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a Employee’s social security number

22222 OMB No. 1545-0008


593925598
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld

$63,890.00 $8,832
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

$3927.88 $0.00
USAF REGIONAL HOSPITAL 5 Medicare wages and tips 6 Medicare tax withheld
307 BOATNER ROAD SUITE 114
BOATNER ROAD, FL 32542-1282 $922.08 $0.00
7 Social security tips 8 Allocated tips

d Control number 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o
d
e

AUSTIN L MARLER 13 Statutory Retirement Third-party 12b


employee plan sick pay C
o
115 KOON ST d
e
FORT WALTON BEACH, FL 32547
14 Other 12c
C
o
d
e

12d
C
o
d
e

f Employee’s address and ZIP code


15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

FL 83-1394083 $63,890.00 $0.00

Form W-2 Wage and Tax Statement


Copy 1—For State, City, or Local Tax Department
2020
Department of the Treasury—Internal Revenue Service

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