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Employer:
| |
Employer Identification Number (EIN):
00-6603889 |
SAMPLE PAYER 1 | |
3242 CEDAR AVE | |
KANSAS CITY, MO 64112 | |
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Employee:
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Employee's Social Security Number:
707-00-8679 |
BRIAN TAYLOR | |
8721 Flint Falls Dr | |
DALLAS, TX 75243 | |
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Submission Type: | Original document |
Wages, Tips and Other Compensation: | $152,965.00 |
Federal Income Tax Withheld: | $19,145.00 |
Social Security Wages: | $132,900.00 |
Social Security Tax Withheld: | $8,239.00 |
Medicare Wages and Tips: | $152,965.00 |
Medicare Tax Withheld: | $2,218.00 |
Social Security Tips: | $0.00 |
Allocated Tips: | $0.00 |
Dependent Care Benefits: | $0.00 |
Deferred Compensation: | $0.00 |
Code "Q" Nontaxable Combat Pay: | $0.00 |
Code "W" Employer Contributions to a Health Savings Account: | $0.00 |
Code "Y" Deferrals under a section 409A nonqualified Deferred Compensation plan: | $0.00 |
Code "Z" Income under section 409A on a nonqualified Deferred Compensation plan: | $0.00 |
Code "R" Employer's Contribution to MSA: | $0.00 |
Code "S" Employer's Contribution to Simple Account: | $0.00 |
Code "T" Expenses Incurred for Qualified Adoptions: | $0.00 |
Code "V" Income from exercise of non-statutory stock options: | $0.00 |
Code "AA" Designated Roth Contributions under a Section 401(k) Plan: | $0.00 |
Code "BB" Designated Roth Contributions under a Section 403(b) Plan: | $0.00 |
Code "DD" Cost of Employer-Sponsored Health Coverage: | $0.00 |
Code "EE" Designated ROTH Contributions Under a Governmental Section 457(b) Plan: | $0.00 |
Code "FF" Permitted benefits under a qualified small employer health reimbursement arrangement: | $0.00 |
Code "GG" Income from Qualified Equity Grants Under Section 83(i): | $0.00 |
Code "HH" Aggregate Deferrals Under Section 83(i) Elections as of the Close of the Calendar Year: | $0.00 |
Third Party Sick Pay Indicator: | Unanswered |
Retirement Plan Indicator: | Unanswered |
Statutory Employee: | Not Statutory Employee |
W2 Submission Type: | Original |
W2 WHC SSN Validation Code: | Correct SSN |
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Payer:
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Payer's Federal Identification Number (FIN):
00-2123161 |
SAMPLE PAYER 2 | |
8058 FOURTH ST | |
AKRON, OH 44223 | |
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Recipient:
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Recipient's Identification Number:
707-00-8679 |
BRIAN TAYLOR | |
8721 Flint Falls Dr | |
DALLAS, TX 75243 | |
| |
Submission Type: | Original document |
Account Number (Optional): | 999999999 |
Interest: | $0.00 |
Tax Withheld: | $0.00 |
Savings Bonds: | $0.00 |
Investment Expense: | $0.00 |
Interest Forfeiture: | $0.00 |
Foreign Tax Paid: | $0.00 |
Tax-Exempt Interest: | $0.00 |
Specified Private Activity Bond Interest: | $0.00 |
Market Discount: | $0.00 |
Bond Premium: | $0.00 |
Bond Premium on Tax Exempt Bond: | $0.00 |
Bond Premium on Treasury Obligations: | $0.00 |
Second Notice Indicator: | No Second Notice |
Foreign Country or US Possession: | |
CUSIP Number: | |
FATCA Filing Requirement: | Box not checked no Filing Requirement |