a Employee’s social security number
22222 OMB No. 1545-0008
012527543
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
ROSS CIGNA CONSTRUCTION
5 Medicare wages and tips 6 Medicare tax withheld
6 AVON LANE OFF SPEEN STEET
NATICK, MA 01760 $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
C
o
d
e
ROSS CIGNA 13 Statutory Retirement Third-party 12b
employee plan sick pay C
6 AVON LANE OFF SPEEN STEET o
d
NATICK, MA 01760 e
14 Other 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
MA S95827330 $35,000.00 $1,389.76
Form W-2 Wage and Tax Statement
Copy 1—For State, City, or Local Tax Department
2020
Department of the Treasury—Internal Revenue Service