Appendix A Continuing Payroll Project: Wayland Custom Woodworking (1 Month, Part 1) (Static)

Wayland Custom Woodworking is a firm that manufactures custom cabinets and woodwork for business and residential customers. Students will have the opportunity to establish payroll records and to complete a month of payroll information for Wayland. Wayland Custom Woodworking is located at 1716 Nichol Street, Logan, Utah, 84321, phone number 435-555-9877. The owner is Mark Wayland. Waylands EIN is 91-7444533, and the Utah Employer Account Number is 99992901685WTH. Wayland has determined it will pay its employees on a semimonthly basis. Federal income tax should be computed using the percentage method.

For Part 1 of this project, you will complete payroll for the last month (December) of the fourth quarter (Q4) of 2019, which consists of the final pay periods of the year. Once payroll has been completed for the fourth quarter, you will then file the annual tax forms for Wayland as well as prepare each employee's Form W-2 in Part 2.

The SUTA (UI) rate for Wayland Custom Woodworking is 2.6 percent on the first $35,300. The state withholding rate is 4.95 percent for all income levels, deductions, and marital statuses, a table has been included to assist with calculations of state tax due for employees. No employee will reach the SUTA wage cap.

Rounding can create a challenge. For this project, the hourly rate for the individuals should be rounded to five decimal places. So take their salary and divide by 2,080 (52 weeks at 40 hours per week) for full-time, nonexempt employees.

Example: Annual Salary to Hourly Rate, Nonexempt Employee

Employee Vardens annual salary is $42,000, and he is a nonexempt employee.

Hourly rate = $42,000 / (52 40) = $42,000 / 2,080

Hourly rate = $20.19231 per hour

Example: Period Gross Pay, Salaried Employee

Employee Chinson earns an annual salary of $24,000 and is paid semimonthly.

Period gross pay = $24,000 / 24 = $1,000 gross pay

For pay periods with holiday hours: determine the amount paid per day, multiply by the number of days applicable to each pay.

Annual salary: $24,000 / (52 5) = $24,000 / 260 = $92.30769 (rounded to 5 decimal points) per day.

After the gross pay has been calculated, round the result to only two decimal points prior to calculating taxes or other withholdings. Employees are paid for the following holidays occurring during the final quarter:

• Thanksgiving day and the day after, Thursday and Friday, November 2829.
• Christmas, which is a Wednesday. Employees receive holiday pay for Tuesday, December 24, and Wednesday, December 25.

For the completion of this project, refer to the tax-related information in the table below. For federal withholding calculations, use the percentage method tables in Appendix C, which is provided below. For Utah state withholding calculations, use the Utah Schedule 3 tax tables linked below (ensure to use the appropriate Utah table based on each employee's marital status). Both 401(k) and insurance are pre-tax for federal income tax and Utah income tax. Round calculations to get to final tax amounts and 401(k) contributions after calculating gross pay.

The departments are as follows:

Department 00: Sales and Administration

Department 01: Factory workers

Department 02: Delivery and Customer service

You have been hired as of October 1 as the new accounting clerk. Your employee number is 00-SUCCE. Your name is Student Success. Your address is 1650 South Street, Logan, UT 84321. Your phone number is 435-556-1211, you were born July 16, 1985, your Utah driver's license number is 887743 expiring in 07/16/2024, and your Social Security number is 555-55-5555. You are considered a nonexempt employee, have one withholding allowance, and paid a rate of $36,000 per year.

The balance sheet for WCW as of November 30, 2019, is as follows:

Forms W-4 and I-9 (Static)

Required:

1. Complete the W-4 and, using the given information, complete the I-9 form to start your employee file. Complete it as if you are single with one withholding, you contribute 3 percent to a 401(k), and health insurance is $50 per pay period. The following file provides the lists of acceptable documents for Form I-9.

(NOTE): Further instructions on format can be found on certain cells within the forms. Employer I-9 PG 2 Section should also be completed. Round your intermediate computations to 2 decimal places.

Federal Withholding Allowance (less 401(k), Section 125) Federal Unemployment Rate (employer only) (less Section 125) Semimonthly Federal Percentage Method Tax Table State Unemployment Rate (employer only) (less Section 125) State Withholding Rate (less 401(k), Section 125) $175.00 per allowance claimed 0.6% on the first $7,000 of wages Appendix C Table #3 2.6% on the first $35,300 of wages See Utah Schedule 3, Table A-1 or use the Excel Version of Schedule 3 Assets Cash Supplies Office Equipment Inventory Vehicle Accumulated Depreciation, Vehicle Building Accumulated Depreciation, Building Land Total Assets Wayland Custom Woodworking Balance Sheet November 30, 2019 Liabilities & Equity $1,085,278.38 Accounts Payable 42,240.11 Salaries and Wages Payable 87,250.00 Federal Unemployment Tax Payable 167,099.00 Social Security Tax Payable 25,000.00 Medicare Tax Payable State Unemployment Tax Payable 164,000.00 Employee Federal Income Tax Payable Employee State Income Tax Payable 35,750.00 401(k) Contributions Payable 1,606,617.49 Employee Medical Premiums Payable Notes Payable Utilities Payable Total Liabilities Owners' Equity Retained Earnings Total Equity Total Liabilities and Equity $ 112,747.25 10,158.53 88.72 3,158.42 738.66 662.24 1,427.61 1,133.72 1,002.34 750.00 224,750.00 356,617.49 1,250,000.00 1,250,000.00 1,606, 617.49 Voluntary deductions for each employee are as follows: Name Chinson Wayland Peppinico Deduction Insurance: $50/paycheck 401(k): 3% of gross pay Insurance: $75/paycheck 401(k): 6% of gross pay Insurance: $75/paycheck 401(k): $50 per paycheck Insurance: $50/paycheck 401(k): 4% of gross pay Insurance: $75/paycheck 401(k): 3% of gross pay Insurance: $50/paycheck 401(k): 3% of gross pay Varden Hissop Student Form W4 19 Page 1 19 Page 2 W4 Instructions Complete the W-4 for Student Success. Form W-4 (2019) B A B D D E E Personal Allowances Worksheet (Keep for your records.) Enter "1" for yourself Enter *1" if you will file as married filing jointly Enter "1" if you will file as head of household You're single, or married filing separately, and have only one job; or Enter "1" if: You're married filing jointly, have only one job, and your spouse doesn't work; or Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less. Child tax credit. See Pub 972, Child Tax Credit, for more information. If your total income will be less than $71,201 (S103,351 if married filing jointly), enter "4" for each eligible child. . If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter 2 for each eligible child. If your total income will be from $179,051 to $200,000 ($345,851 to $400,000 if married filing jointly), enter "1" for each eligible child. . If your total income will be higher than $200,000 ($400,000 if married filing jointly), enter"-0-" Credit for other dependents. If your total income will be less than $71,201 (5103,351 if married filing jointly), enter "1" for each eligible dependent . If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter "1" for every two dependents (for example, "-0-" for one dependent, *1* if you have two or three dependents, and 2if you have four dependents) If your total income will be higher than $179,050 ($345,850 if married filing jointly), enter "-0-" Other credits. If you have other credits, see Worksheet 1-6 of Pub. 505 and enter the amount from that worksheet here. If you use Worksheet 1-6, enter"-O-" on lines E and F Add lines A through G and enter the total here If you plan to itemize or claim adjustments to income and want reduce your withholding, or if you have a large amount of nonwage income not subject withholding and want to increase your For accuracy, withholding, see the Deductions, Adjustments, and Additional Income Worksheet below. complete all If you have more than one job at a time or are married filing jointly and you and your spouse both worksheets work, and the combined earnings from all jobs exceed $53,000 ($24,450 if married filing jointly), see that apply. the Two-Earners/Multiple Jobs Worksheet on page 4 to avoid having too little tax withheld. If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 above. Separate here and give Form W-4 to your employer. Keep the worksheet(s) for your records. F G H Separate here and give Form W-4 to your employer. Keep the worksheets for your records. Form W-4 Employee's Withholding Allowance Certificate OMB No. 1545-0074 Department of the Treasury Whether you're entitled to claim a certain number of allowances or exemption from withholding is subject to review by the Internal Revenue IRS. Your employer may be required to send a copy of this form to the IRS. 2019 Service 1 Your first name and middle initial Last name 2 Your social security number Home address (number and street or rural route) Single Married Married, but withhold at higher Single rate. Note: If married filing separately, check "Married, but withhold at higher Single rate." City or town, state, and ZIP code | 4 If your last name differs from that shown on your social security card, check here. You must call 800-772-1213 for a replacement card. 5 5 6 Total number of allowances you're claiming 6 Additional amount, if any, you want withheld from each paycheck 7 I claim exemption from withholding for 2019, and I certify that I meet both of the following conditions for exemption. . Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write "Exempt" here .. Under penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief, it is true, correct, and complete. Employee's signature (This form is not valid unless you sign it.) 8 Employer's name and address (Employer: Complete boxes 8 and 10 if sending to IRS and First date of complete employment boxes 8, 9, and 10 if sending to State Directory of New Hires.) 10 Employer identification number (EIN) For Privacy Act and Paperwork Reduction Act Notice, see page 4. Cat. No. 102200 Form W-4 (2019) THIS FORM IS A SIMULATION OF AN OFFICIAL U.S. TAX FORM. IT IS NOT THE OFFICIAL FORM ITSELF. DO NOT USE THIS FORM FOR TAX FILINGS OR FOR ANY PURPOSE OTHER THAN EDUCATIONAL. 2020 McGraw-Hill Education. Date 9 Employment Eligibility Verification USCIS Form 1-9 OMB No. 1615-0047 Expires 08/31/2019 Department of Homeland Security U.S. Citizenship and Immigration Services START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form 1-9 no later than the first day of employment, but not before accepting a job offer.) Last name (Family Name) First Name (Given Name) Middle Initial Other Names Used (if any) Address Street Number and Name) Apt. Number City or Town State Zip Code Date of Birth (mm/dd/yyyy) U.S. Social Security Number E-mail Address Telephone Number I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following): 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Alien Registration Number USCIS Number): O4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in this field. (See instructions) Aliens authorized to work must provide only one of the following document numbers to complete Form 1-9 An Alien Registration Number/USCIS Number OR Form 1-94 Admission Number OR Foreign Passport Number. 1. Alien Registration Number/USCIS Number: OR QR Code - Section 1 2. Form 1-94 Admission Number: Do Not Write in This Space OR Foreign Passport Number: Country of Issuance: Signature of Employee: Today's Date (mm/dd/yyyy) Preparer and/or Translator Certification (check one): Preparer and/or Translator Certification (check one): I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct. Signature of Preparer or Translator: Today's Date (mm/dd/yyyy): Last Name (Family Name) First Name (Given Name) Address (Street Number and Name) City or Town State Zip Code Stop Employer Completes Next Page Stop Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.") AND Employee Last Name, First Name and Middle Initial from Section 1: List A OR Identity and Employment Authorization Document Title List B Identity Document Title List C Employment Authorization Document Title: Issuing Authority Issuing Authority Issuing Authority Document Number Document Number Document Number Expiration Date (if any) (mm/dd/yyyy): Expiration Date (if any) (mm/dd/yyyy): Expiration Date (if any) (mm/dd/yyyy): Document Title: Issuing Authority Additional Information QR Code - Sections 2 & 3 Do Not Write in This Space Document Number Expiration Date (if any) (mm/dd/yyyy): Document Title: Issuing Authority Document Number Expiration Date (if any) (mm/dd/yyyy): Certification I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): Signature of Employer or Authorized Representative (See instructions for exemptions.) Title of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Employer's Business or Organization Name Employer's Business or Organization Address (Street Number and Name) City or Town State Zip Code Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.) A. New Name (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial B. Date of Rehire (if applicable) (mm/dd/yyyy) C. If employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the employee presented that establishes current employment authorization in the space provided below. Document Title: Document Number Expiration Date any)(mm/dd/yyyy): I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or Authorized Representative: Today's Date (mm/dd/yyyy): Print Name of Employer or Authorized Representative: Federal Withholding Allowance (less 401(k), Section 125) Federal Unemployment Rate (employer only) (less Section 125) Semimonthly Federal Percentage Method Tax Table State Unemployment Rate (employer only) (less Section 125) State Withholding Rate (less 401(k), Section 125) $175.00 per allowance claimed 0.6% on the first $7,000 of wages Appendix C Table #3 2.6% on the first $35,300 of wages See Utah Schedule 3, Table A-1 or use the Excel Version of Schedule 3 Assets Cash Supplies Office Equipment Inventory Vehicle Accumulated Depreciation, Vehicle Building Accumulated Depreciation, Building Land Total Assets Wayland Custom Woodworking Balance Sheet November 30, 2019 Liabilities & Equity $1,085,278.38 Accounts Payable 42,240.11 Salaries and Wages Payable 87,250.00 Federal Unemployment Tax Payable 167,099.00 Social Security Tax Payable 25,000.00 Medicare Tax Payable State Unemployment Tax Payable 164,000.00 Employee Federal Income Tax Payable Employee State Income Tax Payable 35,750.00 401(k) Contributions Payable 1,606,617.49 Employee Medical Premiums Payable Notes Payable Utilities Payable Total Liabilities Owners' Equity Retained Earnings Total Equity Total Liabilities and Equity $ 112,747.25 10,158.53 88.72 3,158.42 738.66 662.24 1,427.61 1,133.72 1,002.34 750.00 224,750.00 356,617.49 1,250,000.00 1,250,000.00 1,606, 617.49 Voluntary deductions for each employee are as follows: Name Chinson Wayland Peppinico Deduction Insurance: $50/paycheck 401(k): 3% of gross pay Insurance: $75/paycheck 401(k): 6% of gross pay Insurance: $75/paycheck 401(k): $50 per paycheck Insurance: $50/paycheck 401(k): 4% of gross pay Insurance: $75/paycheck 401(k): 3% of gross pay Insurance: $50/paycheck 401(k): 3% of gross pay Varden Hissop Student Form W4 19 Page 1 19 Page 2 W4 Instructions Complete the W-4 for Student Success. Form W-4 (2019) B A B D D E E Personal Allowances Worksheet (Keep for your records.) Enter "1" for yourself Enter *1" if you will file as married filing jointly Enter "1" if you will file as head of household You're single, or married filing separately, and have only one job; or Enter "1" if: You're married filing jointly, have only one job, and your spouse doesn't work; or Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less. Child tax credit. See Pub 972, Child Tax Credit, for more information. If your total income will be less than $71,201 (S103,351 if married filing jointly), enter "4" for each eligible child. . If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter 2 for each eligible child. If your total income will be from $179,051 to $200,000 ($345,851 to $400,000 if married filing jointly), enter "1" for each eligible child. . If your total income will be higher than $200,000 ($400,000 if married filing jointly), enter"-0-" Credit for other dependents. If your total income will be less than $71,201 (5103,351 if married filing jointly), enter "1" for each eligible dependent . If your total income will be from $71,201 to $179,050 ($103,351 to $345,850 if married filing jointly), enter "1" for every two dependents (for example, "-0-" for one dependent, *1* if you have two or three dependents, and 2if you have four dependents) If your total income will be higher than $179,050 ($345,850 if married filing jointly), enter "-0-" Other credits. If you have other credits, see Worksheet 1-6 of Pub. 505 and enter the amount from that worksheet here. If you use Worksheet 1-6, enter"-O-" on lines E and F Add lines A through G and enter the total here If you plan to itemize or claim adjustments to income and want reduce your withholding, or if you have a large amount of nonwage income not subject withholding and want to increase your For accuracy, withholding, see the Deductions, Adjustments, and Additional Income Worksheet below. complete all If you have more than one job at a time or are married filing jointly and you and your spouse both worksheets work, and the combined earnings from all jobs exceed $53,000 ($24,450 if married filing jointly), see that apply. the Two-Earners/Multiple Jobs Worksheet on page 4 to avoid having too little tax withheld. If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 above. Separate here and give Form W-4 to your employer. Keep the worksheet(s) for your records. F G H Separate here and give Form W-4 to your employer. Keep the worksheets for your records. Form W-4 Employee's Withholding Allowance Certificate OMB No. 1545-0074 Department of the Treasury Whether you're entitled to claim a certain number of allowances or exemption from withholding is subject to review by the Internal Revenue IRS. Your employer may be required to send a copy of this form to the IRS. 2019 Service 1 Your first name and middle initial Last name 2 Your social security number Home address (number and street or rural route) Single Married Married, but withhold at higher Single rate. Note: If married filing separately, check "Married, but withhold at higher Single rate." City or town, state, and ZIP code | 4 If your last name differs from that shown on your social security card, check here. You must call 800-772-1213 for a replacement card. 5 5 6 Total number of allowances you're claiming 6 Additional amount, if any, you want withheld from each paycheck 7 I claim exemption from withholding for 2019, and I certify that I meet both of the following conditions for exemption. . Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write "Exempt" here .. Under penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief, it is true, correct, and complete. Employee's signature (This form is not valid unless you sign it.) 8 Employer's name and address (Employer: Complete boxes 8 and 10 if sending to IRS and First date of complete employment boxes 8, 9, and 10 if sending to State Directory of New Hires.) 10 Employer identification number (EIN) For Privacy Act and Paperwork Reduction Act Notice, see page 4. Cat. No. 102200 Form W-4 (2019) THIS FORM IS A SIMULATION OF AN OFFICIAL U.S. TAX FORM. IT IS NOT THE OFFICIAL FORM ITSELF. DO NOT USE THIS FORM FOR TAX FILINGS OR FOR ANY PURPOSE OTHER THAN EDUCATIONAL. 2020 McGraw-Hill Education. Date 9 Employment Eligibility Verification USCIS Form 1-9 OMB No. 1615-0047 Expires 08/31/2019 Department of Homeland Security U.S. Citizenship and Immigration Services START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form 1-9 no later than the first day of employment, but not before accepting a job offer.) Last name (Family Name) First Name (Given Name) Middle Initial Other Names Used (if any) Address Street Number and Name) Apt. Number City or Town State Zip Code Date of Birth (mm/dd/yyyy) U.S. Social Security Number E-mail Address Telephone Number I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following): 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Alien Registration Number USCIS Number): O4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in this field. (See instructions) Aliens authorized to work must provide only one of the following document numbers to complete Form 1-9 An Alien Registration Number/USCIS Number OR Form 1-94 Admission Number OR Foreign Passport Number. 1. Alien Registration Number/USCIS Number: OR QR Code - Section 1 2. Form 1-94 Admission Number: Do Not Write in This Space OR Foreign Passport Number: Country of Issuance: Signature of Employee: Today's Date (mm/dd/yyyy) Preparer and/or Translator Certification (check one): Preparer and/or Translator Certification (check one): I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct. Signature of Preparer or Translator: Today's Date (mm/dd/yyyy): Last Name (Family Name) First Name (Given Name) Address (Street Number and Name) City or Town State Zip Code Stop Employer Completes Next Page Stop Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.") AND Employee Last Name, First Name and Middle Initial from Section 1: List A OR Identity and Employment Authorization Document Title List B Identity Document Title List C Employment Authorization Document Title: Issuing Authority Issuing Authority Issuing Authority Document Number Document Number Document Number Expiration Date (if any) (mm/dd/yyyy): Expiration Date (if any) (mm/dd/yyyy): Expiration Date (if any) (mm/dd/yyyy): Document Title: Issuing Authority Additional Information QR Code - Sections 2 & 3 Do Not Write in This Space Document Number Expiration Date (if any) (mm/dd/yyyy): Document Title: Issuing Authority Document Number Expiration Date (if any) (mm/dd/yyyy): Certification I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): Signature of Employer or Authorized Representative (See instructions for exemptions.) Title of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Employer's Business or Organization Name Employer's Business or Organization Address (Street Number and Name) City or Town State Zip Code Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.) A. New Name (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial B. Date of Rehire (if applicable) (mm/dd/yyyy) C. If employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the employee presented that establishes current employment authorization in the space provided below. Document Title: Document Number Expiration Date any)(mm/dd/yyyy): I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or Authorized Representative: Today's Date (mm/dd/yyyy): Print Name of Employer or Authorized Representative