Company Information: Address:4800 River RoadPhiladelphia, PA 19113-5548Pennsylvania state identification number:00-0-1066Telephone number: (215) 555-0017Federal identification number:00-0000972Fax number: (215) 555-0010Philadelphia identification number:0001895

Kenneth T. Ford	Married, 7 allowances	Social security tax withheld	4,368.69
338 North Side Avenue Philadelphia, PA 19130-6638	$1,350 per week	Medicare tax withheld	1,021.97
	SS#: 000-00-6839	State income tax withheld	2,155.40
	Cost of group-term life insurance exceeding $50,000: $262.75* $100/week401(k)	Local income tax withheld	2,724.28
		State unemployment tax withheld**	42.12

Void 22222 a Employee's social security number b Employer identification number (EIN) For Official Use Only OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheld C Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12 c 13 Statutory employec Retirement plan Third-party sick pey 12b 14 Other 12c c 12d + Employee's address and ZIP code 15 State Employer's state ID number 16 State wagos, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Form W-2 Wage and Tax Statement 20-- Department of the Treasury Internal Revenue Service For Privacy Act and Paperwork Reduction Copy A For Social Security Administration - Send this entire page with Act Notice, see the separate instructions. Form W-3 to the Social Security Administration; photocopies are not acceptable. Cat. No. 10134D Do Not Cut, Fold, or Staple Forms on This Page - Do Not Cut, Fold, or Staple Forms on This Page Void 22222 a Employee's social security number b Employer identification number (EIN) For Official Use Only OMB No. 1545-0008 1 Wages, tips, other compensation 2 Federal income tax withheld C Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12 c 13 Statutory employec Retirement plan Third-party sick pey 12b 14 Other 12c c 12d + Employee's address and ZIP code 15 State Employer's state ID number 16 State wagos, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Form W-2 Wage and Tax Statement 20-- Department of the Treasury Internal Revenue Service For Privacy Act and Paperwork Reduction Copy A For Social Security Administration - Send this entire page with Act Notice, see the separate instructions. Form W-3 to the Social Security Administration; photocopies are not acceptable. Cat. No. 10134D Do Not Cut, Fold, or Staple Forms on This Page - Do Not Cut, Fold, or Staple Forms on This Page