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a Employee’s social security number

22222 OMB No. 1545-0008


160-80-5246
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
$35,000.00 $2,545.50
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
$35,000.00 $1,413.60
Enter y ouisiana, lc 5 Medicare wages and tips 6 Medicare tax withheld
Jefferson i ay,
Jefferson, $35,000.00 $330.60
7 Social security tips 8 Allocated tips

d Control number 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
o
d
e

LINDSEY MARIE MCGRAW 13 Statutory


employee
Retirement
plan
Third-party
sick pay 12b
s ford Dr, o
d
e
pt
est onroe, 14 Other 12c
o
d
e

12d
o
d
e

f Employee’s address and ZIP code


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
CA 94-0322450 $35,000.00 $1,389.76

Form W-2 Wage and Tax Statement 2020 Department of the Treasury—Internal Revenue Service

Copy 1—For State, City, or Local Tax Department

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