a Employee’s social security number 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
147-13-6620 OMB No. 1545-0008 may be imposed on you if this income is taxable and you fail to report it.
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
86-2693793 235725.00 187355.00
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
75295.00 8500.00
GRAPHIC DEVELOPMENT INC
5 Medicare wages and tips 6 Medicare tax withheld
70 MAYFLOWER DRIVE
HANOVER, MA 02339 75295.00 1462.00
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 See instructions for box 12
C
o
JUSTIN ROSARIO d
e
13 Statutory Retirement Third-party 12b
employee plan sick pay
95 WEST 45TH ST C
o
d
BAYONNE, NJ 07002 14 Other
e
12c
C
o
d
e
12d
C
o
d
e
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
235725.00 187355.00
MA 042520457
Form W-2 Wage and Tax Statement
Copy C—For EMPLOYEE’S RECORDS
2023 Department of the Treasury—Internal Revenue Service
Safe, accurate,
FAST! Use
(See Notice to Employee on the back of Copy B.)