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Form W-2 Wage and Tax Statement 2016 OMB No. 1545-0008 Department of the Treasury - Internal Revenue Service
Control number Employer identification number COPY C For Employee's Records (See Notice to Employee on back of
1225760934 52-6000992 Copy B)
Employer's name, address and zip code Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
Prince George's County Public Schools 155-11-9067 91510.51 12069.99
14201 School Lane 7 Social security tips 3 Social security wages 4 Social security tax withheld
Sasscer Administration Building 98635.43 6115.40
Upper Marlboro MD 20772
8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld
98635.43 1430.21
Employee's first name and init Last Name Suffix
9 10 Dependent care benefits 11 Nonqualified plans
Roberto P Bagtas
1201 White Way 12a C | 359.70 14 Other
13 Statutory Employee Health Ins 4108.20
Laurel MD 20707
12b DD | 13844.80 7124.92
Retirement Plan StPkup
12c |
Third-party sick pay
Employee's address and ZIP code 12d |
15 State Employer's State ID number 16 State wages, tips etc. 17 State income tax 18 Local wages, tips etc. 19 Local income tax 20 Locality name
MD 00425104 98635.43 7119.53
This information is being furnished to the Internal Revenue Service. 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.
Form W-2 Wage and Tax Statement 2016 OMB No. 1545-0008 Department of the Treasury - Internal Revenue Service
Control number Employer identification number Copy 1 To Be Filed With Employee's State, City, or Local Income Tax
1225760934 52-6000992 Return
Employer's name, address and zip code Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
Prince George's County Public Schools 155-11-9067 91510.51 12069.99
14201 School Lane 7 Social security tips 3 Social security wages 4 Social security tax withheld
Sasscer Administration Building 98635.43 6115.40
Upper Marlboro MD 20772
8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld
98635.43 1430.21
Employee's first name and init Last Name Suffix
9 10 Dependent care benefits 11 Nonqualified plans
Roberto P Bagtas
1201 White Way 12a C | 359.70 14 Other
Laurel MD 20707 13 Statutory Employee Health Ins 4108.20
12b DD | 13844.80
Retirement Plan StPkup 7124.92
12c |
12d | Third-party sick pay
Employee's address and ZIP code
15 State Employer's State ID number 16 State wages, tips etc. 17 State income tax 18 Local wages, tips etc. 19 Local income tax 20 Locality name
MD 00425104 98635.43 7119.53
Form W-2 Wage and Tax Statement 2016 OMB No. 1545-0008 Department of the Treasury - Internal Revenue Service
Control number Employer identification number Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return
1225760934 52-6000992
Employer's name, address and zip code Employee's SSN 1 Wages, tips, other compensation 2 Federal income tax withheld
Prince George's County Public Schools 155-11-9067 91510.51 12069.99
14201 School Lane 7 Social security tips 3 Social security wages 4 Social security tax withheld
Sasscer Administration Building 98635.43 6115.40
Upper Marlboro MD 20772
8 Allocated tips 5 Medicare wages and tips 6 Medicare tax withheld
98635.43 1430.21
Employee's first name and init Last Name Suffix
9 10 Dependent care benefits 11 Nonqualified plans
Roberto P Bagtas
1201 White Way 12a C | 359.70 14 Other
Laurel MD 20707 13 Statutory Employee Health Ins 4108.20
12b DD | 13844.80
Retirement Plan StPkup 7124.92
12c |
12d | Third-party sick pay
Employee's address and ZIP code
15 State Employer's State ID number 16 State wages, tips etc. 17 State income tax 18 Local wages, tips etc. 19 Local income tax 20 Locality name
MD 00425104 98635.43 7119.53