OMB No. 1545-008 Department of the Treasury-Internal Revenue Service OMB No.
f the Treasury-Internal Revenue Service OMB No. 1545-008 Department of the Treasury-Internal Revenue Service
1 Wages, tips, other compensation 2 Federal income tax withheld 1 Wages, tips, other compensation 2 Federal income tax withheld
19307.91 733.85 19307.91 733.85
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
20975.79 1300.50 20975.79 1300.50
5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
20975.79 304.15 20975.79 304.15
c Employer's name, address and ZIP code c Employer's name, address and ZIP code
HOME DEPOT U.S.A. INC. HOME DEPOT U.S.A. INC.
2455 PACES FERRY RD 2455 PACES FERRY RD
ATLANTA, GA 30339 ATLANTA, GA 30339
7 Social security tips 8 Allocated Tips 9 Advanced EIC payment 7 Social security tips 8 Allocated Tips 9 Advanced EIC payment
10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
c
10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
c
o o
d
e D 1667.88 d
e D 1667.88
12b
c
12c
c
12d
c
12b
c
12c
c
12d
c
o o o o o o
d d d d d d
e e e e e e
b Employer identification number (EIN) a Employee's social security number b Employer identification number (EIN) a Employee's social security number
58-1853319 541-57-2148 58-1853319 541-57-2148
13 Statutory Retirement Third-party 14 Other 13 Statutory Retirement Third-party 14 Other
employee plan sick pay employee plan sick pay
X X
e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code
JENNIFER J MIJANGOS NOYOLA JENNIFER J MIJANGOS NOYOLA
7383 REMCON CIR 7383 REMCON CIR
UNIT 221931 UNIT 221931
EL PASO, TX 79913 EL PASO, TX 79913
15 State Employer's state ID number 16 State wages, tips, etc. 15 State Employer's state ID number 16 State wages, tips, etc.
Form Form
- -OR
- - - - - - - - - - - - - -00801343-7
- - - - - - - - - - - - - - - - - - - - 6056.89
------- - -OR
- - - - - - - - - - - - - -00801343-7
- - - - - - - - - - - - - - - - - - - - 6056.89
-------
W-2 W-2
17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.
Wage and Tax Wage and Tax
Statement - - - - - - - - - - - -425.38
------ ----------------- Statement - - - - - - - - - - - -425.38
------ -----------------
2019 19 Local income tax
----------------- -----------
20 Locality name
2019 19 Local income tax
----------------- -----------
20 Locality name
Copy 2 For State, City Copy 2 For State, City
or Local Tax Department or Local Tax Department
OMB No. 1545-008 Department of the Treasury-Internal Revenue Service OMB No. 1545-008 Department of the Treasury-Internal Revenue Service
1 Wages, tips, other compensation 2 Federal income tax withheld This information is 1 Wages, tips, other compensation 2 Federal income tax withheld
being furnished to
19307.91 733.85 the Internal Revenue
Service. If you are
19307.91 733.85
This information is
3 Social security wages 4 Social security tax withheld required to file a tax 3 Social security wages 4 Social security tax withheld
being furnished to
return, a negligence
the Internal Revenue
penalty or other
Service 20975.79 1300.50 sanction may be 20975.79 1300.50
imposed on you if this
5 Medicare wages and tips 6 Medicare tax withheld income is taxable and
5 Medicare wages and tips 6 Medicare tax withheld
you fail to report it.
20975.79 304.15 20975.79 304.15
c Employer's name, address and ZIP code c Employer's name, address and ZIP code
HOME DEPOT U.S.A. INC. HOME DEPOT U.S.A. INC.
2455 PACES FERRY RD 2455 PACES FERRY RD
ATLANTA, GA 30339 ATLANTA, GA 30339
7 Social security tips 8 Allocated Tips 9 Advanced EIC payment 7 Social security tips 8 Allocated Tips 9 Advanced EIC payment
10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
c
10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
c
o o
d
e D 1667.88 d
e D 1667.88
12b
c
12c
c
12d
c
12b
c
12c
c
12d
c
o o o o o o
d d d d d d
e e e e e e
b Employer identification number (EIN) a Employee's social security number b Employer identification number (EIN) a Employee's social security number
58-1853319 541-57-2148 58-1853319 541-57-2148
13 Statutory Retirement Third-party 14 Other 13 Statutory Retirement Third-party 14 Other
employee plan sick pay employee plan sick pay
X X
e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code
JENNIFER J MIJANGOS NOYOLA JENNIFER J MIJANGOS NOYOLA
7383 REMCON CIR 7383 REMCON CIR
UNIT 221931 UNIT 221931
EL PASO, TX 79913 EL PASO, TX 79913
15 State Employer's state ID number 16 State wages, tips, etc. 15 State Employer's state ID number 16 State wages, tips, etc.
Form Form
- -OR
- - - - - - - - - - - - - -00801343-7
- - - - - - - - - - - - - - - - - - - - 6056.89
------- - -OR
- - - - - - - - - - - - - -00801343-7
- - - - - - - - - - - - - - - - - - - - 6056.89
-------
W-2 W-2
17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.
Wage and Tax Wage and Tax
Statement - - - - - - - - - - - -425.38
------ ----------------- Statement - - - - - - - - - - - -425.38
------ -----------------
2019 19 Local income tax
----------------- -----------
20 Locality name
2019 19 Local income tax
----------------- -----------
20 Locality name
Copy B To Be Filed with Copy C For EMPLOYEE'S RECORDS.
Employee's FEDERAL Tax Return (See Notice to Employee on back of Copy B)
