OMB No. 1545-0008 REISSUED STATEMENT OMB No.

1545-0008 REISSUED STATEMENT

d Control Number 1 Wages, tips, other compensation 2 Federal income tax withheld d Control Number 1 Wages, tips, other compensation 2 Federal income tax withheld
10640.00 806.33 10640.00 806.33
b Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld b Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld
52-0812977 10640.00 659.68 52-0812977 10640.00 659.68
a Employee’s social security number 5 Medicare wages and tips 6 Medicare tax withheld a Employee’s social security number 5 Medicare wages and tips 6 Medicare tax withheld
363-41-6007 10640.00 154.28 363-41-6007 10640.00 154.28
c Employer’s name, address and ZIP code c Employer’s name, address and ZIP code
BARRETT BUSINESS SERVICES INC BARRETT BUSINESS SERVICES INC
SUITE 150 SUITE 150
25124 SPRINGFIELD COURT 25124 SPRINGFIELD COURT
VALENCIA CA 91355 VALENCIA CA 91355

7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9

10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12 10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12

Code

Code
12b 12c 12d 12b 12c 12d
Code

Code
Code

Code

Code

Code
13 Statutory Retirement Third-party 14 Other 13 Statutory Retirement Third-party 14 Other
employee plan sick pay CASDI 95.76 employee plan sick pay CASDI 95.76

e Employee’s name, address and ZIP code e Employee’s name, address and ZIP code
ARIANA FLORES ARIANA FLORES
43305 33RD ST W 43305 33RD ST W
LANCASTER CA 93536 LANCASTER CA 93536

2023 2023
15 State Employer’s state I.D. no. 16 State wages, tips, etc. 15 State Employer’s state I.D. no. 16 State wages, tips, etc.
CA 38673216 10640.00 CA 38673216 10640.00
W-2 W-2
Form

Form
Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc. Wage and Tax Statement 17 State income tax 18 Local wages, tips, etc.
Copy C - For EMPLOYEE’S 274.48 274.48
RECORDS (See Notice to Copy B - To Be Filed With
Employee on back of Copy B.) Employee’s FEDERAL Tax
This information is being furnished to the Return.
Internal Revenue Service. If you are required 19 Local income tax 20 Locality name 19 Local income tax 20 Locality name
to file a tax return, a negligence penalty or This information is being furnished to the
other sanction may be imposed on you if this Internal Revenue Service.
income is taxable and you fail to report it.
Department of the Treasury – Department of the Treasury –
Internal Revenue Service Internal Revenue Service

OMB No. 1545-0008 REISSUED STATEMENT OMB No. 1545-0008 REISSUED STATEMENT
d Control Number 1 Wages, tips, other compensation 2 Federal income tax withheld d Control Number 1 Wages, tips, other compensation 2 Federal income tax withheld

10640.00 806.33 10640.00 806.33

b Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld b Employer identification number (EIN) 3 Social security wages 4 Social security tax withheld

52-0812977 10640.00 659.68 52-0812977 10640.00 659.68

a Employee’s social security number 5 Medicare wages and tips 6 Medicare tax withheld a Employee’s social security number 5 Medicare wages and tips 6 Medicare tax withheld

363-41-6007 10640.00 154.28 363-41-6007 10640.00 154.28

c Employer’s name, address and ZIP code c Employer’s name, address and ZIP code
BARRETT BUSINESS SERVICES INC BARRETT BUSINESS SERVICES INC
SUITE 150 SUITE 150
25124 SPRINGFIELD COURT 25124 SPRINGFIELD COURT
VALENCIA CA 91355 VALENCIA CA 91355

7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9

10 Dependent care benefits 11 Nonqualified plans 12a 10 Dependent care benefits 11 Nonqualified plans 12a
Code
Code

12b 12c 12d 12b 12c 12d

Code
Code

Code
Code
Code

Code

13 Statutory Retirement Third-party 14 Other 13 Statutory Retirement Third-party 14 Other

employee plan sick pay CASDI 95.76 employee plan sick pay CASDI 95.76

e Employee’s name, address and ZIP code e Employee’s name, address and ZIP code
ARIANA FLORES ARIANA FLORES
43305 33RD ST W 43305 33RD ST W
LANCASTER CA 93536 LANCASTER CA 93536

2023 15 State Employer’s state I.D. no.

CA 38673216
16 State wages, tips, etc.
10640.00 2023 15 State Employer’s state I.D. no.
CA 38673216
16 State wages, tips, etc.
10640.00
W-2 W-2
Form

Form

17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.
Wage and Tax Statement Wage and Tax Statement
274.48 274.48
Copy 2 - To Be Filed With Copy 2 - To Be Filed With
Employee’s State, City, or Employee’s State, City, or
Local Income Tax Return. Local Income Tax Return.
19 Local income tax 20 Locality name 19 Local income tax 20 Locality name

Department of the Treasury – Department of the Treasury –

Internal Revenue Service Internal Revenue Service
Notice to Employee Instructions for Employee Instructions for Employee (Continued) S—Employee salary reduction contributions under a section
Do you have to file? Refer to the Form 1040 instructions to Box 1. Enter this amount on the wages line of your tax return. Box 12. The following list explains the codes shown in box 12. 408(p) SIMPLE plan (not included in box 1) T—Adoption benefits
determine if you are required to file a tax return. Even if you Box 2. Enter this amount on the federal income tax withheld line of You may need this information to complete your tax return. (not included in box 1). Complete Form 8839 to figure any taxable
your tax return. Box 5. You may be required to report this amount Elective deferrals (codes D, E, F, and S) and designated Roth and nontaxable amounts. V—Income from exercise of
don’t have to file a tax return, you may be eligible for a refund if
on Form 8959. See the Form 1040 instructions to determine if you contributions (codes AA, BB, and EE) under all plans are nonstatutory stock option(s) (included in boxes 1, 3 (up to the
box 2 shows an amount or if you are eligible for any credit.
are required to complete Form 8959. Box 6. This amount includes generally limited to a total of $22,500 ($15,500 if you only have social security wage base), and 5). See Pub. 525 for reporting
Earned income credit (EIC). You may be able to take the EIC
the 1.45% Medicare tax withheld on all Medicare wages and tips SIMPLE plans; $25,500 for section 403(b) plans if you qualify for requirements. W—Employer contributions (including amounts the
for 2023 if your adjusted gross income (AGI) is less than a the 15-year rule explained in Pub. 571). Deferrals under code G
shown in box 5, as well as the 0.9% Additional Medicare Tax on employee elected to contribute using a section 125 (cafeteria)
certain amount. The amount of the credit is based on income any of those Medicare wages and tips above $200,000. Box 8. are limited to $22,500. Deferrals under code H are limited to plan) to your health savings account. Report on Form 8889.
and family size. Workers without children could qualify for a This amount is not included in box 1, 3, 5, or 7. For information on $7,000.
Y—Deferrals under a section 409A nonqualified deferred
smaller credit. You and any qualifying children must have valid how to report tips on your tax return, see the Form 1040 However, if you were at least age 50 in 2023, your employer may
compensation plan Z—Income under a nonqualified deferred
social security numbers (SSNs). You can’t take the EIC if your instructions. You must file Form 4137 with your income tax return have allowed an additional deferral of up to $7,500 ($3,500 for
section 401(k)(11) and 408(p) SIMPLE plans). This additional compensation plan that fails to satisfy section 409A. This amount
investment income is more than the specified amount for 2023 to report at least the allocated tip amount unless you can prove
with adequate records that you received a smaller amount. If you deferral amount is not subject to the overall limit on elective is also included in box 1. It is subject to an additional 20% tax
or if income is earned for services provided while you were an
have records that show the actual amount of tips you received, deferrals. For code G, the limit on elective deferrals may be higher plus interest. See the Form 1040 instructions. AA—Designated
inmate at a penal institution. For 2023 income limits and more
report that amount even if it is more or less than the allocated tips. for the last 3 years before you reach retirement age. Contact your Roth contributions under a section 401(k) plan
information, visit www.irs.gov/EITC. See also Pub. 596. Any plan administrator for more information. Amounts in excess of the
Use Form 4137 to figure the social security and Medicare tax owed BB—Designated Roth contributions under a section 403(b) plan
EIC that is more than your tax liability is refunded to you, on tips you didn’t report to your employer. Enter this amount on the overall elective deferral limit must be included in income. See the DD—Cost of employer-sponsored health coverage. The amount
but only if you file a tax return. wages line of your tax return. By filing Form 4137, your social Form 1040 instructions. Note: If a year follows code D through H, reported with code DD is not taxable. EE—Designated Roth
Employee’s social security number (SSN). For your security tips will be credited to your social security record (used to S, Y, AA, BB, or EE, you made a make-up pension contribution for contributions under a governmental section 457(b) plan. This
protection, this form may show only the last four digits of your figure your benefits). a prior year(s) when you were in military service. To figure
amount does not apply to contributions under a tax-exempt
SSN. However, your employer has reported your complete SSN Box 10. This amount includes the total dependent care benefits whether you made excess deferrals, consider these amounts for
organization section 457(b) plan. FF—Permitted benefits under a
to the IRS and the Social Security Administration (SSA). that your employer paid to you or incurred on your behalf the year shown, not the current year. If no year is shown, the
contributions are for the current year. A—Uncollected social qualified small employer health reimbursement arrangement
Clergy and religious workers. If you aren’t subject to social (including amounts from a section 125 (cafeteria) plan). Any
amount over your employer’s plan limit is also included in box 1. security or RRTA tax on tips. Include this tax on Form 1040 or GG—Income from qualified equity grants under section 83(i)
security and Medicare taxes, see Pub. 517. HH—Aggregate deferrals under section 83(i) elections as of the
See Form 2441. Box 11. This amount is (a) reported in box 1 if it is 1040-SR. See the Form 1040 instructions. B—Uncollected
Corrections. If your name, SSN, or address is incorrect, correct Medicare tax on tips. Include this tax on Form 1040 or 1040-SR. close of the calendar year Box 13. If the “Retirement plan” box is
a distribution made to you from a nonqualified deferred
Copies B, C, and 2 and ask your employer to correct your compensation or nongovernmental section 457(b) plan, or (b) See the Form 1040 instructions. C—Taxable cost of group-term checked, special limits may apply to the amount of traditional IRA
employment record. Be sure to ask the employer to file Form W- included in box 3 and/or box 5 if it is a prior year deferral under a life insurance over $50,000 (included in boxes 1, 3 (up to the contributions you may deduct. See Pub. 590-A.
2c, Corrected Wage and Tax Statement, with the SSA to correct nonqualified or section 457(b) plan that became taxable for social social security wage base), and 5) D—Elective deferrals to a Box 14. Employers may use this box to report information such
any name, SSN, or money amount error reported to the SSA on security and Medicare taxes this year because there is no longer a section 401(k) cash or deferred arrangement. Also includes as state disability insurance taxes withheld, union dues, uniform
Form W-2. Be sure to get your copies of Form W-2c from your substantial risk of forfeiture of your right to the deferred amount. deferrals under a SIMPLE retirement account that is part of a payments, health insurance premiums deducted, nontaxable
employer for all corrections made so you may file them with This box shouldn’t be used if you had a deferral and a distribution section 401(k) arrangement. E—Elective deferrals under a section
income, educational assistance payments, or a member of the
your tax return. If your name and SSN are correct but aren’t the in the same calendar year. If you made a deferral and received a 403(b) salary reduction agreement F—Elective deferrals under a
section 408(k)(6) salary reduction SEP clergy’s parsonage allowance and utilities. Railroad employers
same as shown on your social security card, you should ask for distribution in the same calendar year, and you are or will be age
62 by the end of the calendar year, your employer should file Form G—Elective deferrals and employer contributions (including use this box to report railroad retirement (RRTA) compensation,
a new card that displays your correct name at any SSA office or nonelective deferrals) to a section 457(b) deferred compensation Tier 1 tax, Tier 2 tax, Medicare tax, and Additional Medicare Tax.
SSA-131, Employer Report of Special Wage Payments, with the
by calling 800-772-1213. You may also visit the SSA website at Social Security Administration and give you a copy. plan H—Elective deferrals to a section 501(c)(18)(D) tax-exempt Include tips reported by the employee to the employer in railroad
www.SSA.gov. Cost of employer-sponsored health coverage organization plan. See the Form 1040 instructions for how to retirement (RRTA) compensation.
(if such cost is provided by the employer). The reporting in deduct. J—Nontaxable sick pay (information only, not included in Note: Keep Copy C of Form W-2 for at least 3 years after the
box 12, using code DD, of the cost of employer-sponsored box 1, 3, or 5) K—20% excise tax on excess golden parachute due date for filing your income tax return. However, to help
health coverage is for your information only. The amount payments. See the Form 1040 instructions. L—Substantiated protect your social security benefits, keep Copy C until you
reported with code DD is not taxable. Credit for excess employee business expense reimbursements (nontaxable) begin receiving social security benefits, just in case there is a
M—Uncollected social security or RRTA tax on taxable cost of
taxes. If you had more than one employer in 2023 and more question about your work record and/or earnings in a particular
group-term life insurance over $50,000 (former employees only).
than $9,932.40 in social security and/or Tier 1 railroad See the Form 1040 instructions. N—Uncollected Medicare tax on year.
retirement (RRTA) taxes were withheld, you may be able to taxable cost of group-term life insurance over $50,000 (former
claim a credit for the excess against your federal income tax. employees only). See the Form 1040 instructions. P—Excludable
See the Form 1040 instructions. If you had more than one moving expense reimbursements paid directly to a member of the
railroad employer and more than $5,821.20 in Tier 2 RRTA tax U.S. Armed Forces (not included in box 1, 3, or 5) Q—Nontaxable
was withheld, you may be able to claim a refund on Form 843. combat pay. See the Form 1040 instructions for details on
See the Instructions for Form 843. reporting this amount. R—Employer contributions to your Archer
MSA. Report on Form 8853.