7 Social security tips 1 Wages, tips, other compensation 2 Federal income tax withheld

Form W-2 Wage and Tax Statement 2019 25120.46 2282.77

c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
COMMONWEALTH OF MASSACHUSETTS
1A L99

ONE ASHBURTON PLACE 9 5 Medicare wages and tips 6 Medicare tax withheld
26888.51 389.88
BOSTON MA 02108 10 Dependent care benefits 11 Nonqualified plans C
12a See instructions for box 12
o
d
e DD 4250.33
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C
o
d
e
JESUS GARCIA Q 0.18 12c
b Employer identification number (EIN) C
o

1284 BROAD ST UNIT 25560 04-6002284 Y 1768.05 d

e

a Employee’s social security number 12d

PROVIDENCE RI 02905 Z 1004.15 C
o
126-80-4664 d
e

15 State 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
MA 046002284 26888.51 1257.86
Copy B-To Be Filed With Employee’s FEDERAL Tax Return This information is being furnished to the Internal Revenue Service. Dept. of the Treasury - IRS
OMB No. 1545-0008 Visit the IRS website at www.irs.gov/efile.

This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a
negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.
7 Social security tips 1 Wages, tips, other compensation 2 Federal income tax withheld
Form W-2 Wage and Tax Statement 2019 25120.46 2282.77
c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
COMMONWEALTH OF MASSACHUSETTS
9 5 Medicare wages and tips 6 Medicare tax withheld
ONE ASHBURTON PLACE 389.88
26888.51
BOSTON MA 02108 10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
C
o
d
e DD 4250.33
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C
o

JESUS GARCIA Q 0.18 d

e

b Employer identification number (EIN) 12c

Y 1768.05 C
1284 BROAD ST UNIT 25560 04-6002284 o
d
e

PROVIDENCE RI 02905 a Employee’s social security number Z 1004.15 12d

C
o
126-80-4664 d
e

15 State 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
MA 046002284 26888.51 1257.86

Copy C-For EMPLOYEE’S RECORDS (See Notice to Employee on the back of Copy B.) OMB No. 1545-0008 Dept. of the Treasury - IRS
Visit the IRS website at www.irs.gov/efile.

7 Social security tips 1 Wages, tips, other compensation 2 Federal income tax withheld
Form W-2 Wage and Tax Statement 2019 25120.46 2282.77
c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
COMMONWEALTH OF MASSACHUSETTS
9 5 Medicare wages and tips 6 Medicare tax withheld
ONE ASHBURTON PLACE 26888.51 389.88
BOSTON MA 02108 10 Dependent care benefits 11 Nonqualified plans 12a
C
o
d
e
DD 4250.33
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C
o
d
e
JESUS GARCIA Q 0.18 12c
b Employer identification number (EIN) C

1284 BROAD ST UNIT 25560 04-6002284 Y 1768.05

o
d
e

a Employee’s social security number 12d

PROVIDENCE RI 02905 Z 1004.15 C
o
126-80-4664 d
e

15 State 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
MA 046002284 26888.51 1257.86
Copy 2-To Be Filed With Employee’s State, City, or Local Income Tax Return OMB No. 1545-0008 Dept. of the Treasury - IRS

7 Social security tips 1 Wages, tips, other compensation 2 Federal income tax withheld
Form W-2 Wage and Tax Statement 2019 25120.46 2282.77
c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
COMMONWEALTH OF MASSACHUSETTS
ONE ASHBURTON PLACE 9 5 Medicare wages and tips 6 Medicare tax withheld
26888.51 389.88
BOSTON MA 02108 10 Dependent care benefits 11 Nonqualified plans 12a
C
o
d
e
DD 4250.33
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C
o
d

JESUS GARCIA Q 0.18 e

b Employer identification number (EIN) 12c

C
1284 BROAD ST UNIT 25560 04-6002284 Y 1768.05 o
d
e

a Employee’s social security number 12d

PROVIDENCE RI 02905
FORM # LW28700

Z 1004.15 C
8403000753

o
126-80-4664 d
e

15 State 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
MA 046002284 26888.51 1257.86
Copy 2-To Be Filed With Employee’s State, City, or Local Income Tax Return OMB No. 1545-0008 Dept. of the Treasury - IRS