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For Official Use Only |
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44444 |
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OMB No. 1545-0008 |
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a Employer’s name, address, and ZIP code |
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c Tax year/Form corrected |
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d Employee’s correct SSN |
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/ W-2 |
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e Corrected SSN and/or name (Check this box and complete boxes f and/or |
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g if incorrect on form previously filed.) |
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Complete boxes f and/or g only if incorrect on form previously filed |
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f Employee’s previously reported SSN |
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b Employer's Federal EIN |
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g Employee’s previously reported name |
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h Employee’s first name and initial |
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Last name |
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Suff. |
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Note. Only complete money fields that are being corrected (exception: for |
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corrections involving MQGE, see the General Instructions for Forms W-2 |
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and W-3, under Specific Instructions for Form W-2c, boxes 5 and 6). |
i Employee’s address and ZIP code |
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Previously reported |
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Correct information |
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Previously reported |
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Correct information |
1 Wages, tips, other compensation |
1 Wages, tips, other compensation |
2 Federal income tax withheld |
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2 Federal income tax withheld |
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3 |
Social security wages |
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3 |
Social security wages |
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4 Social security tax withheld |
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4 Social security tax withheld |
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5 Medicare wages and tips |
5 Medicare wages and tips |
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Medicare tax withheld |
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6 |
Medicare tax withheld |
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7 |
Social security tips |
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7 |
Social security tips |
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8 |
Allocated tips |
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8 |
Allocated tips |
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9 |
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9 |
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10 |
Dependent care benefits |
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10 |
Dependent care benefits |
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11 |
Nonqualified plans |
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11 |
Nonqualified plans |
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12a See instructions for box 12 |
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12a See instructions for box 12 |
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C |
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C |
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o |
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o |
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d |
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d |
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e |
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e |
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13 |
Statutory |
Retirement |
Third-party |
13 |
Statutory |
Retirement |
Third-party |
12b |
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12b |
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employee |
plan |
sick pay |
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employee |
plan |
sick pay |
C |
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C |
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o |
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o |
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d |
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d |
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e |
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e |
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14 Other (see instructions) |
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14 Other (see instructions) |
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12c |
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12c |
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C |
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C |
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o |
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d |
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12d |
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12d |
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C |
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C |
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d |
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d |
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e |
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e |
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State Correction |
Information |
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Previously reported |
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Correct information |
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Previously reported |
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Correct information |
15 State |
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15 State |
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15 State |
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15 State |
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Employer’s state ID number |
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Employer’s state ID number |
Employer’s state ID number |
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Employer’s state ID number |
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16 State wages, tips, etc. |
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16 State wages, tips, etc. |
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16 State wages, tips, etc. |
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16 State wages, tips, etc. |
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17 State income tax |
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17 State income tax |
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17 State income tax |
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17 State income tax |
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Locality Correction |
Information |
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Previously reported |
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Correct information |
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Previously reported |
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Correct information |
18 Local wages, tips, etc. |
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18 Local wages, tips, etc. |
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18 Local wages, tips, etc. |
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18 Local wages, tips, etc. |
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19 Local income tax |
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19 Local income tax |
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19 Local income tax |
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19 Local income tax |
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20 Locality name |
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20 Locality name |
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20 Locality name |
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20 Locality name |
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For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. |
Copy A—For Social Security Administration |
Form W-2c (Rev. 8-2014) |
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Corrected Wage and Tax Statement |
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Department of the Treasury |
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Cat. No. 61437D |
Internal Revenue Service |