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

1. The following

1545-0008

use only

121737 NCN2/EMQ 296600

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.
information

Gross Pay

1854

reflects your final 2015 pay stub plus any adjustments

Social Security
Tax Withheld

4704.15

291.66

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

SUI/SDI

Medicare Tax
Withheld

488.56

Box 2 of W-2

submitted by your employer.

TX. State Income Tax

Box 14 of W-2

68.21

Box 6 of W-2

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

DEANDRA K SCOTT
4406 AUSTIN CIRCLE
TEMPLE TX 76502
b

Employers FED ID number

Wages, tips, other comp.

Social security wages

Medicare wages and tips

Social security tips

Gross Pay

Reported W-2 Wages

a

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

4,704.15

4,704.15

4,704.15

4,704.15

4,704.15

4,704.15

631-40-8601

4704.15

488.56

4704.15

291.66

4704.15

68.21
8 Allocated tips

Verification Code

3. Employee W-4 Profile.

10 Dependent care benefits

12a See instructionsfor box 12

11 Nonqualified plans

DEANDRA K SCOTT
4406 AUSTIN CIRCLE
TEMPLE TX 76502

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: 631-40-8601

Taxable Marital Status: SINGLE
Exemptions/Allowances:
____________________

FEDERAL:
STATE:

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

0
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

4704.15
3

Social security wages

Medicare wages and tips

Social security tax withheld

Medicare tax withheld

Control number

Corp.

Employer

use only

121737 NCN2/EMQ 296600

c

Social security wages

Medicare wages and tips

1854

Control number

a Employees SSA number

Employers FED ID number

75-1444139
7

Verification Code

Medicare tax withheld

Dept.

Social security wages

Medicare wages and tips

Control number

291.66
68.21
Corp.

Employer

use only

1854

Employers FED ID number

8 Allocated tips

Social security tips

Federal income tax withheld

Social security tax withheld

Medicare tax withheld

488.56

4704.15
4704.15

291.66

Dept.

68.21
Corp.

Employer

121737 NCN2/EMQ 296600

c

a Employees SSA number

75-1444139

4704.15

use only

1854

Employers name, address, and ZIP code

EXAMINATION
MANAGEMENT
SERVICES INC
3050REGENT
BOULEVARD
100
IRVING TX 75063

631-40-8601

Social security tips

Employers name, address, and ZIP code

EXAMINATION
MANAGEMENT
SERVICES INC
3050REGENT
BOULEVARD
100
IRVING TX 75063

Social security tax withheld

121737 NCN2/EMQ 296600

c

Employers name, address, and ZIP code

4704.15
d

Wages, tips, other comp.

488.56

4704.15

68.21

Dept.

Federal income tax withheld

4704.15

291.66

4704.15

LLC

Wages, tips, other comp.

488.56

4704.15
d

ADP,

EXAMINATION
MANAGEMENT
SERVICES INC
3050REGENT
BOULEVARD
100
IRVING TX 75063

Employers FED ID number

631-40-8601

a Employees SSA number

75-1444139

8 Allocated tips

Social security tips

631-40-8601
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

DEANDRA K SCOTT
4406 AUSTIN CIRCLE
TEMPLE TX 76502

DEANDRA K SCOTT
4406 AUSTIN CIRCLE
TEMPLE TX 76502

DEANDRA K SCOTT
4406 AUSTIN CIRCLE
TEMPLE TX 76502

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

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

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

TX

TX

TX

17 State income tax

18 Local wages, tips, etc.

17 State income tax

19 Local income tax

20 Locality name

19

Federal Filing Copy

Wage and Tax
Statement
OMB

W-2

Copy B to be filed with employees

Local income tax

No. 1545-0008

17 State income tax

20 Locality name

19

TX.State Reference
Wage and Tax
Statement

2015 W-2

Federal IncomeTax Return.

18 Local wages, tips, etc.

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