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Wage and Income Transcript Page I of2

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This Product Contains Sensitj,ve Taxpayer Data

Wage and Income Transcript


Request Date: 02-73-20I9
Response Date: 02-73-20L9
Tracking Number: 100428593458

SSN Provided: XXX-XX-l717


Tax Period Requested: December, 2015

Form W-2 Wage and Tax Statement


Employer:
Employer fdenLification Number (trIN) : XXXXX749B
IN
PO BOX

Employee:
Employee's SocjaI Security Number: XXX-XX-1717
ANDR
PO BOX

Srrl.rmi eei nn 'T'rzno.


Amended
document
IaJ:acq- Tinc :nd Ol har /-nmnancrFinn.
evrllysrrre urvrr. $0.00
Eederaf Income Tax Withhe]d: $0.00
Sani: l Ca-rrri +r' ,,Jqes:
-r I^1: $0.00
Sociaf Security Tax WiLhhefd: $0.00
Medicare Wages and Tips: $0.00
Medicare Tax Withheld: $o. oo
JOCra-L SeCUrlty I'aps: $0.00
a I t^a^iad 't'r nc t
$0.00
Dependent Care Benefits: $0.00
Deferrcd Comnensation : $0.00
Nonlaxabfe Comlcat Pay: $0.00
Code "W" Employer Contributions to a Health Savinqs AccounL: $0.00
Code "Y" Deferral-s under a section 409A nonqualified Deferred $0.00
Compensat.ion plan:
Code "2" fncome under section 4O9A on a nonqualified Deferred $0.00
Compensation plan:
Code "R" Employerrs Cont.ribution to MSA: $0.00
.,^d6 rrq,, rmnt n'arI S COntribUtiOn Lv Simnl
tO ufruPf c A.corrnt.u r
s nuuvuff $0.00
Code rrTrr F,xncnseq Tncrrrred for OrrAl
Yuqrr!f,es i f i ad Adan+- i nnq.
nuvyervrrr ! $0.00
Code "V" Income from exercise of non-staLutory stock options: $0.00
"*" Designated Roth Contrlbutions under a Section 401(k) $0.00
"od.
PIan:
Code "BB" Designated Roth Contributions under a Section 403 (b) $0.00
PIan:
Code "DD" Cost of Empfoyer-sponsored Heafth Coveraqe: $0.00
Wage and Income Transcript Page2 of2

Code "EE" Designated ROTH Contributions Under a Governmental $0.00


Section 457 (b) Plan:
Th i rd Parf r; (i nlz D:rr
! qf Tndi nr+nr.
+rrsrvs uv! . Unanswered
Reti-rement Plan fndicator: No Correction
Statutory Employee: No Correction
This Product Contains Sensitive Taxpayer Data

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