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
i 7
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
Document 14-2
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
Document 14-2
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