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
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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
. .
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08/23/1984
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08/23/2015
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ARLEAN
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HAS llEEN
ESTABLISHED
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l
MARIE PALMER
C:4.-_~ __ ._ SIGNATURE
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Copy State,
Copy B To Be Filed With ThiS information is being
2 To Be Filed With Em~loyee's City, or Local Income ax Return
a Employee's
14731.11
d Control number
,j
~oclal security wages
75-0868393
6 Medicare tax withheld
3 SOCial Secuflty wages
b Employer to number
4 Social S9CUflty tax withheld
c Employer's
913.33
5 Medicare wages and tips
75-0868393
21360
name, address, and ZIP code
6 MediCare tax withheld
14731.11
213.60
name, address, and ZIP code
GOODWILL INDUSTRIES OF FORT WORTH 4005 CAMPUS DRIVE FORT WORTH TX 76119
e Employee's
name, address, 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
1:1 Aavance
7 Sooal security tips
8 Allocated tips
10 Oependeflt
11 Nonqualified plans
care benefits
2 FederallOCOme tax withheld
14731.11
GOODWILL INDUSTRIES OF FORT WORTH 4005 CAMPUS DRIVE FORT WORTH TX 76119
e Employee's
Return
14731.11
913.33
14731.11
Tax
1 Wages, tiPS, other compensatlOl1
d Control number
4 ~OClal seCUrity tax withheld
5 Medicare wages and tipS
b Employer 10 number
SSN
451-81-4998
14731.11
c Employer's
a Employee's
2 Federal Income lax withheld
1 Wages, lipS, other compensation
SSN
451-81-4998
Emplo~ee'S FEDERAL furnis ed to the IRS
13 Stat Emp
12. 12b
1:1(,,;
Ret plan
payment
3rd-party sick pay
7 SOCial security tips
8 Allocated
10 Dependent
11 Nonqualified plans
care benefits
lips
\I Advance ~Ivpayment
13 Stat Emp
12. 12b
14 Other
I
Relplan
3rd-party sick pay
14 Other
12,
12,
12d
12"
... IX.I
..............•
15 State'
Emol,
er'
............... .
. •. IX.
16 <::tata wa as ti s etc
17 <::tate income tax
15 <::tate J"m 10 er'
19 Local Income tax
20 locality
18 Local wages, lips, etc
. . • . . . . .1~!~J ".1 .. state I,D Ii
18 Local wages, tips, etc
.................... Form W.2 Wage & Tax Statement
. ................ 2010
name
...............
Dept. of Ihe Treasury.IRS
OMS No, 1545.Q008
.
-1- ..............
. ....... state In
Ii
....................
EMPLOYEE'S to Employee
a EmPloSee'S SSN
451- 1-4998 d Control number
. ...............
11'; <::tatewa es II s etc
17 <:tale income tax
19 local
20 locality
Income tax
. . ...............
Form W.2 Wage & Tax Statement
Copy C t:or ~~~n~~t~~
1.4.7;3.1,1.1 .•
2010
RECORDS on the back
Dept. of the Treasury.IRS
10 number
1 Wages, tips, other com ensahon
7
2 Federal income tax withheld
1431.11 ,j
:sooal security wages
4 :SOCialsecuflty tax Withheld
5 Medicare wages and tips
75-0868393 c Employer's
OMS No. 1545.0008
~~~'fr'::~r: ~:."jl~oO$R:.tr.~h~e~~~~:~Re;;~::ie peRdy or Oll\efsallClIOr'lmay be impo~ ORyou ~hOS IRCOme ostaxable arid you fa~10reporl ~
14731 .11 b Employer
name
. ...............
913.33 6 Medicare tax withheld
14731.11
213.60
name, address, 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
of W-2
7 Social security tips
8 Allocated
10 Dependent
11 Nonqualified
care benefits
12b
", '" ... \'1 -I 18 local
9 Advance EIC payment plans
13 Stat Emp
12.
15 <:tate
tipS
Ret.plan
3fd~party sick pay
14 Other
.............. Em 10 er's state 1.0 /I
wages, tips, etc
..................... Form W-2 Wage & Tax Statement
.•.....
.1.4.7;3.1,1.1 ..
16 C:tate wa e
ti s etc.
19 Local income tax
...............
.
17 State income tax 20 Locality name
............... . . ............... 2010
Dept. of the Treasury-lRS
OMS No. 1545.QOO8