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Employer:
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| Employer Identification Number (EIN):134147118 |
| DELOITTE SERVICES LP | |
| 4022 SELLS DRIVE | |
| HERMITAGE, TN 37076-2903 | |
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Employee:
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| Employee's Social Security Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
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| Submission Type: | Original document |
| Wages, Tips and Other Compensation: | $64,590.00 |
| Federal Income Tax Withheld: | $4,163.00 |
| Social Security Wages: | $82,557.00 |
| Social Security Tax Withheld: | $5,118.00 |
| Medicare Wages and Tips: | $82,557.00 |
| Medicare Tax Withheld: | $1,197.00 |
| Social Security Tips: | $0.00 |
| Allocated Tips: | $0.00 |
| Dependent Care Benefits: | $0.00 |
| Deferred Compensation: | $17,967.00 |
| 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: | $7,590.00 |
| 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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Recipient/Lender:
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| Recipient's Federal Identification Number (FIN):941687665 |
| BANK OF AMERICA, N.A. | |
| PO BOX 31785 | |
| TAMPA, FL 33631-3785 | |
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Payer/Borrower:
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| Payer's Social Security Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
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| Submission Type: | Original document |
| Account Number (Optional): | 272414629 |
| Mortgage Interest Received from Payer(s)/Borrower(s): | $9,754.00 |
| Points Paid on Purchase of Principal Residence: | $0.00 |
| Refund of Overpaid Interest: | $0.00 |
| Mortgage Insurance Premiums: | $0.00 |
| Outstanding Mortgage Principle: | $302,961.00 |
| Mortgage Origination Date: | 05-18-2017 |
| Property Address Verification: | |
| Address of property securing Mortgage: | 1506 BRADEN CIR FRANKLIN, TN 37067 |
| Other information from recipient: | |
| The number of mortgaged properties: | 000000000000 |
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Payer:
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| Payer's Federal Identification Number (FIN):541061178 |
| REGENT UNIVERSITY | |
| 1000 REGENT UNIVERSITY DRIVE | |
| VIRGINIA BEACH, VA 23464-0000 | |
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Recipient:
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| Recipient's Identification Number:
607-17-0964 |
| PUSAPATI RAJU | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
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| Submission Type: | Original document |
| Account Number (Optional): | 10980309137643283 |
| Qualified Tuition and Related Expense: | $7,395.00 |
| Scholarships or Grants: | $0.00 |
| Half Time Student Indicator: | Grtr than or Eq to Half Time Student |
| Graduate Student Indicator: | Graduate Student |
| Academic Period Code: | Academic Period Box Not Checked |
| Method of Reporting Indicator: | Change in Reporting Method from the Previous year |
| TIN Checkbox: | box marked |
| Adjustments Made for Prior Year: | $0.00 |
| Adjustments to Scholarships or Grants for a Prior Year: | $0.00 |
| Reimbursements/Refunds from an Insurance Contract: | $0.00 |
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Payer:
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| Payer's Federal Identification Number (FIN):620646576 |
| AUSTIN PEAY STATE UNIVERSITY | |
| STUDENT ACCOUNT SERVICES | |
| PO BOX 4444 | |
| CLARKSVILLE, TN 37044-0000 | |
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Recipient:
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| Recipient's Identification Number:
607-17-0964 |
| PUSAPATI RAJU | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
| |
| Submission Type: | Original document |
| Account Number (Optional): | 109812345678736850 |
| Qualified Tuition and Related Expense: | $11,257.00 |
| Scholarships or Grants: | $10,745.00 |
| Half Time Student Indicator: | Grtr than or Eq to Half Time Student |
| Graduate Student Indicator: | Graduate Student |
| Academic Period Code: | Amt in Box 1 or 2 is for Period beg Jan - Mar Next Tax Year |
| Method of Reporting Indicator: | Change in Reporting Method from the Previous year |
| TIN Checkbox: | box not marked |
| Adjustments Made for Prior Year: | $0.00 |
| Adjustments to Scholarships or Grants for a Prior Year: | $0.00 |
| Reimbursements/Refunds from an Insurance Contract: | $0.00 |
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Payer:
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| Payer's Federal Identification Number (FIN):941737782 |
| CHARLES SCHWAB & CO., INC. | |
| 9800 SCHWAB WAY | |
| LONE TREE, CO 80124-0000 | |
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Recipient:
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| Recipient's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIRCLE | |
| FRANKLIN, TN 37067-0000 | |
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| Submission Type: | Original document |
| Account Number (Optional): | 91216345 |
| Interest: | $3.00 |
| Tax Withheld: | $0.00 |
| Savings Bonds: | $0.00 |
| Investment Expense: | $0.00 |
| Interest Forfeiture: | $0.00 |
| Foreign Tax Paid: | $0.00 |
| Tax-Exempt Interest: | $0.00 |
| Specified Private Activity Bond Interest: | $0.00 |
| Market Discount: | $0.00 |
| Bond Premium: | $0.00 |
| Bond Premium on Tax Exempt Bond: | $0.00 |
| Bond Premium on Treasury Obligations: | $0.00 |
| Second Notice Indicator: | No Second Notice |
| Foreign Country or US Possession: | |
| CUSIP Number: | |
| FATCA Filing Requirement: | Box not checked no Filing Requirement |
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Payer:
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| Payer's Federal Identification Number (FIN):841455663 |
| GREAT-WEST TRUST COMPANY LLC | |
| PO BOX 173764 D999 | |
| DENVER, CO 80217-3764 | |
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Recipient:
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| Recipient's Identification Number:
607-17-0964 |
| RAJU S PUSAPATI | |
| 1506 BRADEN CIR | |
| FRANKLIN, TN 37067-8595 | |
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| Submission Type: | Original document |
| Account Number (Optional): | 98986 |
| Distribution Code Value: | Loans treated as deemed distributions under section 72(p) |
| Distribution Code: | L |
| Distribution Code Value: | Not significant |
| Distribution Code: | Blank |
| Tax Amount Undetermined Code: | Not checked |
| Total Distribution Code: | Not checked |
| 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: | $0.00 |
| Total Employee Contributions: | $0.00 |
| Unrealized Appreciation: | $0.00 |
| Other Income: | $0.00 |
| Gross Distribution: | $40,187.00 |
| Taxable Amount: | $40,187.00 |
| Eligible Capital Gains: | $0.00 |
| Amount to IRR: | $0.00 |
