OMB No.

1545-0008

Department of the Treasury-Internal Revenue

1 Wages, tips, other compensation

OMB No. 1545-0008

811.76

1 Wages, tips, other compensation

0.00

3 Social security wages

811.76

50.32

811.76

11.77

7 Social security tips

8 Allocated tips

10 Dependent care benefits

11 Nonqualified plans

811.76

employee

c
o
d
e
c
o
d
e

7 Social security tips

8 Allocated tips

12a

10 Dependent care benefits

11 Nonqualified plans

12d

c
o
d
e

a Employee's social security number

56-6001199
Retirement
plan

12b

14 Other

13 Statutory

Form

16 State wages, tips, etc.

811.76

17 State income tax

18 Local wages, tips, etc.

19 Local income tax

20 Locality name

Department of the Treasury-Internal Revenue

1 Wages, tips, other compensation

2 Federal income tax withheld

811.76

0.00

3 Social security wages

4 Social security tax withheld

811.76

50.32

5 Medicare wages and tips

6 Medicare tax withheld

811.76

11.77

8 Allocated tips

10 Dependent care benefits

11 Nonqualified plans

employee

c
o
d
e
c
o
d
e

Wage and Tax

Statement

2 Federal income tax withheld

811.76

0.00

3 Social security wages

4 Social security tax withheld

811.76

50.32

5 Medicare wages and tips

6 Medicare tax withheld

811.76

11.77

11 Nonqualified plans

12d

c
o
d
e

12b

c
o
d
e

c
o
d
e

Suff.

Retirement
plan

12a See instructions for box 12

12d

a Employee's social security number

56-6001199
13 Statutory

c
o
d
e

12c

b Employer identification number (EIN)

employee

543-37-1654
Third-party
sick pay

14 Other

e Employee's name, address and ZIP code

Suff.

NATHAN M VOS
808 E. FRANKLIN ST
CHAPEL HILL, NC 27514
16 State wages, tips, etc.

811.76

17 State income tax

Copy B - To Be Filed With

Employee's FEDERAL Tax Return

20 Locality name

Department of the Treasury-Internal Revenue

1 Wages, tips, other compensation

10 Dependent care benefits

14 Other

068000047

2013

19 Local income tax

12a See instructions for box 12

543-37-1654

15 State Employer's state ID number

W-2

18 Local wages, tips, etc.

4.26

8 Allocated tips

NATHAN M VOS
808 E. FRANKLIN ST
CHAPEL HILL, NC 27514

NC

17 State income tax

7 Social security tips

e Employee's name, address and ZIP code

Form

811.76

a Employee's social security number

56-6001199
Third-party
sick pay

16 State wages, tips, etc.

068000047

TOWN OF CHAPEL HILL

405 MARTIN LUTHER KING JR BLVD
CHAPEL HILL, NC 27514

12c

b Employer identification number (EIN)

Retirement
plan

Suff.

c Employer's name, address and ZIP code

7 Social security tips

13 Statutory

NC

OMB No. 1545-0008

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.

TOWN OF CHAPEL HILL

405 MARTIN LUTHER KING JR BLVD
CHAPEL HILL, NC 27514

c
o
d
e

543-37-1654

2013

c Employer's name, address and ZIP code

12b

a Employee's social security number

Copy 2 - To Be Filed With Employee's

State, City, or Local Income Tax Return.

OMB No. 1545-0008

c
o
d
e

12d

14 Other

Third-party
sick pay

Wage and Tax

Statement

Copy 2 - To Be Filed With Employee's

State, City, or Local Income Tax Return.

This information is
being furnished to
the Internal
Revenue Service.

c
o
d
e

15 State Employer's state ID number

W-2

4.26

2013

12c

12a

NATHAN M VOS
808 E. FRANKLIN ST
CHAPEL HILL, NC 27514

068000047

Wage and Tax

Statement

c
o
d
e

e Employee's name, address and ZIP code

Suff.

15 State Employer's state ID number

W-2

Retirement
plan

employee

NATHAN M VOS
808 E. FRANKLIN ST
CHAPEL HILL, NC 27514

NC

56-6001199

e Employee's name, address and ZIP code

Form

c
o
d
e

b Employer identification number (EIN)

543-37-1654
Third-party
sick pay

11.77

TOWN OF CHAPEL HILL

405 MARTIN LUTHER KING JR BLVD
CHAPEL HILL, NC 27514

12c

b Employer identification number (EIN)

13 Statutory

50.32
6 Medicare tax withheld

c Employer's name, address and ZIP code

TOWN OF CHAPEL HILL

405 MARTIN LUTHER KING JR BLVD
CHAPEL HILL, NC 27514

c
o
d
e

4 Social security tax withheld

5 Medicare wages and tips

c Employer's name, address and ZIP code

12b

0.00

3 Social security wages

6 Medicare tax withheld

811.76

2 Federal income tax withheld

811.76

4 Social security tax withheld

5 Medicare wages and tips

c
o
d
e

Department of the Treasury-Internal Revenue

2 Federal income tax withheld

18 Local wages, tips, etc.

4.26
19 Local income tax

20 Locality name

Form

15 State Employer's state ID number

W-2

NC

Wage and Tax

Statement

16 State wages, tips, etc.

068000047

811.76

17 State income tax

2013
Copy C - For EMPLOYEE'S RECORDS
(See Notice to Employee on the back of Copy B.)

18 Local wages, tips, etc.

4.26
19 Local income tax

20 Locality name

TOWN OF CHAPEL HILL

405 MARTIN LUTHER KING JR BLVD
CHAPEL HILL, NC 27514

NATHAN M VOS
808 E. FRANKLIN ST
CHAPEL HILL, NC 27514

Instructions for Employee

(Also see Notice to Employee, on
the back of Copy B.)

DElective deferrals to a section 401(k) cash or deferred

arrangement. Also includes deferrals under a SIMPLE
retirement account that is part of a section 401(k)
arrangement.
EElective deferrals under a section 403(b) salary reduction
agreement
Box 1. Enter this amount on the wages line of your tax
FElective deferrals under a section 408(k)(6) salary
return.
Box 2. Enter this amount on the federal income tax withheld reduction SEP
GElective deferrals and employer contributions (including
line of your tax return.
Box 5. This amount may be required to be entered on Form nonelective deferrals) to a section 457(b) deferred
compensation plan
8959. See Form 1040 instructions to determine if you are
HElective deferrals to a section 501(c)(18)(D) tax-exempt
required to complete Form 8959.
organization plan. See Adjusted Gross Income in the Form
Box 6. This amount includes the 1.45% Medicare Tax
1040 instructions for how to deduct.
withheld on all Medicare wages and tips shown in Box 5, as
JNontaxable sick pay (information only, not included in
well as the 0.9% Additional Medicare Tax on any of those
boxes 1, 3, or 5)
Medicare wages and tips above $200,000.
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For K20% excise tax on excess golden parachute payments.
information on how to report tips on your tax return, see your See Other Taxes in the Form 1040 instructions.
LSubstantiated employee business expense
Form 1040 instructions. You must file Form 4137, Social
reimbursements (nontaxable)
Security and Medicare Tax on Unreported Tip Income, with
MUncollected social security or RRTA tax on taxable cost
your income tax return to report at least the allocated tip
of group-term life insurance over $50,000 (former employees
amount unless you can prove a smaller amount with
only). See Other Taxes in the Form 1040 instructions.
adequate records. If you have records that show the actual
NUncollected Medicare tax on taxable cost of group-term
amount of tips you received, report that amount even if it is
life insurance over $50,000 (former employees only). See
more or less than the allocated tips. On Form 4137 you will
Other Taxes in the Form 1040 instructions.
figure the social security and Medicare tax owed on the
PExcludable moving expense reimbursements paid directly
allocated tips shown on your Form(s) W-2 that you must
report as income and on other tips you did not report to your to employee (not included in boxes 1, 3, or 5)
QNontaxable combat pay. See the instructions for Form
employer. By filing Form 4137, your social security tips will
be credited to your social security record (used to figure your 1040 or Form 1040A for details on reporting this amount.
REmployer contributions to your Archer MSA. Report on
benefits).
Form 8853, Archer MSAs and Long-Term Care Insurance
Box 10. This amount is the total dependent care benefits
Contracts.
that your employer paid to you or incurred on your behalf
SEmployee salary reduction contributions under a section
(including amounts from a section 125 (cafeteria) plan). Any
408(p) SIMPLE plan (not included in box 1)
amount over $5,000 is also included in box 1. Complete
TAdoption benefits (not included in box 1). Complete Form
Form 2441, Child and Dependent Care Expenses, to
8839, Qualified Adoption Expenses, to compute any taxable
compute any taxable and nontaxable amounts.
and nontaxable amounts.
Box 11. This amount is (a) reported in box 1 if it is a
VIncome from exercise of nonstatutory stock option(s)
distribution made to you from a nonqualified deferred
compensation or nongovernmental section 457(b) plan or (b) (included in boxes 1, 3 (up to social security wage base),
included in box 3 and/or 5 if it is a prior year deferral under a and 5). See Pub. 525 and instructions for Schedule D (Form
1040) for reporting requirements.
nonqualified or section 457(b) plan that became taxable for
social security and Medicare taxes this year because there is WEmployer contributions (including amounts the employee
elected to contribute using a section 125 (cafeteria) plan) to
no longer a substantial risk of forfeiture of your right to the
your health savings account. Report on Form 8889, Health
deferred amount. This box should not be used if you had a
Savings Accounts (HSAs).
deferral and a distribution in the same calendar year. If this
YDeferrals under a section 409A nonqualified deferred
happens and you are or will be age 62 by the end of the
calendar year, your employer should file Form SSA-131 with compensation plan
ZIncome under section 409A on a nonqualified deferred
the Social Security Administration and give you a copy.
compensation plan. This amount is also included in box 1. It
Box 12. The following list explains the codes shown in box
is subject to an additional 20% tax plus interest. See Other
12. You may need this information to complete your tax
Taxes in the Form 1040 instructions.
return. Elective deferrals (codes D, E, F, and S) and
designated Roth contributions (codes AA, BB, and EE) under AADesignated Roth contributions under a section 401(k)
all plans are generally limited to a total of $17,500 ($12,000 if plan
BBDesignated Roth contributions under a section 403(b)
you only have SIMPLE plans; $20,500 for section 403(b)
plan
plans if you qualify for the 15-year rule explained in Pub.
DDCost of employer-sponsored health coverage. The
571). Deferrals under code G are limited to $17,500.
amount reported with Code DD is not taxable.
Deferrals under code H are limited to $7,000.
EEDesignated Roth contributions under a governmental
However, if you were at least age 50 in 2013, your
section 457(b) plan. This amount does not apply to
employer may have allowed an additional deferral of up to
contributions under a tax-exempt organization section 457(b)
$5,500 ($2,500 for section 401(k)(11) and 408(p) SIMPLE
plan.
plans). This additional deferral amount is not subject to the
Box 13. If the Retirement plan box is checked, special
overall limit on elective deferrals. For code G, the limit on
limits may apply to the amount of traditional IRA
elective deferrals may be higher for the last 3 years before
contributions you may deduct.
you reach retirement age. Contact your plan administrator
Box 14. Employers may use this box to report information
for more information. Amounts in excess of the overall
such as state disability insurance taxes withheld, union dues,
elective deferral limit must be included in income. See the
Wages, Salaries, Tips, etc. line instructions for Form 1040. uniform payments, health insurance premiums deducted,
nontaxable income, educational assistance payments, or a
Note. If a year follows code D through H, S, Y, AA, BB, or
member of the clergy's parsonage allowance and utilities.
EE, you made a make-up pension contribution for a prior
Railroad employers use this box to report RRTA
year(s) when you were in military service. To figure whether
compensation, Tier I tax, Tier II tax, Medicare tax and
you made excess deferrals, consider these amounts for the
Additional Medicare Tax.
year shown, not the current year. If no year is shown, the
Note. Keep Copy C of Form W-2 for at least 3 years after
contributions are for the current year.
the due date for filing your income tax return. However, to
AUncollected social security or RRTA tax on tips. Include
help protect your social security benefits, keep Copy C
this tax on Form 1040. See Other Taxes in the Form 1040
until you begin receiving social security benefits, just in case
instructions.
there is a question about your work record and/or earnings in
BUncollected Medicare tax on tips. Include this tax on
a particular year.
Form 1040. See Other Taxes in the Form 1040
instructions. CTaxable cost of group-term life insurance
over $50,000 (included in boxes 1, 3 (up to social security
wage base), and 5)

Notice to Employee
Do you have to file? Refer to the Form 1040 Instructions to
determine if you are required to file a tax return. Even if you do not
have to file a tax return, you may be eligible for a refund if box 2
shows an amount or if you are eligible for any credit.
Earned income credit (EIC). You may be able to take the EIC for
2013 if your adjusted gross income (AGI) is less than a certain
amount. The amount of the credit is based on income and family
size. Workers without children could qualify for a smaller credit.
You and any qualifying children must have valid social security
numbers (SSNs). You cannot take the EIC if your investment
income is more than the specified amount for 2013 or if income is
earned for services provided while you were an inmate at a penal
institution. For 2013 income limits and more information, visit
www.irs.gov/eitc. Also see Pub. 596, Earned Income Credit. Any
EIC that is more than your tax liability is refunded to you, but
only if you file a tax return.
Clergy and religious workers. If you are not subject to social
security and Medicare taxes, see Pub. 517, Social Security and
Other Information for Members of the Clergy and Religious
Workers.
Corrections. If your name, SSN, or address is incorrect, correct
Copies B, C, and 2 and ask your employer to correct your
employment record. Be sure to ask the employer to file Form
W-2c, Corrected Wage and Tax Statement, with the Social
Security Administration (SSA) to correct any name, SSN, or money
amount error reported to the SSA on Form W-2. Be sure to get
your copies of Form W-2c from your employer for all corrections
made so you may file them with your tax return. If your name and
SSN are correct but are not the same as shown on your social
security card, you should ask for a new card that displays your
correct name at any SSA office or by calling 1-800-772-1213. You
also may visit the SSA at www.socialsecurity.gov.
Cost of employer-sponsored health coverage (if such cost is
provided by the employer). The reporting in box 12, using code
DD, of the cost of employer-sponsored health coverage is for your
information only. The amount reported with code DD is not
taxable.
Credit for excess taxes. If you had more than one employer in
2013 and more than $7,049.40 in social security and/or Tier I
railroad retirement (RRTA) taxes were withheld, you may be able
to claim a credit for the excess against your federal income tax. If
you had more than one railroad employer and more than
$3,709.20 in Tier II RRTA tax was withheld, you also may be able
to claim a credit. See your Form 1040 or Form 1040A instructions
and Pub. 505, Tax Withholding and Estimated Tax. (Also see
Instructions for Employee on the back of Copy C.)