Fillable Form 13: Federal Tax Return Copy B for

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Form 13: Federal Tax Return Copy B for

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b Employers identification number
c Employers name, address, and ZIP code
e Employees name, address, and ZIP code
This information is being furnished to the
Internal Revenue Service.
Copy B for Employees
Federal Tax Return
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
Form
W-2 Wage and Tax Statement 2003-Reissued
Department of the Treasury-Internal Revenue Service OMB # 1545-0008
Copy B To Be Filed With Employee's FEDERAL Tax Return
e Employees name, address, and ZIP code
Copy 2 for State, City or
Local Tax Departments
Form
W-2 Wage and Tax Statement 2003-Reissued
Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy 2 To Be Filed With Employee's State, CITY or Local Tax Departments
e Employees name, address, and ZIP code
Form
W-2 Wage and Tax Statement 2003-Reissued
Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy 2 To Be Filed With Employee's State, CITY or Local Tax Departments
e Employees name, address, and ZIP code
Copy C for Employees
Records
(See notice on back.)
Form W-2 Wage and Tax Statement 2003-Reissued Department of the Treasury-Internal Revenue Service OMB # 1545-0008 Copy C for Employee's Records
d Employees soc. sec. no
d
Employees soc. sec. no
d
Employees soc. sec. no
d
Employees soc. sec. no
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11Nonqualified plans
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
1 Wages, tips, other compensation
3 Social security wages
5 Medicare wages and tips
7 Social security tips
9 Advance EIC payment
11 Nonqualified plans
2 Federal income tax withheld
4 Social security tax withheld
6 Medicare tax withheld
8 Allocated tips
10 Dependent care benefits
b Employers identification number
c Employers name, address, and ZIP code
b Employers identification number
c Employers name, address, and ZIP code
b Employers identification number
c Employers name, address, and ZIP code
Copy 2 for State, City or
Local Tax Departments
This information is being furnished to the Internal
Revenue Service. If you are required to file a tax
return, a negligence penalty or other sanction may
be imposed on you if this income is taxable and you
fail to report it.
15 State Employers state I.D. No. 16 State wages, tips, etc. 17 State income tax 20 Locality name18 Local wages, tips, etc. 19 Local income tax
15 StateEmployers state I.D. No.16 State wages, tips, etc.17 State income tax20 Locality name18 Local wages, tips, etc. 19 Local income tax
15 State Employers state I.D. No. 16 State wages, tips, etc. 17 State income tax 20 Locality name18 Local wages, tips, etc. 19 Local income tax
15 State Employers state I.D. No. 16 State wages, tips, etc. 17 State income tax 20 Locality name18 Local wages, tips, etc. 19 Local income tax
14 Other
13
14 Other
14 Other
14 Other
Statutory
employee
Retirement
plan
Third-party
sick pay
13
Statutory
employee
Retirement
plan
Third-party
sick pay
13
Statutory
employee
Retirement
plan
Third-party
sick pay
13
Statutory
employee
Retirement
plan
Third-party
sick pay
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See instructions for Box 12
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Form 13: Federal Tax Return Copy B for

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Completed 7 January 2021

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