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 $24,300. The income tax withholding amounted to $5,320 and the FICA tax was $1,858.95 ($1,506.60 for Social Security and $352.35 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 9-45 and 9-46 to prepare a substitute Form W-2 for George.

Form 4852: