1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp.

1 Wages, tips, other comp. 2 Federal income tax withheld

Copy C For 19663.42 2265.10 Copy B 19663.42 2265.10

EMPLOYEE'S 3 Social security wages 4 Social security tax withheld To Be Filed With 3 Social security wages 4 Social security tax withheld
RECORDS Employee's
5 Medicare wages and tips 6 Medicare tax withheld FEDERAL 5 Medicare wages and tips 6 Medicare tax withheld
Tax Return

c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code
REH SERVICES COMPANY REH SERVICES COMPANY
REH SERVICES COMPANY REH SERVICES COMPANY
555 SOUTH MAIN ST. 555 SOUTH MAIN ST.
SALT LAKE CITY, UT 84111 SALT LAKE CITY, UT 84111
7 Social security tips 8 Allocated tips 12a Code See inst. for box 12 7 Social security tips 8 Allocated tips 12a Code See inst. for box 12

9 10 Dependent care benefits 12b Code 9 10 Dependent care benefits 12b Code

11 Nonqualified plans 14 Other 12c Code 11 Nonqualified plans 14 Other 12c Code

b Employer identification number 12d Code b Employer identification number 12d Code
20-3967749 20-3967749
13 Statutory Retirement Third-party 13 Statutory Retirement Third-party
employee plan sick pay employee plan sick pay
a Employee's social security number a Employee's social security number

119-45-2083 119-45-2083
e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code
GABRIEL OVALLES-RUBIERA GABRIEL OVALLES-RUBIERA
ST. 40#24 BEUENA VISTA ST. 40#24 BEUENA VISTA
SANTO DOMINGO NORTE, ID 11206 SANTO DOMINGO NORTE, ID 11206

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
ID 002973498 19663.42 779.00 ID 002973498 19663.42 779.00
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 2022 Form W-2 Wage and Tax Statement 2022
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 Dept. of the Treasury -- IRS This information is being furnished to the Internal Revenue Service. Dept. of the Treasury -- IRS
may be imposed on you if this income is taxable and you fail to report it.

Dept. of the Treasury -- IRS Dept. of the Treasury -- IRS

Form W-2 Wage and Tax Statement 2022 Form W-2 Wage and Tax Statement 2022
1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld

Copy 2 For 19663.42 2265.10 Copy 2 For 19663.42 2265.10

Employee's State, 3 Social security wages 4 Social security tax withheld Employee's State, 3 Social security wages 4 Social security tax withheld
City or Local City or Local
Income Tax 5 Medicare wages and tips 6 Medicare tax withheld Income Tax 5 Medicare wages and tips 6 Medicare tax withheld
Return Return

c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code
REH SERVICES COMPANY REH SERVICES COMPANY
REH SERVICES COMPANY REH SERVICES COMPANY
555 SOUTH MAIN ST. 555 SOUTH MAIN ST.
SALT LAKE CITY, UT 84111 SALT LAKE CITY, UT 84111
7 Social security tips 8 Allocated tips 12a Code 7 Social security tips 8 Allocated tips 12a Code

9 10 Dependent care benefits 12b Code 9 10 Dependent care benefits 12b Code

11 Nonqualified plans 14 Other 12c Code 11 Nonqualified plans 14 Other 12c Code

b Employer identification number 12d Code b Employer identification number 12d Code
20-3967749 20-3967749
13 Statutory Retirement Third-party 13 Statutory Retirement Third-party
employee plan sick pay employee plan sick pay
a Employee's social security number a Employee's social security number

119-45-2083 119-45-2083
e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code
GABRIEL OVALLES-RUBIERA GABRIEL OVALLES-RUBIERA
ST. 40#24 BEUENA VISTA ST. 40#24 BEUENA VISTA
SANTO DOMINGO NORTE, ID 11206 SANTO DOMINGO NORTE, ID 11206

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
ID 002973498 19663.42 779.00 ID 002973498 19663.42 779.00
18 Local wages, tips, etc. 19 Local income tax 20 Locality name 18 Local wages, tips, etc. 19 Local income tax 20 Locality name