a Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld a Employee's SSN 1 Wages, tips, other

a Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
644-12-2517 13388.52 983.35 644-12-2517 13388.52 983.35
OMB No. 1545-0008 3 Social security wages 4 Social security tax withheld OMB No. 1545-0008 3 Social security wages 4 Social security tax withheld
13487.06 836.20 13487.06 836.20
b Employer identification number 5 Medicare wages and tips 6 Medicare tax withheld b Employer identification number 5 Medicare wages and tips 6 Medicare tax withheld
02-0650722 13487.06 195.56 02-0650722 13487.06 195.56
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code

KILGORE INDUSTRIES KILGORE INDUSTRIES

10050 HOUSTON OAKS DRIVE 10050 HOUSTON OAKS DRIVE
HOUSTON, TX 77064 HOUSTON, TX 77064
d Control number 7 Social security tips 8 Allocated tips
e Employee's first name and initial Last name Suff.
JOSE ESPINOZA
e Employee's first name and initial Last name Suff.
15703 CYPRESS MEADOWS DR JOSE ESPINOZA
CHESITO05@GMAIL.COM
15703 CYPRESS MEADOWS DR
CYPRESS, TX 77429 CHESITO05@GMAIL.COM
f Employee's address and ZIP code CYPRESS, TX 77429
d Control number 7 Social security tips 8 Allocated tips
f Employee's address and ZIP code
9 10 Dependent care benefits 11 Nonqualified plans 13 Statutory Retirement Third-party
employee plan sick pay
14 Other 9 10 Dependent care benefits 11 Nonqualified plans
12a
D 98.54
12b 12a 14 Other
D 98.54
12c 12b

12d 12c

13 Statutory Retirement Third-party 12d

employee plan sick pay
15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 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 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form
W-2 Wage and Tax Statement 2021 Department of the Treasury-Internal Revenue Service Form
W-2 Wage and Tax Statement 2021 Department of the Treasury-Internal Revenue Service
Copy B - To Be Filed With Employee's FEDERAL Tax Return. Copy 2 - To Be Filed With Employee's State, City, or Local Income Tax Return.

a Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld a Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
644-12-2517 13388.52 983.35 644-12-2517 13388.52 983.35
OMB No. 1545-0008 3 Social security wages 4 Social security tax withheld OMB No. 1545-0008 3 Social security wages 4 Social security tax withheld
13487.06 836.20 13487.06 836.20
b Employer identification number 5 Medicare wages and tips 6 Medicare tax withheld b Employer identification number 5 Medicare wages and tips 6 Medicare tax withheld
02-0650722 13487.06 195.56 02-0650722 13487.06 195.56
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code

KILGORE INDUSTRIES KILGORE INDUSTRIES

10050 HOUSTON OAKS DRIVE 10050 HOUSTON OAKS DRIVE
HOUSTON, TX 77064 HOUSTON, TX 77064

e Employee's first name and initial Last name Suff. e Employee's first name and initial Last name Suff.
JOSE ESPINOZA JOSE ESPINOZA
15703 CYPRESS MEADOWS DR 15703 CYPRESS MEADOWS DR
CHESITO05@GMAIL.COM CHESITO05@GMAIL.COM
CYPRESS, TX 77429 CYPRESS, TX 77429
f Employee's address and ZIP code f Employee's address and ZIP code
d Control number 7 Social security tips 8 Allocated tips d Control number 7 Social security tips 8 Allocated tips

9 10 Dependent care benefits 11 Nonqualified plans 9 10 Dependent care benefits 11 Nonqualified plans

12a 14 Other 12a 14 Other

D 98.54 D 98.54
12b 12b

12c 12c

12d 12d

13 Statutory Retirement Third-party 13 Statutory Retirement Third-party

employee plan sick pay employee plan sick pay
15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 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 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form
W-2 Wage and Tax Statement
2021 Copy C - For EMPLOYEE'S RECORDS. Form
W-2 Wage and Tax Statement
2021 Department of the Treasury-Internal Revenue Service
Copy 2 - To Be Filed With Employee's State, City, or Local Income Tax Return.
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.