a Employee's social security number For Official Use Only 22222 Void OMB No. 1545-0008 b Employer Identification number (FIN) 1 Wages, tips, other compensation 2 Federal Income tax withheld 3 Social security wages 4 Social security tax withheld c Employer's name, address, and ZIP code 5 Medicare wages and tips 5 Medicare tax withheld Quigley Corporation $1 4800 River Road Philadelphia, PA 19113-5548 7 Social security tips 8 Allocated tips 10 Dependent care benefits d Control number 9 Verification code e Employee's first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12 Ralph I. Volpe Code DY 13 Retirement plan v 56 Andrews Court, Apt. 7 12b Code Philadelphia, PA 19103-3356 14 Other 12c Code f Employee's address and ZIP code PA SUI 24.44 v 12d Code 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 PAY Phila. v