Copy B To Be Filed With Employee's OMB No. Copy C For EMPLOYEE'S RECORDS OMB No.

FEDERAL Tax Return

a Employee's social 1 Wages, tips, other comp.
2022 1545-0008
2 Federal income tax withheld
(See Notice to Employee on back of Copy B.)
a Employee's social 1 Wages, tips, other comp.
2022 1545-0008
2 Federal income tax withheld
security number 4308.00 189.55 security number 4308.00 189.55
844-33-0392 3 Social security wages 4 Social security tax withheld 844-33-0392 3 Social security wages 4 Social security tax withheld
b Employer ID number 4308.00 267.10 b Employer ID number 4308.00 267.10
20-5048313 5 Medicare wages and tips 6 Medicare tax withheld 20-5048313 5 Medicare wages and tips 6 Medicare tax withheld
4308.00 62.47 4308.00 62.47
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code

The Market at Mountain Village LLC - Vail The Market at Mountain Village LLC - Vail
490 Sherman Street 490 Sherman Street

Ridgway, CO 81432 Ridgway, CO 81432

d Control Number d Control Number
0783 8149 Herrera Camila M 814 0783 8149 Herrera Camila M 814
e Employee's first name and initial Last name e Employee's first name and initial Last name

Camila M Herrera Camila M Herrera

450 E. Lionshead Circle 450 E. Lionshead Circle
Vail, CO 81657 Vail, CO 81657
f Employee's address, and ZIP code f Employee's address, and ZIP code
7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9

10 Dependent care benefits 11 Nonqualified plans 12a Code 10 Dependent care benefits 11 Nonqualified plans 12a Code

13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code

Retirement plan 12c Code Retirement plan 12c Code

3rd party sick pay 12d Code 3rd party sick pay 12d Code

CO 42-40141 4308.00 56.00 CO 42-40141 4308.00 56.00

15 State Emplr.'s state I.D. # 16 State wages, tips, etc. 17 State income tax 15 State Emplr.'s state I.D. # 16 State wages, tips, etc. 17 State income tax
18 Local wages, tips, etc. 19 Local income tax 20 Locality name 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement Dept. of the Treasury - IRS Form W-2 Wage and Tax Statement Dept. of the Treasury - IRS
This information is being furnished to the Internal Revenue Service This information is being furnished to the IRS. If you are required to file a tax return, a negligence
penalty/other sanction may be imposed on you if this income is taxable and you fail to report it.
Copy 2 To Be Filed With Employee's State, OMB No. Extra Employee Copy OMB No.
City, or Local Income Tax Return
a Employee's social 1 Wages, tips, other comp.
2022 1545-0008
2 Federal income tax withheld a Employee's social 1 Wages, tips, other comp.
2022 1545-0008
2 Federal income tax withheld
security number 4308.00 189.55 security number 4308.00 189.55
844-33-0392 3 Social security wages 4 Social security tax withheld 844-33-0392 3 Social security wages 4 Social security tax withheld
b Employer ID number 4308.00 267.10 b Employer ID number 4308.00 267.10
20-5048313 5 Medicare wages and tips 6 Medicare tax withheld 20-5048313 5 Medicare wages and tips 6 Medicare tax withheld
4308.00 62.47 4308.00 62.47
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code

The Market at Mountain Village LLC - Vail The Market at Mountain Village LLC - Vail
490 Sherman Street 490 Sherman Street

Ridgway, CO 81432 Ridgway, CO 81432

d Control Number d Control Number
0783 8149 Herrera Camila M 814 0783 8149 Herrera Camila M 814
e Employee's first name and initial Last name e Employee's first name and initial Last name

Camila M Herrera Camila M Herrera

450 E. Lionshead Circle 450 E. Lionshead Circle
Vail, CO 81657 Vail, CO 81657
f Employee's address, and ZIP code f Employee's address, and ZIP code
7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9

10 Dependent care benefits 11 Nonqualified plans 12a Code 10 Dependent care benefits 11 Nonqualified plans 12a Code

13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code

Retirement plan 12c Code Retirement plan 12c Code

3rd party sick pay 12d Code 3rd party sick pay 12d Code

CO 42-40141 4308.00 56.00 CO 42-40141 4308.00 56.00

15 State Emplr.'s state I.D. # 16 State wages, tips, etc. 17 State income tax 15 State Emplr.'s state I.D. # 16 State wages, tips, etc. 17 State income tax
18 Local wages, tips, etc. 19 Local income tax 20 Locality name 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement Dept. of the Treasury - IRS Form W-2 Wage and Tax Statement Dept. of the Treasury - IRS

The Market at Mountain Village LLC - Vail

490 Sherman Street
Ridgway, CO 81432

0783 8149 Herrera Camila M 814

Camila M Herrera
450 E. Lionshead Circle
Vail, CO 81657