Complete the I-9 for employment at Plexivent Plastics starting 9/6/2022. The employer’s address is 1 Plastics Way, Lincoln Valley, ND 58430, and the EIN is 56-4658631. Henry is starting work on 9/6/2022. Be sure to complete Section 2 of Form I-9.
Henry Walker Pierce
2024 Denhoff Highway, Apartment 12
Lincoln Valley, ND 58430
SSN: 687-55-4658
Marital status: Married
Date of Birth: 8/15/1999
U.S. Citizen
Henry’s North Dakota driver’s license number is MKJ-462856 and expires on his birthday in 2024.
Office Manager James MacMillan verified the information for the company.

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Form W-4 Department of the Treasury Internal Revenue Service - Step 1: Enter Personal Information Step 3: Claim Dependents (a) First name and middle initial Step 4 (optional): Other Adjustments Employee's Withholding Certificate ► Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. ►Give Form W-4 to your employer. ►Your withholding is subject to review by the IRS. Last name. Address Step 2: Multiple Jobs or Spouse Works Step 5: Sign Here City or town, state, and ZIP code (c) Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy. Single or Married filing separately Married filing jointly or Qualifying widow(er) Head of household (Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.) Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs. Do only one of the following. (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3-4); or (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job.) If your total income will be $200,000 or less ($400,000 or less if married filing jointly): Multiply the number of qualifying children under age 17 by $2,000 $ Multiply the number of other dependents by $500 ▶ $ Add the amounts above and enter the total here (a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income OMB No. 1545-0074 (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . 2022 (b) Social security number TIP: To be accurate, submit a 2022 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator. ► Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov. Employee's signature (This form is not valid unless you sign it.) Employers Employer's name and address Only For Privacy Act and Paperwork Reduction Act Notice, see page 3. First date of employment (b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here 4(b) S (c) Extra withholding. Enter any additional tax you want withheld each pay period. 4(c) $ . Cat. No. 10220Q Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete. Date 3 $ 4(a) $ Employer identification number (EIN) Form W-4 (2022)