
HIFO
Short-term realized gain/loss
-7,989.16
Long-term realized gain/loss
4,804.81
Staking and other income
689.58
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ADA
17.820672
2024-01-23
2025-01-15
19,226.02
12,525.12
BTC
7.493344
08/18/2025
March 22, 2025
14,469.42
10,040.30
SOL
16.712348
03/12/2023
01/08/2025
1,860.07
1,172.32
ETH
15.587537
April 15, 2025
November 23, 2025
13,889.44
19,072.72
BTC
22.615604
2023-09-15
10/10/2025
12,568.16
10,505.25
USDC
25.049245
May 22, 2023
2025-02-23
19,099.96
22,944.88
This report is for informational purposes and is not an IRS form.
2025 Realized Gains and Losses Report",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-e854b9c25760e8132e301308,v11-CRYPTO_TAX_REPORT-stacked,original,2025,fgen-768c78e7bd5fa2368c505528,synthetic_programmatic_template,stacked,bottom,False,gain_loss
"Asset  Date Acquired  Date Sold  Proceeds  Cost Basis  Gain (Loss)  Holding Period
BTC
04/16/2024
2025-01-17
15880.69
12570.51
8566.28
Long-term
SOL
2024-01-18
2025-09-04
15383.23
8413.14
-872.56
Long-term
SOL
20/09/2024
18/06/2025
16055.86
2586.51
4331.95
Long-term
ETH
04/18/2024
27/09/2025
17221.03
4698.57
-1860.40
Long-term
BTC
2024-11-14
05/27/2025
16395.84
7757.29
-2129.53
Short-term
ETH
14/02/2024
2025-07-20
11824.48
1873.14
1063.28
Long-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d68e088912fde2bff63cd2c4,v11-CRYPTO_TAX_REPORT-stacked,original,2025,fgen-cd61be4300ad41c483840548,synthetic_programmatic_template,stacked,top,False,raw_export
"Crypto Transaction History Export
CoinLedger-style report
Account
Jordan Larsen
Cost basis method
Specific ID
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
SOL
1.383985
October 7, 2022
October 13, 2022
17,453.31
9,971.81
SOL
2.439068
12/15/20
December 25, 2022
14,541.76
11,843.22
ADA
29.372072
2021-07-06
10/16/22
12,355.95
7,511.02
USDC
10.258424
2022-08-12
2022-06-20
3,469.93
3,610.37
USDC
3.447300
October 22, 2021
October 18, 2022
10,959.26
7,628.63
ETH
6.287854
1/7/21
10/19/2022
15,459.97
14,818.70
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-e3f4867360b20af632bd45f2,v11-CRYPTO_TAX_REPORT-stacked,original,2022,fgen-fb975501b21ed842324d0476,synthetic_programmatic_template,stacked,top,False,transaction_history
"CoinHarbor Exchange
Account
Alex Okafor
Cost basis method
FIFO
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ETH
9.877307
2022-09-15
May 9, 2023
7,396.45
3,866.88
BTC
16.542848
November 3, 2021
11/10/23
19,019.58
13,162.95
BTC
24.295979
1/9/21
1/9/23
9,270.75
12,270.69
ADA
5.845667
10/25/2021
4/25/23
7,346.26
8,106.09
ETH
1.847304
08/07/2021
September 3, 2023
7,720.00
5,655.07
USDC
28.982430
2021-02-11
March 17, 2023
18,037.09
18,940.91
Generated by tax software from your exchange history.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-cc29539c955a64f0d2af5f43,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-4d8f241842b78ce42bd26da4,synthetic_programmatic_template,stacked,bottom,False,transaction_history
"2025 Realized Gains and Losses Report
BitMeadow
Account
Wei Brennan
Cost basis method
Specific ID
Short-term realized gain/loss
-8,544.95
Long-term realized gain/loss
-5,259.92
Staking and other income
371.00
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ADA
0.216473
05/28/2025
2025-05-11
5,246.56
3,319.38
USDC
12.346231
2/5/25
2025-09-24
16,984.48
12,218.18
ADA
10.210092
5/25/25
06/27/2025
6,654.70
5,787.90
SOL
29.881830
05/05/2025
April 14, 2025
14,077.36
9,084.79
BTC
12.047719
11/22/25
03/22/2025
17,287.79
23,319.81
USDC
17.298526
January 19, 2024
2025-09-14
3,590.40
2,789.33
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d87e4485c7225b316055910e,v11-CRYPTO_TAX_REPORT-stacked,original,2025,fgen-e80b9595fb7c3a5f5f36826c,synthetic_programmatic_template,stacked,top,False,gain_loss
"2023 Crypto Tax Summary
BitMeadow
Account
Morgan M. Patel
Cost basis method
FIF0
Short-term realized gain/loss
-7,127.01
Long-term realized gain/loss
6,050.02
Staking and other income
S826.74
Asset  Amount  Date Acquired  DateSo1d  Proceeds  Cost Basis
BTC
17.306366
November 10, 2023
6/11/23
10,913.62
10,905.69
BTC
18.981512
7/19/21
2023-02-26
17,888.57
17,823.20
BTC
20.980881
12/14/2022
07/20/2023
11,496.22
16,076.27
S0L
25.987882
03/24/2022
Novcmber 25, 2023
1,874.31
2,556.75
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-ccbcbb5a00018ecfbc4329e1,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-759c3ecd34d02d34e2674efa,synthetic_programmatic_template,stacked,top,True,tax_software_summary
"Transaction history export
Asset  Date Acquired  Date Sold  Proceeds  Cost Basis  Gain (Loss)  Holding Period
ETH
03/01/2025
03/24/2026
3822.44
13.75
3375.94
Short-term
ETH
02/22/2025
06/09/2026
7792.88
19436.90
2254.68
Long-term
ETH
04/21/2025
22/02/2026
5406.69
10045.25
4574.37
Short-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-257fe8f72fae5faff71267fd,v11-CRYPTO_TAX_REPORT-stacked,original,2026,fgen-2391cb9138b34d29622276b2,synthetic_programmatic_template,stacked,top,False,raw_export
"Crypto Transaction History Export
CoinHarbor Exchange
Account
Sofia Larsen
Cost basis method
FIFO
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
BTC
25.903987
October 10, 2020
08/11/2021
10,897.22
13,809.03
BTC
7.510899
2019-06-11
2021-06-19
6,786.78
7,033.38
BTC
17.552215
4/14/21
November 15, 2021
4,379.92
4,276.00
SOL
16.931927
2/9/21
12/02/2021
1,152.44
1,069.95
ETH
3.176809
9/19/19
04/04/2021
10,123.50
11,400.05
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-a94200149039d323e1e3c335,v11-CRYPTO_TAX_REPORT-stacked,original,2021,fgen-d43999f2d00ea5628f1249cd,synthetic_programmatic_template,stacked,top,False,transaction_history
"Crypto Transaction History Export
BitMeadow
Account
Alex Walsh
Cost basis method
FIFO
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
BTC
11.591845
2026-01-01
8/25/26
6,500.97
5,040.49
USDC
21.264966
March 9, 2025
07/09/2026
2,343.20
2,348.59
SOL
10.602983
08/27/2025
2026-05-24
9,279.70
6,042.24
USDC
21.330240
March 23, 2026
2026-08-05
16,193.72
15,801.49
USDC
27.743769
05/27/2026
7/9/26
11,575.46
6,426.77
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-7b755faac4f2e9dd50cd91b6,v11-CRYPTO_TAX_REPORT-stacked,original,2026,fgen-78006c1c606824ffef3303b9,synthetic_programmatic_template,stacked,top,False,transaction_history
"Date  Sent Amount  Sent Currency  Received Amount  Received Currency  Fee Amount  Fee Currency  Tag
25/10/2025
310.1703
ETH
671.731737
ETH
3.0623
USD
trade
08/17/2025
1213.4164
BTC
2057.012058
USD
3.0341
USD
trade
05/02/2025
3091.3624
ETH
3480.154172
ETH
4.9496
USD
airdrop
25/06/2025
942.4363
USD
3713.715660
USD
4.7864
USD
staking
13/05/2025
4212.1202
ETH
735.796901
SOL
2.9451
USD
staking
2025-07-15
386.6582
ETH
2035.646215
SOL
3.6398
USD
staking
11/16/2025
1445.6847
ETH
1283.680433
SOL
0.5157
USD
airdrop
2025-11-24
4609.3212
ETH
360.837838
ETH
0.2425
USD
airdrop
12/16/2025
62.0875
BTC
864.030639
USD
1.4231
USD
trade",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-0b44e459bb96ad21387d56f0,v11-CRYPTO_TAX_REPORT-stacked,original,2025,fgen-6da0189cb85a6a3d4349df8a,synthetic_programmatic_template,stacked,bottom,False,raw_export
"Crypto Transaction History Export
CoinHarbor Exchange
Account
Sofia Haddad
Cost basis method
Specific ID
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ETH
5.033908
September 20, 2021
1/6/21
19,936.66
14,339.62
SOL
13.511048
February 9, 2021
2021-03-19
4,349.21
3,370.63
BTC
8.274107
07/17/2021
July 27, 2021
778.27
626.77
USDC
11.512635
04/08/2021
11/13/21
19,338.56
16,263.56
USDC
12.457168
December 23, 2019
2021-10-07
18,389.84
13,812.22
ADA
5.706779
March 5, 2019
July 14, 2021
859.93
764.64
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-65cde1e08034226e0a8c223a,v11-CRYPTO_TAX_REPORT-stacked,original,2021,fgen-43376c6856980d4ce498ab23,synthetic_programmatic_template,stacked,top,False,transaction_history
"2021 Crypto Tax Summary
BitMeadow
Account
Wei Tanaka
Cost basis method
HIFO
Short-term realized gain/loss
14,048.43
Long-term realized gain/loss
12,390.05
Staking and other income
1,001.49
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ETH
12.054855
6/5/20
July 25, 2021
10,803.18
10,788.44
SOL
14.573932
7/21/21
03/21/2021
15,398.81
10,802.94
BTC
29.723611
June 21, 2021
2021-02-16
3,317.74
4,546.57
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-33b06a1e58da3a7d23ede9b8,v11-CRYPTO_TAX_REPORT-stacked,original,2021,fgen-ddb6b1a49c98f6fc8928d0e9,synthetic_programmatic_template,stacked,top,False,tax_software_summary
"LedgerPeak Markets
Account
Mateo Kowalski
Cost basis method
Specific ID
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
SOL
15.676701
2022-10-21
1/7/24
11,155.05
11,895.18
USDC
15.649822
2023-11-08
10/3/24
6,538.72
9,020.64
SOL
10.588494
04/28/2024
September 21, 2024
3,880.09
3,512.71
ADA
16.816865
April 8, 2023
9/16/24
13,483.03
8,720.51
USDC
10.505472
March 28, 2022
2024-10-21
13,654.21
14,472.49
USDC
19.799223
12/5/24
April 27, 2024
12,278.29
17,144.74
Generated by tax software from your exchange history.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-f06c9a43abfe804cbd12cfb2,v11-CRYPTO_TAX_REPORT-stacked,original,2024,fgen-c5ee35f207d3d6075e6e9417,synthetic_programmatic_template,stacked,bottom,False,transaction_history
"CoinLedger-style report
Account
Avery D. Lindqvist
Cost basis method
Specific ID
Short-term realized gain/loss
-8,531.80
Long-term realized gain/loss
-2,445.28
Staking and other income
2,195.38
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ETH
15.702791
09/28/2021
2022-01-17
5,056.57
3,889.31
ADA
29.911690
6/11/21
10/05/2022
18,874.59
17,171.62
SOL
0.156419
5/6/21
11/24/22
2,247.03
2,118.58
ADA
16.019442
November 14, 2020
2022-02-19
5,744.40
6,290.18
Generated by tax software from your exchange history.
2022 Realized Gains and Losses Report",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-9acec43126d95f405bfb4886,v11-CRYPTO_TAX_REPORT-stacked,original,2022,fgen-6e7ed79216b1641b1b1b7577,synthetic_programmatic_template,stacked,bottom,False,gain_loss
"2023 Crypto Tax Summary
LedgerPeak Markets
Account
Jordan Brennan
Cost basis method
Specific ID
Short-term realized gain/loss
-4,723.60
Long-term realized gain/loss
31,764.76
Staking and other income
$824.56
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
SOL
7.603944
4/10/23
02/16/2023
13,938.21
14,309.40
ADA
10.561097
2022-11-16
7/8/23
8,582.69
6,342.64
SOL
12.362899
04/26/2022
March 26, 2023
11,103.31
7,449.67
SOL
15.094054
01/04/2021
September 9, 2023
14,181.19
14,577.62
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-fce41fe72126417d23a76a39,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-ac33c62c9e26416d7bd97a7e,synthetic_programmatic_template,stacked,top,False,tax_software_summary
"2026 Crypto Tax Summary
BitMeadow
Account
Amara Nguyen
Cost basis method
HIFO
Short-term realized gain/loss
6,616.08
Long-term realized gain/loss
4,430.36
Staking and other income
462.17
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ETH
16.002227
03/18/2026
7/5/26
5,700.17
7,303.03
ADA
29.231974
2026-06-13
11/6/26
1,363.38
1,245.06
ETH
12.322490
March 3, 2024
2026-09-19
508.54
374.94
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-7c3dc3d4e3ab83c86cfe9627,v11-CRYPTO_TAX_REPORT-stacked,original,2026,fgen-f9ccf1d6b569a77e242514f7,synthetic_programmatic_template,stacked,top,False,tax_software_summary
"CoinLedger-style report
Account
Riley J. Moreau
Cost basis method
FIFO
Short-term realized gain/loss
1,342.36
Long-term realized gain/loss
31,252.73
Staking and other income
1,030.27
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
USDC
16.498819
01/18/2022
2023-10-17
17,367.74
15,468.67
SOL
16.466197
08/01/2021
1/25/23
19,557.75
11,839.22
ETH
10.977454
11/4/23
2023-04-24
2,126.56
2,312.73
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-53da972d9b0e886fbf230ba2,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-138908c58385ebffecc8fae1,synthetic_programmatic_template,stacked,none,False,tax_software_summary
"Crypto gains and losses - 2024
Downloaded 2024-12-14
Timestamp  Transaction Type  Asset  Quantity Transacted  Spot Price at Transaction  Subtotal  Total (inclusive of fees)  Fees
2024-01-04T11:08:00Z
Buy
SOL
19.951745
4022.47
8734.06
8641.70
25.43
26/09/2024T02:35:00Z
Receive
USDC
5.625883
11123.91
3218.72
4466.28
0.47
11/12/2024T06:43:00Z
Receive
USDC
8.321509
20752.19
4956.90
8654.20
12.94
06/21/2024T02:18:00Z
Staking Income
BTC
17.320801
22668.14
6245.70
2262.82
21.62
25/06/2024T14:49:00Z
Staking Income
ETH
2.821686
6254.67
8200.39
4734.64
15.94
04/21/2024T05:24:00Z
Sell
ETH
11.481337
18791.68
8135.25
8460.98
23.55
2024-08-03T16:27:00Z
Receive
BTC
4.984070
32048.51
5057.24
4635.48
31.74",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-3ff2d89fd11ec303bb8eb185,v11-CRYPTO_TAX_REPORT-stacked,original,2024,fgen-c35eac404f792993210bfa65,synthetic_programmatic_template,stacked,top,False,raw_export
"Downloaded 06/09/2023
Timestamp  Transaction Type  Asset  Quantity Transacted  Spot Price at Transaction  Subtotal  Total (inclusive of fees)  Fees
06/07/2023T10:02:00Z
Staking Income
SOL
15.710801
31912.27
4255.36
4284.21
25.39
2023-10-06T22:41:00Z
Sell
ETH
12.121069
66358.80
4897.71
3449.47
39.79
07/25/2023T17:33:00Z
Sell
SOL
11.906765
58900.24
5479.90
319.85
15.23
08/12/2023T11:28:00Z
Send
BTC
8.754933
8820.51
7823.18
4731.27
19.69
26/06/2023T21:38:00Z
Receive
ETH
17.540219
58821.35
2840.43
5713.00
22.86
02/09/2023T18:08:00Z
Staking Income
USDC
11.982192
26803.90
7019.25
7822.03
28.89
11/16/2023T04:03:00Z
Receive
SOL
9.148098
17279.04
7454.33
6995.69
33.58
22/06/2023T04:35:00Z
Staking Income
SOL
17.750113
37002.51
7656.56
834.51
35.03
06/22/2023T04:15:00Z
Buy
SOL
14.279146
48836.70
161.08
8488.87
4.19",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-274e5c3f6eb91f06e30537ba,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-618da6d80655518f7e0499eb,synthetic_programmatic_template,stacked,top,False,raw_export
"LedgerPeak Markets
Account
Diego Sato
Cost basis method
FIFO
Short-term realized gain/loss
-6,562.87
Long-term realized gain/loss
60.03
Staking and other income
2,739.93
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
BTC
17.424946
April 12, 2021
12/08/2023
9,342.97
10,597.50
ETH
15.968632
2023-10-17
2023-06-13
3,423.55
2,234.57
ADA
16.556492
04/06/2023
5/26/23
9,003.30
6,661.02
This report is for informational purposes and is not an IRS form.
2023 Realized Gains and Losses Report",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-bbf6d6955a05f8b79bcb86a9,v11-CRYPTO_TAX_REPORT-stacked,original,2023,fgen-4128cd5ffb48adad44ca2677,synthetic_programmatic_template,stacked,bottom,False,gain_loss
"2025 Realized Gains and Losses Report
LedgerPeak Markets
Account
Priya D. Fischer
Cost basis method
HIFO
Short-term realized gain/loss
19,337.44
Long-term realized gain/loss
29,297.09
Staking and other income
$1,686.68
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
USDC
22.615768
2025-09-16
October 13, 2025
14,043.54
7,303.01
ADA
29.745603
03/11/2025
2025-09-02
5,121.37
4,606.69
USDC
6.291820
June 6, 2023
2025-11-13
3,325.13
4,145.76
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-66e450290e618895a951b0f9,v11-CRYPTO_TAX_REPORT-stacked,original,2025,fgen-a5eb963b1d5e731ba437f297,synthetic_programmatic_template,stacked,top,False,gain_loss
"Crypto Transaction History Export
TaxBit-style report
Account  Alex Tanaka
Cost basis method   HIFO
Asset      Amount      Date Acquired      Date Sold      Proceeds      Cost Basis
ETH 26.628679 01/17/2020 2022-08-17 9,193.50 8,674.56
SOL  13.881970  09/20/2021  2022-02-04  12,996.03  15,756.16
ETH 2.736786 10/25/2022 11/21/22 10,954.76 7,891.58
SOL   9.467547   7/17/22   2022-08-01   1,874.50   2,430.83
USDC      26.174455      February 20, 2020      01/22/2022      3,504.92      1,800.87
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-90a1ef02d94be4458838a7e6,v11-CRYPTO_TAX_REPORT-inline,original,2022,fgen-7269822b7d120a51964e991f,synthetic_programmatic_template,inline,top,False,transaction_history
"LedgerPeak Markets
Account Jamie Sato
Cost basis method   HIFO
Short-term realized gain/loss      -5,257.94
Long-term realized gain/loss 20,574.68
Staking and other income $2,732.20
Asset   Amount   Date Acquired   Date Sold   Proceeds   Cost Basis
USDC  5.786489  07/15/2024  2026-05-23  18,899.47  11,517.95
USDC 9.006688 06/12/2025 10/17/2026 16,497.21 16,254.60
ETH   25.563841   4/9/26   2026-08-17   9,894.17   5,639.98
ETH 8.530702 2025-12-14 2026-12-25 12,803.61 11,117.53
USDC   3.995812   08/14/2026   12/06/2026   12,310.34   8,826.66
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-95dfa4f485132f642da6cd27,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-31f093b5e2b8119b2fec3bb9,synthetic_programmatic_template,inline,none,False,tax_software_summary
"2021 Realized Gains and Losses Report
BitMeadow
Account      Fatima Nguyen
Cost basis method  HIFO
Short-term realized gain/loss -424.05
Long-term realized gain/loss   25,345.79
Staking and other income $1,661.36
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
USDC  22.746809  3/21/19  10/05/2021  19,132.35  16,821.28
USDC  21.291050  01/22/2020  April 5, 2021  4,873.24  3,778.16
ETH   12.344424   12/13/19   November 27, 2021   18,033.52   16,941.94
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-f0d8b24ae519b54a44972c6f,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-96320fa0e2037b7d4f86d344,synthetic_programmatic_template,inline,top,False,gain_loss
"2024 Realized Gains and Losses Report
CoinLedger-style report
Account  Riley M. Larsen
Cost basis method  HIFO
Short-term realized gain/loss 2,164.15
Long-term realized gain/loss      14,180.46
Staking and other income 2,814.52
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
ETH   16.427806   2024-02-04   06/13/2024   9,222.62   6,613.85
USDC  14.884509  10/9/24  04/03/2024  8,906.22  4,912.41
ETH      8.408512      6/28/24      04/03/2024      18,686.41      20,939.96
ETH   4.169239   1/4/22   11/26/2024   4,394.73   5,015.29
ADA   5.521585   01/07/2024   08/13/2024   8,750.24   8,139.38
ADA  12.324320  1/14/24  December 22, 2024  4,004.94  4,415.87
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-5c7bee1551456aa9cd59ab85,v11-CRYPTO_TAX_REPORT-inline,original,2024,fgen-35a3d61f7eb45ebb5d6f8710,synthetic_programmatic_template,inline,top,False,gain_loss
"TaxBit-style report
Account      Kwame D. Fischer
Cost basis method      Specific ID
Short-term realized gain/loss 16,672.26
Long-term realized gain/loss      21,114.67
Staking and other income   $393.38
Asset   Amount   Date Acquired   Date Sold   Proceeds   Cost Basis
BTC      13.129042      2021-04-02      04/08/2022      14,296.49      15,528.73
BTC  11.715548  June 14, 2022  01/15/2022  8,797.44  6,442.72
ADA 9.808965 2021-07-12 June 19, 2022 16,650.96 19,267.88
ETH      20.402357      9/12/21      2022-10-04      18,243.90      24,550.51
This report is for informational purposes and is not an IRS form.
2022 Crypto Tax Summary",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-f1b2582f92a55142887c4041,v11-CRYPTO_TAX_REPORT-inline,original,2022,fgen-5b76f2551f83bd160176ce19,synthetic_programmatic_template,inline,bottom,False,tax_software_summary
"2025 Realized Gains and Losses Report
TaxBit-stylereport
Account  Casey Romero
Cost basis method   FIFO
5hort-term realized gain/loss 5,539.41
Long-term realized gain/loss      25,667.15
Staking and other income      S1,953.62
Asset  Amount  Date Acquired  Date So1d  Proceeds  Cost Basis
BTC   28.743345   9/16/23   09/16/2025   741.22   604.12
BTC     22.214502      8/3/23      2025-11-28     11,415.21      9,262.17
ADA 0.998138 02/18/2023 05/17/2025 5,222.23 5,869.75
BTC 12.359580 January 21, 2025 7/10/25 8,001.27 10,039.92
BTC 15.769874 7/10/23 10/15/25 2,833.09 1,710.05
ADA   19.321409   December10, 2024   2025-03-09  l6,941.16   17,791.55
Generated by tax software from your exchange hístory.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-ac771af852d655f4f037d14a,v11-CRYPTO_TAX_REPORT-inline,original,2025,fgen-7684ed1b207b55664f1d589b,synthetic_programmatic_template,inline,top,True,gain_loss
"2023 Realized Gains and Losses Report
CoinHarbor Exchange
Account  Morgan J. Testcase
Cost basis method FIFO
Short-term realized gain/loss  609.46
Long-term realized gain/loss   18,121.75
Staking and other income  2,157.47
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
SOL      3.538665      2023-09-01      March 25, 2023      18,204.29      15,914.52
ADA 1.649121 2/14/21 2023-03-03 3,722.43 5,049.42
BTC 12.372651 December 17, 2022 01/14/2023 18,800.46 26,320.35
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-713d222363f0190aeaae85fa,v11-CRYPTO_TAX_REPORT-inline,original,2023,fgen-0224c2da943b2710ab4773b0,synthetic_programmatic_template,inline,top,False,gain_loss
"Crypto Transaction History Export
LedgerPeak Markets
Account      Wei Kowalski
Cost basis method FIFO
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
SOL 3.133624 2026-10-04 March 26, 2026 15,018.83 18,951.24
ETH      9.870055      2025-03-24      April 2, 2026      15,729.38      8,861.17
SOL  0.234288  12/17/26  08/22/2026  1,360.11  1,613.72
ETH 13.756050 11/19/26 1/20/26 17,696.39 10,025.92
ADA 5.100405 01/22/2024 2026-10-19 12,318.30 12,187.30
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-533b540d53148ffe2d1a4967,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-e05ea6c9eac7fa0c2abf291a,synthetic_programmatic_template,inline,top,False,transaction_history
"2021 Crypto Tax Summary
CoinHarbor Exchange
Account  Hiro Kowalski
Costbasis method Specific ID
Short-term realized gain/loss 2,175.79
Long-term realized gain/loss 18,291.O8
Staking and other income S1,593.08
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
USDC  6.49O419  06/19/2020  11/15/21 16,116.74  17,092.24
BTC      22.185105      09/08/2019      11/26/21     3,693.36      4,791.88
ADA 17.942413 12/18/21 2021-01-14 17,022.96 21,996.78
ETH 21.024391 9/27/20 August 12, 2021 19,425.44 14,874.10
BTC 22.459921 February 26, 2021 February 23, 2021 15,111.08 18,074.61
ETH   26.915453   Ju1y 20, 2019   08/02/2021   19,811.14   10,995.01
Use thís reportto prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-7cf4c9c42568d67c9ae96a89,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-f1ef49768a508a46e1d97439,synthetic_programmatic_template,inline,top,True,tax_software_summary
"TaxBit-style report
Account Jordan Rivera
Cost basis method      HIFO
Asset   Amount   Date Acquired   Date Sold   Proceeds   Cost Basis
ADA 28.891534 2025-07-03 11/12/26 10,084.36 11,034.53
ETH 28.024056 2024-07-23 10/26/2026 18,079.79 22,656.95
ETH 7.282971 08/20/2026 7/12/26 3,291.05 3,208.66
USDC   9.377716  10/18/25   2026-05-09  8,572.97   8,144.65
Gcnerated by tax software from your exchange hístory.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d99cfe0d4b5b18036a575c62,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-204e5ef4b54cd508fa298f3b,synthetic_programmatic_template,inline,bottom,True,transaction_history
"Crypto Transaction HistoryExport
CoinHarbor Exchange
Account  Sofia Walsh
Cost basismethod Specific ID
Asset Amount Date Acquired Date So1d Proceeds Cost Basis
BTC   5.969934   2026-06-26   03/23/2026   5,839.53   3,952.92
USDC 11.217584 Junc 4, 2024 07/03/2026 13,412.37 17,281.00
USDC 28.181779 2026-07-01 March 20,2026 5,354.85 6,443.56
USDC  9.163360  6/8/24  05/04/2026  18,790.75  20,593.15
S0L   9.332504   May 24, 2025   09/17/2026   1,O40.53   973.48
USDC 4.770773 October 9, 2026 June 27, 2026 11,490.37 10,173.07
Thís report is for informationa1 purposes and is not an IR5 form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-54f132df25d4fc44d8088d9e,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-a1ea0acc7025a2babea79261,synthetic_programmatic_template,inline,top,True,transaction_history
"CoinLedger-style report
Account      Morgan Fischer
Cost basis method Specific ID
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
ADA 4.578515 August 5, 2023 June 12, 2025 54.39 39.22
ADA   0.732694   06/03/2024   01/26/2025   17,429.90   13,586.97
BTC 5.862233 2023-10-26 05/24/2025 14,962.39 19,542.01
SOL 16.148202 April 13, 2025 2025-11-25 7,093.33 3,691.58
ADA      21.705991      07/07/2025      8/1/25      18,595.07      17,002.81
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-4a2f396b179d021771f811ae,v11-CRYPTO_TAX_REPORT-inline,original,2025,fgen-39fe1236bd3faa30c55cfb6a,synthetic_programmatic_template,inline,none,False,transaction_history
"2021 Realized Gains and Losses Report
TaxBit-style report
Account      Noah A. Rivera
Cost basis method  Specific ID
Short-term realized gain/loss      10,434.58
Long-term realized gain/loss   -8,628.65
Staking and other income  $1,052.15
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
ETH 23.751603 7/20/20 2021-06-16 3,110.88 3,821.39
SOL 0.797970 10/02/2021 2021-12-28 12,838.35 12,544.19
BTC  25.180153  April 25, 2021  2021-06-26  6,261.89  4,241.69
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d667d70f0380283bd2ad3ba7,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-facadca4372c9d916ac73e58,synthetic_programmatic_template,inline,top,False,gain_loss
"Asset   Date Acquired   Date Sold   Proceeds   Cost Basis   Gain (Loss)   Holding Period
SOL   2021-08-03   2022-07-18   11847.11   7463.76   -6708.49   Long-term
SOL      2021-06-03      09/08/2022      17656.83      19552.44      1500.82      Short-term
BTC      03/03/2021      28/03/2022      14677.84      15602.33      3562.53      Long-term
SOL 2021-06-17 10/15/2022 3429.56 3308.53 2857.97 Long-term
BTC 01/18/2021 03/01/2022 6430.91 12660.07 -3288.99 Long-term
SOL  2021-02-03  07/08/2022  13014.03  13678.14  5567.95  Short-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-aa246e25a15e845ed59a2c0b,v11-CRYPTO_TAX_REPORT-inline,original,2022,fgen-c00c007b8a7e18b2b23bb766,synthetic_programmatic_template,inline,none,False,raw_export
"BitMeadow
Account   Mateo J. Walsh
Cost basis mcthod  Specific ID
Short-termrealized gain/loss 2,772.62
Long-termrealized gain/loss      24,026.09
Staking and other income 601.40
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
ADA      29.156111      01/28/2024      February 22, 2025      5,949.39      8,095.19
ADA 28.662331 06/13/2025 December 13, 2025 6,836.54 8,222.73
U5DC 5.9863O7 04/13/2025 March 25, 2025 15,912.O2 21,627.26
SOL 17.078475 August 6, 2025 01/06/2025 5,085.47 3,054.06
SOL  25.85998909/21/2023  09/07/2025  13,406.86  12,185.13
USDC      26.989588      March 3, 2024      2/13/25      13,734.00     13,089.81
Usc this rcport to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-55e263284184f5e91216898a,v11-CRYPTO_TAX_REPORT-inline,original,2025,fgen-0bf48f528fd5df205294850a,synthetic_programmatic_template,inline,none,True,gain_loss
"2025 Crypto Tax Summary
LedgerPeak Markets
Account Mateo D. Rivera
Cost basis method HIFO
Short-term realized gain/loss  12,708.01
Long-term realized gain/loss   6,261.49
Staking and other income  323.34
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
SOL   5.993317   June 25, 2024   09/02/2025   3,082.39   1,963.34
USDC 10.118985 April 21, 2024 2025-09-15 19,564.26 10,822.77
ADA 4.771165 3/15/24 3/14/25 18,805.52 25,262.32
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d5d987739ba26e69d437c64d,v11-CRYPTO_TAX_REPORT-inline,original,2025,fgen-c97c0a738a39128f36e0e42e,synthetic_programmatic_template,inline,top,False,tax_software_summary
"2022 Realized Gains and Losses Report
LedgerPeak Markets
Account      Hiro Sato
Cost basis method HIFO
Short-term realized gain/loss 944.33
Long-term realized gain/loss  22,712.08
Staking and other income 151.68
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
USDC  27.816417  2021-08-23  1/28/22  1,446.09  1,041.77
ETH   17.974283   09/16/2020   03/22/2022   11,914.28   15,557.30
USDC 7.242261 12/15/20 2022-07-28 18,398.30 13,513.15
SOL      27.224432      3/15/20      7/23/22      1,093.28      1,082.00
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d8b1fc113e44d791f1900741,v11-CRYPTO_TAX_REPORT-inline,original,2022,fgen-855f08b9b1e27da1f1e7db2a,synthetic_programmatic_template,inline,top,False,gain_loss
"Timestamp Transaction Type Asset Quantity Transacted SpotPrice at Transaction Subtotal Total (inclusive of fees) Fees
l0/02/2021T19:43:00Z   5ell   USDC  0.593741  32036.07   3634.13   8077.88   13.64
24/10/2021T05:42:00Z Receive U5DC l8.524691 67116.68 1873.57 1830.48 4.35
2021-02-17T02:48:00Z  Convert  SOL  0.615236  69410.49  3570.93  6882.71  21.74
05/11/2021T14:16:00Z   Stakíng Income   ETH  14.252481   44482.48   4875.98   1747.66   17.97
14/10/2021T05:33:00Z   Sell   SOL   19.785241   23502.49   2595.55   5502.85   33.68
03/24/2021T01:23:00Z  Send  ETH 14.557873  27264.43  4868.78  2837.81  6.58
2021-08-06T11:59:00Z  Convert  USDC  7.770989  45439.04  8739.81  6993.54  33.33
12/08/2021T15:41:00Z  Convert  USDC  4.571257  22079.84 2021.54  543.80  3.81
2021-09-27T13:08:00Z Convert ETH 9.399461 22086.83 1326.12 8356.82 38.62",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-ac05528e9fcdd3f865678e83,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-15e93673e01a3891008415a1,synthetic_programmatic_template,inline,top,True,raw_export
"2021 Crypto Tax Summary
CoinHarbor Exchange
Account      Alex Lindqvist
Cost basis method  Specific ID
Short-term realized gain/loss      19,861.23
Long-term realized gain/loss      19,012.99
Staking and other income   283.58
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
ADA 1.404941 May 15, 2020 04/23/2021 12,204.22 14,671.47
USDC  15.737600  05/04/2020  09/21/2021  10,652.00  8,468.40
SOL      10.982122      September 13, 2019      2021-03-20      5,315.01      3,634.74
SOL 19.246751 2021-02-04 3/20/21 8,396.57 5,815.68
USDC 2.302605 December 1, 2020 November 17, 2021 15,779.25 20,477.48
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-2fe4e70c22d051f2e9a91298,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-deb13f87c17990fe5a8bb1b3,synthetic_programmatic_template,inline,top,False,tax_software_summary
"2026 Crypto Tax Summary
LedgerPeak Markets
Account      Jamie R. Okafor
Cost basis method  FIFO
Short-term realized gain/loss -4,904.69
Long-term realized gain/loss -6,665.06
Staking and other income      1,919.47
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
BTC      27.381180      1/4/24      August 6, 2026      10,163.59      14,073.59
USDC   5.436675   03/20/2026   05/22/2026   16,840.54   23,337.31
USDC   15.170922   9/26/24   08/28/2026   13,014.24   7,070.96
SOL      7.281631      01/01/2026      2026-09-25      6,900.99      4,338.96
ADA 22.426092 2025-10-23 March 7, 2026 5,571.01 2,891.28
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-721acea159e82b23e1bd73ca,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-ccee8a49a5b71304b9cba23f,synthetic_programmatic_template,inline,top,False,tax_software_summary
"Crypto Transaction History Export
TaxBit-style report
Account   Noah Tanaka
Cost basis method      Specific ID
Asset   Amount   Date Acquired   Date Sold   Proceeds   Cost Basis
ADA 17.988695 May 21, 2026 2026-11-11 13,274.05 7,815.59
USDC      15.446100      2026-08-05      March 14, 2026      9,407.92      11,332.82
ETH  23.766642  11/17/2026  2026-05-15  17,010.02  15,902.58
SOL 19.642056 July 26, 2026 01/11/2026 15,504.12 17,170.56
ETH 16.937758 April 28, 2026 08/07/2026 15,414.83 9,709.15
USDC  10.459878  July 25, 2025  08/23/2026  2,053.08  2,523.23
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-63acc388ad5ad793644a053f,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-914578112f399081e18e12ce,synthetic_programmatic_template,inline,top,False,transaction_history
"2021 Realized Gains and Losses Report
CoinLedger-style report
Account   KwameD. Kowalski
Cost basis method HIFO
5hort-term realizcd gain/loss 16,241.82
Long-term realizedgain/loss   24,817.90
Staking and other íncome   $1,374.67
Asset     Amount      Date Acquired      Date Sold      Proceeds      Cost Basis
ETH      15.118476     02/03/2020      October 28, 2021      4,765.4O     3,392.04
BTC 25.653618 1/27/19 2021-12-01 14,348.20 19,386.81
BTC 28.703510 10/11/19 2021-12-04 17,514.54 11,674.98
ADA 25.016857 07/28/2019 2021-07-11 18,509.61 24,389.33
ETH 0.788336 01/21/2020 02/03/2021 1,624.08 815.74
USDC      13.641941      December 25, 2020      02/28/2021      8,500.04      9,525.89
Generated by tax softwarefrom your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-aa87b4f164a708e01496dda2,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-436662a7623d1e253be802ff,synthetic_programmatic_template,inline,top,True,gain_loss
"Asset Date Acquired Date Sold Proceeds Cost Basis Gain (Loss) Holding Period
BTC 05/04/2020 16/11/2021 3677.62 17300.65 -3946.72 Long-term
BTC 26/01/2020 16/09/2021 8349.77 19100.93 -8191.42 Long-term
SOL   2020-12-01   21/11/2021   13484.02   17104.17   1227.04   Short-term
BTC 03/08/2020 2021-07-18 11844.01 8344.48 7261.11 Short-term
ETH 20/09/2020 15/07/2021 4282.47 17211.10 -2291.26 Long-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-b0d5e655524d227df5209fce,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-a8175bcec4e43b0b2d34a7b0,synthetic_programmatic_template,inline,top,False,raw_export
"TaxBit-style report
Account   Kwame E. Castillo
Cost basis method  Specific ID
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
USDC      11.073313      3/14/24      9/28/24      12,172.43      11,542.44
ETH 18.383428 March 1, 2023 2024-05-16 2,368.01 3,076.68
SOL 23.985333 11/14/24 03/04/2024 6,474.18 9,060.46
ETH  1.203061  February 16, 2024  11/08/2024  4,383.86  5,170.24
ADA 16.581573 04/10/2024 2024-10-11 18,228.97 22,550.29
ETH      14.225385      5/10/24      8/4/24      5,489.91      4,012.64
Use this report to prepare Form 8949; it is not a Form 1099-DA.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-febdda3af3a7a4b2af33ee21,v11-CRYPTO_TAX_REPORT-inline,original,2024,fgen-9ff6de8d20f075842eff7d8d,synthetic_programmatic_template,inline,bottom,False,transaction_history
"Crypto Transaction History Export
BitMeadow
Account      Lena D. Larsen
Cost basis method Specific ID
Asset  Amount  Date Acquired  Date Sold  Proceeds  Cost Basis
ETH 24.636065 2020-10-22 December 21, 2021 9,172.81 12,818.33
ETH 5.791271 January 17, 2019 7/23/21 11,784.03 8,683.94
ETH   7.098371   03/25/2019   October 13, 2021   449.37   228.89
BTC 22.062276 2021-03-18 2021-07-03 19,082.02 13,858.29
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-4ccc6ce794453ae01d14843a,v11-CRYPTO_TAX_REPORT-inline,original,2021,fgen-7c3a00dd6b5baaa70ea148cf,synthetic_programmatic_template,inline,top,False,transaction_history
"2026 Realized Gains and Losses Report
CoinLedger-style report
Account  Diego Okafor
Cost basis method   HIFO
Short-termrealized gain/loss -3,447.93
Long-term realized gain/loss 32,553.1O
Staking and other income $1,923.93
Asset  Amount  Date Acquired  Date 5old  Proceeds  Cost Basis
USDC 13.719698 10/25/25 April17,2026 4,153.86 2,225.79
ADA 18.469339 2/15/25 5/26/26 14,620.55 11,265.64
SOL 11.718298 July 13, 2024 02/10/2026 9,515.69 9,491.71
ADA 2.789468 June 21, 2O24 December 17, 2026 1,519.97 1,113.85
5OL 25.551929 2026-01-03 2026-05-15 8,041.86 8,283.77
5OL 29.336380 2/21/26 2026-09-21 9,658.62 9,785.48
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-6ac543cda15206e784216224,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-a0ef5ea86a3fd2233e99b27f,synthetic_programmatic_template,inline,top,True,gain_loss
"CoinLedger-style report
Account Wei Haddad
Cost basis method   HIFO
Short-term realized gain/loss   3,251.81
Long-term realized gain/loss 22,894.40
Staking and other income 1,093.33
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
BTC      25.683617      2023-04-24      05/05/2024      5,458.50      5,452.16
USDC 4.576535 11/8/24 02/26/2024 5,359.85 3,909.40
ADA   28.905368   June 14, 2023   03/02/2024   3,866.14   3,982.86
BTC      5.571736      2023-11-11      2/5/24      3,431.02      2,604.78
SOL      21.903356      07/27/2024      08/17/2024      479.31      577.19
Use this report to prepare Form 8949; it is not a Form 1099-DA.
2024 Crypto Tax Summary",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-3e953fb0c3dfe08d0221b843,v11-CRYPTO_TAX_REPORT-inline,original,2024,fgen-5848c7cbe1f50735b96f0f11,synthetic_programmatic_template,inline,bottom,False,tax_software_summary
"CoinLedger-style report
Account      Jamie Tanaka
Cost basis method   Specific ID
Short-term realized gain/loss -443.01
Long-term realized gain/loss 2,331.81
Staking and other income  225.68
Asset   Amount   Date Acquired   Date Sold   Proceeds   Cost Basis
BTC 0.875765 August 1, 2025 11/2/26 18,631.65 21,273.52
ETH 15.194751 06/02/2025 July 1, 2026 16,752.20 20,007.75
BTC  19.202366  11/22/2025  10/13/2026  3,426.35  4,456.06
ADA 26.708999 2026-05-08 08/28/2026 7,524.41 9,701.76
ADA  6.538779  5/12/25  11/06/2026  6,288.22  4,732.96
Use this report to prepare Form 8949; it is not a Form 1099-DA.
2026 Crypto Tax Summary",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-f8836ad5d64e56e6c09bd059,v11-CRYPTO_TAX_REPORT-inline,original,2026,fgen-23dfd22ae09dbeee9ad8577b,synthetic_programmatic_template,inline,bottom,False,tax_software_summary
"Crypto Transaction History Export
CoinLedger-style report
Account Taylor Castillo
Cost basis method   FIFO
Asset Amount Date Acquired Date Sold Proceeds Cost Basis
ADA  10.350528  April 26, 2023  September 17, 2025  14,194.36  10,578.05
ADA 6.189000 05/03/2023 June 14, 2025 19,855.03 15,021.48
ADA  29.875460  5/19/25  8/13/25  8,197.06  6,003.98
USDC   11.275942   June 25, 2023   02/23/2025   16,024.90   15,947.71
BTC 29.942275 2023-01-23 June 10, 2025 9,370.91 9,707.41
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-a49739b2815a000cd05aa759,v11-CRYPTO_TAX_REPORT-inline,original,2025,fgen-c952ec2f96910d1f0c6e87b9,synthetic_programmatic_template,inline,top,False,transaction_history
"TaxBit-style report
Account  Priya Sato
Cost basis method FIFO
Asset      Amount      Date Acquired      Date Sold      Proceeds      Cost Basis
ETH      25.786707      10/26/23      March 4, 2025      18,474.22      20,085.81
USDC 18.097221 March 7, 2023 February 28, 2025 12,588.73 9,472.41
SOL 11.739228 2025-07-09 February 28, 2025 16,523.37 12,817.18
USDC   21.958667   5/24/24   December 14, 2025   4,471.10   5,953.83
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-1b4fa3a2cf015382eae5787e,v11-CRYPTO_TAX_REPORT-inline,original,2025,fgen-454ef0a2f6f0102df31e88cc,synthetic_programmatic_template,inline,none,False,transaction_history
"Downloaded 21/12/2025
Timestamp Transaction Type Asset Quantity Transacted Spot Price at Transaction Subtotal Total (inclusive of fees) Fees
2025-10-03T11:02:00Z Send BTC 0.442022 29810.56 3947.70 7367.21 29.79
2025-06-08T14:19:00Z Send SOL 2.319043 52432.17 8920.70 6012.52 38.08
10/27/2025T11:16:00Z Staking Income SOL 5.630232 61507.16 8037.63 3240.77 4.39
03/05/2025T21:21:00Z  Send  BTC  13.203080  6762.32  373.10  9051.08  25.05
2025-02-17T13:29:00Z   Buy   ETH   10.815898   51281.08   4963.29   4071.28   1.24",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-74af9d41c06004ef51e4dc2b,v11-CRYPTO_TAX_REPORT-inline,original,2025,fgen-37dd54e641dc04333d1ccfd8,synthetic_programmatic_template,inline,none,False,raw_export
"Asset Date Acquired Date Sold Proceeds Cost Basis Gain (Loss) Holding Period
ETH 20/01/2023 02/25/2024 10556.63 5008.49 -4800.54 Long-term
SOL 06/07/2023 11/18/2024 9714.12 6973.24 1165.81 Short-term
ETH      10/11/2023      03/10/2024      18775.08      622.38      7357.44      Short-term
ETH  25/04/2023  07/17/2024  5556.88  18681.14  7379.12  Short-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-e72c18b2ec56d9a91e6330a4,v11-CRYPTO_TAX_REPORT-inline,original,2024,fgen-ba7cf20209ddfc6f3b8c59be,synthetic_programmatic_template,inline,top,False,raw_export
"Crypto gains and losses - 2021
Asset
Date Acquired
Date Sold
Proceeds
Cost Basis
Gain (Loss)
Holding Period
BTC
2020-01-19
02/01/2021
16111.61
3455.59
3921.28
Short-term
BTC
26/12/2020
14/05/2021
9081.74
8648.51
5773.64
Short-term
ETH
2020-07-07
06/05/2021
7222.84
10572.49
1641.19
Short-term
ETH
10/28/2020
2021-08-27
10920.83
13576.48
-1650.62
Long-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-f319cfbff659adf2ac3f7f6a,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-e4f3e1d89f07677e3655f5d2,synthetic_programmatic_template,columns,top,False,raw_export
"2023 Crypto Tax Summary
TaxBit-style report
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Hiro Okafor
FIFO
15,097.95
-3,264.38
$1,503.88
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
BTC
12.498792
2023-08-25
02/19/2023
16,268.36
17,872.93
ADA
23.767537
11/14/22
March 12, 2023
15,428.42
14,832.22
ETH
0.612329
09/03/2021
2023-02-05
326.49
179.78
SOL
10.308092
5/13/21
February 18, 2023
6,158.92
3,472.11
ETH
2.893569
2021-09-10
06/24/2023
778.11
503.39
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-6635bb6397ded0b6b3a02860,v11-CRYPTO_TAX_REPORT-columns,original,2023,fgen-e4f24c8575111490ae560100,synthetic_programmatic_template,columns,top,False,tax_software_summary
"Crypto Transaction History Export
CoinLedger-style report
Account
Cost basis method
Mateo S. Adeyemi
FIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
BTC
23.511791
October 16, 2020
October 22, 2021
5,290.50
3,277.51
SOL
16.524597
10/7/20
03/20/2021
15,142.04
14,359.82
USDC
24.654953
July 15, 2019
11/10/2021
16,530.60
18,406.21
BTC
2.307639
11/04/2019
2021-03-15
8,300.11
9,747.36
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-25d255c8ff03880367e7383b,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-6f7f7b1cd0d1f2349cdf0117,synthetic_programmatic_template,columns,top,False,transaction_history
"LedgerPeak Markets
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Noah Fischer
Specific ID
17,818.00
7,826.96
967.78
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ADA
26.606015
12/22/2023
2024-10-27
5,306.44
6,901.34
USDC
14.363995
March 21, 2022
December 3, 2024
13,346.79
7,210.19
SOL
25.577602
2023-10-27
1/25/24
133.27
93.68
BTC
26.515980
September 4, 2022
April 3, 2024
10,314.12
7,307.18
USDC
28.891109
8/21/24
02/10/2024
4,283.89
3,061.66
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-414a8ade21d8d5d5297dff74,v11-CRYPTO_TAX_REPORT-columns,original,2024,fgen-ecba41526efbf3c9d01b427d,synthetic_programmatic_template,columns,none,False,gain_loss
"Date
Sent Amount
Sent Currency
Received Amount
Received Currency
Fee Amount
Fee Currency
Tag
2026-11-11
1103.3973
BTC
454.876312
USD
0.2467
USD
airdrop
06/12/2026
2575.8132
USD
3497.329451
USD
0.5049
USD
trade
2026-08-17
4463.4541
ETH
1241.294173
ETH
0.0141
USD
staking
03/21/2026
2250.6085
ETH
2178.704716
USD
2.3362
USD
trade
04/24/2026
1551.6974
USD
735.713599
SOL
1.4033
USD
airdrop
2026-07-19
4093.5794
USD
4872.699407
ETH
0.7302
USD
staking
11/23/2026
2711.8260
USD
2991.510832
SOL
3.6386
USD
trade
08/15/2026
4611.6902
ETH
4978.086970
USD
4.7176
USD
trade",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-6aa67518d6974392b55f32a5,v11-CRYPTO_TAX_REPORT-columns,original,2026,fgen-e89a44d0733958525b76dadd,synthetic_programmatic_template,columns,top,False,raw_export
"Downloaded 2021-12-27
Asset
DateAcquired
Date 5old
Proceeds
Cost Basis
Gain (Loss)
Holding Period
BTC
02/13/2020
03/02/2021
2676.80
17727.13
6070.46
Long-term
ETH
01/22/2020
2021-01-17
11096.30
4658.34
4615.39
5hort-term
BTC
2020-07-26
12/26/2021
3607.58
10004.11
-2250.07
Long-term
ETH
2020-04-24
25/01/2021
19727.82
5934.96
259.84
Short-term
ETH
25/05/2020
01/10/2021
15929.94
2325.26
5836.22
Short-tcrm
ETH
01/01/2020
03/07/2021
16744.36
10967.87
217.84
Short-term
BTC
2020-05-08
12/04/2021
9303.29
7216.45
-6495.25
Long-term
BTC
2020-09-25
2021-05-14
19499.49
10782.89
1838.77
5hort-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-cf348aece3a30dbe1a02b6fa,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-24d69d15fec9e66559fa737e,synthetic_programmatic_template,columns,bottom,True,raw_export
"CoinLedger-style report
Account
Cost basis method
Avery Romero
Specific ID
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
SOL
2.738494
10/16/2025
06/01/2025
2,154.77
1,576.99
SOL
21.018118
April 8, 2025
01/05/2025
3,340.17
3,574.72
BTC
12.851175
12/23/25
06/21/2025
3,427.25
3,018.45
ETH
22.009439
2023-05-26
7/24/25
14,689.56
7,527.70
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-202d47fb9158ecf04b262e20,v11-CRYPTO_TAX_REPORT-columns,original,2025,fgen-35b88bbcbad64ecbf79a9dba,synthetic_programmatic_template,columns,none,False,transaction_history
"Crypto Transaction History Export
CoinLedger-style report
Account
Cost basis method
Wei C. Romero
FIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ETH
0.581785
2020-03-10
3/1/21
11,985.13
15,261.35
ETH
8.720117
2019-12-19
2/26/21
11,709.06
6,685.31
USDC
5.120423
2019-12-21
8/17/21
7,600.45
6,111.69
SOL
2.726720
June 1, 2020
08/19/2021
7,699.44
10,065.80
ADA
19.991257
3/8/19
2021-02-26
17,064.61
20,901.54
SOL
15.349567
08/19/2019
5/7/21
10,526.97
11,083.39
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-33eb448f4935232d20f8ee76,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-e2d99164a8295ad40461d435,synthetic_programmatic_template,columns,top,False,transaction_history
"Asset
Date Acquired
DateSold
Proceeds
Cost Basis
Gain (Loss)
Holding Period
BTC
15/09/2023
09/12/2024
6681.31
14086.99
-3231.96
Long-term
BTC
11/01/2023
2024-09-14
11074.55
19981.46
-99.80
Short-term
BTC
2023-04-21
2024-04-17
19115.09
9013.88
2.69
Long-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-79c6ebdf2591b9bf5e458760,v11-CRYPTO_TAX_REPORT-columns,original,2024,fgen-b29d7ffc3763172015ce1709,synthetic_programmatic_template,columns,none,True,raw_export
"LedgerPeak Markets
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Diego Moreau
HIFO
18,058.81
23,652.15
$965.97
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
SOL
8.863452
9/22/25
February 24, 2026
5,943.11
4,956.26
ETH
9.526125
04/22/2025
May 20, 2026
2,467.82
3,385.55
SOL
28.936631
11/28/26
06/12/2026
8,653.15
9,657.44
ADA
8.199539
10/20/2025
10/13/26
8,097.15
8,274.05
SOL
4.981998
02/09/2024
9/22/26
3,452.02
1,777.09
Use this report to prepare Form 8949; it is not a Form 1099-DA.
2026 Crypto Tax Summary",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-598eca7eceedca786aefdc63,v11-CRYPTO_TAX_REPORT-columns,original,2026,fgen-3d549676cdff88adcf2ecf64,synthetic_programmatic_template,columns,bottom,False,tax_software_summary
"2025 Realized Gains and Losses Report
TaxBit-style report
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Jamie M. Tanaka
FIFO
4,514.25
1,013.01
1,760.54
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ADA
4.149055
2024-12-09
2025-11-24
10,171.84
7,987.95
ADA
21.670111
09/03/2023
June 16, 2025
6,400.00
7,133.39
BTC
12.552176
04/03/2024
4/16/25
15,220.45
18,796.11
USDC
0.036933
2024-06-24
05/10/2025
2,231.89
2,035.93
BTC
22.523435
September 15, 2023
1/16/25
9,129.43
8,639.15
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-194cd198e3c2113f1153b7cd,v11-CRYPTO_TAX_REPORT-columns,original,2025,fgen-43c8a37508c67033baa18cdf,synthetic_programmatic_template,columns,top,False,gain_loss
"Transaction historyexport
Downloaded 18/09/2021
Asset
Date Acquired
Date Sold
Proceeds
Cost Basís
Gain (Loss)
Holding Period
ETH
2020-04-28
12/02/2021
7521.77
18253.19
6097.31
Short-term
ETH
08/12/2020
01/20/2O21
4842.63
19199.25
-1063.13
Long-term
SOL
2020-08-27
2021-08-27
11020.42
6584.57
1606.08
Short-term
ETH
03/23/2020
2021-06-10
10931.61
1O086.51
-5735.22
Long-tcrm",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-c1a531cb1bc5bafe4c5ef45d,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-c52c898ee055910044acff61,synthetic_programmatic_template,columns,top,True,raw_export
"Crypto gains and losses - 2023
Date
Sent Amount
Sent Currency
Received Amount
Received Currency
Fee Amount
Fee Currency
Tag
13/12/2023
3621.0231
USD
536.810197
SOL
1.0985
USD
trade
02/06/2023
1001.2658
ETH
1286.430820
ETH
1.6915
USD
staking
07/08/2023
255.2436
USD
7.209892
SOL
2.2127
USD
trade
12/15/2023
2377.1166
BTC
1554.335163
USD
0.1830
USD

13/07/2023
4142.7263
ETH
1421.794394
ETH
1.1400
USD
airdrop
01/06/2023
2042.5513
USD
2427.376715
USD
4.0315
USD
staking
2023-11-14
4992.9498
ETH
3402.103684
ETH
1.5366
USD",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-aef1e866063744034cbd22a2,v11-CRYPTO_TAX_REPORT-columns,original,2023,fgen-ff05bf3a165b533b454481f1,synthetic_programmatic_template,columns,top,False,raw_export
"CoinLedger-style report
Account
Cost basis method
Olivia Walsh
HIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ADA
17.821633
7/9/22
1/25/23
18,942.75
13,112.51
USDC
11.394728
2022-03-26
2023-03-05
18,636.96
22,201.38
SOL
8.095137
11/22/2023
04/17/2023
7,855.81
9,671.03
ETH
16.757248
2023-05-25
1/23/23
9,246.72
12,585.17
USDC
1.175144
2021-05-01
12/14/2023
6,952.02
5,662.93
ADA
2.932829
6/22/21
2023-08-14
6,024.08
8,051.67
This report is for informational purposes and is not an IRS form.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-fdce51ec4e3b97d88db766d0,v11-CRYPTO_TAX_REPORT-columns,original,2023,fgen-582e32887ebc1183bc2157a1,synthetic_programmatic_template,columns,bottom,False,transaction_history
"CoinLedger-style report
Account
Cost basis method
Hiro Fischer
Specific ID
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
USDC
l0.690235
l2/14/20
July 10, 2021
3,586.47
3,482.12
ADA
27.958794
2019-12-25
09/24/202l
10,038.76
8,179.28
ETH
6.504481
2/3/20
2021-12-17
19,299.82
15,273.59
This report isfor informational purposes and is not an IR5 form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-c6d64b3ee2c43a1451f270a8,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-93b9c6d32fbc9cf6c1be45f5,synthetic_programmatic_template,columns,none,True,transaction_history
"Crypto gains and losses - 2022
Downloaded 02/18/2022
Date
Sent Amount
Sent Currency
Received Amount
Received Currency
Fee Amount
Fee Currency
Tag
18/08/2022
4257.4791
ETH
748.669881
ETH
2.0236
USD
staking
11/09/2022
1115.0036
BTC
3256.619050
SOL
3.8107
USD
trade
03/07/2022
2120.0231
USD
2388.093822
USD
3.4253
USD
staking",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-56b15707aade355c385d2d72,v11-CRYPTO_TAX_REPORT-columns,original,2022,fgen-aa1c25c93a76822ab18247a2,synthetic_programmatic_template,columns,top,False,raw_export
"CoinHarbor Exchange
Account
Cost basis method
Riley Haddad
HIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ADA
5.804051
July 14, 2022
April 16, 2024
18,618.64
21,729.69
ADA
26.583108
01/11/2023
12/10/2024
869.55
634.20
SOL
13.626736
2023-12-18
02/20/2024
2,346.70
3,035.06
ADA
19.394285
2024-08-18
June 15, 2024
11,060.22
14,710.43
ADA
13.791014
July 3, 2023
September 15, 2024
3,337.99
3,563.71
ADA
6.644568
2022-11-24
10/04/2024
18,168.27
9,816.64
This report is for informational purposes and is not an IRS form.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-b70690258fa4215f2054abf4,v11-CRYPTO_TAX_REPORT-columns,original,2024,fgen-04fac073370c8a4a89c7d7a6,synthetic_programmatic_template,columns,bottom,False,transaction_history
"Crypto Transaction History Export
CoinHarbor Exchange
Account
Cost basis method
Morgan J. Moreau
FIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
SOL
22.798540
06/20/2026
8/7/26
12,418.71
6,888.20
USDC
23.849564
October 18, 2025
2026-04-24
15,438.92
18,098.34
ETH
15.379569
2025-04-15
01/07/2026
19,342.27
25,043.13
USDC
22.161573
October 21, 2024
2026-09-17
17,401.51
10,413.14
BTC
8.196523
October 24, 2025
October 8, 2026
18,976.31
16,761.58
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-f06daba1853a02f87e1f5b52,v11-CRYPTO_TAX_REPORT-columns,original,2026,fgen-421a6eff5fa382c43efeb901,synthetic_programmatic_template,columns,top,False,transaction_history
"CoinLedger-style report
Account
Cost basis method
Riley Fischer
HIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ETH
1.628384
October 4, 2024
6/26/25
14,773.78
16,042.60
USDC
29.447330
May 12, 2024
09/21/2025
16,195.94
15,730.68
ETH
23.714247
2024-09-28
2025-01-17
13,038.78
13,774.12
ADA
20.892197
November 25, 2024
10/27/2025
17,977.93
9,531.49
USDC
19.113312
2025-02-19
11/20/2025
5,989.77
4,900.54
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-5704724278b66a0411aa6cdd,v11-CRYPTO_TAX_REPORT-columns,original,2025,fgen-20fe2134afcd6867d4a978f0,synthetic_programmatic_template,columns,none,False,transaction_history
"LedgerPeak Markets
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Taylor M. Walsh
HIFO
17,792.56
-2,458.59
$2,503.50
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
BTC
25.219857
4/7/25
2026-10-08
5,997.48
4,527.94
USDC
20.349674
10/24/2025
1/20/26
15,431.83
18,251.14
BTC
0.108391
2024-12-03
2026-09-18
3,357.98
4,254.50
ETH
28.561328
9/23/25
3/18/26
17,879.18
9,190.80
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-1882e62076aefa3a607bcd7d,v11-CRYPTO_TAX_REPORT-columns,original,2026,fgen-75126e52d63a0e6ee439ae0b,synthetic_programmatic_template,columns,none,False,tax_software_summary
"LedgerPeak Markets
Account
Cost basis method
Fatima Brennan
FIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ETH
11.110076
03/08/2022
December 24, 2022
19,172.43
19,689.73
ADA
12.713194
December 11, 2020
10/12/22
16,690.65
20,509.96
ADA
3.705915
2021-12-27
2022-09-20
15,763.45
15,758.90
This report is for informational purposes and is not an IRS form.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-add37d8d96fc09b473c50070,v11-CRYPTO_TAX_REPORT-columns,original,2022,fgen-518f6d4de64abaf691da42f2,synthetic_programmatic_template,columns,bottom,False,transaction_history
"2022 Crypto Tax Summary
LedgerPeak Markets
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Taylor D. Haddad
FIFO
-5,028.23
8,063.11
$1,131.77
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
SOL
29.556402
09/27/2020
February 5, 2022
6,764.46
5,961.73
SOL
29.452544
8/4/22
10/01/2022
8,642.32
7,559.57
SOL
19.604400
July 23, 2022
September 6, 2022
3,102.73
4,095.24
SOL
28.238545
11/2/20
09/18/2022
12,043.49
13,935.70
ADA
1.960345
3/13/21
September 25, 2022
16,463.39
14,739.64
ETH
28.112501
06/08/2022
January 1, 2022
18,710.99
11,037.59
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-df9fd87da218099b81e858e7,v11-CRYPTO_TAX_REPORT-columns,original,2022,fgen-20ffd9831bce8daa7010b741,synthetic_programmatic_template,columns,top,False,tax_software_summary
"2022 Crypto Tax Summary
TaxBit-style report
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Morgan C. Tanaka
FIFO
12,375.92
16,504.03
$908.20
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ETH
11.492392
11/15/21
2/26/22
9,584.44
7,356.17
ETH
22.586502
7/4/20
10/10/22
14,089.66
11,033.20
USDC
2.392073
2020-06-27
November 18, 2022
13,835.59
14,942.55
ETH
17.739955
10/6/20
7/11/22
4,580.92
3,266.92
USDC
20.617688
2020-07-07
04/06/2022
18,832.12
19,550.61
SOL
23.050141
June 19, 2021
2022-10-21
2,390.85
2,285.61
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-7dc9acab9e1bc2b634b45af5,v11-CRYPTO_TAX_REPORT-columns,original,2022,fgen-d620f8c6103d2300bb313892,synthetic_programmatic_template,columns,top,False,tax_software_summary
"2024 Realized Gains and Losses Report
TaxBit-style report
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Avery J. Sato
HIFO
45.43
6,673.98
$2,039.15
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
USDC
21.676635
2024-06-03
08/23/2024
5,847.41
5,719.03
SOL
25.669154
02/26/2024
7/11/24
14,125.18
18,335.20
ETH
6.247590
May 21, 2024
2024-08-22
4,562.39
5,469.14
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-24bd504dd96aeae9e04668ed,v11-CRYPTO_TAX_REPORT-columns,original,2024,fgen-fa95ce8d6ef08d83d2e70da5,synthetic_programmatic_template,columns,top,False,gain_loss
"Crypto Transaction History Export
BitMeadow
Account
Cost basis method
Noah Tanaka
HIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ADA
1.614436
2022-08-08
2022-05-28
357.57
313.93
BTC
26.202816
2020-10-15
07/17/2022
230.94
298.39
BTC
18.563949
1/3/20
7/16/22
7,799.29
8,849.34
ETH
17.440713
2022-04-13
7/3/22
9,016.21
9,838.29
USDC
12.720085
March 1, 2021
09/24/2022
18,278.44
17,543.15
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-e94e71596724ad3d4d0cb4b2,v11-CRYPTO_TAX_REPORT-columns,original,2022,fgen-5a93b9bbc5591b8de200481e,synthetic_programmatic_template,columns,top,False,transaction_history
"2025 Crypto Tax Summary
BitMeadow
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Lena Castillo
FIFO
12,411.78
16,594.75
$93.16
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ETH
17.011002
December 3, 2025
November 27, 2025
15,135.92
15,274.12
BTC
1.764483
08/12/2025
September 23, 2025
11,234.02
9,248.68
BTC
16.372648
2/11/24
08/13/2025
13,792.90
11,652.40
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-421980339f36c79fca953fda,v11-CRYPTO_TAX_REPORT-columns,original,2025,fgen-5a3278bf2569e4de08d4fae6,synthetic_programmatic_template,columns,top,False,tax_software_summary
"2023 Crypto Tax Summary
LedgerPeak Markets
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Mateo B. Rivera
FIFO
4,869.51
29,877.87
1,178.60
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ADA
28.518649
01/26/2022
1/6/23
16,222.89
10,607.37
ETH
27.596938
September 15, 2023
11/15/2023
11,011.15
6,932.58
SOL
8.627506
01/25/2021
11/28/2023
2,405.14
1,269.54
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-6359dff2c42d655a1851b50f,v11-CRYPTO_TAX_REPORT-columns,original,2023,fgen-541a991b4af2f8c1e293a2f8,synthetic_programmatic_template,columns,top,False,tax_software_summary
"BitMeadow
Account
Cost basis method
Sofia Walsh
FIFO
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
USDC
10.133218
May 5, 2020
June 5, 2021
8,111.13
5,308.02
ETH
26.982003
November 13, 2020
August 3, 2021
14,456.64
18,247.96
SOL
27.723533
2/5/21
11/12/2021
5,355.40
5,840.02
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-2d2d767b0be6136af021bfa3,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-67a66f62212b024cea85e77e,synthetic_programmatic_template,columns,none,False,transaction_history
"Crypto gains and losses - 2021
Date
5ent Amount
Sent Currency
Received Amount
Received Currency
Fee Amount
FeeCurrency
Tag
05/01/2021
1436.8824
BTC
215.816729
U5D
4.5999
USD

03/27/2021
2161.4329
ETH
2356.612211
U5D
1.2690
USD

08/05/2021
2589.1728
BTC
648.973016
USD
0.6428
USD
staking
2021-07-10
1082.1379
BTC
2724.930002
SOL
1.2158
USD
trade
10/02/2021
3610.0180
USD
4182.115204
ETH
4.1595
USD
trade
2021-02-10
484.1606
USD
1115.841323
USD
4.4442
USD

05/12/2021
3607.5388
USD
2301.893473
USD
1.8387
USD

2021-09-08
2237.7922
ETH
4026.l57307
USD
2.6563
USD
trade",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-2433319958325719f693489c,v11-CRYPTO_TAX_REPORT-columns,original,2021,fgen-09cb0e427fa698d0f718c3c3,synthetic_programmatic_template,columns,top,True,raw_export
"2025 Realized Gains and Losses Report
CoinLedger-style report
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Sofia C. Rivera
HIFO
-7,454.32
36,028.87
125.02
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
SOL
11.156122
11/7/23
August 24, 2025
12,009.58
14,441.24
BTC
4.964515
1/5/24
6/2/25
15,571.26
19,941.75
USDC
3.395637
12/1/25
02/28/2025
14,817.70
12,806.16
USDC
15.169155
9/21/24
May 13, 2025
7,641.02
9,788.71
SOL
10.620685
4/25/23
2025-05-09
14,869.83
18,793.50
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-65997dc35a2d83df9eba27f6,v11-CRYPTO_TAX_REPORT-columns,original,2025,fgen-8161f43dce0cd741720db026,synthetic_programmatic_template,columns,top,False,gain_loss
"2023 Realized Gains and Losses Report
CoinLedger-style report
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Avery M. Brennan
HIFO
-3,930.28
3,915.25
2,787.73
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
ETH
13.623733
05/05/2023
August 20, 2023
5,953.20
3,604.96
BTC
24.682099
5/20/22
1/1/23
10,219.50
6,717.22
ETH
0.053571
02/18/2023
March 4, 2023
4,403.54
5,871.17
SOL
15.129178
04/22/2023
5/6/23
15,955.10
11,495.68
SOL
24.569012
5/24/23
10/17/2023
10,487.29
13,134.20
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-8c9cfbe0f44c556403a40213,v11-CRYPTO_TAX_REPORT-columns,original,2023,fgen-5eeacb179fbbf89802a3c472,synthetic_programmatic_template,columns,top,False,gain_loss
"2023 Crypto Tax Summary
LedgerPeak Markets
Account
Cost basis method
Short-term realized gain/loss
Long-term realized gain/loss
Staking and other income
Amara Rivera
Specific ID
10,686.49
8,159.09
$1,616.19
Asset
Amount
Date Acquired
Date Sold
Proceeds
Cost Basis
USDC
9.585337
10/11/21
6/8/23
19,005.35
21,307.17
BTC
22.152715
2022-01-02
5/22/23
1,976.74
2,055.45
SOL
10.227440
2022-10-19
10/08/2023
13,353.82
15,879.96
SOL
17.665861
07/20/2023
2023-11-22
7,530.42
5,404.16
SOL
10.049111
11/23/2021
5/19/23
5,564.32
3,768.50
USDC
12.561037
12/19/2022
2023-01-22
4,825.70
6,311.99
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-d57271c54b9da285f877dfcc,v11-CRYPTO_TAX_REPORT-columns,original,2023,fgen-74e89aebefcaf86e557facfb,synthetic_programmatic_template,columns,top,False,tax_software_summary
"Date,SentAmount,Sent Currcncy,Received Amount,Received Currency,Fee Amount,Fee Currcncy,Tag
10/24/2024,2529.7818,U5D,3244.845903,SOL,1.7548,USD,staking
02/19/2024,153.2095,USD,524.233811,SOL,3.8619,USD,
2024-07-17,1497.8194,USD,2260.059447,ETH,2.9744,USD,trade
28/02/2024,1088.2316,ETH,1342.676898,ETH,3.9673,USD,airdrop
02/06/2024,358.5O52,USD,1934.074638,USD,0.1704,USD,trade
03/08/2024,2723.3072,BTC,339.254374,ETH,3.8962,USD,
16/01/2024,1993.4030,ETH,4l43.486188,5OL,4.4892,USD,trade
2024-02-26,3715.0826,BTC,1047.995600,S0L,4.3074,USD,trade
2024-04-25,4027.9673,ETH,2328.681603,SOL,3.5430,USD,airdrop",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-252428cdfeca872d6b720e06,v11-CRYPTO_TAX_REPORT-csv,original,2024,fgen-0d38ebefd1bd4721bf48ae1b,synthetic_programmatic_template,csv,none,True,raw_export
"Crypto Transaction History Export
BitMeadow
Account,Morgan Walsh
Cost basis method,Specific ID
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
SOL,20.654304,4/16/21,9/18/22,""8,236.94"",""6,519.16""
SOL,3.557571,01/16/2021,03/16/2022,""19,494.13"",""11,300.96""
ETH,26.304939,""January 15, 2021"",05/05/2022,""19,041.22"",""19,466.16""
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-0d731b86f583c61da735df2c,v11-CRYPTO_TAX_REPORT-csv,original,2022,fgen-1aa80130c0877d39258e4d40,synthetic_programmatic_template,csv,top,False,transaction_history
"2024 Crypto Tax Summary
TaxBit-style report
Account,Lena E. Testcase
Cost basis method,HIFO
Short-term realized gain/loss,""-3,880.99""
Long-term realized gain/loss,""13,111.50""
Staking and other income,""$1,159.03""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
USDC,15.506264,12/05/2024,2024-01-26,""14,537.26"",""16,848.90""
USDC,4.459491,5/17/23,2024-02-04,""10,670.84"",""7,340.94""
USDC,3.768836,2024-10-19,5/18/24,""1,361.10"",""1,357.28""
ADA,13.399192,2022-04-19,2024-04-21,""11,090.22"",""12,520.14""
ETH,19.601686,12/1/24,""December 20, 2024"",""4,970.94"",""4,357.34""
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-7dd0796b3a026cbd3f8cb42d,v11-CRYPTO_TAX_REPORT-csv,original,2024,fgen-b564178c1126af559dc8b9db,synthetic_programmatic_template,csv,top,False,tax_software_summary
"Date,SentAmount,Sent Currency,Receíved Amount,Received Currency,Fee Amount,Fee Currency,Tag
2024-10-07,2423.9708,ETH,1264.724714,ETH,0.2336,USD,trade
08/11/2024,398.8169,BTC,1803.367103,ETH,2.7093,USD,staking
01/01/2024,4984.5389,ETH,1080.490714,USD,1.7094,USD,trade
19/04/2024,3023.8298,USD,881.520943,ETH,1.2769,USD,aírdrop
2024-11-14,3735.7779,BTC,1554.634643,USD,3.5841,USD,tradc
24/06/2024,3023.8022,USD,2958.487898,ETH,1.4754,USD,",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-323c8a2ff771e5181e156b34,v11-CRYPTO_TAX_REPORT-csv,original,2024,fgen-1ccb18db98499058966003b6,synthetic_programmatic_template,csv,top,True,raw_export
"2023 Realized Gains and Losses Report
CoinLedger-style report
Account,Jordan M. Tanaka
Cost basis method,5pecific ID
Short-term realízed gain/loss,""13,8O6.54""
Long-term realized gain/loss,""-7,247.77""
Staking and other income,""2,958.11""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
BTC,23.86Ol54,8/20/21,2O23-08-24,""19,438.55"",""25,768.97""
SOL,4.336425,1/12/23,2O23-06-24,""9,058.53"",""9,998.33""
ADA,1.799053,2022-07-14,4/12/23,""15,466.80"",""13,761.87""
BTC,25.521397,2021-02-22,12/7/23,""12,918.20"",""13,617.23""
Thisreport is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-82e3f3ac6874f5f1fa520c6c,v11-CRYPTO_TAX_REPORT-csv,original,2023,fgen-424cc5389b8c1fd2fc2b3abc,synthetic_programmatic_template,csv,top,True,gain_loss
"Timestamp,Transaction Type,Asset,Quantity Transacted,Spot Price at Transaction,Subtotal,Total (inclusive of fees),Fees
10/16/2023T19:58:00Z,Sell,USDC,15.723228,41488.06,6546.37,3211.47,18.06
07/13/2023T23:27:00Z,Sell,ETH,6.846458,56074.41,982.84,84.89,34.21
15/07/2023T08:16:00Z,Staking Income,ETH,3.564399,31498.75,1211.83,2797.72,4.74
01/05/2023T14:35:00Z,Buy,ETH,4.326303,36947.31,7270.81,713.62,20.94
2023-09-08T22:41:00Z,Sell,USDC,15.655062,15415.30,6898.96,9018.69,1.81
2023-02-20T00:15:00Z,Receive,ETH,13.613554,60721.99,5645.56,6141.23,37.04",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-9955274f0f29f58ff6018829,v11-CRYPTO_TAX_REPORT-csv,original,2023,fgen-a4f6a5718b200f45f1c56d75,synthetic_programmatic_template,csv,none,False,raw_export
"2026 Crypto Tax Summary
CoinLedger-style report
Account,Priya Brennan
Cost basis method,HIFO
Short-term realized gain/loss,""-5,193.31""
Long-term realized gain/loss,""4,800.33""
Staking and other income,""$1,303.46""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
BTC,16.833847,5/25/24,""December 13, 2026"",""1,618.93"",""1,396.71""
ADA,2.591255,""February 8, 2025"",2026-11-08,""3,871.90"",""3,550.09""
ADA,26.543655,04/21/2024,09/11/2026,""15,397.95"",""12,509.87""
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-83bd51ed0e7ab65f250a60ad,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-6ac2dbd0e5f368ede51b515b,synthetic_programmatic_template,csv,top,False,tax_software_summary
"TaxBit-style report
Account,Noah Lindqvist
Cost basis method,Specific ID
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
ADA,24.633787,2020-10-16,""January 6, 2021"",""18,164.15"",""14,334.77""
ETH,18.158919,""May 12, 2019"",4/17/21,""17,099.08"",""21,130.34""
USDC,16.930420,2019-02-06,5/23/21,""17,071.68"",""13,187.43""
ADA,22.401928,10/10/21,2/16/21,""12,721.42"",""16,103.15""
USDC,2.565090,""August 5, 2021"",2021-03-02,""2,537.36"",""2,475.50""
Use this report to prepare Form 8949; it is not a Form 1099-DA.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-36335772ae5d079cfc5c47af,v11-CRYPTO_TAX_REPORT-csv,original,2021,fgen-d99d91ad812c45770f105033,synthetic_programmatic_template,csv,bottom,False,transaction_history
"BitMeadow
Account,Morgan Fischer
Cost basis method,FIFO
Short-term realized gain/loss,""2,481.05""
Long-term realized gain/loss,""7,901.64""
Staking and other income,""1,124.92""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
USDC,13.283321,""May 3, 2021"",""November 23, 2023"",""18,956.76"",""14,672.21""
USDC,27.036202,2022-05-05,4/23/23,""3,815.02"",""2,961.19""
ETH,11.611576,11/6/22,08/09/2023,""1,847.83"",""1,468.18""
BTC,27.092611,2022-10-05,12/22/23,""6,769.33"",""3,613.92""
USDC,4.134899,2021-04-06,05/13/2023,""13,797.07"",""17,987.87""
SOL,7.697911,02/16/2022,2023-04-27,""15,891.40"",""17,713.91""
Use this report to prepare Form 8949; it is not a Form 1099-DA.
2023 Realized Gains and Losses Report",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-2d86d8d1a97cc46a5e96589b,v11-CRYPTO_TAX_REPORT-csv,original,2023,fgen-2cb567ca253a4b3ae0c5cffb,synthetic_programmatic_template,csv,bottom,False,gain_loss
"2022 Crypto Tax Summary
CoinHarbor Exchange
Account,AlexSato
Cost basis method,FIFO
Short-term realized gain/loss,""-8,059.31""
Long-term realized gain/loss,""20,528.77""
Staking and other income,""S1,890.45""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
BTC,6.089638,2/15/21,2022-02-13,""15,960.94"",""22,208.95""
SOL,13.612516,12/04/2021,03/09/2022,""4,623.29"",""5,156.17""
USDC,5.852261,""March 18, 2022"",6/26/22,""10,680.08"",""10,488.01""
USDC,10.094455,2021-05-13,5/24/22,""9,659.60"",""8,022.00""
BTC,12.904966,""Octobcr 26, 2021"",""November 2, 2022"",""13,579.51"",""6,833.10""
SOL,17.512830,06/22/2020,03/14/2022,""18,526.96"",""14,228.40""
Use thís report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-b587894bc45cec335e41c284,v11-CRYPTO_TAX_REPORT-csv,original,2022,fgen-006b3eb8e3419e58e566c1c3,synthetic_programmatic_template,csv,top,True,tax_software_summary
"Transaction history export
Downloaded 23/02/2026
Timestamp,Transaction Type,Asset,Quantity Transacted,Spot Price at Transaction,Subtotal,Total (inclusive of fees),Fees
2026-11-01T15:39:00Z,Receive,SOL,16.254627,65863.69,6162.36,3837.84,23.31
20/08/2026T07:49:00Z,Sell,ETH,10.359704,34426.04,3977.87,110.95,23.59
25/05/2026T04:12:00Z,Receive,SOL,18.842991,69580.06,7227.95,3585.91,20.81
14/04/2026T18:13:00Z,Send,BTC,12.336659,48855.76,3699.71,1409.45,3.92
2026-07-28T09:45:00Z,Send,ETH,17.181462,60907.19,1688.63,6202.38,12.92
08/11/2026T02:30:00Z,Convert,SOL,5.806696,35817.12,3824.34,2234.79,13.40
2026-11-20T12:02:00Z,Sell,USDC,0.026404,396.30,4452.49,7469.43,1.35
02/07/2026T13:57:00Z,Convert,BTC,5.206097,64580.12,4608.45,9016.60,0.19
2026-02-01T14:22:00Z,Buy,ETH,12.554820,42870.08,6274.34,6802.17,0.61",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-cca153af20c1c6adbebe135b,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-8e6155d8ff9d6cee8d37ef3c,synthetic_programmatic_template,csv,top,False,raw_export
"Asset,Date Acquired,Date Sold,Proceeds,Cost Basis,Gain (Loss),Holding Period
SOL,12/01/2025,2026-02-05,12606.45,12943.66,-3972.63,Long-term
BTC,01/20/2025,2026-09-10,12403.96,9797.07,816.89,Short-term
SOL,2025-07-21,2026-11-21,7168.89,10180.78,7191.41,Short-term
SOL,2025-10-20,11/08/2026,7828.98,15353.34,-7220.83,Long-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-cbeb3cb6346abafdf6b71dc0,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-91733468e745613d4344383c,synthetic_programmatic_template,csv,top,False,raw_export
"TaxBit-style report
Account,Sofia Rivera
Cost basis method,Specific ID
Short-tcrm realizedgain/loss,""14,46O.48""
Long-term realized gain/loss,""-8,005.01""
Staking and other income,""2,100.36""
Asset,Amount,Date Acquired,Date So1d,Proceeds,Cost Basis
BTC,20.976487,l/7/23,2023-09-08,""15,010.06"",""19,881.20""
ADA,4.889476,12/3/21,4/22/23,""12,681.38"",""6,771.46""
ADA,3.633O64,""June 20, 2022"",6/26/23,""9,494.38"",""9,057.86""
This rcport is for informational purposes and is not an IRS form.
2023 Crypto Tax Summary",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-87a672e3880b2d5c0dd9220b,v11-CRYPTO_TAX_REPORT-csv,original,2023,fgen-b20c7beba9383382aeed10f0,synthetic_programmatic_template,csv,bottom,True,tax_software_summary
"2026 Realized Gains and Losses Report
BitMeadow
Account,Casey Larsen
Cost basis method,FIFO
Short-term realized gain/loss,""16,860.39""
Long-term realized gain/loss,""27,341.03""
Staking and other income,""$1,464.53""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
ADA,25.545117,2024-08-28,02/21/2026,""17,835.91"",""15,970.47""
ETH,11.545642,02/24/2025,""October 19, 2026"",""5,118.57"",""5,905.61""
USDC,27.679376,4/5/24,2026-10-03,""17,653.90"",""24,398.04""
SOL,26.140739,1/17/26,""January 28, 2026"",""1,881.59"",""2,466.65""
SOL,29.640535,5/12/25,04/22/2026,""3,766.53"",""3,756.83""
USDC,22.684992,02/26/2025,2026-12-08,""17,808.12"",""17,649.04""
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-fa42e51f0fc4a1a0d3a36fe0,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-4e3db84b4795652dc83dcac6,synthetic_programmatic_template,csv,top,False,gain_loss
"2026 Realized Gains and Losses Report
CoinLedger-style report
Account,Diego Castillo
Cost basis method,Specific ID
Short-term realized gain/loss,""6,859.16""
Long-term realized gain/loss,152.81
Staking and other income,369.67
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
SOL,8.489727,""February 13, 2026"",4/25/26,""11,757.18"",""6,777.71""
USDC,22.275285,""April 26, 2026"",07/04/2026,""16,876.45"",""11,176.33""
ADA,13.786099,2025-07-10,9/25/26,""4,792.87"",""2,702.97""
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-6b56943b9ceba34ab3efdc75,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-d3f14a402763328a8b6c8761,synthetic_programmatic_template,csv,top,False,gain_loss
"2026 Crypto Tax Summary
CoinLedger-style report
Account,Sofia K. Haddad
Cost basis method,Specific ID
Short-term realized gain/loss,""1,870.75""
Long-term realized gain/loss,""-6,139.14""
Staking and other income,""$2,700.85""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
SOL,26.635768,12/28/25,7/8/26,""19,988.28"",""10,330.97""
ETH,29.115012,10/27/26,12/28/2026,""8,183.79"",""6,454.52""
BTC,0.747771,04/15/2025,01/23/2026,""15,853.50"",""18,084.81""
ETH,19.645329,04/03/2024,2026-05-09,""10,729.80"",""9,625.12""
USDC,11.451161,06/17/2025,4/28/26,""11,074.34"",""8,026.73""
BTC,14.395131,07/15/2026,11/22/26,""7,451.04"",""10,274.46""
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-670e705c765070be2bf1c539,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-afdd4b73b36e3a775e209071,synthetic_programmatic_template,csv,top,False,tax_software_summary
"TaxBit-style report
Account,Olivia Okafor
Cost basis method,Specific ID
Short-term realized gain/loss,""17,923.36""
Long-term realized gain/loss,""19,346.11""
Staking and other income,$419.23
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
SOL,22.525144,""January 24, 2019"",07/02/2021,""10,047.95"",""12,840.82""
USDC,28.895461,07/25/2019,""June 28, 2021"",""7,137.81"",""5,082.78""
SOL,25.906289,07/20/2020,2021-09-08,""1,545.91"",""1,361.53""
USDC,24.884755,8/4/19,2021-03-07,""1,360.02"",715.64
BTC,10.006748,""November 6, 2019"",6/26/21,""13,039.21"",""15,666.18""
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-0dba2978aee94a75b8809b5b,v11-CRYPTO_TAX_REPORT-csv,original,2021,fgen-61bf0f63b2e405a72a4f9e37,synthetic_programmatic_template,csv,none,False,gain_loss
"2025 Crypto Tax Summary
CoinHarbor Exchange
Account,Morgan Okafor
Cost basis method,Specific ID
Short-term realized gain/loss,""17,882.51""
Long-term realized gain/loss,""8,213.97""
Staking and other income,""$1,045.72""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
ETH,25.755810,2024-07-12,11/03/2025,""14,911.85"",""7,645.57""
USDC,2.446438,2023-04-26,""February 22, 2025"",""1,670.38"",""1,047.67""
SOL,24.374445,9/24/24,08/14/2025,""4,204.31"",""2,490.27""
SOL,4.532097,2/13/24,""February 4, 2025"",""7,711.76"",""7,845.53""
ADA,26.689473,""December 8, 2023"",2025-03-01,""1,380.13"",826.26
ADA,1.643485,4/9/24,2025-07-21,""19,780.25"",""23,260.96""
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-680723974cc8989be2c982bd,v11-CRYPTO_TAX_REPORT-csv,original,2025,fgen-0916c5d1c95095919b330f2d,synthetic_programmatic_template,csv,top,False,tax_software_summary
"Transaction history export
Downloaded 2023-09-02
Date,Sent Amount,Sent Currency,Received Amount,Received Currency,Fee Amount,Fee Currency,Tag
03/09/2023,4858.1356,BTC,631.965120,ETH,0.3501,USD,trade
27/11/2023,3617.4403,ETH,4449.764245,SOL,1.4663,USD,airdrop
10/17/2023,303.6550,USD,709.280267,ETH,3.0879,USD,trade
11/14/2023,1296.8941,ETH,4730.137314,ETH,0.6987,USD,
23/07/2023,3522.8376,ETH,1054.747858,USD,3.5476,USD,
2023-12-25,3191.9060,ETH,4764.870834,ETH,3.4971,USD,staking
2023-11-17,524.2188,USD,3237.736049,SOL,2.1614,USD,trade
06/26/2023,2708.1349,USD,829.220783,ETH,3.9097,USD,",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-7d348081caf6b37cc9d8ebb5,v11-CRYPTO_TAX_REPORT-csv,original,2023,fgen-c91a51c466c3ffde58efcca3,synthetic_programmatic_template,csv,top,False,raw_export
"Crypto Transaction History Export
LedgerPeak Markets
Account,Taylor Patel
Cost basis method,HIFO
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
USDC,2.092010,3/28/23,12/8/24,""9,036.26"",""11,504.81""
SOL,27.940631,4/25/22,""November 17, 2024"",""11,590.88"",""14,896.95""
USDC,13.859904,""December 16, 2024"",2024-04-12,""5,811.87"",""3,932.69""
USDC,10.344262,07/16/2022,2024-06-22,""9,156.82"",""5,241.71""
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-a7507227a021034f5570bf25,v11-CRYPTO_TAX_REPORT-csv,original,2024,fgen-059bb31dd3293ec1f7679c8c,synthetic_programmatic_template,csv,top,False,transaction_history
"Asset,Date Acquired,Date Sold,Proceeds,Cost Basis,Gain (Loss),Holding Period
ETH,2023-10-12,2024-05-01,4401.04,10494.48,-3512.34,Short-term
BTC,04/11/2023,2024-06-10,11140.78,174.59,390.14,Short-term
ETH,03/04/2023,2024-09-01,17021.23,3368.30,8388.82,Short-term
BTC,2023-03-10,2024-02-22,11640.40,8056.57,3187.89,Long-term
Transaction history export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-5c31f79e119dd30db2ff1519,v11-CRYPTO_TAX_REPORT-csv,original,2024,fgen-64b96cc11c99d18532d162e9,synthetic_programmatic_template,csv,bottom,False,raw_export
"Asset,Date Acquired,Date Sold,Proceeds,Cost Basis,Gain (Loss),Holding Period
BTC,05/23/2021,2022-10-02,15401.60,477.06,6420.84,Short-term
BTC,02/01/2021,03/21/2022,9195.86,19984.84,2299.56,Short-term
BTC,2021-12-03,07/11/2022,14003.19,9620.48,8077.92,Short-term
BTC,2021-09-20,2022-06-06,12659.26,13514.41,5051.02,Short-term
SOL,05/18/2021,2022-06-06,17000.29,16648.97,-5910.34,Long-term
BTC,01/20/2021,2022-07-07,7103.24,10898.20,4295.17,Long-term
Crypto gains and losses - 2022",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-1aa7611bec613522a45462d4,v11-CRYPTO_TAX_REPORT-csv,original,2022,fgen-9bc2fec7b63311ba4e22bcd1,synthetic_programmatic_template,csv,bottom,False,raw_export
"CoinLedger-style report
Account,Priya Sato
Cost basis method,HIFO
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
SOL,6.472217,2025-04-15,6/15/26,""7,291.75"",""7,576.99""
BTC,4.603075,""June 2, 2026"",3/27/26,24.86,19.56
BTC,11.191336,08/05/2024,07/04/2026,""14,308.36"",""13,190.48""
ETH,7.782403,1/18/26,""January 27, 2026"",""10,165.13"",""9,997.39""
SOL,6.956676,2026-07-23,2/17/26,""16,364.93"",""15,506.76""
Use this report to prepare Form 8949; it is not a Form 1099-DA.
Crypto Transaction History Export",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-f7aca1c6d2232cc01b8d9b4a,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-84b9b1e430c551ecf9aa8fac,synthetic_programmatic_template,csv,bottom,False,transaction_history
"Downloaded 2023-04-27
Asset,Date Acquired,Date Sold,Proceeds,Cost Basis,Gain (Loss),Holding Period
BTC,11/01/2022,2023-03-09,16251.73,18610.98,8019.62,Long-term
SOL,26/02/2022,25/09/2023,4670.86,10294.61,8833.28,Long-term
ETH,09/17/2022,2023-08-08,2332.13,13470.27,1471.41,Short-term
ETH,25/10/2022,21/02/2023,3071.30,4713.00,-1315.69,Short-term
BTC,06/06/2022,03/04/2023,16257.73,14589.23,-2711.11,Long-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-30103769b7186bf5e5fbaa81,v11-CRYPTO_TAX_REPORT-csv,original,2023,fgen-6406453c9e5080ac0afb2fc8,synthetic_programmatic_template,csv,top,False,raw_export
"2025 Realized Gains and Losses Report
BitMeadow
Account,Jordan Larscn
Cost basis method,Specific ID
Short-term realized gain/loss,""10,183.99""
Long-term realized gain/loss,""18,856.27""
Staking and other income,""S1,999.99""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
BTC,15.858567,""February22, 2025"",03/09/2025,""l2,209.90"",""11,957.49""
ETH,29.077529,O8/16/2024,2025-02-12,""9,269.72"",""7,224.21""
ETH,1.086755,4/15/23,12/18/25,""10,843.23"",""10,498.32""
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-72e82674ddcf436603db0fc4,v11-CRYPTO_TAX_REPORT-csv,original,2025,fgen-b1fffc053131b4c4264f69e4,synthetic_programmatic_template,csv,top,True,gain_loss
"2022 Realized Gains and Losses Report
LedgerPeak Markets
Account,Wei R. Sato
Cost basis method,FIFO
Short-term realized gain/loss,""8,522.22""
Long-term realized gain/loss,""5,347.38""
Staking and other income,""$2,616.94""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
ETH,23.094525,2022-09-16,01/12/2022,""18,664.40"",""22,721.79""
ADA,3.160902,""February 16, 2022"",2022-08-27,""18,333.01"",""16,501.85""
USDC,2.299947,2021-11-11,""April 26, 2022"",""19,956.48"",""22,631.26""
ADA,26.196364,6/17/22,09/12/2022,""13,869.28"",""7,903.07""
Generated by tax software from your exchange history.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-ff9fd0ecb01b99454eb52e8d,v11-CRYPTO_TAX_REPORT-csv,original,2022,fgen-bcabb96879782e5dc8c02fd6,synthetic_programmatic_template,csv,top,False,gain_loss
"Asset,Date Acquired,Date Sold,Proceeds,Cost Basis,Gain (Loss),Holding Period
SOL,2021-08-22,2022-03-11,5227.60,1964.14,1305.72,Short-term
BTC,03/18/2021,06/07/2022,11608.89,9638.62,3450.55,Long-term
BTC,09/27/2021,2022-08-13,2058.08,13280.11,6731.72,Long-term
SOL,2021-11-12,2022-06-03,506.44,17330.71,5142.89,Long-term
ETH,2021-07-07,2022-08-14,19870.99,7163.44,5521.48,Long-term
BTC,12/11/2021,13/07/2022,8658.43,19035.51,7118.08,Short-term
SOL,2021-09-16,16/08/2022,15202.84,9569.67,4700.53,Short-term
BTC,08/28/2021,17/06/2022,9163.75,3010.96,8440.16,Short-term",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-cd5de865ad1a7896dca6bb58,v11-CRYPTO_TAX_REPORT-csv,original,2022,fgen-cfaf90a0c335b3f5472722a0,synthetic_programmatic_template,csv,top,False,raw_export
"2021 Crypto Tax Summary
TaxBit-style report
Account,Amara Moreau
Cost basis method,HIFO
Short-term realized gain/loss,""-2,281.10""
Long-term realized gain/loss,""12,034.08""
Staking and other income,$776.49
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
ADA,11.776622,9/5/19,3/13/21,""6,370.53"",""4,579.35""
USDC,18.430024,11/02/2020,2021-05-18,""18,031.09"",""10,290.16""
USDC,12.880367,04/02/2019,""September 6, 2021"",""14,984.58"",""10,882.59""
This report is for informational purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-3e7098ba9a72dae6c904dcc3,v11-CRYPTO_TAX_REPORT-csv,original,2021,fgen-b22aea6dfd5746dd39aa256b,synthetic_programmatic_template,csv,top,False,tax_software_summary
"Downloaded 06/11/2025
Date,Sent Amount,Sent Currency,Receíved Amount,ReceivedCurrency,Fee Amount,Fee Currency,Tag
2025-10-16,4453.9430,ETH,2029.101273,USD,2.5580,USD,airdrop
24/04/2025,1113.4674,BTC,1420.160510,5OL,1.3600,USD,staking
09/20/2025,3672.6543,ETH,4205.788402,ETH,2.1316,USD,tradc
07/09/2025,2494.8910,USD,4168.405842,SOL,0.6484,USD,
04/22/2025,4294.9487,ETH,1829.845616,SOL,3.5148,USD,trade
O4/02/2025,3219.7345,ETH,140.566589,SOL,4.6985,USD,",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-01fd87c874a1badd070bb739,v11-CRYPTO_TAX_REPORT-csv,original,2025,fgen-c7f259ec6844997a7500f68e,synthetic_programmatic_template,csv,top,True,raw_export
"Crypto Transaction History Export
CoinHarbor Exchange
Account,Mateo Kowalski
Cost basis method,HIFO
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
SOL,2.050908,2025-10-02,7/1/25,""8,546.23"",""5,256.72""
ETH,6.971574,""November 15, 2024"",2025-04-27,""13,849.50"",""8,699.62""
BTC,25.793677,9/13/23,""April 3, 2025"",""2,292.48"",""1,549.88""
ETH,14.721500,6/9/24,8/22/25,""4,151.08"",""2,844.79""
Use this report to prepare Form 8949; it is not a Form 1099-DA.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-b01f5ce1f7d7ff230f35d311,v11-CRYPTO_TAX_REPORT-csv,original,2025,fgen-a865a2cabf76ba54233ab083,synthetic_programmatic_template,csv,top,False,transaction_history
"2022 Crypto Tax Summary
CoinHarbor Exchange
Account,Kwame Brennan
Cost basis method,HIFO
Short-term rea1ized gain/loss,""17,96O.83""
Long-term realizedgain/loss,""26,626.12""
Staking and other income,""2,116.45""
Asset,Amount,Date Acquired,Date Sold,Procceds,Cost Basis
S0L,12.086410,10/18/2020,02/22/2022,""4,752.78"",""3,650.27""
USDC,28.018668,3/27/21,11/7/22,""14,019.19"",""7,399.74""
USDC,26.732060,""August 22, 2022"",4/1/22,""9,659.20"",""8,346.46""
Thís report is for informationa1 purposes and is not an IRS form.",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-473c53887ea90be40dae8d20,v11-CRYPTO_TAX_REPORT-csv,original,2022,fgen-59fdedc4f76b263ec0b264ab,synthetic_programmatic_template,csv,top,True,tax_software_summary
"TaxBit-style report
Account,Avery Sato
Cost basis method,Specific ID
Short-term realized gain/loss,""-3,345.51""
Long-term realized gain/loss,""25,557.29""
Staking and other income,""$1,024.88""
Asset,Amount,Date Acquired,Date Sold,Proceeds,Cost Basis
BTC,0.448121,2025-09-18,""April 25, 2026"",652.68,606.85
BTC,21.944409,""July 21, 2025"",09/18/2026,""17,711.82"",""17,721.35""
SOL,6.902398,7/25/25,""June 10, 2026"",""7,725.10"",""8,390.30""
BTC,3.551794,3/13/24,""May 24, 2026"",""8,781.57"",""8,567.68""
ETH,6.693411,06/06/2025,09/17/2026,""11,509.57"",""15,878.91""
Use this report to prepare Form 8949; it is not a Form 1099-DA.
2026 Realized Gains and Losses Report",CRYPTO_TAX_REPORT,46,CRYPTO_TAX_REPORT,fdc-b6001c2dd281101e5d9dc4db,v11-CRYPTO_TAX_REPORT-csv,original,2026,fgen-d504e5b976f275e685bf4e12,synthetic_programmatic_template,csv,bottom,False,gain_loss
"Double your impact today
Riverbend Public Library Foundation
Dear Sofia,
This is a solicitation for a charitable contribution, not a receipt.
Your gift may be tax-deductible to the extent allowed by law.
A generous donor will match every gift until 2022-02-12.
Donate now at our website or return the enclosed reply card.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-8ec2a175829276d8bae764d6,v11-DONATION_APPEAL-inline,original,2022,fgen-749b3737c31f799cae94d73e,synthetic_programmatic_template,inline,top,False,email
"2025 Annual Appeal
Sample Community Food Bank
Dear Neighbor,
Donate now at our website or return the enclosed reply card.
Give $25, $150, or $500 today.
We are $856,000 away from our 2025 goal.
Become a monthly sustainer and make a difference all year long.
Last year you helped serve 27,383 neighbors.
A generous donor will match every gift until 10/3/25.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-2874f1fb9192e6a1af1ba828,v11-DONATION_APPEAL-inline,original,2025,fgen-893914f81baccc59923d2d1a,synthetic_programmatic_template,inline,top,False,email
"2022 Annual Appeal
Riverbend Public Library Foundation
Dear Taylor,
Become a monthly sustainer and make a difference all year long.
This is a solicitation for a charitable contribution, not a receipt.
Your gift may be tax-deductible to the extent allowed by law.
Scan the QR code or call 566-555-9019 to give by phone.
Donate now at our website or return the enclosed reply card.
Every gift provides warm meals and shelter for families in need.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-1cad1f1d46eb71207f878b1f,v11-DONATION_APPEAL-inline,original,2022,fgen-8ef94fecfd5d414d6b9cd807,synthetic_programmatic_template,inline,top,False,year_end_letter
"Your gift matters
St. Brendan Parish
Dear Hiro,
Become a monthly sustainer and make a difference all year long.
Every gift provides warm meals and shelter for families in need.
Your gift may be tax-deductible to the extent allowed by law.
Donate now at our website or return the enclosed reply card.
Last year you helped serve 21,754 neighbors.
This is a solicitation for a charitable contribution, not a receipt.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-d3bd0928507dfe7d8a387704,v11-DONATION_APPEAL-inline,original,2025,fgen-6a8a52b31a5dd74eea1db957,synthetic_programmatic_template,inline,top,False,email
"Your gift matters
Hope Harbor Shelter
Dear Supporter,
Every gift provides warm meals and shelter for families in need.
P.S. Gifts made by December 3l count toward this year's campaign.
This is a solicitation for a charitablecontribution, not a receipt.
We are $267,000 away from our 2023 goa1.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-3e6c116d39da9de3213967bc,v11-DONATION_APPEAL-inline,original,2023,fgen-c37ddfaa320f3e7e3ef8c851,synthetic_programmatic_template,inline,top,True,email
"St. Brendan Parish
Dear Friend,
Scan the QR code or call 531-555-7551 to give by phone.
This is a solicitation for a charitable contribution, not a receipt.
Your gift may be tax-deductible to the extent allowed by law.
A generous donor will match every gift until 9/15/21.
Every gift provides warm meals and shelter for families in need.
Become a monthly sustainer and make a difference all year long.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-a487f5328bc005180ea2fe31,v11-DONATION_APPEAL-inline,original,2021,fgen-f8670b21c366f5124d88e5e3,synthetic_programmatic_template,inline,none,False,matching_campaign
"Your gift matters
Hope Harbor Shelter
Dear Neighbor,
Your gift may be tax-deductible to the extent allowed by law.
Give $50, $100, or $250 today.
Donate now at our website or return the enclosed reply card.
Scan the QR code or call 677-555-6612 to give by phone.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-e2089289c7a79380fa861a90,v11-DONATION_APPEAL-inline,original,2022,fgen-505267437ee13bdd2c53cb96,synthetic_programmatic_template,inline,top,False,year_end_letter
"Your gift matters
Riverbend Public Library Foundation
Dear Friend,
Donate now at our website or return the enclosed reply card.
Give $75, $150, or $1000 today.
This is a solicitation for a charitable contribution, not a receipt.
A generous donor will match every gift until 06/21/2021.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-0544855cc4a05070008bded8,v11-DONATION_APPEAL-inline,original,2021,fgen-df0381d873dd3e9301b9c3e9,synthetic_programmatic_template,inline,top,False,matching_campaign
"2022 Annual Appeal
Riverbend Public Library Foundation
Dear Supporter,
Scan the QR code or call 354-555-2034 to give by phone.
Every gift provides warm meals and shelter for families in need.
We are $40,000 away from our 2022 goal.
Give $75, $150, or $250 today.
Last year you helped serve 17,266 neighbors.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-55c24a696e17698eb804423a,v11-DONATION_APPEAL-inline,original,2022,fgen-f4c1598dfffd25bc67d7b35f,synthetic_programmatic_template,inline,top,False,email
"Greenway Animal Rescue
Dear Friend,
Scan the QR code or call 332-555-5835 to give by phone.
A generous donor will match every gift until 2023-08-09.
Become a monthly sustainer and make a difference all year long.
Will you help a neighbor this winter?",DONATION_APPEAL,27,DONATION_APPEAL,fdc-251c2e451678e19165ae800d,v11-DONATION_APPEAL-inline,original,2023,fgen-4e42e64b110179f539fad3d2,synthetic_programmatic_template,inline,bottom,False,email
"Your gift matters
Greenway Animal Rescue
Dear Supporter,
Every gift provides warm meals and shelter for families in need.
We are $113,000 away from our 2025 goal.
Scan the QR code or call 729-555-2936 to give by phone.
P.S. Gifts made by December 31 count toward this year's campaign.
This is a solicitation for a charitable contribution, not a receipt.
Name  Morgan Walsh
Gift amount $______
☐ Check enclosed  ☐ Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-25aa25e3862262d83ae7ddbb,v11-DONATION_APPEAL-inline,original,2025,fgen-e39a57379fd6c2637ecba14c,synthetic_programmatic_template,inline,top,False,reply_card
"Please give before midnight
Greenway Animal Rescue
Dear Friend,
Become a monthly sustainer and make a difference all year long.
Every gift provides warm meals and shelter for families in need.
P.S. Gifts made by December 31 count toward this year's campaign.
This is a solicitation for a charitable contribution, not a receipt.
A generous donor will match every gift until 10/08/2021.
Name      Taylor Patel
Gift amount      $______
☐ Check enclosed  ☐ Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-451508c2d83a420d8305a712,v11-DONATION_APPEAL-inline,original,2021,fgen-d8be25a6064dc9a139465306,synthetic_programmatic_template,inline,top,False,reply_card
"Double your impact today
Hope HarborShelter
Dear Neighbor,
Become a monthly sustainer and make a difference all year long.
Last year you helped serve 7,834 neighbors.
Every gift provides warm mea1s and shelter for families in need.
Donate now at our website or return the endosed rep1y card.
Name Sofía Lindqvist
Gift amount   $______
☐ Check endosed  ☐Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-058e5e29e83dd91fa4825d09,v11-DONATION_APPEAL-inline,original,2024,fgen-769425c2884195dd6a6b7fc4,synthetic_programmatic_template,inline,top,True,reply_card
"Will you help a neighbor this winter?
St. Brendan Parish
Dear Friend,
Become a monthly sustainer and make a difference all year long.
Every gift provides warm meals and shelter for families in need.
Your gift may be tax-deductible to theextent allowed by law.
Give $35, $l50,or $500 today.
Last year you helped serve 17,597 neighbors.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-7bb59fa7652eba9fb45addf2,v11-DONATION_APPEAL-inline,original,2025,fgen-f392eacf8aba55fb1a0a540a,synthetic_programmatic_template,inline,top,True,year_end_letter
"Spring Giving Campaign
St. Brendan Parish
Dear Amara,
P.S. Gifts made by December 31 count toward this year's campaign.
Scan the QR code or call 700-555-1923 to give by phone.
A generous donor will match every gift until October 3, 2021.
We are $693,000 away from our 2021 goal.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-60cd59c746a326655d93fb1f,v11-DONATION_APPEAL-inline,original,2021,fgen-3ee3afa25c0abadd30419cd9,synthetic_programmatic_template,inline,top,False,email
"Sample Community Food Bank
Dear Jamie,
A generous donor will match every gift until April 3, 2026.
P.S. Gifts made by December 31 count toward this year's campaign.
We are $665,000 away from our 2026 goal.
This is a solicitation for a charitable contribution, not a receipt.
Last year you helped serve 20,166 neighbors.
Become a monthly sustainer and make a difference all year long.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-f6cc8035ba6ad0056dad11b3,v11-DONATION_APPEAL-inline,original,2026,fgen-fe1f4eb09a86e471b8d94604,synthetic_programmatic_template,inline,none,False,year_end_letter
"Your gift matters
Greenway Animal Rescue
Dear Neighbor,
Donate now at our website or return the enclosed reply card.
A generous donor will match every gift until 2026-01-25.
This is a solicitation for a charitable contribution, not a receipt.
Become a monthly sustainer and make a difference all year long.
Name
Gift amount
Hiro Fischer
$______
☐ Check enclosed  ☐ Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-56a4b6b3405cb7e04e48109d,v11-DONATION_APPEAL-columns,original,2026,fgen-16f656b02f5c5ab6cb81318a,synthetic_programmatic_template,columns,top,False,reply_card
"Your gift matters
St. Brendan Parish
Dear Friend,
We are $822,000 away from our 2022 goal.
This is a solicitation for a charitable contribution, not a receipt.
Donate now at our website or return the enclosed reply card.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-94c73542b8fa1ac1fa794350,v11-DONATION_APPEAL-columns,original,2022,fgen-703eeac2734a75a16bc57b19,synthetic_programmatic_template,columns,top,False,matching_campaign
"St. Brendan Parish
Dear Avery,
Become a monthly sustainer and make a difference all year long.
Donate now at our website or return the enclosed reply card.
Last year you helped serve 10,905 neighbors.
Please give before midnight",DONATION_APPEAL,27,DONATION_APPEAL,fdc-7706d568b7ca5dd865e8e024,v11-DONATION_APPEAL-columns,original,2023,fgen-d1b396fe53f0549c5bb74631,synthetic_programmatic_template,columns,bottom,False,matching_campaign
"2025 Annual Appeal
Greenway Animal Rescue
Dear Friend,
This is a solicitation for a charitable contribution, not a receipt.
P.S. Gifts made by December 31 count toward this year's campaign.
Scan the QR code or call 683-555-9222 to give by phone.
Your gift may be tax-deductible to the extent allowed by law.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-f890f48e538ffc5b1d9b277d,v11-DONATION_APPEAL-columns,original,2025,fgen-81bbd0384b24820da78be92f,synthetic_programmatic_template,columns,top,False,email
"Sample Community Food Bank
Dear 5ofía,
Last year you helped serve 1,482 neighbors.
5can the QR code or ca1l 852-555-9318 togive by phone.
Give S25, $100, or $500 today.
Your gift may be tax-deductible to the extent allowed by law.
Become a monthly sustainer and make a difference all year long.
Spring Giving Campaign",DONATION_APPEAL,27,DONATION_APPEAL,fdc-da26b503e4302e5fe0067188,v11-DONATION_APPEAL-columns,original,2022,fgen-cc7805ae80dd407b87d0451b,synthetic_programmatic_template,columns,bottom,True,year_end_letter
"Double your impact today
Greenway Animal Rescue
Dear Kwame,
Scan the QR code or call 811-555-5258 to give by phone.
Every gift provides warm meals and shelter for families in need.
A generous donor will match every gift until 2025-03-15.
P.S. Gifts made by December 31 count toward this year's campaign.
Your gift may be tax-deductible to the extent allowed by law.
Name
Gift amount
Morgan Lindqvist
$______
☐ Check enclosed  ☐ Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-bcd955db28f19e2f934ab017,v11-DONATION_APPEAL-columns,original,2025,fgen-743083a0c5b776977b67bebe,synthetic_programmatic_template,columns,top,False,reply_card
"St. Brendan Parish
Dear Supporter,
Every gift provides warm meals and shelter for families in need.
Become a monthly sustainer and make a difference all year long.
This is a solicitation for a charitable contribution, not a receipt.
Scan the QR code or call 975-555-9083 to give by phone.
Spring Giving Campaign",DONATION_APPEAL,27,DONATION_APPEAL,fdc-f385a6fad684328435173c1f,v11-DONATION_APPEAL-columns,original,2023,fgen-53c93c9ddc2a2f0510523aba,synthetic_programmatic_template,columns,bottom,False,year_end_letter
"Please give before midnight
St. Brendan Parish
Dear Neighbor,
A generous donor will match every gift until 04/06/2026.
We are $278,000 away from our 2026 goal.
Every gift provides warm meals and shelter for families in need.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-d469e4a5658e39432ee484fa,v11-DONATION_APPEAL-columns,original,2026,fgen-bdd6f3f99b0b3f7010346afa,synthetic_programmatic_template,columns,top,False,matching_campaign
"Spring Giving Campaign
Riverbend Public Library Foundation
Dear Lena,
Every gift provides warm meals and shelter for families in need.
Donate now at our website or return the enclosed reply card.
Last year you helped serve 11,445 neighbors.
Give $50, $100, or $1000 today.
This is a solicitation for a charitable contribution, not a receipt.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-df69d373cc8f861f6bacc092,v11-DONATION_APPEAL-columns,original,2023,fgen-1c526707f479deddd55436bd,synthetic_programmatic_template,columns,top,False,year_end_letter
"Your gift matters
St. Brendan Parish
Dear Supporter,
A generous donor will match every gift until 8/8/23.
Become a monthly sustainer and make a difference all year long.
Every gift provides warm meals and shelter for families in need.
We are $644,000 away from our 2023 goal.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-6597544161dbb24cb667b3ab,v11-DONATION_APPEAL-columns,original,2023,fgen-6c2075c57e5eaa197b2cb4a2,synthetic_programmatic_template,columns,top,False,matching_campaign
"Spring Giving Campaign
Riverbend Public Library Foundation
Dear Friend,
P.S. Gifts made by December 31 count toward this year's campaign.
Donate now at our website or return the enclosed reply card.
Your gift may be tax-deductible to the extent allowed by law.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-a58b89c9445314d4484cfc48,v11-DONATION_APPEAL-columns,original,2023,fgen-0974242cbdac5712b9b3b82f,synthetic_programmatic_template,columns,top,False,year_end_letter
"Your gift matters
Sample Community Food Bank
Dear Neighbor,
Become a monthly sustainer and make a difference all year long.
Scan the QR code or call 588-555-4243 to give by phone.
Your gift may be tax-deductible to the extent allowed by law.
This is a solicitation for a charitable contribution, not a receipt.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-c908eb99d33e01c401cfa6db,v11-DONATION_APPEAL-columns,original,2025,fgen-08665e268156af26106d0557,synthetic_programmatic_template,columns,top,False,email
"Greenway Animal Rescue
Dear Supporter,
Scan the QR code or call 732-555-3998 to give by phone.
Give $50, $100, or $500 today.
Last year you helped serve 33,278 neighbors.
Every gift provides warm meals and shelter for families in need.
Your gift may be tax-deductible to the extent allowed by law.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-10cc653edb11734c3d6ec763,v11-DONATION_APPEAL-columns,original,2022,fgen-4aebe6fd35b6330e7579b940,synthetic_programmatic_template,columns,none,False,email
"Double your impact today
Sample Community Food Bank
Dear Neighbor,
Scan the QR code or call 811-555-5435 to give by phone.
Donate now at our website or return the enclosed reply card.
Every gift provides warm meals and shelter for families in need.
Last year you helped serve 9,203 neighbors.
P.S. Gifts made by December 31 count toward this year's campaign.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-721ad3d1dad72884d6c33877,v11-DONATION_APPEAL-columns,original,2025,fgen-34dd7e4d8b8402e219cddc55,synthetic_programmatic_template,columns,top,False,year_end_letter
"Double your impact today
Greenway Animal Rescue
Dear Friend,
Last year you helped serve 11,316 neighbors.
Donate now at our website or return the enclosed reply card.
Scan the QR code or call 462-555-6716 to give by phone.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-9d642709fa0b3bcbfc373c1d,v11-DONATION_APPEAL-columns,original,2022,fgen-c145179768b7e975fc8d76ca,synthetic_programmatic_template,columns,top,False,matching_campaign
"Riverbend Public Library Foundation
Dear Noah,
We are $57,000 away from our 2026 goal.
Scan the QR code or call 945-555-2867 to give by phone.
Lastyear you helped serve 3,779neighbors.
Your gift may bc tax-deductible to the extent allowed by law.
Become a month1y sustainer and make a dífference all year long.
P.S. Gífts made by December 31 count toward this year's campaign.
Wi1l you help a neighbor this winter?",DONATION_APPEAL,27,DONATION_APPEAL,fdc-78098f8ad8bcce2ae618bf8a,v11-DONATION_APPEAL-columns,original,2026,fgen-76fdd1b24e21679040f84c2c,synthetic_programmatic_template,columns,bottom,True,year_end_letter
"Sample Community Food Bank
Dear Neighbor,
P.S. Gifts made by December 31 count toward this year's campaign.
Every gift provides warm meals and shelter for families in need.
Become a monthly sustainer and make a difference all year long.
Name,Kwame E. Haddad
Gift amount,$______
☐ Check enclosed  ☐ Charge my card
Will you help a neighbor this winter?",DONATION_APPEAL,27,DONATION_APPEAL,fdc-844417368cc7909c9dddbb54,v11-DONATION_APPEAL-csv,original,2023,fgen-2dd6cbd8afa6873f3432449f,synthetic_programmatic_template,csv,bottom,False,reply_card
"Double your impact today
Sample Community Food Bank
Dear Neighbor,
Become a monthly sustainer and make a difference all year long.
Donate now at our website or return the enclosed reply card.
This is a solicitation for a charitable contribution, not a receipt.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-12e241bbb47735f85e8d0827,v11-DONATION_APPEAL-csv,original,2021,fgen-35a559050286ee023041ad5a,synthetic_programmatic_template,csv,top,False,year_end_letter
"Riverbend Public Library Foundation
Dear Neighbor,
Give $50, $150, or $1000 today.
Scan the QR code or call 396-555-8033 to give by phone.
Last year you helped serve 27,885 neighbors.
Become a monthly sustainer and make a difference all year long.
Every gift provides warm meals and shelter for families in need.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-bdd643eaf3f8e398ea9653a3,v11-DONATION_APPEAL-csv,original,2021,fgen-e57a533a7cb004f17bcb9c59,synthetic_programmatic_template,csv,none,False,year_end_letter
"Will you help a neighbor this winter?
Riverbend Public Library Foundation
Dear Friend,
Every gift provides warm meals and shelter for families in need.
Give $25, $150, or $500 today.
Donate now at our website or return the enclosed reply card.
A generous donor will match every gift until 2025-03-07.
Become a monthly sustainer and make a difference all year long.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-043eb4d3772cf2487df0a1ee,v11-DONATION_APPEAL-csv,original,2025,fgen-eb243a7195efc005052dcb0a,synthetic_programmatic_template,csv,top,False,matching_campaign
"Hope Harbor Shelter
Dear Neighbor,
Last year you helped serve 26,127 neighbors.
A generous donor will match every gift until 7/23/25.
Your gift may be tax-deductible to the extent allowed by law.
We are $511,000 away from our 2025 goal.
Your gift matters",DONATION_APPEAL,27,DONATION_APPEAL,fdc-61303377b8d5a3d294b79495,v11-DONATION_APPEAL-csv,original,2025,fgen-eaf961013d15f4e61e52d68f,synthetic_programmatic_template,csv,bottom,False,year_end_letter
"Sample Community Food Bank
Dear Friend,
Every gift provides warm meals and shelter for families in need.
Become a monthly sustaíner and make a difference all year long.
Last yearyou he1ped serve 2,893 neighbors.
Your gift may betax-deductíble to the extent allowed by law.
P.S. Gifts made by December 3l count toward this year's campaign.
Your gift matters",DONATION_APPEAL,27,DONATION_APPEAL,fdc-16266ec8263b7d60f1d14f80,v11-DONATION_APPEAL-csv,original,2026,fgen-044029a6885833c94c84b9e2,synthetic_programmatic_template,csv,bottom,True,email
"2022 Annual Appeal
Riverbend Public Library Foundation
Dear Friend,
Scan the QR code or call 711-555-5194 to give by phone.
Your gift may be tax-deductible to the extent allowed by law.
Donate now at our website or return the enclosed reply card.
Last year you helped serve 21,321 neighbors.
Name,Amara Testcase
Gift amount,$______
☐ Check enclosed  ☐ Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-fada952ca002832f92f519d0,v11-DONATION_APPEAL-csv,original,2022,fgen-43afcff47bde71bbcb331042,synthetic_programmatic_template,csv,top,False,reply_card
"2021 Annual Appeal
Hope Harbor Shelter
Dear Alex,
Donate now at our website or return the enclosed reply card.
Scan the QR code or call 884-555-8490 to give by phone.
A generous donor will match every gift until 2/14/21.
Last year you helped serve 39,442 neighbors.
Your gift may be tax-deductible to the extent allowed by law.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-58df8a9a7efc6bfbbf606b53,v11-DONATION_APPEAL-csv,original,2021,fgen-1f8c87e208770164de31b3c4,synthetic_programmatic_template,csv,top,False,matching_campaign
"Greenway Animal Rescue
Dear Neighbor,
Last year you helped serve 19,979 neighbors.
This is a solicitation for a charitable contribution, not a receipt.
Your gift may be tax-deductible to the extent allowed by law.
Scan the QR code or call 381-555-2658 to give by phone.
Spring Giving Campaign",DONATION_APPEAL,27,DONATION_APPEAL,fdc-9a4ad4366d194eb274ef4a05,v11-DONATION_APPEAL-csv,original,2021,fgen-444e3ac27e48a0941f3caa0c,synthetic_programmatic_template,csv,bottom,False,email
"Your gift matters
Hope Harbor Shelter
Dear Friend,
Give $75, $150, or $1000 today.
We are $465,000 away from our 2022 goal.
Your gift may be tax-deductible to the extent allowed by law.
This is a solicitation for a charitable contribution, not a receipt.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-568458d74405379f26dcb3bb,v11-DONATION_APPEAL-csv,original,2022,fgen-c162d960ed3c6f9aba099cc7,synthetic_programmatic_template,csv,top,False,year_end_letter
"Sample Community Food Bank
Dear Hiro,
Give $35, $150, or $1000 today.
Evcry gift provides warm meals and shelter for families in need.
A generous donor will match every giftuntil 09/09/2024.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-d79c9edb5d53ef1dc11775cc,v11-DONATION_APPEAL-csv,original,2024,fgen-4e1d558d5394e12d20d17549,synthetic_programmatic_template,csv,none,True,matching_campaign
"2022 Annual Appeal
Riverbend Public Library Foundation
Dear Friend,
Scan the QR code or call 337-555-8868 to give by phone.
Your gift may be tax-deductible to the extent allowed by law.
P.S. Gifts made by December 31 count toward this year's campaign.
Last year you helped serve 25,153 neighbors.
We are $375,000 away from our 2022 goal.
A generous donor will match every gift until December 3, 2022.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-af48a9c6feae6455ceb159b8,v11-DONATION_APPEAL-csv,original,2022,fgen-603d3d8646b65f8cf360165d,synthetic_programmatic_template,csv,top,False,year_end_letter
"Please give before midnight
Sample Community Food Bank
Dear Neighbor,
P.S. Gifts made by December 31 count toward this year's campaign.
Donate now at our website or return the enclosed reply card.
This is a solicitation for a charitable contribution, not a receipt.
Your gift may be tax-deductible to the extent allowed by law.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-d501cb67892a7301d09d45ba,v11-DONATION_APPEAL-csv,original,2022,fgen-a0ad820d0118eaece196216e,synthetic_programmatic_template,csv,top,False,year_end_letter
"Sample Community Food Bank
Dear Supporter,
Last year you helped serve 11,953 neighbors.
Your gift may be tax-deductible to the extent allowed by law.
Give $75, $150, or $250 today.
Donate now at our website or return the enclosed reply card.
P.S. Gifts made by December 31 count toward this year's campaign.
We are $813,000 away from our 2025 goal.
Double your impact today",DONATION_APPEAL,27,DONATION_APPEAL,fdc-c66aaaf2bf0a4458d2eb6510,v11-DONATION_APPEAL-csv,original,2025,fgen-366080bfeabe5f5486c47988,synthetic_programmatic_template,csv,bottom,False,email
"HopeHarbor Shelter
Dear Friend,
Scan the QR code or call 571-555-2776 to give by phone.
Your giftmay be tax-deductible to the extent allowed by law.
Donate now at our website or return the endosed reply card.
Become a monthly sustainer and make a difference all year long.
Give $35, $l50, or $500 today.
Every gíft provides warm meals and shelter for families in need.
Name,Mateo Kowalski
Gift amount,$______
☐ Check endosed  ☐ Chargc my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-bd8b1a1ef2a5a2e6682795a2,v11-DONATION_APPEAL-csv,original,2022,fgen-cc4264b463d644d7ce15b778,synthetic_programmatic_template,csv,none,True,reply_card
"2023 Annual Appeal
Sample Community Food Bank
Dear Fatima,
We are $574,000 away from our 2023 goal.
Become a monthly sustainer and make a difference all year long.
Last year you helped serve 19,340 neighbors.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-91cef08445e75e7558c36f8a,v11-DONATION_APPEAL-csv,original,2023,fgen-8d59295572496d313f5f61b2,synthetic_programmatic_template,csv,top,False,matching_campaign
"Double your impact today Sample Community Food Bank Dear Supporter, Last year you helped serve 32,424 neighbors. This is a solicitation for a charitable contribution, not a receipt. A generous donor will match every
gift until March 19, 2023. We are $604,000 away from our 2023 goal. Name Sofia Patel Gift amount $______ ☐ Check enclosed ☐
Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-ffb8ea24aedd69a15c2157d2,v11-DONATION_APPEAL-flat,original,2023,fgen-f568059ba67c395080f1b582,synthetic_programmatic_template,flat,top,False,reply_card
"St. Brendan Parish Dear Friend, Become a monthly sustainer and make a difference all year long. We are $175,000 away from our 2023
goal. This is a solicitation for a charitable contribution, not a receipt. Name Alex M. Lindqvist Gift amount $______ ☐ Check enclosed ☐
Charge my card Please give before midnight",DONATION_APPEAL,27,DONATION_APPEAL,fdc-f833f425c3fd77c2e6ecaa18,v11-DONATION_APPEAL-flat,original,2023,fgen-6997a97650c5e389f99f4dd9,synthetic_programmatic_template,flat,bottom,False,reply_card
"Your gift matters Hope Harbor Shelter Dear
Neighbor, This is a solicitation for a charitable contribution, not a receipt. Your gift may be tax-deductible to the extent allowed by law. Donate now at our
website or return the enclosed reply card. Every gift provides warm meals and shelter for families in need. P.S. Gifts made by December 31 count toward this year's campaign.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-12a3ba731f9b1a76dc422a16,v11-DONATION_APPEAL-flat,original,2022,fgen-dd260a57095ce23bf6dd84c9,synthetic_programmatic_template,flat,top,False,email
"St. Brendan Parish Dear Friend, Give $35, $100, or $1000 today. Every gift provides warm meals and
shelter for families in need. This is a solicitation for a charitable contribution, not a receipt. We are $177,000 away from our 2022 goal. Your gift may be
tax-deductible to the extent allowed by law.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-0689618cbd4daee015bf3762,v11-DONATION_APPEAL-flat,original,2022,fgen-2132f9d66fc1786585e0dbdc,synthetic_programmatic_template,flat,none,False,matching_campaign
"2021 Annual Appeal Hope Harbor Shelter Dear Friend, Give $75, $100, or $500 today. Last year you helped
serve 7,272 neighbors. Every gift provides warm meals and shelter for families in need. Donate now at
our website or return the enclosed reply card. P.S. Gifts made by December 31 count toward this year's campaign.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-c7297a1b9c1f3cfefb94deab,v11-DONATION_APPEAL-flat,original,2021,fgen-a92a5b9c05d4422d8dd9a72a,synthetic_programmatic_template,flat,top,False,email
"St. Brendan Parish Dear Friend, Every gift provides warm meals and shelter for families in need. Scan the QR
code or call 457-555-9753 to give by phone. Become a monthly sustainer and make a difference all year long. P.S. Gifts made by December 31 count
toward this year's campaign. This is a solicitation for a charitable contribution, not a receipt. Will you help a neighbor this winter?",DONATION_APPEAL,27,DONATION_APPEAL,fdc-252f93abd6c6580b427cc7ca,v11-DONATION_APPEAL-flat,original,2021,fgen-e3fc03bbbabdc94886ad02e8,synthetic_programmatic_template,flat,bottom,False,year_end_letter
"Hope Harbor Shelter Dear Supporter, P.S. Gifts made by December 31 count toward this year's campaign. This is a solicitation
for a charitable contribution, not a receipt. Last year you helped serve 37,446 neighbors. Give $35, $100, or $500 today. Your gift may be tax-deductible to the extent allowed by law. A generous donor will match every gift until 09/04/2023. Name Casey S. Fischer Gift amount $______ ☐ Check enclosed ☐ Charge
my card Please give before midnight",DONATION_APPEAL,27,DONATION_APPEAL,fdc-874455c2f3115365bd7c5e79,v11-DONATION_APPEAL-flat,original,2023,fgen-2c511fa534e159327abb9ff8,synthetic_programmatic_template,flat,bottom,False,reply_card
"2024 Annual Appeal Sample Community Food Bank Dear Alex, Every gift provides warm meals and
shelter for families in need. Scan the QR code
or call 215-555-9477 to give by phone. P.S. Gifts made by December 31 count toward this year's campaign. This is a solicitation for a charitable contribution, not a receipt.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-1775718116091013385e039a,v11-DONATION_APPEAL-flat,original,2024,fgen-880e0c0cf6ac6d8a8be0835f,synthetic_programmatic_template,flat,top,False,year_end_letter
"St. Brendan Parish Dear Supporter, A generous donor will match every
gift until November 23, 2021. Your gift may be tax-deductible to the extent allowed by law. Every gift provides warm meals and shelter for families in need. P.S. Gifts made by December 31 count toward
this year's campaign. Name Olivia E. Testcase Gift amount $______ ☐ Check enclosed ☐ Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-4881618a4284d44c1a5c4753,v11-DONATION_APPEAL-flat,original,2021,fgen-9053f7f1cd8aadc64d5c72d0,synthetic_programmatic_template,flat,none,False,reply_card
"Your gift matters Greenway Animal Rescue Dear Supporter, Become a monthly sustainer and make a difference all year long. Every gift provides warm meals and shelter for families in need. We are $485,000 away from our 2021
goal. This is a solicitation for a charitable contribution, not a receipt. P.S. Gifts made by December 31 count
toward this year's campaign.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-e941bb32ed5e85e8d4c06887,v11-DONATION_APPEAL-flat,original,2021,fgen-30a9e8be03f89e73dac05af7,synthetic_programmatic_template,flat,top,False,email
"Please give before midnight Hope
Harbor Shelter
Dear Supporter, Give $25, $15O, or $500 today. Yourgift may be tax-deductible to the extent allowed by law. We are $221,000 away from our 2021 goa1.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-2d1e34770f9345854a9a94d4,v11-DONATION_APPEAL-flat,original,2021,fgen-aa1c95476bdcb653be8a9d3e,synthetic_programmatic_template,flat,top,True,year_end_letter
"Greenway Animal Rescue Dear Friend, Scan
the QR
code or call 701-555-7809 to give by phone. Last year you helped serve 13,560 neighbors. Every gift provides warm mea1s andshelter for families in need. Spring Giving Campaign",DONATION_APPEAL,27,DONATION_APPEAL,fdc-e0cdd5fd8c8b51f01635b3be,v11-DONATION_APPEAL-flat,original,2022,fgen-a169f62c586900a874d30891,synthetic_programmatic_template,flat,bottom,True,matching_campaign
"Double your impact today Sample Community Food Bank Dear Supporter,Give $50, $150, or $500
today. A generous donor will match every gift until April 9, 2025. This is a solicitation for a charitable contribution, not a rcceipt.
P.5. Gifts made by December 31 count toward this ycar's campaign.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-2d55724e1a79827999ed390c,v11-DONATION_APPEAL-flat,original,2025,fgen-350a15dfe9f01e88f69249c3,synthetic_programmatic_template,flat,top,True,matching_campaign
"2026 Annual Appeal Sample Community Food Bank Dear Supporter, Become a monthly sustainer and make a difference all year long.
We are $352,000 away from our 2026 goal. Donate now
at our website or return the enclosed reply card.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-acd21fe69b11f6a3d6bddf60,v11-DONATION_APPEAL-flat,original,2026,fgen-cd2b3900ec8066edaf0d6d33,synthetic_programmatic_template,flat,top,False,email
"Will you help a neighbor this winter? Riverbend Public Library Foundation Dear Supporter, Scan the QR code or call 454-555-8251 to give by phone. Give $75, $100, or $1000 today. This is a solicitation for a charitable contribution, not a receipt. Donate now at our website or return the enclosed reply card. We are $115,000 away from our
2022 goal.
Name Olivia C. Tanaka Gift amount $______ ☐ Check enclosed ☐ Charge my card",DONATION_APPEAL,27,DONATION_APPEAL,fdc-754a8daf82910119dbfb06fb,v11-DONATION_APPEAL-flat,original,2022,fgen-53258ce6ea6df7939bf7bcca,synthetic_programmatic_template,flat,top,False,reply_card
"Hope Harbor Shelter Dear Neighbor, Donate now at our website or return the enclosed reply card.
Your gift may be tax-deductible to the extent allowed by law. Scan the QR code or call 973-555-4290 to give by phone. Every gift provides warm
meals and shelter for families in need. Give $50, $100, or $500 today.",DONATION_APPEAL,27,DONATION_APPEAL,fdc-b970ae4398c886f087e8af48,v11-DONATION_APPEAL-flat,original,2026,fgen-e90e87b7a478309abe86e4c9,synthetic_programmatic_template,flat,none,False,year_end_letter
"Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bankaccount
7695-7001-7822
Sofía Nguyen
Estimated Tax
Form 1040-ES
2022
$18,639.34
7/28/22
***-**-8634
Do not mai1 a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-c7cf1a9a5b2aa08d2cd96f2f,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2022,fgen-1db3d687a5791737354df03b,synthetic_programmatic_template,columns,none,True,eftps
"Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
3873-3822-8748
Diego Tanaka
Estimated Tax
1040ES (for 1040, 1040A, 1040EZ)
2023
$7,093.22
February 2, 2023
XXX-XX-5580
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-e2eacedc75e0f9b89c2b3d6b,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2023,fgen-46a3f61bdecd7bf9c45daa5f,synthetic_programmatic_template,columns,none,False,direct_pay
"Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
2966-4433-1655
Noah Walsh
Estimated Tax
1040ES (for 1040, 1040A, 1040EZ)
2021
$2,838.51
2021-10-18
***-**-5971
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-e8c63fb9910922e588f6d9c1,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2021,fgen-35089a1e0272ccd7bace022d,synthetic_programmatic_template,columns,none,False,direct_pay
"Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
2247-1665-2729
Noah Larsen
Estimated Tax
1040ES (for 1040, 1040A, 1040EZ)
2024
$3,568.22
5/7/24
XXXXX4574
Your payment has been scheduled.
EFTPS Payment Acknowledgement",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-58387bb8304d75701b2e756b,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2024,fgen-c9ed2a5d901172125cbbea0e,synthetic_programmatic_template,columns,bottom,False,eftps
"Estimated Payment Submitted
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
1666-5266-7698
Kwame Lindqvist
Estimated Tax
Form 1040-ES
2023
$14,227.59
6/7/23
ending in 3797
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-565046a443c4b2d48cb714ec,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2023,fgen-6b8907065e3cfec2fd51e4df,synthetic_programmatic_template,columns,top,False,state_portal
"Tax Payment Receipt
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
Convenience fee
9596-8854-5509
Avery Romero
Estimated Tax
Form 1040-ES
2024
$1,488.94
2024-06-14
****8166
$58.33
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-e4524c553c390009afb70954,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2024,fgen-b96ed9b2a53ad1c3abb3957d,synthetic_programmatic_template,columns,top,False,card_processor
"Estimated Payment Submitted
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
8395-3035-7014
Jordan A. Castillo
Estimated Tax
Estimated tax
2026
$7,471.08
2026-02-08
XXXXX4864
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-2e25bced07561d3dae9eadb9,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2026,fgen-295e8cfe80b9c1cf799f38ad,synthetic_programmatic_template,columns,top,False,state_portal
"EFTPS Payment Acknowledgement
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
4963-8635-6045
Fatima L. Nguyen
Estimated Tax
1040ES (for 1040, 1040A, 1040EZ)
2024
$3,097.11
09/02/2024
***-**-1810
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-17ecd2e46e131d5d6606cb72,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2024,fgen-aebcae4ad1cd1d9f5e990fac,synthetic_programmatic_template,columns,top,False,eftps
"Tax Paymcnt Receipt
Confirmation number
Name
Reason for payment
Apply payment to
Tax pcriodfor payment
Payment amount
Payment date
Bank account
Convenience fee
8712-3382-5723
Diego Rivera
Estimated Tax
Form 1040-ES
2023
$6,491.96
09/09/2023
XXXXX3352
$37.90
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-d0cbdeb4837a64ae8257b87a,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2023,fgen-224221073442224918a4478d,synthetic_programmatic_template,columns,top,True,card_processor
"Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
4903-5046-6219
Sofia Sato
Estimated Tax
Form 1040-ES
2026
$9,518.65
January 11, 2026
****8465
Keep this confirmation for your records.
Estimated Payment Submitted",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-53cdd371b90ac0c2f614f10e,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2026,fgen-c386ecf09c1d154f20c1d3c8,synthetic_programmatic_template,columns,bottom,False,state_portal
"Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
1353-3278-5945
Jamie Okafor
Estimated Tax
Form 1040-ES
2024
$7,671.18
11/15/24
XXX-XX-4847
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-19fe336bcfd49fc4f208cb49,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2024,fgen-78e176602081172f4368a10b,synthetic_programmatic_template,columns,none,False,state_portal
"Estimated Payment Submitted
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
2794-3052-8774
Jordan Nguyen
Estimated Tax
Form 1040-ES
2026
$3,887.92
8/8/26
XXX-XX-6527
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-7faae9d302305c6b056fea47,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2026,fgen-bf58b26255190388dbaa352f,synthetic_programmatic_template,columns,top,False,state_portal
"Estimated Payment Submitted
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
7448-1251-2465
Lena Patel
Estimated Tax
1040ES (for 1040, 1040A, 1040EZ)
2026
$1,311.79
07/28/2026
***-**-7329
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-e83fd44a43341b1a927909a9,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2026,fgen-dcb29e3cc0316733431dd5a1,synthetic_programmatic_template,columns,top,False,state_portal
"Tax Payment Receipt
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
Convenience fee
4499-1521-3887
Alex Brennan
Estimated Tax
1040ES (for 1040, 1040A, 1040EZ)
2022
$9,396.15
11/13/2022
***-**-3290
$16.92
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-13ab6721eb49ff6692184bd5,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2022,fgen-0bf06cde99a41c1d4f52c3a0,synthetic_programmatic_template,columns,top,False,card_processor
"Tax Payment Receipt
Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
Convenience fee
3246-7032-9044
Priya Patel
Estimated Tax
1040ES (for 1040, 1040A, 1040EZ)
2024
$4,515.22
2024-02-25
XXXXX2919
$53.84
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-a5ee4ac8c6419c4b820d5790,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2024,fgen-d3c88df8408fbbc2ea16adce,synthetic_programmatic_template,columns,top,False,card_processor
"Confirmation number
Name
Reason for payment
Apply payment to
Tax period for payment
Payment amount
Payment date
Bank account
6184-6440-8659
Riley Larsen
Estimated Tax
Form 1040-ES
2023
$6,796.63
11/18/23
XXXXX1143
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f0c2ebfd07d43abe1fd66850,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-columns,original,2023,fgen-c57b1c8d664a94fb025324c3,synthetic_programmatic_template,columns,none,False,direct_pay
"IRS Direct Pay - Payment Confirmation
Confirmation number,8554-5816-6272
Name,Hiro Romero
Reason for payment,Estimated Tax
Apply payment to,Estimated tax
Tax period for paymcnt,2025
Payment amount,""$l9,700.10""
Paymcnt date,07/07/2025
Bank account,XXXXX0759
Yourpayment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-7ee242fe3b0fd41b67877971,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2025,fgen-45849de22ce8b4836f530597,synthetic_programmatic_template,csv,top,True,direct_pay
"Confirmation number,1192-3536-9967
Name,Wei B. Castillo
Reason for payment,Estimated Tax
Apply payment to,Estimated tax
Tax period for payment,2022
Payment amount,""$2,275.78""
Payment date,2022-01-02
Bank account,***-**-4144
Do not mail a voucher for payments made online.
Estimated Payment Submitted",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-970f71366c665d222b0a8143,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2022,fgen-3b3eaf4e4f92fea9c3c4544d,synthetic_programmatic_template,csv,bottom,False,state_portal
"Estimated Payment Submitted
Confirmation number,5404-3737-3977
Name,Mateo Romero
Reason for payment,Estimated Tax
Apply payment to,Estimated tax
Tax period for payment,2021
Payment amount,""$18,736.54""
Payment date,2021-08-02
Bank account,ending in 7020
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ae81e0c8b51a0425cc62848c,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2021,fgen-61d681259e9edb81fc8f1393,synthetic_programmatic_template,csv,top,False,state_portal
"Tax Payment Receipt
Confirmation number,6691-3698-9089
Name,Casey C. Patel
Reason for payment,Estimated Tax
Apply payment to,Form 1040-ES
Tax period for payment,2024
Payment amount,""$11,894.44""
Payment date,3/12/24
Bank account,XXX-XX-4182
Convenience fee,$83.97
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ed29cdc9ab2333c027dd1e3d,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2024,fgen-b2508c493c0bac966960f27c,synthetic_programmatic_template,csv,top,False,card_processor
"Estimated Payment Submitted
Confirmation number,8454-8053-5794
Name,Avery Brennan
Reason for payment,Estimated Tax
Apply payment to,Estimated tax
Tax period for payment,2021
Payment amount,""$2,681.72""
Payment date,11/23/2021
Bank account,****0366
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-8fd2e641cfb796803a794809,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2021,fgen-1eaeaa11c4b82f2a5543e740,synthetic_programmatic_template,csv,top,False,state_portal
"Tax Payment Receipt
Confirmation number,5246-7296-5755
Name,Priya Adeyemi
Reason for payment,Estimated Tax
Apply payment to,Form 1040-ES
Tax period for payment,2026
Payment amount,""$3,579.02""
Payment date,2026-09-15
Bank account,XXX-XX-1577
Convenience fee,$4.72
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-a448851bee91d406795ada47,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2026,fgen-8eb1265587ffa8347969b400,synthetic_programmatic_template,csv,top,False,card_processor
"EFTPS Payment Acknowledgement
Confirmation number,5724-1832-1941
Name,Amara S. Sato
Reason for payment,Estimated Tax
Apply payment to,Form 1040-ES
Tax period for payment,2024
Payment amount,""$4,194.32""
Payment date,2024-04-17
Bank account,****7221
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ae460f710a75963e9625c032,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2024,fgen-2af85cc276732e9a01c42eaa,synthetic_programmatic_template,csv,top,False,eftps
"Confirmationnumber,2891-9942-7806
Name,Sofia J. Rivera
Reason for payment,Estimated Tax
Apply payment to,Form 1040-E5
Tax period for payment,2023
Payment amount,""$5,061.24""
Payment date,09/24/2023
Bank account,****5430
Convenience fee,$73.37
Keep this confirmation for your records.
Tax Payment Receipt",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-466cfa4f4b4c555845c0b77b,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2023,fgen-c87c5fd3b82fc1cf2d64b140,synthetic_programmatic_template,csv,bottom,True,card_processor
"Estimated Payment Submitted
Confirmation number,3734-5216-3005
Name,Avery Lindqvist
Reason for payment,Estimated Tax
Apply payment to,""1040ES (for 1040, 1040A, 1040EZ)""
Tax period for payment,2025
Payment amount,""$19,717.17""
Payment date,09/03/2025
Bank account,****6226
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-1364e869d51be3f61edb9d1a,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2025,fgen-8647cdb09e554d311053adb7,synthetic_programmatic_template,csv,top,False,state_portal
"IRS Direct Pay - Payment Confirmation
Confirmation number,8003-6637-6686
Name,O1ivia Kowalski
Reason for payment,Estimated Tax
Apply payment to,Form 1040-ES
Tax period for payment,2021
Payment amount,""$11,053.73""
Paymentdate,06/04/2021
Bank account,XXX-XX-1732
Keep thís confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-255ade7013f781cd33e21eb3,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2021,fgen-16161db55c51773a4081cc67,synthetic_programmatic_template,csv,top,True,direct_pay
"Tax Payment Receipt
Confirmation numbcr,5189-6970-8539
Name,Morgan R. Testcase
Reason for payment,Estimated Tax
Applypayment to,Estimated tax
Tax period for payment,2026
Payment amount,S775.11
Payment date,11/03/2026
Bank account,***-**-9933
Convenience fee,$58.58
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-0fccdf4a8d9d2bd94b3f05cb,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2026,fgen-3052fd0be955acaa1c1add4f,synthetic_programmatic_template,csv,top,True,card_processor
"Confirmation number,6772-8756-3759
Name,Jamie Walsh
Reason for payment,Estimated Tax
Apply payment to,Form 1040-ES
Tax period for payment,2022
Payment amount,""$11,454.57""
Payment date,7/1/22
Bank account,XXX-XX-8414
Keep this confirmation for your records.
IRS Direct Pay - Payment Confirmation",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-c4e9b0d5272d177ee551650c,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2022,fgen-b6e781b024fc10839fdd833f,synthetic_programmatic_template,csv,bottom,False,direct_pay
"Confirmation number,5854-9249-7236
Name,Sofia R. Moreau
Reason for payment,Estimated Tax
Apply payment to,""1040ES (for 1040, 1040A, 1040EZ)""
Tax period for payment,2025
Payment amount,""$19,166.18""
Payment date,""June 6, 2025""
Bank account,***-**-2160
Your payment has been scheduled.
IRS Direct Pay - Payment Confirmation",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-47fe2562d982bbe8ffb16cb8,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2025,fgen-7d8d85db1b1e006ae60ff0e1,synthetic_programmatic_template,csv,bottom,False,direct_pay
"EFTPS Payment Acknowledgement
Confirmation number,9199-4369-3635
Name,Taylor Testcase
Reason for payment,Estimated Tax
Apply payment to,Estimated tax
Tax period for payment,2025
Payment amount,""$10,159.98""
Payment date,""March 19, 2025""
Bank account,XXX-XX-0815
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-1e3b5998ae9e65e7ef273140,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2025,fgen-f19320fcf45a7be154fa651e,synthetic_programmatic_template,csv,top,False,eftps
"IRS Direct Pay - Payment Confirmation
Confirmation number,5420-1448-6060
Name,Lena Larsen
Reason for payment,Estimated Tax
Apply payment to,Form 1040-ES
Tax period for payment,2026
Payment amount,""$1,615.57""
Payment date,2026-12-09
Bank account,***-**-6176
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-613adba0575672511ceb4f82,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2026,fgen-64c287075cc5146349a327c1,synthetic_programmatic_template,csv,top,False,direct_pay
"Confirmation number,1714-4440-7514
Name,Wei Romero
Reason for payment,Estimated Tax
Apply payment to,""1040ES (for 1040, 1040A, 1040EZ)""
Tax period for payment,2021
Payment amount,""$11,760.92""
Payment date,2021-04-04
Bank account,ending in 2941
Convenience fee,$47.35
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-8ac619b9224f1d63569be186,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-csv,original,2021,fgen-93803e6c8d9395fb01ac9ae7,synthetic_programmatic_template,csv,none,False,card_processor
"Confirmation number 3338-6430-9931 Name Olivia Kowalski
Reason for payment Estimated Tax Apply payment to Estimated tax Tax period for payment 2021 Payment amount $18,154.82
Payment date February 7, 2021 Bank account XXX-XX-2077 Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-dc8362d4909b26065f32c3da,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2021,fgen-d94391ea210c0dcd8b5bd772,synthetic_programmatic_template,flat,none,False,state_portal
"Estimated Payment
Submitted Confirmation number 7667-4413-86O4 Name Mateo Patel Reason for payment Estimated Tax Apply payment to Form 1040-ES Tax period for payment 2024 Payment amount S7,634.58 Paymentdate
2024-0l-07 Bank account ****5660 Your paymcnt has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-2da5d10297dc5858bf68576b,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2024,fgen-28cba43ffaf2150ac32d7ea8,synthetic_programmatic_template,flat,top,True,state_portal
"Confirmation number 1566-9210-8249 Name Taylor Adeyemi Reason for payment Estimated Tax Apply payment to Estimated tax Tax period
for payment 2021 Payment amount $19,413.55 Payment date 7/23/21 Bank account ****3625 Convenience fee
$82.76 Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-87934c5435bb3cd11ecbe63d,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2021,fgen-09083aa59fbe5f5a0e508939,synthetic_programmatic_template,flat,none,False,card_processor
"Confirmation number 4039-3768-2181 Name Jordan S. Haddad Reason for payment Estimated Tax Apply payment to
Estimated tax
Tax period for payment 2025 Payment amount $4,763.81 Payment date 5/11/25 Bank account XXXXX9316 Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-81463a0a521cef1823c06e73,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2025,fgen-dd3da66167d20b3350a2b8a3,synthetic_programmatic_template,flat,none,False,state_portal
"Confirmation number 4111-5354-2468 Name Sofia Haddad Reason for payment Estimated Tax
Apply payment to Estimated tax Tax pcriod for payment 2O26 Payment amount S3,082.74 Payment
date May 23, 2026 Bank account ***-**-9258Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-7b12ef936b6ace216005f2ca,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2026,fgen-1d7302cd13f484e98c2808bf,synthetic_programmatic_template,flat,none,True,direct_pay
"Tax Payment Receipt Confirmation number 1613-2998-7819 Name Riley Patel Reason for payment Estimated Tax Apply payment to Estimated tax Tax period for payment 2022 Payment amount $14,520.44 Payment date 12/11/2022 Bank account XXX-XX-7698 Convenience fee $2.83
Keep
this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-94047d891d744c069755c520,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2022,fgen-fbd4efa4ff027abef23450af,synthetic_programmatic_template,flat,top,False,card_processor
"Tax Payment Receipt Confirmation number 6631-9770-4736 Name Wei Brennan
Reason for payment Estimated Tax Apply payment to l040ES (for 1040, 1040A, 1040EZ) Tax períod for payment 2023 Payment amount
$4,423.08 Payment date 07/05/2023 Bank account XXXXX9604 Convenience fee $59.08 Do not mail a voucherfor payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-67d48caaa8546db2c0371a3b,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2023,fgen-78b07d57af0d80464cadcef8,synthetic_programmatic_template,flat,top,True,card_processor
"Confirmation number 8202-4574-7748 Name Hiro R. Rivera Reason for payment Estimated Tax Apply payment to Estimated tax
Tax period for payment 2021 Payment amount $4,401.84
Payment date 2021-05-18 Bank account ****7107 Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-a8a4a6325e4c76d9da644b3e,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2021,fgen-8c936c69e246d9d1930e3c55,synthetic_programmatic_template,flat,none,False,eftps
"IRS Direct Pay - Payment Confirmation Confirmation number 4812-2389-4420 Name Olivia Romero Reason for payment Estimated Tax Apply payment to 1040E5 (for 1040, 1040A, 1040EZ) Tax period for
payment2022 Payment amount Sl8,315.75 Payment date Ju1y 1, 2022 Bank account ****8503 Keep this confirmation for your
records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-3c6a59ebc246a80c7fa958aa,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2022,fgen-00b2e7f78cbcbef3b1c91b32,synthetic_programmatic_template,flat,top,True,direct_pay
"EFTPS Payment Acknowledgement Confirmation number 5044-8407-2667 Name Casey Testcase Reason for payment Estimated Tax Apply payment to 1040ES (for 1040, 1040A, 1040EZ) Tax period
for payment 2026 Payment amount $9,640.51
Payment date 2026-12-24 Bank account ending in 7156 Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ca9745801c083d6272a55a5b,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2026,fgen-e0becac5ccbe64f8111549e8,synthetic_programmatic_template,flat,top,False,eftps
"Estimated Payment Submitted Confirmation number 4613-3843-2456 Name Noah S. Romero Reason for payment Estimated Tax Apply payment
to 1040ES (for 1040, 1040A, 1040EZ) Tax period for payment 2021 Payment amount
$15,642.54 Payment date April 17, 2021 Bank account ***-**-7805 Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-9d01a4cacb2b8c1e42f819b8,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2021,fgen-c7334d89ad1e6372c22c52a5,synthetic_programmatic_template,flat,top,False,state_portal
"EFTPS Payment Acknowledgement Confirmation number 1229-3814-7644 Name Lena Walsh Reason for payment Estimated Tax
Apply payment to Form 1040-ES Tax period for payment 2022 Payment amount $18,548.74 Payment date March 8, 2022 Bank account ***-**-1539 Do not mail a voucher for
payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-3536f95a3c8f6a8dc950881d,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2022,fgen-267c5062e63df9e31e04fc85,synthetic_programmatic_template,flat,top,False,eftps
"Estimated Payment Submitted Confirmation number 8903-3461-6193 Name Morgan B. Fischer Reason for payment Estimated Tax Apply payment to Form 1040-ES Tax period for
payment 2026 Payment amount $11,859.05 Payment date 1/15/26 Bank account XXX-XX-0490 Keep
this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-81415b532e2fe442083471f3,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2026,fgen-be6e3bfe5b1b7418abf2df26,synthetic_programmatic_template,flat,top,False,state_portal
"IR5 Direct Pay - Payment Confirmation Confirmation numbcr
6312-9818-7826 Name Casey A. Fischer Reason for payment Estimated Tax Apply payment to 1040E5 (for 1040, 1040A,1040EZ) Tax period for payment 2024 Payment amount $2,052.56 Payment
date January 4, 2024 Bank account XXX-XX-5467 Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-286095f29e590797a2793fd4,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2024,fgen-06abcb8bc00eeab8ead499b4,synthetic_programmatic_template,flat,top,True,direct_pay
"Confirmation number 8364-6706-5147 Name Diego Haddad Reason for payment Estimated Tax Apply payment to 1040ES (for 1040, 1040A, 1040EZ) Tax period for payment 2024 Payment amount $12,040.02
Payment date
05/01/2024 Bank account ****2537 Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-44cca34444b43d0ba82fbbd2,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2024,fgen-88f592b8147ac40b084284b6,synthetic_programmatic_template,flat,none,False,eftps
"Confirmation
number 6160-8759-5983 Name Casey Lindqvist Reason
for payment Estimated Tax Apply payment to Form 1040-ES Tax period for payment 2022 Payment amount $13,698.93 Payment date 2022-08-04 Bank account ending in 7424 Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-705ed1907dfb8d4cd99c320f,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-flat,original,2022,fgen-65a6289f057db83d1a2fed22,synthetic_programmatic_template,flat,none,False,state_portal
"EFTPS Payment Acknowledgement
| Field | Value |
| --- | --- |
| Confirmation number | 6155-5929-6959 |
| Name | Morgan B. Patel |
| Reason for payment | Estimated Tax |
| Apply payment to | 1040ES (for 1040, 1040A, 1040EZ) |
| Tax period for payment | 2022 |
| Payment amount | $11,204.51 |
| Payment date | 04/18/2022 |
| Bank account | ***-**-9604 |
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-02b9bf7d05b7fa6e05c4f4f8,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2022,fgen-a2ef327a9f661df6457670e6,synthetic_programmatic_template,markdown,top,False,eftps
"## Tax Payment Receipt
| Field | Value |
| --- | --- |
| Confirmation number | 6167-7311-1665 |
| Name | Hiro Brennan |
| Reason for payment | Estimated Tax |
| Apply payment to | Estimated tax |
| Tax period for payment | 2025 |
| Payment amount | $19,246.70 |
| Payment date | 03/05/2025 |
| Bank account | XXX-XX-8912 |
| Convenience fee | $16.10 |
## Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-6e66107bee71932d3327c710,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2025,fgen-276b5a763b084bc816388aeb,synthetic_programmatic_template,markdown,top,False,card_processor
"| Field | Value |
| --- | --- |
| Confirmation number | 3573-5143-9144 |
| Name | Jamie Larsen |
| Reason for payment | Estimated Tax |
| Apply payment to | Form 1040-ES |
| Tax period for payment | 2021 |
| Payment amount | $5,149.61 |
| Payment date | 2021-03-18 |
| Bank account | XXXXX1635 |
## Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-2328d4227c99142b10a85b2c,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2021,fgen-83ea61f3972e14d23ede0277,synthetic_programmatic_template,markdown,none,False,state_portal
"IRS Direct Pay - Payment Confirmation
| Field | Value |
| --- | --- |
| Confirmation number | 8508-8020-4129 |
| Name | Olivia D. Nguyen |
| Reason for payment | Estimated Tax |
| Apply payment to | 1040ES (for 1040, 1040A, 1040EZ) |
| Tax period for payment | 2026 |
| Payment amount | $16,471.32 |
| Payment date | 7/11/26 |
| Bank account | ****5768 |
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-0c027544f2e9b22dcafc2f65,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2026,fgen-fb4005ffecbbff9a7805295f,synthetic_programmatic_template,markdown,top,False,direct_pay
"| Field | Value |
| --- | --- |
| Confirmation number | 3717-4819-3296 |
| Name | Morgan Tanaka |
| Reason for payment | Estimated Tax |
| Apply payment to | 1040ES (for 1040, 1040A, 1040EZ) |
| Tax period for payment | 2023 |
| Payment amount | $10,398.58 |
| Payment date | 10/15/2023 |
| Bank account | ending in 1785 |
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-128b95534495774d0f13b34c,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2023,fgen-8188673ea54e6ee547ea9507,synthetic_programmatic_template,markdown,none,False,direct_pay
"| Field | Value |
| --- | --- |
| Confirmation number | 8941-3534-8779 |
| Name | Jordan D. Kowalski |
| Reason for payment | Estimated Tax |
| Apply payment to | Estimated tax |
| Tax period for payment | 2023 |
| Payment amount | $18,674.28 |
| Payment date | 11/04/2023 |
| Bank account | ****8067 |
Do not mail a voucher for payments made online.
## Estimated Payment Submitted",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-aabe07a70c52b010a77712fd,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2023,fgen-a54b4a630f7ab32d30981795,synthetic_programmatic_template,markdown,bottom,False,state_portal
"| Field | Value |
| --- | --- |
| Confirmation number | 3013-1505-2452 |
| Name | Noah J. Lindqvist |
| Reason for payment | Estimated Tax |
| Apply payment to | 1040ES (for 1040, 1040A, 1040EZ) |
| Tax period for payment | 2021 |
| Payment amount | $4,920.57 |
| Payment date | 2021-11-21 |
| Bank account | ****1392 |
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-02ebb207bf210af95751561f,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2021,fgen-bf0de4b39a9feb28b4123424,synthetic_programmatic_template,markdown,none,False,eftps
"Tax Payment Receipt
| Field | Value |
| --- | --- |
| Confírmation number | 2419-7320-5143 |
| Name | Noah Sato |
| Reason for payment | Estimated Tax |
| App1y payment to | 1040ES(for 1040, 1040A, 1040EZ) |
| Tax pcriod for payment | 2O2l |
|Payment amount | $10,084.25 |
| Payment date | 2/18/21 |
| Bank account | XXX-XX-3409 |
| Convenience fee | $88.26 |
Your payment has been schedu1ed.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-991c32c7cf6deae3cffa7142,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2021,fgen-b72ad950d9e9a48fa73c455b,synthetic_programmatic_template,markdown,top,True,card_processor
"| Field | Value|
| --- | --- |
| Confirmation number | 7681-5081-6392 |
| Name | Sofia Moreau |
| Reason for payment | Estímated Tax |
| Apply paymcnt to | 1040ES (for 1040, 1040A, 1040EZ) |
| Tax period for payment | 2026 |
| Payment amount| S13,441.91 |
| Payment date | 2026-09-02 |
| Bank account | XXX-XX-0597 |
## Do not mail a voucher for payments made online.
IRS Direct Pay - Payment Confirmatíon",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ef2475f41976581f96a8c890,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2026,fgen-596ab7a77ee64d588f36e366,synthetic_programmatic_template,markdown,bottom,True,direct_pay
"| Field | Value |
| --- | --- |
| Confirmation number | 5868-4606-8885 |
| Name | Morgan L. Larsen |
| Reason for payment | Estimated Tax |
| Apply payment to | Form 1040-ES |
| Tax period for payment | 2024 |
| Payment amount | $14,950.69 |
| Payment date | 9/24/24 |
| Bank account | XXXXX3311 |
Do not mail a voucher for payments made online.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-8527ac5d7cda9322b6e89ee1,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2024,fgen-03cb861fa482954e72699275,synthetic_programmatic_template,markdown,none,False,eftps
"| Field | Value |
| --- | --- |
| Confirmation number | 7129-1385-1354 |
| Name | Sofia D. Nguyen |
| Reason for payment | Estimated Tax |
| Apply payment to | 1040ES (for 1040, 1040A, 1040EZ) |
| Tax period for payment | 2021 |
| Payment amount | $8,727.99 |
| Payment date | January 3, 2021 |
| Bank account | XXX-XX-2944 |
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f4e43dbf2c4638f21e0e47b9,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2021,fgen-ab212fbb0bcc72399c19c024,synthetic_programmatic_template,markdown,none,False,state_portal
"## EFTPS Payment Acknowledgement
| Field | Value |
| --- | --- |
| Confirmation number | 5594-1398-5490 |
| Name | Diego Sato |
| Reason for payment | Estimated Tax |
| Apply payment to | Estimated tax |
| Tax period for payment | 2021 |
| Payment amount | $15,923.37 |
| Payment date | July 3, 2021 |
| Bank account | ***-**-4611 |
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-f3a4309984acd0a7d9b9aad9,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2021,fgen-e17155851579b32cf34975a4,synthetic_programmatic_template,markdown,top,False,eftps
"EFTPS Payment Acknowledgement
| Field | Value |
| --- | --- |
| Confirmation number | 5968-3657-4488 |
| Name | Jordan B. Castillo |
| Reason for payment | Estimated Tax |
| Apply payment to | Estimated tax |
| Tax period for payment | 2026 |
| Payment amount | $8,348.34 |
| Payment date | 11/28/26 |
| Bank account | ****3186 |
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-304b48f7e9d8559c87982c44,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2026,fgen-f521c2d55fef4d0c75c8b9b7,synthetic_programmatic_template,markdown,top,False,eftps
"## IRS Direct Pay - Payment Confirmation
| Field | Value |
| --- | --- |
| Confirmation number | 9129-6703-2710 |
| Name | Priya Larsen |
| Reason for payment | Estimated Tax |
| Apply payment to | 1040ES (for 1040, 1040A, 1040EZ) |
| Tax period for payment | 2026 |
| Payment amount | $4,734.65 |
| Payment date | 2026-02-03 |
| Bank account | XXXXX2655 |
Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-45545b1d0c1e42623a08ced4,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2026,fgen-ce6595e8cff2b0ac6dc4ec9f,synthetic_programmatic_template,markdown,top,False,direct_pay
"IRS Direct Pay - Payment Confirmation
| Field | Value |
| --- | --- |
| Confirmation number | 4948-3306-6971 |
| Name | Jordan Walsh |
| Reason for payment | Estimated Tax |
| Apply payment to | Estimated tax |
| Tax period for payment | 2021 |
| Payment amount | $12,829.59 |
| Payment date | September 4, 2021 |
| Bank account | ****0100 |
Your payment has been scheduled.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-ca53846e7e3817c5ac37d463,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2021,fgen-e089e67be552fe5268c07dca,synthetic_programmatic_template,markdown,top,False,direct_pay
"IRS Direct Pay - Payment Confirmation
| Field | Value |
| --- | --- |
| Confírmationnumber | 5510-9995-7079 |
| Name| Kwame Moreau |
| Reason for payment | Estimated Tax |
| App1y payment to | Estimated tax |
| Tax period for payment | 202l |
| Payment amount | $9,149.34 |
| Payment date | 2021-09-09 |
| Bank account | XXX-XX-7333 |
## Keep this confirmation for your records.",TAX_PAYMENT_CONFIRMATION,36,TAX_PAYMENT_CONFIRMATION,fdc-3d7720e6b6e8432863bdbdf1,v11-ESTIMATED_TAX_PAYMENT_CONFIRMATION-markdown,original,2021,fgen-eb96e192f9e162f23eeb42b7,synthetic_programmatic_template,markdown,top,True,direct_pay
"Health Savings Account Statement
Evergreen Health Savings
Account holder
Morgan Larsen
Account number
ending in 0166
Cash balance
5,137.19
Invested balance
$26,217.56
Employer contributions
4.99
Employee contributions
$3,982.03
Distributions / claims paid
$1,213.65
Interest and earnings
$335.02
Date  Description  Amount
2026-05-25
Card purchase CVS/PHARMACY
-550.69
July 1, 2026
Claim reimbursement - Sample Family Clinic
-147.79
5/27/26
Payroll contribution
21.40
10/28/2026
Interest
640.97
09/20/2026
Payroll contribution
199.63
Tax reminder: amounts on this statement may differ from your Form 5498-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-28920728ff7f700561ab1066,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2026,fgen-f244581a0e9e9f4e67e5d08c,synthetic_programmatic_template,stacked,top,False,monthly
"HSA Transaction History
Evergreen Health Savings
Account holder
Amara S. Walsh
Account number
ending in 6168
Date  Description  Amount
February 6, 2025
Card purchase Brightsmile Dental
-397.04
2/3/25
Card purchase Brightsmile Dental
-333.86
2025-08-27
Card purchase CVS/PHARMACY
-142.17
08/16/2025
Card purchase CVS/PHARMACY
-748.56
10/05/2025
Interest
762.96",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-becced146cde3927b0eef98f,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-cec9fac9e341d07ed01f97c7,synthetic_programmatic_template,stacked,top,False,transaction_export
"HSA Claims and Contributions
Date  Description  Type  Amount  Cash Balance
02/25/2022
Transfer to HSA investments
Interest
-275.84
6501.82
10/26/2022
Card purchase - Pharmacy
Transfer
-697.64
8776.01
11/04/2022
Employer HSA contribution
Contribution
-243.86
4373.84
2022-10-23
Transfer to HSA investments
Contribution
-764.73
6369.42",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-792bff0f27f53d5dd06ce469,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2022,fgen-d1f00aeeb468a573c433b1fe,synthetic_programmatic_template,stacked,top,False,raw_export
"HSA Transaction History
Northwind HSA Custodian
Account holder
Noah Romero
Account number
XXX-XX-9918
Date  Description  Amount
03/22/2022
Payroll contribution
376.79
04/20/2022
Payroll contribution
561.84
12/19/2022
Employer contribution
342.83",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a115265505591e327288e5f2,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2022,fgen-e3484cf602d424447752faf9,synthetic_programmatic_template,stacked,top,False,transaction_export
"Health Savings Account Statement
Northwind HSA Custodian
Account holder
Lena Sato
Account number
XXX-XX-0610
Cash balance
$7,524.66
Invested balance
22,480.12
Employer contributions
1,375.27
Employee contributions
$1,297.16
Distributions / claims paid
$648.08
Interest and earnings
$274.55
Date  Description  Amount
2024-09-11
Card purchase CVS/PHARMACY
-634.62
February 26, 2024
Interest
199.40
8/13/24
Employer contribution
713.16
January 20, 2024
Card purchase Brightsmile Dental
-689.23",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-18d97c6d9244a96fa8b8bb1d,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-046583f0af38c4b3925edca9,synthetic_programmatic_template,stacked,top,False,monthly
"HSA Transaction History
Northwind HSA Custodian
Account holder
Priya Larsen
Account number
XXXXX1532
Date  Description  Amount
2021-03-02
Employer contribution
153.87
March 8, 2021
Card purchase Brightsmile Dental
-572.36
07/20/2021
Claim reimbursement - Sample Family Clinic
-521.20",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2892a92e91e2664cfa408ec5,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2021,fgen-4e2d47e13afa7fe9e816eb22,synthetic_programmatic_template,stacked,top,False,transaction_export
"Health Savings Account Statement
Evergreen Health Savings
Account holder
Taylor K. Okafor
Account number
XXXXX1752
Cash balance
$4,232.74
Invested balance
$30,364.61
Employer contributions
933.27
Employee contributions
$1,469.97
Distributions / claims paid
2,205.53
Interest and earnings
167.44
Date  Description  Amount
January 24, 2025
Card purchase Brightsmile Dental
-613.75
12/27/2025
Payroll contribution
605.34
1/12/25
Claim reimbursement - Sample Family Clinic
-157.25
October 27, 2025
Employer contribution
433.28
2025-05-02
Card purchase CVS/PHARMACY
-515.93
05/27/2025
Claim reimbursement - Sample Family Clinic
-200.70
Tax reminder: amounts on this statement may differ from your Form 5498-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4a137999a525b207d377fb65,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-30f48586673f1124227f5f03,synthetic_programmatic_template,stacked,top,False,monthly
"Downloaded 03/01/2021
Date  Description  Type  Amount  Cash Balance
17/12/2021
Employer HSA contribution
Interest
885.11
6336.28
2021-06-04
HSA interest
Interest
-889.78
831.16
2021-12-25
HSA interest
Distribution
-772.21
10199.34
03/11/2021
Transfer to HSA investments
Distribution
-146.51
6243.19
2021-08-09
Transfer to HSA investments
Transfer
428.64
10463.43
11/09/2021
Payroll contribution
Contribution
260.86
651.02
01/03/2021
Employer HSA contribution
Interest
-576.31
2232.20
2021-02-22
Payroll contribution
Transfer
264.90
9321.77
2021-11-18
Employer HSA contribution
Interest
-105.42
3341.95",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-75665778864361b720e52999,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2021,fgen-f2a7b88d011d2162356d2158,synthetic_programmatic_template,stacked,none,False,raw_export
"Transaction Date  Merchant  Category  Amount  Status  Receipt
14/04/2025
VISION CENTER
Medica1
769.78
Pending
Up1oaded
04/27/2025
SAMPLEFAMILY CLINIC
Pharmacy
843.57
Posted
Missing
09/02/2025
SAMPLE FAMILY CLINIC
Pharmacy
8.25
Pendíng
Missing
2025-12-03
SAMPLE FAMILY CLINIC
Pharmacy
92.74
Pendíng
Up1oaded
03/19/2025
CVS PHARMACY
Pharmacy
81.32
Pending
Uploaded
2025-0l-l6
CVS PHARMACY
Pharmacy
870.38
Posted
Missing
2025-09-03
BRIGHTSMILE DENTAL
Pharmacy
336.27
Pending
Uploaded
l0/01/2025
BRIGHTSMILE DENTAL
Dental
351.48
Posted
Uploaded
02/01/2025
SAMPLE FAMILY CLINIC
Vision
528.95
Posted
Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4790b0bff519bee838730753,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-2c7e828b8814fc7552727ba0,synthetic_programmatic_template,stacked,bottom,True,raw_export
"Northwind HSA Custodian
Account holder
Hiro Okafor
Account number
XXXXX6302
Cash balance
$8,574.73
Invested balance
$6,183.33
Employer contributions
1,292.82
Employee contributions
3,441.66
Distributions / claims paid
3,334.36
Interest and earnings
398.84
Date  Description  Amount
04/18/2023
Employer contribution
61.16
01/12/2023
Claim reimbursement - Sample Family Clinic
-220.46
February 14, 2023
Card purchase CVS/PHARMACY
-505.51
03/03/2023
Interest
23.71
April 24, 2023
Claim reimbursement - Sample Family Clinic
-39.40
12/10/23
Claim reimbursement - Sample Family Clinic
-477.86
Your 2023 Form 5498-SA will be available online by January 31, 2024.
Health Savings Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6b505254ce0bdd11ba691ea0,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2023,fgen-e41c1bd04ec1c2d15bbaba08,synthetic_programmatic_template,stacked,bottom,False,monthly
"Sample HSA Bank
Account holder
Noah Moreau
Account number
XXXXX4702
Date  Description  Amount
11/23/2022
Employer contribution
443.72
8/1/22
Card purchaseBrightsmile Dental
-7l.91
2022-12-13
Payroll contribution
99.55
05/25/2022
Claim rcimbursement - 5ample Family Clinic
-13.32",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6512d7503fee0ac31c3569bc,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2022,fgen-02e788e5bd10563b76d0e5de,synthetic_programmatic_template,stacked,none,True,transaction_export
"Health Savings Account Statement
Evergreen Health Savings
Account holder
Noah Tanaka
Account number
ending in 9114
Cash balance
3,709.77
Invested balance
$9,339.67
Employer contributions
755.46
Employee contributions
2,629.61
Distributions / claims paid
3,721.42
Interest and earnings
$485.88
Date  Description  Amount
January 23, 2022
Interest
752.14
12/24/22
Claim reimbursement - Sample Family Clinic
-59.87
2022-05-28
Claim reimbursement - Sample Family Clinic
-762.53
10/5/22
Card purchase CVS/PHARMACY
-462.84
September 19, 2022
Claim reimbursement - Sample Family Clinic
-227.14",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-43815a7662231706b29c3444,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2022,fgen-60fecaf6368fd3494a182dda,synthetic_programmatic_template,stacked,top,False,monthly
"Evergreen Health Savings
Account holder
Wei K. Kowalski
Account number
****5092
Cash balance
5,301.65
Invested balance
27,245.55
Employer contributions
1,218.30
Employee contributions
2,153.21
Distributions / claims paid
$1,615.83
Interest and earnings
510.48
Date  Description  Amount
December 18, 2024
Card purchase CVS/PHARMACY
-637.03
February 9, 2024
Card purchase CVS/PHARMACY
-667.42
September 15, 2024
Payroll contribution
459.00
April 8, 2024
Payroll contribution
37.62
1/12/24
Interest
633.89
9/8/24
Interest
751.74",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d725ce29c067bc66ce6174f0,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-619ed9a9c0ecb341d5337fba,synthetic_programmatic_template,stacked,none,False,monthly
"HSA Transaction History
Sample HSA Bank
Account holder
Híro K.Romero
Account number
XXX-XX-6723
Date  Description  Amount
03/25/2021
Interest
487.07
April l, 2021
Card purchase CV5/PHARMACY
-751.O2
4/2/21
Payroll contribution
735.77
02/06/2021
Claim reimbursement - Sample Family Clinic
-544.53
February 10, 2021
Card purchase CVS/PHARMACY
-161.27
July 21, 2021
Card purchase CVS/PHARMACY
-161.2O
This statement is not a Form 1099-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-51c59e8bef281777b969f44e,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2021,fgen-0e9cc83d9909d79f3e8a637a,synthetic_programmatic_template,stacked,top,True,transaction_export
"Evergreen Health Savings
Account holder
Avery Brennan
Account number
ending in 4648
Cash balance
$331.80
Invested balance
29,989.37
Employer contributions
$1,245.18
Employee contributions
5l8.99
Distributions / claims paid
l,991.97
Interest and eamings
$305.47
Date  Description  Amount
January 5, 2O24
Employer contribution
315.15
5/19/24
Claim reimbursement - Sample Family Clinic
-793.39
2024-11-27
Card purchase Brightsmile Dental
-118.90
August 8, 2024
Card purchascBrightsmile Dental
-43.44",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-38ace466a6598bff9281dfa6,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-c82b6a0ab247945b3c77f537,synthetic_programmatic_template,stacked,none,True,monthly
"Health Savings Account Statement
Sample HSA Bank
Account holder
Morgan Okafor
Account number
ending in 7352
Cash balance
$1,847.43
Invested balance
3,609.76
Employer contributions
$744.40
Employee contributions
4,105.34
Distributions / claims paid
1,758.90
Interest and earnings
$825.98
Date  Description  Amount
7/26/25
Interest
666.42
11/04/2025
Card purchase CVS/PHARMACY
-334.32
12/8/25
Card purchase Brightsmile Dental
-220.60
8/1/25
Card purchase CVS/PHARMACY
-346.02
November 17, 2025
Claim reimbursement - Sample Family Clinic
-504.21",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d3e690585888ec9bfc156b43,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-f9c5b3ded6eb1816ef9b58cd,synthetic_programmatic_template,stacked,top,False,monthly
"Evergreen Health Savings
Account holder
Riley Romero
Account number
***-**-1393
Cashbalance
S4,704.44
Invested balance
27,324.17
Employer contributions
696.33
Employee contributions
2,002.94
Distributions / claims paid
2,281.46
Interestand earnings
$742.94
Datc  Description  Amount
September 6, 2022
Claim reimbursement - Sample Family Clinic
-364.28
November 8, 2022
Card purchase Brightsmile Dental
-l68.94
April 6, 2022
Claim reimbursement - 5ample Family Clinic
-308.25
Your 2022 Form 5498-5A will be available online by January 31, 2023.
Health Savings Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-68ae4c9509f7c6f8ea6cba5b,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2022,fgen-1475c5ab326580b902a6aba8,synthetic_programmatic_template,stacked,bottom,True,monthly
"Transaction Date  Merchant  Category  Amount  Status  Receipt
08/01/2024
SAMPLE FAMILY CLINIC
Medical
669.84
Pending
Uploaded
09/03/2024
VISION CENTER
Vision
376.21
Pending
Uploaded
04/07/2024
VISION CENTER
Dental
747.42
Posted
Missing
02/09/2024
VISION CENTER
Dental
662.65
Pending
Uploaded
04/26/2024
BRIGHTSMILE DENTAL
Pharmacy
152.30
Posted
Uploaded
2024-08-22
SAMPLE FAMILY CLINIC
Pharmacy
111.53
Posted
Uploaded",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-97c5649999aba17e6ffdad67,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-6b15e5b7a2a558fb5aa0b396,synthetic_programmatic_template,stacked,none,False,raw_export
"HSA TransactionHistory
Evergreen Health 5avings
Account holder
Avery C. Romero
Account number
XXXXX6844
Date  Dcscription  Amount
0ctober 22, 2025
Card purchase Brightsmi1e Dental
-254.77
2025-09-04
Interest
369.08
2025-01-19
Employer contribution
717.85",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7c5030d2fc8f72deb95a4772,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-e091d2b24f1ce893c7923100,synthetic_programmatic_template,stacked,top,True,transaction_export
"Date  Description  Type  Amount  Cash Balance
02/07/2026
Payroll contribution
Distribution
265.11
1777.17
2026-08-26
Transfer to HSA investments
Transfer
505.29
5745.62
2026-08-07
Payroll contribution
Transfer
600.15
591.31
11/11/2026
Card purchase - Pharmacy
Contribution
765.73
5141.95
11/06/2026
Employer HSA contribution
Transfer
165.91
5891.85
06/28/2026
Card purchase - Pharmacy
Transfer
497.64
7985.85
03/07/2026
Payroll contribution
Distribution
479.97
10045.72
17/01/2026
Transfer to HSA investments
Distribution
-844.93
7738.35",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-91a5ebaebbd3bbaab321646d,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2026,fgen-aca656e6e97fae5d0c3923b5,synthetic_programmatic_template,stacked,none,False,raw_export
"HSA Activity
Date  Description  Type  Amount  Cash Balance
2023-05-22
Transfer to HSA investments
Interest
-204.82
7284.61
2023-04-24
Card purchase - Pharmacy
Interest
-797.85
11421.89
21/01/2023
Payroll contribution
Distribution
-824.59
9299.98
19/08/2023
Employer HSA contribution
Contribution
420.82
10146.57
05/19/2023
Transfer to HSA investments
Contribution
689.88
5614.49
07/22/2023
Employer HSA contribution
Transfer
-834.04
4662.47
09/25/2023
Card purchase - Pharmacy
Distribution
-559.14
3771.76
2023-12-04
Employer HSA contribution
Contribution
-377.10
488.51
26/03/2023
Card purchase - Pharmacy
Transfer
-679.52
6748.91",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-9f482fee4ebfa74cdcce9c99,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2023,fgen-0d9b94c54cc3984619d1bae0,synthetic_programmatic_template,stacked,top,False,raw_export
"2024 HSA Annual Summary
Northwind HSA Custodian
Account holder
Lena Okafor
Account number
***-**-4521
Cash balance
$2,295.46
Invested balance
24,552.58
Employer contributions
$524.97
Employee contributions
1,822.07
Distributions / claims paid
$634.95
Interest and earnings
310.49
Date  Description  Amount
07/07/2024
Interest
760.40
02/23/2024
Payroll contribution
721.03
November 3, 2024
Card purchase Brightsmile Dental
-264.18
IRS Form 5498-SA information for 2024 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6e8b944d12187014accafcf2,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-6b979cb1c24c5ee2bd48f2ea,synthetic_programmatic_template,stacked,top,False,annual_summary
"Northwind HSA Custodian
Account holder
Avery Líndqvist
Account number
XXXXX6l90
Cash balance
$420.09
Invested balance
$14,957.53
Employer contributions
$105.10
Employee contributions
2,278.32
Distributions / daims paid
940.56
Interest and carnings
$347.25
Date  Description  Amount
2025-12-18
Emp1oyer contribution
677.90
1/6/25
Interest
378.45
11/14/25
Emp1oyer contribution
414.80
2025-05-14
Claim reimbursement - SampleFamily Clinic
-710.68
Tax reminder: amounts on this statement may differ from your Form 5498-SA.
2025 HSA Annual Summary",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-eec6c85d785d65e1fc2c8a01,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-146a8df6a80d807dc693ca18,synthetic_programmatic_template,stacked,bottom,True,annual_summary
"2025 HSA Annual Summary
Northwind HSA Custodian
Account holder
Fatima K. Brennan
Account number
***-**-4749
Cash balance
$4,111.28
Invested balance
22,059.08
Employer contributions
551.27
Employee contributions
$2,767.91
Distributions / claims paid
$1,200.85
Interest and earnings
$204.06
Date  Description  Amount
03/16/2025
Card purchase CVS/PHARMACY
-490.73
2/26/25
Employer contribution
460.01
2025-09-04
Card purchase Brightsmile Dental
-95.35
November 24, 2025
Card purchase Brightsmile Dental
-189.75
2025-11-26
Interest
376.15
January 20, 2025
Card purchase CVS/PHARMACY
-61.34",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cf763ed2c260b76736564b3c,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-6cdaf253ebccb0ed55893903,synthetic_programmatic_template,stacked,top,False,annual_summary
"Health Savings Account ...5623 transactions
Transaction Date  Merchant  Category  Amount  Status  Receipt
01/10/2026
VISION CENTER
Pharmacy
827.09
Pending
Uploaded
09/16/2026
VISION CENTER
Medical
148.25
Posted
Uploaded
2026-09-26
BRIGHTSMILE DENTAL
Pharmacy
780.15
Pending
Missing
2026-06-28
VISION CENTER
Dental
152.56
Posted
Missing
2026-05-11
BRIGHTSMILE DENTAL
Dental
779.18
Pending
Uploaded
2026-12-20
VISION CENTER
Dental
162.04
Pending
Missing
03/07/2026
BRIGHTSMILE DENTAL
Dental
144.27
Pending
Missing
23/08/2026
VISION CENTER
Dental
672.01
Pending
Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-99701e02c1b92b3331def938,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2026,fgen-89836b410a16fcb7bd37d8c9,synthetic_programmatic_template,stacked,top,False,raw_export
"Evergreen Health Savings
Account holder
Jamie Tanaka
Account number
***-**-7200
Cash balance
1,553.24
Invested balance
19,659.42
Employer contributions
489.63
Employee contributions
$3,954.39
Distributions / claims paid
140.59
Interest and earnings
794.05
Date  Description  Amount
1/28/25
Card purchase Brightsmile Dental
-648.25
March 14, 2025
Claim reimbursement - Sample Family Clinic
-451.92
07/22/2025
Card purchase Brightsmile Dental
-736.50
Your 2025 Form 1099-SA will be available online by January 31, 2026.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5343a2a8f3c2176a93dd608d,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2025,fgen-24f8fa85e8fdfc0778532db6,synthetic_programmatic_template,stacked,none,False,annual_summary
"HSA Transaction History
Northwind HSA Custodian
Account holder
Noah Testcase
Account number
XXXXX2940
Date  Description  Amount
11/22/2022
Card purchase CVS/PHARMACY
-326.29
2022-12-26
Claim reimbursement - Sample Family Clinic
-341.69
01/16/2022
Card purchase CVS/PHARMACY
-103.19
2022-12-20
Employer contribution
719.11
7/13/22
Card purchase CVS/PHARMACY
-239.14",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-36ab89296286dfd8a80ee00d,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2022,fgen-7cd754b06b2b6e8282b8dcaa,synthetic_programmatic_template,stacked,top,False,transaction_export
"HSA Transaction History
Sample HSA Bank
Account holder
Lena Nguyen
Account number
ending in 3033
Date  Description  Amount
2024-08-26
Employer contribution
55.71
July 18, 2024
Claim reimbursement - Sample Family Clinic
-382.31
November 18, 2024
Card purchase CVS/PHARMACY
-294.74
11/14/24
Card purchase CVS/PHARMACY
-616.05
This statement is not a Form 5498-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8d22e8bb5e052f4b849d8bb9,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-108c3e7ca03c541c0a2afc58,synthetic_programmatic_template,stacked,top,False,transaction_export
"Sample HSA Bank
Account holder
Fatima B. Patel
Account number
XXXXX0385
Date  Descríption Amount
2024-03-07
Interest
77.72
December 17, 2024
Card purchase Brightsmile Dental
-227.75
10/27/2024
Card purchase Brightsmile Dental
-544.13
Your 2024 Form 5498-SA will be available online by January 31, 2025.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-eaa4a727b559480cb040ca00,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-af7b032dacbdc7c5ed3164a1,synthetic_programmatic_template,stacked,none,True,transaction_export
"Date  Description  Type  Amount  Cash Balance
2022-10-06
Payroll contribution
Interest
779.57
9982.37
2022-03-25
Transfer to HSA investments
Distribution
-413.12
1451.53
12/07/2022
Employer HSA contribution
Distribution
19.19
10736.06",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-85eda3db42eaf73b58818d93,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2022,fgen-94469d62a51cb6b32a8f310b,synthetic_programmatic_template,stacked,none,False,raw_export
"Downloaded 11/05/2021
Transaction Date  Merchant  Category  Amount  Status  Receipt
10/18/2021
CVS PHARMACY
Dental
829.18
Posted
Missing
2021-04-20
CVS PHARMACY
Medical
623.67
Pending
Missing
2021-10-12
BRIGHTSMILE DENTAL
Vision
233.66
Posted
Uploaded
11/03/2021
CVS PHARMACY
Dental
845.74
Posted
Uploaded
05/11/2021
BRIGHTSMILE DENTAL
Vision
391.34
Posted
Missing
2021-02-08
BRIGHTSMILE DENTAL
Pharmacy
888.85
Pending
Missing
05/23/2021
BRIGHTSMILE DENTAL
Vision
253.89
Pending
Uploaded
2021-06-22
BRIGHTSMILE DENTAL
Dental
898.62
Pending
Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-385d2449994df18bb0eba605,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2021,fgen-ce5d5d1272c9c8450e77bb9a,synthetic_programmatic_template,stacked,top,False,raw_export
"Health Savings Account Statement
Northwind HSA Custodian
Account holder
Priya Brennan
Account number
ending in 7673
Cash balance
8,639.14
Invested balance
13,246.47
Employer contributions
$488.56
Employee contributions
$931.69
Distributions / claims paid
$3,992.98
Interest and earnings
$306.03
Date  Description  Amount
4/23/24
Payroll contribution
253.50
1/8/24
Payroll contribution
392.55
07/01/2024
Payroll contribution
553.76",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8b972b38069f48db2423fbfc,v11-HSA_ACCOUNT_STATEMENT-stacked,original,2024,fgen-7fbdb3dd73259ed5b2792cd9,synthetic_programmatic_template,stacked,top,False,monthly
"HSA Transaction History
Sample HSA Bank
Account holder,Mateo Castillo
Account number,ending in 1820
Date,Description,Amount
2026-04-14,Payroll contribution,581.16
""November 19, 2026"",Interest,43.17
""April 12, 2026"",Employer contribution,778.14
04/01/2026,Interest,540.63
""July 19, 2026"",Card purchase Brightsmile Dental,-73.54
Your 2026 Form 1099-SA will be available online by January 31, 2027.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-03d30c3587c04e1536a1b816,v11-HSA_ACCOUNT_STATEMENT-csv,original,2026,fgen-2788a71553a9f6c418c34b57,synthetic_programmatic_template,csv,top,False,transaction_export
"Evergreen Health Savings
Account holder,Riley Patel
Account number,***-**-3205
Cash balance,""$3,613.10""
Invested balance,""12,289.45""
Employer contributions,$109.96
Employee contributions,""3,008.78""
Distributions / daims paid,""$2,869.02""
Interest and eamings,400.18
Date,Description,Amount
2024-08-22,Card purchase CV5/PHARMACY,-285.18
3/24/24,Card purchase CVS/PHARMACY,-288.05
""November 26,2024"",Interest,761.96
4/1/24,Card purchase CVS/PHARMACY,-146.34",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1d7127c9c11bf4617ef5db37,v11-HSA_ACCOUNT_STATEMENT-csv,original,2024,fgen-c09bceca429b56c43b5c7e36,synthetic_programmatic_template,csv,none,True,annual_summary
"HSA Activity
Date,Description,Type,Amount,Cash Balance
25/09/2025,HSA interest,Transfer,-733.90,7822.13
20/11/2025,Payroll contribution,Contribution,246.32,6616.51
2025-05-24,Card purchase - Pharmacy,Transfer,867.05,4259.33
09/01/2025,Transfer to HSA investments,Interest,296.68,2291.40
2025-04-06,HSA interest,Distribution,-690.82,4682.27
2025-02-01,Card purchase - Pharmacy,Distribution,-615.33,9757.99
23/07/2025,Transfer to HSA investments,Distribution,-119.36,5427.61
2025-04-09,Transfer to HSA investments,Transfer,893.87,3947.08
06/09/2025,Payroll contribution,Contribution,-802.13,2931.92",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b2dca7055a0d20b71e566e53,v11-HSA_ACCOUNT_STATEMENT-csv,original,2025,fgen-1a47e85550811d93bd8a899b,synthetic_programmatic_template,csv,top,False,raw_export
"Transaction Date,Merchant,Category,Amount,Status,Receipt
11/24/2022,VISION CENTER,Pharmacy,152.60,Pending,Uploaded
04/28/2022,CVS PHARMACY,Pharmacy,668.03,Pending,Uploaded
2022-06-05,BRIGHTSMILE DENTAL,Dental,637.28,Pending,Missing
01/09/2022,BRIGHTSMILE DENTAL,Vision,196.19,Posted,Uploaded
2022-09-12,SAMPLE FAMILY CLINIC,Vision,760.74,Posted,Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e75ef19e99e6129fed653b86,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-8d6408c7438a9ea97ad59047,synthetic_programmatic_template,csv,top,False,raw_export
"Health Savings Account Statement
Sample HSA Bank
Account holder,Diego R. Brennan
Account number,XXXXX1146
Cash balance,$553.29
Invested balance,""$36,483.25""
Employer contributions,321.18
Employee contributions,$924.57
Distributions / claims paid,""2,800.72""
Interest and earnings,436.16
Date,Description,Amount
""January 10, 2022"",Payroll contribution,117.45
1/19/22,Claim reimbursement - Sample Family Clinic,-762.10
11/25/22,Interest,91.92",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7aeeb345100996f559f56030,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-1b5673ee6537ff01854dec13,synthetic_programmatic_template,csv,top,False,monthly
"Health 5avings Account Statement
Northwind HSA Custodian
Account holder,Jamic Patel
Account number,XXXXX7795
Cash balance,""$1,521.00""
Invested balance,""$13,083.56""
Employer contributions,210.20
Employee contributions,""l,475.93""
Distributions / claims paid,""2,862.40""
Interest and earnings,$779.40
Date,Description,Amount
4/1/25,Employer contribution,559.63
""March 22,2025"",Payroll contribution,149.31
6/22/25,Card purchase Brightsmile Dental,-398.l1
Your 2025 Form 1099-5A will be available online by January 31, 2026.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6a56634881c17989878bf6cd,v11-HSA_ACCOUNT_STATEMENT-csv,original,2025,fgen-973585ed2a475104a4000463,synthetic_programmatic_template,csv,top,True,monthly
"Northwind HSA Custodian
Account holder,Alex Testcase
Account number,ending in 8883
Cash balance,""4,025.43""
Invested balance,""$16,506.43""
Employer contributions,""$1,078.33""
Employee contributions,""3,128.68""
Distributions / claims paid,1.60
Interest and earnings,372.93
Date,Description,Amount
2021-07-28,Card purchase Brightsmile Dental,-310.79
2021-12-23,Claim reimbursement - Sample Family Clinic,-24.88
03/17/2021,Employer contribution,5.84
10/21/21,Employer contribution,164.12
7/10/21,Payroll contribution,151.10
11/6/21,Card purchase Brightsmile Dental,-760.08
2021 HSA Annual Summary",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1d096016aff4c91024970e45,v11-HSA_ACCOUNT_STATEMENT-csv,original,2021,fgen-38b02b7ddde63f6126d924d2,synthetic_programmatic_template,csv,bottom,False,annual_summary
"Date,Description,Type,Amount,Cash Balance
04/01/2022,Payroll contribution,Transfer,-602.00,721.08
25/05/2022,Reimbursement to self,Transfer,-203.03,8525.53
2022-05-02,Card purchase - Pharmacy,Transfer,245.43,11392.94
01/21/2022,Employer HSA contribution,Distribution,562.84,668.10
2022-05-12,Employer HSA contribution,Interest,-369.94,4797.35
Health Savings Account ...3275 transactions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d5272c0ea7416a710c9447f7,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-e45653d11309a0ba37f87cab,synthetic_programmatic_template,csv,bottom,False,raw_export
"HSA Transaction History
Sample HSA Bank
Account holder,Amara R. Kowalski
Account number,****0126
Date,Description,Amount
12/27/2026,Employer contribution,381.23
""April 3, 2026"",C1aim reimbursement - Sample Family Clinic,-785.86
7/21/26,Card purchase CVS/PHARMACY,-626.45
08/04/2026,Payroll contríbution,414.03
10/27/26,Card purchaseBrightsmi1e Dental,-589.67
""July 14, 2026"",Employer contribution,727.67",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3dab3e005dc07b107c57596e,v11-HSA_ACCOUNT_STATEMENT-csv,original,2026,fgen-71c2dc1830bc97aca59950d6,synthetic_programmatic_template,csv,top,True,transaction_export
"2023 HSA Annual Summary
Northwind HSA Custodian
Account holder,Noah Castillo
Account number,XXXXX7284
Cash balance,""$2,161.23""
Invested balance,""$2,539.03""
Employer contributions,929.65
Employee contributions,""$1,728.97""
Distributions / claims paid,""$2,377.52""
Interest and earnings,$86.32
Date,Description,Amount
""June 20, 2023"",Employer contribution,541.08
""February 27, 2023"",Card purchase Brightsmile Dental,-10.03
2023-08-22,Claim reimbursement - Sample Family Clinic,-675.19
1/6/23,Claim reimbursement - Sample Family Clinic,-120.07
""June 10, 2023"",Card purchase CVS/PHARMACY,-383.98",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6b0697b017c6c4e93bc2f965,v11-HSA_ACCOUNT_STATEMENT-csv,original,2023,fgen-3a5aafebf45027e8cab0defc,synthetic_programmatic_template,csv,top,False,annual_summary
"Health Savings Account Statement
Evergreen Health Savings
Account holder,Morgan J. Moreau
Account number,***-**-8401
Cash balancc,""S5,322.28""
Invested balance,""$9,812.68""
Emp1oyer contributions,742.71
Employee contributions,981.20
Distributions / claims paid,""1,541.02""
Interest and earnings,163.89
Date,Description,Amount
""July 15, 2026"",Claim reimbursemcnt - Sample Family Clinic,-64.65
06/23/2026,Claim rcimbursement - Sample Family Clinic,-146.00
05/11/2026,Employer contribution,553.48
Thisstatement is not a Form 5498-5A. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ba426717802e3cf87e5a2cae,v11-HSA_ACCOUNT_STATEMENT-csv,original,2026,fgen-ac4ffe5ffd05d2aea855d8cc,synthetic_programmatic_template,csv,top,True,monthly
"Health Savings Account Statement
Sample HSA Bank
Account holder,Mateo S. Nguyen
Account number,ending in 9585
Cash balance,""$2,412.73""
Invested balance,""$35,395.38""
Employer contributions,""1,493.55""
Employee contributions,""$1,390.34""
Distributions / claims paid,$973.84
Interest and earnings,704.31
Date,Description,Amount
4/4/22,Card purchase CVS/PHARMACY,-405.40
11/9/22,Payroll contribution,345.89
""September 28, 2022"",Card purchase Brightsmile Dental,-111.34
01/19/2022,Interest,366.54
08/01/2022,Interest,575.30
Tax reminder: amounts on this statement may differ from your Form 1099-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1c22ab0408fbb6ac94df447d,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-349d278cc00aeb9cd148daa0,synthetic_programmatic_template,csv,top,False,monthly
"2021 HSA Annual Summary
Sample HSA Bank
Account holder,Wei Walsh
Account number,***-**-7418
Cash balance,""8,716.55""
Invested balance,""$34,377.09""
Employer contributions,$551.26
Employee contributions,755.07
Distributions / claims paid,""3,373.48""
Interest and earnings,$27.02
Date,Description,Amount
12/15/21,Card purchase CVS/PHARMACY,-439.29
2021-04-07,Card purchase Brightsmile Dental,-117.14
""October 14, 2021"",Interest,548.68
5/21/21,Claim reimbursement - Sample Family Clinic,-569.07
IRS Form 1099-SA information for 2021 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ac74089b4f53465be2c92de3,v11-HSA_ACCOUNT_STATEMENT-csv,original,2021,fgen-2ac92118d1e912e55484c93f,synthetic_programmatic_template,csv,top,False,annual_summary
"HSA Transaction History
Evergreen Health Savings
Account holder,Amara Moreau
Account number,***-**-4420
Date,Description,Amount
2024-04-19,Card purchase Brightsmile Dental,-63.34
9/17/24,Employer contribution,309.84
05/03/2024,Interest,718.87
""October 2, 2024"",Card purchase Brightsmile Dental,-617.58
10/05/2024,Card purchase Brightsmile Dental,-731.19",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-78b819335407f2ea49019f2f,v11-HSA_ACCOUNT_STATEMENT-csv,original,2024,fgen-2376706ce6bea3ac8ec7183b,synthetic_programmatic_template,csv,top,False,transaction_export
"Evergreen Health Savings
Account holder,Taylor Romero
Account number,XXX-XX-2495
Cash balance,""2,751.50""
Invested balance,""32,648.21""
Employer contributions,58.36
Employee contributions,""2,600.60""
Distributions / claims paid,""$2,964.64""
Interest and earnings,585.79
Date,Description,Amount
10/17/24,Card purchase CVS/PHARMACY,-180.13
3/28/24,Payroll contribution,673.35
2024-11-25,Employer contribution,281.68",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-166dafc30fd1ab188984e92c,v11-HSA_ACCOUNT_STATEMENT-csv,original,2024,fgen-42cfed1e977a2552b0afa3da,synthetic_programmatic_template,csv,none,False,annual_summary
"Health Savings Account ...9418 transactions
Date,Description,Type,Amount,Cash Balance
09/02/2022,Reimbursement to self,Contribution,-603.98,4324.38
2022-05-27,Reimbursement to self,Distribution,-131.38,127.40
07/01/2022,Employer HSA contribution,Distribution,101.49,4544.00
2022-03-18,Reimbursement to self,Distribution,370.83,3931.36
14/03/2022,Reimbursement to self,Interest,135.73,5912.13
2022-03-24,Employer HSA contribution,Transfer,793.94,10337.38
2022-03-11,Card purchase - Pharmacy,Interest,754.23,8002.69",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-823a2e1b2b138194ec70cf48,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-844c56a0354e12afa61fb979,synthetic_programmatic_template,csv,top,False,raw_export
"HSA Transaction History
Evergreen Health Savings
Account holder,Sofia E. Lindqvist
Account number,XXX-XX-1894
Date,Description,Amount
01/25/2023,Card purchase CVS/PHARMACY,-152.08
""September 6, 2023"",Card purchase Brightsmile Dental,-339.55
4/10/23,Employer contribution,152.88
12/24/23,Employer contribution,121.30
03/14/2023,Payroll contribution,348.74
2023-04-15,Claim reimbursement - Sample Family Clinic,-28.47",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1f94c26fe71f688d36c38f87,v11-HSA_ACCOUNT_STATEMENT-csv,original,2023,fgen-4a3b288e973d12b5fe03f9c0,synthetic_programmatic_template,csv,top,False,transaction_export
"Health Savings Account Statement
Northwind HSA Custodian
Account holder,Fatima A. Larsen
Account number,XXX-XX-3128
Cash balance,""$8,145.84""
Invested balance,$98.45
Employer contributions,478.26
Employee contributions,202.83
Distributions / claims paid,""3,009.67""
Interest and earnings,178.40
Date,Description,Amount
2026-06-08,Employer contribution,608.26
7/18/26,Card purchase CVS/PHARMACY,-350.07
2026-03-18,Payroll contribution,18.07",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bde87bd1977c6f1158f473d4,v11-HSA_ACCOUNT_STATEMENT-csv,original,2026,fgen-62568b7416adc3d80fa5a347,synthetic_programmatic_template,csv,top,False,monthly
"Evergreen Health Savings
Account holder,Taylor B. Patel
Account number,****0600
Cash balance,""$5,985.41""
Invested balance,""31,074.36""
Employer contributions,$685.40
Employee contributions,""$2,073.02""
Distributions / claims paid,""3,656.48""
Interest and earnings,$57.63
Date,Description,Amount
02/18/2021,Payroll contribution,426.69
1/28/21,Employer contribution,769.29
9/3/21,Card purchase Brightsmile Dental,-227.94
4/4/21,Card purchase Brightsmile Dental,-673.50
3/2/21,Interest,650.26
IRS Form 5498-SA information for 2021 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-01143649474d14c57669170c,v11-HSA_ACCOUNT_STATEMENT-csv,original,2021,fgen-b890cad7af1413d22642df91,synthetic_programmatic_template,csv,none,False,monthly
"2024 HSA Annual Summary
Evergreen Health Savings
Account holder,Fatima Patel
Account number,****0937
Cash balance,""$3,203.99""
Invested balance,""18,520.04""
Employer contributions,$791.44
Employee contributions,""3,909.27""
Distributions / claims paid,$329.81
Interest and earnings,$569.89
Date,Description,Amount
2024-03-21,Card purchase Brightsmile Dental,-627.51
""October 12, 2024"",Claim reimbursement - Sample Family Clinic,-659.03
""February 13, 2024"",Interest,713.18
2024-10-03,Card purchase CVS/PHARMACY,-388.14
IRS Form 5498-SA information for 2024 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8b2ebb5f633dfccabe7c7196,v11-HSA_ACCOUNT_STATEMENT-csv,original,2024,fgen-7eb2d725c8a8bcc56f75d874,synthetic_programmatic_template,csv,top,False,annual_summary
"Downloaded 28/06/2025
Date,Description,Type,Amount,Cash Balance
11/11/2025,Reimbursement to self,Contribution,-632.81,9679.10
28/07/2025,Card purchase - Pharmacy,Contribution,-328.11,7699.72
12/11/2025,Reimbursement to self,Transfer,-697.20,7129.33
12/14/2025,Employer HSA contribution,Interest,282.80,9237.01
05/08/2025,Reimbursement to self,Contribution,8.00,1169.84",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-534d07bbda8c91487646c7e8,v11-HSA_ACCOUNT_STATEMENT-csv,original,2025,fgen-58a51170065bb0f9a57e0d61,synthetic_programmatic_template,csv,top,False,raw_export
"Northwind HSA Custodian
Account holder,Amara Nguycn
Account number,ending in 2819
Date,Description,Amount
O3/07/2022,Card purchase CVS/PHARMACY,-556.43
10/23/22,Payroll contribution,554.00
2022-11-14,Card purchase BrightsmileDental,-41.49",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-21b62958f74d69b28b620074,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-ed5e712220c0c6e61badba33,synthetic_programmatic_template,csv,none,True,transaction_export
"Transaction Date,Merchant,Category,Amount,Status,Receipt
2023-12-16,CVS PHARMACY,Vision,441.34,Pending,Missing
08/18/2023,SAMPLE FAMILY CLINIC,Pharmacy,61.79,Posted,Uploaded
15/05/2023,SAMPLE FAMILY CLINIC,Pharmacy,83.70,Posted,Uploaded
12/12/2023,CVS PHARMACY,Dental,535.12,Posted,Missing
19/12/2023,BRIGHTSMILE DENTAL,Medical,521.12,Pending,Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-741e436b6b22d7481a8fee48,v11-HSA_ACCOUNT_STATEMENT-csv,original,2023,fgen-6bec4402f8689598256636cf,synthetic_programmatic_template,csv,none,False,raw_export
"2021 HSA Annual Summary
Sample HSA Bank
Account holder,Hiro Castillo
Account number,***-**-7739
Cash balance,$677.61
Invested balance,""$38,930.55""
Employer contributions,$153.75
Employee contributions,""2,907.48""
Distributions / claims paid,""$3,868.95""
Interest and earnings,798.25
Date,Description,Amount
2021-09-14,Employer contribution,342.35
""December 18, 2021"",Card purchase CVS/PHARMACY,-667.23
""April 5, 2021"",Interest,70.89
2021-04-19,Card purchase Brightsmile Dental,-103.22
07/24/2021,Employer contribution,277.60",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c2bcdbc485ece90ea54c20c0,v11-HSA_ACCOUNT_STATEMENT-csv,original,2021,fgen-37cf17a6dc047c47b484b59e,synthetic_programmatic_template,csv,top,False,annual_summary
"HSA Transaction History
Sample HSA Bank
Account holder,Diego J. Moreau
Account number,****4962
Date,Description,Amount
2026-11-26,Card purchase Brightsmile Dental,-536.91
2026-08-28,Card purchase CVS/PHARMACY,-51.24
04/03/2026,Payroll contribution,252.51
2026-11-02,Card purchase CVS/PHARMACY,-665.06
""April 1, 2026"",Interest,755.71
12/19/2026,Card purchase Brightsmile Dental,-212.77",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1fede4c64fecdb4a2324e4fd,v11-HSA_ACCOUNT_STATEMENT-csv,original,2026,fgen-f0ad40a04f4d7a4c2392f383,synthetic_programmatic_template,csv,top,False,transaction_export
"HSA Transaction History
Sample HSA Bank
Account holder,Diego Tanaka
Account number,***-**-5741
Date,Description,Amount
2022-01-08,Card purchase CVS/PHARMACY,-156.64
2/28/22,Payroll contribution,325.24
02/26/2022,Card purchase CVS/PHARMACY,-619.73
09/05/2022,Interest,752.38
2022-05-03,Claim reimbursement - Sample Family Clinic,-251.21
7/11/22,Card purchase CVS/PHARMACY,-69.16
This statement is not a Form 5498-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e677d4f652fa309640a97ab5,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-0d235c42cc19fc2fc4f55626,synthetic_programmatic_template,csv,top,False,transaction_export
"HSA Transaction History
Northwind HSA Custodian
Account holder,Olivia Brennan
Account number,ending in 1983
Date,Description,Amount
07/13/2024,Payroll contribution,381.04
3/19/24,Claim reimbursement - Sample Family Clinic,-221.92
11/08/2024,Card purchase CVS/PHARMACY,-40.21
""February 25, 2024"",Card purchase Brightsmile Dental,-677.93
""February 28, 2024"",Card purchase CVS/PHARMACY,-626.02
02/07/2024,Employer contribution,358.06",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-9c143a406171316208d80a15,v11-HSA_ACCOUNT_STATEMENT-csv,original,2024,fgen-2863baa2719966257a9f2f67,synthetic_programmatic_template,csv,top,False,transaction_export
"Sample HSA Bank
Account holder,O1ivia A. Nguyen
Account number,XXXXX3748
Date,Description,Amount
""May 5, 2021"",Claim reimbursement - Sample Family Clinic,-91.11
1/11/21,Card purchase CVS/PHARMACY,-415.36
09/18/2021,Card purchase CVS/PHARMACY,-682.45
2021-12-25,Card purchaseCVS/PHARMACY,-581.95",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ca5aba7c5e228d52ab249f78,v11-HSA_ACCOUNT_STATEMENT-csv,original,2021,fgen-50e0127f2ea877d0dabb76a5,synthetic_programmatic_template,csv,none,True,transaction_export
"Northwind HSA Custodian
Account holder,Diego Romero
Account number,ending in 3292
Date,Description,Amount
5/10/22,Payroll contribution,592.08
""July 1, 2022"",Interest,305.62
07/20/2022,Card purchase Brightsmile Dental,-30.27
3/9/22,Card purchase CVS/PHARMACY,-37.04
""October 11, 2022"",Claim reimbursement - Sample Family Clinic,-490.89
IRS Form 1099-SA information for 2022 will be mailed separately.
HSA Transaction History",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e828538bf74769f33ea0741c,v11-HSA_ACCOUNT_STATEMENT-csv,original,2022,fgen-d022f880718a4ac17a287e6c,synthetic_programmatic_template,csv,bottom,False,transaction_export
"Sample HSA Bank
Account holder,Kwame Kowalski
Account number,***-**-8196
Date,Description,Amount
09/03/2025,Payroll contribution,125.13
5/7/25,Card purchase Brightsmile Dental,-380.79
""June 24, 2025"",Claim reimbursement - Sample Family Clinic,-339.38
9/12/25,Interest,234.97
This statement is not a Form 1099-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-67f1924e92569ec11dccca92,v11-HSA_ACCOUNT_STATEMENT-csv,original,2025,fgen-38e5dca17eeaca7162d4443b,synthetic_programmatic_template,csv,none,False,transaction_export
"HSA Transaction History
Northwind HSA Custodian
Account holder,Jamie Romero
Account number,XXX-XX-1811
Date,Description,Amount
""September 15, 2025"",Interest,244.23
2/9/25,Card purchase CVS/PHARMACY,-210.51
2025-10-16,Card purchase CVS/PHARMACY,-416.89
1/23/25,Employer contribution,605.57
2025-04-0l,Payroll contribution,694.37
This statement is not a Form5498-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5b8f6631fc8223435e878e32,v11-HSA_ACCOUNT_STATEMENT-csv,original,2025,fgen-4508b9025bd40c75ce2f33af,synthetic_programmatic_template,csv,top,True,transaction_export
"2025 HSA Annual Summary
Sample HSA Bank
Account holder,Fatima Lindqvist
Account number,***-**-8084
Cash balance,""S3,429.46""
Invested balance,""$37,627.l5""
Employercontributions,$675.26
Employee contributions,""$3,561.17""
Distributions / claims paid,""2,224.96""
Intcrest and eamings,622.25
Date,Description,Amount
12/25/25,Claim reimbursement - Sample Family Clinic,-239.78
O6/15/2O25,C1aim reimbursement - Sample Family Clinic,-489.67
""October 10, 2025"",Card purchase CVS/PHARMACY,-461.68
12/07/2025,Employer contríbutíon,117.65",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e84b750fff8d45aedc1c3242,v11-HSA_ACCOUNT_STATEMENT-csv,original,2025,fgen-cbff5e1603af221a82df2f8a,synthetic_programmatic_template,csv,top,True,annual_summary
"Transaction Date Merchant Category Amount
Status
Receipt 12/04/2025 SAMPLE FAMILY CLINIC Medical 310.61 Pending Uploaded 2025-11-11 VISION CENTER Dental 759.05 Pending Uploaded 01/09/2025 CVS PHARMACY Pharmacy 596.06 Posted Missing 08/19/2025 BRIGHTSMILE DENTAL Medical 740.62 Posted Missing 01/12/2025 BRIGHTSMILE DENTAL Vision 108.80 Posted Uploaded 05/10/2025 BRIGHTSMILE DENTAL Vision 410.50 Posted Uploaded 10/14/2025 SAMPLE FAMILY CLINIC Medical 24.47 Pending Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2e607984b6e708579c670814,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-a5534de46bfbfb51d38e8c1c,synthetic_programmatic_template,flat,top,False,raw_export
"Health Savings Account Statement Northwind HSA Custodian Account holder Alex Larsen Account number ***-**-3481 Cash balance 7,425.44 Invested
balance $31,206.89 Employer contributions $245.50 Employee contributions 815.74 Distributions / claims paid 3,070.82 Interest and earnings 187.88 Date Description Amount 5/15/24 Claim reimbursement - Sample Family
Clinic -127.07 November 20, 2024 Interest 694.11 December 27, 2024 Card purchase Brightsmile Dental -439.46 IRS Form 1099-SA information for 2024 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-44c1bd36dc5461d165ffadec,v11-HSA_ACCOUNT_STATEMENT-flat,original,2024,fgen-c9bc8938bce0d6888572f39b,synthetic_programmatic_template,flat,top,False,monthly
"Sample HSA Bank Account holder Amara C.
FischerAccount number ***-**-5779 Cash balance 5,057.28 Invested balance 30,487.29 Employer contributions S36.l4 Employee contributions $1,817.32 Distributions / daimspaid $2,645.16 Interest and eamings 846.85 Date Description Amount May 14, 2O24 Interest 152.46 2024-11-13 Interest 631.90 11/6/24 C1aim reimbursement - Sample Family Clinic -717.34 04/06/2024 Claim rcimbursement - Sample Family
Clinic -295.30 4/13/24 Interest 411.64",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-42e9b0e18214b16c2936d9af,v11-HSA_ACCOUNT_STATEMENT-flat,original,2024,fgen-ee2e2914fd88af8b7d4877a2,synthetic_programmatic_template,flat,none,True,monthly
"Sample HSA Bank Account holder Taylor J. Haddad Account number XXX-XX-5934 Cash balance $8,474.72 Invested balance $7,721.68 Employer contributions $283.36 Employee
contributions 3,058.87 Distributions
/ claims paid $97.58 Interest and earnings $15.36 Date Description Amount 09/14/2021 Card purchase Brightsmile Dental -652.42 11/23/21 Interest 478.11 9/15/21 Claim reimbursement - Sample Family Clinic -631.53 2021 HSA Annual Summary",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b52fed0843bc28bd003a6ac0,v11-HSA_ACCOUNT_STATEMENT-flat,original,2021,fgen-29209870c58d6b77c1a65185,synthetic_programmatic_template,flat,bottom,False,annual_summary
"2021 HSA Annual Summary Northwind HSA Custodian Account holder Morgan Patel
Account number ****6133 Cash balance 4,207.60 Invested balance
6,180.94 Employer contributions 997.02 Employee contributions $1,151.84 Distributions / claims paid $326.82 Interest and earnings $168.28 Date Description Amount 4/13/21 Employer contribution 119.76 December 19, 2021 Card purchase CVS/PHARMACY -189.92 December 22, 2021 Card purchase CVS/PHARMACY -130.95 1/15/21 Card purchase CVS/PHARMACY -228.98",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-78b9656bba344fb0292f40bb,v11-HSA_ACCOUNT_STATEMENT-flat,original,2021,fgen-3743ca331e33c0b9e446bd6b,synthetic_programmatic_template,flat,top,False,annual_summary
"Health Savings Account Statement Sample HSA Bank Account
holder Taylor C. Brennan Account number ***-**-0686 Cash balance $213.70 Invested balance 19,544.64 Employer contributions $419.59 Employee contributions $2,985.51 Distributions / claims paid 3,567.46 Interest and earnings $7.42
Date Description Amount 2026-05-26 Interest 557.95 March 19, 2026 Card purchase Brightsmile Dental -525.43 2026-03-08 Claim reimbursement - Sample Family Clinic -728.39 October 16, 2026 Payroll contribution 711.55 4/19/26 Card purchase Brightsmile Dental -741.34 April 22, 2026 Interest 575.73 Your 2026 Form 1099-SA will be available online by January 31, 2027.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0af5d732a4322c1ee6d04289,v11-HSA_ACCOUNT_STATEMENT-flat,original,2026,fgen-c7da6806faa15e8c3be1be02,synthetic_programmatic_template,flat,top,False,monthly
"HSA Transaction History Evergreen Health Savings Account holder Casey L. Moreau Account number XXX-XX-6437 Date
Description Amount 2023-10-28 Claim reimbursement - Sample Family Clinic -480.49 10/15/23 Payroll contribution 103.47 May 17, 2023 Interest 682.72 October 11,
2023 Card purchase CVS/PHARMACY -332.95 Tax reminder: amounts on this statement may differ from your Form 5498-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d865e7341ecfc8bff60ce906,v11-HSA_ACCOUNT_STATEMENT-flat,original,2023,fgen-e785858f37042fa42d18de87,synthetic_programmatic_template,flat,top,False,transaction_export
"Date Description Type Amount Cash Balance 09/21/2024 HSA interest Interest 858.15 5567.26 04/21/2024 HSA interest Interest -223.46 9508.85
2024-02-14 Card purchase - Pharmacy Transfer 854.85
6929.23 06/21/2024 Payroll contribution Distribution -570.18 4646.13 05/01/2024 Card purchase - Pharmacy Contribution 824.71 7462.65 2024-11-17 Transfer to HSA investments Interest 366.45 11968.53 2024-07-09 Reimbursement to self Distribution 9.87 4515.53 04/03/2024 Payroll contribution Interest 631.74 9263.33",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b307b2b0a9e0104e23deaf79,v11-HSA_ACCOUNT_STATEMENT-flat,original,2024,fgen-ca65486ab822f77258a3f405,synthetic_programmatic_template,flat,none,False,raw_export
"Downloaded 06/10/2024 Transaction Date Merchant Category Amount Status Receipt 2024-05-06 CVS
PHARMACY Medical 850.20 Pending Missing 11/03/2024 SAMPLE FAMILY CLINIC Medical 385.19 Posted
Uploaded 10/15/2024 SAMPLE FAMILY CLINIC Medical 327.29 Posted Uploaded 2024-08-21 BRIGHTSMILE DENTAL Medical 628.75 Pending Uploaded",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e67c67b7df2ce44ed54f9c48,v11-HSA_ACCOUNT_STATEMENT-flat,original,2024,fgen-2dd68d638a144a4280e68b15,synthetic_programmatic_template,flat,top,False,raw_export
"HSA Activity Date Description Type Amount Cash Balance 02/01/2023 Card purchase -
Pharmacy Transfer 573.82 9887.14 08/10/2023 Employer HSA contribution Distribution 816.20 5632.43 2023-03-01 Transfer to HSA investments Distribution 40.06 7487.95 03/07/2023 Card purchase - Pharmacy Contribution 474.82
8097.71 08/09/2023 Payroll contribution Contribution 150.04 695.19 06/15/2023 HSA interest Interest 558.49 3449.51",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a838b08081a304154b895daa,v11-HSA_ACCOUNT_STATEMENT-flat,original,2023,fgen-102ad8be0374d963bca85e15,synthetic_programmatic_template,flat,top,False,raw_export
"Health Savings Account Statement Evergreen Health Savings Account holder Taylor Tanaka
Account number ***-**-3948 Cash balance 7,571.57 Invested balance $19,938.57 Employer contributions $241.61 Employee contributions $350.38 Distributions / claims paid 3,256.60 Interest and earnings $338.84 Date Description Amount June 14, 2023 Payroll contribution 304.62 7/24/23 Card purchase
Brightsmile Dental -768.73 2023-03-19 Card purchase CVS/PHARMACY -510.22 2023-06-27 Employer contribution 532.52 12/12/2023 Claim reimbursement - Sample Family Clinic -567.19",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-aefbe8aa661814e445d14532,v11-HSA_ACCOUNT_STATEMENT-flat,original,2023,fgen-264388ebbeb835a136df5523,synthetic_programmatic_template,flat,top,False,monthly
"Evergreen Health Savings Account holder Priya Moreau Account number ending in 9369
Date Description
Amount June 16, 2025 Interest 676.03 4/14/25 Interest 688.92 2025-05-21 Card purchase Brightsmile Dental -264.75 HSA Transaction History",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4925b191f2d1bf4a92f5895a,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-1fde2830ca4b75d821752002,synthetic_programmatic_template,flat,bottom,False,transaction_export
"HSA Transaction History Northwind HSA Custodian Account holder Taylor Nguyen Account number ****8532 Date Description Amount 03/12/2025 Card purchase Brightsmile Dental -285.22 2025-07-18 Card purchase Brightsmile Dental -273.86 05/22/2025 Card purchase CVS/PHARMACY -561.75 June
14, 2025 Payroll contribution 658.20 March 20, 2025 Card purchase Brightsmile Dental -574.47 Your 2025 Form 5498-SA will be available online by January 31,
2026.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b6c25a4b6b6f7625be5b3e0b,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-25d7a8966c2463d07ba878be,synthetic_programmatic_template,flat,top,False,transaction_export
"Evergreen Health Savings Account
holder Taylor Kowalski Account
number XXXXX9043 Date Description Amount 2/12/25 Card purchase CVS/PHARMACY -380.63 9/14/25 Card purchase Brightsmile Dental -253.49 June 7, 2025 Payroll contribution 412.22 2025-06-10 Interest 130.14 May 5, 2025 Claim reimbursement - Sample Family Clinic -467.65 03/04/2025 Employer contribution 540.37 HSA Transaction History",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-74a2b6f7755fd9bac20262a9,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-873185a994561e0e10d0fe19,synthetic_programmatic_template,flat,bottom,False,transaction_export
"2025
HSA Annual Summary Northwind HSA Custodian Account ho1der Amara B. Sato Accountnumber ****2907 Cash balance $7,891.97 Invested balance 8,723.89 Employer contributions$941.83 Employee contributions $3,041.33 Distributions / claims paid $l,180.88 Intcrest and earnings $667.05 Date Description Amount 03/23/2025 Employer contribution 9.81 June 4, 2025
Interest 14.60 May 27, 2025 Claim reimbursement - 5ample Family Clinic -83.66 November 23, 2025 Employer contribution 295.87 March 2, 2025 Card purchase CV5/PHARMACY -111.05",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-77de909002a43e74d9e5669f,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-4d8d95e7bfe99b1b17285ff3,synthetic_programmatic_template,flat,top,True,annual_summary
"2021 HSA Annual Summary Northwind HSA Custodian Account holder Olivia B. Testcase Account number ****4794 Cash balance 159.97 Invested balance $16,530.86 Employer contributions 1,308.89 Employee contributions $1,771.02 Distributions / claims paid 3,667.01 Interest and earnings 270.70 Date Description Amount January
12, 2021 Card purchase CVS/PHARMACY -10.88 10/11/21 Card purchase Brightsmile Dental -626.44 1/20/21
Employer contribution 131.10",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-234ae2b0a5cec3df03629628,v11-HSA_ACCOUNT_STATEMENT-flat,original,2021,fgen-9b996ed5e38ccdb16f312155,synthetic_programmatic_template,flat,top,False,annual_summary
"Health Savings Account Statement Northwind
HSA Custodian Account holder Noah Haddad Account number ****2211 Cash balance 4,512.33 Invested balance 18,753.37 Employer contributions 1,282.29 Employee contributions $471.49
Distributions / claims paid 3,093.98 Interest and earnings $545.72 Date Description Amount 2024-03-03 Card purchase CVS/PHARMACY -490.91 09/15/2024 Card purchase CVS/PHARMACY -718.32 12/26/2024 Employer contribution 446.52 2024-06-13 Card purchase CVS/PHARMACY -471.23 2024-04-11 Employer contribution 561.61 October 1, 2024 Card purchase Brightsmile Dental -328.19 This statement is not a Form 5498-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6dc78a1e68cdc1740585167c,v11-HSA_ACCOUNT_STATEMENT-flat,original,2024,fgen-57e362984c5a2ceeba88b544,synthetic_programmatic_template,flat,top,False,monthly
"HSA Transaction History Northwind HSA
Custodian Account holder Jamie Haddad Account number
****3756 Date Description Amount 6/25/23 Interest 797.59 October 28, 2023 Employer contribution 106.31 September 4, 2023 Card purchase Brightsmile Dental -505.11",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1b634eb9aa0f5c12af6d249f,v11-HSA_ACCOUNT_STATEMENT-flat,original,2023,fgen-9d9a217ee43c7a3d9e9472f9,synthetic_programmatic_template,flat,top,False,transaction_export
"HSA Transaction History Evergreen Health Savings Account holder Sofia Brennan Account number ***-**-6031 Date Description Amount April 13, 2026 Payroll contribution 323.72 04/22/2026 Card purchase CVS/PHARMACY -36.07 December 5,
2026 Claim reimbursement - Sample Family Clinic
-98.92 12/14/26 Interest 364.44",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0426a9eaacd8cb47e1de909b,v11-HSA_ACCOUNT_STATEMENT-flat,original,2026,fgen-bbafaadade344f7ae49c681d,synthetic_programmatic_template,flat,top,False,transaction_export
"2021 HSA Annual Summary Sample HSA Bank Account holder Priya
L. Larsen Account number ****9991 Cash balance $2,026.65 Invested balance 39,318.95 Employer contributions $336.01 Employee contributions 2,098.46 Distributions / daims paid$l,546.56 Interest and earnings $549.79 Date Description Amount 2/17/21 Emp1oyer contribution 757.O3 02/11/2021 Claim reimbursement - Samp1e Family Clinic -642.20 January 3, 2021 Employer contribution 142.54 This statement is not a Form1099-SA. Keep
it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-16f8ecec7bf69524ffdece9b,v11-HSA_ACCOUNT_STATEMENT-flat,original,2021,fgen-f3402eb2f5a46a1485db57db,synthetic_programmatic_template,flat,top,True,annual_summary
"HSA Claims and Contributions Downloaded 2024-07-09 Transaction Date Merchant Category Amount Status Receipt 05/05/2024
SAMPLE FAMILY CLINIC Pharmacy 360.00 Pending Missing 2024-08-21 SAMPLE FAMILY CLINIC Vision 852.73 Posted Missing 2024-09-01 BRIGHTSMILE DENTAL Dental 217.12 Posted Missing 02/03/2024 VISION CENTER Vision 613.03 Pending Missing 11/03/2024 BRIGHTSMILE DENTAL Dental 815.20 Posted Missing 2024-07-10 CVS
PHARMACY Medical 546.63 Pending Missing 25/12/2024 CVS PHARMACY Medical 852.60 Pending Uploaded 03/07/2024 VISION CENTER Vision 188.74 Posted Missing 28/06/2024 BRIGHTSMILE DENTAL Medical 36.14 Pending Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a2174a307539805c7ca3c57e,v11-HSA_ACCOUNT_STATEMENT-flat,original,2024,fgen-7b9ed51d2cffc63251e094d0,synthetic_programmatic_template,flat,top,False,raw_export
"Northwind HSA Custodian Account holder Fatima B.
Lindqvist Account number ***-**-3812 Cash balance 2,121.52 Invested balance 28,369.84 Employer contributions $1,110.39 Employee contributions 2,350.22 Distributions / claims paid $1,321.78 Interest and earnings $42.20 Date Description Amount 7/7/24 Payroll contribution 775.29 1/7/24 Card purchase Brightsmile Dental -727.72 01/14/2024 Employer contribution 654.22 Tax reminder: amounts on this
statement may differ from your Form 5498-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-852941af1941dfe89097a25b,v11-HSA_ACCOUNT_STATEMENT-flat,original,2024,fgen-4d0a51c3f03c0c2d28a510fb,synthetic_programmatic_template,flat,none,False,monthly
"Health Savings Account Statement Northwind HSA Custodian Account holder Kwame B. Okafor Account number ****8771 Cash balance 1,215.33 Invested balance $34,909.71 Employer contributions $653.38 Employee contributions 519.22 Distributions / claims paid $1,091.55 Interest and earnings 591.68 Date Description Amount 06/12/2025 Card purchase CVS/PHARMACY -386.80
2025-01-10 Employer contribution 334.92 August 17, 2025
Claim reimbursement - Sample Family Clinic -749.98 March 23, 2025 Card purchase Brightsmile Dental -654.90 Your 2025 Form 1099-SA will be available online by January 31, 2026.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-01cb1021db73d33a3320c997,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-1e5111c1bac6682a41c3133c,synthetic_programmatic_template,flat,top,False,monthly
"Evergreen Health Savings Account holder Casey C. Larsen Account number XXXXX9842 Date Description Amount 11/12/2025 Employer contribution 9.04 09/04/2025 Payroll contribution 281.50 04/12/2025 Card purchase
CVS/PHARMACY -523.71 2025-09-02 Payroll contribution 763.29
01/18/2025 Card purchase CVS/PHARMACY -481.94",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-21af54036a36df2fe5a872a3,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-d9c31a705a7d2c5dddc450a7,synthetic_programmatic_template,flat,none,False,transaction_export
"2022 HSA Annual Summary Evergreen Health Savings Account holder Avery Larsen Account number ending in 8868 Cash balance 6,478.39 Invested balance 19,527.51 Employer
contributions $801.97 Employee contributions 2,498.40 Distributions
/ claims paid 3,430.39 Interest and earnings 242.08 Date Description Amount 2022-08-02 Card purchase Brightsmile Dental -323.15 2022-02-14 Interest 667.69 2022-08-11 Payroll contribution 343.06",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6c3b40687dc5d0910044aa3e,v11-HSA_ACCOUNT_STATEMENT-flat,original,2022,fgen-91bb06bfeddc1a4d0f66f4f2,synthetic_programmatic_template,flat,top,False,annual_summary
"Evergreen Health Savings Account holder Wei Brennan Account number XXXXX3134 Cash balance 8,953.28 Investcd balance S33,577.73 Employer contríbutions$594.44 Emp1oyee contributions 2,095.78 Distributions / claims paid $2,643.3l Interest and earnings 407.76 Date Description Amount 11/2/26 Interest 421.62 2026-10-19 Payroll contribution 574.78 09/25/2026 Claim reimbursement - 5ample FamilyClinic -719.53
07/01/2026
Card purchase CVS/PHARMACY -233.98 2026-01-05 Interest 793.41 2026 HSA Annual Summary",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8b9c5432cf3afd009480df65,v11-HSA_ACCOUNT_STATEMENT-flat,original,2026,fgen-751b9d0b20a7c6f0e7ed913a,synthetic_programmatic_template,flat,bottom,True,annual_summary
"2026 HSA Annual Summary Evergreen Health Savings Account holder Priya Romero Account
number ***-**-7617 Cash
balance 1,725.76 Invested balance $14,268.93 Employer contributions 394.00 Employee contributions $889.42 Distributions / claims paid $2,394.87 Interest and earnings 156.98 Date Description Amount 6/14/26 Interest 652.33 May 22, 2026 Card purchase CVS/PHARMACY -221.44 11/12/2026 Interest 495.34 This statement is not a Form 1099-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-92950a602d1604a303f33ef5,v11-HSA_ACCOUNT_STATEMENT-flat,original,2026,fgen-651ba7f25a35f3e738f024b4,synthetic_programmatic_template,flat,top,False,annual_summary
"HSA Claimsand Contributions Transaction Date Merchant
Category Amount Status Receipt 27/11/2025 SAMPLE FAMILYCLINIC Medica1 606.78 Pending Uploaded 19/06/2025 BRIGHTSMILE DENTAL Medical 853.56 Posted
Up1oaded 01/12/2025 SAMPLE FAMILY CLINIC Dental 789.56 Pendíng Uploaded 2025-02-28 CVS PHARMACY Vision 464.75 Posted Uploaded 09/07/2025 BRIGHTSMILE DENTAL Vision 197.13 Pending Missing 12/04/2025 BRIGHTSMILE DENTAL Dental 305.33 Pending Missing 2025-02-25 SAMPLE FAMILY CLINIC Medical 445.06 Pending Missing",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-333f2268c9552dce18fb6d09,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-12d691bc47972ea3682daa7d,synthetic_programmatic_template,flat,top,True,raw_export
"HSA
Activity
Date Description Type Amount Cash Balance 2025-04-07 Reimbursement to self Interest -565.89 6270.77 28/03/2025 Employer HSA contribution Distribution -453.29 7515.21 2025-10-07 HSA interest Interest -681.80 2061.07",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-353f7338bd646890012aa674,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-91e6cfc96c33e312528d6a56,synthetic_programmatic_template,flat,top,False,raw_export
"2023 HSA Annual Summary Evergreen Health Savings Account
holder Lena Patel Account number ending in 4961 Cash balance $6,471.86 Invested balance $31,787.29 Employer contributions 792.04 Employee contributions $2,101.19 Distributions / claims paid $228.87 Interest and earnings $834.19 Date Description
Amount 03/22/2023 Employer contribution 356.14 2/27/23 Payroll contribution 62.28 11/5/23 Card purchase CVS/PHARMACY -374.22",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-36cf5c90c0cfc946f3a71784,v11-HSA_ACCOUNT_STATEMENT-flat,original,2023,fgen-b49f4d8efdc978578f6b901a,synthetic_programmatic_template,flat,top,False,annual_summary
"Health Savings Account Statement Sample HSA Bank Account holder Morgan Sato Account number
XXX-XX-5041 Cash balance $7,404.86 Invested balance 18,994.21 Employer contributions $1,452.38
Employee contributions $2,889.02 Distributions / claims paid $27.44 Interest and earnings $486.16 Date Description Amount 8/3/26 Card purchase Brightsmile Dental -284.65 April 27, 2026 Employer contribution 185.32 January 10, 2026 Interest 355.99 1/19/26 Card purchase Brightsmile Dental -98.93 2026-05-20 Employer contribution 455.53 Tax reminder: amounts on this statement may differ from your Form 1099-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e06f7f165da56640269aac6f,v11-HSA_ACCOUNT_STATEMENT-flat,original,2026,fgen-3937826993d0813fe19a9175,synthetic_programmatic_template,flat,top,False,monthly
"2025 HSA Annual Summary Evergreen Health Savings Account holder Priya Fischer Account number XXXXX6035 Cash balance $6,567.26 Invested balance 34,989.59 Employer contributions 1,411.56 Employee contributions
$2,486.39 Distributions / claims paid $199.61 Interest and earnings 716.13 Date Description Amount April 28, 2025 Card purchase Brightsmile Dental -404.95 2025-06-21 Employer contribution 337.30 10/08/2025 Card purchase CVS/PHARMACY -80.32 04/28/2025 Card
purchase Brightsmile Dental -215.37 2025-09-11 Interest 772.20",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5d2498fcf17afa6eba0dc6fc,v11-HSA_ACCOUNT_STATEMENT-flat,original,2025,fgen-e6e6895e51ba4a6ae9441fb4,synthetic_programmatic_template,flat,top,False,annual_summary
"2022 HSA Annual Summary
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Amara R. Castillo |
| Account number | ***-**-7275 |
| Cash balance | 1,030.16 |
| Invested balance | $149.10 |
| Employer contributions | 1,328.54 |
| Employee contributions | $3,364.60 |
| Distributions / claims paid | 3,000.54 |
| Interest and earnings | 756.97 |
| Date | Description | Amount |
| --- | --- | --- |
| 2022-09-12 | Card purchase CVS/PHARMACY | -595.09 |
| 07/05/2022 | Payroll contribution | 673.57 |
| December 22, 2022 | Employer contribution | 550.91 |
| 10/16/22 | Card purchase CVS/PHARMACY | -364.72 |
## Tax reminder: amounts on this statement may differ from your Form 1099-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-15944558cb5e78dad20f7fde,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-c717a731358573308a9d2961,synthetic_programmatic_template,markdown,top,False,annual_summary
"Downloaded 2022-02-11
| Transaction Date | Merchant | Category | Amount | Status | Receipt |
| --- | --- | --- | --- | --- | --- |
| 08/03/2022 | VISION CENTER | Pharmacy | 544.51 | Posted | Missing |
| 2022-08-09 | BRIGHTSMILE DENTAL | Dental | 193.49 | Pending | Uploaded |
| 2022-02-21 | BRIGHTSMILE DENTAL | Dental | 649.20 | Posted | Uploaded |
| 07/03/2022 | BRIGHTSMILE DENTAL | Pharmacy | 811.12 | Pending | Uploaded |
| 06/17/2022 | BRIGHTSMILE DENTAL | Vision | 357.57 | Pending | Uploaded |
| 2022-08-06 | SAMPLE FAMILY CLINIC | Vision | 195.62 | Posted | Uploaded |
| 2022-01-26 | VISION CENTER | Medical | 152.23 | Pending | Uploaded |
| 16/03/2022 | BRIGHTSMILE DENTAL | Vision | 567.43 | Pending | Missing |
| 04/27/2022 | VISION CENTER | Dental | 402.47 | Pending | Missing |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ee70dcbbad56afb29848e97f,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-bbe1ba4dc8ef5f86890a2b01,synthetic_programmatic_template,markdown,none,False,raw_export
"Health Savings Account Statement
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Diego B. Okafor |
| Account number | XXX-XX-6669 |
| Cash balance | 8,579.21 |
| Invested balance | $35,960.32 |
| Employer contributions | 1,454.72 |
| Employee contributions | $3,962.71 |
| Distributions / claims paid | $2,980.14 |
| Interest and earnings | $474.95 |
| Date | Description | Amount |
| --- | --- | --- |
| 2022-09-04 | Card purchase Brightsmile Dental | -271.16 |
| 08/26/2022 | Payroll contribution | 551.56 |
| 07/20/2022 | Interest | 632.84 |
| 7/17/22 | Interest | 730.35 |
| 09/09/2022 | Card purchase CVS/PHARMACY | -261.94 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c38ec72b0d2a88d19af831db,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-2b6400a3b327b04c1dd2f4de,synthetic_programmatic_template,markdown,top,False,monthly
"Health Savings Account Statement
## Sample HSA Bank
| Field | Value |
| --- | --- |
| Account holder | Noah Haddad |
| Account number | XXX-XX-3346 |
| Cash balance | 1,509.79 |
| Invested balance | $3,880.72 |
| Employer contributions | 1,361.06 |
| Employee contributions | 3,180.71 |
| Distributions / claims paid | 3,771.15 |
| Interest and earnings | 690.13 |
| Date | Description | Amount |
| --- | --- | --- |
| 3/12/22 | Claim reimbursement - Sample Family Clinic | -491.67 |
| 07/01/2022 | Claim reimbursement - Sample Family Clinic | -248.01 |
| 2022-06-27 | Employer contribution | 718.70 |
| 2/14/22 | Interest | 282.36 |
| April 3, 2022 | Interest | 400.20 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4486c04291e5932357234f82,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-eff8c87c7a0487b939f65be9,synthetic_programmatic_template,markdown,top,False,monthly
"HSA Transaction History
## Northwind HSA Custodian
| Fie1d | Value |
| --- | --- |
| Account holder | Sofia J. Castillo |
| Account number | XXX-XX-9287 |
| Date | Description | Amount |
| --- | --- | --- |
| 2024-09-l8 |Employer contribution | 419.58 |
| March 20, 2024| Employer contribution | 60.77 |
| 3/27/24 | Card purchase Brightsmile Dental | -646.94 |
| March 2, 2024 | Claim reimbursement - 5ample Family Clinic | -235.09 |
| 2024-l1-22 | Card purchase Brightsmile Dental | -214.73 |
This statement is not a Form 5498-5A.Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b3ec85f3959ce34a2bda96e3,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2024,fgen-5dd785f67619d7bea95922ef,synthetic_programmatic_template,markdown,top,True,transaction_export
"## Health Savings Account Statement
Northwind HSA Custodian
| Field | Value |
| --- | --- |
| Account holder | Sofia Brennan |
| Account number | XXXXX6737 |
| Cash balance | $5,970.98 |
| Invested balance | 27,192.55 |
| Employer contributions | $64.13 |
| Employee contributions | $3,097.11 |
| Distributions / claims paid | $2,927.19 |
| Interest and earnings | $146.24 |
| Date | Description | Amount |
| --- | --- | --- |
| 8/24/24 | Claim reimbursement - Sample Family Clinic | -583.95 |
| 6/8/24 | Payroll contribution | 85.36 |
| 02/20/2024 | Employer contribution | 258.74 |
| 2024-02-08 | Interest | 616.02 |
| 06/27/2024 | Interest | 78.84 |
## This statement is not a Form 1099-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-79afed809bbb2f49abaa1d6f,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2024,fgen-84d7358a0a95e2c4b0013cf5,synthetic_programmatic_template,markdown,top,False,monthly
"HSA Transaction History
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Jordan Okafor |
| Account number | ***-**-5886 |
| Date | Description | Amount |
| --- | --- | --- |
| 04/01/2024 | Card purchase CVS/PHARMACY | -62.80 |
| 08/20/2024 | Card purchase CVS/PHARMACY | -597.73 |
| October 28, 2024 | Payroll contribution | 348.04 |
| 9/15/24 | Payroll contribution | 619.34 |
| 12/14/2024 | Card purchase Brightsmile Dental | -669.02 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-311648056f3df7baa8bf7667,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2024,fgen-eb66c4f04eb65999208ca055,synthetic_programmatic_template,markdown,top,False,transaction_export
"## HSA Transaction History
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Casey M. Larsen |
| Account number | XXX-XX-5314 |
| Date | Description | Amount |
| --- | --- | --- |
| 07/14/2025 | Payroll contribution | 614.64 |
| 2025-03-16 | Employer contribution | 788.86 |
| 2025-11-24 | Employer contribution | 393.00 |
| May 9, 2025 | Interest | 473.57 |
| 2025-01-19 | Employer contribution | 230.01 |
| April 7, 2025 | Card purchase Brightsmile Dental | -511.16 |
This statement is not a Form 5498-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e36724c9f199674f2a921884,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2025,fgen-091b243770207050b5b5f9b8,synthetic_programmatic_template,markdown,top,False,transaction_export
"Health Savings Account Statement
Northwind HSA Custodian
| Field | Value |
| --- | --- |
| Account holder | Jordan M. Castillo |
| Account number | ****5641 |
| Cash balance | $3,080.34 |
| Invested balance | $36,356.73 |
| Employer contributions | 1,063.41 |
| Employee contributions | 1,980.06 |
| Distributions / claims paid | 3,171.65 |
| Interest and earnings | 544.83 |
| Date | Description | Amount |
| --- | --- | --- |
| 04/18/2022 | Interest | 339.88 |
| 11/2/22 | Claim reimbursement - Sample Family Clinic | -210.60 |
| 2022-12-22 | Card purchase Brightsmile Dental | -649.07 |
| 2022-04-19 | Employer contribution | 483.44 |
| 2022-04-23 | Payroll contribution | 140.17 |
IRS Form 5498-SA information for 2022 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2073274b540d686e565ac5a9,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-0217a9ae2e2e1748059e80a7,synthetic_programmatic_template,markdown,top,False,monthly
"HSA Activity
Downloaded 28/06/2022
| Date | Description | Type | Amount | Cash Balance |
| --- | --- | --- | --- | --- |
| 2022-09-10 | Reimbursement to self | Transfer | 655.99 | 6034.06 |
| 2022-08-23 | Employer HSA contribution | Interest | 772.61 | 2497.41 |
| 14/01/2022 | Payroll contribution | Contribution | 289.41 | 1402.02 |
| 20/09/2022 | Employer HSA contribution | Interest | 838.97 | 778.61 |
| 10/09/2022 | Card purchase - Pharmacy | Transfer | 10.09 | 6922.44 |
| 04/13/2022 | HSA interest | Contribution | 191.84 | 2517.80 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a3d5564f510ff1f56cadc03b,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-4fadf1b6070bd76bed95d6b1,synthetic_programmatic_template,markdown,top,False,raw_export
"| Date | Description | Type | Amount | Cash Balance |
| --- | --- | --- | --- | --- |
| 11/02/2023 | Card purchase - Pharmacy | Transfer | 417.42 | 3222.47 |
| 2023-10-26 | Transfer to HSA investments | Distribution | -29.40 | 2923.45 |
| 16/05/2023 | Card purchase - Pharmacy | Distribution | 134.17 | 11374.79 |
| 08/03/2023 | HSA interest | Transfer | -440.80 | 8662.39 |
| 03/23/2023 | Payroll contribution | Transfer | 526.74 | 11441.71 |
## HSA Claims and Contributions",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b7f73875df4739e17a72c37c,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2023,fgen-55c0d8406976f4c61e3bb46d,synthetic_programmatic_template,markdown,bottom,False,raw_export
"Health Savings Account Statement
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Hiro Nguyen |
| Account number | XXX-XX-6635 |
| Cash ba1ance | 3,926.65 |
| Invested balance | 25,374.21 |
| Employer contributions | l,298.98 |
| Employee contributions | 3,3lO.57 |
| Distributions /daims paid | 3,302.42 |
| Interest and carnings | $781.19 |
| Datc | Description | Amount |
| --- | --- | --- |
| 09/23/2023 | Claim reimbursement - 5ample Family Clinic | -678.36 |
| 01/04/2023 | Card purchase Brightsmile Dental | -169.80 |
| 05/14/2023| Payroll contribution | 394.92 |
| 2023-07-26 | Employer contribution | 717.28|
| 2023-02-09 | Payroll contribution | 594.75 |
IR5 Form 5498-SA information for 2023 will bcmailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-679fd7dd38b71214255e420c,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2023,fgen-683af0db733eaade442cf323,synthetic_programmatic_template,markdown,top,True,monthly
"## HSA Transaction History
Northwind HSA Custodian
| Field | Value |
| --- | --- |
| Account holder | Wei Larsen |
| Account number | ****8438 |
| Date | Description | Amount |
| --- | --- | --- |
| 3/4/25 | Card purchase CVS/PHARMACY | -613.46 |
| 3/21/25 | Interest | 34.83 |
| 06/17/2025 | Claim reimbursement - Sample Family Clinic | -175.40 |
| 9/2/25 | Payroll contribution | 665.75 |
Tax reminder: amounts on this statement may differ from your Form 5498-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-12d942a3b4c1e5549326a280,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2025,fgen-32a1bf8b97c17cd4299893db,synthetic_programmatic_template,markdown,top,False,transaction_export
"Health Savings Account Statement
## Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Wei Tanaka |
| Account number | ending in 8548 |
| Cash balance | $3,114.76 |
| Invested balance | 7,294.53 |
| Employer contributions | $549.76 |
| Employee contributions | $3,962.42 |
| Distributions / claims paid | $1,712.67 |
| Interest and earnings | 373.93 |
| Date | Description | Amount |
| --- | --- | --- |
| 5/19/22 | Card purchase CVS/PHARMACY | -460.54 |
| 3/27/22 | Card purchase CVS/PHARMACY | -521.72 |
| 3/21/22 | Interest | 5.82 |
| May 21, 2022 | Interest | 114.93 |
| December 28, 2022 | Employer contribution | 335.12 |
Your 2022 Form 5498-SA will be available online by January 31, 2023.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bb1b6fe7c6b72002715bdd3e,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-d082fd63be5a820195ce8b6e,synthetic_programmatic_template,markdown,top,False,monthly
"## HSA Activity
## Downloaded 07/13/2021
| Date | Description | Type | Amount | Cash Balance |
| --- | --- | --- | --- | --- |
| 12/08/2021 | Employer HSA contribution | Distribution | -549.51 | 6866.38 |
| 2021-04-10 | Employer HSA contribution | Interest | -419.11 | 11938.21 |
| 2021-07-27 | Reimbursement to self | Contribution | 841.61 | 6877.31 |
| 08/22/2021 | Reimbursement to self | Transfer | 892.52 | 3788.72 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-83a3c946e61b595277626250,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2021,fgen-e9c428332c76990892733cd3,synthetic_programmatic_template,markdown,top,False,raw_export
"## Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Riley Tanaka |
| Account number | XXXXX5595 |
| Cash balance | $7,502.73 |
| Invested balance | 20,546.64 |
| Employer contributions | 1,099.56 |
| Employee contributions | 1,835.18 |
| Distributions / claims paid | 3,468.07 |
| Interest and earnings | 308.63 |
| Date | Description | Amount |
| --- | --- | --- |
| 8/1/25 | Card purchase CVS/PHARMACY | -716.65 |
| 2025-08-06 | Employer contribution | 48.84 |
| 1/4/25 | Interest | 26.74 |
Tax reminder: amounts on this statement may differ from your Form 1099-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-19dc5439519278c9c66d01e8,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2025,fgen-410f3adf1c2c7831d5684df0,synthetic_programmatic_template,markdown,none,False,monthly
"Evergreen Health Savings
| Field | Value |
| --- | --- |
| Accountholder | Mateo A. Castillo |
| Account numbcr | XXX-XX-9073 |
| Cash balance | 2,617.49 |
| Invested balance | $18,747.62 |
| Employer contributions | $172.17 |
| Employee contributions | 31O.82 |
| Dístributions / daims paid |$2,930.47 |
| Interest and eamings | 55.06 |
| Date | Description | Amount |
| --- | --- | --- |
| 11/12/26 | Card purchase Brightsmile Dental | -658.86 |
| September 13,2026 | Card purchase Brightsmile Dental | -93.23 |
| Novcmber 17, 2026 | Payroll contribution | 256.04 |
| 2026-05-18 | Payroll contribution |695.24 |
| May 26, 2026 | Interest | 44.69 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-96c88f7ad00823a67228e32c,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2026,fgen-69d84b62d3000e051659299f,synthetic_programmatic_template,markdown,none,True,annual_summary
"## HSA Transaction History
Northwind HSA Custodian
| Field | Value |
| --- | --- |
| Account holder | Amara K. Patel |
| Account number | ending in 7891 |
| Date | Description | Amount |
| --- | --- | --- |
| 2023-02-05 | Card purchase Brightsmile Dental | -305.24 |
| 7/11/23 | Payroll contribution | 513.44 |
| 2023-03-10 | Card purchase CVS/PHARMACY | -490.85 |
| 4/26/23 | Employer contribution | 560.33 |
| 2023-06-15 | Interest | 468.99 |
| 2023-03-19 | Interest | 349.65 |
Your 2023 Form 1099-SA will be available online by January 31, 2024.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3f7aae0f5ab53e38ace1d0db,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2023,fgen-ad574205759754ebf667d2f1,synthetic_programmatic_template,markdown,top,False,transaction_export
"## 2022 HSA Annual Summary
Sample HSA Bank
| Field | Value |
| --- | --- |
| Account holder | Priya Adeyemi |
| Account number | ending in 7682 |
| Cash balance | 8,720.37 |
| Invested balance | $5,905.80 |
| Employer contributions | $267.95 |
| Employee contributions | $4,274.03 |
| Distributions / claims paid | 1,125.28 |
| Interest and earnings | 428.37 |
| Date | Description | Amount |
| --- | --- | --- |
| December 26, 2022 | Payroll contribution | 277.93 |
| 2022-11-05 | Card purchase Brightsmile Dental | -195.66 |
| 10/18/2022 | Payroll contribution | 458.95 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-55b3a94df27213dd716ce752,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-80fda1eb79e496696c15f6ac,synthetic_programmatic_template,markdown,top,False,annual_summary
"HSA Transaction History
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Kwame Rivera |
| Account number | XXXXX2166 |
| Date | Description | Amount |
| --- | --- | --- |
| 01/26/2026 | Employer contribution | 749.73 |
| September 28, 2026 | Card purchase Brightsmile Dental | -292.00 |
| November 4, 2026 | Card purchase Brightsmile Dental | -652.88 |
| October 28, 2026 | Card purchase Brightsmile Dental | -35.98 |
| 08/11/2026 | Card purchase Brightsmile Dental | -678.26 |
Your 2026 Form 1099-SA will be available online by January 31, 2027.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c5aa2aad7622cb3870f6a95b,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2026,fgen-d853c60d0bcbbffad05aae66,synthetic_programmatic_template,markdown,top,False,transaction_export
"Health Savings Account Statement
Northwind HSA Custodian
| Field | Value |
| --- | --- |
| Account holder | Sofia Tanaka |
| Account number | XXXXX1443 |
| Cash balance | $1,213.23 |
| Invested balance | $646.54 |
| Employer contributions | 1,283.92 |
| Employee contributions | 702.12 |
| Distributions / claims paid | $1,461.67 |
| Interest and earnings | 151.90 |
| Date | Description | Amount |
| --- | --- | --- |
| October 2, 2024 | Card purchase Brightsmile Dental | -634.73 |
| January 12, 2024 | Card purchase Brightsmile Dental | -400.90 |
| 11/22/24 | Employer contribution | 143.44 |
| 09/12/2024 | Interest | 727.32 |
This statement is not a Form 1099-SA. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a721d055a3b95e5800db639e,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2024,fgen-94e43db573e8411fa5837077,synthetic_programmatic_template,markdown,top,False,monthly
"Sample HSA Bank
| Field | Value |
| --- | --- |
| Account holder | Hiro Adeyemi |
| Account number | ****0321 |
| Cash balance | $2,099.09 |
| Invested balance | $34,771.14 |
| Employer contributions | $1,007.30 |
| Employee contributions | 2,327.78 |
| Distributions / claims paid | 355.23 |
| Interest and earnings | $400.69 |
| Date | Description | Amount |
| --- | --- | --- |
| 06/21/2022 | Payroll contribution | 66.31 |
| 03/05/2022 | Claim reimbursement - Sample Family Clinic | -78.11 |
| 12/20/22 | Interest | 384.06 |
| December 8, 2022 | Payroll contribution | 38.21 |
| 6/3/22 | Payroll contribution | 480.65 |
| 2022-10-03 | Claim reimbursement - Sample Family Clinic | -592.52 |
Health Savings Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-532e5f3bddbe801d0c358866,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-12539bcfee2c8d9f5b3566ce,synthetic_programmatic_template,markdown,bottom,False,monthly
"HSA Transaction History
Sample HSA Bank
| Field | Value |
| --- | --- |
| Account holder | Alex Moreau |
| Account number | ****9955 |
| Date | Description | Amount |
| --- | --- | --- |
| 2025-03-22 | Employer contribution | 427.70 |
| 2025-11-26 | Card purchase CVS/PHARMACY | -118.01 |
| 08/02/2025 | Employer contribution | 361.14 |
| 2025-03-16 | Employer contribution | 12.61 |
| 12/18/25 | Card purchase Brightsmile Dental | -236.98 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7edb5282540fd03a4f9f6a78,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2025,fgen-e687a1f324bdd607153f1c4f,synthetic_programmatic_template,markdown,top,False,transaction_export
"HSA Transaction History
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Kwame Okafor |
| Account number | ****3195 |
| Date | Description | Amount |
| --- | --- | --- |
| May 15, 2025 | Interest | 238.31 |
| 2025-08-16 | Card purchase CVS/PHARMACY | -354.32 |
| 2025-04-24 | Payroll contribution | 523.66 |
| 6/3/25 | Payroll contribution | 334.81 |
| 9/10/25 | Payroll contribution | 569.94 |
| 06/25/2025 | Card purchase Brightsmile Dental | -721.46 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d00bb020dd9a792d5b905cad,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2025,fgen-fb94f42c1080f875f6c99b9b,synthetic_programmatic_template,markdown,top,False,transaction_export
"HSA Transaction History
Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Jordan K. Okafor |
| Account number | XXXXX1755 |
| Date | Description | Amount |
| --- | --- | --- |
| December 7, 2022 | Interest | 733.05 |
| 11/27/2022 | Payroll contribution | 628.82 |
| 2022-03-16 | Interest | 56.10 |
IRS Form 1099-SA information for 2022 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-533daac05dbd5e945ff5b61e,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2022,fgen-696f80c81b3e73b30bc1084d,synthetic_programmatic_template,markdown,top,False,transaction_export
"| Transaction Date | Merchant | Category | Amount | Status | Receipt |
| --- | --- | --- | --- | --- | --- |
| 2023-08-19 | CVS PHARMACY | Pharmacy | 595.93 | Posted | Uploaded |
| 02/04/2023 | CVS PHARMACY | Medical | 342.87 | Pending | Uploaded |
| 10/01/2023 | SAMPLE FAMILY CLINIC | Dental | 678.02 | Posted | Uploaded |
| 2023-11-09 | BRIGHTSMILE DENTAL | Vision | 332.99 | Pending | Uploaded |
| 20/01/2023 | SAMPLE FAMILY CLINIC | Dental | 673.43 | Posted | Missing |
| 2023-04-07 | CVS PHARMACY | Vision | 652.61 | Posted | Missing |
| 19/06/2023 | VISION CENTER | Pharmacy | 43.46 | Pending | Uploaded |
| 03/21/2023 | VISION CENTER | Medical | 349.63 | Posted | Missing |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-016d05b03d4acf5f16ad312f,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2023,fgen-ce3475009b7e7fdb9d74258a,synthetic_programmatic_template,markdown,none,False,raw_export
"## 2024 HSA Annual Summary
Sample HSA Bank
| Field | Value |
| --- | --- |
| Account holder | Alex Patel |
| Account number | ****8817 |
| Cash balance | 4,753.02 |
| Invested balance | $19,656.69 |
| Employer contributions | $686.24 |
| Employee contributions | $1,414.81 |
| Distributions / claims paid | $2,384.10 |
| Interest and earnings | $667.07 |
| Date | Description | Amount |
| --- | --- | --- |
| 2024-11-11 | Interest | 570.90 |
| February 4, 2024 | Card purchase Brightsmile Dental | -494.48 |
| 2024-10-25 | Payroll contribution | 601.59 |
| April 28, 2024 | Card purchase CVS/PHARMACY | -745.34 |
Your 2024 Form 1099-SA will be available online by January 31, 2025.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-387cdcee027455adcdf3a32f,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2024,fgen-a81094f6e3664f94f9bd87ba,synthetic_programmatic_template,markdown,top,False,annual_summary
"| Date | Description | Type | Amount | Cash Balance |
| --- | --- | --- | --- | --- |
| 22/10/2026 | HSA interest | Transfer | 531.56 | 1973.18 |
| 2026-05-09 | Transfer to HSA investments | Distribution | 521.05 | 10299.91 |
| 23/01/2026 | Transfer to HSA investments | Contribution | 129.56 | 2432.05 |
| 12/17/2026 | Payroll contribution | Transfer | 128.72 | 1452.43 |
| 2026-04-15 | HSA interest | Contribution | 458.46 | 8125.43 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f3f19b7a147c008a6731515e,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2026,fgen-79bd1e157ad7c1bb6cdd2327,synthetic_programmatic_template,markdown,none,False,raw_export
"## Health Savings Account ...4606 transactions
| Date | Description | Type | Amount | Cash Balance |
| --- | --- | --- | --- | --- |
| 2021-03-10 | Reimbursement to self | Contribution | 30.07 | 8318.42 |
| 04/17/2021 | Payroll contribution | Transfer | 45.61 | 6695.72 |
| 09/13/2021 | Transfer to HSA investments | Contribution | 412.10 | 10193.28 |
| 2021-10-15 | Transfer to HSA investments | Contribution | -358.69 | 8248.93 |
| 02/22/2021 | Payroll contribution | Interest | 676.44 | 5679.45 |
| 05/12/2021 | Payroll contribution | Distribution | 480.84 | 10464.64 |
| 14/09/2021 | Card purchase - Pharmacy | Contribution | -659.41 | 3997.09 |
| 2021-07-26 | Card purchase - Pharmacy | Transfer | 149.92 | 1524.93 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-44292c7a7779658a891f064d,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2021,fgen-bbe7ff3e381eab8413fe9c69,synthetic_programmatic_template,markdown,top,False,raw_export
"## Health Savings Account Statement
## Evergreen Health Savings
| Field | Value |
| --- | --- |
| Account holder | Jordan Nguyen |
| Account number | XXX-XX-7670 |
| Cash balance | $2,741.71 |
| Invested balance | $9,813.21 |
| Employer contributions | $738.09 |
| Employee contributions | $581.38 |
| Distributions / claims paid | 3,508.90 |
| Interest and earnings | $764.27 |
| Date | Description | Amount |
| --- | --- | --- |
| 10/27/2026 | Employer contribution | 112.71 |
| 8/6/26 | Card purchase Brightsmile Dental | -468.04 |
| 2026-02-02 | Interest | 511.62 |
| 2026-04-06 | Payroll contribution | 712.03 |
| 3/14/26 | Card purchase CVS/PHARMACY | -511.32 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e639fe290374290813968c7d,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2026,fgen-ddbade95566e376ce480f7d6,synthetic_programmatic_template,markdown,top,False,monthly
"Sample HSA Bank
| Field | Value |
| --- | --- |
| Account holder | Olivia A. Lindqvist |
| Account number | XXX-XX-5805 |
| Cash balance | 4,029.55 |
| Invested balance | $13,173.61 |
| Employer contributions | $1,426.38 |
| Employee contributions | $1,255.83 |
| Distributions / claims paid | $1,208.78 |
| Interest and earnings | $760.95 |
| Date | Description | Amount |
| --- | --- | --- |
| 2026-06-07 | Employer contribution | 171.52 |
| 2026-01-28 | Claim reimbursement - Sample Family Clinic | -241.86 |
| 2/16/26 | Payroll contribution | 667.10 |
| 2026-03-06 | Card purchase Brightsmile Dental | -213.77 |
| 8/19/26 | Employer contribution | 364.95 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6b456c80d940e1437e37647b,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2026,fgen-6aa376f73ba93e74f3782c4a,synthetic_programmatic_template,markdown,none,False,monthly
"HSA Transaction History
Sample HSA Bank
| Field | Value |
| --- | --- |
| Account holder | Sofia Tanaka |
| Account number | XXX-XX-2990 |
| Date | Description | Amount |
| --- | --- | --- |
| September 15, 2025 | Card purchase Brightsmile Dental | -593.00 |
| 07/12/2025 | Employer contribution | 714.26 |
| July 15, 2025 | Payroll contribution | 352.73 |
| 2025-11-08 | Payroll contribution | 400.23 |
| 4/1/25 | Claim reimbursement - Sample Family Clinic | -511.57 |
## Tax reminder: amounts on this statement may differ from your Form 1099-SA.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cf257b21e2751f701a1981fe,v11-HSA_ACCOUNT_STATEMENT-markdown,original,2025,fgen-9a5aebd659925ee06efec54b,synthetic_programmatic_template,markdown,top,False,transaction_export
"Annual Policy Statement - Universal Life
Sample Mutual Insurance
Policy number
UL5554421
Insured
FatimaBrennan
Death benefit
$967,323.48
Premiums paid this year
$7,803.94
Cash value
$44,506.97
Cost of insurance charges
$484.17",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-e700c51fb15267364783c5c1,v11-INSURANCE_DOCUMENT-stacked,original,2022,fgen-be2ae01dcdc4081b7411b12a,synthetic_programmatic_template,stacked,top,True,life_annual
"Sample Mutual Insurance
Policy number
HO-106058
Residence premises
1130 Sample Street Bayside, WA 84442
Coverage A - Dwelling
$536,941.88
Coverage E - Personal liability
$300,000
All other perils deductible
$1,000
Annual premium
$3,834.85
Mortgagee
Bluewater Loan Servicing
Homeowners Policy Declarations",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-9057e1c340be5dcddfe490cb,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-b5cd7afcd97aa5b4aee24041,synthetic_programmatic_template,stacked,bottom,False,home_declarations
"Auto Policy Declarations
Granite Auto Insurance Co.
Policy number
PA-809200
Policy period
2023-05-16 to 03/06/2024
Named insured
Wei Okafor
Vehicle
2021 Honda Civic
Bodily injury liability
$100,000 / $300,000
Collision deductible
$500
Six-month premium
$805.38",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-5b1b63054cd88b20a9f0ab37,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-65d1a06996de786fdc2104f6,synthetic_programmatic_template,stacked,top,False,auto_declarations
"Explanation of Benefits
Evergreen Health Plan
THIS IS NOT A BILL
Member
Fatima Fischer
Claim number
1269245684
Provider
Riverside Urgent Care
Date of service
June 28, 2026
Amount billed  Plan discount  Plan paid  You may owe
2,797.06
839.12
1,398.53
559.41
Deductible met year to date
$2,973.95",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ffa499666c0ee70d20d02cd0,v11-INSURANCE_DOCUMENT-stacked,original,2026,fgen-12b4cfc93ac30f0601bc4ea0,synthetic_programmatic_template,stacked,top,False,eob
"Auto Policy Declarations
Sample Mutual Insurance
Policy number
PA-826374
Policy period
12/26/26 to 2027-10-14
Named insured
Taylor Kowalski
Vehicle
2021 Honda Civic
Bodily injury liability
$100,000 / $300,000
Collision deductible
$500
Six-month premium
$325.85
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-16b20abca6e4a59a3fd002bb,v11-INSURANCE_DOCUMENT-stacked,original,2026,fgen-26a2da0575356548992f0862,synthetic_programmatic_template,stacked,top,False,auto_declarations
"Explanation of Benefits
Evergreen Health Plan
THIS IS N0T A BILL
Member
Lena Moreau
Claím number
58654l5l34
Provider
Sample Family Clinic
Date of service
5/12/24
Amount billed  Plan discount  Plan paid  You may owe
3,376.75
1,O13.02
1,688.37
675.35
Deductib1e met year to date
$2,375.70
Health coverage information forms (1095) are issued separately whenrequired.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-cd52f6c77ff3f8d244183649,v11-INSURANCE_DOCUMENT-stacked,original,2024,fgen-7386d4ec5b5cb6731ab749b4,synthetic_programmatic_template,stacked,top,True,eob
"Homeowners Policy Declarations
Granite Auto Insurance Co.
Policy number
HO-812259
Residence premises
3980 Willow Bend Way Bayside, WA 62369
Coverage A - Dwelling
$424,804.45
Coverage E - Personal liability
$300,000
All other perils deductible
$1,000
Annual premium
$2,489.08
Mortgagee
Riverbend Mortgage Servicing",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-8956e40fbc508292e30623ee,v11-INSURANCE_DOCUMENT-stacked,original,2022,fgen-943015f47f80ec486a8cead7,synthetic_programmatic_template,stacked,top,False,home_declarations
"Premium Due Notice
Sample Mutual Insurance
Policy number
71527400
Policyholder
Kwame Testcase
Amount due
$1,468.10
Due date
2021-10-25
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-e0381b96b22a4389cf67f69f,v11-INSURANCE_DOCUMENT-stacked,original,2021,fgen-ce65ca5d631da0bbe566a81b,synthetic_programmatic_template,stacked,top,False,premium_notice
"Harbor Life Assurance
Policy number
UL6196682
Insured
Diego D. Patel
Death benefit
$874,721.57
Premiums paid this year
$8,435.52
Cash value
$40,289.04
Cost of insurance charges
$1,206.03
Annual Policy Statement - Universal Life",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-fa30a1a3ce35c40c4361b8b3,v11-INSURANCE_DOCUMENT-stacked,original,2025,fgen-87a1df79d6a98428a48ea656,synthetic_programmatic_template,stacked,bottom,False,life_annual
"Premium Due Notice
Harbor Life Assurance
Policy number
38336040
Policyholder
Olivia C. Fischer
Amount due
$563.47
Due date
2022-08-03
Pay online to avoid a lapse in coverage.
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-8292353db1e98d614c4e2a55,v11-INSURANCE_DOCUMENT-stacked,original,2022,fgen-59512aecc56809141c6ea3fa,synthetic_programmatic_template,stacked,top,False,premium_notice
"Homeowners Policy Declarations
Sample Mutual Insurance
Policy number
HO-381460
Residence premises
7696 Prairie Ave Cedar Falls, IA 75377
Coverage A - Dwelling
$367,388.97
Coverage E - Personal liability
$300,000
All other perils deductible
$1,000
Annual premium
$5,075.54
Mortgagee
Riverbend Mortgage Servicing",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-2abe8731f26bf0f4fbe127a2,v11-INSURANCE_DOCUMENT-stacked,original,2026,fgen-0ba414f0ffad4cc7659822b4,synthetic_programmatic_template,stacked,top,False,home_declarations
"Sample Mutual Insurance
THIS IS NOT A BILL
Member
Alex Testcase
Claim number
6839502418
Provider
Brightsmile Dental Group
Date of service
08/14/2021
Amount billed  Plan discount  Plan paid  You may owe
1,995.09
598.53
997.54
399.02
Deductible met year to date
$2,441.40
Explanation of Benefits",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ad1b6e30c9989049917725a0,v11-INSURANCE_DOCUMENT-stacked,original,2021,fgen-5e54093e74fe67d3917f89bb,synthetic_programmatic_template,stacked,bottom,False,eob
"Premium Due Notice
Granite Auto Insurance Co.
Policy number
25038774
Policyholder
Wei Testcase
Amount due
$2,390.4l
Due date
9/4/23
Pay online to avoid a lapse incoverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-dd49ec075d4d4abae5bdf528,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-a689fa8ecc306229554e15aa,synthetic_programmatic_template,stacked,top,True,premium_notice
"Harbor Life Assurance
THIS IS NOT A BILL
Member
Sofia R. Kowalski
Claim number
8445933887
Provider
Lakeshore Pharmacy
Date of service
5/13/23
Amount billed  Plan discount  Plan paid  You may owe
3,899.17
1,169.75
1,949.58
779.83
Deductible met year to date
$1,265.82",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-c996f4ce8e178510c3a1cf31,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-1f7a5f42c9f38dec4f3dbb3c,synthetic_programmatic_template,stacked,none,False,eob
"Auto Policy Declarations
Evergreen Health Plan
Policy number
PA-147244
Policy period
2025-09-22 to 1/16/26
Named insured
Lena Romero
Vehicle
2023 Ford F-150
Bodily injury liability
$100,000 / $300,000
Collision deductible
$500
Six-month premium
$1,662.74",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-1ff02ba34f3219bd9319ed38,v11-INSURANCE_DOCUMENT-stacked,original,2025,fgen-f2e638166873df58f47a8862,synthetic_programmatic_template,stacked,top,False,auto_declarations
"Auto Policy Declarations
Harbor Life Assurance
Policy number
PA-822243
Policy period
August 26, 2021 to 10/08/2022
Named insured
Sofia C. Moreau
Vehicle
2017 Subaru Outback
Bodily injury liability
$100,000 / $300,000
Collision deductible
$500
Six-month premium
$1,492.49",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-3d909362c8e86266727bcb3e,v11-INSURANCE_DOCUMENT-stacked,original,2021,fgen-c5ab287479e1d6467ba5fd79,synthetic_programmatic_template,stacked,top,False,auto_declarations
"Explanation of Benefits
Evergreen Health Plan
THIS IS NOT A BILL
Member
Fatima S. Tanaka
Claim number
1107548367
Provider
Riverside Urgent Care
Date of service
12/05/2023
Amount billed  Plan discount  Plan paid  You may owe
1,542.44
462.73
771.22
308.49
Deductible met year to date
$488.95",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-3e3ba6cb604fc8a9b980e0a7,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-e098008fdf31889eef9870b0,synthetic_programmatic_template,stacked,top,False,eob
"Granite Auto Insurance Co.
THIS IS NOT A BILL
Member
Jordan S. Testcase
Claim number
4706062860
Provider
Brightsmile Dental Group
Date of service
10/25/21
Amount billed  Plan discount  Plan paid  You may owe
3,838.11
1,151.43
1,919.05
767.62
Deductible met year to date
$1,696.60",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-16c98f8d073dd2f57fd9212f,v11-INSURANCE_DOCUMENT-stacked,original,2021,fgen-ded4ba0bf1b0744d497dffac,synthetic_programmatic_template,stacked,none,False,eob
"Evergreen Health Plan
Policy number
PA-757691
Policy period
2023-05-04 to 2024-03-27
Named insured
Wei Tanaka
Vehicle
2018 Toyota Corolla
Bodily injury liability
$100,000 / $300,000
Collision deductible
$500
Six-month premium
$300.39",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-d53c1b8ae0934259184a1fdc,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-401beb4f15923b67cdda25ca,synthetic_programmatic_template,stacked,none,False,auto_declarations
"Evergreen Health Plan
Policy number
UL9836717
Insured
Lena Walsh
Death benefit
$480,145.54
Premiums paid this year
$8,979.81
Cash value
$7,532.12
Cost of insurance charges
$1,705.39
Annual Policy Statement - Universal Life",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-62ae2ad7c05bb2e7b25db50b,v11-INSURANCE_DOCUMENT-stacked,original,2026,fgen-e0d54471eab412bf01daf0fd,synthetic_programmatic_template,stacked,bottom,False,life_annual
"Granite Auto Insurance Co.
THIS IS NOT A BILL
Member
Jamíe R. Adeyemi
Claim number
4331172534
Provider
Lakeshore Pharmacy
Date of service
11/18/25
Amount billed  Plan discount  Plan paíd You may owe
l,748.81
524.64
874.40
349.76
Deductible met year to date
$859.87
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ee9f56c9e89cf2dcfe0df62f,v11-INSURANCE_DOCUMENT-stacked,original,2025,fgen-fe4c8082a184a92e75a61689,synthetic_programmatic_template,stacked,none,True,eob
"Homeowners Policy Declarations
Harbor Life Assurance
Policy number
HO-542655
Residence premises
4804 Granite St Brookhaven, PA 23532
Coverage A - Dwelling
$483,446.48
Coverage E - Personal liability
$300,000
All other perils deductible
$1,000
Annual premium
$2,207.51
Mortgagee
Keystone Home Loans",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-860635f12cf3f536cc3239ad,v11-INSURANCE_DOCUMENT-stacked,original,2025,fgen-88cf132913bd2f79eb3e9d68,synthetic_programmatic_template,stacked,top,False,home_declarations
"Evergreen Hea1thPlan
Policy number
UL4611518
Insured
Casey Fischer
Death benefit
S395,189.20
Premiums paid this year
$2,292.84
Cash value
$55,273.29
Cost of ínsurance charges
$1,433.57
Annual Policy Statement - Universal Life",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b34385555106d9418818fccd,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-84ede0d9b799419e3a34cbe3,synthetic_programmatic_template,stacked,bottom,True,life_annual
"Explanation of Benefits
Harbor Life Assurance
THIS IS NOT A BILL
Member
Morgan Tanaka
Claim number
6864412409
Provider
Brightsmile Dental Group
Date of service
9/4/23
Amount billed  Plan discount  Plan paid  You may owe
2,582.67
774.80
1,291.33
516.53
Deductible met year to date
$605.97",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-d37525455839ccb1f58a194d,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-e24fa0cf50d800c6a74df51c,synthetic_programmatic_template,stacked,top,False,eob
"Homeowners Policy Declarations
Evergreen Health Plan
Policy number
HO-259287
Residence premises
5951 Oak Hollow Ct Riverton, WI 61312
Coverage A - Dwelling
$679,837.52
Coverage E - Personal liability
$300,000
All other perils deductible
$1,000
Annual premium
$1,570.69
Mortgagee
Lakeshore Home Lending",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-a7b2820c351bddca53ccf266,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-fd0f965e01ce0bb1de405195,synthetic_programmatic_template,stacked,top,False,home_declarations
"Homeowners Policy Declarations
Evergreen Health Plan
Policy number
HO-104494
Residence premises
2685 Elm Park Pl Maplewood, MN 96542
Coverage A - Dwelling
$805,575.50
Coverage E - Personal liability
$300,000
All other perils deductible
$1,000
Annual premium
$2,363.26
Mortgagee
Bluewater Loan Servicing",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-883a596e3cf2bc92bd66f0d8,v11-INSURANCE_DOCUMENT-stacked,original,2022,fgen-aab48ed756f992a68be24d60,synthetic_programmatic_template,stacked,top,False,home_declarations
"Auto Policy Declarations
Evergreen Health Plan
Policy number
PA-463866
Policy period
2024-01-06 to December 28, 2025
Named insured
Riley Adeyemi
Vehicle
2022 Toyota Corolla
Bodily injury liability
$100,000 / $300,000
Collision deductible
$500
Six-month premium
$796.78
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-e11e73869e330c0d591aeb91,v11-INSURANCE_DOCUMENT-stacked,original,2024,fgen-953b21c4f8fcad71f7e01a51,synthetic_programmatic_template,stacked,top,False,auto_declarations
"Explanation of Benefits
Harbor Life Assurance
THIS IS NOT A BILL
Member
Casey K. Castillo
Claim number
3231082800
Provider
Sample Family Clinic
Date of service
2022-07-27
Amount billed  Plan discount  Plan paid  You may owe
2,220.67
666.20
1,110.34
444.13
Deductible met year to date
$1,639.52",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-3cf458ba186ab3fd5acc19b7,v11-INSURANCE_DOCUMENT-stacked,original,2022,fgen-338d6f51563ff4603280d1dd,synthetic_programmatic_template,stacked,top,False,eob
"Homeowners Policy Declarations
Evergreen Health Plan
Policy number
HO-223519
Residence premises
1267 Prairie Ave Oak Grove, TX 59987
Coverage A - Dwelling
$282,503.68
Coverage E - Personal liability
$300,000
All other perils deductible
$1,000
Annual premium
$2,861.05
Mortgagee
Lakeshore Home Lending",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-a8552dfb1e88b3c0e93e4799,v11-INSURANCE_DOCUMENT-stacked,original,2022,fgen-c4f2c2a354e68024106b023d,synthetic_programmatic_template,stacked,top,False,home_declarations
"Auto Policy Declarations
Harbor Life Assurance
Policy number
PA-932782
Policy period
04/05/2023 to 2024-08-01
Named insured
Taylor K. Haddad
Vehicle
2014 Honda Civic
Bodily injury liability
$100,000 / $300,000
Collision deductible
$500
Six-month premium
$1,734.42",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-c2ea6800a407e9b515bb9bea,v11-INSURANCE_DOCUMENT-stacked,original,2023,fgen-bea880211fd438794ad1b2b3,synthetic_programmatic_template,stacked,top,False,auto_declarations
"Annual Policy Statement - Universal Life
Sample Mutual Insurance
Policy number
UL3882940
Insured
Wei Tanaka
Death benefit
$883,138.40
Premiums paid this year
$2,040.38
Cash value
$68,829.54
Cost of insurance charges
$207.27",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-32cd3c0d9f0bce3205f6fe5d,v11-INSURANCE_DOCUMENT-stacked,original,2026,fgen-1fd651a8017fe02e94cd4ca4,synthetic_programmatic_template,stacked,top,False,life_annual
"Annual Policy Statement - Universal Life
Sample Mutual Insurance
Policy number
UL9921076
Insured
Sofia Castillo
Death benefit
$631,161.39
Premiums paid this year
$5,575.14
Cash value
$68,291.82
Cost of insurance charges
$1,897.02",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-f50abd5f6f1631610413cea3,v11-INSURANCE_DOCUMENT-stacked,original,2024,fgen-d12969f4661ea63ef502829f,synthetic_programmatic_template,stacked,top,False,life_annual
"Harbor Life Assurance
Policy number UL2031063
Insured   Alex Kowalski
Death benefit $107,569.24
Premiums paid this year      $3,589.52
Cash value $68,852.85
Cost of insurance charges $976.56
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-924ba1e95575692e35f1c455,v11-INSURANCE_DOCUMENT-inline,original,2021,fgen-3d4e7efc0d45ce3a21ab6970,synthetic_programmatic_template,inline,none,False,life_annual
"Explanation of Benefits
Evcrgreen Hcalth Plan
THISIS NOT A BILL
Member  Jordan Tanaka
Claim number 8687165644
Provider   Sample Family Clinic
Date of service  2023-02-27
Amount billed      Plan discount      Plan paid      You may owe
2,75l.70  825.51 1,375.85  550.34
Deductible met year to date  S2,828.87",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-2b6d824b0af2a0be9b935deb,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-99607c6eb403525bcde5aa2c,synthetic_programmatic_template,inline,top,True,eob
"Premium Due Notice
Granite Auto Insurance Co.
Policy number   19085447
Policyholder   Olivia M. Patel
Amount due   $1,746.21
Due date   5/15/21
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-78547d86e6162a412bf87b63,v11-INSURANCE_DOCUMENT-inline,original,2021,fgen-c59dadcd320c44dbced498d3,synthetic_programmatic_template,inline,top,False,premium_notice
"Granite Auto Insurance Co.
Policy number   UL8676544
Insured  Jamie Nguyen
Death benefit $817,333.69
Premiums paid this year   $5,361.37
Cash value   $14,803.40
Cost of insurance charges $116.58
Annual Policy Statement - Universal Life",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ce5dfec8cae3cc6631c5bbca,v11-INSURANCE_DOCUMENT-inline,original,2025,fgen-0eae3e0f77ab9b330ba28eab,synthetic_programmatic_template,inline,bottom,False,life_annual
"Granite Auto Insurance Co.
Policy number   HO-842817
Residence premises   2584 Sample Street Maplewood, MN 19541
Coverage A - Dwelling $632,782.60
Coverage E - Personal liability   $300,000
All other perils deductible      $1,000
Annual premium $2,270.50
Mortgagee      Pinecrest Mortgage Company
Homeowners Policy Declarations",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b77b6629d443b6814668ffa6,v11-INSURANCE_DOCUMENT-inline,original,2025,fgen-97193c97cfb8b00f4e7d3ce1,synthetic_programmatic_template,inline,bottom,False,home_declarations
"Homeowners Policy Declarations
Evergreen Health Plan
Policy number HO-156735
Residence premises 671 Oak Hollow Ct Riverton, WI 84600
Coverage A - Dwelling $566,102.88
Coverage E - Personal liability      $300,000
All other perils deductible   $1,000
Annual premium   $3,682.02
Mortgagee Pinecrest Mortgage Company",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-5d771d08e365750ef9dec0bc,v11-INSURANCE_DOCUMENT-inline,original,2021,fgen-339f9f0e8110789110f55c96,synthetic_programmatic_template,inline,top,False,home_declarations
"Explanation of Benefits
Evergreen Health Plan
THIS IS NOT A BILL
Member  Jordan Rivera
Claim number 6269859468
Provider  Sample Family Clinic
Date of service  2023-05-21
Amount billed  Plan discount  Plan paid  You may owe
3,940.26 1,182.08 1,970.13 788.05
Deductible met year to date      $1,102.03",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-e78509fa0532afba19ccc172,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-63c7008a94a40219e4aea358,synthetic_programmatic_template,inline,top,False,eob
"Homeowners Policy Declarations
Evergreen Health Plan
Policy number  H0-462378
Residence premises 7272 Prairie AveTestville, IL 15232
Coverage A - Dwelling  $464,898.16
Coverage E - Personal liability   $300,000
All othcr perils deductible $1,O00
Annual premium   $3,863.65
Mortgagee Bluewater Loan Servicing",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-1ddb8c09b5bb10260a46a3f6,v11-INSURANCE_DOCUMENT-inline,original,2022,fgen-332ac7837d994d81c787e497,synthetic_programmatic_template,inline,top,True,home_declarations
"Explanation of Benefits
Sample Mutual Insurance
THIS IS NOT A BILL
Member Riley B. Romero
Claim number 4770169649
Provider Sample Family Clinic
Date of service 01/16/2023
Amount billed   Plan discount   Plan paid   You may owe
1,811.01 543.30 905.51 362.20
Deductible met year to date $911.49
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-369633aa69dfda87f077ee2d,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-de231bc7524ce6ccfa0c78a1,synthetic_programmatic_template,inline,top,False,eob
"Premium Due Notice
Harbor Life Assurance
Policy number      55717472
Policyholder Avery Lindqvist
Amount due $1,614.02
Due date 06/02/2024
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-518b1f9b8dabc836b07381e0,v11-INSURANCE_DOCUMENT-inline,original,2024,fgen-3ba449cabae95638c750d8b7,synthetic_programmatic_template,inline,top,False,premium_notice
"Premium Due Notice
Evergreen Health Plan
Policy number   31578753
Policyholder Kwame Rivera
Amount due      $1,243.45
Due date  May 3, 2024
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-c94dab94e8912d3fb7f28546,v11-INSURANCE_DOCUMENT-inline,original,2024,fgen-72dee728bd13ad6347da6920,synthetic_programmatic_template,inline,top,False,premium_notice
"Granite Auto Insurance Co.
Policy number PA-347566
Policy period      11/19/2025 to 12/8/26
Named insured  Sofia A. Rivera
Vehicle 2017 Toyota Corolla
Bodily injury liability $100,000 / $300,000
Collision deductible  $500
Six-month premium  $1,828.99
Auto Policy Declarations",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-fddb43c1b61b5b2e1eff1cff,v11-INSURANCE_DOCUMENT-inline,original,2025,fgen-9fb7f5d31d26f5516e74c80c,synthetic_programmatic_template,inline,bottom,False,auto_declarations
"Premium Due Notice
Granite Auto Insurance Co.
Policy number  62552202
Policyholder      Priya Rivera
Amount due $705.87
Due date  6/5/23
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-0c53b96730035aaa8bb99aa9,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-7213fe14fef3e4b0b6fa2d19,synthetic_programmatic_template,inline,top,False,premium_notice
"Explanation of Benefits
Harbor Life Assurance
THIS IS NOT A BILL
Member Mateo Tanaka
Claim number   2147297413
Provider Riverside Urgent Care
Date of service   2O23-12-08
Amount billed     Plan discount      Plan paid      You may owe
3,875.43 1,162.63 1,937.71 775.09
Deductiblemet year to date $409.44",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-c0ff0717db690b60909817ee,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-77248895fbef401f076e1902,synthetic_programmatic_template,inline,top,True,eob
"Homeowners Policy Declarations
Sample Mutual Insurance
Policy number  HO-809248
Residence premises   4232 Oak Hollow Ct Pinecrest, GA 15286
Coverage A - Dwelling  $550,405.40
Coverage E - Personal liability   $300,000
All other perils deductible   $1,000
Annual premium   $2,050.59
Mortgagee   Riverbend Mortgage Servicing
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-c3bb7e99e1f32db183c388a1,v11-INSURANCE_DOCUMENT-inline,original,2025,fgen-93ace5ebc48c67e2d28ed3b8,synthetic_programmatic_template,inline,top,False,home_declarations
"Premium Due Notice
Evergreen Health Plan
Policy number 44460956
Policyholder     Noah Okafor
Amount due   S846.74
Due date 02/25/2026
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-36382214931b246784683369,v11-INSURANCE_DOCUMENT-inline,original,2026,fgen-118f96fd66910bd55521d92c,synthetic_programmatic_template,inline,top,True,premium_notice
"Explanation of Benefits
Granite Auto Insurance Co.
THI5 IS NOT A BILL
MemberMateo Patel
Claim number   9340911567
Provider Riverside Urgent Care
Date of service      12/23/2022
Amount bi1led  Plan discount  Plan paid  You may owe
3,750.70  1,125.21   1,875.35   750.14
Deductible met year to date      $1,902.77",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-856540be2342e8b12179bd69,v11-INSURANCE_DOCUMENT-inline,original,2022,fgen-9004f7e28038a90eeecbffa8,synthetic_programmatic_template,inline,top,True,eob
"Sample Mutual Insurance
Policy number      48272620
Policyholder   Priya Fischer
Amount due      $2,004.63
Due date   10/19/2022
Pay online to avoid a lapse in coverage.
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-aded880a78c0559faec930c0,v11-INSURANCE_DOCUMENT-inline,original,2022,fgen-0822894814d0cadef25adce3,synthetic_programmatic_template,inline,none,False,premium_notice
"Explanation of Benefits
Sample Mutual Insurance
THIS IS NOT A BILL
Member      Amara C. Okafor
Claím number  22546O7282
Provider Riverside Urgent Care
Date of service 02/02/2023
Amount billedPlan díscount Plan paid You may owe
3,l99.09 959.73 1,599.55 639.82
Deductible met year to date  $2,002.92",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-7b966030fb0767fbf9aca3bd,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-b59007470d72290df65f617f,synthetic_programmatic_template,inline,top,True,eob
"Homeowners Policy Declarations
Sample Mutual Insurance
Policy number HO-202995
Residence premises   5371 Lakeshore Blvd Cedar Falls, IA 20165
Coverage A - Dwelling   $321,867.38
Coverage E - Personal liability $300,000
All other perils deductible      $1,000
Annual premium  $4,578.71
Mortgagee  Pinecrest Mortgage Company
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-e8dcf66a54a9e44837a737bf,v11-INSURANCE_DOCUMENT-inline,original,2026,fgen-3537cf5eb9d3eb22f315cfcd,synthetic_programmatic_template,inline,top,False,home_declarations
"Sample Mutual Insurance
Policy number HO-874072
Residence premises      8864 Sample Street Bayside, WA 72169
Coverage A - Dwelling $738,414.62
Coverage E - Personal liability $300,000
All other perils deductible      $1,000
Annual premium   $2,908.90
Mortgagee      Keystone Home Loans
Homeowners Policy Declarations",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-7042e6d9cea01c5ba5fe363c,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-de13189bed4751479bbca400,synthetic_programmatic_template,inline,bottom,False,home_declarations
"Homeowners Policy Declarations
Evergreen Health Plan
Policy number HO-260478
Residence premises   86 Granite St Cedar Falls, IA 88097
Coverage A - Dwelling $889,369.76
Coverage E - Personal liability      $300,000
All other perils deductible   $1,000
Annual premium $2,835.34
Mortgagee   Pinecrest Mortgage Company
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-d1927000a3908aaa9a76ba1b,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-4f8eee9a248fd31e35fe673c,synthetic_programmatic_template,inline,top,False,home_declarations
"Annual Policy Statement - Universal Life
Sample Mutual Insurance
Policy number      UL6671814
Insured   Jordan L. Brennan
Death benefit   $276,554.91
Premiums paid this year      $4,031.39
Cash value  $75,769.34
Cost of insurance charges $2,220.57",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b4ac4d84621a4bf9231a0f33,v11-INSURANCE_DOCUMENT-inline,original,2026,fgen-8dc5d85ca37bc455d8525a0f,synthetic_programmatic_template,inline,top,False,life_annual
"Premium Due Notice
Evergreen Health Plan
Policy number   90442621
Policyholder   Sofia Okafor
Amount due   $1,707.62
Due date   09/26/2021
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-5d87a4d0afa0fe4a8daafe35,v11-INSURANCE_DOCUMENT-inline,original,2021,fgen-7a48a5ab958a3aaa5c190486,synthetic_programmatic_template,inline,top,False,premium_notice
"Homeowners Policy Declarations
Harbor Life Assurance
Policy number HO-633227
Residence premises 6023 Elm Park Pl Riverton, WI 58473
Coverage A - Dwelling      $460,945.16
Coverage E - Personal liability   $300,000
All other perils deductible      $1,000
Annual premium $1,666.56
Mortgagee Pinecrest Mortgage Company
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-4b04b0eb619ba6aa9a7ac517,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-9dcc384439e8c15a3e4b179a,synthetic_programmatic_template,inline,top,False,home_declarations
"Premium Due Notice
Evergreen Health Plan
Policy number  94275906
Policyholder  Avery E. Adeyemi
Amount due $1,466.94
Due date      November 25, 2023
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-245dba5461ebb3f35d1c378d,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-2fbe8dee162ec312dd801b29,synthetic_programmatic_template,inline,top,False,premium_notice
"Annual Policy Statement - Universal Life
Granite Auto Insurance Co.
Policy number  UL9974155
Insured Wei Romero
Death benefit  $944,320.90
Premiums paid this year      $5,295.27
Cash value  $7,658.27
Cost of insurance charges      $2,504.24",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-4aca4589b537fc4e98cfb8f8,v11-INSURANCE_DOCUMENT-inline,original,2023,fgen-7c496cbfa6cd8f12581f57bf,synthetic_programmatic_template,inline,top,False,life_annual
"Explanation of Benefits
Sample Mutual Insurance
THIS IS NOT ABILL
Member  Hiro B. Rivera
Claim number 7009894346
Provider Sample Family Clinic
Date ofservíce 06/16/2025
Amount billed  Plan discount  Plan paid  You may owe
2,936.78      88l.O3      1,468.39      587.36
Deductible met year to date  S1,277.27",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-f9a29182475a1e3e39e69583,v11-INSURANCE_DOCUMENT-inline,original,2025,fgen-0173c0bfa6e9b0cad73b3913,synthetic_programmatic_template,inline,top,True,eob
"Annual Policy Statement - Universal Life
Harbor Life Assurance
Policy number  UL6394988
Insured Wei Moreau
Death benefit  $638,061.38
Premiums paid this year  $6,395.95
Cash value $32,289.20
Cost of insurance charges $854.35
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-61f0f8a66f538a07630aaada,v11-INSURANCE_DOCUMENT-inline,original,2025,fgen-3b376a3b2364651fa090966a,synthetic_programmatic_template,inline,top,False,life_annual
"Harbor Life Assurance
Policy number PA-763877
Policy period      11/11/24 to 9/11/25
Named insured   Jamie R. Lindqvist
Vehicle      2018 Subaru Outback
Bodily injury liability $100,000 / $300,000
Collision deductible $500
Six-month premium      $582.37
Auto Policy Declarations",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-bf7386d0e80cfd3885839c56,v11-INSURANCE_DOCUMENT-inline,original,2024,fgen-6ab97e846f8086846d19fd2a,synthetic_programmatic_template,inline,bottom,False,auto_declarations
"AnnualPolicy Statement - Universal Life
Harbor Life Assurance
Policy number   UL6731590
Insured   Morgan Haddad
Death benefít $78,9l2.90
Premiums paid this year   $5,054.25
Cash value $82,231.56
Cost of insurance charges      $2,028.22
Health coverage information forms (l095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-da93d234fc0a44bbd886461a,v11-INSURANCE_DOCUMENT-inline,original,2024,fgen-44a7af08dac7c984de984068,synthetic_programmatic_template,inline,top,True,life_annual
"Annual Policy Statement - Universal Life
Sample Mutual Insurance
Policy number      UL3428492
Insured      Riley Romero
Death benefit $59,576.79
Premiums paid this year $3,481.40
Cash value      $55,553.25
Cost of insurance charges  $626.77
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-e97cd0ec8400f9f76df62002,v11-INSURANCE_DOCUMENT-inline,original,2026,fgen-b14b6f788a39bfa387992574,synthetic_programmatic_template,inline,top,False,life_annual
"Sample Mutual Insurance THIS IS NOT A BILL Member Taylor M. Fischer Claim number 1854514103 Provider Sample Family Clinic Date of service 11/22/25 Amount
billed Plan discount Plan paid You may owe 2,018.17 605.45 1,009.09 403.63 Deductible met
year to date $1,485.92",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-d076b54b14b8b6003f6c9843,v11-INSURANCE_DOCUMENT-flat,original,2025,fgen-e22845c11f08edcfb7c8cb31,synthetic_programmatic_template,flat,none,False,eob
"Auto Policy Declarations Granite Auto Insurance
Co. Policy number PA-179133 Policy period 2026-08-14 to 2027-09-04 Named insured Taylor Okafor Vehicle 2024 Ford F-150 Bodily injury liability
$100,000 / $300,000 Collision deductible $500 Six-month premium $1,739.13",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-c84fb22336d99a50ba8399dc,v11-INSURANCE_DOCUMENT-flat,original,2026,fgen-74de80e1d9cd3dd7799ed58c,synthetic_programmatic_template,flat,top,False,auto_declarations
"Homeowners
Policy Dedarations Evergreen Health Plan Policy number HO-583783 Residence premises 8662 Elm Park Pl Pinecrest, GA 90198 Coverage A - Dwelling
S868,532.77 Coverage E - Personal liability$300,000 All other perils deductible $1,000 Annual premium $831.86 Mortgagee Pinecrest Mortgage Company",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-d7a4aa34472060e3f85ed01c,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-8b5d6fc437ae6bd1e641b20c,synthetic_programmatic_template,flat,top,True,home_declarations
"Homeowners Policy Declarations Harbor Life Assurance Policy number HO-372295 Residence premises 1659 Harbor View Rd Brookhaven, PA 3267O Coverage A - Dwelling S849,755.38 Coverage E - Personal liability $300,000 All
other perils deductible $1,000 Annua1
premium$3,871.73 Mortgagee Keystone Home Loans",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-00288bbb5e6f183aa14d2435,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-4f26d6e5fceca9d5366b47e1,synthetic_programmatic_template,flat,top,True,home_declarations
"Auto Policy Declarations Sample Mutual Insurance Policy number PA-530788 Policy period 2022-03-26 to 08/25/2023 Named insured Noah Patel Vehicle
2015 Honda Civic Bodily injury liability
$100,000 / $300,000 Collision deductible $500 Six-month premium $1,472.40",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-9930ba6d5d376af1d3c804a3,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-0b9c6aa0a92e41b331aeee4d,synthetic_programmatic_template,flat,top,False,auto_declarations
"Premium Due Notice Sample Mutual Insurance Policy number 24136448 Policyholder
Riley K. Rivera
Amount due $2,293.49 Due date 6/28/22 Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-bf21730d5dbd47f424588735,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-81ebb5167b0981e77c7df210,synthetic_programmatic_template,flat,top,False,premium_notice
"Harbor Life Assurance
Policy number PA-295171 Policy period 12/07/2024 to 3/9/25 Named insured Jordan Testcase Vehicle 2022 Honda Civic Bodily injury liability
$100,000 / $300,000 Collision deductible $500 Six-month premium $1,803.70",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-d880bbb9512dda02f70198c6,v11-INSURANCE_DOCUMENT-flat,original,2024,fgen-7bd4047531bb186c9f58c845,synthetic_programmatic_template,flat,none,False,auto_declarations
"Homeowners Polícy Declarations Evergreen Health PlanPolicy number HO-866476 Residence premises 2454 Granite St Brookhaven,
PA
l1152 Coverage A - Dwelling $779,749.74 Coverage E - Personal liability $300,000 All other perils deductible $l,000 Annual premium $1,458.32 Mortgagce Lakeshore Home Lending",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b817585276bd2a059a4f872b,v11-INSURANCE_DOCUMENT-flat,original,2024,fgen-03fe2234cfee13f492ad3371,synthetic_programmatic_template,flat,top,True,home_declarations
"Explanation of
Benefits Granite Auto Insurance Co. THIS IS NOT A BILL Member Jamie Moreau Claim number 6166343035 Provider Brightsmile Dental Group Date of service May 5, 2022 Amount billed Plan discount Plan paid You may owe 591.05 177.32
295.53 118.21 Deductible met year to date $2,065.40 Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ca045ffcaea9cb444e08b97e,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-acd925b92fe1d8b9d9078f4b,synthetic_programmatic_template,flat,top,False,eob
"Premium Due Notice Harbor Life Assurance Policynumber 54605457 Policyholder Alex Moreau Amount due $362.46 Due date 2026-07-l4 Pay online to avoid a lapse in coverage.
Health coverage information forms (1O95)
are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-97ad1e4da5328d3a34ff2de4,v11-INSURANCE_DOCUMENT-flat,original,2026,fgen-b77c72846b0f3dcb974bd16c,synthetic_programmatic_template,flat,top,True,premium_notice
"Premium Due Notice Sample Mutual Insurance Policy number 53400288 Policyholder
Sofia Okafor Amount due $220.87 Due date 2024-01-21 Pay online to avoid
a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-3a873a66981c1d2f75c25ee8,v11-INSURANCE_DOCUMENT-flat,original,2024,fgen-2cac984ca78372f5b6d7f8b5,synthetic_programmatic_template,flat,top,False,premium_notice
"Premium Due Notice
Evergreen Health Plan
Policy number 39507540 Policyholder Wei L. Brennan Amount due $784.50 Due date 4/26/25 Pay online to avoid a lapse in coverage. Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-00cae0bd6d09033b2bc9d4c4,v11-INSURANCE_DOCUMENT-flat,original,2025,fgen-0d57a274800c47cd78f03de8,synthetic_programmatic_template,flat,top,False,premium_notice
"Sample Mutual Insurance THIS IS NOT A BILL Member Fatima Larsen Claim number 8245857491 Provider Brightsmile Dental Group Date of service December 22, 2023 Amount billed Plan discount Plan paid You
may owe 1,654.24 496.27 827.12 330.85 Deductible met
year to date $923.93 Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-1ce0215f3814986e6abed05d,v11-INSURANCE_DOCUMENT-flat,original,2023,fgen-39fbde2b0830c5f9b9e47ba9,synthetic_programmatic_template,flat,none,False,eob
"Homeowners Policy Declarations Harbor
Life Assurance Policy
number HO-442425 Residence premises 9177 Cedar Ln Bayside, WA 82506 Coverage A - Dwelling $481,792.31 Coverage E - Personal liability $300,000 All other perils deductible $1,000 Annual premium $3,200.24 Mortgagee Bluewater Loan Servicing",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-e60b2a579f21ad279f3d749b,v11-INSURANCE_DOCUMENT-flat,original,2021,fgen-96dc57519575ea3e35e9bca5,synthetic_programmatic_template,flat,top,False,home_declarations
"Premium Due Notice Sample Mutual Insurance
Policy number 69766301 Policyholder Jamie Haddad
Amount due $121.30 Due date 2023-12-10 Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-d78e6a286dbde67bc88b9d8b,v11-INSURANCE_DOCUMENT-flat,original,2023,fgen-688709084b3b9410572eaf57,synthetic_programmatic_template,flat,top,False,premium_notice
"Homeowners Policy Declarations Granite Auto Insurance Co. Policy
number HO-347382 Residence premises 606 Oak Hollow Ct Bayside, WA 39334 Coverage A - Dwelling $523,485.67 Coverage E - Personal liability $300,000 All other perils deductible $1,000 Annual
premium $964.59 Mortgagee Keystone Home Loans",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-96829ab338853f7927d45d25,v11-INSURANCE_DOCUMENT-flat,original,2026,fgen-13b4036b68e29108cbe27e46,synthetic_programmatic_template,flat,top,False,home_declarations
"Homeowners Policy Declarations Granite Auto Insurance Co. Policy number HO-251422 Residence premises 4414 Sample Street Bayside, WA 44311 Coverage A - Dwelling $426,453.95 Coverage E - Personal
liability $300,000 All other perils deductible $1,000 Annual premium $4,222.02 Mortgagee Bluewater Loan Servicing Health coverage information forms (1095) are
issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-1d4c54780946eae8bc388282,v11-INSURANCE_DOCUMENT-flat,original,2025,fgen-03a67c24d4f2d88a4c828f28,synthetic_programmatic_template,flat,top,False,home_declarations
"Explanation of Benefits Evergreen Health Plan THIS IS NOT A BILL Member Kwame Tanaka
Claim number 1668012602 Provider Sample Family Clinic Date of service 05/28/2022 Amount billed Plan discount Plan paid You may owe 2,256.74 677.02 1,128.37 451.35 Deductible met year
to date $466.17",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-a4ed4a6179132d908dfbb65b,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-a90d2faf8b55866e3695aaec,synthetic_programmatic_template,flat,top,False,eob
"Auto Policy Declarations Sample Mutual Insurance
Policy number PA-144796 Policy period 1/2/21 to 6/26/22 Named insured
Avery R. Walsh Vehicle 2021 Honda Civic Bodily injury liability $100,000 / $300,000 Collision deductible $500 Six-month premium $1,067.74",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-6667cef28122c78285d55053,v11-INSURANCE_DOCUMENT-flat,original,2021,fgen-14268502b4c08f61a765cb95,synthetic_programmatic_template,flat,top,False,auto_declarations
"Auto
Policy Declarations Harbor Life Assurance Policy number PA-745656 Policy period 12/21/21 to O3/04/2022Named insured Jordan K. Moreau Vehide 2012 Toyota Corolla Bodily injury
liability $100,000 / $300,000 Collísion deductible $500 Six-month premium $389.71",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b9143401ca274ad9f7120d2f,v11-INSURANCE_DOCUMENT-flat,original,2021,fgen-4c4b295d74136e4e0010c9b8,synthetic_programmatic_template,flat,top,True,auto_declarations
"Homeowners Policy Declarations Evergreen Health Plan Policy
number HO-908420 Residence premises 5196 Lakeshore
Blvd Cedar Falls, IA 52606 Coverage A - Dwelling $366,662.97 Coverage E - Personal liability $300,000 All other perils deductible $1,000 Annual premium $4,165.25 Mortgagee Keystone Home Loans",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-58d1fd2fe859df083b16ea8b,v11-INSURANCE_DOCUMENT-flat,original,2024,fgen-7a1746d667d063f32bbb29b9,synthetic_programmatic_template,flat,top,False,home_declarations
"Premium Due Notice Granite Auto Insurance Co. Policy number 33858567 Policyholder Jamie Romero Amount
due $1,190.45 Due date 12/19/22
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-62af3f3c75842d6cbc0272fc,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-f5d1776bc5c0a0e66161afe8,synthetic_programmatic_template,flat,top,False,premium_notice
"Annual Policy Statement - Universal Life Evergreen Health Plan Policy number UL7414305 Insured Kwame
K. Okafor Death benefit $231,355.85 Premiums paid this year $1,625.15 Cash value $32,267.81 Cost
of insurance charges $2,704.36",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-4b991860c22b96fede0352b2,v11-INSURANCE_DOCUMENT-flat,original,2026,fgen-fb08d0b23086b6e1535da34a,synthetic_programmatic_template,flat,top,False,life_annual
"Annual Policy Statement - Universal Life Evergreen Health Plan Policy number UL5925130 Insured Noah Kowalski Death benefit
$451,524.14 Premiums paid this year $2,796.44 Cash value
$46,426.07 Cost of insurance charges $1,382.45",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-eeb461e16b43d0cc90de8f49,v11-INSURANCE_DOCUMENT-flat,original,2024,fgen-a2dea86ed6d62b8826241c52,synthetic_programmatic_template,flat,top,False,life_annual
"Granite Auto Insurance Co. THIS IS NOT A BILL Member Lena L. Walsh Claim number 2474439287 Providcr Brightsmilc Dental Group Date
of service
December 22, 2023 Amount bílled Plan discount Plan paid You may owe 1,957.16587.15 978.58 391.43 Deductible met year to date $1,132.34Health coverage information forms (1095) are issued separately when required. Explanation of Benefits",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-c11821da2b0585183df46f6d,v11-INSURANCE_DOCUMENT-flat,original,2023,fgen-f7e7147e751200134d153c87,synthetic_programmatic_template,flat,bottom,True,eob
"Granite Auto
Insurance Co. Policy number PA-296404
Policy period 2022-12-08 to 2023-09-28 Named insured Noah Fischer Vehicle 2019 Ford F-150 Bodily injury liability $100,000 / $300,000 Collision deductible $500 Six-month premium $1,023.47 Auto Policy Declarations",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-7c581051b0524185e897ae1e,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-7c050da933c64897f92eed15,synthetic_programmatic_template,flat,bottom,False,auto_declarations
"Annual Policy Statement - Universal Life Harbor Life Assurance Policy number UL8196125 Insured
Amara
Larsen Death benefit $66,133.95 Premiums paid this year $7,956.36 Cash value $29,334.85 Cost of insurance charges $918.92",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-a96ac3f6cd675536fc4f2520,v11-INSURANCE_DOCUMENT-flat,original,2025,fgen-29c62213b8c16ce0ea5ed5cf,synthetic_programmatic_template,flat,top,False,life_annual
"Premium
Due Notice Granite Auto Insurance Co. Policy number 89833030 Policyholder Jordan Walsh Amount due
$1,900.92 Due date October 14, 2023 Pay online to avoid a lapse in coverage. Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-82b5ef1269009dc7c7f59a0e,v11-INSURANCE_DOCUMENT-flat,original,2023,fgen-04e25eb10eed3ae358508d4c,synthetic_programmatic_template,flat,top,False,premium_notice
"Explanation of Benefits Evergreen Health Plan THIS IS NOT A BILL Member Olivia
L. Moreau Claim number 9630923872 Provider Lakeshore Pharmacy Date of service 7/19/24 Amount billed Plan discount Plan paid You may owe 3,680.31 1,104.09 1,840.16
736.06 Deductible met year to date $2,529.37",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-99fa21098fc20448c9228484,v11-INSURANCE_DOCUMENT-flat,original,2024,fgen-9b63ffd5bd4f23e86def05db,synthetic_programmatic_template,flat,top,False,eob
"Auto Policy Declarations Harbor Life Assurance Policy number PA-553641
Policy
period 2022-11-22 to 04/23/2023 Named insured Alex Moreau Vehicle 2013 Ford F-150 Bodily injury liability $100,000 / $300,000 Collision deductible $500 Six-month premium $847.78",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-414c6d226386317746b8239e,v11-INSURANCE_DOCUMENT-flat,original,2022,fgen-4905d56a47fa31fcf8b4ed61,synthetic_programmatic_template,flat,top,False,auto_declarations
"Premium Due Notice Sample
Mutual Insurance Policy number 86823274 Policyholder Taylor Larsen Amount due $2,273.72 Due date 10/16/23 Pay online to
avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-7ada8973939fc952bd1ea6ee,v11-INSURANCE_DOCUMENT-flat,original,2023,fgen-771e204ed80cafc138ed2f4d,synthetic_programmatic_template,flat,top,False,premium_notice
"Evergreen Health Plan Policy number 26798705 Policyholder Olivia Sato Amount due $273.67 Due date March
2, 2021 Pay online to avoid a lapse in coverage.
Premium Due Notice",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-faca4d5cbd95fdc2e933f95e,v11-INSURANCE_DOCUMENT-flat,original,2021,fgen-5c12f757af0cbe2fa2cde7af,synthetic_programmatic_template,flat,bottom,False,premium_notice
"Explanation of Benefits
Sample Mutual Insurance
## THIS IS NOT A BILL
| Field | Value |
| --- | --- |
| Member | Amara M. Sato |
| Claim number | 6458326626 |
| Provider | Sample Family Clinic |
| Date of service | 06/21/2025 |
| Amount billed | Plan discount | Plan paid | You may owe |
| --- | --- | --- | --- |
| 642.80 | 192.84 | 321.40 | 128.56 |
| Field | Value |
| --- | --- |
| Deductible met year to date | $1,992.92 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ca37b141d16946d2b84e4060,v11-INSURANCE_DOCUMENT-markdown,original,2025,fgen-7f2ea1438b9f35e65f1cf4aa,synthetic_programmatic_template,markdown,top,False,eob
"Annual Policy Statement - Universal Life
Harbor Life Assurance
| Field | Value |
| --- | --- |
| Policy number | UL2245842 |
| Insured | Mateo Sato |
| Death benefit | $447,086.36 |
| Premiumspaidthis year | $6,467.59 |
| Cash value | $9,653.62 |
| Cost of insurance charges | $l,310.51 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b12ad783d4a14b2199ce55eb,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-08ca930c4642a303f0e67ab7,synthetic_programmatic_template,markdown,top,True,life_annual
"Homeowners Policy Declarations
Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number| HO-79l188 |
| Residence premises | 7117 Granite St Riverton, WI 16142 |
|Coverage A - Dwe1ling | S410,962.90 |
| Covcragc E - Personal liability | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $2,716.74 |
| Mortgagee | Bluewater Loan Servicing |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-5062659ec1cc8c7aadada6d8,v11-INSURANCE_DOCUMENT-markdown,original,2023,fgen-e610f5b41090744f815fa2aa,synthetic_programmatic_template,markdown,top,True,home_declarations
"Annual Policy Statement - Universal Life
Harbor Life Assurance
| Field | Value |
| --- | --- |
| Policy number | UL7312648 |
| Insured | Fatima Castillo |
| Death benefit | $538,898.85 |
| Premiums paid this year | $5,023.56 |
| Cash value | $19,292.36 |
| Cost of insurance charges | $1,556.79 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-9fef50ecf56dd17e1eea46e8,v11-INSURANCE_DOCUMENT-markdown,original,2023,fgen-65f8eb1d1cb50e8df95884b0,synthetic_programmatic_template,markdown,top,False,life_annual
"Auto Policy Declarations
5ample Mutual Insurance
| Field | Value |
| --- | --- |
|Policy number | PA-968655 |
| Po1icy period | 2026-10-04 to 2027-07-06 |
| Named insured | Noah Fischer |
| Vehide| 2024 Ford F-150 |
| Bodily injury liability | $100,000 / $300,000 |
| Collision dcductible | $500 |
| Six-month premium | $1,803.50 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ff1332882154bc580ea8b030,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-bea25977344cd5476fc63b64,synthetic_programmatic_template,markdown,top,True,auto_declarations
"Annual Policy Statement - Universal Life
Granite Auto Insurance Co.
| Field | Value |
| --- | --- |
| Policy number | UL8050032 |
| Insured | Lena Fischer |
| Death benefit | $860,641.87 |
| Premiums paid this year | $7,310.70 |
| Cash value | $36,210.37 |
| Cost of insurance charges | $593.56 |
## Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b782c336964e56789e89a3ee,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-9ac5ddcc32921e4d11f910de,synthetic_programmatic_template,markdown,top,False,life_annual
"Annual Policy Statement - Universal Life
## Harbor Life Assurance
| Field | Value |
| --- | --- |
| Policy number | UL3703453 |
| Insured | Avery Testcase |
| Death benefit | $568,157.18 |
| Premiums paid this year | $4,085.77 |
| Cash value | $31,104.04 |
| Cost of insurance charges | $1,707.82 |
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-12aceb447e500fe80fe9f638,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-0db01dc7a233f69217ce0225,synthetic_programmatic_template,markdown,top,False,life_annual
"Sample Mutual Insurance
| Field | Value |
| --- | --- |
| Policy number | 42095862 |
| Policyholder | Priya C. Kowalski |
| Amount due | $2,015.55 |
| Due date | 11/24/21 |
Pay online to avoid a lapse in coverage.
Premium Due Notice",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-b43a3f59fd84f8889e4c5f33,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-aa37bf9874c006e4e25a8f20,synthetic_programmatic_template,markdown,bottom,False,premium_notice
"Explanation of Benefits
Sample Mutual Insurance
THIS IS NOT A BILL
| Field | Value |
| --- | --- |
| Member | Alex R. Walsh |
| Claim number | 3945717594 |
| Provider | Lakeshore Pharmacy |
| Date of service | 11/14/21 |
| Amount billed | Plan discount | Plan paid | You may owe |
| --- | --- | --- | --- |
| 1,845.71 | 553.71 | 922.85 | 369.14 |
| Field | Value |
| --- | --- |
| Deductible met year to date | $915.88 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-0a82de8477e0f8c2edbadb19,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-34d415bffa16f491353dc9d7,synthetic_programmatic_template,markdown,top,False,eob
"## Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number | HO-152313 |
| Residence premises | 7003 Granite St Fairview, OH 49893 |
| Coverage A - Dwelling | $499,009.18 |
| Coverage E - Personal liability | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $2,717.80 |
| Mortgagee | Lakeshore Home Lending |
## Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-f8343460a0d9e2e019c1bda3,v11-INSURANCE_DOCUMENT-markdown,original,2025,fgen-8cb7e72cb103227b0b84c21c,synthetic_programmatic_template,markdown,none,False,home_declarations
"Homeowners Policy Declarations
Granite Auto Insurance Co.
| Field | Value |
| --- | --- |
| Policynumber | HO-846266 |
| Residence premises | l695 Oak Hollow Ct Cedar Falls, IA 73523 |
| Coverage A - Dwellíng | $582,6O7.57 |
| CoverageE - Personal liabi1ity | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $1,006.15 |
| Mortgagee | Bluewater Loan Servicing |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-aa855d1e09ae4294db7ff0a7,v11-INSURANCE_DOCUMENT-markdown,original,2024,fgen-24c80e7553369b667c27ff08,synthetic_programmatic_template,markdown,top,True,home_declarations
"Annual Policy Statement - Universal Life
## Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number | UL1054184 |
| Insured | Alex Nguyen |
| Death benefit | $539,096.99 |
| Premiums paid this year | $6,318.09 |
| Cash value | $12,880.58 |
| Cost of insurance charges | $546.04 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-763b9428b8aeabd5ab031412,v11-INSURANCE_DOCUMENT-markdown,original,2023,fgen-05738853ad727a4de2272f0e,synthetic_programmatic_template,markdown,top,False,life_annual
"Homeowners Policy Declarations
## Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number | HO-725923 |
| Residence premises | 301 Granite St Cedar Falls, IA 74781 |
| Coverage A - Dwelling | $631,317.71 |
| Coverage E - Personal liability | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $5,146.51 |
| Mortgagee | Lakeshore Home Lending |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-282e513b71473c35571ad796,v11-INSURANCE_DOCUMENT-markdown,original,2025,fgen-3c943fd684ec3ed0862b1c07,synthetic_programmatic_template,markdown,top,False,home_declarations
"Annual Policy Statement - Universal Life
Granite Auto Insurance Co.
| Field | Value |
| --- | --- |
| Policy number | UL6118319 |
| Insured | Avery Tanaka |
| Death benefit | $541,461.64 |
| Premiums paid this year | $2,580.38 |
| Cash value | $24,253.93 |
| Cost of insurance charges | $1,370.94 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ff42f8a242a5d23432f700ac,v11-INSURANCE_DOCUMENT-markdown,original,2025,fgen-ee85e717b0ea993c2455be1c,synthetic_programmatic_template,markdown,top,False,life_annual
"Annual Policy Statement - Universal Life
## Sample Mutual Insurance
| Field | Value |
| --- | --- |
| Policy number | UL4108997 |
| Insured | Mateo Kowalski |
| Death benefit | $481,393.88 |
| Premiums paid this year | $5,682.12 |
| Cash value | $28,935.91 |
| Cost of insurance charges | $1,708.36 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-2e8bc7558fff85a9702983c9,v11-INSURANCE_DOCUMENT-markdown,original,2024,fgen-027b083d55911b441692bafc,synthetic_programmatic_template,markdown,top,False,life_annual
"Sample Mutual Insurance
| Field | Value |
| --- | --- |
| Policy number | 77206673 |
| Policyholder | Amara J. Adeyemi |
| Amount due | $901.67 |
| Due date | 6/25/26 |
Pay online to avoid a lapse in coverage.
## Premium Due Notice",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-a5b1f59669c6390bd5a0435b,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-e70a575811f5507266a59d5e,synthetic_programmatic_template,markdown,bottom,False,premium_notice
"Homeowners Policy Declarations
Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number | HO-268791 |
| Rcsidence premises| 9168 Maple Ridge Dr Bayside, WA 23868 |
| Coverage A - Dwelling | $325,415.25 |
| Coverage E - Personal liability | $3O0,000 |
| All other perils deductíble | $1,000 |
| Annual premium | $1,457.97 |
|Mortgagee | Keystone Home Loans |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-13db8415ab4cf8be659763b9,v11-INSURANCE_DOCUMENT-markdown,original,2025,fgen-eb15ec43e07de8ed16c10ae8,synthetic_programmatic_template,markdown,top,True,home_declarations
"Auto Policy Declarations
## Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number | PA-569963 |
| Policy period | November 22, 2021 to 05/15/2022 |
| Named insured | Morgan Rivera |
| Vehicle | 2019 Ford F-150 |
| Bodily injury liability | $100,000 / $300,000 |
| Collision deductible | $500 |
| Six-month premium | $1,329.16 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-ef1b17cf9dab6db81fbf8f78,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-5bc8d25b8400aa17fd2a70b6,synthetic_programmatic_template,markdown,top,False,auto_declarations
"## Premium Due Notice
Granite Auto Insurance Co.
| Field | Value |
| --- | --- |
| Policy number | 65648736 |
| Policyholder | Morgan Moreau |
| Amount due | $2,047.44 |
| Due date | 09/06/2023 |
Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-592c94435115311281c93134,v11-INSURANCE_DOCUMENT-markdown,original,2023,fgen-bd62982260a7ce8fe266dc21,synthetic_programmatic_template,markdown,top,False,premium_notice
"Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number | 739l45O8 |
| Policyholder | Wei M. Brennan |
| Amount due | $1,250.38 |
| Due date | January 20,2021 |
Pay online to avoid a lapse in coverage.
## Premíum Due Notice",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-0a43b8583b4d81ae7253eab9,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-aa52b5f6e7677542bc26c612,synthetic_programmatic_template,markdown,bottom,True,premium_notice
"## Homeowners Policy Declarations
Evergreen Health Plan
| Field | Value |
| --- | --- |
| Policy number | HO-477775 |
| Residence premises | 6251 Sample Street Cedar Falls, IA 47330 |
| Coverage A - Dwelling | $202,777.15 |
| Coverage E - Personal liability | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $4,624.62 |
| Mortgagee | Bluewater Loan Servicing |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-baafbc72be54ad605773630f,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-972b5a8efa004cdc446a4d0d,synthetic_programmatic_template,markdown,top,False,home_declarations
"Homeowners Policy Declarations
Sample Mutual Insurance
| Field | Value |
| --- | --- |
| Policy number | HO-882718 |
| Residence premises | 9599 Willow Bend Way Lakewood, CO 51579 |
| Coverage A - Dwelling | $887,090.68 |
| Coverage E - Personal liability | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $4,428.09 |
| Mortgagee | Riverbend Mortgage Servicing |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-25c53557eaca57c41e37f9e2,v11-INSURANCE_DOCUMENT-markdown,original,2024,fgen-a98ed80eeba5c6aaba1af3c9,synthetic_programmatic_template,markdown,top,False,home_declarations
"Auto Policy Declarations
Harbor Life Assurance
| Field | Value |
| --- | --- |
| Policy number | PA-798959 |
| Policy period | February 13, 2021 to 04/23/2022 |
| Named insured | Priya J. Kowalski |
| Vehicle | 2020 Ford F-150 |
| Bodily injury liability | $100,000 / $300,000 |
| Collision deductible | $500 |
| Six-month premium | $1,660.07 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-85ba6b3208bd6168b027bb5a,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-a7b99db7f8f44fd7f58fbd92,synthetic_programmatic_template,markdown,top,False,auto_declarations
"Explanation of Benefits
Sample Mutual Insurance
THIS IS NOT A BILL
| Field | Value |
| --- | --- |
| Member | Riley Castillo |
| Claim number | 1863472134 |
| Provider | Lakeshore Pharmacy |
| Date of service | 5/26/26 |
| Amount billed | Plan discount | Plan paid | You may owe |
| --- | --- | --- | --- |
| 924.76 | 277.43 | 462.38 | 184.95 |
| Field | Value |
| --- | --- |
| Deductible met year to date | $531.33 |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-cbaa8fffd181009b9b778adf,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-be26cbad27d674ad87a6d81f,synthetic_programmatic_template,markdown,top,False,eob
"Homeowners Policy Declarations
Granite Auto Insurance Co.
| Field | Value |
|--- | --- |
| Policy number| HO-771300 |
| Residence premises | 740 Granite St Maplewood, MN 21064 |
| Coverage A - Dwelling | $23l,437.61 |
| Coverage E - Personal liability | $300,000 |
| All other perils deductiblc | $1,000 |
| Annual premium | $2,437.74 |
| Mortgagee | Pinecrest Mortgage Company |
## Health coveragc information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-53c3e20262de0fdc256723e6,v11-INSURANCE_DOCUMENT-markdown,original,2023,fgen-75c12bb431f0fd8a8520cd0e,synthetic_programmatic_template,markdown,top,True,home_declarations
"Auto Policy Declarations
Granite Auto Insurance Co.
| Field | Value |
| --- | --- |
| Policy number | PA-282593 |
| Policy period | 2026-01-17 to 7/11/27 |
| Named insured | Alex Walsh |
| Vehicle | 2020 Toyota Corolla |
|Bodily injury liability| S100,000 / $300,000 |
| Collision deductible | $500 |
| 5ix-month premium | $l,754.03 |
Health coverage information forms (1095) arc issued separate1y when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-aa78b42ceb6923160d0d174f,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-f93aed0a7af0472e009b6a0b,synthetic_programmatic_template,markdown,top,True,auto_declarations
"## Explanation of Benefits
## Harbor Life Assurance
THIS IS NOT A BILL
| Field | Value |
| --- | --- |
| Member | Alex Brennan |
| Claim number | 2902680054 |
| Provider | Sample Family Clinic |
| Date of service | 08/04/2023 |
| Amount billed | Plan discount | Plan paid | You may owe |
| --- | --- | --- | --- |
| 3,896.11 | 1,168.83 | 1,948.05 | 779.22 |
| Field | Value |
| --- | --- |
| Deductible met year to date | $1,745.86 |
Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-fb4d8604113c1c78dfe606a5,v11-INSURANCE_DOCUMENT-markdown,original,2023,fgen-2e0b22056c99b9b4b174c8bc,synthetic_programmatic_template,markdown,top,False,eob
"Homeowners Policy Declarations
## Granite Auto Insurance Co.
| Field | Value |
| --- | --- |
| Policy number | HO-179335 |
| Residence premises | 4627 Harbor View Rd Maplewood, MN 46270 |
| Coverage A - Dwelling | $432,947.42 |
| Coverage E - Personal liability | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $4,643.39 |
| Mortgagee | Riverbend Mortgage Servicing |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-0455d4d7eeee7384e65cc78f,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-07248840a8114e048a0c4ba3,synthetic_programmatic_template,markdown,top,False,home_declarations
"## Annual Policy Statement - Universal Life
## Sample Mutual Insurance
| Field | Value |
| --- | --- |
| Policy number | UL9668408 |
| Insured | Jordan Okafor |
| Death benefit | $816,929.99 |
| Premiums paid this year | $7,130.23 |
| Cash value | $38,644.83 |
| Cost of insurance charges | $908.46 |
## Health coverage information forms (1095) are issued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-fe9eac49bca67160077698bf,v11-INSURANCE_DOCUMENT-markdown,original,2021,fgen-0e791fb883a9a8eb0aefacbd,synthetic_programmatic_template,markdown,top,False,life_annual
"Annual Policy Statement - Universal Life
Sample Mutual Insurance
| Fie1d | Value |
| --- | --- |
| Policy number | UL4487771 |
| Insured | Lena Rivera |
| Death benefit | $61O,970.39 |
| Premiums paid this year | $7,270.73 |
| Cash value | $1,848.37 |
| Cost of insurance charges | $1,101.32 |
## Health coverage informationforms (1095) areissued separately when required.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-2d6e1c7f5dd9b3abb4dec18e,v11-INSURANCE_DOCUMENT-markdown,original,2026,fgen-4b719a648f8aa3707d0e6f07,synthetic_programmatic_template,markdown,top,True,life_annual
"## Homeowners Policy Declarations
## Harbor Life Assurance
| Field | Value |
| --- | --- |
| Policy number | HO-341654 |
| Residence premises | 7656 Willow Bend Way Fairview, OH 80165 |
| Coverage A - Dwelling | $614,404.26 |
| Coverage E - Personal liability | $300,000 |
| All other perils deductible | $1,000 |
| Annual premium | $891.17 |
| Mortgagee | Lakeshore Home Lending |",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-f47e8d17455dced02dc1d13c,v11-INSURANCE_DOCUMENT-markdown,original,2023,fgen-fd78db27ed1128ba13563e7a,synthetic_programmatic_template,markdown,top,False,home_declarations
"Premium Due Notice
Granite Auto Insurance Co.
| Field | Value |
| --- | --- |
| Policy number | 94979118 |
| Policyholder | Jamie Walsh |
| Amount due | $82.89 |
| Due date | December 21, 2025 |
## Pay online to avoid a lapse in coverage.",INSURANCE_DOCUMENT,45,INSURANCE_DOCUMENT,fdc-acad4a42a5e87122c81bc3ea,v11-INSURANCE_DOCUMENT-markdown,original,2025,fgen-b1ed2823a16ca2fbc4035180,synthetic_programmatic_template,markdown,top,False,premium_notice
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0092
Final K-1  Amended K-1
Part I Information About the Estate or Trust
Larsen Irrevocable Trust 6766 Elm Park Pl Oak Grove, TX 93295
A Estate's or trust's employer identification number
90-3737550
Part II Information About the Beneficiary
Amara Walsh
C Beneficiary's identifying number
ending in 1497
Street address (including apt. no.)
482 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 23349
Account number (see instructions)
ending in 094951
1 Interest income
4,048.94
2a Ordinary dividends
318.37
3 Net short-term capital gain
5 Other portfolio and nonbusiness income
$0.00
14 Other information
C 3,763.94
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-4d16723fd02361fd81f66c62,v11-K-1-1041-stacked,original,2026,fgen-32e2315b9f570133a997771d,synthetic_programmatic_template,stacked,top,False,
"Part I Information About the Estate or Trust:
Estate of R. Walsh
To:
Taylor Nguyen
4a Net long-term capital gain
3,604.18
1 Interest income
485.74
14 Other information
V 4,143.38
Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2022",K-1,30,K-1,fdc-621d286744a3ef218d794808,v11-K-1-1041-stacked,original,2022,fgen-7dc71d8697ba1b94f0a91a10,synthetic_programmatic_template,stacked,bottom,False,
"VOID  CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2023
OMB No. 1545-0092
Final K-1  Amended K-1
Part I Information About the Estate or Trust
Estate of R. Walsh 3662 Lakeshore Blvd Lakewood, CO 65199
A Estate's or trust's employer identification number
88-1196178
Part II Information About the Beneficiary
Sofia Testcase
C Beneficiary's identifying number
***-**-9033
Street address (including apt. no.)
6375 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 99918
1 Interest income
8,878.46
2a Ordinary dividends
$5,445.36
4a Net long-term capital gain
$1,525.01
5 Other portfolio and nonbusiness income
0.00
14 Other information
C 8,905.28
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-3a9081c94cdf43ba9f39ed4b,v11-K-1-1041-stacked,original,2023,fgen-5dde5724ba91efdafa5e313a,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2025
From:
Testcase Family Trust
Recipient's name:
Wei Rivera
2a Ordinary dividends
5,440.84
14 Other information
DD 5,524.58
1 Interest income
$1,435.42",K-1,30,K-1,fdc-36b9934bb25cf8ea4d9ec944,v11-K-1-1041-stacked,original,2025,fgen-9c8b903467fc54ebcddc91d4,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1(Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2024
OMB No. 1545-0092
Final K-1  Amended K-1
Part I Information About thc Estate or Trust
Estate of R. Wa1sh 21O3Maple RidgeDr Cedar Falls, IA 23948
A Estate's or trust's employer identification number
71-6632712
Part II InformationAbout the Beneficiary
Kwame Brennan
C Beneficiary's identifying number
XXXXX8O18
Street address (including apt. no.)
8693 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, CO 43O68
l Interest income
9,419.49
2a Ordinary dividends
5,027.23
3 Net short-term capital gain
5 Other portfolio and nonbusiness income
$0.00
l4 Other information
DD 4,857.03
Department of the Treasury - Intema1 Revenue 5ervice
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormSchedu1eK1Form1041",K-1,30,K-1,fdc-6784bf519b95225b3dd3394e,v11-K-1-1041-stacked,original,2024,fgen-a6ae576819679ae7a378632e,synthetic_programmatic_template,stacked,top,True,
"VOID  CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2023
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
Testcase Family Trust 1344 Prairie Ave Pinecrest, GA 64775
A Estate's or trust's employer identification number
13-5675282
Part II Information About the Beneficiary
Noah Fischer
C Beneficiary's identifying number
XXX-XX-6986
Street address (including apt. no.)
2064 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 38101
Account number (see instructions)
***-**-914785
1 Interest income
912.79
2a Ordinary dividends
$6,002.73
3 Net short-term capital gain
4a Net long-term capital gain
$5,939.57
5 Other portfolio and nonbusiness income
14 Other information
D 891.62",K-1,30,K-1,fdc-63c2f3cad06f7225ba70f8a3,v11-K-1-1041-stacked,original,2023,fgen-a59ec39ab2b46642a6507aa3,synthetic_programmatic_template,stacked,top,False,
"ScheduleK-1 (Form 1O41) Beneficiary's Share of Income, Deductions, Credits, etc. 2026
From:
Testcase Family Trust
Recipient's name:
Jordan A. Adeyemi
4a Net 1ong-term capital gain
S5,061.10
14 Other information
DD 7,526.69
1 Interest income
$5,420.41",K-1,30,K-1,fdc-7fe52f4c2ab07dc1366b0e91,v11-K-1-1041-stacked,original,2026,fgen-ab138fa7a36fa811cb40a243,synthetic_programmatic_template,stacked,top,True,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2024
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
Larsen Irrevocable Trust 9620 Harbor View Rd Oak Grove, TX 76388
A Estate's or trust's employer identification number
54-6944590
Part II Information About the Beneficiary
Jamie J. Kowalski
C Beneficiary's identifying number
XXX-XX-8756
Street address (including apt. no.)
1136 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 45366
1 Interest income
$6,733.62
2a Ordinary dividends
$4,013.61
5 Other portfolio and nonbusiness income
0.00
14 Other information
D 2,319.79
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-70a0273e9dac8eed16b1bc80,v11-K-1-1041-stacked,original,2024,fgen-52c568fcb1b8f4b7d24e3693,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0092
Part I Information About the Estate or Trust
Testcase Family Trust 1164 Maple Ridge Dr Testville, IL 48196
A Estate's or trust's employer identification number
68-4310529
Part II Information About the Beneficiary
Alex Tanaka
C Beneficiary's identifying number
XXXXX4620
Street address (including apt. no.)
2994 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 36752
1 Interest income
1,901.17
2a Ordinary dividends
7,384.12
3 Net short-term capital gain
4a Net long-term capital gain
1,418.50
5 Other portfolio and nonbusiness income
14 Other information
DD 5,286.81",K-1,30,K-1,fdc-26b30c100f190b4bab9e74b9,v11-K-1-1041-stacked,original,2024,fgen-49f0730d126c08d20c362040,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2025
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
Testcase Family Trust 587 Maple Ridge Dr Pinecrest, GA 91386
A Estate's or trust's employer identification number
64-1929915
Part II Information About the Beneficiary
Morgan Moreau
C Beneficiary's identifying number
***-**-5895
Street address (including apt. no.)
2209 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 97007
Account number (see instructions)
XXX-XX-777055
1 Interest income
$325.80
2a Ordinary dividends
$1,750.35
3 Net short-term capital gain
0.00
4a Net long-term capital gain
6,388.55
5 Other portfolio and nonbusiness income
0.00
14 Other information
C 594.76
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-0c0b68baa55947c750688f91,v11-K-1-1041-stacked,original,2025,fgen-86afb89c44d349eb852d060f,synthetic_programmatic_template,stacked,none,False,
"VOID  CORRECTED
2022
OMB No. 1545-0092
Final K-1  Amended K-1
Part I Information About the Estate or Trust
Estate of R. Walsh 1435 Willow Bend Way Riverton, WI 74106
A Estate's or trust's employer identification number
33-1586434
Part II Information About the Beneficiary
Wei Rivera
C Beneficiary's identifying number
XXX-XX-6883
1 Interest income
2,940.55
2a Ordinary dividends
$3,486.50
3 Net short-term capital gain
0.00
4a Net long-term capital gain
$7,720.86
5 Other portfolio and nonbusiness income
0.00
14 Other information
DD 7,270.66
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-d944f17838c86fac93ca7402,v11-K-1-1041-stacked,original,2022,fgen-5ba49247dca1d1306d9347d7,synthetic_programmatic_template,stacked,bottom,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2023
Part I Information About the Estate or Trust:
Larsen Irrevocable Trust
To:
Casey R. Lindqvist
4a Net long-term capital gain
$5,076.87
14 Other information
D 7,126.93
1 Interest income
2,298.72",K-1,30,K-1,fdc-0117fd2ea40772294e893bfb,v11-K-1-1041-stacked,original,2023,fgen-54139b6cf4cc83309631150a,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2023
Final K-1  Amended K-1
Part I Information About the Estate or Trust
Larsen Irrevocable Trust 9828 Harbor View Rd Testville, IL 70349
A Estate's or trust's employer identification number
23-2209506
Part II Information About the Beneficiary
Casey Castillo
C Beneficiary's identifying number
***-**-2949
Street address (including apt. no.)
568 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 15515
Account number (see instructions)
***-**-261467
1 Interest income
$7,966.30
2a Ordinary dividends
8,392.07
3 Net short-term capital gain
0.00
4a Net long-term capital gain
4,159.30
5 Other portfolio and nonbusiness income
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-bec7c2637ed3dbf9af9c0340,v11-K-1-1041-stacked,original,2023,fgen-7b0678cec3b993643839a2b8,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2026
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
Testcase Family Trust 996 Willow Bend Way Fairview, OH 46968
A Estate's or trust's employer identification number
47-7084456
Part II Information About the Beneficiary
Fatima C. Patel
C Beneficiary's identifying number
****2772
1 Interest income
$7,013.09
2a Ordinary dividends
$9,079.32
3 Net short-term capital gain
$0.00
4a Net long-term capital gain
2,592.57
5 Other portfolio and nonbusiness income
14 Other information
DD 7,768.65
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-e04a200b6e8d4aae9499601c,v11-K-1-1041-stacked,original,2026,fgen-e2dff09a1d023d4bf018468d,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc.
Part I Information About the Estate or Trust:
Larsen Irrevocable Trust
RECIPIENT:
Amara M. Tanaka
14 Other information
AA 3,022.47
2a Ordinary dividends
$6,311.38",K-1,30,K-1,fdc-18068eeeb5a6ccf0385609ca,v11-K-1-1041-stacked,original,2025,fgen-b03318f94bac6bca52009d16,synthetic_programmatic_template,stacked,top,False,
"From:
Estate of R. Walsh
To:
Jamie Brennan
4a Net long-term capital gain
$3,353.93
1 Interest income
502.59
2a Ordinary dividends
6,903.73
14 Other information
V 1,474.39",K-1,30,K-1,fdc-548f2d51946bb83450eb26d7,v11-K-1-1041-stacked,original,2025,fgen-a8e77c4050070578d6d2da5c,synthetic_programmatic_template,stacked,none,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2024
From:      Estate of R. Walsh
RECIPIENT:  Diego C. Sato
2a Ordinary dividends $6,954.48
14 Other information D 4,148.24",K-1,30,K-1,fdc-df49fb2975e0a5e77a24b634,v11-K-1-1041-inline,original,2024,fgen-c59b5ef107df908642930285,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0092
Part I Information About the Estate or Trust Testcase Family Trust 2083 Elm Park Pl Cedar Falls, IA 62163
A Estate's or trust's employer identification number   15-4479767
Part II Information About the Beneficiary Diego Rivera
C Beneficiary's identifying number   ending in 8803
Street address (including apt. no.) 1601 Sample Street
City or town, state or province, country, and ZIP or foreign postal code   Bayside, WA 46849
Account number (see instructions) XXXXX846862
1 Interest income   3,554.60
2a Ordinary dividends $7,699.88
4a Net long-term capital gain  $5,877.59
5 Other portfolio and nonbusiness income
14 Other information V 2,463.76
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-8c17eea2fbe903125a9a9f12,v11-K-1-1041-inline,original,2026,fgen-0831f2462f94279200d66fba,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2022
OMB No. 1545-0092
Part I Information About the Estate or Trust   Testcase Family Trust 4817 Lakeshore Blvd Testville, IL 85454
A Estate's or trust's employer identification number      81-6257250
Part II Information About the Beneficiary Priya Lindqvist
C Beneficiary's identifying number XXXXX1506
Street address (including apt. no.)   90 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code   Riverton, WI 96909
1 Interest income   8,325.26
2a Ordinary dividends 6,914.78
3 Net short-term capital gain
4a Net long-term capital gain  6,985.44
5 Other portfolio and nonbusiness income
14 Other information  W 5,886.14",K-1,30,K-1,fdc-f0bff7e22e6d3ea392cc900c,v11-K-1-1041-inline,original,2022,fgen-a7dd60280663b4227617e76a,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2022
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust Testcase Family Trust 4006 Maple Ridge Dr Cedar Falls, IA 42869
A Estate's or trust's employer identification number      75-9418845
Part II Information About the Beneficiary      Amara Okafor
C Beneficiary's identifying number  ending in 9948
Street address (including apt. no.)      9488 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 31147
Account number (see instructions)  ****075105
1 Interest income 912.80
2a Ordinary dividends 5,143.79
3 Net short-term capital gain   0.00
4a Net long-term capital gain $6,854.52
5 Other portfolio and nonbusiness income  $0.00
14 Other information D 3,399.38",K-1,30,K-1,fdc-47e7719ac0a6bb809dd369e9,v11-K-1-1041-inline,original,2022,fgen-ff927eebcb533ef215ccb84f,synthetic_programmatic_template,inline,top,False,
"OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust      Larsen Irrevocable Trust 2906 Maple Ridge Dr Maplewood, MN 60824
A Estate's or trust's employer identification number  79-8282910
Part II Information About the Beneficiary Morgan B. Testcase
C Beneficiary's identifying number  ending in 0552
Account number (see instructions)      XXX-XX-329272
1 Interest income   8,648.86
2a Ordinary dividends   $1,991.64
3 Net short-term capital gain  0.00
4a Net long-term capital gain $4,137.71
5 Other portfolio and nonbusiness income
14 Other information D 3,193.95
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-d83d7a61f43ccd2bdf74486b,v11-K-1-1041-inline,original,2025,fgen-b0e091e765447f871e4f13e8,synthetic_programmatic_template,inline,bottom,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2026
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust Larsen Irrevocable Trust 359 Oak Hollow Ct Fairview, OH 60263
A Estate's or trust's employer identification number      15-9759858
Part II Information About the Beneficiary Jamie Kowalski
C Beneficiary's identifying number      ****2060
Street address (including apt. no.)   2893 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 80725
Account number (see instructions)  ending in 825894
1 Interest income  $8,097.22
2a Ordinary dividends   1,779.21
4a Net long-term capital gain  398.27
5 Other portfolio and nonbusiness income
14 Other information DD 1,417.60
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-704833b93f7a831109c43831,v11-K-1-1041-inline,original,2026,fgen-d84654bd1acde71812f81ae7,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2022
From: Larsen Irrevocable Trust
Recipient's name:  Noah A. Nguyen
14 Other information W 2,442.42",K-1,30,K-1,fdc-8e37919e535ba5e9ef9779d3,v11-K-1-1041-inline,original,2022,fgen-36e84dd44a5ff3e4565c24c6,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0092
Department of the Treasury Interna1 Revenue Service
Part I Information About the Estate or Trust  Testcase Family Trust 7665 Willow Bend Way Bayside, WA 21494
A Estate's or trust's employer identification number  24-94l9552
Part II Information About the Beneficiary     Taylor 0kafor
C Beneficiary's identifying number XXX-XX-3284
1Interest income  $7,892.81
2a 0rdinary dividends $3,080.66
3 Net short-tcrm capital gain 0.00
5 0ther portfolio and nonbusiness income
Department of the Treasury- Internal Revenue 5ervice
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-d91a89ae37c486a5b8f212fb,v11-K-1-1041-inline,original,2022,fgen-cb9148725508337735f5076a,synthetic_programmatic_template,inline,top,True,
"Part I Information About the Estate or Trust:  Larsen Irrevocable Trust
Recipient's name: Olivia Brennan
1 Interestincome $2,558.36
14 Other information W 3,636.1O
2a Ordinary dividends      $566.7l
4a Net long-term capital gain   4,826.72",K-1,30,K-1,fdc-23990ef97eaf71080e1a8695,v11-K-1-1041-inline,original,2023,fgen-38c3aae54b2bee6cc2a98fb5,synthetic_programmatic_template,inline,none,True,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2026
OMB No. 1545-0092
Part I Information About the Estate or Trust      Larsen Irrevocable Trust 9855 Cedar Ln Bayside, WA 99027
A Estate's or trust's employer identification number 94-6507671
Part II Information About the Beneficiary      Riley Rivera
C Beneficiary's identifying number  XXX-XX-2814
Account number (see instructions) ending in 938460
1 Interest income   565.74
2a Ordinary dividends   $823.26
3 Net short-term capital gain 0.00
4a Net long-term capital gain 9,091.17
14 Other information DD 5,053.47",K-1,30,K-1,fdc-103031268a18c676b08380cb,v11-K-1-1041-inline,original,2026,fgen-6c606f36d55f8fdcb3015301,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2021
Part I Information About the Estate or Trust:      Estate of R. Walsh
To: Morgan Okafor
14 Other information      C 4,498.70
4a Net long-term capital gain  2,158.26
1 Interest income      $3,722.31
2a Ordinary dividends $3,580.16",K-1,30,K-1,fdc-12c1120fcddeb20b89e77894,v11-K-1-1041-inline,original,2021,fgen-95a81479c77477a8316155ad,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2022
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust      Testcase Family Trust 1920 Harbor View Rd Bayside, WA 63780
A Estate's or trust's employer identification number      39-9147978
Part II Information About the Beneficiary      Riley Okafor
C Beneficiary's identifying number   ****0400
Street address (including apt. no.) 7399 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code  Riverton, WI 87369
1 Interest income      1,488.83
2a Ordinary dividends $4,537.40
3 Net short-term capital gain 0.00
4a Net long-term capital gain   $7,852.22
5 Other portfolio and nonbusiness income 0.00
14 Other information  C 2,802.11
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-2eda7d7c47bf4b713cd72f30,v11-K-1-1041-inline,original,2022,fgen-fc7737cf35c7c9de0942a0bb,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2025
Part I Information About the Estate or Trust:  Larsen Irrevocable Trust
Recipient's name:      Olivia Rivera
4a Net long-term capital gain $1,992.15
14 Other information      DD 730.61
2a Ordinary dividends $4,310.95",K-1,30,K-1,fdc-82db84a00a517fe1f46bd5df,v11-K-1-1041-inline,original,2025,fgen-c2997e3a2556d89ff111151a,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc.
From:  Testcase Family Trust
To:      Diego Larsen
4a Net long-term capital gain $4,313.22
2a Ordinary dividends  $1,465.04
1 Interest income 3,862.04
14 Other information V 4,151.99",K-1,30,K-1,fdc-db25b151b8f3bde29aeaea11,v11-K-1-1041-inline,original,2022,fgen-237f82fb5f53e639b73c01e8,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2025
From:  Larsen Irrevocable Trust
To: Mateo Brennan
14 Other information   DD 2,603.63",K-1,30,K-1,fdc-1f15d5dea7e44e8e782dcc37,v11-K-1-1041-inline,original,2025,fgen-aa062ee86057e77eff482f7c,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2023
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust Testcase Family Trust 2387 Willow Bend Way Fairview, OH 24715
A Estate's or trust's employer identification number      58-4246372
Part II Information About the Beneficiary      Amara Testcase
C Beneficiary's identifying number XXX-XX-3408
Street address (including apt. no.) 1092 Sample Street
City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 18406
1 Interest income   $6,288.29
2a Ordinary dividends      6,302.67
3 Net short-term capital gain
14 Other information   C 2,374.50",K-1,30,K-1,fdc-90ba4493c68dd4b0e9b22d93,v11-K-1-1041-inline,original,2023,fgen-a3f3fcf13a81086bb69640f6,synthetic_programmatic_template,inline,top,False,
"2025
OMB No. 1545-0092
Final K-1  Amended K-1
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Larsen Irrevocable Trust 81 Sample Street Maplewood, MN 82226
49-4024996
Wei Lindqvist
XXX-XX-8604
3001 Cedar Ln
Testville, IL 87284
5,581.51
7,200.38
$0.00
$4,728.81
W 6,612.41
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-8c7b7a5bfe579814e116b4d0,v11-K-1-1041-columns,original,2025,fgen-0514db955db04348630d8204,synthetic_programmatic_template,columns,bottom,False,
"2021
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Larsen Irrevocable Trust 6477 Willow Bend Way Oak Grove, TX 31459
30-6746930
Casey Okafor
XXX-XX-8481
5191 Prairie Ave
Riverton, WI 84725
$5,478.35
7,221.46
2,555.14
V 1,787.26
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-93bde0c7f9f0ea844ba4e341,v11-K-1-1041-columns,original,2021,fgen-906e8040e10fee71573ccbca,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2025
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Testcase Family Trust 9518 Elm Park Pl Fairview, OH 99046
31-5360444
Mateo Brennan
***-**-4065
9506 Elm Park Pl
Oak Grove, TX 69477
2,168.16
$6,120.64
$2,239.81
DD 2,608.29
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-3a3858d4ef6501119811acd3,v11-K-1-1041-columns,original,2025,fgen-1b10338eebb71d56bba7f2fc,synthetic_programmatic_template,columns,top,False,
"2026
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2a Ordinary dividends
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Testcase Family Trust 9248 Prairie Ave Testville, IL 74178
38-5940805
Mateo Okafor
XXXXX2907
8029 Granite St
Fairview, OH 25121
$8,915.75
9,244.11
C 8,652.93
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-924c589eca30dda6ebdf1533,v11-K-1-1041-columns,original,2026,fgen-29bb0febd27f4ff5a56d99a3,synthetic_programmatic_template,columns,none,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2022
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Interest income
2a Ordinary dividends
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Larsen Irrevocable Trust 1153 Elm Park Pl Brookhaven, PA 40251
41-9788011
Morgan Larsen
***-**-6323
1102 Maple Ridge Dr
Riverton, WI 78778
****889155
6,333.93
4,543.63
5,228.50
C 8,546.78
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-4b73c649acee56fba29a71a2,v11-K-1-1041-columns,original,2022,fgen-a7cf83e0ac06c32dd10ddd82,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2021
Final K-1  Amended K-1
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
14 Other information
Larsen Irrevocable Trust 5403 Willow Bend Way Riverton, WI 89797
70-6250215
Mateo Nguyen
****9630
709 Sample Street
Oak Grove, TX 86836
****913810
3,789.27
7,598.96
$7,398.74
W 1,726.52
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-c6a8571cbcf6ab491a11bb32,v11-K-1-1041-columns,original,2021,fgen-0bd48b92011dfea18ed79fbd,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2026
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Larsen Irrevocable Trust 7544 Lakeshore Blvd Riverton, WI 72114
44-4885908
Diego Rivera
XXX-XX-8765
7414 Sample Street
Pinecrest, GA 74656
****321380
5,609.04
3,070.33
0.00
DD 7,447.73",K-1,30,K-1,fdc-d44cc296b062e95ca0c3116a,v11-K-1-1041-columns,original,2026,fgen-26b174cd981d54fce879b2c3,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2025
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Estate of R. Walsh 7800 Sample Street Testville, IL 89673
71-2159340
Riley D. Moreau
ending in 5445
6663 Cedar Ln
Testville, IL 37157
$8,208.06
0.00
W 8,451.07
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-b6d8a20c51a2644e959308d1,v11-K-1-1041-columns,original,2025,fgen-bbe7bce862beb2f766154ac6,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1O41)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2O25
Final K-1  Amended K-1
Department of the TreasuryInternal Revenuc Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part IIInformatíon About the Beneficiary
C Beneficiary's identifying number
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14Other information
Estate of R. Walsh 8516 Prairie Ave Lakewood, C0 23021
60-3039672
Hiro B. Nguyen
XXXXX4043
1,262.48
0.00
S1,146.71
D 326.94
Department of the Treasury - Internal Revenue 5ervice
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/Form5cheduleK1Form1O41",K-1,30,K-1,fdc-33b7cec0f4f4b0bd54818019,v11-K-1-1041-columns,original,2025,fgen-66f014c55591c690344b2623,synthetic_programmatic_template,columns,top,True,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2022
OMB No. 1545-0092
Final K-1  Amended K-1
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Account number (see instructions)
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Testcase Family Trust 3437 Prairie Ave Fairview, OH 46585
98-4909562
Alex Okafor
XXX-XX-9597
****290299
5,317.55
$8,166.91
$0.00
325.68
D 300.35
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-e3fbaade54c36bf5d78171f8,v11-K-1-1041-columns,original,2022,fgen-fad3b0ea8fc9806aa8a31f36,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
0MB No. 1545-0092
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
5treetaddress (including apt. no.)
City or town, state or province,country, and ZIP or foreign postal code
Account number (see ínstructions)
3 Net short-term capital gain
4a Net long-term capital gain
5 0ther portfolio and nonbusiness income
l4 0ther ínformation
Estate of R. Walsh 1272 Oak Hollow CtTestville, IL 50533
58-8946326
Morgan Moreau
XXXXX7110
748 Elm Park Pl
Lakewood, CO 77317
ending in 756613
S7,596.69
AA 5,842.56",K-1,30,K-1,fdc-d076ccc3e6783281c7cb057c,v11-K-1-1041-columns,original,2025,fgen-9b48c9b86e7356a6799a0cd4,synthetic_programmatic_template,columns,top,True,
"CORRECTED (if checked)
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2021
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Interest income
2a Ordinary dividends
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Estate of R. Walsh 7425 Lakeshore Blvd Maplewood, MN 24546
51-6126560
Priya Haddad
XXX-XX-0090
3016 Granite St
Maplewood, MN 52823
$5,356.34
$7,880.81
7,792.62
W 1,563.16
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-332c760e577edc5e52bd605d,v11-K-1-1041-columns,original,2021,fgen-dbdca517f22bef4991f59048,synthetic_programmatic_template,columns,top,False,
"For calendar year 2022
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Estate of R. Walsh 5249 Maple Ridge Dr Oak Grove, TX 57572
58-8361356
Wei B. Rivera
***-**-7022
1163 Harbor View Rd
Cedar Falls, IA 61322
****298141
$1,353.90
3,393.26
1,648.60
V 5,032.37
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-1202f445834fffd2846a69b7,v11-K-1-1041-columns,original,2022,fgen-abdaa6eac6466083a00d6970,synthetic_programmatic_template,columns,bottom,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2022
Part I Information About the Estate or Trust:
To:
1 Interest income
14 Other information
2a Ordinary dividends
Estate of R. Walsh
Jordan Patel
$2,333.76
V 3,840.14
$8,108.40",K-1,30,K-1,fdc-863150a7d6868ac3dcd0698b,v11-K-1-1041-columns,original,2022,fgen-d21b3c8be86aa56dc002d9aa,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2022
OMB No. 1545-0092
Department of the Treasury Intemal Revenue Service
Part I Information Aboutthe Estate or Trust
A Estate's or trust's employeridentification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postalcode
1 Interest income
3 Net short-term capital gain
4a Net long-term capital gain
14 0ther information
Larsen Irrevocable Trust 6571 Harbor Vicw Rd Pinecrest, GA 99263
98-8963462
Hiro Nguyen
ending in 5539
8O26 Elm Park Pl
Brookhaven, PA 41346
4,174.86
$7,188.78
V 3,622.17",K-1,30,K-1,fdc-81f59e687aa86c37e87925ee,v11-K-1-1041-columns,original,2022,fgen-dcc219157cefdbb4f5518f22,synthetic_programmatic_template,columns,top,True,
"2021
OMB No. 1545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Estate or Trust
A Estate's or trust's employer identification number
Part II Information About the Beneficiary
C Beneficiary's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Interest income
2a Ordinary dividends
3 Net short-term capital gain
4a Net long-term capital gain
5 Other portfolio and nonbusiness income
14 Other information
Testcase Family Trust 7021 Oak Hollow Ct Fairview, OH 86727
51-1715538
Morgan B. Lindqvist
XXX-XX-0505
608 Harbor View Rd
Lakewood, CO 63537
****566831
$223.51
$8,602.57
0.00
$8,178.35
C 4,613.35
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-ea2c47eb95a8fa106d4e542f,v11-K-1-1041-columns,original,2021,fgen-5e638ddb1c038773bbfea409,synthetic_programmatic_template,columns,bottom,False,
"VOID  CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2023
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Testcase Family Trust 9073 Willow Bend Way Brookhaven, PA 92378 |
| A Estate's or trust's employer identification number | 89-9386052 |
| Part II Information About the Beneficiary | Olivia Sato |
| C Beneficiary's identifying number | XXXXX3457 |
| 1 Interest income | 7,857.41 |
| 2a Ordinary dividends | 6,454.30 |
| 3 Net short-term capital gain |  |
| 4a Net long-term capital gain | $2,317.50 |
| 5 Other portfolio and nonbusiness income | 0.00 |
| 14 Other information | D 4,149.68 |
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-3ece9cdf39310e40065336fe,v11-K-1-1041-markdown,original,2023,fgen-91dac2de82ee1e0ca5e802d2,synthetic_programmatic_template,markdown,top,False,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2022
| Field | Value |
| --- | --- |
| From: | Testcase Family Trust |
| RECIPIENT: | Amara Brennan |
| 2a Ordinary dividends | 6,590.47 |
| 1 Interest income | 7,837.33 |",K-1,30,K-1,fdc-79fc1eecdebd573d43558e85,v11-K-1-1041-markdown,original,2022,fgen-e043521dbb81d66fd8e89840,synthetic_programmatic_template,markdown,top,False,
"## Schedule K-1 (Form 1041)
## Beneficiary's Sharc of Incomc, Deductions, Credits, etc.
For calendar year 2026
OMB No. 1545-0092
Final K-1  Amended K-1
|Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Testcase Family Trust 4329 Prairie Ave Testville, IL 65611 |
|A Estate's or trust's employer identification number | 30-4864436 |
| Part II Information About thc Beneficiary | Olivia Okafor |
| C Beneficiary's identifying number | ****4791 |
| Account number(see instructions) | XXXXX854178 |
| 1 Interest income | 81.52 |
| 2a Ordinary dividends | 1,581.42 |
|3 Net short-term capital gain |  |
| 4a Net long-term capital gain | $8,l37.61 |
| 5 Other portfolío and nonbusiness income | $0.00 |
Department of the Treasury -Intema1 Revenue 5ervice
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormSchedu1eK1Form1041",K-1,30,K-1,fdc-68c1b352ca88a9975aa239b5,v11-K-1-1041-markdown,original,2026,fgen-b331cde777557fb186e2bd1f,synthetic_programmatic_template,markdown,top,True,
"CORRECTED (if checked)
Schedule K-1 (Form 1041)
## Beneficiary's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Testcase Family Trust 4827 Cedar Ln Riverton, WI 54245 |
| A Estate's or trust's employer identification number | 36-3922481 |
| Part II Information About the Beneficiary | Riley Moreau |
| C Beneficiary's identifying number | XXXXX5518 |
| Street address (including apt. no.) | 6426 Willow Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 77343 |
| 1 Interest income | 2,794.02 |
| 3 Net short-term capital gain | $0.00 |
| 4a Net long-term capital gain | 391.73 |
| 5 Other portfolio and nonbusiness income |  |
| 14 Other information | W 5,506.04 |",K-1,30,K-1,fdc-4db202f14b39255dc23119f5,v11-K-1-1041-markdown,original,2023,fgen-8101cf85ad5ccbc7b6447f52,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
## For calendar year 2025
OMB No. 1545-0092
Final K-1  Amended K-1
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Estate of R. Walsh 2937 Maple Ridge Dr Fairview, OH 36160 |
| A Estate's or trust's employer identification number | 19-8710201 |
| Part II Information About the Beneficiary | Mateo K. Walsh |
| C Beneficiary's identifying number | XXXXX7007 |
| Street address (including apt. no.) | 2350 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 10248 |
| Account number (see instructions) | ***-**-821851 |
| 1 Interest income | 6,317.79 |
| 2a Ordinary dividends | $5,225.64 |
| 3 Net short-term capital gain |  |
| 4a Net long-term capital gain | $1,397.89 |
| 5 Other portfolio and nonbusiness income |  |
| 14 Other information | C 6,296.46 |
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-37cb84d0956dcf307d7f1aa3,v11-K-1-1041-markdown,original,2025,fgen-b1084e55463f9e95eeae5060,synthetic_programmatic_template,markdown,top,False,
"2024
OMB No. 1545-0092
## Final K-1  Amended K-1
Department of the Treasury InternalRevenue Service
| Field | Value |
| --- | --- |
| Part I Information Aboutthe Estate or Trust | Estate ofR. Walsh 4736 Oak Hollow Ct Pinecrest, GA 72259 |
| A Estate's or trust's employer identification number | 22-9645237 |
| Part II Information About the Beneficiary | Hiro Tanaka |
| C Beneficiary's identifying number | XXXXX5955 |
| 5treet address (including apt. no.) | 3038 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA l7994 |
|l Interest income | 7,36O.83 |
| 2a Ordinarydividends | $8,840.96 |
| 4a Net long-term capítal gain | 295.33 |
| 5 Other portfolio and nonbusiness income |  |
| 14 Other ínformation | DD 4,4O9.O3 |
## Department of the Treasury - Intemal Revenue Service
ScheduleK-l (Form 1041)
Benefíciary's Sharc of Income, Deductions, Credits, etc.
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-3076f1eb554bd5d96c95e594,v11-K-1-1041-markdown,original,2024,fgen-5e427e4af87082a23c102ee7,synthetic_programmatic_template,markdown,bottom,True,
"## ☐ CORRECTED
## Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2025
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Larsen Irrevocable Trust 4180 Maple Ridge Dr Maplewood, MN 12119 |
| A Estate's or trust's employer identification number | 96-7603992 |
| Part II Information About the Beneficiary | Kwame Adeyemi |
| C Beneficiary's identifying number | XXX-XX-0602 |
| 1 Interest income | $4,161.52 |
| 2a Ordinary dividends | $7,271.61 |
| 3 Net short-term capital gain |  |
| 4a Net long-term capital gain | $8,756.27 |
| 5 Other portfolio and nonbusiness income |  |
| 14 Other information | W 2,389.16 |
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-14356e51615dad0bff2c45dc,v11-K-1-1041-markdown,original,2025,fgen-88d00fec1c68d6a9d1d77d8a,synthetic_programmatic_template,markdown,top,False,
"## Schedule K-1 (Form 1041)
## Beneficiary's Share of Income, Deductions, Credits, etc.
2022
OMB No. 1545-0092
## Final K-1  Amended K-1
## Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Larsen Irrevocable Trust 2431 Elm Park Pl Lakewood, CO 63621 |
| A Estate's or trust's employer identification number | 73-7041890 |
| Part II Information About the Beneficiary | Hiro M. Haddad |
| C Beneficiary's identifying number | XXX-XX-1993 |
| 1 Interest income | $2,534.39 |
| 2a Ordinary dividends | 5,110.53 |
| 3 Net short-term capital gain | 0.00 |
| 5 Other portfolio and nonbusiness income |  |
| 14 Other information | AA 1,359.32 |
## Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1041) (keep for your records)  www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-a1baf6e37f9981739b342e1c,v11-K-1-1041-markdown,original,2022,fgen-7f705e24df03398b5b73c5e1,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
Schedule K-1 (Form 1041)
## Beneficiary's Share of Income, Deductions, Credits, etc.
2022
OMB No. l545-0092
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Servíce
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Testcase Famíly Trust l812 Willow Bend Way Brookhaven, PA 45102 |
| A Estate's or trust's employeridentification number | 75-7938799 |
|Part II Information About thc Beneficiary| Diego Patel |
| C Beneficiary'sidentifying number | ***-**-7686 |
| Account number (see instructions) | ****689235 |
| 1 Interest income | $1,965.57 |
| 2a 0rdínary dividends | 5,159.40 |
| 3 Net short-term capital gain |  |
| 4a Net long-term capital gain | $1,204.22 |
| 5 0ther portfolio and nonbusiness income |  |
| 14 Other information | DD 3O5.07 |
## Department ofthe Treasury - Interna1 Revenue 5ervíce
## Form K-1 (Form 1041) (kcep for your records)  www.irs.gov/Form5cheduleK1Form1041",K-1,30,K-1,fdc-aa38b74983b8e99685a0ee48,v11-K-1-1041-markdown,original,2022,fgen-dbef0a3048ab4bd80064a002,synthetic_programmatic_template,markdown,top,True,
"☐ CORRECTED
## Schedule K-1 (Form 1041)
## Beneficiary's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0092
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Larsen Irrevocable Trust 2307 Sample Street Fairview, OH 89904 |
| A Estate's or trust's employer identification number | 55-5353083 |
| Part II Information About the Beneficiary | Wei Lindqvist |
| C Beneficiary's identifying number | ending in 6719 |
| Street address (including apt. no.) | 7456 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 39977 |
| Account number (see instructions) | XXXXX147232 |
| 1 Interest income | 3,311.82 |
| 4a Net long-term capital gain | $8,860.62 |
| 5 Other portfolio and nonbusiness income | $0.00 |
| 14 Other information | DD 5,039.64 |",K-1,30,K-1,fdc-de2d220a9854f72238a08058,v11-K-1-1041-markdown,original,2023,fgen-d10a915527a6cb0cb5868adb,synthetic_programmatic_template,markdown,top,False,
"## Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
## For calendar year 2022
## OMB No. 1545-0092
## Final K-1  Amended K-1
Department of the Treasury Internal Revenue 5ervice
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Testcase Famí1y Trust 9106Maple Ridge Dr Fairview, OH 32778 |
| A Estate's or trust's employer identification number | 15-4582398 |
| Part II InformationAbout the Beneficiary | JordanJ. Lindqvist |
| C Beneficiary'sidentifying number | ****6641 |
| 5treet address (induding apt. no.) | 4118 Wi1low Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 52494 |
| 1 Intcrest income | S9,322.24 |
| 2a Ordinary dividends |9,l72.72 |
| 3 Net short-term capital gain |  |
| 4a Net long-term capital gain | 1,913.71 |
| 14 Other information | D 5,127.44 |
Department of the Treasury - Intema1 Revenue 5ervíce
Form K-l (Form 1041) (keep for your records) www.irs.gov/FormScheduleK1Form1041",K-1,30,K-1,fdc-ceb5b6c2af78a2d6e6b4bf1e,v11-K-1-1041-markdown,original,2022,fgen-35291dfc5da35b36c95f42ca,synthetic_programmatic_template,markdown,top,True,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc.
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust: | Estate of R. Walsh |
| To: | Fatima R. Fischer |
| 2a Ordinary dividends | $5,843.67 |
| 1 Interest income | $1,321.20 |",K-1,30,K-1,fdc-de2d3669918ca34aa892d425,v11-K-1-1041-markdown,original,2021,fgen-04594bdd39f75f4362eec2bd,synthetic_programmatic_template,markdown,top,False,
"VOID  CORRECTED
Schedule K-1 (Form1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
2025
## OMB No. 1545-0092
Fina1 K-1  Amended K-l
## Department of the Treasury Internal Revenue 5ervice
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Testcase Family Trust 2477 Lakeshore Blvd Bayside, WA 78043 |
| A Estate's or trust's employer identification number | 96-4968798 |
| Part II Information About the Beneficiary | Kwame L. Castillo |
| C Beneficiary's identifying number | XXXXX1771 |
| Street address (including apt. no.) | 4348 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 73358 |
| lInterest income | 2,O11.29 |
| 2a 0rdinary dividends | 3,420.07 |
| 3 Net short-term capital gain | $0.00 |
| 5 Other portfolio andnonbusincss income |$0.00 |
| l4Other information | V 5,577.06 |",K-1,30,K-1,fdc-0c57ff25fc840c25fa5a582b,v11-K-1-1041-markdown,original,2025,fgen-cb1a104d350a3a560b3b3c10,synthetic_programmatic_template,markdown,top,True,
"Schedule K-1 (Form 1041) Beneficiary's Share of Income, Deductions, Credits, etc. 2021
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust'S name: | Larsen Irrevocable Trust |
| To: | Diego Walsh |
| 4a Net long-term capital gain | 244.85 |",K-1,30,K-1,fdc-d9e52ba8d37aeb9debc65478,v11-K-1-1041-markdown,original,2021,fgen-35502306c75d18733f325f3f,synthetic_programmatic_template,markdown,top,False,
"Schedule K-1 (Form 1041)
## Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2022
OMB No. 1545-0092
Final K-1  Amended K-1
## Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Part I Information About the Estate or Trust | Larsen Irrevocable Trust 2509 Willow Bend Way Brookhaven, PA 41986 |
| A Estate's or trust's employer identification number | 11-4404393 |
| Part II Information About the Beneficiary | Wei Testcase |
| C Beneficiary's identifying number | XXXXX2237 |
| Street address (including apt. no.) | 8647 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 94641 |
| 2a Ordinary dividends | 8,494.10 |
| 3 Net short-term capital gain |  |
| 4a Net long-term capital gain | $3,216.46 |
| 5 Other portfolio and nonbusiness income |  |
| 14 Other information | V 8,348.30 |",K-1,30,K-1,fdc-827181b56e777f8c2a9bce83,v11-K-1-1041-markdown,original,2022,fgen-7e127954989e38eef5ee6708,synthetic_programmatic_template,markdown,top,False,
"Schedule K-1 (Form 1041)
Beneficiary's Share of Income, Deductions, Credits, etc.
For calendar year 2023
## OMB No. 1545-0092
| Ficld | Value |
| --- | --- |
| Part IInformation About the Estate or Trust | Estateof R. Walsh 3740 Prairie Ave Lakewood, CO 49893 |
| A Estate's or trust's employer identificationnumbcr | 27-8078965 |
| Part II Information About thc Beneficiary | Lena Rivera |
| C Beneficiary's identifying number | ending in 3641 |
| 5treet address (induding apt. no.) | 6134 Granite St |
| City or town, state or provínce, country, and ZIP or foreign postal code | Bayside,WA 46468 |
| Account number (see instructions) | ***-**-021618 |
| 1 Interest income | 1,342.91 |
| 2a 0rdinary dividends | S8,062.79 |
| 3 Net short-term capital gain |  |
| 4a Net long-term capital gain | $7,903.2l |
| 5 0ther portfolio and nonbusincss income | $0.00 |
| 14 Otherínformation | DD 2,446.42 |
Departmentof the Treasury - Intemal Revenue 5ervice
Form K-l (Form 1041) (keep for your records)  www.irs.gov/Form5cheduleK1Form1041",K-1,30,K-1,fdc-e2f461741dfd41f6e3d550c5,v11-K-1-1041-markdown,original,2023,fgen-5ac475dc5ab1362d916703e9,synthetic_programmatic_template,markdown,top,True,
"Schedule K-1 (Form 1065)
Partner's 5hare of Incomc, Deductions, Credits, etc.
For calendar year 2023
OMB No. 1545-0123
Department of the Treasury Internal RevenueServíce
Part I Information About the Partnership
Granite Holdings Partners 4697 Lakeshore Blvd Oak Grove, TX 97168
A Partnership's employer identification number
11-5O958O4
Part II Information About the Partner
Kwame B. Okafor
E Partner's 5SN or TIN
XXX-XX-3038
Street address (induding apt. no.)
7163 Sample Street
Cityor town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 30371
Account number (see instructions)
***-**-421464
4a Guaranteed paymentsfor services
S0.00
5 Interest income
4,435.58
l4 Se1f-employment earnings (loss)
3,787.11
19 Distributions
$6,509.20
L Partner's Capital Account Analysis  Beginning capital account
$110,964.48
L Ending capital account
41,541.01",K-1,30,K-1,fdc-8b4886252ddf7b3816228b4b,v11-K-1-1065-stacked,original,2023,fgen-63e454f2b2a1d936ea4a29ba,synthetic_programmatic_template,stacked,top,True,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc.
From:
Granite Holdings Partners
RECIPIENT:
Taylor Lindqvist
L Ending capital account
27,517.51
19 Distributions
$7,784.45
2 Net rental real estate income (loss)
10,627.25",K-1,30,K-1,fdc-4e191614eeaf22f3a34dd6c9,v11-K-1-1065-stacked,original,2025,fgen-fbd0bd844cd4f002a363c719,synthetic_programmatic_template,stacked,top,False,
"Part I Information About the Partnership:
Sample Rentals LP
RECIPIENT:
Riley Romero
L Partner's Capital Account Analysis  Beginning capital account
63,635.83
5 Interest income
$4,986.40
14 Self-employment earnings (loss)
17,302.05",K-1,30,K-1,fdc-f86f2b0dcebdd6d50c679c9b,v11-K-1-1065-stacked,original,2024,fgen-bab64ca7f364df5a5fad210a,synthetic_programmatic_template,stacked,none,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
Sample Rentals LP1919 Elm Park Pl Lakewood, C0 39560
A Partnership's employer identification number
51-7647201
Part IIInformation About the Partner
Jamie E. Adeyemi
E Partner's 5SN orTIN
XXXXX6548
Streetaddress (including apt. no.)
3l55 Granitc St
City or town, state or province, country, and ZIP or foreign postal codc
Cedar Falls, IA 72747
Account number (see instructions)
XXX-XX-687730
l Ordinary business income (loss)
27,838.5l
2 Net rental real estate íncome (loss)
20,611.76
4a Guaranteed payments for services
5 Interest income
$4,463.33
14 Self-employment eamings (loss)
7,128.43
19 Distributions
$5,696.68
L Partner's Capital Account Analysis  Beginning capital account
29,250.98
Department of the Treasury - Intemal Revenue Service
Form K-l (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-9a3f3b23c04efb7538919a1d,v11-K-1-1065-stacked,original,2021,fgen-cbf4ae54d93b1f7a13bb7b83,synthetic_programmatic_template,stacked,top,True,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnership
Riverbend Ventures LLC1436 Sample Street Riverton,WI 57423
A Partnership's emp1oyer identification number
75-6609455
Part II Information About the Partner
Hiro Sato
E Partner's SSN or TIN
****8410
Street address (inc1uding apt. no.)
1938 Harbor View Rd
City or town, state or province, country, and ZIP orforeign postal code
Fairview, OH 31149
1 Ordinary business income (loss)
1,103.10
2 Net renta1 real estate income (loss)
27,522.38
4a Guaranteed payments forservices
$0.00
5 Intercst income
7,087.68
19 Distributions
9.56
L Partner's Capital Account Analysis  Beginning capital account
$123,064.85
L Ending capital account
98,476.94
Department of the Treasury - Internal Revenue Servíce
Form K-l (Form lO65) (keep for your records)  www.írs.gov/FormScheduleKlForm1065",K-1,30,K-1,fdc-9f33e611b821bdfe18926ed1,v11-K-1-1065-stacked,original,2022,fgen-65bd2f0df13ffee52cf09d05,synthetic_programmatic_template,stacked,top,True,
"Part I Information About the Partnership:
Granite Holdings Partners
RECIPIENT:
Lena D. Rivera
1 Ordinary business income (loss)
29,497.24",K-1,30,K-1,fdc-57665d0e3f5acba39d5d4bde,v11-K-1-1065-stacked,original,2025,fgen-7f39453ea17ebef9183a5bc9,synthetic_programmatic_template,stacked,none,False,
"VOID  CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2022
Part I Information About the Partnership
Sample Rentals LP 760 Elm Park Pl Brookhaven, PA 29268
A Partnership's employer identification number
75-2458103
Part II Information About the Partner
Noah Lindqvist
E Partner's SSN or TIN
****6388
Street address (including apt. no.)
9573 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code
Maplewood, MN 94511
Account number (see instructions)
ending in 478238
2 Net rental real estate income (loss)
(6,201.02)
4a Guaranteed payments for services
0.00
5 Interest income
$8,757.96
19 Distributions
$6,325.67
L Partner's Capital Account Analysis  Beginning capital account
99,511.97
L Ending capital account
$94,362.83",K-1,30,K-1,fdc-13b35155a70f5b75db1776df,v11-K-1-1065-stacked,original,2022,fgen-4d38a60d719bc024985b7a3e,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductíons, Credits, etc. 2021
From:
Granite Holdings Partners
RECIPIENT:
Noah Castillo
14 Self-employment earnings (loss)
23,595.90
1Ordinary business income (loss)
7,802.05
2 Net rental real estate income (loss)
2l,462.28
L Partner's Capital Account Analysis  Beginning capital account
59,149.03",K-1,30,K-1,fdc-9b7cbe7264e2ec1fec3db525,v11-K-1-1065-stacked,original,2021,fgen-dd8f5d98a094ebc6b2ae5e4b,synthetic_programmatic_template,stacked,top,True,
"VOID  CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income,Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnershíp
Samp1e Renta1s LP 7003 Lakeshore Blvd Maplewood,MN 47552
A Partnership's employer identification number
l5-9313254
Part II Information About the Partner
Priya L. Moreau
E Partner's SSN or TIN
****2435
Street address (índudíng apt. no.)
8O48 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 69716
Account number (see instructions)
XXXXX460873
1 Ordinary business income (1oss)
(4,179.14)
4a Guaranteed payments for services
5 Interest income
$2,124.55
14 Se1f-employment eamings (loss)
5,695.77
19 Distributions
6,383.23
L Partner's Capital Account Analysís  Beginning capital account
82,346.97
L Ending capital account
10,573.64
Department ofthe Treasury - Intemal Revenue 5ervice
Form K-1 (Form 1065) (keep for yourrecords)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-a432e99826f73255b562d84b,v11-K-1-1065-stacked,original,2022,fgen-8bd0e42890199c55a032034a,synthetic_programmatic_template,stacked,top,True,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2022
OMB No. 1545-0123
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
Riverbend Ventures LLC 800 Granite St Maplewood, MN 25982
A Partnership's employer identification number
37-5518624
Part II Information About the Partner
Avery M. Rivera
E Partner's SSN or TIN
***-**-7944
1 Ordinary business income (loss)
2,665.09
4a Guaranteed payments for services
5 Interest income
5,544.72
14 Self-employment earnings (loss)
11,711.16
19 Distributions
1,518.60
L Partner's Capital Account Analysis  Beginning capital account
25,310.64
L Ending capital account
$73,204.88",K-1,30,K-1,fdc-5e72e229ed6693d91382bfb0,v11-K-1-1065-stacked,original,2022,fgen-4f7becf4622b97dc5c305b19,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2022
OMB No. 1545-0123
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
Riverbend Ventures LLC 5197 Prairie Ave Oak Grove, TX 25116
A Partnership's employer identification number
40-2642952
Part II Information About the Partner
Kwame Okafor
E Partner's SSN or TIN
***-**-0713
Street address (including apt. no.)
2849 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 39322
1 Ordinary business income (loss)
(7,673.27)
2 Net rental real estate income (loss)
1,904.21
4a Guaranteed payments for services
5 Interest income
$3,346.06
14 Self-employment earnings (loss)
6,914.02
19 Distributions
$4,061.41
L Ending capital account
$99,552.52
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-517489e3feef5a5054d5af60,v11-K-1-1065-stacked,original,2022,fgen-f9164545d45b071bc67bf79d,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2026
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
Granite Holdings Partners 1918 Maple Ridge Dr Fairview, OH 56551
A Partnership's employer identification number
66-8044905
Part II Information About the Partner
Fatima Brennan
E Partner's SSN or TIN
ending in 9767
Street address (including apt. no.)
2294 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 34611
1 Ordinary business income (loss)
25,897.16
2 Net rental real estate income (loss)
17,154.16
4a Guaranteed payments for services
0.00
5 Interest income
$313.22
14 Self-employment earnings (loss)
4,185.68
19 Distributions
$3,419.10
L Ending capital account
2,356.02",K-1,30,K-1,fdc-1d3df3a78d0fb99c34edfceb,v11-K-1-1065-stacked,original,2026,fgen-e644a01a11ea0e9d8a1c5cb2,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc. 2026
Part I Information About the Partnership:
Sample Rentals LP
To:
Diego Romero
14 Self-employment earnings (loss)
22,371.63
1 Ordinary business income (loss)
14,136.19
L Ending capital account
$8,411.59",K-1,30,K-1,fdc-cfb963db172043ad61a2c9a3,v11-K-1-1065-stacked,original,2026,fgen-2de318a2c5b55c4918439875,synthetic_programmatic_template,stacked,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2025
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
Sample Rentals LP 646 Oak Hollow Ct Cedar Falls, IA 43878
A Partnership's employer identification number
13-7104899
Part II Information About the Partner
Amara M. Testcase
E Partner's SSN or TIN
ending in 5364
Street address (including apt. no.)
969 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 65987
1 Ordinary business income (loss)
-5,180.06
2 Net rental real estate income (loss)
2,902.00
4a Guaranteed payments for services
0.00
5 Interest income
$6,459.72
19 Distributions
$1,964.72
L Partner's Capital Account Analysis  Beginning capital account
111,913.06
L Ending capital account
59,321.11
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-3fa029d1b8cd21b3886b0aac,v11-K-1-1065-stacked,original,2025,fgen-d279fb3f28248278ba452cf9,synthetic_programmatic_template,stacked,top,False,
"Part I Information About the Partnership'S name:
Granite Holdings Partners
RECIPIENT:
Fatima Moreau
14 Self-employment earnings (loss)
28,453.72
1 Ordinary business income (loss)
9,904.00
Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-6579a3ee52defa3e76185a28,v11-K-1-1065-stacked,original,2024,fgen-a8deb16af2bd57b3d427381b,synthetic_programmatic_template,stacked,bottom,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2026
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
Granite Holdings Partners 377 Maple Ridge Dr Fairview, OH 88199
A Partnership's employer identification number
48-5839656
Part II Information About the Partner
Hiro Fischer
E Partner's SSN or TIN
****0755
Account number (see instructions)
XXXXX090028
1 Ordinary business income (loss)
7,257.83
2 Net rental real estate income (loss)
8,686.73
4a Guaranteed payments for services
0.00
5 Interest income
6,824.69
14 Self-employment earnings (loss)
(7,763.85)
L Partner's Capital Account Analysis  Beginning capital account
42,710.14
L Ending capital account
$39,356.96",K-1,30,K-1,fdc-7af7745d58016cc7aaf5d727,v11-K-1-1065-stacked,original,2026,fgen-7f972b632cdd8245fc71f82d,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
For calendar year 2021
Final K-1  Amended K-l
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership      Granite Holdings Partners 890l Oak Hollow Ct Maplewood, MN 24399
A Partnershíp's employer identification number 40-5682835
PartII Information About the Partner  Lena Fischer
E Partner's SSN or TIN   ****9l38
Account number (see ínstructíons)      XXXXX774101
4a Guaranteed payments for services 0.00
l4 Self-employment earnings (loss) 13,688.37
L Partner's Capital Account Analysis  Beginningcapital account S14,036.14
L Ending capital account     31,974.12",K-1,30,K-1,fdc-97e7a3b7502149affe5a9305,v11-K-1-1065-inline,original,2021,fgen-5c4df87fe4a2a17ad0eae9c5,synthetic_programmatic_template,inline,none,True,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnership   Granite Holdings Partners 558 Sample Street Fairview, OH 43135
A Partnership's employer identification number      29-1463499
Part II Information About the Partner   Lena Moreau
E Partner's SSN or TIN ending in 4271
Street address (including apt. no.) 2864 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code      Riverton, WI 50281
1 Ordinary business income (loss)  (6,548.88)
2 Net rental real estate income (loss)      14,602.09
4a Guaranteed payments for services      $0.00
5 Interest income  2,822.60
14 Self-employment earnings (loss) -5,444.49
19 Distributions   5,901.86
L Partner's Capital Account Analysis  Beginning capital account  13,339.42",K-1,30,K-1,fdc-eb553da61e9022363742fc13,v11-K-1-1065-inline,original,2022,fgen-1709d738bb70073d9c7b2455,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnership      Granite Holdings Partners 6104 Lakeshore Blvd Pinecrest, GA 77879
A Partnership's employer identification number      72-6723069
Part II Information About the Partner   Hiro Romero
E Partner's SSN or TIN  XXXXX0803
Street address (including apt. no.)   9688 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code   Lakewood, CO 97243
2 Net rental real estate income (loss) -6,259.24
4a Guaranteed payments for services $0.00
5 Interest income      3,749.38
14 Self-employment earnings (loss) 8,059.86
L Partner's Capital Account Analysis  Beginning capital account   $113,793.46
L Ending capital account 111,795.39
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-4092b314656ed966ccdd3dcb,v11-K-1-1065-inline,original,2023,fgen-0d0d7566f274a3ad176e08b7,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnership      Granite Holdings Partners 8109 Granite St Lakewood, CO 15818
A Partnership's employer identification number  21-2817219
Part II Information About the Partner  Alex Tanaka
E Partner's SSN or TIN ****7315
Street address (including apt. no.)      4628 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 95129
Account number (see instructions)   XXX-XX-216225
1 Ordinary business income (loss)   -6,331.78
2 Net rental real estate income (loss)      11,078.38
4a Guaranteed payments for services $0.00
14 Self-employment earnings (loss)      29,591.24
19 Distributions $4,664.61
L Partner's Capital Account Analysis  Beginning capital account      $117,950.38
L Ending capital account  49,936.42
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-6af932ef472c7a5124d67527,v11-K-1-1065-inline,original,2025,fgen-1e6c2d05de2de03694914169,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
ScheduleK-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2026
OMB No. 1545-0123
Part I Information About the Partnership      5ample Rentals LP 5360 Maple Ridge Dr Lakewood, CO 98513
A Partnership's employer identification number 60-5545303
Part II Information About the Partner  Priya Castillo
E Partner's 55N or TIN XXX-XX-9069
Street address(includingapt. no.) 4084 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code      Bayside,WA 27828
1 Ordinary business income (loss) 10,040.13
4a Guaranteed payments for services
5 Interest income $1,687.63
14 5elf-employment eamings (loss)  26,632.64
19 Distributions  $4,54O.99
L Partner's CapitalAccount Analysis  Beginning capital account      $56,516.27
L Ending capital account      $52,196.88",K-1,30,K-1,fdc-69c95d46495a58bb4978c3bb,v11-K-1-1065-inline,original,2026,fgen-e701f1e130d2c63366addb3e,synthetic_programmatic_template,inline,top,True,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2025
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership  Riverbend Ventures LLC 495 Oak Hollow Ct Riverton, WI 45356
A Partnership's employer identification number      81-7657455
Part II Information About the Partner  Jamie Kowalski
E Partner's SSN or TIN  ending in 2311
Street address (including apt. no.)  1695 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code      Fairview, OH 28477
Account number (see instructions)      XXXXX892758
1 Ordinary business income (loss) (685.08)
2 Net rental real estate income (loss)   23,169.19
4a Guaranteed payments for services      $0.00
5 Interest income      $4,065.56
14 Self-employment earnings (loss) 25,006.53
19 Distributions   $8,476.02
L Partner's Capital Account Analysis  Beginning capital account      108,790.14
L Ending capital account 138,266.73
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-7ce9c2bcbdc86a643bf67f03,v11-K-1-1065-inline,original,2025,fgen-894cc33afe7150854f95a380,synthetic_programmatic_template,inline,top,False,
"Part I Information About the Partnership'S name:   Sample Rentals LP
To:   Amara J. Okafor
2 Net rental real estate income (loss) 19,629.00
Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc. 2024",K-1,30,K-1,fdc-0f227f8927c6743265a1e409,v11-K-1-1065-inline,original,2024,fgen-bde383174ddcd7bd41f72449,synthetic_programmatic_template,inline,bottom,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2022
Final K-1  Amended K-1
Part I Information About the Partnership Riverbend Ventures LLC 661 Sample Street Pinecrest, GA 21538
A Partnership's employer identification number   39-2656518
Part II Information About the Partner Morgan B. Moreau
E Partner's SSN or TIN      ****0112
Street address (including apt. no.)      5467 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code  Bayside, WA 35289
Account number (see instructions)  XXXXX005453
1 Ordinary business income (loss)      8,664.46
2 Net rental real estate income (loss) 9,863.39
4a Guaranteed payments for services   0.00
19 Distributions      4,989.44
L Ending capital account      112,252.47",K-1,30,K-1,fdc-881a2201f884be2ccda5db78,v11-K-1-1065-inline,original,2022,fgen-0235bbc27966074f9bc97fa0,synthetic_programmatic_template,inline,top,False,
"2021
OMB No. 1545-0123
FinalK-1  Amended K-1
Part I InformationAbout the Partnership Riverbend Ventures LLC 6698 Lakeshore Blvd Lakewood, CO 20723
A Partnership's employer identification number   47-67613O4
Part II Information About the Partner Lena R. Adeyemi
E Partner's SSN or TIN ****5169
Street address (índuding apt. no.)      4804 0ak Ho11ow Ct
City or town, statc or province,country, and ZIP or foreign postal code      Cedar Falls, IA 65023
1 Ordinary business income (loss)   -1,692.93
2 Net rental real estate income (loss)  8,089.89
4a Guaranteed payments for services
5 Interest income  5,835.41
14 5elf-employment earnings (loss) 26,467.53
19 Distributions 2,198.27
L Partner's Capital Account Analysis  Beginning capitalaccount l7,181.73
L Endíng capital account   $7,158.98
Dcpartment of the Treasury - Intemal Revenue 5ervice",K-1,30,K-1,fdc-11c94481218e276b3c6073c5,v11-K-1-1065-inline,original,2021,fgen-e6582754b4c39ab28f6fb239,synthetic_programmatic_template,inline,none,True,
"Part I Information About the Partnership'S name:  Granite Holdings Partners
Recipient's name: Kwame Lindqvist
1 Ordinary business income (loss) 9,821.03
19 Distributions $143.96
L Ending capital account      13,212.92
2 Net rental real estate income (loss)   24,595.64
Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc. 2022",K-1,30,K-1,fdc-aa098e099ecb4f79177af986,v11-K-1-1065-inline,original,2022,fgen-84b9eef4a8b61a4206a6988c,synthetic_programmatic_template,inline,bottom,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2024
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership      Granite Holdings Partners 2070 Oak Hollow Ct Riverton, WI 50509
A Partnership's employer identification number 96-1174398
Part II Information About the Partner Fatima Romero
E Partner's SSN or TIN   ****1292
Street address (including apt. no.)  8397 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code   Cedar Falls, IA 15209
1 Ordinary business income (loss)      28,147.73
2 Net rental real estate income (loss)  2,010.83
4a Guaranteed payments for services
5 Interest income  8,299.57
14 Self-employment earnings (loss) 25,182.34
19 Distributions      $7,228.94
L Partner's Capital Account Analysis  Beginning capital account  108,741.50
L Ending capital account  $60,684.16
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-434055a125e2027a5ccbe38a,v11-K-1-1065-inline,original,2024,fgen-24cee2f79f346ba064817f73,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2022
OMB No. 1545-0123
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership Granite Holdings Partners 9693 Maple Ridge Dr Cedar Falls, IA 31621
A Partnership's employer identification number      19-4414944
Part II Information About the Partner Noah Kowalski
E Partner's SSN or TIN ending in 6480
Street address (including apt. no.) 6610 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code   Brookhaven, PA 79688
Account number (see instructions)   ***-**-517456
1 Ordinary business income (loss)   -3,088.73
2 Net rental real estate income (loss)  21,070.75
4a Guaranteed payments for services $0.00
5 Interest income      $4,970.91
14 Self-employment earnings (loss) 13,785.06
19 Distributions   $7,021.47
L Partner's Capital Account Analysis  Beginning capital account  $65,241.28
L Ending capital account  $93,616.32",K-1,30,K-1,fdc-9a0ec30baa9b63599192b496,v11-K-1-1065-inline,original,2022,fgen-72bb7f2cf940b2ad7cba04c1,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership   Sample Rentals LP 6127 Oak Hollow Ct Bayside, WA 38116
A Partnership's employer identification number 56-5762107
Part II Information About the Partner  Alex M. Tanaka
E Partner's SSN or TIN XXX-XX-1039
Street address (including apt. no.) 210 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code      Fairview, OH 89877
Account number (see instructions) ending in 073250
1 Ordinary business income (loss)   28,689.43
2 Net rental real estate income (loss) (7,800.16)
5 Interest income      $5,501.70
14 Self-employment earnings (loss) 7,170.90
19 Distributions $2,360.17
L Partner's Capital Account Analysis  Beginning capital account  91,664.31
L Ending capital account 40,995.85",K-1,30,K-1,fdc-841262f789b305cc5ff30a0b,v11-K-1-1065-inline,original,2026,fgen-dc3a6c603b4e3d1ebdcf7883,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2026
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnership Riverbend Ventures LLC 1971 Maple Ridge Dr Maplewood, MN 30327
A Partnership's employer identification number 52-3694128
Part II Information About the Partner   Priya Adeyemi
E Partner's SSN or TIN ending in 8702
Street address (including apt. no.) 8593 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code   Maplewood, MN 91726
1 Ordinary business income (loss) 4,218.09
2 Net rental real estate income (loss)  12,154.96
4a Guaranteed payments for services  0.00
5 Interest income $1,644.00
19 Distributions $3,027.90
L Partner's Capital Account Analysis  Beginning capital account  $49,436.33
L Ending capital account   79,763.45
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-87bbddc416fd4c9221d2f2c8,v11-K-1-1065-inline,original,2026,fgen-02d67b3ae0453dfa84267461,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
2022
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership Riverbend Ventures LLC 2579 Prairie Ave Maplewood, MN 95180
A Partnership's employer identification number      54-1593335
Part II Information About the Partner Fatima Sato
E Partner's SSN or TIN ending in 7901
Street address (including apt. no.)      5104 Granite St
City or town, state or province, country, and ZIP or foreign postal code   Cedar Falls, IA 60673
Account number (see instructions)  ending in 731007
1 Ordinary business income (loss)  12,393.12
2 Net rental real estate income (loss)      -7,708.31
4a Guaranteed payments for services
19 Distributions   $8,622.98
L Partner's Capital Account Analysis  Beginning capital account  $79,176.00
L Ending capital account $113,162.07
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-2f502f9497a30befc3d899cf,v11-K-1-1065-inline,original,2022,fgen-8a650beda7caa4f2081c0ac6,synthetic_programmatic_template,inline,none,False,
"VOID  CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2026
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnership Riverbend Ventures LLC 3307 Cedar Ln Oak Grove, TX 55379
A Partnership's employer identification number      69-3619237
Part II Information About the Partner Diego Romero
E Partner's SSN or TIN ending in 8968
Street address (including apt. no.)  4657 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code      Brookhaven, PA 58926
1 Ordinary business income (loss)  21,880.59
2 Net rental real estate income (loss) 27,504.30
4a Guaranteed payments for services 0.00
5 Interest income      $3,600.77
14 Self-employment earnings (loss)   (2,249.22)
L Partner's Capital Account Analysis  Beginning capital account   1,405.16
L Ending capital account   $117,576.10
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-0bdf68590e6f9abf8f3b713c,v11-K-1-1065-inline,original,2026,fgen-5b3df6c26d03c652c0d67940,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc.
Part I Information About the Partnership:
Recipient's name:
19 Distributions
5 Interest income
14 Self-employment earnings (loss)
Riverbend Ventures LLC
Olivia Testcase
$305.55
$8,747.32
20,589.10",K-1,30,K-1,fdc-8738cd17892b5bdefcfa2bdb,v11-K-1-1065-columns,original,2022,fgen-17819311c5d206e0b5d32971,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
Account number (see instructions)
1 Ordinary business income (loss)
2 Net rental real estate income (loss)
4a Guaranteed payments for services
5 Interest income
14 Self-employment earnings (loss)
Granite Holdings Partners 2524 Granite St Lakewood, CO 54445
36-7185168
Mateo A. Rivera
****6229
XXX-XX-048497
20,084.41
2,383.60
6,534.18
-1,727.78",K-1,30,K-1,fdc-bba48dc91569c57575170193,v11-K-1-1065-columns,original,2022,fgen-502e59c9693c3519c0579666,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
2021
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Ordinary business income (loss)
4a Guaranteed payments for services
14 Self-employment earnings (loss)
19 Distributions
L Ending capital account
Sample Rentals LP 7303 Elm Park Pl Bayside, WA 55836
64-1122352
Jamie Adeyemi
XXXXX2696
2023 Oak Hollow Ct
Fairview, OH 49962
XXXXX080713
14,644.25
$0.00
7,403.94
2,204.49
128,767.86
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-d878f58bd2523429bc6f2e3c,v11-K-1-1065-columns,original,2021,fgen-0b9709e3ef92ac3d076cc85a,synthetic_programmatic_template,columns,bottom,False,
"VOID  CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2024
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
1 Ordinary business income (loss)
2 Net rental real estate income (loss)
4a Guaranteed payments for services
5 Interest income
19 Distributions
L Ending capital account
Sample Rentals LP 7377 Cedar Ln Maplewood, MN 35271
14-8911541
Alex Castillo
XXXXX0376
22,048.26
26,757.25
420.92
5,784.95
$32,722.83",K-1,30,K-1,fdc-fcd33e8fde9f631d2ae669dd,v11-K-1-1065-columns,original,2024,fgen-b31e7973cc01bd35d3ccc53c,synthetic_programmatic_template,columns,top,False,
"Part IInformation About the Partnership'S name:
RECIPIENT:
2 Net rental real estate income (loss)
1 0rdinary business income (loss)
Sample Rentals LP
Príya Fischer
10,993.20
7,144.68",K-1,30,K-1,fdc-60f5354502714cb84a91f2c7,v11-K-1-1065-columns,original,2021,fgen-631fe3e9ee02b6cdf1757aa7,synthetic_programmatic_template,columns,none,True,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
Account number (see instructions)
1 Ordinary business income (loss)
2 Net rental real estate income (loss)
4a Guaranteed payments for services
5 Interest income
14 Self-employment earnings (loss)
19 Distributions
L Partner's Capital Account Analysis  Beginning capital account
L Ending capital account
Sample Rentals LP 9165 Lakeshore Blvd Riverton, WI 62977
81-9251503
Morgan B. Castillo
XXX-XX-8478
ending in 954291
-8,680.20
3,429.94
4,267.75
-5,237.65
$747.16
$78,034.15
$58,426.13",K-1,30,K-1,fdc-c9c215e869311c822bc384e6,v11-K-1-1065-columns,original,2021,fgen-dcfdf59b3512e3b49004cad0,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2026
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Ordinary business income (loss)
5 Interest income
14 Self-employment earnings (loss)
19 Distributions
L Partner's Capital Account Analysis  Beginning capital account
L Ending capital account
Riverbend Ventures LLC 4641 Oak Hollow Ct Testville, IL 19156
82-1504336
Jamie Tanaka
***-**-6414
2815 Granite St
Maplewood, MN 25295
***-**-790119
(4,915.06)
$7,222.75
-424.57
4,226.17
32,573.65
$89,778.88",K-1,30,K-1,fdc-06ddd4ba2585fa84fd5bf24a,v11-K-1-1065-columns,original,2026,fgen-845f8c5d668d033ac1634844,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2024
OMB No. 1545-0123
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Net rental real estate income (loss)
4a Guaranteed payments for services
5 Interest income
14 Self-employment earnings (loss)
19 Distributions
L Ending capital account
Granite Holdings Partners 4297 Harbor View Rd Brookhaven, PA 75765
35-3878703
Riley Tanaka
***-**-0179
2832 Oak Hollow Ct
Riverton, WI 87676
(937.32)
$2,766.28
15,179.58
3,135.82
122,928.80",K-1,30,K-1,fdc-c712c34355cc5e3a050ec5ac,v11-K-1-1065-columns,original,2024,fgen-581af3f0d56b72c99d22b4b4,synthetic_programmatic_template,columns,top,False,
"OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
2 Net rental real estate income (loss)
5 Interest income
19 Distributions
L Partner's Capital Account Analysis  Beginning capital account
L Ending capital account
Granite Holdings Partners 6135 Oak Hollow Ct Fairview, OH 69909
60-8727674
Diego Testcase
XXX-XX-3687
11,430.40
$3,228.19
5,232.19
61,576.19
$82,097.80",K-1,30,K-1,fdc-b72a2c01faa7a3ce06916c38,v11-K-1-1065-columns,original,2024,fgen-00abbb76227c3db6833b24f4,synthetic_programmatic_template,columns,none,False,
"☐ CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2021
OMB No. 1545-0123
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Ordinary business income (loss)
2 Net rental real estate income (loss)
4a Guaranteed payments for services
5 Interest income
14 Self-employment earnings (loss)
19 Distributions
L Partner's Capital Account Analysis  Beginning capital account
L Ending capital account
Riverbend Ventures LLC 5644 Granite St Pinecrest, GA 66931
72-7354081
Noah Fischer
****1658
5833 Maple Ridge Dr
Cedar Falls, IA 71458
****357525
5,282.88
25,902.30
$0.00
7,625.28
-991.63
9,331.83
19,878.06
$43,321.19",K-1,30,K-1,fdc-1a5f2cd09ccf2bfa208036f7,v11-K-1-1065-columns,original,2021,fgen-19e4f9e7b790a3055bf6d0f9,synthetic_programmatic_template,columns,top,False,
"For calendar year 2025
OMB No. 1545-0123
Final K-1  Amended K-1
Departmentof the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
PartII Information About the Partncr
E Partner's SSN or TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
l0rdinary business incomc (loss)
2 Net rental real estate íncome (loss)
4a Guaranteed payments for services
14 Self-employment eamings (loss)
19 Distributions
L Partner's Capital Account Analysís  Beginning capital account
L Ending capital account
Riverbend Ventures LLC 6328 Prairie Ave Pinecrest, GA 29391
58-6540573
Noah Kowalski
ending in 7038
8298 Maple Ridgc Dr
Riverton, WI 26683
20,760.65
29,358.98
9,366.32
2,820.87
69,696.17
$111,648.59
Department of the Treasury - Intemal Revenue 5ervice
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions,Credits, etc.
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleKlForm1065",K-1,30,K-1,fdc-74bda43d06f45b6496ccedd0,v11-K-1-1065-columns,original,2025,fgen-48986615d92cfb97afcf83a9,synthetic_programmatic_template,columns,bottom,True,
"CORRECTED (if chccked)
Final K-1  Amended K-1
Part I Information About the Partncrship
APartnership's employer identification number
Part II Information About thc Partner
E Partner's SSN or TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
l Ordinary business income (loss)
2 Net rental real estate income (loss)
4a Guaranteed payments for services
5 Interest income
14 Self-employment eamings (loss)
l9 Distributions
L Partner's Capital AccountAnalysis  Beginning capital account
L Ending capital account
Sample Rentals LP 380 Sample Street Testville, IL 96248
28-98867l0
Casey Lindqvist
ending in 9079
8482Cedar Ln
Brookhaven, PA 28144
-6,557.83
15,136.82
S8,673.98
14,906.20
$318.21
60,091.55
$46,304.73
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-5087616b0371c4f5c564341e,v11-K-1-1065-columns,original,2021,fgen-29cd1f67ad5fe2e3484cad34,synthetic_programmatic_template,columns,none,True,
"For calendar year 2021
OMB No. 1545-0123
Department of the Treasury InternalRevenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II InformationAbout the Partner
EPartner's 5SN or TIN
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign posta1 code
1 Ordinary business income (loss)
4a Guaranteed payments for services
14 Self-employment eamings (loss)
19 Distributions
L Partner's Capital Account Analysis  Beginning capital account
Granite Holdings Partners 8619 5ample Street Bayside, WA 15596
22-5975265
Morgan Tanaka
****7431
4167 Oak Ho1low Ct
Brookhaven, PA 20334
22,711.99
14,243.06
$6,802.36
66,263.55
Department of the Treasury - Intemal Revenue Service
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions,Credits, etc.
Form K-1 (Form 1065) (keep for your records)  www.írs.gov/FormSchedu1eK1Form1065",K-1,30,K-1,fdc-ba9f7a7ea657aa547503088c,v11-K-1-1065-columns,original,2021,fgen-8534573f49d63e8b121b9fc0,synthetic_programmatic_template,columns,bottom,True,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, ctc.
Part I Information About the Partnership:
Recipient's name:
19 Distributions
14 Se1f-employment earnings (1oss)
L Partner's Capital Account Analysis  Beginningcapital account
5 Interest income
Granite Ho1dings Partners
Alex Sato
3,183.61
19,530.19
4,353.27
3,184.50",K-1,30,K-1,fdc-66e7eef4aa20616b01792bfb,v11-K-1-1065-columns,original,2025,fgen-c8548831c48d84affd914c37,synthetic_programmatic_template,columns,top,True,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc.
From:
Recipient's name:
19 Distributions
L Ending capital account
14 Self-employment earnings (loss)
Riverbend Ventures LLC
Morgan Lindqvist
$7,938.31
$91,839.95
1,415.86",K-1,30,K-1,fdc-e0144e1fc337a003bca5d603,v11-K-1-1065-columns,original,2022,fgen-5fe55e6ee25dd1850e543c33,synthetic_programmatic_template,columns,top,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership
A Partnership's employer identification number
Part II Information About the Partner
E Partner's SSN or TIN
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Ordinary business income (loss)
4a Guaranteed payments for services
5 Interest income
14 Self-employment earnings (loss)
L Partner's Capital Account Analysis  Beginning capital account
L Ending capital account
Granite Holdings Partners 7263 Prairie Ave Oak Grove, TX 68784
12-8157437
Mateo Walsh
XXX-XX-1482
761 Prairie Ave
Fairview, OH 38283
***-**-210710
20,848.57
0.00
$3,088.02
-154.01
137,126.99
$65,795.33
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-ea534dd25926664c0484fd8d,v11-K-1-1065-columns,original,2021,fgen-b8eb341044ade6bdd847aae3,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2022
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership: Granite Holdings Partners 3968 Cedar Ln Lakewood, CO 34596
A Partnership's employer identification number: 37-9654990
Part II Information About the Partner: Kwame Kowalski
E Partner's SSN or TIN: XXX-XX-9635
Street address (including apt. no.): 4767 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 23838
Account number (see instructions): XXXXX408418
Box 1 Ordinary business income (loss): -6,237.96
Box 2 Net rental real estate income (loss): 15,819.76
Box 4a Guaranteed payments for services
Box 5 Interest income: $5,312.12
Box 14 Self-employment earnings (loss): 23,977.24
Box 19 Distributions: 5,752.69
L Partner's Capital Account Analysis  Beginning capital account: 27,971.02
L Ending capital account: 138,307.20",K-1,30,K-1,fdc-ed0b89ae57cbc13b309e0b13,v11-K-1-1065-boxed,original,2022,fgen-b617c8395a3f04a403d7f6a4,synthetic_programmatic_template,boxed,top,False,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc. 2024
Part I Information About the Partnership'S name:: Sample Rentals LP
To:: Sofia Fischer
5 Interest income: 1,456.65
14 Self-employment earnings (loss): 23,019.54
L Partner's Capital Account Analysis  Beginning capital account: 52,717.90
L Ending capital account: 4,118.75",K-1,30,K-1,fdc-d4f0b65c51ddb09bded76c19,v11-K-1-1065-boxed,original,2024,fgen-7542ebc0ade62a37c01a72c8,synthetic_programmatic_template,boxed,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
Part I Information About the Partnership: Sample Rentals LP 2641 Lakeshore Blvd Pinecrest, GA 95353
A Partnership's employer identification number: 47-5945445
Part II Information About the Partner: Alex Kowalski
E Partner's SSN or TIN: XXX-XX-5450
Account number (see instructions): ****436250
Box 1 Ordinary business income (loss): 10,884.19
Box 2 Net rental real estate income (loss): 22,529.88
Box 4a Guaranteed payments for services
Box 5 Interest income: 1,693.13
Box 14 Self-employment earnings (loss): 29,961.24
L Partner's Capital Account Analysis  Beginning capital account: 39,317.29",K-1,30,K-1,fdc-5d2875f03f0ab91298f146a7,v11-K-1-1065-boxed,original,2026,fgen-30c45e8deed6e90ed25f9338,synthetic_programmatic_template,boxed,top,False,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc.
Part I Information About the Partnership'S name:: Granite Holdings Partners
To:: Sofia Walsh
Box 5 Interest income: 755.71",K-1,30,K-1,fdc-0d743c21edf406b149295799,v11-K-1-1065-boxed,original,2021,fgen-18c02f5e521385c8f3e4d693,synthetic_programmatic_template,boxed,top,False,
"ScheduleK-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2025
Department of the Treasury Intemal Revenue Service
Part I Information About the Partnership: Granite Holdings Partners 5886Granite St Lakewood, CO 3l994
A Partnership's employeridentification number: 81-6572962
Part II Information About thc Partner: Mateo Tanaka
E Partner's 5SN or TIN: XXX-XX-5974
Street address (including apt. no.): 1406 ElmPark Pl
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 37083
Account number (see instructions): ****878653
Linc 2 Net rental real estate income (loss): 27,127.24
Line 4a Guaranteed payments for services
Line 5 Interest income: 1,953.O7
Line 14 Self-employment eamings (loss): 27,359.77
Line 19 Distributions: S8,135.85
L Partner's Capital Account Analysis  Beginning capital account: $130,776.09
Department of the Treasury - Intema1 Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-900fb8c6c3cccfb1eeba2b77,v11-K-1-1065-boxed,original,2025,fgen-8d9f8c0d8f15f499e55f58b6,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked)
Schedule K-l (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0l23
Department of the Treasury Intcrna1 Revenue Service
Part I Information About the Partnership: Granite Holdings Partners 9384 Prairie Ave Riverton, WI 11436
A Partnership's employer identification number: 31-3863403
Part II Information Aboutthe Partner: Olivia Haddad
E Partner's SSN or TIN: XXX-XX-8475
Street address (induding apt. no.): 8743 Harbor Víew Rd
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA58O40
l Ordinary business income (loss):-4,401.96
2 Net rental real estate income (loss): 1,703.34
4a Guaranteed payments for services
5 Interest income: $7,538.68
14 Self-employment eamings (loss): (l,281.74)
19 Distributions: $1,960.74
L Partner's Capital Account Analysis  Beginning capital account:$90,352.15
L Ending capital account: 109,467.89",K-1,30,K-1,fdc-613f0b7332ea0897d7e926c5,v11-K-1-1065-boxed,original,2021,fgen-279f458b97b9451d825a4883,synthetic_programmatic_template,boxed,top,True,
"For calendar year 2026
OMB No. 1545-0123
Part I Information About the Partnership: Sample Rentals LP 3893 Sample Street Maplewood, MN 89533
A Partnership's employer identification number: 47-4906878
Part II Information About the Partner: Mateo S. Nguyen
E Partner's SSN or TIN: XXX-XX-7862
Street address (including apt. no.): 3635 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 43384
Box 2 Net rental real estate income (loss): 1,048.84
Box 4a Guaranteed payments for services: $0.00
Box 5 Interest income: 8,745.75
Box 14 Self-employment earnings (loss): 25,920.39
Box 19 Distributions: 6,920.86
L Partner's Capital Account Analysis  Beginning capital account: $82,996.61
L Ending capital account: 107,966.05",K-1,30,K-1,fdc-46d2a0c92a622ae2375ce130,v11-K-1-1065-boxed,original,2026,fgen-c811b7812d8aeaae2edae06a,synthetic_programmatic_template,boxed,none,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
OMB No. 1545-0123
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership: Riverbend Ventures LLC 6156 Lakeshore Blvd Oak Grove, TX 73981
A Partnership's employer identification number: 29-9706924
Part II Information About the Partner: Alex Tanaka
E Partner's SSN or TIN: ****5141
Box 1 Ordinary business income (loss): -3,298.89
Box 2 Net rental real estate income (loss): 17,926.46
Box 4a Guaranteed payments for services
Box 5 Interest income: 4,501.25
Box 14 Self-employment earnings (loss): (6,720.99)
Box 19 Distributions: 1,296.57
L Partner's Capital Account Analysis  Beginning capital account: 56,450.79
L Ending capital account: 13,525.17
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-a1aac14cf8a05ceec6553e68,v11-K-1-1065-boxed,original,2022,fgen-4d30bb5730f00e389b3b9b34,synthetic_programmatic_template,boxed,top,False,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
For calendar year 2025
OMB No. 1545-0123
Part I Information About the Partnership: Sample Rentals LP 1216 Granite St Riverton, WI 81584
A Partnership's employer identification number: 38-3957600
Part II Information About the Partner: Avery Haddad
E Partner's SSN or TIN: ***-**-2074
Street address (including apt. no.): 6203 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 32274
Account number (see instructions): XXX-XX-383858
Line 1 Ordinary business income (loss): 13,629.26
Line 2 Net rental real estate income (loss): 19,140.36
Line 4a Guaranteed payments for services
Line 5 Interest income: 2,069.05
Line 14 Self-employment earnings (loss): 15,679.15
L Ending capital account: 2,001.24",K-1,30,K-1,fdc-ac295cf18d09379dffe594a2,v11-K-1-1065-boxed,original,2025,fgen-7b1cd156e3571a01482b79a7,synthetic_programmatic_template,boxed,top,False,
"Schedule K-1 (Form 1065) Partner's Share of Incomc, Deductions, Credits, etc. 2023
Part I Information About the Partnership'S name:: Samp1e Rentals LP
To:: Riley Walsh
19 Distributions:9,222.58",K-1,30,K-1,fdc-b49a610a379918fbf7b8e322,v11-K-1-1065-boxed,original,2023,fgen-067a698697d5e3cae40c328f,synthetic_programmatic_template,boxed,top,True,
"Schedule K-1 (Form 1065)
Partner's Share of Income, Deductions, Credits, etc.
2024
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Partnership: Sample Rentals LP 5818 Lakeshore Blvd Lakewood, CO 60289
A Partnership's employer identification number: 84-5281389
Part II Information About the Partner: Avery K. Romero
E Partner's SSN or TIN: ending in 5405
Street address (including apt. no.): 989 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 32445
Line 1 Ordinary business income (loss): 9,083.19
Line 2 Net rental real estate income (loss): 10,714.43
Line 4a Guaranteed payments for services: $0.00
Line 5 Interest income: $5,827.70
Line 14 Self-employment earnings (loss): 17,615.05
Line 19 Distributions: 1,717.93
L Partner's Capital Account Analysis  Beginning capital account: 116,060.25
L Ending capital account: 103,113.38
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1065) (keep for your records)  www.irs.gov/FormScheduleK1Form1065",K-1,30,K-1,fdc-3c975eb475ebebd2505f2dd8,v11-K-1-1065-boxed,original,2024,fgen-1f1d3fa2855f4f2c1eec7dcb,synthetic_programmatic_template,boxed,top,False,
"Part I Information About the Partnership'S name:: Sample Rentals LP
RECIPIENT:: Taylor Moreau
L Partner's Capital Account Analysis  Beginning capital account: $41,361.12
Box 2 Net rental real estate income (loss): 11,211.45
Box 14 Self-employment earnings (loss): 6,620.37",K-1,30,K-1,fdc-18dacc4217db9533922c17fe,v11-K-1-1065-boxed,original,2021,fgen-1793e0585967f6ebfc1a65c4,synthetic_programmatic_template,boxed,none,False,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc. 2024
Part I Information About the Partnership:: Granite Holdings Partners
Recipient's name:: Olivia M. Fischer
2 Net rental real estate income (loss): 12,945.66",K-1,30,K-1,fdc-c9ac3342ed0e2528f2cadac2,v11-K-1-1065-boxed,original,2024,fgen-5c95622ad95aca3a340dec2c,synthetic_programmatic_template,boxed,top,False,
"Final K-1  Amended K-1
Part I Information About the Partnership: Riverbend Ventures LLC 1045 Oak Hollow Ct Lakewood, CO 88851
A Partnership's employer identification number: 23-8508273
Part II Information About the Partner: Riley R. Castillo
E Partner's SSN or TIN: XXX-XX-9111
Street address (including apt. no.): 4307 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 64676
Line 2 Net rental real estate income (loss): (8,486.74)
Line 4a Guaranteed payments for services
Line 14 Self-employment earnings (loss): 29,002.42
Line 19 Distributions: 161.46
L Partner's Capital Account Analysis  Beginning capital account: 6,866.03
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-7d1ca2e90e2799a4e534da2c,v11-K-1-1065-boxed,original,2026,fgen-40f8beb96409d9a8dcb492e9,synthetic_programmatic_template,boxed,none,False,
"OMB No. 1545-0123
Part I Information About the Partnership: Riverbend Ventures LLC 1477 Oak Hollow Ct Cedar Falls, IA 41078
A Partnership's employer identification number: 41-1445145
Part II Information About the Partner: Lena Patel
E Partner's SSN or TIN: ****0807
Street address (including apt. no.): 8364 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 72241
Box 1 Ordinary business income (loss): 22,291.85
Box 2 Net rental real estate income (loss): 15,259.91
Box 4a Guaranteed payments for services: $0.00
Box 5 Interest income: $3,635.80
Box 14 Self-employment earnings (loss): -4,398.14
Box 19 Distributions: 5,099.31
L Partner's Capital Account Analysis  Beginning capital account: $5,885.13
L Ending capital account: $35,298.28",K-1,30,K-1,fdc-84b21c9185786bf653ce6568,v11-K-1-1065-boxed,original,2022,fgen-a44584c52750bdafec8d00a9,synthetic_programmatic_template,boxed,none,False,
"Schedule K-1 (Form 1065) Partner's Share of Income, Deductions, Credits, etc. 2023
From:: Granite Holdings Partners
Recipient's name:: Diego B. Castillo
19 Distributions: 8,912.79
5 Interest income: $9,295.93",K-1,30,K-1,fdc-61ce375a3edd5959b127bb99,v11-K-1-1065-boxed,original,2023,fgen-4eda7640fbb6ee462c4a41ab,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
For calendar year 2021
Final K-1  Amended K-1
Part I Information About the Corporation      Bluewater Design Studio Inc. 1635 Prairie Ave Testville, IL 36588
A Corporation's employer identification number   13-4219449
Part II Information About the Shareholder Wei Castillo
E Shareholder's identifying number XXX-XX-0024
1 Ordinary business income (loss)   -6,154.09
4 Interest income 6,331.92
5a Ordinary dividends
16 Items affecting shareholder basis      DD 5,364.10
17 Other information  W 5,556.01
G Current year allocation percentage 97.6331 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-6f538a08a3378a04c0b40779,v11-K-1-1120-S-inline,original,2021,fgen-360503f7945aabc4d260fe07,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
2024
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Corporation  Maple Street Bakery Inc. 7253 Cedar Ln Lakewood, CO 77377
A Corporation's employer identification number  20-1589878
Part II Information About the Shareholder Olivia Rivera
E Shareholder's identifying number   ending in 9038
Street address (including apt. no.)  770 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Testville, IL 84952
1 Ordinary business income (loss) 27,419.04
4 Interest income      $6,943.31
5a Ordinary dividends
16 Items affecting shareholder basis  AA 7,401.59
17 Other information   C 4,817.86
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-c33977835fefcbdec5d55990,v11-K-1-1120-S-inline,original,2024,fgen-18bb6db2f04bfc807d736015,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1120-S)
Sharcholder's Share of Income, Deductíons, Credits, etc.
For calendar year 2O24
OMB No. 1545-0123
Part I Information About thc Corporation Bluewater Design Studío Inc. 2814 Harbor View Rd Bayside, WA 93562
A Corporation's employer identification number 82-8483875
Part II Information About the Shareholder Riley Kowalski
E Shareholder's identifying number  XXX-XX-535O
Street address (including apt. no.)  7789 Elm Park Pl
City ortown, state or province, country, and ZIP or foreígn postal code   Bayside, WA 71342
Account numbcr (see instructions)  XXXXX622958
1 Ordinary business income (loss) -5,22O.35
4Interest income S7,504.49
5a Ordinary dividends  $0.00
16 Items affectingshareholder basis W 1,468.88
17 Other information D 8,297.35
G Current year allocation percentage  53.6755 %
Department of the Treasury - Intemal Revenue5ervíce
Form K-l (Form 112O-5)(keep for your records)  www.irs.gov/FormScheduleK1Form112OS",K-1,30,K-1,fdc-1634ad639782b9d71f55e9df,v11-K-1-1120-S-inline,original,2024,fgen-066435f95cf9111b49a76737,synthetic_programmatic_template,inline,top,True,
"Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
2022
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Corporation Maple Street Bakery Inc. 7770 Willow Bend Way Lakewood, CO 73262
A Corporation's employer identification number 31-9528234
Part II Information About the Shareholder      Mateo Nguyen
E Shareholder's identifying number   ****0868
Street address (including apt. no.)  5346 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code   Brookhaven, PA 89808
1 Ordinary business income (loss) 21,940.91
4 Interest income $3,765.12
5a Ordinary dividends  $0.00
16 Items affecting shareholder basis W 5,479.16
17 Other information      C 1,927.32
G Current year allocation percentage 5.8401 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-d56701ae3092d5812c87c9a2,v11-K-1-1120-S-inline,original,2022,fgen-d0991a4723f1ae8224de27ed,synthetic_programmatic_template,inline,top,False,
"Part I Information About the Corporation'S name:   Maple Street Bakery Inc.
To:      Wei Testcase
4 Interest income $5,700.02
1 0rdinary business income (loss) 19,181.27
16 Items affecting shareholder basis   W 6,329.7O
Schedule K-l (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-988c396986863b17876fee60,v11-K-1-1120-S-inline,original,2026,fgen-8e7ef9bf17b543dc4d16835c,synthetic_programmatic_template,inline,bottom,True,
"Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
2023
OMB No. 1545-0123
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation Maple Street Bakery Inc. 5933 Granite St Testville, IL 77726
A Corporation's employer identification number      19-4733332
Part II Information About the Shareholder  Sofia Tanaka
E Shareholder's identifying number   ****7683
Street address (including apt. no.)      9694 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code   Bayside, WA 49693
1 Ordinary business income (loss)      8,480.95
4 Interest income 2,943.21
16 Items affecting shareholder basis      V 8,037.94
G Current year allocation percentage 17.5786 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-04efd4009ba390399d0ea08c,v11-K-1-1120-S-inline,original,2023,fgen-1b746219cd833e475690d6f5,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2024
From:      Maple Street Bakery Inc.
To: Lena Fischer
4 Interest income      14.10
16 Items affecting shareholder basis D 2,930.21
G Current year allocation percentage   72.3598 %",K-1,30,K-1,fdc-152c1694444522a524407d20,v11-K-1-1120-S-inline,original,2024,fgen-3cdc15cc0b2f3973ec238745,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2022
Part I Information About the Corporation'S name:   Maple Street Bakery Inc.
RECIPIENT: Taylor Haddad
17 Other information   DD 1,660.62
16 Items affecting shareholder basis W 7,325.48
1 Ordinary business income (loss)   15,776.69
G Current year allocation percentage 50.2697 %",K-1,30,K-1,fdc-4ec01d0e7a58efedfce5fd58,v11-K-1-1120-S-inline,original,2022,fgen-e75a4977acc1d6543271f329,synthetic_programmatic_template,inline,top,False,
"Part I Information About the Corporation'S name:   Bluewater Design Studio Inc.
Recipient's name:   Noah Adeyemi
1 Ordinary business income (loss)      10,162.88
G Current year allocation percentage  69.9859 %",K-1,30,K-1,fdc-c2f1e5f55e4d08e5de87d425,v11-K-1-1120-S-inline,original,2026,fgen-2df8e44f774b01ce108e6f82,synthetic_programmatic_template,inline,none,False,
"VOID  CORRECTED
For calendar year 2024
Part I Information About the Corporation   Bluewater Design Studio Inc. 3110 Willow Bend Way Pinecrest, GA 67643
A Corporation's employer identification number   37-6826612
Part II Information About the Shareholder Lena A. Tanaka
E Shareholder's identifying number ***-**-0534
Street address (including apt. no.) 7154 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code  Oak Grove, TX 16178
Account number (see instructions)      ****015435
1 Ordinary business income (loss)      (8,815.43)
4 Interest income      4,623.67
5a Ordinary dividends
17 Other information AA 3,610.88
G Current year allocation percentage   98.0416 %
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-a16d3b81c656f13cb5682cb1,v11-K-1-1120-S-inline,original,2024,fgen-280c195852c63a4a557bb916,synthetic_programmatic_template,inline,bottom,False,
"☐ CORRECTED
2022
OMB No. 1545-0123
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation   Bluewater Design Studio Inc. 8167 Maple Ridge Dr Brookhaven, PA 29830
A Corporation's employer identification number  83-9248146
Part II Information About the Shareholder Casey Rivera
E Shareholder's identifying number  XXXXX8580
Street address (including apt. no.)  4401 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code   Testville, IL 25349
1 Ordinary business income (loss)  19,389.37
4 Interest income      6,019.01
G Current year allocation percentage 97.4834 %
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-8fadf2003620233eeba3dfe3,v11-K-1-1120-S-inline,original,2022,fgen-a355c3cd92be1eea0f23a497,synthetic_programmatic_template,inline,none,False,
"2024
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation Maple Street Bakery Inc. 3577 Elm Park Pl Pinecrest, GA 87724
A Corporation's employer identification number      11-1503744
Part II Information About the Shareholder      Amara M. Brennan
E Shareholder's identifying number   ***-**-0229
Street address (including apt. no.) 684 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code   Lakewood, CO 72457
Account number (see instructions) ****158598
1 Ordinary business income (loss)   -4,982.32
4 Interest income 3,778.41
5a Ordinary dividends
16 Items affecting shareholder basis DD 3,356.46
17 Other information C 3,377.03
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-4c09e67a8265851ef1f996a6,v11-K-1-1120-S-inline,original,2024,fgen-6e5f08435c6a75a87e5117ac,synthetic_programmatic_template,inline,bottom,False,
"For calendar year 2026
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Corporation Copperline Consulting Inc. 3180 Sample Street Riverton, WI 76870
A Corporation's employer identification number 41-4293152
Part II Information About the Shareholder Noah Okafor
E Shareholder's identifying number   ***-**-8054
Account number (see instructions)  XXX-XX-892058
1 Ordinary business income (loss)  4,106.82
4 Interest income $2,912.57
5a Ordinary dividends  $0.00
16 Items affecting shareholder basis      V 5,650.17
17 Other information DD 8,548.45
G Current year allocation percentage 58.3284 %
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-ff9dc6e74fb0ab74437bf337,v11-K-1-1120-S-inline,original,2026,fgen-6c96f6694184f091fe9997ce,synthetic_programmatic_template,inline,bottom,False,
"Part I Information About the Corporation'S name: Copperline Consulting Inc.
To: Mateo Rivera
4 Interest income   8,982.24
Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2021",K-1,30,K-1,fdc-ad20e6e03d229fd5c91aabaf,v11-K-1-1120-S-inline,original,2021,fgen-f626238b740ca4f872d312c8,synthetic_programmatic_template,inline,bottom,False,
"☐ CORRECTED
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation   Bluewater Design Studio Inc. 5028 Elm Park Pl Testville, IL 92843
A Corporation's employer identification number  31-2726128
Part II Information About the Shareholder  Morgan K. Fischer
E Shareholder's identifying number   XXX-XX-9367
Street address (including apt. no.)  6453 Sample Street
City or town, state or province, country, and ZIP or foreign postal code  Lakewood, CO 40634
1 Ordinary business income (loss)  22,449.48
4 Interest income $4,456.34
5a Ordinary dividends
16 Items affecting shareholder basis      AA 3,182.61
17 Other information W 3,262.72
G Current year allocation percentage  64.0788 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-05e3212c02dc42102125e23b,v11-K-1-1120-S-inline,original,2023,fgen-bd0c8b2617d67c559cc02cf6,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
For calendar year 2023
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Corporation  Copperline Consulting Inc. 7680 Granite St Fairview, OH 48099
A Corporation's employer identification number      57-6326874
Part II Information About the Shareholder  Jamie Fischer
E Shareholder's identifying number   XXX-XX-9729
Account number (see instructions)      XXXXX754576
1 Ordinary business income (loss) 7,537.45
5a Ordinary dividends   0.00
16 Items affecting shareholder basis      DD 8,870.37
G Current year allocation percentage   40.4535 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-dfb719e04ec2de75ad3e759d,v11-K-1-1120-S-inline,original,2023,fgen-e25f6e9e88be320989d95e8d,synthetic_programmatic_template,inline,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2025
From:
Recipient's name:
G Current year allocation percentage
1 Ordinary business income (loss)
16 Items affecting shareholder basis
Bluewater Design Studio Inc.
Hiro M. Haddad
95.2964 %
768.53
DD 2,373.38",K-1,30,K-1,fdc-d69de991fda4188f462544f3,v11-K-1-1120-S-columns,original,2025,fgen-38859755a30782369714b107,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
Final K-1  Amended K-1
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Ordinary business income (loss)
4 Interest income
5a Ordinary dividends
16 Items affecting shareholder basis
17 Other information
G Current year allocation percentage
Maple Street Bakery Inc. 6052 Elm Park Pl Cedar Falls, IA 62209
12-4067235
Avery Brennan
XXX-XX-1889
5908 Harbor View Rd
Riverton, WI 73375
8,869.86
6,791.92
V 8,725.10
D 4,646.55
8.9894 %",K-1,30,K-1,fdc-53b5bc8ac80fcd36dd0684fa,v11-K-1-1120-S-columns,original,2026,fgen-420bb16194fb26b910de4797,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
2024
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
Account number (see instructions)
1 Ordinary business income (loss)
4 Interest income
16 Items affecting shareholder basis
17 Other information
G Current year allocation percentage
Maple Street Bakery Inc. 2508 Harbor View Rd Oak Grove, TX 87903
74-4803143
Taylor M. Kowalski
XXXXX5750
XXX-XX-146009
8,092.38
$517.43
D 7,064.14
AA 7,904.38
82.3385 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-b146c9939e3a5ee35ea39d50,v11-K-1-1120-S-columns,original,2024,fgen-77acea0d6fb2cfc78eeb84ad,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2021
Part I Information About the Corporation:
RECIPIENT:
16 Items affecting shareholder basis
17 Other information
1 Ordinary business income (loss)
Maple Street Bakery Inc.
Olivia Castillo
W 6,899.58
V 2,973.79
27,339.45",K-1,30,K-1,fdc-716f3aeebf1576e4658843fc,v11-K-1-1120-S-columns,original,2021,fgen-c72308391a033158334cbefb,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
For calendar year 2021
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
1 Ordinary business income (loss)
4 Interest income
5a Ordinary dividends
16 Items affecting shareholder basis
17 Other information
Copperline Consulting Inc. 8306 Granite St Lakewood, CO 16735
23-7462644
Wei Testcase
XXX-XX-2094
25,891.30
$2,339.49
D 7,648.39
D 8,406.02",K-1,30,K-1,fdc-29731de40352ecde3b131eb3,v11-K-1-1120-S-columns,original,2021,fgen-48f85557f774e8eb41d071d0,synthetic_programmatic_template,columns,top,False,
"From:
Recipient's name:
1 Ordinary business income (loss)
17 Other information
4 Interest income
G Current year allocation percentage
Maple Street Bakery Inc.
Olivia Tanaka
19,743.42
C 8,603.25
$1,359.74
17.2736 %",K-1,30,K-1,fdc-2412beafa944f76a5220ec48,v11-K-1-1120-S-columns,original,2024,fgen-cf09e75e7037013fc2f5533c,synthetic_programmatic_template,columns,none,False,
"☐ CORRECTED
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
2022
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Ordinary business income (loss)
5a Ordinary dividends
17 Other information
Bluewater Design Studio Inc. 9766 Oak Hollow Ct Lakewood, CO 99514
42-2215147
Avery Testcase
XXX-XX-0121
9027 Prairie Ave
Riverton, WI 73133
ending in 817747
(6,131.15)
AA 3,977.02
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-50c671f32b691e4dfa5fdd9a,v11-K-1-1120-S-columns,original,2022,fgen-d2460889bf09dd9399938cd1,synthetic_programmatic_template,columns,top,False,
"Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Ordinary business income (loss)
4 Interest income
16 Items affecting shareholder basis
17 Other information
G Current year allocation percentage
Copperline Consulting Inc. 7727 Prairie Ave Cedar Falls, IA 16139
48-1082786
Kwame Testcase
ending in 0548
4154 Lakeshore Blvd
Bayside, WA 14001
12,099.76
2,739.45
AA 4,408.06
AA 5,398.61
91.7909 %
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-327c686c785b9a32dae46baa,v11-K-1-1120-S-columns,original,2024,fgen-c76b00fe50aa86de8b2abc29,synthetic_programmatic_template,columns,none,False,
"CORRECTED (if checked)
For calendar year 2023
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
4 Interest income
5a Ordinary dividends
16 Items affecting shareholder basis
G Current year allocation percentage
Copperline Consulting Inc. 1649 Oak Hollow Ct Cedar Falls, IA 94195
18-3835171
Priya Testcase
ending in 5259
867 Oak Hollow Ct
Bayside, WA 67837
3,568.92
V 6,745.04
33.4358 %
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-176ec5a2db1808e7b3964fca,v11-K-1-1120-S-columns,original,2023,fgen-6704860fa639411fcbf79a2d,synthetic_programmatic_template,columns,bottom,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc.
Part I Information About the Corporation:
RECIPIENT:
16 Items affecting shareholder basis
4 Interest income
G Current year allocation percentage
Copperline Consulting Inc.
Hiro Haddad
V 8,232.10
7,929.45
83.1885 %",K-1,30,K-1,fdc-3124af430d6312dae5aa9d0e,v11-K-1-1120-S-columns,original,2022,fgen-32c40ab10ea2afdc236957be,synthetic_programmatic_template,columns,top,False,
"From:
RECIPIENT:
16 Items affecting shareholder basis
G Current year allocation percentage
4 Interest income
17 Other information
Bluewater Design Studio Inc.
Noah D. Castillo
D 3,785.85
48.9623 %
$3,064.03
AA 6,744.28
Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2023",K-1,30,K-1,fdc-91b76015235e6d2f1dc007bc,v11-K-1-1120-S-columns,original,2023,fgen-dd6c708a90c8ab6d985ff538,synthetic_programmatic_template,columns,bottom,False,
"Part I Information About the Corporation'S name:
Recipient's name:
4 Interest income
G Current year allocation percentage
1 Ordinary business income (loss)
17 Other information
Bluewater Design Studio Inc.
Noah D. Adeyemi
$8,623.31
79.6568 %
1,437.71
D 2,160.76",K-1,30,K-1,fdc-f6aef851528f0069f8f556d3,v11-K-1-1120-S-columns,original,2026,fgen-3378919acef845a829ea8f19,synthetic_programmatic_template,columns,none,False,
"☐ CORRECTED
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
For calendar year 2022
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Ordinary business income (loss)
5a Ordinary dividends
17 Other information
G Current year allocation percentage
Bluewater Design Studio Inc. 6832 Prairie Ave Testville, IL 65959
82-2711021
Priya Fischer
***-**-4759
6914 Maple Ridge Dr
Maplewood, MN 26326
3,134.38
0.00
AA 6,982.67
73.9000 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-0de15a41651e77bc54b95dda,v11-K-1-1120-S-columns,original,2022,fgen-05ef1c351eb11aa0cc45f149,synthetic_programmatic_template,columns,top,False,
"Part I InformationAbout the Corporation'S name:
To:
17 Other information
Copper1ine Consulting Inc.
Casey Testcase
C 7,065.26",K-1,30,K-1,fdc-3232d1aef373af39505f197e,v11-K-1-1120-S-columns,original,2024,fgen-7341e0a356c77c4bdd42df54,synthetic_programmatic_template,columns,none,True,
"☐ CORRECTED
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
For calendar year 2024
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
1 Ordinary business income (loss)
4 Interest income
17 Other information
G Current year allocation percentage
Bluewater Design Studio Inc. 3279 Sample Street Bayside, WA 36855
75-2633446
Casey S. Castillo
XXXXX4608
28,957.99
$2,636.61
DD 8,541.68
91.2684 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-b9bf0c2ada0bbe9f1ea3fc83,v11-K-1-1120-S-columns,original,2024,fgen-77deb251c9b2cfb78ca187a4,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
2024
OMB No. 1545-0123
Final K-1  Amended K-1
Part I Information About the Corporation
A Corporation's employer identification number
Part II Information About the Shareholder
E Shareholder's identifying number
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Ordinary business income (loss)
4 Interest income
5a Ordinary dividends
16 Items affecting shareholder basis
17 Other information
G Current year allocation percentage
Copperline Consulting Inc. 1455 Oak Hollow Ct Oak Grove, TX 83130
20-3264614
Kwame Nguyen
ending in 8668
7668 Maple Ridge Dr
Testville, IL 88355
28,110.48
$1,321.33
V 2,540.10
AA 2,708.66
27.8540 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-fe5f373f6bd93a2d52e0445c,v11-K-1-1120-S-columns,original,2024,fgen-274b4813c2e5e300f98807e7,synthetic_programmatic_template,columns,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2021
Part I Information About the Corporation'S name:: Bluewater Design Studio Inc.
To:: Hiro Lindqvist
16 Items affecting shareholder basis: C 3,343.42
G Current year allocation percentage: 54.2249 %
1 Ordinary business income (loss): 29,147.91",K-1,30,K-1,fdc-3e54b7d7b1c4a068d464f9e3,v11-K-1-1120-S-boxed,original,2021,fgen-e5a9b8ec9d2fee2ff16fb11f,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
2022
OMB No. 1545-0123
Part I Information About the Corporation: Maple Street Bakery Inc. 5831 Granite St Bayside, WA 64830
A Corporation's employer identification number: 80-3620152
Part II Information About the Shareholder: Taylor Rivera
E Shareholder's identifying number: XXXXX4097
Line 1 Ordinary business income (loss): 28,983.74
Line 5a Ordinary dividends
Line 17 Other information: D 5,975.43
G Current year allocation percentage: 62.3887 %
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-a7a7ab337dd713e428939ac5,v11-K-1-1120-S-boxed,original,2022,fgen-80485baf936e9f9582a00239,synthetic_programmatic_template,boxed,none,False,
"For calendar year 2024
Final K-1  AmendedK-1
PartI Information About the Corporation: Copper1ine Consulting Inc. 8914 Granite St Cedar Falls, IA 14964
A Corporation's employer identification number: 86-6146415
Part II Information About the Shareholder: Hiro Rivera
E Shareholder's identifying number: ending in 2856
5treet address (including apt. no.): 428l Granite St
City or town, statc or province, country, and ZIP or foreign postal code: Testville, IL 38931
Account numbcr (seeinstructions): ****7O51O6
Box 4 Interest income: 7,279.32
Box 5a Ordinary dividends
Box 16 Items affecting shareho1der basis: V 3,393.19
G Currcnt year allocation percentage: 73.7449 %",K-1,30,K-1,fdc-e179d84626ff981ee8c0b3b9,v11-K-1-1120-S-boxed,original,2024,fgen-cd52bd199e4b8262bbbd0085,synthetic_programmatic_template,boxed,none,True,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2026
From:: Maple Street Bakery Inc.
To:: Morgan Castillo
17 Other information: AA 8,341.21",K-1,30,K-1,fdc-632e20591b2f6943fd8b95f5,v11-K-1-1120-S-boxed,original,2026,fgen-04460a95d1f34c4451242456,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
2021
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation: Maple Street Bakery Inc. 6071 Maple Ridge Dr Lakewood, CO 93365
A Corporation's employer identification number: 46-2093102
Part II Information About the Shareholder: Priya Okafor
E Shareholder's identifying number: ***-**-0764
1 Ordinary business income (loss): 5,510.60
16 Items affecting shareholder basis: D 4,480.70
17 Other information: AA 2,501.43
G Current year allocation percentage: 43.7409 %
Department of the Treasury - Internal Revenue Service
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-7b51c8363355460250b9cb95,v11-K-1-1120-S-boxed,original,2021,fgen-0082ab297bb4721446692993,synthetic_programmatic_template,boxed,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2023
Part I Information About the Corporation:: Copperline Consulting Inc.
Recipient's name:: Riley Testcase
Box 16 Items affecting shareholder basis: V 3,415.80
Box 4 Interest income: $8,850.80",K-1,30,K-1,fdc-8b8bfb05542726d15e217034,v11-K-1-1120-S-boxed,original,2023,fgen-b087dc38e329217e2513b680,synthetic_programmatic_template,boxed,top,False,
"For calendar year 2026
Part I Information About the Corporation: Maple Street Bakery Inc. 6915 Sample Street Oak Grove, TX 15856
A Corporation's employer identification number: 90-5215864
Part II Information About the Shareholder: Fatima Okafor
E Shareholder's identifying number: ***-**-5488
Street address (including apt. no.): 1973 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 90564
Box 1 Ordinary business income (loss): 3,363.30
Box 4 Interest income: $7,794.33
Box 5a Ordinary dividends: $0.00
Box 16 Items affecting shareholder basis: V 338.91
Box 17 Other information: AA 8,991.13
G Current year allocation percentage: 7.0037 %
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-ffca1c80646b0c79f687935d,v11-K-1-1120-S-boxed,original,2026,fgen-fad1b14914a185e169c8d481,synthetic_programmatic_template,boxed,bottom,False,
"For calendar year 202l
OMB No. 1545-0123
Department of the TreasuryIntemal Revenue Servíce
Part I Information About the Corporation: Copperline Consulting Inc. 529l Lakeshore BlvdPinecrest, GA 60968
A Corporation's employer identification number: 80-5474861
Part II Information About the Shareholder: Morgan Okafor
E 5hareholder's identifying number: ****326l
Street address (including apt. no.): 7531 Cedar Ln
City ortown, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 667O5
Box 1 Ordinary business income (loss): 28,980.63
Box 4 Interest income: $630.92
Box 5a Ordinary dividends: 0.00
Box 16 Items affecting shareho1der basis: C 5,709.70
Box 17 Other information: DD 7,553.56
G Current year allocation percentage: 92.6915 %",K-1,30,K-1,fdc-6bdf9ed3e7762083ea762675,v11-K-1-1120-S-boxed,original,2021,fgen-b37d819525d285ba4958f7c7,synthetic_programmatic_template,boxed,none,True,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2023
Part I Information About the Corporation'S name:: Copperline Consulting Inc.
RECIPIENT:: Olivia Sato
17 Other information: V 1,495.34
4 Interest income: $3,727.95",K-1,30,K-1,fdc-927133cdeee1b5b0dfe65619,v11-K-1-1120-S-boxed,original,2023,fgen-040c0bbf4752588410165725,synthetic_programmatic_template,boxed,top,False,
"OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation: Bluewater Design Studio Inc. 9138 Maple Ridge Dr Maplewood, MN 39058
A Corporation's employer identification number: 95-5039071
Part II Information About the Shareholder: Riley Nguyen
E Shareholder's identifying number: ending in 2540
Street address (including apt. no.): 6813 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Testville, IL 75286
Account number (see instructions): ending in 198481
Box 5a Ordinary dividends: $0.00
Box 16 Items affecting shareholder basis: C 6,990.67
Box 17 Other information: AA 1,391.25
G Current year allocation percentage: 94.2966 %
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-d9c0ff5a710d4862051bb83a,v11-K-1-1120-S-boxed,original,2025,fgen-64125b164ff82ba336f36ce9,synthetic_programmatic_template,boxed,bottom,False,
"Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credíts, etc.
2024
0MB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Intemal Revenue 5ervíce
Part I Informatíon About the Corporation: Bluewater Design Studio Inc. 264 Elm Park Pl Fairview, OH 60952
A Corporation's employer identification number: 42-4334581
Part II Information About the 5hareholder:Amara L. Moreau
E Shareholder's identifying number:****8742
Account number (see instructions): XXXXX379610
1 Ordinary business income (loss): 6,397.07
4 Interest income: $3,873.19
5a Ordinary dividends: 0.00
16 Itemsaffecting shareholder basis: AA 3,137.45
17 Other information: V 3,354.98",K-1,30,K-1,fdc-9818ff2f77592b1f460a4262,v11-K-1-1120-S-boxed,original,2024,fgen-b0bb462ff2cb95afd8c693b7,synthetic_programmatic_template,boxed,top,True,
"OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation: Bluewater Design Studio Inc. 1073 Cedar Ln Oak Grove, TX 67585
A Corporation's employer identification number: 36-6597957
Part II Information About the Shareholder: Mateo Patel
E Shareholder's identifying number: ****5501
Street address (including apt. no.): 8980 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 72060
Account number (see instructions): ending in 806222
Line 1 Ordinary business income (loss): 17,159.45
Line 4 Interest income: 2,582.37
Line 5a Ordinary dividends: 0.00
Line 16 Items affecting shareholder basis: W 4,539.77
Line 17 Other information: D 8,299.01
G Current year allocation percentage: 52.2166 %
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-572f5632a4ea25baabeab9b7,v11-K-1-1120-S-boxed,original,2022,fgen-19abff8db432b6d49a79403f,synthetic_programmatic_template,boxed,bottom,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2026
Part I Information About the Corporation:: Copperline Consulting Inc.
To:: Mateo Fischer
Line 17 Other information: D 5,663.40
Line 4 Interest income: 9,066.18
Line 1 Ordinary business income (loss): 16,333.30",K-1,30,K-1,fdc-e12c2d3badc9addddec3a2a1,v11-K-1-1120-S-boxed,original,2026,fgen-bc1a1e05d66e5c6a0b946a61,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
2022
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation: Bluewater Design Studio Inc. 1248 Lakeshore Blvd Oak Grove, TX 43344
A Corporation's employer identification number: 16-9478041
Part II Information About the Shareholder: Fatima Romero
E Shareholder's identifying number: ending in 6060
Street address (including apt. no.): 9777 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Brookhaven, PA 69631
Account number (see instructions): ending in 075665
4 Interest income: 3,491.43
5a Ordinary dividends: 0.00
16 Items affecting shareholder basis: AA 4,180.21
17 Other information: C 1,424.39
G Current year allocation percentage: 5.2192 %
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-a0c79cbc1a7efbd4eb8e0de6,v11-K-1-1120-S-boxed,original,2022,fgen-5ef2b388ace62c52156e3a67,synthetic_programmatic_template,boxed,bottom,False,
"☐ CORRECTED
2023
Part I Information About the Corporation: Bluewater Design Studio Inc. 4000 Granite St Testville, IL 74522
A Corporation's employer identification number: 39-3710331
Part II Information About the Shareholder: Lena R. Nguyen
E Shareholder's identifying number: ***-**-9551
Box 1 Ordinary business income (loss): 12,315.65
Box 4 Interest income: $1,351.47
Box 5a Ordinary dividends
Box 16 Items affecting shareholder basis: DD 3,612.77
Box 17 Other information: W 1,565.32
G Current year allocation percentage: 58.9048 %
Department of the Treasury - Internal Revenue Service
Schedule K-1 (Form 1120-S)
Shareholder's Share of Income, Deductions, Credits, etc.
Form K-1 (Form 1120-S) (keep for your records)  www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-57b3633fc3e4fe205e5410bf,v11-K-1-1120-S-boxed,original,2023,fgen-9b03164ce666269c1dbc975e,synthetic_programmatic_template,boxed,bottom,False,
"☐ CORRECTED
For calendar year 2023
OMB No. 1545-0123
Final K-1  Amended K-1
Department of the Treasury Internal Revenue Service
Part I Information About the Corporation: Copperline Consulting Inc. 8127 Cedar Ln Pinecrest, GA 53806
A Corporation's employer identification number: 71-8887448
Part II Information About the Shareholder: Amara Castillo
E Shareholder's identifying number: XXX-XX-2061
Box 1 Ordinary business income (loss): 26,969.08
Box 4 Interest income: 1,741.65
Box 16 Items affecting shareholder basis: W 554.14
Box 17 Other information: DD 4,983.86
G Current year allocation percentage: 46.2548 %
Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-0b5f00c4d206d1405c3f92e2,v11-K-1-1120-S-boxed,original,2023,fgen-620054194c5b6cde0fd3f3ef,synthetic_programmatic_template,boxed,none,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share
of Income, Deductions, Credits, etc. 2022 From: Bluewater Design Studio Inc. RECIPIENT: Wei M. Okafor 16 Items affecting shareholder basis V 259.06 1 Ordinary
business income (loss) (2,786.51)",K-1,30,K-1,fdc-753877cd4a63ba7e4e430a4e,v11-K-1-1120-S-flat,original,2022,fgen-fe562731fc40a9ae7c837c7c,synthetic_programmatic_template,flat,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2022 OMB No. 1545-0123 Part I Information
About the Corporation Bluewater Design Studio Inc. 1290 Lakeshore Blvd Maplewood, MN 37639 A Corporation's employer identification
number 39-1207099 Part II Information About the Shareholder Mateo Patel E Shareholder's identifying number ***-**-8686 Street address (including apt. no.) 3710 Maple Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 63234 1 Ordinary business income (loss) 26,877.41 4 Interest income 33.48 16 Items affecting shareholder basis AA 3,495.35 17 Other information D 7,782.79 G Current year allocation percentage 28.9702 %",K-1,30,K-1,fdc-079a0e8d7410f1132216717d,v11-K-1-1120-S-flat,original,2022,fgen-0309dd4c0d1f98315c170b8e,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. OMB No. 1545-0123 Final K-1 Amended K-1 Department of the Treasury Internal Revenue Service Part I Information About the Corporation Copperline Consulting Inc. 2064 Willow Bend Way Bayside, WA 17109 A Corporation's employer identification number 18-1178346 Part II Information About the Shareholder Priya K. Okafor E Shareholder's identifying number XXX-XX-1164 Account number (see instructions) ending in 831246 1 Ordinary business income (loss) 20,846.01 4 Interest income $700.70 5a Ordinary
dividends 16 Items affecting shareholder basis V 2,052.18 17 Other information D 909.29 G Current year allocation percentage 67.6098 % Department of the Treasury - Internal Revenue Service Form K-1 (Form
1120-S) (keep for your records) www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-b2fbedcebf4fcaa7581c0f32,v11-K-1-1120-S-flat,original,2025,fgen-32800be1de2727fb8b08111f,synthetic_programmatic_template,flat,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2026 Department of the Treasury Internal Revenue Service Part I Information About the Corporation Copperline Consulting Inc. 4620 Harbor View Rd Riverton, WI 31299 A Corporation's employer identification number 20-7192055 Part II Information About the Shareholder Alex Testcase E Shareholder's identifying number XXX-XX-1804 Street address (including apt. no.) 2494 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Cedar Falls, IA 77375 1 Ordinary business income
(loss) 11,856.69 4 Interest income 275.01 5a Ordinary dividends 16 Items affecting
shareholder basis D 7,736.30 17 Other information V 3,421.78 G Current year allocation percentage 95.8480 % Department of the Treasury - Internal Revenue Service Form K-1 (Form 1120-S) (keep for your records) www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-31f9b436388270ffad278a5f,v11-K-1-1120-S-flat,original,2026,fgen-d21a87f689ad3cf305c0b12e,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, ctc. Forcalendar year 2025 OMB No. l545-0123 Part I Information
About thc Corporation Maple 5treet Bakery Inc. 8707 Lakeshore Blvd Maplewood, MN 36320 A Corporation's emp1oyer identification number 46-7019299 Part II Information About the Shareholder Riley Castillo E Shareholder's identifying number ***-**-2603 Street address (induding apt. no.) 3934 Oak Hollow Ct City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 43446Accountnumber (see instructions) ending in 955912 1 Ordinary business income (loss) 26,374.86 5a Ordinary dividcnds
17 Other information DD 1,222.92",K-1,30,K-1,fdc-c8e9cbd9b2c163ce981c6e28,v11-K-1-1120-S-flat,original,2025,fgen-5043665c93b50cdfd64a6db9,synthetic_programmatic_template,flat,top,True,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. For calendar year 2024 OMB No. 1545-0123 Final K-1 Amended K-1 Department of the Treasury Internal Revenue Service Part I Information About the Corporation Maple Street Bakery Inc. 1406 Prairie Ave Riverton, WI 50670 A Corporation's employer identification number 73-4788975 Part II Information About the Shareholder Casey S. Testcase E Shareholder's identifying number ****2641 Street address (including apt. no.) 829 Granite St City or town, state
or province, country, and ZIP or foreign postal code Riverton, WI 59498 1 Ordinary business income (loss) 28,499.33 4 Interest income $9,415.82
5a Ordinary dividends 16 Items affecting shareholder basis V 4,954.95 17 Other information AA 7,369.90 Department of the Treasury - Internal Revenue Service Form K-1 (Form 1120-S) (keep for your records) www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-db846e9cb34de970d7482320,v11-K-1-1120-S-flat,original,2024,fgen-f8862635a84f8b1a4a2740d1,synthetic_programmatic_template,flat,top,False,
"Part I Information About the Corporation: Maple Street Bakery Inc.
Recipient's
name: Lena M. Haddad 4 Interest income $3,718.16 Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc.",K-1,30,K-1,fdc-ec098a5f37311a1339ab6403,v11-K-1-1120-S-flat,original,2021,fgen-e98dc3cf09beebb33d85f2e2,synthetic_programmatic_template,flat,bottom,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. Part I Information About the
Corporation'S name: Bluewater Design Studio Inc. RECIPIENT: Fatima Fischer 4 Interest income $6,611.29 G Current year allocation percentage 27.2292 % 17 Other
information V 6,849.53 16 Items affecting shareholder basis W 4,541.61",K-1,30,K-1,fdc-7be9dab67709ae36dcda47c9,v11-K-1-1120-S-flat,original,2026,fgen-c2d688ce91a0884ef13b1c06,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Schedule
K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. For calendar year 2023 OMB No. 1545-0123 Final K-1 Amended K-1 Department of the Treasury Internal Revenue Service Part I Information About the Corporation Copperline Consulting Inc. 9613 Lakeshore Blvd Testville, IL 72174 A Corporation's employer identification number
53-8561223 Part II Information About the Shareholder Lena Lindqvist E Shareholder's identifying number ending in 8429 1 Ordinary business income (loss) 7,713.69 5a Ordinary dividends 16 Items affecting shareholder basis V 2,539.34 G Current year allocation percentage 18.5866 % Department of the Treasury - Internal Revenue Service Form K-1 (Form 1120-S) (keep for your records) www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-db14243ced37e259780d89c5,v11-K-1-1120-S-flat,original,2023,fgen-cb54667947545e5709612d29,synthetic_programmatic_template,flat,top,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductíons, Credits, etc. 2026 OMB No. 1545-0123 Final K-1Amended K-1 Department of the Treasury
Internal Revenue Servíce Part I Information About the Corporation Copperline Consulting Inc. 4335 Harbor View Rd Pinecrest, GA 60374 ACorporation's employer identification number 15-8927510 PartII Information About the Shareho1der Amara B. Adeyemi E Shareholder's identífying number XXXXX59l1 Street address (including apt. no.) 8912 Prairie Ave City or town, state or province, country, and ZIP or foreign posta1 code Testville, IL 99860
l 0rdinary business income (loss) 15,830.10 4 Intcrest income 7,246.64 5a Ordinary dividends 0.00 16 Items affectingshareholder basis W 8,570.80 17 Othcr information AA 7,771.28 G Current year allocation percentage 35.1778 % Department ofthe Treasury - Intemal Revenue 5ervice Form K-1 (Form 1120-S) (keep for your records) www.irs.gov/FormScheduleK1Form112OS",K-1,30,K-1,fdc-50e86f8db0c01a5408675a0c,v11-K-1-1120-S-flat,original,2026,fgen-ac8f8590e6c8645dac3d5574,synthetic_programmatic_template,flat,top,True,
"☐ CORRECTED Schedule K-1 (Form 1120-S) Shareholder's Sharc of Income, Deductions, Credits, etc.
OMB No. 1545-0123 Final K-1 Amended K-1 Department of the Treasury Internal Revenue Service PartI Information About the Corporation Maple Street Bakery Inc. 5914 Cedar LnTestvi1le, IL 86404 A Corporation's employer identification number 57-3044395 Part II Information About the Shareholder Hiro Testcase E Shareholder's ídentifying number ****9053 l Ordinary business income (loss) 23,553.25 5a Ordinary dividends 16 Items affectingshareholder basis W 8,658.88 17 Other information V 1,588.77 G Current year allocation percentage 13.6116 %Department of the Treasury - Interna1 Revenue Servíce Form K-l (Form 112O-S)
(keep for your records) www.irs.gov/Form5cheduleK1Form1120S",K-1,30,K-1,fdc-92dd2f2326e919bba0400a81,v11-K-1-1120-S-flat,original,2024,fgen-e767360b1edd10c737e30fea,synthetic_programmatic_template,flat,top,True,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. For calendar year 2023 Department of the Treasury Internal Revenue Service Part I Information About the Corporation Bluewater Design Studio Inc. 269 Harbor View Rd Lakewood, CO 98641 A Corporation's employer identification number 29-7824129 Part II Information About the Shareholder Morgan Fischer E Shareholder's identifying number ****2945 Street
address (including apt. no.) 2433 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 63732 Account number (see instructions) ending in 110375 4 Interest income 7,344.55 5a Ordinary dividends 16 Items affecting
shareholder basis C 693.95",K-1,30,K-1,fdc-e7c9dff200474807f5ab1dde,v11-K-1-1120-S-flat,original,2023,fgen-de6ae13a33426141514364c5,synthetic_programmatic_template,flat,top,False,
"☐ CORRECTED Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. OMB No. 1545-0123 Final K-1 Amended K-1 Department of the Treasury
Internal Revenue Service Part I Information About the Corporation Copperline Consulting Inc. 6853 Elm Park Pl Pinecrest, GA 58114 A Corporation's employer identification number 96-8563522 Part II Information About the Shareholder
Taylor Larsen E Shareholder's identifying number ****8734 Street address (including apt. no.) 6167 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 79530 1 Ordinary business income (loss) (8,321.90) 4 Interest income $2,700.98 5a Ordinary dividends 16 Items affecting shareholder basis AA 6,963.21",K-1,30,K-1,fdc-f248f518d1bdef93af616e36,v11-K-1-1120-S-flat,original,2023,fgen-330e7554ea18524a97020326,synthetic_programmatic_template,flat,top,False,
"Part I Information About the Corporation'S name: Copperline Consulting Inc. Recipient's name: Diego Kowalski 16 Items affecting shareholder basis C 6,781.19 1 Ordinary business income (loss) 18,098.87 17 Other
information D 5,035.11 Schedule K-1
(Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2024",K-1,30,K-1,fdc-2c4370d9de99ddd4f8b40bc0,v11-K-1-1120-S-flat,original,2024,fgen-6c64da09f973b00fe3f8e089,synthetic_programmatic_template,flat,bottom,False,
"For calendar year 2022 OMB No. 1545-0123 Final K-1 Amended K-1 Part I Information About the Corporation Copperline Consulting Inc. 7335 Sample Street Fairview, OH 53834 A Corporation's employer identification number 14-5096529 Part II Information About the Shareholder Jordan Romero E
Shareholder's identifying number ending in 2580 1 Ordinary business income (loss) 19,815.07 4 Interest income $6,563.28 5a Ordinary dividends 0.00 16 Items affecting shareholder basis AA 2,528.13 17 Other information C 4,274.61 G Current year allocation percentage 82.2856
% Department of the Treasury - Internal Revenue Service",K-1,30,K-1,fdc-34fae09ceff892f544f829bc,v11-K-1-1120-S-flat,original,2022,fgen-caa7993af1478786cd82b5c4,synthetic_programmatic_template,flat,none,False,
"Schedule K-1 (Form 1120-S) Shareholder's Share of Income, Deductions, Credits, etc. 2021 OMB No. 1545-0123 Department of the Treasury Internal Revenue Service Part I Information About the Corporation Bluewater Design Studio Inc.
1592 Maple Ridge Dr Testville, IL 18894 A Corporation's employer identification number 43-8382652 Part II Information About the Shareholder Morgan A. Lindqvist E Shareholder's identifying number ***-**-9877 Street address
(including apt. no.) 9790 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Fairview, OH 53655 1 Ordinary business income (loss) 25,992.73 4 Interest income 777.60 5a Ordinary dividends 0.00 16 Items affecting shareholder basis C 3,159.07 17 Other information AA 4,771.03 G Current year allocation percentage 60.5187 % Department of the Treasury - Internal Revenue Service Form K-1 (Form 1120-S) (keep for your records) www.irs.gov/FormScheduleK1Form1120S",K-1,30,K-1,fdc-45e9a2bccc324975f7f3bb83,v11-K-1-1120-S-flat,original,2021,fgen-c61400e0244b7d5f2163e0ee,synthetic_programmatic_template,flat,top,False,
"Harbor Personal Lending
Accountnumber
Statement period
Outstanding principal
Interest rate
Monthly payment
Payment due date
Loan typc
Interest paid this year
Repayment plan
ending in l78522
03/01/2023 - 03/28/2023
$8,200.89
11.11%
$134.61
2023-01-06
Private refinance
840.39
Income-Driven Repayment",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-76ec44ed50a38ef827856884,v11-LOAN_STATEMENT-columns,original,2023,fgen-f019b1b92480a276f6e9f78a,synthetic_programmatic_template,columns,none,True,student
"Payment Date
Amount Paid
Principal Paid
Interest Paid
Late Fee
LoanBalance
2022-05-10
103.58
460.10
284.10
0.00
12393.95
16/09/2022
1179.27
271.34
238.70
0.00
82485.60
2022-08-01
570.03
857.95
278.01
0.00
3947.69
04/11/2022
999.50
903.55
284.78
0.00
57072.74",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-f96adb6d634d72f9b684b0ba,v11-LOAN_STATEMENT-columns,original,2022,fgen-7ecd3eb645f28060dad05824,synthetic_programmatic_template,columns,top,True,raw_export
"Northwind Auto Credit
Account number
Statement period
Outstanding principal
Fixed rate
Current amount due
Payment due date
Credit limit
Available credit
****240240
04/01/2024 - 04/30/2024
$1,257.77
6.19%
$1,254.00
06/27/2024
50,075.87
$77,825.72",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-2fff56045b7fa6d79d25f442,v11-LOAN_STATEMENT-columns,original,2024,fgen-5a9e6902f752677a0cb9d048,synthetic_programmatic_template,columns,none,False,heloc
"Harbor Personal Lending
Account number
Statement period
Outstanding principal
Interest rate
Payment due
Due date
Vehicle
Payments remaining
XXX-XX-952336
08/0l/2023- 08/30/2023
S56,642.24
9.66%
$l,099.15
2023-01-20
2020 Toyota Corolla
24
Auto Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-062784c05cbe9387136a88e9,v11-LOAN_STATEMENT-columns,original,2023,fgen-31392b01e0f1a535faf1fd2b,synthetic_programmatic_template,columns,bottom,True,auto
"HELOC Billing Statement
Summit Student Loan Servicing
Account number
Statement period
Current principal
Interest rate
Monthly payment
Payment due date
Credit limit
Available credit
****058675
08/01/2021 - 08/28/2021
$72,973.44
12.03%
$911.68
7/3/21
$25,779.24
$13,019.29
Tax reminder: amounts on this statement may differ from your Form 1098.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a096e95813647c51fe1a6c8d,v11-LOAN_STATEMENT-columns,original,2021,fgen-7e4dfc8f2f010873cb3eeb2f,synthetic_programmatic_template,columns,top,False,heloc
"Your loan bill
Northwind Auto Credit
Account number
Statement period
Outstanding principal
Fixed rate
Payment due
Payment due date
****984222
02/01/2022 - 02/28/2022
$0.00
2.95%
$728.03
09/04/2022
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-b177e4afbb5ba22f48c0266a,v11-LOAN_STATEMENT-columns,original,2022,fgen-d46f3da2cbaf0b162e17bed4,synthetic_programmatic_template,columns,top,False,personal
"Posted
Type
Amount
To Principal
To Interest
Outstanding Balance
14/10/2024
DISBURSEMENT
1145.18
881.11
20.31
73062.07
09/22/2024
LATE FEE
918.28
1075.49
234.50
76593.71
09/19/2024
DISBURSEMENT
1386.15
778.90
104.33
49964.77
2024-02-13
PAYMENT
790.61
27.09
249.66
80886.07
2024-09-24
PAYMENT
171.94
112.48
383.57
36770.26
04/10/2024
PAYMENT
1255.61
230.99
121.10
50749.57
01/12/2024
INTEREST ACCRUAL
136.34
194.06
103.80
2806.09
2024-02-14
DISBURSEMENT
1007.72
1157.27
27.65
81382.12
08/12/2024
INTEREST CAPITALIZATION
118.59
603.29
14.61
38140.03",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-b67aab9ef9a5d2d281524c46,v11-LOAN_STATEMENT-columns,original,2024,fgen-fcb4eff2a1401c22ca4470aa,synthetic_programmatic_template,columns,bottom,False,raw_export
"Payment Date
Amount Paid
Principal Paid
Interest Paid
Late Fee
Loan Balance
12/03/2022
1075.52
1122.06
278.27
0.00
56485.84
06/11/2022
1100.92
479.90
154.17
0.00
43033.75
05/27/2022
591.70
1069.01
123.82
0.00
5565.68
2022-05-07
1254.15
444.82
132.59
0.00
28282.73",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-93d16932d5f44dddb0d85ed3,v11-LOAN_STATEMENT-columns,original,2022,fgen-66e7fe8790561de483b8a01f,synthetic_programmatic_template,columns,none,False,raw_export
"Home Equity Line of Credit Statement
Granite Auto Finance
Account number
Statement period
Outstanding principal
APR
Monthly payment
Due date
Credit limit
Available credit
ending in 837393
11/01/2024 - 11/31/2024
$77,591.53
4.77%
$877.76
7/15/24
104,608.04
$38,443.57
Tax reminder: amounts on this statement may differ from your Form 1098.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-877fe05d2312b2c885c3ba34,v11-LOAN_STATEMENT-columns,original,2024,fgen-36c329b198f30dd9b4d5113e,synthetic_programmatic_template,columns,top,False,heloc
"Student Loan Statement
Northwind Auto Credit
Account numbcr
Statement period
Current principa1
Fixed rate
Payment due
Payment due date
Loan type
Interest paid this year
Repayment plan
***-**-946748
05/01/2026 - 05/31/2026
$6,892.69
5.54%
$117.87
2026-07-05
Direct Unsubsidized
$l,413.84
Income-Driven Repayment
Tax reminder: amounts on this statement may differ from your Form1O98-E.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-ea37c653f38601bd50174e09,v11-LOAN_STATEMENT-columns,original,2026,fgen-a63f4e8aa515da6b1227518a,synthetic_programmatic_template,columns,top,True,student
"HELOC Billing Statement
Harbor Personal Lending
Account number
Statement period
Outstanding principal
Fixed rate
Amount due
Due by
Credit limit
Available credit
***-**-059511
02/01/2025 - 02/28/2025
$15,199.01
10.71%
$137.31
7/19/25
$124,894.15
$61,416.53",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-6a1084e4d0542d941f26432f,v11-LOAN_STATEMENT-columns,original,2025,fgen-cc787f5c61883aa4803ef1b6,synthetic_programmatic_template,columns,top,False,heloc
"Harbor Personal Lending
Account number
Statement period
Current principal
Fixed rate
Amount due
Due by
****497904
06/01/2021 -06/28/2021
S37,220.23
11.21%
$335.22
2021-05-16",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-647c12695f4aaef7eb055f14,v11-LOAN_STATEMENT-columns,original,2021,fgen-1ba852c26162f44c51271d79,synthetic_programmatic_template,columns,none,True,personal
"Loan 5877 payment history
Date
Description
Payment
Principal
Interest
Balance
11/26/2023
Autopay
197.44
626.29
200.40
83565.98
24/08/2023
Autopay
960.35
392.99
388.06
3440.67
26/06/2023
Personal loan installment
973.61
380.55
85.36
36003.86
09/08/2023
Autopay
1394.14
540.46
211.08
22757.50
2023-05-06
Auto loan payment
216.95
903.33
302.29
73430.99
2023-01-07
Personal loan installment
1005.66
1182.49
153.20
75077.60
05/09/2023
Student loan payment
792.45
941.45
187.72
16485.36",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8745603ee836e0f8804ccf72,v11-LOAN_STATEMENT-columns,original,2023,fgen-0e4c14985276c46447bbd109,synthetic_programmatic_template,columns,top,False,raw_export
"Home Equity Line of Credit Statement
Summit Student Loan Servicing
Account number
Statement period
Outstanding principal
Interest rate
Monthly payment
Due date
Credit limit
Available credit
XXXXX677544
05/01/2023 - 05/31/2023
$0.00
8.96%
$714.25
2023-04-28
121,801.84
38,936.98
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-cb68b0b69262535e0ff72fed,v11-LOAN_STATEMENT-columns,original,2023,fgen-e4c99c0435038f08cfa23098,synthetic_programmatic_template,columns,top,False,heloc
"Auto Loan Statement
Summit Student Loan Servicing
Account number
Statement period
Unpaid principal balance
APR
Monthly payment
Payment due date
Vehicle
Payments remaining
XXX-XX-125114
09/01/2026 - 09/30/2026
$0.00
8.82%
$128.73
August 15, 2026
2023 Honda Civic
12
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-df42809f862df308a298b889,v11-LOAN_STATEMENT-columns,original,2026,fgen-aea5afef18493706161c9ae1,synthetic_programmatic_template,columns,top,False,auto
"Vehicle Loan Billing Statement
Northwind Auto Credit
Account number
5tatement period
Principal balance
APR
Payment due
Due by
Vehicle
Paymentsremaining
ending in 828776
12/01/2024 - 12/28/2024
S15,032.32
9.77%
$356.17
February l7, 2024
2020 Toyota Corolla
53",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fe770470bddaf5f3ada914a8,v11-LOAN_STATEMENT-columns,original,2024,fgen-5f0a98577b2fd8383d3040e2,synthetic_programmatic_template,columns,top,True,auto
"Installment Loan Statement
Northwind Auto Credit
Account number
Statement period
Unpaid principal balance
Interest rate
Amount due
Due date
XXX-XX-743921
02/01/2024 - 02/28/2024
$0.00
13.50%
$578.59
3/7/24
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-cbfebd341c127242082c839c,v11-LOAN_STATEMENT-columns,original,2024,fgen-8221440c86dd19470248571c,synthetic_programmatic_template,columns,top,False,personal
"Billing Statement- 5tudent Loans
Summít Student Loan Servicing
Account number
Statement period
Principal balance
APR
Amount due
Payment due date
Loan type
Interest paid this year
Repayment plan
XXXXXO25293
03/01/2022 - 03/31/2022
S42,776.91
13.66%
$492.53
April 13, 2O22
Direct Unsubsidized
1,233.41
Income-Driven Repayment",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a51dacfce08187c66ee42c18,v11-LOAN_STATEMENT-columns,original,2022,fgen-a73bdf687b36b9d2ccbe964f,synthetic_programmatic_template,columns,top,True,student
"Payment Date
Amount Paid
Principal Paid
Interest Paid
Late Fee
Loan Balance
2024-11-24
290.49
1187.00
157.30
0.00
4881.09
24/04/2024
1100.55
1098.30
30.98
0.00
54779.50
09/01/2024
148.37
887.96
49.09
0.00
49258.05
15/10/2024
298.20
1176.05
182.02
0.00
57332.15
04/20/2024
653.68
164.79
25.46
0.00
78090.64
03/24/2024
270.03
340.72
48.63
0.00
1196.37
21/04/2024
919.20
359.77
289.03
0.00
77164.79
2024-02-28
605.65
909.33
227.40
0.00
84184.27
01/06/2024
302.15
460.91
209.93
0.00
47310.81",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a8731b857cecc472b53aad42,v11-LOAN_STATEMENT-columns,original,2024,fgen-0aab7758c5495b7fe5bfcfba,synthetic_programmatic_template,columns,top,False,raw_export
"Loan 4686 payment history
Date
Description
Payment
Principal
Interest
Balance
2026-01-24
Loan payment
1178.53
726.35
146.01
22313.93
08/18/2026
Auto loan payment
1050.41
248.98
253.31
51054.21
03/24/2026
Personal loan installment
724.59
41.87
342.23
460.59
2026-12-28
Student loan payment
635.28
979.44
317.20
57253.43
2026-03-20
Auto loan payment
873.96
181.86
60.57
11154.41
22/07/2026
Student loan payment
1348.01
918.00
141.00
4304.03",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8dcba6433292bf658932afc5,v11-LOAN_STATEMENT-columns,original,2026,fgen-8dd018ef81c98a9044c28699,synthetic_programmatic_template,columns,top,False,raw_export
"Student Loan Transactions
Posted
Type
Amount
To Principal
To Interest
Outstanding Balance
27/l1/2026
INTEREST CAPITALIZATION
422.99
l124.63
78.O1
583.45
12/22/2026
DISBURSEMENT
71.86
410.43
68.58
48475.84
2026-02-15
DISBURSEMENT
1240.99
1147.75
339.26
61455.44
06/04/2026
INTEREST CAPITALIZATION
830.33
8.49
295.73
37764.75
2026-09-01
PAYMENT
1304.40
45.97
29.77
55127.49
2026-10-11
INTERESTCAPITALIZATION
659.46
246.43
88.31
11944.05
10/05/2026
LATE FEE
937.64
722.48
72.89
89655.48",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-5bceee9b6c0cb7462eccf536,v11-LOAN_STATEMENT-columns,original,2026,fgen-81f3f1dc0b805246397c4ac6,synthetic_programmatic_template,columns,top,True,raw_export
"Cedar Valley Credit Union
Account number
Statement period
Unpaid principal balance
Fixed rate
Amount due
Due by
ending in 290025
04/01/2021 - 04/31/2021
$0.00
6.27%
$437.31
2021-10-10
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fe523eadffc00b53b4c96de0,v11-LOAN_STATEMENT-columns,original,2021,fgen-7d383df4e81f0bc3dbc3af7c,synthetic_programmatic_template,columns,none,False,personal
"Home Equity Line of Credit Statement
Summit Student Loan Servicing
Account number
Statement period
Unpaid principal balance
Fixed rate
Payment due
Due date
Credit limit
Available credit
***-**-760643
12/01/2021 - 12/30/2021
$412.75
6.11%
$130.29
2021-07-23
$103,675.64
37,338.84",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-072c50d316d48dd783694e5a,v11-LOAN_STATEMENT-columns,original,2021,fgen-e862be7c537517cd25000779,synthetic_programmatic_template,columns,top,False,heloc
"Harbor Personal Lending
Account number
Statement period
Principal balance
APR
Monthly payment
Due by
****337060
02/01/2024- 02/28/2024
S0.00
6.47%
$448.81
8/7/24
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4babf18c6871b91279d82e2e,v11-LOAN_STATEMENT-columns,original,2024,fgen-d1d88f6cdc0f4c3a844561e1,synthetic_programmatic_template,columns,none,True,personal
"HELOC Billing Statement
Harbor Personal Lending
Account number
Statement period
Current principal
Interest rate
Monthly payment
Payment due date
Credit limit
Available credit
ending inl54868
07/0l/2021 - 07/28/2021
$50,774.49
9.15%
$1,124.91
1/14/21
66,839.23
13,240.49
Tax remindcr: amounts on this statement may differ from your Form l098.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-6e52c349d61021005c35c1c6,v11-LOAN_STATEMENT-columns,original,2021,fgen-c95e49b01e52db31b698e391,synthetic_programmatic_template,columns,top,True,heloc
"Cedar Valley Credit Union
Account number
Statement period
Unpaid principal balance
APR
Monthly payment
Payment due date
Loan type
Interest paid this year
Repayment plan
ending in 292830
03/01/2023 - 03/30/2023
$69,845.92
7.33%
$986.11
7/19/23
Private refinance
1,815.25
Income-Driven Repayment
Tax reminder: amounts on this statement may differ from your Form 1098-E.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-80fe62f488f7e5d9970b2876,v11-LOAN_STATEMENT-columns,original,2023,fgen-95fc8bd08d3f0d888b55daa1,synthetic_programmatic_template,columns,none,False,student
"Downloaded 06/12/2023
Payment Date
Amount Paid
Principal Paid
Interest Paid
Late Fee
Loan Balance
2023-11-24
536.55
389.52
356.68
0.00
85944.91
2023-11-12
1140.16
466.72
318.63
0.00
2640.23
07/14/2023
1204.45
582.09
65.28
0.00
272.53
2023-09-15
201.61
325.96
56.00
0.00
61704.78
2023-03-18
114.81
414.64
130.41
0.00
81318.99",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-b3af2c9defe754b634cb51c9,v11-LOAN_STATEMENT-columns,original,2023,fgen-1cfa8c923cf4d479cfa2674e,synthetic_programmatic_template,columns,top,False,raw_export
"Personal Loan History
Posted
Type
Amount
To Principa1
To Interest
Outstanding Balance
03/04/2025
DI5BURSEMENT
563.63
581.49
3.94
69387.43
O8/20/2025
DISBURSEMENT
108.07
58.46
270.75
76l61.71
05/22/2025
LATEFEE
1295.80
307.53
364.97
48387.20
04/07/2025
INTEREST ACCRUAL
667.85
1164.40
359.38
49237.20
2025-01-13
INTEREST CAPITALIZATION
665.19
857.53
153.48
38706.87
05/28/2025
PAYMENT
536.31
961.48
334.63
66636.90",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-3fd46598160f35e097e5bff3,v11-LOAN_STATEMENT-columns,original,2025,fgen-defd36b564f3ecabacdf2295,synthetic_programmatic_template,columns,top,True,raw_export
"Downloaded 10/09/2023
Date
Description
Payment
Principal
Interest
Balance
2023-02-13
Auto loan payment
1106.23
264.22
388.50
75557.23
22/09/2023
Personal loan installment
334.09
400.01
174.07
33303.29
14/01/2023
Auto loan payment
956.11
1092.24
357.29
8472.09",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a12739367277c4b7f473b57b,v11-LOAN_STATEMENT-columns,original,2023,fgen-1a3d06b187eaf3a8e344fd11,synthetic_programmatic_template,columns,top,False,raw_export
"Downloaded 27/12/2025
Posted
Type
Amount
To Principal
To Interest
Outstanding Balance
16/04/2025
INTEREST CAPITALIZATION
325.43
75.70
344.64
30747.27
27/07/2025
DISBURSEMENT
758.84
927.65
230.86
51713.98
2025-05-21
LATE FEE
1399.90
366.82
122.59
10738.61
07/22/2025
PAYMENT
766.35
156.22
246.90
1965.43
2025-08-15
DISBURSEMENT
1188.80
111.87
384.30
2923.23
13/12/2025
LATE FEE
849.77
889.94
161.06
52321.00",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0aba482b5f8205e9ecb29afd,v11-LOAN_STATEMENT-columns,original,2025,fgen-b0ab329e9ffac448b4a237a6,synthetic_programmatic_template,columns,top,False,raw_export
"Auto Loan Statement
Cedar Valley Credit Union
Account number
Statement period
Principal balance
Interest rate
Amount due
Due date
Vehicle
Payments remaining
XXX-XX-137672
04/01/2022 - 04/28/2022
$61,551.07
9.11%
$905.60
February 11, 2022
2017 Toyota Corolla
7",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e016aec9279d10d6aed5d6a2,v11-LOAN_STATEMENT-columns,original,2022,fgen-42d5ec88fbc777282ddcc0c1,synthetic_programmatic_template,columns,top,False,auto
"Billing Statement - Student Loans
Harbor Personal Lending
Account number
Statement period
Current principal
Fixed rate
Current amount due
Payment due date
Loan type
Interest paid this year
Repayment plan
***-**-921197
10/01/2024 - 10/28/2024
$20,214.63
12.90%
$406.63
4/5/24
Private refinance
$524.73
Income-Driven Repayment",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-66997b2e4ac13ddfb4b525b0,v11-LOAN_STATEMENT-columns,original,2024,fgen-a0a15eb1c1005338395415de,synthetic_programmatic_template,columns,top,False,student
"Your loan bill
Harbor Personal Lending
Account number,XXX-XX-559350
Statement period,05/01/2022 - 05/31/2022
Outstanding principal,""$25,370.46""
Fixed rate,6.34%
Amount due,$388.77
Due date,2022-07-28",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a97839d1873915f0bbb412c7,v11-LOAN_STATEMENT-csv,original,2022,fgen-d420a9f73048bf0dd7561f7f,synthetic_programmatic_template,csv,top,False,personal
"Your monthly student loan bill
Harbor Personal Lending
Account number,****169478
Statement períod,09/01/2021 - 09/28/2021
Remaining balance,""$43,874.5O""
APR,5.48%
Monthly payment,""$1,017.21""
Due date,12/23/2021
Loan type,Direct 5ubsidized
Interest paid this year,$676.42
Repaymentplan,Standard",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c604a0cae2e6b047d6aef194,v11-LOAN_STATEMENT-csv,original,2021,fgen-a3ad17bffbc5ce08c3329492,synthetic_programmatic_template,csv,top,True,student
"Northwind Auto Credit
Account number,***-**-268023
Statement period,01/01/2025 - 01/30/2025
Outstanding principal,""$60,942.89""
APR,13.56%
Amount due,$434.56
Due by,1/7/25
Vehicle,2022 Ford F-150
Payments remaining,9",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-cee546247e5384516531379b,v11-LOAN_STATEMENT-csv,original,2025,fgen-aece9864cac6e7a721108851,synthetic_programmatic_template,csv,none,False,auto
"HELOC Billing Statement
Northwind Auto Credit
Account number,XXX-XX-434076
Statement period,09/01/2026 - 09/31/2026
Current principal,$0.00
Interest rate,9.39%
Monthly payment,""$1,012.75""
Due by,""December 5, 2026""
Credit limit,""$24,025.45""
Available credit,""22,005.67""
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4706fa143899f3815b863bf8,v11-LOAN_STATEMENT-csv,original,2026,fgen-3524f3ef2839d833e338b42d,synthetic_programmatic_template,csv,top,False,heloc
"Student Loan Transactions
Downloaded 01/09/2021
Date,Description,Payment,Principal,Interest,Balance
01/09/2021,Student loan payment,206.49,340.97,37.98,82627.71
08/09/2021,Loan payment,227.11,1072.08,189.79,35987.25
27/02/2021,Personal loan installment,308.74,1063.88,335.57,42070.32",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a52011389d81ab87a96cc5ab,v11-LOAN_STATEMENT-csv,original,2021,fgen-ff1dbb86dc481db95bd6dcb6,synthetic_programmatic_template,csv,top,False,raw_export
"Vehicle Loan Billing Statement
Northwind Auto Credit
Account number,XXX-XX-626944
Statement period,12/01/2022 - 12/30/2022
Remaining balance,""$45,212.40""
Interest rate,9.17%
Monthly payment,$686.05
Due date,""September 11, 2022""
Vehicle,2020 Ford F-150
Payments remaining,50",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4bd2d88261334916daaeae22,v11-LOAN_STATEMENT-csv,original,2022,fgen-75fc131f56fefd4c7f504d4b,synthetic_programmatic_template,csv,top,False,auto
"Personal Loan Statement
Summit Student Loan Servicing
Account number,XXX-XX-643155
Statement period,02/01/2025 - 02/28/2025
Outstanding principal,$0.00
Interest rate,7.95%
Amount due,$250.91
Due date,4/25/25
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8cc9b06b9cdef1439f877ec2,v11-LOAN_STATEMENT-csv,original,2025,fgen-1d4308464167c935ba197953,synthetic_programmatic_template,csv,top,False,personal
"Northwind Auto Credit
Account number,ending in 130132
Statement period,10/01/2024 - 10/28/2024
Principal balance,""$19,686.48""
Interest rate,6.7O%
Payment due,$445.13
Due by,""May 27, 2024""
Loan type,Dírect Unsubsidized
Interest paid this year,""$1,871.69""
Repaymentp1an,Standard
Student Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-57a8bba3210d9b42c0b569e6,v11-LOAN_STATEMENT-csv,original,2024,fgen-559f7b1290707e74145e1a16,synthetic_programmatic_template,csv,bottom,True,student
"Cedar Valley Credit Union
Account number,XXXXX504643
Statement period,02/01/2026 - 02/28/2026
Outstanding principal,""$35,979.83""
APR,10.26%
Payment due,""$1,101.10""
Due date,3/13/26
Vehicle,2026 Honda Civic
Payments remaining,58
Auto Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a66ec9b3ce22451766c45a4d,v11-LOAN_STATEMENT-csv,original,2026,fgen-8ebb89557e22d797db0f874b,synthetic_programmatic_template,csv,bottom,False,auto
"Personal Loan History
Posted,Type,Amount,To Principal,To Interest,Outstanding Balance
07/16/2023,PAYMENT,474.68,423.59,382.62,88044.28
09/04/2023,DISBURSEMENT,1344.11,555.24,27.87,14065.24
09/02/2023,DISBURSEMENT,344.23,696.15,259.64,67387.96",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d7b8ceb4a30bd4f5361a873f,v11-LOAN_STATEMENT-csv,original,2023,fgen-2ef89041b1f30d608dc06840,synthetic_programmatic_template,csv,top,False,raw_export
"Installment Loan Statement
Harbor Personal Lending
Account number,XXX-XX-573130
Statement period,05/01/2022 - 05/31/2022
Principal balance,""$67,150.78""
Interest rate,4.50%
Amount due,$930.47
Due by,""January 10, 2022""",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-18dffc7c8051eeaa9ffdc577,v11-LOAN_STATEMENT-csv,original,2022,fgen-2cf7ca0a9bda66e8faedd70a,synthetic_programmatic_template,csv,top,False,personal
"Personal Loan History
Downloaded 09/09/2023
Date,Description,Payment,Principal,Interest,Balance
04/17/2023,Loan payment,1232.69,659.67,305.15,32281.18
12/22/2023,Auto loan payment,686.92,876.95,319.45,61211.05
2023-09-05,Autopay,408.32,961.53,40.01,76019.30
2023-01-28,Loan payment,533.95,1173.85,363.40,23391.14",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-5a101c26c2b1403affdfdd5c,v11-LOAN_STATEMENT-csv,original,2023,fgen-a6312f3b85369940b35d9e25,synthetic_programmatic_template,csv,top,False,raw_export
"Personal Loan Statement
Northwind Auto Credit
Account number,ending in 992970
Statement period,09/01/2024 - 09/30/2024
Unpaid principal balance,""$9,203.10""
Interest rate,9.65%
Amount due,""$1,370.43""
Payment due date,6/5/24",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-132b5fbd5aea02838b5ec3ab,v11-LOAN_STATEMENT-csv,original,2024,fgen-9a7442a7695172cebd28a0c7,synthetic_programmatic_template,csv,top,False,personal
"Loan 7659 payment history
Payment Date,Amount Paid,Principal Paid,Interest Paid,Late Fee,Loan Balance
12/24/2026,626.32,287.54,95.91,0.00,13111.67
04/06/2026,812.62,728.03,92.23,0.00,88219.74
2026-01-10,1130.63,606.23,148.02,0.00,45011.26
2026-07-07,1390.46,710.82,174.59,0.00,37283.24
09/03/2026,401.82,186.28,218.98,0.00,47619.62",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-aea5ad8c26577f6eaf336db4,v11-LOAN_STATEMENT-csv,original,2026,fgen-cbd96f61bd21db229215b748,synthetic_programmatic_template,csv,top,False,raw_export
"Your auto loan bill
Cedar Valley Credit Union
Account number,***-**-638950
Statement period,05/01/2023 - 05/28/2023
Current principal,""$41,596.89""
APR,10.85%
Current amount due,$554.31
Due by,2023-08-06
Vehicle,2023 Toyota Corolla
Payments remaining,31",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-f8ce5967cf599f5806d1920d,v11-LOAN_STATEMENT-csv,original,2023,fgen-ae922e70567c85c3fd0de19d,synthetic_programmatic_template,csv,top,False,auto
"Auto Loan Activity
Downloaded 08/03/2021
Posted,Type,Amount,To Principal,To Interest,Outstanding Balance
03/20/2021,LATE FEE,300.67,932.59,302.39,36094.76
15/01/2021,INTEREST ACCRUAL,1329.78,1048.94,97.44,48453.21
02/05/2021,INTEREST CAPITALIZATION,166.56,868.74,350.39,71523.61
05/05/2021,PAYMENT,443.75,1154.93,137.84,22206.82
06/25/2021,INTEREST ACCRUAL,573.87,1007.13,214.90,27184.48
08/12/2021,DISBURSEMENT,995.09,723.91,6.54,70036.15
14/07/2021,LATE FEE,1248.78,822.96,184.62,43075.27
2021-09-25,DISBURSEMENT,695.30,333.30,276.86,70912.66",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-bec21acb5ba37ec6cbb61664,v11-LOAN_STATEMENT-csv,original,2021,fgen-09c1afb81073172d42243302,synthetic_programmatic_template,csv,top,False,raw_export
"Posted,Type,Amount,To Principal,To Interest,Outstanding Balance
06/06/2023,INTEREST ACCRUAL,718.92,41.21,248.94,47542.82
01/08/2023,DISBURSEMENT,1162.31,117.28,342.60,84616.37
2023-07-08,LATE FEE,1127.60,335.39,207.71,76104.75
2023-01-20,INTEREST CAPITALIZATION,1297.27,728.49,101.83,12908.13",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-bc56321d59391386542e119f,v11-LOAN_STATEMENT-csv,original,2023,fgen-7d65c99c44069ea2122d3c83,synthetic_programmatic_template,csv,top,False,raw_export
"Auto Loan Statement
Summit Student Loan Servicing
Account number,XXXXX016898
Statement period,09/01/2023 - 09/31/2023
Remaining balance,""$27,313.05""
Interest rate,6.57%
Current amount due,$674.06
Due date,""November 17, 2023""
Vehicle,2023 Toyota Corolla
Payments remaining,2",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-822f86f537badd8496223df2,v11-LOAN_STATEMENT-csv,original,2023,fgen-29fa32351be57bf94081c71a,synthetic_programmatic_template,csv,top,False,auto
"HELOC Billing Statement
Cedar Valley Credit Union
Account number,XXXXX586179
Statement period,08/01/2023 - 08/30/2023
Remaining balance,""$63,953.17""
APR,6.88%
Payment due,$261.13
Due by,2023-08-25
Credit limit,""$77,613.48""
Available credit,""23,622.52""",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-62f7ca69d91bf6d8454cefd1,v11-LOAN_STATEMENT-csv,original,2023,fgen-e5cba0026ea282c1a2749a7f,synthetic_programmatic_template,csv,top,False,heloc
"AutoLoan Statcment
Cedar Valley Credit Union
Account number,****797353
Statement períod,08/01/2022 - 08/30/2022
Current principal,""$36,015.39""
Interest rate,11.82%
Current amount due,$591.70
Due date,09/05/2022
Vehic1e,2021 Subaru Outback
Payments remaining,47",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-15d22c67fdae846c4932cd55,v11-LOAN_STATEMENT-csv,original,2022,fgen-fe804f8d3d60345758ae958f,synthetic_programmatic_template,csv,top,True,auto
"Posted,Type,Amount,To Principal,To Interest,Outstanding Balance
01/03/2021,LATE FEE,1003.53,247.47,315.13,77646.03
19/01/2021,DISBURSEMENT,1335.55,271.17,4.97,2634.83
09/06/2021,INTEREST ACCRUAL,945.88,236.55,87.40,38242.21
08/12/2021,DISBURSEMENT,846.13,794.31,155.18,77967.11
2021-10-14,LATE FEE,257.20,303.06,128.09,85506.56",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-10791d5aad23223821f61a3a,v11-LOAN_STATEMENT-csv,original,2021,fgen-c358be87a0975c6172649203,synthetic_programmatic_template,csv,top,False,raw_export
"Your monthly student loan bill
Harbor Personal Lending
Account number,ending in 922993
Statement period,09/01/2021 - 09/28/2021
Outstanding principal,""$66,305.35""
Fixed rate,9.07%
Current amount due,$592.84
Payment due date,2021-02-27
Loan type,Direct Subsidized
Interest paid this year,""$1,947.04""
Repayment plan,Graduated
Tax reminder: amounts on this statement may differ from your Form 1098-E.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fd866ed9d0a5fb49278cd9a6,v11-LOAN_STATEMENT-csv,original,2021,fgen-2a45317dbc6ade89683abca4,synthetic_programmatic_template,csv,top,False,student
"Auto Loan Activity
Date,Description,Payment,Principal,Interest,Balance
2024-09-23,Auto loan payment,126.06,803.18,66.64,18184.32
12/16/2024,Loan payment,471.49,283.77,241.25,58539.77
2024-09-05,Autopay,408.70,141.30,5.04,75197.23",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0089f0754fcc8d455b1ee276,v11-LOAN_STATEMENT-csv,original,2024,fgen-6d377f5ca8f484a85f2e190f,synthetic_programmatic_template,csv,top,False,raw_export
"Home Equity Line of Credit Statement
Summit Student Loan Servicing
Account number,***-**-860657
Statement period,04/01/2022 - 04/28/2022
Current principal,""$4,089.44""
Fixed rate,12.92%
Amount due,$956.04
Payment due date,""January 12, 2022""
Credit limit,""$55,515.68""
Available credit,""$43,550.70""
Tax reminder: amounts on this statement may differ from your Form 1098.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e5f8e38aa4c4a11552002ac1,v11-LOAN_STATEMENT-csv,original,2022,fgen-22146b0c35f83b3c000f7e67,synthetic_programmatic_template,csv,top,False,heloc
"Downloaded 2024-02-08
Date,Description,Payment,Principal,Interest,Balance
20/02/2024,Auto loan payment,702.66,465.55,330.52,60982.55
06/04/2024,Auto loan payment,646.03,1052.62,215.47,21836.18
03/03/2024,Auto loan payment,245.30,851.76,36.16,56026.44
02/09/2024,Auto loan payment,1238.57,1127.81,58.29,44224.35
11/08/2024,Loan payment,266.64,653.04,80.12,73703.32
09/07/2024,Autopay,939.51,795.76,372.35,50205.82",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-10b4c27d12ae06e252877d77,v11-LOAN_STATEMENT-csv,original,2024,fgen-ec76d851497ff92f69b63573,synthetic_programmatic_template,csv,top,False,raw_export
"Installment Loan Statement
Granite Auto Finance
Account number,ending in 948031
Statement period,01/01/2023 - 01/28/2023
Outstanding principal,""$47,763.27""
APR,8.11%
Monthly payment,$422.28
Due date,2023-01-01",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-bf0533d814c755a38a8ce306,v11-LOAN_STATEMENT-csv,original,2023,fgen-b04c4bae2141b1adba356458,synthetic_programmatic_template,csv,top,False,personal
"Summit Student Loan Servicing
Account number,XXXXX363674
Statement period,04/01/2023 - 04/30/2023
Unpaid principal balance,""$65,198.56""
Fixed rate,11.11%
Payment due,$782.20
Payment due date,2023-10-19
Loan type,Direct Unsubsidized
Interest paid this year,""1,343.48""
Repayment plan,Graduated
Your monthly student loan bill",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-10a748e4848497f77bc83528,v11-LOAN_STATEMENT-csv,original,2023,fgen-4444dacd8d06f154d9e9a463,synthetic_programmatic_template,csv,bottom,False,student
"Auto Loan Statement
Northwind Auto Credit
Account number,***-**-911802
Statement period,07/01/2025 - 07/28/2025
Unpaid principal balance,$0.00
Fixed rate,9.40%
Payment due,""$1,224.79""
Payment due date,2025-01-16
Vehicle,2024 Ford F-150
Payments remaining,2
Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-1e64b49c36b43ed70cc10cc8,v11-LOAN_STATEMENT-csv,original,2025,fgen-a50083cc226f2407e276b371,synthetic_programmatic_template,csv,top,False,auto
"Your loan bill
Summit Student Loan Servicing
Account number,XXX-XX-889482
Statement period,12/01/2025 - 12/30/2025
Outstanding principal,""$67,048.68""
Fixed rate,5.13%
Payment due,$917.07
Due date,2025-04-23",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0ae72a4328e2a9f6d0d1f10f,v11-LOAN_STATEMENT-csv,original,2025,fgen-4ee6c090cbf393c1fd0f27fb,synthetic_programmatic_template,csv,top,False,personal
"HELOC Billing Statement
Summit Student Loan Servicing
Account number,ending in 057958
Statement period,06/01/2022 - 06/30/2022
Outstanding principal,""$17,955.20""
APR,12.64%
Amount due,""$1,216.83""
Payment due date,10/3/22
Credit limit,""129,932.95""
Available credit,""49,201.46""",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-29e83ab25e680eaca4d1dc13,v11-LOAN_STATEMENT-csv,original,2022,fgen-dd20acad6f81e8811b2d564b,synthetic_programmatic_template,csv,top,False,heloc
"Student Loan Statement
Harbor Personal Lending
Account number,ending in 125871
Statement period,11/01/2026 - 11/30/2026
Unpaid principal balance,""$89,013.67""
APR,4.39%
Amount due,$94.96
Due by,""March 8, 2026""
Loan type,Direct Subsidized
Interest paid this year,""2,371.60""
Repayment plan,Graduated",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8968f02f32aceecfa28ad280,v11-LOAN_STATEMENT-csv,original,2026,fgen-92fbfa3ae33169af03b04e53,synthetic_programmatic_template,csv,top,False,student
"HELOC Billing Statement
Cedar Valley Credit Union
Account number,XXX-XX-558141
Statement period,07/01/2022 - 07/28/2022
Remaining balance,""$43,672.53""
Fixed rate,7.82%
Current amount due,""$1,249.38""
Payment due date,05/22/2022
Credit limit,""$136,799.58""
Available credit,""18,975.44""
Your 2022 Form 1098 will be available online by January 31, 2023.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-ef5a3ff293ba3ca6d0de9b4b,v11-LOAN_STATEMENT-csv,original,2022,fgen-7f0a2f6727514984a3ea31c5,synthetic_programmatic_template,csv,top,False,heloc
"CedarValley Credit Union Account number ***-**-171276 Statement period 02/01/2024 - 02/28/2024 Remaining balance $0.00 Interest rate 4.03% Amount due $748.97 Due by 3/23/24 Loan type
Direct Unsubsídized Interest paid this year 1,954.67 Repayment
p1an Income-Driven Repayment Tax reminder:amounts on this statement may differ from your Form 1098-E. Loan status: Paid in full Billing Statement - Student Loans",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-cb3d56355bc14238ef6dc932,v11-LOAN_STATEMENT-flat,original,2024,fgen-9a025fc58c4f831be1ff0aa2,synthetic_programmatic_template,flat,bottom,True,student
"Student Loan Statement Cedar Valley Credit Union Account number XXXXX979472 Statement period 01/01/2025 - 01/31/2025
Outstanding principal $66,815.25 Interest rate 10.61% Current amount due
$650.72 Due date May 4, 2025 Loan type Direct Subsidized Interest paid this year 238.38 Repayment plan Income-Driven Repayment Your 2025 Form 1098-E will be available online by January 31, 2026.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8739766b6856a33239011247,v11-LOAN_STATEMENT-flat,original,2025,fgen-94b8292ce859a93f0cf7de93,synthetic_programmatic_template,flat,top,False,student
"Installment Loan
Statement Granite Auto Finance Account number XXXXX272716 Statement period 12/01/2021- 12/30/2021 Principal balance $38,538.l2 Interest
rate 9.18% Monthly payment $954.47 Payment due date February 18, 2O21",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-28edb44a0d39ed9c9a01a9f1,v11-LOAN_STATEMENT-flat,original,2021,fgen-62d305c6cc0fd086c155f6f0,synthetic_programmatic_template,flat,top,True,personal
"Your monthly student loan bill Cedar Valley Credit Union Account number ****437071 Statement period 06/01/2026 - 06/30/2026 Outstanding principal $41,106.03 Fixed rate 5.19%
Amount due $1,291.29
Payment due date 2026-11-16 Loan type Private refinance Interest paid this year 2,137.34 Repayment plan Standard",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-aae91bfb273120da78c21f26,v11-LOAN_STATEMENT-flat,original,2026,fgen-d2d19df942c8af38210577fb,synthetic_programmatic_template,flat,top,False,student
"Auto Loan Activity Downloaded 27/11/2025 Date Description Payment Principal Interest Balance 19/03/2025 Personal loan installment 676.26 981.36 107.49 86502.59 2025-10-13 Loan payment 1199.53 342.47
84.60 46096.01 01/14/2025 Loan payment 461.86 921.73 160.47 14412.20 2025-03-01 Auto loan payment 934.13 315.36 152.25
80564.62 2025-01-06 Loan payment 401.33 320.65 147.58 85372.04",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8f6cad7c2133eb9afd1fea66,v11-LOAN_STATEMENT-flat,original,2025,fgen-dd41806cb75019276dafcf1a,synthetic_programmatic_template,flat,top,False,raw_export
"Date Description Payment Principal Interest Balance 2026-02-05 Student loan payment 616.94 1163.68 399.28 15787.69 08/18/2026 Personal loan insta1lment 1367.68 604.85 70.61 13963.37 01/06/2026 Autopay 164.26 898.1450.80 74114.59 2026-01-13 Student loan payment 1290.61 1120.39 324.94 26159.45 19/01/2026 Student loan payment 732.32 409.79 102.41 87779.93 2026-02-17
Auto loan payment 923.62 550.33 321.19 28732.81 02/22/2026 Auto loan
payment 121.11 73.10 168.42 53898.9011/05/2026 Auto loan paymcnt 427.30 1117.58 204.84 15376.12",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0c9739b3109b813113edc59a,v11-LOAN_STATEMENT-flat,original,2026,fgen-7cdfd0d067e9505b69f9e829,synthetic_programmatic_template,flat,top,True,raw_export
"Auto Loan Activity Payment Date
Amount Paid Principal Paid Interest Paid Late Fee Loan Balance 28/05/2022 695.37 946.39 275.28 0.00 35662.82 2022-10-05 1036.76 462.32 88.18 0.00 19453.63
2022-06-02 407.62 1010.59 29.08 0.00 3938.11 2022-05-22 434.42 276.72 270.88 0.00 51870.61 01/07/2022 1141.03 1183.21 369.98 0.00 16872.79 10/02/2022 1281.09 288.65 356.97 0.00 45413.10 28/02/2022 166.69 1162.37 79.50 0.00 32098.53",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-aadbed747c5e60957e09571a,v11-LOAN_STATEMENT-flat,original,2022,fgen-51133951e4a6e8dcd750e82a,synthetic_programmatic_template,flat,top,False,raw_export
"Billing Statement - Student Loans Northwind Auto Credit Account number ending in 626374 Statement
period 06/01/2024 - 06/31/2024 Outstanding principa1 $86,483.59 Fixed rate 5.88% Payment due $367.88 Due by 2024-12-03
Loan type Direct Unsubsidized Interest paid thís year 1,81O.19 Repayment p1anIncome-Driven RepaymentThis statement is not a Form 1098-E. Keep it for your rccords.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-eaaed9466766040393c27a64,v11-LOAN_STATEMENT-flat,original,2024,fgen-b4139a744cafd3b54a7c1fd7,synthetic_programmatic_template,flat,top,True,student
"Billing Statement - Student Loans Northwind Auto Credit Account number ending in 771309 Statement period 11/01/2023 - 11/31/2023 Remaining balance $86,447.18
Interest rate 4.51% Monthly payment $392.06 Payment due date 2023-10-09 Loan type Direct Unsubsidized Interest paid this year $588.47 Repayment
plan Standard Tax reminder: amounts on this statement may differ from your Form 1098-E.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-143671b072763bf3139fc263,v11-LOAN_STATEMENT-flat,original,2023,fgen-8447755f744bf88eaa39f2b3,synthetic_programmatic_template,flat,top,False,student
"Student Loan Statement
Harbor Personal Lending Account number XXXXX879963 Statement period 06/01/2023 - 06/28/2023 Outstanding principal $15,496.65 APR 8.74% Amount due $1,249.87 Due date August 25, 2023 Loan type Direct Subsidized Interest
paid this year $310.32 Repayment plan Standard",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-20a7137e0dc9bac3fac50a27,v11-LOAN_STATEMENT-flat,original,2023,fgen-594a65b7626f8aeb6e1bcead,synthetic_programmatic_template,flat,top,False,student
"StudentLoan Statement Northwind Auto Credit Account number ending in 622002
Statement period 04/01/2024 - 04/31/2024 Current principal S33,0l9.53 Fixed rate9.28% Payment due $378.59 Due by 2024-05-10 Loan type Prívate refínance Interest paid this year l,48O.83 Repayment plan Graduated This statement is not a Form 1098-E. Keep
it for your records.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-2e0fab4a4ef8725fd31f0a09,v11-LOAN_STATEMENT-flat,original,2024,fgen-e27b413a8711bad971ae5a7b,synthetic_programmatic_template,flat,top,True,student
"Date Description Payment Principal Interest Balance 07/24/2022 Student loan payment 1033.02 1057.59 148.20 64511.25 09/09/2022 Loan
payment 1349.97
901.86 5.86 76166.63 2022-11-04 Loan payment 397.79 100.05 254.21 173.57 2022-03-24 Auto loan payment 639.14 713.60 188.10 44350.01 27/01/2022 Student loan payment 1393.93 1053.22 103.95 20607.58 08/02/2022 Personal loan installment 104.21 990.95 42.99 15723.78 2022-05-21 Student loan payment 785.46 87.53 374.60 29933.27 05/06/2022 Personal loan installment 588.71 414.50 194.07 79190.20",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-655f1d8a65a3856eec79b294,v11-LOAN_STATEMENT-flat,original,2022,fgen-151928f9b4b1be996ef0e6f3,synthetic_programmatic_template,flat,top,False,raw_export
"Payment Date Amount Paid Principal
Paid Interest
Paid Late Fee Loan Balance 22/09/2021 565.76 509.22 101.87 0.00 16271.13 21/10/2021 102.55 357.03 270.40 0.00 22915.42 08/04/2021 1362.32 1172.46 103.33 0.00 2440.94 2021-12-05 839.30 646.60 390.96 0.00 57229.97",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-274ad81bb1134191e59fec00,v11-LOAN_STATEMENT-flat,original,2021,fgen-8586071cd41887853b1ac667,synthetic_programmatic_template,flat,top,False,raw_export
"Personal
Loan Statement Cedar Valley Credit Union Account number ***-**-865106 Statement period 07/01/2025
- 07/30/2025 Outstanding principal $4l,607.43 Interest rate 7.40% Payment due $1,194.24 Payment due dateFebruary 23, 2O25",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-137ada7c6bb990c266b571d8,v11-LOAN_STATEMENT-flat,original,2025,fgen-f0974504d56270bed55bae5c,synthetic_programmatic_template,flat,top,True,personal
"HELOC Billing Statement Summit Student Loan
Servicing Account number ****916984 Statement period 08/01/2026 - 08/31/2026 Current principal $0.00 Interest rate 8.89% Amount due $783.77 Payment due date
2026-06-10 Credit limit $108,062.63 Available credit 57,507.45 Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-dd41369a421f13847b93fe4d,v11-LOAN_STATEMENT-flat,original,2026,fgen-c18da5b3e383184a7e8f2e01,synthetic_programmatic_template,flat,top,False,heloc
"Date Description Payment
Principal Interest Balance 10/22/2024 Loan payment
163.55 282.41 93.78 5725.90 09/28/2024 Autopay 1017.25 736.43 6.40 30374.40 03/07/2024 Student loan payment 859.07 860.11 284.55 51361.56 10/12/2024 Personal loan installment 231.05 724.33 316.97 660.01",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-9f56ed403deb66d4b9ddb829,v11-LOAN_STATEMENT-flat,original,2024,fgen-0aac38414651dc12eb607037,synthetic_programmatic_template,flat,none,False,raw_export
"Your monthly student loan bill Harbor Personal Lending Account number ending in 183656 Statement period
01/01/2022 - 01/28/2022 Remaining balance $46,811.71 Interest rate 9.77% Amount due $237.69 Payment due date 2022-11-12 Loan type Private refinance Interest paid this year 2,175.05 Repayment plan Standard IRS Form 1098-E information
for 2022 will be mailed separately.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-29306d93bbaa504160dcb716,v11-LOAN_STATEMENT-flat,original,2022,fgen-e20e8bb7a9f2363f595e1303,synthetic_programmatic_template,flat,top,False,student
"Your monthly student loan bill Summit Student Loan Servicing Account number ****117971 Statement period 11/01/2021 - 11/28/2021
Outstanding principal $46,702.90 APR 7.25% Monthly payment $435.09 Payment due date 2021-11-10 Loan type Direct Subsidized Interest paid this year 2,376.38 Repayment plan Graduated Tax reminder: amounts on this statement may differ from your Form
1098-E.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e9a22d954bad6adc929cb8e5,v11-LOAN_STATEMENT-flat,original,2021,fgen-5447f28734829ac385f4bf8a,synthetic_programmatic_template,flat,top,False,student
"Summit Student Loan Servicing Account number ****526520 Statement period 06/01/2024 - 06/31/2024 Principal balance $32,503.57 Fixed rate 4.84% Amount due $721.33 Payment due date 06/18/2024 Credit limit 62,715.90 Available credit 23,656.16 This statement is not a Form 1098. Keep
it for your records. Home
Equity Line of Credit Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-850e263c86c11fe6dc86b7d2,v11-LOAN_STATEMENT-flat,original,2024,fgen-86b0b7a855f344186f738d49,synthetic_programmatic_template,flat,bottom,False,heloc
"Your monthly student loan bill Granite AutoFinance Account number ****423027 Statement period 12/0l/2026 - 12/30/2026 Unpaid principal balance $0.00 Interest rate 3.83%
Monthly payment $1,104.55 Due by November 20, 2026 Loan type Direct Subsídized
Interest paid this year $729.35 Repayment plan Income-Driven Repayment Tax reminder: amounts on thís statcment may differ from your Forml098-E. Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c0aa868b3a446c9f3bb582ef,v11-LOAN_STATEMENT-flat,original,2026,fgen-987f12a89ee779a250bbe39f,synthetic_programmatic_template,flat,top,True,student
"Loan
3531 payment history Date Description Payment Principal Interest Balance 11/11/2026 Personal loan installment 112.73 236.13 371.30 1201.97
06/14/2026 Personal loan installment 1070.51 126.16 358.42 3504.31 09/23/2026 Auto loan payment 539.07 1170.50 280.72 57399.88 2026-06-07 Loan payment 1383.28 655.61 148.75 6150.25 2026-09-03 Student loan payment 615.72 471.20 365.34 11065.41 2026-11-26 Loan payment 603.85 418.18 45.67 60514.94 05/18/2026 Loan payment 517.97 874.57 59.73 34066.67",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-acc6f914ea36644875f63418,v11-LOAN_STATEMENT-flat,original,2026,fgen-1ede9d89417c06617b431c21,synthetic_programmatic_template,flat,top,False,raw_export
"Harbor Personal Lending Account number ****870400 Statement period 03/01/2021 - 03/28/2021 Unpaid principal balance $72,382.36 Fixed rate 8.37% Monthly
payment $262.64 Due by
07/16/2021 Vehicle 2018 Ford F-150 Payments remaining 28 Your auto loan bill",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-951a74df1a8908e9335dc16a,v11-LOAN_STATEMENT-flat,original,2021,fgen-00095678c88a1383f70bb96e,synthetic_programmatic_template,flat,bottom,False,auto
"Northwind Auto
Credit Account number XXXXX679578 Statement period 09/01/2021 - 09/30/2021 Outstanding
principal $0.00 APR 7.36% Monthly payment $1,031.90 Payment due date 2021-05-20 Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-6c207ae683d07fb95baaffd4,v11-LOAN_STATEMENT-flat,original,2021,fgen-13260338f05be8f9c2c5bb9a,synthetic_programmatic_template,flat,none,False,personal
"Installment Loan Statement Granite Auto
Finance Account number ****532625 Statement period 07/01/2024 - 07/28/2024 Unpaid principal balance $66,651.80
APR 4.86% Current amount due $864.57 Payment due date 1/8/24",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-2d3d148d4158bfa290b83038,v11-LOAN_STATEMENT-flat,original,2024,fgen-4919a026bd77a2f9f3852268,synthetic_programmatic_template,flat,top,False,personal
"HELOC Billing Statement Cedar Valley Credit Union Account number XXXXX387077 Statement period 12/01/2024 - 12/30/2024 Outstanding principal $0.00 Interest rate 12.94% Amount
due
$216.37 Due date 2024-06-11 Credit limit $62,254.15 Available credit 18,714.79 Loan status: Paid in full",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4d03e1d47df36e9a27cc0758,v11-LOAN_STATEMENT-flat,original,2024,fgen-c30a8e05de0730349025bd43,synthetic_programmatic_template,flat,top,False,heloc
"Your auto loan bill Cedar Valley Credit Union Account number ending in 197866 Statement period
08/01/2024 - 08/28/2024 Remaining balance $41,980.90 Interest rate 12.54% Payment due $1,066.14 Payment due date 08/04/2024 Vehicle 2021 Subaru Outback Payments
remaining 14",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d9c4112ce4ba89cf9d022303,v11-LOAN_STATEMENT-flat,original,2024,fgen-e5789228e09ee185d52d9af0,synthetic_programmatic_template,flat,top,False,auto
"Installment Loan
Statement Granite Auto Finance Account number XXX-XX-381381 Statement period 06/01/2023 - 06/28/2023 Outstanding principal $70,763.75 APR 4.50% Current amount due $301.02 Payment due date
11/26/23",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e93448a9f225afa8e3916384,v11-LOAN_STATEMENT-flat,original,2023,fgen-f0a42825add41a620a0779be,synthetic_programmatic_template,flat,top,False,personal
"Cedar Valley Credit Union
Account number ****883087 Statement period 09/01/2025 - 09/28/2025 Remaining balance $86,389.19 Fixed rate 4.30% Current amount due $719.87 Due date 6/25/25 Loan type Direct Unsubsidized Interest paid this year
422.14 Repayment plan Standard Your 2025 Form 1098-E will be available online by January 31, 2026.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8b47884bf1d6c98112206c7e,v11-LOAN_STATEMENT-flat,original,2025,fgen-be458715696531847e089acc,synthetic_programmatic_template,flat,none,False,student
"Posted Type Amount To
Principal To Interest Outstanding Balance 2021-01-22 INTEREST CAPITALIZATION 1179.74 943.81 222.43 4804.06 23/11/2021 INTEREST CAPITALIZATION 1089.12 734.92 147.99 71694.31 2021-12-10 LATE FEE 482.45 713.15 287.49 57884.72 02/11/2021 INTEREST ACCRUAL 148.43 177.68 154.59 29711.62 17/03/2021 INTEREST CAPITALIZATION 67.37 705.75 40.78 83141.83
2021-10-11 DISBURSEMENT 1368.08 528.32 318.93 48162.67 2021-05-28 LATE FEE 835.00 747.89 334.23 26713.55 04/13/2021 INTEREST ACCRUAL 1039.79 172.06 325.82 12727.35",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-213f0b5dccf27877f4bf4ff6,v11-LOAN_STATEMENT-flat,original,2021,fgen-93196bb168552668c52dcd9a,synthetic_programmatic_template,flat,bottom,False,raw_export
"Your
loan bill Northwind Auto Credit Account number ****669240 Statement period 04/01/2026 - 04/31/2026 Outstanding principal
$15,080.20 Fixed rate 12.57% Monthly payment $170.07 Payment due date 07/14/2026",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-80091890401a1ea43a2198c0,v11-LOAN_STATEMENT-flat,original,2026,fgen-a8537cf354f4915a1355afd0,synthetic_programmatic_template,flat,top,False,personal
"Your loan bill Summit Student Loan Servicing Account number XXXXX610519 Statement period 09/01/2021 - 09/31/2021 Unpaid
principal
balance $48,828.08 APR 4.85% Monthly payment $491.44 Due date 2021-08-06",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-34ffe5b07fcb08d14a59deea,v11-LOAN_STATEMENT-flat,original,2021,fgen-dacd519f605e13510dbc857c,synthetic_programmatic_template,flat,top,False,personal
"Date Description Payment Principal Interest Balance 2023-05-10 Student loan payment 1015.73 270.25 214.16 44856.09 12/17/2023 Autopay 361.35 218.96 316.38
3268.25 22/O4/2023 Auto loanpayment 398.58 214.18 143.37 30762.69 14/03/2023 Auto loan payment 683.66 48.69 323.81 43851.88 2023-10-13 Personal loan ínstallment
493.26 1018.70 377.96 25119.49",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-9af1fa5b2dcc026a437c7d05,v11-LOAN_STATEMENT-flat,original,2023,fgen-07fa275871247e6e35856330,synthetic_programmatic_template,flat,top,True,raw_export
"## Billing Statement - Student Loans
## Granite Auto Finance
| Field | Value |
| --- | --- |
| Account number | ending in 774903 |
| Statement period | 05/01/2021 - 05/31/2021 |
| Unpaid principal balance | $8,917.51 |
| APR | 8.09% |
| Payment due | $402.30 |
| Due by | June 17, 2021 |
| Loan type | Direct Subsidized |
| Interest paid this year | $2,326.65 |
| Repayment plan | Income-Driven Repayment |
## Your 2021 Form 1098-E will be available online by January 31, 2022.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-bce805cec41f5db53b9c6532,v11-LOAN_STATEMENT-markdown,original,2021,fgen-8efa0ad29e1a855f4dfe1376,synthetic_programmatic_template,markdown,top,False,student
"Billing Statement - Student Loans
## Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | ending in 859543 |
| Statement period | 06/01/2023 - 06/30/2023 |
| Unpaid principal balance | $22,885.32 |
| APR | 9.98% |
| Monthly payment | $90.27 |
| Payment due date | February 20, 2023 |
| Loan type | Private refinance |
| Interest paid this year | $1,140.75 |
| Repayment plan | Income-Driven Repayment |
Tax reminder: amounts on this statement may differ from your Form 1098-E.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-7e87e254782e6bf08b285bbc,v11-LOAN_STATEMENT-markdown,original,2023,fgen-85caf5ea68a76af72c48e72b,synthetic_programmatic_template,markdown,top,False,student
"Loan 6911 payment history
Downloaded 24/08/2026
| Date | Description | Payment | Principal | Interest | Balance |
| --- | --- | --- | --- | --- | --- |
| 2026-04-18 | Student loan payment | 1065.37 | 161.54 | 389.63 | 26474.62 |
| 01/02/2026 | Loan payment | 1387.03 | 885.85 | 30.22 | 61448.68 |
| 21/02/2026 | Loan payment | 956.28 | 944.48 | 205.98 | 35122.08 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d294abfeca3999018f4e4014,v11-LOAN_STATEMENT-markdown,original,2026,fgen-aa780ef6ad06c1d4e6169e88,synthetic_programmatic_template,markdown,top,False,raw_export
"Granite Auto Finance
| Field | Value |
| --- | --- |
| Account number | ending in 140697 |
| Statement period | 12/01/2024 - 12/28/2024 |
| Outstanding principal | $56,977.41 |
| APR | 10.09% |
| Monthly payment | $990.62 |
| Due by | August 5, 2024 |
| Vehicle | 2020 Ford F-150 |
| Payments remaining | 49 |
Your auto loan bill",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-6e441f9ca9340ad26e2f46a4,v11-LOAN_STATEMENT-markdown,original,2024,fgen-5ea749603b36165d97d42eb8,synthetic_programmatic_template,markdown,bottom,False,auto
"Billing Statement - Student Loans
Granite Auto Finance
| Field | Value |
| --- | --- |
| Account number | ***-**-787997 |
| Statement period | 08/01/2024 - 08/28/2024 |
| Remaining balance | $59,663.71 |
| APR | 12.07% |
| Monthly payment | $1,061.72 |
| Due date | 10/18/24 |
| Loan type | Direct Unsubsidized |
| Interest paid this year | $1,116.87 |
| Repayment plan | Standard |
Your 2024 Form 1098-E will be available online by January 31, 2025.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fe367cdf1ca4732804a77361,v11-LOAN_STATEMENT-markdown,original,2024,fgen-2958ffc4a486ed3c9785b86a,synthetic_programmatic_template,markdown,top,False,student
"Your auto loan bill
## Harbor Personal Lending
| Field | Value |
| --- | --- |
| Account number | XXXXX089954 |
| Statement period | 03/01/2026 - 03/31/2026 |
| Remaining balance | $78,008.67 |
| Fixed rate | 11.92% |
| Payment due | $962.38 |
| Due date | 5/25/26 |
| Vehicle | 2022 Honda Civic |
| Payments remaining | 51 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8365bf24307b826e46f90307,v11-LOAN_STATEMENT-markdown,original,2026,fgen-9f93abd71b0188f5f9f9bac5,synthetic_programmatic_template,markdown,top,False,auto
"| Posted | Type | Amount | To Principal | To Interest | Outstanding Balance |
| --- | --- | --- | --- | --- | --- |
| 28/09/2022 | INTEREST ACCRUAL | 527.15 | 1.94 | 68.97 | 80220.54 |
| 2022-07-12 | PAYMENT | 282.19 | 961.08 | 360.60 | 33353.70 |
| 05/19/2022 | PAYMENT | 705.67 | 63.05 | 289.39 | 29203.24 |
| 06/06/2022 | INTEREST ACCRUAL | 555.78 | 79.80 | 8.33 | 52043.63 |
| 2022-01-11 | LATE FEE | 764.25 | 353.00 | 180.78 | 64435.45 |
| 21/01/2022 | INTEREST ACCRUAL | 1298.51 | 768.98 | 379.16 | 55329.66 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d92fe3f48e4985ee169d2f74,v11-LOAN_STATEMENT-markdown,original,2022,fgen-305ae68357d8c40cf5b63be5,synthetic_programmatic_template,markdown,bottom,False,raw_export
"| Posted | Type | Amount | To Principal | To Interest | Outstanding Balance |
| --- | --- | --- | --- | --- | --- |
| 03/08/2022 | LATE FEE | 69.46 | 368.06 | 8.36 | 86462.58 |
| 05/02/2022 | INTEREST CAPITALIZATION | 915.29 | 1180.34 | 35.00 | 8651.01 |
| 06/03/2022 | LATE FEE | 595.61 | 311.86 | 210.35 | 5066.30 |
| 05/11/2022 | LATE FEE | 558.80 | 413.69 | 344.89 | 46352.71 |
| 13/09/2022 | PAYMENT | 1198.75 | 233.66 | 334.11 | 30108.55 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-b10e5759c545baf406fc2dee,v11-LOAN_STATEMENT-markdown,original,2022,fgen-1a43b95c4347560c1bf5aa34,synthetic_programmatic_template,markdown,none,False,raw_export
"Auto Loan Statement
## Harbor Personal Lending
| Field | Value |
| --- | --- |
| Account number | XXXXX806436 |
| Statement period | 10/01/2022 - 10/31/2022 |
| Principal balance | $59,672.38 |
| Fixed rate | 5.32% |
| Monthly payment | $466.96 |
| Payment due date | 5/9/22 |
| Vehicle | 2018 Honda Civic |
| Payments remaining | 55 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-287415f68cb56da5b7748365,v11-LOAN_STATEMENT-markdown,original,2022,fgen-6fb364853f04bce4fb86bc92,synthetic_programmatic_template,markdown,top,False,auto
"## Downloaded 2023-04-27
| Payment Date | Amount Paid | Principal Paid | Interest Paid | Late Fee | Loan Balance |
| --- | --- | --- | --- | --- | --- |
| 2023-07-12 | 502.68 | 743.82 | 16.31 | 0.00 | 22121.18 |
| 03/23/2023 | 454.59 | 1189.83 | 332.00 | 0.00 | 39234.80 |
| 2023-11-04 | 1216.05 | 190.64 | 397.65 | 0.00 | 55038.80 |
| 2023-11-02 | 825.75 | 448.79 | 263.81 | 0.00 | 17028.91 |
| 2023-05-06 | 1013.75 | 609.17 | 53.97 | 0.00 | 31066.38 |
| 2023-04-09 | 407.06 | 759.02 | 250.66 | 0.00 | 12936.21 |
Auto Loan Activity",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fc214c34b649521d12dde998,v11-LOAN_STATEMENT-markdown,original,2023,fgen-559cfd249b1edcadcdc81e70,synthetic_programmatic_template,markdown,bottom,False,raw_export
"Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | XXX-XX-504085 |
| Statement period | 08/01/2026 - 08/31/2026 |
| Unpaid principal balance | $22,731.41 |
| Interest rate | 12.39% |
| Amount due | $93.41 |
| Payment due date | 01/04/2026 |
| Vehicle | 2021 Toyota Corolla |
| Payments remaining | 27 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-2d5ba09b4790c3017d22d3ca,v11-LOAN_STATEMENT-markdown,original,2026,fgen-1487c58e655d214fcbbc93d9,synthetic_programmatic_template,markdown,none,False,auto
"Cedar Valley Credit Union
| Field | Value |
| --- | --- |
| Account number | ****295938 |
| Statement period | 11/01/2026 - 11/30/2026 |
| Unpaid principal balance | $3,575.38 |
| Fixed rate | 13.36% |
| Current amount due | $1,091.98 |
| Due by | 2026-07-25 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0c3fcd6bc63c2e096b9713eb,v11-LOAN_STATEMENT-markdown,original,2026,fgen-83908c7045a18f1db0335fe7,synthetic_programmatic_template,markdown,none,False,personal
"| Date | Description | Payment | Principal | Interest | Balance |
| --- | --- | --- | --- | --- | --- |
| 2021-04-12 | Student loan payment | 146.03 | 78.34 | 319.74 | 21793.09 |
| 27/01/2021 | Personal loan installment | 509.98 | 125.19 | 30.75 | 42293.71 |
| 2021-09-12 | Auto loan payment | 143.18 | 506.41 | 308.85 | 52238.70 |
| 05/09/2021 | Student loan payment | 1305.26 | 251.25 | 361.21 | 54162.59 |
| 2021-07-23 | Loan payment | 1200.28 | 919.99 | 246.29 | 68165.85 |
| 09/09/2021 | Auto loan payment | 1243.46 | 430.64 | 56.97 | 52649.91 |
| 2021-08-22 | Auto loan payment | 1318.30 | 247.56 | 31.46 | 547.73 |
| 12/20/2021 | Auto loan payment | 457.57 | 828.28 | 301.75 | 25367.04 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-64f27d6e4c3b9ba6b8cc79b8,v11-LOAN_STATEMENT-markdown,original,2021,fgen-468ce4c5488c786bcff6d04b,synthetic_programmatic_template,markdown,top,False,raw_export
"HELOC Billing Statement
## Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | ending in 553033 |
| Statement period | 11/01/2024 - 11/28/2024 |
| Principal balance | $41,748.08 |
| Interest rate | 9.46% |
| Monthly payment | $183.37 |
| Due date | 05/19/2024 |
| Credit limit | $32,833.64 |
| Available credit | $70,895.21 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-01e9edbb92306d8987194435,v11-LOAN_STATEMENT-markdown,original,2024,fgen-e193289a57d8743a96d22bdc,synthetic_programmatic_template,markdown,top,False,heloc
"Installment Loan Statement
Summit Student Loan Servicing
| Field | Value |
|--- | --- |
| Account number | XXX-XX-750325 |
| Statement períod | 02/01/2022 - 02/28/2022 |
| Current principal | $76,667.49 |
| APR | 6.31% |
| Payment due | $963.11 |
| Due by | 2/1/22 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-906bb686177089949afac9de,v11-LOAN_STATEMENT-markdown,original,2022,fgen-479594762ea55caebee1ffb0,synthetic_programmatic_template,markdown,top,True,personal
"Cedar Valley Credit Union
| Field | Value |
| --- | --- |
| Account number | XXX-XX-574171 |
| Statement period | 08/01/2022 - 08/31/2022 |
| Outstanding principal | $13,567.61 |
| Fixed rate | 8.39% |
| Amount due | $895.66 |
| Due date | 06/13/2022 |
| Vehicle | 2017 Toyota Corolla |
| Payments remaining | 24 |
Auto Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-32f7ffa7db5a0d84d6ddf632,v11-LOAN_STATEMENT-markdown,original,2022,fgen-64278918a98741ba46495268,synthetic_programmatic_template,markdown,bottom,False,auto
"Student Loan Transactions
| Payment Date | Amount Paid | Principal Paid | Interest Paid | Late Fee | Loan Balance |
| --- | --- | --- | --- | --- | --- |
| 2026-03-15 | 458.26 | 148.98 | 373.02 | 0.00 | 74211.82 |
| 14/02/2026 | 387.95 | 1102.18 | 72.77 | 0.00 | 66606.81 |
| 2026-07-03 | 148.09 | 1082.82 | 394.18 | 0.00 | 12932.96 |
| 12/28/2026 | 322.87 | 1087.38 | 55.83 | 0.00 | 24685.26 |
| 04/06/2026 | 300.29 | 593.03 | 166.84 | 0.00 | 76648.73 |
| 02/07/2026 | 864.86 | 542.85 | 204.89 | 0.00 | 10966.83 |
| 2026-09-24 | 402.40 | 323.23 | 319.85 | 0.00 | 59063.65 |
| 14/03/2026 | 809.77 | 1138.36 | 18.60 | 0.00 | 27246.92 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a4dc734be806cdd86cbf3549,v11-LOAN_STATEMENT-markdown,original,2026,fgen-238372c2bef40187422a850b,synthetic_programmatic_template,markdown,top,False,raw_export
"Northwind Auto Credit
| Field | Value |
| --- | --- |
| Account number | XXX-XX-074026 |
| Statement period | 11/01/2023 - 11/30/2023 |
| Unpaid principal balance | $42,229.42 |
| Fixed rate | 7.40% |
| Amount due | $851.75 |
| Due by | 2023-02-13 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-bb1add716aae67570894055f,v11-LOAN_STATEMENT-markdown,original,2023,fgen-2dcdb87d9c49c6382c2c3b82,synthetic_programmatic_template,markdown,none,False,personal
"Auto Loan Statement
## Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | ending in 024191 |
| Statement period | 01/01/2022 - 01/31/2022 |
| Current principal | $59,956.68 |
| Fixed rate | 3.98% |
| Current amount due | $732.41 |
| Due date | September 8, 2022 |
| Vehicle | 2019 Ford F-150 |
| Payments remaining | 11 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d0d5f05f14c6ae69701a4622,v11-LOAN_STATEMENT-markdown,original,2022,fgen-559d3366bc8244bdd34c82ea,synthetic_programmatic_template,markdown,top,False,auto
"HELOC Billing Statement
Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | ****911385 |
| Statement period | 06/01/2024 - 06/28/2024 |
| Outstanding principal | $82,280.55 |
| Fixed rate | 9.09% |
| Amount due | $952.14 |
| Payment due date | 8/13/24 |
| Credit limit | 108,056.42 |
| Available credit | $28,414.83 |
This statement is not a Form 1098. Keep it for your records.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-5d89cba5720673671849045f,v11-LOAN_STATEMENT-markdown,original,2024,fgen-ce6155d38f545c99a13db00c,synthetic_programmatic_template,markdown,top,False,heloc
"Billing Statement - Student Loans
Cedar Valley Credit Union
| Field | Value |
| --- | --- |
| Account number | XXXXX403261 |
| 5tatementperiod | 03/01/2023 - 03/30/2023 |
| 0utstanding principal | $23,142.68 |
| APR | 3.44% |
| Payment due | $1,205.26 |
| Due by | 2023-01-11 |
| Loan type | Direct Subsidized|
| Interest paid this year | 379.46 |
| Rcpayment plan | Graduated |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-85534e815ae15fff6c413d6f,v11-LOAN_STATEMENT-markdown,original,2023,fgen-456e9a3fdc2284c83f0bda05,synthetic_programmatic_template,markdown,top,True,student
"Northwind Auto Credit
| Field | Value |
| --- | --- |
| Account number | ending in 070912 |
| Statement period | 03/01/2021 - 03/30/2021 |
| Unpaid principal balance | $21,129.44 |
| Interest rate | 13.11% |
| Amount due | $939.50 |
| Due by | 2021-09-01 |
| Loan type | Private refinance |
| Interest paid this year | 1,768.85 |
| Repayment plan | Income-Driven Repayment |
Billing Statement - Student Loans",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-3c882eebd758ec99daa37f29,v11-LOAN_STATEMENT-markdown,original,2021,fgen-47eee81f057b1f460a17982b,synthetic_programmatic_template,markdown,bottom,False,student
"Granite Auto Finance
| Field | Value |
| --- | --- |
| Account number | XXXXX818605 |
| Statement period | 04/01/2026 - 04/31/2026 |
| Principal balance | $10,532.11 |
| Fixed rate | 9.82% |
| Monthly payment | $1,044.20 |
| Due by | 7/3/26 |
| Credit limit | 142,276.17 |
| Available credit | $75,386.69 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e99c31212b2ede275c0f91b9,v11-LOAN_STATEMENT-markdown,original,2026,fgen-ff215e7d721ecbe949f46112,synthetic_programmatic_template,markdown,none,False,heloc
"Installment Loan Statement
## Northwind Auto Credit
| Field | Value |
| --- | --- |
| Account number | ***-**-720527 |
| Statement period | 01/01/2024 - 01/30/2024 |
| Outstanding principal | $28,944.43 |
| APR | 8.21% |
| Monthly payment | $167.74 |
| Due by | February 5, 2024 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-1e9725d0303ef5eb55e7e36f,v11-LOAN_STATEMENT-markdown,original,2024,fgen-46fb4b102bbe19f63f086bfa,synthetic_programmatic_template,markdown,top,False,personal
"## Installment Loan Statement
Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | ***-**-514982 |
| Statement period | 06/01/2022 - 06/30/2022 |
| Principal balance | $62,130.99 |
| Fixed rate | 8.59% |
| Payment due | $1,386.01 |
| Payment due date | 9/5/22 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a0a506206877ce5ef1aec448,v11-LOAN_STATEMENT-markdown,original,2022,fgen-922f668c966ee319e44e0883,synthetic_programmatic_template,markdown,top,False,personal
"Your auto loan bill
Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | ending in 526716 |
| Statement period | 11/01/2025 - 11/31/2025 |
| Remaining balance | $52,387.77 |
| Interest rate | 9.11% |
| Monthly payment | $1,141.51 |
| Due by | 2025-04-14 |
| Vehicle | 2025 Honda Civic |
| Payments remaining | 2 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-1a5b232802651a3dcd17515e,v11-LOAN_STATEMENT-markdown,original,2025,fgen-037ddee724823382a99b2368,synthetic_programmatic_template,markdown,top,False,auto
"Granite Auto Finance
| Field | Value |
| --- | --- |
| Account number | ****253240 |
| Statement period | 09/01/2021 - 09/30/2021 |
| Remaining balance | $39,867.06 |
| APR | 8.37% |
| Monthly payment | $538.23 |
| Payment due date | 8/7/21 |
| Vehicle | 2019 Honda Civic |
| Payments remaining | 42 |
Auto Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-2c53fcd2f427e6d440ba0674,v11-LOAN_STATEMENT-markdown,original,2021,fgen-c34cf55d20fc8ce1f4a9a787,synthetic_programmatic_template,markdown,bottom,False,auto
"## Cedar Valley Credit Union
| Field | Value |
| --- | --- |
| Account number | ending in 851898 |
| Statement period | 02/01/2025 - 02/28/2025 |
| Current principal | $63,191.26 |
| APR | 7.81% |
| Amount due | $342.74 |
| Due date | 2025-03-07 |
| Loan type | Direct Unsubsidized |
| Interest paid this year | $1,428.69 |
| Repayment plan | Income-Driven Repayment |
Tax reminder: amounts on this statement may differ from your Form 1098-E.",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-884f8b46411878e29ba26869,v11-LOAN_STATEMENT-markdown,original,2025,fgen-abdc63d094e353fc33a047e0,synthetic_programmatic_template,markdown,none,False,student
"## Billing Statement - Student Loans
Northwind Auto Credit
| Field | Value |
| --- | --- |
| Accountnumber| XXXXX567659 |
| Statement period | 06/01/2025 - 06/31/2025 |
| Principal balance | $58,855.62 |
| Interest rate | 6.20% |
| Monthly payment | $1,019.74 |
| Due by | 2025-04-09 |
| Loan type | Dírect Subsidized |
| Interest paíd this ycar | 1,984.28 |
| Repayment plan | Income-Driven Repayment |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-7d36d7fedeaf5aa8d024fe20,v11-LOAN_STATEMENT-markdown,original,2025,fgen-46a06dce6693e2eaffbfe5a5,synthetic_programmatic_template,markdown,top,True,student
"## Vehicle Loan Billing Statement
Cedar Valley Credit Union
| Field | Value |
| --- | --- |
| Account number | XXXXX362386 |
| Statement period | 07/01/2026 - 07/31/2026 |
| Unpaid principal balance | $12,080.60 |
| Interest rate | 5.86% |
| Monthly payment | $1,212.38 |
| Due date | February 27, 2026 |
| Vehicle | 2022 Honda Civic |
| Payments remaining | 22 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-effcef581d2a6c74589209f9,v11-LOAN_STATEMENT-markdown,original,2026,fgen-944a12dfeaafac92228742df,synthetic_programmatic_template,markdown,top,False,auto
"| Payment Date | Amount Paid | Principal Paid | Interest Paid | Late Fee | Loan Balance |
| --- | --- | --- | --- | --- | --- |
| 12/10/2021 | 792.09 | 818.90 | 13.24 | 0.00 | 16109.79 |
| 23/07/2021 | 366.39 | 554.80 | 88.51 | 0.00 | 13164.38 |
| 03/11/2021 | 835.70 | 1163.93 | 194.23 | 0.00 | 23072.18 |
| 10/18/2021 | 1351.98 | 889.01 | 70.22 | 0.00 | 25304.99 |
| 2021-01-19 | 894.81 | 671.31 | 18.22 | 0.00 | 39878.00 |
| 20/04/2021 | 282.96 | 376.69 | 76.37 | 0.00 | 73378.10 |
| 2021-12-10 | 1152.48 | 817.41 | 356.64 | 0.00 | 57831.22 |
| 2021-09-22 | 212.50 | 918.37 | 100.03 | 0.00 | 47081.56 |
## Personal Loan History",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-3c69522e74908baf8f1338a4,v11-LOAN_STATEMENT-markdown,original,2021,fgen-9423ebfa8636cb2e5db190b1,synthetic_programmatic_template,markdown,bottom,False,raw_export
"Student Loan Statement
## Summit Student Loan Servicing
| Field | Value |
| --- | --- |
| Account number | ***-**-727873 |
| Statement period | 08/01/2021 - 08/30/2021 |
| Current principal | $24,484.72 |
| Fixed rate | 8.37% |
| Monthly payment | $295.75 |
| Payment due date | 2021-07-02 |
| Loan type | Direct Unsubsidized |
| Interest paid this year | 756.93 |
| Repayment plan | Graduated |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0f2070ce26cba2e658615182,v11-LOAN_STATEMENT-markdown,original,2021,fgen-68e29fe15502dee3733a3afb,synthetic_programmatic_template,markdown,top,False,student
"Dental Visit Receipt
Riverside Urgent Care
Patient
Riley J. Patel
Date of service
2023-05-09
CPT  Description  Charge
99214
Cleaning
2,594.48
Insurance adjustment
-1,037.79
Insurance paid
-1,037.79
Patient paid
518.90
Balance due
$0.00
Payment method
Visa ****9359",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-2f72a1b836047979cf0aa8a6,v11-MEDICAL_RECEIPT-stacked,original,2023,fgen-068127ab4907685f0ae7cfa6,synthetic_programmatic_template,stacked,top,False,dental
"Prescríption Receipt
Lakeshore Pharmacy
Patient
Jamie Sato
Date of service
07/04/2021
Rx #
588419
Drug
Atorvastatin 20mg
Qty
60
Insurance paid
1,424.79
Your copay
61O.63
Payment method
Visa****l259",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-c6d9fbabf05ff7521bfe239c,v11-MEDICAL_RECEIPT-stacked,original,2021,fgen-c85bea90b93d1dca8898408e,synthetic_programmatic_template,stacked,top,True,pharmacy
"Sample Family Clinic
Patient
Kwame Adeyemi
Date of service
06/02/2026
Rx #
868666
Drug
Amoxicillin 500mg
Qty
30
Insurance paid
1,541.45
Your copay
660.62
Payment method
Visa ****8034
Prescription Receipt",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-b0d5101eecaf2652e256f8f8,v11-MEDICAL_RECEIPT-stacked,original,2026,fgen-dcd23ea052100e036e55425a,synthetic_programmatic_template,stacked,bottom,False,pharmacy
"Patient Receipt
Sample Family Clinic
Patient
Avery Fischer
Date of service
9/25/26
CPT  Description  Charge
36415
Filling
316.26
Insurance adjustment
-126.50
Insurance paid
-126.50
Patient paid
63.25
Balance due
$0.00
Payment method
Visa ****0710",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-4813308cfded5a1fab754793,v11-MEDICAL_RECEIPT-stacked,original,2026,fgen-ff59e48d0117dea30f50534a,synthetic_programmatic_template,stacked,top,False,clinic
"Patient Account Statement
Riverside Urgent Care
Patient
Amara J. Testcase
Date of service
09/06/2023
CPT  Description  Charge
2391
Cleaning
1,387.85
Insurance adjustment
-555.14
Insurance paid
-555.14
Patient paid
277.57
Balance due
$0.00
Payment method
HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-cfdd2663cccfb63bfa83bc12,v11-MEDICAL_RECEIPT-stacked,original,2023,fgen-3d8efecb6a1ea3714d5b040d,synthetic_programmatic_template,stacked,top,False,hospital_statement
"Dental Visit Receipt
Lakeshore Pharmacy
Patient
Morgan A. Patel
Date of service
2024-09-28
CPT  Description  Charge
36415
Lab panel
1,155.64
Insurance adjustment
-462.26
Insurance paid
-462.26
Patient paid
231.13
Balance due
$0.00
Payment method
Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-28eaa506b233f219ff722331,v11-MEDICAL_RECEIPT-stacked,original,2024,fgen-47340ed7534ee4a01e905af5,synthetic_programmatic_template,stacked,top,False,dental
"Dental Visit Receipt
Riverside Urgent Care
Patient
Taylor Testcase
Date of service
12/12/2023
CPT  Description  Charge
36415
Lab panel
2,968.72
Insurance adjustment
-1,187.49
Insurance paid
-1,187.49
Patient paid
593.74
Balance due
$0.00
Payment method
Visa ****4819",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-aebfa783bedc85997de49c01,v11-MEDICAL_RECEIPT-stacked,original,2023,fgen-2b4ed61deea25836bed6c469,synthetic_programmatic_template,stacked,top,False,dental
"Patient Account Statement
Lakeshore Pharmacy
Patient
Mateo Fischer
Date of service
2024-12-09
CPT  Description  Charge
36415
Cleaning
71.93
Insurance adjustment
-28.77
Insurance paid
-28.77
Patient paid
14.39
Balance due
$0.00
Payment method
Visa ****7322",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-1f64b6a8fc4f11c29b6ac7c2,v11-MEDICAL_RECEIPT-stacked,original,2024,fgen-732fc6035d681d5ef985c911,synthetic_programmatic_template,stacked,top,False,hospital_statement
"Brightsmile Dental Group
Patient
Jordan E. Rivera
Date of service
2021-10-02
CPT  Description  Charge
99214
Lab panel
2,680.41
Insurance adjustment
-1,072.16
Insurance paid
-1,072.16
Patient paid
536.08
Balance due
$0.00
Payment method
Visa ****0522",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-ca986e60bc8a0017c892c0f3,v11-MEDICAL_RECEIPT-stacked,original,2021,fgen-85429c440bf0d5879e84c06e,synthetic_programmatic_template,stacked,none,False,dental
"Riverside Urgent Care
Patient
Noah Adeyemi
Date of service
2025-07-25
CPT  Description  Charge
99213
Lab panel
716.46
Insurance adjustment
-286.58
Insurance paid
-286.58
Patient paid
143.29
Balance due
$0.00
Payment method
HSA card
Patient Account Statement",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-07164333b118d0ab21da72ad,v11-MEDICAL_RECEIPT-stacked,original,2025,fgen-cdfa2945e82b991b5aebb4b5,synthetic_programmatic_template,stacked,bottom,False,hospital_statement
"Patient Receipt
Sample Family Clinic
Patient
Hiro Kowalski
Date of service
8/1/23
CPT  Description  Charge
80053
Cleaning
2,769.24
Insurance adjustment
-1,107.70
Insurance paid
-1,107.70
Patient paid
553.85
Balance due
$0.00
Payment method
Visa ****3835",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-1af07d4c735e48bc7d3c3b51,v11-MEDICAL_RECEIPT-stacked,original,2023,fgen-100018a48d47949b56313798,synthetic_programmatic_template,stacked,top,False,clinic
"Prescription Receipt
Sample Family Clinic
Patient
Casey B. Adeyemi
Date of service
2022-04-04
Rx #
100193
Drug
Amoxicillin 500mg
Qty
60
Insurance paid
490.06
Your copay
210.02
Payment method
HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-14ef8af809aad8b0ee5c6ab5,v11-MEDICAL_RECEIPT-stacked,original,2022,fgen-1c77929f08f423cc0ffba2b7,synthetic_programmatic_template,stacked,top,False,pharmacy
"Prescription Receipt
Brightsmile Dental Group
Patient
Casey M. Tanaka
Date of service
03/22/2025
Rx #
255212
Drug
Lisinopril 10mg
Qty
90
Insurance paid
686.13
Your copay
294.06
Payment method
Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-985fdac4a8cfbdc69ad030cb,v11-MEDICAL_RECEIPT-stacked,original,2025,fgen-382562e1a76a260ec4b0b0df,synthetic_programmatic_template,stacked,top,False,pharmacy
"Patient Account Statement
Riverside Urgent Care
Patient
Kwame Okafor
Date of service
4/21/22
CPT  Description  Charge
80053
Cleaning
527.83
Insurance adjustment
-211.13
Insurance paid
-211.13
Patient paid
105.57
Balance due
$0.00
Payment method
Visa ****6925",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-6fe34ec9da69b6f3b3e0de52,v11-MEDICAL_RECEIPT-stacked,original,2022,fgen-0c68a854af96e6bac0eeef42,synthetic_programmatic_template,stacked,top,False,hospital_statement
"Brightsmile Dental Group
Patient
Morgan K. Moreau
Date of service
9/25/21
Rx #
175488
Drug
Lisinopril 10mg
Qty
30
Insurance paid
2,072.01
Your copay
888.01
Payment method
HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-9cd628d64eaff93483926e2f,v11-MEDICAL_RECEIPT-stacked,original,2021,fgen-f63a70f759bd0e331caee266,synthetic_programmatic_template,stacked,none,False,pharmacy
"Patient Receipt
Lakeshore Pharmacy
Patient
Jordan J. Adcyemi
Date of service
12/25/24
CPT  Description  Charge
99213
Cleaning
499.66
Insurance adjustment
-199.87
Insurance paid
-199.87
Patientpaid
99.93
Balance due
$0.00
Payment method
Visa ****4046",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-3835d88b07807f6a3987177b,v11-MEDICAL_RECEIPT-stacked,original,2024,fgen-980a61961fa851429aa82441,synthetic_programmatic_template,stacked,top,True,clinic
"Patient Receipt
Brightsmile Dental Group
Patient,Hiro M. Lindqvist
Date of service,2026-09-07
CPT,Description,Charge
99214,Filling,""1,639.01""
Insurance adjustment,-655.61
Insurance paid,-655.61
Patient paid,327.80
Balancedue,$0.00
Payment method,H5A card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-55d70d6359308b2efd67ff3b,v11-MEDICAL_RECEIPT-csv,original,2026,fgen-fc8632cb0cfd7156113e4b82,synthetic_programmatic_template,csv,top,True,clinic
"Patient Receipt
Rivcrside Urgent Care
Patient,Taylor M. Adeyemi
Date ofservice,1/13/25
CPT,Description,Charge
99214,Lab panel,""2,954.O0""
Insurance adjustment,""-1,181.60""
Insurance paid,""-1,181.60""
Patient paid,590.80
Balance due,$0.00
Payment method,HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-49110ee8f9717cf1bd4b7359,v11-MEDICAL_RECEIPT-csv,original,2025,fgen-1e6442415066cd0789e86dc5,synthetic_programmatic_template,csv,top,True,clinic
"Prescription Receipt
Sample Family Clinic
Patient,Alex S. Okafor
Date of service,6/6/22
Rx#,987462
Drug,Atorvastatin 20mg
Qty,90
Insurance paid,112.63
Your copay,48.27
Payment method,HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-0a9a1b34f514c177374aefdc,v11-MEDICAL_RECEIPT-csv,original,2022,fgen-0975aa531ad6939c572f8654,synthetic_programmatic_template,csv,top,True,pharmacy
"Brightsmile Dental Group
Patient,Jordan Sato
Date of service,03/14/2021
CPT,Description,Charge
2391,Office visit,919.92
Insurance adjustment,-367.97
Insurance paid,-367.97
Patient paid,183.98
Balance due,$0.00
Payment method,Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-4be9b61af6dea406e5de77ef,v11-MEDICAL_RECEIPT-csv,original,2021,fgen-9015f4a4d2c15c7ee033b217,synthetic_programmatic_template,csv,none,False,hospital_statement
"Dental Visit Receipt
Brightsmilc Denta1 Group
Patient,Lena Brennan
Date ofservice,2021-01-14
CPT,Description,Charge
2391,Cleaning,484.43
Insurance adjustment,-193.77
Insurance paid,-193.77
Patient paid,96.89
Balance due,$0.00
Payment mcthod,Visa ****4517",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-36724389c12cef4e00a5edc6,v11-MEDICAL_RECEIPT-csv,original,2021,fgen-7b0f6cbb9298930b025c91f3,synthetic_programmatic_template,csv,top,True,dental
"Patient Account Statement
Sample Family Clinic
Patient,Mateo A. Okafor
Date of service,""June 23, 2024""
CPT,Description,Charge
2391,Filling,713.39
Insurance adjustment,-285.35
Insurance paid,-285.35
Patient paid,142.68
Balance due,$0.00
Payment method,Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-df43c902dd3b065a6f1fb487,v11-MEDICAL_RECEIPT-csv,original,2024,fgen-1bcc4d17392a86144a635fc2,synthetic_programmatic_template,csv,top,False,hospital_statement
"Sample Family Clinic
Patient,Noah Patel
Date of service,2024-06-22
CPT,Description,Charge
99213,Filling,880.75
Insurance adjustment,-352.30
Insurance paid,-352.30
Patient paid,176.15
Balance due,$0.00
Payment method,HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-750fe04c1cf0614fbf2f2bc1,v11-MEDICAL_RECEIPT-csv,original,2024,fgen-a05e385542754078dfea2d2b,synthetic_programmatic_template,csv,none,False,hospital_statement
"Riverside Urgent Care
Patient,Amara Moreau
Date of service,07/22/2022
CPT,Description,Charge
99214,Lab panel,""2,136.49""
Insurance adjustment,-854.60
Insurance paid,-854.60
Patient paid,427.30
Balance due,$0.00
Payment method,HSA card
Patient Receipt",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-1e3282d67c0367636294d4c7,v11-MEDICAL_RECEIPT-csv,original,2022,fgen-8800647acab79ba2801dc820,synthetic_programmatic_template,csv,bottom,False,clinic
"Dental Visit Receipt
Lakeshore Pharmacy
Patient,5ofia Sato
Date of service,""February 15, 2025""
CPT,Description,Charge
239l,Lab panel,53.53
Insurance adjustment,-21.41
Insurance paid,-21.41
Patient paid,1O.71
Balance due,$0.00
Payment method,HSAcard",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-ab772dd6b7b40ce742402716,v11-MEDICAL_RECEIPT-csv,original,2025,fgen-6d3d3df14b76f1ca4f635a5b,synthetic_programmatic_template,csv,top,True,dental
"Sample Family Clinic
Patient,Lena Patel
Date of service,2026-12-12
CPT,Description,Charge
2391,Lab panel,""1,389.07""
Insurance adjustment,-555.63
Insurance paid,-555.63
Patient paid,277.81
Balance due,$0.00
Payment method,Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-d980f589f12d611e25ff6efe,v11-MEDICAL_RECEIPT-csv,original,2026,fgen-11a534fab65048605143d3a6,synthetic_programmatic_template,csv,none,False,clinic
"Patient Account Statement
Sample Family Clinic
Patient,Hiro S. Walsh
Date of service,2023-02-21
CPT,Description,Charge
36415,Cleaning,""1,345.94""
Insurance adjustment,-538.38
Insurance paid,-538.38
Patient paid,269.19
Balance due,$0.00
Payment method,HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-31832a81a3b26d77f320f7a5,v11-MEDICAL_RECEIPT-csv,original,2023,fgen-8a8e4e2a9d2c8294a9e17735,synthetic_programmatic_template,csv,top,False,hospital_statement
"Sample Family Clinic
Patient,Morgan B. Haddad
Date of service,2021-04-01
CPT,Description,Charge
2391,Cleaning,""1,845.88""
Insurance adjustment,-738.35
Insurancc paid,-738.35
Patient paid,369.18
Balance due,$0.00
Payment method,Visa ****0392
PatientReceipt",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-31b22daffc16151c9d4da27f,v11-MEDICAL_RECEIPT-csv,original,2021,fgen-36164b87a726cec8fcad566e,synthetic_programmatic_template,csv,bottom,True,clinic
"Prescription Receipt
Lakeshore Pharmacy
Patient,Olivia Moreau
Date of service,12/14/2022
Rx #,239145
Drug,Lisinopril 10mg
Qty,60
Insurance paid,""2,040.80""
Your copay,874.63
Payment method,Visa ****6595",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-14692894c5b5e40d0cd49366,v11-MEDICAL_RECEIPT-csv,original,2022,fgen-9b46cdd9bd391d2f64f48aac,synthetic_programmatic_template,csv,top,False,pharmacy
"Patient Receipt
Brightsmile Dental Group
Patient,Olivia Fischer
Date of service,10/07/2024
CPT,Description,Charge
36415,Lab panel,226.37
Insurance adjustment,-90.55
Insurance paid,-90.55
Patient paid,45.27
Balance due,$0.00
Payment method,Visa ****4324",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-47fcaa32fbd21a33ff0aaaf6,v11-MEDICAL_RECEIPT-csv,original,2024,fgen-f86447cd558ff3c37871a7e4,synthetic_programmatic_template,csv,top,False,clinic
"Sample Family Clinic
Patient,Wei M. Patel
Date of service,5/14/26
CPT,Description,Charge
99214,Cleaning,815.75
Insurance adjustment,-326.30
Insurance paid,-326.30
Patient paid,163.15
Balance due,$0.00
Payment method,Visa ****2380
Patient Account Statement",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-436cf9036e2918533c4e3278,v11-MEDICAL_RECEIPT-csv,original,2026,fgen-97fc662ee663fd6297a900f1,synthetic_programmatic_template,csv,bottom,False,hospital_statement
"Dental Visit Receipt
Riverside Urgent Care
Patient,Fatima R. Adeyemi
Date of service,2024-08-12
CPT,Description,Charge
99214,Filling,""2,056.19""
Insurance adjustment,-822.48
Insurance paid,-822.48
Patient paid,411.24
Balance due,$0.00
Payment method,Visa ****6728",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-5f3417848100519b7894b990,v11-MEDICAL_RECEIPT-csv,original,2024,fgen-6651dbebb01f2d1f32c2ae66,synthetic_programmatic_template,csv,top,False,dental
"Brightsmile Dental Group Patient Lena L. Fischer Date of service 01/25/2023 Rx # 644070 Drug Atorvastatin
20mg Qty 30
Insurance paid 1,213.76 Your copay 520.18 Payment method HSA card Prescription Receipt",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-3b0f097cdf3230b9b90c8aa4,v11-MEDICAL_RECEIPT-flat,original,2023,fgen-9feb879aec6248e0536da8ad,synthetic_programmatic_template,flat,bottom,False,pharmacy
"Patient Account Statement Brightsmile Dental Group Patient Avery
Brennan Date of service December 16, 2026 CPT Description Charge 99213 Cleaning 2,466.40 Insurance adjustment -986.56 Insurance paid
-986.56 Patient paid 493.28 Balance due $0.00 Payment method HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-9f3371e35be07680cbed47de,v11-MEDICAL_RECEIPT-flat,original,2026,fgen-284db7f07247dfb6df58de4e,synthetic_programmatic_template,flat,top,False,hospital_statement
"Patient Account Statement Riverside Urgent Care Patient
Priya Sato Date of service 5/25/21 CPT Description
Charge 99213 Office visit 2,965.07 Insurance adjustment -1,186.03 Insurance paid -1,186.03 Patient paid 593.01 Balance due $0.00 Payment method Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-176717355dbe10fb01d132fa,v11-MEDICAL_RECEIPT-flat,original,2021,fgen-0e252c0e24e31dbad2210c16,synthetic_programmatic_template,flat,top,False,hospital_statement
"Dental Visit Receipt Sample Family Clinic Patient Taylor Fischer Date of service 2026-12-22 CPT Description Charge 80053 Office visit 113.66
Insurance adjustment -45.46
Insurance paid -45.46 Patient paid 22.73 Balance due $0.00 Payment method HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-c0f994fceb3bf0bd8c41ff1c,v11-MEDICAL_RECEIPT-flat,original,2026,fgen-8983d9dacc8a998fa749865a,synthetic_programmatic_template,flat,top,False,dental
"Sample Family Clinic Patient Olivia Walsh Date of service 6/21/23 Rx # 293194 Drug
Amoxicillin 500mg Qty 90 Insurance paid 449.63 Your copay 192.70 Paymcnt
methodCash Prescription Receipt",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-1f86c9e59f37ab07a4dc25cd,v11-MEDICAL_RECEIPT-flat,original,2023,fgen-513e29ea095bcdea35963f0f,synthetic_programmatic_template,flat,bottom,True,pharmacy
"Patient Account Statement Riverside Urgent Care Patient Noah Larsen Date of service 2021-11-02 CPT DescriptionCharge 36415 Cleaning 1,562.15 Insurance adjustment -624.86 Insurancc paid -624.86
Patient paid 312.43 Balance due
S0.00 Payment method Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-d95f8fc2df4896b1a6d229f8,v11-MEDICAL_RECEIPT-flat,original,2021,fgen-526674161483dcca22f2499a,synthetic_programmatic_template,flat,top,True,hospital_statement
"Lakeshore Pharmacy Patient Olivia Okafor Date of service 12/26/26 Rx # 138054 Drug Atorvastatin 20mg Qty 30 Insurance
paid 1,726.28 Your copay 739.84 Payment
method HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-6adf1dce2285469adae2e871,v11-MEDICAL_RECEIPT-flat,original,2026,fgen-3d9611734f62113e6620dae0,synthetic_programmatic_template,flat,none,False,pharmacy
"Prescription Receipt Lakeshore Pharmacy Patient Wei Larsen Date of service 2021-08-06
Rx # 488508 Drug Lisinopril 10mg Qty
90 Insurance paid 370.26 Your copay 158.68 Payment method Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-48c573d7ab43895a2d6733ad,v11-MEDICAL_RECEIPT-flat,original,2021,fgen-0a9b57428964f56269443d27,synthetic_programmatic_template,flat,top,False,pharmacy
"Brightsmile Dental Group Patient Wei Adeyemi Date of service 12/17/2026 CPT Description Charge 36415 Cleaning 1,844.57 Insurance adjustment -737.83 Insurance paid -737.83 Patient paid 368.91 Balance
due $0.00 Payment method Cash
Patient Account Statement",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-4ada868e32c39309908b4a7b,v11-MEDICAL_RECEIPT-flat,original,2026,fgen-3fc0615244b19e91227e918e,synthetic_programmatic_template,flat,bottom,False,hospital_statement
"Prescription Receipt Sample Family Clinic Patient Olivia Sato Date of
service 10/27/2024 Rx # 147234
Drug Lisinopril 10mg Qty 90 Insurance paid 2,090.93 Your copay 896.11 Payment method Cash",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-f7efa84f1d281f90e1a6e3f4,v11-MEDICAL_RECEIPT-flat,original,2024,fgen-8b8ba585c328a359fb2032b1,synthetic_programmatic_template,flat,top,False,pharmacy
"Dental Visit Receipt Brightsmile Dental GroupPatient Jamie E. Walsh Date of service 10/14/2025 CPT Description Charge 2391 Cleaning
l,379.00 Insurance adjustment -551.60 Insurance paid -551.60 Patient paid 275.80 Balance due $0.00 Payment method Visa
****0459",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-17855d584ea6144cb6e726f8,v11-MEDICAL_RECEIPT-flat,original,2025,fgen-beadcc88b68210e7be814f66,synthetic_programmatic_template,flat,top,True,dental
"Lakeshore Pharmacy Patient Priya Fischer Date of service 12/25/23 CPT Description Charge
80053 Office visit 2,299.32 Insurance adjustment -919.73
Insurance paid -919.73 Patient paid 459.86 Balance due $0.00 Payment method Cash Patient Account Statement",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-610adff4017189e4452ebe2e,v11-MEDICAL_RECEIPT-flat,original,2023,fgen-37a428f830da3f0d9b022884,synthetic_programmatic_template,flat,bottom,False,hospital_statement
"Dental Visit Receipt Brightsmile Dental Group Patient Jamie E. Lindqvist Date of service 2023-08-23
CPT Description Charge 1110 Lab panel 1,882.16 Insurance adjustment -752.86 Insurance paid
-752.86 Patient paid 376.43 Balance due $0.00 Payment method HSA card",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-6bed35da198569fafef11f47,v11-MEDICAL_RECEIPT-flat,original,2023,fgen-7dc7880a4156de72b6b8d78c,synthetic_programmatic_template,flat,top,False,dental
"Patient Account Statement Sample Family Clinic Patient Mateo Romero Date of service 09/19/2024 CPT Description Charge 99213 Cleaning 2,828.32 Insurance adjustment -1,131.33
Insurance paid -1,131.33 Patient paid 565.66 Balance due
$0.00 Payment method Visa ****6914",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-6208be5b5e209331e958fc99,v11-MEDICAL_RECEIPT-flat,original,2024,fgen-ae2c4d73c7c0b3c8f87861e7,synthetic_programmatic_template,flat,top,False,hospital_statement
"Dental Visit Receipt Sample Family
Clinic Patient Lena Haddad Date of service 6/19/25 CPT Description Charge 80053 Cleaning 1,110.24 Insurance adjustment -444.09 Insurance paid -444.09
Patient paid 222.05 Balance due $0.00 Payment method Visa ****6552",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-9e85c2ce98e893b88c51d95b,v11-MEDICAL_RECEIPT-flat,original,2025,fgen-c9b04ca7088060c175e2075a,synthetic_programmatic_template,flat,top,False,dental
"Patient Receipt Lakeshore Pharmacy Patient Noah Walsh Date of service 2/22/23 CPT Description Charge 80053 Office visit 2,512.45 Insurance adjustment -1,004.98 Insurance
paid -1,004.98 Patient paid
502.49 Balance due $0.00 Payment method Visa ****2253",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-61cec3a8047e4217575c1c64,v11-MEDICAL_RECEIPT-flat,original,2023,fgen-b4af625e58e04a8ac8ee822c,synthetic_programmatic_template,flat,top,False,clinic
"Patient Receipt
## Sample Family Clinic
| Field | Value |
| --- | --- |
| Patient | Taylor E. Lindqvist |
| Date of service | 2023-08-26 |
| CPT | Description | Charge |
| --- | --- | --- |
| 99213 | Cleaning | 2,411.60 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -964.64 |
| Insurance paid | -964.64 |
| Patient paid | 482.32 |
| Balance due | $0.00 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-82089cf83b615688f4139cbe,v11-MEDICAL_RECEIPT-markdown,original,2023,fgen-b5f029a9e5f1b17eca457ac9,synthetic_programmatic_template,markdown,top,False,clinic
"## Prescription Receipt
## Brightsmile Dental Group
| Field | Value |
| --- | --- |
| Patient | Jamie Castillo |
| Date of service | 2026-11-13 |
| Rx # | 300831 |
| Drug | Amoxicillin 500mg |
| Qty | 90 |
| Insurance paid | 1,923.96 |
| Your copay | 824.55 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-6bd61dc5227a5c6dabfb55e2,v11-MEDICAL_RECEIPT-markdown,original,2026,fgen-419037b0b41a34f5d2a1f30d,synthetic_programmatic_template,markdown,top,False,pharmacy
"Patient Account Statement
## Lakeshore Pharmacy
| Field | Value |
| --- | --- |
| Patient | Diego Patel |
| Date of service | 12/15/25 |
| CPT | Description | Charge |
| --- | --- | --- |
| 99213 | Filling | 2,737.57 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -1,095.03 |
| Insurance paid | -1,095.03 |
| Patient paid | 547.51 |
| Balance due | $0.00 |
| Payment method | Cash |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-13193662bddc28fb397a4dae,v11-MEDICAL_RECEIPT-markdown,original,2025,fgen-3ac270232089366b6aedacac,synthetic_programmatic_template,markdown,top,False,hospital_statement
"Prescription Receipt
Lakeshore Pharmacy
| Field | Value |
| --- | --- |
| Patient | Taylor Moreau |
| Date of service | 2024-03-22 |
| Rx # | 558375 |
| Drug | Lisinopril 10mg |
| Qty | 60 |
| Insurance paid | 1,366.02 |
| Your copay | 585.44 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-1e13b4dcd7262f721dc14077,v11-MEDICAL_RECEIPT-markdown,original,2024,fgen-d6673f104bad1f3d4261c685,synthetic_programmatic_template,markdown,top,False,pharmacy
"Patient Account Statement
## Brightsmile Dental Group
|Field | Value |
| --- | --- |
| Patient | Alex Testcase |
| Date of servíce | O9/05/2021 |
| CPT | Description | Charge |
| --- | --- |--- |
| 99214 | Lab panel | 2,964.67 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -1,185.87 |
| Insurance paid |-1,185.87 |
| Patient paid | 592.93 |
| Balance due | $O.00 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-1b670ac056d7c5048a84209b,v11-MEDICAL_RECEIPT-markdown,original,2021,fgen-d93954e31621009fe14c0e8e,synthetic_programmatic_template,markdown,top,True,hospital_statement
"## Dental Visit Receipt
Riverside Urgent Care
| Field | Value |
| --- | --- |
| Patient | Riley J. Nguyen |
| Date of service | 2023-05-22 |
| CPT | Description | Charge |
| --- | --- | --- |
| 80053 | Cleaning | 2,569.13 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -1,027.65 |
| Insurance paid | -1,027.65 |
| Patient paid | 513.83 |
| Balance due | $0.00 |
| Payment method | Visa ****0680 |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-23694871d8c99d39b1758152,v11-MEDICAL_RECEIPT-markdown,original,2023,fgen-61125c1a6c8e13ce4b2363de,synthetic_programmatic_template,markdown,top,False,dental
"Prescription Receipt
Sample Family Clinic
| Field | Value |
| --- | --- |
| Patient | Taylor Rivera |
| Date of service | 2022-07-09 |
| Rx # | 198465 |
| Drug | Amoxicillin 500mg |
| Qty | 30 |
| Insurance paid | 993.14 |
| Your copay | 425.63 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-7cb22e3e56b7884fc00fe014,v11-MEDICAL_RECEIPT-markdown,original,2022,fgen-ad79f78d0b6972969609dcf5,synthetic_programmatic_template,markdown,top,False,pharmacy
"## Dental Visit Receipt
Sample Family Clinic
| Field | Value |
| --- | --- |
| Patient | Avery R. Adeyemi |
| Date of service | 1/26/26 |
| CPT | Description | Charge |
| --- | --- | --- |
| 99214 | Filling | 179.56 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -71.82 |
| Insurance paid | -71.82 |
| Patient paid | 35.91 |
| Balance due | $0.00 |
| Payment method | Visa ****5657 |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-8ee9b7508efbaf483b0f9ea3,v11-MEDICAL_RECEIPT-markdown,original,2026,fgen-8364723454976f5ea771ffd1,synthetic_programmatic_template,markdown,top,False,dental
"Dental Visit Receipt
Riverside Urgent Care
| Field | Value |
| --- | --- |
| Patient | Taylor Testcase |
| Date of service | June 5, 2024 |
| CPT | Description | Charge |
| --- | --- | --- |
| 99213 | Filling | 876.05 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -350.42 |
| Insurance paid | -350.42 |
| Patient paid | 175.21 |
| Balance due | $0.00 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-155f607becf5dd29dd15adec,v11-MEDICAL_RECEIPT-markdown,original,2024,fgen-3bb9810bf2e23b0fc325b121,synthetic_programmatic_template,markdown,top,False,dental
"Lakeshore Pharmacy
| Field | Value |
| --- | --- |
| Patient | Noah Adeyemi |
| Date of service | September 16, 2021 |
| CPT | Description | Charge |
| --- | --- | --- |
| 2391 | Office visit | 897.77 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -359.11 |
| Insurance paid | -359.11 |
| Patient paid | 179.55 |
| Balance due | $0.00 |
| Payment method | HSA card |
Patient Account Statement",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-a61a6bc8ae8b9e85d7c7315f,v11-MEDICAL_RECEIPT-markdown,original,2021,fgen-40283e7fb5494816267b7dbd,synthetic_programmatic_template,markdown,bottom,False,hospital_statement
"Riverside Urgent Care
| Field | Value |
| --- | --- |
| Patient | Jamie Brennan |
| Date of service | 1/14/23 |
| CPT | Description | Charge |
| --- | --- | --- |
| 99214 | Cleaning | 1,125.67 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -450.27 |
| Insurance paid | -450.27 |
| Patient paid | 225.13 |
| Balance due | $0.00 |
| Payment method | HSA card |
Patient Account Statement",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-042345f2a5a8640c81749a77,v11-MEDICAL_RECEIPT-markdown,original,2023,fgen-b83e1d4f636619b65eab15fd,synthetic_programmatic_template,markdown,bottom,False,hospital_statement
"## Brightsmile Dental Group
| Field | Value |
| --- | --- |
| Patient | Wei Testcase |
| Date of service | 2021-04-15 |
| CPT | Description | Charge |
| --- | --- | --- |
| 99214 | Office visit | 1,379.80 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -551.92 |
| Insurance paid | -551.92 |
| Patient paid | 275.96 |
| Balance due | $0.00 |
| Payment method | Cash |
Dental Visit Receipt",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-2e003cc6f560a96da1a06443,v11-MEDICAL_RECEIPT-markdown,original,2021,fgen-b78eecc5675dc7a166907771,synthetic_programmatic_template,markdown,bottom,False,dental
"## Prescription Receipt
Riverside Urgent Care
| Field| Value |
| --- | --- |
| Patient | Diego Lindqvist |
| Date of service | 2021-12-04 |
| Rx# | 154646 |
| Drug | Amoxícillin 500mg |
| Qty | 30 |
| Insurance paid | 41.18 |
| Your copay | 17.65 |
| Payment method | Visa ****9959 |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-e382911e12446928742bd8fa,v11-MEDICAL_RECEIPT-markdown,original,2021,fgen-36d60ce7470bbbce4e0cbcde,synthetic_programmatic_template,markdown,top,True,pharmacy
"## Dental Visit Receipt
Brightsmile Dental Group
| Ficld | Value |
| --- | --- |
| Patient | Sofia Romero |
| Date of service | 2024-05-11 |
| CPT | Description | Charge|
| --- | --- | --- |
| 364l5 | Cleaning | 2,972.77 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -l,189.11 |
| Insurance paid | -1,189.11|
| Patient paid | 594.55 |
| Ba1ance due| S0.00 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-3766dde22263b6c3bea0bedd,v11-MEDICAL_RECEIPT-markdown,original,2024,fgen-7710315576d72119df07bf00,synthetic_programmatic_template,markdown,top,True,dental
"Patient Account Statement
Rivcrside Urgent Care
| Field | Value |
| --- | --- |
|Patient | Amara Brennan |
| Date of service | December 22, 2024 |
| CPT| Description | Charge |
| --- | --- | --- |
| 239l| Cleaning | 2,835.52 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -l,134.21 |
| Insurance paid | -1,134.21 |
| Patient paid | 567.1O |
| Balance due | $0.00 |
| Payment method | HSA card |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-437d259374fe62a4c3202650,v11-MEDICAL_RECEIPT-markdown,original,2024,fgen-e6001735b401f740a6c49430,synthetic_programmatic_template,markdown,top,True,hospital_statement
"## Patient Receipt
Riverside Urgent Care
| Field | Value |
| --- | --- |
| Patient | Lena M. Patel |
| Date of service | 5/19/22 |
| CPT | Description | Charge |
| --- | --- | --- |
| 99213 | Cleaning | 2,508.54 |
| Field | Value |
| --- | --- |
| Insurance adjustment | -1,003.41 |
| Insurance paid | -1,003.41 |
| Patient paid | 501.71 |
| Balance due | $0.00 |
| Payment method | Visa ****4453 |",MEDICAL_RECEIPT,31,MEDICAL_RECEIPT,fdc-ab6764ed377351fe9e285494,v11-MEDICAL_RECEIPT-markdown,original,2022,fgen-8ca01fa8ed5e6af46c194f44,synthetic_programmatic_template,markdown,top,False,clinic
"Lakeshore Home Lending
Statement date
July 24, 2021
Loan number
***-**-229059
Property address
493 Harbor View Rd Testville, IL 17859
Payment due date
4/28/21
Amount due
$2,500.62
Explanation of amount due
Principal
$792.98
Interest
570.56
Escrow (for taxes and insurance)
$1,139.81
Regular monthly payment
$3,461.12
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
5,705.63
Outstanding principal
$128,233.41
Escrow balance
$2,013.36
Interest rate
7.837%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This is an attempt to collect a debt. NMLS ID 229181",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-acfa55096629881b21394b08,v11-MORTGAGE_STATEMENT-stacked,original,2021,fgen-a170b4edcd12ed2c1ffb5d57,synthetic_programmatic_template,stacked,none,False,monthly
"Mortgage Statement
Keystone Home Loans
Statement date
December 4, 2026
Loan number
***-**-201131
Property address
8152 Prairie Ave Riverton, WI 15046
Payment due date
7/27/26
Amount due
$3,260.29
Explanation of amount due
Principal
1,439.36
Interest
2,318.12
Escrow (for taxes and insurance)
733.33
Regular monthly payment
1,812.33
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
23,181.17
Outstanding principal
$177,349.20
Escrow balance
$4,468.49
Interest rate
6.591%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 535228",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-54b256f561ca14781e332608,v11-MORTGAGE_STATEMENT-stacked,original,2026,fgen-e9ae2b9599e864647070381b,synthetic_programmatic_template,stacked,top,False,monthly
"Home Loan Activity
Payment Date  Total Payment  Principal  Interest Escrow  Principal Balance
l7/12/2021
3727.90
1591.82
1500.46
427.31
96382.14
08/10/2021
3252.29
332.53
1592.48
664.14
5l6501.40
2021-08-10
3162.26
433.25
337.01
637.55
617532.69
24/11/2021
3397.95
507.92
1663.22
991.25
411132.8O
12/06/2021
4166.33
306.91
2171.57
356.38
258753.96
16/12/2021
1297.17
1234.86
2441.01
158.47
84112.04
2021-12-17
3942.89
607.21
2053.49
725.30
519620.80
04/08/2021
3696.72
1500.98
466.13
953.21
328855.51
2021-07-03
2135.16
377.70
764.84
1097.33
252827.60",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-26c6e05c76ab337e4e0e89b0,v11-MORTGAGE_STATEMENT-stacked,original,2021,fgen-00557c1e824b0bb4b0d34cf7,synthetic_programmatic_template,stacked,top,True,raw_export
"Annual Escrow Account Disclosure Statement
Riverbend Mortgage Servicing
Loan number
XXXXX608555
Property address
8811 Harbor View Rd Riverton, WI 85698
Projected property taxes
$6,214.18
Projected homeowners insurance
$3,090.63
Escrow shortage
$30.92
New monthly escrow payment
696.76
New total monthly payment effective
08/09/2022
This is an attempt to collect a debt. NMLS ID 363339",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c56fee57952434f9f332574c,v11-MORTGAGE_STATEMENT-stacked,original,2021,fgen-0e5d88b8c4da5323bc638dfb,synthetic_programmatic_template,stacked,top,False,escrow_analysis
"Bluewater Loan Servicing
Statement date
02/21/2024
Loan number
XXX-XX-5227O4
Property address
3258 Maple Rídge Dr Oak Grove, TX l1416
Payment due date
02/17/2024
Amount duc
$5,077.29
Explanation of amount due
Principal
313.20
Interest
2,454.73
Escrow(for taxes and insurance)
735.45
Regular monthly payment
$2,492.67
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
12,273.64
Outstanding principal
$391,840.95
Escrow balance
$3,732.21
Interest rate
5.206%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Thisstatement is not aForm 1098. Keep it for your records.
This is an attempt to collect a debt. NML5 ID 726224
Mortgage 5tatement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0c419dfd13ffa46d9d53761b,v11-MORTGAGE_STATEMENT-stacked,original,2024,fgen-2eea2e9a9a405958ffd2d0d8,synthetic_programmatic_template,stacked,bottom,True,monthly
"Home Loan Statement
Riverbend Mortgage Servicing
Statement date
2022-09-12
Loan number
ending in 464253
Property address
5406 Elm Park Pl Bayside, WA 53246
Payment due date
08/22/2022
Amount due
$1,950.40
Explanation of amount due
Principal
$435.72
Interest
2,061.73
Escrow (for taxes and insurance)
664.40
Regular monthly payment
$4,945.92
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
4,123.46
Outstanding principal
$447,603.89
Escrow balance
$2,400.18
Interest rate
5.988%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 235855",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a2957c1d1fa40a57ea7d0120,v11-MORTGAGE_STATEMENT-stacked,original,2022,fgen-2eabc83fe7dcf1ddfd172d06,synthetic_programmatic_template,stacked,top,False,monthly
"Annual Escrow Account Disclosure Statement
Pinecrest Mortgage Company
Loan number
XXX-XX-198442
Property address
3192 Prairie Ave Pinecrest, GA 42044
Projected property taxes
7,512.39
Projected homeowners insurance
$2,897.50
Escrow shortage
89.53
New monthly escrow payment
$938.94
New total monthly payment effective
08/05/2027
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 587618",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c451f1f9d05597701bb3e829,v11-MORTGAGE_STATEMENT-stacked,original,2026,fgen-665692d9e91fa6e1c4b32035,synthetic_programmatic_template,stacked,top,False,escrow_analysis
"Bluewater Loan Servicing
Statement date
2022-04-02
Loan number
***-**-922622
Property address
8118 Willow Bend Way Lakewood, CO 10676
Payment due date
October 13, 2022
Amount due
$3,896.59
Explanation of amount due
Principal
1,290.69
Interest
1,561.66
Escrow (for taxes and insurance)
1,010.05
Regular monthly payment
2,862.94
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
17,178.26
Outstanding principal
$213,550.65
Escrow balance
$5,935.29
Interest rate
4.025%
IRS Form 1098 information for 2022 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 472678
Monthly Mortgage Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a63041182928232bd03603f6,v11-MORTGAGE_STATEMENT-stacked,original,2022,fgen-63f368a295bb736669491828,synthetic_programmatic_template,stacked,bottom,False,monthly
"Mortgage loan 6720 - payment history
Downloaded 02/12/2022
Due Date  Amount Paid  Principal Applied  Interest Applied  Escrow Deposit  Remaining Balance
10/10/2022
3577.12
637.75
1370.53
390.46
360947.83
2022-02-12
1911.86
832.12
1035.00
569.65
103623.01
01/17/2022
2598.88
437.13
2295.97
408.49
154884.55
2022-06-18
3002.49
1117.79
2195.40
270.98
462819.20
09/17/2022
3946.12
1354.38
909.79
848.62
599821.87
2022-09-22
3957.68
1091.46
1678.91
606.97
394529.54
09/04/2022
2407.29
656.17
573.94
1161.37
534625.63
07/27/2022
1199.01
1249.49
1979.53
336.11
88435.19
07/20/2022
2721.20
993.68
2337.16
1146.66
395657.77",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0aeca2e3b1c2d6eaa0193c90,v11-MORTGAGE_STATEMENT-stacked,original,2022,fgen-8a2c4ada289f83eac5949655,synthetic_programmatic_template,stacked,top,False,raw_export
"Home Loan Statement
Pinecrest Mortgage Company
Statement date
September 24, 2021
Loan number
ending in 306725
Property address
3164 Sample Street Cedar Falls, IA 92985
Payment due date
08/03/2021
Amount due
$2,580.36
Explanation of amount due
Principal
$2,145.31
Interest
1,517.76
Escrow (for taxes and insurance)
$902.61
Regular monthly payment
1,953.10
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
4,553.29
Outstanding principal
$627,752.41
Escrow balance
$5,496.60
Interest rate
6.257%
Late fee of $75.00 will be charged if payment is received after the 16th.
Your 2021 Form 1098 will be available online by January 31, 2022.
This is an attempt to collect a debt. NMLS ID 152168",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-6532f7f3d5538675776c0e0d,v11-MORTGAGE_STATEMENT-stacked,original,2021,fgen-950c91c22301de74544a5a03,synthetic_programmatic_template,stacked,top,False,monthly
"Annual Escrow Account Disclosure Statement
Pinecrest Mortgage Company
Loan number
XXX-XX-122265
Property address
3923 Elm Park Pl Brookhaven, PA 85800
Projected property taxes
3,072.82
Projected homeowners insurance
2,965.64
Escrow shortage
940.60
New monthly escrow payment
398.56
New total monthly payment effective
2026-12-15
This is an attempt to collect a debt. NMLS ID 274430",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e0f383efcc22adb7a95dd711,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-1e25635a6d3504f9a20c45c1,synthetic_programmatic_template,stacked,top,False,escrow_analysis
"Mortgage Statement
Riverbend Mortgage Servicing
Statement date
April 1, 2025
Loan number
XXXXX100625
Property address
7745 Granite St Brookhaven, PA 97287
Payment due date
8/7/25
Amount due
$2,719.22
Explanation of amount due
Principal
2,214.81
Interest
1,028.21
Escrow (for taxes and insurance)
$380.98
Regular monthly payment
$2,908.49
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
4,112.85
Outstanding principal
$280,660.65
Escrow balance
$4,126.15
Interest rate
3.314%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
Your 2025 Form 1098 will be available online by January 31, 2026.
This is an attempt to collect a debt. NMLS ID 762708",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-1b5fe83106081d5f415d2c6d,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-1f7b11b441c17cc2aa08fbe9,synthetic_programmatic_template,stacked,top,False,monthly
"Home Loan Activity
Downloaded 2024-02-20
Due Date  Amount Paid  Principal Applied  Interest Applied  Escrow Deposit  Remaining Balance
03/14/2024
4393.56
1411.86
2007.79
407.90
314359.07
04/12/2024
1443.53
1199.85
2424.34
1179.53
541394.45
07/10/2024
1868.27
826.92
713.12
730.84
280383.78
02/10/2024
3869.64
977.54
917.93
784.42
432365.54
2024-06-16
1342.65
279.55
1690.82
151.52
412992.42
18/05/2024
1767.39
328.21
1943.76
625.04
62987.83
01/04/2024
2547.81
347.11
1191.93
747.05
109083.31
17/06/2024
2932.81
246.56
1017.18
1178.34
152553.74
05/04/2024
996.82
604.37
1168.56
1158.40
342730.50",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-168240ba19bd1608e822358e,v11-MORTGAGE_STATEMENT-stacked,original,2024,fgen-a08a4045d4c8cf0976df747b,synthetic_programmatic_template,stacked,top,False,raw_export
"Home Loan Statement
Lakeshore Home Lending
Statement date
2026-05-09
Loan number
ending in 787192
Property address
6930 Prairie Ave Cedar Falls, IA 19917
Payment due date
07/10/2026
Amount due
$3,074.96
Explanation of amount due
Principal
209.52
Interest
1,538.76
Escrow (for taxes and insurance)
1,195.86
Regular monthly payment
$2,436.90
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
4,616.28
Outstanding principal
$368,271.17
Escrow balance
$3,363.60
Interest rate
4.671%
Late fee of $75.00 will be charged if payment is received after the 16th.
Your 2026 Form 1098 will be available online by January 31, 2027.
This is an attempt to collect a debt. NMLS ID 628075",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d09f9a8ca5ce00c160811bc0,v11-MORTGAGE_STATEMENT-stacked,original,2026,fgen-5289813aa9f213a701425d59,synthetic_programmatic_template,stacked,top,False,monthly
"Mortgage Statement
Bluewater Loan Servicing
Statement date
2021-05-06
Loan number
XXXXX377790
Property address
6452 Lakeshore Blvd Brookhaven, PA 71856
Payment due date
April 7, 2021
Amount due
$1,917.56
Explanation of amount due
Principal
1,555.40
Interest
612.21
Escrow (for taxes and insurance)
765.14
Regular monthly payment
2,716.40
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
6,734.27
Outstanding principal
$111,611.81
Escrow balance
$3,100.41
Interest rate
6.269%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
IRS Form 1098 information for 2021 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 391233",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-50153685e1a40edf3bb9217d,v11-MORTGAGE_STATEMENT-stacked,original,2021,fgen-12faa0740bb25d78bc02e681,synthetic_programmatic_template,stacked,top,False,monthly
"Monthly Mortgage Statement
Riverbend Mortgage Servicing
Statement date
7/14/25
Loan number
ending in 482270
Property address
5952 Maple Ridge Dr Pinecrest, GA 37087
Payment due date
11/06/2025
Amount due
$3,601.41
Explanation of amount due
Principal
$2,359.63
Interest
1,221.59
Escrow (for taxes and insurance)
1,427.55
Regular monthly payment
2,414.28
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
9,772.71
Outstanding principal
$137,374.13
Escrow balance
$4,540.78
Interest rate
5.279%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Your 2025 Form 1098 will be available online by January 31, 2026.
This is an attempt to collect a debt. NMLS ID 410332",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4cce6bb8b62ce498230a3b1d,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-7582d290e498c080ca754169,synthetic_programmatic_template,stacked,top,False,monthly
"Home Loan Statement
Pinecrest Mortgage Company
Statement date
11/17/23
Loan number
****417988
Property address
9382 Lakeshore Blvd Lakewood, CO 36140
Payment due date
12/21/2023
Amount due
$1,288.64
Explanation of amount due
Principal
$2,297.70
Interest
259.10
Escrow (for taxes and insurance)
$980.77
Regular monthly payment
$1,125.29
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
2,591.02
Outstanding principal
$284,237.19
Escrow balance
$2,522.59
Interest rate
5.617%
This is an attempt to collect a debt. NMLS ID 985604",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-1000cabf34c021bf1d33f3d2,v11-MORTGAGE_STATEMENT-stacked,original,2023,fgen-f81308dd2b513aefd7429b2e,synthetic_programmatic_template,stacked,top,False,monthly
"Home Loan Statement
Bluewater Loan Servicing
Statement date
01/21/2025
Loan number
XXXXX840649
Property address
1408 Prairie Ave Cedar Falls, IA 89351
Payment due date
2025-12-22
Amount due
$2,804.06
Explanation of amount due
Principal
$911.57
Interest
875.24
Escrow (for taxes and insurance)
$1,456.92
Regular monthly payment
2,669.54
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
9,627.64
Outstanding principal
$100,529.39
Escrow balance
$3,642.82
Interest rate
6.542%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This statement is not a Form 1098. Keep it for your records.
This is an attempt to collect a debt. NMLS ID 57312",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-9235f64344fa4a507bda657b,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-c3b59f41e8a7f259bdfa3c31,synthetic_programmatic_template,stacked,top,False,monthly
"Lakeshore Home Lending
Statement date
06/02/2021
Loan number
XXX-XX-102020
Property address
8103 Oak Hollow Ct Riverton, WI 24872
Payment due date
3/13/21
Amount due
$1,337.10
Explanation of amount due
Principal
$1,342.65
Interest
1,727.46
Escrow (for taxes and insurance)
$1,033.94
Regular monthly payment
$3,531.54
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
13,819.71
Outstanding principal
$247,985.04
Escrow balance
$3,168.45
Interest rate
5.526%
This is an attempt to collect a debt. NMLS ID 249441",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-aa4dfd12923223dfbb784a12,v11-MORTGAGE_STATEMENT-stacked,original,2021,fgen-8cbd1de802cbb8c03575fbc8,synthetic_programmatic_template,stacked,none,False,monthly
"Annual Escrow Account Disclosure Statement
Keystone Home Loans
Loan number
ending in 282971
Property address
952 Elm Park Pl Fairview, OH 50924
Projected property taxes
8,155.36
Projected homeowners insurance
4,133.55
Escrow shortage
202.31
New monthly escrow payment
$1,382.59
New total monthly payment effective
August 15, 2027
This statement is not a Form 1098. Keep it for your records.
This is an attempt to collect a debt. NMLS ID 362839",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a4b88c009f2b04d6daaad4eb,v11-MORTGAGE_STATEMENT-stacked,original,2026,fgen-56cf09bfba0618df94b19cd6,synthetic_programmatic_template,stacked,top,False,escrow_analysis
"Lakeshore Home Lending
Loan number
XXXXXl67558
Property address
8707 Willow Bend WayLakewood, C0 28956
Projccted property taxes
$11,798.39
Projected homeowners insurance
$2,308.03
Escrow shortage
$975.81
New monthly escrow payment
$419.02
New total monthly payment effective
5/13/26
This is an attempt to collect a debt. NML5 ID 647921",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8520efcb4238364ce9b69de6,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-17e276cbbd4fd13e998e8c65,synthetic_programmatic_template,stacked,none,True,escrow_analysis
"Home Loan Statement
Riverbend Mortgage Servicing
Statement date
8/22/26
Loan number
ending in 612361
Property address
6124 Elm Park Pl Pinecrest, GA 74040
Payment due date
7/16/26
Amount due
$5,092.40
Explanation of amount due
Principal
2,341.54
Interest
3,130.19
Escrow (for taxes and insurance)
762.16
Regular monthly payment
$4,958.33
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
15,650.93
Outstanding principal
$577,308.43
Escrow balance
$4,140.13
Interest rate
2.908%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This statement is not a Form 1098. Keep it for your records.
This is an attempt to collect a debt. NMLS ID 195325",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-5b36e844f86600fb401ab1fd,v11-MORTGAGE_STATEMENT-stacked,original,2026,fgen-0b6c504cb9a3fea3d0fa19d4,synthetic_programmatic_template,stacked,top,False,monthly
"Mortgage Statement
Keystone Home Loans
Statement date
02/22/2025
Loan number
ending in 087680
Property address
9550 Willow Bend Way Brookhaven, PA 49115
Payment due date
07/17/2025
Amount due
$4,322.75
Explanation of amount due
Principal
475.84
Interest
643.43
Escrow (for taxes and insurance)
$869.80
Regular monthly payment
$1,594.32
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
5,790.88
Outstanding principal
$520,983.24
Escrow balance
$3,853.13
Interest rate
6.088%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Your 2025 Form 1098 will be available online by January 31, 2026.
This is an attempt to collect a debt. NMLS ID 18196",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-ab58fe03eb59d16ef57b050d,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-b22b8a83ea3cf85c9d83dec3,synthetic_programmatic_template,stacked,top,False,monthly
"Payment Date  Total Payment  Principal  Interest  Escrow  Principal Balance
05/03/2024
2401.26
615.28
1083.59
210.22
409121.68
2024-04-14
2514.35
1205.06
1180.90
325.01
206048.45
2024-04-22
3464.87
1518.35
428.55
423.59
626301.28",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a212149ae33f6b9b025c5357,v11-MORTGAGE_STATEMENT-stacked,original,2024,fgen-63e86d32b9c94fee59467fa0,synthetic_programmatic_template,stacked,top,False,raw_export
"Mortgage Statement
Riverbend Mortgage Servicing
Statement date
5/19/25
Loan number
***-**-374024
Property address
7129 Oak Hollow Ct Lakewood, CO 64429
Payment due date
01/19/2025
Amount due
$4,102.92
Explanation of amount due
Principal
1,651.99
Interest
2,613.40
Escrow (for taxes and insurance)
$482.46
Regular monthly payment
1,012.32
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
18,293.79
Outstanding principal
$334,875.05
Escrow balance
$1,418.30
Interest rate
4.622%
This is an attempt to collect a debt. NMLS ID 386009",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-3e373229cadd169658fbd457,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-765ec77671986afbfc9e0a83,synthetic_programmatic_template,stacked,top,False,monthly
"Pinecrest Mortgage Company
Statement date
2025-05-22
Loan number
ending in 446526
Property address
729 Lakeshore Blvd Maplewood, MN 88276
Payment due date
2025-02-24
Amount due
$4,707.14
Explanation of amount due
Principal
$2,261.36
Interest
1,407.55
Escrow (for taxes and insurance)
288.62
Regular monthly payment
$1,768.75
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
2,815.10
Outstanding principal
$559,985.50
Escrow balance
$5,337.28
Interest rate
4.260%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
Your 2025 Form 1098 will be available online by January 31, 2026.
This is an attempt to collect a debt. NMLS ID 149027",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-020ad48bbc8750733ff24fa0,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-56f7a3195b933c2ab145744c,synthetic_programmatic_template,stacked,none,False,monthly
"Mortgage Statement
Pinecrest Mortgage Company
Statement date
1/13/25
Loan number
XXX-XX-596055
Property address
8318 Maple Ridge Dr Bayside, WA 17310
Payment due date
10/28/2025
Amount due
$2,785.21
Explanation of amount due
Principal
576.82
Interest
1,081.00
Escrow (for taxes and insurance)
$679.19
Regular monthly payment
$3,765.03
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
5,405.00
Outstanding principal
$264,432.24
Escrow balance
$5,985.88
Interest rate
2.857%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
IRS Form 1098 information for 2025 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 837896",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8d91dcae1fc03648f21100b4,v11-MORTGAGE_STATEMENT-stacked,original,2025,fgen-dd568ffb1f13b9c10b2ec85a,synthetic_programmatic_template,stacked,top,False,monthly
"Monthly Mortgage Statement
Pinecrest Mortgage Company
Statement date
12/6/22
Loan number
XXXXX665829
Property address
952 Oak Hollow Ct Fairview, OH 56161
Payment due date
12/24/2022
Amount due
$5,140.62
Explanation of amount due
Principal
$2,018.60
Interest
1,851.68
Escrow (for taxes and insurance)
$1,076.38
Regular monthly payment
1,662.45
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
18,516.81
Outstanding principal
$456,877.57
Escrow balance
$1,468.32
Interest rate
6.400%
This is an attempt to collect a debt. NMLS ID 390756",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-367f5f4d1d5f972cfd98ec24,v11-MORTGAGE_STATEMENT-stacked,original,2022,fgen-6c680039833932ad36f6b2d9,synthetic_programmatic_template,stacked,top,False,monthly
"Annual Escrow Account Disclosure Statement
Pinecrest Mortgage Company
Loan number
XXX-XX-774444
Property address
4487 Lakeshore Blvd Fairview, OH 57120
Projected property taxes
12,675.45
Projected homeowners insurance
$3,230.57
Escrow shortage
83.82
New monthly escrow payment
555.05
New total monthly payment effective
01/25/2027
This is an attempt to collect a debt. NMLS ID 556764",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-46f616fec87e0771c99dc585,v11-MORTGAGE_STATEMENT-stacked,original,2026,fgen-6caffa5691ddb5f842785fcb,synthetic_programmatic_template,stacked,top,False,escrow_analysis
"Downloaded 17/05/2024
Due Date  Amount Paid  Principal Applied  Interest Applied  Escrow Deposit  Remaining Balance
07/16/2024
4065.63
604.13
519.08
293.72
301938.07
07/06/2024
2982.23
703.32
1066.57
159.74
263984.35
11/21/2024
4438.01
930.26
1351.87
703.69
91880.91
2024-03-04
1777.54
908.19
2388.14
724.09
432673.77
18/01/2024
3200.72
1535.75
1405.97
649.62
113294.14",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-aca3b85af6e221896c264168,v11-MORTGAGE_STATEMENT-stacked,original,2024,fgen-34409911bf3674c89eb9220b,synthetic_programmatic_template,stacked,top,False,raw_export
"Home Loan Statement
Pinecrest Mortgage Company
Statement date
6/23/26
Loan number
XXX-XX-206695
Property address
2590 Lakeshore Blvd Fairview, OH 64593
Payment due date
3/15/26
Amount due
$1,796.14
Explanation of amount due
Principal
1,480.60
Interest
988.36
Escrow (for taxes and insurance)
796.88
Regular monthly payment
$3,388.90
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
8,895.23
Outstanding principal
$289,350.37
Escrow balance
$3,084.53
Interest rate
2.870%
Late fee of $75.00 will be charged if payment is received after the 16th.
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 524952",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-bc7103e5e13569944d9b57d4,v11-MORTGAGE_STATEMENT-stacked,original,2026,fgen-9d384aa20ad0ff06f136513d,synthetic_programmatic_template,stacked,top,False,monthly
"Home Loan Statement
Lakeshore Home Lending
Statement date
January 21, 2021
Loan number
****418927
Property address
7193 Oak Hollow Ct Testville, IL 99214
Payment due date
2021-08-15
Amount due
$4,300.09
Explanation of amount due
Principal
1,235.36
Interest
2,511.93
Escrow (for taxes and insurance)
$1,087.17
Regular monthly payment
2,498.29
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date
30,143.21
Outstanding principal
$463,254.23
Escrow balance
$4,185.02
Interest rate
2.753%
Your 2021 Form 1098 will be available online by January 31, 2022.
This is an attempt to collect a debt. NMLS ID 415876",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0bc45aedc7a57f0713077453,v11-MORTGAGE_STATEMENT-stacked,original,2021,fgen-be14c11799da063ff67cc46b,synthetic_programmatic_template,stacked,top,False,monthly
"Loan History - Mortgage
Date  Transaction  Amount  Principal  Interest  Escrow  Fees  Unpaid Principal
2026-03-06      Escrow disbursement - county tax      4110.27      1107.37      330.99      882.42      0.00      143980.06
12/27/2026 Additional principal 1020.77 581.04 929.97 951.64 0.00 288450.99
15/06/2026  Hazard insurance disbursement  3141.57  1535.26  1229.34  837.69  0.00  176785.09
12/09/2026 Regular monthly payment 524.78 1116.66 1040.62 1085.59 0.00 100364.76
2026-08-01   Escrow disbursement - county tax   1694.07   1346.86   2365.47   588.65   0.00   563961.89
11/08/2026      Additional principal      3808.10      473.75      866.90      366.52      0.00      527546.57
2026-02-20 Regular monthly payment 1365.75 1251.85 2240.74 459.29 0.00 555153.71",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-3c0486c3a7ee0381a44f5fe1,v11-MORTGAGE_STATEMENT-inline,original,2026,fgen-276e07cee4b1add255cc40f5,synthetic_programmatic_template,inline,top,False,raw_export
"Mortgage Statement
Lakeshore Home Lending
Statement date 10/04/2026
Loan number XXX-XX-991514
Property address 4643 Elm Park Pl Brookhaven, PA 43629
Payment due date September 24, 2026
Amount due   $4,660.20
Explanation of amount due
Principal   659.11
Interest  1,281.09
Escrow (for taxes and insurance)   $1,149.16
Regular monthly payment 2,730.85
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date      11,529.78
Outstanding principal   $489,235.99
Escrow balance  $2,767.14
Interest rate 3.897%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This is an attempt to collect a debt. NMLS ID 310900",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-7eb54546176ce2db95551303,v11-MORTGAGE_STATEMENT-inline,original,2026,fgen-d5c740e89b04fd05192f4a2b,synthetic_programmatic_template,inline,top,False,monthly
"Keystone Home Loans
Statement date   5/4/21
Loan number   XXXXX666929
Property address  4347 Lakeshore Blvd Riverton, WI 60215
Payment due date March 4, 2021
Amount due $1,394.19
Explanation of amount due
Principal   460.52
Interest  2,432.04
Escrow (for taxes and insurance)   $1,074.25
Regular monthly payment      1,206.50
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 29,184.53
Outstanding principal $206,352.56
Escrow balance   $5,410.52
Interest rate  6.355%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Your 2021 Form 1098 will be available online by January 31, 2022.
This is an attempt to collect a debt. NMLS ID 689366
Home Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-188f713ad56be494817ace80,v11-MORTGAGE_STATEMENT-inline,original,2021,fgen-3b1f9ba70c71cdf112d0536e,synthetic_programmatic_template,inline,bottom,False,monthly
"Home Loan Statement
Pinecrest Mortgage Company
Statement date  6/13/22
Loan number XXX-XX-056773
Property address   4147 Willow Bend Way Fairview, OH 41409
Payment due date   2022-06-11
Amount due  $1,646.45
Explanation of amount due
Principal 593.29
Interest 1,995.93
Escrow (for taxes and insurance)   $245.75
Regular monthly payment      $1,778.95
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 23,951.10
Outstanding principal $543,172.40
Escrow balance $2,280.96
Interest rate 7.324%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This is an attempt to collect a debt. NMLS ID 998473",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c1759f862a0b93e63837bdc7,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-b6499759858a22a83237d604,synthetic_programmatic_template,inline,top,False,monthly
"Date Transaction Amount Principal Interest Escrow Fees Unpaid Principal
09/11/2024 Regular monthly payment 2881.32 522.12 2305.25 733.86 0.00 635969.69
2024-03-02  Hazard insurance disbursement  4239.72  1317.77  1575.00  123.49  0.00  183207.84
2024-03-15  Escrow disbursement - county tax  4427.09  478.44  698.19  579.18  0.00  98227.81
2024-09-04   Additional principal   1986.18   92.26   825.43   439.27   0.00   67470.23
01/21/2024 Regular monthly payment 2749.51 736.43 1541.11 1097.63 0.00 515509.80
22/07/2024 Regular monthly payment 2846.29 0.74 1121.73 951.73 0.00 73525.31
17/05/2024 Additional principal 1701.36 515.07 54.60 295.83 0.00 112691.97
05/15/2024      Escrow disbursement - county tax      2651.65      1242.45      268.16      898.33      0.00      531195.00
2024-10-15  Regular monthly payment  3297.48  1232.26  2330.03  111.71  0.00  349215.11
Home Loan Activity",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-52a030d5b29da735273a574b,v11-MORTGAGE_STATEMENT-inline,original,2024,fgen-010d00ded78a6fe94c66b1c4,synthetic_programmatic_template,inline,bottom,False,raw_export
"Home Loan Statement
Riverbend Mortgage Servicing
Statement date   06/02/2022
Loan number      XXX-XX-733087
Property address  1523 Oak Hollow Ct Bayside, WA 22574
Payment due date   December 5, 2022
Amount due $1,926.12
Explanation of amount due
Principal $368.29
Interest   2,458.47
Escrow (for taxes and insurance)   249.94
Regular monthly payment 964.01
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 9,833.90
Outstanding principal $298,248.17
Escrow balance   $1,752.67
Interest rate  6.036%
Late fee of $75.00 will be charged if payment is received after the 16th.
This is an attempt to collect a debt. NMLS ID 352225",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-546b206b1a56a65f6b0b9104,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-36e9cf8c31eacbfdff21aed8,synthetic_programmatic_template,inline,top,False,monthly
"Bluewater Loan Servicing
Statement date      10/20/2021
Loan number      ***-**-015154
Property address  3091 Cedar Ln Lakewood, CO 22419
Payment due date      July 28, 2021
Amount due $2,918.97
Explanation of amount due
Principal 1,239.79
Interest   1,759.48
Escrow (for taxes and insurance)  $1,275.65
Regular monthly payment $1,635.35
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 8,797.38
Outstanding principal   $478,213.66
Escrow balance      $3,054.20
Interest rate 5.408%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
This is an attempt to collect a debt. NMLS ID 934873",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-ccdb81fefa7997d743e90e16,v11-MORTGAGE_STATEMENT-inline,original,2021,fgen-f1e7b7148dd4fa81a98a8e76,synthetic_programmatic_template,inline,none,False,monthly
"Monthly Mortgage Statement
Lakeshore Home Lending
Statement date  September 25, 2026
Loan number   XXX-XX-843573
Property address  7566 Prairie Ave Brookhaven, PA 28995
Payment due date  2026-03-06
Amount due  $3,025.34
Explanation of amount due
Principal $2,227.28
Interest  2,367.95
Escrow (for taxes and insurance)  562.73
Regular monthly payment $2,309.20
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 26,047.44
Outstanding principal      $531,245.65
Escrow balance      $3,829.56
Interest rate  5.235%
Late fee of $75.00 will be charged if payment is received after the 16th.
IRS Form 1098 information for 2026 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 325841",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-9b8c70779316d4f6f40c61b9,v11-MORTGAGE_STATEMENT-inline,original,2026,fgen-56330d36858cdb3511418cb7,synthetic_programmatic_template,inline,top,False,monthly
"Due Date   Amount Paid   Principal Applied   Interest Applied   Escrow Deposit   Remaining Balance
2023-03-08 3507.77 602.60 1819.51 292.99 526659.69
O4/09/2023 2828.10 1139.56 1181.74 614.59 69567.89
02/07/2023      3580.16      1520.31      1044.85     1122.34      222879.55
12/12/2023  2293.64   997.56   1039.82   222.l2   180252.99
11/11/2023  4274.73  1356.02  971.37  1050.33 63837.26
2023-01-26   4263.59   1037.03   1791.29   336.56   625128.53
03/08/2023 1389.01 613.162487.31 718.23 623643.12",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-39b6badbb45946b5647c21f2,v11-MORTGAGE_STATEMENT-inline,original,2023,fgen-c53785332c6f3cd7821d1cd6,synthetic_programmatic_template,inline,top,True,raw_export
"Keystone Home Loans
Loan number  XXX-XX-801807
Property address 1221 Sample Street Cedar Falls, IA 66320
Projected property taxes 8,350.18
Projected homeowners insurance   1,845.24
Escrow shortage   214.73
New monthly escrow payment      337.55
New total monthly payment effective 10/8/22
IRS Form 1098 information for 2021 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 71984
Annual Escrow Account Disclosure Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c4225c56519f8d07c1a52b68,v11-MORTGAGE_STATEMENT-inline,original,2021,fgen-39af9de584b114e34969a366,synthetic_programmatic_template,inline,bottom,False,escrow_analysis
"Keystone Home Loans
Statement date 2021-10-17
Loan number ending in 059717
Property address 4915 Lakeshore Blvd Pinecrest, GA 10828
Payment due date  2021-05-14
Amount due  $3,658.58
Explanation of amount due
Principal   1,904.41
Interest   2,527.83
Escrow (for taxes and insurance)   1,185.68
Regular monthly payment  $3,617.79
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date   5,055.65
Outstanding principal      $224,924.34
Escrow balance      $2,797.75
Interest rate  4.969%
Your 2021 Form 1098 will be available online by January 31, 2022.
This is an attempt to collect a debt. NMLS ID 930827
Home Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fbe25e54c44a7145478b27e8,v11-MORTGAGE_STATEMENT-inline,original,2021,fgen-a07fa7ac1049138d891fd834,synthetic_programmatic_template,inline,bottom,False,monthly
"Payment Date      Total Payment      Principal      Interest      Escrow      Principal Balance
2022-05-09   3294.96   1566.85   857.80   197.50   496540.59
11/02/2022      988.94      898.61      2369.29      565.45      393928.56
02/12/2022   2413.48   371.66   405.36   1030.07   464952.36
2022-01-23 1091.40 1528.49 756.40 870.78 301411.59
02/20/2022 1496.89 425.83 2197.26 499.84 589496.79
02/05/2022 4274.85 891.15 746.94 314.45 243849.02
03/09/2022   1579.97   1289.95   886.88   180.94   637306.16",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-885378c15e824bd3297e49fb,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-e63d80d799dc24f30286bd02,synthetic_programmatic_template,inline,bottom,False,raw_export
"Mortgage Payoff Statement
Pinecrest Mortgage Company
Loan number   ****449713
Good through date 5/14/22
Unpaid principal balance      $441,050.57
Interest from last paid date $1,029.71
Recording fee      $45.00
Total amount to pay off loan      $442,109.82
Your 2022 Form 1098 will be available online by January 31, 2023.
This is an attempt to collect a debt. NMLS ID 969099",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d199f38bf9a3086a8b4e2a87,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-3c0b66fc847d22de82e3871b,synthetic_programmatic_template,inline,top,False,payoff
"Riverbend Mortgage Servicing
Statement date   December 21, 2022
Loan number ****109446
Property address      9515 Oak Hollow Ct Testville, IL 65371
Payment due date      6/9/22
Amount due $1,544.48
Explanation of amount due
Principal $1,176.34
Interest  2,030.42
Escrow (for taxes and insurance) 1,042.28
Regular monthly payment      $1,966.16
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date      6,091.25
Outstanding principal  $491,516.90
Escrow balance   $5,585.26
Interest rate  7.762%
IRS Form 1098 information for 2022 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 863024",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-5b06276b6239c2871d299151,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-e4d005ba880e0adac1e034dc,synthetic_programmatic_template,inline,none,False,monthly
"Due Date Amount Paid Principal Applied Interest Applied Escrow Deposit Remaining Balance
09/26/2022  2804.81  351.71  824.48  930.65  506472.36
11/18/2022 3809.48 956.24 1721.15 611.40 403222.97
05/22/2022   2727.08   1268.83   1815.64   674.26   562141.46
2022-10-28      3126.96      857.02      2001.77      392.93      505975.41
17/12/2022      3867.07      220.65      1028.75      668.20      126897.26
02/06/2022   1897.90   1198.93   1674.57   1106.13   74753.61
15/05/2022 2167.02 262.04 2225.60 361.16 94079.68
2022-03-07      4040.24      406.48      1272.09      521.60      442774.70",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-9b00cc235cc51c44e6a05824,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-92fdd505387266cce07cf3ab,synthetic_programmatic_template,inline,none,False,raw_export
"Keystone Home Loans
Statement date   November 22, 2022
Loan number   XXXXX458679
Property address   8195 Oak Hollow Ct Pinecrest, GA 69297
Payment due date  2022-03-05
Amount due  $4,466.49
Explanation of amount due
Principal      309.77
Interest 1,382.23
Escrow (for taxes and insurance)      792.23
Regular monthly payment      $3,653.90
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date   16,586.79
Outstanding principal $182,558.61
Escrow balance      $400.48
Interest rate      7.046%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
This statement is not a Form 1098. Keep it for your records.
This is an attempt to collect a debt. NMLS ID 705029
Monthly Mortgage Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-72b3064df23e936d649e5e45,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-4bac9fc0885b198a877c5c87,synthetic_programmatic_template,inline,bottom,False,monthly
"Mortgage Payoff Statement
Riverbend Mortgage Servicing
Loan number      ****574970
Good through date   06/23/2026
Unpaid principal balance  $284,757.98
Interest from last paid date 1,914.31
Recording fee $45.00
Total amount to pay off loan      $285,279.84
IRS Form 1098 information for 2026 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 880367",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-f8ee1fee87bdb1f6ff1dfaa5,v11-MORTGAGE_STATEMENT-inline,original,2026,fgen-6f0d592ca667de8505a20a44,synthetic_programmatic_template,inline,top,False,payoff
"Mortgage loan 1873 - payment history
Downloaded 05/15/2024
Due Date  Amount Paid  Principal Applied  Interest Applied  Escrow Deposit  Remaining Balance
12/23/2024  3952.85  252.49  1021.64  789.35  556710.26
12/04/2024   2816.86   557.54   1437.52   1005.20   571843.40
28/05/2024 3421.87 1228.61 2381.60 844.41 436919.91",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e803f2c4c8f5bc684430cb01,v11-MORTGAGE_STATEMENT-inline,original,2024,fgen-4c743c8309c262664087bcdd,synthetic_programmatic_template,inline,top,False,raw_export
"Loan History - Mortgage
Due Date   Amount Paid   Principal Applied   Interest Applied   Escrow Deposit   Remaining Balance
2024-10-01  3752.61  316.44  1090.92  917.56  329512.01
2024-02-24 2042.76 806.08 1211.13 531.13 102745.76
25/11/2024  3124.35  232.91  543.23  1009.70  510292.74
2024-12-02 1454.44 212.97 1106.06 663.48 205185.41",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-986292e6db29e86329cce609,v11-MORTGAGE_STATEMENT-inline,original,2024,fgen-3ffb8407474617b0cff4bc0e,synthetic_programmatic_template,inline,top,False,raw_export
"Due Date Amount Paid Principal Applied Interest Applied Escrow Deposit Remaining Balance
16/01/2026   3006.34   1089.36   1291.70   539.99   124549.56
2026-07-25   2950.33   1193.60   697.21   1182.77   511985.74
06/16/2026      1462.13      765.45      1506.02      939.14      555088.66
2026-11-07      2053.01      881.53      1245.52      188.92      163736.74
2026-04-02   1335.71   1243.49   821.41   317.60   501254.75
14/07/2026 3272.69 612.12 769.59 1127.18 232777.68
18/04/2026  1487.83  1200.98  863.22  877.82  362610.97
2026-01-20      3917.18      687.36      1734.73      376.60      470710.85",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-65d182c642c4ef95b1ff1bd2,v11-MORTGAGE_STATEMENT-inline,original,2026,fgen-b56b843368da52fcf5bdaa72,synthetic_programmatic_template,inline,none,False,raw_export
"Riverbend Mortgage Servicing
Statement date 2026-02-28
Loan number      XXX-XX-101659
Property address  1805 Sample Street Oak Grove, TX 77040
Payment due date 10/6/26
Amount due      $3,199.91
Explanation of amount due
Principal $1,887.24
Interest  1,309.16
Escrow (for taxes and insurance)   $795.37
Regular monthly payment  $4,125.91
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date   7,854.96
Outstanding principal  $295,984.47
Escrow balance      $5,600.84
Interest rate 2.537%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This statement is not a Form 1098. Keep it for your records.
This is an attempt to collect a debt. NMLS ID 325631",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4ab8b8a14079a2fbe6849378,v11-MORTGAGE_STATEMENT-inline,original,2026,fgen-fe09ac24b5be70d2ac368ed4,synthetic_programmatic_template,inline,none,False,monthly
"Monthly Mortgage Statement
Pinecrest Mortgage Company
Statement date  6/12/22
Loan number XXXXX816482
Property address      8965 Lakeshore Blvd Riverton, WI 63883
Payment due date  2022-11-04
Amount due      $3,444.25
Explanation of amount due
Principal  616.17
Interest  2,633.82
Escrow (for taxes and insurance) 482.45
Regular monthly payment 2,882.27
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date      18,436.75
Outstanding principal  $179,322.67
Escrow balance   $2,405.46
Interest rate   3.073%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This is an attempt to collect a debt. NMLS ID 327559",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0d75b9557e5f8923a665333d,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-e53a87d4e78f07bfb2d29a25,synthetic_programmatic_template,inline,top,False,monthly
"Mortgage Payoff Statement
Lakeshore Home Lending
Loan number  XXXXX813823
Good through date August 2, 2021
Unpaid principal balance $596,704.54
Interest from last paid date  1,992.22
Recording fee $45.00
Total amountto pay off loan  $597,776.45
This is an attempt to collect a debt. NMLS ID l56645",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-169721134c1ee6fab7b05fdf,v11-MORTGAGE_STATEMENT-inline,original,2021,fgen-32dd371b1a4b133326dac0c6,synthetic_programmatic_template,inline,top,True,payoff
"Monthly Mortgage Statement
Bluewater Loan Servicing
Statement date  2021-07-11
Loan number XXXXX252374
Property address   5053 Oak Hollow Ct Oak Grove, TX 49775
Payment due date      October 25, 2021
Amount due   $2,875.56
Explanation of amount due
Principal $775.20
Interest  3,068.51
Escrow (for taxes and insurance)   $844.61
Regular monthly payment $2,413.68
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 18,411.06
Outstanding principal   $601,580.76
Escrow balance $333.84
Interest rate  6.524%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This is an attempt to collect a debt. NMLS ID 233725",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fd48049106e732dd9f9b510e,v11-MORTGAGE_STATEMENT-inline,original,2021,fgen-2a6bc36d7756713eb1b98aad,synthetic_programmatic_template,inline,top,False,monthly
"Mortgage loan 7820 - payment history
Due Date   Amount Paid   Principal Applied   Interest Applied   Escrow Deposit   Remaining Balance
23/04/2026  2622.59  549.55  2176.98  529.75  135973.50
2026-08-03  1156.39  939.96  2128.84  426.39  482596.06
05/24/2026 2571.31 1503.06 1452.08 414.56 267981.27
07/04/2026      4056.83      254.62      1175.32      534.03      314509.54
16/07/2026      1681.34      1511.49      1468.63      486.78      629142.28
2026-04-04 3210.00 620.14 1828.07 1152.44 624166.12
22/02/2026  2681.05  1375.43  2191.65  1035.61  495918.63
2026-05-18      3339.87      448.73      1245.90      409.60      598848.17",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-6d3cab1e6578929ecc79ac12,v11-MORTGAGE_STATEMENT-inline,original,2026,fgen-a8280d37c6b234015ae6ef0f,synthetic_programmatic_template,inline,top,False,raw_export
"Mortgage Statement
Keystone Home Loans
Statement date      07/23/2021
Loan number   XXX-XX-239049
Property address   2406 Willow Bend Way Brookhaven, PA 64708
Payment due date   2/19/21
Amount due  $1,897.24
Explanation of amount due
Principal   $842.61
Interest 3,162.08
Escrow (for taxes and insurance)  $790.13
Regular monthly payment  $4,241.38
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 12,648.34
Outstanding principal   $208,575.82
Escrow balance $411.55
Interest rate      7.639%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Your 2021 Form 1098 will be available online by January 31, 2022.
This is an attempt to collect a debt. NMLS ID 732617",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0785cf4df475c399f55b22d6,v11-MORTGAGE_STATEMENT-inline,original,2021,fgen-beb29c8bc9a14a8039c9f273,synthetic_programmatic_template,inline,top,False,monthly
"Riverbend Mortgage Servicing
Loan number XXX-XX-384976
Good through date 8/11/25
Unpaid principal balance $585,933.02
Interest from last paid date      492.13
Recording fee   $45.00
Total amount to pay off loan   $588,319.20
This is an attempt to collect a debt. NMLS ID 768480
Mortgage Payoff Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-12c669e1d4ee555267ec4f98,v11-MORTGAGE_STATEMENT-inline,original,2025,fgen-297aec39a9f4d2fd914cedaa,synthetic_programmatic_template,inline,bottom,False,payoff
"Home Loan Activity
Payment Date      Total Payment      Principal      Interest      Escrow      Principal Balance
26/02/2025 2782.70 248.47 1369.73 476.31 546436.48
07/05/2025  2476.57  896.50  2488.66  341.50  545639.56
2025-06-25  3834.29  1279.80  1626.61  197.34  629931.09
17/09/2025 1568.85 978.43 1301.54 387.49 194054.17
2025-02-14   1230.51   1030.03   813.14   786.51   434800.46
02/06/2025   2098.78   675.67   2261.48   480.28   386634.54",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-283e784bb669688ed5326f48,v11-MORTGAGE_STATEMENT-inline,original,2025,fgen-8251839f1fcc5f0dc9a4c1a4,synthetic_programmatic_template,inline,top,False,raw_export
"Home Loan Statement
Pinecrest Mortgage Company
Statement date 10/11/2024
Loan number ***-**-299027
Property address  7648 Prairie Ave Maplewood, MN 47589
Payment due date 2024-09-17
Amount due      $2,755.74
Explanation of amount due
Principal   $2,417.40
Interest  2,254.92
Escrow (for taxes and insurance)      736.76
Regular monthly payment      987.87
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 4,509.83
Outstanding principal  $99,899.78
Escrow balance   $323.88
Interest rate      6.188%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
This is an attempt to collect a debt. NMLS ID 798747",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-2e4aebb85ddc9009c9ee8069,v11-MORTGAGE_STATEMENT-inline,original,2024,fgen-9fa8505038326f11134a5d2c,synthetic_programmatic_template,inline,top,False,monthly
"Pinecrest Mortgage Company
Statement date  2022-05-02
Loan number  XXXXX576395
Property address 3014 Granite St Maplewood, MN 77572
Payment due date   January 5, 2022
Amount due $4,382.62
Explanation of amount due
Principal 1,850.66
Interest 1,136.21
Escrow (for taxes and insurance) 352.15
Regular monthly payment 2,251.81
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 5,681.03
Outstanding principal $239,130.21
Escrow balance      $5,077.81
Interest rate 5.024%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
This statement is not a Form 1098. Keep it for your records.
This is an attempt to collect a debt. NMLS ID 156165",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-7a83c1229a67b842e09c9cfb,v11-MORTGAGE_STATEMENT-inline,original,2022,fgen-514b6d8d63bb4e5b3bc6792d,synthetic_programmatic_template,inline,none,False,monthly
"Home Loan Statement
Pinecrest Mortgage Company
Statement date      August 15, 2024
Loan number      XXXXX669783
Property address 9611 Willow Bend Way Lakewood, CO 34725
Payment due date   2024-07-09
Amount due      $3,876.24
Explanation of amount due
Principal      1,892.03
Interest 275.05
Escrow (for taxes and insurance) $215.10
Regular monthly payment      $1,552.85
Past payments breakdown  Paid last month  Paid year to date
Interest paid year to date 3,300.57
Outstanding principal $126,485.44
Escrow balance $4,706.06
Interest rate 7.534%
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 360925",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0b18e7693ad4b6d47843ff74,v11-MORTGAGE_STATEMENT-inline,original,2024,fgen-0790e2c513485ef71dbbfded,synthetic_programmatic_template,inline,top,False,monthly
"Annual Escrow Account Disclosure Statement
Pinecrest Mortgage Company
Loan number XXXXX640209
Property address      6197 Oak Hollow Ct Brookhaven, PA 20605
Projected property taxes      8,843.34
Projected homeowners insurance 988.78
Escrow shortage $590.24
New monthly escrow payment   746.68
New total monthly payment effective February 23, 2024
This is an attempt to collect a debt. NMLS ID 208613",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0034ea43230402f3f2971510,v11-MORTGAGE_STATEMENT-inline,original,2023,fgen-6903ac503dc819399c8435dc,synthetic_programmatic_template,inline,top,False,escrow_analysis
"Mortgage Statement Keystone Home Loans Statement date 08/18/2022 Loan number XXX-XX-650886
Property address 8684 Elm Park Pl Maplewood,
MN 86093 Payment due date August 22, 2022 Amount due $3,110.45 Explanation of amount due Principal $1,145.87 Interest 2,981.38 Escrow (for taxes and insurance) $679.92 Regular monthly payment 1,523.21 Past payments breakdown Paid last month Paid year to date Interest paid year to date 14,906.89 Outstanding principal $235,524.34 Escrow balance $3,693.73 Interest rate 6.120% This is an attempt to collect a debt. NMLS ID 770039",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-a675ab34355d92ef7611a838,v11-MORTGAGE_STATEMENT-flat,original,2022,fgen-0a7cf653fece28984a351709,synthetic_programmatic_template,flat,top,False,monthly
"Annual Escrow Account Disclosure Statement Bluewater Loan Servicing Loan number XXX-XX-252175 Property address 3079 Oak
Hollow Ct Bayside, WA 27065 Projected property taxes 9,986.14 Projected homeowners insurance $712.44 Escrow shortage $213.64 New monthly escrow payment $1,420.31 New total monthly payment effective 3/6/23 Your 2022 Form
1098 will be available online by January 31, 2023. This is an attempt to collect a debt. NMLS ID 136075",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-b4ba8beb1bcdafad44e21d45,v11-MORTGAGE_STATEMENT-flat,original,2022,fgen-35c2242306e7bba8c27b6077,synthetic_programmatic_template,flat,top,False,escrow_analysis
"Monthly Mortgage Statement Keystone Home Loans Statement date 03/03/2023 Loan number ending in 552787 Property address 8123 Harbor View Rd Testville, IL
75757 Payment due date 12/22/23 Amount due $1,132.20 Explanation of amount due Principal $2,166.18 Interest 1,650.53 Escrow (for taxes and insurance) $207.02 Regular monthly payment $3,412.11 Past payments breakdown Paid last month Paid year to date Interest paid year to date 4,951.59 Outstanding principal $288,173.81 Escrow balance $5,212.68 Interest rate 2.855% If you are experiencing financial difficulty, call a
HUD-approved housing counselor. Late fee of $75.00 will be charged if payment is received after the 16th. This statement is not a Form 1098. Keep it for your records. This is an attempt to collect a debt. NMLS ID 757832",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8a25981ac4939c4610fa1aa2,v11-MORTGAGE_STATEMENT-flat,original,2023,fgen-84ecf90253f8f5019680b3db,synthetic_programmatic_template,flat,top,False,monthly
"Home
Loan Statement Riverbend Mortgage Servicing Statement date November 7, 2024 Loan number ending in 752143 Property address 613 Lakeshore Blvd Maplewood, MN 21616 Payment due date February 19, 2024 Amount due $1,958.32 Explanation of amount due Principal $1,829.08 Interest 2,308.80 Escrow (for taxes and insurance) 631.21
Regular monthly payment 2,212.30 Past payments breakdown Paid last month Paid year to date Interest paid year to date 16,161.62 Outstanding principal $434,831.25 Escrow balance $3,276.85 Interest rate 5.864% This statement is not a Form 1098. Keep it for your records. This is an attempt to collect a debt. NMLS ID 468887",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-58aa5b0a0a65b3153d4fadbc,v11-MORTGAGE_STATEMENT-flat,original,2024,fgen-7361f9a785d15275d9703370,synthetic_programmatic_template,flat,top,False,monthly
"Home Loan Activity Date Transaction Amount Principal Interest Escrow Fees Unpaid Principal 12/05/2021 Escrow disbursement - county tax 3661.45 1287.41 1612.18 1078.27 0.00 453865.96 03/11/2021 Escrow disbursement - county tax 2721.62 953.84 1188.70 233.68 0.00 205776.62 2021-11-01 Escrow disbursement - county tax 936.20 451.65 2039.26 129.18 0.00 449475.93 01/03/2021 Escrow disbursement - county tax 2637.71 372.04 646.83 161.84 0.00 97095.77 2021-11-10 Regular monthly payment 1321.83
1111.75 678.57 303.15 0.00 126513.50 04/02/2021 Hazard insurance disbursement 2630.66 1235.60 2223.50 163.58 0.00 463719.51 16/01/2021 Additional principal 426.82 1253.65 993.54 48.70 0.00 515064.20 05/05/2021 Regular monthly payment 2270.70 558.61 2214.90 100.12 0.00
489166.22",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4985816271ea70ac4700892e,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-189c8358f90e821d622fdc87,synthetic_programmatic_template,flat,top,False,raw_export
"Pinecrest Mortgage Company Statement date 04/23/2022 Loan number ***-**-741796Property address 7588
Oak Ho1low
Ct Testville, IL 58334 Payment due date O7/21/2O22 Amount due S1,691.54 Explanatíon of amount duePrincipa1 $639.04 Interest 2,427.84 Escrow (fortaxes and insurance) 287.31 Regular monthly payment $4,394.34 Past payments breakdown Paid last month Paid year to date Interest paid year to date 4,855.67 0utstanding principal $231,365.35 Escrow balance $5,464.96 Interest rate 6.121% If you are experiencing fínancial difficulty, call a HUD-approved housing counselor. Tax reminder: amounts on this statement may differ from your Form 1O98. This is an attempt to collect a debt.NMLS ID 6875",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d59a9b117c16a2dedecb89f0,v11-MORTGAGE_STATEMENT-flat,original,2022,fgen-890785feed7f3839a511b838,synthetic_programmatic_template,flat,none,True,monthly
"Payment Date Total Payment Principal Interest Escrow Principal Balance 18/06/2026 3895.97 1166.17 845.81 494.31 127909.30 09/01/2026 4039.70 1485.05 1504.57 354.24 427370.13 2026-11-10 2209.16 802.52 1430.30 1070.75
484088.51 07/12/2026
1849.68 1547.85 2120.69 1088.64 123836.73",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c193ff47a13eea919586068d,v11-MORTGAGE_STATEMENT-flat,original,2026,fgen-42335f02875a2c7e36476000,synthetic_programmatic_template,flat,top,False,raw_export
"Home Loan Statement Riverbend Mortgage
Servicing Statement date July 3, 2024 Loan number ***-**-123932 Property address 9010 Granite St Riverton, WI 34922 Payment due date 12/12/24 Amount due $2,071.82 Explanation of amount due Principal $2,483.21 Interest 2,138.02 Escrow (for taxes and insurance) $1,208.52 Regular monthly payment $4,885.96 Past payments breakdown Paid last month Paid
year to date Interest paid year to date 12,828.15 Outstanding principal $187,143.10 Escrow balance $2,838.56 Interest rate 6.409% This is an attempt to collect a debt. NMLS ID 160524",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-dcc86644e6d6177c5f7eb9ec,v11-MORTGAGE_STATEMENT-flat,original,2024,fgen-8479f628054d4997bdc42209,synthetic_programmatic_template,flat,top,False,monthly
"Mortgage Statement Pinecrest Mortgage Company Statement date06/l7/2023 Loan number XXXXX718154 Property address862 Elm Park Pl Baysidc, WA 16067 Payment due date 12/15/23 Amount due $4,050.21
Explanation of amount due
Principal $2,264.21Interest 1,311.26 Escrow (for taxes and insurance) 637.55 Regu1ar monthly payment 4,193.78 Past payments breakdown Paid last month Paid year to date Interest paid year to date 13,112.58 0utstanding principa1 $381,552.18 Escrow balance $5,018.92 Interest rate 5.812% This is an attempt to collect a debt. NML5 ID 146354",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-b25ac205c2f916a89a1f760c,v11-MORTGAGE_STATEMENT-flat,original,2023,fgen-d33c5c581746e48df71517a2,synthetic_programmatic_template,flat,top,True,monthly
"Mortgage Statement Lakeshore Home Lending Statement date 2024-12-03 Loan number XXX-XX-119790 Property address 8979 Prairie Ave Testville, IL 70379 Payment due date 05/01/2024 Amount due $4,909.34 Explanation of amount due Principal $799.24 Interest 771.29 Escrow (for taxes and insurance) $1,302.51 Regular monthly payment $2,386.34 Past payments breakdown Paid last month Paid year to date Interest paid
year to date 3,085.16 Outstanding principal $284,105.89 Escrow balance $3,170.61 Interest
rate 4.064% This is an attempt to collect a debt. NMLS ID 146218",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-027e21b119a884d471a7f063,v11-MORTGAGE_STATEMENT-flat,original,2024,fgen-d362d2368c585d07daa72719,synthetic_programmatic_template,flat,top,False,monthly
"Annual Escrow Account Disclosure Statement Pinecrest
Mortgage Company Loan number ending in 927816 Property address 4416 Sample Street Riverton, WI 36946 Projected property taxes 5,222.83 Projected homeowners insurance $4,141.30 Escrow shortage $899.72 New monthly escrow payment 721.82 New total monthly payment effective
August 22, 2022 This is an attempt to collect a debt. NMLS ID 463335",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-73e21c6a1cc260881b2e05f1,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-3677988bace76d02fb6dff6b,synthetic_programmatic_template,flat,top,False,escrow_analysis
"Mortgage Payoff Statement Riverbend Mortgage Servicing Loan number XXX-XX-123757 Good through
date 02/18/2024 Unpaid principal balance $93,881.17 Interest from last paid date $916.75 Recording fee $45.00 Total amount to pay off loan $94,406.91 This
is an attempt to collect a debt. NMLS ID 96903",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-50ec8c9d6e5079f862909f9b,v11-MORTGAGE_STATEMENT-flat,original,2024,fgen-3b908da5c4c69a935cb1f202,synthetic_programmatic_template,flat,top,False,payoff
"Riverbend Mortgage
Servicing Statement date 2022-05-12 Loan number ****210764 Propertyaddress 3248 Prairic Ave Maplewood, MN 26736 Paymentdue date December 3, 2022 Amount due $4,505.17 Explanation of amount due Principal 595.74 Interest 3,119.23 Escrow (fortaxes and
insurance) 506.93 Regular monthly payment 3,587.91 Past payments breakdown Paid last month Paid year to date Interest paid year to date 6,238.46 0utstanding principal $523,793.84 Escrow balance $1,773.16 Interest rate 4.550% If you are experiencing financial difficulty, call a HUD-approvcd housing counselor. This statement is not a Form 1098. Keep it for your records. Thisis an attempt to co1lect a dcbt. NML5 ID 727588 Monthly Mortgage Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-41b825161628a63258b8f731,v11-MORTGAGE_STATEMENT-flat,original,2022,fgen-5caf1a1afb0b75b7c9bb7177,synthetic_programmatic_template,flat,bottom,True,monthly
"Due Date Amount Paid Principal Applied
Interest Applied Escrow Deposit Remaining Balance 05/03/2025 2169.35 1002.80 1898.36 209.95 233863.20 2025-05-14 2162.94 870.52 1663.69 458.21 496052.93 2025-12-06 2981.50
554.77 724.71 562.09 422645.27",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-95c7143724fee31b2880f7ca,v11-MORTGAGE_STATEMENT-flat,original,2025,fgen-fd7813bd3e4f4114c72c1914,synthetic_programmatic_template,flat,top,False,raw_export
"Due Date Amount Paid Principal Applied Interest Applied
Escrow Deposit Remaining Balance 10/09/2022 2260.52 833.27 2402.60 361.10 239944.64 2022-10-13 2535.76 273.13 2331.22 808.38 114054.44 01/10/2022 1649.45 742.98 858.39 719.74 427937.95 2022-12-23 3223.71
902.48 1149.64 902.89 120738.85",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-3fff303368aa6e9aab7e0a45,v11-MORTGAGE_STATEMENT-flat,original,2022,fgen-a01f814ce78baf2b9fbd8661,synthetic_programmatic_template,flat,bottom,False,raw_export
"Home Loan Statement Riverbend Mortgage Servicing Statement date 2025-10-02 Loan number ***-**-571135 Property address 9553 Harbor View Rd Lakewood, CO
68925 Payment due date March 9, 2025 Amount due $5,044.79 Explanation of amount due Principal 459.46 Interest 1,562.08 Escrow (for taxes and insurance) 1,357.83 Regular monthly payment $5,072.52 Past payments breakdown Paid last month Paid year to date Interest paid year to date 9,372.51 Outstanding principal $162,724.87 Escrow balance $3,836.67 Interest rate 3.409% If you are experiencing financial difficulty, call a HUD-approved housing counselor. Late fee of $75.00 will be charged if payment is received after the
16th. IRS Form 1098 information for 2025 will be mailed separately. This is an attempt to collect a debt. NMLS ID 796250",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-7cc72e036d31487c44b10f42,v11-MORTGAGE_STATEMENT-flat,original,2025,fgen-0a5d6db3ff1d52ff328c1c86,synthetic_programmatic_template,flat,top,False,monthly
"Riverbend Mortgage Servicing Statement date 2025-01-06 Loan number XXX-XX-731661 Property address 5692 Lakeshore Blvd Bayside, WA 23847 Payment due date June
8, 2025 Amount due $1,281.59 Explanation of amount due Principal 2,194.76 Interest 318.70 Escrow (for taxes and insurance) $297.29 Regular monthly payment 1,731.80 Past payments breakdown Paid last month
Paid year to date Interest paid year to date 3,824.42 Outstanding principal $326,761.78 Escrow balance $5,661.00 Interest rate 4.863% If you are experiencing financial difficulty, call a HUD-approved housing counselor. Tax reminder: amounts on this statement may differ from your Form 1098. This is an attempt to collect a debt. NMLS ID 509108",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-55cbd05d808b0b0b68413cf7,v11-MORTGAGE_STATEMENT-flat,original,2025,fgen-ad22be0ab6dd2e513550449c,synthetic_programmatic_template,flat,none,False,monthly
"Home Loan Statement Bluewater Loan Servicing Statement date 6/9/26 Loan number ending in 768854 Property address 2775 Harbor View Rd Testville, IL 89767 Payment due date 04/21/2026 Amount due $3,749.30 Explanation of amount due Principal $1,070.96 Interest 1,935.15 Escrow (for taxes and insurance) $766.55 Regular monthly payment 2,734.22 Past payments breakdown Paid last month Paid year to date Interest paid year to date 15,481.24 Outstanding
principal $233,791.06 Escrow balance
$3,952.99 Interest rate 2.965% Your 2026 Form 1098 will be available online by January 31, 2027. This is an attempt to collect a debt. NMLS ID 737920",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-1090f341379cef634f9b7360,v11-MORTGAGE_STATEMENT-flat,original,2026,fgen-52266cd8efdfedeb40185495,synthetic_programmatic_template,flat,top,False,monthly
"Date Transaction Amount Principal Interest Escrow Fees Unpaid Principal 2024-04-25 Additional principal 2184.15 421.70 2269.15 453.64 0.00 306429.22 26/10/2024 Additional principal 3565.53 770.52 1045.51 179.91 0.00 560937.85 02/13/2024 Hazard insurance disbursement 1012.07 1441.24 2265.04 844.50 0.00
317620.74 2024-07-26 Regular
monthly payment 1108.84 865.48 941.82 1098.17 0.00 118466.36",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-813be60730356056dad087ae,v11-MORTGAGE_STATEMENT-flat,original,2024,fgen-acdc0c1051e3d21c037dad8a,synthetic_programmatic_template,flat,top,False,raw_export
"Annual Escrow Account Disclosure Statement Lakeshore Home Lending
Loan number ****126711 Property address 5437 Harbor View Rd Testville, IL 15093 Projected property taxes $9,139.19 Projected homeowners insurance 2,565.45 Escrow shortage $453.95 New monthly escrow payment 514.41 New total monthly payment effective 2023-07-18 This is an attempt
to collect a debt. NMLS ID 563224",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-f2c32333818f072f233cc726,v11-MORTGAGE_STATEMENT-flat,original,2022,fgen-2b659bc26778bb1cb91aff36,synthetic_programmatic_template,flat,top,False,escrow_analysis
"Monthly Mortgage Statement Riverbend Mortgage Servicing Statement date 01/25/2021 Loan number ****723934 Property address 8147 Willow Bend Way Bayside, WA 28151 Payment due date 01/04/2021
Amount due $3,664.14 Explanation of amount due Principal $655.42 Interest 2,000.53 Escrow (for taxes and insurance) 708.08 Regular monthly payment 2,045.58 Past payments breakdown Paid last month Paid year to date Interest paid year to date 10,002.63 Outstanding principal $517,612.55 Escrow balance $3,979.90 Interest rate 2.671% Tax reminder: amounts on this statement may
differ from your Form 1098. This is an attempt to collect a debt. NMLS ID 684077",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-2b326ebfabff01babe9e8a78,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-e7bace5e8ec46786df3fa381,synthetic_programmatic_template,flat,top,False,monthly
"Mortgage Payoff Statement Keystone Home Loans Loan number ****967040 Good through date June 25, 2021 Unpaid principal balance $225,153.80 Interest from
last paid date 697.69 Recording fee $45.00
Total amount to pay off loan $227,556.81 This is an attempt to collect a debt. NMLS ID 946733",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-331e0b2c5822c813336b8eb4,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-d0a34879ecc671a5a23f7718,synthetic_programmatic_template,flat,top,False,payoff
"Monthly Mortgage Statement Pinecrest Mortgage Company Statement date April 16, 2025 Loan number ending in 819383 Property address 8341 Harbor View Rd Lakewood, CO 46978 Payment due date August 9, 2025 Amount due $2,248.93 Explanation of amount due Principal 337.99 Interest 663.03 Escrow (for taxes and insurance) 737.83 Regular monthly payment $4,021.87 Past payments breakdown Paid last month Paid year to date Interest paid year to date 2,652.12 Outstanding principal $386,336.68 Escrow
balance $4,323.76 Interest rate 4.318% This statement is not a Form 1098. Keep it for your records. This is an attempt
to collect a debt. NMLS ID 173196",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-3a0c5c82e59f67f4673fb20a,v11-MORTGAGE_STATEMENT-flat,original,2025,fgen-d5a3e8d45ac13f5441ccba7c,synthetic_programmatic_template,flat,top,False,monthly
"Bluewater Loan Servicing Loan number XXXXX742933 Good through dateAugust 25, 2024 Unpaid principal balancc S233,708.47 Interest from last paid date $9O2.88 Recording fee $45.00 Total amount to pay off 1oan $235,298.03 This statement is not a Form 1098. Keepit for your records. This is an
attempt to collect
a debt. NMLS ID 912583",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-eb49963f97c40600f5956b75,v11-MORTGAGE_STATEMENT-flat,original,2024,fgen-b91f49184c6965a545696706,synthetic_programmatic_template,flat,none,True,payoff
"Pinecrest Mortgage
Company Statement date June 23, 2021 Loan number XXXXX960464 Property address 4690 Elm Park Pl Oak Grove, TX 46066 Payment due date2021-09-05 Amount duc S4,390.44 Explanation of amount due Principal 736.01 Interest 1,646.38 Escrow (for taxes and insurance) $702.64 Regular monthly payment 2,516.15 Past payments breakdown Paid last month Paid year to date Interest paid year to date 8,231.88 0utstanding principal $l56,092.79Escrow balance $5,154.16 Interestrate 7.260% If you are experiencing financial difficulty, call a HUD-approved housing counselor. This is an attempt to collect a debt. NML5 ID 735286
Monthly Mortgage 5tatement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0f452f0db8a5d5e4fa496dc4,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-be2cdb0cb919d3347a9ee6c7,synthetic_programmatic_template,flat,bottom,True,monthly
"Monthly Mortgage Statement Pinecrest Mortgage Company Statement date 2026-07-26 Loan number ending in 593186 Property address 4877 Sample Street Pinecrest, GA 87527 Payment due date 05/12/2026 Amount due $3,582.52 Explanation of amount due Principal $1,473.09 Interest 483.54 Escrow (for taxes and insurance) 326.56 Regular monthly payment $1,550.55 Past payments breakdown Paid last month Paid year to date Interest paid year to
date 967.09 Outstanding principal $312,225.18 Escrow balance $5,468.15 Interest rate 2.737% This statement is not a Form 1098. Keep it for your records. This is an attempt to collect a debt. NMLS
ID 791580",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-25e6e522f2f480a0f7ee69b5,v11-MORTGAGE_STATEMENT-flat,original,2026,fgen-41b04ae20f99729bdc15db48,synthetic_programmatic_template,flat,top,False,monthly
"Home Loan Statement Riverbend Mortgage Servicing Statement date 2021-02-20 Loan number ****721648 Property address 8487 Granite St Testville, IL 75508 Payment due date July 13, 2021
Amount due $3,694.59 Explanation of amount due Principal 920.42 Interest 888.61 Escrow
(for taxes and insurance) 980.80 Regular monthly payment $2,544.03 Past payments breakdown Paid last month Paid year to date Interest paid year to date 8,886.10 Outstanding principal $622,968.52 Escrow balance $3,156.02 Interest rate 2.755% IRS Form 1098 information for 2021 will be mailed separately. This is an attempt to collect a debt. NMLS ID 287028",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-da5ccb83b586d8c114205a80,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-0f39fc3b570906e6daa7d414,synthetic_programmatic_template,flat,top,False,monthly
"Monthly Mortgage Statement Keystone Home Loans Statement datc 12/06/2021 Loan number ending in 063159 Property address 2654 Wi1low
Bend Way Pinecrest, GA 27694Payment due date 2021-07-15 Amount due S1,927.87Explanation of amount due Principal $2,394.82 Interest 773.44Escrow (for taxes and insurance) 1,487.98 Regular monthly payment 3,404.76 Past payments
breakdown Paid last month Paid year to date Interest paid year to date 6,187.54 Outstanding principal $98,7O9.44 Escrow balance $1,489.47 Interest rate 6.089% Your 2021 Form 1098 will be available online by January 31, 2022. This is an attempt to co1lect a debt. NMLS ID 941047",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c7763338a19b82dc89db5627,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-e29ae895173682fc5df7443e,synthetic_programmatic_template,flat,top,True,monthly
"Mortgage Statement Riverbend Mortgage Servicing Statement date 10/11/2021 Loan number XXX-XX-121479 Property address 4228 Harbor
View Rd Maplewood, MN 91119 Payment due date September 9, 2021 Amount due $2,631.34 Explanation of amount due Principal 2,379.88 Interest 1,651.50 Escrow (for taxes and insurance) $618.26 Regular monthly payment 5,073.12 Past payments breakdown Paid last month Paid year to date Interest paid year to date 11,560.49 Outstanding principal $570,077.35 Escrow balance $917.07 Interest rate 7.727% If you are experiencing financial difficulty, call a HUD-approved housing counselor. Late
fee of $75.00 will be charged if payment is received after the 16th. This is an attempt to collect a debt. NMLS ID 255898",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d9e816f08cb0cb67407fa101,v11-MORTGAGE_STATEMENT-flat,original,2021,fgen-8f6fbc55c310819ee868b898,synthetic_programmatic_template,flat,top,False,monthly
"Mortgage Payoff Statement Pinecrest Mortgage Company Loan number XXXXX024579 Good through date 2025-02-26 Unpaid principal balance $437,377.25 Interest from last paid date $429.76 Recording fee $45.00 Total
amount to
pay off loan $438,778.43 This is an attempt to collect a debt. NMLS ID 905669",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-fad583f1428ffb09ee9286a8,v11-MORTGAGE_STATEMENT-flat,original,2025,fgen-3c5a6134071db9b4266e2331,synthetic_programmatic_template,flat,top,False,payoff
"Pinecrest Mortgage Company Statement date 12/13/2025 Loan number ****137961 Property address 8731 Maple Ridge Dr Testville, IL 65659 Payment due date 04/19/2025 Amount due $1,818.66 Explanation of amount due Principal $414.14 Interest 2,618.76 Escrow (for taxes and insurance) $297.43 Regular monthly payment 3,699.12 Past payments breakdown Paid last month Paid year to date Interest paid year to date
28,806.38 Outstanding principal $319,981.61 Escrow balance $4,682.28 Interest rate 6.661% Late fee of $75.00 will be charged if payment is received after the 16th. This statement is
not a Form 1098. Keep it for your records. This is an attempt to collect a debt. NMLS ID 667855",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-b374037d54503a5de3286f58,v11-MORTGAGE_STATEMENT-flat,original,2025,fgen-22f6203c45d77bec2aa88846,synthetic_programmatic_template,flat,none,False,monthly
"Payment Date Total Payment Principal Interest Escrow Principa1 Ba1ance 13/05/20223900.35 683.66 1735.57 974.82 536949.04 08/l1/2022 3910.34 1083.56 365.78 182.28 82437.622022-02-13 1665.47 904.72 934.04 295.05 105465.26 11/08/2022 4298.93 1303.85 418.40 190.26 455798.65 08/10/2022 4256.14 723.14
1921.62 675.05 592336.28 10/05/2022 3512.48 1017.14 1120.62 193.98 574663.25 15/12/2022 2859.42 298.80 770.46 751.61 314402.04 24/03/2022 3775.68 1035.38 350.12 502.49 350739.15 06/18/2022 3505.45
1066.66 774.59 768.93 294224.65 Loan Hístory - Mortgagc",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-19fb96f744d43880f3257bf7,v11-MORTGAGE_STATEMENT-flat,original,2022,fgen-007b00b32f212ae705652a75,synthetic_programmatic_template,flat,bottom,True,raw_export
"## Monthly Mortgage Statement
## Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Statement date | 8/4/22 |
| Loan number | ending in 775409 |
| Property address | 5973 Lakeshore Blvd Lakewood, CO 40581 |
| Payment due date | September 10, 2022 |
| Amount due | $3,487.43 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | $538.36 |
| Interest | 944.67 |
| Escrow (for taxes and insurance) | 468.71 |
| Regular monthly payment | $1,676.55 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 5,668.03 |
| Outstanding principal | $343,286.03 |
| Escrow balance | $4,112.70 |
| Interest rate | 2.528% |
## Late fee of $75.00 will be charged if payment is received after the 16th.
Your 2022 Form 1098 will be available online by January 31, 2023.
## This is an attempt to collect a debt. NMLS ID 605906",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-adcc9a9eb4725f03a8ff52ca,v11-MORTGAGE_STATEMENT-markdown,original,2022,fgen-fb7cc3ea26d9f7d14e39b781,synthetic_programmatic_template,markdown,top,False,monthly
"Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Statement date | 06/23/2022 |
| Loan number | ending in 828192 |
| Property address | 8437 Harbor View Rd Pinecrest, GA 91906 |
| Payment due date | 1/15/22 |
| Amount due | $2,183.58 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | $2,398.94 |
| Interest | 3,004.61 |
| Escrow (for taxes and insurance) | $1,299.20 |
| Regular monthly payment | $3,026.78 |
## Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 9,013.83 |
| Outstanding principal | $574,120.47 |
| Escrow balance | $2,814.23 |
| Interest rate | 4.365% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
## Late fee of $75.00 will be charged if payment is received after the 16th.
This is an attempt to collect a debt. NMLS ID 998624",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-af36db398308a66006bda6e6,v11-MORTGAGE_STATEMENT-markdown,original,2022,fgen-927ed146401e885ac4c29649,synthetic_programmatic_template,markdown,none,False,monthly
"## Mortgage Statement
Keystone Home Loans
| Field | Value |
| --- | --- |
| Statement date | 06/23/2021 |
| Loan number | XXX-XX-228057 |
| Property address | 279 Willow Bend Way Fairview, OH 42388 |
| Payment due date | 10/14/2021 |
| Amount due | $1,644.21 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | $1,166.51 |
| Interest | 700.20 |
| Escrow (for taxes and insurance) | 1,460.00 |
| Regular monthly payment | 3,246.63 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 7,702.24 |
| Outstanding principal | $186,477.51 |
| Escrow balance | $3,322.03 |
| Interest rate | 3.898% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
## Late fee of $75.00 will be charged if payment is received after the 16th.
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 347300",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-956694968d2149cb52b3f73e,v11-MORTGAGE_STATEMENT-markdown,original,2021,fgen-7451a010b7c95f95c9bdfd8e,synthetic_programmatic_template,markdown,top,False,monthly
"## Mortgage Statement
Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Statement date | 2026-06-03 |
| Loan number | XXXXX040060 |
| Property address | 9157 Lakeshore Blvd Riverton, WI 45798 |
| Payment due date | April 18, 2026 |
| Amount due | $1,821.57 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 1,407.46 |
| Interest | 1,766.09 |
| Escrow (for taxes and insurance) | 568.89 |
| Regular monthly payment | $1,310.20 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 3,532.19 |
| Outstanding principal | $452,069.35 |
| Escrow balance | $252.14 |
| Interest rate | 7.814% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
IRS Form 1098 information for 2026 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 455087",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-521277d00508a5313f645bf9,v11-MORTGAGE_STATEMENT-markdown,original,2026,fgen-1e973feeb3f70d545fb83e29,synthetic_programmatic_template,markdown,top,False,monthly
"Home Loan Statement
## Riverbend Mortgage Servicing
| Field | Value |
| --- | --- |
| Statement date | August 16, 2025 |
| Loan number | ****963577 |
| Property address | 1543 Lakeshore Blvd Oak Grove, TX 90479 |
| Payment due date | 06/17/2025 |
| Amount due | $933.14 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 771.82 |
| Interest | 2,390.26 |
| Escrow (for taxes and insurance) | 1,183.02 |
| Regular monthly payment | 1,865.14 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 14,341.56 |
| Outstanding principal | $254,269.80 |
| Escrow balance | $313.31 |
| Interest rate | 3.090% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
## This statement is not a Form 1098. Keep it for your records.
This is an attempt to collect a debt. NMLS ID 88436",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-9f88c05955ef5a3a76c1666e,v11-MORTGAGE_STATEMENT-markdown,original,2025,fgen-5f1e77ec6135a7f5f8df1c51,synthetic_programmatic_template,markdown,top,False,monthly
"Monthly Mortgage Statement
Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Statement date | 3/4/24 |
| Loan number | XXXXX627970 |
| Property address | 429 Maple Ridge Dr Cedar Falls, IA 57042 |
| Payment due date | June 10, 2024 |
| Amount due | $3,714.97 |
## Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 1,905.20 |
| Interest | 2,195.69 |
| Escrow (for taxes and insurance) | $975.92 |
| Regular monthly payment | 3,713.19 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 13,174.16 |
| Outstanding principal | $304,912.19 |
| Escrow balance | $1,111.79 |
| Interest rate | 4.918% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
This is an attempt to collect a debt. NMLS ID 875703",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-15dd1512f42197cf013a54ab,v11-MORTGAGE_STATEMENT-markdown,original,2024,fgen-0ef87e1c91a9359185a4d40c,synthetic_programmatic_template,markdown,top,False,monthly
"Mortgage Payoff Statement
Pinecrest Mortgage Company
| Field | Value |
| --- | --- |
| Loan number | XXXXX631925 |
| Good through date | 3/21/24 |
| Unpaid principal balance | $377,022.49 |
| Interest from last paid date | 1,330.84 |
| Recording fee | $45.00 |
| Total amount to pay off loan | $378,994.08 |
Your 2024 Form 1098 will be available online by January 31, 2025.
This is an attempt to collect a debt. NMLS ID 554646",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-19a0df81083cba069c2f2d1b,v11-MORTGAGE_STATEMENT-markdown,original,2024,fgen-6e366fe13c5d2cd92365cf9a,synthetic_programmatic_template,markdown,top,False,payoff
"Lakeshore Home Lending
| Field | Value |
| --- | --- |
| Statement date | 2021-09-26 |
| Loan number | ending in 790754 |
| Property address | 3471 Elm Park Pl Riverton, WI 69218 |
| Payment due date | March 17, 2021 |
| Amount due | $3,316.50 |
## Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 1,090.54 |
| Interest | 2,197.80 |
| Escrow (for taxes and insurance) | 1,375.82 |
| Regular monthly payment | $1,727.15 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 17,582.37 |
| Outstanding principal | $411,446.33 |
| Escrow balance | $2,919.40 |
| Interest rate | 6.227% |
This is an attempt to collect a debt. NMLS ID 146718
Mortgage Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-daab1c91725abedb442a367c,v11-MORTGAGE_STATEMENT-markdown,original,2021,fgen-e0642815f74e31edf4eeb239,synthetic_programmatic_template,markdown,bottom,False,monthly
"Monthly Mortgage Statement
Keystone Home Loans
| Field | Value |
| --- | --- |
| Statement date | 04/13/2023 |
| Loan number | ****635618 |
| Property address | 7619 Maple Ridge Dr Bayside, WA 37625 |
| Payment due date | 2023-12-19 |
| Amount due | $5,063.83 |
## Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 1,032.05 |
| Interest | 534.07 |
| Escrow (for taxes and insurance) | $1,277.35 |
| Regular monthly payment | 4,470.10 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 5,874.80 |
| Outstanding principal | $595,589.12 |
| Escrow balance | $267.25 |
| Interest rate | 5.824% |
## If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Late fee of $75.00 will be charged if payment is received after the 16th.
This statement is not a Form 1098. Keep it for your records.
## This is an attempt to collect a debt. NMLS ID 215609",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-53ac7347e403c09128dfc961,v11-MORTGAGE_STATEMENT-markdown,original,2023,fgen-4ecf76aabcdc2a1b61e1711c,synthetic_programmatic_template,markdown,top,False,monthly
"Mortgage Payoff Statement
Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Loan number | XXXXX604848 |
| Good through date | 1/7/21 |
| Unpaid principal balance | $156,746.51 |
| Interest from last paid date | $1,373.15 |
| Recording fee | $45.00 |
| Total amount to pay off loan | $159,136.87 |
This statement is not a Form 1098. Keep it for your records.
## This is an attempt to collect a debt. NMLS ID 554813",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0c3f9b768a405c319995310d,v11-MORTGAGE_STATEMENT-markdown,original,2021,fgen-d2838f643f5c28feb37eebd3,synthetic_programmatic_template,markdown,top,False,payoff
"Mortgage Payoff Statement
Lakeshore Home Lending
| Field | Value |
| --- | --- |
| Loan number | ending in 834905 |
| Good through date | 11/10/24 |
| Unpaid principal balance | $428,202.43 |
| Interest from last paid date | 749.03 |
| Recording fee | $45.00 |
| Total amount to pay off loan | $428,564.98 |
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 103500",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-169fc29be1587378b1ca76f1,v11-MORTGAGE_STATEMENT-markdown,original,2024,fgen-de7e07a302948a698259c049,synthetic_programmatic_template,markdown,top,False,payoff
"Mortgage Payoff Statement
Riverbend Mortgage Servicing
| Field | Value |
| --- | --- |
| Loan number | XXX-XX-930370 |
| Good through date | August 27, 2026 |
| Unpaid principal balance | $407,213.23 |
| Interest from last paid date | $2,132.53 |
| Recording fee | $45.00 |
| Total amount to pay off loan | $407,642.79 |
This is an attempt to collect a debt. NMLS ID 804470",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-99585360bcf830507c73fa0f,v11-MORTGAGE_STATEMENT-markdown,original,2026,fgen-8251cb82acb7270f18f3f727,synthetic_programmatic_template,markdown,top,False,payoff
"Home Loan Statement
Lakeshore Home Lending
| Field | Value |
| --- | --- |
| Statement date | July 24, 2024 |
| Loan number | XXXXX500595 |
| Property address | 8093 Maple Ridge Dr Bayside, WA 54648 |
| Payment due date | November 21, 2024 |
| Amount due | $4,960.30 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 2,333.12 |
| Interest | 1,216.41 |
| Escrow (for taxes and insurance) | 247.52 |
| Regular monthly payment | $1,890.24 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 10,947.66 |
| Outstanding principal | $323,894.54 |
| Escrow balance | $2,554.50 |
| Interest rate | 5.133% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
## This is an attempt to collect a debt. NMLS ID 862741",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-07f952523932e2cff349f018,v11-MORTGAGE_STATEMENT-markdown,original,2024,fgen-78551162550d50e6417241ed,synthetic_programmatic_template,markdown,top,False,monthly
"## Riverbend Mortgage Servicing
| Field | Value |
| --- | --- |
| Statement date | 6/21/25 |
| Loan number | ***-**-021218 |
| Property address | 9360 Oak Hollow Ct Pinecrest, GA 37232 |
| Payment due date | 12/03/2025 |
| Amount due | $2,217.19 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 1,537.37 |
| Interest | 1,435.66 |
| Escrow (for taxes and insurance) | $1,389.17 |
| Regular monthly payment | $2,861.96 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 8,613.98 |
| Outstanding principal | $250,220.22 |
| Escrow balance | $1,706.37 |
| Interest rate | 5.907% |
Your 2025 Form 1098 will be available online by January 31, 2026.
This is an attempt to collect a debt. NMLS ID 679929
## Monthly Mortgage Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-eaf6a3a5a4514c81b7925aa0,v11-MORTGAGE_STATEMENT-markdown,original,2025,fgen-88e06b505dda9f3c9fa12b66,synthetic_programmatic_template,markdown,bottom,False,monthly
"Home Loan Statement
## Riverbend Mortgage Servicing
| Field | Value |
| --- | --- |
| Statement date | 11/23/2021 |
| Loan number | ***-**-656711 |
| Property address | 6307 Harbor View Rd Riverton, WI 34782 |
| Payment due date | 04/24/2021 |
| Amount due | $4,903.49 |
## Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | $454.56 |
| Interest | 3,053.94 |
| Escrow (for taxes and insurance) | 1,114.62 |
| Regular monthly payment | 4,218.36 |
## Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 9,161.82 |
| Outstanding principal | $234,652.63 |
| Escrow balance | $4,516.18 |
| Interest rate | 6.530% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Tax reminder: amounts on this statement may differ from your Form 1098.
This is an attempt to collect a debt. NMLS ID 547342",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-4dd7d357bbd46903b9c35a0d,v11-MORTGAGE_STATEMENT-markdown,original,2021,fgen-6da2bd52cb2f08fce35dd0fc,synthetic_programmatic_template,markdown,top,False,monthly
"## Annual Escrow Account Disclosure Statement
Pinecrest Mortgage Company
| Field | Value |
| --- | --- |
| Loan number | XXX-XX-343071 |
| Property address | 5610 Granite St Brookhaven, PA 27592 |
| Projected property taxes | 3,262.21 |
| Projected homeowners insurance | 2,220.40 |
| Escrow shortage | $16.23 |
| New monthly escrow payment | 1,441.19 |
| New total monthly payment effective | 4/7/24 |
This is an attempt to collect a debt. NMLS ID 763798",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-c86e976b8c1cba3389ae6e44,v11-MORTGAGE_STATEMENT-markdown,original,2023,fgen-fce133bcf8bc156836f4b7aa,synthetic_programmatic_template,markdown,top,False,escrow_analysis
"Home Loan Statement
Lakeshore Home Lending
| Field | Value |
| --- | --- |
| Statement date | 11/27/26 |
| Loan number | XXX-XX-421918 |
| Property address | 3413 Willow Bend Way Oak Grove, TX 16198 |
| Payment due date | 1/26/26 |
| Amount due | $2,135.21 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 598.52 |
| Interest | 2,382.32 |
| Escrow (for taxes and insurance) | 785.97 |
| Regular monthly payment | 4,791.87 |
## Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 26,205.50 |
| Outstanding principal | $286,879.04 |
| Escrow balance | $5,885.10 |
| Interest rate | 7.138% |
If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This is an attempt to collect a debt. NMLS ID 64393",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-bc0da8cdbeb89ddea0290bc5,v11-MORTGAGE_STATEMENT-markdown,original,2026,fgen-261aa0205805c6dd32da27f5,synthetic_programmatic_template,markdown,top,False,monthly
"Riverbend Mortgage Servicing
| Field | Value |
| --- | --- |
| Loan number | ending in 288781 |
| Good through date | 5/12/23 |
| Unpaid principal balance | $301,185.93 |
| Interest from last paid date | $1,819.44 |
| Recording fee | $45.00 |
| Total amount to pay off loan | $303,404.51 |
## Your 2023 Form 1098 will be available online by January 31, 2024.
## This is an attempt to collect a debt. NMLS ID 711116
## Mortgage Payoff Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-64a43ece63acde42cf2312fd,v11-MORTGAGE_STATEMENT-markdown,original,2023,fgen-cd67a01eb43bd43e9939e958,synthetic_programmatic_template,markdown,bottom,False,payoff
"Loan History - Mortgage
| Payment Date | Total Payment | Principal | Interest | Escrow | Principal Balance |
| --- | --- | --- | --- | --- | --- |
| 2021-11-22 | 2605.73 | 1584.26 | 2462.64 | 837.79 | 106577.20 |
| 2021-12-22 | 3327.52 | 312.13 | 1794.08 | 188.27 | 521067.12 |
| 01/17/2021 | 4452.34 | 1284.48 | 2264.58 | 556.84 | 561444.87 |
| 27/09/2021 | 3357.34 | 889.17 | 769.83 | 915.39 | 478119.23 |
| 05/12/2021 | 2607.93 | 1014.03 | 2181.01 | 820.61 | 257573.75 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-0f2c4c1d784359253191ec97,v11-MORTGAGE_STATEMENT-markdown,original,2021,fgen-b2cef8a8f037df0743854d41,synthetic_programmatic_template,markdown,top,False,raw_export
"## Monthly Mortgage Statement
Riverbend Mortgage Servicing
| Field | Value |
| --- | --- |
| Statement date | 06/23/2023 |
| Loan number | XXXXX554388 |
| Property address | 6433 Willow Bend Way Oak Grove, TX 10322 |
| Payment due date | 3/23/23 |
| Amount due | $4,720.63 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 554.92 |
| Interest | 253.77 |
| Escrow (for taxes and insurance) | 285.70 |
| Regular monthly payment | $3,976.05 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 3,045.19 |
| Outstanding principal | $202,080.73 |
| Escrow balance | $5,184.96 |
| Interest rate | 2.565% |
This is an attempt to collect a debt. NMLS ID 687008",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-29e1bd8cb4f5404dd5ca8348,v11-MORTGAGE_STATEMENT-markdown,original,2023,fgen-08f53ce55ea881686db6ce7c,synthetic_programmatic_template,markdown,top,False,monthly
"Home Loan Statement
## Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Statement date | 05/05/2026 |
| Loan number | ending in 665019 |
| Property address | 4145 Lakeshore Blvd Bayside, WA 30996 |
| Payment due date | July 21, 2026 |
| Amount due | $2,518.64 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 2,242.67 |
| Interest | 1,294.55 |
| Escrow (for taxes and insurance) | $491.54 |
| Regular monthly payment | $3,573.17 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 12,945.47 |
| Outstanding principal | $312,954.52 |
| Escrow balance | $3,582.72 |
| Interest rate | 3.920% |
## If you are experiencing financial difficulty, call a HUD-approved housing counselor.
Your 2026 Form 1098 will be available online by January 31, 2027.
This is an attempt to collect a debt. NMLS ID 740235",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-833be962c631ea00d07a53ad,v11-MORTGAGE_STATEMENT-markdown,original,2026,fgen-b988112fbb1e49c8c5d1ff9d,synthetic_programmatic_template,markdown,top,False,monthly
"Home Loan Statement
## Pinecrest MortgageCompany
| Field | Value |
| --- | --- |
| Statement date | O5/10/2025 |
| Loan number | ending in 405976 |
| Property address | 3027 Oak Hollow Ct Cedar Falls, IA 19714 |
| Payment due date | April 10, 2025 |
| Amount due | S3,l35.19 |
Exp1anation of amount due
| Field | Value |
| --- | --- |
| Principal| $1,567.68 |
| Interest | 2,177.76 |
| Escrow (for taxes and insurance) | $l,096.23 |
| Regular monthly payment | 4,312.33 |
## Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 4,355.52 |
| 0utstanding principa1 | $306,073.70 |
| Escrow balance | $627.63 |
| Interest rate | 4.951% |
If you are experíencing financial difficulty, call a HUD-approved housing counselor.
Thisis an attempt tocollect a debt. NML5ID 478327",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-8c26ebcddc2d5f79b157936d,v11-MORTGAGE_STATEMENT-markdown,original,2025,fgen-0ad10dd1e6c4be7ebc24fdbc,synthetic_programmatic_template,markdown,top,True,monthly
"Annual Escrow Account Disclosure Statement
Pinecrest Mortgage Company
| Field | Value |
| --- | --- |
| Loan number | ****894991 |
| Property address | 3043 Cedar Ln Testville, IL 69848 |
| Projected property taxes | $13,414.89 |
| Projected homeowners insurance | 1,780.48 |
| Escrow shortage | 168.16 |
| New monthly escrow payment | 1,177.57 |
| New total monthly payment effective | 7/1/22 |
IRS Form 1098 information for 2021 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 297894",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-e46db30197e84511b27fb133,v11-MORTGAGE_STATEMENT-markdown,original,2021,fgen-0483525158a3294564b49234,synthetic_programmatic_template,markdown,top,False,escrow_analysis
"Mortgage Statement
## Keystone Home Loans
| Field | Value |
| --- | --- |
| Statement date | November 14, 2024 |
| Loan number | ****273259 |
| Property address | 2046 Sample Street Cedar Falls, IA 80566 |
| Payment due date | 07/05/2024 |
| Amount due | $1,599.08 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 1,260.09 |
| Interest | 2,170.57 |
| Escrow (for taxes and insurance) | 562.26 |
| Regular monthly payment | $1,929.47 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 13,023.41 |
| Outstanding principal | $517,943.22 |
| Escrow balance | $5,143.72 |
| Interest rate | 6.699% |
## If you are experiencing financial difficulty, call a HUD-approved housing counselor.
## Late fee of $75.00 will be charged if payment is received after the 16th.
This is an attempt to collect a debt. NMLS ID 401581",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-19e6e2cfa7e2117d906016f0,v11-MORTGAGE_STATEMENT-markdown,original,2024,fgen-398fac723d47b824f3d62ef1,synthetic_programmatic_template,markdown,top,False,monthly
"Downloaded 05/22/2023
| Due Date | Amount Paid | Principal Applied | Interest Applied | Escrow Deposit | Remaining Balance |
| --- | --- | --- | --- | --- | --- |
| 02/06/2023 | 3828.33 | 712.24 | 2190.44 | 869.77 | 345199.35 |
| 17/04/2023 | 1181.37 | 1221.66 | 2475.24 | 622.59 | 182924.28 |
| 01/04/2023 | 3270.83 | 1433.20 | 1058.63 | 808.36 | 209322.62 |
| 07/06/2023 | 3024.17 | 490.65 | 712.93 | 819.79 | 98325.04 |
| 02/15/2023 | 2270.42 | 1386.81 | 1379.43 | 881.26 | 589951.19 |
| 15/12/2023 | 1758.20 | 1552.43 | 2346.95 | 963.54 | 326221.46 |
| 15/06/2023 | 4436.11 | 938.24 | 343.05 | 1056.12 | 402383.16 |",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-d0414b698e05019b05410db5,v11-MORTGAGE_STATEMENT-markdown,original,2023,fgen-fb8f5d0b47752fa2fb331951,synthetic_programmatic_template,markdown,top,False,raw_export
"## Annual Escrow Account Disclosure Statement
Lakeshore Home Lending
| Field | Value |
| --- | --- |
| Loan number | XXXXX590126 |
| Property address | 9444 Willow Bend Way Pinecrest, GA 45498 |
| Projected property taxes | $12,555.53 |
| Projected homeowners insurance | $2,239.25 |
| Escrow shortage | 103.02 |
| New monthly escrow payment | $652.27 |
| New total monthly payment effective | 10/07/2022 |
Your 2021 Form 1098 will be available online by January 31, 2022.
## This is an attempt to collect a debt. NMLS ID 548668",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-65044090aee1f270b6280346,v11-MORTGAGE_STATEMENT-markdown,original,2021,fgen-c6052295b3f3e74bcf59ed2a,synthetic_programmatic_template,markdown,top,False,escrow_analysis
"Mortgage Payoff Statement
Pinecrest Mortgage Company
| Field | Value |
| --- | --- |
| Loan number | ****067434 |
| Good through date | 10/7/22 |
| Unpaid principal balance | $377,529.47 |
| Interest from last paid date | $834.40 |
| Recording fee | $45.00 |
| Total amount to pay off loan | $379,944.79 |
## IRS Form 1098 information for 2022 will be mailed separately.
This is an attempt to collect a debt. NMLS ID 683906",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-f1fa20dcd85bb74037cdadbf,v11-MORTGAGE_STATEMENT-markdown,original,2022,fgen-bf7b144c53f21ef4d72a93f0,synthetic_programmatic_template,markdown,top,False,payoff
"Monthly Mortgage Statement
## Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Statement date | 2025-12-09 |
| Loan number | XXX-XX-425727 |
| Property address | 4420 Maple Ridge Dr Pinecrest, GA 78220 |
| Payment due date | 08/24/2025 |
| Amount due | $4,449.85 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | $542.35 |
| Interest | 673.05 |
| Escrow (for taxes and insurance) | $1,346.18 |
| Regular monthly payment | 3,755.73 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 2,692.18 |
| Outstanding principal | $360,987.09 |
| Escrow balance | $3,466.38 |
| Interest rate | 5.963% |
## If you are experiencing financial difficulty, call a HUD-approved housing counselor.
This is an attempt to collect a debt. NMLS ID 740138",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-df6ed461c5901f58d73c38ba,v11-MORTGAGE_STATEMENT-markdown,original,2025,fgen-3a225092b3289e50804e1392,synthetic_programmatic_template,markdown,top,False,monthly
"## Riverbend Mortgage Servicing
| Field | Value |
| --- | --- |
| Loan number | ***-**-003547 |
| Property address | 9134 Cedar Ln Brookhaven, PA 41600 |
| Projected property taxes | 9,995.74 |
| Projected homeowners insurance | 2,701.75 |
| Escrow shortage | $1,175.93 |
| New monthly escrow payment | 1,169.16 |
| New total monthly payment effective | August 26, 2027 |
## This is an attempt to collect a debt. NMLS ID 79379",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-57f0a385e2dedfd143962a5b,v11-MORTGAGE_STATEMENT-markdown,original,2026,fgen-98e311768555102213a81ca2,synthetic_programmatic_template,markdown,none,False,escrow_analysis
"## Bluewater Loan Servicing
| Field | Value |
| --- | --- |
| Statement date | 10/15/26 |
| Loan number | ending in 284625 |
| Property address | 1087 Elm Park Pl Bayside, WA 73321 |
| Payment due date | 01/28/2026 |
| Amount due | $4,981.50 |
Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | 411.07 |
| Interest | 1,822.40 |
| Escrow (for taxes and insurance) | 409.65 |
| Regular monthly payment | $3,639.52 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 5,467.19 |
| Outstanding principal | $428,890.94 |
| Escrow balance | $1,076.94 |
| Interest rate | 5.022% |
## If you are experiencing financial difficulty, call a HUD-approved housing counselor.
## This is an attempt to collect a debt. NMLS ID 734947",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-700f71411a75795c6fbf4c98,v11-MORTGAGE_STATEMENT-markdown,original,2026,fgen-ec07fca4485409e24850e3ff,synthetic_programmatic_template,markdown,none,False,monthly
"Keystone Home Loans
| Field | Value |
| --- | --- |
| Statement date | 2022-02-25 |
| Loan number | XXX-XX-624790 |
| Property address | 8933 Prairie Ave Testville, IL 86477 |
| Payment due date | December 5, 2022 |
| Amount due | $3,206.81 |
## Explanation of amount due
| Field | Value |
| --- | --- |
| Principal | $2,460.47 |
| Interest | 631.45 |
| Escrow (for taxes and insurance) | 1,334.54 |
| Regular monthly payment | $4,325.82 |
Past payments breakdown  Paid last month  Paid year to date
| Field | Value |
| --- | --- |
| Interest paid year to date | 5,051.57 |
| Outstanding principal | $258,393.80 |
| Escrow balance | $5,748.78 |
| Interest rate | 6.732% |
This is an attempt to collect a debt. NMLS ID 692587
Home Loan Statement",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-afc231e667fa78cd5c36b832,v11-MORTGAGE_STATEMENT-markdown,original,2022,fgen-cf8654d5951c351a054bb3a7,synthetic_programmatic_template,markdown,bottom,False,monthly
"| Payment Date | Total Payment | Principal | Interest | Escrow | Principal Balance |
| --- | --- | --- | --- | --- | --- |
| 04/08/2023 | 3482.90 | 1236.10 | 1046.42 | 1070.29 | 639533.34 |
| 03/01/2023 | 4383.64 | 437.06 | 1912.59 | 745.39 | 70854.14 |
| 11/19/2023 | 3252.21 | 1266.91 | 1782.47 | 941.92 | 302251.11 |
| 04/10/2023 | 2578.05 | 1336.02 | 573.52 | 817.76 | 237906.74 |
| 11/18/2023 | 4497.89 | 1161.53 | 870.85 | 676.57 | 132435.27 |
## Home Loan Activity",LOAN_STATEMENT,42,LOAN_STATEMENT,fdc-7e00b4927f325a69180fff1f,v11-MORTGAGE_STATEMENT-markdown,original,2023,fgen-49d242463ca78a2b124cf226,synthetic_programmatic_template,markdown,bottom,False,raw_export
"2024
Department of Revenue
Recipient's name
Noah K. Nguyen
Identification number
XXXXX6768
Box 3. Benefits Paid in
April 14, 2024
Box 4. Benefits Repaid to SSA in
$2,417.09
Box 5. Net Benefits for
4/27/24
Box 6. Voluntary Federal Income Tax Withholding
4,758.89",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-78ef84fed575b6a038cfb299,v11-OTHER_TAX_FORM-kind00,original,2024,fgen-83bd36d181d4b03d18e41497,synthetic_programmatic_template,stacked,none,False,SSA-1099
"2024
Keepfor your records
Taxpayer name Jamie Nguyen
Identification number XXXXX5928
Box 3. Benefits Paid in  $13,887.47
Box 4. Benefits Repaid to SSA in O4/06/2024
Box 5. Net Benefits for $17,541.85
Box 6. Vo1untary Federal Income Tax Withholding  2/28/24",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8d80f08f83911991ddf27da1,v11-OTHER_TAX_FORM-kind00,original,2024,fgen-29aaa61c092a9d89878f7f64,synthetic_programmatic_template,inline,none,True,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
Department of the Treasury - Internal Revenue Service
Recipient's name
SSN
Box 3. Benefits Paid in
Box 4. Benefits Repaid to SSA in
Box 5. Net Benefits for
Box 6. Voluntary Federal Income Tax Withholding
Sofia Tanaka
XXXXX6566
17,669.65
1,496.53
25,874.59
2,495.36",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-b25f742ec54ac6d9431bd151,v11-OTHER_TAX_FORM-kind00,original,2025,fgen-3fc3399ef52b600f2e53ed45,synthetic_programmatic_template,columns,top,False,SSA-1099
"2024
Copy B For Recipient
Taxpayer name,Casey Nguyen
SSN,XXXXX9733
Box 3. Benefits Paid in,""4,814.99""
Box 4. Benefits Repaid to SSA in,""28,563.83""
Box 5. Net Benefits for,""$6,626.25""
Box 6. Voluntary Federal Income Tax Withholding,""7,748.98""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cc0232a8878ccb2834980318,v11-OTHER_TAX_FORM-kind00,original,2024,fgen-143494bfd6afeac1a600e1cf,synthetic_programmatic_template,csv,none,False,SSA-1099
"Form SSA-1099 Social Security Benefit Statement 2026 Department of the Treasury - Internal Revenue Service Taxpayer name Noah M. Adeyemi SSN XXX-XX-7558 Box 3. Benefits Paid in October 19, 2026 Box 4. Benefits Repaid to SSA in 5,015.81 Box 5. Net Benefits for 12,527.35 Box 6.
Voluntary
Federal Income Tax Withholding 7,348.49",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-75acaddc76949e51b5b4e45d,v11-OTHER_TAX_FORM-kind00,original,2026,fgen-f3f1048bef9c07739b7ba3de,synthetic_programmatic_template,flat,top,False,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
## 2021
## Department of Revenue
| Field | Value |
| --- | --- |
| Name | Lena Brennan |
| Recipient's TIN | ***-**-1610 |
| Box 3. Benefits Paid in | $28,093.99 |
| Box 4. Benefits Repaid to SSA in | 10,861.45 |
| Box 5. Net Benefits for | 2,295.94 |
| Box 6. Voluntary Federal Income Tax Withholding | 783.93 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-edff6efb45e6ada888136d94,v11-OTHER_TAX_FORM-kind00,original,2021,fgen-2b98d286cbe51517fd180099,synthetic_programmatic_template,markdown,top,False,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
Keep for your records
Taxpayer name
Noah Adeyemi
SSN
***-**-2684
Box 3. Benefits Paid in
$27,153.60
Box 4. Benefits Repaid to SSA in
1,988.82
Box 5. Net Benefits for
December 8, 2025
Box 6. Voluntary Federal Income Tax Withholding
4/3/25",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-f69319dcbbe3a9dcbfaeaf57,v11-OTHER_TAX_FORM-kind00,original,2025,fgen-ce212eb6211ee29d14ae8904,synthetic_programmatic_template,stacked,top,False,SSA-1099
"2024
Department of Revenue
Taxpayer name Mateo Rivera
SSN  ending in 6933
Box 3. Benefits Paid in      17,092.50
Box 4. Benefits Repaid to SSA in 1,532.54
Box 5. Net Benefits for   29,939.68
Box 6. Voluntary Federal Income Tax Withholding   06/19/2024",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7aaf420e7382e1c6f2407876,v11-OTHER_TAX_FORM-kind00,original,2024,fgen-eec2c909318259d7d55cd5ea,synthetic_programmatic_template,inline,none,False,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
Copy B For Recipient
Taxpayer name
Recipient's TIN
Box 3. Benefits Paid in
Box 4. Benefits Repaid to SSA in
Box 5. Net Benefits for
Box 6. Voluntary Federal Income Tax Withholding
Sofia Romero
****1780
23,874.85
$11,242.86
December 27, 2021
13,185.11",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-3f8556221d603ddb76f14fe9,v11-OTHER_TAX_FORM-kind00,original,2021,fgen-290fc00e33076ef4799152c4,synthetic_programmatic_template,columns,top,False,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
Department of the Treasury - Internal Revenue Service
Recipient's name,Diego Fischer
SSN,XXX-XX-7062
Box 3. Benefits Paid in,""$2,740.09""
Box 4. Benefits Repaid to SSA in,""29,722.69""
Box 5. Net Benefits for,""$21,308.73""
Box 6. Voluntary Federal Income Tax Withholding,""22,260.02""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-96b9a0ea39ad354f35398024,v11-OTHER_TAX_FORM-kind00,original,2022,fgen-93d722d5d7d11faf68a23b0f,synthetic_programmatic_template,csv,top,False,SSA-1099
"Department of Revenue Name Hiro Romero
Identification number XXX-XX-0720 Box 3. Benefits Paid in 26,309.20 Box 4. Benefits Repaid
to SSA in 3,071.15 Box 5. Net Benefits for 29,188.16 Box 6. Voluntary Federal Income Tax Withholding June 22, 2026",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5444775841aa68cfca258feb,v11-OTHER_TAX_FORM-kind00,original,2026,fgen-2a91cff977c3584b222dee65,synthetic_programmatic_template,flat,none,False,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
Department of Revenue
| Fíeld | Value |
| --- | --- |
| Name | Diego Larsen |
| Recipient's TIN | XXXXX7439 |
| Box3. Benefits Paid in | 08/27/2022 |
| Box 4. Benefits Repaid to SSA in | 13,823.23 |
| Box 5. Net Benefits for | 2,736.42 |
| Box 6.Vo1untary Federal Income Tax Withholding | $23,319.78 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-9c328248ea411477f298900f,v11-OTHER_TAX_FORM-kind00,original,2022,fgen-0ae10960ec63a87ae9f5bc53,synthetic_programmatic_template,markdown,top,True,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
2025
Copy B For Recipient
Name
Lena Tanaka
Identification number
****0184
Box 3. Benefits Paid in
2025-11-26
Box 4. Benefits Repaid to SSA in
06/10/2025
Box 5. Net Benefits for
22,069.63
Box 6. Voluntary Federal Income Tax Withholding
$3,324.82",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-a7ce8a7b102dbc20a0995fe9,v11-OTHER_TAX_FORM-kind00,original,2025,fgen-01862492f064ddf6a6b97e3a,synthetic_programmatic_template,stacked,top,False,SSA-1099
"Form SSA-1099
Social Security Benefit Statement
2024
Department of the Treasury - Internal Revenue Service
Name   Hiro Kowalski
Identification number ****3952
Box 3. Benefits Paid in $8,635.98
Box 4. Benefits Repaid to SSA in  $11,877.90
Box 5. Net Benefits for      1,698.03
Box 6. Voluntary Federal Income Tax Withholding   4,860.67",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-619c578492559f8c9049bbe1,v11-OTHER_TAX_FORM-kind00,original,2024,fgen-d23c612ead32302543999f38,synthetic_programmatic_template,inline,top,False,SSA-1099
"2022
Department of Revenue
Recipient's name
SSN
Box 3. Benefits Paid in
Box 4. Benefits Repaid to SSA in
Box 5. Net Benefits for
Box 6. Voluntary Federal Income Tax Withholding
Casey Castillo
***-**-0362
19,839.79
18,572.92
06/27/2022
March 12, 2022",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-feca7127b8209e81224dae46,v11-OTHER_TAX_FORM-kind00,original,2022,fgen-5f4b6ede8f9a2d212705bb67,synthetic_programmatic_template,columns,none,False,SSA-1099
"Department of the Treasury - Internal Revenue Service
Recipient's name,JordanWalsh
SSN,XXX-XX-6161
Box 3. Benefits Paid in,2025-06-04
Box 4. Benefits Repaid to 55A in,""1,970.05""
Box 5. Net Benefits for,5/20/25
Box 6. Vo1untary Federal Income Tax Withholding,""11,256.62""
Form SSA-1099
Social Security Benefit Statement",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7bf9d2cf4abda9365cd757ad,v11-OTHER_TAX_FORM-kind00,original,2025,fgen-3af20c756c9348d19332de7c,synthetic_programmatic_template,csv,bottom,True,SSA-1099
"2026 Department of the Treasury - Internal Revenue
Service Name Diego K. Sato Identification number XXX-XX-9910 Box 3. Benefits Paid in $18,252.47 Box 4. Benefits Repaid to SSA in 22,400.97 Box 5. Net Benefits for 12/2/26 Box 6. Voluntary Federal
Income Tax Withholding $18,025.56",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cc850c35f963e50e91ca7688,v11-OTHER_TAX_FORM-kind00,original,2026,fgen-b1d7807b3ab3fbecf5226f86,synthetic_programmatic_template,flat,none,False,SSA-1099
"## Form SSA-1099
Social Security Benefit Statement
Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Recipient's name | Taylor L. Kowalski |
| Identification number | ending in 9963 |
| Box 3. Benefits Paid in | $9,881.03 |
| Box 4. Benefits Repaid to SSA in | $21,762.75 |
| Box 5. Net Benefits for | $15,123.61 |
| Box 6. Voluntary Federal Income Tax Withholding | 24,550.06 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-e524ad8040904db07af96895,v11-OTHER_TAX_FORM-kind00,original,2021,fgen-b60f04a2843dee7065462716,synthetic_programmatic_template,markdown,top,False,SSA-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2025
Keep for your records
Recipient's name   Olivia B. Nguyen
Recipient's TIN XXX-XX-6492
Social Security Equivalent Benefit Portion of Tier 1  7,339.24
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid   24,237.12",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-a178d7373a948de4f4e406d1,v11-OTHER_TAX_FORM-kind01,original,2025,fgen-65bae43905c9f590f55175ec,synthetic_programmatic_template,inline,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2025
Department of the Treasury - Internal Revenue Service
Name
Recipient's TIN
Social Security Equivalent Benefit Portion of Tier 1
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid
Jamie Rivera
****5832
$14,574.64
1,151.73",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7d3cdef0088a7044fc9d4dae,v11-OTHER_TAX_FORM-kind01,original,2025,fgen-5b4589afcc8ac698b17a01bc,synthetic_programmatic_template,columns,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2022
Copy B For Recipient
Recipient's name,Taylor L. Fischer
SSN,ending in 9956
Social Security Equivalent Benefit Portion of Tier 1,""January 15, 2022""
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid,""7,109.46""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-df576b68bb264276b2fa447c,v11-OTHER_TAX_FORM-kind01,original,2022,fgen-87fb901ceb2b633a8c7f9258,synthetic_programmatic_template,csv,top,False,RRB-1099
"Form RRB-1099 Payments by the Railroad Retirement
Board Department of the Treasury -
Internal Revenue Service Name Amara L. Haddad SSN XXX-XX-4187 Social Security Equivalent Benefit Portion of Tier 1 $12,531.04 Gross Social Security Equivalent Benefit Portion of Tier 1 Paid 11/10/2021",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-e5f2e714ab71d7f9976decb3,v11-OTHER_TAX_FORM-kind01,original,2021,fgen-d9768833ae26c3cf87213073,synthetic_programmatic_template,flat,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2026
Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Hiro L. Walsh |
| Recipient's TIN | ****1358 |
| Social Security Equivalent Benefit Portion of Tier 1 | 22,637.30 |
| Gross Social Security Equivalent Benefit Portion of Tier 1 Paid | 2026-01-01 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ab75588fc890a302dc5653c0,v11-OTHER_TAX_FORM-kind01,original,2026,fgen-2d8934aa96ff39866d716e30,synthetic_programmatic_template,markdown,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
Keep for your records
Name
Morgan Moreau
SSN
***-**-6648
Social Security Equivalent Benefit Portion of Tier 1
2,515.81
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid
28,487.86",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-de86d674eb5c888086ca70f8,v11-OTHER_TAX_FORM-kind01,original,2021,fgen-79d55db9040f06bf2ce60731,synthetic_programmatic_template,stacked,top,False,RRB-1099
"2021
Department of Revenue
Recipicnt's name   Morgan S. Haddad
Recipient's TIN ****0460
Social Security Equivalent Benefit Portion ofTier 1 14,829.04
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid S4,289.89",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-10e6e3281b83aabf95020fa1,v11-OTHER_TAX_FORM-kind01,original,2021,fgen-b26fbec0298618795a414d43,synthetic_programmatic_template,inline,none,True,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2023
Keep for your records
Taxpayer name
Recipient's TIN
Social Security Equivalent Benefit Portion of Tier 1
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid
Alex Kowalski
XXXXX3859
$968.24
24,310.96",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-94436d117f578f546ec1f9a8,v11-OTHER_TAX_FORM-kind01,original,2023,fgen-6fef55136b27bda6c9a98ce4,synthetic_programmatic_template,columns,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2024
Keep for your records
Taxpayer name,Avery J. Moreau
Identification number,XXX-XX-8376
Social Security Equivalent Benefit Portion of Tier 1,""18,222.66""
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid,""7,735.75""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-49a4e2b0f0a59ad58ae674b9,v11-OTHER_TAX_FORM-kind01,original,2024,fgen-710862bf44872330200c8962,synthetic_programmatic_template,csv,top,False,RRB-1099
"Form RRB-1099 Payments by the Railroad Retirement Board 2024 Keep for your records Name
Taylor Walsh SSN ***-**-4933 Social Security Equivalent Benefit Portion of Tier 1 August 4, 2024 Gross Social Security Equivalent Benefit Portion of Tier 1 Paid
$5,915.76",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-3eacd710734f3fa69d9d195e,v11-OTHER_TAX_FORM-kind01,original,2024,fgen-69f2edf25ce8546ca4a47518,synthetic_programmatic_template,flat,top,False,RRB-1099
"Form RRB-1099
## Payments by the Railroad Retirement Board
2023
Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Noah Lindqvist |
| SSN | ending in 0973 |
| Social Security Equivalent Benefit Portion of Tier 1 | May 8, 2023 |
| Gross Social Security Equivalent Benefit Portion of Tier 1 Paid | 22,909.57 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-74c28c179fef190053b9b6ef,v11-OTHER_TAX_FORM-kind01,original,2023,fgen-bfee38cd9effd187ecc87364,synthetic_programmatic_template,markdown,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2025
Department of the Treasury - Interna1 Revenue Service
Taxpayer name
Avery J. Fischer
Recipient's TIN
XXX-XX-2364
Socia1 Security Equivalent Benefit Portion of Tier 1
19,795.53
Gross Social Security Equivalent Benefit Portion ofTier 1 Paid
19,235.06",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1e1bf4a2121902112e55d4e1,v11-OTHER_TAX_FORM-kind01,original,2025,fgen-41c3e1b204de3b9adeed9e16,synthetic_programmatic_template,stacked,top,True,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
Copy B For Recipient
Name   Taylor Haddad
Identification number      XXX-XX-1108
Social Security Equivalent Benefit Portion of Tier 1   23,398.58
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid 2024-12-15",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-342736e34f36d921f9bbcc3a,v11-OTHER_TAX_FORM-kind01,original,2024,fgen-76152e38cda5af588877acf8,synthetic_programmatic_template,inline,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2023
Department of the Treasury - Internal Revenue Service
Taxpayer name
SSN
Social Security Equivalent Benefit Portion of Tier 1
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid
Diego Adeyemi
XXXXX5828
$18,567.61
19,412.79",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-a02ca94e4f930415944b533e,v11-OTHER_TAX_FORM-kind01,original,2023,fgen-df8907179e2fb17009df0291,synthetic_programmatic_template,columns,top,False,RRB-1099
"Form RRB-1099
Payments by the Railroad Retirement Board
2025
Keep for your records
Name,Casey B. Tanaka
Identification number,ending in 2867
Social Security Equivalent Benefit Portion of Tier 1,""14,911.80""
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid,""$25,198.87""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-c3d2b1640516d4f7bf9178a3,v11-OTHER_TAX_FORM-kind01,original,2025,fgen-4e96e48da60d2478e576b642,synthetic_programmatic_template,csv,top,False,RRB-1099
"Form RRB-1099 Payments by the Railroad Retirement Board 2024 Keep
for your records Taxpayer name Priya Rivera Recipient's TIN XXXXX7770 Social Security Equivalent Benefit Portion of Tier 1 $8,013.46 Gross Social Security Equivalent Benefit Portion of Tier 1
Paid 3,390.92",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ded9d58f71fb7eda3171ba9f,v11-OTHER_TAX_FORM-kind01,original,2024,fgen-447ae09dfdd1d82707884fbf,synthetic_programmatic_template,flat,top,False,RRB-1099
"2023
Department of Revenue
| Field | Value |
| --- | --- |
| Name | Olivia Larsen |
| Identification number | XXX-XX-3933 |
| Social Security Equivalent Benefit Portion of Tier 1 | 01/20/2023 |
| Gross Social Security Equivalent Benefit Portion of Tier 1 Paid | $22,586.37 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-04ae308f1945c4d6d4f68595,v11-OTHER_TAX_FORM-kind01,original,2023,fgen-6e90ec53c4d72f333b4d3b34,synthetic_programmatic_template,markdown,none,False,RRB-1099
"2025
Keep for your records
Name
Jamie S. Haddad
Identification number
****7318
Social Security Equivalent Benefit Portion of Tier 1
2025-10-14
Gross Social Security Equivalent Benefit Portion of Tier 1 Paid
03/17/2025
Form RRB-1099
Payments by the Railroad Retirement Board",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-fd9618e0eb32c4b05f1153d3,v11-OTHER_TAX_FORM-kind01,original,2025,fgen-3aedb4cc8fc6eabc387a0b3a,synthetic_programmatic_template,stacked,bottom,False,RRB-1099
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
Keep for your records
Name
SSN
1 Gross long-term care benefits paid
2 Accelerated death benefits paid
3 Per diem / Reimbursed amount
Riley Kowalski
***-**-0401
$26,941.44
$26,297.85
$17,572.78",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-3c75e4870caa9bccd41182cc,v11-OTHER_TAX_FORM-kind02,original,2023,fgen-aeb1d8746faca973b3f17274,synthetic_programmatic_template,columns,top,False,1099-LTC
"2021
Keep for your records
Taxpayer name,Diego Moreau
Recipient's TIN,XXXXX2807
1 Gross long-term care benefits paid,""$11,301.34""
2 Accelerated death benefits paid,""12,321.96""
3 Per diem / Reimbursed amount,""20,035.61""
Form 1099-LTC
Long-Term Care and Accelerated Death Benefits",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-c047f7c78f538f549ca434bc,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-3b104257197403d3411efeaf,synthetic_programmatic_template,csv,bottom,False,1099-LTC
"2025 Keep for your records Taxpayer name Diego R. Walsh Recipient's TIN ****5661 1
Gross long-term care benefits paid April 16,2O25 2 Accelerated death benefits paid 13,621.77 3 Per diem / Reimbursed amount 05/05/2025 Form 1099-LTC Long-Term
Care and Acce1erated Death Benefits",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-018208a4aa990fce79d28e3f,v11-OTHER_TAX_FORM-kind02,original,2025,fgen-04de4303f8bce399127cfc21,synthetic_programmatic_template,flat,bottom,True,1099-LTC
"## Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
## 2021
Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Recipient's name | Hiro Testcase |
| Identification number | ****8288 |
| 1 Gross long-term care benefits paid | 14,482.92 |
| 2 Accelerated death benefits paid | $28,842.49 |
| 3 Per diem / Reimbursed amount | $3,173.16 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-9c33899777f138f04f59d1ae,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-dc1c16fb453175cddc9b8561,synthetic_programmatic_template,markdown,top,False,1099-LTC
"2021
Keep for your records
Taxpayer name
Kwame Larsen
Identification number
XXX-XX-5764
1 Gross long-term care benefits paid
21,623.48
2 Accelerated death benefits paid
6,196.87
3 Per diem / Reimbursed amount
$8,572.80",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-530b24aaaebf7c4ae59d27c9,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-f264a7f6ff10a161caeaeb40,synthetic_programmatic_template,stacked,none,False,1099-LTC
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
2023
Department of Revenue
Recipient's name Alex R. Walsh
Recipient's TIN   ending in 4094
1 Gross long-term care benefits paid $16,611.63
2 Accelerated death benefits paid   $12,681.72
3 Per diem / Reimbursed amount   November 25, 2023",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-e6a268a622c74a13188f7de0,v11-OTHER_TAX_FORM-kind02,original,2023,fgen-f6a58429f43e39f1e1214bce,synthetic_programmatic_template,inline,top,False,1099-LTC
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
2021
Department of Revenue
Name
Identification number
1 Gross long-term care benefits paid
2 Accelerated death benefits paid
3 Per diem / Reimbursed amount
Noah Patel
ending in 9964
2021-02-15
5,844.49
$26,672.98",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-72ee5b5d4d67f897db7135f2,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-4d4f7db2ee1d0b0b8c1598d1,synthetic_programmatic_template,columns,top,False,1099-LTC
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
2022
Copy B For Recipient
Recipient's name,Diego Brennan
Identífication number,***-**-2091
1 Gross long-term care benefits paid,""August 1, 2022""
2 Accelerated deathbenefits paid,""15,382.80""
3 Per diem / Reimbursed amount,09/04/2022",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-f498390b5993df53c859f2c9,v11-OTHER_TAX_FORM-kind02,original,2022,fgen-60c7b03fe22781462b5c8301,synthetic_programmatic_template,csv,top,True,1099-LTC
"Form 1099-LTC Long-Term Care and
Accelerated Death Benefits 2026 Department of Revenue Name Lena
Walsh Recipient's TIN ending in 8353 1 Gross long-term care benefits paid $17,288.30 2 Accelerated death benefits paid $6,143.53 3 Per diem / Reimbursed amount $2,832.17",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-811a95767145aaa0d0310e50,v11-OTHER_TAX_FORM-kind02,original,2026,fgen-30b58eae42275be1b8d9034b,synthetic_programmatic_template,flat,top,False,1099-LTC
"Department of Revenue
| Field | Value |
| --- | --- |
| Name | Olivia A. Rivera |
| Identification number | ending in 7771 |
| 1 Gross long-term care benefits paid | $18,935.56 |
| 2 Accelerated death benefits paid | May 19, 2021 |
| 3 Per diem / Reimbursed amount | 2021-06-28 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1f15f5d4d8f0d643c7226f8e,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-7272bd3d7bb82bb5fa962c8c,synthetic_programmatic_template,markdown,none,False,1099-LTC
"2021
Department of the Treasury - Internal Revenue Service
Taxpayer name
Olivia B. Castillo
SSN
****3011
1 Gross long-term care benefits paid
29,359.11
2 Accelerated death benefits paid
$24,080.63
3 Per diem / Reimbursed amount
27,595.08
Form 1099-LTC
Long-Term Care and Accelerated Death Benefits",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-478237ac4103114f2daeca84,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-2d1186d8ebff64126340d3f5,synthetic_programmatic_template,stacked,bottom,False,1099-LTC
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
2026
Copy B For Recipient
Recipient's name Taylor Haddad
Identification number ending in 0617
1 Gross long-term care benefits paid      24,688.54
2 Accelerated death benefits paid 23,443.14
3 Per diem / Reimbursed amount  $916.61",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-6a6edf4a4faba2aa04c27055,v11-OTHER_TAX_FORM-kind02,original,2026,fgen-a1490481f61fb3cad021361e,synthetic_programmatic_template,inline,top,False,1099-LTC
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
Department of the Treasury - Internal Revenue Service
Name
Recipient's TIN
1 Gross long-term care benefits paid
2 Accelerated death benefits paid
3 Per diem / Reimbursed amount
Wei R. Rivera
ending in 1928
$24,471.73
$29,221.71
12,042.92",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-f693016bfc0b0b374a187027,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-838a98a601efb468edd8c235,synthetic_programmatic_template,columns,top,False,1099-LTC
"Form 1099-LTC
Long-TermCare and Accelerated Death Benefits
Department of Revenue
Name,Wei K. Adeyemi
SSN,****7673
1 Gross long-term care benefits paid,""6,483.42""
2 Accelerated death benefits paid,""16,188.34""
3 Per diem / Reimbursed amount,""August 13, 2023""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5c108de34b57d0f1a8f52f57,v11-OTHER_TAX_FORM-kind02,original,2023,fgen-e59a0c52a19f474353f069f3,synthetic_programmatic_template,csv,top,True,1099-LTC
"Form 1099-LTC Long-Term Care and Accelerated Death Benefits 2026 Department of the Treasury - Internal Revenue Service Recipient's name
Taylor Sato SSN ***-**-8617 1 Gross long-term care benefits paid 2026-07-09 2 Accelerated death benefits paid 24,063.86 3 Per
diem / Reimbursed amount 17,001.23",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-57493065e497b80e0b9bc18d,v11-OTHER_TAX_FORM-kind02,original,2026,fgen-e48dfe74af842c6699476b68,synthetic_programmatic_template,flat,top,False,1099-LTC
"## 2021
## Copy B For Recipient
| Field | Value |
| --- | --- |
| Name | Jordan E. Romero |
| Identification number | ****2963 |
| 1 Gross long-term care benefits paid | 10/14/2021 |
| 2 Accelerated death benefits paid | $22,327.49 |
| 3 Per diem / Reimbursed amount | 1,768.05 |
Form 1099-LTC
## Long-Term Care and Accelerated Death Benefits",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-271237dd04fbf210a637a2e2,v11-OTHER_TAX_FORM-kind02,original,2021,fgen-8c6909355bfe02347b49a288,synthetic_programmatic_template,markdown,bottom,False,1099-LTC
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
2024
Department of Revenue
Taxpayer name
Noah Patel
Identification number
ending in 4363
1 Gross long-term care benefits paid
11,121.49
2 Accelerated death benefits paid
$14,668.07
3 Per diem / Reimbursed amount
$12,608.04",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-bb9769628a0f1ee7bb064edc,v11-OTHER_TAX_FORM-kind02,original,2024,fgen-653e3e9129bf00b1c34dee8c,synthetic_programmatic_template,stacked,top,False,1099-LTC
"Form 1099-LTC
Long-Term Care and Accelerated Death Benefits
2023
Department of Revenue
Recipient's name      Amara Moreau
SSN XXXXX7434
1 Gross long-term care benefits paid  18,272.20
2 Accelerated death benefits paid   $14,313.69
3 Per diem / Reimbursed amount 29,927.27",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-60369b483a6e11582f342e9d,v11-OTHER_TAX_FORM-kind02,original,2023,fgen-d10acd5f8b8093c2998c9106,synthetic_programmatic_template,inline,top,False,1099-LTC
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
2026
Keep for your records
Taxpayer name,Olivia Haddad
SSN,ending in 3800
1 Patronage dividends,""19,675.23""
2 Nonpatronage distributions,11/4/26
3 Per-unit retain allocations,02/28/2026",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-f2f16cb19e236decd1652801,v11-OTHER_TAX_FORM-kind03,original,2026,fgen-37bfca21de88c0fc23991038,synthetic_programmatic_template,csv,top,False,1099-PATR
"Form 1099-PATR Taxable Distributions Rcceived From Cooperatives 2026 Department of Revenue Taxpayer name CaseyAdeyemi Recipient's TIN XXXXX0474
1 Patronage dividends $22,587.97 2
Nonpatronage distributions 11,529.37 3 Per-unit retain a11ocations 422.79",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7cb48fd2bae481f5b3f78f1b,v11-OTHER_TAX_FORM-kind03,original,2026,fgen-83c6833618fe7f97cabc0f16,synthetic_programmatic_template,flat,top,True,1099-PATR
"2022
Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Avery Okafor|
| SSN | XXX-XX-6516 |
| 1 Patronage dividends | 16,240.45 |
| 2 Nonpatronage distributions | 28,089.19 |
| 3 Per-unit retain a1locations | l,787.50 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-bc2e10bf241e92177a9649fa,v11-OTHER_TAX_FORM-kind03,original,2022,fgen-5c79084ce4ee85a8263089ec,synthetic_programmatic_template,markdown,none,True,1099-PATR
"2024
Department of Revenue
Recipient's name
Casey Castillo
Recipient's TIN
XXXXX0829
1 Patronage dividends
133.31
2 Nonpatronage distributions
$27,520.62
3 Per-unit retain allocations
13,751.87
Form 1099-PATR
Taxable Distributions Received From Cooperatives",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7c073bab04bdd6ba034eb4c0,v11-OTHER_TAX_FORM-kind03,original,2024,fgen-51a5835dfad921ae503f7083,synthetic_programmatic_template,stacked,bottom,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
2021
Department of the Treasury - Internal Revenue Service
Taxpayer name   Hiro Romero
SSN   ***-**-2690
1 Patronage dividends   14,945.14
2 Nonpatronage distributions  4,997.33
3 Per-unit retain allocations   26,001.29",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-3ee48b1184fd0d3a2afc578d,v11-OTHER_TAX_FORM-kind03,original,2021,fgen-714af9a8287a71a4b7b9354c,synthetic_programmatic_template,inline,top,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
Copy B For Recipient
Taxpayer name
Identification number
1 Patronage dividends
2 Nonpatronage distributions
3 Per-unit retain allocations
Hiro R. Sato
***-**-4361
27,755.07
$16,811.72
May 17, 2023",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1973c6d6754635bfd6ed331d,v11-OTHER_TAX_FORM-kind03,original,2023,fgen-12423af5ec4b726aa38bf0b0,synthetic_programmatic_template,columns,top,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
2024
Department of the Treasury - Internal Revenue Service
Recipient's name,Jamie M. Walsh
Identification number,ending in 7649
1 Patronage dividends,""$15,813.76""
2 Nonpatronage distributions,""12,940.96""
3 Per-unit retain allocations,""$15,235.06""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-76cd09b85f8c5ce48b6bc9cd,v11-OTHER_TAX_FORM-kind03,original,2024,fgen-4aa30a4773c0c2040c421dfb,synthetic_programmatic_template,csv,top,False,1099-PATR
"Form 1099-PATR Taxable Distributions Received From Cooperatives
2021 Department of the Treasury - Internal Revenue Service Name Noah B. Sato Recipient's TIN XXX-XX-2017 1 Patronage dividends July 1, 2021 2 Nonpatronage distributions 2021-11-05 3
Per-unit retain allocations 12,122.86",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-01355435206b54ddd7c2e2ff,v11-OTHER_TAX_FORM-kind03,original,2021,fgen-9a3c571993ecb3847f57e712,synthetic_programmatic_template,flat,top,False,1099-PATR
"## 2023
Keep for your records
| Field | Value |
| --- | --- |
| Recipient's name | Kwame Castillo |
| Recipient's TIN | XXXXX9684 |
| 1 Patronage dividends | 28,145.58 |
| 2 Nonpatronage distributions | $6,079.89 |
| 3 Per-unit retain allocations | 7,260.35 |
Form 1099-PATR
Taxable Distributions Received From Cooperatives",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-bac15d1b7be648bf1f280fac,v11-OTHER_TAX_FORM-kind03,original,2023,fgen-39e69777603b94a0247f0972,synthetic_programmatic_template,markdown,bottom,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
Keep for your records
Taxpayer name
Alex Haddad
Identification number
XXX-XX-2517
1 Patronage dividends
26,657.46
2 Nonpatronage distributions
19,807.97
3 Per-unit retain allocations
25,922.06",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7529b1fd2816167dfb6805a9,v11-OTHER_TAX_FORM-kind03,original,2025,fgen-e3ab0430d24581b9e9bd0690,synthetic_programmatic_template,stacked,top,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
Copy B For Recipient
Taxpayer name      Noah Haddad
Identification number  XXXXX1017
1 Patronage dividends 15,802.38
2 Nonpatronage distributions $14,124.25
3 Per-unit retain allocations $12,563.78",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-075c39d9d40a969f6ee76be7,v11-OTHER_TAX_FORM-kind03,original,2021,fgen-a61d73f636356f8ff31024d5,synthetic_programmatic_template,inline,top,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
Keep for your records
Name
Recipient's TIN
1 Patronage dividends
2 Nonpatronage distributions
3 Per-unit retain allocations
Kwame L. Walsh
****2740
$16,268.28
2021-03-06
February 9, 2021",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-754369f29086ca0fcf127594,v11-OTHER_TAX_FORM-kind03,original,2021,fgen-fb96b50e4d2b8a2e00883f4b,synthetic_programmatic_template,columns,top,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
Department of Revenue
Taxpayer name,Hiro Nguyen
Identification number,***-**-8294
1 Patronage dividends,""3,561.96""
2 Nonpatronage distributions,""$13,961.63""
3 Per-unit retain allocations,12/7/21",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-a9a9c11468fccc6ae65c8ad0,v11-OTHER_TAX_FORM-kind03,original,2021,fgen-0783d6d8a80422dfa273aea2,synthetic_programmatic_template,csv,top,False,1099-PATR
"Form 1099-PATR Taxable Distributions Received From Cooperatives 2026 Keep for your records Taxpayer name Alex Kowalski SSN ****9759 1 Patronage dividends $24,260.39 2 Nonpatronage distributions 03/22/2026 3
Per-unit
retain allocations 10/16/2026",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-d7e45538d56d3e797a5c877b,v11-OTHER_TAX_FORM-kind03,original,2026,fgen-2823f0d241b6c271064e30a4,synthetic_programmatic_template,flat,top,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
## 2023
Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Recipient's name | Kwame J. Testcase |
| Identification number | XXXXX3059 |
| 1 Patronage dividends | February 27, 2023 |
| 2 Nonpatronage distributions | 28,740.97 |
| 3 Per-unit retain allocations | 10.03 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-bd0c415ea3caa8cf2df2bea3,v11-OTHER_TAX_FORM-kind03,original,2023,fgen-668969158f55f6626da985a4,synthetic_programmatic_template,markdown,top,False,1099-PATR
"2022
Keep foryour records
Name
Jordan Haddad
Recipient's TIN
****8982
l Patronage dividends
December 17, 2022
2 Nonpatronage distributions
12/9/22
3 Per-unit retaín allocations
20,620.47
Form 1099-PATR
Taxable Distributions Received From Cooperatives",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-77f6b97a4348e43b35cb6cc0,v11-OTHER_TAX_FORM-kind03,original,2022,fgen-771d17c3e3e5fd27fa26aac1,synthetic_programmatic_template,stacked,bottom,True,1099-PATR
"2022
Copy B For Recipient
Taxpayer name   Taylor Fischer
SSN XXX-XX-4047
1 Patronage dividends  28,183.91
2 Nonpatronage distributions 2,710.61
3 Per-unit retain allocations 5,057.71",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-b8087da68f756a452bdfe237,v11-OTHER_TAX_FORM-kind03,original,2022,fgen-d400e9dfe1146ffd2d5c4b42,synthetic_programmatic_template,inline,none,False,1099-PATR
"Form 1099-PATR
Taxable Distributions Received From Cooperatives
2025
Department of the Treasury - Internal Revenue Service
Recipient's name
Identification number
1 Patronage dividends
2 Nonpatronage distributions
3 Per-unit retain allocations
Kwame B. Sato
ending in 7535
16,168.37
$28,931.86
$6,984.78",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7c94431c4c8bdefd957e23e6,v11-OTHER_TAX_FORM-kind03,original,2025,fgen-0aab35321a8d240c2ad3b529,synthetic_programmatic_template,columns,top,False,1099-PATR
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
Department of the Treasury - Internal Revenue Service
Taxpayer name
Casey Tanaka
Recipient's TIN
XXXXX1265
1 Date option granted
15,734.72
2 Date option exercised
$18,807.61
3 Exercise price per share
2022-06-20
4 Fair market value per share on exercise date
3,754.87
5 No. of shares transferred
4,226.86",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-e93d8e472a24653cc8adab1a,v11-OTHER_TAX_FORM-kind06,original,2022,fgen-fe882992f149e3344d7b500f,synthetic_programmatic_template,stacked,top,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2022
Keep for your records
Taxpayer name Jamie Patel
SSN      ****0259
1 Date option granted 12/27/2022
2 Date option exercised      27,559.60
3 Exercise price per share  10/13/22
4 Fair market value per share on exercise date 7,724.66
5 No. of shares transferred 24,773.58",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-9b5859e551a47a95fc110520,v11-OTHER_TAX_FORM-kind06,original,2022,fgen-bcedd658d49e21dacefe3ef9,synthetic_programmatic_template,inline,top,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
Keep for yourrecords
Recipicnt's name
Identification number
1 Date option granted
2 Date option exercised
3 Exercise price per share
4 Fair market value per share on exercise date
5 No. of shares transferred
Kwame A. Tanaka
****5616
05/03/2023
20,999.51
1,983.98
12,207.97
2023-09-23",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-09c03b6a0c7dcead230eafbc,v11-OTHER_TAX_FORM-kind06,original,2023,fgen-a13367a7c76d80e91e34584b,synthetic_programmatic_template,columns,top,True,3921
"2026
Department of the Treasury - Internal Revenue Service
Name,Sofia Tanaka
Identification number,****8128
1 Date option granted,""$11,749.44""
2 Date option exercised,""2,374.11""
3 Exercise price per share,""17,680.52""
4 Fair market value per share on exercise date,""14,278.15""
5 No. of shares transferred,""June 23, 2026""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-e122ff7c78cdaaaf4925d78b,v11-OTHER_TAX_FORM-kind06,original,2026,fgen-4393704f6d4b4afc25734e2f,synthetic_programmatic_template,csv,none,False,3921
"Form 3921 Exercíse of an Incentive
Stock
Option Under Section 422(b) Department of the Treasury - Intemal Revenue Service Recipient's name Priya Okafor Identification number ***-**-5788 l Date option granted S3,717.18 2 Dateoption exercised $5,101.85 3 Exercise price per share 25,944.25 4 Fair market va1ue per share on exercíse datc$8,401.74 5 No. of shares transferred $28,918.59",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-120b60e7060dfad803a1b8e8,v11-OTHER_TAX_FORM-kind06,original,2021,fgen-224bfae070b5dfbc87306725,synthetic_programmatic_template,flat,top,True,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2026
## Department of Revenue
| Field | Value |
| --- | --- |
| Recipient's name | Hiro Walsh |
| Identification number | XXX-XX-5335 |
| 1 Date option granted | $685.73 |
| 2 Date option exercised | 14,231.49 |
| 3 Exercise price per share | 21,978.20 |
| 4 Fair market value per share on exercise date | 2026-03-21 |
| 5 No. of shares transferred | 24,899.70 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-57a577b5c39cacf5b4c9a791,v11-OTHER_TAX_FORM-kind06,original,2026,fgen-bfb1f01b2f25f709332d1890,synthetic_programmatic_template,markdown,top,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2023
Copy B For Recipient
Name
Diego Haddad
SSN
****9330
1 Date option granted
$28,291.97
2 Date option exercised
4/27/23
3 Exercise price per share
$21,980.89
4 Fair market value per share on exercise date
11,049.12
5 No. of shares transferred
$5,158.54",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-17bb1574a2b4e64a13a735d0,v11-OTHER_TAX_FORM-kind06,original,2023,fgen-acca83c4e5580f612969795d,synthetic_programmatic_template,stacked,top,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2023
Department of Revenue
Name Avery Moreau
Identification number   XXXXX4057
1 Date option granted  $5,729.79
2 Date option exercised  $401.67
3 Exercise price per share 20,737.70
4 Fair market value per share on exercise date   8,864.52
5 No. of shares transferred 4,981.02",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-683f1fe3170871f819cb3014,v11-OTHER_TAX_FORM-kind06,original,2023,fgen-8d14291a93327536412eab7b,synthetic_programmatic_template,inline,top,False,3921
"2022
Department of Revenue
Recipient's name
Recipient's TIN
1 Date option granted
2 Date option exercised
3 Exercise price per share
4 Fair market value per share on exercise date
5 No. of shares transferred
Taylor M. Larsen
XXX-XX-2925
18,429.22
18,919.38
15,301.23
23,005.63
6,666.81",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-772fe4b20c42e4d119668514,v11-OTHER_TAX_FORM-kind06,original,2022,fgen-d4e8c7ae1c87d4537c071745,synthetic_programmatic_template,columns,none,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2O22
Department of Revenue
Taxpayer name,Noah B. Brennan
Recipient's TIN,***-**-0934
1 Date option granted,""10,409.52""
2 Date option exercised,""19,481.26""
3 Exercise price per share,""2,878.42""
4 Faír marketvalue per share on exercise date,""1,242.90""
5 No. of shares transferred,""$23,898.81""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cd2e76f8090ec0fce458cf14,v11-OTHER_TAX_FORM-kind06,original,2022,fgen-880cc388ac2c749dfb50f8a0,synthetic_programmatic_template,csv,top,True,3921
"2024 Department of the Treasury - Internal Revenue Service Recipient's name Amara Tanaka Recipient's TIN ****8565 1 Date option granted $1,086.29 2 Date option exercised 8/25/24 3 Exercise price per share 06/16/2024 4 Fair market value per share on exercise
date $5,202.23 5 No.
of shares transferred 12,114.09",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ac88d538dc0dc426d3362e12,v11-OTHER_TAX_FORM-kind06,original,2024,fgen-0e63d8aa3132576d7202c2fa,synthetic_programmatic_template,flat,none,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Taxpayer name | Olivia Rivera |
| Identification number | XXXXX2913 |
| 1 Date option granted | $18,994.36 |
| 2 Date option exercised | 26,778.91 |
| 3 Exercise price per share | $1,881.34 |
| 4 Fair market value per share on exercise date | $28,002.84 |
| 5 No. of shares transferred | 20,663.65 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-4c76f9d7bef0f8e4005f50da,v11-OTHER_TAX_FORM-kind06,original,2023,fgen-68b3060b82d797a5cc23b754,synthetic_programmatic_template,markdown,top,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2021
Copy B For Recipient
Name
Priya Wa1sh
5SN
XXX-XX-1574
1 Date option granted
$5,540.78
2 Date option exercised
2,487.96
3 Exercise price per share
$14,109.98
4 Fair market va1ue per share on exercise date
$17,172.26
5No. of shares transferred
19,067.45",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-d37eece528221bcd622aeac7,v11-OTHER_TAX_FORM-kind06,original,2021,fgen-30198f654f37717f79b94c45,synthetic_programmatic_template,stacked,top,True,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2023
Copy B For Recipient
Recipient's name   Jamie Fischer
Recipient's TIN ****6231
1 Date option granted   27,042.24
2 Date option exercised      2,377.42
3 Exercise price per share 16,669.74
4 Fair market value per share on exercise date  04/09/2023
5 No. of shares transferred  29,504.06",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5f7200cbf9e94cdc7d6aa219,v11-OTHER_TAX_FORM-kind06,original,2023,fgen-6c1abff1221d4970d0694c26,synthetic_programmatic_template,inline,top,False,3921
"Copy B For Recipient
Recipient's name
Recipient's TIN
1 Date option granted
2 Date option exercised
3 Exercise price per share
4 Fair market value per share on exercise date
5 No. of shares transferred
Riley Okafor
XXXXX3294
December 20, 2021
28,121.46
$8,569.84
5,510.48
20,004.50
Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cc54e4e07da229b7fb596b6c,v11-OTHER_TAX_FORM-kind06,original,2021,fgen-e0aa07b8295e6b215eee4227,synthetic_programmatic_template,columns,bottom,False,3921
"Form 3921
Exercise of an Incentive Stock Option Under Section 422(b)
2022
Department of Revenue
Taxpayer name,Kwame Adeyemi
SSN,XXXXX5104
1 Date option granted,""17,209.10""
2 Date option exercised,""19,565.90""
3 Exercise price per share,""$2,779.72""
4 Fair market value per share on exercise date,""1,382.74""
5 No. of shares transferred,""25,576.64""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1855a4ca04234d19279dcf80,v11-OTHER_TAX_FORM-kind06,original,2022,fgen-30f05bbd88d02079a7e1ebf6,synthetic_programmatic_template,csv,top,False,3921
"Form 3921 Exercise of an Incentive Stock
Option Under Section 422(b) 2021 Keep for your records Name Alex A. Moreau SSN XXX-XX-6413 1 Date option granted $16,612.59 2 Date option
exercised $2,859.80 3 Exercise price per share 11/04/2021 4 Fair market value per share on exercise date 10,591.23 5 No. of shares transferred 9,788.90",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-593e736b6993cfbf95ba8f5f,v11-OTHER_TAX_FORM-kind06,original,2021,fgen-d1a7e77e8598be5d4821a867,synthetic_programmatic_template,flat,top,False,3921
"2024
Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Taxpayer name | Mateo S. Okafor |
| Recipient's TIN | ***-**-7868 |
| 1 Date option granted | 10/6/24 |
| 2 Date option exercised | 14,176.32 |
| 3 Exercise price per share | 14,072.59 |
| 4 Fair market value per share on exercise date | 22,697.44 |
| 5 No. of shares transferred | 29,435.85 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-2e0fa1a9e388548cc7db62ae,v11-OTHER_TAX_FORM-kind06,original,2024,fgen-1eaab7a2350849536426a731,synthetic_programmatic_template,markdown,none,False,3921
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
Copy B For Recipient
Recipient's name   Wei E. Walsh
Recipient's TIN   ending in 5241
1a Total undistributed long-term capital gains   2,092.60
1b Unrecaptured section 1250 gain   14,254.81
2 Tax paid by the RIC or REIT 06/11/2024",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cc557958e27b1cd6333c3c57,v11-OTHER_TAX_FORM-kind07,original,2024,fgen-409e3f71f28411a43cdb21e0,synthetic_programmatic_template,inline,top,False,2439
"2024
Department of Revenue
Recipient's name
SSN
1a Total undistributed long-term capital gains
1b Unrecaptured section 1250 gain
2 Tax paid by the RIC or REIT
Kwame L. Moreau
****3969
10/3/24
20,110.51
1,912.95
Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-189bf4b9100bf9d0530a7bf4,v11-OTHER_TAX_FORM-kind07,original,2024,fgen-e0c361d52693b6d99eb10fe8,synthetic_programmatic_template,columns,bottom,False,2439
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
2025
Department of Revenue
Name,Wei Walsh
Recipient's TIN,XXXXX4730
1a Total undistributed long-term capital gains,""May 8, 2025""
1b Unrecaptured section 1250 gain,""18,229.28""
2 Tax paid by the RIC or REIT,""13,948.64""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-128dde1f95ca9ff4a2c71972,v11-OTHER_TAX_FORM-kind07,original,2025,fgen-5465681b17b01e2825bc6c70,synthetic_programmatic_template,csv,top,False,2439
"Form 2439 Notice toShareholder of Undistributed Long-Term Capital Gains 2O25 Department of the Treasury - Intemal Revenue
Service Name Amara Larsen
SSN ****1995 1a Total undistributed long-term capital gains $29,124.O8 1b Unrecaptured section 1250 gain 11,600.52 2 Tax paid by the RIC or REIT 6,474.25",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-27fe6791aebdc60ed1347bad,v11-OTHER_TAX_FORM-kind07,original,2025,fgen-96b3762ddfd74528f692b15a,synthetic_programmatic_template,flat,top,True,2439
"Form 2439
## Notice to Shareholder of Undistributed Long-Term Capital Gains
2023
## Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Casey R. Testcase |
| SSN | ending in 7901 |
| 1a Total undistributed long-term capital gains | 1,004.84 |
| 1b Unrecaptured section 1250 gain | 8,686.05 |
| 2 Tax paid by the RIC or REIT | $13,993.02 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-554e0e38f18a980b7de7b8b3,v11-OTHER_TAX_FORM-kind07,original,2023,fgen-0cb35ea954ca2bfbe62e6f20,synthetic_programmatic_template,markdown,top,False,2439
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
Department of Revenue
Recipient's name
Mateo Moreau
Identification number
****4079
1a Total undistributed long-term capital gains
18,811.80
1b Unrecaptured section 1250 gain
18,991.42
2 Tax paid by the RIC or REIT
2021-01-10",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-30df962cc217a28812217fd8,v11-OTHER_TAX_FORM-kind07,original,2021,fgen-edf01d62b7a2ef78e64157da,synthetic_programmatic_template,stacked,top,False,2439
"Department of Revenue
Recipient's name   Sofia Testcase
Recipient's TIN ending in 8930
1a Total undistributed long-term capital gains   $20,388.25
1b Unrecaptured section 1250 gain $3,064.83
2 Tax paid by the RIC or REIT  10,423.28
Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1ba886b1fea27bfd1104a09d,v11-OTHER_TAX_FORM-kind07,original,2021,fgen-fd0fe29f1d8e0d25ebb2f42c,synthetic_programmatic_template,inline,bottom,False,2439
"2026
Copy B For Recipient
Taxpayer name
Identification number
1a Total undistributed long-term capital gains
1b Unrecaptured section 1250 gain
2 Tax paid by the RIC or REIT
Diego L. Testcase
ending in 7270
18,841.35
3/4/26
2/2/26
Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1ddb595e95efa9fcca6b82ce,v11-OTHER_TAX_FORM-kind07,original,2026,fgen-c22d064840e2fc8dd21900fc,synthetic_programmatic_template,columns,bottom,False,2439
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
Department of Revenue
Name,Amara J. Larsen
SSN,ending in 1201
1a Total undistributed long-term capital gains,""$16,937.69""
1b Unrecaptured section 1250 gain,09/12/2023
2 Tax paid by the RIC or REIT,2023-12-20",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-e02633d993ea6ef88f12b181,v11-OTHER_TAX_FORM-kind07,original,2023,fgen-3e0c255b4263bacbc0acb801,synthetic_programmatic_template,csv,top,False,2439
"Keep for your records Name
Sofia A. Castillo Recipient's TIN XXX-XX-5295 la Totalundistributed long-term capital gains
13,826.68 1b Unrecaptured section 1250 gain $10,696.65 2 Tax paid by the RIC or REIT January 7, 202l",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-0e4cb611182565888ed9f38f,v11-OTHER_TAX_FORM-kind07,original,2021,fgen-2f8d6a10c032cc0a112f29f1,synthetic_programmatic_template,flat,none,True,2439
"2024
## Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Recipient's name | Kwame Kowalski |
| Recipient's TIN | XXXXX2614 |
| 1a Total undistributed long-term capital gains | 3,561.55 |
| 1b Unrecaptured section 1250 gain | 16,732.36 |
| 2 Tax paid by the RIC or REIT | 3,181.35 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ff6fa9388698f2b28221395d,v11-OTHER_TAX_FORM-kind07,original,2024,fgen-dab3a6a9cc9e0775d83a8857,synthetic_programmatic_template,markdown,none,False,2439
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
Copy B For Recipient
Recipient's name
Jamie Okafor
SSN
***-**-4587
1a Total undistributed long-term capital gains
25,902.46
1b Unrecaptured section 1250 gain
$4,478.12
2 Tax paid by the RIC or REIT
$13,512.92",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-809399abf57b3ff9364874a4,v11-OTHER_TAX_FORM-kind07,original,2022,fgen-9535452bc97db5f673e7e062,synthetic_programmatic_template,stacked,top,False,2439
"Department of Revenue
Taxpayer name Jamie Fischer
Recipient's TIN ****9225
1a Total undistributed long-term capital gains  22,476.38
1b Unrecaptured section 1250 gain 13,340.06
2 Tax paid by the RIC or REIT 01/11/2022",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-81c0f5bd5323f0774cb59323,v11-OTHER_TAX_FORM-kind07,original,2022,fgen-5c46af6c50858cfb06d20be2,synthetic_programmatic_template,inline,none,False,2439
"2022
Department of Revenue
Taxpayer name
Recipient's TIN
1a Totalundistributed long-term capital gains
1b Unrecaptured section 1250 gain
2 Tax paid by the RIC or REIT
Casey Nguyen
****4682
1,035.57
21,717.02
2,521.01",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-18630e8f49ade3471b38b222,v11-OTHER_TAX_FORM-kind07,original,2022,fgen-4b780c64b0b220398f20bded,synthetic_programmatic_template,columns,none,True,2439
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
2022
Copy B For Recipient
Taxpayer name,Diego R. Fischer
Identification number,ending in 6239
1a Total undistributed long-term capital gains,""15,859.79""
1b Unrecaptured section 1250 gain,""10,504.65""
2 Tax paid by the RIC or REIT,7/18/22",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-d0f8d6afbfb1710614eeffe0,v11-OTHER_TAX_FORM-kind07,original,2022,fgen-c3fdd3e90ce8e767ca427b44,synthetic_programmatic_template,csv,top,False,2439
"Form 2439 Notice to Shareholder of Undistributed Long-Term Capital Gains
Keep for your records Name Riley D. Fischer SSN ****0051 1a Total undistributed long-term capital gains
2025-12-02 1b Unrecaptured section 1250 gain 1,929.95 2 Tax paid by the RIC or REIT 4/23/25",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-6ecf729327f69254d2e202c4,v11-OTHER_TAX_FORM-kind07,original,2025,fgen-28e39d86a2fcf7b9a0032ca1,synthetic_programmatic_template,flat,top,False,2439
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
2021
Keep for your records
| Field | Value |
| --- | --- |
| Recipient's name | Priya Brennan |
| SSN | ****4377 |
| 1a Total undistributed long-term capital gains | 04/07/2021 |
| 1b Unrecaptured section 1250 gain | May 23, 2021 |
| 2 Tax paid by the RIC or REIT | 16,209.70 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-2be82bdb39d5c7f9980e86c6,v11-OTHER_TAX_FORM-kind07,original,2021,fgen-77c173237b72b55009dc80b9,synthetic_programmatic_template,markdown,top,False,2439
"Form 2439
Notice to Shareholder of Undistributed Long-Term Capital Gains
2022
Department of the Treasury - Internal Revenue Service
Taxpayer name
Amara Adeyemi
Identification number
ending in 4668
1a Total undistributed long-term capital gains
4,594.67
1b Unrecaptured section 1250 gain
$18,937.81
2 Tax paid by the RIC or REIT
1,442.93",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-c75b1172991d600330cd2e09,v11-OTHER_TAX_FORM-kind07,original,2022,fgen-8de3acc690aedf7faf3a423e,synthetic_programmatic_template,stacked,top,False,2439
"Form 8606
Nondeductible IRAs
2024
Keep for your records
Recipient's name
Identification number
Part I Nondeductible Contributions to Traditional IRAs and Distributions
1 Enter your nondeductible contributions to traditional IRAs
2 Enter your total basis in traditional IRAs
Diego Patel
XXX-XX-9791
$29,787.44
2024-08-06
20,317.12",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-d49560636396acee69948337,v11-OTHER_TAX_FORM-kind08,original,2024,fgen-4245dd60bb907cfd8bf9cbbe,synthetic_programmatic_template,columns,top,False,8606
"Form 8606
Nondeductible IRAs
2O25
Copy B For Recipient
Recipient's name,Mateo Brennan
Recipient's TIN,XXXXX5280
Part I Nondeductible Contributions to Traditional IRAs and Distributions,S444.10
1 Enteryour nondeductible contributions to traditional IRAs,""27,791.62""
2 Enter your total basis in traditional IRAs,""17,256.52""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-316603829e0fb084188e2180,v11-OTHER_TAX_FORM-kind08,original,2025,fgen-607512e3511c12516d3978f4,synthetic_programmatic_template,csv,top,True,8606
"2023 Keep for
your records Recipient's name Noah R. Lindqvist Identification number
****2677 Part I Nondeductible Contributions to Traditional IRAs and Distributions 1,454.72 1 Enter your nondeductible contributions to traditional IRAs $2,066.20 2 Enter your total basis in traditional IRAs 9,238.34 Form 8606 Nondeductible IRAs",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-3a436e2bcf491325c132359c,v11-OTHER_TAX_FORM-kind08,original,2023,fgen-d33510502bed31ef5d5ea26d,synthetic_programmatic_template,flat,bottom,False,8606
"Form 8606
## Nondeductible IRAs
2022
Department of Revenue
| Field | Value |
| --- | --- |
| Recipient's name | Olivia Larsen |
| Identification number | ****0434 |
| Part I Nondeductible Contributions to Traditional IRAs and Distributions | August 17, 2022 |
| 1 Enter your nondeductible contributions to traditional IRAs | 3,626.64 |
| 2 Enter your total basis in traditional IRAs | $4,937.61 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8e265fec697d01b295502f23,v11-OTHER_TAX_FORM-kind08,original,2022,fgen-70e59d39230dcd7f76ea8792,synthetic_programmatic_template,markdown,top,False,8606
"Form 8606
Nondeductible IRAs
2021
Copy B For Recipient
Recipient's name
Kwame C. Fischer
Identification number
XXXXX5157
Part I Nondeductible Contributions to Traditional IRAs and Distributions
20,329.77
1 Enter your nondeductible contributions to traditional IRAs
28,517.49
2 Enter your total basis in traditional IRAs
1,441.22",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-b3a487597d539af7ddf9836d,v11-OTHER_TAX_FORM-kind08,original,2021,fgen-af2c30b85ecdc3cf7a9a1de0,synthetic_programmatic_template,stacked,top,False,8606
"Form 8606
Nondeductible IRAs
2022
Department of the Treasury - Internal Revenue Service
Taxpayer name  Olivia Fischer
Recipient's TIN XXX-XX-3467
Part I Nondeductible Contributions to Traditional IRAs and Distributions  2/7/22
1 Enter your nondeductible contributions to traditional IRAs 2022-05-22
2 Enter your total basis in traditional IRAs 17,361.17",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-618e80f71fce03e521821f86,v11-OTHER_TAX_FORM-kind08,original,2022,fgen-71349f92700cd4e896e5619e,synthetic_programmatic_template,inline,top,False,8606
"Form 8606
Nondeductible IRAs
2023
Keep for your records
Name
SSN
Part I Nondeductible Contributions to Traditional IRAs and Distributions
1 Enter your nondeductible contributions to traditional IRAs
2 Enter your total basis in traditional IRAs
Riley Adeyemi
***-**-7299
February 20, 2023
19,829.73
May 27, 2023",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-c33e1d4fce2de1b88bf9cb80,v11-OTHER_TAX_FORM-kind08,original,2023,fgen-d2aec08218521d01b62561db,synthetic_programmatic_template,columns,top,False,8606
"Form 8606
Nondeductible IRAs
2024
Department of the Treasury - Internal Revenue Service
Taxpayer name,Alex Haddad
SSN,XXXXX1842
Part I Nondeductible Contributions to Traditional IRAs and Distributions,""13,228.85""
1 Enter your nondeductible contributions to traditional IRAs,""25,239.78""
2 Enter your total basis in traditional IRAs,""$21,489.75""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-75031f3db4221b2c28da8132,v11-OTHER_TAX_FORM-kind08,original,2024,fgen-380e2453ba38fefce7a72cb1,synthetic_programmatic_template,csv,top,False,8606
"Copy B For Recipient Recipient's name Amara Fischer Identification number ***-**-7842 Part I Nondeductible Contributions
to Traditional IRAs and Distributions 2,666.87 1 Enter your nondeductible contributions to traditional IRAs 28,836.75 2 Enter your total basis in traditional IRAs
3/12/22",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5ff8c452fe908cae3daf578e,v11-OTHER_TAX_FORM-kind08,original,2022,fgen-ed3ea2cc4752278f5a126d3d,synthetic_programmatic_template,flat,none,False,8606
"Form 8606
Nondeductible IRAs
2024
Keep for your records
| Field | Value |
| --- | --- |
| Name | Kwame Walsh |
| SSN | XXXXX1087 |
| Part I Nondeductible Contributions to Traditional IRAs and Distributions | 708.35 |
| 1 Enter your nondeductible contributions to traditional IRAs | 7/3/24 |
| 2 Enter your total basis in traditional IRAs | 29,536.69 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-2b6bc5f8143e69529250adbc,v11-OTHER_TAX_FORM-kind08,original,2024,fgen-5554e8afd159d9be6dc1ef2d,synthetic_programmatic_template,markdown,top,False,8606
"Form 8606
Nondeductible IRAs
2024
Department of Revenue
Name
Fatima Rivera
SSN
***-**-5077
Part I Nondeductible Contributions to Traditional IRAs and Distributions
7,720.18
1 Enter your nondeductible contributions to traditional IRAs
9,309.60
2 Enter your total basis in traditional IRAs
$10,441.20",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5dba171a76ad1d3b6f46542a,v11-OTHER_TAX_FORM-kind08,original,2024,fgen-6b5543fa47822862de4b512b,synthetic_programmatic_template,stacked,top,False,8606
"Form 8606
Nondeductible IRAs
2026
Department of Revenue
Recipient's name Fatima Moreau
SSN  ending in 3159
Part I Nondeductible Contributions to Traditional IRAs and Distributions   25,609.05
1 Enter your nondeductible contributions to traditional IRAs 6,816.18
2 Enter your total basis in traditional IRAs   2026-04-12",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-a0a83d92db562a5a1f6a4405,v11-OTHER_TAX_FORM-kind08,original,2026,fgen-1e8811bf3db841f1bef05c9c,synthetic_programmatic_template,inline,top,False,8606
"Form 8606
Nondeductible IRAs
Copy B For Recipient
Name
SSN
Part I Nondeductib1e Contributions to Traditional IRAs and Distributions
1 Enteryour nondeductible contributions to traditional IRAs
2 Enter your total basis in traditional IRAs
Kwame Romero
XXXXX4835
March 20, 202l
8,168.10
28,260.14",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-03b772cd9131b28389aab30a,v11-OTHER_TAX_FORM-kind08,original,2021,fgen-772b4a0fdb62a294f26b26d2,synthetic_programmatic_template,columns,top,True,8606
"2023
Department of the Treasury - Internal Revenue Service
Name,Diego Fischer
Recipient's TIN,XXXXX1256
Part I Nondeductible Contributions to Traditional IRAs and Distributions,""3,560.01""
1 Enter your nondeductible contributions to traditional IRAs,""$14,740.77""
2 Enter your total basis in traditional IRAs,""14,450.87""
Form 8606
Nondeductible IRAs",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7bc69dbf61eca18565331663,v11-OTHER_TAX_FORM-kind08,original,2023,fgen-d55b72e3ec6c278b6c48ae55,synthetic_programmatic_template,csv,bottom,False,8606
"2026 Department of the Treasury - Internal Revenue Service Taxpayer name Alex Adeyemi SSN XXX-XX-9015
Part I Nondeductible Contributions to Traditional
IRAs and Distributions $93.86 1 Enter your nondeductible contributions to traditional IRAs 7/20/26 2 Enter your total basis in traditional IRAs 20,078.70 Form 8606 Nondeductible IRAs",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-574f9c2205164ea97888fbae,v11-OTHER_TAX_FORM-kind08,original,2026,fgen-9fd8574be4db9a6ae8877a81,synthetic_programmatic_template,flat,bottom,False,8606
"## 2024
## Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Taxpayer name | Jordan B. Sato |
| Identification number | ***-**-5910 |
| Part I Nondeductible Contributions to Traditional IRAs and Distributions | 11/9/24 |
| 1 Enter your nondeductible contributions to traditional IRAs | $2,802.31 |
| 2 Enter your total basis in traditional IRAs | $14,032.14 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-60a90af1dbc323b45c2d0143,v11-OTHER_TAX_FORM-kind08,original,2024,fgen-0cfeed0a69fce4c9990dafb7,synthetic_programmatic_template,markdown,none,False,8606
"Form 8606
Nondeductible IRAs
2026
Department of the Treasury - Internal Revenue Service
Taxpayer name
Diego Lindqvist
Identification number
XXXXX4224
Part I Nondeductible Contributions to Traditional IRAs and Distributions
23,254.60
1 Enter your nondeductible contributions to traditional IRAs
$20,736.24
2 Enter your total basis in traditional IRAs
11,602.06",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-9b780328a98a64ab745d5bd9,v11-OTHER_TAX_FORM-kind08,original,2026,fgen-3d0b886993468ccdbfd6f55a,synthetic_programmatic_template,stacked,top,False,8606
"Form 8606
Nondeductible IRAs
2024
Department of the Treasury - Internal Revenue Service
Taxpayer name Lena D. Patel
SSN      ending in 6664
Part I Nondeductible Contributions to Traditional IRAs and Distributions  22,072.39
1 Enter your nondeductible contributions to traditional IRAs 22,701.94
2 Enter your total basis in traditional IRAs January 2, 2024",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-0869f75e49dfcefbbe0d53bc,v11-OTHER_TAX_FORM-kind08,original,2024,fgen-20bafbfc472130b1d64fade0,synthetic_programmatic_template,inline,top,False,8606
"Form 1099-QA
Distributions From ABLE Accounts
Copy B For Recipient
Name,Noah Tanaka
Recipient's TIN,XXXXX3113
1 Gross distribution,""6,720.06""
2 Earnings,09/17/2025
3 Basis,""$21,230.74""
4 Program-to-program transfer,""$2,762.86""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-301c911c954530de2782a2d1,v11-OTHER_TAX_FORM-kind09,original,2025,fgen-5c4dbb479c35ca999fa3ee5f,synthetic_programmatic_template,csv,top,False,1099-QA
"Form 1099-QA Distributions From ABLE Accounts Keep for your records Recipient's name Sofia L. Kowalski Recipient's
TIN ***-**-8163
1 Gross distribution $9,376.14 2 Earnings 29,070.55 3 Basis 14,557.60 4 Program-to-program transfer $17,998.77",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ec0367127567953d3fab6e46,v11-OTHER_TAX_FORM-kind09,original,2025,fgen-112da3e25a0488c09fdeb78c,synthetic_programmatic_template,flat,top,False,1099-QA
"Form 1099-QA
## Distributions From ABLE Accounts
2025
Department of Revenue
| Field | Value |
| --- | --- |
| Name | Riley K. Haddad |
| SSN | ****4286 |
| 1 Gross distribution | 29,268.11 |
| 2 Earnings | 10,216.86 |
| 3 Basis | 2,483.89 |
| 4 Program-to-program transfer | $4,002.92 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-28aef19b81d983e71bd914be,v11-OTHER_TAX_FORM-kind09,original,2025,fgen-5e3589285d4ff7b64ee3fb0d,synthetic_programmatic_template,markdown,top,False,1099-QA
"Form 1099-QA
Distributions From ABLE Accounts
Department of Revenue
Recipient's name
Avery Moreau
Identification number
XXXXX2793
1 Gross distribution
12/6/22
2 Earnings
3/23/22
3 Basis
$15,936.86
4 Program-to-program transfer
24,171.94",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-a61499f57a595082f21ada69,v11-OTHER_TAX_FORM-kind09,original,2022,fgen-1bd1fbb7ea77ced74804bbdf,synthetic_programmatic_template,stacked,top,False,1099-QA
"2021
Department of the Treasury - Internal Revenue Service
Taxpayer name      Amara E. Adeyemi
SSN      XXXXX4086
1 Gross distribution 25,951.21
2 Earnings      $9,650.09
3 Basis 24,540.10
4 Program-to-program transfer  28,066.10
Form 1099-QA
Distributions From ABLE Accounts",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-19ab29024c3e09edef395f81,v11-OTHER_TAX_FORM-kind09,original,2021,fgen-7c66c3b82f15232b65169e3d,synthetic_programmatic_template,inline,bottom,False,1099-QA
"Form 1099-QA
Distributions From ABLE Accounts
Department of Revenue
Name
Identification number
1 Gross distribution
2 Earnings
3 Basis
4 Program-to-program transfer
Hiro Fischer
ending in 3907
$19,694.77
12,684.12
16,815.18
17,773.76",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cf828fe342f57e7fd2cd73c1,v11-OTHER_TAX_FORM-kind09,original,2021,fgen-ac4c3550f32aa1a169a4d579,synthetic_programmatic_template,columns,top,False,1099-QA
"Form 1099-QA
Distributions From ABLE Accounts
2024
Department ofRevenue
Name,Amara Rivera
Recipient's TIN,XXXXX8521
1 Gross distribution,""Apri1 19, 2O24""
2 Earnings,""11,906.86""
3 Basis,""27,466.76""
4 Program-to-program transfcr,""22,555.78""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8770ecb42a63fc96a22bc4af,v11-OTHER_TAX_FORM-kind09,original,2024,fgen-ad3971e49726e6959cea650f,synthetic_programmatic_template,csv,top,True,1099-QA
"Form 1099-QA
Distributions From ABLE Accounts 2021 Copy B For Recipíent Taxpayer name Jordan Testcase SSN ending in 9393 1 Gross distribution 27,436.49 2 Earnings $4,286.153
Basis 9,793.88 4 Program-to-program transfer $14,384.08",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ede248f6b7cdf15aea595808,v11-OTHER_TAX_FORM-kind09,original,2021,fgen-a4ad31aacc26dfc24aa8242f,synthetic_programmatic_template,flat,top,True,1099-QA
"Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Name | Priya Tanaka |
| SSN | ***-**-1379 |
| 1 Gross distribution | 3,397.76 |
| 2 Earnings | 22,495.07 |
| 3 Basis | 14,222.61 |
| 4 Program-to-program transfer | 14,826.78 |
## Form 1099-QA
## Distributions From ABLE Accounts",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8a94f88e003f7f741151ccff,v11-OTHER_TAX_FORM-kind09,original,2024,fgen-a0b62de0b049286adc5ae76e,synthetic_programmatic_template,markdown,bottom,False,1099-QA
"Keep for your records
Name
Noah Lindqvist
Recipient's TIN
***-**-1961
1 Gross distribution
10/18/2021
2 Earnings
2021-05-03
3 Basis
2,997.08
4 Program-to-program transfer
01/19/2021
Form 1099-QA
Distributions From ABLE Accounts",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-406545b8f2f7627397843788,v11-OTHER_TAX_FORM-kind09,original,2021,fgen-7f4f3742aeced2023ea68129,synthetic_programmatic_template,stacked,bottom,False,1099-QA
"2026
Keep for your records
Name  Riley Testcase
Recipient's TIN   XXX-XX-0998
1 Gross distribution  2026-10-12
2 Earnings  1,510.54
3 Basis      19,382.44
4 Program-to-program transfer   $5,658.91
Form 1099-QA
Distributions From ABLE Accounts",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-49a331dac315bfb15309a996,v11-OTHER_TAX_FORM-kind09,original,2026,fgen-25e30965b3a4b270f3a5bb92,synthetic_programmatic_template,inline,bottom,False,1099-QA
"Form 1099-QA
Distributions From ABLE Accounts
2025
Keep for your records
Name
Identification number
1 Gross distribution
2 Earnings
3 Basis
4 Program-to-program transfer
Lena Okafor
***-**-0051
14,153.77
14,509.00
$3,425.76
$7,108.05",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5892d5632d270041a88097ee,v11-OTHER_TAX_FORM-kind09,original,2025,fgen-3e83ba8b06f5d98cca2b1c8c,synthetic_programmatic_template,columns,top,False,1099-QA
"Form 1099-QA
Distributions From ABLE Accounts
2021
Department of the Treasury - Internal Revenue Service
Name,Diego Tanaka
SSN,ending in 0393
1 Gross distribution,""$19,840.36""
2 Earnings,""22,495.38""
3 Basis,""$27,494.34""
4 Program-to-program transfer,""$25,167.69""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cd419e4747c7e3371fe7c1ae,v11-OTHER_TAX_FORM-kind09,original,2021,fgen-e94b0d38cfcf3b992654cd59,synthetic_programmatic_template,csv,top,False,1099-QA
"2022 Keep for your records Taxpayer
name Diego Brennan Recipient's TIN XXXXX3320
1 Gross distribution 10,192.78 2 Earnings $5,191.86 3 Basis 22,428.68 4 Program-to-program transfer 3,089.96",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-060b8f32929099a95381a9ed,v11-OTHER_TAX_FORM-kind09,original,2022,fgen-9b15b840d01f37ad252818c1,synthetic_programmatic_template,flat,none,False,1099-QA
"## 2026
## Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Recipient's name | Diego Brennan |
| Identification number | XXXXX2990 |
| 1 Gross distribution | 11,774.61 |
| 2 Earnings | 5,404.92 |
| 3 Basis | $16,924.36 |
| 4 Program-to-program transfer | 11,839.81 |
Form 1099-QA
## Distributions From ABLE Accounts",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-997dec07767f66d39b944e41,v11-OTHER_TAX_FORM-kind09,original,2026,fgen-b85a59b8224238a00fea20fa,synthetic_programmatic_template,markdown,bottom,False,1099-QA
"2022
Department of Revenue
Recipient's name
Fatima Kowalski
Recipient's TIN
ending in 0946
1 Gross distribution
3,257.38
2 Earnings
$11,225.05
3 Basis
21,171.59
4 Program-to-program transfer
4,210.73",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-dee78ffa891ef2d8f9ad3585,v11-OTHER_TAX_FORM-kind09,original,2022,fgen-70188658df08fb2719d9dd57,synthetic_programmatic_template,stacked,none,False,1099-QA
"2024
Keep for your records
Taxpayer name Lena Kowalski
Identification number  ending in 1477
1 Gross distribution 1,833.69
2 Earnings   June 2, 2024
3 Basis 5,255.97
4 Program-to-program transfer 24,922.25
Form 1099-QA
Distributions From ABLE Accounts",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-945bba6ab1d2b51e1727786c,v11-OTHER_TAX_FORM-kind09,original,2024,fgen-56396e4aa447b27228778200,synthetic_programmatic_template,inline,bottom,False,1099-QA
"Form 1099-QA
Distributions FromABLE Accounts
2024
Department of Revenue
Taxpayer name
Identification number
l Gross distribution
2 Earnings
3 Basis
4 Program-to-program transfer
Priya B. Okafor
ending in 3640
l7,083.69
6,638.31
4/19/24
$3,493.26",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-eb496048bbacecb883ce4721,v11-OTHER_TAX_FORM-kind09,original,2024,fgen-a7d001357b29d41b8d2eefc3,synthetic_programmatic_template,columns,top,True,1099-QA
"Form IL-1040
Illinois Individual Income Tax Return
2023
Department of Revenue
Taxpayer name
Casey B. Adeyemi
Identification number
ending in 4771
Step 1: Personal Information
25,922.41
Step 2: Income
$22,467.28
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11
12,181.98",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-10a5e998cd33d75d503b96e9,v11-OTHER_TAX_FORM-kind12,original,2023,fgen-7ae27521efb8940e586d503c,synthetic_programmatic_template,stacked,top,False,IL-1040
"2024
Department of the Treasury - Internal Revenue Service
Taxpayer name      Hiro Sato
SSN ****8174
Step 1: Personal Information 6,554.28
Step 2: Income $22,207.08
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11   $28,206.03
Form IL-1040
Illinois Individual Income Tax Return",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8b00112f506c285af69a54bd,v11-OTHER_TAX_FORM-kind12,original,2024,fgen-37f532f2390a191b24d9dca9,synthetic_programmatic_template,inline,bottom,False,IL-1040
"Form IL-1040
Illinois Individual Income Tax Return
2026
Department of Revenue
Recipient's name
Recipient's TIN
Step 1: Personal Information
Step 2: Income
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11
Wei C. Larsen
***-**-8169
$7,419.53
17,573.15
24,352.07",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-9576305b0266221a9da21266,v11-OTHER_TAX_FORM-kind12,original,2026,fgen-43f1c02ceb4e6645b786e2f9,synthetic_programmatic_template,columns,top,False,IL-1040
"Form IL-1040
Illínois Individual Income Tax Return
2026
Department of Revenue
Recipient's name,Hiro Fischcr
Recipient's TIN,XXX-XX-3004
Step 1:Personal Information,2026-11-20
Step 2: Incomc,""25,885.97""
""1 Federal adjusted gross incomc from your federal Form 1040 or 1040-SR, Line 11"",""$29,098.07""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-79c8622b427effb016ff6564,v11-OTHER_TAX_FORM-kind12,original,2026,fgen-90cbbbf3a1f825f86fc6f432,synthetic_programmatic_template,csv,top,True,IL-1040
"Form IL-1040 Illinois Individual Income Tax Return
Department of the Treasury - Internal Revenue Service Recipient's name Lena J. Larsen SSN ***-**-8433 Step 1: Personal Information January 15, 2024
Step 2: Income 2024-12-03 1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11 1,597.80",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-68b41da881f2c032a1f7f564,v11-OTHER_TAX_FORM-kind12,original,2024,fgen-ad6d419219cd70e6e770d897,synthetic_programmatic_template,flat,top,False,IL-1040
"## 2021
Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Taxpayer name | Diego Walsh |
| Identífication number | ****5318 |
| 5tep 1: Personal Information |18,158.35 |
| Step 2: Income | 20,152.50 |
| 1 Federal adjusted grossincome from your federa1 Form 1040 or 1040-SR, Line 11 | $9,320.16 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-043f965ad025acbc52377258,v11-OTHER_TAX_FORM-kind12,original,2021,fgen-6d27b81e35bf8e5c210cbaaf,synthetic_programmatic_template,markdown,none,True,IL-1040
"Form IL-1040
Illinois Individual Income Tax Return
Department of Revenue
Taxpayer name
Alex Haddad
Identification number
***-**-3002
Step 1: Personal Information
16,821.92
Step 2: Income
15,585.55
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11
11,604.57",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-9d82d30d37431a11a1d35087,v11-OTHER_TAX_FORM-kind12,original,2021,fgen-16187a9753ae288b097395ca,synthetic_programmatic_template,stacked,top,False,IL-1040
"Form IL-1040
Illinois Individual Income Tax Return
2023
Department of Revenue
Recipient's nameTaylor Okafor
SSN   ****8377
Step l: Personal Information      2/10/23
Step 2: Income  2023-11-08
1 Federal adjusted gross income from your federal Form 1O40 or 1040-SR, Líne 11 01/10/2023",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-07c094ba4fba1d9a98be738f,v11-OTHER_TAX_FORM-kind12,original,2023,fgen-f865220635c1e719bc6fe48a,synthetic_programmatic_template,inline,top,True,IL-1040
"Form IL-1040
Illinois Individual Income Tax Return
2025
Copy B For Recipient
Name
Identification number
Step 1: Personal Information
Step 2: Income
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11
0liviaRomero
ending in 9795
S10,695.59
$2,732.61
26,499.06",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7f352bd13aa5bc4ca94d565d,v11-OTHER_TAX_FORM-kind12,original,2025,fgen-f70ff511b8f3786d2d749065,synthetic_programmatic_template,columns,top,True,IL-1040
"2021
Copy B For Recipient
Taxpayer name,Jamie Adeyemi
Identification number,XXXXX1216
Step 1: Personal Information,""24,481.20""
Step 2: Income,""19,071.90""
""1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11"",2021-05-05
Form IL-1040
Illinois Individual Income Tax Return",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-260dfe3138da624972eb52fa,v11-OTHER_TAX_FORM-kind12,original,2021,fgen-780c9fa61753adac1ec8f185,synthetic_programmatic_template,csv,bottom,False,IL-1040
"2024 Department
of the Treasury -
Internal Revenue Service Name Riley E. Haddad SSN XXXXX8045 Step 1: Personal Information 2,547.82 Step 2: Income 7/16/24 1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11 14,492.82",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-0170ab9252ea5e444b75466a,v11-OTHER_TAX_FORM-kind12,original,2024,fgen-ff16ad6385c8264d9a8f7c33,synthetic_programmatic_template,flat,none,False,IL-1040
"## Form IL-1040
Illinois Individual Income Tax Return
Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Priya Lindqvist |
| Identification number | XXXXX6623 |
| Step 1: Personal Information | 25,438.41 |
| Step 2: Income | $4,453.41 |
| 1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11 | 10,999.99 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-966c3ae597041988ebfdcf27,v11-OTHER_TAX_FORM-kind12,original,2026,fgen-ee7bbacf911b17011dc57cbe,synthetic_programmatic_template,markdown,top,False,IL-1040
"2023
Keep for your records
Name
Olivia C. Romero
Identification number
****3707
Step 1: Personal Information
2,026.62
Step 2: Income
12,580.82
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11
$11,857.54",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ebc2577f2e5ac5b244117336,v11-OTHER_TAX_FORM-kind12,original,2023,fgen-db33b6ce50e2d2811ad1d18d,synthetic_programmatic_template,stacked,none,False,IL-1040
"Form IL-1040
Illinois Individual Income Tax Return
Copy B For Recipient
Taxpayer name Wei Testcase
Identification number   ***-**-3880
Step 1: Personal Information      3,761.63
Step 2: Income  8,600.43
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11  10,970.10",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7af5b3d0016473043dd6a8c9,v11-OTHER_TAX_FORM-kind12,original,2024,fgen-95897f7b53ecd5a5bdab8556,synthetic_programmatic_template,inline,top,False,IL-1040
"Form IL-1040
Illinois Individual Income Tax Return
Copy B For Recipient
Recipient's name
Recipient's TIN
Step 1: Personal Information
Step 2: Income
1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11
Lena Brennan
XXX-XX-9452
10,948.08
13,312.36
$7,319.30",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-200f902a43ee426aa10505d7,v11-OTHER_TAX_FORM-kind12,original,2025,fgen-3b720bd3d1d3eed065559c4d,synthetic_programmatic_template,columns,top,False,IL-1040
"Form IL-1040
Illinois Individual Income Tax Return
2026
Copy B For Recipient
Taxpayer name,Wei Sato
SSN,XXXXX4784
Step 1: Personal Information,""25,020.31""
Step 2: Income,""10,437.03""
""1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11"",""17,049.36""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-4863aedcb8df6e6a0758d120,v11-OTHER_TAX_FORM-kind12,original,2026,fgen-4919aa25835643d49b13cb66,synthetic_programmatic_template,csv,top,False,IL-1040
"Department of the Treasury - Internal Revenue Service Recipient's name Fatima B. Testcase Identification number ***-**-9757 Step 1: Personal Information 19,857.69 Step 2:
Income 11,095.79 1 Federal adjusted gross income from your federal Form 1040
or 1040-SR, Line 11 23,780.94",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1619f89221be8afa878d531d,v11-OTHER_TAX_FORM-kind12,original,2024,fgen-c1308e3f0d510d81e4d8a600,synthetic_programmatic_template,flat,none,False,IL-1040
"Form IL-1040
## Illinois Individual Income Tax Return
Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Amara Sato |
| SSN | ending in 8827 |
| Step 1: Personal Information | 25,164.82 |
| Step 2: Income | $25,752.44 |
| 1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11 | $3,392.66 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-3dc0f23c5063afcd5c9caee9,v11-OTHER_TAX_FORM-kind12,original,2023,fgen-b2f93ccaa18fd4ca94069448,synthetic_programmatic_template,markdown,top,False,IL-1040
"Form 540
California Resident Income Tax Return
2021
Copy B For Recipient
Name   Lena Testcase
SSN  ending in 6413
Filing Status   $28,638.32
13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11  $3,115.30
17 California adjusted gross income   $3,016.61",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5a736a7c1c8136bf4d45da41,v11-OTHER_TAX_FORM-kind13,original,2021,fgen-2689fac3b573671a79c95d05,synthetic_programmatic_template,inline,top,False,540
"2022
Keep for your records
Name
Identification number
Filing Status
13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11
17 California adjusted gross income
Fatima Nguyen
XXX-XX-5241
1/22/22
December 5, 2022
05/12/2022
Form 540
California Resident Income Tax Return",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-301a4b06d88b707df52ca8b0,v11-OTHER_TAX_FORM-kind13,original,2022,fgen-bd05fcc02187e15f3557b713,synthetic_programmatic_template,columns,bottom,False,540
"2026
Copy B For Recipient
Taxpayer name,Noah Fischer
Recipient's TIN,***-**-6592
Filing Status,""$4,551.14""
""13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11"",4/6/26
17 California adjusted gross income,10/12/2026
Form 540
California Resident Income Tax Return",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-0b7d9578cb5e72e04a89ae2c,v11-OTHER_TAX_FORM-kind13,original,2026,fgen-9d8049b5b9565e9083b76ad7,synthetic_programmatic_template,csv,bottom,False,540
"2023 Department of the Treasury - Internal Revenue Service Taxpayer name Jamie L. Tanaka Identification number ending in 8345 Filing Status 23,223.40 13
Federal adjusted gross income from federal Form
1040 or 1040-SR, line 11 $21,543.52 17 California adjusted gross income 15,858.06",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-2cef6aa5b3c3996f8b3969b5,v11-OTHER_TAX_FORM-kind13,original,2023,fgen-86af914df63126f06cb99e2e,synthetic_programmatic_template,flat,none,False,540
"Form 540
California Resident Income Tax Return
Copy B For Recipient
| Field | Value |
| --- | --- |
| Recipient's name | Amara R. Okafor |
| Identification number | ***-**-2452 |
| Filing Status | $17,059.99 |
| 13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11 | $8,962.83 |
| 17 California adjusted gross income | 12/17/25 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-4bfc65f08245956bb662d4cc,v11-OTHER_TAX_FORM-kind13,original,2025,fgen-b7bbb3cdb34967af419544d7,synthetic_programmatic_template,markdown,top,False,540
"Form 540
California Resident Income Tax Return
2021
Department of Revenue
Taxpayer name
Lena Haddad
SSN
XXX-XX-5606
Filing Status
380.89
13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11
$19,125.77
17 California adjusted gross income
5,866.76",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-0a5d4963c9fb3907ead71975,v11-OTHER_TAX_FORM-kind13,original,2021,fgen-328c14fc1be648af50c6c4f4,synthetic_programmatic_template,stacked,top,False,540
"Form 540
California Residcnt Income Tax Return
Copy B For Recipient
Name Olivia Sato
Recipient's TIN      ****5112
Filing Status  1,775.53
13 Federal adjusted gross income from federal Form 1O40 or 1040-SR, líne 11  22,432.16
17 California adjusted gross income     7/9/21",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-09f11e99ac1ae4c79067bcf6,v11-OTHER_TAX_FORM-kind13,original,2021,fgen-17491442ed3c4c18c41af872,synthetic_programmatic_template,inline,top,True,540
"Form 540
California Resident Income TaxReturn
2021
Department of Revenue
Taxpayer name
Identification number
Filing Status
13 Federal adjustcd gross income from federal Form 1040 or 1040-SR, line 11
17 Califomia adjusted gross income
Wei Haddad
ending in 1569
O8/19/2021
6,297.74
$3,463.32",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-bb3963ac66c2fc4f1d6640ea,v11-OTHER_TAX_FORM-kind13,original,2021,fgen-eb5f740ebf12781bdbb976c6,synthetic_programmatic_template,columns,top,True,540
"Form 540
California Resident Income Tax Return
2025
Department of Rcvenue
Name,Amara Romero
Recipient's TIN,ending in 2359
Filing Status,09/06/2025
""13 Federaladjusted gross income from federal Form 1040 or 1040-SR, line 11"",""2,840.36""
17 California adjustcd gross income,""$3,241.79""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8f2422a0c84df6e746b145b0,v11-OTHER_TAX_FORM-kind13,original,2025,fgen-8fe6e2366c6a2a4bf871d32e,synthetic_programmatic_template,csv,top,True,540
"Copy B For Recipient Recipient's name Alex Okafor Recipient's TIN ending in 9883 Filing Status $14,752.36 13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11 7,113.76
17 California adjusted gross income 18,697.78
Form 540 California Resident Income Tax Return",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-851991dddb2b06aef8d806be,v11-OTHER_TAX_FORM-kind13,original,2024,fgen-b9a80c864332ca83f1315434,synthetic_programmatic_template,flat,bottom,False,540
"## 2021
Copy B For Recipient
| Field | Value |
| --- | --- |
| Name | Avery Testcase |
| Recipient's TIN | ***-**-5320 |
| Filing Status | 5,066.54 |
| 13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11 | 13,991.65 |
| 17 California adjusted gross income | 6,019.62 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1b4df8f0d38b5674efaf75fa,v11-OTHER_TAX_FORM-kind13,original,2021,fgen-f79bde3279dd69f4803112e6,synthetic_programmatic_template,markdown,none,False,540
"Form 540
California Resident Income Tax Return
2022
Department of Revenue
Recipient's name
Lena D. Kowalski
Recipient's TIN
ending in 4748
Filing Status
5,947.69
13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11
1,662.51
17 California adjusted gross income
$252.70",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-1b02246e39bc4bd25549ab7e,v11-OTHER_TAX_FORM-kind13,original,2022,fgen-40db54f9f25af1ecb80a836f,synthetic_programmatic_template,stacked,top,False,540
"2021
Copy B For Recipient
Recipient's name Jamie Brennan
Recipient's TIN  ***-**-8356
Filing Status      2,333.97
13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11      27,348.16
17 California adjusted gross incomc     13,015.38",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8c9b245c5b14329860638b96,v11-OTHER_TAX_FORM-kind13,original,2021,fgen-801a569ab1344314614b09db,synthetic_programmatic_template,inline,none,True,540
"Form 540
California Resident Income Tax Return
Copy B For Recipient
Name
Recipient's TIN
Filing Status
13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11
17 California adjusted gross income
Alex Brennan
***-**-2354
$29,841.20
15,203.69
148.99",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-dc9600066b3e2c4d9f64c5a4,v11-OTHER_TAX_FORM-kind13,original,2025,fgen-dd313a9b78e9aa04fb93e4f3,synthetic_programmatic_template,columns,top,False,540
"Form 540
California Resident Income Tax Return
2022
Department of the Treasury - Internal Revenue Service
Taxpayer name,Sofia R. Okafor
SSN,ending in 6324
Filing Status,""8,724.34""
""13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11"",""10,922.17""
17 California adjusted gross income,""$20,637.12""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-86f49e6b534218135dec66ce,v11-OTHER_TAX_FORM-kind13,original,2022,fgen-83091145f6ed58714a7c434f,synthetic_programmatic_template,csv,top,False,540
"Form 540 California Resident Income Tax Return 2024 Keep for your records
Name Avery Walsh SSN XXX-XX-9937 Filing Status 2024-12-14 13 Federal adjusted gross income from federal Form 1040 or 1040-SR,
line 11 $19,820.49 17 California adjusted gross income 27,061.26",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-6364eee6b00bbc61cf712380,v11-OTHER_TAX_FORM-kind13,original,2024,fgen-6ab3f9b79b89471a135b92ea,synthetic_programmatic_template,flat,top,False,540
"Form 540
## California Resident Income Tax Return
2026
Department of the Treasury - Internal Revenue Service
| Field | Value |
| --- | --- |
| Taxpayer name | Morgan Nguyen |
| Identification number | XXX-XX-1353 |
| Filing Status | 6,885.60 |
| 13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11 | $27,868.88 |
| 17 California adjusted gross income | $11,447.46 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-89028a71a0c0bbce0c7e84b0,v11-OTHER_TAX_FORM-kind13,original,2026,fgen-a352dc8271fcdec88a3a2598,synthetic_programmatic_template,markdown,top,False,540
"Form 540
California Resident Income Tax Return
2026
Copy B For Recipient
Taxpayer name
Jordan Okafor
Identification number
XXX-XX-0530
Filing Status
28,061.65
13 Federal adjusted gross income from federal Form 1040 or 1040-SR, line 11
2,698.51
17 California adjusted gross income
$10,074.24",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ce6518bf5c9a8462bec7952d,v11-OTHER_TAX_FORM-kind13,original,2026,fgen-a09ba3fbb5974357f25c175f,synthetic_programmatic_template,stacked,top,False,540
"Form IT-201
Resident Income Tax Return (New York State)
2021
Department of the Treasury - Internal Revenue Service
Name
SSN
Filing status
1 Wages, salaries, tips, etc.
19 Federal adjusted gross income
Morgan Brennan
***-**-5594
$7,899.09
22,845.11
5,257.18",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8c573c72ce5ac172a323861d,v11-OTHER_TAX_FORM-kind14,original,2021,fgen-e891d50937fdee5657e2237d,synthetic_programmatic_template,columns,top,False,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
Department of the Treasury - Internal Revenue Service
Recipient's name,Morgan Walsh
Recipient's TIN,XXX-XX-2286
Filing status,""24,742.20""
""1 Wages, salaries, tips, etc."",07/11/2022
19 Federal adjusted gross income,""26,035.59""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cca969d184f8969579d74af0,v11-OTHER_TAX_FORM-kind14,original,2022,fgen-1dba8a052c1e97e04ab697b0,synthetic_programmatic_template,csv,top,False,IT-201
"Form IT-201 Resident Income Tax Return
(New York State)
2026 Department of Revenue Taxpayer name Sofia Lindqvist SSN XXX-XX-7995 Filing status September 12, 2026 1 Wages, salaries, tips, etc. 28,211.13 19 Federal adjusted gross income 19,986.92",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-6307c4b50cbcaf1c35a12bf8,v11-OTHER_TAX_FORM-kind14,original,2026,fgen-a9ef5ddd7505d664ef703332,synthetic_programmatic_template,flat,top,False,IT-201
"2026
Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Hiro Adeyemi |
| SSN | ****7719 |
| Filing status | $12,911.21 |
| 1 Wages, salaries, tips, etc. | 15,801.35 |
| 19 Federal adjusted gross income | 10,133.53 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-eb2ad793c79f339ab2178399,v11-OTHER_TAX_FORM-kind14,original,2026,fgen-c5861753c69d7f395b7148b8,synthetic_programmatic_template,markdown,none,False,IT-201
"2025
Keepfor your records
Name
Kwame J. Okafor
Identification number
ending in 2473
Filing status
16,528.05
1 Wages, salaries, tips, etc.
4,987.07
19 Federal adjusted gross income
$3,280.69",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-815082aaafe0c0c410edc3e4,v11-OTHER_TAX_FORM-kind14,original,2025,fgen-5f917dd8986135ac114861c1,synthetic_programmatic_template,stacked,none,True,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
Department of the Treasury - Internal Revenue Service
Taxpayer name  Sofia A. Tanaka
Identification numbcr   ****0881
Fi1ing status      S24,306.48
1Wages, salaries, tips, etc.  3,O18.87
19 Federa1 adjusted gross income 8,392.56",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-cef14c43fe3f21d8a06734c5,v11-OTHER_TAX_FORM-kind14,original,2024,fgen-9abaf88e3ad75c26b5ebf0d7,synthetic_programmatic_template,inline,top,True,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
2021
Department of Revenue
Recipient's name
SSN
Filing status
1 Wages, salaries, tips, etc.
19 Federal adjusted gross income
Olivia Okafor
XXX-XX-9330
$11,363.15
24,036.53
1/5/21",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-f2909bd9bececfd217219672,v11-OTHER_TAX_FORM-kind14,original,2021,fgen-e36fb6758c8e82815c3d44b1,synthetic_programmatic_template,columns,top,False,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
2022
Department of Revenue
Name,Hiro Lindqvist
Recipient's TIN,ending in 4467
Filing status,""23,517.22""
""1 Wages, salaries, tips, etc."",""$28,434.93""
19 Federal adjusted gross income,""3,598.87""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-aaa3022ee1199c15a70bfeaa,v11-OTHER_TAX_FORM-kind14,original,2022,fgen-87f0098c9a29fd88d96cf72a,synthetic_programmatic_template,csv,top,False,IT-201
"Form IT-201 Resident Income Tax Return (New York State) 2024 Department of Revenue Name Diego Tanaka Recipient's TIN ending in 4173 Filing status 6/26/24 1 Wages, salaries, tips,
etc. $5,464.35 19 Federal
adjusted gross income 23,312.14",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7c71bfa1b3227c60041b2bfc,v11-OTHER_TAX_FORM-kind14,original,2024,fgen-e87d04d511b23e7835ade656,synthetic_programmatic_template,flat,top,False,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
## Keep for your records
| Field | Value |
| --- | --- |
| Recipient's name | Priya C. Nguyen |
| Recipient's TIN | XXX-XX-1436 |
| Filing status | 06/20/2021 |
| 1 Wages, salaries, tips, etc. | 7,550.16 |
| 19 Federal adjusted gross income | $17,109.54 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-0eca92d996ef90fd527960cc,v11-OTHER_TAX_FORM-kind14,original,2021,fgen-cf1d7392a6ec5fb68088c5cd,synthetic_programmatic_template,markdown,top,False,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
2025
Department of the Treasury - Internal Revenue Service
Recipient's name
Fatima M. Haddad
SSN
XXX-XX-4920
Filing status
9/23/25
1 Wages, salaries, tips, etc.
10,443.92
19 Federal adjusted gross income
$3,548.85",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-b39a2148e466504677f1f4eb,v11-OTHER_TAX_FORM-kind14,original,2025,fgen-87024d87b06615ad9e94fe4b,synthetic_programmatic_template,stacked,top,False,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
Keep for your records
Recipient's name  Jamie Haddad
SSN ending in 2865
Filing status 16,165.95
1 Wages, salaries, tips, etc. 17,367.62
19 Federal adjusted gross income   25,897.04",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-8b29555e8cc246c81ab62218,v11-OTHER_TAX_FORM-kind14,original,2025,fgen-8369438b16b3e37b1b2f07a9,synthetic_programmatic_template,inline,top,False,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
2026
Keep for your records
Recipient's name
Recipient's TIN
Filing status
1 Wages, salaries, tips, etc.
19 Federal adjusted gross income
Sofia Romero
***-**-3076
$25,503.89
February 3, 2026
8,095.08",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-d14dc9c48f19f545a50f5a0c,v11-OTHER_TAX_FORM-kind14,original,2026,fgen-61e0aee9292043a9931b8022,synthetic_programmatic_template,columns,top,False,IT-201
"Form IT-201
Resident Income Tax Return (New York State)
2023
Copy B For Recipient
Recipient's name,Noah Walsh
Identification number,***-**-7060
Filing status,""$24,114.78""
""1 Wages, salaries, tips, etc."",""19,674.25""
19 Federal adjusted gross income,2023-09-11",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-821ae8bf149cb2beda2ad1c6,v11-OTHER_TAX_FORM-kind14,original,2023,fgen-ba147444cf7d7288aa3d261b,synthetic_programmatic_template,csv,top,False,IT-201
"2021
Copy B For Recipient Recipient's name Sofia
Patel SSN ****3497 Filing status 12,216.89 1 Wages, salaries, tips, etc. 09/02/2021 19 Federal adjusted gross income 25,708.17",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-6608797d88dd18d88b3b1580,v11-OTHER_TAX_FORM-kind14,original,2021,fgen-228908f5ab1ca72c1ab9beeb,synthetic_programmatic_template,flat,none,False,IT-201
"Form IT-201
## Resident Income Tax Return (New York State)
2022
## Keep for your records
| Field | Value |
| --- | --- |
| Taxpayer name | Amara Castillo |
| Identification numbcr | XXX-XX-6395 |
| Filingstatus | $l8,642.53 |
| 1 Wagcs, salaries,tips, etc. | 2O22-02-09 |
| 19 Federal adjusted gross income | 7,769.17 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-adad3a64723f10148e9855bc,v11-OTHER_TAX_FORM-kind14,original,2022,fgen-ab16f46cdf348af9f36c2bf3,synthetic_programmatic_template,markdown,top,True,IT-201
"2024
Keep for your records
Name
Avery E. Adeyemi
SSN
***-**-4204
Filing status
22,551.43
1 Wages, salaries, tips, etc.
09/25/2024
19 Federal adjusted gross income
15,155.17",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-a168ae8f5619762df01546ea,v11-OTHER_TAX_FORM-kind14,original,2024,fgen-3726cd1d672dd757f64cbeee,synthetic_programmatic_template,stacked,none,False,IT-201
"2026
Department of the Treasury - Internal Revenue Service
Name Riley C. Moreau
Identification number   ending in 5584
Filing status      $1,069.43
1 Wages, salaries, tips, etc.  $9,761.84
19 Federal adjusted gross income   $13,460.63
Form IT-201
Resident Income Tax Return (New York State)",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-39adc37e6ee8d59e322a8e01,v11-OTHER_TAX_FORM-kind14,original,2026,fgen-a71745a4860df9cbb00b2d8e,synthetic_programmatic_template,inline,bottom,False,IT-201
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
Department of Revenue
Name,Riley Lindqvist
Recipient's TIN,***-**-8054
1 Amount of HCTC advance payments,""10,780.11""
2 No. of mos. HCTC payments received,""$28,577.70""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-19d3626dd9124484498652c5,v11-OTHER_TAX_FORM-kind15,original,2025,fgen-fb3d237ee711d32ef0185de1,synthetic_programmatic_template,csv,top,False,1099-H
"Form 1099-H Health Coverage Tax Credit (HCTC) Advance Payments Keep for your records Recipient's name Casey Adeyemi SSN ending in 3505
1 Amount of HCTC
advance payments $22,009.29 2 No. of mos. HCTC payments received 29,964.95",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-331045baae2c050a3dea46c9,v11-OTHER_TAX_FORM-kind15,original,2025,fgen-7c2a0443884fe4171b1f04d6,synthetic_programmatic_template,flat,top,False,1099-H
"2026
Copy B For Recipient
| Field | Value |
| --- | --- |
| Name | Kwame D. Patel |
| SSN | ***-**-0974 |
| 1 Amount of HCTC advance payments | 10,171.49 |
| 2 No. of mos. HCTC payments received | 6,687.28 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-9266ef25b4598379d393b12c,v11-OTHER_TAX_FORM-kind15,original,2026,fgen-c4a89060e016930297ae2c9c,synthetic_programmatic_template,markdown,none,False,1099-H
"2025
Keep for your records
Name
Morgan Testcase
Recipient's TIN
***-**-3901
1 Amount of HCTC advance payments
21,957.76
2 No. of mos. HCTC payments received
4,329.46
Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-18c66cf1c5d9c738b5f999bd,v11-OTHER_TAX_FORM-kind15,original,2025,fgen-08f9df4b8da13ae5c7606c32,synthetic_programmatic_template,stacked,bottom,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
2026
Department of the Treasury - Internal Revenue Service
Recipient's name  Fatima A. Romero
Identification number ***-**-6023
1 Amount of HCTC advance payments 20,731.05
2 No. of mos. HCTC payments received      12/18/2026",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-5319bb93bac94f72833868cf,v11-OTHER_TAX_FORM-kind15,original,2026,fgen-3c4a4ff6d69a452a7b9e663b,synthetic_programmatic_template,inline,top,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
Keep for your records
Name
Identification number
1 Amount of HCTC advance payments
2 No. of mos. HCTC payments received
Lena Patel
XXXXX7870
12,979.17
02/13/2023",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-918d40080687fcb5c8590f68,v11-OTHER_TAX_FORM-kind15,original,2023,fgen-c0493e020d51768414d1c55e,synthetic_programmatic_template,columns,top,False,1099-H
"Department of the Treasury - Internal Revenue Service
Taxpayer name,Noah Adeyemi
Identification number,ending in 6219
1 Amount of HCTC advance payments,""24,109.41""
2 No. of mos. HCTC payments received,""15,025.56""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-395f79a93a970444fe3831b2,v11-OTHER_TAX_FORM-kind15,original,2021,fgen-e044862cf0aced8d184c66d8,synthetic_programmatic_template,csv,none,False,1099-H
"2023 Department
of the Treasury - Internal Revenue Service Name Noah Tanaka Recipient's TIN ***-**-4348 1 Amount of HCTC
advance payments 28,317.70 2 No. of mos. HCTC payments received 22,126.67",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-ae693b55eb8aadedd7b55f1d,v11-OTHER_TAX_FORM-kind15,original,2023,fgen-6e9aa2fbcb47bde3a43183c4,synthetic_programmatic_template,flat,none,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
## 2025
Department of the Treasury - Internal Revenue Servíce
| Field | Value |
| --- | --- |
| Name | Casey Patel |
| SSN | ****0771 |
| 1 Amountof HCTC advance payments | 2025-04-22 |
| 2 No. of mos. HCTCpayments receíved | 17,143.16 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-b517be5750e66b6cb3ee1bbd,v11-OTHER_TAX_FORM-kind15,original,2025,fgen-de6c786ad4fa5f98be8e5da1,synthetic_programmatic_template,markdown,top,True,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
Department of Revenue
Name
Taylor D. Moreau
Identification number
***-**-8295
1 Amount of HCTC advance payments
25,962.67
2 No. of mos. HCTC payments received
$19,194.92",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-42e9cf2a0baf38e44da553f4,v11-OTHER_TAX_FORM-kind15,original,2023,fgen-8228b628bb1f8e3b6b9503cc,synthetic_programmatic_template,stacked,top,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
2023
Keep for your records
Name Wei Lindqvist
Identification number ***-**-3269
1 Amount of HCTC advance payments May 11, 2023
2 No. of mos. HCTC payments received 351.03",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-d9c027d7b6d5f389394296d8,v11-OTHER_TAX_FORM-kind15,original,2023,fgen-e772313e5ab158029855625f,synthetic_programmatic_template,inline,top,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
2022
Department of Revenue
Name
SSN
1 Amount of HCTC advance payments
2 No. of mos. HCTC payments received
Wei Romero
ending in 0819
4,552.27
$27,087.22",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-4761c2523b142b05b1440557,v11-OTHER_TAX_FORM-kind15,original,2022,fgen-40347c813cbb03cbd596eab2,synthetic_programmatic_template,columns,top,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
2026
Keep for your records
Taxpayer name,Riley Nguyen
Identification number,ending in 9270
1 Amount of HCTC advance payments,""6,884.93""
2 No. of mos. HCTC payments received,""6,379.54""",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-b3c2e04b046b5d7cf6adafd6,v11-OTHER_TAX_FORM-kind15,original,2026,fgen-0c7a18d23ce24889c0b1faed,synthetic_programmatic_template,csv,top,False,1099-H
"Form 1099-H Health
Coverage Tax Credit
(HCTC) Advance Payments 2022 Department of Revenue Recipient's name Lena Tanaka Identification number XXX-XX-6105 1 Amount of HCTC advance payments 23,340.19 2 No. of mos. HCTC payments received 2,301.64",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-6e81e053116d61c7030df85e,v11-OTHER_TAX_FORM-kind15,original,2022,fgen-4a6377e0f8526cb2b40e1bad,synthetic_programmatic_template,flat,top,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
2025
Department of Revenue
| Field | Value |
| --- | --- |
| Taxpayer name | Lena Romero |
| SSN | ****9366 |
| 1 Amount of HCTC advance payments | 8,909.63 |
| 2 No. of mos. HCTC payments received | 14,331.04 |",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-57bfff67551b5ca5fe58ce39,v11-OTHER_TAX_FORM-kind15,original,2025,fgen-e73d5d75d83615591cbdddcd,synthetic_programmatic_template,markdown,top,False,1099-H
"2026
Copy B For Recipient
Name
Hiro Moreau
Recipient's TIN
XXX-XX-1839
1 Amount of HCTC advance payments
26,715.04
2 No. of mos. HCTC payments received
April 9, 2026",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-174caede69b35fe4d45dcbd9,v11-OTHER_TAX_FORM-kind15,original,2026,fgen-d26aea93e50ee5ddcacdac79,synthetic_programmatic_template,stacked,none,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
2023
Copy B For Recipient
Recipient's name Avery Tanaka
SSN  XXXXX1561
1 Amount of HCTC advance payments   5,261.96
2 No. of mos. HCTC payments received $19,413.38",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-944558efbbe0d1226d2f8d89,v11-OTHER_TAX_FORM-kind15,original,2023,fgen-7f71579f4c56402049e86cd4,synthetic_programmatic_template,inline,top,False,1099-H
"Form 1099-H
Health Coverage Tax Credit (HCTC) Advance Payments
2025
Keep for your records
Taxpayer name
Identification number
1 Amount of HCTC advance payments
2 No. of mos. HCTC payments received
Wei Okafor
***-**-4065
$22,851.40
$27,752.80",OTHER_TAX_FORM,48,OTHER_TAX_FORM,fdc-7439efcd77e845e8950f409e,v11-OTHER_TAX_FORM-kind15,original,2025,fgen-661b9cc7d3be2a944f04f480,synthetic_programmatic_template,columns,top,False,1099-H
"Pay Statement
Riverside Regional Hospital
1647 Maple Ridge Dr Lakewood, CO 56254
Employee
Fatima Adeyemi
Employee ID
77692
Pay period
07/01/2021 - 07/30/2021
Pay date
June 7, 2021
Earnings  Rate  Hours  Current  YTD
Regular
29.07
86.67
2,519.70
10,078.79
Overtime
43.61
3.00
499.18
3,259.28
Deductions  Current  YTD
Federal Income Tax
277.17
1,108.67
Social Security
156.22
624.89
Medicare
36.54
146.14
State Income Tax
100.79
403.15
401(k)
151.18
604.73
Medical Pre-Tax
75.59
302.36
Gross pay
2,519.70
Net pay
1,713.39
Direct deposit to checking
***-**-3666",PAYSTUB,44,PAYSTUB,fdc-4bab1f6bf7b3ffce5913a08d,v11-PAYSTUB-stacked,original,2021,fgen-ec1eadea8653f1bd34850214,synthetic_programmatic_template,stacked,top,False,biweekly
"Payroll Advice
Granite Peak Manufacturing Co.
9033 Harbor View Rd Riverton, WI 67623
Employee
Hiro Rivera
Employee ID
58246
Pay period
09/01/2022 - 09/31/2022
Pay date
2022-04-01
Earnings  Rate  Hours  Current  YTD
Regular
36.14
80.00
2,891.43
57,828.69
Overtime
54.21
1.00
12.77
6,592.91
Deductions  Current  YTD
Federal Income Tax
318.06
6,361.16
Social Security
179.27
3,585.38
Medicare
41.93
838.52
State Income Tax
115.66
2,313.15
401(k)
173.49
3,469.72
Medical Pre-Tax
86.74
1,734.86
Gross pay
2,891.43
Net pay
1,966.18
Direct deposit to checking
****4297",PAYSTUB,44,PAYSTUB,fdc-95274914f07dd32e99576ecc,v11-PAYSTUB-stacked,original,2022,fgen-b954d5afee117b934e8f0584,synthetic_programmatic_template,stacked,top,False,biweekly
"Payroll Advice
Maple Street Dental PC
8125 Cedar Ln Maplewood, MN 54406
Employee
Mateo C. Rivera
Employee ID
79694
Pay period
01/01/2023 - 01/30/2023
Pay date
November 21, 2023
Earnings  Rate  Hours  Current  YTD
Regular
43.60
86.67
3,778.92
37,789.15
Overtime
65.40
2.00
568.56
4,865.87
Deductions  Current  YTD
Federal Income Tax
415.68
4,156.81
Social Security
234.29
2,342.93
Medicare
54.79
547.94
State Income Tax
151.16
1,511.57
401(k)
226.73
2,267.35
Medical Pre-Tax
113.37
1,133.67
Gross pay
3,778.92
Net pay
2,569.66
Direct deposit to checking
XXXXX8766",PAYSTUB,44,PAYSTUB,fdc-ae1dcb8d05d8f3b357602209,v11-PAYSTUB-stacked,original,2023,fgen-06b902a9221ff9076cf41814,synthetic_programmatic_template,stacked,top,False,semimonthly
"Blue Heron Logistics LLC
2746 Maple Ridge Dr Cedar Falls, IA 18937
Employee
Diego L. Nguyen
Employee ID
98063
Pay period
12/01/2025 - 12/31/2025
Pay date
2025-06-28
Earnings  Rate  Hours  Current  YTD
Regular
60.32
40.00
2,412.99
26,542.92
Overtime
90.49
7.00
167.37
3,956.82
Deductions  Current  YTD
Federal Income Tax
265.43
2,919.72
Social Security
149.61
1,645.66
Medicare
34.99
384.87
State Income Tax
96.52
1,061.72
401(k)
144.78
1,592.58
Medical Pre-Tax
72.39
796.29
Gross pay
2,412.99
Net pay
1,640.84
Direct deposit to checking
XXX-XX-3856
Pay Statement",PAYSTUB,44,PAYSTUB,fdc-bb374a5bbc55dda17d2f8e12,v11-PAYSTUB-stacked,original,2025,fgen-b8b3607231631b1ee2aaf1f5,synthetic_programmatic_template,stacked,bottom,False,biweekly
"Pay Statement
Blue Heron Logistics LLC
4358 Oak Hollow Ct Oak Grove, TX 56406
Employee
Fatima R. Kowalski
Employee ID
55691
Pay period
08/01/2024 - 08/30/2024
Pay date
11/20/2024
Earnings  Rate  Hours  Current  YTD
Regular
71.42
75.00
5,356.43
112,484.94
Overtime
107.13
8.00
58.46
1,586.32
Deductions  Current  YTD
Federal Income Tax
589.21
12,373.34
Social Security
332.10
6,974.07
Medicare
77.67
1,631.03
State Income Tax
214.26
4,499.40
401(k)
321.39
6,749.10
Medical Pre-Tax
160.69
3,374.55
Gross pay
5,356.43
Net pay
3,642.37
Direct deposit to checking
ending in 7168",PAYSTUB,44,PAYSTUB,fdc-4a26125d40e97cec17e39a87,v11-PAYSTUB-stacked,original,2024,fgen-697c179bc06af17e765cc8f6,synthetic_programmatic_template,stacked,top,False,biweekly
"Pay Statement
Tri-County School District
3332 Lakeshore Blvd Cedar Falls, IA 89728
Employee
Casey Okafor
Employee ID
22423
Pay period
11/01/2026 - 11/30/2026
Pay date
12/31/2026
Earnings  Rate  Hours  Current  YTD
Regular
66.74
86.67
5,784.47
150,396.28
Overtime
100.11
0.00
491.89
7,620.23
Deductions  Current  YTD
Federal Income Tax
636.29
16,543.59
Social Security
358.64
9,324.57
Medicare
83.87
2,180.75
401(k)
347.07
9,023.78
Gross pay
5,784.47
Net pay
3,933.44
Direct deposit to checking
****4957
Your 2026 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-cb1b5a77a3ff79022b06155b,v11-PAYSTUB-stacked,original,2026,fgen-78f25fe0aa339078c8d2c803,synthetic_programmatic_template,stacked,top,False,final_of_year
"Granite Peak Manufacturing Co.
2057 Maple Ridge Dr Maplewood, MN 12007
Employee
Jordan Testcase
Employee ID
68893
Pay period
11/01/2025 - 11/31/2025
Pay date
06/09/2025
Earnings  Rate  Hours  Current  YTD
Regular
43.76
40.00
1,750.40
14,003.22
Overtime
65.64
9.00
442.90
5,037.89
Deductions  Current  YTD
Federal Income Tax
192.54
1,540.35
Social Security
108.52
868.20
Medicare
25.38
203.05
State Income Tax
70.02
560.13
401(k)
105.02
840.19
Medical Pre-Tax
52.51
420.10
Gross pay
1,750.40
Net pay
1,190.27
Direct deposit to checking
****0978
Earnings Statement",PAYSTUB,44,PAYSTUB,fdc-212e647860610497e110dd60,v11-PAYSTUB-stacked,original,2025,fgen-9f47407d42654f3ac0359339,synthetic_programmatic_template,stacked,bottom,False,semimonthly
"Earnings Statement
Blue Heron Logistics LLC
7934 Prairie Ave Riverton, WI 76807
Employee
Alex Fischer
Employee ID
79566
Pay period
06/01/2026 - 06/30/2026
Pay date
May 25, 2026
Earnings  Rate  Hours  Current  YTD
Regular
87.71
86.67
7,602.15
121,634.34
Overtime
131.57
5.00
131.36
4,290.15
Deductions  Current  YTD
Federal Income Tax
836.24
13,379.78
Social Security
471.33
7,541.33
Medicare
110.23
1,763.70
State Income Tax
304.09
4,865.37
401(k)
456.13
7,298.06
Medical Pre-Tax
228.06
3,649.03
Gross pay
7,602.15
Net pay
5,169.46
Direct deposit to checking
XXX-XX-5675",PAYSTUB,44,PAYSTUB,fdc-4f248bdf49ca76e33a678e13,v11-PAYSTUB-stacked,original,2026,fgen-2e234c22e6a77c8c48801549,synthetic_programmatic_template,stacked,top,False,biweekly
"Statement of Earnings and Deductions
Copperline Software Inc.
7888 Prairie Ave Maplewood, MN 45762
Employee
Casey Tanaka
Employee ID
97777
Pay period
06/01/2022 - 06/30/2022
Pay date
05/02/2022
Earnings  Rate  Hours  Current  YTD
Regular
82.00
75.00
6,149.68
61,496.84
Overtime
122.99
1.00
25.11
191.82
Deductions  Current  YTD
Federal Income Tax
676.47
6,764.65
Social Security
381.28
3,812.80
Medicare
89.17
891.70
State Income Tax
245.99
2,459.87
401(k)
368.98
3,689.81
Medical Pre-Tax
184.49
1,844.91
Gross pay
6,149.68
Net pay
4,181.79
Direct deposit to checking
****3345",PAYSTUB,44,PAYSTUB,fdc-799d3bb2c34f4605b12d523e,v11-PAYSTUB-stacked,original,2022,fgen-d0c503a788be68b29bf7f3b5,synthetic_programmatic_template,stacked,top,False,biweekly
"Statement of Earnings and Deductions
Acme Test Corp
7536 Cedar Ln Bayside, WA 13799
Employee
Taylor Sato
Employee ID
26477
Pay period
09/01/2022 - 09/28/2022
Pay date
12/04/2022
Earnings  Rate  Hours  Current  YTD
Regular
82.68
75.00
6,201.21
86,817.00
Overtime
124.02
1.00
98.03
467.71
Deductions  Current  YTD
Federal Income Tax
682.13
9,549.87
Social Security
384.48
5,382.65
Medicare
89.92
1,258.85
State Income Tax
248.05
3,472.68
401(k)
372.07
5,209.02
Medical Pre-Tax
186.04
2,604.51
Gross pay
6,201.21
Net pay
4,216.83
Direct deposit to checking
***-**-6263",PAYSTUB,44,PAYSTUB,fdc-6b3cd98863fcf4c69d04f8ba,v11-PAYSTUB-stacked,original,2022,fgen-c2677239315b468e29fc0346,synthetic_programmatic_template,stacked,top,False,biweekly
"Earnings Statement
Copperline Software Inc.
3479 Elm ParkPl Riverton, WI 93648
Employee
Jordan Walsh
EmployeeID
10713
Pay period
03/01/2022 - 03/28/2O22
Pay date
12/31/2022
Earnings  Rate  Hours  Current  YTD
Regu1ar
40.75
80.00
3,260.15
84,763.84
Overtime
61.13
0.00
554.52
1,953.87
Deductions  Current  YTD
Federal Income Tax
358.62
9,324.O2
5ocíal 5ecurity
202.l3
5,255.36
Medicare
47.27
1,229.08
State Income Tax
130.41
3,390.55
401(k)
195.61
5,085.83
Medical Pre-Tax
97.80
2,542.92
Gross pay
3,260.15
Net pay
2,216.90
Direct deposit to checking
****9785
Your 2022 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-91f4b57403b13651d60b41f2,v11-PAYSTUB-stacked,original,2022,fgen-42aad92965ac32d456e35538,synthetic_programmatic_template,stacked,top,True,final_of_year
"Riverside Regional Hospital
9270 Sample Street Maplewood, MN 86419
Employee
Morgan D. Nguyen
Employee ID
51469
Pay period
05/01/2024 - 05/31/2024
Pay date
8/28/24
Earnings  Rate  Hours  Current  YTD
Regular
56.71
75.00
4,253.34
59,546.77
Overtime
85.07
9.00
506.02
909.97
Deductions  Current  YTD
Federal Income Tax
467.87
6,550.14
Social Security
263.71
3,691.90
Medicare
61.67
863.43
State Income Tax
170.13
2,381.87
401(k)
255.20
3,572.81
Medical Pre-Tax
127.60
1,786.40
Gross pay
4,253.34
Net pay
2,892.27
Direct deposit to checking
ending in 0571
Statement of Earnings and Deductions",PAYSTUB,44,PAYSTUB,fdc-b26df336e3bcdbecf23a1720,v11-PAYSTUB-stacked,original,2024,fgen-105c59c3f5d31ebcd9bb3573,synthetic_programmatic_template,stacked,bottom,False,biweekly
"Blue Heron Logistics LLC
5501 Harbor View Rd Testville, IL 51974
Employee
Alex Rivera
Employee ID
17581
Pay period
10/01/2024 - 10/31/2024
Pay date
December 14, 2024
Earnings  Rate  Hours  Current  YTD
Regular
42.92
75.00
3,219.02
67,599.34
Overtime
64.38
3.00
137.98
2,988.64
Deductions  Current  YTD
Federal Income Tax
354.09
7,435.93
Social Security
199.58
4,191.16
Medicare
46.68
980.19
State Income Tax
128.76
2,703.97
401(k)
193.14
4,055.96
Medical Pre-Tax
96.57
2,027.98
Gross pay
3,219.02
Net pay
2,188.93
Direct deposit to checking
***-**-0867
Pay Statement",PAYSTUB,44,PAYSTUB,fdc-67fa13a4c5983f02b0b9fc61,v11-PAYSTUB-stacked,original,2024,fgen-2f8621cb68bb05be81f8692e,synthetic_programmatic_template,stacked,bottom,False,biweekly
"Pay Statement
Blue Heron Logistics LLC
3448 Prairie Ave Pinecrest, GA 72770
Employee
Taylor Sato
Employee ID
95175
Pay period
02/01/2023 - 02/28/2023
Pay date
12/31/2023
Earnings  Rate  Hours  Current  YTD
Regular
35.68
75.00
2,676.03
69,576.65
Overtime
53.52
6.00
376.26
6,030.15
Deductions  Current  YTD
Federal Income Tax
294.36
7,653.43
Social Security
165.91
4,313.75
Medicare
38.80
1,008.86
State Income Tax
107.04
2,783.07
401(k)
160.56
4,174.60
Medical Pre-Tax
80.28
2,087.30
Gross pay
2,676.03
Net pay
1,819.70
Direct deposit to checking
ending in 6081
Your 2023 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-98d328971a8b4a4aaeff835a,v11-PAYSTUB-stacked,original,2023,fgen-fc4c7757445ee6b50b1b9b52,synthetic_programmatic_template,stacked,top,False,final_of_year
"Statement of Earnings and Deductions
Granite Peak Manufacturing Co.
4325 Granite St Oak Grove, TX 40744
Employee
Jamie Testcase
Employee ID
48683
Pay period
12/01/2022 - 12/28/2022
Pay date
11/25/22
Earnings  Rate  Hours  Current  YTD
Regular
49.68
86.67
4,306.16
30,143.09
Overtime
74.53
5.00
148.66
7,614.12
Deductions  Current  YTD
Federal Income Tax
473.68
3,315.74
Social Security
266.98
1,868.87
Medicare
62.44
437.07
401(k)
258.37
1,808.59
Medical Pre-Tax
129.18
904.29
Gross pay
4,306.16
Net pay
2,928.19
Direct deposit to checking
***-**-1559",PAYSTUB,44,PAYSTUB,fdc-fad8fbaf7ed32c10a1685f85,v11-PAYSTUB-stacked,original,2022,fgen-761aa39cd0e419cb9814031a,synthetic_programmatic_template,stacked,top,False,biweekly
"Payroll Advice
Blue Heron Logistics LLC
9371 Maple Ridge Dr Bayside, WA 20878
Employee
Alex Walsh
Employee ID
38301
Pay period
08/01/2026 - 08/31/2026
Pay date
12/31/2026
Earnings  Rate  Hours  Current  YTD
Regular
18.68
40.00
747.12
19,425.22
Overtime
28.02
2.00
211.12
1,963.57
Deductions  Current  YTD
Federal Income Tax
82.18
2,136.77
Social Security
46.32
1,204.36
Medicare
10.83
281.67
State Income Tax
29.88
777.01
401(k)
44.83
1,165.51
Medical Pre-Tax
22.41
582.76
Gross pay
747.12
Net pay
508.04
Direct deposit to checking
***-**-7013",PAYSTUB,44,PAYSTUB,fdc-e90fd6c54f65460ecb651970,v11-PAYSTUB-stacked,original,2026,fgen-5c6acedac805f59e137766a8,synthetic_programmatic_template,stacked,top,False,final_of_year
"Payroll Advice
Acme Test Corp
5457 Maple Ridge Dr Testville, IL 59582
Employee
Priya Testcase
Employee ID
22206
Pay period
04/01/2025 - 04/31/2025
Pay date
December 14, 2025
Earnings  Rate  Hours  Current  YTD
Regular
16.09
75.00
1,206.54
20,511.20
Overtime
24.13
3.00
368.74
276.76
Deductions  Current  YTD
Federal Income Tax
132.72
2,256.23
Social Security
74.81
1,271.69
Medicare
17.49
297.41
401(k)
72.39
1,230.67
Medical Pre-Tax
36.20
615.34
Gross pay
1,206.54
Net pay
820.45
Direct deposit to checking
XXX-XX-3378",PAYSTUB,44,PAYSTUB,fdc-dbe7d2de9b579c08acad9afd,v11-PAYSTUB-stacked,original,2025,fgen-e1db254dc40f68b12d11a0da,synthetic_programmatic_template,stacked,top,False,biweekly
"Tri-County School District
2423 Lakeshore Blvd Riverton, WI 90949
Employee
Wei Kowalski
Employee ID
24886
Pay period
09/01/2021 - 09/31/2021
Pay date
12/8/21
Earnings  Rate  Hours  Current  YTD
Regular
22.99
40.00
919.49
2,758.48
Overtime
34.48
5.00
158.57
5,281.92
Deductions  Current  YTD
Federal Income Tax
101.14
303.43
State Income Tax
36.78
110.34
401(k)
55.17
165.51
Medical Pre-Tax
27.58
82.75
Gross pay
919.49
Net pay
625.26
Direct deposit to checking
ending in 5090",PAYSTUB,44,PAYSTUB,fdc-db49ec94fad33b77ac4042cf,v11-PAYSTUB-stacked,original,2021,fgen-2b7012d4055e9da67a12c364,synthetic_programmatic_template,stacked,none,False,biweekly
"Statement of Earnings and Deductions
Blue Heron Logistics LLC
6107 Willow Bend Way Fairview, OH 92352
Employee
Taylor Nguyen
Employee ID
35217
Pay period
12/01/2022 - 12/28/2022
Pay date
02/24/2022
Earnings  Rate  Hours  Current  YTD
Regular
35.02
40.00
1,400.86
9,806.03
Overtime
52.53
8.00
592.04
1,494.77
Deductions  Current  YTD
Federal Income Tax
154.09
1,078.66
Social Security
86.85
607.97
Medicare
20.31
142.19
State Income Tax
56.03
392.24
Medical Pre-Tax
42.03
294.18
Gross pay
1,400.86
Net pay
952.59
Direct deposit to checking
****8198",PAYSTUB,44,PAYSTUB,fdc-f9ce0cb6629af6014044aa74,v11-PAYSTUB-stacked,original,2022,fgen-da8b145678263b53f67b6f58,synthetic_programmatic_template,stacked,top,False,semimonthly
"Granite Peak Manufacturing Co.
4639 Granite St Pinecrest, GA 12479
Employee
Sofia C. Lindqvist
Employee ID
56650
Pay period
03/01/2022 - 03/31/2022
Pay date
2022-04-12
Earnings  Rate  Hours  Current  YTD
Regular
85.79
80.00
6,863.13
157,852.07
Overtime
128.68
7.00
361.20
3,811.72
Deductions  Current  YTD
Federal Income Tax
754.94
17,363.73
Social Security
425.51
9,786.83
Medicare
99.52
2,288.86
State Income Tax
274.53
6,314.08
401(k)
411.79
9,471.12
Medical Pre-Tax
205.89
4,735.56
Gross pay
6,863.13
Net pay
4,666.93
Direct deposit to checking
XXXXX0070
Statement of Earnings and Deductions",PAYSTUB,44,PAYSTUB,fdc-6e8b3b9611eb5cb7e58f41b0,v11-PAYSTUB-stacked,original,2022,fgen-fa7c83dec0cf72afce6f3de3,synthetic_programmatic_template,stacked,bottom,False,biweekly
"Earnings Statement
Granite Peak Manufacturing Co.
6885 Oak Hollow Ct Cedar Falls, IA 96779
Employee
Alex Adeyemi
Employee ID
43803
Pay period
05/01/2024 - 05/30/2024
Pay date
03/05/2024
Earnings  Rate  Hours  Current  YTD
Regular
48.48
75.00
3,636.12
47,269.60
Overtime
72.72
0.00
102.75
1,208.99
Deductions  Current  YTD
Federal Income Tax
399.97
5,199.66
Social Security
225.44
2,930.72
Medicare
52.72
685.41
401(k)
218.17
2,836.18
Medical Pre-Tax
109.08
1,418.09
Gross pay
3,636.12
Net pay
2,472.56
Direct deposit to checking
****9688",PAYSTUB,44,PAYSTUB,fdc-df247e2dbe19e82be22c2905,v11-PAYSTUB-stacked,original,2024,fgen-e12dfeb2f340b4fd7d20f38a,synthetic_programmatic_template,stacked,top,False,biweekly
"Pay Statement
Acme Test Corp
8969 Sample Street Oak Grove, TX 13298
Employee
Jamie Testcase
Employee ID
54668
Pay period
01/01/2022 - 01/28/2022
Pay date
2022-11-07
Earnings  Rate  Hours  Current  YTD
Regular
63.76
75.00
4,781.99
71,729.81
Overtime
95.64
2.00
11.81
6,028.17
Deductions  Current  YTD
Federal Income Tax
526.02
7,890.28
Social Security
296.48
4,447.25
Medicare
69.34
1,040.08
State Income Tax
191.28
2,869.19
401(k)
286.92
4,303.79
Medical Pre-Tax
143.46
2,151.89
Gross pay
4,781.99
Net pay
3,251.75
Direct deposit to checking
XXXXX0530",PAYSTUB,44,PAYSTUB,fdc-7882c0650f9779a55a1ece78,v11-PAYSTUB-stacked,original,2022,fgen-0c31a36dd6900e50a05156c3,synthetic_programmatic_template,stacked,top,False,semimonthly
"Earnings Statement
Granite Peak Manufacturing Co.
2254 Willow Bend Way Bayside, WA 31487
Employee
Avery Patel
Employee ID
12043
Pay period
06/01/2025 - 06/31/2025
Pay date
2025-05-26
Earnings  Rate  Hours  Current  YTD
Regular
77.70
86.67
6,734.18
26,936.70
Overtime
116.55
4.00
576.19
1,735.18
Deductions  Current  YTD
Federal Income Tax
740.76
2,963.04
Social Security
417.52
1,670.08
Medicare
97.65
390.58
State Income Tax
269.37
1,077.47
401(k)
404.05
1,616.20
Medical Pre-Tax
202.03
808.10
Gross pay
6,734.18
Net pay
4,579.24
Direct deposit to checking
XXXXX2659",PAYSTUB,44,PAYSTUB,fdc-42b9fead4a503d911e9d8e11,v11-PAYSTUB-stacked,original,2025,fgen-f22097d41fbaff44e1fe180c,synthetic_programmatic_template,stacked,top,False,semimonthly
"Earnings Statement
Tri-County School District
3168 Lakeshore Blvd Brookhaven, PA 92783
Employee
Casey E. Romero
Employee ID
94829
Pay períod
04/01/2022 - 04/28/2022
Paydate
12/31/2022
Eamings  Rate  Hours  Current  YTD
Regular
90.03
80.00
7,202.64
187,268.56
Overtime
135.05
7.00
289.26
4,278.55
Deductions Current  YTD
Federal Income Tax
792.29
20,599.54
Social Security
446.56
11,610.65
Medicare
104.44
2,715.39
State Income Tax
288.11
7,490.74
401(k)
432.16
11,236.11
Medical Pre-Tax
216.08
5,618.06
Gross pay
7,202.64
Net pay
4,897.79
Dírect deposit to checking
XXX-XX-0248
Your 2022 Form W-2 wíll be availablc in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-5d7363ea2e6a9a91c6df7cdc,v11-PAYSTUB-stacked,original,2022,fgen-f3cf5274e48ae2599b58da56,synthetic_programmatic_template,stacked,top,True,final_of_year
"Earnings Statement
Ríverside Regional Hospital
448Maple Ridge Dr Oak Grove, TX 77709
Employee
Jordan Sato
Employee ID
50773
Pay period
05/01/2024 - 05/28/2024
Pay date
08/27/2024
Earníngs  Rate  Hours  Current  YTD
Regular
79.80
86.67
6,916.14
152,155.15
0vertime
119.70
0.00
393.12
2,545.51
Deductions  Current  YTD
Federal Income Tax
760.78
16,737.07
Social Security
428.80
9,433.62
Medicare
100.28
2,206.25
State Income Tax
276.65
6,086.21
401(k)
414.97
9,129.31
Medíca1 Pre-Tax
207.48
4,564.65
Gross pay
6,916.14
Net pay
4,702.98
Direct deposit to checking
ending in 0593",PAYSTUB,44,PAYSTUB,fdc-bb49c3c7b17049d383316d6b,v11-PAYSTUB-stacked,original,2024,fgen-b88b8a50015fedac0ef8d0ae,synthetic_programmatic_template,stacked,top,True,biweekly
"Statement of Earnings and Deductions
Maple Street Dental PC
6993 Lakeshore Blvd Lakewood, CO 57106
Employee
Amara Lindqvist
Employee ID
545O1
Pay period
12/01/2023 -12/28/2023
Pay date
12/31/2023
Earnings  Rate  Hours  Current  YTD
Regular
73.48
75.00
5,5l1.04
143,287.15
Ovcrtíme
110.22
7.00
38.96
3,879.82
Deductions  Current  YTD
Federa1 Income Tax
606.21
15,761.59
5ocial 5ecurity
341.68
8,883.80
Medicare
79.91
2,077.66
State Income Tax
220.44
5,731.49
401(k)
330.66
8,597.23
Medical Pre-Tax
165.33
4,298.61
Gross pay
5,511.04
Net pay
3,747.51
Direct deposit to checking
***-**-8727",PAYSTUB,44,PAYSTUB,fdc-f9bb6132b252ca31a6cd27c2,v11-PAYSTUB-stacked,original,2023,fgen-d929b95e535331c43aeb0bd5,synthetic_programmatic_template,stacked,top,True,final_of_year
"Earnings Statement
Tri-County School District
8305 Oak Hollow Ct Fairview, OH 49265
Employee
Diego Moreau
Employee ID
55733
Pay period
12/01/2022 - 12/31/2022
Pay date
12/31/2022
Earnings  Rate  Hours  Current  YTD
Regular
26.06
80.00
2,084.59
54,199.38
Overtime
39.09
5.00
329.33
1,402.09
Deductions  Current  YTD
Federal Income Tax
229.31
5,961.93
Social Security
129.24
3,360.36
Medicare
30.23
785.89
State IncomeTax
83.38
2,167.98
401(k)
125.08
3,251.96
Medica1 Pre-Tax
62.54
l,625.98
Gross pay
2,084.59
Netpay
l,417.52
Direct deposit to checking
XXXXX0086
Your 2022 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-aaaff63fe7ee10cb28860c14,v11-PAYSTUB-stacked,original,2022,fgen-1b588ff2d0a401927f63bc59,synthetic_programmatic_template,stacked,top,True,final_of_year
"Blue Heron Logistics LLC
3886 Elm Park Pl Lakewood, CO 93133
Employee
Mateo Nguyen
Employee ID
87040
Pay period
12/01/2022 - 12/31/2022
Pay date
12/31/2022
Earnings  Rate  Hours  Current  YTD
Regular
55.45
75.00
4,158.82
108,129.29
Overtime
83.18
1.00
456.33
6,202.24
Deductions  Current  YTD
Federal Income Tax
457.47
11,894.22
Medicare
60.30
1,567.87
State Income Tax
166.35
4,325.17
Medical Pre-Tax
124.76
3,243.88
Gross pay
4,158.82
Net pay
2,828.00
Direct deposit to checking
***-**-0417
Statement of Earnings and Deductions",PAYSTUB,44,PAYSTUB,fdc-696f9b93ea3764773dd34cf9,v11-PAYSTUB-stacked,original,2022,fgen-8e518ae30f7510aca1c301cd,synthetic_programmatic_template,stacked,bottom,False,final_of_year
"Payroll Advíce
Granite Peak Manufacturing Co.
4660 Cedar Ln Testvi1le, IL 62976
Employee
Mateo Sato
Employee ID
532O2
Pay period
10/01/2023 - 10/31/2023
Pay date
10/09/2023
Eamings  Rate  Hours  Current  YTD
Regular
32.02
80.00
2,561.79
5,123.58
0vertime
48.03
9.00
448.51
4,439.52
Deductions  Current  YTD
Federal Income Tax
281.80
563.59
5ocial 5ccurity
158.83
317.66
Medicare
37.15
74.29
State Income Tax
102.47
204.94
401(k)
153.71
307.41
Medical Pre-Tax
76.85
153.71
Gross pay
2,561.79
Net pay
1,742.02
Direct depositto checking
XXXXX7079",PAYSTUB,44,PAYSTUB,fdc-e107fe92d9a70ea80be0c3d0,v11-PAYSTUB-stacked,original,2023,fgen-b9358b7c72d10aa3ae4d03d3,synthetic_programmatic_template,stacked,top,True,semimonthly
"Payroll Advice
Tri-County School District
7390 Oak Hollow Ct Testville, IL 62035
Employee
Riley Walsh
Employee ID
73614
Pay period
07/01/2025 - 07/28/2025
Pay date
5/1/25
Earnings  Rate  Hours  Current  YTD
Regular
50.80
86.67
4,402.84
105,668.21
Overtime
76.20
6.00
201.63
7,251.08
Deductions  Current  YTD
Federal Income Tax
484.31
11,623.50
Social Security
272.98
6,551.43
Medicare
63.84
1,532.19
State Income Tax
176.11
4,226.73
Medical Pre-Tax
132.09
3,170.05
Gross pay
4,402.84
Net pay
2,993.93
Direct deposit to checking
****9989",PAYSTUB,44,PAYSTUB,fdc-9afa3b3bdec6d94a770d2a85,v11-PAYSTUB-stacked,original,2025,fgen-96d72100f047dd3ee53ebeb5,synthetic_programmatic_template,stacked,top,False,biweekly
"Pay Statement
Tri-County School District
1718 Oak Hollow Ct Fairview, OH 70192
Employee
Hiro Moreau
Employee ID
33968
Pay period
09/01/2022 - 09/30/2022
Pay date
01/06/2022
Earnings  Rate  Hours  Current  YTD
Regular
47.04
86.67
4,076.60
12,229.79
Overtime
70.55
1.00
362.11
5,320.72
Deductions  Current  YTD
Federal Income Tax
448.43
1,345.28
Social Security
252.75
758.25
Medicare
59.11
177.33
State Income Tax
163.06
489.19
401(k)
244.60
733.79
Medical Pre-Tax
122.30
366.89
Gross pay
4,076.60
Net pay
2,772.09
Direct deposit to checking
XXX-XX-0160",PAYSTUB,44,PAYSTUB,fdc-794362127df3af80a0aebae8,v11-PAYSTUB-stacked,original,2022,fgen-ac44a5eac16cb0fc19b8d4d9,synthetic_programmatic_template,stacked,top,False,semimonthly
"Blue Heron Logistics LLC
9208 Willow Bend Way Brookhaven, PA 89509
Employee
Olivia D. Patel
Employee ID
88250
Pay period
04/01/2022 - 04/28/2022
Pay date
2022-12-02
Earnings  Rate  Hours  Current  YTD
Regular
77.40
75.00
5,805.00
46,440.01
Overtime
116.10
7.00
558.37
4,802.15
Deductions  Current  YTD
Federal Income Tax
638.55
5,108.40
Medicare
84.17
673.38
State Income Tax
232.20
1,857.60
401(k)
348.30
2,786.40
Medical Pre-Tax
174.15
1,393.20
Gross pay
5,805.00
Net pay
3,947.40
Direct deposit to checking
XXXXX0768
Payroll Advice",PAYSTUB,44,PAYSTUB,fdc-dead590f205641549ad04872,v11-PAYSTUB-stacked,original,2022,fgen-759a824e922ab939e147ba09,synthetic_programmatic_template,stacked,bottom,False,biweekly
"Blue Heron Logistics LLC
373 Samp1e Street Lakewood, CO 8l471
Employee Priya Brennan
Employee ID 96486
Pay period   04/01/2026 - 04/30/2026
Pay date 10/15/2026
Earníngs  Rate  Hours Current  YTD
Regular   36.25   75.00   2,718.92   35,346.00
Overtime  54.38 6.00  86.33  6,506.39
Deductions Current YTD
Federal Income Tax   299.08   3,888.06
5ocial Security   168.57   2,191.45
Medicare 39.42 5l2.52
State Income Tax   108.76   1,413.84
401(k)  163.14 2,120.76
Medical Pre-Tax 81.57 1,060.38
Gross pay  2,718.92
Net pay 1,848.87
Dírect deposit to checking ****5600
Statement of Earníngs and Deductíons",PAYSTUB,44,PAYSTUB,fdc-9bf524410bb6fd8470ddf437,v11-PAYSTUB-inline,original,2026,fgen-ce475ba9a862ac03d3449d06,synthetic_programmatic_template,inline,bottom,True,biweekly
"Earnings Statement
Maple Street Dental PC
6347 Willow Bend Way Brookhaven, PA 58160
Employee   Noah S. Nguyen
Employee ID   43197
Pay period 07/01/2024 - 07/28/2024
Pay date May 13, 2024
Earnings Rate Hours Current YTD
Regular  39.67  86.67  3,438.16  51,572.42
Overtime 59.50 9.00 204.27 3,597.07
Deductions  Current  YTD
Federal Income Tax 378.20 5,672.97
Social Security      213.17      3,197.49
Medicare      49.85      747.80
401(k) 206.29 3,094.34
Medical Pre-Tax  103.14  1,547.17
Gross pay   3,438.16
Net pay  2,337.95
Direct deposit to checking ***-**-0467",PAYSTUB,44,PAYSTUB,fdc-7ead61f18c5058f55c7eadcc,v11-PAYSTUB-inline,original,2024,fgen-40453ed10e2d6fccb724a0a6,synthetic_programmatic_template,inline,top,False,biweekly
"Blue Heron Logistics LLC
3079 Prairie Ave Fairview, OH 12852
Employee   Priya K. Tanaka
Employee ID 59891
Pay period 03/01/2022 - 03/28/2022
Pay date 3/17/22
Earnings  Rate  Hours  Current  YTD
Regular 38.90 80.00 3,111.78 24,894.24
Overtime      58.35      0.00      158.70      2,504.29
Deductions Current YTD
Federal Income Tax 342.30 2,738.37
Social Security 192.93 1,543.44
Medicare 45.12 360.97
State Income Tax  124.47  995.77
401(k) 186.71 1,493.65
Gross pay 3,111.78
Net pay   2,116.01
Direct deposit to checking      XXXXX2314
Earnings Statement",PAYSTUB,44,PAYSTUB,fdc-c98ced9c12cd8740ece34796,v11-PAYSTUB-inline,original,2022,fgen-53a738d2c01cbb2d74e44e86,synthetic_programmatic_template,inline,bottom,False,biweekly
"Tri-County School District
1954 Maple Ridge Dr Cedar Falls, IA 82924
Employee   Sofia D. Rivera
Employee ID   39348
Pay period      04/0l/2022 - 04/3l/2022
Pay date 1/14/22
Eamings      Rate     Hours      Current      YTD
Regular 56.94 40.00 2,277.72 31,888.09
Overtime  85.41   9.00   290.54   4,819.07
Deductions   Current   YTD
Federal Income Tax      250.55      3,507.69
Socíal Security  141.22   1,977.O6
Medicare 33.03 462.38
State Income Tax      91.11      1,275.52
401(k) 136.66  1,913.29
Medical Pre-Tax  68.33  956.64
Gross pay  2,277.72
Net pay 1,548.85
Direct deposit to checking   ***-**-3861
Statement of Eamings and Deductions",PAYSTUB,44,PAYSTUB,fdc-2d29944354be7fe367b37b23,v11-PAYSTUB-inline,original,2022,fgen-2dd707270327e05634aee4f2,synthetic_programmatic_template,inline,bottom,True,semimonthly
"Riverside Regional Hospital
9400 Cedar Ln Brookhaven, PA 29091
Employee  Mateo Brennan
Employee ID  80763
Pay period  11/01/2021 - 11/30/2021
Pay date  2021-12-08
Earnings  Rate  Hours  Current  YTD
Regular   56.34   86.67   4,883.11   14,649.32
Overtime  84.51  0.00  98.60  5,964.41
Deductions   Current   YTD
Federal Income Tax 537.14 1,611.42
Social Security 302.75 908.26
Medicare  70.81  212.42
State Income Tax 195.32 585.97
401(k) 292.99 878.96
Medical Pre-Tax  146.49  439.48
Gross pay 4,883.11
Net pay 3,320.51
Direct deposit to checking ending in 1327
Pay Statement",PAYSTUB,44,PAYSTUB,fdc-195124c2875f14afc55eb6a1,v11-PAYSTUB-inline,original,2021,fgen-466844907d1212a1d66cd66f,synthetic_programmatic_template,inline,bottom,False,biweekly
"Payroll Advice
Blue Heron Logistics LLC
4965 Elm Park Pl Oak Grove, TX 33407
Employee      Noah Rivera
Employee ID  74160
Pay period      07/01/2024 - 07/31/2024
Pay date 3/1/24
Earnings  Rate  Hours  Current  YTD
Regular 78.52 80.00 6,281.28 81,656.59
Overtime117.77 4.00 79.37 2,305.06
Deductions   Current  YTD
Federal Income Tax 690.94 8,982.23
5ocial 5ecurity 389.44 5,062.7l
Medicare  91.08  1,184.02
401(k)      376.88      4,899.40
Medical Pre-Tax   l88.44   2,449.70
Gross pay  6,281.28
Net pay      4,271.27
Direct deposit tochecking     ****2698",PAYSTUB,44,PAYSTUB,fdc-0e59a6820d16879812439a57,v11-PAYSTUB-inline,original,2024,fgen-97f9f7af97597a5c362b87ba,synthetic_programmatic_template,inline,top,True,biweekly
"Acme Test Corp
6976 Willow Bcnd Way Rívcrton, WI 22751
Employee Amara Larsen
Employee ID   43954
Pay períod  11/0l/2026 - 11/30/2026
Pay date      12/31/2026
Earnings   Rate   Hours   Current  YTD
Regular   18.40   40.00   736.09   19,138.37
Overtime 27.60 7.00 146.80 2,402.66
Deductions Current YTD
Federa1 Income Tax      80.97    2,105.22
Social Security   45.64   1,186.58
Medicare   10.67  277.51
State Income Tax 29.44 765.53
401(k) 44.17 1,148.30
Medical Pre-Tax   22.08   574.15
Gross pay  736.09
Net pay   500.54
Direct deposit to checking XXXXX2807",PAYSTUB,44,PAYSTUB,fdc-c7e5ff93a68ff2e667d8855f,v11-PAYSTUB-inline,original,2026,fgen-706e4e8ca0c77656e1c40479,synthetic_programmatic_template,inline,none,True,final_of_year
"Statement of Earnings and Deductions
Blue Heron Logistics LLC
8346 Prairie Ave Lakewood, CO 25352
Employee Wei Kowalski
Employee ID  86842
Pay period 09/01/2025 - 09/31/2025
Pay date      2025-01-19
Earnings   Rate   Hours   Current   YTD
Regular  93.05  86.67  8,064.55  32,258.19
Overtime 139.57 0.00 158.53 356.23
Deductions      Current      YTD
Federal Income Tax 887.10 3,548.40
Social Security 500.00 2,000.01
Medicare  116.94  467.74
State Income Tax      322.58      1,290.33
Gross pay 8,064.55
Net pay 5,483.89
Direct deposit to checking ****4586",PAYSTUB,44,PAYSTUB,fdc-4e2f15891d44c8f312ab720b,v11-PAYSTUB-inline,original,2025,fgen-fe7cb6d8d31b8adec296b951,synthetic_programmatic_template,inline,top,False,biweekly
"Statement of Earnings andDeductions
Blue Heron Logistics LLC
1449Cedar Ln Maplewood, MN 61336
Employee   Morgan Líndqvist
Emp1oyee ID      56629
Pay period O7/01/2021 - 07/30/2021
Pay date  October 24, 2021
Eamings  Rate  Hours Current  YTD
Regu1ar     73.46      80.00      5,876.74      111,658.11
0vertime      110.19      5.00      36O.80      97.93
Deductions  Current   YTD
Federa1 Income Tax 646.44 12,282.39
Social Security 364.36 6,922.80
Mcdicare      85.21      1,619.04
State Income Tax      235.07     4,466.32
401(k)      352.6O      6,699.49
Medical Pre-Tax      176.30      3,349.74
Gross pay 5,876.74
Net pay 3,996.19
Direct deposit to checking  ****1594",PAYSTUB,44,PAYSTUB,fdc-3eead54e0d45339a5eff14c1,v11-PAYSTUB-inline,original,2021,fgen-2f4a8bf5abeae96cd962f3cd,synthetic_programmatic_template,inline,top,True,biweekly
"Payroll Advice
Maple Street Dental PC
1483 Granite St Fairview, OH 61453
Employee   Riley K. Fischer
Employee ID 98126
Pay period      10/01/2023 - 10/30/2023
Pay date   2023-05-01
Earnings  Rate  Hours  Current  YTD
Regular 68.87 40.00 2,754.90 49,588.12
Overtime   103.31   2.00   338.02   3,698.52
Deductions      Current      YTD
Federal Income Tax  303.04  5,454.69
Social Security  170.80  3,074.46
Medicare      39.95      719.03
State Income Tax 110.20 1,983.52
401(k)  165.29  2,975.29
Medical Pre-Tax   82.65   1,487.64
Gross pay 2,754.90
Net pay      1,873.33
Direct deposit to checking   XXXXX3783",PAYSTUB,44,PAYSTUB,fdc-217100408edf3ecf4a462544,v11-PAYSTUB-inline,original,2023,fgen-46b890b307373d72d47ce622,synthetic_programmatic_template,inline,top,False,semimonthly
"Copperline Software Inc.
7258 Willow Bend Way Testville, IL 94153
Employee Sofia Tanaka
Employee ID 72993
Pay period   12/01/2022 - 12/28/2022
Pay date      2/15/22
Earnings      Rate      Hours      Current      YTD
Regular 85.14 86.67 7,378.72 132,816.88
Overtime   127.70   5.00   430.11   8,751.41
Deductions      Current      YTD
Federal Income Tax      811.66      14,609.86
Social Security      457.48      8,234.65
Medicare      106.99      1,925.84
State Income Tax   295.15   5,312.68
401(k)  442.72  7,969.01
Medical Pre-Tax 221.36 3,984.51
Gross pay  7,378.72
Net pay 5,017.53
Direct deposit to checking   XXX-XX-1936",PAYSTUB,44,PAYSTUB,fdc-27d28b868b198d5686689250,v11-PAYSTUB-inline,original,2022,fgen-83eabcaede010be920167c0e,synthetic_programmatic_template,inline,none,False,semimonthly
"Earnings Statement
Copperline Software Inc.
8395 Willow Bend Way Riverton, WI 78325
Employee  Lena Haddad
Employee ID 26034
Pay period  04/01/2021 - 04/31/2021
Pay date  09/04/2021
Earnings   Rate   Hours   Current   YTD
Regular  94.00  40.00  3,760.04  48,880.50
Overtime      141.00      3.00      421.83      2,374.91
Deductions   Current   YTD
Federal Income Tax      413.60      5,376.86
Social Security  233.12  3,030.59
Medicare   54.52   708.77
State Income Tax   150.40   1,955.22
401(k) 225.60 2,932.83
Medical Pre-Tax      112.80      1,466.42
Gross pay  3,760.04
Net pay   2,556.83
Direct deposit to checking      XXXXX5337",PAYSTUB,44,PAYSTUB,fdc-b42c3b129906c122f633162d,v11-PAYSTUB-inline,original,2021,fgen-acbd7be051db0f2e783ca342,synthetic_programmatic_template,inline,top,False,biweekly
"Pay Statement
Riverside Regional Hospita1
1545 Samplc Street Pinecrest, GA 32075
Employee Riley Walsh
Employee ID   13469
Pay period 04/01/2023 - 04/30/2023
Pay date      March 28, 2023
Earnings  Rate   Hours   Current   YTD
Regular 71.88 75.00 5,390.8370,080.82
Ovcrtime      107.82     9.00      351.78      5,672.15
Deductíons     Current      YTD
Federa1 Income Tax  592.99  7,708.89
Social Security   334.23   4,345.0l
Medicare      78.17     1,016.17
State Income Tax 2l5.63 2,803.23
401(k)   323.45   4,204.85
Medícal Pre-Tax      161.72      2,102.42
Gross pay   5,390.83
Net pay  3,665.77
Direct deposit to checking      XXX-XX-8943",PAYSTUB,44,PAYSTUB,fdc-e03463b027156276debb1fb9,v11-PAYSTUB-inline,original,2023,fgen-d5f88799854b47f513aae254,synthetic_programmatic_template,inline,top,True,biweekly
"Riverside Regional Hospital
4446 Elm Park Pl Bayside, WA 31369
Employee      Casey Lindqvist
Employee ID   94783
Pay period  05/01/2021 - 05/28/2021
Pay date      2021-02-21
Earnings Rate Hours Current YTD
Regular 38.56 40.00 1,542.54 7,712.69
Overtime      57.85      6.00      599.10      6,180.31
Deductions Current YTD
Federal Income Tax 169.68 848.40
Medicare  22.37  111.83
State Income Tax 61.70 308.51
401(k) 92.55 462.76
Medical Pre-Tax  46.28  231.38
Gross pay 1,542.54
Net pay 1,048.93
Direct deposit to checking XXXXX2217
Statement of Earnings and Deductions",PAYSTUB,44,PAYSTUB,fdc-71610049a1e07128fbe573e1,v11-PAYSTUB-inline,original,2021,fgen-5db1f0cec06d3d1cd92809a2,synthetic_programmatic_template,inline,bottom,False,biweekly
"Earnings Statement
Riverside Regional Hospital
8581 Lakeshore Blvd Cedar Falls, IA 13590
Employee   Sofia Moreau
Employee ID      51834
Pay period 05/01/2024 - 05/31/2024
Pay date  12/31/2024
Earnings   Rate   Hours   Current   YTD
Regular 37.79 86.67 3,275.35 85,159.02
Overtime 56.69 2.00 123.19 1,916.57
Deductions Current YTD
Federal Income Tax  360.29  9,367.49
Social Security 203.07 5,279.86
Medicare  47.49  1,234.81
State Income Tax 131.01 3,406.36
401(k)      196.52      5,109.54
Medical Pre-Tax  98.26  2,554.77
Gross pay 3,275.35
Net pay  2,227.24
Direct deposit to checking   XXXXX7029",PAYSTUB,44,PAYSTUB,fdc-a4c9d768953ebf757a768cda,v11-PAYSTUB-inline,original,2024,fgen-9021f4310d1b7c6571fa2791,synthetic_programmatic_template,inline,top,False,final_of_year
"Payroll Advice
Riverside Regional Hospital
7338 Cedar Ln Bayside, WA 50818
Employee Kwame Castillo
Employee ID      76775
Pay period 08/01/2024 - 08/28/2024
Pay date  12/31/2024
Earnings Rate Hours Current YTD
Regular   78.69   86.67   6,819.85   177,316.07
Overtime 118.03 4.00 148.40 5,079.73
Deductions   Current   YTD
Federal Income Tax  750.18  19,504.77
Medicare 98.89 2,571.08
State Income Tax   272.79   7,092.64
401(k) 409.19 10,638.96
Medical Pre-Tax 204.60 5,319.48
Gross pay 6,819.85
Net pay 4,637.50
Direct deposit to checking ***-**-3918",PAYSTUB,44,PAYSTUB,fdc-7ea623eb03e8f22b5267685b,v11-PAYSTUB-inline,original,2024,fgen-86173e261ac2c3cd7aa6f6fc,synthetic_programmatic_template,inline,top,False,final_of_year
"Blue Heron Logistics LLC
6338 Lakeshore Blvd Lakewood, CO 31173
Employee  Casey Patel
Employee ID      11367
Pay period      02/01/2021 - 02/28/2021
Pay date November 6, 2021
Earnings   Rate   Hours   Current   YTD
Regular 94.03 80.00 7,522.02 45,132.14
Overtime 141.04 7.00 464.41 1,512.42
Deductions      Current      YTD
Federal Income Tax 827.42 4,964.54
Social Security   466.37   2,798.19
Medicare   109.07   654.42
State Income Tax 300.88 1,805.29
401(k)      451.32      2,707.93
Medical Pre-Tax  225.66  1,353.96
Gross pay 7,522.02
Net pay   5,114.98
Direct deposit to checking      XXXXX2506
Statement of Earnings and Deductions",PAYSTUB,44,PAYSTUB,fdc-3727aeb74c251dee31ff9c86,v11-PAYSTUB-inline,original,2021,fgen-4bf5232429d44793dbc408c0,synthetic_programmatic_template,inline,bottom,False,biweekly
"Pay Statement
Tri-County School District
8401 Harbor View Rd Lakewood, CO 17652
Employee      Jordan M. Nguyen
Employee ID      84544
Pay period  08/01/2026 - 08/31/2026
Pay date   3/4/26
Earnings   Rate   Hours   Current   YTD
Regular   31.93   40.00   1,277.21   26,821.31
Overtime  47.90  5.00  119.86  6,103.70
Deductions  Current  YTD
Federal Income Tax  140.49  2,950.34
Social Security   79.19   1,662.92
Medicare  18.52  388.91
State Income Tax  51.09  1,072.85
401(k)      76.63      1,609.28
Medical Pre-Tax  38.32  804.64
Gross pay 1,277.21
Net pay   868.50
Direct deposit to checking  ***-**-2665",PAYSTUB,44,PAYSTUB,fdc-8101dfc9da842b7608556ad9,v11-PAYSTUB-inline,original,2026,fgen-bd21eee48a0b030697f73d31,synthetic_programmatic_template,inline,top,False,biweekly
"Earnings Statement
Acme Test Corp
2819 Oak Hollow Ct Cedar Falls, IA 63462
Employee Fatima E. Brennan
Employee ID 20790
Pay period 04/01/2023 - 04/28/2023
Pay date      07/24/2023
Earnings   Rate   Hours   Current   YTD
Regular 27.16 40.00 1,086.46 4,345.86
Overtime 40.74 7.00 335.02 1,906.38
Deductions      Current      YTD
Federal Income Tax 119.51 478.04
Social Security  67.36  269.44
Medicare 15.75 63.01
State Income Tax      43.46      173.83
401(k)  65.19  260.75
Medical Pre-Tax  32.59  130.38
Gross pay  1,086.46
Net pay 738.80
Direct deposit to checking   XXX-XX-1456",PAYSTUB,44,PAYSTUB,fdc-f1ef21094e53c0d6067e9dc3,v11-PAYSTUB-inline,original,2023,fgen-f087818bc997652762b70ce5,synthetic_programmatic_template,inline,top,False,semimonthly
"Granite Peak Manufacturing Co.
7535 Harbor View Rd Testville, IL 42600
Employee Lena E. Nguyen
Employee ID 37775
Pay period 09/01/2021 - 09/30/2021
Pay date 10/02/2021
Earnings   Rate   Hours   Current   YTD
Regular 77.64 75.00 5,823.05 133,930.07
Overtime 116.46 1.00 200.72 1,781.26
Deductions   Current   YTD
Federal Income Tax 640.54 14,732.31
Social Security   361.03   8,303.66
Medicare      84.43      1,941.99
State Income Tax 232.92 5,357.20
401(k)  349.38  8,035.80
Medical Pre-Tax 174.69 4,017.90
Gross pay  5,823.05
Net pay 3,959.67
Direct deposit to checking      XXX-XX-0758",PAYSTUB,44,PAYSTUB,fdc-d598bee7715e94176c9a1566,v11-PAYSTUB-inline,original,2021,fgen-a76f312559b9cd2071db2f12,synthetic_programmatic_template,inline,none,False,biweekly
"Pay Statement
Granite Peak Manufacturing Co.
2690 Cedar Ln Testville, IL 42867
Employee      Wei 0kafor
Employee ID      39674
Pay period   10/01/2023 - 10/28/2023
Pay date  October 23, 2023
Earnings Rate Hours Current YTD
Regular   57.03   86.67   4,943.l2   88,976.09
Overtime  85.55  4.00  107.01  5,118.11
Deductions   Current   YTD
Federa1 Income Tax543.74 9,787.37
5ocial Security   3O6.47   5,5l6.52
Medicare   71.68   1,290.15
State IncomeTax l97.72 3,559.04
401(k)  296.59  5,338.57
Medical Pre-Tax148.29 2,669.28
Grosspay   4,943.12
Net pay   3,361.32
Direct deposít to checking  XXXXX0592",PAYSTUB,44,PAYSTUB,fdc-98e7d0d74f7fd26558fd79ef,v11-PAYSTUB-inline,original,2023,fgen-6c58c20e2f762e47b81842b2,synthetic_programmatic_template,inline,top,True,biweekly
"Payroll Advice
Granite Peak Manufacturing Co.
1692 Oak Hollow Ct Fairview, OH 81142
Employee Amara Haddad
Employee ID      49022
Pay period 12/01/2021 - 12/28/2021
Pay date   2021-11-28
Earnings  Rate  Hours  Current  YTD
Regular 58.25 80.00 4,659.66 65,235.29
Overtime   87.37   5.00   464.36   4,800.73
Deductions   Current   YTD
Federal Income Tax   512.56   7,175.88
Social Security   288.90   4,044.59
Medicare 67.57 945.91
State Income Tax 186.39 2,609.41
Medical Pre-Tax      139.79      1,957.06
Gross pay   4,659.66
Net pay   3,168.57
Direct deposit to checking   ***-**-1770",PAYSTUB,44,PAYSTUB,fdc-19002dbd91cea16a10c97ea0,v11-PAYSTUB-inline,original,2021,fgen-5b26a58900cefb0709c0ebc3,synthetic_programmatic_template,inline,top,False,biweekly
"Acme Test Corp
8106 Harbor View Rd Maplewood, MN 87358
Employee      Lena Adeyemi
Employee ID   25571
Pay period 01/01/2024 - 01/28/2024
Pay date 2024-01-23
Earnings   Rate   Hours   Current   YTD
Regular   66.36   80.00   5,308.61   90,246.43
Overtime   99.54   5.00   28.61   6,727.24
Deductions   Current   YTD
Federal Income Tax      583.95      9,927.11
Social Security 329.13 5,595.28
Medicare 76.97 1,308.57
State Income Tax 212.34 3,609.86
401(k) 318.52 5,414.79
Medical Pre-Tax   159.26   2,707.39
Gross pay 5,308.61
Net pay      3,609.86
Direct deposit to checking   ***-**-8414
Payroll Advice",PAYSTUB,44,PAYSTUB,fdc-107a2f8c7a44ebf74f4c42a3,v11-PAYSTUB-inline,original,2024,fgen-e71d8ed1a3253af29e89cb7b,synthetic_programmatic_template,inline,bottom,False,biweekly
"Tri-County School District
2850 Lakeshore Blvd Brookhaven, PA 21948
Employee  Lena Kowalski
Employee ID 24279
Pay period      10/01/2026 - 10/28/2026
Pay date      March 2, 2026
Earnings      Rate      Hours      Current      YTD
Regular  77.98  75.00  5,848.36  87,725.44
Overtime 116.97 7.00 461.96 2,399.95
Deductions      Current      YTD
Federal Income Tax 643.32 9,649.80
Social Security      362.60      5,438.98
Medicare 84.80 1,272.02
State Income Tax   233.93   3,509.02
401(k)      350.90      5,263.53
Medical Pre-Tax 175.45 2,631.76
Gross pay   5,848.36
Net pay 3,976.89
Direct deposit to checking   ***-**-0565
Pay Statement",PAYSTUB,44,PAYSTUB,fdc-fcce0bfcf98bbc9bd0f858ec,v11-PAYSTUB-inline,original,2026,fgen-e0401c33631e1b7f609a7dd9,synthetic_programmatic_template,inline,bottom,False,semimonthly
"Pay Statement
Tri-County School District
7190 Willow Bend Way Pinecrest, GA 94736
Employee AmaraL. Tanaka
Employee ID      68998
Pay period 07/01/2024 - 07/30/2024
Pay date 12/31/2024
Earnings      Rate      Hours     Current      YTD
Regular      21.21      75.00      1,590.95     41,364.80
0vertíme  31.82  5.00  270.70  3,378.74
Deductions   Current   YTD
Federal Income Tax      l75.00     4,550.13
5ocial 5ecurity 98.64 2,564.62
Medicare 23.07 599.79
State Income Tax  63.64  1,654.59
401(k) 95.46 2,481.89
Medical Pre-Tax 47.73 1,240.94
Gross pay      1,590.95
Net pay   1,081.85
Direct deposit to checking      ending in 0127",PAYSTUB,44,PAYSTUB,fdc-3dd374289c2581f2a5b09f56,v11-PAYSTUB-inline,original,2024,fgen-0c90d93d6814e4c703ddfd1a,synthetic_programmatic_template,inline,top,True,final_of_year
"Pay Statement
Copperline Software Inc.
4854 Elm Park Pl Oak Grove, TX 16229
Employee Casey Romero
Employee ID 94590
Pay period 06/01/2023 - 06/28/2023
Pay date 12/31/2023
Earnings Rate Hours Current YTD
Regular 47.01 40.00 1,880.53 48,893.67
Overtime      70.52      8.00      6.82      1,060.01
Deductions      Current      YTD
Federal Income Tax 206.86 5,378.30
Social Security      116.59      3,031.41
Medicare      27.27      708.96
State Income Tax 75.22 1,955.75
401(k) 112.83 2,933.62
Gross pay  1,880.53
Net pay   1,278.76
Direct deposit to checking ****1504",PAYSTUB,44,PAYSTUB,fdc-5f35096722b72f9ef9b57e55,v11-PAYSTUB-inline,original,2023,fgen-16fe8ff7d78140066b343e7f,synthetic_programmatic_template,inline,top,False,final_of_year
"Pay Statement
Acme Test Corp
4160 Maple Ridge Dr Lakewood, CO 58128
Employee   Priya Moreau
Employee ID   45974
Pay period   12/01/2022 - 12/28/2022
Pay date  11/05/2022
Earnings  Rate  Hours  Current  YTD
Regular 80.58 86.67 6,983.94 76,823.35
Overtime 120.87 9.00 383.02 2,108.91
Deductions  Current  YTD
Federal Income Tax 768.23 8,450.57
Social Security 433.00 4,763.05
Medicare 101.27 1,113.94
State Income Tax  279.36  3,072.93
401(k) 419.04 4,609.40
Medical Pre-Tax      209.52      2,304.70
Gross pay 6,983.94
Net pay   4,749.08
Direct deposit to checking  ***-**-7532",PAYSTUB,44,PAYSTUB,fdc-a925003348ae2cc886905b88,v11-PAYSTUB-inline,original,2022,fgen-a0420b5f66805529caf4701d,synthetic_programmatic_template,inline,top,False,biweekly
"Earnings Statement
Copperline Software Inc.
4446 Willow Bend Way Oak Grove, TX 86375
Employee  Olivia Sato
Employee ID  39247
Pay period 09/01/2022 - 09/30/2022
Pay date      2022-07-14
Earnings Rate Hours Current YTD
Regular      77.57      86.67      6,722.58      134,451.62
Overtime 116.35 5.00 496.70 4,765.97
Deductions  Current  YTD
Social Security   416.80   8,336.00
Medicare  97.48  1,949.55
State Income Tax   268.90   5,378.06
401(k)      403.35      8,067.10
Medical Pre-Tax      201.68      4,033.55
Gross pay   6,722.58
Net pay   4,571.36
Direct deposit to checking XXXXX0852",PAYSTUB,44,PAYSTUB,fdc-1329bfe903f4e8623cddd3ab,v11-PAYSTUB-inline,original,2022,fgen-ac01b12cf0cdd9e99f1186b1,synthetic_programmatic_template,inline,top,False,biweekly
"Pay Statement
Blue Heron Logistics LLC
8182 Maple Ridge Dr Cedar Falls, IA 67762
Employee Amara Castillo
Employee ID 65529
Pay period 01/01/2026 - 01/28/2026
Pay date      December 21, 2026
Earnings   Rate   Hours   Current   YTD
Regular  24.39  86.67  2,113.84  29,593.79
Overtime 36.58 8.00 485.63 4,640.89
Deductions  Current  YTD
Federal Income Tax 232.52 3,255.32
Social Security 131.06 1,834.82
Medicare  30.65  429.11
State Income Tax   84.55   1,183.75
401(k) 126.83 1,775.63
Medical Pre-Tax 63.42 887.81
Gross pay 2,113.84
Net pay   1,437.41
Direct deposit to checking   ****9491",PAYSTUB,44,PAYSTUB,fdc-ac99f2d1e649048690a30570,v11-PAYSTUB-inline,original,2026,fgen-6c489396ba19dbc6a3c48134,synthetic_programmatic_template,inline,top,False,biweekly
"Pay Statement
Blue Heron Logistics LLC
4007 Granite St Pinecrest, GA 55406
Employee  Priya Lindqvist
Employee ID  95095
Pay period  12/01/2026 - 12/28/2026
Pay date      12/31/2026
Earnings Rate Hours Current YTD
Regular   33.63   40.00   1,345.24   34,976.15
Overtime  50.45  0.00  74.62  8,351.03
Deductions      Current      YTD
Social Security      83.40      2,168.52
State Income Tax  53.81  1,399.05
401(k)  80.71  2,098.57
Medical Pre-Tax  40.36  1,049.28
Gross pay   1,345.24
Net pay   914.76
Direct deposit to checking XXX-XX-7390",PAYSTUB,44,PAYSTUB,fdc-592900ee66efb12a762110b4,v11-PAYSTUB-inline,original,2026,fgen-a4f77a7e9abf884fca3dd74e,synthetic_programmatic_template,inline,top,False,final_of_year
"Payroll Advice
Granite Peak Manufacturing Co.
2531 Granite St Bayside, WA 57368
Employee      Taylor Sato
Employee ID 26836
Pay period 08/01/2021 - 08/31/2021
Pay date   6/14/21
Earnings Rate Hours Current YTD
Regular 24.93 80.00 1,994.56 31,912.91
Overtime 37.40 9.00 218.42 4,063.52
Deductions      Current      YTD
Federal Income Tax  219.40  3,510.42
Social Security      123.66      1,978.60
Medicare   28.92   462.74
State Income Tax   79.78   1,276.52
401(k) 119.67 1,914.77
Medical Pre-Tax 59.84 957.39
Gross pay 1,994.56
Net pay   1,356.30
Direct deposit to checking XXX-XX-8797",PAYSTUB,44,PAYSTUB,fdc-d108fd56accb93cdb5cea418,v11-PAYSTUB-inline,original,2021,fgen-158a77eab520106aeeb7c4d6,synthetic_programmatic_template,inline,top,False,biweekly
"Maple Street Dental PC
8936 Maple Ridge Dr Riverton, WI 78683
Employee Olivia Tanaka
Employee ID      17983
Pay period      11/01/2026 - 11/31/2026
Pay date 12/31/2026
Earnings  Rate  Hours  Current  YTD
Regular      59.55      80.00      4,763.70      123,856.11
Overtime   89.32   9.00   425.21   8,795.59
Deductions  Current  YTD
Federal Income Tax 524.01 13,624.17
Social Security 295.35 7,679.08
Medicare 69.07 1,795.91
State Income Tax 190.55 4,954.24
401(k)   285.82   7,431.37
Gross pay   4,763.70
Net pay 3,239.31
Direct deposit to checking ending in 5367
Your 2026 Form W-2 will be available in the employee portal by January 31.
Payroll Advice",PAYSTUB,44,PAYSTUB,fdc-42ce6fc4ad34c31384bb9fbb,v11-PAYSTUB-inline,original,2026,fgen-1b51d865e0fd4cf922ca7de3,synthetic_programmatic_template,inline,bottom,False,final_of_year
"Earnings Statement
Copperline Software Inc.
4678 Maple Ridge Dr Cedar Falls, IA 73434
Employee
Employee ID
Pay period
Pay date
Noah Larsen
66374
01/01/2026 - 01/31/2026
2026-01-13
Earnings
Rate
Hours
Current
YTD
Regular
88.72
86.67
7,689.67
123,034.79
Overtime
133.09
6.00
450.27
6,603.75
Deductions
Current
YTD
Federal Income Tax
845.86
13,533.83
Social Security
476.76
7,628.16
Medicare
111.50
1,784.00
State Income Tax
307.59
4,921.39
401(k)
461.38
7,382.09
Medical Pre-Tax
230.69
3,691.04
Gross pay
Net pay
Direct deposit to checking
7,689.67
5,228.98
****2610",PAYSTUB,44,PAYSTUB,fdc-dbe4a9740fe97dc483860905,v11-PAYSTUB-columns,original,2026,fgen-3e58144bf606cfe7108f333c,synthetic_programmatic_template,columns,top,False,semimonthly
"Acme Test Corp
3368 Sample Street Brookhaven, PA 77797
Employee
Employee ID
Pay period
Pay date
Lena Sato
38612
05/01/2025 - 05/30/2025
April 7, 2025
Earnings
Rate
Hours
Current
YTD
Regular
52.32
40.00
2,092.99
10,464.93
Overtime
78.49
4.00
586.11
2,282.40
Deductions
Current
YTD
Federal Income Tax
230.23
1,151.14
Social Security
129.77
648.83
Medicare
30.35
151.74
State Income Tax
83.72
418.60
Medical Pre-Tax
62.79
313.95
Gross pay
Net pay
Direct deposit to checking
2,092.99
1,423.23
****2153
Payroll Advice",PAYSTUB,44,PAYSTUB,fdc-2fbf1e2263f0df7cbf397082,v11-PAYSTUB-columns,original,2025,fgen-fac7072b9fada921980567c1,synthetic_programmatic_template,columns,bottom,False,biweekly
"Riverside Regional Hospital
51 Granite St Lakewood, CO 49601
Employee
Employee ID
Pay period
Pay date
Taylor Lindqvist
64981
03/01/2023 - 03/30/2023
1/12/23
Earnings
Rate
Hours
Current
YTD
Regular
78.13
80.00
6,250.52
93,757.79
Overtime
117.20
7.00
397.86
6,673.06
Deductions
Current
YTD
Federal Income Tax
687.56
10,313.36
Social Security
387.53
5,812.98
State Income Tax
250.02
3,750.31
401(k)
375.03
5,625.47
Medical Pre-Tax
187.52
2,812.73
Gross pay
Net pay
Direct deposit to checking
6,250.52
4,250.35
****7336
Statement of Earnings and Deductions",PAYSTUB,44,PAYSTUB,fdc-f718062f41d6adc947e39bb0,v11-PAYSTUB-columns,original,2023,fgen-230d49280e4257f1b0da92b1,synthetic_programmatic_template,columns,bottom,False,semimonthly
"Earnings Statement
Copperline Software Inc.
2749 Harbor View Rd Cedar Falls, IA 27700
Employee
Employee ID
Pay period
Pay datc
Olivia Moreau
73696
11/01/2021 - 11/31/2021
11/20/2021
Eamings
Rate
Hours
Current
YTD
Regu1ar
51.03
75.00
3,827.11
42,098.22
Overtime
76.54
5.00
41.75
6,912.93
Deductions
Current
YTD
FederalIncome Tax
420.98
4,630.80
Social Securíty
237.28
2,6l0.09
State Income Tax
153.08
1,683.93
Gross pay
Net pay
Dírect deposit to checking
3,827.11
2,602.44
XXXXX6871",PAYSTUB,44,PAYSTUB,fdc-bb8209610f0cbd79750c855e,v11-PAYSTUB-columns,original,2021,fgen-280295bc5049a627104a651a,synthetic_programmatic_template,columns,top,True,biweekly
"Granite Peak Manufacturing Co.
2644 Granite St Bayside, WA 56253
Employee
Employee ID
Pay period
Pay date
Fatima Patel
28096
07/01/2023 - 07/31/2023
December 14, 2023
Earnings
Rate
Hours
Current
YTD
Regular
36.87
40.00
1,474.83
26,546.91
Overtime
55.31
2.00
440.06
2,322.25
Deductions
Current
YTD
Federal Income Tax
162.23
2,920.16
Social Security
91.44
1,645.91
Medicare
21.39
384.93
State Income Tax
58.99
1,061.88
401(k)
88.49
1,592.81
Gross pay
Net pay
Direct deposit to checking
1,474.83
1,002.88
XXX-XX-1187",PAYSTUB,44,PAYSTUB,fdc-6869461f011f015e5a446cdd,v11-PAYSTUB-columns,original,2023,fgen-80f387c81fe89ad93c7bd58b,synthetic_programmatic_template,columns,none,False,biweekly
"Maple Street Dental PC
5581 Willow Bend Way Testville, IL 91712
Employee
Employee ID
Pay period
Pay date
Hiro Nguyen
71932
10/01/2021 - 10/30/2021
11/8/21
Earnings
Rate
Hours
Current
YTD
Regular
87.79
86.67
7,609.15
159,792.19
Overtime
131.69
2.00
300.67
2,634.42
Deductions
Current
YTD
Federal Income Tax
837.01
17,577.14
Social Security
471.77
9,907.12
Medicare
110.33
2,316.99
State Income Tax
304.37
6,391.69
401(k)
456.55
9,587.53
Medical Pre-Tax
228.27
4,793.77
Gross pay
Net pay
Direct deposit to checking
7,609.15
5,174.22
XXX-XX-4661",PAYSTUB,44,PAYSTUB,fdc-51ad900b2355c73cc7f45e55,v11-PAYSTUB-columns,original,2021,fgen-db8608a817a2d3cc844d88da,synthetic_programmatic_template,columns,none,False,biweekly
"Copperline Software Inc.
4763 Maple Ridge Dr Bayside, WA 48987
Employee
Employee ID
Pay period
Pay date
Riley Lindqvist
30784
05/01/2023 - 05/28/2023
06/13/2023
Earnings
Rate
Hours
Current
YTD
Regular
67.56
86.67
5,855.59
81,978.21
Overtime
101.34
1.00
320.25
761.23
Deductions
Current
YTD
Federal Income Tax
644.11
9,017.60
Social Security
363.05
5,082.65
Medicare
84.91
1,188.68
State Income Tax
234.22
3,279.13
401(k)
351.34
4,918.69
Medical Pre-Tax
175.67
2,459.35
Gross pay
Net pay
Direct deposit to checking
5,855.59
3,981.80
****2946",PAYSTUB,44,PAYSTUB,fdc-93afd688d0b2d5ec40d6deff,v11-PAYSTUB-columns,original,2023,fgen-985de60804bf9c01896d249b,synthetic_programmatic_template,columns,none,False,biweekly
"Payroll Advice
Maple Street Dental PC
2774 Oak Hollow Ct Brookhaven, PA 29992
Employee
Employee ID
Pay period
Pay date
Wei R. Haddad
92855
11/01/2023 - 11/28/2023
09/01/2023
Earnings
Rate
Hours
Current
YTD
Regular
35.36
40.00
1,414.22
19,799.03
Overtime
53.03
0.00
126.65
3,025.29
Deductions
Current
YTD
Federal Income Tax
155.56
2,177.89
Social Security
87.68
1,227.54
Medicare
20.51
287.09
State Income Tax
56.57
791.96
401(k)
84.85
1,187.94
Gross pay
Net pay
Direct deposit to checking
1,414.22
961.67
XXX-XX-7309",PAYSTUB,44,PAYSTUB,fdc-bd4a461dd43526a6f0cf0de3,v11-PAYSTUB-columns,original,2023,fgen-4fd48c3a4e29f8ca551e78cb,synthetic_programmatic_template,columns,top,False,semimonthly
"Statement of Earnings and Deductions
Acme Test Corp
9511 Oak Hollow Ct Pinecrest, GA 21790
Employee
Employee ID
Pay period
Pay date
Sofia Nguyen
74988
06/01/2023 - 06/31/2023
12/31/2023
Earnings
Rate
Hours
Current
YTD
Regular
89.42
86.67
7,749.85
201,496.19
Overtime
134.13
8.00
362.83
7,126.33
Deductions
Current
YTD
Federal Income Tax
852.48
22,164.58
Social Security
480.49
12,492.76
Medicare
112.37
2,921.69
State Income Tax
309.99
8,059.85
401(k)
464.99
12,089.77
Medical Pre-Tax
232.50
6,044.89
Gross pay
Net pay
Direct deposit to checking
7,749.85
5,269.90
****9341",PAYSTUB,44,PAYSTUB,fdc-8691b1cc17035ee1172f80ca,v11-PAYSTUB-columns,original,2023,fgen-aeba11f55cbbe6545c58a785,synthetic_programmatic_template,columns,top,False,final_of_year
"Pay Statement
Blue Heron Logistics LLC
503 Lakeshore Blvd Fairview, OH 29378
Employee
Employee ID
Pay period
Pay date
Alex Moreau
88090
05/01/2025 - 05/31/2025
2025-05-22
Earnings
Rate
Hours
Current
YTD
Regular
86.47
80.00
6,917.26
13,834.52
Overtime
129.70
9.00
154.94
1,640.20
Deductions
Current
YTD
Federal Income Tax
760.90
1,521.80
Social Security
428.87
857.74
State Income Tax
276.69
553.38
401(k)
415.04
830.07
Medical Pre-Tax
207.52
415.04
Gross pay
Net pay
Direct deposit to checking
6,917.26
4,703.74
***-**-6122",PAYSTUB,44,PAYSTUB,fdc-acbbca443fc60792b6dc83d2,v11-PAYSTUB-columns,original,2025,fgen-18b7eebe813c6acf323e7e98,synthetic_programmatic_template,columns,top,False,biweekly
"Statement of Earnings and Deductions
Copperline Software Inc.
4334 Maple Ridge Dr Lakewood, CO 92112
Employee
Employee ID
Pay period
Pay date
Sofia Adeyemi
45348
04/01/2025 - 04/28/2025
12/31/2025
Earnings
Rate
Hours
Current
YTD
Regular
36.36
75.00
2,727.00
70,901.91
Overtime
54.54
0.00
335.93
3,795.66
Deductions
Current
YTD
Federal Income Tax
299.97
7,799.21
Social Security
169.07
4,395.92
Medicare
39.54
1,028.08
State Income Tax
109.08
2,836.08
401(k)
163.62
4,254.11
Gross pay
Net pay
Direct deposit to checking
2,727.00
1,854.36
XXXXX3027
Your 2025 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-e50cf1130fccef422c557a84,v11-PAYSTUB-columns,original,2025,fgen-3397ac29cbd8445c283d5e83,synthetic_programmatic_template,columns,top,False,final_of_year
"Statement of Earnings and Deductions
Granite Peak Manufacturing Co.
5892 Map1e Ridge Dr Bayside, WA 90633
Employee
Employee ID
Pay period
Pay date
Hiro Rivera
96695
O2/01/2026 - 02/28/2026
12/10/26
Earnings
Rate
Hours
Current
YTD
Regular
42.17
75.00
3,163.05
37,956.60
0vertime
63.26
4.00
592.85
8,000.52
Deductions
Current
YTD
Federal Income Tax
347.94
4,175.23
Social Security
196.11
2,353.31
Medicare
45.86
55O.37
State Income Tax
126.52
1,518.26
401(k)
189.78
2,277.40
Medical Prc-Tax
94.89
1,138.70
Gross pay
Nct pay
Direct deposit tochecking
3,163.05
2,l50.87
****7685",PAYSTUB,44,PAYSTUB,fdc-449847e93548fa18cb70abc6,v11-PAYSTUB-columns,original,2026,fgen-a5ad96a04472e8f0e077ae5a,synthetic_programmatic_template,columns,top,True,semimonthly
"Statement of Earnings and Deductions
Tri-County School District
3604 Sample Street Fairview, OH 70690
Employee
Employee ID
Pay period
Pay date
Noah M. Haddad
43606
10/01/2025 - 10/30/2025
12/31/2025
Earnings
Rate
Hours
Current
YTD
Regular
41.90
80.00
3,351.67
87,143.30
Overtime
62.84
3.00
326.15
5,198.91
Deductions
Current
YTD
Social Security
207.80
5,402.88
Medicare
48.60
1,263.58
State Income Tax
134.07
3,485.73
401(k)
201.10
5,228.60
Gross pay
Net pay
Direct deposit to checking
3,351.67
2,279.13
***-**-3252",PAYSTUB,44,PAYSTUB,fdc-facb4d2c4d8ba82419a43c65,v11-PAYSTUB-columns,original,2025,fgen-57a4923c1ee3a2402f836d08,synthetic_programmatic_template,columns,top,False,final_of_year
"Payroll Advice
Blue Heron Logistics LLC
4958 Sample Street Brookhaven, PA 44274
Employee
Employee ID
Pay period
Pay date
Lena D. Okafor
78240
11/01/2026 - 11/30/2026
12/31/2026
Earnings
Rate
Hours
Current
YTD
Regular
72.75
86.67
6,305.65
163,946.80
Overtime
109.13
0.00
284.47
8,268.26
Deductions
Current
YTD
Federal Income Tax
693.62
18,034.15
Social Security
390.95
10,164.70
Medicare
91.43
2,377.23
State Income Tax
252.23
6,557.87
Medical Pre-Tax
189.17
4,918.40
Gross pay
Net pay
Direct deposit to checking
6,305.65
4,287.84
XXX-XX-0445
Your 2026 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-404337004c47dc9e01069923,v11-PAYSTUB-columns,original,2026,fgen-9dc452074cbee018bad0b093,synthetic_programmatic_template,columns,top,False,final_of_year
"Copperline Software Inc.
7267 Granite St Riverton, WI 24891
Employee
Employee ID
Pay period
Pay date
Priya Rivera
21969
11/01/2024 - 11/31/2024
12/31/2024
Earnings
Rate
Hours
Current
YTD
Regular
55.78
86.67
4,834.50
125,697.03
Overtime
83.67
8.00
542.76
6,253.18
Deductions
Current
YTD
Federal Income Tax
531.80
13,826.67
Social Security
299.74
7,793.22
Medicare
70.10
1,822.61
401(k)
290.07
7,541.82
Medical Pre-Tax
145.04
3,770.91
Gross pay
Net pay
Direct deposit to checking
4,834.50
3,287.46
XXX-XX-9300
Your 2024 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-793b3082938608e73aa07c80,v11-PAYSTUB-columns,original,2024,fgen-a1e33209223e389ba0b8a129,synthetic_programmatic_template,columns,none,False,final_of_year
"Tri-County School District
5393 Willow Bend Way Riverton, WI 85177
Employee
Employee ID
Pay period
Pay date
Priya Walsh
98888
11/01/2025 - 11/30/2025
12/31/2025
Earnings
Rate
Hours
Current
YTD
Regular
57.41
75.00
4,305.58
111,945.02
Overtime
86.11
1.00
324.99
3,743.94
Deductions
Current
YTD
Federal Income Tax
473.61
12,313.95
Social Security
266.95
6,940.59
Medicare
62.43
1,623.20
State Income Tax
172.22
4,477.80
401(k)
258.33
6,716.70
Medical Pre-Tax
129.17
3,358.35
Gross pay
Net pay
Direct deposit to checking
4,305.58
2,927.79
XXX-XX-7362
Your 2025 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-d47df73e1142b11a408012d2,v11-PAYSTUB-columns,original,2025,fgen-7776e2aed8f4cb4fe79fa8c1,synthetic_programmatic_template,columns,none,False,final_of_year
"Earnings Statement
Copperline Software Inc.
3753 Sample Street Oak Grove, TX 10062
Employee
Employee ID
Pay period
Pay date
Hiro A. Brennan
10370
12/01/2026 - 12/30/2026
March 24, 2026
Earnings
Rate
Hours
Current
YTD
Regular
26.81
40.00
1,072.28
16,084.27
Overtime
40.21
2.00
427.80
4,462.03
Deductions
Current
YTD
Federal Income Tax
117.95
1,769.27
Social Security
66.48
997.22
Medicare
15.55
233.22
Medical Pre-Tax
32.17
482.53
Gross pay
Net pay
Direct deposit to checking
1,072.28
729.15
***-**-0790",PAYSTUB,44,PAYSTUB,fdc-6477ae33c1eee6b53fe84e19,v11-PAYSTUB-columns,original,2026,fgen-9c89d4858126dbe893ad9139,synthetic_programmatic_template,columns,top,False,semimonthly
"Payroll Advice
Tri-County School District
3909 Willow Bend Way Bayside, WA 66421
Employee
Employee ID
Pay period
Pay date
Wei Lindqvist
47536
08/01/2024 - 08/28/2024
12/31/2024
Earnings
Rate
Hours
Current
YTD
Regular
46.04
80.00
3,683.29
95,765.61
Overtime
69.06
6.00
378.66
6,109.58
Deductions
Current
YTD
Federal Income Tax
405.16
10,534.22
Social Security
228.36
5,937.47
Medicare
53.41
1,388.60
State Income Tax
147.33
3,830.62
401(k)
221.00
5,745.94
Medical Pre-Tax
110.50
2,872.97
Gross pay
Net pay
Direct deposit to checking
3,683.29
2,504.64
XXX-XX-4597
Your 2024 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-6e5013b4b2f6cb38481d005f,v11-PAYSTUB-columns,original,2024,fgen-7dcc5484a9869314ac3336d5,synthetic_programmatic_template,columns,top,False,final_of_year
"Statement of Earnings and Deductions
Riverside Regional Hospital
4840 Sample Street Riverton, WI 52969
Employee
Employee ID
Pay period
Pay date
Wei C. Patel
84821
01/01/2022 - 01/31/2022
10/13/22
Earnings
Rate
Hours
Current
YTD
Regular
91.24
86.67
7,907.65
118,614.71
Overtime
136.86
8.00
515.26
3,355.22
Deductions
Current
YTD
Federal Income Tax
869.84
13,047.62
Social Security
490.27
7,354.11
State Income Tax
316.31
4,744.59
401(k)
474.46
7,116.88
Medical Pre-Tax
237.23
3,558.44
Gross pay
Net pay
Direct deposit to checking
7,907.65
5,377.20
XXX-XX-8547",PAYSTUB,44,PAYSTUB,fdc-2964e7d41b5322e6b81877b2,v11-PAYSTUB-columns,original,2022,fgen-32c2264f001c3704d29afc0a,synthetic_programmatic_template,columns,top,False,biweekly
"Earnings Statcment
Blue Heron Logistics LLC
2891 0ak Hollow CtOak Grove, TX 3l445
Employee
Employee ID
Pay period
Pay date
Alex Haddad
69622
0l/0l/2026 - 01/31/2026
12/31/2026
Earnings
Rate
Hours
Current
YTD
Regular
39.18
8O.00
3,134.63
81,500.35
Overtime
58.77
2.00
18.09
1,759.33
Deductions
Current
YTD
Federal Income Tax
344.81
8,965.04
Social Security
194.35
5,053.02
Medicare
45.45
1,181.76
State Income Tax
125.39
3,260.01
401(k)
188.08
4,890.02
Medica1 Pre-Tax
94.04
2,445.01
Gross pay
Net pay
Direct deposit to checking
3,134.63
2,131.55
XXXXX4748
Your 2026 Form W-2 wi1l bc available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-06e456a67d8b1308041ad066,v11-PAYSTUB-columns,original,2026,fgen-d2a835b7c92ee0cad63b63fe,synthetic_programmatic_template,columns,top,True,final_of_year
"Statement of Earnings and Deductions
Riverside Regional Hospital
2418 Elm Park Pl Fairview, OH 89075
Employee
Employee ID
Pay period
Pay date
Fatima B. Lindqvist
65943
02/01/2026 - 02/28/2026
4/9/26
Earnings
Rate
Hours
Current
YTD
Regular
60.88
80.00
4,870.54
58,446.54
Overtime
91.32
4.00
4.65
6,236.88
Deductions
Current
YTD
Federal Income Tax
535.76
6,429.12
Social Security
301.97
3,623.69
Medicare
70.62
847.47
401(k)
292.23
3,506.79
Medical Pre-Tax
146.12
1,753.40
Gross pay
Net pay
Direct deposit to checking
4,870.54
3,311.97
XXX-XX-2639",PAYSTUB,44,PAYSTUB,fdc-97988327f13939a1afaf1ac6,v11-PAYSTUB-columns,original,2026,fgen-5db46dcc1ab96838397779dd,synthetic_programmatic_template,columns,top,False,biweekly
"Earnings Statement
Acme Test Corp
2161 Lakeshore Blvd Oak Grove, TX l4l06
Employee
Employee ID
Pay period
Pay date
Mateo D. Walsh
47O87
03/0l/2024 - O3/28/2024
2024-03-21
Earnings
Rate
Hours
Current
YTD
Regular
69.63
4O.00
2,785.22
36,207.91
0vertime
104.45
4.00
594.03
7,658.71
Deductions
Current
YTD
Federal Income Tax
306.37
3,982.87
Social Security
172.68
2,244.89
State Income Tax
111.41
1,448.32
Medical Pre-Tax
83.56
1,086.24
Gross pay
Netpay
Direct deposit to checking
2,785.22
1,893.95
ending in 7305",PAYSTUB,44,PAYSTUB,fdc-8909462a458edfd9f93d08f2,v11-PAYSTUB-columns,original,2024,fgen-e42019eb2cb6d95728c0e7ea,synthetic_programmatic_template,columns,top,True,biweekly
"Statement of Earnings and Deductions
Maple Street Dental PC
4163 Elm Park Pl Cedar Falls, IA 19185
Employee
Employee ID
Pay period
Pay date
Noah Lindqvist
75422
02/01/2022 - 02/28/2022
March 4, 2022
Earnings
Rate
Hours
Current
YTD
Regular
54.18
40.00
2,167.09
28,172.13
Overtime
81.27
4.00
361.12
2,670.69
Deductions
Current
YTD
Federal Income Tax
238.38
3,098.93
Medicare
31.42
408.50
State Income Tax
86.68
1,126.89
Medical Pre-Tax
65.01
845.16
Gross pay
Net pay
Direct deposit to checking
2,167.09
1,473.62
ending in 3068",PAYSTUB,44,PAYSTUB,fdc-5fde8bfea563e40e30bcb1ee,v11-PAYSTUB-columns,original,2022,fgen-6ff5a0a3e8533d754b619206,synthetic_programmatic_template,columns,top,False,biweekly
"Copper1ine Software Inc.
2490 Granite St Fairview,OH 54180
Emp1oyee
Employee ID
Pay period
Pay date
Jordan Físcher
33255
08/01/2021 - 08/31/2021
11/24/21
Earnings
Rate
Hours
Current
YTD
Regular
45.05
75.00
3,378.82
10,136.45
Ovcrtime
67.58
3.00
382.65
3,542.06
Deductions
Current
YTD
Federal Income Tax
371.67
1,115.01
Social Security
209.49
628.46
Medicare
48.99
146.98
State Income Tax
135.15
4O5.46
401(k)
202.73
608.19
Gross pay
Net pay
Direct deposit to checking
3,378.82
2,297.60
ending in 8665",PAYSTUB,44,PAYSTUB,fdc-8ddd36414b9b2692efbc7e9c,v11-PAYSTUB-columns,original,2021,fgen-65e6c8d8afcda544dae3a891,synthetic_programmatic_template,columns,none,True,biweekly
"Payroll Advice
Copperline Softwarc Inc.
98 Elm Park Pl Fairview, OH 94411
Employee
Employee ID
Pay period
Pay date
Fatima Walsh
94633
03/01/2021 - 03/28/2021
10/14/21
Eamings
Rate
Hours
Current
YTD
Regular
49.11
86.67
4,256.54
8,513.07
0vertime
73.67
8.00
391.49
329.66
Deductions
Current
YTD
Federal Income Tax
468.22
936.44
Social Security
263.91
527.81
Medicare
61.72
123.44
State IncomeTax
170.26
340.52
401(k)
255.39
510.78
Gross pay
Nct pay
Direct deposit to checking
4,256.54
2,894.44
XXXXX9474",PAYSTUB,44,PAYSTUB,fdc-63fba5a7e6655c41f97ca5d0,v11-PAYSTUB-columns,original,2021,fgen-ee732b82377347cc5d5de305,synthetic_programmatic_template,columns,top,True,biweekly
"Pay Statement
Acme Test Corp
4090 Lakeshore Blvd Lakewood, CO 11272
Employee
Employee ID
Pay period
Pay date
Priya J. Castillo
17566
11/01/2025 - 11/31/2025
12/31/2025
Earnings
Rate
Hours
Current
YTD
Regular
24.51
40.00
980.56
25,494.61
Overtime
36.77
9.00
313.95
915.73
Deductions
Current
YTD
Federal Income Tax
107.86
2,804.41
Social Security
60.79
1,580.67
Medicare
14.22
369.67
401(k)
58.83
1,529.68
Medical Pre-Tax
29.42
764.84
Gross pay
Net pay
Direct deposit to checking
980.56
666.78
XXX-XX-1857
Your 2025 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-b25afef6c3177769fb15a20a,v11-PAYSTUB-columns,original,2025,fgen-743f914ebc04f7f26b389342,synthetic_programmatic_template,columns,top,False,final_of_year
"Blue Heron Logistics LLC
4103 Elm Park Pl Maplewood, MN 75135
Employee
Employee ID
Pay period
Pay date
Priya E. Sato
50641
03/01/2025 - 03/28/2025
November 24, 2025
Earnings
Rate
Hours
Current
YTD
Regular
44.81
75.00
3,360.84
80,660.25
Overtime
67.22
8.00
560.87
7,813.86
Deductions
Current
YTD
Federal Income Tax
369.69
8,872.63
Social Security
208.37
5,000.94
Medicare
48.73
1,169.57
State Income Tax
134.43
3,226.41
401(k)
201.65
4,839.61
Medical Pre-Tax
100.83
2,419.81
Gross pay
Net pay
Direct deposit to checking
3,360.84
2,285.37
***-**-9400
Payroll Advice",PAYSTUB,44,PAYSTUB,fdc-a09bec33761f48744a6de370,v11-PAYSTUB-columns,original,2025,fgen-e2afe8a63f85c15e11b3199c,synthetic_programmatic_template,columns,bottom,False,biweekly
"Granite Peak Manufacturing Co.
6866 Harbor View Rd Pinecrest, GA 48305
Employee
Employee ID
Pay period
Pay date
Lena S. Okafor
19739
03/01/2025 - 03/30/2025
April 17, 2025
Earnings
Rate
Hours
Current
YTD
Regular
63.28
80.00
5,062.04
111,364.84
Overtime
94.91
7.00
468.11
3,874.62
Deductions
Current
YTD
Federal Income Tax
556.82
12,250.13
Social Security
313.85
6,904.62
Medicare
73.40
1,614.79
State Income Tax
202.48
4,454.59
401(k)
303.72
6,681.89
Medical Pre-Tax
151.86
3,340.95
Gross pay
Net pay
Direct deposit to checking
5,062.04
3,442.19
XXXXX3776
Earnings Statement",PAYSTUB,44,PAYSTUB,fdc-79be28d8e9245f720a32df23,v11-PAYSTUB-columns,original,2025,fgen-317cb0790d359dbeef5a51f9,synthetic_programmatic_template,columns,bottom,False,biweekly
"Statement of Earnings and Deductions
Blue Heron Logistics LLC
9035 Prairie Ave Fairview, OH 73422
Employee
Employee ID
Pay period
Pay date
Kwame Testcase
51530
03/01/2024 - 03/30/2024
2024-04-22
Earnings
Rate
Hours
Current
YTD
Regular
44.68
86.67
3,872.75
85,200.50
Overtime
67.03
9.00
102.37
4,519.44
Deductions
Current
YTD
Federal Income Tax
426.00
9,372.05
Social Security
240.11
5,282.43
Medicare
56.15
1,235.41
State Income Tax
154.91
3,408.02
401(k)
232.36
5,112.03
Gross pay
Net pay
Direct deposit to checking
3,872.75
2,633.47
***-**-1637",PAYSTUB,44,PAYSTUB,fdc-30314cdb02c77e3ec2e25c8f,v11-PAYSTUB-columns,original,2024,fgen-f635f61a0d19683072c5af4f,synthetic_programmatic_template,columns,top,False,biweekly
"Tri-County School District
2026 Prairie Ave Oak Grove, TX 53045
Employee
Employee ID
Pay period
Pay date
Jamie J. Brennan
46604
10/01/2023 - 10/30/2023
April 9, 2023
Earnings
Rate
Hours
Current
YTD
Regular
25.99
75.00
1,949.37
42,886.19
Overtime
38.99
4.00
585.91
3,142.08
Deductions
Current
YTD
Federal Income Tax
214.43
4,717.48
State Income Tax
77.97
1,715.45
401(k)
116.96
2,573.17
Medical Pre-Tax
58.48
1,286.59
Gross pay
Net pay
Direct deposit to checking
1,949.37
1,325.57
***-**-9709
Payroll Advice",PAYSTUB,44,PAYSTUB,fdc-57a4abab20dd6ff72d223053,v11-PAYSTUB-columns,original,2023,fgen-c04b3b5c0a1f0f62e5005b77,synthetic_programmatic_template,columns,bottom,False,semimonthly
"Statement of Earnings and Deductions
Riverside Regional Hospital
1891 Oak Hollow Ct Fairview, OH 36162
Employee
Employee ID
Pay period
Pay date
Alex M. Brennan
37951
10/01/2025 - 10/31/2025
12/31/2025
Earnings
Rate
Hours
Current
YTD
Regular
35.47
40.00
1,418.86
36,890.40
Overtime
53.21
4.00
430.30
5,360.29
Deductions
Current
YTD
Federal Income Tax
156.07
4,057.94
Social Security
87.97
2,287.20
State Income Tax
56.75
1,475.62
401(k)
85.13
2,213.42
Medical Pre-Tax
42.57
1,106.71
Gross pay
Net pay
Direct deposit to checking
1,418.86
964.83
XXX-XX-2189
Your 2025 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-73be6b0df39e9341afa9f939,v11-PAYSTUB-columns,original,2025,fgen-ae826c1c682c7190d83126ad,synthetic_programmatic_template,columns,top,False,final_of_year
"Earnings Statement
Granite Peak Manufacturing Co.
9200 Prairie Ave Testville, IL 82018
Employee
Employee ID
Pay period
Pay date
Casey Tanaka
70278
02/01/2023 - 02/28/2023
12/31/2023
Earnings
Rate
Hours
Current
YTD
Regular
56.62
86.67
4,907.32
127,590.36
Overtime
84.93
4.00
331.14
1,273.91
Deductions
Current
YTD
Federal Income Tax
539.81
14,034.94
Social Security
304.25
7,910.60
Medicare
71.16
1,850.06
State Income Tax
196.29
5,103.61
Medical Pre-Tax
147.22
3,827.71
Gross pay
Net pay
Direct deposit to checking
4,907.32
3,336.98
XXX-XX-4638",PAYSTUB,44,PAYSTUB,fdc-11be1f48295f57d946ecfdd4,v11-PAYSTUB-columns,original,2023,fgen-27cd781aa1d59d002e2d618d,synthetic_programmatic_template,columns,top,False,final_of_year
"Payroll Advice
Riverside Regional Hospital
9827 Maple Ridge Dr Testville, IL 16512
Employee,Amara Brennan
Employee ID,55022
Pay period,02/01/2023 - 02/28/2023
Pay date,2023-05-12
Earnings,Rate,Hours,Current,YTD
Regular,48.78,40.00,""1,951.16"",""31,218.54""
Overtime,73.17,2.00,26.88,""7,817.35""
Deductions,Current,YTD
Federal Income Tax,214.63,""3,434.04""
Social Security,120.97,""1,935.55""
Medicare,28.29,452.67
State Income Tax,78.05,""1,248.74""
401(k),117.07,""1,873.11""
Medical Pre-Tax,58.53,936.56
Gross pay,""1,951.16""
Net pay,""1,326.79""
Direct deposit to checking,***-**-0288",PAYSTUB,44,PAYSTUB,fdc-2e995354e09de5b5777e3897,v11-PAYSTUB-csv,original,2023,fgen-de22fca5ab7eceea4c96c93e,synthetic_programmatic_template,csv,top,False,semimonthly
"Pay Statement
Acme Test Corp
7162 Lakeshore Blvd Bayside, WA 31994
Employee,Mateo J. Okafor
Employee ID,87325
Pay period,04/01/2025 - 04/31/2025
Pay date,2025-01-06
Earnings,Rate,Hours,Current,YTD
Regular,79.45,75.00,""5,958.55"",""41,709.85""
Overtime,119.17,9.00,39.84,""3,705.44""
Deductions,Current,YTD
Social Security,369.43,""2,586.01""
Medicare,86.40,604.79
State Income Tax,238.34,""1,668.39""
401(k),357.51,""2,502.59""
Medical Pre-Tax,178.76,""1,251.30""
Gross pay,""5,958.55""
Net pay,""4,051.81""
Direct deposit to checking,***-**-8961",PAYSTUB,44,PAYSTUB,fdc-6c11970a11960bbce76d1c82,v11-PAYSTUB-csv,original,2025,fgen-9d37f45931ff33b9ce5ada56,synthetic_programmatic_template,csv,top,False,biweekly
"Payroll Advice
Granite Peak Manufacturing Co.
1128 Lakeshore Blvd Brookhaven, PA 30633
Employee,Amara R. Haddad
Employee ID,44320
Pay period,02/01/2022 - 02/28/2022
Pay date,8/24/22
Earnings,Rate,Hours,Current,YTD
Regular,53.68,86.67,""4,652.21"",""88,391.99""
Overtime,80.52,8.00,588.46,""7,207.15""
Deductions,Current,YTD
Federal Income Tax,511.74,""9,723.12""
Social Security,288.44,""5,480.30""
Medicare,67.46,""1,281.68""
401(k),279.13,""5,303.52""
Medical Pre-Tax,139.57,""2,651.76""
Gross pay,""4,652.21""
Net pay,""3,163.50""
Direct deposit to checking,ending in 7833",PAYSTUB,44,PAYSTUB,fdc-b0b373b29a9db5986dc5daa4,v11-PAYSTUB-csv,original,2022,fgen-bff5d7b33dc578dce0f0251b,synthetic_programmatic_template,csv,top,False,biweekly
"Earnings Statement
Acme Test Corp
6567 Cedar Ln Fairview, OH 49760
Employee,Jamie Larsen
Employee ID,15626
Pay period,04/01/2025 - 04/31/2025
Pay date,12/31/2025
Earnings,Rate,Hours,Current,YTD
Regular,78.59,80.00,""6,287.40"",""163,472.32""
Overtime,117.89,8.00,31.07,""2,865.42""
Deductions,Current,YTD
Federal Income Tax,691.61,""17,981.96""
Social Security,389.82,""10,135.28""
Medicare,91.17,""2,370.35""
State Income Tax,251.50,""6,538.89""
401(k),377.24,""9,808.34""
Medical Pre-Tax,188.62,""4,904.17""
Gross pay,""6,287.40""
Net pay,""4,275.43""
Direct deposit to checking,****0780
Your 2025 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-5dca988f905cb6e71c2bc988,v11-PAYSTUB-csv,original,2025,fgen-481334d0ef5b0bfa69c9cd8a,synthetic_programmatic_template,csv,top,False,final_of_year
"Earnings Statement
Tri-County School District
8097 MaplcRidge Dr Bayside, WA 32784
Employee,Alex Walsh
Employee ID,29085
Pay period,l1/01/2021 - 11/31/2021
Pay date,""September 5, 2021""
Earnings,Rate,Hours,Current,YTD
Regular,60.21,40.00,""2,408.39"",""50,576.20""
Overtime,90.31,3.00,139.14,""7,032.48""
Deductions,Current,YTD
Federal Income Tax,264.92,""5,563.38""
5ocial Security,l49.32,""3,135.72""
Medicarc,34.92,733.35
State Income Tax,96.34,""2,023.05""
401(k),144.50,""3,034.57""
Medical Pre-Tax,72.25,""1,517.29""
Gross pay,""2,408.39""
Nct pay,""1,637.71""
Direct deposit to checking,XXXXX5214",PAYSTUB,44,PAYSTUB,fdc-7b110745331c48dd2d69672a,v11-PAYSTUB-csv,original,2021,fgen-13d5f0506d530afa5c31ab5c,synthetic_programmatic_template,csv,top,True,semimonthly
"Earnings Statement
Maple Street Dental PC
721 Granite St Testville, IL 58666
Employee,Fatima Haddad
Employee ID,14787
Pay period,06/01/2025 - 06/28/2025
Pay date,""September 18, 2025""
Earnings,Rate,Hours,Current,YTD
Regular,27.75,86.67,""2,405.47"",""26,460.16""
Overtime,41.63,1.00,422.93,""4,103.38""
Deductions,Current,YTD
Federal Income Tax,264.60,""2,910.62""
Social Security,149.14,""1,640.53""
Medicare,34.88,383.67
State Income Tax,96.22,""1,058.41""
401(k),144.33,""1,587.61""
Medical Pre-Tax,72.16,793.80
Gross pay,""2,405.47""
Net pay,""1,635.72""
Direct deposit to checking,XXX-XX-3986",PAYSTUB,44,PAYSTUB,fdc-72f749262cb427b542d4ae67,v11-PAYSTUB-csv,original,2025,fgen-b67d7a030f41ea71d0b35ee3,synthetic_programmatic_template,csv,top,False,semimonthly
"Earnings Statement
Acme Test Corp
2482 Maple Ridge Dr Bayside, WA 52788
Employee,Alex Haddad
Employee ID,11720
Pay period,08/01/2026 - 08/31/2026
Pay date,05/24/2026
Earnings,Rate,Hours,Current,YTD
Regular,69.36,86.67,""6,011.32"",""126,237.75""
Overtime,104.04,0.00,519.26,""1,198.33""
Deductions,Current,YTD
Social Security,372.70,""7,826.74""
Medicare,87.16,""1,830.45""
State Income Tax,240.45,""5,049.51""
401(k),360.68,""7,574.27""
Medical Pre-Tax,180.34,""3,787.13""
Gross pay,""6,011.32""
Net pay,""4,087.70""
Direct deposit to checking,****3200",PAYSTUB,44,PAYSTUB,fdc-68df4773b0dddf9f60e3a5fc,v11-PAYSTUB-csv,original,2026,fgen-e114df9eb765c820f4c1df57,synthetic_programmatic_template,csv,top,False,semimonthly
"Earnings Statement
Blue Heron Logistics LLC
3254 Willow Bend Way Cedar Falls, IA 53981
Employee,Priya Tanaka
Employee ID,53754
Pay period,07/01/2024 - 07/28/2024
Pay date,2024-05-18
Earnings,Rate,Hours,Current,YTD
Regular,42.51,75.00,""3,188.03"",""51,008.45""
Overtime,63.76,2.00,426.43,""5,816.17""
Deductions,Current,YTD
Federal Income Tax,350.68,""5,610.93""
Social Security,197.66,""3,162.52""
Medicare,46.23,739.62
State Income Tax,127.52,""2,040.34""
401(k),191.28,""3,060.51""
Medical Pre-Tax,95.64,""1,530.25""
Gross pay,""3,188.03""
Net pay,""2,167.86""
Direct deposit to checking,XXXXX1217",PAYSTUB,44,PAYSTUB,fdc-8fb99cb9c3a876770c0816b5,v11-PAYSTUB-csv,original,2024,fgen-15fd1375136247267572bb4d,synthetic_programmatic_template,csv,top,False,semimonthly
"Granite Peak Manufacturing Co.
7686 Willow Bend Way Bayside, WA 97201
Employee,Morgan M. Adeyemi
Employee ID,57245
Pay period,02/01/2021 - 02/28/2021
Pay date,12/31/2021
Earnings,Rate,Hours,Current,YTD
Regular,61.83,75.00,""4,637.04"",""120,562.98""
Overtime,92.74,6.00,199.46,""2,279.52""
Deductions,Current,YTD
Federal Income Tax,510.07,""13,261.93""
Social Security,287.50,""7,474.90""
Medicare,67.24,""1,748.16""
State Income Tax,185.48,""4,822.52""
401(k),278.22,""7,233.78""
Medical Pre-Tax,139.11,""3,616.89""
Gross pay,""4,637.04""
Net pay,""3,153.19""
Direct deposit to checking,ending in 1749
Your 2021 Form W-2 will be available in the employee portal by January 31.
Pay Statement",PAYSTUB,44,PAYSTUB,fdc-4d4efdfe652975c6d0010cd2,v11-PAYSTUB-csv,original,2021,fgen-3ca820e33f7cb7014b6f93e5,synthetic_programmatic_template,csv,bottom,False,final_of_year
"Earnings Statement
Blue Heron Logistics LLC
6014 Elm Park Pl Pinecrest, GA 34068
Employee,Alex Okafor
Employee ID,43104
Pay period,10/01/2022 - 10/31/2022
Pay date,12/31/2022
Earnings,Rate,Hours,Current,YTD
Regular,46.09,75.00,""3,456.44"",""89,867.47""
Overtíme,69.13,3.00,436.78,477.21
Deductions,Current,YTD
Federal Income Tax,380.21,""9,885.42""
Socia1 Security,2l4.30,""5,571.78""
StateIncome Tax,138.26,""3,594.70""
40l(k),207.39,""5,392.05""
Medícal Pre-Tax,103.69,""2,696.02""
Gross pay,""3,456.44""
Net pay,""2,350.38""
Dírect deposit to checking,XXXXX6313",PAYSTUB,44,PAYSTUB,fdc-2f1b822dd79682d2d7277b65,v11-PAYSTUB-csv,original,2022,fgen-0e2aa5156bc982ce08169a70,synthetic_programmatic_template,csv,top,True,final_of_year
"Granite Peak Manufacturing Co.
2923 Cedar Ln Pinecrest, GA 45701
Employee,Morgan Adeyemi
Employee ID,29075
Pay period,10/01/2021 - 10/30/2021
Pay date,""May 18, 2021""
Earnings,Rate,Hours,Current,YTD
Regular,84.55,75.00,""6,341.19"",""88,776.65""
Overtime,126.82,2.00,14.16,""2,057.61""
Deductions,Current,YTD
Medicare,91.95,""1,287.26""
State Income Tax,253.65,""3,551.07""
401(k),380.47,""5,326.60""
Medical Pre-Tax,190.24,""2,663.30""
Gross pay,""6,341.19""
Net pay,""4,312.01""
Direct deposit to checking,XXXXX8940",PAYSTUB,44,PAYSTUB,fdc-8a2c58b2b7024e9440e3da2f,v11-PAYSTUB-csv,original,2021,fgen-ccdc1c0075f09f02be8d950c,synthetic_programmatic_template,csv,none,False,biweekly
"Payroll Advice
Maple Street Dental PC
7139 Cedar Ln Brookhaven, PA 56610
Employee,Priya K. Larsen
Employee ID,32383
Pay period,04/01/2026 - 04/30/2026
Pay date,12/31/2026
Earnings,Rate,Hours,Current,YTD
Regular,29.22,86.67,""2,532.56"",""65,846.61""
Overtime,43.83,1.00,405.18,497.29
Deductions,Current,YTD
Federal Income Tax,278.58,""7,243.13""
Social Security,157.02,""4,082.49""
Medicare,36.72,954.78
State Income Tax,101.30,""2,633.86""
401(k),151.95,""3,950.80""
Medical Pre-Tax,75.98,""1,975.40""
Gross pay,""2,532.56""
Net pay,""1,722.14""
Direct deposit to checking,XXXXX8299
Your 2026 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-1cb1710bf1c04a718b01dcb7,v11-PAYSTUB-csv,original,2026,fgen-817e9e4f79d2a6eec0ec6cae,synthetic_programmatic_template,csv,top,False,final_of_year
"Statement of Earnings and Deductions
Granite Peak Manufacturing Co.
2475 Granite St Brookhaven, PA 59144
Employee,Kwame Okafor
Employee ID,55444
Pay period,08/01/2021 - 08/30/2021
Pay date,7/21/21
Earnings,Rate,Hours,Current,YTD
Regular,16.55,40.00,662.20,""3,973.19""
Overtime,24.83,0.00,377.99,""6,352.32""
Deductions,Current,YTD
Federal Income Tax,72.84,437.05
Social Security,41.06,246.34
Medicare,9.60,57.61
State Income Tax,26.49,158.93
401(k),39.73,238.39
Medical Pre-Tax,19.87,119.20
Gross pay,662.20
Net pay,450.29
Direct deposit to checking,***-**-2696",PAYSTUB,44,PAYSTUB,fdc-23d68dec6dd4382c7d63ac1a,v11-PAYSTUB-csv,original,2021,fgen-b3fc69132cf3beb9103b7bab,synthetic_programmatic_template,csv,top,False,biweekly
"Statement of Earnings and Deductions
Acme Test Corp
4428 Harbor View Rd Testville, IL 81880
Employee,Taylor Testcase
Employee ID,19470
Pay period,01/01/2023 - 01/28/2023
Pay date,12/31/2023
Earnings,Rate,Hours,Current,YTD
Regular,19.59,86.67,""1,697.98"",""44,147.56""
Overtime,29.39,6.00,514.07,""2,692.50""
Deductions,Current,YTD
Federal Income Tax,186.78,""4,856.23""
Social Security,105.27,""2,737.15""
Medicare,24.62,640.14
State Income Tax,67.92,""1,765.90""
401(k),101.88,""2,648.85""
Medical Pre-Tax,50.94,""1,324.43""
Gross pay,""1,697.98""
Net pay,""1,154.63""
Direct deposit to checking,XXXXX7500
Your 2023 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-26115c8f6a736916d56800cf,v11-PAYSTUB-csv,original,2023,fgen-6562c7716cbf8baac46bbd2c,synthetic_programmatic_template,csv,top,False,final_of_year
"Statement of Earnings and Deductions
Blue Heron Logistics LLC
81945ample Street Oak Grove, TX 5322l
Employee,Hiro C. Romero
Employee ID,48205
Pay period,10/01/2022 - 10/28/2022
Pay date,01/19/2022
Earnings,Rate,Hours,Current,YTD
Regu1ar,19.95,75.00,""1,496.10"",""32,914.l3""
Overtime,29.92,4.00,516.98,""3,736.57""
Deductions,Current,YTD
Federal Income Tax,164.57,""3,620.55""
Social Security,92.76,""2,040.68""
Medicare,21.69,477.25
State Income Tax,59.84,""1,316.57""
401(k),89.77,""1,974.85""
Medical Prc-Tax,44.88,987.42
Gross pay,""1,496.10""
Net pay,""1,017.35""
Direct deposit to checking,***-**-3253",PAYSTUB,44,PAYSTUB,fdc-2da1873c2f8246d71d5d81f3,v11-PAYSTUB-csv,original,2022,fgen-364cd3ed65d11828402c9963,synthetic_programmatic_template,csv,top,True,semimonthly
"Tri-County School District
8636 Harbor View Rd Fairview, OH 78825
Employee,Casey Rivera
Employee ID,62678
Pay period,03/01/2025 - 03/28/2025
Pay date,2025-03-16
Earnings,Rate,Hours,Current,YTD
Regular,94.45,40.00,""3,778.01"",""64,226.17""
Overtime,141.68,0.00,588.50,335.53
Deductions,Current,YTD
Federal Income Tax,415.58,""7,064.88""
Social Security,234.24,""3,982.02""
Medicare,54.78,931.28
401(k),226.68,""3,853.57""
Medical Pre-Tax,113.34,""1,926.79""
Gross pay,""3,778.01""
Net pay,""2,569.05""
Direct deposit to checking,***-**-9580",PAYSTUB,44,PAYSTUB,fdc-f83c3f1c41ed6b780471e039,v11-PAYSTUB-csv,original,2025,fgen-1ad2a2a65b03ba3edd4b5b02,synthetic_programmatic_template,csv,none,False,biweekly
"Payroll Advice
Maple Street Dental PC
494 Willow Bend Way Lakewood, CO 34031
Employee,Casey Castíllo
Employee ID,65O63
Pay period,10/01/2023 - 10/31/2023
Pay date,5/5/23
Eamings,Rate,Hours,Current,YTD
Regular,54.09,86.67,""4,688.21"",""46,882.12""
Overtime,81.14,1.00,107.58,""6,194.02""
Deductions,Current,YTD
FederalIncome Tax,515.70,""5,157.03""
5ocial Security,290.67,""2,906.69""
Medicare,67.98,679.79
State Income Tax,187.53,""1,875.28""
401(k),281.29,""2,8l2.93""
Medical Pre-Tax,140.65,""1,406.46""
Gross pay,""4,688.21""
Net pay,""3,187.98""
Direct deposit to checking,****2211",PAYSTUB,44,PAYSTUB,fdc-b626b485e13ff6f114d2299a,v11-PAYSTUB-csv,original,2023,fgen-ab9a650bb50c4d1b1ad20481,synthetic_programmatic_template,csv,top,True,biweekly
"Pay Statement
Tri-County School District
6759 Maple Ridge Dr Bayside, WA 46365
Employee,Fatima Sato
Employee ID,10246
Pay period,08/01/2022 - 08/31/2022
Pay date,""January 17, 2022""
Earnings,Rate,Hours,Current,YTD
Regular,76.94,40.00,""3,077.73"",""30,777.32""
Overtime,115.41,7.00,145.90,""4,758.90""
Deductions,Current,YTD
Federal Income Tax,338.55,""3,385.51""
Social Security,190.82,""1,908.19""
Medicare,44.63,446.27
State Income Tax,123.11,""1,231.09""
401(k),184.66,""1,846.64""
Medical Pre-Tax,92.33,923.32
Gross pay,""3,077.73""
Net pay,""2,092.86""
Direct deposit to checking,XXXXX9682",PAYSTUB,44,PAYSTUB,fdc-50d1f1183ea75cdc93acc018,v11-PAYSTUB-csv,original,2022,fgen-9e31a81cc8df460ec360e5e3,synthetic_programmatic_template,csv,top,False,semimonthly
"Statement of Earnings and Deductions
Tri-County School District
7126 Prairie Ave Fairview, OH 53731
Employee,Sofia Brennan
Employee ID,45470
Pay period,10/01/2022 - 10/31/2022
Pay date,""August 19, 2022""
Earnings,Rate,Hours,Current,YTD
Regular,50.81,40.00,""2,032.21"",""34,547.60""
Overtime,76.21,6.00,486.12,""5,617.04""
Deductions,Current,YTD
Federal Income Tax,223.54,""3,800.24""
Social Security,126.00,""2,141.95""
Medicare,29.47,500.94
State Income Tax,81.29,""1,381.90""
401(k),121.93,""2,072.86""
Gross pay,""2,032.21""
Net pay,""1,381.90""
Direct deposit to checking,XXXXX0891",PAYSTUB,44,PAYSTUB,fdc-3bd4cbc4b58dcf22aa6ba031,v11-PAYSTUB-csv,original,2022,fgen-1ab35db36f52d6ef541b099e,synthetic_programmatic_template,csv,top,False,semimonthly
"Payroll Advice
Riverside Regional Hospital
7322 Willow Bend Way Pinecrest, GA 37886
Employee,Sofia Tanaka
Employee ID,98085
Pay period,10/01/2022 - 10/31/2022
Pay date,12/31/2022
Earnings,Rate,Hours,Current,YTD
Regular,79.96,86.67,""6,930.10"",""180,182.53""
Overtime,119.94,2.00,143.97,""8,932.63""
Deductions,Current,YTD
Federal Income Tax,762.31,""19,820.08""
Social Security,429.67,""11,171.32""
Medicare,100.49,""2,612.65""
State Income Tax,277.20,""7,207.30""
Medical Pre-Tax,207.90,""5,405.48""
Gross pay,""6,930.10""
Net pay,""4,712.47""
Direct deposit to checking,ending in 5933
Your 2022 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-df62c6994664af7e203a1e65,v11-PAYSTUB-csv,original,2022,fgen-4397c4114d9ad3c438f683d1,synthetic_programmatic_template,csv,top,False,final_of_year
"Blue Heron Logistics LLC
4033 Granite St Brookhaven,PA 51352
Employee,Jamie Adeyemi
Employee ID,42223
Pay period,09/01/2023 - 09/31/2023
Pay date,12/31/2023
Earnings,Rate,Hours,Current,YTD
Regular,20.46,80.00,""1,636.78"",""42,556.36""
0vertime,30.69,4.00,552.80,""5,222.18""
Deductions,Current,YTD
Federal Income Tax,180.05,""4,681.20""
5ocial Security,101.48,""2,638.49""
Medicare,23.73,617.07
State Income Tax,65.47,""1,702.25""
401(k),98.21,""2,553.38""
Mcdical Pre-Tax,49.10,""1,276.69""
Gross pay,""1,636.78""
Net pay,""1,113.01""
Direct deposit to chccking,***-**-6241
Statement of Eamings and Deductíons",PAYSTUB,44,PAYSTUB,fdc-221070d3287e23febf614f15,v11-PAYSTUB-csv,original,2023,fgen-6bee6aef08f1952003177b93,synthetic_programmatic_template,csv,bottom,True,final_of_year
"Copperline Software Inc.
5783 Maple Ridge Dr Fairview, OH 40539
Employee,Amara J. Walsh
Employee ID,44804
Pay period,06/01/2024 - 06/28/2024
Pay date,04/04/2024
Earnings,Rate,Hours,Current,YTD
Regular,55.12,80.00,""4,409.55"",""8,819.10""
Overtime,82.68,6.00,241.41,""7,593.02""
Deductions,Current,YTD
Federal Income Tax,485.05,970.10
Social Security,273.39,546.78
Medicare,63.94,127.88
State Income Tax,176.38,352.76
401(k),264.57,529.15
Medical Pre-Tax,132.29,264.57
Gross pay,""4,409.55""
Net pay,""2,998.49""
Direct deposit to checking,XXXXX2577
Pay Statement",PAYSTUB,44,PAYSTUB,fdc-5731e1e4116791c5c2485295,v11-PAYSTUB-csv,original,2024,fgen-a00fa078b17554dc9f5eb606,synthetic_programmatic_template,csv,bottom,False,semimonthly
"Granite Peak Manufacturing Co.
5238 Elm Park Pl Fairview, OH 54728
Employee,Amara S. Okafor
Employee ID,10271
Pay period,09/01/2023 - 09/30/2023
Pay date,""July 1, 2023""
Earnings,Rate,Hours,Current,YTD
Regular,20.80,86.67,""1,802.91"",""9,014.55""
Overtime,31.20,4.00,100.37,""3,183.26""
Deductions,Current,YTD
Federal Income Tax,198.32,991.60
Social Security,111.78,558.90
Medicare,26.14,130.71
State Income Tax,72.12,360.58
401(k),108.17,540.87
Medical Pre-Tax,54.09,270.44
Gross pay,""1,802.91""
Net pay,""1,225.98""
Direct deposit to checking,XXXXX0538
Payroll Advice",PAYSTUB,44,PAYSTUB,fdc-65e086b37c8d55fa4b7e4cf9,v11-PAYSTUB-csv,original,2023,fgen-272616cd8f4cca8f9b8e29be,synthetic_programmatic_template,csv,bottom,False,biweekly
"Earnings Statement
Riverside Regional Hospital
7376 Harbor View Rd Pinecrest, GA 48637
Employee,Amara Brennan
Employee ID,75463
Pay period,05/01/2023 - 05/30/2023
Pay date,11/4/23
Earnings,Rate,Hours,Current,YTD
Regular,81.98,75.00,""6,148.87"",""98,381.90""
Overtime,122.98,2.00,440.30,""6,925.35""
Deductions,Current,YTD
Social Security,381.23,""6,099.68""
Medicare,89.16,""1,426.54""
State Income Tax,245.95,""3,935.28""
401(k),368.93,""5,902.91""
Gross pay,""6,148.87""
Net pay,""4,181.23""
Direct deposit to checking,***-**-8603",PAYSTUB,44,PAYSTUB,fdc-5ed2dd998e8b05597456bc0b,v11-PAYSTUB-csv,original,2023,fgen-6f5c2b921b4802f4fed5ee6b,synthetic_programmatic_template,csv,top,False,semimonthly
"Pay Statement
Tri-County School District
1899 Cedar Ln Oak Grove, TX 85501
Employee,Noah D. Tanaka
Employee ID,14546
Pay period,03/01/2023 - 03/30/2023
Pay date,12/31/2023
Earnings,Rate,Hours,Current,YTD
Regular,33.99,40.00,""1,359.45"",""35,345.71""
Overtime,50.98,4.00,155.86,""5,474.99""
Deductions,Current,YTD
Federal Income Tax,149.54,""3,888.03""
Social Security,84.29,""2,191.43""
State Income Tax,54.38,""1,413.83""
401(k),81.57,""2,120.74""
Medical Pre-Tax,40.78,""1,060.37""
Gross pay,""1,359.45""
Net pay,924.43
Direct deposit to checking,***-**-1495
Your 2023 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-7e1bc7fcd3130ecc14352dd8,v11-PAYSTUB-csv,original,2023,fgen-f783a93b1dc3b8eb15f466c1,synthetic_programmatic_template,csv,top,False,final_of_year
"Earnings Statement
Tri-County School District
1424 Oak Hollow Ct Testville, IL 92266
Employee,Priya Kowalski
Employee ID,23215
Pay period,02/01/2026 - 02/28/2026
Pay date,6/21/26
Earnings,Rate,Hours,Current,YTD
Regular,72.59,40.00,""2,903.46"",""66,779.68""
Overtime,108.88,3.00,383.72,""6,506.29""
Deductions,Current,YTD
Federal Income Tax,319.38,""7,345.76""
Social Security,180.01,""4,140.34""
Medicare,42.10,968.31
State Income Tax,116.14,""2,671.19""
Medical Pre-Tax,87.10,""2,003.39""
Gross pay,""2,903.46""
Net pay,""1,974.36""
Direct deposit to checking,XXX-XX-2304",PAYSTUB,44,PAYSTUB,fdc-bc6ffb6a75ffa43dd925d162,v11-PAYSTUB-csv,original,2026,fgen-f339523edec5d45e3e9eacd1,synthetic_programmatic_template,csv,top,False,biweekly
"Pay Statement
Tri-County School District
3889 Lakeshore Blvd Maplewood, MN 50968
Employee,Riley Nguyen
Employee ID,21294
Pay period,05/01/2026 - 05/31/2026
Pay date,12/31/2026
Earnings,Rate,Hours,Current,YTD
Regular,82.93,80.00,""6,634.62"",""172,500.19""
Overtime,124.40,9.00,172.61,""8,839.14""
Deductions,Current,YTD
Federal Income Tax,729.81,""18,975.02""
Social Security,411.35,""10,695.01""
Medicare,96.20,""2,501.25""
State Income Tax,265.38,""6,900.01""
401(k),398.08,""10,350.01""
Medical Pre-Tax,199.04,""5,175.01""
Gross pay,""6,634.62""
Net pay,""4,511.54""
Direct deposit to checking,XXXXX9746
Your 2026 Form W-2 will be available in the employee portal by January 31.",PAYSTUB,44,PAYSTUB,fdc-490003eea30843ce3dfbdb36,v11-PAYSTUB-csv,original,2026,fgen-67b157c390f437998bb98ff4,synthetic_programmatic_template,csv,top,False,final_of_year
"Tri-County School District
8133 Lakeshore Blvd Lakewood, CO 62091
Employee,Kwame L. Nguyen
Employee ID,63069
Pay period,04/01/2023 - 04/31/2023
Pay date,2023-12-28
Earnings,Rate,Hours,Current,YTD
Regular,73.46,80.00,""5,876.42"",""11,752.84""
Overtime,110.18,3.00,76.32,""7,182.30""
Deductions,Current,YTD
Federal Income Tax,646.41,""1,292.81""
Social Security,364.34,728.68
Medicare,85.21,170.42
State Income Tax,235.06,470.11
401(k),352.59,705.17
Medical Pre-Tax,176.29,352.59
Gross pay,""5,876.42""
Net pay,""3,995.96""
Direct deposit to checking,***-**-9608",PAYSTUB,44,PAYSTUB,fdc-bfc134e98ed3bd3eca99b68e,v11-PAYSTUB-csv,original,2023,fgen-558b3fb0900c5eceb13fba0e,synthetic_programmatic_template,csv,none,False,semimonthly
"Earnings Statement
Blue Heron Logistics LLC
2069 Willow Bend Way Cedar Falls, IA 26889
Employee,Olivia R. Moreau
Employee ID,15023
Pay period,04/01/2023 - 04/28/2023
Pay date,01/15/2023
Earnings,Rate,Hours,Current,YTD
Regular,93.20,40.00,""3,727.86"",""22,367.13""
Overtime,139.79,7.00,231.77,""2,971.19""
Deductions,Current,YTD
Federal Income Tax,410.06,""2,460.38""
State Income Tax,149.11,894.69
401(k),223.67,""1,342.03""
Medical Pre-Tax,111.84,671.01
Gross pay,""3,727.86""
Net pay,""2,534.94""
Direct deposit to checking,XXXXX4470",PAYSTUB,44,PAYSTUB,fdc-3fc45bdae6856d4d9765632b,v11-PAYSTUB-csv,original,2023,fgen-db1f2de9e208966039a01bde,synthetic_programmatic_template,csv,top,False,semimonthly
"Earnings Statement
Acme Test Corp
658 Granite St Cedar Falls, IA 63604
Employee,Jamie Patel
Employee ID,83586
Pay period,05/01/2021 - 05/31/2021
Pay date,12/31/2021
Earnings,Rate,Hours,Current,YTD
Regular,37.20,40.00,""1,488.16"",""38,692.25""
Overtime,55.81,5.00,159.19,""8,265.81""
Deductions,Current,YTD
Federal Income Tax,163.70,""4,256.15""
Social Security,92.27,""2,398.92""
Medicare,21.58,561.04
State Income Tax,59.53,""1,547.69""
401(k),89.29,""2,321.53""
Medical Pre-Tax,44.64,""1,160.77""
Gross pay,""1,488.16""
Net pay,""1,011.95""
Direct deposit to checking,****1501",PAYSTUB,44,PAYSTUB,fdc-a441c358e1f779504fd1201b,v11-PAYSTUB-csv,original,2021,fgen-e8f63e7407077f2071594fb5,synthetic_programmatic_template,csv,top,False,final_of_year
"Earnings Statement
Maple Street Dental PC
2536 Prairie Ave Pinecrest, GA 11393
Employee,Sofia R. Lindqvist
Employee ID,13016
Pay period,10/01/2026 - 10/31/2026
Pay date,12/31/2026
Earnings,Rate,Hours,Current,YTD
Regular,51.21,86.67,""4,438.69"",""115,405.98""
Overtime,76.82,4.00,211.89,""6,080.75""
Deductions,Current,YTD
Federal Income Tax,488.26,""12,694.66""
Social Security,275.20,""7,155.17""
Medicare,64.36,""1,673.39""
State Income Tax,177.55,""4,616.24""
401(k),266.32,""6,924.36""
Medical Pre-Tax,133.16,""3,462.18""
Gross pay,""4,438.69""
Net pay,""3,018.31""
Direct deposit to checking,ending in 2712",PAYSTUB,44,PAYSTUB,fdc-a8478c65ed72dbc5d2d95683,v11-PAYSTUB-csv,original,2026,fgen-a6bc7fec7ac2d85f3b17e18a,synthetic_programmatic_template,csv,top,False,final_of_year
"Pay Statement
Riverside Regional Hospital
3104 Granite St Riverton, WI 34026
Employee,Amara A. Adeyemi
Employee ID,70988
Pay period,09/01/2026 - 09/28/2026
Pay date,12/31/2026
Earnings,Rate,Hours,Current,YTD
Regular,28.17,75.00,""2,112.40"",""54,922.52""
Overtime,42.25,8.00,238.52,""5,640.33""
Deductions,Current,YTD
Federal Income Tax,232.36,""6,041.48""
Social Security,130.97,""3,405.20""
Medicare,30.63,796.38
State Income Tax,84.50,""2,196.90""
Medical Pre-Tax,63.37,""1,647.68""
Gross pay,""2,112.40""
Net pay,""1,436.44""
Direct deposit to checking,XXXXX8294",PAYSTUB,44,PAYSTUB,fdc-9d39e76461e94d8b640a2279,v11-PAYSTUB-csv,original,2026,fgen-d6f036117b151e444c81b479,synthetic_programmatic_template,csv,top,False,final_of_year
"P&L Summary 2023
Category      Jan      Feb      Mar      YTD
Income   20207.65   20128.03   10494.70   13850.63
Contractors      6580.58      13919.27      11063.88      17172.26
Operating expenses      11839.44      12691.88      29541.08      11791.63
Operating expenses   24934.83   5710.44   4893.98   290.64
Operating expenses  29058.14  21373.17  14059.27  168.44",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0beaaf1fad9990585ba0c6a5,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2023,fgen-082cc4262efdd4d0481d313c,synthetic_programmatic_template,inline,top,False,raw_export
"Income Statement
Riverbend Landscaping
January - December 2024
Accrual Basis
Income
Sales   67,997.10
Total Income 67,997.10
Cost of Goods Sold  32,074.14
Gross Profit 35,922.96
Expenses      Total
Contract Labor 4,144.57
Office Supplies      981.79
Software Subscriptions      954.76
Travel  1,679.06
Utilities 488.14
Total Expenses 8,248.32
Net Operating Income   27,674.64
Net Income      27,674.64",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-570cecc1ccd9dc02d07ff881,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2024,fgen-c8529d97fc2ad3a6bef9f38f,synthetic_programmatic_template,inline,top,False,annual
"Profit and Loss
Maple Street Bakery
January - December 2024
Accrual Basis
Income
Sales  528,793.93
Total Income     528,793.93
Cost of Goods Sold 79,259.36
Gross Profít 449,534.57
Expcnses Total
Advertising & Marketing l3,646.38
Contract Labor 43,882.52
Officc Supplies 2,654.82
Rent or Lease   32,583.65
Software Subscriptions 4,046.l6
Travel 10,129.56
Utilities   4,672.11
Total Expenses 111,615.20
Net Operating Income      337,919.37
Net Income 337,919.37",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0114951f0ba573376fc35296,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2024,fgen-06fd31b4679bd950ecd900c3,synthetic_programmatic_template,inline,top,True,annual
"Income Statement
Bright Pixel Design LLC
January - December 2025
Cash Basís
Income
Sales243,830.88
Total Income   243,830.88
Cost of Goods Sold  l18,382.82
Gross Profit 125,448.06
Expenses Total
Advertising & Marketing  6,958.89
Contract Labor l9,969.65
Rent or Lease  12,308.09
Software Subscriptions  3,162.74
Travel 3,120.95
Utilities      2,0l0.33
Total Expenses 47,530.65
Net Operating Income  77,9l7.41
Net Income77,917.41",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8360aff321b26aa85e45556a,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2025,fgen-cb77f25eaa705b385dcac879,synthetic_programmatic_template,inline,top,True,cash_basis
"Profit and Loss
Riverbend Landscaping
March 2023
Accrual Basis
Income
Sales 163,761.88
Total Income  163,761.88
Cost of Goods Sold      70,159.63
Gross Profit   93,602.25
Expenses      Total
Advertising & Marketing  3,994.77
Insurance  2,230.14
Software Subscriptions  1,029.87
Travel   3,023.07
Total Expenses   10,277.85
Net Operating Income 83,324.40
Net Income      83,324.40",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-93f90c526f430b92e6faa374,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2023,fgen-fdbf1b61a49ea9dca2f78378,synthetic_programmatic_template,inline,top,False,monthly
"Profit & Loss Statement
Maple Street Bakery
October 2021
Accrual Basis
Income
Sales   78,422.77
Total Income   78,422.77
Cost of Goods Sold      18,688.02
Gross Profit  59,734.75
Expenses      Total
Contract Labor      8,189.61
Insurance  788.13
Office Supplies   494.92
Rent or Lease      5,406.88
Software Subscriptions  637.84
Travel   1,192.98
Utilities 949.23
Total Expenses 17,659.59
Net Operating Income 42,075.16
Net Income  42,075.16",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f9a009e3df630884fe565437,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2021,fgen-dc074545496cf2d63ce3871b,synthetic_programmatic_template,inline,top,False,monthly
"Profit & Loss Statement
Bright Pixel Design LLC
January - December 2023
Cash Basis
Income
Sales 389,644.68
Total Income   389,644.68
Cost of Goods Sold 125,348.36
Gross Profit   264,296.32
Expenses Total
Advertising & Marketing 15,889.54
Contract Labor 29,847.75
Insurance 5,533.85
Office Supplies 2,595.69
Rent or Lease   31,306.88
Travel   10,398.83
Utilities 2,184.09
Total Expenses      97,756.63
Net Operating Income   166,539.69
Net Income  166,539.69",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-34ac5d6c68a64c1dfbaeb225,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2023,fgen-93ecf4a6d16fe7ce200c4b52,synthetic_programmatic_template,inline,top,False,cash_basis
"Profit & Loss Statement
Maple Street Bakery
March 2026
Accrual Basis
Income
Sales  169,899.85
Total Income      169,899.85
Cost of Goods Sold 50,677.52
Gross Profit      119,222.33
Expenses  Total
Advertising & Marketing  5,009.36
Contract Labor  12,890.11
Insurance 4,904.62
Rent or Lease   7,528.42
Software Subscriptions 1,436.69
Travel 3,417.73
Utilities 940.70
Total Expenses 36,127.63
Net Operating Income   83,094.70
Net Income      83,094.70",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f71b16b7f782ba11c67d9d98,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2026,fgen-2d491897941c2e44d5b83ef0,synthetic_programmatic_template,inline,top,False,monthly
"Bright Pixel Design LLC
June 2022
Accrua1 Basis
Income
Sales 182,696.07
Total Income   182,696.07
Cost ofGoods 5old      73,288.14
Gross Profit 109,407.93
Expenses Total
Contract Labor  14,916.98
0ffice Supplies 2,054.06
Software Subscriptions  2,113.82
Utilities   2,130.83
Total Expenses   21,215.69
Net Operating Income 88,192.24
Net Income   88,192.24",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-3939a0c425a0c6c558029efa,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2022,fgen-3491ddabfdadbf855e0919bd,synthetic_programmatic_template,inline,none,True,monthly
"Profit & Loss Statement
Riverbend Landscaping
January - December 2024
Cash Basis
Income
Sales 203,769.10
Total Income   203,769.10
Cost of Goods Sold  36,728.28
Gross Profit      167,040.82
Expenses   Total
Advertising & Marketing 5,525.17
Contract Labor   9,690.33
Insurance 2,730.77
Office Supplies 2,131.07
Software Subscriptions      2,006.26
Travel   2,397.69
Total Expenses   24,481.29
Net Operating Income      142,559.53
Net Income 142,559.53",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ea77b4d032739349c97c5483,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2024,fgen-d24fbce4a0c572f138d503dd,synthetic_programmatic_template,inline,top,False,cash_basis
"Profit & Loss Statement
Maple Street Bakery
January - December 2021
Accrual Basis
Income
Sales  447,877.48
Total Income 447,877.48
Cost of Goods Sold  110,007.28
Gross Profit 337,870.20
Expenses Total
Advertising & Marketing      16,124.67
Office Supplies  2,325.97
Rent or Lease 15,112.07
Software Subscriptions 5,168.23
Travel      6,877.49
Total Expenses      45,608.43
Net Operating Income   292,261.77
Net Income      292,261.77",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-3e606464459d58fccefd211d,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2021,fgen-e5613507c72a830139a2428b,synthetic_programmatic_template,inline,top,False,annual
"Profit and Loss
Riverbend Landscaping
January - December 2026
Accrual Basis
Income
Sales 473,858.49
Total Income  473,858.49
Cost of Goods Sold  191,954.02
Gross Profit  281,904.47
Expenses Total
Advertising & Marketing 20,996.60
Contract Labor 19,036.73
Office Supplies      4,189.05
Rent or Lease 23,542.07
Travel 5,039.65
Utilities   4,569.29
Total Expenses   77,373.39
Net Operating Income  204,531.08
Net Income 204,531.08",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e638542759e04524b1c32ee5,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2026,fgen-b05f75da8efe260e04074c80,synthetic_programmatic_template,inline,top,False,annual
"Riverbend Landscaping
January - December 2024
Cash Basis
Income
Sales 345,719.18
Total Income   345,719.18
Cost of Goods Sold 54,315.01
Gross Profit      291,404.17
Expenses   Total
Advertising & Marketing 11,382.54
Contract Labor  24,466.57
Insurance 9,728.84
Office Supplies  5,182.56
Rent or Lease   22,851.71
Software Subscriptions 4,341.62
Travel 9,007.10
Utilities 4,222.65
Total Expenses 91,183.59
Net Operating Income  200,220.58
Net Income      200,220.58",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-663be7a0ec18221db5ad31c3,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2024,fgen-a8bf40fb009944f8c7750b78,synthetic_programmatic_template,inline,none,False,cash_basis
"Profit and Loss
Maple Street Bakery
January - December 2021
Cash Basís
Income
Sales   181,483.3O
Total Income      181,483.30
Cost of Goods Sold 22,114.62
Gross Profít     159,368.68
Expenses     Total
Advertising & Marketing   3,742.29
Contract Labor   10,990.91
Insurance     2,340.92
Office 5upplies  1,078.49
Rent or Lease   10,667.07
Software Subscriptions  1,075.33
Travel 2,997.27
Utilitics  1,735.85
Total Expenses  34,628.13
Net Operating Income      124,740.55
Net Income 124,740.55",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-798869372468ab178b437d2b,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2021,fgen-0efe5ba6b3e9f09e86e78cf6,synthetic_programmatic_template,inline,top,True,cash_basis
"Profit and Loss
Riverbend Landscaping
January - December 2026
Accrual Basís
Income
Sales   256,8O9.81
Total Income 256,809.81
Cost of Goods Sold 95,984.46
Gross Profit  160,825.36
Expenses     Total
Advertísing & Marketing 6,947.29
Contract Labor  20,l19.71
Insurance 7,310.76
0ffice 5upplies      3,440.87
Rcnt or Lease  7,864.43
Software Subscriptions   2,343.8l
Travel 5,196.45
Utilities      1,878.35
Total Expenses   55,101.67
Net Operating Income  105,723.69
Net Income 105,723.69",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4ee075f5f33d29ee5e40656b,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2026,fgen-3419d549134c09cb52667387,synthetic_programmatic_template,inline,top,True,annual
"Downloaded 08/02/2024
Category Jan Feb Mar YTD
Software      28745.61      3557.22      7889.93      11925.64
COGS  21171.52  28728.05  4063.14  11861.87
COGS 7860.26 6930.59 16502.24 13938.47
Contractors 745.17 12399.64 25493.58 18670.98
Contractors 14192.70 21660.16 10478.88 1451.91",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-7cfa3a2245a6e976a8ede5e3,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2024,fgen-85cc25553396b599ff5da9f7,synthetic_programmatic_template,inline,top,False,raw_export
"Income statement by month
Account      Q1      Q2      Q3      Q4      Total
Sales   29270.12   5141.28   43281.75   56209.10   62799.69
Marketing      19705.16      11730.25      81865.30      53574.30      88363.21
Cost of Goods Sold 27904.30 17470.84 56083.93 80654.05 62911.72
Payroll Expenses 46206.93 36251.47 8730.45 22368.41 56992.95
Rent      63405.67      33811.46      49609.98      53561.22      23484.88
Payroll Expenses      4328.17      48466.96      29988.08      3823.98      53732.70",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4ca76cb435da7745c5b63cad,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2025,fgen-2d28224006134963963a0fdc,synthetic_programmatic_template,inline,top,False,raw_export
"Profit & Loss Statement
Riverbend Landscaping
January - December 2023
Cash Basis
Income
Sales  296,670.47
Total Income 296,670.47
Cost of Goods Sold  88,224.74
Gross Profít   208,445.73
Expenses Total
Contract Labor 21,083.50
Insurance  7,078.98
0ffice Supplies 3,296.75
Rcnt or Lease 19,496.09
Software Subscriptions  3,192.12
Uti1ities 3,472.82
Total Expcnses      57,620.26
Net Operating Income 150,825.47
NetIncome 150,825.47",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-50614f40085634c8fe7f6f7d,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2023,fgen-745d7157bbf7f544b439fa23,synthetic_programmatic_template,inline,top,True,cash_basis
"Profit & Loss Statement
Copperline Consulting
January - December 2022
Cash Basis
Income
Sales  365,500.45
Total Income   365,500.45
Cost of Goods Sold      172,373.05
Gross Profit      193,127.40
Expenses      Total
Advertising & Marketing  9,947.30
Contract Labor   39,512.57
Insurance  10,677.84
Office Supplies 4,567.91
Software Subscriptions   5,366.46
Utilities  3,440.57
Total Expenses  73,512.65
Net Operating Income   119,614.75
Net Income 119,614.75",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f629334c6fd04960ff67b918,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2022,fgen-7a0cd71b6a1e251008b1d844,synthetic_programmatic_template,inline,top,False,cash_basis
"Copperline Consulting
January - December 2022
Accrua1 Basis
Income
Sales   436,943.97
Total Income 436,943.97
Cost of Goods Sold 86,687.78
Gross Profít     350,256.19
Expenses Total
0ffice Supplies  4,795.01
Rent or Lease 35,611.82
5oftware Subscriptions  2,962.93
Travel 7,337.42
Utilities 2,821.55
Total Expenses      53,528.73
Net Operatíng Income 296,727.46
Net Income     296,727.46
Profit and Loss",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-415ed227ed99edfc778d2d4c,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2022,fgen-8b121234d3e5851eea675cf4,synthetic_programmatic_template,inline,bottom,True,annual
"P&L Summary 2025
Downloaded 2025-06-25
Category   Jan   Feb   Mar   YTD
COGS  29536.20  7397.74  27380.49  21713.23
COGS   12773.86   10854.31   4258.22   9265.97
Service revenue 24238.43 4986.47 13526.44 105.93
Service revenue   6493.20   15166.91   21254.90   13693.66
Service revenue   20031.00   26883.31   4456.99   17251.27
Operating expenses 24940.49 16149.54 25609.85 29838.84
Contractors  14472.83  17505.42  22348.33  7722.25
Software  13528.45  21413.85  24837.10  29009.12",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8bb34d91aca3dae09fed996c,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2025,fgen-7dadef38ba627a203dbf8c72,synthetic_programmatic_template,inline,top,False,raw_export
"Income Statement
Riverbend Landscaping
January - December 2021
Accrual Basis
Income
Sales   307,301.41
Total Income      307,301.41
Cost of Goods Sold 127,448.22
Gross Profit      179,853.19
Expenses  Total
Advertising & Marketing 12,485.61
Contract Labor 12,728.72
Insurance  3,352.99
Rent or Lease 13,202.88
Software Subscriptions 2,133.41
Travel  3,276.65
Utilities      2,382.23
Total Expenses      49,562.49
Net Operating Income   130,290.70
Net Income   130,290.70",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-dae5931391776d9c4749ce35,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2021,fgen-b704e4d00e7a7f88e62be662,synthetic_programmatic_template,inline,top,False,annual
"Profit & Loss Statement
Riverbend Landscaping
January - December 2022
Accrual Basis
Income
Sales  417,190.28
Total Income 417,190.28
Cost of Goods Sold      196,737.87
Gross Profit  220,452.41
Expenses Total
Advertising & Marketing   14,468.90
Contract Labor  39,972.17
Insurance  5,942.31
Office Supplies 4,936.87
Software Subscriptions  3,800.05
Travel      12,199.06
Utilities 5,206.00
Total Expenses      86,525.36
Net Operating Income      133,927.05
Net Income      133,927.05",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ce3abcae2267e05d52656a1b,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2022,fgen-2ce7e83e4b641a01f04390e0,synthetic_programmatic_template,inline,top,False,annual
"Profit and Loss
Bright Pixel Design LLC
June 2022
Accrual Basis
Income
Sales 361,902.26
Total Income      361,902.26
Cost of Goods Sold 61,208.13
Gross Profit 300,694.14
Expenses  Total
Advertising & Marketing   15,341.63
Contract Labor 40,002.74
Office Supplies   2,414.08
Rent or Lease 29,255.36
Software Subscriptions 2,212.45
Utilities  3,661.84
Total Expenses 92,888.10
Net Operating Income  207,806.04
Net Income      207,806.04",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-10f3e996aa966a1603413a0e,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2022,fgen-f723e435f32e91eec16d0ff5,synthetic_programmatic_template,inline,top,False,monthly
"Copperline Consulting
June 2022
Accrual Basis
Income
Sales 63,462.60
Total Income  63,462.60
Cost of Goods Sold      28,761.67
Gross Profit  34,700.93
Expenses  Total
Advertising & Marketing 2,284.51
Contract Labor 4,845.89
Insurance  1,657.84
Rent or Lease 3,514.00
Software Subscriptions   802.37
Travel   1,547.25
Total Expenses      14,651.86
Net Operating Income   20,049.07
Net Income   20,049.07",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0cd6a107b6ced1a5f17a52b2,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2022,fgen-07d41a6f1c5d71de51a1d663,synthetic_programmatic_template,inline,none,False,monthly
"Copperline Consulting
January - December 2023
Cash Basis
Income
Sales      528,364.33
Total Income  528,364.33
Cost of Goods Sold  132,800.35
Gross Profit      395,563.98
Expenses  Total
Advertising & Marketing 22,391.51
Contract Labor   48,673.83
Insurance 12,865.79
Rent or Lease      46,454.38
Software Subscriptions 4,126.19
Travel   6,909.59
Total Expenses   141,421.29
Net Operating Income      254,142.69
Net Income  254,142.69",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e5532146e6e55c868d204915,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2023,fgen-c350407c9edb493e555dab37,synthetic_programmatic_template,inline,none,False,cash_basis
"Bright Pixel Design LLC
January - December 2026
Cash Basis
Income
Sales      123,371.95
Total Income   123,371.95
Cost of Goods Sold      54,032.10
Gross Profit 69,339.85
Expenses Total
Advertising & Marketing      3,573.69
Contract Labor   5,496.02
Insurance   2,478.32
Office Supplies   1,148.30
Software Subscriptions  1,374.66
Travel 2,611.97
Utilities  1,158.74
Total Expenses  17,841.70
Net Operating Income   51,498.15
Net Income   51,498.15
Profit and Loss",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-20e8f9b8716a52a01ce263ce,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2026,fgen-f32e5cb239269f8865d8bca8,synthetic_programmatic_template,inline,bottom,False,cash_basis
"Category      Jan      Feb      Mar      YTD
Operating expenses  15744.91  28482.97  4590.22  20033.57
Service revenue 7631.23 21552.08 14714.43 27293.99
Contractors      22423.02      17241.03      22957.74      1326.88
Income 16165.96 12957.50 29382.82 1611.33
Software   6069.45   18633.83   24592.79   14516.55",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-27eff5b2f965c0f4b703a726,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2025,fgen-011cfcbddb306c0f0ed265c4,synthetic_programmatic_template,inline,none,False,raw_export
"P&L Summary 2025
Account   Q1   Q2   Q3   Q4   Total
Gross Profit 48146.28 45137.76 10354.02 86338.40 45541.76
Marketing   51913.64   1827.89   17025.03   16183.41   6892.25
Marketing 23150.89 45772.53 12083.91 23036.68 62765.51
Marketing 81421.44 13697.95 36932.62 65221.56 61550.67
Marketing      13544.30      31652.23      34498.19      14057.77      47950.23
Total Revenue  18291.90  12266.85  56206.88  17838.11  42612.66
Sales 8088.62 65230.42 28446.25 67820.08 12131.87
Sales   76894.37   21690.58   37031.57   34560.52   29452.41",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-925d33a271f15248c31fa510,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2025,fgen-be37fb0e6b1214a184e4a9a9,synthetic_programmatic_template,inline,top,False,raw_export
"Bright Pixel Design LLC - Profit and Loss - 2026
Category Jan Feb Mar YTD
COGS  122.85  21958.42  15015.20  22005.31
Income  6532.94  12464.32  25194.24  20750.14
Operating expenses 10151.28 23071.27 10707.53 11746.17
Contractors   8955.24   13297.38   3885.16   16439.45
Contractors 4438.30 25634.93 15141.67 12475.69",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2dd866c8a7fe7c3ca44bf06a,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2026,fgen-9e2fc75ace69db0fae228fcd,synthetic_programmatic_template,inline,top,False,raw_export
"Income Statement
Riverbend Landscaping
October 2024
Accrual Basis
Income
Sales 598,886.93
Total Income      598,886.93
Cost of Goods Sold      90,710.44
Gross Profit   508,176.49
Expenses  Total
Advertising & Marketing 11,937.76
Contract Labor 36,643.48
Office Supplies  5,145.29
Rent or Lease 43,539.76
Travel   16,860.22
Utilities 5,241.10
Total Expenses   119,367.61
Net Operating Income  388,808.88
Net Income 388,808.88",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e035171f656ac8db92ee7080,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2024,fgen-c389e9783f97c5f756e0088e,synthetic_programmatic_template,inline,top,False,monthly
"Category   Jan   Feb   Mar   YTD
COGS 20878.85 26866.89 19794.82 26192.02
COGS  24152.97  17745.74  16942.46  2733.16
Operating expenses  4899.56  25758.37  2941.21  11028.12
Contractors   4425.10   29673.76   13703.62   8745.49
Contractors   823.87   5441.10   17304.65   25058.23
Operating expenses 9679.09 14832.09 15393.98 10861.89
Service revenue 27430.49 11687.76 22240.96 19582.06
Service revenue 5433.32 2047.73 17852.08 29671.96
Operating expenses  753.89  13638.04  27645.37  19201.85",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ed7ebb62bc112a6486f5eedb,v11-PROFIT_AND_LOSS_STATEMENT-inline,original,2022,fgen-3e91ddaa816a752de943f781,synthetic_programmatic_template,inline,none,False,raw_export
"Income Statement
Maple Street Bakery
June 2021
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
461,774.80
461,774.80
177,563.01
284,211.79
Expenses
Total
Advertising & Marketing
16,187.01
Contract Labor
24,225.56
Insurance
4,934.54
Office Supplies
3,097.27
Rent or Lease
21,713.10
Software Subscriptions
5,364.20
Travel
10,283.82
Utilities
6,178.54
Total Expenses
Net Operating Income
Net Income
91,984.04
192,227.75
192,227.75",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8ffbd446adae712732fa2c98,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2021,fgen-f9473fee4f0b6be061a7acef,synthetic_programmatic_template,columns,top,False,monthly
"Profit & Loss Statement
Bright Pixel Design LLC
January - December 2021
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
54,512.15
54,512.15
21,453.28
33,058.87
Expenses
Total
Advertising & Marketing
1,790.48
Contract Labor
3,278.30
Office Supplies
385.57
Rent or Lease
2,323.71
Travel
1,091.51
Utilities
532.89
Total Expenses
Net Operating Income
Net Income
9,402.46
23,656.41
23,656.41",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-dc108d40b81aa29aea0fdd93,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2021,fgen-a8dff6ab30a2228818c666c8,synthetic_programmatic_template,columns,top,False,annual
"Category
Jan
Feb
Mar
YTD
Income
15984.45
22840.06
13612.97
3825.07
Net operating income
17693.76
25365.00
4240.83
11177.24
COGS
21179.83
27824.26
24461.82
5138.32
Service revenue
20872.78
7618.73
21981.82
14558.07
Net operating income
20448.58
23616.41
19354.56
23170.59",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-58890d35d691d26eef459f42,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2021,fgen-7cb39845b8196fd6bb8e1e61,synthetic_programmatic_template,columns,top,False,raw_export
"Profit & Loss Statement
Bright Pixel Design LLC
March 2023
Accrual Basis
Income
Sales
Total Income
Cost of Goods 5old
Gross Profit
363,415.57
363,415.57
88,158.89
275,256.68
Expenses
Total
Advertising & Marketing
5,978.77
Insurance
8,166.14
Rent or Lease
21,686.51
5oftware Subscriptions
4,639.59
Travel
8,516.51
Utilities
2,385.41
Total Expenses
Net 0peratíng Incomc
NetIncome
51,372.93
223,883.75
223,883.75",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-466cb10cc366543f5783ed7e,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2023,fgen-103d574af89a4cf08a9f1f20,synthetic_programmatic_template,columns,top,True,monthly
"Income Statement
Riverbend Landscaping
October 2024
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
239,692.66
239,692.66
107,587.76
132,104.90
Expenses
Total
Advertising & Marketing
7,574.12
Contract Labor
17,537.52
Rent or Lease
16,853.23
Software Subscriptions
2,882.59
Travel
6,451.94
Utilities
2,040.51
Total Expenses
Net Operating Income
Net Income
53,339.91
78,764.99
78,764.99",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1f892d149198b1a2ea7fdf99,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-59e6d36841816d5573645ef9,synthetic_programmatic_template,columns,top,False,monthly
"Profit and Loss
Copperline Consulting
January - December 2025
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
218,143.67
218,143.67
62,102.97
156,040.70
Expenses
Total
Advertising & Marketing
5,070.72
Contract Labor
12,011.03
Office Supplies
3,159.99
Rent or Lease
16,857.31
Software Subscriptions
2,344.66
Travel
3,262.36
Utilities
1,551.21
Total Expenses
Net Operating Income
Net Income
44,257.28
111,783.42
111,783.42",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-22a8fff506214183878ae1d1,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2025,fgen-760eb53e1bcdffbe300e8959,synthetic_programmatic_template,columns,top,False,annual
"Account
Q1
Q2
Q3
Q4
Total
Total Revenue
74807.20
20316.57
81101.48
10519.65
21759.69
Payroll Expenses
22721.43
73544.89
22273.45
16186.83
9891.87
Net Income
75613.49
58969.64
15622.84
56888.63
12747.77
Net Income
54427.67
60383.14
73609.52
36929.75
30352.84
Rent
81669.54
89803.49
11957.56
10191.68
41935.39
Net Income
62013.50
44495.40
24413.37
79005.70
44968.83
Sales
47838.41
17196.23
49848.53
83341.33
6731.31",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1ef126b7f4bf1d0e7f6df54b,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-fd75d244baeb6a334903b71e,synthetic_programmatic_template,columns,top,False,raw_export
"Category
Jan
Feb
Mar
YTD
Contractors
29015.41
22403.77
13959.06
24542.70
Operating expenses
1536.37
26956.91
21732.24
7639.69
Contractors
24478.96
10048.92
10752.25
23581.66
Contractors
6248.13
1815.21
17252.19
6669.54
Service revenue
28470.52
5400.90
8903.58
25105.79
Bright Pixel Design LLC - Profit and Loss - 2022",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8a26897d4fa8d5f8c038ca2e,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2022,fgen-5c32744a0fc5dc6cbd836426,synthetic_programmatic_template,columns,bottom,False,raw_export
"Maple Street Bakery
January - December 2024
Cash Basis
Incomc
Sales
Total Income
Cost of Goods Sold
Gross Profit
418,857.72
418,857.72
153,001.14
265,856.58
Expenses
Total
Contract Labor
16,815.46
Insurance
6,555.22
OfficeSupplies
4,426.67
Software Subscríptions
3,547.55
Utilitics
5,738.44
Total Expenses
Net Operating Income
Net Income
37,083.34
228,773.24
228,773.24",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f66d52f210b9ea6e8663cbc1,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-73c93bbfc8d4f3278e062534,synthetic_programmatic_template,columns,none,True,cash_basis
"Profit and Loss
Riverbend Landscaping
June 2024
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
68,414.87
68,414.87
13,583.17
54,831.69
Expenses
Total
Insurance
1,918.94
Office Supplies
816.92
Rent or Lease
2,714.66
Software Subscriptions
905.35
Travel
1,030.33
Utilities
878.23
Total Expenses
Net Operating Income
Net Income
8,264.43
46,567.26
46,567.26",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4ff15a174c3a8a899d68c716,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-5d3e30f6ccaa18982795ea02,synthetic_programmatic_template,columns,top,False,monthly
"Copperline Consulting
January - December 2023
Cash Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
549,167.68
549,167.68
58,966.61
490,201.07
Expenses
Total
Contract Labor
51,072.10
Insurance
5,741.23
Office Supplies
6,557.34
Rent or Lease
28,051.55
Software Subscriptions
5,383.96
Total Expenses
Net Operating Income
Net Income
96,806.18
393,394.89
393,394.89
Profit & Loss Statement",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0997d1944cab5e4a520179ca,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2023,fgen-ec662d9206aee15637730d56,synthetic_programmatic_template,columns,bottom,False,cash_basis
"Riverbend Landscaping
January - December 2022
Cash Basis
Income
5ales
Total Incomc
Cost of GoodsSold
Gross Profit
286,164.85
286,164.85
28,646.17
257,518.68
Expenses
Total
Insurance
3,163.53
Office Supplies
2,372.59
Software Subscriptions
1,433.84
Trave1
6,642.63
Utilities
3,6O6.63
Total Expenses
Net 0perating Income
Net Income
l7,219.22
240,299.46
240,299.46
Profit & Loss Statement",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-52f0024d5544a05bc7ed5114,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2022,fgen-04bce7ac6ec2a7212cb46850,synthetic_programmatic_template,columns,bottom,True,cash_basis
"Profit & Loss Statement
Riverbend Landscaping
March 2024
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
549,903.68
549,903.68
85,387.62
464,516.06
Expenses
Total
Advertising & Marketing
12,459.56
Contract Labor
56,337.51
Office Supplies
4,891.19
Rent or Lease
31,319.26
Software Subscriptions
3,392.31
Travel
15,989.53
Total Expenses
Net Operating Income
Net Income
124,389.36
340,126.70
340,126.70",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1e4e95e03c7da209b4f5b0a9,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-7a62a7315c7cf6d9ec148443,synthetic_programmatic_template,columns,top,False,monthly
"Profit & Loss Statement
Bright Pixel Design LLC
January - December 2024
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
239,920.36
239,920.36
38,797.41
201,122.95
Expenses
Total
Advertising & Marketing
4,202.78
Contract Labor
10,379.67
Office Supplies
3,135.44
Rent or Lease
15,303.05
Software Subscriptions
1,402.46
Travel
6,182.09
Utilities
1,981.52
Total Expenses
Net Operating Income
Net Income
42,587.01
158,535.94
158,535.94",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2cd2bdfb169b282faad07bf9,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-d06d9f5c3c028a4681703a47,synthetic_programmatic_template,columns,top,False,annual
"Profit & Loss Statement
Maple Street Bakery
March 2025
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
419,019.00
419,019.00
161,402.50
257,616.50
Expenses
Total
Advertising & Marketing
16,475.71
Insurance
4,395.56
Office Supplies
2,159.19
Rent or Lease
31,347.90
Software Subscriptions
5,559.76
Utilities
2,753.45
Total Expenses
Net Operating Income
Net Income
62,691.57
194,924.93
194,924.93",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-de47a797b6e4e54d58f8cb4c,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2025,fgen-9977fc1c078f4ee83567b3a5,synthetic_programmatic_template,columns,top,False,monthly
"Income Statement
Maple Street Bakery
January - December 2021
Cash Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
387,668.21
387,668.21
148,432.55
239,235.66
Expenses
Total
Advertising & Marketing
8,897.96
Insurance
6,350.54
Office Supplies
2,367.47
Rent or Lease
21,419.95
Software Subscriptions
4,553.94
Travel
4,667.43
Utilities
3,352.49
Total Expenses
Net Operating Income
Net Income
51,609.78
187,625.88
187,625.88",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2a501017cf2a6f452175e978,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2021,fgen-146af40e80be64cc027f4d53,synthetic_programmatic_template,columns,top,False,cash_basis
"Profit and Loss
Maple Street Bakery
January - December 2023
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
282,792.88
282,792.88
87,623.38
195,169.49
Expenses
Total
Advertising & Marketing
6,403.02
Contract Labor
28,841.52
Insurance
7,299.49
Office Supplies
1,702.28
Rent or Lease
8,694.79
Software Subscriptions
1,963.37
Travel
4,936.64
Utilities
2,684.87
Total Expenses
Net Operating Income
Net Income
62,525.98
132,643.51
132,643.51",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f8c0bbb7b3beea7da12e71c6,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2023,fgen-d45fff36a934573d5ee75a0f,synthetic_programmatic_template,columns,top,False,annual
"Maple Street Bakery
January - December 2024
Cash Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
441,446.30
441,446.30
63,659.61
377,786.69
Expenses
Total
Advertising & Marketing
17,025.90
Contract Labor
46,838.96
Rent or Lease
16,006.95
Travel
9,782.09
Total Expenses
Net Operating Income
Net Income
89,653.90
288,132.79
288,132.79",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-947984432e43fc12110dc9e8,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-80ebf483a51ea573e9dd540a,synthetic_programmatic_template,columns,none,False,cash_basis
"Category
Jan
Feb
Mar
YTD
Operating expenses
23071.06
25553.03
17197.88
8818.10
Service revenue
5061.30
11897.67
11710.78
922.89
Income
279.92
17220.47
9821.52
23276.19
Service revenue
15895.35
971.10
25554.04
25975.96",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ddab4a68805f346230ad747c,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2022,fgen-b71beb024ec566c691c6fe7c,synthetic_programmatic_template,columns,top,False,raw_export
"Bright Pixel Design LLC
January - December 2022
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
161,893.40
161,893.40
32,152.24
129,741.15
Expenses
Total
Insurance
3,858.12
Rent or Lease
9,530.55
Software Subscriptions
2,327.34
Utilities
1,015.58
Total Expenses
Net Operating Income
Net Income
16,731.59
113,009.56
113,009.56
Income Statement",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-d2418b220a30ba9e1427eb98,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2022,fgen-aeb575fb59cecff9e38810c2,synthetic_programmatic_template,columns,bottom,False,annual
"Bright Pixel Design LLC
October 2026
Accrual Basís
Income
Sales
Total Income
Cost of Goods Sold
Gross Profít
247,368.23
247,368.23
93,692.31
153,675.92
Expenses
Total
Advertising & Marketing
8,658.54
Insurance
6,192.76
Office 5upplies
2,943.04
Rent or Lease
15,985.49
5oftware Subscriptions
3,687.65
Trave1
4,777.30
Utilities
1,340.36
Total Expenses
Net OperatingIncome
Net Income
43,585.14
11O,090.78
110,090.78
Income Statement",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8a7cc491cf072ec97819f275,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2026,fgen-e0fd965776694b59c31f09e7,synthetic_programmatic_template,columns,bottom,True,monthly
"Profit and Loss
Bright Pixel Design LLC
January - December 2025
Cash Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
260,895.79
260,895.79
65,812.37
195,083.42
Expenses
Total
Advertising & Marketing
4,731.73
Contract Labor
19,495.73
Insurance
5,528.18
Office Supplies
2,114.61
Rent or Lease
7,949.73
Software Subscriptions
3,794.61
Total Expenses
Net Operating Income
Net Income
43,614.59
151,468.83
151,468.83",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-41acb15b86d789421db42635,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2025,fgen-4b7c3434037d8fef465e073c,synthetic_programmatic_template,columns,top,False,cash_basis
"Income statement by month
Account
Q1
Q2
Q3
Q4
Total
Sales
19555.62
16113.53
40672.73
30962.83
88277.14
Payroll Expenses
53502.73
7426.58
2897.23
49701.63
55146.13
Gross Profit
29129.39
58891.90
77187.68
88403.74
86520.47
Gross Profit
22629.44
28772.38
57499.83
40868.93
18349.38
Marketing
83680.46
66291.40
82250.25
62585.65
64864.54",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-a7aedb7874a6b28ad21d1a41,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2022,fgen-44a4f35c389859022c2d8901,synthetic_programmatic_template,columns,top,False,raw_export
"Profit & Loss Statement
Bright Pixel Design LLC
January - December 2023
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
461,883.04
461,883.04
108,607.76
353,275.28
Expenses
Total
Contract Labor
48,592.27
Insurance
8,682.58
Office Supplies
3,679.95
Rent or Lease
28,586.53
Software Subscriptions
4,850.83
Travel
4,684.79
Utilities
5,032.87
Total Expenses
Net Operating Income
Net Income
104,109.82
249,165.46
249,165.46",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e05f1f3929f6eb49a6097a28,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2023,fgen-72a68a5f1212f711cc98da32,synthetic_programmatic_template,columns,top,False,annual
"Income Statement
Riverbend Landscaping
January - December 2026
Accrual Basis
Income
Sales
Total Income
Cost of Goods 5old
Gross Profit
196,407.43
196,407.43
91,180.28
105,227.15
Expenses
Total
Advertísing & Marketing
4,935.54
Contract Labor
13,440.06
Insurance
4,103.63
Office 5upplies
983.05
Rentor Lease
7,115.01
Travel
4,023.48
Utilities
1,835.87
Total Expenses
Net Operating Income
Net Income
36,436.64
68,790.51
68,790.51",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f340b7b798ff1230390180e2,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2026,fgen-21faa1313babc11b6f7e411a,synthetic_programmatic_template,columns,top,True,annual
"Profit & Loss Statement
Bright Pixel Design LLC
January - December 2024
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
204,835.67
204,835.67
90,229.80
114,605.87
Expenses
Total
Advertising & Marketing
5,246.53
Insurance
3,500.16
Office Supplies
2,724.16
Rent or Lease
8,692.30
Software Subscriptions
1,463.88
Travel
4,258.41
Utilities
2,137.28
Total Expenses
Net Operating Income
Net Income
28,022.72
86,583.15
86,583.15",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4a5d7ebf1e430c2c743d6679,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2024,fgen-d5134c1ecf24af7610b14039,synthetic_programmatic_template,columns,top,False,annual
"Profit & Loss Statement
Riverbend Landscaping
January - December 2022
Cash Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
170,050.68
170,050.68
69,436.16
100,614.53
Expenses
Total
Advertising & Marketing
3,521.34
Contract Labor
13,662.31
Office Supplies
2,229.66
Rent or Lease
8,382.09
Software Subscriptions
2,352.31
Travel
4,459.20
Utilities
1,842.40
Total Expenses
Net Operating Income
Net Income
36,449.31
64,165.22
64,165.22",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2f7670777ae064dd6f37cca6,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2022,fgen-5dcd1cf79a6bb09cedbf5985,synthetic_programmatic_template,columns,top,False,cash_basis
"Account
Q1
Q2
Q3
Q4
Total
Rent
46710.96
7199.07
65967.38
38222.28
4394.59
Total Revenue
46568.54
15868.13
36385.27
75952.28
26236.92
Payroll Expenses
53118.33
5754.59
82274.46
51982.O9
18732.42
Costof Goods Sold
33243.44
6773.43
88957.81
26332.21
75588.45",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0f1b3a0fb8e6a73548960b72,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2025,fgen-a1f6d01cd33681697f241ede,synthetic_programmatic_template,columns,top,True,raw_export
"Profit and Loss
Copperline Consulting
January - December 2023
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
359,173.37
359,173.37
172,692.40
186,480.97
Expenses
Total
Advertising & Marketing
13,532.31
Contract Labor
37,385.82
Office Supplies
1,851.59
Rent or Lease
26,516.78
Travel
8,729.19
Utilities
1,828.60
Total Expenses
Net Operating Income
Net Income
89,844.29
96,636.68
96,636.68",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ddb1775f600650169fef389c,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2023,fgen-ce6ce3daf401d2be0c9d116a,synthetic_programmatic_template,columns,top,False,annual
"Profit & Loss Statement
Bright Pixel Design LLC
January - December 2022
Accrual Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
361,274.21
361,274.21
45,823.01
315,451.20
Expenses
Total
Advertising & Marketing
15,722.07
Contract Labor
15,832.44
Insurance
3,696.04
Rent or Lease
17,278.36
Software Subscriptions
4,744.66
Travel
5,858.68
Utilities
2,975.60
Total Expenses
Net Operating Income
Net Income
66,107.85
249,343.35
249,343.35",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-6fbe91e28411bbfc1bd49dba,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2022,fgen-3bfac29a3c3877645cb3c30b,synthetic_programmatic_template,columns,top,False,annual
"Copperline Consulting
January - December 2021
Cash Basis
Income
Sales
Total Income
Cost of Goods Sold
Gross Profit
336,938.91
336,938.91
149,964.26
186,974.65
Expenses
Total
Advertising & Marketing
11,220.22
Contract Labor
21,614.45
Insurance
7,789.85
Office Supplies
2,483.73
Rent or Lease
20,475.53
Software Subscriptions
4,056.57
Travel
7,610.90
Utilities
5,025.60
Total Expenses
Net Operating Income
Net Income
80,276.85
106,697.80
106,697.80",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-9a5930e885b178490331102f,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2021,fgen-1b3288f5ac2c28a3ff96247e,synthetic_programmatic_template,columns,none,False,cash_basis
"Downloaded 2021-02-20
Account
Q1
Q2
Q3
Q4
Total
Cost of Goods Sold
9322.45
20148.16
15596.85
89068.45
64021.68
Payroll Expenses
78354.51
30790.12
84463.10
27746.75
67289.06
Marketing
24845.65
26463.61
6197.94
62834.59
49481.18
Gross Profit
80261.37
59788.48
14645.44
66396.32
12580.70
Net Income
58512.32
7286.48
44715.44
60864.90
70155.14
Gross Profit
67565.52
15549.94
69694.38
7901.22
64618.63
Gross Profit
48344.70
44239.41
3486.24
81347.27
18891.04
Total Revenue
37394.47
40750.38
38560.67
58459.40
78659.32
Total Revenue
41341.39
40760.05
41384.68
51513.18
55814.47
P&L Summary 2021",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8354547fb674380fb7818d22,v11-PROFIT_AND_LOSS_STATEMENT-columns,original,2021,fgen-6ab3650e36fc19ebd3349794,synthetic_programmatic_template,columns,bottom,False,raw_export
"Profit and Loss
Riverbend Landscaping
January - December 2021
Cash Basis
Income
Sales,""89,341.70""
Total Income,""89,341.70""
Cost of Goods Sold,""36,766.40""
Gross Profit,""52,575.29""
Expenses,Total
Advertising & Marketing,""1,792.09""
Contract Labor,""9,883.08""
Insurance,""1,603.22""
Office Supplies,823.89
Travel,""2,546.16""
Utilities,653.81
Total Expenses,""17,302.25""
Net Operating Income,""35,273.04""
Net Income,""35,273.04""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-025c20a1f6a9906442722551,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2021,fgen-ae516fb85729b1f4ba0e11df,synthetic_programmatic_template,csv,top,False,cash_basis
"Bright Pixel Design LLC
June 2023
Accrual Basis
Income
Sales,""502,918.22""
Total Income,""502,918.22""
Cost of Goods Sold,""156,902.11""
Gross Profit,""346,016.10""
Expenses,Total
Advertising & Marketing,""21,554.61""
Insurance,""7,508.42""
Office Supplies,""6,352.01""
Rent or Lease,""33,684.60""
Travel,""14,856.00""
Utilities,""5,322.16""
Total Expenses,""89,277.80""
Net Operating Income,""256,738.30""
Net Income,""256,738.30""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4c177f498e4cf48b805af619,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2023,fgen-09353035f86e34aeb58ec43f,synthetic_programmatic_template,csv,none,False,monthly
"Profit & Loss Statement
Bright Pixel Design LLC
January - December 2022
Cash Basis
Income
Sales,""525,561.04""
Total Income,""525,561.04""
Cost of Goods Sold,""104,704.47""
Gross Profit,""420,856.57""
Expenses,Total
Advertising & Marketing,""11,915.37""
Contract Labor,""21,203.84""
Office Supplies,""6,341.64""
Software Subscriptions,""7,186.61""
Travel,""5,526.71""
Utilities,""2,864.80""
Total Expenses,""55,038.97""
Net Operating Income,""365,817.60""
Net Income,""365,817.60""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4a259fde37402b5b5b99e2b1,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-6dcfa2b6b0db4f7d92f971a0,synthetic_programmatic_template,csv,top,False,cash_basis
"Account,Q1,Q2,Q3,Q4,Total
Total Revenue,33017.36,86082.78,19817.46,67299.58,74985.98
Sales,10219.50,14974.45,48904.85,39808.97,4669.76
Payroll Expenses,65297.05,75222.74,72910.42,44937.62,19096.08
5ales,62282.71,87147.46,79645.48,23263.77,66063.68
Rent,52073.99,16500.53,31959.36,75591.55,57711.42
Net Income,36285.92,20101.78,75351.26,63690.27,89240.43
Cost of GoodsSold,20584.56,22800.85,64288.58,75014.18,23928.92
Payroll Expenses,81422.49,51322.02,81209.80,40479.18,48203.49",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-d79addba93ea5765a98b7c7f,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2024,fgen-cb0d92fa1935158bdc303c85,synthetic_programmatic_template,csv,none,True,raw_export
"Category,Jan,Feb,Mar,YTD
Income,20837.52,21413.34,14375.99,2116.36
COGS,1493.24,11399.41,1606.08,13812.26
Software,29649.54,25358.61,4332.74,2514.21",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-cb831a199fefca548243c592,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2021,fgen-ee8a7dd05748cff8adb48219,synthetic_programmatic_template,csv,top,False,raw_export
"Income Statement
Copperline Consulting
January - December 2021
Cash Basis
Income
Sales,""22,507.94""
Total Income,""22,507.94""
Cost of Goods Sold,""9,597.21""
Gross Profit,""12,910.74""
Expenses,Total
Advertising & Marketing,912.85
Contract Labor,""1,268.42""
Insurance,662.45
Office Supplies,268.07
Rent or Lease,""1,151.56""
Software Subscriptions,297.20
Travel,301.55
Utilities,166.14
Total Expenses,""5,028.24""
Net Operating Income,""7,882.50""
Net Income,""7,882.50""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-3d2df8d6b9bfc276cb6dc849,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2021,fgen-095b544d9af25d12d0b1688b,synthetic_programmatic_template,csv,top,False,cash_basis
"Profit & Loss Statement
Maple Street Bakery
January - December 2023
Cash Basis
Income
Sales,""147,982.35""
Total Income,""147,982.35""
Cost of Goods Sold,""47,532.81""
Gross Profit,""100,449.55""
Expenses,Total
Advertising & Marketing,""6,546.64""
Contract Labor,""6,253.74""
Rent or Lease,""6,094.71""
Travel,""2,905.74""
Utilities,""1,305.68""
Total Expenses,""23,106.51""
Net Operating Income,""77,343.04""
Net Income,""77,343.04""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-859ead6cadf767876123a1e4,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2023,fgen-e04a85119a8a523994b14752,synthetic_programmatic_template,csv,top,False,cash_basis
"Profit and Loss
Bright Pixel Design LLC
March 2026
Accrual Basis
Income
Sales,""193,039.89""
Total Income,""193,039.89""
Cost of Goods Sold,""60,448.14""
Gross Profit,""132,591.75""
Expenses,Total
Advertising & Marketing,""3,627.54""
Insurance,""3,944.46""
Office Supplies,""1,739.81""
Rent or Lease,""9,547.49""
Software Subscriptions,""2,655.12""
Travel,""4,942.96""
Utilities,""2,706.25""
Total Expenses,""29,163.63""
Net Operating Income,""103,428.12""
Net Income,""103,428.12""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8eaec26f0acb99a2c95837a1,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2026,fgen-49584ed6ad7222a2dad45b46,synthetic_programmatic_template,csv,top,False,monthly
"Income Statement
Maple Street Bakery
January - December 2022
Accrual Basis
Income
Sales,""155,548.52""
Total Income,""155,548.52""
Cost of Goods Sold,""16,087.53""
Gross Profit,""139,461.00""
Expenses,Total
Advertising & Marketing,""6,479.29""
Contract Labor,""7,474.87""
Insurance,""3,847.97""
Office Supplies,""1,731.91""
Rent or Lease,""8,116.05""
Software Subscriptions,""2,257.84""
Travel,""3,730.64""
Utilities,""1,678.60""
Total Expenses,""35,317.17""
Net Operating Income,""104,143.83""
Net Income,""104,143.83""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-3ab46644587aadd1475ceee5,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-dd4cee9e2c633ab82e464297,synthetic_programmatic_template,csv,top,False,annual
"Profit and Loss
Riverbend Landscaping
January - December 2021
Cash Basis
Income
Sales,""511,112.20""
Total Income,""511,112.20""
Cost of Goods Sold,""249,560.66""
Gross Profit,""261,551.54""
Expenses,Total
Advertising & Marketing,""17,501.51""
Contract Labor,""51,414.43""
Insurance,""6,819.68""
Office Supplies,""2,901.79""
Rent or Lease,""17,002.01""
Software Subscriptions,""2,852.00""
Travel,""9,925.72""
Utilities,""5,401.78""
Total Expenses,""113,818.92""
Net Operating Income,""147,732.62""
Net Income,""147,732.62""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e14e8ea05bbd44a2e2f0c702,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2021,fgen-729d13eaf3f64237a50a64c8,synthetic_programmatic_template,csv,top,False,cash_basis
"Riverbend Landscaping - Profit and Loss - 2024
Account,Q1,Q2,Q3,Q4,Total
Net Income,31973.10,82926.84,16140.34,18892.56,9999.79
Marketing,72574.38,89027.51,30336.22,69982.92,15369.23
Marketing,80121.84,7446.32,25895.64,87515.04,3261.07
Rent,27111.86,24778.22,14620.55,27774.29,24222.11
Payroll Expenses,48880.30,3761.59,53043.74,79923.78,77683.30
Net Income,24062.75,70374.19,71080.85,50345.86,58264.76
Sales,17299.31,50504.44,63067.23,45289.28,20037.47
Total Revenue,40130.20,51831.57,70165.35,4609.79,19283.14",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-04a0bbffd0572ea48eea7e7a,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2024,fgen-71f754660dcf42e1cb0bdcf1,synthetic_programmatic_template,csv,top,False,raw_export
"Profit and Loss
Bright Pixel Design LLC
January - December 2023
Accrual Basis
Income
Sales,""110,210.77""
Total Income,""110,210.77""
Cost of Goods Sold,""25,994.36""
Gross Profit,""84,216.41""
Expenses,Total
Advertising & Marketing,""3,456.57""
Contract Labor,""8,747.74""
Insurance,""1,802.75""
Office Supplies,579.13
Rent or Lease,""6,247.46""
Software Subscriptions,""1,365.09""
Travel,""3,303.69""
Total Expenses,""25,502.43""
Net Operating Income,""58,713.98""
Net Income,""58,713.98""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-19089994cb2fc7bbcaf43409,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2023,fgen-6f1286d33b016b960316fc4a,synthetic_programmatic_template,csv,top,False,annual
"Profit and Loss
Bright Pixel Design LLC
January - December 2022
Cash Basis
Income
Sales,""445,851.73""
Total Income,""445,851.73""
Cost of Goods Sold,""53,896.70""
Gross Profit,""391,955.03""
Expenses,Total
Advertising & Marketing,""7,395.37""
Contract Labor,""24,719.10""
Rent or Lease,""13,511.61""
Travel,""12,969.21""
Total Expenses,""58,595.29""
Net Operating Income,""333,359.74""
Net Income,""333,359.74""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-a802ced243b2471d75970ccd,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-76a4845f175981aba3fe6555,synthetic_programmatic_template,csv,top,False,cash_basis
"Profit and Loss
Bright Pixel Design LLC
March 2023
Accrual Basis
Income
Sales,""531,045.14""
Total Income,""531,045.14""
Cost of Goods Sold,""205,686.41""
Gross Profít,""325,358.73""
Expenses,Total
Advertising & Marketing,""8,384.51""
Contract Labor,""51,948.33""
Insurance,""15,323.23""
Office Supp1ies,""5,757.21""
Software Subscriptions,""7,524.45""
Utilities,""7,574.26""
TotalExpenses,""96,511.99""
Net Operating Income,""228,846.74""
Net Income,""228,846.74""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e896742427eaeb3416dc508c,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2023,fgen-27f301d05cd57d21b8d9b3e7,synthetic_programmatic_template,csv,top,True,monthly
"Income Statement
Copperline Consulting
October 2021
Accrual Basis
Income
Sales,""110,236.81""
Total Income,""110,236.81""
Cost of Goods Sold,""31,538.37""
Gross Profit,""78,698.44""
Expenses,Total
Contract Labor,""10,681.77""
Insurance,""1,574.10""
Office Supplies,990.41
Rent or Lease,""9,694.78""
Software Subscriptions,""1,257.94""
Travel,""2,284.08""
Utilities,""1,267.60""
Total Expenses,""27,750.68""
Net Operating Income,""50,947.76""
Net Income,""50,947.76""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-fda55656da9078f076e496ef,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2021,fgen-1502e6fc9faba55e8acfaf85,synthetic_programmatic_template,csv,top,False,monthly
"Profit and Loss
Copperline Consulting
January - December 2024
Accrual Basis
Income
Sales,""103,368.23""
Total Income,""103,368.23""
Cost of Goods Sold,""46,166.11""
Gross Profit,""57,202.13""
Expenses,Total
Advertising & Marketing,""1,872.40""
Contract Labor,""6,567.47""
Office Supplies,""1,207.42""
Rent or Lease,""3,364.39""
Software Subscriptions,829.34
Utilities,""1,385.79""
Total Expenses,""15,226.81""
Net Operating Income,""41,975.32""
Net Income,""41,975.32""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-9eec89f2ef698a26269d6141,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2024,fgen-2d2c650c2e7d3f7d0ae863bc,synthetic_programmatic_template,csv,top,False,annual
"Income Statement
Riverbend Landscaping
March 2025
Accrual Basis
Income
Sales,""152,192.21""
Total Income,""152,192.21""
Cost of Goods Sold,""46,694.91""
Gross Profit,""105,497.30""
Expenses,Total
Contract Labor,""7,039.20""
Insurance,""3,404.04""
Office Supplies,""1,907.14""
Rent or Lease,""11,799.78""
Software Subscriptions,""1,628.98""
Travel,""2,518.14""
Utilities,""1,725.68""
Total Expenses,""30,022.96""
Net Operating Income,""75,474.34""
Net Income,""75,474.34""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-84d4f7a4b10944ad783b7683,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2025,fgen-c054f5e2df0bfdd1035080a4,synthetic_programmatic_template,csv,top,False,monthly
"Riverbend Landscaping
January - December 2022
Accrual Basis
Income
Sales,""568,572.51""
Total Income,""568,572.51""
Cost of Goods Sold,""209,015.74""
Gross Profit,""359,556.77""
Expenses,Total
Advertising & Marketing,""24,330.70""
Insurance,""11,968.53""
Office Supplies,""8,318.95""
Rent or Lease,""47,682.46""
Software Subscriptions,""4,107.41""
Travel,""16,175.20""
Utilities,""4,373.45""
Total Expenses,""116,956.70""
Net Operating Income,""242,600.07""
Net Income,""242,600.07""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2f7076036f9bb84be3042379,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-a8d65d92ed8e2178cdcf0176,synthetic_programmatic_template,csv,none,False,annual
"Income Statement
Maple Street Bakery
January - December 2022
Cash Basis
Income
Sales,""331,220.48""
Total Income,""331,220.48""
Cost of Goods Sold,""161,886.07""
Gross Profit,""169,334.41""
Expenses,Total
Advertising & Marketing,""7,260.02""
Insurance,""5,321.74""
Office Supplies,""3,502.74""
Rent or Lease,""28,677.90""
Software Subscriptions,""3,633.04""
Travel,""5,347.30""
Utilities,""3,729.37""
Total Expenses,""57,472.11""
Net Operating Income,""111,862.30""
Net Income,""111,862.30""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-86d102d96ffaa44d4f025bc3,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-9c6e958f6493ab4509e0b120,synthetic_programmatic_template,csv,top,False,cash_basis
"Copperline Consulting
June 2021
Accrual Basis
Income
Sales,""456,502.98""
Total Income,""456,502.98""
Cost of Goods Sold,""210,158.68""
Gross Profit,""246,344.29""
Expenses,Total
Contract Labor,""38,269.98""
Insurance,""7,342.22""
Office Supplies,""5,669.57""
Rent or Lease,""37,633.28""
Software Subscriptions,""5,034.48""
Travel,""9,729.22""
Utilities,""2,903.96""
Total Expenses,""106,582.71""
Net Operating Income,""139,761.58""
Net Income,""139,761.58""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-b7a63ea70dfc1122fee25740,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2021,fgen-b8aa5cf6556080c5458e074f,synthetic_programmatic_template,csv,none,False,monthly
"Riverbend Landscaping
March 2023
Accrual Basis
Income
Sales,""481,502.08""
Total Income,""481,502.08""
Cost of Goods Sold,""90,161.24""
Gross Profit,""391,340.83""
Expenses,Total
Advertising & Marketing,""19,738.86""
Contract Labor,""26,296.98""
Insurance,""6,837.51""
Office Supplies,""4,737.61""
Software Subscriptions,""6,235.59""
Utilities,""6,350.61""
Total Expenses,""70,197.16""
Net Operating Income,""321,143.67""
Net Income,""321,143.67""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-7dc53668dbc85b4c86cd6be9,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2023,fgen-bf79ecd4cc1104b644b7a58a,synthetic_programmatic_template,csv,none,False,monthly
"Income Statement
Maple Street Bakery
January - December 2024
Accrual Basis
Income
Sales,""256,297.03""
Total Income,""256,297.03""
Cost of Goods Sold,""31,382.70""
Gross Profit,""224,914.33""
Expcnses,Total
Advertising & Marketing,""10,504.03""
Contract Labor,""13,657.23""
Insurance,""5,691.3O""
Office Supp1ies,""3,401.42""
Rcnt or Lease,""15,343.76""
SoftwareSubscriptions,""2,577.75""
Utilities,""1,958.85""
Total Expenses,""53,134.34""
Net 0perating Income,""171,779.99""
Net Income,""171,779.99""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1450a3104a9e7dd734a716fe,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2024,fgen-25a393f8f7868bdd14df6899,synthetic_programmatic_template,csv,top,True,annual
"Income Statement
Riverbend Landscaping
January - December 2O22
Accrual Basis
Income
Sales,""584,787.11""
Total Incomc,""584,787.11""
Cost of Goods So1d,""233,800.41""
Gross Profit,""350,986.70""
Expenses,Total
Advertising & Marketing,""22,309.84""
Contract Labor,""55,479.86""
Insurance,""16,062.25""
Office 5upplies,""5,827.04""
Rent or Lease,""41,365.66""
Software Subscríptions,""6,693.35""
Trave1,""11,240.30""
Utilities,""4,925.02""
Tota1 Expenses,""163,903.32""
Net Operating Income,""187,083.38""
NetIncome,""187,083.38""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-290b7b4ac02316650d91319e,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-506c26407b66f21531f896e2,synthetic_programmatic_template,csv,top,True,annual
"Riverbend Landscaping
March 2022
Accrual Basis
Income
Sales,""28,967.28""
Total Income,""28,967.28""
Cost of Goods Sold,""9,105.93""
Gross Profit,""19,861.35""
Expenses,Total
Advertising & Marketing,918.76
Contract Labor,""3,300.09""
Insurance,513.19
Office Supplies,153.25
Software Subscriptions,258.54
Travel,669.60
Utilities,232.01
Total Expenses,""6,045.44""
Net Operating Income,""13,815.91""
Net Income,""13,815.91""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-4b12410c4bc70a60d5608464,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-2ee1eb4206c98987beb70b07,synthetic_programmatic_template,csv,none,False,monthly
"Income Statement
Bright Pixel Design LLC
June 2023
Accrual Basis
Income
Sales,""68,622.92""
Total Income,""68,622.92""
Cost of Goods Sold,""18,892.88""
Gross Profit,""49,730.03""
Expenses,Total
Advertising & Marketing,""1,110.79""
Contract Labor,""3,388.91""
Office Supplies,641.02
Rent or Lease,""2,696.37""
Software Subscriptions,762.51
Travel,""1,193.64""
Utilities,899.04
Total Expenses,""10,692.28""
Net Operating Income,""39,037.75""
Net Income,""39,037.75""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ad1ec0f6aacf9d1963dae53d,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2023,fgen-36d9d4990b2b817a088451a4,synthetic_programmatic_template,csv,top,False,monthly
"Profit & Loss Statement
Maple Street Bakery
January - December 2022
Cash Basis
Income
Sales,""527,566.18""
Total Income,""527,566.18""
Cost of Goods Sold,""65,579.44""
Gross Profit,""461,986.74""
Expenses,Total
Insurance,""9,752.32""
Office Supplies,""3,534.67""
Rent or Lease,""47,248.74""
Software Subscriptions,""5,029.30""
Travel,""15,558.79""
Utilities,""7,629.82""
Total Expenses,""88,753.64""
Net Operating Income,""373,233.10""
Net Income,""373,233.10""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-7557833e383a8d00ccc76a9f,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2022,fgen-01c7866c0129d746e39f359c,synthetic_programmatic_template,csv,top,False,cash_basis
"Profit & Loss Statement
Copperline Consulting
January - December 2026
Accrual Basis
Income
Sales,""181,681.85""
Total Income,""181,681.85""
Cost of Goods Sold,""45,217.76""
Gross Profit,""136,464.09""
Expenses,Total
Advertising & Marketing,""5,153.33""
Contract Labor,""17,310.66""
Office Supplies,""2,060.28""
Rent or Lease,""5,972.62""
Software Subscriptions,""2,408.57""
Travel,""5,021.99""
Utilities,""1,032.59""
Total Expenses,""38,960.04""
Net Operating Income,""97,504.05""
Net Income,""97,504.05""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2a7f4212e886089de8a393cb,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2026,fgen-77b7493f91891a1500471bc2,synthetic_programmatic_template,csv,top,False,annual
"Downloaded 05/03/2021
Category,Jan,Feb,Mar,YTD
Netoperating income,25825.54,17470.17,2433.77,12959.94
Opcrating expenses,27685.30,12664.O6,22136.68,7403.63
Service revenue,9201.44,10532.91,11707.74,8086.19
Net operating income,1323.63,17694.97,16059.62,16478.84
Net operating income,23530.03,6527.63,23007.80,13200.13
COGS,9798.20,24863.18,11594.73,27542.07
Operating expenses,2768.92,5965.24,5664.86,4018.47",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-90268e1e54358483345fbb9d,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2021,fgen-58a00733edd7913d8888b08f,synthetic_programmatic_template,csv,top,True,raw_export
"Profit & Loss Statement
Maple Street Bakery
January - December 2025
Cash Basis
Income
Sales,""43,229.66""
Total Income,""43,229.66""
Cost of Goods Sold,""15,723.00""
Gross Profit,""27,506.66""
Expenses,Total
Advertising & Marketing,""1,430.30""
Insurance,551.42
Rent or Lease,""2,682.14""
Software Subscriptions,621.04
Travel,""1,222.24""
Utilities,574.20
Total Expenses,""7,081.34""
Net Operating Income,""20,425.32""
Net Income,""20,425.32""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-aa5c796d21719679c3cec3cc,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2025,fgen-191b193e643859df7a09bae2,synthetic_programmatic_template,csv,top,False,cash_basis
"Bright Pixel Design LLC
January - December 2025
Accrual Basis
Income
Sales,""43,550.62""
Total Income,""43,550.62""
Cost of Goods Sold,""13,086.50""
Gross Profit,""30,464.12""
Expenses,Total
Advertising & Marketing,""1,198.05""
Contract Labor,""2,080.10""
Insurance,749.72
Office Supplies,527.32
Software Subscriptions,312.97
Travel,976.66
Utilities,527.66
Total Expenses,""6,372.48""
Net Operating Income,""24,091.64""
Net Income,""24,091.64""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bba695a46ce7b8c7789287ac,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2025,fgen-a3085842c40d2bf8dfe514c1,synthetic_programmatic_template,csv,none,False,annual
"Income Statement
Bright Pixel Design LLC
January - December 2024
Accrual Basis
Income
Sales,""342,788.21""
Total Income,""342,788.21""
Cost of Goods Sold,""109,101.56""
Gross Profit,""233,686.64""
Expenses,Total
Advertising & Marketing,""5,250.78""
Insurance,""3,655.99""
Software Subscriptions,""1,961.60""
Travel,""6,017.49""
Utilities,""2,458.99""
Total Expenses,""19,344.85""
Net Operating Income,""214,341.79""
Net Income,""214,341.79""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-26fdc5ac6aa2053a817ded3b,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2024,fgen-fcb6d6d22c067331546ee18e,synthetic_programmatic_template,csv,top,False,annual
"Profit & Loss Statement
Copperline Consulting
January - December 2024
Cash Basis
Income
Sales,""171,854.33""
Total Income,""171,854.33""
Cost of Goods Sold,""83,296.39""
Gross Profit,""88,557.95""
Expenses,Total
Insurance,""3,051.18""
Office Supplies,""2,199.22""
Rent or Lease,""8,070.12""
Software Subscriptions,""1,397.82""
Travel,""1,929.51""
Total Expenses,""16,647.85""
Net Operating Income,""71,910.10""
Net Income,""71,910.10""",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-435c9f97d5dd6f6b0c14c3aa,v11-PROFIT_AND_LOSS_STATEMENT-csv,original,2024,fgen-e2573b640842cb5eaf21a493,synthetic_programmatic_template,csv,top,False,cash_basis
"Profit & Loss Statement Copperline Consulting June 2025 Accrual Basis Income Sales 427,922.98 Total Income 427,922.98 Cost of Goods Sold 164,558.63 Gross Profit 263,364.35 Expenses Total
Advertising & Marketing 16,241.92 Contract Labor 50,388.61
Software Subscriptions 5,742.98 Travel 7,618.89 Utilities 3,320.06 Total Expenses 83,312.46 Net Operating Income 180,051.89 Net Income 180,051.89",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-c9cebcc1b84d03cde7ad255d,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2025,fgen-cc10e4d463a7ee147766e992,synthetic_programmatic_template,flat,top,False,monthly
"Profit and Loss Maple Street Bakery January - December 2023 Accrual Basis Income Sales 435,616.48 Total
Income 435,616.48 Cost of Goods Sold
88,243.20 Gross Profit 347,373.28 Expenses Total Contract Labor 20,787.97 Insurance 11,512.80 Office Supplies 3,369.73 Rent or Lease 35,512.50 Travel 12,142.15 Utilities 3,121.03 Total Expenses 86,446.18 Net Operating Income 260,927.10 Net Income 260,927.10",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e1ed62975d53abb545d06b14,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-87eaad542a04301bc11f0a42,synthetic_programmatic_template,flat,top,False,annual
"Category Jan Feb Mar
YTD Service revenue 29649.31 24077.50 19412.13
17261.54 Contractors 7149.77 17869.15 2900.10 26525.56 Net operating income 9482.35 10383.18 15427.29 2070.53 Contractors 19482.85 4064.41 15379.32 17518.88 Income 10979.25 25208.60 26212.82 29297.01",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0ec9728dc8bd9b7b4298089b,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-2e4aca7e3ebc71c307a58db2,synthetic_programmatic_template,flat,top,False,raw_export
"Profit and Loss Maple Street Bakery January - December 2023 Cash Basis Income Sales 491,679.57
Total Income 491,679.57 Cost of Goods Sold 83,792.59 Gross Profit 407,886.98 Expenses
Total Advertising & Marketing 10,663.81 Contract Labor 25,934.43 Office Supplies 4,139.30 Rent or Lease 16,625.30 Software Subscriptions 5,930.11 Travel 12,535.25 Total Expenses 75,828.20 Net Operating Income 332,058.78 Net Income 332,058.78",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1ae6199ed81bfcab4d5e75ce,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-f99ec69280321e9d08b77e37,synthetic_programmatic_template,flat,top,False,cash_basis
"Profit & Loss Statement Bright Pixel Design LLC January - December 2022
Cash Basis Income Sales 59,012.60 Total Income 59,012.60 Cost of GoodsSold 19,753.10 Gross Profít 39,259.50 Expenses Total Advertísíng & Marketing
1,200.22 Contract Labor 5,185.97 Insurancc 1,302.620ffice 5upplies 357.79 Rent or Lease 3,662.60 Software Subscriptions 454.32 Travel 627.48 Utilities 836.22 Total Expenses 13,627.22 Net Operating Income 25,632.28 Net Income 25,632.28",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-599a6296480b0ee9cd60231d,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2022,fgen-27ebdf2a0d32a17c372287a9,synthetic_programmatic_template,flat,top,True,cash_basis
"Copperline Consulting -
Profit and Loss - 2024 Downloaded
11/18/2024 Account Q1 Q2 Q3 Q4 Total Cost of Goods Sold 13145.27 80260.93 80140.49 55979.18 89701.58 Payroll Expenscs 44388.62 58998.04 57230.71 57582.47 70910.22 Payroll Expenses 11827.32 61382.17 38636.99 23O20.25 52322.80 Payroll Expenses 42648.19 75636.43 87925.28 48947.19 13159.19Marketíng 69859.54 74138.98 28l99.67 7O098.28 40796.74 Sales 25411.8455326.05 65616.12 45060.29 31053.84 Net Income 13266.93 1330.06 80006.41 55747.32 3837.08",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bcf60a42587340cf9d29b229,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-fb7f5d992f24224e0830531a,synthetic_programmatic_template,flat,top,True,raw_export
"Copperline Consulting March 2025 Accrual
Basis Income Sales 81,518.42 Total Income 81,518.42 Cost of Goods Sold 33,607.31 Gross Profit 47,911.11 Expenses Total Advertising & Marketing 1,996.21 Contract Labor 8,973.21
Rent or Lease 6,939.86 Software Subscriptions 616.23 Total Expenses 18,525.51 Net Operating Income 29,385.60 Net Income 29,385.60 Profit & Loss Statement",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-46a73ed0f996fd9eba3293ec,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2025,fgen-fd31bb1b2ba91c8ebfe98704,synthetic_programmatic_template,flat,bottom,False,monthly
"Bright Pixel Design LLC - Profit and Loss - 2024 Category Jan Feb Mar YTD Contractors 27206.44 8373.17
27889.96 3851.89 Service revenue 6862.95 6203.44 10529.66 24759.32 Service revenue 8752.28 8066.01 997.52 7170.42 Service revenue 24921.41 23016.38 4695.23 15989.10 COGS 11390.78 20135.82
3192.91 14382.40",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-6f8bfc82dd3908188e2666b1,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-d3cba407c28bfe19cb8a559f,synthetic_programmatic_template,flat,top,False,raw_export
"Income Statement Riverbend Landscaping January - December 2021 Accrual Basis Incomc Sales 478,803.57 Total Income 478,803.57 Cost
of Goods So1d 195,797.79
Gross Profit 283,005.77 Expenses Total Advertising & Marketing 10,922.59 Contract Labor30,236.30 Insurance 9,926.16 0ffice Supplies 2,673.80 Software Subscriptions 3,442.12 Trave1 5,795.33Total Expenses 62,996.30 Net Operating Income 220,009.47 Net Income 220,009.47",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bcf7b049bc7c3cc3719dd44a,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2021,fgen-86d13cbad728d352d5a494b1,synthetic_programmatic_template,flat,top,True,annual
"Income Statement Copperline Consulting January - December 2024 Accrual Basis Income Sales 181,713.17 Total Income 181,713.17 Cost of Goods Sold 76,529.97 Gross Profit 105,183.21 Expenses Total Advertising & Marketing 7,889.74
Contract Labor 13,764.41 Insurance 4,782.83 Office Supplies 1,928.84 Rent or Lease 12,839.92 Software Subscriptions 2,474.95 Utilities 2,560.03 Total Expenses 46,240.72 Net Operating
Income 58,942.49 Net Income 58,942.49",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bf97e0bd6973f454dcb670ea,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-59525610370c0f75cdf33b75,synthetic_programmatic_template,flat,top,False,annual
"Income Statement Copperline Consulting March 2023 Accrual Basis Income Sales 546,035.19 Total Income 546,035.19 Cost of Goods Sold 156,209.62 Gross Profit 389,825.56 Expenses Total Advertising & Marketing 13,495.27 Contract Labor 28,230.66 Insurance 7,089.08 Office
Supplies 8,156.22 Rent or Lease 45,133.44 Software Subscriptions 3,966.61
Utilities 8,021.94 Total Expenses 114,093.22 Net Operating Income 275,732.34 Net Income 275,732.34",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1357be1673bb897481d32ef8,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-54f4fdbd2566bcaca6c5c500,synthetic_programmatic_template,flat,top,False,monthly
"Maple Street Bakery - Profit and Loss - 2022 Account Q1 Q2 Q3 Q4 Total Net Income 64952.53 72991.45 50660.53 41630.09 10399.73 Payroll Expenses 36277.37 46732.89 52055.91 22875.11 32879.38 Total Revenue 22562.17 31355.61 25107.25
42615.49 66749.53 Rent 57061.73 78882.90 39299.73 64999.64 20486.40 Cost of Goods Sold 2791.86 79357.06 87646.41 87998.67
21822.45 Total Revenue 65812.54 73843.67 15220.49 24322.54 36005.06 Sales 49887.92 63273.72 50976.59 23941.55 7099.48 Net Income 13532.97 26276.53 85613.16 80269.41 67829.31 Net Income 11107.58 13846.22 67547.16 7322.70 31812.53",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ddc9cf2b48ff721815b4d644,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2022,fgen-a4640700df5b881afbb70c30,synthetic_programmatic_template,flat,top,False,raw_export
"Maple Street Bakery January - December 2024 Accrual Basis Income Sales 217,370.96 Total Income 217,370.96 Cost of Goods Sold 64,184.01 Gross Profit 153,186.94 Expenses
Total Advertising & Marketing 7,155.16 Insurance 5,040.25 Office
Supplies 2,689.89 Rent or Lease 12,783.53 Software Subscriptions 1,716.65 Travel 3,231.08 Utilities 1,332.41 Total Expenses 33,948.97 Net Operating Income 119,237.97 Net Income 119,237.97 Profit and Loss",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-6161ab1c22c36ac5390f598a,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-54c9b764d320977fb2268118,synthetic_programmatic_template,flat,bottom,False,annual
"Profit and Loss Copperline Consulting January - December 2024 Accrual Basis
Income Sales 184,919.82 Total Income 184,919.82 Cost of Goods Sold 60,466.35
Gross Profit 124,453.47 Expenses Total Contract Labor 9,982.82 Office Supplies 1,948.98 Rent or Lease 15,183.40 Software Subscriptions 2,353.73 Travel 5,541.93 Utilities 927.68 Total Expenses 35,938.54 Net Operating Income 88,514.93 Net Income 88,514.93",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-1d890cf12364214f901decf0,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-b2fc7eeae42e994bc44f7db6,synthetic_programmatic_template,flat,top,False,annual
"Profit & Loss Statement Bright Pixel Design LLCJune 2021 Accrual Basis Income 5ales
517,628.10 Total Income 517,628.10 Cost of Goods Sold 68,068.65 Gross
Profit 449,559.45 Expcnses Total Advertising & Marketing 14,512.53 Contract Labor 38,068.71 Insurance11,900.41 Office Supplics 2,598.23 Rent or Lease 15,661.06 Travel 6,935.24 Utilities 2,782.40 Total Expenses 92,458.58 Net Operating Income 357,100.87 Net Income 357,1O0.87",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-5085630c53628ade31864b97,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2021,fgen-953ce212072b4248c54795d7,synthetic_programmatic_template,flat,top,True,monthly
"Profit and Loss
Bríght Pixel DesignLLC October 2O23 Accrual Basis Income Sales 2O8,416.88 Total Incomc 208,416.88 Cost of Goods Sold 96,472.03 Gross Profít 111,944.85 Expenses Total Advertising & Marketing 4,209.98
Rent or Lease 9,178.98 Software Subscriptions 1,360.72 Travel 3,507.53 Utilitics 1,899.47 Total Expenses 20,156.68 NetOperating Income 91,788.17 Net Income 91,788.17",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-47d00030baf58158af07967a,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-fb8d05ffd7896dcd87a5f503,synthetic_programmatic_template,flat,top,True,monthly
"Copperline Consulting January - December 2024 Accrual Basis Income Sales 35,114.35
Total Income 35,114.35 Cost of Goods Sold 4,282.73 Gross Profit 30,831.63 Expenses Total Advertising & Marketing 1,064.05 Contract Labor 2,971.22 Office
Supplies 276.01 Rent or Lease 1,454.97 Software Subscriptions 254.80 Travel 390.68 Utilities 234.13 Total Expenses 6,645.86 Net Operating Income 24,185.77 Net Income 24,185.77",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-42e22eb640165fb2f6c70dc2,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-07122e8f8739c6f4942d0047,synthetic_programmatic_template,flat,none,False,annual
"Riverbend
Landscaping January - December 2024
Accrual Basis Income Sales 179,806.67 Total Income 179,806.67 Cost of Goods Sold 84,288.91 Gross Profit 95,517.76 Expenses Total Contract Labor 15,339.90 Insurance 4,837.91 Office Supplies 2,230.11 Software Subscriptions 1,159.96 Travel 4,059.50 Utilities 1,007.99 Total Expenses 28,635.37 Net Operating Income 66,882.39 Net Income 66,882.39 Income Statement",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8a4db1e769ee2c416516fb83,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-555d9bf4bf94a7a494b4ed77,synthetic_programmatic_template,flat,bottom,False,annual
"Income statement by month Downloaded 2021-02-12 Account Q1 Q2 Q3 Q4 Total Sales 28081.04 24065.38 28985.44 l5917.99 28984.42 Payroll Expenses 41003.75 62888.96 61955.99 32204.4117023.29 Payroll Expenses 57417.71 13506.38
57417.21
33611.99 36191.03",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-a3aa26fe61b4abaf0ae24e1d,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2021,fgen-69071c6c87e7485003378d7e,synthetic_programmatic_template,flat,top,True,raw_export
"Category
Jan Feb Mar YTD Operating expenses
3172.98 26483.84 15853.56 2794.88 Income 16577.93 5729.46 16848.86 1243.68 Contractors 20208.51 18674.23 28282.56 17944.52 Software 6052.67 26455.00 18211.81 26335.85",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e99e0aa6b636a378862fbcfe,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2022,fgen-f88c3ad2587c9d9934649f03,synthetic_programmatic_template,flat,top,False,raw_export
"Downloaded 11/08/2021 Account Q1 Q2 Q3 Q4 Total Net Income 47239.13 900.40 15329.46 9381.36 73281.48 Rent 33522.56 53042.91
60961.13
22961.89 40070.79 Payroll Expenses 28536.95 15882.69 31997.57 89959.65 37276.85",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-63d9eb9cdc25a14635c09870,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2021,fgen-0fb1ee435d56c220bcd77110,synthetic_programmatic_template,flat,none,False,raw_export
"Profit & Loss
Statement Riverbend Landscaping January - December 2021 Accrual Basis Income Sales 382,286.91 Total Income 382,286.91 Cost of Goods Sold 150,213.31 Gross Profit 232,073.61 Expenses Total Advertising & Marketing 9,014.32 Contract Labor 27,749.68 Insurance 4,428.03 Office Supplies 2,080.23 Utilities 5,497.01 Total Expenses 48,769.27 Net
Operating Income 183,304.34 Net Income 183,304.34",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-e64acfed559948908fbc8ebf,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2021,fgen-b884de4c7a2d783f17d671e2,synthetic_programmatic_template,flat,top,False,annual
"Profit & Loss Statement Maple
Street Bakery October 2023 Accrual Basis Income 5ales217,603.10 Total Income 217,603.10 Cost of Goods Sold 47,749.33Gross Profít 169,853.77 Expenses Total Contract Labor 19,965.22 Offíce Supplies 3,133.37 Rent or
Lease 15,796.04 Software Subscriptions 2,982.17 Travel 4,218.60 Utilities 1,956.58 Total Expenses 48,051.98 Net 0perating Income 121,801.79 Net Income 121,801.79",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-0fe5e0f6d0af3595bddf103d,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-26d8c3e49b689b0df4fd8d9a,synthetic_programmatic_template,flat,top,True,monthly
"Bright Pixel Design LLC January - December 2023 Cash
Basis Income Sales 534,342.89 Total Income 534,342.89 Cost of Goods Sold 257,147.74 Gross Profit 277,195.15 Expenses Total Advertising & Marketing 13,859.17 Contract
Labor 48,100.99 Insurance 13,794.46 Office Supplies 6,505.32 Rent or Lease 30,632.75 Software Subscriptions 3,564.87 Utilities 7,793.73 Total Expenses 124,251.29 Net Operating Income 152,943.86 Net Income 152,943.86",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-c803cda77582148cee0174cb,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-35023dd67e38311d37675205,synthetic_programmatic_template,flat,none,False,cash_basis
"Income Statement Riverbend Landscaping October 2026 Accrual Basis Income Sales 349,323.58 Total Income 349,323.58 Cost of Goods Sold 73,998.67 Gross Profit
275,324.90 Expenses Total Advertising
& Marketing 5,895.24 Contract Labor 34,172.88 Insurance 4,870.95 Office Supplies 4,777.19 Rent or Lease 29,385.26 Utilities 3,391.89 Total Expenses 82,493.41 Net Operating Income 192,831.49 Net Income 192,831.49",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-ac73fa885b7cbddd902c7002,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2026,fgen-f4455e11e2792116c9b56fae,synthetic_programmatic_template,flat,top,False,monthly
"Profit and Loss Bright Pixel Design LLC January - December 2023 Accrual Basis Income Sales 302,733.72 Total Income 302,733.72 Cost of Goods Sold 62,718.97 Gross Profit 240,014.75 Expenses Total Contract Labor
33,212.93 Office Supplies 3,179.61 Rent or Lease 11,565.72 Software
Subscriptions 2,579.50 Travel 3,731.20 Utilities 4,182.85 Total Expenses 58,451.81 Net Operating Income 181,562.94 Net Income 181,562.94",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-070ed54a112eabc59665a734,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-4860b0af7bf691870071c0e0,synthetic_programmatic_template,flat,top,False,annual
"Income Statement RiverbendLandscaping
January - December 2024 Cash Basís Income Sales 596,994.62 Total
Income 596,994.62 Cost of Goods Sold 236,175.64 Gross Profit 360,818.98 Expenses Total Contract Labor 61,906.19 Insurance 14,778.80 Office Supplies 5,890.l9 Rent or Lease 48,869.93 Software Subscriptions 7,462.68 Travel 9,304.31 Utilities 7,813.95 Total Expenses156,026.05 Net Operating Income 204,792.93 Net Income 2O4,792.93",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-2c4575e51c02d85a80b41b3e,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2024,fgen-595a1147094b8f90d9500258,synthetic_programmatic_template,flat,top,True,cash_basis
"Profit &Loss Statement Bright Pixel Design LLC January - December 2025 Accrual Basis Income Sales 179,633.02 Total Income 179,633.02 Cost of Goods 5old 78,292.28 Gross Profít 101,340.74 Expenses Total Advertising & Marketing 5,976.38 Insurance 3,533.25 Office Supplies l,633.88
Rent or Lease 5,874.15 Software Subscriptions 1,448.94 Travel 2,009.82 Utilitics 2,548.28Total Expenses 23,024.70 Net Opcrating Income 78,316.04 Net Income
78,316.04",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-7c261713f597d8688914a8ec,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2025,fgen-406ad078cf25a5872dba89ac,synthetic_programmatic_template,flat,top,True,annual
"Copperline Consulting January - December 2023 Cash Basis Income Sales 567,020.24 Total Income 567,020.24 Cost of GoodsSold 63,201.56 Gross Profit 5O3,818.68 Expcnses Total Advertising & Marketing 15,718.67 Contract Labor27,737.64 Insurancc 9,772.07 Office Supplies 6,662.82
Rent or Lease 37,697.25 Software Subscriptions 6,099.47
Trave1 12,31O.57 Total Expenses 115,998.49 Net Operating Income 387,820.19 Net Income 387,82O.19 Profit & Loss Statement",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-f9c37c07994dc850eb38723c,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2023,fgen-fed1d41de3cd8640139d362c,synthetic_programmatic_template,flat,bottom,True,cash_basis
"Account Q1 Q2 Q3 Q4 Total Gross Profit 12070.88 7855.32 37615.27 13532.82 13332.05 Total Revenue 5603.57 59704.11 35155.14
10105.62 43774.86 Cost of Goods Sold
39151.29 58084.76 40082.96 35095.97 17051.94 Cost of Goods Sold 27450.86 62841.29 89340.07 40087.20 68873.61 Gross Profit 14045.44 49148.22 34853.71 63185.21 10185.34",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-b404ea3618ceb05dbec27acd,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2022,fgen-082c4c875cbc0d579b892705,synthetic_programmatic_template,flat,top,False,raw_export
"Downloaded
10/02/2021 Category Jan Feb Mar YTD COGS 27473.37 8126.90 25279.9l 10704.87 Contractors 9008.38 21703.90 17722.78 15788.87 Service revenue 7974.67 4358.42 26019.38 24566.99 Income
15303.93 23701.89 6070.78 5245.54 Maple 5treet Bakery - Profit andLoss - 2021",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-8d042a726f53949532f10075,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2021,fgen-575eec730eadca7cc5697803,synthetic_programmatic_template,flat,bottom,True,raw_export
"Copperline Consulting January - December 2025 Accrual Basis Income Sales 563,559.97 Total Income 563,559.97 Cost of Goods Sold 178,261.31 Gross Profit 385,298.66 Expenses Total Advertising & Marketing 22,320.69 Contract Labor 27,076.34 Office Supplies 3,864.18 Rent or Lease 50,236.16 Software Subscriptions 8,166.11 Travel
13,581.39 Utilities 7,864.48 Total Expenses 133,109.35 Net Operating Income
252,189.31 Net Income 252,189.31",BUSINESS_RECORD,25,BUSINESS_RECORD,fdc-bc86628e31d12fa92a26046e,v11-PROFIT_AND_LOSS_STATEMENT-flat,original,2025,fgen-51bb16f7a6912155c55b9dae,synthetic_programmatic_template,flat,none,False,annual
"2021 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
27-20-422-19
4880 Lakeshore Blvd Cedar Falls, IA 67193
Amara Larsen
$428,368.90
$948.86
2.5571%
Taxing district
Amount
Park District
1,158.24
Community College 502
302.58
City of Testville
4,099.33
Library District
4,581.25
Total tax
First installment due
Second installment due
$11,271.90
8/1/21
11/10/2021",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-32290d5ad8fa4fb113e55e41,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-d6db5f0990830f57f6786914,synthetic_programmatic_template,columns,top,False,annual_bill
"Property Tax Payment Receipt
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
85-45-146-37
4866 Prairie Ave Oak Grove, TX 26466
Kwame K. Brennan
$469,388.63
$2,847.85
2.8179%
Taxing district
Amount
Community College 502
2,134.35
School District 204
2,578.96
County General
4,122.18
Library District
3,855.17
Total tax
First installment due
Second installment due
Amount paid
$3,293.31
January 8, 2025
02/03/2025
$1,646.66",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-1dd7bb7bff2785cbfb4b2ef8,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-a701c30e9dd40038ab5ce135,synthetic_programmatic_template,columns,top,False,paid_receipt
"2026 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
97-89-878-41
5625 Oak Hollow Ct Riverton, WI 47177
Hiro Romero
$383,137.22
$5,850.22
3.2865%
Taxing district
Amount
Park District
2,981.13
Library District
768.60
County General
3,214.80
School District 204
4,515.29
Total tax
First installment due
Second installment due
$7,922.16
09/11/2026
10/06/2026
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-9c60d28a90347ab73cccd925,v11-PROPERTY_TAX_BILL-columns,original,2026,fgen-ed99be1272b2af660b967381,synthetic_programmatic_template,columns,top,False,annual_bill
"2025 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
79-30-847-76
945 Oak Hollow Ct Riverton, WI 25532
Riley Nguyen
$563,096.93
$2,073.23
6.5354%
Taxing district
Amount
Park District
2,917.20
County General
2,839.85
Library District
4,608.89
School District 204
561.06
Total tax
First installment due
Second installment due
$13,283.79
February 25, 2025
05/18/2025
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-46aef125b3e27c592015606c,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-dcdb84a71a0163a2b0636964,synthetic_programmatic_template,columns,top,False,annual_bill
"2025 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
69-17-490-89
9720 Granite St Pinecrest, GA 87349
Noah K. Adeyemi
$622,999.81
$4,760.40
1.6928%
Taxing district
Amount
Park District
4,157.80
City of Testville
1,716.81
County General
4,327.08
Library District
2,248.50
Total tax
First installment due
Second installment due
$9,370.32
02/18/2025
2025-10-13",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-f32002f2d2d5f2d60712bbe3,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-9e5330c03cb01829be302616,synthetic_programmatic_template,columns,top,False,annual_bill
"Second Installment Property Tax Notice
Lake County Collector
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
29-30-468-93
8264 Harbor View Rd Cedar Falls, IA 45859
Morgan Patel
$144,195.04
$9,048.45
3.1616%
Taxing district
Amount
City of Testville
2,858.12
Library District
2,094.24
5choo1 District 204
4,672.16
County General
2,242.22
Total tax
Firstinstallment due
5econd installment due
$11,755.45
2026-04-27
08/18/2026",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-af3859b9ad4e8b55cc405523,v11-PROPERTY_TAX_BILL-columns,original,2026,fgen-4160fd5963bacc31081b8485,synthetic_programmatic_template,columns,top,True,installment_notice
"Harbor County Treasurer
Parcel number
Property locatíon
Owner
Assessed value
Homestead exemptíon
Tax rate
10-93-521-97
3039 Harbor Vicw RdLakewood, CO 79007
Diego A. Nguyen
$622,299.32
$5,625.69
1.5114%
Taxing district
Amount
5choo1 District 204
3,186.46
Park District
4,681.31
City of Testville
2,906.54
Community College 502
2,930.49
Total tax
First installment due
Second installment due
$2,332.24
12/26/2021
12/10/21",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-0b133b6492bd5cbedeff1d86,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-26203a29a78dabb35b723771,synthetic_programmatic_template,columns,none,True,annual_bill
"Property Tax Payment Receipt
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
46-61-834-54
7179 Sample Street Bayside, WA 68579
Diego C. Moreau
$254,262.01
$8,338.94
7.8444%
Taxing district
Amount
Library District
557.31
Cityof Testville
1,289.49
Park Dístrict
4,570.82
County General
3,549.l5
Total tax
First installment due
Second installment due
Amount paid
$l2,939.48
2021-12-14
November 1, 2021
$6,469.74
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-d46db533a90936402fb0fb81,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-3fba40dce62e503827608753,synthetic_programmatic_template,columns,top,True,paid_receipt
"Property Tax Payment Receipt
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
11-50-139-14
57 Willow BendWay 0ak Grove, TX 52O32
Lena E. Testcase
$12O,905.16
$9,095.26
2.3483%
Taxing district
Amount
City of Testville
229.35
County General
2,137.59
School District 204
2,077.76
Community Co1lege 502
1,983.87
Total tax
First installment due
Second installment due
Amount paid
$12,435.59
12/27/2022
01/13/2022
$6,217.79
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7ab02e3f26ef8c1f6d35cf7d,v11-PROPERTY_TAX_BILL-columns,original,2022,fgen-74c7ae2e20ec15cf2765de2e,synthetic_programmatic_template,columns,top,True,paid_receipt
"Property Tax Payment Receipt
Lake County Collector
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
40-89-148-84
6607 Willow Bend Way Cedar Falls, IA 48593
Olivia Castillo
$694,553.56
$5,206.82
3.2605%
Taxing district
Amount
School District 204
928.30
Park District
3,622.39
City of Testville
3,600.82
County General
1,653.08
Total tax
First installment due
Second installment due
Amount paid
$9,990.68
2025-07-28
2025-01-05
$4,995.34",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-e95fc2d5267f3868efe66c9f,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-ed6e7cbfd6cc56c6d0dc4ee9,synthetic_programmatic_template,columns,top,False,paid_receipt
"Second Installment Property Tax Notice
Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
39-25-145-24
4804 Maple Ridge Dr 0ak Grove, TX 95079
Avery Nguyen
S359,866.81
$233.71
8.6674%
Taxing district
Amount
City of Testville
4,343.06
School District 204
3,046.32
Park District
436.65
LibraryDistrict
4,291.75
Tota1 tax
First installmcnt due
Second installment due
$1,76O.94
01/26/2021
7/3/21",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-3b5d1b35ab707a4f62d2a555,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-3d3511dc15d8499560775375,synthetic_programmatic_template,columns,top,True,installment_notice
"2021 Real Estate Property Tax Bill
Cedar County Tax Office
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
28-57-369-45
3625 Maple Ridge Dr Fairview, OH 38756
Amara Nguyen
$690,085.39
$1,972.76
4.8061%
Taxing district
Amount
Park District
904.67
City of Testville
607.86
Library District
1,185.10
County General
1,596.16
Total tax
First installment due
Second installment due
$11,861.86
2021-12-02
2021-05-26",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-8008af26bc4ba1bd4c0d6d39,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-9bb84859dccf236e305ba377,synthetic_programmatic_template,columns,top,False,annual_bill
"Second Installment Property Tax Notice
Lake County Collector
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
60-51-137-37
4274 Prairie Ave Bayside, WA 74135
Jordan Haddad
$190,847.94
$448.76
2.0079%
Taxing district
Amount
Library District
2,355.17
Park District
1,040.91
Community College 502
2,295.17
County General
4,014.36
Total tax
First installment due
Second installment due
$2,573.06
01/23/2026
9/5/26",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-3bd02e1341b627490e160cbe,v11-PROPERTY_TAX_BILL-columns,original,2026,fgen-f988dc4c74fee58b4d6320b2,synthetic_programmatic_template,columns,top,False,installment_notice
"Second Installment Property Tax Notice
Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
89-71-849-66
2849 Harbor View Rd Riverton, WI 58795
Fatima Brennan
$439,720.71
$5,593.71
6.5775%
Taxing district
Amount
Library District
4,419.03
Park District
2,949.24
School District 204
4,389.73
County General
1,880.59
Total tax
First installment due
Second installment due
$9,875.58
2023-11-22
2023-10-27
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-378ff8f842b8b063308feed1,v11-PROPERTY_TAX_BILL-columns,original,2023,fgen-54087175b7bcf961de731d44,synthetic_programmatic_template,columns,top,False,installment_notice
"Lake County Collector
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
47-24-329-14
7044 Prairie Ave Brookhaven, PA 64718
Casey S. Haddad
$491,501.58
$9,022.57
2.5584%
Taxing district
Amount
Community College 502
4,385.24
Park District
2,085.86
County General
4,968.00
Library District
2,232.17
Total tax
First installment due
Second installment due
$15,736.20
6/10/26
2026-06-28
If your taxes are paid through an escrow account, forward this bill to your mortgage company.
Second Installment Property Tax Notice",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-e8b49033886a0badff1ae420,v11-PROPERTY_TAX_BILL-columns,original,2026,fgen-8586cc339e75675c61b181d3,synthetic_programmatic_template,columns,bottom,False,installment_notice
"2021 Real Estate Property Tax Bill
Cedar County Tax Office
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
81-30-454-71
3067 Maple Ridge Dr Cedar Falls, IA 29797
Amara E. Testcase
$613,590.96
$9,253.74
7.3377%
Taxing district
Amount
City of Testville
4,760.13
Park District
1,112.86
School District 204
1,267.30
Library District
741.49
Total tax
First installment due
Second installment due
$7,134.50
September 6, 2021
2021-06-14",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-078eafe1a3fdafdc0ff4eb4f,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-07c3882ef26aef7f2592464e,synthetic_programmatic_template,columns,top,False,annual_bill
"Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
29-95-975-21
5685 Willow Bend Way Cedar Falls, IA 48662
Casey Rivera
$570,973.73
$8,324.28
1.1492%
Taxing district
Amount
City of Testville
1,409.97
Park District
4,263.12
School District 204
1,205.02
Community College 502
3,032.47
Total tax
First installment due
Second installment due
$4,317.31
6/28/23
2023-05-28
Second Installment Property Tax Notice",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-f8430cce27268c4a8d23b11c,v11-PROPERTY_TAX_BILL-columns,original,2023,fgen-8608edf5f9b012bda743ada5,synthetic_programmatic_template,columns,bottom,False,installment_notice
"Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
60-72-522-85
9785 Harbor View Rd Testville, IL 73273
Casey Walsh
$267,516.56
$3,193.02
1.2158%
Taxing district
Amount
County General
2,715.53
Park District
3,886.34
City of Testville
1,545.42
Library District
4,083.00
Total tax
First installment due
Second installment due
Amount paid
$5,474.80
11/06/2025
3/9/25
$2,737.40",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-f36a9145aa935e1a0d7ba0da,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-2590ee82e7d4e8980667df79,synthetic_programmatic_template,columns,none,False,paid_receipt
"Property Tax Payment Receipt
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
52-54-409-32
8307 Elm Park Pl Brookhaven, PA 99793
Jamie Fischer
$234,262.07
$9,392.81
3.0904%
Taxing district
Amount
Library District
638.93
Park District
2,138.02
School District 204
1,485.47
County General
1,604.33
Total tax
First installment due
Second installment due
Amount paid
$6,553.29
2026-08-05
5/10/26
$3,276.65",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-9aad8b1489d7cfd6e2b88691,v11-PROPERTY_TAX_BILL-columns,original,2026,fgen-369644da787af3f0bc1a0dd8,synthetic_programmatic_template,columns,top,False,paid_receipt
"Second Installment Property Tax Notice
Cedar County Tax Office
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
79-19-338-96
7950 Prairie Ave Riverton, WI 87991
Noah Tanaka
$257,657.20
$1,028.81
9.2427%
Taxing district
Amount
City of Testville
2,792.87
Library District
2,925.09
Community College 502
737.39
School District 204
2,885.99
Total tax
First installment due
Second installment due
$2,077.54
7/21/23
2023-07-18",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-0802e9bf17465039f59df795,v11-PROPERTY_TAX_BILL-columns,original,2023,fgen-32a7c4dd6a8116127a5651f7,synthetic_programmatic_template,columns,top,False,installment_notice
"Cedar County Tax Office
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
30-12-484-72
2871 Maple Ridge Dr Testville, IL 54397
Avery D. Sato
$201,409.84
$485.82
2.3766%
Taxing district
Amount
City of Testville
2,080.02
School District 204
4,374.11
Library District
1,315.83
County General
4,396.62
Total tax
First installment due
Second installment due
$15,317.36
4/4/25
May 16, 2025",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-bb731c3cf7dc0d2343c6e61c,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-6cb8ad6f9a634abb7eed39ae,synthetic_programmatic_template,columns,none,False,annual_bill
"Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
24-67-128-57
7202 Prairie Ave Maplewood, MN 20811
Casey Testcase
$174,723.52
$5,934.45
1.8902%
Taxing district
Amount
School District 204
3,835.13
City of Testville
531.95
Community College 502
1,879.10
Park District
4,430.32
Total tax
First installment due
Second installment due
$6,145.56
February 13, 2022
5/5/22",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-8207ac499dae4e44edd5a0ae,v11-PROPERTY_TAX_BILL-columns,original,2022,fgen-48ec19b9dd6cefeefda6e0dd,synthetic_programmatic_template,columns,none,False,annual_bill
"Second Installment Property Tax Notice
Cedar County Tax Office
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
93-56-124-67
2254 Maple Ridge Dr Maplewood, MN 39874
Noah Rivera
$133,778.11
$4,435.50
6.5570%
Taxing district
Amount
Community College 502
4,516.76
Park District
447.69
County General
613.83
School District 204
1,653.22
Total tax
First installment due
Second installment due
$3,460.38
2024-01-16
November 22, 2024",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-8fc19531b64341efd34441a6,v11-PROPERTY_TAX_BILL-columns,original,2024,fgen-2d62f15e05ad3c28a95aaf4d,synthetic_programmatic_template,columns,top,False,installment_notice
"Property Tax Payment Receipt
Cedar County Tax Office
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
26-46-505-90
8225 Willow Bend Way Testville, IL 11303
Lena Haddad
$425,067.44
$6,320.19
2.1670%
Taxing district
Amount
Community College 502
2,910.07
Library District
2,239.78
County General
984.26
School District 204
2,999.76
Total tax
First installment due
Second installment due
Amount paid
$8,534.97
August 18, 2021
August 24, 2021
$4,267.48
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-e20bb10fca5097f8ebd6077a,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-1c7817772b09268cc308da84,synthetic_programmatic_template,columns,top,False,paid_receipt
"Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
80-47-810-30
2924 Sample Street Maplewood, MN 26748
Noah C. Testcase
$186,494.28
$4,769.31
5.4199%
Taxing district
Amount
Community College 502
3,857.91
City of Testville
4,044.20
School District 204
1,867.13
County General
2,316.91
Total tax
First installment due
Second installment due
$7,168.27
2022-01-23
2022-08-28
Second Installment Property Tax Notice",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-bd81f9b5530fbaea48d48f45,v11-PROPERTY_TAX_BILL-columns,original,2022,fgen-aabe50546ba63d75facd0dac,synthetic_programmatic_template,columns,bottom,False,installment_notice
"Property Tax Payment Receipt
Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
36-84-215-84
308 Harbor View Rd Cedar Falls, IA 69222
Mateo L. Okafor
$282,648.63
$9,135.62
9.7686%
Taxing district
Amount
School District 204
1,796.25
County General
819.62
Park District
2,994.99
Community College 502
1,951.38
Total tax
First installment due
Second installment due
Amount paid
$8,943.41
October 28, 2025
January 28, 2025
$4,471.70",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-d9d4f1cc0861db0c9c00d710,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-f5b9d44e5687fa0c77d29835,synthetic_programmatic_template,columns,top,False,paid_receipt
"Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
78-57-889-25
3859 Lakeshore Blvd Fairview, OH 98O90
Fatima Patel
S78,402.l1
$4,132.77
2.2853%
Taxing district
Amount
Community Collcge 502
3,270.48
Library District
4,421.22
County Gcneral
2,575.04
Cíty of Testville
3,394.18
Total tax
Fírstinstallment due
Second installment due
$14,220.46
2024-09-09
2024-12-13
If your taxes are paid through an escrow account, forward this bill to your mortgage company.
2024 Rea1 Estate Property Tax Bill",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-bb52990a283fc48a4b268ad4,v11-PROPERTY_TAX_BILL-columns,original,2024,fgen-bcef2dae6bba552127ef90cd,synthetic_programmatic_template,columns,bottom,True,annual_bill
"Property Tax Payment Receipt
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
91-16-406-59
3642 Maple Ridge Dr Lakewood, CO 89863
Priya Tanaka
$161,183.14
$4,233.96
5.2570%
Taxing district
Amount
County General
567.39
School District 204
1,949.13
Park District
3,632.16
Community College 502
1,176.96
Total tax
First installment due
Second installment due
Amount paid
$12,820.61
7/4/25
12/2/25
$6,410.31
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-3f13c7d346d57c91fa9c0597,v11-PROPERTY_TAX_BILL-columns,original,2025,fgen-04edf205538205259cb9f9d1,synthetic_programmatic_template,columns,top,False,paid_receipt
"2024 Real Estate Property Tax Bill
Marion County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
35-67-658-97
9619 Harbor View Rd Testville, IL 19730
Noah Nguyen
$218,827.82
$9,057.75
9.2778%
Taxing district
Amount
School District 204
2,601.19
County General
2,802.80
Community College 502
883.19
Library District
1,017.34
Total tax
First installment due
Second installment due
$9,649.53
August 16, 2024
11/26/2024",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-5eea783d29db0c402a262629,v11-PROPERTY_TAX_BILL-columns,original,2024,fgen-258301ee6482d24b92f0a552,synthetic_programmatic_template,columns,top,False,annual_bill
"Cedar County Tax Office
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
16-60-313-30
3460 Prairie Ave Brookhaven, PA 87037
Avery Testcase
$410,574.03
$7,732.72
6.7740%
Taxing district
Amount
Library District
3,333.73
Park District
2,761.53
School District 204
3,225.25
Community College 502
3,981.30
Total tax
First installment due
Second installment due
$14,376.19
March 11, 2022
October 24, 2022",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-044c812735e5fd15597e19d1,v11-PROPERTY_TAX_BILL-columns,original,2022,fgen-79cde037088ffec82c226fa3,synthetic_programmatic_template,columns,none,False,installment_notice
"Second Installment Property Tax Notice
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
20-56-194-68
5537 Maple Ridge Dr Oak Grove, TX 46948
Avery D. Adeyemi
$263,500.16
$8,912.42
3.6983%
Taxing district
Amount
City of Testville
1,371.83
Community College 502
4,900.63
Park District
232.53
School District 204
3,802.28
Total tax
First installment due
Second installment due
$5,174.80
2021-07-27
March 13, 2021",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-6afdc8f06bdb5a5d5d477fce,v11-PROPERTY_TAX_BILL-columns,original,2021,fgen-4e126bcc173932d71f2635e4,synthetic_programmatic_template,columns,top,False,installment_notice
"Second Installment Property Tax Notice
Harbor County Treasurer
Parcel number
Property location
Owner
Assessed value
Homestead exemption
Tax rate
59-84-324-47
7765 Prairie Ave Pinecrest, GA 69485
Avery Tanaka
$419,754.00
$8,745.41
2.0469%
Taxing district
Amount
County General
2,637.49
Library District
2,964.39
Community College 502
1,441.67
City of Testville
3,693.57
Total tax
First installment due
Second installment due
$4,263.40
January 18, 2026
10/10/2026",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-e2f5b79a9f3f66a1e36685e5,v11-PROPERTY_TAX_BILL-columns,original,2026,fgen-5f5daba68dbf6feac46ce7a5,synthetic_programmatic_template,columns,top,False,installment_notice
"Second Installment Property Tax Notice
Cedar County Tax Office
Parcel number,17-63-235-76
Property location,""5862 Harbor View Rd Maplewood, MN 21547""
Owner,Diego Moreau
Assessed value,""$599,079.86""
Homestead exemption,""$2,613.67""
Tax rate,3.5824%
Taxing district,Amount
Park District,304.91
Library District,""4,717.14""
City of Testville,""2,025.91""
School District 204,365.46
Total tax,""$8,799.53""
First installment due,10/1/22
Second installment due,""December 2, 2022""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7acef7689482bd432599a8b2,v11-PROPERTY_TAX_BILL-csv,original,2022,fgen-6929947aa79de46b85a972c7,synthetic_programmatic_template,csv,top,False,installment_notice
"Property Tax Payment Receipt
Marion County Treasurer
Parcel number,25-50-867-17
Property location,""7162 Prairie Ave Cedar Falls, IA 14448""
Owner,Wei S. Okafor
Assessed value,""$350,162.03""
Homestead exemption,""$5,809.87""
Tax rate,6.3948%
Taxing district,Amount
Park District,""4,399.04""
County General,""3,312.73""
City of Testville,""4,164.16""
Community College 502,""1,478.76""
Total tax,""$15,899.86""
First installment due,06/20/2026
Second installment due,2026-03-24
Amount paid,""$7,949.93""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-73971d033dadcff12c328e7c,v11-PROPERTY_TAX_BILL-csv,original,2026,fgen-bd9e480722a18421bc4c55b2,synthetic_programmatic_template,csv,top,False,paid_receipt
"Property Tax Payment Receipt
Cedar County Tax Office
Parcel number,11-64-755-18
Property location,""1484 Cedar Ln Fairview, OH 58660""
Owner,Amara Larsen
Assessed value,""$684,051.20""
Homestead exemption,""$8,056.56""
Tax rate,6.0915%
Taxing district,Amount
Community College 502,""2,358.91""
City of Testville,""2,866.40""
Park District,""2,234.15""
County General,""2,717.32""
Total tax,""$8,585.72""
First installment due,3/20/24
Second installment due,10/12/2024
Amount paid,""$4,292.86""",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-17f04e7a867d8dd88a6b8c15,v11-PROPERTY_TAX_BILL-csv,original,2024,fgen-57b339be652c9d8322c444fd,synthetic_programmatic_template,csv,top,False,paid_receipt
"2024 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number,22-16-121-42
Property location,""6479 Sample Street Lakewood, CO 78495""
Owner,Jordan Lindqvist
Assessed value,""$102,539.00""
Homestead exemption,""$6,222.92""
Tax rate,4.0935%
Taxing district,Amount
Community College 502,""2,116.83""
City of Testville,874.22
Library District,""4,603.61""
County General,""4,077.30""
Total tax,""$4,750.29""
First installment due,""July 28, 2024""
Second installment due,9/11/24",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-75ffaa1fa543e276e491015a,v11-PROPERTY_TAX_BILL-csv,original,2024,fgen-1cb19f2c29f40425f25590f8,synthetic_programmatic_template,csv,top,False,annual_bill
"Property Tax Payment Receipt
Marion County Treasurer
Parcel number,67-84-481-80
Property location,""9624 Willow Bend Way Brookhaven, PA 23953""
Owner,Jordan Lindqvist
Assessed value,""$242,324.73""
Homestead exemption,""$7,991.91""
Tax rate,7.5066%
Taxing district,Amount
Community College 502,""1,452.05""
City of Testville,""3,701.26""
School District 204,""3,958.56""
County General,""1,513.73""
Total tax,""$3,729.27""
First installment due,5/9/21
Second installment due,10/20/21
Amount paid,""$1,864.63""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-1e7fadd3984f24c0ad60821b,v11-PROPERTY_TAX_BILL-csv,original,2021,fgen-399dcd474573f7b8b85f9a0f,synthetic_programmatic_template,csv,top,False,paid_receipt
"Cedar County Tax Office
Parcel number,95-28-928-26
Property location,""2982 Lakeshore Blvd Testville, IL 14093""
Owner,Riley Tanaka
Assessed value,""$698,889.91""
Homestead exemption,""$5,764.52""
Tax rate,2.0623%
Taxing district,Amount
Park District,""2,328.94""
City of Testville,932.64
Library District,""4,820.84""
County General,""2,392.38""
Total tax,""$7,738.74""
First installment due,2024-05-09
Second installment due,""February 11, 2024""
Amount paid,""$3,869.37""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-ed1f40d62badc020eaf1f4b5,v11-PROPERTY_TAX_BILL-csv,original,2024,fgen-1893725fbc53a7beb631fead,synthetic_programmatic_template,csv,none,False,paid_receipt
"2023 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number,11-27-792-46
Property location,""696 Harbor View Rd Fairview, OH 12537""
Owner,Kwame Adeyemi
Assessed value,""$115,706.16""
Homestead exemption,""$3,400.77""
Tax rate,1.2037%
Taxing district,Amount
Library District,404.69
Community College 502,""1,225.00""
County General,""4,419.71""
City of Testville,935.08
Total tax,""$2,434.52""
First installment due,""November 26, 2023""
Second installment due,""October 2, 2023""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-47ea69f801a27c35b23cb975,v11-PROPERTY_TAX_BILL-csv,original,2023,fgen-eda9a94b76d232f11ab6da36,synthetic_programmatic_template,csv,top,False,annual_bill
"2024 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number,99-51-308-41
Property location,""2815 Prairie Ave Cedar Falls, IA 65191""
Owner,Sofia Haddad
Assessed value,""$314,348.07""
Homestead exemption,""$6,850.75""
Tax rate,6.6782%
Taxing district,Amount
School District 204,""4,490.57""
City of Testville,""1,042.88""
Community College 502,""4,610.96""
Library District,""3,563.09""
Total tax,""$11,798.73""
First installment due,1/10/24
Second installment due,05/14/2024",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-0935083cd31b2b28ca6d35ad,v11-PROPERTY_TAX_BILL-csv,original,2024,fgen-3d095a8dee7831d2772cb046,synthetic_programmatic_template,csv,top,False,annual_bill
"2024 Real Estate Property Tax Bill
Marion County Treasurer
Parcel number,54-20-177-35
Property location,""9437 Elm Park Pl Fairview, OH 74118""
Owner,Wei M. Lindqvist
Assessed value,""$353,966.35""
Homestead exemption,""$6,797.90""
Tax rate,8.1939%
Taxing district,Amount
Community College 502,740.56
City of Testville,""1,822.15""
County General,""2,044.81""
Park District,""2,497.36""
Total tax,""$2,822.47""
First installment due,""February 28, 2024""
Second installment due,10/22/24",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-0df0cbf61f99b4ffdeb7752d,v11-PROPERTY_TAX_BILL-csv,original,2024,fgen-e1be52918a5121cf13d696cd,synthetic_programmatic_template,csv,top,False,annual_bill
"Harbor County Treasurer
Parcel number,29-58-208-91
Property location,""5505 Willow Bend Way Riverton, WI 83771""
Owner,Casey Tanaka
Assessed value,""$483,244.15""
Homestead exemption,""$5,985.11""
Tax rate,5.3883%
Taxing district,Amount
County General,""3,748.81""
City of Testville,709.74
Park District,""3,204.46""
Library District,""1,355.81""
Total tax,""$15,338.19""
First installment due,6/6/26
Second installment due,1/16/26
Second Installment Property Tax Notice",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-774dbd18fe4a08530dabe31b,v11-PROPERTY_TAX_BILL-csv,original,2026,fgen-dec62b27eef4234e95117f48,synthetic_programmatic_template,csv,bottom,False,installment_notice
"Second Installment Property Tax Notice
Harbor County Treasurer
Parcel number,65-25-345-98
Property location,""7023 Maple Ridge Dr Riverton, WI 88772""
Owner,Priya Walsh
Assessed value,""$600,578.77""
Homcstead exemption,""$9,258.06""
Tax rate,5.2799%
Taxing district,Amount
County General,""3,284.l3""
Library District,""4,962.05""
Park District,""l,443.38""
5chool District 204,""1,769.40""
Total tax,""$14,104.84""
First installment due,""5eptember 7, 2025""
Second installment due,2025-02-15
If your taxes arepaíd through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-18fa142d883a02900860ec83,v11-PROPERTY_TAX_BILL-csv,original,2025,fgen-c7188d4e0bd0e42e1fe346be,synthetic_programmatic_template,csv,top,True,installment_notice
"Second Installment Property Tax Notice
Marion County Treasurer
Parcel number,56-32-461-79
Property location,""3633 Lakeshore Blvd Fairview, OH 29270""
Owner,Kwame Testcase
Assessed value,""$376,554.91""
Homestead exemption,""$8,935.58""
Tax rate,9.3288%
Taxing district,Amount
Community College 502,""1,264.86""
School District 204,324.54
Library District,""2,168.19""
Park District,""3,262.15""
Total tax,""$7,134.94""
First installment due,12/02/2024
Second installment due,2024-02-07",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-82a368283cc7d0184bd19419,v11-PROPERTY_TAX_BILL-csv,original,2024,fgen-37a47c2bea0930209e2c0b67,synthetic_programmatic_template,csv,top,False,installment_notice
"Cedar County Tax Office
Parcel number,21-82-661-70
Property location,""4957 Elm Park Pl Bayside, WA 45208""
Owner,Diego R. Romero
Assessed value,""$227,032.28""
Homestead exemption,""$6,811.10""
Tax rate,8.4467%
Taxing district,Amount
Park District,""4,529.53""
County General,""2,072.00""
School District 204,""4,662.83""
Community College 502,""4,179.50""
Total tax,""$12,942.97""
First installmcnt due,8/2/23
5econd installment due,02/22/2023
Amount paid,""$6,471.49""
If your taxes are paidthrough an escrow account, forward this bill to your mortgage company.
Property Tax Payment Receipt",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7bc30e2399a40e701fc9b457,v11-PROPERTY_TAX_BILL-csv,original,2023,fgen-11595d443066f5da9ec685b5,synthetic_programmatic_template,csv,bottom,True,paid_receipt
"2021 Real Estate Property Tax Bill
Marion County Treasurer
Parcel number,23-72-227-45
Property location,""2427 Prairie Ave Oak Grove, TX 81895""
Owner,Alex Castillo
Assessed value,""$570,524.64""
Homestead exemption,$3.74
Tax rate,8.2128%
Taxing district,Amount
Library District,""1,753.43""
Community College 502,244.30
City of Testville,""1,835.10""
County General,""3,894.48""
Total tax,""$11,619.03""
First installment due,""January 16, 2021""
Second installment due,2021-12-06",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-fcd62f92c95d0c748c0427bf,v11-PROPERTY_TAX_BILL-csv,original,2021,fgen-2339d59d670e12e831f8b674,synthetic_programmatic_template,csv,top,False,annual_bill
"Second Installment Property Tax Notice
Marion County Treasurer
Parcel number,60-79-736-84
Propertylocation,""6863 Oak Hollow Ct Bayside, WA 15707""
0wner,Wei A. Adcyemi
Assessed value,""S656,790.34""
Homestead cxemption,""$1,431.38""
Tax rate,2.8476%
Taxing district,Amount
City of Testville,""3,426.07""
Park District,""4,199.61""
Library District,""1,847.33""
Community College 502,""4,529.93""
Total tax,""$4,226.66""
First installment due,""March 10, 2025""
5econd installment due,2025-l2-16
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7ba20a1ad4f325e31ade7b4b,v11-PROPERTY_TAX_BILL-csv,original,2025,fgen-1365425cb4ece8e3971c0eae,synthetic_programmatic_template,csv,top,True,installment_notice
"Second Installment Property Tax Notice
Cedar County Tax Office
Parcel number,28-31-146-57
Property location,""5317 Prairie Ave Riverton, WI 36366""
Owner,Hiro M. Kowalski
Assessed value,""$502,643.09""
Homestead exemption,$101.98
Tax rate,7.3379%
Taxing district,Amount
City of Testville,""2,484.18""
Park District,509.95
Community College 502,""1,919.49""
School District 204,""2,192.63""
Total tax,""$5,216.22""
First installment due,12/14/2025
Second installment due,05/08/2025",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-0b88303f80aa38592d39f098,v11-PROPERTY_TAX_BILL-csv,original,2025,fgen-4e78b229e814e4c455550b1d,synthetic_programmatic_template,csv,top,False,installment_notice
"Second Installment Property Tax Notice
Cedar County Tax Office
Parcel number,26-43-203-48
Property location,""7209 Oak Hollow Ct Maplewood, MN 26613""
Owner,Alex Moreau
Assessed value,""$180,884.48""
Homestead exemption,""$7,005.74""
Tax rate,2.3126%
Taxing district,Amount
Community College 502,""2,428.19""
School District 204,""3,129.66""
City of Testville,""4,115.58""
Library District,""1,975.43""
Total tax,""$2,620.95""
First installment due,""June 27, 2025""
Second installment due,2025-04-28",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-3fd2cab120f3b2471189ebc3,v11-PROPERTY_TAX_BILL-csv,original,2025,fgen-29736939111ccf492c1091af,synthetic_programmatic_template,csv,top,False,installment_notice
"Property Tax Payment Receipt
Cedar County Tax Office
Parcel number,70-98-361-88
Property location,""1326 Granite St Pinecrest, GA 15266""
Owner,Diego Kowalski
Assessed value,""$196,553.43""
Homestead exemption,$114.62
Tax rate,7.1224%
Taxing district,Amount
Park District,""2,300.02""
County General,""3,904.29""
Library District,769.52
City of Testville,""3,067.81""
Total tax,""$12,929.79""
First installment due,9/28/21
Second installment due,2021-05-02
Amount paid,""$6,464.90""",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-067c69d5224829cd2d859644,v11-PROPERTY_TAX_BILL-csv,original,2021,fgen-bf624c8a08043f6c7c12fe43,synthetic_programmatic_template,csv,top,False,paid_receipt
"Second Installment Property Tax Notice
Lake County Collector
Parcel number,60-99-428-77
Property location,""4602 Willow Bend Way Maplewood, MN 65661""
Owner,Kwame D. Fischer
Assessed value,""$185,905.71""
Homestead exemption,""$2,783.17""
Tax rate,1.5053%
Taxing district,Amount
Library District,""3,622.77""
Park District,104.08
School District 204,""4,363.12""
Community College 502,""1,179.32""
Total tax,""$13,113.92""
First installment due,5/2/22
Second installment due,""March 20, 2022""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-28102ac51052cc6a73cacdb3,v11-PROPERTY_TAX_BILL-csv,original,2022,fgen-371baef77023f0da4ae136a7,synthetic_programmatic_template,csv,top,False,installment_notice
"Second Installment Property Tax Notice
Lake County Collector
Parcel number,74-67-688-76
Property location,""3922 Elm Park Pl Brookhaven, PA 56553""
Owner,Hiro Brennan
Assessed value,""$664,723.93""
Homestead exemption,""$7,661.00""
Tax rate,5.9268%
Taxing district,Amount
Library District,""4,893.86""
School District 204,""2,151.98""
Community College 502,""2,563.28""
Park District,""3,507.20""
Total tax,""$8,825.38""
First installment due,1/5/22
Second installment due,04/02/2022
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-77b83821b2cdfb4f22d8d2a4,v11-PROPERTY_TAX_BILL-csv,original,2022,fgen-9e5a3d28198009497fdd73aa,synthetic_programmatic_template,csv,top,False,installment_notice
"Second Installment Property Tax Notice
Harbor County Treasurer
Parcel number,60-93-775-83
Property location,""7658 Elm Park Pl Oak Grove, TX 80709""
Owner,Diego Fischer
Assessed value,""$634,357.11""
Homestead exemption,""$5,208.15""
Tax rate,4.7283%
Taxing district,Amount
Park District,""2,414.23""
County General,""1,580.26""
City of Testville,""4,036.07""
Library District,""2,017.87""
Total tax,""$2,924.69""
First installment due,""October 2, 2026""
Second installment due,""October 21, 2026""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-1a9fede7e428970ea7a7359a,v11-PROPERTY_TAX_BILL-csv,original,2026,fgen-15a3db011e66d831e80739e5,synthetic_programmatic_template,csv,top,False,installment_notice
"Cedar County Tax Office
Parcel number,18-73-363-66
Property location,""9586 Elm Park Pl Brookhaven, PA 14270""
Owner,Amara Moreau
Assessed value,""$84,608.39""
Homestead exemption,""$3,884.62""
Tax rate,8.7132%
Taxing district,Amount
Community College 502,""4,358.27""
Library District,875.98
Park District,504.06
School District 204,""4,485.97""
Total tax,""$1,675.82""
First installment due,""June 25, 2023""
Second installment due,2023-12-22
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-cb850692f601993c47eec4bf,v11-PROPERTY_TAX_BILL-csv,original,2023,fgen-20747386b5d7371e208395ef,synthetic_programmatic_template,csv,none,False,annual_bill
"Property Tax Payment Receipt
Cedar County Tax Office
Parcel number,91-72-364-32
Property location,""1486 Granite St Maplewood, MN 37091""
Owner,Priya Nguyen
Assessed value,""$400,413.94""
Homestead exemption,""$6,538.28""
Tax rate,1.1289%
Taxing district,Amount
Community College 502,""2,122.79""
County General,""3,410.19""
Park District,""3,190.31""
City of Testville,""2,254.48""
Total tax,""$6,324.63""
First installment due,1/17/22
Second installment due,2/4/22
Amount paid,""$3,162.31""
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-54f02053fa12365429a0c0d1,v11-PROPERTY_TAX_BILL-csv,original,2022,fgen-d3ad7674d60b3de292997c15,synthetic_programmatic_template,csv,top,False,paid_receipt
"Lake County Collector
Parcel number,43-26-345-97
Property location,""4465 Granite St Riverton, WI 98533""
Owner,Casey Okafor
Assessed value,""$166,567.37""
Homestead exemption,""$4,661.09""
Tax rate,3.7628%
Taxing district,Amount
Community College 502,""3,847.92""
County General,100.57
Park District,""3,509.48""
City of Testville,""1,746.36""
Total tax,""$2,714.21""
First installment due,2/8/22
Second installment due,04/07/2022",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-3420ff965e968b18e9609dfb,v11-PROPERTY_TAX_BILL-csv,original,2022,fgen-a062c7dae716d35613c4fcd3,synthetic_programmatic_template,csv,none,False,annual_bill
"Marion County Treasurer
Parcel number,15-68-881-52
Property location,""4094 Lakeshore Blvd Testville, IL 91271""
Owner,Diego Adeyemi
Assessed value,""$433,704.71""
Homestead exemption,""$4,965.57""
Tax rate,8.2904%
Taxing district,Amount
Community College 502,""1,124.44""
School District 204,""2,656.29""
Library District,""1,239.50""
Park District,568.42
Total tax,""$1,394.83""
First installment due,""July 7, 2023""
Second installment due,11/15/23
Amount paid,$697.41
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-9579293fbacc9b466182ec5a,v11-PROPERTY_TAX_BILL-csv,original,2023,fgen-aba369af3fe9965fadecc685,synthetic_programmatic_template,csv,none,False,paid_receipt
"Cedar County Tax Office
Parcel number,36-38-648-52
Property location,""5690 Cedar Ln Lakewood, CO 80394""
Owner,TaylorSato
Assessed value,""S171,065.51""
Homestead exemption,""$1,566.18""
Tax rate,8.3933%
Taxing district,Amount
Library District,883.O9
Community Collcge 502,""1,771.62""
City of Testville,708.14
Park District,""1,338.09""
Total tax,""$14,055.35""
First insta1lmcnt due,""May 14, 2026""
5econd installment due,08/09/2026",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-a0c453cda60807b486a1fdf6,v11-PROPERTY_TAX_BILL-csv,original,2026,fgen-420124a1a6f6e053381301d4,synthetic_programmatic_template,csv,none,True,annual_bill
"Harbor County Treasurer
Parcel number,57-48-451-64
Property location,""897 Sample Street Bayside, WA 34743""
Owner,Diego Testcase
Assessed value,""$453,395.99""
Homestead exemption,""$4,136.00""
Tax rate,3.7302%
Taxing district,Amount
County General,""1,731.73""
City of Testville,""4,522.49""
Park District,""2,678.09""
Library District,162.69
Total tax,""$7,979.33""
First installment due,6/13/21
Second installment due,10/16/2021
If your taxes are paid through an escrow account, forward this bill to your mortgage company.
Second Installment Property Tax Notice",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-32e50703bd7f184b8fb7b592,v11-PROPERTY_TAX_BILL-csv,original,2021,fgen-fe0da5c7e826d96de06b209b,synthetic_programmatic_template,csv,bottom,False,installment_notice
"2024 Real Estate Property Tax Bill
Marion County Treasurer
Parcel number,78-98-886-88
Property location,""6173 Maple Ridge Dr Oak Grove, TX 87438""
Owner,Olivia Adeyemi
Assessed value,""$157,778.55""
Homestead exemption,""$3,488.47""
Tax rate,9.0008%
Taxing district,Amount
Park District,""3,790.42""
City of Testville,""4,708.89""
School District 204,""2,207.59""
Library District,""2,245.27""
Total tax,""$11,559.25""
First installment due,11/23/24
Second installment due,05/04/2024
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-b771f9b4ca2f2b10945ebd4e,v11-PROPERTY_TAX_BILL-csv,original,2024,fgen-050287e89a6ad597c4d1975a,synthetic_programmatic_template,csv,top,False,annual_bill
"2023 Real Estate Property Tax Bill
Harbor County Treasurer
Parcel number,62-38-748-36
Property location,""7182 Lakeshore Blvd Riverton, WI 66430""
Owner,Jamie M. Testcase
Assessed value,""$394,457.20""
Homestead exemption,""$4,395.15""
Tax rate,2.2352%
Taxing district,Amount
Community College 502,""2,864.11""
Library District,""2,139.59""
School District 204,""4,114.61""
City of Testville,""1,188.38""
Total tax,""$7,449.46""
First installment due,4/8/23
Second installment due,06/27/2023",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-81133a61bdbc87a44fa140aa,v11-PROPERTY_TAX_BILL-csv,original,2023,fgen-7693f89e11d33a1ccbdc392b,synthetic_programmatic_template,csv,top,False,annual_bill
"Second Installment Property Tax Notice
Cedar County Tax Office
Parcel number,93-77-441-28
Property location,""1396 Harbor View Rd Riverton, WI 35511""
Owner,Wei Sato
Assessed value,""$607,610.44""
Homestead exemption,""$6,542.03""
Tax rate,6.0169%
Taxing district,Amount
County General,""3,331.18""
School District 204,""4,147.95""
City of Testville,""4,246.68""
Community College 502,""3,666.55""
Total tax,""$6,222.26""
First installment due,""August 7, 2023""
Second installment due,08/16/2023",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-4e2d51319b1a785a08644e89,v11-PROPERTY_TAX_BILL-csv,original,2023,fgen-cf7744d9b70b315569422932,synthetic_programmatic_template,csv,top,False,installment_notice
"2026 Real Estate Property Tax Bill
Cedar County Tax Office
Parcel number,98-79-137-54
Property location,""9031 Cedar Ln Pinecrest, GA 24286""
Owner,Amara E. Patel
Assessed value,""$118,721.06""
Homestead exemption,""$9,424.58""
Tax rate,7.8042%
Taxing district,Amount
School District 204,501.79
Library District,""4,188.19""
Park District,""4,912.92""
County General,536.42
Total tax,""$12,366.97""
First installment due,2026-01-02
Second installment due,11/26/26
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-294328e62d253b2a1b1855a7,v11-PROPERTY_TAX_BILL-csv,original,2026,fgen-48feed0233f882e82991338c,synthetic_programmatic_template,csv,top,False,annual_bill
"Property TaxPayment Receipt
Lakc County Collector
Parcel number,45-84-731-72
Property location,""5773 Prairie Ave Brookhaven, PA 24564""
Owner,Taylor Nguyen
Assessed value,""$487,191.6O""
Homestead exemption,""$7,732.93""
Tax rate,3.1543%
Taxing district,Amount
County General,""2,837.57""
Library District,""l,067.70""
Park District,""4,129.46""
5chool District 204,""3,417.23""
Tota1 tax,""$13,065.16""
First installment due,11/20/2021
Second installment due,11/24/2021
Amount paid,""$6,532.58""",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-055e5ec51e49d5c9067bb00b,v11-PROPERTY_TAX_BILL-csv,original,2021,fgen-681e17d035a3f337b3aed76c,synthetic_programmatic_template,csv,top,True,paid_receipt
"Property Tax Payment Receipt Harbor County Treasurer Parcel number 32-10-330-38 Property location 5441 Willow Bend
Way Lakewood, CO 66535 Owner Hiro Okafor Assessed value $328,951.59 Homestead exemption $1,075.21 Tax rate 4.0566% Taxing district Amount Community
College 502 1,952.12 Park District 140.27 School District 204 3,907.34 City of Testville 3,151.57 Total tax $13,043.32 First installment due 6/17/25 Second installment due 11/1/25 Amount paid $6,521.66",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-1771dbd7b1d272ca9e1cc2ac,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-71e21dc4ce75140c04cb898f,synthetic_programmatic_template,flat,top,False,paid_receipt
"2025 Real Estate Property Tax Bill Harbor County Treasurer Parcel number 78-32-935-58 Property location 4105
Maple Ridge Dr Oak Grove, TX 71158 Owner Lena Fischer Assessed value $322,080.52 Homestead exemption $2,649.33 Tax rate 5.0591% Taxing district Amount County General 3,558.95
Library District 1,883.94 City of Testville 755.26 School District 204 4,760.22 Total tax $1,814.26 First installment due 2025-10-05 Second installment due February 4, 2025",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-400aa12d4d6489ef8234fdec,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-53e0ccd24a1227a3d9121872,synthetic_programmatic_template,flat,top,False,annual_bill
"Second Installment Property Tax Notice Lake County Collector Parcel number
83-31-391-74
Property location 7907 Sample Street Lakewood, CO 56062 Owner Avery B. Rivera Assessed value $580,454.10 Homestead exemption $2,889.72 Tax rate 6.5213% Taxing district Amount Community College 502 3,266.10 Library District 4,929.78 School District 204 4,806.90 Park District 4,968.39 Total tax $4,207.38 First installment due 2/13/25 Second installment due 8/19/25",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-07f1b0e8fe89f9639dbbd50a,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-d6603b30e7ac28f42f98ab2d,synthetic_programmatic_template,flat,top,False,installment_notice
"2023 Real Estate Property
Tax Bill Cedar County Tax Office Parcel number 44-32-440-30 Property location 1361 Lakeshore Blvd Oak Grove, TX 10791 Owner Diego Okafor Assessed value $626,178.39 Homestead exemption $7,410.65 Tax rate 1.8701% Taxing district Amount Community College 502 1,161.70 Library District 2,427.78 Park District 4,067.06 School District 204 2,882.81 Total tax $4,385.52 First installment due October 4,
2023 Second installment due 1/14/23",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7282b174ac4365d73636ba93,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-b323e1f357150dd2d282cf49,synthetic_programmatic_template,flat,top,False,annual_bill
"Second Installment Property Tax Notice Harbor County Treasurer Parcel number
96-44-446-61 Property location 9079 Oak Hollow Ct Oak Grove, TX 70759 Owner Mateo Lindqvist Assessed value $97,186.93 Homestead exemption $6,596.05 Tax rate 8.7440% Taxing district Amount City of Testville 2,348.81 Park District 4,426.40 Library District 4,193.53 County General 4,204.01 Total tax $7,206.73 First installment due 2023-02-16 Second installment due 2023-11-07 If your taxes
are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-641deb2e3f016bf82fa7c090,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-03494c32151d60b7f7d0ee51,synthetic_programmatic_template,flat,top,False,installment_notice
"Harbor County Treasurer Parcel number 14-66-715-50 Property location 7707 Harbor View Rd Cedar Falls, IA 76624 Owner Noah L. Walsh Assessed value $165,991.14 Homestead exemption $171.48 Tax rate
1.5024% Taxing district Amount City of Testville 4,401.68 Community College 502 967.47 Park
District 3,451.19 Library District 3,228.23 Total tax $10,368.43 First installment due April 11, 2021 Second installment due 2021-07-19 Amount paid $5,184.22",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-deaee8f171dbcc725c8c0779,v11-PROPERTY_TAX_BILL-flat,original,2021,fgen-50d8f171f12e31414eecea2d,synthetic_programmatic_template,flat,none,False,paid_receipt
"Property Tax Payment Receipt Cedar County Tax Office Parcel number 73-95-510-61 Property location 3860 Granite St Cedar Falls, IA 37199 Owner Fatima
M. Okafor Assessed value $655,711.32 Homestead exemption $8,315.29 Tax rate 8.4811% Taxing district Amount Park District 1,871.66
City of Testville 3,894.19 Library District 2,149.81 Community College 502 1,982.47 Total tax $7,135.96 First installment due 7/13/21 Second installment due June 12, 2021 Amount paid $3,567.98",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-5f448e911bcd6406e4122cf1,v11-PROPERTY_TAX_BILL-flat,original,2021,fgen-5f0aa4536787f1c51ec204de,synthetic_programmatic_template,flat,top,False,paid_receipt
"Property Tax Payment Receipt Lake County Collector Parcel number 66-23-910-50
Property location 5593 Harbor View Rd Oak Grove, TX 89746 Owner Priya Sato Assessed value $354,677.11 Homestead exemption $8,248.50 Tax rate 2.7831% Taxing district Amount Park District 2,333.80 County General 4,434.94 City of Testville 3,489.51 School District
204 4,717.76 Total tax $6,916.69 First installment due 04/20/2026 Second installment due October 11, 2026 Amount paid $3,458.35 If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-e1881953b3605a442a4e2e59,v11-PROPERTY_TAX_BILL-flat,original,2026,fgen-2d255a3d4f30c18c3faf0d1f,synthetic_programmatic_template,flat,top,False,paid_receipt
"Second Installment Property Tax Notice Cedar County Tax Office Parcel number 86-44-577-25 Property location 5457 Granite St Riverton, WI 87713 Owner Mateo R. Testcase Assessed value $360,873.04 Homestead exemption $3,857.24 Tax
rate 4.0167% Taxing district
Amount Community College 502 3,828.05 Park District 4,048.31 County General 3,527.16 City of Testville 3,377.50 Total tax $13,761.90 First installment due 12/02/2024 Second installment due 2024-09-16 If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-d62f403c6beb148bc1452a97,v11-PROPERTY_TAX_BILL-flat,original,2024,fgen-151e1369d0c3202a46319fd1,synthetic_programmatic_template,flat,top,False,installment_notice
"Lake County Collector Parcel number 57-19-563-67 Property location 5063 Willow Bend Way Oak Grove, TX 22088 Owner Riley E. Haddad Assessed value $519,608.48 Homestead exemption $5,613.99 Tax rate 3.4454% Taxing
district Amount City of Testville 4,948.35 Community College 502 1,222.09 Park District 1,162.39 School District 204 4,690.27 Total tax $10,730.18 First installment due 2023-10-17 Second installment due 9/17/23 Amount
paid $5,365.09 Property Tax Payment Receipt",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-61dce221eba22811c6acc6bd,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-ff8d1594ba9fe0b86aa9ac6f,synthetic_programmatic_template,flat,bottom,False,paid_receipt
"Property Tax Payment Receipt Harbor County TreasurerParcel number 92-63-703-64 Property
location 7328 Prairie Ave Cedar Falls, IA 64663 Owner Kwame A. Okafor Assessedvalue $386,380.67 Homestead exemption $4,257.66
Tax rate 3.7662% Taxing district Amount County General 4,337.56 5chool District 204 3,043.83 Park District 3,3l2.25 Community College 502 4,958.13 Tota1 tax $11,115.68 First installment due June 12, 2025 5econd installment due 01/10/2025 Amount paid $5,557.84",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-5cb3470766ee6881557f15a1,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-ff9398248f8d4b2a0b0254dd,synthetic_programmatic_template,flat,top,True,paid_receipt
"2021 Real Estate Property Tax Bill Harbor County Treasurer Parcel number
47-53-843-67 Property location 6436 Willow Bend Way Brookhaven, PA 10760 Owner Morgan R. Haddad Assessed value $625,435.72 Homestead exemption $3,240.17 Tax rate 2.7334% Taxing district Amount School District 204 333.02 County General 992.13 Community College 502
4,197.39 Park District 4,611.95 Total tax $14,560.15 First installment due 09/10/2021 Second installment due 6/4/21 If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-39961dee12d77595fb301b57,v11-PROPERTY_TAX_BILL-flat,original,2021,fgen-8e4ac1aa37cc8bdfb7dc23dc,synthetic_programmatic_template,flat,top,False,annual_bill
"Second Installment Property Tax
Notice Harbor County Treasurer Parcel number 98-29-898-71 Property location 7979
Sample Street Lakewood, CO 69550 Owner Noah L. Larsen Assessed value $693,703.52 Homestead exemption $6,476.83 Tax rate 6.5814% Taxing district Amount Park District 527.52 Library District 4,899.74 City of Testville 1,089.91 School District 204 1,964.97 Total tax $12,265.59 First installment due 11/4/23 Second installment due August 9, 2023",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-3b77f8611ae4b4613abd512d,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-b0c6322cccef3bfa6950454c,synthetic_programmatic_template,flat,top,False,installment_notice
"Property Tax Payment Receipt Cedar County Tax Office Parcel number 57-15-180-70 Property location 1232
Granite St Maplewood, MN 27810 Owner Riley Rivera Assessed value $668,507.42 Homestead exemption $2,312.47 Tax rate 9.6736% Taxing district Amount City of Testville 4,385.43 Library District 3,444.70 Community College 502 4,507.43 County
General 2,946.11 Total tax $11,875.59 First installment due 7/18/24 Second installment due 04/23/2024 Amount paid $5,937.79",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-1d770a7216e249553561650a,v11-PROPERTY_TAX_BILL-flat,original,2024,fgen-cd38565b19b68129332202e9,synthetic_programmatic_template,flat,top,False,paid_receipt
"Second Installment Property Tax Notice MarionCounty Treasurer Parcel number 64-74-256-58 Property location l759 Maple Ridge Dr Fairview, OH87823 Owner Alex Walsh Assessed value S611,OO9.41
Homestead exemption $8,O14.72 Tax rate 9.0786% Taxing district Amount Library District 3,865.59 City of Testville 1,898.69 Community College 502 4,107.86 Park District 3,568.81 Total tax $4,227.08 First installment due 12/22/25 Second installment due December
11, 2025",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-aea5e2630ef84de862ad51ae,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-2031ccc99aaa43574d84b998,synthetic_programmatic_template,flat,top,True,installment_notice
"Harbor County Treasurer Parcel number 31-20-972-59 Property location 6706 Harbor View Rd Cedar Falls, IA 85362 Owner Alex Sato Assessed value $342,369.02 Homestead exemption $125.64 Tax rate 1.5584% Taxing district Amount City of Testville 845.69 Park District 1,344.33 Community College 502 2,718.85 County General
799.38 Total tax $15,798.71 First installment due 12/18/25 Second
installment due 11/16/2025 If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-bfefcbc060bf229c5d784bfb,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-096bc0100eedbb7ab3be1057,synthetic_programmatic_template,flat,none,False,installment_notice
"Marion County Treasurer
Parcel number 19-11-399-79 Property location 387 Harbor View Rd Brookhaven, PA
11919 Owner Noah B. Nguyen Assessed value $531,008.87 Homestead exemption $9,417.43 Tax rate 8.0284% Taxing district Amount Library District 3,810.64 School District 204 2,600.99 Community College 502 477.22 City of Testville 4,085.24 Total tax $12,572.66 First installment due 2022-03-02 Second installment due 2022-07-26 If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-5c8bc18bbb82994007a6a266,v11-PROPERTY_TAX_BILL-flat,original,2022,fgen-e297c6647e8ecfceca4b9a11,synthetic_programmatic_template,flat,none,False,installment_notice
"Marion County Treasurer Parcel number 68-50-568-67
Property locatíon 4452 Prairie Ave Oak Grove, TX93322 0wner Priya Brennan Assessed value $429,032.42 Homestead exemption $7,533.34 Tax rate 1.4060% Taxing district AmountLibrary District 3,651.82 Community College 502 2,370.38 Park District 3,628.51 School District 204 3,243.84
Total tax $1,537.11 First installment due O4/25/2023 Second installment due 03/09/2023",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-13300d6d8938015feae7794b,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-45d3fab96bee053ac244af45,synthetic_programmatic_template,flat,none,True,installment_notice
"Property Tax Payment Receipt Lake County Collector Parcel number 69-37-720-10 Property location 7993 Maple
Ridge Dr Brookhaven, PA 10484 Owner Priya Larsen Assessed value $517,834.83 Homestead
exemption $7,582.43 Tax rate 2.8607% Taxing district Amount Community College 502 4,955.75 County General 1,521.21 Park District 4,763.86 Library District 3,798.16 Total tax $11,741.99 First installment due 12/2/22 Second installment due 12/6/22 Amount paid $5,870.99 If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-b0bb6a642b5709773fc7f3c8,v11-PROPERTY_TAX_BILL-flat,original,2022,fgen-bbf2cfa037dd3a24148c6f6f,synthetic_programmatic_template,flat,top,False,paid_receipt
"Property Tax
Payment Receipt Cedar County Tax Office Parcel number 26-87-712-94 Property location 7915 Harbor View Rd Testville, IL 93577 Owner Wei Fischer Assessed value $134,618.17 Homestead exemption $7,536.78 Tax rate 5.0877% Taxing district Amount Library District 4,563.57 City of Testville 4,397.03 Park District 725.28 County General 1,183.47 Total
tax $10,728.63 First installment due March 18, 2021 Second installment due 2021-11-02 Amount paid $5,364.32",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-213c29a2ff64f32cc34b0d21,v11-PROPERTY_TAX_BILL-flat,original,2021,fgen-cf05f8a57bcd4ff89d811902,synthetic_programmatic_template,flat,top,False,paid_receipt
"Second Installment Property Tax Notice Lake County Collector Parcel number 60-23-240-87 Property location 4486 Maple Ridge Dr Cedar Falls, IA 88392 Owner Morgan Fischer Assessed value
$483,694.64 Homestead
exemption $2,978.33 Tax rate 4.5330% Taxing district Amount County General 2,122.83 Library District 1,260.78 School District 204 1,825.06 Park District 4,360.53 Total tax $6,061.63 First installment due 12/24/2022 Second installment due 2022-05-21",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-4f099f945daabc4c2b528a88,v11-PROPERTY_TAX_BILL-flat,original,2022,fgen-f7a326db86ca482ffead9ed1,synthetic_programmatic_template,flat,top,False,installment_notice
"Harbor County Treasurer Parcel
number 10-31-121-38 Property location 6840 Willow Bend Way Lakewood, CO 81617 Owner Casey Okafor Assessed value $100,645.42 Homestead exemption $951.60 Tax rate 3.0867% Taxing district Amount County General 396.55 Library District 996.54 City of Testville 2,585.97 School District 204 3,086.29 Total tax $13,920.45 First installment due December 24, 2021 Second installment due 10/22/2021 Amount paid $6,960.22 If your taxes are paid through an escrow account, forward this bill to your mortgage company. Property Tax Payment
Receipt",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-aaf359ac86f3eefdf8052216,v11-PROPERTY_TAX_BILL-flat,original,2021,fgen-2aea13387c10045ead7abc3b,synthetic_programmatic_template,flat,bottom,False,paid_receipt
"Marion County Treasurer Parcel number 22-75-727-79 Property location
1097 Maple Ridge Dr Maplewood, MN 18487 Owner Diego K. Haddad Assessed value $272,656.56 Homestead exemption $4,630.12 Tax rate 7.9329% Taxing district Amount Park
District 2,859.61 Community College 502 2,359.77 Library District 3,638.45 School District 204 2,982.23 Total tax $14,076.98 First installment due 2025-11-12 Second installment due 2025-05-20",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-0bf6f08c2313d4f6d123f0fc,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-c2b7df547fdab37389a91e8b,synthetic_programmatic_template,flat,none,False,annual_bill
"Second Installment Property Tax Notice Marion County Treasurer Parcel number 69-88-984-72 Property location 1068 Granite
St Maplewood, MN 50617 Owner Fatima B. Fischer Assessed value $513,305.33 Homestead exemption $3,531.98 Tax rate 8.5548% Taxing district Amount School District 204 2,172.17 County General 894.17 Park District 644.77 Library District 408.56 Total tax $11,897.87 First
installment due 1/26/23 Second installment due 2023-10-09",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-9137f5787456ccecc345c4b1,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-ad6ade2737e59619c7ed9929,synthetic_programmatic_template,flat,top,False,installment_notice
"2024 Real Estate Property Tax Bill Lake County Collector Parcel number 84-38-719-82 Property location 9344 Sample Street Riverton, WI 17460 Owner Wei Nguyen Assessed value $460,589.28 Homestead exemption $7,608.17 Tax rate 8.3786% Taxing district Amount City of Testville 3,170.34 Library District 1,459.59 County General 4,150.97 Community College 502 2,829.99 Total tax $9,960.66 First installment due 7/17/24 Second installment due 2024-06-22 If your taxes
are paid
through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-77110001c377df3dfddc14c4,v11-PROPERTY_TAX_BILL-flat,original,2024,fgen-31f11cfb85483ec85b01de10,synthetic_programmatic_template,flat,top,False,annual_bill
"Second Installment Property Tax Notice
Harbor County Treasurer Parcel number 15-57-529-67 Property location 5625 Sample Street Maplewood, MN 16882 Owner Kwame Rivera Assessed value $600,516.31 Homestead exemption $5,929.46 Tax rate 6.9132% Taxing district Amount Community College 502 2,716.33 County General 1,495.04 Library District 280.54 School District 204 1,917.61 Total tax
$13,452.31 First installment due 2023-07-07 Second installment due October 4, 2023",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-f7617e5fc663cb458c2e594d,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-90c93aeb6a1f21b7fd725fda,synthetic_programmatic_template,flat,top,False,installment_notice
"Property Tax
Payment Receipt Harbor County Treasurer Parcel number 34-83-912-72 Property location 2741 Granite St Brookhaven, PA 55585 Owner Lena B. Patel Assessed value $129,959.69 Homestead exemption $2,396.61 Tax rate 7.7102% Taxing
district Amount County General 1,699.01 Community College 502 2,525.09 Library District 4,579.88 School District 204 467.12 Total tax $9,927.91 First installment due 4/19/23 Second installment due 2023-04-11 Amount paid $4,963.96",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-9424a2a51be1e3f1c399f32e,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-bab8dce43d6c382c0ca8781b,synthetic_programmatic_template,flat,top,False,paid_receipt
"Harbor County Treasurer Parcel number 55-67-585-35 Property location 2737 Harbor View Rd Bayside, WA 30231 Owner
Kwame Tanaka Assessed value $158,853.94 Homestead exemption $1,698.62 Tax rate 9.6109% Taxing district Amount Community College 502 4,459.74 City of Testville 3,901.23 School District 204 4,102.80 Library District 484.78 Total tax $1,874.38 First installment due November 25, 2024 Second installment due July 14, 2024 If your taxes are paid through an
escrow account, forward this bill to your mortgage company. 2024 Real Estate Property Tax Bill",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-af6c817ea49fdbabdd1325ba,v11-PROPERTY_TAX_BILL-flat,original,2024,fgen-5e1ff32a07d00fe2d54ad989,synthetic_programmatic_template,flat,bottom,False,annual_bill
"Second Installment Property Tax Notice Marion County Treasurer Parcel number 74-56-108-18 Property location 6765 Granite St Lakewood, CO 59030 Owner Hiro Sato Assessed value $484,963.61 Homestead exemption $1,726.65 Tax rate 9.7784% Taxing district Amount County General 1,439.63 City of Testville 2,860.55 Community College 502 4,687.44 School District 204 2,877.21
Total tax $2,748.70
First installment due 8/21/25 Second installment due January 18, 2025 If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-8c38995daf59ebbeef788e9e,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-2232dddc4ed80fcf3667f74d,synthetic_programmatic_template,flat,top,False,installment_notice
"Second Installment Property Tax Notice
Cedar County Tax 0fficeParcel number 80-75-697-74 Property location 4078 Granite 5t Lakewood, CO 92652 Owner Mateo M. Tanaka Assessed value $530,997.63 Homestead exemption $9,035.88 Tax rate 4.2088% Taxing district Amount School District 204 4,200.00 City of Tcstville 4,496.72
Library District l,998.37 Community College502 l,918.98 Total tax $7,553.14 First insta1lment due June 10, 2023 Second installment due 2023-11-12",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-6bc94a196c0e7c562c84c714,v11-PROPERTY_TAX_BILL-flat,original,2023,fgen-ddb516414ec3eb007d07661e,synthetic_programmatic_template,flat,top,True,installment_notice
"2025 Real Estate Property Tax Bill Cedar County Tax Office Parcel number 15-41-216-76 Property location 284 Elm Park Pl Lakewood, CO 31713 Owner Amara S. Lindqvist Assessed value $323,142.39 Homestead exemption $2,595.61 Tax rate 1.5599% Taxing district Amount Library District 2,064.74 School District 204 3,689.85 Park District 3,215.99 Community College 502 706.07 Total tax $5,823.35 First
installment due 2025-07-15 Second installment due 1/2/25 If your taxes are paid
through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-853dd0227d98dde63fea1e60,v11-PROPERTY_TAX_BILL-flat,original,2025,fgen-9342583f7a66398672644643,synthetic_programmatic_template,flat,top,False,annual_bill
"Property Tax Payment Receipt Marion County Treasurer Parcel number 62-69-529-73 Property location 3960 Sample Street Pinecrest, GA 88334 Owner Avery Haddad Assessed value $93,595.00 Homestead exemption $3,206.25 Tax
rate 7.7680% Taxing district Amount Community College 502 2,906.10 Library District 451.28 County General 884.15 City of Testville 1,705.75 Total tax $11,697.09 First installment due
05/09/2021 Second installment due October 24, 2021 Amount paid $5,848.55",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-52c7b3fca851a381f45ba34f,v11-PROPERTY_TAX_BILL-flat,original,2021,fgen-9bf0f9cd9b09449312599327,synthetic_programmatic_template,flat,top,False,paid_receipt
"2024 Real Estate Property Tax Bill
Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 49-66-198-85 |
| Property location | 8648 Sample Street Oak Grove, TX 75306 |
| Owner | Priya Patel |
| Assessed value | $593,653.20 |
| Homestead exemption | $3,208.80 |
| Tax rate | 7.0766% |
| Taxing district | Amount |
| --- | --- |
| School District 204 | 807.81 |
| Library District | 1,744.83 |
| County General | 2,769.88 |
| Community College 502 | 4,078.19 |
| Field | Value |
| --- | --- |
| Total tax | $13,056.75 |
| First installment due | 5/25/24 |
| Second installment due | April 16, 2024 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-35d6df86eba53e38d82eb25c,v11-PROPERTY_TAX_BILL-markdown,original,2024,fgen-ae1835bcc8e14d2aedbdd303,synthetic_programmatic_template,markdown,top,False,annual_bill
"Property Tax Payment Receipt
## CedarCounty Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 26-l2-595-18 |
| Property location | 4976 PrairieAve Bayside, WA 73581 |
| Owner | Jamie B. Adeyemi |
| Assessed value | $6l2,183.63 |
| Homestead exemption | $7,198.96 |
| Tax rate | 1.2386% |
| Taxing district | Amount |
| --- | --- |
| Park District | 2,434.46 |
| Community College 502 | 4,345.94 |
| City of Testville | 2,242.93|
| School Dístrict 204 | 2,648.32 |
| Ficld | Value |
| --- | --- |
| Total tax |$4,464.14 |
| First installment due | 2026-07-04 |
| Second installment due | February 27, 2026 |
| Amount paid | $2,232.07|
If your taxes are paid through an escrow account, forward this bi1l to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-f4b5926e024a66341920589e,v11-PROPERTY_TAX_BILL-markdown,original,2026,fgen-b4ff22bca6a3c641fbe12234,synthetic_programmatic_template,markdown,top,True,paid_receipt
"## Lake County Collector
| Field | Value |
| --- | --- |
| Parcel number | 53-50-937-51 |
| Property location | 8696 Willow Bend Way Cedar Falls, IA 71648 |
| Owner | Hiro A. Larsen |
| Assessed value | $625,867.46 |
| Homestead exemption | $3,486.79 |
| Tax rate | 6.4617% |
| Taxing district | Amount |
| --- | --- |
| Community College 502 | 2,993.35 |
| Park District | 787.15 |
| School District 204 | 4,584.03 |
| County General | 3,386.54 |
| Field | Value |
| --- | --- |
| Total tax | $5,215.68 |
| First installment due | November 1, 2026 |
| Second installment due | April 13, 2026 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-5b58340b881b40cc9581a39f,v11-PROPERTY_TAX_BILL-markdown,original,2026,fgen-e1b2b6db2877e99dadf6c0c7,synthetic_programmatic_template,markdown,none,False,installment_notice
"2025 Real Estate Property Tax Bill
## Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 56-77-902-46 |
| Property location | 1275 Sample Street Pinecrest, GA 15077 |
| Owner | Alex K. Larsen |
| Assessed value | $596,045.72 |
| Homestead exemption | $6,783.96 |
| Tax rate | 2.7680% |
| Taxing district | Amount |
| --- | --- |
| City of Testville | 1,771.73 |
| Community College 502 | 2,752.73 |
| Library District | 439.91 |
| Park District | 1,016.26 |
| Field | Value |
| --- | --- |
| Total tax | $15,684.12 |
| First installment due | 9/2/25 |
| Second installment due | 10/4/25 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-e70f0b28c800ebf57e8d1e27,v11-PROPERTY_TAX_BILL-markdown,original,2025,fgen-656e56740908a1dcfbaf1777,synthetic_programmatic_template,markdown,top,False,annual_bill
"2026 Real Estate Property Tax Bill
## Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 38-39-436-81 |
| Property location | 1707 Lakeshore Blvd Lakewood, CO 40429 |
| Owner | Lena Kowalski |
| Assessed value | $323,540.56 |
| Homestead exemption | $264.88 |
| Tax rate | 1.9482% |
| Taxing district | Amount |
| --- | --- |
| Library District | 608.67 |
| School District 204 | 4,772.23 |
| Community College 502 | 2,805.41 |
| City of Testville | 4,173.40 |
| Field | Value |
| --- | --- |
| Total tax | $8,302.35 |
| First installment due | 11/17/26 |
| Second installment due | 11/28/2026 |
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-4f060aa3a73eea9a1169a953,v11-PROPERTY_TAX_BILL-markdown,original,2026,fgen-ba377d10758818b4ffdb78b1,synthetic_programmatic_template,markdown,top,False,annual_bill
"2025 Real Estate Property Tax Bill
Marion County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 67-94-495-73 |
| Property location | 8279 Prairie Ave Lakewood, CO 73196 |
| Owner | Olivia E. Tanaka |
| Assessed value | $233,777.20 |
| Homestead exemption | $3,614.81 |
| Tax rate | 8.3045% |
| Taxing district | Amount |
| --- | --- |
| Park District | 132.96 |
| City of Testville | 4,358.03 |
| Community College 502 | 4,087.00 |
| County General | 3,241.41 |
| Field | Value |
| --- | --- |
| Total tax | $13,731.76 |
| First installment due | January 22, 2025 |
| Second installment due | March 6, 2025 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-ca7de1e2043b9158d8746e95,v11-PROPERTY_TAX_BILL-markdown,original,2025,fgen-c45636587e48c51ef7569624,synthetic_programmatic_template,markdown,top,False,annual_bill
"Second Installment Property Tax Notice
## Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 15-21-961-60 |
| Property location | 419 Prairie Ave Maplewood, MN 48237 |
| Owner | Alex Rivera |
| Assessed value | $459,226.14 |
| Homestead exemption | $1,470.05 |
| Tax rate | 8.6412% |
| Taxing district | Amount |
| --- | --- |
| Library District | 3,398.62 |
| Community College 502 | 3,112.90 |
| School District 204 | 1,932.17 |
| County General | 3,914.46 |
| Field | Value |
| --- | --- |
| Total tax | $14,315.53 |
| First installment due | October 6, 2024 |
| Second installment due | 8/15/24 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-f1d9752c08979ae801629439,v11-PROPERTY_TAX_BILL-markdown,original,2024,fgen-9929006369f52f5119bf8ba2,synthetic_programmatic_template,markdown,top,False,installment_notice
"Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 23-44-830-76 |
| Property location | 9665 Willow Bend Way Testville, IL 14047 |
| Owner | Diego Haddad |
| Assessed value | $234,351.72 |
| Homestead exemption | $100.95 |
| Tax rate | 3.8966% |
| Taxing district | Amount |
| --- | --- |
| Park District | 4,486.29 |
| Library District | 704.53 |
| Community College 502 | 4,203.36 |
| City of Testville | 410.23 |
| Field | Value |
| --- | --- |
| Total tax | $1,858.32 |
| First installment due | January 27, 2023 |
| Second installment due | September 19, 2023 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-235feb96367f2d973687c55a,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-0ce9bb364474a498f8fad891,synthetic_programmatic_template,markdown,none,False,annual_bill
"2021 Real Estate Property Tax Bill
Marion CountyTreasurer
| Field | Value |
| --- | --- |
| Parcel number | 8O-56-124-58 |
|Property location | 5024 Elm Park Pl Maplcwood, MN 58546 |
| Owner | Wei Castillo |
| Assessed value | S248,323.08 |
| Homesteadexemption | $8,751.16 |
| Tax rate | 6.0560% |
|Taxing district | Amount |
| --- | --- |
| Community College 502 | 3,866.22 |
| City of Testvílle | 829.38 |
| Park District | 452.11 |
| 5chool Dístrict 2O4 | 1,54O.34 |
| Field | Value |
| --- | --- |
| Totaltax | $7,710.54 |
| First installment due | November 7, 2021 |
| Second installment due | 2021-11-17 |
## If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-1e57cbb62ec93cff14e22ab8,v11-PROPERTY_TAX_BILL-markdown,original,2021,fgen-5774e96035581655f2e9dd7a,synthetic_programmatic_template,markdown,top,True,annual_bill
"Second Installment Property Tax Notice
## Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 81-13-666-52 |
| Property location | 4518 Sample Street Fairview, OH 66302 |
| Owner | Hiro J. Rivera |
| Assessed value | $451,229.43 |
| Homestead exemption | $145.93 |
| Tax rate | 1.6729% |
| Taxing district | Amount |
| --- | --- |
| Community College 502 | 4,459.97 |
| City of Testville | 4,619.98 |
| School District 204 | 1,222.44 |
| Park District | 4,300.67 |
| Field | Value |
| --- | --- |
| Total tax | $13,225.43 |
| First installment due | June 19, 2023 |
| Second installment due | 2023-08-08 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-86a863a945e8c9d6dc9c57bc,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-92869e66dbce376d6f50c764,synthetic_programmatic_template,markdown,top,False,installment_notice
"Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 33-38-927-74 |
| Property location | 8089 Prairie Ave Testville, IL 22441 |
| Owner | Taylor B. Brennan |
| Assessed value | $366,719.87 |
| Homestead exemption | $6,682.87 |
| Tax rate | 8.0835% |
| Taxing district | Amount |
| --- | --- |
| Park District | 1,438.20 |
| Community College 502 | 3,487.92 |
| County General | 945.14 |
| City of Testville | 1,722.51 |
| Field | Value |
| --- | --- |
| Total tax | $15,954.12 |
| First installment due | April 27, 2023 |
| Second installment due | December 1, 2023 |
| Amount paid | $7,977.06 |
## If your taxes are paid through an escrow account, forward this bill to your mortgage company.
Property Tax Payment Receipt",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-2373332284eb5c00be669674,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-2017b8263a4d7cd5e60e4322,synthetic_programmatic_template,markdown,bottom,False,paid_receipt
"Marion County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 53-15-761-70 |
| Property location | 9804 Maple Ridge Dr Cedar Falls, IA 19376 |
| Owner | Casey Sato |
| Assessed value | $76,753.46 |
| Homestead exemption | $7,726.92 |
| Tax rate | 6.0492% |
| Taxing district | Amount |
| --- | --- |
| City of Testville | 4,980.95 |
| County General | 1,299.45 |
| Library District | 4,274.41 |
| Community College 502 | 3,762.59 |
| Field | Value |
| --- | --- |
| Total tax | $12,395.75 |
| First installment due | 2021-10-16 |
| Second installment due | June 25, 2021 |
| Amount paid | $6,197.87 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-2dc282724ad53b8c22ed92dc,v11-PROPERTY_TAX_BILL-markdown,original,2021,fgen-c6fa099f03c8cecd0c09640c,synthetic_programmatic_template,markdown,none,False,paid_receipt
"Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 24-85-987-91 |
| Property location | 1254 Lakeshore Blvd Cedar Falls, IA 22911 |
| Owner | Alex Testcase |
| Assessed value | $391,440.67 |
| Homestead exemption | $8,487.54 |
| Tax rate | 6.2858% |
| Taxing district | Amount |
| --- | --- |
| Park District | 3,839.85 |
| School District 204 | 1,880.88 |
| County General | 4,878.38 |
| City of Testville | 2,724.05 |
| Field | Value |
| --- | --- |
| Total tax | $13,363.87 |
| First installment due | 2022-11-11 |
| Second installment due | 08/01/2022 |
| Amount paid | $6,681.94 |
## If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-14142a199268eaa04c54fcec,v11-PROPERTY_TAX_BILL-markdown,original,2022,fgen-9a2a59e7d82c4e09b4664313,synthetic_programmatic_template,markdown,none,False,paid_receipt
"Second Installment Property Tax Notice
Marion County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 56-86-694-35 |
| Property location | 7342 Sample Street Brookhaven, PA 22285 |
| Owner | Lena Fischer |
| Assessed value | $663,588.23 |
| Homestead exemption | $4,808.71 |
| Tax rate | 1.6614% |
| Taxing district | Amount |
| --- | --- |
| City of Testville | 2,345.70 |
| School District 204 | 3,057.52 |
| Park District | 1,468.72 |
| Community College 502 | 4,611.46 |
| Field | Value |
| --- | --- |
| Total tax | $14,501.26 |
| First installment due | 4/27/21 |
| Second installment due | January 1, 2021 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-4aeef9206d64cea92e442e12,v11-PROPERTY_TAX_BILL-markdown,original,2021,fgen-e5ec8d8fd64972da9beb3678,synthetic_programmatic_template,markdown,top,False,installment_notice
"Property Tax Payment Receipt
Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 28-65-519-44 |
| Property location | 1788 Maple Ridge Dr Riverton, WI 96528 |
| Owner | Jamie Brennan |
| Assessed value | $239,140.18 |
| Homestead exemption | $1,920.21 |
| Tax rate | 2.2427% |
| Taxing district | Amount |
| --- | --- |
| Library District | 3,078.72 |
| Community College 502 | 743.62 |
| Park District | 1,797.18 |
| School District 204 | 3,702.57 |
| Field | Value |
| --- | --- |
| Total tax | $13,699.16 |
| First installment due | 08/13/2023 |
| Second installment due | November 4, 2023 |
| Amount paid | $6,849.58 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-8d5338cdbc10bf62e2094e92,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-2ef04a684bde3704581c3d3b,synthetic_programmatic_template,markdown,top,False,paid_receipt
"2023 Real Estate Property Tax Bill
Marion County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 31-92-775-46 |
| Property location | 3537 Maple Ridge Dr Testville, IL 57833 |
| Owner | Fatima Castillo |
| Assessed value | $215,365.09 |
| Homestead exemption | $2,484.53 |
| Tax rate | 5.7658% |
| Taxing district | Amount |
| --- | --- |
| County General | 4,234.95 |
| City of Testville | 784.65 |
| Park District | 2,153.51 |
| School District 204 | 2,550.66 |
| Field | Value |
| --- | --- |
| Total tax | $11,469.19 |
| First installment due | 4/25/23 |
| Second installment due | 2023-11-02 |
## If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-4082745040049086bfa74dfd,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-ee6ac55c37f7d2acc4dd1ca4,synthetic_programmatic_template,markdown,top,False,annual_bill
"Second Installment Property Tax Notice
Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 64-56-721-83 |
| Property location | 8283 Sample Street Fairview, OH 57563 |
| Owner | Sofia Nguyen |
| Assessed value | $302,542.40 |
| Homestead exemption | $8,430.93 |
| Tax rate | 6.1454% |
| Taxing district | Amount |
| --- | --- |
| School District 204 | 2,220.76 |
| City of Testville | 2,518.44 |
| Library District | 421.00 |
| County General | 2,841.07 |
| Field | Value |
| --- | --- |
| Total tax | $2,505.67 |
| First installment due | 2024-07-07 |
| Second installment due | November 23, 2024 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7d4193ed9f4ffde725777b0b,v11-PROPERTY_TAX_BILL-markdown,original,2024,fgen-44915cd3735bfbe8799c0aa5,synthetic_programmatic_template,markdown,top,False,installment_notice
"Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 22-62-612-99 |
| Property location | 8243 Prairie Ave Oak Grove, TX 89142 |
| Owner | Diego Sato |
| Assessed value | $474,985.22 |
| Homestead exemption | $222.32 |
| Tax rate | 3.4262% |
| Taxing district | Amount |
| --- | --- |
| Library District | 302.10 |
| County General | 312.20 |
| Community College 502 | 3,559.34 |
| City of Testville | 288.56 |
| Field | Value |
| --- | --- |
| Total tax | $13,254.61 |
| First installment due | 2024-01-14 |
| Second installment due | 2024-06-20 |
If your taxes are paid through an escrow account, forward this bill to your mortgage company.
## 2024 Real Estate Property Tax Bill",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-fc6be4b6eba68923ecf2f8eb,v11-PROPERTY_TAX_BILL-markdown,original,2024,fgen-7a01f8c2507c6557f0805c56,synthetic_programmatic_template,markdown,bottom,False,annual_bill
"Property Tax Payment Receipt
## Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 26-43-841-63 |
| Property location | 3097 Elm Park Pl Cedar Falls, IA 39234 |
| Owner | Noah A. Romero |
| Assessed value | $464,124.34 |
| Homestead exemption | $5,473.21 |
| Tax rate | 5.9611% |
| Taxing district | Amount |
| --- | --- |
| County General | 3,164.82 |
| Library District | 3,792.92 |
| School District 204 | 4,081.62 |
| City of Testville | 1,116.06 |
| Field | Value |
| --- | --- |
| Total tax | $12,105.48 |
| First installment due | 11/16/25 |
| Second installment due | 2025-09-13 |
| Amount paid | $6,052.74 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-3a4de57c70246e4c95c9050c,v11-PROPERTY_TAX_BILL-markdown,original,2025,fgen-06f9d57433c981d57f0a12c6,synthetic_programmatic_template,markdown,top,False,paid_receipt
"Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 34-54-798-24 |
| Property location | 5O24 5ample Street Baysíde, WA 1O359 |
| Owner | Avery Haddad |
| Assessed value | $203,619.32 |
| Homesteadexemption | $4,743.68 |
| Tax rate | 9.7672% |
| Taxing district | Amount |
| --- | --- |
| Community Collcge 502 | 2,282.60 |
| School District 204 | 483.56 |
| Library District | 3,211.60 |
| City of Testville |756.10 |
| Field | Value |
| --- | --- |
| Totaltax | $3,463.49 |
| First installmcnt duc | l1/11/2026 |
| Second installmentdue | September 5, 2O26 |
## 2026 Real Estate Property Tax Bill",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-d82259da2f34c57a4891363e,v11-PROPERTY_TAX_BILL-markdown,original,2026,fgen-17a1987f27b6893ddbc314fd,synthetic_programmatic_template,markdown,bottom,True,annual_bill
"Marion County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 20-59-690-70 |
| Property location | 5932 Prairie Ave Brookhaven, PA 88867 |
| Owner | Casey E. Testcase |
| Assessed value | $140,310.51 |
| Homestead exemption | $6,786.31 |
| Tax rate | 2.5421% |
| Taxing district | Amount |
| --- | --- |
| Library District | 1,341.66 |
| School District 204 | 4,493.98 |
| County General | 579.81 |
| City of Testville | 3,549.41 |
| Field | Value |
| --- | --- |
| Total tax | $2,479.87 |
| First installment due | 12/02/2024 |
| Second installment due | April 17, 2024 |
| Amount paid | $1,239.94 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-d3054294c1febcd04db1f15b,v11-PROPERTY_TAX_BILL-markdown,original,2024,fgen-91a9297f49c6c84c57b1ed7f,synthetic_programmatic_template,markdown,none,False,paid_receipt
"2022 Real Estate Property Tax Bill
Lake County Collector
| Field | Value |
| --- | --- |
| Parcel number | 24-94-730-79 |
| Property location | 9849 Harbor View Rd Cedar Falls, IA 35378 |
| Owner | Noah E. Patel |
| Assessed value | $178,907.36 |
| Homestead exemption | $6,550.07 |
| Tax rate | 2.5639% |
| Taxing district | Amount |
| --- | --- |
| Community College 502 | 774.26 |
| Park District | 4,431.66 |
| School District 204 | 677.85 |
| Library District | 4,694.29 |
| Field | Value |
| --- | --- |
| Total tax | $3,578.23 |
| First installment due | November 24, 2022 |
| Second installment due | July 24, 2022 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7ce190f77719b2fa60e83ea1,v11-PROPERTY_TAX_BILL-markdown,original,2022,fgen-17519e3deccb8644ccea5f65,synthetic_programmatic_template,markdown,top,False,annual_bill
"Second Installment Property Tax Notice
## Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 55-80-574-57 |
| Property location | 5267 Maple Ridge Dr Maplewood, MN 66967 |
| Owner | Mateo E. Castillo |
| Assessed value | $662,866.65 |
| Homestead exemption | $1,918.02 |
| Tax rate | 7.2483% |
| Taxing district | Amount |
| --- | --- |
| Community College 502 | 1,817.27 |
| City of Testville | 3,498.19 |
| School District 204 | 4,791.88 |
| Park District | 4,837.41 |
| Field | Value |
| --- | --- |
| Total tax | $14,798.35 |
| First installment due | 06/25/2025 |
| Second installment due | June 7, 2025 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-6919457eef6473d67580822e,v11-PROPERTY_TAX_BILL-markdown,original,2025,fgen-422df7fe58a5bd52b37c23ef,synthetic_programmatic_template,markdown,top,False,installment_notice
"Second Installment Property Tax Notice
Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 41-65-791-19 |
| Property location | 5404 Maple Ridge Dr Oak Grove, TX 71480 |
| Owner | Avery Larsen |
| Assessed value | $465,441.93 |
| Homestead exemption | $3,530.25 |
| Tax rate | 1.4134% |
| Taxing district | Amount |
| --- | --- |
| City of Testville | 2,068.99 |
| County General | 4,916.22 |
| Community College 502 | 1,219.23 |
| School District 204 | 2,722.57 |
| Field | Value |
| --- | --- |
| Total tax | $6,581.23 |
| First installment due | 2022-01-23 |
| Second installment due | 8/20/22 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-154b715e7c3a102647428c2a,v11-PROPERTY_TAX_BILL-markdown,original,2022,fgen-54873ee818288bf58f7647b0,synthetic_programmatic_template,markdown,top,False,installment_notice
"## 2022 Rea1 Estate Property Tax Bill
Lake County Collector
| Fíeld | Value |
| --- | --- |
|Parcel number | 67-13-563-50 |
| Property location | 9532 Cedar Ln Lakewood, C0 902O9 |
| Owner | Sofia R. Brennan |
| Assessed value | $2O0,712.38 |
| Homestead exemption | $8,195.28 |
| Tax rate | 2.2820%|
| Taxing district | Amount |
| --- | --- |
| Library District| 1,525.91 |
| Park Dístrict | 2,949.15 |
| City of Testville | 3,889.01 |
| 5chool District 204 | 3,634.46 |
| Field | Value |
| --- | --- |
| Tota1 tax | $11,822.14 |
| First installment due | 5/23/22 |
| Second installment due | 2/2/22|
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-7552408503aef8eddd128324,v11-PROPERTY_TAX_BILL-markdown,original,2022,fgen-5807c7e7d63c435df1919d67,synthetic_programmatic_template,markdown,top,True,annual_bill
"Property Tax Payment Receipt
Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 27-72-658-32 |
| Property location | 461 Sample Street Cedar Falls, IA 67460 |
| Owner | Alex D. Lindqvist |
| Assessed value | $495,273.80 |
| Homestead exemption | $2,934.27 |
| Tax rate | 7.9251% |
| Taxing district | Amount |
| --- | --- |
| County General | 1,625.40 |
| City of Testville | 4,931.86 |
| Library District | 2,753.10 |
| Park District | 4,939.60 |
| Field | Value |
| --- | --- |
| Total tax | $2,985.52 |
| First installment due | February 19, 2022 |
| Second installment due | April 3, 2022 |
| Amount paid | $1,492.76 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-8b0df81f21ac34d26ed097ac,v11-PROPERTY_TAX_BILL-markdown,original,2022,fgen-bc58786c66e315e65a94f0b7,synthetic_programmatic_template,markdown,top,False,paid_receipt
"Property Tax Payment Receipt
Lake County Collector
| Field | Value |
| --- | --- |
| Parcel number | 75-42-259-12 |
| Property location | 991 Prairie Ave Bayside, WA 97237 |
| Owner | Priya Testcase |
| Assessed value | $222,631.05 |
| Homestead exemption | $4,952.81 |
| Tax rate | 6.9770% |
| Taxing district | Amount |
| --- | --- |
| Community College 502 | 2,720.24 |
| City of Testville | 2,522.52 |
| Park District | 2,153.08 |
| Library District | 3,102.38 |
| Field | Value |
| --- | --- |
| Total tax | $10,522.63 |
| First installment due | January 18, 2025 |
| Second installment due | 2025-03-28 |
| Amount paid | $5,261.31 |
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-b1619ec5372ca93d28a59240,v11-PROPERTY_TAX_BILL-markdown,original,2025,fgen-17c28bbd2e0049146124c6fd,synthetic_programmatic_template,markdown,top,False,paid_receipt
"## Marion County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 53-21-901-80 |
| Property location | 5842 Harbor View Rd Oak Grove, TX 81531 |
| Owner | Morgan Romero |
| Assessed value | $652,781.85 |
| Homestead exemption | $2,172.57 |
| Tax rate | 3.0359% |
| Taxing district | Amount |
| --- | --- |
| Park District | 3,844.35 |
| School District 204 | 819.43 |
| City of Testville | 1,155.29 |
| Community College 502 | 217.22 |
| Field | Value |
| --- | --- |
| Total tax | $14,083.28 |
| First installment due | January 18, 2021 |
| Second installment due | 2021-02-22 |",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-2a281f929b8ee9c62f76d8c4,v11-PROPERTY_TAX_BILL-markdown,original,2021,fgen-ad699e11525879b9fe4ae9b2,synthetic_programmatic_template,markdown,none,False,installment_notice
"## Property Tax Payment Receipt
Cedar County Tax Office
| Field | Value |
|--- | --- |
| Parcel number | 84-93-5l5-51 |
| Property locatíon | 6345 Sample Street Fairview, OH 59884 |
| Owner | Taylor C. Fischer |
| Assessed value | Sl28,305.70 |
| Homestead exemption | $9,912.56 |
| Tax rate | 1.3035% |
| Taxing district | Amount |
| --- | --- |
| 5chool District 204 | 2,425.60 |
|Park District | 4,862.53|
| Library District | 1,208.55 |
| Community Co1lege 502 | 2,030.26 |
| Field| Value|
| --- | --- |
| Total tax | $13,900.60 |
| Fírst installment due | November 8, 2023 |
| 5econd installment due | December 24, 2023 |
| Amount paid | $6,950.30 |
If your taxes are paid through an escrow account, forward this bill to your mortgagc company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-761ab60a3d3d7f1ea6549967,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-d549c5ba5e07858e17613c99,synthetic_programmatic_template,markdown,top,True,paid_receipt
"Second Installment Property Tax Notice
Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 87-53-967-59 |
| Property location | 3890 Granite St Riverton, WI 34678 |
| Owner | Diego Romero |
| Assessed value | $448,324.66 |
| Homestead exemption | $3,415.97 |
| Tax rate | 7.4736% |
| Taxing district | Amount |
| --- | --- |
| Community College 502 | 4,753.95 |
| Library District | 4,458.51 |
| Park District | 4,078.74 |
| School District 204 | 2,001.14 |
| Field | Value |
| --- | --- |
| Total tax | $6,220.28 |
| First installment due | 3/1/21 |
| Second installment due | January 24, 2021 |
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-02e61fd564cc7a9059a1b3f5,v11-PROPERTY_TAX_BILL-markdown,original,2021,fgen-382a865981e223664a682d78,synthetic_programmatic_template,markdown,top,False,installment_notice
"Second Installment Property Tax Notice
Cedar County Tax Office
| Field | Value |
| --- | --- |
| Parcel number | 29-62-502-69 |
| Property location | 4126 Maple Ridge Dr Bayside, WA 34471 |
| Owner | Jamie Romero |
| Assessed value | $659,605.33 |
| Homestead exemption | $6,356.81 |
| Tax rate | 7.6240% |
| Taxing district | Amount |
| --- | --- |
| Community College 502 | 4,305.68 |
| School District 204 | 3,064.23 |
| County General | 2,469.28 |
| Park District | 3,509.89 |
| Field | Value |
| --- | --- |
| Total tax | $5,437.22 |
| First installment due | 2023-12-16 |
| Second installment due | 5/8/23 |
If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-5cdc542ac65b905e3359d874,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-c3871fb282c903d7e3bd8437,synthetic_programmatic_template,markdown,top,False,installment_notice
"Property Tax Payment Receipt
Harbor County Treasurer
| Field | Value |
| --- | --- |
| Parcel number | 28-60-434-14 |
| Property location | 5560 Oak Hollow Ct Testville, IL 66312 |
| Owner | Alex Nguyen |
| Assessed value | $531,628.37 |
| Homestead exemption | $7,958.46 |
| Tax rate | 1.9743% |
| Taxing district | Amount |
| --- | --- |
| Library District | 3,132.97 |
| Community College 502 | 3,533.39 |
| School District 204 | 2,297.39 |
| County General | 2,702.40 |
| Field | Value |
| --- | --- |
| Total tax | $2,108.25 |
| First installment due | 2023-08-05 |
| Second installment due | April 28, 2023 |
| Amount paid | $1,054.13 |
## If your taxes are paid through an escrow account, forward this bill to your mortgage company.",PROPERTY_TAX_BILL,47,PROPERTY_TAX_BILL,fdc-8fb680c8244aa2b9d51ae787,v11-PROPERTY_TAX_BILL-markdown,original,2023,fgen-19152823939d7dbf304f1705,synthetic_programmatic_template,markdown,top,False,paid_receipt
"1390 Oak Hollow Ct Fairview, OH 73937
December 25, 2025 3:41 PM  Store 045
Item  Qty  Price
Organic Apples
3
389.62
Printer Paper 10pk
2
36.68
Subtotal
426.30
Sales tax
29.84
Total
456.14
Visa
XXX-XX-2089
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-b6ae67e0c5a3e1e533dd6575,v11-PURCHASE_RECEIPT-stacked,original,2025,fgen-53df3c3767204a262f763d68,synthetic_programmatic_template,stacked,none,False,retail
"4163 Harbor View Rd Oak Grove, TX 33167
2026-03-08 3:41 PM  Store 046
Item  Qty  Price
Drill Bit Set
2
364.16
Drill Bit Set
2
325.62
Organic Apples
1
209.25
LED Bulbs 4pk
1
265.12
Subtotal
1,164.15
Sales tax
81.49
Total
1,245.64
Visa
***-**-0418
Thank you for shopping! Returns within 30 days with receipt.
Northwind Electronics",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-36b48b9759124f7e5d130604,v11-PURCHASE_RECEIPT-stacked,original,2026,fgen-7d7ee8126ea94af2ca6ce7a3,synthetic_programmatic_template,stacked,bottom,False,retail
"1259 Elm Park Pl Cedar Falls, IA 55044
8/19/23 3:41 PM  Store 049
Item  Qty  Price
Monitor 27in
2
58.92
USB-C Cable
3
320.43
Drill Bit Set
2
321.35
Printer Paper 10pk
3
386.33
Organic Apples
1
216.74
USB-C Cable
3
268.36
Subtotal
1,572.13
Sales tax
110.05
Total
1,682.18
Visa
ending in 4489
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-e00a50a41a5cfb80b4f2239c,v11-PURCHASE_RECEIPT-stacked,original,2023,fgen-6689e052177ca7a45f59cda4,synthetic_programmatic_template,stacked,none,False,retail
"Harbor Hardware
1980 Oak Hollow Ct Brookhaven, PA 85887
January 18, 2022 3:41 PM  Store 061
Item  Qty  Price
LED Bulbs 4pk
1
310.63
LED Bulbs 4pk
2
261.64
Monitor 27in
3
256.09
USB-C Cable
1
201.30
Monitor 27in
3
374.93
Monitor 27in
1
133.78
Subtotal
1,538.37
Sales tax
107.69
Total
1,646.06
Visa
****0087
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-fd3eedd05d6aead5472f35fc,v11-PURCHASE_RECEIPT-stacked,original,2022,fgen-43f65992c3e365d30f5ef25f,synthetic_programmatic_template,stacked,top,False,retail
"Maple Market
8428 Cedar Ln Testville, IL 12049
12/10/2024 3:41 PM  Store 026
Item  Qty  Price
Printer Paper 10pk
3
36.40
USB-C Cable
1
32.65
Monitor 27in
1
4.01
LED Bulbs 4pk
3
204.42
Drill Bit Set
1
50.33
Subtotal
327.81
Sales tax
22.95
Total
350.76
Visa
ending in 1621
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-0531da47f685289e6823fc17,v11-PURCHASE_RECEIPT-stacked,original,2024,fgen-ae56e0a2d4e16163b19597be,synthetic_programmatic_template,stacked,top,False,retail
"Maple Market
2249 Elm Park Pl Fairview, OH 18708
2024-01-06 3:41 PM  Store 027
Item  Qty  Price
Drill Bit Set
3
10.40
LED Bulbs 4pk
3
262.62
Subtotal
273.02
Sales tax
19.11
Total
292.13
Visa
ending in 3349
Thank you for shopping! Rctums within 30 days withreceipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-20d5e5307af7d27047994744,v11-PURCHASE_RECEIPT-stacked,original,2024,fgen-8eea8e4e3f4c8bb6d36eb1b1,synthetic_programmatic_template,stacked,top,True,retail
"Harbor Hardware
9178 Oak Hollow Ct Oak Grove, TX 65223
03/07/2023 3:41 PM  Store 074
Item  Qty  Price
Drill Bit Set
3
168.32
LED Bulbs 4pk
1
129.67
Subtotal
297.99
Sales tax
20.86
Total
318.85
Visa
***-**-0531
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-17151d7aa0b8902fd017a3e6,v11-PURCHASE_RECEIPT-stacked,original,2023,fgen-f36ff09a7069202f36768d19,synthetic_programmatic_template,stacked,top,False,retail
"Harbor Hardware
6035 Prairie Ave Testville, IL 83749
12/01/2023 3:41 PM  Store 051
Item  Qty  Price
Drill Bit Set
3
73.26
Printer Paper 10pk
2
273.54
Printer Paper 10pk
2
324.75
Subtotal
671.55
Sales tax
47.01
Total
718.56
Visa
****3133
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8cbcfff15f03e6fc013a6674,v11-PURCHASE_RECEIPT-stacked,original,2023,fgen-a3f08abd6cca76d0f9b69eba,synthetic_programmatic_template,stacked,top,False,retail
"Maple Market
1624 Oak Hollow Ct Bayside, WA 36766
11/22/25 3:41 PM  Store 090
Item  Qty  Price
Printer Paper 10pk
2
172.24
USB-C Cable
3
128.67
Subtotal
300.91
Sales tax
21.06
Total
321.97
Visa
ending in 2240
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-6e3656324584614e8b556147,v11-PURCHASE_RECEIPT-stacked,original,2025,fgen-b05ab650020c0e59bdbf9f66,synthetic_programmatic_template,stacked,top,False,retail
"Northwind Electronics
4982 Harbor View Rd Lakewood, CO 30969
06/04/2025 3:41 PM  Store 054
Item  Qty  Price
USB-C Cable
3
3O.74
USB-C Cable
3
234.10
Printer Paper 10pk
3
321.29
Subtotal
586.13
Sales tax
41.03
Total
627.16
Visa
****8889
Thank you for shopping! Retums within 30 days withreceipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-27d9e08d2ffbf853a95d6ac4,v11-PURCHASE_RECEIPT-stacked,original,2025,fgen-af111322a3ab85ba01b852d5,synthetic_programmatic_template,stacked,top,True,retail
"Harbor Hardware
8378 Harbor View Rd Testville, IL 84104
April 12, 2023 3:41 PM  Store 049
Item  Qty  Price
USB-C Cable
3
87.93
USB-C Cable
1
243.98
LED Bulbs 4pk
1
174.30
Drill Bit Set
3
316.24
Monitor 27in
3
20.66
Organic Apples
1
173.23
Subtotal
1,016.34
Sales tax
71.14
Total
1,087.48
Visa
ending in 4864
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-d5d20143bc57055d48ba9626,v11-PURCHASE_RECEIPT-stacked,original,2023,fgen-a4bd638560fdfdd61af56043,synthetic_programmatic_template,stacked,top,False,retail
"Northwind Electronics
2348 Elm Park Pl Lakewood, CO 90552
07/15/2026 3:41 PM  Store 019
Item  Qty  Price
Printer Paper 10pk
2
145.03
LED Bulbs 4pk
3
82.89
Organic Apples
2
337.21
Organic Apples
3
202.28
Organic Apples
3
159.25
Subtotal
926.66
Sales tax
64.87
Total
991.53
Visa
XXX-XX-2151
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-64607418a403e36b8e821a6c,v11-PURCHASE_RECEIPT-stacked,original,2026,fgen-4b6457cfea9f6e27472840e8,synthetic_programmatic_template,stacked,top,False,retail
"Northwind Electronics
8833 Maple Ridge Dr Oak Grove, TX 68170
6/7/25 3:41 PM  Store 018
Item  Qty  Price
LED Bulbs 4pk
1
282.04
Printer Paper 10pk
3
69.17
Organic Apples
1
37.12
Organic Apples
2
18.97
Organic Apples
1
246.34
Subtotal
653.64
Sales tax
45.75
Total
699.39
Visa
****5886
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-94faed2572ded3832bf7eb52,v11-PURCHASE_RECEIPT-stacked,original,2025,fgen-18fd593482632fa8ed2e07cf,synthetic_programmatic_template,stacked,top,False,retail
"Northwind Electronics
2441 Cedar Ln Bayside, WA 72347
1/13/25 3:41 PM  Store 051
Item  Qty  Price
Printer Paper 10pk
1
207.95
Printer Paper 10pk
2
321.14
LED Bulbs 4pk
2
156.51
Drill Bit Set
2
364.22
Subtotal
1,049.82
Sales tax
73.49
Total
1,123.31
Visa
ending in 2384
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-6c3d0b1aa71e5fd5eb6d2d65,v11-PURCHASE_RECEIPT-stacked,original,2025,fgen-76f3fe723cb89deb0fa422ca,synthetic_programmatic_template,stacked,top,False,retail
"Northwind Electronics
7140 Sample Street Maplewood, MN 90693
2021-09-02 3:41 PM  Store 072
Item  Qty  Price
Organic Apples
3
295.32
LED Bulbs 4pk
2
265.55
LED Bulbs 4pk
2
62.24
Monitor 27in
1
148.91
Printer Paper 10pk
3
278.93
LED Bulbs 4pk
3
35.53
Subtotal
1,086.48
Sales tax
76.05
Total
1,162.53
Visa
****3995
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-a00d7b13809ffc5d636768a9,v11-PURCHASE_RECEIPT-stacked,original,2021,fgen-fe8533da7d97d7cde4c9839a,synthetic_programmatic_template,stacked,top,False,retail
"Maple Market
891 Oak Hollow Ct Maplewood, MN 61148
06/16/2021 3:41 PM  Store 097
Item  Qty  Price
Monitor 27in
2
315.33
USB-C Cable
1
258.32
Subtotal
573.65
Sales tax
40.16
Total
613.81
Visa
***-**-1589
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-d4ee370e43c509b0d5d74125,v11-PURCHASE_RECEIPT-stacked,original,2021,fgen-f564569f4e97b0f62d64c503,synthetic_programmatic_template,stacked,top,False,retail
"Northwind Electronics
1563 Granite St Cedar Falls, IA 61115
2023-10-21 3:41 PM  Store 045
Item,Qty,Price
Printer Paper 10pk,1,313.80
USB-C Cable,3,28.30
Monitor 27in,1,273.42
Monitor 27in,2,327.55
Subtotal,943.07
Sales tax,66.01
Total,""1,009.08""
Visa,XXX-XX-8480
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-c606ef568c3ef0d0efe45aa1,v11-PURCHASE_RECEIPT-csv,original,2023,fgen-8f88802ed85bea3a25479539,synthetic_programmatic_template,csv,top,False,retail
"Harbor Hardware
2145 Granite St Lakewood, CO 44031
2021-06-05 3:41 PM  Store 027
Item,Qty,Price
LED Bulbs 4pk,1,41.46
LED Bulbs 4pk,1,217.74
Subtotal,259.20
Sales tax,18.14
Total,277.34
Visa,XXXXX3362
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-713afa66696a57823d6c6e16,v11-PURCHASE_RECEIPT-csv,original,2021,fgen-a3a4f500da969ef296a275dc,synthetic_programmatic_template,csv,top,False,retail
"Northwind Electronics
5834 Willow Bend Way Brookhaven, PA 26459
2022-03-28 3:41 PM  Store 075
Item,Qty,Price
USB-C Cable,1,229.18
Monitor 27in,3,173.40
USB-C Cable,2,340.88
Monitor 27in,2,86.22
Drill Bit Set,2,304.92
Organic Apples,1,129.03
Subtotal,""1,263.63""
Sales tax,88.45
Total,""1,352.08""
Visa,****9707
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-58a255955ce31a35e503d2cd,v11-PURCHASE_RECEIPT-csv,original,2022,fgen-2f4db699d3f09e2f345b4088,synthetic_programmatic_template,csv,top,False,retail
"Maple Market
5993 Willow Bend Way Lakewood, CO 84148
05/23/2026 3:41 PM  Store 056
Item,Qty,Price
Drill Bit Set,3,154.84
Printer Paper 10pk,2,219.25
Monitor 27in,3,270.28
LED Bulbs 4pk,3,339.10
Subtotal,983.47
Sales tax,68.84
Total,""1,052.31""
Visa,XXXXX5668
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-075bdab5d7fa069fce40889e,v11-PURCHASE_RECEIPT-csv,original,2026,fgen-749761c458829443ad7449b7,synthetic_programmatic_template,csv,top,False,retail
"Maple Market
2076 Willow Bend Way Bayside, WA 63320
August 9, 2025 3:41 PM  Store 095
Item,Qty,Price
Drill Bit Set,2,357.66
Drill Bit Set,3,101.99
LED Bulbs 4pk,1,45.34
USB-C Cable,2,15.69
Drill Bit Set,2,119.31
Subtotal,639.99
Salestax,44.80
Total,684.79
Visa,XXXXX3618
Thank you for shopping! Retums within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-cc7cd9680f3a532de36cb09d,v11-PURCHASE_RECEIPT-csv,original,2025,fgen-408bce18774da68da871c792,synthetic_programmatic_template,csv,top,True,retail
"Harbor Hardware
8301 Cedar Ln Bayside, WA 91193
December 27, 2025 3:41 PM  Store 079
Item,Qty,Price
Printer Paper 10pk,2,292.36
LED Bulbs 4pk,1,317.53
Printer Paper 10pk,2,90.20
Organic Apples,1,361.80
LED Bulbs 4pk,1,373.30
Monitor 27in,2,268.31
Subtotal,""1,703.50""
Sales tax,119.25
Total,""1,822.75""
Visa,XXXXX4519
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-dabfad20015188b081533cbe,v11-PURCHASE_RECEIPT-csv,original,2025,fgen-fd246ec484be08504572dfab,synthetic_programmatic_template,csv,top,False,retail
"Northwind Electronics
2801 Cedar Ln Lakewood, CO 75764
07/10/2026 3:41 PM  Store 086
Item,Qty,Price
USB-C Cable,3,330.50
USB-C Cable,1,340.63
Subtotal,671.13
Sales tax,46.98
Total,718.11
Visa,ending in 6630
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-e88805a90842e7e58e91f08a,v11-PURCHASE_RECEIPT-csv,original,2026,fgen-93eb0bde61ff63c1c41e8ab5,synthetic_programmatic_template,csv,top,False,retail
"Harbor Hardware
3008 Sample Street Oak Grove, TX 53858
6/18/24 3:41 PM  Store 068
Item,Qty,Price
Organic Apples,2,178.21
Drill Bit Set,2,8.65
Organic Apples,3,203.71
Organic Apples,2,100.84
Subtotal,491.41
Sales tax,34.40
Total,525.81
Visa,ending in 5699
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-4712d6292bc124f48e0f9d60,v11-PURCHASE_RECEIPT-csv,original,2024,fgen-7f18a77d5e302c50e65bd2b0,synthetic_programmatic_template,csv,top,False,retail
"Northwind Electronics
5768 Prairie Ave Pinecrest, GA 61298
11/06/2022 3:41 PM  Store 079
Item,Qty,Price
USB-C Cable,1,377.90
Monitor 27in,2,293.28
Printer Paper 10pk,2,272.24
Subtotal,943.42
Sales tax,66.04
Total,""1,009.46""
Visa,ending in 9858
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-822045e25ea3b2df53f751b9,v11-PURCHASE_RECEIPT-csv,original,2022,fgen-13c250862106ff20b4460abc,synthetic_programmatic_template,csv,top,False,retail
"Harbor Hardware
9712 Willow Bend Way Cedar Falls, IA 76432
Novcmber 12, 2024 3:41 PM  Store 016
Item,Qty,Price
Printer Paper 10pk,1,167.01
Monitor 27in,3,240.94
Monitor 27in,1,272.16
Monitor27in,1,36.14
Subtotal,716.25
Sales tax,50.14
Total,766.39
Visa,***-**-1420
Thank you for shopping! Retums within 30 days wíth receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-401576c7eca174ec465f7de9,v11-PURCHASE_RECEIPT-csv,original,2024,fgen-748f8a398739a5939461c053,synthetic_programmatic_template,csv,top,True,retail
"9279 Lakeshore Blvd Maplewood, MN 67872
3/13/243:41 PM  Store 054
Item,Qty,Price
Drill Bit Set,3,370.80
Organic Apples,2,251.96
Printer Paper 10pk,3,7.50
Drill Bit 5et,1,17.67
Printer Paper 10pk,3,231.79
Subtota1,879.72
Sa1es tax,61.58
Total,941.30
Visa,ending in 1561
Thank you for shoppíng! Retums within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-459d604c2d7d6c0ccc505d08,v11-PURCHASE_RECEIPT-csv,original,2024,fgen-28f19ca5cda7e91b4faa68bc,synthetic_programmatic_template,csv,none,True,retail
"Northwind Electronics
9250 Cedar Ln Cedar Falls, IA 72616
02/08/2021 3:41 PM  Store 011
Item,Qty,Price
LED Bulbs 4pk,2,213.08
Drill Bit Set,3,74.81
Drill Bit Set,3,117.88
Drill Bit Set,3,359.28
Subtotal,765.05
Sales tax,53.55
Total,818.60
Visa,****9384
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-63f14896eaf3efbe5255c75d,v11-PURCHASE_RECEIPT-csv,original,2021,fgen-214ef5250372dd43b02317e4,synthetic_programmatic_template,csv,top,False,retail
"6677 Granite St Maplewood, MN 66868
2024-03-01 3:41 PM  Store 061
Item,Qty,Price
LED Bulbs 4pk,1,116.66
USB-C Cable,1,330.57
LED Bulbs 4pk,2,194.37
Drill Bit Set,2,94.80
Monitor 27in,2,179.45
Organic Apples,2,287.96
Subtotal,""1,203.81""
Sales tax,84.27
Total,""1,288.08""
Visa,ending in 7450
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-5f89e63807fa965ee7d258f4,v11-PURCHASE_RECEIPT-csv,original,2024,fgen-354e2e4c5b84718614d20fa8,synthetic_programmatic_template,csv,none,False,retail
"6369 Granite St Bayside, WA 45832
01/21/2021 3:41 PM  Store 010
Item,Qty,Price
Drill Bit Set,3,21.56
Printer Paper 10pk,2,258.37
Monitor 27in,2,57.54
LED Bulbs 4pk,1,71.96
Drill Bit Set,2,355.03
Subtotal,764.46
Sales tax,53.51
Total,817.97
Visa,XXX-XX-2323
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8ea852852a0b146e9f5f6ddd,v11-PURCHASE_RECEIPT-csv,original,2021,fgen-e548eedff47a17aa6493dd88,synthetic_programmatic_template,csv,none,False,retail
"Maple Market
1803 Lakeshore Blvd Pinecrest, GA 38642
7/1/25 3:41 PM  Store 059
Item,Qty,Price
USB-C Cable,3,101.15
Organic Apples,1,282.07
Monitor 27in,2,85.93
Subtotal,469.15
Sales tax,32.84
Total,501.99
Visa,****6206
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-fc42aa915c41bdb5237fc277,v11-PURCHASE_RECEIPT-csv,original,2025,fgen-6f0b5bb6f8ece11cc3c3c8d9,synthetic_programmatic_template,csv,top,False,retail
"Northwind Electronics
3239 Sample Street Maplewood, MN 92867
9/15/22 3:41 PM Store 020
Item,Qty,Price
Organic Apples,2,359.58
Organic Apples,3,12.99
USB-C Cable,2,29.56
Drill Bít Set,2,325.19
Monitor 27in,3,242.96
USB-C Cable,3,95.18
Subtotal,""1,065.46""
Sales tax,74.58
Total,""1,140.04""
Vísa,XXX-XX-0940
Thank you for shopping! Retums within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-40f4c3c407c0bfd4ecc1235c,v11-PURCHASE_RECEIPT-csv,original,2022,fgen-d924083f710087188b315663,synthetic_programmatic_template,csv,top,True,retail
"Cedar Office Supply 2147 Oak Hollow Ct Brookhaven, PA 91711 09/03/2022 3:41 PM Store 061
Item Qty Price Organic Apples 1 4.68 USB-C Cable 2 245.99 Subtotal 250.67 Sales tax 17.55 Total 268.22 Visa ****6951 Thank you
for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-2c577796ea419bbc05129846,v11-PURCHASE_RECEIPT-flat,original,2022,fgen-6d6371f86da2d99ec121eacf,synthetic_programmatic_template,flat,top,False,retail
"Northwind Electronics 9045 Cedar Ln
Testville, IL 71105
May 21, 2021 3:41 PM Store 026 Item Qty Price Organic Apples 1 35.41 USB-C Cable 2 288.51 Drill Bit Set 1 44.68 Organic Apples 1 249.88 Monitor 27in 2 10.80 Subtotal 629.28 Sales tax 44.05 Total 673.33 Visa XXX-XX-8496 Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-a12978288ec743c8e81f2785,v11-PURCHASE_RECEIPT-flat,original,2021,fgen-17d0156b628d4d4a9aeb8828,synthetic_programmatic_template,flat,top,False,retail
"Northwind Electronics 7495 Sample Street Riverton, WI 76162 01/09/2021 3:41 PM Store
078 Item Qty Price Drill Bit Set 1 205.32 USB-C Cable 2 15.59 Organic Apples 2 150.98 Organic Apples 2 168.21 Subtotal 540.10 Sales tax 37.81 Total 577.91 Visa XXX-XX-9622 Thank you for shopping! Returns within 30
days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-ab208b8dcc75f59db15e0b6f,v11-PURCHASE_RECEIPT-flat,original,2021,fgen-48560bd52b0f66817eacba3c,synthetic_programmatic_template,flat,top,False,retail
"Cedar Office Supply 5915 Lakeshore Blvd Fairview, OH 46865 06/15/2021 3:41 PM Store 070 Item Qty Price Organic Apples 2 96.62 Monitor
27in 1 155.86 Subtotal 252.48 Sales tax 17.67 Total 270.15 Visa XXXXX6597 Thank you for shopping! Returns within 30
days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-7abbc7f4ede6e6ef31d42487,v11-PURCHASE_RECEIPT-flat,original,2021,fgen-04aae12f104996bceb27d39c,synthetic_programmatic_template,flat,top,False,retail
"7727 Lakeshore Blvd Maplewood, MN 96854 February 28, 2024 3:41 PM Store 086 Item Qty Price LED Bulbs 4pk 3 210.73 LED Bulbs 4pk 3 190.65 Monitor 27in 1 171.66 USB-C Cable 1 219.04 Drill Bit Set 2 144.98 LED Bulbs 4pk 3 278.48 Subtotal 1,215.54 Sales
tax 85.09 Total 1,300.63 Visa ****4443
Thank you for shopping! Returns within 30 days with receipt. Cedar Office Supply",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-ddbcb034626b1f769d44e7fa,v11-PURCHASE_RECEIPT-flat,original,2024,fgen-531441e27af2e50596826853,synthetic_programmatic_template,flat,bottom,False,retail
"Northwind Electronics 9748 Sample Street Brookhaven,
PA 36746 2022-05-083:4l PM Store 059 Item Qty Price Monitor 27in 2
165.83 Monitor 27in 1 85.76Printer Paper 10pk 2 382.93 USB-C Cab1e 2 147.64 Subtota1 782.16 Sales tax 54.75 Total 836.91 Visa ***-**-3498 Thank you for shopping! Retums within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8ef042587525369b109b4822,v11-PURCHASE_RECEIPT-flat,original,2022,fgen-06bb987ad581fd0ced3a8ffe,synthetic_programmatic_template,flat,top,True,retail
"Northwind Electronics 6424 Prairie Ave Lakewood, CO 83240 2024-01-07 3:41 PM Store 063 Item
Qty Price USB-C Cable 1 113.67 Monitor
27in 3 78.09 Subtotal 191.76 Sales tax 13.42 Total 205.18 Visa ***-**-2445 Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-a1c8a6eb475d905e3829e078,v11-PURCHASE_RECEIPT-flat,original,2024,fgen-4a8cd649a70555976874c12c,synthetic_programmatic_template,flat,top,False,retail
"Northwind Electronics 3415 Oak Hollow Ct Maplewood, MN 39034 2022-04-28 3:41 PM Store 020 Item Qty Price Drill Bit Set 3 197.42 Printer Paper 10pk 3 398.50 Subtotal 595.92 Sales tax 41.71 Total 637.63 Visa
XXXXX3366 Thank
you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-3241241c21965871da3def04,v11-PURCHASE_RECEIPT-flat,original,2022,fgen-22446e4d30c5cfb1d2032825,synthetic_programmatic_template,flat,top,False,retail
"Maple Market 8357 Willow Bend Way Fairview, OH 29342 08/22/2025 3:41 PM Store 077 Item Qty Price Organic Apples 1 228.96 Organic Apples 3 362.58 Organic
Apples 3 5.92 USB-C Cable 3 221.68
Subtotal 819.14 Sales tax 57.34 Total 876.48 Visa XXXXX6536 Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-a97a674001f1de3bd86c075a,v11-PURCHASE_RECEIPT-flat,original,2025,fgen-221a5762367734544d43cf07,synthetic_programmatic_template,flat,top,False,retail
"Northwind Electronics 4425 Lakeshore Blvd Fairview, OH
23012 October
11, 2023 3:41 PM Store 049 Item Qty Price Printer Paper 10pk 1 340.09 USB-C Cable 3 254.51 LED Bulbs 4pk 1 219.57 Organic Apples 1 274.70 Subtotal 1,088.87 Sales tax 76.22 Total 1,165.09 Visa XXXXX2634 Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-a5e1b2787f9712cf0405a325,v11-PURCHASE_RECEIPT-flat,original,2023,fgen-ba2cb40a6c9d3d571f41195e,synthetic_programmatic_template,flat,top,False,retail
"Maple Market 2242 Harbor View Rd Oak Grove, TX 15721 September 16, 2021 3:41 PM Store 048 Item Qty Price Organic Apples 1 389.26 Monitor 27in 1 77.80
Drill Bit Set 1 23.56 Monitor 27in 2 339.45 Printer Paper 10pk 1 216.91 Printer Paper 10pk 2 396.21 Subtotal 1,443.19 Sales tax 101.02 Total 1,544.21
Visa XXX-XX-7331 Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-b4e798a17c4a932dab158442,v11-PURCHASE_RECEIPT-flat,original,2021,fgen-cc8e3f6aec609c4d7443d5ae,synthetic_programmatic_template,flat,top,False,retail
"7698
Lakeshore Blvd Bayside, WA 32342 2023-02-17 3:41 PM Store 063 Item Qty Price Printer Paper 10pk 1 172.87 Organic Apples 2
304.15 Printer Paper 10pk 1 393.98 Subtotal 871.00 Sales tax 60.97 Total 931.97 Visa ****5498 Thank you for shopping! Returns within 30 days with receipt. Cedar Office Supply",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-28acef163ee783891e400ace,v11-PURCHASE_RECEIPT-flat,original,2023,fgen-aa3922c3f454c8bc096f21aa,synthetic_programmatic_template,flat,bottom,False,retail
"Cedar Office Supply 2020 Lakeshore
Blvd Cedar Falls, IA 16006 1/9/25 3:41 PM Store 099 Item Qty Price Drill Bit Set 2 194.15 USB-C Cable 2 79.29 Drill Bit Set 1 99.13 Organic Apples 2 49.66 LED Bulbs 4pk 3 190.49 LED Bulbs 4pk 2 222.00 Subtotal 834.72 Sales tax 58.43 Total 893.15 Visa XXXXX0945 Thank you for shopping! Returns within
30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-ade36938e1b5314ffbb50cb4,v11-PURCHASE_RECEIPT-flat,original,2025,fgen-2b37f273304641c987423e42,synthetic_programmatic_template,flat,top,False,retail
"9273 Prairie Ave Oak Grove, TX 61744 March 9, 2025 3:41 PM Store 072 Item Qty Price LED Bulbs 4pk 2 195.65 Drill Bit Set 1 254.70 Organic Apples 2 119.10
Subtotal 569.45 Sales tax 39.86 Total 609.31 Visa
XXX-XX-5184 Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-5ac0960c89fec30b0c7385ec,v11-PURCHASE_RECEIPT-flat,original,2025,fgen-13aad93ca883e66382d93bbd,synthetic_programmatic_template,flat,none,False,retail
"6154
Prairie Ave Maplewood, MN 34961 December 6, 2026 3:41 PM Store 076 Item Qty Price USB-C Cable 2 218.87 Monitor 27in 1 62.23 Subtotal 281.10 Sales tax 19.68 Total 300.78 Visa ****1506 Thank you for shopping! Returns
within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-e81e858826312bcc0521424d,v11-PURCHASE_RECEIPT-flat,original,2026,fgen-95ec0ff70c9986ac0899c5c4,synthetic_programmatic_template,flat,none,False,retail
"HarborHardware 8033 Sample Street Maplewood,
MN 48157 03/21/2024 3:41 PM Store 034 Item Qty Price USB-C Cable 2 23.72
Printcr Paper l0pk 1 21.40 Subtotal 45.12 Sales tax 3.16 Total 48.28 Visa XXX-XX-2644 Thank you for shopping! Retums within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-ffbde78df8f8e2cd332913d7,v11-PURCHASE_RECEIPT-flat,original,2024,fgen-2c45db3920d1f8f823c48612,synthetic_programmatic_template,flat,top,True,retail
"## 4513 Elm Park Pl Pinecrest, GA 89062
2024-07-25 3:41 PM  Store 061
| Item | Qty | Price |
| --- | --- | --- |
| Monitor27in | 3 | 324.64 |
| Monitor 27in | 1 | 214.18 |
| Field | Value |
| --- | --- |
| Subtotal | 538.82 |
| Sales tax | 37.72 |
| Total | 576.54 |
| Visa | endíng in l408|
## Thank you for shopping! Retums within30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-1748803957ffd9ca71c53f08,v11-PURCHASE_RECEIPT-markdown,original,2024,fgen-1a9a503e3d7eed21bc24e2a3,synthetic_programmatic_template,markdown,none,True,retail
"Maple Market
## 6127 Oak Hollow Ct Pinecrest, GA 13801
August 7, 2025 3:41 PM  Store 092
| Item | Qty | Price |
| --- | --- | --- |
| USB-C Cable | 2 | 300.84 |
| Organic Apples | 1 | 326.82 |
| Drill Bit Set | 3 | 298.64 |
| LED Bulbs 4pk | 1 | 222.98 |
| Drill Bit Set | 2 | 35.19 |
| Printer Paper 10pk | 1 | 202.95 |
| Field | Value |
| --- | --- |
| Subtotal | 1,387.42 |
| Sales tax | 97.12 |
| Total | 1,484.54 |
| Visa | XXXXX7461 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-6ea9c3ebd1d2f7186e4853ed,v11-PURCHASE_RECEIPT-markdown,original,2025,fgen-8ee9a56128b8168423abb5c5,synthetic_programmatic_template,markdown,top,False,retail
"Cedar Office Supply
## 797 Lakeshore Blvd Cedar Falls, IA 78607
July 23, 2026 3:41 PM  Store 015
| Item | Qty | Price |
| --- | --- | --- |
| Monitor 27in | 1 | 175.47 |
| USB-C Cable | 1 | 137.04 |
| Printer Paper 10pk | 2 | 320.16 |
| Organic Apples | 3 | 145.19 |
| USB-C Cable | 1 | 273.80 |
| Monitor 27in | 2 | 147.55 |
| Field | Value |
| --- | --- |
| Subtotal | 1,199.21 |
| Sales tax | 83.94 |
| Total | 1,283.15 |
| Visa | ***-**-3486 |
## Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-2503ea9a5188d3f051f757f4,v11-PURCHASE_RECEIPT-markdown,original,2026,fgen-d751e9ddad529c6162c3004a,synthetic_programmatic_template,markdown,top,False,retail
"## Northwind Electronics
## 9537 Sample Street Riverton, WI 56315
## 07/27/2024 3:41 PM  Store 073
| Item | Qty | Price |
| --- | --- | --- |
| Organic Apples | 2 | 13.88 |
| USB-C Cable | 1 | 151.67 |
| USB-C Cable | 1 | 204.45 |
| Field | Value |
| --- | --- |
| Subtotal | 370.00 |
| Sales tax | 25.90 |
| Total | 395.90 |
| Visa | ****6789 |
## Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-82d0839aa5a102db2bd96a2c,v11-PURCHASE_RECEIPT-markdown,original,2024,fgen-2382ad382c2792cda0fb80a9,synthetic_programmatic_template,markdown,top,False,retail
"## 101 Oak Hollow Ct Testville, IL 50114
February 13, 2026 3:41 PM  Store 033
| Item | Qty | Price |
| --- | --- | --- |
| USB-C Cable | 2 | 237.97 |
| USB-C Cable | 2 | 314.62 |
| Field | Value |
| --- | --- |
| Subtotal | 552.59 |
| Sales tax | 38.68 |
| Total | 591.27 |
| Visa | ****7328 |
Thank you for shopping! Returns within 30 days with receipt.
Maple Market",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-abb0a719ed5b8793b5deb72e,v11-PURCHASE_RECEIPT-markdown,original,2026,fgen-286e861a12fffce3520e5382,synthetic_programmatic_template,markdown,bottom,False,retail
"## Northwind Electronics
## 2745 Granite St Lakewood, CO 44320
11/8/26 3:41 PM  Store 065
| Item | Qty | Price |
| --- | --- | --- |
| Organic Apples | 2 | 273.36 |
| LED Bulbs 4pk | 2 | 301.31 |
| Monitor 27in | 3 | 24.72 |
| Field | Value |
| --- | --- |
| Subtotal | 599.39 |
| Sales tax | 41.96 |
| Total | 641.35 |
| Visa | XXXXX1173 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-b2d385d7ee88adb415ffdf75,v11-PURCHASE_RECEIPT-markdown,original,2026,fgen-b53b5f1c0c2538d50c56ae80,synthetic_programmatic_template,markdown,top,False,retail
"Harbor Hardware
## 3155 Willow Bend Way Testville, IL 21832
## May 26, 2021 3:41 PM  Store 078
| Item | Qty | Price |
| --- | --- | --- |
| Monitor 27in | 1 | 217.75 |
| USB-C Cable | 3 | 31.94 |
| Drill Bit Set | 1 | 229.56 |
| LED Bulbs 4pk | 2 | 294.62 |
| Drill Bit Set | 1 | 199.89 |
| Field | Value |
| --- | --- |
| Subtotal | 973.76 |
| Sales tax | 68.16 |
| Total | 1,041.92 |
| Visa | XXXXX0823 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-97885921041c976950a9cd35,v11-PURCHASE_RECEIPT-markdown,original,2021,fgen-9579ff544a0b998d427e180c,synthetic_programmatic_template,markdown,top,False,retail
"6395 Maple Ridge Dr Bayside, WA 42307
## 11/12/2023 3:41 PM  Store 069
| Item | Qty | Price |
| --- | --- | --- |
| Monitor 27in | 1 | 377.52 |
| Monitor 27in | 3 | 328.51 |
| Printer Paper 10pk | 3 | 394.98 |
| Field | Value |
| --- | --- |
| Subtotal | 1,101.01 |
| Sales tax | 77.07 |
| Total | 1,178.08 |
| Visa | ****7121 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-bee54e26b3983af6d784e9a4,v11-PURCHASE_RECEIPT-markdown,original,2023,fgen-36f472bfb73d3402a56b5e56,synthetic_programmatic_template,markdown,none,False,retail
"Maple Market
## 1775 Harbor View Rd Oak Grove, TX 92776
2023-10-01 3:41 PM  Store 026
| Item | Qty | Price |
| --- | --- | --- |
| Printer Paper 10pk | 1 | 288.22 |
| Drill Bit Set | 2 | 203.76 |
| Printer Paper 10pk | 1 | 170.36 |
| Monitor 27in | 3 | 67.90 |
| Field | Value |
| --- | --- |
| Subtotal | 730.24 |
| Sales tax | 51.12 |
| Total | 781.36 |
| Visa | XXX-XX-7298 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-c81f3cba9df108dba2b95c9a,v11-PURCHASE_RECEIPT-markdown,original,2023,fgen-fa96d3cfc03d1e1b988f0d19,synthetic_programmatic_template,markdown,top,False,retail
"## Maple Market
7554 Harbor View Rd Riverton, WI 67122
## 05/17/2022 3:41 PM  Store 036
| Item | Qty | Price |
| --- | --- | --- |
| Printer Paper 10pk | 3 | 197.73 |
| Monitor 27in | 2 | 232.04 |
| Field | Value |
| --- | --- |
| Subtotal | 429.77 |
| Sales tax | 30.08 |
| Total | 459.85 |
| Visa | ending in 4699 |
## Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-7e49a7014399b00f319625b1,v11-PURCHASE_RECEIPT-markdown,original,2022,fgen-d70f12ed6e45ad4793389521,synthetic_programmatic_template,markdown,top,False,retail
"Harbor Hardware
7986 Lakeshore Blvd Brookhaven, PA 96465
June 18, 2023 3:41 PM  Store 034
| Item | Qty | Price |
| --- | --- | --- |
| USB-C Cable | 2 | 13.41 |
| LED Bulbs 4pk | 1 | 240.87 |
| Organic Apples | 3 | 296.57 |
| Printer Paper 10pk | 3 | 383.22 |
| Organic Apples | 2 | 241.31 |
| Field | Value |
| --- | --- |
| Subtotal | 1,175.38 |
| Sales tax | 82.28 |
| Total | 1,257.66 |
| Visa | ****0460 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-275639d8b59725267eb2c333,v11-PURCHASE_RECEIPT-markdown,original,2023,fgen-87dae6ab195facc6ea3ab327,synthetic_programmatic_template,markdown,top,False,retail
"1348 Sample Street Fairview, OH 50892
## 8/28/22 3:41 PM  5tore 092
| Item | Qty | Príce |
| --- | ---| --- |
| Monitor 27in | 3 | 391.99 |
| Printer Paper 10pk | 3 | 338.69 |
|Printer Paper 10pk | 3 | 233.57 |
| U5B-C Cable | 3 | 291.09 |
| LED Bulbs 4pk | 3 | 356.83 |
| Monítor 27in | 2 | 95.8O |
|Field | Value |
| --- | --- |
| 5ubtotal | 1,707.97 |
| Sales tax | 119.56 |
| Total | 1,827.53 |
| Visa | XXX-XX-8936 |
## Thank you for shopping! Retums within 30 days with receipt.
MapleMarket",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-fad8447da098d87545271623,v11-PURCHASE_RECEIPT-markdown,original,2022,fgen-f5640bcec47b56c719528588,synthetic_programmatic_template,markdown,bottom,True,retail
"Cedar Office Supply
3438Elm Park Pl Oak Grove, TX 57780
May 6, 2026 3:41 PM  Store 032
| Item | Qty | Price |
| --- | --- | --- |
| LED Bulbs 4pk| 1 | 273.61 |
| Organic Apples | 2| 225.07 |
| Drill Bit Set | 1 | 234.65 |
| USB-C Cable | 1 | 210.80 |
| Printer Paper 10pk | 2 | 138.13 |
| Field | Value |
| --- | --- |
| 5ubtotal | 1,082.26 |
| 5ales tax | 75.76 |
| Total| 1,158.02 |
| Vísa | XXXXX1671 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-8f992bb0599e879bc30e364d,v11-PURCHASE_RECEIPT-markdown,original,2026,fgen-667463944a2a507a1ea96053,synthetic_programmatic_template,markdown,top,True,retail
"## Northwind Electronics
## 8044 Willow Bend Way Bayside, WA 96957
2026-10-24 3:41 PM  Store 088
| Item | Qty | Price |
| --- | --- | --- |
| Printer Paper 10pk | 3 | 150.59 |
| Printer Paper 10pk | 2 | 16.85 |
| Printer Paper 1Opk |3 | 288.93 |
| Fíeld | Value |
| --- | --- |
| 5ubtotal |456.37 |
| Sales tax | 31.95 |
| Total | 488.32 |
| Visa | ****3030 |
Thank you for shopping! Rcturns within 30 days withreceipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-7f7b768be8129bd355e281f3,v11-PURCHASE_RECEIPT-markdown,original,2026,fgen-ecf93315cf54bd96bc41ded7,synthetic_programmatic_template,markdown,top,True,retail
"2112 Maple Ridge Dr Testville, IL 14951
2021-04-04 3:41 PM  Store 075
| Item | Qty | Price |
| --- | --- | --- |
| Organic Apples | 3 | 66.46 |
| USB-C Cable | 2 | 207.87 |
| LED Bulbs 4pk | 3 | 205.11 |
| Organic Apples | 2 | 336.77 |
| USB-C Cable | 2 | 107.95 |
| Field | Value |
| --- | --- |
| Subtotal | 924.16 |
| Sales tax | 64.69 |
| Total | 988.85 |
| Visa | ***-**-5175 |
## Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-c4641608e9d7b0c16e45d677,v11-PURCHASE_RECEIPT-markdown,original,2021,fgen-e15f8e7566eb08c4e891d8e9,synthetic_programmatic_template,markdown,none,False,retail
"Northwind Electronics
5989 Prairie Ave Brookhaven, PA 17881
August 28, 2024 3:41 PM  Store 034
| Item | Qty | Price |
| --- | --- | --- |
| Organic Apples | 1 | 343.28 |
| Printer Paper 10pk | 3 | 231.82 |
| Drill Bit Set | 1 | 189.43 |
| LED Bulbs 4pk | 1 | 186.40 |
| Field | Value |
| --- | --- |
| Subtotal | 950.93 |
| Sales tax | 66.57 |
| Total | 1,017.50 |
| Visa | ****8835 |
Thank you for shopping! Returns within 30 days with receipt.",PURCHASE_RECEIPT,33,PURCHASE_RECEIPT,fdc-53d5104d8697771cadbd432f,v11-PURCHASE_RECEIPT-markdown,original,2024,fgen-181ca48913ed9b8f8b7c11a5,synthetic_programmatic_template,markdown,top,False,retail
"Evergreen Retirement Services
Plan
Riverside Regional Hospital 401(k) Savings Plan
Participant
Sofia Walsh
Statement period
10/01/2025 - 10/31/2025
Beginning balance
122,592.16
Employee contributions (pre-tax)
22,591.25
Roth contributions
3,110.89
Employer match
6,019.02
Investment gain/loss
38,833.67
Ending balance
$239,620.47
Vested balance
$174,808.65
Personal rate of return
10.0%
Investment  Allocation  Balance
Total Bond Index
44%
41,773.78
S&P 500 Index Fund
15%
32,174.86
Target Retirement 2050 Fund
22%
124,062.85
Retirement Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7151c37015b96f6fe8dc9d23,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2025,fgen-6115d3d0c3dc915fb45fd53a,synthetic_programmatic_template,stacked,bottom,False,401k_quarterly
"Downloaded 24/05/2024
Pay Datc 5ource  Investment  Amount  Units  Unit Price
27/05/2024
Profit Sharing
Large Cap Index
1169.41
3.30
148.92
07/08/2024
Profit Sharing
Large Cap Index
1121.62
55.76
52.64
14/07/2024
Roth 401(k)
Stable Value Fund
l293.65
51.55
275.87
22/12/2024
Safe Harbor Match
Large Cap Index
977.38
35.81
226.40
2024-04-22
Roth 401(k)
Large Cap Index
1065.71
6.48
268.77
01/03/2024
Profit Sharing
Large Cap Index
807.87
30.28
l64.63",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5f7a17c34100a6a556eddbd8,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2024,fgen-5d1033076f9cb64c57b1ce36,synthetic_programmatic_template,stacked,top,True,raw_export
"Northstar Retirement Plan Services
Account
ending in 4211
Statement period
07/01/2021 - 07/30/2021
2021 contributions
$1,459.89
2020 contributions made in 2021
521.69
Account value
$328,945.39
Required minimum distribution for 2021
Not applicable
Tax reminder: amounts on this statement may differ from your Form 5498.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cfbe6686b9a374ae36b3c01d,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-6e26800d0c4fdc51736e18aa,synthetic_programmatic_template,stacked,none,False,ira_statement
"Traditional IRA Statement
Northstar Retirement Plan Services
Account
****0818
Statement period
12/01/2025 - 12/30/2025
2025 contributions
1,906.41
2024 contributions made in 2025
4,152.90
Account value
$336,951.26
Required minimum distribution for 2025
$1,026.37",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b2722699f19d8dd954e7df0b,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2025,fgen-794ef0645a7a7aebd380064d,synthetic_programmatic_template,stacked,top,False,ira_statement
"Retirement Account Statement
Clearwater 401(k) Administration
Plan
Maple Street Dental PC 401(k) Savings Plan
Participant
Olivia Lindqvist
Statement period
05/01/2022 - 05/28/2022
Beginning balance
$58,582.96
Employee contributions (pre-tax)
747.57
Roth contributions
$1,293.34
Employer match
6,051.94
Investment gain/loss
11,027.24
Ending balance
201,460.35
Vested balance
$61,679.82
Personal rate of return
17.6%
Investment  Allocation  Balance
Target Retirement 2050 Fund
6%
96,751.60
Total Bond Index
24%
134,413.49
S&P 500 Index Fund
12%
60,063.05",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-70300183ccadcfd7e1a89ec0,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2022,fgen-b3ed813b0417eb04f4c7b3fe,synthetic_programmatic_template,stacked,top,False,401k_quarterly
"Downloaded 26/06/2021
Account  Account Type  Symbol  Quantity  Value  Contributions YTD
...7709
Rollover IRA
VTI
324.09
296266.76
1639.08
...9267
Roth IRA
VTTSX
349.74
53348.53
2207.41
...9968
SEP IRA
VTTSX
220.79
291528.08
4357.67
...4243
SIMPLE IRA
BND
394.54
84830.60
3485.87
...2121
SEP IRA
BND
359.96
264543.03
4706.72
...5064
SIMPLE IRA
FXAIX
107.10
253948.53
893.93
...2210
Rollover IRA
BND
111.23
152117.38
4409.89
...9957
SIMPLE IRA
BND
227.69
227651.73
2653.81
401(k) Plan contribution history",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-904816bb7b8f7a80c2b5c97e,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-34d8629242104eee761ff5f3,synthetic_programmatic_template,stacked,bottom,False,raw_export
"Account  Account Type  Symbol  Quantity  Value  Contributions YTD
...9324
SEP IRA
BND
123.27
194314.63
5228.59
...9622
Rollover IRA
VTI
305.11
236730.87
1942.01
...9191
SIMPLE IRA
FXAIX
309.06
240995.55
2919.78
...9678
SEP IRA
VTI
82.05
15551.88
1131.89",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0a1a7456bf20381841e2ba4d,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-a66f9e667808ea1e52b006a1,synthetic_programmatic_template,stacked,bottom,False,raw_export
"Evergreen Retirement Services
Plan
Blue Heron Logistics LLC 401(k) Savings Plan
Participant
Fatima Romero
Statement period
10/01/2022 - 10/31/2022
Beginning balance
$454,122.11
Employee contributions (pre-tax)
$9,016.54
Roth contributions
4,207.83
Employer match
1,374.13
Investment gain/loss
53,694.82
Ending balance
338,887.65
Vested balance
445,096.90
Personal rate of return
11.4%
Investment  Allocation  Balance
Stable Value Fund
13%
78,192.68
Target Retirement 2050 Fund
47%
7,733.46
Total Bond Index
6%
194,844.39
Retirement Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-00ab59a9166d518e1a2f882e,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2022,fgen-6903203790ed783db8cd8a0b,synthetic_programmatic_template,stacked,bottom,False,401k_quarterly
"Pay Date  Source  Investment  Amount  Units  Unit Price
17/11/2025
Employee Pre-Tax
Stable Value Fund
910.46
32.98
70.41
2025-06-23
Profit Sharing
Large Cap Index
1028.86
23.43
214.59
14/09/2025
Employee Pre-Tax
Large Cap Index
1002.76
40.32
88.91
27/06/2025
Employee Pre-Tax
Large Cap Index
1113.32
34.31
31.81
05/20/2025
Rollover
Stable Value Fund
1331.86
47.29
165.29
01/21/2025
Roth 401(k)
Target Retirement 2050
803.71
11.51
140.49
2025-11-11
Roth 401(k)
Large Cap Index
478.91
58.56
133.78
03/09/2025
Employee Pre-Tax
Stable Value Fund
637.98
57.69
73.96",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1f5c51d41094f6ab99f48da9,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2025,fgen-8eb3c003e0991b4202b6a77d,synthetic_programmatic_template,stacked,top,False,raw_export
"Evergreen Retirement Services
Plan
Riverside Regional Hospital 403(b) Plan
Participant
Alcx Larsen
Statement period
04/01/2022 - 04/30/2022
Beginning balance
385,057.43
Employee contributions (pre-tax)
S14,149.18
Roth contributions
$538.21
Employer match
8,603.77
Investment gaín/loss
30,580.15
Ending balance
$220,509.12
Vested balance
$537,539.39
Personal rate of return
19.5%
Investment  Allocation  Balance
5table Value Fund
56%
55,004.11
Target Retirement 2050 Fund
59%
69,647.64
Total Bond Index
60%
l30,673.92
Annual Benefit5tatement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d2b9acdac56c360ca8478b99,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2022,fgen-cb7df4ec3bb05efe54671f61,synthetic_programmatic_template,stacked,bottom,True,403b_annual
"Rollover IRA Statement
Summit Retirement Trust
Account
****3300
Statement period
03/01/2026 - 03/31/2026
2026 contributions
5,960.40
2025 contributions made in 2026
3,066.16
Account value
$379,766.07
Required minimum distribution for 2026
$17,884.07
Tax reminder: amounts on this statement may differ from your Form 5498.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4abd6c00f84e5a066bb75552,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2026,fgen-4afe40cd1de7c58d9b666527,synthetic_programmatic_template,stacked,top,False,ira_statement
"Retirement Account Statement
Clearwater4O1(k) Administration
Plan
Granite Peak Manufacturing Co. 401(k) Savings Plan
Participant
Diego C. Testcase
Statement period
06/01/2021 - 06/31/2021
Beginning ba1ance
$371,854.63
Employee contributions (pre-tax)
$4,095.29
Roth contríbutions
4,842.42
Employer match
$8,560.95
Investment gain/loss
25,227.77
Ending balancc
258,351.80
Vested balance
$26,035.58
Personal rate of return
-6.5%
Investment  Allocation  Balance
Total Bond Index
36%
l77,955.96
5table Value Fund
70%
173,976.13
5&P 500 Index Fund
41%
45,050.71",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-810712d580f744eaf03f7982,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-af9aa31d040b321906bc0b8e,synthetic_programmatic_template,stacked,top,True,401k_quarterly
"Annual Benefit Statement
Evergreen Retirement Services
Plan
Copperlíne Software Inc. 403(b) Plan
Participant
Diego Brennan
Statement period
06/0l/2026 - 06/31/2026
Beginning balance
166,952.48
Employeecontributions (pre-tax)
$15,383.29
Roth contributions
$1,567.68
Employer match
$5,331.50
Investment gain/loss
-18,903.64
Ending balance
$396,004.46
Vested balance
$341,061.57
Personal rate of retum
0.3%
Investment  Allocation  Balance
Total Bond Index
48%
48,885.13
Target Retirement 2050 Fund
49%
176,233.04
5&P 500 Index Fund
45%
164,562.92
Your 2026 Form 1099-R will be avaílable online by January 31, 2027.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0a1db7a97c08a9d3fd138559,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2026,fgen-5721c3466df1d5263b993f22,synthetic_programmatic_template,stacked,top,True,403b_annual
"Northstar Retirement Plan Services
Plan
Copperline Software Inc. 401(k) Savings Plan
Participant
Diego Larsen
Statement period
01/01/2023 - 01/30/2023
Beginning balance
383,406.49
Employee contributions (pre-tax)
18,948.64
Roth contributions
$3,605.67
Employer match
7,844.72
Investment gain/loss
-6,151.45
Ending balance
33,324.62
Vested balance
281,318.92
Personal rate of return
21.1%
Investment  Allocation  Balance
Total Bond Index
19%
199,447.79
Stable Value Fund
65%
116,158.76
S&P 500 Index Fund
64%
19,549.99
Retirement Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f7a3169e4f89371dd9fdccd2,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2023,fgen-5bd09869e23cdee33e4151a5,synthetic_programmatic_template,stacked,bottom,False,401k_quarterly
"Retirement Account Statement
Summit Retirement Trust
Plan
Maple Street Dental PC 401(k) Savings Plan
Participant
Diego Moreau
Statement period
02/01/2025 - 02/28/2025
Beginning balance
60,279.35
Employee contributions (pre-tax)
15,868.22
Roth contributions
402.76
Employer match
1,584.01
Investment gain/loss
33,972.86
Ending balance
530,886.93
Vested balance
$179,120.73
Personal rate of return
2.8%
Investment  Allocation  Balance
Stable Value Fund
48%
18,535.30
S&P 500 Index Fund
49%
175,222.11
Total Bond Index
19%
68,774.89",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-53f2fd9235f6bd0188e8fbe5,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2025,fgen-bdd5331680457b2e80f9a154,synthetic_programmatic_template,stacked,top,False,401k_quarterly
"Pay Date  Source  Investment  Amount  Units  Unit Price
02/13/2026
Safe Harbor Match
Stable Value Fund
608.09
55.68
93.18
2026-09-13
Rollover
Large Cap Index
306.65
41.95
222.12
08/06/2026
Rollover
Large Cap Index
1216.11
46.05
25.58
2026-10-19
Profit Sharing
Target Retirement 2050
583.71
4.15
135.17
15/06/2026
Employee Pre-Tax
Large Cap Index
346.85
37.14
165.09
26/03/2026
Safe Harbor Match
Stable Value Fund
25.09
46.19
262.90",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-51916141019531d99aa9c67a,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2026,fgen-0bef12901a2da1f666c3c4e0,synthetic_programmatic_template,stacked,top,False,raw_export
"Retirement Account Statement
Clearwater 401(k) Administration
Plan
Copperline Software Inc. 401(k) Savings Plan
Participant
Taylor K. Tanaka
Statement period
05/01/2025 - 05/28/2025
Beginning balance
$198,231.18
Employee contributions (pre-tax)
$9,803.46
Roth contributions
$2,715.44
Employer match
$5,685.35
Investment gain/loss
-18,224.68
Ending balance
$585,652.32
Vested balance
247,035.18
Personal rate of return
-4.7%
Investment  Allocation  Balance
Target Retirement 2050 Fund
38%
191,335.80
Stable Value Fund
60%
148,997.13
Total Bond Index
37%
41,950.90",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-89ff95dec867351823c41f5c,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2025,fgen-a6cef4d1164579d48f582893,synthetic_programmatic_template,stacked,top,False,401k_quarterly
"Account  Account Type  Symbol  Quantity  Value  Contributions YTD
...8224
Rollover IRA
VTTSX
152.23
127609.58
3484.64
...2238
Traditional IRA
BND
139.84
18329.96
4663.56
...9207
Rollover IRA
VTI
206.31
200037.25
1662.55
...4668
SIMPLE IRA
BND
161.02
155637.21
4819.99
...5267
Traditional IRA
FXAIX
3.84
263946.65
3210.35
...7385
SEP IRA
FXAIX
107.60
238643.62
5818.55
...8318
SIMPLE IRA
VTI
43.36
54649.34
1478.73
...5413
Roth IRA
BND
183.27
102091.49
6151.29",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-39a1b9261ea9ad0c8414ba7c,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-df2921f91deee63a9e7a0f0d,synthetic_programmatic_template,stacked,top,False,raw_export
"Summit Retirement Trust
Account
XXXXX6022
Statement period
07/01/2025 - 07/28/2025
2025 contributions
1,364.14
2024 contributions made in 2025
$2,698.48
Account value
330,166.55
Required minimum distribution for 2025
Not applicable
Your 2025 Form 5498 will be available online by January 31, 2026.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-61b44cc0b9e0cf70f99c1932,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2025,fgen-0b24c83e15df523a3fa07277,synthetic_programmatic_template,stacked,none,False,ira_statement
"Annual Benefit Statement
Evergreen Retirement Services
Plan
Blue Heron Logistics LLC 403(b) Plan
Participant
Wei Haddad
Statement period
04/01/2023 - 04/28/2023
Beginning balance
391,321.04
Employee contributions (pre-tax)
$6,029.60
Roth contributions
$2,946.15
Employer match
$6,313.35
Investment gain/loss
18,123.68
Ending balance
$582,680.42
Vested balance
$418,802.98
Personal rate of return
7.2%
Investment  Allocation  Balance
Total Bond Index
78%
198,745.96
Target Retirement 2050 Fund
26%
15,156.97
S&P 500 Index Fund
46%
100,310.99",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-dc25f3a28f41c8bce5dcb49b,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2023,fgen-22f5afdbdf7b82594e4345d7,synthetic_programmatic_template,stacked,top,False,403b_annual
"Retirement Account Statement
Clearwater 401(k) Administration
P1an
Granite Peak Manufacturing Co. 401(k) Savings Plan
Participant
Sofia Fischer
Statement period
12/O1/2O21 - 12/31/2021
Beginning balance
219,344.17
Employee contributions (pre-tax)
$2,347.80
Roth contributions
2,194.16
Employcr match
$4,836.20
Investment gain/loss
56,135.33
Ending balance
200,947.86
Vested balance
$46,437.42
Personal rate of retum
-4.9%
Investment  Allocation  Balance
5&P 500 Index Fund
64%
127,691.27
5table Value Fund
45%
98,172.05
Targct Retirement 2050Fund
68%
177,614.50
Tax reminder: amounts on this statement may differ from your Form 1099-R.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-656a2305ded70b80662ed053,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-a92da60469626f5a56b623c8,synthetic_programmatic_template,stacked,top,True,401k_quarterly
"Retirement Plan Activity
Account  Account Type  Symbol  Quantity  Value  Contributions YTD
...9832
Roth IRA
BND
386.24
117096.65
4990.85
...5888
SEP IRA
VTI
316.84
280684.22
3272.19
...5607
SIMPLE IRA
FXAIX
98.82
255128.66
4295.58
...5962
Roth IRA
FXAIX
371.71
81334.41
6489.67
...2170
SIMPLE IRA
FXAIX
209.05
8656.81
4468.05
...6047
Roth IRA
FXAIX
173.40
104131.96
1002.28
...5014
SEP IRA
VTTSX
231.46
123376.83
1158.40
...8011
Rollover IRA
BND
78.84
87344.54
37.09",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2e8c382c48523033cedaa224,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2026,fgen-dc9f773dec4d82da03aaddc1,synthetic_programmatic_template,stacked,top,False,raw_export
"Annual Benefit Statement
Evergreen Retirement Services
Plan
Copperline Software Inc. 403(b) Plan
Participant
Alex Okafor
Statement period
12/01/2026 - 12/30/2026
Beginning balance
$91,526.68
Employee contributions (pre-tax)
$7,235.38
Roth contributions
2,936.18
Employer match
7,863.56
Investment gain/loss
-13,050.22
Ending balance
$227,069.43
Vested balance
101,985.00
Personal rate of return
12.4%
Investment  Allocation  Balance
Stable Value Fund
50%
147,364.54
S&P 500 Index Fund
9%
163,011.39
Total Bond Index
58%
76,003.03",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-846019407471d7b93c3248f7,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2026,fgen-bba57a818d7f5602b4f2d7f6,synthetic_programmatic_template,stacked,top,False,403b_annual
"Retirement Account Statement
Northstar Retirement Plan Services
Plan
Riverside Regional Hospital 401(k) Savings Plan
Participant
Noah D. Patel
Statement period
09/01/2021 - 09/28/2021
Beginning balance
$70,930.36
Employee contributions (pre-tax)
22,907.87
Roth contributions
$3,736.54
Employer match
$7,407.95
Investment gain/loss
39,024.52
Ending balance
$469,890.54
Vested balance
228,372.68
Personal rate of return
7.0%
Investment  Allocation  Balance
S&P 500 Index Fund
47%
101,395.09
Target Retirement 2050 Fund
15%
125,879.18
Total Bond Index
48%
30,663.36
This statement is not a Form 1099-R. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-38fc5b8251dbd80c8b95ad0a,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-1a141e11372c10d7e49d2b13,synthetic_programmatic_template,stacked,top,False,401k_quarterly
"Annual Benefit Statement
Evergreen Retirement Services
Plan
Blue Heron Logistics LLC 403(b) Plan
Participant
Sofia Castillo
Statement period
05/01/2022 - 05/28/2022
Beginning balance
215,908.57
Employee contributions (pre-tax)
1,923.48
Roth contributions
1,056.15
Employer match
3,509.41
Investment gain/loss
25,161.29
Ending balance
$47,736.97
Vested balance
$15,444.71
Personal rate of return
21.5%
Investment  Allocation  Balance
Stable Value Fund
76%
101,841.49
Target Retirement 2050 Fund
51%
186,274.22
S&P 500 Index Fund
79%
193,476.77
IRS Form 1099-R information for 2022 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a3a9e5275428d033647b9b19,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2022,fgen-38154b5f298d6b1fffdce060,synthetic_programmatic_template,stacked,top,False,403b_annual
"Rollover IRA Statement
Summit Retirement Trust
Account
ending in 4117
Statement period
10/01/2024 - 10/28/2024
2024 contributions
$3,854.47
2023 contributions made in 2024
$3,492.37
Account value
390,886.55
Required minimum distribution for 2024
Not applicable",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2007735a862727c592e82e70,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2024,fgen-01df555c9263bbb7a0903d6a,synthetic_programmatic_template,stacked,top,False,ira_statement
"AnnualBenefit Statement
Clearwater 4O1(k) Administration
Plan
Tri-County School District 403(b) Plan
Participant
Lena M. Brennan
Statement period
05/01/2023 - 05/28/2023
Bcginning balance
S219,154.42
Employee contributions (pre-tax)
$1,155.63
Roth contributions
2,677.90
Employer match
$2,621.36
Investment gain/loss
35,103.09
Ending balance
$335,545.41
Vested balance
594,683.53
Personal rate of retum
4.4%
Investment  Allocation  Balance
5&P 500 Index Fund
72%
8,636.48
Stable Value Fund
22%
135,911.12
Total Bond Index
49%
194,499.49
Tax reminder: amounts on this statement may differ from your Form 1099-R.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5dc5e2222c93836a4faff384,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2023,fgen-65943720945fbd45bf7bb20c,synthetic_programmatic_template,stacked,top,True,403b_annual
"Northstar Retirement P1an Services
Account
ending in 1779
Statement period
04/01/2021 - 04/28/2021
2021 contributions
4,143.07
2020 contributions made in 2021
S2,531.86
Account value
$295,759.44
Required minimum distribution for2021
$23,319.94
This statement is not a Form 5498. Keep it for your records.
Ro1lover IRA 5tatement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8c1d5e1103e9eebf07759d1b,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2021,fgen-d3f7127497a16d71098528b2,synthetic_programmatic_template,stacked,bottom,True,ira_statement
"Retirement Account Statement
Clearwater 401(k) Administration
Plan
Copperline Software Inc. 401(k) Savings Plan
Participant
Olivia Rivera
Statement period
04/01/2026 - 04/31/2026
Beginning balance
168,470.20
Employee contributions (pre-tax)
21,214.54
Roth contributions
1,685.58
Employer match
$7,751.25
Investment gain/loss
-2,035.16
Ending balance
12,805.35
Vested balance
475,775.90
Personal rate of return
14.8%
Investment  Allocation  Balance
Total Bond Index
30%
54,122.72
Target Retirement 2050 Fund
63%
147,818.98
Stable Value Fund
37%
44,989.31",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c56ad5c198caa340e676eed3,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2026,fgen-73ec786efc547ba317818a12,synthetic_programmatic_template,stacked,top,False,401k_quarterly
"Summit Retirement Trust
Plan
Copperline Software Inc. 401(k) Savings Plan
Participant
Wei Lindqvist
Statement period
06/01/2022 - 06/31/2022
Beginning balance
$170,403.49
Employee contributions (pre-tax)
$9,259.48
Roth contributions
1,432.15
Employer match
$5,532.62
Investment gain/loss
9,382.38
Ending balance
$240,221.45
Vested balance
$431,754.98
Personal rate of return
-1.4%
Investment  Allocation  Balance
S&P 500 Index Fund
45%
92,192.36
Stable Value Fund
6%
8,981.78
Total Bond Index
31%
164,534.16
Your 2022 Form 1099-R will be available online by January 31, 2023.
Retirement Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-30d57aee59cddb63fcfc6aac,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2022,fgen-e175b64935b8cba090d0784d,synthetic_programmatic_template,stacked,bottom,False,401k_quarterly
"Traditional IRA Statement
Northstar Retirement Plan Services
Account
XXX-XX-0058
Statement period
09/01/2022 - 09/31/2022
2022 contributions
4,823.41
2021 contributions made in 2022
5,126.71
Account value
$210,784.14
Required minimum distribution for 2022
3,227.45
This statement is not a Form 5498. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-fc32a39d17d77d305c454e7d,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2022,fgen-434bd33f724a8ffb09907dc0,synthetic_programmatic_template,stacked,top,False,ira_statement
"IRA ...2391 Positions
Account  Account Type  Symbol  Quantity  Value  Contributions YTD
...9627
Traditional IRA
BND
353.78
115702.18
1898.10
...4596
Rollover IRA
BND
233.60
127724.49
6246.07
...3229
SIMPLE IRA
VTI
293.00
26028.27
3116.35
...9570
Traditional IRA
BND
395.70
88095.24
1305.65
...1362
Traditional IRA
VTTSX
208.97
39972.66
4063.10
...4110
SIMPLE IRA
VTTSX
382.21
37163.42
5791.86
...9270
Rollover IRA
FXAIX
139.15
242739.74
3087.02",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-933924bfe8338ef8f36fd2f5,v11-RETIREMENT_ACCOUNT_STATEMENT-stacked,original,2026,fgen-c3050c2f3d3c8287d36ea37a,synthetic_programmatic_template,stacked,top,False,raw_export
"Downloaded 03/02/2022
Account      Account Type      Symbol      Quantity      Value      Contributions YTD
...2368 Traditional IRA BND 128.22 244374.34 108.07
...7646      SIMPLE IRA      BND      395.36      270220.19      327.70
...1269   Roth IRA   VTI   228.06   258900.17   5560.92",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cd0d0ab686ad4bc47613571a,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2022,fgen-e1612bd56ead0633962eeb64,synthetic_programmatic_template,inline,top,False,raw_export
"Northstar Retirement Plan Services
Plan      Blue Heron Logistics LLC 403(b) Plan
Participant Kwame Walsh
Statement period   01/01/2026 - 01/30/2026
Beginning balance      $115,568.46
Employee contributions (pre-tax) 19,257.89
Roth contributions 774.79
Employer match   $155.66
Investment gain/loss -356.18
Ending balance 578,303.11
Vested balance   $154,397.84
Personal rate of return 6.5%
Investment      Allocation      Balance
Stable Value Fund 27% 152,395.10
S&P 500 Index Fund 56% 42,482.44
Target Retirement 2050 Fund  29%  189,946.42
Annual Benefit Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-01ac81bfbdb9c5aa86b7b755,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2026,fgen-a9369f8e8163909a50b9d465,synthetic_programmatic_template,inline,bottom,False,403b_annual
"IRA ...1629 Positions
Downloaded 06/22/2023
Date      Fund      Employee Contribution      Employer Match      Gain/Loss    Balance
16/04/2023   Target Date 2055   456.83   641.19   -1400.26  222174.16
20/12/2023 Stable Value 805.83 96.41 810.57 359988.78
2023-07-25 Targct Date 2055 897.45 729.27 772.35 157669.53
11/17/2023  S&P 500 Index  1237.60  325.89  -162.06  324232.35
08/24/2023     S&P 500 Index      649.62      135.10      -2137.32      521301.46
11/02/2023   Stable Value   225.12   689.45  -548.63   374295.87
O2/07/2023 Stablc Value 938.80 730.21 -2977.82 13025.70
05/05/2023   TDF2050   1217.71   562.31   2009.57   174194.01
2023-03-28  Targct Date 2055  294.78  717.98 1798.88  275931.07",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ec31a79f029da37534201bf3,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2023,fgen-5b01c9148f97609bba11c363,synthetic_programmatic_template,inline,top,True,raw_export
"Annual Benefit Statement
Summit Retirement Trust
Plan Riverside Regional Hospital 403(b) Plan
Participant  Taylor Testcase
Statement period 09/01/2023 - 09/30/2023
Beginning balance $239,560.40
Employee contributions (pre-tax) $3,854.55
Roth contributions  1,542.06
Employer match   $472.29
Investment gain/loss      31,229.73
Ending balance      320,652.57
Vested balance 61,621.38
Personal rate of return   13.0%
Investment   Allocation   Balance
Stable Value Fund 33% 114,192.41
S&P 500 Index Fund  55%  62,039.98
Target Retirement 2050 Fund  36%  6,451.32
Your 2023 Form 1099-R will be available online by January 31, 2024.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a989c029ff50e0f38787fae2,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2023,fgen-eab1e4921e54f7eb85a8f84e,synthetic_programmatic_template,inline,top,False,403b_annual
"Retirement Account Statement
Clearwater 401(k) Administration
Plan Blue Heron Logistics LLC 401(k) Savings Plan
Participant Riley Walsh
Statement period   05/01/2023 - 05/30/2023
Beginning balance  $246,071.55
Employee contributions (pre-tax) $17,513.16
Roth contributions  2,542.65
Employer match      5,124.11
Investment gain/loss 56,609.92
Ending balance   437,541.13
Vested balance  262,518.53
Personal rate of return 0.7%
Investment Allocation Balance
S&P 500 Index Fund  44%  106,982.41
Stable Value Fund 76% 96,708.65
Target Retirement 2050 Fund      10%      115,153.73",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a558b5a3371b90ff2fb48422,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2023,fgen-ff94e84ae81fa1c6784b78bc,synthetic_programmatic_template,inline,top,False,401k_quarterly
"Retirement Account Statement
Summit Retirement Trust
Plan      Tri-County School District 401(k) Savings Plan
Participant Lena Walsh
Statement period 02/01/2022 - 02/28/2022
Beginning balance $427,040.64
Employee contributions (pre-tax) 12,830.93
Roth contributions 4,822.67
Employer match  2,105.59
Investment gain/loss  -4,401.36
Ending balance 262,625.17
Vested balance   275,929.68
Personal rate of return   -2.0%
Investment      Allocation      Balance
S&P 500 Index Fund 60% 108,252.27
Target Retirement 2050 Fund 65% 66,483.32
Total Bond Index 64% 159,552.36
IRS Form 1099-R information for 2022 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b7a19d776d929615351ef491,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2022,fgen-df996f2cea03bc0bcc10cf49,synthetic_programmatic_template,inline,top,False,401k_quarterly
"Retirement Account Statement
Northstar Retirement Plan Services
Plan   Acme Test Corp 401(k) Savings Plan
Participant      Kwame Nguyen
Statement period  06/01/2021 - 06/30/2021
Beginning balance      $84,893.97
Employee contributions (pre-tax) $21,635.25
Roth contributions 389.77
Employer match  $5,793.33
Investment gain/loss  391.89
Ending balance $28,968.12
Vested balance      567,102.80
Personal rate of return  -7.7%
Investment      Allocation      Balance
Stable Value Fund      58%      96,485.58
Target Retirement 2050 Fund  66%  19,543.80
Total Bond Index   72%   194,806.95",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a582ba6cace43f8154fae651,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2021,fgen-876f499a35d9e3b5dddf17d1,synthetic_programmatic_template,inline,top,False,401k_quarterly
"Roth IRA Statement
Northstar Retirement Plan Services
Account   ****6229
Statement period   02/01/2021 - 02/28/2021
2021 contributions 4,638.14
2020 contributions made in 2021      6,647.60
Account value $377,887.75
Required minimum distribution for 2021  Not applicable",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-788ec5ce9857f2d8c20b602b,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2021,fgen-5ece9b0917725bf52cac6413,synthetic_programmatic_template,inline,top,False,ira_statement
"PayDate Source Investment Amount Units Unit Price
2022-01-27   5afe Harbor Match   Stable Value Fund   444.35   0.18   85.32
03/23/2022  Roth 401(k)  Target Retirement 2050  610.81  29.02  237.55
15/05/2022  5afe Harbor Match   5tab1e Value Fund   291.11   21.25   94.47
11/11/2022 Profit Sharing Target Retirement 2050 790.83 13.88 199.96
2022-05-09      Rollover      Stable Value Fund      735.48      32.57      21.28
09/10/2022     Employee Pre-Tax      Stable Value Fund      382.05      13.67     68.04
22/07/2022 Employee Pre-Tax  Target Retirement 2050  1451.68  29.40  233.48",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-feab55097da8fc61c33e6926,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2022,fgen-dc4ed8bd0c8559631571270d,synthetic_programmatic_template,inline,top,True,raw_export
"IRA ...7993 Positions
Date Fund Employee Contribution Employer MatchGain/Loss Balance
14/11/2O22      Target Date 2O55      379.05      6.51      740.54      564317.46
01/20/2022 TDF2050 1230.78 775.91-1091.86 48730.80
26/06/2022      Stable Value      249.04      205.67      -1642.92     398202.96
04/17/2022   TDF2050   480.96   366.98   2563.07   389441.90",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-854b012cbb7334fd05ef29c3,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2022,fgen-24d1fc0aab4923dd34beacdf,synthetic_programmatic_template,inline,top,True,raw_export
"Northstar Retirement Plan Services
Plan Copperline Software Inc. 401(k) Savings Plan
Participant  Lena Romero
Statement period 05/01/2024 - 05/30/2024
Beginning balance  105,787.36
Employee contributions (pre-tax)      $16,031.17
Roth contributions      4,206.82
Employer match  $7,177.61
Investment gain/loss 42,360.78
Ending balance  $274,572.63
Vested balance  $378,079.82
Personal rate of return      13.0%
Investment  Allocation  Balance
S&P 500 Index Fund  56%  96,778.21
Target Retirement 2050 Fund 37% 188,362.85
Stable Value Fund 7% 82,925.08
Your 2024 Form 1099-R will be available online by January 31, 2025.
Retirement Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-f4c088795d531a7fca53ec68,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2024,fgen-9ee2fb97fcb2ec990bffd487,synthetic_programmatic_template,inline,bottom,False,401k_quarterly
"Downloaded 2026-10-24
Account  Account Type  Symbol  Quantity  Value  Contributions YTD
...3476      Rollover IRA      BND      135.82      220049.05      5945.89
...8759   Roth IRA   FXAIX   387.44   65668.00   6242.21
...8190   Roth IRA   FXAIX   73.23   271211.18   482.08
...5458   Roth IRA   VTI   326.48   194903.02   5546.17
...3406  SEP IRA  VTI  397.82  140548.14  2054.71",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7a21dda7ed07838844f68508,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2026,fgen-ac5d0acc3bdae7cdf480508f,synthetic_programmatic_template,inline,top,False,raw_export
"Account Account Type Symbol Quantity Value Contributions YTD
...3011  Traditional IRA  FXAIX  338.00  35526.70  586.34
...7943   SIMPLE IRA   FXAIX   107.13   190850.89   1803.06
...3505      SIMPLE IRA      VTI      154.01      80975.00      2973.36",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bbd773de628446101e3fd2df,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2021,fgen-53518f95c059acdb7be4f0fc,synthetic_programmatic_template,inline,top,False,raw_export
"IRA ...4695 Positions
Account Account Type Symbol Quantity Value Contributions YTD
...2300  Rollovcr IRA BND  366.77  79142.73  5393.72
...5386 Roth IRA BND 7.43 123731.55 631.43
...8949  SIMPLE IRA  VTI  55.19  25387.46  938.88
...5732  Roth IRA  VTI  261.79  299343.83  2187.49",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-eaf1d49b8bc41a679d4b73de,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2023,fgen-f361978d48cfdc2a321afb3c,synthetic_programmatic_template,inline,top,True,raw_export
"Traditional IRA Statement
Clearwater 401(k) Administration
Account   XXX-XX-2939
Statement period 03/01/2023 - 03/30/2023
2023 contributions $2,994.91
2022 contributions made in 2023 748.99
Account value 520,834.76
Required minimum distribution for 2023  28,037.77
Your 2023 Form 5498 will be available online by January 31, 2024.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-fdee1ba497e35a6951d06ff4,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2023,fgen-10d392439dede3f2a07e5198,synthetic_programmatic_template,inline,top,False,ira_statement
"Traditional IRA Statement
Evergreen Retirement Services
Account   ending in 5342
Statement period   04/01/2022 - 04/31/2022
2022 contributions  1,979.58
2021 contributions made in 2022 $4,862.78
Account value      $184,423.32
Required minimum distribution for 2022   13,640.16",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-abbc1f0bf9308951c9f63848,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2022,fgen-57258031e21c61f0602477ac,synthetic_programmatic_template,inline,top,False,ira_statement
"Rollover IRA Statement
Clearwater 401(k) Administration
Account XXX-XX-1997
Statement period   08/01/2024 - 08/30/2024
2024 contributions 516.61
2023 contributions made in 2024   $4,980.52
Account value 370,468.03
Required minimum distribution for 2024   22,098.61
Your 2024 Form 5498 will be available online by January 31, 2025.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d7ed3f4d415f375d328bf918,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2024,fgen-425aac2b958115ecb36160e2,synthetic_programmatic_template,inline,top,False,ira_statement
"Retirement Account 5tatement
Summit Retirement Trust
Plan MapleStreet Dental PC 401(k) Savings Plan
Participant Avery C. Romero
Statement period 03/01/2024 - 03/31/2024
Beginning balance 410,474.53
Employee contributions (pre-tax)   $19,262.82
Roth contributions  881.70
Employer match  $1,855.75
Investment gain/loss 32,643.08
Ending balance 447,221.51
Vested balance 275,571.87
Personal rate of retum      13.2%
Investment Allocation Balance
5tableValue Fund 1O% 69,808.22
Target Retirement 2050 Fund      73%      125,646.35
5&P 500 Index Fund 29% 182,954.82",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-14535026cc9e689a3b56e78e,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2024,fgen-5579795294e9a58856ea30cb,synthetic_programmatic_template,inline,top,True,401k_quarterly
"Annual Benefit Statement
Northstar Retirement Plan Services
Plan   Granite Peak Manufacturing Co. 403(b) Plan
Participant   Mateo Moreau
Statement period 07/01/2026 - 07/30/2026
Beginning balance 45,207.77
Employee contributions (pre-tax)      1,219.87
Roth contributions $4,933.41
Employer match $6,261.87
Investment gain/loss   51,839.99
Ending balance 442,134.57
Vested balance   $547,700.47
Personal rate of return   -0.9%
Investment  Allocation  Balance
S&P 500 Index Fund   8%   113,791.09
Stable Value Fund   40%   27,675.71
Total Bond Index 25% 135,128.99",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4fcb7093008e78d55913ee46,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2026,fgen-df5cdefce879ad0c4a5e3a90,synthetic_programmatic_template,inline,top,False,403b_annual
"Annual Benefit Statement
Evergreen Retirement Services
Plan Tri-County School District 403(b) Plan
Participant Kwame Brennan
Statement period  08/01/2021 - 08/31/2021
Beginning balance      $493,925.73
Employee contributions (pre-tax) $9,819.22
Roth contributions  1,641.99
Employer match  8,770.35
Investment gain/loss 47,220.96
Ending balance 407,720.94
Vested balance  451,801.22
Personal rate of return  17.4%
Investment Allocation Balance
Stable Value Fund      46%      109,028.80
Target Retirement 2050 Fund 36% 106,948.59
Total Bond Index 76% 154,614.86",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-76aa14208865b960845024d7,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2021,fgen-837245b0e50d122944cc9975,synthetic_programmatic_template,inline,top,False,403b_annual
"Retirement Account Statement
Clearwater 401(k) Administration
Plan      Acme Test Corp 401(k) Savings Plan
Participant   Jordan Nguyen
Statement period 01/01/2024 - 01/28/2024
Beginning balance      479,623.69
Employee contributions (pre-tax) $12,538.97
Roth contributions      $1,044.06
Employer match      8,984.08
Investment gain/loss -11,879.63
Ending balance   547,471.12
Vested balance 408,883.89
Personal rate of return 12.4%
Investment Allocation Balance
Total Bond Index   51%   126,433.51
Target Retirement 2050 Fund  74%  46,177.64
Stable Value Fund  44%  180,474.76
Tax reminder: amounts on this statement may differ from your Form 1099-R.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6cd0b9cef301724a5bd9aff6,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2024,fgen-a623ece31a7ca1c98807beae,synthetic_programmatic_template,inline,top,False,401k_quarterly
"Retirement Account Statement
Northstar Retirement Plan Services
Plan Maple Street Dental PC 401(k) Savings Plan
Participant  Kwame S. Patel
Statement period      10/01/2025 - 10/30/2025
Beginning balance      $287,587.87
Employee contributions (pre-tax) $3,347.54
Roth contributions   4,790.95
Employer match   4,263.73
Investment gain/loss 51,638.93
Ending balance      $41,205.49
Vested balance $551,865.85
Personal rate of return -0.6%
Investment   Allocation   Balance
S&P 500 Index Fund  13%  98,210.71
Stable Value Fund      36%      185,748.00
Target Retirement 2050 Fund 76% 87,052.41",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a9815e6b56ea80dd2b24a820,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2025,fgen-f40f2fa91194158ed70d5c2a,synthetic_programmatic_template,inline,top,False,401k_quarterly
"Summit Retirement Trust
Plan Blue Heron Logistics LLC 401(k) Savings Plan
Participant Olivia Lindqvist
Statement period  12/01/2021 - 12/30/2021
Beginning balance      428,675.40
Employee contributions (pre-tax)   10,661.85
Roth contributions   $932.22
Employer match  $7,143.71
Investment gain/loss 19,103.43
Ending balance      $409,859.10
Vested balance   $173,435.50
Personal rate of return   3.2%
Investment Allocation Balance
Total Bond Index      51%      32,208.13
S&P 500 Index Fund 52% 118,151.15
Target Retirement 2050 Fund      29%      142,908.65",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c20c90a8439fc10aa355874a,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2021,fgen-9996479bb7157e3906a26b81,synthetic_programmatic_template,inline,none,False,401k_quarterly
"Date      Fund      Employee Contribution      Employer Match      Gain/Loss      Balance
2024-02-11   Target Date 2055   535.51   575.68   -131.09   209198.30
08/28/2024 Target Date 2055 1223.05 736.23 2068.00 267793.24
05/25/2024  S&P 500 Index  1067.63  359.23  2044.84  576209.22
401(k) Plan contribution history",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-92203a0eb0dce5f029ab8243,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2024,fgen-08b9a819560d8b8aa11e7a1f,synthetic_programmatic_template,inline,bottom,False,raw_export
"Annual Benefit Statement
Evergreen Retirement Services
Plan   Blue Heron Logistics LLC 403(b) Plan
Participant  Diego Romero
Statement period      11/01/2022 - 11/28/2022
Beginning balance $184,143.07
Employee contributions (pre-tax) 22,634.93
Roth contributions  3,638.83
Employer match   8,910.01
Investment gain/loss      55,356.05
Ending balance 411,401.06
Vested balance  571,023.88
Personal rate of return 21.4%
Investment Allocation Balance
Target Retirement 2050 Fund 71% 27,826.16
Total Bond Index   14%   137,680.27
Stable Value Fund   25%   153,229.89
IRS Form 1099-R information for 2022 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1c09b3beef39c80a3fb8c01c,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2022,fgen-d6ddfa7618e3a76a850dbfc7,synthetic_programmatic_template,inline,top,False,403b_annual
"Downloaded 2021-08-12
Date Fund   Employee Contribution   Employer Match   Gain/Loss   Balance
23/O6/2021      S&P 500 Index      1219.13      91.44      -2428.43      111160.83
03/06/2021   5table Value   338.85   296.07   2520.07   74275.82
2021-11-26   Target Date 2055   660.90   4.26   -1676.30   351416.82
06/10/2021  S&P 500 Index  1321.65  754.06  -1343.08  318384.60
27/03/2021 S&P 500 Indcx1119.92 237.26 -2743.79 219696.07
28/12/2021      TDF2050      517.17     455.2O      189.41      39853.86
2021-10-22      TDF2050      733.01      168.62      228.83      506633.01
2021-07-06  TDF2050  1087.84 769.62  1090.85 295707.69",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-fb76a1057b31eab266a5574a,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2021,fgen-58872c040ee6f976cf30a576,synthetic_programmatic_template,inline,top,True,raw_export
"IRA ...2013 Positions
Date Fund Employee Contribution Employer Match Gain/Loss Balance
28/02/2022 TDF2050 1052.56 740.91 247.53 133885.32
09/03/2022   Stable Value   440.94   567.15   -2389.67   236072.99
04/13/2022      TDF2050      1238.71      762.12      552.73      227599.86
2022-06-11 Target Date 2055 404.44 61.14 -1980.67 98675.24
02/02/2022  TDF2050  147.82  218.39  1462.56  291725.21
03/01/2022   Target Date 2055   1468.47   240.67   -999.50   280322.88",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8ccbe7541b5c866c4d12a7a1,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2022,fgen-ad18b362cae219177e19fce0,synthetic_programmatic_template,inline,top,False,raw_export
"Date   Fund   Employee Contribution   Employer Match   Gain/Loss   Balance
2024-08-03 TDF2050 672.18 17.40 -961.45 278223.03
2024-08-21   TDF2050   202.25   791.13   217.14   174178.99
03/06/2024      TDF2050      1255.04      67.82      -1780.13      487189.21
2024-11-06 S&P 500 Index 189.52 599.60 255.53 556263.33
05/18/2024 S&P 500 Index 284.32 365.29 408.32 287376.13
09/09/2024 S&P 500 Index 815.39 51.13 687.77 558877.13",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-49cf869d1d3edaaddadb6220,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2024,fgen-d5de6d6698bb46ca89c2febb,synthetic_programmatic_template,inline,top,False,raw_export
"401(k) Plan contribution history
Account Account Type Symbol Quantity Value Contributions YTD
...2525   Roth IRA   VTTSX   239.91   242180.88   6186.30
...7692 Roth IRA VTTSX 124.92 167361.91 2075.18
...1779   Rollover IRA   BND   147.27   16951.34   4765.74
...522O     Traditional IRA      FXAIX      218.17      168600.17     5741.36
...3024      Rollover IRA      BND      276.77     120039.98     5526.76",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-12b86d882eb282dca776fc57,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2025,fgen-6ae4771580440764d8bcc737,synthetic_programmatic_template,inline,top,True,raw_export
"Retirement Account Statement
Evergreen Retirement Services
Plan Acme Test Corp 401(k) Savings Plan
Participant      Alex Kowalski
Statement period  10/01/2025 - 10/31/2025
Beginning balance      183,366.03
Employee contributions (pre-tax) 5,329.28
Roth contributions $1,676.59
Employer match   6,358.51
Investment gain/loss   57,348.11
Ending balance   $310,954.95
Vested balance 19,810.89
Personal rate of return      2.8%
Investment Allocation Balance
Total Bond Index      64%      24,035.00
S&P 500 Index Fund   31%   130,973.58
Target Retirement 2050 Fund      38%      140,420.10",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3e9720625a6fa7796cd982da,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2025,fgen-5e097550032094057175f951,synthetic_programmatic_template,inline,top,False,401k_quarterly
"Clearwater 401(k) Administration
Account      XXXXX6656
Statement period   08/01/2021 - 08/28/2021
2021 contributions   $4,817.96
2020 contributions made in 2021  583.72
Account value $558,843.72
Required minimum distribution for 2021 Not applicable
Traditional IRA Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6d1c86df976be91085c6e3f2,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2021,fgen-46c474988de7a781ed6190c8,synthetic_programmatic_template,inline,bottom,False,ira_statement
"Date Fund Employee Contribution Employcr Match Gain/Loss Balance
2023-11-12  TDF2050  1188.71 591.77  950.60  237344.93
07/27/2023   Target Date 2055   213.27   605.23   1620.10   338956.35
2023-02-06   TDF2050   837.84  85.62   131.51  442556.02
2023-03-13      TDF2050      264.41      508.46      447.19      505974.25
05/21/2023 Targct Date 2055 1289.54 104.01 2804.41 353389.42
08/16/2023      5tab1eValue      497.74      315.54      -496.93      l71215.24
01/04/20235&P 500 Index 158.26 608.10 1348.32 374766.55
05/05/2023 Target Date 2055 287.78 37.98 -744.57 8705l.30
06/19/2023 5table Value 444.04 772.89 401.59 538832.13",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1233cd0dd86dc61139e15f26,v11-RETIREMENT_ACCOUNT_STATEMENT-inline,original,2023,fgen-b629cc6c10da82bc07eeb8dc,synthetic_programmatic_template,inline,none,True,raw_export
"Evergreen Retirement Services Plan Copperline Software Inc. 403(b) Plan Participant Lena Castillo Statement period
09/01/2026 - 09/31/2026 Beginning balance $358,950.86 Employee contributions (pre-tax) 7,952.30 Roth contributions 1,106.49 Employer match $2,143.79 Investment gain/loss -19,200.33 Ending balance $128,256.53 Vested balance 520,474.18 Personal rate of return 19.7% Investment Allocation Balance S&P 500 Index Fund 61% 76,848.91 Stable Value Fund 69% 187,881.34
Target Retirement 2050 Fund 34% 89,954.00",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3a0dfd0810829dee819375c8,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2026,fgen-0bc83b75307f832a051b9eb6,synthetic_programmatic_template,flat,none,False,403b_annual
"Annual Benefit Statement Clearwater 401(k) Administration Plan Tri-County School District 403(b) Plan Participant Riley J. Okafor Statement period 05/01/2025 - 05/30/2025 Beginning balance 6,445.75 Employee contributions (pre-tax)
10,130.29 Roth contributions 487.54 Employer match $302.93 Investment gain/loss 1,651.31 Ending balance $491,041.11 Vested balance $37,021.06 Personal rate of return 21.1%
Investment Allocation Balance Target Retirement 2050 Fund 11% 159,298.26 Total Bond Index 26% 120,398.94 S&P 500 Index Fund 32% 89,233.05",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7935def604364cd520c3c6a6,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2025,fgen-643cd1c1225d9baef70d85fb,synthetic_programmatic_template,flat,top,False,403b_annual
"Annual Benefit Statement Evergreen Retirement Services Plan Granite Peak Manufacturing Co. 403(b) Plan Participant Noah E. Sato Statement period 03/01/2022 - 03/28/2022 Beginning balance 36,861.39 Employee contributions (pre-tax) 18,361.27 Roth contributions 4,559.75 Employer match 7,042.33 Investment gain/loss 10,695.15 Ending balance 390,837.61 Vested balance 110,656.23 Personal rate of return 20.7% Investment Allocation Balance Target Retirement 2050 Fund 67% 150,641.35 Total Bond Index 78% 158,029.30
S&P 500 Index Fund
45% 39,016.81 Tax reminder: amounts on this statement may differ from your Form 1099-R.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-6fc4c7570dba9a3754e07365,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-4b60ea5951249bae9e42de45,synthetic_programmatic_template,flat,top,False,403b_annual
"Annual
Benefit Statement Clearwater 401(k) Administration Plan Tri-County School District 403(b) Plan Participant Priya Patel Statement period 07/01/2024 - 07/28/2024 Beginning balance 134,037.08 Employee contributions (pre-tax) 17,935.59 Roth contributions 3,347.97 Employer match 4,769.30 Investment gain/loss 47,040.68 Ending balance 167,432.10 Vested balance $278,206.97 Personal rate of return 13.7% Investment
Allocation Balance S&P 500 Index Fund 63% 49,907.22 Target Retirement 2050 Fund 66% 47,640.30 Stable Value Fund 60% 112,530.50",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d211e5b3841367dede989cd5,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2024,fgen-c58d9e8b7dbf314dc2b4a443,synthetic_programmatic_template,flat,top,False,403b_annual
"AnnualBenefit Statement Northstar Retirement Plan 5ervices Plan Tri-County School District 403(b) Plan Participant Riley Brennan Statement period 10/01/2025 - 10/30/2025 Beginning ba1ance 324,606.57 Employee
contributions (pre-tax) $9,821.11 Roth contributions $251.20 Employer match $8,115.59 Investment gain/1oss30,554.90 Ending balance 300,083.13 Vested balance $505,540.20 Personal rate of return 9.9% Invcstment Allocation Balance 5tablc Value Fund 77% 76,541.58
Target Retirement 2050 Fund 10% 149,090.69 Total Bond Index 6% 105,420.79",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-2332976e3ce8165d721c2337,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2025,fgen-cdf577877d1631b9110f8003,synthetic_programmatic_template,flat,top,True,403b_annual
"401(k) Plan contribution history Downloaded 02/06/2021 Pay Date Source Investment Amount Units
Unit Price 04/06/2021 Rollover Stable Value
Fund 619.88 53.43 34.56 05/03/2021 Profit Sharing Large Cap Index 224.99 46.28 256.80 2021-07-28 Roth 401(k) Target Retirement 2050 716.66 18.96 299.89 08/08/2021 Safe Harbor Match Target Retirement 2050 105.92 48.63 104.66 12/20/2021 Profit Sharing Large Cap Index 20.26 58.67 153.68",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-12fbd45fa07a374a1fd72833,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2021,fgen-6f88678bef6f0e852187838f,synthetic_programmatic_template,flat,top,False,raw_export
"Retirement Account Statement
Northstar Retirement Plan Services Plan Blue Heron Logistics LLC 401(k) Savings Plan Participant Fatima Patel Statement period 01/01/2026 - 01/28/2026 Beginning balance $70,123.30 Employee contributions (pre-tax) $8,653.93 Roth contributions
2,499.20 Employer match 4,155.70 Investment gain/loss 59,496.82 Ending balance 571,323.73 Vested balance $367,064.21 Personal rate of return 3.1% Investment Allocation Balance Stable Value Fund 54% 169,907.02 Total Bond Index 77% 56,377.97 S&P 500 Index Fund 72% 180,739.32 This statement is not a Form 1099-R. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c8a763e2bd3771734d1052ab,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2026,fgen-96f63b95971cb057d4332aaa,synthetic_programmatic_template,flat,top,False,401k_quarterly
"Summit Retirement Trust Plan Acme Test Corp 401(k) Savings Plan Participant Priya Fischer Statement period 05/01/2021 - 05/30/2021 Beginning balance 161,770.52 Employee contributions (pre-tax) $19,367.76
Roth contributions $2,982.53 Employer match 2,413.75 Investment gain/loss
1,497.80 Ending balance $375,660.54 Vested balance $547,208.03 Personal rate of return 7.8% Investment Allocation Balance Target Retirement 2050 Fund 72% 105,442.39 Stable Value Fund 11% 83,535.30 Total Bond Index 40% 47,065.79 IRS Form 1099-R information for 2021 will be mailed separately. Retirement Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4b39123588d8f5ba8a662314,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2021,fgen-8a47f674cebd9f550134384c,synthetic_programmatic_template,flat,bottom,False,401k_quarterly
"Pay Date Source Investment Amount Units Unit Price 2024-05-24 Employee Pre-Tax Target Retirement 2O50 1196.11 41.38 20.96 2024-10-11 Safe
Harbor Match Stable
Value Fund 728.95 38.28 160.56 2024-04-21 Emp1oyeePre-Tax Stable Value Fund 750.56 31.77 230.44",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-12f9b9f49b6cfaf6b3e029a8,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2024,fgen-1783d5628d0cc751fba4684a,synthetic_programmatic_template,flat,top,True,raw_export
"Summit Retirement Trust
Account ***-**-3441 Statement period
10/01/2022 - 10/31/2022 2022 contributions 5,471.73 2021 contributions made ín 2022 $272.52 Account value 240,994.75 Requíred minimumdistribution for 2022 Not applicable",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-84fcb4a246170d82e56e1c71,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-c2b1fd8ff02e3b2f0cc22eb3,synthetic_programmatic_template,flat,none,True,ira_statement
"Annual Benefit Statement Clearwater 401(k) Administration Plan Granite Peak Manufacturing Co. 403(b) Plan Participant Noah
R. Patel Statement period 12/01/2021 - 12/30/2021 Beginning balance $82,216.90 Employee contributions (pre-tax) $3,855.12 Roth contributions $2,789.02 Employer match $437.45 Investment gain/loss
8,632.32 Ending balance $393,661.82 Vested balance 547,654.34 Personal rate of return 8.2% Investment Allocation Balance S&P 500 Index Fund 34% 197,581.55 Stable Value Fund 17% 16,734.50 Target Retirement 2050 Fund 55% 143,545.54",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5b11e1055dde5a800a12467d,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2021,fgen-b741fd125152247d0d1fc482,synthetic_programmatic_template,flat,top,False,403b_annual
"Downloaded 2023-06-04
Pay Date Source Investment Amount Units Unit Price 15/03/2023 Safe Harbor Match Target Retirement 2050 59.73 9.40 269.21 2023-01-02 Profit Sharing Large Cap Index 1387.97 42.22 205.56
02/03/2023 Employee Pre-Tax Target Retirement 2050 166.37 42.61 128.67 04/09/2023 Employee Pre-Tax Large Cap Index 347.12 9.98 151.47 19/09/2023 Employee Pre-Tax Large Cap Index 1289.54 46.77 153.59 06/02/2023 Roth 401(k) Target Retirement 2050 244.40 15.84 180.21 26/11/2023 Safe Harbor Match Large Cap Index 655.09 24.22 87.64",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b4e41b688d9124aec0bf9ec7,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2023,fgen-a10d35bdc1475352b8bb3b90,synthetic_programmatic_template,flat,bottom,False,raw_export
"Summit Retirement Trust Plan Acme Test Corp 401(k) Savings Plan Participant Priya Patel Statement period 03/01/2026 - 03/30/2026 Beginning balance 27,260.39 Employee contributions (pre-tax) 7,205.95 Roth contributions $1,713.50 Employer match $1,769.10 Investment gain/loss 2,128.89 Ending balance 174,001.44 Vested balance
412,050.46 Personal rate of return 9.6% Investment Allocation Balance Target Retirement 2050 Fund 80% 28,971.01 Stable Value
Fund 48% 17,656.72 Total Bond Index 14% 22,391.97 IRS Form 1099-R information for 2026 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-b079db32a39ec0d8a787e47d,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2026,fgen-10000061915dda6c100e04c4,synthetic_programmatic_template,flat,none,False,401k_quarterly
"Retirement Account Statement Evergreen Retirement Services Plan Granite Peak Manufacturing Co. 401(k) Savings Plan Participant Hiro Nguyen Statement period 08/01/2022 - 08/30/2022 Beginning balance $290,399.83 Employee contributions (pre-tax) 9,576.69 Roth contributions 4,810.82 Employer match 973.58 Investment gain/loss 3,943.91 Ending balance $181,202.88 Vested balance 332,200.79 Personal rate of return 8.9% Investment Allocation Balance Total Bond Index 67%
124,382.70 S&P 500 Index Fund
47% 127,901.35 Stable Value Fund 74% 97,500.44",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-4660346d9dea38caea6fe972,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-94b20dd199a7ad5738f816cd,synthetic_programmatic_template,flat,top,False,401k_quarterly
"Retirement Account Statement Clearwater 401(k) Administration Plan Maple Street
Dental PC 401(k) Savings Plan Participant Taylor Lindqvist Statement period 01/01/2025 - 01/28/2025 Beginning balance 250,903.80 Employee contributions (pre-tax) $16,182.05 Roth contributions $2,053.58 Employer match $7,503.12 Investment gain/loss 16,434.80 Ending balance $588,701.41 Vested balance 221,562.73 Personal rate of
return 13.7% Investment Allocation Balance Target Retirement 2050 Fund 39% 12,028.71 Stable Value Fund 27% 51,277.53 Total Bond Index 45% 59,636.25 This statement is not a Form 1099-R. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-76d69a81a92175fd50d20c9d,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2025,fgen-b7aa5d6cb8e3c52323ee671c,synthetic_programmatic_template,flat,top,False,401k_quarterly
"Clearwater 401(k) Administration Account ending
in 7744 Statement period 02/01/2026 - 02/28/2026 2026 contributions $1,484.93 2025 contributions made in 2026 394.13 Account value $207,738.53 Required minimum distribution for
2026 $5,949.88 Traditional IRA Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0d685bcc469d4be3c9a29e85,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2026,fgen-dcaabc3749a813dccbdd5f42,synthetic_programmatic_template,flat,bottom,False,ira_statement
"Annual Benefit Statement Clearwater 401(k) Administration Plan Riverside Regional Hospital 403(b) Plan Participant Morgan Fischer
Statement period 04/01/2022 - 04/28/2022 Beginning balance 273,857.39 Employee contributions (pre-tax) $14,788.26 Roth contributions 1,393.75 Employer match $1,333.01
Investment gain/loss 50,194.16 Ending balance $426,606.78 Vested balance $199,978.50 Personal rate of return 13.0% Investment Allocation Balance Target Retirement 2050 Fund 57% 117,790.15 Stable Value Fund 29% 6,390.83 Total Bond Index 57% 30,378.69",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-46a31e561b6aac4aa6369a24,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-d20d79a23f40ca60c1899a5f,synthetic_programmatic_template,flat,top,False,403b_annual
"Retirement Account Statement Evergreen Retirement Services Plan Tri-County School District 401(k) Savings Plan Participant Jordan Walsh Statement period 02/01/2025 - 02/28/2025 Beginning balance $242,078.00 Employee contributions (pre-tax) 2,584.19 Roth contributions $1,429.04 Employer match $1,443.20 Investment gain/loss -4,683.56 Ending balance 237,704.61 Vested balance
$246,678.31 Personal rate of return 10.1% Investment
Allocation Balance Total Bond Index 52% 104,664.74 S&P 500 Index Fund 71% 151,205.33 Target Retirement 2050 Fund 66% 178,467.26",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1b6d913c08125f43aea32eac,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2025,fgen-de7e83112a2d0dd6dab893ab,synthetic_programmatic_template,flat,top,False,401k_quarterly
"Traditional IRA Statement Northstar Retirement Plan Services Account XXX-XX-8578 Statement period 03/01/2022 - 03/28/2022 2022 contributions $5,737.49 2021 contributions made in 2022 2,206.38 Account value 532,998.02 Required minimum distribution for 2022 Not applicable IRS Form
5498 information for
2022 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3b7c6155260515d41e9c59b0,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-95627861b10f4f0c5c4464d2,synthetic_programmatic_template,flat,top,False,ira_statement
"Annual Benefit Statement Northstar Retirement Plan Services Plan Tri-County School District 403(b) Plan Participant Sofia Testcase Statement period 04/01/2021 - 04/28/2021 Beginning balance 31,476.21 Employee contributions (pre-tax) $14,985.12 Roth contributions $1,615.37 Employer match 6,376.14 Investment gain/loss 52,604.76 Ending balance 453,094.79 Vested balance $226,829.43
Personal rate of return 13.8% Investment
Allocation Balance Target Retirement 2050 Fund 6% 91,800.21 Stable Value Fund 54% 181,432.64 S&P 500 Index Fund 16% 72,542.75 Tax reminder: amounts on this statement may differ from your Form 1099-R.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e4ba64213e0e63905295bd63,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2021,fgen-c6aeb45cf0cf68593b25abd8,synthetic_programmatic_template,flat,top,False,403b_annual
"Annual Benefit Statement Clearwater 401(k) Administration Plan Riverside Regional Hospital 403(b) Plan ParticipantRiley Rivera Statement period 12/01/2025 - 12/28/2025 Beginning balance $461,813.12 Employee contributions (pre-tax) l1,360.02 Roth contributionsl,214.16 Employer match
$2,357.79 Investment gain/1oss 54,226.35 Ending balance 78,829.85 Vested balance $383,614.44 Personal rate of return -2.7%
Investment Allocatíon Balance S&P 500 Index Fund 28% 107,361.93 Stab1e Valuc Fund 14% 182,625.24 Target Retirement 2050 Fund 2l% 140,830.72",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8ca6b7f58dfa3fc052b1b480,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2025,fgen-75f47ad87a5ef82f2e6b9163,synthetic_programmatic_template,flat,top,True,403b_annual
"Retirement Account Statement Summit Retirement Trust Plan Maple Street Dental PC 401(k)
Savings Plan Participant Noah A. Moreau Statement period 01/01/2023 - 01/28/2023 Beginning balance $338,475.45 Employee contributions (pre-tax) 7,023.29 Roth contributions $4,507.28 Employer match $8,690.98 Investment gain/loss 47,541.30 Ending balance $73,952.37 Vested balance
145,070.23 Personal rate of return 8.3% Investment Allocation Balance Total Bond Index 24% 184,442.08 Target Retirement 2050 Fund 5% 22,836.22 Stable Value Fund 54% 53,550.71 Your 2023 Form 1099-R will be available online by January 31, 2024.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cdd91efb4025f01242d4a125,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2023,fgen-2562f67320a1ab43d0fb171d,synthetic_programmatic_template,flat,top,False,401k_quarterly
"Rollover IRA Statement Evergreen Retirement Services Account ending in 4342 Statement period 04/01/2023 - 04/28/2023 2023 contributions
1,532.76 2022 contributions
made in 2023 4,845.60 Account value $498,861.30 Required minimum distribution for 2023 Not applicable",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8287f55bee20e269d7c15827,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2023,fgen-0b6942d5138bd4d50a30b86e,synthetic_programmatic_template,flat,top,False,ira_statement
"Clearwater 40l(k) Administration Plan Maple 5treet Dental PC 403(b) Plan Participant Avery TanakaStatement period 02/01/2022 - 02/28/2022 Beginning balance $497,199.84 Employee contributions (pre-tax) $17,773.43 Roth contributions 3,153.77 Employer
match $5,394.5O Investment gain/loss 50,765.48 Ending balance202,837.97 Vested balance $197,913.58 Personal rate of retum 14.9% Invcstment Allocation Balance Target Retirement 2050
Fund 33% 149,446.62 5table Value Fund 19% 162,497.76 Total Bond Index 38% 174,319.26 Annual Benefit Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-8cdc00841a351bacdd8b120f,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-c9be37f941f307040cd5eecb,synthetic_programmatic_template,flat,bottom,True,403b_annual
"Evergreen Retirement Services Plan
Copperline Software Inc. 403(b) Plan Participant Olivia D. Adeyemi Statement period 01/01/2021 - 01/30/2021 Beginning balance 108,562.07 Employee contributions (pre-tax) $12,237.86 Roth contributions $3,755.63 Employer match $7,553.96 Investment gain/loss 35,150.20 Ending balance 50,226.52 Vested balance $395,103.28 Personal rate of retum 16.4% Investment Allocation Balancc5table Value Fund 57% 54,280.89 5&P 500 Index Fund 12% 29,631.88 Target Retirement 2050 Fund 69% 169,977.54 Thisstatement is not
a Form1099-R. Keep ít for your records. Annual Benefit 5tatement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-962c298055e46ca4f86bd83d,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2021,fgen-a3bd765cca40810cd3e68a3a,synthetic_programmatic_template,flat,bottom,True,403b_annual
"Retirement Account Statement Summit Retirement Trust Plan Tri-County School District 401(k) Savings Plan Participant Jordan J. Tanaka Statcmcnt period06/01/2022 - 06/31/2022 Beginning balance $121,469.46 Employee contributions (pre-tax) $14,044.98 Roth contributions $4,563.54 Employer match 1,147.55 Investment gain/loss 48,256.45 Ending balance $581,744.67 Vested balance $121,706.95 Personal rate ofretum 8.9% Investment Allocatíon Balance 5&P 5O0 Index Fund 50% 134,768.49 Target Retirement 2050 Fund
39% 190,180.23 Total Bond Index 7%
155,744.43",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-bc54cf70bb79e4ec6156b10d,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-ffa6f35851091217a3ddfd02,synthetic_programmatic_template,flat,top,True,401k_quarterly
"Retirement Account Statement Summit Retirement Trust Plan Acme
Test Corp 401(k) Savings Plan Participant Mateo L. Tanaka Statement period 06/01/2025 - 06/28/2025 Beginning balance $378,811.25 Employee contributions (pre-tax) $9,396.16 Roth
contributions 4,389.63 Employer match $6,257.26 Investment gain/loss 33,322.01 Ending balance $151,162.39 Vested balance $469,951.75 Personal rate of return 5.1% Investment Allocation Balance Target Retirement 2050 Fund 39% 108,891.79 Stable Value Fund 29% 52,652.36 Total Bond Index 13% 47,506.16",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-fe8a1d0e1813b3476c728cab,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2025,fgen-2e4b6a5b3f59ee7a3903e2e0,synthetic_programmatic_template,flat,top,False,401k_quarterly
"Retirement Account Statement Summit Retirement Trust Plan Acme Test Corp 401(k) Savings Plan Participant Fatima Lindqvist Statement period 02/01/2025 - 02/28/2025 Beginning ba1ance S35,262.98 Employee contributions (pre-tax) 13,816.74 Roth contributions 1,467.00 Employer match 3,720.89
Investment gain/loss -6,856.40 Ending balancc $67,366.90 Vested
balance 114,780.29 Personal rate ofreturn 15.5% Investment Allocation Balance TotalBond Index 37% 137,773.1O Target Retirement 2050 Fund 45% 145,112.61 Stable Value Fund 13% 187,215.73 This statement is not a Form1099-R. Keep it for your records.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-1d42ccef35ec778d6dc738ef,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2025,fgen-d8223548935ab8c755cff05b,synthetic_programmatic_template,flat,top,True,401k_quarterly
"Retirement Account Statement Summit Retirement Trust Plan Riverside Regional Hospital 401(k) Savings Plan Participant Sofia Okafor Statement períod 08/01/2022 - 08/28/2022 Beginning balance 17,643.08 Employee contributions
(pre-tax) $8,041.48 Roth contríbutions $84.33 Employcr match
$1,746.89 Investment gain/loss -18,898.56 Ending balance 289,888.99 Vested balance$331,8O6.98 Personal rate of retum 10.0% Investment A1location Balance Target Retirement 2050 Fund 17% 2,200.09 Total BondIndex 65% 53,205.22 S&P 500 Indcx Fund 49% 146,953.54",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-62e8026c8c8be0740568fe74,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-9ed4c51d36e2f63c1831540b,synthetic_programmatic_template,flat,top,True,401k_quarterly
"Rollover IRA Statement Clearwater 401(k)
Administration Account ***-**-1891 Statement period 03/01/2022 - 03/30/2022 2022 contributions 5,945.33 2021
contributions made in 2022 $5,832.32 Account value 343,888.49 Required minimum distribution for 2022 $8,144.23",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-487ce83104bb0caa9a8aaa4f,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-66fe30e0fe9f1b0805d2b9d1,synthetic_programmatic_template,flat,top,False,ira_statement
"Rollover IRA Statement Evergreen Retirement Services Account XXX-XX-3522 Statement period 12/01/2026 -
12/31/2026 2026 contributions $4,995.11 2025 contributions made in 2026 770.59 Account value $306,129.85 Required minimum distribution for
2026 Not applicable IRS Form 5498 information for 2026 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c5aef018fdae26b1c7be0207,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2026,fgen-df35cf57aee5d80c7a173f22,synthetic_programmatic_template,flat,top,False,ira_statement
"Retirement Account Statement Summit Retirement Trust Plan Copperline Software Inc. 401(k) Savings Plan Participant Noah Adeyemi Statement period 10/01/2022 - 10/31/2022
Beginning balance $324,778.87 Employee contributions
(pre-tax) $4,290.00 Roth contributions 214.90 Employer match $1,604.73 Investment gain/loss -11,118.86 Ending balance $450,228.63 Vested balance 266,217.96 Personal rate of return 3.5% Investment Allocation Balance S&P 500 Index Fund 51% 170,827.11 Stable Value Fund 17% 182,847.78 Total Bond Index 39% 4,908.95",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-37a03b86786774f42538bc9c,v11-RETIREMENT_ACCOUNT_STATEMENT-flat,original,2022,fgen-f53d106089608b670ff23bd4,synthetic_programmatic_template,flat,top,False,401k_quarterly
"## Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Plan | Granite Peak Manufacturing Co. 401(k) Savings Plan |
| Participant | Alex Patel |
| Statement period | 03/01/2024 - 03/30/2024 |
| Beginning balance | 422,743.14 |
| Employee contributions (pre-tax) | $15,652.49 |
| Roth contributions | $1,218.11 |
| Employer match | $7,925.70 |
| Investment gain/loss | -6,976.81 |
| Ending balance | $57,971.63 |
| Vested balance | 179,055.79 |
| Personal rate of return | -1.8% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Target Retirement 2050 Fund | 54% | 11,137.86 |
| S&P 500 Index Fund | 18% | 189,854.66 |
| Stable Value Fund | 46% | 144,226.56 |
## Your 2024 Form 1099-R will be available online by January 31, 2025.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-372cef441ffb18c5418c5366,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2024,fgen-04a823163cf74e0123ec4c1d,synthetic_programmatic_template,markdown,none,False,401k_quarterly
"Evergreen Retirement Services
| Field | Value |
| --- | --- |
| Account | ****0942 |
|Statement period | 05/01/2025 - 05/28/2025 |
| 2025 contributions | S4,177.74|
| 2024 contributions made in 2025 | 1,156.84 |
| Account va1ue | $20,400.38 |
| Required minimum distribution for 2025 | 23,655.47 |
This statement is not a Form 5498. Keep it for your records.
Roth IRA 5tatement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7b4577d23ba9f64fd4bd308d,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2025,fgen-20e5cc0ffbe22692a001eb6c,synthetic_programmatic_template,markdown,bottom,True,ira_statement
"Annual Benefit Statement
Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Plan | Granite Peak Manufacturing Co. 403(b) Plan |
| Participant | Olivia M. Testcase |
| Statement period | 01/01/2023 - 01/30/2023 |
| Beginning balance | $264,848.71 |
| Employee contributions (pre-tax) | 10,349.43 |
| Roth contributions | 3,038.43 |
| Employer match | $3,542.70 |
| Investment gain/loss | -9,246.61 |
| Ending balance | $138,334.20 |
| Vested balance | 28,664.84 |
| Personal rate of return | 2.1% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Stable Value Fund | 61% | 40,429.93 |
| Total Bond Index | 54% | 30,142.16 |
| Target Retirement 2050 Fund | 17% | 62,845.69 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-a34f494fdc2cf3a253160d15,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2023,fgen-c5cda9f6ff327c523ddbc4fd,synthetic_programmatic_template,markdown,top,False,403b_annual
"Downloaded 14/03/2021
| Date | Fund | Employee Contribution | Employer Match | Gain/Loss | Balance |
| --- | --- | --- | --- | --- | --- |
| 10/02/2021 | S&P 500 Index | 645.25 | 573.58 | 378.48 | 106216.79 |
| 27/05/2021 | Stable Value | 208.76 | 732.99 | -576.08 | 137157.51 |
| 2021-06-26 | TDF2050 | 1076.01 | 348.54 | -2460.18 | 303704.82 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-da008fa0442458fe55502d63,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2021,fgen-7b038ec3631df27c8e1e43c6,synthetic_programmatic_template,markdown,bottom,False,raw_export
"Downloaded 2024-11-26
| Date | Fund | Employee Contribution | Employer Match | Gain/Loss | Balance |
| --- | --- | --- | --- | --- | --- |
| 2024-02-14 | S&P 500 Index | 1075.68 | 198.60 | 5.22 | 461505.79 |
| 02/18/2024 | S&P 500 Index | 1145.48 | 196.31 | 2698.31 | 379784.68 |
| 11/06/2024 | Target Date 2055 | 616.45 | 375.82 | 2442.42 | 245315.39 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-c0b00fd9c1afbd6f476dfaca,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2024,fgen-4aa37c042eb14af1946e7806,synthetic_programmatic_template,markdown,top,False,raw_export
"Retirement Account Statement
## Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Plan | Riverside Regional Hospital 401(k) Savings Plan |
| Participant | Noah J. Patel |
| Statement period | 03/01/2022 - 03/28/2022 |
| Beginning balance | 408,895.32 |
| Employee contributions (pre-tax) | $15,982.29 |
| Roth contributions | $3,334.89 |
| Employer match | 2,492.40 |
| Investment gain/loss | 176.93 |
| Ending balance | 286,436.93 |
| Vested balance | 71,061.06 |
| Personal rate of return | 1.2% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Total Bond Index | 21% | 59,241.90 |
| S&P 500 Index Fund | 64% | 146,225.14 |
| Target Retirement 2050 Fund | 47% | 175,434.14 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0de1337e96962ba51fa49497,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2022,fgen-516a573490773c19c4eed671,synthetic_programmatic_template,markdown,top,False,401k_quarterly
"## Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Account | ending in 0598 |
| Statement period | 10/01/2026 - 10/28/2026 |
| 2026 contributions | $6,226.80 |
| 2025 contributions made in 2026 | $6,170.94 |
| Account value | 295,934.65 |
| Required minimum distribution for 2026 | Not applicable |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0de66850d1e8bccae71adb16,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-561150b8ba4afaf697d48afd,synthetic_programmatic_template,markdown,none,False,ira_statement
"## Northstar Retirement Plan Services
| Field |Value |
| --- | --- |
| Plan | Copperline Software Inc. 4O1(k) Savíngs Plan |
|Participant | Noah L. Fischer |
| Statcment period | 09/01/2023 - 09/28/2023|
| Beginning balance | 369,154.46 |
| Employce contributions (pre-tax) | l5,672.65 |
| Roth contributions | 4,638.37 |
| Employer match | S1,188.4O |
| Investment gain/loss | 39,511.36 |
| Ending balance | 249,745.72 |
| Vcsted balance | $35,647.73 |
| Personal rate of return| -6.4% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| S&P 500 Index Fund | 32% | 64,115.19 |
| Total Bond Index | 41% | 99,797.44 |
| Target Retirement 2050 Fund | 76% | 164,013.10 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-55d92c55b371915b98677f30,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2023,fgen-f7a21998fbe4b9698b7c1e68,synthetic_programmatic_template,markdown,none,True,401k_quarterly
"## Downloaded 2023-07-15
| Date | Fund | Employee Contribution | Employer Match | Gain/Loss | Balance |
| --- | --- | --- | --- | --- | --- |
| 2023-11-12 | S&P 500 Index | 1254.79 | 311.09 | 445.72 | 296259.64 |
| 10/17/2023 | Stable Value | 534.72 | 142.75 | 2079.32 | 497813.10 |
| 25/05/2023 | TDF2050 | 334.91 | 786.71 | 1852.54 | 214149.05 |
| 06/01/2023 | TDF2050 | 1165.70 | 508.85 | 596.14 | 8823.42 |
| 22/04/2023 | TDF2050 | 1172.41 | 336.13 | 960.99 | 237569.83 |
| 10/01/2023 | TDF2050 | 922.52 | 607.35 | 531.43 | 485395.91 |
## Retirement Plan Activity",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cb4bfe6ca5ca60ff5cd7e4d0,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2023,fgen-6ad80b1ed9702b56b3d27112,synthetic_programmatic_template,markdown,bottom,False,raw_export
"IRA ...9138 Positions
Downloaded 2022-08-01
| Account | Account Type | Symbol | Quantity | Value | Contributions YTD |
| --- | --- | --- | --- | --- | --- |
| ...7216 | Rollover IRA | FXAIX | 351.40 | 240014.63 | 1691.45 |
| ...7556 | Rollover IRA | VTTSX | 371.31 | 155135.94 | 5833.06 |
| ...8114 | Roth IRA | VTI | 4.38 | 46002.11 | 6324.16 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-0c7bb48773acf2fff4fa9882,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2022,fgen-dd077f8486a3264edd662b44,synthetic_programmatic_template,markdown,top,False,raw_export
"Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Plan | Maple Street Dental PC 401(k) Savings Plan |
| Participant | Diego Haddad |
| Statement period | 02/01/2026 - 02/28/2026 |
| Beginning balance | $59,759.59 |
| Employee contributions (pre-tax) | 19,684.43 |
| Roth contributions | $4,724.33 |
| Employer match | $6,049.69 |
| Investment gain/loss | 57,909.62 |
| Ending balance | $337,450.79 |
| Vested balance | $437,137.25 |
| Personal rate of return | 16.1% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Total Bond Index | 78% | 114,898.31 |
| Stable Value Fund | 20% | 103,763.08 |
| Target Retirement 2050 Fund | 54% | 184,559.98 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-df8115fd23b5437514b644d4,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-7cd3e7efeef994914b04d605,synthetic_programmatic_template,markdown,none,False,401k_quarterly
"Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Plan | Tri-County School District 403(b) Plan |
| Participant | Jordan E. Walsh |
| Statement period | 07/01/2022 - 07/30/2022 |
| Beginning balance | $151,029.60 |
| Employee contributions (pre-tax) | $12,449.11 |
| Roth contributions | $1,182.67 |
| Employer match | $2,515.16 |
| Investment gain/loss | 43,081.85 |
| Ending balance | 171,972.39 |
| Vested balance | 128,967.99 |
| Personal rate of return | 7.4% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Stable Value Fund | 32% | 187,908.32 |
| Total Bond Index | 65% | 189,872.21 |
| S&P 500 Index Fund | 37% | 66,576.02 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-3f491898fc8777c038ed16ed,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2022,fgen-0c97a437b6548827589868df,synthetic_programmatic_template,markdown,none,False,403b_annual
"Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Account | ***-**-7354 |
| Statement period | 04/01/2023 - 04/28/2023 |
| 2023 contributions | $271.86 |
| 2022 contributions made in 2023 | $4,013.44 |
| Account value | $89,320.05 |
| Required minimum distribution for 2023 | 25,713.80 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-18e9f23d02eb2c81d9a0cd77,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2023,fgen-58d2e480adb76dff7969c220,synthetic_programmatic_template,markdown,none,False,ira_statement
"Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Account | XXXXX8045 |
| Statement period | 12/01/2023 - 12/30/2023 |
| 2023 contributions | 5,697.62 |
| 2022 contributions made in 2023 | 562.69 |
| Account value | 580,344.28 |
| Required minimum distribution for 2023 | Not applicable |
This statement is not a Form 5498. Keep it for your records.
## Roth IRA Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-d20b7549e02f1021deb399a5,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2023,fgen-6168edd4f2705012658be70f,synthetic_programmatic_template,markdown,bottom,False,ira_statement
"Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Plan | Acme Test Corp 403(b) Plan |
| Participant | Diego Testcase |
| Statement period | 06/01/2026 - 06/30/2026 |
| Beginning balance | $128,010.23 |
| Employee contributions (pre-tax) | $2,080.13 |
| Roth contributions | $2,874.78 |
| Employer match | 8,996.65 |
| Investment gain/loss | 56,775.12 |
| Ending balance | $100,204.47 |
| Vested balance | 38,790.21 |
| Personal rate of return | 0.7% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| S&P 500 Index Fund | 33% | 124,042.46 |
| Stable Value Fund | 12% | 187,964.46 |
| Target Retirement 2050 Fund | 39% | 104,596.09 |
Annual Benefit Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7c19e008f55b9864a505601b,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-491c19a99b0bf0de6fc19411,synthetic_programmatic_template,markdown,bottom,False,403b_annual
"## Annual Benefit Statement
Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Plan | Maple Street Dental PC 403(b) Plan |
| Participant | Alex Larsen |
| Statement period | 02/01/2026 - 02/28/2026 |
| Beginning balance | 312,360.30 |
| Employee contributions (pre-tax) | 20,070.86 |
| Roth contributions | $1,930.33 |
| Employer match | 2,657.07 |
| Investment gain/loss | 18,158.11 |
| Ending balance | $355,288.40 |
| Vested balance | $313,370.88 |
| Personal rate of return | 7.4% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Target Retirement 2050 Fund | 56% | 15,815.28 |
| Total Bond Index | 47% | 145,423.85 |
| S&P 500 Index Fund | 58% | 135,937.03 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5457549d7b22a063e5ec5684,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-5e49071a2275d8fd46060884,synthetic_programmatic_template,markdown,top,False,403b_annual
"## Annual Benefit Statement
## Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Plan | Maple Street Dental PC 403(b) Plan |
| Participant | Amara L. Romero |
| Statement period | 09/01/2024 - 09/28/2024 |
| Beginning balance | $126,956.88 |
| Employee contributions (pre-tax) | $6,690.58 |
| Roth contributions | $1,997.92 |
| Employer match | 3,745.69 |
| Investment gain/loss | 17,903.99 |
| Ending balance | 588,702.09 |
| Vested balance | $354,800.17 |
| Personal rate of return | 1.0% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Stable Value Fund | 73% | 194,177.07 |
| S&P 500 Index Fund | 57% | 125,505.85 |
| Target Retirement 2050 Fund | 25% | 145,580.68 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-5735b8882073d8ecc94ad748,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2024,fgen-f7acd72c1b50cd0c20db2093,synthetic_programmatic_template,markdown,top,False,403b_annual
"Annual Benefit Statement
Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Plan | Blue Heron Logistics LLC 403(b) Plan |
| Participant | Hiro A. Brennan |
| Statement period | 11/01/2021 - 11/28/2021 |
| Beginning balance | 69,265.01 |
| Employee contributions (pre-tax) | 12,231.29 |
| Roth contributions | 447.13 |
| Employer match | $7,121.64 |
| Investment gain/loss | 6,434.14 |
| Ending balance | $216,539.02 |
| Vested balance | 281,616.72 |
| Personal rate of return | 9.9% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Target Retirement 2050 Fund | 59% | 83,840.36 |
| Stable Value Fund | 39% | 121,849.53 |
| Total Bond Index | 6% | 107,195.49 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-10c9b3ca787320f60f885e6b,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2021,fgen-315a637705012a3eed1f72de,synthetic_programmatic_template,markdown,top,False,403b_annual
"## Annual Benefit Statement
## Evergreen Retirement Services
| Field | Value |
| --- | --- |
| Plan | Copperline Software Inc. 403(b) Plan |
| Participant | Amara Brennan |
| Statement period | 10/01/2026 - 10/30/2026 |
| Beginning balance | $399,869.27 |
| Employee contributions (pre-tax) | 7,892.80 |
| Roth contributions | 4,464.92 |
| Employer match | 8,902.97 |
| Investment gain/loss | 10,942.10 |
| Ending balance | 40,836.32 |
| Vested balance | 121,847.47 |
| Personal rate of return | 4.0% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Total Bond Index | 43% | 32,414.37 |
| Stable Value Fund | 35% | 110,641.22 |
| S&P 500 Index Fund | 46% | 121,801.36 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-143548a46420d666df6d30ba,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-18cad00c72d768989314b2ce,synthetic_programmatic_template,markdown,top,False,403b_annual
"Traditional IRA Statement
## Summit Retirement Trust
| Field | Value |
| --- | --- |
| Account | ****9921 |
| Statement period | 04/01/2026 - 04/30/2026 |
| 2026 contributions | $3,155.90 |
| 2025 contributions made in 2026 | 6,956.28 |
| Account value | $337,965.46 |
| Required minimum distribution for 2026 | 18,467.78 |
## Your 2026 Form 5498 will be available online by January 31, 2027.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e5699dfe5ba913b6d6a7af4d,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-f8aa37cac9559ae1e9583af2,synthetic_programmatic_template,markdown,top,False,ira_statement
"Summit Retirement Trust
| Field | Value |
| --- | --- |
| Plan | Riverside Regional Hospital 401(k) Savings Plan |
| Participant | Wei Testcase |
| Statement period | 08/01/2026 - 08/30/2026 |
| Beginning balance | $72,794.01 |
| Employee contributions (pre-tax) | 18,365.07 |
| Roth contributions | 115.94 |
| Employer match | $538.96 |
| Investment gain/loss | 45,544.56 |
| Ending balance | 568,977.75 |
| Vested balance | $598,942.64 |
| Personal rate of return | -0.1% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Total Bond Index | 11% | 179,020.62 |
| S&P 500 Index Fund | 39% | 36,460.29 |
| Target Retirement 2050 Fund | 7% | 78,588.50 |
Retirement Account Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-573fb1c6e2b11e29ad1aa532,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-2c23bb8a6a94417c4124c9d9,synthetic_programmatic_template,markdown,bottom,False,401k_quarterly
"Summit Retirement Trust
| Field | Value |
| --- | --- |
| Account | XXXXX5254 |
| Statement períod | 06/01/2022 - 06/31/2022 |
| 2022 contributions | $4,456.20 |
| 2021 contríbutions madc in 2022 | 6,978.02 |
| Account value| 130,107.34 |
| Requíred minimum distribution for 2022 | Not applicable |
This statement is not a Form5498. Keep it for your records.
Rollover IRA 5tatement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-12c4c840957df0ceba904c4a,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2022,fgen-20480cd21a409cdffa38d3c2,synthetic_programmatic_template,markdown,bottom,True,ira_statement
"Summit Retirement Trust
| Field | Value |
| --- | --- |
| Plan | Maple Street Dental PC 403(b) Plan |
| Participant | Casey Haddad |
| Statement period | 08/01/2021 - 08/30/2021 |
| Beginning balance | $12,669.38 |
| Employee contributions (pre-tax) | 4,079.36 |
| Roth contributions | $3,839.04 |
| Employer match | 8,369.26 |
| Investment gain/loss | 5,963.75 |
| Ending balance | 526,713.11 |
| Vested balance | $183,449.55 |
| Personal rate of return | 5.3% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| S&P 500 Index Fund | 18% | 79,269.39 |
| Stable Value Fund | 22% | 21,283.69 |
| Total Bond Index | 36% | 22,861.09 |
Annual Benefit Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-cbdb15e164c3a243693e3260,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2021,fgen-3f9bb74d7d89a4afa849905a,synthetic_programmatic_template,markdown,bottom,False,403b_annual
"Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Account | XXX-XX-0317 |
| Statement period | 11/01/2025 - 11/31/2025 |
| 2025 contributions | $6,249.44 |
| 2024 contributions made in 2025 | 2,919.81 |
| Account value | 432,168.33 |
| Required minimum distribution for 2025 | $29,814.69 |
IRS Form 5498 information for 2025 will be mailed separately.
Roth IRA Statement",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e3de494afb2719fb6caa065e,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2025,fgen-fb402b979494536cc0ff097d,synthetic_programmatic_template,markdown,bottom,False,ira_statement
"Summit Retirement Trust
| Field | Value |
| --- | --- |
| Account | ****6931 |
| Statement period | 06/01/2022 - 06/31/2022 |
| 2022 contributions | 2,771.56 |
| 2021 contributions made in 2022 | 4,427.11 |
| Account value | 346,995.78 |
| Required minimum distribution for 2022 | Not applicable |
IRS Form 5498 information for 2022 will be mailed separately.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-e33b4d6ee66385d7b172e379,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2022,fgen-e8e62970e61efb76ebbfaa9b,synthetic_programmatic_template,markdown,none,False,ira_statement
"## Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Plan | Blue Heron Logistics LLC 403(b) Plan |
| Participant | Hiro Testcase |
| Statement period | 01/01/2026 - 01/30/2026 |
| Beginning balance | 442,545.48 |
| Employee contributions (pre-tax) | $1,863.58 |
| Roth contributions | $4,559.73 |
| Employer match | 4,095.33 |
| Investment gain/loss | 26,943.94 |
| Ending balance | $446,969.21 |
| Vested balance | $217,303.23 |
| Personal rate of return | -6.6% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Total Bond Index | 34% | 178,807.77 |
| Target Retirement 2050 Fund | 6% | 76,633.13 |
| S&P 500 Index Fund | 55% | 102,862.55 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-7b244c0882d6e531eedf9ebb,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2026,fgen-ee9abb96215cbca312dfdfa9,synthetic_programmatic_template,markdown,none,False,403b_annual
"Roth IRA Statement
## Evergreen Retirement Services
| Field | Value |
| --- | --- |
| Account | ****9614 |
| Statement period | 11/01/2024 - 11/31/2024 |
| 2024 contributions | 4,505.39 |
| 2023 contributions made in 2024 | 6,709.89 |
| Account value | 415,062.90 |
| Required minimum distribution for 2024 | $6,700.43 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-28a69cb47c8458e3277d9806,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2024,fgen-f0b6df38916d5e6edd41239e,synthetic_programmatic_template,markdown,top,False,ira_statement
"Clearwater 401(k) Administration
| Field | Value |
| --- | --- |
| Plan | Acme Test Corp 401(k) Savings Plan |
| Participant | Casey S. Testcase |
| Statement period | 10/01/2022 - 10/31/2022 |
| Beginning balance | $432,302.87 |
| Employee contributions (pre-tax) | 5,048.78 |
| Roth contributions | $3,182.38 |
| Employer match | 228.43 |
| Investment gain/loss | 31,605.53 |
| Ending balance | $122,065.44 |
| Vested balance | 57,601.24 |
| Personal rate of return | 4.8% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Target Retirement 2050 Fund | 23% | 197,610.23 |
| Total Bond Index | 55% | 137,871.14 |
| S&P 500 Index Fund | 21% | 80,303.96 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-48fcbd4b1aca7038ebea4430,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2022,fgen-592d487bcb685a7279d1e6e6,synthetic_programmatic_template,markdown,none,False,401k_quarterly
"Retirement Account Statement
## Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Plan | Tri-County School District 401(k) Savings Plan |
| Participant | Noah A. Castillo |
| Statement period | 12/01/2021 - 12/31/2021 |
| Beginning balance | 350,692.26 |
| Employee contributions (pre-tax) | 12,910.86 |
| Roth contributions | 394.46 |
| Employer match | 5,171.58 |
| Investment gain/loss | 7,250.81 |
| Ending balance | 473,928.48 |
| Vested balance | 296,968.58 |
| Personal rate of return | 20.5% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Total Bond Index | 18% | 170,231.21 |
| Stable Value Fund | 39% | 177,596.39 |
| S&P 500 Index Fund | 18% | 152,260.28 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-705f51012e5a6675b4733ac8,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2021,fgen-55a3c6f4d765eeadb218221f,synthetic_programmatic_template,markdown,top,False,401k_quarterly
"## Evergreen Retirement Services
| Field | Value |
| --- | --- |
| Plan | Blue Heron Logístics LLC 4O3(b) Plan |
| Participant | Wei Sato |
| Statement period | O1/01/2023 - 01/28/2023 |
| Beginning balance | S474,046.15 |
| Employee contributions (pre-tax) | 22,43l.49 |
| Roth contributions | $4,045.01 |
| Employer match | 7,844.88 |
| Investment gain/loss |-14,421.29 |
| Ending balance | $424,042.25 |
| Vested balance | 390,465.29 |
| Personal rate of retum |9.0% |
| Investment | Allocation | Balance |
| --- |--- | --- |
| Total Bond Index | 28% |l83,772.65 |
| S&P 500 Index Fund | 59% | 162,315.64 |
| Target Retirement 2050 Fund | 79% | 155,170.52 |",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-700a6ef2c10809f79014e505,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2023,fgen-0810b196adf3a36adfba0052,synthetic_programmatic_template,markdown,none,True,403b_annual
"## Annual Benefit Statement
## Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Plan | Maple Street Dental PC 403(b) Plan |
| Participant | Taylor Adeyemi |
| Statement period | 06/01/2025 - 06/30/2025 |
| Beginning balance | $442,487.86 |
| Employee contributions (pre-tax) | $18,795.85 |
| Roth contributions | 3,413.88 |
| Employer match | 5,071.14 |
| Investment gain/loss | -17,497.13 |
| Ending balance | $329,889.25 |
| Vested balance | 51,568.03 |
| Personal rate of return | 5.9% |
| Investment | Allocation | Balance |
| --- | --- | --- |
| Stable Value Fund | 65% | 192,553.09 |
| Total Bond Index | 17% | 140,083.93 |
| Target Retirement 2050 Fund | 66% | 77,480.53 |
Your 2025 Form 1099-R will be available online by January 31, 2026.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ee1caff1f2ea22b2b82bee27,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2025,fgen-8785435a37c4d02e0624a010,synthetic_programmatic_template,markdown,top,False,403b_annual
"## Rollover IRA Statement
## Northstar Retirement Plan Services
| Field | Value |
| --- | --- |
| Account | XXX-XX-6957 |
| Statement period | 10/01/2023 - 10/28/2023 |
| 2023 contributions | $4,832.53 |
| 2022 contributions made in 2023 | $1,718.11 |
| Account value | $487,251.16 |
| Required minimum distribution for 2023 | Not applicable |
## Your 2023 Form 5498 will be available online by January 31, 2024.",INVESTMENT_STATEMENT,43,INVESTMENT_STATEMENT,fdc-ea2acb0126af6d3e51a33ec4,v11-RETIREMENT_ACCOUNT_STATEMENT-markdown,original,2023,fgen-f445b6cb3bc3b6a1345a430c,synthetic_programmatic_template,markdown,top,False,ira_statement
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2021
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Taylor Nguyen
Social security number (SSN)
4537 Elm Park Pl Fairview, OH 10059
A Principal business or profession, including product or service
XXX-XX-6183
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
$113,165.04
7 Gross income
40,540.62
9 Car and truck expenses
6,903.19
18 Office expense
$3,815.68
28 Total expenses before expenses for business use of home
$41,027.55
31 Net profit or (loss)
-4,365.48
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-0d8ec9bcbe126bebe587d6e3,v11-SCHEDULE-C-stacked,original,2021,fgen-0bd342e85c6492f99b5226b9,synthetic_programmatic_template,stacked,top,False,
"SCHEDULE C (Form 1040)
Profitor Loss From Business (Sole Proprietorship)
2023
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name of propríetor
Riley E. Lindqvist
Social security number (SSN)
416 Sample Street Bayside, WA 21032
A Principal business or profession, induding product or service
XXXXX6981
C Business name. If no separate business name, leave blank.
1 Gross receípts or sales
S126,697.57
7 Gross income
$109,836.09
8 Advertising
$51.14
9 Car and truck expenses
5,206.07
28 Tota1 expenses before expenses for business useof home
20,792.48
31Net profit or (loss)
-5,726.28
Department of the Treasury - Intemal Revenue 5ervice
Form C (Form 1040) (keep for your records)  www.irs.gov/Form5CHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-7e956a3cbe8b9850b524be32,v11-SCHEDULE-C-stacked,original,2023,fgen-70efc560a8de3ca6ffb61826,synthetic_programmatic_template,stacked,top,True,
"For calendar year 2021
Attach to Form l040,1040-SR, 1040-SS, 1040-NR, or 1041; partnershíps must genera1ly file Form 1065.
Department of the Treasury Intemal Revenue Service
Name of proprietor
Mateo A. Sato
Social security number (SSN)
4483 Maple Ridge Dr Bayside, WA l3938
A Principal business or profession, including product or service
XXX-XX-l318
C Business name. If no separate business name, leave blank.
1Gross receipts or sales
4,305.72
7 Gross income
20,331.23
8 Advertising
1,106.60
9 Car and truck expenses
470.29
18 0ffice expense
1,895.23
28 Total expenses before expenses for business use ofhome
$131,842.33
31 Net profit or (loss)
9,247.01",SCHEDULE,34,SCHEDULE,fdc-c133897c6d0f65b555e9d2db,v11-SCHEDULE-C-stacked,original,2021,fgen-b9ce0c908d9f8132cb43e555,synthetic_programmatic_template,stacked,none,True,
"SCHEDULE C (Form 1040)
Profitor Loss From Business (Sole Propríetorship)
2023
Name of proprietor
Fatima Lindqvist
Social security number (SSN)
6019 Harbor View Rd Testville, IL 67183
A Principal business or profession, induding product orservice
ending in 2O52
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
20,481.98
7 Gross income
28,326.76
8 Advertising
$6,921.69
9 Car and truck expenses
$3,846.85
18 Offíce expense
5,748.97
28 Total expenses before expenses for busíness use of home
112,426.03
Departmentof the Treasury - Internal Revenue 5ervice
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1O4O",SCHEDULE,34,SCHEDULE,fdc-f8cb305cf7e8ad6a402a4da2,v11-SCHEDULE-C-stacked,original,2023,fgen-901d0afb7a42123876a287b8,synthetic_programmatic_template,stacked,top,True,
"2023
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor
Kwame Romero
Social security number (SSN)
3103 Prairie Ave Maplewood, MN 79607
A Principal business or profession, including product or service
ending in 4944
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
88,403.00
7 Gross income
$124,853.89
8 Advertising
$5,555.48
18 Office expense
$4,395.48
28 Total expenses before expenses for business use of home
$20,885.29
31 Net profit or (loss)
5,840.72
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)",SCHEDULE,34,SCHEDULE,fdc-0642481556236e5da92828c6,v11-SCHEDULE-C-stacked,original,2023,fgen-ff9dc6a3efc412f07ae55724,synthetic_programmatic_template,stacked,bottom,False,
"OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name of proprietor
Riley Okafor
Social security number (SSN)
4910 Willow Bend Way Riverton, WI 50419
A Principal business or profession, including product or service
ending in 6939
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
37,946.01
7 Gross income
$16,420.84
8 Advertising
$5,536.73
9 Car and truck expenses
8,958.82
18 Office expense
$7,948.84
28 Total expenses before expenses for business use of home
$127,771.51
31 Net profit or (loss)
15,750.40
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-9dd383a3df37a56172daa7fa,v11-SCHEDULE-C-stacked,original,2021,fgen-409e9bd8b161623825f5d385,synthetic_programmatic_template,stacked,none,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Avery Fischer
Social security number (SSN)
4483 Lakeshore Blvd Fairview, OH 44597
A Principal business or profession, including product or service
ending in 1201
C Business name. If no separate business name, leave blank.
7 Gross income
$10,908.15
8 Advertising
$7,518.68
9 Car and truck expenses
$9,053.73
28 Total expenses before expenses for business use of home
$86,507.58
31 Net profit or (loss)
6,922.34
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-94699878ea2105779bac703b,v11-SCHEDULE-C-stacked,original,2021,fgen-94b4156024f195b8cebf209a,synthetic_programmatic_template,stacked,top,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2026
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor
Sofia Fischer
Social security number (SSN)
7318 Granite St Bayside, WA 79903
A Principal business or profession, including product or service
ending in 1908
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
$129,441.74
8 Advertising
$2,228.97
9 Car and truck expenses
$6,814.28
28 Total expenses before expenses for business use of home
65,773.92",SCHEDULE,34,SCHEDULE,fdc-d7522f16562a7f1509ea17ec,v11-SCHEDULE-C-stacked,original,2026,fgen-9fd1ea456c027809dc329034,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2026
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name of proprietor
Riley J. Kowalski
Social security number (SSN)
5576 Cedar Ln Brookhaven, PA 74048
A Principal business or profession, including product or service
XXX-XX-3514
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
77,126.52
7 Gross income
49,762.62
9 Car and truck expenses
879.46
18 Office expense
3,530.57
28 Total expenses before expenses for business use of home
75,980.69
31 Net profit or (loss)
9,189.25
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-a215d39bf7ff62a5af9a335a,v11-SCHEDULE-C-stacked,original,2026,fgen-720d32f3d81ae875b3f8de52,synthetic_programmatic_template,stacked,top,False,
"2026
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Alex Moreau
Social security number (SSN)
1450 Maple Ridge Dr Brookhaven, PA 12393
A Principal business or profession, including product or service
ending in 4277
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
$2,259.28
7 Gross income
$93,655.13
8 Advertising
$6,685.30
9 Car and truck expenses
$4,629.55
18 Office expense
$8,784.37
28 Total expenses before expenses for business use of home
$31,583.30
31 Net profit or (loss)
3,121.06",SCHEDULE,34,SCHEDULE,fdc-7f8e54600d8838fe5a486c5e,v11-SCHEDULE-C-stacked,original,2026,fgen-f9284fb27134d509596fdd7e,synthetic_programmatic_template,stacked,none,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor
Amara E. Fischer
Social security number (SSN)
2126 Willow Bend Way Cedar Falls, IA 74501
A Principal business or profession, including product or service
****8984
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
1,639.27
7 Gross income
68,565.56
8 Advertising
950.33
9 Car and truck expenses
$4,838.35
28 Total expenses before expenses for business use of home
12,249.94
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-33c94af5b72b742b7b5446d3,v11-SCHEDULE-C-stacked,original,2021,fgen-df02611ce58106aa37d6042c,synthetic_programmatic_template,stacked,top,False,
"OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name of proprietor
Sofia Tanaka
Social security number (SSN)
6184 Elm Park Pl Pinecrest,GA 86820
A Principal business or profession, induding product or service
****0443
C Business namc. If no separate business name, leave blank.
1 Gross receipts or sales
$5l,143.37
7 Gross íncome
132,741.28
8Advertising
5,630.77
9 Car and truck expenses
$7,67l.26
18 0ffice expense
1,242.12
31 Net profit or (loss)
-4O0.52
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-812cdfbb15b37346077dce74,v11-SCHEDULE-C-stacked,original,2026,fgen-23aa119085993834358a13bf,synthetic_programmatic_template,stacked,none,True,
"☐ CORRECTED
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2025
Name of proprietor
Priya Tanaka
Social security number (SSN)
7006 Willow Bend Way Lakewood, CO 97708
A Principal business or profession, including product or service
ending in 5629
C Business name. If no separate business name, leave blank.
7 Gross income
135,238.15
9 Car and truck expenses
5,681.22
18 Office expense
$4,238.54
28 Total expenses before expenses for business use of home
$82,939.51
31 Net profit or (loss)
26,413.07
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-eb748357b0bf3f452601efc8,v11-SCHEDULE-C-stacked,original,2025,fgen-2eb6d4e9cde67609aab7f14b,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
SCHEDULEC (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendarycar 2025
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form l065.
Department of the Treasury Internal Revenue 5ervice
Name of proprietor
Alex B. Moreau
Social security number (SSN)
3288 Prairic Ave Pinecrest, GA 32388
A Principal business or profession, induding product or service
ending in 9472
C Business name. If no separate business name, leave blank.
1 Gross receiptsor sales
139,907.36
8 Advertisíng
2,498.74
9Car and truck expenses
4,820.09
18 0ffice expense
7,951.89
28 Total expenses before expenses for busíness use of home
$138,781.99
31 Net profít or (loss)
24,431.70
Department of the Treasury - Intemal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/Form5CHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-1d3eb8a9b18a37ee9f0fa25e,v11-SCHEDULE-C-stacked,original,2025,fgen-0124867d4a99f31d16e720fc,synthetic_programmatic_template,stacked,top,True,
"SCHEDULE C(Form 1040) Profít or Loss From Business (Sole Proprietorship)
Name:
Kwame Adeyemi
9 Car and truck expenses
$1,191.26
31 Net profit or (loss)
27,362.04
28 Total expenses before expenses for business use of home
$45,360.54",SCHEDULE,34,SCHEDULE,fdc-d9dd5aa6b5d2dab82e88ea2b,v11-SCHEDULE-C-stacked,original,2022,fgen-cb8c32b095cf58faf71ae64d,synthetic_programmatic_template,stacked,top,True,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2024
OMB No. 1545-0074
Name of proprietor
Avery Walsh
Social security number (SSN)
3934 Lakeshore Blvd Pinecrest, GA 46129
A Principal business or profession, including product or service
XXXXX3269
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
14,528.00
7 Gross income
63,871.85
8 Advertising
3,764.01
28 Total expenses before expenses for business use of home
$90,522.90
31 Net profit or (loss)
12,584.70
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-eb371989848927cdbd40da64,v11-SCHEDULE-C-stacked,original,2024,fgen-45494c9fdf9d05c83e98b16d,synthetic_programmatic_template,stacked,top,False,
"Name:   Jordan J. Moreau
31 Net profit or (loss) 21,430.22
1 Gross receipts or sales $14,868.53
18 Office expense 9,218.16
SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) 2023",SCHEDULE,34,SCHEDULE,fdc-31155a2b9f3096bb95d4b155,v11-SCHEDULE-C-inline,original,2023,fgen-fe05fe91b74befc19eda6648,synthetic_programmatic_template,inline,bottom,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2022
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor Lena Walsh
Social security number (SSN)  4367 Cedar Ln Brookhaven, PA 13729
A Principal business or profession, including product or service   ****1175
C Business name. If no separate business name, leave blank.
7 Gross income      73,639.12
8 Advertising 9,294.64
9 Car and truck expenses   $1,982.84
18 Office expense $4,683.08
31 Net profit or (loss)      6,676.78
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-0e2f9a2f83d517ddf6936ac1,v11-SCHEDULE-C-inline,original,2022,fgen-4c668353e437fd50961ba307,synthetic_programmatic_template,inline,top,False,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship)
Name: Jordan B. Larsen
18 Office expense $3,541.37
1 Gross receipts or sales  132,679.33",SCHEDULE,34,SCHEDULE,fdc-13fe2dbca150e6ac31b635ae,v11-SCHEDULE-C-inline,original,2024,fgen-09e86e498f210fdcbf895eca,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2024
Name of proprietor  Sofia Sato
Social security number (SSN)  8291 Granite St Bayside, WA 88444
A Principal business or profession, including product or service  ***-**-1479
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales      $128,303.49
7 Gross income   $38,333.23
8 Advertising  5,200.88
18 Office expense      8,288.53
28 Total expenses before expenses for business use of home   56,222.40
31 Net profit or (loss)   28,818.86",SCHEDULE,34,SCHEDULE,fdc-984a30266b36bdc1989a7949,v11-SCHEDULE-C-inline,original,2024,fgen-0efbedcc0b399271734d9560,synthetic_programmatic_template,inline,top,False,
"Name:   Olivia Okafor
18 Office expense   $8,434.65",SCHEDULE,34,SCHEDULE,fdc-6f6a37fbba2731f95011bd70,v11-SCHEDULE-C-inline,original,2025,fgen-563cb0a67cdc9e046576e9dd,synthetic_programmatic_template,inline,none,False,
"CORRECTED (if checked)
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2026
OMB No. 1545-0074
Name of propríetor   Diego C. Romcro
Social security number (SSN)  129 Wi1low Bend Way Lakewood, CO 28711
A Principal busincss orprofession, including product or service      ****3068
C Business name. If no separatebusiness name, leave blank.
1 Gross receípts or sales     15,410.31
8 Advertising 2,485.51
9 Car and truck cxpenses     S1,710.33
18 0ffice expense      $7,954.74
28 Total expenses before expenses for business use of home      42,306.03
31 Net profit or (loss)  14,180.53
Department of the Treasury - Intemal Revenue Service
Form C (Form 1O40) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-eb9ec1fc5ecd9d5a65a63338,v11-SCHEDULE-C-inline,original,2026,fgen-e15ff041b6487437d1d514da,synthetic_programmatic_template,inline,top,True,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship)
Name:      Morgan M. Brennan
28 Total expenses before expenses for business use of home $11,624.52
18 Office expense      $8,789.60
7 Gross income   111,895.04
31 Net profit or (loss) 20,564.80",SCHEDULE,34,SCHEDULE,fdc-9518a8f0556b8380000976c0,v11-SCHEDULE-C-inline,original,2024,fgen-a273c1ce3be7702d9150aed7,synthetic_programmatic_template,inline,top,False,
"☐ C0RRECTED
2025
OMB No. 1545-0074
Attach to Form 1040,1040-SR, 1040-SS, 1040-NR, or 1041; partnershíps must genera11y file Form 1O65.
Department of the Treasury Intemal Revenue Service
Name of proprietor Noah Romero
Social security number (SSN)  5626 Lakeshore Blvd Brookhaven, PA 76645
A Principal business or profession, induding product or service XXX-XX-4949
CBusiness name. If no separate business name, leave blank.
l Gross receipts or sales     34,796.34
7 Grossincome $123,245.98
8 Advertising   4,985.82
9 Car and truck expenses $969.8O
18 Office expense 2,392.45
28 Total expenses before expenses for business use of home   l07,386.42
3l Net profit or (loss) 5,672.30
Department of the Treasury - Internal Revenue 5ervice
SCHEDULE C (Form l040)
Profit or Loss From Business (Sole Proprietorship)
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-0352563c931eb1852923fa71,v11-SCHEDULE-C-inline,original,2025,fgen-d2cfa2a5790c4c816a619def,synthetic_programmatic_template,inline,bottom,True,
"SCHEDULE C(Form 1040) Profit or Loss From Business (Sole Proprietorship) 2025
Name:      Jamíe D. Larsen
18 Office expense $8,7l0.54",SCHEDULE,34,SCHEDULE,fdc-faa8b406f7614260834b418b,v11-SCHEDULE-C-inline,original,2025,fgen-f82a486a4e5cceb63a70a6d3,synthetic_programmatic_template,inline,top,True,
"VOID  CORRECTED
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2024
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor      Jordan Larsen
Social security number (SSN)   2581 Cedar Ln Pinecrest, GA 23896
A Principal business or profession, including product or service  XXX-XX-1899
C Business name. If no separate business name, leave blank.
7 Gross income 101,541.04
8 Advertising 1,291.89
9 Car and truck expenses   $9,048.91
18 Office expense   $2,054.42
28 Total expenses before expenses for business use of home   $29,259.61
31 Net profit or (loss)      2,206.16
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-323e418a66bbd0413435df64,v11-SCHEDULE-C-inline,original,2024,fgen-5cf3537d092e28fb963d17ac,synthetic_programmatic_template,inline,top,False,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) 2024
Name: Priya Brennan
9 Car and truck expenses  4,284.73",SCHEDULE,34,SCHEDULE,fdc-04b02eac7131692b17eb91ac,v11-SCHEDULE-C-inline,original,2024,fgen-ef2d8cd116482b9d66131be3,synthetic_programmatic_template,inline,top,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor Taylor Patel
Social security number (SSN)  8930 Prairie Ave Lakewood, CO 30919
A Principal business or profession, including product or service ***-**-7178
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales 123,547.95
7 Gross income 68,905.28
8 Advertising $3,300.63
9 Car and truck expenses $6,209.37
18 Office expense      7,185.64
28 Total expenses before expenses for business use of home 83,375.94
31 Net profit or (loss) -2,639.41
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-715e45a03157d937f758a52f,v11-SCHEDULE-C-inline,original,2023,fgen-639d4feb27f5d86d96d695d0,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
For calendar year 2025
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor Olivia Romero
Social security number (SSN) 3189 Granite St Maplewood, MN 12896
A Principal business or profession, including product or service  ****1536
C Business name. If no separate business name, leave blank.
7 Gross income      88,385.51
8 Advertising  $355.37
9 Car and truck expenses   5,311.46
18 Office expense   $7,690.30
28 Total expenses before expenses for business use of home  65,239.96
31 Net profit or (loss) 21,785.96
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-9b4266899d0531c7ec0e4a61,v11-SCHEDULE-C-inline,original,2025,fgen-f5b515954a241e003984698c,synthetic_programmatic_template,inline,none,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2025
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor Hiro Larsen
Social security number (SSN) 2999 Granite St Riverton, WI 14704
A Principal business or profession, including product or service  XXXXX1144
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales   $114,188.61
7 Gross income      $52,804.69
8 Advertising  $265.89
9 Car and truck expenses   846.02
18 Office expense  $2,511.41
28 Total expenses before expenses for business use of home $119,263.78
31 Net profit or (loss)      2,324.30",SCHEDULE,34,SCHEDULE,fdc-ba82d74406b9851098996247,v11-SCHEDULE-C-inline,original,2025,fgen-44b389bdc508aac27c6e8d91,synthetic_programmatic_template,inline,top,False,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) 2022
Name: Sofia Patel
8 Advertising      $5,041.64",SCHEDULE,34,SCHEDULE,fdc-2f3eda3327eeafbbe2d00f0a,v11-SCHEDULE-C-inline,original,2022,fgen-0ed6c4145fb6915f2732d7c0,synthetic_programmatic_template,inline,top,False,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship)
Name:      Olivia S. Rivera
28 Total expenses before expenses for business use of home  132,137.57
8 Advertising 6,745.52
18 Office expense 4,163.71",SCHEDULE,34,SCHEDULE,fdc-4ef36a2feb6ea54874965828,v11-SCHEDULE-C-inline,original,2022,fgen-1440ab309fef7de378ede7c3,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2026
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Casey Tanaka
657 Cedar Ln Pinecrest, GA 23337
****7278
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
$135,506.45
$460.19
$1,371.16
70,563.24
13,838.70
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-b0aa9ba2db7f275e97c27dbb,v11-SCHEDULE-C-columns,original,2026,fgen-dcfdb21e1aa17c73c4511098,synthetic_programmatic_template,columns,top,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2025
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Lena Brennan
5035 Cedar Ln Fairview, OH 45754
****7815
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
$23,981.74
5,888.53
5,530.74
4,975.85
77,804.54
(7,948.62)",SCHEDULE,34,SCHEDULE,fdc-c1c339c03cf30a5aa09ebca8,v11-SCHEDULE-C-columns,original,2025,fgen-09380e0c0b27b17feca8cf61,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
For calendar year 2021
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Hiro R. Castillo
7160 Prairie Ave Fairview, OH 78267
***-**-6957
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
$43,462.66
96,219.53
$1,840.32
$9,025.13
7,961.14
$12,527.43
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)",SCHEDULE,34,SCHEDULE,fdc-ad745d52341b393cfa35897a,v11-SCHEDULE-C-columns,original,2021,fgen-5e8cb88f5b8edc924a56b0bf,synthetic_programmatic_template,columns,bottom,False,
"For calendar year 2026
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Kwame E. Moreau
2605 Cedar Ln Pinecrest, GA 55701
XXXXX7406
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
31 Net profit or (loss)
$69,542.84
68,583.61
3,949.44
3,747.82
$4,372.51
2,600.91
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-8cc05fef865d166b007e93c9,v11-SCHEDULE-C-columns,original,2026,fgen-64974ea8a5d451375dccec18,synthetic_programmatic_template,columns,none,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2022
Attach to Form 1040, 1O40-SR, 1040-SS, l040-NR, or 1041; partnerships must genera1ly file Form 1065.
Name of proprietor
Social security number (SSN)
A Principal business or profession,including product or service
Alex Tanaka
34O5 Elm Park Pl Maplewood, MN 57331
****7944
C Business name. Ifno separate business name, leave blank.
8 Advcrtising
9 Car and truck expenses
18 Office expense
31 Net profit or (loss)
5,702.27
$19.06
$2,142.72
13,954.27",SCHEDULE,34,SCHEDULE,fdc-2d921089877c080edee4a8bc,v11-SCHEDULE-C-columns,original,2022,fgen-4b336ad02a256c6c4ca73cca,synthetic_programmatic_template,columns,top,True,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2023
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Kwame M. Romero
8268 Cedar Ln Brookhaven, PA 84867
XXXXX3658
C Business name. If no separate business name, leave blank.
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
31 Net profit or (loss)
$117,499.65
8,369.12
8,618.95
$7,287.09
-4,935.36
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-8d5e11419f7a60b1b497b1af,v11-SCHEDULE-C-columns,original,2023,fgen-643e9ddaee282c15ee1fadb1,synthetic_programmatic_template,columns,top,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Olivia J. Haddad
2792 Elm Park Pl Pinecrest, GA 60605
ending in 6959
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
87,345.62
83,163.74
6,246.19
$2,556.44
$2,205.32
$8,493.24
(3,095.32)
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-085c1a7d05f59cd2494bd628,v11-SCHEDULE-C-columns,original,2024,fgen-ed687bcb3fb4c16fa8dd70d9,synthetic_programmatic_template,columns,top,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Jordan J. Rivera
9342 Sample Street Oak Grove, TX 86037
ending in 4321
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
70,972.70
$86,373.48
9,447.66
$1,881.10
3,591.14
133,820.62
8,061.28",SCHEDULE,34,SCHEDULE,fdc-06b57b0b74ceabdea251fdbb,v11-SCHEDULE-C-columns,original,2021,fgen-ca42df7547d76420215400a0,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2025
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Fatima Fischer
6993 Oak Hollow Ct Oak Grove, TX 49223
***-**-1075
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
$31,526.50
56,460.98
5,349.07
$4,413.56
$5,756.82
107,650.07
19,096.70",SCHEDULE,34,SCHEDULE,fdc-c985479a2bb3b4c0e71d239f,v11-SCHEDULE-C-columns,original,2025,fgen-5adcb34c0cb2cef82d8299b9,synthetic_programmatic_template,columns,top,False,
"2022
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Jordan K. Adeyemi
4715 Harbor View Rd Brookhaven, PA 15676
XXXXX1153
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
47,540.12
$104,098.16
$2,247.11
$2,579.00
1,737.75
60,464.31
(2,842.98)
Department of the Treasury - Internal Revenue Service
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-49ca9dd0d0a5092548c26cde,v11-SCHEDULE-C-columns,original,2022,fgen-b00486fe36421378711fd501,synthetic_programmatic_template,columns,bottom,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2021
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Avery Fischer
7059 Lakeshore Blvd Testville, IL 59807
****9962
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
121,431.36
1,358.20
$2,636.42
4,861.26
3,164.22
$38,315.79
7,891.61
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-60b94f3ec340f9b9bd0ac520,v11-SCHEDULE-C-columns,original,2021,fgen-5e66c99b23354ef35f61befe,synthetic_programmatic_template,columns,top,False,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2026
OMB No. 1545-0074
Department of the Treasury Internal Revenue Service
Nameof proprietor
5ocial security number (SSN)
A Principal business or profession, including product or service
Lena Romero
7874 Lakeshore Blvd Lakewood, C0 295O6
***-**-488O
C Business name. If no separate business name, leave blank.
1 Gross receipts or salcs
7 Gross income
8 Advertising
9 Car andtruck expenses
28 Total expenses before expenses for business use of home
31 Net profít or (loss)
$110,719.29
$126,889.66
791.81
787.50
62,572.56
14,933.05",SCHEDULE,34,SCHEDULE,fdc-68657efdf46c525ae7b14203,v11-SCHEDULE-C-columns,original,2026,fgen-516b2d0fc80c30bcba31ae70,synthetic_programmatic_template,columns,top,True,
"OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Morgan B. Larsen
1531 Granite St Maplewood, MN 15809
XXX-XX-3934
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
$45,764.52
129,224.68
1,713.14
$8,357.20
6,439.99
139,834.06
16,534.05",SCHEDULE,34,SCHEDULE,fdc-b425a87e80eb6162a1b7a65d,v11-SCHEDULE-C-columns,original,2024,fgen-b7817757946ff028e710c8f0,synthetic_programmatic_template,columns,none,False,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) 2021
Name:
28 Total expenses before expenses for business use of home
Hiro Brennan
55,202.51",SCHEDULE,34,SCHEDULE,fdc-c74d32c82d5e5ec91bd7dc91,v11-SCHEDULE-C-columns,original,2021,fgen-90d5b1a278d4fcdd1563b965,synthetic_programmatic_template,columns,top,False,
"For calendar year 2026
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Avery Walsh
5056 Prairie Ave Oak Grove, TX 62810
XXX-XX-1014
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
8 Advertising
9 Car and truck expenses
18 Office expense
28 Total expenses before expenses for business use of home
31 Net profit or (loss)
$40,376.29
4,893.27
5,959.45
$4,541.11
107,497.39
13,417.43
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-74e1ad53c8635179fd3f05d6,v11-SCHEDULE-C-columns,original,2026,fgen-9071e57a092a1cd7955790b1,synthetic_programmatic_template,columns,none,False,
"☐ CORRECTED
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2026
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
Name of proprietor
Social security number (SSN)
A Principal business or profession, including product or service
Riley Larsen
3265 Harbor View Rd Lakewood, CO 39365
***-**-6034
C Business name. If no separate business name, leave blank.
1 Gross receipts or sales
7 Gross income
8 Advertising
9 Car and truck expenses
31 Net profit or (loss)
84,721.36
81,123.78
4,197.81
$7,587.23
7,977.85
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-b181cee266fa46eb69cf62e3,v11-SCHEDULE-C-columns,original,2026,fgen-5b2a54b9efd704e49a6ea22b,synthetic_programmatic_template,columns,top,False,
"## SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2023
## OMB No. 1545-0074
## Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
## Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name of proprietor | Kwame Fischer |
| Social security number (SSN) | 5264 Cedar Ln Fairview, OH 16091 |
| A Principal business or profession, including product or service | ending in 4503 |
## C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 1 Gross receipts or sales | 77,377.50 |
| 8 Advertising | $4,086.70 |
| 9 Car and truck expenses | $913.49 |
| 18 Office expense | 6,397.08 |
| 28 Total expenses before expenses for business use of home | $90,707.63 |
| 31 Net profit or (loss) | 6,057.69 |
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-3744a96ee545ac9129a4217e,v11-SCHEDULE-C-markdown,original,2023,fgen-3666b428bc6fe6e610483a73,synthetic_programmatic_template,markdown,top,False,
"SCHEDULE C (Form 1040)
Profitor Loss From Business (So1e Proprietorship)
2023
## Attach to Form l040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue5ervice
| Field | Value |
| ---| --- |
| Name of proprietor | 0livia Walsh |
| 5ocial security number (SSN) | 5353 Elm Park Pl Riverton, WI 34578 |
| A Principal business or profession, induding product orservice | ****6714 |
C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 7 Gross income | S127,743.76 |
| 8 Advertising | $3,969.86 |
| 9 Car and truck expenses | $1,057.24 |
| 28 Total expcnses before expensesfor business use of home | 28,143.74 |
| 31 Net profit or (loss) | 11,715.89 |",SCHEDULE,34,SCHEDULE,fdc-26cf571ba0e2b99c3996c9c8,v11-SCHEDULE-C-markdown,original,2023,fgen-286b531d0517795f69f04866,synthetic_programmatic_template,markdown,top,True,
"SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
For calendar year 2026
OMB No. 1545-0074
## Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name of proprietor | Hiro J. Rivera |
| Social security number (SSN) | 1775 Elm Park Pl Maplewood, MN 61785 |
| A Principal business or profession, including product or service | XXX-XX-7739 |
## C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 1 Gross receipts or sales | 23,413.74 |
| 7 Gross income | 107,945.42 |
| 8 Advertising | $5,542.03 |
| 9 Car and truck expenses | $5,152.15 |
| 28 Total expenses before expenses for business use of home | $78,631.31 |
| 31 Net profit or (loss) | 6,145.53 |",SCHEDULE,34,SCHEDULE,fdc-0e50c88ccff20de4978730cb,v11-SCHEDULE-C-markdown,original,2026,fgen-8fc406233c5e9aff76fad95e,synthetic_programmatic_template,markdown,top,False,
"SCHEDULE C (Form 1040)Profit or Loss From Business (5ole Proprietorship) 2026
|Field | Value |
| --- | --- |
| Name: | Diego Nguyen |
| 8 Advertising | 1,831.64 |
| 1 Gross receipts or sales | $15,259.74 |
| 18 0ffice expense | $3,293.50 |
| 31 Net profit or (1oss) | 19,293.98 |",SCHEDULE,34,SCHEDULE,fdc-beb3e12ae9fa83e177b21e3c,v11-SCHEDULE-C-markdown,original,2026,fgen-5276c57edf297b3724fa3340,synthetic_programmatic_template,markdown,top,True,
"SCHEDULE C (Form 1040) Profit orLoss From Busincss (Sole Proprietorship) 2022
| Field | Value |
| --- | --- |
| Namc: | Mateo Moreau |
| 8 Advertising | 6,142.43 |
| 28 Total expenses before expenses for busincss use of home | 95,313.08 |",SCHEDULE,34,SCHEDULE,fdc-fae85ec49860a91bcfc4a2f8,v11-SCHEDULE-C-markdown,original,2022,fgen-7728b75f76323fae7507e898,synthetic_programmatic_template,markdown,top,True,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) 2021
| Field | Value |
| --- | --- |
| Name: | Mateo Romero |
| 7 Gross income | 86,045.90 |
| 8 Advertising | 291.90 |
| 9 Car and truck expenses | 1,041.71 |
| 1 Gross receipts or sales | 89,976.27 |",SCHEDULE,34,SCHEDULE,fdc-c8e92d9437a88ac48098ca35,v11-SCHEDULE-C-markdown,original,2021,fgen-e716571a28856efbb7dfdc69,synthetic_programmatic_template,markdown,top,False,
"SCHEDULE C (Form 1040)
## Profit or Loss From Business (Sole Proprietorship)
For calendar year 2023
0MB No. 1545-0074
## Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or l041;partnerships must generally file Form 1065.
| Field | Value |
| --- | --- |
| Name of proprietor | Morgan Nguyen |
| Social security numbcr (SSN) |7298 Willow Bend Way Lakewood, C047634 |
| A Príncípal business or profession, induding product or servíce | ending in 3067 |
C Business name. If no separate busíness name, leaveblank.
| Field | Value |
| --- | --- |
| 1 Gross receipts or sales | $122,590.88 |
| 9 Car and truck expenses | 2,572.50 |
| 18 0fficeexpense | $3,330.68 |
| 28 Total expenses before expenses for business use of home | $18,466.35 |
| 31 Net profit or (loss) | 24,975.31 |",SCHEDULE,34,SCHEDULE,fdc-6f444be3b17fb6da7d1e157b,v11-SCHEDULE-C-markdown,original,2023,fgen-055e31d2ba9b626516bf0c84,synthetic_programmatic_template,markdown,top,True,
"CORRECTED (if checked)
SCHEDULE C (Form l040)
## Profit or Loss From Business (Sole Proprietorship)
## 2023
OMB No. 1545-0074
| Field | Value |
| --- | --- |
| Name of proprietor |Priya Nguyen |
| 5ocial security number (5SN)| 521 Oak Hollow Ct Fairview, OH 98347 |
| A Principal business or profession, including product or service | ***-**-6387 |
C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 1 Gross rcceípts or sales | S123,6O6.36 |
| 7 Gross income | $92,282.31 |
| 8 Advertising | $5,197.14 |
| 9 Car and truck expenses | 7,847.78 |
| 18 Office expense | 7,704.86 |
| 28 Total expenses before expenses for business use of home | $93,476.97|
| 31 Net profitor (loss) | 3,147.44 |
## Department of the Treasury- Internal Revenue 5ervice
Form C (Form l040) (keep for your records)  www.irs.gov/FormSCHEDULECFormlO40",SCHEDULE,34,SCHEDULE,fdc-56f4f58a9d46d057d52261e7,v11-SCHEDULE-C-markdown,original,2023,fgen-4d5d4535de717175eef7536a,synthetic_programmatic_template,markdown,top,True,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) 2021
| Field | Value |
| --- | --- |
| Name: | Riley Patel |
| 8 Advertising | 860.47 |
| 9 Car andtruck expenses | $7,084.08 |
| 31 Net profit or (1oss) | 11,O66.75 |
|1 Gross receipts or sales | $l18,O78.80 |",SCHEDULE,34,SCHEDULE,fdc-b91abf74202a78f29f11360d,v11-SCHEDULE-C-markdown,original,2021,fgen-de05275e4b6d0d692d6ed106,synthetic_programmatic_template,markdown,top,True,
"SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship)
| Field | Value |
| --- | --- |
| Name: | Olivia A. Okafor |
| 1 Gross receipts or sales | 31,427.87 |
| 31 Net profit or (loss) | 7,741.31 |
| 18 Office expense | 6,584.42 |",SCHEDULE,34,SCHEDULE,fdc-297c3a8625cfc7996c41fa1f,v11-SCHEDULE-C-markdown,original,2022,fgen-4ac0daf303c96f832b5385a7,synthetic_programmatic_template,markdown,top,False,
"SCHEDULE C (Form 1040)
## Profit or Loss From Business (Sole Proprietorship)
## For calendar year 2021
OMB No. 1545-0074
## Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name of proprietor | Noah Haddad |
| Social security number (SSN) | 460 Cedar Ln Riverton, WI 78437 |
| A Principal business or profession, including product or service | ending in 9828 |
C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 1 Gross receipts or sales | $108,374.91 |
| 7 Gross income | 28,673.57 |
| 8 Advertising | 6,492.99 |
| 9 Car and truck expenses | 9,122.96 |
| 28 Total expenses before expenses for business use of home | $124,745.48 |
Department of the Treasury - Internal Revenue Service
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-4c520551bb577d0af64e3334,v11-SCHEDULE-C-markdown,original,2021,fgen-ce4b501bb77076890de089e3,synthetic_programmatic_template,markdown,top,False,
"SCHEDULEC (Form 1040)
Profit or Loss From Business (So1e Proprietorship)
For ca1endar year 2022
Attach to Form 1040, 1040-5R, 1040-SS, 1040-NR, or 1041; partncrships must generally fileForm 1065.
| Field |Value |
| --- | --- |
| Name of proprietor | Olivia Testcasc |
| Social security number (SSN) | 2867 Willow Bend Way Lakewood, CO 73709 |
| A Principal business or profession, including product or service | ****1426 |
C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 1 Gross receipts or sales | S35,830.30 |
| 8 Advertising | $4,340.97 |
| 9 Car and truck expenses | $7,086.93 |
|18 Office expense | $2,751.94 |
| 28 Tota1 expenses before expcnses for business use of home | $123,247.61 |
| 31 Net profit or (loss)| 27,213.05 |
## Department of the Treasury - Internal Revenue 5ervíce
Form C (Form 1040) (keep for your rccords)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-c2507dc57c54fdee4b80ee9b,v11-SCHEDULE-C-markdown,original,2022,fgen-f339bc98d4918a41152823f1,synthetic_programmatic_template,markdown,top,True,
"## SCHEDULE C (Form 1O40)
Profit or Loss From Business (Sole Proprietorship)
2021
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1O65.
## Department of the Treasury Intemal Revenue Service
| Field | Value |
| --- | --- |
| Name of proprietor | MateoD. Rivera |
| Social securíty number (SSN) | 6411 Oak Hollow Ct Testville, IL 3O398 |
| A Principal business or profession, induding product or servíce | ****4649 |
C Business name. If no separate business name, leave blank.
| Fíeld | Value |
| --- |--- |
| l Gross receipts orsales |$51,582.14 |
| 7 Gross income |87,334.14 |
| 8 Advertising | 4,100.28 |
| 9 Car and truck cxpcnses | 2,428.59 |
| 18 0ffice expense | 7,156.02 |
| 28 Total expenses before expenses forbusiness use of home | $4,379.30 |
| 31 Net profit or (loss) | 13,079.26 |
Department of the Treasury - Internal Revenue 5ervice
Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-1f522bad64a010f3d72b7de0,v11-SCHEDULE-C-markdown,original,2021,fgen-7c126e05f380e085b27f7514,synthetic_programmatic_template,markdown,top,True,
"## SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship)
| Field | Value |
| --- | --- |
| Name: | Amara M. Rivera |
| 31 Net profit or (loss) | 15,227.60 |
| 8 Advertising | 3,472.96 |
| 9 Car and truck expenses | 4,429.01 |",SCHEDULE,34,SCHEDULE,fdc-b0a4f0e619e30db9575dc3af,v11-SCHEDULE-C-markdown,original,2021,fgen-75ea6314f722f75389b3ec22,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name of proprietor | Olivia Adeyemi |
| Social security number (SSN) | 6103 Granite St Riverton, WI 31455 |
| A Principal business or profession, including product or service | ***-**-4810 |
## C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 1 Gross receipts or sales | 101,780.15 |
| 8 Advertising | 261.43 |
| 9 Car and truck expenses | $5,153.09 |
| 18 Office expense | $751.15 |
| 28 Total expenses before expenses for business use of home | $12,592.03 |
Department of the Treasury - Internal Revenue Service
## Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-5256530a767a0559c176c46e,v11-SCHEDULE-C-markdown,original,2023,fgen-23a69c2e4d1b3f91146e4f6b,synthetic_programmatic_template,markdown,top,False,
"## SCHEDULE C (Form 1040)
Profit or Loss From Business (Sole Proprietorship)
2023
OMB No. 1545-0074
## Attach to Form 1040, 1040-SR, 1040-SS, 1040-NR, or 1041; partnerships must generally file Form 1065.
## Department of the Treasury Internal Revenue Service
| Field | Value |
| --- | --- |
| Name of proprietor | Mateo C. Okafor |
| Social security number (SSN) | 9230 Harbor View Rd Maplewood, MN 95875 |
| A Principal business or profession, including product or service | ending in 8535 |
C Business name. If no separate business name, leave blank.
| Field | Value |
| --- | --- |
| 9 Car and truck expenses | $7,375.53 |
| 18 Office expense | 5,280.76 |
| 28 Total expenses before expenses for business use of home | 3,878.49 |
| 31 Net profit or (loss) | 2,249.80 |
Department of the Treasury - Internal Revenue Service
## Form C (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULECForm1040",SCHEDULE,34,SCHEDULE,fdc-63c50fef7b576f0989af0088,v11-SCHEDULE-C-markdown,original,2023,fgen-ecd6f32e9dfefd33e0ed5595,synthetic_programmatic_template,markdown,top,False,
"SCHEDULE E (Form 1040) Supplemental Income and Loss 2023
Name:
Diego Larsen
2 Fair Rental Days / Personal Use Days
393",SCHEDULE,34,SCHEDULE,fdc-b4c6c616eecdf21c9a5afa5f,v11-SCHEDULE-E-stacked,original,2023,fgen-8220f56648444e8c896d10a7,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
2025
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Jamie Moreau
Your social security number
756 Sample Street Oak Grove, TX 92170
Part I Income or Loss From Rental Real Estate and Royalties
XXXXX6888
1a Physical address of each property
1b Type of Property (from list below)
478
2 Fair Rental Days / Personal Use Days
668
3 Rents received
48,362.92
9 Insurance
$2,648.48
16 Taxes
$2,034.14
18 Depreciation expense or depletion
$7,303.54
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
15,535.37
26 Total rental real estate and royalty income or (loss)
2,149.94
SCHEDULE E (Form 1040)
Supplemental Income and Loss",SCHEDULE,34,SCHEDULE,fdc-abce84e286e6c60f694cb478,v11-SCHEDULE-E-stacked,original,2025,fgen-5af371bbc1d1158394d5518f,synthetic_programmatic_template,stacked,bottom,False,
"Name:
Sofia L. Adeyemi
1b Type of Property (from list below)
55
26 Total rental real estate and royalty income or (loss)
22,083.87",SCHEDULE,34,SCHEDULE,fdc-9a4ad53f1247a79dc3454deb,v11-SCHEDULE-E-stacked,original,2021,fgen-af227e1019dc98c92320e31e,synthetic_programmatic_template,stacked,none,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Olivia Tanaka
Your social security number
8611 Elm Park Pl Riverton, WI 79218
Part I Income or Loss From Rental Real Estate and Royalties
XXXXX9093
1a Physical address of each property
1b Type of Property (from list below)
369
2 Fair Rental Days / Personal Use Days
389
3 Rents received
$89,141.45
9 Insurance
1,411.80
12 Mortgage interest paid to banks, etc.
2,454.67
16 Taxes
3,593.96
18 Depreciation expense or depletion
967.95
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
21,887.63
26 Total rental real estate and royalty income or (loss)
4,744.28",SCHEDULE,34,SCHEDULE,fdc-4161186913df2a5936072005,v11-SCHEDULE-E-stacked,original,2024,fgen-820c345c0285677412b7989e,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2026
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Casey J. Walsh
Your social security number
4413 Willow Bend Way Testville, IL 55974
Part I Income or Loss From Rental Real Estate and Royalties
XXXXX1840
1a Physical address of each property
1b Type of Property (from list below)
683
2 Fair Rental Days / Personal Use Days
930
3 Rents received
29,752.44
9 Insurance
$7,711.32
12 Mortgage interest paid to banks, etc.
$2,195.56
16 Taxes
5,799.70
18 Depreciation expense or depletion
2,295.67
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
9,583.75",SCHEDULE,34,SCHEDULE,fdc-4c6cb931a2144b08702cec42,v11-SCHEDULE-E-stacked,original,2026,fgen-7040b8c8ec799f4a29ea6451,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Avery C. Sato
Your social security number
8473 Maple Ridge Dr Fairview, OH 69301
Part I Income or Loss From Rental Real Estate and Royalties
XXXXX5093
1a Physical address of each property
1b Type of Property (from list below)
310
2 Fair Rental Days / Personal Use Days
122
3 Rents received
93,364.10
9 Insurance
627.81
12 Mortgage interest paid to banks, etc.
$4,100.42
16 Taxes
571.39
18 Depreciation expense or depletion
$4,997.44
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
20,423.82
26 Total rental real estate and royalty income or (loss)
-3,233.65
Department of the Treasury - Internal Revenue Service
SCHEDULE E (Form 1040)
Supplemental Income and Loss
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-9345f78068ed287c646e5420,v11-SCHEDULE-E-stacked,original,2026,fgen-d9d3883b7b704223d428b7e4,synthetic_programmatic_template,stacked,bottom,False,
"SCHEDULE E (Form 1040) Supplemental Income and Loss
Name:
Sofia J. Kowalski
12 Mortgage interest paid to banks, etc.
$6,434.86
16 Taxes
580.32
2 Fair Rental Days / Personal Use Days
319",SCHEDULE,34,SCHEDULE,fdc-1e8a99fc6a2c4d974c39f70f,v11-SCHEDULE-E-stacked,original,2021,fgen-d46414f87092b4f5ceecef1b,synthetic_programmatic_template,stacked,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2026
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Wei J. Haddad
Your socia1 security number
1931 Oak Ho1low Ct Pinecrest, GA 22565
Part I Income or Loss From Rental Real Estate and Royalties
ending in 0671
1a Physical address of each property
2 Fair Rental Days / Personal Use Days
456
3 Rents received
48,474.68
9 Insurance
978.11
12 Mortgage interest paid to banks,etc.
8,307.64
16 Taxes
S7,213.02
l8 Depreciation expenseor depletion
5,928.82
26 Totalrental rcal estate and royalty income or (loss)
(2,356.8O)",SCHEDULE,34,SCHEDULE,fdc-20368e281322f6debf2bd4c4,v11-SCHEDULE-E-stacked,original,2026,fgen-aabbe315d987833b742fa604,synthetic_programmatic_template,stacked,top,True,
"☐ CORRECTED
SCHEDULE E (Form 1040)
Supplemental Incomeand Loss
For calendar year 2025
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, 5 corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return
Wei A. Testcase
Your social security number
9269 Maple Ridge Dr Testville, IL 35168
Part I Income or Loss From Rental Real Estate and Royalties
****8085
1a Physical address of each property
2 Fair Rental Days / PersonalUse Days
981
3 Rents received
45,986.48
9 Insurance
24.11
12 Mortgage interest paid to banks, etc.
6,375.93
26 Total rental real estate and roya1ty íncome or (loss)
l0,806.08
Department of the Treasury - Internal Revenue 5ervice
FormE (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-5e87d4f9ee2ab933b4fc9d6f,v11-SCHEDULE-E-stacked,original,2025,fgen-769b947ce43ad88274674bd3,synthetic_programmatic_template,stacked,top,True,
"SCHEDULE E (Form 1040) Supplemental Income and Loss
Name:
Amara Kowalski
3 Rents received
$115,162.82
16 Taxes
$3,158.15",SCHEDULE,34,SCHEDULE,fdc-bdf56c0281c2fe1dbc0a991b,v11-SCHEDULE-E-stacked,original,2025,fgen-f06073b8aa80ab528d3295f1,synthetic_programmatic_template,stacked,top,False,
"SCHEDULE E (Form 1040) Supplemental Income and Loss
Name:
Wei Tanaka
3 Rents received
23,449.77
12 Mortgage interest paid to banks, etc.
$8,577.02
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
(3,516.88)
26 Total rental real estate and royalty income or (loss)
25,081.33",SCHEDULE,34,SCHEDULE,fdc-0977639b4e9d6deec11bc802,v11-SCHEDULE-E-stacked,original,2026,fgen-dfa83c1aa56e26c895b16dcd,synthetic_programmatic_template,stacked,top,False,
"Name:
Amara Larsen
1b Typeof Property (from list below)
196
26 Total rental real estate and royalty income or (loss)
-7,l38.13
12 Mortgage interest paid to banks, etc.
$7,563.04
SCHEDULE E (Form 1040) Supp1emental Income and Loss 2025",SCHEDULE,34,SCHEDULE,fdc-42e809a4bbfd3c24ca101320,v11-SCHEDULE-E-stacked,original,2025,fgen-4948b462806d9539fd86615f,synthetic_programmatic_template,stacked,bottom,True,
"☐ CORRECTED
SCHEDULE E (Form 1040)
Supplemental Income and Loss
2022
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return
Morgan Brennan
Your social security number
7178 Oak Hollow Ct Maplewood, MN 87200
Part I Income or Loss From Rental Real Estate and Royalties
XXX-XX-1437
1a Physical address of each property
2 Fair Rental Days / Personal Use Days
871
3 Rents received
50,842.34
9 Insurance
5,250.69
12 Mortgage interest paid to banks, etc.
4,357.00
16 Taxes
8,794.99
26 Total rental real estate and royalty income or (loss)
12,302.40",SCHEDULE,34,SCHEDULE,fdc-bb5c425f09d9688ae19ea769,v11-SCHEDULE-E-stacked,original,2022,fgen-cb5855a45c0b1c5663f9de55,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2021
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Jordan Okafor
Your social security number
5197 Sample Street Fairview, OH 51649
Part I Income or Loss From Rental Real Estate and Royalties
ending in 6764
1a Physical address of each property
1b Type of Property (from list below)
582
3 Rents received
$54,043.02
9 Insurance
$7,158.75
12 Mortgage interest paid to banks, etc.
$2,568.56
16 Taxes
6,916.99
18 Depreciation expense or depletion
9,087.19
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
21,575.00
26 Total rental real estate and royalty income or (loss)
23,053.23",SCHEDULE,34,SCHEDULE,fdc-6c26d3d79206e4076f773b7d,v11-SCHEDULE-E-stacked,original,2021,fgen-472c71c03556e16d3c1cbebc,synthetic_programmatic_template,stacked,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2025
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Mateo Sato
Your social security number
7574 Oak Hollow Ct Riverton, WI 58711
Part I Income or Loss From Rental Real Estate and Royalties
****6031
1a Physical address of each property
1b Type of Property (from list below)
815
2 Fair Rental Days / Personal Use Days
369
3 Rents received
$14,987.35
9 Insurance
$107.17
12 Mortgage interest paid to banks, etc.
$4,534.26
16 Taxes
871.95
18 Depreciation expense or depletion
669.49
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
27,651.83
26 Total rental real estate and royalty income or (loss)
-4,585.28",SCHEDULE,34,SCHEDULE,fdc-f60d9b8751d1483e80a0e64c,v11-SCHEDULE-E-stacked,original,2025,fgen-cd45c5be90f836e9a819bb39,synthetic_programmatic_template,stacked,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income andLoss
For calendar year 2025
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on retum
Sofia Haddad
Your socia1 sccurity number
9840ak Hollow Ct Cedar Falls, IA 64932
Part I Income or Loss From Rental Real Estate and Royalties
ending in l635
1a Physical addressof each property
1bType of Property (from list below)
390
2 Fair Rental Days / Personal Use Days
981
3 Rents received
133,891.92
9 Insurance
$186.85
12 Mortgage interest paid to banks, etc.
696.15
16 Taxes
487.76
18 Depreciation expense or depletion
9,332.65
26 Total rental real estate and royalty income or (loss)
-3,592.87
Department of the Treasury - Intemal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-158acbc59a35b3d91a122bc1,v11-SCHEDULE-E-stacked,original,2025,fgen-cb3cd61460d159c9feffc30a,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
SCHEDULE E (Form 1040)
Supp1emental Income and Loss
2026
OMB No. 1545-0074
(From rental real estate, royaltíes,partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on returnJordan Tanaka
Your socia1 security number   9355 Maple Ridge Dr Brookhaven, PA 24154
Part I Income or Loss From Rental Real Estate and Royaltics  XXXXX8603
1a Physical address of each property
1b Type of Property (from list below) 839
2 Fair Rental Days / Personal Use Days 867
3 Rents received  $62,185.10
12 Mortgageinterest paid to banks, etc. 5,333.53
16 Taxes 7,169.16
18 Depreciation expense or depletion $7,234.l1
21 5ubtract line 20 from line 3 (rents) and/or 4 (royalties)  9,511.12
26 Total rental real estate and royalty income or (loss)   19,351.28
Department of the Treasury - Intemal Revenue 5ervice
Form E (Form l040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-f6df2df7e8a04cf28390a776,v11-SCHEDULE-E-inline,original,2026,fgen-84cea49af1aaf9d8f83c1e3a,synthetic_programmatic_template,inline,top,True,
"☐ CORRECTED
For calendar year 2021
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return   Priya Sato
Your social security number   7162 Elm Park Pl Pinecrest, GA 94538
Part I Income or Loss From Rental Real Estate and Royalties XXXXX5106
1a Physical address of each property
1b Type of Property (from list below)   443
2 Fair Rental Days / Personal Use Days      591
3 Rents received  139,064.38
9 Insurance   $2,955.47
12 Mortgage interest paid to banks, etc.      2,537.77
16 Taxes  6,782.93
18 Depreciation expense or depletion  3,935.71
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)   13,026.79
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-71a861a3c5be2041aa45b115,v11-SCHEDULE-E-inline,original,2021,fgen-a039b4598f6d270beeb9928e,synthetic_programmatic_template,inline,none,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2021
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return Hiro Okafor
Your social security number   5620 Harbor View Rd Cedar Falls, IA 17539
Part I Income or Loss From Rental Real Estate and Royalties   XXX-XX-2796
1a Physical address of each property
1b Type of Property (from list below) 25
3 Rents received  $29,232.85
9 Insurance   6,280.81
12 Mortgage interest paid to banks, etc.      485.17
16 Taxes 167.02
18 Depreciation expense or depletion   9,464.59
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)      3,124.83
26 Total rental real estate and royalty income or (loss)      8,283.55
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-a1c855657b79c90852e42ec8,v11-SCHEDULE-E-inline,original,2021,fgen-bc556e573ebee40e93cb8e8c,synthetic_programmatic_template,inline,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2024
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return Hiro K. Lindqvist
Your social security number 4892 Sample Street Testville, IL 88047
Part I Income or Loss From Rental Real Estate and Royalties      ****7094
1a Physical address of each property
2 Fair Rental Days / Personal Use Days 33
12 Mortgage interest paid to banks, etc. $3,442.86
16 Taxes $2,212.95
18 Depreciation expense or depletion $2,473.70
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties) (6,530.43)
26 Total rental real estate and royalty income or (loss) 20,652.16
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-a6e1eaaceff53146dfbd6495,v11-SCHEDULE-E-inline,original,2024,fgen-65d48f906ad6dd01c2aff5cf,synthetic_programmatic_template,inline,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2024
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return  Riley M. Castillo
Your social security number 8329 Prairie Ave Brookhaven, PA 38718
Part I Income or Loss From Rental Real Estate and Royalties  ***-**-8911
1a Physical address of each property
1b Type of Property (from list below)      715
2 Fair Rental Days / Personal Use Days  929
3 Rents received  $1,291.73
9 Insurance      $2,378.01
12 Mortgage interest paid to banks, etc.  8,567.20
16 Taxes      8,384.68
18 Depreciation expense or depletion   $5,191.98
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties) 26,799.19
26 Total rental real estate and royalty income or (loss) 86.27
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-a86b8ad107296f6e3f6fe87c,v11-SCHEDULE-E-inline,original,2024,fgen-74d45037062f3d0c57368ab8,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
SCHEDULE E (Form 1040)
Supplemental Income and Loss
2022
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return      Wei Nguyen
Your social security number 5006 Sample Street Cedar Falls, IA 83849
Part I Income or Loss From Rental Real Estate and Royalties   ****5039
1a Physical address of each property
1b Type of Property (from list below)      116
3 Rents received $111,487.83
9 Insurance   8,884.73
12 Mortgage interest paid to banks, etc.   $8,544.75
16 Taxes      8,825.49
18 Depreciation expense or depletion   $2,219.28
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties) 15,091.91
26 Total rental real estate and royalty income or (loss) 14,691.35",SCHEDULE,34,SCHEDULE,fdc-2200927f02bd9b03236ffcb4,v11-SCHEDULE-E-inline,original,2022,fgen-2a213207b31bc792cf685370,synthetic_programmatic_template,inline,top,False,
"For calendar year 2021
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return   Alex Sato
Your social security number      2632 Prairie Ave Oak Grove, TX 36685
Part I Income or Loss From Rental Real Estate and Royalties      XXX-XX-5865
1a Physical address of each property
1b Type of Property (from list below)  540
2 Fair Rental Days / Personal Use Days  175
3 Rents received $17,897.86
9 Insurance 2,722.88
12 Mortgage interest paid to banks, etc. 6,418.17
16 Taxes  $4,817.58
18 Depreciation expense or depletion   4,543.79
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)   9,845.91
SCHEDULE E (Form 1040)
Supplemental Income and Loss",SCHEDULE,34,SCHEDULE,fdc-6677ce05ff0fafdaecf55e05,v11-SCHEDULE-E-inline,original,2021,fgen-dd2c4be230e485153a2a5800,synthetic_programmatic_template,inline,bottom,False,
"2026
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return      Mateo S. Castillo
Your social security number 9283 Prairie Ave Testville, IL 57910
Part I Income or Loss From Rental Real Estate and Royalties  ***-**-9223
1a Physical address of each property
1b Type of Property (from list below)  895
2 Fair Rental Days / Personal Use Days 494
3 Rents received   53,494.36
9 Insurance  $8,057.29
12 Mortgage interest paid to banks, etc.   $6,895.88
16 Taxes  $9,195.27
18 Depreciation expense or depletion      $6,167.37
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties) 24,059.49
26 Total rental real estate and royalty income or (loss) 7,235.66
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-62c5497c1ae05d7513147e16,v11-SCHEDULE-E-inline,original,2026,fgen-16a01fd1cb8926e135219ef6,synthetic_programmatic_template,inline,none,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2026
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return Diego Patel
Your social security number 365 Granite St Testville, IL 74180
Part I Income or Loss From Rental Real Estate and Royalties XXX-XX-8629
1a Physical address of each property
1b Type of Property (from list below)      256
2 Fair Rental Days / Personal Use Days  183
9 Insurance      8,052.38
16 Taxes $7,681.00
18 Depreciation expense or depletion      $1,343.82
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties) -3,435.95
26 Total rental real estate and royalty income or (loss)  12,764.82
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-24bf7e19f428f7af467afe85,v11-SCHEDULE-E-inline,original,2026,fgen-eb9084edbcb67cf30d31ab83,synthetic_programmatic_template,inline,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2026
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return Avery B. Patel
Your social security number 1730 Maple Ridge Dr Maplewood, MN 45478
Part I Income or Loss From Rental Real Estate and Royalties   ****7870
1a Physical address of each property
1b Type of Property (from list below)  429
2 Fair Rental Days / Personal Use Days 722
3 Rents received      64,142.78
9 Insurance $3,001.39
12 Mortgage interest paid to banks, etc.      $613.07
16 Taxes  9,074.49
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)   11,055.06
26 Total rental real estate and royalty income or (loss)  24,199.05
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-5bc772557201aa3d9a53fc87,v11-SCHEDULE-E-inline,original,2026,fgen-99173dc24fde6d3ac813c797,synthetic_programmatic_template,inline,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2024
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return   Wei Sato
Your social security number      7932 Cedar Ln Bayside, WA 52918
Part I Income or Loss From Rental Real Estate and Royalties  ending in 2143
1a Physical address of each property
1b Type of Property (from list below) 214
2 Fair Rental Days / Personal Use Days 813
3 Rents received $83,978.60
9 Insurance  $8,686.76
12 Mortgage interest paid to banks, etc.  $7,206.83
16 Taxes $3,989.04
18 Depreciation expense or depletion $1,869.54
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)  14,328.88
26 Total rental real estate and royalty income or (loss) 17,620.79
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-e5960e4ef7c018e7251fc6f5,v11-SCHEDULE-E-inline,original,2024,fgen-4e318e1a0768be2fd809691b,synthetic_programmatic_template,inline,top,False,
"OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, cstates, trusts, REMICs, etc.)
Name(s) shown on return Amara Tanaka
Your social security number      1511 Willow Bend Way Maplewood, MN 18437
Part I Income or Loss FromRental Real Estate and Royalties  ***-**-7426
1a Physical address of each property
lb Type of Property (from list below)  304
2 Fair Rental Days / Personal Use Days      514
3Rents receíved 109,437.89
9 Insurance 8,293.64
12 Mortgage interest paid to banks, etc.     $9,202.30
16 Taxes  $4,510.00
18 Depreciation expense or depletion   $2,711.O8
26Total rental real estate and royalty income or (loss) 6,219.81
Department of thc Treasury - Internal Revenue Service
SCHEDULE E (Form 1040)
Supplemental Income and Loss
Form E(Form 1040) (kcep for your records)  www.irs.gov/Form5CHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-fb07cd55b45738669a768a6f,v11-SCHEDULE-E-inline,original,2024,fgen-13eb7539f4c00e2d47ba031b,synthetic_programmatic_template,inline,bottom,True,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2026
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return Lena S. Lindqvist
Your social security number  2807 Granite St Cedar Falls, IA 50141
Part I Income or Loss From Rental Real Estate and Royalties ending in 1326
1a Physical address of each property
1b Type of Property (from list below) 712
3 Rents received      119,413.31
9 Insurance  $5,325.17
12 Mortgage interest paid to banks, etc. 76.97
16 Taxes      $6,144.67
18 Depreciation expense or depletion $4,115.07
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties) 2,019.79",SCHEDULE,34,SCHEDULE,fdc-f1a0ce63fc2f76908a038026,v11-SCHEDULE-E-inline,original,2026,fgen-aa920bda98f4908d4b21b199,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
For calendar year 2026
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return  Diego Castillo
Your social security number      7681 Prairie Ave Maplewood, MN 10616
Part I Income or Loss From Rental Real Estate and Royalties XXXXX2497
1a Physical address of each property
2 Fair Rental Days / Personal Use Days  368
3 Rents received  15,862.42
12 Mortgage interest paid to banks, etc. $5,906.47
16 Taxes      8,035.51
18 Depreciation expense or depletion   $5,689.63
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)  29,436.35
26 Total rental real estate and royalty income or (loss)  23,033.34
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-47f03bc50c7e745b712aba10,v11-SCHEDULE-E-inline,original,2026,fgen-ac02b79549a688c6168f069e,synthetic_programmatic_template,inline,none,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2022
OMB No. 1545-0074
Name(s) shown on return Lena Tanaka
Your social security number   3086 Elm Park Pl Pinecrest, GA 81790
Part I Income or Loss From Rental Real Estate and Royalties  XXX-XX-9401
1a Physical address of each property
1b Type of Property (from list below)  313
2 Fair Rental Days / Personal Use Days  390
3 Rents received   35,489.68
9 Insurance   $6,288.95
12 Mortgage interest paid to banks, etc.      $1,530.20
16 Taxes 3,023.64
18 Depreciation expense or depletion  910.11
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)      17,306.15
26 Total rental real estate and royalty income or (loss)   10,726.27
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-dcf82cdba4f923a3c84eacea,v11-SCHEDULE-E-inline,original,2022,fgen-e8af229937869bc87461729e,synthetic_programmatic_template,inline,top,False,
"VOID  CORRECTED
For calendar year 2024
OMB No. 1545-0074
Name(s) shown on return  Amara S. Rivera
Your social security number 4185 Granite St Testville, IL 69182
Part I Income or Loss From Rental Real Estate and Royalties      ***-**-1650
1a Physical address of each property
1b Type of Property (from list below)      798
2 Fair Rental Days / Personal Use Days 598
3 Rents received $124,088.77
16 Taxes   6,338.42
18 Depreciation expense or depletion      $894.21
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)      -4,473.80
26 Total rental real estate and royalty income or (loss) 10,372.72
Department of the Treasury - Internal Revenue Service
SCHEDULE E (Form 1040)
Supplemental Income and Loss
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-276d1f219d806280f920ce8f,v11-SCHEDULE-E-inline,original,2024,fgen-e6a327720fdc1a5b51c21114,synthetic_programmatic_template,inline,bottom,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2022
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Amara Kowalski
3026 Maple Ridge Dr Fairview, OH 61672
****5249
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
3 Rents received
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or depletion
26 Total rental real estate and royalty income or (loss)
50
621
$6,602.66
$5,424.05
$3,481.40
$4,047.55
8,544.60
6,668.57
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-a0ba7197c3bf80476243ab36,v11-SCHEDULE-E-columns,original,2022,fgen-0178b0092c2d94a4425600d0,synthetic_programmatic_template,columns,top,False,
"Name:
18 Depreciation expense or depletion
9 Insurance
Alex Walsh
$5,931.21
1,559.77
SCHEDULE E (Form 1040) Supplemental Income and Loss 2022",SCHEDULE,34,SCHEDULE,fdc-447eaa5e258038b2bc8ed892,v11-SCHEDULE-E-columns,original,2022,fgen-e75e1332094a59dd1659bb0b,synthetic_programmatic_template,columns,bottom,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2022
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Jamie Okafor
2267 Prairie Ave Brookhaven, PA 37358
***-**-4622
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
3 Rents received
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or depletion
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
26 Total rental real estate and royalty income or (loss)
318
356
$60,676.42
3,522.62
8,856.87
3,352.76
$36.98
15,620.09
1,402.82",SCHEDULE,34,SCHEDULE,fdc-ebfcd2b66e0acd07bc7987b7,v11-SCHEDULE-E-columns,original,2022,fgen-c8559b96ee002f61e0a4df5d,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
SCHEDULE E (Form 1040)
Supplemental Income and Loss
2024
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Avery Patel
3742 Cedar Ln Bayside, WA 60926
XXX-XX-4172
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
3 Rents received
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or depletion
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
26 Total rental real estate and royalty income or (loss)
438
101
35,437.97
7,614.47
$1,956.36
5,185.84
$333.63
-5,457.74
19,295.47",SCHEDULE,34,SCHEDULE,fdc-c9fdd95ddc73175125ffe6f9,v11-SCHEDULE-E-columns,original,2024,fgen-9b33ca253d6703742df297b1,synthetic_programmatic_template,columns,top,False,
"Name:
1b Type of Property (from list below)
Jamie Fischer
125
SCHEDULE E (Form 1040) Supplemental Income and Loss 2022",SCHEDULE,34,SCHEDULE,fdc-3d1af1cd7c1e80a2fe587630,v11-SCHEDULE-E-columns,original,2022,fgen-424d11058e86d7a4fd52be6a,synthetic_programmatic_template,columns,bottom,False,
"CORRECTED (if checked)
SCHEDULE E (Form 1040)
SupplementalIncome and Loss
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income orLoss From Rental Real Estate and Royaltíes
Amara Larsen
5650 Elm Park Pl 0ak Grove, TX 3l85l
XXX-XX-5801
1a Physical address of each property
2 Fair Rental Days / Personal Use Days
3 Rents received
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or dep1etion
21 Subtract 1ine 20 from line3 (rents) and/or 4 (royalties)
426
126,528.36
5,927.79
S7,452.19
2,574.59
5,367.72
28,593.03
Department of the Treasury - Interna1 Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/Form5CHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-578a5086ee206a7c46ba7aef,v11-SCHEDULE-E-columns,original,2023,fgen-5532fe03cf8ca79dd63843e3,synthetic_programmatic_template,columns,top,True,
"CORRECTED (if checked)
SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2021
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Avery Testcase
6911 Prairie Ave Fairview, OH 17142
XXX-XX-2197
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
3 Rents received
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or depletion
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
26 Total rental real estate and royalty income or (loss)
95
791
81,305.47
$9,303.12
$8,540.75
68.79
$1,945.03
29,981.63
11,468.44",SCHEDULE,34,SCHEDULE,fdc-49773eb15bd77d54995a2f7d,v11-SCHEDULE-E-columns,original,2021,fgen-b0a404c0069a9110b83477dc,synthetic_programmatic_template,columns,top,False,
"For calendar year 2025
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Wei Fischer
534 Oak Hollow Ct Pinecrest, GA 20204
***-**-8971
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
3 Rents received
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or depletion
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
26 Total rental real estate and royalty income or (loss)
250
504
68,834.96
6,353.46
$4,446.49
$7,231.88
(1,961.36)
214.59
Department of the Treasury - Internal Revenue Service
SCHEDULE E (Form 1040)
Supplemental Income and Loss
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-57a89bf83007decf951f6848,v11-SCHEDULE-E-columns,original,2025,fgen-38b349c6e9e823cc4e8036ee,synthetic_programmatic_template,columns,bottom,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2026
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Taylor A. Okafor
9406 Oak Hollow Ct Lakewood, CO 74031
XXXXX6839
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
3 Rents received
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or depletion
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
26 Total rental real estate and royalty income or (loss)
150
605
93,510.47
$7,721.99
$4,606.03
4,321.31
81.92
6,774.27
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-d73ecb15f017afbd5d9842dd,v11-SCHEDULE-E-columns,original,2026,fgen-372b22b86249a055f3a598c8,synthetic_programmatic_template,columns,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2026
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Kwame J. Testcase
9670 Oak Hollow Ct Cedar Falls, IA 91741
****7284
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
26 Total rental real estate and royalty income or (loss)
707
375
$4,761.28
$2,434.51
9,312.01
17,037.43",SCHEDULE,34,SCHEDULE,fdc-2b0e62af7f2b504478a40c78,v11-SCHEDULE-E-columns,original,2026,fgen-620dc1755b693c580594618d,synthetic_programmatic_template,columns,top,False,
"SCHEDULE E (Form 1040) Supplemental Income and Loss
Name:
18 Depreciation expense or depletion
Mateo A. Testcase
$7,609.69",SCHEDULE,34,SCHEDULE,fdc-d39a4a3c902a4b7921e4a9c8,v11-SCHEDULE-E-columns,original,2025,fgen-2e5e74a6e10ce5e4d13c9c2f,synthetic_programmatic_template,columns,top,False,
"SCHEDULE E (Form 1040) Supplemental Income andLoss
Name:
18 Deprecíation expense or depletion
Casey Patel
S2,916.61",SCHEDULE,34,SCHEDULE,fdc-4431df618f4630cc25490424,v11-SCHEDULE-E-columns,original,2025,fgen-0df584d5bcbef317f97d338b,synthetic_programmatic_template,columns,top,True,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2023
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Jamie L. Haddad
9309 Willow Bend Way Lakewood, CO 94810
XXX-XX-2627
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
26 Total rental real estate and royalty income or (loss)
36
316
$841.06
1,582.47
$4,250.59
23,003.24
11,292.28",SCHEDULE,34,SCHEDULE,fdc-ca31ddb44535359e52d32c58,v11-SCHEDULE-E-columns,original,2023,fgen-b8728edbb38cfef46dcbbbb0,synthetic_programmatic_template,columns,top,False,
"SCHEDULE E (Form 1040) Supplemental Income and Loss 2021
Name:
21 Subtract line 20 fromline 3 (rents) and/or 4 (royaltíes)
Diego Adeyemi
-4,759.84",SCHEDULE,34,SCHEDULE,fdc-3a558fbcf8c32608cdb958aa,v11-SCHEDULE-E-columns,original,2021,fgen-7883f5da71fb3d1247de4c26,synthetic_programmatic_template,columns,top,True,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2026
(From rental real estate, royalties, partnerships, 5 corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Avery Romero
2064 Harbor View Rd Riverton, WI 29630
****3107
1a Physical address of each property
1b Type of Property (fromlist below)
2 Fair Rental Days / Personal Use Days
3 Rents receivcd
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciationexpense or depletion
26 Total rental real estate and royalty income or (loss)
38
698
43,970.04
6,857.79
1,833.27
6,216.18
S3,289.44
13,000.33
Dcpartment of the Treasury - Internal Revenue 5ervice
Form E(Form lO40) (keep for your records)  www.irs.gov/Form5CHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-07ed9c2ef5867d152c8efb7a,v11-SCHEDULE-E-columns,original,2026,fgen-71e5c4078a96410bc32a0b35,synthetic_programmatic_template,columns,top,True,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2023
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return
Your social security number
Part I Income or Loss From Rental Real Estate and Royalties
Sofia Okafor
3542 Granite St Riverton, WI 37256
ending in 8739
1a Physical address of each property
1b Type of Property (from list below)
2 Fair Rental Days / Personal Use Days
3 Rents received
9 Insurance
12 Mortgage interest paid to banks, etc.
16 Taxes
18 Depreciation expense or depletion
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties)
26 Total rental real estate and royalty income or (loss)
135
560
$14,333.72
$2,020.75
1,447.72
$9,374.54
$1,548.50
15,404.76
26,269.83
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-c2ec644d31ba93501854ca6d,v11-SCHEDULE-E-columns,original,2023,fgen-8722f4ea44b7b350eb2d93a0,synthetic_programmatic_template,columns,top,False,
"SCHEDULE E (Form1040)
Supplemental Income and Loss
For calcndar year 2O21
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or1041.
Name(s)shown on retum: Wei Fischer
Your social security number: 8873 Elm Park Pl Fairview, 0H 5286l
Part I Income orLoss From Rental Real Estate and Royalties: ending in 1097
1a Physical address of each property
Line 1b Type of Property (from list below): 442
Line 2 Faír Rental Days / Personal Use Days: 483
Line 3 Rents received: S23,756.89
Line 9 Insurance: 8,980.61
Line 16 Taxes: 6,746.48
Line 18 Depreciation expense or depletion: 3,544.20
Line 21 5ubtract line 2O from line 3 (rents) and/or 4 (royalties): 11,181.O8
Line 26 Total rental real estate and royalty income or (loss): 8,5O4.59",SCHEDULE,34,SCHEDULE,fdc-da0dbcfe0ab35275b6521f52,v11-SCHEDULE-E-boxed,original,2021,fgen-6b95544066e88bd4b13affd2,synthetic_programmatic_template,boxed,top,True,
"CORRECTED(if checked)
2023
OMB No. 1545-0074
(From rental real estate, royaltics, partnerships, S corporations, estates, trusts,REMICs, etc.)
Attach to Form1O40, 1040-5R, l040-NR, or 1041.
Name(s) shown on return: Jordan Larsen
Your social security number: 135O OakHollow Ct Brookhaven, PA 74730
Part I Income or Loss From Rental Real Estate and Royalties: XXX-XX-9598
1a Physícal address of each property
Box lb Type of Property (from list below): 588
Box 2 Fair Rental Days / Personal Usc Days: 645
Box 9 Insurance: 4,723.16
Box 12 Mortgage interest paid to banks, etc.: 6,042.45
Box 16 Taxes: $3,843.70
Box 18 Depreciation expense or depletion: 614.36
Box 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 8,259.96
Box 26 Total renta1 real estate and royalty íncome or (loss): 21,239.34",SCHEDULE,34,SCHEDULE,fdc-c1500ebfddbf360c6d0503ce,v11-SCHEDULE-E-boxed,original,2023,fgen-1c8325a46f21ffd1993f753d,synthetic_programmatic_template,boxed,none,True,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2025
OMB No. 1545-0074
Name(s) shown on return: Alex C. Fischer
Your social security number: 1373 Sample Street Fairview, OH 13097
Part I Income or Loss From Rental Real Estate and Royalties: XXX-XX-0206
1a Physical address of each property
Box 1b Type of Property (from list below): 191
Box 2 Fair Rental Days / Personal Use Days: 959
Box 3 Rents received: 73,324.87
Box 12 Mortgage interest paid to banks, etc.: 7,875.71
Box 16 Taxes: 4,003.65
Box 18 Depreciation expense or depletion: 946.97
Box 26 Total rental real estate and royalty income or (loss): -1,572.72",SCHEDULE,34,SCHEDULE,fdc-55e2ca11a5363b77277acfdc,v11-SCHEDULE-E-boxed,original,2025,fgen-6800ac9c25e4c74d81c31f89,synthetic_programmatic_template,boxed,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
For calendar year 2026
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return: Casey Haddad
Your social security number: 7985 Granite St Maplewood, MN 61134
Part I Income or Loss From Rental Real Estate and Royalties: ending in 3067
1a Physical address of each property
Box 1b Type of Property (from list below): 239
Box 2 Fair Rental Days / Personal Use Days: 809
Box 3 Rents received: $127,107.93
Box 12 Mortgage interest paid to banks, etc.: 7,395.40
Box 16 Taxes: $3,730.80
Box 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 23,935.66
Box 26 Total rental real estate and royalty income or (loss): 25,920.16
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-c40624053f847d8c10183943,v11-SCHEDULE-E-boxed,original,2026,fgen-c06a73cf7ecc8dd89ba7e15e,synthetic_programmatic_template,boxed,top,False,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2023
Name(s) shown on return: Kwame E. Adeyemi
Your social security number: 4543 Lakeshore Blvd Oak Grove, TX 76162
Part I Income or Loss From Rental Real Estate and Royalties: ending in 0645
1a Physical address of each property
Box 2 Fair Rental Days / Personal Use Days: 369
Box 3 Rents received: $75,102.42
Box 9 Insurance: $7,501.18
Box 12 Mortgage interest paid to banks, etc.: $6,850.74
Box 18 Depreciation expense or depletion: 2,473.08
Box 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 29,018.26
Box 26 Total rental real estate and royalty income or (loss): (5,224.44)
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-5437eb13279608da49e17d40,v11-SCHEDULE-E-boxed,original,2023,fgen-dbc3561d5e479d74c233ff07,synthetic_programmatic_template,boxed,top,False,
"2021
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return: Mateo L. Nguyen
Your social security number: 2971 Elm Park Pl Fairview, OH 53674
Part I Income or Loss From Rental Real Estate and Royalties: XXX-XX-6908
1a Physical address of each property
1b Type of Property (from list below): 449
2 Fair Rental Days / Personal Use Days: 619
3 Rents received: $13,183.72
9 Insurance: $3,434.29
12 Mortgage interest paid to banks, etc.: $1,848.23
16 Taxes: $4,032.76
18 Depreciation expense or depletion: 5,505.34
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 20,256.34
26 Total rental real estate and royalty income or (loss): 24,051.84
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-2c4d3e97f384abd7e534d79e,v11-SCHEDULE-E-boxed,original,2021,fgen-6b6f7badcec314690805d34e,synthetic_programmatic_template,boxed,none,False,
"For calendar year 2026
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return: Diego Kowalski
Your social security number: 6366 Maple Ridge Dr Bayside, WA 92724
Part I Income or Loss From Rental Real Estate and Royalties: XXXXX2747
1a Physical address of each property
1b Type of Property (from list below): 362
3 Rents received: 77,260.12
9 Insurance: $3,489.20
12 Mortgage interest paid to banks, etc.: $2,980.30
16 Taxes: $5,204.79
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): (1,233.43)
26 Total rental real estate and royalty income or (loss): (1,892.27)
Department of the Treasury - Internal Revenue Service
SCHEDULE E (Form 1040)
Supplemental Income and Loss
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-2b79b364ed49f361f29be6ea,v11-SCHEDULE-E-boxed,original,2026,fgen-102f3ec08504feef8a58aa62,synthetic_programmatic_template,boxed,bottom,False,
"VOID  CORRECTED
SCHEDULE E (Form 1040)
Supplemental Income and Loss
2022
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return: Diego D. Castillo
Your social security number: 3813 Sample Street Bayside, WA 47923
Part I Income or Loss From Rental Real Estate and Royalties: ending in 3597
1a Physical address of each property
Box 1b Type of Property (from list below): 153
Box 2 Fair Rental Days / Personal Use Days: 195
Box 3 Rents received: 65,528.38
Box 12 Mortgage interest paid to banks, etc.: 8,900.73
Box 16 Taxes: $3,249.60
Box 18 Depreciation expense or depletion: $7,590.89
Box 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 6,270.76
Box 26 Total rental real estate and royalty income or (loss): 9,944.83
Department of the Treasury - Internal Revenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-37fe6af00b3a34fafa9f104e,v11-SCHEDULE-E-boxed,original,2022,fgen-79d085facd6f7ebee92c3663,synthetic_programmatic_template,boxed,top,False,
"For calendar year 2021
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return: Mateo Rivera
Your social security number: 6340 Willow Bend Way Oak Grove, TX 48040
Part I Income or Loss From Rental Real Estate and Royalties: XXX-XX-0394
1a Physical address of each property
Box 3 Rents received: $133,531.83
Box 9 Insurance: 6,005.23
Box 12 Mortgage interest paid to banks, etc.: 6,145.49
Box 16 Taxes: 7,699.33
Box 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 21,433.92
Box 26 Total rental real estate and royalty income or (loss): (6,411.64)
SCHEDULE E (Form 1040)
Supplemental Income and Loss",SCHEDULE,34,SCHEDULE,fdc-a72cd0900cac9a900685bb5d,v11-SCHEDULE-E-boxed,original,2021,fgen-e8ac9cce4477be30bf939d02,synthetic_programmatic_template,boxed,bottom,False,
"SCHEDULE E (Form1040) Supplemental Income and Loss 2024
Name:: Mateo Pate1
l2 Mortgage interest paid to banks, etc.: 9,446.98
9 Insurance: S3,882.42
3 Rents received: 137,994.59
21 Subtract line 20 from line 3 (rents) and/or 4 (royaltics): (8,528.73)",SCHEDULE,34,SCHEDULE,fdc-72e10a3f266f10e254a8d2cc,v11-SCHEDULE-E-boxed,original,2024,fgen-e1bc2448f7e326efdf16499b,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
SCHEDULE E (Form 1040)
Supp1emental Income and Loss
For calendar year 2022
Name(s) shown on return: Kwame Brennan
Your social security number: 8706 Elm Park Pl Brookhaven, PA 57751
Part I Income orLoss From Rental Real Estate and Royalties: ****5966
1a Physical address of cach property
Line 1b Type of Property (from list below): 21
Line 2 Fair Rental Days / Personal Use Days: 50
Líne 3 Rents received: $59,421.38
Line 12 Mortgage interest paid tobanks, etc.: l,338.4O
Line 16 Taxes: 489.48
Line l8 Depreciation expense or depletíon:4,440.75
Line 21 5ubtract line 20 from line 3 (rents) and/or 4 (royalties): (2,216.85)
Department of the Treasury - IntemalRevenue Service
Form E (Form 1040) (keep for your records)  www.irs.gov/FormSCHEDULEEForm1040",SCHEDULE,34,SCHEDULE,fdc-3c23fd6de3f8861c5621e845,v11-SCHEDULE-E-boxed,original,2022,fgen-756089df3a1932d98724da6d,synthetic_programmatic_template,boxed,top,True,
"SCHEDULE E (Form 1040)
Supplemental Income and Loss
2025
Attach to Form 1040,1040-5R, 1040-NR, or1041.
Name(s) shownon return: Wei M. Tanaka
Your social security number: 6536 Lakeshore Blvd Oak Grove, TX 75474
Part I Income or Loss From Rental Real Estate and Royalties: ending in 3487
la Physical address of each property
Box 1b Type of Property (from list below): 324
Box 2 Fair Rental Days / Personal Use Days: 377
Box 3 Rents received: 59,825.O2
Box 9 Insurance:9,049.l0
Box l2 Mortgage interest paid to banks, etc.: $4,425.06
Box 16 Taxes: $4,387.35
Box 18 Dcpreciation expense or depletion: $1,582.44
Box 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 12,694.79
Box 26 Total rental real estate and royalty income or (loss): 1,131.53",SCHEDULE,34,SCHEDULE,fdc-4fadcb94dda47e2ddc45234b,v11-SCHEDULE-E-boxed,original,2025,fgen-c4fdaa3f7ef63167a41c8f0e,synthetic_programmatic_template,boxed,top,True,
"SCHEDULE E (Form 1040) Supplemental Income and Loss 2023
Name:: Mateo Lindqvist
Box 18 Depreciation expense or depletion: 9,394.18
Box 16 Taxes: $7,133.12",SCHEDULE,34,SCHEDULE,fdc-527f50d58b0ef7d3eba00ff3,v11-SCHEDULE-E-boxed,original,2023,fgen-98cad02e49cbf5a517fa190c,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
2021
OMB No. 1545-0074
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return: Kwame A. Larsen
Your social security number: 4013 Oak Hollow Ct Brookhaven, PA 91633
Part I Income or Loss From Rental Real Estate and Royalties: ***-**-0389
1a Physical address of each property
Line 1b Type of Property (from list below): 347
Line 2 Fair Rental Days / Personal Use Days: 813
Line 9 Insurance: $713.73
Line 12 Mortgage interest paid to banks, etc.: $4,765.31
Line 16 Taxes: $5,246.77
Line 18 Depreciation expense or depletion: $6,338.34
Line 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 27,426.40
Line 26 Total rental real estate and royalty income or (loss): 12,626.80
Department of the Treasury - Internal Revenue Service",SCHEDULE,34,SCHEDULE,fdc-620e39f561f00f2e152251bc,v11-SCHEDULE-E-boxed,original,2021,fgen-d7b712f46a3778290a42410f,synthetic_programmatic_template,boxed,none,False,
"2024
OMB No. 1545-0074
Attach to Form 1040, 1040-SR, 1040-NR, or 1041.
Name(s) shown on return: Casey Castillo
Your social security number: 2402 Lakeshore Blvd Pinecrest, GA 30404
Part I Income orLoss From Rental Real Estatc and Royaltíes: ***-**-6987
1a Physical address of each property
Box1b Type of Property (from list bclow): 539
Box 2 Fair Rental Days / Personal Use Days: 513
Box 3 Rents received: 57,978.62
Box 9 Insurance: 5,406.24
Box 12 Mortgage interest paid to banks, etc.:8,676.28
Box 21 Subtract line 2O from line 3 (rents) and/or 4 (royalties): 27,723.47",SCHEDULE,34,SCHEDULE,fdc-04ed3128f43c8e5f7fab312e,v11-SCHEDULE-E-boxed,original,2024,fgen-963b7e192b3d78aeaa178ea3,synthetic_programmatic_template,boxed,none,True,
"VOID  CORRECTED
For calendar year 2022
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
Name(s) shown on return: Diego D. Larsen
Your social security number: 4153 Sample Street Riverton, WI 28433
Part I Income or Loss From Rental Real Estate and Royalties: ***-**-7307
1a Physical address of each property
Line 1b Type of Property (from list below): 992
Line 2 Fair Rental Days / Personal Use Days: 925
Line 3 Rents received: 26,999.07
Line 9 Insurance: $801.06
Line 12 Mortgage interest paid to banks, etc.: $7,255.28
Line 16 Taxes: 6,245.09
Line 18 Depreciation expense or depletion: 3,562.13
Line 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties): 17,013.01
Line 26 Total rental real estate and royalty income or (loss): 4,832.55",SCHEDULE,34,SCHEDULE,fdc-5ded110cb2501bd2a59c9781,v11-SCHEDULE-E-boxed,original,2022,fgen-c8b9b4ee34e402b8b2e3f747,synthetic_programmatic_template,boxed,none,False,
"Please bring the following documents:
☐ All Forms W-2 and 1099
☐ Form 1098 mortgage interest statements
☐ Property tax bills and charitable receipts
☐ Last year's federal and state returns
2024 Tax Organizer Checklist",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-ab984c97ea08645fb3956b02,v11-TAX_INSTRUCTIONS-inline,instruction,2024,fgen-c671cb88d8235e4f9329238e,synthetic_programmatic_template,inline,bottom,False,preparer_checklist
"(Rev. January 2021)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 1098, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b0285d22b11cf56546896556,v11-TAX_INSTRUCTIONS-inline,instruction,2021,fgen-0ed361ba6156ac143596ad25,synthetic_programmatic_template,inline,none,False,irs_instructions
"Understanding your Form W-2
This guide explains each box on the Form W-2 you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-6eb3b258b111eb0b19d33bee,v11-TAX_INSTRUCTIONS-inline,instruction,2021,fgen-f897db55e318d68cc1ecf2cf,synthetic_programmatic_template,inline,top,False,employer_guide
"(Rev. January 2026)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 1099-INT, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-6754be8a9bdf7be38897e7a2,v11-TAX_INSTRUCTIONS-inline,instruction,2026,fgen-ba9c6ddb21d418935172ceb6,synthetic_programmatic_template,inline,none,False,irs_instructions
"Instructions for Form 8949
(Rev. January 2025)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 8949, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-a7a5d841e29b4f514c17e36c,v11-TAX_INSTRUCTIONS-inline,instruction,2025,fgen-4f19c83283883348417ecb54,synthetic_programmatic_template,inline,top,False,irs_instructions
"Instructions for Form 1099-R
(Rev. January 2023)
Section references are to the Internal Revenue Code unless otherwíse noted.
What's New
Future developments. For the latest information about developments related to Form 1099-R, go to IR5.gov.
GeneralInstructíons
Specific Instructions
Box 1. Enter the amount reported to you. Do not indude amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out theIntemal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-8ccef7add178a5e4419314ec,v11-TAX_INSTRUCTIONS-inline,instruction,2023,fgen-4f59b2b5f4f7d389999d6ab8,synthetic_programmatic_template,inline,top,True,irs_instructions
"This guide explains each box on the Form Schedule C you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-312ff58480d3ce4f69c4b341,v11-TAX_INSTRUCTIONS-inline,instruction,2023,fgen-cc5b51f575e0efaacfab77d5,synthetic_programmatic_template,inline,none,False,employer_guide
"Instructions for Form Schedule C
(Rev. January 2026)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form Schedule C, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-36d5a848a1d8be1dbf324851,v11-TAX_INSTRUCTIONS-inline,instruction,2026,fgen-2b10581218d125a214202764,synthetic_programmatic_template,inline,top,False,irs_instructions
"Understanding your Form 8949
This guide explains each box on the Form 8949 you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-1495a56354af24db443b35e0,v11-TAX_INSTRUCTIONS-inline,instruction,2022,fgen-4b35fcdbed94081ce00fe817,synthetic_programmatic_template,inline,top,False,employer_guide
"This guide explains each box on the Form 1099-INT you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b234bcc8ddb7f221475037b4,v11-TAX_INSTRUCTIONS-inline,instruction,2025,fgen-a21edd42370f78d75a6dc565,synthetic_programmatic_template,inline,none,False,employer_guide
"2022 Tax Organizer Checklist
Please bring the following documents:
☐ All Forms W-2 and 1099
☐ Form 1098 mortgage interest statements
☐ Property tax bills and charitable receipts
☐ Last year's federal and state returns",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-c98334c8622e284485ed543e,v11-TAX_INSTRUCTIONS-inline,instruction,2022,fgen-c8306b3784bac3ab1bc9006a,synthetic_programmatic_template,inline,top,False,preparer_checklist
"2026 Tax Organizer Checklist
Please bring the following documents:
☐ All Forms W-2 and 1099
☐ Form 1098 mortgageinterest statements
☐ Property tax bills and charitable receipts
☐ Last year's federal and state returns",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b54ee1897d93cdb43ac405b6,v11-TAX_INSTRUCTIONS-inline,instruction,2026,fgen-02a5587119b77333360fd3b3,synthetic_programmatic_template,inline,top,True,preparer_checklist
"Please bring the following documents:
☐All Forms W-2 and l099
☐ Form 1098 mortgage interest statements
☐ Property tax bills and charitable receipts
☐ Last year's federal and state returns",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-5e12575bb71e2065081a68bd,v11-TAX_INSTRUCTIONS-inline,instruction,2022,fgen-dbd87d1cd020c547b5da14ee,synthetic_programmatic_template,inline,none,True,preparer_checklist
"Understanding your Form W-2
This guide explains each box on the Form W-2 you receive.
Box 1 shows the amount reportcdto the IRS.
Boxes l5 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-f7045b65237a241d60893e41,v11-TAX_INSTRUCTIONS-columns,instruction,2025,fgen-aa2ddceae39dbde702187940,synthetic_programmatic_template,columns,top,True,employer_guide
"Understanding your Form 1099-B
This guide explains each box on the Form 1099-B you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b4409b8ff66d361beed6357f,v11-TAX_INSTRUCTIONS-columns,instruction,2024,fgen-d032d9355e0d1fbf6f5609ba,synthetic_programmatic_template,columns,top,False,employer_guide
"Instructions for Form 1099-B
(Rev. January 2024)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 1099-B, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-df05a1c2ca09d73bb459e3b4,v11-TAX_INSTRUCTIONS-columns,instruction,2024,fgen-9e92cbd2814b37171f4b2d59,synthetic_programmatic_template,columns,top,False,irs_instructions
"Understanding your Form 1099-R
This guide explains each box on the Form 1099-R you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-2845583103f82386d947e9df,v11-TAX_INSTRUCTIONS-columns,instruction,2026,fgen-82bd4d563f1b2a12a9e89261,synthetic_programmatic_template,columns,top,False,employer_guide
"Please bring the following documents:
☐ All Forms W-2 and 1099
☐ Form1098 mortgage interest statements
☐ Property tax bills and charitable receipts
☐ Last year's federal and statc returns
2025 Tax 0rganizer Checklist",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-03c70a1c11630f80fd411b84,v11-TAX_INSTRUCTIONS-columns,instruction,2025,fgen-4fe111abe753a742e29ad029,synthetic_programmatic_template,columns,bottom,True,preparer_checklist
"This guide explains each box on the Form W-2 you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-dc6ce519d5776dc8e9f58a76,v11-TAX_INSTRUCTIONS-columns,instruction,2021,fgen-c2ddeccbba6eeab007047ca0,synthetic_programmatic_template,columns,none,False,employer_guide
"Understanding your Form 1099-R
This guide explains each box on theForm 1099-R you receive.
Box 1 shows the amount rcported to the IRS.
Boxes 15 through 17 show state information.
This pagc is an exp1anation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-6e7f63b4ad675bd13e29050a,v11-TAX_INSTRUCTIONS-columns,instruction,2023,fgen-9635ee77b50695fe3e0cd9df,synthetic_programmatic_template,columns,top,True,employer_guide
"(Rev. January 2022)
Section references are to the Interna1 Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 8949, go to IRS.gov.
General Instructions
5pecific Instructions
Box 1. Enter the amount reported to you. Do not includcamounts reported on another form.
Paperwork Reductíon Act Notice. We ask for the informationon this form to carry out the Intemal Revenue laws.
Instructions for Form 8949",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-db67bab1c74bfe1fcdbcc309,v11-TAX_INSTRUCTIONS-columns,instruction,2022,fgen-3ce9327f2f9ce45c13b4f20f,synthetic_programmatic_template,columns,bottom,True,irs_instructions
"This guide explains each box on the Form W-2 you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.
Understanding your Form W-2",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-16e0b411f5d8081a73f7b0bd,v11-TAX_INSTRUCTIONS-columns,instruction,2026,fgen-4b39935fc02553e8d1137601,synthetic_programmatic_template,columns,bottom,False,employer_guide
"(Rev. January 2024)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 1099-R, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.
Instructions for Form 1099-R",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b0aa09933992c9cd4464e46b,v11-TAX_INSTRUCTIONS-columns,instruction,2024,fgen-3a015e34151ec11cb5c1a26d,synthetic_programmatic_template,columns,bottom,False,irs_instructions
"Understanding your Form 1099-R
This guidc explains each box on the Form 1099-R you receive.
Box 1 shows the amount reported to the IRS.
Boxes l5 through 17 show state information.
This page is an explanation only; your actualform is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-871a67f7158d703aa5dcf0d5,v11-TAX_INSTRUCTIONS-columns,instruction,2025,fgen-8e095f8ee819715388d58d31,synthetic_programmatic_template,columns,top,True,employer_guide
"Instructions for Form 1099-R
(Rev. January 2024)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 1099-R, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-dd63062d44cc260da0c0bf2c,v11-TAX_INSTRUCTIONS-csv,instruction,2024,fgen-f5551a075fe674fbdc5a4a7a,synthetic_programmatic_template,csv,top,False,irs_instructions
"(Rev. January 2025)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form Schedule C, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.
Instructions for Form Schedule C",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-5b056e50b3e681040686c7d2,v11-TAX_INSTRUCTIONS-csv,instruction,2025,fgen-14625c1de45a4e3bc4ff63d4,synthetic_programmatic_template,csv,bottom,False,irs_instructions
"Instructions for Form 1099-INT
(Rev. January 2024)
Section references are to the Internal Revenue Code unless otherwise noted.
What's New
Future developments. For the latest information about developments related to Form 1099-INT, go to IRS.gov.
General Instructions
Specific Instructions
Box 1. Enter the amount reported to you. Do not include amounts reported on another form.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-69d5a87996fc24ba5288d848,v11-TAX_INSTRUCTIONS-csv,instruction,2024,fgen-61c31113ec3edf8b70fee21e,synthetic_programmatic_template,csv,top,False,irs_instructions
"Understanding your Form W-2
This guide explainseach box on the Form W-2 you rcceive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-b69ff82fe913fdf7dfdd2dc1,v11-TAX_INSTRUCTIONS-csv,instruction,2021,fgen-0156dc36f24704f1244c3535,synthetic_programmatic_template,csv,top,True,employer_guide
"Understanding your Form 1098
This guidc explains each box on the Form l098 you receive.
Box 1 shows the amount reported to the IRS.
Boxes l5 through 17 show state information.
This page is an explanation only; youractual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-e2c81ec890f235e84a8d0a9a,v11-TAX_INSTRUCTIONS-csv,instruction,2023,fgen-82a36390f44c30a46edc7f8c,synthetic_programmatic_template,csv,top,True,employer_guide
"Understanding your Form Schedule C
This guide explains each box on the Form Schedule C you receive.
Box 1 shows the amount reported to the IRS.
Boxes 15 through 17 show state information.
This page is an explanation only;your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-6b60b373a70a8d8a9be60967,v11-TAX_INSTRUCTIONS-csv,instruction,2025,fgen-01181f670028403f43996f4f,synthetic_programmatic_template,csv,top,True,employer_guide
"(Rev. January 2024) Section references are to the Internal Revenue Code unless otherwise noted. What's New
Future developments. For the latest information about developments related to Form Schedule C, go to IRS.gov. General Instructions Specific
Instructions Box 1. Enter the amount reported to you. Do not include amounts reported on another form. Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-8b56f1ec42ec42abdb70bd24,v11-TAX_INSTRUCTIONS-flat,instruction,2024,fgen-0df51cefb763fae3abbcc644,synthetic_programmatic_template,flat,none,False,irs_instructions
"Please bring the following documents: ☐
All Forms W-2 and 1099 ☐ Form 1098
mortgage interest statements ☐ Property tax bills and charitable receipts ☐ Last year's federal and state returns",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-d7bd5f8a4f507c3197225a6d,v11-TAX_INSTRUCTIONS-flat,instruction,2023,fgen-dad38d12a5ecd3c4ffc787db,synthetic_programmatic_template,flat,none,False,preparer_checklist
"Instructions for Form
1099-B (Rev. January 2026) Sectíon references are to the Internal Revenue Codeunless otherwise noted. What's New Future developments. For the latest information about developments relatedto Form
1099-B, go to IR5.gov. General Instructíons Specific Instructions Box 1. Enter the amount reported to you. Do not indude amounts reported on another form. Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Intemal Revenue laws.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-c898bbc4d46af5811fb4dbb4,v11-TAX_INSTRUCTIONS-flat,instruction,2026,fgen-6b66ea2bc6ed9f8b99906b7d,synthetic_programmatic_template,flat,top,True,irs_instructions
"2025 Tax Organizer Checklist Please bring the following documents: ☐ All Forms W-2 and 1O99 ☐ Form 1O98 mortgage interest statements ☐ Property tax bills
andcharitablc receipts ☐ Last year's federal
and state returns",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-e85aa73c49aad43469a6ffb2,v11-TAX_INSTRUCTIONS-flat,instruction,2025,fgen-975c6e7b5603df561e42b74e,synthetic_programmatic_template,flat,top,True,preparer_checklist
"This guide explains each box on the Form 1040 you receive. Box 1 shows
the amount reported to the IRS. Boxes 15 through 17 show state information. This page
is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-e79115ffeadd6f11f742b8d4,v11-TAX_INSTRUCTIONS-flat,instruction,2025,fgen-6d4bfb23c87d23e4cbc447a6,synthetic_programmatic_template,flat,none,False,employer_guide
"This guide explains each box onthe Form 1099-B you receive. Box 1 shows the
amount reported to the IRS. Boxes 15 through 17 show state information. This
page is an explanation only; your actual form is attached separately.",TAX_INSTRUCTIONS,35,TAX_INSTRUCTIONS,fdc-13308473c31168a69ea260bb,v11-TAX_INSTRUCTIONS-flat,instruction,2022,fgen-63e28e6417754fa2af0bd7fc,synthetic_programmatic_template,flat,none,True,employer_guide
"Cedar Valley Electric Co-op
Your Electric Bill
Service address: 7957 Elm Park Pl Oak Grove, TX 93764
Billing period: 10/01/2024 - 10/30/2024
Previous reading 41,203 kWh  Current reading 42,018 kWh
Due date 10/19/2024
Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-084a70d7b5d63d290ed3514b,v11-UNKNOWN_DOCUMENT-kind00,unknown,2024,fgen-f4c64c7cf325c696d5aa05e9,synthetic_programmatic_template,stacked,top,False,utility_bill
"Cedar Valley Electric Co-op
Your Electric Bill
Service address: 6748 Cedar Ln Riverton, WI 39964
Billing period: 08/01/2026 - 08/31/2026
Total amount due $1,851.30
Due date October 23, 2026",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ebc570baa3d2eab6d97cba7b,v11-UNKNOWN_DOCUMENT-kind00,unknown,2026,fgen-4ef2e2f4a5195a645edb1362,synthetic_programmatic_template,inline,top,False,utility_bill
"Prairie Power & Light
Your Electric Bill
Service address: 6626 Cedar Ln Brookhaven, PA 11053
Billing period: 02/01/2024 - 02/28/2024
Previous reading 41,203 kWh  Current reading 42,018 kWh
Total amount due $2,233.07
Due date 2024-08-03
Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-5f2c84237ee3f890fa2ff18d,v11-UNKNOWN_DOCUMENT-kind00,unknown,2024,fgen-29b45c8a76ee6a0269bbb9ca,synthetic_programmatic_template,columns,top,False,utility_bill
"Prairie Power & Light
Your Electric Bill
Service address: 8O3 Prairie Ave Maplewood, MN 32890
Previous reading 41,203 kWh  Currentreading 42,018 kWh
Total amount due $141.16
Due date 2022-08-24
Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-3df95f1291e50dbc5b486cfb,v11-UNKNOWN_DOCUMENT-kind00,unknown,2022,fgen-380465ca5fd801010582b219,synthetic_programmatic_template,csv,top,True,utility_bill
"Prairie Power & Light Your Electric Bill Service address: 4112 Lakeshore
Blvd Cedar Falls,
IA 20446 Billing period: 08/01/2023 - 08/28/2023 Previous reading 41,203 kWh Current reading 42,018 kWh Totalamount due $447.92 Due date 2023-05-01 Pay onlinc, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-638369f379669f5226b3f2cc,v11-UNKNOWN_DOCUMENT-kind00,unknown,2023,fgen-f7996b16897ff217a300cc87,synthetic_programmatic_template,flat,top,True,utility_bill
"Prairie Power & Light
Your Electric Bill
## Service address: 5113 Willow Bend Way Maplewood, MN 23657
## Billing period: 01/01/2022 - 01/28/2022
Total amount due $436.61
Due date September 6, 2022
## Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-5ac4fafaf63c9ff660063774,v11-UNKNOWN_DOCUMENT-kind00,unknown,2022,fgen-89bd1f524c0e34fe58a9698b,synthetic_programmatic_template,markdown,top,False,utility_bill
"Prairie Power & Light
Your Electric Bill
Service address: 6431 Lakeshore Blvd Fairview, OH 73748
Billing period: 01/01/2025 - 01/28/2025
Previous reading 41,203 kWh  Current reading 42,018 kWh
Total amount due $1,696.14
Due date July 3, 2025",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f2086d50a88372157924bcca,v11-UNKNOWN_DOCUMENT-kind00,unknown,2025,fgen-b4cdb6813e051b07ff032c08,synthetic_programmatic_template,stacked,top,False,utility_bill
"Prairie Power & Light
Your Electric Bill
Service address: 1714 Sample Street Testville, IL 42689
Billing period: 01/01/2025 - 01/28/2025
Previous reading 41,203 kWh  Current reading 42,018 kWh
Total amount due $517.06
Due date 11/05/2025
Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b703cfd2355f8ed827a91245,v11-UNKNOWN_DOCUMENT-kind00,unknown,2025,fgen-829fe6265b07dfc20b935c09,synthetic_programmatic_template,inline,top,False,utility_bill
"Prairie Power & Light
Your Electric Bill
Service address: 8126 Maple Ridge Dr Maplewood, MN 11524
Billing period: 04/01/2023 - 04/30/2023
Previous reading 41,203 kWh  Current reading 42,018 kWh
Total amount due $2,637.12
Due date 2023-01-03
Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-eb6f99413ab02657bcc11493,v11-UNKNOWN_DOCUMENT-kind00,unknown,2023,fgen-34aec5b79c046f740028d9ec,synthetic_programmatic_template,columns,top,False,utility_bill
"Service address: 1468 Cedar Ln Fairview, OH 39588
Billing period: 10/01/2026 - 10/31/2026
Total amount due $196.24
Due date 3/24/26
Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-224b9b194c1be1b9471acc24,v11-UNKNOWN_DOCUMENT-kind00,unknown,2026,fgen-323f29185901ef2fd28f7050,synthetic_programmatic_template,csv,none,False,utility_bill
"Harbor City Utilities Your Electric Bill Service address: 3556 Sample Street Bayside, WA 32173 Billing period: 08/01/2021
-
08/30/2021 Due date 6/25/21 Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1575c887b2d29c82d3504906,v11-UNKNOWN_DOCUMENT-kind00,unknown,2021,fgen-3b672c9625b44ed5794cc935,synthetic_programmatic_template,flat,top,False,utility_bill
"Prairie Power & Light
Your Electric Bill
Service address: 6795 Prairie Ave Oak Grove, TX 54015
Billing period: 02/01/2025 - 02/28/2025
Previous reading 41,203 kWh  Current reading 42,018 kWh
## Total amount due $1,409.70
## Due date 10/21/2025
Pay online, by phone, or by mail. Late payments may incur a fee.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-57a5e1a8416c12e3c7675fb4,v11-UNKNOWN_DOCUMENT-kind00,unknown,2025,fgen-c9b319671bdef5c6b61034cd,synthetic_programmatic_template,markdown,top,False,utility_bill
"Summit Mobile
Wireless Statement
Account number 497900547
Bill period 01/01/2023 - 01/30/2023
Plan: Unlimited Talk & Text
Device installment 12 of 24
Taxes, surcharges & fees $65.66
Total due $487.09",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-aef8c1cdae8762c23c76fd3c,v11-UNKNOWN_DOCUMENT-kind01,unknown,2023,fgen-32edd177aa8981826647a68f,synthetic_programmatic_template,inline,top,False,phone_bill
"Account number 255382611
Bill period 08/01/2022 - 08/31/2022
Plan: Unlimited Talk & Text
Device installment 12 of 24
Taxes, surcharges & fees $266.67
Total due $1,991.21
Bluewater Telecom
Wireless Statement",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-59851de4cfd586a086e745b7,v11-UNKNOWN_DOCUMENT-kind01,unknown,2022,fgen-d8a1f7f238930b85604b9c99,synthetic_programmatic_template,columns,bottom,False,phone_bill
"Summit Mobile
Wireless Statement
Account number 701951961
Plan: Unlimited Talk & Text
Device installment 12 of 24
Taxes, surcharges & fees $249.46
Total due $1,368.17",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-942ffc5cf2e35b3c8dea053d,v11-UNKNOWN_DOCUMENT-kind01,unknown,2025,fgen-9a363129481297eb610fb96e,synthetic_programmatic_template,csv,top,False,phone_bill
"Account number 399912462 Bill period 07/01/2024 - 07/30/2024 Plan: Unlimited Talk
& Text Device installment
12 of 24 Taxes, surcharges & fees $5.13 Total due $43.84 Summit Mobile Wireless Statement",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-385579f7595e6f29ebe784c5,v11-UNKNOWN_DOCUMENT-kind01,unknown,2024,fgen-d14eea955ce9033249821570,synthetic_programmatic_template,flat,bottom,False,phone_bill
"Summit Mobile
Wireless Statement
Account number 520447002
Bill period 12/01/2022 - 12/31/2022
Plan: Unlimited Talk & Text
Device installment 12 of 24
## Total due $2,837.78",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ceda6d4862ee3331d4549b2a,v11-UNKNOWN_DOCUMENT-kind01,unknown,2022,fgen-83601cb8a2d1f4a7a3ad86e4,synthetic_programmatic_template,markdown,top,False,phone_bill
"Bluewater Telecom
Wireless Statement
Account number 769053567
Bill period 02/01/2025 - 02/28/2025
Plan: Unlimited Talk & Text",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-9e3a48ceb8ab13360725dbcd,v11-UNKNOWN_DOCUMENT-kind01,unknown,2025,fgen-33e58f0b63d8fc7780783168,synthetic_programmatic_template,stacked,top,False,phone_bill
"Account number 404239271
Bill period 01/01/2023 - 01/30/2023
Plan: Unlimited Talk & Text
Device installment 12 of 24
Taxes, surcharges & fees $64.55
Total due $359.62",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-9b231df5aad5f03fbaa29c93,v11-UNKNOWN_DOCUMENT-kind01,unknown,2023,fgen-09f017b2730ffe74bb7912c4,synthetic_programmatic_template,inline,none,False,phone_bill
"Bluewater Telecom
Wireless Statement
Account number 177558530
Bill period 08/01/2024 - 08/30/2024
Plan: Unlimited Talk & Text
Device installment 12 of 24
Taxes, surcharges & fees $147.32
Total due $1,254.61",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-53b699ff7a5546cc3e07f18f,v11-UNKNOWN_DOCUMENT-kind01,unknown,2024,fgen-19f12327e4eaa0d22923539f,synthetic_programmatic_template,columns,top,False,phone_bill
"Northwind Wireless
Wireless Statement
Account number 160645992
Bill period 04/01/2023 - 04/30/2023
Plan: Unlimited Talk & Text
Device installment 12 of 24
Taxes, surcharges & fees $137.84
Total due $2,658.70",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-3242dca7b32f73c64f524774,v11-UNKNOWN_DOCUMENT-kind01,unknown,2023,fgen-1b1b880215dbb5f5910b5231,synthetic_programmatic_template,csv,top,False,phone_bill
"Summit Mobile Wireless Statement Plan: Unlimited Talk & Text
Device installment
12 of 24 Taxes, surcharges & fees $263.50",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0301a1520ed2c3d7c5307ab9,v11-UNKNOWN_DOCUMENT-kind01,unknown,2025,fgen-e27bfa3632286d07d46814d4,synthetic_programmatic_template,flat,top,False,phone_bill
"Summit Mobile
Wireless Statement
## Account number 203870094
Plan: Unlimited Talk & Text
## Device installment 12 of 24
Taxes, surcharges & fees $115.27
## Total due $724.63",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c15b98fe89663f462a9d503e,v11-UNKNOWN_DOCUMENT-kind01,unknown,2025,fgen-fb77d1b375ab5a916b5418ba,synthetic_programmatic_template,markdown,top,False,phone_bill
"Northwind Wireless
Wireless Statement
Account number 842624607
Plan: Unlimited Talk & Text
Device installment 12 of 24
Taxes, surcharges & fees $189.48
Total due $2,749.35",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0a409c4b69647d3255a348dd,v11-UNKNOWN_DOCUMENT-kind01,unknown,2021,fgen-e649804158b953aaacfad740,synthetic_programmatic_template,stacked,top,False,phone_bill
"RESIDENTIAL LEASE AGREEMENT
This Lease is entered into on 06/21/2021 between Avery Patel (""Tenant"") and Riverbend Commons (""Landlord"").
Premises: 3861 Sample Street Bayside, WA 29070
Monthly rent: $327.58 due on the 1st of each month
Security deposit: $2,248.72
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b50b7324aee4a79f9893d33c,v11-UNKNOWN_DOCUMENT-kind02,unknown,2021,fgen-ef6063fcff11b3f6e6f1606a,synthetic_programmatic_template,columns,top,False,lease
"This Lease is entered into on February 25, 2024 between Noah J. Fischer (""Tenant"") and Oak Hollow Property Mgmt (""Landlord"").
Premises: 4099 Oak Hollow Ct Oak Grove, TX 46731
Term: 12 months beginning 01/27/2024
Security deposit: $1,564.04
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0b3cefbba46efb303d73e56b,v11-UNKNOWN_DOCUMENT-kind02,unknown,2024,fgen-05e26f35d3f423e1aeb2b70a,synthetic_programmatic_template,csv,none,False,lease
"This Lease is entered into on 11/08/2022 between Fatima D. Rivera
(""Tenant"") and Riverbend Commons (""Landlord""). Premises: 5892 Elm Park Pl Fairview, OH 70430 Term: 12 months beginning 12/14/2022 Monthly rent: $2,261.88 due on the 1st of each month Tenant shall not sublet the Premises without written
consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-8f66f1944715807f2ca41aa5,v11-UNKNOWN_DOCUMENT-kind02,unknown,2022,fgen-dbf2f7de2346107e2570d084,synthetic_programmatic_template,flat,none,False,lease
"This Lease is entered into on 01/20/2025 between Fatima B. Adeyemi (""Tenant"") and Oak Hollow Property Mgmt (""Landlord"").
Premises: 3820 Cedar Ln Oak Grove, TX 53761
## Term: 12 months beginning 03/07/2025
Monthly rent: $177.66 due on the 1st of each month
## Security deposit: $744.30
Tenant shall not sublet the Premises without written consent.
RESIDENTIAL LEASE AGREEMENT",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f81a4a12aa18f31e943f273b,v11-UNKNOWN_DOCUMENT-kind02,unknown,2025,fgen-1e3ca2bc0afb952382b9c061,synthetic_programmatic_template,markdown,bottom,False,lease
"RESIDENTIAL LEASE AGREEMENT
This Lease is entered into on 2022-10-25 between Mateo E. Romero (""Tenant"") and Oak Hollow Property Mgmt (""Landlord"").
Premises: 4992 Prairie Ave Bayside, WA 14168
Term: 12 months beginning 11/25/22
Monthly rent: $789.59 due on the 1st of each month
Security deposit: $1,257.52
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7ff7108942ff88637b23513a,v11-UNKNOWN_DOCUMENT-kind02,unknown,2022,fgen-e3b978d87f2701553b1e1147,synthetic_programmatic_template,stacked,top,False,lease
"This Lease is entered into on 10/22/25 bctween Kwame Castillo (""Tcnant"") and Granite Ridge (""Landlord"").
Premises: 23125ample Street Oak Grove, TX 30841
Term: 12 months beginning 8/25/25
Month1y rent: $1,481.96 due on the lst of each month
Security deposit: $2,573.17
Tenant shall not sublet the Premises without written consent.
RESIDENTIAL LEASE AGREEMENT",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d0e10ec8e4a5d124ad0f91d8,v11-UNKNOWN_DOCUMENT-kind02,unknown,2025,fgen-6537d8ff32a8aa282b436cdb,synthetic_programmatic_template,inline,bottom,True,lease
"RESIDENTIAL LEASE AGREEMENT
This Lease is entered into on 1/24/21 between Morgan Patel (""Tenant"") and Oak Hollow Property Mgmt (""Landlord"").
Premises: 3112 Prairie Ave Cedar Fa1ls, IA 83172
Term:12months beginning January 10, 2021
Month1y rent: S90.75 due on the 1st of each month
Security deposit: $1,895.31
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-996629add1e97f3bd1427ee4,v11-UNKNOWN_DOCUMENT-kind02,unknown,2021,fgen-4c6b3a691befb4172e191554,synthetic_programmatic_template,columns,top,True,lease
"RESIDENTIAL LEASE AGREEMENT
This Lease is entered into on 2/3/22 between Mateo Castillo (""Tenant"") and Riverbend Commons (""Landlord"").
Term: 12 months beginning November 13, 2022
Monthly rent: $1,265.68 due on the 1st of each month
Security deposit: $2,125.93
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2617a187caf9c9fbe1ed24d2,v11-UNKNOWN_DOCUMENT-kind02,unknown,2022,fgen-2264c3792514459422eb6f46,synthetic_programmatic_template,csv,top,False,lease
"RESIDENTIAL
LEASE AGREEMENT This Lease is entered into on 12/23/21 between Sofia Walsh (""Tenant"") and Oak Hollow Property Mgmt (""Landlord""). Premises: 4852 Sample Street Fairview, OH 65487 Term: 12 months
beginning 02/28/2021 Monthly rent: $2,836.82 due on the 1st of each month Security deposit: $232.39 Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b65b9c7bfc75f7bfa8c7d823,v11-UNKNOWN_DOCUMENT-kind02,unknown,2021,fgen-28f5ba63f4a34336d424fafa,synthetic_programmatic_template,flat,top,False,lease
"RESIDENTIAL LEASE AGREEMENT
This Lease is entered into on 2026-02-21 between Priya Castillo (""Tenant"") and Riverbend Commons (""Landlord"").
Premises: 6297 Sample Street Lakewood, CO 53715
Term: 12 months beginning 03/20/2026
Security deposit: $916.21
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7731ba1ec59db1af6fb02364,v11-UNKNOWN_DOCUMENT-kind02,unknown,2026,fgen-391adec65ee0c9410e394fa8,synthetic_programmatic_template,markdown,top,False,lease
"RESIDENTIAL LEASE AGREEMENT
This Lease is entered into on 2025-07-10 between Lena M. Rivera (""Tenant"") and Granite Ridge (""Landlord"").
Premises: 6768 Granite St Fairview, OH 81237
Term: 12 months beginning 4/13/25
Monthly rent: $1,816.72 due on the 1st of each month
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b8bdba934e6519a3ae77c35f,v11-UNKNOWN_DOCUMENT-kind02,unknown,2025,fgen-87592e07eccd483c1a4ae92a,synthetic_programmatic_template,stacked,top,False,lease
"RESIDENTIAL LEASE AGREEMENT
This Lease is entered into on December 9, 2022 between Hiro R. Rivera (""Tenant"") and Granite Ridge (""Landlord"").
Term: 12 months beginning 7/16/22
Monthly rent: $1,609.42 due on the 1st of each month
Security deposit: $1,341.99
Tenant shall not sublet the Premises without written consent.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-28a6c2d35daeb97208479ec3,v11-UNKNOWN_DOCUMENT-kind02,unknown,2022,fgen-9a1ff2157d863fb8c0c65db5,synthetic_programmatic_template,inline,top,False,lease
"Plate number CUGTWJ
VIN JVP9F00JLKX7JXF9B
Year/Make/Model 2023 Toyota Corolla
Registration fee $56.82
Expires 5/23/26
Proof of insurance is required.
DEPARTMENT OF MOTOR VEHICLES
Vehicle Registration Renewal Notice",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f49b7b2e593aa331eb8219d2,v11-UNKNOWN_DOCUMENT-kind03,unknown,2026,fgen-e608c0f6103b8cd3c3a07535,synthetic_programmatic_template,csv,bottom,False,vehicle_registration
"DEPARTMENT OF MOTOR VEHICLES Vehicle Registration Renewal Notice P1ate number 2U3DV2 VIN 4AZ56K296ZKPTBNN9 Year/Make/Model 2019 Honda
Civic Registration fee
$187.87 Expires December 18, 2022 Proof ofinsurance is required.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-3651e5f7d1d21953489b6103,v11-UNKNOWN_DOCUMENT-kind03,unknown,2022,fgen-b549b733ba75f43c83e48c59,synthetic_programmatic_template,flat,top,True,vehicle_registration
"DEPARTMENT OF MOTOR VEHICLES
Vehicle Registration Renewal Notice
Plate number AMDEDP
VIN EBM7C1TLFNBY0WBDV
Year/Make/Model 2021 Subaru Outback
Registration fee $165.07
## Expires 12/23/2024
## Proof of insurance is required.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1b7d58dc57089a882584d6b9,v11-UNKNOWN_DOCUMENT-kind03,unknown,2024,fgen-85e5ef8f7003471459067edb,synthetic_programmatic_template,markdown,top,False,vehicle_registration
"Plate number JVL0RJ
VIN FA1EK0TN3N39E8YRD
Year/Make/Model 2023 Toyota Corolla
Registration fee $78.56
Proof of insurance is required.
DEPARTMENT OF MOTOR VEHICLES
Vehicle Registration Renewal Notice",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7435d2084395233c5300027d,v11-UNKNOWN_DOCUMENT-kind03,unknown,2026,fgen-acbd027fabfa54ea260dbc4e,synthetic_programmatic_template,stacked,bottom,False,vehicle_registration
"DEPARTMENT OF MOTOR VEHICLES
Vehicle Registration Renewal Notice
Plate number 7VFEVN
VIN P8LHV3A122U1WPEZF
Year/Make/Mode1 2O20 Honda Civic
Rcgistration fee S195.41
Expires April 4, 2023
Proof of insurance isrequired.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c8a271aeba3cc43a7129e1d7,v11-UNKNOWN_DOCUMENT-kind03,unknown,2023,fgen-345436cf31806b61160047b1,synthetic_programmatic_template,inline,top,True,vehicle_registration
"VIN 8CANEYTYCCY9A6KMT
Year/Make/Model 2021 Toyota Corolla
Expires 2024-03-13
Proof of insurance isrequired.
DEPARTMENT 0F MOTOR VEHICLES
Vehicle Registration Renewal Notice",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-08504d1513e0e2fbfc4c401c,v11-UNKNOWN_DOCUMENT-kind03,unknown,2024,fgen-078f9c5184e19a215124f94d,synthetic_programmatic_template,columns,bottom,True,vehicle_registration
"Plate number AKTYVM
VIN NN9K4A4NUJNA3XBDM
Year/Make/Model 2021 Ford F-150
Registration fee $294.56
Expires 2024-09-21",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-fe94d579c8ede7af71c1a935,v11-UNKNOWN_DOCUMENT-kind03,unknown,2024,fgen-503018bbc975bcd1998282fc,synthetic_programmatic_template,csv,none,False,vehicle_registration
"Plate number LCCD6G VIN LR252XK1PK82C5GTB Year/Make/Model 2022 Subaru Outback Registration fee $84.58
Expires 2025-12-04 Proof of insurance is
required.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-64ec51dca440e650decf8563,v11-UNKNOWN_DOCUMENT-kind03,unknown,2025,fgen-11c4f4eb517bb363861aff3b,synthetic_programmatic_template,flat,none,False,vehicle_registration
"Plate numberEFNVVW
## VIN TGBGZKPVCHP7G76X1
Rcgistration fee S79.21
Expires 2021-08-09
Proof of insurance is requíred.
DEPARTMENT 0F MOTOR VEHICLES
Vehicle Registration Renewal Notice",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-31532d87c721f6e037bd661b,v11-UNKNOWN_DOCUMENT-kind03,unknown,2021,fgen-1c07c406856dd50152ae6637,synthetic_programmatic_template,markdown,bottom,True,vehicle_registration
"DEPARTMENT OF MOTOR VEHICLES
Vehicle Registration Renewal Notice
Plate number 7UHVJP
VIN 26L6P7FHL2D1B50G8
Year/Make/Model 2020 Toyota Corolla
Registration fee $77.47
Expires 2023-10-18
Proof of insurance is required.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4cd1f05baae459ba6ae1065c,v11-UNKNOWN_DOCUMENT-kind03,unknown,2023,fgen-307f846a50518d58a5055eaf,synthetic_programmatic_template,stacked,top,False,vehicle_registration
"DEPARTMENT OF MOTOR VEHICLES
Vehide Registration Renewal Notice
Platenumber FKMB9R
VIN 1NDJ0F3Y6M8Z80LDL
Year/Make/Model 2023 Ford F-l50
Registration fee $17.24
Expires 2026-01-19",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-5b3226d5fcce31bde30427e8,v11-UNKNOWN_DOCUMENT-kind03,unknown,2026,fgen-5ad3c493adc516b43b5c01d1,synthetic_programmatic_template,inline,top,True,vehicle_registration
"DEPARTMENT OF MOTOR VEHICLES
Vehicle Registration Renewal Notice
Plate number VLZMB2
Year/Make/Model 2019 Subaru Outback
Registration fee $111.52
Expires 8/19/22
Proof of insurance is required.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d5822a1181d1c3c9c6efe7f5,v11-UNKNOWN_DOCUMENT-kind03,unknown,2022,fgen-f6575ced41fcf82c960c885a,synthetic_programmatic_template,columns,top,False,vehicle_registration
"Dear Avery Larsen,
We are p1eased to offer you the position of Operations Analyst.
Your starting annual salary will be S1,152.10, paid biweekly.
Your start dateis 2026-02-01.
This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e1f6d3e14ef8b0c55dbeee8e,v11-UNKNOWN_DOCUMENT-kind06,unknown,2026,fgen-3849bef56d17e6555c407a59,synthetic_programmatic_template,stacked,none,True,offer_letter
"Blue Heron Logistics LLC
Dear Noah Fischer,
We are pleased to offer you the position of Operations Analyst.
Your starting annual salary will be $563.64, paid biweekly.
Your start date is 2O21-O5-08.
Thisoffer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7f2d78a58fd0121c47be6278,v11-UNKNOWN_DOCUMENT-kind06,unknown,2021,fgen-25402adfcab7dc3b165b1812,synthetic_programmatic_template,inline,top,True,offer_letter
"Dear Avery Brennan,
We are pleased to offer you the position of Operations Analyst.
Your starting annual salary will be $2,733.43, paid biweekly.
Your start date is November 13, 2024.
This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-04d6cc6414e9b51954353091,v11-UNKNOWN_DOCUMENT-kind06,unknown,2024,fgen-a42cfd0e56ddcab525fbf3cc,synthetic_programmatic_template,columns,none,False,offer_letter
"Dear Casey Okafor,
We are pleased to offer you the position of Operations Analyst.
Your start date is 01/07/2021.
This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-8da93d32aaf2182d02c058c2,v11-UNKNOWN_DOCUMENT-kind06,unknown,2021,fgen-5a86ec85d19a3dda5758dd49,synthetic_programmatic_template,csv,none,False,offer_letter
"Riverside Regional Hospital Dear
Avery Walsh, We are pleased
to offer you the position of Operations Analyst. Your starting annual salary will be $122.43, paid biweekly. Your start date is 4/27/22. This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ac765c3f120518a4f82d8105,v11-UNKNOWN_DOCUMENT-kind06,unknown,2022,fgen-f2df9e7fa96c8ae7f8a6ceaa,synthetic_programmatic_template,flat,top,False,offer_letter
"Maple Street Dental PC
Dear Kwame Nguyen,
We are pleased to offer you the position of Operations Analyst.
Your starting annual salary will be $2,091.49, paid biweekly.
Your start date is 10/20/21.
## This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-5efc4c7b4bbc015ce7d9d871,v11-UNKNOWN_DOCUMENT-kind06,unknown,2021,fgen-bf9ebef2b1914bbda824c950,synthetic_programmatic_template,markdown,top,False,offer_letter
"Copperline Software Inc.
Dear Taylor D. Haddad,
We are pleased to offer you the position of Operations Analyst.
Your starting annual salary will be $862.61, paid biweekly.
Your start date is February 6, 2025.
This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-fbc6c33c039d77d3be232e61,v11-UNKNOWN_DOCUMENT-kind06,unknown,2025,fgen-a21cd8adfe0cf39bd831f96a,synthetic_programmatic_template,stacked,top,False,offer_letter
"Maple Street Dental PC
Dear Mateo Brennan,
We are pleased to offer youthe position of Operations Analyst.
Your starting annual salary will be $2,748.49, paid biweek1y.
This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-de2e136449e525ba654b9f1c,v11-UNKNOWN_DOCUMENT-kind06,unknown,2026,fgen-7dd314a41956685e4d7e36da,synthetic_programmatic_template,inline,top,True,offer_letter
"Riverside Regional Hospital
Dear Lena Romero,
We are pleased to offer you the position of Operations Analyst.
Your starting annual salary will be $381.29, paid biweekly.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-172d8797033a79d3c38310ce,v11-UNKNOWN_DOCUMENT-kind06,unknown,2023,fgen-79c7cfeae866d02a415e3404,synthetic_programmatic_template,columns,top,False,offer_letter
"Granite Peak ManufacturingCo.
Dear Jordan Adeyemi,
Your starting annual salary will be $1,319.81, paid biweekly.
Your start date is 04/06/2025.
This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-8fbb69eeef235111e30e9c1a,v11-UNKNOWN_DOCUMENT-kind06,unknown,2025,fgen-f7b4555966a9661d894c12ea,synthetic_programmatic_template,csv,top,True,offer_letter
"Copperline Software Inc. Dear Mateo B. Okafor, We are pleased to offer you the position of
Operations Analyst. Your starting annual
salary will be $1,969.80, paid biweekly. Your start date is 1/3/23. This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-233213adeb55232f6259e48d,v11-UNKNOWN_DOCUMENT-kind06,unknown,2023,fgen-5857c7a0a67ae0e5ad0eb861,synthetic_programmatic_template,flat,top,False,offer_letter
"## Tri-County School District
## Dear Mateo Lindqvist,
## We are pleased to offer you the position of Operations Analyst.
Your starting annual salary will be $1,768.39, paid biweekly.
Your start date is November 3, 2021.
This offer is contingent on a background check.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ec16d65239c3d5ac75c1751f,v11-UNKNOWN_DOCUMENT-kind06,unknown,2021,fgen-c9b874b7196db7749608f7f5,synthetic_programmatic_template,markdown,top,False,offer_letter
"Passenger: Mateo Okafor
Flight 482 departs October 25, 2021 7:45 AM
Seat 14C  Economy
Total fare $148.59",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0e26c8900148409685652a8f,v11-UNKNOWN_DOCUMENT-kind07,unknown,2021,fgen-b3f36ee017fbe35569f694ea,synthetic_programmatic_template,inline,none,False,travel_itinerary
"Passenger: Sofia Patel
Flight 482 departs August 10, 2025 7:45 AM
Seat 14C  Economy
Total fare $1,539.67
Trip Confirmation
Booking reference BKT1PN",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f0740201b694ad1795521155,v11-UNKNOWN_DOCUMENT-kind07,unknown,2025,fgen-56a864b6048efcf56964beee,synthetic_programmatic_template,columns,bottom,False,travel_itinerary
"Trip Confirmation
Booking reference T1M9D4
Flight 482 departs 6/28/23 7:45 AM
5eat 14C  Economy
Totalfare $769.11",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-906c588aa7c2dac8f420b752,v11-UNKNOWN_DOCUMENT-kind07,unknown,2023,fgen-2c86b1ef69b18e225d0357a5,synthetic_programmatic_template,csv,top,True,travel_itinerary
"Passenger: Jordan Fischer Flight 482 departs 2022-06-16 7:45 AM Seat 14C
Economy Total fare $2,927.51 Baggage allowance:
1 personal item Trip Confirmation Booking reference M6R8T3",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-34525ca86fb92a038f29bb5f,v11-UNKNOWN_DOCUMENT-kind07,unknown,2022,fgen-a62ef7550179a6edc7c46db4,synthetic_programmatic_template,flat,bottom,False,travel_itinerary
"## Flight 482 departs 2/18/21 7:45 AM
Seat 14C  Economy
Total fare $644.87
Baggage allowance: 1 personal item",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c03e220197e27a27c8e99ff0,v11-UNKNOWN_DOCUMENT-kind07,unknown,2021,fgen-cc2d110f153e981db4ad4d5e,synthetic_programmatic_template,markdown,none,False,travel_itinerary
"Trip Confirmation
Booking reference 9FLEZ8
Passenger: Priya Okafor
Flight 482 departs 12/16/25 7:45 AM
Seat 14C  Economy
Total fare $642.64
Baggage allowance: 1 personal item",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-9403c6f689ca168ba3953c6f,v11-UNKNOWN_DOCUMENT-kind07,unknown,2025,fgen-5acfc0ebae34ac7f2dc18517,synthetic_programmatic_template,stacked,top,False,travel_itinerary
"Trip Confirmation
Booking reference 6MLSF4
Passenger: Kwame Moreau
Flight 482 departs 03/15/2022 7:45 AM
Seat 14C  Economy
Total fare $2,551.12
Baggage allowance: 1 personal item",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4eca566eefb582cc9ec27dde,v11-UNKNOWN_DOCUMENT-kind07,unknown,2022,fgen-6a9e34f2636a05ac7407675c,synthetic_programmatic_template,inline,top,False,travel_itinerary
"Trip Confirmation
Booking reference T64UCJ
Passenger: Sofia Haddad
Flight 482 departs 09/27/2025 7:45 AM
Baggage allowance: 1personal ítem",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-bf38c89a7685b7369084f43e,v11-UNKNOWN_DOCUMENT-kind07,unknown,2025,fgen-bffaae0811d56c64eed446c6,synthetic_programmatic_template,columns,top,True,travel_itinerary
"Trip Confirmation
Booking reference 507FDR
Passenger: Jordan Larsen
Flight 482 departs 05/18/2023 7:45 AM
Seat 14C  Economy
Total fare $1,269.40
Baggage allowance: 1 personal item",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1a38fd241427a0f27953070d,v11-UNKNOWN_DOCUMENT-kind07,unknown,2023,fgen-2a79a9f14f675c9d0360ed7b,synthetic_programmatic_template,csv,top,False,travel_itinerary
"Trip Confirmation Booking reference
GZX6M0 Passenger: Diego L. Romero Total fare $51.89 Baggage allowance: 1
personal item",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c51dacad7c3491e44934e290,v11-UNKNOWN_DOCUMENT-kind07,unknown,2026,fgen-2a094b695ff9e994639bffa2,synthetic_programmatic_template,flat,top,False,travel_itinerary
"Passcnger: Avery E. Romero
Flight482 departs February 19, 2023 7:45 AM
Seat 14C  Economy
## Total fare S77.56
## Baggage allowance: 1 personal item",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d29e53c444ca5b64e289b104,v11-UNKNOWN_DOCUMENT-kind07,unknown,2023,fgen-ff050d676e132f36019581a0,synthetic_programmatic_template,markdown,none,True,travel_itinerary
"Trip Confirmation
Booking reference C15F4P
Passcnger: Olivia Tanaka
Flight 482 departs August 19, 2022 7:45AM
Seat 14C  Economy
Total fare $2,199.20",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d8f1a2b41876544ca004a5c1,v11-UNKNOWN_DOCUMENT-kind07,unknown,2022,fgen-f44d2d4a3cfddad0bd260358,synthetic_programmatic_template,stacked,top,True,travel_itinerary
"Your Credit Report
Report date: November 22, 2024
Accounts in good standing: 7
Revolving utilization: 18%
This report is not a tax document.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4a1e9cfff84253b61bf83300,v11-UNKNOWN_DOCUMENT-kind08,unknown,2024,fgen-f6813935befeea001a450624,synthetic_programmatic_template,columns,top,False,credit_report
"Report date: April 8, 2022
Accounts in good standing: 7
Hard inquiries in the last 24 months: 2
Revolving utilization: 18%
This report is not a tax document.
Your Credit Report",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1b5b7594d495a9baf77304bb,v11-UNKNOWN_DOCUMENT-kind08,unknown,2022,fgen-b1c3447678d3ab09489f3e72,synthetic_programmatic_template,csv,bottom,False,credit_report
"Your Credit Report Report date: 01/26/2022 Accounts in good
standing: 7 Revolving utilization: 18% This report is
not a tax document.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-75f82637979cb6039d6ad7ff,v11-UNKNOWN_DOCUMENT-kind08,unknown,2022,fgen-c8862d56e54da1660dc61101,synthetic_programmatic_template,flat,top,False,credit_report
"## Your Credit Report
Report date: 09/15/2022
Accounts in good standing: 7
Hard inquiries in the last 24 months: 2
## Revolving utilization: 18%
This report is not a tax document.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-93c34eeb54640bf4e5d94d60,v11-UNKNOWN_DOCUMENT-kind08,unknown,2022,fgen-58324b47ddc1e2fb23287a79,synthetic_programmatic_template,markdown,top,False,credit_report
"Report date: 2024-08-24
Accounts in good standing: 7
Hard inquiries in the last 24 months: 2
Revolving utilization: 18%
This report is not a tax document.
Your Credit Report",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7dc3fd07f1de604d794bb170,v11-UNKNOWN_DOCUMENT-kind08,unknown,2024,fgen-07d9af32f5fc4b36f829470b,synthetic_programmatic_template,stacked,bottom,False,credit_report
"Report date: 3/28/26
Accounts in good standing: 7
Hard inquiries in the last 24 months: 2
Revolving utilization: 18%
This report is not a tax document.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c71c36e6225abfedcaa3099e,v11-UNKNOWN_DOCUMENT-kind08,unknown,2026,fgen-8f7efcf3cd0fddfb10659eb3,synthetic_programmatic_template,inline,none,False,credit_report
"Report date: 06/09/2023
Accounts ingood standing: 7
Hard inquiries in the last 24 months: 2
Revolving utilization: 18%
This report is not a tax document.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4549e49828bedfd06a4ed5b3,v11-UNKNOWN_DOCUMENT-kind08,unknown,2023,fgen-e211203ee29d0f06e0eb20b0,synthetic_programmatic_template,columns,none,True,credit_report
"Your Credit Report
Report date: 10/23/22
Accounts in good standing: 7
Hard inquiries in the last 24 months: 2
Revolving utilization: 18%
This report is not a tax document.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-de4ea8002395fdf326a43ced,v11-UNKNOWN_DOCUMENT-kind08,unknown,2022,fgen-ea41c777671d2cb836ce27f7,synthetic_programmatic_template,csv,top,False,credit_report
"Your Credit Report Report date: 2023-12-21 Accounts in
good standing: 7 Hard inquiries in the last 24 months: 2 Revolving utilization:
18%",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d1b520482f0254139351f025,v11-UNKNOWN_DOCUMENT-kind08,unknown,2023,fgen-be494e5bdea62c6617978b15,synthetic_programmatic_template,flat,top,False,credit_report
"## Your Credit Report
Accounts in good standing: 7
Hard inquiries in the last 24 months: 2
Revolving utilization: 18%",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-61888bf429dd6b2cdec4e470,v11-UNKNOWN_DOCUMENT-kind08,unknown,2025,fgen-dc0f294db20e9437d7a6bcff,synthetic_programmatic_template,markdown,top,False,credit_report
"Your Credit Report
Report date: October 10, 2022
Accounts in good standíng: 7
Hard inquiries in the last 24 months: 2
This report is nota tax document.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-30b6767ef385d41e9103854c,v11-UNKNOWN_DOCUMENT-kind08,unknown,2022,fgen-154db80508d73309e50c8d85,synthetic_programmatic_template,stacked,top,True,credit_report
"Your Credít Report
Report date: April 9, 2026
Hard inquiries inthe last 24 months: 2
Revolving utilization: 18%
This report is not a tax documcnt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ba83e9ecd1334c7b48f64314,v11-UNKNOWN_DOCUMENT-kind08,unknown,2026,fgen-c4ebfd13efa8fdae559e0d35,synthetic_programmatic_template,inline,top,True,credit_report
"Earn a $300 bonus when you open a new checking account!
Offer ends 2022-09-17.
Minimum opening deposit $41.55.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0c7928a9e776885f4c4d2956,v11-UNKNOWN_DOCUMENT-kind09,unknown,2022,fgen-91cd6223bb8667356f810215,synthetic_programmatic_template,csv,none,False,bank_marketing
"Earn a $300
bonus when you open a new checking account! Minimum opening deposit $279.71. Member FDIC.
Equa1Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-dd33053104b0369746893442,v11-UNKNOWN_DOCUMENT-kind09,unknown,2026,fgen-bcaa1936171c75022e8e5c82,synthetic_programmatic_template,flat,none,True,bank_marketing
"## Bayview Community Bank
Offer ends 2026-06-03.
Minimum opening deposit $243.38.
Member FDIC. Equal Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1112d40ee2afaf7f7a513c1d,v11-UNKNOWN_DOCUMENT-kind09,unknown,2026,fgen-b77586e9c813b6d0f58fd4d5,synthetic_programmatic_template,markdown,top,False,bank_marketing
"Granite Peak Bank
Earn a $300 bonus when you open a new checking account!
Minimum opening deposit $8.24.
Member FDIC. Equal Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-845391c243f6aae45f859d7b,v11-UNKNOWN_DOCUMENT-kind09,unknown,2022,fgen-55d404dd0a8400eca17d95ec,synthetic_programmatic_template,stacked,top,False,bank_marketing
"Earn a $3O0 bonus whenyou open a new checking account!
Minimum opening deposit $76.95.
Member FDIC. Equa1 Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e73dcb9c3c02370d5dd33542,v11-UNKNOWN_DOCUMENT-kind09,unknown,2021,fgen-798c394a08287aa10094d0c8,synthetic_programmatic_template,inline,none,True,bank_marketing
"Lakeshore National Bank
Earn a $300 bonus when you open a new checking account!
Offer ends 07/08/2024.
Minimum opening deposit $198.24.
Member FDIC. Equal Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-68ffd5cf89e5dc49e12cb8b2,v11-UNKNOWN_DOCUMENT-kind09,unknown,2024,fgen-fbf078933d9cb9161e591654,synthetic_programmatic_template,columns,top,False,bank_marketing
"Offer ends 2022-09-27.
Minimum opening deposit $79.63.
Member FDIC. Equal Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-bf6d2c9ab72b8b54faafca0b,v11-UNKNOWN_DOCUMENT-kind09,unknown,2022,fgen-2e6b16f800655a93955bedd4,synthetic_programmatic_template,csv,none,False,bank_marketing
"Earn a $300 bonus when you open a new
checking account! Offer ends June
24, 2022. Minimum opening deposit $139.54. Member FDIC. Equal Housing Lender. Riverbend Bank & Trust",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b78aa648d5125e1909ce832d,v11-UNKNOWN_DOCUMENT-kind09,unknown,2022,fgen-a1fbfeaaf5fe3ac7cca838d3,synthetic_programmatic_template,flat,bottom,False,bank_marketing
"Earn a $300 bonus when you open a new checking account!
Offer ends 02/12/2023.
## Member FDIC. Equal Housing Lender.
## Bayview Community Bank",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-5e02882cf478923e77643cfe,v11-UNKNOWN_DOCUMENT-kind09,unknown,2023,fgen-071d9b6caf8e87b086c08b58,synthetic_programmatic_template,markdown,bottom,False,bank_marketing
"Summit Ridge Bank
Offer ends 2022-02-19.
Minimum opening deposit $237.93.
Member FDIC. Equal Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-caf971bdf72f133162276788,v11-UNKNOWN_DOCUMENT-kind09,unknown,2022,fgen-e09632487521bf4a5a8d0d76,synthetic_programmatic_template,stacked,top,False,bank_marketing
"Cedar Valley Credit Union
Earn a $300 bonus when you open a new checking account!
Offer ends 2021-06-19.
Minimum opening deposit $135.90.
Member FDIC. Equal Housing Lender.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4e272fb68c85136b684a863a,v11-UNKNOWN_DOCUMENT-kind09,unknown,2021,fgen-60b355cbdd63b557418b719c,synthetic_programmatic_template,inline,top,False,bank_marketing
"Granite Peak Bank
Earn a $300 bonus when you open a new checking account!
Offer ends August 14, 2025.
Minimum opening deposit $105.96.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-3597fb853b301f89cafd4b20,v11-UNKNOWN_DOCUMENT-kind09,unknown,2025,fgen-66a40c905cf627f201c1d4f0,synthetic_programmatic_template,columns,top,False,bank_marketing
"2026assessment: $1,287.26 per year",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-54963d72013e04bf1bf1b1d4,v11-UNKNOWN_DOCUMENT-kind12,unknown,2021,fgen-99a8c795cc614ae4e6d177c3,synthetic_programmatic_template,stacked,none,True,hoa_notice
"Riverbend Commons Homeowners Association
Annual meeting 2023-05-23 7:00 PM, Clubhouse
2026 assessment: $2,164.03 per year",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ea86b950062531f80b10ab8d,v11-UNKNOWN_DOCUMENT-kind12,unknown,2023,fgen-0d1c4636c6cf068d1e42898d,synthetic_programmatic_template,inline,top,False,hoa_notice
"Annual meeting 03/01/2022 7:00 PM, Clubhouse
2026 assessment: $2,776.92 per year
Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-394f3562952f789c42648b10,v11-UNKNOWN_DOCUMENT-kind12,unknown,2022,fgen-415dcafac76556b65580c605,synthetic_programmatic_template,columns,none,False,hoa_notice
"Riverbend Commons Homeowners Association
Annual meeting 04/02/2021 7:00 PM, Clubhouse
2026 assessment: $244.69 per year
Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e08812ce75721e885f44179d,v11-UNKNOWN_DOCUMENT-kind12,unknown,2021,fgen-1623d522686e96f5204fc05c,synthetic_programmatic_template,csv,top,False,hoa_notice
"Granite Ridge Homeowners Association Annual
meeting July 20, 2024 7:00 PM, Clubhouse
2026 assessment: $886.74 per year Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-dbdc5f17b26fa463fd7ae04d,v11-UNKNOWN_DOCUMENT-kind12,unknown,2024,fgen-b7cb9b75de88c3a73075e123,synthetic_programmatic_template,flat,top,False,hoa_notice
"Annual meeting 2025-11-25 7:00 PM, Clubhouse
## 2026 assessment: $1,230.53 per year
## Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-077a13e5a18e9b46b4b330af,v11-UNKNOWN_DOCUMENT-kind12,unknown,2025,fgen-cafa387ccead4420bbaa43e2,synthetic_programmatic_template,markdown,none,False,hoa_notice
"Riverbend Commons Homeowners Association
Annual meeting April 20, 2026 7:00 PM, Clubhouse
Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ae4d413cc42cf17b0fa9f600,v11-UNKNOWN_DOCUMENT-kind12,unknown,2026,fgen-7ed46945f348a0e475cd0fd1,synthetic_programmatic_template,stacked,top,False,hoa_notice
"Riverbend Commons Homeowners Association
Annual meeting 11/13/2026 7:00 PM, Clubhouse
Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b95cab82fbea273db950d5b2,v11-UNKNOWN_DOCUMENT-kind12,unknown,2026,fgen-604618375d694926e5158a74,synthetic_programmatic_template,inline,top,False,hoa_notice
"Riverbend Commons Homeowners Association
2026 assessment: $884.38 per year
Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-6611cb3e7b0185345343310f,v11-UNKNOWN_DOCUMENT-kind12,unknown,2025,fgen-8b99d9c202cf5838b10dfb36,synthetic_programmatic_template,columns,top,False,hoa_notice
"Oak Hollow Property Mgmt Homeowners Association
Annual meeting 09/10/2026 7:00 PM, Clubhouse
2026 assessment: $119.21 per year
Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e10570e28adab028098b61cc,v11-UNKNOWN_DOCUMENT-kind12,unknown,2026,fgen-261a07474dd5adbb6f2248d3,synthetic_programmatic_template,csv,top,False,hoa_notice
"Annual meeting 06/08/2023 7:00 PM, Clubhouse 2026 assessment: $630.26 per year Pool hours change on
Labor
Day. Riverbend Commons Homeowners Association",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4a491ab3c7f655e5f1d9faad,v11-UNKNOWN_DOCUMENT-kind12,unknown,2023,fgen-8a474976c41720801ddfeb3f,synthetic_programmatic_template,flat,bottom,False,hoa_notice
"Annual meeting 10/24/25 7:00 PM, Clubhouse
## 2026 assessment: $2,499.63 per year
Pool hours change on Labor Day.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-8b1f111ec4f052bb100e1cc4,v11-UNKNOWN_DOCUMENT-kind12,unknown,2025,fgen-877d47215c8d8d0846dd38bc,synthetic_programmatic_template,markdown,none,False,hoa_notice
"Product Registration and Limited Warranty
Model Corolla  Serial GBN42C9SL5AJBLWB1
Purchase date 5/16/24
This product is warranted against defects for 1 year.
Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-68534d7a6b9ff5b87684d1b9,v11-UNKNOWN_DOCUMENT-kind13,unknown,2024,fgen-a1fc839c83048f183154286d,synthetic_programmatic_template,inline,top,False,warranty
"Product Registration and Limited Warranty
Model Corolla  Serial 1SF72SCNKMH9ESCSG
Purchase date 8/26/22
This product is warranted against defects for 1 year.
Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-97a829fad99bcffebf14c060,v11-UNKNOWN_DOCUMENT-kind13,unknown,2022,fgen-4e404cb5f71bbe8f6051ce0a,synthetic_programmatic_template,columns,top,False,warranty
"Model Civic  Serial JEPC2CZTB7VFT7EZ5
Purchase date 11/26/21
Keep your receipt.
Product Regístrationand Limited Warranty",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0ffc586d05502f2d27e5ba33,v11-UNKNOWN_DOCUMENT-kind13,unknown,2021,fgen-ff90f4de1f400337a4bc5837,synthetic_programmatic_template,csv,bottom,True,warranty
"Product Registration and Limited Warranty Model F-150 Serial 7BVU8H9PHUM49G9P6 Purchase date 08/06/2023 This
product is warranted against defects for 1 year.
Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-4f31bb8b28b6de37cd41bf56,v11-UNKNOWN_DOCUMENT-kind13,unknown,2023,fgen-1830b08fd4e3af85b75697a1,synthetic_programmatic_template,flat,top,False,warranty
"Product Registration and Limited Warranty
Model Outback  Serial XAWZ7W7V9NMNU4H02
Purchase date 2022-05-05
This product is warranted against defects for 1 year.
Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-73b2b68b1ab5b96657a3d55b,v11-UNKNOWN_DOCUMENT-kind13,unknown,2022,fgen-add7573405dbc65eee00f0ac,synthetic_programmatic_template,markdown,top,False,warranty
"Model Outback  Serial 89YAJWW71BAAKYCFD
Purchase date January 12, 2026
This product is warranted against defects for 1 year.
Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-324003735768f344941ccd9b,v11-UNKNOWN_DOCUMENT-kind13,unknown,2026,fgen-2a29e3b875625bdba567e14b,synthetic_programmatic_template,stacked,none,False,warranty
"Product Registration and Limited Warranty
Model Corolla  Serial XXFL6JUAYWG4R2CXD
Purchase date 2021-04-22
This product is warranted against defects for 1 year.
Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-48a7b858d280fe6ef000d776,v11-UNKNOWN_DOCUMENT-kind13,unknown,2021,fgen-8cde8e124eedf99e73901245,synthetic_programmatic_template,inline,top,False,warranty
"Product Registration and Limited Warranty
Model Corolla  Serial 2CPMUXTKAGXWWPS1L
Purchase date 2023-01-08
This product is warranted against defects for 1 year.
Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-30859d8786369161af3763e2,v11-UNKNOWN_DOCUMENT-kind13,unknown,2023,fgen-3a6e3c86cd34d6b8afc5833b,synthetic_programmatic_template,columns,top,False,warranty
"ModelOutback  Serial GTS4WWZ9T9RJJ7H49
Purchase date 2022-02-24
This product is warranted against defects for l year.
Keep your receípt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a92c6a7c4be36062a5e5b2a8,v11-UNKNOWN_DOCUMENT-kind13,unknown,2022,fgen-cd140fe35c7736b892888abe,synthetic_programmatic_template,csv,none,True,warranty
"Purchase date 10/4/21 Keep your
receipt.
Product Registration and Limited Warranty",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-93fb0fefb11c03b96415d94f,v11-UNKNOWN_DOCUMENT-kind13,unknown,2021,fgen-8861549283b10242487d904d,synthetic_programmatic_template,flat,bottom,False,warranty
"Product Registration and Limited Warranty
Model Civic  Serial UPSZYJVHHCYTJP8UA
Purchase date 5/27/21
## Keep your receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-6386e02bf98495332377938c,v11-UNKNOWN_DOCUMENT-kind13,unknown,2021,fgen-00ddca877a9952aecdabb32e,synthetic_programmatic_template,markdown,top,False,warranty
"Product Registration and Limited Warranty
Mode1 Corolla  5erial JBR4WXBSGF80PNTAG
Purchase date 2023-08-23
This product is warranted against defects for 1 year.
Keepyour receipt.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d44cae2a0420ee19c2fa5c35,v11-UNKNOWN_DOCUMENT-kind13,unknown,2023,fgen-599fe35c9ffea0e09fffd49f,synthetic_programmatic_template,stacked,top,True,warranty
"Citation number 595472365
Date/time 2023-11-13 2:14 PM
Violation: Expired meter
Fine $97.65
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a1f8d45bbc5ad44de3b3ce0d,v11-UNKNOWN_DOCUMENT-kind14,unknown,2023,fgen-345e7302c11dc317f9344f96,synthetic_programmatic_template,columns,none,False,parking_citation
"Citation number 167217924
Date/time 2/17/25 2:14 PM
Violation: Expired meter
Fine $250.17
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-05a7eecb755ddd0741d109b3,v11-UNKNOWN_DOCUMENT-kind14,unknown,2025,fgen-03667994b10c8581b1c4997e,synthetic_programmatic_template,csv,none,False,parking_citation
"CITY OF PINECREST PARKING CITATION Datc/time 12/21/2O22
2:14 PM Violation: Expired meter
Fine $52.24 Pay within 21days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d4e9de684be8a7964aeb8666,v11-UNKNOWN_DOCUMENT-kind14,unknown,2022,fgen-a8ef9d8fce41a42086781d75,synthetic_programmatic_template,flat,top,True,parking_citation
"CITY OF TESTVILLE
PARKING CITATION
Citation number 300097352
Violation: Expired meter
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-8ff6b70b9f996e83079914f3,v11-UNKNOWN_DOCUMENT-kind14,unknown,2021,fgen-e0510f17cface2209de22038,synthetic_programmatic_template,markdown,top,False,parking_citation
"CITY OF CEDAR FALLS
PARKING CITATION
Citation number 51025866
Date/time 02/04/2023 2:14 PM
Fine $80.45
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-45873f2e032ce48171662fd3,v11-UNKNOWN_DOCUMENT-kind14,unknown,2023,fgen-27a1e114e6b9fbafb461c76b,synthetic_programmatic_template,stacked,top,False,parking_citation
"Date/time 3/6/21 2:14 PM
Violation: Expired meter
Fine $16.37
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ee9e1b560416dd7735fbce7d,v11-UNKNOWN_DOCUMENT-kind14,unknown,2021,fgen-9b9f30003472aca65e89eb3e,synthetic_programmatic_template,inline,none,False,parking_citation
"CITY OF LAKEWOOD
PARKING CITATION
Citation number 251481176
Date/time 2021-05-17 2:14 PM
Violation: Expired meter
Fine $269.30
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-8cb9d3638a9b6c4931803b83,v11-UNKNOWN_DOCUMENT-kind14,unknown,2021,fgen-d562bcd21808b2767e162ad2,synthetic_programmatic_template,columns,top,False,parking_citation
"CITY OF BAYSIDE
PARKING CITATION
Citation number 158929636
Date/time November 17, 2025 2:14 PM
Violation: Expired meter
Fine $191.75
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7e3b0e185fb408f2db4b26b4,v11-UNKNOWN_DOCUMENT-kind14,unknown,2025,fgen-9af62246025283ac7b97ae17,synthetic_programmatic_template,csv,top,False,parking_citation
"Citation number 234808672 Date/time 2025-04-06 2:14 PM Violation: Expired meter Fine $169.88 Pay within 21 days to avoid a
late penalty. CITY
OF BAYSIDE PARKING CITATION",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f25ff57b498909e0be22d295,v11-UNKNOWN_DOCUMENT-kind14,unknown,2025,fgen-b968dc35f6a0e568192f9e37,synthetic_programmatic_template,flat,bottom,False,parking_citation
"## CITY OF MAPLEWOOD
## PARKING CITATION
## Citation number 70981756
## Date/time 2025-03-21 2:14 PM
Violation: Expired meter
Fine $53.97
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2bf921d0a43ec1cd1a09d098,v11-UNKNOWN_DOCUMENT-kind14,unknown,2025,fgen-2ce0dd5318465ed5841ed871,synthetic_programmatic_template,markdown,top,False,parking_citation
"CITY OF LAKEWOOD
PARKING CITATION
Citation number 154463496
Violation: Expired meter
Fine $220.10
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-826c17a4d4348a4054c2d149,v11-UNKNOWN_DOCUMENT-kind14,unknown,2025,fgen-314b51ace3b34ebc6437244b,synthetic_programmatic_template,stacked,top,False,parking_citation
"Citation number 833168410
Date/time 1/7/24 2:14 PM
Violation: Expired meter
Fine $194.07
Pay within 21 days to avoid a late penalty.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-103717f6e1fe2080679c943c,v11-UNKNOWN_DOCUMENT-kind14,unknown,2024,fgen-75caf9632b905d2acf057cce,synthetic_programmatic_template,inline,none,False,parking_citation
"Lakeshore Veterinary
Vaccination Certificate
Rabies vaccine administered December 18, 2024
Next due 01/13/2024",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a53263045ca3b89d19cbe114,v11-UNKNOWN_DOCUMENT-kind15,unknown,2024,fgen-cca20952613ce1f6bca098ce,synthetic_programmatic_template,csv,top,False,pet_vaccine
"Riverside
Veterinary Vaccination Certificate Patient: Biscuit (canine)
Rabies vaccine administered May 15, 2022 Next due 2022-09-28",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-59dc376b82f4f934a1841c39,v11-UNKNOWN_DOCUMENT-kind15,unknown,2022,fgen-def4b1ddb980dacbb2c185f5,synthetic_programmatic_template,flat,top,False,pet_vaccine
"Lakeshore Veterinary
Vaccination Certificate
Rabies vaccine administered 2022-03-05
Next due 2022-10-22
## Veterinarian signature on file",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e9c5facd63353540ec9f201a,v11-UNKNOWN_DOCUMENT-kind15,unknown,2022,fgen-6948d3c80d48a63de6380a40,synthetic_programmatic_template,markdown,top,False,pet_vaccine
"Sample Veterinary
Vaccination Certificate
Patient: Biscuit (canine)
Rabies vaccine administered 2024-01-04
Next due November 8, 2024",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c35da28b8cbd45e78eca9cbd,v11-UNKNOWN_DOCUMENT-kind15,unknown,2024,fgen-402f4670370721a2a7d568ff,synthetic_programmatic_template,stacked,top,False,pet_vaccine
"Rabies vaccine administered 01/17/2025
Next due 11/24/25
Veterinarian signature on file
Brightsmile Veterinary
Vaccination Certificate",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d6e0aa1240b2d1dddc41e089,v11-UNKNOWN_DOCUMENT-kind15,unknown,2025,fgen-fbf4ce8d366b8fa4b9daf19a,synthetic_programmatic_template,inline,bottom,False,pet_vaccine
"Next due2023-02-21
Veterínarian signature on file
Lakeshore Veterinary
Vaccination Certificate",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-bb4c5a578d969e85742e0651,v11-UNKNOWN_DOCUMENT-kind15,unknown,2023,fgen-c121c7fca2ed11faf2ef925e,synthetic_programmatic_template,columns,bottom,True,pet_vaccine
"Sample Veterinary
Vaccination Certificate
Patient: Biscuit (canine)
Rabies vaccine administered February 14, 2022
Next due 2022-02-05
Veterinarian signature on file",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-33d783af8f94e07fff8d0a23,v11-UNKNOWN_DOCUMENT-kind15,unknown,2022,fgen-bb8043d40f8f2c618af9157a,synthetic_programmatic_template,csv,top,False,pet_vaccine
"Brightsmile Veterinary Vaccination Certificate Patient: Biscuit (canine) Rabies vaccine administered
2025-12-08 Next due July 20,
2025 Veterinarian signature on file",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-fc6d012cb17c267c606fe6ca,v11-UNKNOWN_DOCUMENT-kind15,unknown,2025,fgen-adf2ba02a3a759d6ce5be648,synthetic_programmatic_template,flat,top,False,pet_vaccine
"Riverside Veterinary
## Vaccination Certificate
Patient: Biscuit (canine)
Rabies vaccine administered November 12, 2022
Next due September 10, 2022
Veterinarian signature on file",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0e153de1a1a6590140f89096,v11-UNKNOWN_DOCUMENT-kind15,unknown,2022,fgen-484213e268a4062013dab510,synthetic_programmatic_template,markdown,top,False,pet_vaccine
"Patient: Biscuit(canine)
Rabies vaccine administered 06/11/2021
Next due 09/24/2021
Veterinarian signature on fi1e",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-7d346bfb00833fb4589de10a,v11-UNKNOWN_DOCUMENT-kind15,unknown,2021,fgen-56cdbdc201bce32240b37ce9,synthetic_programmatic_template,stacked,none,True,pet_vaccine
"Lakeshore Veterinary
Vaccination Certificate
Patient: Biscuit (canine)
Rabies vaccine administered 2022-11-02
Next due June 3, 2022
Veterinarian signature on file",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a3935e18ef3957cc85d267a7,v11-UNKNOWN_DOCUMENT-kind15,unknown,2022,fgen-e9b676310c909920bacc9673,synthetic_programmatic_template,inline,top,False,pet_vaccine
"Sample Veterinary
Vaccination Certificate
Patient: Biscuit (canine)
Rabies vaccine administered 03/19/2022
Next due 2022-09-19
Veterinarian signature on file",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-d6667db9b593f315b84f626e,v11-UNKNOWN_DOCUMENT-kind15,unknown,2022,fgen-581f99d15f1c2608502936c7,synthetic_programmatic_template,columns,top,False,pet_vaccine
"Reset your password
Hi Noah Romero,
We received a request to reset your password.
This link expires in 30 minutes.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-50bfcb6f9fdff93287d06b05,v11-UNKNOWN_DOCUMENT-kind18,unknown,2022,fgen-80a67ca0d34b408cb4dee807,synthetic_programmatic_template,stacked,top,False,password_email
"Hi Wei Larsen,
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c1cb2a4bbb89e3812729403c,v11-UNKNOWN_DOCUMENT-kind18,unknown,2025,fgen-5d8110902ab62621c2adf825,synthetic_programmatic_template,inline,none,False,password_email
"Reset your password
Hi Taylor Romero,
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-39abcbe0ca02acc4b42b0c02,v11-UNKNOWN_DOCUMENT-kind18,unknown,2022,fgen-b927611df95d32a134c31c7b,synthetic_programmatic_template,columns,top,False,password_email
"Reset your password
Hi Jordan Haddad,
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-cd7c36aac20daefaa986baaf,v11-UNKNOWN_DOCUMENT-kind18,unknown,2024,fgen-bf57083ff705ddd0788b7353,synthetic_programmatic_template,csv,top,False,password_email
"Reset your password Hi
Lena Moreau, We received a request to reset your password. If you did
not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-03567b39c07fd597ce3dd380,v11-UNKNOWN_DOCUMENT-kind18,unknown,2025,fgen-adf99a52ba31dca68bfeed6b,synthetic_programmatic_template,flat,top,False,password_email
"Reset your password
## Hi Casey Castillo,
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-6392c73a66728fc2647b16f9,v11-UNKNOWN_DOCUMENT-kind18,unknown,2024,fgen-2190ecbddc69eb1b964232a0,synthetic_programmatic_template,markdown,top,False,password_email
"Reset your password
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-6e1569a586221469f11debd5,v11-UNKNOWN_DOCUMENT-kind18,unknown,2022,fgen-f0479f4bae2e2e03d885c901,synthetic_programmatic_template,stacked,top,False,password_email
"Reset your password
Hi Lena Lindqvist,
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-6c9b2581fec0371619d5c041,v11-UNKNOWN_DOCUMENT-kind18,unknown,2022,fgen-90a1db3df567e9ed5dd1ddda,synthetic_programmatic_template,inline,top,False,password_email
"Reset your password
Hi Kwame Kowalski,
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-33306b47e23bffd924fb584c,v11-UNKNOWN_DOCUMENT-kind18,unknown,2023,fgen-ef2c8a60c7a18a6b66c8ac31,synthetic_programmatic_template,columns,top,False,password_email
"Reset your password
Hi Hiro Larsen,
We received a request to reset your password.
This link expires in 30 minutes.
If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-18771d50e4887747894454c4,v11-UNKNOWN_DOCUMENT-kind18,unknown,2021,fgen-e3b2a74b562c8ddb8c3a2069,synthetic_programmatic_template,csv,top,False,password_email
"Reset your password Hi Noah Haddad, We received a request to rcset your password. This link expires in30 minutes. If you
did not request this,
ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a2f91c0480b0bfd45f616598,v11-UNKNOWN_DOCUMENT-kind18,unknown,2023,fgen-b8e0770f7db6a50e5a934a16,synthetic_programmatic_template,flat,top,True,password_email
"Reset your password
Hi Jordan R. Okafor,
We received a request to reset your password.
## If you did not request this, ignore this email.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a7d99b500076cdde0683c1cd,v11-UNKNOWN_DOCUMENT-kind18,unknown,2023,fgen-6ab08121cc5f21dfd8c1529b,synthetic_programmatic_template,markdown,top,False,password_email
"Grandma's Banana Bread
3 ripe bananas
1/3 cup melted butter
Bake at 350°F for 60 minutes",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-c7cc696ebcc12dd81904fd6f,v11-UNKNOWN_DOCUMENT-kind19,unknown,2023,fgen-d388e5b96f6a4363b3b0bbcf,synthetic_programmatic_template,inline,top,False,recipe
"3 ripe bananas
1/3 cup melted butter
Bake at 350°F for 60 minutes",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e7afe5891cb4e56776098c33,v11-UNKNOWN_DOCUMENT-kind19,unknown,2022,fgen-7e39b8b44bd34ebe2af42cba,synthetic_programmatic_template,columns,none,False,recipe
"Grandma's Banana Bread
3 ripe bananas
1/3cup melted butter",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-3871d8bc216a0abbfd8df03b,v11-UNKNOWN_DOCUMENT-kind19,unknown,2024,fgen-f0322e36bd3c835d8064542e,synthetic_programmatic_template,csv,top,True,recipe
"Grandma's Banana Bread
3 ripe bananas
1/3 cup melted butter
## Bake at 350°F for 60 minutes",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e00a83d42c8016a730542dd9,v11-UNKNOWN_DOCUMENT-kind19,unknown,2025,fgen-9869d9e020099f8d682f2a2f,synthetic_programmatic_template,markdown,top,False,recipe
"Grandma's Banana Bread
3 ripe bananas
1/3 cup meltedbutter
Bake at 350°F for 60 minutes",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-897b9c90a175713f2deee8ac,v11-UNKNOWN_DOCUMENT-kind19,unknown,2023,fgen-783140906fdd32a92e642b64,synthetic_programmatic_template,stacked,top,True,recipe
"3ripe bananas
1/3 cup mclted butter",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f641ed39114b0fe68ca92483,v11-UNKNOWN_DOCUMENT-kind19,unknown,2021,fgen-4dff2c411b1e83dba8383542,synthetic_programmatic_template,inline,none,True,recipe
"3 ripe bananas
Bake at 350°F for 60 minutes",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a44ef9b5ed2fe30a1f7fbbfb,v11-UNKNOWN_DOCUMENT-kind19,unknown,2022,fgen-fe26227fcc9c7d9ce2d81334,synthetic_programmatic_template,columns,none,False,recipe
"## 3 ripe bananas
1/3 cup melted butter
Bake at 350°F for 60 minutes
Grandma's Banana Bread",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-53106b8f87f22be32a8235de,v11-UNKNOWN_DOCUMENT-kind19,unknown,2022,fgen-c607c8aa4e1dc15c5b2b7ab6,synthetic_programmatic_template,markdown,bottom,False,recipe
"Contacts export
Diego J. Lindqvist,jo@example.com,869-555-5522,Copperline Software Inc.
Noah Moreau,priya.k@example.com,627-555-4675,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-9816581cb1c10378469cd5c1,v11-UNKNOWN_DOCUMENT-kind20,unknown,2022,fgen-dd672bde21ee987137d3ee38,synthetic_programmatic_template,columns,top,False,contacts_csv
"Contacts export
Name,Email,Phone,Company
Fatima M. Brennan,jo@example.com,371-555-4871,Acme Test Corp
Amara D. Testcase,m.lee@example.com,545-555-5289,
Hiro D. Romero,m.lee@example.com,447-555-5208,Oak Hollow Property Mgmt",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-bd8c8c3860ce60ee8c5fc742,v11-UNKNOWN_DOCUMENT-kind20,unknown,2023,fgen-082712822af2718392d90cd0,synthetic_programmatic_template,csv,top,False,contacts_csv
"Contacts export Name,Email,Phone,Company Olivia Castillo,m.lee@example.com,592-555-5413,Granite Peak Manufacturing Co. Amara
Lindqvist,avery@example.com,321-555-6396,Granite
Ridge",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-09987c42cdbe155fe094f321,v11-UNKNOWN_DOCUMENT-kind20,unknown,2023,fgen-90d93e203136f3a044830e85,synthetic_programmatic_template,flat,top,False,contacts_csv
"## Contacts export
## Name,Email,Phone,Company
## Wei Patel,avery@example.com,291-555-7111,
Sofia Kowalski,priya.k@example.com,561-555-6153,Oak Hollow Property Mgmt",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-67c8da72eaf49433d94f6b18,v11-UNKNOWN_DOCUMENT-kind20,unknown,2023,fgen-3cfef715b0e8a43c9f827b8e,synthetic_programmatic_template,markdown,top,False,contacts_csv
"Name,Email,Phone,Company
Mateo Castillo,casey88@example.com,343-555-6865,Copperline Software Inc.
Casey Walsh,casey88@example.com,392-555-2938,
Lena Castillo,jo@example.com,793-555-5306,Granite Ridge
Contacts export",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-20915a3795fb1736c8e763d5,v11-UNKNOWN_DOCUMENT-kind20,unknown,2024,fgen-1f4429e970a869eff2c6ef95,synthetic_programmatic_template,stacked,bottom,False,contacts_csv
"Contacts export
Name,Email,Phone,Company
AveryLarsen,priya.k@example.com,983-555-2328,Copperline Software Inc.
Morgan Brennan,priya.k@example.com,626-555-745O,
Casey Lindqvist,jo@example.com,251-555-5532,Oak Hollow Property Mgmt",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-13d3e6b4b5eb3caab96a32f5,v11-UNKNOWN_DOCUMENT-kind20,unknown,2026,fgen-689332f23bd36e0b3c77e427,synthetic_programmatic_template,inline,top,True,contacts_csv
"Name,Email,Phone,Company
AmaraRomero,priya.k@example.com,239-555-6326,Riverside Regional Hospital
Lcna Nguyen,priya.k@example.com,900-555-6411,
Alex Castillo,priya.k@example.com,466-555-6916,Riverbend Commons",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-fb8dfc13f57c3eec7d381f58,v11-UNKNOWN_DOCUMENT-kind20,unknown,2022,fgen-3d71515a32079380bbde38e3,synthetic_programmatic_template,columns,none,True,contacts_csv
"Contacts export
Name,Email,Phone,Company
Lena D. Moreau,avery@example.com,732-555-8462,Maple Street Dental PC
Morgan L. Kowalski,jo@example.com,952-555-4845,
Jamie L. Fischer,priya.k@example.com,301-555-1046,Riverbend Commons",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a0ef2b3bf7e42530558c9278,v11-UNKNOWN_DOCUMENT-kind20,unknown,2024,fgen-7f17a6f8a48fff6b28fc17e3,synthetic_programmatic_template,csv,top,False,contacts_csv
"Name,Email,Phone,Company
Fatima Nguyen,priya.k@example.com,588-555-3328,Maple Street Dental PC Jordan Castillo,avery@example.com,683-555-4831, Hiro
Brennan,casey88@example.com,569-555-4216,Granite Ridge",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-56685fbd59d3a98150fdc9b5,v11-UNKNOWN_DOCUMENT-kind20,unknown,2025,fgen-8798663401ed713f9747dd72,synthetic_programmatic_template,flat,none,False,contacts_csv
"## Contacts export
## Name,Email,Phone,Company
Alex R. Patel,jo@example.com,354-555-3804,Granite Peak Manufacturing Co.",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-e8daab00249f492b0e48ea7a,v11-UNKNOWN_DOCUMENT-kind20,unknown,2022,fgen-0138f1e925e363fef87460b8,synthetic_programmatic_template,markdown,top,False,contacts_csv
"Contacts export
Name,Email,Phone,Company
Amara Testcase,avery@example.com,638-555-7951,Copperline Software Inc.
Kwame E. Tanaka,m.lee@example.com,741-555-8631,
Casey Moreau,jo@example.com,763-555-5362,Granite Ridge",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-1847d2f16e9a6d43ade8bae4,v11-UNKNOWN_DOCUMENT-kind20,unknown,2023,fgen-07ed5a98f5802eadf2a52796,synthetic_programmatic_template,stacked,top,False,contacts_csv
"Contacts export
Name,Email,Phone,Company
Jordan Okafor,m.lee@example.com,506-555-1340,Copperline Software Inc.
Jordan L. Haddad,m.lee@example.com,979-555-5620,
Taylor Brennan,casey88@example.com,610-555-1182,Granite Ridge",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-902dcf859d3abba6994219c1,v11-UNKNOWN_DOCUMENT-kind20,unknown,2022,fgen-ae5286374e36c15efadbaa6b,synthetic_programmatic_template,inline,top,False,contacts_csv
"Activity log
Date,Activity,Distance (mi),Duration,Calories
2024-11-01,Walk,2.00,00:40:10,349",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b7b1dab8c9b2478ab2a314fb,v11-UNKNOWN_DOCUMENT-kind21,unknown,2024,fgen-4c05ac4d0cbcc9502bea9566,synthetic_programmatic_template,csv,top,False,workout_log
"Activity log Date,Activity,Distance
(mi),Duration,Calories
3/17/25,Run,3.10,00:28:41,545 2025-12-15,Bike,12.40,00:51:02,389",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-017d19a47742dfbe9e3195d9,v11-UNKNOWN_DOCUMENT-kind21,unknown,2025,fgen-309756f446d4a1811b6320de,synthetic_programmatic_template,flat,top,False,workout_log
"Activity log
Date,Activity,Distance (mi),Duration,Calories
05/19/2021,Run,3.10,00:28:41,385
11/3/21,Bike,12.40,00:51:02,588
2021-12-04,Walk,2.00,00:40:10,298",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-04c27f2e03a2fb8769263d90,v11-UNKNOWN_DOCUMENT-kind21,unknown,2021,fgen-90f98cf1005550ea6cfb86eb,synthetic_programmatic_template,markdown,top,True,workout_log
"Date,Activity,Distance (mi),Duration,Calories
2026-05-15,Run,3.10,00:28:41,408
02/02/2026,Bike,12.40,00:51:02,545
2026-11-24,Walk,2.00,00:40:10,521",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-81a6b695b4bde77199d63da1,v11-UNKNOWN_DOCUMENT-kind21,unknown,2026,fgen-9fa6addabf5de05588a70e10,synthetic_programmatic_template,stacked,none,False,workout_log
"Activity log
Date,Activity,Distance (mi),Duration,Calories
2021-06-04,Run,3.10,00:28:41,332
February 12, 2021,Bike,12.40,00:51:02,539
10/13/21,Walk,2.00,00:40:10,211",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-3bbe6ab7474cec5582ca239c,v11-UNKNOWN_DOCUMENT-kind21,unknown,2021,fgen-09323e1a1de69f918e1d74ad,synthetic_programmatic_template,inline,top,False,workout_log
"Activity log
Date,Activity,Distance (mi),Duration,Calories
September 23, 2023,Run,3.10,00:28:41,255
8/8/23,Bike,12.40,00:51:02,572
05/03/2023,Walk,2.00,00:40:10,227",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-13ef0fbd6e126988df2aa3a1,v11-UNKNOWN_DOCUMENT-kind21,unknown,2023,fgen-0e84c8530ae89bd681b4d3bb,synthetic_programmatic_template,columns,top,False,workout_log
"Date,Activity,Distance (mi),Duration,Calories
04/16/2026,Run,3.10,00:28:41,120
03/20/2026,Bike,12.40,00:51:02,470
Activity log",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-22fb175cb3563d8d19584907,v11-UNKNOWN_DOCUMENT-kind21,unknown,2026,fgen-ee9638084a6b131c13876614,synthetic_programmatic_template,csv,bottom,True,workout_log
"Date,Activity,Distance (mi),Duration,Calories August
6, 2023,Run,3.10,00:28:41,542 February 17,
2023,Bike,12.40,00:51:02,405 04/27/2023,Walk,2.00,00:40:10,343 Activity log",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-acfad343d1eca66f4781fb89,v11-UNKNOWN_DOCUMENT-kind21,unknown,2023,fgen-2166af53faaaaf6786588eae,synthetic_programmatic_template,flat,bottom,False,workout_log
"## Activity log
Date,Activity,Distance (mi),Duration,Calories
## 09/22/2021,Run,3.10,00:28:41,499
February 1, 2021,Bike,12.40,00:51:02,64",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-cb6fb5359687c6dd88785e1e,v11-UNKNOWN_DOCUMENT-kind21,unknown,2021,fgen-a07d7385f1ac33727dc43d16,synthetic_programmatic_template,markdown,top,False,workout_log
"Activity log
May 10, 2025,Run,3.10,00:28:41,563
04/07/2025,Bike,12.40,00:51:02,382
February 22, 2025,Walk,2.00,00:40:10,23",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2369be44b4248a43075ba61a,v11-UNKNOWN_DOCUMENT-kind21,unknown,2025,fgen-f8c3566333732279cf1ba896,synthetic_programmatic_template,stacked,top,False,workout_log
"Activity log
Date,Activity,Distance (mi),Duration,Calories
12/5/24,Run,3.10,00:28:41,490
2024-04-07,Bike,12.40,00:51:02,218
April 17, 2024,Walk,2.00,00:40:10,78",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a21d9ab24ed060f6838f8af1,v11-UNKNOWN_DOCUMENT-kind21,unknown,2024,fgen-1b374f2a2867a6e2b823cbd0,synthetic_programmatic_template,inline,top,False,workout_log
"Activity log
3/10/24,Run,3.10,00:28:41,95
5/16/24,Bike,12.40,00:51:02,443
05/16/2024,Walk,2.00,00:40:10,295",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-a3b2dc72cfdc7551d8875a4a,v11-UNKNOWN_DOCUMENT-kind21,unknown,2024,fgen-62adc08ff329aae6524bf30a,synthetic_programmatic_template,columns,top,False,workout_log
"Project hours
Date,Project,Task,Hours,Notes
02/12/2026,Website redesign,Client call,1.0,follow-up
April 28, 2026,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-af39a9ebf30e662b087b6d96,v11-UNKNOWN_DOCUMENT-kind24,unknown,2026,fgen-65c8dc36c532b5f582c415dd,synthetic_programmatic_template,stacked,top,False,timesheet
"Projcct hours
Date,Project,Task,Hours,Notes
01/28/2026,Websiteredesign,Client call,1.0,follow-up
Septembcr 12, 2026,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-75b23abe15f0e737d5173be3,v11-UNKNOWN_DOCUMENT-kind24,unknown,2026,fgen-5324c18712c63d6eecb6e86f,synthetic_programmatic_template,inline,top,True,timesheet
"Project hours
Date,Project,Task,Hours,Notes
February 10, 2023,Website redesign,Wireframes,6.5,
2023-08-27,Website redesign,Client call,1.0,follow-up
4/20/23,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-17dceec3236ea4a84e6e799b,v11-UNKNOWN_DOCUMENT-kind24,unknown,2023,fgen-33be73994d1784aea1d0b123,synthetic_programmatic_template,columns,top,False,timesheet
"Project hours
Date,Project,Task,Hours,Notes
07/23/2025,Website redesign,Wireframes,6.5,
August 23, 2025,Website redesign,Client call,1.0,follow-up
06/07/2025,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-0fe958dedc3193115c63254c,v11-UNKNOWN_DOCUMENT-kind24,unknown,2025,fgen-14cc8eedc7da216a2efa2192,synthetic_programmatic_template,csv,top,False,timesheet
"Project hours Date,Project,Task,Hours,Notes 06/14/2021,Website
redesign,Wireframes,6.5, March 4,
2021,Website redesign,Client call,1.0,follow-up",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-dc30a93a3b2d6ba90f2d0b25,v11-UNKNOWN_DOCUMENT-kind24,unknown,2021,fgen-a93e81a64193689a1f04a767,synthetic_programmatic_template,flat,top,False,timesheet
"## Project hours
Date,Project,Task,Hours,Notes
10/20/23,Wcbsite redesign,Wireframes,6.5,
## 2023-03-24,Websiteredesign,Client call,1.0,fo1low-up
July 16, 2023,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f19a3e9e18a23d54f5446a5a,v11-UNKNOWN_DOCUMENT-kind24,unknown,2023,fgen-cedcbff65e9f428e61627cfa,synthetic_programmatic_template,markdown,top,True,timesheet
"Project hours
Date,Project,Task,Hours,Notes
January 16, 2026,Website redesign,Wireframes,6.5,
2026-08-06,Website redesign,Client call,1.0,follow-up",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2af451ca60b57016a3cc5626,v11-UNKNOWN_DOCUMENT-kind24,unknown,2026,fgen-c639ac93ad7fda18a38b4c3a,synthetic_programmatic_template,stacked,top,False,timesheet
"Date,Project,Task,Hours,Notes
2025-04-13,Website redesign,Wireframes,6.5,
December 9, 2025,Website redesign,Client call,1.0,follow-up
2025-10-10,Internal,Admin,2.0,
Project hours",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-864980f7b660f34969033f9f,v11-UNKNOWN_DOCUMENT-kind24,unknown,2025,fgen-59aa27fac5c70c59f4bb5608,synthetic_programmatic_template,inline,bottom,False,timesheet
"Date,Project,Task,Hours,Notes
December 4, 2025,Website redesign,Wireframes,6.5,
December 9, 2025,Website redesign,Client call,1.0,follow-up
04/12/2025,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-57fb9f0c12092fefdda6aa23,v11-UNKNOWN_DOCUMENT-kind24,unknown,2025,fgen-28ed36e82103afb0f05b9da1,synthetic_programmatic_template,columns,none,False,timesheet
"Project hours
Date,Project,Task,Hours,Notes
01/22/2021,Website redesign,Wireframes,6.5,
05/09/2021,Website redesign,Client call,1.0,follow-up
09/08/2021,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-791eba118598c014d14c1e49,v11-UNKNOWN_DOCUMENT-kind24,unknown,2021,fgen-b818b0ccaf9b968e06b3f60b,synthetic_programmatic_template,csv,top,False,timesheet
"Project hours
Date,Project,Task,Hours,Notes 6/20/22,Website redesign,Wireframes,6.5, 2022-04-01,Website
redesign,Client call,1.0,follow-up 2022-04-08,Internal,Admin,2.0,",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-dddd4bcd899aa8b9f0addcbd,v11-UNKNOWN_DOCUMENT-kind24,unknown,2022,fgen-db38f5e47ca8adba56f5cf3c,synthetic_programmatic_template,flat,top,False,timesheet
"Date,Project,Task,Hours,Notes
## 2021-12-06,Website redesign,Wireframes,6.5,
2021-05-07,Website redesign,Client call,1.0,follow-up
1/23/21,Internal,Admin,2.0,
Project hours",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-684ed1627d144054f077d7e8,v11-UNKNOWN_DOCUMENT-kind24,unknown,2021,fgen-4c0c5e62d3f8272ea00c755c,synthetic_programmatic_template,markdown,bottom,False,timesheet
"Thermostat history
1/17/26 08:00,68.5,70,41%,Heat
9/21/26 12:00,71.2,70,39%,Off
02/27/2026 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ee76c761593202f31d959168,v11-UNKNOWN_DOCUMENT-kind25,unknown,2026,fgen-1b2c9d8d385c676faeba4a2d,synthetic_programmatic_template,inline,top,False,sensor_readings
"Timestamp,Indoor Temp,Setpoint,Humidity,Mode
10/26/2022 08:00,68.5,70,41%,Heat
2022-07-26 12:00,71.2,70,39%,Off
May 25, 2022 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b995dd6d5818db079f3f1124,v11-UNKNOWN_DOCUMENT-kind25,unknown,2022,fgen-599604bf5edc35392b6929b6,synthetic_programmatic_template,columns,none,False,sensor_readings
"Thermostat history
Timestamp,Indoor Temp,Setpoínt,Humidity,Mode
1/20/22 08:00,68.5,70,41%,Heat
07/03/202212:00,71.2,70,39%,Off
2022-12-17 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-38c893ba8e2243e3898158db,v11-UNKNOWN_DOCUMENT-kind25,unknown,2022,fgen-8de4274c94d75c2bfcf66fdb,synthetic_programmatic_template,csv,top,True,sensor_readings
"Thermostat history Timestamp,Indoor Temp,Setpoint,Humidity,Mode 2023-02-05 08:00,68.5,70,41%,Heat July 22, 2023
12:00,71.2,70,39%,Off
2023-03-16 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-b3903bad3157e9ab99648e9b,v11-UNKNOWN_DOCUMENT-kind25,unknown,2023,fgen-a948fb4e47cc6763bc1d67ab,synthetic_programmatic_template,flat,top,False,sensor_readings
"Thermostat history
## Timestamp,IndoorTemp,Setpoint,Humidity,Mode
11/15/2024 08:00,68.5,70,41%,Hcat
05/24/2024 12:00,71.2,70,39%,Off
7/20/24 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-500d58fbffc06d689bb40403,v11-UNKNOWN_DOCUMENT-kind25,unknown,2024,fgen-fe22c9f745c03012bbd466ac,synthetic_programmatic_template,markdown,top,True,sensor_readings
"Thermostat history
Timestamp,Indoor Temp,Setpoint,Humidity,Mode
09/28/2023 08:00,68.5,70,41%,Heat
2023-11-10 12:00,71.2,70,39%,Off
9/9/23 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-21057c30238ce3d2431f5d4e,v11-UNKNOWN_DOCUMENT-kind25,unknown,2023,fgen-93b32bbbaf630fc9db398f28,synthetic_programmatic_template,stacked,top,False,sensor_readings
"Thermostat history
04/18/2024 08:00,68.5,70,41%,Heat
2024-04-11 12:00,71.2,70,39%,Off
2024-08-19 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2e063d69fa7a8f5b5b24fc1f,v11-UNKNOWN_DOCUMENT-kind25,unknown,2024,fgen-a58b75df06f2464a7ebdb368,synthetic_programmatic_template,inline,top,False,sensor_readings
"Thermostat history
Timestamp,Indoor Temp,Setpoint,Humidity,Mode
October 22, 2025 08:00,68.5,70,41%,Heat
February 22, 2025 12:00,71.2,70,39%,Off
2025-04-12 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-f12788c02bd83324cad3349f,v11-UNKNOWN_DOCUMENT-kind25,unknown,2025,fgen-80ce3b1d3bc341988410ae79,synthetic_programmatic_template,columns,top,False,sensor_readings
"Thermostat history
Timestamp,Indoor Temp,Setpoint,Humidity,Mode
3/24/21 08:00,68.5,70,41%,Heat
January 8, 2021 12:00,71.2,70,39%,Off
07/03/2021 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-68913d669dd080f73cf79956,v11-UNKNOWN_DOCUMENT-kind25,unknown,2021,fgen-ac7b4e1cb47337f18a0f614d,synthetic_programmatic_template,csv,top,False,sensor_readings
"Timestamp,Indoor Temp,Setpoint,Humidity,Mode 3/2/21 08:00,68.5,70,41%,Heat September 13, 2021
12:00,71.2,70,39%,Off March 18, 2021 18:00,69.8,70,40%,Heat Thermostat
history",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-2a289998f32c3585b09d4ca5,v11-UNKNOWN_DOCUMENT-kind25,unknown,2021,fgen-edb14059cb88b15f711a9524,synthetic_programmatic_template,flat,bottom,False,sensor_readings
"## Thermostat history
## Timestamp,Indoor Temp,Setpoint,Humidity,Mode
09/07/2024 08:00,68.5,70,41%,Heat
## 2024-06-23 12:00,71.2,70,39%,Off
2024-12-16 18:00,69.8,70,40%,Heat",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-ec81b6244015952b77644683,v11-UNKNOWN_DOCUMENT-kind25,unknown,2024,fgen-2d22cea5bf2609be481acb95,synthetic_programmatic_template,markdown,top,False,sensor_readings
"Timestamp,Indoor Temp,Setpoint,Humidity,Mode
2022-04-14 08:00,68.5,70,41%,Heat
11/27/22 18:00,69.8,70,40%,Heat
Thermostat history",UNKNOWN_DOCUMENT,37,UNKNOWN_DOCUMENT,fdc-607aeb0d9ca5252a2bee80b0,v11-UNKNOWN_DOCUMENT-kind25,unknown,2022,fgen-1b46bb1ce2ecebee1237165b,synthetic_programmatic_template,stacked,bottom,False,sensor_readings
"CORRECTED (if checked)
Form W-2
Wage and Tax Statement
For calendar year 2026
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code
Granite Peak Manufacturing Co. 743 Harbor View Rd Oak Grove, TX 16169
b Employer identification number (EIN)
86-7852589
e Employee's first name and initial  Last name
Mateo L. Fischer
a Employee's social security number
ending in 6306
Street address (including apt. no.)
2695 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Pinecrest, GA 67136
1 Wages, tips, other compensation
$137,896.94
2 Federal income tax withheld
7,667.80
3 Social security wages
$114,618.89
4 Social security tax withheld
2,544.21
5 Medicare wages and tips
$75,913.60
6 Medicare tax withheld
4,068.57
12a See instructions for box 12
D 6,954.77
15 State  Employer's state ID number
MN 6650991
16 State wages, tips, etc.
$28,300.22
17 State income tax
4,578.79
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-10270f3c993b15dbfad3c69c,v11-W-2-stacked,original,2026,fgen-337ea70832e9bb056077bb91,synthetic_programmatic_template,stacked,top,False,
"Form W-2
Wage and Tax Statement
2026
OMB No. 1545-0029
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
c Employer's name, address, and ZIP code
Tri-County School District 568 Maple Ridge Dr Riverton, WI 66413
b Employer identification number (EIN)
98-7708615
e Employee's first name and initial  Last name
Wei Rivera
a Employee's social security number
XXX-XX-2798
1 Wages, tips, other compensation
$831.57
3 Social security wages
$16,054.50
4 Social security tax withheld
3,796.02
5 Medicare wages and tips
$110,911.80
6 Medicare tax withheld
$9,246.42
12a See instructions for box 12
D 2,597.98
13 Retirement plan
15 State  Employer's state ID number
OH 5387262
16 State wages, tips, etc.
2,355.04
d Control number
751
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-f15dbda413c96afea51dc88a,v11-W-2-stacked,original,2026,fgen-c3ff58be20e5b1dd87c233dd,synthetic_programmatic_template,stacked,top,False,
"Form W-2
Wage and Tax Statcment
2023
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
c Employer's name, address, and ZIP code
Riverside Regional Hospital 3043 Prairie Ave Oak Grove, TX 15743
b Employer identification number (EIN)
28-2005515
e Employce's first name and initial  Last name
Amara Adeyemi
a Employee's social security number
XXX-XX-2665
5treet address (induding apt. no.)
6676 Granite St
City or town, state or province, country, and ZIP orforeign postal code
Cedar Falls, IA 9754O
Account number (see instructions)
XXXXX250581
1 Wages, tips, other compensation
98,648.23
2 Federal income tax withheld
$3,536.29
3 Social security wages
$35,594.32
5 Medicare wages and tips
$128,292.41
6 Medicare tax withheld
$3,919.09
12a 5ee instructions for box 12
AA 7,073.35
13 Retirement p1an
[X]
15 State Employer's stateIDnumber
PA 4767578
17 5tatc income tax
$6,982.65
d Control number
559
Department of the Treasury - Intemal Revenue 5ervíce
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-d0cc513c4fbaa816e2bef87c,v11-W-2-stacked,original,2023,fgen-039a1a1ad3892a26ce6d391b,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
Form W-2
Wage and Tax Statement
2023
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
c Employer's name, address, and ZIP code
Granite Peak Manufacturing Co. 390 Cedar Ln Testville, IL 32657
b Employer identification number (EIN)
83-9047939
e Employee's first name and initial  Last name
Diego Brennan
a Employee's social security number
ending in 1005
2 Federal income tax withheld
8,150.58
3 Social security wages
$26,693.88
4 Social security tax withheld
248.77
5 Medicare wages and tips
$83,873.82
6 Medicare tax withheld
1,333.28
12a See instructions for box 12
D 6,317.54
13 Retirement plan
X
15 State  Employer's state ID number
WI 2512930
17 State income tax
2,578.91",W-2,38,W-2,fdc-1acdb5bba60278c7516cbc26,v11-W-2-stacked,original,2023,fgen-c929c1541303a5f4cc424f2a,synthetic_programmatic_template,stacked,top,False,
"Form W-2 Wage and Tax Statement 2026
From:
Acme Test Corp
To:
Avery Nguyen
4 Social security tax withheld
$6,346.49
13 Retirement plan
X
3 Social security wages
138,626.80",W-2,38,W-2,fdc-f446c57178d9a934cf953f03,v11-W-2-stacked,original,2026,fgen-73bad5f0bbd93822338d1053,synthetic_programmatic_template,stacked,top,False,
"Form W-2
Wage and Tax Statement
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
c Employer's name, address, and ZIP code
Tri-County School District 1584 Lakeshore Blvd Fairview, OH 80127
b Employer identification number (EIN)
56-5911678
e Employee's first name and initial  Last name
Casey Okafor
a Employee's social security number
****2103
Account number (see instructions)
ending in 342748
1 Wages, tips, other compensation
$47,618.46
2 Federal income tax withheld
$3,579.24
3 Social security wages
5,701.60
4 Social security tax withheld
$2,008.57
5 Medicare wages and tips
$82,586.00
6 Medicare tax withheld
7,744.99
12a See instructions for box 12
AA 3,462.99
15 State  Employer's state ID number
MN 8989921
16 State wages, tips, etc.
31,869.30
17 State income tax
4,711.69
d Control number
399
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-c60eac117a38fdfe76d7f5f0,v11-W-2-stacked,original,2024,fgen-1aa05cb6e21efda5bc0126fe,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form W-2
Wage and Tax Statement
2023
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 6334 Granite St Testville, IL 81216
b Employer identification number (EIN)
88-9649556
e Employee's first name and initial  Last name
Avery L. Walsh
a Employee's social security number
ending in 9600
Street address (including apt. no.)
2371 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 60189
Account number (see instructions)
XXX-XX-174994
1 Wages, tips, other compensation
1,919.26
2 Federal income tax withheld
661.32
3 Social security wages
36,215.70
4 Social security tax withheld
4,530.59
5 Medicare wages and tips
$73,380.32
6 Medicare tax withheld
$2,946.38
12a See instructions for box 12
V 4,147.27
13 Retirement plan
X
15 State  Employer's state ID number
MN 4352674
16 State wages, tips, etc.
$100,224.06
17 State income tax
$6,790.90
d Control number
779",W-2,38,W-2,fdc-1db53c4f9b1f5397f372e1cd,v11-W-2-stacked,original,2023,fgen-e05beb577f6fa76059f151b0,synthetic_programmatic_template,stacked,top,False,
"Form W-2
Wage and Tax Statement
For calendar year 2024
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 3669 Prairie Ave Fairview, OH 64787
b Employer identification number (EIN)
95-2165657
e Employee's first name and initial  Last name
Priya Castillo
a Employee's social security number
ending in 9315
Street address (including apt. no.)
1734 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 16474
Account number (see instructions)
***-**-860078
1 Wages, tips, other compensation
$43,131.25
2 Federal income tax withheld
$8,514.14
3 Social security wages
$66,278.70
5 Medicare wages and tips
$38,110.13
12a See instructions for box 12
AA 8,579.57
15 State  Employer's state ID number
TX 6307301
16 State wages, tips, etc.
$86,950.75
17 State income tax
$2,669.87
d Control number
685",W-2,38,W-2,fdc-2c61ed1b09ea337624a7c9bd,v11-W-2-stacked,original,2024,fgen-155512b7bf6614184797a2df,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
2026
OMB No. 1545-0029
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code
Tri-County School District 6634 Sample Street Pinecrest, GA 35598
b Employer identification number (EIN)
50-4219860
e Employee's first name and initial  Last name
Fatima L. Patel
a Employee's social security number
ending in 0243
2 Federal income tax withheld
$2,857.92
3 Social security wages
17,978.06
4 Social security tax withheld
$9,155.84
5 Medicare wages and tips
$82,979.74
6 Medicare tax withheld
$6,893.10
13 Retirement plan
☐
16 State wages, tips, etc.
53,708.73
17 State income tax
334.27
d Control number
904
Department of the Treasury - Internal Revenue Service",W-2,38,W-2,fdc-81a8d48cb0657491a1ef5c26,v11-W-2-stacked,original,2026,fgen-478aed0aaa59d772fa60c25e,synthetic_programmatic_template,stacked,none,False,
"Form W-2 Wage and Tax Statement 2025
c Employer:
Tri-County School District
To:
Casey E. Castillo
1 Wages, tips, other compensation
123,199.78",W-2,38,W-2,fdc-8eb36a76913e39415a495ee1,v11-W-2-stacked,original,2025,fgen-007da5910d1ffe7eeb64e858,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
2026
OMB No. 1545-0029
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 8832 Oak Hollow Ct Maplewood, MN 19657
b Employer identification number (EIN)
62-6698580
e Employee's first name and initial  Last name
Taylor Tanaka
a Employee's social security number
***-**-9980
Street address (including apt. no.)
8298 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 43493
2 Federal income tax withheld
7,266.32
3 Social security wages
$32,800.02
4 Social security tax withheld
2,705.18
5 Medicare wages and tips
127,448.64
6 Medicare tax withheld
4,548.21
12a See instructions for box 12
D 6,606.77
13 Retirement plan
☒
16 State wages, tips, etc.
$115,103.10
17 State income tax
$1,100.16
d Control number
404
Department of the Treasury - Internal Revenue Service
Form W-2
Wage and Tax Statement
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-fe2424bf94d9cc01a5dc817d,v11-W-2-stacked,original,2026,fgen-611d4b5307d8d0459f07abc8,synthetic_programmatic_template,stacked,bottom,False,
"OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy 2—To Be Filed WithEmployee's 5tate, City, or Local Income TaxRetum
c Employer's name, address, and ZIP code
GranitePeak Manufacturíng Co. 2937 Maple Ridge Dr Bayside, WA 44534
b Employer identification number (EIN)
25-l668494
e Employee's first name and initial  Last name
Riley Larsen
a Employee's socia1 security number
ending in 3667
Street address (induding apt. no.)
8315 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 60743
Account number (see instructions)
***-**-443373
l Wages,tips, other compensation
14,748.50
2 Federal income tax withheld
1,768.19
3 Social security wages
S44,529.45
5 Medicare wages and tips
127,457.15
12a See instructions for box 12
V 6,869.90
13 Rctirement plan
☐
15 State  Employer's state ID number
WI 8546949
16 State wages, tips, etc.
$45,051.94
17 State income tax
6,111.81
d Contro1 number
774
Department of theTreasury - Intemal Revenue Service",W-2,38,W-2,fdc-e0b07292aed7b41daa57075b,v11-W-2-stacked,original,2022,fgen-bb7121ee40bad20fd34b9eac,synthetic_programmatic_template,stacked,none,True,
"Form W-2 Wage and Tax Statement
c Employer:
Riverside Regional Hospital
Recipient's name:
Lena Walsh
17 State income tax
4,388.29
16 State wages, tips, etc.
$64,235.34",W-2,38,W-2,fdc-35e3da972aa7ee108e3740a5,v11-W-2-stacked,original,2025,fgen-eabeb6ef14b36a74a672b4ca,synthetic_programmatic_template,stacked,top,False,
"Form W-2
Wage and Tax Statement
For calendar year 2025
0MB No. 1545-0029
CopyB—To Be Fi1ed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City,or Local Income Tax Return
c Employer's name, address, and ZIP code
Acme Test Corp 7451 Lakeshore Blvd Lakewood, CO 19981
b Employer identification number (EIN)
10-8968327
e Employee's first name and initial Last name
Taylor R. Moreau
a Employee's socíal security number
XXX-XX-3433
Street address (including apt. no.)
5152 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Lakewood, C0 87491
1 Wages, tips, other compensation
$17,076.37
2 Federal income tax withheld
$1,065.50
3 5ocial securíty wages
14,094.78
4 Socia1 security tax withheld
601.74
5 Medicare wages and tips
$86,564.51
6 Medicare tax withheld
4,371.76
13 Retirement p1an
X
l5State  Employer'sstate ID number
GA 2845327
16 Statc wages, tips, etc.
101,756.87
17 State income tax
3,503.47
d Contro1 number
283
Department of the Treasury - Intemal Revenue Servíce
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-636d9e482dbe6d3b2e5f6ec7,v11-W-2-stacked,original,2025,fgen-fea867632cbfc46d00fce0dc,synthetic_programmatic_template,stacked,top,True,
"CORRECTED (if checked)
Form W-2
Wage and Tax Statement
2026
OMB No. 1545-0029
c Employer's name, address, and ZIP code
Tri-County School District 791 Elm Park Pl Cedar Falls, IA 24983
b Employer identification number (EIN)
17-8103887
e Employee's first name and initial  Last name
Kwame Lindqvist
a Employee's social security number
XXX-XX-1997
Street address (including apt. no.)
964 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 60408
1 Wages, tips, other compensation
53,433.29
2 Federal income tax withheld
$2,606.49
3 Social security wages
$32,648.05
4 Social security tax withheld
1,342.77
5 Medicare wages and tips
$42,423.59
6 Medicare tax withheld
$9,382.90
12a See instructions for box 12
AA 3,168.97
13 Retirement plan
☒
15 State  Employer's state ID number
WI 6292500
17 State income tax
6,515.98
d Control number
137
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-93990e9eef29db8b6a1e5249,v11-W-2-stacked,original,2026,fgen-a339c33194683615b034b06f,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
2026
OMB No. 1545-0029
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
c Employer's name, address, and ZIP code
Maple Street Dental PC 71 Sample Street Pinecrest, GA 40820
b Employer identification number (EIN)
97-3652227
e Employee's first name and initial  Last name
Olivia Tanaka
a Employee's social security number
ending in 0523
Street address (including apt. no.)
8618 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 90722
1 Wages, tips, other compensation
$76,777.11
2 Federal income tax withheld
$5,459.20
3 Social security wages
$81,532.85
4 Social security tax withheld
8,994.08
6 Medicare tax withheld
9,488.82
12a See instructions for box 12
V 7,381.79
13 Retirement plan
☐
15 State  Employer's state ID number
OH 4619863
17 State income tax
$8,579.94
d Control number
248",W-2,38,W-2,fdc-b43ccc747b651e3c047eba92,v11-W-2-stacked,original,2026,fgen-315c5c5e219fb6d0bdbea0b0,synthetic_programmatic_template,stacked,none,False,
"FormW-2
Wage and Tax Statement
2022
OMB No. 1545-0029
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Fíled With Employee's State, City, or Local Income Tax Retum
c Employer's name, address, and ZIP code: Maple Street Dental PC 84l6 Sample Street Fairview, OH 54574
b Emp1oyer identification number (EIN): 90-8678842
e Employee's fírst name and ínitial  Last name: Casey Nguyen
a Employee's social security number: XXX-XX-6550
Street address (including apt. no.): 83l6 Oak Hollow Ct
Cityor town, state or province, country, and ZIP or foreign postal code: Bayside, WA 58381
2 Federal íncome tax withheld: 9,339.80
4 Socia1 security tax withheld: 3,917.32
5 Medicare wages and tips: 22,706.83
6 Medicare tax withhe1d: S1,089.63
12a See instructions for box 12: V 3,360.25
13 Retirement plan: X
15 State Employer's state ID number: GA 3383971
17 State income tax: 6,446.63
d Contro1number: 824
Department of the Treasury - Intemal Revenue Service
Form W-2 (keep for yourrecords)  www.irs.gov/FormW2",W-2,38,W-2,fdc-b7f3da9e909801aa76e5c867,v11-W-2-boxed,original,2022,fgen-149b8d37a06c14379caebae1,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked)
For calendar year 2023
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code: Copperline Software Inc. 8338 Granite St Maplewood, MN 21971
b Employer identification number (EIN): 87-2549898
e Employee's first name and initial  Last name: Olivia C. Moreau
a Employee's social security number: XXX-XX-7739
Street address (including apt. no.): 6005 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Oak Grove, TX 66717
1 Wages, tips, other compensation: $116,610.08
3 Social security wages: $93,213.80
4 Social security tax withheld: 5,035.72
5 Medicare wages and tips: $125,130.75
6 Medicare tax withheld: 5,978.64
12a See instructions for box 12: W 8,235.05
15 State  Employer's state ID number: PA 1179747
16 State wages, tips, etc.: $123,849.60
17 State income tax: $539.28
d Control number: 782",W-2,38,W-2,fdc-0af046cdb6ed17154d6528e6,v11-W-2-boxed,original,2023,fgen-59ea5eb6d72ff52c222b686a,synthetic_programmatic_template,boxed,none,False,
"Form W-2
Wage and Tax Statement
2024
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code: Tri-County School District 7443 Lakeshore Blvd Testville, IL 60507
b Employer identification number (EIN): 52-7142839
e Employee's first name and initial  Last name: Olivia K. Fischer
a Employee's social security number: ***-**-3108
Street address (including apt. no.): 7898 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 92281
1 Wages, tips, other compensation: 129,155.92
2 Federal income tax withheld: 5,200.81
5 Medicare wages and tips: 125,314.32
6 Medicare tax withheld: 8,318.85
12a See instructions for box 12: AA 3,956.93
15 State  Employer's state ID number: OH 3763132
16 State wages, tips, etc.: 128,193.89",W-2,38,W-2,fdc-8dc47c205558b92004304cf3,v11-W-2-boxed,original,2024,fgen-9905551d7f1ef801a7536393,synthetic_programmatic_template,boxed,top,False,
"2026
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code: Blue Heron Logistics LLC 693 Harbor View Rd Cedar Falls, IA 13199
b Employer identification number (EIN): 62-4591256
e Employee's first name and initial  Last name: Noah Kowalski
a Employee's social security number: ****7837
Street address (including apt. no.): 3380 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 20577
1 Wages, tips, other compensation: 5,096.88
2 Federal income tax withheld: $1,567.43
3 Social security wages: 63,980.33
4 Social security tax withheld: $1,753.39
5 Medicare wages and tips: $133,788.28
12a See instructions for box 12: W 489.14
13 Retirement plan: [X]
15 State  Employer's state ID number: WI 2901065
16 State wages, tips, etc.: 7,256.72
17 State income tax: $5,561.93
d Control number: 506
Department of the Treasury - Internal Revenue Service",W-2,38,W-2,fdc-2d1a7780241d83b80351eb13,v11-W-2-boxed,original,2026,fgen-22466c53aad33f2ed098cf4b,synthetic_programmatic_template,boxed,none,False,
"CORRECTED (if checked)
Form W-2
Wage and Tax 5tatement
Forcalendar year 2024
OMB No. l545-0029
c Employer's name, address, and ZIP code: RiversideRegionalHospital 4768 Granite St Bayside, WA 45402
b Employcr identification number (EIN): 85-4094115
e Employce's first name and initial  Last name: Riley K. Sato
a Employee's social security number: ****6199
Street address (induding apt. no.): 4205 GraniteSt
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 93O72
Account number (see instructions): XXX-XX-869297
1 Wages, tips, other compensation: S119,175.15
3 Social security wages: $20,813.32
5 Medicare wages and tips: 12,85O.68
6 Mcdicare tax withheld: 2,225.45
12a See instructions for box 12: C 2,275.02
13 Retirement plan
15 5tate  Employer'sstate ID number: PA 1976587
16 State wages, tips, etc.: 132,713.64
17 State income tax: 6,062.37
d Control number: 90
Department of the Treasury - Intemal Revenue Servíce
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-2171ae03f6c4ff992f1f6922,v11-W-2-boxed,original,2024,fgen-6ddecb3355ef6692a0ab90ad,synthetic_programmatic_template,boxed,top,True,
"Form W-2
Wage and Tax Statement
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
c Employer's name, address, and ZIP code: Copperline Software Inc. 4695 Harbor View Rd Testville, IL 93129
b Employer identification number (EIN): 43-8443377
e Employee's first name and initial  Last name: Fatima D. Adeyemi
a Employee's social security number: ****3081
1 Wages, tips, other compensation: 34,759.59
2 Federal income tax withheld: 8,004.66
3 Social security wages: 60,057.45
4 Social security tax withheld: 3,166.47
5 Medicare wages and tips: 35,634.41
6 Medicare tax withheld: 3,741.44
12a See instructions for box 12: C 6,404.04
13 Retirement plan: [X]
15 State  Employer's state ID number: PA 2793764
16 State wages, tips, etc.: $43,317.23
17 State income tax: $4,768.85
d Control number: 38
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-0ab74bdeffc2545d754fc628,v11-W-2-boxed,original,2026,fgen-924b51ff7fadb74b2cf1b7ae,synthetic_programmatic_template,boxed,top,False,
"2022
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
c Employer's namc, address, and ZIP code: Acme Test Corp 8707 Prairie Ave Cedar Fa1ls, IA 33194
b Employeridentification number (EIN): 53-7054919
e Employee's first name and initial  Last name: Jordan Patel
aEmployee's social security number: ***-**-93O1
Street address (including apt. no.): 1707 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Bayside, WA 85210
Account number (see instructions): XXX-XX-328925
1 Wages, tips, other compensation: l16,569.91
2 Federal income tax withheld: 4,089.92
3 Social security wages: $27,661.73
4 Socíal security tax withheld: 4,221.59
5 Medicare wages and tips: 58,519.17
6 Medicare tax withhcld: $5,770.45
12a 5ce instructions for box 12: C 5,052.98
13 Retirement plan: X
15 State  Employer's state ID number: MN 9933969
17State income tax: $6,797.17
dControl number: 480
Department of the Treasury -Intemal Revenue 5ervice",W-2,38,W-2,fdc-8c98a37a647ac399aadd59e3,v11-W-2-boxed,original,2022,fgen-52aff3be4a3a36173514dc8d,synthetic_programmatic_template,boxed,none,True,
"Form W-2
Wage and Tax 5tatement
2026
OMB No. 1545-0029
Copy B—To Be Fíled With Employee'sFEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
c Employcr's name, address, and ZIP code: Tri-County Schoo1 District 2552 Elm Park Pl Brookhaven, PA 97l39
bEmployer identification number (EIN): 16-4328185
e Employee's first name and initial  Lastname: TaylorNguyen
a Employee's social security number: XXXXX0745
Account number (see instructions): ****448584
1 Wages, tips, other compensation: 34,593.72
2 Federa1 income tax withheld: 7,032.59
3 Socia1 security wages: 19,964.21
5 Medicare wages and tips: 39,025.39
6 Medicare tax withheld: S914.22
12a 5ee instructions for box 12: AA 1,584.45
15 State  Employer's state ID number: GA 6893408
16 State wages, tips, etc.: 112,578.11
17 State income tax: 1,002.56
d Control number: 271",W-2,38,W-2,fdc-c857e8bd66ee8971a4906017,v11-W-2-boxed,original,2026,fgen-d821300198eec9464e015212,synthetic_programmatic_template,boxed,top,True,
"From:: Granite Peak Manufacturing Co.
To:: Morgan K. Okafor
Line 16 State wages, tips, etc.: $52,100.82
Form W-2 Wage and Tax Statement",W-2,38,W-2,fdc-eee6b2e02cf0ed6a20bb4e22,v11-W-2-boxed,original,2025,fgen-c7936e31be923e19080edb0d,synthetic_programmatic_template,boxed,bottom,False,
"CORRECTED (if checked)
Form W-2
Wage and Tax Statement
For calendar year 2024
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
c Employer's name, address, and ZIP code: Blue Heron Logistics LLC 505 Elm Park Pl Riverton, WI 21855
b Employer identification number (EIN): 27-6038471
e Employee's first name and initial  Last name: Mateo Okafor
a Employee's social security number: ending in 6637
Line 1 Wages, tips, other compensation: $13,777.49
Line 2 Federal income tax withheld: $1,287.45
Line 3 Social security wages: $90,293.30
Line 4 Social security tax withheld: 2,298.57
Line 5 Medicare wages and tips: $13,073.22
Line 12a See instructions for box 12: AA 3,195.30
Line 13 Retirement plan
Line 15 State  Employer's state ID number: MN 8058890
Line 16 State wages, tips, etc.: 14,925.62
d Control number: 395",W-2,38,W-2,fdc-7380e3f74a430c27255eca25,v11-W-2-boxed,original,2024,fgen-c209242bf98b8e5e9221443c,synthetic_programmatic_template,boxed,top,False,
"Form W-2
Wage and Tax Statement
For calendar year 2025
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
c Employer's name, address, and ZIP code: Riverside Regional Hospital 3433 Cedar Ln Bayside, WA 89773
b Employer identification number (EIN): 54-3004987
e Employee's first name and initial  Last name: Olivia Patel
a Employee's social security number: ****2684
Street address (including apt. no.): 2984 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Pinecrest, GA 47027
1 Wages, tips, other compensation: $130,049.04
2 Federal income tax withheld: 7,173.99
3 Social security wages: $68,403.98
4 Social security tax withheld: $9,016.56
5 Medicare wages and tips: $56,413.49
6 Medicare tax withheld: $4,661.03
12a See instructions for box 12: D 4,824.21
13 Retirement plan: X
15 State  Employer's state ID number: MN 9126342
16 State wages, tips, etc.: 18,662.75
17 State income tax: 8,676.21
d Control number: 439
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-a18074ba0cdd728fa45d5f40,v11-W-2-boxed,original,2025,fgen-4856564e8b6b4cebb5c09541,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form W-2
Wage and Tax Statement
2021
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
c Employer's name, address, and ZIP code: Maple Street Dental PC 5637 Sample Street Lakewood, CO 53258
b Employer identification number (EIN): 49-8736732
e Employee's first name and initial  Last name: Hiro Moreau
a Employee's social security number: ****9464
Street address (including apt. no.): 5946 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code: Lakewood, CO 44530
Account number (see instructions): XXXXX482235
Line 1 Wages, tips, other compensation: 98,246.57
Line 2 Federal income tax withheld: $8,402.03
Line 3 Social security wages: 1,838.36
Line 4 Social security tax withheld: 5,158.17
Line 6 Medicare tax withheld: $900.03
Line 12a See instructions for box 12: C 4,695.68
Line 13 Retirement plan: X
Line 15 State  Employer's state ID number: IL 4860541
Line 16 State wages, tips, etc.: $96,079.54
Line 17 State income tax: $6,380.41
d Control number: 191",W-2,38,W-2,fdc-985bd49ff3fdb365dcfb6a25,v11-W-2-boxed,original,2021,fgen-229ff3c8f6c9bbb0c7c697a3,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
Form W-2
Wage and Tax Statement
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
c Employer's name, address, and ZIP code: Tri-County School District 68 Granite St Oak Grove, TX 92539
b Employer identification number (EIN): 52-9315217
e Employee's first name and initial  Last name: Mateo Larsen
a Employee's social security number: ending in 7869
1 Wages, tips, other compensation: 130,065.41
2 Federal income tax withheld: 2,867.75
4 Social security tax withheld: 5,811.61
5 Medicare wages and tips: 65,501.00
6 Medicare tax withheld: $1,554.77
12a See instructions for box 12: AA 1,398.07
13 Retirement plan: ☐
15 State  Employer's state ID number: IL 5632012
d Control number: 474
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-eb1742aa12ca19d56ba2ffec,v11-W-2-boxed,original,2025,fgen-a8024e9703ff473a16495af5,synthetic_programmatic_template,boxed,top,False,
"Form W-2
Wage and Tax Statement
For calendar year 2023
0MB No. 1545-0029
Copy B—To BeFiled With Employee's FEDERAL Tax Return.
c Employer's name, address, and ZIP code: Blue Heron Logistics LLC 4203 Wíllow Bend Way Brookhavcn, PA 73184
b Employer identification number (EIN): 62-l413480
e Employee's first name and initial  Last name: Mateo Nguyen
a Employee's social security number: ***-**-7292
Accountnumber (see instructions): endingin 055775
Line 1 Wages, tips, other compensation: $131,496.53
Line 2 Federa1 income tax withhe1d: $6,432.88
Line 3 5ocial security wages: $12,681.30
Line 4 5ocial security tax withheld: 124.49
Line 6 Medicare tax withheld: 2,700.23
Line 12a See instructionsfor box 12: V 7,059.48
Line 13 Retirement plan: [X]
Line 16 5tate wages, tips, etc.: $125,358.07
Líne 17 State income tax: $3,241.82
d Control number: 515",W-2,38,W-2,fdc-a0f47926658b1b9104e76aa0,v11-W-2-boxed,original,2023,fgen-5dac1080342e2b81ecd3e623,synthetic_programmatic_template,boxed,top,True,
"CORRECTED (if checked)
Form W-2
Wage and Tax Statement
For calendar year 2025
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code: Tri-County School District 141 Granite St Oak Grove, TX 67315
b Employer identification number (EIN): 26-1557188
e Employee's first name and initial  Last name: Jordan M. Nguyen
a Employee's social security number: XXXXX4294
Street address (including apt. no.): 2389 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code: Cedar Falls, IA 72797
Box 1 Wages, tips, other compensation: $85,712.26
Box 2 Federal income tax withheld: 6,206.72
Box 3 Social security wages: 134,129.36
Box 4 Social security tax withheld: $4,354.16
Box 6 Medicare tax withheld: $1,642.51
Box 12a See instructions for box 12: V 2,393.05
Box 15 State  Employer's state ID number: IL 8905235
Box 16 State wages, tips, etc.: $81,502.58
d Control number: 326
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-bf7dd22d8e6bf04f3a6f7b2a,v11-W-2-boxed,original,2025,fgen-5a956bd949f917a93dfed0bd,synthetic_programmatic_template,boxed,top,False,
"☐ CORRECTED
Form W-2
Wage and Tax Statement
2021
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
c Employer's name, address, and ZIP code: Acme Test Corp 2835 Granite St Fairview, OH 98406
b Employer identification number (EIN): 95-1797622
e Employee's first name and initial  Last name: Fatima B. Larsen
a Employee's social security number: ending in 6469
Street address (including apt. no.): 4038 Sample Street
City or town, state or province, country, and ZIP or foreign postal code: Riverton, WI 34088
Account number (see instructions): XXXXX869118
1 Wages, tips, other compensation: $106,941.38
2 Federal income tax withheld: 7,007.03
3 Social security wages: 1,962.07
4 Social security tax withheld: $2,848.97
5 Medicare wages and tips: 97,988.83
6 Medicare tax withheld: 8,128.29
12a See instructions for box 12: C 722.64
13 Retirement plan
16 State wages, tips, etc.: 117,656.40
17 State income tax: 6,650.18
d Control number: 178
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-84d498f502fc164feb242632,v11-W-2-boxed,original,2021,fgen-3dfade429e5b72e1e6321020,synthetic_programmatic_template,boxed,top,False,
"Form W-2 Wage and Tax Statement For calendar year 2026 OMB No. 1545-0029 Copy B—To Be Filed With Employee's FEDERAL Tax Return. Copy C—For EMPLOYEE'S RECORDS Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c Employer's name, address, and ZIP code Acme Test Corp 5049 Sample Street Bayside, WA 15996 b Employer identification number (EIN) 32-5057592 e Employee's first name and initial Last name Alex K. Sato a Employee's social
security number XXXXX3196 Account number (see instructions) XXX-XX-234951 1 Wages,
tips, other compensation 85,854.46 2 Federal income tax withheld $2,385.20 3 Social security wages $57,229.67 4 Social security tax withheld $8,608.62 5 Medicare wages and tips $75,827.87 6 Medicare tax withheld $4,944.39 12a See instructions for box 12 V 8,782.39 13 Retirement plan ☒ 15 State Employer's state ID number MN 8319783 d Control number 566",W-2,38,W-2,fdc-ef0c02d9ed4340aee3adb4aa,v11-W-2-flat,original,2026,fgen-153855f8224184f84596f542,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and Tax Statement Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c Employer's name, address, and ZIP code Coppcrline Software Inc. 9304 Sample Street Brookhavcn, PA
92078 b Emp1oyer identification number (EIN) 51-9686286 c Employee's first name and initial Last name Wei S. Rivera a Employee's social security number***-**-1415
Street address (induding apt. no.) 798 Wi1lowBend Way City or town, state or province, country, and ZIP or forcign postal code Pinecrest, GA 6232l 1 Wages, tips, other compensation 97,606.93 2 Federal income tax withheld $8,947.18 12a Seeinstructions for box 12 AA 622.5415 State Employer's state ID number GA 5l73091 16 State wages, tips, etc. 96,772.25 17 State income tax $5,019.48 d Control number 593",W-2,38,W-2,fdc-3236936469cde48dcc70f4f2,v11-W-2-flat,original,2024,fgen-6e94afb33bdfb85ae4e98428,synthetic_programmatic_template,flat,top,True,
"Form W-2 Wage and Tax Statement 2022 OMB No. 1545-0029 Copy B—To Be Filed With Employee's FEDERAL Tax Retum. c Employer's name, address, and ZIP code Maple Street DentalPC 747 Maple Ridge Dr Pinecrest, GA 21502 b Employer identification number (EIN) 46-6570919 e Employee's fírst name and initial Last name Taylor Brennan a Employee's
social security number ***-**-1854 Street address (induding apt. no.) 9652 Ccdar Ln City or town, state or province, country, and ZIP or foreign posta1 code Pinecrest, GA 18671 Account numbcr (seeinstructions) endingin 650499 1 Wages, tips, other compensation 52,131.022 Federal income tax withheld 6,634.98 3 5ocial security wages 55,094.41 4 Social
security tax withheld 516.48 5 Medicare wages and tips 5,105.86 6 Medícare tax withheld $7,375.28 12a See instructions for box 12 V 554.98 13 Retirement plan ☐ 15 State Employer's state ID number TX 8714367 16 State wages, típs, etc. $45,027.49 17 State income tax $9,171.92 dControl number 280 Department of the Treasury - Intemal Revenue ServíceForm W-2 (keep for your records) www.irs.gov/FormW2",W-2,38,W-2,fdc-060bab03d5d1d19aaf6b0259,v11-W-2-flat,original,2022,fgen-8e33abaa9bef738c1c9b104a,synthetic_programmatic_template,flat,top,True,
"Form W-2 Wage and Tax Statement OMB No. 1545-0029 Copy C—For EMPLOYEE'S RECORDS Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c Employer's name, address, and ZIP code Acme Test Corp 7347 Harbor View Rd Lakewood, CO 75040 b Employer identification number (EIN) 62-7102231 e Employee's first name and initial Last name Fatima E. Patel a Employee's social security number ****9094 Street address
(including apt. no.) 4861 Maple
Ridge Dr City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 94577 Account number (see instructions) ****678292 1 Wages, tips, other compensation $111,829.47 2 Federal income tax withheld $6,845.93 3 Social security wages 37,689.12 4 Social security tax withheld 5,974.62 5 Medicare wages and tips 81,391.44 12a See instructions for box 12 D 2,872.76 13 Retirement plan ☒ 15 State Employer's state ID number TX 1425695 16 State wages, tips, etc. $88,621.20 17 State income tax $7,779.94 d Control number 750 Department of the Treasury - Internal Revenue Service Form W-2 (keep for your records) www.irs.gov/FormW2",W-2,38,W-2,fdc-a0024260f1f0903476d55225,v11-W-2-flat,original,2025,fgen-f7dc022152f86cb151efbd58,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and Tax Statement Copy C—For EMPLOYEE'S RECORDS Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c Employer's
name, address, and ZIP code Copperline Software Inc. 3976 Oak Hollow Ct Oak Grove, TX 82690 b Employer identification number (EIN) 55-3701426 e Employee's first name and initial Last name Wei Castillo a Employee's social security number ****7754 1 Wages, tips, other compensation 90,019.89 2 Federal income tax withheld 1,932.75 3 Social security wages $62,356.77 4 Social security tax withheld $2,326.34 5 Medicare wages and tips $18,204.16 6 Medicare tax withheld 3,123.07 13 Retirement plan X 15 State Employer's
state ID number MN 2954881 16 State wages, tips, etc. $67,956.79 17 State income tax $8,778.35 d Control number 771 Department of the Treasury - Internal Revenue Service Form W-2 (keep for your records) www.irs.gov/FormW2",W-2,38,W-2,fdc-37d3562fd7db266daadd87ac,v11-W-2-flat,original,2023,fgen-002dd6525104ce70fef1aea4,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and
Tax Statement 2023 c Employer'S name:
Tri-County School District Recipient's name: Morgan Larsen 5 Medicare wages and tips $86,460.57",W-2,38,W-2,fdc-1cb1c399cf8809e618854bf7,v11-W-2-flat,original,2023,fgen-609c184f7439892d91ef4804,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and Tax Statement For calendar year 2023 OMB No. 1545-0029 c Employer's name, address, and ZIP code Tri-County School District 7389 Sample Street Maplewood, MN 25974 b Employer identification number (EIN) 77-3268196 e Employee's first name and initial Last name Kwame Testcase a Employee's social security number ****6925 Street address (including apt. no.) 291 Lakeshore Blvd City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 28978 1 Wages, tips, other compensation 2,712.36 2 Federal income
tax withheld 8,311.05 3 Social security wages $120,607.57 4 Social security tax withheld $5,883.77 5 Medicare wages and tips 16,550.17 6 Medicare tax withheld 4,388.50 12a See instructions for box 12 AA
525.97 13 Retirement plan ☒ 16 State wages, tips, etc. 105,226.43 17 State income tax 126.91 d Control number 633",W-2,38,W-2,fdc-08adf92b5807eefe1ad3b52c,v11-W-2-flat,original,2023,fgen-98a2b589b68b4f0af91a7acc,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and Tax Statement 2022 Copy B—To Be Filed With Employee's FEDERAL Tax Return. Copy C—For EMPLOYEE'S RECORDS Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c Employer's name, address, and ZIP code Maple Street Dental PC 2000 Harbor View Rd Riverton, WI 18431 b Employer identification number (EIN) 18-6702811 e Employee's first name and initial Last name Jamie A. Patel a Employee's social security number ****4050 3 Social security wages 15,569.37 4 Social security tax withheld 1,928.74 5 Medicare wages and tips $127,159.61 6 Medicare tax withheld 231.42 12a See instructions for box 12 C 7,737.48 13 Retirement plan ☒ 15 State Employer's state ID number OH 8350491 16 State
wages, tips, etc. 44,240.27 17 State income tax 1,901.19 d Control number 746 Department of the Treasury - Internal
Revenue Service Form W-2 (keep for your records) www.irs.gov/FormW2",W-2,38,W-2,fdc-a88dd6e1c2702fda8a410110,v11-W-2-flat,original,2022,fgen-ce261fa7432667a00307cfdb,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and Tax Statement 2025 c Employer:
Copperline Software Inc. Recipient's name: Diego Okafor 3 Social security wages $138,660.35 4 Social security tax withheld $5,993.31 15
State Employer's state ID number CO 6048779 17 State income tax 1,386.53",W-2,38,W-2,fdc-5d00aa53fe261c72e6927429,v11-W-2-flat,original,2025,fgen-a3dac9bae106ce35afcaa6f7,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Form W-2 Wage and Tax Statement 2024 Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c Employer's name, address, and ZIP code Acme Test Corp 1339 Willow Bend Way Testville, IL 85044 b Employer identification number (EIN) 83-3480729 e Employee's first name and initial Last name Lena C. Tanaka a Employee's social security number XXX-XX-8404 Street address (including apt. no.) 7919 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Bayside, WA 46594 1 Wages, tips, other compensation 75,126.97 2 Federal income tax withheld 3,974.24 3 Social security wages 59,806.91 5
Medicare wages and tips $115,009.52 6 Medicare tax withheld $8,430.99 12a See instructions for box 12 DD 8,876.35 13 Retirement plan ☒ 16 State wages, tips, etc. 77,574.13 17 State income tax 4,566.94 d Control number 379 Department of the Treasury - Internal Revenue Service Form
W-2 (keep for your records) www.irs.gov/FormW2",W-2,38,W-2,fdc-c02490ac020877b6499a8152,v11-W-2-flat,original,2024,fgen-e586a6ee3b521e4786b740db,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and
Tax Statement 2021 From: Blue Heron Logistics LLC RECIPIENT: Lena Castillo 17 State income tax 7,583.26 5 Medicare wages and tips 129,279.64
6 Medicare tax withheld $5,493.41 4 Social security tax withheld $610.99",W-2,38,W-2,fdc-5b9932e03b1e6e5b31b3ab36,v11-W-2-flat,original,2021,fgen-81b8d8bc36daf4600a4f97a8,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and Tax Statement 2025 OMB No. 1545-0029 Copy B—To Be Filed With Employee's FEDERAL Tax Return. Copy C—For EMPLOYEE'S RECORDS Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c Employer's name, address, and ZIP code Granite Peak Manufacturing Co. 7079 Maple Ridge
Dr Cedar Falls, IA 43699 b Employer identification number (EIN) 96-6903951 e Employee's first name and initial Last name Priya Haddad a Employee's social security number ****1230 Street
address (including apt. no.) 3623 Cedar Ln City or town, state or province, country, and ZIP or foreign postal code Testville, IL 34761 Account number (see instructions) XXXXX706019 3 Social security wages 13,512.93 4 Social security tax withheld 6,864.40 5 Medicare wages and tips $12,245.45 6 Medicare tax withheld $516.78 16 State wages, tips, etc. 50,425.60 17 State income tax $4,316.08",W-2,38,W-2,fdc-5208a201eaeac2d8b1a88fcc,v11-W-2-flat,original,2025,fgen-8a97e794025340671e81fa6c,synthetic_programmatic_template,flat,top,False,
"OMB No. 1545-0029 Copy B—To Be Filed With Employee's FEDERAL Tax Return. c Employer's name, address, and ZIP code Riverside Regional Hospital 7296 Oak Hollow Ct Maplewood, MN 16867 b Employer identification number (EIN) 85-8908758 e Employee's first name and initial Last name Alex Adeyemi a Employee's social security number ending in 5815
Street address (including apt. no.) 5099 Willow Bend Way City or town,
state or province, country, and ZIP or foreign postal code Maplewood, MN 56101 Account number (see instructions) ***-**-251066 1 Wages, tips, other compensation $32,309.21 2 Federal income tax withheld 8,074.49 3 Social security wages $111,584.60 4 Social security tax withheld $7,509.05 5 Medicare wages and tips 20,673.32 6 Medicare tax withheld 395.01 12a See instructions for box 12 C 2,030.37 13 Retirement plan ☐ 15 State Employer's state ID number IL 1466809 16 State wages, tips, etc. 38,986.17 17 State income tax 3,324.80 d Control number 788 Department of the Treasury - Internal Revenue Service",W-2,38,W-2,fdc-207e03292825c448f626e9b7,v11-W-2-flat,original,2025,fgen-e59caec32b52b08da6c22d84,synthetic_programmatic_template,flat,none,False,
"c Employer'S name: Acme Test Corp
Recipient's name: Hiro Walsh 5 Medicare wages and tips
$25,110.39 Form W-2 Wage and Tax Statement",W-2,38,W-2,fdc-c7a640a9331c82f172a4c802,v11-W-2-flat,original,2024,fgen-bdd1edca48176deb87117901,synthetic_programmatic_template,flat,bottom,False,
"c Employer'S name: Tri-County School District To: Jordan
Rivera
12a See instructions for box 12 W 2,420.83 6 Medicare tax withheld 7,828.28 Form W-2 Wage and Tax Statement",W-2,38,W-2,fdc-6130e0b373ea334e3dd208dc,v11-W-2-flat,original,2024,fgen-631dedc389cc64263f291a3b,synthetic_programmatic_template,flat,bottom,False,
"Form W-2 Wage and Tax Statement 2021 OMB No. 1545-0029 Copy C—For EMPLOYEE'S RECORDS Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return c
Employer's
name, address, and ZIP code Acme Test Corp 6257 Cedar Ln Brookhaven, PA 40608 b Employer identification number (EIN) 29-5072043 e Employee's first name and initial Last name Diego Nguyen a Employee's social security number XXX-XX-6795 Street address (including apt. no.) 274 Granite St City or town, state or province, country, and ZIP or foreign postal code Pinecrest, GA 50139 Account number (see instructions) XXX-XX-484595 1 Wages, tips, other compensation 48,327.70 2 Federal income tax withheld 5,508.59 3 Social security wages $62,557.87 4 Social security tax withheld 3,266.70 6 Medicare tax withheld $6,543.08 12a See instructions for box 12 W 6,557.28 13 Retirement plan 15 State Employer's state ID number WI 8010931 16 State wages, tips, etc. 86,217.94 d Control number 617 Department of the Treasury - Internal Revenue Service Form W-2 (keep for your records) www.irs.gov/FormW2",W-2,38,W-2,fdc-efed076028e829f294d9d24c,v11-W-2-flat,original,2021,fgen-3b888cb3c0ccf4c42489f919,synthetic_programmatic_template,flat,top,False,
"Form W-2 Wage and Tax Statement
| Field | Value |
| --- | --- |
| From: | Maple Street Dental PC |
| Recipient's name: | Sofia E. Lindqvist |
| 2 Federal income tax withheld | 4,385.29 |
| 1 Wages, tips, other compensation | $37,435.93 |
| 13 Retirement plan | [X] |
| 15 State  Employer's state ID number | WI 8434449 |",W-2,38,W-2,fdc-4c08e99c9348718fb115c6ea,v11-W-2-markdown,original,2022,fgen-91bf03ad31babe1bd5c49ae0,synthetic_programmatic_template,markdown,top,False,
"## Form W-2 Wage and Tax Statement 2024
| Field | Value |
| --- | --- |
| c Employer'S name: | Maple Street Dental PC |
| To: | Amara Sato |
| 6 Medicare tax withheld | 7,672.43 |",W-2,38,W-2,fdc-74511fa1f7b275cacb3dae77,v11-W-2-markdown,original,2024,fgen-d8224564f2e28bef56cc6ef2,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
## 2024
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Tri-County School District 1149 Lakeshore Blvd Lakewood, CO 60859 |
| b Employer identification number (EIN) | 56-4787707 |
| e Employee's first name and initial  Last name | Priya Walsh |
| a Employee's social security number | ***-**-4680 |
| Street address (including apt. no.) | 1296 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 13323 |
| 1 Wages, tips, other compensation | 87,407.63 |
| 2 Federal income tax withheld | $8,504.07 |
| 4 Social security tax withheld | 6,685.74 |
| 5 Medicare wages and tips | $41,936.88 |
| 6 Medicare tax withheld | 2,836.43 |
| 12a See instructions for box 12 | W 6,615.53 |
| 15 State  Employer's state ID number | WI 9920173 |
| 17 State income tax | $3,812.52 |
| d Control number | 682 |
## Form W-2
## Wage and Tax Statement",W-2,38,W-2,fdc-41018aa444eec5c6227fac09,v11-W-2-markdown,original,2024,fgen-ad939653bd416773362a0ca4,synthetic_programmatic_template,markdown,bottom,False,
"OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
## Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Maple Street Dental PC 2787 Prairie Ave Lakewood, CO 90159 |
| b Employer identification number (EIN) | 72-1966712 |
| e Employee's first name and initial  Last name | Jordan Moreau |
| a Employee's social security number | ***-**-8214 |
| 2 Federal income tax withheld | 1,207.46 |
| 3 Social security wages | $55,421.75 |
| 4 Social security tax withheld | $7,242.74 |
| 5 Medicare wages and tips | $109,735.17 |
| 6 Medicare tax withheld | 4,462.11 |
| 12a See instructions for box 12 | W 6,967.79 |
| 13 Retirement plan | [X] |
| 15 State  Employer's state ID number | PA 8388614 |
| 16 State wages, tips, etc. | $43,836.75 |
| 17 State income tax | 8,678.57 |
| d Control number | 242 |
Department of the Treasury - Internal Revenue Service",W-2,38,W-2,fdc-2e00dc26ffec0b3af7fea007,v11-W-2-markdown,original,2021,fgen-5e7ef62c0eddaf37532c6cb6,synthetic_programmatic_template,markdown,none,False,
"## 2026
OMB No. 1545-0029
## Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Maple Street Dental PC 5485 Maple Ridge Dr Lakewood, CO 24659 |
| b Employer identification number (EIN) | 38-8966848 |
| e Employee's first name and initial  Last name | Riley Tanaka |
| a Employee's social security number | ****8921 |
| Street address (including apt. no.) | 3291 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 33906 |
| 1 Wages, tips, other compensation | 77,457.56 |
| 2 Federal income tax withheld | $1,680.31 |
| 4 Social security tax withheld | $6,880.26 |
| 5 Medicare wages and tips | 39,940.28 |
| 6 Medicare tax withheld | 3,080.21 |
| 13 Retirement plan | ☐ |
| 15 State  Employer's state ID number | OH 8157807 |
| 16 State wages, tips, etc. | 14,999.33 |
| d Control number | 837 |",W-2,38,W-2,fdc-8ce2422cf01d9a035159123a,v11-W-2-markdown,original,2026,fgen-b2a8747c8608f32966d1a4bb,synthetic_programmatic_template,markdown,none,False,
"Form W-2
Wage and Tax Statement
For calendar year 2024
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Maple Street Dental PC 9294 Maple Ridge Dr Lakewood, CO 97839 |
| b Employer identification number (EIN) | 15-2922050 |
| e Employee's first name and initial  Last name | Morgan Kowalski |
| a Employee's social security number | XXX-XX-4299 |
| Street address (including apt. no.) | 7216 Elm Park Pl |
| City or town, state or province, country, and ZIP or foreign postal code | Riverton, WI 58623 |
| 1 Wages, tips, other compensation | $78,233.90 |
| 3 Social security wages | 59,223.34 |
| 4 Social security tax withheld | $9,059.33 |
| 5 Medicare wages and tips | 118,348.43 |
| 6 Medicare tax withheld | 7,530.42 |
| 12a See instructions for box 12 | D 8,061.31 |
| 13 Retirement plan | ☒ |
| 15 State  Employer's state ID number | GA 5873432 |
| 16 State wages, tips, etc. | $32,669.37 |
| 17 State income tax | $8,381.82 |",W-2,38,W-2,fdc-be1084e8f77f85dc5d5ed4fc,v11-W-2-markdown,original,2024,fgen-cb1a1062b24658c1c52e79af,synthetic_programmatic_template,markdown,top,False,
"## Form W-2
Wage and Tax Statement
2024
OMB No. 1545-0029
Copy C—For EMPLOYEE'S RECORDS
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Acme Test Corp 8255 Cedar Ln Oak Grove, TX 97600 |
| b Employer identification number (EIN) | 34-7876689 |
| e Employee's first name and initial  Last name | Alex Nguyen |
| a Employee's social security number | ****2701 |
| Street address (including apt. no.) | 3087 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 79650 |
| 1 Wages, tips, other compensation | 95,843.02 |
| 2 Federal income tax withheld | $845.72 |
| 3 Social security wages | 128,589.01 |
| 4 Social security tax withheld | 2,268.02 |
| 6 Medicare tax withheld | 8,202.05 |
| 12a See instructions for box 12 | DD 1,529.35 |
| 13 Retirement plan | [X] |
| 15 State  Employer's state ID number | WI 2222147 |
| 17 State income tax | 3,435.82 |
| d Control number | 375 |
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-f0f87e5204f1bddaa26e6028,v11-W-2-markdown,original,2024,fgen-4833d8cb1b9dcc236a8d33e0,synthetic_programmatic_template,markdown,top,False,
"## 2026
## OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
## Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Tri-County School District 3629 Willow Bend Way Pinecrest, GA 77674 |
| b Employer identification number (EIN) | 22-5466715 |
| e Employee's first name and initial  Last name | Avery K. Walsh |
| a Employee's social security number | ***-**-9032 |
| Street address (including apt. no.) | 7767 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 58704 |
| 1 Wages, tips, other compensation | 134,671.28 |
| 2 Federal income tax withheld | $1,845.75 |
| 3 Social security wages | $18,136.92 |
| 4 Social security tax withheld | $1,230.06 |
| 5 Medicare wages and tips | $74,140.99 |
| 6 Medicare tax withheld | 3,007.98 |
| 12a See instructions for box 12 | DD 2,286.02 |
| 13 Retirement plan | X |
| 15 State  Employer's state ID number | GA 9186624 |
| 16 State wages, tips, etc. | $43,384.59 |
| 17 State income tax | 7,744.09 |
Form W-2
Wage and Tax Statement",W-2,38,W-2,fdc-7dcca94fa56ea8d980983093,v11-W-2-markdown,original,2026,fgen-56ba0dddc633e2f250d3f38a,synthetic_programmatic_template,markdown,bottom,False,
"☐ CORRECTED
## Form W-2
## Wage and Tax Statement
2022
## OMB No. 1545-0029
## Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Granite Peak Manufacturing Co. 4093 Lakeshore Blvd Pinecrest, GA 54186 |
| b Employer identification number (EIN) | 14-4317786 |
| e Employee's first name and initial  Last name | Wei Walsh |
| a Employee's social security number | ****3935 |
| 1 Wages, tips, other compensation | $36,805.45 |
| 2 Federal income tax withheld | 6,876.23 |
| 3 Social security wages | $63,185.71 |
| 4 Social security tax withheld | 1,798.94 |
| 5 Medicare wages and tips | 6,220.93 |
| 6 Medicare tax withheld | $4,188.16 |
| 13 Retirement plan |  |
| 15 State  Employer's state ID number | MN 9258034 |
| 16 State wages, tips, etc. | $38,009.24 |
| 17 State income tax | 9,339.91 |
| d Control number | 668 |
Department of the Treasury - Internal Revenue Service
## Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-647cdddf9d8b9b8cfdf97976,v11-W-2-markdown,original,2022,fgen-12d022d82244afa894b57079,synthetic_programmatic_template,markdown,top,False,
"Form W-2
Wage and Tax Statement
2023
## OMB No. 1545-0029
Copy C—For EMPLOYEE'S RECORDS
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Copperline Software Inc. 6585 Sample Street Bayside, WA 86459 |
| b Employer identification number (EIN) | 21-2486146 |
| e Employee's first name and initial  Last name | Wei K. Brennan |
| a Employee's social security number | XXX-XX-4051 |
| Street address (including apt. no.) | 930 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 32421 |
| Account number (see instructions) | ****361082 |
| 1 Wages, tips, other compensation | $46,399.54 |
| 3 Social security wages | $130,942.68 |
| 4 Social security tax withheld | 3,570.20 |
| 5 Medicare wages and tips | $15,950.97 |
| 6 Medicare tax withheld | $7,378.20 |
| 12a See instructions for box 12 | AA 7,349.70 |
| 16 State wages, tips, etc. | 19,357.67 |
| 17 State income tax | $1,884.87 |
| d Control number | 849 |
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-7cecbbc943efe91a5144208e,v11-W-2-markdown,original,2023,fgen-476cd0fdc3f280a45e7f9244,synthetic_programmatic_template,markdown,top,False,
"## ☐ CORRECTED
Form W-2
## Wage and Tax Statement
2021
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Acme Test Corp 4641 Willow Bend Way Pinecrest, GA 55291 |
| b Employer identification number (EIN) | 50-6416892 |
| e Employee's first name and initial  Last name | Hiro Moreau |
| a Employee's social security number | XXXXX1286 |
| Account number (see instructions) | ending in 914777 |
| 2 Federal income tax withheld | 7,055.59 |
| 3 Social security wages | 25,290.16 |
| 4 Social security tax withheld | 6,978.12 |
| 5 Medicare wages and tips | 10,959.60 |
| 6 Medicare tax withheld | 8,062.56 |
| 12a See instructions for box 12 | AA 7,629.22 |
| 15 State  Employer's state ID number | MN 6493879 |
| 16 State wages, tips, etc. | $136,649.99 |
| 17 State income tax | 4,097.10 |
| d Control number | 819 |",W-2,38,W-2,fdc-99231445260c9869e531f75a,v11-W-2-markdown,original,2021,fgen-42d486c45b33b82261e4b9b3,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| From: | Acme Test Corp |
| Recipient's name: | Jordan Nguyen |
| 1 Wages, tips, other compensation | $1,814.74 |
| 5 Medicare wages and tips | 60,306.75 |",W-2,38,W-2,fdc-cfde62471996c1c6680a2864,v11-W-2-markdown,original,2026,fgen-eefab945a77f02ec1a3c1b65,synthetic_programmatic_template,markdown,none,False,
"Form W-2
Wage and Tax Statement
## For calendar year 2022
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Blue Heron Logistics LLC 4818 Elm Park Pl Lakewood, CO 11902 |
| b Employer identification number (EIN) | 50-1980973 |
| e Employee's first name and initial  Last name | Olivia S. Brennan |
| a Employee's social security number | ending in 6732 |
| Street address (including apt. no.) | 6020 Willow Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 18901 |
| Account number (see instructions) | XXX-XX-005815 |
| 3 Social security wages | $127,403.07 |
| 4 Social security tax withheld | $615.68 |
| 5 Medicare wages and tips | $75,277.35 |
| 12a See instructions for box 12 | V 6,123.35 |
| 13 Retirement plan | ☐ |
| 17 State income tax | 5,212.46 |
| d Control number | 427 |
Department of the Treasury - Internal Revenue Service
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-38c90f04281f9bc2dea50287,v11-W-2-markdown,original,2022,fgen-d3ae697af9bba4933ee1cc1a,synthetic_programmatic_template,markdown,top,False,
"## Form W-2
## Wage and Tax Statement
##For calendar year 2024
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPL0YEE'S RECORDS
Copy 2—To Bc Filcd With Employee's State, City, or Local Income Tax Return
| Field | Value|
| --- | --- |
| c Employer's name, address, and ZIP code | Copperline Software Inc. 646 Maple Ridge Dr Brookhaven, PA 774l5 |
| b Employcr identification number (EIN) | 8l-37075l8 |
| e Emp1oyee's first name and initial  Last name | Taylor Adeyemi |
| a Employee's social security number | endingin 1O51 |
| Street address (including apt. no.) | 2744 PrairieAve |
| City or town, statc or province, country, and ZIP or foreign postal code | Fairview, OH 75314 |
| 1 Wages, tips, other compensation | $111,768.83 |
| 2 Federal income tax withheld | 4,l39.47 |
| 3 Social security wages | $77,4O2.93 |
| 4 Social security tax withheld | 7,668.44 |
| 5 Medicare wages and tips | 1O,603.63 |
| 6 Medicare tax withheld | $9,252.89 |
| 12a See ínstructions for box 12 | AA 212.07|
| 15State  Emp1oyer's state ID number | WI 6445979 |
| 17 State income tax | 2,320.34 |
| d Control number |149 |
Dcpartment of the Treasury - Internal Revenue Service
Form W-2 (keep foryour records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-ac3e5b5aeb89f0b9133a2c44,v11-W-2-markdown,original,2024,fgen-80572ce1d423c703feba640f,synthetic_programmatic_template,markdown,top,True,
"☐ CORRECTED
Form W-2
Wage and Tax Statement
For calendar year 2025
OMB No. 1545-0029
Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Blue Heron Logistics LLC 4084 Harbor View Rd Pinecrest, GA 22803 |
| b Employer identification number (EIN) | 10-2602265 |
| e Employee's first name and initial  Last name | Lena Castillo |
| a Employee's social security number | ****1520 |
| Street address (including apt. no.) | 8524 Prairie Ave |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 64170 |
| 1 Wages, tips, other compensation | 94,364.34 |
| 3 Social security wages | $60,572.41 |
| 4 Social security tax withheld | 2,121.20 |
| 5 Medicare wages and tips | 3,921.36 |
| 6 Medicare tax withheld | 6,913.07 |
| 12a See instructions for box 12 | W 3,638.79 |
| 13 Retirement plan |  |
| 15 State  Employer's state ID number | IL 7208423 |
| 16 State wages, tips, etc. | 95,651.16 |
| 17 State income tax | 3,053.76 |",W-2,38,W-2,fdc-1c6b14ff1852550c55b9a9e8,v11-W-2-markdown,original,2025,fgen-906056479dd119b155077be5,synthetic_programmatic_template,markdown,top,False,
"## 2022
OMB No. 1545-0029
## Copy B—To Be Filed With Employee's FEDERAL Tax Return.
Copy C—For EMPLOYEE'S RECORDS
Copy 2—To Be Filed With Employee's State, City, or Local Income Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Granite Peak Manufacturing Co. 8834 Cedar Ln Riverton, WI 85216 |
| b Employer identification number (EIN) | 24-9234914 |
| e Employee's first name and initial  Last name | Olivia S. Okafor |
| a Employee's social security number | ****6985 |
| 2 Federal income tax withheld | 7,527.31 |
| 3 Social security wages | 136,277.29 |
| 4 Social security tax withheld | 8,185.97 |
| 5 Medicare wages and tips | 10,648.63 |
| 6 Medicare tax withheld | $5,495.94 |
| 12a See instructions for box 12 | W 8,066.21 |
| 13 Retirement plan | X |
| 15 State  Employer's state ID number | MN 8793629 |
| 16 State wages, tips, etc. | $102,489.89 |
| 17 State income tax | $7,440.18 |
| d Control number | 712 |
## Department of the Treasury - Internal Revenue Service
Form W-2
## Wage and Tax Statement
Form W-2 (keep for your records)  www.irs.gov/FormW2",W-2,38,W-2,fdc-a1f1e0d5b1ec538016b9739e,v11-W-2-markdown,original,2022,fgen-9a3d27e3eeec882aa448220e,synthetic_programmatic_template,markdown,bottom,False,
"Form W-2c
Corrected Wage and Tax Statement
2022
OMB No. 1545-0008
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 3003 Prairie Ave Fairview, OH 47018
b Employer's Federal EIN
97-7968941
f Employee's first name and initial  Last name
Sofia Kowalski
d Employee's correct SSN
XXX-XX-2592
Street address (including apt. no.)
1410 Sample Street
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 78763
Account number (see instructions)
ending in 067961
a Tax year/Form corrected
2022
1 Wages, tips, other compensation  Previously reported
$76,121.19
1 Wages, tips, other compensation  Correct information
$23,086.62
2 Federal income tax withheld  Previously reported
$8,521.49
2 Federal income tax withheld  Correct information
$4,012.54
3 Social security wages  Previously reported
5,074.05
3 Social security wages  Correct information
$129,960.60",W-2,38,W-2,fdc-d45323535025e066f8945e7f,v11-W-2C-stacked,corrected,2022,fgen-c6ad0020af66941c7389f713,synthetic_programmatic_template,stacked,top,False,
"Form W-2c
Corrected Wage and Tax Statement
For calendar year 2021
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Tri-County School District 7152 Elm Park Pl Brookhaven, PA 92789
b Employer's Federal EIN
75-3477408
f Employee's first name and initial  Last name
Fatima D. Patel
d Employee's correct SSN
****9620
Street address (including apt. no.)
1255 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Riverton, WI 40932
Account number (see instructions)
****660977
1 Wages, tips, other compensation  Previously reported
$129,443.80
1 Wages, tips, other compensation  Correct information
$29,622.26
2 Federal income tax withheld  Previously reported
2,101.82
2 Federal income tax withheld  Correct information
$8,711.71
3 Social security wages  Previously reported
74,084.15
3 Social security wages  Correct information
$123,972.89
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-cc1007da08b62323a6a46b07,v11-W-2C-stacked,corrected,2021,fgen-6a69450f7372cdc2031c04a5,synthetic_programmatic_template,stacked,top,False,
"Form W-2c
Corrected Wage and Tax Statement
2021
OMB No. 1545-0008
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 5869 Elm Park Pl Lakewood, CO 17033
b Employer's Federal EIN
31-4895955
f Employee's first name and initial  Last name
Amara Romero
d Employee's correct SSN
***-**-9643
a Tax year/Form corrected
2021
1 Wages, tips, other compensation  Previously reported
117,468.94
1 Wages, tips, other compensation  Correct information
77,395.55
2 Federal income tax withheld  Previously reported
$2,026.75
2 Federal income tax withheld  Correct information
4,745.16
3 Social security wages  Previously reported
$86,732.64
3 Social security wages  Correct information
110,644.11",W-2,38,W-2,fdc-60cf8e9b3f1a396c5a480db0,v11-W-2C-stacked,corrected,2021,fgen-69663551a317e3f4bf0b7eeb,synthetic_programmatic_template,stacked,top,False,
"Form W-2c
Corrected Wage andTax Statement
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
c Employer's name, address, and ZIP code
Granitc Peak Manufacturing Co. 9887 Granite St Cedar Falls, IA 28938
b Emp1oyer's Federal EIN
74-7930938
f Employee's first name and initial  Last name
Fatima J. Brennan
d Employee's correct SSN
XXXXX6517
Street address (induding apt. no.)
241 Maple Ridge Dr
City or town, state or province, country, and ZIP or forcignposta1 code
Maplewood, MN 13105
Account number (see instructions)
***-**-581051
a Tax ycar/Form corrected
2026
1 Wages, tips, other compensation  Previous1y reported
S1O8,117.03
1 Wages, tips, other compensatíon  Correct information
126,296.33
2 Federal íncome tax withheld  Previously reported
6,9O2.91
2 Federal income tax withheld  Correct information
106.86
3Socia1 security wages  Previously reported
81,255.81
Department of theTreasury - Intemal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-c1150399a441fad5292fa6a3,v11-W-2C-stacked,corrected,2026,fgen-6c5295a3d00aeb8bd2b4b6da,synthetic_programmatic_template,stacked,top,True,
"☐CORRECTED
Form W-2c
Corrected Wage and Tax Statement
For calendar year 2O26
Copy B—To Be Fíled With Employee's Federal Tax Return
c Employer's name, address, and ZIP code
Tri-County Schoo1 District 6977 Granite St Maplewood, MN 85976
b Employer's Federal EIN
3l-3808388
f Emp1oyee's first name and initial  Last name
Hiro Okafor
d Employee's correct SSN
****1071
Street address (including apt. no.)
5798Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Brookhaven, PA 43006
Account number (sce instructions)
XXXXX019807
a Tax year/Form corrected
2026
1 Wages, tips, other compensation  Correct information
80,562.17
2 Federal income tax withheld  Previously reported
$1,976.37
2 Federal income tax withheld  Correct information
9,426.55
3 Socialsecurity wages  Previously reported
66,480.54
3 5ocial securitywages  Correct ínformation
$30,724.34",W-2,38,W-2,fdc-e60bac0190a2bc74555f17e3,v11-W-2C-stacked,corrected,2026,fgen-5a9b1700f6f736c2136f6303,synthetic_programmatic_template,stacked,top,True,
"Form W-2c
Corrected Wage and Tax Statement
2022
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Riverside Regional Hospital 9064 Maple Ridge Dr Bayside, WA 83492
b Employer's Federal EIN
48-8608551
f Employee's first name and initial  Last name
Avery Kowalski
d Employee's correct SSN
ending in 5955
Street address (including apt. no.)
8039 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 44985
Account number (see instructions)
ending in 440427
a Tax year/Form corrected
2022
1 Wages, tips, other compensation  Previously reported
$42,117.14
1 Wages, tips, other compensation  Correct information
$79,003.49
2 Federal income tax withheld  Previously reported
$6,140.39
2 Federal income tax withheld  Correct information
$4,914.07
3 Social security wages  Previously reported
$69,712.49
3 Social security wages  Correct information
$26,370.80
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-7cb713adedab3d7406be34b5,v11-W-2C-stacked,corrected,2022,fgen-aa2a227edbd60734ab7f3dab,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
OMB No. 1545-0008
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 4965 Maple Ridge Dr Maplewood, MN 55061
b Employer's Federal EIN
87-2912913
f Employee's first name and initial  Last name
Fatima Sato
d Employee's correct SSN
ending in 0168
Street address (including apt. no.)
7377 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 45666
Account number (see instructions)
***-**-414919
a Tax year/Form corrected
2021
1 Wages, tips, other compensation  Previously reported
133,351.55
1 Wages, tips, other compensation  Correct information
28,455.98
2 Federal income tax withheld  Correct information
5,120.71
3 Social security wages  Previously reported
$58,202.06
3 Social security wages  Correct information
$8,419.56
Form W-2c
Corrected Wage and Tax Statement",W-2,38,W-2,fdc-11c53e621c502c96103825f9,v11-W-2C-stacked,corrected,2021,fgen-37331ff6fc1589eff81b4696,synthetic_programmatic_template,stacked,bottom,False,
"VOID  CORRECTED
Form W-2c
Corrected Wage andTax Statement
2023
OMB No. 1545-0008
Copy B—To Be Fíled With Employee's Federal Tax Return
c Employer's name, address, and ZIP code
Graníte Peak Manufacturing Co. 2016 0ak Ho1low Ct Oak Grove, TX 23521
b Employer's Federal EIN
l3-2982062
f Employee's first name and initial  Lastname
Amara J. Rivera
d Employee's correct 5SN
XXX-XX-2984
Street address (includingapt. no.)
6555 Cedar Ln
City or town, state orprovince, country, and ZIP or foreign postal code
Pinecrest, GA 17163
1 Wages, tips, other compensation  Previously reported
26,507.62
1 Wages, tips, other compensation  Correct information
S63,702.02
2 Federa1 income tax withheld  Previously reported
$4,843.O4
2 Federal income tax withheld  Correct information
2,040.44
3 5ocial security wages  Previously reported
78,814.26
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.írs.gov/FormW2c",W-2,38,W-2,fdc-8255175bbb34300647f8f410,v11-W-2C-stacked,corrected,2023,fgen-066bce6e7c838e3652b82a07,synthetic_programmatic_template,stacked,top,True,
"☐CORRECTED
Form W-2c
Corrected Wage and Tax 5tatement
For calendar year 2024
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Riverside Regional Hospital 5332 Oak Hollow Ct Bayside, WA l6415
b Employer's Federal EIN
11-6380037
f Employee's fírst name and initial  Last name
Jamie Castillo
d Employee's correct 5SN
endíng in 3726
a Tax year/Form corrected
2024
1 Wages, tips, other compensation  Previously reported
123,341.10
1 Wages, tips, other compensation  Correct information
18,254.54
2 Federal income tax withheld Previously reported
5,933.15
3 5ocial security wages Previously reported
11,188.90
3 Socia1 security wages  Correct information
S22,574.52",W-2,38,W-2,fdc-c3c9bd6cc41988200262aa5d,v11-W-2C-stacked,corrected,2024,fgen-9b177dee9cd6a1948e5362e9,synthetic_programmatic_template,stacked,top,True,
"For calendar year 2023
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Tri-County School District 6323 Harbor View Rd Oak Grove, TX 36734
b Employer's Federal EIN
27-7238403
f Employee's first name and initial  Last name
Olivia Nguyen
d Employee's correct SSN
XXXXX8027
Street address (including apt. no.)
2983 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 88563
a Tax year/Form corrected
2023
1 Wages, tips, other compensation  Previously reported
$74,536.37
1 Wages, tips, other compensation  Correct information
$62,972.49
2 Federal income tax withheld  Previously reported
218.32
2 Federal income tax withheld  Correct information
$4,117.54",W-2,38,W-2,fdc-27ccc2381081d0e5458488b9,v11-W-2C-stacked,corrected,2023,fgen-0467fe44d7d2ee962cc36f38,synthetic_programmatic_template,stacked,none,False,
"CORRECTED (if checked)
Form W-2c
Corrected Wage and Tax Statement
For calendar year 2023
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Riverside Regional Hospital 1155 Maple Ridge Dr Brookhaven, PA 28327
b Employer's Federal EIN
72-5633693
f Employee's first name and initial  Last name
Mateo Tanaka
d Employee's correct SSN
XXX-XX-0496
Street address (including apt. no.)
1537 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 41875
Account number (see instructions)
XXX-XX-725664
a Tax year/Form corrected
2023
1 Wages, tips, other compensation  Previously reported
$54,213.76
1 Wages, tips, other compensation  Correct information
43,189.11
2 Federal income tax withheld  Previously reported
$6,729.39
2 Federal income tax withheld  Correct information
$6,894.05
3 Social security wages  Previously reported
87,304.83
3 Social security wages  Correct information
62,613.71",W-2,38,W-2,fdc-93300298ccffe853d3eaf429,v11-W-2C-stacked,corrected,2023,fgen-5929a125f94c950555e9f0cc,synthetic_programmatic_template,stacked,top,False,
"Form W-2c Corrected Wage and Tax Statement
From:
Copperline Software Inc.
RECIPIENT:
Mateo B. Moreau
2 Federal income tax withheld  Previously reported
$2,408.72
3 Social security wages  Correct information
$129,588.59
2 Federal income tax withheld  Correct information
$5,876.01",W-2,38,W-2,fdc-a9598a1ec2013406bd7f6cef,v11-W-2C-stacked,corrected,2022,fgen-62333fa2721af4369c06607e,synthetic_programmatic_template,stacked,top,False,
"Form W-2c
Corrected Wage and Tax Statement
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
c Employer's name, address, and ZIP code
Acme Test Corp 1672 Oak Hollow Ct Riverton, WI 23413
b Employer's Federal EIN
70-1593436
f Employee's first name and initial  Last name
Jamie Testcase
d Employee's correct SSN
****9298
Account number (see instructions)
***-**-595696
a Tax year/Form corrected
2026
1 Wages, tips, other compensation  Previously reported
$127,334.41
2 Federal income tax withheld  Correct information
$5,635.94
3 Social security wages  Previously reported
134,166.42
3 Social security wages  Correct information
49,744.57
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-404310338e135cac49df3628,v11-W-2C-stacked,corrected,2026,fgen-9153635cf9a5f30e80a13b9e,synthetic_programmatic_template,stacked,top,False,
"VOID  CORRECTED
Form W-2c
Corrected Wage and Tax Statement
For calendar year 2024
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code
Acme Test Corp 2144 Granite St Lakewood, CO 80648
b Employer's Federal EIN
85-5232969
f Employee's first name and initial  Last name
Noah Castillo
d Employee's correct SSN
***-**-1432
Street address (including apt. no.)
4754 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 10620
Account number (see instructions)
XXX-XX-237008
a Tax year/Form corrected
2024
1 Wages, tips, other compensation  Previously reported
$131,749.28
1 Wages, tips, other compensation  Correct information
19,066.64
2 Federal income tax withheld  Previously reported
$9,066.18
2 Federal income tax withheld  Correct information
$1,905.77
3 Social security wages  Previously reported
137,157.70
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-5af2dff084b1bcc840ffcfea,v11-W-2C-stacked,corrected,2024,fgen-0e01cea3b231f6bce734847f,synthetic_programmatic_template,stacked,top,False,
"Form W-2c
Corrected Wage and Tax Statement
2024
OMB No. 1545-0008
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 5279 Willow Bcnd Way Testville, IL 50457
b Employer's Federal EIN
16-3360827
f Employee's fírst name and initial  Last name
AmaraL. Haddad
dEmployee's correct SSN
***-**-1187
Street address (íncluding apt. no.)
6674 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code
Bayside, WA 59O06
a Tax year/Form corrected
2024
1 Wages, tips, other compensation Previously reported
$112,685.73
1 Wages, típs, other compensation  Correct information
81,873.54
2 Federal income tax withheld Previously reported
$2,34l.99
2 Federal income tax withheld  Correct information
$1,O12.54
3 Social sccurity wages  Previously reported
$63,799.66
Department of the Treasury - Intemal Revenue 5ervice
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-b3c24f7017f9b610c61962cd,v11-W-2C-stacked,corrected,2024,fgen-c6673d692b585861f282e7b7,synthetic_programmatic_template,stacked,top,True,
"Form W-2c
Corrected Wage and Tax Statement
2026
OMB No. 1545-0008
c Employer's name, address, and ZIP code
Blue Heron Logistics LLC 9100 Lakeshore Blvd Bayside, WA 76293
b Employer's Federal EIN
43-5897363
f Employee's first name and initial  Last name
Avery Larsen
d Employee's correct SSN
***-**-5194
Street address (including apt. no.)
1847 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Cedar Falls, IA 31135
1 Wages, tips, other compensation  Previously reported
122,198.74
1 Wages, tips, other compensation  Correct information
$118,371.96
2 Federal income tax withheld  Previously reported
8,532.77
2 Federal income tax withheld  Correct information
$8,060.48
3 Social security wages  Previously reported
65,541.72
3 Social security wages  Correct information
$75,153.24",W-2,38,W-2,fdc-24e91eda99684833f55021e7,v11-W-2C-stacked,corrected,2026,fgen-b133ecf62f132d9aa5731fa3,synthetic_programmatic_template,stacked,top,False,
"Form W-2c
Corrected Wage and Tax Statement
For calendar year 2025
OMB No. 1545-0008
Copy C—For Employee's Records
c Employer's name, address, and ZIP code   Blue Heron Logistics LLC 3199 Lakeshore Blvd Oak Grove, TX 78711
b Employer's Federal EIN   80-3430369
f Employee's first name and initial  Last name Amara Lindqvist
d Employee's correct SSN      ***-**-2645
Account number (see instructions)   ending in 354953
a Tax year/Form corrected  2025
1 Wages, tips, other compensation  Previously reported      $56,887.97
1 Wages, tips, other compensation  Correct information      $119,649.40
2 Federal income tax withheld  Previously reported  $5,882.08
2 Federal income tax withheld  Correct information $7,001.52
3 Social security wages  Previously reported      $36,207.06
3 Social security wages  Correct information      $42,896.96",W-2,38,W-2,fdc-a4e91bf0315a8ab2e94bdbdd,v11-W-2C-inline,corrected,2025,fgen-1c9826b6e502281e1920ebf1,synthetic_programmatic_template,inline,top,False,
"Form W-2c
Corrected Wage and Tax Statement
2026
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code Maple Street Dental PC 6682 Sample Street Oak Grove, TX 90464
b Employer's Federal EIN   97-7476164
f Employee's first name and initial  Last name Kwame Sato
d Employee's correct SSN   XXXXX8364
Street address (including apt. no.)      3606 Lakeshore Blvd
City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 15353
a Tax year/Form corrected   2026
1 Wages, tips, other compensation  Previously reported 123,552.11
1 Wages, tips, other compensation  Correct information $93,669.34
2 Federal income tax withheld  Previously reported      $7,030.73
2 Federal income tax withheld  Correct information 8,555.64
3 Social security wages  Previously reported   $38,571.12
3 Social security wages  Correct information $38,300.92",W-2,38,W-2,fdc-b7e751bd9d36178627483da7,v11-W-2C-inline,corrected,2026,fgen-444ea769a0b014ac733bbae0,synthetic_programmatic_template,inline,top,False,
"2025
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code Copperline Software Inc. 4542 Elm Park Pl Lakewood, CO 74803
b Employer's Federal EIN  79-8617946
f Employee's first name and initial  Last name  Lena Patel
d Employee's correct SSN  ***-**-4141
Account number (see instructions)  ****824518
a Tax year/Form corrected 2025
1 Wages, tips, other compensation  Previously reported  79,086.75
1 Wages, tips, other compensation  Correct information $79,281.43
2 Federal income tax withheld  Correct information      3,826.43
3 Social security wages  Previously reported $103,455.33
3 Social security wages  Correct information   $116,137.10
Department of the Treasury - Internal Revenue Service
Form W-2c
Corrected Wage and Tax Statement
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-fe8b1cc02b9d3d294c83388d,v11-W-2C-inline,corrected,2025,fgen-4b570f13c47e5b816c3686bf,synthetic_programmatic_template,inline,bottom,False,
"Form W-2c
Corrected Wage and Tax Statement
For calendar year 2024
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
c Employer's name, address, and ZIP code Acme Test Corp 255 Granite St Brookhaven, PA 69774
b Employer's Federal EIN  28-4671846
f Employee's first name and initial  Last name Casey Haddad
d Employee's correct SSN  ending in 0224
Account number (see instructions) ending in 730935
a Tax year/Form corrected 2024
1 Wages, tips, other compensation  Previously reported      72,107.24
1 Wages, tips, other compensation  Correct information  132,810.83
3 Social security wages  Previously reported   $127,479.26
3 Social security wages  Correct information 26,322.44
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-820798f26f27116d663afbe1,v11-W-2C-inline,corrected,2024,fgen-32d78f5fd718f8b06357c631,synthetic_programmatic_template,inline,top,False,
"CORRECTED (if checked)
2021
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code  Tri-County School District 5254 Sample Street Pinecrest, GA 90623
b Employer's Federal EIN   15-1778214
f Employee's first name and initial  Last name  Lena L. Haddad
d Employee's correct SSN      XXXXX7321
Street address (including apt. no.)   5027 Sample Street
City or town, state or province, country, and ZIP or foreign postal code   Maplewood, MN 86557
a Tax year/Form corrected   2021
1 Wages, tips, other compensation  Previously reported 46,366.23
1 Wages, tips, other compensation  Correct information  $22,464.25
2 Federal income tax withheld  Previously reported   $1,264.02
2 Federal income tax withheld  Correct information  563.05
3 Social security wages  Previously reported $87,633.05
3 Social security wages  Correct information   55,647.17
Form W-2c
Corrected Wage and Tax Statement",W-2,38,W-2,fdc-7e6d9b03543ee6b406cd63b2,v11-W-2C-inline,corrected,2021,fgen-914e9de8ec7af97a75f880d3,synthetic_programmatic_template,inline,bottom,False,
"2022
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
c Employer's name, addrcss, and ZIP code   Granite Peak Manufacturing Co. 8268 Granite St Cedar Falls, IA 12220
b Employer's FederalEIN   22-8161483
f Employee's fírst name and initial  Last name Priya Nguyen
d Employee's correct SSN      ****9626
a Tax year/Form corrected 2022
1 Wagcs, tips, other compensation  Previously reported      S53,564.60
1 Wages, tips, other compensation  Correct information     $67,682.96
2 Federal income tax withheld  Previouslyreported $9,16O.20
3 5ocial security wages Previous1y reported      28,594.53
3 Social security wages  Correct information      $43,321.68
Department of the Treasury - Internal Revenue Service
Form W-2c
Corrected Wage and Tax Statement
Form W-2c(keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-9fe4dcf706f5bcf11ebe1f41,v11-W-2C-inline,corrected,2022,fgen-1d50bca7eb399e402f59c98d,synthetic_programmatic_template,inline,bottom,True,
"VOID  CORRECTED
Form W-2c
Corrected Wage and Tax Statement
2021
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code      Copperline Software Inc. 3411 Prairie Ave Oak Grove, TX 21887
b Employer's Federal EIN  33-4746580
f Employee's first name and initial  Last name Noah Testcase
d Employee's correct SSN      ending in 4496
Street address (including apt. no.)  2286 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code      Lakewood, CO 82595
Account number (see instructions) XXXXX494710
1 Wages, tips, other compensation  Previously reported   129,996.42
1 Wages, tips, other compensation  Correct information      $94,655.80
2 Federal income tax withheld  Correct information 2,372.50
3 Social security wages  Previously reported      21,055.68
3 Social security wages  Correct information $127,719.10
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-0ae8aad33b694cc9bca591c4,v11-W-2C-inline,corrected,2021,fgen-d5cad978df2b6bf9323da4a2,synthetic_programmatic_template,inline,top,False,
"From: Riverside Regional Hospital
RECIPIENT: Jamie Rivera
3 Social security wages  Previously reported 122,126.51
a Tax year/Form corrected 2026
3 Social security wages  Correct information 98,529.90",W-2,38,W-2,fdc-93a087f61a4cae610fe6f16c,v11-W-2C-inline,corrected,2026,fgen-fa250b3b06222bfb24eafff2,synthetic_programmatic_template,inline,none,False,
"VOID  CORRECTED
OMB No. 1545-0008
c Employer's name, address, and ZIP code   Riverside Regional Hospital 5624 Granite St Pinecrest, GA 26164
b Employer's Federal EIN   69-6762185
f Employee's first name and initial  Last name   Noah Larsen
d Employee's correct SSN      XXXXX3788
Street address (including apt. no.) 8187 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 85504
a Tax year/Form corrected 2025
1 Wages, tips, other compensation  Correct information      $43,110.51
2 Federal income tax withheld  Previously reported   4,122.56
2 Federal income tax withheld  Correct information   $9,035.68
3 Social security wages  Previously reported  60,871.77
3 Social security wages  Correct information  $118,134.94",W-2,38,W-2,fdc-6d470102bfae510ad52317ec,v11-W-2C-inline,corrected,2025,fgen-ac43ab497b85ccd7b8619eb7,synthetic_programmatic_template,inline,none,False,
"For calendar year 2021
Copy B—To Be Filed With Employee's Federal Tax Return
c Employer's name, address, and ZIP code   Tri-County School District 8959 Maple Ridge Dr Oak Grove, TX 36183
b Employer's Federal EIN   68-1324611
f Employee's first name and initial  Last name Casey Okafor
d Employee's correct SSN ****8551
1 Wages, tips, other compensation  Previously reported $62,781.18
1 Wages, tips, other compensation  Correct information $53,808.27
2 Federal income tax withheld  Correct information      $1,807.69
3 Social security wages  Correct information $73,977.41
Department of the Treasury - Internal Revenue Service
Form W-2c
Corrected Wage and Tax Statement
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-2542fb9ee6907f8b1f308caa,v11-W-2C-inline,corrected,2021,fgen-95b53bd4f886a8c1181bf305,synthetic_programmatic_template,inline,bottom,False,
"Form W-2c Corrected Wage and Tax Statement 2022
c Employer'S namc: Tri-County School District
RECIPIENT:      Noah Larsen
l Wages, tips, other compensation  Previouslyreported 131,385.55
a Tax year/Form corrected 2022
2 Federal income tax withheld  Previously reported      S7,631.45",W-2,38,W-2,fdc-a71e74297038f70d9e1be233,v11-W-2C-inline,corrected,2022,fgen-f2a906464354bc443c632ec7,synthetic_programmatic_template,inline,top,True,
"From:Riverside Regional Hospital
RECIPIENT: Lena Fischer
1 Wages, tips, other compensation  Previously reported      $86,948.57
Form W-2c Corrected Wage and Tax 5tatement 2025",W-2,38,W-2,fdc-f47ea590c59e77f104a4418b,v11-W-2C-inline,corrected,2025,fgen-f4b9455f30ec093dd42505e8,synthetic_programmatic_template,inline,bottom,True,
"c Employer'S name:  Acme Tcst Corp
RECIPIENT: Wei S. Moreau
a Tax year/Form corrected     2022
3 Social security wages  Previously reported S45,838.04
3 Social security wages  Correct information 134,936.79",W-2,38,W-2,fdc-5026002fb9169113526c68d5,v11-W-2C-inline,corrected,2022,fgen-8e4d38a5bb4c16450ae8e2dc,synthetic_programmatic_template,inline,none,True,
"c Employer: Maple Street Dental PC
Recipient's name:   Hiro K. Brennan
a Tax year/Form corrected      2021
3 Social security wages  Previously reported $62,553.34
2 Federal income tax withheld  Correct information      $6,462.64
3 Social security wages  Correct information $49,592.43
Form W-2c Corrected Wage and Tax Statement 2021",W-2,38,W-2,fdc-65ef8cb0d6f2b9f9ab6e257b,v11-W-2C-inline,corrected,2021,fgen-75cc1d524338337b3fbdc7a9,synthetic_programmatic_template,inline,bottom,False,
"Form W-2c
Corrected Wage and Tax Statement
2026
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
c Employer's name, address, and ZIP code Tri-County School District 4367 Prairie Ave Bayside, WA 76347
b Employer's Federal EIN 19-8421826
f Employee's first name and initial  Last name   Hiro Brennan
d Employee's correct SSN XXX-XX-0492
a Tax year/Form corrected 2026
1 Wages, tips, other compensation  Previously reported 108,108.61
1 Wages, tips, other compensation  Correct information 28,009.44
2 Federal income tax withheld  Previously reported  $4,098.22
2 Federal income tax withheld  Correct information   $5,876.44
3 Social security wages  Previously reported      21,544.07
3 Social security wages  Correct information $83,464.14",W-2,38,W-2,fdc-7db14cc43e50052cc0ae78ba,v11-W-2C-inline,corrected,2026,fgen-be0e9e4b8e1b3471e83e0c4b,synthetic_programmatic_template,inline,top,False,
"Form W-2c
Corrected Wage and Tax Statement
For calendar year 2022
c Employer's name, address, and ZIP code      Granite Peak Manufacturing Co. 165 Cedar Ln Lakewood, CO 76817
b Employer's Federal EIN 48-3685277
f Employee's first name and initial  Last name   Diego Walsh
d Employee's correct SSN      XXXXX4012
a Tax year/Form corrected      2022
1 Wages, tips, other compensation  Previously reported  16,693.12
2 Federal income tax withheld  Correct information $258.21
3 Social security wages  Previously reported 56,193.64
3 Social security wages  Correct information  70,073.24",W-2,38,W-2,fdc-b441ee2b017da1545158385f,v11-W-2C-inline,corrected,2022,fgen-e6f80a5980f66c4b4a9a4505,synthetic_programmatic_template,inline,top,False,
"2025 OMB No.1545-0008 Copy C—For Employee's Records c Employer'sname, address, and ZIP code Tri-County School District 8432 Harbor View Rd Oak Grove, TX59831 b Employer's Federal EIN l7-854O865 f Employee's first name and ínitial Last name Lena Brennan d Employee's correct SSN XXX-XX-2O96 Street address (induding apt. no.) 5518 Oak Hollow Ct Cityor town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 14439 Account numbcr (see instructions) ending in 915237 a Tax year/Form
corrected 2025 1 Wages, tips, other compensation Previously reported 10,465.42 1 Wages, tips, other compensation Correct information S133,117.71
2 Federal income tax wíthheld Correct informatíon $1,672.37 3 5ocial security wages Previously reported 20,440.21 3 5ocial security wages Correctinformation 118,019.31 Form W-2c Corrected Wage and Tax 5tatement",W-2,38,W-2,fdc-6ed1d51c6928a576dc131d11,v11-W-2C-flat,corrected,2025,fgen-c2825742461e14a791e80d0d,synthetic_programmatic_template,flat,bottom,True,
"CORRECTED (if checked) Form W-2c Corrected Wage and Tax Statement 2026 OMB No. 1545-0008 Copy B—To Be Filed With Employee's Federal Tax Return c
Employer's name, address, and ZIP code Maple Street Dental PC 5532 Elm Park Pl Cedar Falls, IA 69158 b Employer's Federal EIN 98-2282881 f Employee's first name and initial Last name Avery A. Adeyemi d Employee's correct SSN XXXXX6026 Street
address (including apt. no.) 4467 Granite St City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 54063 a Tax year/Form corrected 2026 1 Wages, tips, other compensation Previously reported 38,698.57 2 Federal income tax withheld Previously reported $1,172.95 2 Federal income tax withheld Correct information $8,072.28 3 Social security wages Previously reported $136,008.00 3 Social security wages Correct information 92,163.31",W-2,38,W-2,fdc-a3eb7bc1e6575b8fe28c6f5e,v11-W-2C-flat,corrected,2026,fgen-1865b998457de0716e310d0f,synthetic_programmatic_template,flat,top,False,
"Form W-2c
CorrectedWage and Tax 5tatement For calendar
year 2025 Copy B—To Be Filed With Employee's Federal Tax Retum c Employcr's name, address, and ZIP code Riverside Regional Hospital 2280 Cedar Ln Oak Grove,TX 72834 b Employer'sFederal EIN 17-1582172 f Emp1oyee's first name and initial Last name Mateo C. Larsen d Employee's correct SSN ****9769 Street address (íncluding apt. no.) 4710 Samplc Street City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 27827 Account number (see instructions) XXX-XX-681669 a Tax year/Form corrected 2O25 1 Wages, tips, other compensation Previous1y reported $111,116.92 1Wages, típs, other compensation Correct information 3,039.752 Federal income tax withheld Previously reported 8,651.39 2 Federal incomc tax withheld Correct information $8,942.45 3 5ocial security wages Previously reported $83,619.61",W-2,38,W-2,fdc-a72992f6e7605ea6163d6cf1,v11-W-2C-flat,corrected,2025,fgen-9307cca2ef27e07ad2d26c05,synthetic_programmatic_template,flat,top,True,
"Form
W-2c Corrected Wage and Tax Statement 2021 c Employer'S name: Granite Peak Manufacturing Co. RECIPIENT: Noah Okafor 1 Wages, tips, other compensation Correct
information 35,748.68 2 Federal income tax withheld Correct information $7,273.61",W-2,38,W-2,fdc-23cc8daf2efdeb5ea98ca120,v11-W-2C-flat,corrected,2021,fgen-f35f7302fc19c544fcf4b243,synthetic_programmatic_template,flat,top,False,
"Form W-2c Corrected Wage and Tax Statement For calendaryear 2026 OMB No. 1545-0008 Copy B—To Be Filed With Employee's Federal Tax Retum c Employer's name, address, and ZIP codeGranite Peak Manufacturing Co. 6563 Prairie Ave Fairview, OH 70031 b Employer's Federal EIN 9O-843l815 f Employee's first name and initial
Lastname Sofia Okafor d Employee's correct SSN ***-**-4459 Account number (see ínstructions) ***-**-990179 a Tax year/Form corrected 2026 1 Wages, típs, othercompensatíon Previous1y reported $16,860.07 1 Wages, tips, other compensation Correct information 40,000.24 2 Federa1 income tax withheld
Correct information 1,311.00 3 Social security wages Previous1y reported 71,656.67 3 Social security wages Correct information 63,650.90",W-2,38,W-2,fdc-7eaab615d6bd6d9b40ec699f,v11-W-2C-flat,corrected,2026,fgen-5cc9f9a276dbebd9b3ef75a2,synthetic_programmatic_template,flat,top,True,
"Form W-2c Corrected Wage and Tax Statement 2023 c Employer'S name: Acme Test
Corp RECIPIENT: Avery L. Testcase a Tax year/Form corrected 2023 2 Federal income tax withheld Correct information 5,122.65 1 Wages, tips, other compensation Previously reported
$118,421.60",W-2,38,W-2,fdc-3494697c20a80e87f095baec,v11-W-2C-flat,corrected,2023,fgen-e2aed2e2ea0a71210a54498b,synthetic_programmatic_template,flat,top,False,
"VOID CORRECTED Form W-2c Corrected Wage and Tax Statement 2026 OMB No. 1545-0008 Copy B—To Be Filed With Employee's Federal Tax Return c Employer's name, address, and ZIP code
Riverside Regional Hospital 6766 Prairie Ave Riverton, WI 63233 b Employer's Federal EIN 75-8566087 f Employee's
first name and initial Last name Sofia Kowalski d Employee's correct SSN XXXXX6910 a Tax year/Form corrected 2026 1 Wages, tips, other compensation Previously reported $109,832.84 1 Wages, tips, other compensation Correct information $23,500.44 2 Federal income tax withheld Previously reported $6,552.90 2 Federal income tax withheld Correct information 8,836.86 3 Social security wages Previously reported $36,383.90 3 Social security wages Correct information $94,885.67 Department of the Treasury - Internal Revenue Service Form W-2c (keep for your records) www.irs.gov/FormW2c",W-2,38,W-2,fdc-120347fb9e00dc7f53578438,v11-W-2C-flat,corrected,2026,fgen-020afe0a369ad4cb796c58f7,synthetic_programmatic_template,flat,top,False,
"Form W-2c Corrected Wage and
Tax Statement OMB No. 1545-0008 Copy C—For Employee's Records c Employer's name, address, and ZIP code Blue Heron Logistics LLC 5857 Sample Street Oak Grove, TX 92871 b Employer's Federal EIN 44-3765212 f Employee's first name and initial Last name Jamie Nguyen d Employee's correct SSN ***-**-7316 1 Wages, tips, other compensation Previously reported 92,413.22 1 Wages, tips, other compensation Correct information 51,614.27 2 Federal income tax withheld Previously reported $8,069.13 2 Federal income tax withheld
Correct information $3,961.53 3 Social security wages Previously reported 93,299.07 3 Social security wages Correct information 45,277.96",W-2,38,W-2,fdc-075838a9cf2c4a51951c65ac,v11-W-2C-flat,corrected,2022,fgen-c9a0eb7aed3aefeab15320a6,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) Form W-2c Corrected Wage and Tax Statement 2023 OMB No. 1545-0008 Copy B—To Be Filed With Employee's Federal Tax Return c Employer's name, address, and
ZIP code Maple Street Dental PC 4299 Maple Ridge Dr Pinecrest, GA 19295 b Employer's Federal EIN 66-6166776 f Employee's first name and initial Last name Sofia D. Patel d Employee's correct SSN ***-**-9742
Street address (including apt. no.) 2168 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Lakewood, CO 40964 Account number (see instructions) ***-**-878393 a Tax year/Form corrected 2023 1 Wages, tips, other compensation Previously reported 104,157.96 1 Wages, tips, other compensation Correct information $35,249.98 2 Federal income tax withheld Correct information 598.80 3 Social security wages Previously reported 70,958.14 3 Social security wages Correct information 45,976.68 Department of the Treasury - Internal Revenue Service Form W-2c (keep for your records) www.irs.gov/FormW2c",W-2,38,W-2,fdc-357ae27e5e30e015b789d5bf,v11-W-2C-flat,corrected,2023,fgen-7db592a47e29904e5ff1d27d,synthetic_programmatic_template,flat,top,False,
"Form W-2c Corrected Wage and Tax Statement 2021 Copy C—For Employee's Records c Employer's name, address, and ZIP code Tri-County School District 94 Prairie Ave Fairview, OH 89170 b Employer's Federal EIN 37-2134729 f Employee's first name
and initial Last name Avery Walsh d Employee's correct SSN XXX-XX-6906 Street address (including apt. no.) 7480 Willow Bend Way City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 97011 Account number (see instructions) ending in 066333 1 Wages, tips, other compensation Previously reported 104,097.16 1 Wages, tips, other compensation Correct information 12,840.18 2 Federal income tax withheld
Correct information $1,028.19 3 Social security wages Previously reported $72,075.45 3 Social security wages Correct information $72,938.68",W-2,38,W-2,fdc-d03d00b349fecea0381c2c41,v11-W-2C-flat,corrected,2021,fgen-4d7b9e66128f99b9346569fd,synthetic_programmatic_template,flat,top,False,
"Form W-2c Corrected Wage and Tax Statement For calendar year 2022
OMB No. 1545-0008 Copy B—To Be Filed With Employee's Federal Tax Return Copy C—For Employee's Records c Employer's name, address, and ZIP code Acme Test Corp 3333 Lakeshore Blvd Lakewood, CO 31963 b Employer's Federal EIN 70-8813529 f Employee's first name and initial Last name Taylor C. Fischer d Employee's correct SSN ****1228 Street address (including apt. no.) 4430 Prairie Ave City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 77081 a Tax year/Form corrected
2022 1 Wages, tips, other compensation Previously reported 88,023.40 2 Federal income tax withheld Correct information $8,548.84 3 Social security wages Previously reported 20,367.15 3 Social security wages Correct information 109,180.57",W-2,38,W-2,fdc-f00eb7513b149e94d165613d,v11-W-2C-flat,corrected,2022,fgen-1da4f5d550627c5bf44ffd95,synthetic_programmatic_template,flat,top,False,
"Form W-2c Corrected Wage and Tax Statement For calendar year 2022 OMB No. 1545-0008 Copy B—To Be Filed With Employee's Federal Tax Return Copy C—For Employee's Records c Employer's name, address, and ZIP code Tri-County School District 6357 Elm Park Pl Testville, IL 90689 b Employer's Federal EIN 28-8846944 f Employee's first name and initial Last name Avery M. Moreau d Employee's correct SSN ***-**-0121 Street address (including apt. no.) 7597 Lakeshore Blvd City or town, state or province, country, and ZIP or
foreign postal code Oak Grove, TX 43135 Account number (see instructions) XXX-XX-684329 a Tax year/Form corrected 2022 1 Wages, tips, other compensation Previously reported $113,317.65 1 Wages, tips, other compensation Correct information 10,991.00 2 Federal income tax withheld Previously reported 7,334.70 2 Federal income tax withheld Correct information $6,386.12 3 Social security wages Previously reported $3,296.44 3 Social security wages Correct information $96,144.92 Department of the Treasury -
Internal Revenue Service Form W-2c (keep for your records) www.irs.gov/FormW2c",W-2,38,W-2,fdc-fe293272e9cc5d753fa9e0fe,v11-W-2C-flat,corrected,2022,fgen-3b1d1f3a319467d4c19dfb99,synthetic_programmatic_template,flat,top,False,
"CORRECTED (if checked) 2023 c Employer's name, address, and ZIP code Riverside Regional Hospital 3076 Granite St Riverton, WI
50958 b Employer's Federal EIN 58-6068001 f Employee's first name and initial Last name Priya Romero d Employee's correct SSN ending in 0694 Street address (including apt. no.) 4706 Harbor View Rd City or town, state or province, country, and ZIP or foreign postal code Riverton, WI 11904 Account number (see instructions) XXXXX786536 a Tax year/Form corrected 2023 1 Wages, tips, other compensation Previously reported $89,165.42 1 Wages, tips, other compensation Correct information 9,420.50 2 Federal income tax withheld Previously reported $4,107.38 2 Federal income tax withheld Correct information $4,935.55 Department of the Treasury - Internal Revenue Service Form W-2c Corrected Wage
and Tax Statement Form W-2c (keep for your records) www.irs.gov/FormW2c",W-2,38,W-2,fdc-aa40b67c91b0c989f1d21249,v11-W-2C-flat,corrected,2023,fgen-54fcb30c04c0111b6d4fb3e4,synthetic_programmatic_template,flat,bottom,False,
"c Employer'S name: Acme Test Corp To: Noah Castillo 1 Wages, tips,
other compensation
Correct information $120,855.07 Form W-2c Corrected Wage and Tax Statement 2023",W-2,38,W-2,fdc-bbc2cd350f8ec4c6e1e4b5dd,v11-W-2C-flat,corrected,2023,fgen-dc9b81189c5b11b056252eaa,synthetic_programmatic_template,flat,bottom,False,
"Form W-2c
Corrected Wage and Tax Statement 2024 c Employer: Maple Street
Dental PC Recipient's name: Casey Walsh 1 Wages, tips, other compensation Correct information $109,245.92",W-2,38,W-2,fdc-b60ac28208314ca1b1ad7dcd,v11-W-2C-flat,corrected,2024,fgen-1dbe074ca4611757932a7f78,synthetic_programmatic_template,flat,top,False,
"Form W-2c Corrected Wage and Tax Statement 2024 From: Blue Heron Logistics LLC RECIPIENT: Jordan B. Brennan 3 Social security wages Correct information $99,979.57 1
Wages, tips, other compensation
Correct information 13,188.97 3 Social security wages Previously reported 81,142.28",W-2,38,W-2,fdc-9b8d6af0dd0f24740548fd66,v11-W-2C-flat,corrected,2024,fgen-ced7d9637305bc9ec9c51d69,synthetic_programmatic_template,flat,top,False,
"| Field | Value |
| --- | --- |
| c Employer'S name: | Blue Heron Logistics LLC |
| Recipient's name: | Lena Moreau |
| 1 Wages, tips, other compensation  Previously reported | 47,258.77 |
| 2 Federal income tax withheld  Previously reported | 1,227.68 |
| 2 Federal income tax withheld  Correct information | $6,504.95 |",W-2,38,W-2,fdc-130ea25332a8900205678210,v11-W-2C-markdown,corrected,2022,fgen-006c687b8ea2625067796c81,synthetic_programmatic_template,markdown,none,False,
"2024
## OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Acme Test Corp 7693 Elm Park Pl Riverton, WI 59917 |
| b Employer's Federal EIN | 63-2215130 |
| f Employee's first name and initial  Last name | Hiro R. Adeyemi |
| d Employee's correct SSN | ending in 4456 |
| Street address (including apt. no.) | 3170 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 55606 |
| Account number (see instructions) | ending in 904222 |
| a Tax year/Form corrected | 2024 |
| 1 Wages, tips, other compensation  Previously reported | $39,548.92 |
| 2 Federal income tax withheld  Previously reported | 6,605.53 |
| 2 Federal income tax withheld  Correct information | 1,749.49 |
| 3 Social security wages  Previously reported | $135,495.61 |
| 3 Social security wages  Correct information | 130,371.40 |
Department of the Treasury - Internal Revenue Service",W-2,38,W-2,fdc-2f906ce4c761e243dad79162,v11-W-2C-markdown,corrected,2024,fgen-189f37bb8e064dd371f62802,synthetic_programmatic_template,markdown,none,False,
"Form W-2c Corrected Wage and Tax Statement 2023
| Field | Value |
| --- | --- |
| c Employer: | Blue Heron Logistics LLC |
| To: | Casey Kowalski |
| 3 Social security wages  Correct information | $76,761.44 |
| 3 Social security wages  Previously reported | 129,640.62 |
| 1 Wages, tips, other compensation  Previously reported | 134,239.16 |",W-2,38,W-2,fdc-ae599b35826fa1c3677cfcdf,v11-W-2C-markdown,corrected,2023,fgen-93b385f35a2ad940705825f5,synthetic_programmatic_template,markdown,top,False,
"Form W-2c
Corrected Wage and Tax Statement
For calendar year 2023
OMB No. 1545-0008
## Copy B—To Be Filed With Employee's Federal Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Blue Heron Logistics LLC 4051 Maple Ridge Dr Cedar Falls, IA 44644 |
| b Employer's Federal EIN | 87-2223504 |
| f Employee's first name and initial  Last name | Fatima Romero |
| d Employee's correct SSN | ****7232 |
| Street address (including apt. no.) | 5233 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 69281 |
| a Tax year/Form corrected | 2023 |
| 1 Wages, tips, other compensation  Previously reported | 81,819.62 |
| 1 Wages, tips, other compensation  Correct information | $74,728.42 |
| 2 Federal income tax withheld  Previously reported | $8,517.11 |
| 2 Federal income tax withheld  Correct information | 6,635.53 |
| 3 Social security wages  Previously reported | $93,022.02 |
| 3 Social security wages  Correct information | $29,522.15 |
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-8285d33731b3cc82f95337d2,v11-W-2C-markdown,corrected,2023,fgen-ee8e060caf7940bd3b3d87b9,synthetic_programmatic_template,markdown,top,False,
"| Field | Value |
| --- | --- |
| From: | Riverside Regional Hospital |
| To: | Hiro S. Larsen |
| 2 Federal income tax withheld  Correct information | $1,453.66 |",W-2,38,W-2,fdc-743ba6653c36c04978c4de76,v11-W-2C-markdown,corrected,2023,fgen-c44b50cecafecff2ef47cc7d,synthetic_programmatic_template,markdown,none,False,
"## CORRECTED (if checked)
Form W-2c
## Corrected Wage and Tax Statement
Copy C—For Employee's Records
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Copperline Software Inc. 8646 Oak Hollow Ct Riverton, WI 23764 |
| b Employer's Federal EIN | 70-3507135 |
| f Employee's first name and initial  Last name | Priya Adeyemi |
| d Employee's correct SSN | XXX-XX-3180 |
| Street address (including apt. no.) | 8992 Willow Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Bayside, WA 13871 |
| 1 Wages, tips, other compensation  Previously reported | 130,398.40 |
| 1 Wages, tips, other compensation  Correct information | $128,644.74 |
| 2 Federal income tax withheld  Previously reported | 8,366.56 |
| 3 Social security wages  Previously reported | 13,925.82 |
| 3 Social security wages  Correct information | 124,818.62 |",W-2,38,W-2,fdc-570edfd6fcfc18c17e22b52e,v11-W-2C-markdown,corrected,2023,fgen-50d95b4bc2b66ef1c1ee9f04,synthetic_programmatic_template,markdown,top,False,
"Form W-2c
Corrected Wage and Tax Statement
2021
## OMB No. 1545-0008
Copy C—For Employee's Records
| Field | Value |
| --- |--- |
| c Employer's name, address, and ZIPcode | Blue Heron Logistics LLC 2264 Prairie Ave Pinecrest, GA 23459|
| b Employer's Federal EIN | 73-2947433 |
|f Employee's first name and initial  Last name | Jamíe M. Larsen |
| d Employee's correct 5SN | XXXXX6602 |
| Street address (íncluding apt. no.) | l09 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Testvílle, IL 8l901 |
| Account number (see instructions) | ****805822 |
| l Wages, tips, other compensation  Prevíously reported | S3,679.93 |
| 1 Wages, tips, other compensation  Correct information | 6,799.24 |
|2 Federal income tax withheld  Previously reported | 1,778.99 |
| 2 Federa1 income tax withheld Correct information | $4,505.38 |
| 3 5ocial security wages  Previously reported | 2,268.56 |
| 3 Social security wages  Correct information | 84,958.61 |",W-2,38,W-2,fdc-c475325e37081e99c5f4e0b5,v11-W-2C-markdown,corrected,2021,fgen-3b5f9292a4d6ecf5db199662,synthetic_programmatic_template,markdown,top,True,
"2026
OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Acme Test Corp 6437 Granite St Testville, IL 45011 |
| b Employer's Federal EIN | 22-5459314 |
| f Employee's first name and initial  Last name | Priya D. Romero |
| d Employee's correct SSN | XXXXX9636 |
| Street address (including apt. no.) | 5336 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 79939 |
| a Tax year/Form corrected | 2026 |
| 1 Wages, tips, other compensation  Correct information | $103,041.23 |
| 2 Federal income tax withheld  Previously reported | 2,114.96 |
| 2 Federal income tax withheld  Correct information | 6,583.90 |
| 3 Social security wages  Previously reported | $42,496.71 |
| 3 Social security wages  Correct information | $132,188.02 |
## Department of the Treasury - Internal Revenue Service
## Form W-2c
## Corrected Wage and Tax Statement
## Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-d697a50a3d89086dd6d70405,v11-W-2C-markdown,corrected,2026,fgen-4821755500b0ce48ca2d7e58,synthetic_programmatic_template,markdown,bottom,False,
"## Form W-2c Corrected Wage and Tax Statement 2022
| Field | Value |
| --- | --- |
| c Employer: | Blue Heron Logistics LLC |
| To: | Sofia Nguyen |
| 2 Federal income tax withheld  Previously reported | $3,604.38 |",W-2,38,W-2,fdc-22245e426e1f41dae11f81ed,v11-W-2C-markdown,corrected,2022,fgen-3905f00c9e0caf20d0151978,synthetic_programmatic_template,markdown,top,False,
"## Form W-2c
Corrected Wage and Tax Statement
## For calendar year 2022
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Riverside Regional Hospital 1458 Harbor View Rd Bayside, WA 27220 |
| b Employer's Federal EIN | 37-8412455 |
| f Employee's first name and initial  Last name | Riley Haddad |
| d Employee's correct SSN | XXXXX4321 |
| Street address (including apt. no.) | 4077 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 61470 |
| a Tax year/Form corrected | 2022 |
| 1 Wages, tips, other compensation  Previously reported | $108,296.36 |
| 1 Wages, tips, other compensation  Correct information | $11,618.57 |
| 2 Federal income tax withheld  Previously reported | 2,613.32 |
| 3 Social security wages  Previously reported | $111,777.74 |
| 3 Social security wages  Correct information | $20,576.83 |",W-2,38,W-2,fdc-c72a65cf4ca64f19aba97866,v11-W-2C-markdown,corrected,2022,fgen-4a5afd02283bb4c2d6586dbf,synthetic_programmatic_template,markdown,top,False,
"Form W-2c
## Corrected Wage and Tax Statement
2022
OMB No. 1545-0008
## Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Maple Street Dental PC 3044 Prairie Ave Maplewood, MN 61464 |
| b Employer's Federal EIN | 48-9530741 |
| f Employee's first name and initial  Last name | Diego Okafor |
| d Employee's correct SSN | ***-**-3544 |
| Street address (including apt. no.) | 5126 Willow Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 87731 |
| Account number (see instructions) | ending in 970968 |
| a Tax year/Form corrected | 2022 |
| 1 Wages, tips, other compensation  Previously reported | $107,550.90 |
| 1 Wages, tips, other compensation  Correct information | 86,797.48 |
| 2 Federal income tax withheld  Correct information | 3,891.62 |
| 3 Social security wages  Previously reported | 80,813.41 |
| 3 Social security wages  Correct information | $121,475.10 |
Department of the Treasury - Internal Revenue Service
Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-b7a0d73bf7fe39157da0a0c8,v11-W-2C-markdown,corrected,2022,fgen-efdf4419bc795b0d83eafa50,synthetic_programmatic_template,markdown,top,False,
"## Form W-2c
Corrected Wage and Tax Statement
## For calendar year 2024
OMB No. 1545-0008
Copy C—For Employee's Records
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Riverside Regional Hospital 5134 Prairie Ave Bayside, WA 96948 |
| b Employer's Federal EIN | 75-4433714 |
| f Employee's first name and initial  Last name | Mateo Kowalski |
| d Employee's correct SSN | ending in 6626 |
| a Tax year/Form corrected | 2024 |
| 1 Wages, tips, other compensation  Correct information | $88,381.40 |
| 2 Federal income tax withheld  Previously reported | $1,001.01 |
| 2 Federal income tax withheld  Correct information | 8,134.85 |
| 3 Social security wages  Previously reported | $30,070.52 |
| 3 Social security wages  Correct information | $59,824.85 |",W-2,38,W-2,fdc-dcabb8a22bbab2f1dbd384a3,v11-W-2C-markdown,corrected,2024,fgen-d89d94508262d5f36f63da4c,synthetic_programmatic_template,markdown,top,False,
"☐ CORRECTED
2023
## OMB No. 1545-0008
Copy C—For Employee's Records
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Maple Street Dental PC 5983 Harbor View Rd Lakewood, CO 96259 |
| b Employer's Federal EIN | 43-4435490 |
| f Employee's first name and initial  Last name | Noah Fischer |
| d Employee's correct SSN | ***-**-0263 |
| Account number (see instructions) | XXX-XX-241817 |
| a Tax year/Form corrected | 2023 |
| 1 Wages, tips, other compensation  Previously reported | $3,566.79 |
| 1 Wages, tips, other compensation  Correct information | 85,578.64 |
| 2 Federal income tax withheld  Previously reported | $1,859.41 |
| 2 Federal income tax withheld  Correct information | 4,582.63 |
| 3 Social security wages  Previously reported | $25,080.62 |
Form W-2c
Corrected Wage and Tax Statement",W-2,38,W-2,fdc-aae6908f928d6fdddf85cfbb,v11-W-2C-markdown,corrected,2023,fgen-6bb8835468777e59c9f11765,synthetic_programmatic_template,markdown,bottom,False,
"Form W-2c Corrected Wage and Tax Statement
| Field | Value |
| --- | --- |
| c Employer: | Maple Street Dental PC |
| Recipient's name: | Kwame Haddad |
| 3 Social security wages  Previously reported | $118,521.39 |
| 1 Wages, tips, other compensation  Correct information | 132,605.82 |
| 2 Federal income tax withheld  Correct information | 5,076.84 |",W-2,38,W-2,fdc-16c2444f65cecf0e620beff5,v11-W-2C-markdown,corrected,2025,fgen-be80a48844e44a41f418e12d,synthetic_programmatic_template,markdown,top,False,
"For calendar year2026
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
| Fie1d | Value |
| --- | --- |
| c Employcr's name, address, and ZIP code | Copperlíne Software Inc. 466l Oak Hollow Ct Oak Grove, TX 98963 |
|b Employer's Federal EIN| 17-3640040 |
| f Employee's fírstname and initial  Last name | Jordan B. Moreau |
| d Employee's correct SSN | XXXXX2333 |
| Strcet address (íncluding apt. no.) | 616 Maple Ridge Dr |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 28259 |
| Account number (see instructions) | ****997l11 |
| a Tax year/Form corrected | 2026 |
| 1 Wages, tips, other compensation Previous1y reported | S106,976.08 |
| 1 Wages, típs, other compensation  Correct information | 48,722.19 |
| 2 Federal income tax withheld  Correct information |$8,624.47 |
| 3 5ocial security wages  Correct information | 95,752.55 |",W-2,38,W-2,fdc-a08df12a23bb57774edf7d93,v11-W-2C-markdown,corrected,2026,fgen-977d3189358f314d6e5ca9ce,synthetic_programmatic_template,markdown,none,True,
"CORRECTED (if checked)
Form W-2c
Corrected Wage and Tax Statement
2021
## OMB No. 1545-0008
Copy B—To Be Filed With Employee's Federal Tax Return
Copy C—For Employee's Records
| Field | Value |
| --- | --- |
| c Employer's name, address, and ZIP code | Tri-County School District 3282 Lakeshore Blvd Lakewood, CO 71182 |
| b Employer's Federal EIN | 59-2307216 |
| f Employee's first name and initial  Last name | Avery Rivera |
| d Employee's correct SSN | ending in 8066 |
| Street address (including apt. no.) | 4834 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Maplewood, MN 92898 |
| Account number (see instructions) | ***-**-644274 |
| a Tax year/Form corrected | 2021 |
| 2 Federal income tax withheld  Previously reported | 3,801.60 |
| 2 Federal income tax withheld  Correct information | $2,829.80 |
| 3 Social security wages  Previously reported | 11,129.61 |
| 3 Social security wages  Correct information | $84,704.69 |
Department of the Treasury - Internal Revenue Service
## Form W-2c (keep for your records)  www.irs.gov/FormW2c",W-2,38,W-2,fdc-1f99e33dd1210bd6108c518f,v11-W-2C-markdown,corrected,2021,fgen-1e811513095a707bfcd06d8d,synthetic_programmatic_template,markdown,top,False,
"2025
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Harbor Lights Gaming Resort 3048 Lakeshore Blvd Bayside, WA 77740
PAYER'S federal identification number
30-1203217
WINNER'S name
Jamie Castillo
WINNER'S taxpayer identification no.
***-**-6837
Account number (see instructions)
****480243
1 Reportable winnings
115,168.99
2 Date won
4/27/24
4 Federal income tax withheld
$3,458.42
5 Transaction
711
7 Winnings from identical wagers
8,818.71
8 Cashier
432
15 State income tax withheld
$2,046.54
Department of the Treasury - Internal Revenue Service
Form W-2G
Certain Gambling Winnings
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-7762089ef6afe4c123aaada8,v11-W-2G-stacked,original,2025,fgen-f066381f2217bd8951c8f82c,synthetic_programmatic_template,stacked,bottom,False,
"Form W-2G Certain Gambling Winnings
From:
Lucky River Casino
RECIPIENT:
Kwame Sato
7 Winnings from identical wagers
3,325.73
5 Transaction
318
14 State winnings
109,366.66",W-2G,39,W-2G,fdc-8961a760e78b60b684fe2f3f,v11-W-2G-stacked,original,2024,fgen-d62d4edbdba82f73492deae5,synthetic_programmatic_template,stacked,top,False,
"OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Harbor Lights Gaming Resort 9048 Elm Park Pl Cedar Falls, IA 11782
PAYER'S federal identification number
50-9605082
WINNER'S name
Sofia Nguyen
WINNER'S taxpayer identification no.
XXX-XX-8603
1 Reportable winnings
35,220.11
2 Date won
February 19, 2023
3 Type of wager
Poker tournament
4 Federal income tax withheld
$8,209.47
5 Transaction
83
7 Winnings from identical wagers
$9,144.28
10 Window
86
14 State winnings
892.90
15 State income tax withheld
$2,909.98
Department of the Treasury - Internal Revenue Service",W-2G,39,W-2G,fdc-ba49eaf0bc4bb256a4a43bd3,v11-W-2G-stacked,original,2023,fgen-067af6eed42a4948e55b9db2,synthetic_programmatic_template,stacked,none,False,
"☐ CORRECTED
Form W-2G
Certain Gambling Winnings
For calendar year 2025
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP
Prairie Downs Racetrack 681 Prairie Ave Maplewood, MN 29607
PAYER'S federal identification number
87-4265981
WINNER'S name
Jordan S. Moreau
WINNER'S taxpayer identification no.
XXX-XX-3331
Street address (including apt. no.)
2574 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Fairview, OH 41605
1 Reportable winnings
$83,942.90
3 Type of wager
Lottery
4 Federal income tax withheld
150.12
7 Winnings from identical wagers
7,641.48
10 Window
865
14 State winnings
$87,686.41
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-7e84b45c7f9dd9fadebf5f26,v11-W-2G-stacked,original,2025,fgen-a177b3d9291d0c9bf3bece5a,synthetic_programmatic_template,stacked,top,False,
"2024
OMB No. 1545-0238
Copy C For Wínner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Harbor Lights Gaming Resort 594 Maple RidgeDr Pinecrest, GA 64l41
PAYER'S federal identification number
12-8014403
WINNER'5 name
Diego Tanaka
WINNER'S taxpayer identification no.
ending in 9829
Account number (see instructions)
ending in 345968
1 Reportab1e winnings
113,613.97
2 Date won
4/3/24
3 Type of wager
Horse race
4 Federal income tax withheld
$8,164.18
7 Winnings from identical wagers
4,573.53
8 Cashier
7O8
10 Window
135
14 5tate winnings
$33,579.87
15 State income tax withheld
8,723.62
Departmentof the Treasury - Intemal Revenue Service
Form W-2G
Certain Gambling Winnings
Form W-2G(keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-b43985ebaa1ff9314d235622,v11-W-2G-stacked,original,2024,fgen-b2d2087504650826a588ebf5,synthetic_programmatic_template,stacked,bottom,True,
"CORRECTED (if checked)
Form W-2G
Certain Gambling Winnings
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP
Prairie Downs Racetrack 4844 Sample Street Lakewood, CO 88311
PAYER'S federal identification number
28-9626198
WINNER'S name
Fatima Castillo
WINNER'S taxpayer identification no.
XXX-XX-6018
2 Date won
2024-01-13
3 Type of wager
Poker tournament
4 Federal income tax withheld
$7,782.83
5 Transaction
239
7 Winnings from identical wagers
$2,019.31
8 Cashier
234
10 Window
526
14 State winnings
$74,550.22
15 State income tax withheld
$8,605.83",W-2G,39,W-2G,fdc-4fe0c1e748fc85184f363fdb,v11-W-2G-stacked,original,2024,fgen-96475d2e9b8bd6940fc06309,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
Form W-2G
Certain Gambling Winnings
2026
OMB No. 1545-0238
PAYER'S name, street address, city or town, province or state, country, and ZIP
Lucky River Casino 3133 Granite St Bayside, WA 44202
PAYER'S federal identification number
43-6586919
WINNER'S name
Lena Kowalski
WINNER'S taxpayer identification no.
***-**-0419
Street address (including apt. no.)
7407 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 34763
1 Reportable winnings
$16,919.66
3 Type of wager
Lottery
4 Federal income tax withheld
4,314.26
7 Winnings from identical wagers
7,692.05
8 Cashier
853
10 Window
360
15 State income tax withheld
$3,867.48",W-2G,39,W-2G,fdc-85514d3955e5cbfcd3f90785,v11-W-2G-stacked,original,2026,fgen-dc12ea88071a6e700c6126c6,synthetic_programmatic_template,stacked,top,False,
"Form W-2G Certain Gambling Winnings
PAYER:
Lucky River Casino
Recipient's name:
Olivia S. Sato
1 Reportable winnings
$98,225.41",W-2G,39,W-2G,fdc-b833b46e1056d906701e90bd,v11-W-2G-stacked,original,2022,fgen-d2fc52883b8458a114fec270,synthetic_programmatic_template,stacked,top,False,
"Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Prairie Downs Racetrack 6440 Elm Park Pl Pinecrest, GA 90916
PAYER'S federal identification number
12-3969614
WINNER'S name
Jamie Lindqvist
WINNER'S taxpayer identification no.
***-**-1639
Street address (including apt. no.)
766 Granite St
City or town, state or province, country, and ZIP or foreign postal code
Testville, IL 54308
1 Reportable winnings
$115,974.05
2 Date won
2020-05-12
3 Type of wager
Poker tournament
5 Transaction
585
7 Winnings from identical wagers
$7,638.09
8 Cashier
430
10 Window
674
15 State income tax withheld
$1,105.24
Department of the Treasury - Internal Revenue Service
Form W-2G
Certain Gambling Winnings
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-ad4952dbdde7440961b4d035,v11-W-2G-stacked,original,2023,fgen-be6152f1a2354b50651d2d8f,synthetic_programmatic_template,stacked,bottom,False,
"Form W-2G Certain Gambling Winnings 2026
PAYER:
Harbor Lights Gaming Resort
To:
Mateo Haddad
14 State winnings
48,314.31
2 Date won
08/02/2023
5 Transaction
367",W-2G,39,W-2G,fdc-0be6f60de584395a0ab89ac5,v11-W-2G-stacked,original,2026,fgen-6f07c23bbba80f4c8a9dc3bc,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2022
OMB No. 1545-0238
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Prairie Downs Racetrack 2518 Granite St Bayside, WA 49588
PAYER'S federal identification number
27-6549246
WINNER'S name
Jordan Haddad
WINNER'S taxpayer identification no.
XXX-XX-9593
1 Reportable winnings
$106,524.81
2 Date won
2021-12-20
3 Type of wager
Horse race
5 Transaction
506
8 Cashier
815
10 Window
488
14 State winnings
$19,999.10
15 State income tax withheld
3,098.24",W-2G,39,W-2G,fdc-7188d0d3f0a5de8a240dc883,v11-W-2G-stacked,original,2022,fgen-d92623f725c851809866f14a,synthetic_programmatic_template,stacked,none,False,
"Form W-2G
Certain Gambling Winnings
For calendar year 2022
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Lucky River Casino 3474 Granite St Bayside, WA 43541
PAYER'S federal identification number
14-1690610
WINNER'S name
Kwame Testcase
WINNER'S taxpayer identification no.
XXX-XX-1057
Account number (see instructions)
XXXXX643002
1 Reportable winnings
$72,261.84
2 Date won
2022-05-27
3 Type of wager
Lottery
4 Federal income tax withheld
3,396.13
5 Transaction
351
7 Winnings from identical wagers
7,205.58
8 Cashier
52
10 Window
760
14 State winnings
77,731.05",W-2G,39,W-2G,fdc-e9f0ecc0b8ff5e671d88af2f,v11-W-2G-stacked,original,2022,fgen-cfc431731c44a3495eca0239,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
Form W-2G
Certain Gambling Winnings
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Harbor Lights Gaming Resort 3600 Willow Bend Way Pinecrest, GA 17048
PAYER'S federal identification number
17-4967918
WINNER'S name
Jamie Testcase
WINNER'S taxpayer identification no.
XXX-XX-3236
Account number (see instructions)
XXXXX771336
1 Reportable winnings
119,388.53
2 Date won
2023-12-20
3 Type of wager
Poker tournament
4 Federal income tax withheld
9,187.55
5 Transaction
121
7 Winnings from identical wagers
3,180.07
8 Cashier
130
10 Window
873
14 State winnings
$42,265.92
15 State income tax withheld
$769.72
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-e13bbb9bfb93255af6ff499c,v11-W-2G-stacked,original,2024,fgen-0f0d4b6e39a31bf7f61a9f35,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2022
OMB No. l545-O238
Copy B Report thís income on your federal tax return.
Copy CFor Winner's Records
PAYER'S name, street address, city or town,provínce or state, country, and ZIP
Lucky River Casino 8l40 Oak Hollow Ct Fairview, OH 24654
PAYER'S federal identification number
63-4271658
WINNER'S name
Avery Tanaka
WINNER'S taxpayer identification no.
ending in 9845
Streetaddress (induding apt. no.)
3176 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign posta1 code
Lakewood, CO 4684O
1 Reportable winnings
11,882.78
2 Date won
11/04/2019
3 Type of wager
Keno
4 Federal income tax withheld
6,643.83
5 Transaction
220
7 Winnings from identical wagers
9,4l6.82
8 Cashier
499
10 Window
920
15 State income tax withheld
6,843.62",W-2G,39,W-2G,fdc-8febef6bdce1091431d0a354,v11-W-2G-stacked,original,2022,fgen-e8c2280df7de77341807e675,synthetic_programmatic_template,stacked,none,True,
"VOID  CORRECTED
Form W-2G
Certain Gambling Winnings
2021
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
Prairie Downs Racetrack 6829 Willow Bend Way Bayside, WA 34990
PAYER'S federal identification number
43-7771920
WINNER'S name
Jordan Okafor
WINNER'S taxpayer identification no.
****4919
Street address (including apt. no.)
9689 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code
Oak Grove, TX 67315
Account number (see instructions)
****205287
1 Reportable winnings
107,535.01
2 Date won
12/22/21
3 Type of wager
Poker tournament
4 Federal income tax withheld
$4,620.77
5 Transaction
812
7 Winnings from identical wagers
$7,622.39
8 Cashier
900
15 State income tax withheld
$5,210.35
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-b0b66211c743418fd9fc6d9d,v11-W-2G-stacked,original,2021,fgen-c79b6b1abe98782bbebc3cd0,synthetic_programmatic_template,stacked,top,False,
"PAYER'S name:
Lucky River Casino
RECIPIENT:
Priya Brennan
2 Date won
2024-02-27
8 Cashier
29
15 State income tax withheld
$705.50
Form W-2G Certain Gambling Winnings",W-2G,39,W-2G,fdc-079c0ca11bb40676bf2b6029,v11-W-2G-stacked,original,2024,fgen-291cc9a427d55b1d0a8336c7,synthetic_programmatic_template,stacked,bottom,False,
"Form W-2G
Certain Gambling Winnings
2022
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP      Prairie Downs Racetrack 6429 Prairie Ave Oak Grove, TX 12032
PAYER'S federal identification number  19-1435868
WINNER'S name   Olivia L. Sato
WINNER'S taxpayer identification no.  ending in 1824
Street address (including apt. no.) 5706 Prairie Ave
City or town, state or province, country, and ZIP or foreign postal code   Riverton, WI 95817
Account number (see instructions)   ****181022
1 Reportable winnings 138,249.58
2 Date won 03/08/2019
3 Type of wager Poker tournament
7 Winnings from identical wagers   333.49
8 Cashier  540
10 Window 306
14 State winnings   $19,893.33
15 State income tax withheld 7,046.28
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-959938abd7a5f01f4e4eed76,v11-W-2G-inline,original,2022,fgen-14982df36bdc41178119f80e,synthetic_programmatic_template,inline,top,False,
"For calendar year 2025
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP Prairie Downs Racetrack 3189 Lakeshore Blvd Oak Grove, TX 95397
PAYER'S federal identification number   58-5286681
WINNER'S name   Priya Fischer
WINNER'S taxpayer identification no.   ***-**-8077
Street address (including apt. no.) 3001 Elm Park Pl
City or town, state or province, country, and ZIP or foreign postal code  Oak Grove, TX 65276
Account number (see instructions) ending in 274524
1 Reportable winnings 137,103.85
2 Date won December 20, 2022
3 Type of wager Horse race
4 Federal income tax withheld      $4,794.99
5 Transaction 194
7 Winnings from identical wagers  7,105.95
8 Cashier 731
10 Window 436
Department of the Treasury - Internal Revenue Service",W-2G,39,W-2G,fdc-7da1e77787ede67f70b553b3,v11-W-2G-inline,original,2025,fgen-8d630f26e8f1640cd60f216c,synthetic_programmatic_template,inline,none,False,
"Form W-2G Certain Gambling Winnings
PAYER'S name:      Prairie Downs Racetrack
Recipient's name:      Mateo Patel
14 State winnings   $99,074.85",W-2G,39,W-2G,fdc-bcaea5f1e9a99a650634d986,v11-W-2G-inline,original,2022,fgen-cab6521ff60bdc638e4089f7,synthetic_programmatic_template,inline,top,False,
"Form W-2G
Certain Gambling Winnings
2026
PAYER'S name, street address, city or town, province or state, country, and ZIP   Prairie Downs Racetrack 8467 Sample Street Riverton, WI 77384
PAYER'S federal identification number 32-3877974
WINNER'S name  Casey K. Lindqvist
WINNER'S taxpayer identification no. ending in 8082
Street address (including apt. no.) 6529 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code   Cedar Falls, IA 50081
Account number (see instructions)   ending in 711404
1 Reportable winnings      50,591.09
2 Date won  4/16/26
3 Type of wager   Lottery
4 Federal income tax withheld      7,459.55
5 Transaction      942
7 Winnings from identical wagers $8,920.25
10 Window   88
14 State winnings   9,841.77
15 State income tax withheld      $2,255.59",W-2G,39,W-2G,fdc-19e9b3f8556e6e43c5b6b2cf,v11-W-2G-inline,original,2026,fgen-8df3cbacd6b53387b89a7ebb,synthetic_programmatic_template,inline,top,False,
"Form W-2G
Certain Gambling Winnings
2024
OMB No. 1545-0238
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP  Prairie Downs Racetrack 7757 Oak Hollow Ct Riverton, WI 83643
PAYER'S federal identification number  41-2150927
WINNER'S name Priya Tanaka
WINNER'S taxpayer identification no.  XXXXX1454
Street address (including apt. no.) 5365 Harbor View Rd
City or town, state or province, country, and ZIP or foreign postal code Oak Grove, TX 24327
Account number (see instructions)  XXXXX341668
1 Reportable winnings  $77,054.83
2 Date won 12/18/24
3 Type of wager Horse race
4 Federal income tax withheld 3,085.72
5 Transaction      921
7 Winnings from identical wagers      1,850.89
8 Cashier 563
10 Window 229
15 State income tax withheld $1,236.81",W-2G,39,W-2G,fdc-fdbdd98b73dab86c26eda0ea,v11-W-2G-inline,original,2024,fgen-5fdee090f30b267a9c54098b,synthetic_programmatic_template,inline,top,False,
"Form W-2G
Certain Gambling Winnings
2026
OMB No. 1545-0238
PAYER'S name, street address, city or town, province or state, country, and ZIP  Harbor Lights Gaming Resort 574 Granite St Testville, IL 94683
PAYER'S federal identification number 38-2713807
WINNER'S name Amara L. Larsen
WINNER'S taxpayer identification no.      ****2911
Street address (including apt. no.)      4170 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code  Lakewood, CO 89378
1 Reportable winnings $93,880.87
2 Date won 2026-07-17
3 Type of wager Keno
4 Federal income tax withheld  $410.21
7 Winnings from identical wagers   1,881.84
8 Cashier      463
10 Window      380
14 State winnings   83,497.79
15 State income tax withheld 4,004.38
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-8be91336bef4baf8f95d5d1a,v11-W-2G-inline,original,2026,fgen-0e44e3c51b23fcc752afc0d6,synthetic_programmatic_template,inline,top,False,
"☐ CORRECTED
Form W-2G
Certain Gambling Winnings
2023
OMB No. 1545-0238
PAYER'S name, street address, city or town, province or state, country, and ZIP Harbor Lights Gaming Resort 6089 Harbor View Rd Maplewood, MN 22466
PAYER'S federal identification number      53-9082110
WINNER'S name  Olivia Brennan
WINNER'S taxpayer identification no.  ****0826
Street address (including apt. no.)      3665 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code Brookhaven, PA 95775
Account number (see instructions) ***-**-812631
1 Reportable winnings      $42,838.64
2 Date won July 4, 2023
3 Type of wager Poker tournament
5 Transaction 902
7 Winnings from identical wagers 5,036.99
10 Window 827",W-2G,39,W-2G,fdc-a2ca962aabca9e25af7e9b13,v11-W-2G-inline,original,2023,fgen-20c9f16e466c8d812bb9d6ab,synthetic_programmatic_template,inline,top,False,
"Form W-2G
Certain Gambling Winnings
For calendar year 2026
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP   Prairie Downs Racetrack 585 Lakeshore Blvd Lakewood, CO 40220
PAYER'S federal identification number   29-1106214
WINNER'S name Alex Romero
WINNER'S taxpayer identification no.   ending in 0813
Account number (see instructions) ****897131
1 Reportable winnings 77,056.26
2 Date won   2/12/26
3 Type of wager   Lottery
4 Federal income tax withheld   6,890.29
5 Transaction 441
8 Cashier   769
10 Window   675
14 State winnings 53,293.81
15 State income tax withheld      8,513.94
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-a1e12f602be2b1b618242b4f,v11-W-2G-inline,original,2026,fgen-52f9232876c22263b4892829,synthetic_programmatic_template,inline,top,False,
"For calendar year 2024
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP Harbor Lights Gaming Resort 2214 Oak Hollow Ct Cedar Falls, IA 95437
PAYER'S federal identification number  28-4719696
WINNER'S name  Fatima L. Romero
WINNER'S taxpayer identification no. XXXXX2830
Street address (including apt. no.)      2823 Cedar Ln
City or town, state or province, country, and ZIP or foreign postal code  Riverton, WI 94821
Account number (see instructions)      ending in 087901
1 Reportable winnings 28,023.08
2 Date won      January 15, 2021
3 Type of wager Horse race
4 Federal income tax withheld  8,097.28
5 Transaction  895
8 Cashier 481
10 Window 566
14 State winnings  74,303.96
15 State income tax withheld      4,746.69
Department of the Treasury - Internal Revenue Service",W-2G,39,W-2G,fdc-11abbfb93aef6936dee0688e,v11-W-2G-inline,original,2024,fgen-5d88b47e65600b4c06c6140b,synthetic_programmatic_template,inline,none,False,
"CORRECTED (if checked)
2024
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP      Prairie Downs Racetrack 7420 Lakeshore Blvd Cedar Falls, IA 78864
PAYER'S federal identification number 25-9738737
WINNER'S name Casey Rivera
WINNER'S taxpayer identification no.   XXX-XX-6855
2 Date won   10/2/23
3 Type of wager  Lottery
5 Transaction  892
7 Winnings from identical wagers $3,899.35
8 Cashier      843
10 Window 124
14 State winnings      $3,332.06
Department of the Treasury - Internal Revenue Service
Form W-2G
Certain Gambling Winnings
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-18a3dd3421b131116f4e8887,v11-W-2G-inline,original,2024,fgen-c9d9ab5340bc491ea7419b31,synthetic_programmatic_template,inline,bottom,False,
"CORRECTED (if checked)
For calendar year 2024
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP   Prairie Downs Racetrack 6710 Elm Park Pl Fairview, OH 81223
PAYER'S federal identification number  21-5682240
WINNER'S name   Fatima Fischer
WINNER'S taxpayer identification no. ***-**-3231
1 Reportable winnings  $43,218.64
2 Date won December 12, 2024
3 Type of wager Horse race
4 Federal income tax withheld $4,893.25
5 Transaction  344
7 Winnings from identical wagers $7,838.28
14 State winnings      126,508.63
15 State income tax withheld 7,204.45
Department of the Treasury - Internal Revenue Service
Form W-2G
Certain Gambling Winnings
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-f11809b977e554b7fa94dbd5,v11-W-2G-inline,original,2024,fgen-20efb006133a3294f22f2868,synthetic_programmatic_template,inline,bottom,False,
"Form W-2G
Certain Gambling Winnings
2026
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP      Harbor Lights Gaming Resort 4402 Lakeshore Blvd Lakewood, CO 14586
PAYER'S federal identification number 39-4639105
WINNER'S name Priya R. Patel
WINNER'S taxpayer identification no.  ***-**-7434
Street address (including apt. no.) 1957 Oak Hollow Ct
City or town, state or province, country, and ZIP or foreign postal code Maplewood, MN 94494
Account number (see instructions)      XXXXX913721
1 Reportable winnings      $28,301.78
2 Date won   10/17/2023
3 Type of wager Horse race
4 Federal income tax withheld 7,997.04
7 Winnings from identical wagers 6,031.15
8 Cashier 173
10 Window  98
15 State income tax withheld  116.82
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-49ec3fa21131559b8e115b76,v11-W-2G-inline,original,2026,fgen-532e961bd80ed39d324001f6,synthetic_programmatic_template,inline,top,False,
"2024
OMB No. 1545-0238
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP   Lucky River Casino 7900 Prairie Ave Riverton, WI 98510
PAYER'S federal identification number 80-7045955
WINNER'S name      Riley Castillo
WINNER'S taxpayer identification no.  ****5096
1 Reportable winnings      16,943.24
3 Type of wager Horse race
5 Transaction  824
8 Cashier   622
10 Window      640
Form W-2G
Certain Gambling Winnings",W-2G,39,W-2G,fdc-d05fcc1f77b858c286c6ed32,v11-W-2G-inline,original,2024,fgen-4763ad0705e3d95bc1f3e0af,synthetic_programmatic_template,inline,bottom,False,
"OMB No. 1545-0238
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP Lucky River Casino 7226 Granite St Riverton, WI 95824
PAYER'S federal identification number   94-8872165
WINNER'S name  Casey Kowalski
WINNER'S taxpayer identification no. XXX-XX-2908
Street address (including apt. no.) 9266 Willow Bend Way
City or town, state or province, country, and ZIP or foreign postal code      Maplewood, MN 51131
2 Date won   04/24/2023
3 Type of wager      Keno
5 Transaction      985
7 Winnings from identical wagers   $9,398.24
8 Cashier  695
10 Window      800
14 State winnings      131,981.04
15 State income tax withheld  $5,280.90",W-2G,39,W-2G,fdc-c529da58c61c9c30212263f1,v11-W-2G-inline,original,2023,fgen-2fe764e7e27a984b5d2c3246,synthetic_programmatic_template,inline,none,False,
"For calendar year 2025
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP Harbor Lights Gaming Resort 5529 Cedar Ln Fairview, OH 72771
PAYER'S federal identification number      72-5738711
WINNER'S name      Fatima L. Castillo
WINNER'S taxpayer identification no. XXXXX9837
Street address (including apt. no.)  1467 Maple Ridge Dr
City or town, state or province, country, and ZIP or foreign postal code   Riverton, WI 38494
Account number (see instructions)   XXX-XX-976200
1 Reportable winnings $133,552.89
2 Date won  2022-08-20
3 Type of wager   Poker tournament
4 Federal income tax withheld $4,057.42
5 Transaction   928
7 Winnings from identical wagers $450.27
8 Cashier  153
10 Window  967
14 State winnings 14,305.35
Form W-2G
Certain Gambling Winnings",W-2G,39,W-2G,fdc-673db50c41a5344f1b7aee5b,v11-W-2G-inline,original,2025,fgen-2e13d86528a9deb377230128,synthetic_programmatic_template,inline,bottom,False,
"2025
Copy B Report thís income on your federal tax return.
PAYER'Sname, street address, city or town, province or state, country, andZIP      Prairie Downs Racetrack 7l29 Oak Ho1low Ct Lakewood, CO 88218
PAYER'S federal identification number  73-47l5348
WINNER'S name   Casey A. Rivera
WINNER'S taxpayer identification no.  XXXXX1885
Account numbcr (see instructions)      XXXXX3O674l
2 Date won October 11, 2022
3 Type of wager Poker toumament
4 Federal income tax wíthheld     $6,735.19
5 Transaction 163
7 Winnings from identical wagers $6,467.02
8 Cashier      123
10 Window   562
14 5tate winnings  136,736.89
15 State income tax withheld   $8,276.77
Form W-2G
Certain Gambling Winnings",W-2G,39,W-2G,fdc-c78a8603ebf6bacb579a2d44,v11-W-2G-inline,original,2025,fgen-73d33cfc32af54ea0f13a0d8,synthetic_programmatic_template,inline,bottom,True,
"VOID  CORRECTED
Form W-2G
Certain Gambling Winnings
2021
OMB No. 1545-0238
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Reportable winnings
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
8 Cashier
14 State winnings
15 State income tax withheld
Harbor Lights Gaming Resort 167 Harbor View Rd Riverton, WI 85759
43-2041432
Hiro M. Rivera
XXX-XX-7536
2340 Sample Street
Testville, IL 35866
$9,023.78
Keno
$6,192.09
892
$8,858.16
804
96,146.28
2,354.90
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-4e5593510876dc9e7a4fbd6e,v11-W-2G-columns,original,2021,fgen-6ba53d9312cbbe591b6ff3ba,synthetic_programmatic_template,columns,top,False,
"Form W-2G
Certain Gambling Winnings
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Account number (see instructions)
1 Reportable winnings
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
8 Cashier
10 Window
14 State winnings
15 State income tax withheld
Prairie Downs Racetrack 3943 Oak Hollow Ct Riverton, WI 53755
27-2440031
Hiro C. Castillo
ending in 0699
****911123
92,911.85
January 27, 2022
Horse race
$1,594.21
149
4,945.29
386
32
$113,773.28
$3,260.75",W-2G,39,W-2G,fdc-19c317243040b4236f570dfc,v11-W-2G-columns,original,2022,fgen-539071cb37338f29af529655,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form W-2G
Certain Gambling Winnings
2022
OMB No. 1545-0238
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
1 Reportable winnings
2 Date won
3 Type of wager
5 Transaction
7 Winnings from identical wagers
8 Cashier
10 Window
14 State winnings
15 State income tax withheld
Lucky River Casino 7992 Prairie Ave Lakewood, CO 26123
96-7046019
Amara D. Testcase
ending in 7225
31,979.69
2022-04-10
Lottery
174
7,678.48
719
847
$42,502.99
$8,274.78",W-2G,39,W-2G,fdc-e0b7744e23544ef2dee51d3a,v11-W-2G-columns,original,2022,fgen-f991e54addcf48481ef949d5,synthetic_programmatic_template,columns,top,False,
"Form W-2G Certain Gambling Winnings 2022
PAYER'S name:
Recipient's name:
7 Winnings from identical wagers
8 Cashier
10 Window
5 Transaction
Lucky River Casino
Olivia S. Romero
5,893.29
200
808
88",W-2G,39,W-2G,fdc-410867e5d18e6b38835db942,v11-W-2G-columns,original,2022,fgen-0c348a3bf14ba2bccb0a43ff,synthetic_programmatic_template,columns,top,False,
"Form W-2G Certain Gambling Winnings
PAYER:
RECIPIENT:
14 State winnings
Harbor Lights Gaming Resort
Lena A. Adeyemi
$9,604.95",W-2G,39,W-2G,fdc-08cd4f2d5af2b7645f8a53d7,v11-W-2G-columns,original,2023,fgen-adf9c2079a6571b2b7d5e798,synthetic_programmatic_template,columns,top,False,
"Form W-2G
Certain Gambling Winnings
For calendar year 2023
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Reportable winnings
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
8 Cashier
15 State income tax withheld
Lucky River Casino 2689 Elm Park Pl Maplewood, MN 68839
28-1671109
Priya Walsh
ending in 6675
9587 Granite St
Bayside, WA 40805
***-**-236878
$19,741.28
08/06/2023
Lottery
8,440.69
350
$7,734.69
941
$9,326.91
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-3a4dd81cf5da4ef8f0795922,v11-W-2G-columns,original,2023,fgen-3da0620720bbc61a489d0d8d,synthetic_programmatic_template,columns,top,False,
"Form W-2G
Certain Gambling Winnings
For calendar year 2022
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Reportable winnings
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
10 Window
14 State winnings
15 State income tax withheld
Lucky River Casino 3967 Granite St Oak Grove, TX 97254
37-1179804
Jordan S. Testcase
XXXXX0168
7549 Cedar Ln
Riverton, WI 49744
$127,941.29
06/27/2021
Poker tournament
$4,198.43
179
2,567.89
967
17,683.70
$4,515.68
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-569c4940bb03d0b8465e5cd6,v11-W-2G-columns,original,2022,fgen-d23f80a84e064404352c9374,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form W-2G
Certain Gambling Winnings
For calendar year 2021
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
15 State income tax withheld
Lucky River Casino 5804 Cedar Ln Bayside, WA 30017
11-9663709
Hiro Sato
****8717
2203 Willow Bend Way
Oak Grove, TX 61105
ending in 455524
2018-12-16
Keno
$7,186.50
957
5,543.65
2,331.13",W-2G,39,W-2G,fdc-7c3293bebed1edbde9851996,v11-W-2G-columns,original,2021,fgen-7baf9373193a761d8eb04dcc,synthetic_programmatic_template,columns,top,False,
"For calendar year 2024
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Reportable winnings
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
8 Cashier
10 Window
14 State winnings
15 State income tax withheld
Harbor Lights Gaming Resort 5975 Willow Bend Way Pinecrest, GA 25355
88-4299381
Riley Rivera
****2335
4019 Elm Park Pl
Pinecrest, GA 78765
54,203.79
2021-08-11
Lottery
7,361.03
410
6,622.59
111
509
$103,437.19
$3,671.43
Department of the Treasury - Internal Revenue Service",W-2G,39,W-2G,fdc-bcba8a36e0cb77108e9b22b6,v11-W-2G-columns,original,2024,fgen-b48d045ce6c4ff878cf6b599,synthetic_programmatic_template,columns,none,False,
"2022
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Reportable winnings
3 Type of wager
5 Transaction
7 Winnings from identical wagers
8 Cashier
10 Window
14 State winnings
15 State income tax withheld
Harbor Lights Gaming Resort 8177 Granite St Fairview, OH 28190
57-7792244
Olivia Sato
***-**-5816
8219 Lakeshore Blvd
Oak Grove, TX 58481
37,212.28
Keno
741
$4,324.93
905
437
$119,572.85
$1,242.89
Department of the Treasury - Internal Revenue Service
Form W-2G
Certain Gambling Winnings
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-c687110643d776ff2c1055c6,v11-W-2G-columns,original,2022,fgen-8e9c9792e1d33928469dac1e,synthetic_programmatic_template,columns,bottom,False,
"VOID  CORRECTED
2025
OMB No. 1545-0238
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Reportable winnings
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
14 State winnings
15 State income tax withheld
Prairie Downs Racetrack 4635 Maple Ridge Dr Bayside, WA 46062
52-2502738
Olivia Walsh
ending in 4333
2945 Elm Park Pl
Testville, IL 75726
$107,174.33
Lottery
$9,046.36
760
240.02
72,842.20
$8,335.50
Department of the Treasury - Internal Revenue Service
Form W-2G
Certain Gambling Winnings
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-5c36424563b4d44a60085a75,v11-W-2G-columns,original,2025,fgen-378d630bc75b63cc33d80e9b,synthetic_programmatic_template,columns,bottom,False,
"2026
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
1 Reportable winnings
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
8 Cashier
14 State winnings
15 State income tax withheld
Lucky River Casino 1871 Oak Hollow Ct Riverton, WI 56059
27-9252544
Mateo Adeyemi
XXXXX3450
5418 Willow Bend Way
Bayside, WA 27592
$77,257.46
12/15/25
Keno
8,043.60
791
1,478.19
499
116,135.38
4,327.13
Form W-2G
Certain Gambling Winnings",W-2G,39,W-2G,fdc-6d2f6133d04a2b8affca987a,v11-W-2G-columns,original,2026,fgen-a40f29006590145732029fe7,synthetic_programmatic_template,columns,bottom,False,
"Form W-2G Certain Gambling Winnings 2021
PAYER:
RECIPIENT:
4 Federal income tax withheld
2 Date won
Lucky River Casino
Kwame Haddad
$4,353.34
October 22, 2020",W-2G,39,W-2G,fdc-d53c71fec3ffcac9550011ed,v11-W-2G-columns,original,2021,fgen-040e17a5bfda6e364d15f041,synthetic_programmatic_template,columns,top,False,
"Form W-2G
Certain Gambling Winnings
2023
OMB No. 1545-0238
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
8 Cashier
10 Window
14 State winnings
15 State income tax withheld
Prairie Downs Racetrack 5756 Cedar Ln Bayside, WA 86234
14-4031851
Taylor M. Fischer
ending in 2064
9207 Sample Street
Lakewood, CO 94488
1/18/23
Keno
1,520.19
235
$2,150.00
376
566
$49,887.20
2,322.37",W-2G,39,W-2G,fdc-c07f23c5d81bda7289a28f22,v11-W-2G-columns,original,2023,fgen-d1115e35bcd8f4ba95d77988,synthetic_programmatic_template,columns,top,False,
"For calendar year 2021
OMBNo. 1545-0238
Copy B Report this income on your federal taxreturn.
Copy C For Winncr's Records
PAYER'S name, strcet address, city or town, province or state,country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpaycr identification no.
Street address (induding apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
2 Date won
5 Transaction
7 Winnings from idcntica1 wagers
8 Cashier
15 State income tax withheld
Lucky River Casino 2095 0ak Hollow Ct 0ak Grove, TX 27810
30-7981930
Díego Larsen
****7952
5218 Prairie Ave
Testville, IL 83385
XXXXX462426
2O21-01-23
577
$4,120.03
945
2,361.58
Department of the Treasury - Internal Revcnue Servíce
Form W-2G
Certain Gambling Winnings
Form W-2G (keepfor your records)  www.írs.gov/FormW2G",W-2G,39,W-2G,fdc-553da948832212fcd45951fe,v11-W-2G-columns,original,2021,fgen-9a8fe8f90359580c85112865,synthetic_programmatic_template,columns,bottom,True,
"Form W-2G
Certain Gambling Winnings
Copy C For Winner's Records
PAYER'S name, street address, city or town, province or state, country, and ZIP
PAYER'S federal identification number
WINNER'S name
WINNER'S taxpayer identification no.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
2 Date won
3 Type of wager
4 Federal income tax withheld
5 Transaction
7 Winnings from identical wagers
8 Cashier
10 Window
14 State winnings
15 State income tax withheld
Prairie Downs Racetrack 7901 Granite St Lakewood, CO 13292
54-6283785
Jamie Nguyen
****1852
9633 Elm Park Pl
Bayside, WA 13922
2020-01-05
Slots
7,475.71
581
1,251.14
405
539
119,750.86
$2,147.40
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-e8f07ec0804e6a9a0f063f3b,v11-W-2G-columns,original,2023,fgen-c5cbe015857e0dfa962d3f90,synthetic_programmatic_template,columns,top,False,
"## Form W-2G
Certain Gambling Winnings
For calendar year 2021
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Harbor Lights Gaming Resort 2461 Harbor View Rd Oak Grove, TX 21741 |
| PAYER'S federal identification number | 53-7571589 |
| WINNER'S name | Noah Fischer |
| WINNER'S taxpayer identification no. | ****0965 |
| Street address (including apt. no.) | 14 Lakeshore Blvd |
| City or town, state or province, country, and ZIP or foreign postal code | Pinecrest, GA 32589 |
| Account number (see instructions) | XXXXX329108 |
| 1 Reportable winnings | 12,749.32 |
| 2 Date won | March 4, 2021 |
| 3 Type of wager | Horse race |
| 5 Transaction | 979 |
| 7 Winnings from identical wagers | 8,406.96 |
| 8 Cashier | 453 |
| 10 Window | 788 |
| 14 State winnings | $57,337.34 |
| 15 State income tax withheld | $243.01 |
Department of the Treasury - Internal Revenue Service
## Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-ddac68d06a523be64dd005d6,v11-W-2G-markdown,original,2021,fgen-8883d55ace0762f2683aee81,synthetic_programmatic_template,markdown,top,False,
"OMB No. 1545-0238
Copy B Report this income on your federal tax return.
## Copy C For Winner's Records
| Field | Valuc |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Lucky River Casino 544O Granite St Testvílle, IL 12709 |
| PAYER'Sfederal identification number | 27-3208049 |
| WINNER'S name | Amara S. Rivera |
| WINNER'S taxpayeridentificationno. | ***-**-6303 |
| 5treet address (índuding apt. no.) | 9809 Prairie Ave |
| City or town, state or provínce, country, andZIP or foreign postal code | Bayside, WA 87544 |
| 1 Reportable winnings | 65,482.90 |
| 2 Date won |2018-10-03 |
| 3 Type of wager | 5lots |
| 4 Federal income tax withheld | 977.69 |
| 5Transaction | 464 |
| 8 Cashier | 564 |
| 10 Window | 825 |
| 15 5tate income tax withhe1d | 8,710.44 |
Department of the Treasury - Intemal Revenue Servíce",W-2G,39,W-2G,fdc-83824ad46cf62859c9ac0d98,v11-W-2G-markdown,original,2021,fgen-f2406c149ca29f3f87b1588e,synthetic_programmatic_template,markdown,none,True,
"Form W-2G Certain Gambling Winnings
| Field | Value |
| --- | --- |
| From: | Lucky River Casino |
| Recipient's name: | Morgan A. Okafor |
| 10 Window | 26 |
| 7 Winnings from identical wagers | 1,920.02 |",W-2G,39,W-2G,fdc-20300c3d28871e489f635eae,v11-W-2G-markdown,original,2022,fgen-1790c0ebaa5bb960cf0a0bd9,synthetic_programmatic_template,markdown,top,False,
"## ☐ CORRECTED
Form W-2G
Certain Gambling Winnings
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'5 namc, street address, cíty or town, province or state, country, and ZIP | Prairie Downs Racetrack 2281 Harbor View Rd Testvi1le, IL 6464O |
| PAYER'S federal identification number | 35-3534239 |
| WINNER'S name | Wei D. Sato |
| WINNER'S taxpayer identification no. | ****7187 |
| 5treet address(including apt. no.)| 6346 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, 0H 297l8 |
| 1 Reportab1e winnings | 117,O45.94 |
| 2 Date won | February 13, 2025 |
| 3 Type ofwager| Poker tournament |
| 5 Transaction | 968 |
| 7 Winnings from identical wagers | 687.5O |
| 8 Cashier |697 |
| 10 Window | 488 |
| 14 5tate winnings | S57,287.22 |
|l5 5tate income tax withhcld | $7,814.46 |
Department of the Treasury- Internal Revenue 5ervice
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-6dbc82a30610b66342716a52,v11-W-2G-markdown,original,2025,fgen-2334af7ddc8a147b1332f15f,synthetic_programmatic_template,markdown,top,True,
"VOID  CORRECTED
## Form W-2G
Certain Gambling Winnings
For calendar year 2023
OMB No. 1545-0238
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Lucky River Casino 3320 Willow Bend Way Bayside, WA 83569 |
| PAYER'S federal identification number | 36-2172501 |
| WINNER'S name | Olivia Rivera |
| WINNER'S taxpayer identification no. | ****9576 |
| 2 Date won | 2020-03-17 |
| 3 Type of wager | Poker tournament |
| 4 Federal income tax withheld | $4,691.13 |
| 5 Transaction | 177 |
| 8 Cashier | 445 |
| 14 State winnings | $131,454.51 |
| 15 State income tax withheld | 7,851.77 |
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-79269d10fbd377b8ddded7d9,v11-W-2G-markdown,original,2023,fgen-4956dcec74d06f4c9a659028,synthetic_programmatic_template,markdown,top,False,
"Form W-2G
Certain Gambling Winnings
## For calendar year 2023
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Prairie Downs Racetrack 4998 Sample Street Maplewood, MN 73062 |
| PAYER'S federal identification number | 19-1935997 |
| WINNER'S name | Kwame Testcase |
| WINNER'S taxpayer identification no. | ending in 0363 |
| Street address (including apt. no.) | 6575 Willow Bend Way |
| City or town, state or province, country, and ZIP or foreign postal code | Cedar Falls, IA 97361 |
| 1 Reportable winnings | 59,663.49 |
| 3 Type of wager | Lottery |
| 7 Winnings from identical wagers | $4,497.81 |
| 8 Cashier | 764 |
| 10 Window | 512 |
| 14 State winnings | $111,692.70 |
| 15 State income tax withheld | 4,512.87 |",W-2G,39,W-2G,fdc-92f3f9d4968d17aa23b42e7c,v11-W-2G-markdown,original,2023,fgen-c518a86876ff6e1ff7143f20,synthetic_programmatic_template,markdown,top,False,
"CORRECTED (if checked)
Form W-2G
## Certain Gambling Winnings
2024
## OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Harbor Lights Gaming Resort 2772 Sample Street Testville, IL 89638 |
| PAYER'S federal identification number | 96-5099688 |
| WINNER'S name | Noah Okafor |
| WINNER'S taxpayer identification no. | ***-**-0778 |
| Street address (including apt. no.) | 3432 Harbor View Rd |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 82666 |
| Account number (see instructions) | ***-**-951902 |
| 1 Reportable winnings | 64,483.43 |
| 2 Date won | 2024-09-10 |
| 3 Type of wager | Horse race |
| 4 Federal income tax withheld | $1,224.37 |
| 5 Transaction | 910 |
| 7 Winnings from identical wagers | 78.13 |
| 8 Cashier | 427 |
| 10 Window | 838 |
| 14 State winnings | $108,976.02 |
| 15 State income tax withheld | $6,245.17 |
## Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-1f37550d12bf65b9264e9c81,v11-W-2G-markdown,original,2024,fgen-fcb650adab29154ff3a83d72,synthetic_programmatic_template,markdown,top,False,
"Form W-2G Certain Gambling Winnings 2024
| Field | Value |
| --- | --- |
| PAYER: | Lucky River Casino |
| RECIPIENT: | Riley S. Okafor |
| 2 Date won | September 14, 2021 |
| 15 State income tax withheld | 7,898.92 |",W-2G,39,W-2G,fdc-91a943d8a08814448b9fa845,v11-W-2G-markdown,original,2024,fgen-bf19a0d5d3e19b66531e9912,synthetic_programmatic_template,markdown,top,False,
"Form W-2G
Certain Gambling Winnings
## 2025
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Prairie Downs Racetrack 4833 Sample Street Lakewood, CO 32133 |
| PAYER'S federal identification number | 77-5180448 |
| WINNER'S name | Jordan Adeyemi |
| WINNER'S taxpayer identification no. | ****3979 |
| 1 Reportable winnings | 67,852.06 |
| 2 Date won | 4/2/24 |
| 3 Type of wager | Poker tournament |
| 4 Federal income tax withheld | 1,209.93 |
| 5 Transaction | 915 |
| 7 Winnings from identical wagers | 2,347.88 |
| 8 Cashier | 497 |
| 10 Window | 373 |
| 14 State winnings | $30,660.43 |
| 15 State income tax withheld | 8,387.63 |
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-fd27bb9334e7f6bbf15c992d,v11-W-2G-markdown,original,2025,fgen-cc774288cb853c840c1903da,synthetic_programmatic_template,markdown,top,False,
"Form W-2G
Certain Gambling Winnings
## For calendar year 2025
## OMB No. 1545-0238
Copy B Report this income on your federal tax return.
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Prairie Downs Racetrack 7137 Lakeshore Blvd Oak Grove, TX 97105 |
| PAYER'S federal identification number | 77-2485945 |
| WINNER'S name | Sofia Rivera |
| WINNER'S taxpayer identification no. | ending in 4266 |
| Street address (including apt. no.) | 595 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Brookhaven, PA 17801 |
| 1 Reportable winnings | $69,400.78 |
| 2 Date won | 2024-03-22 |
| 3 Type of wager | Lottery |
| 4 Federal income tax withheld | $6,493.88 |
| 5 Transaction | 221 |
| 7 Winnings from identical wagers | $4,900.57 |
| 10 Window | 48 |
| 14 State winnings | 107,816.21 |
| 15 State income tax withheld | 1,445.45 |
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-b33a2827321a253dfec45223,v11-W-2G-markdown,original,2025,fgen-fbd48d4345bb00971e613c55,synthetic_programmatic_template,markdown,top,False,
"Form W-2G
## Certain Gambling Winnings
For calendar year 2026
0MB No. 1545-0238
## Copy B Report this income on your federal tax return.
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, andZIP| Lucky River Casino 7139 Willow Bcnd Way Maplewood, MN 9676O |
| PAYER'S federal identification number | 22-8811190 |
| WINNER'S name | Sofía B. Romero |
| WINNER'S taxpayer identification no. | XXXXX1561 |
| Street address (inc1uding apt. no.) | 3418 GraniteSt |
| City or town,state or province, country, and ZIP or foreign postal code | Oak Grove, TX 86166 |
| 1 Reportable winnings | 122,663.97 |
| 2 Date won | O5/09/2025 |
| 3 Type of wager | Poker tournament |
| 4 Federal income tax withheld | 7,O79.25 |
| 5Transaction | 339 |
| 7 Winnings from identical wagers | S5,839.O5 |
| 8 Cashier | 33l |
| l0 Window | 971 |
| 14 5tate winnings | 55,694.86 |
| 15 5tate income tax withheld |4,189.13 |",W-2G,39,W-2G,fdc-7ef7ae69f48a6023d4792971,v11-W-2G-markdown,original,2026,fgen-736a377bfd32ba7e8ea3086b,synthetic_programmatic_template,markdown,top,True,
"## Form W-2G
Certain Gambling Winnings
For calendar year 2024
OMB No. 1545-0238
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Prairie Downs Racetrack 4251 Granite St Cedar Falls, IA 17916 |
| PAYER'S federal identification number | 42-9572052 |
| WINNER'S name | Alex Patel |
| WINNER'S taxpayer identification no. | XXX-XX-9028 |
| Street address (including apt. no.) | 9397 Cedar Ln |
| City or town, state or province, country, and ZIP or foreign postal code | Testville, IL 62232 |
| 1 Reportable winnings | $115,993.17 |
| 2 Date won | 01/26/2024 |
| 3 Type of wager | Poker tournament |
| 5 Transaction | 240 |
| 7 Winnings from identical wagers | $3,251.29 |
| 8 Cashier | 260 |
| 10 Window | 332 |
| 14 State winnings | $118,904.33 |
| 15 State income tax withheld | $4,582.23 |
Department of the Treasury - Internal Revenue Service
Form W-2G (keep for your records)  www.irs.gov/FormW2G",W-2G,39,W-2G,fdc-f98c6279cf004604090253d7,v11-W-2G-markdown,original,2024,fgen-6b19a39adc2d8fbc26fd5e7e,synthetic_programmatic_template,markdown,top,False,
"For calendar year 2022
## OMB No. 1545-0238
## Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Harbor Lights Gaming Resort 9770 Lakeshore Blvd Fairview, OH 39589 |
| PAYER'S federal identification number | 61-9639571 |
| WINNER'S name | Noah A. Larsen |
| WINNER'S taxpayer identification no. | ending in 5915 |
| Street address (including apt. no.) | 4051 Sample Street |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 88158 |
| 1 Reportable winnings | 53,780.38 |
| 2 Date won | 1/16/22 |
| 4 Federal income tax withheld | $3,485.92 |
| 5 Transaction | 127 |
| 8 Cashier | 508 |
| 10 Window | 468 |
| 14 State winnings | $69,426.01 |
| 15 State income tax withheld | 160.51 |
Form W-2G
Certain Gambling Winnings",W-2G,39,W-2G,fdc-ed36a75a4c368d09e2713d6c,v11-W-2G-markdown,original,2022,fgen-6b5566d073f691929ee073af,synthetic_programmatic_template,markdown,bottom,False,
"For calendar year 2021
OMB No. 1545-0238
Copy B Report this income on your federal tax return.
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Harbor Lights Gaming Resort 736 Prairie Ave Brookhaven, PA 89951 |
| PAYER'S federal identification number | 61-7495597 |
| WINNER'S name | Alex Okafor |
| WINNER'S taxpayer identification no. | ****0144 |
| 1 Reportable winnings | $4,380.25 |
| 3 Type of wager | Keno |
| 5 Transaction | 268 |
| 7 Winnings from identical wagers | $3,356.51 |
| 8 Cashier | 380 |
| 10 Window | 674 |
| 14 State winnings | $106,068.18 |
| 15 State income tax withheld | $591.09 |
Department of the Treasury - Internal Revenue Service",W-2G,39,W-2G,fdc-b1cfdbc0fcefb63dc4f8d05c,v11-W-2G-markdown,original,2021,fgen-d4d30a03cb653af7156cb01c,synthetic_programmatic_template,markdown,none,False,
"Form W-2G
Certain Gambling Winnings
For calendar year 2022
OMB No. 1545-0238
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Harbor Lights Gaming Resort 7350 Granite St Lakewood, CO 50766 |
| PAYER'S federal identification number | 56-1339084 |
| WINNER'S name | Taylor M. Adeyemi |
| WINNER'S taxpayer identification no. | ***-**-8435 |
| Street address (including apt. no.) | 3828 Granite St |
| City or town, state or province, country, and ZIP or foreign postal code | Fairview, OH 83979 |
| Account number (see instructions) | ending in 295305 |
| 2 Date won | 2022-05-08 |
| 3 Type of wager | Lottery |
| 5 Transaction | 557 |
| 7 Winnings from identical wagers | $6,241.11 |
| 14 State winnings | 132,318.26 |
| 15 State income tax withheld | 6,979.41 |",W-2G,39,W-2G,fdc-7582f630cf327ebfbcbc9fb0,v11-W-2G-markdown,original,2022,fgen-29334501a6db25944503ffe4,synthetic_programmatic_template,markdown,top,False,
"## 2025
OMB No. 1545-0238
Copy C For Winner's Records
| Field | Value |
| --- | --- |
| PAYER'S name, street address, city or town, province or state, country, and ZIP | Prairie Downs Racetrack 1201 Oak Hollow Ct Brookhaven, PA 80076 |
| PAYER'S federal identification number | 91-5275555 |
| WINNER'S name | Priya J. Adeyemi |
| WINNER'S taxpayer identification no. | XXX-XX-0820 |
| Street address (including apt. no.) | 5202 Oak Hollow Ct |
| City or town, state or province, country, and ZIP or foreign postal code | Oak Grove, TX 46402 |
| Account number (see instructions) | ***-**-683713 |
| 1 Reportable winnings | $8,649.18 |
| 2 Date won | October 9, 2024 |
| 3 Type of wager | Keno |
| 4 Federal income tax withheld | 6,022.07 |
| 5 Transaction | 125 |
| 7 Winnings from identical wagers | $8,169.53 |
| 8 Cashier | 208 |
| 10 Window | 493 |
| 14 State winnings | $37,670.11 |
| 15 State income tax withheld | $8,729.28 |
Form W-2G
## Certain Gambling Winnings",W-2G,39,W-2G,fdc-4a89d391886b12c57eb9be75,v11-W-2G-markdown,original,2025,fgen-28d1c91be8a76898d70c4dac,synthetic_programmatic_template,markdown,bottom,False,
"Form W-9 Request for Taxpayer Identification Number and Certification
Name:
Sofia S. Nguyen
5 Address (number, street, and apt. or suite no.)
7608 Maple Ridge Dr Testville, IL 61078
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ Individual/sole proprietor",W-9,41,W-9,fdc-94cb3b77cb85ec65d0cba81d,v11-W-9-stacked,original,2022,fgen-326d7258706ff14db9505a60,synthetic_programmatic_template,stacked,top,False,
"Name:
Sofia Romero
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ C corporation
5 Address (number, street, and apt. or suite no.)
114 Cedar Ln Lakewood, CO 38697
Form W-9 Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-75851e7a4cb53a100ba36888,v11-W-9-stacked,original,2024,fgen-e99b00c54ec2a7acd89c582a,synthetic_programmatic_template,stacked,bottom,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
2025
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.
Lena C. Okafor
2 Business name/disregarded entity name, if different from above.
8039 Harbor View Rd Pinecrest, GA 85972
Part I Taxpayer Identification Number (TIN)
XXXXX8210
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ Individual/sole proprietor
5 Address (number, street, and apt. or suite no.)
7664 Cedar Ln Bayside, WA 85305
Signature of U.S. person",W-9,41,W-9,fdc-a26f07f07b7eedb7e01b0772,v11-W-9-stacked,original,2025,fgen-b7475e707a24329feea96526,synthetic_programmatic_template,stacked,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.
Amara Lindqvist
2 Business name/disregarded entity name, if different from above.
1841 Cedar Ln Testville, IL 37619
Part I Taxpayer Identification Number (TIN)
***-**-3328
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ S corporation
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person",W-9,41,W-9,fdc-13052e37a7833c40d841ee7d,v11-W-9-stacked,original,2021,fgen-b4beeeff3d39226837b66ed0,synthetic_programmatic_template,stacked,top,False,
"For calendar year 2025
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
Jamie A. Larsen
2 Business name/disregarded entity name, if different from above.
418 Elm Park Pl Lakewood, CO 85352
Part I Taxpayer Identification Number (TIN)
ending in 0825
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ Individual/sole proprietor
5 Address (number, street, and apt. or suite no.)
3243 Lakeshore Blvd Testville, IL 99761
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Form W-9
Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-ce50b883db18764469c5aaac,v11-W-9-stacked,original,2025,fgen-62256db5fca687808ca596b5,synthetic_programmatic_template,stacked,bottom,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calcndar year 2022
1 Name of entity/individual.An entry is rcquired.
Hiro Adeyemi
2Business name/disregarded entity name, if different from above.
5221 Samp1e Street Bayside, WA 41712
Part I Taxpayer Identification Number (TIN)
***-**-6994
Part II Certification
3a Check the appropriate box for federa1 tax dassification of the entity/individual whose name is enteredon line 1
☒ C corporation
5 Address (number, street, and apt. or suite no.)
5626 Lakeshore Blvd Bayside, WA 74080
Under penalties of perjury, I certify that: l. The numbcr shown on this form is my correct taxpayer identification number",W-9,41,W-9,fdc-ff2740a7fd72a071e67ba467,v11-W-9-stacked,original,2022,fgen-a4941491faeb09aba7695d8b,synthetic_programmatic_template,stacked,top,True,
"Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
Wei Lindqvist
2 Business name/disregarded entity name, if different from above.
2547 Harbor View Rd Pinecrest, GA 95595
Part I Taxpayer Identification Number (TIN)
ending in 6195
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ S corporation
5 Address (number, street, and apt. or suite no.)
8090 Cedar Ln Riverton, WI 41496
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Department of the Treasury - Internal Revenue Service
Form W-9
Request for Taxpayer Identification Number and Certification
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-ca29e63c14ad9d81317ed6e2,v11-W-9-stacked,original,2021,fgen-d4a09cf96417f90ec2c5c703,synthetic_programmatic_template,stacked,bottom,False,
"2023
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
Jordan Sato
2 Business name/disregarded entity name, if different from above.
1307 Lakeshore Blvd Maplewood, MN 29168
Part I Taxpayer Identification Number (TIN)
****3309
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ Limited liability company  P
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Form W-9
Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-fc7afc46bc6a27a105a2c7e3,v11-W-9-stacked,original,2023,fgen-6c5a6cf86ad7bee09608bcec,synthetic_programmatic_template,stacked,bottom,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2021
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
Priya Nguyen
2 Business name/disregarded entity name, if different from above.
1040 Elm Park Pl Lakewood, CO 57362
Part I Taxpayer Identification Number (TIN)
ending in 0274
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.)
7655 Harbor View Rd Bayside, WA 59049
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-407b82ca9a44630c6decc91c,v11-W-9-stacked,original,2021,fgen-42beaa9cb8c9d823cc494e04,synthetic_programmatic_template,stacked,top,False,
"☐ CORRECTED
For calendar year 2025
1 Name of entity/individual. An entry is required.
Olivia Testcase
2 Business name/disregarded entity name, if different from above.
880 Maple Ridge Dr Pinecrest, GA 11473
Part I Taxpayer Identification Number (TIN)
ending in 5081
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ S corporation
5 Address (number, street, and apt. or suite no.)
7552 Maple Ridge Dr Lakewood, CO 34462
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Department of the Treasury - Internal Revenue Service",W-9,41,W-9,fdc-2d64a1626bc002bc48807749,v11-W-9-stacked,original,2025,fgen-185b6abbc11102b9d3da3bf1,synthetic_programmatic_template,stacked,none,False,
"Form W-9 Request for Taxpayer Identification Number and Certification
Name:
Jordan Brennan
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ S corporation
5 Address (number, street, and apt. or suite no.)
6254 Granite St Riverton, WI 16462",W-9,41,W-9,fdc-82c67f42136839f50a48fba7,v11-W-9-stacked,original,2023,fgen-fad01f70d4edbbd647a8d919,synthetic_programmatic_template,stacked,top,False,
"Form W-9 Request for Taxpayer Identification Number and Certification 2024
Name:
Alex Moreau
5 Address (number, street, and apt. or suite no.)
9795 Prairie Ave Bayside, WA 34736",W-9,41,W-9,fdc-9024875145837f0b507ed195,v11-W-9-stacked,original,2024,fgen-65791a2be3a91d821c0c17cf,synthetic_programmatic_template,stacked,top,False,
"CORRECTED (if checked)
For calendar year 2021
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
Jamie Kowalski
2 Business name/disregarded entity name, if different from above.
9246 Harbor View Rd Oak Grove, TX 19121
Part I Taxpayer Identification Number (TIN)
XXX-XX-1166
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.)
729 Sample Street Bayside, WA 36263
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Form W-9
Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-a51d40b639c4f1f2afe2f184,v11-W-9-stacked,original,2021,fgen-c97a4db500337149fe04e493,synthetic_programmatic_template,stacked,bottom,False,
"☐ CORRECTED
For calendar year 2026
Giveform to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
Riley Okafor
2 Business name/disregarded entity name, if different from above.
6741 Maple Ridge Dr Lakewood, CO 11O67
Part I Taxpayer Identification Number (TIN)
XXX-XX-3251
Part II Certification
3a Check the appropriate box for federal tax dassification of the entity/individual whose name is entered on line 1
☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.)
4499 LakeshoreBlvd Fairview, 0H 80267
Under penalties of perjury, I certify that: l. The number shown on this form is my correct taxpayer identification number
5ignatureof U.5. person
Department of the Treasury - Intema1 Rcvenue Service
Form W-9
Request for Taxpayer Identification Number andCertification
Form W-9 (kcep for yourrecords)  www.irs.gov/FormW9",W-9,41,W-9,fdc-76a47f2d640badc1b3efe59b,v11-W-9-stacked,original,2026,fgen-5638925f88dac47cccb05c05,synthetic_programmatic_template,stacked,bottom,True,
"VOID  CORRECTED
Form W-9
Request for Taxpayer Identification Number and Certification
2024
1 Name of entity/individual. An entry is required.
Riley Larsen
2 Business name/disregarded entity name, if different from above.
4031 Cedar Ln Riverton, WI 63832
Part I Taxpayer Identification Number (TIN)
XXX-XX-6989
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.)
5364 Willow Bend Way Pinecrest, GA 55476
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-3e96d8590d13d30afe72d290,v11-W-9-stacked,original,2024,fgen-f76422efe78b51094ece602a,synthetic_programmatic_template,stacked,top,False,
"Form W-9 Request for Taxpayer Identification Number and Certification
Name:
Riley Moreau
3a Check theappropriate box for federal tax classification of the entity/indívidual whose name is entered on line 1
☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.)
8932 Oak Hollow Ct Cedar Falls, IA 38256",W-9,41,W-9,fdc-8ef7c8e9079d51dcb64ed578,v11-W-9-stacked,original,2022,fgen-eb586765d8ac2276c3bddf14,synthetic_programmatic_template,stacked,top,True,
"☐ CORRECTED
For calendar year 2024
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required. Fatima J. Moreau
2 Business name/disregarded entity name, if different from above. 7039 Lakeshore Blvd Oak Grove, TX 78512
Part I Taxpayer Identification Number (TIN) XXX-XX-1695
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1  ☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.)      1487 Maple Ridge Dr Oak Grove, TX 75935
Signature of U.S. person
Department of the Treasury - Internal Revenue Service",W-9,41,W-9,fdc-07ff25d9e4f4a9c6cf872bdf,v11-W-9-inline,original,2024,fgen-c0497d803fe04162e8dd8a4a,synthetic_programmatic_template,inline,none,False,
"Name:  Taylor B. Moreau
5 Address (number, street, and apt. or suite no.) 1979 Willow Bend Way Oak Grove, TX 64628
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1 ☒ S corporation
Form W-9 Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-9bb1d83500c762779459d4ac,v11-W-9-inline,original,2026,fgen-e4156151bd316f06876ed94f,synthetic_programmatic_template,inline,bottom,False,
"☐ CORRECTED
For calendar year 2021
(Rev. March 2024)
1 Name of entity/individual. An entry is required.  Alex Castillo
2 Business name/disregarded entity name, if different from above. 3001 Sample Street Oak Grove, TX 33189
Part I Taxpayer Identification Number (TIN) XXX-XX-1025
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1 ☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.) 4572 Prairie Ave Lakewood, CO 60159
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Department of the Treasury - Internal Revenue Service",W-9,41,W-9,fdc-69fa0d0d926f5109127fd1e4,v11-W-9-inline,original,2021,fgen-095a2d68d3db363bce86d344,synthetic_programmatic_template,inline,none,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
2023
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.  Noah Testcase
2 Business name/disregarded entity name, if different from above.      2188 Elm Park Pl Maplewood, MN 10258
Part I Taxpayer Identification Number (TIN)      XXXXX1711
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1   ☒ Individual/sole proprietor
5 Address (number, street, and apt. or suite no.)   3824 Elm Park Pl Cedar Falls, IA 19587
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-e46f67a387cb20ccd8a9ab69,v11-W-9-inline,original,2023,fgen-86f9df35c05965c0354abf83,synthetic_programmatic_template,inline,top,False,
"2022
(Rev. March 2024)
1 Name of entity/individual. An entry is required. Alex D. Fischer
2 Business name/disregarded entity name, if different from above.  300 Maple Ridge Dr Riverton, WI 70466
Part I Taxpayer Identification Number (TIN) XXX-XX-8101
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1 ☒ C corporation
5 Address (number, street, and apt. or suite no.) 3045 Maple Ridge Dr Oak Grove, TX 38803
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Form W-9
Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-b0ba40cf6ca1b0c4057d6b9f,v11-W-9-inline,original,2022,fgen-390288cc35b86a5ecd801dfa,synthetic_programmatic_template,inline,bottom,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2022
(Rev. March 2024)
1 Name of entity/individual. An entry is required.   Taylor Okafor
2 Business name/disregarded entity name, if different from above. 5276 Elm Park Pl Pinecrest, GA 67085
Part I Taxpayer Identification Number (TIN) ****6104
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1   ☒ C corporation
5 Address (number, street, and apt. or suite no.)  7337 Granite St Fairview, OH 38963
Signature of U.S. person
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-e7ae175abdcfca57e9ba43fa,v11-W-9-inline,original,2022,fgen-7f64ce72190a45962a5e0ef8,synthetic_programmatic_template,inline,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
2024
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.      Jordan Lindqvist
2 Business name/disregarded entity name, if different from above.      168 Lakeshore Blvd Fairview, OH 64911
Part I Taxpayer Identification Number (TIN) ***-**-5244
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1 ☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.)      3127 Prairie Ave Testville, IL 25665
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person",W-9,41,W-9,fdc-9ab835e092c28fe62276cee5,v11-W-9-inline,original,2024,fgen-1c94ef10ea5022fcc4a0392e,synthetic_programmatic_template,inline,top,False,
"Form W-9 Request for Taxpayer Identification Number and Certification 2022
Name:  Noah Sato
5 Address (number, street, and apt. or suite no.)   7810 Willow Bend Way Oak Grove, TX 71580
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1 ☒ C corporation",W-9,41,W-9,fdc-fabacf6e650cd7dd13461098,v11-W-9-inline,original,2022,fgen-6cf8a762fcb3f8d4177253c7,synthetic_programmatic_template,inline,top,False,
"Form W-9 Request for Taxpayer Identification Number and Certification
Name:      Olivia K. Lindqvist
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1 ☒ S corporation
5 Address (number, street, and apt. or suite no.)   6275 Maple Ridge Dr Riverton, WI 69357",W-9,41,W-9,fdc-b24298a4511a104c6dd04688,v11-W-9-inline,original,2023,fgen-204f9450d334adc0fc4a29cb,synthetic_programmatic_template,inline,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2022
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.  Mateo Rivera
2 Business name/disregarded entity name, if different from above. 8985 Willow Bend Way Oak Grove, TX 37308
Part I Taxpayer Identification Number (TIN)   ***-**-1801
Part II Certification
5 Address (number, street, and apt. or suite no.) 3189 Willow Bend Way Cedar Falls, IA 74873",W-9,41,W-9,fdc-35f3cdc2889e518eaf86e446,v11-W-9-inline,original,2022,fgen-5a9addb1ba0f9259fbfd986b,synthetic_programmatic_template,inline,top,False,
"Form W-9 Request for Taxpayer Identification Number and Certification 2026
Name:   Kwame C. Romero
3a Check the appropriate box for federal tax classification of the entity/individual whose name is enteredon line l ☒ 5 corporation",W-9,41,W-9,fdc-a1e24a5370e57acedbf71917,v11-W-9-inline,original,2026,fgen-cda3f065200fabc476b41f32,synthetic_programmatic_template,inline,top,True,
"☐ CORRECTED
2025
Give form to therequester. Do not send to the IR5.
1 Name of entity/individual. An entry ís required.      Olivia S. Sato
2 Busincss name/disregarded entity name, if differentfrom above.  7254 Prairie Ave Fairview, OH 65756
Part I Taxpayer Identification Number (TIN) XXXXX5190
Part II Certification
3a Check the appropriate box for federa1 tax dassification of the entity/individual whosc name is entered on line 1  ☒ Individual/sole proprietor
5 Address (number, street,and apt. or suite no.) 9724 Lakeshore Blvd Pinecrest, GA 80775
Under penalties of perjury, I certify that: l. The number shown on this form is my correct taxpayeridentification number
Signature of U.S. person
Department of the Treasury - Intemal Revenue Service",W-9,41,W-9,fdc-3008d6b50391efecc4ac2206,v11-W-9-inline,original,2025,fgen-395dba76b7b863a4db3b50b2,synthetic_programmatic_template,inline,none,True,
"VOID  CORRECTED
2025
(Rev. March 2024)
1 Name of entity/individual. An entry is required. Fatima L. Okafor
2 Business name/disregarded entity name, if different from above.      6612 Sample Street Cedar Falls, IA 77238
Part I Taxpayer Identification Number (TIN) XXXXX5026
Part II Certification
Signature of U.S. person",W-9,41,W-9,fdc-aae4caa4954f7a32ccd38b79,v11-W-9-inline,original,2025,fgen-aeefadc8d96375a9e058a398,synthetic_programmatic_template,inline,none,False,
"Name:   Diego Walsh
5 Address (number, street, and apt. or suite no.)  8486 Lakeshore Blvd Pinecrest, GA 18080
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1   ☒ C corporation",W-9,41,W-9,fdc-4e32f074efb06b0020fc0e4c,v11-W-9-inline,original,2023,fgen-53f28b7b02c07fdd7d478675,synthetic_programmatic_template,inline,none,False,
"Name: Riley Patel
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1      ☒ S corporation
5 Address (number, street, and apt. or suite no.)  6450 Lakeshore Blvd Testville, IL 31229",W-9,41,W-9,fdc-9e9c4e7568a4c748de97f696,v11-W-9-inline,original,2022,fgen-652a61e623cae58a227b3641,synthetic_programmatic_template,inline,none,False,
"VOID  CORRECTED
Form W-9
Request for Taxpayer Identification Number and Certification
2022
(Rev. March 2024)
1 Name of entity/individual. An entry is required.   Kwame Adeyemi
2 Business name/disregarded entity name, if different from above.   2318 Lakeshore Blvd Maplewood, MN 43232
Part I Taxpayer Identification Number (TIN)      ending in 4752
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1      ☒ S corporation
5 Address (number, street, and apt. or suite no.)   3251 Maple Ridge Dr Lakewood, CO 84169
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-a858256c9b8539ee87a6366d,v11-W-9-inline,original,2022,fgen-20ee0040d74571e643c094bd,synthetic_programmatic_template,inline,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2022
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Wei Moreau
932 Elm Park Pl Riverton, WI 26899
****3338
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ S corporation
3492 Lakeshore Blvd Maplewood, MN 91805
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-b416d332157a0a1c63a3c5f0,v11-W-9-columns,original,2022,fgen-f9a14967aa72b7b67aac9de2,synthetic_programmatic_template,columns,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2025
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Amara Sato
6666 Sample Street Bayside, WA 75279
****6562
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
☒ Limited liability company  P
8997 Sample Street Bayside, WA 91571
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-1a0a6eb925601008371822f1,v11-W-9-columns,original,2025,fgen-0047047c84248189cbd9b933,synthetic_programmatic_template,columns,top,False,
"Form W-9 Request for TaxpayerIdentification Number and Certification
Name:
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line l
5 Address (number, street, and apt. or suite no.)
5ofia Patel
☒ S corporation
3919 Cedar Ln Riverton, WI 17213",W-9,41,W-9,fdc-da6a92b236c9fa2c0b3d6472,v11-W-9-columns,original,2026,fgen-990e4b3b0ec254fb41e1bf63,synthetic_programmatic_template,columns,top,True,
"Form W-9 Request for Taxpayer Identification Number and Certification 2026
Name:
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Diego Kowalski
☒ Individual/sole proprietor
4573 Sample Street Maplewood, MN 25590",W-9,41,W-9,fdc-b0ceae73f12c4ff8146b1194,v11-W-9-columns,original,2026,fgen-908249ed71ca20523c4c89ff,synthetic_programmatic_template,columns,top,False,
"☐ CORRECTED
Form W-9
Request for Taxpayer Identification Number and Certification
2021
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Diego Romero
812 Lakeshore Blvd Brookhaven, PA 55473
***-**-7433
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ Limited liability company  P
2803 Maple Ridge Dr Oak Grove, TX 97669
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-35633e21f3983637df8c9013,v11-W-9-columns,original,2021,fgen-7302054ebc2e4697885a2419,synthetic_programmatic_template,columns,top,False,
"Name:
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Diego Testcase
☒ C corporation
207 Willow Bend Way Fairview, OH 51335",W-9,41,W-9,fdc-5319e63f0ae15abdd2c5f980,v11-W-9-columns,original,2026,fgen-bc154355b2f2e475b99fb260,synthetic_programmatic_template,columns,none,False,
"Name:
5 Address (number, street, and apt. or suite no.)
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
Noah Tanaka
679 Cedar Ln Brookhaven, PA 88902
☒ S corporation",W-9,41,W-9,fdc-7de98c3a2396398045e1cca8,v11-W-9-columns,original,2021,fgen-586c9bfacfa8a1a86f21fa01,synthetic_programmatic_template,columns,none,False,
"For calendar year 2023
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if differentfrom above.
Part I Taxpayer Identífication Number (TIN)
Fatima Romero
4073 Map1e Ridge DrMaplewood, MN 66219
endingin 9224
Part II Certification
3a Check the appropriate box for federal tax dassification of the entity/individual whose name is entered on line l
Under penaltíes of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ C corporation
Department of the Treasury - Intemal Revenue Service",W-9,41,W-9,fdc-14ce4e3c838b48e6e081191c,v11-W-9-columns,original,2023,fgen-660a1741280c8c1787b6454b,synthetic_programmatic_template,columns,none,True,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2024
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Noah Walsh
7812 Oak Hollow Ct Riverton, WI 98389
XXXXX3266
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ C corporation
4268 Granite St Maplewood, MN 82846",W-9,41,W-9,fdc-3210dd38a76ffce5ea251d90,v11-W-9-columns,original,2024,fgen-a0a46a314e0dba29a1a01501,synthetic_programmatic_template,columns,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2025
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Diego Rivera
2619 Maple Ridge Dr Oak Grove, TX 82232
XXXXX2148
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ Individual/sole proprietor
2199 Willow Bend Way Maplewood, MN 52418
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-44f2a47c1ddf3ef156cea460,v11-W-9-columns,original,2025,fgen-64889ff39c6a3577cb420f8e,synthetic_programmatic_template,columns,top,False,
"VOID  CORRECTED
Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2026
Give form to the requester. Do not send to the IRS.
1 Name of entíty/individual. An entry is required.
2 Busincss name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Diego Larsen
6273 Oak Ho1low Ct Lakewood, C0 57328
XXX-XX-3441
Part II Certification
3a Check the appropriate box for federal tax classífication of the entity/individual whose nameis entered on line 1
5ignature of U.S. pcrson
☒ Scorporation
Departmentof the Treasury - Intemal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-6bc5826522416d9907fa09c7,v11-W-9-columns,original,2026,fgen-f6fcac74eb9d8115fc21e0e5,synthetic_programmatic_template,columns,top,True,
"Form W-9 Request for Taxpayer Identification Number and Certification
Name:
5 Address (number, street, and apt. or suite no.)
Olivia Tanaka
3613 Lakeshore Blvd Pinecrest, GA 60959",W-9,41,W-9,fdc-7408f714aa5c576ba3e1ed53,v11-W-9-columns,original,2026,fgen-d97032696581807ff2847cb7,synthetic_programmatic_template,columns,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
2026
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Taylor Walsh
4255 Granite St Lakewood, CO 48907
XXXXX1615
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ Limited liability company  P
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-18d2421c286f5ac43d16fe17,v11-W-9-columns,original,2026,fgen-ffc53539efe4d790f49af8cb,synthetic_programmatic_template,columns,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
2021
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Kwame Fischer
5570 Prairie Ave Oak Grove, TX 58026
XXXXX6088
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ Individual/sole proprietor
3540 Harbor View Rd Pinecrest, GA 46308
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-346b92d9fbb4968577f78ed7,v11-W-9-columns,original,2021,fgen-cab7856fcd221e1c0ab3664f,synthetic_programmatic_template,columns,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2023
l Namc of entity/individual. An entry is required.
2 Business name/disregarded entity name, if diffcrent from above.
Part I Taxpayer Identification Numbcr(TIN)
Priya B. Okafor
8959 OakHollow Ct Riverton, WI 16513
****7195
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under pena1ties of perjury, I certify that: 1. The numbershown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ S corporation
2483 Prairie Ave Fairview,0H 71927
Department of the Treasury - Intemal Revenue Servíce
Form W-9 (kcep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-f3fdba3e8375fc19555ed725,v11-W-9-columns,original,2023,fgen-4cc187f8f61a332e8a1e6f17,synthetic_programmatic_template,columns,top,True,
"Form W-9
Request for Taxpayer Identification Number and Certification
2024
1 Name of entity/individual. An entry is required.
2 Business name/disregarded entity name, if different from above.
Part I Taxpayer Identification Number (TIN)
Amara Haddad
4364 Harbor View Rd Oak Grove, TX 27389
XXX-XX-1563
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1
5 Address (number, street, and apt. or suite no.)
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number
Signature of U.S. person
☒ Individual/sole proprietor
5000 Oak Hollow Ct Lakewood, CO 23679
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-dbd430a346cef6199fcfc070,v11-W-9-columns,original,2024,fgen-7f371c6e5fb5bbb6cad50e09,synthetic_programmatic_template,columns,top,False,
"Form W-9 Request for Taxpayer Identification Number and Certification 2022
Name:: Kwame B. Castillo
Line 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ C corporation",W-9,41,W-9,fdc-5dfae8310def4b1377ad78b7,v11-W-9-boxed,original,2022,fgen-bf3b4fcedd6ea4047802a446,synthetic_programmatic_template,boxed,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
2024
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
Box 1 Name of entity/individual. An entry is required.: Alex Lindqvist
Box 2 Business name/disregarded entity name, if different from above.: 1497 Willow Bend Way Oak Grove, TX 13484
Part I Taxpayer Identification Number (TIN): ending in 9399
Part II Certification
Line 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ S corporation
Line 5 Address (number, street, and apt. or suite no.): 9174 Lakeshore Blvd Pinecrest, GA 45723
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
Signature of U.S. person:",W-9,41,W-9,fdc-f8d11c4686229016a7233dea,v11-W-9-boxed,original,2024,fgen-c8171e1e3bdd5a6aef4f0ab3,synthetic_programmatic_template,boxed,top,False,
"VOID  CORRECTED
For calendar year 2023
1 Name of entity/individual. An entry is required.: Amara Brennan
2 Business name/disregarded entity name, if different from above.: 5304 Willow Bend Way Testville, IL 95526
Part I Taxpayer Identification Number (TIN): ***-**-0347
Part II Certification
Line 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ S corporation
Line 5 Address (number, street, and apt. or suite no.): 9419 Harbor View Rd Riverton, WI 97099
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
Signature of U.S. person: 
Form W-9
Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-0daa03377ed0b86a09e65d99,v11-W-9-boxed,original,2023,fgen-d5d6c55adf72fdc16348eea7,synthetic_programmatic_template,boxed,bottom,False,
"Form W-9 Request for Taxpayer Identification Number and Certification 2021
Name:: Jordan Fischer
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ C corporation
5 Address (number, street, and apt. or suite no.): 134 Harbor View Rd Bayside, WA 84205",W-9,41,W-9,fdc-63880f5b0fc087f90d3eb5cc,v11-W-9-boxed,original,2021,fgen-b3fe7f5043e33fea7c4b2f8a,synthetic_programmatic_template,boxed,top,False,
"2022
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.: Avery E. Moreau
2 Business name/disregarded entity name, if different from above.: 3679 Willow Bend Way Testville, IL 89203
Part I Taxpayer Identification Number (TIN): ****2218
Part II Certification
Line 5 Address (number, street, and apt. or suite no.): 8980 Harbor View Rd Cedar Falls, IA 85811
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
Signature of U.S. person: 
Form W-9
Request for Taxpayer Identification Number and Certification",W-9,41,W-9,fdc-f5316ee662e4443952ee7d90,v11-W-9-boxed,original,2022,fgen-d567aebde667f398edeb986d,synthetic_programmatic_template,boxed,bottom,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2022
Give form to the requester. Do not send to the IRS.
Line 1 Name of entity/individual. An entry is required.: Olivia A. Walsh
Line 2 Business name/disregarded entity name, if different from above.: 4561 Willow Bend Way Testville, IL 31591
Part I Taxpayer Identification Number (TIN): ****0738
Part II Certification
Line 5 Address (number, street, and apt. or suite no.): 7909 Willow Bend Way Fairview, OH 75307
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
Signature of U.S. person:",W-9,41,W-9,fdc-4b18b9d3da7e8f6d3caf1a63,v11-W-9-boxed,original,2022,fgen-695b02d977c82d392bca58e1,synthetic_programmatic_template,boxed,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2026
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.: Riley Walsh
2 Business name/disregarded entity name, if different from above.: 5422 Lakeshore Blvd Oak Grove, TX 16774
Part I Taxpayer Identification Number (TIN): ending in 6546
Part II Certification
5 Address (number, street, and apt. or suite no.): 1508 Granite St Lakewood, CO 25970
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
Signature of U.S. person:",W-9,41,W-9,fdc-7d9b269e64787b5f43c4ea6d,v11-W-9-boxed,original,2026,fgen-c2cf0785be136d9b8ad54ff2,synthetic_programmatic_template,boxed,top,False,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2021
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry isrequired.: Jamie S. Nguyen
2 Busíness name/disregarded entity name, if different from above.: 6269 Granite St Map1ewood, MN 54l65
Part I Taxpayer Identification Number (TIN): XXXXX6157
Part II Certification
3a Check the appropriate box for federal tax dassification of the entity/individual whose name isentered on line 1: ☒ Individual/sole proprietor
5 Address (number, street, and apt. or suite no.): 7652 Elm Park P1 Testville, IL 37435
Under penalties of perjury, I certifythat: 1. Thenumber shown on this form is my correct taxpayer identification number:",W-9,41,W-9,fdc-6f6aa1e007fbb6e903403442,v11-W-9-boxed,original,2021,fgen-e52e59955854bb83f2c561fd,synthetic_programmatic_template,boxed,top,True,
"Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2024
Give form to the requester. Do not send to the IRS.
1 Name of entity/individual. An entry is required.: Casey J. Adeyemi
2 Business name/disregarded entity name, if different from above.: 6422 Oak Hollow Ct Cedar Falls, IA 40866
Part I Taxpayer Identification Number (TIN): XXXXX2317
Part II Certification
Line 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ Limited liability company  P
Line 5 Address (number, street, and apt. or suite no.): 8135 Oak Hollow Ct Pinecrest, GA 93551
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-d25ad6777c46c6e12416bd5b,v11-W-9-boxed,original,2024,fgen-dcc4daa96d52f50d03f5accc,synthetic_programmatic_template,boxed,top,False,
"Name:: Sofia J. Castillo
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ C corporation
5 Address (number, street, and apt. or suite no.): 5806 Granite St Fairview, OH 89568",W-9,41,W-9,fdc-46fe410fe6f7dbd23ef5a55c,v11-W-9-boxed,original,2022,fgen-a3178eda3eda3e2f3e60041d,synthetic_programmatic_template,boxed,none,False,
"☐ CORRECTED
Form W-9
Request for Taxpayer Identification Number and Certífication
For calendar year 2O25
Give form to the requester. Do not send to the IRS.
(Rev.March 2024)
1 Name of entity/índividual. An entry is required.: Jordan A. Brennan
2 Busíness name/disregarded entity name, if different from above.:426 Harbor View Rd 0ak Grove, TX46373
Part I Taxpayer Identification Number (TIN): ****0965
Part II Certificatíon
3a Check the appropriate box for federal tax classification of the entity/individual whosename is entered on line l: ☒ Limited liabílity company  P
Under penaltics of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
5ignature of U.5. person: 
Department of the Treasury - Internal Revenue 5ervice
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-d899b449d3bad007eafbb50e,v11-W-9-boxed,original,2025,fgen-a129f98449515fbb24ea1bee,synthetic_programmatic_template,boxed,top,True,
"☐ CORRECTED
Form W-9
Request for Taxpayer Identification Number and Certification
For calendar year 2024
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
1 Name of entity/individual. An entry is required.: Morgan K. Haddad
2 Business name/disregarded entity name, if different from above.: 5162 Lakeshore Blvd Cedar Falls, IA 68494
Part I Taxpayer Identification Number (TIN): XXX-XX-7988
Part II Certification
Line 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ C corporation
Line 5 Address (number, street, and apt. or suite no.): 7283 Oak Hollow Ct Lakewood, CO 77446
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number: 
Signature of U.S. person:",W-9,41,W-9,fdc-1fe8ab55b61afad0d1820886,v11-W-9-boxed,original,2024,fgen-222fb7704e284d0ecdd64578,synthetic_programmatic_template,boxed,top,False,
"Name:: Jordan Brennan
Line3a Check the appropriate box for fcderal tax classification of the entity/individual whose name is entered on line 1: ☒ Individual/sole proprietor
Line 5 Address (number, street, andapt. or suite no.): 7473 Willow Bend Way Brookhaven, PA 242Ol
Form W-9 Request for Taxpayer Identification Number and Certification 2024",W-9,41,W-9,fdc-8086f7f4245d6ff931aaa5bb,v11-W-9-boxed,original,2024,fgen-05a5024552ade2484b663033,synthetic_programmatic_template,boxed,bottom,True,
"Form W-9
Request for Taxpayer Identification Number and Certification
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
Box 1 Name of entity/individual. An entry is required.: Riley K. Lindqvist
Box 2 Business name/disregarded entity name, if different from above.: 9680 Willow Bend Way Brookhaven, PA 64755
Part I Taxpayer Identification Number (TIN): ****9124
Part II Certification
Box 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ S corporation
Box 5 Address (number, street, and apt. or suite no.): 5567 Oak Hollow Ct Maplewood, MN 98053
Signature of U.S. person: 
Department of the Treasury - Internal Revenue Service
Form W-9 (keep for your records)  www.irs.gov/FormW9",W-9,41,W-9,fdc-a94669bc629e5440d73aec51,v11-W-9-boxed,original,2023,fgen-b8534ad999c0a41aabfac402,synthetic_programmatic_template,boxed,top,False,
"CORRECTED (if checked)
2025
Give form to the requester. Do not send to the IRS.
(Rev. March 2024)
Line 1 Name of entity/individual. An entry is required.: Wei Rivera
Line 2 Business name/disregarded entity name, if different from above.: 7163 Cedar Ln Oak Grove, TX 75089
Part I Taxpayer Identification Number (TIN): XXXXX9218
Part II Certification
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ Limited liability company  P
5 Address (number, street, and apt. or suite no.): 1796 Willow Bend Way Bayside, WA 69504
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number:",W-9,41,W-9,fdc-00b6421a535baee154de2fd1,v11-W-9-boxed,original,2025,fgen-a127ca3da3f8c08d498a7693,synthetic_programmatic_template,boxed,none,False,
"Name:: Lena Kowalski
Box 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1: ☒ Individual/sole proprietor
Box 5 Address (number, street, and apt. or suite no.): 3567 Elm Park Pl Brookhaven, PA 14253",W-9,41,W-9,fdc-8b02afbd4d0192a36744ba74,v11-W-9-boxed,original,2025,fgen-51c96b63610e472c6fa8f2b5,synthetic_programmatic_template,boxed,none,False,