2015

a Employee's social security number

OMB No. 1545-0008

2015
W2 & EARNINGS 364-93-9496
c Employer's name, address, and ZIP code 1 Wages,tips,other compensation 2 Federal income tax
SUMMARY LBO HOLDING INC 4307.65 375.82
PO BOX 308 3 Social security wages 4 Social security tax

BARTLETT, NH 03812

Wage and Tax Statement

5 Medicare wages and tips 6 Medicare tax withheld

Copy B to be filed with Employee's Federal Income Tax Return.

b Employer's identification number d Control Number

Federal Filing Copy

LBO HOLDING INC
01-0488967 65449 9853 7 Social security tips 8 Allocated tips
PO BOX 308
e Employee's name and address 9 Advanced EIC payment 10 Dependent care benefits
BARTLETT, NH 03812
ALEJANDRA P. YANEZ PIAGGIO
11 Nonqualified plans 12 See instrs. for box 12
RTE 302
BARTLETT, NH 03812 13 Stat emp. Ret. Plan 3 Party Sick

14 Other

ALEJANDRA P. YANEZ PIAGGIO

W2
5667-0081-4474-25 15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
Filing Status Exemptions NH NO W/H 4307.65
FITWH S 1
NH S 0
a Employee's social security number

OMB No. 1545-0008

2015
364-93-9496
WAGES c Employer's name, address, and ZIP code 2 Federal income tax
1 Wages,tips,other compensation
TOTAL GROSS WAGES 4307.65 LBO HOLDING INC 4307.65 375.82
Description Amount Box PO BOX 308 3 Social security wages 4 Social security tax

BARTLETT, NH 03812

Wage and Tax Statement

Soc. Security Wages 0 3 5 Medicare wages and tips 6 Medicare tax withheld
b Employer's identification number d Control Number

Copy 2 to be filed with Employee's State Income Tax Return.

Medicare Wages 0 5

State Filing Copy

01-0488967 65449 9853 7 Social security tips 8 Allocated tips
Fed. Taxable Wages 4307.65 1
e Employee's name and address 9 Advanced EIC payment 10 Dependent care benefits
NH Taxable Wages 4307.65 16
ALEJANDRA P. YANEZ PIAGGIO
WITHHOLDINGS 11 Nonqualified plans 12 See instrs. for box 12
RTE 302
Description Amount Box
BARTLETT, NH 03812 13 Stat emp. Ret. Plan 3 Party Sick
Fed. Income Tax 375.82 2
14 Other
Soc. Security Tax 0 4
Medicare Tax 0 6
NH Income Tax 0 17

W2
15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
NH NO W/H 4307.65

a Employee's social security number

OMB No. 1545-0008

2015
364-93-9496
c Employer's name, address, and ZIP code 1 Wages,tips,other compensation 2 Federal income tax
LBO HOLDING INC 4307.65 375.82
PO BOX 308 3 Social security wages 4 Social security tax

BARTLETT, NH 03812

Wage and Tax Statement

City or Local Filing Copy
5 Medicare wages and tips 6 Medicare tax withheld
b Employer's identification number d Control Number

01-0488967 65449 9853 7 Social security tips 8 Allocated tips

Copy 2 for Employee's City/Local Income Tax Return.

e Employee's name and address 9 Advanced EIC payment 10 Dependent care benefits
ALEJANDRA P. YANEZ PIAGGIO
11 Nonqualified plans 12 See instrs. for box 12
RTE 302
BARTLETT, NH 03812 13 Stat emp. Ret. Plan 3 Party Sick

14 Other

W2
15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
NH NO W/H 4307.65

a Employee's social security number

OMB No. 1545-0008
2015
364-93-9496
c Employer's name, address, and ZIP code 1 Wages,tips,other compensation 2 Federal income tax
LBO HOLDING INC 4307.65 375.82
PO BOX 308 3 Social security wages 4 Social security tax
Employee Reference Copy

BARTLETT, NH 03812
Wage and Tax Statement

5 Medicare wages and tips 6 Medicare tax withheld

b Employer's identification number d Control Number

01-0488967 65449 9853 7 Social security tips 8 Allocated tips

e Employee's name and address 9 Advanced EIC payment 10 Dependent care benefits
ALEJANDRA P. YANEZ PIAGGIO
11 Nonqualified plans 12 See instrs. for box 12
RTE 302
BARTLETT, NH 03812 13 Stat emp. Ret. Plan 3 Party Sick
Copy C for Employee's records.

14 Other
W2

15 State & Employer's state ID 16 State wages,tips,etc 17 State income tax 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
NH NO W/H 4307.65