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Medicare wages and tips Medicare tax withheld Medicare wages and tips Medicare tax withheldOMB No. 1545-0008 1Wages, tips, other compensation Department of the TreasuryInternal 2 Revenue ServiceOMB No. 1545-0008 1Wages, tips, other compensation Department of the Treasury 2 tax withheld cEmployers name, address and ZIP code cEmployers name, address and ZIP codeFederal income tax withheld This information Federal income InternalRevenue ServiceInternal Revenue to is thebeing furnishedThis information is 3Social security wages 4Social security tax withheld Service. youa 3Social security wages 4Social security tax withheldbeing furnished return, a Iftonegligencethe Internal required file are taxRevenue Service. to 5Medicare wages and tips 6Medicare tax withheld penalty or may 5Medicare wages and tips 6Medicare tax withheld 7Social security tips 8Allocated tips 9 7Social security tips 8Allocated tips 9sanctionother beincome istaxableimposedon you ifandthiscEmployers name, address, and ZIP code you fail to report it. c 10Dependent care bene\x1fts 11Nonquali\x1fed plans C 12a e d o 10Dependent care bene\x1fts 11Nonquali\x1fed plans C 12a o d eEmployers name, address, and ZIP codeC d o e 12b b C o e d 12c a C 12d o e d C o e d 12b b C o d e 12c a C 12d e o dEmployer identi\x1fcation number (EIN) Employees social security number Employer identi\x1fcation number (EIN) Employees social security number7Social security tips 8Allocated tips 9 7Social security tips 8Allocated tips 9 13Sme taptulotyoreye Retirement Third-party 14Other 13Sme taptulotyoreye Retirement Third-party 14Otherplan sick pay plan sick pay10Dependent care benefits 11Nonqualified plans C o d e 12aSee instructions for box 12 o e d b 10Dependent care benefits C d e o 11Nonqualified plans a C o e d o e d 12aSee instructions for box 12 O eEmployees name, address and ZIP code eEmployees name, address and ZIP code GC o d e b 12b C o d e 12c a C d o e 12d C 12b 12c C 12d G OEmployer identification number (EIN) Employees social security number Employer identification number (EIN) Employees social security number13Sme taptulotoyeryepleantirementR Third-party14Other 13 em Rlaetnirement p Third-party14Other 15StateEmployers state ID No. 16State wages, tips, etc. 15StateEmployers state ID No. 16State wages, tips, etc.sick pay Staptulotoyreye sick pay2021 2021eEmployees name, address, and ZIP code eEmployees name, address, and ZIP code W-2 Statement 17State income tax 18Local wages, tips, etc. W-2 Statement 17State income tax 18Local wages, tips, etc.Form Wage and Tax Form Wage Filed and With TaxEmployeesFiledReturn. 19Local income tax 20Locality name Copy 2-ToIncome Be State, TaxReturn.City, or 19Local income tax 20Locality nameCopy2-ToIncome Be State, Tax City, EmployeesLocalWith or Local PROOF 1; 3-25-2020 8510027743Department of the TreasuryInternalRevenue Service Department of the TreasuryInternalRevenue ServiceForm 15StateEmployers state ID number 16State wages, tips, etc. Form 15StateEmployers state ID number 16State wages, tips, etc.W-2 17State income tax 18Local wages, tips, etc. W-2 17State income tax 18Local wages, tips, etc. FROM:Wage and Tax 19Local income tax 1A 20Locality name Wage and Tax 19Local income tax 20Locality name S2001 APEX Statement Statement2021 2021Copy B - ToFEDERALBe Filed With Tax Return. A CopyNotice Employee on the RECORDS back of Copy B.) PS283Employees (See C - For to EMPLOYEESFACE; EXTRA PERFS AS SHOWN; PANTO SCREENED 10% & 20%. MW283 TFP 5223 Important Tax Document Enclosed First-Class MailSEE REVERSE INSTRUCTIONS SIDE FOR OPENING1A 851020608 APEX PS1289A S2032BTFP 5225PRINTED IN USAMW1289G O Front Blank Front BlankPRINTED IN USAO Gwith W2 Instructionswith W2 Instructions W 2 - COPY CW 2 - COPY B on back side. on back side.Front Blank Front BlankO OG Gwith W2 Instructionswith W2 Instructions This panel This panelcontains W2 Backer contains W2 Backeron back side. on back side.Information InformationFront Blank Front Blankwith W2 Instructionswith W2 Instructions VFold on back side. on back side.FROM:Important Tax Document Enclosed First-Class MailSEE REVERSE INSTRUCTIONS SIDE FOR OPENINGEccentric ZFoldAPEX Sheets per packTFP Forms per pack500s500sFORM DESCRIPTIONPS285522011" W2 4-Up Box Employees Copy B, C, 2 And 2 or Extra CopyV-Fold Duplex1 Page Equals 1 FormPS283522311" W2 4-Up Box With Printed Backer Copy BV-Fold Duplex1 Page Equals 1 FormPS1287522414" W2 4-Up Box Employees Copy B, C, 2 Or Extra CopyEZ-Fold Simplex1 Page Equals 1 FormPS1289522514" W2 4-Up Box With Printed Backer Copy B and CEZ-Fold Simplex1 Page Equals 1 Form19'