I need help filling out a 1049 form with this part 1

22222 Void a Employee's social security number 535-22-4466 For Official Use Only OMB No. 1545-0008 b Employer identification number (EIN) 91-0001002 Wages, tips, other compensation 2 Federal income tax withheld 163,645.00 25,000.00 c Employer's name, address, and ZIP code 3 Social security wages Social security tax withheld Flyby Airlines 128,400.00 7,960.80 375 West Flight Blvd. 5 Medicare wages and tips 6 Medicare tax withheld Las Vegas, NV 89119 178,645.00 2,590.35 Social security tips 8 Allocated tips d Control number 9 Verification code 10 Dependent care benefits e Employee's first name and initial Last name Suff 11 Nonqualified plans 12a See instructions for box 12 Keith Hamilton 15,000.00 Statutory Retirement mac-party employee plan sick pay 12b 3678 Blue Sky Drive 14 Other 12c Henderson, NV 89052 12d f Employee's address and ZIP code 15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips. etc. 19 Loca income tax 20 Locality name NV 987654321 163,645.00 0.00 Form W-2 Wage and Tax Statement 2018 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