Wage and Tax Statement: Last Name Suff
Wage and Tax Statement: Last Name Suff
$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
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o
d
e
12d
C
o
d
e