Form W-2 Sub - Idaho Substitute W-2 Wage And Tax Statement

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Idaho Substitute W-2
W-2 SUB
20
Wage and Tax Statement
Social security number
1 . Your name
Address
State
Zip
City
Phone number
2.
Employer (business name or owner's name)
Employer's ID number, if known
Address
State
Zip
Phone number, if known
City
3 . Wages, tips, other compensation
Federal income tax withheld
Idaho income tax withheld
Social security tax withheld
$_____________________________
$____________________________
$ ___________________________
$ ______________________________
4.
How did you determine the amounts in 3? You must attach copies of any documents or schedules used to determine this
amount.
5.
Give reason, if known, why a W-2 form was not furnished by employer.
Attach photocopy of payroll check stub(s)or other document(s)
to verify the Idaho withholding amount(s) claimed.
I verify that I have made efforts to contact this employer and have given this employer sufficient time to mail or
otherwise provide this statement.
Date
Your signature
EFO00169
01-27-2006

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