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GControl Thisinformation otherfurnishedthe imposedonthisFederal incomewithheld Control number sanctiontips,to other compensationThis information to theis being 5 3Social security wages 6 4Social security tax withheld OMB No. 1545-0008 5 3Social security wages 6 4Social security tax withheld 15StateEmployers state ID number 16State wages, tips, etc. 17State income tax 15StateEmployers state ID number 16State wages, tips, etc. 17State income tax ZFoldfurnished Medicare wages and tips Medicare tax withheld Medicare wages and tips Medicare tax withheldInternal Revenue Service.cEmployers name, address, and ZIP code cEmployers name, address, and ZIP code 18Local wages, tips, etc. 19Local income tax 20Locality name 18Local wages, tips, etc. 19Local income tax 20Locality name7Social security tips 8Allocated tips 9Verification code 7Social security tips 8Allocated tips 9Verification code10 b Dependent care benefits 1Nonqualified plans a 12a C e d o See instructions for box 12 10 b o d Dependent care benefits 1 12c C d o e Nonqualified plans a 12a C C e o d e d o See instructions for box 12 SEE REVERSE SIDE FOR OPENING INSTRUCTIONS12b C d o e Employer identification number (EIN) C 12c o d e 12d C o e d 12b C e Employer identification number (EIN) 12dEmployees social security number Employees social security number13Sme taptulotoyerye Retirement Third-party 14Other 13 em Retirement Third-party 14Otherplan sick pay Staptulotoyerye plan sick payPRINTED IN USAeEmployees name, address, and ZIP code eEmployees name, address, and ZIP codeForm 15StateEmployers state ID number 16State wages, tips, etc. Form 15StateEmployers state ID number 16State wages, tips, etc. IMPORTANT TAX RETURN DOCUMENT ENCLOSEDW-2 17State income tax 18Local wages, tips, etc. W-2 17State income tax 18Local wages, tips, etc.Wage and Tax 19Local income tax 20Locality name Wage and Tax 19Local income tax 20Locality name APEX PS1279MW1280ZStatement Statement2021 2021Copy B - To Be Filed With Employees FEDERAL Tax Return. Copy C - For EMPLOYEES RECORDS (See Notice to Employee on the back of Copy B.)Department of the TreasuryInternalRevenue ServiceA 85102754 S20351AO OG GW2-COPY B W2-COPY CPRINTED IN USAMW1279 Eccentric ZFoldBlank face with backer instructionsAPEX Sheets per packTFP Forms per pack500s500sFORM DESCRIPTIONPS1280ZN/A14" W2 Employees 4-Up BoxCopy B, C, 2, 2EZ-Fold Duplex1 Page Equals 1 FormPS1279N/A14" Blank W2 4-Up Box With Backer InstructionsEZ-Fold Duplex1 Page Equals 1 FormLW2PSN/A14" W2 Employees 4-Up BoxCopy B, C, 2, 2EZ-Fold Duplex1 Page Equals 1 Form21'