Form W-2 Wage and Tax Statement
Contact Information:
Name:
Email:
Phone:
Employer Identification Number
1 Wages, tips, other comp
2 Federal Income tax withheld
Employer's name and address
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
Control number
9 Advance EIC payment
10 Dependent care benefits
Employees first name, middle initial, last name
11 Nonqualified plans
Employee's address
12a See instructions for box 12
12b
12c
12d
13
Statutory Employee
Retirement Plan
Third-party sick pay
14 Other
15
Employer's state ID #
16
State wages, tips, etc.
17
State Income tax
18
Local wages, tips, etc.
19
Local Income tax
20
Locality name