b"PRE-PRINTED W2 FORM SALTERNATE LASER COMBINED FORMATXXXa Copy BTo Be Filed With Employee's 1 241-0852411 a Copy 2To Be Filed With Employee's State, 1 241-0852411 APEX L4UPARaEmployee's soc. sec. no.b Copy 1/D Employer's- State, Local or File Copy22222 OMBNo.1545-0008 APEX L3UPR b FEDERAL Tax Return. 5 3 Wages, tips, other comp. 6 4 Federal income tax withheld b City, or Local Income Tax Return. 5 3 6 4 Federal income tax withheldEmployee's soc. sec. no. OMB No. 1545-0008 Employee's soc. sec. no. Wages, tips, other comp. OMB No. 1545-0008 DETACH BEFORE MAILINGL3UPREmployer ID number (EIN) Social security wages Social security tax withheld Employer ID number (EIN) Social security wages Social security tax withheldcEmployers name, address, and ZIP code 3Social secu 1 rity wages 2 4 Federal income tax withheld c Medicare wages and tips Medicare tax withheld c Medicare wages and tips Medicare tax withheld TFP 5405AWages, tips, other compensation Socialsecuritytaxwithheld Employer's name, address, and ZIP code Employer's name, address, and ZIP code5Medicare wages and tipsrity tips7Social secu 8Allocated tips 6 Medicaretaxwithheld 9e 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-2WageandTaxStatement2021 Notice, see separate instructions.Third-party sick pay 12dCode Third-party sick pay 12dCodea c Employee's soc. sec. no. b Copy 1/D Employer's- State, Local or File Copy1 4 22222 OMBNo.1545-0008 158 1State Employer's state ID number 19Local income tax 20 1Locality name 7 Employers State, Local, or File Copy 1 1622222 2021OMB No. Employers State, Local, or File Copy22222 2021 OMB No. APEX L4UPA Employers name, address, and ZIP code Wages, tips, other compensation 2FSocialsecuritytaxwithheld Local wages, tips, etc. 16State wages, tips, etc. State income tax 158 State Employer's state ID number 19Local income tax 20 1Locality name a Employee's soc. sec. no. 1 Wages, tips, other comp. 1545-00083Social security wages ederal income tax withheld Local wages, tips, etc. State wages, tips, etc. 71545-0008 2 Federal income tax withheldState income tax6Medicaretaxwithheld 9 APEX L3UP Form W-2 Wage and Tax Statement 2021 a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld b Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld7Social secur 8Allocated tips This information is being furnished to the Internal Revenue Service. Dept. of the Treasury IRS Form W-2 Wage and Tax Statement3 Social security wages 2021 5 Medicare wages and tips 6 Medicare tax withheld TFP 5205A4 Social security tax withheldDept. of the Treasury IRSwww.irs.gov/eleb Employer ID number (EIN)5Medicare wages and tipsity tips 5 Medicare wages and tips 6 Medicare tax withheldc Employers name, address, and ZIP code c Employers name, address, and ZIP codee dControl numberSuff. 12bCode 12cCode plans 12dCode TFP 5210 a Copy CFor EMPLOYEE'S RECORDS (See 1 2 OMB No. 1545-0008 a Copy 2To Be Filed With Employee's State, 1 2 OMB No. 1545-000810 11 12aCode See inst. for box 1241-085241141-0852411Employees name, address, and ZIP code Notice to Employee on the back of Copy B.) Federal income tax withheld City, or Local Income Tax Return. Federal income tax withheld13 14OtherEmployee's soc. sec. no. Wages, tips, other comp. Employee's soc. sec. no. Wages, tips, other comp.Statutoryemployee bEmployer ID number (EIN) 5 3Social security wages 6 4Social security tax withheldd Control numberbEmployer ID number (EIN) 5 3Social security wages 6 4Social security tax withheldd Control numberSuff.Retirement planMedicare wages and tips Medicare tax withhelde Employees name, address, and ZIP code Medicare wages and tips Medicare tax withheldThird-party sick pay Suff. e Employees name, address, and ZIP code15State 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 cEmployer's name, address, and ZIP code7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9FormW-2WageandTaxStatement2021 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 10 dControl number11 10 11For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. eEmployee's name, address, and ZIP code 12a Suff. eEmployee's name, address, and ZIP code13 Stat. Emp. Ret. plan 3rd-party sick pay 12a Suff. 13 Stat. Emp. Ret. plan 3rd-party sick payaEmployee's soc. sec. no. b Copy 1/D Employer's- State, Local or File Copy22222 OMBNo.1545-0008 12b 14 Other 12b 14 OthercEmployers name, address, and ZIP code 2021 1Wages, tips, other compensation 2FSocial4 securitytaxwithheld 7Social security tips 8Allocated tips 9 12c 7Social security tips 8Allocated tips 9 12c3Social security wages ederal income tax withheld 12d 12d5Medicare wages and tipsity tips 8Allocated tips 6Medicaretaxwithheld 9 13Statutory employee 14Other 12bCode 18 Local wagesr, tip.s state I.s, etc.D. # 16 Local income taxplans 12b Code 15 State Empl 16 State wages, tips, etc. 17Locality name10 11plans 12aCodeSee inst. for box 1215 State Empl10 19State wages, tips, etc.11 17 State income tax12a 18 Local wagesr, tip.s state I.s, etc.D. # 19 Local income tax 20 State income tax7Social secur 13Statutory employee 14Other 20 Locality name Codee dControl number10 Code 11 Code plans 12aCode See inst. for box 12 Retirement plan 12cCode For Privacy Act and Paperwork Reduction Dept. of the Treasury - IRS Form W-2 Wage and Tax Statement Dept. of the Treasury - IRSForm W-2 Wage and Tax Statement 12cCode For Privacy Act and Paperwork ReductionRetirement planAct Notice, see separate instructions. Act Notice, see separate instructions.Employees name, address, and ZIP code Suff. 12b 12c 12dCode Third-party sick pay 12dCode Third-party sick pay 12dCode13 14Other Statutoryemployee 16State wages, tips, etc. 20 1Locality name 7 Employers State, Local, or File Copy 1 Local income tax 7 OMB No. Employers State, Local, or File Copy22222 2021 1545-0008Retirement plan185 1 State Employer's state ID number 19Local income tax State income tax 158 State Employer's state ID number 19 1622222 2021 1545-0008 a Employee's soc. sec. no. 1 Wages, tips, other comp. OMB No.Third-party sick pay Local wages, tips, etc. Local wages, tips, etc. State wages, tips, etc. 20 1Locality name 2 Federal income tax withheldState income taxa Employee's soc. sec. no.1 Wages, tips, other comp. 2 Federal income tax withheld15State Employers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld- Form W-2 Wage and Tax Statement 2021 Dept. of the Treasury IRS Form W-2 Wage and Tax Statement3 Social security wages 2021 Dept. of the Treasury IRS 5 Medicare wages and tips 6 Medicare tax withheldpenalty or other sanction may be imposed on you if this income is taxable and you fail to report it. b Employer ID number (EIN) 5 Medicare wages and tips 6 Medicare tax withheld b Employer ID number (EIN)L4UP 5205FormW-2WageandTaxStatement2021 This information is being furnished to the Internal Revenue Service. DepartmentoftheTreasury-InternalRevenueService c Employers name, address, and ZIP code c Employers name, address, and ZIP coded Control numberd Control number 2021 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 101112a 13 Stat. Emp. Ret. plan 3rd-party sick pay 12a 13 Stat. Emp. Ret. plan 3rd-party sick pay12b 14 Other 12b 14 Other12c 12c12d 12d15 State Empl 16 Local income tax 17 State income tax 15Local wagesr, tip.s state I.s, etc.D. # 16 Local income tax 17 State income tax18 Local wagesr, tip.s state I.s, etc.D. # 19State wages, tips, etc. 20 Locality name 18 State Empl 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.2021Apex DW4S/D or DW4SSApex DW3 or DW3S TFP 99991 or 99992 required envelopeTFP 33331 or 33332 required envelopeFormW-2Wage and Tax Statement2021 OMB No. 1545-0008 Employer identic ation number (EIN) 1DepaT2reasu APEX L4DNControl number Copy B To Be Filed With Employees FEDERALWages, tips, other comprtment of the. Federy - Interal inc romenal R tax withheldevenue ServiceTax Return Employees so c ial sec urity number 3Soc ial sec urity wages 4 Soc ial sec urity tax withheldEmployers name, address, and ZIP code7 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 3 employee 1 2a -12dStatutory14Otherplan Retirement Third-party 1 5StateEmployers state I.D. number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc al wages, tips, etc. 1 9 Loc al inc ometax 20Losic alitc ky payname This information is being furnished to the Internal Revenue Service www.irs.gov/eleFormW-2Wage and Tax Statement2021 OMB No. 1545-0008 Employ c ation number (EIN) 1Department 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 so c ial 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 6 Medic are tax withheld8Alocatedtips 9 1 0 Dependent cEmployees name, address, and ZIP code Suff.11plansCode See inst. for box 1 2 1 1 3 employee2a -12dStatutory14Otherplan Retirement Third-partysic k pay1 5StateEmployers state I.D. number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc al wages, tips, etc. 1 9 Loc al inc ome tax 20Loc 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 Statement2021 OMB No. 1545-0008 Employ c ation number (EIN) 1Department of the Treasury - Internal Revenue Service 2Control number Copy 2 Lo To Be Filedc al Inc ome Tax Return With Employees State,Wages, tips, other comp. 4Federal inc ome tax withheldCity, orSoc ial sec urity tax withheldEmployers name, address, and ZIP code Employees so c ial 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 5StateEmployers state I.D. number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc al wages, tips, etc. 1 9 Loc al inc ometax 20Loc ality name FormW-2 WageandTaxStatement 2021 OMB No. 1545-0008 Employ c ation number (EIN) 1Department of the Treasury - Internal Revenue Service 2Control number Copy 2 Lo To Be Filedc al Inc ome Tax Return With Employees State,Employees so c ial 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 6 Medic 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 5StateEmployers state I.D. number 1 6State wages, tips, etc. 1 7 State inc ome tax 1 8Loc al wages, tips, etc. 1 9 Loc al inc ometax 20Loc ality name L4DN 5218Apex DW4DN or DW4DNS or DW4DNDTFP 51511 or 51512 required envelopeAPEX Sheets per packTFP Forms per pack50s500s100s500sFORM DESCRIPTIONL3UPL3UP50052105210BLaser W2 W-Style 3-Up Employees Copies B, C & 2 Combined1 Page Equals 1 FormL3UPRL3UPR500N/AN/ALaser W2 W-Style 3-Up Employers Copies 1/D, 1/D, 1/D1 Page Equals 1 FormL4UPAL4UPA5005205A5205ABLaser W2 P-Style 4-Up Employees Copies B, C, 2, 2 Combined1 Page Equals 1 FormL4UPARL4UPAR5005405A5405ABLaser W2 P-Style 4-Up Employers Copies 1/D, 1/D, 1/D, 1/D1 Page Equals 1 FormL4DNL4DN50052185218BLaser W2 N-Style 4-Up Employees Copies B, C, 2, 2 Combined1 Page Equals 1 Form15"