W2 Information

Income

Not a valid number! Please round to the nearest dollar.

a Employee's Social Security Number

IRS

b Employer identification Number (EIN)

c Employer name, address, and ZIP code

d Control number

e Employee's first name and initial Last name Suff.

f Employee's address and ZIP code

1 Wages, tips, other compensation

2 Federal income tax withheld

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

10 Department care benefits

11 Nonqualified plans

12a See Instructions for box 12

Code

Amount

Statutory
Employee

Retirement
Plan

Third-party
sick pay

12b

Code

Amount

14 Other

12c

Code

Amount

12d

Code

Amount

15 Employer's state ID number

State

ID number

State

ID number

16 State wages, tips, etc.

17 State income tax

18 Local wages, tips, etc.

19 Local income tax

20 Locality name