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Wage and Income Transcript

Request Date: 06-14-2024
Response Date: 06-14-2024
Tracking Number: 106130510055

SSN Provided: 647-40-0297
Tax Period Requested: December, 2019

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN):272976158
ZIPRECRUITER INC
604 ARIZONA
SANTA MONICA, CA 90401-0000

Employee:

Employee's Social Security Number: 647-40-0297
CHANDLER KINSEY
5135 E EVERGREEN ST
MESA, AZ 85205-0000

Submission Type:Original document
Wages, Tips and Other Compensation:$18,739.00
Federal Income Tax Withheld:$2,143.00
Social Security Wages:$18,979.00
Social Security Tax Withheld:$1,176.00
Medicare Wages and Tips:$18,979.00
Medicare Tax Withheld:$275.00
Social Security Tips:$0.00
Allocated Tips:$0.00
Dependent Care Benefits:$0.00
Deferred Compensation:$240.00
Code "Q" Nontaxable Combat Pay:$0.00
Code "W" Employer Contributions to a Health Savings Account:$0.00
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan:$0.00
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan:$0.00
Code "R" Employer's Contribution to MSA:$0.00
Code "S" Employer's Contribution to Simple Account:$0.00
Code "T" Expenses Incurred for Qualified Adoptions:$0.00
Code "V" Income from exercise of non-statutory stock options:$0.00
Code "AA" Designated Roth Contributions under a Section 401(k) Plan:$0.00
Code "BB" Designated Roth Contributions under a Section 403(b) Plan:$0.00
Code "DD" Cost of Employer-Sponsored Health Coverage:$0.00
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan:$0.00
Code "FF" Permitted benefits under a qualified small employer health reimbursement arrangement:$0.00
Code "GG" Income from Qualified Equity Grants Under Section 83(i):$0.00
Code "HH" Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year:$0.00
Third Party Sick Pay Indicator:Unanswered
Retirement Plan Indicator:Yes - retirement plan
Statutory Employee:Not Statutory Employee
W2 Submission Type:
W2 WHC SSN Validation Code:Correct SSN

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN):462852392
DOORDASH FKA PALO ALTO DELIVERY
303 2ND STREET
SAN FRANCISCO, CA 94107-0000

Employee:

Employee's Social Security Number: 647-40-0297
CHANDLER S KINSEY
5135 E EVERGREEN ST UN
MESA, AZ 85205-0000

Submission Type:Original document
Wages, Tips and Other Compensation:$11,286.00
Federal Income Tax Withheld:$0.00
Social Security Wages:$11,286.00
Social Security Tax Withheld:$699.00
Medicare Wages and Tips:$11,286.00
Medicare Tax Withheld:$163.00
Social Security Tips:$0.00
Allocated Tips:$0.00
Dependent Care Benefits:$0.00
Deferred Compensation:$0.00
Code "Q" Nontaxable Combat Pay:$0.00
Code "W" Employer Contributions to a Health Savings Account:$0.00
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan:$0.00
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan:$0.00
Code "R" Employer's Contribution to MSA:$0.00
Code "S" Employer's Contribution to Simple Account:$0.00
Code "T" Expenses Incurred for Qualified Adoptions:$0.00
Code "V" Income from exercise of non-statutory stock options:$0.00
Code "AA" Designated Roth Contributions under a Section 401(k) Plan:$0.00
Code "BB" Designated Roth Contributions under a Section 403(b) Plan:$0.00
Code "DD" Cost of Employer-Sponsored Health Coverage:$191.00
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan:$0.00
Code "FF" Permitted benefits under a qualified small employer health reimbursement arrangement:$0.00
Code "GG" Income from Qualified Equity Grants Under Section 83(i):$0.00
Code "HH" Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year:$0.00
Third Party Sick Pay Indicator:Unanswered
Retirement Plan Indicator:Unanswered
Statutory Employee:Not Statutory Employee
W2 Submission Type:
W2 WHC SSN Validation Code:Correct SSN

Form W-2 Wage and Tax Statement

Employer:

Employer Identification Number (EIN):943327894
WEB COM GROUP INC
5335 GATE PARKWAY
JACKSONVILLE, FL 32256-0000

Employee:

Employee's Social Security Number: 647-40-0297
CHANDLER S KINSEY
5135 E EVERGREEN
MESA, AZ 85206-0000

Submission Type:Original document
Wages, Tips and Other Compensation:$12,256.00
Federal Income Tax Withheld:$0.00
Social Security Wages:$12,256.00
Social Security Tax Withheld:$759.00
Medicare Wages and Tips:$12,256.00
Medicare Tax Withheld:$177.00
Social Security Tips:$0.00
Allocated Tips:$0.00
Dependent Care Benefits:$0.00
Deferred Compensation:$0.00
Code "Q" Nontaxable Combat Pay:$0.00
Code "W" Employer Contributions to a Health Savings Account:$0.00
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan:$0.00
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan:$0.00
Code "R" Employer's Contribution to MSA:$0.00
Code "S" Employer's Contribution to Simple Account:$0.00
Code "T" Expenses Incurred for Qualified Adoptions:$0.00
Code "V" Income from exercise of non-statutory stock options:$0.00
Code "AA" Designated Roth Contributions under a Section 401(k) Plan:$0.00
Code "BB" Designated Roth Contributions under a Section 403(b) Plan:$0.00
Code "DD" Cost of Employer-Sponsored Health Coverage:$0.00
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan:$0.00
Code "FF" Permitted benefits under a qualified small employer health reimbursement arrangement:$0.00
Code "GG" Income from Qualified Equity Grants Under Section 83(i):$0.00
Code "HH" Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year:$0.00
Third Party Sick Pay Indicator:Unanswered
Retirement Plan Indicator:Unanswered
Statutory Employee:Not Statutory Employee
W2 Submission Type:
W2 WHC SSN Validation Code:Correct SSN

Form 1099-B Proceeds From Broker and Barter Exchange Transactions

Payer:

Payer's Federal Identification Number (FIN):800429876
SQUARE, INC.
1455 MARKET STREET
SAN FRANCISCO, CA 94103-0000

Recipient:

Recipient's Identification Number: 647-40-0297
CHANDLER SCOTT KINSEY
5135 EAST EVERGREEN STREET
MESA, AZ 85205-0000

Submission Type:Original document
Account Number (Optional):7872054T6
Date Sold or Disposed:06-14-2019
CUSIP Number:0000000000000
Gross Proceeds:Nothing checked
Bartering:$0.00
Federal Income Tax Withheld:$0.00
Proceeds:$0.00
Aggregate Profit or (Loss):$0.00
Realized Profit or (Loss):$0.00
Unrealized Profit or (Loss) 12/31 Prior Year:$0.00
Unrealized Profit or (Loss) 12/31 Current Year:$0.00
Cost or Basis:$0.00
Wash Sale Loss Disallowed:$0.00
Accrued Market Discount Amount:$0.00
Description:SEE DETAIL STATEMENT
Second Notice Indicator:
Date Acquired:01-01-1900
Noncovered Security Indicator:Noncovered Security Basis not reported to IRS
Type of Gain or Loss Code:
Applicable Check Box on Form 8949:Transactions that do not flow to Form 8949
Loss Not Allowed Indicator:
FATCA Filing Requirement:Box not checked no Filing Requirement
Proceeds from:Box not checked

Form 1099-G

Payer:

Payer's Federal Identification Number (FIN):866004791
ARIZONA DEPARTMENT OF REVENUE
1600 W MONROE
PHOENIX, AZ 85007-0000

Recipient:

Recipient's Identification Number: 647-40-0297
KINSEY CHANDLER
5135 E EVERGREEN ST UNIT 1250
MESA, AZ 85205-0000

Submission Type:Original document
Account Number (Optional):201901862166
RTAA Payments:$0.00
Tax Withheld:$0.00
Taxable Grants:$0.00
Unemployment Compensation:$0.00
Agricultural Subsidies:$0.00
Prior Year Refund:$75.00
Market gain on Commodity Credit Corporation loans repaid:$0.00
Year of Refund:2018
1099G Offset:Not Refund, Credit, or Offset for Trade or Business
Second TIN Notice:

Form 1099-R Distributions from Pensions, Annuities, Retire or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.

Payer:

Payer's Federal Identification Number (FIN):046568107
FIDELITY INVESTMENTS
100 MAGELLAN WAY KW1C
COVINGTON, KY 41015-0000

Recipient:

Recipient's Identification Number: 647-40-0297
KINSEY, CHANDLER
5135 E EVERGREEN ST
MESA, AZ 85205-0000

Submission Type:Original document
Account Number (Optional):20200104023605192556
Distribution Code Value:Early Distribution, no known exception (in most cases, under age 59 1/2)
Distribution Code:1
Distribution Code Value:Not significant
Distribution Code:Blank
Tax Amount Undetermined Code:Not checked
Total Distribution Code:Total Distribution
First Year Roth Contribution:0000
SEP Indicator:IRA/SEP/SIMP box not checked
FATCA Indicator:not FATCA
Date of Payment for Reportable Death Benefits under Section 6050Y:00-00-0000
Tax Withheld:$48.00
Total Employee Contributions:$0.00
Unrealized Appreciation:$0.00
Other Income:$0.00
Gross Distribution:$240.00
Taxable Amount:$240.00
Eligible Capital Gains:$0.00
Amount to IRR:$0.00

This Product Contains Sensitive Taxpayer Data