Form W-2as - American Samoa Wage And Tax Statement - 2018 Page 3
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9a Employee’s social security number
22222
Void
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Samoa income tax withheld
c Employer’s name, address, and ZIP code
3 Social security wages
4 Social security tax withheld
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8
d Control number
9
10
e Employee’s first name and initial
11 Nonqualified plans
12a
Last name
Suff.
C
o
d
e
13
Statutory
Retirement
Third-party
12b
employee
plan
sick pay
C
o
d
e
14 Other
12c
C
o
d
e
12d
C
o
f Employee’s address and ZIP code
d
e
W-2AS
American Samoa
Department of the Treasury—Internal Revenue Service
2018
Wage and Tax Statement
Form
Copy 1—For American Samoa Treasurer
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