Patty Banyan is a single taxpayer, age 27 (birthdate May 18, 1992) living at 543 Space Drive, Houston, TX 77099 Her Social Security number is 466 33 1234 For 2019, Patty has no dependents, and received a W 2, from her job at a local restaurant where she parks cars These wages are Patty's only income for 2019 Required Complete Form 1040 for Patty Banyan for the 2019 tax year If there is an over payment, she would like a refund She wants to donate $3 to the Presidential Election Campaign Fund The election to donate does not affect tax liability in any way Patty has health care coverage for the full year Enter all amounts as positive numbers If an amount box requires no entry or the amount is zero, enter 0 If required, round amounts to the nearest dollar an Employee's social security number 466 33 1234 OMB No 1545 0008 Safe, accurate, FAST Use IRS e file Visit the IRS website at www irs gov efile b Employer identification number (EIN) 33 1235672 1 Wages, tips, other compensation 20,051 12 2 Federal income tax withheld 1,197 78 c Employer's name, address, and ZIP code Burger Box 1234 Mountain Road Houston, TX 77099 3 Social security wages 20,051 12 4 Social security tax withheld 1,243 17 5 Medicare wages and tips 20,051 12 6 Medicare tax withheld 290 74 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 Patty Banyan 543 Space Drive Houston, TX 77099 11 Nonqualified plans 12a See instructions for box 12 13 Statutory employee Retirement plan Third party sick pay Code 12b 14 Other Code 12c Code 12d Code f Employee's address and ZIP code 15 State TX 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 Form W 2 Wage and Tax Statement CopyTo Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service 2019 Department of the TreasuryInternal Revenue Service

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Patty Banyan is a single taxpayer, age 27 (birthdate May 18, 1992) living at 543 Space Drive, Houston, TX 77099. Her Social Security number is

Patty Banyan is a single taxpayer, age 27 (birthdate May 18, 1992) living at 543 Space Drive, Houston, TX 77099. Her Social Security number is 466-33-1234. For 2019, Patty has no dependents, and received a W-2, from her job at a local restaurant where she parks cars. These wages are Patty's only income for 2019.

Required:
Complete Form 1040 for Patty Banyan for the 2019 tax year. If there is an over-payment, she would like a refund.

She wants to donate $3 to the Presidential Election Campaign Fund. The election to donate does not affect tax liability in any way.
Patty has health care coverage for the full year.
Enter all amounts as positive numbers.
If an amount box requires no entry or the amount is zero, enter "0".
If required, round amounts to the nearest dollar.

an Employee's social security number

466-33-1234

OMB No. 1545-0008

Safe, accurate,
FAST! Use

^IRSe ~ file

Visit the IRS website at
www.irs.gov/efile

b Employer identification number (EIN) 33-1235672	1 Wages, tips, other compensation 20,051.12	2 Federal income tax withheld 1,197.78
c Employer's name, address, and ZIP code Burger Box 1234 Mountain Road Houston, TX 77099	3 Social security wages 20,051.12	4 Social security tax withheld 1,243.17
	5 Medicare wages and tips 20,051.12	6 Medicare tax withheld 290.74
	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. Patty Banyan 543 Space Drive Houston, TX 77099	11 Nonqualified plans	12a See instructions for box 12
	13Statutory employee Retirement plan Third-party sick pay ◻ ◻ ◻	Code \|
		12b
	14 Other	Code \|
		12c
		Code \|
		12d
		Code \|
f Employee's address and ZIP code

15 State TX	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

Form W-2 Wage and Tax Statement
Copy—To Be Filed With Employee's FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.

2019

Department of the Treasury—Internal Revenue Service