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

Form W-2 Wage and Tax Statement 2016 41668.39 502.06

c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
CITY OF MILWAUKEE 45299.84 2808.59
1A L99

RM 401 9 5 Medicare wages and tips 6 Medicare tax withheld

45299.84 656.85
200 EAST WELLS ST 10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
C
MILWAUKEE WI 53202-3566 o
d
e
G 1402.69
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C
o
d
e
DD 7404.00
KEVIN SIMMONS b Employer identification number (EIN) 12c
C

10407 W DAPHNE 39-6005532 o

d
e

a Employee’s social security number 12d

MILWAUKEE WI 53224 587-51-6683
C
o
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
WI 036102042114803 41668.39 1966.41

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 2016 41668.39 502.06
c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
CITY OF MILWAUKEE 45299.84 2808.59
RM 401 9 5 Medicare wages and tips 6 Medicare tax withheld
45299.84 656.85
200 EAST WELLS ST 10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
C
MILWAUKEE WI 53202-3566 o
d
e
G 1402.69
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C

KEVIN SIMMONS
o
d
e DD 7404.00
b Employer identification number (EIN) 12c
C
10407 W DAPHNE 39-6005532 o
d
e

MILWAUKEE WI 53224 a Employee’s social security number 12d

C
587-51-6683 o
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
WI 036102042114803 41668.39 1966.41

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 2016 41668.39 502.06
c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
CITY OF MILWAUKEE 45299.84 2808.59
RM 401 9 5 Medicare wages and tips 6 Medicare tax withheld
45299.84 656.85
200 EAST WELLS ST 10 Dependent care benefits 11 Nonqualified plans 12a
MILWAUKEE WI 53202-3566
C
o
d
e
G 1402.69
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C
o
d
e
DD 7404.00
KEVIN SIMMONS b Employer identification number (EIN) 12c
C
10407 W DAPHNE 39-6005532 o
d
e

MILWAUKEE WI 53224 a Employee’s social security number 12d

C
o
587-51-6683 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
WI 036102042114803 41668.39 1966.41

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 2016 41668.39 502.06
c Employer’s name, address, and ZIP code 8 Allocated tips 3 Social security wages 4 Social security tax withheld
CITY OF MILWAUKEE 45299.84 2808.59
RM 401 9 5 Medicare wages and tips 6 Medicare tax withheld
45299.84 656.85
200 EAST WELLS ST 10 Dependent care benefits 11 Nonqualified plans 12a
C
MILWAUKEE WI 53202-3566 o
d
e
G 1402.69
Statutory Retirement Third-party
e Employee’s name, address, and ZIP code 13 employee plan sick pay 14 Other 12b
C
o
d
e
DD 7404.00
KEVIN SIMMONS b Employer identification number (EIN) 12c
C
10407 W DAPHNE 39-6005532 o
d
e

MILWAUKEE WI 53224 a Employee’s social security number 12d

FORM # LW28700

C
8403000753

587-51-6683 o
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
WI 036102042114803 41668.39 1966.41

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