Copy 2 To Be Flied With Em~loyee's State, City, or Local Income ax Return a Employee's
1 Wages,
SSN
tips, other compensation
2 Federal
Soc,al secunty
5 Medicare
wages and tips
75-0868393
6 Medicare
d Control
tax w,thheld
name, address,
3 Social security
wages
10 number
5 Medicare
income tax withheld
4 Social security tax withheld
c Employer's
913.33
wages and tips
75-0868393
213.60
and ZIP code
6 Medicare
tax withheld
14731.11
name, address,
213.60
and ZIP code
.
GOODWILL INDUSTRIES OF FORT WORTH 4005 CAMPUS DRIVE FORT WORTH TX 76119
e Employee's
and ZIP code
name, address,
and ZIP code
ARLEAN M PALMER 7444 CANDLE RIDGE CIR
ARLEAN M PALMER 7444 CANDLE RIDGE CIR FORT WORTH TX 76133
FORT WORTH TX 76133
7 Social security tips
8 Allocated
10 Dependent
11 Nonqualified
care benefits
2 Federal
14731.11
number
b Employer
GOODWILL INDUSTRIES OF FORT WORTH 4005 CAMPUS DRIVE FORT WORTH TX 76119
e Employee's
tips, other compensation
14731,11
tax withheld
14731.11
name, address,
1 Wages,
913.33
14731.11 10 number
SSN
451.81-4998 I4
3 Soc'al secunty wages
d Control number
c Employer's
a Employee's
income tax withheld
14731.11
451-81-4998
b Employer
Copy B To Be Flied With Emplo~ee's FEDERAL Tax Return iThls Information is being furnls ed to the IRS
.
9 Advance
tips plans
13 Stat. Emp.
12a 12b
EIC payment
Ret. plan
3rd-party
sick pay
14 Other
7 Social security tips
8 Allocated
10 Dependent
11 Nonqualified
care benefits
tips
9 Acvance
EIC payment
Ret.plan
3rd-party
plans
12a
13 Stat. Emp.
12b
14 Other
sick pay
12c
12c
12d
12d
.. :r:~.1............... 15 Slate
Emnlover's
. . . . . . . .1~7~' .,1.1.. slate 1.0.
#
16 State waoes
tios elc
19 Local income tax
18 Local wages, tips, etc.
. ...............
.................... Form W.2 Wage & Tax Statement
2010
...............
.
15 State
17 Stale income tax 20 Locality name
. ...............
Dept. of the Treasury.IRS
Emnlover's
18 Local wages,
.
OMB No. 1545.0008
.. :r:~-1- ..............
. ....... state 1.0. #
16 State wanes
tips, etc.
Copy C ~or EMPLOYEE'S
2010
RECORDS
to Employee on the back SSN
451- 1-4998 d Control number
etc.
1 Wages,
. ............... 17 State income tax 20 Locality name
. . ...............
...............
Form W.2 Wage & Tax Statement
a EmPloaee's
tins
19 Local income tax
. ....................
I ~~~n~etlf.~
1.4.7.3.1:1.1. .
Dept. of the Treasury.IRS
~~~ii~:W:J~~;: ~~~?r~~rr~sRI:datfa~h~e:~~~:~Re~~~~ penany or olher sanct,on may be imposed on you r;\hlS Income
IS taxable
and you fall to report it.
tips, other com-짜ensation
2 Federal
10 number
3 Soc,a
secunty wages
5 Medicare
4 Soc, a' secunty
wages and tips
75-0868393 c Employer's
income tax withheld
14 31.11 14731.11
b Employer
OMB No. 1545-0008
name, address,
tax w,tnnelO
913.33 6 Med,care
14731.11
tax withheld
213.60
and ZIP code
GOODWILL INDUSTRIES OF FORT WORTH 4005 CAMPUS DRIVE FORT WORTH TX 76119
.
This area intentionally left blank
e Employee's
name, address,
and ZIP code
ARLEAN M PALMER 7444 CANDLE RIDGE CIR FORT WORTH TX 76133
Page
1
ofW.2
7 Social security tips
8 Allocated
, 0 Dependent
11 Nonqualified
care benefits
tips
12b
EtC payment
Ret.plan
3rd-party
plans
13 Stat. Emp.
12a
9 Advance
sick pay
14 Other
12c 12d
.. :J:>S -I- .............. Emnlover's state 1.0. 15 State 18 Local wages, lips, etc.
. ....... #
..................... Form W-2 Wage & Tax Statement
l'\lOPDER
ORM II 5209C
1.4.7~.1:1.1..
16 State wanes
tins etc.
...............
19 Local income tax
17 State income tax 20 Locality name
...............
. ...............
2010
Dept. of the Treasury-IRS
OMB No. 1545-0008
. .