IIII ElARKANNII III

IIII ElARKANNII III 011447 Department of Treasury Internal Revenue Service IRS PO BOX HOLT 9 IE012 SVIL NY 11742-9012 011447.364035.0078.002 2 AT 0.384 1404 DANIEL M & LESLEY GROFF Proposed changes to your 2011 Form 1040 Amount due: $1,267 The income and payment information we have on file from sources such as employers or financial institutions doesn't match the information you reported on your tax return. If our information is correct, you will owe 51,267 (including interest), which you need to pay by October 3, 2013. Notice CP2000 Tax Year 2011 Not'ce date September 3, 2013 Soc al Security number AUR control number 500637223 To contact us Phone cax Page 1 of 8 Summary of proposed changes Tax you owe 51,232 Payments SO Interest S35 Amount due by October 3, 2013 51,267 What you need to do immediately Review this notice, and compare our changes to the information on your 2011 tax return. If you agree with the changes we made • Complete, sign and date the Response form on Page 5, and mail it to us along with your payment of 51,267 so we receive it by October 3, 2013. • If you can't pay the amount due, pay as much as you can now, and make payment arrangements that allow you to payoff the rest over time. If you want to apply for an installment plan, send in your Response form AND a completed Installment A eeme R st (Form 9465). Download Form 9465 from www.irs.gov, or call to request a copy. You can also save time and money by applying online if you qualify. Visit ‘vww.irs.gov. and search for keyword: "tax payment options" for more information about: — Installment and payment agreements — Payroll deductions — Credit card payments If you don't agree with the changes Complete the Response form on Page 5, and send it to us along with a signed statement and any documentation that supports your claim so we receive it by October 3, 2013. If we don't hear from you If we don't receive your response by October 3, 2013, we will send you a Statutory Notice of Deficiency followed by a final bill for the proposed amount due. During this time, interest will inaease and penalties may apply. Continued on back... EFTA00313229 UM a "MIN Notice CP2000 Tax Year 2011 Notice date September 3, 2013 Sot al Security number Pag 2 of 8 Changes to your 2011 tax return Your income and deductions Shown on return As corrected by RS Difference Health savings account distribution SO $2,180 $2,180 Retirement income taxable Interest • • • • • SO 56,596 S38 $6,640 S38 544 Income net difference $2,262 Change to taxable income $2,262 Your tax computations Shown on return As corrected by IRS Difference Taxable income, line 43 S1,063,225 51,065,487 $2,262 Tax, line 44 $339,091 5339,883 $792 Self Employment tax, line 56 530,117 $30,117 SO Tax on qualdred plans, including IRAs, and other tax-favored accounts, line 58 SO $440 $440 Total tax, line 61 5369,268 $310,500 $1,232 Tax you owe $1,232 Explanation of changes to your 2011 Form This section tells you specifically what income information the IRS received about you 1040 from others (including your employers, banks, mortgage holders, etc.). This information doesn't match the information you reported on your tax return. Use the table to compare the data the IRS received from others to the information you reported on your tax return to understand where the difference(s) occurred. To assist you in reviewing your income amounts, the table may include both reported and unreported amounts. Health Savings Account Distribution Received from Address Account Information Shovm on return Reported to IRS by others Difference REALTHEQUITY CORPORATE 15 WEST SCENIC POINTE 431773.000 $20 DRIVE SUITE 4 SSN DRAPER UT 84020 PRINCIPAL LH INSURANCE CO DI HIGH STREET DES MOINES IA 503920001 Form 1099-SA 5067263T1 SSN Fon 1099-SA 52,160 Health Savings Account Distribution Total $0 $2,180 52,180 Interest Received from E TRADE CLEARING LLC Address PO BOX 484 JERSEY CITY NJ 073030484 Account Information 23770829004 551 Form 1099-INT Shown on return Repotted to IRS by others Difference SO $44 $44 Retirement Income Taxable Received from Address BANK Of AMERICA P 0 BOX 1551 PENNINGTON Nl 08534 Account Information 700800-1 SSF form 1099-R Distfib CD 1 Shown on return Reported to IRS by others Difference 50 538 $38 EFTA00313230 1111.KKIrAgrertaill III IRS Noti e 02000 Tax Year 2011 Notice date Septembe 3, 2013 Soc'al Security number- Page 3 of 8 20% Tax on Health Savings Account distributions Premature distributions from a Health Savings Account are subject to an additional 20% tax. A distribution is considered premature if it was paid before you reached age 65. The 20% tax is based on the taxable portion of the distribution. Exceptions may apply as indicated in Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans. If the distribution(s) shown on this notice are exempt from the additional tax, please send us a signed explanation. 10% Tax on premature distributions from a qualified retirement plan 011447 Premature distributions from a qualified retirement plan are subject to an additional 10% tax. A distribution is considered premature if it was paid before you readied age 59 112. Exceptions may apply as indicated in Publication 17, Your Federal Income Tax (For Individuals), or Publication 590, Individual Retirement Arrangements. If the distribution(s) shown on this notice are exempt from the additional tax, please send us a signed explanation. Refigured tax based on Schedule D computation We refigured your tax using the Schedule D tax computation. Health savings account distribution The Health Savings Account distribution reported on your return does not agree with the information provided to us on Form(s) 1099.5A, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA. Form W-2 or 1099 not received The law requires you to report your income correctly. If your payers did not send you a yearly income statement (Form W-2, Form 1099, etc.), you must use the information you have (pay stubs, monthly income statements, deposit slips, etc.) to estimate the total amount of income you received during the year. Misidentified income If any of the income shown on this notice is not yours, send us the name, address, and social security number of the person who received the income. Please notify the payers to correct their records to show the name and social security number of the person who actually received the income, so that future reports to us are accurate. Continued on back... EFTA00313231 H;1/4Eta Notice CP2C00 Tax Year 2011 Notice date September 3, 2013 Social Security number-Page 4 of 8 Retirement distributions We need more information for the distribution shown on this notice. We need to know if the income is a pension or an annuity, an IRA or lump sum rollover, or an employee savings plan. If the income is from a pension/annuity or an Employee Savings Plan and you are recovering your contributions using the General Rule or the Simplified General Rule, please send us a signed statement with the date of your first pension payment, the amount you receive monthly, and the total amount you contributed. If the income is an IRA or lump sum and was rolled over, please send us Form 5498, IRA Contribution Information or similar documentation. If the income is an employee savings plan, please send us a copy of the document showing the total distribution amount you received for 2011 and the nontaxable amount of the distribution. Next steps • You don't need to file an amended tax return for 2011. We will make the correction when we receive your response. However, if you choose to file an amended tax return (Form 1040X), write "CP2000* on the top of your amended federal tax return (Form 1040X) and attach it behind your completed Response form. Go to www.irs.gov to download Form 1040X or call 1.800-TAX-FORM (1-800-829-3676). • Please file an amended tax return (Form 1040X) for any other tax years in which the same error occurred. • We send information about these changes to state and local tax agencies, so if the changes we made apply, file an amended state or local tax return as soon as possible. Interest charges We are required by law to charge interest on unpaid tax from the date the tax return was due to the date the tax is paid in full. The interest is charged as long as there is an unpaid amount due, including penalties, if applicable. (Internal Revenue Code section 6601) DespipOon Mond Total Interest $35 The table below shows the rates used to calculate the interest on your unpaid amount from the date the tax return was due until the tax is paid in full. For a detailed calculation of your interest, call - Pend Beginning October 1, 2011 weirsi fait 3% Additional information • Call TeleTax at and select topic 652. • Visit www.irs.gov/cp2000. You can also find the following online: Amended U.S. Individual Tax Return (Form 1040X). • For tax forms instructions, and publications, visit www.irs.gov or call 1.800-TAX- FORM IONE. • Review the enclosed Publication 3498-A, The Examination Process. • Keep this notice for your records. If you need assistance, please don't hesitate to contact us. EFTA00313232 IIII MEV cig 011447 Department of Treasury Internal Revenue Service PO BOX 9012 IRS HOLTSVILLE NY 11742-9012 INTERNAL REVENUE SERVICE PO BOX 9012 HOLTSVILLE NY 11742-9012 Notice CP2000 Tax Year 20:1 Notice date Se ember 3 2013 Social Security numbe AUR control number To contact us Phon Fa Page 5 of 8 37860972620111 iIill Feed here Response form Complete both sides of this form, and send it to us in the enclosed envelope so we receive it by October 3, 2013. Use the attached address sheet and be sure the correct address shows through the window. To request more time to respond, call us at 1- Remember: Additional interest will be charged during this period if the information in this notice is correct. Provide your contact information If your address has changed, please make the changes below. DANIEL M & LESLEY GROFF a.m. O O p.m. Neal [tore 8esi rime to cal SKOnstm phone Best twee to cal 1. Indicate your agreement or disagreement o I agree with all changes I consent to the assessment of my 2011 income tax, and understand that: • I owe $1,267 in additional tax, payment adjustments, and interest. • The IRS is required by law to charge interest on taxes that weren't paid in full by April 17, 2012. • The IRS will continue to charge interest until I've paid the tax in full. Certain penalties may also apply. • I can challenge these changes in the U.S. Tax Court only if the IRS determines after the date I sign this form that I owe additional taxes for 2011. • I can file for a refund at a later date. Please sign and return this form with your payment. Seguin Date slimes s.4nsIste. Date Continued on back... EFTA00313233 11111 141111 CP2000 Notice Tax Year 2011 Notice date S tember 3, 2013 Social Security numbe Page 6 of 8 Indicate your agreement or disagreement --Continued o I don't agree with some or all of the changes Please return this form and include a statement signed by you that explains what you don't agree with. Also include copies of any documents, such as corrected W- 2, 1099, or missing forms that support your statement. Note: You can fax documentation tr 2. Indicate your payment option I am enclosing (check all that apply): in Full payment of $1,267 O Partial payment of S a No payment a A completed Installment Agreement Request (Form 9465) • Write your Social Security numbe the tax year (2011), and the notice number (CP2000) on your payment and any correspondence. • Make your check or money order payable to the United States Treasury. 3. Authorization optional If you would like to authorize someone, in addition to you, to contact the IRS concerning this notice, please include the person's information, your signature, and the date. The authority granted is limited as indicated by the statement above the signature line. The contact may not sign returns, enter into agreements, or otherwise represent you before the IRS. If you want to have a designee with expanded authorization, see IRS Publication 947, Practice Before the IRS and Power of Attorney. Full name of authorized person Address City Primary phone Bast time to call O am. O p.m. State Count'', •.,• Zip code O a.m. o pa. Secondary phone Best time 10 cal I authorize the person listed above to discuss and provide information to the IRS about this notice. ABnatue 0hte. Spouse's *maw Getz EFTA00313234 1111 hi§ • 011447 IRS Noti e (P2000 Tax Year 2011 Notice date Social Security number Page 7 of 8 2013 IRS '• r • Payment Internal Revenue Service PO BOX 145577 CINCINNATI OH 45250-5577 DANIEL M & LESLEY GROFF Notice CP2000 Notice date Se tember 3, 2013 Social Security numbe, • Make your check or money order nited States Treasury. • Write your Social Security number the tax year (2011), and the notice number (CP2000) on your payment and any correspondence. Amount due by 2013-10-03 $1,267 378609726 PC GROF 30 0 201112 640 000000000126700 EFTA00313235