b"W-2 PRE-PRINTED FORMSAlternate Laser Combined FormatCopy BTo Be Filed With Employee's41-0852411 Copy 2To Be Filed With Employee's State,41-0852411 APEX L4UPARaEmployee's soc. sec. no.b Copy 1/D Employer's- State, Local or File Copy22222 OMBNo.1545-0008 APEX L3UPR b a FEDERAL Tax Return. 5 3 1Wages, tips, other comp. 6 4 2Federal income tax withheld b a City, or Local Income Tax Return. 5 3 1 6 4 2Federal income tax withheldEmployee's soc. sec. no. OMB No. 1545-0008 Employee's soc. sec. no. Wages, tips, other comp. OMB No. 1545-0008cEmployers name, address, and ZIP code 3Social secur 1 ity wages 2 4 Federal income tax withheld c Employer ID number (EIN) Social security wages Social security tax withheld c Employer ID number (EIN) Social security wages Social security tax withheld TFP 5405A DETACH BEFORE MAILINGL3UPRWages, tips, other compensation Socialsecuritytaxwithheld Medicare wages and tips Medicare tax withheld Medicare wages and tips Medicare tax withheldEmployer's name, address, and ZIP code Employer's name, address, and ZIP code7Social secur 8Allocated tips 6 Medicaretaxwithheld 95Medicare wages and tipsity tipse dControl number Suff. 10 Code 12cCode plans 12dCode d e Control number Suff. d e Control number Suff.Employees name, address, and ZIP code 12b 11 12aCode See inst. for box 12 Employee's name, address, and ZIP code Employee's name, address, and ZIP code13 14Other StatutoryemployeeRetirement plan Third-party sick pay 7Social security tips 8Allocated tips 9 7Social security tips 8Allocated tips 915State Employers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name 10 11plans 12aCodeSee inst. for box 12 10 11plans 12aCode13Statutory employee 14Other 12bCode 13Statutory employee 14Other 12bCodeThis information is being furnished to the Internal Revenue Service. For Privacy Act and Paperwork Reduction Act DepartmentoftheTreasury-InternalRevenueService Retirement plan 12cCode Retirement plan 12cCodeFormW-2WageandTaxStatement2022 Notice, see separate instructions.Third-party sick pay 12dCode Third-party sick pay 12dCodeaEmployee's soc. sec. no. b Copy 1/D Employer's- State, Local or File Copy1 4 22222 OMBNo.1545-0008 1State Employer's state ID number 19Local income tax 20 1Locality name 7 185 1 State Employer's state ID number 19Local income tax 20 1Locality name 7 Employers State, Local, or File Copy22222 2022 1545-0008cEmployers name, address, and ZIP code Wages, tips, other compensation 2FSocialsecuritytaxwithheld 158Local wages, tips, etc. 16State wages, tips, etc. State income tax Local wages, tips, etc. 16State wages, tips, etc. State income tax 1 Wages, tips, other comp. OMB No. APEX L4UPA 3Social security wages ederal income tax withheld Employers State, Local, or File Copy22222 1545-00082022OMB No.Form W-2 Wage and Tax Statement 2022 Dept. of the Treasury IRSa Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld 2 Federal income tax withheldForm W-2 Wage and Tax Statement 2022 Dept. of the Treasury IRSa Employee's soc. sec. no.dControl number7Social secur 8Allocated tips plans 6Medicaretaxwithheld 9 Code See inst. for box 12 APEX L3UP This information is being furnished to the Internal Revenue Service. www.irs.gov/ele 3 Social security wages 4 Social security tax withheld b Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld5Medicare wages and tipsity tips b Employer ID number (EIN) 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheldeEmployees name, address, and ZIP code Suff. 10 Code 11 Code 12a Code a Copy CFor EMPLOYEE'S RECORDS (See 1 241-0852411c Employers name, address, and ZIP code a 1Wages, tips, other comp. 241-0852411c Employers name, address, and ZIP code TFP 5205A12b 12c 12d Notice to Employee on the back of Copy B.) OMB No. 1545-0008 Copy 2To Be Filed With Employee's State, Federal income tax withheldCity, or Local Income Tax Return.13 14OtherTFP 5210 b Employee's soc. sec. no. 5 3 Wages, tips, other comp. 6 4 Federal income tax withheld b Employee's soc. sec. no. 5 3Social security wages 6 4 OMB No. 1545-0008Social security tax withheldStatutoryemployee Employer ID number (EIN) Social security wages Social security tax withheld Employer ID number (EIN) Medicare wages and tips Medicare tax withheldd Control number Retirement planMedicare wages and tips Medicare tax withheldd Control number Third-party sick pay15State Employers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name cEmployer's name, address, and ZIP code e Employees name, address, and ZIP code c Suff. e Employees name, address, and ZIP code Suff.Employer's name, address, and ZIP codeSe instructions for box 12FormW-2WageandTaxStatement2022 Notice, see separate instructions.This information is being furnished to the Internal Revenue Service. For Privacy Act and Paperwork Reduction Act DepartmentoftheTreasury-InternalRevenueService dControl number 7 Social security tipsdControl number8 Allocated tips 9 7 Social security tips 8 Allocated tips 9For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. eEmployee's name, address, and ZIP code 10 Suff. eEmployee's name, address, and ZIP code 10 Suff. 11aEmployee's soc. sec. no. b Copy 1/D Employer's- State, Local or File Copy22222 OMBNo.1545-0008 See instructions for box 12 11 13 Stat. Emp. Ret. plan 3rd-party sick pay See instructions for box 12 13 Stat. Emp. Ret. plan 3rd-party sick paycEmployers name, address, and ZIP code 1Wages, tips, other compensation 2FSocial4 securitytaxwithheld 7Social security tips 8Allocated tips 9 12a 7Social security tips 14 Other 8 9 12a 14 Other3Social security wages ederal income tax withheld 12b Allocated tips 12b2022 10 11plans 12a 12c 10 11plans 12aCode 12cCodeSee inst. for box 1212d 12d5Medicare wages and tipsity tips 8Allocated tips 6Medicaretaxwithheld 9 13Statutory employee 14Other 12bCode 13Statutory employee 14Other 12bCode7Social securdControl number10 Code 11 Code plans 12aCode See inst. for box 12 Retirement plan 12cCode 18 State Emplr Retirement plan16 State wages, tips, etc. 17Locality name 12d Code 15Local wages, tips.s state ID #, etc. 16 Local income tax 17Locality name15Local wages, tips.s state ID #, etc. 19 Local income tax 20 State income tax12c 18 State Emplr 19State wages, tips, etc. 20 State income taxeEmployees name, address, and ZIP code Suff. 12b 12c 12dCode Third-party sick pay 12dCode Third-party sick pay CodeForm W-2 Wage and Tax Statement Form W-2 Wage and Tax Statement13 14OtherFor Privacy Act and Paperwork Reduction Dept. of the Treasury - IRS For Privacy Act and Paperwork Reduction Dept. of the Treasury - IRSStatutoryemployee Act Notice, see separate instructions. Act Notice, see separate instructions.16State wages, tips, etc. State income tax 16State wages, tips, etc. State income taxRetirement plan1581 State Employer's state ID number 19Local income tax 20 1Locality name 7 185 1 State Employer's state ID number 19Local income tax 20 1Locality name 7Third-party sick pay Local wages, tips, etc. Local wages, tips, etc.15State Employers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax - 20Locality name Form W-2 Wage and Tax Statement Dept. of the Treasury IRS Form W-2 Wage and Tax Statement 22222 OMB No. Employers State, Local, or File Copy22222 2022 OMB No.penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.a Employee's soc. sec. no.1 Wages, tips, other comp. 2022 1545-0008 a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld2022 Employers State, Local, or File Copy2022 Dept. of the Treasury IRS 1545-0008L4UP 2 Federal income tax withheld 5205FormW-2WageandTaxStatement2022 This information is being furnished to the Internal Revenue Service. DepartmentoftheTreasury-InternalRevenueService b Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld b Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheldc Employers name, address, and ZIP code c Employers name, address, and ZIP code2022 d Control numberd Control number e Employees name, address, and ZIP code Suff. e Employees name, address, and ZIP code Suff.7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 91011 1011See instructions for box 12 13 Stat. Emp. Ret. plan 3rd-party sick pay See instructions for box 12 13 Stat. Emp. Ret. plan 3rd-party sick pay12a 12a12b 14 Other 12b 14 OtherSe instructions for box 12 12c 12c12d 12d15Local wages, tips.s state ID #, etc. 16 Local income tax 17 State income tax 15Local wages, tips.s state ID #, etc. 16 Local income tax 17 State income tax18 State Emplr 19State wages, tips, etc. 20 Locality name 18 State Emplr 19State wages, tips, etc. 20 Locality nameForm W-2 Wage and Tax Statement Form W-2 Wage and Tax StatementFor Privacy Act and Paperwork Reduction Dept. of the Treasury - IRS For Privacy Act and Paperwork Reduction L4UPAR Dept. of the Treasury - IRS5405AAct Notice, see separate instructions. Act Notice, see separate instructions.2022Required Envelope:Required Envelope: APEX: DW4S or DW4SD or DW4SSAPEX: DW3 or DW3S TFP: 99991 or 99992TFP: 33331 or 33332 FormW-2Wage and Tax Statement2022 OMB No. 1545-0008 Employer identic ation number (EIN) 1Depar Treasur 2 APEX L4DNControl number Copy B To Be Filed With Employees FEDERALWages, tips, other comptment of the . Federy - Interal inc ome nal Retax withheldvenue ServiceTax Return Employees social sec urity number 3Soc ial sec urity wages 4 Soc ial sec urity tax withheldEmployers name, address, and ZIP code 7 8 Soc ial sec urity tips 5 9 Medic are wages and tips 1 0 6Medic are tax withheld TFP 5218AlocatedtipsDependent cEmployees name, address, and ZIP code Suff.11plansCode See inst. for box 1 2 1 1 3 employee2a -12dStatutory14Otherplan Retirement Third-party k pay1 5State Employers state ID number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc alwages, tips, etc. 1 9Loc al inc ometax 20 Locsic ality name This information is being furnished to the Internal Revenue Service www.irs.gov/eleFormW-2Wage and Tax Statement2022 OMB No. 1545-0008 Employ c ation number (EIN) 1 Department of the Treasury - Internal Revenue Service 2Control number Copy CFor EMPLOYEE'S RECORDS. (SeeWages, tips, other comp. Federal inc ome tax withheldNotice to Employee on back of Copy B). Employees social sec urity number 3Soc ial sec urity wages 4Soc ial sec urity tax withheldEmployers name, address, and ZIP code7Soc ial sec urity tips 5Medic are wages and tips 6Medic are tax withheld8Alocatedtips 9 1 0 Dependent cEmployees name, address, and ZIP code Suff.11plansCode See inst. for box 1 2 1 13employee2a -12dStatutory14Otherplan Retirement Third-partysic k pay1 5State Employers state ID number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc alwages, tips, etc. 1 9Loc al inc ome tax 20 Loc ality name This information is being furnished to the IRS.Ifc e penaltyor other sanc tion maybe imposed on y ou if this inc ome is taxable and y ou fail to report it. FormW-2Wage and Tax Statement2022 OMB No. 1545-0008 Employ c ation number (EIN) 1 Department of the Treasury - Internal Revenue Service 2Control number Copy 2 Loc To Be Filedal Inc ome Tax ReturnWith Employees State,Wages, tips, other comp. 4Federal inc ome tax withheldCity, orSoc ial sec urity tax withheldEmployers name, address, and ZIP code Employees social sec urity number 3Soc ial sec urity wages7Soc ial sec urity tips 5Medic are wages and tips 6Medic are tax withheld8Alocatedtips 9 1 0 Dependent cEmployees name, address, and ZIP code Suff.11plansCode1 12d 1 3 employee2a -StatutoryRetirement14OtherplanThird-partysic k pay1 5State Employers state ID number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc alwages, tips, etc. 1 9Loc al inc ometax 20 Loc ality name FormW-2 WageandTaxStatement 2022 OMB No. 1545-0008 Employ c ation number (EIN) 1 Department of the Treasury - Internal Revenue Service 2Control number Copy 2LocTo Be Filedal Inc ome Tax ReturnWith Employees State,Employees social sec urity number 3 Wages, tips, other comp. 4 Federal inc ome tax withheldCity, orSoc ial sec urity wages Soc ial sec urity tax withheldEmployers name, address, and ZIP code7Soc ial sec urity tips 5Medic are wages and tips 6Medic are tax withheld8Alocatedtips 9 1 0 Dependent cEmployees name, address, and ZIP code Suff.11plansCode1 12d 1 3 employee2a -Statutory14Otherplan Retirement Third-partysic k pay1 5State Employers state ID number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc alwages, tips, etc. 1 9Loc al inc ometax 20 Loc ality name L4DN 5218Required Envelope:APEX: DW4DN or DW4DNS or DW4DNDTFP: 51511 or 51512APEX - Sheets per packTFP - Forms per pack50s500s100s500sFORM DESCRIPTIONL3UPL3UP50052105210BW-2 W-Style 3-Up Employees Copies B, C & 2 Combined1 Page Equals 1 FormL3UPRL3UPR500N/AN/AW-2 W-Style 3-Up Employers Copies 1/D, 1/D, 1/D1 Page Equals 1 FormL4UPAL4UPA5005205A5205ABW-2 P-Style 4-Up Employees Copies B, C, 2, 2 Combined1 Page Equals 1 FormL4UPARL4UPAR5005405A5405ABW-2 P-Style 4-Up Employers Copies 1/D, 1/D, 1/D, 1/D1 Page Equals 1 FormL4DNL4DN50052185218BW-2 N-Style 4-Up Employees Copies B, C, 2, 2 Combined1 Page Equals 1 Form14"