Case File
efta-01700743DOJ Data Set 10OtherEFTA01700743
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01700743
Pages
3
Persons
0
Integrity
Extracted Text (OCR)
EFTA DisclosureText extracted via OCR from the original document. May contain errors from the scanning process.
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giljeeteser
EFTA01700743
3. Employee W.i4 Profile. To change your Employee W-4 Profile Information, file a new W-4 with your payroll dept.
33404
0 U04 AOTOUATI0 DATA PROCEE411.0.
1
1 Wages, tips, other comp.
175323.09
2 Fedora/ Incometax withheld
29092.14
3 Social security wages
90000.00
4 Social seeunly tax withheld
5580.00
5 Medicare wages and Ups
185323.09
6 Medicare lax withheld
2687.18
•
Control number
0009
66/1314/
Dept
Coop.
Employer use only
19
o Entiloyar's name, alder" and
NES LLC
457 MADISON AVENUE
NEW YORK, NY
MP code
10022
b &WS.
r
0 E
"
:Sn
Ilir—
7 Social security bps
I AS
I
Advance ETC paymeot
to Dependent care Imelda,
11 Nonsitmlified Plana
12 C 1
515.38
14 Other
'lab S I
10000.00
32.40 NYDD
12e
I
is
13 fitatemilflettrl
petty slek py
as Employee's name, *Mimeo and ZIP code
tillaill 33404
IS State
ID no.
NY
16 State wages. tics. We.
175323.09
17 State moome tax
II Local wage:slips. ale.
1
19 Local inmate lax
20 Locally name
i
,tej t .:?..t
la
n;f 1.; 61tt7 C; 3"
•
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---- ' •
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bsEsr.:;lanc:§0111#11
.
itsisaCA
Social Security Number gi p
Taxable Mantel Status:
Exemptions/Allowances:
FEDERAL: 8
STATE:
a
I
Wages. ape. WM/ 00.P.
175323.09
2 Federal income lax Withheld
29092.14
3 Sozdal leeway wages
90000.00
4 Social security tax withheld
5580.00
S lledlearewages and ape
185323.09
6 Medicare tax withheld
2687.18
•
Control numb.
0003
66/TPW
Dept
Coop.
Employer use only
19
o Employers name, Stens, and ZIP code
NES LLC
457 MADISON AVENUE
NEW YORK, NY 10022
it
b Emplaiinistber
d Em
'
r
7 Social security bps
4 Allocated bps
s Advance EC payment
10 Dependent care bowels
it Nonqualified plans
12a
C I
515.38
14 Otter
32.40 NYDD
1fbS I
10000.00
I
lad12e
13 Mal salliagiaarld MS GM It
of Employee's name. address end ZIP code
IIIIIIIIIIL 33404
isfIllsla
'
le ID ma
NY
16 State wages, tips, .e
175323.09
StMe Income W
IS Lodal wages, Ups, at.
II Least beset=
20 Locality name
CS
f raT
I T
07 "ow
rift 14;
17
—P 44:1
•
6.
ba
tit
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•
EFTA01700744
•
Refund. Even if yai do not have to Rea tax return, you
should Re to got a refund if box 2 shows federal income
tax withheld or if you can take the earned income credit.
Earned Income credit (EIC). You must file a tax return if
any amount is shown in box 9.
You may be able to take the EC for 2005 W: (a) you do
not have a qt4ifying child and year earned less than
$11 750 ($13,750 if married fling jointly), lb) you have one
qua .1'412 child and you earnediess than $31 (330 (533,030
mare
fling lantlY), or (c) you have more than one
guarding chid and you earned less than 535253 ($37263
if married Ming j'ointly). You and any qualifying children
must have valid social security numbers -MNs). You
cannot take the EIC if yourinvestment incomes more than
$2/00. Any EIC that is morn than your tax liability is
refunded to you, but only if you file atier return. El ycu
have at least one qualifying dead, you may get as rntr-h as
$1,597 of the EC rn advance b/ completing Form W-5,
Ea rod Income Credit Acvarre Payment Certificate, and
giving it to your empoyer.
Clergy and migious workers. If you are not suited to
Social secur
and Medicare taxes, see publication 517,
Social Security and Dine' Information for Members of the
Clergy and Religious Workers.
Corrections. U your name. SSN, or address is incorrect.
correct Copies 8 C, and 2 and ask your employer to
correct your elloyment record. Be sure to ask the
to fileForm W-2c, Corrected Wage and Tax
Sertnact)Arnt, with the Social Security AdmInietration (SSA) to
correct any name, SSN or money amount error reported to
the SSA on Fonn W-2. If your name and SSN are correct
but are not the same as
own on your Waal Seculty
card you should ask for a new card at any SSA office or
cal 1-800-772-1213.
Credit for excess taxes. If you had more than one
emptioc
Tie
in 2005 and moo than $5580.00 in cooly
sccuri and/or
r I railroad retirement (RFITA) taxes wae
withho , you may be able to claim a credit for the excess
against your federal hcome tax. If you had more than one
railroad employer and more than $2,943.60 in Tree II RRTA
tax was withheld. you also may be able to claim a credit.
See your Form 1040 or Form 1040A instructions and
Pubfcation 505, Tax Withholdirg and Estimated Tax.
Instructions
Box 1. Enter.this acquit on the wages line of your tax
return.
Box 2. Enter ttis amount on the federal income tax
withheld fine of your tax return.
Box 8. This amens Is not included in boxes 1, 3, 5. or 7.
For information on how to report tips on your tax return.
see your Form 1040 instrucbons.
Box 9. Enter his amount on the advance earned Income
credit payments line of you Form 1040 or Form 1040A.
Box 10. This amount is the total dependent care benefits
that your employer paid to you or knosred an our behalf
(including amens from a section 125 (cafeteria) plan).
amount over_
5S,000 also is hcluded in box 1. Yee must
complete Schedule 2 (Form 1040A) or Farm 2441, Chid
and Nporident Cale Evenies, to compute any taxable
and nontaxable amounts.
Box 11. This amount is: (a) reported in box 1 if it is a
distribution made to you from a nonquadfied deferred
compensation Cr nongovernmental section 457(0) plan
(b) InMded in box 3 and/or 5 it m is a pea year deferral
under a nonqualiged cr section 457(b) plan that became
taxeb's for social sexany and Med cam taxes this year
becaµse there is no longer a substantial risk of I
your right to the deferred amount.
Box 12. The following list explains the codes shown In
12. You may need this information to complete your tat
return. Elective deferrals (codes D. E, F. and S) under
or section 403 ) plans if you qualify for the 15-year
are genelly linked to a total of 314.000017
explained in F . 571). Deferrals under code G are fire
to $14,000. Deferrals under code H are kneed to $7
However, if you were at least age 50 in 2005, your
employer may have mowed an additional defend of u
$4.000 ($2,000 for section 401(1)(11) and 408(p) SIM
plans). Ins addtional deferral amount s not subject to
34
overal limit on elective deorrals. For code G the knit 4 _
elective deferrals may be higher for the last three years
•
before you reach retirement age. Contact your plan
• •
administrator to' more information. Frown% In excess
the overall elective deferrer knit must be included Si
income. See the "Wages, Salaries, Tops, etc." line
,r‘
instructions for Form 1040.
mefrt-up pcmicer contribution for a prior
when yt
Note. Ha year foilows code D, E, F, 0, H. or S
maC,
were in miNtary service. To figure whether you made arc
deferrals, consider these arrsounts for The year shown n
the current year lino year is sewn, the contributions ar,
for the anent yea:
A—Uncollected social securitya RRTA tax on bps Include'.
tWs tax on Form 1040. See 'Total Tar in the Form 1040
instructions.
8—Uncollected Medicare lex on Ups. Include this tax of
Form 1040. See "Total Tax" in the Form 1040 ham
0—Taxable cost of group-term fife insurance over
and
011abled in barns 1.3 (up to soda! security wage
51
D--Elective deferrals to a section 401(k) cash or defiant
: arrangement. Also includes deferrals under a SIMPLE'
PatirCl/XIII account that is part of a section 401(1)
arrangement.
E—Elective deferrals under a section 403(0) salary
reduction agreement
F—Elective deferrals under a section 40881(6) salary :
reduction SEP
G—Elective deferrals and employer centributiorts (ache
nonelective deferrals) to a section 4570o) deferred
.
compensation plan
NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDB
Department of the Then, ay • hernal Revenue
Service
This informant:in is being furnished to the Internal
Revenue Set
IMPORTANT NOTE:
In order to enure efficient processing,
attach this W-2 to my tax return like this
(following city or Idol Instructtons):
Department of the litastny - Internal Revenue
Service
This information is being furnished to the Internal
Revenue Service.
IMPORTANT NOTE
In order to insure efficient processeig,
attach this W-2 to your tax return like this
(followhg state Instructions):
TAX RETURN
TAX RETURN
TIM
THIS
FORM
OTHER)
FORM
OTHER
004
was
W-2
W-25
NOTE: THESE ARE SUBSTTTUTE WAGE AND
TM STATEMENTS AND ARE ACCEPTABLE
FOR FIUNG WITH YOUR FEDERAL. STATE AND
LOCAL/CITY INCOME TAX RETURNS.
NOTE THESE ARE SUBSTITUTE WAGE AND
TAX STATEMENTS AND ARE ACCEPTABLE
FOR FIUNG WITH YOUR FEDERAL. STATE ANO
LOCAL/CITY INCOME TM RETURNS.
EFTA01700745
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