Employee’s SSA numberaEmployer’s FED ID numberb
e/f Employee’s name, address, and ZIP code
2. Your Gross Pay was adjusted as follows to produce your W-2 Statement.
c Employer’s name, address, and ZIP code
Employer use onlyCorp.Control numberd Dept.
1. The following information reflects your final pay stub plus any adjustments submitted by your employer.
The reverse side includes general information that you may also find helpful.
This blue Earnings Summary section is included with your W-2 to help describe portions in more detail.
Y2017 W-2 and EARNINGS SUMMAR
910 Dependent care benefits910 Dependent care benefits Verification Code Verification CodeVerification Code9
7Allocated tips8Social security tipsAllocated tips8Social security tips Allocated tips87 Social security tips7
Employer’s FED ID number Employee’s SSA numberaEmployer’s FED ID numberbab Employee’s SSA numberaEmployer’s FED ID numberbEmployee’s SSA number
Employer’s name, address, and ZIP codec Employer’s name, address, and ZIP code Employer’s name, address, and ZIP codec c
Employer use onlyCorp.Dept.Control numberdEmployer use onlyCorp.Dept.Control numberdEmployer use onlyCorp.Dept.Control numberd
65Medicare wages and tips Medicare wages and tipsMedicare tax withheldMedicare wages and tipsMedicare tax withheld 6565 Medicare tax withheld
Social security wagesSocial security tax withheldSocial security tax withheld 4343 43 Social security tax withheldSocial security wagesSocial security wages
2121 2 Federal income tax withheldWages, tips, other comp.Wages, tips, other comp. 1 Wages, tips, other comp.Federal income tax withheldFederal income tax withheld
¤ 2017 ADP, LLC20 Locality nameLocal income tax19
17 18 Local wages, tips, etc.State income tax
1615 State State wages, tips, etc.Employer’s state ID no.
3rd party sick pay13 Ret. planStat emp.
12d
12cOther14
12b
Social Security Number:
Nonqualified plans11 12a See instructions for box 12
To change your Employee W-4 Profile Information, file a new W-4 with your payroll dept.10 Dependent care benefits9 3. Employee W-4 Profile.Verification Code
Allocated tips8Social security tips7
6 Medicare tax withheldMedicare wages and tips5
Social security wages Social security tax withheld43
Federal income tax withheld1 2Wages, tips, other comp.
20Local income tax Locality name19 Locality name19 201920 Locality nameLocal income tax Local income tax
Local wages, tips, etc.State income tax17 18 17 Local wages, tips, etc.Local wages, tips, etc.State income tax State income tax 181817
1516 16 State wages, tips, etc.Employer’s state ID no.StateState wages, tips, etc.Employer’s state ID no.State Employer’s state ID no.StateState wages, tips, etc. 161515
Employee’s name, address and ZIP codee/fEmployee’s name, address and ZIP codee/f Employee’s name, address and ZIP codee/f
Stat emp. Ret. planRet. planStat emp. 3rd party sick pay3rd party sick pay3rd party sick pay Ret. plan1313 Stat emp.13
12d12d12d
12c12c12c
Other1414 14OtherOther 12b12b12b
1112a...
