B  Employer identification number (EIN) 

                 58-5648648

22222 

OMS No. 1545-0008 

28,000.00

1 Wages, tips, other compensation 

3150.00

2 Federal income tax withheld 

c Employer's name, address, and ZIP code 

Danny’s Disco
Hwy 5
Douglasville, GA 30134

Douglasville, GA 30135

252-02-6874

d Employee Social Security Number 

28,000.00

3 Social security wages 

28,000.00

5 Medicare wages and tips 

7 Social security tips 

9 Advance EIC payment 

1736.00

4 Social security tax withheld 

406.00

6 Medicare tax withheld 

8 Allocated tips 

10 Dependent care benefits 

12a.

e Employee's Name

Junie B. Jones
234 Stupid Drive
Douglasville, GA 30135

. 	11 Nonqualified plans 

 

f Employee's address and ZIP code 
	15 State 	Employer's state 10 number 

GA

Form W-2 

28000.00

16 State wages, tips, etc. 

17 State income tax 

1120.00

18 Local wages, tips, etc. 

wage and Tax Statement 
Copy 1-For State, City, or Local Tax Department 

Junie B. Jones
234 Stupid Drive
Douglasville, GA 30135

She wants to contribute to the Presidential Campaign Fund.

She is not married.

Her 1099-INT form shows that she has $54 in taxable interest

She CAN be claimed as a dependent on her parent’s tax return.

If she gets a refund, she wants it directly deposited into her savings account. Her savings account number is 444666888. The bank routing number is 123456789.

2015 

Department of the Treasury-Internal Revenue Service