Fly-By-Night (P.O. Box 1234, Dallas, TX 75221, EIN 12-9876543) paid George Smith, an employee who lives at 432 Second Street, Garland, TX 75040, wages of $25,400. Based on George’s final 2018 pay stub, the income tax withholding amounted to $5,380 and the FICA tax was $1,943.10 ($1,574.80 for Social Security and $368.30 for Medicare). George’s FICA wages were the same as the total wages, and his Social Security number is 466-47-3313. Fly-By-Night’s owner, a shady character, took off to South America with all the firm’s funds, and did not file the required Forms W-2, etc., for George (and other employees). The above numbers are taken from the year-to date section of George’s last pay stub. Use the Form 4852 on Pages 9-47 and 9-48 to prepare a substitute Form W-2 for George. 

Transcribed Image Text:

4852 Substitute for Form W-2, Wage and Tax Statement, or Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAS, Insurance Contracts, etc. Form Per. September 2017 OMB No. 1545-0074 Departmant of the Troasury Intemal Revenue Service Attach to Fom 1040, 1040A, 1040-EZ, or 1040X. Go to www.irs.gov/Form4852 tor the latest information. 1 Name(s) shown on return 2 Your social security number 3 Address 4 Enter year in space provided and check one box. For the tax year ending December 31, I have been unable to obtain (or have received an incorrect) OForm W-2 OR OForm 1099-R. I have notified the IRS of this fact. The amounts shown on line 7 or line 8 are my best estimates for all wages or payments made to me and tax withheld by my employer or payer named on line 5. 5 Employer's or payer's name, address, and ZIP code 6 Employer's or payer's identification number if known) 7 Form W-2. Enter wages, tips, other compensation, and taxes withheld. a Wages, tips, and other compensation b Social security wages c Medicare wages and tips d Social security tips e Federal income tax withheld State income tax withheld (Name of state). 9 Local income tax withheld (Name of locality) h Social security tax withheld. i Medicare tax withheld Form 1099-R. Enter distributions from pensions, annuities, retirement or profit-sharing plans, IRAS, insurance contrects, etc. a Gross distribution b Taxable amount c Taxable amount not determined d Total distribution e Capital gain (included in line 8b) f Federal income tax withheld g State income tax withheld h Local income tax withheld i Employee contributions. Distribution codes. 9 How did you determine the amounts on lines 7 and 8 above? 10 Explain your efforts to obtain Form W-2, Form 1099-R, or Form Vw-2c, Corrected Wage and Tax Statement. If you received an incorrect Form W-2 or Form 1099-R, you should always attempt to have your employer or payer issue a corrected form before filing Form 4852. Note: Retain a copy of Form 4852 for your records. To help protect your social security benefits, koep a copy of Form 4852 until you begin receiving social security benefits, just in case there is a question about your work record and/or earnings in a particular year. After September 30 following the date shown on line 4, you may use your Social Security online account to verify wages reported by your employers. Please visit www.SSA.gov/myaccount. Or, you may contact your local SSA office to verify wages reported by your employer. General Instructions Section references are to the Internal Revenue Code. Future developments. Information about any future developments affecting Form 4852 (such as legislation enacted aftar we relesse it) will be available at www.irs.gov/Form4852. Purpose of form. Form 4852 serves as a substitute for Forms W-2, W-2c, and 1099-R and is completed by you or your representatives when (a) your employer or payer doesn't issue you a Form W-2 or Form 1099-R or (b) an employer or payer has issued an incorrect Form W-2 or Form 1099-R. Attach this form to the back of your income tax return, before any supporting forms or schedules. You should always attempt to get your Form W-2, Form W-2c, or Form 1099-R from your employer or payer before contacting the IRS or filing Form 4852. If you do not receive the missing or corrected form from your employer or payer by the end of February. you may call the IRS at 1-800-629-1040 for assistance. You must provide your name, address (including ZIP code), phone number, social security number, and dates of employment. You must also provide your employer's or payer's name, address (including ZIP code), and phone number. The IRS will contact your employer or peyer and request the missing form. The IRS will also send you a Form 4852. If you don't receive the missing form in sufficient time to file your income tax return timely, you may use the Form 4852 that the IRS sent you. Will I need to amend my retum? If you receive a Form W-2, Form W-20, or Form 1099-R after your return is filed with Form 4852, and the information you receive differs from the information reported on your return, you must amend your retum by filing Form 1040X, Amended U.S. Individual Income Tax Return. You are responsible for filing your income tax return with accurate information regardless of whether you receive a Form W-2, Form W-2c, or Form 1099-R and regardiess of whether the information on any forms received is correct. Penalties. The IRS will challenge the claims of individuals who attempt to avoid or evade their federal tax liability by using Form 4852 in a manner other than as prescribed. Potential penalties for the improper use of Form 4852 include