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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
69-

9 Employee's name, address, and ZIP code

10 Employer's name, address, and ZIP code

incorrect on the last form you

Complete 11 and/or 12 only if

filed. Show incorrect item here

11 Employee's incorrect SSN

2

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

CHANGES

Item

(@) As Previously Reported

(b) Correct Information

(©) Increase (decrease)-(b) less (a)

13

Social security wages

14

Social security tips

Social security tax withheld

Wages, tips, other comp.

Federal income tax withheld

Allocated tips

Gross annuity, etc. (W-2P)

Taxable amount (W-2P)

State wages

State tax withheld

Local wages

Local tax withheld

Copy B to be filed with employ.

Form W-2c¢ (Rev. 11-87) Statement of Corrected Income and Tax Amounts

's FEDERAL tax return

Department of the Treasury
Internal Revenue Service

1 Year being corrected

19

2 Employer's use

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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

D

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

CHANGES

Item

(2) 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

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

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

Form W-2c (Rev. 11.87) Statement of Corrected Income and Tax Amounts

Department of the Treasury
Internal Revenue Service





1 Year being corrected

2 Employer's use

3 Form: [] w-2
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5 Employee's correct SSN

6 Employer's SSA number

7 Crew re

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

11 Employee's incorrect SSN

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

8 Employer's state 1.0. number

filed. Show incorrect item here

U

CHANGES

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

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-2¢ (Rev. 11-87) Statement of Corrected Income and Tax Amounts

Copy C for employee's records

Department of the Treasury
Internal Revenue Service

T Year being corrected 2 Employers use
19___

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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

T1 Employee's incorrect SSN

D

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

CHANGES

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

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-2¢ (Rev. 11-87) Statement of Corrected Income and Tax Amounts

Copy C for employee's records

Department ofthe Treasury
Internal Revenue Service





1 Year being corrected 2 Employer's use

19___

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'5 Employee's correct SSN 6 Employer's SSA number 7 Employer's Federal EIN ‘8 Employer's state ILD. number
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)

incorrect on the last form you

filed. Show incorrect item here

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

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

Department of the Treasury

Form W-2¢ (Rev. 11-87) Statement of Corrected Income and Tax Amounts Internal Revenue Service
1 Year being corrected 2 Employer's use
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3 Form: [] w2 Dy weas  [) Wenn) 4 erp. ceased lan ep emp. comp. govi-sinp.| OMBNo, 1645-0008

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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 11 Employee's incorrect SSN 12 Employee's name (as incorrectly shown on previous form)
incorrect on the last form you
filed, Show incorrect item here

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

[20 Gross annuity, ete. (W-2P)
21_Taxable amount (W-2P)

22 State wages

23> State tax withheld

CHANGES

24 Local wages
25 Local tax withheld

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

Department ofthe Treasu
Form W-2c (Rev. 11:87) Statement of Corrected Income and Tax Amounts Interna Revenue Serie



9 [77 Year being corrected 2 Employer's use For Official
3 Use Only >
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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)
incorrect on the last form you
filed. Show incorrect item here
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.
Q |17_ Federal income tax withheld
© 18 Allocated tips
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—qji9*
J | 20. Gross annuity, ete. (W-2P)
21 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. Copy A for Social Security Administration
Department of the Treasury
Form W-2€ (Rev. 11-87) Statement of Corrected Income and Tax Amounts Internal Revenue Service
S| 1 Year being corrected 2 Employer's use For Official
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= \-

‘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

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

3

24 Local wages

25 Local tax withheld

g

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

Form W-2¢ (Rev. 11-87) Statement of Corrected Income and Tax Amounts

‘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 1s 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, W-2NMI,
or W-2VI. Use a separate Form W-3c, Transmittal of
Corrected Income and Tax Statements, to transmit Forms
W-2c for each type of form shown in item 3, Section 218
filers (certain state and local governmental employers)
should follow the instructions received from their State
Social Security Administrator in preparing corrections for
years before 1987

Asingle Form W-2c may be submitted without a Form
W-3c, When making corrections for more than one
employee, however, you must use a Form W-3c unless the
forms are only correcting the employees’ names or social
security numbers (SSN).
Where to File.—Copy A of Form W-2c should be filed with
the Social Security Administration (SSA). 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

If any line shows a dollar change, and one of the amounts
's 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 |s an optional item that
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, W-2NMI,
or W-2VI. Use a separate Form W-3c, Transmittal of
Corrected Income and Tax Statements, to transmit Forms
W.-2c for each type of form shown in item 3. Section 218
filers (certain state and local governmental employers)
should follow the instructions received from their State
Social Security Administrator in preparing corrections for
years before 1987

Asingle Form W-2c may be submitted without a Form
W-3c, When making corrections for more than one
employee, however, you must use a Form W-3c unless the
forms are only correcting the employees’ names or social
security numbers (SSN).
Where to File.—Copy A of Form W-2c should be filed with
the Social Security Administration (SSA). 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.

If any line 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 1s an optional item that
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 for use for years before 1987
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 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 or deferred compensation shown in Box 16 of
Form W-2, the advance earned income credit payment
shown in Box 7 of Form W-2, or the distribution code shown
in Box 14 of Form W-2P. Be sure to label the item as “Fringe
benefits,” the deferred compensation code section,
“Advance EIC payment,” or “‘Distribution 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

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 for use for years before 1987.
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.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 or deferred compensation shown in Box 16 of
Form W-2, the advance earned income credit payment
shown in Box 7 of Form W-2, or the distribution code shown
in Box 14 of Form W-2P. Be sure to label the item as “Fringe
benefits,” the deferred compensation code section,
“Advance EIC payment,” or ‘'Distribution 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.

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

2 Employer's use

3 Form: [] w-2
O w2e

O weas [) w2nmi
OO weeu

4 Stat.

O wevi

De- Pension Legal
emp.ceased plan rep.

942 Def'd. Medicare

emp. comp. gov't-emp.

OMB No. 1545-0008
Expires: 10-31-90

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

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

13

Social security wages

14

Social security tips

15

Social security tax withheld

16

Wages, tips, other comp.

7

Federal income tax withheld

Allocated tips

19

20

CHANGES

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-2¢ (Rev. 11-87) Statement of Corrected Income and Tax Amounts

Copy D for employer

Department ofthe Treasury
Internal Revenue Service

T Year being corrected 2 Employer's use
19___
7 Lf PB ie 4 Stat. - 4 fd. Me

3 fom CJ we] wens] wanw | 438i Ge. Paison ee Sip. ane gOvE ap | OMB No, 2545-9008
O wep O weeu J wav o Expires: 10-31-90

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, a

nd 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

20

CHANGES

Gross annuity, etc. (W-2P)

2)

Taxable amount (W-2P)

22

State wages

23

State tax withheld

24

Local wages

Local tax withheld

Form W-2¢ (Rev. 11-87) 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 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, W-2NMI, or W-2VI) for further information.

When you file your return, attach this corrected
statement with the original W-2. If you have already
filed a return, attach this W-2c to your amended
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, W-2NMI, or W-2VI) for further information.

When you file your return, attach this corrected
statement with the original W-2. If you have already
filed a return, attach this W-2c to your amended
return.




T Year being corrected 2 Employer's use
19___

3 Form: [] we C1 was DWN | ee ae eso tage oer Cama, Eve mp.| OMB No. 1545-0008
O wap O weeu  wavi oO o ogo o Expires: 10-31-90

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

11 Employee's incorrect SSN

D

filed. Show incorrect item here

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

CHANGES

(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

20

Gross annuity, ete. (W-2P)

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-2c (Rev. 11-87) Statement of Corrected Income and Tax Amounts

Department ofthe Treasury
Internal Revenue Service

1 Year being corrected 2 Employer's use
19__

3 Form: [] We Co wens [) w-2nni | 4 Stat: De. (Pension Lega ee Osmo: gavtiane.| OMB No, 1645-0008
Oo we O wee §] wav oo ee eye | Expires: 10-31-90

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)

CHANGES

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

20

Gross annuity, ete. (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. 11.87) Statement of Corrected Income and Tax Amounts

Department of the Treasury
Internal Revenue Service