| |
|
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 |
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|
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 |
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|
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 |
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Payer:
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| Payer's Federal Identification Number (FIN):800429876 |
| SQUARE, INC. | |
| 1455 MARKET STREET | |
| SAN FRANCISCO, CA 94103-0000 | |
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|
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 |
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Payer:
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| Payer's Federal Identification Number (FIN):866004791 |
| ARIZONA DEPARTMENT OF REVENUE | |
| 1600 W MONROE | |
| PHOENIX, AZ 85007-0000 | |
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|
Recipient:
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| 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: | |
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Payer:
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| Payer's Federal Identification Number (FIN):046568107 |
| FIDELITY INVESTMENTS | |
| 100 MAGELLAN WAY KW1C | |
| COVINGTON, KY 41015-0000 | |
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|
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 |
