This document contains four copies of a Form W-2 Wage and Tax Statement for the year 2011. The Form W-2 provides information about an employee's wages, taxes, and other compensation for the tax year. It includes boxes for the employer and employee identification numbers and addresses, amounts of wages, taxes withheld, and other compensation details. The copies are labeled as being for filing with the employee's federal tax return, state/local tax returns, and as a record for the employee.
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Copy B To Be Filed With Employee S FEDERAL Tax Return: See Instructions For Box 12
This document contains four copies of a Form W-2 Wage and Tax Statement for the year 2011. The Form W-2 provides information about an employee's wages, taxes, and other compensation for the tax year. It includes boxes for the employer and employee identification numbers and addresses, amounts of wages, taxes withheld, and other compensation details. The copies are labeled as being for filing with the employee's federal tax return, state/local tax returns, and as a record for the employee.
This document contains four copies of a Form W-2 Wage and Tax Statement for the year 2011. The Form W-2 provides information about an employee's wages, taxes, and other compensation for the tax year. It includes boxes for the employer and employee identification numbers and addresses, amounts of wages, taxes withheld, and other compensation details. The copies are labeled as being for filing with the employee's federal tax return, state/local tax returns, and as a record for the employee.
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Copy B To Be Filed With Employee S FEDERAL Tax Return: See Instructions For Box 12
This document contains four copies of a Form W-2 Wage and Tax Statement for the year 2011. The Form W-2 provides information about an employee's wages, taxes, and other compensation for the tax year. It includes boxes for the employer and employee identification numbers and addresses, amounts of wages, taxes withheld, and other compensation details. The copies are labeled as being for filing with the employee's federal tax return, state/local tax returns, and as a record for the employee.
Copyright:
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b Employer identification number (EIN)
c Employers name, address, and ZIP code
1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 7 Social security tips 9 Advance EIC payment 11 Nonqualified plans 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 10 Dependent care benefits a Employees social security number 14 Other 13 Statutory employee Retirement plan Third-party sick pay 12a C o d e 12b 12c 12d $ $ $ $ $ C o d e C o d e C o d e C o d e 12e b Employer identification number (EIN) c Employers name, address, and ZIP code This information is being furnished to the Internal Revenue Service. Copy B To Be Filed With Employees FEDERAL Tax Return 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 7 Social security tips 9 Advance EIC payment 11 Nonqualified plans 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 10 Dependent care benefits a Employees social security number 14 Other 13 Statutory employee Retirement plan Third-party sick pay See instructions for box 12 12a C o d e 12b 12c 12d $ $ $ $ $ C o d e C o d e C o d e C o d e 12e 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. b Employer identification number (EIN) c Employers name, address, and ZIP code 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 7 Social security tips 9 Advance EIC payment 11 Nonqualified plans 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 10 Dependent care benefits a Employees social security number 14 Other 13 Statutory employee Retirement plan Third-party sick pay See instructions for box 12 12a C o d e 12b 12c 12d $ $ $ $ $ C o d e C o d e C o d e C o d e 12e Copy C For EMPLOYEES RECORDS. (See Notice to Employee on back.) b Employer identification number (EIN) c Employers name, address, and ZIP code 1 Wages, tips, other compensation 3 Social security wages 5 Medicare wages and tips 7 Social security tips 9 Advance EIC payment 11 Nonqualified plans 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 10 Dependent care benefits a Employees social security number 14 Other 13 Statutory employee Retirement plan Third-party sick pay 12a C o d e 12b 12c 12d $ $ $ $ $ C o d e C o d e C o d e C o d e 12e Copy 2 To Be Filed With Employees STATE, CITY or LOCAL Income Tax Return e Employees first name and initial Last name f Employees address and ZIP code e Employees first name and initial Last name f Employees address and ZIP code e Employees first name and initial Last name f Employees address and ZIP code e Employees first name and initial Last name f Employees address and ZIP code 20 Locality name 15 State Employers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 15 State Employers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 15 State Employers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 15 State Employers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax Copy 2 To Be Filed With Employees STATE, CITY or LOCAL Income Tax Return 1A-w 1B-w 673307 Suff. Suff. Suff. Suff. 23069.61 23069.61 2730.73 2730.73 24741.07 24741.07 1039.12 1039.12 24741.07 24741.07 358.75 358.75 0.00 0.00 X X X X 23069.61 23069.61 2730.73 2730.73 24741.07 24741.07 1039.12 1039.12 24741.07 24741.07 358.75 358.75 0.00 0.00 1 of 1 1 of 1 1 of 1 1 of 1 ID:10974000000000000145405344 ID:10974000000000000145405344 ID:10974000000000000145405344 ID:10974000000000000145405344 33-0479906 33-0479906 33-0479906 33-0479906 PETCO ANIMAL SUPPLIES,INC PETCO ANIMAL SUPPLIES,INC PETCO ANIMAL SUPPLIES,INC PETCO ANIMAL SUPPLIES,INC SAN DIEGO, CA 92121-2270 SAN DIEGO, CA 92121-2270 SAN DIEGO, CA 92121-2270 SAN DIEGO, CA 92121-2270 474-19-2490 474-19-2490 474-19-2490 474-19-2490 CHRYSTAL RAYNE BIPES CHRYSTAL RAYNE BIPES CHRYSTAL RAYNE BIPES CHRYSTAL RAYNE BIPES 8200 SCANDIA TRAIL NORTH 8200 SCANDIA TRAIL NORTH 8200 SCANDIA TRAIL NORTH 8200 SCANDIA TRAIL NORTH FOREST LAKE, MN 55025 FOREST LAKE, MN 55025 FOREST LAKE, MN 55025 FOREST LAKE, MN 55025 9125 REHCO ROAD 9125 REHCO ROAD 9125 REHCO ROAD 9125 REHCO ROAD D D D D 1671.46 1671.46 1671.46 1671.46 MN MN MN MN 2997985 2997985 2997985 2997985 23069.61 23069.61 23069.61 23069.61 1126.00 1126.00 1126.00 1126.00 Form W-2 Wage and Tax Statement 2011 Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy B To Be Filed With Employee's FEDERAL Tax Return Form W-2 Wage and Tax Statement 2011 Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy 2 To Be Filed With Employee's State, CITY or Local Tax Departments Form W-2 Wage and Tax Statement 2011 Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy 2 To Be Filed With Employee's State, CITY or Local Tax Departments Form W-2 Wage and Tax Statement 2011 Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy C for Employee's Records Notice to Employee Refund. Even if you do not have to file a tax return, you should file to get a refund if box 2 shows federal income tax withheld or if you can take the earned income credit. Earned income credit (EIC). You may be able to take the EIC for 2011 if (a) you do not have a qualifying child and you earned less than $13,660 ($18,740 if married filing jointly), (b) you have one qualifying child and you earned less than $36,052 ($41,132 if married filing jointly), (c) you have two qualifying children and you earned less than $40,964 ($46,044 if married filing jointly), or (d) you have three or more qualifying children and you earned less than $43,998 ($49,078 if married filing jointly). You and any qualifying children must have valid social security numbers (SSNs). You cannot take the EIC if your investment income is more than $3,150. Any EIC that is more than your tax liability is refunded to you, but only if you file a tax return. Clergy and religious workers. If you are not subject to social security and Medicare taxes, see Pub. 517, Social Security and Other Information for Members of the Clergy and Religious Workers. Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask your employer to correct your employment record. Be sure to ask the employer to file Form W-2c, Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any name, SSN, or money amount error reported to the SSA on Form W-2. If your name and SSN are correct but are not the same as shown on your social security card, you should ask for a new card that displays your correct name at any SSA office or by calling 1-800-772-1213. You also may visit the SSA at www.socialsecurity.gov. Cost of employer-sponsored health coverage (if such cost is provided by the employer). The reporting in Box 12, using Code DD, of the cost of employer-sponsored health coverage is for your information only. The amount reported with Code DD is not taxable. Credit for excess taxes. If you had more than one employer in 2011 and more than $4,485.60 in social security and/or Tier I railroad retirement (RRTA) taxes were withheld, you may be able to claim a credit for the excess against your federal income tax. If you had more than one railroad employer and more than $3,088.80 in Tier II RRTA tax was withheld, you also may be able to claim a credit. See your Form 1040 or Form 1040A instructions and Pub. 505, Tax Withholding and Estimated Tax Instructions for Employee Box 1. Enter this amount on the wages line of your tax return. Box 2. Enter this amount on the federal income tax withheld line of your tax return. Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on your tax return, see your Form 1040 instructions. Unless you have records that show you did not receive the amount reported in box 8 as allocated tips, you must file Form 4137, Social Security and Medicare Tax on Unreported Tip Income, with your income tax return to report the allocated tip amount. On Form 4137 you will figure the social security and Medicare tax owed on the allocated tips shown on your Form(s) W-2 that you must report as income and on other tips you did not report to your employer. By filing Form 4137, your social security tips will be credited to your social security record (used to figure your benefits). Box 10. This amount is the total dependent care benefits that your employer paid to you or incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over $5,000 is also included in box 1. Complete Form 2441, Child and Dependent Care Expenses, to compute any taxable and nontaxable amounts. Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified deferred compensation or nongovernmental section 457(b) plan or (b) included in box 3 and/or 5 if it is a prior year deferral under a nonqualified or section 457(b) plan that became taxable for social security and Medicare taxes this year because there is no longer a substantial risk of forfeiture of your right to the deferred amount. Box 12. The following list explains the codes shown in box 12. You may need this information to complete your tax return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE) under all plans are generally limited to a total of $16,500 ($11,500 if you only have SIMPLE plans; $19,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals under code G are limited to $16,500. Deferrals under code H are limited to $7,000. However, if you were at least age 50 in 2011, your employer may have allowed an additional deferral of up to $5,500 ($2,500 for section 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is not subject to the overall limit on elective deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years before you reach retirement age. Contact your plan administrator for more information. Amounts in excess of the overall elective deferral limit must be included in income. See the Wages, Salaries, Tips, etc. line instructions for Form 1040. Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension contribution for a prior year(s) when you were in military service. To figure whether you made excess deferrals, consider these amounts for the year shown, not the current year. If no year is shown, the contributions are for the current year. AUncollected social security or RRTA tax on tips. Include this tax on Form 1040. See Total Tax in the Form 1040 instructions. BUncollected Medicare tax on tips. Include this tax on Form 1040. See Total Tax in the Form 1040 instructions. CTaxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up to social security wage base), and 5) DElective deferrals to a section 401(k) cash or deferred arrangement. Also includes deferrals under a SIMPLE retirement account that is part of a section 401(k) arrangement. EElective deferrals under a section 403(b) salary reduction agreement FElective deferrals under a section 408(k)(6) salary reduction SEP GElective deferrals and employer contributions (including nonelective deferrals) to a section 457(b) deferred compensation plan HElective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See Adjusted Gross Income in the Form 1040 instructions for how to deduct. JNontaxable sick pay (information only, not included in boxes 1, 3, or 5) K20% excise tax on excess golden parachute payments. See Total Tax in the Form 1040 instructions. LSubstantiated employee business expense reimbursements (nontaxable) MUncollected social security or RRTA tax on taxable cost of group- term life insurance over $50,000 (former employees only). See Total Tax in the Form 1040 instructions. NUncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former employees only). See Total Tax in the Form 1040 instructions. PExcludable moving expense reimbursements paid directly to employee (not included in boxes 1, 3, or 5) QNontaxable combat pay. See the instructions for Form 1040 or Form 1040A for details on reporting this amount. REmployer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and Long-Term Care Insurance Contracts. SEmployee salary reduction contributions under a section 408(p) SIMPLE (not ncluded in box 1) T Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to compute any taxable and nontaxable amounts. VIncome from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to social security wage base), and 5). See Pub. 525 and instructions for Schedule D (Form 1040) for reporting requirements. WEmployer contributions (including amounts the employee elected to contribute using a section 125 (cafeteria) plan) to your health savings account. Report on Form 8889, Health Savings Accounts (HSAs). YDeferrals under a section 409A nonqualified deferred compensation plan ZIncome under section 409A on a nonqualified deferred compensation plan. This amount is also included in box 1. It is subject to an additional 20% tax plus interest. See Total Tax in the Form 1040 instructions. AADesignated Roth contributions under a section 401(k) plan BBDesignated Roth contributions under a section 403(b) plan DDCost of employer-sponsored health coverage. The amount reported with Code DD is not taxable. EEDesignated Roth contributions under a governmental section 457(b) plan. This amount does not apply to contributions under a tax-exempt organization section 457(b) plan. Box 13. If the Retirement plan box is checked, special limits may apply to the amount of traditional IRA contributions you may deduct. Note. Keep Copy C of Form W-2 for at least 3 years after the due date for filing your income tax return. However, to help protect your social security benefits, keep Copy C until you begin receiving social security benefits, just in case there is a question about your work record and/or earnings in a particular year. Compare the Social Security wages and the Medicare wages to the information shown on your annual (for workers over 25) Social Security Statement. CALIFORNIA NOTICE TO EMPLOYEES Based on your annual earnings, you may be eligible to receive the earned income tax credit from the federal government. The earned income tax credit is a refundable federal income tax credit for low-income working individuals and families. The earned income tax credit has no effect on certain welfare benets. In most cases, earned income tax credit payments will not be used to determine eligibility for Medicaid, supplemental security income, food stamps, low-income housing or most temporary assistance for needy families payments. Even if you do not owe federal taxes, you must le a tax return to receive the earned income tax credit. Be sure to ll out the earned income tax credit form in the federal income tax return booklet. The New Jersey Earned Income Tax Credit (NJEITC) is a credit for certain residents who work and have earned income. The credit reduces the amount of New Jersey tax you owe and may also give you a refund, even if you are not required to pay income tax to New Jersey. Most residents who are eligible and le for a Federal earned income tax credit can also receive the NJEITC. There are several criteria which must be met to qualify for the Federal earned income tax credit. See the information below on how to contact the Internal Revenue Service to nd out if you are eligible for the Federal earned income tax credit. Note: You dont qualify for the NJEITC if you and your spouse/civil union partner le separate income tax returns. The amount of your NJEITC is a percentage of your Federal earned income tax credit. This year, the NJEITC amount is equal to 20% of the Federal earned income tax credit. So, if your Federal earned income tax credit is $4,000, the amount of your NJEITC will be $800. (2011 NJEITC = Federal EITC x 20%) Note: If you lived in New Jersey for only part of 2011, your NJEITC will be prorated based on the number of months you were a New Jersey resident. (For this calculation, 15 days or more is a month.) To receive the NJEITC, you must le a New Jersey resident income tax return. This is true even if you are not required to le a tax return because your income is below New Jerseys minimum ling threshold. For more information about the Federal earned income tax credit, visit: www.irs.gov/individuals or call the IRS at 1-800-829-1040. For more information about the NJEITC: Call the New Jersey Division of Taxation at 609-292-6400. Listen to recorded information or order forms by calling the Divisions Automated Tax Information System from a Touch-tone phone: 1-800-323-4400 (within NJ, NY, PA, DE, MD) or 609-826-4400. Visit the NJ Division of Taxations Web site at: www.state.nj.us/treasury/taxation 2011 Federal Earned Income Tax Credit State of New Jersey Department of the Treasury Division of Taxation IMPORTANT NOTICE TO NEW JERSEY RESIDENTS For information regarding your eligibility to receive the earned income tax credit, including information on how to obtain the IRS Notice 797 or any other necessary forms and instructions, contact the Internal Revenue Service at 1-800-829-3676 or through its Web site at www.irs.gov. 2011 NJ Earned Income Tax Credit (NJEITC) DID YOU KNOW THAT FEDERAL AND NJ STATE EARNED INCOME TAX CREDITS ARE AVAILABLE TO CERTAIN LOW- INCOME WORKING INDIVIDUALS AND FAMILIES? THESE CREDITS CAN REDUCE THE AMOUNT OF INCOME TAX YOU OWE OR INCREASE YOUR INCOME TAX REFUND. AND, YOU CAN RECEIVE THE CREDITS EVEN IF YOU DIDNT EARN ENOUGH INCOME TO BE REQUIRED TO FILE A TAX RETURN. TEXAS NOTICE TO EMPLOYEES WAS YOUR FAMILYS INCOME LAST YEAR LESS THAN $49,078? YOU MAY BE ENTITLED TO AN INCOME TAX REFUND. The Earned Income Tax Credit (EITC) campaign is a program to help Texas families get the dollars they deserve. The EITC is a refund to qualied taxpayers even if you dont owe any taxes on your income! Each year, the EITC brings more than a billion federal income tax dollars back home and into Texans pockets. You may qualify, if: You had three or more children who lived with you for more than six months of the year and your family income was less than $49,078; or You had two children who lived with you for more than six months of the year and your family income was less than $46,044; or Your family earned less than $41,132 in adjusted gross income in 2011 and you had a child who lived with you for more than six months of the year; or You had no qualifying children and your family income was less than $18,740. For more detailed information, you may visit the Comptrollers Window on State Government Website at www.window.state.tx.us/ taxinfo/eitc/ or call the IRS at (800) 829-1040 or simply dial 211. ILLINOIS NOTICE TO EMPLOYEES Claim Your Earned Income Tax Credit (EITC)!! The Tax Break for Hard-Working People - And YOU Could Qualify! How do I Apply? You can only get the EITC if you apply for it on your federal income tax return and you can get it even if you do not owe federal income taxes. You must have received earned income in 2011 to qualify - that includes wages reported on Form W-2 or self-employment reported on Form 1099-MISC or other earnings. If you were raising children in 2011, le federal Form 1040 or 1040A and attach Schedule EIC. If you were not raising children, le any federal income tax return. If you worked in the last 3 years and you did not claim the EITC in those years but were eligible, you can still apply for EITC benets by ling an amended tax return. Illinois also has a State EITC! Illinois residents who claim the federal EITC may also get a State EITC which can be worth up to $288! The State EITC is worth 5 percent of the federal EITC and is fully refundable. Need help ling your taxes? There are programs throughout Illinois where families with incomes under $50,000 and individuals with incomes under $25,000 can get free electronic tax preparation and access to nancial services. Call 312-630-0273 in Cook county or 888-827-8511 outside of Cook county; Call 312-409-1555 in Cook, DuPage, Kane, and Lake counties; 312-701-1326 (TTY). You may also call the IRS at 800-829-1040 or 800-829-4059 (TTY). Note: EITC payments will not affect any DHS benets you are currently receiving. What is it worth? If you worked in 2011, you could claim the EITC and reduce your federal income taxes and/or get a bigger refund if: Your household earnings were less than $43,998 (or $49,078 if married ling jointly) and you were raising three or more children in your home you could get up to $5,751! Your household earnings were less than $40,964 (or $46,044 if married ling jointly) and you were raising two children in your home you could get up to $5,112! Your household earnings were less than $36,052 (or $41,132 if married ling jointly) and you were raising one child in your home you could get up to $3,094! Your household earnings were less than $13,660 (or $18,740 if married ling jointly), you had no children, and you were between the ages of 25 and 64 you could get up to $464! There are special rules to determine which children qualify. In most cases, all household members must have Social Security Numbers.