Form W-2vi - U.s. Virgin Islands Wage And Tax Statement - 2017 Page 4

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a Employee’s social security number
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 VI 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
10
9
e Employee’s first name and initial
11 Nonqualified plans
12a See instructions for box 12
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-2VI
U.S. Virgin Islands
Department of the Treasury—Internal Revenue Service
2017
Wage and Tax Statement
Form
This information is being furnished to the
VI Bureau of Internal Revenue.
Copy B—To Be Filed With Employee’s VI Tax Return

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