Professional Documents
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Kind Kind sick pay
of Hshld. Medicare of State/local
Payer CT-1 emp. govt. emp. Employer non-501c State/local 501c Federal govt.
c Total number of Forms W-2 d Establishment number 1 Wages, tips, other compensation 2 Federal income tax withheld
1 $136,100.00 $7,650.00
e Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld
94-3267344 $136,100.00 $8,438.20
f Employer’s name 5 Medicare wages and tips 6 Medicare tax withheld
PFIZER PHARMACEUTICALS $138,000.00 $2,001.00
7 Social security tips 8 Allocated tips
1101 POYDRAS
NEW ORLEANS, LA 70112 $0.00 $0.00
10 Dependent care benefits
9
$0.00
11 Nonqualified plans 12a Deferred compensation
15 State Employer’s state ID number 14 Income tax withheld by payer of third-party sick pay
LA 94 - 3267344 $0.00
16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax
$135,000.00 $2,750.00 $0.00 $0.00
Employer's contact person Employer's telephone number For Official Use Only
JOHN WILLIAMS 240-451-1015 Ext.
Employer's fax number Employer's email address
JOHN.WILLIAMSXX@OUTLOOK.COM
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature ▶
YOUR COPY Date ▶
Title ▶
Form W-3 Transmittal of Wage and Tax Statements 2021 Department of the Treasury
Internal Revenue Service
Purpose of Form
Complete a Form W-3 Transmittal only when filing paper Copy A of Form(s)
W-2, Wage and Tax Statement. Don't file Form W-3 alone. All paper forms
must comply with IRS standards and be machine readable. Photocopies are
not acceptable. Use a Form W-3 even if only one paper Form W-2 is being
filed. Make sure both the Form W-3 and Form(s) W-2 show the correct tax year
and Employer Identification Number (EIN). Make a copy of this form and keep
it with Copy D (For Employer) of Form(s) W-2 for your records. The IRS
recommends retaining copies of these forms for 4 years.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
a Employee’s social security number
*****9012 OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
94-3267344 $136,100.00 $7,650.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
PFIZER PHARMACEUTICALS $136,100.00 $8,438.20
1101 POYDRAS 5 Medicare wages and tips 6 Medicare tax withheld
NEW ORLEANS, LA 70112
$138,000.00 $2,001.00
7 Social security tips 8 Allocated tips
$0.00 $0.00
d Control number 9 10 Dependent care benefits
$0.00
e Employee’s first name and initial Last name Suff 11 Nonqualified plans 12a
C
o
RANDI EVANS $0.00 d
e D $1,200.00
1122 ROSE AVENUE 13 Statutory Retirement Third-party 12b
employee plan sick pay C
NEW ORLEANS, LA 70122 o
d
DD $1,000.00
e
14 Other 12c
C
o
d
e $0.00
$0.00
12d
C
$0.00 o
d
$0.00
e
14 Other 12c
C
o
d
e $0.00
$0.00
12d
C
o
$0.00 d
e $0.00
f Employee’s address and ZIP code
$0.00
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
LA 94 - 3267344 $135,000.00 $2,750.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00
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
a Employee’s social security number This information is being furnished to the Internal Revenue Service. If you are
OMB No. 1545-0008 required to file a tax return, a negligence penalty or other sanction may be
*****9012 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
94-3267344 $136,100.00 $7,650.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
PFIZER PHARMACEUTICALS $136,100.00 $8,438.20
1101 POYDRAS 5 Medicare wages and tips 6 Medicare tax withheld
NEW ORLEANS, LA 70112
$138,000.00 $2,001.00
7 Social security tips 8 Allocated tips
$0.00 $0.00
d Control number 9 10 Dependent care benefits
$0.00
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o
RANDI EVANS $0.00 d
e D $1,200.00
1122 ROSE AVENUE 13 Statutory Retirement Third-party 12b
employee plan sick pay C
NEW ORLEANS, LA 70122 o
d
DD $1,000.00
e
14 Other 12c
C
o
d
e $0.00
$0.00
12d
C
$0.00 o
d
$0.00
e
f Employee’s address and ZIP code
$0.00
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
LA 94 - 3267344 $135,000.00 $2,750.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00
Form W-2 Wage and Tax Statement 2021 Safe, accurate,
FAST! Use
Copy C—For EMPLOYEE’S RECORDS Department of the Treasury—Internal Revenue Service
a Employee’s social security number Safe, accurate, Visit the IRS website at
OMB No. 1545-0008 FAST! Use www.irs.gov/efile
*****9012
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
94-3267344 $136,100.00 $7,650.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
PFIZER PHARMACEUTICALS $136,100.00 $8,438.20
1101 POYDRAS 5 Medicare wages and tips 6 Medicare tax withheld
NEW ORLEANS, LA 70112
$138,000.00 $2,001.00
7 Social security tips 8 Allocated tips
$0.00 $0.00
d Control number 9 10 Dependent care benefits
$0.00
e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o
RANDI EVANS $0.00 d
e D $1,200.00
1122 ROSE AVENUE 13 Statutory
employee
Retirement
plan
Third-party
sick pay 12b
C
NEW ORLEANS, LA 70122 o
d
e DD $1,000.00
14 Other 12c
C
o
d
e $0.00
$0.00
12d
C
$0.00 o
d
$0.00
e
f Employee’s address and ZIP code
$0.00
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
LA 94 - 3267344 $135,000.00 $2,750.00 $0.00 $0.00
$0.00 $0.00 $0.00 $0.00
Form W-2 Wage and Tax Statement
Copy B—To Be Filed With Employee’s FEDERAL Tax Return.
2021 Department of the Treasury—Internal Revenue Service
This information is being furnished to the Internal Revenue Service.
Notice to Employee
Do you have to file? Refer to the Instructions for Forms 1040 and 1040-SR to determine if you Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask your
are required to file a tax return. Even if you don't have to file a tax return, you may be eligible employer to correct your employment record. Be sure to ask the employer to file Form W-2c,
for a refund if box 2 shows an amount or if you are eligible for any credit. Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any
Earned income credit (EIC). You may be able to take the EIC for 2021 if your adjusted gross name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your
income (AGI) is less than a certain amount. The amount of the credit is based on income and copies of Form W-2c from your employer for all corrections made so you may file them with
family size. Workers without children could qualify for a smaller credit. You and any qualifying your tax return. If your name and SSN are correct but aren't the same as shown on your social
children must have valid social security numbers (SSNs). You can't take the EIC if your security card, you should ask for a new card that displays your correct name at any SSA office or
investment income is more than the specified amount for 2021 or if income is earned for by calling 1-800-772-1213. You also may visit the SSA Website at www.SSA.gov.
services provided while you were an inmate at a penal institution. For 2021 income limits and Cost of employer-sponsored health coverage (if such cost is provided by the employer).
more information, visit www.irs.gov/EITC. See also Pub. 596, Earned Income Credit. Any EIC that The reporting in box 12, using code DD, of the cost of employer-sponsored health coverage is
is more than your tax liability is refunded to you, but only if you file a tax return. for your information only. The amount reported with code DD is not taxable.
Employee's social security number (SSN). For your protection, this form may show only the Credit for excess taxes. If you had more than one employer in 2021 and more than $8,853.60
last four digits of your SSN. However, your employer has reported your complete SSN to the IRS in social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able
and SSA. to claim a credit for the excess against your federal income tax. If you had more than one
Clergy and religious workers. If you aren't subject to social security and Medicare taxes, see railroad employer and more than $5,203.80 in Tier 2 RRTA tax was withheld, you may also be
Pub. 517, Social Security and Other Information for Members of the Clergy and Religious able to claim a credit. See the Instructions for Forms 1040 and 1040-SR and Pub. 505, Tax
Workers. Withholding and Estimated Tax.
(See also Instructions for Employee on the back of Copy C.)