Use this sample W2 to complete the 1040 . This PDF comes directly from the IRS website. You can type directly into the form or p and complete manually. Submit when completed. a Employee's social security number For Official Use Only 123-XX-XXXX OMB No. 1545-0008 b Employer Identification Number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld 12-XXXXXXX $5,505.00 $336.00 c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld $5,505.00 $341.31 5 Medicare wages and tips 6 Medicare tax withheld $5,505.00 $79.82 Wynwood Pool Cleaning 999 Spellman Ave. 7 Social security tips 8 Allocated tips Los Angeles, CA 90004 d Control number 9 10 Dependent care benefits e Employee's first name and initial Last name Suff. 11 Nonqualfied plans 12a See instructions for box 12 13 12b 14:Other 120 12c EDGAR J. FLORES 111 West Main St. Los Angeles, CA 90004 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 CA 12-XXXXXXX $5,505.00 $55.05