b'PRE-PRINTED AND BLANK W-2 FORMSTFP PACKAGED SETTFP W-2 PACKAGED LASER SETTFP 5201 TFP 5202 TFP 5203 TFP 5204 TFP 5200aEmployees social security number This information is being furnished to the Internal Revenue Service. If youDO NOT STAPLE22222 VOID aEmployees social security number For Ofcial Use OnlyaEmployees social security number OMB No. 1545-0008 Safe, accurate,Visit the IRS website atOMB No. 1545-0008 b 22222 VOID aEmployees social security number OMB No. 1545-000833333 a Control number 943 For Ofcial Use Only None apply501c non-govt. Third-partyOMB No. 1545-0008b 2 Federal income tax withheld FAST! Use www.irs.gov/ele 1 Wages, tips, other compensation 2 Federal income tax withheld 1 Wages, tips, other compensation 2 Federal income tax withheld OMB No. 1545-0008 sick pay b 1 Wages, tips, other compensation 4 Social security tax withheld 1 Wages, tips, other compensation 2 Federal income tax withheld may be imposed on you if this income is taxable and you fail to report it. 3b Kind 941 Military govt. emp. 944 Kind State/localFederal govt. applicable) bcEmployers name, address, and ZIP code cEmployers name, address, and ZIP code 3 Social security wagescEmployers name, address, and ZIP code4 Social security tax withheld 3 Social security wages cEmployers name, address, and ZIP code Social security wages 4 Social security tax withheld Medicareof (Check if of CT-1 Hshld.Employer 3 Social security wages 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 4 Social security tax withheld Payer6 Medicare tax withheld (Check one) State/local 501c2 Federal income tax withheld5 Medicare wages and tips emp. 1 Wages, tips, other compensationnon-501c6 Medicare tax withheld (Check one) 8 Allocated tips d Establishment numberc Total number of Forms W-25 Medicare wages and tips 7 Social security tipsdControl number Last name Suff. 7 Social security tips sick pay C C C dddoooe e e 8 Allocated tips Suff. 13 7 Social security tips Third-partyC C C C dddoooe e e 8 Allocated tips Suff. 13 7 Social security tips dControl number C C C C ddddooooe e e e 8 Allocated tips 16State wages, tips, etc. Suff. 13 9 Statutoryplan e fEmployers name 10C C C C ddddooooe e e e See instructions for box 12 119 3 Social security wages 104 Social security tax withheld TFP 6666-29dControl number 109 dControl number 109 eEmployees name, address, and ZIP code 1112a 5 Medicare wages and tips 6 Medicare tax withheld10 e 11eEmployees name, address, and ZIP code 11eEmployees name, address, and ZIP code12aSee instructions for box 12 1112aSee instructions for box 12 employee Retirement Third-party 12b 7 Social security tips 8 Allocated tips12aSee instructions for box 12 sick pay13StatutoryRetirement Third-party 12b StatutoryRetirementsick pay 12b StatutoryRetirement Third-party 12b 14Other 12cemployee plan employee plan employee plan sick pay14Other 12c 14Other 12c 14Other 12c 12d 12a Deferred compensationg Employers address and ZIP code12d C doe 12d doe 15State 12d 17State income tax h Other EIN used this year 20Locality name 13 For third-party sick pay use only 12bEmployers state ID number 18Local wages, tips, etc.19Local income taxfEmployees address and ZIP code 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 2016State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name 17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name 15 State Employers state ID number 14 Income tax withheld by payer of third-party sick pay15StateEmployers state ID number 15StateEmployers state ID number Locality name 15StateEmployers state ID number 16State wages, tips, etc. 16 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 telephone numberFor Privacy Act and Paperwork Reduction CopyDFoEmployer.City, Employers contact personAct Notice, see separate instructions.Department of the TreasuryInternal Revenue ServiceDepartment of the TreasuryInternal Revenue Service Copy1Forr State, orLocalTaxDepartmentForm W-2 Wage and Tax Statement 2021 Form W-2 Wage and Tax Statement 2021 Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service Employers fax number Employers email addressFor Privacy Act and Paperwork Reduction Form W-3 to the Social Security Administration; photocopies are Act Notice, see the separate instructions.Employee on the back of Copy B.)Safe, accurate,complete.Copy AFor Social Security Administration. Send this entire page with not acceptable. Copy BTo Be Filed With Employees FEDERAL Tax Return.Copy CFor EMPLOYEES RECORDS (See Notice toFAST!Use 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, and 41-0852411 Employees State, City or Local Incomeor Cop Taxy 2tReturno be Filed With b VOID aEmployees social security number OMB No. 1545-0008Signature2 Federal income tax withheld TitleDateDepartment of the Treasury This information is being furnished to the Internal Revenue Service.Do Not Cut, Fold, or Staple Forms on This Page 22222 VOIDaEmployees social security number c 22222 aEmployees social security number 3Form W-3 4 Social security tax withheldaEmployees social security number For Ofcial Use Onlyb aEmployees social security number OMB No. 1545-0008 Safe, accurate,Visit the IRS website atOMB No. 1545-0008 This information is being furnished to the Internal Revenue Service. If you1 Wages, tips, other compensation Transmittal of Wage and Tax Statements 2021 Internal Revenue Serviceb 22222 VOID OMB No. 1545-00082 Federal income tax withheld 1 Wages, tips, other compensation www.irs.gov/elebEmployers name, address, and ZIP code OMB No. 1545-0008 Social security wages 2 Medicare tax withheldmay be imposed on you if this income is taxable and you fail to report it. 5Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA).1 Wages, tips, other compensation FAST! Useb 2 Federal income tax withheld 1 Wages, tips, other compensation 2 Federal income tax withheld 1 Wages, tips, other compensation 6Federal income tax withheldPhotocopies 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.cEmployers name, address, and ZIP code 3 Medicare wages and tips 4 Social security tax withheldSocial security wagescEmployers name, address, and ZIP code 3 Social security wagescEmployers name, address, and ZIP code4 Social security tax withheld 3 Social security wagescEmployers name, address, and ZIP code4 Social security tax withheld 3 Social security wages 4 Social security tax withheld 7Reminder 8See the 2021 General Instructions for Forms 5 Medicare wages and tips 6 Allocated tipsSocial security tipsSeparate instructions. 7 Social security tips 8 Medicare tax withheld12d C C doe e 14Other Third-party 12b C C C dddooooe e e e 13StatutoryRetirementdControl number C C C ddddooooe e e e 16State wages, tips, etc. Suff.11StatutoryW-2Third-party10C C C C ddddoooe e e e C C C C ddddooooe e e e Allocated tips 20Locality name When To File Paper Forms5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 9 W-3 for Form(s) W-2 that were submitted electronically to the SSA.7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 7 Social security tips e dEmployees name, address, and ZIP code 13 9 employee Purpose of FormdControl number Last name Suff. 9StatutorydControl number 10C C ddooe Suff. 13 9 StatutorydControl number 10C dSuff. 9 employee plan Control number C 8 Allocated tips Suff.11 Other Retirementsick pay 12a oSee instructions for box 12 Mail Form W-3 with Copy A of Form(s) W-2 by January 31, 2022. TFP 66661 or 66662 10 10plan Third-party12bacceptable. Use a Form W-3 even if only one eEmployees name, address, and ZIP code 14 Statutorypaper forms must notcomply with IRS standards and be machine readable. Photocopies are12aSee instructions for box 1213 employee Retirementsick pay 12cplan 12be 11employee eEmployees name, address, and ZIP code12aSee instructions for box 12 doe 11employee eEmployees name, address, and ZIP code12aSee instructions for box 12 11Third-party12aSee instructions for box 12 16State wages, tips, etc. 14Other Number (EIN). Make a copy of this form and keep it with Copy D (ForWhere To File Paper Forms Suggested envelopes 12d13 Retirement Third-party 12b Retirementsick pay sick pay 12b Employer) of Form(s) W-2 for your records. The IRS recommends 12cplan sick pay plan retaining copies of these forms for 4 years.14Other 12c 12c 14Other 15StateEmployers state ID number 17State income tax E-Filing 1912d12c 18Local wages, tips, etc. Local income taxThe SSA strongly suggests employers report Form W-3 and Forms W-2 fEmployees address and ZIP code 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 2016State wages, tips, etc.17State income tax 18Local wages, tips, etc. 12d 20Locality name 17State income tax 15StateEmployers state ID number TaxLocality name 17State income tax 18Local wages, tips, etc.Department of the TreasuryInternal Revenue Service usingSend this entire page with the entire Copy A page of Form(s) W-2 to: for use with LaserLink 12d Copy A electronically instead of on paper. The SSA provides two freetoSocial Security AdministrationForm DFo State, orLocal20DepartmentW-2 Online.19Local income tax 20Locality namethe SSAsNote:Direct Operations Center15StateEmployers state ID number 15StateEmployers state ID number Locality name 15StateEmployers state ID number 16State wages, tips, etc. Copy W-2 Wage and Tax Statement 2021 50 Forms W-2 at a time to the SSA. Wilkes-Barre, PA 18769-000119Local income tax 18Local wages, tips, etc. Employer.City,File Upload.Act Notice, see separate instructions.5204 18769-0002. If you use an IRS-approved private delivery service, addFor Privacy Act and Paperwork Reduction Copy 1Forr19Local income tax TaxDepartment Specications for Filing Forms W-2 Electronically (EFW2). . First- ATTN: W-2 Process, 1150 E. Mountain Dr. to the address and change Form Wage and Tax Statement Form Department of the TreasuryInternal Revenue ServiceForm Department of the TreasuryInternal Revenue Service Form W-2 Wage and Tax Statement 2021 LW2D1For Privacy Act and Paperwork Reductionwww.SSA.gov/bso the ZIP code to 18702-7997. See Pub. 15 (Circular E), Employers Tax or TFP 20.20 software. Department of the TreasuryInternal Revenue Service Copy DForr State, orLocal January 31, 2022. For more information, go toLog In. Guide, for a list of IRS-approved private delivery services.Copy 1Fo Employer.City, Act Notice, see separate instructions.RegisterW-2 2021 W-2 For Privacy Act and Paperwork Reduction2021 W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.Wage and Tax Statement Safe, accurate, Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411 LW2AAct Notice, see the separate instructions. 5201 Copy CFor EMPLOYEES RECORDS (See Notice toLW2C/LW22 FAST!Use VOID aEmployees social security number OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheld LW3 41-0852411 5200 Envelopes ordered Copy BTo Be Filed With Employees FEDERAL Tax Return.Employee on the back of Copy B.)5202Form W-3 to the Social Security Administration; photocopies areThis information is being furnished to the Internal Revenue Service. Employees State, City or Local Incomeor Cop Taxy 2tReturno be Filed With 22222 5203LW2Bb 3 Social security wages 4 Social security tax withheld separately.TFP W-2 PACKAGED BLANK LASER SET cEmployers name, address, and ZIP code 5Social security tips 6Allocated tips7 Medicare wages and tips 8 Medicare tax withheldControl number 9 10 dEmployees name, address, and ZIP code Suff.11StatutoryRetirement Third-party12a C C C dddoooe e e See instructions for box 12eTFP 5201 TFP 5207 TFP 5209 TFP 5200 13 employee plan sick pay 12b14Other 12c12d C doeDO NOT STAPLE22222 VOID aEmployees social security number For Ofcial Use Only33333 a Control number For Ofcial Use Only15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality nameOMB No. 1545-0008OMB No. 1545-0008b 1 Wages, tips, other compensation 2 Federal income tax withheld b Kind 941 Military 943 944 KindNone apply501c non-govt. Third-party Department of the TreasuryInternal Revenue Service of CT-1 Hshld.govt. emp. (Check one)Form W-2State/localor State/local 501cFederal govt. sick payLW2D1For Privacy Act and Paperwork Reduction of (Check if cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld Payeremp. MedicareEmployernon-501c applicable) 5 Medicare wages and tips 6 Medicare tax withheld (Check one) d Establishment number Copy DFor State, Wage and Tax Statement 2021 Act Notice, see separate instructions.5204c Total number of Forms W-2 1 Wages, tips, other compensation LocalTax2 Federal income tax withheldCopy 1For Employer.City, DepartmentdControl number 7 Social security tips Front Blank e Front Blank 3 Social security wages 4 Social security tax withheld8 Allocated tips910fEmployers name 5 Medicare wages and tips 6 Medicare tax withheld7 Social security tips 8 Allocated tipse Last name Suff.11employee plan sick pay 12aSee instructions for box 12 C C dddooe e e with W-2 Instructions119 10 13Statutorywith W-2 Instructions Retirement Third-party 12b14Other 12c C doe g Employers address and ZIP code 13 For third-party sick pay use only 12a Deferred compensationon back side. C oon back side. 12b12d h Other EIN used this yearfEmployees address and ZIP code 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name 15 State Employers state ID number 14 Income tax withheld by payer of third-party sick pay15StateEmployers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income taxEmployers contact person Employers telephone numberForm W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue ServiceEmployers fax number Employers email addressFor Privacy Act and Paperwork Reduction Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Act Notice, see the 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, and Form W-3 to the Social Security Administration; photocopies arecomplete.Do Not Cut, Fold, or Staple Forms on This Page SignatureTitleDate aEmployees social security number For Ofcial Use OnlyForm W-3 Transmittal of Wage and Tax Statements 2021 Department of the Treasury Internal Revenue Service22222 VOID OMB No. 1545-0008Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA).b 1 Wages, tips, other compensation 2 Federal income tax withheld 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.cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld Reminder See the 2021 General Instructions for Forms Separate instructions. W-2 5 Medicare wages and tips 6 Medicare tax withheld W-3 for Form(s) W-2 that were submitted electronically to the SSA.7 Social security tips 8 Allocated tips Purpose of FormdControl number 9Front Blank Front Blankpaper forms must comply with IRS standards and be machine readable. 10Photocopies are not acceptable. Use a Form W-3 even if only one e Last name Suff.11plan 12aSee instructions for box 12 C C ddooe e Number (EIN). Make a copy of this form and keep it with Copy D (ForWhen To File Paper Forms13Statutorywith W-2 Instructionswith W-2 InstructionsMail Form W-3 with Copy A of Form(s) W-2 by January 31, 2022.employee Retirement Third-party 12b Employer) of Form(s) W-2 for your records. The IRS recommends sick pay retaining copies of these forms for 4 years.fEmployees address and ZIP code 16State wages, tips, etc. 14Other 18Local wages, tips, etc. 12c C C ddooe e 20Locality name E-Filing on back side.usingWhere To File Paper FormsThe SSA strongly suggests employers report Form W-3 and Forms W-2 on back side. Copy A electronically instead of on paper. The SSA provides two freetoSend this entire page with the entire Copy A page of Form(s) W-2 to:12dW-2 Online.Social Security Administration50 Forms W-2 at a time to the SSA. Direct Operations Center15StateEmployers state ID number 17State income tax 19Local income taxFile Upload.Note:Wilkes-Barre, PA 18769-0001Specications for Filing Forms W-2 Electronically (EFW2). the SSAs18769-0002. If you use an IRS-approved private delivery service, addATTN: W-2 Process, 1150 E. Mountain Dr. to the address and changeJanuary 31, 2022. For more information, go to www.SSA.gov/bso. First- the ZIP code to 18702-7997. See Pub. 15 (Circular E), Employers Tax Register Log In. Guide, for a list of IRS-approved private delivery services.Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue ServiceFor Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.For Privacy Act and Paperwork ReductionLW3 41-0852411 5200Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411 LW2AAct Notice, see the separate instructions. 5201 LW2NB/LMRNB 5207Form W-3 to the Social Security Administration; photocopies are TFP W2 Packaged Blank Laser Sets3 Transmittal W3 forms are included with each set FOR 50 EMPLOYEES57466-Part SET includes: 50 - 5201, 100 - 5207, 50 - 5209,TFP W2 Packaged Laser Set 3 - 5200 W-3FOR 25 EMPLOYEESFOR 50 EMPLOYEES 5746256-Part SET includes: 25 - 5201, 50 - 5207, 25 - 5209,56454-Part SET includes: 50 - 5201, 50 - 5202, 50 - 5203, 3 - 5200 W-350 - 5204, 3 - 5200 W-3TFP W2 4-Up Packaged Laser Sets5645E4-Partincludes: 50-5201, 50-5202, 50-FOR 50 EMPLOYEES5203, 50-5204, 3 - 5200 W-3, 50 - 6666-2 Envelopes 5844 4-Part SET includes: 50 - 5201, 50 - 5204, 50 - 5205, 3 - 520056506-Part SET includes: 50 - 5201, 50 - 5202, 25 - 5203, 5846 6-Part SET includes: 50 - 5201, 100 - 5204, 50 - 5205,50 - 5204, 3 - 5200 W-3 3 - 52005650E6-Part SET includes: 50 - 5201, 50 - 5202, 50 - 5203, 5848 8-Part SET includes:50 - 5201, 150 - 5204, 50 - 5205,50 - 5204, 3 - 5200 W-3, 50 - 6666-2 Envelopes 3 - 520056558-Part SET includes: 50 - 5201, 50 - 5202, 150 - 5203, TFP W2 Packaged Laser Set for Electronic Filing150 - 5204, 3 - 5200 W-35655E8-Part SET includes: 50 - 5201, 50 - 5202, 150 - 5203, FOR 50 EMPLOYEES150 - 5204, 3 - 5200 W-3, 50 -6666-2 Envelopes 56485-Part SET includes: 50 - 5202, 100 - 5203, 100 - 5204FOR 25 EMPLOYEES 5648E 5-Part SET includes: 50 - 5202, 100 - 5203, 100 - 5204,5645254-Part SET includes: 25 - 5201, 25 - 5202, 25 - 5203, 50 - Envelopes 6666225 - 5204, 3 - 5200 W-3 TFP W2C Corrected Income Packaged Laser Sets5645E254Part SET includes: 25 - 5201, 25 - 5202, 25 - 5203, FOR 50 EMPLOYEES25 - 5204, 3 - 5200 W-3, 25 - 6666-2 Envelopes 53174-Part SET includes: 505313, 505314, 505315,5650256-Part SET includes: 25 - 5201, 25 - 5202, 25 - 5203, 505316, 3530925 - 5204, 3 - 5200 W-3 5318 6-Part SET includes: 505313, 505314, 1005315,5650E256-Part SET includes: 25 - 5201, 25 - 5202, 25 - 5203, 1005316, 3530925 - 5204, 3 - 5200 W-3, 25 - 6666-2 Envelopes FOR 25 EMPLOYEES5655258-Part SET includes: 25 - 5201, 25 - 5202, 75 - 5203, 531725 4-Part SET Includes: 255313, 255314, 255315,75 - 5204, 3 - 5200 W-3 255316, 353095655E258-Part SET includes: 25 - 5201, 25 - 5202, 75 - 5203, 531825 6-Part SET Includes: 255313, 255314, 505315,75 - 5204, 3 - 5200 W-3, 25 - 6666-2 Envelopes 505316, 3530917'