tyree rock
OMB No. 1545-0008
OMB No. 1545-0008
d Control Number
1 Wages, tips, other compensation
2 Federal income tax withheld
16357.93 b Employer identification number (EIN)
3 Social security wages
65-0791368
4 Social security tax withheld
16357.93
a Employee’s social security number
5 Medicare wages and tips
253-53-2586
d Control Number
16357.93
b Employer identification number (EIN)
65-0791368
10 Dependent care benefits
11 Nonqualified plans
12a
11 Nonqualified plans
12a
12b
12c
Code
9
2715.36
14 Other
DEN
MED
VIS
608.00
3367.52
152.00
13 Statutory employee Third-party sick pay
2715.36
Code
14 Other
DEN
MED
VIS
608.00
3367.52
152.00
e Employee’s name, address and ZIP code
LA'SHALAE D LOCKEY
367 DERBYSHIRE DR
STONE MOUNTAIN GA 30088
Employer’s state I.D. no.
2012
16 State wages, tips, etc.
GA 2113700-IC
16357.93
W-2
Form
17 State income tax
18 Local wages, tips, etc.
15 State
Employer’s state I.D. no.
16357.93
W-2
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
Wage and Tax Statement
Copy C For EMPLOYEE’S
RECORDS (See Notice to
Employee on back of Copy B.)
16 State wages, tips, etc.
GA 2113700-IC
20 Locality name
Copy B To Be Filed With
Employee’s FEDERAL Tax
Return.
This information is being furnished to the
Internal Revenue Service. If you are required 19 Local income tax to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.
This information is being furnished to the
Internal Revenue Service.
20 Locality name
Department of the Treasury –
Internal Revenue Service
Department of the Treasury –
Internal Revenue Service
OMB No. 1545-0008
OMB No. 1545-0008
1 Wages, tips, other compensation
2 Federal income tax withheld
16357.93 b Employer
OMB No. 1545-0008
d Control Number
1 Wages, tips, other compensation
2 Federal income tax withheld
16357.93 b Employer identification number (EIN)
3 Social security wages
65-0791368
4 Social security tax withheld
16357.93
a Employee’s social security number
5 Medicare wages and tips
253-53-2586
d Control Number
16357.93
b Employer identification number (EIN)
65-0791368
10 Dependent care benefits
11 Nonqualified plans
12a
11 Nonqualified plans
12a
12b
12c
Code
9
2715.36
14 Other
DEN
MED
VIS
608.00
3367.52
152.00
13 Statutory employee Third-party sick pay
2715.36
Code
14 Other
DEN
MED
VIS
608.00
3367.52
152.00
e Employee’s name, address and ZIP code
LA'SHALAE D LOCKEY
367 DERBYSHIRE DR
STONE MOUNTAIN GA 30088
Employer’s state I.D. no.
2012
16 State wages, tips, etc.
GA 2113700-IC
16357.93
W-2
Form
17 State income tax
18 Local wages, tips, etc.
15 State
Employer’s state I.D. no.
16357.93
W-2
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
Wage and Tax Statement
Copy C For EMPLOYEE’S
RECORDS (See Notice to
Employee on back of Copy B.)
16 State wages, tips, etc.
GA 2113700-IC
20 Locality name
Copy B To Be Filed With
Employee’s FEDERAL Tax
Return.
This information is being furnished to the
Internal Revenue Service. If you are required 19 Local income tax to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.
This information is being furnished to the
Internal Revenue Service.
20 Locality name
Department of the Treasury –
Internal Revenue Service
Department of the Treasury –
Internal Revenue Service
OMB No. 1545-0008
OMB No. 1545-0008
1 Wages, tips, other compensation
2 Federal income tax withheld
16357.93 b Employer