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- 2021
1 of 1
2021
1 Wages, tips, other compensation 2 Federal Income tax withheld 1 Wages, tips, other compensation 2 Federal Income tax withheld
2017
24500.48 1065.80 24500.48 1065.80
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
608-78-3771 608-78-3771
b Employer's FED ID number d Control number b Employer's FED ID number d Control number
56-1874931 01138098 56-1874931 01138098
2020
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code
2018
9 10 Dependent care benefits 9 10 Dependent care benefits
11 Nonqualified plans 12a See instructions for box 12 11 Nonqualified plans 12a See instructions for box 12
13 Statutory Employee
Retirement plan
Third-Party Sick pay 12b 13 Statutory Employee
Retirement plan
Third-Party Sick pay 12b
12d 12d
e Employee's first name and initial Last name Suff. e Employee's first name and initial Suff.Last name
FERMIN CASTRO FERMIN CASTRO
2500 NORTH 38TH ST 2500 NORTH 38TH ST
FORT SMITH AR 72904 FORT SMITH AR 72904
f Employee's address and ZIP code f Employee's address and ZIP code
15 State Employer's state ID 18 Local wages, tips, etc 15 State Employer's state ID 18 Local wages, tips, etc
AR 12265126-WHW AR 12265126-WHW
16 State wages, tips, etc. 19 Local income tax 16 State wages, tips, etc. 19 Local income tax
24500.48 24500.48
17 State income tax 20 Locality name 17 State income tax 20 Locality name
553.63 553.63
Form OMB. No. 1545-0008 Form
Dept. of the Treasury - Internal Revenue Service. This information isOMB.
beingNo. 1545-0008
furnished to the IRS. If you are required
Dept.to
offile
theaTreasury
tax return, a negligence
- Internal penalty or other sanction may b
Revenue
W-2 Wage and Tax Statement
2021 W-2 Wage and Tax Statement
2021 Service
Copy C for Employee's records Copy 2 To Be Filed With Employee's STATE Income Tax Return
1 Wages, tips, other compensation 2 Federal Income tax withheld 1 Wages, tips, other compensation 2 Federal Income tax withheld
24500.48 1065.80 24500.48 1065.80
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
24500.48 1519.03 24500.48 1519.03
5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
24500.48 355.26 24500.48 355.26
a Employee's SSA number Employer use only a Employee's SSA number Employer use only
608-78-3771 608-78-3771
b Employer's FED ID number d Control number b Employer's FED ID number d Control number
56-1874931 01138098 56-1874931 01138098
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code
11 Nonqualified plans 12a See instructions for box 12 11 Nonqualified plans 12a See instructions for box 12
13 Statutory Employee
Retirement plan
Third-Party Sick pay 12b 13 Statutory Employee
Retirement plan
Third-Party Sick pay 12b
12d 12d
e Employee's first name and initial Last name Suff. e Employee's first name and initial Last name Suff.
FERMIN CASTRO FERMIN CASTRO
2500 NORTH 38TH ST 2500 NORTH 38TH ST
FORT SMITH AR 72904 FORT SMITH AR 72904
f Employee's address and ZIP code f Employee's address and ZIP code
15 State Employer's state ID 18 Local wages, tips, etc 15 State Employer's state ID 18 Local wages, tips, etc
AR 12265126-WHW AR 12265126-WHW
16 State wages, tips, etc. 19 Local income tax 16 State wages, tips, etc. 19 Local income tax
24500.48 24500.48
17 State income tax 20 Locality name 17 State income tax 20 Locality name
553.63 553.63
Form OMB. No. 1545-0008 Dept. of the Treasury - Internal Revenue Form OMB. No. 1545-0008
Wage and Tax StatementDept. of the Treasury - Internal Revenue
W-2 Wage and Tax StatementService
2021 W-2 2021
Service
Copy B To Be Filed With Employee's FEDERAL Tax Return Copy 2 To Be Filed With Employee's CITY or LOCAL Income Tax Return