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IRSDepartmentWage and Tax OMB No. 1545-0008 Wages, tips, other compensation Federal income tax withheldForm W-2 Statement 2021 7Social security tips 3Social security wages 4Social security tax withheld OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheldc IncomeTax Be Filed With Employees State, City, or Local 8Allocated tips 5Medicare wages and tips 6Medicare tax withheld FormW-2 Wage and Tax Statement 2021 7 Social security tips 3 Social security wages 4 Social security tax withheldCopy 2To Return.Employers name, address, and ZIP code c Employers name, address, and ZIP code 8 Allocated tipsO 9 10Dependent care benefits 11Nonqualified plans O 9 5 Medicare wages and tips 6 Medicare tax withheldG 12a e d o C o d e bEmployer identification number (EIN) 1 13 C d o e 2b a Sme taptutory p RlaetnirementThird-party 12c C d o e Other G e Employees name, address, and ZIP code 10 Dependent care benefits 11 Nonqualified plans C C o d e d o e 12aeEmployees name, address, and ZIP code 1 C 2d sick pay 14 b Employer identification number (EIN) 14 Other 12bEmployees social security number a Employees social security number t C C o e d o e d 12c13 em Retiremen Third-party 12dStaptulotoeyrye plan sick pay15StateEmployers state ID number 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19 20Locality 15 State Employers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name1 Local income of the tax TreasuryInternal 2 Revenue name ServiceDepartmentForm To Wage and Tax OMB No. 1545-0008 Wages, tips, other compensation Federal income tax withheld This information penalty isbeingor other furnished sanction to may theInternalbe imposed Revenue on you Service. if thisincomeIf you are is required OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheldCopy 2 W-2Statement 2021 7Social security tips 3Social security wages 4Social security tax withheld Copy2To Be Filed with Employees State, City, or Local Income Tax Return Dept. of the Treasury - IRSPRINTED IN USABe Filed With Employees State, City, or Local negligence taxable and to file you a fail tax to return, report a it.Income Tax Return. 7 Social security tipscEmployers name, address, and ZIP code 8Allocated tips 5Medicare wages and tips 6Medicare tax withheld Form name, address, and ZIP code 2021 8 Allocated tips 3 Social security wages 4 Social security tax withheld9 10Dependent care benefits 11Nonqualified plans W-2 Wage and Tax Statementc Employers12a C o d e C d o e Employer identification number (EIN) 12b 1 C o d e 3 a em R pleantirementThird-party 1 12c C o d e 4Other e Employees name, address, and ZIP code 9 10 Dependent care benefits 5 Medicare wages and tips C C e d o e d o 6 Medicare tax withheldeEmployees name, address, and ZIP code 12d Staptutory sick pay 11Nonqualified plans 12a See instructions for box 126 8 12 W M 8510021792 2019 RR Donnelley - 0667b Employees social security number b Employer identification number (EIN) 14Other 12ba Employees social security number C o d e 12c13 em Retirement Third-party C d e o 12dStaptulotoyreye plan sick pay15StateEmployers state ID number 16State wages, tips, etc. 17State income tax 18Local wages, tips, etc. 19Local income tax 20Locality name15 State Employers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality nameFROM:Copy CForEMPLOYEES RECORDS (See Notice to Employee on the back of Copy B.) Dept. of the Treasury - IRSOMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheldFormW-2 Wage and Tax Statement 2021 7 Social security tips 3 Social security wages 4 Social security tax withheldc Employers name, address, and ZIP code 8 Allocated tipsSEE REVERSE INSTRUCTIONS SIDE FOR OPENING9 5 Medicare wages and tips 6 Medicare tax withheldImportant Tax Document Enclosed 1A 806314/1095979 First-Class Mail APEX PS1288 1A 10 Dependent care benefits 11Nonqualified plans C C o e d o d e 12a See instructions for box 12 APEX LW287PSBe Employees name, address, and ZIP code b Employer identification number (EIN) 14Other 12bA S2032B a Employees social security number C o e d 12cTFP 5227 15 State Employers state ID number 16 State wages, tips, etc. 13Sme taptulotoyreye Retirement Third-party 18 Local wages, tips, etc. 19C o d e 12d 20 Locality nameplan sick pay17 State income tax Local income taxCopy BToBe Filed With Employees FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. Dept. of the Treasury - IRSS14EZ073O GG OPRINTED IN USA 1288 MW 8710039512 2020 RR Donnelley. All rights reserved. - 0221O OG GFROM:SEE REVERSE INSTRUCTIONS SIDE FOR OPENINGImportant Tax Document Enclosed First-Class MailEccentricEccentric ZFold ZFoldBlank face with backer instructions Blank face with backer instructionsAPEX Sheets per packTFP Forms per pack500s500sFORM DESCRIPTIONPS1288522714" Blank W2 Employees 4-Up HorizontalBlank with Backer Instructions B,C,2, 2EZ-Fold Simplex1 Page Equals 1 FormPS1286522814" W2 Employees 4-Up HorizontalCopy B, C, 2, 2EZ-Fold Simplex1 Page Equals 1 FormLW287PSN/A14" W2 Employees 4-Up HorizontalCopy B, C, 2, 2EZ-Fold Simplex1 Page Equals 1 FormLW287PSBN/A14" Blank W2 Employees 4-Up Horizontal With Backer InstructionsEZ-Fold Simplex1 Page Equals 1 Form20'