Question

DO NOT STAPLE 33333 a Control number For Official Use Only OMB No. 1545-0008 b Kind of Payer (Check one) 941 [x] Military [ ] 943 [ ] 944 [ ] Kind of Employer (Check one) None apply [x] 501c non-govt. [ ] Third-party sick pay (Check if applicable) [ ] CT-1 [ ] Hshld. emp. [ ] Medicare govt. emp. [ ] State/local non-501c [ ] State/local 501c [ ] Federal govt. [ ] c Total number of Forms W-2 [x] d Establishment number 1 Wages, tips, other compensation $ [x] 2 Federal income tax withheld $ [x] e Employer identification number (EIN) 44-4444444 [x] 3 Social security wages $ [x] 4 Social security tax withheld $ [x] f Employer's name [x] 5 Medicare wages and tips $ [x] 6 Medicare tax withheld $ [x] 7 Social security tips $ [x] 8 Allocated tips $ 9 [x] 10 Dependent care benefits $ g Employer's address and ZIP code 11 Nonqualified plans 12a Deferred compensation $ [x] h Other EIN used this year 13 For third-party sick pay use only 12b 15 State [x] Employer's state ID number [x] 14 Income tax withheld by payer of third-party sick pay 16 State wages, tips, etc. $ [x] 17 State income tax $ [x] 18 Local wages, tips, etc. $ 19 Local income tax $ Employer's contact person [x] Employer's telephone number [x] For Official Use Only Employer's fax number [x] Employer's email address Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete. Signature Michael Sierra Title [x] Date 01/31/2022

          DO NOT STAPLE
33333
a Control number
For Official Use Only
OMB No. 1545-0008
b Kind of Payer (Check one)
941 [x]
Military [ ]
943 [ ]
944 [ ]
Kind of Employer (Check one)
None apply [x]
501c non-govt. [ ]
Third-party sick pay (Check if applicable) [ ]
CT-1 [ ]
Hshld. emp. [ ]
Medicare govt. emp. [ ]
State/local non-501c [ ]
State/local 501c [ ]
Federal govt. [ ]
c Total number of Forms W-2 [x]
d Establishment number
1 Wages, tips, other compensation $ [x]
2 Federal income tax withheld $ [x]
e Employer identification number (EIN) 44-4444444 [x]
3 Social security wages $ [x]
4 Social security tax withheld $ [x]
f Employer's name [x]
5 Medicare wages and tips $ [x]
6 Medicare tax withheld $ [x]
7 Social security tips $ [x]
8 Allocated tips $
9 [x]
10 Dependent care benefits $
g Employer's address and ZIP code
11 Nonqualified plans
12a Deferred compensation $ [x]
h Other EIN used this year
13 For third-party sick pay use only
12b
15 State [x]
Employer's state ID number [x]
14 Income tax withheld by payer of third-party sick pay
16 State wages, tips, etc. $ [x]
17 State income tax $ [x]
18 Local wages, tips, etc. $
19 Local income tax $
Employer's contact person [x]
Employer's telephone number [x]
For Official Use Only
Employer's fax number [x]
Employer's email address
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature Michael Sierra
Title
[x]
Date 01/31/2022

DO NOT STAPLE
33333
a Control number
For Official Use Only
OMB No. 1545-0008
b Kind of Payer (Check one)
941 [x]
Military [ ]
943 [ ]
944 [ ]
Kind of Employer (Check one)
None apply [x]
501c non-govt. [ ]
Third-party sick pay (Check if applicable) [ ]
CT-1 [ ]
Hshld. emp. [ ]
Medicare govt. emp. [ ]
State/local non-501c [ ]
State/local 501c [ ]
Federal govt. [ ]
c Total number of Forms W-2 [x]
d Establishment number
1 Wages, tips, other compensation [x]
2 Federal income tax withheld [x]
e Employer identification number (EIN) 44-4444444 [x]
3 Social security wages [x]
4 Social security tax withheld [x]
f Employer's name [x]
5 Medicare wages and tips [x]
6 Medicare tax withheld [x]
7 Social security tips [x]
8 Allocated tips
9 [x]
10 Dependent care benefits g Employer's address and ZIP code
11 Nonqualified plans
12a Deferred compensation [x]
h Other EIN used this year
13 For third-party sick pay use only
12b
15 State [x]
Employer's state ID number [x]
14 Income tax withheld by payer of third-party sick pay
16 State wages, tips, etc. [x]
17 State income tax [x]
18 Local wages, tips, etc. 19 Local income tax
Employer's contact person [x]
Employer's telephone number [x]
For Official Use Only
Employer's fax number [x]
Employer's email address
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature Michael Sierra
Title
[x]
Date 01/31/2022

Added by Jose Ramon P.

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