a Employee's social security number
638771614 OMB No. 15450008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
843009663 446.00 0.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
Twenty Pho Hour LLC 325.71 27.65
11951 International Drive
Unit B2
Orlando, Florida 32821
d Control number 5 Medicare wages and tips 6 Medicare tax withheld
446.00 6.47
e/f Employee's name, address, and ZIP code
SANTIAGO TOMAS FOJANINI
5475 Vineland Rd
Kissimme, FL 32811
7 Social security tips 8 Allocated tips 9 Advanced EIC payment
120.29 0.00 0.00
10 Dependent care benefits 11 Nonqualified plans See instructions for box 12
0.00 0.00 12a Code
12b Code 12c Code 12d Code
13 Statutory employee Retirement plan Thirdparty sick pay 14 Other
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
Department of the Treasury—Internal Revenue Service
Form W2 Wage and Tax Statement 2023
Copy B To Be Filed with Employee's FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
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.
a Employee's social security number
638771614 OMB No. 15450008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
843009663 446.00 0.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
Twenty Pho Hour LLC 325.71 27.65
11951 International Drive
Unit B2
Orlando, Florida 32821
d Control number 5 Medicare wages and tips 6 Medicare tax withheld
446.00 6.47
e/f Employee's name, address, and ZIP code
SANTIAGO TOMAS FOJANINI
5475 Vineland Rd
Kissimme, FL 32811
7 Social security tips 8 Allocated tips 9 Advanced EIC payment
120.29 0.00 0.00
10 Dependent care benefits 11 Nonqualified plans See instructions for box 12
0.00 0.00 12a Code
12b Code 12c Code 12d Code
13 Statutory employee Retirement plan Thirdparty sick pay 14 Other
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15 State Employer's state ID number 16 State wages, tips, etc 17 State income tax
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.
a Employee's social security number
638771614 OMB No. 15450008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
843009663 446.00 0.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
Twenty Pho Hour LLC 325.71 27.65
11951 International Drive
Unit B2
Orlando, Florida 32821
d Control number 5 Medicare wages and tips 6 Medicare tax withheld
446.00 6.47
e/f Employee's name, address, and ZIP code
SANTIAGO TOMAS FOJANINI
5475 Vineland Rd
Kissimme, FL 32811
7 Social security tips 8 Allocated tips 9 Advanced EIC payment
120.29 0.00 0.00
10 Dependent care benefits 11 Nonqualified plans See instructions for box 12
0.00 0.00 12a Code
12b Code 12c Code 12d Code
13 Statutory employee Retirement plan Thirdparty sick pay 14 Other
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
Department of the Treasury—Internal Revenue Service
Form W2 Wage and Tax Statement 2023
Copy C For Employee's Record.
a Employee's social security number
638771614 OMB No. 15450008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
843009663 446.00 0.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
Twenty Pho Hour LLC 325.71 27.65
11951 International Drive
Unit B2
Orlando, Florida 32821
d Control number 5 Medicare wages and tips 6 Medicare tax withheld
446.00 6.47
e/f Employee's name, address, and ZIP code
SANTIAGO TOMAS FOJANINI
5475 Vineland Rd
Kissimme, FL 32811
7 Social security tips 8 Allocated tips 9 Advanced EIC payment
120.29 0.00 0.00
10 Dependent care benefits 11 Nonqualified plans See instructions for box 12
0.00 0.00 12a Code
12b Code 12c Code 12d Code
13 Statutory employee Retirement plan Thirdparty sick pay 14 Other
15 State Employer's state ID number 16 State wages, tips, etc 17 State income tax
Powered by eStratex.com 1/31/2024 11:09 PM Page 2 / 4
a Employee's social security number
638771614 OMB No. 15450008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
843009663 446.00 0.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
Twenty Pho Hour LLC 325.71 27.65
11951 International Drive
Unit B2
Orlando, Florida 32821
d Control number 5 Medicare wages and tips 6 Medicare tax withheld
446.00 6.47
e/f Employee's name, address, and ZIP code
SANTIAGO TOMAS FOJANINI
5475 Vineland Rd
Kissimme, FL 32811
7 Social security tips 8 Allocated tips 9 Advanced EIC payment
120.29 0.00 0.00
10 Dependent care benefits 11 Nonqualified plans See instructions for box 12
0.00 0.00 12a Code
12b Code 12c Code 12d Code
13 Statutory employee Retirement plan Thirdparty sick pay 14 Other
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
Department of the Treasury—Internal Revenue Service
Form W2 Wage and Tax Statement 2023
Copy 2To Be Filed With
Employee's State, City, or
Local Income Tax Return.
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Powered by eStratex.com 1/31/2024 11:09 PM Page 4 / 4
