Tax return

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a Employee’s social security number

OMB No. 1545-0008

Safe, accurate, FAST! Use

Visit the IRS website at www.irs.gov/efile

b Employer identification number (EIN)

c Employer’s name, address, and ZIP code

d Control number

e Employee’s first name and initial Last name Suff.

f Employee’s address and ZIP code

1 Wages, tips, other compensation 2 Federal income tax withheld

3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8 Allocated tips

9 10 Dependent care benefits

11 Nonqualified plans 12a See instructions for box 12 C o d e

12b C o d e

12c C o d e

12d C o d e

13 Statutory employee

Retirement plan

Third-party sick pay

14 Other

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement 2019 Department of the Treasury—Internal Revenue Service

Copy B—To Be Filed With Employee’s FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service.

111-00-2793

59-9888777

THINE OWN SELF PHARMACEUTICALS 2020 20TH STREET KANSAS CITY, MO 64105

CLAUDE HAMLIT 144 DOVER LANE INDEPENDENCE, MO 64056

72,692.00 8,333.00

72,692.00

72,692.00

4,506.90

1,054.03

MO 59988-877 72,692.00 3,744.00 72,692.00 726.92 KCMO

Form 1099-INT

2019 Interest Income

Copy B

For Recipient

Department of the Treasury - Internal Revenue Service

This is important tax information and is

being furnished to the IRS. If you are

required to file a return, a negligence

penalty or other sanction may be

imposed on you if this income is

taxable and the IRS determines that it has

not been reported.

OMB No. 1545-0112

CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

FATCA filing requirement

Account number (see instructions)

Payer's RTN (optional)

1 Interest income

$ 2 Early withdrawal penalty

$ 3 Interest on U.S. Savings Bonds and Treas. obligations

$ 4 Federal income tax withheld

$ 5 Investment expenses

$ 6 Foreign tax paid

$ 7 Foreign country or U.S. possession

8 Tax-exempt interest

$

9 Specified private activity bond interest

$ 10 Market discount

$

11 Bond premium

$ 12 Bond premium on Treasury obligations

$ 13 Bond premium on tax-exempt bond

$ 14 Tax-exempt and tax credit

bond CUSIP no. 15 State 16 State identification no. 17 State tax withheld

$ $

Form 1099-INT (keep for your records) www.irs.gov/Form1099INT

Page 1 of 2

Rosencrantz & Guildenstern Investments 720 Westchester Drive Columbia, MO 65201 Payer’s TIN: 09-2310103

Recipient:

2019 IRS CONSOLIDATED REPORTING STATEMENT

Copy B – For Recipient (keep for your records) Department of Treasury Internal Revenue Service

CLAUDE & GERTRUDE HAMLIT 225 9TH STREET COLUMBIA, MO 65201

ACCOUNT NUMBER: 7328-9304

This is important tax information that is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.

Recipient ID No.: ***-**-2793

Form 1099-DIV 2019 Dividends and Distributions

Line 1a Total Ordinary Dividends ........................................................ 1,121.85 Line 7 Foreign Tax Paid ......................................................................................0.00 Line 1b Qualified Dividends ................................................................. 1,121.85 Line 8 Foreign Country or US Possession .................................................................. Line 2a Total Capital Gain Distributions ..................................................... 0.00 Line 9 Cash Liquid Distributions .........................................................................0.00 Line 2b Unrecaptured §1250 Gain ............................................................. 0.00 Line 10 Non-Cash Liquid Distributions ...............................................................0.00 Line 2c Section 1202 Gain .......................................................................... 0.00 Line 11 Exempt Interest Dividends ....................................................................0.00 Line 2d Collectibles (28%) Gain .................................................................. 0.00 Line 12 Specified Private Activity Bond Interest Dividends ...............................0.00 Line 3 Nondividend Distributions ............................................................... 0.00 Line 13 State ............................................................................................................. Line 4 Federal Income Tax Withheld .......................................................... 0.00 Line 14 State Identification No. ................................................................................ Line 5 Section 199A Dividends ................................................................... 0.00 Line 15 State Tax Withheld ................................................................................0.00 Line 6 Investment Expenses ....................................................................... 0.00

Form 1099-INT 2019 Interest Income

Line 1 Interest Income ................................................................................ 9.45 Line 10 Market Discount ....................................................................................0.00 Line 2 Early Withdrawal Penalty................................................................. 0.00 Line 11 Bond Premium .......................................................................................0.00 Line 3 Interest on U.S. Savings Bonds and Treasury Obligations ............... 0.00 Line 12 Bond Premium on U.S. Treasury Obligations ........................................0.00 Line 4 Federal Income Tax Withheld .......................................................... 0.00 Line 13 Bond Premium on Tax-Exempt Bond ....................................................0.00 Line 5 Investment Expenses ....................................................................... 0.00 Line 14 Tax-Exempt Bond CUSIP no. ........................................................................ Line 6 Foreign Tax Paid ............................................................................... 0.00 Line 15 State ............................................................................................................. Line 7 Foreign Country of U.S. Possession ........................................................ Line 16 State Identification No. ................................................................................ Line 8 Tax-Exempt Interest ......................................................................... 5.45 Line 17 State Tax Withheld ................................................................................0.00 Line 9 Specified Private Activity Bond Interest .......................................... 0.00

Page 2 of 2

Rosencrantz & Guildenstern Investments 720 Westchester Drive Columbia, MO 65201 Payer’s TIN: 09-2310103

2019 IRS CONSOLIDATED REPORTING STATEMENT

Copy B – For Recipient (keep for your records) Department of Treasury Internal Revenue Service

Form 1099-B 2019 Proceeds from Broker and Barter Exchange Transactions

1a Description of Property 1b Date Acquired

1c Date Sold or Disposed

1d Proceeds 1e Cost or Other Basis

1f Accrued Market Discount

1g Wash Sale Loss Disallowed

4 Federal Income Tax Withheld

100 SH Kronborg Castle Ltd. (KCL) 11/25/18 03/20/19 8,500.00 7,250.00 0.00 0.00 0.00

Box A Short-Term Subtotal 8,500.00 7,250.00

200 SH Fortinbras Capital Holdings (FCH) 06/30/17 03/20/19 5,250.00 6,375.00 0.00 0.00 0.00

50 SH Jester Yorick Technologies, Inc. (JYT) 09/03/16 03/20/19 11,100.00 10,800.00 0.00 0.00 0.00

150 SH Gravediggers Co. (GDC) 10/15/15 03/20/19 4,500.00 8,625.00 0.00 0.00 0.00

Box D Long-Term Subtotal 20,850.00 25,800.00

Form 1099-G

2019 Certain

Government Payments

Copy B For Recipient

Department of the Treasury - Internal Revenue Service

This is important tax information and is

being furnished to the IRS. If you are required

to file a return, a negligence penalty or

other sanction may be imposed on you if this income is taxable and

the IRS determines that it has not been

reported.

OMB No. 1545-0120

CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Unemployment compensation

$ 2 State or local income tax

refunds, credits, or offsets

$ 3 Box 2 amount is for tax year 4 Federal income tax withheld

$ 5 RTAA payments

$ 6 Taxable grants

$ 7 Agriculture payments

$ 8 If checked, box 2 is

trade or business income ▶

9 Market gain

$ 10a State 10b State identification no. 11 State income tax withheld

$ $

Form 1099-G (keep for your records) www.irs.gov/Form1099G

  • 1099-MISC DEWEY
  • 1099-MISC NUNNERY
  • Consolidated Brokerage Statement
  • Form 1099-G
  • Form 1099-INT
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  2. g1: MISSOURI DEPARTMENT OF REVENUE PO BOX 2200 JEFFERSON CITY, MO 65105-2200
  3. g2: 43-1283723
  4. int1: PLAY WITHIN A PLAY FCU 3610 VOLTIMAND DRIVE NORTH KANSAS CITY, MO 64117
  5. int2: 43-0170190
  6. int7: XXX-XX-2739
  7. int4: CLAUDE HAMLIT
  8. int5: 144 DOVER LANE
  9. int6: INDEPENDENCE, MO 64056
  10. int3: 131.79