b"PRE-PRINTED W2 FORMSALTERNATE 4-UP LASER COMBINED FORMATXXXOMB No. 1545-0008 1Wages, tips, other compensation 2Federal income tax withheld OMB No. 1545-0008 1Wages, tips, other compensation 2Federal income tax withheld APEX L275 OMBNo.1545-0008 Form W-2Wageand Tax Statement2021 OMBNo.1545-0008 Form W-2Wage VisittheIRSWebSite APEX L4UPW at Department of theTreasury - Internal Revenue Service Department of theTreasury - Internal Revenue Serviceand Tax Statement20213Socialsecuritywages 4 Social security tax withheld 3Socialsecuritywages 4 Social security tax withheld TFP 5214 7 8 Socialsecuritytips 1 3 Wages, tips, other comp. 2 Federal income tax withheld 7 8 Socialsecuritytips 1 3 Wages, tips, other comp. 2Federal income tax withheld TFP 52165 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld Allocatedtips Socialsecuritywages 4 Social security tax withheld Allocatedtips Socialsecuritywages 4 Social security tax withheldc Employers name, address, and ZIP code c Employers name, address, and ZIP code 9 5 Medicare wages and tips 6 Medicare tax withheld 9 5 Medicare wages and tips 6 Medicare tax withheldc Employers name, address, and ZIP code c Employers name, address, and ZIP code7Socialsecuritytips 8Allocatedtips 9 7Socialsecuritytips 8Allocatedtips 9e d o 10Dependentcare d o e 11 plans C e d o e d o 12a Se instructions for box 1210 e d o Dependentcare e d o 11 plans 12a C e d o C e d o Seinstructionsforbox 1210Dependentcare 11 plansC12a o e d Seinstructionsforbox1210Dependentcare 11 plansC12a o e d Seinstructionsforbox12C 12b C 12c C 12d C 12b C 12c 12db Employers n number (EIN) a Employees social security number b Employers iden n number (EIN)a Employees social security number b Employ umber (EIN)C12bo e d b Employ number (EIN)C12bo e d13S em tapt l u ot y o e ry e R pl eatnirement T shicir kdp-a p y arty 14Other 13S em tapt l uotyoery e R pl eatnirement T shicir kdp-a p y arty14Other a Employees social security numberC12co e d a Employees social security numberC12co e d14OtherC12de d o S maptluotyoeyrt Rlatnire p ement T si hcikrdp-apyarty 14OtherC12de d o S emaptt l u otyoery e Rleatinrement p T si hci kdp-apyarrtye Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff. 13 e 13e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff.15State Employers state I.D. number 16 State wages, tips, etc. 15State Employers state I.D. number 16 State wages, tips, etc.W-2 17 State income tax 18Localwages,tips,etc. W-2 Tax 17 State income tax 18Localwages,tips,etc. 15State EmployersstateI.D.no. 16 State wages, tips, etc. 17 State income tax 15State EmployersstateI.D.no. 16 State wages, tips, etc. 17 State income taxWtaatgeemaenndtS Tax Wtaatgeem aenndtS2021 C 19 Local income tax 20Localityname 2021 C 19 Local income tax 20Localityname 18Localwages,tips,etc. 19 Local income tax 20Localityname 18Localwages,tips,etc. 19 Local income tax 20LocalitynameCoitpyy, o2r TLoo cBael FInicleodm wei tTha ExmRpeltouyrne.e's State, Ciotypy, o 2rTLoocBael FInilceodm wei tTha ExmRpeltouyren.e's State,b www.irs.gov/ele Department of theTreasury - Internal Revenue Service pe y This pcotislto,y e iln d t io s re be x the 3Socialsecuritywages Department of theTreasury - Internal Revenue Service7 oehnqiyus ioireunfdiofrttmohaist iionanc otisam xbeeris urnfxu,arn a b linseehagenldidgteyonoctuhee fpaIenil 1 tea W-2Wage 2 (See Notice to Employee 7 This information is being furnished to the Internal Revenue Ser 1 vice 2 2021OMB No. 1545-0008 1Wages, tips, other compensation 2Federal income tax withheld OMB No. 1545-0008 I a ntosi 1Wages, tips, other compensation 2Federal income tax withheld COPY Cr T For EMPLOYEE'S eni tg ta RECORDS nDept. of theTreasury - IRS COPYBTo Beled withemployeesFEDERALTaxReturnDept. of theTreasury - IRSTheiinsIginntfefuorrnrnmaislahteiodntios 3Socialsecuritywages 4 Social security tax withheld i rm s being Sn informfeiysvahoeeungeer this5 Medicare wages and tips 4 Social security tax withheld OMBNo.1545-0008 Form tor nlrtyaelpooRr reotvtithe.neur esaSnecrtviiocnem. Iaf yyobue aimreposed on back of Copy B.) OMBNo.1545-0008 Form W-2Wageand Tax Statementthe Service. 5 Medicare wages and tips 6 Medicare tax withheld etnuran furntIo tioduaaneretcae 6 Medicare tax withheld Socialsecuritytips and Tax Statement2021 Socialsecuritytips Wages, tips, other comp. Federal income tax withheldRevenue an cofame ela.Rnomrengaoyytlihou Wages, tips, other comp. Federal income tax withheldreetqeruvrniircedoinou tapxaobrtleiat.ndifc Employers name, address, and ZIP code c Employers name, address, and ZIP code 8Allocatedtips 3Socialsecuritywages 4 Social security tax withheld 8Allocatedtips 3Socialsecuritywages 4 Social security tax withheld9 5 Medicare wages and tips 6 Medicare tax withheld 9 5 Medicare wages and tips 6 Medicare tax withheld7Socialsecuritytips 8Allocatedtips 9 7Socialsecuritytips 8Allocatedtips 9 c Employers name, address, and ZIP code c Employers name, address, and ZIP code10Dependentcare 11 plans C e d o 12aSeinstructionsforbox1210Dependentcare 11 plans C e d o 12aSe instructionsfor box12 C e d o 12b tapt l uotyoery e iden p rement T shicir kdp-ap C e d o y 12c arty 14Other C e d o 12d C e d o 12b Smt e apt l u otyoery e iden R pl eatnirement T shicir kdp-ap C e d o y a 12c rty 14Other C e d o 12d 10Dependentcare 11 plansCC12a o o e e d d Seeinstructionsfor box1210Dependentcare 11 plansCC12a o o e e d d See instructions for box12 b Employers n number (EIN)a Employees social security number b Employers n number (EIN) a Employees social security number13S em Rleatni 13 b Employ number (EIN)12bb Employ number (EIN)12b e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff. a Employees social security numberC12co e d a Employees social security numberC12co e d14OtherC12de d o y o e ry e Rleatnirement p T si hci kdp-apr y arty 14OtherC12de d o Smt e apt l u otyoery e Rlatinrement p e T si h ci k rdp-ap y arty13Smt e apt l uot 1315State Employers state I.D. number 16 State wages, tips, etc. 15State Employers state I.D. number 16 State wages, tips, etc. e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff.W-2 17 State income tax 18Localwages,tips,etc. W-2 17 State income tax 18Localwages,tips,etc.Wtaatgeem aenndtS Tax Staatgeem aenndt TaxW2021 19 Local income tax 20Localityname 2021 Act Notice, se 19 Local income tax 20LocalitynameFor Privacy Act and Paperwork ReductionAct Notice, se separate instructions. APEX L276 15State EmployersstateI.D.no. 16 State wages, tips, etc. 17 State income tax 15State EmployersstateI.D.no. 16 State wages, tips, etc. 17 State income tax APEX L4UPWRCopy B To Be Filed with(See Notice to Employee on back of Copy B).Copy C For EMPLOYEE'S RECORDS.Employee's FEDERAL Tax Return. OMB No. 1545-0008For Privacy Act and Paperwork Reductionseparate instructions. OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheld 18Localwages,tips,etc. 19 Local income tax 20 22222 FormW-2 Wage and Tax Statement2021 20 22222 FormW-2 Wage and Tax Statement20211 Wages, tips, other compensation 2 Federal income tax withheld 5214 4 Social security tax withheld Localityname 1 Wages, tips, other comp. tips,etc. 19 Local income tax Localityname 1 Wages, tips, other comp. 2 Federal income tax withheldL275 18Localwages, 2 Federal income tax withheld 7 Social security tips22222 3 Social security wages 4 Social security tax withheld 22222 3 Social security wages 7 Social security tips5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld TFP 5215 Copy2 ForEmployee's State,CityorLocalIncomeTax Return 9Dept. of theTreasury - IRS Copy2 ForEmployee's State,CityorLocalIncome 9 8 Allocated tipsDept. of theTreasury - IRS 4 Social security tax withheld TFP 52178 Allocated tips 3 Social security wages 4 Social security tax withheld Tax Return 3 Social security wagesc Employers name, address, and ZIP code c Employers name, address, and ZIP code 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheldL4UPW 5216c Employers name, address, and ZIP code c Employers name, address, and ZIP code7 Social security tips 8 Allocated tips 97 Social security tips 8 Allocated tips 9 10 Dependent care11 plans C e d o 12a Se instructions for box 12 10 Dependent care11 plans 12a C e d oSe instructions for box 12 10 Dependent 11 plansC12a o edSe instructions for box 1210 Dependent care11 plansC12a o edSee instructions for box 12 C e d o 12b C d o e 12c C e d o 12d C e 12b d o C e d o 12c 12d C e d o b Employ number (EIN)C12bo ed b Employ number (EIN)C12bo edb Employersn number (EIN) a Employees social security number b Employers iden n number (EIN)a Employees social security number a Employees social security numberC12co ed a Employees social security numberC12co ed13Smt e apt l uotyoery e Rleatni p rement T shicir kd p- a p y arty 14 Other 13Smt e apt l uotyoery e Rleatni p rement T shci i r kd p-apyarty 14 Other 14 OtherC12ded o Smt e aptluotyoeyr R pl e atnirement T si hcikrdp-apy arty 14 OtherC12ded o Smt e apt l u otyoery e Rleat pnriement T si hci k rdp- a p y rty13 13e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff.e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff.15State Employer s state I.D. number 16 State wages, tips, etc. 15State Employer s state I.D. number 16 State wages, tips, etc.W-2 17 State income tax 18 Local wages, tips, etc. W-2 17 State income tax 18 Local wages, tips, etc. 15 State Employers state I.D. no. 16 State wages, tips, etc. 17 State income tax 15 State Employers state I.D. no. 16 State wages, tips, etc. 17 State income taxW W 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Void 18 Local wages, tips, etc. 19 Local income tax 20 Locality name VoidStaatgeem aenndt Tax Staatgeem aenndt Tax2021 19 Local income tax 20 Locality name 2021 19 Local income tax 20 Locality name COPY 1/D EMPLOYER'S - STATE, OMB No. 1545-0008 Dept. of the Treasury - IRS t COPY 1/D EMPLOYER'S - STATE, OMB No. 1545-0008 Dept. of the Treasury - IRS tEMPLOYER'SEMPLOYER'SState, Local, or File CopyFor Privacy Act and Paperwork ReductionAct Notice, se separate instructions.State, Local, or File CopyFor Privacy Act and Paperwork ReductionAct Notice, se separate instructions.LOCAL OR FILE COPYFor PArcitv aNcoyti cAec,tsaenedsPeappaerrawteo rink sRterudcutcioinosn. LOCAL OR FILE COPYFor PArcitv aNcoyti cAec,tsaenedsPeappaerrawteo rink sRtreudcutcioinosn.Department of the Treasury - IRS Department of the Treasury - IRSOMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheld OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheld 22222 FormW-2 Wage and Tax Statement2021 22222 FormW-2 Wage and Tax Statement202122222 3 Social security wages 4 Social security tax withheld 22222 3 Social security wages 4 Social security tax withheld 7 Social security tips 1 Wages, tips, other comp. 2 Federal income tax withheld 7 Social security tips 1 Wages, tips, other comp. 2 Federal income tax withheld5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 8 Allocated tips 3 Social security wages 4 Social security tax withheld 8 Allocated tips 3 Social security wages 4 Social security tax withheldc Employers name, address, and ZIP code c Employers name, address, and ZIP code 9 5 Medicare wages and tips 6 Medicare tax withheld 9 5 Medicare wages and tips 6 Medicare tax withheldc Employers name, address, and ZIP code c Employers name, address, and ZIP code7 Social security tips 8 Allocated tips 97 Social security tips 8 Allocated tips 9 10 Dependent care11 plans C e d o 12a Se instructions for box 1210 Dependent care11 plans C e d o 12a Se instructions for box 1210 Dependent care11 plansC12a o edSee instructions for box 1210 Dependent care11 plansC12a o edSee instructions for box 12 C e d o 12b C e d o 12c C e d o 12d C e d o 12b C e d o 12c C e d o 12d b Employ number (EIN)C12bo ed b Employ number (EIN)C12bo edb Employers iden n number (EIN)a Employees social security number b Employers iden n number (EIN) a Employees social security number a Employees social security numberC12co ed a Employees social security numberC12co ed13Smt e apt l uotyoery e Rleatni p rement T s hci i r k dp-a p y arty 14 Other 13Smt e apt l uotyoery e R pl eatnirement T s hci i r k dp-a p y arty 14 Other 14 OtherC12ded o Smt e apt l uot y o e ry e Rleatni p rement T si hci kdp-ra p y rty 14 OtherC12ded o Smt e apt l uotyoery e R pl e atnriement T si hci k rdp-ap y arty13 13e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff.e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff.15State Employer s state I.D. number 16 State wages, tips, etc. 15State Employer s state I.D. number 16 State wages, tips, etc.W-2 17 State income tax 18 Local wages, tips, etc. W-2 17 State income tax 18 Local wages, tips, etc. 15 State Employers state I.D. no. 16 State wages, tips, etc. 17 State income tax 15 State Employers state I.D. no. 16 State wages, tips, etc. 17 State income taxW Wtaatgeem aenndt Tax S 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Void 18 Local wages, tips, etc. 19 Local income tax 20 Locality name VoidStaatgeem aenndt Tax2021 19 Local income tax 20 Locality name 2021 19 Local income tax 20 Locality name COPY 1/D EMPLOYER'S - STATE, OMB No. 1545-0008 Dept. of the Treasury - IRS t COPY 1/D EMPLOYER'S - STATE, OMB No. 1545-0008 Dept. of the Treasury - IRS tEMPLOYER'SEMPLOYER'SState, Local, or File CopyState, Local, or File Copy LOCAL OR FILE COPYFor APrcitv Nacoyti cAec,tsaenedsPeappaerrawteo rikn sRterudcutcioinosn. LOCAL OR FILE COPYFor PAcritv aNcoyti cAec,tsaenedsPeappaerrawteo rink sRterudcutci 5217Department of the Treasury - IRS Department of the Treasury - IRS L4UPWR oinosn.L276 5215Apex DW298 Apex DW4MW/D or DW4MWSTFP 91911 required envelope TFP 61611 or 61612 required envelopeAPEX Sheets per packTFP Forms per pack50s500s100s500sFORM DESCRIPTIONN/AN/A 5213N/A Laser W2 T-Style Alternate 4-Up Employees Copies B, C, 2, 21 Page Equals 1 FormTFP 31311 Required EnvelopeL275L27550052145214BLaser W2 M-Style Alternate 4-Up Employees Copies B, C, 2, 21 Page Equals 1 FormL276L27650052155215BLaser W2 M-Style Alternate 4-Up Employers Copies 1/D, 1/D, 1/D, 1/D1 Page Equals 1 FormL4UPWL4UPW50052165216BLaser W2 W-Style Alternate 4-Up Employees Copies B, C, 2, 21 Page Equals 1 FormL4UPWRL4UPWR50052175217BLaser W2 W-Style Alternate 4-Up Employers Copies 1/D, 1/D, 1/D, 1/D1 Page Equals 1 Form14"