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Misal Romano
Misal Romano
Misal Romano
12b
DD 1544.70 CARLOS J RODRIGUEZ
14 Other
12c 317 OCEAN STREET
409.40 SDI
12d SANTA CRUZ CA 95060
13 Stat emp. Ret. plan 3rd party sick pay
1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld
37218.13 2803.51 37218.13 2803.51 37218.13 2803.51
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld
37218.13 2307.52 37218.13 2307.52 37218.13 2307.52
5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld
37218.13 539.66 37218.13 539.66 37218.13 539.66
d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only
007221 NCN2/JTD 100818 A 105 007221 NCN2/JTD 100818 A 105 007221 NCN2/JTD 100818 A 105
c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code
REMINGTON LODGING & REMINGTON LODGING & REMINGTON LODGING &
HOSPITALITY LLC HOSPITALITY LLC HOSPITALITY LLC
14185 DLLAS PKWY #1150 14185 DLLAS PKWY #1150 14185 DLLAS PKWY #1150
DALLAS TX 75254 DALLAS TX 75254 DALLAS TX 75254
b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number
20-0111553 XXX-XX-3028 20-0111553 XXX-XX-3028 20-0111553 XXX-XX-3028
7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips
11 Nonqualified plans 12a See instructions for box 12 11 Nonqualified plans 12a
12 11 Nonqualified plans 12a
DD 1544.70 DD 1544.70 DD 1544.70
14 Other 12b 14 Other 12b 14 Other 12b
12c 12c 12c
409.40 SDI 409.40 CA SDI 409.40 CA SDI
12d 12d 12d
13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay 13 Stat emp. Ret. plan 3rd party sick pay
e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code
CARLOS J RODRIGUEZ CARLOS J RODRIGUEZ CARLOS J RODRIGUEZ
317 OCEAN STREET 317 OCEAN STREET 317 OCEAN STREET
SANTA CRUZ CA 95060 SANTA CRUZ CA 95060 SANTA CRUZ CA 95060
15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc.
CA 239-7767 1 37218.13 CA 239-7767 1 37218.13 CA 239-7767 1 37218.13
17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.
970.88 970.88 970.88
19 Local income tax 20 Locality name 19 Local income tax 20 Locality name 19 Local income tax 20 Locality name
NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDERAL, STATE AND LOCAL/CITY INCOME TAX RETURNS.
This information is being furnished to the Internal
Revenue Service. If you are required to file a tax Notice to Employee
return, a negligence penalty or other sanction may
be imposed on you if this income is taxable and Do you have to file? Refer to the Form 1040 instructions Corrections. If your name, SSN, or address is incorrect,
you fail to report it. correct Copies B, C, and 2 and ask your employer to
to determine if you are required to file a tax return. Even if
you don’t have to file a tax return, you may be eligible for correct your employment record. Be sure to ask the
IMPORTANT NOTE:
a refund if box 2 shows an amount or if you are eligible for employer to file Form W-2c, Corrected Wage and Tax
In order to insure efficient processing,
any credit. Statement, with the SSA to correct any name, SSN, or
attach this W-2 to your tax return like this
money amount error reported to the SSA on Form W-2. Be
(following agency instructions): Earned income credit (EIC). You may be able to take the
sure to get your copies of Form W-2c from your employer
EIC for 2022 if your adjusted gross income (AGI) is less
for all corrections made so you may file them with your tax
than a certain amount. The amount of the credit is based
return. If your name and SSN are correct but aren’t the
on income and family size. Workers without children could
same as shown on your social security card, you should
qualify for a smaller credit. You and any qualifying children
ask for a new card that displays your correct name at any
must have valid social security numbers (SSNs). You can’t
SSA office or by calling 800-772-1213. You may also visit
take the EIC if your investment income is more than the
the SSA website at www.SSA.gov.
TAX RETURN specified amount for 2022 or if income is earned for
services provided while you were an inmate at a penal Cost of employer-sponsored health coverage (if such
institution. For 2022 income limits and more information, cost is provided by the employer). The reporting in box
visit www.irs.gov/EITC. See also Pub. 596, Earned Income 12, using code DD, of the cost of employer-sponsored
THIS Credit. Any EIC that is more than your tax liability is health coverage is for your information only. The amount
OTHER refunded to you, but only if you file a tax return. reported with code DD is not taxable.
FORM
W-2’S Credit for excess taxes. If you had more than one
W-2 Employee’s social security number (SSN). For your
protection, this form may show only the last four digits of employer in 2022 and more than $9,114 in social
your SSN. However, your employer has reported your security and/or Tier 1 railroad retirement (RRTA) taxes
complete SSN to the IRS and the Social Security were withheld, you may be able to claim a credit for the
Administration (SSA). excess against your federal income tax. See the Form
1040 instructions. If you had more than one railroad
Clergy and religious workers. If you aren’t subject to employer and more than $5,350.80 in Tier 2 RRTA tax
social security and Medicare taxes, see Pub. 517, Social was withheld, you may be able to claim a refund on
Security and Other Information for Members of the Clergy Form 843. See the Instructions for Form 843.
and Religious Workers.
Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service