Complete the W-3 Form for J. Dodds, Inc. (employer identification #22-5555555), based on the employee information listed below. The company is located at 876 James Street, Charleston, SC 29401, and its South Carolina State ID number is the same as its federal identification number. The form is signed by the President of the company, Donald Baron (telephone #843-555-2245), and is submitted on the due date for e-filing. The company files Form 941 during the year and selects none apply in the Kind of Employer section.

• Employee #1: Donald Baron is an employee of J. Dodds, Inc. Gross earnings for federal income tax withholding, Social Security tax, and Medicare tax were $92,450.05 for the year, while these taxes were $9,180, $5,731.90, and $1,340.53, respectively. Charitable contributions totaled $5,890 for the year, while the annual union dues were $750. South Carolina income tax withholding was $5,994 (based on the above gross earnings for federal income tax), with no local taxes withheld.
• Employee #2: Damian South is an employee of J. Dodds, Inc. Gross earnings for federal income tax withholding, Social Security tax, and Medicare tax were $144,050.02 for the year, while these taxes were $14,160, $8,537.40, and $2,088.73, respectively. Annual union dues were $750, and Damian elects to have charitable contributions of $250 withheld. South Carolina income tax withholding was $9,134 (based on the above gross earnings for federal income tax), with no local taxes withheld.

DO NOT STAPLE a Control number 33333 For Official Use Only OMB No. 1545-0008 b 941 Military 943 944 5010 non-govt. Kind of Payer (Check one) Kind of Employer (Check one) None apply V State/local non-5010 Third-party sick pay (Check it applicable) CT-1 Hshld emp Medicare govt. emp. State/local 501C Federal govt. d Establishment number c Total number of Forms W-2 2 e Employer identification number (EIN) 22-5555555 f Employer's name 2 Federal income tax withheld $ 4 Social security tax withheld $ 1 Wages, tips, other compensation $ 3 Social security wages $ 5 Medicare wages and tips $ 7 Social security tips $ 6 Medicare tax withheld $ 8 Allocated tips $ 10 Dependent care benefits $ 9 11 Nonqualified plans g Employer's address and ZIP code 12a Deferred compensation $ 12b h Other EIN used this year 13 For third-party sick pay use only 15 State Employer's state ID number 14 Income tax withheld by payer of third-party sick pay 19 Local income tax 16 State wages, tips, etc. $ Employer's contact person 17 State income tax $ 18 Local wages, tips, etc. $ Employer's telephone number $ For Official Use Only Employer's fax number Employer's email address Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete Signature Title President Date 01/31/2021 Donald Baron Form W-3 Transmittal of Wage and Tax Statements 20XX Department of the Treasury Internal Revenue Service Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA). Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA. Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3. DO NOT STAPLE a Control number 33333 For Official Use Only OMB No. 1545-0008 b 941 Military 943 944 5010 non-govt. Kind of Payer (Check one) Kind of Employer (Check one) None apply V State/local non-5010 Third-party sick pay (Check it applicable) CT-1 Hshld emp Medicare govt. emp. State/local 501C Federal govt. d Establishment number c Total number of Forms W-2 2 e Employer identification number (EIN) 22-5555555 f Employer's name 2 Federal income tax withheld $ 4 Social security tax withheld $ 1 Wages, tips, other compensation $ 3 Social security wages $ 5 Medicare wages and tips $ 7 Social security tips $ 6 Medicare tax withheld $ 8 Allocated tips $ 10 Dependent care benefits $ 9 11 Nonqualified plans g Employer's address and ZIP code 12a Deferred compensation $ 12b h Other EIN used this year 13 For third-party sick pay use only 15 State Employer's state ID number 14 Income tax withheld by payer of third-party sick pay 19 Local income tax 16 State wages, tips, etc. $ Employer's contact person 17 State income tax $ 18 Local wages, tips, etc. $ Employer's telephone number $ For Official Use Only Employer's fax number Employer's email address Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete Signature Title President Date 01/31/2021 Donald Baron Form W-3 Transmittal of Wage and Tax Statements 20XX Department of the Treasury Internal Revenue Service Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA). Photocopies are not acceptable. Do not send Form W-3 if you filed electronically with the SSA. Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3