Income Tax Retirement Plan
Resume:
* *****,****,***** ************
1187.09
b Employer ID number (EIN)
***-**-****
a Employee's social security
number
38-2099803
OMB No. 1545-0008
20 Locality name
17 State income tax
19 Local income tax
16 State wages, tips, etc.
18 Local wages, tips, etc.
15 State Employer's state ID Number
12d Code
12c Code
14 Other 12b Code
Third-party sick pay
Retirement plan
13 Statutory employee
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 7 Social security tips 8 Allocated tips 9
Derrick D Jones
2716 east loop 820
116
fort worth, TX 76116
e Employee's name, address, and ZIP code
115646
d Control number
Key Personnel
710 Paluxy Rd
Granbury, TX 76048
c Employer's name, address, and ZIP code
17.21
6 Medicare tax withheld
73.59
4 Social security tax withheld
Copy B -- To Be Filed With Employee's
FEDERAL Tax Return.
0.00
2 Federal income tax withheld
This information is being furnished to the Internal Revenue Service Form W-2 Wage and Tax Statement
1187.09
1 Wages,tips,other compensation
1187.09
5 Medicare wages and tips
1187.09
3 Social security wages
75-2464742
b Employer ID number (EIN)
***-**-****
a Employee's social security
number
38-2099803
OMB No. 1545-0008
20 Locality name
17 State income tax
19 Local income tax
16 State wages, tips, etc.
18 Local wages, tips, etc.
15 State Employer's state ID Number
12d Code
12c Code
14 Other 12b Code
Third-party sick pay
Retirement plan
13 Statutory employee
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 7 Social security tips 8 Allocated tips 9
Derrick D Jones
2716 east loop 820
116
fort worth, TX 76116
e Employee's name, address, and ZIP code
115646
d Control number
Key Personnel
710 Paluxy Rd
Granbury, TX 76048
c Employer's name, address, and ZIP code
17.21
6 Medicare tax withheld
73.59
4 Social security tax withheld
Copy 2 -- To Be Filed With Employee's State,
City, or Local Income Tax Return.
0.00
2 Federal income tax withheld
1187.09
1 Wages,tips,other compensation
1187.09
5 Medicare wages and tips
1187.09
3 Social security wages
75-2464742
b Employer ID number (EIN)
***-**-****
a Employee's social security
number
38-2099803
OMB No. 1545-0008
20 Locality name
17 State income tax
19 Local income tax
16 State wages, tips, etc.
18 Local wages, tips, etc.
15 State Employer's state ID number
12d Code
12c Code
14 Other 12b Code
Third-party sick pay
Retirement plan
13 Statutory employee
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 7 Social security tips 8 Allocated tips 9
Derrick D Jones
2716 east loop 820
116
fort worth, TX 76116
e Employee's name, address, and ZIP code
115646
d Control number
Key Personnel
710 Paluxy Rd
Granbury, TX 76048
c Employer's name, address, and ZIP code
17.21
6 Medicare tax withheld
73.59
4 Social security tax withheld
Copy C -- For EMPLOYEE'S RECORDS (See Notice
to Employee.)
0.00
2 Federal income tax withheld
1187.09
1 Wages,tips,other compensation
1187.09
5 Medicare wages and tips
1187.09
3 Social security wages
75-2464742
b Employer ID number (EIN)
***-**-****
a Employee's social security
number
38-2099803
OMB No. 1545-0008
20 Locality name
17 State income tax
19 Local income tax
16 State wages, tips, etc.
18 Local wages, tips, etc.
15 State Employer's state ID Number
12d Code
12c Code
14 Other 12b Code
Third-party sick pay
Retirement plan
13 Statutory employee
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 7 Social security tips 8 Allocated tips 9
Derrick D Jones
2716 east loop 820
116
fort worth, TX 76116
e Employee's name, address, and ZIP code
115646
d Control number
Key Personnel
710 Paluxy Rd
Granbury, TX 76048
c Employer's name, address, and ZIP code
17.21
6 Medicare tax withheld
73.59
4 Social security tax withheld
Copy 2 -- To Be Filed With Employee's State,
City, or Local Income Tax Return.
0.00
2 Federal income tax withheld
Form W-2 Wage and Tax Statement 2020 Dept. of the Treasury -- IRS 2020 Dept. of the Treasury -- IRS This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it. Form W-2 Wage and Tax Statement 2020 Dept. of the Treasury -- IRS Form W-2 Wage and Tax Statement 2020 Dept. of the Treasury -- IRS
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