b'INFORMATION FOR ORDERING W2 FORMSaEmployees social security number This information is being furnished to the Internal Revenue Service. If you OMB No. 1545-0008 may be imposed on you if this income is taxable and you fail to report it.22222 VOID aEmployees social security number For Ofcial Use Onlyb 1 Wages, tips, other compensation 2 Federal income tax withheldOMB No. 1545-0008 b 1 Wages, tips, other compensation 2 Federal income tax withheld cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheldcEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips7 Social security tips 8 Allocated tips dControl number 9 10 aEmployees social security numberdControl number 910Visit the IRS website ateEmployees name, address, and ZIP code Suff.11Statutoryb 22222 Third-partyVOID12aSee instructions for box 12 C C doe OMB No. 1545-00082 Federal income tax withhelde Last name Suff.1112aSee instructions for box 12 C ooe e OMB No. 1545-0008 Safe, accurate,www.irs.gov/ele13 employee Retirementsick pay 12b C ddooe e 1 Wages, tips, other compensation 4 Social security tax withheldaEmployees social security number FAST! Use pland 13Statutory bRetirementThird-party12b C d1 Wages, tips, other compensation 2 Federal income tax withheld 14Other cEmployers name, address, and ZIP code12c 3 Social security wagesemployee plan sick pay14Other cEmployers name, address, and ZIP code12c C doe 3 Social security wages 4 Social security tax withheld 12d C doe 5 Medicare wages and tips 6 Medicare tax withheld12d C doe 5 Medicare wages and tips 6 Medicare tax withheld 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name 7 Social security tips 8 Allocated tipsfEmployees address and ZIP code 7 Social security tips 8 Allocated tips dControl number 9 10 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality namedControl number 9 10eEmployees name, address, and ZIP code Suff.11Third-party12aSee instructions for box 12 C C oeForm eEmployees name, address, and ZIP code Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C ddooe e Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service 13StatutoryRetirementsick pay 12b C dddooe eSafe, accurate,employee planW-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service13 employee plan sick pay 12b Copy CFor EMPLOYEES RECORDS (See Notice toFAST!Use 14Other 12cFor Privacy Act and Paperwork ReductionEmployee on the back of Copy B.) Copy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411Act Notice, see the separate instructions.14Other 12c C doe Employees State, City or Local Incomeor Cop Taxy 2tReturno be Filed With 12d C doeForm W-3 to the Social Security Administration; photocopies are Do Not Cut, Fold, or Staple Forms on This Page 12d C oe aEmployees social security number This information is being furnished to the Internal Revenue Service. If you17State income tax 18Local wages, tips, etc.19Local income tax 20Locality named15StateEmployers state ID number 16State wages, tips, etc.OMB No. 1545-0008 may be imposed on you if this income is taxable and you fail to report it.22222 VOID aEmployees social security number For Ofcial Use Only15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name b 1 Wages, tips, other compensation 2 Federal income tax withheldOMB No. 1545-0008 cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld Department of the TreasuryInternal Revenue Service Form W-2 Wage and Tax Statement 2021 For Privacy Act and Paperwork Reduction b 1 Wages, tips, other compensation 2 Federal income tax withheld cEmployers name, address, and ZIP code 3 Social security wages 4 Social security tax withheld Department of the TreasuryInternal Revenue Service Form W-2 Wage and Tax Statement 2021 5 Medicare wages and tipsState, 6 Medicare tax withheld Act Notice, see separate instructions.Copy1Fo Employer.City,orLocalTaxDepartmentCopyDForr5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tipsCopy BTo Be Filed With Employees FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service.7 Social security tips 8 Allocated tips dControl number 9 10 dControl number 910e eEmployees name, address, and ZIP code Suff.11Statutoryb 22222 Third-partyVOID12aSee instructions for box 12 C C ddoe e OMB No. 1545-00082 Federal income tax withheldaEmployees social security numbere Last name Suff.1112aSee instructions for box 12 C doOMB No. 1545-0008 Safe, accurate,Visit the IRS website at13 employee Retirementsick pay 12b o1 Wages, tips, other compensationaEmployees social security number FAST! Use www.irs.gov/eleplan13Statutory bRetirementThird-party12b C doe 1 Wages, tips, other compensation 2 Federal income tax withheld 14Other cEmployers name, address, and ZIP code12c C doe 3 Social security wages 4 Social security tax withheldemployee plan sick pay14Other 12c C doe 3 Social security wages 4 Social security tax withheld 12d C doe 5 Medicare wages and tips 6 Medicare tax withheldcEmployers name, address, and ZIP code12d C oe 5 Medicare wages and tips 6 Medicare tax withheld 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name 7 Social security tips 8 Allocated tipsd fEmployees address and ZIP code 7 Social security tips 8 Allocated tips dControl number 9 10 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality namedControl number 9 10eEmployees name, address, and ZIP code Suff.1112aSee instructions for box 12 C oeeEmployees name, address, and ZIP code Suff.11StatutoryRetirementThird-party12aSee instructions for box 12 C C doe Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service 13StatutoryRetirementThird-party12b C C dddooe eWage and Tax Statement Department of the TreasuryInternal Revenue Service13 employee plan sick pay 12b doe Copy CFor EMPLOYEES RECORDS (See Notice toSafe, accurate,5203 employee plan sick pay 12cForm W-2 2021 For Privacy Act and Paperwork ReductionEmployee on the back of Copy B.)FAST!Use 14OtherCopy AFor Social Security Administration. Send this entire page with not acceptable. 41-0852411 LW2AAct Notice, see the separate instructions. 5201 14Other 12c C doe Employees State, City or Local Incomeor Cop Taxy 2tReturno be Filed With LW2C/LW22 12d C doeForm W-3 to the Social Security Administration; photocopies are 12d C doe 15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality name15StateEmployers state ID number 16State wages, tips, etc.17State income tax 18Local wages, tips, etc.19Local income tax 20Locality nameDepartment of the TreasuryInternal Revenue Service Form W-2 Wage and Tax Statement 2021 Department of the TreasuryInternal Revenue Service For Privacy Act and Paperwork Reduction Form W-2 Wage and Tax Statement 2021 Copy1Forr State, orLocalTaxDepartment LW2D1Act Notice, see separate instructions.5204CopyDFoEmployer.City,Copy BTo Be Filed With Employees FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. LW2B 5202PARTS DESCRIPTION EMPLOYERS COPIES EMPLOYEES COPIESW2 FORMCopy AFor Social Security Administration Copy B To be filed with Employees Federal Tax Copy 1For State, City, or Local TaxReturn Department Copy CFor Employees Records Copy D For Employers Records Copy 2To be filed with Employees State, City orLocal Income Tax ReturnW-2 GUIDE TO INFORMATION RETURNSDue DateTo Recipient(unless FormTitleWhat to ReportAmounts to ReportTo IRS indicated otherwise)Wages, tips, other compensation; social security, Medicare, withheld income taxes, andFebruary 1W-2 Wages and Taxadvance earned income credit (EIC) payments. Include bonuses, vacation allowances,See separatefor Paper February 1Statement severance pay, certain moving expense payments, some kinds of travel allowances, andinstructions and e-filingthird-party payments of sick pay.Generally, $600 orMarch 1 Gambling winnings from horse racing, dog racing, jai alai, lotteries, keno, bingo, slotmore; $1,200 or morefor Paper W-2G Certain Gamblingmachines, sweepstakes, wagering pools, poker tournaments, etc. from bingo or slotand March 31February 1Winnings machines; $1,500 or more from keno for e-filingIf the due date falls on a Saturday, Sunday, or legal holiday, the due date is the next business day.7'