Cool Hand Luke

b Employer identification number (EIN) c Employer’s name, address, and ZIP code

71-0794409

12a See instructions for box 12
C o d e

1 Wages, tips, other compensation

2 Federal income tax withheld

WAL-MART ASSOCIATES, INC.

12b
C o d e

$ $ $ $ $

13874.83
3 Social security wages

1330.56
4 Social security tax withheld

13874.83
5 Medicare wages and tips 6 Medicare tax withheld

582.74 201.19
8 Allocated tips 10 Dependent care benefits

12c

702 SW 8TH STREET BENTONVILLE, AR 72716-0135 e Employee’s first name and initial Last name

C o d e

12d Suff. 12e
C o d e C o d e

13874.83
7 Social security tips 9 Advance EIC payment

00512 0512

1 of 1

ID:10108000000000000148308275

ERIC BARRAGAN 1369 COPPER GATE EL PASO, TX 79936

This information is being furnished to the Internal Revenue Service.

0.00
11 Nonqualified plans 14 Other 13 Statutory employee Retirement plan Third-party sick pay

Copy B To Be Filed With Employee’s FEDERAL Tax Return a Employee’s social security number

f Employee’s address and ZIP code 15 State Employer’s state ID number

644-26-0681
16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

TX

NO #

13874.83
Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy B To Be Filed With Employee 's FEDERAL Tax Return
1 Wages, tips, other compensation 2 Federal income tax withheld

Form W-2 Wage and Tax Statement 2012 b Employer identification number (EIN) c Employer’s name, address, and ZIP code

71-0794409

12a
C o d e

WAL-MART ASSOCIATES, INC.

12b
C o d e

$ $ $ $ $

13874.83
3 Social security wages

1330.56
4 Social security tax withheld

13874.83
5 Medicare wages and tips 6 Medicare tax withheld

582.74 201.19
8 Allocated tips 10 Dependent care benefits

12c

702 SW 8TH STREET BENTONVILLE, AR 72716-0135 e Employee’s first name and initial Last name Suff.

C o d e