E Employee's social security number Safe, accurate, Visit the IRS website at 460-30-2020 OMB No. 1545-D008 FASTT Use b Employer identification number (EIN) 1 Wages, lips, other compensation 2 Federal Income tax withheld 72-5415634 52000-00 10400.00 c Employer's name, address, and ZIP code 3 Social security wage Social security tax withheld 52000. 00 3224.00 HOWARD PAYNE UNIVERSITY 5 Medicare wages and tips 6 Medicare tax withheld 1000 FISK AVE 52000,00 754.00 BROWNWOOD, TX 76801 Social security tips B Allocated tips d Control number 10 Dependent care benefits e Employee's first name and initial Last name Sutt. 11 Nonqualified plans 126 See instructions for box 12 NILA R AMBERSON 315 WEST AVE 13 Statutory uck pay 12b TEMPLE, TX 76501 14 Other 120 12 Employee's address and ZIP code 15 Stale Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 18 Local income tax 20 Locality name Wage and Tax Department of the Treasury-Internal Revenue Service Form Statement 2019 Copy B-To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service