2015 W-2 and EARNINGS SUMMARY

Employee Reference Copy

Wage and Tax
Statement
OMB No.

W-2

2015

Copy C for employeesrecords.

Dept.
d Control number

Corp.

Employer

122681 NCN2/EMQ 296700

c

This blue Earnings Summary section is included with your W-2 to help describe portions in more detail.
The reverse side includes general information that you may also find helpful.
1. The following

1545-0008

use only

information

Gross Pay

EIC 1943

reflects your final 2015 pay stub plus any adjustments

Social Security
Tax Withheld

1304.10

80.85

Box 17 of W-2

Box 4 of W-2

Employers name, address, and ZIP code

EXAMINATION
MANAGEMENT
SERVICES INC
3050REGENT
BOULEVARD
100
IRVING TX 75063

Fed. Income
Tax Withheld

Medicare Tax
Withheld

Box 2 of W-2

Box 6 of W-2

submitted by your employer.

TX. State Income Tax

SUI/SDI
Box 14 of W-2

18.91

2. Your Gross Pay was adjusted as follows to produce your W-2 Statement.

Batch

#02844

Wages, Tips, other

Compensation
Box 1 of W-2

e/f Employees name, address, and ZIP code

TERESA R SPEIGHT
1100 NORTH 6TH STREET
WACO TX 76707
b

Employers FED ID number

Wages, tips, other comp.

Social security wages

APT#E5

Gross Pay

Reported W-2 Wages

Employees SSA number

Federal income tax withheld

Social security tax withheld

Medicare tax withheld

75-1444139

Social Security
Wages
Box 3 of W-2

Medicare
Wages
Box 5 of W-2

TX. State Wages,

Tips, Etc.
Box 16 of W-2

1,304.10

1,304.10

1,304.10

1,304.10

1,304.10

1,304.10

629-40-1782

1304.10
1304.10
5

Medicare wages and tips

Social security tips

80.85

1304.10

18.91
8 Allocated tips

Verification Code

3. Employee W-4 Profile.

10 Dependent care benefits

12a See instructionsfor box 12

11 Nonqualified plans

TERESA R SPEIGHT
1100 NORTH 6TH STREET APT#E5
WACO TX 76707

12b
12c
12d
13 Stat emp. Ret. plan 3rd party sick pay

14 Other

To change your Employee W-4 Profile Information,

file a new W-4 with your payroll dept.

Social Security Number: 629-40-1782

Taxable Marital Status: SINGLE
Exemptions/Allowances:
____________________

FEDERAL:
STATE:

15 State Employers state ID no. 16 State wages, tips, etc.

7
No State Income Tax

TX
17 State income tax

18 Local wages, tips, etc.

19 Local income tax

20 Locality name

Wages, tips, other comp.

2015

Federal income tax withheld

ADP,

Wages, tips, other comp.

1304.10
3

Social security wages

Social security tax withheld

Medicare wages and tips

Control number

Medicare tax withheld

Dept.

Corp.

Employer

use only

EIC 1943

Control number

Employers FED ID number

a Employees SSA number

75-1444139
7

Social security tips

Verification Code

Dept.

Social security wages

80.85
Medicare tax withheld

1304.10

18.91
Corp.

Employer

122681 NCN2/EMQ 296700

c

Employers name, address, and ZIP code

Social security tax withheld

Medicare wages and tips

use only

EIC 1943

Medicare wages and tips

Control number

1304.10

Employers FED ID number

a Employees SSA number

75-1444139

8 Allocated tips

Social security tips

Federal income tax withheld

Social security tax withheld

Medicare tax withheld

80.85

Dept.

18.91
Corp.

Employer

122681 NCN2/EMQ 296700

use only

EIC 1943

Employers name, address, and ZIP code

EXAMINATION
MANAGEMENT
SERVICES INC
3050REGENT
BOULEVARD
100
IRVING TX 75063

629-40-1782

1304.10

Employers name, address, and ZIP code

EXAMINATION
MANAGEMENT
SERVICES INC
3050REGENT
BOULEVARD
100
IRVING TX 75063

Wages, tips, other comp.

1304.10

1304.10

18.91

122681 NCN2/EMQ 296700

c

Social security wages

80.85

1304.10

Federal income tax withheld

1304.10

1304.10
5

LLC

EXAMINATION
MANAGEMENT
SERVICES INC
3050REGENT
BOULEVARD
100
IRVING TX 75063

Employers FED ID number

629-40-1782

a Employees SSA number

75-1444139

8 Allocated tips

Social security tips

629-40-1782
8 Allocated tips

10 Dependent care benefits

10 Dependent care benefits

10 Dependent care benefits

11 Nonqualified plans

12a See instructions for box 12

11 Nonqualified plans

12a
12

11 Nonqualified plans

12a

14 Other

12b

14 Other

12b

14 Other

12b

12c

12c

12c

12d

12d

12d

13 Stat emp. Ret. plan 3rd party sick pay

13 Stat emp. Ret. plan 3rd party sick pay

13 Stat emp. Ret. plan 3rd party sick pay

e/f Employees name, address and ZIP code

e/f Employees name, address and ZIP code

e/f Employees name, address and ZIP code

TERESA R SPEIGHT
1100 NORTH 6TH STREET
WACO TX 76707

TERESA R SPEIGHT
1100 NORTH 6TH STREET
WACO TX 76707

TERESA R SPEIGHT
1100 NORTH 6TH STREET
WACO TX 76707

APT#E5

15 State Employers state ID no. 16 State wages, tips, etc.

TX

APT#E5

15 State Employers state ID no. 16 State wages, tips, etc.

TX
18 Local wages, tips, etc.

17 State income tax

19 Local income tax

20 Locality name

19

W-2

Copy B to be filed with employees

Local income tax

No. 1545-0008

18 Local wages, tips, etc.

17 State income tax

20 Locality name

19

TX.State Reference
Wage and Tax
Statement

2015 W-2

Federal IncomeTax Return.

15 State Employers state ID no. 16 State wages, tips, etc.

TX

17 State income tax

Federal Filing Copy

Wage and Tax
Statement
OMB

APT#E5

Copy

Local income tax

OMB

No. 1545-0008

20 Locality name

TX.State Filing Copy

Wage and Tax
Statement
OMB

2015 W-2

Copy 2 to be filed with employeesState IncomeTax Return.

18 Local wages, tips, etc.

2015

Copy 2 to be filed with employeesState IncomeTax Return.

No. 1545-0008