Copy B -- To Be Filed With Employee's
FEDERAL Tax Return.
a Employee's soc. sec. no
Copy 2 -- To Be Filed With Employee's State,
City, or Local Income Tax Return.
1 Wages, tips, other comp.
225-90-5472
2 Federal income tax withheld
15678.83
3 Social security wages
980.55
5 Medicare wages and tips
1 Wages, tips, other comp.
972.09
6 Medicare tax withheld
15678.83
3 Social security wages
5 Medicare wages and tips
972.09
6 Medicare tax withheld
15678.83
227.34
c Employer's name, address and ZIP code
MOKA
715 TERRACE STREET, SUITE 201
Muskegon MI 49440
MOKA
715 TERRACE STREET, SUITE 201
Muskegon MI 49440
d Control number
d Control number
WA-66440438
WA-66440438
e Employee's name, address, and ZIP code
e Employee's name, address, and ZIP code
Jeffrey I. Shirley
9181 Fox Street
Hesperia, MI 49421
Jeffrey I. Shirley
9181 Fox Street
Hesperia, MI 49421
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a
DD
13 Statutory employee
980.55
4 Social security tax withheld
15678.83
b Employer ID number (EIN)
38-2227805
227.34
c Employer's name, address and ZIP code
2 Federal income tax withheld
15678.83
4 Social security tax withheld
15678.83
b Employer ID number (EIN)
38-2227805
a Employee's soc. sec. no
225-90-5472
14 Other
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a
4760.73
DD
12b
13 Statutory employee
13 Retirement plan
12c
13 Retirement plan
12c
13 Third-party sick pay
12d
13 Third-party sick pay
12d
15 State Employer's state ID number 16 State wages, tips, etc.
MI 38-2227805
17 State income tax
15678.83
18 Local wages, tips, etc.
19 Local income tax
Form W-2 Wage and Tax Statement
634.99
20 Locality name
4760.73
12b
15 State Employer's state ID number 16 State wages, tips, etc.
MI 38-2227805
17 State income tax
15678.83
18 Local wages, tips, etc.
Dept. of the Treasury -- IRS
2023
14 Other
19 Local income tax
Form W-2 Wage and Tax Statement
634.99
20 Locality name
Dept. of the Treasury -- IRS
2023
This information is being furnished to the Internal Revenue Service.
Copy C -- For EMPLOYEE's RECORDS
a Employee's soc. sec. no
Copy 2 -- To Be Filed With Employee's State,
City, or Local Income Tax Return.
1 Wages, tips, other comp.
225-90-5472
2 Federal income tax withheld
15678.83
3 Social security wages
980.55
5 Medicare wages and tips
1 Wages, tips, other comp.
972.09
6 Medicare tax withheld
15678.83
3 Social security wages
5 Medicare wages and tips
972.09
6 Medicare tax withheld
15678.83
227.34
c Employer's name, address and ZIP code
MOKA
715 TERRACE STREET, SUITE 201
Muskegon MI 49440
MOKA
715 TERRACE STREET, SUITE 201
Muskegon MI 49440
d Control number
d Control number
WA-66440438
WA-66440438
e Employee's name, address, and ZIP code
e Employee's name, address, and ZIP code
Jeffrey I. Shirley
9181 Fox Street
Hesperia, MI 49421
Jeffrey I. Shirley
9181 Fox Street
Hesperia, MI 49421
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a
DD
13 Statutory employee
980.55
4 Social security tax withheld
15678.83
b Employer ID number (EIN)
38-2227805
227.34
c Employer's name, address and ZIP code
2 Federal income tax withheld
15678.83
4 Social security tax withheld
15678.83
b Employer ID number (EIN)
38-2227805
a Employee's soc. sec. no
225-90-5472
14 Other
7 Social security tips
8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a
4760.73
DD
12b
13 Statutory employee
13 Retirement plan
12c
13 Retirement plan
12c
13 Third-party sick pay
12d
13 Third-party sick pay
12d
15 State Employer's state ID number 16 State wages, tips, etc.
MI 38-2227805
18 Local wages, tips, etc.
Form W-2 Wage and Tax Statement
17 State income tax
15678.83
19 Local income tax
2023
634.99
20 Locality name
Dept. of the Treasury -- IRS
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.
14 Other
15 State Employer's state ID number 16 State wages, tips, etc.
MI 38-2227805
18 Local wages, tips, etc.
Form W-2 Wage and Tax Statement
4760.73
12b
17 State income tax
15678.83
19 Local income tax
2023
634.99
20 Locality name
Dept. of the Treasury -- IRS