W 2
W 2
W 2
(See
OMB NO. 1545-008 OMB NO. 1545-008
Notice to Employee on back of Copy B.)
a Employee’s SSN 1 Wages, tips, other compensation 2 Federal income tax withheld a Employee’s SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
e Employee’s first name and initial Last name Suff. e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code f Employee’s address and ZIP code
7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12
13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code
Third-party sick pay 12d Code Third-party sick pay 12d Code
Form W-2 Wage and Tax Statement 2012 Dept. of Treasury -- IRS Form W-2 Wage and Tax Statement 2012 Dept. of Treasury -- IRS
This information is being furnished to the Internal Revenue Service This information is being furnished to the IRS. 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.
Copy 2 -- To Be Filed with Employee’s State, Copy 2 -- To Be Filed with Employee’s State,
OMB NO. 1545-008 OMB NO. 1545-008
City, or Local Income Tax Return. City, or Local Income Tax Return.
a Employee’s SSN 1 Wages, tips, other compensation 2 Federal income tax withheld a Employee’s SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
e Employee’s first name and initial Last name Suff. e Employee’s first name and initial Last name Suff.
HAYDEN R. JONES HAYDEN R. JONES
1744 ANDREW JACKSON RD 1744 ANDREW JACKSON RD
ALEX CITY, AL 35010 ALEX CITY, AL 35010
f Employee’s address and ZIP code f Employee’s address and ZIP code
7 Social security tips 8 Allocated tips 9 7 Social security tips 8 Allocated tips 9
10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12 10 Dependent care benefits 11 Nonqualified plans 12a Code See inst. for box 12
13 Statutory employee 14 Other 12b Code 13 Statutory employee 14 Other 12b Code
Third-party sick pay 12d Code Third-party sick pay 12d Code
Form W-2 Wage and Tax Statement 2012 Dept. of Treasury -- IRS Form W-2 Wage and Tax Statement 2012 Dept. of Treasury -- IRS
Notice to Employee 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
Refund. Even if you do not have to file a tax return, you should file to get sure to ask the employer to file Form W-2c, Corrected Wage and Tax
a refund if box 2 shows federal income tax withheld or if you can take the Statement, with the Social Security Administration (SSA) to correct any
earned income credit. name, SSN, or money amount error reported to the SSA on Form W-2.
If your name and SSN are correct but are not the same as shown on your
Earned income credit (EIC). You may be able to take the EIC for 2012 if social security card, you should ask for a new card that displays your
(a) you do not have a qualifying child and you earned less than $13,980 correct name at any SSA office or by calling 1-800-772-1213. You also may
($19,190 if married filing jointly), (b) you have one qualifying child and you visit the SSA at www.socialsecurity.gov.
earned less than $36,920 ($42,130 if married filing jointly), (c) you have two
qualifying children and you earned less than $41,952 ($47,162 if married 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
filing jointly), or (d) you have three or more qualifying children and you
employer-sponsored health coverage is for your information only. The
earned less than $45,060 ($50,270 if married filing jointly). You and any amount reported with Code DD is not taxable.
qualifying children must have valid social security numbers (SSNs). You
cannot take the EIC if your investment income is more than $3,200, or if Credit for excess taxes. If you had more than one employer in 2012 and
income is earned for services provided while you were an inmate at a penal more than $4,624.20 in social security and/or Tier I railroad retirement
institution. Any EIC that is more than your tax liability is refunded to (RRTA) taxes were withheld, you may be able to claim a credit for the excess
you, but only if you file a tax return. against your federal income tax. If you had more than one railroad
employer and more than $3,192.90 in Tier II RRTA tax was withheld, you
also may be able to claim a credit. See your Form 1040 or Form 1040A
Clergy and religious workers. If you are not subject to social security and
instructions and Pub. 505, Tax Withholding and Estimated Tax.
Medicare taxes, see Pub. 517, Social Security and Other Information for
Members of the Clergy and Religious Workers. (Also see Instructions for Employee )
Instructions for Employee (Also see Notice to Employee.) Instructions for Employee (continued)
Box 1. Enter this amount on the wages line of your tax return. F—Elective deferrals under a section 408(k)(6) salary reduction SEP
Box 2. Enter this amount on the federal income tax withheld line of your tax return. G—Elective deferrals and employer contributions (including nonelective deferrals) to a section 457(b) deferred
compensation plan
Box 8. This amount is not included in boxes 1, 3, 5, or 7. For information on how to report tips on your tax return, see
your Form 1040 instructions. H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See “Adjusted Gross Income” in the Form
Unless you have records that show you did not receive the amount reported in box 8 as allocated tips, 1040 instructions for how to deduct.
you must file Form 4137, Social Security and Medicare Tax on Unreported Tip Income, with your income tax return to
report the allocated tip amount. On Form 4137 you will figure the social security and Medicare tax owed on the J—Nontaxable sick pay (information only, not included in boxes 1, 3, or 5)
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
employer. By Filing Form 4137, your social security tips will be credited to your social security record (used to figure your K—20% excise tax on excess golden parachute payments. See “Other Taxes” in the Form 1040 instructions.
benefits).
L—Substantiated employee business expense reimbursements (nontaxable)
Box 10. This amount is the total dependent care benefits that your employer paid to you or incurred on your behalf
(including amounts from a section 125 (cafeteria) plan). Any amount over $5,000 is also included in box 1. Complete M—Uncollected social security or RRTA tax on taxable cost of groupterm life insurance over $50,000 (former employees
Form 2441, Child and Dependent Care Expenses, to compute any taxable and nontaxable amounts. only). See “Other Taxes” in the Form 1040 instructions.
Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified deferred N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former employees only). See
compensation or nongovernmental section 457(b) plan or (b) included in box 3 and/or 5 if it is a prior year deferral “Other Taxes” in the Form 1040 instructions.
under a nonqualified or section 457(b) plan that became taxable for social security and Medicare taxes this year because
there is no longer a substantial risk of forfeiture of your right to the deferred amount. P—Excludable moving expense reimbursements paid directly to employee (not included in boxes 1, 3, or 5)
Box 12. The following list explains the codes shown in box 12. You may need this information to complete your tax Q—Nontaxable combat pay. See the instructions for Form 1040 or Form 1040A for details on reporting this amount.
return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE) under all plans
are generally limited to a total of $17,000 ($11,500 if you only have SIMPLE plans; $20,000 for section 403(b) plans if you R—Employer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and Long-Term Care Insurance
qualify for the 15-year rule explained in Pub. 571). Deferrals under code G are limited to $17,000. Deferrals under code H Contracts.
are limited to $7,000.
However, if you were at least age 50 in 2012, your employer may have allowed an additional deferral of S—Employee salary reduction contributions under a section 408(p) SIMPLE (not included in box 1)
up to $5,500 ($2,500 for section 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is not subject to
the overall limit on elective deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years before T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to compute any
you reach retirement age. Contact your plan administrator for more information. Amounts in excess of the overall taxable and nontaxable amounts.
elective deferral limit must be included in income. See the “Wages, Salaries, Tips, etc.” line instructions for Form 1040.
V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to social security wage base), and
Note. If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension contribution for a prior year(s) 5). See Pub. 525 and instructions for Schedule D (Form 1040) for reporting requirements.
when you were in military service. To figure whether you made excess deferrals, consider these amounts for the year
shown, not the current year. If no year is shown, the contributions are for the current year. W—Employer contributions (including amounts the employee elected to contribute using a section 125 (cafeteria) plan)
to your health savings account. Report on Form 8889, Health Savings Accounts (HSAs).
A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040. See “Other Taxes” in the Form 1040
instructions. Y—Deferrals under a section 409A nonqualified deferred compensation plan
B—Uncollected Medicare tax on tips. Include this tax on Form 1040. See “Other Taxes” in the Form 1040 instructions. Z— Income under section 409A on a nonqualified deferred compensation plan. This amount is also included in box 1. It
is subject to an additional 20% tax plus interest. See “Other Taxes” in the Form 1040 instructions.
C—Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up to social security wage base), and
5). AA—Designated Roth contributions under a section 401(k) plan
D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also includes deferrals under a SIMPLE BB—Designated Roth contributions under a section 403(b) plan
retirement account that is part of a section 401(k) arrangement.
DD—Cost of employer-sponsored health coverage. The amount reported with Code DD is not taxable.
E—Elective deferrals under a section 403(b) salary reduction agreement
EE—Designated Roth contributions under a governmental section 457(b) plan. This amount does not apply to
contributions under a taxexempt organization section 457(b) plan.
Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional IRA contributions
you may deduct.
Note. Keep Copy C of Form W-2 for at least 3 years after the due date for filing your income tax return. However, to help
protect your social security benefits, keep Copy C until you begin receiving social security benefits, just in case there is
a question about your work record and/or earnings in a particular year.