Form W-* Wage and Tax Statement

Employer's name, address, and ZIP code

Employee's name, address, and ZIP code

Social security tips Wages, tips, other compensation Federal income tax withheld Allocated tips

Dependent care benefits

Social security wages

Medicare wages and tips

Nonqualified plans

Social security tax withheld

Medicare tax withheld

See instructions for box 12

Suff. Statutory Other

employee

Retirement

Plan

Third-party

Sick pay

State Employer's state ID no. State wages, tips, etc. State income tax Local wages, tips, etc. Local income tax Locality name Employer identification number (EIN)

Employee's social security number

C

o

d

e

C

o

d

e

C

o

d

e

C

o

d

e

Copy B To Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service. OMB No. 1545-0008 Visit the IRS Web Site at www.irs.gov/efile

.

Dept of the Treasury - IRS

2019 7 1 2

8

9

3

5

4

6

10 11

13 14

12a

12b

12c

12d

**-**-**-**-**-**

b

a

c

e

Form W-2 Wage and Tax Statement

Employer's name, address, and ZIP code

Employee's name, address, and ZIP code

Social security tips Wages, tips, other compensation Federal income tax withheld Allocated tips

Dependent care benefits

Social security wages

Medicare wages and tips

Nonqualified plans

Social security tax withheld

Medicare tax withheld

See instructions for box 12

Suff. Statutory Other

employee

Retirement

Plan

Third-party

Sick pay

Employer identification number (EIN)

Employee's social security number

C

o

d

e

C

o

d

e

C

o

d

e

C

o

d

e

2019 7 1 2

8

9

3

5

4

6

10 11

13 14

12a

12b

12c

12d

b

a

c

e

Dept of the Treasury - IRS

State Employer's state ID no. State wages, tips, etc. State income tax Local wages, tips, etc. Local income tax Locality name Copy C For EMPLOYEE'S RECORDS OMB No. 1545-0008

**-**-**-**-**-**

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

Employer's name, address, and ZIP code

Employee's name, address, and ZIP code

Social security tips Wages, tips, other compensation Federal income tax withheld Allocated tips

Dependent care benefits

Social security wages

Medicare wages and tips

Nonqualified plans

Social security tax withheld

Medicare tax withheld

See instructions for box 12

Suff. Statutory Other

employee

Retirement

Plan

Third-party

Sick pay

Employer identification number (EIN)

Employee's social security number

C

o

d

e

C

o

d

e

C

o

d

e

C

o

d

e

2019 7 1 2

8

9

3

5

4

6

10 11

13 14

12a

12b

12c

12d

b

a

c

e

OMB No. 1545-0008 Dept of the Treasury - IRS

State Employer's state ID no. State wages, tips, etc. State income tax Local wages, tips, etc. Local income tax Locality name Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return **-**-**-**-**-**

Allocated tips

Form W-2 Wage and Tax Statement

Employer's name, address, and ZIP code

Employee's name, address, and ZIP code

Social security tips Wages, tips, other compensation Federal income tax withheld Dependent care benefits

Social security wages

Medicare wages and tips

Nonqualified plans

Social security tax withheld

Medicare tax withheld

See instructions for box 12

Suff. Statutory Other

employee

Retirement

Plan

Third-party

Sick pay

Employer identification number (EIN)

Employee's social security number

C

o

d

e

C

o

d

e

C

o

d

e

C

o

d

e

2019 7 1 2

8

9

3

5

4

6

10 11

13 14

12a

12b

12c

12d

b

a

c

e

15

OMB No. 1545-0008 Dept of the Treasury - IRS

State Employer's state ID no. 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax Locality name 20

Universal Protection Service, LLC

161 Washington Street, Suite 600

Eight Tower Bridge

Conshohocken PA 19428

vernell robinson

380 east dison

memphis TN 38106

837862

4,212.09

4,212.09

153.77

261.14

4,212.09 61.08

DD 220.56

INSUR 293.04

560515447

***-**-****

jr

161 Washington Street, Suite 600

Eight Tower Bridge

Conshohocken PA 19428

Universal Protection Service, LLC

vernell robinson

380 east dison

memphis TN 38106

837862

4,212.09

4,212.09

153.77

261.14

4,212.09 61.08

DD 220.56

INSUR 293.04

560515447

***-**-****

jr

Universal Protection Service, LLC

161 Washington Street, Suite 600

Eight Tower Bridge

Conshohocken PA 19428

vernell robinson

380 east dison

memphis TN 38106

837862

4,212.09

4,212.09

153.77

261.14

4,212.09 61.08

DD 220.56

INSUR 293.04

560515447

***-**-****

jr

Universal Protection Service, LLC

161 Washington Street, Suite 600

Eight Tower Bridge

Conshohocken PA 19428

vernell robinson

380 east dison

memphis TN 38106

837862

4,212.09

4,212.09

153.77

261.14

4,212.09 61.08

DD 220.56

INSUR 293.04

560515447

***-**-****

jr

www.irs.gov/efile

.

Visit the IRS Web Site at

Copy 2 To Be Filed With Employee's State, City, or Local Income Tax

Contact this candidate