Free Notice (Other) - District Court of Federal Claims - federal

Case 1:05-cv-00773-EJD

Document 14-2

Filed 02/02/2006

Page 1 of 4

United States

of America

Department of the Treasury

Internal Revenue Service
Date: January 11, 2006

CERT-lFICATE OF OFFICIAL RECORD

I certify that the annexed: is a true Form 4340, Certificate of Assessments, Payments and Other

Specified Matters for David Sunshine, SSN: 5
(Form 1040), for tax period December 31,2000, consisting of

, for U.S. Individual Income Tax Return three page

under the custody of this office.

IN WITNESS WHEREOF, I have hereunto set my hand, and caused the seal of this offce to be affixed, on the day and year first above written.
By direction of the Secretary of the Treasury:

-i

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I

.. EXHIBIT .;

c¿..~~.~.
Supervisor Accounting Technician
SW Delegation Order 198
Form 2866 (Rev. 09-1997)

Ogden W &1 Submission Processing

Catalog Number 19002E

Case 1:05-cv-00773-EJD

Document 14-2

Filed 02/02/2006

Page 2 of 4

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS -------------------------------------------------------------------------------DAVID SUNSH INE

E IN/SSN:

FORM: 1040 TAX PERIOD: DEC 2000
DATE

TYPE OF TAX: U.S. INDIVIDUAL INCOME TAX RETURN
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

-------------------------------------------------------------------------------ADJUSTED GROSS INCOME

EXPLANATION OF TRANSACTION

CREDIT (REVERSAL)

ASSESSMENT

DATE (23C, RAC 006 )

122,594.00

TAXABLE INCOME

30,380.00
228.00

SELF EMPLOYMENT TAX

04-22-2004 RETURN FILED & TAX ASSESSED 09221-136-22334-4 200422

4,304.00
36,000.00

06- 14-2004

04- 15-200 1 WITHHOLDING & EXCESS FICA
04-15-2001 EXTENSION OF TIME TO FILE

EXT. DATE 08-15-2001

08-16-2001 EXTENSION OF TIME TO FILE

EXT. DATE 10-15-2001

04-21-2004 RECEIVED POA/TIA
04- 15-200 1 OVERPAYMENT CREDIT TRANSFERRED

(469.12)
0.24

1040 200112

05-31-2004 INTEREST DUE TAXPAYER

04-15-2001 04-15-2001 04-15-2001
04- 15-200 1

OVERPAYMENT CREDIT

TRANSFERRED

(1,547.00)
(45.00)

1040
1040

200212 200212

OVERPAYMENT CREDIT

TRANSFERRED

OVERPAYMENT CREDIT

TRANSFERRED

(0.21)
(13,103.73)
PAGE
1

1040

200212
199909

OVERPAYMENT CREDIT

TRANSFERRED
CVPN

FORM 4340 (REV. 01-2002)

Case 1:05-cv-00773-EJD

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Filed 02/02/2006

Page 3 of 4

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
DAVID SUNSHINE

E IN/SSN:

2

FORM: 1040 TAX PERIOD: DEC 2000
DATE

TYPE OF TAX: U. S. INDIVIDUAL INCOME TAX RETURN

EXPLANATION OF TRANSACTION

OTHER DEB I TS

ASSESSMENT,

(REVERSAL)

CREDIT (REVERSAL)

PAYMENT,

ASSESSMENT

DATE (23C, RAC 006 )

04- 15-200 1 OVERPAYMENT

CREDIT

TRANSFERRED
CVPN

(16,530.94)
(0.24 )

199912

05-31-2004

OVERPAYMENT INTEREST

TRANSFERRED
CVPN

199912

04-01-2002 Taxpayer Deliquency Notice 07-07-2003 Taxpayer Deliquency Notice 09-01-2003 Taxpayer Deliquency Notice
FORM

4340

(REV.

01-2002)

PAGE

2

Case 1:05-cv-00773-EJD

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Filed 02/02/2006

Page 4 of 4

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
DAVID SUNSH INE

EIN/SSN:

1040 TAX PERIOD: DEC 2000
BALANCE

TAX: U.S. INDIVIDUAL INCOME TAX RETURN

o .00

I CERTIFY THAT THE FOREGOING TRANSCRIPT OF THE TAXPAYER NAMED ABOVE IN RESPECT TO THE TAXES SPECIFIED IS A TRUE AND COMPLETE TRANSCRIPT FOR THE PERIOD STATED, AND ALL ASSESSMENTS, ABATEMENTS, CREDITS, REFUNDS, AND ADVANCE OR UNIDENTIFIED PAYMENTS, AND THE ASSESSED BALANCE RELATING THERETO, AS DISCLOSED BY THE RECORDS OF THIS OFFICE AS OF THE ACCOUNT STATUS DATE ARE SHOWN THEREIN. I FURTHER CERTIFY THAT THE OTHER SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFF ICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

:~ ~:~ ~~:::~: - :::~: :~L~~:: ~:~i~~cq":I~J~=~ ~~-¡£- - m m - - - - - m_
TITLE:
DELEGATION ORDER:
Supervisor Accounting Technician, Ogden W&I Submission Processing

SW Delegation Order 198

LOCATION: INTERNAL REVENUE SERVICE
ACCOUNT STATUS DATE 01/11/2006

FORM 4340 (REV. 01-2002)

PAGE

3