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Complete Form W-3 for Wayland Custom Woodworking. (Round your answers to 2 decimal places.) DO NOT STAPLE a Control number For Official Use Only 33333 OMB No. 1545-0006 b Kind of Payer 941 Military 943 kind of Employer ONone apply 501c non-govt. Third-party sick [Chock ono) 944 OCT-1 OHahid. amp. State/local (Check one) Federal govt. pay (If applicable) 5010 Medicare govt emp State/local non-501c c Total number of forms V-2 d Establishment number 1 Wages, tips, other compensation 2 Federal income tax withheld e Employee identification number (EIN) 3 Social security wages 4 Social security tax withheld Employer's name 5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips 9 10 Dependent care benefits 11 Nonqualified plans 12a Deferred compensation g Employer's address and ZIP code h Other EIN used this year 13 For third-party sick pay use only 12b 15 State Employor's state ID number 14 Income tax withheld by payer of third-party sick pay 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax Employer's contact person Employer's telephone number For Official Use Only Employer's fax number Employer's email address Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete Signature Mark Wayland Title Owner Date 01/06/2017 Form W-3 Transmittal of Wage and Tax Statements 2016 Department of the Treasury Internal Revenue Service