b'PRE-PRINTED AND BLANK W2 FORMSINDIVIDUAL 2-UP LASER PACKSXXXaEmployees social security number For Ofcial Use OnlyAPEX LW2AAPEX LW2BL 22222 VOID OMB No. 1545-0008 b 1 Wages, tips, other compensation 2 Federal income tax withheld TFP 5201 TFP 5222cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld5 Medicare wages and tips 6 Medicare tax withheld7 Social security tips 8 Allocated tips Front BlankdControl number 910 e Last name Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C ddooe e APEX LW2Bwith W2 Instructions 13 employee plan sick pay 12b14Other 12c C doe on back side.fEmployees address and ZIP code b 16State wages, tips, etc. aEmployees social security number 12d C doe Safe, accurate,20Locality name Visit the IRS website atTFP 520215StateEmployers state ID number 17State income tax OMB No. 1545-0008 FAST! Use www.irs.gov/eleAPEX 18Local wages, tips, etc.19Local income tax 2 Federal income tax withheld1 Wages, tips, other compensationcEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld LW2NB 5 Medicare wages and tips 6 Medicare tax withheldForm W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service8 Allocated tips APEX 7 Social security tipsFor Privacy Act and Paperwork Reduction Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Act Notice, see the separate instructions.10 Form W-3 to the Social Security Administration; photocopies areaEmployees social security number9 OMB No. 1545-0008 C doe This information is being furnished to the Internal Revenue Service. If youTFP 5207dControl numberDo Not Cut, Fold, or Staple Forms on This Page Suff.11StatutoryRetirementThird-partyC doe may be imposed on you if this income is taxable and you fail to report it. LW2CLW22 eEmployees name, address, and ZIP codeb 1 Wages, tips, other compensation 2 Federal income tax withheld12aSee instructions for box 1222222 VOID aEmployees social security numbercEmployers name, address, and ZIP code 13 employee plan sick pay 3 Social security wages 4 Social security tax withheld 12bFor Ofcial Use Onlyb OMB No. 1545-000814Other 5 Medicare wages and tips C doe 6 Medicare tax withheldcEmployers name, address, and ZIP code 1 Wages, tips, other compensation 2 Federal income tax withheld 12c C doe 8 Allocated tips TFP 52033 Social security wages 4 Social security tax withheld 7 Social security tips12d15State dControl number16State wages, tips, etc. 10 5 Medicare wages and tips17State income tax6 Medicare tax withheld18Local wages, tips, etc.919Local income tax 20Locality nameEmployers state ID numbereEmployees name, address, and ZIP code7 Social security tips 8 Allocated tips Suff.11StatutoryRetirementThird-party12a C C ddooe e See instructions for box 12 APEXaEmployees social security number OMB No. 1545-0008 Safe, accurate,Visit the IRS website atAPEX LW2BCdControl number 922222 VOID1013 employee plan sick pay 12b FAST! Use www.irs.gov/ele aEmployees social security numbere Form W-2 Wage and Tax Statement Statutoryb Retirement2021 C C dooe e Department of the TreasuryInternal Revenue ServiceOMB No. 1545-0008C C ddooe e 2 Federal income tax withheld LW2D1b 1 Wages, tips, other compensation 2 Federal income tax withheldCopy BTo Be Filed With Employees FEDERAL Tax Return.12aSee instructions for box 1214Other 1 Wages, tips, other compensationLast name Suff.1112cThis information is being furnished to the Internal Revenue Service. Third-party12b d312d 4 Social security tax withheld cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld TFP 521213 employee cEmployers name, address, and ZIP code Social security wagesplan sick pay15State 14Other 16State wages, tips, etc. C C ddooe e 17State income tax 18Local wages, tips, etc.19Medicare wages and tips 8 Allocated tips TFP 5204 dControl number 5 Medicare wages and tips 6 Medicare tax withheldEmployers state ID number 12c 5Local income tax 20Locality name6 Medicare tax withheld12d Safe, accurate,Visit the IRS website at 7 Social security tips 7 Social security tips 8 Allocated tipsfEmployees address and ZIP code b 16State wages, tips, etc. aEmployees social security numberdControl numberOMB No. 1545-0008 FAST! Use 20Locality name www.irs.gov/ele910C ddooe e See instructions for box 12 eEmployees name, address, and ZIP code Suff. 13 9 StatutoryRetirementThird-party10C C ddooe e15StateEmployers state ID number cEmployers name, address, and ZIP codeForm W-2 Wage and Tax Statement 1 Wages, tips, other compensation 2 Federal income tax withheld 12a C 1112aSee instructions for box 1217State income tax 18Local wages, tips, etc. 2021 Department of the TreasuryInternal Revenue Service19Local income tax 11 eEmployees name, address, and ZIP code3 Social security wages 4 Social security tax withheldSuff.Safe, accurate, FAST!Use13StatutoryRetirementThird-party12b employee plan sick pay 12bCopy CFor EMPLOYEES RECORDS (See or Cop Taxy 2 Notice toed With 6 Medicare tax withheld employee plan sick payEmployee on the back of Copy B.) to be FilEmployees State, City or Local IncomeReturn 5 Medicare wages and tipsForm W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service8 Allocated tips 14Other 12c C doe 14Other 12c C doe7 Social security tipsFor Privacy Act and Paperwork Reduction Copy AFor Social Security Administration. Send this entire page with not acceptable. LW2AAct Notice, see the separate instructions. 52011012d C doe LW2BL 5222 12d C doeForm W-3 to the Social Security Administration; photocopies are41-0852411aEmployees social security number9 This information is being furnished to the Internal Revenue Service. If you dControl numberSuff.11OMB No. 1545-0008 C doe may be imposed on you if this income is taxable and you fail to report it. 20Locality name 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality nameeEmployees name, address, and ZIP codeb 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 2 Federal income tax withheld 19Local income tax12aSee instructions for box 121 Wages, tips, other compensation 18Local wages, tips, etc.cEmployers name, address, and ZIP code 13StatutoryRetirementThird-party12b C doe 4 Social security tax withheldemployee plan sick pay 3 Social security wages12c14Other 5 Medicare wages and tips 6 Medicare tax withheldDepartment of the TreasuryInternal Revenue Service Form W-2 Wage and Tax Statement 12d C C ddooe e 2021 For Privacy Act and Paperwork ReductionForm W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue ServiceCopy DFoEmployer.City, 7 Social security tips 8 Allocated tips Act Notice, see separate instructions. Copy BTo Be Filed With Employees FEDERAL Tax Return. dControl number Copy 1Forr State, orLocalTaxDepartment 9 10This information is being furnished to the Internal Revenue Service.15StateEmployers state ID numbereEmployees name, address, and ZIP code16State wages, tips, etc.17State income tax 18Local wages, tips, etc.Suff.1119Local income tax 20Locality name C doe See instructions for box 1212aStatutoryRetirementThird-party Wage and Tax Statement b 22222 VOID aEmployees social security number13 employee plan sick pay 12b C C ddooe e 2 Federal income tax withheld33333 a Control number DO NOT STAPLE b aEmployees social security number OMB No. 1545-0008 This information is being furnished to the Internal Revenue Service. If you Form W-2 2021 Department of the TreasuryInternal Revenue Service For Ofcial Use Onlymay be imposed on you if this income is taxable and you fail to report it.14Other OMB No. 1545-0008 12c 1 Wages, tips, other compensation 2 Federal income tax withheld1 Wages, tips, other compensation OMB No. 1545-0008Copy BTo Be Filed With Employees FEDERAL Tax Return.LW2B 3 5202 C doe 4 Social security tax withheld b Kind 941 Military 943 944 KindNone apply 501c non-govt. Third-party cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheldThis information is being furnished to the Internal Revenue Service. 12d sick pay cEmployers name, address, and ZIP code Social security wages5 Medicare wages and tips of CT-1 Hshld.govt. emp. of State/localState/local 501cFederal govt. applicable)5 Medicare wages and tips 6 Medicare tax withheldLocal income tax 20Locality name6 Medicare tax withheld Payeremp. MedicareEmployernon-501c (Check if 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Social security tips 8 Allocated tips (Check one) d Establishment number (Check one) 2 Federal income tax withheld LW2NB/LMRNB 5207 7 Social security tips 8 Allocated tips7c Total number of Forms W-2 1 Wages, tips, other compensationdControl number 9 10e 3 Social security wages 4 Social security tax withheld dControl number 9 10 Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service C doe fEmployers name 5 Medicare wages and tips 6 Medicare tax withheld eEmployees name, address, and ZIP code Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C ddooe eeEmployees name, address, and ZIP code Suff.Safe, accurate,12aSee instructions for box 1211 Copy CFor EMPLOYEES RECORDS (SeeFAST!UseEmployee on the back of Copy B.) or Copy 2Notice toto be Filed With LW2C/LW2213StatutoryRetirementThird-party5203C doe 7 Social security tips 8 Allocated tips 13 employee plan sick pay 12bEmployees State, City or Local Income Tax Return employee plan sick pay 12b14Other 12c C doe 9 1014Other 12c C doe12d C doe g Employers address and ZIP code 1112a Deferred compensation 12d C doeh Other EIN used this year 13 For third-party sick pay use only 12b 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name15 State Employers state ID number 14 Income tax withheld by payer of third-party sick pay16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income taxForm W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue ServiceEmployers contact person Employers telephone number Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue ServiceFor Privacy Act and Paperwork ReductionCopy CFor EMPLOYEES RECORDS (See Notice toSafe, accurate, Copy DForEmployer.City, Act Notice, see separate instructions. Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, andAPEX LW3 Employee on the back of Copy B.)FAST!UseCopy 1ForState, orLocalTaxDepartment LW2D15204 Employers fax number Employers email address Employees State, City or Local Incomeor Cop Taxy 2tReturno be Filed With LW2BC 5212complete.SignatureTitleDate Form W-3 Transmittal of Wage and Tax Statements 2021 Department of the TreasuryTFP 5200Internal Revenue ServiceSend this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA).Photocopies are not acceptable. Do not send Form W-3 if you led electronically with the SSA. Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.ReminderSeparate instructions. See the 2021 General Instructions for Forms W-2 W-3 for Form(s) W-2 that were submitted electronically to the SSA.Purpose of FormApex DWCL or DWCLS paper forms must notcomply with IRS standards and be machine readable. Photocopies are acceptable. Use a Form W-3 even if only one Number (EIN). Make a copy of this form and keep it with Copy D (For Employer) of Form(s) W-2 for your records. The IRS recommends retaining copies of these forms for 4 years. When To File Paper FormsTFP 66661 or 66662 required envelope E-Filing Mail Form W-3 with Copy A of Form(s) W-2 by January 31, 2022.Copy A electronically instead of on paper. The SSA provides two freeWhere To File Paper FormsThe SSA strongly suggests employers report Form W-3 and Forms W-2 Send this entire page with the entire Copy A page of Form(s) W-2 to: W-2 Online. toSocial Security Administration50 Forms W-2 at a time to the SSA. Direct Operations Center File Upload. usingWilkes-Barre, PA 18769-0001Specications for Filing Forms W-2 Electronically (EFW2). the SSAs18769-0002. If you use an IRS-approved private delivery service, addNote: January 31, 2022. For more information, go to www.SSA.gov/bso. First- ATTN: W-2 Process, 1150 E. Mountain Dr. to the address and change Guide, for a list of IRS-approved private delivery services. Employers Tax Register Log In. the ZIP code to 18702-7997. See Pub. 15 (Circular E),For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.LW3 41-0852411 52005 Transmittal W3 forms are included with each Red Federal Copy A form orderAPEX Sheets per packTFP Forms per pack50s500s100s1000sFORM DESCRIPTION ( 10 or 25 forms (500 forms LW3 LW35005200per package) 5200Bper package) Laser W3 Transmittal Of Income And Tax StatementLW2ALW2A50052015201BLaser W2 IRS Federal Copy A1 Page Equals 2 FormsLW2BLW2B50052025202BLaser W2 Employees IRS Federal Copy B1 Page Equals 2 FormsLW2CLW22LW2CW2250052035203BLaser W2 Employees Copy C and/or State, City Or Local Copy 21 Page Equals 2 formsLW2D1LW2D150052045204BLaser W2 Employers Copy D and/or State, City Or Local Copy 21 page equals 2 formsLW2BLLW2BL50052225222BLaser W2 Blank Face, With W2 Backer Instructions1 Page Equals 2 FormsLW2NBLW2NB50052075207BLaser W2 Blank Face, No Backer1 Page Equals 2 FormsLW2BCLW2BC50052125212BLaser W2 Employees Copies B & C Combined1 Page Equals 1 Form50s500s100s500s FORM DESCRIPTION LW3CN/A5309N/A W3C Transmittal of Corrected Income and Tax StatementLW2CALW2CA50053135313BW2C Corrected Income Fed Copy A1 page equals 1 formLW2CBLW2CB50053145314BW2C Corrected Income Employees Fed Copy B1 page equals 1 formLW2CCLW2CC50053165316BW2C Corrected Income Employees Copy C and/or State, City, Local Copy 21 page equals 1 formLW2C2LW2C250053165316BW2C Corrected Income Employees Copy C and/or State, City, Local Copy 21 page equals 1 formLW2CD1LW2CD150053155315BW2C Corrected Income Employers Copy D and/or State, City, local Copy 11 page equals 1 formWE OFFER W-2 CORRECTION FORMS IN SETS, SEE PAGE 17.12'