Form W-2 - Wage And Tax Statement - 2017 Page 2

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a Employee’s social security number
For Official Use Only
22222
Void
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal 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 Allocated tips
d Control number
9 Verification code
10 Dependent care benefits
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
d
e
f Employee’s address and ZIP code
15
Employer’s state ID number
16
17 State income tax
18
19
20
State wages, tips, etc.
Local wages, tips, etc.
Local income tax
Locality name
State
W-2
2017
Department of the Treasury—Internal Revenue Service
Wage and Tax Statement
For Privacy Act and Paperwork Reduction
Form
Act Notice, see the separate instructions.
Copy A For Social Security Administration — Send this entire page with
Form W-3 to the Social Security Administration; photocopies are not acceptable.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page

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Parent category: Financial