Copy B - To Be Filed with Employees FEDERAL Tax Return

a Employees soc. sec. no. 1 Wages, tips, other comp. 3 Social security wages

2011

OMB No. 1545-0008

597-07-7129
b Employer ID number (EIN)

71037.69

2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld

Copy 2-To Be Filed With Employees State, City, or Local Income Tax Return
a Employees soc. sec. no. 1 Wages, tips, other comp. 3 Social security wages

2011

OMB No. 1545-0008

611.16

597-07-7129
b Employer ID number (EIN)

71037.69 71037.69

2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld

611.16

71037.69

2983.58

2983.58 1030.05

330714183

5 Medicare wages and tips

71037.69

1030.05

330714183

5 Medicare wages and tips

71037.69

c Employers name, address, and ZIP code

c Employers name, address, and ZIP code

VALIDATION TECHNOLOGIES, INC 10815 RANCHO BERNARDO COURT SUITE 120 SAN DIEGO, CA 921272187
d Control number e Employees name, address, and ZIP code

VALIDATION TECHNOLOGIES, INC 10815 RANCHO BERNARDO COURT SUITE 120 SAN DIEGO, CA 921272187
d Control number e Employees name, address, and ZIP code

ENRIQUE POMALES 811 ALTON WOODS DRIVE CONCORD, NH 03301

7 Social security tips 10 Dependent care benefits 13 Statutory Employee
Retirement Plan Third-Party sick pay

ENRIQUE POMALES 811 ALTON WOODS DRIVE CONCORD, NH 03301

9 12a Code See inst. for box 12 12b Code 7 Social security tips 10 Dependent care benefits 13 Statutory Employee
Retirement Plan Third-Party sick pay

8 Allocated tips 11 Nonqualified plans 14 Other

8 Allocated tips 11 Nonqualified plans 14 Other

9 12a Code See inst. for box 12 12b Code 12c Code 12d Code

PRDD

27.00
12c Code 12d Code

PRDD

27.00

PR 330714183

74677.58

4020.46

PR 330714183

74677.58

4020.46
17 State income tax 20 Locality name

15 State employers state ID number 16 State wages, tips, etc. 18 Local wages, tips, etc. 19 Local income tax

17 State income tax 20 Locality name

15 State employers state ID number 16 State wages, tips, etc. 18 Local wages, tips, etc. 19 Local income tax

Form W-2 Wage and Tax Statement This information is being furnished to the Internal Revenue Service.

Dept. of the Treasury - IRS

Form W-2 Wage and Tax Statement

Dept. of the Treasury - IRS

Copy C-For EMPLOYEES RECORDS (See Notice to Employee on back of Copy B.)
a Employees soc. sec. no. 1 Wages, tips, other comp. 3 Social security wages

2011

OMB No. 1545-0008

597-07-7129
b Employer ID number (EIN)

71037.69 71037.69

2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld

Copy 2-To Be Filed With Employees State, City, or Local Income Tax Return
a Employees soc. sec. no. 1 Wages, tips, other comp. 3 Social security wages

2011

OMB No. 1545-0008

611.16

597-07-7129
b Employer ID number (EIN)

71037.69 71037.69

2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld

611.16

2983.58

2983.58

330714183

5 Medicare wages and tips

71037.69

1030.05

330714183

5 Medicare wages and tips

71037.69

1030.05

c Employers name, address, and ZIP code

c Employers name, address, and ZIP code

VALIDATION TECHNOLOGIES, INC 10815 RANCHO BERNARDO COURT SUITE 120 SAN DIEGO, CA 921272187
d Control number e Employees name, address, and ZIP code

VALIDATION TECHNOLOGIES, INC 10815 RANCHO BERNARDO COURT SUITE 120 SAN DIEGO, CA 921272187
d Control number e Employees name, address, and ZIP code

ENRIQUE POMALES 811 ALTON WOODS DRIVE CONCORD, NH 03301

7 Social security tips 10 Dependent care benefits 13 Statutory Employee
Retirement Plan Third-Party sick pay

ENRIQUE POMALES 811 ALTON WOODS DRIVE CONCORD, NH 03301

9 12a Code See inst. for box 12 12b Code 12c Code 12d Code 7 Social security tips 10 Dependent care benefits 13 Statutory Employee
Retirement Plan Third-Party sick pay

8 Allocated tips 11 Nonqualified plans 14 Other

8 Allocated tips 11 Nonqualified plans 14 Other

9 12a Code See inst. for box 12 12b Code 12c Code 12d Code

PRDD

27.00

PRDD

27.00

PR 330714183

74677.58

4020.46

PR 330714183

74677.58

4020.46
17 State income tax 20 Locality name

15 State employers state ID number 16 State wages, tips, etc. 18 Local wages, tips, etc. 19 Local income tax

17 State income tax 20 Locality name

15 State employers state ID number 16 State wages, tips, etc. 18 Local wages, tips, etc. 19 Local income tax

Form W-2 Wage and Tax Statement This information is being furnished to the IRS. If you are required to file a tax return, negligence penalty/other sanction may be imposed on you if this income is taxable and you fail to report it.

Dept. of the Treasury - IRS

Form W-2 Wage and Tax Statement

Dept. of the Treasury - IRS