Forest Inst
Resume:
**** ********** ** *** ******** ~ Internal Revenue Service 2020 Department of the Treasury ~ Internal Revenue Service Form W-2 Wage and Tax Statement 2020 Department of the Treasury ~ Internal Revenue Service 2020 Department of the Treasury ~ Internal Revenue Service 173.42
Copy B--To Be Filed With Employee's FEDERAL Tax Return OMB No. 1545-0008 ***-**-****
b. Employer ID number (EIN)
82-4201388
2870.64
1. Wages, tips, other compensation
2870.64
3. Social security wages
177.98
4. Social security tax withheld
2870.64
5. Medicare wages and tips
41.62
6. Medicare tax withheld
EJBR Investments, LLC
106 Oak Way Lane
Lafayette, LA 70506
c. Employer's name, address, and ZIP code
JOENISHA CLARK
2001 S SHERWOOD FOREST BLVD
Baton Rouge, LA 70816
e. Employee's name, address, and ZIP code
1100E-12167
d. Control number
7. Social security tips 8. Allocated tips 9.
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12
13. Statutory employee
12b. Code
Retirement plan
12c. Code
Third-party sick pay
12d. Code
LA
15. State Employer's state ID number
16. State wages, tips, etc.
2870.64
17.State income tax
61.46
18. Local wages, tips, etc. 19. Local income tax 20. Locality name a. Employee's social security number
This information is being furnished to the Internal Revenue Service. 2. Federal income tax withheld
14. Other
Form W-2 Wage and Tax Statement
Form W-2 Wage and Tax Statement Form W-2 Wage and Tax Statement 173.42
Copy 2--To Be Filed With Employee's State, City,
or Local Income Tax Return
***-**-****
b. Employer ID number (EIN)
82-4201388
2870.64
1. Wages, tips, other compensation 2. Federal income tax withheld 2870.64
3. Social security wages
177.98
4. Social security tax withheld
2870.64
5. Medicare wages and tips
41.62
6. Medicare tax withheld
c. Employer's name, address, and ZIP code
e. Employee's name, address, and ZIP code
1100E-12167
d. Control number
7. Social security tips 8. Allocated tips 9.
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12
13. Statutory employee 14. Other
12b. Code
Retirement plan
12c. Code
Third-party sick pay
12d. Code
LA
15. State Employer's state ID number
16. State wages, tips, etc.
2870.64
17.State income tax
61.46
18. Local wages, tips, etc. 19. Local income tax 20. Locality name a. Employee's social security number
EJBR Investments, LLC
106 Oak Way Lane
Lafayette, LA 70506
JOENISHA CLARK
2001 S SHERWOOD FOREST BLVD
Baton Rouge, LA 70816
OMB No. 1545-0008
173.42
Copy C--For EMPLOYEE'S RECORDS(See Notice to Employee.) ***-**-****
b. Employer ID number (EIN)
82-4201388
2870.64
1. Wages, tips, other compensation 2. Federal income tax withheld 2870.64
3. Social security wages
177.98
4. Social security tax withheld
2870.64
5. Medicare wages and tips
41.62
6. Medicare tax withheld
c. Employer's name, address, and ZIP code
e. Employee's name, address, and ZIP code
1100E-12167
d. Control number
7. Social security tips 8. Allocated tips 9.
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12
13. Statutory employee 14. Other
12b. Code
Retirement plan
12c. Code
Third-party sick pay
12d. Code
LA
15. State Employer's state ID number
16. State wages, tips,
etc. 2870.64
17.State income tax
61.46
18. Local wages, tips, etc. 19. Local income tax 20. Locality name a. Employee's social security number
EJBR Investments, LLC
106 Oak Way Lane
Lafayette, LA 70506
JOENISHA CLARK
2001 S SHERWOOD FOREST BLVD
Baton Rouge, LA 70816
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.
OMB No. 1545-0008
173.42
Copy 2--To Be Filed With Employee's State, City,
or Local Income Tax Return
***-**-****
b. Employer ID number (EIN)
82-4201388
2870.64
1. Wages, tips, other compensation 2. Federal income tax withheld 2870.64
3. Social security wages
177.98
4. Social security tax withheld
2870.64
5. Medicare wages and tips
41.62
6. Medicare tax withheld
c. Employer's name, address, and ZIP code
e. Employee's name, address, and ZIP code
1100E-12167
d. Control number
7. Social security tips 8. Allocated tips 9.
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12
13. Statutory employee 14. Other
12b. Code
Retirement plan
12c. Code
Third-party sick pay
12d. Code
LA
15. State Employer's state ID number
16. State wages, tips,
etc. 2870.64
17.State income tax
61.46
18. Local wages, tips, etc. 19. Local income tax 20. Locality name a. Employee's social security number
EJBR Investments, LLC
106 Oak Way Lane
Lafayette, LA 70506
JOENISHA CLARK
2001 S SHERWOOD FOREST BLVD
Baton Rouge, LA 70816
OMB No. 1545-0008
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