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Wage and Tax Statement: Page 1 / 4
Wage and Tax Statement: Page 1 / 4
Employee's social security number
638825740 OMB No. 15450008
Department of the Treasury—Internal Revenue Service
This information is being furnished to the Internal Revenue Service.
If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.
a Employee's social security number
638825740 OMB No. 15450008
a Employee's social security number
638825740 OMB No. 15450008
Department of the Treasury—Internal Revenue Service
a Employee's social security number
638825740 OMB No. 15450008
Department of the Treasury—Internal Revenue Service