Department of the Treasury -- Internal Revenue Service
d Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld 39194 48734.22 4314.43
OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld 52059.41 3227.68
5 Medicare wages and tips 6 Medicare tax withheld
52059.41 754.86
c Employer's name, address and ZIP code
STATE OF WEST VIRGINIA
1900 KANAWHA BLVD EAST
CHARLESTON WV 25305
7 Social security tips 8 Allocated tips 9
0.00 0.00
10 Dependent care benefits 11 Nonqualified plans C o
d
e
12a
G
See instructions for box 12
0.00 0.00 260.00
C
o
d
e
12b
DD
C
o
d
e
12c
C
o
d
e
12d
6242.00
b Employer identification number (EIN) a Employee's social security number 472045326 ***-**-****
13 Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
X
RETIREMENT 3065.19
e Employee's name, address and ZIP code This information is being furnished to the Internal
Revenue Services. 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.
JOSEPH A WILLIS
PO BOX 483
CEDAR GROVE WV 25039
Form
W-2
15 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.22
0.00
Wage and Tax
Statement
17 State income tax 18 Local wages, tips, etc.
1784.87 0.00
2023 19 Local 0.00 income tax 20 Locality name 0.00 0.00
Copy C-For EMPLOYEE'S RECORDS
(See Notice to Employee on the back of
Copy B)
0.00
Department of the Treasury -- Internal Revenue Service d Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld 39194 48734.22 4314.43
OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld 52059.41 3227.68
5 Medicare wages and tips 6 Medicare tax withheld
52059.41 754.86
c Employer's name, address and ZIP code
STATE OF WEST VIRGINIA
1900 KANAWHA BLVD EAST
CHARLESTON WV 25305
7 Social security tips 8 Allocated tips 9
0.00 0.00
10 Dependent care benefits 11 Nonqualified plans C o
d
e
12a
0.00 0.00 G 260.00
C
o
d
e
12b
DD
C
o
d
e
12c
C
o
d
e
12d
6242.00
b Employer identification number (EIN) a Employee's social security number 472045326 ***-**-****
13 Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
X
RETIREMENT 3065.19
e Employee's name, address and ZIP code
JOSEPH A WILLIS
PO BOX 483
CEDAR GROVE WV 25039
Form
W-2
15 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.22
0.00
Wage and Tax
Statement
17 State income tax 18 Local wages, tips, etc.
1784.87 0.00
2023 19 0.Local 00 income tax 20 Locality name 0.00 0.00
Copy 2-To Be Filed With Employee's
State, City, or Local Income Tax Return. 0.00
Department of the Treasury -- Internal Revenue Service d Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld 39194 48734.22 4314.43
OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld 52059.41 3227.68
5 Medicare wages and tips 6 Medicare tax withheld
52059.41 754.86
c Employer's name, address and ZIP code
STATE OF WEST VIRGINIA
1900 KANAWHA BLVD EAST
CHARLESTON WV 25305
7 Social security tips 8 Allocated tips 9
0.00 0.00
10 Dependent care benefits 11 Nonqualified plans C o
d
e
12a
G
See instructions for box 12
0.00 0.00 260.00
C
o
d
e
12b
DD
C
o
d
e
12c
C
o
d
e
12d
6242.00
b Employer identification number (EIN) a Employee's social security number 472045326 ***-**-****
13 Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
X
RETIREMENT 3065.19
e Employee's name, address and ZIP code
JOSEPH A WILLIS
PO BOX 483
CEDAR GROVE WV 25039
Form
W-2
15 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.22
0.00
Wage and Tax
Statement
17 State income tax 18 Local wages, tips, etc.
1784.87 0.00
2023 19 Local 0.00 income tax 20 Locality 0.name 00 0.00
Copy B-To Be Filed With Employee's
FEDERAL Tax Return . This information
is being furnished to the Internal Revenue
Service.
0.00
Department of the Treasury -- Internal Revenue Service d Control number 1 Wages, tips, other compensation 2 Federal Income tax withheld 39194 48734.22 4314.43
OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld 52059.41 3227.68
5 Medicare wages and tips 6 Medicare tax withheld
52059.41 754.86
c Employer's name, address and ZIP code
STATE OF WEST VIRGINIA
1900 KANAWHA BLVD EAST
CHARLESTON WV 25305
7 Social security tips 8 Allocated tips 9
0.00 0.00
10 Dependent care benefits 11 Nonqualified plans C o
d
e
12a
0.00 0.00 G 260.00
C
o
d
e
12b
DD
C
o
d
e
12c
C
o
d
e
12d
6242.00
b Employer identification number (EIN) a Employee's social security number 472045326 ***-**-****
13 Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
X
RETIREMENT 3065.19
e Employee's name, address and ZIP code
JOSEPH A WILLIS
PO BOX 483
CEDAR GROVE WV 25039
W-Form 2
15 State Employer's state ID number 16 State wages, tips, etc. WV 23057468 48734.22
0.00
Wage and Tax
Statement
17 State income tax 18 Local wages, tips, etc.
1784.87 0.00
2023 19 0.Local 00 income tax 20 Locality 0.name 00 Copy 2-To Be Filed With Employee's 0.00
State, City, or Local Income Tax Return. 0.00
Notice to Employee
Do you have to file?Refer to the Form 1040
instructions to determine if you are required to file a tax return. Even if you don’t have to file a tax return, you may be eligible for a refund if box 2 shows an amount or if you are eligible for any credit.
Earned income credit (EIC). You may be able to
take the EIC for 2023 if your adjusted gross income
(AGI) is less than a certain amount. The amount of the credit is based on income and family size.
Workers without children could qualify for a smaller credit. You and any qualifying children must have
valid social security numbers (SSNs). You can’t
take the EIC if your investment income is more than the specified amount for 2023 or if income is
earned for services provided while you were an
inmate at a penal institution. For 2023 income limits and more information, visit www.irs.gov/EITC. See
also Pub. 596, Earned Income Credit. Any EIC that
is more than your tax liability is refunded to
you, but only if you file a tax return.
Employee’s social security number (SSN). For
your protection, this form may show only the last
four digits of your SSN. However, your employer
has reported your complete SSN to the IRS and the
Social Security Administration (SSA).
Clergy and religious workers. If you aren’t
subject to social security and Medicare taxes, see Pub. 517.
Corrections. If your name, SSN, or address is
incorrect, correct Copies B, C, and 2 and ask your employer to correct your employment record. Be
sure to ask the employer to file Form W-2c,
Corrected Wage and Tax Statement, with the SSA
to correct any name, SSN, or money amount error
reported to the SSA on Form W-2. Be sure to get
your copies of Form W-2c from your employer for
all corrections made so you may file them with your tax return. If your name and SSN are correct but
aren’t the same as shown on your social security
card, you should ask for a new card that displays
your correct name at any SSA office or by calling
800-***-****. You may also visit the SSA website
at www.SSA.gov.
Cost of employer-sponsored health coverage
(if such cost is provided by the employer). The
reporting in Box 12, using Code DD, of the cost of employer-sponsored health coverage is for your
information only. The amount reported with Code
DD is not taxable.
Credit for excess taxes. If you had more than one
employer in 2023 and more than $9,932.40 in
social security and/or Tier 1 railroad retirement
(RRTA) taxes were withheld, you may be able to
claim a credit for the excess against your federal income tax. See the Form 1040 instructions. If you had more than one railroad employer and more
than $5,821.20 in Tier 2 RRTA tax was withheld,
you may be able to claim a refund on Form 843.
See the Instructions for Form 843.
(See also Instructions for Employee on the back of Copy C.)
Instructions for Employee
(See also Notice to Employee on the back of Copy B.) Box 1. Enter this amount on the wages line of your tax return.
Box 2. Enter this amount on the federal income tax withheld line of your tax return.
Box 5.You may be required to report this amount on Form 8959. See the Form 1040 instructions to determine if you are required to complete Form 8959.
Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare wages and tips shown in box 5, as well as the 0.9% Additional Medicare Tax on any of those Medicare wages and tips above $200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on your tax return, see the Form 1040 instructions.
You must file Form 4137 with your income tax return to report at least the allocated tip amount unless you can prove with adequate records that you received a smaller amount. If you have records that show the actual amount of tips you received, report that amount even if it is more or less than the allocated tips. Use Form 4137 to figure the social security and Medicare tax owed on tips you didn’t report to your employer. Enter this amount on the wages line of your tax return. By filing Form 4137, your social security tips will be credited to your social security record (used to figure your benefits).
Box 10. This amount includes the total dependent care benefits that your employer paid to you or incurred on your behalf (including amounts from a section 125
(cafeteria) plan). Any amount over your employer’s plan limit is also included in box 1. See Form 2441.
Box 11.This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified deferred compensation or nongovernmental section 457(b) plan, or (b) included in box 3 and/or box 5 if it is a prior year deferral under a nonqualified or section 457(b) plan that became taxable for social security and Medicare taxes this year because there is no longer a substantial risk of forfeiture of your right to the deferred amount. This box shouldn’t be used if you had a deferral and a distribution in the same calendar year. If you made a deferral and received a distribution in the same calendar year, and you are or will be age 62 by the end of the calendar year, your employer should file Form SSA-131, Employer
Report of Special Wage Payments, with the Social
Security Administration and give you a copy.
Box 12. The following list explains the codes shown in box 12. You may need this information to complete your tax return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE) under all plans are generally limited to a total of $22,500
($15,500 if you only have SIMPLE plans; $25,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals under code G are limited to $22,500. Deferrals under code H are limited to
$7,000. (Instructions for Employee continued on the back of Copy C.)
Instructions for Employee
(continued from back of Copy B)
However, if you were at least age 50 in 2023, your employer may have allowed an additional deferral of up to $7,500 ($3,500 for section 401(k)(11) and
408(p) SIMPLE plans). This additional deferral
amount is not subject to the overall limit on elective deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years before you reach retirement age. Contact your plan administrator for more information. Amounts in excess of the overall elective deferral limit must be included in income. See the Form 1040 instructions.
Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension
contribution for a prior year(s) when you were in
military service. To figure whether you made excess deferrals, consider these amounts for the year
shown, not the current year. If no year is shown, the contributions are for the current year.
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040 or 1040-SR. See the
Form 1040 instructions.
B—Uncollected Medicare tax on tips. Include this
tax on Form 1040 or 1040-SR. See the Form 1040
instructions.
C—Taxable cost of group-term life insurance over
$50,000 (included in boxes 1, 3 (up to the social
security wage base), and 5)
D—Elective deferrals to a section 401(k) cash or
deferred arrangement. Also includes deferrals under a SIMPLE retirement account that is part of a
section 401(k) arrangement.
E—Elective deferrals under a section 403(b) salary reduction agreement
F—Elective deferrals under a section 408(k)(6)
salary reduction SEP
G—Elective deferrals and employer contributions
(including nonelective deferrals) to a section 457(b) deferred compensation plan
H—Elective deferrals to a section 501(c)(18)(D) tax- exempt organization plan. See the Form 1040
instructions for how to deduct.
J—Nontaxable sick pay (information only, not
included in boxes 1, 3, or 5)
K—20% excise tax on excess golden parachute
payments. See the Form 1040 instructions.
L—Substantiated employee business expense
reimbursements (nontaxable)
M—Uncollected social security or RRTA tax on
taxable cost of group-term life insurance over
$50,000 (former employees only). See the Form
1040 instructions.
N—Uncollected Medicare tax on taxable cost of
group-term life insurance over $50,000 (former
employees only). See the Form 1040 instructions.
P—Excludable moving expense reimbursements
paid directly to a member of the U.S. Armed
Forces (not included in box 1, 3, or 5)
Q—Nontaxable combat pay. See the Form 1040
instructions for details on reporting this amount. R—Employer contributions to your Archer MSA.
Report on Form 8853, Archer MSAs and Long-
Term Care Insurance Contracts.
S—Employee salary reduction contributions under
a section 408(p) SIMPLE plan (not included in box
1)
T—Adoption benefits (not included in box 1).
Complete Form 8839, Qualified Adoption
Expenses, to figure any taxable and nontaxable
amounts.
V—Income from exercise of nonstatutory stock
option(s) (included in boxes 1, 3 (up to the social security wage base), and 5). See Pub. 525,
Taxable and Nontaxable Income, for reporting
requirements.
W—Employer contributions (including amounts
the employee elected to contribute using a section 125 (cafeteria) plan) to your health savings
account. Report on Form 8889, Health Savings
Accounts (HSAs).
Y—Deferrals under a section 409A nonqualified
deferred compensation plan
Z—Income under a nonqualified deferred
compensation plan that fails to satisfy section
409A. This amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Form 1040 instructions.
AA—Designated Roth contributions under a
section 401(k) plan
BB—Designated Roth contributions under a
section 403(b) plan
DD—Cost of employer-sponsored health
coverage. The amount reported with Code DD
is not taxable.
EE—Designated Roth contributions under a
governmental section 457(b) plan. This amount
does not apply to contributions under a tax-
exempt organization section 457(b) plan.
FF—Permitted benefits under a qualified small
employer health reimbursement arrangement
GG—Income from qualified equity grants under
section 83(i)
HH—Aggregate deferrals under section 83(i)
elections as of the close of the calendar year
Box 13. If the “Retirement plan” box is checked,
special limits may apply to the amount of
traditional IRA contributions you may deduct. See
Pub. 590-A, Contributions to Individual Retirement Arrangements (IRAs).
Box 14. Employers may use this box to report
information such as state disability insurance
taxes withheld, union dues, uniform payments,
health insurance premiums deducted, nontaxable
income, educational assistance payments, or a
member of the clergy’s parsonage allowance and
utilities. Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1
tax, Tier 2 tax, Medicare tax, and Additional
Medicare Tax. Include tips reported by the
employee to the employer in railroad retirement
(RRTA) compensation.
Note. Keep Copy C of Form W-2 for at least 3
years after the due date for filing your income tax return. However, to help protect your social
security benefits, keep Copy C until you begin
receiving social security benefits, just in case
there is a question about your work record and/or
earnings in a particular year.
Employer's Name, Address and ZIP Code
STATE OF WEST VIRGINIA
1900 KANAWHA BLVD EAST
CHARLESTON WV 25305
Employee's Name, Address and ZIP Code
JOSEPH A WILLIS
PO BOX 483
CEDAR GROVE WV 25039