Tax Year
Employee Information
Employer Information
Federal Wages & Taxes
Additional Information (Optional)
State & Local Taxes
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PREVIEW ONLY
a Employee's social security number
000-00-0000
000-00-0000
W-2
Wage and Tax Statement
2025
Copy B
b Employer identification number (EIN)
00-0000000
c Employer's name, address, and ZIP code
Employer Name
123 Business Ave
City, ST 00000
123 Business Ave
City, ST 00000
d Control number
e Employee's first name and initial Last name Suff.
Employee Name
f Employee's address and ZIP code
123 Main Street
City, ST 00000
City, ST 00000
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages
4 Social security tax withheld
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a-d See instructions for box 12
13
Statutory
Retire.
3rd party
14 Other
15 State / Employer's state ID
16 State wages
17 State tax
18 Local wages
19 Local tax
20 Locality
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.
Notice to Employee: The information on this form is important. Keep it for your tax return. Employers are required to furnish employees with this statement by January 31 of the following year.
PREVIEW ONLY
a Employee's social security number
000-00-0000
000-00-0000
W-2
Wage and Tax Statement
2025
Copy B
b Employer identification number (EIN)
00-0000000
c Employer's name, address, and ZIP code
Employer Name
123 Business Ave
City, ST 00000
123 Business Ave
City, ST 00000
d Control number
e Employee's first name and initial Last name Suff.
Employee Name
f Employee's address and ZIP code
123 Main Street
City, ST 00000
City, ST 00000
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages
4 Social security tax withheld
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a-d See instructions for box 12
13
Statutory
Retire.
3rd party
14 Other
15 State / Employer's state ID
16 State wages
17 State tax
18 Local wages
19 Local tax
20 Locality
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.
Notice to Employee: The information on this form is important. Keep it for your tax return. Employers are required to furnish employees with this statement by January 31 of the following year.
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