Copy B -- To Be Filed With Employee's 38-2099803 Copy 2 -- To Be Filed With Employee's State, 38-2099803
OMB No. 1545-0008 OMB No. 1545-0008
FEDERAL Tax Return. City, or Local Income Tax Return.
a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld
122-72-4212 9027.00 701.71 122-72-4212 9027.00 701.71
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
b Employer ID number (EIN) 9027.00 559.69 b Employer ID number (EIN) 9027.00 559.69
47-3140924 5 Medicare wages and tips 6 Medicare tax withheld 47-3140924 5 Medicare wages and tips 6 Medicare tax withheld
9027.00 130.91 9027.00 130.91
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code
Noor Staffing Group Noor Staffing Group
622 3rd Ave 622 3rd Ave
7th Floor 7th Floor
New York, NY 10017 New York, NY 10017
d Control number d Control number
56010137 56010137
e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code
Anthony Jerome Lebron Anthony Jerome Lebron
315 E 102nd Street 315 E 102nd Street
Manhattan, NY 10029 Manhattan, NY 10029
7 Social security tips 8 Allocated tips 9 Advance EIC payment 7 Social security tips 8 Allocated tips 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12
13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code
NY SDI:20.40 NY SDI:20.40
Retirement plan 12c Code Retirement plan 12c Code
Third-party sick pay 12d Code Third-party sick pay 12d Code
NY 47-3140924 9027.00 389.15 NY 47-3140924 9027.00 389.15
15 State Employer's state ID Number 16 State wages, tips, etc. 17 State income tax 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 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
9027.00 268.56 NEW YORK CITY 9027.00 268.56 NEW YORK CITY
Form W-2 Wage and Tax Statement 2019 Dept. of the Treasury -- IRS Form W-2 Wage and Tax Statement 2019 Dept. of the Treasury -- IRS
This information is being furnished to the Internal Revenue Service
Copy C -- For EMPLOYEE'S RECORDS (See Notice 38-2099803 Copy 2 -- To Be Filed With Employee's State, 38-2099803
OMB No. 1545-0008 OMB No. 1545-0008
to Employee.) City, or Local Income Tax Return.
a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld a Employee's soc. sec. no. 1 Wages, tips, other comp. 2 Federal income tax withheld
122-72-4212 9027.00 701.71 122-72-4212 9027.00 701.71
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
b Employer ID number (EIN) 9027.00 559.69 b Employer ID number (EIN) 9027.00 559.69
47-3140924 5 Medicare wages and tips 6 Medicare tax withheld 47-3140924 5 Medicare wages and tips 6 Medicare tax withheld
9027.00 130.91 9027.00 130.91
c Employer's name, address, and ZIP code c Employer's name, address, and ZIP code
Noor Staffing Group Noor Staffing Group
622 3rd Ave 622 3rd Ave
7th Floor 7th Floor
New York, NY 10017 New York, NY 10017
d Control number d Control number
56010137 56010137
e Employee's name, address, and ZIP code e Employee's name, address, and ZIP code
Anthony Jerome Lebron Anthony Jerome Lebron
315 E 102nd Street 315 E 102nd Street
Manhattan, NY 10029 Manhattan, NY 10029
7 Social security tips 8 Allocated tips 9 Advance EIC payment 7 Social security tips 8 Allocated tips 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12
13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code
NY SDI:20.40 NY SDI:20.40
Retirement plan 12c Code Retirement plan 12c Code
Third-party sick pay 12d Code Third-party sick pay 12d Code
NY 47-3140924 9027.00 389.15 NY 47-3140924 9027.00 389.15
15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 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 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
9027.00 268.56 NEW YORK CITY 9027.00 268.56 NEW YORK CITY
Form W-2 Wage and Tax Statement 2019 Dept. of the Treasury -- IRS Form W-2 Wage and Tax Statement 2019 Dept. of the Treasury -- IRS
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.
