a Employee's social security number 466-33-1234 b Employer identification number (EIN) 33-1235672 Employer's name, address, and ZIP code Burger Box 1234 Mountain Road Houston, TX 77099 d Control number Safe, accurate, OMB No. 1545-0008 FAST! Use Visit the IRS website at ase file www.irs.goviefile 1 Wages, tips, other compensation 21,500.00 3 Social security wages 21,500.00 5 Medicare wages and tips 21,500.00 7 Social security tips 2 Federal income tax withheld 1,207.81 4 Social security tax withheld 1,333.00 6 Medicare tax withheld 311.75 8 Allocated tips 10 Dependent care benefits 12a See instructions for box 12 Employee's first name and initial Maria Tallchief 543 Space Drive Houston, TX 77099 Last name Suff. 11 Nonqualified plans 13 Statutory employe Retreat Third-party plan 12b 14 Other 12 8 12d 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name f Employee's address and ZIP code 15 State Employer's state ID number TX L Form W-2 Wage and Tax Statement Copy B-To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. 2021 Department of the Treasury-Internal Revenue Service