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W2 Data
W2 Data
364-13-4523 www.irs.gov/efile
OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
37-1756977 30897.14 3056.78
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
30897.14 1915.60
DEPARTMENT OF SOCIAL & HEALTH SE
Payer for SANDRA WILLIAMS 5 Medicare wages and tips 6 Medicare tax withheld
PO BOX 45842 30897.14 447.99
OLYMPIA , WA 98504-5842
7 Social security tips 8 Allocated tips
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
C
o
Joshlyn Tesler d
e
14 Other 12c
PML 37.06 C
o
PFL 41.08 d
e
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
Form Statement
Copy B—To Be Filed With Employee’s FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
a Employee’s social security number This information is being furnished to the Internal Revenue Service. If you
OMB No. 1545-0008 are required to file a tax return, a negligence penalty or other sanction
364-13-4523 may be imposed on you if this income is taxable and you fail to report it.
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
37-1756977 30897.14 3056.78
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
30897.14 1915.60
DEPARTMENT OF SOCIAL & HEALTH SE
Payer for SANDRA WILLIAMS 5 Medicare wages and tips 6 Medicare tax withheld
PO BOX 45842 30897.14 447.99
OLYMPIA , WA 98504-5842
7 Social security tips 8 Allocated tips
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12
C
o
Joshlyn Tesler d
e
14 Other 12c
PML 37.06 C
o
PFL 41.08 d
e
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