a Employee’s social security number

000-00-0000 OMB No. 1545-0008

b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
12-3456789 $40,000 $4,000
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
$40,000 $2,400
Fake Company
5 Medicare wages and tips 6 Medicare tax withheld
1234 Fake Dr
$40,000 $600
Augusta, GA 30909
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
C
o
d D $2,233.02
Casey Smith e
13 Statutory Retirement Third-party 12b
4321 Fake Dr employee plan sick pay C

Augusta, GA 30909 ✘
o
d
e
DD $2,687.04
14 Other 12c
C
o
d
e

12d
C
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
GA 1234567YZ $20,000 $1,750

SC 7654321AB $20,000 $1,750

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

Form Statement
Copy 2—To Be Filed With Employee’s State, City, or Local
2019
Income Tax Return