THE HUNTINGTON NATIONAL BANK PO BOX 1558 EAIWS7_ i CBbmaus om ser6-1650 (Huntington CAROL E DAY Have a Question or Concern? MICHAEL E DAY 11671 DUNCAN PLAINS RD ‘Stop by your nearest Customer JOHNSTOWN OH 43031-9386 ‘Huntington office or Information contact us at: Privacy Notic 4-800-480-BANK (2285) ‘www.huntington.com Huntington Employee Premier Checking Account Account: 8826 Date: From 07/01/2022 to 08/10/2022 ‘Type: Direct Deposit YW fs Dee th aes 74 Transaction History ‘Transaotions from 07/11/22 through 08/10/22 Date Description ‘Type Amount Balance —— SSA TREAS 310 XX Sys) Direot eee SOC SEC Deposit *, 08/04/22, ee a TRANSF pirat Deposit $1,000.00 - OHIO PERS RETIR “=x Direct 07/28/22 EMENT De st $2,768.69 ‘SSATREAS 310 XX irect ees S00 SEC SD) Deposit sense 072122 a a TRANSF pirgot Deposit $197.19 SSA TREAS 310 XX Direct 0711/22, SOC SEC Deposit $1,658.00 Transaction History ‘Transactions from 07/14/22 through 08/10/22 Date Description ‘Type “Amount Balance 08/03/22 DEPOSIT Ese] Deposit $6,000.00 [ATM CHECK DEPO prey Deposit ee SIT 38743742 976.00Social Security Administration Benefit Verification Letter Date: May 12, 2022 BNC#: 22EX707E99944 REF: A bly yd beheld CAROL ELAINE DAY. 11671 DUNCAN PLAINS RD_ JOHNSTOWN OH 43031-9386 ‘You asked us for information from your record. The information that you requested ig shown below. If you want anyone else to have this information, you may send them this letter. Information About Current Social Security Benefits Beginning December 2021, the full monthly Social Security benefit before any deductions is $1,658.20. We deduct $0.00 for medical insurance premiums each month. The regular monthly Social Security payment is $1,658.00. (We must round down to the whole dollar.) Social Security benefits for a given month are paid the following month. (For example, Social Security benefits for March are paid in April.) Your: fo Security benefits are paid on or about the second Wednesday of each month. Information About Past Social Security Benefits From November 2021 to November 2021, the full monthly Social Security benefit before any deductions was $1,565.90. ‘We deducted $0.00 for medical insurance premiums each month. The regular monthly Social Security payment was $1,565.00. (We must round down to the whole dollar.) ‘Type of Social Security Benefit Information ‘You are entitled to monthly retirement benefits. Date of Birth Information ‘The date of birth shown on our records is April 1, 1959. See Next Page TSOgRtL ABATE SLN'NOO sOKUAMTAEATATONOS\-1089-R-OP 1 (01-2022) Discontinue Prior Editions FORM SSA-1099 — SOCIAL SECURITY BENEFIT STATEMENT 2021 ‘Box 1. Name CAROL = DAY FOR MORE INFORMATION. |- PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME. + SEE FACTS ABOUT YOUR 2021 SOCIAL SECURITY BENEFIT STATEMENT AND NOTICE 703 [Box 2. Beneficiary’s Social Security Number '288-52-8518 Box 3. Benefits paid in 2021 $1,565.00 NONE [Box 4. Benefits Repaid to SSA in 2021 |Box 5. Net Benefits for 2021 (Box 3 minus Box 4) DESCRIPTION OF AMOUNT IN BOX 3 Paid by check or Direct deposit Benefits for 2021 $1,565.00 DESCRIPTION OF AMOUNT IN BOX 4 $1,565.00 $1,565.00 NONE Box 6. Voluntary Federal Income Tax Withheld NONE Box 7. Address CAROL B DAY 11671 DUNCAN PLAINS RD JOHNSTOWN OH 43031-9386 Box 8. Claim Number (Use this number if you need to contact SSA.) 288-52-8518A, DO NOT RETURN THIS FORM TO SSA OR IRS:2020 W-2 and EARNINGS SUMMARY W-2 iat 2020 Wee ee eos aetna [> Employers name, eres and 2 ace PUBLIC PARTNERSHIPS FOR OH HH ER AGENT FOR NANCY MASON 4 GABOT ROAD, STE 102 MEDFORD, MA 02185 lat aoa C name eres aod EP os ‘CAROL DAY ier? DUNCAN PLAINS RD JOHNSTOWN, OH 43031 pegs: [F Seca acamages [1 Salona a “24a76.00, 1590.58 “inna se ton WTS ato masa Depa cr Friend ios Ta —| Foe CAROL DAY ‘ost sony Manbur DoOOCstE 11671 DUNCAN PLAINS RD Tamara «JOHNSTOWN, OH 43031 Biya a na FB aE we Of | ease 3816.00 Fv Sis cst TTS WB eo ay ma ‘zan.as_[° TOTAL TocaL, [Waa anes PE FaerTncame Tae] | (Wane ipa ar comm tone Recerca agape | [5 Boshi ouriga wm a816 00 wry ago 4816.00 Tina wae Tearing aaa a i816"00 "388.02 “igte-00 Teint] Bast | Cam | Separate] [SCamrataamter | Dept ropuoneso 0 "375 | Pooaccano Teo © Engayers nana oaran and HP eal PUBLIC PARTNERSHIPS FOR OH HH ER AGENT FOR NANCY MASON 1 CABOT ROAD, STE 102 MEDFORD, MA "02185, PUBLIC PARTNERSHIPS FOR OH HH ER AGENT FOR NANCY MASON 4 CABOT ROAD, STE 102 MEDFORD, MA 02155 | PUBLIC PARTNERSHIPS FOR OH HH ER AGENT FOR NANCY MASON 4 CAaBoT ROAD, STE 102 MEDFORD, MA 02155 eT vulgare ae | EE FE "Ga! 3540008, aeteast Becaes00de [SOC ass Pepa s9a0008 EOC BST ea | sear — ears saat aera Sa =| Zz omar a i — | A Roa ; refs a rar = ro r= i a f=} | 1 1 Fascha roa aan NA SRP RTTR femoris Fe TSS TT Oe ra ITE ‘canOL DAY ARO. bay ARO BAY Sire aongan pLains RO tert BUNGAN PLANS RO tet Donan PLANS RO JOHNSTOWN, OH” 43031 JOHNSTOWN, OH 43031 JOHNSTOWN, OH” 43081 15 Sas Eazy wa TO eae waa ta a eo ES SRE Aa ay Bn wane te on "pisie.oo || On| sso "16.00, 1 tas ame [Coane ts = Wanna ste | [TT Steliconetax aap 457.62 487.62 487.62 Toston as ag PHORM TOCAL eaTincoa tx iy mae ‘OH, State Filing Copy W=2 “seers 2020 (Cy tetany ets ea ling Copy tate afin Tap, W-2 "eee 2020 | W—2 “se ‘220 Chay tsb ia wt empl er re Ht Wi? “enePAYER'S name, street adérese, cy, state, and ZIP code a “OME Ne 156.0110 NATIONAL FINANCIAL SERVICES LLC s az010|5 amie] 2020 7.0.6 26019 San TS suai om ‘Abuqueraue, NM 87125-6018 ie Sepia Fear icone Trent st freuen eo2y | “tran rata Fae, we $ s "Sone RECIPIENT'S Name and Adress "Eeiemeatencecs | emetetetence”” | bong tmhests Stnaomn rene tnelorel Raven CAROLE DAY 7 ; Se roaaaios AT [or 5/3 PASSAGEWAY eae [oem copye 11671 DUNCAN PLAINS RD JOHNSTOWN OH 43031-9386 For Recipient's Records a SS 5 on 62-67887 Sasi cai eer OTEOATS 8 PAYERS TW REGPENTS TH Tea Se a eT ovr.aeerreoo1 [8 = FORM 1080-8 Deparment of te Treasury teal Revenue Sence PAYER'S name, srst adress, oly, sate, and ZP code SaaS a Taio San eee NATIONAL FINANCIAL SERVICES LLC s aees0|s 70019 2020 P.O, Box 23019 eet a Ditton rom ‘Nuquergue, WM 87125-8019 rrememest "0 Saxman __()_| pentonn Aaton ein “rawr coor tnt feuatisiacan | “Toma Prot.Shaing Pee, s $ "onan, RECIPIENT'S Name and Adress Fimpmectencocs |Semmetetae” | Dey tonaedts svat! Ravn ‘Sewn, CAROLE DAY : 5/3 PASSAGEWAY copy? 11671 DUNCAN PLAINS RD JOHNSTOWN OH 43031-9386 7 [xs 2 | Fe tn cong Serpe TET | YU ate oF ret, when ss requ, aa — cE Tee 5 on s2-57987 Sanaa aro pane nab B58 BBS TOE 5 PAVERS TH REGPENTS TH a ST Tssrerwnted — [eran ey roa (04503887 orraserrecor | 5 FORM 1068-8 Deparment othe Treasury intemal Revenue Senice PAYER'S name, srt adress, oly, sate, an ZIP code NATIONAL FINANCIAL SERVICES LLC P.O. Box 26010 ‘Abuquergue, NM 87125-8019 RECIPIENTS Name and Adsross Ea there Ros CAROLE DAY S arma jaar — Too 5/3 PASSAGEWAY coPYB 11671 DUNCAN PLAINS RD eet nome on JOHNSTOWN OH 43031-9386 ¥ sis . SERSaes Pisewece | vr — sors xs ree Tha he ea s on-s2-s7887 io i one mao BH BEE TORE 5 $ PAVERS TH, RECPENTS TW sa Ne Tianna — eee Tey ———hotear aaa 06 525867 aad orr.aserre0o1 | is FORM 1090-R ‘iTS:2001 7030465658 DDepartnent of the Treasury Internal Revenue ServiceFIFTH THIRD SECURITIES, INC. MD 1MOBZA 5050 KINGSLEY DRIVE CINGINNATI, OF 45269 ‘SP 01 053985 285626 115 ASNGLP CAROLE DAY 5/3 PASSAGEWAY 11671 DUNCAN PLAINS RD. JOHNSTOWN OH 43031-8386 o1/s!2021 7090459588OHIO PUBLIC EMP RET SYS oe out no user 277 EAST TOWN STREET woe ao7736, 2021 COLUMBUS OHIO 43215-4642 fie soa Form tno 'PAYER'S Federal Identification number | RECIPIENT'S klantiication number, $33,836.72 34-0797516 G Y00-XK0652 | eee] dorttee J] "meneame [Fane Tox Whe Epona Roh eonnaions—|__Seteminad sis0ess | §16064 |" TT MICHAEL E DAY (iam! aa 11671 DUNCAN PLAINS RD Sa Tats Tics | a a wT JOHNSTOWN OH 43031-9386 (enact 75. SnaPyer ne wane $0.00 0H51-8539176 06/18 peso a pal OOGKX-0652_ Ra co) OHIO PUBLIC EMP RET SYS = cone io txs-24i8 | pitbuten rom 277 EAST TOWN STREET emanate 97736| 2021 | nan teint COLUMBUS OHIO 43215-4642 a Tain oat rm oe | “esuranee Cones oe 'PAYER’S Federal identification number | RECIPIENT'S identifeation aumber_ $33,836.72 31-0797516 G WOOKK-0652 [™ Seeoeent] cattoaen(]/SCMEORNTRER Z| erie | [fedoras Tex Wines FEegarnts. Reese Se eaten mae | "SE $1,306.58 $140.64 |* Sastre ssertes 7 a. | zee, MICHAELE DAY = [a | Se 11671 DUNCAN PLAINS RD 'Sp. Total employee contributions | #2. State tax withheld - JOHNSTOWN OH 43031-9386 0.00|-—— (OH51-8539176 ost ‘emo oat oan) YOOGXX-0652 eee ee semcin) T OHIO PUBLIC EMP RET SYS LB uso. eerie | Dltibutons From 277 EAST TOWN STREET 133,977.36, 2021 | promsueing ice COLUMBUS OHIO 43215-4642 a at romsteon | Tonroen onto 'PAYER'S Federal Wentification number | RECIPIENT'S identification number $33,836.72, 310797516 G YXK-XK-0852 a ton como STN [&. Federal income Tax Withheld 5: Empioyen!Dezig, Roth contributions ae _ copyc Sharann pene [Ehctasccmaopedaions [TOReBain ae] AEP | Frenne $1,306.58 $140.64 |" Seer ewarce vol Sar | aco renee [| Seapets aioat MICHAEL E DAY | ‘betes a 41671 DUNCAN PLAINS RD 1: enioansniaoms Ste wane JOHNSTOWN OH 43031-9386 $0.00. [a Snhoer ase | ove Do Riroment OH51-8539176 06/18. ee Aecoant namie (ptoral “om XXK-XX-0652_FACTS ABOUT YOUR 2021 SOCIAL SECURITY BENEFIT STATEMENT Your 2021 Social Security Benefit Statement is on the back of this form. Use it, along with the information below, to see if part of your Social Security benefits may be taxable. ‘What YouNeed ‘To Do Box 2-'Social Security Box 4-‘Benefits Repaid to SSA ‘Use the 2021 statement on the Number" shows the Social {in 2021" shows the total amount of reverse, with the Internal ‘Seourity number ofthe person shown benefits yourepeid us in 2021. We Revenue Service (TRS) Notice in Box 1, if we have the number. show items that apply to you in the ‘708 below, to see ifany of your Box 8-“Benefits Paid in ‘cohumn headed “Description of Social Security benefits are 2021" shows the total amount Amount in Box 4” ‘taxable Donot return this ‘of Social Seourtv we neid vou in Box 5-Net Benefits for 2021" FORM SSA-1099 — SOCIAL SECURITY BENEFIT STATEMENT 202 1 « PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME, + SEE THE REVERSE FOR MORE INFORMATION. Box 1 Name Box 8. Bently Socil Sexurly Nember MICHAEL E DAY 293-54-0652 Box Banat Pad n EA Box. Batis Repaid io SSA a1 Box Net Banas Yor 2021 ors ara Bac) $5,142.00 NONE $5,142.00 DESCRIPTION OF AMOUNTIN BOXS ‘DESCRIPTION OF AMOUNT IN BOX Paid by check or Direct deposit $3,372.00 ‘Medicare Part B premiums deducted a from your benefits $1,770.00 ‘Total Additions $5,142.00 Benefits for 2021 $5.142.00 "Box 6. Voluntary Federal income Tax Wael ‘NONE, ‘Box 7. Address | MICHAEL E DAY 11671 DUNCAN PLAINS RD JOHNSTOWN OH 43031-9386 ‘Box 8 Clalm Number (Use this numberif you need to contact SSA) 293-54-0652A Form $8A-1099-8M (1-202) DO NOT RETURN THIS FORNTO SSA OR IRSTama T OHIO PUBLIC EMP RET SYS Tacconee —— ommmname | Relate 277 EAST TOWN STREET t 33,69: | promt shring ans A, | COLUMBUS OHIO 43215-4642 (ia Taso amount $93.693-42/ on | Seaton | Paves Fotalcoifcicsnanbr REGENTS Heian nis’ | _,_—_ $88,852.78 | oo 31-0797516 G _XXK-XX-068; PS) Stan] Peer | Tegal tenon wy | ntl Sacer ata egg, al -| sisi MICHAEL E DAY ase 11671 DUNCAN PLAINS RD aa cats | Sar od JOHNSTOWN OH 49031-0386 as "$0.00 — {3 bah enon cn B Rooe _OHs1-9530176 oats (00.0652 to | i] OHIO PUBLIC EMP RET SYS maenconed nore | M277 EAST TOWN STREET “= | “fesrement or COLUMBUS OHIO 43215-4642 -q; $38.80842, a en =— chen | [Prats sclera rai "$33,552.78, Lo mr PSteo ce Oe MICHAEL E DAY 14671 DUNCAN PLAINS RD JOHNSTOWN OH 43031-0386 [sein ner oponah I YOOKX-065: Coo T OHIO PUBLIC EMP RET SYS oreo | uno. ssesonie 277 EAST TOWN STREET eanaajee2020, |, memes | COLUMBUS OHIO 43215-4642 cq Fam sosen | “nuance conc sarreeo ena oese cata go aesintoca | | Engle Reh corns _ ata rimuaneeremions $440.64 “eapiyerssecns ace “coe | MICHAEL E DAY (a Lt —* _ 11671 DUNCAN PLAINS RD |ab, Total employee conirtbations | 12 Siate tax withheld eer oe eerie 13, StatePayer's state number aa" __0H51-8539176 ogts | mtematen |~information below, tw see if part ot your Social Security benefits may be taxable, ‘What YouNeed ToDo Box 2-“Social Security Box 4Benefits Repaid to SSA ‘Usethe 2020 statement on the ‘Numiber”-shows the Social {in 2020"- shows the total amount of reverse, with the internal Security mumher ofthe person shown benefits you rep us in 2020, We Revenue Service (RS) Notice inBox 1, ifwehave the number shes tt opin the TOBbelov; to see ifany of your ‘ ids ‘headed “Description Socal Seen bear Loa onstetatennt ——AnauntinBoxd” FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT 2020 « PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME. * SEE THE REVERSE FOR MORE INFORMATION. Box Name Box 2, Banofidan/s Socal Socuity Nubar MICHAEL E DAY 298-54.0652 Box. Bevatia Paid in BORD ‘ona Banaita Repaid wo SEA a 3500 [Box 6 Net Boneh or BOLD SarS mas Bor) $5,071.20 NONE $5,071.20 ‘DESCRIPTION OF ANOUNT IN BOXS ‘DESCRIPTION OF AMOUNT INBOX Paid by check or direct deposit. $8,972.00 NONE “Medicare Part B premiums deducted from your benefits $1,600.20 ‘Total Additions $5,071.20 Benefits for 2020 $5,071.20 "Box 6. Voluntary Federal Income Tax Withheld NONE Bax 7. Ades MICHAEL E DAY 11871 DUNCAN PLAINS RD | JOHNSTOWN OH 43031-9986 "Box 8 Claim Number (Use tis number you need fo contact SSA) 298-54-0852A Form S8A-1086-0M (12021) DO NOT RETURN THIS FORIITO SSA OR IRSnpr fie emay—ierlRewnig senior (8 £1040 (s"incividcar income Tax Retum [2018 our soso Ting BAS! CT Se Bel Mavedang nay] aris Rng sraaney [] Wend oreo] Gut wine) 1 Us cry-0o not wt rata espe Tassreneeai ce arate Wichael = bay asncs4-0682 Yas anand acta [Seren Gasper _[] YOST —CTvone we Tinea new ar = os carol 3s aee-s2-8518 “oovse sanded deduciow’ L] Somaone can caim your spouse asa dapandent’[-] Spouse was bom before Januar/2, 105 [Bx] Fullyear heath care coverage D1 Spouses bing C1 Spouse tamizes on a separate return or you were dua-status aon cutter Percussion Ta Fo 11671 Duncan Plains Rd (seeirst) vou C) spouse Carp Sh te Ee a ROR EIR errors ‘Johnstown OH 43031-9386 _ _| saan and v nae ® Dopenors beers) aaa | a © Frm nen ta on pin O O O O O oO O oO ES le Here ‘Your signature: Date ‘Your occupation {the IFS sent you an erty Protection ua nevirea Be ee nm Seen rie Retired | ae ar Th Preparer “amp Geli pramaiad Rams swe fies Fa Deon Pay goa Rona eas roms ve 7 ee cs RO 7 Trae os eames m wn ot * SUE 2 onmcravene = S oumeyae ae GRAMS! 4g tata pncona damien | [ae 1 Table anount * 739,218 ae" Sateen Cael * ras = ofan ate ha oh anima [975,068 Sites teat ns Arete rs, ToT on SEIT NT Alaa tr te tron on te : 34.000 CSc on rst : : Tomercom nthe sen acorn et cs COC Tax (soe inst) 24,674. Check anyim: 1 [] Fomig ae 2 C]remaore 3 C) ’ 1b Add any amount from Schedule 2 and check here > Ol} | 24,674. ‘aCildiaxcectlcedtioroterdependarts Add ryan tom Shee andctackhee® C] | 42 | Stmatetttenietitiecetm ao " (ofan 67acs oer steate [et 0: reenact [saa ‘rene tone Wh Lie sian. tcmmnauievaebere) Wen bea crams ta pant tonsa | »| Ajnotagt tense eae lea Eas. etng tre aban sone tanta heme * be hrocatte i preety onan he > 0 [as Oraampot? my Rouingnombor |XX XX KX XXX retype Llovwcing [)saiege To Kine GOCE Bese aCe x el ek 21 _ Aout one 19 you want applied to your 2018 estimated tax > lal ira aow Sanne on Senor Fras ion emmaes La 25 Estimated tax penalty (se instructions). > | 2s | Bee ‘Gore maw govIFamniO40 ferinerucons a the test information BAA Tenaarnmaase rom 1040 por)Beh ets rps, ons Obnio | SE" avjguetinccone tov return MUIINTIINITI eens Individual Income Tax Return 10 15 19 Use only black ink and UPPERCASE letters. 18000133 Sequence No. 1 Check here if this fs an amended retum. Include the Ohio IT RE (do NOT include a copy ofthe previously filed return) ‘Check here this is Net Operating Loss (NOL) camyback. Include Ohio Schedule IT NOL. “Taxpayer's SSN (required) deceased Spouse's SSN (fing jointly) deceased Enter schoo! district # for 293 54 0652 Ke 288 52 8518 » this return (ee instructions} check box checkbox SD#>> 4503 Fistrame MA. Lastname MICHAEL E DAY Spouse's fst name (only marie fing joey) ML Lastname CAROL E DAY ‘Adoress tne 1 (number and street) oF RO. Box 11671 DUNCAN PLAINS RD ‘acess Ine 2 (epertent number, sue suber, et) ty State Z1P code bi crn (et four etre) JOHNSTOWN OH © 43032 LICK Foreign county (the malin aderessis outside th U.S) Foreign postal cose Qhio Residency Status - Check applicable box Eiling Status - Check one (as reported on federal income tax return) X Fubkyesr Panyear Nonresident yy Single, head of household or auatying widower resident resident Ingest tate x atone bla) ‘check applcable box for spouse (nl it maria ing jot) ce % Fulkyear Panyear Nonresisent py cies ey sepa readent resident Inca state ; Check here you fl the federal extersion 4888, ‘Ohio Political Party Fund Check her f someone ele able to ci yu (or your spouse i check here if you want $1 to goto this fund, Jone a a dependent. (Check here if your spouse wants $1 to go to this fund (Fling joint), Note: Checking this box wil not increase you tx or decrease your refund. +, Federal adjusted gross income (from the federal 1040, ine 7). Include page 1 and 2 of your federal return the amounts zero or negative. Place ain box atthe right Do not staple or paper clip. a 2 173066 00 2a, Additions ~ Ohio Schedule A, fin 10 (INCLUDE SCHEDULE)... 22. 00 2b. Deductions ~ Ohio Schedule A fine $7 (INCLUDE SCHEDULE... sone BD. 00 3. Ohio adjusted gross income (line 1 plus line 2a minus line 26). Place @ the right ifthe amount is less than zero. 3 173066 00 4, Exemption amount (if claiming dependent(s), INCLUDE SCHEDULE J). A. 3700 00 Number of exemptions claimed: 2 5. Ohio income tax base (ine $ minus line 4; ifless than zero, enter zero) 5 169366 00 6, Taxable business income ~ Ohio Schedule IT BUS, line 13 INCLUDE SCHEDULE) nn----8. 00 169366 00 7. Line 5 minus line 6 (less than zero, enter 220). IO O Postmark date Code a 10/15/2019 04:14 PM : 2018 IT 1040 - page 1 of 2 Mi