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5 Employee's correct SSN 6 Employer's SSA number 7 Employer's a EIN 8 Employer's state |.D. number

& Employee's name, addvess, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the fest form you
filed, Show incorrect item here

> [11 Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

Item

(a) As Previously Reported

(b) Correct Information

13 Social security wage

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp.

| 17 Federal income tax withneld

1

Allocated tips

19

CHANGES

20. Gross annuity, ete. (W-2P)

21 Taxable amount (W-2P)

22

(c) Increase (decrease)-(b) less (a)

State wages

23

State tax withheld

24

Local wages

25

Local tax withheld

Form

Copy B to be filed with employee's FEDERAL tax return

W-2c (Rev. 10:85) Statement of Corrected Income and Tax Amounts

Department of the Treasury
Internal Revenue Service

1 Year being corrected

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5 Employee's correct SSN

6 Employer's SSA number

7 Employer's Federal EIN

8 Employer's state I.D. number

‘9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the last form you
filed. Show incorrect item here

Ti Employee's incorrect SSN

»

12 Employee's name (as incorrectly shown on previous form)

Item

(a) As Previously Reported

(b) Correct Information

(c) Increase (decré

13 Social security wages

14 Social security tips

15

Social security tax withheld

Wages, tips, other comp.

Federal income tax withheld

Allocated tips

CHANGES

Gross annuity, etc. (W-21

P)

Taxable amount (W-2?)

State wages
State tax withheld

Local wages

Local tax withheld

Form

Copy B to be filed with employee's FEDERAL tax return

W-2c (Rev. 10-85) Statement of Corrected Income and Tax Amounts

Department of the Treasury
Internal Revenue Service





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5 Employee's correct SSN

6 Employer's SSA number

7 Employer's Federal EIN

‘9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if

11 Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

& Employer's state I.D. number

incorrect on the last form you
filed. Show incorrect item here

U

Item

(a) As Previously Reported

(b) Correct Information

(c) Increase (decrease)-(b) less (a)

13 Social security wages

14 Social security tips

15 Social security tax withheld

16 Wages. tins, other comp,

17 Federal income tax withhelc

18 Allocated tips

19

CHANGES

20 Gross annuity, ete. (W-2P)

21 Taxabie amount (W. 2p)

| 22. State wages

23. State tax withheld

24 Local wages

25 Local tax withheld

Form W-2c (Rev. 10:85) Statement of Corrected Income and Tax Amounts

Copy C for employee's records

Department of the Treasury
Internal Revenue Service

1 Year being corrected 2 Employer's use

3 Form: [] W2 OO w.2as

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OMB No. 1545-0008
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5 Employee's correct SSN 6 Employer's SSA

number 7 Employer's Federal EIN

'8 Employer's state I.D. number

9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the last form you
filed. Show incorrect item here

11 Employee's incorrect SSN

12 Employee's name (as Incorrectly shown on previous form)

Item

(a) As Previously Reported

(b) Correct Information

(¢) Increase (decrease)-(b) less (a)

13 Social security wages

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp.

17 Federal income tax withheld

18 Allocated tips

19

CHANGES

20. Gross annuity. etc. (W-2P)

21 Taxable amount (W-2P)

22 State wages

23. State tax withheld

24 Local wages

25. Local tax withheld

Form

W-2c (Rev. 10-85) Statement of Corrected Income and Tax Amounts

Copy C for employee's records

Department of the Treasury
Internal Revenue Service





1 Year being corrected 2 Employer's use

19
3 Form: [] w2 1 weeas
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5 Employee's correct SSN 6 Employer's SSA number

7 canoer EIN [8 Employer's state |.D. number

9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the last form you
filed. Show incorrect item here

11 Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

Item (a) As Previously Reported

(b) Correct Information (c) Increase (decrease)-(b) less (a)

3. Social security wages

Social security tips

Social security tax withheld

Wages, tips, other comp.

Federal income tax withheld

Allocated tips

CHANGES

Gross annuity, etc. (W-2P)

Taxable amount (W-2P)

State wages

State tax withheld

Local wages

Local tax withheld

Form W-2c (Rev. 10:85) Statement of Corrected Income and Tax Amounts

y 2 to be filed with employee's state,
city, or local income tax return

Department of the Treasury
Internal Revenue Service

T Year being corrected 2 Employer's use
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3 Form: C] w2 Ol was 4 Stato Oted employee KER! Pédvemp. | OMBNo. 1545-0008
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5 Employee's correct SSN 6 Empioyer's SSA number

7 Employer's Federal EIN ‘8 Employer's state .0. number

‘9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
Incorrect on the last form you
filed. Show incorrect item here

11 Employee's incorrect SSN

U

12 Employee's name (as incorrectly shown on previous form)

Item (a) As Previously Reported

(b) Correct Information (c) Increase (decr

sse)-(b) less (a)

13 Social security wages

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp.

17. Federal income tax withheld

18 Allocated tips

19

CHANGES

20 Gross annuity, etc. (W-2P)

21 Taxable amount (W-2P)

22 State wages

23. State tax withheld |

24 Local wages

25 Local tax withheld

Form

W-2c (Rev. 10-85) Statement of Corrected Income and Tax Amounts

Copy 2 to be filed with employee's state,
city, or local income tax return
Department ofthe Treasury
Internal Revenue Service



T Year being corrected

19___

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Use Only >

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'5 Employee's correct SSN

6 Employer's SSA number

7 Employer's Federal EIN

& Employer's state I.D. number

‘9 Employee's name, address.

‘and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the last form you

filed. Show incorrect item here

11 Employee's incorrect SSN

D

12 Employee's rame (as incorrectly shown on previous form)

ttem

(a) As Previously Reported

(b) Correct Information

(c) Increase (decrease)-(b) less (a)

CHANGES

13 Social security wages

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp.

17. Federal income tax withheld

18 Allocated tips

19 *

20. Gross annuity, etc. (W-2P)

2

Taxable amount (W-2P)

22 State wages

23. State tax withheld

24 Local wages

25 Local tax withheld

*See instructions. For Paperwork Reduction Act Notice, see back of Copy D.

Form W-2¢ (Rev. 10-85) Statement of Corrected Income and Tax Amounts

Copy A for Social Security Administration

Department of the Treasury
Internal Revenue Service

1 Year being corrected

19

2 Employer's use

For Official

Use Oniy >

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employee

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'5 Employee's correct SSN

6 Employer's SSA number

7 Employer's Federal EIN

‘8 Employer's state |.0. number

9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the last form you
filed, Show incorrect item here

D

11 Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

Item

(a) As Previously Reported

(b) Correct Information

13 Social security wages

Social security tips

Social security tax withheld

Wages, tips, other comp.

Federal income tax withheld

Allocated tips

19 *

Gross annuity, etc. (W-2P)

CHANGES

Taxable amount (W-2P)

State wages

x
8

State tax withheld

Local wages

25. Local tax withheld

See instructions. For Paperwork Reduction Act Notice, see back of Copy D.

Form W-2¢ (Rev. 10:85) Statement of Corrected Income and Tax Amounts

() Increase (decrease)-(b) less (a)

Copy A for Social Security Administration

Department of the Treasury
Internal Revenue Service



Instructions for Preparing Form W-2c

Purpose of Form.—Form W-2c is used by an employer (or
other payer, in the case of Form W-2P) to correct errors in
previously filed Forms W-2, W-2P, W-2AS, W-2GU, or W-2VI.
Use a separate Form W-3c, Transmittal of Corrected Income
and Tax Statements, to transmit each type of form shown in
item 3. Section 218 filers (certain state and local
governmental employers) must use Form SSA-3964, State's
Report of Adjustments, for years before 1982

Where to File.—Copy A of Form W-2c should be filed with
the Social Security Administration. Correct addresses are on
the back of Form W-3c. File the remaining copies of W-2c as
noted on the bottom of each form

How to Complete Form W-2c.—For descriptions of
individual items, see the instructions for Forms W-2 and
W-2P. Complete items 1-10 as applicable. For items 11-25
(Changes) complete only those items that are being
corrected. Otherwise leave blank.

Always use a Form W-3c to send more than one Form
W-2c. A single Form W-2c may be submitted without a Form
W-3c. (Note: Section 218 filers must always submit a Form
W-3c.)

On any line that shows a dollar change, and one of the
amounts Is zero, enter ‘‘zero”’ or ‘'0''—do not leave blank.

Negative amounts in column (c) (decreases) must be
bracketed.

Specific Instructions

Item 2—Employer’s use.—This is an optional item which
employers may use to identify individual forms.

Instructions for Preparing Form W-2c

Purpose of Form.—Form W-2c is used by an employer (or
other payer, in the case of Form W-2P) to correct errors in
previously filed Forms W-2, W-2P, W-2AS, W-2GU, or W-2VI
Use a separate Form W-3c, Transmittal of Corrected Income
and Tax Statements, to transmit each type of form shown in
item 3. Section 218 filers (certain state and local
governmental employers) must use Form SSA-3964, State's
Report of Adjustments, for years before 1982.

Where to File.—Copy A of Form W-2c should be filed with
the Social Security Administration. Correct addresses are on
the back of Form W-3c, File the remaining copies of W-2c as
noted on the bottom of each form

How to Complete Form W-2c.—For descriptions of
individual items, see the instructions for Forms W-2 and
W-2P. Complete items 1-10 as applicable. For items 11-25
(Changes) complete only those items that are being
corrected. Otherwise leave blank.

Always use a Form W-3c to send more than one Form
W-2c. A single Form W-2c may be submitted without a Form
W-3c. (Note: Section 218 filers must always submit a Form
W-3c.)

On any line that shows a dollar change, and one of the
amounts is zero, enter ‘‘zero’’ or '0''—do not leave blank.

Negative amounts in column (c) (decreases) must be
bracketed.

Specific Instructions

item 2—Employer's use.—This Is an optional item which
employers may use to identify individual forms.

item 6—Employer's SSA number.—This is a number
beginning with '“69-” that is assigned to certain state or
local governmental employers. Also add the L indicator,
coverage group and/or PRU number, if these have been
assigned fo you by SSA

Item 8—Employer’s state I.D. number.—You are not
required to complete this item. This number is assigned by
the individual states. You may want to complete this item if
you use copies of this form for your state returns.

Items 11 and 12.—Complete items 11 and/or 12 only if you
wish to correct an employee's SSN or name. If the previously
reported money amounts were correct, you do not need to
enter them on Form W-2c.

Item 19 .—Use this line to correct the amount of taxable
fringe benefits shown in Box 16 of Form W-2, the advance
earned income credit payment shown in Box 7 of Form W-2,
or the IRA code shown in Box 14 of Form W-2P. Be sure to
label the item as “Fringe benefits,” “Advance EIC payment,”
or “IRA code.”

Items 22 through 25—State or local data.—If your ONLY
changes to the original W-2 are to state or local data, DO
NOT send the W-2c to SSA or your State Social Security
Administrator.

Paperwork Reduction Act Notice.—We ask for this
information to carry out the Internal Revenue and Social
Security laws of the United States. We need it to ensure that
taxpayers are complying with these laws and so that we can
figure and collect the right amount of tax. You are required to
give us this information.

item 6—Employer's SSA number. —This is a number
beginning with '"69- that is assigned to certain state or
local governmental employers. Also add the L indicator,
coverage group and/or PRU number, if these have been
assigned to you by SSA

item 8—Employer's state 1.0. number.—You are not
required to complete this item. This number is assigned by
the individual states. You may want to complete this item if
you use copies of this form for your state returns.

Items 11 and 12.—Complete iterns 11 and/or 12 only if you
wish to correct an employee's SSN or name. If the previously
reported money amounts were correct, you do not need to
enter them on Form W-2c

tem 19 .—Use this line to correct the amount of taxable
fringe benefits shown in Box 16 of Form W-2, the advance
earned income credit payment shown in Box 7 of Form W-2,
or the IRA code shown in Box 14 of Form W-2P. Be sure to
label the item as “Fringe benefits,” “Advance EIC payment,”
or “IRA code.”’

items 22 through 25—State or local data.—If your ONLY
changes to the original W-2 are to state or local data, DO
NOT send the W-2c to SSA or your State Social Security
Administrator.

Paperwork Reduction Act Notice.—We ask for this
information to carry out the Internal Revenue and Social
Security laws of the United States. We need it to ensure that
taxpayers are complying with these laws and so that we can
figure and collect the right amount of tax. You are required to
give us this information.


1 Year being corrected T 2 Employer's use
19___ H
Fe 4 Statut k r
3 Fon [we OF Weas SHEE ceded employee MEP! AUG TAIS. | OMB No, 1545-0008
O we 1 w2cu O wav Expires 6-30-88

5 Employee's correct SSN

6 Employer's SSA number

69-

7 Employer's Federal EIN

8 Employer's state I.D. number

9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Compiete 11 and/or 12 only if
incorrect on the last form you
filed. Show incorrect item here

U

11 Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

Item

(a) As Previously Reported

(b) Correct Information

(c) Increase (decrease)-(b) less (a)

13 Social security wages

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp.

17 Federal income tax withheld

18 Allocated tips

19

CHANGES

20 Gross annuity, etc. (W-2P)

21 Taxable amount (W-2P)

22. State wages

23. State tax withheld

24 Local wages

25

Local tax withheld I

Form W-2¢ (Rev. 10-85) Statement of Corrected Income and Tax Amounts

Copy D for employer

Department of the Treasury
Internal Revenue Service

1 Year being corrected 2 Employer's use
[ ' ; 4 Statut
3 fom [we (] wens SHE es orb MER Mts | Quan eros
O wep O weeu O wevi Expires 6-30-88

'5 Employee's correct SSN

6 Employer's SSA number

7 Employer's waa EIN

8 Employer's state |.0. number

9 Employee's name, adcress, and ZIP code

10 Employer's name, address, and ZIP

code

Complete 11 and/or 12 only if
incorrect on the last form you
filed. Show incorrect item here

U

T1 Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

Item

(a) As Previously Reported

(b) Correct Information

(c) Increase (decrease)-(b) less (a)

13 Social security wages

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp.

17 Federal income tax withheld

18 Allocated tips

19

CHANGES

20 Gross annuity, etc. (W-2P)

21 Taxable amount (W-2P)

22. State wages

23. State tax withheld

24 Local wages

25. Local tax withheld

Form

W-2c (rev. 10-85) Statement of Corrected Income and Tax Amounts

Copy D for employer

Department of the Treasury
Internal Revenue Service



Notice to Employee:

This is a corrected version of the W-2 form checkec
in item 3. If you have aiready filed a tax return for the
year shown in item 1, you may have to file an amended
return if any of the corrections change your tax liability
for that year, Contact the Internal Revenue Sen

other taxing authority i tire case of Form W-2AS,
W-2GU, or W-2V1) for further information.

When you file your retuin, attach this corrected
statement with the oi If you have already
filed a return, attach this W-2c to your amendes
return,

Notice to Employee:

This is a corrected version of the W-2 form checked
in item 3. If you have already filed a tax return for the
year shown in item 1, you may have to file an amended
return if any of the corrections change your tax liability
for that year. Contact the Internal Revenue Service (or

other taxing authority in the case of Form W-2AS,
W-2GU, or W-2V3) for fu nformation

When you file your return, attach this corrected
statement with the origina/ W-2. \f you have already
filed a return, attach this W-2c to your amended
return





1 Year being corrected

2 Employer's use

19_
4 Statyte De 942 Legal ic
3 Form [) w2 CO w2as SON Sea empisvee HET Mesicare
Ol wee Ol weeu O wv Oo o oO oO oO

OMB No. 1545-0008
Expires 6-30-88

5 Employee's correct SSN

6 Employer's SSA number

7 Employer's Federal EIN

8 Employer's state |.D. number

9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the last form you
filed. Show incorrect item here

11 Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

Item

(a) As Previously Reported

(b) Correct Information

(c) Increase (decrease)-(b) less (a)

13 Social security wages

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp.

17 Federal income tax withheld

1B Allocated tips

19

CHANGES

20 Gross annuity, etc. (W-2P)

2:

Taxable amount (W-2P)

22. State wages

23. State tax withheld

24 Local wages

25. Local tax withheld

Copy 1 for state, city, or local tax department

Form W-2c (Rev. 10-85) Statement of Corrected Income and Tax Amounts

Department of the Treasury
Internal Revenue Service

1 Year being corrected 2 Employer's use
19__
4 Si De- ‘942 r
3 Form: [] W2 CO weas SHER Bea enbivee RS" MERE | oma no. 1545-0008
Owe Owe O wav Oo oF oF 4 Expires 6-30-88,

'5 Employee's correct SSN

6 Employer's SSA number

7 Employer's Federal EIN

8 Employer's state |.D. number

9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

Complete 11 and/or 12 only if
incorrect on the last form you
filed. Show incorrect item here

U

TI Employee's incorrect SSN

12 Employee's name (as incorrectly shown on previous form)

Item

(@) As Previously Reported

(b) Correct Information

13 Social security wages

[(©) Increase (decrease)-(b) less (a)

14 Social security tips

15 Social security tax withheld

16 Wages, tips, other comp,

17 Federal income tax withheld

1

Allocated tips

19

CHANGES

20 Gross annuity, etc. (W-2?)

21 Taxable amount (W-2P)

22. State wages

23. State tax withheld

24 Local wages

| 25. Local tax withheld

Copy 1 for state, city, or local tax department

Form W-2¢ (Rev. 10:85) Statement of Corrected Income and Tax Amounts

Department of the Treasury
Internal Revenue Service