b"PRE-PRINTED W2 FORM SCOMBINED 4-UP LASERXXXa Copy BTo Be Filed With Employee's 1 241-0852411 a Copy 2To Be Filed With Employee's State, 1 241-0852411 APEX L4UP Form c W-2 Wage and Tax Statement 2021 7Social security tips 1 Wages, tips, other comp. 2Federal income tax withheld APEX L87FEDERAL Tax Return. OMB No. 1545-0008 City, or Local Income Tax Return. Federal income tax withheld Employers name, address, and ZIP code 8Allocated tips 3Social security wages 4Social security tax withheldEmployee's soc. sec. no. Wages, tips, other comp. Federal income tax withheld Employee's soc. sec. no. Wages, tips, other comp. OMB No. 1545-0008b c Employer ID number (EIN) 5 3Social security wages 6 4Social security tax withheld b c Employer ID number (EIN) 5 3Social security wages 6 4Social security tax withheld TFP 5205 eEmployees name, address, and ZIP codeSuff. 10 9 emtaptulotoy S eye r RetirementThird-party 5Medicare wages and tipsC C e e d d o o 6Medicare tax withheld TFP 5206Medicare wages and tips Medicare tax withheld Medicare wages and tips Medicare tax withheld 11 plans 12a See instructions for box 12 Employer's name, address, and ZIP code Employer's name, address, and ZIP code 13 plansickpay 14Other 12bb Employer number (EIN)C e e d d o o 12caEmployees social security no.C 12d dControl number dControl numbereEmployee's name, address, and ZIP code Suff. eEmployee's name, address, and ZIP code Suff.15State Employers state I.D. no. 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality nameCopy B To Be Filed With Employees FEDERAL Tax Return This information is being furnished to the Internal Revenue Service. Dept. of the Treasury - IRSOMB No.1545-008Visit the IRS Web Site atwww.irs.gov/eleThis information is being furnished to the Internal Revenue Service.7Social security tips 8Allocated tips 9 7Social security tips 8Allocated tips 9 7Social security tips 1 negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.Wages, tips, other comp. 2Federal income tax withheld10 11plans 12aCodeSee inst. for box 12 10 11plans 12aCode Form c W-2 Wage and Tax Statement 2021 8Allocated tips 3Social security wages 4Social security tax withheldEmployers name, address, and ZIP code13Statutory employee 14Other 12bCode 13Statutory employee 14Other 12bCode 9 5Medicare wages and tips 6Medicare tax withheld Retirement plan 12cCode Retirement plan 12cCode 10 11 plansC ed o 12a See instructions for box 12 Third-party sick pay 12dCode Third-party sick pay 12dCode eEmployees name, address, and ZIP codeSuff.13e Smtaptulotoyeye r Retirement Third-party 14OtherC e d o 12bplansick payb Employer number (EIN)C ed o 12c16State wages, tips, etc. State income tax Local wages, tips, etc. 16State wages, tips, etc. State income tax aEmployees social security no. 12d 158 1State Employer's state ID number 19Local income tax 20 1Locality name 7 158 1State Employer's state ID number 19Local income tax 20 1Locality name 7C e d oLocal wages, tips, etc.15State Employers state I.D. no. 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality nameForm W-2 Wage and Tax Statement 2021 Dept. of the Treasury IRS Form W-2 Wage and Tax Statement 2021 Dept. of the Treasury IRSThis information is being furnished to the Internal Revenue Service. www.irs.gov/ele Copy C For EMPLOYEE'S RECORDS (See Notice toEmployee on back of Copy B)OMB No.1545-008 Dept. of the Treasury - IRS7Social security tipsCopy CFor EMPLOYEE'S RECORDS (See41-0852411 a Copy 2To Be Filed With Employee's State, 1 241-0852411 Form c W-2 Wage and Tax Statement 2021 8Allocated tips 1 Wages, tips, other comp. 2Federal income tax withhelda Notice to Employee on the back of Copy B.) 1 2 OMB No. 1545-0008 City, or Local Income Tax Return. Federal income tax withheld Employers name, address, and ZIP code 3Social security wages 4Social security tax withheldEmployee's soc. sec. no. Wages, tips, other comp. Federal income tax withheld Employee's soc. sec. no. Wages, tips, other comp. OMB No. 1545-00083Social security wages 4Social security tax withheld bEmployer ID number (EIN) 3Social security wages 4Social security tax withheld 9 5Medicare wages and tips 6Medicare tax withheldbEmployer ID number (EIN) 5Medicare wages and tips 6Medicare tax withheld 5Medicare wages and tips 6Medicare tax withheld 10pay11 plansCC e e d d o o 12acEmployer's name, address, and ZIP code cEmployer's name, address, and ZIP code eEmployees name, address, and ZIP codeSuff.13emtaptulotyoreye S Retirement sick14Other 12bplanThird-partyb Employer number (EIN)C ed o 12caEmployees social security no.C e d o 12d dControl number dControl number15State Employers state I.D. no. 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality nameeEmployee's name, address, and ZIP code Suff. eEmployee's name, address, and ZIP code Suff. Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return OMB No.1545-008 Dept. of the Treasury - IRS7Social security tips 1 Wages, tips, other comp. 2Federal income tax withheld7Social security tips 8Allocated tips 9 7Social security tips 8Allocated tips 9 c Form W-2 Wage and Tax Statement 2021 8Allocated tips 3Social security wages 4Social security tax withheld10 11plans 12aCodeSee inst. for box 12 10 11plans 12aCode Employers name, address, and ZIP code13Statutory employee 14Other 12bCode 13Statutory employee 14Other 12bCode 9 5Medicare wages and tips 6Medicare tax withheldRetirement plan 12cCode Retirement plan 12cCode 10 11 plansC ed o 12aThird-party sick pay 12dCode Third-party sick pay 12dCode eEmployees name, address, and ZIP codeSuff.13e Smtaptulotoyeye r Retirement Third-party 14OtherC e d o 12bplansick pay bEmployer number (EIN) 12c185 1 State Employer's state ID number 19Local income tax 20 1Locality name a 7 State,Local, 1 1 158 State Employer's state ID number 2 19Local income tax 20 1Locality name a 7 State,Local,or File 1 Copy22222 2 2021 1545-0008 APEX L4UPR15State Employers state I.D. no. c 2021 Form aEmployees social security no. 22222Void8Allocated tipsCC e e d d o o 12d1 Wages, tips, other comp. 2Federal income tax withheld APEX L87RLocal wages, tips, etc. 16State wages, tips, etc. State income tax or File Local wages, tips, etc. 16State wages, tips, etc. State income tax OMB No.W-2 Wage and Tax Statement 7Social security tips 20Locality name 4Social security tax withheld Employers Copy22222 2021 1545-0008 Employers Wages, tips, other comp. Federal income tax withheld 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 3Social security wagesOMB No.Employee's soc. sec. no. Wages, tips, other comp. Federal income tax withheld Employee's soc. sec. no. Employers name, address, and ZIP codeForm W-2 Wage and Tax Statement 2021 Dept. of the Treasury IRS 3Social security wages 2021 Dept. of the Treasury IRS 3Social security wages 4Social security tax withheldCopy 2 To Be Filed With Employee's State, City, or Local Income Tax Return L87 OMB No.1545-008 9 5206 Dept.oftheTreasury-IRS 6 Medicare tax withheldpenalty or other sanction may be imposed on you if this income is taxable and you fail to report it. b 5 Form W-2 Wage and Tax Statement4 6 Social security tax withheld bEmployer ID number (EIN) 5205 5Medicare wages and tips 6Medicare tax withheld 10 5Medicare wages and tipsC ed o 12aSee instructions for box 12 c Employer ID number (EIN) L4UP Medicare tax withheld cEmployer's name, address, and ZIP code TFP 5405 eEmployees name, address, and ZIP code Suff.13 e Smtaptluotoyerye P Relatnirement Third-party 11 plansC e d o 12b TFP 5406Medicare wages and tipsEmployer's name, address, and ZIP codeSick pay 14OtherbEmployer number (EIN)C ed d o 12caEmployees social security no.C e o 12d dControl number dControl numbereEmployee's name, address, and ZIP code Suff. eEmployee's name, address, and ZIP code Suff.15State EmployersstateI.D.no. 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality nameCOPY 1/D EMPLOYER'S - STATE, LOCAL OR FILE COPYFor Privacy Act and Paperwork ReductionActNotice,seeseparateinstructions. OMB No. 1545-008 Dept. of the Treasury - IRS7Social security tips 8Allocated tips 9 7Social security tips 8Allocated tips 9 2021 FormW-2 Wage and Tax Statement22222Void 7Social security tips 1 Wages, tips, other comp. 2Federal income tax withheld10 11plans 12aCode See inst. for box 12 10 11plans 12aCode See inst. for box 12 cEmployers name, address, and ZIP code 8Allocated tips 3Social security wages 4Social security tax withheld13Statutory employee 14Other 12bCode 13Statutory employee 14Other 12bCode 9 5Medicare wages and tips 6 Medicare tax withheldRetirement plan 12cCode Retirement plan 12cCode 10R Pleatnirement Sick pay 11 plansCC e e d d o o 12aSee instructions for box 12 Third-party sick pay 12dCode Third-party sick pay 12dCode eEmployees name, address, and ZIP code Suff.13 S emtaptulotyoerye Third-party 14Other 12bState income tax bEmployer number (EIN)CC e e d d o o 12c1 158 State Employer's state ID number 19 16State wages, tips ,etc.7State income tax 1851State Employer's state ID number 19 16State wage s ,tips ,etc. 20 1Locality name 7 aEmployees social security no. 12d Local wages, tips, etc. Local income tax 20 1Locality name Local wages, tips, etc. Local income taxForm W-2 Wage and Tax Statement Dept. of the Treasury IRS Form W-2 Wage and Tax Statement Dept. of the Treasury IRS15State EmployersstateI.D.no. 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality nameFor Privacy Act and Paperwork Reduction For Privacy Act and Paperwork ReductionAct Notice, see separate instructions. Act Notice, see separate instructions. COPY 1/D EMPLOYER'S - STATE, LOCAL OR FILE COPYFor Privacy Act and Paperwork ReductionActNotice,seeseparateinstructions. Dept. of the Treasury - IRS OMB No. 1545-008OMB No. OMB No. 7Social security tips 2Federal income tax withhelda EmployersState,Local,or File 1 Copy22222 2 2021 1545-0008 a EmployersState,Local,or File 1 Copy22222 2 2021 1545-0008 c 2021 FormW-2 Wage and Tax Statement22222Void8Allocated tips 1 Wages, tips, other comp. 4Social security tax withheldEmployee's soc. sec. no. Wages, tips, other comp. Federal income tax withheld Employee's soc. sec. no. Wages, tips, other comp. Federal income tax withheld Employers name, address, and ZIP code 3Social security wages3Social security wages 4Social security tax withheld 3Social security wages 4Social security tax withheld 9 5Medicare wages and tips 6 Medicare tax withheldbEmployer ID number (EIN) 5Medicare wages and tips 6Medicare tax withheld bEmployer ID number (EIN) 5Medicare wages and tips 6Medicare tax withheld 10 11 plansC ed o 12aSee instructions for box 12 cEmployer's name, address, and ZIP code cEmployer's name, address, and ZIP code eEmployees name, address, and ZIP code Suff.13 e Smtaptulotoyerye RPelatnirement Third-party 14OtherC e d o 12b Sick paybEmployer number (EIN)C e e d d o 12caEmployees social security no.Co 12d dControl number dControl numbereEmployee's name, address, and ZIP code Suff. eEmployee's name, address, and ZIP code Suff.15State EmployersstateI.D.no. 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality nameCOPY 1/D EMPLOYER'S - STATE, LOCAL OR FILE COPYFor Privacy Act and Paperwork Reduction ActNotice,seeseparateinstructions. Dept. of the Treasury - IRS OMB No. 1545-008 7Social security tips 8Allocated tips 9 7Social security tips 8Allocated tips 9 2021 FormW-2 Wage and Tax Statement22222Void 7Social security tips 1 Wages, tips, other comp. 2Federal income tax withheld10 11plans 12aCode See inst. for box 12 10 11plans 12aCode See inst. for box 12 cEmployers name, address, and ZIP code 8Allocated tips 3Social security wages 4Social security tax withheld13Statutory employee 14Other 12bCode 13Statutory employee 14Other 12bCode 9 5Medicare wages and tips 6 Medicare tax withheldRetirement plan 12cCode Retirement plan 12cCode 10 11 plansC ed o 12aSee instructions for box 12 Third-party sick pay 12dCode Third-party sick pay 12dCode eEmployees name, address, and ZIP code Suff.13 e Smtaptluotyoerye PRelatnirement Third-party 14OtherC e d o 12b Sick payState income tax bEmployer number (EIN)CC e e d d o o 12cLocal wages, tips, etc. Local income tax State income tax Local wages, tips, etc. Local income tax aEmployees social security no. 12d 1581 State Employer's state ID number 19 16State wages, tips ,etc. 20 1Locality name 7 1581 State Employer's state ID number 19 16State wage s ,tips, etc. 20 1Locality name 7Form W-2 Wage and Tax Statement Form W-2 Wage and Tax Statement15State EmployersstateI.D.no. 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality nameFor Privacy Act and Paperwork Reduction Dept. of the Treasury IRS For Privacy Act and Paperwork Reduction L4UPR Dept. of the Treasury IR540S5 COPY 1/D EMPLOYER'S - STATE, LOCAL OR FILE COPYFor Privacy Act and Paperwork Reduction ActNotice,seseparateinstructions.L87R 5406 OMB No. 1545-0Dept. of the Treasury - IRS08Act Notice, see separate instructions. Act Notice, see separate instructions.Apex DW4S or DW4SS Apex DW387 or DW387STFP 99991 or 99992 required envelope TFP 44441 or 44442 required envelopeA full PDF Image Library available at Complyrightdealer.comAPEX Sheets per packTFP Forms per pack50s500s100s500sFORM DESCRIPTIONL4UPL4UP50052055205BLaser W2 4-Up Box Employees Copies B, C, 2 & 2 Combined1 Page Equals 1 FormL4UPRL4UPR50054055405BLaser W2 4-Up Box Employers Copies 1/D, 1/D, 1/D, 1/D1 Page Equals 1 FormN/AL4UP24500N/AN/AAvailable On 24# Paper Stock1 Page Equals 1 FormL87L8750052065206BLaser W2 4-Up Horizontal Employees Copies B, C, 2 & 2 Combined1 Page Equals 1 FormL87RL87R50054065406BLaser W2 4-Up Horizontal Employers Copies 1/D, 1/D, 1/D, 1/D Combined1 Page Equals 1 FormN/AL8724500N/AN/AAvailable On 24# Paper Stock1 Page Equals 1 Form13"