22222 a Employee's social security number 535-44-2255 b Employer identification number (EIN) 91-0001003 c Employer's name, address, and ZIP code Small World Elementary School 333 Tiny Tot Lane Henderson, NV 89053 d Control number e Employee's first name and initial Jennifer 3678 Blue Sky Drive Henderson, NV 89052 OMB No. 1545-0008 1 Wages, tips, other compensation 36,825.00 3 Social security wages 39,925.00 5 Medicare wages and tips 39,925.00 7 Social security tips 9 2 Federal income tax withheld 3,350.00 4 Social security tax withheld 2,475.35 6 Medicare tax withheld 578.91 8 Allocated tips 10 Dependent care benefits Last name. Suff. 11 Nonqualified plans Hamilton 13 Statutory employee 14 Other f Employee's address and ZIP code 15 State Employer's state ID number NV 123456789 16 State wages, tips, etc. 17 State income tax 36,825.00 W-2 Wage and Tax Statement Copy 1-For State, City, or Local Tax Department 12a D 3,100.00 Retirement plan Third-party sick pay 12b 12c 12d 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 2021 Department of the Treasury-Internal Revenue Service