Form 80-107-06-3-1-000 - Individual W-2 Data Sheet - 2006

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MISSISSIPPI
Form 80-107-06-3-1-000 Rev. (05/06)
Individual W-2 Data Sheet
This form must be attached as a schedule to the return
without cutting into separate W-2's. It should be attached as
2006
the last page of the return. If you have more than 4 W-2's,
please use as many copies of this form as needed to include
801070631000
all W-2's. All original W-2S must also be attached the return
along with this form.
W-2 Data
First Employer
a
Control Number
For State, City, or Local Tax Department.
1
Wages, tips, other comp.
2
Federal income tax withheld
4
3
Social security tax withheld
c
Employers name, address, and ZIP code
b
Employer I.D. number
Social security wages
d
Employee's social security no.
5
6
Medicare tax withheld
Medicare Wages, and tips
9
7
8
Advance EIC payment
Social security tips
Allocated tips
13
e Employee
's first, initial, and last names
1
0
Dependent care benefits
11
Nonqualified plans
State
Retirement
3rd party
plan
sick pay
empl.
14
12a Code
See inst. for box 12
12b
Code
Other
12c
Code
12d
Code
f
Employee's address and ZIP code
19
Local income tax
15
Employer's state ID no.
16
17
State income tax
18
20
Locality name
State
State Wages, tips,etc
Local wages, tips, etc. tax
MS
W-2 Data
Second Employer
a
Control Number
For State, City, or Local Tax Department.
1
Wages, tips, other comp.
2
Federal income tax withheld
4
c
b
3
Social security wages
Social security tax withheld
Employers name, address, and ZIP code
Employer I.D. number
d
Employee's social security no.
6
5
Medicare Wages, and tips
Medicare tax withheld
7
9
Advance EIC payment
Social security tips
8
Allocated tips
e Employee
0
11
13
Retirement
3rd party
's first, initial, and last names
1
Dependent care benefits
Nonqualified plans
State
empl.
plan
sick pay
12a Code
See inst. for box 12
12b
14
Code
Other
12c
12d
Code
Code
f
Employee's address and ZIP code
19
15
17
Local income tax
Locality name
State
Employer's state ID no.
16
State Wages, tips,etc
State income tax
18
Local wages, tips, etc. tax
20
MS
W-2 Data
Third Employer
a
2
Control Number
For State, City, or Local Tax Department.
1
Wages, tips, other comp.
Federal income tax withheld
4
c
b
3
Social security wages
Social security tax withheld
Employers name, address, and ZIP code
Employer I.D. number
d
Employee's social security no.
6
5
Medicare Wages, and tips
Medicare tax withheld
9
7
Social security tips
8
Advance EIC payment
Allocated tips
e Employee
0
11
13
Retirement
's first, initial, and last names
1
Dependent care benefits
Nonqualified plans
State
3rd party
empl.
plan
sick pay
12a Code
See inst. for box 12
12b
14
Code
Other
12c
12d
Code
Code
f
Employee's address and ZIP code
17
19
Local income tax
15
State
Employer's state ID no.
16
State Wages, tips,etc
State income tax
18
Local wages, tips, etc. tax
20
Locality name
MS
W-2 Data
Fourth Employer
a
Control Number
For State, City, or Local Tax Department.
1
Wages, tips, other comp.
2
Federal income tax withheld
4
c
b
3
Social security wages
Social security tax withheld
Employers name, address, and ZIP code
Employer I.D. number
d
Employee's social security no.
6
5
Medicare Wages, and tips
Medicare tax withheld
9
7
Social security tips
8
Advance EIC payment
Allocated tips
e Employee
0
11
13
Retirement
's first, initial, and last names
1
Dependent care benefits
Nonqualified plans
State
3rd party
plan
sick pay
empl.
12a Code
See inst. for box 12
12b
14
Code
Other
12c
Code
12d
Code
f
Employee's address and ZIP code
17
19
Local income tax
15
State
Employer's state ID no.
16
State Wages, tips,etc
State income tax
18
Local wages, tips, etc. tax
20
Locality name
MS

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