a Employee's social security number OMB No.

1545-0008
202-64-5295
b Employer identification number d Control number 1 Wages, tips, other compensation 2 Federal income tax withheld
35-9990000 7615.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
DFAS ATTN:DFASIN/JAMBE 7615.00 472.13
8899 EAST 56TH STREET 5 Medicare wages and tips 6 Medicare tax withheld
INDIANAPOLIS IN 46249-2410 7615.00 110.42
7 Social security tips 8 Allocated tips

e Employee's name, address, and ZIP code 9 Advance EIC payment 10 Dependent care benefits
JAMAR SINCLAIR SHERMAN
5ZC1D52C 4839 12 See instructions for box 12 14 See instructions for box 14

13 Statutory Retirement Third party

employee X Plan sick pay
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
DE 359990000 7615.00 115.18
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

Department of the Treasury - Internal Revenue Service

Wage and Tax
Form
W-2 Statement 2009 Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return

a Employee's social security number OMB No. 1545-0008

202-64-5295
b Employer identification number d Control number 1 Wages, tips, other compensation 2 Federal income tax withheld
35-9990000 7615.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
DFAS ATTN:DFASIN/JAMBE 7615.00 472.13
8899 EAST 56TH STREET 5 Medicare wages and tips 6 Medicare tax withheld
INDIANAPOLIS IN 46249-2410 7615.00 110.42
7 Social security tips 8 Allocated tips

e Employee's name, address, and ZIP code 9 Advance EIC payment 10 Dependent care benefits
JAMAR SINCLAIR SHERMAN
5ZC1D52C 4839 12 See instructions for box 12 14 See instructions for box 14

13 Statutory Retirement Third party

employee X Plan sick pay
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
DE 359990000 7615.00 115.18
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

Department of the Treasury - Internal Revenue Service

Wage and Tax
Form
W-2 Statement 2009 Copy 2 To Be Filed With Employee's State, City, or Local Income Tax Return
a Employee's social security number OMB No. 1545-0008
202-64-5295
b Employer identification number d Control number 1 Wages, tips, other compensation 2 Federal income tax withheld
35-9990000 7615.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
DFAS ATTN:DFASIN/JAMBE 7615.00 472.13
8899 EAST 56TH STREET 5 Medicare wages and tips 6 Medicare tax withheld
INDIANAPOLIS IN 46249-2410 7615.00 110.42
7 Social security tips 8 Allocated tips

e Employee's name, address, and ZIP code 9 Advance EIC payment 10 Dependent care benefits
JAMAR SINCLAIR SHERMAN
5ZC1D52C 4839 12 See instructions for box 12 14 See instructions for box 14

13 Statutory Retirement Third party

employee X Plan sick pay
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
DE 359990000 7615.00 115.18
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

Wage and Tax Department of the Treasury - Internal Revenue Service

Form
W-2 Statement 2009 Copy B To Be Filed With Employee's FEDERAL Tax Return
This information is being furnished to the Internal Revenue Service

a Employee's social security number OMB No. 1545-0008 This information is being furnished to the Internal Revenue Service. If you are required to file a
202-64-5295 tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it.
b Employer identification number d Control number 1 Wages, tips, other compensation 2 Federal income tax withheld
35-9990000 7615.00
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
DFAS ATTN:DFASIN/JAMBE 7615.00 472.13
8899 EAST 56TH STREET 5 Medicare wages and tips 6 Medicare tax withheld
INDIANAPOLIS IN 46249-2410 7615.00 110.42
7 Social security tips 8 Allocated tips

e Employee's name, address, and ZIP code 9 Advance EIC payment 10 Dependent care benefits
JAMAR SINCLAIR SHERMAN
5ZC1D52C 4839 12 See instructions for box 12 14 See instructions for box 14

13 Statutory Retirement Third party

employee X Plan sick pay
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
DE 359990000 7615.00 115.18
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

Department of the Treasury - Internal Revenue Service

Wage and Tax
Form
W-2 Statement 2009 Copy C For EMPLOYEE'S RECORDS (See Notice to Employee on back of Copy B)