Copy Employee Reference we 29 1 1 0008 Emplayer's name: 9890.55.18 0F. Wage and Tax Statement a Emp social sec 1 Wages, tips of?er comp 2 Fe: erat moe . el 196116.73 36882.98 3 808831 security wages 4 Sacral security tax 1: Employer ID number 11850000 7347.00 5 Medicare wages and tips. 6 Medicare tax withheld - 217098.73 3301.83 nd code 01 Control number Employee's name, address, and code PATRICK LAWTON GERMANTOWN TN 38138 7 Sociai security tips 8 Allocated tips 19 09990390195"? bene?ts 12a Code See inst. For box 12 11 Nonquali?ed plans DD 13 Statutory employee 14 Other 121: Code .1 Retirement plan 12c Code Third-party sick pay 12d Code 15 State Emplr?s state LD. 16 State wages, tips, etc. 18 Local wages. tips, etc. 19 Local income tax 2 17 Stats income tax Locality name mm Form Wage and Tax Statement 41-1628061 Dept. of the Treasury This information is being furnished to the lntemal Revenue Service. if you are required to ?le a tax return a negligence penaity or other sanction may be imposed on you if this income is taxable and you fall to report Copy 2 To Be Filed With Employee?s OMB No. STATE Tax Return 2 2015 1545-0008 - 1 Wages, tips other comp 2 Federal income tax withheld "bf 196116.73 36832.98 3 Sociat security wages 4 Social security tax withheld 9 Emma er ID number 118500.00 7347.00 5 Medicare wages and tips. 6 Medicare tax withheld 217098.73 3301.83 Employer?s name, address, and code CITY OF GERMANTOWN PO BOX 38809 1930 GERMANTOWN RD GERMANTOWN TN 38183?0809 Control number Employee?s name, address, and code PATRICK LAWTON TN 38138 7 Social security tips 3 Anacate? tips 12a Code See inst. Forbox 12 DD 16 Dependent care benefits 11 Nonquall?ed Plans 13 Statutory employee 14 Other 121: Code (3 Retirement plan 12c Code Third-party sick pay 12d Code 15 State Empir's state LD. it 16 State wages, tips. etc a '13 Locaiwages,1ip5_ etc, 19 coal income tax 20 Locality name Form Wage and Tax Statement 414628061 Dept. of the Treasury -- IRS GERMANTOWN TN 38 1 83-0809 41 30 413 Cepy To Be Filed With Employee?s FEDERAL Tax Rett rn 2915 23333508 a Emp sociai sec 1 Wages, tips other comp 2 Federal income tax withheld - 196116.73 3688;,gg, 3 Social security wages 4 Social security tax withheld Em ioyer tD number 113500 00 7347_00 5 Medicare wages and tips. 6 Medicare tax withheld 217098.73 3301.83 Employer's name, address, and code CITY OF GERMANT OWN PO BOX 38809 1930 GERMANTOW RD 11 Control number PATRIQ Employee's nameaddress, and ZIP code 7 Social security tips 8 Atlocated tips 10 Dependent care bene?ts 11 Nonquaii?ed plans 1 2e Code See inst. For box 12 on 13 Statutory employee 14 Other 121; Code Retirement plan 12c Code m! Third-party Sick pay 12d Code 15 State Emplr?s state ti 16 State wages, zips. etc, 1? State income tax 18 Local wages, tips, etc. 19 -ocal income tax 20 Locality name Form W-2 Wage and Tax Statement 41-1 628061 Dept. ofthe Treasury IRS Copy 2 To Be Filed With Employee?s OMB No. CITY or LOCAL Ta It Retu 2 201 5 1545-0008 a Em social sec 1 Wages, tips other comp 2 Fade-rat income tax withheld - 196116.73 1 36882.98 3 Social security wages 4 Social security tax withheld Em Io or ID number 118500.00 7347.00 5 Medicare wages and tips. 6 Medicare tax withheld 217098.73 3301.83 Emptoyer's name, address, and coda CITY OF GERMANTOWN PO BOX 38809 1930 GERMANTOW RD GERMANTOWN TN 3818341809 C'ontroi number Emptoyee?s name, address, and ZIP code PATRICK LAWTON GERMANTOWN TN 38138 7 Social security tips 8 Allocated tips 10 Dependent care bene?ts 11 Nonquali?ed plans 123 Code See instStatutory empioyee 14 Other 12b Code i - Retirement plan 12c Code Third-party sick pay 12d Code 15 State Empir?s State LD. 5? 16 State wages, tips, etc. 1? State income tax 1B coca? wages, tips, etc. 19 Local income tax 20 Locatity name Form W-2 Wage and Tax Statement 414028061 Dept. of the Treasury -- IRS