Form W-2 Wage and Tax Statement and Form W-3 Transmittal of Wage and Tax Statements (2015)

Summary: This is an example of Form W-2 and Form W-3. The line items completed are:

Form W-2 Wage and Tax Statement (2016)

b. Employer identification number” field contains 00-1234567
c. Employer's name, address, and ZIP code” field contains
Mary Brown
20 Gray Street
Anyplace, California 92665
a. Employee's social security number” field contains 000-00-4567
e. Employee's first name and initial” field contains Jane A.
Last name” field contains Oak
f. Employee's address and ZIP code” field contains
18 Pine Avenue
Anycity, California 92666
1. Wages, tips, other compensation” field contains 2300.00
3. Social security wages” field contains 2300.00
4. Social security tax withheld” field contains 142.60
5. Medicare wages and tips” field contains 2300.00
6. Medicare tax withheld” field contains 33.35

Form W-3 Transmittal of Wage and Tax Statements (2016)

b. Kind of Payer: Household emp.” checkbox checked
e. Employer identification number” field contains 00-1234567
f. Employer's name” field contains Mary Brown
g. Employer's address and ZIP code” field contains
20 Gray Street
Anyplace, California 92665
1. Wages, tips, other compensation” field contains 2300.00
3. Social security wages” field contains 2300.00
4. Social security tax withheld” field contains 142.60
5. Medicare wages and tips” field contains 2300.00
6. Medicare tax withheld” field contains 33.35
Under declaration statement:
Signature” field contains Mary Brown
Date” field contains 1/31/2017