b"PRE-PRINTED W2 FORMS 1 WIDE CONTINUOUSXXXW2 COPY A W2 COPY B W-3aEmployees social security number For Ofcial Use OnlyaEmployees social security number Safe, accurate,Visit the IRS website at 33333 a Control number DO NOT STAPLEFor Ofcial Use Only 22222 VOID OMB No. 1545-0008OMB No. 1545-0008 FAST! Use www.irs.gov/eleOMB No. 1545-0008 b 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 Kind sick paycEmployers 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 of CT-1 Hshld.govt. emp. of State/localState/local 501cFederal govt. applicable) Payeremp. MedicareEmployernon-501c (Check if 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.11sick pay 12aSee instructions for box 12 C C dooe e eEmployees name, address, and ZIP code Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C ddooe e 7 Social security tips 9 8 Allocated tipsd 13StatutoryRetirementThird-party12b 13 employee plan sick pay 12b 10 FORM 9811-4 4PT/X-17 FORM 7933-22PT employee planFORM 7640-3 3PT/X-13A FORM 7640-3 3PT/X-13A14Other 12c C C dooe e 14Other 12c C C ddooe e g h Employers address and ZIP code 1112a Deferred compensation12dd12dOther 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 2021 Department of the TreasuryInternal Revenue ServiceForm Wage and Tax Statement 2021 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 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 2021 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.APEX5 Medicare wages and tips TFP cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld Reminder See the 2021 General Instructions for Forms 6 Medicare tax withheld Separate instructions. W-2 7 Social security tips 8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld W-3 for Form(s) W-2 that were submitted electronically to the SSA.Purpose of FormdControl number Last name Suff. 910C doe FORM DESCRIPTION 7 Social security tips 8 Allocated tips paper forms must notcomply with IRS standards and be machine readable. e 1112aSee instructions for box 12 dControl number 9 10Photocopies are acceptable. Use a Form W-3 even if only one X1713StatutoryRetirementThird-party12b C C ddooe e 4-Part W2 1 Wide Carbonless Copy A, B, C, 1/D Third-party12aSee 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 Formsemployee plan 98114eEmployees name, address, and ZIP code Suff.11StatutoryRetirementsick pay 12b Employer) of Form(s) W-2 for your records. The IRS recommendsMail Form W-3 with Copy A of Form(s) W-2 by January 31, 2022.FORM 9811-4 4PT/X-17sick pay14Other 12c 13 employee plan retaining copies of these forms for 4 years.12d C doe 14Other 12c C doe E-Filing Where To File Paper Forms15State X1816State wages, tips, etc.17State income tax 9811620Locality name 6-Part W2 1 Wide Carbonless Copy A, 1/D, B, C, 2, 1/D C doe 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:The SSA strongly suggests employers report Form W-3 and Forms W-2 fEmployees address and ZIP code 12dW-2 Online. toSocial Security AdministrationEmployers state ID number 18Local wages, tips, etc.19Local income tax 50 Forms W-2 at a time to the SSA. Direct Operations CenterWilkes-Barre, PA 18769-0001X13760033-Part Twin Set W2 1 Wide Employers Carbonless Copy A, 1/D, 1/DFile Upload. using18769-0002. If you use an IRS-approved private delivery service, add 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name Specications for Filing Forms W-2 Electronically (EFW2). the SSAsNote: Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue ServiceJanuary 31, 2022. For more information, go to www.SSA.gov/bso. First- ATTN: W-2 Process, 1150 E. Mountain Dr. to the address and change For Privacy Act and Paperwork Reductionthe ZIP code to 18702-7997. See Pub. 15 (Circular E), Employers TaxAct Notice, see the separate instructions.Register Log In. Guide, for a list of IRS-approved private delivery services.X13A41-0852411 764033-Part Twin Set W2 1 Wide Employees Carbonless Copy B, C, 2 For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.Copy AFor Social Security Administration. Send this entire page with not acceptable. Form Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service 41-0852411Form W-3 to the Social Security Administration; photocopies areW-2Copy BTo Be Filed With Employees FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service.X14760044-Part Twin Set W2 1 Wide Employers Carbonless Copy A, 1/D, 1/D, 1/DX14A764044-Part Twin Set W2 1 Wide Employees Carbonless Copy B, C, 2, 2X41752144-Part W2 Electronic Filing Carbonless Copy B, C, 2, 1/DCL38RN/ALaser Continuous W2 Employers Copies 1/D, 1/D, 1/D, 1/D CombinedCL38N/ALaser Continuous W2 Employees Copies B, C, 2 & 2 CombinedW2C552266-Part 1 Wide Dateless W2C Statement Of Corrected Income & Tax Amounts Requires Envelope Dww2C Double WindowW3793322-Part 1 Wide W3 Transmittal Of Income And Tax StatementsW3C795422-Part 1 Wide W3C Transmittal Of Corrected Income And Tax Statements5 Transmittal W3 forms are included with each Red Federal Copy A 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 E 10 Dependent caredControl number 7 Social security tips 8 Allocated tips All non-mailers on 12a See instructions for box 12 910 d Control number Suff. O O D C D C E E 12b e Last name Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C ddooe e this page fit Apex e Employees name, address, and ZIP code O D C D 12c 13 employee plan sick pay 12b C doe DWCL/S or TFP 66661 12d 14Other 12c15 State Employers state ID number 16 State wages, tips, etc. E 14Other fEmployees address and ZIP code 12d C doe or 66662 Double 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name Window EnvelopeForm1 Wage and Tax 2021 Department of the Treasury - Internal Revenue Service Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service For Privacy Act and Paperwork Reduction CopyW-2 Statement For PriAct Notice, see separate instructions. Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Act Notice, see the separate instructions. Copy DForForState,Employer City, or Local tax Department vacy Act and PaperOMBwork Reduction No. 1545-0008 Form W-3 to the Social Security Administration; photocopies are Do 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 11APEX6 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 paytyplans 7 Social security tips 8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld3rd-parc Employers name, address, and ZIP code O D E 10 Dependent caredControl number 9FORM DESCRIPTION7 Social security tips 8 Allocated tipsC 12a See instructions for box 12 10 d Control number e X4Suff. O O C D D C E 12b e 88884Last name Suff.11Statutory8-Part W2 2 Wide Carbonless (Left) Copy 1/D, 1/D, 1/D, Blank, Blank (Right) Copy A, B, 2, 2, C C C ddooe e12aSee instructions for box 12 Employees name, address, and ZIP code 12c 13 employee RetirementThird-party12bplan sick payEO 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 Wage and Tax Statement W 2 FORM PARTS DESCRIPTIONF Copy W-2Wage and Tax 2021 Department of the Treasury - Internal Revenue Service W-2 2021 Department of the TreasuryInternal Revenue Service For Privacy Act and Paperwork Reduction DFor or Local vacy Act and PaperOMBwork Reduction No. 1545-0008 Form W-3 to the Social Security Administration; photocopies are Act Notice, see the separate instructions. ormForState, Statementtax Department For PriAct Notice, see separate instructions. Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Copy1 Employer City,EMPLOYERS COPIES EMPLOYEES COPIESCopy A For Social Security Administration Copy BTo be filed with Employees Federal Tax ReturnCopy 1 For State, City, or Local Tax DepartmentCopy DCopy CFor Employees RecordsFor Employers RecordsCopy 2 To be filed with Employees State, City or Local Income Tax Return22"