RR Donnelley 2012 Tax Forms : Page 17

PRESSURE SEAL W -2 F o r m s ECC Z FOLD 5980 -1287 -2222 ECC Z FOLD 5980 -1301 -2222 V FOLD 5980 -0285 -1222 FORM 1287 Department of the Treasury-Internal Revenue Service 16-0431690 Department of the Treasury Internal Revenue Service OMB No. 1545-0008 Department of the Treasury Internal Revenue Service OMB No. 1545-0008 a Control number 1 Wages, tips, other compensation 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld a Control number 1 Wages, tips, other compensation 2 Federal income tax withheld 4 Social security tax withheld S2032A Form OMB NO. 1545-0008 3 Social security wages 5 Medicare wages and tips OMB NO. 1545-0008 3 Social security wages This information is being furnished to the Internal Revenue Service. Wage and Tax W-2 Statement Copy B To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. c Employer's name, address, and ZIP code 2012 C o d e 1 Wages, tips, other compensation 2 Federal income tax withheld S2001 S2032A Department of the Treasury Internal Revenue Service OMB No. 1545-0008 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips c Employer's name, address, and ZIP code 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips c Employer's name, address, and ZIP code 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8510027741 10 Dependent care benefits 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 1 1A c Employer's name, address and ZIP code c Employer's name, address and ZIP code 8510020608 12a See instructions for box 12 5 Medicare wages and tips 6 Medicare tax withheld 1A A S2001 12b 7 Social security tips 8 Allocated tips 7 Social security tips 10 Dependent care benefits 12b 8 Allocated tips 11 Nonqualified plans 12c 9 12a See instructions for box 12 7 Social security tips 10 Dependent care benefits 12b 8 Allocated tips 11 Nonqualified plans 12c 9 b Employer identification number d Employee's social security number C o d e C o d e C o d e C o d e C o d e 12a See instructions for box 12 e Employee's name, address, and ZIP code S2032A 12c C o d e 9 14 Other B FORM 285 7 Social security tips 10 Dependent care benefits 8 Allocated tips 11 Nonqualified plans 12c 9 12a See instructions for box 12 12d 7 Social security tips 10 Dependent care benefits 12b 8 Allocated tips 11 Nonqualified plans 12c 9 C o d e C o d e 12d C o d e C o d e 12d 12d C o d e 11 Nonqualified plans C o d e C o d e C o d e C o d e C o d e 12a See instructions for box 12 12d FORM MW283 12b b Employer's identification number 13 Statutory Retirement plan Third-party sick pay d Employee's social security number 14 Other b Employer's identification number 13 Statutory Retirement plan Third-party sick pay d Employee's social security number 14 Other C o d e C o d e C o d e 13 Statutory emp Retirement plan Third-party sick pay b Employer identification number 13 Statutory Retirement plan Third-party sick pay d Employee's social security number 14 Other b Employer identification number 13 Statutory Retirement plan Third-party sick pay d Employee's social security number 14 Other employee employee e Employee's name, address and ZIP code PressureSeal Pat. Nos. 4,918,128; 4,928,875 and other pats. -0221 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 may be imposed on you if this income is taxable and you fail to report it. e Employee's name, 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 PressureSeal Patents 4,918,128; 5,829,670; and other pats. employee employee PRINTED IN USA FORM MW1289 e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code Form W-2 Wage and Tax Statement PRINTED IN USA 2012 Form 15 State Employer's state I.D. No. 16 State wages, tips, etc. 2012 Form 15 State Employer's state I.D. No. 16 State wages, tips, etc. Copy 2 To Be Filed with Employee's State, City, or Local Income Tax Return. c Employer's name, address, and ZIP code 2012 C o d e 1 Wages, tips, other compensation 2 Federal income tax withheld OMB No. 1545-0008 10 Dependent care benefits 3 Social security wages 4 Social security tax withheld Form 15 State Employer's state ID number 16 State wages, tips, etc. Form 15 State Employer's state ID number 16 State wages, tips, etc. and Tax W-2 Wage Statement 17 State income tax 18 Local wages, tips, etc. and Tax W-2 Wage Statement 17 State income tax 18 Local wages, tips, etc. 12a See instructions for box 12 5 Medicare wages and tips 6 Medicare tax withheld W-2 Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc. W-2 Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc. Copy C For EMPLOYEE'S RECORDS 19 (See Notice to Employee on back of Copy B.) Local income tax 20 Locality name Copy B To Be Filed With Employee's FEDERAL Tax Return 16-0331690 19 Local income tax 20 Locality name 12b b Employer identification number d Employee's social security number C o d e 7 Social security tips 8 Allocated tips O G 2012 OMB No. 1545-0008 This information is being furnished to the Internal Revenue Service. 19 Local income tax 20 Locality name Department of the Treasury-Internal Revenue Service 12c e Employee's name, address, and ZIP code C o d e 9 14 Other Copy 2 For State, City or Local Tax Department 16-0331690 Department of the Treasury Internal Revenue Service 2 Federal income tax withheld 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 4 Social security tax withheld 6 Medicare tax withheld 2012 OMB No. 1545-0008 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 may be imposed on you if this income is taxable and you fail to report it. 19 Local income tax 20 Locality name O G PRINTED IN USA Copy 2 For State, City or Local Tax Department 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips a Control number PressureSeal Patents 4,918,128; 4,928,875. 1 Wages, tips, other compensation 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld a Control number 1 Wages, tips, other compensation 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld Department of the Treasury Internal Revenue Service 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld O G 12d C o d e 11 Nonqualified plans OMB NO. 1545-0008 3 Social security wages 5 Medicare wages and tips c Employer's name, address and ZIP code OMB NO. 1545-0008 3 Social security wages 5 Medicare wages and tips c Employer's name, address and ZIP code 13 Statutory emp Retirement plan Third-party sick pay O G c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code PressureSeal Patents 4,918,128; 4,928,875; 5,372,302 and other pats. O G 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 Department of the Treasury O G 20 Locality name Internal Revenue Service 7 Social security tips 10 Dependent care benefits 12b 8 Allocated tips 11 Nonqualified plans 12c 9 12a See instructions for box 12 7 Social security tips 10 Dependent care benefits 12b 8 Allocated tips 11 Nonqualified plans 12c 9 7 Social security tips 8 Allocated tips 11 Nonqualified plans 12c 9 12a See instructions for box 12 12d 7 Social security tips 10 Dependent care benefits 12b 8 Allocated tips 11 Nonqualified plans 12c 9 W 2 -COPY C W 2 -COPY B O G C o d e C o d e C o d e C o 12a See instructions for box 12 C o d e C o d e 12d C o d e C o d e 12d O Form Wage and Tax W-2 Statement b Employer's identification number 13 Statutory Retirement plan Third-party sick pay d Employee's social security number 14 Other b Employer's identification number 13 Statutory Retirement plan Third-party sick pay d G e d Employee's social security number Copy C for EMPLOYEE'S RECORDS. (See Notice to Employee on back of Copy B). c Employer's name, address, and ZIP code 2012 C o d e 1 Wages, tips, other compensation 2 Federal income tax withheld 10 Dependent care benefits 12b C o d e C o d e C o d e C o d e 12a See instructions for box 12 12d OMB No. 1545-0008 10 Dependent care benefits 3 Social security wages 4 Social security tax withheld C o d e C o d e C o d e C o d e b Employer identification number 13 Statutory Retirement plan Third-party sick pay d Employee's social security number 14 Other b Employer identification number 13 Statutory Retirement plan Third-party sick pay d Employee's social security number 14 Other employee employee 14 Other 12a See instructions for box 12 5 Medicare wages and tips 6 Medicare tax withheld employee employee 12b 7 Social security tips 8 Allocated tips e Employee's name, address and ZIP code e Employee's name, address and ZIP code b Employer identification number d Employee's social security number O G O G 12c e Employee's name, address, and ZIP code C o d e 9 14 Other 12d C o d e 11 Nonqualified plans 8510027743 ©2006, Moore Wallace. All rights reserved. PressureSeal Patents 4,918,128; 5,829,670; and other pats. -0667 C o d e e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code PRINTED IN USA Form 15 State Employer's state ID number 16 State wages, tips, etc. Form 15 State Employer's state ID number 16 State wages, tips, etc. 2012 Form 15 State Employer's state I.D. No. 16 State wages, tips, etc. 2012 Form 15 State Employer's state I.D. No. 16 State wages, tips, etc. 13 Statutory emp FORM 1301 W-2 Statement Wage and Tax 17 State income tax 18 Local wages, tips, etc. W-2 Statement Wage and Tax 17 State income tax 18 Local wages, tips, etc. Retirement plan Third-party sick pay 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 may be imposed on you if this income is taxable and you fail to report it. W-2 Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc. W-2 Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc. Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return. 16-0331690 19 Local income tax 20 Locality name Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return. 16-0331690 19 Local income tax 20 Locality name 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 2012 19 Local income tax 20 Locality name Department of the TreasuryóInternal Revenue Service Copy B To Be Filed with Employee's FEDERAL Tax Return. 2012 19 Local income tax 20 Locality name Copy C For EMPLOYEE'S RECORDS. (See Notice to Employee on back of Copy B). Department of the Treasury-Internal Revenue Service Department of the Treasury-Internal Revenue Service FROM: FROM: FROM: Important Tax Document Enclosed FIRST-CLASS MAIL SEE REVERSE SIDE FOR OPENING INSTRUCTIONS SEE REVERSE SIDE FOR OPENING INSTRUCTIONS FIRST-CLASS MAIL Important Tax Document Enclosed Form size is 8 1 ⁄ 2 " x 11" SEE REVERSE SIDE FOR OPENING INSTRUCTIONS Important Tax Document Enclosed First-Class Mail Form size is 8 1 ⁄ 2 " x 14" Form size is 8 ⁄ 2 " x 14", Continuous 9 ⁄ 2 " x 14" 1 1 Item No. MW 28 5 * MW 28 3 * *Duplex Printing Required Description Cut Sheet Cut Sheet Blank w/Backers Item No. Description Item No. M W 1 3 01 Description Cut Sheet M W 1 2 8 7 M W 2 9 1 M W 1 2 8 9 Cut Sheet Continuous Cut Sheet Blank w/Backers Z FOLD PressureSeal Pat. Nos. 4,918,128; 5,253,798; 5,829,670 and other pats. B2042 5980 -0295 -2222 Same Format as Laser Cut Sheet MW275 on Page 4. FORM 295 OMB No. 1545-0008 a Control number 7 Social security tips 8 Allocated tips 9 c Employer's name, address, and ZIP code PRINTED IN USA OMB No. 1545-0008 a Control number 7 Social security tips 8 Allocated tips 9 c Employer's name, address, and ZIP code 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 may be imposed on you if this income is taxable and you fail to report it. 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 10 Dependent care benefits 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 11 Nonqualified plans 12a C o d e This information is being furnished to the Internal Revenue Service. 1 Wages, tips, other compensation 2 Federal income tax withheld 3 Social security wages 5 Medicare wages and tips 10 Dependent care benefits 4 Social security tax withheld 6 Medicare tax withheld 11 Nonqualified plans 12a C o d e See instructions for box 12 See instructions for box 12 12b C o d e 12b C o d e 12c C o d e 12c C o d e b Employer identification number d Employee's social security number 12d C o d e b Employer identification number Retirement plan Third-party sick pay d Employee's social security number 12d C o d e e Employee's name, address, and ZIP code 13 Statutory employee 14 Other e Employee's name, address, and ZIP code 13 Statutory employee 14 Other Retirement plan Third-party sick pay W-2 Form 2012 OMB No. 1545-0008 a Control number 7 Social security tips 8 Allocated tips 9 Wage and Tax Statement 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 2012 OMB No. 1545-0008 a Control number 7 Social security tips 8 Allocated tips 9 Form 15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax W-2 15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax Wage and Tax Statement 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Copy C for EMPLOYEE'S RECORDS. (See Notice to Employee on back of Copy B.) 16-0331690 Department of the Treasury Internal Revenue Service (Rev. February 2002) Copy B To Be Filed With Employee's FEDERAL Tax Return 16-0331690 Department of the Treasury Internal Revenue Service (Rev. February 2002) 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 10 Dependent care benefits 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 11 Nonqualified plans 12a C o d e 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 10 Dependent care benefits 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 11 Nonqualified plans 12a C o d e c Employer's name, address, and ZIP code See instructions for box 12 c Employer's name, address, and ZIP code See instructions for box 12 Cut sheet forms are pack-aged 500 sheets/pack, 2000 sheets/carton. Min. order qty. for cut sheet pressure seal is 500. Continuous pressure seal forms sold only in full cartons of 2000. O G 12b C o d e SAME TS A FORM 011! AS 2 12b C o d e 12c C o d e 12c C o d e b Employer identification number d Employee's social security number 12d C o d e b Employer identification number Retirement plan Third-party sick pay d Employee's social security number 12d C o d e e Employee's name, address, and ZIP code Statutory 13 employee e Employee's name, address, and ZIP code Statutory 13 employee Retirement plan Third-party sick pay 14 Other 14 Other W-2 2012 Form Wage and Tax Statement 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 2012 Form 15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax W-2 15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax Wage and Tax Statement 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Copy 2 To Be Filed With Employee's State Tax Return 16-0331690 Department of the Treasury Internal Revenue Service (Rev. February 2002) THIS COPY TO BE FILED WITH EMPLOYEE'S LOCAL OR CITY TAX RETURN WHEN REQUIRED 16-0331690 Department of the Treasury Internal Revenue Service (Rev. February 2002) SEE REVERSE SIDE FOR OPENING INSTRUCTIONS Form size is 14 7 ⁄ 8 " x 11" O G Item No. M W 2 95 Description Continuous – R o ta t e d F o r m a t Imprinting Available Upon Request. Free Samples Available Upon Request. 17

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