a Employee’s social security number
22222                                                               OMB No. 1545-0008
                                                160-80-5246
 b Employer identification number (EIN)                                                        1 Wages, tips, other compensation                  2 Federal income tax withheld
                                                                                                                              $35,000.00                                    $2,545.50
 c Employer’s name, address, and ZIP code                                                      3 Social security wages                            4 Social security tax withheld
                                                                                                                              $35,000.00                                    $1,413.60
 Enter y ouisiana, lc                                                                          5 Medicare wages and tips                          6 Medicare tax withheld
       Jefferson i    ay,
 Jefferson,                                                                                                                   $35,000.00                                     $330.60
                                                                                                7 Social security tips                            8 Allocated tips
 d Control number                                                                               9                                             10 Dependent care benefits
 e Employee’s first name and initial         Last name                                 Suff.   11 Nonqualified plans                          12a
                                                                                                                                              o
                                                                                                                                              d
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 LINDSEY MARIE MCGRAW                                                                          13    Statutory
                                                                                                     employee
                                                                                                                 Retirement
                                                                                                                 plan
                                                                                                                                Third-party
                                                                                                                                sick pay      12b
      s ford Dr,                                                                                                                              o
                                                                                                                                              d
                                                                                                                                              e
  pt
   est onroe,                                                                                  14 Other                                       12c
                                                                                                                                              o
                                                                                                                                              d
                                                                                                                                              e
                                                                                                                                              12d
                                                                                                                                              o
                                                                                                                                              d
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 f Employee’s address and ZIP code
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
  CA                 94-0322450                                 $35,000.00                $1,389.76
Form   W-2           Wage and Tax Statement                                     2020                                     Department of the Treasury—Internal Revenue Service
Copy 1—For State, City, or Local Tax Department