a: Employees Social Security Number

OMB No.1545-0008

b Employers Identification Number (EIN) 1 Wages, tips, other compensation 2 Federal Income tax withheld
120,000.00 19527.5

с Employers Name, Address and Zip code 3 Social security wages 4 Social Security tax withheld
JOHN DOE 120,000.00 7440
123 ABC AVE
5 Medicare Wages and tips 6 Medicare tax withheld
LETTERS, NY 12345
120,000.00 1740

7 Social security tips 8 Allocated tips

d Control Number 9 10 Dependet care benefits

e Employers Name, Address and Zip codes 11 Nonqualified Plans 12a

ABC COMPANY
ALPHABET, NY 12345
13 Statutory Retirement Third-party 12b
employee plan sick pay

14 Others 12c

12d

15 State Employers State ID number 16 State, Wages, tips etc 17 State income tax 18 Local wages, tips etc 19 Local income tax 20 Locality name
NY 123456789 120,000.00 6695.09

From
W-2 Wage and Tax 2023 Department of the Treasury -- Internal Revenue System
For Privacy Act and Paperwork Reduction Act Notice,
Statements see separate instructions

Copy D -- For Employer