Form W-2 - Wage and Tax Statement

Copy B - To Be Filed With Employee's FEDERAL Tax Return

Employee's social security number: ***-**-1234
Employer identification number: 12-3456789

Employer's name, address, and ZIP code:
TECH INNOVATIONS INC
123 Business Park Drive
San Francisco, CA 94105

Employee's first name and initial: JOHN M.
Last name: SMITH
Address: 456 Oak Street
         San Francisco, CA 94102

Control number: 12345

1. Wages, tips, other compensation: $95,000.00
2. Federal income tax withheld: $18,500.00
3. Social security wages: $95,000.00
4. Social security tax withheld: $5,890.00
5. Medicare wages and tips: $95,000.00
6. Medicare tax withheld: $1,377.50

12a. See instructions for box 12
    Code: D Amount: $2,500.00

13. Statutory   Retirement   Third-party
    employee      plan        sick pay
      [ ]         [X]           [ ]

14. Other:

15. State: CA
    Employer's state ID number: 123-456-78

16. State wages, tips, etc.: $95,000.00
17. State income tax: $8,200.00

Tax Year: 2023

Department of the Treasury - Internal Revenue Service