Form W-3ss - Transmittal Of Wage And Tax Statements - 2018 Page 3
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1
2
3DO NOT STAPLE OR FOLD
a Control number
For Official Use Only
▶
33333
OMB No. 1545-0008
b
941-SS
Military
943
944
None apply
501c non-govt.
Third-party
sick pay
Kind
Kind
of
of
(Check if
Hshld.
Medicare
State/local
Payer
Employer
applicable)
emp.
govt. emp.
State/local 501c
Federal govt.
non-501c
(Check one)
(Check one)
c Total number of Forms W-2
d Establishment number
1 Wages, tips, other compensation
2 Income tax withheld
e Employer identification number (EIN)
3 Social security wages
4 Social security tax withheld
f Employer’s name
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8
9
10
11 Nonqualified plans
12a Deferred compensation
g Employer’s address and ZIP code
h Other EIN used this year
13 For third-party sick pay use only
12b
15 Employer’s territorial ID number
14 Income tax withheld by payer of third-party sick pay
Employer’s contact person
Employer’s telephone number
For Official Use Only
Employer’s fax number
Employer’s email address
Copy 1—For Local Tax Department
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature
Title
Date
▶
▶
▶
2018
Form W-3SS Transmittal of Wage and Tax Statements
Department of the Treasury
Internal Revenue Service
Where To File
For more information about where to file Copy 1, contact your state, city, or local tax department.
American Samoa. File Copy 1 of Form W-3SS and Forms W-2AS at the following address.
American Samoa Tax Office
Executive Office Building
First Floor
Pago Pago, AS 96799
Guam. File Copy 1 of Form W-3SS and Forms W-2GU at the following address.
Guam Department of Revenue and Taxation
P.O. Box 23607
GMF, GU 96921
U.S. Virgin Islands. File Copy 1 of Form W-3SS and Forms W-2VI at the following address.
Virgin Islands Bureau of Internal Revenue
6115 Estate Smith Bay
Suite 225
St. Thomas, VI 00802
Commonwealth of the Northern Mariana Islands. File Form OS-3710 and Copy 1 of Forms W-2CM at the following address.
Division of Revenue and Taxation
Commonwealth of the Northern Mariana Islands
P.O. Box 5234 CHRB
Saipan, MP 96950
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