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1 22222 Vi b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr Fr Official Us Only OMB N Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 Avanc EI paymnt 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi plans 12a S instructins fr bx Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt plan Thir-party sick pay 12b 12c 12 Frm W-2 Wag an Tax Statmnt 2010 py A Fr Scial Scurity Aministratin Sn this ntir pag with Frm W-3 t th Scial Scurity Aministratin; phtcpis ar nt accptabl. Dpartmnt f th Trasury Intrnal Rvnu Srvic Fr Privacy Act an Paprwrk Ructin Act Ntic, s back f py D. at. N D D Nt ut, Fl, r Stapl Frms n This Pag D Nt ut, Fl, r Stapl Frms n This Pag

2 22222 Vi b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr Fr Official Us Only OMB N Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 Avanc EI paymnt 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi plans 12a S instructins fr bx Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt plan Thir-party sick pay 12b 12c 12 Frm W-2 Wag an Tax Statmnt 2010 py A Fr Scial Scurity Aministratin Sn this ntir pag with Frm W-3 t th Scial Scurity Aministratin; phtcpis ar nt accptabl. Dpartmnt f th Trasury Intrnal Rvnu Srvic Fr Privacy Act an Paprwrk Ructin Act Ntic, s back f py D. at. N D D Nt ut, Fl, r Stapl Frms n This Pag D Nt ut, Fl, r Stapl Frms n This Pag

3 22222 Vi b Emplyr intificatin numbr (EIN) a Emply s scial scurity numbr Fr Official Us Only OMB N Wags, tips, thr cmpnsatin 2 Fral incm tax withhl c Emplyr s nam, arss, an ZIP c 3 Scial scurity wags 4 Scial scurity tax withhl 5 Micar wags an tips 6 Micar tax withhl 7 Scial scurity tips 8 Allcat tips ntrl numbr 9 Avanc EI paymnt 10 Dpnnt car bnfits Emply s first nam an initial Last nam Suff. 11 Nnqualifi plans 12a S instructins fr bx Statutry mply 14 Othr f Emply s arss an ZIP c 15 Stat Emplyr s stat ID numbr 16 Stat wags, tips, tc. 17 Stat incm tax 18 Lcal wags, tips, tc. 19 Lcal incm tax 20 Lcality nam Rtirmnt plan Thir-party sick pay 12b 12c 12 Frm W-2 Wag an Tax Statmnt 2010 py A Fr Scial Scurity Aministratin Sn this ntir pag with Frm W-3 t th Scial Scurity Aministratin; phtcpis ar nt accptabl. Dpartmnt f th Trasury Intrnal Rvnu Srvic Fr Privacy Act an Paprwrk Ructin Act Ntic, s back f py D. at. N D D Nt ut, Fl, r Stapl Frms n This Pag D Nt ut, Fl, r Stapl Frms n This Pag

4 ORRETED PAYER S nam, strt arss, city, stat, ZIP c, an tlphn n. 1 Unmplymnt cmpnsatin OMB N Stat r lcal incm tax rfuns, crits, r ffsts PAYER S fral intificatin numbr REIPIENT S intificatin numbr 3 Bx 2 amunt is fr tax yar 4 Fral incm tax withhl REIPIENT S nam 5 ATAA paymnts 6 Taxabl nrgy grants Strt arss (incluing apt. n.) ity, stat, an ZIP c Accunt numbr (s instructins) Frm 1099-G 8686 VOID 7 Agricultur paymnts 9 Markt gain 10a Stat at. N M 10b Stat intificatin n Frm 1099-G 8 hck if bx 2 is tra r businss incm 11 Stat incm tax withhl rtain Gvrnmnt Paymnts py A Fr Intrnal Rvnu Srvic ntr Fil with Frm Fr Privacy Act an Paprwrk Ructin Act Ntic, s th 2010 Gnral Instructins fr rtain Infrmatin Rturns. Dpartmnt f th Trasury - Intrnal Rvnu Srvic D Nt ut r Sparat Frms n This Pag D Nt ut r Sparat Frms n This Pag

5 9898 VOID ORRETED PAYER S nam, strt arss, city, stat, an ZIP c 1 Grss istributin PAYER S fral intificatin numbr REIPIENT S intificatin numbr 2a Taxabl amunt 2b Taxabl amunt nt trmin 3 apital gain (inclu in bx 2a) OMB N Frm 1099-R Ttal istributin 4 Fral incm tax withhl Distributins Frm Pnsins, Annuitis, Rtirmnt r Prfit-Sharing Plans, IRAs, Insuranc ntracts, tc. py A Fr Intrnal Rvnu Srvic ntr REIPIENT S nam Strt arss (incluing apt. n.) ity, stat, an ZIP c Accunt numbr (s instructins) 1st yar f sig. Rth cntrib. 5 Emply cntributins /Dsignat Rth cntributins r insuranc prmiums 7 Distributin c(s) IRA/ SEP/ SIMPLE 9a Yur prcntag f ttal istributin % 10 Stat tax withhl 13 Lcal tax withhl 6 Nt unraliz apprciatin in mplyr s scuritis 8 Othr Fil with Frm Fr Privacy Act an Paprwrk Ructin Act Ntic, s th 2010 Gnral Instructins fr rtain Infrmatin Rturns. % 9b Ttal mply cntributins 11 Stat/Payr s stat n. 12 Stat istributin 14 Nam f lcality 15 Lcal istributin Frm 1099-R at. N Q Dpartmnt f th Trasury - Intrnal Rvnu Srvic D Nt ut r Sparat Frms n This Pag D Nt ut r Sparat Frms n This Pag

6 Yur lgal last nam Yur scial scurity numbr If a jint rturn, spus s lgal last nam Lgal first nam Hm arss (numbr an strt). If yu hav a PO Bx, s pag 6. ity r pst ffic Spus s scial scurity numbr Spus s lgal first nam Stat M.I. If yu want 3 t g t th Stat Elctin ampaign Fun an th Dmcracy Trust Fun, chck hr. M.I. Yu Yur spus Zip c Apt. N. Dsignating an amunt will nt chang yur tax r rfun. hck blw thn fill in ithr th nam f city, villag, r twn an th cunty in which yu liv at th n f ity, villag, r twn ity Villag Twn Singl Marri filing jint rturn (vn if nly n ha incm) Ha f hushl Als, chck hr if marri. Fill in qualifying prsn s nam (s pag 23) I-080i Wags, salaris, tips, tc. (s pag 7)... Intrst (s pag 8)... Orinary ivins (frm lin 9a f fral Frm 1040A r 1040)... apital gain istributins (s pag 8)... Unmplymnt cmpnsatin (frm wrksht, pag 8) Taxabl IRA istributins, pnsins, an annuitis (s pag 8)... A lins 1 thrugh 6... IRA uctin (s pag 10)... Stunt lan intrst uctin (s pag 10)... Mical car insuranc uctin (s pag 10)... A lins 8 thrugh Subtract lin 11 frm lin 7. This is yur Wiscnsin incm.... If yur parnt (r smn ls) can claim yu (r yur spus) as a pnnt, chck hr Fill in th fr yur filing status frm tabl, pag 31. if yu chck lin 13, fill in amunt frm wrksht, pag Subtract lin 14 frm lin 12. If lin 14 is largr than lin 12, fill in 0... (autin: s pag 11) Fill in xmptins frm yur fral rturn... x hck if 65 r lr Yu Spus x A lins 16a an 16b... Subtract lin 16c frm lin 15. If lin 16c is largr than lin 15, fill in 0. This is yur taxabl incm.. Tax. Us amunt n lin 17 t fin yur tax using tabl, pag Arm frcs mmbr crit (must b statin utsi U.S., s pag 12) Schl prprty tax crit Rnt pai in 2010 hat inclu Fin crit frm Rnt pai in 2010 hat nt inclu tabl pag 13.. Fin crit frm Prprty taxs pai n hm in 2010 tabl pag 14.. Wrking familis tax crit, s pag Marri cupl crit. mplt schul n rvrs si... A lins 19 thrugh 22. This is th ttal f yur crits..... Subtract lin 23 frm lin 18. If lin 23 is largr than lin 18, fill in 0. This is yur nt tax..

7 Frm 1A (2010) Fill in nt tax frm lin Sals an us tax u n ut-f-stat purchass (s pag 15)... Avanc arn incm crit (s pag 16) Dnatins (crass rfun r incrass amunt w) Enangr rsurcs Firfightrs mmrial Packrs ftball staium Prstat cancr rsarch Brast cancr rsarch Military family rlif Vtrans trust fun Scn Harvst Multipl sclrsis Ttal (a lins a thrugh i)... A lins 25, 26, 27, an 28j... Wiscnsin incm tax withhl. Encls withhling statmnts stimat tax paymnts an amunt appli frm 2009 rturn... Earn incm crit (s pag 17) Qualifying Fral chilrn crit... x % =... Hmsta crit. Attach Schul H r H-EZ... Eligibl vtrans an surviving spuss prprty tax crit A lins 30 thrugh If lin 35 is mr than lin 29, subtract lin 29 frm lin 35. This is th Amunt f lin 36 yu want... Amunt f lin 36 yu want... If lin 35 is lss than lin 29, subtract lin 35 frm lin 29. This is th.. Unrpaymnt intrst. Fill in xcptin c S Sch. U (S pag 19) Dsign s nam Pag f Wiscnsin Dpartmnt f Rvnu...PO Bx 268, Maisn WI PO Bx 34, Maisn WI PO Bx 59, Maisn WI Wags, salaris, tips, an thr mply cmpnsatin frm lin 1 f Frm 1A. D nt inclu frr cmpnsatin r schlarships an fllwships that ar nt rprt n a W IRA uctin, if any, frm lin 8 f Frm 1A.... Subtract lin 2 frm lin mpar amunts in clumns (A) an (B) f lin 3. Fill in th smallr amunt hr. If mr than 16,000, fill in 16, Rat f crit is 03 (3%)... Multiply lin 4 by lin 5. Run th rsult an fill in hr an n lin 22 f Frm 1A D yu want t allw anthr prsn t iscuss this rturn with th partmnt? mplt th fllwing. Phn n. ( ) Yur signatur Spus s signatur (if filing jintly, BOTH must sign) Dat Daytim phn ( ) Prsnal intificatin numbr (PIN) X

7.1. Nicole s W-2 Wage and Tax Statement W-2 VISUAL. THEME 2 Lesson 7: Uncle Sam Takes a Bite 123-45-6789 1,822.00 00000000 24,050.

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