Sample Tax Return Transcript Template Modify Form

Sample Tax Return Transcript Template

A Sample Tax Return Transcript is a document that provides a summary of your tax return information as reported to the IRS. It includes key details such as income, deductions, and tax liability for a specific tax year. This transcript is essential for verifying your tax information and can be requested for various purposes, including loan applications and financial aid.

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Structure

The Sample Tax Return Transcript form provides a comprehensive overview of a taxpayer's financial situation for a specific tax year. This document includes essential details such as the taxpayer's Social Security Number (SSN), filing status, and income sources. It highlights various income categories, including wages, business income, and adjustments that affect the overall tax calculation. Notably, the form outlines the total income, adjustments, and the resulting adjusted gross income, which is crucial for determining tax liability. Furthermore, it details tax credits, payments made, and any amounts owed or refunded. By summarizing this information, the transcript serves as a valuable tool for individuals and tax professionals alike, facilitating a clear understanding of the taxpayer's financial standing and obligations for the specified period.

Instructions on How to Fill Out Sample Tax Return Transcript

Filling out the Sample Tax Return Transcript form is straightforward. You will need to provide personal information, income details, and any adjustments or credits you may have. After completing the form, you can use it to verify your tax information or for other purposes as needed.

  1. Start by entering the request date at the top of the form. This is the date you are filling out the transcript request.
  2. Fill in the response date, which is usually the same as the request date.
  3. Locate and enter your tracking number. This helps you keep track of your request.
  4. Input your customer file number. This number is unique to your tax records.
  5. Provide your Social Security Number (SSN) and your spouse's SSN, if applicable.
  6. Write your name as it appears on your tax return in the NAME(S) SHOWN ON RETURN section.
  7. Enter your address where you currently reside.
  8. Select your filing status, such as Single, Married Filing Jointly, etc.
  9. Fill in the form number used for your tax return, typically 1040.
  10. Provide the tax period ending date, which is usually December 31 of the tax year.
  11. List any income sources such as wages, business income, or dividends. Be sure to include the amounts.
  12. Include any adjustments to income that apply to you, such as self-employment tax deductions.
  13. Calculate your total income and adjusted gross income and enter those figures.
  14. Detail your tax and credits section, including any deductions or credits you may qualify for.
  15. Complete the other taxes section, including self-employment taxes if applicable.
  16. Fill in the payments
  17. Finally, determine if you have a refund or amount owed and fill in the respective amounts.

Key takeaways

When filling out and using the Sample Tax Return Transcript form, consider the following key takeaways:

  • The form contains sensitive taxpayer data, including Social Security Numbers (SSNs) and income details.
  • Ensure that the Tax Period Ending date is accurate; this form reflects the tax year ending on December 31, 2017.
  • Verify the Filing Status listed; in this example, it is marked as Single.
  • Check the Total Income amount, which is listed as $15,500. This includes wages, business income, and other sources.
  • Review any Adjustments to Income, which in this case total $177. This affects the Adjusted Gross Income (AGI).
  • The Taxable Income is calculated at $7,373, which is essential for determining tax liability.
  • Payments and credits should be examined closely; the total payments made are $1,000, but an amount owed of $103 is indicated.
  • Consider the Third Party Designee section if someone else is authorized to discuss the tax return with the IRS.

Documents used along the form

When filing your taxes or applying for financial aid, you may need to provide additional documentation alongside your Sample Tax Return Transcript. Each of these forms serves a specific purpose and can help clarify your financial situation to lenders, schools, or government agencies. Below is a list of common documents that may be requested.

  • Form 1040: This is the standard individual income tax return form used by U.S. taxpayers. It reports your income, deductions, and tax liability for the year.
  • W-2 Form: Issued by your employer, this form summarizes your annual wages and the taxes withheld from your paycheck. It's essential for verifying your income.
  • 1099 Form: This form is used to report various types of income other than wages, salaries, and tips. Freelancers and independent contractors often receive this form.
  • Schedule C: If you are self-employed, this form details your profit or loss from business activities. It helps determine your taxable income.
  • Form 4868: This is an application for an automatic extension of time to file your federal income tax return. It’s crucial if you need more time to gather your documents.
  • Form 4506-T: This form allows you to request a transcript of your tax return from the IRS. It can be helpful if you need to verify your income for loans or financial aid.
  • Form 1098: This form reports mortgage interest paid and is typically used for tax deductions. It’s important for homeowners to keep track of their mortgage payments.

Gathering these documents ahead of time can streamline the process of filing your taxes or applying for aid. Being prepared not only saves you time but also ensures that your applications are accurate and complete, reducing the risk of delays or complications.

Sample - Sample Tax Return Transcript Form

Page 1 of 6

This Product Contains Sensitive Taxpayer Data

Tax Return Transcript

 

Request Date:

08-09-2018

 

Response Date:

08-09-2018

 

Tracking Number:

100200235179

 

Customer File Number:

0987654321

SSN Provided:

XXX-XX-5084

 

Tax Period Ending: Dec. 31, 2017

The following items reflect the amount as shown on the return (PR), and the amount as adjusted (PC), if applicable. They do not show subsequent activity on the account.

SSN:

 

XXX-XX-5084

SPOUSE SSN:

 

 

NAME(S) SHOWN ON RETURN: DRAK

ADDRESS:

 

123 DA

FILING STATUS:

Single

FORM NUMBER:

 

1040

CYCLE POSTED:

20181005

RECEIVED DATE:

Jan.15, 2018

REMITTANCE:

 

$0.00

EXEMPTION NUMBER:

1

DEPENDENT 1

N ME CTRL:

 

DEPENDENT 1

SSN:

 

DEPENDENT 2

N ME CTRL:

 

DEPENDENT 2

SSN:

 

DEPENDENT 3

N ME CTRL:

 

DEPENDENT 3

N:

 

DEPENDENT 4

N ME CTRL:

 

DEPENDENT 4

N:

 

PTIN:

 

 

PREPARER EIN:

 

Income

WAGES, SALARIES, TIPS, ETC:

$13,000.00

TAXABLE INTEREST INCOME: SCH B:

$0.00

TAX-EXEMPT INTEREST:

$0.00

ORDINARY DIVIDEND INCOME: SCH B:

$0.00

QUALIFIED DIVIDENDS:

$0.00

REFUNDS OF STATE/LOCAL TAXES:

$0.00

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Page 2 of 6

ALIMONY RECEIVED:

 

$0.00

BUSINESS INCOME OR LOSS (Schedule C):

 

$2,500.00

BUSINESS INCOME OR LOSS: SCH C PER COMPUTER:

 

$2,500.00

CAPITAL GAIN OR LOSS: (Schedule D):

 

$0.00

CAPITAL GAINS OR LOSS: SCH D PER COMPUTER:

 

$0.00

OTHER GAINS OR LOSSES (Form 4797):

 

$0.00

TOTAL IRA DISTRIBUTIONS:

 

$0.00

TAXABLE IRA DISTRIBUTIONS:

 

$0.00

TOTAL PENSIONS AND ANNUITIES:

 

$0.00

SAMPLE

$0.00

TAXABLE PENSION/ANNUITY AMOUNT:

 

RENT/ROYALTY/PARTNERSHIP/ESTATE (Schedule E):

 

$0.00

RENT/ROYALTY/PARTNERSHIP/ESTATE (Schedule E) PER COMPUTER:

 

$0.00

RENT/ROYALTY INCOME/LOSS PER COMPUTER:

 

$0.00

ESTATE/TRUST INCOME/LOSS PER COMPUTER:

 

$0.00

PARTNERSHIP/S-CORP INCOME/LOSS PER COMPUTER:

 

$0.00

FARM INCOME OR LOSS (Schedule F):

 

$0.00

FARM INCOME OR LOSS (Schedule F) PER COMPUTER:

 

$0.00

UNEMPLOYMENT COMPENSATION:

 

$0.00

TOTAL SOCIAL SECURITY BENEFITS:

 

$0.00

TAXABLE SOCIAL SECURITY BENEFITS:

 

$0.00

TAXABLE SOCIAL SECURITY BENEFITS PER COM UTER:

 

$0.00

OTHER INCOME:

 

$0.00

SCHEDULE EIC SE INCOME PER COMPUTER:

 

$2,323.00

SCHEDULE EIC EARNED INCOME PER COMPUTER:

$15,323.00

SCH EIC DISQUALIFIED INC COMPUTER:

 

$0.00

TOTAL INCOME:

$15,500.00

TOTAL INCOME PER COMPUTER:

$15,500.00

Adjustments to Income

EDUCATOR EXPENSES:

 

$0.00

EDUCATOR EXPENSES PER CO PUTER:

$0.00

RESERVIST AND OTHER

BUSINESS EXPENSE:

$0.00

HEALTH

VINGS

CCT

DEDUCTION:

$0.00

HEALTH S VINGS

CCT

DEDUCTION PER CO PTR:

$0.00

MOVING EXPENSES: F3903:

$0.00

SELF EMPLOYMENT T X DEDUCTION:

$177.00

SELF EMPLOYMENT T X DEDUCTION PER COMPUTER:

$177.00

ELF EMPLOYMENT T X DEDUCTION VERIFIED:

$0.00

KEOGH/ EP CONTRIBUTION DEDUCTION:

$0.00

ELF-EMP HE LTH INS DEDUCTION:

$0.00

EARLY WITHDRAWAL OF

AVINGS PENALTY:

$0.00

ALIMONY PAID

N:

 

 

ALIMONY PAID:

 

 

$0.00

IRA DEDUCTION:

 

 

$0.00

IRA DEDUCTION PER COMPUTER:

$0.00

STUDENT LOAN INTEREST DEDUCTION:

$0.00

STUDENT LOAN INTEREST DEDUCTION PER COMPUTER:

$0.00

STUDENT LOAN INTEREST DEDUCTION VERIFIED:

$0.00

TUITION AND FEES DEDUCTION:

$0.00

TUITION AND FEES DEDUCTION PER COMPUTER:

$0.00

DOMESTIC PRODUCTION ACTIVITIES DEDUCTION:

$0.00

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DOMESTIC PRODUCTION ACTIVITIES DEDUCTION PER COMPUTER:

 

$0.00

OTHER ADJUSTMENTS:

 

 

$0.00

ARCHER MSA DEDUCTION:

 

$0.00

ARCHER MSA DEDUCTION PER COMPUTER:

 

$0.00

TOTAL ADJUSTMENTS:

 

 

$177.00

TOTAL ADJUSTMENTS PER COMPUTER:

 

$177.00

ADJUSTED GROSS INCOME:

$15,323.00

ADJUSTED GROSS INCOME PER COMPUTER:

$15,323.00

SAMPLE

 

Tax and Credits

 

 

65-OR-OVER:

 

 

NO

BLIND:

 

 

 

 

NO

SPOUSE 65-OR-OVER:

 

 

NO

SPOUSE BLIND:

 

 

NO

STANDARD DEDUCTION PER COMPUTER:

 

$4,850.00

ADDITIONAL STANDARD DEDUCTION PER COMPUTER:

 

$0.00

TAX TABLE INCOME PER COMPUTER:

$10,473.00

EXEMPTION AMOUNT PER COMPUTER:

 

$3,100.00

TAXABLE INCOME:

 

 

$7,373.00

TAXABLE INCOME PER COMPUTER:

 

$7,373.00

TOTAL POSITIVE INCOME PER COMPUTER:

$15,500.00

TENTATIVE TAX:

 

 

$749.00

TENTATIVE TAX PER COMPUTER:

 

$749.00

FORM 8814 ADDITIONAL TAX AMOUNT:

 

$0.00

TAX ON INCOME LESS SOC SEC INCOME PER COM UTER:

 

$0.00

FORM 6251 ALTERNATIVE MINIMUM TAX:

 

$0.00

FORM 6251 ALTERNATIVE INI UM TAX PER CO UTER:

 

$0.00

FOREIGN TAX CREDIT:

 

$0.00

FOREIGN TAX CREDIT PER CO PUTER:

 

$0.00

FOREIGN INCOME EXCLUSION PER CO PUTER:

 

$0.00

FOREIGN INCOME EXCLUSION TAX PER CO PUTER:

 

$0.00

EXCESS ADVANCE PREMIUM TAX CREDIT REPAY ENT OUNT:

 

$0.00

EXCESS

DV NCE PREMIUM T X CREDIT REP Y ENT VERIFIED A OUNT:

 

$0.00

CHILD & DEPENDENT C RE CREDIT:

 

$0.00

CHILD & DEPENDENT C RE CREDIT PER COMPUTER:

 

$0.00

CREDIT FOR ELDERLY

ND DIS BLED:

 

$0.00

CREDIT FOR ELDERLY

ND DIS BLED PER COMPUTER:

 

$0.00

EDUCATION CREDIT:

 

 

$0.00

EDUCATION CREDIT PER COMPUTER:

 

$0.00

GRO EDUC TION CREDIT PER COMPUTER:

 

$0.00

RETIREMENT

AVINGS CNTRB CREDIT:

 

$0.00

RETIREMENT

AVINGS CNTRB CREDIT PER COMPUTER:

 

$0.00

PRIM RET

 

AV CNTRB: F8880 LN6A:

 

$0.00

EC RET

AV CNTRB: F8880 LN6B:

 

$0.00

TOTAL RETIREMENT

AVINGS CONTRIBUTION: F8880 CMPTR:

 

$0.00

RESIDENTIAL ENERGY CREDIT:

 

$0.00

RESIDENTIAL ENERGY CREDIT PER COMPUTER:

 

$0.00

CHILD TAX CREDIT:

 

 

$0.00

CHILD TAX CREDIT PER COMPUTER:

 

$0.00

ADOPTION CREDIT: F8839:

 

$0.00

ADOPTION CREDIT PER COMPUTER:

 

$0.00

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Page 4 of 6

FORM 8396 MORTGAGE CERTIFICATE CREDIT:

$0.00

FORM 8396 MORTGAGE CERTIFICATE CREDIT PER COMPUTER:

$0.00

F3800, F8801 AND OTHER CREDIT AMOUNT:

$0.00

FORM 3800 GENERAL BUSINESS CREDITS:

$0.00

FORM 3800 GENERAL BUSINESS CREDITS PER COMPUTER:

$0.00

PRIOR YR MIN TAX CREDIT: F8801:

$0.00

PRIOR YR MIN TAX CREDIT: F8801 PER COMPUTER:

$0.00

F8936

ELECTRIC MOTOR VEHICLE CREDIT AMOUNT:

$0.00

F8936

ELECTRIC MOTOR VEHICLE CREDIT PER COMPUTER:

$0.00

SAMPLE

$0.00

F8910

ALTERNATIVE MOTOR VEHICLE CREDIT AMOUNT:

F8910

ALTERNATIVE MOTOR VEHICLE CREDIT PER COMPUTER:

$0.00

OTHER CREDITS:

$0.00

TOTAL CREDITS:

$0.00

TOTAL CREDITS PER COMPUTER:

$0.00

INCOME TAX AFTER CREDITS PER COMPUTER:

$749.00

Other Taxes

SE TAX:

 

$354.00

SE TAX PER COMPUTER:

 

$354.00

SOCIAL SECURITY AND MEDICARE TAX ON UNREPORTED TIPS:

 

$0.00

SOCIAL SECURITY AND MEDICARE TAX ON UNRE ORTED TI

ER COM UTER:

$0.00

TAX ON QUALIFIED PLANS F5329 (PR):

 

$0.00

TAX ON QUALIFIED PLANS F5329 PER COM UTER:

 

$0.00

IRAF TAX PER COMPUTER:

 

$0.00

TP TAX FIGURES (REDUCED BY IRAF) PER COM UTER:

 

$1,103.00

IMF TOTAL TAX (REDUCED BY IRAF) PER COM UTER:

 

$1,103.00

OTHER TAXES PER COMPUTER:

 

$0.00

UNPAID FICA ON REPORTED TIPS:

 

$0.00

OTHER TAXES:

 

$0.00

RECAPTURE TAX: F8611:

 

$0.00

HOUSEHOLD EMPLOYMENT TAXES:

 

$0.00

HOUSEHOLD EMPLOYMENT TAXES PER CO PUTER:

 

$0.00

HEALTH C RE RESPONSIBILITY PEN LTY:

 

$0.00

HEALTH C RE RESPONSIBILITY PEN LTY VERIFIED:

 

$0.00

HEALTH COVER GE REC PTURE: F8885:

 

$0.00

RECAPTURE T XES:

 

$0.00

TOTAL SSESSMENT PER COMPUTER:

 

$1,103.00

TOTAL T X LI BILITY TP FIGURES:

 

$1,103.00

TOTAL T X LI BILITY TP FIGURES PER COMPUTER:

 

$1,103.00

Payments

FEDERAL INCOME TAX WITHHELD:

$1,000.00

HEALTH CARE: INDIVIDUAL RESPONSIBILITY:

$0.00

HEALTH CARE FULL-YEAR COVERAGE INDICATOR:

0

E TIMATED TAX

PAYMENT :

$0.00

OTHER PAYMENT CREDIT:

$0.00

REFUNDABLE EDUCATION CREDIT:

$0.00

REFUNDABLE EDUCATION CREDIT PER COMPUTER:

$0.00

REFUNDABLE EDUCATION CREDIT VERIFIED:

$0.00

EARNED INCOME CREDIT:

$0.00

EARNED INCOME CREDIT PER COMPUTER:

$0.00

EARNED INCOME CREDIT NONTAXABLE COMBAT PAY:

$0.00

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Page 5 of 6

SCHEDULE 8812

NONTAXABLE COMBAT PAY:

$0.00

EXCESS SOCIAL

SECURITY & RRTA TAX WITHHELD:

$0.00

SCHEDULE 8812

TOT SS/MEDICARE WITHHELD:

$0.00

SCHEDULE 8812

ADDITIONAL CHILD TAX CREDIT:

$0.00

SCHEDULE 8812

ADDITIONAL CHILD TAX CREDIT PER COMPUTER:

$0.00

SCHEDULE 8812

ADDITIONAL CHILD TAX CREDIT VERIFIED:

$0.00

AMOUNT PAID WITH FORM 4868:

$0.00

FORM 2439 REGULATED INVESTMENT COMPANY CREDIT:

$0.00

FORM 4136 CREDIT FOR FEDERAL TAX ON FUELS:

$0.00

SAMPLE

$0.00

FORM 4136 CREDIT FOR FEDERAL TAX ON FUELS PER COMPUTER:

HEALTH COVERAGE TX CR: F8885:

$0.00

PREMIUM TAX CREDIT AMOUNT:

$0.00

PREMIUM TAX CREDIT VERIFIED AMOUNT:

$0.00

PRIMARY NAP FIRST TIME HOME BUYER INSTALLMENT AMT:

$0.00

SECONDARY NAP

FIRST TIME HOME BUYER INSTALLMENT AMT:

$0.00

FIRST TIME HOMEBUYER CREDIT REPAYMENT AMOUNT:

$0.00

FORM 5405 TOTAL HOMEBUYERS CREDIT REPAYMENT PER COMPUTER:

$0.00

SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER:

$0.00

SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER (2):

$0.00

FORM 2439 AND

OTHER CREDITS:

$0.00

TOTAL PAYMENTS:

$1,000.00

TOTAL PAYMENTS PER COMPUTER:

$1,000.00

Refund or Amount Owed

AMOUNT YOU OWE:

$103.00

APPLIED TO NEXT YEAR'S ESTIMATED TAX:

$0.00

ESTIMATED TAX PENALTY:

$0.00

TAX ON INCOME LESS STATE REFUND PER CO UTER:

$0.00

BAL DUE/OVER PYMT USING TP FIG PER CO PUTER:

$103.00

BAL DUE/OVER PYMT USING CO PUTER FIGURES:

$103.00

FORM 8888 TOTAL REFUND PER CO PUTER:

$0.00

Third Party Designee

THIRD P RTY DESIGNEE ID NU BER:

 

AUTHORIZ TION INDIC TOR:

0

THIRD RTY DESIGNEE N ME:

 

Schedule C--Profit or Loss From Business

OCIAL

ECURITY NUMBER:

 

EMPLOYER

ID NUMBER:

 

BU INE

NAME:

 

DE CRIPTION OF BU INE /PROFESSION:

DRAK

NAICS CODE:

000000

ACCT MTHD:

 

FIR T TIME CHEDULE C FILED:

N

TATUTORY EMPLOYEE IND:

N

INCOME

GROSS RECEIPTS OR SALES:

$2,700.00

RETURNS AND ALLOWANCES:

$0.00

NET GROSS RECEIPTS:

$0.00

COST OF GOODS SOLD:

$0.00

SCHEDULE C FORM 1099 REQUIRED:

NONE

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Page 6 of 6

SCHEDULE C FORM 1099 FILED:

NONE

OTHER INCOME:

$0.00

EXPENSES

CAR AND TRUCK EXPENSES:

$0.00

DEPRECIATION:

$0.00

INSURANCE (OTHER THAN HEALTH):

$0.00

MORTGAGE INTEREST:

$0.00

LEGAL AND PROFESSIONAL SERVICES:

$0.00

SAMPLE

$0.00

REPAIRS AND MAINTENANCE:

TRAVEL:

$0.00

MEALS AND ENTERTAINMENT:

$0.00

WAGES:

$0.00

OTHER EXPENSES:

$0.00

TOTAL EXPENSES:

$200.00

EXP FOR BUSINESS USE OF HOME:

$0.00

SCH C NET PROFIT OR LOSS PER COMPUTER:

$2,500.00

AT RISK CD:

 

OFFICE EXPENSE AMOUNT:

$0.00

UTILITIES EXPENSE AMOUNT:

$0.00

COST OF GOODS SOLD

INVENTORY

AT

BEGINNING OF

YEAR:

$0.00

INVENTORY

AT

END OF YEAR:

 

$0.00

Schedule SE--Self-Employment Tax

SSN OF SELF-EMPLOYED TAXPAYER:

XXX-XX-5084

NET FARM PROFIT/LOSS: SCH F:

$0.00

CONSERVATION RESERVE PROGRAM PAY ENTS:

$0.00

NET NONFARM PROFIT/LOSS:

$2,500.00

TOTAL SE INCOME:

$2,500.00

SE QUARTERS COVERED:

4

TOTAL SE TAX PER COMPUTER:

$353.12

SE INCOME COMPUTER VERIFIED:

$0.00

SE INCOME PER COMPUTER:

$2,308.00

TOTAL NET E RNINGS PER CO PUTER:

$2,308.00

LONG FORM ONLY

TENTATIVE

CHURCH RNINGS:

$0.00

TOTAL SOC

SEC & RR W GES:

$0.00

E

T X

COMPUTER:

$286.19

E MEDIC RE INCOME PER COMPUTER:

$2,308.00

E MEDICARE TAX PER COMPUTER:

$66.93

E FARM OPTION METHOD U ED:

0

E OPTIONAL METHOD INCOME:

$0.00

Form 8863 - Education Credits (Hope and Lifetime Learning Credits)

PART III - ALLOWABLE EDUCATION CREDITS

GROSS EDUCATION CR PER COMPUTER:

$0.00

TOTAL EDUCATION CREDIT AMOUNT:

$0.00

TOTAL EDUCATION CREDIT AMOUNT PER COMPUTER:

$0.00

 

 

This Product Contains Sensitive Taxpayer Data

 

 

 

 

 

 

8/9/2018

Dos and Don'ts

When filling out the Sample Tax Return Transcript form, it is important to follow certain guidelines to ensure accuracy and completeness. Here are five things you should and shouldn't do:

  • Do double-check all entries for accuracy before submission.
  • Do use the correct Social Security Number (SSN) for yourself and any dependents.
  • Do provide all required information, including income and deductions.
  • Do keep a copy of the completed form for your records.
  • Do consult a tax professional if you have any questions about the form.
  • Don't leave any fields blank; fill in all applicable sections.
  • Don't use outdated or incorrect tax forms.
  • Don't forget to sign and date the form before submitting it.
  • Don't ignore instructions provided with the form.
  • Don't submit the form without reviewing it for any errors.