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2019 W-2 and EARNINGS SUMMARY

Employee Reference Copy This blue section is your Earnings Summary which provides more detailed

W-2 Wage and Tax


Statement
Copy C for employee’srecords.
OMB No.
2019 1545-0008
information on the generation of your W-2 statement and W-4 profile. The
reverse side includes instructions and other general information.
d Control number Dept. Corp. Employer use only
290288 CHIC/5EZ 201050 T 203
c Employer’s name, address, and ZIP code
GREAT LAKES SERVICES 1

LLC
1255 FOURIER DRIVE # 201
MADISON WI 53717
1. Your Gross Pay was adjusted as follows to produce your W-2 Statement.
Batch #03110
Wages, Tips, other Social Security Medicare OH. State Wages,
e/f Employee’s name, address, and ZIP code Compensation Wages Wages Tips, Etc.
Box 1 of W-2 Box 3 of W-2 Box 5 of W-2 Box 16 of W-2
LUCAS L GEORGE RAUL
4600 MILAN ROAD Gross Pay 4,778.55 4,778.55 4,778.55 4,778.55
SANDUKSY OH 44870 Less Exempt Wages N/A 4,778.55 4,778.55 N/A
Reported W-2 Wages 4,778.55 0.00 0.00 4,778.55
b Employer’s FED ID number a Employee’s SSA number
27-1371313 APPLIED FOR
1 Wages, tips, other comp. 2 Federal income tax withheld
4778.55 360.35
3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8 Allocated tips

9 10 Dependent care benefits 2. Employee Current W-4 Profile. To make changes, file a new W-4 with your payroll department.

11 Nonqualified plans 12a See instructionsfor box 12

12b
LUCAS L GEORGE RAUL Social Security Number: APPLIED FOR
14 Other
12c 4600 MILAN ROAD Taxable Marital Status: SINGLE

12d SANDUKSY OH 44870 Exemptions/Allowances:


____________________
13 Stat emp. Ret. plan 3rd party sick pay FEDERAL: 1
STATE: 1
15 State Employer’s state ID no. 16 State wages, tips, etc.
OH 52-7599690 4778.55
17 State income tax 18 Local wages, tips, etc.
93.28
19 Local income tax 20 Locality name 2019 ADP, LLC

1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld 1 Wages, tips, other comp. 2 Federal income tax withheld
4778.55 360.35 4778.55 360.35 4778.55 360.35
3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld 3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 5 Medicare wages and tips 6 Medicare tax withheld

d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only d Control number Dept. Corp. Employer use only

290288 CHIC/5EZ 201050 T 203 290288 CHIC/5EZ 201050 T 203 290288 CHIC/5EZ 201050 T 203
c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code c Employer’s name, address, and ZIP code

GREAT LAKES SERVICES GREAT LAKES SERVICES GREAT LAKES SERVICES


LLC LLC LLC
1255 FOURIER DRIVE # 201 1255 FOURIER DRIVE # 201 1255 FOURIER DRIVE # 201
MADISON WI 53717 MADISON WI 53717 MADISON WI 53717

b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number b Employer’s FED ID number a Employee’s SSA number
27-1371313 APPLIED FOR 27-1371313 APPLIED FOR 27-1371313 APPLIED FOR
7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips 7 Social security tips 8 Allocated tips

9 10 Dependent care benefits 9 10 Dependent care benefits 9 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 Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code e/f Employee’s name, address and ZIP code

LUCAS L GEORGE RAUL LUCAS L GEORGE RAUL LUCAS L GEORGE RAUL


4600 MILAN ROAD 4600 MILAN ROAD 4600 MILAN ROAD
SANDUKSY OH 44870 SANDUKSY OH 44870 SANDUKSY OH 44870

15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc. 15 State Employer’s state ID no. 16 State wages, tips, etc.
OH 52-7599690 4778.55 OH 52-7599690 4778.55 OH 52-7599690 4778.55
17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 17 State income tax 18 Local wages, tips, etc.
93.28 93.28 93.28
19 Local income tax 20 Locality name 19 Local income tax 20 Locality name 19 Local income tax 20 Locality name

Federal Filing Copy OH.State Reference Copy OH.State Filing Copy

W-2 Wage and Tax


Statement
Copy B to be filed with employee’s
OMB
2019 W-2
No. 1545-0008
Federal IncomeTax Return.
Wage and Tax
Statement
Copy 2 to be filed with employee’sState IncomeTax Return.
2019 W-2
OMB No. 1545-0008
Wage and Tax
Statement OMB
2019
Copy 2 to be filed with employee’sState IncomeTax Return.
No. 1545-0008