b"W-2 PRE-PRINTED FORMS1-Wide ContinuousW-2 COPY A W-2 COPY B W-3aEmployees social security number For Ofcial Use OnlyaEmployees social security number OMB No. 1545-0008 Safe, accurate,Visit the IRS website at33333 a Control number DO NOT STAPLE22222 VOID OMB No. 1545-0008FAST! Use www.irs.gov/eleFor Ofcial Use Only OMB No. 1545-0008b 1 Wages, tips, other compensation 2 Federal income tax withheld b 1 Wages, tips, other compensation 2 Federal income tax withheld b 941 Military 943 944None apply 501c non-govt. Third-party Kind MedicareKind State/localState/local 501cFederal govt. sick payof of (Check if cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld PayerCT-1 Hshld.govt. emp. Employernon-501c applicable) emp.5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld (Check one) d Establishment number (Check one) 2 Federal income tax withheldc Total number of Forms W-2 1 Wages, tips, other compensation7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips e 3 Social security wages 4 Social security tax withhelddControl number 910dControl number 9 10fEmployers name 5 Medicare wages and tips 6 Medicare tax withhelde Last name Suff.1112aSee instructions for box 12 C C C doooe e e eEmployees name, address, and ZIP code Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C C C dddooooe e e e g Employers address and ZIP code 7 Social security tips 9 8 Allocated tips13StatutoryRetirementThird-party12b oe 13 employee plan sick pay 12b d10 FORM 9811-4 4PT/X-17 FORM 7933-22PT employee plan sick pay d FORM 7640-3 3PT/X-13A FORM 7640-3 3PT/X-13A14Other 12c C d14Other 12c 1112a Deferred compensation12dd12d h Other EIN used this year 13 For third-party sick pay use only 12bfEmployees address and ZIP code15StateEmployers state ID number 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 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income taxForm W-2 Wage and Tax Statement 2022 Department of the TreasuryInternal Revenue ServiceForm Wage and Tax Statement Department of the TreasuryInternal Revenue Service Employers contact person Employers telephone numberCopy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411 For Privacy Act and Paperwork ReductionW-2 2022 Employers fax number Employers email address Act Notice, see the separate instructions. Form W-3 to the Social Security Administration; photocopies areCopy BTo Be Filed With Employees FEDERAL Tax Return. Do Not Cut, Fold, or Staple Forms on This Page This information is being furnished to the Internal Revenue Service. 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 complete.SignatureTitleDate 22222 VOID aEmployees social security number For Ofcial Use OnlyForm W-3 Transmittal of Wage and Tax Statements 2022 Department of the Treasury OMB No. 1545-0008aEmployees social security number Safe, accurate,Visit the IRS website atSend this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA). Internal Revenue Serviceb 1 Wages, tips, other compensation 2 Federal income tax withheld OMB No. 1545-0008 FAST! Use www.irs.gov/elePhotocopies are not acceptable. Do not send Form W-3 if you led electronically with the SSA. cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld b 1 Wages, tips, other compensation 2 Federal income tax withheld Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.Reminder5 Medicare wages and tips 6 Medicare tax withheld cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld Separate instructions. See the 2022 General Instructions for Forms APEX7 Social security tips TFP 5 Medicare wages and tips 6 Medicare tax withheld W-2 8 Allocated tips W-3 for Form(s) W-2 that were submitted electronically to the SSA.Purpose of FormdControl number 9107 Social security tips 8 Allocated tipspaper forms must notcomply with IRS standards and be machine readable. e Last name Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C ddooe e FORM DESCRIPTION dControl number Suff. 9 10C doe Photocopies are acceptable. Use a Form W-3 even if only one 13 employee plan sick pay 12b eEmployees name, address, and ZIP code 1112aSee instructions for box 12 number (EIN). Make a copy of this form and keep it with Copy D (For FORM 9811-4 4PT/X-1712c Statutoryplan sick pay Employer) of Form(s) W-2 for your records. The IRS recommendsWhen To File Paper FormsX1714Other 98114C C ddooe e 4-Part W-2 Carbonless Copy A, B, C, 1/D 13 employee RetirementThird-party12b C C ddooe e retaining copies of these forms for 4 years. Mail Form W-3 with Copy A of Form(s) W-2 by January 31, 2023.12d 14Other 12c E-Filing Where To File Paper FormsThe SSA strongly suggests employers report Form W-3 and Forms W-2 Copy A electronically instead of on paper. The SSA provides two freeSend this entire page with the entire Copy A page of Form(s) W-2 to:fEmployees address and ZIP code15State X1816State wages, tips, etc.17State income tax 9811620Locality name 6-Part W-2 Carbonless Copy A, 1/D, B, C, 2, 1/D 12d C doe 20Locality name 50 Forms W-2 at a time to the SSA.the SSAs toNote:Social Security AdministrationEmployers state ID number 18Local wages, tips, etc.19Local income taxW-2 Online.Direct Operations Center File Upload. usingWilkes-Barre, PA 18769-000115StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax Specications for Filing Forms W-2 Electronically (EFW2). 18769-0002. If you use an IRS-approved private delivery service, add Form W-2 X132022 760033-Part Twin Set W-2 Employers Carbonless Copy A, 1/D, 1/D January 31, 2023. For more information, go to www.SSA.gov/bso. First- the ZIP code to 18702-7997. See Pub. 15 (Circular E), Employers Tax ATTN: W-2 Process, 1150 E. Mountain Dr. to the address and change Wage and Tax Statement Department of the TreasuryInternal Revenue ServiceRegister Log In. Guide, for a list of IRS-approved private delivery services.For Privacy Act and Paperwork Reduction Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Act Notice, see the separate instructions.Form Wage and Tax Statement 2022 Department of the TreasuryInternal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.Form W-3 to the Social Security Administration; photocopies areW-2 41-0852411X13A764033-Part Twin Set W- 2 Employees Carbonless Copy B, C, 2Copy BTo Be Filed With Employees FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service.W2C552266-Part Dateless W-2C Statement Of Corrected Income and Tax Amounts (Requires Envelope DWW2C Double Window)W3793322-Part W-3 Transmittal Of Income and Tax StatementsW3C795422-Part W-3C Transmittal Of Corrected Income and Tax Statements(5) W-3 Transmittal forms are included with each Federal Copy A (Red) form order2-Wide Continuous22222 Void a Employee's soc. sec. no 1 Wages, tips, other comp. 2 Federal income tax withheld 22222 VOID aEmployees social security number For Ofcial Use Only OMB No. 1545-0008 b Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld b 1 Wages, tips, other compensation 2 Federal income tax withheldStatutory13 Employee 9 5 Medicare wages and tips 6 Medicare tax withheld cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheldRet. plan sick payty 11 plans 7 Social security tips 8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld3rd-parc Employers name, address, and ZIP code O C D E 10 Dependent caredControl number 7 Social security tips 8 Allocated tips All non-mailersd C ontrol number O O D D C E E 12a See instructions for box 12 e Last name Suff. 9StatutoryRetirementThird-party10C C ddooe e onthispagefit:12b 1112aSee instructions for box 12e Employees name, address, and ZIP code Suff. C 12c 13 employee plan sick pay 12bO C D E 12d 14Other 12c C C dooe e APEX: DWCL or DWCLS14Other 12d15 State Employers state ID number 16 State wages, tips, etc. d 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name fEmployees address and ZIP code 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name TFP: 66661 or 6666215StateEmployers state ID numberFormW-2Wage and Tax 2022 DepartmentFor Priv of the Act Notice, see separate instructions. Form W-2 Wage and Tax Statement 2022 Department of the TreasuryInternal Revenue ServiceDouble Window Treasury - Internal Revenue Service For Privacy Act and Paperwork Reduction CopyFor State,Statement acy Act and Paperwork Reduction Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Act Notice, see the separate instructions. Copy D For 1EmployerCity, or Local tax Department OMB No. 1545-0008 Form W-3 to the Social Security Administration; photocopies areEnvelopeDo Not Cut, Fold, or Staple Forms on This Page22222 Void a Employee's soc. sec. no 1 Wages, tips, other comp. 2 Federal income tax withheld 22222 VOID aEmployees social security number For Ofcial Use Only OMB No. 1545-0008 b Employer ID number (EIN) 3 Social security wages 4 Social security tax withheld b 1 Wages, tips, other compensation 2 Federal income tax withheld13 Employee 9 APEX6 Medicare tax withheld TFP 3 Social security wages 4 Social security tax withheldStatutory 5 Medicare wages and tips cEmployers name, address, and ZIP codeRet. plan sick payty 11 plans 7 Social security tips 8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld3rd-parc Employers name, address, and ZIP code O 10 Dependent caredControl number 9FORM DESCRIPTION7 Social security tips 8 Allocated tipsC 12a See instructions for box 12 10 e d Control number X4Suff. O O D D D C C E E E 12b e 88884Last name Suff.11Statutory8-Part W C C ddooe e -2 Carbonless (Left) Copy 1/D, 1/D, 1/D, Blank, Blank (Right) Copy A, B, 2, 2, C12aSee instructions for box 12 Employees name, address, and ZIP code 12c 13 employee RetirementThird-party12bplan sick payO C D E 12d 14Other 12c C doe14Other 12d C doe15 State Employers state ID number 16 State wages, tips, etc.fEmployees address and ZIP code15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Form W-2 Wage and Tax Statement 2022 W-2 FORM PARTS DESCRIPTIONDepartment of the TreasuryInternal Revenue Service Wage and Tax Treasury - Internal Revenue Service For Privacy Act and Paperwork Reduction FormW-2 Statement 2022 DepartmentFor Priv of the Act Notice, see separate instructions. Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Act Notice, see the separate instructions. acy Act and Paperwork ReductionCopy For State,OMB No. 1545-0008 Form W-3 to the Social Security Administration; photocopies are Copy D For 1EmployerCity, or Local tax DepartmentEMPLOYERS COPIES EMPLOYEES COPIESCopy AFor Social Security Administration CopyB TobefiledwithEmployeesFederalTaxReturnCopy 1For State, City, or Local Tax Department Copy CFor Employees Records Copy DFor Employers Records Copy2 TobefiledwithEmployeesState,CityorLocalIncomeTaxReturn21"