Copy B--To Be Filed With Employee's FEDERAL Tax Return OMB No.

OMB No. 1545-0008 Copy 2--To Be Filed With Employee's State, City, OMB No. 1545-0008
This information is being furnished to the Internal Revenue Service. or Local Income Tax Return
a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld

XXX-XX-2455 21358.82 1930.09 XXX-XX-2455 21358.82 1930.09

b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld
84-1913703 5774.29 1324.25 84-1913703 5774.29 1324.25
d. Control number 5. Medicare wages and tips 6. Medicare tax withheld d. Control number 5. Medicare wages and tips 6. Medicare tax withheld
Q2305-1-169 21358.82 309.70 Q2305-1-169 21358.82 309.70
c. Employer's name, address, and ZIP code c. Employer's name, address, and ZIP code
Begging Burro LLC Begging Burro LLC
PO Box 548 PO Box 548
Custer, SD 57730-0548 Custer, SD 57730-0548

e. Employee's name, address, and ZIP code e. Employee's name, address, and ZIP code

JOSE A GUTIERREZ TOME JOSE A GUTIERREZ TOME

140 Mt.rushmore rd 140 Mt.rushmore rd
Custer, SD 57730 Custer, SD 57730

7. Social security tips 8. Allocated tips 9. 7. Social security tips 8. Allocated tips 9.
15584.53 15584.53
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12 10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12

13. Statutory employee 14. Other 12b. Code 13. Statutory employee 14. Other 12b. Code

Retirement plan 12c. Code Retirement plan 12c. Code

Third-party sick pay 12d. Code Third-party sick pay 12d. Code

15. State Employer's state ID number 16. State wages, tips, etc. 17.State income tax 15. State Employer's state ID number 16. State wages, tips, etc. 17.State income tax

18. Local wages, tips, etc. 19. Local income tax 20. Locality name 18. Local wages, tips, etc. 19. Local income tax 20. Locality name

Form W-2 Wage and Tax Statement 2023 Department of the Treasury ~ Internal Revenue Service Form W-2 Wage and Tax Statement 2023 Department of the Treasury ~ Internal Revenue Service

Copy C--For EMPLOYEE'S RECORDS(See Notice to Employee.)

This information is being furnished to the Internal Revenue Service. If you are required to file a tax OMB No. 1545-0008 Copy 2--To Be Filed With Employee's State, City, OMB No. 1545-0008
return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you or Local Income Tax Return
fail to report it.
a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld a. Employee's social security number 1. Wages, tips, other compensation 2. Federal income tax withheld

XXX-XX-2455 21358.82 1930.09 XXX-XX-2455 21358.82 1930.09

b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld b. Employer ID number (EIN) 3. Social security wages 4. Social security tax withheld
84-1913703 5774.29 1324.25 84-1913703 5774.29 1324.25
d. Control number 5. Medicare wages and tips 6. Medicare tax withheld d. Control number 5. Medicare wages and tips 6. Medicare tax withheld
Q2305-1-169 21358.82 309.70 Q2305-1-169 21358.82 309.70
c. Employer's name, address, and ZIP code c. Employer's name, address, and ZIP code

Begging Burro LLC Begging Burro LLC

PO Box 548 PO Box 548
Custer, SD 57730-0548 Custer, SD 57730-0548

e. Employee's name, address, and ZIP code e. Employee's name, address, and ZIP code

JOSE A GUTIERREZ TOME JOSE A GUTIERREZ TOME

140 Mt.rushmore rd 140 Mt.rushmore rd
Custer, SD 57730 Custer, SD 57730

7. Social security tips 8. Allocated tips 9. 7. Social security tips 8. Allocated tips 9.
15584.53 15584.53
10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12 10. Dependent care benefits 11. Nonqualified plans 12a. Code See inst. for Box 12

13. Statutory employee 14. Other 12b. Code 13. Statutory employee 14. Other 12b. Code

Retirement plan 12c. Code Retirement plan 12c. Code

Third-party sick pay 12d. Code Third-party sick pay 12d. Code

15. State Employer's state ID number 16. State wages, tips, 17.State income tax 15. State Employer's state ID number 16. State wages, tips, 17.State income tax
etc. etc.

18. Local wages, tips, etc. 19. Local income tax 20. Locality name 18. Local wages, tips, etc. 19. Local income tax 20. Locality name

Form W-2 Wage and Tax Statement Department of the Treasury ~ Internal Revenue Service Form W-2 Wage and Tax Statement Department of the Treasury ~ Internal Revenue Service
2023 2023